The Experiences of Nursing Managers in Implementing Palliative Care in Long-Term Care Facilities.

Purpose: The purpose of this study was to explore the experiences of nursing managers in implementing palliative care in long-term care facilities and to provide recommendations for managers who plan to introduce palliative care into their facilities. Methods: This study used semi-structured interviews and grounded theory methodology, with purposive sampling. A total of 11 long-term care facilities in eastern Taiwan that had implemented palliative care were selected, and 11 facility nursing managers participated in in-depth, face-to-face interviews. Results: The introduction of palliative care in long-term care facilities can be divided into four stages: (1) the opportunity for change, (2) playing a supportive role, (3) a new collaboration model, and (4) facility transformation. The core category shared by the participants may be summed up as "the palliative care captain in the facility". It reflects the spirit of the successful implementation of palliative care by managers in long-term care facilities. Conclusion: The study reveals that during the initial phases of implementing palliative care, the palliative care teams assume a crucial leadership role, while the facilities play a supportive role. At this stage, managers should focus on personnel training and addressing internal issues within the facilities to facilitate successful collaboration with the palliative care teams. In the later stages, the facilities transition from a supportive role to one of independence, marking a critical juncture for the facilities' potential stable development. During this period, managers are tasked not only with establishing the facilities' own palliative care team but also with facilitating the transformation of staff from learners to instructors. Finally, even after successful implementation, managers must contemplate how to innovate and set more ambitious goals.

Using Artificial Intelligence for the Early Detection of Micro-Progression of Pressure Injuries in Hospitalized Patients: A Preliminary Nursing Perspective Evaluation.

This study established a predictive model for the early detection of micro-progression of pressure injuries (PIs) from the perspective of nurses. An easy and programing-free artificial intelligence modeling tool with professional evaluation capability and it performed independently by nurses was used for this purpose. In the preliminary evaluation, the model achieved an accuracy of 89%. It can bring positive benefits to clinical care. Only the overfitting issue and image subtraction method remain to be addressed.

The Experience to Implement Palliative Care in Long-term Care Facilities: A Grounded Theory Study of Caregivers.

PURPOSE: The purpose of this study was to explore the experiences of caregivers in long-term care facilities as they implement palliative care. Although palliative care has been available in Taiwan for more than 30 years, it is often provided in hospitals, few models in the long-term care facilities. METHODS: Semi-structured interviews using grounded theory methodology and purposive sampling. Two small long-term care facilities that had performed well in palliative care were selected from eastern Taiwan. A total of 12 caregivers participated in in-depth semi-structured face-to-face interviews. RESULTS: Four major stages in the implementation of palliative care were identified: (1) feeling insecure, (2) clarifying challenges, (3) adapting to and overcoming the challenges, and (4) comprehending the meaning of palliative care. The core category of these caregivers as "the guardians at the end of life" reflects the spirit of palliative care. CONCLUSION: This study demonstrates that successful palliative care implementation would benefit from three conditions. First, the institution requires a manager who is enthusiastic about nursing care and who sincerely promotes a palliative care model. Second, the institution should own caregivers who possess personality traits reflective of enthusiasm for excellence, unusual ambition, and a true sense of mission. Third, early in the implementation phase of the hospice program, the institution must have the consistent support of a high-quality hospice team.

Swallowing ability and its impact on dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment.

PURPOSE: The purpose of this study was to identify the characteristics of swallowing ability, depression, and dysphagia-specific health-related quality of life (QOL), and the predictors of dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment. METHODS: A cross-sectional study of 151 oral cavity cancer patients was performed at a medical center. Patients were assessed for swallowing ability, depression, and dysphagia-specific health-related QOL. Multiple stepwise regression was used to identify factors related to dysphagia-specific health-related QOL. RESULTS: Of the 151 patients surveyed, the top swallowing impairments were difficulty swallowing dry foods, difficulty swallowing hard food, and swallowing problems interfering with enjoyment or QOL. Patients with tumors of the tongue had worse functional dysphagia QOL than those with cancers in other locations. Patients with buccal cancer had worse overall dysphagia QOL, functional dysphagia QOL, and physical dysphagia QOL than patients with cancers in other locations. Patients with poor swallowing ability were more likely to have worse global dysphagia QOL. Emotional dysphagia QOL was associated with poor swallowing ability and depression. Poor swallowing ability, higher level of depression, and tumors of the tongue were associated with the worst functional dysphagia QOL. Patients with poor swallowing ability, higher level of depression, and less functional oral intake were more likely to have worse physical dysphagia QOL. CONCLUSION: Swallowing ability and depression were the most important factors associated with dysphagia-specific health-related QOL. Patient-centered swallowing rehabilitation programs are recommended to help cope with swallowing impairment.

Effects of a swallowing exercise education program on dysphagia-specific health-related quality of life in oral cavity cancer patients post-treatment: a randomized controlled trial.

PURPOSE: The purpose of this study was to evaluate the effects of a swallowing exercise education program (SEEP) on swallowing ability, depression, and dysphagia-specific health-related quality of life (QOL) in oral cavity cancer (OCC) patients. METHODS: This was a prospective, randomized controlled study with two groups using a pre- and post-repeated measures design. A total of 76 participants were randomly assigned to an experimental group (n = 38) and a control group (n = 38). The experimental group participated in a SEEP and the control group received normal care. Patients were assessed at five time points: baseline assessment (T0) and then 1, 2, 3, and 6-months (T1, T2, T3, and T4) after participating in the SEEP or receiving normal care. RESULTS: Patients in the experimental group had significantly greater emotional dysphagia QOL compared to those in the control group. In the experimental group, post-education (T4) depression was better than baseline (T0). For both groups, functional dysphagia QOL and physical dysphagia QOL were greatest at T0, decreased from T1 to T2, and slightly decreased at T3 and T4. There were no differences between the groups and within the groups with respect to dysphagia-specific health-related QOL, global dysphagia QOL, functional dysphagia QOL, and physical dysphagia QOL. CONCLUSIONS: The SEEP was effective in improving emotional dysphagia QOL during the initial 6 months after treatment of patients with OCC.

The relation between patient education, patient empowerment and patient satisfaction: A cross-sectional-comparison study.

PURPOSE: Patient empowerment is a paradigm of clinical practice. The goal of patient empowerment is to lead patients' health and wellbeing. The aim of this study is to evaluate the relation between patient education, patient empowerment and patient satisfaction based on multi-hospital cross-sectional study design in Taiwan. METHODS: In this cross-sectional survey, 609 inpatients in four teaching hospitals in northern Taiwan from August 2009 to July 2010 were recruited. Data were collected using Chinese version of the Patient Perceptions of Empowerment Scale (PPES), Sufficiency of Patient Education Questionnaire (SPEQ) and Patient Satisfaction Questionnaire (PSQ). The multiple linear regression model was used to assess the independent effects of relevant factors on patient empowerment after controlling for the covariates. RESULTS: The overall mean empowerment scores was 44.80±5.94. There was a significant difference between the total scores and four dimensions of patient empowerment at different hospitals (t=5.44, p≤0.01). Sufficient patient education (ß=0.568, 95%CI: 0.486-0.649) and patient satisfaction (ß=0.317, 95%CI: 0.259-0.375) could significantly predict patient empowerment based on the multiple linear regression analysis, with a total variance was 54.4%. CONCLUSIONS: In conclusion, both sufficient patient education and patient satisfaction were positively related to patient empowerment. Hospitals in Taiwan should try to improve their patients' active involvement toward empowerment.

Factors associated with continued smoking after treatment of oral cavity cancer: An age and survival time-matched study.

AIMS: The aims of this study of people with oral cavity cancer were to compare the social support, depression, nicotine dependence, physical function and social-emotional function of those who continued smoking with those who quit smoking, by matching age and survival time and to identify the predictors of continued smoking during the survival period. BACKGROUND: People who continue to smoke after cancer treatment may have an impact on treatment response and survival. DESIGN: A cross-sectional survey was conducted. METHODS: This study compared 92 people with oral cavity cancer who continued smoking with 92 people who quit smoking, with matching for age and survival time between January 2015 - November 2015. Conditional logistic regression analysis was used to compare the two groups. RESULTS: The quit smoking group had significantly more social support, less depression and greater social-emotional function than the continued smoking group. People who were unmarried, received surgery without reconstruction, had poor social support and had poor social-emotional function were more likely to continue smoking. CONCLUSIONS: People with oral cavity cancer were more likely to continue smoking after the treatment if they had low social support, depression, greater nicotine dependence and poor social-emotional function. Healthcare professionals should pay more attention to social support, psychological status and nicotine dependence of people who were treated for oral cavity cancer.

Psychosocial effects of a skin camouflage program in female survivors with head and neck cancer: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to evaluate the effects of a skin camouflage program on disfigurement, self-esteem, social interaction, and body image in female head and neck cancer (HNC) survivors. METHODS: A prospective, repeated-measures, randomized controlled therapeutic intervention design was used. A total of 66 participants were randomly assigned to each group, with 32 in the experimental group and 34 in the control group. The experimental group received a 4-session skin camouflage program, and the control group received routine care. Patients were assessed at 3 time points: baseline assessment (T0) and then at 1, 2, and 3 months (T1, T2, and T3, respectively) after participating in the skin camouflage program. RESULTS: Patients in the experimental group had significantly less facial disfigurement, depression, fear of social interaction, and anxiety regarding social interaction compared with those in the control group. Participants in both groups had significantly lower levels of facial disfigurement, depression, fear of social interaction, anxiety of social interaction, and body image at the final posttest assessment than at the pretest assessment. There were no differences between the groups and within groups with respect to self-esteem. CONCLUSIONS: The 3-month skin camouflage program effectively improved facial disfigurement, fear of social interaction, anxiety of social interaction, and body image of female HNC survivors. A survival care plan should include a skin camouflage program to improve body image perception and decrease anxiety after treatment of HNC.

Exercise engagement in people with prediabetes--a qualitative study.

AIMS AND OBJECTIVES: To explore the experiences of people with prediabetes who engage in exercise, from the initiation of exercise to the discontinuation or continuation of exercise. BACKGROUND: People with prediabetes are the high-risk group for developing type 2 diabetes. Engaging in exercise is an important health behaviour to prevent or delay this. However, many people with prediabetes fail to develop and maintain a regular exercise regime. DESIGN: A grounded theory study. METHODS: Data were collected from August 2011-November 2012. Twenty participants with impaired fasting glucose from a medical centre in Taiwan were enrolled in this study for in-depth interview. The data were entered into NVivo 8·0 qualitative data management software after transcription and were analysed by constant comparative method. RESULTS: A theory of the process by which people with prediabetes approach the development of exercise behaviour was developed, comprising four stages: developing awareness, creating the health blueprint, action cycle of internal struggle and developing spontaneous regular exercise. Developing awareness was the starting point for the process of implementing exercise. The core category was action cycle of struggle that all participants experienced this stage, and the spontaneous regular exercise was the highest level of exercise process. CONCLUSION: It is not easy for people with prediabetes to develop a regular exercise regime. Exercise behaviour will be either continued or discontinued secondary to driving and resistive forces. RELEVANCE TO CLINICAL PRACTICE: This study provides useful information to help practitioners design exercise intervention strategies and provide psychological support to people with prediabetes.

Nurses' attitudes towards physical activity care among older people.

AIMS AND OBJECTIVES: To understand nurses' attitudes towards physical activity care for older people in long-term care facilities. BACKGROUND: In long-term care facilities, a common approach to daily physical activity is based on the identifiable portions of daily life during which the activity occurs. However, older people are at risk of falling when they perform daily physical activities. Nurses are the first-line caregivers. What nurses' think and do regarding older people's participation in daily physical activities in long-term care facilities is very important in terms of the clinical decision-making regarding older people's physical activity care. DESIGN: An exploratory qualitative design. METHODS: Twenty nurses with more than three years of clinical experience from 13 long-term care facilities located in northern Taiwan were sampled purposively. Data were collected though semi-structured interviews. The constant comparative data analysis method was used throughout the research. RESULTS: Five themes emerged from the data analysis: 'recognising the importance of participation in daily physical activity', 'encouraging participation in physical activity', 'respecting the autonomy of the residents regarding participation in physical activity', 'preventing falls' and 'facing a dilemma'. CONCLUSIONS: This study identifies that there is a conflict between the nurses' perceptions of the residents' daily physical activities, the risk of falls and encouraging greater independence. The majority of staff employed in long-term care facilities is nursing personnel, and it is these nurses who have the most contact with the residents. It is therefore believed that nurses can make the greatest difference to the residents' lives and support the quality of care if they can resolve this conflict. Relevance to clinical practice. The results suggest the need to increase the nurses' knowledge base regarding the benefits of physical activity and also highlight the potentially adverse effect of restraint usage by nurses.

Nurses' beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan.

AIM: To gain an insight into this issue, this study used a qualitative approach and aims to explore and describe nurses' beliefs, experiences and practice regarding complementary and alternative medicine in Taiwan. BACKGROUND: The integration of complementary and alternative medicine with conventional medicine has become more common worldwide in recent years. An increase in patient use and an expansion of nurses using complementary and alternative medicine has spawned further investigation. Most published studies have concentrated on the usage of complementary and alternative medicine in western societies and have focused principally on physicians' attitudes and practice patterns in this regard. Despite the large amount of time and the unique relationship that nurses share with their patients, little research has investigated the nurse's attitudes and practice regarding complementary and alternative medicine. Moreover, there has been no previous research into understanding this issue from the Taiwanese nursing perspective. DESIGN: A qualitative research design. METHOD: By using an exploratory, descriptive, qualitative approach, data were collected from 11 registered nurses. The methods of the data collection were in-depth, semi-structured interviews, field notes and memos and the data were analysed using the constant comparative method. RESULTS: Three major categories emerged from the data; namely, a 'lack of clear definition', 'limited experience' and 'high interest' towards complementary and alternative medicine. These results suggest that the definition of complementary and alternative medicine is often unclear for nurses in Taiwan. Due to the organisational policies and personal knowledge base, very few nurses integrate complementary and alternative medicine into their daily practice. However, the nurses in Taiwan show a great desire to participate in complementary and alternative medicine continuing education programmes. CONCLUSIONS: This study is not only significant in filling the gap in the existing literature, but is also important in understanding this issue from the nurses' perspective, to offer a series of recommendations for policy, nursing education, nursing practice and suggestions for further research. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of nursing attitude in the use of complementary and alternative medicine. Clinical nurses have the potential to provide appropriate information to their patients to ensure safe complementary and alternative medicine use.

The Chinese version of the Outcome Expectations for Exercise scale: validation study.

BACKGROUND: Estimates of the reliability and validity of the English nine-item Outcome Expectations for Exercise (OEE) scale have been tested and found to be valid for use in various settings, particularly among older people, with good internal consistency and validity. Data on the use of the OEE scale among older Chinese people living in the community and how cultural differences might affect the administration of the OEE scale are limited. AIM: To test the validity and reliability of the Chinese version of the Outcome Expectations for Exercise scale among older people. METHODS: A cross-sectional validation study was designed to test the Chinese version of the OEE scale (OEE-C). Reliability was examined by testing both the internal consistency for the overall scale and the squared multiple correlation coefficient for the single item measure. The validity of the scale was tested on the basis of both a traditional psychometric test and a confirmatory factor analysis using structural equation modelling. The Mokken Scaling Procedure (MSP) was used to investigate if there were any hierarchical, cumulative sets of items in the measure. RESULTS: The OEE-C scale was tested in a group of older people in Taiwan (n=108, mean age=77.1). There was acceptable internal consistency (alpha=.85) and model fit in the scale. Evidence of the validity of the measure was demonstrated by the tests for criterion-related validity and construct validity. There was a statistically significant correlation between exercise outcome expectations and exercise self-efficacy (r=.34, p<.01). An analysis of the Mokken Scaling Procedure found that nine items of the scale were all retained in the analysis and the resulting scale was reliable and statistically significant (p=.0008). CONCLUSION: The results obtained in the present study provided acceptable levels of reliability and validity evidence for the Chinese Outcome Expectations for Exercise scale when used with older people in Taiwan. Future testing of the OEE-C scale needs to be carried out to see whether these results are generalisable to older Chinese people living in urban areas.

A systematic review and meta-ethnography of the qualitative literature: experiences of the menarche.

AIM: This article is a report of a systematic review and meta-ethnography of women's experience of menarche. BACKGROUND: Adolescents may experience menarche at different ages, but menarche remains an important milestone in the female maturation process, representing the transition from childhood to womanhood. DESIGN: Systematic review and meta-ethnography. METHODS: Electronic databases were systematically searched and supplemented with reference lists searching. Qualitative studies of women's experience of menarche were purposely selected and questions proposed by the critical appraisal skills programme was adapted and used to assess papers prior to synthesis. Key themes and concepts were extracted and synthesised using meta-ethnography. RESULTS: Fourteen studies on menarche experience were identified. The majority of studies were descriptive. Five key concepts were identified from all 14 papers as being descriptive of women's experience of menarche. These included: menarche preparation, significant others' response to menarche, physical experience of menarche, psychological experience of menarche and social-cultural perspective of menarche. CONCLUSIONS: Menarche experience had a major impact on women. Women went through physical, psychological and social-culture changes when their first menstrual flow came. Menarche preparation has been shown to have a beneficial impact on the menarcheal woman. School nurses have accurate knowledge about sexual health; they can and should provide appropriate menstrual education. RELEVANCE TO CLINICAL PRACTICE: The findings can be used by school nurses working with adolescents as the basis for a framework of intervention strategies directed towards helping adolescents to better accept their menarche and transition into womanhood.

Ammonium-dependent sodium uptake in mitochondrion-rich cells of medaka (Oryzias latipes) larvae.

In this study, a scanning ion-selective electrode technique (SIET) was applied to measure H(+), Na(+), and NH(4)(+) gradients and apparent fluxes at specific cells on the skin of medaka larvae. Na(+) uptake and NH(3)/NH(4)(+) excretion were detected at most mitochondrion-rich cells (MRCs). H(+) probing at MRCs revealed two group of MRCs, i.e., acid-secreting and base-secreting MRCs. Treatment with EIPA (100 muM) blocked 35% of the NH(3)/NH(4)(+) secretion and 54% of the Na(+) uptake, suggesting that the Na(+)/H(+) exchanger (NHE) is involved in Na(+) and NH(3)/NH(4)(+) transport. Low-Na(+) water (<0.001 mM) or high-NH(4)(+) (5 mM) acclimation simultaneously increased Na(+) uptake and NH(3)/NH(4)(+) excretion but decreased or even reversed the H(+) gradient at the skin and MRCs. The correlation between NH(4)(+) production and H(+) consumption at the skin surface suggests that MRCs excrete nonionic NH(3) (base) by an acid-trapping mechanism. Raising the external NH(4)(+) significantly blocked NH(3)/NH(4)(+) excretion and Na(+) uptake. In contrast, raising the acidity of the water (pH 7 to pH 6) enhanced NH(3)/NH(4)(+) excretion and Na(+) uptake by MRCs. In situ hybridization and real-time PCR showed that the mRNAs of the Na(+)/H(+) exchanger (slc9a3) and Rhesus glycoproteins (Rhcg1 and Rhbg) were colocalized in MRCs of medaka, and their expressions were induced by low-Na(+) acclimation. This study suggests a novel Na(+)/NH(4)(+) exchange pathway in apical membranes of MRCs, in which a coupled NHE and Rh glycoprotein is involved and the Rh glycoprotein may drive the NHE by generating H(+) gradients across apical membranes of MRCs.

Nursing home care for older people in Taiwan: a process of forced choice.

AIM: To generate a substantive theory for understanding the phenomenon of nursing home care for older people in Taiwan. BACKGROUND: Taiwanese culture shows great respect for older people and older people are traditionally cared for at home by their families. However, the older population in Taiwan is rapidly increasing and this demographic shift, together with various socio-economic changes, has resulted in nursing homes becoming a new and significant care option. DESIGN: A grounded theory approach was used to study the residents and relatives from three nursing homes in Taiwan. METHODS: Formal and informal interviews and participant observation data were collected over two months in each nursing home. Forty nursing home residents and 20 of their relatives were recruited. The data were analysed using the constant comparative method and involved the use of theoretical memos and theoretical sampling procedures. RESULTS: The study found that nursing home care for older people in Taiwan is understood to be a process of forced choice, involving three stages; namely, 'becoming a problem', 'making a forced choice' and 'coping with the forced choice'. CONCLUSION: Taiwan is in a state of conflict with regard to providing care for older people, a situation in which the influence of traditional cultural and that of industrialization exist side by side. The consequence of having to relocate older people into nursing homes means that both parties are the victims of this choice. RELEVANCE TO CLINICAL PRACTICE: This conceptual explanation helps us to understand how the Taiwanese respond to the issue of care for older people and how they resolve their main concerns related to it. Subsequently, it is hoped that this will help health care practitioners to provide care more effectively to meet the needs of the Taiwanese with the aim of enhancing the standards of care for older people.

Analysis of pooled data from two pivotal controlled trials on the efficacy of topiramate in the prevention of migraine.

CONTEXT: A substantial proportion of the patient population with migraine headache should be considered for preventive treatment based on the frequency and disability associated with this disorder. Use of the anticonvulsant topiramate was previously examined in two large, double-blind, randomized, placebo-controlled clinical trials of a subset of patients who have 3 to 12 migraine episodes per month. OBJECTIVE: To better characterize the efficacy of topiramate for prevention of migraine, with or without aura, by pooling and analyzing data from the two large clinical trials. METHODS: The pooled intent-to-treat population included 937 patients receiving topiramate at one of three dosages (50 mg/d, 100 mg/d, 200 mg/d) or placebo. Outcome measures included change in mean monthly migraine frequency and categorical responder rate throughout the 26-week doubleblind phase. RESULTS: At daily doses of 100 and 200 mg, topiramate was associated with significant reductions in mean monthly migraine frequency throughout the double-blind phase compared with placebo (P<.001). Significantly more patients treated with these topiramate doses exhibited high-percentage reductions in monthly migraine frequency (>/=50% [P<.001], >/=75% [P<.001], 100% [P=.049]) versus placebo. The most common adverse events included anorexia, cognitive deficits, diarrhea, fatigue, nausea, and paresthesia. Topiramate (100 mg/d, 200 mg/d) was associated with significant and sustained reductions in mean monthly migraine frequency beginning as early as 1 week into therapy. CONCLUSION: Pooled efficacy data from two large, similarly designed, placebo-controlled migraine-prevention trials demonstrated that a statistically significant proportion of patients using topiramate met or exceeded two main outcome guidelines recommended by the International Headache Society (>/=50% and >/=75% reduction in frequency of monthly attacks). Based on efficacy and tolerability, topiramate at a dosage of 100 mg per day (50 mg twice daily) should be the target dosage for most patients with migraine.

Topiramate monotherapy in newly diagnosed epilepsy in children and adolescents.

A double-blind, dose-controlled study evaluated topiramate as monotherapy in 470 patients with newly diagnosed (< or = 3 months) epilepsy or epilepsy relapse in the absence of therapy. In addition to having at least 2 lifetime-unprovoked seizures, patients had 1 or 2 partial-onset seizures or generalized-onset tonic-clonic seizures during a 3-month retrospective baseline. The trial included a large cohort (N = 151, 32%) of children and adolescents 6 to 15 years of age. Eligible patients were randomized to treatment groups in which topiramate was titrated to target maintenance dosages of either 400 mg/day (n = 77) or 50 mg/day (n = 74). Patients were followed for at least 6 months. Based on Kaplan-Meier analyses, the primary efficacy endpoint of time to first seizure favored the higher topiramate dose in both the overall population and the cohort of children/adolescents. The probability that children/adolescents remaining in the study were seizure free at 6 months was 78% in the 50-mg target dose group and 90% with the higher dose. At 12 months, the probability of being seizure free was 62% and 85%, respectively. The incidence of treatment-limiting adverse events was 4% in the 50-mg target dose group and 14% in the group assigned to 400 mg as a target dose. The most common adverse events, excluding typical childhood illnesses, were headache, appetite decrease, weight loss, somnolence, dizziness, concentration/attention difficulty, and paresthesia. As shown in this subset analysis, topiramate is effective and well tolerated as monotherapy in children and adolescents.

Assessment of interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale in essential tremor.

The purpose of this study was to evaluate interrater and intrarater reliability of the Fahn-Tolosa-Marin Tremor Rating Scale (TRS) in essential tremor (ET). Proper treatment of ET is contingent upon correct assessment of the severity, loss of function, and disability related to tremor. Videotape recordings of 17 subjects with ET evaluated with the TRS were produced and sent to 59 raters. Once the raters returned the videotape and completed the score sheet, they were mailed a second tape with the same recordings presented in a different order. In the interrater reliability evaluation, modified Kappa statistics for seven tremor type composites ranged from 0.10 to 0.65 in the first videotape and 0.17 to 0.62 in the second videotape. Interrater reliabilities were greater for Part A items (magnitude of tremor in different body parts) than for Part B items (tremor in writing and drawings) of the TRS. The average Spearman correlation was 0.87, indicating very good consistency between the two videotapes, but correlations for Part A were somewhat better than for Part B. It is best when the same rater performs repeated measures of tremor on a patient, particularly when judging tremor in handwriting and drawings. Training of raters on use of the TRS would help standardize judgement.

Efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder: a randomized, double-blind, placebo-controlled study.

OBJECTIVE: This double-blind, placebo-controlled trial assessed efficacy and safety of topiramate monotherapy in civilian posttraumatic stress disorder (PTSD). METHOD: Outpatients (18-64 years) with DSM-IV non-combat-related PTSD and Clinician-Administered PTSD Scale (CAPS) scores >or= 50 were eligible. Topiramate was started at 25 mg/day and titrated by 25-50 mg/week to 400 mg/day or maximum tolerated dose. Data were collected between April 26, 2002, and February 4, 2004. Primary efficacy, change in total CAPS score, and secondary efficacy measures were assessed by analysis of covariance in the intent-to-treat (ITT) population with last observation carried forward. RESULTS: The ITT population comprised 38 patients with mean +/- SD baseline total CAPS scores of 88.3 +/- 13.8 (topiramate, N = 19) and 91.1 +/- 13.7 (placebo, N = 19). Although a decrease in total CAPS score was noted (topiramate, -52.7; placebo, -42.0), this difference was not statistically significant (p = .232). Topiramate-treated patients exhibited significant reductions in reexperiencing symptoms (CAPS cluster B: topiramate, 74.9%; placebo, 50.2%; p = .038) and Treatment Outcome PTSD scale (topiramate, 68.0%; placebo, 41.6%; p = .025). Reductions approaching statistical significance, based on a nominal p value, were noted in mean total Clinical Global Impressions-Improvement Scale scores (topiramate, 1.9 +/- 1.2; placebo, 2.6 +/- 1.1; p = .055). CONCLUSION: These preliminary results suggest that further, adequately powered studies of topiramate for the treatment of civilian PTSD are warranted.

The outcome expectancy model for areca-quid chewing behavior.

Outcome expectancies as regards areca-quid chewing played an important role in areca-quid addiction. In this study, areca-quid user expectancies will be explored. A total of 179 adolescents selected from high school completed the areca-quid chewing expectancy questionnaire and related chewing-behavior scale. Three factors (physical/emotional reward, negative consequences and social benefit) relating to areca-quid chewing behavior were explored by factor analysis and the two-dimensional model of chewing expectancy (positive-negative effect of chewing and physical-social reaction to chewing) was found using non-metric multi-dimensional scaling. The structure of the areca-quid chewing expectancy was determined for an adolescent group and the social factors involved in areca-quid chewing clearly warrant further investigation.