Antibiotic Knowledge, Antibiotic Resistance Knowledge, and Antibiotic Use: A Cross-Sectional Study among Community Members of Bangkok in Thailand.

This study aimed to explore antibiotic knowledge, antibiotic resistance knowledge, and antibiotic use among adults in Bangkok, Thailand. This is a secondary analysis of cross-sectional data generated from a sample of 161 individuals living in Bangkok. Participants completed an online self-administered questionnaire developed by the World Health Organization. Descriptive analysis, the chi-square test, and multiple logistic regression analyses were performed. The sample comprised more females (56.5%) than males (42.2%). The majority of responders (67.7%) were between the ages of 18 and 40. More than half of the respondents mistakenly believed that antibiotics could treat colds and flu (54.7% and 47.2%, respectively). About 54.7% were aware that antibiotic resistance could harm them and their families. The chi-square test results showed that the levels of education were associated with antibiotic knowledge (p = 0.012), antibiotic resistance knowledge (p < 0.001), and antibiotic use (p = 0.023). Multiple logistic regressions showed that respondents with at least a bachelor's degree or higher had better knowledge of antibiotics. Respondents who worked in the profession had better knowledge of antibiotic resistance. Respondents with sufficient incomes were more likely to use antibiotics. Baseline data from the study will be useful in antibiotic stewardship and public health campaigns among Bangkok residents.

From resistance to acceptance in small group work: Students' narratives.

BACKGROUND: Small group work helps the development of students' collaborative attributes and their knowledge enhancement. However, teachers may face challenges when they have students who resist group work. Possible reasons of their resistance may have been generally discussed but rigorous study of this specific student population is often overlooked. OBJECTIVES: To compare the perspectives of small group learning among students who resisted group work before and after group learning. DESIGN: Students' narratives were collected before and after group work. A structured intervention consisted of a combination of strategies, including a structured guideline, regular group interactions, and intensive tutor's support, was employed to facilitate students' learning through group work. METHOD: Convenience sampling was carried out in a class with 299 students. Narratives were collected before and after group work. Students who resisted group work were selected for further investigation. RESULTS: A total of 12 students (6%) resisted group work due to limited self-mastery in learning, difficulty in working with strangers/free riders, and unfair conditions in group work. After group work, the majority of students had more positive perception of group work on time management for learning, knowledge enhancement, communication and collaborative skill development, and sufficient guidance from the tutor. Students' narratives before and after group work were compared. Students' insecurity from working in a small group increased their preference of individual study but a well-planned intervention increased student's engagement and facilitated students' interactions. CONCLUSIONS: This study revealed that the perception of students who resist group learning can be changed when they engaged their learning with clear direction, adequate guidance, supportive peer-interaction, and effective tutor's facilitation. The results increase tutors' insight in planning an appropriate teaching pedagogy to facilitate students' learning by preventing obstacles which make students resist group work.

Lysosomal exocytosis of HSP70 stimulates monocytic BMP6 expression in Sjögren's syndrome.

BMP6 is a central cytokine in the induction of Sjögren's syndrome-associated (SS-associated) secretory hypofunction. However, the upstream initiation leading to the production of this cytokine in SS is unknown. In this study, RNA ISH on salivary gland sections taken from patients with SS indicated monocytic lineage cells as a cellular source of BMP6. RNA-Seq data on human salivary glands suggested that TLR4 signaling was an upstream regulator of BMP6, which was confirmed by in vitro cell assays and single-cell transcriptomics of human PBMCs. Further investigation showed that HSP70 was an endogenous natural TLR4 ligand that stimulated BMP6 expression in SS. Release of HSP70 from epithelial cells could be triggered by overexpression of lysosome-associated membrane protein 3 (LAMP3), a protein also associated with SS in several transcriptome studies. In vitro studies supported the idea that HSP70 was released as a result of lysosomal exocytosis initiated by LAMP3 expression, and reverse transcription PCR on RNA from minor salivary glands of patients with SS confirmed a positive correlation between BMP6 and LAMP3 expression. BMP6 expression could be experimentally induced in mice by overexpression of LAMP3, which developed an SS-like phenotype. The newly identified LAMP3/HSP70/BMP6 axis provided an etiological model for SS gland dysfunction and autoimmunity.

How Socioeconomic, Health Seeking Behaviours, and Educational Factors Are Affecting the Knowledge and Use of Antibiotics in Four Different Cities in Asia.

Antibiotic resistance is occurring widely throughout the world and is affecting people of all ages. Socioeconomic factors, education, use of antibiotics, knowledge of antibiotics, and antibiotic resistance were assessed in four cities in Asia, namely Hong Kong, Shanghai, Hangzhou, and Bangkok. A survey using cluster sampling was used in 2021 to collect data on 642 subjects. Hongkongers used less antibiotics and were knowledgeable about using antibiotics to treat diseases, while Shanghainese were knowledgeable about antibiotic resistance. The multi-linear regression model reported that respondents who lived in Hong Kong (ß = 0.744 (95% CI: 0.36-1.128), Shanghai (ß = 1.65 (95% CI: 1.267-2.032), and Hangzhou (ß = 1.393 (95% CI: 0.011-1.775) (reference group: Bangkok), who had higher scores on antibiotics knowledge (ß = 0.161 (95% CI: 0.112-0.21)), higher educational attainment (ß = 0.46 (95% CI: 0.296-0.625)), and who were more likely to consult a doctor on using antibiotics (ß = 1.102 (95% CI: 0.606-1.598)), were more likely to give correct answers about antibiotic resistance, p < 0.001. Older respondents were less likely to answer the items correctly (ß = -0.194 (95% CI: -0.333--0.055), p < 0.01. When educating the public on the proper use of antibiotics and antibiotic resistance, multiple strategies could be considered for people from all walks of life, as well as target different age groups.

Review of current controversial issues in clinical trials.

In clinical development, adequate and well-controlled randomised clinical trials are usually conducted to evaluate the safety and efficacy of test treatment under investigation. The purpose is to ensure that there is an accurate and reliable assessment of test treatment under study. In practice, however, some controversial issues inevitably appear despite the compliance of good clinical practice. These debatable issues include, but are not limited to, (1) appropriateness of hypotheses for clinical investigation, (2) feasibility of power calculation for sample size requirement, (3) integrity of randomisation/blinding, (4) strategy for clinical endpoint selection, (5) demonstrating effectiveness or ineffectiveness, (6) impact of protocol amendments and (7) independence of independent data monitoring committee. In this article, these controversial issues are discussed. The impact of these issues in evaluating the safety and efficacy of the test treatment under investigation is also assessed. Recommendations regarding possible resolutions to these issues are provided whenever possible.

Loneliness in Old Age, the Related Factors, and Its Association with Demographics and Districts of Residence.

Loneliness among older people has now become a serious public health issue. There have been few previous studies conducted among Chinese populations on the correlations between loneliness, self-rated health, and instrumental activities of daily living (IADL), and their association with demographic characteristics. In this study, data were collected using quota sampling through survey interviews. Older people living in representative districts were recruited. Of the participants, 60.1% rated their health as average and 58.1% showed a high level of loneliness. IADL and self-rated health (SRH) were found to be moderately positively correlated, with r = 0.357, p < 0.001. A low negative correlation was found between the level of loneliness and IADL, with r = -0.276; and SRH, with r = -0.288, p < 0.05. Ordinal Regression results showed that subjects with higher IADL scores (OR: 0.64, 95% CI: 0.39-1.05) were less lonely, while those with a less desirable economic status (OR: 3.34, 95% CI: 1.40-7.96) and living in the central business district were more likely to have a higher loneliness score (OR: 21.33, 95% CI: 4.81-95.41). It is essential to screen for loneliness, and interventions should be focused on improving social connections and support for older people to overcome their feelings of loneliness.

Bystanders' Views on the Use of Automated External Defibrillators for Out-of-Hospital Cardiac Arrest: Implications for Health Promotions.

Despite the widespread availability of automated external defibrillators, not everyone is enthusiastic about using them. The aim of this study was to examine the reasons for not using an automated external defibrillator (AED) and predictors of the reasons. The study had a cross-sectional design using an online survey. Data were collected in eighteen districts in Hong Kong to be representative of the city. The questionnaire consisted of questions on demographics, knowledge and attitude towards AED use, reasons for not using AED, and whether the kind of victim could affect the decision of the bystanders. There was a high significant correlation between knowledge and attitude, with r = 0.782 and p < 0.001. Of the respondents, 53.3% agreed that the kind of victim would affect their willingness to operate an AED. A binary logistic regression model revealed that a higher education (OR 6.242, 95% CI: 1.827-21.331), concern about the kind of victim involved (OR 2.822, 95% CI: 1.316-6.052), and a younger age were significant predictors of worrying about taking on responsibility in using AED. Other than knowledge, other barriers included a desire to avoid legal liability, and the kind of victim they encountered. Life experiences in adulthood could possibly affect the social responsibility and influence the behaviors of adults to operate AEDs.

Family caregiver's burden and the social support for older patients undergoing peritoneal dialysis.

BACKGROUND: Most elderly people undergoing peritoneal dialysis (PD) treatment have a high incidence of frailty, cognitive impairment and emotional disturbance leading to a significant impact on families. The burden experienced by the family caregivers could affect their physical and emotion health. The objective of this study was to examine the level of burden on family caregivers of elderly adults receiving PD and to identify any contributing factors. MATERIALS AND METHODS: This was a cross-sectional study employing convenience sampling. Patient-caregiver dyads were recruited from the outpatient clinic of a university hospital in China in 2019. Caregivers provided information on their perceived burden and health-related quality of life. The elderly patients reported their functional dependence and depressive symptoms in the same interview. Linear regression analyses were used to determine the factors contributing to caregivers' burden. RESULTS: Sixty patient-caregiver dyads were recruited. The patients had a mean age of 70.7 ± 7.4 years. The caregivers reported moderate levels of burden having ZBI score of 30.5 ± 15.9. Multivariate analyses showed that being female, perceiving one's financial status as insufficient, a low level of social support for the caregiver, depressive symptoms in the patients and disability in carrying out the instrumental activities of daily life were statistically significant predictors of caregiver burden (adjusted R2 = 0.46, p < 0.001). CONCLUSION: Elderly adults receiving PD who experience physical dependence and depressive symptoms are a burden for caregivers. In response to this challenge, interventions designed with the goal of supporting the emotional and mental wellbeing of caregivers are warranted.

Assessing the Mental Health, Physical Activity Levels, and Resilience of Today's Junior College Students in Self-Financing Institutions.

In recent decades, the number of adolescents and young adults with poor mental health has been increasing, particularly among students in tertiary institutions. This study investigates the physical activities, resilience, and mental health status of junior college students in Hong Kong. The questionnaire consisted of demographic characteristics, the Positive Mental Health Scale, the Brief Resilience Scale, and the Godin-Shephard Leisure-Time Physical Activity Questionnaire. Four hundred and sixteen students participated in the study. The results showed a moderate positive correlation (r = 0.485) between resilience and mental health, and a low positive correlation (r = 0.258) between resilience and physical activity. The one-way analysis of variance (ANOVA) with a post hoc test showed that arts students engaged in more physical activity than students from other disciplines. A multiple regression analysis was used to examine the predictors of a positive mental health status. The significant predictors are: resilience (ß = 0.704; 95% CI = 0.575-0.833; P < 0.001), physical activity score (ß = 0.032; 95% CI = 0.016-0.048; P < 0.001), the male gender (ß = 1.035, 95% CI = 0.171-1.900; P < 0.05), and students' enrollment in a health science discipline (ß = 1.052, 95% CI = 0.175-1.930; P < 0.05). Preventive measures, such as strengthening resilience, a broad curriculum and taking note of the demographic and cognitive characteristics of students are essential for improving the mental health of freshmen in colleges.

The technology implications of master's level education in the professionalization of nursing: A narrative inquiry.

AIMS: (a) To explore the meanings of master's education in the professionalization of nursing; and (b) to describe the core attributes that nurses gained through master's study. DESIGN: Narrative inquiry. METHODS: From June 2017 to June 2018, unstructured interviews were conducted with 12 master-prepared nurses at advanced nursing position with minimum 5 years of postregistration experience. Collaborative thematic narrative analysis was conducted on verbatim transcripts. Members checking, peer validation and audience validation assured verisimilitude and utility. RESULTS: There was a need to fit one's own assertion for professional growth in nursing career structure. Master's study equipped nurses with specialty skills and knowledge with enhanced reflexivity, which nurtured morality, problem-solving ability and capacity to collaborate inter-professionally. Master-prepared nurses demonstrated effective clinical leadership through acting as change agents. CONCLUSIONS: Master's level education and master-prepared nurses are instrumental to the professionalization of nursing by expanding the roles of nurses. Nursing career mentoring will maximize nurses' agency in healthcare system. Developing innovative inter-professional pedagogy will nurture the reflexivity of master-prepared nurses.

Do demographic factors and a health-promoting lifestyle influence the self-rated health of college nursing students?

BACKGROUND: To adopt a healthy lifestyle is considered an essential component of nursing education. Self-rated health is a subjective assessment of health status and is consistent with objective health status. Previous studies have shown an association between self-rated health and engagement in a healthy lifestyle. Nursing students need to feel good about their subjective health status and to be able to adopt health improvements in their lifestyle before attempting to disseminate health messages to clients. The aims of this study were to compare the difference in self-rated health and health promotion lifestyle profile between senior and junior nursing students, describe correlations between self-rated health and health promotion lifestyle profile, and identify the predictors of self-rated health. METHODS: A cross-sectional descriptive survey was adopted. The study sample consisted of 314 junior and senior year nursing students from a tertiary institution. The self-reported questionnaire consisted of a single-item question to examine their self-rated health. The Health Promoting Lifestyle Profile-II: Chinese version short form (HPLP-IICR) was used to investigate the health-promoting lifestyles of the students. Descriptive statistics, Mann-Whitney U test, Chi-square test, Fisher's exact test, Spearman's correlation, and ordinal logistic regression were used to analyze the data. RESULTS: The median scores for self-rated health were 3 (Mean 3.26, IQR 3-4) and 3 (Mean 3.19, IQR 3-4) out of 5 for Year 2 and Year 5 students, respectively, with no significant difference between the two groups. The two groups of students showed no significant differences in overall score and in most subscales of the HPLP-IICR. An ordinal logistic regression showed that those students with higher health management score (OR: 1.12, 95% CI: 1.04-1.21) and who had experienced no family conflicts in the recent month than having family conflict (OR: 1.64, 95% CI: 1.01-2.66) were more likely to have higher self-rated health. CONCLUSION: Nursing education and clinical practice can undoubtedly increase the health knowledge of students, but may not lead to changes in actual health-promoting behaviours. Students with a higher health management score and no family conflicts are more likely to give a positive appraisal of their health status.

Cardiac health knowledge and misconceptions among nursing students: implications for nursing curriculum design.

BACKGROUND: Cardiac misconceptions are common among healthcare professionals. The development of professional knowledge is considered an essential component of nursing education. Nurses, regardless of their grade, skills, and experience, should be updated with information so as to be able to rectify their misconceptions, as these could affect patient health outcomes. As the literature evaluating the cardiac knowledge and misconceptions of nursing students is sparse, a study of the subject seems warranted. METHODS: A cross-sectional sample survey was used to study the cardiac knowledge and cardiac misconceptions of nursing students in Hong Kong. The study sample included 385 senior nursing students from three universities. Their level of knowledge of cardiac disease was assessed using the modified Coronary Heart Disease Knowledge Test. The York Cardiac Beliefs Questionnaire (YCBQv1) was used to examine cardiac misconceptions. RESULTS: The scores for the nursing students' level of knowledge were diverse. Their mean score in the Cardiac Knowledge Test was 12.27 out of 18 (SD 2.38), with a range of 2-17. For cardiac misconceptions, their mean score in the YCBQv1 was 6.98 out of 20 (SD 2.84), with a range of 0-14. A negative correlation, r = -0.33 was found among students with more knowledge and fewer misconceptions. (p < 0.001). The Chi-square tests found some associations between the students' experiences of caring for cardiac patients and misconceptions about stress and physiology. CONCLUSIONS: The results of our analyses indicate a diversity in levels of knowledge among the nursing students. Students with higher scores in cardiac knowledge did not necessarily have fewer misconceptions. There were associations between the students' misbeliefs and their caregiving experiences with cardiac patients. This study presents a framework for designing the contents of cardiac nursing programmes and is a starting point for promoting research on misconceptions held by undergraduate nursing students. A new paradigm of teaching should include inputs from both perspectives to help students to make critical use of theoretical knowledge to rectify their misconceptions and pursue excellence in the working world.

The effects of a nurse-supervised home exercise programme on improving patients' perceptions of the benefits and barriers to exercise: A randomised controlled trial.

AIMS AND OBJECTIVES: To explore the effects of a home exercise programme on patients' perceptions of the barriers and benefits to exercise and adherence to the programme. BACKGROUND: Great efforts have been made to encourage dialysis patients to participate in rehabilitation regimens. The promotion of exercise in this population is still limited. DESIGN: This was a post hoc analysis of a randomised, two-group parallel study. METHODS: A total of 113 adult patients recruited from the haemodialysis units were randomised into two groups on a 1:1 ratio. Both groups received in-centre group exercise training weekly for 6 weeks. The intervention group patients were provided with an additional individualised nurse-led home exercise prescription and behavioural support for 12 weeks. The patients' perceptions of the barriers and benefits to exercise, adherence to the home exercise prescription and their exercise level at weeks 6 and 12 were evaluated. RESULTS: There was a significant between-group difference in the score on patient perceptions of the barriers and benefits to exercise, with the intervention group reporting a greater reduction in perceived barriers to exercise. Significant group differences were noted in exercise level upon the completion of the programme, with the intervention group reporting higher such levels. The average adherence rate to the negotiated exercise plans was 78.9%. The intervention group of patients did better at meeting or exceeding the minimum exercise goal than did the control group. CONCLUSION: Home exercise prescriptions and behavioural support provided by trained nurses are effective at helping patients to remove barriers to engaging in exercise training. RELEVANCE TO CLINICAL PRACTICE: Physical exercise in a clinical arena should not be considered the exclusive domain of physical therapists; the team could collaborate with nurses to play a core role in making physical exercise for patients an essential practice of care in a multidisciplinary team.

Substitution of SF-36 by SF-12 Among Hong Kong Chinese Older Adults: Secondary Analysis of Randomized Controlled Trials.

PURPOSE: This study aims to examine the appropriateness of substituting the Short-Form 36 (SF-36) by its shortened version (SF-12) in measuring health-related quality of life (HRQoL) in older Chinese population. METHODS: Secondary analysis of two transitional care management programs, conducted from 2009 to 2012, were analyzed (n = 1188, aged 60-97). Participants were discharged patients with respiratory disease, type 2 diabetes, cardiac disease, and renal disease, and were classified according to number of chronic diseases. SF-36 was administered at baseline and 4-week follow-up. RESULTS: Both overestimations and underestimations of HRQoL by SF-12 were found. Most domain scores of SF-36 and SF-12 were highly correlated (Spearman correlation (ρ) > 0.85), with the exception of General Health (ρ = 0.64) and Vitality subscales (ρ = 0.82). Multiple linear regression adjusted for demographic characteristics showed that the four out of eight domains of SF-36 and SF-12 were equivalent in measuring the difference across numbers of chronic diseases (all p < 0.05). Paired sample t tests in 989 (83.2 %) who completed the SF-36 survey 4 weeks after baseline showed that SF-12 overestimated the 4-week changes in most of the domains. CONCLUSIONS: The use of the Chinese version of SF-12v2 for reporting the change over time in quality of life among medical patients after hospital discharge may need to be interpreted with caution. The SF-12 tends to underestimate the difference when compared with the SF-36.

A nurse-led case management program on home exercise training for hemodialysis patients: A randomized controlled trial.

BACKGROUND: Patients on maintenance hemodialysis suffer from diminished physical health. Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being. However, nurses seldom include an exercise intervention in the care plan for hemodialysis patients. OBJECTIVES: The purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients. DESIGN: The study was a randomized, two-parallel group trial. SETTINGS: Hemodialysis units in two tertiary hospitals in Nanjing, mainland China. PARTICIPANTS: One hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and randomly assigned to either the study group (n=57) or the control group (n=56). METHODS: Both groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks. The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks. The intervention was to facilitate patients in performing regular exercise at home. Outcome measures, including gait speed, 10-repetition sit-to-stand performance, and quality of life were collected at baseline, and at 6 and 12 weeks into the program. RESULTS: The results revealed that patients in the study group demonstrated greater increases in normal gait speed [F(1,111)=4.42, p=0.038] than the control group. For the study group, a mean increase of 12.02 (±3.03)centimeters/second from baseline to week 12 was found. With regard to the fast gait speed, there was a marginally significant between-group effect [F(1,111)=3.93, p=0.050]. The study group showed a mean improvement of 11.08 (±3.32)cm/s, from baseline to week 12. Patients from both groups showed improvements in their 10-repetition sit-to-stand performance. The between-group differences approached significance [F(1,111)=3.92, p=0.050], with the study group showed greater improvement than the control group. The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (±3.88)s from baseline to week 12. Significant improvements in quality of life across three time points were found only in the study group. CONCLUSIONS: Home exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients.

Is the kidney disease quality of life-36 (KDQOL-36) a valid instrument for Chinese dialysis patients?

BACKGROUND: The aim of this study is to determine the validity and reliability of the Cantonese Chinese version of the Kidney Disease Quality of Life-36 (KDQOL-36™) questionnaire. The scale has been translated into Cantonese Chinese, but has not been tested among the Cantonese-speaking populations. METHODS: A total of 110 dialysis patients and 122 renal transplant patients were recruited. The data for the KDQOL-36™ were extracted from the KDQOL-Short Form. The criterion validity and scale equivalence were examined using the KDQOL-Short Form scores as the gold standard. The Hospital Anxiety and Depression scale was used to identify the correlations between depression, anxiety, and quality of life to establish the convergent validity. Discriminant validity was examined using the transplant patients to compare the quality of life of dialysis patients. The Cronbach's alpha coefficient and test-retest were used for estimating reliability. RESULTS: There were very strong positive correlations for the physical and mental component summary between the KDQOL-36™ and KDQOL-Short Form. Despite the strong correlations, the effect size was 0.6 and 0.13 for the physical composite summary and mental composite summary score, respectively. Most of the subscales demonstrated significant moderate correlations with the Hospital Anxiety and Depression Scale, from -0.265 to -0.516. The discriminant validity was confirmed with a significant difference between the dialysis and transplant group patients. A high intraclass correlation of >0.98 was demonstrated in the test-retest. CONCLUSION: The Cantonese Chinese KDQOL-36™ was reliable. Further testing will be required to determine its validity for the physical health summary scale.

Determining the validity and reliability of the Chinese version of the Kidney Disease Quality of Life Questionnaire (KDQOL-36™).

BACKGROUND: Health-related quality of life is a crucial outcome for the chronic kidney disease population, the Kidney Disease Quality of Life (KDQOL) questionnaire is commonly used as an integral part of clinical evaluations. The abbreviated version of the KDQOL-36™ has been translated into Mandarin Chinese, but has not been tested for use in the Chinese patients. The aim of the study was to evaluate the validity and reliability of the KDQOL-36™ with a sample of Chinese patients. METHODS: The Mandarin Chinese version of the KDQOL-36™ has been translated by Amgen, Inc. and the MAPI Institution following the instrument translation specifications provided by the RAND health. The translated instrument was further reviewed by a Chinese expert panel for content validity and translational equivalence. The KDQOL-36™ along with Beck depression Inventory-II were administrated to 103 chronic renal disease patients recruited through convenience sampling procedure from the renal wards and an outpatient dialysis clinic. The convergent validity was determined through investigating the correlational evidence of the KDQOL-36™ with the Beck depression Inventory-II and the overall health rating. Known-group validity was supported by the evidence that the instrument could differentiate subgroups of patients. The internal consistency was estimated using Cronbach's α and test-retest reliability was examined using an intraclass correlation coefficient. RESULTS: For the convergent validity, there were positive correlations between the overall health rating and most of the KDQOL-36™ subscales, and the Beck depression inventory score was inversely correlated with the mental component summary score and disease-specific scores of the scale. Significant correlations were noted between disease-targeted and generic dimensions of the KDQOL-36™. The results of the known-group comparisons indicated females, the unemployed, and patients had a longer dialysis history reported a worse quality of life. With regard to the reliability, the Cronbach's alpha ranged from 0.69 to 0.78, and the intraclass correlation test-retest was higher than 0.70. CONCLUSIONS: The Mandarin Chinese version of the KDQOL-36™ is a brief, valid, and reliable instrument for use in examining the quality of life of chronic kidney disease patients in China.

The impact and importance of clinical learning experience in supporting nursing students in end-of-life care: cluster analysis.

BACKGROUND: Nursing students are often expected to provide end-of-life care to patients during clinical practice. Little research has been conducted to examine the heterogeneity of the students and how learning outcomes are affected by their education experience and other demographic factors. AIM: The aim of this study was to identify and compare groups of nursing students based on their demographics, clinical experience, knowledge, perceived competency, and attitude towards end-of-life care. METHOD: A group of 253 nursing students was asked to complete a cross-sectional survey to explore their clinical experience, knowledge, attitude, and perceived competency towards end-of-life care. Cluster analysis was used to determine whether specific groups of students could be identified within the study cohort. RESULTS: Three distinct clusters were identified. Students from the three clusters showed no significant differences in end-of-life knowledge. Significant differences were identified in clinical experience amongst the three clusters and in attitude and perceived competency within the clusters. The cluster of students that had greater clinical experience demonstrated higher perceived competency and a more positive attitude towards end-of-life care. CONCLUSION: Clinical experience was found to be crucial in enhancing the perceived competency and attitude of nursing students in end-of-life care.

A randomized controlled trial of a nurse-led case management programme for hospital-discharged older adults with co-morbidities.

AIM: To examine the effects of a nurse-led case management programme for hospital-discharged older adults with co-morbidities. BACKGROUND: The most significant chronic conditions today involve diseases of the cardiovascular, respiratory, endocrine and renal systems. Previous studies have suggested that a nurse-led case management approach using either telephone follow-ups or home visits was able to improve clinical and patient outcomes for patients having a single, chronic disease, while the effects for older patients having at least two long-term conditions are unknown. A self-help programme using motivation and empowerment approaches is the framework of care in the study. DESIGN: Randomized controlled trial. METHOD: The study was conducted from 2010-2012. Older patients having at least two chronic diseases were included for analysis. The participants were randomized into three arms: two study groups and one control group. Data were collected at baseline and at 4 and 12 weeks later. RESULTS: Two hundred and eighty-one patients completed the study. The interventions demonstrated significant differences in hospital readmission rates within 84 days post discharge. The two intervention groups had lower readmission rates than the control group. Patients in the two study arms had significantly better self-rated health and self-efficacy. There was significant difference between the groups in the physical composite score, but no significant difference in mental component score in SF-36 scale. CONCLUSION: The postdischarge interventions led by the nurse case managers on self-management of disease using the empowerment approach were able to provide effective clinical and patient outcomes for older patients having co-morbidities.