Local Irradiation Modulates the Pharmacokinetics of Metabolites in 5-Fluorouracil—Radiotherapy–Pharmacokinetics Phenomenon

[[abstract]]Background: The effects of radiotherapy (RT) on the pharmacokinetics (PK) of 5-FU and 5-fluoro-5,6-dihydro-uracil (5-FDHU) were investigated by animal experiments. Methods: Whole-pelvis RT with 0.5 and 2 Gy was delivered to Sprague-Dawley rats. 5-FU at 100 mg/kg was intravenously infused 24 h after radiation. The pharmacokinetics of 5-FU and 5-FDHU in the plasma and bile system were calculated. Results: The areas under the concentration versus time curve (AUC) of 5-FU in the plasma were reduced by local irradiation by 23.7% at 0.5 Gy (P < 0.001) and 35.3% at 2 Gy (P < 0.001). The AUCs of 5-FDHU were also reduced by 21.4% at 0.5 Gy (P < 0.001) and 51.5% at 2 Gy (P < 0.001). Irradiation significantly increased the clearance values (CLs) of 5-FU by 30.6% at 0.5 Gy and 50.1% at 2 Gy, respectively. The CLs of 5-FDHU were increased by 27.2% at 0.5 Gy and 106% at 2 Gy. The AUCs of 5-FU in the bile were increased by 36.7% at 0.5 Gy (P < 0.001) and 68.6% at 2 Gy (P = 0.005). The AUCs of 5-FDHU in the bile were increased by 40.3% at 0.5 Gy (P < 0.001) and 248.1% at 2 Gy (P < 0.001). The CLs of 5-FU in the bile were increased by 31.8% at 0.5 Gy and 11.2% at 2 Gy. However, the CLs of 5-FDHU in the bile were decreased by 29.1% at 0.5 Gy and 71.0% at 2 Gy. Conclusion: Both conventional and low-dose irradiation can affect the pharmacokinetics of 5-FU and its metabolite, 5-FDHU. RT plus 5-FU could cause more adverse events than 5-FU alone by increasing the AUC ratio of 5-FU/5-FDHU. Irradiation decreases the AUC of 5-FU in the plasma, which may cause poor clinical outcomes

The preliminary effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life among older people with sarcopenia.

[[abstract]]Background: Studies have shown that sarcopenia easily leads to difficulty moving, disability, and poor quality of life. However, researches on the use of whole-body vibration for older adults with sarcopenia living in institutions have been lacking. Therefore, the main objective of the present study was to investigate the effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life of older adults with sarcopenia living in institutions. Methods: This study adopted a quasi-experimental, single-group, pretest-posttest design. The whole-body vibration intervention was performed over a 3-month period, in which the older adults trained 3 times per week; each training lasted 60 s with a break of 30 s for 10 repetitions. The older adults' skeletal muscle mass index, physical fitness and quality of life before and after the intervention of the whole-body vibration was collected. Concerning the statistical methods adopted, nonparametric method-based tests were employed. Results: According to the results of analysis, after the intervention of the 12-week whole-body vibration, the skeletal muscle mass index (z = - 3.621, p = 0.000), physical fitness on standing on one foot (z = - 2.447, p = 0.014), shoulder-arm flexibility (z = - 3.159, p = 0.002), 8-ft up and go test (z = - 2.692, p = 0.009), hand grip strength (z = - 3.388, p = 0.009), and five repeated sit-to-stand tests (z = - 2.936, p = 0.003), all improved significantly. Furthermore, concerning the quality of life of the older adults in the pretest and posttest, the improvements were statistically significant (z = - 2.533, p = 0.011). Conclusions: The study results showed the effect of whole-body vibration intervention on improving the skeletal muscle mass index, physical fitness, and quality of life of sarcopenic older people living in institutions and could serve as a crucial reference to health care professionals

Effect of resistance training on quality of life in older people with sarcopenic obesity living in long-term care institutions: A quasi-experimental study

[[abstract]]Aims and objectives: To measure the effect of chair resistance training (RT) on the quality of life (QoL) of older long-term care residents with sarcopenic obesity (SO). Background: Sarcopenia combined with obesity, commonly called SO, is considered to be related to health-related QoL. Despite concerns regarding SO-related long-term healthcare issues, intervention studies on SO residents in nursing homes are scant in Taiwan. Design: This research was a quasi-experiment conducted according to the TREND Checklist. A total of 123 older persons were enrolled from six nursing facilities. The RT was implemented between October 2015-March 2016. Method: The intervention group received progressive RT with sandbags/dumbbells twice a week for 3 months, whereas the comparison group received the usual care. QoL was the major outcome variable. Data were analysed using chi-square test, Student's t test and generalised estimating equation (GEE). Results: The various definition criteria for SO can influence the results of QoL in the older persons. From the body composition perspective, in the GEE analysis, the SO cut-off points for neither skeletal muscle mass percentage (SMMp) nor appendicular skeletal muscle mass index demonstrated significant between-group differences in the QoL variable after the 3-month RT intervention. Between-group analysis revealed a significant effect of time on anxiety/depression [Exp(B): 0.41, 95% confidence interval: 0.18-0.93, p-value < .05] in participants who met all three criteria of the definition of SO (low SMMp, low handgrip strength, and obesity). RT was one of the protective factors. Conclusion: In the SO group, the effect of muscle strength on QoL is greater than the effect of changes in body composition after RT. Relevance to clinical practice: This study analysed the influence of RT on QoL in subjects with different categories of SO. RT is one of the ways to promote QoL among the SO population. ClinicalTrials.gov Identifier: NCT02912338

Preoperative disability and its influencing factors in patients with lumbar spondylolisthesis

[[abstract]]Background: Patients with lumbar spondylolisthesis typically suffer from symptom discomfort and various degrees of disability for months or years prior to receiving surgical treatments. Knowing the factors that influence the disability status of these patients will help healthcare providers develop effective preventive measures. Purpose: To explore preoperative disability and its important predictive factors in patients with lumbar spondylolisthesis. Methods: A predictive correlational design was used and a convenience sample of eighty-six lumbar spondylolisthesis preoperative patients were recruited from a medical center in northern Taiwan. Data were collected using a study questionnaire, which included the Oswestry disability index, the revised geriatric depression scale-short form, and a pain numeric rating scale. Results: The average disability index of the participants was 48.52 (SD = 16.14). The multiple linear regression analyses identified lower back pain, depression, age, and gender as significant predictors of preoperative disability, collectively explaining 40.9% of the variation in disability severity. Being female, being older, having a higher degree of lower back pain, and having depression were significantly associated with preoperative disability. Conclusions / implications for practice: The results of the present study indicate that lumbar spondylolisthesis patients who are older in age, female, currently experiencing lower back pain, and suffering from depression face a higher risk of preoperative disability. Patients in these at-risk categories should be assessed actively and provided with appropriate patient education in order to enhance their quality of life

Biofeedback relaxation for pain associated with continuous passive motion in Taiwanese patients after total knee arthroplasty

[[abstract]]Effective pain management is crucial for patient recovery after total knee arthroplasty (TKA). Biofeedback therapy, which encourages relaxation and helps alleviate various conditions associated with stress, may help to decrease postoperative pain in patients undergoing TKA. A quasi- experimental design was used to investigate the efficacy of a biofeedback relaxation intervention in reducing pain associated with postoperative continuous passive motion (CPM) therapy. Sixty-six patients admitted to a general hospital in Taiwan for TKA were recruited and randomly assigned to the intervention or control group. The intervention group received biofeedback training twice daily for 5 days, concurrent with CPM therapy, whereas the control group did not receive the biofeedback intervention. Pain was measured using a numeric rating scale before and after each CPM therapy session on postoperative days 1 through 5. The CPM-elicited pain score was calculated by subtracting the pre-CPM pain score from the post-CPM pain score. Results of repeated-measures analysis of variance showed intervention group reported significantly less pain caused by CPM than did the control group (f = 29.70, p < 0.001). The study results provide preliminary support for biofeedback relaxation, a non-invasive and non-pharmacological intervention, as a complementary treatment option for pain management in this population

Disease knowledge, self-efficacy and quality of life in patient with hypertensive nephropathy

[[abstract]]The purpose of this study is to investigate the relationships among disease knowledge, self-efficacy, and quality of life in patients with hypertensive nephropathy. A cross-sectional and correlational design is employed in this study, and a total of 213 participants are collected by convenience sampling from the outpatient Department of Nephrology of a regional teaching hospital in Taiwan. The research instruments include the Hypertensive Nephropathy Knowledge Instrument, the Chronic Kidney Disease Self-Efficacy Instrument, and the Medical Outcome Study Short Form-12, and stepwise multiple regression analysis is used to test the explanatory power of each significantly-correlated independent variable regarding the quality of life. The results show that the higher the disease knowledge, the better the self-efficacy, and the better the quality of life, and self-efficacy is the most important predictor of the quality of life

Resilience in Stroke Patients: A Concept Analysis

[[abstract]](1) Background: Resilience enables individuals to develop positive coping strategies when faced with adversity. However, knowledge on resilience in stroke patients remains limited, and resilience assessment methods continue to be debated. (2) Aim: To perform a concept analysis of resilience in stroke patients. (3) Methods: The Walker and Avant approach to concept analysis was adopted. Searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Chinese Electronic Periodical Services (CEPS) databases and grey literature using the keywords "stroke patient", "resilience", and "concept analysis". (4) Results: The defining attributes of resilience in stroke patients were classified into internal personality traits and external environmental support. Antecedents included physical, mental, and familial and social impairments caused by the disease, and the consequences were good adaptation, which included active cooperation with rehabilitation activities, positive thinking, goal setting, and harboring hope for the future. (5) Conclusion: Resilience is of a diverse and complex nature. Optimism and positivity, problem-solving ability, and familial and social support may assist in re-adjusting or restoring the balance between physical and mental health when a stroke patient faces adversity. Key factors affecting resilience in stroke patients should be further investigated in future research to assist in the development of effective interventional treatment measures

Concerns about pain and prescribed opioids in Taiwanese oncology outpatients

[[abstract]]Pharmacologic agents are considered to be a cornerstone of cancer pain management. Patients' concerns about use of analgesics are likely to lead to poor pain management. The purpose of this study was to describe participants' responses to their beliefs regarding pain and prescribed opioids. Ninety-two outpatients age ≥18 years who had taken prescribed opioid analgesics for cancer-related pain in two teaching hospitals in the Taipei area completed the Pain Opioid Analgesics Beliefs Scale-Cancer. An important finding of this study is that large numbers of patients had misconceptions about using opioids for pain. Between 33.7% and 68.5% of the patients in this study held negative beliefs about opioids and beliefs about pain. Specifically, 68.5% of the patients agreed that "opioid medication is not good for a person's body." Many patients (62%) agreed that "the more opioid medicine a patient used, the greater the possibility that he/she might rely on the medicine forever," and 61.0% agreed that "if a patient starts to use opioid medicine at too early a stage, the medicine will have less of an effect later." Two-thirds (66.3%) of the sample agreed that adult patients should not use opioid medicine frequently. The findings provide empirical support for the need for better programmatic efforts to improve beliefs of pain and analgesics in Taiwanese oncology outpatients

[[alternative]]The effects of urban-rural differences on palliative care use and home death among cancer patients

[[abstract]]背景：癌症為臺灣十大死因之首，癌症病人安寧療護使用及在宅死亡被認為是生命末期的品質指標，了解城鄉差異有助於衛生主管機關作為醫療資源分配與提升癌症病人醫療照護品質之參考依據。目的：探討臺灣近十年來，城鄉差異對癌症病人安寧療護使用及在宅死亡的影響。方法：本研究使用衛生福利部衛生福利資料科學中心之全民健康保險資料庫，以17,091位2011年至2020年死亡之癌症病人為研究對象，首先將各變項分為城市和鄉村以次數、百分比等描述性統計方式呈現其分佈情形，再以卡方檢定探討各類別變項間的差異，並採用簡單邏輯斯迴歸、多元邏輯斯迴歸分別探討自變項和控制變項對使用安寧療護和在宅死亡之影響。本研究將顯著水準(α level)設定為0.05，使用SAS 9.4統計套裝軟體進行資料處理及統計分析。結果：本研究之研究對象共17,091位，城市有11,818位，其中使用安寧療護者4,804位(40.65%)，在宅死亡者3,672位(31.07%)，鄉村有5,273位，其中使用安寧療護者2,013位(38.18%)，在宅死亡者3,407位(64.61%)；在使用安寧療護方面，相較於城市的癌症病人，鄉村的癌症病人使用安寧療護的機率顯著較低(AOR=0.919，95% CI：0.859~0.983)，在宅死亡方面，相較於城市的癌症病人，鄉村的癌症病人在宅死亡的機率顯著較高(AOR=4.014，95% CI：3.741~4.306)。結論：本研究發現癌症病人使用安寧療護及在宅死亡皆存在城鄉差異，城市的癌症病人更可能使用安寧療護，鄉村的癌症病人更可能在宅死亡，因此，研擬偏鄉安寧療護相關措施及提升醫療照護品質為衛生主管機關必須重視之任務，此外，臺灣城市之癌症病人多於醫院死亡，和過去研究中醫院死亡的臨終品質較差之論點相異，此現象值得主管機關深究。[[abstract]]Background:Cancer is the number one cause of death in Taiwan. The use of palliative care and dying at home among cancer patients is considered a quality indicator for end-of-life care. Understanding the differences between urban and rural areas is helpful for health authorities as a reference for allocating medical resources and enhancing the quality of healthcare for cancer patients.Objectives:Examining the impact of urban-rural disparities on the utilization of palliative care and home deaths among cancer patients in Taiwan over the past decade.Methods:This study utilized the National Health Insurance Database from the Health and Welfare Data Science Center to investigate 17,091 cancer patients who passed away between 2011 and 2020. Firstly, descriptive statistics such as frequencies and percentages were employed to present the distribution of various variables, categorized as urban and rural. Subsequently, chi-square tests were conducted to explore the differences between categorical variables. Simple logistic regression and multiple logistic regression analyses were then employed to examine the influence of independent and control variables on the utilization of palliative care and death at home, respectively. The significance level (α level) was set at 0.05, and data processing and statistical analyses were performed using SAS 9.4 statistical software.Results:The study included a total of 17,091 participants, with 11,818 individuals from urban areas. Among them, 4,804 individuals (40.65%) used palliative care, and 3,672 individuals (31.07%) died at home. In the rural areas, there were 5,273 participants, with 2,013 individuals (38.18%) using palliative care, and 3,407 individuals (64.61%) dying at home. Regarding the utilization of palliative care, the likelihood of rural cancer patients using palliative care was significantly lower compared to their urban counterparts (AOR=0.919，95% CI：0.859~0.983). On the other hand, concerning the place of death, the probability of rural cancer patients dying at home was significantly higher compared to urban cancer patients (AOR=4.014，95% CI：3.741~4.306).Conclusions:This study found that there are urban-rural disparities in the use of palliative care and place of death among cancer patients. Urban cancer patients are more likely to utilize palliative care, whereas rural cancer patients are more likely to die at home. Therefore, it is imperative for health authorities to develop measures related to palliative care in remote areas and enhance the quality of medical care. Additionally, in Taiwan, a significant number of cancer patients in urban areas die outside the hospital, which differs from the argument in previous studies that hospital deaths are associated with poorer end-of-life quality. This phenomenon warrants further investigation by the relevant authorities

[[alternative]]The effectiveness of the theory-integrated intervention on medication adherence among community-dwelling persons with schizophrenia

[[abstract]]思覺失調症是一種慢性精神疾病，藥物治療是其重要的治療方式，但高達半數以上的思覺失調症病人無法規則服藥導致精神症狀反覆發作，增加醫療照護成本。計畫行為理論 (Theory of planned behavior) 強調增加個人對欲改變行為的正向態度 (Attitude) 、能覺察他人對他執行行為的規範與期待 (Subject norms) 以及增加個人知覺行為控制力 (Perceived behavior control) ，可以增強欲改變行為的意圖，當其意圖愈高，就愈容易達到行為的改變。而目前較缺乏以完整的理論引導探討社區思覺失調症病人信守服藥，也鮮少針對此群體及照顧者多面向的介入並探討成效，故本研究發展計畫行為理論整合式介入方案並評量其成效。 本研究採用類實驗性兩組重複測量研究設計，探討以計畫行為理論整合式介入方案對社區思覺失調症病人信守服藥之主要成效及精神症狀、再住院率、服藥動機及服藥態度等次要成效。以方便取樣於北部、中部某兩家精神專科醫院為研究地點，接受居家治療之社區思覺失調症病人為研究對象，於民國 110 / 04 / 01 ~ 111 / 08 / 01 以招募符合條件共 75 位，非隨機分派至實驗組 (n = 39 ) 和對照組 (n = 36 ) ，實驗組接受理論整合式介入方案，居家訪視每兩週一次，每次 1 小時，共 12 小時；對照組維持常規居家治療，頻率同實驗組。於介入前、介入6 小時後測（第12週）及介入 12 小時後再測（第24週），介入歷時 6 個月。以信、效度良好之病人自填結構式問卷及培訓護理師以問卷進行資料收集，測量變項有1.個案因素：疾病與治療相關因素（性別、年齡、婚姻、教育程度、整體功能、罹病時間）、服用精神科藥物種類（藥物名稱、劑量）；2.信守服藥；3.精神症狀；4.再住院率；5.服藥動機及6.服藥態度。以IBM SPSS 23.0為統計軟體，運用獨立 t 檢定、卡方檢定及變異數分析檢測兩組基本屬性與疾病特徵之同質性。以重複測量變異數分析 (Repeated measure ANOVA) 分析兩組於信守服藥、精神症狀、再住院率、服藥動機、服藥態度的組間與時間交互作用之成效差異。 研究結果顯示實驗組病人於信守服藥、精神症狀、服藥動機與服藥態度，均隨時間與對照組有顯著差異兩組於研究期間皆無病人再住院。本研究支持以計畫行為理論整合式介入方案，可顯著提升社區思覺失調症病人信守服藥、服藥動機與服藥態度，而兩組隨時間皆能改善精神症狀。本研究結果可促進社區思覺失調症病人及其主要照顧者對服藥的正向態度、病人能感受重要他人支持、並且促進病人可控制因素，進而改善服藥行為。[[abstract]]Schizophrenia, a chronic mental disorder, often necessitates pharmacology therapy as a vital treatment approach. However, more than half of individuals with schizophrenia struggle to adhere to their medication regimen, leading to recurring episodes of psychiatric symptoms and consequent escalating medical expenses. The Theory of Planned Behavior emphasizes the significance of cultivating a positive attitude toward the desired behavioral change, comprehending subject norms and external expectations related to an individual's behavior, and enhancing one's perceived behavior control. This approach enhances the intention to modify behavior, with a stronger intention facilitating smoother behavioral transitions. Currently, there is a dearth of comprehensive theories guiding the exploration of medication adherence among community-based patients with schizophrenia. Moreover, there is a notable scarcity of multifaceted interventions and discussions addressing effective strategies for both patients and caregivers. In light of these gaps, the present study aimed to develop a behavioral theory-integrated intervention program and assess its effectiveness. This study employed a quasi-experimental two-group repeated measures design to investigate the primary effect of a planned behavior theory-integrated intervention on the medication adherence of community-based patients with schizophrenia. The study also assessed the secondary effects of the intervention on psychiatric symptoms, rehospitalization rates, medication motivation, and medication attitude. Convenience sampling was employed to recruit community-based patients diagnosed with schizophrenia and undergoing home care from the two psychiatric hospitals located in northern and central Taiwan that were designated as the study sites for this research. A total of 75 patients meeting the inclusion criteria were enrolled between 04/01/2021 and 08/01/2022. These participants were subsequently divided into the experimental group (n = 39) and the control group (n = 36) through non-random assignment. The experimental group received a theory-integrated intervention, involving home visits once every two weeks, with each visit lasting for one hour, totaling 12 hours over the intervention period. Meanwhile, the control group adhered to their routine home treatment regimen, maintaining a frequency similar to that of the experimental group. Data were collected at three distinct time points: prior to the intervention, 6 hours after the intervention in the 12th week, and 12 hours after the intervention in the 24th week, with the entire intervention spanning a duration of 6 months. Trained nurses used self-administered structured questionnaires with established reliability and validity for data collection. The measured variables encompassed various aspects: (1) personal factors pertinent to the disease and treatment, including gender, age, marital status, education level, overall functional status, and time of confirmed diagnosis, along with specifics about the types of psychiatric medications taken, such as drug names and dosages; (2) medication adherence; (3) psychiatric symptoms; (4) rehospitalization rate; (5) medication motivation; and (6) medication attitude. IBM SPSS 23.0 software was used for statistical analysis. A combination of methods, including independent t-tests, chi-square tests, and analysis of variance, was applied to assess the homogeneity of the fundamental demographics and disease characteristics between the two groups. To explore the differences in medication adherence, psychiatric symptoms, rehospitalization rate, medication motivation, and medication attitude, both the between-group effect and the interaction effect with time were examined using repeated measure ANOVA. The findings of this study revealed significant differences between the participants in the experimental group and those in the control group concerning medication adherence, psychiatric symptoms, medication motivation, and medication attitude over the duration of the study. Notably, no participants from either group required re-hospitalization throughout the study period. These outcomes support the theory-integrated intervention program rooted in the theory of planned behavior, demonstrating its potential to substantially enhance medication adherence, medication motivation, and medication attitude among community-based individuals with schizophrenia. Furthermore, both groups demonstrated progressive improvement in their psychiatric symptoms over time. The implications of this study extend to promoting a positive medication attitude among community-based schizophrenia patients and their primary caregivers, fostering patients' perception of support from significant others, and enhancing factors within their control. It can be concluded that the trialed intervention holds the potential to lead to improvement in medication behavior