Effectiveness of Tailored Rehabilitation Education in Improving the Health Literacy and Health Status of Postoperative Patients With Breast Cancer: A Randomized Controlled Trial.

BACKGROUND: The improvement of breast cancer treatment and the extension of survivorship have led to the development of postoperative complications among cancer survivors. Health literacy (HL), defined as patients' capability of using health information to maintain their health status, can enable breast cancer patients to manage postoperative complications. OBJECTIVE: The aims of this study were to develop a tailored rehabilitation education (TRE) program and examine the effectiveness of this program in improving the HL and health status with breast cancer. METHODS: This randomized controlled trial recruited 99 breast cancer patients (49 and 50 in the intervention and control groups, respectively) within 1 week after surgery. Four-week individualized TRE programs were implemented to improve their HL and health status. RESULTS: Our results showed that the TRE program produced significant improvements in HL and health status in the components of the International Classification of Functioning, Disability and Health. However, no significant difference was observed in the activity scores obtained using the Barthel Index between the 2 groups. CONCLUSION: Our finding supports the effectiveness of 1-month TRE in improving HL and all components of the International Classification of Functioning, Disability and Health status, except the activity component among breast cancer in Taiwan. IMPLICATIONS FOR PRACTICE: Clinicians could incorporate the TRE techniques in the rehabilitation sessions according to the healthcare, disease prevention, and health promotion domains to improve the clinical outcomes as well as change their health behaviors and attitudes of patients with breast cancer.

The relationship between health literacy and perceived shared decision making in patients with breast cancer.

OBJECTIVES: We explored the relationship between patient-perceived shared decision making (SDM) and three domains of health literacy (HL) in patients with breast cancer. METHODS: In this cross-sectional study, we prospectively recruited a convenience sample of 511 breast cancer patients from 3 hospitals in Taiwan. Patients completed questionnaires about HL and perceived SDM in a recent consultation. Sequential regressions, controlling for International Classification of Functioning, Disability and Health (ICF)-related factors) were conducted. Interactions of each HL domain with age or education were also assessed for the relationship with perceived SDM. RESULTS: Higher scores in the HL domains of healthcare and disease prevention, but lower scores in the health promotion domain, were significantly associated with a higher perceived level of SDM after controlling for ICF-related factors (R2 = 33.44%). The association of SDM with two domains of HL varied with age, while the relationship between the 3 HL domains and SDM differed across education levels. CONCLUSION: Each HL domain was significantly associated with perceived SDM after controlling for the ICF-related factors and across different age- and education-stratifications. PRACTICE IMPLICATIONS: Clinicians should be cognizant of patients' HL levels and incorporate HL best practices into consultations and interactions with patients with breast cancer to facilitate SDM.

Development of a Tablet-based symbol digit modalities test for reliably assessing information processing speed in patients with stroke.

PURPOSE: To develop a Tablet-based Symbol Digit Modalities Test (T-SDMT) and to examine the test-retest reliability and concurrent validity of the T-SDMT in patients with stroke. METHODS: The study had two phases. In the first phase, six experts, nine college students and five outpatients participated in the development and testing of the T-SDMT. In the second phase, 52 outpatients were evaluated twice (2 weeks apart) with the T-SDMT and SDMT to examine the test-retest reliability and concurrent validity of the T-SDMT. RESULTS: The T-SDMT was developed via expert input and college student/patient feedback. Regarding test-retest reliability, the practise effects of the T-SDMT and SDMT were both trivial (d=0.12) but significant (p≦0.015). The improvement in the T-SDMT (4.7%) was smaller than that in the SDMT (5.6%). The minimal detectable changes (MDC%) of the T-SDMT and SDMT were 6.7 (22.8%) and 10.3 (32.8%), respectively. The T-SDMT and SDMT were highly correlated with each other at the two time points (Pearson's r=0.90-0.91). CONCLUSIONS: The T-SDMT demonstrated good concurrent validity with the SDMT. Because the T-SDMT had a smaller practise effect and less random measurement error (superior test-retest reliability), it is recommended over the SDMT for assessing information processing speed in patients with stroke. Implications for Rehabilitation The Symbol Digit Modalities Test (SDMT), a common measure of information processing speed, showed a substantial practise effect and considerable random measurement error in patients with stroke. The Tablet-based SDMT (T-SDMT) has been developed to reduce the practise effect and random measurement error of the SDMT in patients with stroke. The T-SDMT had smaller practise effect and random measurement error than the SDMT, which can provide more reliable assessments of information processing speed.

Practice effects and test-re-test reliability of the Five Digit Test in patients with stroke over four serial assessments.

OBJECTIVES: To investigate practice effect and test-re-test reliability of the Five Digit Test (FDT) over four serial assessments in patients with stroke. DESIGN: Single-group repeated measures design. METHODS: Twenty-five patients with stroke were administered the FDT in four consecutive assessments every 2 weeks. The FDT contains four parts with five indices: 'basic measures of attention and processing speed', 'selective attention', 'alternating attention', 'ability of inhibition' and 'ability of switching'. RESULTS: The five indices of the FDT showed trivial-to-small practice effects (Cohen's d = 0.03-0.47) and moderate-to-excellent test-re-test reliability (intra-class correlation coefficient = 0.59-0.97). Practice effects of the five indices all appeared cumulative, but one index, 'basic measures of attention and processing speed', reached a plateau after the second assessment. The minimum and maximum values of the 90% confidence interval (CI) of reliable change index modified for practice (RCIp) for this index were [-17.6, 11.2]. CONCLUSIONS: One of five indices of the FDT reached a plateau, whose minimum and maximum values of the 90% CI RCIp are useful to determine whether the change in an individual's score is real. However, clinicians and researchers should be cautious when interpreting the test results of these four indices over repeated assessments.

[A project to improve psychiatric nursing station air quality].

BACKGROUND: Ambient air at the psychiatric nursing station in our hospital had been notably poor for an extensive period of time. CO2 levels at the station averaged 1211 ppm during August, 2009 and a specialist team estimated a CO2 abnormality ratio of 32%. Analysis identified key issues in three problem areas, including (1) ENVIRONMENT: air at the station was not refreshed and electronic equipment was in constant operation; (2) Staff: the station had a high staff-to-space ratio and staffs lacked practical knowledge on indoor air quality maintenance; and (3) Policy: the hospital had no guidelines addressing indoor air quality maintenance. PURPOSE: The purpose of this project was to reduce ambient CO2 levels at the hospital's acute psychiatric ward in order to create a high-quality working environment for all staff. The short-term goal was to reduce the CO2 abnormality ratio from 32% to 10%. Long-term goals were to maintain an ambient CO2 level in the ward below 1000ppm and further reduce the abnormality ratio to 0%. METHODS: To address environment-related issues, we increased the number of indoor plants and turned certain computers off at night. To address staff-related issues, we rearranged staff activity space and educated staff on how to maintain indoor air quality. To address the policy-related issue, we drafted proposed hospital guidelines on indoor air quality maintenance. RESULTS: Post-intervention measurements made in October, 2011 found significantly improved ambient air quality, with CO2 levels at 997ppm and a CO2 abnormality ratio of 0%. CONCLUSIONS: Results demonstrate that improvement measures implemented can effectively improve the quality of ambient air at psychiatric nursing stations. A post-intervention survey further found that staffs were both more satisfied with ward air quality and perceived a friendlier ward work environment.

Skin permeation of buprenorphine and its ester prodrugs from lipid nanoparticles: lipid emulsion, nanostructured lipid carriers and solid lipid nanoparticles.

The aim of this study was to develop and characterize lipid nanoparticle systems for the transdermal delivery of buprenorphine and its prodrugs. A panel of three buprenorphine prodrugs with ester chains of various lengths was synthesized and characterized by solubility, capacity factor (log K'), partitioning between lipids and water and the ability to penetrate nude mouse skin. Colloidal systems made of squalene (lipid emulsion, LE), squalene + Precirol (nanostructured lipid carriers, NLC) and Precirol (solid lipid nanoparticles, SLN) as the lipid core material were prepared. Differential scanning calorimetry showed that the SLN had a more-ordered crystalline lattice in the inner matrix compared to the NLC. The particle size ranged from 220-300 nm, with NLC showing the smallest size. All prodrugs were highly lipophilic and chemically stable, but enzymatically unstable in skin homogenate and plasma. The in vitro permeation results exhibited a lower skin delivery of drug/prodrug with an increase in the alkyl chain length. SLN produced the highest drug/prodrug permeation, followed by the NLC and LE. A small inter-subject variation was also observed with SLN carriers. SLN with soybean phosphatidylcholine (SLN-PC) as the lipophilic emulsifier showed a higher drug/prodrug delivery across the skin compared to SLN with Myverol, a palmitinic acid monoglyceride. The in vitro permeation of the prodrugs occurred in a sustained manner for SLN-PC. The skin permeation of buprenorphine could be adjusted within a wide range by combining a prodrug strategy and lipid nanoparticles.

Lipid nanoparticles with different oil/fatty ester ratios as carriers of buprenorphine and its prodrugs for injection.

Buprenorphine is a promising drug for the treatment of chronic pain and opioid dependence. The aim of the present work was to evaluate the feasibility of lipid nanoparticles with different oil/fatty ester ratios for injection of buprenorphine. To improve the release properties and analgesic duration of the drug, ester prodrugs were also incorporated into the nanoparticles for evaluation. Linseed oil and cetyl palmitate were respectively chosen as the liquid lipid and solid lipid in the inner phase of the nanoparticulate systems. Differential scanning calorimetry (DSC) was performed, and the particle size, zeta potential, molecular environment, and lipid/water partitioning were determined to characterize the state of the drug/prodrug and lipid modification. The in vitro release kinetics were measured by a Franz assembly. DSC showed that systems without oil (solid lipid nanoparticles, SLNs) had a more ordered crystalline lattice in the inner matrix compared to those with oil (nanostructured lipid carriers, NLCs and lipid emulsion, LE). The mean diameter of the nanoparticles ranged between 180 and 200nm. The in vitro drug/prodrug release occurred in a delayed manner in decreasing order as follows: SLN>NLC>LE. It was found that the release rate was reduced following an increase in alkyl ester chains in the prodrugs. The in vivo antinociception was examined by a cold ethanol tail-flick test in rats. Compared to an aqueous solution, a prolonged analgesic duration was detected after an intravenous injection of buprenorphine-loaded SLNs and buprenorphine propionate (Bu-C3)-loaded NLCs (with 10% linseed oil in the lipid phase). The Bu-C3 in NLCs even showed a maximum antinociceptive activity for 10h. In vitro erythrocyte hemolysis and lactate dehydrogenase (LDH) release from neutrophils demonstrated a negligible toxicity of these carriers. Our results indicate the feasibility of using lipid nanoparticles, especially SLNs and NLCs, as parenteral delivery systems for buprenorphine and its prodrugs.

Psychometric properties of the Loewenstein Occupational Therapy Cognitive Assessment-Second Edition in Taiwanese persons with schizophrenia.

OBJECTIVE: This study sought to determine the psychometric properties for the Loewenstein Occupational Therapy Cognitive Assessment-Second Edition (LOTCA-II) in a population of persons with schizophrenia. METHOD: Sixty-four participants with schizophrenia were administered the LOTCA-II at baseline, and 43 of these were randomly selected to undertake four more standardized measures of cognitive and instrumental activities of daily living (IADL) functions to test convergent validity. One week later, 48 randomly selected participants from the total sample were readministered the LOTCA-II to determine test-retest reliability. RESULTS: Substantial ceiling effects existed in 96% of LOTCA-II items. Cronbach's alpha for all six sub-tests ranged from .20 to .91; the alpha for the global scale was .90. Intraclass correlation coefficients ranged from .49 to .89 for the subtests and .95 for the full LOTCA-II. Low to moderate correlations were found between LOTCA-II total score and scores on cognitive and IADL measures. No overall significant differences in subtest scores were found across participants differing in employment status. CONCLUSION: LOTCA-II performance is best interpreted in the context of total score. Further revision of the test items is recommended for a more reliable and valid use of the LOTCA-II in persons with schizophrenia.

[A project to raise the participation rate in education groups by psychiatric patient family members].

The objective of this project was to increase the rate of participation in relevant educational programs of immediate relatives of individuals currently undergoing psychiatric treatment. According to statistics, the average participation rate in such educational programs averages only 23.4%; a ratio considered unacceptably low. After analysis, major problems identified included: (1) relatives were not informed in advance of meeting schedules; (2) there was no standard manner by which hospitals communicated with relatives; (3) interaction between patients and their families was, in general, poor; (4) program staff were unable to ensure that relatives knew correct meeting times; and (5) relatives generally lacked interest in health education topics. A special project group was organized and charged to improve the rate of participation of psychiatric patient relatives in health education groups. Three proposals made by this group included: (1) create an annual patient relative attendance planning schedule; (2) implement a patient "life passport" for use as a standardized tool in day hospital care; and (3) arrange time after education activities for patient-parent interaction. After measures were implemented, patient relative participation in education programs rose to 64.8% from 23.4%. Results demonstrate method feasibility and validity. As the proposed method does not require nurses to send out notifications or conduct follow-ups over the phone, it indirectly cuts down costs and manpower and improves patient-family relations, ultimately raising the quality of nursing care.