Narrative medicine and humanities for health professions education: an experimental study

BACKGROUND

Narrative medicine can serve as a tool to empathize with human beings' predicament and suffering. The research intended to examine whether the use of narrative medicine to form an empathetic connection could bring any positive impacts on health professions students.

METHODS

A two-group quasi-experimental design was adopted to examine whether the intervention of narrative medicine to form an empathetic connection could demonstrate differences between the experimental group (35 students) and the control group (32 students) with regard to professional identity, self-reflection, emotional catharsis, and reflective writing competency. These 67 participants were health professions students in a medical university (mean age = 20.02; SD = 0.23), with varied majors in health disciplines. The 16-week intervention was the use of narrative medicine to form an empathetic connection with those suffering, via the three stages of narrative medicine: attention → representation → affiliation. The quantitative instruments included a professional identity scale (PIS-HSP), a reflective thinking scale (RTS-HSP), and an emotional catharsis scale (ECS-IN), as well as an analytic reflective writing scoring rubric (ARWSR-HSP). To triangulate the quantitative results, the study also used the student interviews. The SPSS software was used to analyze the data.

RESULTS

The quantitative results demonstrated that the narrative medicine-based intervention could bring positive effects on the health professions students. After going through the intervention, the students in the experimental group had stronger professional identity, a higher reflective thinking level, more emotional catharsis, and greater improvement in reflective writing competency than those not receiving the intervention, though some subscales not reaching statistical significance.

CONCLUSION

This research results proved that the use of narrative medicine to form an empathetic connection could bring positive impacts on health professions students regarding professional identity, self-reflection, emotional catharsis, and self-reflective writing competency.

The use of social cognitive learning for humanistic professional role modelling: impacts on awareness of humanistic professionalism, caring behaviour, and transitional anxiety

BACKGROUND

Although medical literature has highlighted the importance of role modelling, hardly any reveals how humanistic qualities and role modelling should be taught. This study aimed to determine whether the use of Bandura's social cognitive learning for humanistic professional role modelling could elicit any positive effect on medical university students' awareness of humanistic professionalism, caring behaviours, and school-to-work transitional anxiety.

METHODS

We conducted a 16-week quasi-experimental study to examine whether the intervention could elicit any differences between the experimental group (BanduraSCLT - HPRM - Literature-and-Film Study; N = 34) and the control group (non-BanduraSCLT - HPRM - Literature-and-Film Study; N = 33), comprising of medical university students from the central part of Taiwan. The quantitative instruments included the Humanistic Professional Awareness Scale (HPAS-HSP), Caring Behaviour Scale (CBS-HSP) and School-to-Work Transitional Anxiety Scale (StWTA-HS). One-way MANOVA (multivariate analysis of variance) and one-way MANCOVA (multivariate analysis of covariance) were used for statistical analysis.

RESULTS

The results revealed that students who received Bandura's social cognitive learning for humanistic professional role modelling had significantly stronger humanistic professional awareness in terms of 'personal integrity and accountability', 'sensitivity to others' and 'professional competence'. They also had more effective caring behaviour in terms of 'support and attentiveness', 'professional knowledge and skills', 'gratifying needs and responsiveness' and 'confidentiality and trust'. In addition, they had less school-to-work transitional anxiety in terms of 'inexperience in professional knowledge and skills', 'fear of death', 'fear of being infected' and 'interpersonal interactions.'

CONCLUSION

The findings suggest that using Bandura's social cognitive learning for humanistic professional role modelling can have a positive impact on awareness of humanistic professionalism, caring behaviour and school-to-work transitional anxiety. Hence, it can be an effective teaching tool for medical education.

A Scale Development for Visual Literacy on Health Students and Professionals

Objective

Viewing that there is a lack of valid and reliable measures to assess visual literacy in clinical and healthcare settings, this study aimed to develop a visual literacy scale to assess health students' and professionals' visual literacy, by which teachers can further help them sharpen their visual literacy skills and sensitivity to let them reach effective communication in clinical and healthcare settings.

Methods

The scale was constructed according to Slavec and Drnovšek's three-phase scale development process: theoretical significance and existence of the scale construct, representative data collection and appropriate data collection methods, and statistical analysis of data collection and statistical evidence of the scale construct. To investigate the psychometrical properties, the researchers first performed a pilot study on randomly selected 464 health students and professionals, using exploratory factor analysis (EFA) with SPSS to derive the hidden factor structure, and then on randomly selected 303 participants, using confirmatory factor analysis (CFA) with AMOS to validate the derived factor structure. Internal consistency, convergent validities, discriminant validities, and goodness-of-fit indices were also examined in the study.

Results

After going through the EFA, 30 items in three factors were identified: "allegorical meaning" (12 items), "explicit meaning" (10 items), and "symbolic meaning" (8 items). The three factors explained 73.191 of the total variance. The CFA generated the same three factors and 22 items: "allegorical meaning" (12 items), "explicit meaning" (4 items), and "symbolic meaning" (6 items). The three factors accounted for 75.022% of variance. Both the EFA and CFA models demonstrated satisfactory goodness-of-fit and good convergent and discriminant validities. Regarding the reliabilities, the Cronbach's alpha values in the EFA and CFA models were all above 0.90.

Conclusion

The findings have demonstrated that the VLS-HSP can be a formal instrument to measure visual literacy on health students and professionals.

Development and psychometric testing of a scale measuring caring behaviors for healthcare students and providers

This study intended to develop and assess the psychometric properties of a caring behavior scale on healthcare students and providers (CBS-HSP) in a Taiwanese population. After a literature review was conducted and an expert panel was consulted for item generation, 104 items for the CBS-HSP scale were derived on a nine-point Likert scale, with 9 indicating 'extremely important' and 1 indicating 'extremely unimportant.' A pilot study was then conducted with seven hundred forty-eight healthcare students and providers in Taiwan for further data analysis. The statistic software used in the study was SPSS for the exploratory factor analysis (EFA) and AMOS for the confirmatory factor analysis (CFA). Also, to examine the psychometric properties of the scale, internal consistency, convergent validities, discriminant validities, and model fit indices were calculated in the study. The EFA results derived 31 items in four factors, with 65.742% of the total variance explained: 'support and attentiveness' (11 items; 48.714% of the variance explained), 'professional knowledge and skills' (8 items; 8.226% of the variance explained), 'gratifying needs and responsiveness' (7 items; 5.236% of the variance explained), and 'confidentiality and trust' (5 items; 3.566% of the variance explained). The Cronbach's alphas for the four subscales and the overall scale ranged from 0.894 to 0.964. The CFA results yielded the same 31 items, with the same four factors. The CFA results demonstrated good to excellent model fit in the χ2/df ratio (1.242), GFI (0.988), CFI (0.988), TFI (0.985), and RMSEA (0.031). The Cronbach's alphas ranged between 0.866 and 0.971; the composite alphas ranged between 0.854 and 0.964. The convergent and discriminant validities also proved the stability of the CBS-HSP scale. The research results indicated that the developed CBS-HSP appeared to be a reliable instrument to measure healthcare students' and providers' caring behaviors.

The Study of Learning Computer Programming for Students with Medical Fields of Specification—An Analysis via Structural Equation Modeling

In this study, the authors constructed structural equation models in order to determine the relationship between students’ learning attitudes and their computational thinking perspectives and programming empowerment. The purpose is to understand students’ perceived competence to use computational thinking effectively, along with their computer programming learning attitude regarding the C++ programming language for one semester (2 hours per week, 36 total learning hours). A total of 495 students specializing in the medical field participated in the study. Structural equation models were constructed according to three adapted scales: the computer programming learning attitude scale, the computational thinking perspectives scale, and the programming empowerment scale. The computer programming learning attitude scale is based on three factors: willingness, negativity, and necessity. The computational thinking perspectives scale also considers three factors: the ability to express, the ability to connect, and the ability to question. The programming empowerment scale is composed of four factors: meaningfulness, impact, creative self-efficacy, and programming self-efficacy. The results showed that a positive learning attitude will positively affect computational thinking perspectives and programming empowerment. However, when students have a negativity attitude, feeling that they are being forced to learn the C++ programming language, their computational thinking perspectives and programming empowerment will be negatively affected. In order to promote students’ learning attitude, various teaching strategies, teaching curriculum design, and pedagogy design could be further explored.

A Desperate Need for Psoriasis Health Care in Remote Regions as Revealed by a Live Interactive Teledermatology Program Serving Penghu Islands in Taiwan Strait

Introduction: Several studies indicated that teledermatology is good for people living on offshore islands. However, what disease benefits the most from interactive dermatology geographically in offshore islands remain uncertain. Objectives: This study aimed to investigate the seasonal and geographical distribution with different diseases in remote regions of Penghu islands in Taiwan Strait, thus to study the medical needs for specific disease in remote islands. The cost differences among three models by professional dermatologists were analyzed. Methods: This interactive teledermatology program serving Penghu Hospital, Ministry of Health and Welfare (MOHW-PH, March 2020 to February 2021) from a medical center in Taiwan recruited 145 patients with 280 patient-visits. The seasons, the timing from residential houses to MOHW-PH, the number of disease diagnosis, and the numbers of teledermatology visits are compared. The association of the distance from residential houses to MOHW-PH with different disease diagnosis was analyzed. Results: Eczema (33%), dermatophytosis (13%), and psoriasis (11%) were most common. Seasonal analysis showed dermatophytosis and eczema are more common in summer and winter, respectively. Geographical analysis showed that psoriasis has relatively higher case numbers, higher visits per case, with cases living in longer distances. The patient satisfaction was good (>95%). Among the three care modes of dermatologist, the cost estimation of interactive teledermatology and in-person clinic were similar yearly (2.4-2.9 million New Taiwan Dollars, roughly 80,000-90,000 USD). Conclusions: The study indicates that health care for psoriasis, being underprivileged but in desperate need in distant regions, could be delivered with quality and satisfaction by interactive teledermatology.

Development and Validation of a Scale Measuring Humanistic Professional Awareness for Healthcare Students and Providers

Objective

This study aimed to develop an appropriate scale accessing healthcare students’ and providers’ humanistic professional awareness (HPAS-HSP).

Methods

Following a literature review, stakeholder interviews, and panel discussions for item generation, 65 items for the HPAS-HSP scale were created based on a nine-point Likert scale, with 9 indicating “strongly agree” and 1 indicating “strongly disagree.” A pilot study using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), with seven hundred twenty-five medical care students and providers in Taiwan as the total sample number of the study, was administered to examine the practicability of the HPAS-HSP scale. The statistics software SPSS and AMOS 24.0 were used to examine the psychometric properties of the scale, including internal consistency, convergent validities, discriminant validities, and exploratory and confirmatory factor analysis.

Results

The EFA resulted in 21 items in three factors, with 66.221% of the total variance explained: “personal integrity and accountability” (9 items; 51.763% of the variance explained), “sensitivity to others” (6 items; 8.667% of the variance explained), and “medical professional competence” (6 items; 5.791% of the variance explained). The Cronbach’s alphas for the three subscales and the entire questionnaire ranged from 0.892 to 0.949. The CFA results yielded 20 items, with the same three factors, and demonstrated good model fit in the χ²/df ratio (1.130; p = 0.140), CFI (0.998), TFI (0.998), and RMSEA (0.013). The composite alphas ranged between 0.900 and 0.969. Convergent and discriminant validity also confirmed the stability and consistency of the scale.

Conclusion

The statistical results demonstrated that the HPAS-HSP scale can be a measure to assess healthcare students’ and providers’ humanistic professional awareness.

Development and Validation of a Chinese Version of a School-to-Work Transition Anxiety Scale for Healthcare Students

OBJECTIVE

The aim of this paper was to develop an appropriate scale measuring healthcare students' anxiety during the transition from school to work.

METHODS

After an extensive literature review and panel discussion to prove the face validity and content validity, the initial item pool was reduced to 52 items. In a pilot study, a sample of four hundred and twenty-four healthcare students participated, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. Psychometric properties-construct validity, convergent validity, discriminant validity, goodness of fit, and reliabilities-were also analyzed.

RESULTS

After the use of EFA, the 52 items were reduced to 31 items in four factors, with 66.70% of the total variance explained. The Cronbach's alpha values ranged between 0.91 and 0.93. The study also used CFA to validate the EFA model, and the results demonstrated that with the same thirty-one items in a 7-point Likert scale, the model was a better fit in four factors: "inexperience in professional knowledge and skills" (nine items; factor loadings: 0.642-0.867; 43.72% of the variance explained), "fear of death" (eight items; factor loadings: 0.745-0.831; 9.94% of the variance explained), "fear of being infected" (eight items; factor loadings: 0.678-0.866; 7.86% of the variance explained), and "interpersonal interactions" (six items; factor loadings: 0.704-0.913; 5.18% of the variance explained). The CFA model demonstrated a good model fit in the χ²/df ratio (1.17; p = 0.016), CFI (0.99), TFI (0.99), and RMSEA (0.02). The composite reliabilities ranged from 0.89 to 0.92, confirming the StWTA-HS scale's stability and internal consistency. The convergent validity and discriminant validity were also confirmed. The StWTA-HS scale has been proven to be a stable scale to measure healthcare students' school-to-work transition anxiety.

Integrating the Gender Perspective into Literature Studies to Enhance Medical University Students' Gender Awareness and Critical Thinking

OBJECTIVE

This study attempted to integrate the gender perspective into literature studies to allow medical university students to examine internalized gender prescriptions and investigate whether the integration of the gender perspective into literature studies would create any difference among students in gender awareness and critical thinking.

METHODS

This study used fifteen-week quasi-experimental research to verify the feasibility of using the gender perspective in literature studies to arouse medical university students' gender awareness and critical thinking. Before and after the intervention, a gender awareness test and a critical thinking disposition test were carried out by both the experimental group (41 students) and control group (41 students).

RESULTS

The findings show that regarding gender awareness, with the integration of the gender perspective into literature studies, medical university students had significantly higher post-test scores for "public gender consciousness" and "private gender consciousness." In regard to critical thinking, they also had significantly better post-test scores in "systematicity and analyticity," "maturity and skepticism," and "inquisitiveness and conversance."

CONCLUSION

This study demonstrated that the integration of the gender perspective into literature studies could result in positive learning outcomes among medical university students in terms of gender awareness and critical thinking.

Development and Validation of a Chinese Version of a Professional Identity Scale for Healthcare Students and Professionals

This study was intended to develop a comprehensive and psychometrically adequate professional identity scale for healthcare students and professionals based on Taiwanese cultural contexts. In order to elicit a more consistent result of the psychometric indices of the newly developed scale, the study adopted a combination of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to examine the consistency of the scale factors. In a pilot study of 562 randomly selected healthcare students and professionals, the EFA yielded a 33-item four-factor model with the terms "professional commitment & devotion" (16 items; 47.33% of variance), "emotional identification & belongingness" (7 items; 9.72% of variance), "professional goals & values" (5 items; 8.17% of variance), and "self-fulfillment & retention tendency" (5 items; 3.38% of variance). The CFA yielded an 18-item four-factor model with good or even excellent fit to the data, where the χ²/df ratio = 1.138, Tucker Lewis index (TLI) = 0.997, comparative fit index (CFI) = 0.997, and root mean square of approximation (RMSEA) = 0.016. The convergent validity and discriminant validities were also conducted to test the feasibility of the Professional Identity Scale for Healthcare Students and Professionals (PIS-HSP) scale. For the EFA model, the Cronbach's alphas for the four factors and the overall scale ranged from 0.84 to 0.96; for the CFA model, the Cronbach's alphas and composite reliabilities were, respectively, in the ranges of 0.78-0.93 and 0.78-0.97, demonstrating satisfactory reliabilities. The results proved that the developed PIS-HSP can be a reliable measurement tool to assess professional identity for healthcare students and professionals.

Development and Validation of the Patient–Healthcare Provider Communication Scale: Chinese Version

Our objective was to construct the Patient–Healthcare Provider Communication Scale (P–HCS) in Chinese. An initial sample of 494 healthcare students and providers in Taiwan participated in the scale development stage, and another sample of 150 participants was then used to examine the test–retest reliability and concurrent validity of the P–HCS. We conducted exploratory factor analysis and derived 23 items across 4 factors: perception of trust and receptivity, patient-centered information giving, rapport building, and facilitation of patient involvement. Significant correlations between the P–HCS and the Provider-Patient Relationship Questionnaire also provided evidence of our scale's concurrent validity. The Cronbach's α and test–retest reliability coefficients for the entire scale and subscales ranged from .72 to .93, and from .80 to .90, respectively. Thus, the P–HCS can be considered a reliable and valid instrument to measure patient–healthcare provider communication in the Chinese context.

Reflective Thinking Scale for Healthcare Students and Providers—Chinese version

We developed the Reflective Thinking Scale for Healthcare Students and Providers (RTS-HSP) in Chinese by conducting a systematic literature review and consulting with a panel of experts. Participants were 579 randomly selected healthcare students and professionals from Taiwan. Using exploratory factor analysis we developed 22 items rated on a 9-point Likert scale, and extracted 4 factors: reflective skepticism (6 items explaining 29.48% of the variance), self-examination (6 items explaining 11.41% of the variance), empathetic reflection (5 items explaining 8.96% of the variance), and critical open-mindedness (5 items explaining 6.81% of the variance). Cronbach’s alpha reliability values for the 4 dimensions and the overall scale ranged from .77 to .87. An assessment of the RTS-HSP’s concurrent validity with the Questionnaire for Reflective Thinking also supported our scale’s external validity. Thus, the RTS-HSP can be considered a reliable instrument for measuring reflective thinking among healthcare students and professionals.

The Impact of the Hazard Correlation between Risk Factors and Diabetes

This study examined the occurrence of diabetes and sustainable risk factors in residents aged 30 and above of a community in Taoyuan County, Taiwan. The main purpose of this research was to explore the correlations between related variables and the occurrence of diabetes. The demographic variables, health exam variables, healthy behavior variables, and environmental variables had obvious impacts on the risk of diabetes. As age increased, the risk of developing the disease also increased; higher educational levels lowered risk, while unemployment raised it. Also, analysis of the health exam variables showed that abnormal BMIs, waist-hip ratios, and body fat percentages had significant impacts on individuals' risk of diabetes. Moreover, it was found that smoking affected the risk of having diabetes: smokers, particularly male smokers, had a relatively higher risk of developing the disease. Lastly, the results showed that exposure to second-hand smoke did not have a significant effect on the diabetes proportion in the male population. However, a significantly higher proportion of females who had been exposed to second-hand smoke had diabetes.

Using comprehension strategies for students' self-efficacy, anxiety, and proficiency in reading English as a foreign language

We examined whether or not instructing Taiwanese students in the use of comprehension strategies when they are reading English as a foreign language, reduces their English reading anxiety and increases their English reading self-efficacy and proficiency. We used a quasiexperimental design and conducted a 15-week course. The experimental group (n = 31) received instruction in reading comprehension strategies and the control group (n = 31) received instruction by traditional teaching methods. The results show that the experimental group had less anxiety when reading English and higher proficiency than the control group. In regard to self-efficacy when reading English, the experimental group also performed better than the control group in terms of self-affirmation, perseverance, verbal persuasion, and performance overall. However, there was no statistically significant difference for learning attitude between the groups.

Development and validation of the Empathy Scale in Patient Care: Chinese version

Our objective was to construct a comprehensive and psychometrically tested Chineselanguage Empathy Scale in Patient Care (ES-PC) for use with Taiwanese people. We randomly selected 820 medical-care students and professionals who provided 789 valid responses to a written survey. After exploratory factor analysis, 23 items were derived, which were rated on a 9-point scale, and 3 factors were elicited: behavioral empathy (9 items; 44.73% of total variance), affective empathy (7 items; 10.99%), and intellectual empathy (7 items; 5.71%). The Cronbach's α coefficient values for the 3 subscales and the overall scale ranged from .87 to .94, indicating internal consistency. Evidence of concurrent validity was also provided to support the external validity of the ES-PC. The test–retest correlation coefficient for the entire scale was r = .89. The findings proved that the ES-PC could be a reliable and valid instrument to measure the level of empathy in the medical cultural context of Taiwan.

The application of heterogeneous cluster grouping to reflective writing for medical humanities literature study to enhance students' empathy, critical thinking, and reflective writing

BACKGROUND

To facilitate interdisciplinary collaboration and to make connections between patients' diseases and their social/cultural contexts, the study examined whether the use of heterogeneous cluster grouping in reflective writing for medical humanities literature acquisition could have positive effects on medical university students in terms of empathy, critical thinking, and reflective writing.

METHODS

A 15-week quasi-experimental design was conducted to investigate the learning outcomes. After conducting cluster algorithms, heterogeneous learning clusters (experimental group; n = 43) and non-heterogeneous learning clusters (control group; n = 43) were derived for a medical humanities literature study. Before and after the intervention, an Empathy Scale in Patient Care (ES-PC), a critical thinking disposition assessment (CTDA-R), and a reflective writing test were administered to both groups.

RESULTS

The findings showed that on the empathy scale, significant differences in the "behavioral empathy," "affective empathy," and overall sections existed between the post-test mean scores of the experimental group and those of the control group, but such differences did not exist in "intelligent empathy." Regarding critical thinking, there were significant differences in "systematicity and analyticity," "skepticism and well-informed," "maturity and skepticism," and overall sections. As for reflective writing, significant differences existed in "ideas," "voice and point of view," "critical thinking and representation," "depth of reflection on personal growth," and overall sections, but not in "focus and context structure" and "language and conventions."

CONCLUSION

This study outlined an alternative for using heterogeneous cluster grouping in reflective writing about medical humanities literature to facilitate interdisciplinary cooperation to provide more humanizing medical care.

The Relationship of Vocabulary Learning Strategies and Self-Efficacy with Medical English and Terminology

This study examined the relationship between the use of vocabulary learning strategies and self-efficacy in medical English learning, and whether after an initial six-week course to master the basics of medical terminology, those with higher use of vocabulary learning strategies and those with a higher degree of self-efficacy would have significant score improvements in the medical English proficiency. Second-year medical students (N = 115; M age = 19.6, SD = 0.5; 82 men, 33 women) participated in the study. A one-group pretest-posttest design was used. Measures included medical English tests, the English Vocabulary Learning Strategies Survey (EVLSS), and the English Learning Self-Efficacy Scale (ELSES). Results showed that there was no significant correlation between vocabulary learning strategies and English learning self-efficacy. In addition, as a whole, vocabulary learning strategies and self-efficacy significantly predicted students' score improvements in medical English proficiency.

Hazard Prevention Regarding Occupational Accidents Involving Blue-Collar Foreign Workers: A Perspective of Taiwanese Manpower Agencies

Since 1989, blue-collar foreign workers have been permitted to work in Taiwanese industries. Most blue-collar foreign workers apply for jobs in Taiwan through blue-collar foreign workers’ agencies. Because blue-collar foreign workers are not familiar with the language and culture in Taiwan, in occupational accident education and hazard prevention, the agencies play an important role in the coordination and translation between employees and blue-collar foreign workers. The purpose of this study is to establish the agencies’ role in the occupational accidents education and hazard prevention for blue-collar foreign workers in Taiwan. This study uses a qualitative method—grounded theory—to collect, code, and analyze the data in order to understand the agencies’ role in occupational accident education and hazard prevention for blue-collar foreign workers in Taiwan. The results show that the duty of agencies in occupational accident education and hazard prevention includes selecting appropriate blue-collar foreign workers, communicating between employees and blue-collar foreign workers, collecting occupational safety and health information, assisting in the training of occupational safety and health, and helping blue-collar foreign workers adapt to their lives in Taiwan. Finally, this study suggests seven important points and discusses the implementation process necessary to improve governmental policies. The government and employees should pay attention to the education/training of occupational safety and health for blue-collar foreign workers to eliminate unsafe behavior in order to protect the lives of blue-collar foreign workers.

Using Complementary Learning Clusters in Studying Literature to Enhance Students' Medical Humanities Literacy, Critical Thinking, and English Proficiency

This study examined whether students studying literature in complementary learning clusters would show more improvement in medical humanities literacy, critical thinking skills, and English proficiency compared to those in conventional learning clusters. Ninety-three students participated in the study ( M age = 18.2 years, SD = 0.4; 36 men, 57 women). A quasi-experimental design was used over 16 weeks, with the control group ( n = 47) working in conventional learning clusters and the experimental group ( n = 46) working in complementary learning clusters. Complementary learning clusters were those in which individuals had complementary strengths enabling them to learn from and offer assistance to other cluster members, hypothetically facilitating the learning process. Measures included the Medical Humanities Literacy Scale, Critical Thinking Disposition Assessment, English proficiency tests, and Analytic Critical Thinking Scoring Rubric. The results showed that complementary learning clusters have the potential to improve students’ medical humanities literacy, critical thinking skills, and English proficiency.

CONSTRUCTION AND VALIDATION OF A MEANING IN LIFE SCALE IN THE TAIWANESE CULTURAL CONTEXT

The objective was to construct and validate a Chinese-language Meaning in Life Scale (MiLS) and to assess its psychometric properties. The three most popular scales have some weaknesses and are grounded in a Western cultural context. Consequently, a comprehensive and psychometrically adequate meaning in life scale is needed for use in Asian samples. 500 randomly selected participants from the Taiwanese public provided 476 valid responses to a written questionnaire. The participants' ages ranged from 18 to 63 years (M age = 42.3 yr.; 181 men, 295 women). Exploratory factor analysis reduced the initial 41 items to 33 items, based on a 5-point rating scale. Five factors were extracted: Contented with life (10 items; 33.20% of total variance), Goals in life (5 items; 6.95%), Enthusiasm and commitment (7 items; 6.28%), Understanding (6 items; 5.41%), and Sense or meaning to human existence (5 items; 4.57%). The MiLS showed satisfactory internal consistency and test-retest reliability, and concurrent validity. Therefore, the MiLS was found to be a valid and reliable instrument to measure the subjective sense of a meaning in life in the Taiwanese cultural context.

Creating a positive learning environment for students with English classroom anxiety

Students situated in post-structural feminist pedagogical learning (PFPL) in a freshman English course (37 students) were expected to have lower English classroom anxiety, score higher in English, and have greater satisfaction with the class they attended than those in conventional lecture classes (40 students). Seventy-four students participated in the study (M age=18.5 yr., SD=0.5; 34 men, 43 women). The measures included the English Classroom Anxiety Scale (ECAS), English proficiency tests, the Student Satisfaction Questionnaire (SSQ), and student interviews. After the classes were completed, students in PFPL reported a significant decrease in anxiety toward the English classroom, scored significantly higher on English proficiency, and expressed significantly greater satisfaction with the course. PFPL potentially decreases students' English classroom anxiety and increases their English proficiency.

A recommended integrated mechanism to enhance OSH management of blue-collar foreign workers in Taiwan

This study examines the roles and functions of businesses, labor-exporting countries' representative offices in Taiwan, religious organizations, and manpower agencies in promoting occupational safety and health (OSH). It also offers advice to Taiwanese authorities on making policies and improvements regarding the oversight mechanism mandated by the Labor Safety and Health Act, giving them an idea of what to focus on when enforcing control over blue-collar foreign workers' OSH conditions. This study also proposes that Taiwanese authorities may serve not only as an overseer/inspector of those hiring blue-collar foreign workers in Taiwan, but also expand their role to lay down policies regarding a variety of OSH teaching materials in the blue-collar foreign workers' native languages (spoken or written), the qualifications of translators in blue-collar foreign workers' OSH training programs, and regulations concerning the longer hours such training programs take.

Promoting English oral communication and higher-order thinking in Taiwanese ESL students through the use of knowledge visualization techniques

The study examined whether the students using concept mapping in a Freshman English course would improve English oral communication proficiency, higher-order thinking, and perception of abilities. A quasi-experimental design, lasting for 12 weeks, was administered to an experimental group (21 students) and a control group (20 students). The experimental group had significantly better performance on all measures. Concept mapping was effective in improving college students' English oral communication, higher-order thinking, and perception of abilities development.

Development of a Scale to Measure the Critical Thinking Disposition of Medical Care Professionals

Our aim was to develop the Critical Thinking Disposition Assessment (CTDA) scale to assess medical care professionals' or students' level of critical thinking disposition and to validate the psychometric properties of this instrument. A total of 775 medical care professionals and students agreed to respond to the survey instrument. Exploratory factor analysis extracted 3 factors; systematicity and analyticity, inquisitiveness and conversance, and maturity and skepticism, accounting for 63.40% of the variance. The final scale comprised 19 statements rated on a 7-point Likert scale. Reliability analysis produced Cronbach's alpha coefficients ranging from .86 to .94 for the 3 factors and the overall scale, indicating acceptable reliability for the instrument. The concurrent validity analysis was also conducted to compare the instrument with other measures. In light of these findings, the CTDA was found to be a valid and reliable instrument to measure the critical thinking disposition of medical care professionals and students.

Glycemic Control Outcomes by Gender in the Pay-for-Performance System: A Retrospective Database Analysis in Patients with Type 2 Diabetes Mellitus

Background. The purpose of this study was to investigate how the degree of glycemic control in patients with type 2 diabetes associated with lifestyle interventions as well as sociodemographic factors and further examine the differences by gender. Methods. This was a retrospective study using data collected from a diabetes quality improvement plan that began in 2002 in a medical center in Taiwan. Statistic analysis was used to determine the associations of sociodemographic data, lifestyle intervention, and treatment regimens with changes in HbA1c levels (between the initial visit and the latest follow-up measured level), and the differences were then sorted by the sex of the patients. Results. Our results showed that HbA1c averaged 7.50% for males and 7.80% for females at the initial visit, compared to levels averaging 7.50% for males and 7.70% for females at the most recent follow-up visit. There was no significant change (P = 0.541) in HbA1c in males, but there was a 0.10% (P = 0.384) reduction in females. The duration of the diabetes and medication regimen was associated with the decrease seen in the females. Conclusions. The results of these analyses provide important insights for policy makers to formulate healthcare policies related to chronic diseases or illnesses.

Examining factors associated with pre-admission to discharge of stroke patients

Stroke is the second leading cause of death and a major cause of adult disability in Taiwan. This research established correlations between pre-admission and discharge data in stroke patients to promote education of the general public, prevention, treatment and high standards of chronic care. A total of 790 stroke patients at Chung Shan Medical University Hospital from 2007 to 2009 contained in the Taiwan Stroke Registry were included in this study. The patients were classified into two major categories: ischemic and hemorrhagic. Thirteen variables, including time series variables, were explored. Our results showed that age, education, hours from symptom onset to the emergency department (ED) arrival, and length of stay in hospital were significantly associated with stroke incidence. These findings show the present situation and medical quality of medical care for stroke patients in Taiwan. The factors association model may assist in developing a set of improvement plans for the coming year.

Anxiety of university students in Taiwan about the General English Proficiency Test

In this study we examined whether or not university students in Taiwan experience anxiety when taking the General English Proficiency Test (GEPT), and whether there are differences in GEPT anxiety levels among students according to gender and/or personality. We developed a GEPT test anxiety scale (GEPT-TAS) to explore the anxiety levels of university students. The final questionnaire included 36 questions, covering the cognitive, emotional, and affective dimensions of test anxiety. Several conclusions can be drawn from the findings of this study. First, university students do experience GEPT test anxiety. Second, females experience more emotional anxiety than do males. Third, students who are inclined to be introverted tend to experience more anxiety compared with students inclined to be extroverted.

Adrenal insufficiency in critically ill emergency department patients: a Taiwan preliminary study

OBJECTIVE

Unrecognized adrenal insufficiency can have serious consequences in critically ill emergency department (ED) patients. This prospective pilot study of adrenal function in patients with severe illness was undertaken to determine the prevalence of adrenal dysfunction and any relation to prior herbal drug use.

METHODS

In a high-volume urban tertiary care ED, adult patients with sepsis or acute myocardial infarction (AMI) were eligible for the study. Over a two-month period, a convenience sample was enrolled by the authors on arrival to the ED. Inclusion criteria were systemic inflammatory response syndrome (SIRS) criteria plus evidence of at least one organ dysfunction or cardiac marker plus electrocardiogram-proven AMI. Exclusion criteria included known corticosteroid use. Serum cortisol was measured on arrival and for those patients with a level of <15 microg/dL (<414 nmol/L), an adrenocorticotropic hormone (ACTH) stimulation test was performed.

RESULTS

Of the 30 enrolled patients, 23 (77%) were suffering from severe sepsis and the other seven (23%) had an AMI. Thirteen of the 30 patients (43%; 95% CI = 25% to 65%) had serum cortisol levels of <15 microg/dL, consistent with adrenal insufficiency, nine with severe sepsis and four with an AMI. Eight (62%; 95% CI = 32% to 86%) of the 13 patients with low cortisol levels reported using herbal medications, while only two (12%; 95% CI = 1% to 36%) of the 17 with normal cortisol levels reported taking herb drugs (p = 0.01). Only two (15%; 95% CI = 2% to 45%) of the patients with low cortisol levels failed their corticotropin stimulation test, suggestive of true adrenocortical insufficiency. Both reported using herbal preparations.

CONCLUSIONS

These results indicate that adrenal dysfunction is common among a group of critically ill patients seen in this Taiwanese ED. Moreover, the use of herbal drugs was high in the patients with low serum cortisols. Further studies are required to both confirm these findings and clarify whether a number of herbal medications contain corticosteroids.

Clinical presentations of elderly patients at emergency departments: a comparison between a medical center and a community hospital

BACKGROUND

The utilization of emergency services is expected to increase in parallel with an increase of the elderly population. This article compares the elderly patient Emergency Department (ED) utilization at a 3500-bed medical center with that of a 600-bed community hospital serviced by the same group of emergency physicians.

METHODS

We retrospectively reviewed all patients over 64 years old who presented to Linkou Chang Gung Memorial Hospital (CGMH) and Keelung CGMH between July 1, 1995 and June 30, 1996 by using the 2 ED's real-time computer logs. Data comparisons included age, gender, mode of arrival, arriving source, triage category, chief complaint, impression, and final disposition.

RESULTS

There were 18,285 patients in the Linkou ED and 8038 in Keelung. Significant differences in arrival mode, arriving source, triage category, disease pattern, and final disposition were observed between the Linkou and Keelung CGMH EDs.

CONCLUSION

Significant differences reflected the different roles between the Linkou and Keelung CGMH EDs. Hospital EDs should be prepared to adapt to meet the needs of the elderly based on their roles in the medical care system, at the elderly population grows in the 21st century.

Differences of disease characteristics between genders in emergency department elderly of a community hospital in Taiwan

BACKGROUND

The purpose of this study was to catalog the chief complaints and diagnoses of elderly patients visiting to a Taiwanese emergency department (ED), and to compare gender differences.

METHODS

ED computer log data of patients 65 years and older, who visited the ED from July 1995 to June 1996, were retrospectively reviewed. The computer log data for each patient was entered prospectively by the doctor providing the ED care. All patient data were separated by gender, and then subdivided into trauma and non-trauma groups for analysis.

RESULTS

There were 8038 elderly patients treated during the study period. The most common male chief complaint was dyspnea, and for females, it was abdominal pain, followed by injuries for both genders. Falls were the most common mechanism of injury for both genders, but they were more common among females (63.2% vs. 46.1%, p < 0.001). Motorbike accidents, however, were 3 times as frequent among males (16.05% vs. 5.45%, p < 0.001). Males presented most commonly with COPD (12.2%), compared to only 4.16% for females (p < 0.001), with urinary retention the second most common diagnosis (5.04% vs. 0.72%, p < 0.001). Females suffered a greater number of urinary tract infections (5.42% vs. 2.03%, p < 0.001), presentations for renal failure (2.98% vs. 1.56% p < 0.001), and diabetes-associated problems (4.58% vs. 2.48%, p < 0.001).

CONCLUSION

Elderly females presented to the ED more frequently with urinary tract and diabetic problems; while their male counterparts presented with complications of COPD, urinary retention, and motorbike accidents.

Rates and causes of emergency department revisits within 72 hours

The purpose of this study was to determine the rates and causes of revisits to the emergency department (ED) of a 3,500-bed referral hospital, to identify areas for improvement, and to generate baseline data for the development of a computerized, automatic monthly audit system. We identified all patients returning within 72 hours of their initial ED visits, from 1 July 1995 to 30 June 1997, and monthly revisit rates were calculated. To determine the reasons for revisits, two independent reviewers examined the charts of revisit cases from 1 July 1996 to 30 June 1997. A one-in-three sampling method was used to select charts. A total of 485 revisit charts were reviewed. The monthly revisit rates ranged from 1.32% to 2.38%, with no particular seasonal or event-specific pattern. Most revisits were attributed to disease factors (79.0%). Those felt to be medical errors only accounted for 7.8% of the revisits but led to a higher hospital admission rate (73.7%) subsequently. By contrast, the overall hospital admission rates for revisit patients (36.5%) and all ED patients (36.2%) were similar. We suggest setting baseline monthly ED revisit rates at 2% for future computer-programmed audit filters. While this study indicates that most revisits are disease-related, further prospective studies are needed to evaluate the most common and serious causes of revisits to see if improvements can be made.

Splenic artery aneurysm rupture in pregnancy--a review and case report

Spontaneous rupture of a splenic artery aneurysm in the third trimester of pregnancy is a catastrophic event associated with a very high fetal and maternal mortality rate. Review of the literature reveals nine reported cases of combined maternal and fetus survival. None were diagnosed prior to rupture and the need for an emergency laparotomy. They survived due to early surgery after fetal distress was noted. We present a 29-year-old female presenting at 33 weeks gestation seeking emergency assistance for vomiting, diarrhea and epigastralgia. During her evaluation and initial management she into shock. At laparotomy a ruptured splenic artery aneurysm was found and ligated. After splenectomy the mother recovered well but unfortunately fetus did not survive.

Preliminary experience with growth factor and porcine graft-young collagenous wettable membrane in the treatment of chronic diabetic ulcer

Chronic ulcers are well-known complication of diabetes mellitus, often compounded by infection. Healing of lesions is problematic in some cases using conventional treatment. We have treated a group of six hospitalized diabetic patients with chronic ulcer by a combined regimen consisting of metabolic control, parenteral antibiotics, growth factor and porcine graft-young collagenous wettable membrane (YCWM) treatment. Five of our uncontrolled group had their ulcers improved at 87 +/- 37.6 hospital days after 45.8 +/- 20.2 days of growth factor and YCWM treatment. In conclusion, growth factor and porcine graft-YCWM therapy may be promising as an alternative choice in treatment of chronic diabetic ulcer.