[The Effects of the Question Prompt List on Usefulness, Satisfaction and Anxiety in Patients With Terminal Cancer: A Meta-Analysis].

BACKGROUND: Difficulties and anxiety caused by poor communication between patients with terminal cancer and their caregivers and medical teams are common in clinical practice. This may lead to uncertainty and fear of treatment, affecting the progress of treatment and achievement of hospice-care goals. The results of prior research indicate that using a question prompt list to promote shared decision-making can improve communication between medical care providers and patients. PURPOSE: This study was developed to explore the effectiveness of using question prompt lists in communications with terminal cancer patients and their families in clinical settings in Taiwan. METHODS: A systematic review of the literature using a meta-analysis research design was conducted in this study. Cochrane Risk of Bias Tool 2 was used to assess literature quality. The selected keywords were used to search six databases, including the English-language PubMed, Cochrane Library, Embase, EBSCOhost, and MEDLINE databases and the Chinese-language Airiti Library database. RevMen 5.4 software (the latest version released by the Nordic Cochrane Center in September 2020) was used for data analysis. RESULTS: Applying the question prompt list was found to significantly increase the number of questions asked (MD = 2.45, p = .01) and the usefulness (SMD = 0.25, p = .02). However, no significant changes in consultation time (MD = 4.49, p = .11), satisfaction (MD = 0.08, p = .91), or anxiety (SMD = 0.06, p = .62) were found. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results support that simplifying and focusing the topics of each chapter and theme of the question prompt list based on time of use may allow the list to be used effectively in combination with family meetings in clinical practice and to be focused based on patient, caregiver, and family needs to facilitate more-productive discussions. This will allow meetings to better facilitate therapeutic relationships and patient and caregiver participation in treatment plans. An external communication coach may be added in the future to help patients and caregivers clarify needs and concerns and improve the effectiveness of consultations. As questioning skills are important to empowering patients, a question prompt list for patients with terminal cancer should be developed. The results of this study may be used to guide the practice of healthcare providers and referenced in caregiver in-service education.

Spiritual practices and effects of spiritual well-being and depression on elders' self-perceived health.

As the population is quickly ageing, strategies for helping elders to maintain and promote good health and well-being are urgently needed. Self-perceived health is a powerful predictor of mortality, physical morbidity, and disability among elderly people. Delivering culturally competent care is necessary for taking care of elders. Self-perceived health is a powerful predictor of mortality, physical morbidity, and disability among elderly people. Spiritual well-being has been found particularly important for older adults' overall health. This descriptive, correlational and predictive study used data that was collected from a convenience sample (N = 150) to examine the effects of spiritual well-being on the relationship between depression and self-perceived health, and to describe spiritual practices commonly used by Taiwanese elders. Findings from this study revealed that spiritual well-being was positively correlated with self-perceived health, negatively associated with depression, and significantly mediated the relationship between depression and self-perceived health. Relaxation and exercise were the most commonly used spiritual practices by Taiwanese elders. Findings from this study support the important role of spiritual well-being in elders' health and add to the body of knowledge about the spiritual practices used by Taiwanese elders. Nurses and health care providers should deliver culturally appropriate spiritual care to enhance spiritual well-being for elders to maintain good health for diverse elder population.

In Vitro and In Vivo Anti-Osteoarthritis Effects of 2,3,5,4'-Tetrahydroxystilbene-2-O-ß-d-Glucoside from Polygonum Multiflorum.

Polygonum multiflorum Thunb. is a traditional herbal medicine that is rich in polyphenols. The major compound, 2,3,5,4'-tetrahydroxystilbene-2-O-ß-d-glucoside (THSG) has many pharmacological activities, such as antioxidative and free radical-scavenging properties, and the abilities to reduce hyperlipidemia, prevent lipid peroxidation, and protect the cardiovascular system. In this study, the anti-osteoarthritis (OA) effects of THSG were explored using in vitro and in vivo models. THSG inhibited nitric oxide (NO) and prostaglandin E2 (PGE2) production and inducible NO synthase (iNOS) and cyclooxygenase-2 expressions by lipopolysaccharide-stimulated RAW 264.7 cells. On the other hand, THSG inhibited PGE2 production and iNOS and matrix metalloproteinase-13 expressions by interleukin-1ß-stimulated primary rat chondrocytes. Through a mono-iodoacetate-induced rat OA model assay, THSG reduced paw edema and improved the weight-bearing distribution. Therefore, THSG has anti-inflammatory activity and could be applied as a lead compound for the development as an OA drug.

The Mediating Effect of Spiritual Well-being on Depressive Symptoms and Health-related Quality of Life Among Elders.

The purpose of this study was to investigate the mediating effect of spiritual well-being (SWB) on depressive symptoms (DS) and health-related quality of life (HRQOL) among Taiwanese elders. A convenience sample of 150 Taiwanese elders completed self-administrated questionnaires participated in this cross-sectional study. This study revealed that SWB was positively related to HRQOL but negatively correlated with DS. Results of hieratical regression analyses suggested that SWB significantly mediated the relationship between DS and mental components of HRQOL. Findings from this study suggest that nurses and health care providers should develop strategies to enhance spiritual well-being when caring for elders to maintain good health and promote quality of life.

Biocompatibility assessment of nanomaterials for environmental safety screening.

In view of the extensive use of nanoparticles in countless applications, a fast and effective method for assessing their potential adverse effects on the environment and human health is extremely important. At present, in vitro cell-based assays are the standard approach for screening chemicals for cytotoxicity because of their relative simplicity, sensitivity, and cost-effectiveness compared with animal studies. Regrettably, such cell-based viability assays encounter limitations when applied to determining the biological toxicity of nanomaterials, which often interact with assay components and produce unreliable outcomes. We have established a cell-impedance-based, label-free, real-time cell-monitoring platform suitable for use in a variety of mammalian cell lines that displays results as cell index values. In addition to this real-time screening platform, other traditional cytotoxicity assays were employed to validate cytotoxicity assessments. We suggest that the cell impedance measurement approach is effective and better suited to determining the cytotoxicity of nanomaterials for environmental safety screening. © 2016 Wiley Periodicals, Inc. Environ Toxicol 32: 1170-1182, 2017.

Capsaicin Inhibits Multiple Bladder Cancer Cell Phenotypes by Inhibiting Tumor-Associated NADH Oxidase (tNOX) and Sirtuin1 (SIRT1).

Bladder cancer is one of the most frequent cancers among males, and its poor survival rate reflects problems with aggressiveness and chemo-resistance. Recent interest has focused on the use of chemopreventatives (nontoxic natural agents that may suppress cancer progression) to induce targeted apoptosis for cancer therapy. Capsaicin, which has anti-cancer properties, is one such agent. It is known to preferentially inhibit a tumor-associated NADH oxidase (tNOX) that is preferentially expressed in cancer/transformed cells. Here, we set out to elucidate the correlation between tNOX expression and the inhibitory effects of capsaicin in human bladder cancer cells. We showed that capsaicin downregulates tNOX expression and decreases bladder cancer cell growth by enhancing apoptosis. Moreover, capsaicin was found to reduce the expression levels of several proteins involved in cell cycle progression, in association with increases in the cell doubling time and enhanced cell cycle arrest. Capsaicin was also shown to inhibit the activation of ERK, thereby reducing the phosphorylation of paxillin and FAK, which leads to decreased cell migration. Finally, our results indicate that RNA interference-mediated tNOX depletion enhances spontaneous apoptosis, prolongs cell cycle progression, and reduces cell migration and the epithelial-mesenchymal transition. We also observed a downregulation of sirtuin 1 (SIRT1) in these tNOX-knockdown cells, a deacetylase that is important in multiple cellular functions. Taken together, our results indicate that capsaicin inhibits the growth of bladder cancer cells by inhibiting tNOX and SIRT1 and thereby reducing proliferation, attenuating migration, and prolonging cell cycle progression.

Capsaicin Inhibited Aggressive Phenotypes through Downregulation of Tumor-Associated NADH Oxidase (tNOX) by POU Domain Transcription Factor POU3F2.

Capsaicin has been reported to preferentially inhibit the activity of tumor-associated NADH oxidase (tNOX), which belongs to a family of growth-related plasma membrane hydroquinone oxidases in cancer/transformed cells. The inhibitory effect of capsaicin on tNOX is associated with cell growth attenuation and apoptosis. However, no previous study has examined the transcriptional regulation of tNOX protein expression. Bioinformatic analysis has indicated that the tNOX promoter sequence harbors a binding motif for POU3F2, which is thought to play important roles in neuronal differentiation, melanocytes growth/differentiation and tumorigenesis. In this study, we found that capsaicin-mediated tNOX downregulation and cell migration inhibition were through POU3F2. The protein expression levels of POU3F2 and tNOX are positively correlated, and that overexpression of POU3F2 (and the corresponding upregulation of tNOX) enhanced the proliferation, migration and invasion in AGS (human gastric carcinoma) cells. In contrast, knockdown of POU3F2 downregulates tNOX, and the cancer phenotypes are affected. These findings not only shed light on the molecular mechanism of the anticancer properties of capsaicin, but also the transcription regulation of tNOX expression that may potentially explain how POU3F2 is associated with tumorigenesis.

Evaluation of using the Chinese version of the Spirituality Index of Well-Being (SIWB) scale in Taiwanese elders.

PURPOSE: Spirituality and spiritual well-being have emerged as important indicators for one's quality of life and health outcomes. Nursing as a profession is concerned with a holistic approach to improve health and overall well-being. To evaluate the outcomes of holistic nursing interventions, using valid and reliable instruments to assess spiritual well-being becomes necessary. There is a lack of instruments for measuring spiritual well-being in Chinese populations. Little has been known about the feasibility of using the Spirituality Index of Well-Being (SIWB) in Taiwanese elders. The purpose of this cross-sectional study was to evaluate the uses of the translated Chinese version of the Spirituality Index of Well-Being (SIWB-C) with Taiwanese elders. METHODS: A total of 150 individual who were 65 years old or older and living in southern Taiwan were recruited from a public community center. A four-step procedure was used to translate the English version of the SIWB to the traditional Chinese language. Internal consistency, factor analysis, and correlation coefficient were conducted to evaluate the reliability and validity of the SIWB-C. RESULTS: The SIWB-C demonstrated a high internal consistency with Cronbach's alpha .95. The construct validity of SIWB-C was supported by factor analysis and by significant correlations with its subscales and the CES-D scale. CONCLUSION: The psychometric analysis indicates that the SIWB-C is a valid and reliable instrument for measuring spiritual well-being. This instrument provides a feasible and valid approach for assessing Taiwanese elders' spiritual well-being in the future.

Depression and AIDS Preventive Self-efficacy Among Taiwanese Adolescents.

Effectively reducing adolescents' risky sexual behaviors has been an urgent need since the HIV/AIDS infections among young people has been acknowledged as a priority. Self-efficacy has been considered playing an essential role in behavioral changes, and depressed individuals may demonstrate lower self-efficacy. The purpose of this cross-sectional study was to gain insights into self-reported depression among 16-18 years-old Taiwanese adolescents as well as to explore psychosocial predictors of AIDS preventive self-efficacy. A convenience sample of 734 adolescents from southern Taiwan was recruited, and several reliable and valid questionnaires were used to collect data. Descriptive statistics, odds ratio, independent t-test, and hierarchical multiple regression analyses were utilized to analyze data. Results showed that the differences in self-reported depression and in the AIDS preventive self-efficacy varied by gender, substance use, and having sexual experience. Furthermore, depression was a significant predictor of AIDS preventive self-efficacy while controlling the covariates. This study suggests that gender and mental health status such as depression may play significant roles in AIDS preventive self-efficacy. Nurses and health care providers should take the influence of mental health into consideration when designing AIDS preventive interventions for male and female Taiwanese adolescents. The provided information may also enhance psychiatric nurses' capability to provide care and to enhance the prevention of HIV infection for adolescents.

Optimization of titanium dioxide and immunoaffinity-based enrichment procedures for tyrosine phosphopeptide using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry.

Tyrosine phosphorylation is an important regulator of signaling in cellular pathways, and dysregulated tyrosine phosphorylation causes several diseases. Mass spectrometry has revealed the importance of global phosphoproteomic characterization. Analysis of tyrosine phosphorylation by studying the mass-spectrometry (MS)-determined phosphoproteome remains difficult because of the relatively low abundance of tyrosine phosphoproteins. To effectively evaluate tyrosine-phosphopeptide enrichment and reduce ion suppression from non-phosphorylated peptides in MS analysis, three trypsin-digested BSA peptides and 14 standard phosphopeptides, including six tyrosine phosphopeptides, four serine phosphopeptides, and four threonine phosphopeptides, were subjected to titanium dioxide immunoaffinity-based enrichment and also to combined enrichment using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and liquid chromatography-mass spectrometry (LC-MS) analyses. The enrichment factors were evaluated to determine the efficiency of each enrichment procedure. Comparison of five optimized enrichment methods, including TiO2-based immunoaffinity purification in Tris and MOPS buffer systems, TiO2-immunoaffinity enrichment, and immunoaffinity-TiO2 enrichment for total tyrosine, serine and threonine phosphopeptides, revealed that the order of the enrichment factors for total tyrosine phosphopeptides is: (i) immunoaffinity-TiO2 (enrichment factor = 38,244), (ii) TiO2-immunoaffinity (enrichment factor = 24,987), (iii) TiO2 micro-column (enrichment factor = 10,305), (iv) immunoaffinity in Tris buffer system (enrichment factor = 1450), and (v) immunoaffinity in the MOPS buffer system (enrichment factor = 32). These results reveal that an alternative enrichment scheme before use of a TiO2 micro-column, using immunoaffinity 4G10 and PY99 antibody enrichment under optimized conditions, can provide greater selectivity for tyrosine-phosphopeptide enrichment.

Emergency visits among end-of-life cancer patients in Taiwan: a nationwide population-based study.

BACKGROUND: An increased number of emergency visits at the end of life may indicate poor-quality cancer care. The study aimed to investigate the prevalence and utilization of emergency visits and to explore the reasons for emergency department (ED) visits among cancer patients at the end of life. METHODS: A retrospective cohort study was performed by tracking one year of ambulatory medical service records before death. Data were collected from the cancer dataset of Taiwan's National Health Insurance Research Database (NHIRD). RESULTS: A total of 32,772 (19.2%) patients with malignant cancer visited EDs, and 23,883 patients died during the study period. Of these, the prevalence of emergency visits in the mortality group was 81.5%, and their ED utilization was significantly increased monthly to the end of life. The most frequent types of cancer were digestive and peritoneum cancers (34.8%), followed by breast cancer (17.7%) and head and neck cancers (13.3%). Older patients, males, and those diagnosed with metastases, respiratory or digestive cancer were more likely to use ED services at the end of life. Use of an ED service in the nearest community hospital to replace medical centers for dying cancer patients would be more acceptable in emergency situations. CONCLUSIONS: Our study provided population-based evidence related to ED utilization. An understanding of the reasons for such visits could be useful in preventing overuse of ED visits to improve the quality of end-of-life care.

Extensive evaluations of the cytotoxic effects of gold nanoparticles.

BACKGROUND: Many in vitro studies have revealed that the interference of dye molecules in traditional nanoparticle cytotoxicity assays results in controversial conclusions. The aim of this study is to establish an extensive and systematic method for evaluating biological effects of gold nanoparticles in mammalian cell lines. METHODS: We establish the cell-impedance measurement system, a label-free, real-time cell monitoring platform that measures electrical impedance, displaying results as cell index values, in a variety of mammalian cell lines. Cytotoxic effects of gold nanoparticles are also evaluated with traditional in vitro assays. RESULTS: Among the six cell lines, gold nanoparticles induce a dose-dependent suppression of cell growth with different levels of severity and the suppressive effect of gold nanoparticles was indirectly associated with their sizes and cellular uptake. Mechanistic studies revealed that the action of gold nanoparticles is mediated by apoptosis induction or cell cycle delay, depending on cell type and cellular context. Although redox signaling is often linked to the toxicity of nanoparticles, in this study, we found that gold nanoparticle-mediated reactive oxygen species generation was not sustained to notably modulate proteins involved in antioxidative defense system. CONCLUSION: The cell-impedance measurement system, a dye-free, real-time screening platform, provides a reliable analysis for monitoring gold nanoparticle cytotoxicity in a variety of mammalian cell lines. Furthermore, gold nanoparticles induce cellular signaling and several sets of gene expression to modulate cellular physical processes. GENERAL SIGNIFICANCE: The systematic approach, such as cell-impedance measurement, analyzing the toxicology of nanomaterials offers convincing evidence of the cytotoxicity of gold nanomaterials.

Relationship of abdominal circumference and trunk length with spinal anesthesia level in the term parturient.

BACKGROUND: We hypothesized that body shape metrics influence the anatomy of spinal canal and intraabdominal pressure in three dimensions. We explored the effects of abdominal circumference, trunk length, and their combination on the level of spinal anesthesia in the term parturient in this study. METHODS: Thirty term parturients, ASA class I-II, from 20 to 41 years of age, scheduled for cesarean section were enrolled in this observational study. Abdominal circumference (AC) and trunk length (TL) were recorded preoperatively. Spinal anesthesia was performed with 10 mg 0.5% hyperbaric bupivacaine at the L4-L5 intervertebral space in all parturients. Correlation between maximal sensory spinal anesthesia level and physical parameters was analyzed with Spearman rank correlation coefficients. The calculated r value was compared with r = 0 with p < 0.05 as the significant level. The prediction power of these physical parameters for spinal level was evaluated by prediction probability. RESULTS: The parameter TL/AC2 was statistically correlated with maximal sensory level (Spearman correlation coefficient, -0.45 with p < 0.02). The prediction probability of TL/AC2 for the dermatomal level was P K = 0.685. If the dermatomal levels were lumped as higher (above T2) and lower (below T3) levels, the prediction probability of TL/AC2 was as high as P K = 0.856. CONCLUSIONS: TL/AC2, which simulated the ratio of the long axis and transection area of the abdomen, was correlated with maximal spinal level, and parturients with low TL/AC2 values tended to have higher dermatomal levels during spinal anesthesia.

Recruiting Chinese American adolescents to HIV/AIDS-related research: a lesson learned from a cross-sectional study.

The purpose of this article was to report identified barriers and challenges experienced in the recruiting process of Chinese American adolescents to a cross-sectional HIV/AIDS-related study. Snowball sampling method was used to recruit Chinese American adolescents from Chinese American communities in a U.S. Midwestern state. Barriers and challenges to recruitment were reviewed and analyzed from Chinese cultural perspectives in the hope of aiding researchers and health care providers understand and facilitate future recruitment of Chinese Americans for HIV/AIDS prevention studies. Barriers to recruitment were found related to the taboo topic of sexual issues in Chinese culture, unawareness and denial of HIV/AIDS risks, authoritarian parenting style in Chinese culture, and the required active consents. Facilitating factors of recruiting Chinese American adolescents to future HIV/AIDS prevention research or intervention programs are discussed. Information provided in this article may increase nurses' awareness of various barriers that they might encounter when they conduct research or address HIV/AIDS-related topics of Chinese American adolescents.

Expectations of an Online-Self-Management Program for Rheumatoid Arthritis.

This qualitative descriptive study aimed to explore expectations of patients and healthcare experts for an online self-management program for rheumatoid arthritis. Participants were recruited from rheumatology clinics, medical centers, and universities in Taiwan. Individual face-to-face, semi-structured interviews were conducted with patients (n = 16) and healthcare experts (n = 7). Content analysis of the interview data resulted in five subthemes for expectations of an online self-management program: information about how the disease trajectory would impact future health status, availability of opportunities for self-monitoring, opportunities to interact with fellow patients and healthcare providers, simplicity and ease-of-use of the program, and methods to facilitate patient-motivation. These subthemes formulated two overarching themes: content and format. An online self-management program for patients with rheumatoid arthritis should provide evidence-based information about disease variables and behaviors aligned with the specific needs of the individual and adopt strategies that encourage and increase motivation and confidence.

Treatment incidence of and medical utilization for hospitalized subjects with pathologic fractures in Taiwan-Survey of the 2008 National Health Insurance data.

BACKGROUND: Almost all studies of pathologic fractures have been conducted based on patients with tumours and hospital-based data; however, in the present study, a nationwide epidemiological survey of pathologic fractures in Taiwan was performed and the medical utilization was calculated. METHODS: All claimants of Taiwan's National Health Insurance (NHI) Program in 2008 were included in the target population of this descriptive cross-sectional study. The registration and inpatient expenditure claims data by admission of all hospitalized subjects of the target population were examined and the concomitant International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes were evaluated and classified into seven major categories of fracture. RESULTS: A total of 5,244 incident cases of pathologic fracture were identified from the 2008 hospitalized patient claims data. The incidence of pathologic fracture of the humerus, distal radius/ulna, vertebrae, femoral neck, other part of the femur, and tibia/fibula was 0.67, 0.08, 10.58, 1.11, 0.56, and 0.11 per 100,000 people, respectively, and patients with those fractures were hospitalized for 43.9 ± 42.9, 31.1 ± 32.9, 29. 4 ± 34.4, 43.3 ± 41.2, 42.4 ± 38.1, and 42.0 ± 32.8 days, respectively, incurring an average medical cost of US$11,049 ± 12,730, US$9,181 ± 12,115, US$6,250 ± 8,021, US$9,619 ± 8,906, US$10,646 ± 11,024, and US$9,403 ± 9,882, respectively. The percentage of patients undergoing bone surgery for pathologic fracture of the humerus, radius/ulna, vertebrae, femoral neck, other part of the femur, and tibia/fibula was 31.2%, 44.4%, 11.3%, 46.5%, 48.4%, and 52.5% respectively. CONCLUSIONS: Comparing Taiwan to other countries, this study observed for Taiwan higher medical utilization and less-aggressive surgical intervention for patients hospitalized with pathologic fractures.

Epidemiological survey of orthopedic joint dislocations based on nationwide insurance data in Taiwan, 2000-2005.

BACKGROUND: The epidemiology of acute orthopedic dislocations is poorly understood. A nationwide database provides a valuable resource for examining this issue in the Taiwanese population. METHODS: A 6-year retrospective cohort study of 1,000,000 randomly-sampled beneficiaries from the year 2005 was used as the original population. Based on the hospitalized and ambulatory data, the concomitant ICD9-CM diagnosis codes and treatment codes were evaluated and classified into 8 and 3 major categories, respectively. The cases matching both inclusive criteria of dislocation-related diagnosis codes and treatment codes were defined as incident cases. RESULTS: During 2000-2005, the estimated annual incidence (per 100,000 population) of total orthopedic dislocations in Taiwan was 42.1 (95%CI: 38.1-46.1). The major cause of these orthopedic dislocations was traffic accidents (57.4%), followed by accident falls (27.5%). The annual incidence dislocation by location was shoulder, 15.3; elbow, 7.7; wrist, 3.5; finger, 4.6; hip, 5.2; knee, 1.4; ankle, 2.0; and foot, 2.4. Approximately 16% of shoulder dislocations occurred with other concomitant fractures, compared with 17%, 53%, 16%, 76% and 52%, respectively, of dislocated elbow, wrist, hip, knee, and ankle cases. Including both simple and complex dislocated cases, the mean medical cost was US$612 for treatment of a shoulder dislocation, $504 for the elbow, $1,232 for the wrist, $1,103 for the hip, $1,888 for the knee, and $1,248 for the ankle. CONCLUSIONS: In Taiwan, three-quarters of all orthopedic dislocations were of the upper limbs. The most common complex fracture-dislocation was of the knee, followed by the wrist and the ankle. Those usually needed a treatment combined with open reduction of fractures and resulted in a higher direct medical expenditure.

Effects of Mobile Application Program (App)-Assisted Health Education on Preventive Behaviors and Cancer Literacy among Women with Cervical Intraepithelial Neoplasia.

OBJECTIVE: This study aimed (1) to study the effects of health education on preventive behaviors and cancer literacy among women with cervical intraepithelial neoplasia (CIN); (2) to compare the effects of mobile application program (App)-assisted health education with traditional book-form health education. PARTICIPANTS: A total of 132 women ages 20 to 69 years women. METHODS: This prospective longitudinal study enrolled 132 CIN women who were evaluated three times. Propensity score matching was used by controlling subjects' age strata, body mass index, education level, occupation, and type of surgery. RESULTS: The influences of various educational tools were investigated. Four domains were assessed, including health behavior, attitude towards behavior change, self-efficacy of behavior, and cervical cancer (CCa) literacy. Significant improvements in behavior change and CCa literacy due to a health education program were observed (p ≤ 0.002). The App combined with a traditional booklet had the highest score for behavior change and was significantly greater than the booklet-only learning (p = 0.002). The App-assisted form, either App alone or combined with booklet, had a significantly better impact on health promotion when compared to the booklet alone (p = 0.045 and 0.005, respectively). App-only learning had the highest score of CCa literacy (p = 0.004). CONCLUSION: Health education interventions can have positive effects in terms of change of behavior and CCa literacy. App-assisted learning could be used as a supportive technology, and App learning alone or combined with a traditional booklet may be an innovative model of clinical health promotion for women with CIN.

Prescription Patterns of Wu Lin San Concentrated Extract Product for Cystitis in Taiwan: A Population-Based Study.

The indications for the concentrated extract product (CEP) of Wu Lin San (WLS) are urethritis, cystitis, and gonorrhea. In clinical settings, WLS is combined with other CEPs used. However, there are no prescribed guidelines of CEPs in Taiwan. In this study, we would establish the CEP-prescribed applications of WLS for cystitis according to the clinical prescription patterns and ancient traditional medicine books. The prescription patterns of WLS were analyzed from the National Health Insurance Research Database of Taiwan for the period from 2000 to 2015. The results show that WLS was most frequently prescribed for cystitis (17.12% of a total prescriptions), and its prescribed dosage was 3∼5 g per day. Among them, 62.53% were for patients >40 years, and 72.45% were for women. Moreover, prescription patterns of WLS for cystitis were divided into 4 types: Type 1, WLS combined with Pa Cheng San (PCS) and Ti Tang Tang (29.75%); Type 2, WLS combined with PCS and dandelion (13.89%); Type 3, WLS combined with PCS and Tao Ho Cheng Chi Tang (6.63%); and Type 4, WLS combined with PCS (2.75%). According to lectures, review revealed the following principles of WLS application. WLS only should be adopted for simple heat strangury, while Type 4 should be applied for excess heat and dampness strangury. For patients with heat strangury coupled with an early-stage blood amassment pattern in lower jiao (abdomen), Type 3 could be administered. Type 2 should be used for heat strangury accompanied by dampness toxicity with infection. By contrast, Type 1 should be applied to patients with severe blood stasis. The application principles of WLS with other CEPs could serve as a reference for cystitis treatment in clinical settings.

Utilization of and direct expenditure for emergency medical care in Taiwan: a population-based descriptive study.

BACKGROUND: We surveyed the emergency medical system (EMS) in Taiwan to provide information to policymakers responsible for decisions regarding the redistribution of national medical resources. METHODS: A systematic sampling method was used to randomly sample a representative database from the National Health Insurance (NHI) database in Taiwan, during the period from 2000 to 2004. RESULTS: We identified 10,124, 10,408, 11,209, 10,686, and 11,914 emergency room visits in 2000, 2001, 2002, 2003, and 2004, respectively. There were more males than females, and the majority of adults were younger than 50 years. Diagnose of injury/poisoning was the most frequently noted diagnostic category in emergency departments (EDs) in Taiwan. There were 13,196 (24.3%) and 2,952 (5.4%) patients with 2 and 3 concomitant diagnoses, respectively. There was a significant association between advanced age and the existence of multiple diagnoses (P < 0.001). With the exception of the ill-defined symptoms/signs/conditions, the two most frequent diagnoses were diseases of the circulatory system and diseases of the respiratory system in patients aged 65 years or older. On average, treatment-associated expenditure and drug-associated expenditure in Taiwan EDs averaged NT$1,155 ($35.0) and NT$190 ($5.8), respectively, which was equal to 64.5% and 10.6% of the total ED-associated cost. General ED medical expenditure increased with patient age; the increased cost ratio due to age was estimated at 8% per year (P < 0.001). CONCLUSIONS: The frequency of major health problems diagnosed at ED visits varied by age: more complicated complaints and multiple diagnoses were more frequent in older patients. In Taiwan, the ED system remains overloaded, possibly because of the low cost of an ED visit.