Religion and Spiritual Health in Patients With and Without Depression Receiving Hemodialysis: A Cross-Sectional Correlational Study.

BACKGROUND: Hemodialysis is the most common therapy for managing patients with end-stage renal disease. Depression is one of the most common psychological problems faced by dialysis patients, and there is limited research on the influences of religion and spirituality on dialysis patients. PURPOSE: This study was designed to compare religion and spiritual health status between hemodialysis patients with and without depressive symptoms. METHODS: A cross-sectional survey was conducted on 137 hemodialysis patients living in Taiwan. The self-report instruments used included the Religious Beliefs Scale, Spiritual Health Scale-Short Form, and Beck Depression Inventory-II. Data were analyzed using t test, chi-square test, point-biserial correlation of variance, and logistic regression. RESULTS: Most (63.5%) of the participants were classified with depression, of which most were male (70.1%), older (mean = 62.56 years), and unemployed (73.6%) and had less formal education. Fifty-two of the participants with depression had a 1- to 5-year duration of hemodialysis, whereas the nondepressed group had a higher mean score for number of religious activities, positive religious beliefs, and total score for spiritual health. Logistic regression showed an increased odds ratio ( OR ) of depression for participants with a duration of hemodialysis of 1-5 years ( OR = 3.64, 95% CI [1.01, 13.15]). Participants with higher scores for spiritual health had a lower risk of depression ( OR = 0.82, 95% CI [0.75, 0.90]), indicating a positive association between spiritual health and lower depression risk. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The prevalence rate of depression in hemodialysis patients is higher than that in the general population. Providing screenings for spiritual health and depression as part of routine medical care for hemodialysis patients is recommended to detect spiritual distress and depression early.

Mediating role of spirituality on the relationships between posttraumatic stress and posttraumatic growth among patients with cancer: A cross-sectional study.

Objective: This study explores the impact of posttraumatic stress (PTS) on posttraumatic growth (PTG) and verifies the mediating effect of spirituality among patients with cancer. Methods: This study used a cross-sectional correlational design. This study surveyed 141 hospitalized patients over 20 years of age diagnosed with cancer. Participants were recruited by convenience sampling from a regional hospital in Taiwan. Data were collected from January to April 2021. Measurements included sociodemographic and disease-related information and data from the following self-report questionnaires: Posttraumatic Stress Reaction Index-Short Form, Posttraumatic Growth Inventory, and Spiritual Health Scale-Short Form. Structural equation modeling and bootstrapping were used to analyze the mediating effect of spiritual health on PTS and PTG. Results: PTS and spirituality were negatively correlated, spirituality, and PTG were positively correlated, and PTS had no correlation with PTG. Spirituality fully presented a mediating role between PTS and PTG. Conclusions: Patients' spirituality should be regarded as an important variable that can impact stress appraisal and improve the patient's PTG when a diagnosis of cancer is received. Assessing spiritual health at regular intervals and integrating spiritual care with clinical care could decrease PTS and improve PTG for patients with cancer.

Development and validation of the oral presentation evaluation scale (OPES) for nursing students.

BACKGROUND: Oral presentations are an important educational component for nursing students and nursing educators need to provide students with an assessment of presentations as feedback for improving this skill. However, there are no reliable validated tools available for objective evaluations of presentations. We aimed to develop and validate an oral presentation evaluation scale (OPES) for nursing students when learning effective oral presentations skills and could be used by students to self-rate their own performance, and potentially in the future for educators to assess student presentations. METHODS: The self-report OPES was developed using 28 items generated from a review of the literature about oral presentations and with qualitative face-to-face interviews with university oral presentation tutors and nursing students. Evidence for the internal structure of the 28-item scale was conducted with exploratory and confirmatory factor analysis (EFA and CFA, respectively), and internal consistency. Relationships with Personal Report of Communication Apprehension and Self-Perceived Communication Competence to conduct the relationships with other variables evidence. RESULTS: Nursing students' (n = 325) responses to the scale provided the data for the EFA, which resulted in three factors: accuracy of content, effective communication, and clarity of speech. These factors explained 64.75% of the total variance. Eight items were dropped from the original item pool. The Cronbach's α value was .94 for the total scale and ranged from .84 to .93 for the three factors. The internal structure evidence was examined with CFA using data from a second group of 325 students, and an additional five items were deleted. Except for the adjusted goodness of fit, fit indices of the model were acceptable, which was below the minimum criteria. The final 15-item OPES was significantly correlated with the students' scores for the Personal Report of Communication Apprehension scale (r = -.51, p < .001) and Self-Perceived Communication Competence Scale (r = .45, p < .001), indicating excellent evidence of the relationships to other variables with other self-report assessments of communication. CONCLUSIONS: The OPES could be adopted as a self-assessment instrument for nursing students when learning oral presentation skills. Further studies are needed to determine if the OPES is a valid instrument for nursing educators' objective evaluations of student presentations across nursing programs.

The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study.

BACKGROUND: Intravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children. OBJECTIVE: The main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan. METHODS: We applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test. RESULTS: A total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=-3.551, P<.001 and Z=-3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=-2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=-3.643, P<.001). CONCLUSIONS: The intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.

The relationship between spiritual health, health-promoting behaviors, depression and resilience: A longitudinal study of new nurses.

AIM: To determine if levels of spiritual health, health-promoting behaviors, depressive symptoms and resilience change over time and determine if any variables have an impact on resilience among new nurses. BACKGROUND: Nurses provide patients with medical care and emotional support in high-stress environments. Resilience is a characteristic that allows one to adjust to these adverse situations. Resilience can help new nurses withstand the emotional stress of the workplace and improve nurse retention. METHOD: The study was conducted from 2017 to 2019 with a convenience sample of nursing students (N = 195). Data were collected at four timepoints with self-report questionnaires on spiritual health, health-promoting behaviors, resilience and the Beck Depression Inventory-II from 2017 to 2019. Three timepoints were collected during the fourth year of the student stage: fall semester (T1), spring semester (T2) and just prior to graduation (T3); the fourth timepoint was the novice stage (T4), after at least 3 months as a registered nurse. General estimating equations determined predictors of resilience. RESULTS: A total of 124 new nurses completed all questionnaires (63% response rate). Although mean scores fluctuated slightly during the student stage, the scores at T4 were significantly worse for spiritual health (Wald χ2 = 30.23, p < .001), health-promoting behaviors (Wald χ2 = 34.89, p < .001), depressive symptoms (Wald χ2 = 46.75, p < .001) and resilience (Wald χ2 = 21.54, p < .001). Spiritual health, health-promoting behaviors were positively correlated with resilience (p < .001); depressive symptoms were negatively correlated (p < .001). Controlling for the effect of time, resilience of novice nurses was positively associated with nursing school practicum grade, spiritual health and health-promoting behaviors (ß = 10.30, p < .001; ß = 12.14, p < .001; and ß = 14.62, p < .001, respectively) and negatively associated with depressive symptoms (ß = - 0.53, p < .001). CONCLUSIONS: Scores for all variables were similar over the three timepoints of the student stage. However, the significant changes at T4 compared with the student stage suggest the novice stage of nursing was challenging. Increasing resilience could reduce the challenges of transitioning to a hospital environment. Nursing educators and administrators could increase nursing students' resilience by restructuring the educational curricula. This could include helping nurses increase their spirituality and health-related behaviors and providing psychological support to reduce depressive symptoms. Increasing levels of resilience could reduce nurses' emotional stress and improve retention of new nurses.

A spiritual education course to enhance nursing students' spiritual competencies.

The study aimed to determine the impact of an elective spiritual education course for nursing students on spiritual competencies. A convenience sample of nursing students (N = 92) was recruited from a baccalaureate school of nursing between February and July 2016. The intervention group (n = 45) was comprised of students enrolled in the elective spiritual education course which integrated non-Christian Eastern cultural beliefs; the control group was comprised of students not enrolled in the elective (n = 47). A quasi-experimental design examined pretest, posttest, and follow-up data from students' self-administered questionnaires. The intervention effect of the course was analyzed using generalized estimation equation. The results indicated posttest scores among nursing students in the intervention group were significantly better than the comparison group for spiritual health. Practicum stress and professional commitment were significantly better at follow-up. Spiritual care attitudes, caring behavior, and religious belief were significantly improved from pretest to posttest, and at follow-up for the intervention group compared with the control group. In conclusion, a spiritual education course should be considered as a regular course in the nursing curriculum, which could improve students' spiritual competencies, individual spiritual growth, and the ability to care for patients.

Comparison of the effectiveness of teaching strategies for a pediatric pain management program for undergraduate nursing students: A quantitative evaluation using an objective structured clinical examination.

Pain is a common experience for hospitalized children; however, nursing students are often not adequately trained in pediatric pain management. Innovative teaching strategies, such as e-learning, have been employed for instructing students, however success of these platforms has not been quantitatively measured. This study compared students' knowledge and skill performance following a researcher-designed pain management program administered with three teaching strategies: traditional face-to-face, e-learning, or blended learning. Undergraduate nursing students in Taiwan (N = 296) randomly assigned to one of the teaching strategies participated. Knowledge of pain management, and pain management skills were quantified. A subjective assessment of attitudes towards learning found no significant difference between groups. Knowledge of pediatric pain management did not differ significantly between groups (p = 0.36). A 15-item objective structured clinical examination (OSCE) measured the competency of pain management skills; scores were not significantly different, regardless of teaching strategy (p = 0.70). Traditional face-to-face teaching was as effective as both innovative strategies. Evaluating students' skills following a pain management program with an OSCE provided a quantitative assessment of competency. Innovative strategies for teaching pediatric pain management could be a cost-effective way to provide flexible learning opportunities for nursing students who are distant from educational institutions.

Exploration of the Association Between Religious Affiliation and Attitude Toward Spiritual Care in Clinical Nurses.

BACKGROUND: Religion is an important cultural asset that is known to affect the thoughts, behaviors, and lifestyles of individuals. However, the impact of religious affiliation, religious activities, and religious beliefs on the attitudes of nurses toward providing spiritual care to their patients is an issue that has been inadequately explored. PURPOSES: The aim of this study was to explore the relationship between religion (including religious affiliation, religious activities, and religious beliefs) and attitude toward spiritual care in clinical nurses. METHODS: This study used a cross-sectional correlation study design. Six hundred nineteen nurses were included as participants. The measurements used included a questionnaire on religious affiliation, religious activities, and religious beliefs; the Spiritual Health Scale-Short Form; the Spiritual Care Attitude Scale; and a sociodemographic datasheet. The study employed hierarchical regression modeling to establish the relationships between the aspects and degrees of religious belief and practice as well as the attitudes of participants toward spiritual care. RESULTS: Most of the participants participated infrequently in religious activities. After controlling for demographic variables and spiritual health, religious belief was found to be an important factor impacting participants' attitudes toward providing spiritual care. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings indicate that religious belief is an important factor impacting the attitudes of nurses toward providing spiritual care and that the religious/spiritual beliefs of nurses may impact on their fitness to provide spiritual care to patients. Education on religion may be needed to improve the attitude of nurses toward providing spiritual care.

Molecular and Functional Analysis of the Type IV Pilus Gene Cluster in Streptococcus sanguinis SK36.

Streptococcus sanguinis, dominant in the oral microbiome, is the only known streptococcal species possessing a pil gene cluster for the biosynthesis of type IV pili (Tfp). Although this cluster is commonly present in the genome of S. sanguinis, most of the strains do not express Tfp-mediated twitching motility. Thus, this study was designed to investigate the biological functions encoded by the cluster in the twitching-negative strain S. sanguinis SK36. We found that the cluster was transcribed as an operon, with three promoters located 5' to the cluster and one in the intergenic region between SSA_2307 and SSA_2305. Studies using promoter-cat fusion strains revealed that the transcription of the cluster was mainly driven by the distal 5' promoter, which is located more than 800 bases 5' to the first gene of the cluster, SSA_2318. Optimal expression of the cluster occurred at the early stationary growth phase in a CcpA-dependent manner, although a CcpA-binding consensus is absent in the promoter region. Expression of the cluster resulted in a short hairlike surface structure under transmission electron microscopy. Deletion of the putative pilin genes (SSA_2313 to SSA_2315) abolished the biosynthesis of this structure and significantly reduced the adherence of SK36 to HeLa and SCC-4 cells. Mutations in the pil genes downregulated biofilm formation by S. sanguinis SK36. Taken together, the results demonstrate that Tfp of SK36 are important for host cell adherence, but not for motility, and that expression of the pil cluster is subject to complex regulation.IMPORTANCE The proteins and assembly machinery of the type IV pili (Tfp) are conserved throughout bacteria and archaea, and yet the function of this surface structure differs from species to species and even from strain to strain. As seen in Streptococcus sanguinis SK36, the expression of the Tfp gene cluster results in a hairlike surface structure that is much shorter than the typical Tfp. This pilus is essential for the adherence of SK36 but is not involved in motility. Being a member of the highly diverse dental biofilm, perhaps S. sanguinis could more effectively utilize this structure to adhere to host cells and to interact with other microbes within the same niche.

Symptom clustering in patients with childhood-onset systemic lupus erythematosus.

AIMS: To: (a) explore the prevalence of the symptoms perceived by patients with childhood-onset systemic lupus erythematosus; (b) identify the symptom clusters occurring in patients with childhood-onset Systemic lupus erythematosus; and (c) examine the association of the burden of each symptom cluster with sleep quality and depression. BACKGROUND: Systemic lupus erythematosus is an inflammatory autoimmune disease that may result in patients' perception of various symptoms, with possible negative effects on their quality of life. Understanding the prevalence of symptoms perceived by childhood-onset Systemic lupus erythematosus patients and the disease's symptom clusters may be helpful in managing such burdensome symptoms. DESIGN: A correlational study design was used for this study in 2016. METHODS: Self-reported data from the Systemic lupus erythematosus symptom checklist were used to assess the symptoms perceived by patients. Symptom clusters were analysed using cluster analysis. RESULTS: Seventy-five patients were included in this study. The most prevalent and burdensome symptom perceived by patients was fatigue. Five clusters were derived, including symptoms related to pain and itching; bruises and stomach complaints; weight gain; body image and circulatory problems; and fatigue. A poor sleeper may perceive a greater symptom burden in all five of the symptom clusters, except for cluster #3, which refers to symptoms related to weight gain. CONCLUSION: Five symptom clusters were identified. It is hoped that this study will give useful knowledge for understanding the symptom clusters for patients with Systemic lupus erythematosus and for improving nursing care quality.

Psychometric Testing of a Religious Belief Scale.

BACKGROUND: Nurses account for a significant percentage of staff in the healthcare system. The religious beliefs of nurses may affect their competence to provide spiritual care to patients. No reliable and valid instruments are currently available to measure the religious beliefs of nurses in Taiwan. PURPOSES: The aims of this study were to develop a religious belief scale (RBS) for Taiwanese nurses and to evaluate the psychometric properties of this scale. METHODS: A cross-sectional study design was used, and 24 RBS items were generated from in-depth interviews, a literature review, and expert recommendations. The RBS self-administered questionnaire was provided to 619 clinical nurses, who were recruited from two medical centers and one local hospital in Taiwan during 2011-2012. A calibration sample was used to explore the factor structure, whereas a validation sample was used to validate the factor structure that was constructed by the calibration sample. Known-group validity and criterion-related validity were also assessed. RESULTS: An exploratory factor analysis resulted in an 18-item RBS with four factors, including "religious effects," "divine," "religious query," and "religious stress." A confirmatory factor analysis recommended the deletion of one item, resulting in a final RBS of 17 items. The convergent validity and discriminate validity of the RBS were acceptable. The RBS correlated positively with spiritual health and supported concurrent validity. The known-group validity was supported by showing that the mean RBS between nurses with or without religious affiliation was significant. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The 17-item RBS developed in this study is a reliable, valid, and useful scale for measuring the religious beliefs of nurses in Taiwan. This scale may help measure the religious beliefs of nurses and elicit the relationship between these beliefs and spirituality.

The impact of nurses' spiritual health on their attitudes toward spiritual care, professional commitment, and caring.

BACKGROUND: The personal spiritual health of nurses may play an important role in improving their attitudes toward spiritual care and their professional commitment and caring capabilities. PURPOSE: The purpose of this study was to explore the impact of nurses' personal spiritual health on their attitudes toward spiritual care, professional commitment, and caring. METHODS: A total of 619 clinical nurses were included in this cross-sectional survey. The measurements included the spiritual health scale-short form, the spiritual care attitude scale, the nurses' professional commitment scale, and the caring behaviors scale. Structural equation modeling was used to establish associations between the main research variables. RESULTS: The hypothetical model provided a good fit with the data. Nurses' spiritual health had a positive effect on nurses' professional commitment and caring. Nurses' attitudes toward spiritual care could therefore mediate their personal spiritual health, professional commitment, and caring. CONCLUSIONS: The findings indicated that nurses' personal spiritual health is an important value and belief system and can influence their attitudes toward spiritual care, professional commitment, and caring.

Auricular point acupressure as an adjunct analgesic treatment for cancer patients: a feasibility study.

This study aimed (1) to examine the feasibility of an auricular point acupressure (APA) research protocol in terms of recruitment and for the assessment and management of pain and (2) to examine the potential APA analgesic effects for cancer patients. This study was a repeated-measures one-group design. Participants were recruited from the cancer center follow-up clinic affiliated with a large university hospital in the northeastern United States. Participants included 50 patients aged 55-87 years with a diagnosis of cancer. Participants received 7 days of APA treatment for their pain. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point on each ear. The study recruitment and retention rates were 92% and 91%, respectively. Importantly, the study found preliminary evidence for the analgesic effects of APA for cancer pain management. For example, by the end of the 7-day study, APA reduced pain intensity more than 55% for "worst pain" and about 57% for "average pain" and "pain intensity." Moreover, the use of pain medication was reduced during the APA treatment (e.g., 78% of patients [n = 39] took less pain medication than before the treatment). APA appears to be highly acceptable to patients with cancer-related pain. However, without a placebo control, we cannot draw conclusive evidence for the analgesic effect of APA for cancer patients. A sham group must be added to future studies to differentiate the true effects of APA from the possible psychological effects of the APA treatment.

Efficacy of auricular therapy for pain management: a systematic review and meta-analysis.

Objective. The objective of this systematic review and meta-analysis was to assess the efficacy of auricular therapy by including a sham therapy control group. Methods. Relevant, randomized clinical trials (RCTs) were identified by searching medical related databases from, depending on journal, 1900 (at the earliest) to 1994 (at the latest) through May 2013. The outcome measure was a pain intensity score. Results. Twenty-two RCTs were identified and 13 RCTs were included for meta-analysis. In these studies, auricular therapy provided significant pain relief when compared to a sham or control group. The overall standardized mean differences (SMD) was 1.59 (95% CI [-2.36, -0.82]) (13 trials, total subject numbers = 806), indicating that, on average, the mean decrease in pain score for auricular therapy group was 1.59 standard deviations greater than the mean decrease for the sham control. In terms of the efficacy of the different treatment methods, auricular acupressure boasts the largest strength of evidence for pain relief, followed by auricular acupuncture. Electroacupuncture stimulation did not show significant evidence for efficacy, which may be due to the small sample size (i.e., only 19 subjects were included). Conclusion. Further large-scale RCTs are needed to determine the efficacy of auricular therapy for pain.

Binding of the extreme carboxyl-terminus of PAK-interacting exchange factor ß (ßPIX) to myosin 18A (MYO18A) is required for epithelial cell migration.

The PAK2/ßPIX/GIT1 (p21-activated kinase 2/PAK-interacting exchange factor-ß/G protein-coupled receptor kinase-interactor 1) complex has been shown to distribute to both membrane ruffles and focal adhesions of cells, where it plays an important role in regulating focal adhesion turnover. However, the detailed mechanism underlying this regulation is largely unknown. We previously reported that MYO18Aα interacts via its carboxyl terminus with the PAK2/ßPIX/GIT1 complex through direct binding to ßPIX, and that knockdown of MYO18Aα in epithelial cells causes accumulation of the complex in focal adhesions and decreased cell migration ability (Hsu et al., 2010). The current study characterized the detailed MYO18Aα-ßPIX interaction mechanism and the biological significance of this interaction. We found that deletion of the carboxyl-terminal globular domain of MYO18Aα profoundly altered the cellular localization of ßPIX and inhibited cell migration. ßPIX interacts through its most carboxyl-terminus, PAWDETNL (639-646), with MYO18Aα and partially colocalized with MYO18Aα in membrane ruffles of cells, whereas ßPIX(1-638), a mutant with deletion of PAWDETNL, accumulated in focal adhesions. Both focal adhesion numbers and area in ßPIX(1-638)-expressing cells were greater than those in cells expressing wild-type ßPIX(FL). Further experiments using deletion mutants of MYO18A and ßPIX showed that disruption of MYO18A-ßPIX interaction not only impaired cell motility but also decreased Rac1 activity. Collectively, our data unravel the interaction regions between MYO18A and ßPIX and provide evidence for the critical role of this interaction in regulating cellular localization of ßPIX, Rac1 activity, and adhesion and migration in epithelial cells.

Psychometric testing of the properties of the spiritual health scale short form.

AIMS AND OBJECTIVES: To further examine the psychometric properties of the spiritual health scale short form, including its reliability and validity. BACKGROUND: Spirituality is one of the main factors associated with good health outcomes. A reliable and valid instrument to measure spirituality is essential to identify the spiritual needs of an individual and to evaluate the effect of spiritual care. DESIGN: A cross-sectional study design was used. METHODS: The study was conducted in six nursing schools in northern, central and southern Taiwan. The inclusion criterion for participants was nursing students with clinical practice experience. Initially, 1141 participants were recruited for the study, but 67 were absent and 48 did not complete the questionnaires. A total of 1026 participants were finally recruited, indicating a response rate of 89·9%. The psychometric testing of the spiritual health scale short form included construct validity with confirmatory factor analysis, known-group validity and internal consistency reliability. RESULTS: The results of the confirmatory factor analysis supported the five-factor model as an acceptable model fit. In the known-group validity, the results indicated that people who are in the category of primary religious affiliation have better spiritual health than people in the category of secondary religious affiliation and atheism. The result also indicated that the 24-item spiritual health scale short form achieved an acceptable internal consistency coefficient. CONCLUSIONS: The findings suggest that the spiritual health scale short form is a valid and reliable instrument for the appraisal of individual spiritual health. RELEVANCE TO CLINICAL PRACTICE: The spiritual health scale short form could provide useful information to guide clinical practice in assessing and managing people's spiritual health in Taiwan.

Auricular point acupressure for chronic low back pain: a feasibility study for 1-week treatment.

Objectives. The objective of this one-group, repeated-measures design was to explore the acceptance of auricular point acupressure (APA) to reduce chronic low back pain (CLBP) and estimate minimum clinically important differences (MCIDs) for pain intensity change. Methods. Subjects received 7-day APA treatment. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point for 7-day. The Brief Pain Inventory Short Form (BPI) was used to collect outcome data. Results. A total of 74 subjects participated in the study. Ten subjects dropped out and the retention rate was 87%. Subjects reported a 46% reduction in BPI worst pain, and over 50% reduction in BPI average pain, overall pain severity and pain interference by the end of study, and 62.5% subjects also reported less pain medication use. The MCIDs for the subscale of BPI ranged from .70 to 1.86 points. The percentage improvement of MCIDs from baseline was between 14.5-24.9%. Discussion. APA appears to be highly acceptable to patients with CLBP. A sham group is needed in order to differentiate the true effects of APA from the possible psychological effects of more frequent visits by the auricular therapist and patients' expectation of the APA treatment.

Reduction in nausea and vomiting in children undergoing cancer chemotherapy by either appropriate or sham auricular acupuncture points with standard care.

BACKGROUND: Over 40% of children with cancer have reported that chemotherapy-induced nausea and vomiting (CINV) are the two most distressing side-effects of treatment even when antiemetic drugs have been used. OBJECTIVES: The purpose of this article is to report the findings from a feasibility and pilot study using auricular point acupressure point for CINV in a small group of children in Taiwan. METHODS: This was a crossover randomized design study. CINV symptoms were assessed on 10 patients just prior to and for 7 days following each of three rounds of chemotherapy drugs (CTX). They received standard care (SC) and were not entered into a test treatment group until they completed the baseline assessment, which was conducted during their first round of chemotherapy after entering the study. Just prior to receiving the second round of CTX, patients were randomized into one of two treatment conditions: auricular acupressure intervention, in addition to standard care (AAP) or auricular acupressure using sham auricular points (SAP) in addition to standard care. For the third round of CTX, they were switched to the other treatment group. RESULTS: The enrollment rate for this study was 77% of the children invited to participate and of those, 88% provided completed data sets for all three treatment conditions. Patients in the AAP group reported significantly lower occurrence and severity of nausea and vomiting than patients in the SC group (p<0.05). There were no significant differences of nausea and vomiting for patients between the AAP and SAP groups. All of the patients took antiemetic medication on the day they received CTX, and 80% of patients reported that the antiemetics did not help to treat CINV. CONCLUSIONS: These preliminary findings did show evidence that AAP is acceptable to the children and their parents to prevent/treat CINV. However, there were no statistically significant differences between the AAP and SAP groups in the prevention/treatment of CINV. There were clinical trend differences between the groups, which may due to the small sample size. In a larger study, it would be important to determine whether the effects of the AAP and SAP treatment are independent of any psychologic effects, such as the researcher's increased presence in both treatment groups.

Effects of a home-based aerobic exercise programme in children with type 1 diabetes mellitus.

AIMS: To explore the effects of exercise programme on glycosylated haemoglobin and peak oxygen uptake in children and adolescents with type 1 diabetes mellitus. BACKGROUND: Regular exercise has been shown to be effective in blood glucose control, which includes improving glucose tolerance and insulin sensitivity, decreasing glycosylated haemoglobin levels and improving cardiorespiratory fitness. DESIGN: Quasi-experimental design with a twelve-week home-based aerobic exercise programme. METHOD: Twenty-eight participants completed the study: 12 in the home-based exercise group, 11 in the non-exercise control group and five in the self-directed exercise group. A mixed model was used to capture longitudinal change in glycosylated haemoglobin levels. RESULTS: The home-based aerobic exercise group showed no significant effect on glycemic control and peak oxygen uptake in this study across assessment times. However, a group difference in glycosylated haemoglobin levels at the nine-month follow-up was significant (general linear model: F = 4.06, p = 0.03). A Bonferroni test indicated that glycosylated haemoglobin levels in the home-based exercise group were higher than in the self-directed exercise group (p < 0.05) and higher in the control group than in the self-directed exercise group (p < 0.05) at the nine-month follow-up. Home-based aerobic exercise showed no significant effect on peak oxygen uptake in this study. CONCLUSIONS: A three-month home-based aerobic exercise programme has no significant effect on glycosylated haemoglobin and peak oxygen uptake levels in children with type 1 diabetes mellitus. RELEVANCE TO CLINICAL PRACTICE: Our exercise programme has designed that children can practice exercise at home and is a viable component of self-care intervention to improve patient's self-care skill and diabetes care control. However, how to encourage patients to adhere the exercise programme is a challenge for health care providers.

A pilot study to examine the feasibility and effects of a home-based aerobic program on reducing fatigue in children with acute lymphoblastic leukemia.

BACKGROUND: Fatigue is one of the most frequent symptoms experienced by children with cancer during treatment. Effective management of fatigue is essential for improving children's quality of life. OBJECTIVE: The aim of this study was to examine the feasibility of a home-based aerobic exercise intervention to reduce fatigue in children with acute lymphoblastic leukemia (ALL). METHODS: A 6-week home-based aerobic exercise intervention was implemented for children who were in the intervention group, whereas patients in the control group received routine care. Multivariate analysis was used to examine the effects of the aerobic exercise intervention on the children's self-reported levels of fatigue at posttest and 1-month follow-up. Two types of analysis were used: intent-to-treat analysis and per-protocol analysis. RESULTS: This study was conducted with 22 children with ALL: 12 in the intervention group and 10 in the control group who were matched by age and sex. For per-protocol analysis, the finding indicated that children who received the exercise intervention reported significantly lower "general fatigue" subscale than those in the control group at the 1-month follow-up measurement. For intent-to-treat analysis, the findings indicated that there were no intervention and time effect for any of the 3 fatigue subscales at either posttest or 1-month follow-up. CONCLUSION: The finding indicated that the exercise program is feasible and warrants being tested in a clinical trial with a much larger sample of children for ALL. IMPLICATIONS FOR PRACTICE: It suggests that a home-based exercise program may reduce fatigue for ALL children who are undergoing maintenance chemotherapy.