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1.
Res Social Adm Pharm ; 2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-32033877

RESUMO

BACKGROUND: People with diabetes face many challenges to following healthcare provider recommendations for self-management and few are able to achieve and maintain reductions in average blood glucose level. Interdisciplinary teams are a promising strategy to help patients with diabetes improve outcomes. METHODS: An observational analysis of electronic health record data to evaluate the impact of a clinical pharmacist, case manager, or a combination of both on clinical outcomes for patients with diabetes. FINDINGS: All patients (N = 970), regardless of visit type, had a statistically significant improvement in A1C, LDL, and total cholesterol over 1 year. Patients who saw both a case manager and clinical pharmacist had the greatest improvements with the steepest changes across all measures. CONCLUSION: Clinics should create interdisciplinary teams that include a clinical pharmacist and a case manager to have the best outcomes for their patients with diabetes.

2.
J Nurs Adm ; 49(10): 503-508, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31517758

RESUMO

OBJECTIVE: To examine changes in new nurses' competencies across the 1st year of practice. BACKGROUND: Competency assessment is a challenge for nurse residency programs and often focuses on skills checklists and confidence self-reports. The Appraisal of Nursing Practice, an observational rating based on Quality and Safety in Nursing Education standards, was developed to help evaluate an RN residency program. METHODS: Preceptors, nurse educators, and/or unit managers from various units rated new nurse residents. Ratings were compared for 353 nurses at 3 points: within the 1st month in the program (T1), at 5 months (T2), and at month 11 (T3). RESULTS: Competency ratings increased significantly for all subscales from T1 to T2. Ratings continued to increase significantly from T2 to T3, although at a slightly slower rate. Teamwork and evidence-based practice increased the most. CONCLUSIONS: Future studies should explore factors affecting the trajectory in developing nursing competencies within various settings.


Assuntos
Competência Clínica/normas , Avaliação de Desempenho Profissional/normas , Guias como Assunto , Cuidados de Enfermagem/normas , Recursos Humanos de Enfermagem/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Estados Unidos
4.
Psychol Health Med ; 24(8): 925-935, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31060366

RESUMO

Diabetes is the 7th leading cause of death in the U.S. and impacts patients' physical health and also increases the risk for psychological distress. Sleep disturbance is a common complaint in patients with diabetes and likely impacts psychological well-being. This study examined the relationship between sleep characteristics and serious psychological distress (SPD) in people with diabetes by conducting a secondary analysis of cross-sectional data from the 2015 National Health Interview Survey (N= 3474). Approximately 7% of the participants reported SPD and 27% reported sleep durations that were shorter or longer than the recommended 6-8 hours daily. Hierarchical logistic regression analysis showed that people who reported daily sleep of 1-5 hours or 9 or more hours were more likely to report SPD than individuals who slept 6-8 hours a day. Respondents who reported a higher frequency of taking medication for sleep and having trouble staying asleep were also substantially more likely to have SPD. However, an increase in the number of days feeling rested when waking up was a protective factor that decreased the risk of SPD. The findings suggest that both sleep disturbances and SPD, because of their high prevalence, should be included in the routine evaluation for diabetes care.

5.
J Food Drug Anal ; 27(2): 502-509, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30987721

RESUMO

Chronic kidney disease (CKD) is a complex disorder that affects multiple organs and increases the risk of cardiovascular complications. CKD affects approximately 12% of the population in Taiwan. Loss of kidney function leads to accumulation of potentially toxic compounds such as indoxyl sulfate (IS) and p-cresyl sulfate (pCS), two protein-bound uremic solutes that can stimulate the progression of CKD. The aim of this study was to assess whether IS and pCS levels were correlated with CKD stage. We developed and validated a method for quantitating total and free IS and pCS in serum by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Serum samples were pretreated using protein precipitation with acetonitrile containing stable isotope-labeled IS and pCS as internal standards. After centrifugation, the supernatant was diluted and injected into a UPLC-MS/MS system. Analyte concentrations were calculated from the calibration curve and ion ratios between the analyte and the internal standard. The calibration curves were linear with a correlation coefficient of >0.999; the analytical measurement range was 0.05-5 mg/L. The limit of quantitation of this assay was 0.05 mg/L for both analytes. The reference interval was ≤0.05-1.15 mg/L for total-form IS, ≤0.05-5.33 mg/L for total-form pCS, ≤0.05 mg/L for free-form IS, and ≤0.12 mg/L for free-form pCS. A positive correlation was observed between analyte concentration and CKD stage. Our sensitive UPLC-MS/MS method for quantifying total and free-form IS and pCS in serum can be used to monitor the progression of CKD in clinical settings, identify patients at risk, and facilitate development of further therapies for this devastating disease.

6.
Ethn Health ; : 1-20, 2018 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-29385815

RESUMO

OBJECTIVES: Literature review evaluating the effectiveness and cultural surface and deep structures of interventions designed to improve Chinese Americans' chronic disease self-management. METHOD: PubMed, PsycINFO, CINAHL, and Health Source databases were searched for research conducted from 1990 to 2016 on self-management interventions for Chinese Americans with chronic disease. RESULTS: Ten articles comprised eight interventions, which each addressed a dimension of cultural surface structure, all providing linguistically appropriate messages delivered via bilingual staff. Five interventions also addressed cultural deep structure dimensions by providing culturally congruent counsellors or educators, or incorporating Chinese cultural values and social customs. Six interventions resulted in significant improvements in major outcome variables. Participants also reported high satisfaction and retention rates were high. CONCLUSION: Culturally-tailored interventions that incorporate surface and deep structural elements of culture are sensitive and generally effective for Chinese Americans to improve access to health care, disease awareness, social environment, and participants' ability to practice self-management skills.

7.
Clin Chim Acta ; 479: 1-6, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29317194

RESUMO

BACKGROUND: Acute intermittent porphyria (AIP) is caused by diminished activity of porphobilinogen deaminase (PBGD). The purpose of this study was to validate and compare two assays for PBGD activity. The clinical sensitivity of the PBGD activity assays in AIP diagnosis was also evaluated. METHODS: This study included 74 subjects from 18 Taiwanese families including symptomatic patients with AIP, asymptomatic carriers, and healthy family members. The specific mutations in AIP patients were identified by DNA sequencing. PBGD activity was measured in erythrocytes by quantifying formation of coproporphyrin or uroporphyrin by the enzyme using porphobilinogen (PBG) as a substrate and fluorimetry for detection. RESULTS: The calibration curves obtained with pure coproporphyrin or uroporphyrin were linear with correlation coefficients >0.99 in the range of 0-200nM for coproporphyrin and 0-150nM for uroporphyrin. The coefficients of variation for within-run and between-day imprecision were <9.8% for both assays. The three groups of subjects were used to establish the best cut-off of PBGD activity for identifying symptomatic AIP patients by using area under receiver operating characteristic curve analysis. The symptomatic AIP patients and asymptomatic carriers had significantly lower PBGD activity compared with the healthy family members (all p<.001). CONCLUSION: Two different PBGD activity assays were validated. The best cut-off for coproporphyrin was derived as 46.4nmol/h/mL RBC with corresponding sensitivity of 100% and specificity of 100% and the best cut-off for uroporphyrin was derived as 43.7nkat/L RBC with corresponding sensitivity of 100% and specificity of 97.4%.


Assuntos
Hidroximetilbilano Sintase/metabolismo , Porfiria Aguda Intermitente/diagnóstico , Adolescente , Adulto , Idoso , Criança , DNA/análise , Feminino , Fluorometria , Hematócrito , Hemoglobinas/análise , Humanos , Hidroximetilbilano Sintase/sangue , Hidroximetilbilano Sintase/genética , Masculino , Pessoa de Meia-Idade , Estrutura Molecular , Mutação , Porfobilinogênio/análise , Porfobilinogênio/metabolismo , Porfiria Aguda Intermitente/sangue , Porfiria Aguda Intermitente/metabolismo , Especificidade por Substrato , Taiwan , Adulto Jovem
9.
Health Soc Care Community ; 26(1): 72-79, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28620950

RESUMO

Using data from the 2015 Asian American Quality of Life Survey (N = 2,609), latent profile analysis was conducted on general (health insurance, usual place for care and income) and immigrant-specific (nativity, length of stay in the U.S., English proficiency and acculturation) risk factors of healthcare access. Latent profile analysis identified a three-cluster model (low-risk, moderate-risk and high-risk groups). Compared with the low-risk group, the odds of having an unmet healthcare need was 1.52 times greater in the moderate-risk group and 2.24 times greater in the high-risk group. Challenging the myth of model minority, the present sample of Asian Americans demonstrates its vulnerability in access to healthcare. Findings also show the heterogeneity in healthcare access risk profiles.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Aculturação , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Qualidade de Vida , Fatores de Risco
10.
Oncotarget ; 8(36): 60469-60478, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-28947985

RESUMO

This study surveyed urinary nickel concentrations in peritoneal dialysis (PD) patients, and analyzed the association of urinary nickel concentrations with clinical outcomes and inflammatory biomarkers. In total, 50 PD patients and 50 healthy controls were recruited for this study. All participants were examined for the presence of toxic trace elements (antimony, arsenic, bismuth, cadmium, copper, manganese, mercury, nickel, lead, tellurium, thallium and zinc) in their urine by using inductively coupled plasma mass spectrometry (ICP-MS). It was found that PD patients demonstrated higher urinary nickel concentrations than healthy controls (6.1±3.5 versus 2.8±1.4 µg/L, P<0.001). There were 24 (48.0%) PD patients with normal urinary nickel concentrations, and 26 (52.0%) PD patients with high urinary nickel concentrations. The PD patients with high urinary nickel concentrations demonstrated higher log serum levels of high sensitivity C-reactive protein (0.4±0.5 versus 0.1±0.5 mg/L, P=0.046) than patients with normal urinary nickel concentrations. Furthermore, patients with high urinary nickel concentrations exhibited higher levels of cadmium (1.3±0.9 versus 0.6±0.5 µg/L, P<0.001), copper (7.7±5.7 versus 3.3±1.4 µg/L, P<0.001) and manganese (0.9±1.1 versus 0.4±0.4 µg/L, P=0.023) than patients with normal urinary nickel concentrations. Nevertheless, there were no significant differences in the clinical outcomes between PD patients with high and normal urinary nickel concentrations (P>0.05). Thus, it is concluded that approximately half of the patients undergoing PD had elevated urinary nickel levels, and these patients also had elevated serum levels of high sensitivity C-reactive protein. Nevertheless, no other real correlations were discovered including no impact on patient outcome. Further studies are warranted.

11.
Soc Work Public Health ; 31(4): 309-15, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27104949

RESUMO

The present study examined the factors associated with self-rated health (SRH) and self-rated mental health (SRMH) in a sample of 108 older Chinese Americans (MeanAge = 70.6, SD = 7.70). SRH and SRMH were highly associated with each other. In the multiple regression models, chronic conditions and functional disability emerged as significant predictors of poor SRH and SRMH. However, the significance of depressive symptoms was only obtained in the model of SRMH. The findings reflect the body-mind connection among older Chinese Americans and provide implications for integrative health promotion efforts.


Assuntos
Americanos Asiáticos , Indicadores Básicos de Saúde , Saúde Mental/etnologia , Autorrelato , Idoso , Idoso de 80 Anos ou mais , China , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Análise de Regressão
12.
Biomed J ; 37(6): 375-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25179702

RESUMO

BACKGROUND: The risk of coronary artery disease (CAD) increases two- to fourfold in diabetes. Small dense low-density lipoprotein (sdLDL) particles have been linked to an increased risk for CAD. In this study, we sought to compare the sdLDL cholesterol (sdLDL-C) level between the healthy control group and diabetics with CAD in the Taiwanese population. METHODS: Serum specimens were collected from healthy females and males of various age groups (n = 294), type 2 diabetics (DM) without complications (n = 113), and patients having DM with CAD (DM-CAD) (n = 46). The commercial kit was used for the measurement of sdLDL-C level, which employs a simpler method. After heparin-magnesium precipitation of lipoproteins with density <1.044 g/ml, sdLDL (density = 1.044-1.063 g/ml) remained in the supernatant and this sdLDL-C was measured using an automated chemistry analyzer. RESULTS: The sdLDL-C level was significantly higher in males than in females (p < 0.001) and there was an age effect on sdLDL-C (p < 0.001). The DM-CAD group had significantly higher sdLDL-C levels than the healthy control group (p < 0.001), but there was no statistical difference in the LDL-C level between DM-CAD group and the healthy control group. In addition, only individuals having both high LDL-C and sdLDL-C levels had a higher risk for DM-CAD, compared to those with low LDL-C levels and low sdLDL-C levels [Odds Ratio (OR) 4.97; 95% Confidence Interval (CI) 1.96-12.57; p = 0.001]. CONCLUSIONS: Our data suggest that the sdLDL-C level together with the LDL-C level are better risk assessment markers for type 2 diabetics with CAD than the LDL-C level alone.


Assuntos
LDL-Colesterol/metabolismo , Colesterol/metabolismo , Doença da Artéria Coronariana/sangue , Diabetes Mellitus Tipo 2/sangue , Lipoproteínas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , HDL-Colesterol/metabolismo , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Adulto Jovem
13.
J Adv Nurs ; 67(1): 158-68, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20973811

RESUMO

AIM: This paper is a report of a study analysing the effect of a home-based walking exercise program on symptoms and mood distress among breast cancer women receiving chemotherapy postoperatively. BACKGROUND: Treatment-related symptoms, mood distress and decline in physical activity have been identified as major complaints among cancer patients. Studies on the efficacy of home-based walking exercise for symptoms and mood did not fully describe the exercise prescriptions that could be safe and beneficial for women with breast cancer, especially these receiving adjuvant chemotherapy. METHOD: This is a prospective, randomized clinical trial. In 2008-2009, participants were recruited from the oncology outpatient clinic of a medical center in Taiwan, and were assigned to either the exercise group (n=19) or the control group (n=21). Women in the exercise group participated in a moderate-intensity home-based walking program for 12 weeks during their chemotherapy treatments. Symptoms, mood status and physical activity level were measured at baseline, 6- and 12-week follow-up. Data were analysed by two-way repeated-measures analysis of variance. RESULTS: Women in the exercise group reported significantly lower symptom severity scores and mood disturbance compared with those in the control group throughout the study period. CONCLUSION: Regular moderate-intensity exercise can play an important role in improving treatment-related symptoms and mood in women with breast cancer. A home-based walking exercise program can be easily incorporated into care for women with breast cancer undergoing chemotherapy.


Assuntos
Sintomas Afetivos/prevenção & controle , Neoplasias da Mama/terapia , Terapia por Exercício , Serviços Hospitalares de Assistência Domiciliar , Caminhada , Adaptação Psicológica , Adulto , Sintomas Afetivos/induzido quimicamente , Idoso , Análise de Variância , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante/efeitos adversos , Fadiga/induzido quimicamente , Fadiga/prevenção & controle , Feminino , Frequência Cardíaca/fisiologia , Humanos , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Cooperação do Paciente , Avaliação de Programas e Projetos de Saúde , Escalas de Graduação Psiquiátrica , Qualidade de Vida , Índice de Gravidade de Doença , Taiwan , Fatores de Tempo , Resultado do Tratamento
15.
Free Radic Biol Med ; 42(7): 936-44, 2007 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-17349922

RESUMO

Lipid rafts are involved in many cell biology events, yet the molecular mechanisms on how rafts are formed are poorly understood. In this study we probed the possible requirement of reactive oxygen species (ROS) for T-cell receptor (TCR)-induced lipid raft formation. Microscopy and biochemical analyses illustrated that blockage of ROS production, by superoxide dismutase-mimic MnTBAP, significantly reduced partitioning of LAT, phospho-LAT, and PLC-gamma in lipid rafts. Another antioxidant N-acetylcysteine (NAC) displayed a similar suppressive effect on the entry of phospho-LAT into raft microdomains. The involvement of ROS in TCR-mediated raft assembly was observed in T-cell hybridomas, T leukemia cells, and normal T cells. Removal of ROS was accompanied by an attenuated activation of LAT and PKCtheta, with reduced production of IL-2. Consistently, treating T cells with the ROS-producer tert-butyl hydrogen peroxide (TBHP) greatly enhanced membrane raft formation, distribution of phospho-LAT into lipid rafts, and increased IL-2 production. Our results indicate for the first time that ROS contribute to TCR-induced membrane raft formation.


Assuntos
Espécies Reativas de Oxigênio/metabolismo , Linfócitos T/metabolismo , Humanos , Ativação Linfocitária , Receptores de Antígenos de Linfócitos T/metabolismo
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