Anti-tumor effects of deubiquitinating enzyme inhibitor PR-619 in human chondrosarcoma through reduced cell proliferation and endoplasmic reticulum stress-related apoptosis.

Chondrosarcoma, a treatment-resistant cancer with limited therapeutic options, lacks significant advancements in treatment methods. However, PR-619, a novel inhibitor of deubiquitinating enzymes, has demonstrated anti-tumor effects in various malignancies. This study aimed to investigate the impact of PR-619 on chondrosarcoma both in vitro and in vivo. Two human chondrosarcoma cell lines, SW11353 and JJ012, were utilized. Cell viability was assessed using an MTT assay, while flow cytometry enabled the detection of apoptosis and cell cycle progression. Western blotting analyses were conducted to evaluate apoptosis, cell stress, and endoplasmic reticulum (ER) stress. Furthermore, the in vivo anti-tumor effects of PR-619 were examined using a xenograft mouse model. The results revealed that PR-619 induced cytotoxicity, apoptosis, and cell cycle arrest at the G0/G1 stage by activating caspases, PARP cleavage, and p21. Moreover, PR-619 increased the accumulation of polyubiquitinated proteins and ER stress by activating IRE1, GRP78, caspase-4, CHOP, and other cellular stress responses, including JNK activation. In vivo analysis demonstrated that PR-619 effectively inhibited tumor growth with minimal toxicity in the xenograft mouse model. These findings provide evidence of the anti-tumor effects and induction of cellular and ER stress by PR-619 in human chondrosarcoma, suggesting its potential as a novel therapeutic strategy for in human chondrosarcoma.

The effects of job characteristics on physicians' orientation toward lifelong learning.

With the rapidly growing body of medical knowledge, physicians must engage in lifelong learning. Physicians' orientation toward lifelong learning is of crucial importance. This study aimed to explore the effects of job characteristics on physicians' lifelong learning. A multicenter study collecting data from physicians from three medical centers in Taiwan was performed. A total of 321 physicians were surveyed with the Chinese version of the Job Content Questionnaire (C-JCQ) and the revised Jefferson Scale of Physician Lifelong Learning (JeffSPLL) to assess their job characteristics (i.e., job demands, job control, social support) and orientation toward lifelong learning. Exploratory factor analysis was employed to validate both questionnaires. Hierarchical regression was utilized to explore the relationship of job characteristics and predictors with physicians' lifelong learning. The results revealed that job demands (ß = 0.10), job control (ß = 0.19), social support from supervisors (ß = 0.16), the interaction of job demands × job control (ß = - 0.11) and the interaction of job demands × social support from colleagues (ß = 0.13) were significantly (p < .05, p < .001) related to lifelong learning. Moreover, physicians in the active group (high demand, high control) possessed a stronger orientation toward lifelong learning (mean = 3.57) than those in the low-strain group (mean = 3.42), high-strain group (mean = 3.39) and passive group (mean = 3.20). In conclusion, examining physicians' job demands, job control and social support helps us to understand their orientation toward lifelong learning and may provide insight to improve educational strategies.

Moving from tangibility toward digitalization: investigating team dynamics and facilitator support among medical students in conventional and digital small-group tutorials.

BACKGROUND: Small group tutorials (SGT) promotes self-directed learning and is widely used in medical education. The coronavirus pandemic (COVID-19) has accelerated the trend toward SGT digitalization, with unclear effect. We hypothesize that team dynamics and facilitator support influence SGT satisfaction in digital versus conventional SGT. METHODS: During the spring semester of year 2021, medical students (the second, third, and fourth year; n = 433) participating in conventional face-to-face and digital SGT curricula were enrolled. Participating students completed the collaborative learning attitude scale (including team dynamics, team acquaintance, and facilitator support dimensions) and teamwork satisfaction scale, previously validated for small-group collaborative learning, and chose preference between conventional or digital SGT in future curricula. Exploratory factor analysis (EFA) was performed to extract the essential structural factors of these scales. Paired t-tests were conducted to compare differences in different dimensions and satisfaction between the conventional and digital SGT settings. Two sets of multiple regression analyses were done; one with team satisfaction scale results and the other with preference for digital SGT as the dependent variable were used to evaluate determinants of these two variables. RESULTS: The EFA results revealed that the original collaborative learning attitude scale was concentrated on two dimensions: team dynamics and facilitator support. No significant differences were noted between the SGT settings for the two dimensions and teamwork satisfaction. Regression analyses showed that teamwork dynamics was independently correlated with teamwork satisfaction in both conventional and digital SGT. Facilitator support was positively correlated with teamwork satisfaction in conventional, but not digital SGT. Higher teamwork satisfaction was an important determinant of preference for digital SGT among medical students. CONCLUSIONS: Team dynamics were closely linked to teamwork satisfaction among medical students in both conventional and digital SGT, while the role of facilitator support became less obvious during digital SGT.

Laypeople's Online Health Information Search Strategies and Use for Health-Related Problems: Cross-sectional Survey.

BACKGROUND: With the increase in the use of the internet to search for health information about health-related problems, there is a need for health care professionals to better understand how their patients search for and use the online health information that may influence their medical decision making. OBJECTIVE: The aims of this study are to explore laypeople's online health information search strategies and examine the relationships between their search strategies and utilization behavior of online health information. METHODS: Two scales, namely match and elaboration, were used to measure patients' basic search strategies (ie, simple approach) and advanced search strategies (ie, integrative approach), respectively. In addition, the consultation scale was used to evaluate the participants' use of online health information to consult doctors and others. A total of 253 outpatients without university education were purposely selected and surveyed. The participants were outpatients at a university-affiliated teaching hospital. Partial least squares-structural equation modeling (PLS-SEM) was performed to analyze the measurement model to specify the measurement validation. In addition, the structure model of PLS-SEM was evaluated to examine the path correlations between variables and to execute interaction effect and curvilinear relationship analyses. RESULTS: The results of the path correlation analysis by PLS-SEM showed that both elaboration strategy (path coefficient=0.55, P<.001) and match strategy (path coefficient=0.36, P<.001) were positively correlated with consultation on online health information with doctors and others. In addition, interaction effect and curvilinear relationship analyses indicated that there was a significant interaction effect between elaboration and match on consultation (path coefficient=-0.34, P<.001) and a significant curvilinear relationship between match and consultation (path coefficient=-0.09, P=.046). CONCLUSIONS: Increasing patients' exposure to online health information through both a simple search approach (ie, match strategy) and a complex search approach (ie, elaboration strategy) may lead them to appropriately use the information to consult doctors and others. However, the results of interaction effect and curvilinear relationship analyses highlighted the essential role of the elaboration strategy to properly locate, evaluate, and apply online health information. The findings of this study may help health care professionals better understand how to communicate with their patients through the health information on the internet.

Effectiveness of tutor shadowing on faculty development in problem-based learning.

BACKGROUND: To enhance tutors' teaching skills, tutor shadowing for novice tutors of problem-based learning (PBL) in addition to conventional faculty development (FD) was applied. This study aimed to develop a tutoring-skill scale (TS-scale) and evaluate the effect of shadowing on PBL tutors. METHODS: This study employed a before-and-after study design with three phases. In phase 1, a TS-scale was elaborated. A validity examination was performed in phase 2. Phase 3 was a study of the effectiveness using a TS-scale survey of novice PBL tutors before and after the FD course. The FD course for novice PBL tutors included an FD workshop and PBL shadowing activities. RESULTS: A TS-scale with a 32-item questionnaire of self-rated confidence for PBL tutors was identified in phase 1. In phase 2, 7 experienced specialists in medical education were invited to evaluate the content validity of the scale. The item content validity index (I-CVI) ranged from 0.86 to 1, and the scale-CVI (S-CVI) was 0.95. A total of 85 novice PBL tutors completed the TS-scale before the FD course, yielding a Cronbach's alpha of 0.98. An exploratory factor analysis with varimax rotation was performed. The twenty-four items with significant loadings greater than 0.5 were incorporated into a new TS-scale and were grouped into three factors: student contact, medical expertise, and teaching expertise. In phase 3, 76 novice PBL tutors completed the 24-item TS-scale before (pretest) and after (posttest) the FD course. Their self-rated confidence improved significantly across the three factors after the FD course. The pretest and posttest scores did not differ according to the tutors' gender, the grades they taught, or their specialty background. CONCLUSIONS: Novice PBL tutors benefit from FD that incorporates tutor shadowing in the 3 key domains of tutoring competencies. The TS-scale developed in this study can be applied in future research on FD design.

Internet-Specific Epistemic Beliefs in Medicine and Intention to Use Evidence-Based Online Medical Databases Among Health Care Professionals: Cross-sectional Survey.

BACKGROUND: Evidence-based medicine has been regarded as a prerequisite for ensuring health care quality. The increase in health care professionals' adoption of web-based medical information and the lack of awareness of alternative access to evidence-based online resources suggest the need for an investigation of their information-searching behaviors of using evidence-based online medical databases. OBJECTIVE: The main purposes of this study were to (1) modify and validate the internet-specific epistemic beliefs in medicine (ISEBM) questionnaire and (2) explore the associations between health care professionals' demographics, ISEBM, and intention to use evidence-based online medical databases for clinical practice. METHODS: Health care professionals in a university-affiliated teaching hospital were surveyed using the ISEBM questionnaire. The partial least squares-structural equation modeling was conducted to analyze the reliability and validity of ISEBM. Furthermore, the structural model was analyzed to examine the possible linkages between health professionals' demographics, ISEBM, and intention to utilize the evidence-based online medical databases for clinical practice. RESULTS: A total of 273 health care professionals with clinical working experience were surveyed. The results of the measurement model analysis indicated that all items had significant loadings ranging from 0.71 to 0.92 with satisfactory composite reliability values ranging from 0.87 to 0.94 and average variance explained values ranging from 0.70 to 0.84. The results of the structural relationship analysis revealed that the source of internet-based medical knowledge (path coefficient -0.26, P=.01) and justification of internet-based knowing in medicine (path coefficient 0.21, P=.001) were correlated with the intention to use evidence-based online medical databases. However, certainty and simplicity of internet-based medical knowledge were not. In addition, gender (path coefficient 0.12, P=.04) and academic degree (path coefficient 0.15, P=.004) were associated with intention to use evidence-based online medical databases for clinical practice. CONCLUSIONS: Advancing health care professionals' ISEBM regarding source and justification may encourage them to retrieve valid medical information through evidence-based medical databases. Moreover, providing support for specific health care professionals (ie, females, without a master's degree) may promote their intention to use certain databases for clinical practice.

Reappraisal of effects of serum chemerin and adiponectin levels and nutritional status on cardiovascular outcomes in prevalent hemodialysis patients.

Although chemerin, an adipokine, increases the cardiovascular (CV) risk in obese people, it is associated with a survival advantage in incident hemodialysis (HD) patients. We explored the potential effects of chemerin on CV outcomes in prevalent HD patients. This prospective study included 343 prevalent HD patients. The composite outcome was the occurrence of CV events and death during follow-up. We used multivariate Cox regression analysis to test the predictive power of different chemerin and adiponectin levels and geriatric nutritional risk index (GNRI) for the outcomes. HD patients with higher chemerin levels (≥211.4 ng/mL) had a lower risk of CV events (adjusted hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.41-0.98) and composite CV outcome (adjusted HR, 0.67; 95% CI, 0.45-0.99) than those with lower chemerin levels (<211.4 ng/mL). When evaluating CV outcomes, we identified an interaction between chemerin levels and GNRI, but not between chemerin and adiponectin levels. The findings remained robust in the sensitivity analysis. Thus, in prevalent HD patients with negligible residual renal function, higher chemerin levels predict more favourable CV outcomes.

Exploring the relationships between epistemic beliefs about medicine and approaches to learning medicine: a structural equation modeling analysis.

BACKGROUND: Students' epistemic beliefs may vary in different domains; therefore, it may be beneficial for medical educators to better understand medical students' epistemic beliefs regarding medicine. Understanding how medical students are aware of medical knowledge and how they learn medicine is a critical issue of medical education. The main purposes of this study were to investigate medical students' epistemic beliefs relating to medical knowledge, and to examine their relationships with students' approaches to learning medicine. METHODS: A total of 340 undergraduate medical students from 9 medical colleges in Taiwan were surveyed with the Medical-Specific Epistemic Beliefs (MSEB) questionnaire (i.e., multi-source, uncertainty, development, justification) and the Approach to Learning Medicine (ALM) questionnaire (i.e., surface motive, surface strategy, deep motive, and deep strategy). By employing the structural equation modeling technique, the confirmatory factor analysis and path analysis were conducted to validate the questionnaires and explore the structural relations between these two constructs. RESULTS: It was indicated that medical students with multi-source beliefs who were suspicious of medical knowledge transmitted from authorities were less likely to possess a surface motive and deep strategies. Students with beliefs regarding uncertain medical knowledge tended to utilize flexible approaches, that is, they were inclined to possess a surface motive but adopt deep strategies. Students with beliefs relating to justifying medical knowledge were more likely to have mixed motives (both surface and deep motives) and mixed strategies (both surface and deep strategies). However, epistemic beliefs regarding development did not have significant relations with approaches to learning. CONCLUSIONS: Unexpectedly, it was found that medical students with sophisticated epistemic beliefs (e.g., suspecting knowledge from medical experts) did not necessarily engage in deep approaches to learning medicine. Instead of a deep approach, medical students with sophisticated epistemic beliefs in uncertain and justifying medical knowledge intended to employ a flexible approach and a mixed approach, respectively.

Improving Health Care Providers' Capacity for Self-Regulated Learning in Online Continuing Pharmacy Education: The Role of Internet Self-Efficacy.

INTRODUCTION: Although Internet-based learning is widely used to improve health professionals' knowledge and skills, the self-regulated learning (SRL) activities of online continuing education in pharmacy are seldom discussed. The main purpose of this study was to explore the relationships between pharmacists' Internet self-efficacy (ISE) and their SRL in online continuing education. METHODS: A total of 164 in-service pharmacists in Taiwan were surveyed with the Internet Self-Efficacy Survey, including basic ISE (B-ISE), advanced ISE (A-ISE) and professional ISE (P-ISE), as well as the Self-Regulated Learning Questionnaire consisting of preparatory SRL (P-SRL) and enactment SRL (E-SRL). RESULTS: Results of a 1-by-3 (educational levels: junior college versus bachelor versus master) analysis of variance and a 1-by-4 (institutions: community-based versus hospital versus clinic versus company) analysis of variance revealed that there were differences in ISE and SRL among different education levels and working institutions. The hierarchical regression analyses indicated that B-ISE and P-ISE were significant predictors of P-SRL, whereas P-ISE was a critical predictor of E-SRL. Moreover, the interaction of P-ISE × age was linked to E-SRL, implying that P-ISE has a stronger influence on E-SRL for older pharmacists than for younger pharmacists. However, the interactions between age and ISE (A-ISE, B-ISE, and P-ISE) were not related to P-SRL. DISCUSSION: This study highlighted the importance of ISE and age for increasing pharmacists' SRL in online continuing education.

The roles of social factor and internet self-efficacy in nurses' web-based continuing learning.

This study was conducted to explore the relationships among social factor, Internet self-efficacy and attitudes toward web-based continuing learning in a clinical nursing setting. The participants recruited were 244 in-service nurses from hospitals in Taiwan. Three instruments were used to assess their perceptions of social factor, Internet self-efficacy (including basic and advanced Internet self-efficacy) and attitudes toward web-based continuing learning (including perceived usefulness, perceived ease of use, affection and behavior). Structural equation modeling (SEM) was utilized to identify the hypothesized structural model. The results of this study support that social factor is a significant factor correlated to Internet self-efficacy and attitudes toward web-based continuing learning (including perceived usefulness, perceived ease of use and affection). In addition, nurses' basic Internet self-efficacy plays a key role in attitudes including perceived usefulness, perceived ease of use and affection. However, advanced self-efficacy was not correlated to any of the attitudes. The behavior dimension was not linked to social factor or Internet self-efficacy, but was linked to perceived ease of use and affection.

The relationships among nurses' job characteristics and attitudes toward web-based continuing learning.

The purpose of this study was to explore the relationships between job characteristics (job demands, job control and social support) and nurses' attitudes toward web-based continuing learning. A total of 221 in-service nurses from hospitals in Taiwan were surveyed. The Attitudes toward Web-based Continuing Learning Survey (AWCL) was employed as the outcome variables, and the Chinese version Job Characteristic Questionnaire (C-JCQ) was administered to assess the predictors for explaining the nurses' attitudes toward web-based continuing learning. To examine the relationships among these variables, hierarchical regression was conducted. The results of the regression analysis revealed that job control and social support positively associated with nurses' attitudes toward web-based continuing learning. However, the relationship of job demands to such learning was not significant. Moreover, a significant demands×job control interaction was found, but the job demands×social support interaction had no significant relationships with attitudes toward web-based continuing learning.

Serum fetuin A and chemerin levels correlate with hepatic steatosis and regional adiposity in maintenance hemodialysis patients.

BACKGROUND: A deficiency of fetuin A is linked to cardiovascular calcification and mortality in dialysis patients. But, high levels of fetuin A and chemerin correlate with hepatic steatosis and regional adiposity in general population. The association between hepatic steatosis and fetuin A/chemerin levels in hemodialysis (HD) remains unclear. METHODS: We performed a cross-sectional, observational study; 216 prevalent HD patients from a single center were enrolled. Baseline serum fetuin A, chemerin levels, conicity index and anthropometric parameters were checked. Presence of hepatic steatosis was qualified by liver ultrasound and quantified by the hepato-renal index (HRI); central obesity defined by waist circumference (WC). ROC analyses and multivariate logistic regression analyses for prediction of hepatic steatosis and central obesity on the basis of fetuin A/chemerin levels, anthropometric parameters, and other relevant covariates were performed. RESULTS: Data from 103 women and 113 men (mean age 60±12 years) were analyzed. Eighty subjects had hepatic steatosis and their HRIs were significantly higher than those without hepatic steatosis (P<0.001). Serum fetuin A levels were positively associated with HRIs (P<0.001) and chemerin levels (P<0.001). Fetuin A, chemerin and WC were predictors for hepatic steatosis and central obesity by ROC curve. In multivariate logistic regression analysis, fetuin A and WC independently predicted hepatic steatosis defined by HRIs. And chemerin predicted central obesity and regional adiposity after covariate adjustments (all P<0.05). CONCLUSIONS: Serum fetuin A levels were higher in prevalent HD patients with hepatic steatosis, and positively correlated with chemerin levels. Chemerin levels predicted central obesity as well as regional adiposity in the HD patients.

Factors influencing the intention to utilize out-of-pocket health checkup services: A sample of citizens from 12 townships of Taichung County in Taiwan.

BACKGROUND: Taiwan started its National Health Insurance (NHI) system in 1995. However, until now, most cancer screening tests and preventive care have been out-of-pocket (OOP) medical items excluded from the coverage of NHI. The aim of this study was to explore the factors influencing an individual's intention to utilize OOP health checkups. METHODS: A cross-sectional research method was adopted in this study. Based on the theory of planned behavior, a questionnaire was developed and used to survey purposively sampled residents (n = 940) from 12 randomly selected townships in Taichung County, Taiwan, from August to September 2006. Descriptive statics and linear regression were conducted to analyze the collected data. RESULTS: Our results showed that result evaluation (beta = 0.092), behavioral beliefs (beta = 0.088), behavioral norms of people with experience in utilizing OOP health checkups (beta = 0.116), perceived convenience (beta = 0.273), and worry about illness and perceived health (beta = 0.110) were important factors influencing the intention to utilize OOP health checkups. Age, education and acceptable health checkup charges were also related. CONCLUSION: Reinforcing disease- and health checkup-related knowledge may positively influence an individual's intention to utilize OOP health checkups. In addition, improving perceived convenience and reducing disease-screening barriers can intensify the individual's intention to use OOP health checkups. The influence of age, education level and OOP checkup charges should also be taken into consideration when related policies are formulated.

The effects of job demands, control, and social support on hospital clinical nurses' intention to turn over.

Nursing turnovers may cause a serious setback to the quality of health delivery system. In addition, this turnover increases direct and indirect labor costs. This study examined the influence of job demand, job control, and social support on clinical nurses' turnover intention based on the job strain model. In total, 373 hospital clinical nurses in northern, central, and southern Taiwan were surveyed. The results show that nurses in high job demand and low-control work situations reveal the highest turnover intention. Job-related social support may decrease this turnover rate.

Skin color is associated with insulin resistance in nondiabetic peritoneal dialysis patients.

BACKGROUND: Changes in skin color are common among dialysis patients. They are associated with urochrome pigments, hemoglobin, and changes in cutaneous vasculature. Insulin resistance (IR) is strongly linked to cutaneous vascular dysfunction and is prevalent in dialysis patients. We postulated skin color may be associated with IR in dialysis patients because of the alternation in cutaneous vasculature. METHODS: 50 nondiabetic peritoneal dialysis (PD) patients were recruited for measurements of skin color by the Commission Internationale de I'Eclairage (CIE; International Commission on Illumination) system ("L" "a" "b" system). The "L" values represent skin brightness, "a" redness, and "b" yellowness. Correlation analysis between skin color, homeostatic model assessment (HOMA(IR)), high-density lipoprotein cholesterol (HDL-C), and adiponectin was performed. RESULTS: We divided patients (age 45 +/- 13 years, 31 women) into 3 groups according to tertiles of HOMA(IR). Patients with higher HOMA(IR) had a trend to have poor skin color (lower "a" and "b" values; p = 0.038 and 0.064). HOMA(IR), adiponectin, and HDL-C levels were correlated with "a" and "b" values in logarithm (all p < 0.05). After adjustments for age, hemoglobin level, duration of PD, and residual renal glomerular filtration rate, only HOMA(IR) was associated with "a" values (p = 0.038) and HDL-C was associated with "b" values (p = 0.048) in logarithm. CONCLUSIONS: Skin color, measured noninvasively, is associated with HOMA(IR) and HDL-C. Nondiabetic PD patients that had more severe IR had worse skin color.

Association of serum fetuin A with truncal obesity and dyslipidemia in non-diabetic hemodialysis patients.

BACKGROUND: Fetuin A, a predictor of cardio-vascular (CV) mortality in dialysis patients has been associated with dyslipidemia in non-diabetic coronary artery disease. Truncal obesity is linked to dyslipidemia and also predicts CV mortality. This study had aimed to investigate the associations among fetuin A, truncal obesity, and dyslipidemia in hemodialysis (HD) patients. METHODS: One hundred and nine non-diabetic HD patients were evaluated. Waist circumference, highly sensitive C-reactive protein (hs-CRP), fetuin A, and lipoprotein levels (i.e. total cholesterol (T-CHO), low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), non-HDL-C, and triglyceride (TG)) were measured for analysis of correlations. The patients were divided into tertiles by fetuin A concentrations. RESULTS: Data from 63 women and 46 men aged 60+/-13 years were analyzed. Patients in the highest tertile of fetuin A (0.33-0.51 g/l) had higher serum creatinine, albumin, T-CHO, LDL-C, non-HDL-C, and TG, more truncal obesity and lower hs-CRP than patients in the lowest tertile (all P<0.05). In multi-variable linear regression analysis, fetuin A was independently associated with TG level and total iron binding capacity after adjustments for age, hemoglobin, albumin, calcium, body mass index, and hs-CRP. Patients in the highest fetuin A tertile had 3.2- and 4.4-fold higher incidence of truncal obesity (P=0.038) and hyper-triglyceridemia (P=0.015) independent of nutritional status and inflammation. CONCLUSION: Fetuin A is positively associated with truncal obesity and dyslipidemia, which are independent of malnutrition and inflammation. It may predict visceral adiposity and dyslipidemia, especially TG and TG-rich lipoproteins, in HD patients.

Factors influencing the purchasing behavior of TCM outpatients in Taiwan.

OBJECTIVES: To test the factors that influence Chinese medicine outpatients' behavior patterns in purchasing Traditional Chinese Medicine (TCM) under the National Health Insurance (NHI) system in Taiwan. METHODS: A structural questionnaire was developed and administered to randomly selected outpatients waiting for Chinese Medicine at pharmacies in two academic hospitals that offered Chinese Medicine services in central Taiwan. A total of 641 effective questionnaires were collected. SPSS 10.0 (Statistical Package for Social Sciences, SPSS Inc., Chicago, IL) was used to run descriptive analysis and one-way analysis of variance (ANOVA). In addition, LISREL 8.30 (Analytical Package, Scientific Software International, Inc., Chicago, IL) was used to modify and analyze the relationship between the variables of the hypothetical pathway model. RESULTS: Path analysis showed that "behavioral intention" and "suffering from disease" had positive and direct influences on the outpatients' patterns of purchasing TCM. Furthermore, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly influenced the purchasing behavior of TCM outpatients. In addition, one-way ANOVA showed that the purchasing behavior was significantly influenced by the number of diseases that an individual suffered. The results of the pathway model showed that "behavioral intention" and "suffering from disease" had positive and direct influence on the TCM purchasing behavior of Chinese Medicine outpatients. However, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly had influence on the TCM purchasing behavior. Furthermore, the analysis result of one-way ANOVA showed that the more chronic diseases the surveyed subject suffered, the more significant the influence on purchasing behavior became. CONCLUSIONS: Under the current NHI system, patients with multiple chronic diseases are the major purchasers of TCM products not covered by NHI. Therefore, increasing the usable resources of TCM products for the patients with chronic diseases will help hospitals in developing TCM services under the current NHI system.

A study on the clinical effects of physical therapy and acupuncture to treat spontaneous frozen shoulder.

The integration of traditional Chinese and Western medicine and their clinical effects have been widely evaluated. Many studies have shown that using a combination of these two remedies has resulted in better outcomes than using only one of them. Acupuncture is a traditional Chinese medical technique, which plays an important role in enforcing pain control, prevention and functional improvement. In 1979, the World Health Organization (WHO) journal introduced acupuncture as a remedy for 43 diseases, including frozen shoulder. This study aims to assess the therapeutic outcomes of combining acupuncture and physical therapy to treat frozen shoulder, and hopes to establish an evidence-based study of the integration of acupuncture and western medicine in the future. A total of 75 frozen shoulder patients treated in a medical center were recruited for the study between January 2002 and December 2002. The average age of these patients was 54.8 years. The average duration of the condition was 25.8 weeks before treatment. Of the 75 patients, 30 were treated by physical therapy, 30 by acupuncture and 15 by both remedies. Before the treatment began, all patients were evaluated by assessing static pain scale, motion pain scale, active and passive ROM (range of motion) and quality of life scale sheet SF-36 (Short Form-36). The outcome was evaluated by follow-up assessments conducted at the 2nd week and 4th week of treatment sessions. All patients showed improvement in quality of life (Short Form-36). Pain was controlled better by acupuncture while ROM improved following physical therapy. However, patients treated by both methods had the best outcome. The integration of acupuncture and physical therapy to treat frozen shoulder leads to a better outcome than using only one method. The author suggests that an evidence-based foundation of the integration of Chinese and Western medicine should be established in the future, to encourage the integration of Chinese and Western medicine.