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Biomedical subjects

Ching-Yu Chen

Publications and source records attributed to Ching-Yu Chen.

At least 19 recordsLinked to original sources

Antitumor effects of a novel phenylbutyrate-based histone deacetylase inhibitor, (S)-HDAC-42, in prostate cancer.

PURPOSE: To assess the antitumor effects of a novel phenylbutyrate-derived histone deacetylase (HDAC) inhibitor, (S)-HDAC-42, vis-à-vis suberoylanilide hydroxamic acid (SAHA) in in vitro and in vivo models of human prostate cancer. EXPERIMENTAL DESIGN: The in vitro effects of (S)-HDAC-42 and SAHA were evaluated in PC-3, DU-145, or LNCaP human prostate cancer cell lines. Cell viability, apoptosis, and indicators of HDAC inhibition were assessed. Effects on Akt and members of the Bcl-2 and inhibitor of apoptosis protein families were determined by immunoblotting. Immunocompromised mice bearing established s.c. PC-3 xenograft tumors were treated orally with (S)-HDAC-42 (50 mg/kg q.o.d. or 25 mg/kg q.d.) or SAHA (50 mg/kg q.d.) for 28 days. In vivo end points included tumor volumes and intratumoral changes in histone acetylation, phospho-Akt status, and protein levels of Bcl-xL and survivin. RESULTS: (S)-HDAC-42 was more potent than SAHA in suppressing the viability of all cell lines evaluated with submicromolar IC50 values. Relative to SAHA, (S)-HDAC-42 exhibited distinctly superior apoptogenic potency, and caused markedly greater decreases in phospho-Akt, Bcl-xL, and survivin in PC-3 cells. The growth of PC-3 tumor xenografts was suppressed by 52% and 67% after treatment with (S)-HDAC-42 at 25 and 50 mg/kg, respectively, whereas SAHA at 50 mg/kg suppressed growth by 31%. Intratumoral levels of phospho-Akt and Bcl-xL were markedly reduced in (S)-HDAC-42-treated mice, in contrast to mice treated with SAHA. CONCLUSIONS: (S)-HDAC-42 is a potent orally bioavailable inhibitor of HDAC, as well as targets regulating multiple aspects of cancer cell survival, which might have clinical value in prostate cancer chemotherapy and warrants further investigation in this regard.

Administration, Oral↗

Overcoming trastuzumab resistance in HER2-overexpressing breast cancer cells by using a novel celecoxib-derived phosphoinositide-dependent kinase-1 inhibitor.

Although trastuzumab has been successfully used in patients with HER2-overexpressing metastatic breast cancer, resistance is a common problem that ultimately culminates in treatment failure. In light of the importance of Akt signaling in trastuzumab's antitumor action, we hypothesized that concurrent inhibition of Akt could enhance trastuzumab sensitivity and moreover reverse the resistant phenotype in HER2-positive breast cancer cells. Based on our finding that celecoxib mediates antitumor effects through the inhibition of phosphoinositide-dependent kinase-1 (PDK-1)/Akt signaling independently of cyclooxygenase-2 (COX-2), we used celecoxib as a scaffold to develop a COX-2-inactive PDK-1 inhibitor, 2-amino-N-[4-[5-(2-phenanthrenyl)-3-(trifluoromethyl)-1H-pyrazol-1-yl]phenyl]-acetamide (OSU-03012). Here, we investigated the effect of OSU-03012 on trastuzumab-mediated apoptosis in four breast cancer cell lines with different HER2 expression and trastuzumab-resistance status, including MDA-MB-231, BT474, SKBR3, and insulin-like growth factor-I receptor-overexpressing SKBR3 (SKBR3/IGF-IR). Effects of trastuzumab and OSU-03012, individually or in combination, on cell viability and changes in pertinent biomarkers including HER2 expression, phosphorylation of Akt, p27(kip1), and the PDK-1 substrate p70(S6K) were assessed. OSU-03012 alone was able to trigger apoptosis in all cell lines with equal potency (IC(50) = 3-4 microM), suggesting no cross-resistance with trastuzumab. Medium dose-effect analysis indicates that OSU-03012 potentiated trastuzumab's antiproliferative effect in HER2-positive cells, especially in SKBR3/IGF-IR cells, through the down-regulation of PDK-1/Akt signaling. This synergy, however, was not observed in HER2-negative MDA-MB-231 cells. This combination treatment represents a novel strategy to increase the efficacy of trastuzumab and to overcome trastuzumab resistance in the treatment of HER2-positive breast cancer.

3-Phosphoinositide-Dependent Protein Kinases↗

Development of small-molecule cyclin D1-ablative agents.

Previously, we demonstrated that the peroxisome proliferator-activated receptor gamma (PPARgamma) agonist troglitazone mediated the repression of cyclin D1 in MCF-7 breast cancer cells by facilitating proteasome-facilitated proteolysis. This PPARgamma-independent mechanism provided a molecular basis for using troglitazone as scaffold to develop a novel class of cyclin D1-ablative agents. The proof of principle of this premise is provided by Delta2TG, in which the introduction of a double bond adjacent to the thiazolidinedione ring abrogated the PPARgamma activity while retaining the activity in cyclin D1 repression. Structural optimization of Delta2TG led to STG28 [(S)-5-(4-{[6-(allyloxy)-2,5,7,8-tetramethylchroman-2-yl]methoxy}-3-methoxybenzylidene)thiazolidine-2,4-dione], which exhibited low micromolar potency in ablating cyclin D1 and inhibiting MCF-7 cell proliferation. It is noteworthy that STG28 mediated the proteasomal degradation of cyclin D1 with a high degree of specificity. Exposure to STG28 did not cause any appreciable change in the expression levels of a series of other cyclins and CDK-dependent kinases. In light of the pivotal role of cyclin D1 in promoting tumorigenesis and drug resistance, this novel cyclin D1-ablating agent may have therapeutic relevance in cancer therapy.

Antineoplastic Agents↗

Social support and family functioning on psychological symptoms in elderly Chinese.

The purpose of this study was to extend our knowledge about how social support and family functioning affect mental health, and to examine the buffering effects of support in the presence of health stressors. A random cluster sample of 507 elderly community people were surveyed with a structured questionnaire, which included the depression and anxiety subscale of the Chinese version of Symptom Checklist 90-R (SCL-90-R), Social Support Rating Scale (SSRS), Family Emotional Involvement and Criticism Scale (FEICS), Short Portable Mental Status Questionnaire (SPMSQ), and the Katz Activities of Daily Living Scale (KADL). Results revealed that women had more anxiety symptoms than men (mean=3.49; 95% CI: 3.02-3.95 versus mean=2.56; 95% CI: 2.27-2.85). Emotional support was more important than instrumental support for psychological symptoms. Family emotional involvement was inversely correlated to depression (r=-0.19) and anxiety (r=-0.22), while criticism was positively correlated to depression (r=0.29) and anxiety (r=0.31). Multivariate analysis revealed that women, impaired cognitive function, urban residents with chronic diseases, less emotional support, and more criticism from the family were associated with more depressive and anxiety symptoms. Family involvement had buffering effects on psychological symptoms for people with cognitive impairment and medical diseases. Our results imply that elderly people with mental symptoms and chronic medical diseases benefit more from family involvement.

Aged↗

Factors affecting students' evaluation in a community service-learning program.

A community service-learning curriculum was established to give students opportunities to understand the interrelationship between family and community health, the differences between community and hospital medicine, and to be able to identify and solve community health problems. Students were divided into small groups to participate in community health works such as home visits etc. under supervision. This study was designed to evaluate the community service-learning program and to understand how students' attitude and learning activities affected students' satisfaction. The results revealed that most medical students had a positive attitude towards social service and citizenship but were conservative towards taking the role to serve people in the community. Students had achieved what they were required to learn especially the training in communication skills and ability to identify social issues. Students' attitude towards social service did not affect their opinions on the quality of the program and subjective rating on their achievement. The quality of the program was related to the quality of learning rated by the students.

Attitude of Health Personnel↗

The influence of awareness of terminal condition on spiritual well-being in terminal cancer patients.

We developed a Spirituality Transcendence Measure (STM) and studied whether awareness of terminal illness affects spiritual well-being in terminal cancer patients. Three sources of spiritual transcendence--the situational, the moral and biographical, and the religious aspect--were assessed in the STM. Cronbach's alpha of the STM was 0.95, and the principle axis factor analysis extracted only one factor. Thirty-seven terminal cancer patients with male predominance (59.5%) were studied. Awareness of terminal illness was associated with a higher total STM score (Z = -2.21, P = 0.027), along with the individual scores for each of the three transcendences (Z = -2.39, P = 0.017; Z = -2.71, P = 0.007; and Z = -1.96, P = 0.050). Acceptance of death was associated with a higher situational score (Z = 2.01, P = 0.046) and a higher religious score (Z = -2.27, P = 0.023). Announcement of testament was associated with a higher situational score (Z = -2.30, P = 0.021). We conclude that awareness of terminal illness is associated with spiritual well-being. Telling the complete truth is necessary even when dealing with terminal conditions.

Adult↗

Symptom patterns of advanced cancer patients in a palliative care unit.

This study involved longitudinal evaluations of symptom severity and describes the symptom patterns of 77 terminal cancer patients (median age: 62 years; 61% female), selected from 537 consecutive patients admitted to the Palliative Care Unit of the National Taiwan University Hospital. The most common primary cancer sites in these patients were lung (23.4%), liver (15.6%), and stomach (13%). Nineteen physical and psychological symptoms were assessed using different scales. The median number of symptoms was 11 (range: 1-18) on admission, among which weakness, fatigue, anorexia, pain, and depression were the most common. A comparison of the initial symptom severity scores with those at one week after admission and two days before death suggested six symptom change patterns: A: continuous static (restless/heat, abdominal fullness, constipation, dizziness, and insomnia); B: static-increase (fatigue, weakness, nausea/vomiting, taste alteration, dysphagia, diarrhea, dry mouth, and night sweats); C: decrease-static (pain and depression); D: decrease-increase (anorexia and dyspnea); E: static-decrease (aggression); and F: gradually decrease (anxiety). These six symptom patterns can be divided into two categories on the basis of the relative severity of symptoms between one week after admission and two days before death. The first category included patterns A, C, E and F, and the symptoms improved with palliative care. However, the symptoms in the second category (patterns B and D), which were associated with the anorexia-cachexia syndrome and dyspnea, did not show improvement. As symptom management is an essential component of palliative care, holistic care, which encompasses physical, psychosocial and spiritual aspects, represents a rational approach for the relief of these incurable symptoms at the end stage of life for these patients.

Adolescent↗

Factors that influence physicians in providing palliative care in rural communities in Taiwan.

GOALS OF WORK: To identify the willingness, influencing factors, and educational needs of community physicians in providing palliative care in the rural areas of Taiwan. METHODS: A questionnaire was sent to all medical directors of the 140 government health stations assigned to the rural areas of Taiwan. RESULTS: The overall response rate was 62.8% with 85 valid questionnaires retrieved. The majority of respondents (84.7%) expressed a willingness to provide palliative care if they encountered an advanced cancer patient. However, they would limit their services to consultation and referral (93.0% and 87.5%, respectively), and were less likely to provide home visits (40.3%) or bereavement support of the family (29.2%). With respect to knowledge, the accurate answers to the philosophy/principles and clinical practice of palliative care were 93.4% and 57.3%, respectively. Regarding attitudes, the highest score item in perceiving the threat about providing palliative care was "uncomfortable to meet and take care of the advanced cancer patient." The highest score item in perceiving barriers was "providing palliative care may shorten patient's life, just like euthanasia." The results of stepwise logistic regression analysis for the willingness to provide home visits showed that only the subjective norms remained in the model (OR = 1.87, 95% CI = 1.17-3.01). Educational needs expressed by the respondents were ranked as follows: emotional support to, communication skills with, and bereavement support for the advanced cancer patients and their relatives. CONCLUSIONS: Effective training courses that emphasize the practical knowledge of palliative care for community physicians, incorporating palliative care into medical education particularly in terms of communication skills and ethical roles, and active health policy administration including insurance payments, are important for the enhancement of community palliative care in Taiwan.

Adult↗

Fear of death and good death among the young and elderly with terminal cancers in Taiwan.

Fear of death is a common characteristic among palliative care patients. We might think that the elderly display a higher degree of acceptance of the inevitability and less fear in the face of death. This study was aimed at investigating the relationship between the death fear level and the good-death scale in two age groups. The study was conducted in 224 patients with terminal cancers admitted to the Palliative Care Unit in National Taiwan University Hospital during the period of January 1 through October 31, 2001. The mean age was 62.13 +/- 15.47 years. The duration of admission in the elderly group was shorter than that of the younger group (P < 0.05). The severity of death fear decreased gradually in both groups after being admitted to the hospice (P < 0.05). However, the elderly (> or = 65 years of age) displayed higher levels of death fear than the younger group at two days before death (P < 0.05). A significant negative correlation was observed between the degree of death fear and the total good death score in both groups at two days before death (P < 0.05). The comprehensive care in the palliative care unit might relate to the relief of the death fear of terminal cancer patients. There is a need for psychological and spiritual care in elderly patients.

Age Distribution↗

Bright liver and alanine aminotransferase are associated with metabolic syndrome in adults.

OBJECTIVES: The metabolic syndrome has become a significant health problem worldwide. In this study, we investigated the relationship between the metabolic syndrome, bright liver (BL) by ultrasonography (US), and plasma alanine aminotransferase (ALT) levels among apparently healthy adults. RESEARCH METHODS AND PROCEDURES: A total of 15,430 nonalcoholic healthy adults without hepatitis B or C were recruited from four nationwide MJ Health Screening Centers in Taiwan in 2000. Metabolic syndrome was defined using the National Cholesterol Education Panel (NCEP) metabolic syndrome criteria or modified NCEP criteria. Based on liver US, subjects were classified into either having BL or not. The relationship between the metabolic syndrome, BL, and ALT levels was examined using multivariate logistic regression analysis. RESULTS: The crude OR of the metabolic syndrome was 13.92 (12.19 using modified NCEP criteria), and the age-BMI-sex-adjusted OR was 3.77 (3.71 using modified NCEP criteria) in subjects with BL vs. subjects without BL, respectively. The ORs of the metabolic syndrome were significantly higher in subjects with elevated ALT levels than in those with normal ALT levels. After adjustment for age, sex, and BMI, BL and elevated ALT level were independently associated with increased risk of the metabolic syndrome. DISCUSSION: Presence of BL and elevated plasma ALT level was independently associated with increased risk of the metabolic syndrome in adults. These factors contribute to a list of well-known risk factors, including obesity, aging, and male sex, and thus can be applied as an additional evaluation for the metabolic syndrome in a clinical setting.

Adult↗

Why Taiwanese hospice patients want to stay in hospital: health-care professionals' beliefs and solutions.

Patient-related barriers and their solution in the planning of discharge to palliative home care were investigated through a nationwide survey conducted in Taiwan. Of 250 questionnaires sent to palliative care workers at 15 hospices in Taiwan, 229 valid questionnaires (91.6%) were retrieved. Most of the respondents were nursing staff (72.5%) while only 38 were physicians (16.6%). Canonical correlation analysis was used to examine the association between the barriers and solutions, and revealed that the value of the first variate was 0.49 ( P<0.05). The barriers and canonical loadings were: unable to manage emergent medical conditions (0.83), the quality of care in the hospital is better (0.74), and insufficient number of caregivers (0.72). The effective solutions that correlated significantly with the above factors were ranked as: to reassure the patient about the possibility of smooth readmission (0.84), to arrange palliative home care programs (0.68), and to educate family members on taking care of the patient at home (0.64). In conclusion, to solve patient-related barriers in the planning of the discharge of patients with terminal cancer, the results suggest that (1). health professionals involved in the care of patients with terminal cancer should have adequate knowledge of palliative care, particularly communication skills, (2). an effective referral system among general or oncology and palliative care units should be established, (3). inpatient care facilities and home-care programs should be provided, and (4). patients and families should be educated as to what may happen and how to manage these conditions at home and should be assured of the availability of medical help.

Adult↗

Prediction of survival in terminal cancer patients in Taiwan: constructing a prognostic scale.

We prospectively identified prognostic factors and developed a prognostic scale in 356 Taiwanese terminal cancer patients (training set). Demographic data, severity of symptoms/signs, and survival were statistically analyzed to create the scale, which was tested in another 184 patients (testing set). In the training set, liver and lung metastases, functional performance status, weight loss, edema, cognitive impairment, tiredness, and ascites were independently associated with shorter survival (multivariate analysis). The scale ranged from 0.0 (no altered variables) to 8.5 (maximal alteration for all variables). When scores were < 3.5, 2-week survival was predicted with 0.72 and 0.61 accuracy for the training and testing sets, respectively. With scores < 6.0, 1-week survival was predicted with 0.72 and 0.66 accuracy, respectively. This scale, which includes lung and liver metastases and severity of symptoms/signs, may help in identifying the stage of dying and its corresponding symptoms/signs and also in improving survival prediction in terminal cancer patients.

Adult↗

Dyspnea and its correlates in taiwanese patients with terminal cancer.

This study prospectively assessed dyspnea and related bio-psycho-social-spiritual factors--including severity, cause, psychological distress, and fear of death--that were possibly related to dyspnea in 125 terminal cancer patients at admission and two days before their death. At admission, 74 patients had dyspnea, which improved but later worsened. Causes included cachexia, anemia, pleural effusion, and lymphangitis. Quality of life, anxiety, depression, and fear of death improved after admission; anxiety was correlated with dyspnea before death (r = 0.211, P < 0.05, univariate analysis). Lung infection (odds ratio = 2.29, 95% confidence interval = 0.68-3.90; multiple regression), airway obstruction (2.27, 1.41-3.13), acidemia (1.82, 0.72-2.98), and pericardial effusion (1.38, 0.44-2.32) were independent correlates of dyspnea severity at admission (42.8% of explained variance). Before death, airway obstruction, esophageal cancer, pericardial effusion, lung infection, and mediastinal mass were independent correlates of severity (42.7% of explained variance). Comprehensive care, including improved psychospiritual status, can help in controlling dyspnea and enhancing patients' quality of life.

Adolescent↗

Terminal cancer patients' wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan.

Identifying the concerns of terminal cancer patients and respecting their wishes is important in clinical decision-making concerning the provision of artificial nutrition and hydration (ANH). The aim of this study was to discover terminal cancer patients' wishes and determine influencing factors toward the provision of ANH. One hundred and ninety-seven patients with terminal cancer, admitted to a palliative care unit in Taiwan over a two-year period, completed a questionnaire interview, which included demographic characteristics, knowledge and attitudes on ANH, the health locus of control, subjective norms, and the wishes to use ANH. One hundred and fifty-four patients (78.2%) used ANH in the past month. A knowledge test on issues related to ANH showed the rates of accurate responses were ranked as: peripheral intravenous route can only provide hydration (48.7%), excessive artificial nutrition may increase the proliferation of cancer cells (32%), ANH can prolong life expectancy for all patients (17.3%), and ANH can prevent all patients from starving to death (5.6%). The strongest attitude of patients toward the potential benefit of ANH was "it can provide the body need with nutrition and hydration when inability to eat or drink occurs." Otherwise, the strongest attitude toward the potential burdens of ANH was "gastrostomy makes the illness worse." One hundred and twenty-two of 197 patients (62.9%) expressed their wishes to have ANH. The results of logistic regression analysis showed that the experience of using a nasogastric tube and intravenous fluids, and subjective norms were the most significant variables related to the wishes of patients to use ANH (odds ratio [OR]=11.11, 95% confidence interval [CI]=3.20-38.64; OR=2.51, 95% CI=1.22-5.15, OR=1.30, 95% CI=1.05--1.60, respectively). However, the use of artificial nutrition was negatively affected by the knowledge of ANH (OR=0.53, 95% CI=0.37-0.84). In conclusion, Taiwanese patients with terminal cancer have insufficient knowledge about AHN and still believe in the benefits of ANH, especially in avoiding dehydration or starvation. The findings of this study indicate the importance of medical professional training and decision-making in the initial consideration of using ANH. By improving the knowledge about ANH among patients, more appropriate decisions can be achieved.

Adult↗

Morphine for dyspnea control in terminal cancer patients: is it appropriate in Taiwan?

Morphine for dyspnea control usually arouses ethical controversy in terminal cancer care. This study prospectively assessed the use of morphine for dyspnea control in terminal cancer patients in terms of two characteristics: the extent to which medical staff, family, and patients found morphine to be ethically acceptable and efficacious, and the influence of morphine on survival. One hundred and thirty-six palliative care patients meeting specific eligibility criteria were enrolled. A structured data collection form was used daily to evaluate clinical conditions, which were analyzed at the time of admission and 48 h before death. Sixty-six (48.6%) of the 136 patients had dyspnea on admission. The intensity was mild in 14.0% and moderate or severe in 34.6%. The intensity of dyspnea became worse 48 h before death (4.29+/-2.55 vs. 4.94+/-2.60, P < 0.001, range 0-10). Twenty-seven (40.9%) of 66 patients with dyspnea received morphine on admission for the control of dyspnea; the routes of administration were oral (59.3%) and subcutaneous (40.7%). Fewer than two-thirds (59.3%) of the patients were given morphine with the consent of both patient and family. More than one-third (40.7%) on admission and about one-half (52.8%) in the 48 h before death had the consent of family alone. Positive ethical acceptability and satisfaction with using morphine for dyspnea control were found in both medical staff and family in this study. Multiple Cox regression analysis showed that using morphine for dyspnea, both on admission and in the 48 h before death, did not significantly influence the patients' survival (HR: 0.015, 95% CI: 0.00-4.23; HR: 1.76, 95% CI: 0.73-4.24). In this population, the use of morphine for dyspnea control in the terminal phase of cancer was effective and ethically validated in the study. Research efforts to find the most appropriate route and dosage of morphine for dyspnea, based on the patient's situation, remain worthwhile.

Adolescent↗

The hypoglycemic effects of soy isoflavones on postmenopausal women.

OBJECTIVES: Soy isoflavones have many effects similar to those of estrogen and have become popular among postmenopausal women as an alternative for hormone replacement therapy (HRT). The purpose of this study was to determine the effects of soy isoflavones on glucose, insulin, and lipid profiles in postmenopausal Taiwanese women. METHODS: We conducted a randomized, double-blind, active placebo-controlled clinical trial to compare the effects of isoflavones with estrogen replacement therapy (ERT) on blood glucose, insulin, and lipid profiles in postmenopausal Taiwanese women. Thirty postmenopausal Taiwanese women were randomly assigned to two groups, and each received treatment for 6 months. The isoflavone group received 100 mg isoflavone soft capsules, 300 mg calcium, and a blank vitamin capsule per day. The estrogen active control group received 0.625 mg conjugated estrogen, 300 mg calcium, and blank isoflavone soft capsules per day. We measured baseline levels of fasting blood sugar, insulin, lipid profiles, and isoflavone concentrations prior to the study and repeated the same measurements every 3 months for a total duration of 6 months. RESULTS: Two-way ANOVA revealed that fasting glucose (p < 0.001) and insulin (p < 0.005) levels were significantly affected by estrogen and isoflavone treatments after 6 months. For the isoflavone group, the average blood genistein concentration was 6-10 times higher than those of the estrogen group. Within the same periods, the fasting blood glucose was reduced to 83% and 85% of the baseline levels, and insulin was reduced to 56% and 67% of the baseline levels, respectively, in the estrogen and isoflavone groups. CONCLUSIONS: Soy isoflavones (100 mg) and 0.625 mg conjugated estrogen equally lower fasting blood glucose and insulin levels in postmenopausal women.

Aged↗

Using senior residents as standardized patients for evaluating basic clinical skills of medical students.

BACKGROUND AND PURPOSE: The use of standardized patients (SPs) is a powerful method for performance evaluation in medical education. It has gained increasing popularity in teaching and evaluation of clinical skills of medical students in the last decade. Maintaining an active and effective SP program requires a tremendous amount of financial and manpower investment, which may be difficult for many medical schools to provide. This study investigated the feasibility and effectiveness of using senior residents as SPs (SRSPs) to alleviate the financial and manpower burdens of an SP program. METHODS: A total of 112 fifth year medical students and 26 third year senior residents from a university hospital participated in this research in 2000. Students at the end of a 9-week rotating clerkship in internal medicine formed groups of 7 members. Senior residents took multiple roles as case developers, SPs, teachers, and evaluators. Test and recess stations were integrated, and sequential individual and group discussion with SRSPs was used to provide feedback immediately after the completion of the examination. Students were given a test report including scores and written narrative feedback. Semi-constructive questionnaires were used for opinion survey from students as well as the SRSPs. RESULTS: All SRSPs demonstrated their ability to function in multiple roles and regarded the SRSP experience as helpful to improve this ability. Most SRSPs (89%) considered the experience beneficial in improving their clinical teaching skills. Ninety percent of SRSPs thought that a case should be portrayed for no more than 4 hours in order to maintain the consistency and accuracy. Seventy two percent of medical students reported that SRSPs' status as teachers did not interfere with their performance, 68% reported being able to treat SRSPs as real patients, and 96% reported that the evaluation was helpful to their professional development. CONCLUSIONS: An SRSP program is feasible, practical, and easy to establish. It can provide benefits to both students and senior residents with clinical training responsibilities, and serve as an alternative method for performance evaluation of students in medical schools with limited resources.

Clinical Clerkship↗

Nurses' willingness and the predictors of willingness to provide palliative care in rural communities of taiwan.

The aims of this study are to identify the willingness of district nurses to provide palliative care in the rural communities in Taiwan and determine the predictors of this willingness. A questionnaire was sent to all 1,121 community nurses of the 174 government health stations assigned to all the rural areas of Taiwan. The overall response rate was 86.4%, with 940 valid questionnaires retrieved. The majority of respondents (93.0%) expressed a willingness to provide palliative care if they encountered a terminal cancer patient. However, they would limit their services to consultation and referral (91.6% and 87.3%), and were less likely to provide home visiting (51.0%) or bereavement support of family (38.4%). With regard to knowledge, the accurate answers to the philosophy/principles and clinical practice of palliative care were 88.5% and 43%, respectively. The results of stepwise logistic regression analysis showed that "palliative care knowledge," "the belief in external control by authority," and "the belief in external control by chance" were the most significant variables related to the willingness of district nurses to provide palliative care (OR=12.83, 95% CI=2.46-66.76, P<0.01; OR=2.11, 95% CI=1.32-3.35, P<0.01; OR=0.54, 95% CI=0.31-0.95, P<0.05, respectively). However, regarding the content of services, the willingness to provide home visiting was affected positively by the level of information resources, subjective norms, and the belief in external control by authority. This willingness was negatively affected by age of the patient. These data suggest that effective training courses focused on practical knowledge of palliative care for these district nurses, the incorporation of the palliative care into nursing education, and active health policy administration are critical for the community palliative care movement in Taiwan.

Adult↗