[[alternative]]The effectiveness of physiological and psychological

[[abstract]]術後乳癌病患爲防止癌細胞微小轉移，多數會行輔助性化學治療，然而化學治療之副作用帶給病患之威脅，有時甚至超過疾病本身。因此降低乳癌化療病患之生、心理困擾以及合併症之發生，可說是臨床照護上一個重要的課題。氣功療法為我國傳統醫學的一部份，依中醫理論其調身、調心、調息之吐納方式，有調節臟腑、扶正去邪去邪之療病功效。雖然國內外亦有探討有關氣功療法之相關文獻，但實際應用在臨床之探討則非常有限，尤未見應用於乳癌化療照護方面之研究，故本研究目的旨在探討站樁氣功療法於乳癌化療病患之生、心理指標成效。 本研究採用類實驗設計法（Quasi-experimental design）。研究對象取自台北某醫學中心之乳癌化療病患；研究者以方便取樣方式，將個案分為控制組35名及執行站樁氣功療法之實驗組32名，收案時間自92.04.01至93.03.31止，使用工具（症狀困擾量表、心理困擾量表、BECKMAN 血液自動分析儀）經信、效度測定後進行相關之資料收集。其中化療前第一天所測得之生理指標（白血球、血小板、血色素、症狀困擾程度）及心理指標（心理困擾程度）為前測基準值；後續測得的包括化療後第一週（第八天）、第二週（第十五天）、第三週（第二十二天）資料，進行站樁氣功療法成效之比較分析。 相關資料藉敘述性（次數分配、平均值、標準差、百分比）及推論性（T檢定、配對T檢定、卡方檢定、單因子變數分析、重複測量）統計分析後，研究結果為：接受站樁氣功療法之乳癌化療病患，其生理指標中血球指數之白血球平均上升416立方毫米（p>.05），控制組白血球平均下降810立方毫米（p .05）。此外在血紅素方面，實驗組下降0.27mg/dl（p >.05），控制組下降0.43 mg/dl（p .05）。在生理指標症狀困擾方面，實驗組於第三週時困擾程度低於控制組（p .05）。 整體而言，本研究發現站樁氣功療法在乳癌化療病患有其成效；期盼未來於執行各項臨床護理作業之際，能適時將氣功療法引為發展性照護措施之一部份，以提升臨床護理品質及乳癌化療病患之生活品質。[[abstract]]In order to prevent cancer cell micrometastasis after surgery, most breast cancer patients will do supplementary chemotherapy. However, the threat that aftereffect of chemotherapy bring to patient may exceed the disease itself. Therefore, decreasing the physical and metal disturbance of breast cancer patient in chemotherapy and combination occurrence is an important issue to clinical nursing. Chi therapy is part of our traditional medicine, in which the breath guiding for body, mind and breath harmonization has the therapy effect of internal organs correlation, strength buildup and weakness elimination. Although there are some related domestic and abroad archives discussing chi treatment, there are very few in discussion applying to clinical practice, especially the research applying to chemotherapy of breast cancer. Therefore, the purpose of this research is to explore the physiological and psychological index effect by Chan-Chuang chi therapy in chemotherapy patients with breast cancer . This research adopts Quasi-experimental design, in which the research subjects are chemotherapy patients with breast cancer from certain Taipei medical center. By convenience sampling, researcher divided cases into 35 people in control group and 32 in experimental group excising chi treatment. The tools (Symptom Distress Scale; The Symptom Chechlist-90-Revised; BACKMAN blood automatic analyzer) passed reliability and validity tests were used for related data collection. Among them, the physiological index (leukocyte, platelets, hemoglobin, syndrome distress level) and psychological index (psychological distress level) measured by the day before chemotherapy is the basic value of pre-test; and the consequent data measured at first week (the eighth day) after chemotherapy, second week (the fifteenth day), third week (the twenty-second day) as for comparison analysis of Chan-Chuang chi therapy effect. After descriptive (number allocation, average value, standard variance, percentage) and inferential (T test, pair T test, chi square test, ANOVA, repeating measurement) statistics analysis, the research result of related data is: the leukocyte index of experimental group increases 416 cube mm (p >.05) in average, while the leukocyte index of control group decreases 810 cube mm (p .05). From hemoglobin aspect, experimental group decreases 0.27mg/dl (p >.05), while control decreases 0.43 mg/dl (p .05). Concerning the syndrome distress of physiological index, the distress level of experimental group is lower than control group in the third week (p .05). In overall, this research found the effect of Chan-Chuang chi therapy in chemotherapy patients with breast cancer. About the application in nursing in the future, we hope chi therapy could be introduced as part of nursing intervention to promote clinical nursing care quality and the life quality of breast cancer patients in chemotherapy

[[alternative]]Triangulation research on psychological factors and breast cancer patients

[[abstract]]在台灣地區2005年的乳癌發生率逐漸升高已成警惕，好發年齡亦逐漸年輕化。乳癌發生的許多因子當中，心理因子的影響仍是爭論的，探討乳癌之發展與心理因子的關係，面臨了一些研究方法學上的困難，如缺乏標準測量、樣本數少或研究前個案已知為乳癌診斷的干擾等。本研究目的在探討心理因子與乳癌發生之相關性，以及罹患乳癌病人之壓力感受，最終期望發展一份測量初罹患乳癌婦女之壓力感受量表。 本研究第一階段探討心理因子與乳癌發展之關係，採橫斷面研究，以某醫學中心門診為研究場所，接受乳房攝影篩檢前之婦女為研究對象，以壓力、焦慮、憂鬱等量表為工具，進行獨立t檢定,卡方檢定, 皮爾森相關檢定, 邏輯斯複回歸及危險對比值之統計分析。第二階段探討初罹患乳癌婦女之壓力經驗感受，採質性訪談法，了解個案罹癌經驗，並發展一份量表。此階段以乳房外科病房為研究場所，初罹患乳癌術前患者為研究對象，研究工具採半結構式問卷進行深度訪談，以內容分析法進行分析。第三階段之研究設計為問卷發展之信效度檢定，以乳房外科病房為研究場所，初罹患乳癌之術前患者為研究對象，進行內容效度、專家效度、內在一致性信度及探索性因素分析之信效度檢定。 本研究收案時間自2007年10月自2008年4月，共收集1160份乳房攝影篩檢者問卷、20份初罹患乳癌婦女之訪談及125份初罹患乳癌婦女之問卷，研究結果如下：1教育程度與乳癌之風險有相關性2.經教育因子校正後，心理因子(焦慮、憂鬱、壓力)在乳癌風險上為預測因子3.初罹患乳癌婦女從接獲診斷、面對問題、進行調適到接受治療，經驗到害怕癌症、負向情緒、失眠、失去吸引力與社會化之衝擊、生命改變、擔心治療、家人、工作與未來4.新發展量表(Stress of Newly Diagnosed Breast Cancer Scale, SNDBCS)經探索性因素分析產生四個構面：不可預期之感受、不可控制之感受、心理負荷重之感受、挑戰之感受；量表內在一致性信度Cronbach`sα=0.844，與SPSS-10壓力量表之效標效度為r=0.462(p=0.000)，與HADS-14量表之輻合效度焦慮為r=0.566(p=0.000)，憂鬱為r=0.354(p=0.000)。 本研究結果建議醫護理人員應加強重視婦女心理衛生，對於初罹患乳癌婦女之壓力感受應給於適當之護理措施，本研究發展具有信效度之SNDBCS量表，可有效方便的提供醫護人員評估參考。[[abstract]]The growing prevalence rate of breast cancer is alarming. The susceptible age of breast cancer was changed more and more young. Many risk factors are involved with breast cancer, whereas psychological impact of cancer is still a controversial factor to breast cancer. To study the relationship between psychological factors and breast cancer development was faced methodological handicap as lack of standard measurements, few sample or confounders of cases suspicious of their breast cancer diagnosis before research. To overcome a number of research methodological issues, this study aimed to explore the psychological factors associated with breast cancer development, conduct the qualitative research with new diagnosed breast cancer women of their stress experience, and then to develop a stress scale. In Phase I, a cross-sectional design was used to explore the relationship between breast cancer and stress development. Research participants were recruited from the outpatient department of a medical center. Stress, anxiety, and depression data were collected. The t test, Pearson correlation, multiple logistic regressions, odds ratio was used to analyze data. In Phase II, a qualitative method was used to interview newly diagnosed breast cancer women to understand their stress experiences and then develop a questionnaire. Research participants were recruited from the breast surgical ward of a medical center. Before operation, in-depth interview were administered under a semi-structured questionnaire. Content analysis was use to analyze data. In Phase III, a methodological design was used to test reliability and validity of developed questionnaire. The newly diagnosed breast cancer women were recruited from the breast surgical ward of a medical center. Internal consistency reliability, content validity, expert validity, and exploratory factor analysis were test to establish reliability and validity.Cases were sampled form Oct 2008. to April 2009, including 1160 mammography screening women, 20 newly diagnosed breast cancer women interviewed, and 125 newly diagnosed breast cancer women tested by the new questionnaire. Results were: 1) Relationship existed between breast cancer risk and educational levels. 2) After adjusting education, psychological factors served as breast cancer predictors. 3) Newly diagnosed breast cancer women experienced suffering from cancer, adjusting life, facing challenge, being afraid of cancer, negative moods, insomnia, impact on the attractiveness and socialization, life change, and worrying about treatment, families, jobs, and future. To collect information and to choose good reputation hospitals/physicians to build up confidence were also involved. 4) The new stress questionnaire (Stress of Newly Diagnosed Breast Cancer Scale, SNDBCS) was categorized four factors: unpredictable feelings, uncontrollable feelings, overloaded feelings, and challenged feelings. Internal consistency reliability showed Cronbach’s α=0.84, criterion validity showed r=0.46 (p<0.001) with a SPSS-10 stress scale, and r=0.57 (p<0.001) with HADS-14 anxiety, r= 0.35 (p<0.001) with depression scale.This study recommends that psychological health of women should be strengthened. As to women in newly diagnosed breast cancer, professionals should provide adequate interventions depending on the finding of woman’s stress perception and experience. For measuring breast cancer women stress, the SNDBCS with reliability and validity can effectively facilitate the professionals assess reference to breast cancer

[[alternative]]The Application of Qi-Gong Therapy to Health Care

[[abstract]]以中醫結合西醫在臨床上所做之多項研究證實，有其在醫學上相輔相成之療效。就氣功於傳統中醫理論而言，其調心、調身、調息之中國傳統吐納方式，具有調節臟腑、扶正去邪之作用，由國內外相關文獻亦指出，氣功可減輕慢性疼痛，疏緩情緒、增加人體多核球之噬菌細胞之活動力、改善心肺功能、增加視力保健及影響血液生化指數等。有鑒於氣功療法在醫學上有其不可忽視之療效，故本文藉由介紹氣功之概念及其在醫學上之研究，企盼醫護人員於執行醫護措施之際，能結合傳統中醫氣功療法做一科學性的應用；或於未來進行更廣泛之研究，相信在病患照顧的品質更能達到截長補短及整體醫療的目的。[[abstract]]A great number of clinical studies merging traditional Chinese medicine (TCM) and Western medicine have proved the complementary healing effects of qi-gong in medical science. Traditional Chinese respiration exercises help to regulate our mind, body and breathing and coordinate our internal organs, remove toxins and enhance immunity. Domestic and foreign studies indicate that qi-gong can relieve chronic pain, reduce tension, increase activities of phagocytes in coenocytes, improve cardiopulmonary function, improve eyesight, influence the index of blood biochemistry, etc. Due to the obvious healing effects of qi-qong therapy, through introducing qi-gone concepts and related medical research, this paper aims to inspire health care workers to integrate qi-qong therapy into medical treatments and nursing care, or to carry out further studies in order to make good the shortfall in provision of holistic medicine and nursing in the interests of the quality of patient care

輕省科技與數位轉型翻轉長期照護

[[abstract]]本文主要在探討台灣目前長照機構遇到系統設計的問題，如：無法即時掌握照護需求、資訊介面未考量人因設計及無法提供家人科技溝通資訊。並藉由參訪加拿大長照系統標竿學習後，整理具有學習價值的科技設計融入長期照護系統之運用，如UX（user experience）設計思維，回到人的主動式參與的需求，建立更智慧的健康照護模式，提供一站式資訊服務，解決機構整體資料儲存與應用的安全性，發展物聯網設計，把人與人的連結變得簡單快速，崁入照護零距離的概念，提升服務品質與滿意度。這些科技化設計不但可改善工作流程照護模式，也能提供更多臨床決策，另可搭配現代串聯5G的高流量科技，提供更快速即時的資訊傳遞服務、簡化護理工作與提升了護理價值，達到輕省科技目的。本文經整理相關科技發展內容，期能對台灣長照科技發展有所參考與助益

温光敏小麦雄性不育系C49S的育性转换及恢复研究

温光敏小麦雄性不育系Ｃ４９Ｓ的育性转换及恢复研究①王涛张作仕曾秀英李竹林（中国科学院成都生物研究所，成都６１００４１）Ｃ４９Ｓ－８７、Ｃ４９Ｓ８９具有矮秆、早熟、分蘖力强、成穗率高、株型紧凑等优良农艺性状，由于具有育性转换能力，与一般核不育小麦相比..

远程心电图监控之远距照护模式的效果

[[abstract]]目的：分析近年来在某医学中心接受远距照护民众的人口学趋势，以期为未来医疗机构发展远距照护提供参考。方法：本研究收集2013年7月至2018年5月某医学中心参与远距照护的1 621例个案，监测相关数据。结果：服务对象以女性（64.7%)居多；平均年龄（71.0±24.7)岁；以小区筛检的单一疗程使用者居多（69.1%），其次为使用<1年者；个案平均管理时间为4.2个月。服务个案过去的疾病诊断分析以心血管疾病诊断（45%）居多，其他为高血压诊断（35%）。心电图量测方面经由医师判读结果发现，诊断正常心律人次占最多（71.5%），心房颤动（7.2%）次之。有异常值电话关怀1 387人次（24.1%）及定期电话关怀3 787人次（65.9%）。结论：远距照护能成功找出偶发型心房颤动病人，对其防治大有进展。电话关怀功能提醒个案回诊，虽增加门诊次数但可降低住院次数与风险，增加经济效益。未来建议能扩大远距照护保险给付，提升连续性照护与照护质量。 Objective: To analyze the demographic trends of receiving remote care for people in a medical center in recent years, as a reference for the future development of medical institutions. As a result, adopting remote care for the prevention and control of cardiovascular diseases has become a trend, and people's need for such healthcare options has increased. Methods: This study collected data from 1 621 remote care cases monitored by a medical center in Taiwan between July 2013 and May 2018. Results: Most of the case patients were female (n=1 019) and had an average age of 71.0±24.7 years. In addition, most were patients who had undergone a single treatment after community-based screening (69.1%), followed by those who had undergone treatment for <1 year. The average duration of case management was 4.2 months. Most patients had received diagnosis for cardiovascular diseases (n=394; 45%), followed by hypertension (n=308; 35%). Physician interpretation of electrocardiogram readings revealed that the conditions of most of the case patients were diagnosed as normal cardiac rhythm (n=1 315; 71.5%), followed by atrial fibrillation (n=133; 7.2%). The medical center made 1 378 reassurance phone calls (24.1%) to the patients with abnormal values detected and 3 787 regular reassurance phone calls (65.9%) to all patients. Conclusions: The study results determined that remote care effectively assist in identifying patients with sporadic atrial fibrillation for early treatment. Moreover, although reassurance phone calls increase the number of clinical visits by patients, they can also reduce the number of hospital admissions as well as hospital admission risks, thereby yielding economic benefits. This study recommends that the scope of health insurance benefits be extended to remote care to enhance the continuity and quality of care

A Study of the Demographic Factor on the Risk of Breast Cancer

[[abstract]]台灣地區2005年的乳癌發生率逐漸升高，發生率佔女性癌症的第一位，好發年齡亦逐漸年輕化中，這種趨勢對婦女健康已形成重大威脅。過去在探討乳癌相關因子之研究中，會面臨一些方法學上的議題，如研究前婦女已知罹患乳癌而產生之研究誤差。本研究探討乳癌發生之相關人口學因子，採前瞻性研究設計，以某醫學中心門診為研究場所，接受乳房攝影篩檢前之婦女為研究對象，以乳癌相關因子之人口學屬性量表為工具，進行獨立t檢定、卡方檢定、及粗危險勝算比之統計分析。共收集1160份乳房攝影篩檢者問卷，結果發現罹患乳癌婦女之年齡層較國外低，教育程度與乳瘤風險有相關性，其餘因子尚無顯著相關。故建議未來研究應加大樣本數，且醫護人員宜加強重視婦女乳瘤防治之教育與資訊，尤其是對於教育程度較低的婦女族群，以降低可能發生乳癌之風險。 The occurrence of breast cancer in the women in Taiwan has significant increase since 2005. The age of onset of disease is younger than in the past and becomes a significant threat to women's health. This study aimed to probe the correlation between the demographic characteristics and breast cancer development. A cross-sectional, prospective study design was adopted. Women who were scheduled for mammography screening at the clinic of a medical center in Taiwan were included. Data related to the risk of breast cancer were collected by a structured questionnaire. Data were analyzed with independent t-test, Chi-square test, and crude odds ratio. A total of 1,160 samples were completed our survey. The mean age of the onset of breast cancer was lower than that in other countries, and the educational level was closely associated with the incidence of breast cancer. Based on the finding, the recommendations included reinforcement of education on breast cancer prevention and provision of breast cancer-related information, especially those women with lower educational background

草鱼Ⅰ型微卫星标记的发掘及其多态性检测

表达序列标签(EST)是发掘Ⅰ型微卫星标记的重要资源。研究运用生物信息学方法,从草鱼头肾组织3027条EST序列中搜索到322个微卫星位点,占整个EST数据库的10.6%。其中,二核苷酸重复位点151个(46.9%),三核苷酸重复位点137个(42.5%),四、五、六核苷酸重复位点较少;在二核苷酸重复位点中,AC/GT重复位点最为丰富,占二核苷酸重复位点总数的50.3%,AG/CT重复次之,占二核苷酸重复位点总数的40.4%,AT和GC重复较少。10个微卫星位点的多态性检测结果显示,4个位点在草鱼测试群体中呈多态性,多态性位点的平均多态信息含量(PIC)和平均遗传杂合度(H)分别为0.5236和0.5441,其中,2个多态性位点的PIC值大于0.5,呈现高度多态性特征。Ⅰ型微卫星标记将为草鱼遗传连锁图谱构建和QTL分析提供有效的基因分子标记