Publications by authors named "Chia-Huei Lin"

34 Publications

[Applying Multiple Strategies to Increase the Rate of Early Rehabilitation Exercise Adoption in Patients With Acute Stroke].

Hu Li Za Zhi 2021 Feb;68(1):64-73

PhD, RN, Professor, School of Nursing, National Defense Medical Center and Consultant, Department of Nursing, Tri-Service General Hospital, Taiwan, ROC.

Background & Problems: Early rehabilitation exercise has been shown to reduce the onset of disability in patients following acute stroke. However, the clinical execution rate of early rehabilitation exercise for those patients remains low. Our medical team developed an early rehabilitation care plan for patients with acute stroke in 2013, at which time the execution rate of early rehabilitation exercise for these patients in our hospital was only 37.1%. The survey found that patients and caregivers had insufficient awareness of early rehabilitation exercise; hospital staffs lacked appropriate assistive devices, rehabilitation equipment, nursing guidance tools, and handover records; and new nursing staffs were insufficiently aware of the importance of early rehabilitation exercise. This care plan was developed to improve the execution rate of early rehabilitation exercise in patients with acute stroke to slow the progression of their disability.

Purpose: The project was designed to improve the knowledge of new nursing staffs regarding early rehabilitation care and the early rehabilitation exercise completion rate of nursing staffs to raise the execution rate of early rehabilitation exercise in patients with acute stroke.

Resolution: After completing the cause analysis, multiple strategies were pursued: (1) nursing education sheets with texts, illustrations, video, and posters were used; (2) group in-service educational training was organized; (3) an innovative transfer belt was designed; (4) facilities were set up to deliver virtual-reality (VR) training; (5) standard procedures on early rehabilitation exercise in patients with acute stroke were revised and implemented; (6) nursing handover procedures were revised; and (7) education courses on early rehabilitation exercise for post-stroke patients were developed.

Results: The accuracy of knowledge related to early rehabilitation exercise among new nursing staff improved from 31.3% to 80%; the completion rate for nursing education increased from 53.6% to 98%; and the early rehabilitation exercise execution rate increased from 37.1% to 82.8%.

Conclusions: This project successfully increased the motivation and confidence of patients in rehabilitation and the rate of exercise program execution, which may be expected to impact positively on patients' quality of life.
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http://dx.doi.org/10.6224/JN.202102_68(1).09DOI Listing
February 2021

Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial.

Int J Environ Res Public Health 2020 12 25;18(1). Epub 2020 Dec 25.

Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan.

The presence of multimorbidity in middle-aged and older adults, which reduces their physical activity and quality of life, is a global health challenge. Exercise is one of the most important health behaviors that individuals can engage in. Previous studies have revealed that aerobic exercise training is beneficial for healthy middle-aged and older adults and those with various chronic diseases, but few studies have designed individualized aerobic exercise training for individuals with multimorbidity. Although individuals with multimorbidity are considerably less adherent to physical activity interventions, telephone-based motivational interviewing may help in strengthening motivation and promoting behavioral change for increasing physical activity and health-related physical fitness. This study aimed to examine whether a 12-week individualized aerobic exercise training in a rehabilitation center combined with telephone-based motivational interviewing is effective in promoting physical activity and health-related physical fitness among middle-aged and older adults with multimorbidity. A randomized controlled trial was conducted. Forty-three participants (aged > 40) were recruited and randomly assigned to the intervention group, comparison group, or control group. The participants' physical activity and health-related physical fitness were assessed at baseline and at 12 weeks. The results indicated that after individualized aerobic exercise training combined with telephone-based motivational interviewing, the participants reported increased total physical activity ( = 481.3 = 0.011), vigorous-intensity physical activity ( = 0.007), dominant and nondominant hand grip (kg) = 1.96, = 0.019; = 2.19, = 0.027, respectively, FEV/FVC = 0.045, = 0.043, VO max (ml/kg/min) = 5.30, = 0.001, VO max predicted (%) = 21.6 = 0.001, work (watts) = 22.5, = 0.001, and anaerobic threshold (L/min) = 0.165, = 0.011. Twelve weeks of individualized aerobic exercise training in the rehabilitation center combined with telephone-based motivational interviewing can increase the total physical activity, vigorous physical activity, and cardiorespiratory fitness of middle-aged and older adults with multimorbidity.
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http://dx.doi.org/10.3390/ijerph18010101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794827PMC
December 2020

pH Mapping of Skeletal Muscle by Chemical Exchange Saturation Transfer (CEST) Imaging.

Cells 2020 12 4;9(12). Epub 2020 Dec 4.

Biomedical Translation Research Center, Academia Sinica, Taipei 115, Taiwan.

Magnetic resonance imaging (MRI) is extensively used in clinical and basic biomedical research. However, MRI detection of pH changes still poses a technical challenge. Chemical exchange saturation transfer (CEST) imaging is a possible solution to this problem. Using saturation transfer, alterations in the exchange rates between the solute and water protons because of small pH changes can be detected with greater sensitivity. In this study, we examined a fatigued skeletal muscle model in electrically stimulated mice. The measured CEST signal ratio was between 1.96 ppm and 2.6 ppm in the z-spectrum, and this was associated with pH values based on the ratio between the creatine (Cr) and the phosphocreatine (PCr). The CEST results demonstrated a significant contrast change at the electrical stimulation site. Moreover, the pH value was observed to decrease from 7.23 to 7.15 within 20 h after electrical stimulation. This pH decrease was verified by P magnetic resonance spectroscopy and behavioral tests, which showed a consistent variation over time.
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http://dx.doi.org/10.3390/cells9122610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7762073PMC
December 2020

Effectiveness of a Home-Based Telehealth Exercise Training Program for Patients With Cardiometabolic Multimorbidity: A Randomized Controlled Trial.

J Cardiovasc Nurs 2020 Sep/Oct;35(5):491-501

Background: Exercise training has positive effects on the management of cardiometabolic conditions. Little is known about the effectiveness of home-based telehealth exercise training programs among patients with cardiometabolic multimorbidity, which is associated with functional decline and decreased health-related quality of life.

Objective: The aim of this study was to determine the effectiveness of a 12-week home-based telehealth exercise training program designed to increase physical activity and exercise capacity and improve health-related quality of life in patients with cardiometabolic multimorbidity.

Methods: A randomized controlled trial was conducted. Fifty eligible patients with 2 or more cardiometabolic conditions from outpatient clinics of a medical center in Northern Taiwan were randomized to either an experimental group (EG; received a 12-week home-based telehealth exercise training program) or a control group (CG; maintained usual lifestyles). The home-based telehealth exercise training program consisted of 36 individualized home-based exercise training sessions and a weekly reminder for maintenance of exercise and providing patient support. Amounts of physical activity, exercise capacity, and health-related quality of life were assessed at baseline and 12 weeks. Generalized estimating equations were used to examine the intervention effects via the interaction of time and group.

Results: The EG had higher amounts of physical activity (β = 1333, P = .004) and moderate-intensity physical activity (β = 330, P = .04) than the CG after the intervention. The EG had increased exercise capacity (VO2peak, β = 4.43, P = .04), as well as improved health-related quality of life (physical function, β = 7.55, P = .03; and physical component summary, β = 4.42, P = .03) compared with those in the CG.

Conclusions: A 12-week home-based telehealth exercise training program is feasible and effective in increasing amounts of physical activity, elevating exercise capacity, and improving health-related quality of life in patients with cardiometabolic multimorbidity.
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http://dx.doi.org/10.1097/JCN.0000000000000693DOI Listing
June 2020

Validating the Capability for Measuring Age-Related Changes in Grip-Force Strength Using a Digital Hand-Held Dynamometer in Healthy Young and Elderly Adults.

Biomed Res Int 2020 20;2020:6936879. Epub 2020 Apr 20.

Master Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei 11031, Taiwan.

Background: Grip-force performance can be affected by aging, and hand-grip weakness is associated with functional limitations of dasily living. However, using an appropriate digital hand-held dynamometer with continuous hand-grip force data collection shows age-related changes in the quality of hand-grip force control may provide more valuable information for clinical diagnoses rather than merely recording instantaneous maximal hand-grip force in frail elderly adults or people with a disability. Therefore, the purpose of this study was to indicate the construct validity of the digital MicroFET3 dynamometer with Jamar values for maximal grip-force assessments in elderly and young adults and confirmed age-related changes in the maximal and the quality of grip-force performance using the MicroFET3 dynamometer in elderly people.

Methods: Sixty-five healthy young (23.3 ± 4.5 years) and 50 elderly (69.5 ± 5.8 years) adults were recruited and asked to perform a validity test of the grip-force maximum voluntary contraction (MVC) using both the dominant and nondominant hands with a Jamar dynamometer and a MicroFET3 dynamometer.

Results: A strong correlation of maximal grip-force measurements was found between the MicroFET3 dynamometer and Jamar standard dynamometer for both hands in all participants ( < 0.05). Although, the results showed that a lower grip force was measured in both hands by the MicroFET3 dynamometer than with the Jamar dynamometer by 49.9%~57% ( < 0.05), but confidently conversion formulae were also developed to convert MicroFET3 dynamometer values to equivalent Jamar values for both hands. Both dynamometers indicated age-related declines in the maximum grip-force performance by 36.7%~44.3% ( < 0.05). We also found that the maximal hand-grip force values generated in both hand by the elderly adults were slower and more inconsistent than those of the young adults when using the MicroFET3 dynamometer.

Conclusions: This study demonstrated that the digital MicroFET3 dynamometer has good validity when used to measure the maximal grip force of both hands, and conversion formulae were also developed to convert MicroFET3 dynamometer force values to Jamar values in both hands. Comparing with the Jamar dynamometer for measuring grip force, the MicroFET3 dynamometer not only indicated age-related declines in the maximum grip-force performance but also showed slower and more inconsistent maximal hand-grip strength generation by the elderly.
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http://dx.doi.org/10.1155/2020/6936879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191369PMC
February 2021

Effectiveness of Early Rehabilitation Combined With Virtual Reality Training on Muscle Strength, Mood State, and Functional Status in Patients With Acute Stroke: A Randomized Controlled Trial.

Worldviews Evid Based Nurs 2020 Apr 25;17(2):158-167. Epub 2020 Mar 25.

School of Nursing, National Defense Medical Center, Taipei, Taiwan.

Background: Early rehabilitation has been shown to enhance functional outcomes. Whether the addition of virtual reality (VR) training could further improve muscle strength, mood state, and functional status for patients with acute stroke is unknown.

Aims: To investigate the effectiveness of VR training on muscle strength, mood state (depression, anxiety), and functional status in patients following acute stroke.

Methods: A randomized controlled trial was conducted. Patients with acute ischemic stroke (N = 152) were selected and randomly assigned with a 1:3 randomization ratio to either experimental group (EG) or comparison group (CG). Both groups received early rehabilitation. The EG received an extra 5 days of VR training (15 min of time, two times a day), started 24 hr to 3 days poststroke. Muscle strength, mood state, and functional status were collected at admission and at the day of discharge. Generalized estimating equations were applied to examine the intervention effects.

Results: A total of 143 participants (94%) completed the study, and 145 were included in the intention-to-treat analysis. Participants in the EG reported increased muscle strength of upper and lower limbs in both affected and unaffected sides, decreased depression and anxiety, and increased functional status at discharge. When the group-time interaction was examined, the EG had greater increased upper limb muscle strength of the unaffected side (ß = 0.34, p < .001) and decreased depression and anxiety scores (ß = -2.31, p = .011; ß = -1.63, p = .047) at discharge compared with the CG. However, there was no difference in the functional status change scores from baseline between EG and CG.

Linking Evidence To Action: A poststroke program that includes both early rehabilitation and VR training has greater benefit in relation to mood state and muscle strength at discharge than early rehabilitation alone. Therefore, an early physical rehabilitation program that includes VR training for acute stroke inpatients should be considered for implementation in clinical settings.
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http://dx.doi.org/10.1111/wvn.12429DOI Listing
April 2020

Effects of a 12-week moderate-intensity exercise training on blood glucose response in patients with type 2 diabetes: A prospective longitudinal study.

Medicine (Baltimore) 2019 Sep;98(36):e16860

School of Nursing & School of Medicine, National Defense Medical Center; Department of Nursing, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, ROC.

Background: The blood glucose response to moderate-intensity exercise remains unclear for patients with type 2 diabetes (T2DM). In addition, little is known about determinants of blood glucose response to a 12-week moderate-intensity exercise training. Therefore, this study aimed to explore trends in blood glucose in response to a 12-week moderate-intensity exercise training in patients with T2DM and to explore the predictors of post-exercise blood glucose (PEBG) and exercise-induced glucose response (EIGR).

Methods: A prospective longitudinal study was conducted. Of the 66 participants with T2DM recruited from outpatient clinics of a medical center, 20 were eligible to enroll in a 12-week moderate-intensity exercise training. Participants were randomly assigned to 1 of 3 exercise times (morning, afternoon, or evening). Blood glucose were measured pre- and post-exercise. The EIGR was calculated by subtracting the PEBG from the before-exercise blood glucose (BEBG). Generalized estimating equations were used to examine the trends and predictors of PEBG and EIGR.

Results: The BEBG declined progressively (β = -1.69, P < .001); while the PEBG (β = -0.18, P = .08) remained stable over time during the 12-week exercise training. Higher BEBG predicted higher (β = 0.53, P < .001) PEBG. Higher baseline maximum oxygen uptake (VO2max) contributed to a larger magnitude of EIGR; higher HgbA1c and BEBG predicted higher EIGR (β = 0.27, P = .02; β = 0.45, P < .001); afternoon or evening exercise predicted lower (β = -13.2, P = .04; β = -5.96, P = .005) EIGR than did morning exercise.

Conclusions: A 12-week moderate-intensity exercise training appears safe for patients with T2DM. Time of day for exercise, baseline VO2max, and baseline metabolic control may influence the impact of exercise for individuals with T2DM. These findings provide considerations for design of optimal exercise training for T2DM patients.
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http://dx.doi.org/10.1097/MD.0000000000016860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739009PMC
September 2019

Bimanual coordination deficits in hands following stroke and their relationship with motor and functional performance.

J Neuroeng Rehabil 2019 08 2;16(1):101. Epub 2019 Aug 2.

Master Program in Long-Term Care & School of Gerontology Health Management, College of Nursing, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan, Republic of China.

Background: Stroke can lead to movement disorders that affect interlimb coordination control of the bilateral upper extremities, especially the hands. However, few studies have investigated the influence of a stroke on bimanual force coordination control between the hands using a quantitative measurement tool, or the relationship of force coordination with paretic upper extremity motor and functional performance. We aimed to investigate these outcomes using a novel measurement device, and analyze the relationship of bimanual force coordination control deficits in both hands with motor and functional performances of the paretic upper extremity in stroke patients.

Methods: Sixteen healthy adults and 22 stroke patients were enrolled. A novel bilateral hand grip measurement device with two embedded dynamometers was used to evaluate the grip force during a bilateral hand grip-force coordination control task. The alternating time and force applied for coordination with the grip force of both hands were calculated to analyze control of bimanual grip force coordination. Motor and functional measurements included the upper-extremity portion of the Fugl-Meyer assessment (FMA-UE), Wolf Motor Function Test (WMFT), Motor Assessment Scale (MAS), and Barthel Index (BI).

Results: Compared with the healthy group, the alternating time from the non-paretic to the paretic hand was 27.6% shorter for stroke patients (p < 0.001). The grip force generated for coordination in the healthy group was significantly greater (30-59%) than that of the stroke group (p < 0.05), and the coefficients of variation of alternating time (p = 0.001) and force applied (p = 0.002) were significantly higher in the stroke group than the healthy group. The alternating time from the paretic to the non-paretic hand showed moderately significant correlations with the FMA-UE (r = - 0.533; p = 0.011), the WMFT (r = - 0.450; p = 0.036), and the BI (r = - 0.497; p = 0.019).

Conclusions: Stroke results in a decline in bimanual grip force generation and increases the alternating time for coordinating the two hands. A shorter alternating time is moderately to highly associated with enhanced motor and functional performances.
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http://dx.doi.org/10.1186/s12984-019-0570-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679439PMC
August 2019

Active Physical Activity Patterns Are Associated With Improved Quality of Life and Depression Status in Taiwanese Women With Metabolic Syndrome.

J Cardiovasc Nurs 2019 Nov/Dec;34(6):491-502

Li-Chi Chiang, PhD, RN Professor, School of Nursing, National Defense Medical Center, Taipei; and School of Nursing, China Medical University, Taichung, Taiwan, ROC. Shang-Lin Chiang, MD, PhD Assistant Professor, School of Medicine, National Defense Medical Center; and Director, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei, Taiwan, ROC. Wen-Chii Tzeng, PhD, RN Associate Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC. Meei-Shyuan Lee, PhD Professor, School of Public Health and Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC. Yi-Jen Hung, MD Professor, School of Medicine, National Defense Medical Center; Superintendent, Songshan Branch of Tri-Service General Hospital; Taipei, Taiwan, ROC. Chia-Huei Lin, PhD, RN Assistant Professor, Schools of Nursing and Medicine, National Defense Medical Center; and Supervisor, Department of Nursing, Songshan Branch of Tri-Service General Hospital, Taipei, Taiwan, ROC.

Background: Metabolic syndrome (MetS), health-related quality of life (HRQL), and depression status are independently associated with cardiac health. Therefore, understanding the associations between MetS, HRQL, and depression status and determining factors related to improved HRQL and depression status in people with MetS may help in cardiovascular disease prevention.

Objective: The aim of this study was to examine whether there are differences in HRQL and depression status between Taiwanese women with and without MetS and whether physical activity patterns are associated with HRQL and depression status in this population.

Methods: A cross-sectional study of 326 Taiwanese middle-aged and older women (≥40 years) was conducted. Metabolic syndrome was determined based on the National Cholesterol Education Program Adult Treatment Panel III definition. Health-related quality of life and depression status were collected using the Short Form 36 Health Survey and Beck Depression Inventory. Univariate and multivariate linear regression analyses were conducted.

Results: Women with MetS had lower HRQL (P < .001) and higher depression status (P = .002) than those without MetS. Participants with active physical activity patterns had higher HRQL (P < .001) and lower depression status (P = .046) than those with sedentary patterns. Among women with MetS, those with active physical activity patterns had higher HRQL (P = .001) and lower depression status (P = .007) than those with sedentary patterns.

Conclusions: Metabolic syndrome is related to lower HRQL and higher depression status in women 40 years and older. Active physical activity patterns are associated with better HRQL and reduced depression status in middle-aged and older women (≥40 years) with MetS.
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http://dx.doi.org/10.1097/JCN.0000000000000602DOI Listing
September 2020

Motivational Counseling to Reduce Sedentary Behaviors and Depressive Symptoms and Improve Health-Related Quality of Life Among Women With Metabolic Syndrome.

J Cardiovasc Nurs 2019 Jul/Aug;34(4):327-335

Li-Chi Chiang, PhD, RN Professor, School of Nursing, China Medical University, Taichung; and School of Nursing & Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, R.O.C. Margaret McLean Heitkemper, PhD, RN, FAAN Professor and Chairperson, Department of Biobehavioral Nursing and Health Systems, and Adjunct Professor, Division of Gastroenterology, School of Medicine, University of Washington, Seattle. Shang-Lin Chiang, MD, PhD Assistant Professor, School of Medicine, National Defense Medical Center; and Director, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei, Taiwan, ROC. Wen-Chii Tzeng, PhD, RN Associate Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan, R.O.C. Meei-Shyuan Lee, PhD Professor, School of Public Health & Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, R.O.C. Yi-Jen Hung, MD Professor, School of Medicine, National Defense Medical Center; and Superintendent, Songshan Branch of Tri-Service General Hospital, Taipei, Taiwan, R.O.C. Chia-Huei Lin, PhD, RN Assistant Professor, Schools of Nursing and Medicine, National Defense Medical Center; and Supervisor, Department of Nursing, Songshan Branch of Tri-Service General Hospital, Taipei, Taiwan, R.O.C.

Background: Motivational interviewing, as a counseling approach, could promote not only behavioral changes but also individuals' psychological adaptation. Previous studies provide evidence that motivational interviewing focused on increasing physical activity decreases the risk of metabolic syndrome in women. Its effects on sedentary behaviors, depressive symptoms, and health-related quality of life (HRQL) remain unknown.

Objectives: The aim of this study was to evaluate whether a 12-week motivational counseling program reduces sedentary behaviors and depressive symptoms and improves HRQL in Taiwanese women.

Methods: A randomized controlled study was conducted. Participants (n = 115) were randomly assigned into 3 groups: experimental group (received a brochure on lifestyle modification combined with 12 weeks of motivational counseling), comparison group (received a lifestyle modification brochure), and usual care group (UCG). Outcome variables were measured at baseline and at 12 weeks post intervention by the International Physical Activity Questionnaire, Beck Depression Inventory, and Medical Outcomes Short Form-36 Health Survey. Generalized estimating equations were applied to analyze the intervention effects of groups by interaction of group and time.

Results: Women in the experimental group not only reduced (P < .001) weekly sitting time by 374 minutes but also decreased (P < .05) depressive symptoms, as well as had greater overall HRQL including 8 subscales as compared with the UCG. As compared with the UCG, the women in the comparison group had no change in sedentary behaviors, but they had reduced depressive symptoms and improvement on some HRQL subscales.

Conclusions: Motivational counseling that incorporates behavioral change principles is effective in reducing sedentary behaviors and depressive symptoms and improving HRQL for women with metabolic syndrome.
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http://dx.doi.org/10.1097/JCN.0000000000000573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581294PMC
October 2020

Analysis of trunk rolling in Parkinson's disease patients using a mattress mobility detection system.

Comput Methods Programs Biomed 2018 Aug 2;162:157-163. Epub 2018 May 2.

School of Nursing & School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan. Electronic address:

Background And Objective: Parkinson's disease (PD) is a neurodegenerative condition characterized by motor dysfunction and various types of non-motor impairments. The reaction time and movement time are reported to become more severe delayed in worse PD patients. Most tools for evaluating motor impairment are limited by relying on subjective observations and being qualitative in design. The aim of this study was to investigate trunk rolling performance in PD patients by using a recently developed system to detect turning in bed.

Methods: The study included 20 PD patients and 42 healthy controls. A mattress mobility detection system was employed for quantitative measurements. Each test session consisted of subjects starting by lying in a supine position on a bed and rolling 10 times onto their left side and 10 times onto their right side. Strain gauges mounted under the feet of the bed recorded changes in the center of pressure (CoP).

Results: For turning back, the patients compared with the controls had significantly longer movement time (P = 0.017), longer time to peak counteraction (P = 0.001), larger ratio of peak counteraction to movement time (P = 0.006), shorter CoP displacement (P < 0.0001), slower turning speed (P = 0.000), weaker peak counteraction (P = 0.013), and smaller ratio of peak counteraction to weight (P = 0.032). Results for turning over were similar except there was no significant difference in the ratio of peak counteraction to weight.

Conclusions: The mattress mobility detection system was useful for objectively assessing trunk rolling performance of PD patients. Improved assessment of trunk function in PD patients could lead to better treatments and improved rehabilitation procedures.
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http://dx.doi.org/10.1016/j.cmpb.2018.04.029DOI Listing
August 2018

[Diabetic Foot Neuropathy and Related Factors in Patients With Type 2 Diabetes Mellitus].

Hu Li Za Zhi 2018 06;65(3):28-37

PhD, RN, Associate Professor, School of Nursing, National Defense Medical Center, and Consultant, Department of Nursing, Taiwan, ROC.

Background: Patients with type 2 diabetes mellitus (T2DM) face a higher risk of diabetic foot neuropathy, which increases the risk of death. The early detection of factors that influence diabetic neuropathy reduces the risk of foot lesions, including foot ulcerations, lower extremity amputation, and mortality.

Purpose: To explore the demographic, disease-characteristic, health-literacy, and foot-self-care-behavior factors that affect diabetic foot neuropathy in patients with T2DM.

Methods: A case-control study design was employed in which cases (Michigan Neuropathy Screening Instrument, MNSI) ≥ 2 were matched to controls based on age and gender in a medical center. A total of 114 patients diagnosed with T2DM in a medical center were recruited as participants. Data were collected using a structured questionnaire. The collected data were analyzed using Fisher's exact test, Mann-Whitney U test, and logistic regression.

Results: The results of multiple logistic regression showed that glycated hemoglobin (B = 1.696, p = .041) and communication and critical health literacy (B = -0.082, p = .034) were significant factors of diabetic foot neuropathy.

Conclusions / Implications For Practice: The findings of this study suggest that nurses should assess the health literacy of patients with T2DM before providing health education and should develop a specific foot-care intervention for individuals with poor glycemic control.
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http://dx.doi.org/10.6224/JN.201806_65(3).06DOI Listing
June 2018

Intermediate Molecular Mass Hyaluronan and CD44 Receptor Interactions Enhance Neutrophil Phagocytosis and IL-8 Production via p38- and ERK1/2-MAPK Signalling Pathways.

Inflammation 2017 Oct;40(5):1782-1793

Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No. 7, Chung-San South Road, Taipei, 10002, Taiwan.

CD44 is a common leukocyte adhesion molecule expressed on the surface of various cells. Hyaluronan (HA), the natural ligand of CD44, is a simple repeated disaccharide with variable molecular mass that is widely distributed on cell surfaces and the connective tissue matrix. The binding of small molecular mass HA (SMM-HA, MW < 80 kDa) to CD44 on immune-related cells elicits cell proliferation, differentiation, and cytokine production. However, the effects and molecular basis of intermediate molecular mass HA (IMM-HA, MW ≈ 500 kDa)-CD44 interactions on polymorphonuclear neutrophil (PMN) functions have not been elucidated. We hypothesised that IMM-HA would potentiate immune functions as well as SMM-HA. In the present study, we demonstrated IMM-HA and CD44 interactions enhanced normal PMN phagocytosis and IL-8 production compared to those with LPS or anti-CD45 treatment via F-actin cytoskeleton polymerization and subsequent ERK1/2- and p38-MAPK phosphorylation. Antibody-based inhibition of CD44 did not affect PMN function; however, F-actin aggregation was induced without MAPK phosphorylation. Enhanced PMN function via IMM-HA was determined to be CD44-dependent since this effect was abolished in DMSO-induced CD44(-) PMN-like cells obtained from HL-60 cells. In conclusion, we demonstrated that IMM-HA and CD44 interactions on PMNs potently elicit F-actin cytoskeleton polymerization and p38- and ERK1/2-MAPK phosphorylation to enhance PMN function.
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http://dx.doi.org/10.1007/s10753-017-0622-5DOI Listing
October 2017

Readiness of hospital nurses for disaster responses in Taiwan: A cross-sectional study.

Nurse Educ Today 2016 Dec 2;47:37-42. Epub 2016 Mar 2.

Department of Nursing, Cheng Hsin General Hospital, Taiwan (ROC) No. 45, Cheng Hsin St., Pai-Tou, Taipei City 11220, Taiwan, ROC. Electronic address:

Background: Because patients in disaster areas require the most critical care, mobilising hospital nurses has become a pivotal strategy. Given the importance of disaster nursing training programmes, understanding how well prepared hospital nurses are to provide disaster care is vital.

Objectives: This paper analyses the perceived readiness of hospital nurses for a disaster response and the factors influencing their report for work outside the hospital environment.

Design: A cross-sectional research design was used.

Settings: This study was conducted at a military hospital in Taiwan.

Participants: A sample of 311 registered nurses participated in this study.

Methods: Data were collected on readiness for disaster responses using a 40-item researcher-designed, self-administered questionnaire found to have satisfactory reliability and validity. The questionnaire has four domains: personal preparation (16 items), self-protection (11 items), emergency response (6 items), and clinical management (7 items). Data were analysed using descriptive statistics, independent t-tests and generalised linear models.

Results: The majority of hospital nurses demonstrated poor readiness for disaster responses. Scores on the four domains were most associated with nurses' disaster-related training, experience in disaster response and emergency/intensive care experience.

Conclusions: Our results indicate that disaster-related training should be included in undergraduate programmes and continuing education courses to help hospital nurses recognise and improve their own readiness for disaster responses outside the hospital environment. Future research is needed to improve hospital nurses' disaster-response readiness in Taiwan and other countries.
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http://dx.doi.org/10.1016/j.nedt.2016.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7131547PMC
December 2016

Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial.

Int J Nurs Stud 2016 Aug 12;60:12-23. Epub 2016 Mar 12.

School of Nursing & Graduated Institute of Medical Sciences, National Defense Medical Center & China Medical University, Taipei & Taichung, Taiwan, ROC. Electronic address:

Background: Lifestyle modification is often difficult for middle-aged and older women living in the community who are at high risk of physical inactivity and metabolic syndrome.

Objectives: To examine the effects of telephone-based motivational interviewing in a 12-week lifestyle modification program on physical activity, MetS, metabolic risks (fasting plasma glucose, blood pressure, triglyceride, high-density lipoprotein, and central obesity), and the number of metabolic risks in community-living middle-aged and older women diagnosed with metabolic syndrome.

Research Design And Method: A randomized controlled trial was conducted. Recruited were 328 middle-aged and older women from a community health center in Taiwan. Eligible women medically diagnosed with metabolic syndrome (n=115) were randomly assigned to one of three groups: The experimental group received an individualized telephone delivered lifestyle modification program that included motivational interviewing delivered by an experienced nurse. The brief group received a single brief lifestyle modification counseling session with a brochure. The usual care group received standard care. Physical activity was assessed with the International Physical Activity Questionnaire and metabolic risks were determined by serum markers and anthropometric measures at pre- and post-intervention. One hundred women completed the study and an intention-to-treat analysis was performed. Generalized estimating equations were used to examine the intervention effects.

Results: Women in the experimental group increased physical activity from 1609 to 1892 MET-min/week (β=846, p=.01), reduced the percentage of diagnosed with metabolic syndrome to 81.6% (β=-0.17, p=.003), and decreased the number of metabolic risks from 4.0 to 3.6 (β=-0.50, p<.001), compared to the usual care group (4.4-4.6). There was not a reduction in the percentage of diagnosed with metabolic syndrome in the brief group, but they had fewer metabolic risks after 12 weeks (mean=4.0 vs. 4.6, β=-0.2, p=.02) compared to the usual care group.

Conclusions: Motivational interviewing as a component of an individualized physical activity and lifestyle modification program has positive benefit in reducing metabolic risks in middle-aged and older women.
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http://dx.doi.org/10.1016/j.ijnurstu.2016.03.003DOI Listing
August 2016

Influence of Socioeconomic Status and Perceived Barriers on Physical Activity Among Taiwanese Middle-Aged and Older Women.

J Cardiovasc Nurs 2017 Jul/Aug;32(4):321-330

Chia-Huei Lin, PhD, RN Assistant Professor, School of Nursing, National Defense Medical Center, and Supervisor, Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan, ROC. Shang-Lin Chiang, MD, PhD Lecturer, School of Medicine, National Defense Medical Center, and Attending Physician, Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei, Taiwan, ROC. Patsy Yates, PhD Professor and Head of School Faculty of Health, School of Nursing, and Director, Centre for Palliative Care Research and Education, Queensland University of Technology, Australia. Wen-Chii Tzeng, PhD Associate Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC. Meei-Shyuan Lee, PhD Professor, School of Public Health & Graduated Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, ROC. Li-Chi Chiang, PhD Professor, School of Nursing & Graduated Institute of Medical Science, National Defense Medical Center & China Medical University, Taipei & Taichung, Taiwan, ROC.

Background: Physical activity (PA) is associated with cardiovascular health in general populations, particularly in women. Middle-aged and older women are at high risk of less engagement in PA for unknown and complicated reasons.

Objectives: The aim of this study was to investigate whether PA was positively associated with socioeconomic status and psychosocial correlates of PA (self-efficacy and perceived benefits) but inversely correlated with perceived barriers in women (age >40 years).

Methods: A cross-sectional survey of 326 community-dwelling women was conducted. Data on socioeconomic status, PA, and its psychosocial correlates (ie, perceived benefits/barriers and self-efficacy) were collected using self-report questionnaires. Analyses were performed by multiple linear regressions.

Results: Monthly income (β = .35, P = .015), employment status (β = .32, P < .001), and perceived barriers to PA (β = -.19, P = .008) were significantly associated with PA. More highly educated women participated in more (β = .13, P = .033) vigorous PA, women with fewer perceived barriers participated in more (β = -.14, P = .047) moderate-intensity PA, and employed women participated in more (β = .35, P < .001) walking. Significantly higher scores of perceived barriers, including "no trainer," "feeling exhausted," "lack of motivation," and "lack of guidance," were identified in women with low PA compared with those with moderate PA.

Conclusion: Socioeconomic status and perceived barriers are associated with PA and its intensity level. Some specific barriers provide insights into the key factors that contribute to low PA in middle-aged and older women. These findings can be considered in future interventions to design PA promotion programs for this population to protect against cardiovascular diseases.
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http://dx.doi.org/10.1097/JCN.0000000000000354DOI Listing
April 2018

Analysis of Trunk Rolling Performances by Mattress Mobility Detection System in Poststroke Patients: A Pilot Study.

Biomed Res Int 2016 3;2016:8743051. Epub 2016 Mar 3.

Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei 114, Taiwan.

Purpose: The purpose of this study was to investigate the correlation of kinematic variables with quality of trunk control in poststroke patients.

Methods: This cross-sectional study included stroke subjects with mild to moderate motor deficit corresponding to Brunnstrom stages 3-4. Trunk functional performance was measured using bed mobility monitor system. All tasks were repeated ten times for both directions in each subject. Outcome measurements included the movement time and displacement of center of pressure (CoP) from supine to side lying and returning.

Results: The results revealed that a significant longer turning time was observed when turning from the paretic side toward the nonparetic side compared to the other direction, with an estimated mean difference of 0.427 sec (P = 0.005). We found a significant difference in the time of rolling back to supine position between two directions. The displacement of CoP in rolling back from side lying on the nonparetic side was smaller than that from the paretic side with an estimated mean difference of -0.797 cm (P = 0.023).

Conclusions: The impaired trunk mobility was associated with increased movement time and decreased displacement of CoP in poststroke patients. Trunk rolling performance has potential in assessment of stroke patients.
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http://dx.doi.org/10.1155/2016/8743051DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794586PMC
December 2016

Influential factors of insufficient physical activity among adolescents with asthma in Taiwan.

PLoS One 2014 31;9(12):e116417. Epub 2014 Dec 31.

School of Nursing, China Medical University, Taichung, Taiwan; School of Nursing, National Defense Medical Center, Taipei, Taiwan.

Purpose: Little research has been reported concerning insufficient physical activity in Taiwanese adolescents with asthma. The aims of this paper are to compare the amount of physical activity between asthmatic and non-asthmatic adolescents in Taiwan, as well as to investigate the influential factors associated with insufficient physical activity in asthmatic adolescents.

Methods: Self-reporting structured questionnaires (socio-economic status, scale of family support for physical activity, amount of physical activity) and peak expiratory flow were assessed from 286 adolescents with asthma and 588 non-asthmatic adolescents in a cross-sectional design. Insufficient amount of physical activity was based on less than 300 minutes per week of moderate and vigorous physical activity.

Results: Adolescents with asthma have a greater amount of physical activity and a higher level of family support than those who are non-asthmatic. In Taiwan, adolescents with asthma, girls relative to boys, obesity relative to average weight, and low family support relative to high family support were found to be associated with insufficient physical activity.

Conclusion: Physical activity in adolescents with asthma is insufficient especially in girls, in asthmatics with obesity, and in those with low family support. We suggest that physical activity programs should be applied to Taiwan adolescents with asthma in order to match the criteria of 300 minutes per week of moderate and vigorous physical activity, especially for girls, the obese and those with a low level of family support.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116417PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281071PMC
January 2016

Systematic review of impact of lifestyle-modification programs on metabolic risks and patient-reported outcomes in adults with metabolic syndrome.

Worldviews Evid Based Nurs 2014 Dec;11(6):361-8

Doctoral candidate, Graduate Institute of Medical Sciences, National Defense Medical Center; Lecturer of School of Nursing, National Defense Medical Center and Supervisor of Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.

Background: Metabolic syndrome (MetS) is primarily attributed to an unhealthy lifestyle, which is a modifiable risk factor. Researchers have been exploring various strategies, including lifestyle-modification programs (LMPs), to prevent the progression of MetS. However, the effectiveness of LMPs on metabolic risks and patient-reported outcomes (PROs) among adults with MetS remains inconclusive.

Aim: To evaluate the effectiveness of LMPs on the metabolic risks and PROs among adults with MetS.

Methods: A systematic review of randomized controlled trials published from January 1985 to June 2014 was conducted. The review extracted LMP interventions that included outcomes on the metabolic risks and PROs (quality of life and any other psychological health indicators). The quality of the included studies was assessed using the Cochrane Collaboration criteria.

Results: Among the five trials included, the most commonly applied intervention components were diet plans, supervised exercise, health education, individual counseling, behavioral modification, and motivational interviewing. Three fifths of the studies were nurse-led, and only one of the selected trials was theory-guided. LMPs can effectively reduce triglyceride levels, waist circumference, and systolic blood pressure. However, few trials consistently confirmed the benefits of metabolic risks, and none revealed a significant effect on high-density lipoprotein, fasting blood glucose, or any PRO, except quality of life. The duration of LMPs in the included trials ranged from 4 to 24 weeks, and durations of at least 12 weeks significantly improved quality of life.

Linking Evidence To Action: LMPs had positive effects on some metabolic risks and on quality of life, whereas longer-duration LMPs may have highly beneficial effects on quality of life. The essential elements of LMPs need to be evaluated more thoroughly to determine their effectiveness. Larger and more rigorous randomized controlled trials are required to assess the effectiveness of LMPs on metabolic risks and PROs among adults with MetS.
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http://dx.doi.org/10.1111/wvn.12069DOI Listing
December 2014

Moderate physical activity level as a protective factor against metabolic syndrome in middle-aged and older women.

J Clin Nurs 2015 May 25;24(9-10):1234-45. Epub 2014 Sep 25.

Graduate Institute of Medical Sciences, School of Nursing, National Defense Medical Center, Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.

Aims And Objectives: To investigate whether physical activity is a protective factor against metabolic syndrome in middle-aged and older women.

Background: Socio-demographic and lifestyle behaviour factors contribute to metabolic syndrome. To minimise the risk of metabolic syndrome, several global guidelines recommend increasing physical activity level. However, only limited research has investigated the relationship between physical activity levels and metabolic syndrome in middle-aged and older women after adjusting for socio-demographic and lifestyle behaviour factors.

Design: Cross-sectional design.

Methods: A convenience sample of 326 middle-aged and older women was recruited. Metabolic syndrome was confirmed according to the National Cholesterol Education Program, Adult Treatment Panel III guidelines, and physical activity levels were measured by the International Physical Activity Questionnaire.

Results: The sample had a mean age of 60·9 years, and the prevalence of metabolic syndrome was 43·3%. Postmenopausal women and women with low socioeconomic status (low-education background, without personal income and currently unemployed) had a significantly higher risk of developing metabolic syndrome. After adjusting for significant socio-demographic and lifestyle behaviour factors, the women with moderate or high physical activity levels had a significantly lower (OR = 0·10; OR = 0·11, p < 0·001) risk of metabolic syndrome and a lower risk for each specific component of metabolic syndrome, including elevated fasting plasma glucose (OR = 0·29; OR = 0·26, p = 0·009), elevated blood pressure (OR = 0·18; OR = 0·32, p = 0·029), elevated triglycerides (OR = 0·41; OR = 0·15, p = 0·001), reduced high-density lipoprotein (OR = 0·28; OR = 0·27, p = 0·004) and central obesity (OR = 0·31; OR = 0·22, p = 0·027).

Conclusions: After adjusting for socio-demographic and lifestyle behaviour factors, physical activity level was a significant protective factor against metabolic syndrome in middle-aged and older women. Higher physical activity levels (moderate or high physical activity level) reduced the risk of metabolic syndrome in middle-aged and older women.

Relevance To Clinical Practice: Appropriate strategies should be developed to encourage middle-aged and older women across different socio-demographic backgrounds to engage in moderate or high levels of physical activity to reduce the risk of metabolic syndrome.
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http://dx.doi.org/10.1111/jocn.12683DOI Listing
May 2015

Measurement of bed turning and comparison with age, gender, and body mass index in a healthy population: application of a novel mobility detection system.

Biomed Res Int 2014 29;2014:819615. Epub 2014 Apr 29.

Department of Physical Therapy and Assistive Technology, National Yang Ming University, No. 155, Sec. 2, Linong Street, Beitou, Taipei City 112, Taiwan.

We developed a mobility detection system to analyze pressure changes over time during side-turns in 29 healthy volunteers (17 males and 12 females) with a mean age of 46.1 ± 19.64 years (ranging from 23 to 86 years) in order to determine the effect of gender, age, and BMI on performance during bed postural change. Center of gravity (COG) location, peak pressure of counteraction, and time to reach peak pressure were the main outcomes used to gauge the ability to make a spontaneous side-turn. Men exhibited significantly higher side-turning force (P = 0.002) and back-turning force (P = 0.002) compared with women. Subjects with BMI ≥ 27 kg/m(2) had significantly higher side-turning force (P = 0.007) and back-turning force (P = 0.007) compared with those with BMI < 27 kg/m(2). After adjusting for other covariates, age positively correlated with back-turning time (P = 0.033) and negatively correlated with side-turning speed (P = 0.005), back-turning speed (P = 0.014), side-turning force (P = 0.010), and back-turning force (P = 0.016), respectively. Turning times negatively correlated with time to reach peak pressure (P = 0.008). Our system was effective in detecting changes in turning swiftness in the bed-ridden subject.
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http://dx.doi.org/10.1155/2014/819615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4021992PMC
February 2015

[The new era of evidence-based nursing: comprehensive mobilization and development of the nursing sciences].

Hu Li Za Zhi 2013 Oct;60(5):11-7

Department of Nursing, Taipei Veterans General Hospital, Taiwan, ROC.

Science is subject to inevitable evolutionary change. Philosopher of science Thomas Kuhn defined a scientific revolution as a period in time during which a particular field of scientific knowledge is set to transition to a new paradigm that will propel it toward a new milestone. Because person-centered care embraces the universal values of trans-disciplinary healthcare teams, evidence-based healthcare represents a paradigm shift toward evidence-based nursing. The rapid development of evidence-based practice is an evolutionary process of revolutionary importance to science. The resulting era of evidence-based nursing will help fully realize the development potential of the nursing sciences. This article introduces the process of knowledge construction in evidence-based nursing, reviews the literature to identify the general model used to promote evidence-based nursing internationally, and proposes practical strategies to promote evidence-based nursing in Taiwan. We hope this article will help further promote the clinical application of evidence-based nursing and the development of nursing science.
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http://dx.doi.org/10.6224/JN.60.5.11DOI Listing
October 2013

[Spontaneous fracture: a potential clinical concern].

Hu Li Za Zhi 2013 Aug;60(4):93-8

School of Nursing, National Defense Medical Center, Taiwan, ROC.

Spontaneous fracture is an issue of increasing concern in clinical care. However, this topic has received only limited attention in nursing research. Gaps in understanding related to spontaneous fractures may increase medical-legal risks faced by frontline care nurses, exacerbate nursing pressures, and serve as a disincentive to remain in the already understaffed nursing profession. This article reviews previous research on spontaneous fractures to determine the epidemiological causes of clinical spontaneous fracture and identify effective prevention strategies. We hope this paper may increase clinical practitioner and expert awareness of spontaneous fractures; help establish a screening mechanism to identify high risk spontaneous fracture patients; and help nurses develop and implement proactive prevention / treatment strategies to strengthen awareness of this topic among patients and their families.
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http://dx.doi.org/10.6224/JN.60.3.93DOI Listing
August 2013

Associations between dietary patterns and kidney function indicators in type 2 diabetes.

Clin Nutr 2014 Feb 15;33(1):98-105. Epub 2013 Apr 15.

Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Public Health and Environmental Science, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address:

Background & Aims: Dietary patterns link to risks for chronic diseases. Few studies explore relationships between dietary patterns and kidney function in adult type 2 diabetes in Asian.

Methods: Diabetic patients (n = 635) were selected from a cohort participating in a diabetic control study in Taiwan. Three dietary patterns, high fat (meats, processed meats, seafood, fatty foods, eggs), vegetable and fish (light- or dark- colored vegetables, pond and marine fish) and traditional Chinese-snack (soy/gluten products, rice, noodles, root vegetables, nuts), were generated using factor analysis. Urinary albumin to creatinine (ACR), creatinine and estimated glomerular filtration rate (eGFR) served as clinical indicators of kidney function.

Results: After adjusting for confounders, tertile scores of vegetable and fish dietary patterns correlated significantly (p-trend = 0.032) and dose-responsively with multivariable-adjusted means of decreased creatinine and marginally with increased eGFR (p- trend = 0.065). Traditional Chinese-snack dietary pattern was marginally associated with creatinine (p-trend = 0.065) and eGFR (p-trend = 0.064). High fat dietary patterns did not correlate with any kidney function indicator.

Conclusions: Healthy diets such as frequent intake of fish and vegetable may be related to indicators of better kidney function in type 2 diabetes. Further prospective studies with larger sample sizes and use of sensitive indicators for studying early renal function decline are needed to confirm this association.
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http://dx.doi.org/10.1016/j.clnu.2013.04.010DOI Listing
February 2014

[Clinical outcomes: the impact of patient-centered care].

Hu Li Za Zhi 2012 Dec;59(6):104-10

Department of Nursing, Tri-Service General Hospital, Graduate Institue of Medical Science, National Defense Medical Center, Taiwan, ROC.

An extensive body of literature advocating a "patient-centered" approach to medical care has emerged over the past three decades. This approach is now a mainstream trend in healthcare. Despite its popularity, there remains little consensus regarding the content or definition of patient-centered care. Various quantitative and qualitative research studies have extracted core meanings from "doctor-patient relationship" perspectives and investigated the relationships of these meanings with patient satisfaction, compliance with health promoting behavior, and health status. Mead and Bower's review of the conceptual and empirical literature represented the first attempt to develop a model of the doctor-patient relationship that considered the multiple aspects embraced by the "patient-centered" approach. However, any interpretation of the "patient-centered" concept that fails to consider the perspective of nursing is likely incomplete, as patient-centered care is the essence of nursing. This paper reviewed the concept of "patient-centered care", conducted a systematic review of randomized control trials to explore the effectiveness of patient-centered care, and integrated nursing-related studies that focused on patient-centered care. Our search covered articles published through the end of February 2011 in the Cochrane Controlled Trials Register, JBI, MEDLINE, CINAHL, Pubmed, ProQuest, PsycInfo, and CEPS, with 13 relevant articles identified. The majority of trials addressed by these studies demonstrated a positive "patient-centered care" effect on self-care knowledge and skills but a limited/insignificant effect on disease improvement. The reviewed studies used traditional definitions of "patient-centered care" that were inconsistent with the concepts defined by Mead and Bower. Heterogeneities exist between reviewed studies and the lack of related research in Taiwan. We thus integrated outcome indicators related to "patient-centered care". This study may be referenced by nursing research and clinical care professionals responsible to improve and integrate medical care quality.
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http://dx.doi.org/10.6224/JN.59.6.104DOI Listing
December 2012

[Family-centered care and post-traumatic stress disorder].

Hu Li Za Zhi 2012 Jun;59(3):5-10

School of Nursing, National Defense Medical Center, Republic of China.

A year has passed since a major earthquake and tsunami hit northeastern Honshu, Japan in March 2011. Amidst mourning for the tens of thousands of victims, survivors have just begun the difficult and urgent tasks of rebuilding. Many survivors suffer from post-traumatic stress disorder (PTSD). PTSD causes chronic, long-term suffering for patients and their families and inevitably burdens social and medical care systems. This article tries to integrate PTSD evidence-based treatment experiences into a practical and detailed nursing intervention protocol for PTSD. We also elicit the function and effect of "family-centered care." We hope that nursing professionals apply family-centered care principles to PTSD treatment and care approaches in order to promote PTSD patient resilience. Nurses can thus enhance PTSD care efficacy and improve the opportunity for PTSD patients to overcome their symptoms and recover their life.
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June 2012

Dependence of 6beta-acetoxy-7alpha-hydroxyroyleanone block of Kv1.2 channels on C-type inactivation.

Cell Mol Life Sci 2010 Jan 29;67(1):147-56. Epub 2009 Oct 29.

Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, 40402, Taiwan.

Voltage-gated K(+) (Kv) channels exhibit slow or C-type inactivation during continuous depolarization. A selective pharmacological agent targeting C-type inactivation is hitherto lacking. Here, we report that 6beta-acetoxy-7alpha-hydroxyroyleanone (AHR), a diterpenoid compound isolated from Taiwania cryptomerioides, can selectively modify C-type inactivation of Kv1.2 channels. Extracellular, but not intracellular, AHR (50 muM) dramatically accelerated the slow decay of Kv currents and left-shifted the steady-state inactivation curve. AHR blocked Kv currents with an IC(50) of 17.7 muM. AHR did not affect the kinetics and voltage-dependence of Kv1.2 channel activation. Channel block by AHR was independent of intracellular K(+) concentration. In addition, effect of AHR was much attenuated in a Kv1.2 V370G mutant defective in C-type inactivation. Therefore, block of Kv1.2 channels by AHR did not appear to involve direct occlusion of the outer pore but depended on C-type inactivation. AHR could thus be a probe targeting Kv channel C-type inactivation gate.
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http://dx.doi.org/10.1007/s00018-009-0178-0DOI Listing
January 2010

Osthol is a use-dependent blocker of voltage-gated Na+ channels in mouse neuroblastoma N2A cells.

Planta Med 2010 Jan 28;76(1):34-40. Epub 2009 Jul 28.

Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan.

Osthol, a Chinese herbal compound, has been shown to possess vasorelaxant and neuroprotective properties. Not much is known about the effects of osthol on ionic channels, activities of which are implicated in vasorelaxation and neuroprotection. In this work we report that osthol could inhibit voltage-gated Na (+) currents with state-dependence in mouse neuroblastoma N2A cells (IC (50) = 12.3 microM and 31.5 microM at holding potentials of - 70 mV and - 100 mV, respectively). Current blockade was equally effective in both extracellular and intracellular application of osthol. Osthol (18 microM) did not significantly affect the kinetics and voltage-dependence of Na (+) channel activation, but left-shifted the steady-state inactivation curve (V (1/2) = - 60.5 mV and - 78.7 mV in the absence and presence of osthol, respectively). Osthol also mildly but significantly retarded channel recovery from inactivation (recovery time constant = 19.9 ms and 35.6 ms in the absence and presence of osthol, respectively). In addition, osthol blocked Na (+) currents in a frequency-dependent fashion: blockades of 17 %, 34 % and 49 % when currents were triggered at 0.33 Hz, 1 Hz and 3.33 Hz, respectively. Taken together, our results therefore suggest that osthol blocked voltage-gated Na (+) channels intracellularly with state- and frequency-dependence.
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http://dx.doi.org/10.1055/s-0029-1185941DOI Listing
January 2010

Rhynchophylline from Uncaria rhynchophylla functionally turns delayed rectifiers into A-Type K+ channels.

J Nat Prod 2009 May;72(5):830-4

Department of Physiology, Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung 40402, Taiwan, Republic of China.

Rhynchophylline (1), a neuroprotective agent isolated from the traditional Chinese medicinal herb Uncaria rhynchophylla, was shown to affect voltage-gated K(+) (Kv) channel slow inactivation in mouse neuroblastoma N2A cells. Extracellular 1 (30 microM) accelerated the slow decay of Kv currents and shifted the steady-state inactivation curve to the left. Intracellular dialysis of 1 did not accelerate the slow current decay, suggesting that this compound acts extracellularly. In addition, the percent blockage of Kv currents by this substance was independent of the degree of depolarization and the intracellular K(+) concentration. Therefore, 1 did not appear to directly block the outer channel pore, with the results obtained suggesting that it drastically accelerated Kv channel slow inactivation. Interestingly, 1 also shifted the activation curve to the left. This alkaloid also strongly accelerated slow inactivation and caused a left shift of the activation curve of Kv1.2 channels heterologously expressed in HEK293 cells. Thus, this compound functionally turned delayed rectifiers into A-type K(+) channels.
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http://dx.doi.org/10.1021/np800729qDOI Listing
May 2009

Effects of a preceptorship programme on turnover rate, cost, quality and professional development.

J Clin Nurs 2009 Apr;18(8):1217-25

Department of Cheng Hsin Rehabilitation Medical Center, School of Nursing, National Taipei College of Nursing, Taipei, Taiwan.

Aim And Objectives: The purpose of the present study was to design a preceptorship programme and to evaluate its effects on turnover rate, turnover cost, quality of care and professional development.

Background: A high turnover rate of nurses is a common global problem. How to improve nurses' willingness to stay in their jobs and reduce the high turnover rate has become a focus. Well-designed preceptorship programmes could possibly decrease turnover rates and improve professional development.

Design: A quasi-experimental research design was used.

Methods: First, a preceptorship programme was designed to establish the role and responsibilities of preceptors in instructing new nurses. Second, a quasi-experimental design was used to evaluate the preceptorship programme. Data on new nurses' turnover rate, turnover cost, quality of nursing care, satisfaction of preceptor's teaching and preceptor's perception were measured.

Results: After conducting the preceptorship programme, the turnover rate was 46.5% less than the previous year. The turnover cost was decreased by US$186,102. Additionally, medication error rates made by new nurses dropped from 50-0% and incident rates of adverse events and falls decreased. All new nurses were satisfied with preceptor guidance.

Conclusions: The preceptorship programme effectively lowered the turnover rate of new nurses, reduced turnover costs and enhanced the quality of nursing care, especially by reducing medication error incidents. Positive feedback about the programme was received from new nurses.

Relevance To Clinical Practice: Study findings may offer healthcare administrators another option for retaining new nurses, controlling costs, improving quality and fostering professional development. In addition, incentives and effective support from the organisation must be considered when preceptors perform preceptorship responsibilities.
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http://dx.doi.org/10.1111/j.1365-2702.2008.02662.xDOI Listing
April 2009