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Background Cancer-related fatigue is one of the most common and persistent issues experienced by cancer patients. Cancer-related fatigue is a distinct form of fatigue that is subjective, long-lasting and unalleviated by rest or sleep. Studies have shown that almost all cancer patients experience severe fatigue that disrupts the quality of life and physical function, but cancer-related fatigue remains under-addressed in clinical care, and only about half of all patients receive treatment. Methods To increase the awareness of cancer-related fatigue and improve current management, the Taiwan Society of Cancer Palliative Medicine and the Taiwan Oncology Nursing Society convened a consensus committee to develop recommendations for the screening, assessment and treatment of cancer-related fatigue. Results Thirteen consensus recommendations were subsequently developed based on the best available evidence and the clinical experience of committee members. Conclusions These recommendations are expected to facilitate the standardization of cancer-related fatigue management across Taiwan and may also serve as a reference for other clinicians.

Objective: This study investigated the lived experiences of ovarian cancer survivors amid the disease trajectory and psychosocial adaptation. Materials and methods: Twenty-one women, all of whom were ovarian cancer survivors, were recruited from medical centers in Taiwan. In-depth, face-to-face, semi-structured interviews were conducted and transcribed verbatim from audio recordings. The sample size was determined by information saturation during data collection. The steps of data process and analysis were performed using Giorgi's phenomenology. Results: Three themes and 12 subthemes were extracted: (1) a depressed state, as if facing a fierce enemy: being sentenced to a death penalty like facing an insurmountable challenge; contradictory information and helplessness; turnaround for treatment decision; and facing stigmatization from society; (2) shadow of cancer recurrence: side-effects of cancer treatment; falling into desperation and frustration; worrying about cancer recurrence; and continuing to fight cancer; (3) a change of mindset to move forward: experiencing changes in outlook on life; activating the self-healing process; coexisting with cancer and treating it as a chronic disease; and experiencing physical and mental purification and enhancement. Conclusion: The conventional models caring for patients with ovarian cancer are based on disease and unable to meet their needs because the lengthy rehabilitation journey. Therefore, medical personnel should emphasize patients’ medical autonomy and combine professional care and social resources to help patients developing adjustment strategies and establishing support systems in timely manner for body, mind, and soul of these patients. Keywords: Ovarian cancer survivors, Life experience, Disease trajectory, Phenomenology

Case managers are crucial providers of health education and consultation for patients with gynecologic cancer to satisfy their informational needs. The purpose of this study is to understand the experience of case managers working to meet the needs of these patients in order to further improve their overall quality of care.A qualitative study employed. Twenty case managers recruited from Taiwanese healthcare institutes using purposive sampling. Participants were interviewed in semi-structure fashion. All interviews were verbatim transcribed. The steps of Giorgi's phenomenological method were used to analyze the transcripts.Three major themes and twelve subthemes emerged. Major themes were associated with cancer development: (1) during diagnosis, build a communication bridge and provide appropriate treatment early on, become consultants; (2) during treatment, provide comprehensive medical care for cancer, become the patient's manager; (3) during follow-ups, assist patients to comprehend and adapt to living with cancer, return to society and the original pace of life.Case managers accompany patients with gynecologic cancer and address their problems to other medical professional. The informational needs of patients with gynecologic cancer differ along the course of the disease. It is important for cancer care manager to deliver the information of individualized health care in timely manner to ensure the overall quality of care for patients with gynecologic cancer.

To investigate nurse practitioners' (NPs) experience of job strain in acute care settings, and to examine the factors that may affect job strain in that context.Descriptive design using a national survey was employed.A total of 1396 NPs completed online surveys that recorded demographic characteristics and included a Job Content Questionnaire (JCQ), a Condition for Work Effectiveness Questionnaire (CWEQ), and the Dempster Practice Behavior Scale (DPBS). Multiple logistic regressions were conducted to explore the factors associated with job strain types.NPs were classified into job strain categories of passive (24.4%), active (31.4%), low (19.2%), or high (24.9%). The passive job strain type was associated with overtime hours, organizational empowerment, and autonomy. The active job type was associated with higher organizational empowerment and autonomy. The high-strain and low-strain job types were both associated with overtime hours and autonomy.Nearly 25% of acute care NPs are in a high job strain type. Organizational empowerment and autonomy were two major factors associated with the passive and active job strain types. Overtime hours and autonomy were both associated with the high-strain and low-strain job types.Supportive hospital/nursing leadership should acknowledge the impact of NP practice as they can contribute to the operational efficacy of their organization. Hospital administrators should provide a supportive practice environment by empowering NPs, enhancing autonomy, and addressing working conditions for NPs to decrease the odds of having a passive or high-strain job type in practice.

Objective: To culturally adapt the self-regulation questionnaire to the Taiwan Chinese version (TC-SRQ) and to evaluate its psychometric properties for gynecologic cancer survivors. Materials and methods: A cross-sectional study was employed with a purposive sample of 287 gynecologic cancer survivors. The TC-SRQ was adapted from a Germany version through back-translation to ensure its quality. For construct validity, confirmatory factor analysis (CFA) was used to assess the TC-SRQ measurement model with fit indexes including the χ2 test, the root mean square error of approximation (RMSEA), and the normed fit index (NFI), the comparative fit index (CFI), and non-normed fit indices (NNFI). For concurrent validity, the Taiwanese version of the European Organization for Research and Treatment of Cancer's 30-item core quality of life (EORTC QLQ-C30) questionnaire was used as a criterion measure for quality of life (QOL). Reliability was evaluated by internal consistency and test-retest reliability. Results: For a modified measurement model of TC-SRQ, the model fit (χ2 = 311.23, P = .0; RMSEA = .088; NFI = .97, CFI = .98, NNFI = .97) was acceptable. The evidence of construct validity of TC-SRQ scale was confirmed by the model estimates. TC-SRQ correlated positively with the global QOL, physical, cognitive, emotional, and social functioning domains, and negatively with fatigue and pain domains of EORTC QLQ-C30. For known groups validity, TC-SRQ was correlated with groups attributed by age, family support, health status, and sleep quality. A Cronbach's α of .91 indicated good internal consistency; the test-retest reliability was .82. Conclusions: TC-SRQ is a valid and reliable instrument for assessing self-regulation in gynecologic cancer survivors. Keywords: Gynecologic cancer survivors, Self-regulation, Quality of life, Psychometrics, Confirmatory factor analysis

Various treatments are available for patients with liver cancer; however, complications after treatment affect their quality of life (QOL). To improve the QOL of patients with liver cancer, this study investigated the postoperative lifestyle of sixty patients at the Liouying District Hospital, Taiwan. A self-reported structured questionnaire and a modified Chinese version of the Health Enhancement Lifestyle Profile (HELP-C) were used to collect the demographic data and to assess patients’ overall postoperative lifestyle, respectively. Significant differences were observed between the overall postoperative lifestyle and the demographic variables of age, ethnicity, education level, marital status, chronic diseases, and postoperative complications (p < 0.05). Significant differences (p < 0.05) were observed in the HELP-C domains of diet, leisure, and activities of daily living (ADL) between the sexes. The scores for diet (9.66 ± 4.21) and leisure (4.33 ± 2.03) in women were significantly lower (p < 0.05) than those in men (13.13 ± 4.98 and 6.17 ± 2.37, respectively), indicating that women with liver cancer should be more concerned about diet and leisure after surgery. However, the score for ADL was significantly higher (p < 0.05) in women (17.90 ± 5.15) than in men (13.48 ± 2.56), indicating that men should focus on improving ADL. This research provides reference clinical data on the postoperative lifestyle of patients with liver cancer to improve their QOL.

Objective: The purpose of this study was to examine the correlations among fear of cancer recurrence (FCR), illness representation (IR), self-regulation (SR), and quality of life (QOL) in gynecologic cancer survivors. Materials and methods: A cross-sectional study was conducted with 287 participants recruited from a medical center in northern Taiwan. Four questionnaires, the Assessment of Survivor Concerns (ASC), the Brief Illness Perception Questionnaire (BIPQ), the Self-Regulation Questionnaire (SRQ), and the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire-Core 30-item (EORTC QLQ-C30), were used to assess FCR, IR, SR, and QOL respectively. Data pertaining to socio-demographic characteristics and self-reported medical status was also collected from the participants. Stepwise regression analysis was performed to identify predictors of QOL. Results: The results showed that FCR (r = −.21, P

Objective To identify distinct subgroups of patients newly diagnosed with lung cancer (LC) over time and to explore the predictors of distinct trajectories of symptom and fatigue distress in LC patients. Methods A total of 120 patients newly diagnosed with LC were recruited in this longitudinal prospective study. Our survey investigated patients' symptoms in 6 months. Latent growth curve analysis (LGCA) was conducted to identify patients with distinct trajectories of symptom and fatigue distress. The characteristics of the patients among groups were compared for statistical differences by the chi-square test or ANOVA. Results The results of LGCA revealed that the linear three-trajectory model had the best model fit for symptom and fatigue distress. Patients' symptom and fatigue distress improved with time, except for patients with increasing trajectories. Patients' trajectories of symptom and fatigue distress were affected by pain, lower functional status, total symptom score and depression. Moreover, patients with increasing trajectories of symptom and fatigue distress experienced more pain, physiological symptoms and depression from 1 to 6 months. Conclusions Pain and functional status were the major factors that deteriorated the recovery of trajectory in symptom distress and fatigue distress among patients with increasing trajectories.

Summary: Background: Elderly cancer patients undergoing cancer treatments were vulnerable to fall incidents and injuries, an important issue in patient safety. The aims of this study were to explore the effects of using balanced scorecard management strategies on reducing fall incidents and injuries among elderly cancer patients in a medical center. Methods: A prospective, intervention study was employed using records of fall incidents of elderly cancer patients retrieved from Taiwan Patient safety Reporting system (TPR). The intervention, balanced scorecard measures designed to reduce fall incident and injury, was added to the customer, internal process, learning and growth, financial perspectives of the balanced scorecard implemented by the medical center. SPSS 20.0 was used to in statistic analysis for frequency, percentage, mean, standard deviation, and Chi-square test. Results: Prior to the intervention, 41 fall incidents (all sustained injury) recorded in 2010: fall incident (3.26%), fall injury (100%). With the intervention, 24 fall incidents (17 sustained injuries) recorded 2011: fall incident (1.87%; χ2 = 4.985, P = 0.026) and fall injury (62.5%; χ2 = 17.845, p

Background: Although it is now possible to achieve permanent remission in a large percentage of gynecologic cancer (GC) cases, many GC patients in remission experience side effects or complications that influence their physical function and family relationships. Compared with other types of cancer patients, survivors of GC face greater challenges in terms of physical and psychological adaptations, and many of these do not receive sufficient assistance. An in-depth understanding of the lived experiences and demands of GC survivors is key to constructing comprehensive related healthcare services. Purpose: The aim of this study was to understand the lived experience of GC survivors in Taiwan to help their return to a healthy life. Methods: This was a phenomenological study. Twenty-three survivors of GC participated in semistructured interviews that were held in a private environment. The transcripts were based on synchronous recordings from the interviews. Giorgi's phenomenology analysis was adopted for data analysis. Results: Three themes with six subthemes were extracted from the data, including (a) the inner struggle of living with cancer and recurrence: repeatedly exploring the causes of cancer and treatment and facing a fear of cancer recurrence, (b) the interpretation and adjustment to cancer treatment: filled with fluctuating physical and mental distress and working to adopt a different perspective, and (c) the long passage of finding a desirable lifestyle: adjusting to long-term coexistence with side effects and realizing the strength of society, body, and mind. Conclusions/Implications for Practice: The journey of rehabilitation for GC survivors is very long. The participants in this study faced different respective challenges during the diagnosis, treatment, and adjustment phases. Conventional disease-oriented medical care cannot satisfy the requirements of cancer patients because of patient-decentralized services. Our results indicate that GC survivors face diverse problems, both physically and mentally. Healthcare professionals should work to facilitate the psychological adjustment of cancer survivors and provide timely professional advice in combination with social resources. These results may serve as a reference for cancer care professionals who are navigating healthcare services.

Background Falls and fall-related injuries are important indicators for quality of nursing care in institutions. Few studies have been conducted specifically on this topic for hospitalized patients with cancer in Taiwan. Purpose The aims of this study were to understand falls and levels of injury; to identify associations among fall-related injuries, demographics, and causes of falling; and to predict fall-related injuries in hospitalized patients with cancer. Methods A retrospective survey design was used. Data were retrieved from the Taiwan Patient-Safety Reporting system query fall incidences for persons hospitalized with cancer at a medical center in northern Taiwan from 2010 to 2012. Data were encoded and analyzed with descriptive statistics, the chi-square test, and multiple stepwise logistic regression analysis using IBM SPSS Statistics version 18.0. Results One hundred fifty-six (85%) of the 184 hospitalized patients with cancer had fall-related injuries. Falling tended to be more frequent in men without a history of falls and more prevalentat night. The results of regression analysis showed that the variables being with companions at the time of a fall (OR = 5.411, 95% CI [1.619, 18.081]), lower limb weakness (OR = 0.284, 95% CI [0.097, 0.832]), postural hypotension (OR = 0.101, 95% CI [0.014, 0.733]), total score of fall risk factors (OR = 1.688, 95% CI [1.071, 2.660]), and a fall occurring at the bedside (OR = 3.493, 95% CI [1.119, 10.903]) were all positively associated with fall-related injuries, with a Nagelkerke R of 42.8%. Conclusions/implications for practice The risk factors for falls that affect hospitalized patients with cancer are complex. Nursing staff must evaluate the risk factors and treatment methods for each patient and facilitate fall prevention measures to achieve safety-centered quality of care. This study provides an example for nursing staff when assessing factors associated with falls and working to reduce fall-related injuries among patients with cancer.

Background: Most gynecological cancer survivors outlive the acute stage, and many reach permanent survival. However, the fear of cancer recurrence (FCR) is stressful and affects quality of life. Purpose: This study was designed to validate a Chinese version of the Assessment of Survivor Concerns (ASC) questionnaire in terms of its ability to assess FCR in gynecological cancer survivors. Methods: A two-stage study procedure was employed. The first stage involved the translation of the ASC questionnaire from English into Chinese using the methods proposed by Guillemin, which include translation, back-translation, consensus meetings, and a trial of potential users. In the second stage, a pilot study was completed with 37 gynecological cancer survivors followed by a psychometric property study with 287 gynecological cancer survivors. Construct validity was determined using confirmatory factor analysis (CFA) with structural equation modeling. Convergent validity was determined using composite reliability and the average variance extracted values of the ASC model. Discriminant validity was determined by comparing the model fitness of the ASC model against the model fitness of a one-construct model. Concurrent criterion validity was assessed using the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30 as the auxiliary instrument. Reliability was determined by measuring the internal consistency reliability using Cronbach's α in addition to the 3-week test–retest reliability with a 95% confidence interval of the intraclass correlation coefficient. Results: The process of translation and back-translation was performed to ensure the conceptual equivalence of the Chinese version with the original ASC questionnaire. For CFA, the fit indices of the ASC model (χ2 = 9.87, p > .05; root mean square error of approximation = .03. comparative fit index = 1, nonnormed fit index = 1) indicated appropriate model fitness. For convergent validity, the composite reliability and average variance extracted values of the ASC model were satisfactory. For discriminant validity, the model fitness of the ASC model was significantly improved over the one-construct model. For concurrent criterion validity, the ASC scores correlated negatively with the scores of the global quality of life and the five functions (physical, role, cognition, emotions, and social) of the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30, as hypothesized. For reliability, the Cronbach's α and the 95% confidence interval of intraclass correlation coefficient for the ASC model were .91 and [.18, .68], respectively. Conclusions/Implications for Practice: The Chinese version of the ASC questionnaire is a valid and reliable instrument that is suitable for assessing FCR in gynecological cancer survivors in clinical and research settings.

BACKGROUND Colonoscopy is considered a safe and effective tool for detecting colorectal cancer. Nevertheless, the proportion of patients are hesitating to receive colonoscopy. Smartphone education may decrease the barrier of colonoscopy. The aim of this study is to examine the effectiveness of smartphone education in colonoscopy. METHODS We conducted a prospective, double-blinded, randomized, controlled study to examine the effectiveness of smartphone education on embarrassment, bowel preparation, and satisfaction in colonoscopy. The patients' embarrassment was measured by the colonoscopy embarrassment scale. The quality of the bowel preparation was evaluated by gastroenterologists according to the Aronchik Scale. The satisfaction of colonoscopy care was assessed by a satisfaction scale developed by the authors. RESULTS A total of 150 patients were analyzed in the smartphone education and control groups (n = 75 in each group). The smartphone education group reported fewer embarrassment (B = -2.78, P = .02) than those of the control group, the patients who were older (B = .15, P = .001) and who were male (B = 2.91, P = .003) showed higher embarrassment. Additionally, smartphone education group were likely to have better colon preparation (odds ratio = 2.46, 95% confidence interval: 1.20-5.02) than that of the control group. Smartphone education also improved the satisfaction with care (β = 4.60, P

Falls are known to be one of the most common in patient adverse events. A high incidence of falls was reported on patients with cancer. The purpose of this study was to explore the effect of a participatory program on patient's knowledge and self-efficacy of fall prevention and fall incidence in an oncology ward. In this quasi-experimental study, 68 participants were recruited at a medical centre in Taiwan. A 20-min fall prevention program was given to patients. A questionnaire was used to evaluate the effectiveness of program after on day 3 of intervention. The data of fall incidence rates were collected from hospital record. Fall incidences with and without the program were used to compare the effectiveness of intervention. The patients' knowledge and self-efficacy of fall prevention are better than after intervention. A statistically significant difference in fall incidence rate was observed with (0.0%) and without (19.3%) the program. Our findings suggest that the fact of the bedside is that the most risk for falling in hospital must be communicated to the hospitalized patients. Educating patients about fall prevention and activities associated with falling increases their awareness of the potential of falling and promoting patient safety.

Lacking a stable tertiary structure, intrinsically disordered proteins (IDPs) possess particular functions in cell regulation, signaling, and controlling pathways. The study of their unique structural features, thermal stabilities, and folding kinetics is intriguing. In this study, an identified IDP, securin, was used as a model protein. By using a quasi-static five-step (on-path) folding process, the function of securin was restored and analyzed by isothermal titration calorimetry. Fluorescence spectroscopy and particle size analysis indicated that securin possessed a compact hydrophobic core and particle size. The glass transition of securin was characterized using differential scanning microcalorimetry. Furthermore, the folding/unfolding rates (kobs) of securin were undetectable, implying that the folding/unfolding rate is very fast and that the conformation of securin is sensitive to solvent environmental change. Therefore, securin may fold properly under specific physiological conditions. In summary, the thermal glass transition behavior and undetectable kobs of folding/unfolding reactions may be two of the indices of IDP.

Background The increasing number of cancer survivors and the trend of shifting cancer treatments into outpatient clinics have increased rapidly the supportive care needs of patients with cancer. However, no brief assessment tool is available to screen for these needs. Purpose In this study, we aimed to (a) translate and develop a nine-item Chinese version of the Supportive Care Needs Survey Screening Tool (SCNS-ST9-C) and (b) examine the psychometric properties of this tool in a sample of patients with head and neck cancer (HNC) in Taiwan. Methods In this two-phase instrument validation study, the SCNS-ST9-C was translated and evaluated for content, face validity, and feasibility in Phase I and was examined for internal consistency reliability and construct validity (including factor structure and theoretically supported correlations) on a sample of patients with HNC in Phase II. Results In Phase I, the SCNS-ST9-C was translated and developed by three bilingual doctoral-prepared nurse researchers (Chinese and English). A standardized score system ranging from 0 to 100 was built, with higher scores indicating higher unmet supportive care needs. Good content and face validity were confirmed by five cancer care experts and 20 patients with HNC, respectively. In Phase II, 116 subjects were recruited. A clear four-factor structure, which incorporated one of the original five dimensions (sexuality care needs, with one item) into the dimension of psychological and emotional care needs, was identified using exploratory factor analysis. Good internal consistency reliability for the overall SCNS-ST9-C was supported by a Cronbach's α of .75 and its four subscales (domains). Good construct validity was also confirmed by the theoretically supported correlations. Better performance status and longer time since treatment completion correlated negatively with the SCNS-ST9-C (i.e., lower unmet care needs), whereas higher distress (anxiety, depression, and symptoms) correlated positively with the SCNS-ST9-C (i.e., greater unmet care needs). Female patients reported higher overall unmet care needs and psychological and emotional care needs and higher scores on the care and support needs subscale than male patients. Conclusions The SCNS-ST9-C is a brief, low-burden, and psychometrically valid instrument that may be applied in ethnically Chinese settings. This tool takes 1-2 minutes to complete. Further testing of the psychometrics of this instrument in different cancer populations is recommended.

Long-term memory requires activity-dependent synthesis of plasticity-related proteins (PRPs) to strengthen synaptic efficacy and consequently consolidate memory. Cytoplasmic polyadenylation element binding protein (CPEB)3 is a sequence-specific RNA-binding protein that regulates translation of several PRP RNAs in neurons. To understand whether CPEB3 plays a part in learning and memory, we generated CPEB3 knock-out (KO) mice and found that the null mice exhibited enhanced hippocampus-dependent, short-term fear memory in the contextual fear conditioning test and long-term spatial memory in the Morris water maze. The basal synaptic transmission of Schaffer collateral-CA1 neurons was normal but long-term depression evoked by paired-pulse low-frequency stimulation was modestly facilitated in the juvenile KO mice. Molecular and cellular characterizations revealed several molecules in regulating plasticity of glutamatergic synapses are translationally elevated in the CPEB3 KO neurons, including the scaffolding protein PSD95 and the NMDA receptors along with the known CPEB3 target, GluA1. Together, CPEB3 functions as a negative regulator to confine the strength of glutamatergic synapses by downregulating the expression of multiple PRPs and plays a role underlying certain forms of hippocampus-dependent memories.

The aim of this study was to investigate a nursing staff’s knowledge of the Natural Death Act before and after an educational intervention. This was a quasi-experimental designed study. Questionnaires were sent to 135 nurses in a medical center who volunteered to participate in the educational program. Demographic data and knowledge of the Natural Death Act were collected. The return rate was 85.37% (n=105). The educational program lasted for 6 h and included five subjects: hospice-palliative care, Natural Death Act, how to face suffering patients, nursing for agonized patients, and communicating with families. The program was a combination of lectures, case discussions, evaluation of individuals’ values, and attitudes toward patient death. At baseline, the average total score in the 18-item questionnaire on the Natural Death Act was 12.96, with a range of 5–18. After the educational intervention, the average total score increased from 12.9 correct answers to 17.04 (of 18). The average increase was 4.08 points, a statistically significant difference. A provision of appropriate training for medical professionals appears to be a useful educational strategy, and this result shows that the Natural Death Act should be included in nursing school educational program. In the future, more effort should be made to fulfill patients’ expectations and to follow medical ethics guidelines.

Cytoplasmic polyadenylation element binding protein (CPEB) 3 is a sequence-specific RNA-binding protein that confines the strength of glutamatergic synapses by translationally downregulating the expression of multiple plasticity-related proteins (PRPs), including the N-methyl-D-aspartate receptor (NMDAR) and the postsynaptic density protein (PSD) 95. CPEB3 knockout (KO) mice exhibit hippocampus-dependent abnormalities related not only to long-term spatial memory but also to the short-term acquisition and extinction of contextual fear memory. In this study, we identified a specific form of NMDAR-dependent synaptic depotentiation (DPT) that is impaired in the adult CPEB3 KO hippocampus. In parallel, cultured KO neurons also exhibited delayed morphological and biochemical responses under NMDA-induced chemical long-term depression (c-LTD). The c-LTD defects in the KO neurons include elevated activation of calcium/calmodulin-dependent protein kinase II alpha subunit (CaMKIIa), increased Ser831 phosphorylation of GluA1 and slow degradation of PSD95 and GluA1. Because transient pharmacological suppression of CaMKIIa activity during the DPT-initiating phase successfully reversed the long-term potentiation (LTP) in the KO hippocampus, DPT and c-LTD in the two different systems shared common molecular defects due to the absence of CPEB3. Together, our results suggest that CPEB3 deficiency imbalances NMDAR-activated CaMKIIa signaling, which consequently fails to depress synaptic strength under certain stimulation conditions.

It is highly desirable to develop a therapeutic, observable nanoparticle complex for specific targeting in cancer therapy. Growth hormone (GH) and its antagonists have been explored as cancer cell-targeting molecules for both imaging and therapeutic applications. In this study, a low toxicity, biocompatible, therapeutic, and observable GH–nanoparticle complex for specifically targeting growth hormone receptor (GHR) in cancer cells was synthesized by conjugating GH with green fluorescence protein and carboxylated nanodiamond. Moreover, we have shown that this complex can be triggered by laser irradiation to create a “nanoblast” and induce cell death in the A549 non-small-cell lung cancer cell line via the apoptotic pathway. This laser-mediated, cancer-targeting platform can be widely used in cancer therapy.

Enterovirus 71 (EV71) infection is an emerging infectious disease causing neurological complications and/or death within two to three days after the development of fever and rash. A low viral titre in clinical specimens makes the detection of EV71 difficult. Conventional approaches for detecting EV71 are time consuming, poorly sensitive, or complicated, and cannot be used effectively for clinical diagnosis. Furthermore, EV71 and Coxsackie virus A16 (CA16) may cross react in conventional assays. Therefore, a rapid, highly sensitive, specific, and user-friendly test is needed. We developed an EV71-specific nanogold-modified working electrode for electrochemical impedance spectroscopy in the detection of EV71. Our results show that EV71 can be distinguished from CA16, Herpes simplex virus, and lysozyme, with the modified nanogold electrode being able to detect EV71 in concentrations as low as 1 copy number/50 μl reaction volume, and the duration between sample preparation and detection being 11 min. This detection platform may have the potential for use in point-of-care diagnostics.

Cytoplasmic polyadenylation element binding protein 4 (CPEB4) is a sequence-specific RNA-binding protein and translational regulator, with expression associated with tumor progression. Nevertheless, CPEB4 seems to play paradoxical roles in cancers-an oncogenic promoter in pancreatic ductal adenocarcinoma (PDA) and glioblastomas but a tumor suppressor in hepatocellular carcinoma (HCC). To assess whether CPEB4-regulated carcinogenesis is tissue-specific, we reevaluated the role of CPEB4 in HCC. Although proliferation of hepatocytes appeared normal in CPEB4-knockout (KO) mice after partial hepatectomy, knockdown (KD) of CPEB4 in HepG2 liver cancer cells promoted colony formation in vitro. Moreover, the growth of CPEB4-KD cells was accelerated in an in vivo xenograft mouse model. In tumorous and adjacent non-tumorous paired liver specimens from 49 HCC patients, the protein level of CPEB4 was significantly upregulated in early-stage HCC but decreased toward late-stage HCC. This finding agrees with changes in CPEB4 mRNA level from analysis of two sets of HCC microarray data from the Gene Expression Omnibus (GEO) database. Taken together, downregulation of CPEB4 likely occurs at the late cancer stage to facilitate HCC progression. Biphasic alteration of CPEB4 expression during HCC progression suggests its complicated role in tumorigenesis.

This paper aims to explore characteristics of demoralization syndrome as well as the relationship between demoralization syndrome and psychosocial issues as seen through examinations of cancer outpatients in Taiwan.Outpatients with different cancer types were enrolled in this study. The Demoralization Scale Mandarin Version (DS-MV), Patient Health Questionnaire, Beck Hopelessness Scale, and McGill Quality of Life Questionnaire-Taiwan Version were used as instruments. All data were analyzed using SPSS 18.0.Among the 234 patients studied (97 men and 223 women), the majority had cervical cancer (29.1%), followed by breast cancer (26.5%) and head and neck cancer (24.3%). The mean score of DS-MV was 31.05 (SD 14.87). The results of ANOVA analysis showed a significant effect of occupation F(4.209) = 7.145 (p0.001), cancer diagnosis F(7.206) = 3.795 (p0.001), and treatment F(8.206) = 3.553 (p0.001) on DS-MV.Demoralization syndrome was found to be related to psychosocial issues, different cancer types, and treatments. Further studies are recommended to better understand causes and impacts of demoralization in the quality of life and care of cancer patients.

Cancer pain is identified as a multidimensional experience, but relatively few brief instruments are available for assessing the complex pain-related experiences of terminal cancer patients in Taiwan. The purposes of this study were to (1) translate and examine the feasibility and psychometric characteristics of the eight-item Multidimensional Pain Inventory-Screening Chinese (MPI-sC) when used with patients having terminal cancer and (2) apply the MPI-sC to examine multidimensional pain-related experiences of terminal cancer patients in Taiwan. The MPI-sC was tested in 106 terminal cancer inpatients at a hospice setting in Taipei. The results showed that the MPI-sC has satisfactory face and content validity, feasibility, acceptable internal consistency reliability (overall Cronbach’s alpha of 0.75), and overall support of theoretical assumptions. However, instead of the four-factor structure of the original instrument, we found a three-factor structure (with pain intensity and pain interference merged into one factor) that explained 76.73% of the variance. Close to half the patients (48.1%) had considerable levels of pain interference, and a majority (72.6%) reported not having control in life based on the cut-point of MPI-sC categorization. Our results support the brief MPI-sC as a feasible and valid tool for assessing and representing multidimensional pain experiences in terminal cancer patients. The MPI-sC could help clinicians and researchers assess the complex multidimensional pain experiences of terminal cancer patients, including Chinese-speaking cancer populations.

Rhythmic oscillations of up to 600 Hz in grouped neurons frequently occur in the brains of animals. These high-frequency oscillations can be sustained in calcium-free conditions and may be blocked by gap junction blockers, implying a key role for electrical synapses in oscillation generation. Mathematical theories have been developed to demonstrate oscillations mediated by electrical synapses without chemical modulation; however, these models have not been verified in animals. Here we report that oscillations of up to 686 Hz are induced by paired spikes of short spike intervals (SIs) in a junction-coupled network. To initiate oscillations, it was essential that the second spike was elicited during the relative refractory period. The second spike suffered from slow propagation speed and failure to transmit through a low-conductance junction. Thus, at the spike initiation site, paired spikes of short SIs triggered one transjunctional spike in the postsynaptic neuron. At distant synaptic sites, two transjunctional spikes were produced as the SI increased during spike propagation. Consequently, spike collision of these asymmetrical transjunctional spikes occurred in the interconnected network. The remaining single spike reverberated in a network serving as an oscillator center. Paired-spike-induced oscillations were modeled by computer simulation and verified electrophysiologically in a network that mediates the tail-flip escape response of crayfish.

Background: Delirium is a common syndrome in terminal cancer patients. However, its detection and treatment by palliative care teams are not well documented. This survey aimed to determine the prevalence, detection and treatment of delirium in terminal cancer inpatients. Methods: The survey was conducted in Mackay Hospice and Palliative Care Center, Taiwan, from August 2006 to January 2007. All terminal cancer inpatients were invited to participate. The Delirium Rating Scale-Chinese Version was used by a research assistant as the screening instrument. Patients detected by screening were reviewed by psychiatrists to verify the diagnosis and determine the sub-type of delirium. The palliative care team members were asked to evaluate all the participants weekly. The medications used for delirium were obtained by a medical chart review. Result: Two hundred and twenty eight participants (49.9%) among 457 inpatients were screened. The prevalence of delirium was 46.9% (n ¼ 107). Of these, the most common subtype was hypoactive (68.2%, 95% confidence interval (CI): 59.4‐77.0%). The mortality rate of inpatients with delirium (77.6%, 95% CI: 69.7‐85.5%) was higher (P , 0.0001) than those without delirium (50.9%, 95% CI: 44.4‐57.4%). The overall detection rate by any member of the palliative team was 44.9% (n ¼ 48) (95% CI: 35.5‐54.3%). The detection rate of the hypoactive subtype was only 20.5% (95% CI: 11.2‐29.8%), which was significantly lower than that of the hyperactive/mixed subtypes (P , 0.0001). Therapy for delirium was prescribed in 42.1% ( n ¼ 45) (95% CI: 32.7‐51.5%) with haloperidol being the most common medication. Conclusion: The prevalence of delirium was high, but the rates of detection and treatment were low. Interventions are recommended to improve the diagnosis and treatment of delirium in palliative care units.

We aimed to evaluate the palliative care quality for terminal cancer patients as a reference for prospective service improvements.A prospective study was conducted to analyze the quality audit data collected from 1,476 samples in one medical center's palliative care unit. Lai's modified version of the support team assessment schedule was utilized for 2-year data collection, applying 17 categories of audit criteria rated on a scale of 0 to 4 (0-no symptoms, 4-significant symptoms). The quality audit criteria were scored weekly for 2 weeks following patient admission.Average scores of quality audit criteria from admission to week 2 were 10.05, 8.85, and 8.49, respectively, with statistical differences noted weekly. Efficacy of palliative care was most evident 2 weeks after hospitalization. Factors with statistically significant differences between admission and week 1 included: pain control, constipation, vomiting, anorexia, other symptom control, patient anxiety, self awareness and preparation of patient for illness, self awareness and preparation of family for illness, and satisfaction of patient's spiritual belief and life philosophy. Factors with statistically significant differences between weeks 1 and 2 included: pain control, other symptom control, self awareness and preparation of family for illness, and satisfaction of patient's spiritual belief and life philosophy.Patients in hospice care received adequate symptom relief. Total quality audit scores declined progressively over the 2 weeks following patient admission, indicating efficacy of palliative care quality.

Fatigue is one of the most distressful problems faced by terminally ill cancer patients, but few studies have explored fatigue experiences in this population. The purpose of this descriptive correlational study was to examine fatigue status and its related factors in terminally ill cancer patients in an institutionalized hospice in Northern Taiwan. Data were collected using the Fatigue subscale of the Profile of Mood States, modified Symptom Distress Scale, Hospital Anxiety and Depression Scale, Karnofsky's Performance Status Index and a background information form. We found that patients generally had moderate to severe levels of fatigue. Fatigue was associated with the overall symptom distress, depression, anxiety, and performance status. Furthermore, fatigue was significantly correlated with 8 individual distressful symptoms: nausea, vomiting, lack of appetite, sleep disturbance, dyspnea, dry mouth, restlessness, and problems of concentration. These results suggest that fatigue is still a problem faced by terminally ill cancer patients. To provide better care to this population, the above-mentioned fatigue-related factors should be simultaneously assessed and cared for. The authors recommend examining the causal relationship between these factors and fatigue, using symptom cluster concepts and skills to examine the possible shared mechanisms among fatigue and related symptoms and developing interventions to decrease fatigue in terminally ill cancer patients.

Nurses play a crucial role in cancer pain control, but little is known about how well-prepared nurses are to manage cancer pain in Taiwan. The purpose of this study was to examine the level of knowledge about pain management among Taiwanese nurses with different background characteristics and to determine the predictor(s) of nurses' pain management knowledge. Nurse subjects were recruited by a cross-sectional nationwide survey with stratified sampling from nine hospitals distributed in the four major geographic regions of Taiwan. The Nurses' Knowledge and Attitudes Survey-Taiwanese version (NKAS-T) and a background information form were used to collect the data. Of 1900 surveys distributed, 1797 valid questionnaires (94.5%) were analyzed. The average correct response rate was 50.5%, with rates ranging from 7-86% for each survey question. Results from stepwise regression showed that nurses with higher mean correct answer scores had BS or higher degrees, had received pain education at professional conferences, had more prior hours of pain education, had longer clinical care experiences, and always worked with cancer patients. Nurses who worked in intensive care units, however, had significantly lower mean correct scores. The results strongly suggest an urgent need to strengthen pain education in Taiwan. The results also provide the direction for developing pain education.

The purpose of the study was to develop and preliminarily test the feasibility, validity, reliability, and factor structures of the Pain Opioid Analgesics Beliefs Scale–Cancer (POABS-CA) in hospitalized adults diagnosed with cancer in Taiwan. This scale was developed in three phases. In Phase I, item development was based on qualitative analysis as well as a review of the literature. Face validity, content validity, and feasibility were also evaluated. In Phase II, internal consistency reliability was further tested in 42 subjects with pain. In Phase III, test-retest reliability, internal consistency, and essential construct validity were further assessed in a sample of 361 hospitalized cancer patients with pain. The POABS-CA evolved from testing as a 10-item 5-point Likert-type instrument. Higher scores indicated more negative beliefs regarding opioids and their use in managing pain. Satisfactory face validity and content validity were found. The POABS-CA was also shown to be a reliable and stable pain belief scale, with Cronbach's alpha and test-retest reliability of 0.70 and 0.94, respectively. Two factors, namely pain endurance beliefs and negative effect beliefs, were extracted from the principal component factor analysis to support the construct validity. In conclusion, preliminary evidence indicates the POABS-CA is a reliable, stable, valid and easily applied scale for assessing beliefs regarding opioid use for cancer pain. Further studies should test this scale in different populations to increase its applications in cancer pain management.

Regulated RNA translation is critical to provide proteins needed to maintain persistent modification of synaptic strength, which underlies the molecular basis of long-term memory (LTM). Cytoplasmic polyadenylation element-binding proteins (CPEBs) are sequence-specific RNA-binding proteins and regulate translation in various tissues. All four CPEBs in vertebrates are expressed in the brain, including the hippocampal neurons, suggesting their potential roles in translation-dependent plasticity and memory. Although CPEB1 and CPEB3 have been shown to control specific kinds of hippocampus-related LTM, the role of CPEB2 and CPEB4 in learning and memory remains elusive. Thus, we generated CPEB4 knockout (KO) mice and analyzed them using several behavioral tests. No difference was found in the anxiety level, motor coordination, hippocampus-dependent learning and memory between the KO mice and their wild-type (WT) littermates. Electrophysiological recordings of multiple forms of synaptic plasticity in the Schaffer collateral pathway-CA1 neurons also showed normal responses in the KO hippocampal slices. Morphological analyses revealed that the CPEB4-lacking pyramidal neurons possessed slightly elongated dendritic spines. Unlike its related family members, CPEB1 and CPEB3, CPEB4 seems to be dispensable for hippocampus-dependent plasticity, learning and memory.

Toc34 is a member of the outer membrane translocon complex that mediates the initial stage of protein import into chloroplasts. Toc34, like most outer membrane proteins, is synthesized in the cytosol at its mature size without a cleavable transit peptide. The majority of outer membrane proteins do not require thermolysin-sensitive components on the chloroplastic surface or ATP for their insertion into the outer membrane. However, different results have been obtained concerning the factors required for Toc34 insertion into the outer membrane. Using an Arabidopsis homologue of pea Toc34, atToc34, we show that the insertion of atToc34 was greatly reduced by thermolysin pretreatment of chloroplasts as assayed either by protease digestion or by alkaline extraction. The insertion was also dependent on the presence of ATP or GTP. A mutant of atToc34 with the GTP-binding domain deleted still required ATP for optimal insertion, indicating that ATP was used by other protein components in the import system. The ATP-supported insertion was observed even in thermolysin-pretreated chloroplasts, suggesting that the protein component responsible for ATP-stimulated insertion is a different protein from the thermolysin-sensitive component that assists atToc34 insertion.