Comparing Cancer Risks and Mortality between Phytopharmaceuticals and Estrogen-Progestogen Medications for Menopausal Women: A Population-Based Cohort Study.

We evaluated the long-term risks of overall cancer and all-cause mortality associated with five types of phytopharmaceuticals and the most commonly used estrogen-progestogen medications for the treatment of postmenopausal syndrome in women. Using data from Taiwan's National Health Insurance Research Database (NHIRD) from 1 January 2000 to 31 December 2018, we conducted a 1:2 matched cohort study with 12,087 eligible patients. We compared phytopharmaceuticals -only users (n = 4029, phytopharmaceuticals group) with HRT-only users (n = 8058, HRT group) with a washout period of ≥6 months. The phytopharmaceuticals group had significantly lower risks of overall cancer and all-cause mortality than the HRT group (adjusted hazard ratio [95% confidence interval]: 0.60 [0.40-0.9] and 0.40 [0.16-0.99], respectively) after over 180 days of use. Bupleurum and Peony Formula were associated with lower risks of overall cancer and all-cause mortality (aHR: 0.57 [0.36-0.92] and 0.33 [0.11-1.05], respectively). In conclusion, phytopharmaceuticals may serve as an alternative therapy to HRT for alleviating menopausal symptoms and reducing health risks, leading to more favorable long-term health outcomes. Further randomized control trials are necessary to validate the findings of this study.

Design of Dual-Configuration Dual-Mode Stimulator in Low-Voltage CMOS Process for Neuro-Modulation.

A dual-configuration dual-mode stimulator for neuro-modulation is proposed and designed. All the electrical stimulation patterns that frequently used for neuro-modulation can be generated by the proposed stimulator chip. Dual-configuration represents the bipolar or monopolar structure, meanwhile dual-mode stands for the current or voltage output. No matter what stimulation circumstance is chosen, biphasic or monophasic waveforms can be fully supported by the proposed stimulator chip. The stimulator chip with 4 stimulation channels has been fabricated in 0.18-µm 1.8-V/3.3-V low-voltage CMOS process with common grounded p-type substrate, which is suitable for SoC integration. The design has conquered the overstress and reliability issues in the low-voltage transistors under the negative voltage power domain. Each channel in the stimulator chip only occupies the silicon area of 0.052 mm2, and the maximum output level of stimulus amplitude is up to ±3.6 mA and ±3.6 V. With the built-in discharge function, bio-safety concern of unbalanced charge in neuro-stimulation can be dealt with properly. Moreover, the proposed stimulator chip has been applied on both imitation measurement and in-vivo animal test successfully.

[Nursing Digital Transformation: An Example of an Electronic Whiteboard in a Regional Hospital in Central Taiwan].

The electronic whiteboard system is an important part of smart medical care. This system has been digitized and upgraded gradually over time, and now functions as a dashboard, incorporating sound effects, touch control, image display, face recognition, and other functions that maximize usage efficiency. In hospitals, electronic whiteboards are specialized for dedicated use in one of two areas: nursing stations and wards. Those used in nursing stations may upload data into the medical information system based on departmental and institutional requirements. Systems are built to the specific needs of different clinical departments and thus differ widely in terms of settings and functionality. Therefore, hospitals should promote regular communication among doctors, nurses, and patients.

Simplifying and Testing the Psychometric Psychiatric Patients' Fall Risk Scale: An Analysis of One-Year Admissions.

This study aimed to simplify the number of items evaluated by fall risk assessment scales for psychiatric patients, conduct associated reliability, validity, and receiver operating characteristic analyses, and determine fall predictors for psychiatric patients. This methodological study was conducted in a hospital specializing in psychiatry, using data from 1101 patients who were hospitalized in 2018. This fall risk assessment scale was modified by the hospital for use in psychiatric patients. The mean age of the sample population was 44.88 (SD = 12.05) years, and the mean duration of hospital stay was 44.04 (SD = 48.14) days. Men comprised 66% of the study population, and women were 34%. Item reduction, psychometric testing for validity and reliability, and receiver operating characteristic analyses were conducted. Logistic regressions were used to analyze fall predictors, including "having anti-epileptic drugs", "need for walking aids", and "having experienced fall occurrence within one year". This study successfully reduced the number of items assessed by the previous scale. The optimal cutoff point was reduced, and the sensitivity and accuracy of the newly revised scale were good. Three fall predictors for psychiatric patients were identified. The revised scale can facilitate the rapid and accurate identification of high-risk, fall-prone psychiatric patients by psychiatric nurses. Hospital information screening should include each patient's fall history.

Monopolar Biphasic Stimulator With Discharge Function and Negative Level Shifter for Neuromodulation SoC Integration in Low-Voltage CMOS Process.

A 16-channel monopolar biphasic stimulator chip with discharge function for biomedical applications is proposed and designed. To provide monopolar biphasic stimulus currents, the positive (6V) and the negative (-6V) voltage sources are supported to generate the desired current pulses of ±3 mA. The monopolar biphasic stimulator chip was fabricated in a 0.18-µm 1.8-V/3.3-V CMOS process with the common grounded p-type substrate. The overstress and reliability issues on the low-voltage transistors in the stimulator circuits were fully overcome by circuit design. The silicon area of each single channel only occupies 0.08 mm2 and the output level of stimulus current is up to ±3 mA. By applying the discharge function, safety concern of unbalanced charge in neuro-stimulation can be dealt properly. The residual average dc current is less than 3.42 nA after discharge is activated. Moreover, this chip has also been verified with both in-vitro imitation measurement and in-vivo animal test.

Validating METCAM/MUC18 as a Novel Biomarker to Predict the Malignant Potential of Prostate Cancer at an Early Stage by Using a Modified Gold Nanoparticles-Based Lateral Flow Immunoassay.

(1) Background: To further validate METCAM/MUC18 as a diagnostic biomarker for prostate cancer, a modified Lateral Flow Immune Assay (LFIA) with increased sensitivity and specificity was designed by taking advantage of the extremely high affinity between biotin and streptavidin and used. (2) Methods: The combination of a commercial biotinylated rabbit antibody (EPP11278), or the home-made biotinylated chicken antibody, and the nano-gold conjugated home-made chicken antibody or a commercial rabbit antibody (EPP11278), had the higher sensitivity and specificity in this modified LFIA to establish calibration curves from the two recombinant METCAM/MUC18 proteins and were used for determining METCAM/MUC18 concentrations in serum specimens from normal individuals, benign prostatic hyperplasia (BPH) patients, prostatic intraepithelial neoplasia (PIN) patients, prostate cancer patients with various Gleason scores, and treated patients. (3) Results: Data obtained by this modified LFIA were statistically better than traditional LFIA and prostate-specific antigen (PSA) test. Interestingly, serum METCAM/MUC18 concentrations were higher in pre-malignant PIN patients than prostate cancer patients and both were higher than normal individuals, BPH patients, and treated patients. Serum METCAM/MUC18 concentrations were directly proportional to most serum PSA. (4) Conclusions: Elevated serum METCAM/MUC18 concentrations may be used for predicting the malignant potential of prostate cancer at an early premalignant (PIN) stage, which is not achievable by the current PSA test.

[Using Healthcare Failure Mode and Effects Analysis to Reduce Intra-Arterial Thrombectomy Preoperative Preparation Error Rates in the Emergency Room].

BACKGROUND & PROBLEMS: Intra-arterial thrombectomy (IAT) is a novel surgery that may restore cerebral blood flow in patients with ischemic stroke and lower the risks of permanent brain damage and disability. Because the process of preoperative preparation for IAT is complicated, error rates for this process have been reported in previous studies to be as high as 100%. Although these errors did not result in serious damage to patients, the risk to patient safety remains. Therefore, reducing the error rate for IAT preoperative preparation is necessary to improve patient safety. PURPOSE: To reduce the rate of IAT preoperative preparation error in an emergency room. RESOLUTION: This project applied healthcare failure mode and effect analysis (HFMEA) to evaluate the potential risks of IAT preoperative preparation in an emergency room. Based on the resultant hazard score, critical preventive measures were adopted, including creating a quick response code consent form, designing order packages, developing a checklist form, modifying stroke operating procedures and policies, planning suitable education content for staffs, developing criteria for evaluating preoperative preparation procedures, and installing vital signs equipment. RESULTS: After implementation of these measures, the hazard scores of 13 out of the 16 potential failure causes decreased to < 8, and the progress rate was 81.3%. The follow-up error rate for preoperative preparation was 0% in October 2019, which fulfilled the goal of this project. CONCLUSIONS: Preoperative preparation for IAT is complicated and time-consuming. In this project, HFMEA was introduced to ensure that preoperative preparation was accomplished in a complete and timely manner. Based on the results, after implementation, preparation work was effectively completed and operations were performed on schedule. Other hospitals may consider using this tool to evaluate potential risks to patient safety and to develop solutions to improve the quality of healthcare processes.

METCAM/MUC18 is a new early diagnostic biomarker for the malignant potential of prostate cancer: Validation with Western blot method, enzyme-linked immunosorbent assay and lateral flow immunoassay.

BACKGROUND: METCAM/MUC18 expression was increased with the malignant progression of prostate cancer and also a bona fide metastatic gene, capable of initiating and driving the metastasis of a non-metastatic human prostate cancer cell line to multiple organs. OBJECTIVE: We explored if METCAM/MUC18 was detectable in human serum and a novel biomarker to predict malignant propensity of prostate cancer. MATERIALS AND METHODS: Two antibodies were identified by Western blot analysis having the highest sensitivity and specificity to establish calibration curves from the recombinant METCAM/MUC18 proteins. They were used in ELISA and LFIA to determine the METCAM/MUC18 concentrations in serum samples from 8 normal individuals, 4 BPH patients, 1 with PIN, 6 with high-grade prostate cancer, and 2 treated cancer patients. RESULTS: Serum METCAM/MUC18 concentrations were statistically significantly higher in the patients with PIN and prostate cancer than those with BPH, the treated patients and normal individuals. The LFIA results were statistically better than ELISA and Western blot methods. Serum METCAM/MUC18 concentrations were in direct proportional to most of serum PSA concentrations.

Increased Long-Term Risks of Occupational Diseases in Homecare Nurses: A Nationwide Population-Based Retrospective Cohort Study.

Background: The work of homecare nurses is different from that of general hospital nurses; therefore, it is necessary to understand the risks of occupational diseases in homecare nurses. Materials and Methods: In this retrospective cohort research conducted from 2000 to 2013, nursing staff comprised the sample obtained from the National Health Insurance Research Database. Nursing staff were subgrouped according to practice site into homecare, medical center, regional hospital, and local community hospital nurses. The control group included 4,108 subjects. Results: The risk of severe kidney disease was higher in homecare nurses than in medical center nurses (hazard ratio [HR]: 7.3, 95% confidence interval [CI]: 2.45-21.78) and regional hospital nurses (HR: 3.30, 95% CI: 1.37-7.96). The risk of severe liver disease was higher in homecare nurses than in medical center nurses (HR: 1.92, 95% CI: 1.10-3.35) and regional hospital nurses (HR: 2.06, 95% CI: 1.17-3.62). Conclusions: The prevalence of occupational diseases was higher in homecare nurses than in noncaregivers. The correlation between different practice environments and disease prevalence rates revealed that various types of nurses can be ranked in the following order based on the prevalence of the aforementioned diseases: homecare nurses > local community hospital nurses > regional hospital nurses > medical center nurses.

[The Spiritual Health Status and Spiritual Care Behaviors of Nurses in Intensive Care Units and Related Factors].

BACKGROUND: Patients suffer sudden and life-threatening conditions in intensive care units (ICU), which frequently result in traumatic changes in physical, mental, and spiritual health. Little research has been conducted on the spiritual health and spiritual care behaviors of nurses in ICU. PURPOSE: To explore the relationship among demographic characteristics, spiritual health, and spiritual care behaviors in ICU nurses. METHODS: A descriptive correlational research was used and 219 nurses from three teaching hospitals were enrolled as study participants. A structured questionnaire consisting of a demographic datasheet, a spiritual health scale, and a spiritual care behavior scale was used for data collection. SPSS for Windows version 22.0 was used for statistical analysis. RESULTS: The participants received few hours of spiritual-care education. The highest scored item for spiritual health was "connecting with people". The highest scored item for spiritual care behavior was "helping the patient out of adversity". Participants who were older in age and who had more years of clinical experience exhibited spiritual care behaviors such as "helping the patient out of adversity" and "retaining hope" more frequently with their ICU patients. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The older and more clinically experienced nurses in this study performed spiritual care behaviors at a higher frequency than their younger, less experienced counterparts. Therefore, it is recommended that hospitals retain more-experienced nursing staff to elevate the level of holistic health care. Concurrently, training in spiritual care skills should be provided to younger and less experienced nurses in order to facilitate more spiritual care behaviors. The results of this study provide a reference for providing spiritual care behaviors to patients.

A Low Glutathione Redox State Couples with a Decreased Ascorbate Redox Ratio to Accelerate Flowering in Oncidium Orchid.

Glutathione (GSH) plays multiple roles in plants, including stress defense and regulation of growth/development. Previous studies have demonstrated that the ascorbate (AsA) redox state is involved in flowering initiation in Oncidium orchid. In this study, we discovered that a significantly decreased GSH content and GSH redox ratio are correlated with a decline in the AsA redox state during flowering initiation and high ambient temperature-induced flowering. At the same time, the expression level and enzymatic activity of GSH redox-regulated genes, glutathione reductase (GR1), and the GSH biosynthesis genes γ-glutamylcysteine synthetase (GSH1) and glutathione synthase (GSH2), are down-regulated. Elevating dehydroascorbate (DHA) content in Oncidium by artificial addition of DHA resulted in a decreased AsA and GSH redox ratio, and enhanced dehydroascorbate reductase (DHAR) activity. This demonstrated that the lower GSH redox state could be influenced by the lower AsA redox ratio. Moreover, exogenous application of buthionine sulfoximine (BSO), to inhibit GSH biosynthesis, and glutathione disulfide (GSSG), to decrease the GSH redox ratio, also caused early flowering. However, spraying plants with GSH increased the GSH redox ratio and delayed flowering. Furthermore, transgenic Arabidopsis overexpressing Oncidium GSH1, GSH2 and GR1 displayed a high GSH redox ratio as well as delayed flowering under high ambient temperature treatment, while pad2, cad2 and gr1 mutants exhibited early flowering and a low GSH redox ratio. In conclusion, our results provide evidence that the decreased GSH redox state is linked to the decline in the AsA redox ratio and mediated by down-regulated expression of GSH metabolism-related genes to affect flowering time in Oncidium orchid.