Purpose: QTc interval prolongation is a focus of attention in application of antipsychotics as it may induce polymorphoric ventricular tachycardia, or torsade de pointes, and cause fatal risk. This study aims to investigate the influence of second generation antipsychotics on QTc interval prolongation for Taiwanese patients with schizophrenia. Method: A total of 64 schizophrenic patients without heart disease and stroke history were recruited and treated with second generation antipsychotics. An electrocardiogram examination was provided to them before and half year after the treatment respectively. The data were statistically evaluated using comparison of means and analysis of variances. Result: Average QTc of all of the patients after medication was 420ms, no more than 500ms. QTc of the patients prolonged in an average of 10.8ms and presented significant variances after they took the second generation antipsychotics. In terms of individual drugs, Quetiapine (13.3ms) and Clozapine (23.8ms) caused significant variances in QTc; but the remaining three drugs didn’t pose any notable variance. In comparison, Clozapine posed a remarkably greater effect on QTc than Risperidone and the remaining drugs didn't create any significant variance. Conclusion: Findings of this study indicated QTc intervals of all of the patients after medication were no more than 500ms; however some drugs still created significant influences on QTc. Clinically, physicians should be cautious in prescribing for schizophrenia patients with heart disease or using drugs that may affect QTc together with antipsychotics.
Patients with advanced cancer are prone to experience burdensome physical, psychological, and financial consequences. Healthcare providers may not fully appreciate advanced cancer patients' medical care autonomy, such as at that emboded by Advance Care Planning (ACP), and by doing so may compromise their quality of end-of-life (EOL). Hence, it is essential for healthcare providers to effectively assess and communicate with patients' regarding their medical decisions before their patients are incapacitated by their disease progression. The purpose of this investigation was to describe the decisional balance, attitudes, and practice behaviors of ACP and its predictors of ACP-related experiences in Taiwanese patients with advanced cancer.This cross-sectional, descriptive study employed a mixed-methodsquantitative and qualitative design with a sample of 166 patients that were purposely recruited from in-patient oncology units at a regional teaching hospital in southern Taiwan. Study data consisted of patient replies to a 34-item self-report tool, Decisional Balance, Attitudes, Practice Behaviors of ACP (DAP-ACP) and 4 semi-structured questions.Findings indicated that, in general, study participants exhibited favorable ACP-decisional balance and positive ACP-attitudes & practice behaviors. The results also indicated that gender, educational level, and cancer diagnosis were associated with significant differences on the "ACP-decisional balance" and "ACP-attitudes" scales. In addition, our findings documented that the participants' gender and educational level were significant predictors of both ACP-decisional balance and ACP-attitudes. Furthermore the participants' ACP-practice behaviors were predicted by ACP-decisional balance, but not with their ACP-attitudes. The qualitative analysis of the semi-structured questions identified six themes in responses to current medical decision making (e.g., compliance with physician instructions, family engagement in treatment decision-making); and eight themes pertaining to future ACP-related concerns were identified (e.g., family conflict, effectiveness of time-limited trials).To promote patients' engagement in ACP, the healthcare professional need to assess and advocate patients' concerns or attitudes regarding ACP in a timely manner. In addition, factors or concerns that might influence patients' responses to ACP derived from both the quantitative and qualitative findings of this current study need to be considered especially in initiating the dialogue regarding ACP with patients with advanced cancer.No. CYCH 2,019,072, Date of registration 5 Dec 2019.
The objective structured clinical examination (OSCE) is one of the evaluation strategies used to examine the clinical competence of nursing students. More attention needs to be paid to establishing an examination that is based on the standardized protocol and on reliability and validity.The aims of this study were to develop an OSCE that is based on a standardized protocol and to analyze the content validity and predictive validity, inter-rater consistency, internal consistency, item-to-total correlation, and the degree of discrimination and difficulty of this OSCE.Based on the blueprint for OSCEs that use an 8-station format, this study used a descriptive, cross-sectional design and a sample population of 207 senior students who were preparing for their last-mile practicum at a nursing technology university in northern Taiwan. The study period lasted from September 2015 to October 2016. Furthermore, the validity, reliability, degree of discrimination, and difficulty of the OSCE were examined.An OSCE with an eight-station format was developed. The content validity index (CVI) was .85-1.0, inter-rater reliability was .80-1.0, Cronbach' alpha internal consistency was .53-.82, and item-to-total correlation was .36-.63. In addition, the level of difficulty of the OSCE was easy to moderate and the discrimination of the OSCE ranged from fair to excellent. Meanwhile, the OSCE scores of the participants appeared to be a valid predictor of scores on the last mile practicum.According to the standardized protocol of OSCE development, an 8- station nursing OSCE format is reliable and valid, providing fair levels of difficulty and discrimination. The developed OSCE may be applied to evaluate the clinical competence of nursing students prior to beginning their last mile practicum. The results from the present study may provide a reference for nursing educators who are responsible for developing OSCE evaluation strategies.建構及檢測護理客觀結構式臨床技能測驗考題之信效度、鑑別度及難易度.客觀結構式臨床技能測驗（objective structured clinical examination, OSCE）是目前評估護理學生專業臨床能力的方式之ㄧ，其標準化流程之考題發展與考題信效度檢測值得關注。.本研究旨在，依標準化流程建構護理OSCE考站；分析OSCE考站專家效度及預測效度、評分者間一致性、內在一致性、考題相關性、鑑別度與難易度。.以描述性、橫斷式研究設計，自2015年9月至2016年10月依測驗藍圖發展8站式OSCE考試，應用於北部某科技大學207位四技四年級臨床選習前的護理系學生，並且測試OSCE考題的信效度、鑑別度與難易度。.本研究共建構8站OSCE考題，各題的專家效度指標為.85–1.0，評分者間一致性為.80–1.0，Cronbach's alpha為.53–.82，考題相關性為.36–.63，鑑別度多為優良或非常優良，難易度多為容易到適中，且OSCE成績對臨床選習成績具良好的預測效度。.透過標準化的考題建置流程，發展的8站式護理OSCE考題具良好的信效度、難易度適中及良好的鑑別度，並可做為檢測學生最後一哩專業技能的方法，期許本研究的結果提供護理教育者於發展OSCE評量之參考。.
Purpose: Metabolic syndrome is a focus of attention in the application of second generation antipsychotics, which has been regarded as a risk factor of Type 2 Diabetes and cardiovascular diseases and may raise the incidence of coronary heart disease and stroke by a factor of three. This study aims to explore the effect of second generation antipsychotics on the occurrence of the metabolic syndrome of Taiwanese patients.
Method: A total of 41 schizophrenic patients without personal and family history of diabetes were recruited and they were treated with the second generation antipsychotics. An examination including biochemical status, blood, waistline and body weight was given to them and a judgment of metabolic syndrome was executed according to the diagnosis principles of NCEP ATP III modified criteria for Asians before and one year after the treatment. The statistic method applied including means comparison and analysis of variance.
Result: There were 6 metabolic syndrome patients found (14.6%) before treatment and the prevalence increased to 26.8% (11 of 41 patients) after one-year of treatment. No new diabetes patients were observed after taking the antipsychotics. Triglyceride values increased by an average of 37 mg/dl and presented a significant variance for all of the patients after taking the second generation antipsychotics. With regards to the individual drug, Clozapine and Olanzapine caused a significant variance in triglyceride values. Body weight of all patients increased in an average of 5.3 kg and exhibited a significant variance after taking the antipsychotics. With respect to individual drug, patients displayed a remarkable variance in body weight after taking Olanzapine. No significant variances exhibited for other items of drugs being examined.
Conclusion: This study demonstrated that part of second generation antipsychotics could exert remarkable influences on body weight and triglyceride value. And patients after taking the antipsychotics presented a higher prevalence rate of metabolic syndrome than general Taiwanese and American adults.
85%-95% of patients with cancer experience chemotherapy-induced peripheral neuropathy (CIPN), which may lead to neuropathic pain, emotional distress, functional difficulties, and interpersonal problems. Although exercise interventions have been proposed for improving and preventing CIPN, evidence regarding the efficacy of these interventions has been inconsistent and of inadequate quality. In addition, few domestic systematic reviews have examined the effects of exercise on CIPN.To examine the effects of exercise interventions in cancer patients with CIPN using a systematic review (SR) method.An SR method was used in this paper by applying the concept of PICO using keywords P "cancer", I "rehabilitation", "exercise", C "usual care, standard of care", and O "chemotherapy-Induced peripheral neuropathy" in a search of the Ovid Medline, PubMed, Cochrane Library, EMBASE and Airiti Library databases for articles published from 2002 to 2021. Based on the inclusion and exclusion criteria, a total of 13 research articles were identified for review in this study.The 13 randomized controlled trials reviewed in this SR included 909 cancer patients during or after chemotherapy who were receiving exercise interventions. The results indicate that single or combined exercise protocols have consistent benefits in terms of improving CIPN symptoms. However, because of the relatively small sample sizes (n = 19-355) and the multiple types (n = 9), frequencies (1-7 day/week), and durations (5-60 minutes/time) of exercise protocols used in these studies, future research is necessary to explore differences in the types and subgroup effects of exercise.The results from this systematic review indicate that the combined exercise model has consistent benefits in terms of helping prevent and alleviate the symptoms of CIPN. In clinical practice, healthcare providers may consider encouraging cancer patients to initiate mild physical activity when their physical conditions are stable and without evident side effects from chemotherapy to minimize the impacts of CIPN on daily functioning and quality of life.減緩化學治療引起周邊神經病變之運動介入設計與成效—系統性文獻回顧.85%–95%癌症病人會因化學治療引起周邊神經病變（chemotherapy-induced peripheral neuropathy），而易造成神經性疼痛、情緒困擾、影響日常生活功能及人際關係。透過運動介入似乎可改善或預防周邊神經病變，但其成效仍不一致，目前國內缺乏探討運動對於化學治療引起周邊神經病變成效之系統文獻探討。.系統性文獻探討運動介入緩解化學治療引起之周邊神經病變之成效。.採系統性文獻回顧法，搜尋從2002至2021年8月前，使用MEDLINE、PubMed、Cochrane Library、Embase、華藝線上圖書館、臺灣博碩士論文等資料庫，以PICO（patient, intervention, comparator, outcome）建立關鍵字，分別為P：「cancer, cancer survivor」、「癌症、癌症存活者」；I：「rehabilitation」、「exercise」、「復健」、「運動」；C：「usual care」、「常規照護」；O：「chemotherapy-induced peripheral neuropathy」、「化學治療引起周邊神經病變」、等進行搜尋，以運動為介入措施於癌症病人周邊神經病變之實驗性研究文章，共審閱141篇文獻，依排除與納入條件，共納入13篇文獻做研究分析。.回顧13篇隨機分派之實驗性研究，共909位癌症病人。結果發現，單一性或組合式運動措施對於預防或減緩化療引起之周邊神經病變都可能有效果。但受限於研究樣本數範圍差異大（19至355人），且運動種類（9種）、頻率（2–7天/週）、時間（5–60分鐘）不同，仍需更多研究探討何種運動劑量較有效、有無次族群效益等。.運動訓練可能預防或減緩化療引起之周邊神經病變。醫護人員可考慮在癌症病人身體功能穩定且未出現嚴重化療副作用時，鼓勵癌症個案自輕度活動開始增加運動量，以減少周邊神經病變對日常生活功能與生活品質之影響。.
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