Effect of Music Therapy on Pain After Orthopedic Surgery-A Systematic Review and Meta-Analysis.

BACKGROUND: Although music interventions on postoperative pain (POP) have positive effects, limited research has focused on systematic reviews and meta-analyses of its efficacy for orthopedic patients. This systematic review aimed to examine the effects of music therapy on pain after orthopedic surgery. METHOD: The Cochrane Library, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Nursing Reference Center (NRC), Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan were searched up to August 2019. The risk of bias from the Cochrane Handbook for Randomized Controlled Trials of Interventions was used. A standard mean difference (SMD) with 95% confidence intervals (CIs) was applied as a summary effect on postoperative pain and anxiety using RevMan version 5.3. A meta-analysis was also carried out using subgroup analysis. RESULTS: Nine randomized controlled trials were selected. (1) Music can relieve pain significantly for both music medicine (MM; SMD = -0.41, 95% CI [-0.75, -0.07], P = 0.02) and music therapy (MT; SMD = -0.31, 95% CI [-0.57, 0.04], P = 0.02). (2) Music chosen by the subjects showed significant differences for both MM (P = 0.002) and MT (P = 0.02). (3) Anxiety improved significantly among patients using MT (SMD = 0.44, 95% CI [-0.75, -0.13], P = 0.005). However, the results for the physiologic parameters, opioid requirement, and length of stay showed subtle distinctions. CONCLUSION: Music can significantly relieve POP, specifically music chosen by the participants.

Psychometric Validation of the Mandarin Version Control Attitudes Scale-Revised Questionnaire in Taiwanese Patients With Heart Failure.

BACKGROUND: Perceived control is an important construct in patients with heart failure (HF) and related to improved health outcomes. There is no reliable and valid instrument available for the measurement of perceived control in Taiwan, limiting the practical application of the construct in research and clinical practice. PURPOSE: The aim of this study was to translate, culturally adapt, and validate the Mandarin version of the Control Attitudes Scale-Revised (Mandarin CAS-R) in Taiwanese patients with HF. METHODS: The Mandarin CAS-R was developed using a translation/back-translation process and semantic equivalence; importantly, conceptual equivalence was also examined. Reliability was assessed using Cronbach's α to determine internal consistency, and item homogeneity was assessed using item-total and interitem correlations. Construct validity was examined using exploratory factor analysis and hypothesis testing for known associations. RESULTS: Three hundred forty-eight patients with HF were included, and 5-item Mandarin CAS-R was validated in the study. The model performance was acceptable with all factor loadings greater than 0.70, a variance explained of 55.2%, and a Cronbach's α of .79. The 5-item Mandarin CAS-R was associated with higher levels of self-care maintenance (ß = 0.395, P < .001), management (ß = 0.219, P < .01), and confidence (ß = 0.524, P < .001); perceived social support (ß = 0.246, P < .001); and depression (ß = -0.125, P < .05). CONCLUSIONS: This study provided evidence of the reliability and validity of the 5-item Mandarin CAS-R as a measure of perceived control in Taiwanese patients with HF.

Validation of the Clinical COPD Questionnaire in Taiwan.

Health status improvement is a critical treatment goal for physicians managing chronic obstructive pulmonary disease (COPD). Numerous instruments to measure the disease-specific health-related quality of life (HRQOL) for patients with COPD have been used in daily clinical practice. The Clinical COPD Questionnaire (CCQ) is one of these recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). This study examined the psychometric properties of the CCQ in patients with COPD in Taiwan. A descriptive, cross-sectional design was conducted. Data were collected in a secondary care unit. We administered the CCQ, the modified Medical Research Council (mMRC) dyspnea scale, and the 12-item Short Form Health Survey (SF-12) for patients with COPD. Reliability was assessed using Cronbach's alpha and item-total correlation coefficients. Construct validity was assessed using confirmatory factor analysis (CFA) and testing the hypothesis that severity of dyspnea measured using the mMRC dyspnea scale is associated with the CCQ scores. Convergent validity was assessed by testing the correlation between the CCQ and the SF-12. Discriminant validity was assessed to differentiate among the classifications of COPD Groups A to D. A total of 114 subjects were recruited in the study. Cronbach's alpha was high (0.90) for the total score of the CCQ. Significant correlations were found between the CCQ scores and those of the mMRC dyspnea scale (ρ = 0.67) and domains of the SF-12 (ρ = -0.44 to -0.75). Furthermore, the CCQ scores showed a significant difference among the classifications of COPD Groups A to D. CFA confirmed the construct validity, with a good model fit. Good to excellent psychometric properties of the Chinese Version CCQ were demonstrated in the study. Wide usage of the Chinese Version CCQ for Taiwanese COPD patients can be recommended in daily clinical practice or clinical trials.

Sociodemographic and meteorological correlates of sudden infant death in Taiwan.

BACKGROUND: This study was designed, using three national datasets including the Taiwan Death Registry, Taiwan Birth Registry, and National Meteorological Dataset, to examine the sociodemographic, geographic and meteorological correlates of sudden infant death syndrome (SIDS). METHODS: One thousand, six hundred and seventy-one cases of SIDS occurring between 1994 and 2003, and 8355 matched controls were included in this nested case-control study. RESULTS: Over the study period, the annual rate of SIDS declined only slightly, with an average annual rate of 57.9/10(5) . Male infants (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI]: 1.06-1.33), preterm births (AOR, 1.69; 95%CI: 1.33-2.13), low birthweight (AOR, 2.87; 95%CI: 2.30-3.59), and birth order ≥3 (AOR, 1.62; 95%CI: 1.37-1.92) were the demographic risk factors for SIDS. Additionally, paternal age <25 years (AOR, 1.37; 95%CI: 1.09-1.71), urbanization (AOR, 1.46; 95%CI: 1.20-1.78), lower paternal education (elementary and less; AOR, 1.28; 95%CI: 1.01-1.64), and parental age difference >10 years (AOR, 1.72; 95%CI: 1.24-2.39) were also associated with increased risk of SIDS. It was also noted that daily average temperature ranging from 9.2°C to 14.2°C (AOR, 2.10; 95%CI: 1.67-2.64) was associated with the most increased risk, while temperature ≥26.4°C (AOR 0.60, 0.61) was significantly associated with the most reduced risk. CONCLUSION: Sociodemographic, geographic and meteorological data can be used to identify families in greater need of early guidance and to promote various prevention measures to avoid the occurrence of SIDS.

Predicting Trends in Dyspnea and Fatigue in Heart Failure Patients' Outcomes.

BACKGROUND: Dyspnea and fatigue are distressing symptoms commonly seen in heart failure (HF) patients, and are closely related to patients' disease trajectory of contributes. Identifying the effect of symptom trends on disease outcomes is important to develop effective symptom management interventions in HF patients. METHODS: One hundred and twenty-two patients were recruited. Dyspnea, fatigue, clinical characteristics, and disease outcomes were measured at the baseline assessment, three months, and 12 months. Latent class growth model and Kaplan-Meier survival analysis were used on dyspnea and fatigue to examine the relationship of disease trajectories and effects on disease outcomes. RESULTS: A total of 122 patients were examined (mean age 62.8 ± 13.0 yrs; 79% male; 39% NYHA III/IV; 48% preserved systolic function HF). Three groups based on HF patients' dyspnea-fatigue trends were identified as "constant good," "recovery," and "getting worse." The cumulative incidence of a first cardiac event in both dyspnea and fatigue groups yielded similar results. The quality of life score for the getting worse group was significantly higher than that of the constant good and recovery groups. The result of the log-rank test was significant (χ(2) = 8.11, p = 0.017). Post hoc comparison showed that the prognosis status of the constant good group was better than that of the getting worse (p = 0.046) and recovery groups (p = 0.020), while getting worse and recovery groups did not differ in prognosis status (p = 0.30). CONCLUSIONS: The results demonstrate the value of tracking symptoms over time to determine symptom trajectories as well as severe baseline (even with improvements at follow-ups) or increased fatigue over time were related to a worse event-free survival as compared with low but stable fatigue. KEY WORDS: Disease outcome; Kaplan-Meier survival analysis; Symptom trajectory.

Factors related to medication non-adherence for patients with hypertension in Taiwan.

AIMS AND OBJECTIVE: To characterise a Taiwanese population and to examine the prevalence of antihypertensive medication non-adherence and how the cultural/clinical factors were associated with non-adherence in Taiwan. BACKGROUND: Antihypertensive medication non-adherence is a significant clinical issue in the United States. However, little is known about hypertension (HTN) control and cultural/clinical factors related to non-adherence in Taiwan. DESIGN: A convenience sample survey design was used. METHOD: Data were gathered from a convenience sample of 200 subjects recruited from a large teaching hospital. Medication non-adherence and cultural/clinical factors were recorded using various self-administered questionnaires, and blood pressure was taken twice for each participant. RESULTS: The mean age of the participants was 60.4 (SD 11.5 years) including 62% men. Two-thirds had less than a high school education (64.5%), and the majority of them were married (86·0%) and lived with family or close friends (93.5%). The average length of HTN diagnosis was 8.6 years (SD 9.0 years). Medication non-adherence rate was 47·5%, and uncontrolled HTN rate was 49.0%. Some participants (17.0%) used Chinese herbs for treating their disease (e.g. cough) and promoting health in addition to their regular antihypertensive medications. Two factors were found to be statistically significant for predicting medication non-adherence: Lower Perceived Susceptibility to Specific Diseases [OR = 1.15 (95%CI, 1.01-1.31)] and Longer Length of HTN Diagnosis [OR = 1.06 (95%CI, 1.01-1.12)]. CONCLUSIONS: Taiwanese at risk of non-adherence included those who perceived lower susceptibility to specific diseases and had been diagnosed with HTN for a longer time. Those using herbs need to be studied for an impact of herbs on their adherence behaviour. RELEVANCE TO CLINICAL PRACTICE: These findings can help guide the development of culturally sensitive and clinically appropriate nursing interventions for HTN management in Taiwan.

The relationship between spiritual well-being and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy.

PURPOSE: We examined relationships among demographic and clinical characteristics, spiritual well-being, and psychosocial adjustment in Taiwanese patients with colorectal cancer and a colostomy. DESIGN: A descriptive, cross-sectional, exploratory study design was used to answer research questions. SUBJECTS AND SETTING: Participants were recruited from the outpatient ambulatory clinic in the gastrointestinal surgical department at the medical center of National Taiwan University. Forty-five Taiwanese patients aged 42 to 83 years who were diagnosed with colorectal cancer and underwent colostomy surgery participated in the study. METHODS: Participants completed a personal data questionnaire designed for this study, along with 2 validated instruments, the Spiritual Well-Being Scale and the Psychosocial Adjustment to Illness Scale-Self Report. FINDINGS: Forty-five persons participated in the study; 69% reported a moderate level of spiritual well-being. Participants reported strong adjustment to extended family relationships, but poor adjustment in sexual relationships. Spiritual well-being was significantly associated with psychosocial adjustment (r = -0.52, P < .01), and 4 predictors (income change after surgery, self-rated disease severity, time since surgery, and spiritual well-being) accounted for 53% of the variance in psychosocial adjustment. CONCLUSIONS: Spiritual well-being plays an important role for Taiwanese patients when faced with psychosocial adjustment related to life with colorectal cancer and a colostomy.

Predictors of exercise frequency in breast cancer survivors in Taiwan.

AIM: To apply social cognitive theory to elucidate factors that motivate change in exercise frequency in breast cancer survivors during the six months after completing cancer treatment. BACKGROUND: Exercise is now a well-recognised quality-of-life intervention in breast cancer survivors. However, only regular exercise yields long-term benefits. Motivations for exercise have not been analysed in Taiwan patients with cancer. DESIGN: A prospective, longitudinal and repeated measures design was used. METHODS: A convenience sample of 196 breast cancer survivors was recruited from hospitals in metropolitan areas of north and south Taiwan. Study participants were allowed to select their preferred exercised activities. Exercise behaviour and other factors were then recorded using various standardised instruments. Medical charts were also reviewed. Data were analysed by a linear mixed model and by hierarchical multiple regression equations. RESULTS: Exercise frequency significantly changed over time. Explained variance in exercise frequency change was modest. Baseline exercise frequency was the best significant predictor of exercise frequency during the six-month study. The study also identified possible age-related differences in the effect of social support on exercise. The effect of social support for exercise on exercise frequency was apparently larger in older subjects, especially those over 40 years old, than in younger subjects. Mental health, exercise barriers and exercise outcome expectancy significantly contributed to change in exercise frequency during the six-month study. CONCLUSIONS: The analytical results revealed several ways to increase exercise frequency in breast cancer survivors: (1) encourage exercise as early as possible; (2) improve health status and provide social support for exercise, especially in women aged 40 years or older; (3) reduce exercise barriers and promote mental health; (4) reinforce self-efficacy and positive expectations of exercise outcomes and (5) provide strategies for minimising fatigue in early stages of rehabilitation. Relevance to clinical practice. Social cognitive theory provides a useful framework for understanding the motivation to exercise in breast cancer survivors.

"SURVIVAL" intervention program effects on student nurses' transition to staff nurses: A quasi-experimental study.

OBJECTIVE: The purpose of this study is to explore the effects of the "SURVIVAL" intervention program on the nursing competencies, work self-efficacy, occupational stress and retention rate for students who recently graduated from the two-year baccalaureate nursing program. BACKGROUND: The role transition for students who have recently graduated is a dynamic process, which is associated with stress and challenges. It was also a vital stage for successfully adapting to a nursing career to overcome the reality shock and become competent. DESIGN: A prospective, longitudinal, quasi-experimental design was used to examine the effects of the SURVIVAL intervention on 72 participants in the control group and 38 participants in the experimental group. METHODS: The SURVIVAL intervention included an internship program, the adjustment of the college curriculum, career mentorship and peer support. The outcomes, including nursing competencies, work self-efficacy, occupational stress and the retention rate, were evaluated prior to the participants started working and one, three, six and 12 months after they started working. RESULTS: Compared with the participants in the control group, those in the experimental group performed significantly better with regard to general clinical nursing skills, basic biomedical science, ethics, overall assessment, work self-efficacy and lower occupational stress. CONCLUSIONS: The "SURVIVAL" intervention program for career transition, jointly developed through a partnership between academia and practice, improved some of the nursing competencies and work self-efficacy of the newly graduated nurses and also reduced their occupational stress.

Habitual Physical Activity and Diabetes Control in Young and Older Adults with Type II Diabetes: A Longitudinal Correlational Study.

This study aimed to determine whether daily physical activity in young and older adults with T2DM is associated with diabetes control. A prospective correlational study involving 206 young (≤65 years) and older (>65 years) adults was conducted. The International Physical Activity Questionnaire was used to assess their daily physical activity levels. Patients' mean HbA1c level was 7.8% (±1.4), and 95.9% of patients had unsatisfactory diabetes control. Performing more minutes per week of moderate-intensity daily physical activity was associated with a lower risk of glycemia in both young and older adults. Furthermore, moderate daily physical activity significantly lowered the risk of glycemia. Health personnel must encourage patients to engage in moderate daily physical activities to improve diabetes control.

Factors associated with low bone mass in the hemodialysis patients--a cross-sectional correlation study.

BACKGROUND: Low bone mass is common in end-stage renal disease patients, especially those undergoing hemodialysis. It can lead to serious bone health problems such as fragility fractures. The purpose of this study is to investigate the risk factors of low bone mass in the hemodialysis patients. METHODS: Sixty-three subjects on hemodialysis for at least 6 months were recruited from a single center for this cross-sectional study. We collected data by questionnaire survey and medical records review. All subjects underwent a bone mineral density (BMD) assay with dual-energy x-ray absorptiometry at the lumbar spine and right hip. Data were statistically analyzed by means of descriptive analysis, independent t test and one way analysis of variance for continuous variables, Pearson product-moment correlation to explore the correlated factors of BMD, and stepwise multiple linear regression to identify the predictors of low bone mass. RESULTS: Using WHO criteria as a cutoff point, fifty-one subjects (81%) had a T-score lower than -1, of them 8 subjects (13%) had osteoporosis with the femoral neck most commonly affected. Regarding risk factors, age, serum alkaline phosphatase (ALP) level, and intact parathyroid hormone (iPTH) level had significant negative correlations with the femoral neck and lumbar spine BMD. On the other hand, serum albumin level, effective exercise time, and body weight (BW) had significant positive correlations with the femoral neck and lumbar spine BMD. Age, effective exercise time, and serum albumin level significantly predicted the femoral neck BMD (R(2) x 0.25), whereas BW and the ALP level significantly predicted the lumbar spine BMD (R(2) x 0.20). CONCLUSION: This study showed that advanced age, low BW, low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients. We suggest that regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW, and undertaking an exercise program are important to improve bone health in the patients undergoing hemodialysis.

Validation of Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire with heart failure patients in Taiwan.

BACKGROUND: Dyspnea is a distressing and functionally limiting symptom that patients with heart failure commonly experience. A valid instrument to quantify dyspnea for comparison of groups and for illness management is important. OBJECTIVE: To validate the Chinese version of the Modified Pulmonary Functional Status and Dyspnea Questionnaire. METHODS: The Chinese version was developed by using translation and back translation and was tested in Taiwan in 88 patients who had heart failure but no pulmonary disease or comorbid conditions limiting physical function. Data on a Taiwanese subsample (n=30) were compared with data on 30 patients in the United States matched by sex, age, and severity of disease to determine the equivalence of the Chinese and English versions. Construct validity was assessed by testing the hypothesis that health-related quality of life measured by using the Minnesota Living With Heart Failure Questionnaire is associated with the score on the dyspnea questionnaire. Reliability was assessed by using the Cronbach alpha and item-total correlations. RESULTS: Equivalence between the US and Taiwanese samples was high, from 0.67 to 0.91 for each item of the questionnaire and for the total score. Satisfactory correlations between the Chinese dyspnea and the Minnesota questionnaires, especially in the physical dimension (r=0.71, P<.001), provided support for the construct validity of the Chinese questionnaire. Reliability of the Chinese questionnaire was adequate (alpha=0.94). CONCLUSIONS: The Chinese Modified Pulmonary Functional Status and Dyspnea Questionnaire is a reliable and valid measure for dyspnea that can be used in Taiwanese patients with heart failure.

An evaluation of a weight-loss program incorporating E-learning for obese junior high school students.

Obesity in adolescents is continuing to rise at an alarming rate and is becoming an important public health problem in Taiwan. Therefore, the aims of this study were (1) to evaluate the effectiveness of a Weight-loss E-learning Program (WEP) on obese Chinese adolescents and (2) to gauge this group's satisfaction with the WEP. The design was quasi-experimental, using purposive samples from two junior high schools in Taipei, Taiwan. Obese adolescents between 12 and 14 years of age with body mass indexes (BMI) over 25 kg/m2 were recruited. A 14-week WEP was developed to expedite weight loss for the selected adolescents. Data such as BMI, waist-to-hip ratio, waist circumference, hip circumference, mid-arm circumference, triceps skinfold, blood pressure, and physical fitness were collected through standardized instruments and methods before and after the WEP. The satisfaction of the subjects and four psychosocial variables were evaluated and taken into account by authoritative scales and questionnaires. In total, 37 adolescents participated in this study. After the WEP, we found significant decreases in BMI (p < 0.05), waist circumference (p < 0.05), and triceps skinfold (p < 0.001) in the sample population. Improvements were found in three of four tests of physical fitness (p < 0.001, p < 0.05, and p < 0.01, respectively). All psychosocial variables showed significant favorable changes (p < 0.01 for self-esteem scores, p < 0.001 for the other three variables) and satisfaction levels for the WEP ranged from 56.6% to 83.8% in four different criteria. The WEP was effective in helping obese Chinese adolescents lose weight. However, there is still room for improvement.

Identification, Associated Factors, and Prognosis of Symptom Clusters in Taiwanese Patients With Heart Failure.

BACKGROUND: Patients with heart failure (HF) have multiple distressing symptoms that are associated with poor outcomes. These symptoms do not occur in isolation from each other but likely occur as discrete clusters that may prove helpful to clinicians trying to counsel patients about symptom monitoring and management. Defining common symptom clusters and determining the associations between symptom clusters and outcomes may improve patient management. PURPOSE: The aim of this study was to define symptom clusters and their association with event-free survival in terms of cardiac hospitalization and all-cause mortality in patients with HF. METHODS: Patients were recruited from outpatient HF clinics. Physical symptoms (dyspnea, fatigue, edema, sleeplessness, anorexia, and poor memory) were measured using the modified Pulmonary Function Status and Dyspnea Questionnaire and the Minnesota Living with Heart Failure Questionnaire. A two-stage cluster analysis was conducted to identify subgroups of patients based on the self-perceived severity of the six symptoms. The Kaplan-Meier survival curve and log-rank test were used to assess whether symptom clusters were associated with event-free survival through a 12-month follow-up. RESULTS: Two hundred fifty-eight patients (mean age = 61.2 ± 12.3 years, 75% male, 41% New York Heart Association class III/IV) participated. Three symptom clusters were identified based on the severity of symptoms. These clusters were called the nonsevere symptom cluster (all symptoms were rated with low severity), the typical severity symptom cluster (high level of severity for dyspnea and fatigue, low level of severity for edema, and moderate level of severity for all other symptoms), and the atypical severity symptom cluster (low level of severity for dyspnea and fatigue, high level of severity for edema, and moderate level of severity for all other symptoms). Symptom clusters were associated with event-free survival (p < .001). A post hoc comparison showed that the prognosis was better in the nonsevere symptom cluster than both the typical symptom (p < .001) and nontypical symptom (p < .001) clusters and that the prognoses for the latter two clusters did not differ significantly. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Symptom clusters play an important role in the prognoses of patients with HF. Both patients and healthcare providers may use the information that is provided by this study to improve the surveillance and management of related symptoms.

Vagal withdrawal and psychological distress during ventilator weaning and the related outcomes.

OBJECTIVE: This study investigated the associations between changes in autonomic nervous system (ANS) function, psychological status during the mechanical ventilation (MV) weaning process, and weaning outcomes. METHODS: In this prospective study, we recruited 67 patients receiving MV for >24h at a medical center in northern Taiwan. Patients' ANS function, represented by heart rate variability (HRV), the rapid shallow breathing index (RSBI), anxiety, fear, and dyspnea, was repeatedly measured 10min before and 30min after undergoing a weaning trial. Forty-nine patients capable of sustaining a 2-h weaning trial were successfully weaned. RESULTS: Compared with the failed group, the success group showed significantly smaller decreases in high-frequency HRV (HRV-HF) and smaller increases in RSBI (per 10 breaths/min/L), fear, dyspnea, and anxiety in response to the weaning trial (odds ratio [OR]=2.19, 0.81, 0.69, 0.66, and 0.77, respectively; p<0.05). Multivariate analyses revealed that low-frequency HRV before weaning (OR=2.32; 95% confidence interval [CI]=1.13-4.78, p=0.02), changes in HRV-HF (OR=3.33; 95% CI=1.18-9.44, p=0.02), and psychological fear during the weaning process (OR=0.50; 95% CI=0.27-0.92, p=0.03) were three independent factors associated with 2-h T-piece weaning success. CONCLUSIONS: ANS responses and psychological distress during weaning were associated with T-piece weaning outcomes and may reflect the need for future studies to utilize these factors to guide weaning processes and examine their impact on outcomes.

Symptom Cluster Trajectories During Chemotherapy in Breast Cancer Outpatients.

CONTEXT: Breast cancer patients often experience multiple symptoms and substantial discomfort. Some symptoms may occur simultaneously and throughout the duration of chemotherapy treatment. OBJECTIVES: The aim of this study was to investigate symptom severity and symptom cluster trajectories during chemotherapy in outpatients with breast cancer in Taiwan. METHODS: This prospective, longitudinal, repeated measures study administered a standardized questionnaire (M. D. Anderson Symptom Inventory Taiwan version) to 103 breast cancer patients during each day of the third 21-day cycle of chemotherapy. Latent class growth analysis was performed to examine symptom cluster trajectories. RESULTS: Three symptom clusters were identified within the first 14 days of the 21-day chemotherapy cycle: the neurocognition cluster (pain, shortness of breath, vomiting, memory problems, and numbness/tingling) with a trajectory of Y = 2.09 - 0.11 (days), the emotion-nausea cluster (nausea, disturbed sleep, distress/upset, drowsiness, and sadness) with a trajectory ofY = 3.57 - 0.20 (days), and the fatigue-anorexia cluster (fatigue, lack of appetite, and dry mouth) with a trajectory of Y = 4.22 - 0.21 (days). The "fatigue-anorexia cluster" and "emotion-nausea cluster" peaked at moderate levels on chemotherapy days 3-5, and then gradually decreased to mild levels within the first 14 days of the 21-day chemotherapy cycle. CONCLUSION: Distinct symptom clusters were observed during the third cycle of chemotherapy. Systematic and ongoing evaluation of symptom cluster trajectories during cancer treatment is essential. Healthcare providers can use these findings to enhance communication with their breast cancer patients and to prioritize symptoms that require attention and intervention.

Quality of sleep and related factors during chemotherapy in patients with stage I/II breast cancer.

BACKGROUND: Insomnia causes severe distress in patients with breast cancer who receive chemotherapy. Few studies have focused on using objective methods to assess sleep. This study explored the quality of sleep and related factors in patients with breast cancer during chemotherapy. METHODS: The participants were 16 women with stage I or II breast cancer receiving their third cycle of chemotherapy with cyclophosphamide, epirubicin and fluorouracil, or cyclophosphamide, methotrexate and fluorouracil. The effects of chemotherapy on sleep were assessed on the 8th and 9th days of the third cycle, i.e. the active phase in terms of side effects, and the last 2 days before the start of the fourth cycle for comparison. Instruments used to assess sleep quality and related factors included actigraphy, the Hospital Anxiety and Depression Scale (HADS), the Symptom Distress Scale (SDS), the Fatigue Visual Analogue Scale (FVAS), the Epworth Sleepiness Scale (ESS), and sleep logs. RESULTS: During the active phase, patients showed an anxiety tendency with an average HADS score of 7.8 +/- 3.8. The average FVAS score was 4 +/- 2, indicative of mild fatigue, and SDS score (1.8 +/- 0.3) also indicated mild symptom distress. The number of awakenings each night was 2.2 +/- 1.6 by sleep logs, and the total time spent awake during these episodes was 47.8 +/- 26.1 minutes by Actiwatch. Sleep efficiency measured by Actiwatch in the active phase was 82.1 +/- 9.4% below the normal limit. Daytime sleepiness assessed by ESS showed mild sleepiness (6.0 +/- 3.5) in the active phase. CONCLUSION: The study showed poor sleep quality and daytime sleepiness in patients with breast cancer during the active phase of chemotherapy. Chemotherapy may bring symptom distress to patients and adversely influence sleep quality.

[Problems and their frequency, and emotional disturbances and needs among nurses providing sexual health education].

This study investigated the problems encountered by nurses delivering sexual health education, the frequency of occurrence of such problems, the types of emotional disturbances experienced by such nurses, and the needs of such nurses. Ninety urology nurses from six hospitals in northern Taiwan participated in this cross-sectional survey by completing a Problems and Needs in Sexual Health Education (PNSHE) questionnaire. Factor analysis showed that the PNSHE consisted of three dimensions: patient's response, environmental interaction, and nurses' self-preparation. Among 26 items listed as "difficult," nurses faced 23 (89%), at frequencies ranging from "half the time" to "often". They faced "moderate" degrees of emotional disturbance and "moderate" needs for assistance. Over all, Environmental interaction was the dimension which arose most frequently, caused the greatest degree of disturbance and prompted the greatest need for assistance among nurses. Nurses were frequently disturbed by the problem of "evaluating effects of sexual health education," and most needed assistance for "lacking suitable materials." Stepwise multiple regressions demonstrated that ability in providing sexual health education, years of nursing experience, and proactiveness in providing sexual health education were significant variables related to the frequency of the problems, accounting for 21% of the variance. Ability in providing sexual health education was significantly related to the degree of emotional disturbance, accounting for 6% of the variance. Ability in providing sexual health education and years of nursing experience were related to nurses' needs while providing sexual health education, accounting for 6% of the variance. The findings of this study provide information of problems and needs encountered by nurses while delivering sexual health education, and should also assist senior nurses in identifying educational courses and resources to develop competency in providing sexual education.

Are diabetic physicians at a lower risk of hospitalization for coronary heart disease? A nationwide cohort study in Taiwan.

It is not uncommon for physicians to work through illness and to be reluctant to seek health care from their colleagues, which is detrimental for quality of care. This study sought to assess the risk of admission for coronary artery diseases (CADs) in diabetic physicians. A cohort of 995 diabetic physicians and 9950 age- and sex-matched controls with diabetes were identified in 2000 and were followed to the end of 2008. Over an 8-year period, 200 (20.1%) diabetic physicians and 2255 (22.7%) controls were admitted for CAD. After controlling for potential confounders, diabetic physicians experienced a reduced, but insignificantly, adjusted odds ratio (OR) of CAD admission (OR = 0.89; 95% confidence interval = 0.75-1.06). Diabetic physicians in Taiwan were not at a significantly reduced risk of CAD admission. Future studies are needed to further explore the barriers that impede diabetic physicians from appropriately managing their disease.

Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: the effect of coping behaviors.

Initial clinical practice is stressful. Nursing students entering clinical practice for the first time in a five-year associate degree program in Taiwan are young and have questionable coping skills, all of which can affect their own health. This study examined the following: (1) the degree of stress perceived and types of stressful events; (2) the physio-psycho-social status of nursing students during the practice; (3) the coping behaviors of these students; and (4) the effect of different coping behaviors on their physio-psycho-social health. The subjects were 561 nursing students who had completed their initial clinical practice at the largest nursing school in Taiwan. Three measurements, including Perceived Stress Scale (PSS), Physio-Psycho-Social Response Scale (PPSRS), and Coping Behavior Inventory (CBI), were adopted. Results showed that stress for these students came mainly from the lack of professional knowledge and skills as well as caring of patients. The most common response to stress was social behavioral symptoms. Staying optimistic had a positive main effect, which reduced the occurrence of physio-psycho-social symptoms and improved physio-psycho-social status. Finally, problem-solving behavior also had a positive main effect, while avoidance had a negative main effect, which deteriorated physio-psycho-social status. This study has important implications for nursing educators in helping their students to overcome stress during clinical practice.