Because of increasingly stressful, dangerous and unpredictable psychiatric nursing work, psychiatric nurses have experienced higher job stress than general ward nurses. Little is known about the factors that affect the turnover intention of Chinese psychiatric nurses. Understanding the influencing factors of nurses' turnover intention will help to formulate targeted measures to stabilize psychiatric nursing teams.The results showed that 70.2% of psychiatric nurses had higher turnover intention. The strong turnover intention of Chinese psychiatric nurses is a problem that needs to be considered by managers. The results showed that having more children, between 31 and 39 years old, and having a part-time job were strongly associated with turnover intention. In addition, "job stress" was also an important factor, psychiatric nurses' turnover intention decreased as their job stress level decreased.Nursing managers should pay attention to nurses who have more children, between 31 and 39 years old, and take on part-time jobs. Additionally, nursing managers should reduce job stress and implement targeted programmes to prevent psychiatric nurses' turnover. Experience-sharing meetings and mindfulness-based stress reduction training are also useful to improve the mental health status of psychiatric nurses with great job stress. Nursing managers should arrange human resources and shifts appropriately to give nurses with more children more time with their families. Provide more development opportunities for psychiatric nurses between 31 and 39 years old. Managers explore the reasons why nurses take on part-time jobs and take targeted interventions (such as increasing income) to reduce the behaviour that happens.Introduction Nurses' turnover is the main cause of nursing shortages, greatly affected by nurses' intention to leave. Nurses' turnover rate is particularly high in psychiatric wards. Several factors influencing the turnover intention of psychiatric nurses have not been well identified in China, and the association between job stress and turnover intention is still limited. Aims To examine the relationship between job stress and turnover intention and identify the influencing factors of psychiatric nurses' turnover intention. Methods Data were collected from 2355 psychiatric Chinese nurses using a cross-sectional design with an online questionnaire investigation. Results Psychiatric nurses had higher turnover intention. Significant factors influencing their turnover intention were job stress, having more children, age between 31 and 39 years old, part-time jobs, education, income and patient-to-nurse ratio. Discussion Demographics and job-related factors should be considered when developing strategies to reduce the turnover intention of psychiatric nurses. Implications for practice Nursing managers should pay attention to nurses with higher job stress levels and different demographic characteristics. Effective measures should be taken to reduce psychiatric nurses' job stress and turnover intention, such as arranging reasonable shifts, implementing targeted family-friendly policies, increasing their occupational possibilities and promoting mental health.
In plants, the exogenous transgene transcribing inverted-repeat (exo-IR) sequences produces double-stranded RNAs that are processed by DCL4. The 21-nt small interfering RNAs generated function as mobile signals to trigger non-cell autonomous silencing of target endogenes in the neighboring 10-15 cells. The potential involvement of nuclear silencing pathway components in signal spreading or sensing in target cells is not clear. Here, we demonstrate that the exo-IR silencer (exo-Pdsi) is negatively autoregulated through methylation spreading, which acts in cis to reinforce the self-silencing of the silencer. Mutations affecting nuclear proteins DRD1 and Pol V (NRPE1 or NRPD2) relieved exo-Pdsi self-silencing, resulting in higher levels of Pdsi transcripts, which increased the non-cell autonomous silencing of endo-PDS. Our results suggest that in an experimental silencing pathway, methylation spreading on a silencer transgene may not have a direct endogenous plant counterpart when the protein-encoding gene is the target. DRD1-Pol V-dependent de novo methylation, by acting in cis to reinforce self-silencing of exo-IR, may play a role in restraining the inappropriate silencing of active protein-coding genes in plants.
Obstructive sleep apnea hypopnea syndrome (OSAHS) is a common respiratory disease.In recent years, a growing number of studies reported on the OSAHS associated with optic nerve disease, including primary open-angle glaucoma, non-arterial anterior ischemic optic neuropathy, papilledema, etc.This paper reviews the relationship between OSAHS and optic neuropathy and the pathogenesis, as well as the treatment.The purpose is to prompt OSAHS patients to pay more attention to eye symptoms, and to provide new ideas for respiratory and ophthalmic diagnosis and treatment.
Key words:
Sleep apnea, obstructive; Optic nerve diseases; Continuous positive airway pressure
New, science-based cancer treatments have proliferated in recent years. Immunotherapy provides new hope for prolonging survival in patients with advanced-stage cancers. However, patients with cancer must not only face their disease progression, physical, and psychological symptoms, but also deal with the side effects and efficacy of immunotherapy. Patients with cancer may experience complex emotions such as fear, anxiety, depression, or uncertainty relatively frequently and may have many unmet care needs specific to immunotherapy. However, articles on the physical and psychological impacts and supportive care needs experienced by patients with advanced-stage cancers undergoing immunotherapy and their family caregivers are limited in the literature. Thus, this paper was developed to present (1) a brief introduction to cancer immunotherapy; (2) the physical and psychological impacts experienced by patients with cancer undergoing immunotherapy and their caregivers; (3) the status of the supportive care needs of patients and family caregivers during the immunotherapy process; and (4) an assessment of and intervention to address the supportive care needs of these patients with cancer and their caregivers. We hope this article will help clinical healthcare providers understand the physical and psychological impacts and supportive care needs of advanced patients with cancer and their family caregivers during the immunotherapy process. Furthermore, we suggest that appropriate medical care be provided or developed in the future to improve their quality of life during the immunotherapy process and to enhance clinical practices.免疫療法對癌症病人及其家屬照顧者的身心衝擊與支持性照護需求.近年來新興治療的篷勃發展，免疫治療為晚期癌症病人帶來延長存活期的希望，然而，在免疫治療抗癌歷程中，病人除了要面對病情變化、身心症狀外，還需面對特定於免疫治療的副作用及成效問題，這些都可能使病人及其家屬照護者更常處於害怕、焦慮、憂鬱或不確定感等複雜情緒之中，進而產生特定於免疫治療期間未被滿足的照護需求問題，由於現階段針對免疫治療期間，晚期癌症病人及其家屬照顧者的身心衝擊與支持性照護需求問題的論述文章相當有限。故本文將針對以下內容進行說明：（一）癌症免疫治療簡介；（二）免疫治療病人與家屬照顧者之身心衝擊情形；（三）免疫治療病人與家屬照顧者之支持性照護需求現況；（四）免疫治療病人與家屬照顧者支持性照護需求評估與措施，期望透過本文能幫助未來臨床上醫護人員瞭解面對晚期癌症病人及其家屬照顧者免疫治療期間身心衝擊和支持性照護需求，同時，建議未來可提供或發展的適切措施，進而提升他們的生活品質，增進臨床護理照護品質。.
In older age, tissue degeneration, decreased cellular competition, and the declining efficiency of clearance mechanisms lead to higher rates of survival and accumulation for cells with adaptive mutations, which increase the risk of cancer cell development (Laconi et al., 2020). Thus, age is a significant risk factor for cancer. It is projected that by 2050, the global population aged 60 and above will rise to 2.1 billion, with those aged 80 and above expected to reach 426 million (World Health Organization, 2024). Taiwan, which became an aging society in 2018, is expected to be a nation in which older adults constitute 46.5% of the total population by 2070 (National Development Council, 2024). As the older adult population increases, the number of patients with cancer will also almost certainly continue to rise. Older adults respond differently to traditional cancer treatments than younger individuals, often experiencing declines in physical function, frailty, and cognitive impairment (Extermann, 2000). Moreover, older adult patients frequently have multiple chronic diseases (e.g., cardiovascular disease, diabetes, pulmonary, renal, liver diseases) that increase the complexity and risks associated with cancer treatment (Dale et al., 2012). They may also use over-the-counter medications or herbal supplements in addition to prescription drugs (Maggiore et al., 2010), which raises the risk of treatment toxicity and complications, presenting challenges for treatment decision-making. According to a survey by the National Cancer Institute, only 32% of patients with cancer participating in clinical trials were over 65 years old (Murthy et al., 2004). This may relate to the common exclusion of patients with comorbidities, physician attitudes, and/or the lower willingness of older adult patients to participate (Lewis et al., 2003). Thus, existing data may be insufficient to support the development of optimal treatment plans for older adult patients with cancer (Dale et al., 2012; Extermann, 2000). Age discrimination may lead to undertreatment or overtreatment, affecting patients' functional status and quality of life (Extermann, 2000; Hamaker et al., 2022). Currently, most oncology research relies on either the Eastern Cooperative Oncology Group performance status scale or Karnofsky Performance Scale to assess health status. However, neither adequately differentiates for the characteristics of older adult patients (Pal et al., 2010). In assessing quality of life in patients with cancer, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire or Medical Outcomes Study 36-item Short Form Health Survey is commonly used. However, these tools lack targeted assessments for cognitive function, activities of daily living, and autonomy (such as cooking, shopping, making phone calls, and managing finances), which are issues of particular concern in older adult patients (Terret et al., 2011). The American Society of Clinical Oncology recommends that older adult cancer care should include geriatric assessments (GAs) of key elements such as functional status, mental health, cognitive ability, nutritional status, chemotherapy toxicity risks, life expectancy, comorbidities, fall history, and social support to provide critical reference data for treatment planning (Chapman et al., 2021; Dale et al., 2023; Hamaker et al., 2022). However, a randomized controlled trial showed that GAs do not significantly improve physical function or quality of life for older adult patients with cancer, suggesting the benefits of these assessments remain unclear (Portielje & van den Bos, 2024). Nevertheless, other studies have shown that GAs significantly reduce chemotherapy toxicity and improve satisfaction among patients and their families (Dale et al., 2023). Despite these recommendations, knowledge of geriatric oncology has not been widely integrated into medical training, and GAs have not been incorporated into clinical care processes (Chapman et al., 2021; Diaz et al., 2024), highlighting a global healthcare system lacking the expertise and skills necessary to provide appropriate targeted care for older adult patients with cancer. Given the increasing importance of geriatric cancer care, this column provides an in-depth exploration of the care needs of older adult patients with cancer, treatment decision-making, cognitive impairment issues, and the burdens faced by family caregivers. The four articles within are geared toward enhancing the knowledge and skills of nursing professionals in geriatric oncology care and, ultimately, improving the quality of care provided to older adult patients with cancer.
Objective: To explore the clinical effect of various doses of Budesonide combined with Tiotropium bromide in the treatment of elderly patients with chronic obstructive pulmonary disease (COPD). Methods: Clinical data of elderly patients with COPD, admitted to Affiliated Hospital of Shaoxing University from April 2021 to February 2023, were retrospectively analyzed. Based on the dosage of Budesonide combined with Tiotropium bromide, patients were divided into Low-dose group (Budesonide = 1mg), Medium-dose group (Budesonide = 2mg), and High-dose group (Budesonide = 3mg). All groups were matched for age, gender, course of disease, and BMI. Patients treated with Tiotropium bromide alone were assigned to the Control group. The clinical effect, pulmonary function index level, symptom improvement, inflammatory factor index level and adverse reactions in all groups were analyzed and compared. Results: A total of 88 patients were included in this study with 22 patients in each group. The total efficacy of Medium-dose (90.91%) and High-dose group (90.91%) was significantly higher than that of Low-dose group (63.64%) and the Control group (59.09%) (P<0.05). After the treatment, levels of pulmonary function, symptom improvement and inflammatory factors in the High-dose and the Medium-dose groups were better than those in the Low-dose group and the Control group. Pulmonary function, symptom improvement and levels of inflammatory factors was significantly better in the Low-dose group compared to the Control group (P<0.05). Conclusions: Budesonide combined with tiotropium bromide is better than tiotropium bromide alone in the treatment of elderly patients with COPD. Compared with low (1mg) dosage, medium (2mg) and high (3mg) dosage of budesonide are more effective in improving lung function, alleviating symptoms, reducing inflammatory response,, and are not associated with increased rate of adverse reactions. doi: https://doi.org/10.12669/pjms.40.7.9209 How to cite this: Yu J, Ni J, Chen X, Fang Y, Fu S. Effect of different doses of Budesonide combined with Tiotropium bromide inhalation on elderly patients with chronic obstructive pulmonary disease. Pak J Med Sci. 2024;40(7):---------. doi: https://doi.org/10.12669/pjms.40.7.9209 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Drought frequency and severity are exacerbated by global climate change, which could compromise forest ecosystems. However, there have been minimal efforts to systematically investigate the genetic basis of the response to drought stress in perennial trees. Here, we implemented a systems genetics approach that combines co-expression analysis, association genetics, and expression quantitative trait nucleotide (eQTN) mapping to construct an allelic genetic regulatory network comprising four key regulators (PtoeIF-2B, PtoABF3, PtoPSB33, and PtoLHCA4) under drought stress conditions. Furthermore, Hap_01PtoeIF-2B, a superior haplotype associated with the net photosynthesis, was revealed through allelic frequency and haplotype analysis. In total, 75 candidate genes related to drought stress were identified through transcriptome analyses of five Populus cultivars (P. tremula × P. alba, P. nigra, P. simonii, P. trichocarpa, and P. tomentosa). Through association mapping, we detected 92 unique SNPs from 38 genes and 104 epistatic gene pairs that were associated with six drought-related traits by association mapping. eQTN mapping unravels drought stress-related gene loci that were significantly associated with the expression levels of candidate genes for drought stress. In summary, we have developed an integrated strategy for dissecting a complex genetic network, which facilitates an integrated population genomics approach that can assess the effects of environmental threats.
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