Posttraumatic stress disorder and its risk factors among adolescent survivors three years after an 8.0 magnitude earthquake in China.

BACKGROUND: Serious and long-lasting psychiatric consequences can be found in children and adolescents following earthquake, including the development of posttraumatic stress disorder (PTSD). Although researchers have been focused on PTSD recently, its prevalence and risk factors after a huge natural disaster are still unclear because of limited sample size. The purpose of this study is to explore the prevalence of posttraumatic stress disorder (PTSD) in adolescent survivors three years after the Wenchuan earthquake, describe PTSD symptoms, and to find out risk factors of PTSD. METHODS: A total of 4,604 adolescents from three middle schools which located in earthquake-stricken areas were recruited in this study. Instruments included the demographic questionnaire, questionnaire about earthquake exposure, the Social Support Appraisal Scale (SSA), the Posttraumatic stress disorder Checklist-Civilian Version (PCL-C), and the structured clinical interview for DSM-IV Disorders (SCID). RESULTS: The prevalence rate of PTSD was 5.7% (frequency: n = 261), and the most commonly occurring symptoms of PTSD were distress at reminders (64.5%), difficulty concentration (59.1%), and being easily startled (58.6%). Loss of houses and property, being injured, deaths of family members, and witness of death are positive risk factors of PTSD, and physical exercise and social support are negative risk factors of PTSD. CONCLUSIONS: Professional and effective interventions are needed to reduce the development of PTSD among adolescents after the Wenchuan earthquake, especially for these who lost their houses or property and lost their family members, witnessed death, and lacked of social support in the earthquake. Moreover, injured adolescents and adolescents who lacked of physical exercise also need intervention due to high risk.

Development and psychometric testing of a Chinese-language instrument for assessing institutionalised older males' motivations for living.

AIMS AND OBJECTIVES: To develop and psychometrically test a Chinese-language instrument, the Motivations for Living Inventory, for use with older adult institutionalised males. BACKGROUND: While tools exist for testing reasons for living among English-speaking individuals, none are available to assess Chinese-speaking older adults' motivation for living. DESIGN: This study had three steps: cross-sectional survey to collect data on instrument items, instrument development and psychometric testing. METHODS: Participants were 247 older male residents of five veterans' homes, including 22 who had attempted suicide in the previous three months and 225 nonsuicide attempters. The Chinese-language instrument, Motivations for Living Inventory, was developed based on individual interviews with older male residents of nursing homes and veterans' homes, focus groups with workers at nursing and veterans' homes, the literature and the authors' clinical experiences. The resulting Inventory was examined by content validity, construct validity, criterion-related validity, internal consistency reliability and test-retest reliability. RESULTS: The inventory had good content validity index (1·00). Factor analysis yielded a five-factor solution, accounting for 82·02% of the variance. Veterans' home male residents who had not attempted suicide tended to have higher scores than residents who had attempted suicide in the previous three months across the global inventory and all its subscales, indicating good criterion validity. Inventory reliability (Cronbach's α for the total scale was 0·86 and for subscales ranged from 0·80-0·94) and intraclass correlation coefficient (0·81) was satisfactory. CONCLUSIONS: The Chinese-language Motivations for Living Inventory can be completed in five to seven minutes and is perceived as easy to complete. Moreover, the inventory yielded highly acceptable parameters of validity and reliability. RELEVANCE TO CLINICAL PRACTICE: The Chinese-language Motivations for Living Inventory can be used to assess reasons for living in Chinese-speaking, institutionalised older male adults.

Reasons for living among older male Chinese residents of veterans' homes.

AIM: The purpose of this paper was to report a study of reasons for living among older male residents of veterans' homes in Taiwan. BACKGROUND: Suicide rates are high for older persons worldwide. Little is known about protective factors against suicide among elderly Chinese populations. METHOD: A qualitative descriptive design was used. Two veterans' homes, one government paid and one self-paid, were randomly selected from 18 institutions throughout Taiwan. Participants were 36 residents (≥65 years) who had expressed suicidal ideas in the past 6 months but had never shown suicidal behaviours. Data were collected in individual interviews from 2006 to 2007 and analysed by content analysis. RESULTS: Five major themes related to reasons for living were identified: fear of death, comparative improvement in health condition, maintaining self-dignity, family related concerns and concerns for staff. CONCLUSION: Fear of death, maintaining self-dignity and family related concerns are similar to reasons for living found in western studies, but not comparatively better health and concerns for staff. These differences may be due to our sample being veterans' home residents rather than community-dwelling elders and residents' perceived social support from staff. Since most healthcare providers are nurses and nurses' aides, they may consider promoting/maintaining older people's health, promoting their self-dignity, and strengthening relationships with family members and staff to strengthen protective factors against suicide in older Chinese/Asians. Given the aging population worldwide, nurses should become aware of protective factors related to suicide among older people to improve care for this population.

Female nurses' sensitivity to male genitalia-related care in mainland China.

AIMS: To discover the latent psychosocial construct of female nurses' sensitivity to male genitalia-related care in the context of sexual conservativeness. BACKGROUND: Many nursing activities involve direct exposure or contact with male external genitalia. In the sexually conservative culture and the predominance of female nurses, this area is the subject of continuing interest and investigation. DESIGN: Methodological research design. METHODS: An item pool related to male genitalia-related care was generated through a panel of experts and then reduced to a short form questionnaire, the Female Nurses' Sensitivity to Male Genitalia Related Care scale. Using data from a purposive sample of 588 female nurses, the structure of the questionnaire was examined using structural equation modelling. The validity was examined against existing scales. RESULTS: The 13-item Female Nurses' Sensitivity to Male Genitalia Related Care scale has a two-factor structure with high internal consistency (α = 0·87) and test-retest reliability of 0·90. Nearly all model fit measures reach the criteria of being an acceptable model fit except chi-squared statistics. Scores on Female Nurses' Sensitivity to Male Genitalia Related Care can be best predicted by that of brief Fear of Negative Evaluation Scale, Embarrassability Scale and Situational Susceptibility to Embarrassment Scale. CONCLUSIONS: The anxiety of projecting a positive image and the pursuit of sexual propriety may underpin female nurses' sensitivity to male genitalia-related care. This trait can be measured by the 13-item female nurses' sensitivity-male genitalia-related care scale with satisfactory psychometric properties including internal consistency, reliability, content validity and construct validity. RELEVANCE TO CLINICAL PRACTICE: Particular attention shall be paid to the negative effects of social rules or norms including sexual propriety rules over (female) nurses' perceptions, attitudes and behaviours. Strengthening nursing education in this regard is important to overcome negative effects on female nurses of male genitalia-related care.

Meaning making: psychological adjustment to breast cancer by Chinese women.

Based on a study exploring the phenomenon of coping among Hong Kong Chinese women afflicted with breast cancer, from diagnosis to completion of treatment, we report the findings on meaning making by the informants. Using the grounded theory method, we conducted 35 interviews with 24 women suffering from breast cancer. Among them, we followed and interviewed 5 women thrice, from diagnosis to 3 months after completion of treatment. We noted the evolution of reframing as the key category in the adjustment process through which the women identified meaning at different points of time in the cancer experience, to achieve different outcomes. Chinese women identified a sustaining force from minimizing social disturbance during treatment. The integration of cancer into their lives after completion of treatment was achieved through positive transformation in their philosophy of life and social relationships. Nurses should aim to understand the cancer patients' interpretation of the situation, explore personally meaningful sustaining forces, and reflect on their cancer experience.

Digitalizing traditional chinese medicine pulse diagnosis with artificial neural network.

OBJECTIVES: The increasing popularities of traditional Chinese medicine (TCM) and telehealth indicate a need for digitalizing major clinical assessment methods used during TCM consultations. In this study, an electronic TCM pulse diagnostic system was developed, and its validity was explored. MATERIALS AND METHODS: The system was developed with an artificial neural network (ANN). The output neurons were TCM pulse qualities operationalized as the intensity of eight elements (depth, rate, regularity, width, length, smoothness, stiffness, and strength) at six locations (left and right cun, guan, and chi). The input neurons were physical parameters of arterial pressure waveform acquired from the six locations by a pulse acquisition device. TCM pulse quality was rated by a TCM doctor on a 0-10 visual analog scale. Physical parameters were extracted from the arterial pressure waveform with a pulse extraction program developed in-house. The model structure, including number of hidden neurons and hidden layers, and training algorithms were manipulated to optimize model performance. The value of r² was the outcome measure indicating model performance. RESULTS: Two hundred twenty-nine subjects were recruited. Four-layer ANN models trained with 45 hidden neurons and the Levenberg-Marquardt algorithm performed the best. The r² ranged from 0.60 to 0.86. CONCLUSIONS: The validity of the proposed system generated by ANN is established and can assist TCM doctors in collecting relevant health data during telehealth consultation.

Prevalence and risk factors associated with prehypertension: identification of foci for primary prevention of hypertension.

BACKGROUND AND RESEARCH OBJECTIVE: Prehypertension (pre-HT) has become an important public health issue in China because it identifies people at higher risk for hypertension (HT) and cardiovascular diseases. The aims of this study were to (1) examine the prevalence of pre-HT, (2) identify risk factors of pre-HT, and (3) identify factors that increase the likelihood of developing HT among the pre-HT group. SUBJECT AND METHODS: This was a cross-sectional descriptive study. Community-dwelling residents of an urban district in Wuhan, central China (obtained from stratified random sampling), aged between 35 and 74 years completed the study. Data were collected by using a structured self-reporting questionnaire and a standardized protocol for blood pressure measurement and risk screening. Blood pressure categories were defined according to the results of the seventh report of the Joint National Committee on the Prevention, Detection and Treatment of High Blood Pressure. RESULTS: Among the 1,448 participants, 618 (42.7%) had pre-HT. Multivariate logistic regression analysis revealed the risk factors of being overweight (adjusted odds ratio [aOR], 1.93; 95% confidence interval [CI], 1.26-2.98) or obese (aOR, 8.9; 95% CI, 1.14-62.3) and having above-optimal triglyceride level (aOR, 1.67; 95% CI, 1.24-2.26) were associated with pre-HT. Age and lower educational level were also associated with pre-HT risk. There was a clear trend toward an increased risk of HT among the pre-HT group with every 10-year increment in age starting from 45 years (aORs were 3.47, 6.82, and 7.58, respectively). Participants with Pre-HT currently engaging in sedentary work were also found to have a higher risk of developing HT. Other risk factors for HT included being overweight (aOR, 2.0; 95% CI, 1.50-2.68), a known family history of HT (aOR, 2.54; 95% CI, 1.98-3.26), and presence of diabetes mellitus (aOR, 2.51; 95% CI, 1.66-3.80). CONCLUSION: Prehypertension is common among residents in an urban district in central China. Findings of this study serve to identify the at-risk groups. Targeting these people early with therapeutic lifestyle changes may provide important long-term benefit for HT prevention.

Effects of Ving Tsun sticking-hand training on upper-limb sensorimotor performance in community-dwelling middle-aged and older adults: A randomized controlled trial.

OBJECTIVE: To evaluate the effects of Ving Tsun (VT) sticking-hand training on upper-limb joint position sense and muscular performance in community-dwelling middle-aged and older adults. METHODS: Thirty-three adults were randomly allocated to either a VT group or a control group. The VT group received VT sticking-hand training twice per week for 3 months. Measurements were taken before and after the intervention period. The primary outcome was elbow-joint repositioning error, which was measured by an elbow-joint passive positioning and active repositioning test using a universal goniometer. Secondary outcomes were upper-limb muscles' peak force and time taken to reach peak force as measured by a hand-held dynamometer. RESULTS: No significant time, group or time-by-group interaction effects were found for elbow-joint repositioning error or upper-limb muscle peak force outcomes. Shoulder flexor time to peak force decreased by 33.8% from pre-test to post-test in the VT group (P = 0.007). Shoulder abductor, internal and external rotator, and elbow extensor times to peak force decreased by 30.0%-35.9% in the VT group (P < 0.05) and by 30.4%-37.1% in the control group (P < 0.05). CONCLUSIONS: VT sticking-hand training does not improve elbow-joint position sense or the maximum strength of upper-limb muscles in middle-aged and older adults. However, VT can improve shoulder flexor muscles' time to reach peak force in these populations. VT had no obvious effect on the time required to reach peak force in other shoulder muscles and elbow extensors.

Chinese female nurses' perceptions of male genitalia-related care--Part 2.

AIMS: This study was designed to investigate Chinese female nurses' perceptions of certain male genitalia-related care and the influence of their demography and experiences on their perceptions. BACKGROUND: Several physical conditions, in which male genitalia-related care is required, have been found to have considerable negative impact on male patients, leading to decreased quality of life and psychosocial and sexual dysfunctions. Available studies suggest that Chinese female nurses' conduct during the provision of male genitalia-related care is negative. However, the evidence is weak with respect of the degree of Chinese nurses' negativity and what the contributory factors may be. DESIGN: Survey. METHODS: Chinese female nurses in nine units in five hospitals were surveyed. Of 378 returned questionnaires, 312 were usable, and 138 contained textual comments. Numerical data were analysed using spss 14.0, and textual data were analysed using thematic analysis. RESULTS; The majority of participants had never performed genital wound care, perineal area shaving, perineal hygiene, suprapubic and urinary catheterisation. More than half preferred only bladder irrigation and washout to be performed by nurses and preferred the other male genitalia-related care to be performed by a male. Participants tended to agree meatal cleansing, perineal area shaving, perineal hygiene and urinary catheterisation were embarrassing, awkward and intrusive, but to disagree that they were sexual, dirty, stigmatizing or having an impact on the male patient's sexual health. CONCLUSION: This study suggests that Chinese female nurses play limited roles in the practice of male genitalia-related care, but their perceptions of such care are not negative. RELEVANCE TO CLINICAL PRACTICE: Given the increasing move of Chinese female nurses to other countries, sexuality, sexual harassment, privacy and the constraints of traditional Chinese beliefs on sexuality over professional nursing conduct should be emphasised in clinical training programmes.

Chinese female nurses' perceptions of male genitalia-related care--Part 1.

AIMS: To explore Chinese female nurses' experiences of male genitalia-related care. BACKGROUND: Male patients who require male genitalia-related care may have psychosocial and sexual concerns and needs. Nurses' attitudes and conduct in the provision of male genitalia-related care, if negative, may obviate meeting these needs. Previous research indicates that limited studies have been conducted focusing on nurses' perceptions, responses and attitudes towards male genitalia-related care. There is a dearth of knowledge about the practice of Chinese female nurses delivering male genitalia-related care, particularly given that physical contact between Chinese adults of different genders outside marriage is traditionally prohibited. DESIGN: This study is an exploratory qualitative study. METHODS: Through purposive sampling, eight subjects were approached and semi-structured interviews were conducted. Digitally recorded interviews were transcribed verbatim and thematic analysis was conducted. The strategies of long engagement, member checking, peer debriefing and journal writing were used to establish trustworthiness. RESULTS: Two themes emerged from interviews: 'association with sexuality' and 'consequences'. The theme 'association with sexuality' comprised the sub-themes of 'being sexual', 'impact on intimate relationship' and 'emotional responses'. The theme 'consequences' was constituted by the sub-themes of 'care with preconditions', 'unavoidable responsibilities' and 'limited involvement with implicit approval'. CONCLUSIONS: This study suggests that Chinese female nurses' perceptions, responses and attitudes towards male genitalia-related care may be negative, with the consequence that the quality of male genitalia-related care might be compromised. The Chinese culture of sexual conservativeness may play a critical role. RELEVANCE TO CLINICAL PRACTICE: Risks may be embedded in the practice of male genitalia-related care by Chinese female nurses. Particular attention, therefore, should be drawn to the possibility of adverse effects of Chinese female nurses delivering male genitalia-related care on them and their patients.

Reframing: psychological adjustment of Chinese women at the beginning of the breast cancer experience.

In this article, we present findings from a larger study that explored how Chinese women cope with breast cancer. We report on the process of early psychological adjustment, along with contextual factors and how they influence the women's coping mechanisms at the beginning of the cancer experience. Twenty-four women with diagnoses of breast cancer were interviewed. The grounded theory method was adopted in data collection and analysis. "Reframing" was the core category of the early adjustment process. Focus and approach were the two contextual conditions. Women adopted "fighting," "following the natural course," "struggling," and "bearing" modes in coping with the disease. These findings highlight the significance of focusing on coping and realizing the role of the self in creating a subjective positive interpretation, which subsequently enhances acceptance of the disease at the beginning of the cancer experience. Characteristics of the Chinese people with respect to coping include the collaborative meaning of control and the philosophy of acquiescence to fate.

An iterative approach to enhance the clinical learning experience in Macao nursing education.

OBJECTIVE: The aim of this study was to reduce or eliminate the stressors to enhance nursing students' clinical learning experience through implementation of an iterative approach that developed a personalised response to student stress. METHODS: A prospective cohort research design was applied to collect data from a sample of undergraduate nursing students across the four study years. An iterative approach was employed to improve students' learning experience and the Stressors in Nursing Students Scale-Chinese Version (SINS-CN) was used to measure student stress. Key problems encountered by students were identified, refined and the responding solutions were worked out and implemented among this group of students through their first year to fourth year. RESULTS: The overall SINS-CN mean score (2.17-2.82) of students was declined to a moderate level. CONCLUSIONS: Having implemented iterative approach to address factors that led to stressful environments encountered by the nursing students, the overall stress score and each sub-dimension score decreased significantly. Therefore, it is recommended that this approach could be adopted by other colleagues in the nursing arena around the world.

Neuromuscular training for children with developmental coordination disorder: A randomized controlled trial.

BACKGROUND: Adaptive balance control is often compromised in children with developmental coordination disorder (DCD). Neuromuscular training (NMT) is commonly used in clinical settings to improve neuromuscular control and hence balance performance in these children. However, its effectiveness has not been proven scientifically. This randomized controlled study aimed to explore the effectiveness of NMT for improving adaptive balance performance and the associated leg muscle activation times in children with DCD. METHODS: Eighty-eight children with DCD were randomly assigned to the NMT or control group (44 per group). The NMT group received two 40-minute NMT sessions/week for 3 months, whereas the control group received no intervention. The outcomes were measured at baseline and 3 and 6 months. The primary outcome was the sway energy score (SES) in both the toes-up and toes-down conditions as derived using the Adaptation Test (ADT). Secondary outcomes included the medial gastrocnemius, medial hamstring, tibialis anterior and rectus femoris muscle activation onset latencies during ADT, measured using surface electromyography and accelerometry. Data were analyzed using a repeated measures analysis of covariance based on the intention-to-treat principle. RESULTS: At 3 months, no significant within-group or between-group differences were noted in the SESs for either group. At 6 months, the toes-down SES decreased by 6.8% compared to the baseline value in exclusively the NMT group (P = .004). No significant time, group or group-by-time interaction effects were observed in any leg muscle activation outcomes. CONCLUSIONS: Short-term NMT failed to improve adaptive balance performance and leg muscle activation times in children with DCD. Further studies should explore the clinical applications of longer-term task-specific interventions intended to improve the adaptive balance performance of these children.

Self-worth therapy for depressive symptoms in older nursing home residents.

AIM: The aim of this study is to report the effects of self-worth therapy on depressive symptoms of older nursing home residents. BACKGROUND: Depression in older people has become a serious healthcare issue worldwide. Pharmacological and non-pharmacological therapies have been shown to have inconsistent effects, and drug treatment can have important side-effects. METHOD: A quasi-experimental design was used. Older people were sampled by convenience from residents of a nursing home in northern Taiwan between 2005 and 2006. To be included in the study participants had to: (i) have no severe cognitive deficits; (ii) test positive for depressive status and (iii) take the same anti-depressant medication in the previous 3 months and throughout the study. Participants in the experimental group (n = 31) received 30 minutes of one-to-one self-worth therapy on 1 day a week for 4 weeks. Control group participants (n = 32) received no therapy, but were individually visited by the same research assistant, who chatted with them for 30 minutes on 1 day/week for 4 weeks. Depressive status, cognitive status and functional status were measured at baseline, immediately after the intervention and 2 months later. Data were analysed by mean, standard deviations, t-test, chi-squared test and univariate anova. FINDINGS: Self-worth therapy immediately decreased depressive symptoms relative to baseline, but not relative to control treatment. However, 2 months later, depressive symptoms were statistically significantly reduced relative to control. CONCLUSION: Self-worth therapy is an easily-administered, effective, non-pharmacological treatment with potential for decreasing depressive symptoms in older nursing home residents.

Learning from the severe acute respiratory syndrome (SARS) epidemic.

AIMS AND OBJECTIVES: This study uses two models of nursing practice, conventional and modular design, to compare nursing activities, hand hygiene, time efficiency and nurse-patient satisfaction in medical and surgical wards. Background. Learning from the SARS epidemic pointed to the importance of quality nursing practice considerations that minimize cross-transmission of infection while maximizing patient-focused care. Hence, a modular nursing model was adopted. DESIGN AND METHOD: This study comprised pre- and postintervention phases. Data collection tools to evaluate modular nursing practice included a work sampling observation checklist, focused group interviews with nurses, questionnaires addressing nurses' perceived competence and caring attributes, a patient satisfaction questionnaire, and a hand hygiene audit. A series of education sessions were conducted between the two phases. Quantitative and qualitative analyses were used for data triangulation. RESULTS: Modular nursing practice, focusing on continuity of care, led to changes in the nature of direct care activities and improvement in patient/family education frequency. Also, a general increase in nurses' hand washing frequency was noted. However, when nurses perceived time pressure, a lapse in hand hygiene compliance was found. Because of human resource and inefficiency issues, some nurses in the studied wards did not embrace geographical separation for infection control. Positive correlations were found for nurses' perceived infection control practice competence and their perceived caring attributes. RELEVANCE TO CLINICAL PRACTICE: In examining nursing practice models within complex clinical situations, the significance lies not only in the model's effects but also in other operational outcomes.

A review of the psychosocial issues for nurses in male genitalia-related care.

AIM: This literature review aimed to highlight psychosocial issues for nurses in the practice of male genitalia-related care so as to guide the improvement of the teaching and practice of male genitalia-related care. BACKGROUND: Male genitalia-related care is common in hospitals and in the community. In several conditions, e.g. incontinence, postradiotherapy or following operation for cancer of genitalia, bladder, colon or rectum, patients will require male genitalia-related care. Patients who require male genitalia-related care may encounter psychosocial and/or sexual dysfunction. In the holistic approach to men's health, nurses are expected to meet patients' psychosocial and sexual needs, while the literature suggests that nurses' perceptions and attitudes in providing certain male genitalia-related care, e.g. genital hygiene, sexual counselling, are negative. METHOD: Systematic literature review. CONCLUSION: Issues surrounding male genitalia-related care for nurses are complicated and may be related to privacy, intimacy, sexuality, dirty work and emotional discomfort. Age, gender, race and social class could compound these issues. Relevance to clinical practice. Nurses' negative perceptions, responses and attitudes towards male genitalia-related care may exacerbate patients' conditions under which male genitalia-related care is required. Appropriate strategies should be developed to overcome these problems.

Evaluation of services of the integrative health clinic in Hong Kong.

AIMS: (i) To provide a profile of the clients who have used the Integrative Health Clinic's services, (ii) to determine the clients' extent of satisfaction with the services received and (iii) to assess whether integrative therapies can/should be recommended to other clinics. BACKGROUND: Based on the integration of various health paradigms and the use of health promotion strategies, our Integrative Health Clinic in Hong Kong provides a range of different therapies for integrated symptom management. The integrative therapies are derived from conventional, complementary and alternative medicine. Design. Postal survey, followed by routine data analysis. METHOD: Hong Kong Chinese clients attending a residential community health clinic were surveyed about health status and satisfaction towards the services received. RESULTS: A total of 489 clients (30.8% were male and 69.2% female) were registered with the clinic during the study period. The mean age (SD) was 47.8 (15.4) years. The customer satisfaction survey found that traditional Chinese medicine consultation was the most frequently used modality of the Integrative Health Clinic, followed by pain management. Out of the 489 clients, those who attended the Integrative Health Clinic only once in the study period for an annual health assessment and those who died during the period were excluded from the survey, giving a total of 276 eligible clients. Out of the 276 clients, 52.5% (128) responded to the survey that asked them to evaluate their satisfaction with the services received at the clinic and the performance of the clinic's practitioners who interacted with them. For practitioner performance, the percentage of respondents who gave a rating of satisfaction was found to range between 86.3-64.3%, while the percentage of respondents who gave a rating of dissatisfaction ranged from 13.7-35.7%. Overall, the survey found that most aspects of the Integrative Health Clinic's services were rated as satisfactory. CONCLUSION: The overwhelming satisfaction of clients with the services they received at the Integrative Health Clinic suggests that this integrative health services model could be considered for adoption in other clinics in Hong Kong and perhaps the region. RELEVANCE TO CLINICAL PRACTICE: It is necessary to review the use of integrative therapies so as to provide more data for the evaluation of this increasingly popular modality of health services.

Evaluation of the performance of using mean absolute amplitude analysis of thoracic and abdominal signals for immediate indication of sleep apnoea events.

AIM: To evaluate the sensitivity of mean absolute amplitudes of the thoracic and the abdominal signals as a prompt indicator of the occurrence of sleep apnoea events. BACKGROUND: To provide symptomatic management of sleep apnoea, a reliable method of detecting sleep apnoea is essential to ensure that the intervention can be applied only when needed. It is also crucial to identify the threshold for the trigger of an intervention using a deployed sensor. DESIGN: Twenty-six subjects aged between 18-65 years who were diagnosed with obstructive or central sleep apnoea underwent an overnight sleep study. METHOD: Signals of nasal and oral airflow, thoracic and abdominal efforts and pulse oximetry level were recorded using a polysomnography device. RESULTS: With a 95% CI, the overall area under the receiver operating characteristic of the thoracic signal, the abdominal signal and the combination of the thoracic and the abdominal signals were 84.56, 87.48 and 90.91%, respectively. Using -20, -25 and -30% as a cut-off point, the sensitivity values of thoracic signal, abdominal signal and combination of the thoracic and the abdominal signals ranged from 70.29-86.25% and the specificity values ranged from 74.82 to 90.09%. CONCLUSIONS: Using mean absolute amplitude analysis, the results of this study showed that combination of the thoracic and the abdominal signals achieved the best overall and individual performances compared with thoracic signal and abdominal signal. Overall, thoracic signal, abdominal signal and combination of the thoracic and the abdominal signals have a good performance with an receiver operating characteristic value higher than 80%. The thoracic and the abdominal signals were good parameters for the identification of the occurrence of sleep apnoea, being as quick as the nasal airflow signal. RELEVANCE TO CLINICAL PRACTICE: These results suggested that sleep apnoea events could be identified through constant monitoring of the patient's thoracic and abdominal signals. Knowledge of these signals could help nurses to manage sleep apnoea in patients.

Challenge Based Learning nurtures creative thinking: An evaluative study.

BACKGROUND: The demand for more creative and innovative nurses and together with the rapid expansion of nurse education in Mainland China have called for new approaches to student learning. Challenge Based Learning, an active student-directed approach was incorporated into an elective course in an undergraduate nursing programme. Initially, the students were given some big ideas about the real world. They worked together in small groups to identify the most challenging problems from these ideas, develop some innovative solutions, formulate an action plan for a selected solution, carry out the actions and evaluate the outcome. OBJECTIVES: To evaluate the effectiveness of Challenge Based Learning on students' creativity and innovativeness. DESIGN: Quasi-experimental. SETTINGS: A medical university in Guangzhou, China. METHOD AND PARTICIPANTS: A convenience sample of 48 undergraduate nursing students from the bilingual class, who enrolled in the elective course, Innovation and Creative Thinking was invited to participate in the evaluative study. They completed the Creativity and Innovation Effectiveness Profile before and after the course. RESULTS: Apart from descriptive statistics, the mean scores of the Creativity and Innovation Effectiveness Profile between the pretest and posttest assessments were analyzed using the Wilcoxon signed ranks test. The results showed that the mean scores of all 7 domains (i.e. creative consciousness, levels of curiosity, pattern breaking skills, idea nurturing ability, willingness to experiment and take risks, courage and resilience and energetic persistence) of Creativity and Innovation Effectiveness were significantly higher in the posttest. CONCLUSION: Students can enhance their ability to innovate and create through learning. The successful practical experience of using CBL in the study provides a good reference for nurse teachers who want their students to be self-directed, creative and innovative.

Evaluation of the Morse Fall Scale: applicability in Chinese hospital populations.

BACKGROUND: Patient falls have been identified as a significant health problem in the general hospital patient population. The Morse Fall Scale (MFS) is an individualized criterion-referenced assessment tool designed for measuring the likelihood of patient falls in hospitals. Despite the scale has demonstrated high validity and reliability in the previous researches, this study is to provide additional validity tests to determine the applicability in the Chinese hospital population. OBJECTIVES: To examine the predictive power of the MFS to predict patient falls. To conduct reliability tests on internal consistency, item analysis, inter-rater and test-retest reliability. DESIGN: The study was a cross-sectional study. SETTINGS: The medical and geriatric units of three rehabilitation hospitals in Hong Kong participated in the study. PARTICIPANTS: A convenience sample of 954 Chinese patients was recruited sequentially upon admission in the hospital ward units. They ranged in age from 17 to 100 years, with a mean of 70.2 years. METHODS: The patients were assessed for fall risk using the MFS on admission. Data was collected on the number of patients who fell rather than the number of falls. RESULTS: The scale had a sensitivity of 31% and a specificity of 83% when the cut-off point was determined at 45. The field test demonstrated excellent inter-rater reliability with an ICC value of 0.97 (95%CI 0.94-0.98). Repeatability was high with an ICC of 0.98 (95% CI 0.98-0.99). The evaluation revealed a low Cronbach's alpha coefficient and a low to moderate item-to-scale correlation. CONCLUSIONS: The evidence collected in this study has shown both the positive and negative aspects of using the MFS in assessing the fall risk of Chinese patients during rehabilitation. The discriminative validity and internal consistency reliability provide researchers and clinicians with a major step in further developing or modifying the scale.