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Background: Red blood cell distribution width (RDW) is a numerical measure of the variation in the size of circulating red blood cells. Recently, there is increasing interest in the role of RDW as a biomarker for inflammatory states and as a prognostication tool for a wide range of clinical manifestations. The predictive power of RDW on mortality among patients receiving mechanical circulatory support remains largely unknown. Methods: A retrospective analysis of 281 VA-ECMO patients at a tertiary referral academic hospital from 2009 to 2019 was performed. RDW was dichotomized with RDW-Low <14.5% and RDW-High ≥14.5%. The primary outcome was all-cause mortality at 30 days and 1 year. Cox proportional hazards models were used to examine the association between RDW and the clinical outcomes after adjusting for additional confounders. Results: 281 patients were included in the analysis. There were 121 patients (43%) in the RDW-Low group and 160 patients (57%) in the RDW-High group. Survival to ECMO decannulation [RDW-H: 58% versus RDW-L: 67%, p = 0.07] were similar between the two groups. Patients in RDW-H group had higher 30-days mortality (RDW-H: 67.5% vs RDW-L: 39.7%, p < 0.001) and 1 year mortality (RDW-H: 79.4% vs RDW-L: 52.9%, p < 0.001) compared to patients in the RDW-L group. After adjusting for confounders, Cox proportional hazards model demonstrated that patients with high RDW had increased odds of mortality at 30 days (hazard ratio 1.9, 95% CI 1.2–3.0, p < 0.01) and 1 year (hazard ratio 1.9, 95% CI 1.3–2.8, p < 0.01) compared to patients with low RDW. Conclusions: Among patients receiving mechanical circulatory support with VA-ECMO, a higher RDW was independently associated with increased 30-days and 1-year mortality. RDW may serve as a simple biomarker that can be quickly obtained to help provide risk stratification and predict survival for patients receiving VA-ECMO. [ABSTRACT FROM AUTHOR]

Background: In situ simulation is the practice of using simulated scenarios to improve skill implementation, train critical thinking and problem-solving abilities, and enhance self-efficacy. This study aimed to enhance nursing knowledge, skills, and attitudes toward clinical work by applying in situ simulation training to improve the healthcare of critically ill patients. Methods: This study was conducted from a medical center in northern Taiwan and included 86 trainees who received intensive care training courses from 1 June 2017 to 31 May 2019. The self-report knowledge assessment, empathetic self-efficacy scale, skill assessment, and attitudes of instructors before and after training were collected. The statistical analysis used the Wilcoxon test for knowledge and attitudes, and chi-square tests were used for skills to evaluate the learning effect. Results: The results showed a statistically significant improvement in knowledge, skills, attitudes, and empathy in nursing care. Conclusions: In situ simulation learning can be an accepted method for nursing skills in the intensive care unit. Through this study, we understood that the in situ simulation method was beneficial to nurses' care and care thinking processes. It is worth developing and evaluating integrated simulation education to enhance learning, change behavior, and promote holistic care in the nursing field. [ABSTRACT FROM AUTHOR]

(1) Background: Patients who are critically ill or undergo major surgery are admitted to intensive care units (ICUs). Prolonged immobilization is the most likely cause of pressure injuries (PrIs) in the ICU. Previous studies of Western populations found that effective protocols could reduce the incidence of PrIs, and the efficacy of systemic targeted intervention protocols in preventing PrIs in the Chinese population needs to be surveyed. (2) Methods: We reviewed cases of PrIs in the ICUs of Taipei Veterans General Hospital from 2014 to 2019. The ICU nurses at the hospital began to implement targeted interventions in January 2017. The incidence density of PrIs was calculated by dividing the number of PrIs by person days of hospitalizations in the pre-bundle (2014–2016) and post-bundle (2017–2019) stages. Poisson regression was performed to compare the trend of incidence densities. (3) Results: The incidence density of PrIs was 9.37/1000 person days during the pre-bundle stage and 1.85/1000 person days during the post-bundle stage (p < 0.001). The relative risk (RR) was 0.197 (95% confidence interval: 0.149–0.26). The incidence densities of iatrogenic PrIs and non-iatrogenic PrIs decreased as the RRs decreased. (4) Conclusions: Targeted interventions could significantly reduce the incidence of PrIs. Healthcare providers must follow the bundle care protocol for PrI prevention to improve the quality of healthcare and promote patient health. [ABSTRACT FROM AUTHOR]

Background: Caregiving burden is common among family caregivers (FCs). In Taiwan, no reports have compared caregiving burden according to disease stage, or explored the comprehensive factors of caregiving burden in the FCs of patients with hepatocellular carcinoma (HCC). Aim: The aim of the study was to investigate caregiving burden at different diagnosis stages and its potential predictors in the FCs of patients with hepatocellular carcinoma. Methods: This descriptive, cross-sectional study included 192 FCs. Caregiving burden was measured using the Caregiver Reaction Assessment tool. The predictive factors of caregiving burden in the FCs of patients with HCC were identified using a linear regression model. Results: The global caregiving burden had no significant differences between the four disease stages. The lack of family support and impact on schedule were significantly higher at the terminal stage than at the earlier stage. The risk factors of caregiving burden were high depression, high financial demand, heavy caregiving tasks, advanced age and frequent patient contact, which obtained a variance of 47.8% in the regression model. Conclusion: Healthcare providers need to proactively identify and assess FCs with risk factors of caregiving burden and provide appropriate interventions specific to individual needs at different disease stages. [ABSTRACT FROM AUTHOR]

Objective: Regular retrospective analysis is necessary for potential improvement in clinical practice for the treatment of hard-to-heal wounds. Comorbidities and outcomes have demonstrated spatial and temporal diversity, emphasising the importance of updates in epidemiology. The complexity of healing hard-to-heal wounds has long been known, and so we sought evidence-based improvement on the current principles of treatment. Method: Demographic and clinical information of patients from the WoundCareLog database was collected. Patients who met the inclusion criteria and completed follow-up after treatment were included. Comorbidities were diagnosed and classified into eight categories based on ICD-10. We compared the demographic and aetiological characteristics between patients with and without comorbidities by t-test and Chi-squared test. The impact of comorbidities on wound healing were evaluated with a multivariate Cox model. Results: A total of 2163 patients met the inclusion criteria and were enrolled, of whom 37.0% were aged 61–80 years, 36.0% were aged 41–60 years and 60.8% were male. The lower extremities and buttocks were the most commonly affected areas with hard-to-heal wounds. Non-traumatic wounds accounted for 66.6% of cases, and infection, pressure and diabetes were the most common causes. Paralysis and diabetes were the most important factors which led to a prolonged healing process and inferior clinical outcomes. Conclusion: Comorbidities of hard-to-heal wounds were treated as separate contributors and their weighted effect on outcome was calculated through correlation analysis. Paralysis and diabetes were the most unfavourable comorbidities affecting the treatment of non-traumatic hard-to-heal wounds. Our study highlighted the priority of comorbidity treatment through data-driven approaches. It provides potential value in developing better public health strategies and preventive medicine. [ABSTRACT FROM AUTHOR]

Objective: To analyze the effect of Xuezhikang on the markers of the serum lipid levels of cholesterol synthesis and absorption in early menopausal women with hypercholesterolemia, and preliminarily explore its lipid-lowering mechanism. Methods: A total of 90 early menopausal women with hypercholesterolemia were enrolled from December, 2014 to May, 2016 from Beijing Anzhen Hospital, Capital Medical University, who were randomly allocated to receive Xuezhikang (1200 mg/d, orally) or atorvastatin (10 mg/d, orally) according to a random number table. Serum levels of some related biomarkers, including cholesterol synthesis markers (squalene, dihydrocholesterol, dehydrocholesterol, and lathosterol), and absorption markers (campesterol, stigmasterol, and sitosterol) as well as safety indices were obtained at baseline and after 8 weeks of the intervention. Results: Eight weeks after treatment, both Xuezhikang and atorvastatin significantly reduced the levels of total cholesterol, triglycerides, low density cholesterol compared to baseline (all P<0.01). Xuezhikang significantly reduced the levels of squalene, dehydrocholesterol and lathosterol compared to baseline (all P<0.01), but atorvastatin only significantly reduced the level of squalene (P<0.01), compared to baseline. All cholesterol absorption markers showed no significant differences before and after treatment (P>0.05), however, a more obvious downward trend was shown in the Xuezhikang group. In addition, all the safety indices showed no significant differences between the two groups. Although the creatinekinase level in the Xuezhikang group was significantly higher, it remained within the safe range. Conclusions: Xuezhikang may have more comprehensive effects on the markers of cholesterol synthesis and metabolism in early menopausal women with hypercholesterolemia through ergosterol and flavonoids in its "natural polypill." [ABSTRACT FROM AUTHOR]

Purpose: To evaluate progressive muscle relaxation (PMR) as an intervention for anxiety, psychotic symptoms, and quality of life (QOL) in patients with chronic schizophrenia. Design and methods: Eighty patients were recruited from a Taiwanese psychiatry ward. The intervention group received group PMR; control group received treatment‐as‐usual. Results: The results indicated that PMR might have a short‐term effect on reducing anxiety, improving psychotic syndromes, and QOL among patients with chronic schizophrenia; however, the effectiveness at the 3‐month follow‐up was not evident. Practice Implications: Both the psychiatric patients and the health institutions may be able to list PMR as a clinical routine care, and then become a mental health practice strategy for mental patients to improve the quality of mental care. Implications for Nursing Practice: Our studies suggest that prevention of severe mental illness among patients with schizophrenia requires PMR interventions. PMR had an immediate effect, and it is possible that a shorter intervention period using this approach would also be successful. [ABSTRACT FROM AUTHOR]

Purpose Since the vocational outcomes of people with schizophrenia should be viewed in a holistic way, the second edition of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) might provide an evaluation regarding employment potential. To determine whether the WHODAS 2.0 scores can be used to predict employment status, we examined the probabilistic cut-off values of the scores and analyzed the relationship between work status and demographic characteristics. Methods We selected 31,793 people aged between 18 and 65 with schizophrenia or schizoaffective disorder from the disability evaluation database in Taiwan and separated them into two groups based on employment status (employed and unemployed). We used logistic regression to explore the association between employment and demographic characteristics. Moreover, we conducted a receiver operating characteristic (ROC) analysis to determine the cut-off point to assist in determining employment potential based on the WHODAS 2.0 score. Results Among the 31,793 participants, 3367 were employed and 18,801 were unemployed. The unemployed participants accounted for a higher percentage of disability in each domain of the WHODAS. The ROC analysis revealed that the optimal cut-off point of the WHODAS score to distinguish the people who were employed and unemployed was 25.78 (area under curve = 0.80). Conclusions The present study indicated that work status can be determined by the total score across the six domains of the WHODAS score. Furthermore, the probability of employment may be determined initially by the cut-off point of the WHODAS score in order to economize evaluation time and prepare prevocational training for those with scores above 25.78. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of integrative medicine (IM) on patients with coronary artery disease (CAD) and investigate the prognostic factors of CAD in a real-world setting.Methods: A total of 1,087 hospitalized patients with CAD from four hospitals in Beijing, China were consecutively selected between August 2011 and February 2012. The patients were assigned to two groups based on the treatment: Chinese medicine (CM) plus conventional treatment, i.e., IM therapy (IM group); or conventional treatment alone (CT group). The endpoint was major adverse cardiac events [MACE; including cardiac death, myocardial infarction (MI), and revascularization].Results: A total of 1,040 patients finished the 2-year follow-up. Of them, 49.4% (514/1,040) received IM therapy. During the 2-year follow-up, the total incidence of MACE was 11.3%. Most of the events involved revascularization (9.3%). Cardiac death/MI occurred in 3.0% of cases. For revascularization, logistic stepwise regression analysis revealed that age ⩾ 65 years [odds ratio (OR), 2.224], MI (OR, 2.561), diabetes mellitus (OR, 1.650), multi-vessel lesions (OR, 2.554), baseline high sensitivity C-reactive protein level ⩾ 3 mg/L (OR, 1.678), and moderate or severe anxiety/depression (OR, 1.849) were negative predictors (P<0.05); while anti-platelet agents (OR, 0.422), β-blockers (OR, 0.626), statins (OR, 0.318), and IM therapy (OR, 0.583) were protective predictors (P<0.05). For cardiac death/MI, age ⩾ 65 years (OR, 6.389) and heart failure (OR, 7.969) were negative predictors (P<0.05), while statin use (OR, 0.323) was a protective predictor (P<0.05) and IM therapy showed a beneficial tendency (OR, 0.587), although the difference was not statistically significant (P=0.218).Conclusion: In a real-world setting, for patients with CAD, IM therapy was associated with a decreased incidence of revascularization and showed a potential benefit in reducing the incidence of cardiac death or MI. [ABSTRACT FROM AUTHOR]

Bacteraemia is a systemic infection associated with strong febrile immune reactions. Fever definitions, fever intensity and other factors might affect the recognition, management and prognosis of patients with bacteraemia. A prospective observational design was used to study 412 consecutive Taiwanese patients with healthcare-associated bacteraemia. The study variables were fever intensity, factors related to fever intensity, the association of physical function to thermogenic capacity and the sensitivity of three definitions of fever for identifying patients with bacteraemia. Age, Charlson comorbidity index ( CCI) score, chills and pathogen types were predictors of fever intensity. Barthel index score, CCI score and pathogen types were predictors of chills, an indicator of thermogenic capacity. The sensitivity of three fever definitions (basal body temperature plus 1°C, ≥ 38°C and ≥ 38.3°C) to identify patients with bacteraemia was 93.3%, 83.5% and 71.4%, respectively. Clinicians can target patients with factors associated with blunted febrile response to bacteraemia for closer monitoring. [ABSTRACT FROM AUTHOR]

Objective: Sleep disturbances among family caregivers (FCs) are common in advanced cancer. The comprehensive factors for sleep disturbances among the FCs of patients with cancer have not been investigated in Taiwan. The purposes of this study were to investigate the sleep disturbances among the FCs of patients with advanced cancer and to determine predictors of sleep disturbance. Methods: A descriptive, cross-sectional study was conducted among 172 FCs. Data were collected using the Pittsburgh Sleep Quality Index and wrist actigraphy. A linear regression model was used to identify the predictive factors for sleep quality. Results: Seventy-six percent of the FCs experienced some sleep disturbances. Female gender, more fatigue, greater depression, more caregiving burden, and spending over 16 h per day on caregiving tasks were risk factors for sleep disturbances in caregivers. Conclusions: Sleep disturbances were common among the Taiwanese FCs of patients with advanced cancer. FCs with risk factors for sleep disturbances should be identified and provided assistance. [ABSTRACT FROM AUTHOR]

Background: According to Taiwan Department of Health and World Health Organization statistics, hepatic tumors are the second leading cause of death from malignant disease in Taiwan, with 600,000 deaths from HBV (hepatitis B virus ) infected complication annually. Hepatitis B virus infection is thus an important issue in public health policy. Purpose: The aims of this study were to investigate hepatitis B knowledge and screening behavior and then identify significant prediction factors of hepatitis B screening behavior. Methods: A cross-sectional survey and convenience sampling were used to investigate 282 outpatients at the one target hospital. Descriptive statistics, independent t test, one-way ANOVA, Spearman relation, and multiple regression were used to analyze impact factors. Results: Slightly over half (55.7%) of the participants had received HBV screening. The average hepatitis B knowledge score was 9.38, with an average correct rate of 72.2%.“Whether friends and relatives suffer from hepatitis B”, “knowledge of hepatitis B”, “perceived barriers to action”, and “cue for action” explained 12.3% of total variance. Of these, “perceived barriers of action” was the most important predictor of hepatitis B screening behavior. Conclusions: Although participant knowledge of hepatitis B was relatively good, the screening rate was less than ideal. Results point to “perceived barriers of action” as a key factor affecting screening behavior. We suggest establishing an independent outpatient service to offer screening for hepatitis B in order to reduce waiting time and provide greater convenience. We also suggest the implementation of a policy to unify charges to raise public motivation to undergo screening. [ABSTRACT FROM AUTHOR]

The mechanism of action of Prunella vulgaris L. (PV) affecting cell migration and invasion of human liver cancer cells remains unknown. In this work we showed that the aqueous extract of PV affected migration and invasion of human liver carcinoma cells by inhibiting activities of metalloproteases, MMP-2 and MMP-9, without affecting cell viabilities. We further showed that PV suppressed migration through attenuation of enzymatic activities of MMP-9 and MMP-2 at transcriptional levels and the effects can be correlated with the status of p53 in hepatocarcinoma cells. This work provides a new dimension of understanding on Prunella vulgaris in restraining migration and invasion in human liver cancer cells. [ABSTRACT FROM AUTHOR]

Abstract: Background: Severely ill patients often experience problems with sleep. Either acupressure or valerian aromatherapy are reported as helpful in promoting sleep. Objectives: The purpose of this study was to explore the effectiveness of valerian acupressure on the sleep of patients in the intensive care unit (ICU). Design: A randomized clinical trial. Setting: A 42-bed adult intensive care unit. Participants: Forty-one subjects in the experimental group and 44 subjects in the control group. Methods: The measurement included observation, and actigraphy measures during 10pm–6am, and the Stanford Sleepiness Scale (SSS) measures on the next morning. Experimental groups received valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints between 7pm and 10pm of the second day while control groups received regular treatment. Heart rate was measured for 5min before and after valerian acupressure present for HR variability analysis to measure relaxation response. Results: The results indicated that after receiving valerian acupressure, patients’ sleeping hours increased, wake frequency reduced and SSS grades declined. The HR variability data indicated relaxation response immediately after valerian acupressure. Conclusion: This study supports the hypothesis that valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints could improve the sleeping time and quality of ICU patients. [Copyright &y& Elsevier]

Ventilator-associated pneumonia (VAP) is a subset of hospital-acquired pneumonias and is a serious, sometimes fatal, complication in patients who need mechanical ventilation. In addition, pay-for-performance initiative has placed increased emphasis on preventing nosocomial infections including VAP. Facilities may not be reimbursed for costs associated with prevalence infections. This article presents a review and meta-analysis of the prevention of VAP through the aspiration of subglottic secretion. [ABSTRACT FROM AUTHOR]

Three new isoquinoline alkaloids including a morphine derivative (1), two aporphine alkaloids (2 – 3), together with five known alkaloids (4 – 8) were obtained from the extract of Dactylicapnos scandens (D.Don) Hutch. (D. scandens). Their structures and absolute configurations were elucidated by extensive spectroscopic data analysis including HRESIMS, NMR and electronic circular dichroism (ECD) and ECD calculation. Compounds 1 – 8 were evaluated for ATP Citrate Lyase (ACLY) inhibitory activity through an enzymatic assay. Among them, 2 and 3 showed the high ACLY inhibitory activity with an IC 50 value of 10.48 ± 1.59 and 10.89 ± 4.89 μM. [Display omitted] • Three new alkaloids were obtained from Dactylicapnos scandens. • Their structures were evaluated by the analysis of extensive spectroscopic data. • Compound 2 and 3 exhibited significant ACLY inhibitory activity. [ABSTRACT FROM AUTHOR]