The Scale of Perceptions and Self-Participation in Hemodialysis: Development and Psychometric Evaluation.

Hemodialysis patients undergo hemodialysis two to three times a week and must live together with the dialysis machine. The patient's self-participation is to combine the patient's own experience and professional knowledge to influence the care. A successful self-participation experience empowers patients to adapt to living with hemodialysis. However, few studies have been conducted regarding the subjective experiences of such patient participation. There is a lack of a self-participation dialysis life scale for hemodialysis patients. Therefore, this study aims to develop and evaluate a self-participation dialysis life scale for hemodialysis patients. The items for the self-participation dialysis life scale were confirmed through qualitative interviews based on grounded theory. After expert content validity evaluation, 435 hemodialysis patients were purposively sampled from hemodialysis centers in two regional teaching hospitals in Taiwan. Descriptive statistics, principal axis factoring, reliability analysis, Pearson's correlation, and one-way ANOVA were used for data analysis. The results show that the item- and scale-content validity indices are 0.96 and 0.73, respectively. This scale is divided into two scales. The first part is "Scale of Perceptions of Hemodialysis", including two factors. The overall can explain 66.34% of the cumulative variances. The second part is the "Scale of Self-Participation in Hemodialysis", including four factors. The overall can explain 58.91% of the cumulative variances. The Cronbach's α is 0.812 for "Perceptions of Hemodialysis" and 0.959 for "Self-Participation in Hemodialysis", respectively. The self-participation dialysis life scale has good reliability and validity and can be used to evaluate the implementation of a patient's self-participation in their hemodialysis life. Discussing or consulting with patients based on their characteristics, life priorities, and their desired life on dialysis is essential for a high-quality of clinical care among hemodialysis patients.

Factors Related to Quality of Life of Hemodialysis Patients during the COVID-19 Pandemic.

Taiwan had the second highest number globally of end-stage renal disease patients undergoing treatment in 2018. A meta-analysis of Chen et al. (2021) showed the incidence and mortality rates of COVID-19 were 7.7% and 22.4%, respectively. Few studies have explored the effects of patients' self-participation and perceptions of hemodialysis on their quality of life. This study aimed to explore the factors related to hemodialysis patients' quality of life during the COVID-19 pandemic. This study was a descriptive correlational study. Patients were recruited (n = 298) from the hemodialysis unit of a medical center in northern Taiwan. Variables included patients' sociodemographic, psychological, spiritual, and clinical characteristics (i.e., perceived health level, comorbidities, hemodialysis duration, weekly frequency, transportation, and accompaniment during hemodialysis), perceptions of hemodialysis, self-participation in hemodialysis, and health-related quality of life (KDQOL-36 scale). Data were analyzed using descriptive and bivariate and multivariate linear regression. Multivariate linear regression, after adjusting for covariates, showed that anxiety, self-perceived health status, two vs. four comorbidities, and self-participation in hemodialysis were significantly associated with quality of life. The overall model was significant and accounted for 52.2% (R2 = 0.522) of the variance in quality of life during hemodialysis (adjusted R2 = 0.480). In conclusion, the quality of life of hemodialysis patients with mild, moderate, or severe anxiety was poorer, whereas that of patients with fewer comorbidities, higher self-perceived health status, and higher self-participation in hemodialysis was better.

Identifying sensory drivers of liking for plant-based milk coffees: Implications for product development and application.

The global plant-based product market is growing rapidly, and plant-based milks show promising potential in the coffee beverage sector. This study aimed to identify sensory drivers of liking of plant-based milk coffees for guiding the development of plant-based products with competitive advantages over dairy milk coffees. Twelve coffee samples were prepared with plant-based (oat, soy, almond, and coconut) and dairy (cow) milk. Quantitative descriptive analysis was used to generate sensory attribute terms for the 12 samples. Check-all-that-apply (CATA) questions were given to consumers to evaluate the sensory profiles and consumer acceptance of the 12 samples. Correspondence analysis and cluster analysis of the CATA results from 80 consumers showed that the oat and soy milk coffee samples were closer to what the consumers perceived as "typical" milk products, while the coconut and almond milk coffee samples were closer to the "flavored" milk products. Partial least squares regression results revealed that the attributes smooth, milky, and thick were important drivers of liking for the milk coffee samples. On the contrary, rancid oil, greasy, astringent, and rice bran were the major sensory attributes lowering the panelists' acceptance of the milk coffee samples. The majority of consumers (53.5%) were "dairy milk lovers," who specifically liked the dairy milk coffee sample and had low acceptance for the plant-based milk coffee samples. There was also a group of consumers (46.2%) classified as "plant-based milk coffee lovers." They enjoyed coffees prepared with a wide range of milks (both dairy and nondairy milks) and represent high-potential consumers for plant-based milk coffee products. PRACTICAL APPLICATION: The positive and negative drivers of liking for plant-based milk coffee samples were identified. A competitive landscape analysis method for assessing the acceptability and sensory attributes of 12 milk coffee samples (11 commercial plant-based milks and 1 dairy milk product) in the current Asian market was established. The sensory terms developed in this study can also be applied to evaluate sensory profiles of other plant-based and dairy milk coffee samples.

The effectiveness of light/dark exposure to treat insomnia in female nurses undertaking shift work during the evening/night shift.

STUDY OBJECTIVES: The present study investigated whether bright light exposure during the first half of the evening/night shift combined with light attenuation in the morning is effective in improving sleep problems in nurses undertaking rotating shift work who suffer from clinical insomnia. METHODS: This was a prospective, randomized control study. The Insomnia Severity Index (ISI) and the Hospital Anxiety Depression Scale (HADS) were used to evaluate insomnia and anxiety/depression severity, respectively. Female hospital nurses on rotating shifts during the evening or night shift with an ISI score > 14 were enrolled. Subjects in the treatment group (n = 46) were exposed to bright light at 7,000-10,000 lux for ≥ 30 minutes. Exposure was continued for at least 10 days during 2 weeks, and the subjects avoided daytime outdoor sun exposure after work by wearing dark sunglasses. Subjects in the control group (n = 46) were not exposed to bright light, but also wore sunglasses after work. Statistical analyses were performed to examine group differences and differences across treatments. RESULTS: After treatment, the treatment group showed significant improvements in the ISI score and the HADS total and subscale scores as compared with pre-treatment. The ISI, HADS, and subscales of the HADS scores were significantly improved across treatments in the treatment group as compared with the control group. CONCLUSIONS: The design of this study is easy to put into practice in the real world. This is the first study to document that a higher intensity and briefer duration of bright light exposure during the first half of the evening/night shift with a daytime darkness procedure performed in rotating shift work female nurses suffering from clinical insomnia could improve their insomnia, anxiety, and depression severity.

Change and predictors of social support in caregivers of newly diagnosed oral cavity cancer patients during the first 3 months after discharge.

BACKGROUND: Caregivers of oral cavity cancer patients report stress during caregiving time. OBJECTIVE: This study aimed to examine changes in social support and predictors in caregivers of oral cavity cancer patients over the 3 months after patients' first discharge. METHODS: This was a prospective longitudinal study. Caregivers of oral cavity cancer patients with planned discharge were recruited from inpatient wards and the outpatient department at a major medical center in Taiwan. Caregivers' needs and satisfaction with available social support were assessed at 4 time points: before discharge and at 1 week, 1 month, and 3 months after the first discharge. The generalized estimating equation was used to determine predictive factors of social support. RESULTS: Caregivers had mild-to- moderate levels of needs and were satisfied with available social support during the first 3 months after discharge. The peak for both overall and individual needs of social support was before discharge. Caregivers overall and individual satisfaction with social support peaked at 3 months after discharge. Spouse caregivers had greater overall needs for social support. Caregivers with longer caregiving time were associated with dissatisfaction during the first 3 months after discharge. CONCLUSIONS: Caregivers of oral cavity cancer patients had unmet needs of social support, especially wife caregivers. IMPLICATIONS FOR PRACTICE: A comprehensive assessment of caregiver needs and satisfaction with available social support is necessary to improve caregiving for oral cavity cancer patients and address the concerns of caregivers in a timely manner.

Hazardous alcohol-drinking problems among a Chinese hospital patient population.

AIM: The aims of this study were to explore: (1) the prevalence and predictors for hazardous alcohol-drinking problems; and (2) previous assessments and interventions for alcohol-drinking problems in hospitalized Chinese patients. BACKGROUND: Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings. DESIGN: A cross-sectional design was used. METHOD: Self-report data were collected in 2009 from 484 patients at five randomly selected general teaching hospitals. FINDINGS: The prevalence of hazardous alcohol-drinking problems was 19·2%. Logistic regression analysis revealed that predictors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29·1% of participants had been assessed for drinking problems in the past year. Only 38·7% of participants with drinking problems had received a drinking intervention in the past year. CONCLUSION: These findings suggest that alcohol problems in Taiwanese general teaching hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups in general teaching hospitals is important to prevent patients' drinking problems.

Hazardous drinking problems in family members of problem-drinker patients in Chinese general hospitals.

OBJECTIVE: To explore (1) the prevalence and risk factors for hazardous alcohol-drinking problems and (2) previous assessments and interventions for alcohol-drinking problems among family members of Chinese problem-drinker patients. METHOD: Self-report data were collected from 517 family members of problem-drinker patients at five randomly selected general hospitals in Taiwan. RESULTS: Family members' prevalence of hazardous alcohol-drinking problems was 13.3%. Logistic regression analysis revealed that risk factors for hazardous drinking were male gender, low education level, heart disease, smoking, and chewing betel quid. Only 11.8% of participants had been assessed for drinking problems in the past year. Only 5.2% of participants with drinking problems had received a drinking intervention in the past year. CONCLUSION: Alcohol problems among family members of problem-drinker patients in Taiwanese general hospitals are insufficiently assessed and targeted with interventions. Targeting this high-risk group is important to prevent drinking problems in family members of problem-drinker patients.

Effectiveness of a brief intervention for managing hazardous drinking problems of inpatients in Taiwan.

AIMS: This paper is a report of a randomized control trial undertaken to evaluate the efficacy of the Brief Intervention for Alcohol Use in Taiwanese inpatients with hazardous drinking patterns. BACKGROUND: The Brief Intervention for Alcohol Use has been found to be as effective as medical and psychological treatments for individuals with alcohol use disorders in western countries. However, few studies have examined brief alcohol interventions for a Chinese population. METHODS: Patients from the medical and surgical wards of a medical centre in northern Taiwan were enrolled if they had an Alcohol Use Disorders Identification Test score >8. Participants were randomly assigned to the experimental group (n = 47), which received the Brief Intervention, and the control group (n = 48), which received no special psychosocial intervention except routine nursing care. Data were collected from February 2005 to March 2006 on hospitalized participants' demographic characteristics and alcohol use. Scores on the Alcohol Use Disorders Identification Test were re-assessed over the telephone 6 months later by a trained assistant blinded to the treatment group. RESULTS: The experimental group had a significantly higher mean improved Alcohol Use Disorders Identification Test score and better outcomes in all three dimensions of the test than the control group. CONCLUSIONS: The Brief Intervention for Alcohol Use is recommended for use in clinical settings to help Taiwanese inpatients with hazardous drinking patterns to improve their drinking problems.

An alcohol training program improves Chinese nurses' knowledge, self-efficacy, and practice: a randomized controlled trial.

BACKGROUND: Excessive alcohol use has been associated with health, social and legal problems. Helping health care providers to manage hazardous or harmful drinkers is an important worldwide issue. Alcohol is a legal and accessible substance in Taiwan and is viewed as an acceptable drink for relieving stress and enhancing socialization in Chinese culture. These cultural factors may contribute to drinking problems being easily ignored and to lack of alcohol training programs for health care providers. METHODS: For this randomized controlled clinical trial with 1- and 3-month posttests, six hospitals were randomly selected throughout Taiwan and were randomly assigned to an experimental or control group. In these hospitals, nurses were selected from the Emergency Department, psychiatric, and gastrointestinal medical-surgical units where most patients with alcohol problems are seen. For the experimental group, nurses received a 1.5-hour alcohol training program consisting of an introduction to alcohol, factors influencing alcohol drinking, impacts of high-risk drinking on a person, as well as introduction to and practice of the Alcohol Use Disorders Identification Test and brief alcohol intervention. The program also discussed Taiwanese nurses' perceived barriers and facilitators to intervening for problem alcohol use. Teaching strategies included lecture, discussion, demonstration, practice, role-playing, and sharing experiences. The control group did not receive any training. Data were collected at pretest, 1-month, and 3-month posttests using a self-report questionnaire on knowledge, self-efficacy, clinical practice scales, and a demographic form. RESULTS: The study was completed by 395 nurses, including 191 nurses in the experimental group and 204 nurses in the control group. Knowledge scores significantly improved in the experimental group at the 1- and 3-month posttests but not for the control group. Similarly, nurses' self-efficacy and clinical practice scores significantly improved in the experimental group at the 3-month posttest but not for the control group. CONCLUSIONS: Our results suggest that the alcohol training program could be used to enhance nurses' alcohol knowledge, self-efficacy, and clinical practice not only in Taiwan but also other countries.

Facilitators and barriers to intervening for problem alcohol use.

AIM: This article is a report of a study exploring nurses' perceived facilitators and barriers to conducting brief interventions for problem alcohol use. BACKGROUND: Excessive alcohol use has been associated with health, social and legal problems. Healthcare providers worldwide need help to detect and intervene with hazardous/harmful drinkers. METHODS: For this cross-sectional study, ten hospitals were randomly selected throughout Taiwan during 2007. Nurses (N = 741) were selected from the emergency department, and psychiatric and gastrointestinal medical-surgical units where most patients with alcohol problems are seen. Data collected using facilitator and barrier scales and a demographic information form were analysed by descriptive statistics and stepwise, multiple linear regression analysis. RESULTS: Nurses identified the top facilitator to intervening for problem alcohol use as 'patients' drinking problems are related to their illness'. Top barriers were 'patients lack motivation to change' and 'patients express no interest in receiving intervention'. Perceived facilitators were associated with nurses' work unit, intention to intervene for problem alcohol use, and age. Perceived barriers were associated with work unit, experience in intervening for problem alcohol use, and having attended a training course. CONCLUSION: Source of perceived barriers reflected cultural influences. Taiwanese nurse education needs to be strengthened in terms of brief interventions for problem alcohol use. Emergency department nurses need to become more aware of their important role in alcohol intervention. Alcohol-related education is needed for the general population and hospital policymakers to enhance facilitators and reduce barriers to intervening for problem alcohol use.

Prevalence and correlates of supportive care needs in oral cancer patients with and without anxiety during the diagnostic period.

BACKGROUND: Many oral cancer patients experience profound anxiety and supportive care needs during the diagnostic phase. OBJECTIVE: The purposes of this study were to (1) examine and compare levels of disease impact, symptom distress, supportive care needs, and prevalence of unmet care needs in oral cancer patients with and without anxiety during the diagnostic period and (2) examine and compare the correlates of supportive care needs of patients in these 2 groups. METHODS: A total of 165 oral cancer patients from the otolaryngology inpatient wards of a medical center in northern Taiwan participated in this study: 65 with anxiety and 100 without anxiety. A cross-sectional survey was conducted using a variety of questionnaires. RESULTS: Patients with anxiety experienced higher levels of disease impact, intrusion, and avoidance than patients without anxiety. Both groups had moderate-to-severe levels of symptom distress and high supportive care needs, with the highest prevalence of unmet needs being in the area of health system and information, followed by psychological care. In patients with anxiety, overall supportive care needs were correlated to religious beliefs and symptom distress. In patients without anxiety, overall care needs were associated with time since diagnosis and symptom distress. Religion was most highly correlated with each need domain. CONCLUSION: Assessment and screening for anxiety should be increased in head and neck cancer care outpatient settings to determine patients' mood during the diagnostic stage. IMPLICATIONS FOR PRACTICE: Provision of extensive information, satisfactory consultation, and spiritual encouragement are necessary to improve the quality of health care.

Support needs of patients with oral cancer and burden to their family caregivers.

Oral cancer patients' supportive care needs during the postoperative period can impact their family caregivers' burden. The purposes of this study were to (1) examine patients' perceived levels of supportive care needs, (2) examine caregivers' perceived levels of caregiving burden, and (3) examine the predictive factors for caregivers' caregiving burden with newly diagnosed oral cancer patients during the postoperative period. A cross-sectional, correlational study was conducted. One hundred twenty-two pairs of eligible patients and caregivers were recruited from the otolaryngology and plastic/reconstructive inpatient wards in a medical center in northern Taiwan. A set of questionnaires was used to assess patients' needs, including the Karnofsky's Performance Status Index, Cancer Needs Questionnaire Short Form, Head and Neck Specific Needs Questionnaire, and Background Information Form; the caregivers' burden was evaluated using the Caregiver Reaction Assessment, Inventory of Socially Supportive Behavior, and Characteristics of Care Experiences Form. In general, patients reported having high overall supportive care needs with the highest level in the "health system and information" domain among 6 needs domains. Caregivers had moderate levels of caregiving burden, with the highest level in the "self-esteem" domain among 5 caregiving experience domains. Factors significantly related to those burdens across 5 domains of caregiving burden were caregivers' social support, patients' physical and daily living needs, patients' health system and information needs, and patients' psychological needs. Postoperative oral cancer patients experienced relatively high unmet supportive care needs, and caregivers perceived moderate levels of caregiving burden. Healthcare professionals should systematically assess patients' and caregivers' problems and provide timely supportive care clinically.

Brief intervention for problem drinkers in a Chinese population: a randomized controlled trial in a hospital setting.

BACKGROUND: Alcohol is a legal and accessible substance in Taiwan. As excessive alcohol has been linked to health and social problems, it is necessary to develop a brief, rapid, and low-cost tool to help health care providers deal with persons in Taiwan whose alcohol consumption has become hazardous or harmful to their health. METHODS: A randomized controlled clinical trial with 6- and 12-month follow-ups was designed. Eighteen medical/surgical units at a medical center in northern Taiwan were randomly assigned to 2 groups: experimental (n = 9) and control (n = 9). Inpatients on the units were enrolled if they met the following criteria: were older than 18 years, had no severe psychiatric illness, and were not pregnant. The experimental group (n = 138) received the intervention, a 15-minute counseling visit in which nurses screened participants using the Alcohol Use Disorders Identification Test (AUDIT), provided a health promotion booklet for adults, and individually discussed the booklet contents with patients based on their drinking level (AUDIT score). The control group (n = 137) received no treatment. Patterns of alcohol consumption were determined by AUDIT scores at baseline, 6, and 12 months later. RESULTS: Alcohol use disorders identification test scores decreased significantly in both groups at 6 months after the intervention, but did not differ significantly between the 2 groups. However, 12 months after the brief alcohol intervention, experimental subjects' AUDIT scores were significantly better than those of the control group. CONCLUSIONS: Our brief alcohol intervention provided a 12-month benefit for problem drinkers in Taiwan.

[A project to improve nasal ice packs].

Nasal problems are a commonly encountered diseases in the ENT (ear, nose, and throat) specialty. People with nasal problems usually seek medical therapy. When the problem cannot resolved by medical therapy then surgery becomes an option. According to statistics of the ENT unit where author served in 2006, 255 patients underwent nasal surgery. Swelling and pain are the most common discomfort symptoms for patients after nasal surgery. After data collection, it was found that only 16.7% of patients were willing to use ice packs, because they attached poorly (100%), were difficult to secure (100%), and were inconvenient to use (83.3%). After seeking an alternative ice pack replacement, the group decided to use a latex glove filled with 50 gm crushed ice and water in its index and middle fingers, tied with shoe laces and tied to the ears. The project involved three periods: preparation, execution, and evaluation. The results showed that 96.7% of patients were willing to use the new ice pack. The satisfaction rate for use of the new ice pack was 96.7%. The results of this project might improve patients' quality of care, as well as cost reduction.

Alcohol Use Disorders Identification Test (AUDIT): establishment of cut-off scores in a hospitalized Chinese population.

BACKGROUND: Alcohol use has become a problem for Taiwanese society. Developing a brief, rapid, and flexible tool to screen an individual's alcohol consumption is important. Many countries use the Alcohol Use Disorders Identification Test (AUDIT) to screen for harmful and dangerous alcohol consumption. The psychometric characteristics of the AUDIT have not been examined in a Chinese population. METHODS: Determination of the cutoff points for the AUDIT Chinese version included three stages: translating the questionnaire, expert review and formal testing on subjects. Participants (N = 112) were recruited from a medical research center of four gastroenterology wards in northern Taiwan. RESULTS: The cutoff point for participants diagnosed as "harmful users" was an AUDIT score of 8. The sensitivity was 0.96, specificity was 0.85, positive predictive value (PPV) was 0.85, negative predictive value (NPV) was 0.96, and area under the receiver-operating characteristic curve (AUROC) was 0.93. The cutoff point for participants diagnosed as "alcohol dependent" was an AUDIT score of 11. The sensitivity was 0.94, specificity was 0.63, PPV was 0.31, NPV was 0.98, and AUROC was 0.84. Furthermore, males had significantly higher AUDIT and AUDIT-C scores. Males were also significantly more likely than females to be diagnosed as harmful users or alcohol dependents. CONCLUSIONS: The Chinese version of the AUDIT gave the same cutoff point for harmful alcohol use by Taiwanese individuals as that set by the World Health Organization. This finding shows that this cutoff point is generally appropriate in screening for problem alcohol consumption. Moreover, the cutoff AUDIT score of 11 for alcohol dependence provides a reference for screening in Taiwanese clinics.