Differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease.

AIMS: The study compares the differences in self-care knowledge, self-efficacy, psychological distress and self-management between patients with early- and end-stage chronic kidney disease (CKD), and predicts the influential factors of self-management. DESIGN: A cross-sectional study. METHODS: A total of 185 subjects by using convenience sampling from one teaching hospital were collected. The research instruments included the Chronic Kidney Disease Self-Care Instrument Knowledge, the Chronic Kidney Disease Self-Efficacy Instrument, the Hospital Anxiety and Depression Scale, and the Chronic Kidney Disease Self-Management Instrument. Descriptive statistics is used frequency, percentage, mean and standard deviation. Inferential statistics is used independent t-test, one-way ANOVA and multiple linear regression analysis. STROBE checklist was used as the guideline for this study. RESULTS: Our results showed that a significant difference was found in the age (p = 0.005), systolic pressure (p = .006), self-care knowledge (p = .011) and depression level (p = .003) between patients with early- and end-stage CKD. Furthermore, patients with early-stage CKD have less self-care knowledge and lower depression levels compared with patients with end-stage CKD. However, self-efficacy is the most significant predictor of self-management for patients with early- and end-stage CKD. For patients with early-stage CKD, self-efficacy explained 69.1% of the variation in self-management. CONCLUSION: According to our results, the management of depression in patients with CKD may improve their outcomes. Improving self-care knowledge of patients with end-stage CKD may improve their self-management. Therefore, our findings suggest various interventions with different necessary and prioritised precision care at early- and late-stage of CKD. RELEVANCE TO CLINICAL PRACTICE: Nurses should strive to improve the self-care knowledge of patients with early-stage CKD to delay the progression of the disease to end-stage. Screening for depression among patients with end-stage CKD is relevant, and these patients should be referred to professional counsellors when necessary.

The impact of pain on the quality of life of Taiwanese oncology patients.

This study explored the relationship between participants' pain experience and quality of life (QOL). One hundred nine patients aged 18 years and older who had taken prescribed opioid analgesics for cancer-related pain at a teaching hospital in Taipei, Taiwan, completed the Brief Pain Inventory and European Organization for Research and Treatment of Cancer Quality of Life Group Questionnaire. The results indicated that participants in this study had experienced a mean functional QOL of 55.47 (SD 21.48), a mean symptom QOL of 41.97 (SD 16.89), and a mean global QOL of 42.13 (SD 20.69). Participants reported that in the previous 7 days, they had experienced a mean least pain of 1.75 (SD 0.18) and a mean worst pain of 6.81 (SD 0.24). The mean score for average pain intensity was 4.14 (SD 0.21), whereas the mean for current pain level was 2.53 (SD 0.21). The mean pain interference in the patients' daily activities was 3.50 (SD 0.22) on a scale ranging from 0 to 10. Furthermore, a significant correlation existed between global (r = -0.375, p < .01), functional (r = -0.300, p < .01), and symptom (r = 0.405, p < .01) QOL and worst pain. Moreover, the results indicated a significant correlation between global (r = -0.461, p < .01), functional (r = -0.430, p < .01), and symptom (r = 0.505, p < .01) QOL and pain interference. The current results support the observation that cancer pain substantially affects a patient's quality of life. The findings provide empirical support for the need for better programmatic efforts to improve pain management in Taiwanese oncology outpatients.

Concerns about pain and prescribed opioids in Taiwanese oncology outpatients.

Pharmacologic agents are considered to be a cornerstone of cancer pain management. Patients' concerns about use of analgesics are likely to lead to poor pain management. The purpose of this study was to describe participants' responses to their beliefs regarding pain and prescribed opioids. Ninety-two outpatients age ≥18 years who had taken prescribed opioid analgesics for cancer-related pain in two teaching hospitals in the Taipei area completed the Pain Opioid Analgesics Beliefs Scale-Cancer. An important finding of this study is that large numbers of patients had misconceptions about using opioids for pain. Between 33.7% and 68.5% of the patients in this study held negative beliefs about opioids and beliefs about pain. Specifically, 68.5% of the patients agreed that "opioid medication is not good for a person's body." Many patients (62%) agreed that "the more opioid medicine a patient used, the greater the possibility that he/she might rely on the medicine forever," and 61.0% agreed that "if a patient starts to use opioid medicine at too early a stage, the medicine will have less of an effect later." Two-thirds (66.3%) of the sample agreed that adult patients should not use opioid medicine frequently. The findings provide empirical support for the need for better programmatic efforts to improve beliefs of pain and analgesics in Taiwanese oncology outpatients.

Rosiglitazone elevates sensitization of drug-resistant oral epidermoid carcinoma cells to vincristine by G2/M-phase arrest, independent of PPAR-γ pathway.

Rosiglitazone (ROSI), an oral antidiabetic agent, has been reported the anti-cancer properties recent years. In this paper, the potency of ROSI as a synergistic drug for vincristine (VCR) on resistant oral cancer cells was investigated. We found that ROSI potently enhanced the susceptibility of KB cells or KB/V cells to VCR in a dose manner and the synergy in KB/V cells was much more prominent than that in KB cells. The synergistic anti-proliferative effect of ROSI and VCR was associated with inhibition on tubulin polymerization, cell cycle arrest in G2/M phase and cell apoptosis induction, but has no effect on drug efflux-protein P-gp and was independent with PPARγ. The combination treatment of ROSI and VCR could regulate the PTEN/PI3K/AKT survival pathway with an upregulation of PTEN and down-regulation of p-AKT. The effect of G2/M phase arrest was associated with the upregulation of cyclin B1 and downregulation of p-cdc2. The apoptosis induction of ROSI and VCR was partly due to an upregulation of cleaved PARP and downregulation of Bcl-2/Bax ratio. In addition, combination treatment of ROSI and VCR had also shown anti-angiogenic effect by suppressing the migration and blocking the capillary tube formation of HUVECs. More importantly, this combination treatment induced an acceptably weak cytotoxicity in human normal HL-7702 cells, GES-1 cells and HUVECs. Taken together, ROSI may be used as a potential compound for combinatorial therapy or as a complement to VCR for treatment on oral cancer, especially on that have acquired resistance to VCR therapy.

1118-20, an indazole diarylurea compound, inhibits hepatocellular carcinoma HepG2 proliferation and tumour angiogenesis involving Wnt/ß-catenin pathway and receptor tyrosine kinases.

OBJECTIVES: Sorafenib is a first multi-kinase inhibitor and one of the most widely used small-molecule oral-targeted drugs. It has been widely used for the treatment of patients with advanced renal cell carcinoma and hepatocellular carcinoma. However, some common adverse effects of sorafenib may impact quality of life. In this study, we evaluated the inhibitory effect on the growth of hepatocellular carcinoma cell line (HepG2) and suppression on angiogenesis of 1118-20, a newly synthesized indazole diarylurea compound. METHODS: We evaluated the activity of 1118-20 against HepG2 cells growth and tumour angiogenesis of human umbilical vascular endothelial cell line (HUVECs) with sorafenib as a positive control. KEY FINDINGS: The cytotoxic efficacy of 1118-20 was higher in HepG2 cells than human normal liver cell line (HL-7702). 1118-20 significantly suppressed the proliferation of HepG2 cells by apoptosis induction via Bcl-2 family-mediated mitochondria pathway and inhibition on Wnt/ß-catenin signalling pathway. 1118-20 effectively blunt the motility and migration, and inhibited the formation of capillary tube of HUVECs through suppression of angiogenic factors expression. Moreover, the results indicated that 1118-20 exerted higher efficacy than sorafenib on tumour cell proliferation and angiogenesis. CONCLUSIONS: Compared with its parent drug sorafenib, we found that 1118-20 possessed more potential on inhibition of angiogenesis and cancer cells growth. Inhibitory effect of 1118-20 on non-tumour liver cell HL-7702 was lower than that on hepatoma carcinoma cell HepG2. These results suggest that 1118-20 is a promising candidate compound that could be developed to a potent anticancer agent.

A novel anticancer diarylurea derivative HL-40 as a multi-kinases inhibitor with good pharmacokinetics in Wistar rats.

HL-40, N-(4-(1-(4-chlorine indazole)) phenyl)-N-(4-chloro-3-three fluorine methyl phenyl) urea, is a novel diarylurea derivative. In this study, we investigated the kinases activities and binding constants, pharmacokinetics of HL-40, and then evaluated its anticancer efficacy by both in vitro and in vivo methods. Enzyme activities assays in vitro were employed to identify eight candidate kinase targets. The competition binding assays against eight candidate kinases suggested that HL-40 showed strong affinity to c-Kit, PDGFRß and FLT3. The pharmacokinetic studies in Wistar rats showed that HL-40 could maintain high compound concentration and long residence time in the blood circulation. HL-40 possessed strong inhibition activities against 12 human cancer cells. Meanwhile, HL-40 effectively delayed the growth of cancer xenografts without significant toxicity to mice. Based on these in vitro and in vivo results, we suggested that HL-40 might be developed as a potential multi-kinases inhibitor for cancer treatment.

Efficacy of warm showers on labor pain and birth experiences during the first labor stage.

OBJECTIVE: To determine the efficacy of warm showers on parturition pain and the birth experiences of women during the first stage of labor. DESIGN: Randomized controlled trial (RCT). SETTING/PARTICIPANTS: The study was conducted from July 10, 2010 to January 12, 2011 in the maternity ward of a Taipei City regional teaching hospital, site of approximately 220 to 250 births per month. Ninety-two expectant mothers were recruited (recruitment rate: 70.8%) and allocated by block randomization into the two arms of the study. In total, 80 women completed the trial: 41 in the control group and 39 in the experimental group. METHODS: Participants in the experimental group received warm shower bath interventions. Each shower lasted 20 minutes. After a 5-minute full body or lower back shower, participants could spend 15 minutes directing shower water toward any body region that felt most comfortable. Facilities allowed participants to stand and sit as desired. Water was constantly monitored and maintained at a temperature of 37°C. Participants in the control group received standard childbirth care. RESULTS: Labor pain and the birth experience were assessed using the Visual Analogue Scale for Pain (VASP) and the Labour Agentry Scale, respectively. After adjusting for demographic and obstetric data, experimental-group women who participated in warm showers reported significantly lower VASP scores at 4-cm and 7-cm cervical dilations, and higher birth experiences than the control group. CONCLUSION: Apart from the positive physical hygiene effects, warm showers are a cost-effective, convenient, easy-to-deploy, nonpharmacological approach to pain reduction. This intervention helps women in labor to participate fully in the birthing process, earn continuous caregiver support, feel cared for and comforted, and have a more positive overall experience.