Nurse-led shared decision-making on complementary therapy use by patients with diabetes: An participatory action research.

AIMS: The aim of this study was to develop, implement and evaluate a nurse-led shared decision-making model of care for discussing the use of complementary and alternative medicine with diabetic patients and to explore to what extent the risk-benefit assessment of using complementary and alternative medicine can provide a framework for facilitating nurse-patient dialogue and strengthening patient involvement in their disease management. DESIGN: Participatory action research with pre-post intervention. METHODS: A two-run cycle of action and spirals from participatory action research was undertaken using a purposive sampling method to involve healthcare professionals and diabetic patients from September 2021 to June 2022. The nurse-led shared decision-making model of care was designed and implemented congruent with participatory action research principles. Quantitative measures were collected about patients' perceived involvement in shared decision-making and their understanding of the risks and benefits of using complementary and alternative medicine. Patients' outcomes of disease control (fasting plasma glucose and HbA1c) were also collected. Data were analysed using IBM SPSS software (version 28). Interviews were summarized using thematic analysis. An EQUATOR Network guideline for participatory action research supported the preparation of this paper. RESULTS: Comparison of pre-post intervention outcomes showed that patients' scale scores on shared decision-making involvement and understanding of the risk-benefit of using complementary and alternative medicine improved significantly after implementing the model. Fasting plasma glucose improved only slightly after a 3-month follow-up. CONCLUSIONS: The care model strengthens patient involvement in their disease management and makes appropriate decisions about CAM use that should reduce potentially harmful side effects or interactions between CAM and conventional medicine. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The shared decision-making model of care incorporates evidence-based CAM research into practice, facilitates the standardization of CAM management in diabetes, improves care options for patients and educates nurses about CAM use in managing diabetes. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Factors Considered Important by Healthcare Professionals for the Management of Using Complementary Therapy in Diabetes: A Text-Mining Analysis.

Text-mining algorithms can identify the most prevalent factors of risk-benefit assessment on the use of complementary and integrative health approaches that are found in healthcare professionals' written notes. The aims of this study were to discover the key factors of decision-making on patients' complementary and integrative health use by healthcare professionals and to build a consensus-derived decision algorithm on the benefit-risk assessment of complementary and integrative health use in diabetes. The retrospective study of an archival dataset used a text-mining method designed to extract and analyze unstructured textual data from healthcare professionals' responses. The techniques of classification, clustering, and extraction were performed with 1398 unstructured clinical notes made by healthcare professionals between 2019 and 2020. The most important factor for decision-making by healthcare professionals about complementary and integrative health use in patients with diabetes was the ingredients of the product. Other important factors were the patient's diabetes control, the undesirable effects from complementary and integrative health, evidence-based complementary and integrative health, medical laboratory data, and the product's affordability. This exploratory text-mining study provides insight into how healthcare professionals decide complementary and integrative health use for patients with diabetes after a risk-benefit assessment from clinical narrative notes.

Development of the Benefit-Risk Assessment of Complementary and Alternative Medicine Use in People With Diabetes: A Delphi-Analytic Hierarchy Process Approach.

This study aimed to develop consensus on a decision-making algorithm for benefit-risk assessment of complementary and alternative medicine use in people with diabetes. Delphi-analytic hierarchy process was used with an anonymous voting scheme, based on a three-round procedure, to achieve consensus regarding the important criteria of decision-making algorithm to assess the benefit-risk ratio of complementary and alternative medicine use in people with diabetes. A total of five criteria were considered, namely, the safety of usage (weightage: 46.6%), diabetes-specific patient data (14.6%), complementary and alternative medicine attributes (14.2%), institutional culture in complementary and alternative medicine use (12.8%), and applicability of complementary and alternative medicine (11.8%). The consistency of this hierarchy structure was computed based on the following indices: λmax = 5.041, consistency index = 0.01; random consistency index =1.781; and consistency ratio = 0.009. All criteria to optimize decision-making in ensuring safe use of complementary and alternative medicine in patients with diabetes should be considered by healthcare professionals.

Comparison of the Acute Effects of Kinesio Taping and Sleeper Stretching on the Shoulder Rotation Range of Motion, Manual Muscle Strength, and Sub-Acromial Space in Pitchers with Glenohumeral Internal Rotation Deficit.

BACKGROUND AND OBJECTIVES: Sleeper stretching (SS) can improve the shoulder's range of motion (ROM) for pitchers with glenohumeral internal rotation deficit (GIRD). However, no evidence has proven the effect of Kinesio taping (KT) on shoulder strength and ROM. Therefore, this study compared the effects of SS and KT on shoulder rotation ROM, muscle strength, and sub-acromial distance in pitchers with GIRD. MATERIALS AND METHODS: Thirty-one pitchers with GIRD were allocated into control, KT, and SS groups. Shoulder rotation ROM, muscle strength, and sub-acromial space were measured before and after treatment with SS or KT. RESULTS: The results revealed that KT and SS significantly enhanced shoulder rotation ROM in pitchers with GIRD. External rotator strength significantly increased following KT but significantly decreased after SS. KT and SS exerted no effects on the sub-acromial space. CONCLUSIONS: KT and SS improve shoulder rotation ROM in pitchers with GIRD. In addition, KT improves shoulder external rotator strength, and SS reduces it.

Effects of 4-Week Inspiratory Muscle Training on Sport Performance in College 800-Meter Track Runners.

Background and objectives: Respiratory muscle fatigue is one of the important factors limiting sports performance due to the metaboreflex. This reflex will cause a decrease in blood flow to the extremities and accelerate exercising limb fatigue. Previous studies found that inspiratory muscle training (IMT) can effectively enhance the respiratory muscle endurance and reduce fatigue during long-duration exercise or aerobic exercise, thereby enhancing athletic performance. However, the mechanism between inspiratory muscle strength, change of limb blood flow and sports performance still requires investigation, especially in short-duration exercise, anaerobic or both aerobic and anaerobic exercise. The purpose of this study was to investigate the effects of 4-week inspiratory muscle training on respiratory muscle strength, limb blood flow change rate and sports performance in recreational 800-m college runners. Materials and Methods: Twenty healthy 800-m college runners randomized into the IMT group (11 subjects) and control group (9 subjects). IMT consisted of 30 inspiratory efforts twice daily, 5 days a week, with intensity at 50%, 60%, 70% and 80% of maximum inspiratory pressure (MIP) for 4 weeks, while a control group kept 50% of MIP for 4 weeks. An 800-m trial test, limb blood flow change rate by using Impedance Plethysmography, and MIP were as the outcome measured variables and be evaluated. All measured variables were assessed before and after 4-week IMT training. Two-way ANOVA was conducted for statistical analysis. Results: The results showed significantly interaction between groups and pre-posttest. IMT group significantly decreased limb blood flow change rate from 19.91 ± 11.65% to 9.63 ± 7.62% after received the IMT training program (p < 0.05). The MIP significantly improved from 112.95 ± 27.13 cmH2O to 131.09 ± 28.20 cm H2O in IMT group, and the 800-m trial test also shorted the running time from 162.97 ± 24.96 s to 156.75 ± 20.73 s. But the control group no significantly changed in MIP and 800-m trial test. Conclusions: Our results indicated that the 4-week IMT training (twice a day, 5 days a week) significantly improves participants' inspiratory muscle strength, 800-m running performance and decreases the limb blood flow change rate.

[The Relationship Between Symptoms and Nursing Diagnoses in Hospitalized Patients With Dengue Fever].

BACKGROUND: Supportive care is a primary method for treating dengue fever. Understanding the symptoms of dengue fever and its related nursing diagnosis is crucial for nurses as references for individual care. This research study was motivated by the few literature reviews available on this topic. PURPOSE: This study was developed to elucidate the symptoms experienced by hospitalized patients with dengue fever and to compare the consistency between symptoms and nursing diagnoses. METHODS: A retrospective descriptive research method was employed. The data were collected from the electronic medical records of patients in the data pools of two regional hospitals in Kaohsiung City. A total of 105 patient records were acquired covering the period 2014-2016. IBM SPSS Statistics v22 was used to examine the descriptive statistics of patient attributes and symptoms of dengue fever using averages and percentages and the inferential statistics of symptoms, hospitalization days, and nursing diagnosis using the Chi-square test and Kappa consistency coefficient. RESULTS: The average age of inpatients was 51.0 ± 27.3 years and the average length of hospital stays was 6.1 ± 3.6 days. The common symptoms were fever and headache. The consistency between nursing diagnosis and symptoms ranged up to 45.4%, including hyperthermia, acute pain, nausea, risk of ineffective gastrointestinal perfusion, and risk of bleeding. Inconsistency of nursing diagnosis was found to be 27.3%, including anxiety, deficient fluid volume, and risk of falls. The rate of undiagnosed symptoms was found to be 27.3%, including diarrhea, risk of infection, and impaired oral mucous membrane. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The reasons for the inconsistency between symptoms and nursing diagnoses may relate to insufficient nursing knowledge of dengue fever and inadequate nursing diagnosis education resulting in insufficient clinical experience / poor judgment amongst nursing staff. The findings of this study suggest the need for continuity of education to make the use of a dengue-fever-symptom checklist more widespread in patient care.

Possible climate-induced environmental impacts on parasite-infection rates of northern shrimp Pandalus borealis eggs in the Gulf of Maine.

The Gulf of Maine northern shrimp Pandalus borealis population once supported a significant commercial winter fishery for the New England states. However, the fishery has been on moratorium since 2014 due to consecutive recruitment failures. The issue of parasite-infected eggs, so-called 'white eggs,' has long been identified for the Gulf of Maine northern shrimp, which makes shrimp eggs nonviable and subsequently hampers the recruitment potential. Furthermore, the proportion of infected females was observed to increase with water temperature. As Gulf of Maine temperatures have been increasing for decades, it is important to re-visit issues related to white eggs to evaluate possible impacts of climate-induced environmental changes on the white egg infection rates. We used biological samples collected by the Northeast Fisheries Science Center in 2012-2016 to evaluate the probability that a female shrimp was infected (Pinf) and the proportion of white eggs in an infected female shrimp (pwe). Although Pinf was high, with an average of 73.81% over the Gulf of Maine, pwe was mostly <5%. The variation in both Pinf and pwe examined in this study was not well explained by environmental factors or female body size. However, the average rates of both Pinf and pwe observed in this study were higher than those observed in the 1960s when the bottom temperatures were cooler. The results can be used to account for egg mortality and provide information on potential impacts of possible climate-induced variability on shrimp population dynamics.

The impact of an mHealth app on knowledge, skills and anxiety about dressing changes: A randomized controlled trial.

AIMS: To evaluate the effectiveness of a mobile health (mHealth) application, based on self-regulation theory, on patients' knowledge of wound care, skills in changing dressings and anxiety. DESIGN: A prospective randomized controlled trial. METHODS: Seventy patients (or family members) at a 1,500-bed university hospital in Taiwan were randomized into an experimental (N = 35) or control group (N = 35) from March to December 2016. The experimental group used a mHealth application for wound care; the control group received verbal instructions and a booklet. Instruments to collect data were a wound care knowledge scale, wound care skills scale, State-Trait Anxiety Inventory, and a digital heart variability device. Data were collected at baseline, after three additional demonstrations and before discharge. The generalized estimating equation was used for statistical analysis. RESULTS: The experimental group showed significantly higher levels of wound care knowledge, improved wound care skills, lower levels of state anxiety, and lower heart rate variability than the control group after baseline data collection. CONCLUSIONS: Results support hat a mHealth application may be effective in health education. Clinicians can use the results to promote patients' wound care knowledge, enhance their wound care skills, and reduce anxiety related to dressing changes. IMPACT: Lack of wound care knowledge and skills can affect the willingness and ability to perform effective wound dressing changes, producing anxiety and having an impact on a patient's self-care after hospital discharge. mHealth applications (apps) have the potential to deliver health information in targeted and tailored ways that strengthen the self-management of diseases. mHealth app can increase wound care knowledge, improve care skills, and reduce anxiety related to wound care. mHealth app effectively supports self-monitoring of the wound healing process, self-judgement of the wound condition, and self-reaction of wound care accuracy. mHealth app provides step-by-step visual tutorials on wound care that allow patients and family caregivers to take pictures of the wounds and monitor the wound healing process. mHealth app for wound care knowledge is an effective and individualized method for learning. CLINICAL TRIAL: This study was registered by U.S. National Library of Medicine, ClinicalTrials.gov (ID: NCT03683303).

Development and validation of traditional & complementary medicine (TCM) scales for nurses: Using structural equation modelling (SEM).

OBJECTIVES: This study aimed to develop and validate scales to assess attitudes towards patient' s use of TCM (APUTCM) and to measure a communicative competence in TCM (CCTCM) among nurses. METHODS: The instrument development process was conducted from Sep 2013 to Jul 2014, using the following steps: 1) item development; 2) internal review and refinement; 3) face and content validation; 4) instrument administration to a development sample; and 5) evaluation of validity and reliability. A convenience sample was used to recruit registered and advanced practice nurses who worked in different regions throughout Taiwan. A total of 755 respondents completed the online questionnaire. Statistical analyses were performed using the software of SPSS Version 21.0 and Analysis of Moment Structures (AMOS) version 24.0. RESULTS: The scale-level indexes (S-CVI) of content validity for both scales were over 80%. The reliabilities for the 13-item APUTCM scale and for the five-item CCTCM scale were 0.88 and 0.84, respectively. The model suitability for both scales was assessed, and the findings revealed suitable parameters for all indicators: GFI = 0.954, AGFI = 0.932, CFI = 0.959, RMSEA = 0.62, and chi-square/df = 3.891 for APUTCM; and GFI = 0.992, AGFI = 0.969, CFI = 0.992, RMSEA = 0.63, and chi-square/df = 4.04 for CCTCM. The convergent and divergent validity of scores on both scales provided evidence in the expected direction. CONCLUSION: This scale development study provides preliminary evidence that suggests that the 13-item APUTCM and the five-item CCTCM are reliable and valid scales for assessing attitudes toward patient's TCM use and communicative competence in TCM.

The use of a dual-task paradigm to identify superior sensory organisation ability in rhythmic gymnasts.

Previous study has showed superior sensory organisation ability in rhythmic gymnasts, but mostly in longitudinal data. With a cross-sectional design, this study used a dual-task paradigm to examine the above phenomenon. Fifteen female rhythmic gymnasts (15.0 ± 1.8 yr.) and matched peers (15.1 ± 2.1 yr.) were recruited. The Sensory Organization Test (SOT) was administered with a concurrent lower-demand (serial subtraction of three, serving as the baseline) or higher-demand (serial subtraction of seven, serving as the dual-task) arithmetic task. The results showed no main effect of group, but a group by level of arithmetic task (P = 0.001) interaction effect on SOT equilibrium score. The higher-demand task facilitated balance performance in the gymnasts, but it impeded performance in the controls, with the differences more pronounced in challenging SOT conditions. With the higher-demand task, the gymnasts adopted a sensory strategy with a higher visual ratio but a smaller somatosensory ratio compared to the controls. Better visual utilisation of sensory organisation ability was apparent in gymnasts, but only when the SOT test was performed with a higher-demand secondary task. We have demonstrated the efficacy of using the dual-task paradigm to identify the superior sensory organisation ability of adolescent rhythmic gymnasts.

[：Q].

BACKGROUND: The gap between the expectation and the development of role competency is a dilemma that nurse practitioners (NPs) face in clinical settings. PURPOSE: This study was designed to explore the perceived importance and actual practice of the role competencies of NPs and to compare the differences between the ideal and practical domains as well as related factors. METHODS: This cross-sectional design study used Q-sort to collect data. A 56-item "Nurse Practitioner Role Capacity Questionnaire" was used as the research tool. Two questionnaires: Perceptions of Important Role Competencies and Actual Execution of Role Competencies were distributed to NPs twice, at times that were 2 weeks apart. A total of 40 participants were recruited, including 21(52.5%) internal medicine NPs and 19 (47.5%) surgical medicine NPs. RESULTS: The significant differences that were identified in this study between the perceived importance and actual practice of role competencies were, by domain: medical assistance (t = -5.62, p < .001), clinical research (t = 4.14, p < .001), professional consultation (t = 2.29, p = .027), and direct care (t = 2.21, p = .033). The correlative factors for these differences were: education level (t = -2.17, p = .036) and membership in the Nurse Practitioner Association (t = -2.36, p = .017). NPs with higher levels of education and with membership in the Nurse Practitioner Association earned higher scores for self-expectation in important clinical competency. CONCLUSIONS: NPs face discrepancies in their role expectations, in important part due to their role as providers of medical assistance in clinical practical settings. NPs need to learn and demonstrate the roles and functions of advanced nursing practice to enhance nursing professionalism profoundly.

Superior short-term learning effect of visual and sensory organisation ability when sensory information is unreliable in adolescent rhythmic gymnasts.

Rhythmic gymnasts specialise in dynamic balance under sensory conditions of numerous somatosensory, visual, and vestibular stimulations. This study investigated whether adolescent rhythmic gymnasts are superior to peers in Sensory Organisation test (SOT) performance, which quantifies the ability to maintain standing balance in six sensory conditions, and explored whether they plateaued faster during familiarisation with the SOT. Three and six sessions of SOTs were administered to 15 female rhythmic gymnasts (15.0 ± 1.8 years) and matched peers (15.1 ± 2.1 years), respectively. The gymnasts were superior to their peers in terms of fitness measures, and their performance was better in the SOT equilibrium score when visual information was unreliable. The SOT learning effects were shown in more challenging sensory conditions between Sessions 1 and 2 and were equivalent in both groups; however, over time, the gymnasts gained marginally significant better visual ability and relied less on visual sense when unreliable. In conclusion, adolescent rhythmic gymnasts have generally the same sensory organisation ability and learning rates as their peers. However, when visual information is unreliable, they have superior sensory organisation ability and learn faster to rely less on visual sense.

The effects of threshold inspiratory muscle training in patients with chronic obstructive pulmonary disease: A randomised experimental study.

AIMS AND OBJECTIVES: To investigate the effects of threshold inspiratory muscle training in patients with stages II through IV chronic obstructive pulmonary disease using maximum inspiratory pressure, baseline dyspnoea index, 6-minute walk test and quality of life. BACKGROUND: A threshold inspiratory muscle training device provides pressure for inspiratory muscle strength, but there is limited information on the effects of threshold inspiratory muscle training starting at low pressure training. DESIGN: Randomised experimental design. METHODS: A total of 55 patients completed this study between September 2013-April 2014. The experimental group (n = 27) was provided medical treatment and routine care, along with five sessions of threshold inspiratory muscle training per week (21-30 min per session), accompanied by a progressive increase in the pressure threshold over a period of 8 weeks. The control group (n = 28) was provided medical treatment and routine care only, without intervention. In the inferential analysis, p values <.05 were considered to indicate statistical significance. RESULTS: After 8 weeks in the experimental group, mean maximum inspiratory pressure improved by -17.6 ± 0.18 cmH2 O, mean 6-minute walk test improved by 47.8 ± 1.46 m, and the baseline dyspnoea index increased from 4.48 ± 2.12 points to 9.0 ± 2.27 points. These data and quality of life were statistically different between the experimental and the control groups (p < .05). CONCLUSIONS: The threshold inspiratory muscle training can reduce patients' difficulties with respect to daily activities, thereby reducing the burden on the family, and improving prognosis in patients with moderate-to-very severe chronic obstructive pulmonary disease.

Electrotransfer of the tilapia piscidin 3 and tilapia piscidin 4 genes into skeletal muscle enhances the antibacterial and immunomodulatory functions of Oreochromis niloticus.

Tilapia piscidin 3 (TP3) and tilapia piscidin 4 (TP4) are antimicrobial peptides recently isolated from Oreochromis niloticus. We previously showed that synthetic TP3 and TP4 possessed antimicrobial activities. Here, we analyzed the bactericidal abilities and immunomodulatory properties of these AMPs following the electroporation of pCMV-GFP-TP3 or pCMV-GFP-TP4 plasmid into tilapia (O. niloticus) muscle and subsequent infection with Vibrio vulnificus or Streptococcus agalactiae. Prior overexpression of TP3 or TP4 in tilapia muscle tissues efficiently reduced bacterial numbers at 24 and 48 h after V. vulnificus infection and reduced bacterial numbers at 24 h after S. agalactiae infection compared to numbers in controls expressing pCMV-GFP (EGFP). Electroporation of pCMV-EGFP-TP3 (TP3) or pCMV-EGFP-TP4 (TP4) significantly increased expression of several immune-related genes in muscle (IL-1ß (12 h, TP3), IL-8 (12 h, TP3), TGFß (3 h, TP4), and IκB (48 h, TP3, TP4)) and decreased the expression of TLR5 (12 h and 24 h, TP3) after V. vulnificus infection. Following S. agalactiae infection, expression of the following genes was significantly decreased in muscle: IL-1ß (12 h, TP3), IL-8 (12 h, TP3, TP4), TLR5 (3 h-24 h, TP3, TP4), TGFß (3 h, TP4; 24 h, TP3, TP4), and IκB (3 h, TP3). These data suggest that TP3 and TP4 exert antimicrobial effects after overexpression in the O. niloticus muscle, and also play important roles in the regulation of immune-related gene expression.

A review of nurses' knowledge, attitudes, and ability to communicate the risks and benefits of complementary and alternative medicine.

AIMS AND OBJECTIVES: This study reviewed existing literature to investigate how frequently nurses include complementary and alternative forms of medicine in their clinical practice. In so doing, we investigated nurses' knowledge of and attitudes towards complementary and alternative medicine as well as their ability to communicate the risks and benefits of these therapies with patients. BACKGROUND: Little information is available concerning nurses' knowledge and attitudes towards complementary and alternative medicine or how they incorporate these therapies into their practice. In addition, little is known about the ability of nurses to communicate the risks and benefits of complementary and alternative medicine to their patients. STUDY DESIGN: This study used a scoping review method to map and synthesise existing literature. DATA SOURCES: Both electronic and manual searches were used to identify relevant studies published between January 2007 and January 2014. REVIEW METHODS: The review was conducted in five stages: (1) identification of research question(s), (2) locate studies, (3) selection of studies, (4) charting of data, and (5) collating, summarising, and reporting of results. RESULTS: Fifteen papers met the inclusion criteria for this review, among which 53·7% referenced how frequently nurses include complementary and alternative medicine in their practice. We found that 66·4% of nurses had positive attitudes towards complementary and alternative medicine; however, 77·4% did not possess a comprehensive understanding of the associated risks and benefits. In addition, nearly half of the respondents (47·3-67·7%) reported feeling uncomfortable discussing complementary and alternative medicine therapies with their patients. CONCLUSION: The lack of knowledge about complementary and alternative medicine among nurses is a cause for concern, particularly in light of its widespread application. RELEVANCE TO CLINICAL PRACTICE: Findings from this study suggest that health care professionals need to promote evidence informed decision-making in complementary and alternative medicine practice and be knowledgeable enough to discuss complementary and alternative medicine therapies. Without involvement of complementary and alternative medicine communication on the part of our profession, we may put our patients at risk of uninformed and without medical guidance.

[Systematic review of yoga for depression and quality of sleep in the elderly].

BACKGROUND: Aging and age-related health problems are major issues of concern for community health services. Yoga is an exercise with both physiological and psychological effects on aging. Although many studies have assessed the effectiveness of yoga in the elderly, little information is available in the literature to support empirical conclusions. PURPOSE: This review synthesizes and characterizes findings related to the effects of yoga on depression and quality of sleep in the elderly. METHODS: Researchers used keywords including yoga, elderly, aged / older adult, depression, sleep, and quality to search 6 electronic databases for relevant studies published prior to March 2013. Inclusion and exclusion criteria were used to screen identified study abstracts. The Jadad scale appraised the quality of identified studies. RESULTS: Seven studies met the inclusion criteria. Five studies found significant changes in participant depression symptoms after doing yoga. Three studies found significant effects on the quality of sleep of participants after 6 months of doing yoga. CONCLUSION: Yoga significantly reduced the depressive symptoms of elderly participants and improved their quality of sleep after 6 months. Findings were similar for elderly living in institutions and in the community. However, the majority of participants in the assessed studies were women characterized by a high level of social participation and proactive participation in health promotion activities. Future studies should broaden the scope of research to address different aging populations and use long-term cohort observations in order to better elicit the effectiveness of yoga and to develop strategies to introduce yoga into daily activities.

[Effects of tai chi in postmenopausal women with osteoporosis: a systematic review].

BACKGROUND: Tai chi has been increasingly applied in osteoporosis patients. However, systematic reviews of the efficacy of this practice have been few and of limited scope. PURPOSE: This study reviews previous experimental research work using tai chi as an intervention in postmenopausal women with osteoporosis and to appraise the reported research designs used, tai chi methods used, and outcomes. METHODS: A systematic review method was used to search 14 databases for articles published between January 1980 and July 2013. Searched keywords included: "tai chi," "osteoporosis," and "postmenopausal women". The 2,458 articles initially identified were reduced to 4 valid articles based on considerations of criteria and repeatability. The 4 valid articles used either a randomized clinical trial (RCT) or a controlled clinical trial (CCT). They were further analyzed and synthesized in terms of common variables such as balance, muscle strength, and quality of life. RESULT: Three of the 4 studies identified significant pretest / posttest differences in physiological aspects of quality of life in participants but did not obtain consistent results in terms of the psychological aspects. While reports identified a significant and positive tai chi effect on balance, they all used different measurements to do so. Only one of the four studies identified significant improvement in muscle strength. Therefore, this review could not identify clear support for the effectiveness of tai chi on balance or muscle strength. CONCLUSIONS: This review did not definitively support the positive effects of tai chi on balance, muscle strength, and quality of life in postmenopausal women with osteoporosis. The designs used in the tai chi interventions may be referenced for future studies. We suggest that future studies use data triangulation rather than a single-item tool to validate the research in order to cross-verify the same information. This may strengthen the research and increase the credibility and the validity of related findings.

Exploring the decision to disclose the use of natural products among outpatients: a mixed-method study.

BACKGROUND: There is little understanding of the reasons for the limited communication between patients and conventional healthcare professionals regarding patients' use of complementary and alternative medicine (CAM). The purpose of this study is to explore the predictors of outpatients' decision to disclose their use of natural products to conventional healthcare professionals. METHODS: A mixed method design was used. Quantitative data were obtained through a survey and qualitative data were obtained from semi-structured interviews. A total of 257 outpatients who fulfilled the criteria of having used natural products prior to the interview were recruited for this study. Subsequently, 39 patients of those who completed the survey were further selected to take part in an in-depth qualitative interview. RESULTS: Predictors of the decision to disclose the use of natural products to conventional healthcare professionals included age, frequency of clinic visits, knowledge of the natural products and the attitude towards the benefits of CAM use. The themes that emerged from the qualitative data included safeness of the natural products, consulting alternative sources of information, apprehension regarding the development of negative relationships with healthcare professionals and reactions from the healthcare professionals. CONCLUSIONS: Understanding the factors and reasons affecting patients' decision as to whether to disclose their use of natural products provides an opportunity for conventional healthcare professionals to communicate better with patients. It is important to encourage patients to disclose their use of natural products in order to provide responsible health care as well as increasing patient safety regarding medication usage.

Performance enhancement among adolescent players after 10 weeks of pitching training with appropriate baseball weights.

Compared with regulation-weight baseballs, lightweight baseballs generate lower torque on the shoulder and elbow joints without altering the pitching movement and timing. This study investigates the throwing accuracy, throwing velocity, arm swing velocity, and maximum shoulder external rotation (MSER) of adolescent players after 10 weeks of pitching training with appropriate lightweight baseballs. We assigned 24 adolescent players to a lightweight baseball group (group L) and a regulation-weight baseball group (group R) based on their pretraining throwing velocity. Both groups received pitching training 3 times per week for 10 weeks with 4.4- and 5-oz baseballs. The players' throwing accuracy, throwing velocity, arm swing velocity, and MSER were measured from 10 maximum efforts throws using a regulation-weight baseball before and after undergoing the pitching training. The results showed that the players in group L significantly increased their throwing velocity and arm swing velocity (p < 0.05) after 10 weeks of pitching training with the 4.4-oz baseball, whereas group R did not (p > 0.05). Furthermore, the percentage change in the throwing velocity and arm swing velocity of group L was significantly superior to that of group R (p < 0.05). Thus, we concluded that the 10 weeks of pitching training with an appropriate lightweight baseball substantially enhanced the arm swing velocity and throwing velocity of the adolescent baseball players. These findings suggest that using a lightweight baseball, which can reduce the risk of injury without altering pitching patterns, has positive training effects on players in the rapid physical growth and technique development stage.

A comparative analysis of complementary therapies use among patients attending diabetic clinics in Taiwan: 2007 vs. 2023.

BACKGROUND: We conducted a comparative study to examine the differences in the use of complementary therapies (CT) among patients who attended diabetic clinics for follow-up treatment between 2007 and 2023 in Taiwan. METHODS: This study employed a cross-sectional survey design to recruit individuals with diabetes from two regions (northern and southern) of Taiwan. A total of 183 and 307 participants were included in the surveys of 2007 and 2023, respectively. The data were analyzed using IBM SPSS Statistics version 28.0 to compare the survey results between the two time periods. RESULTS: Among the various CTs, nutritional supplements remained the most prevalent, with a significant increase in usage from 68.3% in 2007 to 89.9% in 2023. Conversely, other therapies, such as Chinese herbal medicines, manipulative-based therapies, supernatural healings, and bioelectromagnetic-based therapies, demonstrated a significant decrease in usage between the two time periods. Furthermore, the disclosure rate of CT use to healthcare professionals remained persistently low, with only 24.6% in 2007 and a slight increase to 30.3% in 2023. CONCLUSION: The significant rise in the use of nutritional supplements in conjunction with conventional medicine, without adequate monitoring and guidance from healthcare professionals, poses a substantial risk of unregulated blood sugar control, compromised diabetes management, and potential harm to health outcomes.