PPARα agonist fenofibrate relieves acquired resistance to gefitinib in non-small cell lung cancer by promoting apoptosis via PPARα/AMPK/AKT/FoxO1 pathway.

Recent studies show that intracellular accumulation of cholesterol leads to acquired resistance to gefitinib in non-small cell lung cancer (NSCLC) cells. In this study we investigated how to regulate the cholesterol levels in gefitinib-resistant NSCLC cells. We showed that intracellular cholesterol levels in gefitinib-resistant cell lines (PC-9/GR, H1975, H1650, and A549) were significantly higher than that in gefitinib-sensitive cell line (PC-9). Treatment with gefitinib (5 µM) significantly increased intracellular cholesterol levels in PC-9/GR, H1975, and H1650 cells. Gefitinib treatment downregulated the expression of PPARα, LXRα, and ABCA1, leading to dysregulation of cholesterol efflux pathway. We found that a lipid-lowering drug fenofibrate (20, 40 µM) dose-dependently increased the expression of PPARα, LXRα, and ABCA1, decreased the intracellular cholesterol levels, and enhanced the antiproliferative effects of gefitinib in PC-9/GR, H1975, and H1650 cells. We revealed that fenofibrate increased the gefitinib-induced apoptosis via regulating the key proteins involved in the intrinsic apoptosis pathway. In PC-9/GR, H1975 and H1650 cells, fenofibrate dose-dependently increased the expression of AMPK, FoxO1, and decreased the expression of AKT, which were remarkably weakened by knockdown of PPARα. In PC-9/GR cell xenograft mice, combined administration of gefitinib (25 mg · kg-1 · d-1) and fenofibrate (100 mg · kg-1 · d-1) caused remarkable inhibition on tumor growth as compared to treatment with either drug alone. All the results suggest that fenofibrate relieves acquired resistance to gefitinib in NSCLC by promoting apoptosis via regulating PPARα/AMPK/AKT/FoxO1 pathway. We propose that combination of gefitinib and fenofibrate is a potential strategy for overcoming the gefitinib resistance in NSCLC.

Stress and uncertainty in parents of children with tracheobronchial malacia and stenosis.

BACKGROUND: An increasing number of children are undergoing flexible bronchoscopy because of tracheobronchial malacia and stenosis, but there is little research related to their parents' stress and uncertainty. AIM: To explore and identify risk factors associated with stress and uncertainty among Taiwanese parents of children with tracheobronchial malacia and tracheabronchostenosis in a paediatric intensive care unit. METHODS: A cross-sectional study design was implemented using two psychometric scales: Parenting Stress Index and Parents' Perception of Uncertainty Scale. Parents of Taiwanese children (0-18 years/o) with a diagnosis of tracheobronchial malacia or/and tracheabronchostenosis who underwent bronchoscopy in a paediatric intensive care unit were recruited. The analysis used descriptive statistics and multivariable linear regression. RESULTS: Ninety parents who were caring for a total of 51 children were recruited. Stress and uncertainty both scored high and were positively correlated with each other. Four risk factors arising from parental stress were unemployment, parental uncertainty, the child's tracheobronchial malacia and tracheabronchostenosis and use of oxygen. CONCLUSIONS: Identifying likely causes of stress and uncertainty is essential for this parental group, particularly for parents facing unemployment, feelings of uncertainty and caring for children with both tracheobronchial malacia and tracheabronchostenosis and requiring oxygen. RELEVANCE TO CLINICAL PRACTICE: Nursing practice can focus on better parental support for those parents who are unemployed, show feeling of uncertainty and care for children with combined tracheobronchial malacia and tracheabronchostenosis and other medical care, such as breathing symptom management, nasogastric feeding and oxygen therapy.

The influence of personality traits and socio-demographic characteristics on paediatric nurses' compassion satisfaction and fatigue.

AIMS: To explore the level of and the association between, compassion satisfaction and fatigue of paediatric nurses; to determine the association between personality traits and compassion satisfaction and fatigue; to identify the determinants of compassion satisfaction and fatigue. BACKGROUND: Paediatric nurses are prone to experiencing compassion fatigue associated with caring for children with illness and their families, yet its connection with nurses' personality traits remains unknown. DESIGN: A cross-sectional descriptive study design was used. METHODS: The data collection used three instruments measuring socio-demography, responses to the compassion satisfaction and fatigue test and the revised NEO personality inventory. The study used descriptive, correlation and multiple regression analysis for the data collected between April - July 2014. RESULTS: From 173 female paediatric nurses, two-thirds worked in critical care units and indicated a satisfactory level of compassion satisfaction and a low level of compassion fatigue, despite a lack of association between the two concepts. Four determinants-agreeableness, extraversion, conscientiousness and engaging with outdoor activities-were predictive and explained 43.6% of total variance of compassion satisfaction. Two risk factors of compassion fatigue identified were less emotional stability and singlehood (marital status) and these explained 26.1% of total variance of compassion fatigue. CONCLUSION: Support for improving agreeableness and emotional stability in paediatric nurses' workplaces including involvement in the outdoor activities and an increase in social connection may enhance compassion satisfaction and prevent exhaustive compassion fatigue.

Primary caregivers of in-home oxygen-dependent children: predictors of stress based on characteristics, needs and social support.

AIM: To identify the predictors of primary caregivers' stress in caring for in-home oxygen-dependent children by examining the association between their levels of stress, caregiver needs and social support. BACKGROUND: Increasing numbers of primary caregivers of oxygen-dependent children experience caregiving stress that warrants investigation. DESIGN: The study used a cross-sectional design with three psychometric scales - Modified-Parenting Stress Index, Caregiver Needs Scale and Social Support Index. METHODS: The data collected during 2010-2011 were from participants who were responsible for their child's care that included oxygen therapy for ≧6 hours/day; the children's ages ranged from 3 months-16 years. Descriptive statistics and multivariable linear regression were used. RESULTS: A total of 104 participants (M = 34, F = 70) were recruited, with an average age of 39·7 years. The average age of the oxygen-dependent children was 6·68 years and their daily use of oxygen averaged 11·39 hours. The caregivers' overall levels of stress were scored as high and information needs were scored as the highest. The most available support from family and friends was emotional support. Informational support was mostly received from health professionals, but both instrumental and emotional support were important. Levels of stress and caregiver needs were significantly correlated. Multivariable linear regression analyses identified three risk factors predicting stress, namely, the caregiver's poor health status, the child's male gender and the caregiver's greater financial need. CONCLUSION: To support these caregivers, health professionals can maintain their health status and provide instrumental, emotional, informational and financial support.

Semi-Prone Position Can Influence Variability in Respiratory Rate of Premature Infants Using Nasal CPAP.

UNLABELLED: To determine the effect of positions (supine, lateral, semiprone) on the physiological parameters (HR, RR, SpO2) of premature infants receiving NCPAP who were non-oxygen-dependent and non-BPD, and to identify significant clinical changes associated with these variables. METHODS: A crossover study design with three different positions in the assigned sequence (supine-supine, supine-lateral and supine-semiprone) was used, and each position was maintained for 1h. The subjects' vital signs were recorded 30 min after initiation of each position and measured for 30 min. RESULTS: Forty-seven infants with a median GA of 28.6 weeks (range 26-35) were studied, and their median BW was 1210g (range 776-2920). Overall, position-related effects showed significant difference in the variability in RR (OR=0.68; CI 0.51-0.89), with the variability in RR being significantly lower in the semiprone position. The lateral position was associated with increased RR (B=2.9; p=0.02). Previous use of ventilator (PUV) was associated with increased HR, whereas BW and GA were negatively associated with higher HR. Cesarean birth, use of surfactant and PUV were associated with lower SpO2, whereas BW and GA were correlated with higher SpO2. GA was identified as a protective factor, while PUV was a risk factor for the variability in both HR and SpO2. CONCLUSIONS: Premature infants receiving NCPAP sleeping in the semiprone position may have more stable RR, while the lateral position did not improve RR. Thus, the semiprone and supine positions may be considered preferable when positioning the monitored premature infants with NCPAP.

A new in situ magnetic method to indicate the source and seasonal diffusion of heavy metal contamination at Qingdao Beach, China.

The accumulation of heavy metals from sewage and garbage dumping can seriously impact beach tourism and thus the local economy, but it is difficult to quickly and accurately determine the pollution location and source of heavy metals and clarify their diffusion range. This study investigates a new in situ magnetic testing method to address this issue. (1) The in situ method can be used to effectively and quickly evaluate heavy metal sources and diffusion ranges based on the distribution of κ values. (2) According to chemical experiments, the specific elements polluting a beach can be determined, such as the Cr, Ni, Zn, and Fe pollution of Beach No. 3. (3) Although κ values for assessing heavy metal pollution on different beaches vary, metal pollution occurs when the higher κ value is more than 50 times the lower κ value on the same beach. (4) The κ values vary in different seasons due to the influence of natural factors and urban seasonal sewage policies.

The experiences of adult ventilator-dependent patients: a meta-synthesis review.

Studies exploring the perceptions of patients whose lives are maintained by mechanical ventilation highlight the stressful nature of this type of experience. The objective of this meta-synthesis study was to describe the nature of the experience of adult ventilator-dependent patients. A systematic literature search of English and Chinese databases was undertaken, covering the period between 1970 and 2012. Qualitative research findings were extracted and pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A total of 1004 papers were identified from various database and hand searches. Nineteen papers were critically appraised and 16 met inclusion criteria. Five meta-synthesis themes emerged from the analysis: (1) the feelings of fear due to being dependent on a ventilator and the loss of control of life; (2) disconnection with reality; (3) impaired embodiment; (4) construction of coping patterns; (5) trust and caring relationship. Suggested implications for practice include enhancing the trust relationship with health professionals, as well as nursing actions throughout the suction procedure relating to release of patient's psychological distress and empowering their resilience factors.

Evaluating nurses' knowledge of chemotherapy.

BACKGROUND: The characteristics of the drugs that are used in chemotherapy have given rise to many issues, one of which is whether nurses are competent when working with chemotherapy. METHODS: Nurses' knowledge of chemotherapy was evaluated with a questionnaire that included 20 true-or-false questions. The questionnaire was developed from literature and expert input and validated by subject experts (content validity). A pilot study (contrasted-groups approach) was also conducted. RESULTS: A total of 203 nurses participated in the study and achieved an average overall correct answer rate of 60.9%. Most of the respondents, 63.5% (129 of 203), had a score of less than 70, and 77.3% (157 of 203) hoped to undergo more training on chemotherapy. Their knowledge of chemotherapy came mainly from consultation with colleagues (4.0 ± 0.8) and in-hospital continuing education (3.9 ± 0.8). CONCLUSION: The evidence-based results suggested that nurses have insufficient knowledge about chemotherapy. More fundamentally, however, nurses need more education about chemotherapy in nursing school and through in-hospital continuing education.

Association of Blood Pressure Indices with Right and Left Cardio-Ankle Vascular Index (CAVI) and Its Mathematically Corrected Form (CAVI0) for the Evaluation of Atherosclerosis.

BACKGROUND AND OBJECTIVES: The cardio-ankle vascular index (CAVI) is an index for arterial stiffness that is theoretically independent of blood pressure. CAVI0 is the mathematically corrected formula of CAVI that has been claimed to be less dependent on blood pressure changes. The association of right and left CAVI and CAVI0 with blood pressure indices can reveal the importance of considering the blood pressure of the patient despite their theoretical independency. In this study, we assessed the right and left CAVI and CAVI0 and evaluated the main effect of blood pressure indices on them with respect to age. MATERIALS AND METHODS: We collected the following data of 136 community-dwelling individuals: age; sex; weight; height; body mass index; right and left CAVI and CAVI0; and systolic (SBP), diastolic (DBP), and mean blood pressure (MBP). The association of right and left CAVI and CAVI0 with blood pressure indices was evaluated using regression analysis. RESULTS: Regression analysis revealed that SBP, DBP, and MBP were associated with right and left CAVI (independent of age). Moreover, SBP was associated with both right and left CAVI0 (independent of age), whereas DBP was not associated with right or left CAVI0. CONCLUSION: Right and left arterial stiffness measured using CAVI has no different associations with SBP, DBP, and MBP. Both right and left CAVI0 were independently associated with SBP, whereas neither left nor right CAVI0 was independently associated with DBP. MBP was only associated with the right-side CAVI0 in community-dwelling individuals.

[Thyroidectomies: surgical site infection risk factors of using prophylactic antibiotics].

BACKGROUND: Surgical site infection is one of the most common types of nosocomial infection and an important factor in increased mortality and medical costs. The effectiveness of prophylactic antibiotics use on thyroidectomy wound sites merits further examination. PURPOSE: This study compared the influence of prophylactic antibiotics use or non-use on surgical site infection risk, average hospital stay length and average medical costs in thyroidectomy patients. METHODS: This cross-sectional study targeted patients undergoing thyroidectomies at the general surgery ward of a medical center during the period 2007 to 2008. Subjects were divided into two groups. The first comprised patients who received prophylactic antibiotics thirty minutes before receiving a thyroidectomy between January 1, 2007 and October 31, 2007. A retrospective review of patient charts and reports was conducted for this group. The second consisted of patients that did not receive prophylactic antibiotics 30 minutes before receiving a thyroidectomy between November 1, 2007 and October 31, 2008 in line with a new antibiotics policy enforced at the research hospital. RESULTS: A total of 310 subjects were enrolled in the study. All subjects were free of surgical site infection. Fifteen patients (4.8%) received a course in antibiotics after surgery and six (40.0%) of these showed surgical site swelling (x² = 120.33; p < .01). Statistically significant risk factors of post-surgery antibiotics use included diabetes mellitus (x² = 6.39; p = .03), a surgery duration in excess of 2 hours (x² = 4.40; p = .04), drainage tube remaining in place at the surgical site (x² = 4.58; p = .03) and drainage tube insertion for more than 2 days (x² = 6.24; p = .03). Significant reductions in average hospital stay length (3.65 days ± 1.04; p < .01) and medical costs (p < .01) were observed when prophylactic antibiotics were not used before surgery. The cost of post-operative antibiotics increased by $5,851 and medical costs increased from $32,436 to $63,895 when hospital stay length exceeded four days. If hospital stay length was kept within four days and post-operative antibiotics were used, this study found no significant difference in drug or medical costs. CONCLUSION: Not using prophylactic antibiotics before thyroidectomy does not increase surgical site infection risk.

Mothers' experience with 1st-3rd-grade children with asthma assisting their child's adaptation of school life in Taiwan.

AIMS AND OBJECTIVES: This study used purposive sampling through semi-structured interviews to obtain the experiences of mothers of 7-11-year-old children with asthma who were assisting their child's adaptation to school life. BACKGROUND: Children with asthma often have problems with social adaptation, including school absenteeism, limits to their activity and bullying by peers. From kindergarten to elementary school, it is a transitional process where the child experiences multiple changes in the body, mind and social situations. It can be difficult for mothers of children with asthma to assist their children with their adaptation to school life. DESIGN: A qualitative enquiry design was used. METHODS: A total of 15 mothers having elementary school children with asthma in grades 1-3 were interviewed. Participants were contacted at the outpatient department of a medical centre in Taiwan. Verbatim transcriptions of the interviews were examined by the content analysis method. After analysis of the interview data of the 15 informants, no new themes had emerged. Lincoln and Guba's trustworthiness criteria were employed to evaluate methodological rigour. RESULTS: There were four themes that formed part of the mothers' experiences. Those were: (1) being concerned about the child's adaptation to school life, (2) improving attitudes and relieving symptoms, (3) establishing the child's self-management abilities and (4) bearing role strain and normalising the life of the child. CONCLUSIONS: The findings of this study should help health professionals and schoolteachers to understand the needs of families and mothers who have a child with asthma. The findings provide appropriate information and resources to assist the children's adjustment to school life. RELEVANCE TO CLINICAL PRACTICE: The findings indicate that nursing professionals should provide child-focused and family-centred care that will assist parents of children with asthma to adjust to school life.

Removal of oral secretion prior to position change can reduce the incidence of ventilator-associated pneumonia for adult ICU patients: a clinical controlled trial study.

AIM: The purpose of this study was to explore the effect of oral secretion on aspiration and reducing ventilator-associated pneumonia. BACKGROUND: Ventilator-associated pneumonia is a serious hospital-acquired infection with reported incidence rate of 12.2% and mortality rate of 29.3%. Oral secretion is purported as a media which brings the oropharyngeal pathogens down to the respiratory track. METHODS: Two-group comparison study design was adopted. Subjects were recruited from an adult general intensive care unit of a medical centre in Taipei city. Patients in the study group received suction of oral secretion before each positional care, in contrast with patients in the control group who received routine care. RESULTS: Ventilator-associated pneumonia was found in 24 of 159 (15.1%) patients in the control group and in five of 102 (4.9%) patients in the study group with a reduction of risk ratio of 0.32 (95% CI 0.11-0.92). Eight of the 24 ventilator-associated pneumonia patients died in the control group; however, none of those ventilator-associated pneumonia patients died in the study group. The increased chance of survival was 1.50 (95% CI 1.13-1.99). The length of stay in ICU and duration of mechanical ventilation were reduced in the study group. In consideration of cost, the cost of tubes used to remove oral secretion is much less than the one used to do continuous subglottal suction. CONCLUSION: Removal of oral secretion is effective in reducing the incidence of ventilator-associated pneumonia with minimum cost intervention. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence that removal of oral secretion prior to position change is cost effective to reduce the incidence of ventilator-associated pneumonia. As such intervention is an easy task, routine removal of oral secretion is recommended as the standard of daily nursing care of patients on ventilator.

Influence of physical restraint on unplanned extubation of adult intensive care patients: a case-control study.

BACKGROUND: Unplanned extubation commonly occurs in intensive care units. Various physical restraints have been used to prevent patients from removing their endotracheal tubes. However, physical restraint not only does not consistently prevent injury but also may be a safety hazard to patients. OBJECTIVES: To evaluate the effect of physical restraint on unplanned extubation in adult intensive care patients. METHODS: A total of 100 patients with unplanned extubations and 200 age-, sex-, and diagnosis-matched controls with no record of unplanned extubation were included in this case-control study. The 300 participants were selected from a population of 1455 patients receiving mechanical ventilation during a 21-month period in an adult intensive care unit at a medical center in Taiwan. Data were collected by reviewing medical records and incident reports of unplanned extubation. RESULTS: The incidence rate of unplanned extubation was 8.7%. Factors associated with increased risk for unplanned extubation included use of physical restraints (increased risk, 3.11 times), nosocomial infection (increased risk, 2.02 times), and a score of 9 or greater on the Glasgow Coma Scale on admission to the unit (increased risk, 1.98 times). Episodes of unplanned extubation also were associated with longer stays in the unit. CONCLUSIONS: An impaired level of consciousness on admission to the intensive care unit and the presence of nosocomial infection intensify the risk for unplanned extubation, even when physical restraints are used. To minimize the risk of unplanned extubation, nurses must establish better standards for using restraints.

Caregivers' experiences at home with a ventilator-dependent child.

With advancing technology and transformation in health care delivery, more chronically ventilator-dependent children are being discharged to home. Pediatric home health care aims to increase the quality of life of patients and families, decrease cost and duration of hospital stay, and promote community participation in health care delivery. The authors aimed to describe and identify the qualitatively different experiences of primary caregivers who support ventilator-dependent children at home. Through phenomenographic inquiry 17 primary caregivers described their experiences through interviews that were later analyzed using accepted qualitative methods. Seven categories of description and an outcome space were identified, with findings highlighting the unique experience of this group and providing insight into their personal, social, and collective experiences. Outcomes reveal the significant and distinctive nature of understanding and have implications for clinical practice development, health education, policy formulation, social support, and future research in pediatric home health care.

Uncertainty of Parents With Children Undergoing Herniorrhaphy.

This study reports the association between parental uncertainty and characteristics of 123 parent-child dyads prior to the child's herniorrhaphy. A cross-sectional study design and Mishel's Parents' Perception of Uncertainty Scale (PPUS) were used. Parent participants were married (98%), had a university degree (45%), identified with a religion (77%), and worked (69%). More boys (76%) than girls (23%) underwent herniorrhaphy (average age = 2.26 years); 60% were the first-born child and 25% were premature. More children presented with unilateral (63.4%; right = 44.7%, left = 18.7%) than bilateral (36.6%) hernias and most were primary (98%). Overall uncertainty was perceived as moderate and ambiguity had the highest score. Religion, birth order (first child), and hernia site (bilateral) explained 20.6% of total variance of uncertainty. Providing information about postoperative symptom and pain management is important for all parents, particularly for parents identified with a religion and whose first-born child had bilateral hernias.

Children With Inguinal Hernia Repairs: Age and Gender Characteristics.

Objective. This study reports the age and gender characteristics of children with inguinal hernia repairs (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] Operation Codes 530-533). Methods. We used a retrospective cohort study design based on 2 data sources from 2007 to 2011 (the Bureau of National Health Insurance, Department of Health, Taiwan, and a local teaching children's hospital database) and descriptive statistics to analyze the group's age and gender differences as independent variables. Results. The gender ratio was 7 males to 1 female in the general population, whereas the gender ratio in children was 3.5 males to 1 female. Gender difference was found statistically significant in the age subgroup difference: boys (49.1%) were more than girls (39.3%) in ages 1 to 4, while girls (37.8%) were more than boys (23.7%) in ages 5 to 9. Based on the local hospital's data, of those 611 (15%) children born and who received herniorrhaphy, 204 (33.4%) were born as preterm infants and 407 (66.6%) as term infants. The gender ratio among 204 children born prematurely and received herniorrhaphy was 3 males to 1 female. Of those 353 infants under 6 months who received herniorrhaphy, 155 (76%) were preterm infants while 198 (48.6%) were term infants. Conclusion. Early screening of inguinal hernia for children is important and should focus on those born prematurely, particularly those aged <6 months and boys.

Verapamil Use Is Associated With Reduction of Newly Diagnosed Diabetes Mellitus.

Objective: The mechanism of the beneficial effect of calcium-channel blockers (CCBs), especially verapamil, on the development of type 2 diabetes mellitus (T2DM) has been described. This study compared the incidence of T2DM in adults prescribed oral verapamil and propensity score-matched adults prescribed other oral CCBs. Methods: This retrospective population-based cohort study used Taiwan's National Health Insurance Research Database from 2000 to 2011. T2DM was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Results: During follow-up periods of 41,958 and 42,118 person-years, 269 of 4930 patients in the verapamil cohort and 340 of 4930 patients in the matched cohort, respectively, developed T2DM. The incidence rates were 6.41 and 8.07 per 1000 population per year among verapamil and other CCB users, respectively. The adjusted hazard ratio (HR) for T2DM associated with use of verapamil (vs. other CCBs) was 0.80 [95% confidence interval (CI), 0.68 to 0.94; P = 0.006]. After exclusion of patients followed for <180 days or <365 days (to avoid bias derived from delayed diagnosis), adjusted HRs remained significant [0.79 (95% CI, 0.67 to 0.93; P = 0.005) and 0.77 (95% CI, 0.65 to 0.91; P = 0.002), respectively]. Only the interaction term for age was significant (P = 0.009). Verapamil had a more prominent effect on patients aged older than 65 years (P < 0.001). Conclusions: In patients with no known history of diabetes mellitus, oral verapamil use was associated with a decreased incidence of T2DM compared with other CCBs.

The desire to survive: the adaptation process of adult cancer patients undergoing radiotherapy.

AIM: Radiotherapy is one of the primary treatment strategies for cancer. However, patients not only deal with the side-effects of radiotherapy, but they must also endure the psychological distress caused by cancer. This study explores how cancer patients adapt to the treatment process when receiving radiotherapy. METHODS: This study used a grounded theory approach, and eight in-depth interviews were conducted with newly diagnosed cancer patients who received radiotherapy as a primary treatment. RESULTS: The core category that emerged from this study was "the desire to survive". The categories and subcategories that emerged from the data include facing unknown situations (e.g. searching for relevant information and decision-making considerations, and listening to healthcare professionals' suggestions), experiencing the pain of treatment (e.g. tolerating side-effects, tolerating inconvenience during the treatment, accepting support during the treatment, and adjusting lifestyles), and chances to extend life (e.g. accepting fate, determination to undergo the treatment, and adjusting negative emotions). CONCLUSION: The study results provide a better understanding of the experiences of cancer patients undergoing radiotherapy. Healthcare professionals should provide effective medical management for side-effects and psychological support to cancer patients during the journey of radiotherapy.

A correlational study of illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure.

BACKGROUND: Patients with heart failure experience adverse physical symptoms that affect quality of life. The number of patients with heart failure in Taiwan has been growing in recent years. PURPOSE: This article examines correlations among illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure. METHODS: A cross-sectional research design using three questionnaires was adopted. The study was undertaken in an outpatient department of a teaching hospital in Taiwan from January to June 2008. Potential participants aged 65 years or older were selected by a physician based on several diagnostic findings of heart failure that included an International Classification of Diseases' code 4280 or 4289. Patients who were bedridden or had a prognosis of less than 6 months were excluded from consideration. RESULTS: One hundred forty-one patients with heart failure were recruited. Most participants were men (51.8%), older adults (49.6% older than 71 years old), and either educated to an elementary school level or illiterate (69.5%) and have New York Heart Association class II (61.0%). Participants had an average left ventricular ejection fraction of 41.1%. The illness knowledge of participants was poor (accuracy rate: 29.3%), and most were unaware of the significance of self-care. Illness knowledge correlated with both self-care behaviors (r = -.42, p < .01) and quality of life (r = -.22, p < .01). Illness knowledge and age were identified as significant correlated factors of self-care behaviors (R = .22); and functional class, living independently, and age were identified as significant correlated factors of quality of life (R = .41). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Participants in this study with higher self-reported self-care behaviors and quality of life were younger in age and had better illness knowledge. Furthermore, physical function and independence in daily living significantly affected quality of life. Care for patients with heart failure, particularly older adults, should focus on teaching these patients about heart failure illness and symptom management. Assisting elderly patients with heart failure to promote and maintain physical functions to handle activities of daily living independently is critical to improving patient quality of life.

Evaluation of nurses' knowledge and understanding of obstacles encountered when administering resuscitation medications.

AIM: The aim of the study was to develop and validate an instrument to evaluate nurses' knowledge and to understand the obstacles that they encounter when administering resuscitation medications. BACKGROUND: Insufficient knowledge is a major factor in nurses' drug administration errors. Resuscitation involves situations in which doctors issue oral orders, and is inherently highly stressful. Sufficient knowledge is vital for nurses if they are to respond quickly and accurately when administering resuscitation medications. METHODS: A cross-sectional study was conducted. A questionnaire (20 true-false questions) developed from literature and expert input, and validated by subject experts and one pilot study, was used to evaluate nurses' knowledge of resuscitation medications. Stratified sampling and descriptive statistics were applied. RESULTS: A total of 188 nurses participated. The overall correct answer rate was 70.5% and the greater the nurse's work experience the higher the score. Only 8% of nurses considered themselves to have sufficient knowledge and 73.9% hoped to gain more training about resuscitation medications. The leading obstacle reported was "interruption of the drug administration procedure on resuscitation" (62.8%). Seventeen out of 20 questions achieved a discriminatory power of over 0.36, indicating good to excellent questions. In the study, a total of 16 resuscitation medication errors were reported by the participants, in which the errors involved atropine (five cases), epinephrine (three cases) and others (eight cases). The errors mainly involved misinterpretation of orders, insufficient knowledge and confusing certain drugs for other look-alike drugs. CONCLUSION: Evidence-based results strongly suggest that nurses have insufficient knowledge and could benefit from longer working experience and additional training about resuscitation medications. Further research to validate the instrument is needed and the education of nurses regarding resuscitation medications is recommended.