[The Effects of Supportive Caring on Symptoms Distress, Nursing Needs, and Depression in Patients With Brain Tumor After Surgery: A Preliminary Study].

BACKGROUND: Brain tumors are mainly treated with surgery. However, patients still experience many symptoms and nursing needs due to disease and treatment-related factors that, if not improved in a timely manner, may result in depression. PURPOSE: The purpose of this study was to examine the effectiveness of supportive caring on symptom distress, nursing needs, and depressive symptoms in patients with brain tumor after surgery. METHODS: This study adopted a two-group, pre- and post-test experimental design. The enrolled participants were randomized into two groups. Those in the experimental group received a phone-based supportive caring intervention twice at 1 and 3 months after surgery. Those in the control group received usual discharge care. The measurement outcomes included a supportive care needs survey, symptom distress scales, and the center for epidemiological studies of depression. Baseline data was collected prior to hospital discharge (T0), with follow-up data collected at one month (T1), three months (T2), and six months (T3) after surgery. RESULTS: The results of the generalized estimating equation analysis showed that nursing needs in the experimental group at T1 (ß = -23.61, p < .001), T2 (ß = -22.51, p < .001), and T3 (ß = -22.26, p < .001) were significant lower than in the control group. Also, symptom distress in the experimental group at T1 (ß = -7.03, p = .019) and T2 (ß = -8.39, p = .003) was significantly lower than in the control group. However, depressive symptoms in the experimental group were lower than in the control group only at T2 (ß = -8.55, p = .005). CONCLUSIONS: The results of this study confirm that supportive care helps improve nursing needs, symptoms distress, and depressive symptoms in patients with brain tumor after surgery. Medical team members should pay attention to these issues following surgery.

Using a simple preliminary screening tool to explore related factors of osteoporosis in the elderly of southern Taiwan.

ABSTRACT: The aims of this study were to use a simple screening tool to explore related factors with osteoporosis in the elderly in the community of southern Taiwan.This was an observational cross-sectional study using Osteoporosis Self-Assessment Tool for Asia (OSTA), Osteoporosis Self-Assessment Tool for Taiwanese (OSTAi), and the basic demographic information to identify osteoporosis in the participants. This study collected data from 200 participants aged 65 and above and living in southern Taiwan.The prevalence of osteoporosis among elders in the community was 30.5% (OSTA) and 58.0% (OSTAi), respectively. The prevalence of osteoporosis determined by OSTA and OSTAi in female (33.1% and 63.1%, respectively.) was higher than in male (25.7% and 48.6%, respectively.). Risk factors such as gender, age, and body mass index (BMI) were significantly associated with osteoporosis (P < .001). Using OSTA and OSTAi to assess the risk for osteoporosis, for every 1 year of age increase, the odds ratio (OR) value of osteoporosis increased by 1.84 and 1.50 times, respectively (P < .001); for every 1 kg/m2 increase in BMI, the OR of osteoporosis decreases by 0.36 and 0.44 times, respectively. The results of this study can be used a simple tool of OSTA and OSTAi self-examination to screen potential high-risk groups for osteoporosis in the community.OSTA and OSTAi can screen for possible high-risk groups early and without invasive examinations and self-examination tools in a hospital. Low BMI poses higher risks of osteoporosis for the elderly, so increasing functional ability, improving muscle strength, maintaining exercise habits and keeping proper weight could prevent osteoporosis in the seniors.

Association of home care needs and functional recovery among community-dwelling elderly hip fracture patients.

The aim of this study was to assess the home care needs and task difficulty of community-dwelling aged hip fracture and the association of functional recovery with care received. A cohort of hip fracture patients admitted to orthopedic wards for surgery was collected from August 2009 to December 2010. Patients transferred to long-term care facilities after surgery were excluded. Functional status (feeding, clothing, grooming, bathing, getting in/out of bed, walking, toileting, standing up/sitting down, and walking up/down stairs) and task difficulty for caregivers were recorded at discharge, one week and one month after discharge. In total, 116 patients (mean age: 79.4 ± 8.5 years, 51.7% males) were enrolled. The mean age of primary caregivers was 53.4 ± 14.2 years, and most were daughters or sons (54.3%), spouses (34.5%) or foreign workers (11.0%). The most common care needs were wound care (95.7%), medical visits (94.8%), cleaning and maintaining living quarters (92.2%) and vigilance to ensure patient safety (92.2%). The care needs and task difficulty significantly correlated with physical function before, one week and one month after discharge (r=-0.530, p<0.001; r=-0.326, p=0.001; r=-0.432, p<0.001; r=-0.684, p<0.001; and r=-0.475, p<0.001, respectively). The complex and taxing home care needs of community-dwelling elderly hip fracture patients were significantly associated with functional recovery. Comprehensive geriatric assessment and related special medical services may greatly help caregivers and promote the practice of aging in place. Further study is needed to develop appropriate caregiver education to promote the functional recovery of elderly hip fracture patients at home.

A model to personalize scheduling of complex prescriptions.

Medication adherence tends to affect the recovery of patients. Patients having poor medication adherence show a worsening of their condition and/or increased complications. Unfortunately, between 20% and 50% of chronic patients are unable to manage their medications. This study proposes a model to improve the patients' medication compliance by reducing medication frequency. Published studies have shown that, based on the patients' lifestyle, simplification of the medication frequency and remodeling of the medication schedule is able to help improve medication adherence. Therefore, this study tried to simplify medication frequency by combining therapies. Moreover, by adjusting according to lifestyle, the study also tries to remodel medication timing in relation to mealtimes to create personal medication schedules. In this study, we used 19,393,452 outpatient prescriptions from the National Health Insurance Research Database to verify our system (algorithm optimized). At the same time, we examined the differences between the frequency summarized by general public and experts' advice medication behavior. Compared with the experts' advice method, this system has reduced the medication frequency in about 49% of prescriptions. Using combined medication to simplify medication frequency is able to reduce the medication frequency significantly and improve medication adherence. Furthermore, this should also improve patient recovery, reduce drug hazards and result in less drug wastage.

Waist circumference and risk of elevated blood pressure in children: a cross-sectional study.

BACKGROUND: Increasing childhood obesity has become a major health threat. This cross-sectional study reports associations between schoolchildren's waist circumference (WC) and risk of elevated blood pressure. METHODS: We measured height, weight, neck and waist circumference, and blood pressure in regular health examinations among children in grade 1 (ages 6-7 years) at six elementary schools in Taipei County, Taiwan. Elevated blood pressure was defined in children found to have mean systolic or diastolic blood pressure greater than or equal to the gender-, age-, and height-percentile-specific 95th-percentile blood pressure value. RESULTS: All 2,334 schoolchildren were examined (response rate was 100% in the six schools). The mean of systolic and diastolic blood pressure increased as WC quartiles increased (p < 0.0001). The prevalence of elevated blood pressure for boys and girls within the fourth quartile of waist circumference was 38.9% and 26.8%, respectively. In the multivariate logistic regression analyses, the adjusted odds ratios of elevated blood pressure were 1.78 (95% confidence interval [CI] = 1.13-2.80), 2.45 (95% CI = 1.56-3.85), and 6.03 (95% CI = 3.59-10.1) for children in the second, third, and fourth waist circumference quartiles compared with the first quartile. The odds ratios for per-unit increase and per increase of standard deviation associated with elevated blood pressure were 1.14 (95% CI = 1.10-1.18) and 2.22 (95% CI = 1.76-2.78), respectively. CONCLUSIONS: Elevated blood pressure in children was associated with waist circumference. Not only is waist circumference easier to measure than blood pressure, but it also provides important information on metabolic risk. Further research is needed on effective interventions to identify and monitor children with increased waist circumference to reduce metabolic and blood pressure risks.

A path model of health-related quality of life in type 2 diabetic patients: a cross-sectional study in Taiwan.

AIMS: To construct a path model about relationships of perceptions of empowerment, diabetes distress, self-care behaviour and glycemic control to health-related quality of life in Taiwanese Type 2 diabetic patients, suffering from diabetes for 10 years or less. BACKGROUND: Health-related quality of life is the primary end point for people with diabetes. Understanding the path model of health-related quality of life in Type 2 diabetic patients is useful for nurses to design early intervention programmes. METHODS: This was a cross-sectional study. An anonymous questionnaire was used to collect data from 2007 to 2008. Glycosylated haemoglobin (HbA1c) was also collected. Data from 428 Type 2 diabetic patients were analysed with structural equation modelling to test the fit of the hypothesized path model to the data. RESULTS: A model was produced in which self-care behaviour had a statistically significantly direct influence on satisfaction, impact and worry aspects of health-related quality of life. Glycosylated haemoglobin had a statistically significantly negative influence on satisfaction, and impact aspects of health-related quality of life. Perceptions of empowerment had a statistically significantly direct influence on satisfaction aspect of health-related quality of life. Diabetes distress had a statistically significantly direct influence on satisfaction, impact and worry aspects of health-related quality of life. CONCLUSIONS: Nurses should develop new approaches to improve various aspects of health-related quality of life. Nurses could empower patients to improve satisfaction aspect of health-related quality of life. To improve the impact and worry aspects of health-related quality of life, nurses should reduce diabetes distress felt by patients.