The decision-making process of palliative care among male caregivers of chronically ill patients-A grounded theory study.

BACKGROUND: Family caregivers have a vital role to play in palliative care for chronically ill patients. In Taiwan, caregiver demographics are evolving, with the number of male caregivers increasing. Gender differences influence psychosocial behaviours, thought processes and communication styles. In healthcare, acknowledgement of gender differences facilitates effective delivery of high-quality care. AIM: The aim of this study is to explore male caregivers' decision-making process for palliative care for chronically ill family members. METHODS: This study employed grounded theory to generate a substantive theory of male caregivers' decision-making process for palliative care for chronically ill family members. We recruited 22 male participants from three inner-city teaching hospitals in Taiwan. FINDINGS: Regarding the decision-making process of palliative care of chronic ill family, where male caregivers do not want their loved ones suffering anymore, the male caregivers' decision-making process was impacted, first, by caregivers' views on the last stage of life; second, by their wish for good care during the end of life; and third, by their conviction that the patients' wishes should be respected. Furthermore, caregivers' philosophy of life and death is also a supportive ground for decision-making. This philosophy was influenced by their education in palliative care, financial status and religious beliefs and practices. The core category emerging from this study is encapsulated by a participant's assertion, 'How difficult is it? There are no male and female differences'. CONCLUSION: We found that palliative care experiences of male caregivers are important for the decision-making process for palliative care for their chronically ill family members. Caregivers want their loved ones to receive good care as the last step in life, to respect their wishes and no more suffering for the patient. Therefore, health professionals should be familiar with the palliative care process that caregivers go through to offer updated information when needed.

Biomarkers Screening and Mechanisms Analysis of the Restraint Stress-Induced Myocardial Injury in Hyperlipidemia ApoE-/- Mice.

OBJECTIVES: To explore the biomarkers and potential mechanisms of chronic restraint stress-induced myocardial injury in hyperlipidemia ApoE-/- mice. METHODS: The hyperlipidemia combined with the chronic stress model was established by restraining the ApoE-/- mice. Proteomics and bioinformatics techniques were used to describe the characteristic molecular changes and related regulatory mechanisms of chronic stress-induced myocardial injury in hyperlipidemia mice and to explore potential diagnostic biomarkers. RESULTS: Proteomic analysis showed that there were 43 significantly up-regulated and 58 significantly down-regulated differentially expressed proteins in hyperlipidemia combined with the restraint stress group compared with the hyperlipidemia group. Among them, GBP2, TAOK3, TFR1 and UCP1 were biomarkers with great diagnostic potential. KEGG pathway enrichment analysis indicated that ferroptosis was a significant pathway that accelerated the myocardial injury in hyperlipidemia combined with restraint stress-induced model. The mmu_circ_0001567/miR-7a/Tfr-1 and mmu_circ_0001042/miR-7a/Tfr-1 might be important circRNA-miRNA-mRNA regulatory networks related to ferroptosis in this model. CONCLUSIONS: Chronic restraint stress may aggravate myocardial injury in hyperlipidemia mice via ferroptosis. Four potential biomarkers are selected for myocardial injury diagnosis, providing a new direction for sudden cardiac death (SCD) caused by hyperlipidemia combined with the restraint stress.

Effects of a Multiple-Intervention Program on the Depressive Tendencies, Social Support, and Life Satisfaction of Older Adults in Taiwan.

PURPOSE: This study evaluated the effectiveness of a multiple-intervention program (MIP) on the life satisfaction, social support, and depressive tendencies of older adults. DESIGN: A cross-sectional, pretest-posttest design involving a questionnaire survey was adopted. METHODS: Thirty-seven older adults were recruited from 2 daycare centers for an 8-week MIP comprising 60-min sessions conducted once a week. The questionnaire comprised the Short Portable Mental Status Questionnaire, Geriatric Depression Short Form-15 (GDS-SF15), Life Satisfaction Scale (LSS), and Inventory of Social Support Scale (ISSB). FINDINGS: The participants' average GDS-SF15 score decreased considerably (by 35.3%), their average ISSB score increased from 61.9% to 80.9%, and their average LSS score increased from 48% to 64%. CONCLUSIONS: The outcomes for depressive tendencies, social support, and life satisfaction were measured before and after the intervention, and the participants successfully engaged in the MIP throughout its duration and exhibited improvement. The MIP can serve as a basis for planning group activities for older adults. CLINICAL EVIDENCE: The MIP benefits older adults at daycare centers. Incorporating multiple activities into daily care can help increase the diversity, uniqueness, and innovativeness of a daycare center.

Application of SNaPshot Technology in Semen-Specific cSNP Genetic Marker.

OBJECTIVES: To explore the feasibility of genetic marker detection of semen-specific coding region single nucleotide polymorphism (cSNP) based on SNaPshot technology in semen stains and mixed body fluid identification. METHODS: Genomic DNA (gDNA) and total RNA were extracted from 16 semen stains and 11 mixtures composed of semen and venous blood, and the total RNA was reverse transcribed into complementary DNA (cDNA). The cSNP genetic markers were screened on the validated semen-specific mRNA coding genes. The cSNP multiplex detection system based on SNaPshot technology was established, and samples were genotyped by capillary electrophoresis (CE). RESULTS: A multiplex detection system containing 5 semen-specific cSNPs was successfully established. In 16 semen samples, except the cSNP located in the TGM4 gene showed allele loss in cDNA detection results, the gDNA and cDNA typing results of other cSNPs were highly consistent. When detecting semen-venous blood mixtures, the results of cSNP typing detected were consistent with the genotype of semen donor and were not interfered by the genotype of venous blood donor. CONCLUSIONS: The method of semen-specific cSNPs detection by SNaPshot technology method can be applied to the genotyping of semen (stains) and provide information for determining the origin of semen in mixed body fluids (stains).

Families of Patients With Cancer: Responses and Actions to People With Cancer Who Use Complementary and Alternative Medicine: A Qualitative Study in Taiwan.

This study aims to explore how the families of patients with cancer respond to and act toward complementary and alternative medicine (CAM) use. A qualitative research design based on grounded theory was adopted in this study. Semistructured and face-to-face in-depth interviews were conducted. Each participant was involved in a one-to-one individual interview. Five categories emerged regarding how the families of patients with cancer responded to and acted toward CAM use: purposes of using CAM, CAM use between patients and families, role of family caregivers, actions when using CAM, and seeking religious practice. The core category following coding emphasized the paramount importance of patients' comfort. The findings revealed that the families of patients with cancer may respond and act differently regarding patients' use of CAM. During this process, patients may not inform family members that they are using CAM. Health care professionals should consider this in their interactions with family members.

Application and Prospect of RNA Profiling Analysis in Forensic Body Fluid Identification.

In forensic physical evidence identification, the accurate identification of the individual origin and their body fluid composition of the biological samples obtained from the crime scene play a critical role in determining the nature of a crime. In recent years, RNA profiling has become one of the fastest developing methods for body fluids identification. Due to the characteristics of tissue or body fluid specific expression, various types of RNA markers have been proven to be promising candidate markers for body fluids identification in previous studies. This review summarizes the research progress of RNA markers in body fluids identification, including the RNA markers that have been effectively verified in current research and their advantages and disadvantages. Meanwhile, this review prospects the application of RNA markers in forensic medicine.

Effectiveness of a Multimedia Patient Education Intervention on Improving Self-care Knowledge and Skills in Patients with Colorectal Cancer after Enterostomy Surgery: A Pilot Study.

OBJECTIVE: Colorectal cancer is most commonly treated through surgery. Self-care knowledge and skills are instrumental for disease adaptation once the patient returns home. Therefore, this study examined the effects of a multimedia patient education intervention on improving self-care knowledge and skills in patients with colorectal cancer who underwent colostomy surgery. METHODS: A quasi-experimental design was adopted to measure the self-care knowledge and skills of patients with colorectal cancer before and after surgery. The experimental group (n = 33) received a multimedia patient education intervention, whereas the control group (n = 30) was provided conventional instructions. Results were evaluated using analysis of covariance. RESULTS: On the day prior to discharge from hospital, the experimental group exhibited significantly greater improvement in self-care knowledge than did the control group. The experimental group also exhibited significantly greater improvement in self-care skills than did the control group on the day of gas passage, the day prior to discharge from hospital, and during the first clinic visit after discharge from the hospital. CONCLUSIONS: Multimedia patient education intervention yielded greater improvement in self-care knowledge and skills than did conventional instruction. Therefore, multimedia patient education is an adequate educational tool for patients with colorectal cancer who have undergone colostomy surgery.

Shame, Suffering, and Believing in the Family: The Experiences of Grandmothers of a Grandchild With a Developmental Delay or Disability in the Context of Chinese Culture.

Grandparents are primary resources of caregiving support for parents worldwide, regardless of the cultural background. In Chinese societies, grandmothers often fill the role of supportive caregiver. However, a knowledge gap in the literature exists about how Chinese culture influences caregiving for grandmothers of grandchildren with a disability, particularly in Taiwan. This phenomenological study explored the lived experience of grandmothers caring for a grandchild with a developmental delay or disability in the context of Chinese culture. Twenty-five grandmothers were interviewed. When grandmothers learned of their grandchild's disability, they experienced suffering, which was compounded by the stigma attached to persons with a disability in Chinese cultures, and they also experienced shame and fear of social rejection. Grandmothers' belief in the importance of family gave meaning to their suffering and prompted them to find new ways to deal with everyday difficulties. These findings can guide nurses and health care professionals responsible for supporting grandmothers caring for a child with a disability in the context of Chinese culture.

[Comprehensive Assessment and Treatment of Cataracts].

Cataract is a global disease that may cause blindness. Due to the slow pace of disease progression, patients often presume incorrectly that their blurred vision is caused by excessive fatigue or lack of sleep. In addition to their role in causing blindness, cataracts that are diagnosed late into their progression are more difficult to treat with corrective surgery. Furthermore, many older individuals believe incorrectly that declines in vision are part of the natural course of aging and accept these declines as inevitable. Reduced vision has a significant and negative effect on quality of life. Although aging is one of the main causes of cataracts, other major factors include common chronic diseases and the side effects of drugs. In addition, lifestyle factors such as diet, activity, and environmental exposure to ultraviolet rays and radiation are factors in cataract development. Surgery is the only treatment for cataracts currently available. Healthcare professionals not only consider a patient's background but also whether surgery may promote quality of life. While preoperative evaluation requires a holistic and comprehensive approach, postoperative care is also important to the overall success of cataract surgery. For example, instructions in topical-drop application, wound assessment, and symptoms of comorbidities are crucial for patients. Therefore, a critical literature review was used in this article to establish a strategy for the holistic evaluation of and perioperative nursing care and prevention strategies for cataracts. In addition, recommendations for the comprehensive assessment of and nursing care for patients with cataracts are provided to healthcare professionals article in hopes of improving the quality of care provided to patients with cataracts.

The Diabetic Foot Amputation Decision-Making Process.

OBJECTIVE: Diabetes has been the fourth leading cause of death in Taiwan since 2002 and is one of the top four most prevalent chronic diseases worldwide. Patients who have diabetic foot, as well as their families, are faced with the burden of possible limb amputation. The aim of this study was to explore the amputation decision-making process with patients with diabetic foot and their families. METHODS: Grounded theory was used in this study. Data from 16 participants at a regional hospital in Taiwan were collected using purposive sampling. The data analysis was conducted through open coding, axial coding, selective coding, and memo writing. RESULTS: The study revealed that the core factor in the decision-making process was "amputation in order to survive." Patients and families additionally considered "the devastation of experiencing multiple diseases," "treatment of poorly healing wounds," and "facing the decision of whether to undergo amputation." CONCLUSIONS: After understanding the patients' decision-making process regarding amputation, healthcare providers should be encouraged to empathize with such patients. Further, providers should respect the patients' and families' decision and provide them with necessary care. Future research should explore professional perspective and family members' care process for amputees to understand the decision-making process of patients who require amputation.

Ischemic Stroke Patients' Decision-Making Process in Their Use of Western Medicine and Alternative and Complementary Medicine.

Stroke is ranked third among the top 10 causes of death in Taiwan. Besides a high mortality rate, stroke survivors are often left with physical or functional sequela. This study aimed to explore ischemic stroke patients' decision-making process using Western medicine (WM) and complementary and alternative medicine (CAM). This study is a qualitative study based on grounded theory. A total of 12 participants were recruited. Findings revealed that the participants accepted WM and CAM treatments following the onset of ischemic stroke. Three categories and several subcategories emerged from stroke patients' decision-making process. These are "uncertainty of stroke," "delicate balance between WM and CAM," and "reestablishing confidence and faith." Eventually, they exhibited the core category of "breakthrough and the pursuit of a sense of rebirth." This study also found that the participants were unwilling to inform their health care professionals on their use of CAM. Therefore, health care professionals should empathize with the views and needs of their patients and respect their decision to combine WM with CAM. The views of other medical teams concerning CAM into their analysis of patients' decision-making process are recommended. Therefore, comprehensive insight into ischemic stroke patients' decision-making process for using CAM can be further explored.

Nursing Students' Willingness to Care for Older Adults in Taiwan.

BACKGROUND: The possibilities that nurses will take care of persons 65 years of age or older in hospitals and communities are increasing due to a growing aged population. Nursing students should be prepared to face the challenges of their future practice. Therefore, factors associated with nursing students' willingness to care for older adults need to be identified. AIM: This study aimed to explore Taiwanese nursing students' willingness to work with older persons and factors associated with this. METHODS: A cross-sectional research design was used. Stratified sampling was applied to recruit participants from seven nursing schools in northern, central, southern, and eastern areas of Taiwan. There were 612 nursing students who successful completed the questionnaire including demographic data, the Attitudes Toward the Elderly Scale, and the Willingness Toward the Elderly Care Scale. Data were collected between November 2012 and January 2013. A stepwise regression analysis was conducted to identify predictors of nursing students' willingness to care for older adults. FINDINGS: The mean score of nursing students' attitudes toward older people was 73.86 (SD = 8.9), with a range of 44-106. The mean score on the willingness to care for older adults was 55.01 (SD = 6.4), with a range of 36-75. The length of time with older adults per week (r = 0.12, p = .003) and grandparents having served as caregivers during the students' childhood (t = -2.147, ß = .032) were both positively associated with the willingness to care for older adults. The best predictors of nursing students' willingness to care for older adults were students' attitudes toward older adults (ß = 0.38, p < .001), paying attention to issues related to older adults (ß = 0.24, p < .001), and having the experience of being a volunteer who served older people (ß = 0.10, p = .005), which explained 26.8% of the total variance. CONCLUSIONS: Taiwanese undergraduate nursing students had neutral to slightly favorable attitudes toward working with older adults. Nursing students' positive attitudes about older adults, paying attention to issues related to older adults, and having been a volunteer that served older people were predictors of their willingness to care for older persons. Appropriate and practical strategies should be developed for students in order to increase their preference for caring for older people. CLINICAL RELEVANCE: The findings of this study can provide information for faculty members and clinical preceptors for designing curricula and related activities or arranging practicum in the future.

[Exploring the Primary Adaptation Process of First-Ever Stroke Patients].

BACKGROUND: Stroke is a leading cause of death worldwide and the third leading cause of disease-related mortality in Taiwan. Furthermore, stroke is a major cause of functional disability in adults, causing physiological, psychological, and social impacts. Little qualitative research has been conducted on the primary adaptation process of patients with first-ever stroke in Taiwan. PURPOSE: The present study explored the primary adaptation process of patients with first-ever stroke. METHODS: This qualitative study used purposive sampling to enroll 12 patients with first-ever stroke for interviews, followed by theoretical sampling. Grounded theory guided the methodology and data analysis. Data analysis was performed simultaneously in accordance with the coding process. RESULTS: The primary adaptation process used by the participants involved the two main categories of "impacts of stroke" and "adaptation after stroke", with three subcategories associated, respectively, with the former (loss of physical autonomy, diminishing perceptions of self-value, and stroke-related hardships turning into social isolation) and with the latter (regaining autonomy after rehabilitation, receiving support from family without being a burden, and release from suffering/becoming more positive). The core category that emerged from the present study was: "Facing stroke, hoping for the best, transforming lives." CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The above findings on the primary adaptation process of stroke patients provide an important reference for clinical nurses/healthcare professionals who have responsibilities to care for patients with first-ever stroke. In addition, healthcare professionals should offer more health education and psychological support to stroke patients based on individual patient needs.

Molecular events underlying maggot extract promoted rat in vivo and human in vitro skin wound healing.

Maggot extracts promote wound healing, but their bioactive part(s) and molecular effects on the regenerating tissues/cells remain largely unclear. These issues are addressed here by treating rat skin wounds, human keratinocyte line/HaCat and fibroblasts with maggot secretion/excretion, and the extracts of maggots without and with secretion/excretion. The wound closure rates, cell proliferation activities, and statuses of wound healing-related signaling pathways (STAT3, Notch1, Wnt2, NF-κB, and TGF-beta/Smad3) and their downstream gene expression (c-Myc, cyclin D1, and VEGF) are evaluated by multiple approaches. The results reveal that the maggot extracts, especially the one from the maggots without secretion/excretion, show the best wound healing-promoting effects in terms of quicker wound closure rates and more rapid growth of keratinocytes and fibroblasts. Of the five signaling pathways checked, the ones mediated by TGF-beta/Smad3, and STAT3 are activated in the untreated wounds and become further enhanced by the maggot extracts, accompanied with c-Myc, VEGF, and cyclin D1 up-regulation. Our results thus show (1) that both body extract and secretion/excretion of maggots contain favorable wound healing elements and (2) that the enhancement of TGF-beta/Smad3 and STAT3 signaling activities may be the main molecular effects of maggot extracts on the wound tissues.

[DNA Extraction of Cast-off Cells of Fingerprints from 502 Glue Fumigated Contact Samples].

OBJECTIVE: To establish a method of fingerprint position, sample transfer and fingerprint DNA extraction in contact samples. METHODS: Sixty-six cases were visualized by 502 glue fingerprint fumigation. Two methods, ordinary wipe and acetone wipe, were used to transfer cast-off cells of fingerprints from testing samples, respectively. DNA was extracted and purified by ultramicro magnetic bead kit. The data was resolved on genetic analysis after amplification. RESULTS: In 33 samples, 30 samples got better STR analysis by acetone wipe method. The peak range was 1,000-4,000 RFU and peak shapes were equable. It was hard to get ideal STR typing by ordinary wipe method. CONCLUSION: The samples are visualized by 502 glue fingerprint fumigation and the case-off cells are transferred by acetone wipe method. The method shows better STR analysis result, which might be a better method for forensic science practice.

Registered nurses' perceptions and experience of working in aged care: A qualitative approach.

AIM: To understand and report on the perceptions and experiences of registered nurses in the aged care sector. DESIGN: An exploratory qualitative study. METHODS: Semi-structured telephone interviews were utilised as the primary data collection method. Fifteen registered nurses were interviewed. All interviews were recorded, transcribed verbatim and analysed using conventional content analysis. Participants were quoted verbatim to ensure authenticity. RESULTS: The results indicated a demand for increased administrative and staffing support in the aged care workplace. Poor morale and unethical practices contributed to negative perceptions and attitudes among nurses towards aged care. Managing and communicating with older people was reported as challenging, which impacts nursing staff recruitment and retention. Future work is needed to ensure that outstanding clinical role models and leadership support nursing staff recruitment and retention. Incorporating aged care content into the nursing curriculum and providing professional development opportunities to aged care professionals would be the foundation towards solutions, as the study primarily explored nurses' perspectives.

[Esophageal cancer: common health problems and health management].

Esophageal cancer is the 9th leading cause of cancer death in Taiwan. Lack of obvious symptoms or signs during its early stages means that patients are often already in the terminal stage or metastasis at their first diagnosis. A diagnosis of cancer greatly impacts both patients and their families. The purpose of this paper is to explore the current diagnostic methods and treatments used for esophageal cancer. We discuss the effects of physical, psychological and social problems such as dysphagia, fatigue, pain, uncertainty, and social isolation. We also explore the nursing interventions related to these problems. Understanding the health issues related to esophageal cancer will not only help nurses who take care of patients with esophageal cancer provide holistic care, it will also reduce patients' suffering through the treatment and recovery process. By applying interventions that effectively address the physical, psychological, and social realms, healthcare professionals can help patients feel more secure when dealing with related problems. This will improve patients' dignity, value and quality of life through their cancer journey.

Decision-making process for breast-conserving therapy from the perspective of women with breast cancer: A grounded theory study.

PURPOSE: To explore the decision-making and coping processes of women with newly diagnosed breast cancer receiving breast-conserving therapy. METHODS: The grounded theory methodology approach was employed in this study. Purposive and theoretical sampling methods were used to enroll 27 women with stage I-III breast cancer. Individual interviews were conducted using a semi-structured interview guide, and data were analyzed using open, axial, and selective coding. RESULTS: The core category is "limitations of boundaries," which includes three categories: feminine body boundary, emotional boundary, and knowledge boundary. Clusters, conflicts, and changeability were among the unique contextual conditions. The decision-making process became more challenging because of the differences between the levels of knowledge of physicians and patients receiving treatment information. Women's actions and interactions included information seeking, controlling, negotiating, and accepting nondecision-making support. The consequences of decisions included redecision and reoperation, and most women did not regret receiving breast-conserving therapy. CONCLUSION: Even after choosing breast-conserving therapy, some women may experience changes in treatment procedures. Medical professionals should identify women's challenges and limitations during their decision-making process, explain the benefits and drawbacks of different surgical modalities, address concerns about the outcome of breast-conserving surgery, and provide intellectual and emotional support for decision-making.

Nurses' perspectives, attitudes and experiences related to e-learning: A systematic review.

OBJECTIVE: To summarize the current evidence on registered nurses (RNs) perspectives, attitudes and experiences related to e-learning. DESIGN: A systematic review of the literature. DATA SOURCES: The CINAHL, PubMed, Embase, the Cochrane Library, Scopus and Web of Science databases were searched for studies published in English from 2000 to 2021. REVIEW METHODS: The study followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Inclusion criteria comprised studies with cross-sectional, quasi-experimental, qualitative, and randomised control designs on the attitudes toward, perspectives and experiences of registered nursing about e-learning. Quality appraisal for each study, based on their designs, was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Data were synthesized using a narrative approach. RESULTS: In the 15 included studies, 4 were high quality while 11 were moderate quality. Four themes were revealed in this review including e-learning approaches, facilitators of e-learning and barriers to e-learning barriers to e-learning among RNs and learning in practice barriers. CONCLUSIONS: The systematic review uncovered that E-learning is an effective method for integrating knowledge with practice and promoting professional development among RNs in healthcare settings. However, RNs may lack motivation to engage with E-learning and face challenges associated with user-friendly platforms.

Adults' perspectives of experiences and preferences for end-of-life care.

BACKGROUND: Decisions about end-of-life care often raise clinical and ethical challenges, especially when the person's capacity to contribute in the decision making at the end of life is limited. AIM: This study aimed to explore Taiwanese adults' preferences associated with communication, healthcare planning, life-sustaining treatments and palliative care and experiences of end-of-life care. METHODS: Semi-structured interviews were conducted with 16 adults aged 20 years and above. The sampling approach was a convenience strategy in a community centre located in a metropolitan area in the Southern region of Taiwan. A qualitative content analysis approach was used to elicit key themes from the data. RESULTS: Significant findings related to the two main themes of adults' experiences, including the observed distress of those who were dying and the distress experienced by the family. Other key findings pertain to personal preferences for end-of-life care, such as preferred end-of-life communication, preparing for the end-of-life and maintenance of quality of life. CONCLUSIONS: This exploratory study offers insight into 16 Taiwanese community-dwelling adults' views of preferences regarding end-of-life communication, preparation for the end of life and maintenance of quality of life, as well as their experiences of end-of-life care. A further exploration is suggested to elicit how personal end-of-life experiences shape individuals' health practices in advance care planning for end-of-life care.