Factors affecting cognitive frailty improvement and progression in Taiwanese older adults.

BACKGROUND: Knowledge of predictors of cognitive frailty (CF) trajectories is required to develop preventive strategies to delay or reverse the progression from CF to dementia and other adverse outcomes. This 2-year prospective study aimed to investigate factors affecting the progression and improvement of CF in older Taiwanese adults. METHODS: In total, 832 community-dwelling people aged ≥ 65 years were eligible. Fried's five frailty criteria were used to measure prefrailty and frailty, while cognitive performance was assessed by the Clinical Dementia Rating and Mini-Mental State Examination. Each component of reversible CF and potentially reversible CF was assigned a score, with a total score ranging 0 to 5 points. Two annual follow-up CF assessments were conducted. The group-based trajectory model was applied to identify latent CF trajectory groups, and a multinomial logistic regression was used to examine relationships of explanatory variables with CF trajectories. RESULTS: According to data on 482 subjects who completed the two annual follow-ups, three CF trajectories of robust, improvement, and progression were identified. After adjusting for the baseline CF state, CF progression was significantly associated with an older age (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.02 ~ 1.14), a lower Tinetti balance score (OR = 0.72; 95% CI, 0.54 ~ 0.96), a slower gait (OR = 0.98; 95% CI, 0.97 ~ 0.99), and four or more comorbidities (OR = 2.65; 95% CI, 1.19 ~ 5.90), while CF improvement was not significantly associated with any variable except the baseline CF state. In contrast, without adjusting for the baseline CF state, CF progression was significantly associated with an older age, female sex, balance scores, gait velocity, regular exercise, the number of comorbidities, and depression, while CF improvement was significantly associated with female sex, balance scores, and the number of comorbidities. CONCLUSIONS: The baseline CF state, an older age, poorer balance, slower gait, and a high number of comorbidities may contribute to CF progression, while the baseline CF state may account for associations of engaging in regular exercise and depression with CF development.

The relationships among overcommitment, effort-reward imbalance, safety climate, emotional labour and quality of working life for hospital nurses: a structural equation modeling.

BACKGROUND: Quality of working life (QWL) is a highly important issue for nurses. Nurses with lower QWL tend to have lower job performance and intention to stay. The aim of this study was to apply a theoretical model to examine the structural relationships among overcommitment, effort-reward imbalance (ERI), safety climate, emotional labour and QWL for hospital nurses. METHODS: A cross-sectional study design and a simple random sampling method were used to recruit 295 nurses in a teaching hospital and used a structured questionnaire was used to collect data. RESULTS: Overall, the nurses' QWL was moderate. Our theoretical model showed a good model fit. Overcommintment had a significant direct positive effect on ERI (ß = 0.35, p < 0.001) and indirect effects on safety climate (ß = -0.149, p = 0.001), emotional labour (ß = 0.105, p = 0.001) and QWL (ß = -0.061, p = 0.004). Additionally, ERI not only had significant direct effects on safety climate (ß = -0.42, p < 0.001), emotional labour (ß = 0.30, p < 0.001) and QWL (ß = -0.17, p < 0.001) but also indirectly affected QWL through safety climate (ß = -0.304, p = 0.001) and emotional labour (ß = -0.042, p = 0.005). Both safety climate (ß = 0.72, p < 0.001) and emotional labour (ß = -0.14, p = 0.003) showed significant direct effects on QWL. Our final model accounted for 72% of the variance in QWL. CONCLUSION: Our results highlight the necessity of improving the QWL of nurses. Policymakers and hospital administrators should develop policies and strategies that encourage nurses to exhibit an appropriate level of commitment, balance effort and reward, establish a climate of safety, and reduce emotional labour to improve the QWL of hospital nurses.

Determinants of the health care service choices of long-term mechanical ventilation patients: Applying andersen's behavioral model.

AIMS: The number of ventilator-dependent patients is rapidly increasing globally. As a result, long-term mechanical ventilation (LTMV) patients face the choice of receiving health care in respiratory care wards (RCWs) rather than at home. In this study, we applied Andersen's behavioral theoretical model (ABM) to investigate the determinants of the health care service decisions of patients receiving LTMV. METHODS: A cross-sectional research design and cluster random sampling were used to select 365 participants from nine RCWs and eight home care facilities in northern Taiwan. Data were collected in face-to-face interviews using a structured questionnaire. RESULTS: Of the predisposing factors, advanced age and an education level of at least junior high school influenced the choice to use RCW services. Being married, living with extended family, and medium or higher socioeconomic status were associated with the decision to use home care services. Of the enabling factors, patients with more caregivers, those whose family caregivers held strong beliefs about providing care, and those who perceived greater social support from health care providers were more likely to choose home care services. Of the need factors examined, poor cognitive function and higher dependence on assistance for activities of daily living (ADL) increased the probability of patients choosing RCW services. Hierarchical logistic regression analysis indicated that our final model accounted for 44.8% of the observed variance in health care service choice. CONCLUSIONS: ABM enables an improved understanding of the health care service choices of LTMV patients. Our findings also highlight the importance of rigorously assessing patient needs and helping patients choose the most appropriate health care service.

Effectiveness of a Nurse-Led Tele-Homecare Program for Patients With Multiple Chronic Illnesses and a High Risk for Readmission: A Randomized Controlled Trial.

PURPOSE: Multiple chronic illnesses, such as those associated with advanced age, are leading causes of poor health, disability, death, and high healthcare expenditures. Tele-homecare is a novel method for providing home care to patients with chronic illnesses. The purpose of this study was to evaluate the effectiveness of an integrated nurse-led tele-homecare program for patients with multiple chronic illnesses and a high risk for readmission. DESIGN: A randomized controlled trial. METHODS: Two hundred patients from a regional hospital who were scheduled to receive home care after discharge were randomly assigned to the intervention group (n = 100) or the control group (n = 100). The patients in the intervention group participated in an integrated tele-homecare program. For outcome evaluation, primary outcomes included the number of emergency department (ED) visits as well as readmittance and mortality. Secondary outcomes included patients' medication adherence, activities of daily living, health status, and quality of life (QOL). Data were collected at three time points: pretest baseline (T0), 3 months after intervention (T3), and 6 months after intervention (T6). A generalized estimating equation model was used to compare changes and evaluate the effect of differences between the two groups over time. FINDINGS: For primary outcome evaluation, we found that the tele-homecare program significantly reduced mortality and ED visits, whereas no significant effect on readmission was observed. For secondary outcome evaluation, patients' QOL indicated significant improvement. CONCLUSIONS AND CLINICAL RELEVANCE: The nurse-led tele-homecare program involves daily 24-hr remote monitoring and surveillance. In this study, the system detected patients' physical changes early and provided timely and appropriate management, consequently reducing ED visits and mortality. Additionally, it improved patients' QOL. On the basis of our findings, nurses' independent roles and functions revealed that the effectiveness of this nurse-led tele-homecare program strengthened the care of patients with multiple chronic illnesses.

Evaluation of Nurse Practitioners' Professional Competence and Comparison of Assessments Using Multiple Methods: Self-Assessment, Peer Assessment, and Supervisor Assessment.

PURPOSE: Nurse practitioners (NPs) are increasingly important in healthcare as they play a key role in leading advanced nursing practices. Assessing their professional competence is essential. The aim of this study was to evaluate NPs' professional competencies based on at a collaborative model around NP self and compare different methods of assessment. METHODS: This is a cross-sectional study, and a purposive sample of 211 participants in the teaching hospital was used. Methods used were self-assessment (nurse practitioners), peer assessment (physicians and nurses) and supervisor assessment (head nurses). RESULTS: The competence of nurse practitioners was rated as moderate (mean score = 3.45 of a possible 5; SD = 0.59). However, each method resulted in differences in competence for total scores and dimensions. The highest competence was in direct patient care (mean = 3.55, SD = 0.53), and the lowest score was in monitoring the quality of patient care (mean = 3.30, SD = 0.82). post hoc analysis shown that supervisor assessment rated professional competence significantly lower than the method of self-assessment and peer assessment (F = 10.07, p < .001). CONCLUSION: NPs require an increased effort to continuous learning for enhancing professional competencies. Moreover, using multiple methods for assessment to obtain a more comprehensive and accurate evaluation of NPs' professional competence.

Application of a Q Method Study to Understanding Nurses' Perspective of Adopting Evidence-Based Nursing.

PURPOSE: This study applied the Q method to identify and describe the various types of nurse perceptions that are crucially associated with their engagement in evidence-based nursing (EBN). METHODS: The study participants were nurses at a medical center and a regional teaching hospital. A series of Q sorts was performed by nurses to subjectively rank the Q statements. Q statements were constructed based on the literature related to EBN adoption by nurses and face-to-face interviews. RESULTS: A total of 60 participants were invited to rank 44 Q statements related to EBN. Factor analysis was conducted on the rankings of the Q statements. The following are the five prominent shared perspectives: (1) emphasized the obstacles to evidence searching and reading ability; (2) emphasized the organizational promotive strategies; (3) emphasized the available supportive resources; (4) emphasized the significance of EBN; and (5) emphasized the evidence-searching ability and external incentives. The five identified groups of perspectives can enhance hospital administrators to acknowledge the barriers and incentives associated with EBN practices. CONCLUSION: The exploration of clustering nurses' perceptions may facilitate the development of customized strategies to enable more appropriate training.

Nurse characteristics, leadership, safety climate, emotional labour and intention to stay for nurses: a structural equation modelling approach.

AIM: The aim of this study was to propose a theoretical model and apply it to examine the structural relationships among nurse characteristics, leadership characteristics, safety climate, emotional labour and intention to stay for hospital nurses. BACKGROUND: Global nursing shortages negatively affect the quality of care. The shortages can be reduced by retaining nurses. Few studies have independently examined the relationships among leadership, safety climate, emotional labour and nurses' intention to stay; more comprehensive theoretical foundations for examining nurses' intention to stay and its related factors are lacking. DESIGN: Cross-sectional. METHODS: A purposive sample of 414 full-time nurses was recruited from two regional hospitals in Taiwan. A structured questionnaire was used to collect data from November 2013-June 2014. Structural equation modelling was employed to test the theoretical models of the relationships among the constructs. RESULTS: Our data supported the theoretical model. Intention to stay was positively correlated with age and the safety climate, whereas working hours per week and emotional labour were negatively correlated. The nursing position and transformational leadership indirectly affected intention to stay; this effect was mediated separately by emotional labour and the safety climate. CONCLUSION: Our data supported the model fit. Our findings provide practical implications for healthcare organizations and administrators to increase nurses' intent to stay. Strategies including a safer climate, appropriate working hours and lower emotional labour can directly increase nurses' intent to stay. Transformational leadership did not directly influence nurses' intention to stay; however, it reduced emotional labour, thereby increasing intention to stay.

DNA aptamers that target human glioblastoma multiforme cells overexpressing epidermal growth factor receptor variant III in vitro.

AIM: Aptamers are oligonucleic acid or peptide molecules that bind to a specific target molecule in cells, thus may act as effective vehicles for drug or siRNA delivery. In this study we investigated the DNA aptamers that target human glioblastoma multiforme (GBM) cells overexpressing epidermal growth factor receptor variant III (EGFRvIII), which was linked to radiation and chemotherapeutic resistance of this most aggressive brain tumor. METHODS: A 73-mer ssDNA library containing molecules with 30 nt of random sequence flanked by two primer hybridization sites was chosen as the initial library. Cell systematic evolution of ligands by exponential enrichment (Cell-SELEX) method was used to select the DNA aptamers that target EGFRvIII. The binding affinity of the aptamers was measured using a cell-based biotin-avidin ELISA. RESULTS: After 14 rounds of selection, four DNA aptamers (32, 41, 43, and 47) that specifically bound to the EGFRvIII-overexpressing human glioma U87Δ cells with Kd values of less than 100 nmol/L were discovered. These aptamers were able to distinguish the U87Δ cells from the negative control human glioma U87MG cells and HEK293 cells. Aptamer 32 specifically bound to the EGFRvIII protein with an affinity similar to the EGFR antibody (Kd values of aptamer 32 and the EGFR antibody were 0.62±0.04 and 0.32±0.01 nmol/L, respectively), and this aptamer was localized in the cell nucleus. CONCLUSION: The DNA aptamers are promising molecular probes for the diagnosis and treatment of GBM.