The effectiveness of a modified advance care planning programme.

BACKGROUND: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. RESEARCH OBJECTIVE: This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. RESEARCH DESIGN: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. PARTICIPANTS AND RESEARCH CONTEXT: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. ETHICAL CONSIDERATIONS: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. FINDINGS: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. DISCUSSION: This study promoted the participants' autonomy and broke through the inherent custom of avoiding talking about death in China. CONCLUSION: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society.

Advance care planning for frail older people in China: A discussion paper.

As the aging population, including frail older people, continues to grow in Mainland China, quality of life and end-of-life care for frail older people has attracted much attention. Advance care planning is an effective way to improve end-of-life care for people with advanced diseases, and it is widely used in developed countries; however, it is a new concept in Mainland China. The effects of advance care planning and its acceptability in Mainland China are uncertain because of its culture-sensitive characteristics. The objective of this article is to discuss the serious social issue of caring for frail older people and illustrate the possibility of implementing advance care planning in nursing homes in Mainland China through a review of relevant literature, which will focus on legislation, healthcare system engagement, public engagement, and cultural issues. Recommendations to promote and implement advance care planning include choosing nursing homes as a proper setting, establishing an ethical climate, and enhancing public awareness.

Evaluation on the implementation of respiratory protection measures in old age homes.

PURPOSE: Old age homes (OAHs) represent a vulnerable community for influenza outbreaks. Effective implementation of respiratory protection measures has been identified as an effective prevention measure to reduce mortality and morbidity caused by such outbreaks. Yet, relatively little is known about this aspect in these homes. This study evaluated the implementation of respiratory protection measures among infection control officers (ICOs) and health care workers (HCWs) in these homes in Hong Kong. PATIENTS AND METHODS: A territory-wide, cross-sectional survey was conducted in 87 OAHs. A total of 87 ICOs and 1,763 HCWs (including nurses, health workers, care workers, allied HCWs and assistants) completed the questionnaires that evaluated the implementation at the organizational level and individual level, respectively. Generalized estimating equations with unstructured working correlation matrix were used to analyze the simultaneous influence of organizational and individual factors on the implementation. RESULTS: At the organizational level, all homes had a policy on respiratory protection and implementation of such measures was generally adequate. Basic resources such as paper towels/hand dryers and equipment disinfectants, however, were rated as most inadequate by HCWs. Training opportunities were also identified as grossly inadequate. Only less than half of the ICOs and HCWs participated in training on infection control either at the initiation of employment or on a regular basis. Twenty-five percent of HCWs even indicated that they had never participated in any infection control training. At the individual level, hand hygiene, among other protection measures, was found to be less well implemented by HCWs. In terms of the association of various organizational and individual characteristics, private homes and health workers rated significantly higher scores in the implementation of various domains in respiratory protection. CONCLUSION: Addressing the unmet training needs and promoting hand hygiene practice are efforts suggested to further enhance the implementation of respiratory protection measures in OAHs.

Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial.

BACKGROUND: Self-management after a stroke is a challenge because of multifaceted care needs and complex disabling consequences that cause further hindrance to patient participation. A 13-week stroke patient empowerment intervention (Health Empowerment Intervention for Stroke Self-management [HEISS]) was developed to enhance patients' ability to participate in self-management. PURPOSE: To examine the effects of the empowerment intervention on stroke patients' self-efficacy, self-management behavior, and functional recovery. METHODS: This is a single-blind randomized controlled trial with stroke survivors assigned to either a control group (CG) receiving usual ambulatory rehabilitation care or the HEISS in addition to usual care (intervention group [IG]). Outcome data were collected at baseline (T0), 1 week (T1), 3 months (T2), and 6 months (T3) postintervention. Data were analyzed on the intention-to-treat principle. The generalized estimating equation model was used to assess the differential change of self-efficacy in illness management, self-management behaviors (cognitive symptom management, communication with physician, medication adherence, and self-blood pressure monitoring), and functional recovery (Barthel and Lawton indices) across time points (baseline = T0, 1 week = T1, 3 months = T2, and 6 months = T3 postintervention) between the two groups. RESULTS: A total of 210 (CG =105, IG =105) Hong Kong Chinese stroke survivors (mean age =69 years, 49% women, 72% ischemic stroke, 89% hemiparesis, and 63% tactile sensory deficit) were enrolled in the study. Those in IG reported better self-efficacy in illness management 3-month (P=0.011) and 6-month (P=0.012) postintervention, along with better self-management behaviors at all follow-up time points (all P<0.05), apart from medication adherence (P>0.05). Those in IG had significantly better functional recovery (Barthel, all P<0.05; Lawton, all P<0.001), compared to CG. The overall dropout rate was 16.7%. CONCLUSION: Patient empowerment intervention (HEISS) may influence self-efficacy in illness management and improve self-management behavior and functional recovery of stroke survivors. Furthermore, the HEISS can be conducted in parallel with existing ambulatory stroke rehabilitation services and provide added value in sustaining stroke self-management and functional improvement in the long term.

Tai chi qigong as a means to improve night-time sleep quality among older adults with cognitive impairment: a pilot randomized controlled trial.

PURPOSE: Age-related cognitivee decline is a growing public health concern worldwide. More than a quarter of adults with cognitive impairment experience sleep disturbance. The objective of this pilot study was to evaluate the preliminary effects of tai chi qigong (TCQ) on improving the night-time sleep quality of older adults with cognitive impairment. PARTICIPANTS: Older adults with cognitive impairment who complain of sleep disturbance. METHODS: A randomized controlled trial with two groups. Fifty-two subjects were recruited from two district elderly community centers and randomly assigned to either the TCQ group (n=27) or the control group (n=25). The intervention group received TCQ training consisting of two 60-minute sessions each week for 2 months. The control group was advised to maintain their usual activities. Sleep quality was measured by the Chinese Pittsburgh Sleep Quality Index. Quality of life was measured by Short-form 12, cognitive functions measured by mini-mental state examination, and subjective memory deficits measured by the memory inventory for Chinese. RESULTS: Data were collected at baseline, 2 months, and 6 months. Significant results were noted at 6 months in the Chinese Pittsburgh Sleep Quality Index global score (P=0.004), sleep duration (P=0.003), habitual sleep efficiency (P=0.002), and the Short-form 12 mental health component (P<0.001). The TCQ participants reported better sleep quality and a better (quality of life) mental health component than the control group. CONCLUSION: TCQ can be considered a useful nonpharmacological approach for improving sleep quality in older adults with cognitive impairment. CLINICAL TRIAL REGISTRATION: CUHK_CCT00448 (https://www2.ccrb.cuhk.edu.hk/registry/public/287).

Application of a glycaemic control optimization programme in patients with stress hyperglycaemia.

BACKGROUND: Stress-induced hyperglycaemia (SHG) can be observed in as high as 75% of critically ill patients, which can induce severe complications or adverse events. However, conventional intensive insulin therapy (CIIT) tends to induce hypoglycaemia and glucose variability. AIMS: This study investigated the clinical effects of a blood glycaemic control optimization programme (BGCOP) in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery. DESIGN: This study is a randomized, controlled, prospective clinical observation. METHODS: Eighty-six patients with postoperative SHG were randomly divided into a control and experimental groups. Participants in the control group underwent CIIT, while participants in the experimental group underwent blood glycaemic control optimization programme (BGCOP). A range of 7·8-10·0 mmol/L was designated as the target range for effective control of blood sugar. The validity index, adverse events and complications were compared between two groups. RESULTS: Compared to participants treated with CIIT, participants treated with BGCOP reached the target range of blood sugar levels more quickly (p = 0·000). The high glycaemic index (p = 0·000), incidence of hypoglycaemia (p = 0·011), and other adverse events as well as the incidence of abdominal infection (p = 0·026), incision infection (p = 0·044), and lung infection (p = 0·047) were significantly lower in participants who underwent the BGCOP than in patients treated with CIIT. CONCLUSION: BGCOP can more effectively control blood sugar levels compared with CIIT in patients with SHG after hepatobiliary or pancreatic surgery. RELEVANCE TO CLINICAL PRACTICE: This study provides a direction for blood glycaemic control in patients with stress hyperglycaemia post hepatobiliary or pancreatic surgery.

Eye irrigation for patients with ocular chemical burns: a systematic review.

AIM: The aim of this systematic review is to present the best available research evidence on eye irrigation methods for ocular chemical burns. INCLUSION CRITERIA: Randomized, quasi-randomized controlled trials and observational studies comparing the effectiveness of methods of eye irrigation among adults or children as an active form of emergency treatment for ocular chemical burns were considered for review. Studies were eligible for inclusion if methods of eye irrigation were examined within the following comparison categories: time to commence first eye irrigation; types, volumes, durations, flow rates and temperature of eye irrigating fluids; and comfort measures during eye irrigation. The types of outcome measures include immediate ocular outcomes and complications, clinical outcomes, self-reported outcomes, length of hospital stay and working days lost. SEARCH STRATEGY: Electronic bibliographic databases in English and Chinese were searched from inception to June 2010 and yield 8,999 citations. Other sources were searched by hand to identify studies or additional relevant source materials. The reference lists and bibliographies of all articles retrieved were scrutinized to identify further studies and added a further 22 articles. A forward search on the authors of the studies identified was also performed. METHODOLOGICAL QUALITY: A study eligibility verification form was developed for the assessment and two reviewers made independent decisions on whether to include each publication in the systematic review. Critical appraisals of study quality were undertaken independently by two reviewers using the Joanna Briggs Institute critical appraisal tools. Any disagreement that arose between the two reviewers was resolved by discussion. DATA EXTRACTION: Data extraction was performed by one reviewer using a data extraction form developed for the systematic review. Another reviewer checked for accuracy. DATA SYNTHESIS: Given the clinical and methodological diversity among the studies included in this review, the review findings are presented in a narrative form and no meta-analysis has been performed. RESULTS AND DISCUSSION: A total of four studies involving 302 adults and children with ocular chemical burns met the inclusion criteria for the systematic review. One study determined the effects of prompt irrigation of the eyes with tap water immediately after alkali burns had been suffered at the scene of injury. The authors report that patients who underwent immediate irrigation had significantly better clinical and ocular outcomes. One study compared four ocular irrigation fluids administered in an emergency department and found more patients preferred a modified saline (balanced saline solution plus) than other type of irrigation fluids. Another study compare the effectiveness of two ocular irrigation fluids in hospital setting reported that for patients with grade 1 and 2 burns, the time elapsed to re-epithelialization was shorter in the group rinsing with diphoterine when compared with the group rinsing with normal saline. The results in another study demonstrated that patients with ocular chemical burns treated with prolonged irrigation reported shorter duration of treatment at the hospital and absence from work. However, the results should be treated with caution, as there were significant differences between the comparison groups in some studies, and incomplete details on methods of random assignment and a small sample size were issues of concern. CONCLUSIONS: There is insufficient evidence to determine the optimal eye irrigation methods to improve ocular and clinical outcomes. Randomized trials using sample sizes with adequate power are needed to compare the clinical benefits of eye irrigation methods and further trials should take into account the potentially important factors such as the time to commence eye irrigation and cumulative effects of irrigating fluids that might affect the outcomes and adopt strategies to deal with them. IMPLICATIONS FOR PRACTICE: Currently there is insufficient evidence to inform practice of eye irrigation among adults or children as an active form of emergency treatment for ocular chemical burns. Healthcare professionals need to continuously update themselves about the latest evidence on the optimal methods of eye irrigation in enhancing patient outcomes. IMPLICATIONS FOR RESEARCH: More well designed randomized and quasi-experimental trials with adequate sample size are needed to further examine the effective methods of eye irrigation for ocular chemical burns. Future studies should provide sufficient information about the demographic and clinical data including the types and severity of ocular injuries, causative chemicals, first-aid management, and time elapsed to eye irrigation. Furthermore, a clear description of the eye irrigation protocol is crucial to facilitate comparisons across studies. POTENTIAL CONFLICT OF INTERESTS: The authors of this systematic review do not have any type of conflict of interest.

A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failure.

AIMS AND OBJECTIVES: To evaluate the effectiveness and cost-effectiveness of a community nurse-supported hospital discharge programme in preventing hospital re-admissions, improving functional status and handicap of older patients with chronic heart failure. DESIGN: Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re-admission at six months. Secondary outcomes were number of unplanned re-admissions, six-minute walking distance, London Handicap Scale and public health care and personal care costs. RESULTS: At sixth months, the re-admission rates were not significantly different (46 vs. 57% in control subjects, p = 0.233, Chi-square test). But the median number of re-admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0.057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0.5 in control subjects, p = 0.002, Mann Whitney test), but there was no difference in six-minute walking distance. There was no significant group difference in median total public health care and personal care costs. CONCLUSION: Community nurse-supported post-discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re-admissions. The cost benefits to public health care were not significant. RELEVANCE TO CLINICAL PRACTICE: Older chronic heart failure patients are likely to benefit from post-discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken.