Simple self-report FRAIL scale might be more closely associated with dialysis complications than other frailty screening instruments in rural chronic dialysis patients.

AIM: Despite the perceived importance of frailty, few studies focus on its impact on rural patients undergoing chronic dialysis. Comparison of different self-report questionnaires in assessing frailty among these patients has not been attempted before. METHODS: A prospectively enrolled chronic dialysis cohort from a rural centre was recruited for analysis. Six types of self-report questionnaires were administered to these patients. Clinical and dialysis-related laboratory parameters were collected. Correlation analyses between questionnaire results and dialysis complications were performed, and variables demonstrating significant correlations were entered into multivariate regression models to determine their independent associations. RESULTS: Six types of questionnaire (Strawbridge questionnaire, Edmonton Frail Scale, simple FRAIL scale, Groningen Frail Indicator, G8 questionnaire, and Tilburg Frail Indicator) were provided to rural patients undergoing chronic dialysis. Scores from each questionnaire showed significant association with each other, except the G8 questionnaire. Scores from the simple FRAIL scale correlated significantly with age (P = 0.02), female gender (P = 0.03), higher Liu's comorbidity index (P = 0.02), lower serum albumin (P = 0.03) and creatinine levels (P < 0.01), and higher ferritin levels (P = 0.02). The other five questionnaires did not show consistently significant relationships with important dialysis-related complications. Multivariate linear regression analysis identified an independently negative association between serum albumin and the simple FRAIL scale results (P = 0.01). CONCLUSION: This is the first study establishing the utility of different self-report questionnaires for assessing frailty in chronic dialysis patients. The simple FRAIL scale scores might demonstrate a closer relationship with dialysis-related complications.

[The present and future of community/home-based palliative care in Taiwan].

In Taiwan, the Department of Health (DOH) has implemented regulations and policies related to hospice and palliative care since 1995. Taiwan is the first country in Asia to have a Natural Death Act, promulgated in 2000. Although recognition of the need for palliative care in non-cancer terminally ill patients is increasing, at present, the needs of these patients are often not met. Moreover, while a majority of the population prefers to die at home, the percentage of patients who die in the home setting remains small. The palliative care system should be adjusted to improve the accessibility and continuity of care based on the needs of patients. Therefore, the Jin-Shan Branch of the National Taiwan University Hospital has run a pilot community palliative care service model since 2012. National Health Insurance reimbursement was introduced in 2014 for community-based palliative care services. Establishing a formal system of community-based palliative care should be encouraged in order to improve the quality of care at the end of life and to allow more patients to receive end-of-life care and die in their own communities. This system will require that skilled nurses provide discharge planning, symptoms control, end-of-life communications, social-resources integration, and social-support networks in order to achieve a high quality of end-of-life care.

Effects of a diabetes mellitus-specific care intervention and home environment among older adults following hip fracture surgery.

OBJECTIVES: To explore the impact of home environment on effects of a diabetes mellitus (DM)-specific care model among older adults following hip-fracture surgery. METHODS: A secondary analysis using the Home Environmental Barriers Scale assessed home environment (intervention group=81, control group=79) at 1- and 3-months post-discharge. Outcomes of physical functioning were assessed at 1-, 3-, 6-, and 12-months post-discharge. RESULTS: The intervention group had better home environmental improvements compared with the control group. Participants were characterized as having good or poor environmental improvements. Those with good improvements and received the intervention had better activities of daily living compared with matched controls. Participants with poor improvements and received the intervention had better scores for hip range of motion and quadriceps muscle strength compared with matched controls. DISCUSSION: A DM-specific home rehabilitation for older adults following hip-fracture surgery that includes assessment of the home environment can facilitate complex postoperative functional recovery.

An outcome-based educational intervention to improve nursing students' knowledge and competencies in oncology nursing: a randomized controlled Trial.

Background: Caring for cancer patients is a complex process that requires considerable knowledge and a wide range of skills.Aim: The purpose of this study is to demonstrate that outcome-based course design would bring about significant differences in the nursing students' knowledge, confidence, and skills.Method: This was a randomized controlled trial with two-group pretest and post-test experimental study in 2014 involving a total of 213 students. The descriptive and inferential statistics were used to analyze the data.Results: The mean cancer nursing knowledge test score of the experimental group was higher than the control group at the post-test. The mean cognitive load score of the experimental group was lower than the control group at the post-test. The mean learning satisfaction and self-confidence score of the experimental group was higher than the control group.Conclusions: This study demonstrated the feasibility of implementing an outcome-based educational intervention in baccalaureate nursing education.