Association between leisure-time physical activity and incident cancer risk: a nationwide population-based cohort study.

BACKGROUND: The effects of physical activity on the development of different types of cancers have not been comprehensively studied. This nationwide, population-based cohort study investigated the effects of leisure-time physical activity (LTPA) on the development of different types of cancer in Taiwanese adults. A total of 67,890 adult participants (≥ 18 y old) from five rounds (2001, 2005, 2009, 2013, and 2017) of the Taiwan National Health Interview Survey were included. LTPA was measured as the metabolic equivalent of task (MET) expenditure per week and was classified as inactive (< 1 MET-h), low (1-7.49 MET-h), or high (≥ 7.5 MET-h). The LTPA and other covariates were collected through in-person interviews at baseline. New-onset cancer was ascertained from histopathological reports. The Fine-Gray sub-distribution method, with death as a competing risk, was used to determine the impact of LTPA on incident cancer risk. RESULTS: During the 844,337 person-years of follow-up, 4,435 individuals developed cancer. Compared to inactive adults, individuals engaging in high levels of LTPA (≥ 7.5 MET-h/week) were significantly associated with a reduced risk of developing cancer (adjusted hazard ratio [aHR] = 0.93; 95% confidence interval [CI] = 0.87-0.99). However, those with low levels of LTPA (1-7.49 MET-h/week) did not exhibit a significant association with a reduced risk of developing cancer (aHR = 1.00; 95% CI = 0.92-1.10). When considering specific types of cancers, participants with high levels of LTPA (≥ 7.5 MET-h/week) had a significantly lower risk of developing bladder cancer (aHR = 0.68; 95% CI = 0.47-0.99), cervical cancer (aHR = 0.48; 95% CI = 0.24-0.95), and thyroid cancer (aHR = 0.64; 95% CI = 0.44-0.93). CONCLUSIONS: Our findings suggest that high LTPA (≥ 7.5 MET-h/week) is significantly associated with a low risk of incident bladder, cervical, and thyroid cancers.

Exploring Nurse Use of Digital Nursing Technology.

Technological developments and nursing shortages have become global trends. To solve the problem of shortage of healthcare professionals, technology may be used as a backup. Nurses constitute the largest working group in the healthcare system. Therefore, nurses are very important to the success of implementing digitization in hospitals. This cross-sectional study used the characteristics and adoption roles of innovation diffusion theory to understand technology use within the organization. Data were collected through structured questionnaires and open-ended questions from March 21 to May 31, 2022, in two hospitals in Taiwan. In total, 159 nurses agreed to participate in the study. The results of this study revealed that observability, simplicity, advantage, trialability, and compatibility positively improved the acceptance of digital nursing technology. In the distribution of users' innovative roles, early adopters had a significant impact on innovation characteristics and technology acceptance. Nurses in acute and critical care units perceived a greater comparative advantage and trial availability of digital nursing technology use than did those in general wards and outpatient clinics. In addition, based on user opinions and suggestions, the development of smart healthcare and the use of digital technology are expected to improve the quality of nursing care.

Impacts of COVID-19 pandemic prevention measures to the palliative care in Taiwan.

Background: Prevention measures for palliative care and the provision of discharge planning services for inpatients in Taiwan before and during the COVID-19 pandemic had not been investigated. This study was aimed to investigate the factors associated with heightened palliative care needs and increased mortality rates. Methods: This research adopts a retrospective case-control study design. The investigation encompasses patients admitted before the pandemic (from January 1, 2019, to May 31, 2019) and during the COVID-19 pandemic (from January 1, 2020, to May 31, 2020). The case group consisted of 231 end-of-life inpatients during the pandemic, control group was composed of the pool of inpatients with pre-pandemic and matched with cases by sex and age in a 1:1 ratio. Results: The results showed that the prevalence of respiratory failure symptoms (p = 0.004), residing in long-term care facilities (p = 0.017), palliative care needs assessment scores (p = 0.010), as well as the provision of guidance for nasogastric tube feeding (p = 0.002), steam inhalation (p = 0.003), turning and positioning (p < 0.001), percussion (p < 0.001), passive range of motion (p < 0.001), and blood pressure measurement (p < 0.001). Furthermore, the assessment of the necessity for assistive devices, including hospital beds, also exhibited statistically significant variations (p < 0.001). Further investigation of the factors associated with high palliative care needs and the risk of mortality for both the case and control groups. Risk factors for high palliative care needs encompassed assessments of daily activities of living, the presence of pressure ulcers, and the receipt of guidance for ambulation. Risk factors for mortality encompassed age, a diagnosis of cancer, palliative care needs assessment scores, and the provision of guidance for disease awareness. Conclusion: This research highlights the heightened risk of COVID-19 infection among end-of-life inpatients during the COVID-19 pandemic. The findings of this study may advance care planning to alleviate avoidable suffering. To meet the needs of inpatients during pandemic, healthcare professionals should undergo comprehensive palliative care training and receive policy support.

Psychological distress, sexual satisfaction and quality of life of gynaecological cancer patients and their spouses during cancer survivorship: A comparison of husbands and wives.

AIMS AND OBJECTIVES: To investigate the psychological distress, sexual satisfaction, and quality of life of gynaecological cancer survivors and their spouses during cancer survivorship. BACKGROUND: The survival rate of patients with cancer is increasing owing to advances in medical treatment technology. Spouses are the closest companions of gynaecological cancer survivors. Patients with gynaecological cancer and their spouses face different situations and challenges after experiencing cancer invasion. DESIGN: Questionnaire-based cross-sectional study. METHODS: Convenience sampling was employed, and 180 participants, including patients with gynaecological cancer and their spouses, were enrolled. A structured questionnaire was used to investigate the psychological distress, sexual satisfaction, and quality of life of gynaecological cancer survivors and their spouses during acute, extended, and permanent survivorship. The STROBE checklist guided the study preparation. RESULTS: For gynaecological cancer survivors and their spouses, (1) severe psychological distress was present during acute survivorship, with anxiety extending until permanent survivorship; (2) no significant differences were observed in pre- and post-treatment sexual satisfaction, although pre-treatment sexual satisfaction was higher than post-treatment sexual satisfaction in all three cancer survivorship stages and (3) quality of life decreased during acute survivorship and gradually improved with time. CONCLUSIONS: Psychological distress, sexual satisfaction and quality of life of gynaecological cancer survivors and their spouses worsened during acute survivorship and improved over time until permanent survivorship. RELEVANCE TO CLINICAL PRACTICE: Gynaecological cancer survivors and their spouses experience anxiety and depression from diagnosis confirmation until permanent survivorship (>5 years survival). Therefore, clinical nurses' sensitivity to emotional distress in cancer survivors and their spouses can be improved and a consistent and routine evaluation method has been established for the early detection of such emotional distress. The results of this study can provide a reference for clinical healthcare professionals and contribute to a better quality of care.

Translation, adaptation, and validation of a Chinese version of the Hypertension Self-Care Activity Level effects (H-SCALE) for patients with hypertension.

BACKGROUND: Lifestyle modification is an essential component of prevention and management of hypertension. Existing instruments in Taiwan focus on assessing lifestyle modifications by evaluating medication adherence or confidence in controlling blood pressure. However, other self-care activities, such as diet, physical activity, weight management, smoking, and alcohol consumption are also important. The Hypertension Self-Care Activity Level Effects (H-SCALE) is one such instrument, but there are no similar tools available in Taiwan. AIM: This study aimed to translate the H-SCALE into Chinese and test its validity, and reliability in a sample of adults with hypertension. METHODS: The English version of the 31-item H-SCALE was translated into Chinese using the forward-backward method. The content validity index (CVI) of the translated scale was determined by five experts in hypertension. Item analysis was conducted with a pilot sample of 20 patients with hypertension. Cronbach's α was used to establish the internal consistency reliability for the Chinese version of the H-SCALE (H-SCALE-C). Exploratory factor analysis (EFA) explored the structure of the H-SCALE-C. Additionally, construct validity was examined with confirmatory factor analysis (CFA). Patients with hypertension were recruited by convenience sampling from a cardiovascular outpatient clinic of a medical center in northern Taiwan. A total of 318 patients met the inclusion criteria and participated in factor analysis in the study. RESULTS: Pilot testing of the scale items indicated most patients could not accurately estimate the number of days of alcohol consumption for the previous week. Therefore, three alcohol-related items were removed. The adaptation resulted in a 28-item H-SCALE-C. EFA revealed a 4-factor solution with 13 items that explained 63.93% of the total variance. CFA indicated a good fit for a 4-factor model and construct validity was acceptable. Internal consistency reliability was acceptable (Cronbach's alpha for the four subscales ranged from 0.65 to 0.94). Convergent validity was acceptable, and discriminant validity was significant. CONCLUSIONS: The H-SCALE-C is a valid, reliable tool for promptly assessing life-style activities for patients with hypertension in Taiwan. The instrument is suitable for assisting healthcare providers in evaluating self-care activities, which could be used to facilitate lifestyle modifications for patients with hypertension.

Exploring the Effectiveness of Nurses' Usage of a Wound-Photography System.

As a result of rapid advancements in health information technology, uploading health-related information and records onto an electronic health record system has become a common practice. Photographs of patients' wounds have been uploaded electronically, but widespread acceptance by nurses has been prevented owing to issues such as file size and equipment. This research explores the attitude and satisfaction toward using an electronic health record for uploading wound photos. Through the integration of the Technology Acceptance Model, Information System Success Model, and other study results, this research aims to explore the impact of the following variables: system quality, information quality, perceived usefulness, perceived ease of use, user attitude, user satisfaction, and net benefits. We also tested nurses' understanding regarding the process of taking photographs and explored the photograph quality and the photography uploading rates. The results revealed that users were satisfied with the wound-photography system, but some believed that the system stability, processing time, and image resolution should be improved. In addition, more than 80% of the nurses correctly answered photo-taking questions, the study photos reached 70% of the quality standards, and the average uploading rate was 74%. The results could serve as guidelines for system design in the future.

Exploring the Usage Effectiveness of a Nursing Charge System.

The nursing charge system for inpatient accounting has been utilized in healthcare institutions for years. However, the level of its effectiveness in meeting the needs of nursing services, including further development, has not been systematically evaluated. A cross-sectional study based in Delone and McLean's information system success model was applied to explore the level of effective nursing charge system usage across the five dimensions of system quality, information quality, service quality, user satisfaction, and net benefits. We conducted a survey of the inpatient units of a medical center in Taiwan from June 23, 2021, to July 23, 2021. A total of 214 valid questionnaires were collected. Using a 5-point Likert scale, the dimension with the highest score was information quality (3.71), followed by service quality (3.37), user satisfaction (3.36), net benefits (3.31), and system quality (3.23). Older nurses ( r = -0.176) and those with more clinical experience ( r = -0.151) viewed the nursing charge system as having less information quality. The comfort level with using the computer was positively associated with system quality ( r = 0.396), information quality ( r = 0.378), service quality ( r = 0.275), user satisfaction ( r = 0.417), and net benefits ( r = 0.355). The opinions of nurses are vital. User feedback and advice should be investigated regularly to achieve system optimization.

Social participation, positive affect, and negative affect in postoperative patients with hip fractures: A cross-sectional study.

This study investigated the social participation, positive affect (PA), and negative affect (NA) of patients with hip fractures after surgery and determined their possible predictive factors. We used a cross-sectional study design to recruit 154 participants with hip fractures post-surgery. Assessment tools included the Barthel Index, the Automatic Thoughts Questionnaire, the Assessment of Life Habits, and the Positive and Negative Affect Schedule. Patients with better functioning in daily living activities experienced more social participation, higher PA, and lower NA. Patients with more positive automatic thoughts experienced more social participation and higher PA. Patients with more negative automatic thoughts experienced more social participation, lower PA, and higher NA. Early rehabilitation and psychosocial interventions should be provided for postoperative hip fracture patients to improve their activities of daily living and emotional well-being.

Risk of Malnutrition in Adults Who Have Undergone Sleeve Gastrectomy: A Retrospective Study.

Sleeve gastrectomy achieves long-term weight control by reducing gastric volume. However, postoperative gastrointestinal symptoms and insufficient nutritional intake are likely to occur, which are not conducive to physical health. A retrospective study aimed to investigate changes in nutritional status and associated factors in patients after sleeve gastrectomy. Data were collected from the medical records of patients who underwent sleeve gastrectomy at a teaching hospital in Taiwan. Data from 120 patients who met the eligibility criteria were included in the analysis. The results show that sleeve gastrectomy has a strong weight loss effect. Within 12 months, the average body mass index of the patients decreased by 13.47 kg/m2. The number of morbidly obese patients decreased from 62 (51.7%) to 3 (2.5%). However, surgery is also associated with gastrointestinal symptoms and the threat of malnutrition. The number of patients with moderate to severe nutritional risk increased from 4 (3.3%) before surgery to 24 (20%) at 12-month follow-up. Likewise, the number of patients with anemia increased from 11 (9.2%) to 29 (24.17%). Gender, constipation, and diarrhea affected postoperative nutritional status. These findings suggest that patients after sleeve gastrectomy are at risk of malnutrition and require regular monitoring. Special attention should be given to women and patients with constipation or diarrhea, as they are at a particularly high risk of malnutrition.

Efficacy of a Decision Support Intervention on Decisional Conflict Related to Hepatocellular Cancer Treatment: A Randomized Controlled Trial.

The purpose of this study was to investigate the efficacy of decision support intervention on treatment knowledge, decision self-efficacy, decisional conflict, and decision satisfaction in patients with hepatocellular cancer. The study was a randomized controlled trial. In all, 69 patients with hepatocellular carcinoma (HCC) were recruited and randomly assigned to a decision support group or a control group. Data were collected at baseline, post-test, and follow-up using self-report questionnaires. After controlling for baseline scores, the between-group difference (95% confidence interval [CI]) for treatment-related knowledge in post-test scores was 11.9 (6.1, 17.8). After controlling for baseline scores, the between-group difference (95% CI) for decisional conflict was -7.0 (-12.0, -2.0). There was no statistically significant between-group difference in decision self-efficacy and decision satisfaction. Findings supported the efficacy of decision support intervention to improve treatment knowledge and reduce decisional conflict but had no significant effect on decision self-efficacy and decision satisfaction in patients with HCC.

Development of the Self-Perceived Safety of Orthopedic Post-Surgery Inpatients (SPSOPSI) Scale.

In recent decades, patient safety in orthopedics has gained increasing importance and has been regarded as a core concept of medical care quality. However, according to currently published studies, measurement instruments used to evaluate post-surgery orthopedic patient's perceptions are still very rare. This study aimed to develop a new measurement instrument, the self-perceived safety of orthopedic post-surgery inpatients (SPSOPSI) scale, which can provide healthcare workers with a better understanding of orthopedic patients' self-perceived safety and give more precise clinical suggestions. Item analysis and exploratory factor analysis (EFA) were used, and the results showed that the six-factor model is good-fit: root mean square residual (RMR) 0.00, root mean square error of approximation (RMSEA) 0.06, goodness-of-fit index (GFI) 0.90, comparative fit index (CFI) 0.98, incremental fit index (IFI) 0.98. The results showed the SPSOPSI scale is a valid and reliable tool for health care providers can use to evaluate orthopedic post-surgery patients' perceived safety.

Development of the Interstitial Cystitis Self-Help and Medical Resources Scale (ICSR) for Women with Interstitial Cystitis.

Background and Objectives: Women with interstitial cystitis (IC) suffer from spontaneous serious bladder pain symptoms without immediate resolution. Women with IC may lack knowledge of how to help themselves. Therefore, a measurement of IC self-help and medical-resource-seeking for women with IC is needed. Materials and Methods: This study recruited 100 women with IC from a teaching hospital in Northern Taiwan. The reliability and validity of the Interstitial Cystitis Self-Help and Medical Resources Scale (ICSR) were assessed using expert validity, confirmatory factor analysis (CFA) to test the construct validity, composite reliability to evaluate the internal consistency, and item analysis to test the discrimination validity of each item. Results: The results showed that the ICSR had accurate goodness-of-fit indices and the component reliability ranged from 0.42 to 0.83, indicating good reliability and validity. Conclusions: The ICSR is recommended for screening the self-help and medical-resource-seeking abilities of women with IC to aid in diagnosing IC and providing more precise medical treatments.

Factors Related to Family Caregivers' Readiness for the Hospital Discharge of Advanced Cancer Patients.

Background: Many family caregivers of advanced cancer patients worry about being unable to provide in-home care and delay the discharge. Little is known about the influencing factors of discharge readiness. Methods: This study aimed to investigate the influencing factors of family caregivers' readiness, used a cross-sectional survey, and enrolled 123 sets of advanced cancer patients and family caregivers using convenience sampling from four oncology wards in a medical centre in northern Taiwan. A self-developed five-point Likert questionnaire, the "Discharge Care Assessment Scale", surveyed the family caregivers' difficulties with providing in-home care. Results: The study showed that the discharge readiness of family caregivers affects whether patients can be discharged home. Moreover, the influencing factors of family caregivers' discharge readiness were the patient's physical activity performance status and expressed discharge willingness; the presence of someone to assist family caregivers with in-home care; and the difficulties of in-home care. The best prediction model accuracy was78.0%, and the Nagelkerke R2 was 0.52. Conclusion: Discharge planning should start at the point of admission data collection, with the influencing factors of family caregivers' discharge readiness. It is essential to help patients increase the likelihood of being discharged home.

Relationship between prescribed opioids, pain management satisfaction, and pain intensity in oncology outpatients.

BACKGROUND: Pain is the most severe and commonest symptom for patients with cancer. Patients' pain management satisfaction is an essential indicator of quality care and further affects their willingness to seek care. PURPOSE: This study aimed to examine the correlations between patients' prescribed opioids, pain management satisfaction, and pain intensity. METHODS: This study adopted a cross-sectional correlation design, recruited a total of 123 patients with cancer pain through convenience sampling, and used two research scales, namely the Chinese version of the Pain Treatment Satisfaction Scale and the Brief Pain Inventory-Short Form. RESULTS: The findings indicated that the correlations of prescribed opioid dosage with pain management satisfaction (r = - .10, p > .05) and pain intensity (worst pain, least pain, average pain, and pain right now; r = - .05 to .01, p > .05) were nonsignificant. The correlations of pain management satisfaction with pain intensity (r = .24 to .32, p < .01), pain interference (r = .32, p < .01), and pain relief (r = - .25, p < .01) were all significant, but that with the worst pain (r = .06, p > .05) was nonsignificant. CONCLUSIONS: Medical professionals providing cancer pain management should focus on medicines strategies and individuals' pain relief requirements. In particular, patients with the worst pain require extra investigations into their needs, and their satisfaction with their level of pain should be further evaluated.

Factors Related to Frailty in Older Cancer Patients Undergoing Colorectal Surgery: A Longitudinal Study.

BACKGROUND: Frailty is common in older cancer patients undergoing colorectal surgery, but few studies have focused on frailty and its associations in this population. OBJECTIVE: The aim of this study was to investigate the prevalence of frailty and its associations in older cancer patients undergoing colorectal surgery. METHODS: A convenience sample of 88 cancer patients 60 years or older undergoing colorectal surgery was recruited from 1 medical center. Frailty, physical activity, functional status, anxiety, depression, and social support of the patients were assessed before surgery, at discharge post surgery, and at 1 month post surgery. RESULTS: The prevalence of frailty in cancer patients undergoing colorectal surgery was 22.7% before surgery, decreased to 19.3% before discharge, and was 12.7% at 1 month after surgery. The proportion of prefrail patients significantly increased from 47.7% before surgery to 71.1% before discharge and was 64.6% at 1 month after surgery. Frail patients were more likely to be older and unmarried, have a lower albumin level, have lower physical activity, and be more dependent on others than nonfrail patients. CONCLUSION: Older cancer patients undergoing colorectal surgery were more likely to be prefrail after surgery than before surgery. Assessment of frailty and its associated factors is necessary for older cancer patients undergoing colorectal surgery before and after surgery. IMPLICATIONS FOR PRACTICE: Frailty may occur in cancer patients after colorectal surgery and is related to malnutrition and low physical activity. Appropriate discharge planning with physical activity tracking and an appropriate diet is encouraged to prevent frailty in cancer patients after colorectal surgery.

A Comparison of Two Cross-Sectional Studies on Successful Model of Introducing Nursing Information System in a Regional Teaching Hospital in Taiwan.

Nursing information system introduction is an important measure for hospital nursing departments to promote the clinical practice of nursing with both efficiency and quality. A comparison of two cross-sectional study designs was adopted, and the information systems success model, as proposed by DeLone and McLean (2003), was used to explore the effectiveness of the six dimensions of system quality, information quality, service quality, use, user satisfaction, and net benefits at 6 and 12 months after the introduction launch of the nursing information system in hospitals. Multiple regression analysis was used across the two cross-sectional studies. The research results found that the nursing information system conformed to the information systems success model, and half a year to 1 year after the introduction of the nursing information system, use affected the nursing information system net benefits via the mediator variable of user satisfaction; however, the effect of full mediation changed to partial mediation effect with time. The research results can be used as a reference for hospitals and nursing administrators for the newly developed nursing information system.

Factors Associated With Frailty in Patients Undergoing Cardiac Surgery: A Longitudinal Study.

BACKGROUND: Frailty may increase the risk of complications and mortality in patients undergoing cardiac surgery. Few studies on frailty and its associated factors have been conducted in these patients. OBJECTIVE: The aim of this study was to explore frailty and related factors in patients undergoing cardiac surgery. METHODS: A total of 154 patients undergoing cardiac surgery in northern Taiwan were recruited using a longitudinal study design and interviewed using structured questionnaires assessing physical activity, anxiety and depression, and social support before surgery and at 1 month and 3 months after surgery. RESULTS: The prevalence of frailty in patients undergoing cardiac surgery was 16.2%, 20.5%, and 16.6% before surgery and at 1 month and 3 months after surgery, respectively. Frail and prefrail patients undergoing cardiac surgery were more likely to be unemployed, have gout, have a higher New York Heart Association class, have preoperative dysrhythmia, undergo cardiopulmonary bypass, have a lower functional ability, have a higher European System for Cardiac Operative Risk Evaluation score, have a longer anesthesia time, have longer endotracheal tube and extracorporeal circulation times, have longer intensive care unit and hospital stays, have lower hemoglobin and albumin levels, have higher anxiety and depression levels, and have lower Mini-Mental State Examination scores. The significant predictors of prefrailty and frailty included unemployment, the presence of gout, higher New York Heart Association classes, less independence in activities of daily living, lower hemoglobin levels, and higher levels of depression. CONCLUSIONS: Frailty was associated with patients' functional status, perioperative conditions and psychosocial factors. Preoperative assessments of frailty and appropriate interventions are needed to improve frailty in patients undergoing cardiac surgery.

Risk factors associated with longer stays in cardiovascular surgical intensive care unit after CABG.

BACKGROUND/PURPOSE: Monitoring ICU length of stay (LOS) after CABG and examining its risk factors can guide initiatives on the improvement of care. But few have evaluated this issue to include personal and clinical factors, and demands of ICU care. This study applied Donabedian model to identify risk factors for longer ICU stays after CABG. Lifestyle, clinical factors during and after CABG, TISS were viewed as structure factors, and infection and organ failures during ICU did as process factors. METHODS: This retrospective cohort study used data via medical records at a medical center. A stratified randomized sample of 230 adults from a cohort of 690 isolated CABGs was to reflect the rate of 34.7% longer than 3-day-ICU LOS. The sample comprised of longer-stay group (n = 150) and shorter-stay group (n = 80). RESULT: Hierarchical logistic regression analysis revealed that potential signs of infection (3-day average WBC higher than 10,000/µL, OR: 3.41 and the body temperature higher than 38 °C, OR:5.67) and acute renal failure (OR: 8.97) remained as the most significant predicted factors of stay longer than 3 ICU days. Along with higher TISS score within 24 hours (OR:1.06), structure factors of female gender (OR:4.16) smoking(OR: 4.87), higher CCI before surgery(OR:1.49), bypass during CABG (OR:3.51) had higher odds of risk to stay longer. CONCLUSION: Further quality improvement initiatives to shorten ICU stay after CABG may include the promotion of a smoking cessation program in clinical practice, and better management of the manpower allocation, infection control and renal failure.

Development and psychometric evaluation of the Caregiver Caregiving Self-Efficacy Scale for family members with oral cancer.

AIM: The aim of this study was to develop and initially assess the psychometric properties of the Caregiver Caregiving Self-Efficacy Scale-Oral Cancer (CSES-OC). METHODS: In total, 28 items in the Caregiver Caregiving Self-Efficacy Scale-Oral Cancer were originally employed for a reliability and validity test based on expert suggestions and qualitative findings. The Cronbach's alpha coefficient and test-retest reliability were evaluated with the pilot sample, which included 30 caregivers. The main test, which included 107 caregivers during May 2016 to 2018, was used to execute the exploratory factor analysis (EFA) and concurrent validity. RESULTS: The results of the main test showed a Cronbach's alpha coefficient of .95 for the revised 18-item total scale after EFA. Four factors (acquiring resources, managing sudden and uncertain patient conditions, managing patient-related nutritional issues and exploring and making decisions on patient care) were classified from EFA of the Caregiver Caregiving Self-Efficacy Scale-Oral Cancer. The r coefficient was .59 (P < .01), which supported the concurrent validity between CSES-OC and General Self-Efficacy Scale. CONCLUSION: The study results show appropriate psychometric properties for the Caregiver Caregiving Self-Efficacy Scale-Oral Cancer that was constructed for evaluating caregiver caregiving self-efficacy in caring for family members with oral cancer.

Assessment of preoperative frailty and identification of patients at risk for postoperative delirium in cardiac intensive care units: a prospective observational study.

BACKGROUND: Postoperative delirium (POD) is a common complication that may occur from 24 to 72 h after cardiac surgery. Frailty is a chronic syndrome that leads to a decline in physiological reserve and to disability. The associations between frailty and POD are unclear. AIMS: To investigate associations between POD and frailty in patients undergoing cardiac surgery and to analyse predictors of POD. METHODS AND RESULTS: Convenience sampling was used to recruit 152 patients who underwent cardiac surgery in two medical centres in northern Taiwan. Preoperative frailty in these patients was evaluated using Fried's frailty phenotype. Delirium in patients was assessed from postoperative day 1 to day 5 using the confusion assessment method for intensive care units. A total of 152 patients who underwent cardiac surgery included 68 (44.74%) prefrail patients and 21 (13.81%) patients with frailty after the surgery. Ten patients (6.58%) developed delirium after cardiac surgery. The occurrence of delirium peaked at postoperative day 2, and the average duration of delirium was 3 days. A case-control comparison revealed a significant correlation between preoperative frailty and POD. Significant predictors of POD in patients undergoing cardiac surgery included the European System for Cardiac Operative Risk Evaluation II, preoperative arrhythmia, and preoperative anxiety and depression. CONCLUSION: Preoperative frailty was correlated with POD. Preoperative arrhythmia, anxiety, and depression are predictors of POD. Nurses should perform preoperative assessments of surgical risk and physiological and psychological conditions of patients undergoing cardiac surgery and monitor the occurrence of POD.