Enhancing wound healing and adhesion through dopamine-assisted gelatin-silica hybrid dressings.

Gelatin, widely employed in hydrogel dressings, faces limitations when used in high fluid environments, hindering effective material adhesion to wound sites and subsequently reducing treatment efficacy. The rapid degradation of conventional hydrogels often results in breakdown before complete wound healing. Thus, there is a pressing need for the development of durable adhesive wound dressings. In this study, 3-glycidoxypropyltrimethoxysilane (GPTMS) was utilized as a coupling agent to create gelatin-silica hybrid (G-H) dressings through the sol-gel method. The coupling reaction established covalent bonds between gelatin and silica networks, enhancing structural stability. Dopamine (DP) was introduced to this hybrid (G-H-D) dressing to further boost adhesiveness. The efficacy of the dressings for wound management was assessed through in-vitro and in-vivo tests, along with ex-vivo bioadhesion testing on pig skin. Tensile bioadhesion tests demonstrated that the G-H-D material exhibited approximately 2.5 times greater adhesion to soft tissue in wet conditions compared to pure gelatin. Moreover, in-vitro and in-vivo wound healing experiments revealed a significant increase in wound healing rates. Consequently, this material shows promise as a viable option for use as a moist wound dressing.

[Exploring Fatigue Patterns and Associated Factors Among Patients on Hemodialysis].

BACKGROUND: Fatigue in patients on hemodialysis varies based on disease and treatment situations. Most studies have assessed the effectiveness of interventions based on average fatigue during the past week. However, two different types of fatigue are identified: post-dialysis fatigue and continuous fatigue. Identifying different types of fatigue and related factors may facilitate the development of more-effective, type-specific measures to reduce patient fatigue. PURPOSE: The purpose of this study was to explore fatigue patterns and predictors in patients on hemodialysis during their eight-day dialysis cycle. METHODS: A perspective, observational research design was adopted. One hundred and two patients were recruited from three hospitals and one hemodialysis clinic in New Taipei City. During the dialysis, patients answered a structured questionnaire that included a demographic datasheet, Taiwanese depression questionnaire, hemodialysis social support scale, trait anxiety inventory, Pittsburgh sleep quality index, and fatigue visual analogy scale. After dialysis on each day, patients completed the fatigue visual analogy scale for a period of eight consecutive days every morning, noon, and night. Biochemical data and inter-dialysis weight gain were collected from medical charts. RESULTS: This study found three distinct fatigue status groups: fatigue adaptation, rapid change and continuous fatigue. After the day of dialysis, fatigue level was the lowest in the fatigue adaptation group, followed by the continuous fatigue group. The rapid change group reported the highest level of fatigue. With regard to the degree of increase in fatigue after dialysis (fatigue score after dialysis minus fatigue score before dialysis), the rapid change group had the highest average increase in score after dialysis, while the continuous fatigue group had the lowest. Sleep quality, trait anxiety, and health caregiver support were also found to be predictors of group affiliation. CONCLUSIONS: Nurses can provide individual social support interventions and methods to improve sleep quality and alleviate anxiety to reduce fatigue in patients on hemodialysis.

Theranostic doxorubicin encapsulated FeAu alloy@metal-organic framework nanostructures enable magnetic hyperthermia and medical imaging in oral carcinoma.

Metal-organic frameworks (MOFs) have emerged as attractive candidates in cancer theranostics due to their ability to envelop magnetic nanoparticles, resulting in reduced cytotoxicity and high porosity, enabling chemodrug encapsulation. Here, FeAu alloy nanoparticles (FeAu NPs) are synthesized and coated with MIL-100(Fe) MOFs to fabricate FeAu@MOF nanostructures. We encapsulated Doxorubicin within the nanostructures and evaluated the suitability of this platform for medical imaging and cancer theranostics. FeAu@MOF nanostructures (FeAu@MIL-100(Fe)) exhibited superparamagnetism, magnetic hyperthermia behavior and displayed DOX encapsulation and release efficiency of 69.95 % and 97.19 %, respectively, when stimulated with alternating magnetic field (AMF). In-vitro experiments showed that AMF-induced hyperthermia resulted in 90 % HSC-3 oral squamous carcinoma cell death, indicating application in cancer theranostics. Finally, in an in-vivo mouse model, FeAu@MOF nanostructures improved image contrast, reduced tumor volume by 30-fold and tumor weight by 10-fold, which translated to enhancement in cumulative survival, highlighting the prospect of this platform for oral cancer treatment.

Study of polymethylmethacrylate/tricalcium silicate composite cement for orthopedic application.

BACKGROUND: Among orthopedic surgery materials, poly (methyl methacrylate) (PMMA) is most commonly used for its excellent mechanical properties and rapid self-setting time. However, PMMA bone cement has been reported to cause thermal necrosis and to have poor bioactivity, which must be improved. In contrast, tricalcium silicate (TCS), the most significant component of Portland Cement and the most effective bone cement material, might not always meet the needs of the cement due to its poor mechanical properties and elevated pH levels during hydration. We hypothesize that the benefits of both PMMA and TCS can be harnessed by mixing them together in different proportions. This would represent a better solution for the issues faced when using them alone. METHODS: We, therefore, prepared a novel organic-inorganic PMMA/TCS composite bone cement mixing PMMA and different amounts of TCS and tested its effect on the biophysical properties. RESULTS: The addition of 30% TCS reduced the exothermic temperature and pH variation during cement setting and hydration processes. However, the mechanical and handling properties of the bioactive PMMA/TCS composite were not affected. The in vitro study also revealed that the composite materials had higher cell viability than pure PMMA and TCS. Also, the in vivo study on animals indicated that the composite materials were more capable of forming bone, which further reinforced the biocompatibility of the proposed PMMA/TCS bone cement. CONCLUSION: By combining the advantages of each component, it could be possible to construct a more effective composite bone cement material. This would meet the needs of implantation material for orthopedic surgeries or a possible bone filler.

Assessing Suitability of Co@Au Core/Shell Nanoparticle Geometry for Improved Theranostics in Colon Carcinoma.

The interactions between cells and nanomaterials at the nanoscale play a pivotal role in controlling cellular behavior and ample evidence links cell intercommunication to nanomaterial size. However, little is known about the effect of nanomaterial geometry on cell behavior. To elucidate this and to extend the application in cancer theranostics, we have engineered core-shell cobalt-gold nanoparticles with spherical (Co@Au NPs) and elliptical morphology (Co@Au NEs). Our results show that owing to superparamagnetism, Co@Au NPs can generate hyperthermia upon magnetic field stimulation. In contrast, due to the geometric difference, Co@Au NEs can be optically excited to generate hyperthermia upon photostimulation and elevate the medium temperature to 45 °C. Both nanomaterial geometries can be employed as prospective contrast agents; however, at identical concentration, Co@Au NPs exhibited 4-fold higher cytotoxicity to L929 fibroblasts as compared to Co@Au NEs, confirming the effect of nanomaterial geometry on cell fate. Furthermore, photostimulation-generated hyperthermia prompted detachment of anti-cancer drug, Methotrexate (MTX), from Co@Au NEs-MTX complex and which triggered 90% decrease in SW620 colon carcinoma cell viability, confirming their application in cancer theranostics. The geometry-based perturbation of cell fate can have a profound impact on our understanding of interactions at nano-bio interface which can be exploited for engineering materials with optimized geometries for superior theranostic applications.

Polyelectrolyte multilayer composite coating on 316 L stainless steel for controlled release of dual growth factors accelerating restoration of bone defects.

A composite coating of polyelectrolyte multilayers (PEMs) consisting of collagen, a chitosan barrier, and poly-γ-glutamic acid was fabricated using a spin coating technique to investigate and overcome the limited osseointegration capacity of 316 L stainless steel (316 L SS). To further enhance the biocompatibility, bone morphogenetic protein 2 (BMP-2) and basic fibroblast growth factor-2 (FGF-2) were loaded separately as dual growth factors, allowing for progressive drug release following the natural process of bone regeneration. The first burst release of FGF-2 triggered the proliferation of surrounding cells, and the subsequent release of BMP-2 stimulated their differentiation. The microstructure, surface potential, hardness, reduced Young's modulus, and wettability were assessed using scanning electron microscopy, nanoindentation, and water contact angle. The formation of apatite layers after immersion in simulated body fluid confirmed the bioactivity of this PEM. PEMs loaded with BMP-2 and FGF-2 showed a long sustained release of growth factors for up to 48 days. The biological properties were studied in vitro with rat bone mesenchymal stem cells (rBMSCs) and in vivo using a rat critical-sized calvarial defect model. PEMs loaded with growth factors further stimulated the proliferation and osteogenic differentiation of rBMSCs and the histology results indicated that new bone tissues could directly grow onto the PEMs. These findings suggest that PEM composite coating possesses significant potential for surface modification and long-term drug release of metallic implants to assist with bone restoration.

[Effects of Motivational Interview and Mobile Social Network Support on Smoking Cessation in Male Patients With Coronary Heart Disease].

BACKGROUND: Patients with coronary heart disease (CHD) who quit smoking exhibit lower rates of heart attack recurrence and mortality than their peers who continue smoking. However, most male patients with CHD resume smoking after hospital discharge. PURPOSE: To explore the effectiveness of motivational interventions and mobile social network support on smoking cessation and other predictors of smoking cessation in male patients with CHD. METHODS: An experimental design was used, and a convenience sample was recruited from a cardiology ward of a hospital in northern Taiwan. The participants were randomly assigned to the experimental group (n = 57) and control group (n = 64). During hospitalization, each participant completed a questionnaire after undergoing cardiac catheterization. The questionnaire included a demographic datasheet, the Fagerström Test for Nicotine Dependence, and the contemplation ladder. Afterward, the experimental group received motivational interventions, filled out a self-efficacy scale and the contemplation ladder, and joined an online mobile social group (LINE) for three months. The control group received regular care and a smoking cessation booklet, and then filled out the self-efficacy scale and contemplation ladder. An intention-to-treat analysis was adopted to evaluate smoke cessation status. Information on post-discharge smoking status was collected from the participants via the Line communications app or phone calls at three-months after hospital discharge and was further confirmed using urinary cotinine levels. RESULTS: The results revealed that both groups registered improvements in motivation to quit smoking. This motivation was relatively higher in the experimental group after the intervention than in the control group. The smoking cessation rate in the experimental group (35.09%) was higher than that in the control group (17.19%). However, the intergroup difference in the cessation rate only approached statistical significance (OR: 2.34; p = .055) after controlling for the baseline difference between the two groups. Controlling for the effects of the intervention, age of smoking initiation, first diagnosis of CHD, and self-efficacy were identified as predictors of smoking cessation. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Healthcare providers are encouraged to provide motivational interviews to enhance the motivation of their patients to quit smoking as well as to incorporate self-efficacy into related interventions to increase the smoking cessation rate.

Oral Cancer Theranostic Application of FeAu Bimetallic Nanoparticles Conjugated with MMP-1 Antibody.

Metastatic oral squamous cell carcinoma (SCC) displays a poor disease prognosis with a 5-year survival rate of 39%. Chemotherapy has emerged as the mainstream treatment against small clusters of cancer cells but poses more risks than benefits for metastatic cells due to the non-specificity and cytotoxicity. To overcome these obstacles, we conjugated antibodies specific for matrix metalloproteinase-1 (MMP-1), a prognostic biomarker of SCC, to iron-gold bimetallic nanoparticles (FeAu NPs) and explored the capability of this complex to target and limit SSC cell growth via magnetic field-induced hyperthermia. Our results showed that 4.32 ± 0.79 nm sized FeAu NPs were superparamagnetic in nature with a saturation magnetization (Ms) of 5.8 emu/g and elevated the media temperature to 45 °C, confirming the prospect to deliver hyperthermia. Furthermore, conjugation with MMP-1 antibodies resulted in a 3.07-fold higher uptake in HSC-3 (human tongue squamous cell carcinoma) cells as compared to L929 (fibroblast) cells, which translated to a 5-fold decrease in cell viability, confirming SCC targeting. Finally, upon magnetic stimulation, MMP-1-FeAu NPs conjugate triggered 89% HSC-3 cellular death, confirming the efficacy of antibody-conjugated nanoparticles in limiting SCC growth. The synergistic effect of biomarker-specific antibodies and magnetic nanoparticle-induced hyperthermia may open new doors towards SCC targeting for improved disease prognosis.

Effects of situational simulation and online first-aid training programs for nurses in general medical wards: A prospective study.

BACKGROUND: To maintain patient safety, effective first-aid skills are necessary during emergencies. It is important to develop in-service education programs to equip clinical nurses with first-aid skills. OBJECTIVES: This study explored the effects of first-aid skills and knowledge between situational simulation training and online teaching. It also examined the different effects of two training programs associated with nurses' baseline first-aid ability. DESIGN: This was a randomized, single-blind controlled study. SETTING: The study was conducted from December 15, 2016 to May 28, 2018, in the nursing department of a medical center in Taiwan. PARTICIPANTS: Participants were 92 general ward nurses. METHODS: Participants were randomly assigned to either a situational simulation training or an online teaching group. We used a first-aid knowledge test (FAKT) and a first-aid skills test (FAST) to measure the participants' learning outcomes after intervention and we did cost comparisons between groups. RESULTS: There were no significant differences in the changes in FAKT and FAST scores after intervention between situational simulation training and online teaching groups (p = 0.76, p = 0.45). All the participants in both training programs showed improvements via increased scores on FAST (M ± SD = 35.27 ± 12.08 for online teaching, M ± SD = 36.08 ± 10.78 for situational simulation training) and FAKT (M ± SD = 21.09 ± 18.59 for online teaching, M ± SD = 23.39 ± 15.36 for situational simulation training). However, for the subgroup of participants who scored <75% on the FAST pretest, better improvements only occurred in the situational simulation training, but the situational simulation training program had higher costs than the online teaching program. CONCLUSIONS: The improvement was greater in the situational simulation training group among nurses who could not exceed scores of 75% for first-aid skills. First-aid skill scores below 75% are likely a sign of nurses who need more assistance, discussion, and debriefing from situational simulation training.

Perceived pain for orthodontic patients with conventional brackets or self-ligating brackets over 1 month period: A single-center, randomized controlled clinical trial.

BACKGROUND/PURPOSE: The objective of this 2-arm parallel trial was to test the superiority of self-ligating brackets (SLB) over conventional brackets (CB) in terms of perceived pain for orthodontic patients. METHODS: Patients about to undergo treatment were included to fixed appliance placed with CB or SLB. Eligibility criteria included malocclusion patients whose age between 12 to 40 years and suitable for orthodontic fixed appliance treatment. The main outcome was pain intensity measured by visual analog scale (VAS) with all patients followed at 4 h, 24 h, 3 days, 1 week and 1 month. Randomization was accomplished with a computer-generated list of random numbers. Blinding was applicable for outcome assessment only. Data were analyzed using multi-level nonlinear mixed effect model, Friedman's test and Wilcoxon signed rank test with the Bonferroni correction for multiple tests. RESULTS: Eight-eight patients were randomized in a 1:1 ratio to either SLB or CB. All patients completed the study, and none were lost to follow-up. There were no drop-outs after randomization. Baseline characteristics were similar between groups. The is no statistical significant difference in pain intensity between CB and SLB at 4 h, 24 h, 3 days, 1 week and 1 month. Data were analyzed on an intention-to-treat basis. No serious harm was observed. CONCLUSION: The results of this study indicated no evidence that the pain intensity differs between CB and SLB at 4 h, 24 h, 3 days, 1 week and 1 month.

Gamma-poly glutamate/gelatin composite hydrogels crosslinked by proanthocyanidins for wound healing.

A novel multifunctional poly(γ-glutamic acid) (γ-PGA)/gelatin hydrogel has been developed and used as a wound dressing. An ideal wound dressing should effectively provide a moist environment, absorb wound exudates and protect the wound from foreign microbes. Water soluble γ-PGA salts of sodium and calcium forms were chosen for their good biocompatibility, biodegradability and water absorption capacity. Oligomeric proanthocyanidins (OPCs), naturally occurring plant metabolites and potent antioxidants, were investigated as a non-toxic crosslinking agent in this study. The effects of hydrogels on the degree of crosslinking, swelling, in vitro degradation, mechanical properties and radical scavenging activity were systemically evaluated. A cell viability assay demonstrated that these OPCs crosslinked γ-PGA/gelatin (PGO) hydrogels were not cytotoxic to L929 fibroblasts. Dermal irritation and skin sensitization tests were examined using a guinea pig model; the hydrogels were considered to be neither allergic nor a dermal sensitizer in guinea pigs. Lastly, an in vivo wound healing model in rats was used to study the effects of the hydrogels on wound healing for 21 days. PGO hydrogels formed by both Na and Ca salts could accelerate wound contraction and re-epithelialization, in which Na-PGO hydrogel was significantly better than the untreated control group. The findings suggest that PGO hydrogels are promising wound dressing materials for the treatment for wound healing.

Effect of oral appliance on circulating leukocyte telomere length and SIRT1 in obstructive sleep apnea.

OBJECTIVES: The increased cardiovascular risk seen in patients with obstructive sleep apnea (OSA) may be due to combination of oxidative stress, systemic inflammation and damage to leukocyte telomere length (LTL) seen with aging. Another molecule, Sirtuin 1 (SIRT1), a histone/protein deacetylase, regulates endothelial nitric oxide synthase and is involved in different aspects of cardiovascular disease, aging and stress resistance. The aim of this study was to evaluate the effects of mandibular advancement device (MAD) on the circulating LTL and SIRT1 protein level in peripheral blood mononuclear cells (PBMCs) in patients with OSA. MATERIALS AND METHODS: Forty patients with moderately severe to severe OSA who desired MAD and 20 healthy controls were prospectively enrolled. The LTL was measured by quantitative polymerase chain reaction while SIRT1 protein levels in PBMC was assessed using a Sirtuin 1 ELISA Kit. All study subjects underwent baseline sleep study, with OSA patients having repeat testing at 3 months after MAD. RESULTS: Compared to healthy subjects, patients with OSA at baseline had lower LTL and SIRT1 protein levels in PBMC. After 3 months of MAD, 24 OSA patients, designated as MAD responders, median (range) LTL increased from (0.556 [0.393-0.748]) to (0.708 [0.533-0.893]) and SIRT1 protein levels in PBMC increased from 0.58 ± 0.23 pg/µg of total protein to 0.95 ± 0.26 pg/µg of total protein. For the 16 MAD unresponsive patients, LTL and SIRT1 protein levels remained low. CONCLUSIONS: Successful treatment of OSA with MAD can restore LTL and SIRT1 protein levels in PBMC. CLINICAL RELEVANCE: LTL and SIRT1 protein levels in PBMC can be improved following effective treatment of OSA using MAD.

[Factors Associated With Successful Smoking Cessation in Male Patients With Coronary Artery Disease at 3 Months After Hospital Discharge].

BACKGROUND: The promising effects of smoking cessation for coronary artery disease (CAD) patients include decreased risks of subsequent clinical events and mortality. However, most CAD patients continue to smoke after being hospitalized for a cardiac event. PURPOSE: To explore the factors that are associated with successful smoking cessation in CAD male patients at 3 months after hospital discharge. METHODS: A correlational design was applied. A convenience sample (N = 165) was recruited from the cardiac wards of two medical centers in northern Taiwan and 154 of these completed the 3-month follow up. The medical charts of the participants were reviewed to obtain their disease-related factors. All of the participants finished one questionnaire during their hospital stay. This questionnaire collected data on participant demographics, smoking and quitting history, and nicotine addiction as well as the causal attribution of heart disease to smoking, importance of smoking outcomes, self-efficacy for quitting, and post-discharge intention to quit. Information on post-discharge smoking status was collected via phone calls to the participants at three-months after hospital discharge and, for participants who claimed to have not smoked since discharge, was further confirmed by measuring their expired CO (carbon monoxide) level. Multiple logistic regression analysis was used to examine the identified predictors of successful smoking cessation. RESULTS: The 3-month self-reported rate of abstinence was 37.01% (n = 57), while the rate of abstinence as confirmed by expired CO was 31.17% (n = 48). Those with acute coronary syndrome, longer hospital stays, and higher post-discharge intention to quit were more likely to quit smoking. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The abstinence rate as confirmed by expired CO for hospitalized male patients with CAD is more accurate than the rate obtained by self-reporting. Healthcare providers should stress the importance of smoking cessation, especially for those who have been diagnosed with angina, are hospitalized for shorter periods of time, and indicate a lower post-discharge intention to abstinence.

Assessing the impact of diabetes on quality of life: validation of the Chinese version of the 19-item Audit of Diabetes-Dependent Quality of Life for Taiwan.

OBJECTIVE: To examine the reliability and validity of the Chinese version of the 19-item Audit of Diabetes-Dependent Quality of Life for Taiwan (ADDQoL-CnTW). METHODS: Linguistic validation procedures for patient-reported outcome measures were used to translate the Taiwan version from the original 19-item UK-English ADDQoL. The psychometric properties of the ADDQoL-CnTW were evaluated in a convenience sample, recruited from outpatient facilities, of 260 patients diagnosed with diabetes mellitus. RESULTS: The forced one-factor solution supported one general 19-item factor with all items loading above 0.43, accounting for 51.5% of the variance, although the results of confirmatory factory analysis did not strictly adhere to a one-factor structure. Using Kaiser's Criterion, exploratory factor analysis identified four sub-dimensions but the pattern of loading also confirmed the presence of a large general factor with 11 of 19 items loading ≥0.4 on the first component, accounting for 49.73% of the variance. Internal consistency for the entire scale was 0.94. Convergent and discriminant validity were suggested by a stronger correlation of average weighted impact (AWI) scores with the overview Diabetes-specific QoL item than with the Present QoL item. The Present QoL item correlated better with the World Health Organization Quality of Life-BREF(TW) dimension scores than the Diabetes-specific QoL scores or the AWI scores. Insulin-treated patients reported significantly more negative AWI scores and Diabetes-specific QoL scores than those treated with tablets and/or diet, demonstrating known-groups validity. CONCLUSIONS: The ADDQoL-CnTW revealed excellent internal consistency reliability, and showed evidence of validity for use in Taiwanese people with diabetes.

Comparing the rubella seronegativity in pregnant women who received one dose of rubella vaccine at different ages in Taiwan.

INTRODUCTION: Vaccination is the best strategy to prevent rubella and congenital rubella. The aim of our study was to assess the immunity to rubella and determine rubella virus antibody titers in pregnant women who were offered a single dose of rubella vaccine at different ages of their lives. METHODS: A total 15,067 rubella IgG antibody test results for Taiwanese pregnant women who received routine prenatal checkup at Fooyin University Hospital from 1999 to 2014 were analyzed in this study. The women were divided into five birth cohorts in order to compare their rubella seronegativities and antibody titers according to the different period of rubella vaccination policy in Taiwan. RESULTS: The total rubella seronegativity rate was 11.2% (95% CI: 10.7-11.7%) and the mean rubella antibody titers was 51.0IU/mL (SD=54.7IU/mL). The junior school cohort has the lowest rubella seronegativity of 7.6% (95% CI: 6.9-8.2%). The seronegativities were significantly high in the preschool cohort and in the 15-month-old cohort, 14.9% (95% CI: 13.2-16.6%) and 14.8% (95% CI: 11.5-18.1%), respectively. The OR values were 2.1 (95% CI: 1.8-2.5, p<0.001) in the preschool cohort and 2.2 (95% CI: 1.6-2.8, p<0.001) in the 15-month-old cohort, respectively, against the junior school cohort. Women in the 15-month-old cohort have lowest average rubella IgG titer, 25.4IU/mL. CONCLUSION: The total rubella seronegativity rate was 11.2% in all native pregnant women. Women who received one dose rubella vaccine at preschool and 15-month-old have highest seronegativities. The 15-month-old cohort has the lowest average rubella IgG titer. We recommend a revised catch-up immunization policy to women who received one dose rubella vaccine at a younger age.

The development of a questionnaire measure of diabetes-related distress in Chinese-speaking patients: the Diabetes-Related Distress Questionnaire (DRDQ).

PURPOSE: To develop and evaluate the reliability and validity of a Diabetes-Related Distress Questionnaire for Chinese-speaking patients with diabetes. METHODS: The Diabetes-Related Distress Questionnaire (DRDQ) included 11 quality-of-life questions translated from a Diabetes, Attitudes, Wishes, and Needs study and four native items developed by researchers based on patients' experiences. A sample of 981 Chinese-speaking patients with diabetes in Taiwan was invited to complete the questionnaire. RESULTS: A minimum of 4.2 % of patients used each response option for each item. Exploratory factor analysis suggested a two-factor structure, representing treatment-related distress (factor 1) and progression-related distress (factor 2). The mean loading of items on their corresponding factor was high (0.60), while the mean loading on the other factor was low (0.10). A confirmatory factor analysis confirmed a single structure of the DRDQ (root-mean-square error of approximation = 0.063, comparative fit index = 0.93). The Cronbach's alpha was 0.89 for the DRDQ scale, 0.87 for the factor 1, and 0.68 for the factor 2. As expected, people with insulin-treated and HbA1c > 7 % reported significantly greater negative scores than their counterparts on the total score and all items of the DRDQ, with the exception of item 2. A moderate effect size was demonstrated between insulin known groups (ranging from 0.14 to 0.46) and between HbA1c known groups (ranging from 0.08 to 0.87). CONCLUSIONS: The DRDQ is a psychometrically sound instrument that can be used to assess diabetes-related distress in Chinese-speaking patients in Taiwan.

Effect of oral appliance on endothelial function in sleep apnea.

OBJECTIVES: This study evaluated the effects of mandibular advancement device (MAD) on serum levels of nitric oxide derivatives and endothelial function by endothelium-dependent flow-mediated dilation (FMD) in obstructive sleep apnea syndrome (OSAS). METHODS: Thirty patients with moderately severe-to-severe OSAS who desired MAD and 15 healthy controls were prospectively enrolled. FMD was measured by high-resolution B-mode ultrasonography, while serum NO x level from peripheral blood samples was measured by ELISA. All subjects participated in the sleep studies, which were repeated 2 months after MAD in OSAS patients. RESULTS: Serum NO x level and FMD were lower in patients with OSAS than in controls prior to MAD. Serum NO x levels in 19 of 30 patients with OSAS, the designated MAD responders, increased from 11.8 ± 5.8 µM pre-MAD to 22.7 ± 4.9 µM post-MAD. The FMD increased from 5.9 ± 4.6 pre-MAD to 10.5 ± 4.8 post-MAD. For the 11 unresponsive patients, serum NO x and FMD remained impaired after MAD. CONCLUSIONS: Successful treatment of OSAS with MAD can restore serum levels of NO x and FMD. CLINICAL RELEVANCE: Endothelial function can be improved following effective treatment of OSAS using MAD.

[Exploring the effectiveness of a health education program on the stimuli frame and on uncertainty in patients with sudden hearing loss].

BACKGROUND: Uncertainty may limit communication and affect the ability of patients to adapt to their illness. A high level of uncertainty in patients concurrent with sudden hearing loss has been related to poor comprehension of communications and poor illness understanding. Currently, there is no any certain standard information sheet in the clinical setting. PURPOSE: This study evaluates the effect of a one-to-one oral instruction strategy combined with an information sheet firstly on the stimuli frame and then on uncertainty in patients suffering from idiopathic sudden sensorineural hearing loss. METHODS: An experimental design was employed and 60 patients were randomly assigned to either the experimental group (n=28) or the control group (n=32). A structured questionnaire that included the stimuli frame of uncertainty and the Mishel uncertainty illness scale was used to collect data. All samples received regular care following admission to the hospital and received the pretest within 24 hours after admission. The experimental group received the one-to-one oral instruction strategy combined with an information sheet immediately after the pretest. All participants completed the posttest three days later. RESULTS: The health education program increased perceived understanding of illness in patients with the sudden hearing loss, and reduced their illness uncertainty. Perceived understanding of illness was negatively related to the level of illness uncertainty. The stimuli frame of uncertainty acted as a mediator between the intervention and the uncertainty. The intervention increased the level of cognition of the stimuli frame of uncertainty and then indirectly lowered the uncertainty level. CONCLUSIONS/IMPLICATIONS: These findings support the effectiveness of the individual health education strategy with the information sheet in delivering to patients critical information about their condition and treatment. Moreover, this intervention may effectively increase illness cognition and reduce uncertainty in patients with sudden hearing loss. Clinical nurse staffs may use the findings of this study to improve their health education efficacy.

Effects of urinary catheter education for patients undergoing prostatectomy.

In a nonrandomized prospective study, significant decreases in patient anxiety with home urinary catheter management and in length of stay were reported when patients attended the preoperative prostatectomy class with standard postoperative education versus standard postoperative education.

The quality of life of adults with type 2 diabetes in a hospital care clinic in Taiwan.

PURPOSE: To assess the impact of diabetes on quality of life (QoL) and identify major determinants affecting that impact using a multiple regression model. METHODS: This was a cross-sectional design. The audit of diabetes-dependent quality of life (ADDQoL) was administered to assess QoL. RESULTS: A sample of 256 outpatients with type 2 diabetes was recruited. A negative impact of diabetes was observed on all life domains. The first three most impacted life domains were 'future', 'freedom to eat', and 'self-confidence'. 'Freedom to eat' was also the domain the most frequently impacted in five previous ADDQoL studies conducted in Singapore, UK, India, the United States, and Slovakia. Factors negatively associated with some domain scores were younger age (future), being male (close personal relationship and sex life), more education (leisure activities, future, dependence, and freedom to drink), low income (leisure activities), having more diabetic complications (do physically and sex life), treatment with insulin (finances and living conditions), and higher HbA1c (freedom to drink). CONCLUSION: QoL is impaired in patients with diabetes, especially for the 'freedom to eat' domain, indicating that an intervention to improve dietary freedom might be a good way of improving QoL. Greater negative impact of diabetes on QoL was associated with being younger, male, more educated with low income, more diabetes complications, higher HbA1c, and using insulin. These need to be considered in responding to patients' individual needs.