Prediction of high visceral adipose tissue for sex-specific community residents in Taiwan.

Visceral adipose tissue accumulation is strongly linked with numerous chronic diseases; however, the accessibility for visceral adipose tissue measurement is limited. This study employed a cross-sectional design to determine the optimal strongest predictor of high visceral adipose tissue in each sex and identified the optimal cutoff value thereof. Purposive sampling was used to recruit 94 men and 326 women aged ≥40 years in southern Taiwan. Receiver operating characteristic curve analysis was used to explore the optimal predictor of high visceral adipose tissue (defined as ≥135 cm2 for men and ≥100 cm2 for women) in each sex. The waist-to-hip ratio was the strongest predictor for men, with a cutoff value of 0.96 yielding the maximum sensitivity (94.29%) and specificity (93.22%). By contrast, body mass index was the strongest predictor for women, with a cutoff value of 25.45 kg/m2 yielding the maximum sensitivity (87.18%) and specificity (87.55%). The results may serve as a reference for health policy-makers in screening for high visceral adipose tissue to identify individuals at high risk of developing chronic diseases for health promotion.

Management of cancer-related fatigue in Taiwan: an evidence-based consensus for screening, assessment and treatment.

BACKGROUND: Cancer-related fatigue is one of the most common and persistent issues experienced by cancer patients. Cancer-related fatigue is a distinct form of fatigue that is subjective, long-lasting and unalleviated by rest or sleep. Studies have shown that almost all cancer patients experience severe fatigue that disrupts the quality of life and physical function, but cancer-related fatigue remains under-addressed in clinical care, and only about half of all patients receive treatment. METHODS: To increase the awareness of cancer-related fatigue and improve current management, the Taiwan Society of Cancer Palliative Medicine and the Taiwan Oncology Nursing Society convened a consensus committee to develop recommendations for the screening, assessment and treatment of cancer-related fatigue. RESULTS: Thirteen consensus recommendations were subsequently developed based on the best available evidence and the clinical experience of committee members. CONCLUSIONS: These recommendations are expected to facilitate the standardization of cancer-related fatigue management across Taiwan and may also serve as a reference for other clinicians.

Resilience process in individuals with colorectal cancer: a qualitative study.

PURPOSE: Resilience is a positive outcome in giving individuals strength to adapt to cancer and have better various aspects of health-related quality of life. However, research focusing on resilience in relation to colorectal cancer (CRC) is limited. Therefore, the aim of this study was to explore the process of resilience in individuals with CRC. METHOD: Sixteen individuals diagnosed with stage Ι to III CRC within the last five years were recruited from a CRC surgical outpatient department in a medical center in Northern Taiwan. Semi-structured interviews were used to explore the resilience process of living with CRC. Recorded interviews were transcribed verbatim and were analyzed using modified grounded theory. FINDINGS: Resilience is a dynamic three-phase process, including impact of CRC, adaptation or maladaptation following CRC, and growth from CRC experience. Resilience strategies (i.e., attitude adjustment, developing personal strategies to conquer CRC and side effects, setting new goals in life, and viewing death as a normal process), avoidance behaviors, and passive waiting strategy were shown across the resilience process. CONCLUSIONS: All individuals showed negative impacts during CRC diagnosis and treatments, but some individuals used the resilience strategies in helping to promote positive adjustment and redirect to develop their resilience process. Furthermore, resilient and maladaptive individuals may change the situation depending on which strategies are used and on the progression of CRC because resilience is dynamic. Oncology clinicians should help individuals use resilience strategies to smoothly go through the resilience process.

Predicting hospital mortality and length of stay: A prospective cohort study comparing the Intensive Care Delirium Screening Checklist versus Confusion Assessment Method for the Intensive Care Unit.

OBJECTIVE: The objective of this study was to compare two tools, the Intensive Care Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the intensive care unit (ICU) (CAM-ICU), for their predictive validity for outcomes related to delirium, hospital mortality, and length of stay (LOS). METHODS: The prospective study conducted in six medical ICUs at a tertiary care hospital in Taiwan enrolled consecutive patients (≥20 years) without delirium at ICU admission. Delirium was screened daily using the ICDSC and CAM-ICU in random order. Arousal was assessed by the Richmond Agitation-Sedation Scale (RASS). Participants with any one positive result were classified as ICDSC- or CAM-ICU-delirium groups. RESULTS: Delirium incidence evaluated by the ICDSC and CAM-ICU were 69.1% (67/97) and 50.5% (49/97), respectively. Although the ICDSC identified 18 more cases as delirious, substantial concordance (κ = 0.63; p < 0.001) was found between tools. Independent of age, Acute Physiology and Chronic Health Evaluation II score, and Charlson Comorbidity Index, both ICDSC- and CAM-ICU-rated delirium significantly predicted hospital mortality (adjusted odds ratio: 4.93; 95% confidence interval [CI]:1.56 to 15.63 vs. 2.79; 95% CI: 1.12 to 6.97, respectively), and only the ICDSC significantly predicted hospital LOS with a mean of 17.59 additional days compared with the no-delirium group. Irrespective of delirium status, a sensitivity analysis of normal-to-increased arousal (RASS≥0) test results did not alter the predictive ability of ICDSC- or CAM-ICU-delirium for hospital mortality (adjusted odds ratio: 2.97; 95% CI: 1.06 to 8.37 vs. 3.82; 95% CI: 1.35 to 10.82, respectively). With reduced arousal (RASS<0), neither tool significantly predicted mortality or LOS. CONCLUSIONS: The ICDSC identified more delirium cases and may have higher predictive validity for mortality and LOS than the CAM-ICU. However, arousal substantially affected performance. Future studies may want to consider patients' arousal when deciding which tool to use to maximise the effects of delirium identification on patient mortality.

[Patient- and Family-Centered Physical and Psychological Distress Care Model for Adult Patients With Cancer].

Patient- and family-centered care (PFCC) has become more important due to advances in medical treatment and the impact of the COVID-19 pandemic. The evidence in the literature has proven the ability of PFCC to accomplish win-win results for the three principal parties (patients, family, and healthcare providers). In Taiwan, pancreatic cancer has risen to the 7th largest cause of cancer mortality, with increasing numbers of pancreatic-cancer-related deaths over the past ten years. Pancreatic cancer is difficult to diagnose early, and diagnoses are nearly always made during the late stage, resulting in high levels of physical and psychological distress for patients. This article was developed to introduce the core concept of PFCC and its evidence in the context of adult patients with cancer. Furthermore, the rehabilitation care model, based on PFCC, includes the 6 aspects of Family involvement, Optimistic attitude, Coping effectiveness, Uncertainty reduction, Symptom management, and Physical enhancement (FOCUS+P). A PFCC-based example of pancreatic cancer care is proposed that may be expanded to the care of patients with other types of cancer to improve the quality of life of patients and their families.

Effect of exercise intervention dosage on reducing visceral adipose tissue: a systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND: Visceral adipose tissue (VAT) are deleterious fat deposits in the human body and can be effectively reduced by exercise intervention. Despite well-established exercise prescriptions are available, the effective dosage of exercise for reducing VAT requires verification. OBJECTIVES: The aims of this systematic review and meta-analysis were to determine the most effective exercise dosage (modality, intensity, duration, and amount) for decreasing VAT. METHODS: Nine databases (EMBASE, Medline, Cochrane Central Register of Controlled Trial, PubMed, CINAHL, Scopus, Web of Science, Airiti Library, and PerioPath) were systematically searched for randomized controlled trials that objectively assessed VAT. The arms of included studies covered with different exercise modalities and dosage. Relevant databases were searched through February 2020. RESULTS: Of the 34 studies (n = 1962) included in systematic review, 32 (n = 1900) were pooled for pairwise or network meta-analysis. The results indicated that high-intensity interval training (SMD -0.39, 95% CI -0.60 to -0.18) and aerobic exercise (SMD -0.26, 95% CI -0.38 to -0.13) of at least moderate intensity were beneficial for reducing VAT. By contrast, resistance exercise, aerobic exercise combined with resistance exercise, and sprint interval training had no significant effects. No difference in VAT reduction was observed between exercising more or less than 150 min per week. Meta-regression revealed that the effect of VAT reduction was not significantly influenced by an increase in the duration of or amount of exercise in an exercise program. The effective dosage of exercise for reducing VAT was three times per week for 12 to 16 weeks, while duration per session for aerobic exercise was 30-60 min, and either less than 30 min or 30-60 min of high-intensity interval training accomplished sufficient energy expenditure to impact VAT. CONCLUSIONS: These results can inform exercise prescriptions given to the general population for improving health by reducing VAT.

The Gaps of Healthcare Service Quality in Nurse Practitioner Practice and Its Associated Factors From the Patients' Perspective.

PURPOSE: This study investigates the expectations, perceptions, and gaps of the healthcare service quality (HSQ) from the patients' perspective, and explores the significant demographic and clinical factors associated with the HSQ in nurse practitioner practice (NPP). DESIGN: A cross-sectional design was carried out, with convenience sampling performed under the NPP in Taiwan, from June to November 2016. METHODS: The Nurse Practitioner Healthcare Service Quality Scale was used to assess the expectations, perceptions, and gaps of the HSQ. The demographics, clinical characteristics, and symptom severity of patients were collected, and the Importance-Performance Analysis was applied to identify the priority of ranking items for the improvement of nurse practitioners (NPs). The Generalized Estimating Equation was used to explore the factors associated with the HSQ in NPP. FINDINGS: A total of 200 patients completed the questionnaires. The results revealed that the patients had overall high expectations (M = 6.35, SD = 0.46), moderate perceptions (M = 4.21, SD = 0.95), and a mild HSQ gap (M = -2.14, SD = 0.69), with statistically significant differences (p < .001). In NPP, the largest gap in the HSQ dimensions was reliable responsiveness, followed by empathy, assurance, and tangibility. Patients with greater symptom severity and a longer in-hospital stay were associated with larger HSQ gaps; however, patients who were transferred from the emergency department had smaller gaps than those in the outpatient department. CONCLUSIONS: The patients' expectations were not fully satisfied in the NPP, especially for the dimensions of reliable responsiveness and empathy. The patients' symptom severity was a significant factor related to the gaps in the HSQ. The awareness of unmet needs, from the patients' perspective, could guide the convergence of a rational policy to promote healthcare delivery in the NPP. CLINICAL RELEVANCE: The managers of NPP need to pay attention to increasing NPs' reliable responsiveness and empathy, by setting the appropriate scope of practice, regulating the NP-to-patient ratio, applying for certification programs in prescribing training, and cultivating patient-centered care with shared decision making. In addition, building up the knowledge and competency of symptom management is also suggested for NP training.

[From Peritoneal Dialysis Education Guidelines to Clinical Practice].

Peritoneal dialysis (PD) education, which has been shown to impact life quality and survival rates, is thus crucial to patients with end-stage renal disease. As medical workers in the PD field, it is our hope and obligation to lead every patient to achieve their individual self-care goals. Although the International Society of Peritoneal Dialysis (ISPD) published guidelines for peritoneal dialysis training in 2006 to help build a comprehensive educational program for better outcomes, how to implement related education programs has not yet been taken seriously by clinical health workers. In Taiwan, no articles introducing these guidelines and no report on the clinical implementation of these guidelines have been published. Thus, this article was written to describe the ISPD guidelines on PD education, including education content, space requirements, soft / hard equipment needs, training hours, and mode. Medical workers may use evaluation and periodical retraining to continuously monitor the self-care ability of patients. Aided by timely home visitations, learning outcomes and patient adaption may be followed comprehensively. Furthermore, to help patients under PD strengthen their capabilities of self-management and self-care, practical training suggestions based on the practice experience of our PD center are also included in this article as references for all medical workers in the PD field.

A nationwide survey of fatigue in cancer patients in Taiwan: an unmet need.

BACKGROUND: Cancer-related fatigue (CRF) is an emerging clinical issue, although its prevalence and impact on quality of life (QOL) in cancer patients in Taiwan remain unclear. The present nationwide cross-sectional study was conducted to provide a thorough overview of the prevalence, related factors and impact of CRF in Taiwan. METHODS: In this multi-center survey, data were collected using the International Classification of Diseases 10th Revision (ICD-10) Fatigue evaluation, Brief Fatigue Inventory-Taiwan (BFI-T), the Chinese version of the Symptom Distressed Scale and a fatigue experience survey. Logistic regression was used to determine the correlations between fatigue characteristics and the factors studied. RESULTS: A total of 1207 cancer patients were recruited from 23 hospitals in Taiwan. Fatigue was the most distressing symptom in Taiwanese cancer patients. The distress score was higher if CRF was diagnosed using ICD-10 compared with BFI-T. Rest and nutritional supplementation were the most common non-pharmacological treatments; blood transfusion was the most common pharmacological treatment. There were 45% of patients reported not receiving a timely intervention for fatigue. CONCLUSIONS: Fatigue is the most bothersome symptom reported by Taiwanese cancer patients. Caregivers should be aware of the impact of CRF on QOL in cancer patients, constantly measure the severity of fatigue and provide appropriate interventions.

The self-care coping process in patients with chronic heart failure: A qualitative study.

AIM: To understand the self-care coping process among chronic heart failure patients. BACKGROUND: Previous studies have been carried out to understand the experience and the challenges of living with chronic heart failure. However, the coping processes that patients use to overcome self-care challenges are less understood. DESIGN: A qualitative design with qualitative content analysis of data was employed. METHODS: Purposive sampling was conducted to recruit inpatients with chronic heart failure between March 1, 2014-March 1, 2015, in a teaching hospital in Taiwan. Semi-structured interviews (N = 27) were completed, and a content analysis was performed using an inductive method to explore the self-care coping processes in patients with chronic heart failure. RESULTS: The findings were categorised into three themes: (a) responding to chronic heart failure self-care (dealing with negative emotions, accepting reality and struggling between a self-care regime and self preference), (b) finding ways to live with chronic heart failure (enhancing understanding and knowledge about chronic heart failure, maintaining outer and inner self, engaging positively/negatively with others and relying on religious thoughts and seeking consolation) and (c) reinterpreting chronic heart failure and performing meaning-oriented coping (re-evaluating the meaning of life, assigning a new perspective for chronic heart failure and discovering a deeper meaning behind it). CONCLUSION: Self-appearance concerns should be given more attention by healthcare professionals. Meaning-oriented coping was found to be helpful to cope with the challenges of chronic heart failure. Thus, there is a need to develop interventions associated with meaning-oriented coping to enhance coping strategies for chronic heart failure patients. RELEVANCE TO CLINICAL PRACTICE: It is suggested for healthcare professionals to understand an individual's coping process and support people with chronic heart failure who struggle with self-care coping. Furthermore, specific interventions including meaning-oriented interventions might benefit people with chronic heart failure to cope more successfully.

[Development and Psychometric Testing of the Nurse Practitioner Healthcare Service Quality Scale].

BACKGROUND: Many hospitals in Taiwan currently use the nurse practitioner (NP) care model to ameliorate the chronic shortage of resident physicians. However, no healthcare service quality scale is presently available that allows the evaluation of the healthcare quality provided by NPs from the perspective of patients. A scale of this type is necessary in order to effectively monitor and improve care outcomes. PURPOSE: This project was designed to develop the Nurse Practitioner Healthcare Service Quality Scale (NPHSQS) and then to test its validity and reliability. METHODS: A cross-sectional design combined with Parasuraman, Zeithaml, and Berry's Service Quality Model was adopted to construct the NPHSQS. After expert evaluation and confirmation of the model's content validity, 200 valid questionnaires were collected from a convenience sample of patients from medical center wards in northern Taiwan that regularly used the NP care model. The data were analyzed by group using item analysis, construct validity, internal consistency, and discriminant validity. RESULTS: The 25-item NPHSQS developed in this study earned a CVI (content validity index) of .91 and a good CR (critical ratio). Exploratory factor analysis revealed that four factors extracted in the expectation level, including reliable responsiveness, assurance, empathy, and tangibility, explained 62.47% of the total variance. Furthermore, three factors extracted in the perception level, including reliable responsiveness, trust, and tangibility, explained 67.71% of the total variance. The NPHSQS has a good overall internal consistency coefficient and may also significantly distinguish differences in patient satisfaction between good and bad healthcare service quality groups (p < .001). CONCLUSIONS: The developed NPHSQS has good reliability and validity and is a reliable instrument for assessing the quality of NP-provided healthcare services from the perspective of healthcare recipients.

Trajectories of caregiver burden and related factors in family caregivers of patients with lung cancer.

OBJECTIVE: This study aimed to (1) identify the changes of 5 domains of family caregiver (FC) burden, overall burden, and its subtrajectories when caring for newly diagnosed advanced lung cancer patients during the first 6 months following cancer diagnosis; and (2) identify the FC-related and patient-related factors most associated with the overall FC burden and each of its subtrajectories. METHODS: A total of 150 newly diagnosed advanced lung cancer patient-FC dyads were recruited from a Taiwanese medical center. The overall FC burden was evaluated 4 times: before treatment, and 1, 3, and 6 months after treatment. The potential subtrajectory of the caregiver burden was investigated by latent class growth analysis. The FC-related and patient-related factors having the greatest effect on the overall FC burden and its subtrajectories over time were identified by generalized estimating equations. RESULTS: The highest level of burden domain was "Impact on daily schedule" over time. Generally, most of the FC reported a moderate level of overall burden over the investigation period. Three subtrajectories of the overall FC burden over time (% caregivers) were identified: high burden (34.7%), moderate burden (56.0%), and low burden (9.3%), respectively. The self-efficacy of FC was the strongest factor related to the changes of the FC's burden and burden in each subtrajectory. CONCLUSION: The results support the existing and different types of subtrajectories of the FC's burden. Health care professionals should provide care based on those differences. Further research to test interventions which integrate those important factors related to FC's burden, particularly FC's self-efficacy, is strongly suggested.

[Care Plan for Resuming the Physical Activity of Patients With Pancreatic Cancer and Diabetes After Surgery].

Many barriers influence the ability of postoperative cancer patients to reengage in normal physical activities. Training programs have been shown to be effective in helping restore physical activity in patients and in reducing the care burdens of family members. Nurses cannot use physical activity guidelines in their care plan to assess individual needs. The clinical practice guidelines for physical activity in survivorship were published by the National Comprehensive Cancer Network (NCCN) in 2016. These guidelines are used to assess patients' physical status, curable factors, physical barriers, and risk of postoperative pancreatic cancer and diabetes. In line with this assessment tool, the physical activity guidelines, and the recommendations for cancer patients, the authors planned a physical activity training program that addressed the actual needs of patients under their care. Further, the authors provided special notes for a diabetic diet that helped reduce the barriers to resuming physical activity and enhanced independent care efficacy. Meanwhile, the authors encouraged family members to participate in patient-care activities and family mental-health support and to promote patient participation in the training program in order to increase quality of life. The present project demonstrates that this care plan may provide an effective guide for nurses to help other cancer patients resume physical activity.

[Association Between Sleep Patterns and Diurnal Blood Pressure Variation and Its Predictors in Women With Systemic Lupus Erythematosus].

BACKGROUND: Sleep disturbances and hypertension are common health issues in patients with systemic lupus erythematosus (SLE). Limited information is available regarding the objective sleep quality and the variation of diurnal blood pressure (BP) in patients with SLE. Moreover, the relationship between sleep patterns and diurnal BP variation in SLE patients is not clear. PURPOSE: To explore the subjective/objective sleep patterns and the diurnal BP variation in women with SLE, to identify the factors associated with diurnal BP variation, and to identify the predictors of this variation. METHODS: A cross-sectional, descriptive, correlational study was conducted and 42 women with SLE were recruited. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale, and Brief Pain Inventory. Rheumatologists rated current lupus disease activity. Additionally, the participants wore a wrist actigraph for 7 consecutive days and underwent 24h ambulatory BP monitoring for one day. RESULTS: The mean Global PSQI score was 7.74 ± 3.21; 69% of the participants reported poor subjective sleep quality; the actigraphy-measured sleep efficiency was 85.29 ± 5.95%; and 42.9% had poor objective sleep quality. Total sleep time at night was positively associated with diurnal change in diastolic BP (r = .315. p < .05) and pain severity was negatively associated with diurnal change in systolic BP (r = -.430, p < .01) and diastolic BP (r = -.371, p < .05). Multiple linear regression analysis was used to predict diurnal BP variation. Moreover, pain was a significant predictor of diurnal change in systolic BP (ß = -0.397, p < .01) and diurnal change in diastolic BP (ß = -0.325, p < .05). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings of the present study suggest that healthcare professionals should routinely evaluate sleep quality and pain in SLE patients. Improving both the poor sleep and pain management of these patients is clinically important. Further studies of the association between pain management and diurnal BP variation are needed.

Impact of Fatigue Characteristics on Quality of Life in Patients After Heart Transplantation.

BACKGROUND: Fatigue has been identified as a major symptom in heart transplant (HTx) patients; however, researchers have not examined the role of fatigue characteristics (ie, intensity, interference, and duration) in the quality of life (QOL) of HTx patients. OBJECTIVE: The aim of this study was to explore differences in physical and mental aspects of QOL by patient characteristics, as well as the association between fatigue characteristics and QOL in HTx patients after considering other confounding factors (symptom distress and psychological distress). METHODS: A cross-sectional study was conducted in which patients completed the Transplant Symptom Frequency and Symptom Distress Scale, the Fatigue Symptom Inventory, the Hospital Anxiety and Depression Scale, and the 12-item Short-Form Health Survey. Multiple regressions were used to identify factors significantly related to QOL. RESULTS: A total of 126 patients reported moderate levels of fatigue intensity, mild fatigue interference, and low QOL scores in the physical and mental domains. Patients with better physical and cardiac function and lower symptom distress and fatigue interference had better scores on the physical aspect of QOL (explaining 30.7% of the variance); patients with lower fatigue interference, anxiety, and depression had better scores on the mental aspect of QOL (explaining 50% of the variance). CONCLUSIONS: Fatigue interference had a greater influence on QOL domains than fatigue intensity. The degree to which fatigue interferes with daily life should be assessed, and suitable interventions should be introduced in clinical settings to help patients manage their fatigue and improve their QOL.

[Using the FOCUS Family Intervention in Caring for a Patient-Spouse Dyad With Advanced Colorectal Cancer].

The care-related burdens of the spouses of advanced cancer patients often impact negatively on their physical health, emotional well-being, social functioning, and quality of life. Thus, dyad interventions have been created to meet the demands of advanced cancer patients and their spouses. However, the application of dyadic care in clinical settings is currently rather limited in Taiwan. The present case study involved a patient with advanced colorectal cancer and malignant bowel obstruction whose disease-related demands had eroded the patient's physical, psychological, and spiritual health. The patient's condition placed overwhelming stress on the spouse, jeopardizing the relationship of the dyad. This article elaborates the implementation of the FOCUS program with the goal of helping the dyad achieve better disease adjustment through family involvement, optimistic attitude, effective coping, better symptom management, and uncertainty reduction. Through this delineated experience, the authors hope to help healthcare providers achieve a higher quality of care while caring for patient-family dyads with colorectal cancer.

Validation of the Chinese Version of the Functional Outcomes of Sleep Questionnaire-10 in Pregnant Women.

We evaluated the psychometric properties of a Mandarin Chinese version of the Functional Outcomes of Sleep Questionnaire-10 (FOSQ-10) in pregnant women. A total of 228 first-trimester pregnant women participated in the study, which was conducted in an outpatient obstetric clinic at a medical center in Taipei, Taiwan. The Chinese version of the FOSQ-10 demonstrated satisfactory internal consistency (Cronbach alpha = .85), adequate corrected item-total correlations (from .40 to .67), and acceptable test-retest reliability over 7 days (ICC = .73). Construct validity was supported by exploratory factor analysis showing a one-factor structure with item loadings between .49 and .77. Significant associations with the Medical Outcomes Study Short-Form Health Survey 12 version 2 and Pittsburgh Sleep Quality Index supported criterion-related and convergent validity. Significant differences in the Chinese version of the FOSQ-10 total scores were found between women with clinically significant daytime sleepiness and those without, suggesting adequate discriminant validity. Ceiling effects were observed for all items, but no floor or ceiling effects were found for total scores. Findings suggest that the Chinese version of the FOSQ-10 is a valid and reliable instrument to identify important effects of sleep-related impairment in Chinese women during pregnancy. Further testing is needed in more diverse pregnant women, such as women with complicated pregnancies and those with sleep disorders. © 2016 Wiley Periodicals, Inc.

[The Nutritional Care Experience of a Post-Operative Periampullary Cancer Patient With Cachexia].

Cachexia is one of the most widely overlooked of the syndromes that are experienced by cancer patients. This syndrome is especially prevalent among patients with gastroenterology tract cancer. Although the National Comprehensive Cancer Network (NCCN) issued palliative-care practice guidelines for cachexia in 2015, guidelines have yet to be issued for the clinical setting. The authors reviewed the literature and applied their clinical experience to create an approach for identifying the degree of cachexia in a post-operative patient with periampullary cancer. This approach assesses the nutritional status, physical status, laboratory results, and gastrointestinal system functions of the patient using the Cachexia Assessment Scale (CAS) and NCCN Practice Guidelines for Cachexia. The patient improved under nursing care with an increase in nutritional intake and physical activity facilitating their process of post-surgical physical recovery. The authors hope that this experience using the combined CAS-NCCN Practice Guidelines will help clinical caregivers better understand how to apply the relevant guidelines in clinical settings. The developed approach may help nurses assess the comprehensive nutrition status of patients and related factors in order to provide interventions that will decrease the progression of cachexia effectively and promote quality of life.

Adherence to prescribed exercise time and intensity declines as the exercise program proceeds: findings from women under treatment for breast cancer.

PURPOSE: Adherence to prescribed exercise is a challenge for cancer patients undergoing treatment. The changing pattern of exercise adherence over time cannot be fully understood by an overall measure of adherence. This study was aimed to identify the trajectory of exercise adherence and its predictors for women with breast cancer during their chemotherapy. METHODS: Participants were 78 women with breast cancer assigned to the exercise arm of a randomized control trial. Based on the weekly adherence rates in time and intensity, patients were classified as good (>100%), acceptable (80-100%), and poor (<80%) adherents. Data were analyzed using ordinal logistic hierarchical linear modeling. RESULTS: The trajectories for both time and intensity adherence declined significantly. The decline in exercise-time adherence was significantly slower in women who reported higher interest in exercise. Women with higher perceived importance of exercise, early disease stage, and employed were more likely to be classified as good intensity adherents. Poorer weekly adherence for both exercise time and intensity was associated with higher fatigue level for that week. CONCLUSIONS: Adherence to exercise adherence in breast cancer patients declined as the dose of exercise prescription increased. Factors influencing overall adherence and adherence trend were identified.