Is abnormal non-high-density lipoprotein cholesterol a gender-specific predictor for metabolic syndrome in patients with schizophrenia taking second-generation antipsychotics?

Evidence supports an association between metabolic syndrome (MetS) and schizophrenia. However, specific risk factors for MetS and gender differences in patients with schizophrenia taking second-generation antipsychotics (SGAs) have not been well explored. A cross-sectional cohort of 329 Han Chinese patients was recruited in a psychiatric hospital in central Taiwan. Using the definitions of the International Diabetes Federation for Chinese, the prevalence of MetS was 23.7% (men: 25.7%; women: 21.2%). Logistic regression analyses showed that patients with a BMI ≥ 24 and an abnormal non-high-density lipoprotein cholesterol (non-HDL-C) were significantly (p < 0.001) more likely to develop MetS. A BMI ≥ 24 was a significant risk factor in men (OR: 6.092, p < 0.001) and women (OR: 5.886, p < 0.001). An abnormal non-HDL-C was a significant specific risk factor for men with MetS (OR: 4.127, p < 0.001), but not for women. This study supports a greater prevalence of MetS in patients with schizophrenia taking SGAs than in the general population. Abnormal BMI and non-HDL-C were significantly associated with developing MetS, and an abnormal non-HDL-C was a specific risk factor for men. Future development of specific interventions and regular monitoring for MetS is imperative for early identification and prevention.

[The effectiveness of far-infrared therapy in hemodialysis patients with arteriovenous fistula: a systematic review]

BACKGROUND

Over 85% of end-stage renal disease (ESRD) patients receive hemodialysis and 80% of hemodialysis patients in Taiwan contract arteriovenous fistula (AVF). Studies have shown that using far infrared therapy (FIR) improves AVF by improving blood flow. However, the systematic literature reviews have been insufficient to make definite conclusions regarding the effectiveness of this intervention.

PURPOSE

This paper uses a systematic review of the literature to evaluate the FIR intervention and to explore its effectiveness.

METHODS

Researchers searched the following five Chinese and English electronic databases for relevant articles: National Dissertations and Theses, Airiti Library, CINAHL, Cochrane Library, ProQuest, and PubMed/MEDLINE. Keywords including "far infrared therapy", "arteriovenous fistula", and "hemodialysis" were entered. The search was limited to articles published before February 2014. A total of 98 articles that matched the search criteria were extracted. Article topics were screened and repetitions of topics were removed. Three articles met the study inclusion criteria and were selected for further analysis. An assessment of the quality of these 3 studies using the Modified Jadad Scale earned a score of 3.

RESULTS

Findings of this systematic review show that FIR interventions improve blood flow to and from the AVF and that the intervention decreases AVF malfunctioning. Currently, literature on this topic is limited in Taiwan. Therefore, more evidence is needed to validate the findings of the current study.

CONCLUSIONS / IMPLICATIONS FOR PRACTICE

The results of the current study support the ability of patients with FIR to improve their AVF functions as well as the immediate clinical applicability of the suggested intervention. Although current empirical evidence supports the effectiveness of gripping a ball in maintaining AVF functions, many hemodialysis patients, due to age or illness, are not physically capable of doing this exercise. Therefore, FIR is a very good alternative measure.

The effects of tai chi exercise on elders with osteoarthritis: a longitudinal study

PURPOSE

Tai Chi exercise has been proven to be beneficial among elders with osteoarthritis (OA). The long-term effects of this exercise remain unclear. The purpose of this study was to evaluate the effects of the Tai Chi exercise for Arthritis (TCEA) program on the physical status and quality of life of OA elders.

METHODS

This was a time series study with one group design. Subjects diagnosed with OA of the lower extremities, aged 60 years or over, were recruited from an outpatient clinic at a community teaching hospital. Thirteen participants joined a TCEA exercise class three times per week for 2 years. Physical status including body mass index (BMI), lean body mass, hand grasp strength, flexibility, and equilibrium were measured four times-at baseline, 3 months, 1 year, and 2 years of the TCEA exercise class. Quality of life was also measured at these time points.

RESULTS

Lean body mass was significantly decreased within the study period (p < .05). Participants experienced significant improvements in physical functioning, role limitations, and social functioning on the dimensions of quality of life (SF-36) (p < .05).

CONCLUSION

Elderly people with OA should be encouraged to exercise using Tai Chi for maintaining physical function and improving quality of life.

[Exploring the lived experiences of middle-aged males diagnosed with chronic kidney disease]

BACKGROUND

The majority of studies addressing chronic kidney disease (CKD) have been quantitative. The lived experiences of patients with early stage CKD have not been explored in the literature. Due to the lack of symptoms during the early stages of CKD, the progress of this disease is often ignored.

PURPOSE

This study explores the lived experiences of middle-aged males diagnosed with CKD. Research focuses on the work experiences, interpersonal relationships, and dietary habits of this group.

METHODS

This qualitative study used a narrative research method with purposive sampling. Ten middle-aged male patients were interviewed. We employed the 3 strategies of member checks, peer review, and debriefing in order to enhance the trustworthiness of the data analysis.

RESULTS

Four major themes were identified: (1) keeping the same life pace as usual with concerns of deterioration; (2) continuing to support their family and play the role of father; (3) hoping to participate in family and friend relationships despite the illness; and (4) being challenged to maintain a healthy diet.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Although the physical status of participants was similar to the general middle-aged adult population, participants were concerned regarding disease deterioration. The results of this study suggest that health professionals: (1) provide appropriate information based on patients' personality, particularly at the first onset or apparent deterioration of the disease; (2) offer specialized healthcare information to patients relevant to their career choices; and (3) understand CKD-patient difficulties in daily life such as eating out habits and challenges faced in maintaining a healthy diet. Results may provide important information to healthcare providers in education planning and implementation and support programs for patients and families.

Assessing the toxicity and associated costs among pediatric patients admitted with unintentional poisonings of attention-deficit/hyperactivity disorder drugs in the United States

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is widespread, with a national (United States) prevalence of nearly 10%. The 2011 changes in the diagnostic criteria will likely further increase the prevalence of this disorder. Little is known about the incidence of toxicity from unintentional poisonings of ADHD medications. This study attempted to determine the incidence of these ingestions and the corresponding financial impact in the United States.

METHODS

Four geographically different centers were chosen. Subjects with unintentional poisonings due to ADHD medications were included if the admission dates were between 2000 and 2002 (cohort A) or between 2009 and 2010 (cohort B). Using data from the participating hospitals and the number of monitored beds in each corresponding county, data were extrapolated on a national (United States) level.

RESULTS

Sixty-three subjects were admitted at four hospitals (18, cohort A and 45, cohort B). The crude incidence rate ratio increased in the later time frame as compared to that in the earlier time frame (incidence rate ratio, 3.13; 95% CI, 1.80-5.68; p < 0.0001). The median (IQR) charges per patient, adjusted for inflation, were $4780 ($3,895-$8,287) and $5912 ($3,432-$9,433) for cohorts A and B, respectively (p = 0.57). If the subjects in the participating counties were only admitted to the participating hospitals, the annual charges, extrapolated throughout the United States for the two periods, would be $2,419,016 and $8,129,538, respectively. If the subjects were evenly distributed across all pediatric monitored beds in a given county, the annual charges extrapolated throughout the United States for the two periods would be $5,694,232 and $24,126,640, respectively.

CONCLUSION

The incidence of unintentional poisonings from ADHD drugs is increasing and is associated with a significant cost.

Effects of targeted interventions on lifestyle modifications of chronic kidney disease patients: randomized controlled trial

Targeting interventions to an individual's readiness to modify lifestyle factors, specifically diet and exercise behaviors, may delay chronic kidney disease (CKD) progression. This study examined the effects of a targeted Lifestyle Modification Program based on the readiness to change health-promotion lifestyle behaviors, renal protection knowledge, and physical indicators of patients with early CKD. A repeated-measures design randomized 160 CKD patients from four southern Taiwan outpatient nephrology clinics into control and intervention groups. Data were collected five times over a year with a participant retention rate of 64.4%. The intervention group demonstrated significant improvement with regard to diet behavior modifications. Compared with the control group, the intervention group showed a significant improving trend of renal function protection knowledge, stress management, and interpersonal relations. Targeted interventions for patients in the early phases of CKD promotes adherence to proper diet, exercise behavior, and positive lifestyle modifications.

Proarrhythmic safety of repeat doses of mirabegron in healthy subjects: a randomized, double-blind, placebo-, and active-controlled thorough QT study

Potential effects of the selective β(3)-adrenoceptor agonist mirabegron on cardiac repolarization were studied in healthy subjects. The four-arm, parallel, two-way crossover study was double-blind and placebo- and active (moxifloxacin)-controlled. After 2 baseline ECG days, subjects were randomized to one of eight treatment sequences (22 females and 22 males per sequence) of placebo crossed over with once-daily (10 days) 50, 100, or 200 mg mirabegron or a single 400-mg moxifloxacin dose on day 10. In each period, continuous ECGs were recorded at two baselines and on the last drug administration day. The lower one-sided 95% confidence interval for moxifloxacin effect on QTcI was >5 ms, demonstrating assay sensitivity. According to ICH E14 criteria, mirabegron did not cause QTcI prolongation at the 50-mg therapeutic and 100-mg supratherapeutic doses in either sex. Mirabegron prolonged QTcI interval at the 200-mg supratherapeutic dose (upper one-sided 95% CI >10 ms) in females, but not in males.

[Measuring quality of life in chronic kidney disease patients: reflections and prospects]

Quality of life is a complex and multidimensional concept. Understanding a patient'squality of life can assist healthcare providers to assess risk factors associated with hospitalization and mortality, and, potentially, delay disease progression. As chronic kidney disease (CKD) symptoms vary during different stages of the disease, instruments must be properly adjusted to measure quality of life accurately. This article explores comprehensively the development and appropriateness of relevant instruments, and recommends specific instruments for use at specific CKD stages.

Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and meta-analysis

Nasogastric tube (NGT) intubations occur frequently in clinical practice and can be a painful procedure for patients. A systematic review of current knowledge concerning the use of nebulized lidocaine to reduce the pain of NGT insertion was conducted in order to develop evidence-based guidelines. In addition, a meta-analysis of appropriate randomized controlled trials (RCTs) was performed. The databases included PubMed (1996-2009), ProQuest (1982-2009), CINAHL (1982-2009), and the Cochrane Central Register of Controlled Trials (2009), and reference lists of articles. Experts in this field also were contacted. Two investigators selected the research based on inclusion criteria and reviewed each study's quality according to the Jadad scale. Five RCTs with 212 subjects were identified. A total of 113 (58%) subjects were women. The mean age of treatment and control groups was 59.6 and 55 years, respectively. The countries of studies were the United States, United Kingdom, Australia, Canada, and Thailand. In the treatment groups, the use of lidocaine concentration was 4% and 10%. The pooled effect size was 0.423 (95% confidence interval: 0.204-0.880; Z=-2.301; P=0.021), indicating that the use of nebulized lidocaine before NGT insertion can decrease pain by 57.7%. There is insufficient evidence to recommend the dosage, concentration, or delivery method. Further research is needed to articulate a comprehensive clinical guideline.

A critical thinking disposition scale for nurses: short form

AIMS AND OBJECTIVES

The aim of this study was to test the Chinese version of the Critical Thinking Disposition Inventory (CTDI-CV) among nurses in Taiwan.

BACKGROUND

Critical thinking is the use of purposeful self-regulatory judgments to identify patient's problems and provide patient care. Critical thinking influences nurses' decision making. To date, no inventory to understand nurse's critical thinking disposition has been developed.

DESIGN

This was a survey design with a stratified random sampling to test the reliability and validity of the CTDI-CV.

METHODS

The participants comprised 864 registered nurses who were chosen by stratified random sampling from seven hospitals in Taiwan. Data were collected through self-administered structured questionnaires.

RESULTS

A new scale, short form (SF) CTDI-CV, contains 18 items with three subscales: 'systematic analysis', 'thinking within the box' and 'thinking out of the box', was generated from the analysis with 44% explained variance. Cronbach's alpha coefficients and intra-class correlation coefficients for overall and subscale were above 0.8. Goodness-of-fit test for the final model of SF-CTDI-CV revealed an acceptable result in the overall fit (χ(2)/df = 4.04, p < 0.05, GFI = 0.93, AGFI = 0.91, SRMR = 0.076, RMSEA = 0.059).

CONCLUSION

On the basis of these results, the SF-CTDI-CV is a reliable instrument for assessing critical thinking disposition for nurses.

RELEVANCE TO CLINICAL PRACTICE

A short and valid critical thinking instrument for nurses will facilitate critical thinking research in the clinical practice arena. When designing continuing education activities, clinical educators will be able to efficiently and effectively evaluate the quality of critical thinking among practicing nurses.

[Managing constipation in the elderly: an evidence-based approach]

Constipation is a common problem afflicting the elderly. When elderly patients complain of constipation to their healthcare providers, they are typically prescribed laxatives rather than given a clinical examination to explore the specific causes. This approach not only does not resolve the long-term problem of constipation, but may also lead to further complications (e.g., constipation alternating with diarrhea, abdominal distention, poor appetite, and ileus). Effective management of constipation in the elderly should in many cases be tailored to the symptoms and conditions of individual patients rather than simply applying evidence-based treatment. There is a lack of consistency amongst specialists on how best to deal with the problem of constipation. The aim of this article was to explore evidence-based management approaches to constipation in the elderly. A definition of constipation is given and relevant causes are first given. Pharmacological and non-pharmacological treatment approaches are then introduced with regard to effective approaches to conducting physical examinations, assessing patient medical history, and performing laboratory tests. In addition, this article also developed a constipation protocol as a reference tool in the clinical management of constipation in the elderly. The authors hope results can help reduce the problem of constipation in the elderly population.

Health promotion lifestyle profile-II: Chinese version short form

AIM

This paper is a report of an examination of the validity and reliability of the Chinese version of the Health Promoting Lifestyle Profile.

BACKGROUND

The Health Promotion Lifestyle Profile, a well-known instrument measuring health promotion lifestyle behaviours and developed by Walker in 1987 and later refined, has been translated into several languages. The original Chinese translated version, based on Walker's 48-item 1987 version, detected six dimensions of health promotion lifestyle behaviours. The 52-item revised Health Promotion Lifestyle Profile-II has not been tested for Mandarin-speakers.

METHOD

After the English version of the Health Promotion Lifestyle Profile-II was translated into Chinese using established forward-backward translation procedures, the psychometric properties of the translated version were determined with 331 Taiwanese Mandarin-speaking adults. Data were collected from August 2007 to July 2008 at outpatient clinics for health screening in Southern Taiwan. The psychometric properties of the instrument were evaluated, including the internal consistency, test-retest reliability, item analysis and factor analysis.

RESULTS

Neither Walker's original 6-factor model nor a forced 6-factor solution of the 52 items of the Health Promotion Lifestyle Profile-II was supported. Parallel analysis suggested that five factors be retained, with the 5-factor solution statistically and conceptually satisfactory. The 5-factor Chinese version of the Health Promoting Lifestyle Profile explained 53% of the variance in healthy lifestyles. Thirty items were retained for the Chinese version of the Health Promoting Lifestyle Profile.

DISCUSSION

Deletion of 22 items from the Health Promotion Lifestyle Profile-II did not impair the ability of the Chinese version of the Health Promoting Lifestyle Profile to measure a healthy lifestyle among a sample of Taiwanese adults. The data support the fact that lifestyle is influenced by culture.

Revised Acute Physiology and Chronic Health Evaluation score as a predictor of neurosurgery intensive care unit readmission: a case-controlled study

PURPOSE

Patients with neurologic system problems are among the most common patients readmitted to the intensive care unit (ICU). Readmission predictors for neurologic ICU patients have not been established. Previous research suggests that the Revised Acute Physiology and Chronic Health Evaluation (APACHE II) score is one indication of the critical status of ICU-admitted patients; however, the ability of the discharge APACHE II to predict readmission to the ICU requires further study. The purpose of this study was to investigate the ability of the APACHE II scoring system to predict ICU readmission of neurosurgical and ICU patients.

MATERIALS AND METHODS

A retrospective case-controlled comparison study and a review of patient records for all patients admitted to 8 ICUs from January 2003 to June 2005 (N = 753) were conducted. Readmitted neurosurgery ICU patients were matched with 58 randomly selected nonreadmitted patients.

RESULTS

Nine variables were significantly different between the readmission and case-controlled group. The APACHE II discharge score was the only significant predictor and was able to predict 18.6% of neurologic ICU readmissions. The risk of ICU readmission increased when the APACHE II score at the time of discharge exceeded 8.5 points.

CONCLUSIONS

The risk of ICU readmission of neurologic ICU patients can be predicted by determining APACHE II score upon ICU discharge.

[Development and evaluation of a nursing database]

The progress of information technology (IT) has not only changed the way we live, but also made health instruments more user friendly and convenient. In recent years, the application of IT in nursing has increased, as has relevant research in the literature. It also has been verified in the literature that IT has improved clinical practice efficiency and effectiveness. However, the development of IT in nursing has progressed slower than expected in health care settings because nursing information system flows are complicated and the scope necessarily covered by nursing information systems is broad. In addition, with limited experience, the development of nursing information systems has posed a tremendous challenge, with nurse administrators facing significant barriers and difficulties. The purpose of this paper was to share our experience establishing a unit based on a nationwide nurses' information bank.

A model of medication-taking behavior in elderly individuals with chronic disease

Adherence with prescription medications among elderly patients with cardiac conditions is poor. Mechanisms underlying adherence behavior have not been fully investigated. The purpose of this study was to develop a substantive model that describes medication-taking behavior in elderly individuals with chronic diseases. The study was exploratory using grounded theory. Purposive sampling was used to recruit 19 elderly cardiac patients. Four major themes were delineated from the data to describe readiness to adhere: perceived effectiveness, perceived partnership, perceived reality, and interpersonal influences. To convert perceptions into actions, 2 influencing factors, facilitating and inhibiting factors, played pivotal roles. This model could provide a useful framework for health professionals to design valid interventions for elderly patients to increase medication adherence.

Evaluation of a Telephone Call Service for Ambulatory Surgery Patients in Taiwan

The purpose of this study was to evaluate the outcomes of a telephone call service (TCS) for ambulatory surgery patients. Three outcomes were evaluated: patient satisfaction, patients' perceptions of the value of a TCS intervention, and nurses' perceptions of difficulties in implementing it. The results indicated that patients were satisfied with the TCS intervention and were positive about its value. Nurses indicated that the main difficulties in implementing the TCS were their lack of knowledge in answering patients' questions and time limitations.

Cross-mapping ICNP terms with Taiwanese gynecological nursing records

Cross-mapping the terms of International Classification for Nursing Practice (ICNP) with the handwritten nursing records of gynecological patients at one district of private teaching hospital in the south of Taiwan was conducted in July and August, 2004. The purpose of this study was to validate the applicability of ICNP for electronic nursing records in a gynecological setting. A Chinese version of the ICNP beta 2 browser was used to code nursing record sentences. Medical charts were reviewed until data were saturated. A total of sixty-two patient records were analyzed, producing 6,327 sentences, this included 1,918 sentences on nursing phenomena (30.3%) and 4,409 sentences on nursing action (69.7%). The ratio between the two was about 1:2.3. Coded sentences were compared according to the four levels of applicability with the original records, each was identified as a "perfect fit", "conceptual fit", "partial fit", or "unable to fit". Of the 6,327 sentences, 2,041 (32.3%) were designated as "perfect fit", 2,457 (38.8%) as "conceptual fit", 1,663 (26.3%) as "partial fit", and 166 (2.6%) as "unable to fit". The top ten most described nursing phenomena included: acute pain, high temperature, conscious change, potential infection risk, state of mind change, potential risk patient's mobility change endurance level, gastrointestinal function obstacles, changes in urination, anxiety, and diarrhea. The top ten most described nursing actions included: observe surgical wounds, monitor vital signs, changes of mentality, instruction on medication, arranging clinical check ups, wound infection prevention, urinary drainage tube and urine nature observation, checking for vaginal drainage, pre/post-operative healthcare, and discharge planning. Study results indicated that 71.1% of sentences could be cross-mapped. Further validation is suggested to validate ICNP in other gynecological hospitals.