Metabolic coupling between soil aerobic methanotrophs and denitrifiers in rice paddy fields.

Paddy fields are hotspots of microbial denitrification, which is typically linked to the oxidation of electron donors such as methane (CH4) under anoxic and hypoxic conditions. While several anaerobic methanotrophs can facilitate denitrification intracellularly, whether and how aerobic CH4 oxidation couples with denitrification in hypoxic paddy fields remains virtually unknown. Here we combine a ~3300 km field study across main rice-producing areas of China and 13CH4-DNA-stable isotope probing (SIP) experiments to investigate the role of soil aerobic CH4 oxidation in supporting denitrification. Our results reveal positive relationships between CH4 oxidation and denitrification activities and genes across various climatic regions. Microcosm experiments confirm that CH4 and methanotroph addition promote gene expression involved in denitrification and increase nitrous oxide emissions. Moreover, 13CH4-DNA-SIP analyses identify over 70 phylotypes harboring genes associated with denitrification and assimilating 13C, which are mostly belonged to Rubrivivax, Magnetospirillum, and Bradyrhizobium. Combined analyses of 13C-metagenome-assembled genomes and 13C-metabolomics highlight the importance of intermediates such as acetate, propionate and lactate, released during aerobic CH4 oxidation, for the coupling of CH4 oxidation with denitrification. Our work identifies key microbial taxa and pathways driving coupled aerobic CH4 oxidation and denitrification, with important implications for nitrogen management and greenhouse gas regulation in agroecosystems.

Anxiety, pain intensity, and decision regret of living liver donors during postoperative period.

AIM: The aim of this study was to explore and examine the relationship between anxiety, acute pain intensity, and decision regret of living liver donors in the postoperative stage. METHODS: This is a prospective correlational study. Data were collected consecutively for one year (from September 2017 to September 2018) at a medical center in northern Taiwan. Information about anxiety and acute pain intensity was collected preoperatively and on postoperative day (POD) 3 and POD 7. Satisfaction with pain management and decision regret was inquired about on POD 7. RESULTS: Data of 57 consecutive living liver donors (56.1 % male, mean age 34.12 ± 9.92 years) were analyzed. Living liver donors experienced moderate anxiety and acute pain levels in the postoperative period. The mean score of decision regret was 12.63 (range 0-60), indicating a low level of regret. The acute pain intensity decreased significantly between POD 3 and POD 7 (p < .001); however, the anxiety level slightly increased (p = .031). Older and married living liver donors had higher anxiety levels. The satisfaction level of pain management was negatively correlated with the POD 7 acute pain intensity (r = -0.26, p = .049) and decision regret (r = -0.37, p = .005), but it was positively correlated with POD 7 anxiety (r = 0.38, p = .004). CONCLUSIONS: The postoperative period was hard for living liver donors as they would experience moderate acute pain and anxiety. Although the decision regret was low, the satisfaction level of pain management would negatively affect it. Therefore, the effectiveness of pain management and anxiety management should be continually ensured in the postoperative period.

The impact of symptom distress on health-related quality of life in liver cancer patients receiving arterial chemoembolization: the mediating role of hope.

BACKGROUND: Trans-hepatic arterial chemoembolization (TACE) is a treatment option for liver cancer patients. It can prolong patients' survival but can also cause symptom distress. Symptom distress (SDs) can directly impact quality of life (QOL) and may indirectly influence QOL by lessening hope. In this study, we wanted to explore the mediating effect of hope on the relationship between SDs and QOL among patients with liver cancer receiving TACE. METHODS: A cross-sectional study was conducted from December 20, 2017, to August 6, 2018, at a gastroenterology ward of a medical center. The participants were 92 liver cancer patients (69.6% male, mean age 67.8) who were admitted for TACE treatment. Information on SDs, hope, and QOL was collected by questionnaire on discharge day. Hayes' PROCESS model was used to test the mediating effect of hope on the relationship between SDs and QOL. RESULTS: The mean score and standard deviation (SD) of SDs, hope, and QOL were 32.08 (SD = 6.22), 27.09 (SD = 3.51), and 55.16 (SD = 17.33), respectively. SDs negatively impacts quality of life. The total effect of SDs on QOL was - 1.41 (95% confidence interval [CI]: - 1.96, - 0.86). The indirect effect via the mediation of hope was - 0.95 (95% CI: - 1.7, - 0.45). Hope partially mediated the effect of SDs on QOL. CONCLUSION: SDs after TACE is vital; it directly reduces a patient's overall QOL and can indirectly hinder it by reducing the patient's hope. In addition to symptom management, interventions that help patients maintain their hope are key to improving QOL among patients receiving TACE.

Factors related to quality of life after video-assisted thoracoscopic surgery in patients with stage I adenocarcinoma lung cancer: A longitudinal study.

PURPOSE: This study aimed to assess the 5-year survival, quality of life for cancer- and lung-specific symptoms, and to identify predictive factors of quality of life during a 12-month period after video-assisted thoracic surgery (VATS) for early-stage lung adenocarcinoma. METHODS: A convenience sample of 53 patients who had undergone VATS for lung cancer was used for this longitudinal, prospective study. All participants provided responses to the cancer-specific quality-of-life European Organization for Research and Treatment of Cancer questionnaire as well as a questionnaire for lung cancer-specific symptoms using structured interviews at baseline (T0) and 3-, 6-, 9-, and 12-months post-surgery (T1, T2, T3, and T4, respectively). Generalized estimating equation models were used to investigate whether quality of life scores improved from baseline measures and to determine characteristics associated with changes in scores for quality-of-life post-surgery. RESULTS: The mean age of participants was 58.5 years (SD = 8.76), and most were female (64.2%). Participants received either a wedge or sublobular lobectomy (47.2%) or a lobectomy (52.8%). The size of the primary tumour for most participants was <2 cm (78.7%). The five-year survival rate was 90%. Lung-specific symptoms of insomnia were worse at T1 compared with baseline. Significant improvements in scores for function and cancer symptoms were seen at T4 compared with scores at T0. Age, marital status, smoking, alcohol consumption, and a history of previous cancer were significantly associated with quality of life. CONCLUSIONS: Surgical resection with VATS resulted in good 5-year survival rates and long-term improvements in quality of life. Our findings suggest VATS for patients with early-stage lung adenocarcinoma should be considered as a means of improving long-term survival and quality of life.

Post-Discharge Depression Status for Survivors of Extracorporeal Membrane Oxygenation (ECMO): Comparison of Veno-Venous ECMO and Veno-Arterial ECMO.

Extracorporeal membrane oxygenation (ECMO) is one of the common invasive treatments for the care of critically ill patients with heart failure, respiratory failure, or both. There are two modes of ECMO, namely, veno-venous (VV) and veno-arterial (VA), which have different indications, survival rates, and incidences of complications. This study's aim was to examine whether depression status differed between patients who had received VV-ECMO or VA-ECMO and had been discharged from the hospital. This was a descriptive, cross-sectional, and correlational study of patients who had been discharged from the hospital at least one month after receiving ECMO at a medical center in northern Taiwan from June 2006 to June 2020 (N = 142). Participants were recruited via convenience and quota sampling. Data were collected in the cardiovascular outpatient department between October 2015-October 2016 (n = 52) and September 2019-August 2020 (n = 90). Participants completed the Hospital Anxiety and Depression Scale-Depression (HADS-D) as a measure of depression status. Post-discharge depression scores for patients who received VV-ECMO (n = 67) was significantly higher (p = 0.018) compared with participants who received VA-ECMO (n = 75). In addition, the mode of ECMO was a predictor of post-discharge depression (p = 0.008) for participants who received VV-ECMO. This study concluded that patients who received VV-ECMO may require greater mental health support. Healthcare professionals should establish a psychological clinical care pathway evaluated by multiple healthcare professionals.

Health-related outcomes of extracorporeal membrane oxygenation in adults: A cross-sectional study.

BACKGROUND: Patients with critical illness may face challenges after hospital discharge; therapeutic outcomes of extracorporeal membrane oxygenation (ECMO) are typically measured by survival rate. However, ECMO is an integral part of treatment in critical care medicine, which requires an outcome measure beyond survival. Post-discharge health-related quality of life (HRQoL) is such an indicator. OBJECTIVES: To measure HRQoL in adult patients who had previously undergone ECMO and explore influential factors related to HRQoL. METHODS: This cross-sectional descriptive study used a convenience sample of patients discharged between April 2006-April 2016 after at least one month following ECMO. The study was conducted from October 2015 to October 2016, which included data collected from structured questionnaires: the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised and Short-Form Survey-36-v2. Stepwise linear regression determined predictor variables of physical and mental HRQoL. RESULTS: Age of participants (N = 144) ranged from 24 to 81 years; long-term survival rate was 28.6% after a median follow-up of 1060 days (range = 44-3150 days). Mean scores for physical and mental components of HRQoL were 46.32 and 50.39, respectively. Level of HRQoL was low to moderate. Employment affected all physical components of HRQoL; depression was the main predictor for physical and mental components. Self-perceived health status and anxiety were also factors that influenced HRQoL. CONCLUSIONS: Variables of employment, self-perceived health status and mental health influenced HRQoL. Early assessment of these factors by healthcare professionals can allow integration of multidimensional interventions following hospital discharge, which could improve HRQoL for patients weaned from ECMO.

Long-Term Use of Statins Lowering the Risk of Rehospitalization Caused by Ischemic Stroke Among Middle-Aged Hyperlipidemic Patients: A Population-Based Study.

Background: The long-term effects of statin use on rehospitalization due to ischemic stroke (reHospIS) in hyperlipidemic patients are still unknown. Therefore, we aimed to assess the long-term risks of reHospIS for hyperlipidemic patients who were taking statins and nonstatin lipid-lowering medicines on a regular basis. Methods and Materials: The National Health Insurance Research Database in Taiwan was used to conduct a 6-year cohort study of patients >45 years old (n = 9,098) who were newly diagnosed with hyperlipidemia and hospitalized for the first or second time due to ischemic stroke (IS). The risk of reHospIS was assessed using Cox proportional hazards regression model. Results: Nonstatin lipid-lowering medicines regular users were associated with a higher risk of reHospIS compared to stains users (hazard ratio, HR = 1.29-1.39, p < 0.05). Rosuvastatin was the most preferred lipid-lowering medicine with lower HRs of reHospIS in hyperlipidemic patients whether they developed diabetes or not. Bezafibrate regular users of hyperlipidemic patients developing diabetes (HR = 2.15, p < 0.01) had nearly 50% lower reHospIS risks than those without diabetes (HR = 4.27, p < 0.05). Age, gender, drug dosage, comorbidities of diabetes and heart failure (HF), and characteristics of the first hospitalization due to IS were all adjusted in models. Moreover, increasing trends of HRs of reHospIS were observed from Rosuvastatin, nonstatin lipid-lowering medicines, Lovastatin, and Gemfibrozil to Bezafibrate users. Conclusion: Statins were associated with long-term secondary prevention of reHospIS for hyperlipidemic patients. Rosuvastatin seemed to have the best protective effects. On the other hand, Bezafibrate appears to be beneficial for hyperlipidemic patients developing diabetes. Further research into the combination treatment of statin and nonstatin lipid-lowering medicines in hyperlipidemic patients developing diabetes is warranted.

Genetic co-expression networks contribute to creating predictive model and exploring novel biomarkers for the prognosis of breast cancer.

Genetic co-expression network (GCN) analysis augments the understanding of breast cancer (BC). We aimed to propose GCN-based modeling for BC relapse-free survival (RFS) prediction and to discover novel biomarkers. We used GCN and Cox proportional hazard regression to create various prediction models using mRNA microarray of 920 tumors and conduct external validation using independent data of 1056 tumors. GCNs of 34 identified candidate genes were plotted in various sizes. Compared to the reference model, the genetic predictors selected from bigger GCNs composed better prediction models. The prediction accuracy and AUC of 3 ~ 15-year RFS are 71.0-81.4% and 74.6-78% respectively (rfm, ACC 63.2-65.5%, AUC 61.9-74.9%). The hazard ratios of risk scores of developing relapse ranged from 1.89 ~ 3.32 (p < 10-8) over all models under the control of the node status. External validation showed the consistent finding. We found top 12 co-expressed genes are relative new or novel biomarkers that have not been explored in BC prognosis or other cancers until this decade. GCN-based modeling creates better prediction models and facilitates novel genes exploration on BC prognosis.

Factors associated with registration for organ donation among clinical nurses.

PURPOSE: Healthcare professionals play an important role in the organ donation process. The aim of this study was to examine the organ donation registration rate and related factors among clinical nurses. MATERIAL AND METHODS: In this cross-sectional, correlational study, we used mailed questionnaires to collect data from four geographical areas and three hospital levels in Taiwan from June 6 to August 31, 2018. Two thousand and thirty-three clinical nurses participated in this study. RESULTS: Participants' mean age was 34.47 years, and 95.7% were women. Of them, 78.3% were willing to donate their organs and 20.6% had registered for organ donation after death. The results of logistic regression showed that in the personal domain, higher age (odds ratio (OR) = 1.03, p < 0.001), better knowledge of organ donation (OR = 1.09, p < 0.001), and a positive attitude toward organ donation (OR = 2.91, p < 0.001) were positively associated with organ donation registration, while cultural myths (OR = 0.69, p < 0.001) were negatively correlated. In the policy domain, the convenience of the registration procedure (OR = 1.45, p < 0.001) was positively associated with registration. A gap between willingness to donate and actual registration was observed. CONCLUSIONS: Personal factors played an important role in organ donation registration. Therefore, efforts to improve knowledge and inculcate positive cultural beliefs about organ donation among clinical nurses are recommended. There is also a need to cooperate with government policies to provide appropriate in-service training and policy incentives and establish an efficient registration process.

Using betaxolol for the prevention of paronychia induced by epidermal growth factor receptor inhibitors: a case-control cohort study.

BACKGROUND: High rates of posttreatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion resulting from epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)-induced paronychia, which may even interrupt the course of treatment for EGFR-TKI therapy. Thus, we conducted this study to determine how effectively a topical ß-blocker, betaxolol, prevents EGFR-TKI-induced paronychia. METHODS: This case-control cohort study included a total of 131 non-small-cell lung cancer patients. The prevention group comprised 40 patients treated with topical betaxolol 0.25% solution to prevent paronychia while they received EGFR-TKI therapy. The control group comprised 91 patients who did not preventively use topical betaxolol 0.25% solution while receiving EGFR-TKI therapy. The patients' age, gender, antineoplastic regimen, duration of antineoplastic treatment before the appearance of lesions, number of involved digits (fingernails or toenails) with lesions, grading of paronychia, and pain score were recorded. RESULTS: In terms of the cumulative incidence of paronychia, significant differences (P < 0.01) were noted at both the 2nd and 3rd months after starting EGFR-TKIs. Furthermore, the average visual analogue scale scores were 3.125 and 6.29 in the prevention group and control group, respectively (P < 0.01). The average grades of paronychia were 1.5 and 2.12 in the prevention group and control group, respectively (P < 0.01). The average numbers of involved digits were 2.25 (range: 1-5 digits) in the prevention group and 3.03 (range: 1-7) in the control group (P = 0.07). CONCLUSIONS: Preventively using topical betaxolol can significantly decrease the incidence, VAS score, and grading of EGFR-TKI-induced paronychia.

Usability of Wearable Devices With a Novel Cardiac Force Index for Estimating the Dynamic Cardiac Function: Observational Study.

BACKGROUND: Long-distance running can be a form of stress to the heart. Technological improvements combined with the public's gradual turn toward mobile health (mHealth), self-health, and exercise effectiveness have resulted in the widespread use of wearable exercise products. The monitoring of dynamic cardiac function changes during running and running performance should be further studied. OBJECTIVE: We investigated the relationship between dynamic cardiac function changes and finish time for 3000-meter runs. Using a wearable device based on a novel cardiac force index (CFI), we explored potential correlations among 3000-meter runners with stronger and weaker cardiac functions during running. METHODS: This study used the American product BioHarness 3.0 (Zephyr Technology Corporation), which can measure basic physiological parameters including heart rate, respiratory rate, temperature, maximum oxygen consumption, and activity. We investigated the correlations among new physiological parameters, including CFI = weight * activity / heart rate, cardiac force ratio (CFR) = CFI of running / CFI of walking, and finish times for 3000-meter runs. RESULTS: The results showed that waist circumference, smoking, and CFI were the significant factors for qualifying in the 3000-meter run. The prediction model was as follows: ln (3000 meters running performance pass probability / fail results probability) = -2.702 - 0.096 × [waist circumference] - 1.827 × [smoke] + 0.020 × [ACi7]. If smoking and the ACi7 were controlled, contestants with a larger waist circumference tended to fail the qualification based on the formula above. If waist circumference and ACi7 were controlled, smokers tended to fail more often than nonsmokers. Finally, we investigated a new calculation method for monitoring cardiac status during exercise that uses the CFI of walking for the runner as a reference to obtain the ratio between the cardiac force of exercise and that of walking (CFR) to provide a standard for determining if the heart is capable of exercise. A relationship is documented between the CFR and the performance of 3000-meter runs in a healthy 22-year-old person. During the running period, data are obtained while participant slowly runs 3000 meters, and the relationship between the CFR and time is plotted. The runner's CFR varies with changes in activity. Since the runner's acceleration increases, the CFR quickly increases to an explosive peak, indicating the runner's explosive power. At this period, the CFI revealed a 3-fold increase (CFR=3) in a strong heart. After a time lapse, the CFR is approximately 2.5 during an endurance period until finishing the 3000-meter run. Similar correlation is found in a runner with a weak heart, with the CFR at the beginning period being 4 and approximately 2.5 thereafter. CONCLUSIONS: In conclusion, the study results suggested that measuring the real-time CFR changes could be used in a prediction model for 3000-meter running performance.

Effects of tyrosine kinase inhibitor therapy on skin toxicity and skin-related quality of life in patients with lung cancer: An observational study.

Epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy is the primary treatment option for patients with non-small cell lung cancer (NSCLC). However, one of the major adverse effects associated with this therapy is skin toxicity, which impacts the patient's quality of life. This study aimed to describe the severities and locations of skin toxicity, and to analyze their association with the quality of life in patients with advanced NSCLC who received EGFR-TKI therapy as first-line treatment.This cross-sectional and correlation study was conducted at a tertiary medical center in northern Taiwan between July 2015 and March 2016. Skin toxicity was assessed and graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). The Skindex-16 scale was used to measure the skin disease-related quality of life.A total of 146 NSCLC patients who received EGFR-TKI therapy within the first 3 months of diagnosis were included in this study; 93.2% of these patients experienced skin toxicities. Approximately 70% of the patients developed xerosis and pruritus, while 50% had papulopustular eruptions and paronychia. The mean skin symptom impact score was 5.38 (standard deviation = 2.65). The skin-related quality of life varied widely among the participants but remained acceptable (mean score = 13.96, standard deviation = 16.55). Skin symptoms correlated significantly with poor quality of life (r = 0.50, P < .001). Younger patients and those treated with afatinib were the most affected, reporting the poorest quality of life. Patients who required EGFR-TKI dose reduction had experienced more severe skin symptoms than had patients who did not require it (7.35 vs 5.01, P < .001).Skin toxicity related to EGFR-TKI treatment impacts the quality of life in patients with NSCLC. During the treatment period, skin assessment and tailored management should be incorporated into the daily care plan.

Health-related quality of life of living liver donors 1 year after donation.

BACKGROUND: Improving the health-related quality of life (HRQOL) of living liver donors post-donation is an important aspect of care quality. Analyzing the HRQOL of living liver donors prospectively could help improve our understanding of the recovery of HRQOL and help improve the quality of donor care. In this study, we examined the HRQOL of living liver donors at pre-donation and at 1-year post-donation and analyzed the effect of pre- and post-donation factors on the donors' physical and mental HRQOL. METHODS: This was a prospective study. During the enrollment period (August 2013 to December 2015), 68 living liver donors completed the study questionnaires 5 times: at pre-donation and at 1, 3, 6, and 12 months post-donation. The Medical Outcomes Study Questionnaire Short Form-36, which yields both physical (PCS) and mental (MCS) component summary scores, was used to measure the HRQOL. The pre- and post-donation factors included donation ambivalence, recipients' physical condition, post-donation complications, and recipients' survival status. RESULTS: Participants' mean PCS scores were 43.59 and 56.50 at 1 and 12 months after donation, respectively, whereas their mean MCS scores were 46.89 and 46.28, respectively. The mean PCS score was worse at 1 month after donation but improved significantly over time (P<0.05); conversely, the MCS was quite stable over time (P>0.05). A good PCS score was associated with no surgical complications of donation (coefficient =2.87, P=0.02), whereas a poor MCS score was associated with an education of less than a bachelor's degree (coefficient =-3.60, P=0.004), a higher Model for End-Stage Liver Disease (MELD) score in the recipient (coefficient =-0.13, P=0.03), and recipient death (coefficient =-3.48, P=0.03). Pre-donation ambivalence and sense of coherence were not significant predictors of the PCS or MCS scores. CONCLUSIONS: The impact of living liver donation on HRQOL was strongest in the early stages of the post-surgery period for the physical domain. Health-care professionals should carefully manage and monitor the progress of surgical outcomes, particularly in high-risk groups such as donors with a low education level or donors whose recipients have severe illness or end up dying after the surgery. Doing so may allow for suitable intervention opportunities to improve the HRQOL of living liver donors.

Changes in quality of life and health status in patients with extracorporeal life support: A prospective longitudinal study.

BACKGROUND: Extracorporeal life support (ECLS) provides emergency pulmonary and cardiac assistance for patients in respiratory or cardiac failure. Most studies evaluate the success of ECLS based on patients' survival rate. However, the trajectory of health status and quality of life (QOL) should also be important considerations. The study's aim was to explore changes in health status and QOL in adult patients weaned from ECLS who survived to hospital discharge over a one-year period. STUDY DESIGN: A prospective longitudinal study was conducted from April 2012 to September 2014. A convenience sample of patients who had undergone ECLS was followed for one-year after hospital discharge. Heath status was measured with a physical activity scale, the Centre for Epidemiologic Studies Depression scale, and a social support scale; we assessed quality of life with the physical and mental component summary scales of the Short-Form 36 Health Survey. Changes in depression, social support, physical activity and QOL were analysed with generalized estimating equations at 3-month intervals; participants' QOL at 12 months after discharge was compared with the general population. RESULTS: A total of 231 patients received ECLS during the study period. Sixty-five patients survived to hospital discharge (28% survival rate); 32 participants completed the study. Data showed scores for physical activity increased significantly over time (p < .001), while depression and social support significantly decreased (p < .05 and p < .001, respectively). Participants with veno-venous ECLS had higher scores for depression than participants with veno-arterial ECLS (p < .05). PCS scores significantly increased at 9, and 12 months after discharge (p < .05 and p < .001, respectively). There was no significant change in MCS scores. CONCLUSIONS: This was a preliminary study of patients with ECLS following hospital discharge over a one-year period. One year following hospital discharge survivors of ECLS continued to experience physical complications and some continued to have depressive symptoms; the level of social support was significantly lower after hospital discharge. Healthcare professionals should understand the trajectory of health status and QOL after discharge, which can help developing evidence-based interventions and improve QOL for survivors of ECLS.

Predictors of advance directives among nursing home residents with dementia.

ABSTRACTBackground:Advance directives are important for nursing home residents with dementia; for those with advanced dementia, surrogates determine medical decisions. However, in Taiwan, little is known about what influences the completion of these advance directives. The purpose of this study was to identify factors, which influence the presence of advance directives for nursing home residents with dementia in Taiwan. METHOD: Our cross-sectional study analyzed a convenience sample of 143 nursing home dyads comprised of residents with dementia and family surrogates. Documentation of residents' advance directives, physical and cognitive status was obtained from medical charts. Surrogates completed the stress of end-of-life care decision scale and a questionnaire regarding their demographic characteristics. Nursing home characteristics were obtained from each chief administrator. RESULTS: Less than half of the nursing home residents (39.2%) had advance directives and most (96.4%) had been completed by family surrogates. The following were predictors of an advance directive: surrogates had previously signed a do-not-resuscitate as a proxy and had been informed of advance directives by a healthcare provider; nursing homes had policies for advance directives and a religious affiliation. CONCLUSIONS: Advance directives were uncommon for nursing home residents with dementia. Presence of an advance directive was associated with surrogate characteristics and the nursing home facilities; there was no association with characteristics of the nursing home resident. Our findings emphasize the need to develop policies and strategies, which ensure that all residents of nursing homes and their surrogates are aware of their right to an advance directive.

End-of-Life Care Discussion for Residents With Dementia in Long-Term Care Facilities.

BACKGROUND: Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts. PURPOSE: The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families. METHODS: This is a cross-sectional and correlational study. A stratified random sampling was conducted, and self-administered questionnaires were mailed to physicians, registered nurses, and social workers who work in long-term care facilities with accreditation ranks ≥ Grade A in Taiwan. RESULTS: Questionnaires were returned by 478 participants (response rate = 94.1%). Fewer than 10% of the participants reported often discussing end-of-life care with residents with dementia and their families. Physicians were significantly more likely to discuss life-sustaining treatment than nurses and social workers. The frequency of professionals discussing advance directives and life-sustaining treatment for residents with dementia was predicted by higher confidence in end-of-life care skills and greater perceived facility support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Most professionals did not frequently discuss end-of-life care with residents with dementia and their caregivers. Discussions of end-of-life care in long-term care facilities should be promoted by enhancing the confidence of these professionals in providing end-of-life care and creating a supportive environment for end-of-life discussions and care.

Changes in and Determinants of Quality of Life in Patients With Advanced Non-Small-Cell Lung Cancer Undergoing Initial Chemotherapy.

BACKGROUND: Few studies have evaluated completely the changes in quality of life (QOL) that occur from pretreatment through the first four consecutive cycles of chemotherapy or determined its determinants in patients with advanced non-small-cell lung cancer (NSCLC). PURPOSE: The aim of this study was to explore the changes to and determinants of QOL in patients with advanced NSCLC under initial chemotherapy from pretreatment through Cycle 4 of chemotherapy. METHODS: The QOL of 139 patients with advanced NSCLC was assessed from prechemotherapy through Cycle 4 of chemotherapy. Changes to and determinants of QOL were evaluated using multivariate linear regression, which used generalized estimation equation models. RESULTS: No significant changes were observed in the global QOL or the physical, role, emotional, or cognitive functional domains of QOL during the course of chemotherapy. However, the social functional domain of QOL improved significantly at Cycle 3 in comparison with the prechemotherapy values. Better global QOL was determined as better performance status, less frequent physical symptoms, and less severe anxiety and depressive symptoms. Important determinants of better QOL in the five functional domains included younger age, better performance status, less frequent physical symptoms, less severe anxiety and depressive symptoms, and weaker perceived social support. Furthermore, patients who achieved a partial response after chemotherapy enjoyed stronger improvements in global QOL and the QOL emotional functional domain than those who did not. CONCLUSIONS: To help patients with advanced NSCLC optimize their QOL, healthcare professionals should enhance their ability to identify patients who are at elevated risk of poor QOL throughout the course of chemotherapy and to appropriately detect and manage the related physical symptoms and side effects, strengthen patients' social support, and lessen the anxiety and depressive symptoms of patients.

Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey.

BACKGROUND: Empowering personal health records (PHRs) provides basic human right, awareness, and intention for health promotion. As health care delivery changes toward patient-centered services, PHRs become an indispensable platform for consumers and providers. Recently, the government introduced "My health bank," a Web-based electronic medical records (EMRs) repository for consumers. However, it is not yet a PHR. To date, we do not have a platform that can let patients manage their own PHR. OBJECTIVE: This study creates a vision of a value-added platform for personal health data analysis and manages their health record based on the contents of the "My health bank." This study aimed to examine consumer expectation regarding PHR, using the importance-performance analysis. The purpose of this study was to explore consumer perception regarding this type of a platform: it would try to identify the key success factors and important aspects by using the importance-performance analysis, and give some suggestions for future development based on it. METHODS: This is a cross-sectional study conducted in Taiwan. Web-based invitation to participate in this study was distributed through Facebook. Respondents were asked to watch an introductory movie regarding PHR before filling in the questionnaire. The questionnaire was focused on 2 aspects, including (1) system functions, and (2) system design and security and privacy. The questionnaire would employ 12 and 7 questions respectively. The questionnaire was designed following 5-points Likert scale ranging from 1 ("disagree strongly") to 5 ("Agree strongly"). Afterwards, the questionnaire data was sorted using IBM SPSS Statistics 21 for descriptive statistics and the importance-performance analysis. RESULTS: This research received 350 valid questionnaires. Most respondents were female (219 of 350 participants, 62.6%), 21-30 years old (238 of 350 participants, 68.0%), with a university degree (228 of 350 participants, 65.1%). They were still students (195 out of 350 participants, 56.6%), with a monthly income of less than NT $30,000 (230 of 350 participants, 65.7%), and living in the North Taiwan (236 of 350 participants, 67.4%), with a good self-identified health status (171 of 350 participants, 48.9%). After performing the importance-performance analysis, we found the following: (1) instead of complex functions, people just want to have a platform that can let them integrate and manage their medical visit, health examination, and life behavior records; (2) they do not care whether their PHR is shared with others; and (3) most of the participants think the system security design is not important, but they also do not feel satisfied with the current security design. CONCLUSIONS: Overall, the issues receiving the most user attention were the system functions, circulation, integrity, ease of use, and continuity of the PHRs, data security, and privacy protection.

Risk analysis of colorectal cancer incidence by gene expression analysis.

BACKGROUND: Colorectal cancer (CRC) is one of the leading cancers worldwide. Several studies have performed microarray data analyses for cancer classification and prognostic analyses. Microarray assays also enable the identification of gene signatures for molecular characterization and treatment prediction. OBJECTIVE: Microarray gene expression data from the online Gene Expression Omnibus (GEO) database were used to to distinguish colorectal cancer from normal colon tissue samples. METHODS: We collected microarray data from the GEO database to establish colorectal cancer microarray gene expression datasets for a combined analysis. Using the Prediction Analysis for Microarrays (PAM) method and the GSEA MSigDB resource, we analyzed the 14,698 genes that were identified through an examination of their expression values between normal and tumor tissues. RESULTS: Ten genes (ABCG2, AQP8, SPIB, CA7, CLDN8, SCNN1B, SLC30A10, CD177, PADI2, and TGFBI) were found to be good indicators of the candidate genes that correlate with CRC. From these selected genes, an average of six significant genes were obtained using the PAM method, with an accuracy rate of 95%. The results demonstrate the potential of utilizing a model with the PAM method for data mining. After a detailed review of the published reports, the results confirmed that the screened candidate genes are good indicators for cancer risk analysis using the PAM method. CONCLUSIONS: Six genes were selected with 95% accuracy to effectively classify normal and colorectal cancer tissues. We hope that these results will provide the basis for new research projects in clinical practice that aim to rapidly assess colorectal cancer risk using microarray gene expression analysis.