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This study set out to analyze the relationship among teachers' workplace spirituality, sense of meaning in life, and psychological well-being. Taking 610 teachers as its subjects, the study employed three scales: one to measure the subjects' sense of workplace spirituality, another to measure their sense of meaning in life, and a third to measure their sense of psychological well-being. These three scales were pretested and found to have good reliability and validity. The questionnaire data were analyzed using hierarchical regression in order to understand the explanatory power of the predictors (workplace spirituality and meaning in life) to dependent variable of psychological well-being. The results showed 62.70% explanatory power. According to the research findings, this study suggests that teachers should understand the importance of having workplace spirituality, of being psychologically sound and of feeling they have a meaningful life. Future studies may further explore the factors that influence teachers' sense of psychological well-being.

Background: This study aimed to evaluate the necessity of abdominal drainage after laparoscopic appendectomy in patients with complicated appendicitis. Methods: Patients with acute appendicitis undergoing laparoscopic appendectomy at two hospitals between January 2014 and December 2018 were retrospectively included. Complicated appendicitis was defined as the American Association for the Surgery of Trauma (AAST) grade ≥ II. The patients were classified according to the AAST grade and the indwelling of abdominal drainage. The postoperative surgical outcomes and recovery were compared among patient groups to evaluate the impact of abdominal drainage for patients with complicated appendicitis undergoing laparoscopic appendectomy. Results: A total of 1241 patients was retrospectively included. Among them, there were 820 patients with simple appendicitis (AAST grade I) and 421 patients with complicated appendicitis (AAST grade ≥ II). For complicated appendicitis, the drainage group (N = 192) tended to harbor more overall complications, intra-abdominal abscess formation, time to resume a soft diet, and the postoperative length of hospitalization (P = 0.0000 for all). Multivariate logistic regression confirmed that abdominal drainage increased the risk of overall complications [Odds ratio (OR) 2.439; 95% confidence interval (CI) 1.597–3.726; P ≤ 0.0001] and failed to decrease the risk of intra-abdominal abscess formation (OR 1.655; 95% CI 0.487–5.616; P = 0.4193). Multivariate linear regression analysis also showed that the drainage group harbored longer postoperative length of hospitalization (Coefficients: 20.697; 95% CI 15.251–26.143; P < 0.0001) and time to resume a soft diet (Coefficients: 45.899; 95% CI 34.502–57.297; P < 0.0001). Conclusions: Abdominal drainage did not prevent overall complications in patients with complicated appendicitis; paradoxically, it delayed the convalescence. Our results discourage the routine use of abdominal drainage and suggest that abdominal drainage should be performed sparingly. [ABSTRACT FROM AUTHOR]

Background: Over 30% of cancer survivors experience chronic fatigue. An alteration in energy metabolism is one of the hypothesized mechanisms for cancer-related fatigue (CRF). No studies have evaluated for changes in metabolic profiles in cancer survivors with CRF. The purpose of this pilot study was to evaluate for differences in metabolic profiles between fatigued and non-fatigued survivors of colorectal cancer (CRC). Methods: Survivors were recruited from the surgical outpatient department and the oncology clinic of a medical center in northern Taiwan. Fatigue was assessed using the Fatigue Symptom Inventory. Fasting blood samples were collected on the day the fatigue questionnaire was completed. Metabolomic profile analysis was performed using non-targeted, liquid chromatography/time-of-flight mass spectrometry. Fold change analyses, t-tests, and pathway analyses were performed to identify differences in metabolomic profiles between the fatigued and non-fatigued survivors. Results: Of the 56 CRC survivors in this study, 28.6% (n = 16) were in the fatigue group. Statistically significant differences in carnitine, L-norleucine, pyroglutamic acid, pyrrolidonecarboxylic acid, spermine, hydroxyoctanoic acid, and paraxanthine were found between the two fatigue groups. In addition, two pathways were enriched for these metabolites (i.e., glutathione metabolism, D-glutamine and D-glutamate metabolism). Conclusions: Findings from this pilot study provide preliminary evidence that two pathways that are involved with the regulation of ATP production and cellular energy (i.e., glutathione metabolism, D-glutamine and D-glutamate metabolism) are associated with fatigue in CRC survivors. If these findings are confirmed, they may provide new therapeutic targets to decrease fatigue in cancer survivors. [ABSTRACT FROM AUTHOR]

Background: It is well established that adjuvant chemotherapy with 5-fluouracil and leucovorin (5-FU/LV) improves survival for patients with resected colon cancer; however, the benefits of oral uracil and tegafur (UFT) chemotherapy in these patients are still uncertain.Methods: All patients enrolled in this retrospective study with stage II disease who were treated with surgery or surgery plus UFT were examined to determine the overall survival and disease-free interval. Time-to-event by treatment group was examined using Kaplan-Meier estimates and multivariable Cox regression analysis.Results: There were 456 eligible patients-217 (47.5%) patients had surgery and 239 (52.5%) patients had surgery plus UFT. In patients aged ≧65 years, deeper tumor depth and fewer nodes observed were associated with lower survival. The 5-year survival rate was 84.2% in the surgery group and 89.1% in the surgery plus UFT group (P = 0.006). Treatment with UFT after surgery was associated with improved outcome compared with surgery alone: overall survival (HR = 0.611, P = 0.018) and disease-free survival (HR = 0.590, P = 0.032).Conclusions: Oral fluoropyrimidines improve the disease-free rate and the overall survival of patients after resection of stage II colon cancer. These observations support the use of these agents following surgery as it provides a benefit over surgery alone. [ABSTRACT FROM AUTHOR]

The management of the patient with radiation-induced bowel obstruction remains controversial. To reassess the surgical therapy for radiation-induced bowel obstruction, we analyzed 22 patients operated upon at the National Taiwan University Hospital. In 10 patients, peritoneal carcinomatosis was found during operation. We classified them as “recurrence group” and the remaining 12 patients as the “study group.” Three patients in the study group had metastases, which did not cause bowel obstruction. The clinical presentation and image findings of both groups were not significantly different. The patients of the study group tended to have a low body mass index (mean ± SD, 18.7 ± 1.92 kg/m2) and decreased serum albumin level (mean ± SD, 3.12 ± 0.32 g/dl). Total parenteral nutrition was given for 27.1 ± 16.0 days (mean ± SD). The strategies of operation included resection and anastomosis (nine patients), bypass (two patients), or ileostomy (one patient). Operation resolved bowel obstruction and enteral nutrition was resumed in all the patients postoperatively. No early postoperative mortality occurred. Four patients had morbidity, including one reoperation because of anastomotic failure, one enterovesical fistula, and two cases of wound infection. The estimated median survival time of the study group (21 months) was significantly longer than that of the recurrence group (5 months). Specifically in the patients without previous neoplasm recurrence or metastasis, overall survival was 100%, 80%, and 53%, at 1, 2, and 5 years after surgery, respectively. We conclude surgery plays a role in both diagnostic and therapeutic aspects of radiation bowel injury. For selected patients, resection and primary anastomosis is an appropriate choice. [Copyright &y& Elsevier]

Purpose/Objectives: To explore the association between supportive care needs and type D personality, and to identify personality traits, including negative affectivity (NA) and social inhibition (SI), and their influence on the supportive care needs of patients with colorectal cancer (CRC).Design: Cross-sectional, correlational survey.Setting: Oncology and surgical outpatient clinics at a medical center in northern Taiwan.Sample: 277 patients diagnosed with CRC.Methods: Data were collected using a set of structured questionnaires to measure supportive care needs, symptom distress, anxiety, depression, and personality traits. The associations between type D personality and supportive care needs were verified by the Mann-Whitney U test. The significant roles of personality traits were identified by generalized estimating equations, controlling for biophysical and psychological factors overall, and for the five supportive care domains.Main Research Variables: Supportive care needs, type D personality.Findings: Patients with CRC reported the most unmet needs in the health system and the information domain. Type D patients had higher needs overall and in most domains, except for sexuality needs. A higher level of NA indicated higher overall and psychological needs. A higher level of SI indicated lower needs in health system and information.Conclusions: The level of unmet supportive care needs of patients with CRC is highly associated with type D personality. The trait of NA alters levels of overall supportive care and psychological needs, and the trait of SI influences needs in health system and information.Implications for Nursing: Assessing personality traits before providing an education program is highly recommended for patients with cancer. The assessment could improve the quality of personalized education programs and better meet patient needs. [ABSTRACT FROM AUTHOR]

To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery. Cluster randomized trial. Two 36-bed GI wards at a university-affiliated medical center in Taiwan. Older patients (≥65 years, N = 377) were recruited if they were scheduled for elective GI surgery with an expected length of hospital stay >6 days. After transferring to the GI ward after surgery, participants were randomly assigned to the mHELP or control group (1:1) by room rather than individually because most patient units are double- or triple-occupancy rooms. The mHELP protocols (early mobilization, oral and nutritional assistance, and orienting communication) were administered daily with usual care by a trained nurse until hospital discharge. The control group received usual care only. Outcomes were in-hospital nutritional decline, measured by body weight and Mini-Nutritional Assessment (MNA) scores, and Fried's frailty phenotype. Return of GI motility was examined as a potential mechanism contributing to observed outcomes. Participants (mean age = 74.5 years; 56.8% male) primarily underwent colorectal (56.5%), gastric (21.2%), and pancreatobiliary (13.8%) surgery. Participants who received the mHELP [for a median of 7 days (interquartile range = 6–10 days)] had significantly lower in-hospital weight loss and decline in MNA scores (weight −2.1 vs −4.0 lb, P =.002; score −3.2 vs −4.0, P =.03) than the control group. The mHELP group also had significantly lower rates of incident frailty during hospitalization (12.0% vs 21.7%, P =.022), and persistent frailty (50.0% vs 92.9%, P =.03). Participants in the mHELP group had trends toward an accelerated return of GI motility. The mHELP effectively reduced nutritional decline, prevented new frailty, and promoted recovery of frailty present before admission. These nurse-administered protocols might be useful in other settings, including conditions managed at home or in nursing facilities. [ABSTRACT FROM AUTHOR]

Background: Stage II colorectal cancer has a relatively good prognosis. Adjuvant chemotherapy following surgery is the standard treatment for stage III colorectal cancer but is not routinely recommended for all stage II colorectal cancer patients. We aimed to evaluate the clinical outcomes, treatment results, and prognostic factors in stage II colorectal cancer patients who underwent curative surgery with/without oral tegafur-uracil (UFT)., Methods: We included stage II colorectal cancer patients who underwent curative surgery and were followed up for at least 5 years after surgery at the National Taiwan University Hospital between January 2008 and December 2012. Excluding patients receiving neoadjuvant therapy, adjuvant therapy other than UFT, and those lost follow-up, patients treated with UFT (UFT group) and those without adjuvant therapy (surgery alone group) were analyzed for their clinical outcomes and prognostic factors., Results: A total of 233 patients were recruited. Of these, 104 (44.64%) underwent only surgery while 129 (55.36%) received adjuvant chemotherapy with oral UFT following surgery. Recurrence or death occurred within 5 years in 60 patients (25.75%), with a significant difference between the surgery alone (36/104, 34.62%) and UFT groups (24/129, 18.61%) (p = 0.007). The UFT group demonstrated significantly superior 5-year disease-free (p = 0.003) and overall survival rates (p = 0.001), respectively. Patient age of ≤35.3 or ˃72.7 years, UFT duration of <486.8 days, 7.1 cm < tumor size ≤13.2 cm, number of harvested lymph nodes ≤13.5, and mucinous adenocarcinoma were associated with poorer 5-year overall survival., Conclusion: The present data suggest that UFT following curative surgery may be associated with lower recurrence and improved survival in patients with stage II colorectal cancer., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2020 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background & Aims: The serrated pathway is a distinct pathway of colorectal carcinogenesis that has been implicated in development of a substantial proportion of interval colorectal cancers. The fecal immunochemical test (FIT) detects early neoplasms with a higher level of sensitivity than the guaiac test. We investigated the sensitivity of the FIT in detection of sessile serrated adenomas/polyps (SSA/Ps)., Methods: We performed a prospective study of 6198 asymptomatic subjects (mean age, 59.0 ± 7.0 years) who received concurrent screening colonoscopies and FITs at the Health Management Center of National Taiwan University Hospital from August 2010 through November 2014. The sensitivity of FIT for conventional adenoma, advanced adenoma, and SSA/P at different cutoffs was calculated, and results were compared by using multivariate analysis adjusted for potential confounders., Results: Prevalence values of SSA/P, adenoma, and advanced adenoma were 1.4%, 20.2%, and 5.5%, respectively. At cutoffs of 10, 15, and 20 μg hemoglobin/g feces, the FIT detected all SSA/Ps with 12.3%, 6.2%, and 6.2% sensitivity, large SSA/Ps with 18.4%, 10.5%, and 10.5% sensitivity, and advanced adenomas with 32.4%, 24.5%, and 20.9% sensitivity, respectively. Multivariate analysis revealed that positive results from the FIT did not differ significantly between individuals with SSA/P and those with non-advanced adenoma or those with negative findings from colonoscopy. Patients with large SSA/Ps were less likely to have positive results from the FIT than patients with advanced adenoma, with odds ratios of 0.44 (95% confidence interval [CI], 0.18-1.05), 0.30 (95% CI, 0.10-0.90), and 0.37 (95% CI, 0.12-1.12) at cutoffs of 10, 15, and 20 μg hemoglobin/g feces, respectively, after adjusting for lesion size, even with synchronous conventional adenoma., Conclusions: In a prospective study of 6198 subjects receiving the FIT and colonoscopy, we found that the FIT detected SSA/Ps with significantly lower levels of sensitivity than conventional adenoma. Further studies are needed to determine the effects of these findings on the effectiveness of FIT-based colorectal cancer screening program., (Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background & Aims: The fecal immunochemical test (FIT) can identify patients with advanced colorectal neoplasms, but it also has a high rate of false-negative results. It would be helpful to characterize colorectal neoplasms that are not detected by FIT to aid in development of new tests. We characterized colorectal neoplasms from patients who had negative results from the FIT., Methods: We analyzed data from 18,296 subjects who were screened for colorectal cancer by colonoscopy and the FIT at the Health Management Center of National Taiwan University Hospital from September 2005 through September 2010. We identified 4045 subjects with colorectal neoplasms (3385 with nonadvanced adenomas, 632 with advanced adenomas, and 28 with cancer). We analyzed the sensitivity of the FIT in identifying these patients, along with information on lesion size, location, and morphology., Results: The FIT identified patients with nonadvanced adenomas, advanced adenomas, and cancer with sensitivity values of 10.6% (95% confidence interval [CI], 10.2%-12.3%), 28.0% (95% CI, 24.6%-31.7%), and 78.6% (95% CI, 58.5%-91.0%), respectively. The FIT detected proximal advanced adenomas and nonpolypoid lesions with lower levels of sensitivity than distal advanced adenomas; it had a high false-negative rate in detection of adenomas <15 mm (adjusted odds ratio, 2.85; 95% CI, 1.79-4.54) and nonpolypoid adenomas (adjusted odds ratio, 2.15; 95% CI, 1.22-3.80), after adjusting for demographic characteristics, colonoscopy findings, and potential confounders. The FIT produced a higher percentage of false-negative results in detection of carcinoma in situ and T1 cancer than in T2-T4 cancers (66.7% sensitivity vs 100%; P = .049)., Conclusions: The FIT produces a high rate of false-negative results for patients with small or nonpolypoid adenomas. Early-stage cancers are associated with a high rate of false-negative results from the FIT., (Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Colorectal cancer (CRC) is a leading cause of cancer death worldwide. Surgery is the only way to potentially cure the disease and may be accomplished in 70% to 80% of newly diagnosed cases. However, 40% to 50% of patients who undergo surgery alone ultimately relapse and die of metastatic disease. Adjuvant chemotherapy, which has been developed to reduce the recurrence of CRC, has evolved from the single agent fluorouracil (5FU) to combinations with oxaliplatin, which now have an established role in stage III CRC. FOLFOX4 has been widely used as an adjuvant treatment of CRC, including the Asia-Pacific region. Adjuvant chemotherapy for CRC has been extensively investigated in the West but whether treatment outcomes in Asian individuals vary due to racial differences is uncertain. Racial differences should be considered, and differences in outcomes have been shown in patients with non-small cell lung cancer (NSCLC) treated with epidermal growth factor receptor tyrosine kinase inhibitors. This article critically reviews the evolution of adjuvant chemotherapy in CRC and focuses on the side effects of FOLFOX4 when administered to Asian patients for the adjuvant treatment of CRC. Comparisons of the tolerability of FOLFOX4 in different races from well-designed studies conducted in the West and Asia will be reviewed.

Taiwan's rubella vaccination program was launched in 1986; each schoolgirl in the third grade of junior high school received one dose of rubella (RA 27/3) vaccine. We reviewed the results of 14,090 prenatal rubella tests for primiparas from three areas of Taiwan during 2002 to 2008 to investigate seronegativity rates and titer changes. In all primiparous women, the average rubella virus seronegativity rate was 6.5% (95% confidence interval [95% CI], 6.1 to 6.9%), and the average rubella virus antibody titer was 65.9 IU/ml (95% CI, 64.7 to 67.1 IU/ml). There were 1,220 women (8.7%) with weakly positive antibody titers (10 to 20 IU/ml). The rubella virus seronegativity rates, which ranged from 5.4 to 9.7%, did not exhibit a linear trend from 9 to 22 years after vaccination (P = 0.201); in contrast, a significant trend appeared in the average rubella virus IgG titer (P = 0.003), dropping from 69.9 IU/ml in the 9th year after vaccination to 54.8 IU/ml in the 22nd year. The mean annual antibody decay rate was -0.77 IU/ml. This study reveals that the level of rubella virus antibodies declined slowly in women of childbearing age who were vaccinated with RA 27/3 at junior high school age. The number of women who were seronegative or had weakly positive antibody titers was still high (15.2%). Therefore, in countries that implement a single-dose regimen in children or teenagers, it should remain an important policy to encourage voluntary immunization in seronegative women and to immunize all postpartum women who are susceptible to rubella virus infection before they leave the hospital.

Aim: To investigate the clinicopathological characteristics of late-stage lung cancer patients with gastrointestinal (GI)-tract metastases, focusing on therapeutic options and outcomes., Methods: Our institution (the National Taiwan University Hospital) diagnosed 8159 patients with lung cancer between 1987 and 2008, of which 21 developed symptomatic GI metastases. This study reviewed all of the patients' information, including survival data, pathological reports, and surgical notes., Results: The most common histological type of lung cancer was adenocarcinoma, and 0.26% of patients with lung cancer developed GI metastases. The median duration from lung cancer diagnosis to GI metastases was three months (range, 0-108 mo), and the average time from diagnosis of GI metastasis to death was 2.8 mo. Most patients with symptomatic gastric and/or duodenal metastases exhibited GI bleeding and were diagnosed by panendoscopy. In contrast, small bowel metastases typically presented as an acute abdomen and were not diagnosed until laparotomy. All patients with small bowel or colonic metastases underwent surgical intervention, and their perioperative mortality was 22%. Our data revealed a therapeutic effect in patients with solitary GI metastasis and a favorable palliative effect on survival when metastases were diagnosed preoperatively. In patients with multiple GI metastases, the presentation varied according to the locations of the metastases., Conclusion: Surgical treatment is worthwhile in a select group of patients with bowel perforation or obstruction. Physicians should be more alert to symptoms or signs indicating GI metastases.

Purpose/objectives: To explore the association between quality of life (QOL) and type D personality, which is characterized by the traits of negative affectivity and social inhibition, and to further identify impacts of these traits after controlling for biophysical and psychological factors in colorectal cancer survivors., Design: Cross-sectional and correlational., Setting: Oncology and surgical outpatient clinics of a medical center in Taiwan., Sample: 124 patients diagnosed with colorectal cancer who had completed active treatment., Methods: Data were collected using a set of structured questionnaires to explore type D personality, biophysical and psychological factors, and QOL. Their associations were verified with Mann-Whitney U test and Spearman's rho correlation. Significant factors associated with QOL were identified with generalized estimating equations., Main Research Variables: Type D personality and QOL., Findings: Patients with type D personality experienced higher physical and psychological distress than those with non-type D personality. Social inhibition remained an important factor leading to impairment in the mental component of QOL after controlling for other associated factors. Negative affectivity was associated with fatigue intensity and interference of fatigue with life activities., Conclusions: Personality trait was found to be an important factor associated with QOL. The trait of social inhibition was a significant factor influencing mental aspects of QOL, whereas negative affectivity was associated with fatigue., Implications for Nursing: Assessing patients' personality, including negative affectivity and social inhibition, could help nurses to develop supportive groups or social networks for these patients and thereby improve QOL for cancer survivors.