Configuring the Professional Touch in Physical Examinations in Chinese Outpatient Clinical Interaction: Talk, Touch, Professional Vision, and Intersubjectivity.

Touch is a fundamental resource mobilized by clinicians in physical examinations in outpatient clinical consultations. However, few studies have been conducted to explore the sequential organization of touch in the interactional process of physical examinations where clinicians' touch is launched and responded to in Chinese medical settings. Based on a collection of video recordings of naturally occurring clinician-patient interaction in an orthopedic outpatient clinic in China, we observed four types of clinicians' touch in the physical examination framework: the guiding touch, the diagnostic touch, the demonstrative touch, and the therapeutic touch. Together with clinical expertise, the sensorial knowledge obtained through touch enables clinicians to professionally evaluate patients' physical conditions and diagnose their illnesses. We also demonstrated that patients do not merely put themselves into clinicians' hands as clinical objects for inspection and defer to clinicians' medical authority. Instead, they actively and agentively participate in physical examinations to jointly accomplish social actions and activities through the temporal and sequential mobilization of their multimodal resources. This study not only adds to an emerging body of research on touch in medical settings but also sheds some light on the understanding of the clinician-patient interaction in Chinese outpatient clinics.

Companions' contributions to information gathering in Chinese outpatient clinical interaction.

Patients are commonly accompanied to visit clinicians in Chinese outpatient clinics. Although there has been extensive research on the roles of companions in asymmetric interactions within medical settings, there is a paucity of conversation analytic studies that examine the active participation and contributions of companions on an equal footing in medical consultations. How companions on an equal footing participate and contribute in Chinese outpatient clinical consultations remains under-explored. By employing video recordings of three-party consultations in the Chinese orthopaedic outpatient clinic as the data and adopting conversation analysis as the method, this study investigated how companions participated in and contributed to the information-gathering activity and how their contributions were interactionally negotiated and managed by clinicians and adult patients over sequences of interaction. We showed that companions negotiated epistemic rights in reporting and repairing the information about medical problems in the patients' epistemic domain and displayed different levels of encroachment on patients' epistemic rights by endorsing patients' responses, repairing the information in patients' responses, and offering information directly to clinicians. Companions also exerted deontic authority and shaped the trajectory of the consultations by hindering or facilitating the progressivity of the interaction. We argued that companions' contributions to the information-gathering activity might reflect the family-centred model of the doctor-patient relationship in the Chinese orthopaedic outpatient clinic. Clinicians are suggested to open up opportunities for companions' participation and contributions while respecting patients' rights, especially when there is a collision of knowledge claims between patients and their companions.

Companion responses to diagnosis in Chinese outpatient clinical interaction.

Patients regularly attend clinical consultations with companions in Chinese outpatient clinics. Despite companions' significant influence on clinical consultations, how companions respond to diagnosis and their contributions to the activity of diagnosis in Chinese outpatient clinical interaction remain under-researched. The present study, by adopting the method of conversation analysis, investigated clinicians' diagnostic deliveries and companions' subsequent responses in Chinese outpatient clinical interaction. The data for this study consisted of 79 video recordings of clinical consultations in the Chinese orthopedic outpatient clinic, approximately lasting 12 h and involving three male clinicians, 79 patients (37 male/42 female), and 91 companions (51 male/40 female). Three basic categories of companion responses to diagnosis were identified: minimal verbal responses, embodied responses, and extended responses. It was demonstrated that these distinct responses allowed companions to challenge clinicians' medical authority in the activity of diagnosis by delivering their own diagnostic judgments, resisting clinicians' diagnoses, and orienting to clinicians' accounts for their diagnostic statements and reasoning, thus displaying companion agency in the Chinese outpatient clinical decision-making and indicating a transition from a paternalistic model to a family-centered model of the doctor-patient relationship in the Chinese orthopedic outpatient interaction. This study furthers current knowledge of companion involvement across healthcare contexts and contributes to raising clinicians' awareness of the significance of companions' contributions in Chinese outpatient clinical interaction.

Seeking medical services through guanxi in China.

OBJECTIVE: Seeking access to medical services through social networks and personal relationships, referred to as 'guanxi', is a common phenomenon in China. This study aims to use a qualitative methodology to examine the experiences and perceptions of patients using guanxi in seeking medical services in China. METHODS: A semi-structured, face-to-face interview was conducted with eleven participants who had the experiences of using guanxi in seeking medical services. An inductive content analysis was employed to explore the themes and subthemes of these interviews. RESULTS: Five themes were generated: (1) underlying systemic context, (2) reasons for utilizing guanxi, (3) personal practices, (4) personal attitudes towards guanxi in healthcare seeking, (5) suggested solutions. CONCLUSIONS: Seeking medical services through guanxi exerts a negative influence on the doctor-patient relationship in China. This study uncovered a range of factors unidentified in the previous studies, which may have been important in helping to understand the social phenomenon of seeking medical services through guanxi in China. Further research needs to be conducted to explore measures that could reduce the disharmonious doctor-patient relationship caused by the social phenomenon of seeking medical services through guanxi. PRACTICE IMPLICATIONS: We recommend that doctors need to improve their communication skills, and pay more attention to the patient's biopsychosocial care; (2) hospitals should supervise doctors to treat patients in strict accordance with medical procedures; (3)government should implement healthcare reforms to provide affordable and reliable medical care services.

Secoisolariciresinol Diglucoside Exerts Anti-Inflammatory and Antiapoptotic Effects through Inhibiting the Akt/IκB/NF-κB Pathway on Human Umbilical Vein Endothelial Cells.

Inflammation is a key regulator in the progression of atherosclerosis (AS) which extremely affects people's health. Secoisolariciresinol diglucoside (SDG), a plant lignan, is relevant to angiogenesis and cardioprotection against ischemia-reperfusion injury and improves vascular disorders. However, the effect of SDG on cardiovascular disorder is not clear. In the present study, we aimed to investigate the effects of SDG on lipopolysaccharide- (LPS-) stimulated Human Umbilical Vein Endothelial Cells (HUVECs) and elucidate the underlying mechanism. The LPS-stimulated HUVEC cellular model was established. The cell viability, the cell tube formation activity, the nitric oxide (NO) release, the levels of inflammatory cytokine interleukin-1ß (IL-1ß), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), the activation of nuclear factor kappa-B (NF-κB) pathway, and the expression of protein kinase B (Akt) were determined using Cell Counting Kit-8, cell tube-formation assay, western blotting, and enzyme-linked immunosorbent assay. Our results revealed that SDG reduces the angiogenic capacity of HUVECs and inhibited LPS-mediated HUVEC injury and apoptosis. In addition, SDG increased NO release and decreased the levels of IL-1ß, IL-6, and TNF-α in LPS-treated HUVECs. Meanwhile, SDG inhibited the NF-κB pathway and downregulated Akt expression in LPS-induced HUVECs. Our results indicated that SDG relieves LPS-mediated HUVEC injury by inhibiting the NF-κB pathway which is partly dependent on the disruption of Akt activation. Therefore, SDG exerts its cytoprotective effects in the context of LPS-treated HUVECs via regulation of the Akt/IκB/NF-κB pathway and may be a potential treatment drug for cardiovascular disease.

Lived Experiences of Novice Male Nurses in Taiwan.

PURPOSE: Nursing remains a female-dominated profession around the world. The masculinity and male identity of men who choose nursing careers is questioned by the general public in many countries. Few studies report the situation of novice male nurses at their first year. The purpose of this study was to explore the lived experience of novice male nurses when they first enter the workplace. DESIGN AND METHOD: A qualitative descriptive study was conducted using purposive and snowball sampling for recruitment. Fourteen participants, 21 to 25 years old, were recruited, all of whom had at least 5 months of work experience. On average, in-depth, face-to-face interviews lasted 1 hour, with more than one follow-up telephone interview per participant. FINDINGS: The following six themes emerged from the transcribed verbatim data based on content analysis: choosing appropriate work departments based on personality and needs, facing the pressure and frustration of independent work, getting help, obtaining acceptance among female cliques, reflecting on the relationship between gender and profession, and concerns about dependents and financial needs. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study addresses masculinity issues and gender stereotyping. In addition, male nurses were very concerned about their career options and development and the likelihood of promotion. This research not only has implications for better understanding of novice male nurses' needs and the challenges in their social life but also makes suggestions for nursing practice to attract and keep more male nurses in the nursing profession. The results illustrate how culturally congruent nursing care can be achieved when we more concern male nurses' role pressure and address traditional gender sensitivity to promote male nurses' career development.

Rebuilding Life: Investigating the Long-Term Homecare Needs of Clients With Spinal Cord Injuries.

BACKGROUND: Clients with a spinal cord injury (SCI) must learn to manage their disabilities and may never be able to resume their previous lifestyle. Therefore, receiving relevant information and support from care practitioners and institutions is essential for clients with long-term SCI. PURPOSE: This study investigated the long-term homecare needs of clients with SCIs. METHODS: A qualitative approach was used in this study. Data were collected from March to May 2013. Four SCI associations were selected using purposive sampling, and four focus group interviews were conducted in Northern, Central, Southern, and Eastern Taiwan. Each focus group was composed of 7-12 participants. In-depth interviews (1.5-2.5 hours) were conducted. A content analysis method was adopted for data analysis. RESULTS: Thirty-eight participants took part in the study. The long-term care needs of clients with SCI require the following dynamic processes for rebuilding their lives: physical care and complication prevention, life planning, social support, discovery of the value of existence, and sexual satisfaction. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results reveal the long-term care needs of clients with SCI. Nurses are expected to provide client-centered care, emphasize prevention rather than treatment of complications, initiate life planning at the early stages of a client's rehabilitation, enhance a client's social support, encourage a client's search for companionship and search for the value of existence and a life purpose, and be attentive to the sexual concerns of people with physical disabilities.

Push and pull: Exposure of young Taiwanese women to sexually explicit materials.

This study was designed to understand young Taiwanese women's perception of sexually explicit materials (SEMs). Researchers conducted six focus group discussions with 38 young women between the ages of 18 and 22 in Taiwan in 2009-2010 and used content analysis to analyze the data based on the push-pull theory. The results showed that the exposure of young women to SEMs was a sexual exploration process from no sexual activity to future sexual activity. This process was affected by the interactions of three powers: push power, pull power, and personal factors. The push power included factors, such as parents and social values, which failed to satisfy their sexual curiosity and provide them with autonomy. The pull power included SEMs and peer influence, which increased sexual arousal stimuli and curiosity to try sexual activity. The most important personal factors were young women's growth, including sexual curiosity, cognition of SEMs, and gender equity in freedom to make sexual decisions. Understanding this push-pull process regarding SEM can help health-care providers with their own discourses in addressing sex and influence young women's participation in desired, protected, and enjoyable sex when sufficiently ready.

The expression and correlation of SIRT1 and Phospho-SIRT1 in colorectal cancer.

SIRT1 is the homologue of sir2 in mammals, which is a nicotinamide adenine dinucleotide (NAD(+)) dependent histone deacetylase. SIRT1 is involved in many physiological processes, such as metabolism, senescence, inflammatory response, neuroprotection, and tumorigenesis by acetylating histones and multiple transcription factors. However, the exact role of SIRT1 in tumor is still under controversial. Immunohistochemistry and Western blot were performed to investigate the expressions and subcellular localizations of SIRT1 and Phospho-SIRT1 in colorectal cancer tissues and adjacent normal tissues. The relationship between SIRT1 or Phospho-SIRT1 and clinicopathological characteristics was also analyzed. Real-Time PCR was performed to investigate the transcriptional level of SIRT1 mRNA in colorectal cancer tissues and adjacent normal tissues. SIRT1 and Phospho-SIRT1 were both localized in the nucleus. The expressions of SIRT1 and Phospho-SIRT1 were higher in colorectal cancer tissues than normal tissues. SIRT1 expression in cancer tissues was associated with patient age, TNM stage and mutant P53 loss. Phospho-SIRT1 expression in cancer tissues was associated with Ki67. SIRT1 and Phospho-SIRT1 were highly correlated in cancer tissues and normal tissues. The ratios of Phospho-SIRT1 and SIRT1 expression in cancer tissues were higher than normal tissues. SIRT1 mRNA level was no significant difference in cancer tissues and normal tissues. SIRT1 have a dual character in colorectal cancer, and Phospho-SIRT1 may determine the role of SIRT1 in colorectal cancer formation.

Evaluation of super-link system theory for spinal cord injury patients using participatory action research in a rehabilitation hospital.

PURPOSE: The purpose of this study was to integrate and evaluate the spinal cord injury rehabilitation nursing theory named Super-Link System Theory using participatory action research. METHOD: Data were collected from October 2007 to September 2008 in a rehabilitation hospital by means of interviews, participant observations, documentary resources, case conferences and reports, and participants' self-reflective inquiries. The Super-Link System Theory was introduced to 31 rehabilitation nurses. The nurses selected a key reference group including the researcher to facilitate the participatory action research process to implement and evaluate the theory. Data were analyzed using content analysis. RESULTS: The findings shows that several key concepts were clarified and specific nursing interventions were identified. Furthermore, an integrated link system from the hospital to the community through both rehabilitation nurses and discharge planners was established. CONCLUSION: The study demonstrated an evidence base for an evolving theory of care, and empowered nurses to make sustainable changes to their practice.