• Factors Associated with Outcomes of Hematopoietic Stem Cell Transplants in Taiwan: A Population-Based Study Using Nationwide Claims Data

      Hsieh, Suh-Ing; Johantgen, Mary E. (2009)
      Background: Advances in conditioning regimens and stem cell sources and processing has made it possible for hematopoietic stem cell transplantation (HSCT) to be conducted in broader patient populations and in more hospitals. While there are some reports about the effectiveness of these procedures from large databases in the US and internationally, most are descriptive and focus on clinical characteristics. The majority of studies reflect programs at individual hospitals and provide a narrow picture of the population of patients undergoing transplant. Few studies have examined the variation in effectiveness by transplant program characteristics. Purposes: 1) Describe the recipient and program/organizational factors of the HSCT patients with hematological cancers in Taiwan between 2001 and 2005; 2) Determine the influence of HSCT program and organizational factors on 100-day readmission and overall survival. Methods: This population-based retrospective cohort study with longitudinal follow-up used Taiwan's National Health Insurance Research Database from the years 2001 to 2006. All adult patients who underwent an HSCT procedure from 2001 to 2005 were identified using ICD-9-CM procedure codes. The PROC GENMOD and PROC PHREG of SAS programs were used to model 100-day readmission and overall survival, adjusting for the nested design. Results: The number of HSCT recipients steadily increased from 2001 to 2005. Mean age increased from 32.6 in 2001 to 39.5 in 2005 and then decreased to 36.8 in 2005. The majority of recipients were male and the mix of diseases varied across the five years. In the ten hospitals studied, there were more private nonprofit hospitals than pubic hospitals. Most hospitals were medical centers except one district hospital. The mean number of HSCT beds was stable and the mean length of stay for the entire sample was 43.7 days. Despite the long lengths of stay, 52% of recipients were readmitted within 100 days of discharge. Ownership status, the number of HSCT hematologists, and the ratio of HSCT procedures to HSCT hematologists independently predicted 100-day readmission after adjusting for clustered data and controlling for recipient characteristics. In survival analysis, ownership and volume of HSCT procedures were not independent predictors of overall survival, after controlling for recipient characteristics. Conclusion: This population-based study of HSCT procedures for hematological conditions found that program characteristics influenced 100-day readmission but not overall survival. Appropriately, recipient and transplant characteristics strongly influenced both outcomes. While a registry would be ideal, this study demonstrated the feasibility of using claims data to study an entire population of patients undergoing HSCT.
    • The perceived meanings of cancer pain: An instrument development

      Chen, Mei-Ling; Belcher, Anne E. (1997)
      The purpose of this study was to develop a reliable and valid instrument that measures the perceived meanings of cancer pain for Taiwanese patients. A 46-item Perceived Meanings of Cancer Pain Inventory (PMCPI) which contains six scales was constructed for field testing. Two hundred cancer patients with pain were recruited from three teaching hospitals in Taiwan. The field testing of the PMCPI included three parts. An item analysis procedure using 100 randomly selected subjects was conducted to select items for the purpose of increasing the internal consistency and decreasing the item number in each scale. The selected items were cross validated with the remaining 100 subjects. A two-facet (item and occasion) generalizability study (G study) was conducted on selected items to estimate the variances associated with each facet and person. Twenty of the 200 subjects constituted the G study sample in which patients responded to study instruments twice. A series of confirmatory factor analyses with weighted least squares (WLS) estimations were performed on selected items to evaluate the construct validity for each scale and each pair combination of the scales. A total of 27 items was selected from the item analysis procedure. Cross validation shows that the fluctuation rate of alpha ranges from -9.24% to 16.25%. The alpha coefficients (n = 200) obtained from the selected items are.763,.783,.709,.556,.620, and.750 for Loss, Threat, Challenge, Blame-Other, Blame-Self and Spiritual-Awareness, respectively. The results of the G study indicate that the variances associated with "occasion" for each scale are near zero. However, the proportions of variances associated with "person-occasion interaction" were found to be 15.78% for the Threat scales. The proportion of variances associated with "item" is small for each scale except Loss (16.02%). The proportion of variances associated with "person-item interaction" ranges from 5.23% to 33.12%. The percentage of variance associated with "individual differences" ranges from 20.81% to 37.09%. The unspecified error variance which cannot be separated from "person-item-occasion interaction" accounts for 26.23 to 65.66% of total variance. The confirmatory factor analyses show that Loss, Challenge and Spiritual-Awareness scales have good model-data fit; the Threat scale also demonstrates reasonable fit after deleting one item. The measurement models of Blame-other and Blame-Self scales do not fit the data well enough. Six two-factor measurement models were formed using the four valid scales; all six models fit the data well. The four scales were tested for parallel items. The results show that the data are consistent with the parallel-item measurement models. Potential demographic and disease/treatment factors that may influence the four scales were identified.
    • The relationship between stress appraisal, coping behavior, and subjective well-being in Chinese elderly with a diagnosis of congestive heart failure

      Lee, Wen-Lin; Spellbring, Ann Marie (1999)
      The purpose of this study was to examine the relationships between stress appraisal, coping behavior, and subjective well-being. The theoretical framework for the investigation was based on a process theory of stress and coping developed by Lazarus and Folkman (1984). A descriptive correlational research design was used to examine the relationships among the variables. Convenience sampling was used to select the subjects from three hospitals in Northern Taiwan. A convenience sample of 133 Chinese elderly aged 60 and over had a diagnosis of Congestive Heart Failure. Subjects were interviewed with structured questionnaires. Stress appraisal was measured by the Appraisal Scale. Coping was measured by the revised Ways of Coping Checklist. Subjective well-being was measured by the Philadelphia Geriatric Center Morale Scale. Descriptive statistics were reported for several demographic variables. Several multiple regressions were performed to determine the significance of the independent variables. Those Chinese elderly patients who perceived Congestive Heart Failure as a challenge, used more problem-focused coping and less emotional-focused coping. When Congestive Heart Failure is viewed as a threat or harm, they used more emotional-focused coping. There were no significant relationships between benefit appraisal and coping behaviors. The seven significant predictors of subjective well-being were identified as higher income, less threat and harm appraisals, less avoidance coping behavior, and higher health perception. Demographics (age, gender, education and income), severity of illness, and comorbidity variables together explained a significant amount of the variance (11%) in subjective well-being, but only income was an individually significant predictor. Stress appraisal, coping behaviors, physical functioning, and health perception contributed an additional statistically significant amount variance (46%) of subjective well-being after controlling for demographic variables, severity of illness, and comorbidity. Additional findings indicated that men had significantly higher physical functioning and subjective well-being than women. In addition, men used more problem-focused coping. Findings provide more information for health care providers to recognize the variables that influence subjective well-being, identify patients at greater risk for lower subjective well-being, and assist patients to achieve the highest subjective well-being possible within the constraints of their heart disease.
    • A study of the perceptions of transformational versus transactional leadership style as an influence on nursing faculty job satisfaction in associate and baccalaureate degree programs in Taiwan

      Shieh, Hueih-Lirng; Mills, Mary Etta C. (1996)
      The higher nursing education environment and health care systems in Taiwan are rapidly changing. The demand by consumers for higher education and educational quality is increasing. Nursing faculty need to work more to meet the demands of their jobs. As a result, job dissatisfaction may occur. Nursing deans or directors need to use innovative leadership skills to retain a satisfied work force. The theoretical and empirical evidence of superiority of transformational leadership over transactional leadership has been found in the United States. However, whether or not transformational leadership is more effective than transactional leadership on nursing faculty job satisfaction in Taiwan has remained an unexplored research area. Therefore, the purposes of the cross-cultural survey were to explore: (1) nursing deans'/directors' leadership styles as perceived by their nursing faculty in nursing associate and baccalaureate degree programs in Taiwan, and (2) the influence of transformational leadership style, relative to transactional leadership style, on nursing faculty job satisfaction in nursing associate and baccalaureate degree programs in Taiwan. Five hundred and seventeen nursing faculty in eighteen associate and baccalaureate degree programs in Taiwan were asked to respond to questionnaires and an open-ended question. Two hundred and thirty three (45.1%) returned usable questionnaires. One hundred and twenty two (52.4%) complete data sets were received and used for analysis. Data analysis procedures included: descriptive statistics, univariate repeated-measure ANOVA, hierarchical multiple regression, ANCOVA, and content analysis. The findings showed that the predominate leadership styles of nursing deans and directors were transformational and transactional. Idealized Influence, Intellectual Stimulation, and Contingent Reward leadership styles positively predicted satisfaction with the style of leadership. Active Management-by-Exception leadership style negatively predicted faculty satisfaction. Nursing faculty who were led by transformational deans/directors had the highest frequency of satisfaction with leadership style, followed by those led by transactional deans/directors, and then those led by Laissez-Faire deans/directors. That nursing deans and directors should consider the faculty members' perceptions in implementation of transformational and Contingent Reward leadership styles was suggested.