A model for predicting fall risks of hospitalized elderly in Taiwan-A machine learning approach based on both electronic health records and comprehensive geriatric assessment.

Backgrounds: Falls are currently one of the important safety issues of elderly inpatients. Falls can lead to their injury, reduced mobility and comorbidity. In hospitals, it may cause medical disputes and staff guilty feelings and anxiety. We aimed to predict fall risks among hospitalized elderly patients using an approach of artificial intelligence. Materials and methods: Our working hypothesis was that if hospitalized elderly patients have multiple risk factors, their incidence of falls is higher. Artificial intelligence was then used to predict the incidence of falls of these patients. We enrolled those elderly patients aged >65 years old and were admitted to the geriatric ward during 2018 and 2019, at a single medical center in central Taiwan. We collected 21 physiological and clinical data of these patients from their electronic health records (EHR) with their comprehensive geriatric assessment (CGA). Data included demographic information, vital signs, visual ability, hearing ability, previous medication, and activity of daily living. We separated data from a total of 1,101 patients into 3 datasets: (a) training dataset, (b) testing dataset and (c) validation dataset. To predict incidence of falls, we applied 6 models: (a) Deep neural network (DNN), (b) machine learning algorithm extreme Gradient Boosting (XGBoost), (c) Light Gradient Boosting Machine (LightGBM), (d) Random Forest, (e) Stochastic Gradient Descent (SGD) and (f) logistic regression. Results: From modeling data of 1,101 elderly patients, we found that machine learning algorithm XGBoost, LightGBM, Random forest, SGD and logistic regression were successfully trained. Finally, machine learning algorithm XGBoost achieved 73.2% accuracy. Conclusion: This is the first machine-learning based study using both EHR and CGA to predict fall risks of elderly. Multiple risk factors of falls in hospitalized elderly patients can be put into a machine learning model to predict future falls for early planned actions. Future studies should be focused on the model fitting and accuracy of data analysis.

[Nursing experience using cognitive behavior therapy on a multiple suicide adolescent patient].

This case report described a nursing process that employed cognitive behavior therapy in the care of a repeated suicide adolescent patient between January 25 and March 25, 2007. Data collection was done through observations, interviews and discussions conducted concurrently with the patient and his family. The patient was evaluated physically, emotionally, intellectually, socially and spiritually. Major nursing problems identified included: (1) potential suicide risk, (2) social interaction disturbance, and (3) sleep pattern disturbance. During hospitalization, cognitive behavior therapy was employed to correct distortions in patient cognition, reduce suicidal ideations and improve sleep quality. Role-playing was also employed to deliver social skills training, which enhanced the ability of the patient to interact with others. After eight weeks and prior to discharge, the patient was able to use effective coping skills to face his negative-automatic thinking and actively participate in group therapy. After discharge, the author tracked patient progress by visiting the OPD and through communications over the telephone. His family and teacher described the patient as having a stable mood, no longer attempting suicide and being able to join clubs on campus and live a a normal daily life.

Evaluation of assertiveness training for psychiatric patients.

AIM AND OBJECTIVES: To investigate the effectiveness of assertiveness training programmes on psychiatric patients' assertiveness, self-esteem and social anxiety. BACKGROUND: Assertiveness training programmes are designed to improve an individual's assertive beliefs and behaviours, which can help the individual change how they view themselves and establish self-confidence and social anxiety. It is useful for patients with depression, depressive phase of bipolar disorder, anxiety disorder or adjustment disorder. DESIGN: Experimental. METHOD: There were 68 subjects (28, experimental group; 40, diagnosis-matched comparison group). Subjects in experimental groups participated in experimenter-designed assertiveness training twice a week (two hours each) for four weeks. The comparison groups participated the usual activities. Data were collected in the two groups at the same time: before, after and one month after training programme. Efficacy was measured by assertiveness, self-esteem and social anxiety inventories. A generalised estimating equation was used for analysis. RESULTS: After training, subjects had a significant increase in assertiveness immediately after the assertiveness training programme and one-month follow-up. There was a significant decrease in social anxiety after training, but the improvement was not significant after one month. Self-esteem did not increase significantly after training. CONCLUSION: With our sample of patients with mixed diagnoses, assertiveness seemed to be improved after assertiveness training. RELEVANCE TO CLINICAL PRACTICE: Patients would benefit more from the assertiveness training programme for the change in how they view themselves, improve their assertiveness, properly express their individual moods and thoughts and further establish self-confidence. The assertiveness training protocol could be provided as a reference guide to clinical nurses.

Ligusticum chuanxiong prevents rat pheochromocytoma cells from serum deprivation-induced apoptosis through a protein kinase A-dependent pathway.

Ligusticum chuanxiong (LC) is a traditional Chinese herbal medicine used to treat various cardiovascular diseases. In this study, the butanol extract of LC was found to protect neuronal-like pheochromocytoma cells from serum deprivation-induced apoptosis. Both a serine/threonine kinase inhibitor and a specific protein kinase A (PKA) inhibitor blocked the protective effect of LC. A transcription inhibitor (actinomycin D) and a protein synthesis inhibitor (cyclohexamide) also attenuated the protective effect of LC, suggesting the requirement of gene expression for the protection of LC. On the other hand, LC increased both the formation of cyclic-AMP and the phosphorylation of the cyclic-AMP response element-binding protein (CREB), a downstream target of PKA and a nuclear transcription factor known for neuroprotective mechanism. Furthermore, LC-induced CREB phosphorylation and protective effect could be blocked by a PKA inhibitor and overexpression of the dominant negative CREB, respectively. Taken together, the protective mechanism of LC in antagonizing serum deprivation-induced PC12 cell apoptosis might be mediated through a PKA/CREB-dependent pathway.

A study on the personal traits and knowledge base of Taiwanese medical students following problem-based learning instructions.

INTRODUCTION: Problem-based learning (PBL), a pedagogic concept using a student-centred approach and problem-solving through small group discussions, has been adopted in varying degrees for years at all 11 medical institutes in Taiwan. Much evidence has shown that a number of factors can seriously affect student performance in PBL courses, such as the design of PBL scenarios, the tutors' character and students' attitudes and efforts. MATERIALS AND METHODS: The aim of this study was to examine how the personal characters or knowledge base of Taiwanese medical students influence their performance in a hybrid-PBL curriculum. A total of 309 (234 male, 75 female) high-school entry undergraduate medical students participated in this survey. Self-assessed personal traits were presented in a 44-item questionnaire with a Big Five factor structure. Knowledge base was assessed by students' score point average (SPA) based on their previous 4-year education in medical school. Peer-assessed performance of students in the PBL curriculum was carried out using a well-developed, reliable and validated evaluation form. RESULTS: Each student's peer-evaluated PBL performance can be divided into 5 principal components, which included control-lead, assist-coordinate, written organisation and compromise- comply (Eigen value >1). The consistency and reliability of the Big Five questionnaire on personal traits was analysed and discordant items were deleted (Cronbach's alpha = 0.72 to 0.86 after deletion). The relationship between the personal traits, knowledge base and PBL performance, as analysed by simple regression, showed that "extraversion" and "openness to experience" were positively related to the "assist-coordinate" characteristic in PBL performance, and "conscientiousness" was positively related to the "control-lead" characteristic in PBL performance. The SPA was positively related to the "assist-coordinate" or "control-lead" characteristic in PBL performance. The "agreeableness" was negatively correlated with the "control-lead" characteristic in PBL performance. After stepwise regression between the Big Five and each component of PBL performance, only the correlation between conscientiousness and control/lead, and between extraversion and assist/coordinate remained significant. CONCLUSION: Knowledge and personality characteristics appear to be associated with student performance in a hybrid-PBL curriculum. The implications of this study on the future development and application of this assessment tool in medical schools are presented.

[A nursing experience in a patient with antipsychotics-induced overweight].

The purpose of this article is to describe a nursing experience with a patient with schizophrenia who had antipsychotics-induced overweight. The authors assessed the patient's health condition and provided weight management to reduce her hallucinations as well as her body weight between May 1 and June 10, 2004. Three nursing problems had been identified as follows: disturbed sensory perception, imbalanced nutrition, and ineffective health maintenance. During the nursing process, the authors established a rapport relationship with the patient and her mother, educated them in skills for reducing hallucinations, and designed an individual body weight management program. After the interventions, the patient was able to positively face her illness, effectively use methods to reduce the impact of hallucinations, and successfully lose 5.5 kg. From this perspective, an individual body weight management program can be an effective intervention for nurses to care for this group of patients.

[Group cohesion: a concept analysis].

Group cohesion is considered an essential condition for achieving a successful treatment team. High cohesion groups more readily reach their goals, with group members also feeling more secure about their functions and contributions. In clinical practice, nurses use group teaching and group therapy to help patient and family members gain knowledge and skills related to illness treatment and recuperation. Effective group leadership helps minimize non-productive time and manpower and enhance interpersonal interaction. A further advantage of group cohesion is that the more effective administration of nursing programs that results can raise the profession level of staffs and reduce turnover. Walker and Avant (1995) employ concept analysis to use defining attributes in order to apply the same definition and communication to the same profession. The purpose of this paper was to apply this methodology to an analysis of group cohesion. Steps used include a review of the literature on conceptual definitions of group cohesion, a determination of defining attributes, model construction, identification of borderline, contrary, and related cases, and identification of antecedents and consequences and empirical tools. It is hoped that this analysis can help nursing staff to gain a better understanding of the concept of group cohesion and to apply such to clinical practice and nursing administration.

Adenosine as an active component of Antrodia cinnamomea that prevents rat PC12 cells from serum deprivation-induced apoptosis through the activation of adenosine A(2A) receptors.

Antrodia cinnamomea (formerly named Antrodia camphorata) is a rare medicinal fungus. We previously reported that it exhibits antioxidative, vasorelaxative, anti-inflammatory, and anti-angiogenic effects. When serum deprivation-induced apoptosis in neuronal-like PC12 cells was used as a stress model, the extract of A. cinnamomea displayed effectiveness in preventing serum-deprived apoptosis. Since our previous data show that the extract of A. cinnamomea contains adenosine (ADO), we attempt to investigate if the active component is ADO and to identify its targeting site in this study. After pre-incubation with ADO deaminase, neither ADO nor the extract of A. cinnamomea exerted any protection, demonstrating that the active component of A. cinnamomea is ADO. Furthermore, an ADO A(2A) receptor (A(2A)-R) antagonist was used and was able to block the protective effects of ADO and the extract of A. cinnamomea, demonstrating that the ADO targeting site in this model is A(2A)-R. Taken together, the protective effect of A. cinnamomea is owed to its active component, ADO, which acts through activation of A(2A)-R to prevent serum deprivation-induced PC12 cell apoptosis.

[Sleep hygiene for female nurses].

Sleep is a basic human need. A good night's sleep shapes our physical and mental health. Female nurses experience particularly complex sleep disturbance problems because of after working rotating shifts, as well as because of the effects of the female reproductive hormones. Both issues present a challenge to the understanding of female nurses' sleep. This paper summarizes the existing knowledge about sleep in women, including shift workers in relation to their reproductive status, and introduces practical sleep hygiene concepts and strategies for female nurses.

Evaluation of an assertiveness training program on nursing and medical students' assertiveness, self-esteem, and interpersonal communication satisfaction.

This study's objective was to evaluate the effect of an assertiveness training program on nursing and medical students' assertiveness, self-esteem, and interpersonal communication satisfaction. Using a longitudinal research design, 69 participants whose scores on the Assertive Scale were < or = 50% (i.e., low assertiveness) and who were willing to participate were included and assigned to an experimental group (33 subjects) or comparison group (36 participants; participants were matched with the experimental group by grade and sex). Participants in the experimental group received eight 2-h sessions of assertiveness training once a week. Data were collected before and after training and again one month after the end of the training using the Rotter's Internal versus External Control of Reinforcement Scale, Sex Role Inventory, Assertive Scale, Esteem Scale, and Interpersonal Communication Satisfaction Inventory. The generalized estimated equation (GEE) method was used for statistical analysis. The assertiveness and self-esteem of the experimental group were significantly improved in nursing and medical students after assertiveness training, although interpersonal communication satisfaction of the experimental group was not significantly improved after the training program.

Methamphetamine downregulates peroxiredoxins in rat pheochromocytoma cells.

Methamphetamine (METH) is an abusive psychostimulant that induces neuronal cell death/degeneration in experimental animals and humans. METH-induced apoptosis in rat pheochromocytoma cells was utilized to study the neurotoxic mechanism. During METH intoxication, we found that peroxiredoxins and thioredoxins/thioredoxin reductases (peroxiredoxin reducing systems) which are known to prevent oxidative stress and apoptosis were differentially downregulated and upregulated, respectively. We also found not only the free radicals but also the oxidative forms of peroxiredoxin and thioredoxin were increased, indicating the dysfunction of these enzymes. Thus, METH-induced differential regulation and oxidation of peroxiredoxins and thioredoxin may be an important mechanism for apoptosis.