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Chen Y.-M.,Kaohsiung Municipal Hsiao Kang Hospital | Chen Y.-M.,Kaohsiung Medical University | Johantgen M.E.,University of Maryland, Baltimore
International Journal of Nursing Studies

Background: The Magnet Recognition Program in the USA has been based on 14 hospital characteristics that were common in hospitals that were "magnets" for professional nurses. While the program has expanded to other countries, no research has explored how the concept translates to other cultures and healthcare systems, nor have multilevel approaches been used. Objective: The primary aim of this study was to explore the presence of Magnet Hospital attributes in hospitals in two European countries. In addition, the relationship between Magnet Hospital attributes and nurses' job satisfaction was examined at both the nurse and the hospital level. Design: A secondary data analysis with cross-sectional design was conducted. A multilevel approach was taken to account for the hospital effect due to the nested nature of the data. Settings: Nurses practicing in acute care hospitals in Germany (16) and Belgium (15) were examined. Hospitals that had less than five respondents were excluded. Participants: Survey responses from 2303 registered nurses (RNs) from Belgium and 2646 RNs from Germany were included. Non-RN providers, RNs with administrative positions, and those working in non-inpatient areas were excluded. The final sample was 3182 staff nurses working in acute care hospitals. Methods: Magnet Hospital attributes that might be represented in NEXT survey items were reviewed by an expert panel before psychometric testing. Only six Magnet Forces could be measured. Latent constructs of these forces and job satisfaction were established. The measurement models and structural regression models were estimated using multilevel modeling in Mplus 4.21. Results: Six Magnet Forces were validated by two-level confirmatory factor analyses, with good fit to the data as demonstrated by the fit indices. All six Magnet Forces significantly predicted job satisfaction at the nurse level, with personnel policies having the strongest effect (b = 0.96). At the hospital level, management style had the strongest effect (b = 0.84) in predicting job satisfaction, followed by professional development, interdisciplinary relationship, and autonomy. Conclusions: Magnet Hospital attributes are evident in hospitals in two European countries and were found to be associated with job satisfaction. Further multilevel research should explore these attributes particularly at the nursing unit-level where work environment is experienced. © 2010 Elsevier Ltd. Source

Lin S.-Y.,Kaohsiung Medical University | Chiang H.-Y.,Chi Mei Medical Center | Chiang H.-Y.,Chang Jung Christian University | Chen I.-L.,Kaohsiung Municipal Hsiao Kang Hospital
Nursing and Health Sciences

Few existing studies have compared nurses' perceptions of the practice environment in relation to intent to leave or stay in employment and nursing concurrently. This study compared the differences between Taiwanese nurses' intent to leave or stay in employment and nursing, as related to their perceptions of the practice environment. A cross-sectional questionnaire survey was conducted at four hospitals in southern Taiwan. Questionnaires including the Chinese Nursing Practice Environment Scale, regarding intention in employment and nursing, were distributed to 535 nurses who provided direct patient care in Taiwan hospitals. Taiwanese nurses with intent to stay perceived the practice environment as better than nurses with intent to leave employment and nursing. The influences of the nursing practice environment on nurses' intent in employment and nursing were supported preliminarily. Targeting interventions to enhance participation in hospital affairs and adequacy of staffing and resources could be beneficial for a stable nursing workforce. © 2011 Blackwell Publishing Asia Pty Ltd.. Source

Lee C.-H.,Kaohsiung Municipal Hsiao Kang Hospital | Lee C.-H.,Kaohsiung Medical University | Yu H.-S.,Kaohsiung Medical University
Current Problems in Dermatology

Atopic dermatitis (AD) is a common allergic disease and constitutes a huge social and economic burden for the whole country. AD usually heralds other allergic diseases, such as asthma and allergic rhinitis. The pathogenesis of AD remains to be studied but generally includes abnormal skin barrier and aberrant cutaneous immune responses. Biomarkers are important in monitoring disease severity, prognosis and treatment responses. With the investigation and robust knowledge on AD pathophysiology, more and more biomarkers are being explored. Aberrant cutaneous inflammation is associated with Th2 polarization, chemokine upregulation in Langerhans cells and keratinocytes, IgE production by B cells, and degranulation of mast cells and eosinophils, subsequently leading to changes in the levels of cell-specific biomarkers in blood or urine. Furthermore, skin barrier abnormalities, including increased transepidermal water loss and decreased skin hydration, are biomarkers for severity and itch intensity in AD. Cross-talk between skin barrier abnormalities and aberrant immune responses is evidenced by epidermal abnormalities enhancing the release of keratinocyte-derived cytokines and chemokines, including CC chemokine ligand (CCL) 17, CCL27 and thymic stromal lymphopoietin, resulting in modulation of skin immune responses. The pathophysiology of itch in AD remains unclear. The subjective nature of itch makes biomarkers to estimate its intensity crucial in AD patients. Pruritus results from the activation of small nerve endings in the skin by noxious mediators, including neuropeptides, proinflammatory cytokines and prostaglandins, all of which might serve as potential biomarkers for itch. Recently, IL-31 and gastrin-releasing peptide have been reported to be involved in the development of itch, making the estimation of itch intensity a future reality. With the enormous amount of research in immunology, skin physiology and neurology in AD, more biomarkers in AD and its itch will be found in the near future. Copyright © 2011 S. Karger AG, Basel. Source

Chou S.-H.,Kaohsiung Medical University | Li H.-P.,Kaohsiung Medical University | Lee J.-Y.,Kaohsiung Medical University | Huang M.-F.,Kaohsiung Medical University | And 2 more authors.
World Journal of Surgery

Background: The prognosis and quality of life (QOL) for those with cervical esophageal cancer is extremely poor, and chemoradiotherapy remains the mainstay treatment. During the past few years, our surgical teams has implemented a more aggressive and radical resection: total laryngopharyngectomy with neck dissection, total esophagectomy, and reconstruction with stomach. This study compares the results of chemoradiotherapy and that of the aforementioned surgical approach. Methods: This is a retrospective study of 15 patients who underwent radical resection and 14 patients who received chemoradiation. Their age, sex, tumor stage and grade, pre- and posttreatment dysphagia scores, operating time, blood loss, length of intensive care and postoperative stay, days to resume oral intake, complications, Eastern Cooperative Oncology Group (ECOG) status, QOL score, and disease-specific survival were recorded and compared. Results: There were no significant differences in age, sex, pretreatment dysphagia score, cancer stage and grade, ECOG status (posttreatment), associate diseases, preoperative QOL, or follow-up period between the two groups. However, the posttreatment dysphagia score was significantly better for the operative group (P < 0.001). QOL improved in both groups, and the operative group seemed better although the difference was not significant. In addition, the survival between the two groups was statistically insignificant (P = 0.97, log-rank test). Conclusions: Our experience showed that radical surgery that includes total laryngopharyngectomy with neck dissection, total esophagectomy, and reconstruction with stomach for cervical esophageal cancer is beneficial to patients in terms of better eating. © 2010 Société Internationale de Chirurgie. Source

Kao A.-P.,Kaohsiung Medical University | Wang K.-H.,Kaohsiung Medical University | Chang C.-C.,Michigan State University | Lee J.-N.,Kaohsiung Medical University | And 5 more authors.
Fertility and Sterility

Objective: To elucidate the role of endometrial stem-progenitor cells in the etiology of endometriosis and to develop an animal model to study the invasion ability of endometrial cells. Design: Gene expression and cell function studies were designed. Setting: Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Patient(s): Human endometrial mesenchymal stem cells (MSCs) were isolated from 22 different endometrium biopsies after surgery for treatment of endometriosis. Intervention(s): Endometrial MSCs developed from eutopic and ectopic endometrial tissues. Main Outcome Measure(s): Characterization of MSC phenotypes (i.e., differentiation induction and gene expression by flow cytometric analysis); comparative study of cell functions (i.e., cell growth, migration, and invasion assays). The invasion of implants in an animal model was examined by histologic staining. Result(s): We compared the characteristics of eutopic and ectopic endometrial MSCs from the same endometrial donor. Although both showed similar mesenchymal cell phenotypes, ectopic endometrial MSCs showed distinctly greater ability of cell migration and invasion. Furthermore, in an in vivo cell invasion model using cells grown in scaffold and transplantation in immune-deficient mice, the ectopic endometrial MSCs were found to form many new blood vessels and to invade surrounding tissue. Conclusion(s): These results indicate unique invasion and angiogenesis characteristics of ectopic endometrial MSCs that may underlie the pathogenesis of ectopic endometriosis. The animal invasion model will be useful for future characterization of endometrial MSCs. © 2011 American Society for Reproductive Medicine, Published by Elsevier Inc. Source

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