[Application of Light Therapy in Dementia Care].

Patients with dementia often display related sleep disturbance, depression, and behavioral and psychological symptoms, which are traditionally managed through the use of antipsychotic medications or physical restraint. However, these management interventions can have negative effects on the physical and psychological health of patients. The results of several meta-analyses suggest non-pharmacological interventions, including light therapy, should be used for the first-line management of these dementia symptoms. Light therapy uses artificial light to compensate for insufficient light exposure during the daytime and to help patients with dementia properly regulate their circadian rhythms. Sleep disturbance and depression in those with dementia may be effectively relieved through the application of light therapy. Nurses should assess the needs and symptoms of patients with dementia and consider applying light therapy as a complementary care intervention to improve quality of care.

Development and validation of a brief version of the traditional Chinese Stressors in Nursing Students scale among college nursing students in Taiwan.

Objective: The 43-item Stressors in Nursing Students (SINS) scale has been evaluated among nursing students in several countries, including China, Hong Kong, Japan, Pakistan, and Spain. However, the original four-factor structure has not been consistently replicated in all of these populations. The aim of this study was to develop a brief version of the traditional Chinese SINS (TC-SINS) scale and to validate it in Taiwanese nursing students. Materials and Methods: Data obtained from a cross-sectional survey study of 814 nursing students in a nursing college and a university in Taiwan were randomly divided into two parts. The first part was used to conduct an exploratory factor analysis using principal axis factoring with oblique rotation. After the removal of cross-loading items, the resulting scale was validated with the data from the second part using confirmatory factor analysis. Results: A three-factor solution (social, clinical, and education) with 23 items accounting for 54.5% of variance was obtained in the exploratory factor analysis. The confirmatory factor analysis further reduced the number of items to 20. The goodness-of-fit indexes were good (Root Mean Square Error of Approximation = 0.075 and Comparative Fit Index = 0.90). Conclusions: The number of items in the TC-SINS could be reduced from 43 to 20, without sacrificing its psychometric properties. The brief version of TC-SINS might be able to reduce respondent burden.

Effects of a dementia virtual reality-based training with peer support for home care workers: A cluster randomized controlled trial.

OBJECTIVES: Home care workers who are the first-line care workers for community-dwelling dementia patients often have limited dementia knowledge, skills, and empathy towards those with dementia. Research is sparse on dementia care training using virtual reality (VR) technology and support network for home care workers. METHODS: This cluster randomized controlled trial evaluated the effects of a dementia VR-based training with peer support on dementia knowledge, attitude, competence, and empathy of home care workers. Each home care worker team was used as the unit for randomization. Sixteen teams were randomly assigned to either VR group or non-VR control group There was a total of 124 participants completed the study, the VR group (n = 61) received a dementia VR-based training consisted of 3-month dementia care e-book modules, dementia VR-based activity and 1-h monthly face-to-face peer support group meetings. The non-VR control group (n = 63) only receive the 3-month dementia care e-book modules and 1-h monthly regular staff meetings with no VR activity. Outcome measures were assessed at three time points: baseline, the end of the 3-month intervention, and 1-month post intervention. RESULTS: Generalized estimating equations results indicate that the improvement in dementia knowledge, attitudes, competence, and empathy over time is significant in the VR group compared to the non-VR control group. The effects remained significant 1 month after the end of the 3-month intervention. CONCLUSIONS: Innovative and accessible dementia training using VR technology with peer support is a promising training approach to improve dementia knowledge, attitudes, competence, and empathy of home care workers.

[Three-Step Interdisciplinary Team Program for Nasogastric Tube Care].

Patients with chewing disorders and dysphagia often take nutrition via nasogastric tube feeding. Patients with indwelling nasogastric tubes often experience discomfort, resulting in increased incidences of self-extubation and slippage. Frequent changes or misplacement of the nasogastric tube may also cause patient safety issues such as aspiration pneumonia, gastrointestinal trauma, and pneumothorax. Collaboration within the interdisciplinary team is needed to provide proper nasogastric tube care prior to placement, during the indwelling process, and during the removal of the nasogastric tube. Interdisciplinary teams should develop standardized procedures for nasogastric tube care, initiate swallow screening, oral care and training early, and develop a care plan for nasogastric tube removal. An evidence-based, practical example of nasogastric tube care implemented by an interdisciplinary team in a neurology unit is presented in this article. Interdisciplinary teams may assist patients to prepare to return to a normal tube-free life using individualized, safe, and dignified nasogastric tube care to improve quality of life.

Psychometric properties of the dementia knowledge assessment scale-traditional Chinese among home care workers in Taiwan.

BACKGROUND: The Dementia Knowledge Assessment Scale (DKAS) is a reliable and valid measurement of dementia knowledge for diverse allied health professionals but its traditional Chinese version has not been formally validated yet. The purpose of this study was to translate the DKAS from English to traditional Chinese and evaluate its psychometric properties among home care workers in Taiwan. METHODS: The DKAS scale was translated into traditional Chinese through a forward translation and back translation process following the cross-cultural translation guideline. A total of 285 home care workers in eastern Taiwan were recruited using convenience sample. A total of 252 participants completed the questionnaires, giving a response rate of 88.4%. We tested the construct validity by confirmatory factor analysis (CFA) and evaluated the reliability by internal consistency. RESULTS: The results of the CFA supported the 25-item, four-factor model for the DKAS-TC. The DKAS-TC achieved a good overall Cronbach's alpha of .93 and McDonald's omega of 0.94 with acceptable subscales McDonald's omega ranged from .77 to .82. CONCLUSIONS: The DKAS-TC has adequate construct validity and reliability and can serve as an assessment tool to evaluate the knowledge level of home care workers in a dementia training program in Taiwan. The dementia knowledge level among home care workers in Taiwan was inadequate. There is a need for developing suitable dementia care training tailored to their learning needs and educational levels, and to improve their quality of care for those with dementia.

Effects of three-dimensional holograms on the academic performance of nursing students in a health assessment and practice course: A pretest-intervention-posttest study.

BACKGROUND: Traditional teaching approaches are generally teacher-directed, and students are taught in a manner that is conducive to sitting and listening. Using three-dimensional (3D) holograms has many benefits in a higher education environment. However, relevant studies on this topic are very limited. OBJECTIVES: To confirm the efficacy of 3D holograms for educational purposes to support the academic and practical performance of nursing students. DESIGN: A randomly allocated pretest and posttest quasi-experimental design. SETTINGS: Mackay Medical College in Taiwan. PARTICIPANTS: Ninety third-year nursing students at a medical school in Taiwan. METHODS: The data were collected between January and May 2020. The participants were randomly allocated to an intervention group and a control group. The learning method used in the intervention group was a combination of a 3D hologram learning module and classroom lectures. The control group was exposed to classroom lectures without 3D holograms. The tool included hardware (Windows Mixed Reality Helmet and VR Remote Control) and software (Health Assessment® and Patient First Patient Condition VR System®). The Health Assessment and Practice Knowledge Assessment tool and the Health Assessment and Practice Techniques Performance tool were used to evaluate the effects of the study intervention on the knowledge and techniques of the students. RESULTS: A total of 79 participants (40 in the intervention group and 39 in the control group) were included in the final statistical analysis. The response rate was 88%. Statistically significant differences in knowledge and practical learning in the health assessment and practice course were observed between the intervention group and the control group (p < .05). The η2 effect level was 0.134. CONCLUSIONS: After attending classroom lectures, the students who also attended the 3D hologram-based laboratory courses had significantly higher knowledge and practical learning scores. This approach may be used as a complementary learning tool in higher education.

A dementia care training using mobile e-learning with mentoring support for home care workers: a controlled study.

BACKGROUND: Caring of older adults with dementia at home can be challenging for home care workers. There is a need to develop suitable training for home care workers to improve the quality of dementia care. We evaluated a 12-week dementia care training including mobile e-learning, social networking, and mentoring support group meetings on the dementia care knowledge, attitude, and competence of home care workers. METHODS: This controlled study involved 140 home care workers from two home care agencies, which were selected from 12 home care agencies in eastern Taiwan. The two home care agencies were randomly allocated either the intervention group or the control group. The intervention group received mobile e-learning, mentor-led online social support networking, and monthly face-to-face mentoring support group meetings. Participants in the control group received 8-h conventional lectures. The primary outcomes were knowledge, attitude, and competence in dementia care. Questionnaires consisting of the Dementia Knowledge Assessment Scale, Approaches to Dementia Questionnaire, and Sense of Competence in Dementia Care Staff scale were administered to the participants at three time points (baseline, end of the 12-week intervention, and 12 weeks after the end of the intervention). RESULTS: Generalized estimating equation analyses showed that the intervention significantly improved the knowledge, attitude, and competence of home care workers on dementia care. The effects remained significant even 12 weeks after the end of the intervention. CONCLUSIONS: A 12-week dementia care training program consisting of mobile e-learning, social networking, and face-to-face mentoring support group meetings were found to a feasible approach in improving the knowledge, attitude, and competence of home care workers. Mobile e-learning and online environment provides a platform that is self-directed, flexible, accessible, and cost-effective for training home care workers. The findings provide a call to action for nurse educators and policy makers to re-design existing dementia care training for home care workers to meet the critical home care needs of a growing dementia population. TRIAL REGISTRATION: ClinicalTrials.gov. NCT03822286 . Registration date: 27/01/2019. Posted date: 31/01/2019.

Effect of Bright Light Therapy on Depressive Symptoms in Middle-Aged and Older Patients Receiving Long-Term Hemodialysis.

Depressive symptoms are common psychiatric comorbidities among individuals receiving long-term hemodialysis. The aim of this two-arm parallel design study is to assess the effects of bright light therapy (BLT) on depressive symptoms among middle-aged and older adults receiving long-term hemodialysis. Study participants are recruited using convenient sampling from four dialysis clinics in eastern Taiwan. The eligible participants are block-randomized to either the BLT group (n = 30), with 30 min sessions of BLT five times a week for six weeks at their own home, or to the routine care control group (n = 30). The Beck Depression Inventory-II (BDI-II) scores and the salivary cortisol levels are obtained from the participants at three time points: baseline (T0), week 3 (T1), and week 6 (T2). The results, from the generalized estimating equations, indicate that the decline in the BDI-II scores over time is significant in the BLT group at T1 (ß = -7.57, p < 0.001) and at T2 (ß = -6.20, p = 0.002) compared to the control group. The decrease in salivary cortisol levels at each visit is also significant in the BLT group at T1 (ß = -7.37, p = 0.017) and at T2 (ß = -12.22, p = 0.005) compared to the control group. Our findings support the hypothesis that a six-week program of BLT is able to alleviate depressive symptoms in middle-aged and older patients who receive long-term hemodialysis.

Virtual reality education for dementia care: a scoping review protocol.

OBJECTIVE: This scoping review aims to examine the content and outcome measurements of health care education programs using virtual reality for the care of people with dementia, involving, but not limited to, health science students, health care professionals, family, and unpaid caregivers INTRODUCTION:: Several studies have examined approaches for improving the care of people with dementia by both professional, family and unpaid caregivers using virtual reality. However, the content and outcomes of these interventions are disjointed, and there is currently no unified indicator to evaluate virtual reality educational programs. INCLUSION CRITERIA: This review will consider studies that include educational programs using virtual reality for health science students, health care professionals, and family caregivers of people with dementia. All study designs will be considered. METHODS: The proposed scoping review will be conducted following the JBI methodology for scoping reviews. The databases to be searched include MEDLINE, CINAHL, Embase, Cochrane, and JBI Evidence Synthesis; local databases in Japanese, Thai, Taiwanese, and Chinese; and sources of unpublished studies and gray literature. Studies published in English, Japanese, Chinese, and Thai languages will be included. The data extracted will include specific details about the population, concept, context, study methods, and critical findings relevant to the review objective and be presented in diagrammatic or tabular form in a manner that aligns with the objective of this scoping review.

Low interest in clinical practicum placement is associated with increased stress in nursing students in Taiwan: A cross-sectional survey study.

BACKGROUND: Nursing students often find themselves in a highly competitive environment, and stress is a commonly acknowledged experience in nursing students. OBJECTIVES: The aim of this study was to explore factors, particularly an interest in nursing and in clinical practicum placement, associated with stress in Taiwanese nursing students. DESIGN: Cross-sectional survey study. SETTINGS: A nursing college in central Taiwan and a university in eastern Taiwan. PARTICIPANTS: 814 nursing students. METHODS: Level of stress of the participants was measured using the 43-items Stressors in Nursing Students (SINS) scale, which was translated into a traditional Chinese version (TC-SINS). Simple and multiple linear regression analyses were used to evaluate factors significantly associated with stress. RESULTS: A total of 814 nursing students completed the questionnaire with a return rate of 83.6%. The mean age of the participants was 18.9 years and 94.8% was female. Regarding the students' interest in nursing, 2.6% expressed that they strongly or somewhat disagree. In addition, regarding the students' interest in clinical practicum placement, 7.2% indicated that they strongly or somewhat disagree. Results from multiple regression analysis showed that students who expressed somewhat or strong disagreement to interest in clinical practicum placement were significantly associated with a higher level of stress. Of the various strategies for stress relief, listen to music (75.2%) was the most popular choice, followed by talk to a friend (72.3%), and catch up on sleep (61.3%). A third of the participants used three strategies for stress relief. CONCLUSIONS: Low interest in clinical practicum placement was associated with increased stress levels in nursing students in Taiwan. Future studies should explore the underlying reasons for stress induced by clinical practicum placement, and possible solutions for stress reduction in nursing students.

The experience of advance care planning discussion among older residents in a long-term care institution: A qualitative study.

AIMS AND OBJECTIVES: To explore the experiences and processes of advance care planning (ACP) discussions in older residents of a long-term care institution. BACKGROUND: Advance care planning can facilitate discussion about end-of-life care and help to identify individual's views, wishes and beliefs about dying at a time when they have the cognitive capacity to reflect on and/or make such decisions. DESIGN: A qualitative study was conducted. METHODS: Twenty-eight older adults in a long-term care institution participated in person-to-person interviews using an ACP booklet, which included topics such as life review, healthy habits and behaviours, and end-of-life care issues and information. The discussions were recorded, and thematic analysis was used to analyse the qualitative data. The Standards for Reporting Qualitative Research (SRQR) checklist was followed. RESULTS: Three themes were identified. First, participants identified that ACP could help to ensure that they achieved their view of a "good death." Second, the process of ACP bought up difficult decisions that many participants expressed uncertainty about making. Third, participants' ability and willingness to plan for end of life were shaped by considerations about their family members' needs, views and potential role as their future carer. CONCLUSIONS: The ACP process involved not only personal ideas about good death but also families' concerns. Uncertainty and lack of information created difficult barriers. RELEVANCE TO CLINICAL PRACTICE: Healthcare professionals could address the concept of good death, deliver information for their concerns and promote communication with family members.

Internet-Delivered Cognitive Behavior Therapy for Young Taiwanese Female Nursing Students with Irritable Bowel Syndrome-A Cluster Randomized Controlled Trial.

Irritable Bowel Syndrome (IBS) is prevalent within the general population. Studies have shown that stress and anxiety co-exist with IBS. Young Taiwanese women commonly exhibit physical and psychological health problems caused by academic stress. The purpose of our current study was to evaluate the efficacy of short-term Internet-delivered cognitive-behavioral therapy (ICBT) on female nursing students in practicum. We performed a cluster randomized controlled trial comprised of 160 participants who met the inclusion criteria, which were divided into three groups: (1) ICBT, (2) expressive writing (EW), and (3) wait-list control. Treatment interventions lasted for 6 weeks. Levels of anxiety, depression, and IBS symptoms were assessed at four time points, baseline assessment at T0, 2 weeks after T0 (T1), at the end of practicum (T2), and at 3-month follow-up (T3). The results showed that ICBT and EW groups exhibited a significant, yet small, reduction in anxiety and depression at T2 and T3 compared to the wait-list control group. The EW group exhibited significantly greater reduction in anxiety and depression compared to the ICBT group at T2. However, the ICBT group demonstrated greater improvements in alleviating anxiety and depression at T3 compared to the EW group. These data indicate that ICBT and EW groups exhibited small effects on anxiety and depression reduction at T2 and T3 compared to the wait-list control group, with no effects on IBS symptoms in young Taiwanese female nursing students.

Prevalence of incontinence among cognitively impaired older residents in long-term care facilities in East Asia: A cross-sectional study.

AIM: The current study was an international cross-sectional study comparing the prevalence of incontinence among cognitively impaired older residents in long-term care facilities in East Asia, including Japan, Korea, China, Taiwan and Thailand between 2015 and 2016. METHODS: Participants were cognitively impaired older residents in long-term care facilities. Demographic data were collected. The Clinical Dementia Rating scale was used to assess dementia severity, and the Barthel Index was used as a surrogate measure of incontinence and toilet use dependence. The prevalence of urinary incontinence and fecal incontinence were examined. Multiple logistic regression analysis was used to predict incontinence and toilet use dependence. RESULTS: We analyzed data from 662 participants (age 82.6 ± 9.9 years, 57.6% women). The prevalence of urinary incontinence ranged from 10.1% in Taiwan to 71.0% in Korea. The prevalence of fecal incontinence varied from 4.0% in Taiwan to 57.0% in Korea. A higher Clinical Dementia Rating score was a significant predictor of urinary and fecal incontinence and toilet use dependence (P < 0.0001). CONCLUSIONS: The current survey showed a high prevalence of incontinence in long-term care residents in East Asia, and identified challenges for future studies. Development of clinical guidelines for incontinence care in cognitively impaired older persons is urgently required. Geriatr Gerontol Int 2019; 19: 444-450.

Variations and factors associated with psychotropic use in cognitively impaired elderly residing in long-term care facilities in East Asia: a cross-sectional study.

BACKGROUND: The aim of this cross-sectional study was to compare patterns of psychotropic prescription drug use among cognitively impaired residents in long-term care facilities in East Asia and to explore factors associated with these patterns. METHODS: This study included elderly participants with cognitive impairments residing in long-term care facilities with and without dementia care units in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, the Clinical Dementia Rating, and the Neuropsychiatric Inventory, Nursing Home version were used to assess cognitive status, examine dementia severity, and evaluate behavioural psychological symptoms of dementia, respectively. The rate of psychotropic drug use and the relationship between the number of psychotropic drugs and clinical factors were examined. RESULTS: In total, 662 people were analyzed. Facilities with dementia care units had a higher rate of anti-dementia drug use than regular elderly care sites. Among the three dementia care sites, a Japanese hospital and a Korean site had a high rate of antipsychotic use and use of other types of psychotropics, whereas these drugs were used at a low rate in a Chinese nursing home. Patterns of psychotropic drug use may be partially associated with local regulations and facility type. Poly-pharmacy was identified as a common problem at all study sites. CONCLUSIONS: Our findings will be beneficial for health-care professionals and policymakers when developing practice guidelines and strategies to regulate overuse of psychotropics and poly-pharmacy. Prospective studies are needed to examine patterns of psychotropic prescriptions and to promote evidence-based practice.

Advance Care Planning Program and the Knowledge and Attitude Concerning Palliative Care.

OBJECTIVES: The study aimed to evaluate the effects of an advance care planning (ACP) program on knowledge and attitudes concerning palliative care, and decisions regarding DNR orders in the older residents in a long-term care institution. METHODS: A quasi-experimental design was used. Participants were cognitively unimpaired older residents in a long-term care institution in Taiwan. The experimental group (n = 29) received the intervention including an individual interview using an ACP handbook and a group patient education; whereas the control group (n = 28) received the group patient education only. RESULTS: There were significant positive effects of the ACP program on understanding of DNR and palliative care, willingness to sign a DNR order, and knowledge of and attitude towards palliative care; however, there was no significant effect on willingness to receive palliative care. Six participants signed the DNR order after the intervention compared to none in the control group. CONCLUSIONS: The ACP program can improve knowledge and attitudes towards palliative care in older residents in long-term care institutions. CLINICAL IMPLICATIONS: The ACP program could incorporate multiple components, including individual interview using ACP handbook and group patient education, and address knowledge and attitudes towards palliative care.

Prevalence of behavioural and psychological symptoms of dementia in cognitively impaired elderly residents of long-term care facilities in East Asia: a cross-sectional study.

OBJECTIVE: The aim of this study was to compare the prevalence of behavioural and psychological symptoms of dementia (BPSD) in cognitively impaired elderly residents of long-term care facilities in East Asia and to explore the factors associated with these patterns. METHODS: This was a cross-sectional survey of BPSD in cognitively impaired elderly residents of long-term care facilities in Japan, South Korea, China, Taiwan, and Thailand. The Mini-Mental State Examination, Clinical Dementia Rating (CDR), and Neuropsychiatric Inventory, Nursing Home version (NPI-NH), were used to assess cognitive status, dementia severity, and BPSD, respectively. NPI-NH subscale severity scores were multiplied by frequency scores to obtain the subscale scores and aggregated into two groups based on score (clinically insignificant = 1- 3; clinically significant ≥4). RESULTS: Data from 662 people were analyzed. Median age, median Mini-Mental State Examination scores, and median CDR scores differed significantly among the seven study sites. The prevalence of BPSD varied from 64% in Taiwan to 100% in dementia care units in Japan, and the median total NPI-NH scores ranged from 2 in Taiwan to 14 in dementia care units in Japan. After stratification of the sample by dementia severity and clinical significance of NPI-NH scores, differences in the prevalence of clinically significant BPSD were mostly observed among facilities dedicated to dementia patients in the CDR 1 group. In the CDR 3 group, the prevalence of some clinically significant BPSD, such as apathy, was high even among study sites with low median total NPI-NH scores. CONCLUSIONS: Our findings may suggest referral and selection biases in the study sites. Future prospective studies are needed to address the impact of environmental and care factors on the occurrence of BPSD in Asian countries.

An Investigation of the Factors Related to Low Parent-Adolescent Attachment Security in Taiwan.

BACKGROUND: Adolescence may involve increases in many behavioral problems and psychosocial maladaptation. Adolescents must successfully cope with these challenges to achieve positive developmental milestones. OBJECTIVES: To investigate whether low parental attachment security among adolescents in Taiwan is associated with their demographic characteristics, psychosocial maladaptation, and depression. DESIGN: A cross-sectional survey. A total of 335 adolescents completed the questionnaires. The Inventory of Parent and Peer Attachment, the Chinese version of the Youth Self-Report, and the Beck Depression Inventory-II were used to survey the participants. Correlation and multiple linear regressions, using low attachment security as the response variable, were used in the statistical analysis. RESULTS: The prevalence of Taiwanese adolescents with low parental attachment security was 38.5%. Low parental attachment security in adolescents was significantly associated with parental remarriage status and psychosocial maladaptation. CONCLUSIONS: By considering these risk factors, nursing educators and nurses could develop effective interventions to strengthen parent-adolescent attachment security.

Vascular burden and brain aging in a senior volunteer cohort: A pilot study.

OBJECTIVE: To test the feasibility of establishing a senior volunteer cohort and describe vascular risks, cognitive function, and brain aging indices in a pilot study. MATERIALS AND METHODS: We enrolled 40 senior volunteers from the Tzu Chi Foundation and other organizations in Hualien in 2014-2015. We conducted in-person interviews to collect information on demographic features, physical fitness, dietary habits, comorbidities, and narratives of aging. Vascular risks including blood pressure, body mass index (BMI), serum glucose level, and lipid profile were examined. Each participant underwent a comprehensive battery of neuropsychological tests and structural brain magnetic resonance imaging (MRI). Descriptive statistics and tabulation were applied to characterize this pilot cohort. RESULTS: There were more volunteers from the Tzu Chi Foundation (n = 25) than other organizations. The mean age was 66.7 years (standard deviation = 5.1) and there was a female predominance (M:F = 13:27). The mean number of comorbid chronic diseases was 2.1 and the mean BMI was 24.5. Most participants (77.5%) engaged in outdoor walking activities every week. Nutrient intake in vegetarians (n = 18) did not differ from nonvegetarians except for lower Vitamin B12 levels (mean = 0.9 µg). All participants but one scored 26 or above in the Mini-Mental State Examination (mean = 28.4). Among the other cognitive tests, only one task related to inhibition and switching abilities was at the low average level. The mean values of vascular risk markers were within the normal ranges. The most common genotype of apolipoprotein E was ɛ3/ɛ3 (n = 32). The quality of MRI was sufficient for volumetric analysis. CONCLUSION: It is feasible to establish a volunteer-based cohort to study brain aging in Taiwan. The senior volunteers were physically active and cognitively healthy. Vascular risks were well distributed among these participants. Future longitudinal study will allow us to observe changes in these markers over time and provide dynamic evidence about vascular health and cognitive aging.

Cardiac-diabetes self-management program for Australians and Taiwanese: A randomized blocked design study.

Cardiac disease and type 2 diabetes are prevalent diseases globally. Cardiac rehabilitation and diabetes self-management programs empower patients' self-management to improve their health outcomes. However, inappropriate delivery modes and continuing low participation rates indicate some programs are less than optimal. A previous study demonstrated the feasibility of incorporating telephone and text messages into a cardiac-diabetes self-management program in Australia; however, the program did not specifically address patients' cultural backgrounds. This current study used a randomized blocked design to evaluate short-term efficacy of the cardiac-diabetes self-management program incorporating telephone and text-messaging across different cultural contexts in Australia and Taiwan in comparison to usual care. No significant differences between groups were observed for outcomes of self-care behavior, self efficacy, knowledge and health-related quality of life, with patients in both groups demonstrating improvements. Patient-reported outcomes indicated some evidence of an interaction effect between country of origin and group allocation. Findings indicated an improved tendency of outcome measures between the baseline and follow-up assessments within usual care and intervention groups. Further research is required to clarify components of the program work for each cultural group.

Meditative music listening to reduce state anxiety in patients during the uptake phase before positron emission tomography (PET) scans.

OBJECTIVE: This study examines the effects of listening to meditative music on state anxiety and heart rate variability (HRV) of patients during the uptake phase before positron emission tomography (PET) scans. METHODS: A two-group randomized experimental design was used. Eligible patients were randomly assigned to either the experimental or control group. All patients received baseline assessments of state anxiety using Spielberger State-Trait Anxiety Inventory (STAI-S) and HRV before receiving an intravenous injection of radiopharmaceutical fluorine-18 fludeoxyglucose in the uptake room. The experimental group (n = 35) listened individually to 30 min of meditative music, integrating Chinese "Chi" and western frequency resonation in the uptake room. The control group (n = 37) lay on bed quietly for 40 min in the uptake room without music. All patients were assessed for their anxiety level and HRV again, before receiving PET scanning as post-test. RESULTS: The results indicated that patients in the experimental group showed a significant reduction in state anxiety and heart rate, and increase on high frequency norm of HRV (p < 0.001). There was a statistically significant reduction on anxiety level (p < 0.001), heart rate (p < 0.001) and high frequency norm (p = 0.001) in the experimental group compared with those of the control group. CONCLUSION: Listening to meditative music as a non-invasive and cost-effective strategy can help maximize efforts to promote comfort and relaxation for patients awaiting stressful procedures, such as PET scans. Meditative music can be effective in alleviating state anxiety of patients during the uptake phase before PET scans. Advances in knowledge: The study provides scientific evidence of the effects of listening to meditative music for reducing state anxiety in patients during the uptake phase before PET scans. It may have the potential to lower the risk of unwanted false-positive fluorine-18 fludeoxyglucose uptake in normal organs and to further improve image quality and image interpretation. Listening to meditative music is a safe and inexpensive intervention which can be incorporated into routine procedures to reduce anxiety of patients undergoing PET scans.