Modified CTAB protocols for high-molecular-weight DNA extractions from ferns.

Premise: Efficient protocols for extracting high-molecular-weight (HMW) DNA from ferns facilitate the long-read sequencing of their large and complex genomes. Here, we perform two cetyltrimethylammonium bromide (CTAB)-based protocols to extract HMW DNA and evaluate their applicability in diverse fern taxa for the first time. Methods and Results: We describe two modified CTAB protocols, with key adjustments to minimize mechanical disruption during lysis to prevent DNA shearing. One of these protocols uses a small amount of fresh tissue but yields a considerable quantity of HMW DNA with high efficiency. The other accommodates a large amount of input tissue, adopts an initial step of nuclei isolation, and thus ensures a high yield in a short period of time. Both methods were proven to be robust and effective in obtaining HMW DNA from diverse fern lineages, including 33 species in 19 families. The DNA extractions mostly had high DNA integrity, with mean sizes larger than 50 kbp, as well as high purity (A260/A230 and A260/A280 > 1.8). Conclusions: This study provides HMW DNA extraction protocols for ferns in the hope of facilitating further attempts to sequence their genomes, which will bridge our genomic understanding of land plant diversity.

Integrating tissue-direct PCR into genetic identification: An upgraded molecular ecology approach to survey fern gametophytes in the field.

Premise: The gametophytes of different fern species collected in the field can be difficult to distinguish because of their morphological similarities. Nonetheless, emerging molecular ecology techniques are starting to be used to tackle such limitations. Here, using case studies and a detailed protocol, we demonstrate a convenient methodology, tissue-direct PCR (TD-PCR), that foregoes a traditional DNA extraction and facilitates the identification of fern gametophytes, as well as enabling the elucidation of their natural distribution. Methods: Based on updated plastome information, we designed a universal primer set targeting the trnL-L-F region, which is effective across extant ferns. We used this primer set to perform TD-PCR on the case-studied populations of Taiwanese Lomariopsis gametophytes, using the generated sequences for their identification. In the case study concerning the microhabitat preference of Vaginularia junghuhnii, we designed and used a taxon-specific primer set. Results: Compared with approaches requiring DNA extraction, the use of TD-PCR with either universal or taxon-specific primers could save significant time, money, labor, and research materials in the genetic identification of fern gametophytes. Discussion: The use of modern genetic tools can aid in the identification of fern gametophytes. An updated TD-PCR strategy not only facilitates the DNA-based identification of gametophytes, but also promotes new avenues of research for investigating these plants in the field.

Prevalence of Geriatric Syndromes and the Need for Hospice Care in Older Patients of the Emergency Department: A Study in an Asian Medical Center.

BACKGROUND: The prevalence of geriatric syndromes and the need for hospice care in the emergency department (ED) in Asian populations remain unclear. This study was conducted to fill the data gap. METHODS: Using a newly developed emergency geriatric assessment (EGA), we investigated the prevalence of geriatric syndromes and the need for hospice care in older ED patients of a tertiary medical center between September 1, 2016, and January 31, 2017. RESULTS: We recruited a total of 693 patients with a mean age of 78.0 years (standard deviation 8.2 years), comprising 46.6% of females. According to age subgroups, 37.4% of patients were aged 65-74 years, 37.4% were aged 75-84 years, and 25.2% were aged ≥85 years. The prevalence rates of geriatric syndromes were as follows: delirium (11.4%), depression (23.4%), dementia (43.1%), deterioration of activities of daily living (ADL) for <1 year (29.4%), vision impairment (22.2%), hearing impairment (23.8%), sleep disturbance (13.1%), any fall in <1 year (21.8%), polypharmacy (28.7%), pain (35.1%), pressure ulcer (5.6%), incontinence or retention (29.6%), indwelling device or physical restrain (21.6%), nutrition problem (35.7%), frequent use of medical resources (50.1%), lack of advance care planning (84.0%), caregiver problem (4.6%), socioeconomic problem (5.5%), and need for family meeting (6.2%). The need for hospice care was 11.9%. Most geriatric syndromes increased with advancing age except depression, sleep disturbance, polypharmacy, pain, nutrition problem, lack of advance care planning, caregiver problem, and socioeconomic problem. CONCLUSION: Geriatric syndromes and the need for hospice care were common in the older ED patients. Further studies about subsequent intervention for improving geriatric care are needed.

Factors that affect the health status of health care providers-A cross-sectional design.

AIM: To explore the factors that affect the health status of health care providers. BACKGROUND: There is a lack of studies that address the stress, resilience, social support and health status of health care providers. METHODS: Using a cross-sectional study design, 500 participants were recruited from three hospitals which were operated by one entity in southern Taiwan. Data were collected with structured questionnaires. A logistic regression analysis was performed to explore the factors that might affect the health status of health care providers. RESULTS: Among the 500 health care providers, 345 were healthy and 155 were unhealthy. Health status was not significantly correlated with any demographic characteristics, but was significantly correlated with work stress, resilience and social support, with work stress being an important factor influencing the health status of health care providers. CONCLUSIONS: Health care providers with health issues had higher work stress, less resilience and less social support than did healthy medical personnel. Moreover, work stress was the main factor affecting the health of health care providers. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital administrators should conduct a series of health management programmes to identify high-risk employees who might need assistance. Such programmes promoting healthy workplaces are necessary, as well as studies that examine the effectiveness of such strategies.

On the difficulty of finding one's place: A qualitative study of new nurses' processes of growth in the workplace.

AIMS AND OBJECTIVE: To explore new nurses' processes of growth in the workplace in order to understand the challenges they face. BACKGROUND: Quantitative and qualitative research to date has not adequately explored the complex ways in which initial work experiences may shape new nurses' very high quit rate and, consequently, impact the long-term nursing shortage in Taiwan. DESIGN/METHODS: We conducted in-depth interviews with new nurses to explore their professional development, including the challenges they faced, and their feelings about staying or quitting. Twenty newly registered nurses who had worked in a hospital setting full-time for a year or less in two southern Taiwan medical centres were interviewed. Data were collected from March-November 2016. EQUATOR guidelines were followed, using the COREQ checklist. RESULTS: Interview transcripts were analysed and coded; three stages of growth were discovered: Feeling disillusioned and shocked, Gaining experiential knowledge and Making a place for oneself. Most nurses (n = 18/20) went through these three stages within 9 months and continued to work in nursing at follow-up 2 years later. CONCLUSIONS: Job continuity was contingent upon new nurses' enduring a painful process of adjustment in the first two stages when new nurses were unsure of themselves and their interactions with preceptors were wrought with social tensions. New nurse development and retention efforts should make explicit the possibility of these tensions and how to deal with them. RELEVANCE TO CLINICAL PRACTICE: A better understanding of new nurses' growth processes and adjustment pains can help refocus professional development and retention efforts towards how new nurses can succeed in finding a place for themselves.

Nurses have a four-fold risk for overdose of sedatives, hypnotics, and antipsychotics than other healthcare providers in Taiwan.

Nurses have high work stress that may contribute to an increased overdose for sedatives, hypnotics, and antipsychotics (OSHA). We conducted this nationwide population-based cross-sectional study to clarify this still unclear issue. We used a nationwide database to identify 110,379 nurses, 22,032 other healthcare providers (HCPs), and an identical number of individuals from the general population matched by age and sex. We compared the period prevalence of OSHA between nurses and the general population, other HCPs and the general population, and nurses and other HCPs, among nurse subgroups from 2006 to 2012. The risk for OSHA in nurses and in the general population was not significantly different after adjusting for anxiety, insomnia, depression, schizophrenia, and affective disorders (adjusted odds ratio [AOR]: 1.145; 95% confidence interval [CI]: 0.974-1.346). However, in the age subgroups < 35 years, nurses had higher risk than the general population of having OSHA (AOR: 1.333; 95% CI: 1.109-1.601). Other HCPs had a significantly lower risk for OSHA than the general population (AOR: 0.237; 95% CI: 0.122-0.460). Nurses had a significantly higher risk for OSHA than other HCPs (AOR: 3.902; 95% CI: 2.159-7.048). Comparison among nurses showed that younger nurses (< 35 years) had a significantly higher risk for OSHA than the older nurses (≥ 50 years) (AOR: 3.569; 95% CI: 1.252-10.330). Registered nurses had significantly higher risk for OSHA than registered professional nurses (AOR: 1.810; 95% CI: 1.405-2.332); and nurses from clinics, local hospitals, and regional hospitals had significantly higher risk than nurses from medical centers. This study delineated that nurses had a nearly four-fold risk for OSHA when compared to other HCPs. Younger nurses, registered nurses, and nurses from clinics, local hospitals, and regional hospitals had higher risks for OSHA than their respective nurse controls; it suggests that more attention should be given to the occupational health of these populations.

Posttraumatic Psychiatric Disorders and Resilience in Healthcare Providers following a Disastrous Earthquake: An Interventional Study in Taiwan.

BACKGROUND: Posttraumatic psychiatric disorders (PTPDs) are common in disaster workers; however, their incidence and resilience in healthcare providers (HCPs) following a disastrous earthquake are still unclear. Therefore, we conducted an interventional study to clarify this issue. METHODS: After a medical response to the scene of a collapsed huge building, we conducted an assessment of the HCPs using an immediate self-administered questionnaire and a follow-up questionnaire 1 month later. Psychological support after the operation was implemented. We performed analysis of the risk for PTPDs and comparison between immediate and follow-up questionnaires. RESULTS: The mean age (standard deviation) of the HCPs was 32.7 (5.2) years, with 33.5 (5.8) years for nurses and 32.4 (4.4) years for physicians. The proportion of females among the nurses and physicians was 94.3% and 12.5%, respectively. In total, 16.4% (11/67) of HCPs fit the criteria of PTPDs. Nurses had a trend of higher incidence than physicians. Female HCPs had a trend of higher incidence than male HCPs. After intervention, none of the HCPs reported PTPDs in the follow-up questionnaire (p < 0.05). CONCLUSION: This study delineated that PTPDs were common in HCPs following medical response to an earthquake; however, the resilience was good after the early intervention.

Implementing a novel model for hospice and palliative care in the emergency department: An experience from a tertiary medical center in Taiwan.

Hospice and palliative care has been recognized as an essential part of emergency medicine; however, there is no consensus on the optimal model for the delivery of hospice and palliative care in the emergency department (ED). Therefore, we conducted a novel implementation in a tertiary medical center in Taiwan. In the preintervention period, we recruited a specialist for hospice and palliative medicine in the ED to lead our intervention. In the early stage of the intervention, starting on July 1, 2014, we encouraged and funded ED physicians and nurses to receive training for hospice and palliative medicine and residents of emergency medicine to rotate to the hospice ward. In the late stage of the intervention, we initiated educational programs in the ED, an interdisciplinary meeting with the hospice team every month, sharing information and experience via a cell phone communication app, and setting aside an emergency hospice room for end-of-life patients. We compared the outcomes among pre-, during, and postintervention periods. Compared with 4 in the preintervention period, the cases of do not resuscitate (DNR) per month increased significantly to 30.1 in the early stage of intervention, 23.9 in late stage of intervention, and 34.6 in the postintervention period (all P < .001 compared with the preintervention period). Compared with 10.8% in the preintervention period, the ratio of DNR orders signed in the ED/total DNR orders signed in the study hospital was increased to 17.1% in early stage of intervention, 12.5% in late stage of intervention, and 22.8% in postintervention. Compared with zero in preintervention and early intervention, the cases of consultation with the hospice team increased significantly to 19 cases per month in the late stage of intervention and postintervention. The ability of nurses in hospice and palliative care, including knowledge and the timing and method of consultation with the hospice team, was also significantly improved. We successfully implemented a novel model of hospice and palliative care in the ED via a champion, education, and close collaboration with the hospice team, which could be an important reference for other EDs and intensive care unit in the future.

The effects of nursing preceptorship on new nurses' competence, professional socialization, job satisfaction and retention: A systematic review.

AIMS: The aim of this study was to determine the effects of nursing preceptorship on the competence, job satisfaction, professional socialization and retention of new nurses. BACKGROUND: Although studies have focused on the effects of nursing preceptorship on new nurses' competence and retention, a systematic review of the overall effects is lacking. DESIGN: A quantitative systematic review. DATA SOURCES: Five English/Chinese databases were searched for original articles published before June 2015 and only six articles published between 2001-2014 were included in the final analysis. REVIEW METHODS: Joanna Briggs Methodology was used to process one randomization control trial, one quasi-experimental study and four observational studies. Two appraisers independently reviewed each study using the standardized critical appraisal tools from the Joanna Briggs Institute. RESULTS: The most adopted preceptorship was a fixed preceptor/preceptee model and one-on-one for 1-3-month duration. It showed that new nurses' overall competence increased significantly due to preceptorship. Only a few studies explored the effects of preceptorship on the job satisfaction and professional socialization of new nurses. Clear conclusions regarding the effect of preceptorship on nurses' retention rate could not be made because of inconsistent time points for calculation and a lack of control groups in the study design. CONCLUSIONS: Preceptorship can improve new nurses' nursing competence; however, more studies are needed to ascertain its effects on new nurses' retention rates, job satisfaction and professional socialization to promote nursing care quality and resolve nursing shortages.

Effects of Colloidal Oatmeal Lotion on Symptoms of Dermatologic Toxicities Induced by Epidermal Growth Factor Receptor Inhibitors.

OBJECTIVE: The common adverse effects associated with targeted therapy for cancer, such as epidermal growth factor receptor inhibitors (EGFRIs), are dermatologic toxicities that cause the patient physical discomfort and affect treatment. Colloidal oatmeal lotion (COL) has been proven to help prevent dermatitis and xerosis. Evidence of its effect on EGFRI-induced dermatologic toxicities, however, is limited. The purpose of this study was to explore the effect of COL on EGFRI-induced dermatologic toxicities. DESIGN AND SETTING: This study used a 1-group pretest-posttest design with a convenience sample of 30 patients with cancer who developed EGFRI-induced dermatologic toxicities from a medical center in southern Taiwan. All participants applied topical COL 3 to 5 times a day for 4 consecutive weeks and received a pretest and 4 posttests. OUTCOME MEASURES: A generalized estimating equation was used to assess the impact of demographics, disease characteristics, and weeks of COL use on dermatologic toxicity severity, body surface area affected, and level of pruritus. MAIN RESULTS: Significant differences were found between the pretest and all posttests after using COL with regard to the severity, body surface area affected, and level of pruritus in participants who developed EGFRI-induced dermatologic toxicities (P < .05). There were no significant differences in demographics or disease characteristics on EGFRI-induced dermatologic toxicities. CONCLUSIONS: Based on the study results, COL could improve the symptoms of dermatologic toxicities in those receiving EGFRIs with no adverse effects. Therefore, the authors suggest the use of COL in clinical settings.

[An Experience Promoting the Interdisciplinary Care Model for Dengue Fever].

Emergency departments represent the first line in facing major healthcare events. During major epidemic outbreaks, patients crowding into the emergency departments increase the wait time for patients and overload the staffs that are on duty. The dengue fever outbreak in southern Taiwan during the summer 2015 presented a huge management challenge for physicians and nurses in local hospitals. We responded to this challenge by integrating resources from different hospital departments. This strategy successfully increased group cohesiveness among the medical team, ensuring that they could not only ultimately cope with the outbreak together but also effectively provide patient-centered care. This interdisciplinary care model may serve as a reference for medical professionals for the management of future epidemics and similar events.

An exploration of nursing preceptorship and functions and nurses' intention to stay from the perspective of cultural differences.

BACKGROUND: Culture has a great impact on human behavior; this is the key for organizational cultures in the Chinese society where relationships and hierarchy are emphasized and is especially exerted to the utmost by relationalism in Taiwan's collective society. PURPOSE: The purpose of this study was to explore the differences in the nature of preceptorship and functions between Eastern and Western cultures. METHODS: An exploratory research design was used. Qualitative field interviews were carried out with 20 new nurses who had worked in hospital settings for one year or less. RESULTS: In addition to the existing phases of a mentoring relationship, we drew out another preceptorship function dimension which represented the unique family ethics and superior-subordinate relationships in the Chinese nursing field and also added an important function, the quasi-family functions to the mentoring. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: With the in-depth understanding of preceptorship in the Chinese culture, the development of localized teaching strategies for preceptors could effectively improve new nurses' job satisfaction and intention to stay and reduce their reality shock and role ambiguity.

[Exploring the application of rogers' empirical theory in research using Rogers' conceptual model].

Rogers' model treats people and the environment as pan-space energy fields that integrate with one another and exchange energies. The nurse model is an abstract system concept that emphasizes totality, experiences, existence and correlates with the continuous nursing model emphasized by the current health nursing system. Rogers' model offers an abstract philosophical framework to explain "whole person-environment field phenomenalism." This article discusses and critiques the application of Rogers' theory in nursing practice. The author hopes that it will help nurses better understand Rogers' theory and his central concept in order to better apply them in nursing practice.

[A nurse's experience applying Rotter's locus of control theory in a myocardial infarction patient].

This case report shares the experience of one nurse in applying Rotter's locus of control theory in her care of a myocardial infarction patient. Period of care ran from November 23 to December 1, 2007. The author collected subjective and objective data through observations and interviews with the patient in the ward. Data was analyzed to identify key healthcare problems. These included the inadequate information of the patient on his condition, which negatively influenced health behavior; inadequate health information available; and the flare-up of disease symptoms. Internal locus of control, as presented in Rotter's locus of control theory, was applied to the above nursing problems in order to deliver individualized nursing care to the patient based on mutual trust. Such enhanced patient disease cognition, facilitated his obtaining health information, helped him adjust to disease symptom episodes, and promoted his adjustment to the disease and adoption of more healthy behavior.