Does Far-Infrared Therapy Improve Peritoneal Function and Reduce Recurrent Peritonitis in Peritoneal Dialysis Patients?

The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients for the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to explore the changes in abdominal blood vessels. (2) We compared the effects of peritoneal dialysis using blood glucose, HbAlC, albumin, urea nitrogen, creatinine, white blood cells, hs-CRP; peritoneal Kt/V of peritoneal function, and eGFR. (3) We compared the cytokines' concentrations in the two groups while controlling for the other cytokines. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT over the 6 months. (2) Our study demonstrates statistically significant effects of FIR therapy on the following parameters: creatinine (p = 0.039 *) and hs-CRP (p < 0.001 **) levels decreased significantly, and eGFR (p = 0.043 *), glucose (p < 0.001 **), and albumin (p = 0.048 *) levels increased significantly. Our study found that in the experimental group, creatinine and hs-CRP levels decreased significantly due to FIR therapy for 6 months. However, our study also found that the glucose level was significantly different after FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of the glucose in the dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. (3) In addition, we also found that no statistically significant difference in any inflammatory cytokine after FIR therapy. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements after peritoneal dialysis with FIR treatment over 6 months. Conclusions: We found that the effectiveness of peritoneal dialysis was improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed.

Do cognitive performance and physical function differ between individuals with motoric cognitive risk syndrome and those with mild cognitive impairment?

BACKGROUND: Motoric cognitive risk syndrome (MCR) is defined by slow gait speed combined with subjective cognitive complaint. MCR is a predementia syndrome, similar to mild cognitive impairment (MCI). However, there is currently no study comparing the differences in cognitive performance and physical function between these two types of cognitive impairment. Thus, the aim of this study is to compare cognitive performance and physical function in individuals with MCR versus MCI. METHODS: A total of 77 participants, free of dementia, were recruited from the neurological outpatient clinic of a medical center in Taiwan. Participants were separated into 2 groups, MCR (n = 33) and MCI (n = 44) groups, based on definition criteria from previous studies. The priority was to assign a diagnosis of MCR first, followed by MCI. Hence, "pure" MCI had no overlap with MCR syndrome. Cognitive performance, including executive function, attention, working memory, episode memory, visuospatial function, and language, were measured. Physical functions such as activities in daily living, the Tinetti Assessment Scale, and the Timed Up and Go test were also measured. RESULTS: Executive function, attention, working memory, episodic memory and language were all significantly lower in the MCR group than the MCI group. Abilities related to physical function, including those measured by the Tinetti Assessment Scale and the Timed Up and Go test, were significantly lower in the MCR group than the MCI group. CONCLUSIONS: We noted that cognitive performance and physical function were lower in MCR individuals than MCI but without MCR syndrome. However, the conclusions were based on the enrollment procedure of participants prioritizes the MCR syndrome. Because of the overlap of MCR and MCI, future studies should use different enrollment strategies to further clarify the status of these two populations.

Effects of Far-Infrared Therapy on Foot Circulation Among Hemodialysis Patients With Diabetes Mellitus.

BACKGROUND: Far-infrared radiation (FIR) therapy improves vessel dilation, circulation, vessel endothelial function, and angiogenesis and reduces atherosclerosis. However, evidence of FIR therapy's effects on foot circulation among diabetic patients undergoing hemodialysis is scarce. AIM: To determine whether FIR therapy improves foot circulation in diabetic patients undergoing hemodialysis. DESIGN: Quasi-experimental. METHODS: In June to November 2017, diabetic patients undergoing hemodialysis (N = 58) at a hemodialysis center in northern Taiwan were divided into two groups: the experimental group (n = 31) received FIR therapy to the bilateral dorsalis pedis artery (40 min/session, 3 times/week for 6 months) and the control group (n = 27) received conventional dialysis care. Paired t test, independent samples t test, two-proportion Z test, and repeated-measures analysis of covariance were performed to compare changes from baseline to the end of the 6-month intervention between the groups. RESULTS: Significant positive effects of FIR therapy on temperature, pulse, and blood flow of the dorsalis pedis artery were observed. Sensitivity to pain, tactility, and pressure also improved significantly in the experimental group. The Edinburgh Claudication Questionnaire revealed that the experimental group had reductions in subjective experiences of soreness, tingling, and coldness in the feet. CONCLUSION: The findings of significant improvements to objective and subjective measures of blood flow and neural function in the experimental group indicate that FIR therapy improves blood circulation to the feet. This therapy thus has great potential to be an effective adjuvant treatment for patients with diabetes mellitus undergoing hemodialysis.

Development of a nursing-specific Mini-CEX and evaluation of the core competencies of new nurses in postgraduate year training programs in Taiwan.

BACKGROUND: Modern nursing requires a broad set of academic and practical skills, and an effective nurse must integrate these skills in a wide range of healthcare contexts. Cultivation of core competencies has recently become a key issue globally in the development of nursing education. To assess the performance of new nurses, this study developed a nursing-specific Mini-Clinical Evaluation Exercise (Mini-CEX) to evaluate the effect of postgraduate year (PGY) nurse training programs in Taiwan. METHODS: A nursing-specific Mini-CEX was developed based on the required core competencies of nurses. Reliability and validity were confirmed in evaluator workshops carried out prior to the administration of the pilot test and final test. Thirty-two PYG trainees were recruited with a supervisor-to-trainee ratio of 1:1.94. Data were collected from February to June 2012 and analyzed using the Kruskal-Wallis test. RESULTS: The 32 PGY trainees scored highest in the "nursing professionalism" dimension and the lowest in the "physical examination" dimension. The overall competency score was satisfactory. The trainee nurses with 19-24 months of experience scored higher than the other two groups in overall performance. CONCLUSION: The results of this research indicate the feasibility of using our Mini-CEX tool to evaluate the competencies of PGY trainees.

The effect of far infrared radiation therapy on inflammation regulation in lipopolysaccharide-induced peritonitis in mice.

OBJECTIVE: Far infrared radiation has been widely used in a variety of healthcare institutions and clinical research. Previous studies have shown that far infrared radiation can promote blood circulation and enhance the functioning of the immune system. Many patients receiving peritoneal dialysis have been co-treated with far infrared radiation to reduce the occurrence of inflammation. This study seeks to evaluate the effects of far infrared radiation therapy on inflammation. METHOD: We used the lipopolysaccharide-induced peritonitis mouse model to study the effect of far infrared radiation treatment. Sixteen mice were randomly divided into two groups, a far infrared radiation treatment group (n = 8) and a non-far infrared radiation treatment group (n = 8). Collected blood samples were studied by analyzing the RNA level of peripheral blood mononuclear cells and the plasma protein levels of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and endothelial nitric oxide synthase (eNOS). RESULTS: The administration of far infrared radiation inhibited the RNA levels of interleukin-6 and TNF-α after stimulation by lipopolysaccharide. The far infrared radiation treatment inhibited the endothelial nitric oxide synthase RNA levels at 1 h, but the RNA levels returned close to the baseline level after 2 h. In the control group, the endothelial nitric oxide synthase RNA levels were continuously decreasing. The interleukin-6 concentration in the plasma of the far infrared radiation group showed significant inhibition 30 min after lipopolysaccharide stimulation. The tumor necrosis factor alpha RNA concentration in plasma of the far infrared radiation group was significantly reduced 2 h after lipopolysaccharide stimulation. CONCLUSION: Far infrared radiation therapy can inhibit interleukin-6 and tumor necrosis factor alpha RNA levels of peripheral blood mononuclear cells and recover endothelial nitric oxide synthase expression. These results demonstrate that far infrared radiation therapy might aid in reducing the level of inflammation experienced by patients going through peritoneal dialysis treatment.

Influence of new hire transition workload on insomnia in nurses.

AIMS: In this study, we investigated the relationship of the prevalence and incidence of insomnia with the new hire transition workload in nurses. METHODS: This retrospective study used the clinical diagnosis data of the entire nursing population in Taiwan for 2005 to 2008, drawn from the National Health Insurance Research Database. Adjusted logistic regression and Cox regression models were used to separately analyse factors related to the prevalence and incidence of insomnia. RESULTS: During this period, the prevalence of insomnia increased, whereas its incidence remained stable. After adjustment for demographic variables in the logistic regression models, the higher prevalence of insomnia was associated with a longer employment duration and a higher new hire ratio. In the Cox regression models, a higher incidence of insomnia was associated with a shorter employment duration and a higher new hire ratio. Nurses with a longer employment duration had a higher prevalence, but lower incidence, of insomnia. A higher new hire ratio was associated with a higher prevalence and incidence of insomnia. CONCLUSION: To mitigate the risk of insomnia, we suggest that additional support should be provided to non-new nurses to assist them in the new hire transition.

Distribution of Cytotoxic T Lymphocyte-Associated Antigen-4 Promoter Polymorphisms in Taiwanese Patients with Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is associated with chronic inflammation, suggesting the metabolic abnormalities are originated from or exacerbated by cytokine overproduction. Cytokines and counter-regulatory molecules are crucial in keeping the balance of immune responses and, therefore, are potential candidates involved in T2DM etiology, development and complications. Our previous reports identify several significant associations between the genotypes of cytokine genes and T2DM and/or the clinical lipid parameters, which strongly suggest the participation of immune-regulatory molecules in lipid metabolism. The aim of this study is to determine the distribution of gene encoding cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), a T-cell negative regulator, in T2DM patients and health subjects. Genomic DNA was extracted from 287 Taiwanese T2DM patients and 278 ethnic- and age- matched healthy subjects, and two CTLA-4 polymorphisms (-318 C/T and +49 A/G) were analyzed by polymerase chain reaction-restriction fragment length polymorphism. Intriguingly, CTLA-4 -318 genotype was associated with circulatory triglycerides in T2DM subjects (P=0.019) although no significant association between CTLA-4 -318 (P=0.119) and +49 (P=0.2) genotypes with T2DM was identified. In addition, CTLA-4 +49 genotype was significantly associated with the ratio between total cholesterol and high-density lipoprotein (P=0.004) in control subjects. Our results suggest that CTLA-4 may be involved in lipid metabolism and affect T2DM disease progression and/or the development of diabetic complications although this gene does not represent a major risk factor for T2DM.

Seasonal variations in sleep disorders of nurses.

AIMS AND OBJECTIVES: To investigate the difference between nurses and the general population regarding seasonal variations in sleep disorders during 2004-2008. The effects of season and group interaction on sleep disorders with regard to different comorbidities were also examined. BACKGROUND: Studies on seasonal variations in sleep disorders were mainly conducted in Norway for the general population. Furthermore, whether different comorbidities cause seasonal variations in sleep disorders in nurses remains unknown. DESIGN: A retrospective study. METHODS: Data from the Taiwan National Health Insurance Research Database were used in generalised estimating equation Poisson distribution models to investigate the differences in sleep disorders between nurses and the general population diagnosed with sleep disorders (each n = 7643) as well as the interaction effects of sleep disorders between the groups with respect to different seasons. Furthermore, the interaction effects between groups and seasons on sleep disorders in the subgroups of comorbid anxiety disorders and depressive disorders were studied. RESULTS: Both the nurses and the general population had fewer outpatient visits for sleep disorders in winter than in other seasons. The nurses had fewer outpatient visits for sleep disorders than the general population did in each season. The nurses had more outpatient visits for sleep disorders in winter than in summer compared with the general population in the comorbid depressive disorder subgroup but not in the comorbid anxiety disorder subgroup. CONCLUSIONS: Nurses and the general population exhibited similar seasonal patterns of sleep disorders, but nurses had fewer outpatient visits for sleep disorders than the general population did in each season. For nurses with comorbid depressive disorders, outpatient visits for sleep disorders were more numerous in winter than in summer, potentially because nurses with comorbid depressive disorders are affected by shorter daylight exposure during winter. RELEVANCE TO CLINICAL PRACTICE: Depression and daylight exposure may be considered in mitigating sleep disorders in nurses.

Use of Zarit Burden Interview in analysis of family caregivers' perception among Taiwanese caring with hospitalized relatives.

This study was conducted to examine the relationships between family caregivers' perception of caregiving and its influencing factors among Taiwanese with hospitalized relatives. The study used a cross-sectional and descriptive correlational design. A convenience sample of 200 primary caregivers of hospitalized patients diagnosed with cancer, stroke and chronic illness was recruited in a Taiwanese Medical Center; this focus was chosen because cancer, stroke and chronic illness generally require long term care. Data were collected by structured questionnaires. Pearson product-moment correlation and stepwise multiple regression analyses were used to analyse the results of this study. Family caregivers who lacked family support and whose patients' ADL (activities of daily living) dependency was increasing experienced a greater caregiving burden. Family caregivers who had better psychological well-being, better quality of relationship and more caregiving knowledge experienced a lower caregiving burden. Quality of relationship, lack of family support and patients' ADL dependency accounted for 43% of the Zarit Burden Interview variance. The results indicated that family caregivers' perception of caregiving included sacrifice, strain, embarrassment, anger and loss of control. It is vital for nurses to understand these caregiving perceptions and their related factors to provide a holistic care plan.

Culture influence and predictors for behavioral involvement in patient safety among hospital nurses in Taiwan.

This study explored the effects of incident reporting culture and willingness of incident reporting on behavioral involvement in patient safety (BIPS) by surveying 1049 hospital nurses in Taiwan. The highest areas of BIPS were handoff communication and discussion on error prevention. Yet, sharing information about human factors toward safety awareness was less frequent. Results indicated that the reporting culture, willingness to report, tenure of work, and reporting rate contributed positively to BIPS.

Family carer reactions and their related factors among Taiwanese with hospitalized relatives.

AIM: The purpose of this study was to examine the relationships among family carer reactions and their related factors among Taiwanese with hospitalized relatives. BACKGROUND: In Taiwan, most hospitalized patients have relatives or foreign labourers with them 24 hours a day. Limited research has focused on the reactions of family members who provide care for hospitalized relatives. METHODS: A cross-sectional, correlation design was used. A convenience sample of 200 primary carers of hospitalized patients diagnosed with cancer, stroke, and enduring illness was recruited between 2009 and 2010. Data were collected by structured questionnaires. RESULTS: The findings indicate that participants with a moderate level of family support experienced a moderate impact on health and finances, but a high impact on schedule. Family carers' health status and work time were significantly different between, before and after serving as a carer. The multiple regression model variables accounted for 40.1% of the total family carer reaction variance. Three factors were found to predict significantly greater impact on a family carer: (1) lower scores of caregiving knowledge, (2) increasing patient's activities of daily living dependency and (3) lack of family support. CONCLUSION: It is vital for nurses not only to assess patients' activities of daily living, but also to assess family carers' knowledge of caregiving and the patient's existing family support in developing a plan of care that reduces negative impact on family carers.

[Information technology in nursing: using the decision-making support system in the OPD nursing instruction information system].

In line with Department of Health promotion of electronic medical records, health care institutions have increased their information technology facilities in order to improve medical quality and patient safety, streamline healthcare procedures, reduce hospital management costs, and increase the use of statistical analysis in medical teaching, research and administration. However, applying information technology must consider many factors apart from system design and development. Such other factors include effectiveness in reducing user reliance on memory faculties, ability to streamline work processes, and capacity to recommend viable decisions. This paper provides an example of the nursing instruction information system deployment process. In addition to describing the development and implementation, applications of patient education and nursing decision-making are also presented. It is hoped that this experience may serve as reference to other healthcare institutions in the process of building nursing information systems.

Psychosocial aspects in myasthenic patients treated by plasmapheresis.

Knowledge about the postintervention psychosocial status of myasthenia gravis (MG) is limited and based on questionnaire studies. In this study, the effects of improvement in muscle strength with plasmapheresis treatment on both quality of life (QoL) and psychological status of MG patients were studied. Between January 2008 and December 2009, 29 MG patients were enrolled to receive one course of plasmapheresis treatment. Differences in baseline and posttherapy clinical, laboratory, and psychosocial measures were determined. The mean MG score decreased from 7.8 points at baseline to 4.2 after plasmapheresis, accompanied by the mean antibody clearance of 56%. Psychosocial tests showed significant pre- and posttherapy differences in illness identity (mean scores 23.62 and 20.79 points, respectively) and disability (mean scores 11.28 and 7.63 points, respectively) (p < 0.01). No significant differences were found for the other indices. Although both anxiety and depression scores did not differ significantly, there was a clear change in patients, as evidenced by their decreases in severity after treatment. The mean mental components scores of QoL were still less than 40 after treatment, indicating that myasthenic patients need assistance in adapting to their disease. Thus, although plasmapheresis treatment achieved immediate improvement of myasthenic symptoms, reduced disability, and better illness identity, both emotional status and QoL did not differ significantly after intervention. Systematical evaluation for patients' illness perceptions and emotional problems are warranted and related strategies should be taken for long-term stabilization of psychosocial function.

Do-not-resuscitate orders for critically ill patients in intensive care.

End-of-life decision making frequently occurs in the intensive care unit (ICU). There is a lack of information on how a do-not-resuscitate (DNR) order affects treatments received by critically ill patients in ICUs. The objectives of this study were: (1) to compare the use of life support therapies between patients with a DNR order and those without; (2) to examine life support therapies prior to and after the issuance of a DNR order; and (3) to determine the clinical factors that influence the initiation of a DNR order in ICUs in Taiwan. A prospective, descriptive, and correlational study was conducted. A total of 202 patients comprising 133 (65.8%) who had a DNR order, and 69 (34.1%) who did not, participated in this study. In the last 48 hours of their lives, patients who had a DNR order were less likely to receive life support therapies than those who did not have a DNR order. Older age, being unmarried, the presence of an adult child as a surrogate decision maker, a perceived inability to survive ultimate discharge from the ICU, and longer hospitalization in the ICU were significant predictors of issuing a DNR order for critically ill patients. This study will draw attention to how, when, and by whom, critically ill patients' preferences about DNR are elicited and honored.

The effectiveness of intradialytic leg ergometry exercise for improving sedentary life style and fatigue among patients with chronic kidney disease: a randomized clinical trial.

BACKGROUND: Over the past three decades, research has been carried out on the effects of exercise on chronic kidney disease patients for improving their physical potential. OBJECTIVES: The purpose of this study is to evaluate the effect of intradialytic leg ergometry exercise for improving fatigue and daily physical activity levels among chronic kidney disease patients. DESIGN: A quasi-experimental clinical trial. SETTING: Two hemodialysis units in a medical center in northern Taiwan. METHOD: The leg ergometry exercise was performed within the first hour of each hemodialysis session for 30 min for 8 weeks. There were 36 subjects in the experimental group and 35 subjects in the control group who completed the study. Measurement on a fatigue scale and a physical activity log were done at the time of enrollment, and again on the fourth and eighth weeks. RESULT: Active subjects demonstrated significantly less fatigue and higher physical activity levels than those with a sedentary lifestyle at baseline. During the 8 weeks of intervention, subjects in both the active and sedentary groups reduced their fatigue levels significantly, with the exception of sedentary subjects in the control group. Only active subjects in the experimental group demonstrated an increase in activity levels. The 36 subjects performed 3456 leg ergometry exercise sessions with three early terminations (<.01%) among the sedentary subjects. CONCLUSIONS: Intradialytic leg ergometry is a safe exercise that is effective to reduce fatigue and improve physical fitness in already active chronic kidney disease patients and it also reduces fatigue in sedentary patients. Interventions to motivate sedentary patients to become active require further investigation. IMPLICATION FOR NURSING PRACTICE: Exercise during hemodialysis does not cost patients extra time and is effective in reducing fatigue and increasing physical activity potential as demonstrated by our study; 30 min of intradialytic leg ergometer exercise can be considered as routine care while delivering hemodialysis.

Safety and efficacy of mixing cetrorelix with follitropin alfa: a randomized study.

OBJECTIVE: To assess the safety and efficacy of mixing cetrorelix with follitropin alfa (rFSH) in assisted reproductive technology. DESIGN: Prospective, randomized study. SETTING: An IVF center in a teaching hospital. PATIENT(S): One hundred forty patients undergoing intracytoplasmic sperm injection were randomized into mixed (M) or separate (S) injection groups. INTERVENTION(S): In the M group, rFSH and cetrorelix were mixed immediately before administration, whereas in the S group, rFSH and cetrorelix were administered separately. MAIN OUTCOME MEASURE(S): The primary efficacy end point was the incidence of premature LH surge. The secondary efficacy endpoints included estradiol levels on the day of hCG injection, numbers of oocytes obtained, implantation, and ongoing pregnancy rates. The safety endpoints included ovarian hyperstimulation syndrome, and adverse events related to injections including local tolerability. RESULT(S): Excluding eight patients who dropped out of the study, there were 66 patients in each group for analysis. Patients in the M group received significantly fewer injections than patients in the S group (9.1 vs. 13.9). Other outcome parameters, including incidences of premature LH surge, numbers of oocytes retrieved, fertilization, implantation, and ongoing pregnancy rates were similar between the two groups. CONCLUSION(S): Cetrorelix and rFSH can be mixed together without compromising their reported safety and efficacy. This observation is in line with the reported safety and efficacy profile of the products listed in their current package inserts.

Effects of a prenatal yoga programme on the discomforts of pregnancy and maternal childbirth self-efficacy in Taiwan.

OBJECTIVE: to evaluate a yoga programme provided to primigravidas in the third trimester of pregnancy with the aim of decreasing the discomforts associated with pregnancy and increasing childbirth self-efficacy. DESIGN: non-randomised controlled experimental study. SETTING: a hospital in northern Taiwan. PARTICIPANTS: the target population was primigravidas at 26-28 weeks of gestation (no high-risk pregnancies) who had not engaged in regular exercise or yoga for at least one year. The study included 88 individuals; 43 in the control group and 45 in the experimental group who took part in the prenatal yoga programme. INTERVENTION: the duration of the prenatal yoga programme was 12-14 weeks, with at least three sessions per week. Each workout lasted for 30 minutes. MEASUREMENTS AND FINDINGS: women who took part in the prenatal yoga programme reported significantly fewer pregnancy discomforts than the control group (38.28 vs 43.26, z=-2.58, p=0.01) at 38-40 weeks of gestation. The subjects who participated in the yoga programme exhibited higher outcome and self-efficacy expectancies during the active stage of labour (104.13 vs 83.53, t=3.24, p=0.002; 99.26 vs 77.70, t=3.99, p ≤ 0.001) and the second stage of labour (113.33 vs 88.42, t=3.33, p=0.002; 102.19 vs 79.40, t=3.71, p ≤ 0.001) compared with the control group. KEY CONCLUSIONS: the provision of booklets and videos on yoga during pregnancy may contribute to a reduction in pregnancy discomforts and improved childbirth self-efficacy. IMPLICATIONS FOR PRACTICE: this yoga programme provides health-care professionals with an evidence-based intervention.

Prevalence and impact on quality of life of lower urinary tract symptoms among a sample of employed women in Taipei: a questionnaire survey.

BACKGROUND: Previous studies about the prevalence and impact of lower urinary tract symptoms (LUTS) were focused on urinary incontinence or overactive bladder in the general population. Little research has been focused on the role that the workplace has in employed women's experiences with LUTS or the impact of LUTS on their health-related quality of life (HRQL). OBJECTIVES: To estimate the prevalence of LUTS among employed female nurses in Taipei and to compare the HRQL for nurses with and without LUTS. DESIGN: This study was a cross-sectional, questionnaire survey. SETTINGS: Three medical centers and five regional hospitals in Taipei were selected randomly. PARTICIPANTS: In the selected hospitals, 1065 female nurses were selected randomly. Data analyses were based on 907 usable surveys. All participants were native Taiwanese; most of the female nurses were 26-35 years of age (mean=31.02, SD=6.32), had normal body mass index, and had never given birth. Most nurses' bladder habits were poor or very poor and their personal habits of fluid consumption at work were inadequate. METHODS: Data were collected using the Taiwan Nurse Bladder Survey and the Short Form 36 Taiwan version. Chi-square tests were used to compare the prevalence rates of different LUTS for nurses in different age groups. Student's t-tests were conducted to compare the mean scores of HRQL for nurses with and without LUTS. RESULTS: Based on 907 usable surveys, 590 (65.0%) experienced at least one type of LUTS. The prevalence for different LUTS ranged from 8.0% to 46.5%. Nurses who reported LUTS also reported lower HRQL, more so on physical health than mental health, than nurses who did not report LUTS. CONCLUSIONS: Although most of the nurses in this study were young (< or =35 years) and nulliparous, LUTS were common among this group. The high prevalence rate of LUTS leads to concerns about nurses' possible dysfunctional voiding patterns and possible effects of working environment and poor bladder and personal habits on LUTS. Study results showed a possible negative impact of LUTS on nurses' physical health. Designing a continence-related education program for this group is essential for delivering information about LUTS prevention and management.

The impact of Chinese cultural values on Taiwan nursing leadership styles: comparing the self-assessments of staff nurses and head nurses.

The purpose of this study was to investigate the influence of Chinese culture on nursing leadership behavior in Taiwan nurses. A descriptive study compared staff nurses' assessment of Chinese value in the leadership behavior of their head nurses. Data analysis was made on a convenience sample in Taiwan of 214 head nurses and 2,127 staff nurses who had worked with their head nurse for at least one year. Six medical centers and regional hospitals in northern (Taipei), central (Taichung) and southern (Kaohsiung) Taiwan were recruited for this study. Instruments included the demographic questionnaire, Chinese Value Survey, and Kang's Chinese Leadership Behaviors Module Scale. Results indicated that head nurses scored significantly higher than staff nurses in terms of all cultural values and leadership behaviors. Both staff nurses and head nurses scored the highest mean scores in personal integrity (Yi) and human connectedness (Ren) and the lowest in moral discipline (Li). Staff nurse perceptions of leadership behavior indicated the role of parent to be higher than either the role of director or mentor. Head nurses perceptions of leadership behavior emphasized the role of the director more than either parent or mentor. There were no significant differences between the staff nurses and head nurses in terms of expectative leadership behavior, which gave the role of director higher mean scores than those of either the parent or mentor. Positive and significant associations (r = .266 to r = .334) were found between cultural values and perceptions of leadership behavior. Cultural values predicted 10.6% of leadership behavior variance. The three demographic characteristics of location in northern Taiwan (beta = .09), intention to leave (beta = -.14), and general unit (beta = .10) and the two cultural values of human connectedness (Ren) (beta = .16) and personal integrity (Yi) (beta = .16) together reported a cumulative R2 of 14.6% to explain variance in leadership behavior perceptions. Results of this study identified the important cultural values "Ren" and "Yi". Managers and administrators could add the consideration of such cultural values into nursing leadership to enhance the organization in which Taiwan nurses work.

[Applications of nursing information systems: sharing the experience of implementation in a hospital].

With the rapid development of information technology, many information devices have been utilized in health environments to improve care quality. There are many factors involved in designing and implementing information systems, such as: using graphical user interface, user-oriented design, "Help" information, graphic capabilities, consistency of system interface and the redo function. There are different strategies for system implementation, such as: big-bang (directly cutover from the old to the new system), parallel (both old and new systems are used at the same time) and phased (gradually replacing the old with the new system step by step). The most commonly used method of system evaluation involves conducting a questionnaire survey. This paper provides an experience of topic choice, interface design, export outputs, installation process and difficulties encountered in implementing a nursing information system. The experience could serve as a reference for related healthcare institutions or agencies implementing nursing information applications.