A Meta-Analysis of Interventions for Informal Stroke Caregivers
The purpose of this study is to examine the effectiveness of the interventions for improving mental health of caregivers of people with stroke by synthesizing individual studies. A meta-analysis was performed to summarize findings of intervention studies of caregivers of elderly stroke patients. Additionally, a sensitivity analysis and a publication bias were tested. The overall mean weighted effect size (MWES) for the four studies is 0.277 (Z = 3.432, p = .001) with a 95% CI .118 to .435 (N = 718) indicating that the intervention was effective in improving the mental health of informal stroke caregivers. The MWES for the education program was 0.354 (Z= 2.613, p < .01) and for the support program was .234 (Z = 2.335, p= .02). The MWES for the Europe study was .219 (Z= 2.613, p < .01) and for the United States was .922 (Z = 3.287, p = .001). The results show that overall interventions improved mental health of informal stroke caregivers. The small number of studies included in the meta-analysis limits the generalizability of results while supporting the need for more research in this area.

title: Factor structure investigation of perceived facilitators and barriers in end-of-life care among Korean nurses.
abstract: The aim of this study was to assess the validity and reliability of the Korean version of a questionnaire assessing facilitators/barriers in end-of-life care that was originally developed for nurses in the USA.



Back-translation was undertaken to produce the Korean version. A principal component analysis with varimax rotation and Cronbach's alpha was used to test factorial validity and reliability, respectively.



The analysis examined data from 383 nurses in a tertiary hospital in Korea. For end-of-life care facilitators, five factors accounted for 59% of the total variance. The factors were labeled "family preparedness", "support for nurses", "nurse-patient relationship", "transition after death", and "decision-making". Six factors, explaining 59% of the variance, were extracted for end-of-life care barriers. These factors were "misunderstanding patient's will", "preoccupied nursing workload", "lack of institutional support", "dealing with family's maladaptive coping", "visiting hours", and "communication about patient's status with family members". Cronbach's alpha was 0.89 for the 23 facilitator items and 0.90 for the 24 barrier items.



Overall, the findings demonstrate that the questionnaire has measurement properties in a sample of Korean nurses. Further studies are needed with different populations to reflect end-of-life care in various clinical settings.

title: Measurement issues across different cultures.
abstract: The purposes of this methodologic paper are to (1) describe theoretical background in conducting research across different cultures; (2) address measurement issues related to instrument administration; and (3) provide strategies to deal with measurement issues.



A thorough review of the literature was conducted. A theoretical background is provided, and examples of administering instrument in studies are described.



When applying an instrument to different cultures, both equivalence and bias need to be established. Three levels of equivalence, i.e., construct equivalence, measurement unit equivalence, and full score comparability, need to be explained to maintain the same concept being measured. In this paper, sources of bias in construct, method, and item are discussed. Issues related to instrument administration in a cross-cultural study are described.



Researchers need to acknowledge various group differences in concept and/or language that include a specific set of symbols and norms. There is a need to question the philosophical and conceptual appropriateness of an assessment measure that has been conceptualized and operationalized in a different culture. Additionally, testing different response formats such as narrowing response range can be considered to reduce bias.

title: Development and validation of a scale for the end of life caregiving appraisal.
abstract: End-of-life caregiving experiences can be complex. Family members experience physical and mental suffering as they anticipate their impending loss. Healthcare providers should be able to provide good quality of end-of-life (EOL) care and support for primary EOL caregivers. Studies have highlighted the role of healthcare providers providing information in the EOL situation to caregivers of chronic disease patients. This has resulted in the development of the End-of-life Caregiving Experience Appraisal Scale (EOLCAS) presented in this paper. The purposes of this study were to develop a scale that can evaluate the experiences of EOL caregivers, and to test the reliability and validity of this scale.



The scale domains were derived from systematic review of 35 relevant studies. We then examined its content validity with nurse scholars and clinicians using content validity index. To examine construct validity, a total of 175 caregivers from tertiary hospital setting in Korea participated in this study from December 2007 to May 2008. For the construct validity, factor analysis was utilized.



The scale was composed of 32 items with four subscales: two negative appraisals (physical suffering and burden), one positive appraisal (maturation), and one neutral appraisal (social support pursuit). In this sample, the Cronbach's alpha for the entire scale was .84 indicating adequate reliability. However, Cronbach's alpha of subscales was varied.



Nurses and other healthcare professionals could use the EOLCAS to assess the experiences of EOL caregivers to understand their experience in the EOL and enhance their quality of life although psychometrics of EOLCAS shows limited findings.

title: Korean nurses' perceived facilitators and barriers in provision of end-of-life care.
abstract: This study examined nurses' perceived facilitators and barriers to end-of-life (EOL) care in clinical settings. The study participants were 383 Korean nurses working at tertiary hospitals. The nurses had an average of 7.6 years of clinical experience. The three highest-scoring facilitating items were 'family member acceptance of patient death', 'having time to prepare the family for the patient's expected death' and 'having the physician meet with the family after the patient's death to offer support and validate the given care'. The top two perceived barriers were 'families not accepting what the physician is telling them about the patient's prognosis' and 'dealing with angry family members'. Nurses who had received EOL care education showed a higher score in perception of facilitators than nurses who did not receive that education. EOL care for patients and their families is a challenge; thus, continuing education should be provided to improve nursing practice.

title: Korean version of the Revised Caregiving Appraisal Scale: a translation and validation study.
abstract: This paper is a report of a study to examine the reliability and validity of a Korean version of the Revised Caregiving Appraisal Scale with Korean caregivers of older stroke survivors.



The Revised Caregiving Appraisal Scale was developed in the United States of America for an American English-speaking population to measure primary caregivers' appraisals of potential stressors and the efficacy of their coping efforts related to caregiving experiences.



Using the back-translation method, the instrument was translated into Korean. The Korean version of the Revised Caregiving Appraisal Scale was self-administered by 147 primary family caregivers recruited from three outpatient clinics and two home health agencies in Korea. The study was conducted in 2005.



In this sample, Cronbach's alpha for the total scale was 0.86. Reliability coefficients for each of the five subscales ranged from 0.40 to 0.85. Two subscales, burden and satisfaction, showed good reliability; one subscale, impact, showed marginally acceptable reliability; two subscales, mastery and demand, had low reliability. Principal components factor analysis of the Korean version of the Revised Caregiving Appraisal Scale yielded six factors. Except for the mastery domain, which was divided into two factors, the other factors were similar to those in the original scale.



The Korean version of the Revised Caregiving Appraisal Scale had adequate reliability and validity in a sample of Korean caregivers of stroke survivors. It can be used to assess the impact of caregiving and interventions on Korean caregiver attitudes. Further studies are needed with different categories of caregiver.

title: Determination of total monomeric anthocyanin pigment content of fruit juices, beverages, natural colorants, and wines by the pH differential method: collaborative study.
abstract: This collaborative study was conducted to determine the total monomeric anthocyanin concentration by the pH differential method, which is a rapid and simple spectrophotometric method based on the anthocyanin structural transformation that occurs with a change in pH (colored at pH 1.0 and colorless at pH 4.5). Eleven collaborators representing commercial laboratories, academic institutions, and government laboratories participated. Seven Youden pair materials representing fruit juices, beverages, natural colorants, and wines were tested. The repeatability relative standard deviation (RSDr) varied from 1.06 to 4.16%. The reproducibility relative standard deviation (RSDR) ranged from 2.69 to 10.12%. The HorRat values were < or = 1.33 for all materials. The Study Director recommends that the method be adopted Official First Action.

title: Is partial colectomy the operation of choice in pediatric Clostridium difficile colitis?
abstract: PurposeThis study examined the national trends in incidence and surgical management of pediatric Clostridium difficle colitis (CDC) hospitalizations.MethodsThis was a cross-sectional Nationwide Inpatient Sample (NIS) analysis of pediatric CDC from 2000 to 2008. Data analysis included patient demographics, procedures, length of stay (LOS), total hospital charges (THC), and in-hospital mortality.ResultsDuring the 9-year study period, the total number of CDC hospitalizations per year increased almost twofold, from 2,513 in 2000 to 4,817 in 2008. The rate per 100,000 discharges followed a similar trend, increasing from 38.08 in 2000 to 72.57 in 2008. Abdominal colectomy was performed in 0.35 %, with partial colectomy performed more often than total colectomy. Mortality, mean LOS, and mean THC were not statistically different between partial versus total colectomy. Children with ulcerative colitis were more likely to undergo total colectomy, (OR 35.700, CI 11.025–115.98, P < 0.001). Infants under the age of 1 year were less likely to undergo total colectomy (OR 0.568, 0.477–0.677, P < 0.001).ConclusionPediatric hospitalizations for CDC are on the rise. Partial colectomy is performed more often than total colectomy without statistical compromise of mortality, length of stay, and total hospital charges. Further studies are needed to determine the standard surgical management of pediatric CDC.

title: Establishing a case for improved food phenolic analysis
abstract: Future phenolic research findings using a multidisciplinary approach will ensure profitability and sustainability of specialty crop industries, while also improving the nutritional and economic choices available to increasingly health- and environmentally conscious consumers. Recent examples of phenolics used in commercial and research scenarios, and new phenolic research discoveries are discussed. Despite being a heavily researched topic, there remains a need to identify, develop, and define analyses targeted for specific quality-related plant metabolites.

title: Expansion and conversion of human pancreatic ductal cells into insulin-secreting endocrine cells
abstract: Pancreatic islet β-cell insufficiency underlies pathogenesis of diabetes mellitus; thus, functional β-cell replacement from renewable sources is the focus of intensive worldwide effort. However, in vitro production of progeny that secrete insulin in response to physiological cues from primary human cells has proven elusive. Here we describe fractionation, expansion and conversion of primary adult human pancreatic ductal cells into progeny resembling native β-cells. FACS-sorted adult human ductal cells clonally expanded as spheres in culture, while retaining ductal characteristics. Expression of the cardinal islet developmental regulators Neurog3, MafA, Pdx1 and Pax6 converted exocrine duct cells into endocrine progeny with hallmark β-cell properties, including the ability to synthesize, process and store insulin, and secrete it in response to glucose or other depolarizing stimuli. These studies provide evidence that genetic reprogramming of expandable human pancreatic cells with defined factors may serve as a general strategy for islet replacement in diabetes.

title: In vitro peptide release from liquid crystalline buccal delivery systems.
abstract: Swelling and [D-Ala(2), D-Leu(5)]enkephalin (DADLE) release from the lamellar and cubic liquid crystalline phases of glyceryl monooleate (GMO) were studied using two in vitro methods, a total immersion method and a Franz cell method. The swelling of the lamellar phase and glyceryl monooleate (0% w/w water content) and DADLE release from the liquid crystalline phases were temperature dependent. The swelling ratio was greater at 20 degrees C than 37 degrees C while DADLE release increased at 37 degrees C compared to 20 degrees C for both the lamellar and cubic phases. The water uptake increased dramatically with decreasing initial water content of the liquid crystalline phases. However, DADLE release increased with increasing initial water content, which corresponded to increased viscosity. The swelling and DADLE release profiles obtained using a Franz cell method with a moist nylon membrane to mimic buccal drug release conditions were slower than the total immersion method. These results show that the swelling and DADLE release strongly depended on temperature, the initial water content of the liquid crystalline matrix and the methodology employed for determining the swelling and DADLE release.