Anxiety, pain intensity, and decision regret of living liver donors during postoperative period.

AIM: The aim of this study was to explore and examine the relationship between anxiety, acute pain intensity, and decision regret of living liver donors in the postoperative stage. METHODS: This is a prospective correlational study. Data were collected consecutively for one year (from September 2017 to September 2018) at a medical center in northern Taiwan. Information about anxiety and acute pain intensity was collected preoperatively and on postoperative day (POD) 3 and POD 7. Satisfaction with pain management and decision regret was inquired about on POD 7. RESULTS: Data of 57 consecutive living liver donors (56.1 % male, mean age 34.12 ± 9.92 years) were analyzed. Living liver donors experienced moderate anxiety and acute pain levels in the postoperative period. The mean score of decision regret was 12.63 (range 0-60), indicating a low level of regret. The acute pain intensity decreased significantly between POD 3 and POD 7 (p < .001); however, the anxiety level slightly increased (p = .031). Older and married living liver donors had higher anxiety levels. The satisfaction level of pain management was negatively correlated with the POD 7 acute pain intensity (r = -0.26, p = .049) and decision regret (r = -0.37, p = .005), but it was positively correlated with POD 7 anxiety (r = 0.38, p = .004). CONCLUSIONS: The postoperative period was hard for living liver donors as they would experience moderate acute pain and anxiety. Although the decision regret was low, the satisfaction level of pain management would negatively affect it. Therefore, the effectiveness of pain management and anxiety management should be continually ensured in the postoperative period.

Use of photo diary and focus group to explore needs for digital disease management program among community older adults with chronic disease.

As technology advanced, new e-health solutions are evolved to empower people to manage their care at home. This study explored the needs for disease management in activity tracking using photo diary through older adults' subjective perspective. It further aimed to suggest which lifestyle measures, symptoms and behaviours would be meaningful to include in such a digital diseases care management program for technology design. Both photo diary and focus group discussion were used, 11 older adults with multiple metabolism-related chronic diseases (Mean age, 72.5 ± 6.14 years) were recruited and asked to carry out the photo diary to trace their living situation and needs using a tablet camera. A focus group discussion was applied to identify the needs of chronic disease management, based on the results of living context tracing. Five themes, regular physical activity, smart management of healthy behaviors, healthy diet, regular daily routine and social connection, were identified by content analysis from photo diary and the focus group discussion. The results indicated that the photo diary program can raise awareness and promotes positive behavior changes. It is believed that the E-approach can be applied to the effectively enhance older adults' self-management by monitoring their health status and their daily routine activities.

Profile of elderly with multiple physician visits: advocacy for tailored comprehensive geriatric assessment use in clinics.

AIM: The rapid growth of the elderly population has given rise to the need for better geriatric care. The present study explored the common conditions of elderly outpatients with multiple physician visits in order to develop feasible clinical indicators that can be rapidly administered for the evaluation of geriatric syndromes in outpatient settings. METHODS: The National Health Insurance Research Database (2008) was analyzed. Claims for elderly outpatients with more than two physician visits in the same day were retrieved. The primary diagnoses, types of prescriptions and comorbidities were cross-examined. RESULTS: The overall prevalence rate for elderly patients with multiple physician visits ranged from 28.41% to 39.40%, and which increased steadily with age. A maximum of seven physician visits in a single day was observed. The most common multiple physician visit was two visits per day, with a prevalence rate of 30.97%. The two most common accompanying conditions were hypertension (3.79%) and type 2 diabetes mellitus (3.68%). There was a greater relative increase in the prevalence of senile dementia and chronic obstructive pulmonary disease in older age groups. The three overall leading specialties were cardiology, internal medicine, and ophthalmology; however, rehabilitation medicine was the most common female-specific specialty. The most commonly prescribed medications were antihypertension drugs. The most prevalent comorbidity was type 2 diabetes mellitus and hypertension. CONCLUSION: We conclude that our data represent crucial information for the design of concise assessment metrics for application to the most chronic conditions in an effort to implement better geriatric healthcare.

Development of frailty indicators for the community-dwelling older adults.

BACKGROUND: Faster than anticipated increases in population, aging is making the issue of frailty among the elderly increasingly important. Despite general agreement that a frailty assessment is important for planning care for the older adults, a lack of consensus remains regarding the best methodology to use for frailty assessments. PURPOSE: The aim of this study was first to cross-examine results between perception of frailty and physical assessment outcomes then try to establish frailty indicators for elderly people in Taiwan. METHODS: This study used both qualitative and quantitative methods. From August to September 2010, researchers recruited a convenience sample of 10 community older adults from six different elderly centers in northern Taiwan. Qualitative in-depth interviews were conducted in Mandarin or Taiwanese and audiotaped. After the in-depth interview, researchers conducted a series of physical assessments on the participants. RESULTS: Ten elderly women were interviewed and assessed. The three themes identified by this study related to frailty perception included overall physical function performance, psychological health, and physiological health. These reflected the concept of successful aging. Participant frailty was compared with subjective perceptions to identify and/or check for consistency between qualitative and quantitative results. Although quantitative results revealed that participants were in fairly good health, there were many complaints about frailty during the qualitative interview. Better sensitive measures reflecting frailty changes are thus needed. CONCLUSIONS: These indicators can be considered as an integration of all maintained functions. We hope that results will provide better insights into understanding the process of frailty among the older adults.

[Living donor liver transplantation: the decision experience].

Living donor liver transplantation is a treatment choice for end-stage liver disease patients who face a shortage of currently available donated livers. The decision process involved in living donor organ donation has been described as a complicate process within the family of the patient. Donors have expressed willingness to donate a part of their own living liver in order to ensure the health of a loved one or relative when such a proposition was raised by the attending physician. Such decisions were taken even in the face of certain struggle, fear and ambiguous feelings. Donation decisions may be reinforced through feelings of confidence and trust in the physician and positive evaluations of the risk to donor health of making a 'living' donation. Necessary surgery will impact not only the recipient and donor but also family members. Staff on the transplantation team should make greater efforts to explore perceptions and concerns within families of living donors in order to deliver effective evidence-based care.

Copolymerization of divinylsilyl-11-silicotungstic acid with butyl acrylate and hexanediol diacrylate: synthesis of a highly proton-conductive membrane for fuel-cell applications.

Highly conducive to high conductivity: Polyoxometalates were incorporated in the backbone of a hydrocarbon polymer to produce proton-conducting films. These first-generation materials contain large, dispersed clusters of polyoxometalates. Although the morphology of these films is not yet optimal, they already demonstrate practical proton conductivities and proton diffusion within the clusters appears to be very high.