The Effectiveness of Home-Based Inspiratory Muscle Training on Small Airway Function and Disease-Associated Symptoms in Patients with Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitations, occurring mainly in the small airways. Weakness in the respiratory muscles contributes to dyspnea and a decreased exercise capacity in COPD patients. This study aimed to investigate the effectiveness of home-based inspiratory muscle training (IMT) on small airway function and symptoms in COPD patients. This research adopted a non-randomized controlled-study quasi-experimental design. The IMT program consisted of two 15 min sessions·d-1, 5 d·wk-1, with 40% of the maximal inspiratory pressure (PImax) on each participant's assessment results and lasted for 12 weeks. Small airway function was assessed using plethysmography at baseline and after 12 weeks. The modified British Medical Research Council (mMRC), COPD assessment test (CAT), PImax, and 6 min walking distance (6MWD) were recorded at baseline as well as four, eight, and twelve weeks. Twenty-three participants with at least moderate COPD were enrolled in IMT (n = 16) or in the control group (n = 7) in this study. The study participants were mostly male (82.6%), and the average age was 68.29 ± 10.87 years, with a mean body mass index (BMI) of 23.54 ± 4.79. After 12 weeks, the ratios of the first second of forced expiration to the forced vital capacity (FEV1/FVC%) (B coefficient [95% Wald confidence interval] of 5.21 [0.46 to 9.96], p = 0.032), forced expiratory flow (FEF25-75%) (0.20 [0.04 to 0.35] L/s, p = 0.012), and FEF50% (0.26 [0.08 to 0.43] L/s, p = 0.004) in the IMT group were significantly better than in the control group. The IMT group showed significantly lower CAT scores at week 8 (-5.50 [-10.31 to -0.695] scores, p = 0.025) than the control group. The mMRC grade, CAT score, PImax, and 6MWD were significantly improved compared to their values at baseline in the IMT group. Home-based IMT effectively improved post-bronchodilator small airway function and disease-associated symptoms in COPD patients.

Effectiveness of a Protocol Intervention for Aspiration Pneumonia Prevention in Patients With Esophageal Cancer During Concurrent Chemoradiotherapy: A Randomized Control Trial.

BACKGROUND: Dysphagia is a leading cause of aspiration pneumonia and negatively affects tolerance of chemoradiotherapy in patients with esophageal cancer. OBJECTIVE: This study aimed to assess a protocol for preventing the occurrence of aspiration pneumonia for adult patients with esophageal cancer experiencing swallowing dysfunction. METHODS: This study tested a dysphagia intervention that included high-risk patients confirmed by the Eating Assessment Tool questionnaire and Water Swallowing Test. A protocol guide (Interventions for Esophageal Dysphagia [IED]) to prevent aspiration pneumonia during chemoradiotherapy was also implemented. Thirty participants were randomly assigned to an intervention or control group. The study period was 50 days; participants were visited every 7 days for a total of 7 times. Instruments for data collection included The Eating Assessment Tool, Water Swallowing Test, and personal information. The IED was administered only to the experimental group. All data were managed using IBM SPSS statistics version 21.0. RESULTS: The IED significantly reduced the occurrence of aspiration pneumonia (P = .012), delayed the onset of aspiration pneumonia (P = .005), and extended the survival time (P = .007) in the experimental group. CONCLUSION: For patients with esophageal cancer undergoing chemoradiotherapy, this protocol improved swallowing dysfunction and reduced aspiration pneumonia. IMPLICATION FOR PRACTICE: The IED protocol should be included in continuous educational training for clinical nurses to help them become familiar with these interventions and to provide these strategies to patients.

Use of Transcutaneous Electrical Nerve Stimulation to Alleviate Thirst After Surgery: A Randomized Controlled Trial.

PURPOSE: This prospective study investigated the preventive effect of transcutaneous electrical nerve stimulation (TENS) for postoperative thirst. DESIGN: This experimental study was conducted with the CONSORT checklist. METHODS: A total of 105 surgical patients who received general anesthesia were recruited from a medical center. Each patient was randomly assigned to the experimental group (n = 53; 20 min of TENS) or the control group (n = 52; routine care). In each group, oral moisture wetness was measured at 1 min, 20 min, and 50 min post-surgery. Descriptive and inferential statistics (Chi-square test, t test, one-way ANOVA, and generalized estimating equation (GEE) regression analysis) were performed to assess the proposed relationships. FINDINGS: The two groups showed similar characteristics at baseline. The oral moisture wetness was significantly higher in the experimental group than the control group at each post-surgery assessment time (all P < .001). The GEE results showed that patients in the experimental group reported more oral moisture wetness than patients in the control group. CONCLUSIONS: This study demonstrated that TENS can reduce thirst reported by patients after general anesthesia. Thus, this method may have clinical applications for managing postoperative thirst.

A cross-sectional study on sleep disturbances and associated factors among nurses.

BACKGROUND: Many studies have measured sleep disturbances among nurses globally, but none have addressed this issue in Vietnam. Therefore, this study aimed to assess the prevalence of sleep disturbance and identify associated factors among staff nurses in Vietnam. To identify sleep disturbances and associated factors among staff nurses in Vietnam. METHODS: A cross-sectional design was used in this study. Participant nurses (n = 420) completed a general information questionnaire, the Vietnamese version of the General Sleep Disturbance Scale (GSDS), the Perceived Stress Scale, and the Short Form 12. Data were collected between July and September 2019 from three public hospitals located in southwestern Vietnam. Data were analyzed using Chi-square, independent Student's t-test, and multivariate logistic regression analysis. RESULTS: The average GSDS score was 41.10 (SD = 19.48), indicating sleep disturbances among 46.9% of nurses. Age, health condition, stress, and quality of life had an impact on sleep disturbance. Multivariate logistic regression analysis confirmed that nurses with high stress and poor physical health status were more likely to experience sleep disturbances. CONCLUSION: Vietnamese nursing staff suffers from a high rate of sleep disturbances. Significant predictors included high stress and poor physical health status. Administrators of healthcare services should carefully consider how to conduct interventions to help the nurses handle their sleep disturbances such as stress management and physical health promotion.

Exercise effects on fatigue in breast cancer survivors after treatments: A systematic review and meta-analysis.

AIM: The aim of this study is to explore the effects of exercise interventions by type, duration and intensity of exercise for fatigue in breast cancer survivors who had completed their treatment. BACKGROUND: Most studies found that exercise has valuable outcomes for cancer survivors. This meta-analysis comprehensively summarizes the benefits of exercise intervention for fatigue in breast cancer patients who had completed their adjuvant treatments. METHODS: We conducted a meta-analysis on randomized control trials published during 1 January 2000 through 31 December 2019, from PubMed, Cochrane Library databases, EMBASE, Medline (ProQuest), CINAHL, PsycINFO, Chinese Electronic Periodical Service and Wan Fan Data with prespecified searching criteria. Breast cancer patients earlier than stage IIIc and completing adjuvant treatments were included, and the effects of exercise on fatigue were investigated. RESULTS: Nine randomized controlled trials (RCTs) were included (N = 581). Patients receiving exercise interventions showed reduced fatigue comparing with those without exercise. Exercise with low-moderate intensity, 20 min/day, three times per week and lasting up to 12 weeks had a significant effect on reducing fatigue for breast cancer survivors. CONCLUSION: Our study suggested that exercise interventions can reduce fatigue for this group of cancer survivors. The duration and intensity of exercise intervention could be prescribed for this specific group of cancer patients as a basic requirement to handle their reported fatigue.

Comparison of the early development of the professional values for nursing students in the traditional program and the second-degree program: a longitudinal study.

AIM: This study aims to compare the early development of professional value between the students in the traditional programme (BSN) and those in the accelerated BSN (ABSN) programmes. DESIGN: A longitudinal design was conducted. METHODS: Data were collected from three schools of nursing during one academic year. A total of 117 BSN students and 101 ABSN students completed the survey of demographic information and the Nurses' Professional Values Scale-Revised questionnaires. All data were analysed by IBM SPSS-Statistics 22. RESULTS: Results showed that, in the beginning of the first professional nursing course, both students in the BSN and the ABSN programmes reported similar level of professional values. However, after one academic year, the changes in the professional value varied both between these two programmes and among the three different nursing schools. The increased professional value in school A represented the possibility for students to improve during their first-year professional nursing programme. As educators, we should redesign our teaching strategies according to the different conditions of students in each programme.

[Exploration of Distress Symptoms and Medical Interventions in Patients With Terminal Cancer in Hospice Shared Care].

BACKGROUND: Hospice shared care is a model of care widely used in patients with terminal cancer. Appropriate interventions to improve related symptoms should be provided during disease progression through the end of life. PURPOSE: The purpose of this study was to explore the related symptoms and to compare symptom severity before and after the implementation of hospice shared care and medical care interventions. METHODS: Fifty patients with terminal cancer were enrolled in this longitudinal, quasi-experimental research. Inclusion criteria included having an expected life span of < 6 months and agreeing to enter hospice shared care. RESULTS: The three most-frequently noted physical symptoms were, in rank order: "pain", "weakness", and "dyspnea". In terms of severity, "pain" was the most severe, followed by "weakness" and "disturbance of sleep". The three most-frequently noted psychological symptoms were, in rank order: "depression", "worry about the disease", and "afraid of dragging others down". In terms of severity, "depression" was the most severe, followed by "anxiety" and "worry about the disease". The frequency and severity of the top-3 social and spiritual distress symptoms were, in rank order: "unfinished wish", "economic difficulties", and "painlessness". During the study period, the severity of physical symptoms improved gradually, while the severity of psychological symptoms improved significantly. The top-3 items in the original medical team`s hospice-care interventions were, in rank order: "tube care", "laboratory test", and "wound care" in the non-pharmacological category; "symptom control medication", "antibiotic injection", and "intravenous fluid infusion" in the pharmacological category; and "cognitive clarification of the prognosis condition", "do not conduct resuscitation discussions and signing", and "emotional stress consoling" in the problem-coordination and interview categories. The interventions implemented by the hospice specialist team included "emotional stress interview", "team communication", and "cognitive clarification of prognosis condition" in the problem coordination and interview categories, and "massage", "consultation", and "nursing advice" in the non-pharmacological category. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The symptoms identified in this study provide clinical staff with a reference for the rapid assessment of patients with terminal-stage cancer. Manpower from various professional fields are committed to providing diversified services in the care teams, which positively affect the control of related symptoms. The experience presented in this article may be used as a reference to promote the hospice shared care model.

Optimal timing for hospice-shared care initiation in terminal cancer patients.

PURPOSE: The existing concept suggests early palliative and hospice therapy for a better quality of care (QOC) and less medical expense in terminal cancer patients, but the time points of "early" initiation were defined by pre-set study protocol rather than the real-world data. The study aimed to determine the optimal timing of initiating palliative care for patients with terminal cancer. METHODS: This retrospective population-based study was conducted using a nationwide database. We extracted patients with cancer who were in their last year of lives in the period from 1 January 2010 to 31 December 2013 and categorized them into two groups ("hospice-shared care" (HSC) group and "usual care" (UC) group) after a matching process. Subsequently, we used a generalized linear mixed-effects model to compare the QOC and medical expenses between groups. RESULTS: After the selection and matching process, we enrolled 1714 patients (67.7 ± 13.2 years, 62.7% male) categorized into the HSC and UC groups (n = 857 in each group). The HSC groups showed generally better QOC in the four indices (with emergency room visit, hospitalization, intensive care unit admission, and receiving chemotherapy) than the UC group in those who initiated HSC 8-60 days before death. The HSC group also had significantly lower medical expenses than the UC group in those who initiated HSC 15-90 days before death. CONCLUSIONS: Among patients with terminal cancer, HSC initiation before the last 8 days and 15 days of lives can effectively improve QOC and save medical expenses, respectively.

Factors associated with the critical thinking ability of professional nurses: A cross-sectional study.

AIM: To measure the level of critical thinking among Vietnamese professional nurses and to identify the related factors. DESIGN: A cross-sectional design was used. METHODS: The total sample included 420 professional nurses. Data were collected from July to September 2019 in three public hospitals located in Southwestern Vietnam. The level of critical thinking was measured using the Vietnamese version of the Nursing Critical Thinking in Clinical Practice Questionnaire. The data were analysed using the independent Student's t tests, ANOVA, Pearson's correlation and regression analysis. RESULTS: Most of the participants had a low (48.3%) or moderate (45.5%) level of critical thinking. Age, gender, ethnicity, education level, health condition, duration of working as a nurse, duration of working in the current hospital, having heard the term "critical thinking" and work position had an impact on the critical thinking ability. Work position and gender explained 11% of the total variance in critical thinking ability.

The Vietnamese version of the nursing critical thinking in clinical practice questionnaire: Translation and psychometric evaluation.

AIMS: This study translated and evaluated the validity and reliability of the Vietnamese version of the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice (V-v)). DESIGN: Forward- and back-translation approach developed by Sousa and Rojjanasrirat (2011). METHODS: 545 nurses were recruited based on convenience sampling and asked to complete the N-CT-4 Practice (V-v) questionnaire for psychometric testing. Data were collected during June 2019 in three public hospitals located in Southwestern Vietnam. We evaluated translation equivalence, the item content validity index, floor/ceiling effects, construct validity, internal consistency reliability and test-retest reliability. RESULTS: The N-CT-4 Practice (V-v) questionnaire retained the meaning of the original English version and was clear, explicit and easy for nurses to understand. The item content validity index was 1.0. There were no floor/ceiling effects. The Cronbach's alpha was 0.98. The intraclass correlation coefficient was 0.81. Confirmatory factor analysis indicated that this Vietnamese version fit the proposed model.

Definitive intensity-modulated radiotherapy or surgery for early oral cavity squamous cell carcinoma: Propensity-score-matched, nationwide, population-based cohort study.

BACKGROUND: No evidence is currently available to estimate the outcomes of intensity-modulated radiation therapy (IMRT) and surgery for patients with early oral cavity squamous cell carcinoma (E-OCSCC). METHODS: We recruited patients from the Taiwan Cancer Registry Database who had received a diagnosis of E-OCSCC. Propensity score matching was performed, and Cox proportional hazards model was used to analyze all-cause mortality. RESULTS: In the multivariate Cox regression analyses, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive IMRT, T2N0M0 compared with T1N0M0, and male patients compared with female patients were 0.303 (0.245, 0.375), 1.340 (1.077, 1.668), and 2.012 (1.432, 2.826), respectively. The aHRs (95% CIs) for age 61 to 70, 71 to 80, and ≧81 years compared with <40 years were 2.984 (1.43, 4.225), 3.353 (2.578, 4.112), and 4.277 (4.104, 5.679), respectively. CONCLUSIONS: For patients with E-OCSCC, surgery may be considered the first option rather than definitive IMRT.

[A Preliminary Study to Investigate Frailty in Advanced Lung Cancer Patients Before Receiving Immunotherapy].

BACKGROUND: Most advanced lung cancer patients have already received many types of treatment before starting immunotherapy. Compared with advanced lung cancer patients under first-line treatment, those receiving immunotherapy are vulnerable to many health problems and increased frailty. PURPOSE: This study was designed to investigate frailty in advanced lung cancer patients before starting immunotherapy. METHODS: A total of 52 pre-immunotherapy patients completed the survey. Frailty status was determined using the Fried standard and survey questionnaires included the Barthel Index, Center for Epidemiologic Studies Depression Scale, the Chinese version of scales of international physical activities questionnaire (short version). In addition, the handgrip and 4.6-meter walk speed of the participants were measured. RESULTS: The ratio of frailty was 17.3%, with comorbidities (p = .023), body mass index (p = .004), Eastern Cooperative Oncology Group Status (p < .001), activities of daily living status (p < .001), albumin (p = .042), and C-reactive protein (p = .048) all associated with frailty. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: In this study, weight loss and low physical activity were the main symptoms of frailty in patients with advanced lung cancer. Therefore, healthcare workers should assess the nutrition and physical activity status of patients before initiating immunotherapy. We suggest that clinical care workers provide frailty care to patients before administering immunotherapy.

Definitive radiotherapy or surgery for early oral squamous cell carcinoma in old and very old patients: A propensity-score-matched, nationwide, population-based cohort study.

PURPOSE: Although patients aged >70 years are subject to early oral cavity squamous cell carcinoma (E-OCSCC), evidence is currently lacking regarding the probable outcomes of definitive radiotherapy (RT) compared to surgery in this population. METHODS: We recruited patients aged ≥70 years with a diagnosis of E-OCSCC from the Taiwan Cancer Registry Database. Propensity score matching was performed, and Cox proportional-hazards model curves were used to analyze all-cause mortality of patients at different age intervals undergoing different treatments. RESULTS: The matching process yielded a final cohort of 604 patients in the definitive RT and surgery cohorts who were eligible for further analysis. These patients were classified as old (70-80 years) and very old (>80 years). In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for surgery compared with definitive RT was 0.465 (0.354-0.610, P < 0.001). The aHR (95% CI) for age >80 years compared with age 70-80 years was 2.370 (1.720, 3.265, P < 0.001). The aHR (95% CI) for T2N0M0 compared with T1N0M0 was 1.752 (1.321-2.32, P < 0.001). The aHR (95% CI) for Charlson Comorbidity Index (CCI) ≥ 2 compared with CCI = 0 was 1.264 (1.137-1.738, P = 0.011). After stratified analysis, the aHRs for surgery compared with definitive RT were 0.484 (0.352-0.665, P < 0.001) and 0.411 (0.232-0.728, P = 0.002) among old and very old patients with E-OCSCC, respectively. CONCLUSIONS: Surgery may be more beneficial than definitive RT in selected elderly patients with E-OCSCC.

The Immediate Effects of Lavender Aromatherapy Massage versus Massage in Work Stress, Burnout, and HRV Parameters: A Randomized Controlled Trial.

BACKGROUND: Occupational stress is a common issue faced by workers in every discipline. Complementary and alternative medicine (CAM) therapies, such as aromatherapy massage or massage, have antistress effects in the literature. The purpose of this randomized clinical trial with triple blinds is to evaluate the immediate effects of lavender aromatherapy massage for improving work stress, burnout, and HRV parameters of female employees in a university. METHODS: A total of 53 subjects in experimental group whereas 57 subjects in control group completed interventions and measurement and led to power of 0.98. Inferential statistics, as independent t-test, paired t-test, and Chi-Square test, were performed to verify the expected relationships. RESULTS: The present study found that subjects in experimental group reported a lower role stress and less inclined to type A personality trait after aromatherapy massage with lavender. For control group, only less inclined to type A personality trait was reported after receiving massage. For burnout, a significant lower personal burnout and work-related burnout were reported after aromatherapy massage whereas only increased client-related burnout was reported in control group. For HRV, both the experimental and control groups reported higher SDNN and RMSSD in time domain after intervention. Contradictory HRT and PSI in time domain were significantly lower after intervention. In frequency domain of HRV, both groups reported significantly higher value in VLF and HF. In addition, the experimental group reported significantly higher value in TP and LF after intervention. CONCLUSIONS: Both the lavender aromatherapy massage and massage did show immediate effect on different dimensions of work stress, burnout, and HRV. These two interventions can be applied as routine leisure activities by personal preference to reduce stresses occurring in work environment.

Factors associated with professional healthcare advice seeking in breast cancer-related lymphedema.

OBJECTIVES: This study aimed to identify the cognitive factors associated with the professional healthcare advice (PHCA) seeking behavior in breast cancer-related lymphedema (BCRL). METHODS: From January 2018 to December 2018, patients with BCRL were prospectively enrolled for a cross-sectional survey of lymphedema-related perceived risks, lymphedema quality of life (LYMQoL), knowledge scale of lymphedema, and PHCA behavior at first clinical visit, 3 and 6 months postbaseline. RESULTS: A total of 180 patients including 100 (55.6%) patients underwent a vascularized lymph node transfer (VLNT) and 80 (44.4%) patients received compressive decongestive therapy (CDT) were enrolled. At 6 months of follow-up, mean episodes of cellulitis (from 2.2 to 0.2 times/year), mean circumferential difference (7.8 ± 3.9%), wearing compression garments (from 29% to 0 %) in the VLNT group were statistically reduced than those in the CDT group (p = .01, <.01, and <.01, respectively). The overall LYMQoL had statistical improvement in VLNT group (p < .01). The short symptom duration, greater education level, less episodes of cellulitis, and higher knowledge of lymphedema were associated with increased adherence to PHCA (p = .03, .03, .02, and .01, respectively). CONCLUSION: BCRL patients who sought PHCA had great control of lymphedema and improve their quality of life.

Maintenance of pegylated liposomal doxorubicin/carboplatin in patients with advanced ovarian cancer: randomized study of an Asian Gynecologic Oncology Group.

OBJECTIVES: An Asian Gynecologic Oncology Group phase III randomized trial was conducted to determine whether maintenance chemotherapy could improve progression-free survival (PFS) in stages III/IV ovarian cancer. METHODS: Between 2007 and 2014, 45 newly-diagnosed ovarian cancer patients were enrolled after complete remission and randomized (1:1) to arm A (4-weekly carboplatin area under the curve 4 and pegylated liposomal doxorubicin [PLD] 30 mg/m², n=24) for 6 cycles or arm B (observation, n=21). The primary end-point was PFS. A post hoc translational study was conducted to deep sequence BRCA/homologous recombination deficiency (HRD) genes, because BRCA/HRD mutations (BRCA/HRDm) are known to be associated with better prognosis. RESULTS: Enrollment was slow, accrual was closed when 7+ years had passed. With a median follow-up of 88.9 months, the median PFS was significantly better in arm A (55.5 months) than arm B (9.2 months) (hazard ratio [HR]=0.40; 95% confidence interval [CI]=0.19-0.87; p=0.020), yet the median overall survival was not significantly different in arm A (not reached) than arm B (95.1 months) (p=0.148). Overall grade 3/4 adverse events were more frequent in arm A than arm B (60.9% vs 0.0%) (p<0.001). Quality of life was generally not significantly different. Distribution of BRCA1/2m or BRCA/HRDm was not significantly biased between the two arms. Wild-type BRCA/non-HRD subgroup seemed to fare better with maintenance therapy (HR=0.35; 95% CI=0.11-1.18; p=0.091). CONCLUSIONS: Despite limitations in small sample size, it suggests that maintenance carboplatin-PLD chemotherapy could improve PFS in advanced ovarian cancer.

Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time series design.

BACKGROUND: For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent-infant interactions. A substantial lack of interactional knowledge can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers' mother-infant interaction quality and parenting sense of competence. METHODS: Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother-infant interactions. RESULTS: We observed an increase in the quality of mother-infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother-infant interaction. CONCLUSIONS: Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants' abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction.

Mediating effects of burden on quality of life for caregivers of first-time stroke patients discharged from the hospital within one year.

BACKGROUND: Caregiver burden may be either a predictor or an outcome of caregiver quality of life (QoL). Patient or caregiver factors that directly affect caregiver QoL, predictors that are simultaneously shared with caregiver burden and QoL, and factors that affect caregiver QoL through caregiver burden are not well understood. This study explored predictors of caregiver QoL and identified whether caregiver burden is a mediator for caregivers of first-time stroke patients. METHODS: This is a cross-sectional study. We recruited first-time stroke patients who had been discharged from the hospital within 1 year. We screened caregivers with two major inclusion criteria: age > 20 years old and being the family member who provides the most patient-care hours out of all family caregivers. Caregiver burden (Caregiver Strain Index, CSI), QoL (Caregiver Quality of Life Index, CQLI), and patient and caregiver characteristics were assessed with structured questionnaires. Multiple-regression and bootstrap analysis were conducted for data analysis. RESULTS: A total of 126 caregivers completed the questionnaires. Higher caregiver burdens, lower caregiver education level, lower self-rated health, lower monthly family income, and spouses who were responsible for medical fees were significant predictors of lower caregiver QoL. Poor self-rated health and monthly family income of $ 666 USD or below were the strongest predictors of caregiver QoL. Spouses who were responsible for medical fees and lower monthly family income had direct negative effects on caregiver QoL, but these factors exhibited no indirect mediating effect between caregiver characteristics and QoL through caregiver burden as a mediator. Caregiver education level at or below elementary school and poor or fair self-rated-health had direct negative effects on caregiver QoL, which were mediated by caregiver burden. CONCLUSIONS: Our study indicated predictors of caregiver QoL and the relationships with caregiver burden among first-time stroke survivors in the early stage. Caregivers' financial factors affected caregiver QoL directly. Caregivers' poor self-rated health and lower education level negatively affected caregiver QoL indirectly through caregiver burden as a mediator. Interventions to make appropriate policies for financial subsidies, to enhance caregivers' health and to provide tailored stroke-related education through multidisciplinary cooperation may effectively promote caregiver QoL.

The diagnostic accuracy of the Ascertain Dementia 8 questionnaire for detecting cognitive impairment in primary care in the community, clinics and hospitals: a systematic review and meta-analysis.

Background: The prevalence of cognitive impairment is increasing due to the aging population, and early detection is essential clinically. The Ascertain Dementia 8 (AD8) questionnaire is a brief informant-based measure recently developed to assess early cognitive impairment, however, its overall diagnostic performance is controversial. The objective of this meta-analysis was to assess the diagnostic accuracy of the AD8 for cognitive impairment. Methods: All relevant studies were collected from databases including MEDLINE, EMBASE and the Cochrane Library up to April 2017. We used QUADAS-2 to assess the methodological quality after the systematic search. The accuracy data and potential confounding variables were extracted from the eligible studies which included those in English and non-English. All analyses were performed using the Midas module in Stata 14.0 and Meta-DiSc 1.4 software. Results: Seven relevant studies including 3728 subjects were collected, and classified into two subgroups according to the severity of cognitive impairment. The overall sensitivity (0.72, 0.91) was superior to specificity (0.67, 0.78). The pooled negative likelihood ratio (0.17, 0.13) was better than the positive likelihood ratio (2.52, 3.94). The areas under the summary receiver operating characteristic curve were 0.83 and 0.92, respectively. Meta-regression analysis showed that location (community versus non-community) may be the source of heterogeneity. The average administration time was less than 3 minutes. Conclusion: Our findings suggest that the AD8 is a competitive tool for clinically screening cognitive impairment and has an optimal administration time in the busy primary care setting. Subjects with an AD8 score ≧2 should be highly suspected to have cognitive impairment and a further definite diagnosis is needed.

Renal Transplant Recipients: The Factors Related to Immunosuppressive Medication Adherence Based on the Health Belief Model.

BACKGROUND: Kidney transplant failures are caused primarily by lack of adherence to immunosuppressive medication regimens by patients after transplantation. A number of studies have indicated that health-related beliefs are an effective predictor of health-related behavior. PURPOSE: The aim of this study is to understand the influence of the personal characteristics and health-related beliefs of patients on adherence to treatment with immunosuppressive medication based on the Health Belief Model. METHODS: This cross-sectional study distributed questionnaires to patients who had been recruited via purposive sampling at one medical center in Taipei. All of the potential participants had undergone kidney transplantation at least 6 months previously. The self-developed questionnaire collected data in three areas: personal characteristics, health-related beliefs regarding transplant rejection, and adherence to the immunosuppressive medication regimen. One hundred twenty-two valid questionnaires were received. The collected data were analyzed using descriptive statistics, independent t test, one-way analysis of variance, Pearson's correlation, and multiple regression. RESULTS: Participants who had received dialysis treatment or had experienced rejection perceived susceptibility to rejection more strongly than those who had not. Participants who had undergone transplantation in Taiwan, had experienced more drug-related symptoms, or had contracted severe to extremely severe infections in the past showed lower rates of adherence to treatment with immunosuppressive medication. Adherence to medication regimens correlated negatively with length of time since transplantation. Length of time since transplantation, drug-related symptoms, perceived susceptibility to rejection, and perceived benefits of treatment were identified as major predictors of adherence to immunosuppressive medication regimens. CONCLUSIONS: The results partially conformed to the concepts of the Health Belief Model. Perceived susceptibility to rejection and perceived benefits of adherence to treatment were found to predict adherence rates. Patient education should be enhanced to reduce the risks of rejection and increase adherence rates to improve outcomes.