A quick method to customize pictorial blood assessment tools towards better measurement: Method development and validation.

OBJECTIVE: Identification of heavy menstrual bleeding (HMB) cases in primary care settings is often done by using pictorial blood assessment charts (PBAC). The study aims to highlight the challenge of assessing blood loss, to develop a standardized method to efficiently customize a patient-reported pictorial chart, to validate the tool produced with our proposed method, and to demonstrate the feasibility of using PBACs in settings where resources are scarce. MATERIALS AND METHODS: Using blood samples and feedback from 21 women aged 30-51 years, we followed guidelines suggested in the literature, developed a method to produce PBACs for regular, long and night sizes, and had 9 participants testuse them. Linear regression analysis was performed to determine the correlation between participants' scores and menstrual blood weight. RESULTS: The study demonstrated the feasibility of customizing product-sensitive and size-specific pictorial charts by adopting essential steps including collecting menstrual blood with menstrual cups, employing fluid application techniques, and using sanitary pads as icons for easy identification. Linear regression analyses of score versus blood weight showed that the recorded blood weight was around 95% of the scored values (R2 = 0.9428, 0.947, and 0.9508, respectively; p < 0.001). CONCLUSION: Valid patient-reported PBACs created by the proposed method provides an innovative women's healthcare solution to assist HMB identification and reduce health expenditure by preventing risks for HMB related complications in varying economic and technological contexts. Women's participation in tracking menstrual abnormalities may improve health literacy.

[Acupressure and Evidence-Based Nursing].

Acupressure is a traditional Chinese medicine approach to disease prevention and treatment that may be operated by nurses independently. Therefore, acupressure is being increasingly applied in clinical nursing practice and research. Recently, the implementation of evidence-based nursing (EBN) in clinical practice has been encouraged to promote nursing quality. Evidence-based nursing is a method-ology and process of implementation that applies the best-available evidence to clinical practice, which is acquired through the use of empirical nursing research. Therefore, in this paper, we address the topic of acupressure within the context of empirical nursing practice. We first introduce the current status of acupressure research and provide the locations of common acupoints in order to guide future empirical nursing research and to help nurses use these acupoints in clinical practice. Finally, we describe the steps that are necessary to apply the current empirical information on acupressure as well as provide suggestions to promote safety and efficacy in order to guide nurses in the accurate application of acupressure in nursing practice.

SEED: the six excesses (Liu Yin) evaluation and diagnosis scale.

BACKGROUND: Infections such as common colds, influenza, acute upper respiratory infections, bacterial gastroenteritis, and urinary tract infections are usually diagnosed according to patients' signs and symptoms. This study aims to develop a scale for the diagnosis of infectious diseases based on the six excesses (Liu Yin) etiological theory of Chinese medicine (CM) by the Delphi method. METHODS: A total of 200 CM-guided diagnostic items measuring signs and symptoms for infectious diseases were compiled from CM literature archives from the Han to Ming dynasties, CM textbooks in both China and Taiwan, and journal articles from the China Knowledge Resource Integrated Database. The items were based on infections and the six excesses (Liu Yin) etiological theory, i.e., Feng Xie (wind excess), Han Xie (coldness excess), Shu Xie (summer heat excess), Shi Xie (dampness excess), Zao Xie (dryness excess), and Huo Xie (fire excess). The items were further classified into the six excess syndromes and reviewed via a Delphi process to reach consensus among CM experts. RESULTS: In total, 178 items with a mean or median rating of 7 or above on a scale of 1-9 from a panel of 32 experts were retained. The numbers of diagnostic items in the categories of Feng (wind), Han (coldness), Shu (summer heat), Shi (dampness), Zao (dryness), and Huo (fire) syndromes were 15, 22, 25, 37, 17, and 62, respectively. CONCLUSIONS: A CM-based six excesses (Liu Yin) evaluation and diagnosis (SEED) scale was developed for the evaluation and diagnosis of infectious diseases based only on signs and symptoms.

BCQ-: a body constitution questionnaire to assess Yin-Xu. Part I: establishment of a provisional version through a Delphi process.

BACKGROUND: Nowadays, the individual differences are emphasized in personalized medicine. Traditional Chinese Medicine (TCM) which prescribes tailored treatment based on each patient's different body constitution may provide new strategy to break the bottleneck of modern medicine (MM). Therefore, to integrate TCM into MM, an objective, reliable and rigorous diagnostic tool is necessary for the assessment of TCM constitution of each individual. This study aimed to develop a provisional version of the Yin-Xu Constitution Questionnaire (BCQ-), because evaluating the level of individual's Yin deficiency (Yin-Xu) by his manifestations is frequently involved in TCM clinical trials. METHODS: The provisional version of BCQ- was developed using a step-by-step approach: 1) to form the research team and select a panel of 26 experts who had both MM and TCM educational background and professional training for Delphi method; 2) to generate questionnaire items from literature review and Delphi process, refine these items to be colloquially acceptable, and evaluate their face and content validities by Delphi process again; 3) to evaluate the difficulty of answering these questions by a pilot study with 81 participants whose age ranged from 20 to 60 years. RESULTS: After 2 rounds of Delphi process, 22 colloquially appropriate questions were established and answered without difficulty by the 81 participants. CONCLUSIONS: This provisional version of BCQ- appeared to have considerable face and content validities and may be the basis to develop an advanced Yin-Xu questionnaire. The reliability and validity of BCQ- were further tested in the second part of the study.

BCQ-: A Body Constitution Questionnaire to assess Yin-Xu. Part II: evaluation of reliability and validity.

BACKGROUND: Based on the Traditional Chinese Medicine (TCM) theory and guided by the principles of modern medicine (MM), we aimed to develop an effective and reliable diagnostic tool using self-reported data in order to assess the Yin-Xu body constitution. In this study, we further evaluated a provisional 22-item version of the Yin-Xu Body Constitution Questionnaire (BCQ-) previously derived from the Delphi process. METHODS: A total of 1,272 eligible participants aged between 20 and 60 years was recruited. The participants had received health examination in teaching hospitals and had not shown any disease onset in the prior month. The factor structure of the BCQ- was explored, and the reliability and validity of each derived factor (scale) were evaluated. RESULTS: Exploratory factor analysis revealed 5 factors corresponding to the manifestations of the diminishing Yin-Xu level in 5 different body areas: head, 4 limbs, gastrointestinal tract, body surface, and abdominal cavity. 3 items with low factor loading (<0.4) were dropped, resulting in a 19-item BCQ-. Cronbach's α ranged from 0.57 to 0.85, and the intra-class correlation coefficients were greater than 0.7 for most items. The diagnoses of Yin-Xu by both the BCQ- and experienced TCM doctors were consistent. The concurrent validity showed that higher Yin-Xu scores were associated with lower hemoglobin. CONCLUSIONS: The final BCQ- measures the Yin-Xu constitution of 5 different body areas. The questionnaire is a reliable, valid, and potentially useful instrument for evaluating the Yin-Xu constitution in clinical research and practice.

[Personal health maintenance: the perspective of traditional Chinese medicine].

The World Health Organization (WHO) is increasingly stressing the importance of living a healthy lifestyle in its health promotion work. Lifestyle is associated inextricably with ethnic and cultural mores. Traditional Chinese medicine is closely tied to traditional culture, with traditional Chinese medicine concepts accepted by and woven into the daily life of people living in Taiwan. Traditional Chinese medicine embodies comprehensive principles and methods for maintaining personal health in daily life, which helps prevent disease. Thus, traditional Chinese medicine encompasses and reflects daily life concepts advocated by the WHO and fits within the framework of WHO traditional medical policies. This article was written to introduce the principles of health promotion of daily life as advocated by traditional Chinese medicine, including regular daily activities (sleep, diet, defecation and exercise) and methods of preventing unhealthy environmental factors from negatively impacting human health. Health promotion principles and methods embodied in traditional Chinese medicine may serve as a reference for enhancing health promotion and policy development work of health institutions.

BCQ+: a body constitution questionnaire to assess Yang-Xu. Part II: Evaluation of reliability and validity.

INTRODUCTION: Integrated medicine has become an important issue in this century. In order to bridge the gap between traditional Chinese medicine (TCM) and modern medicine, we have established a first final version of a Yang-Xu constitution questionnaire, the BCQ+, in a previous study. The objective of the present investigation is to assess the reliability and validity of the BCQ+. PARTICIPANTS AND METHODS: A total of 1,310 eligible participants, aged between 20-60, no disease onset in the past month, who received health examination in teaching hospitals were recruited. The BCQ+ was developed and psychometrically evaluated to ascertain and validate the factor structure of the BCQ+. Furthermore, the reliability and validity of the BCQ+ were examined. RESULTS: 19 items from the BCQ+ were developed. Exploratory factor analysis identified 5 primary domains that represent the Yang-Xu constitution and correspond to the diminishing energy levels of 5 different body areas: head, chest, limbs, abdominal cavity, and body surface. Cronbach's alpha ranged between 0.55-0.88 and the intraclass correlation coefficients were >0.7 for most of the 19 questions. The diagnoses of Yang-Xu by the BCQ+ and an experienced TCM doctor were consistent. Systolic blood pressure (SBP) was used as an indicator of concurrent validity of the BCQ+, and it was found that higher Yang-Xu scores were associated with a lower SBP. CONCLUSIONS: Five domains with 19 items in the BCQ+ were developed. The BCQ+ is a valid and potentially useful tool for evaluating the Yang-Xu constitution in clinical practice and research.

BCQ+: a body constitution questionnaire to assess Yang-Xu. Part I: establishment of a first final version through a Delphi process.

INTRODUCTION: Assessing an individual's level of Yang deficiency (Yang-Xu) by its manifestations is a frequent issue in traditional Chinese medicine (TCM) clinical trials. To this end, an objective, reliable and rigorous diagnostic tool is required. This study aimed to develop a first final version of the Yang-Xu Constitution Questionnaire. METHODS: We conducted 3 steps to develop such an objective measurement tool: 1) the research team was formed and a panel of 26 experts was selected for the Delphi process; 2) items for the questionnaire were generated by literature review and a Delphi process; items were reworded into colloquial questions; face and content validity of the items were evaluated through a Delphi process again; 3) the difficulty of the questionnaire was evaluated in a pilot study with 81 subjects aged 20-60 years. RESULTS: The literature review retrieved 35 relevant items which matched the definition of 'constitution' and 'Yang-Xu'. After a first Delphi process, 22 items were retained and translated into colloquial questions. According to the second part of the Delphi process, the content validity index of each of the 22 questions ranged between 0.85-1. These 22 questions were evaluated by 81 subjects, 2 questions that were hard to tell the difference were combined; 3 questions were modified after the research team had discussed the participants' feedback. Finally, the questionnaire was established with 21 questions. CONCLUSIONS: This first final version of a questionnaire to assess Yang-Xu constitution with considerable face and content validity may serve as a basis to develop an advanced Yang-Xu questionnaire.

[SARS prevention and nursing in traditional Chinese medicine].

This study adopts the concept of the three levels of prevention from traditional Chinese medicine to discuss Severe Acute Respiratory Syndrome (SARS) prevention and nursing. The emphasis in traditional Chinese medicine is on primary and tertiary prevention. The study presents nursing interventions based on traditional Chinese medicine (TCM), including daily care, diets, massage care, exercise, and Chinese psychosocial care. This course of interventions is designed for the consideration of nurses caring for SARS patients and to bolster their ability to fight the disease.