Effects of aromatherapy with essential oil massage on the sleep quality of critical care nurses: A randomized controlled trial.

The purpose of this study was to explore the effectiveness of an essential oil massage on the sleep quality of the critical care nurses. A randomized controlled trial with single blind was conducted. A total of 112 critical care nurses were recruited. Participants were randomly allocated to either the experimental or control group. Only the experimental group received four sessions consisting of a lavender essential oil massage. The results of this study revealed that the overall subjective sleep quality and objective sleep parameters did not reach a significant difference between the two groups before and after the intervention, but a progressive the subjective sleep quality score reduction was observed in the experimental group. The findings of this study might provide information to critical care nurses who are under high pressure to find the optional alternative way of managing their self-sleep health by employing safe and convenient alternatives through aromatherapy.

[Applying a Sleep Care Bundle to Improve Quality of Sleep in Patients in the Intensive Care Unit].

BACKGROUND & PROBLEMS: Poor sleep quality during hospitalization may lead to post-hospital symptoms and increase readmission rates and mortality. Patients in our intensive care unit (ICU) reported low mean scores on the Richards-Campbell Sleep Questionnaire (RCSQ) during their third and fifth days of hospitalization (49.7 mm and 51.7 mm, respectively). Therefore, a project to improve sleep quality in the ICU was established. PURPOSE: To increase the mean RCSQ score from 51.7 mm to 76.0 mm on the fifth day. The fifth day timeframe was chosen because of the disease conditions of the patients and related clinical-medical factors. RESOLUTIONS: The project team proposed an evidence-based, sleep care bundle that included non-medication pain control, environmental regulation, improvement of the care process, and individualized sleep care. RESULTS: After implementing the bundled intervention, the mean RCSQ score of patients in our ICU increased from 49.7 mm to 55.9 mm on the third day and from 51.7 mm to 80.9 mm on the fifth day. CONCLUSIONS: This application of a sleep care bundle effectively improved the factors affecting sleep disturbance and improved quality of sleep in the patients in our intensive care unit.

Lessons from the MOHW compensation pilot program on birth incidents: First step and looking forward.

OBJECTIVE: In Taiwan, the number of medical disputes and litigation has increased dramatically over the past 20 years. The seriousness of medical disputes continuing grows in clinical practice, especially in obstetricians. This study provided a possible solution to the medical dispute litigation issue. MATERIALS AND METHODS: The Ministry of Health and Welfare (MOHW) compensation program for birth incidents has been implemented since 2012 and it provided pecuniary compensation for mothers, newborns, and fetuses who got injured or died in birth-related medical incidents. We analyzed the amount and distribution of compensation, and assessed the effect of compensation on the number of medical dispute litigation. RESULTS: From 2012 to 2015, a total of 348 applications was received, 322 of which were examined by the committee. Among the examined cases, 278 were approved for compensation. The total amount of compensation had reached 266.16 million NTD (8.32 million USD). For the medical dispute litigation, a dramatic decrease in number was observed after the implementation of this compensation pilot program. CONCLUSION: Prompt compensation provided instant economic and spiritual support for patients and families. Pecuniary compensation could be an alternative choice of justice, which might encourage the injured to receive economic compensation, instead of filing a lawsuit against the physician or hospital institution. As a result, the number of dispute litigation has decreased. This indicates that the compensation program is an efficient way to improve medical dispute litigation difficulties.

Microwave-Assisted Multicomponent Synthesis of Dihydroquinoxalinones on Soluble Polymer Support.

A one-pot and two-step reaction of four components, including aldehydes, Fmoc-protected α-amino acid, isocyanide, and soluble polymer-supported 4-fluoro-3-amino benzoate ester, was developed for an efficient synthesis of dihydroquinoxalinones under microwave irradiation. Fmoc deprotection followed by intramolecular cyclization of the diamide gave a facile access to novel bicyclic quinoxalin-2-ones. On the basis of this approach, a new route to synthesize this privileged scaffold from the diamide intermediate was designed and accomplished with high yields. Use of multicomponent reaction (MCR) has been shown to display a good functional group tolerance, while the product isolation and purification is straightforward by precipitation and washings. Current library discusses the synthesis and diversification of 21 compounds produced using this strategy.

The effects of Tai-Chi in conjunction with thera-band resistance exercise on functional fitness and muscle strength among community-based older people.

AIMS AND OBJECTIVES: The aim of this study was to investigate the effects of Tai-Chi in conjunction with thera-band resistance exercise on functional fitness and muscle strength in community-based older people. BACKGROUND: Tai-Chi is known to improve functional fitness in older people. Tai-Chi is usually performed with free hands without resistance training and usually focuses on training lower limbs. To date, no study has examined the use of Tai-Chi in conjunction with thera-band resistance exercise in this population. DESIGN: Cluster randomised trial design. METHODS: Older people at six senior day care centres in Taiwan were assigned to thera-band resistance exercise or control group using a cluster randomisation. The thera-band resistance exercise group (n = 48) received sixty minute thera-band resistance exercise twice weekly for a period of 16 weeks. The control group (n = 47) underwent routine activities in the day care centre, receiving no Tai-Chi or resistance exercise. RESULTS: After receiving the thera-band resistance exercise, intervention participants displayed a significant increase in muscle strength of upper and lower extremities. Significant improvements were recorded on most measures of the Senior Fitness Test, with the exception of the chair-stand and back-scratch test. CONCLUSION: Thera-band resistance exercise has the potential to improve functional fitness and muscle strength in community-based older people. RELEVANCE TO CLINICAL PRACTICE: Thera-band resistance exercise potentially offers a safe and appropriate form of physical activity that nursing staff can easily incorporate into the daily routine of older people in day care centres, potentially improving functional performance and muscle strength.

Relationships among affective factors and preferred engagement in science-related activities.

This study investigated how affective factors impact participation in science learning using structural equation modeling. Using a dataset from Taiwan, a model was obtained that showed the relationships among science-related interest, enjoyment, self-efficacy, self-concept, competency, leisure time engagement, and future interest in science. The paths relating to engagement and future interest were much stronger for interest and enjoyment than for self-efficacy and self-concept. There was no significant path between science competency and future science interest or engagement. The results suggest that the affective and cognitive pathways to scientific competency are divergent and that they might be differentially activated by different contexts and activities. This indicates that school science educators might wish to reconsider the merit of overemphasizing achievement in comparison to interest. Finally, the results suggest that the development of science competency per se may not be the best way to ensure public engagement and understanding of science.

[A controlled study on the treatment of acute progressive cerebral infarction by continuous anticoagulation with small doses of heparin].

OBJECTIVE: To discuss the treatment of acute progressive cerebral infarction by continuous anticoagulation with small doses of heparin. METHODS: A prospective, randomized, and controlled clinical research was conducted. Three hundred and fifty-one patients were randomly divided into three groups. Group A (n=119) was treated with heparin, which was controlled by an infusion pump with a speed of 18 U×kg(-1)×h(-1) for 24 hours, and the dosage was regulated according to the changes in activated partial thromboplastin time (APTT) which was determined every 8 hours. Group B (n=115) was treated with intravenous drip of 12,500 U of heparin with a speed of 18 U×kg(-1)×h(-1) once a day. Group C (n=117) was treated with 5000 U of low-molecular-weight heparin calcium injection twice a day. After 14 days, nerve function defect according to the National Institutes of Heath stroke scale (NIHSS) score was determined, the adverse events (e.g. intracranial hemorrhage, subcutaneous ecchymosis, gingival bleeding, hematuria and occult blood in stools) were observed. After 6 months, the recurrence rate and Barthel index (BI) would be determined. RESULTS: The total efficiency in group A (95.80%) was significantly higher than that in group B (85.22%) and group C (85.47%). Recurrence rate in group A (1.68%) was significantly lower than group B (8.70%) and group C (8.33%) with significant differences (P<0.05 or P<0.01), while there was no significant difference between group B and group C (both P>0.05). The BI of group A (89.27±8.56) was significantly higher than group B (72.57±9.77) and group C (71.66±9.37) with significant difference (both P<0.01), while there was no significant difference between group B and group C (P>0.05). Adverse event rate in group A (5.88%) was slightly higher than that of group B (3.48%) and group C (4.27%), but the difference was not significant (both P>0.05). CONCLUSIONS: Continuous infusion of low dosage of heparin could significantly reduce neurologic impairment score in patients with progressive cerebral infarction, increase cure rate, reduce the recurrence rate, and raise the BI of patients, and it dose not increase the risk of intracranial and extracranial hemorrhage.

Traceless synthesis of diketopiperazine fused tetrahydro-ß-carbolines on soluble polymer support.

The Pictet-Spengler reaction, using polyethylene glycol immobilized tryptophan ester with a variety of ketones, was achieved by refluxing condition in acidic chloroform. The linear as well as cyclic ketones were employed. All the ketones were reacted within 6-8 h to furnish soluble polymer-supported tetrahydro-ß-carboline in good yields. Further expansion at N-terminus of tetrahydro-ß-carbolines was achieved through a reaction with chloroacetyl chloride. Finally, the 2,5-diketopiperazine skeleton was constructed over a ß-carboline by amination of the resulting N-chloroacetamides and subsequent intramolecular cyclization leading to cleavage of the polymer; constitutes a traceless synthesis of tetracyclic molecular architecture. Significantly, this strategy affords a straightforward and efficient approach for the construction of biological promising molecules with high purity and good yields.

Mediating roles of social support on poststroke depression and quality of life in patients with ischemic stroke.

AIMS: The purposes of this study were to examine the associations among social support, poststroke depression and quality of life among patients with first-time ischemic stroke and to further test the impact of the dimensions of social support on poststroke depression and quality of life. The proposed models included mediation hypotheses to examine the mediating roles of social support. BACKGROUND: Although considerable attention has recently been devoted to explaining why poststroke depression and poor quality of life are frequent concomitants of stroke, little empirical work has been conducted to test predictions based on these models, especially in Taiwan. DESIGN: A cross-sectional, descriptive correlation design was used. METHODS: The 102 patients with first-time ischemic stroke aged 32-90 (mean = 64.5, SD 11.8) were recruited from a large general hospital in Taiwan and through face-to-face survey interviews. The participants were assessed using the Social Support Inventory, Centre for Epidemiologic Studies Depression Scale, Barthel Index, the Instrumental Activities of Daily Living and Quality of Life Index-Stroke Version. The models were tested and confirmed through the application of structural equations with proposed variables. RESULTS: Nearly half of the Taiwanese patients with stroke felt depressed. Social support fully mediated the prediction of quality of life by age and partially mediated the prediction of quality of life by functional ability. Social support partially mediated the prediction of poststroke depression by functional ability. CONCLUSION: This study provides researchers and nurses with increased understanding of the mediating role of social support between functional ability and poststroke depression/quality of life. Social support may be a promising intervening variable in stroke outcome. RELEVANCE TO CLINICAL PRACTICE: The results suggest several clinical implications. The inclusion of social support in poststroke depression and quality of life after stroke may help nurses in planning stroke programme development, patient education, effective and efficient use of health care resources and effective rehabilitation, especially in those individuals who lack support or who are involved in stressful situations.

Diversity-oriented synthesis of angular bis-benzimidazole derivatives under microwave irradiation.

Pharmaceutically interesting, angular bis-benzimidazoles with three appendages have been synthesized successfully through a diversity-oriented approach with soluble support under microwave irradiation. Polymer immobilized o-phenylenediamine was selectively N-acylated with 2-chloro-3-nitrobenzoic acid in a primary aromatic amino moiety. The obtained amide was cyclized to benzimidazole in an acidic condition, and subsequently nucleophilic aromatic substitution with different amines was performed. Successive reduction, cyclization with various aldehydes and activated isothiocyanates yielded angular biheterocyclic benzimidazoles in good quantities. Reaction progress on polymer support was precisely monitored using the conventional proton NMR spectroscopy. Preliminary screening results showed some of these interesting compounds exhibited moderately to good inhibition against vascular endothelial growth factor receptor 3 (VEGFR-3), which is related to invasion and migration of cancer cells.

Lightwand-guided endotracheal intubation performed by the nondominant hand is feasible.

The aim of this study was to evaluate the efficiency of lightwand-guided endotracheal intubation (LWEI) performed using either the right (dominant) or left (nondominant) hand. Two hundred and forty patients aged 21-64 years, with a Mallampati airway classification grade of I-II and undergoing endotracheal intubation under general anesthesia, were enrolled in this randomized and controlled study. Induction of anesthesia was initiated by intravenous administration of fentanyl (2 microg/kg) and thiopentone (5 mg/kg), and tracheal intubation was facilitated by intravenous atracurium (0.5 mg/kg). In the direct-vision laryngoscope group (group D; n = 80), the intubator held the laryngoscope in the left hand and inserted the endotracheal tube (ETT) into the glottic opening with the right hand. In the group in which LWEI was performed with the right hand (group R; n = 80), the intubator lifted the patients' jaws with the left hand and inserted the ETT-LW unit into the glottic openings with the right hand. On the contrary, in the group in which LWEI was performed with the left hand (group L; n = 80), the intubator lifted the jaws with the right hand and inserted the ETT-LW unit with the left hand. Data including total intubation time, the number of intubation attempts, hemodynamic changes during intubation, and side effects following intubation, were collected. Regardless of whether lightwand manipulation was performed with the left hand (group L; 11.4 +/- 9.3 s) or the right-hand (group R; 12.4 +/- 9.2 s), less time was consumed in the LWEI groups than in the laryngoscope group (group D; 17.9 +/- 9.9 s) (p < 0.001). All three groups obtained success rates greater than 95% on their first intubation attempts. The changes in mean arterial blood pressure and heart rate were similar among the three groups. A higher incidence of intubation-related oral injury and ventricular premature contractions (VPC) was found in group D compared with groups L and R (oral injury: group D 8.5%, group L 1.3%, group R 0%, p = 0.005; VPC: group D 16.3%, group L 5%, group R 7.5%, p = 0.04). We concluded that LWEI performed by either dominant or nondominant hands resulted in similar efficiency, and could be a suitable alternative to traditional laryngoscopy. It is both feasible and logical for an experienced anesthesiologist to use the nondominant hand to perform LWEI.

[The HPLC fingerprint analysis of Fructus citri].

OBJECTIVE: To study and establish the fingerprint of raw Fructus Citri by phased high performance liquid chromatography. METHOD: The chromatographic conditions were as follows: a Kromasil C18 column was used; the mobile phase was composed of methanol and acetic-water(3.1:100, v/v) with gradient elution; the flow rate was 1.0 ml/min and the UV absorbance detection was set at 284 nm. RESULT: Under the selected chromatographic conditions, good HPLC fingerprints of Fructus Citri were obtained. CONCLUSION: Quality of raw Fructus Citri can be controlled effectively by HPLC fingerprint.

Copper halide-bridged ruthenium telluride carbonyl complexes: discovery of the semiconducting cluster chain polymer {[PPh4]2[Te2Ru4(CO)10Cu4Br2Cl2].THF}infinity.

A new series of Te-Ru-Cu carbonyl complexes was prepared by the reaction of K(2)TeO(3) with [Ru(3)(CO)(12)] in MeOH followed by treatment with PPh(4)X (X=Br, Cl) and [Cu(MeCN)(4)]BF(4) or CuX (X=Br, Cl) in MeCN. When the reaction mixture of K(2)TeO(3) and [Ru(3)(CO)(12)] was first treated with PPh(4)X followed by the addition of [Cu(MeCN)(4)]BF(4), doubly CuX-bridged Te(2)Ru(4)-based octahedral clusters [PPh(4)](2)[Te(2)Ru(4)(CO)(10)Cu(2)X(2)] (X=Br, [PPh(4)](2)[1]; X=Cl, [PPh(4)](2)[2]) were obtained. When the reaction mixture of K(2)TeO(3) and [Ru(3)(CO)(12)] was treated with PPh(4)X (X=Br, Cl) followed by the addition of CuX (X=Br, Cl), three different types of CuX-bridged Te-Ru carbonyl clusters were obtained. While the addition of PPh(4)Br or PPh(4)Cl followed by CuBr produced the doubly CuBr-bridged cluster 1, the addition of PPh(4)Cl followed by CuCl led to the formation of the Cu(4)Cl(2)-bridged bis-TeRu(5)-based octahedral cluster compound [PPh(4)](2)[{TeRu(5)(CO)(14)}(2)Cu(4)Cl(2)] ([PPh(4)](2)[3]). On the other hand, when the reaction mixture of K(2)TeO(3) and [Ru(3)(CO)(12)] was treated with PPh(4)Br followed by the addition of CuCl, the Cu(Br)CuCl-bridged Te(2)Ru(4)-based octahedral cluster chain polymer {[PPh(4)](2)(Te(2)Ru(4)(CO)(10)Cu(4)Br(2)Cl(2)).THF}(infinity) ({[PPh(4)](2)[4].THF}(infinity)) was produced. The chain polymer {[PPh(4)](2)[4].THF}(infinity) is the first ternary Te-Ru-Cu cluster and shows semiconducting behavior with a small energy gap of about 0.37 eV. It can be rationalized as resulting from aggregation of doubly CuX-bridged clusters 1 and 2 with two equivalents of CuCl or CuBr, respectively. The nature of clusters 1-4 and the formation and semiconducting properties of the polymer of 4 were further examined by molecular orbital calculations at the B3LYP level of density functional theory.

Coat color-tagged green mouse with EGFP expressed from the RNA polymerase II promoter.

Laborious molecular genotyping and variegated gene expression are two widely encountered issues for transgenic mouse studies. To facilitate genotyping in the FVB/N albino background and to reduce variegated expression, we successfully generated double-tagged transgenic mice for direct visual genotyping with the coat color phenotype derived from tyrosinase cDNA driven by the tyrosinase promoter and with simultaneous high enhanced green fluorescent protein (EGFP) expression driven by the promoter of RNA polymerase II large subunit gene. Incorporation of insulator into a transgene construct achieved high efficiency of transgene expression in more than 90% of the founders. EGFP was detected as early as the one-cell fertilized egg and lasted for the whole embryo development, as well as in all of the adult tissues examined. The coat color-tagged green mice offer opportunities in applications such as tissue transplantation, lineage tracing, chimera biology, RNA interference, and other transgenic studies.