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Cognitive impairment is common in lung cancer patients and impacts their quality of life. Little is known about the etiology of cognitive impairment in lung cancer patients. However, the associated factors of cognitive impairment among lung cancer patients have not been systematically reviewed. This review aimed to summarize the factors related to cognitive impairment among lung cancer patients. PubMed, EMBASE, PsycINFO, CINAHL Plus, and Web of Science were searched to retrieve articles published from data inception until January 21, 2024, focusing on factors associated with cognitive impairment among lung cancer patients. Critical appraisal was undertaken by two reviewers independently using the Newcastle–Ottawa Scale. A total of 17 observational studies were included. The results showed that 20 factors are associated with cognitive impairment, including psychological factors (loneliness, fatigue, anxiety, depression, high symptom burden, and baseline cognitive impairment), lifestyle and functional factors (daily step counts, smoking, and activities of daily living or instrumental activities of daily living impairments), medical treatment factors (cranial irradiation, chemotherapy, lobar resection, postoperative delirium, and on medication), and neuroimmunological factors (have neuronal autoantibodies, altered Default Mode Network connectivity, dysregulation in glutamate and glutamate metabolism, mitochondrial dysfunction, blood-brain barrier leakage, and reduced T-lymphocytes). This is the first study to systematically review 20 factors associated with cognitive impairment among lung cancer patients, encompassing psychology, lifestyle and functional, medical treatment, and neuroimmunological factors. These findings can help clinicians identify at-risk patients and develop evidence-based interventions to prevent cognitive impairment among lung cancer patients. • We identified 20 factors and categorized them into four categories. • Anxiety is the most common issue among the 20 factors. • Early assessment by nurses to identify at-risk patients is necessary. • Targeted interventions to prevent cognitive impairment need to be developed. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility and potential effects of qigong Baduanjin for reversing frailty status among older cancer survivors. Twenty-eight older cancer survivors screened as pre-frail or frail were recruited. They were randomly assigned (1:1) to receive a sixteen-week Baduanjin intervention or an active control condition (light flexibility exercise). Frailty status (primary outcome) and secondary outcomes (physical performance, activities of daily living performance, psychological well-being, and health-related quality of life) were measured by physical performance tests and questionnaires. Qualitative interviews were conducted to explore participants' perspectives on the intervention. Twenty-one participants (75%) completed the study, with reasons of withdrawal mainly relating to the COVID-19 pandemic. Attendance at Baduanjin sessions and adherence to self-practice were satisfactory, with all retained participants attending all sessions and 81.8% practicing Baduanjin for more than 90 min per week. Qualitative findings demonstrated that participants accepted Baduanjin. The proportion of improvement in frailty status at post-intervention appeared to be higher in the intervention group (26.7%; 95% confidence interval [CI], 10.1% to 54.0%) than the control group (15.4%; 95% CI, 3.7% to 46.0%); yet the difference was not statistically significant (p = 0.461). Baduanjin qigong appears to be feasible and acceptable among older cancer survivors. To confirm the intervention effect, an adequately powered trial is warranted. ClinicalTrials.gov, NCT04694066. Retrospectively registered 5 January 2021, https://clinicaltrials.gov/ct2/show/NCT04694066. [ABSTRACT FROM AUTHOR]

To assess exercise levels and exercise counselling /programming preferences among older cancer survivors. A mixed-methods study design was employed. Quantitative instruments on exercise levels, exercise counselling and programming preferences, frailty status, and cancer-related symptoms were administered to 290 post-treatment older cancer survivors aged ≥65. Twelve participants with different exercise levels and different views on exercise counselling and programming were purposively selected to participate in semi-structured interviews. Overall, 58.3% of participants did not meet the recommended exercise guidelines, and 44.1% were not engaging in any vigorous or moderate exercise. Frail survivors were less likely to meet the guidelines (aOR = 0.194, 95%CI = 0.053, 0.712) compared to their robust counterparts. However, 66.9% and 62.8% of participants expressed a definite or possible interest in receiving exercise counselling and participating in an exercise program, respectively. Particularly, survivors who are male, did not receive chemotherapy, are less educated, and have higher symptom burden were less likely to show interest. Most preferred low-intensity exercise (59.8%) and wanted to start the exercise program after treatment (68.2%), which differs from the literature on general adult survivors. The major trigger to initiate and maintain exercise behaviors was the benefits of exercise and a common barrier to exercising was lack of time. Most older cancer survivors did not meet the recommended exercise guidelines, but they were open to exercise counselling and programming. Reviewing education on the benefits of exercise is especially important after treatment completion to promote healthy lifestyles. [ABSTRACT FROM AUTHOR]

To examine the diagnostic performance of the FRAIL Scale for frailty screening with reference to the Fried phenotype and investigate its association with health outcomes in older cancer survivors. In this cross-sectional quantitative study, participants were post-treatment cancer survivors aged 65 or above. Measurements included the FRAIL Scale, Fried phenotype, Geriatric Depression Scale-15 item, Modified Barthel Inventory, and EORTC Core Quality of Life Questionnaire. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of the FRAIL Scale with reference to the Fried phenotype. Health outcomes associated with being frail as estimated by the FRAIL Scale and Fried phenotype were also examined using regressions. Based on 293 older cancer survivors, the area under curve (AUC) of the FRAIL Scale was 0.79, and the optimal cut-off of 1 yielded a sensitivity of 92% and specificity of 41%. According to regression results, the FRAIL Scale was modified by adding an item on time since cancer treatment completion (AUC = 0.81), and using a cut-off of 2 for older cancer survivors, which yielded a sensitivity of 74% and specificity of 67%. The modified FRAIL Scale was associated with depressive symptoms, functional independence, fatigue, dyspnea, physical functioning, and role functioning. The modified FRAIL Scale is proposed for use in older cancer survivors, and a cut-off of 2 should be used. The modified FRAIL Scale can serve as a brief screening tool for identifying frailty among older cancer survivors in practice. [ABSTRACT FROM AUTHOR]

This study aimed (1) to estimate the prevalence of cognitive frailty, (2) to identify factors associated with cognitive frailty and (3) to examine the association of cognitive frailty with health-related quality of life (HRQOL) in older cancer survivors. This was a cross-sectional study. Participants were aged 65 or above, diagnosed with cancer and had completed cancer treatment. Measures on physical frailty, cognitive functioning and HRQOL were administered. Multiple linear regression models were used to examine the association of cognitive frailty with HRQOL. Among 293 recruited participants, 18.8% had a cognitive functioning decline, 8.9% were physically frail and 8.2% were cognitively frail. Regular exercise (OR = 0.383, p =.035) and shorter time since treatment completion were associated with less likelihood of cognitive frailty (OR = 1.004, p =.045). Cognitive frailty was significantly associated with global health status (β = −0.116; p =.044), physical functioning (β = −0.177; p =.002), social functioning (β = −0.123; p =.035) and fatigue symptoms (β = 0.212; p <.001) after adjusting for potential confounding variables. Cognitive frailty, found in 8.2% of older cancer survivors, is associated with various dimensions of HRQOL. Longitudinal research examining the trajectory and impact of cognitive frailty on more diverse health outcomes in older cancer survivors is warranted. The findings improve service providers' knowledge of cognitive frailty in older cancer survivors and inform surveillance and care for geriatric cancer survivorship. • Studies that examine the prevalencve of cognitive frailty and its associated outcomes in older cancer survivors are scarce. • Cognitive frailty was associated with global health status, physical functioning, social functioning and fatigue symptoms. • Prevalences of cognitive functioning decline, physical frailty, cognitive frailty were 18.8%, 8.9%, and 8.2, respectively. [ABSTRACT FROM AUTHOR]

This review aimed to determine whether walking is more effective than yoga at improving sleep disturbance in cancer patients. A systematic search of randomized controlled trials was performed in the PubMed, EMBASE, CINAHL, Cochrane Library, CNKI, Airiti Library, and other health-related databases. Twenty-five studies were identified with a total of 1918 participants. The Pittsburgh sleep quality index was the most commonly used outcome measurement tool, and moderate-intensity walking was the most frequently used intervention. The majority of the included subjects were breast cancer patients. Overall, walking significantly improved sleep disturbance compared to yoga (p = 0.01). Statistically significant moderators included adherence rate for walking (p < 0.001) and allocation concealment and outcome measurement tool for yoga (p = 0.04; p = 0.03). We concluded that walking is more effective than yoga in improving sleep disturbance in cancer patients. Thus, moderate-intensity walking is recommended for cancer patients with sleep disturbance. [ABSTRACT FROM AUTHOR]

The authors sought to 1) review the literature on the remote care model that uses remote patient monitoring software (RPMS) as key mechanisms in oncology care for symptom tracking and health information provision and (2) compare the remote care model to standard care in terms of health-related quality of life, symptom burden, health management self-efficacy, anxiety, and depression. The search was conducted on March 23, 2022, in the Cochrane Library, MEDLINE/PubMed, PsycINFO, and CINAHL databases. The primary strategies for applying digital technology in remote care models are patient-reported outcomes (PRO) tracking and health information delivery. Common PRO measurements applied in the RPMS include quality of life, symptom burden, self-efficacy, anxiety, and depression. Nine randomized controlled trials testing seven RPMS interventions were examined. Compared to standard care, remote patient monitoring via RPMS was related to greater quality of life and lower physical symptom burden during cancer therapy. The RPMS incorporated into routine clinical care with nurses providing remote monitoring performed better on PRO than that not integrated. The RPMS-based remote care model improves patient outcomes during cancer treatment, and it is not inferior to standard care until the RPMS function is more integrated with existing clinical care. Nurses are well-positioned to engage patients in self-care skills via RPMS and can play a vital role in integrating such a model of remote patient care into routine care practices. [ABSTRACT FROM AUTHOR]

Weight loss is highly prevalent in oesophageal cancer survivors, who often experience disease-related or treatment-related symptoms and quality of life (QoL) impairment. This study aimed to explore the relationships among weight loss, symptom distress, and QoL postoperatively in patients with oesophageal cancer undergoing chemotherapy and to identify the factors influencing the QoL. We conducted a retrospective observational study with 101 patients and collected data on weight loss (percentage of total body mass loss), QoL (EORTC-QLQ-C30 and EORTC-QLQ-OES-18), and symptom distress (MDASI-GI-C). The associations among weight loss, QoL, and symptom distress were assessed using Pearson's correlation. Multiple linear regression analysis was used to identify independent factors influencing patients' QoL scores. The distribution of weight loss of each stage in survivors of oesophageal cancer was 1.00% (SD: 2.48%), 4.69% (SD: 4.73%), 1.66% (SD: 5.37%), 2.83% (SD: 4.89%) respectively. The mean QoL score was 66.24 (SD 18.65). The participants' mean symptom severity and symptom interference scores were 3.30 (SD 1.74) and 2.76 (SD 1.90), respectively. Weight loss and symptom distress were negatively related to patients' QoL (p < 0.05, p < 0.01, respectively). Weight loss between 6 months before diagnosis and the time of diagnosis (p < 0.05) and symptom interference (p < 0.01) were independent predictors for the QoL. This study suggests that oesophageal cancer survivors with larger weight reduction between 6 months before diagnosis and the time of diagnosis and more symptom distress have a worse QoL. Clinicians should focus more on patients' weight and symptom management to improve their QoL. • Oesophageal cancer survivors experience weight loss constantly along with treatment. • Patients with larger weight loss before diagnosis and those with more symptom interference have worse quality of life (QoL). • Attention should be paid to patients' weight management, social function, financial difficulties, fatigue, and dysphagia. [ABSTRACT FROM AUTHOR]

Purpose After being diagnosed with lung cancer, patients often experience sleep disturbance, anxiety, depression, and fatigue. These symptoms may occur because of changes in neurotransmitter secretion caused by tumors. This study investigated the correlation of cortisol and melatonin rhythms with sleep quality, anxiety, depression, and fatigue levels in patients with newly diagnosed lung cancer. Method We conducted a case–control study and recruited 40 patients with newly diagnosed lung cancer and 40 healthy adults. Results The patient group had a lower salivary melatonin level and flatter slope ( p < 0.001 and p < 0.001), higher salivary cortisol level and steeper slope ( p < 0.001 and p < 0.001), higher sleep disturbance level ( p = 0.004), and higher depression level ( p < 0.001). The multivariate linear regression analysis indicated that the cortisol slope ( p = 0.005) and fatigue score ( p = 0.032) predicted the sleep quality score ( p = 0.011). Conclusion Overall, the patients with newly diagnosed lung cancer had poorer sleep quality, higher depression levels, lower salivary melatonin levels, higher cortisol levels, and flatter melatonin and cortisol slopes than did the controls. The fatigue level and cortisol slope significantly predicted sleep quality. Therefore, the assessment of cortisol and melatonin rhythms and levels could provide crucial information that may be beneficial for managing symptoms in patients with newly diagnosed lung cancer. [ABSTRACT FROM AUTHOR]

Both clinical and cultural competencies are of paramount importance in ensuring patients' safety and high-quality care. While problem-based learning (PBL) is a widely applied pedagogy in nursing education, an emerging technology-based pedagogy, virtual simulation provides a realistic clinical learning experience for students. It can be an effective solution for continuing clinical and cultural learning across countries in the era of the pandemic. This study aimed to compare the effectiveness of virtual simulation and PBL on the perceived clinical and cultural competence for nursing students. A randomized controlled cross-over study design was used. Sixty-one undergraduate and postgraduate nursing students from five Asian regions were selected for participation. Participants were randomized to receive either virtual simulation (group A) or PBL (group B) for one day, followed by another intervention on the second day. Three self-reported questionnaires were used: Clinical Competence Questionnaire (CCQ), Inventory for Assessing the Process of Cultural Competence among Healthcare Professionals-Student Version (IAPCC-SV), and demographic questionnaire. The results revealed that students in both arms had significant improvements in CCQ total score (A: d = 21.500, P < 0.001; B: d = 16.710, P = 0.001), nursing professional behavior (A: d = 8.233, P < 0.001; B: d = 6.323, P < 0.001), and advanced nursing skills (A: d = 2.533, P = 0.008; B: d = 2.129, P = 0.029) after two interventions. In addition, both arms demonstrated significant improvements in IAPCC-SV total score (A: d = 3.467, P = 0.037; B: d = 4.032, P = 0.010) and cultural skills (A: d = 0.767, P = 0.012; B: d = 1.000, P = 0.001). No significant differences were observed between the two arms. The findings indicated that both virtual simulation and PBL were effective in promoting students' perceived clinical and cultural competence. As both education modes have their own uniqueness and effectiveness in both outcomes, the combination of both could enhance the variability of learning modalities. Notably, the use of virtual simulation first could engage students better in learning and achieve better educational outcomes. • Clinical and cultural competence are key factors in promoting patient outcomes. • Both virtual simulation and problem-based learning showed beneficial effects on perceived clinical and cultural competence. • Future nursing education could adopt virtual simulation first to engage students better in learning. [ABSTRACT FROM AUTHOR]

With the rapidly aging population, the quality of end-of-life (EOL) care has become a significant issue. As the majority of deaths in Hong Kong (HK) currently occur in public hospitals, promoting palliative home care can relieve hospital burden and provide good deaths. There is a practical need to properly educate and train nurses on the skills to provide EOL care in home care settings. To evaluate the effect of the first EOL care training program for nurses working in home care settings or nursing homes on quality of life at work, orientation toward dying and death, and self-competence in death work. A pre-experimental research design was utilized to conduct this study using a one-group pretest and posttest approach. A convenience sample of 153 nurses working in home care settings or nursing homes in HK was selected. Participating nurses attended two-day entry-level and seven-day advanced-level courses. Quality of life at work, multidimensional orientation toward dying and death, and self-competence in death work were assessed using questionnaires at baseline and immediately after entry- and advanced-level training. The results revealed that nurses reported a higher level of compassion satisfaction (d = 2.52, p < 0.001), less burnout at work (d = −3.25, p = 0.045), less fear about their own death (d = −1.33, p = 0.019), and more acceptance of others' deaths (d = 1.07, p = 0.004) in post-advanced-level courses. In general, participants were satisfied with the delivery method, duration, and logistical arrangement of the courses. Nurses reported improved professional quality of life, less fear, and more acceptance toward death and dying after the training program. More educational strategies, such as role-play and case study discussions, are needed to improve the overall learning experience and effectiveness of the program. Future studies could add a qualitative component to yield deeper insights through the findings. As training programs allow nurses to cultivate their skills in clinical situations, there is an undeniable need to continue implementing standardized education and training for palliative care nurses to improve EOL care quality. • EOL care training can improve the quality of life toward death among nurses. • EOL care training can reduce fear toward death and dying among nurses. • EOL care training can increase acceptance levels toward death among nurses. • Cultivating and developing specific home-based EOL care skills is important. • Educational strategies can enhance nurses' overall learning experiences. [ABSTRACT FROM AUTHOR]

Purpose of the research Pain and sleep disturbance have been shown to have a profound influence on the outcomes of cancer treatment. This study sought to determine whether administering opioid analgesics or sleeping medication to cancer patients during their first admission to a hospital is associated with poor prognoses. Methods and sample We conducted a population-based retrospective cohort study by analyzing data obtained from the National Health Insurance Research Database in Taiwan. The study population comprised cancer patients whose first admission to a hospital for initial cancer treatment was in 2004. Key results We collected data on 2302 cancer patients. To analyze the effect of opioid analgesic and sleeping medication usage on cancer patient survival, we compared the 3-year survival rates among 4 groups of patients (no use, sleeping medications–only, opioid analgesics–only, both used). The 3-year Kaplan–Meier plots for these 4 groups show that the difference was statistically significant (log rank 48.244, p < 0.001). The longevity of cancer patients was the greatest among the no–use group, followed by the sleeping medications–only group, then the opioid analgesics–only group, and finally, the group in which both sleeping medications and opioid analgesics were used. Conclusions The use of opioid analgesics or sleeping medication was shown to be negatively correlated with the survival rate of cancer patients. [ABSTRACT FROM AUTHOR]

Highlights: [•] Forms, sources and spatial extent of place attachments were assessed. [•] Sense of place was found to comprise affective, functional and cognitive forms. [•] Evidence was found for both spatially localized and generalized senses of place. [•] Localized affective and functional attachments had social and biophysical sources. [•] Generalized attachments were functional and cognitive with historic sources. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused extraordinary disruptions to education systems globally, forcing a rapid switch from conventional to online education. Although some qualitative studies have been carried out exploring the online education experiences of nursing students and faculty members during the COVID-19 pandemic, to our knowledge, no study has used the Photovoice approach. To explore the experiences of nursing students and faculty members as related to online education during the COVID-19 pandemic. A descriptive qualitative design using Photovoice was adopted. The study took place across five countries and one city in Southeast Asia (Indonesia, Malaysia, the Philippines, Thailand, Vietnam, and Hong Kong). Fifty-two nursing students and twenty-eight nursing faculty members who participated in online education during the COVID-19 pandemic. Each participant submitted one photo substantiated with written reflections. Data were analysed using thematic analysis. Ethical approval was obtained from institution-specific ethics boards. Three themes and eleven sub-themes emerged from the data. The three main themes were: 1) Psychological roadblocks to online education; 2) Developing resilience despite adversities; and 3) Online education: What worked and what did not. Through Photovoice, the reflections revealed that nursing students and faculty members were generally overwhelmed with the online education experience. At the same time, participants were satisfied with the flexibility and convenience, opportunities for professional and personal development and safety afforded by online education. However, concerns over academic integrity, practical skills and clinical competencies, engagement and participation, the duality of technology and social isolation out-shadowed the advantages. It is worthwhile to explore the concerns raised to enhance online education across the nursing curriculum. • Existing literature on Photovoice to explore participants' experiences and perceptions during COVID-19 is limited. • Flexibility, convenience, safety, and opportunities for development were most appreciated by students and faculties. • Academic integrity, skills, competency, engagement, participation, technology duality and social isolation were important. • Institutions should consider a hybrid/blended learning approach to sustain learning progress and goals. • More studies triangulating the experiences of different stakeholders in the educational system is warranted. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected. The descriptive cross-sectional quantitative design was used. Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021. A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study. Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic. Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels. While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better. • COVID-19 has largely affected the lives of nursing students and faculty members. • Satisfaction with learning modalities was positively correlated with students' confidence in their nursing abilities. • Sense of coherence was positively correlated with mental well-being. • Experience of acute stress symptoms is correlated with lower sense of coherence. • Results suggest that having a stronger sense of coherence improves stress coping. [ABSTRACT FROM AUTHOR]

Background/Purpose: Individuals with mild-to-moderate dementia often exhibit depression and apathy as manifested by symptoms of negative affect. The purpose of this study was to determine whether or not reminiscence group therapy (RGT) reduces depression and improves symptoms of apathy. Methods: The study was one of experimental design with a pre-post control group; 61 residents from two nursing homes were randomly distributed into two parallel groups. An RGT program consisting of 12 sessions, 40-50 minutes per week, was implemented for the residents in the experimental (intervention) group. The instruments used to collect data included the Clinical Dementia Rating Scale, the Geriatric Depression Scale, the Apathy Evaluation Scale, and the Neuropsychiatric Inventory. Statistical analysis was performed with SPSS 15.0. Results: After 12 sessions, the residents in the intervention group reported a reduction in depressed mood (Z = −2.99, p < 0.05), and showed specific improvements in their behavior score (Z = −3.10, p < 0.05) and cognition apathy score (Z = −1.95, p < 0.05). Neuropsychiatric I nventor y depression scores had also decreased (Z = −2.20, p < 0.05). Conclusion: RGT has significant efficacy in the treatment of depressed mood and apathy in patients with mild-to-moderate stage dementia. This non-pharmacological intervention reduced emotional distress among nursing home residents with dementia. [Copyright &y& Elsevier]

Background and Aim: No study has examined associations between physician volume or hospital volume and survival in patients with liver malignancies in the hepatitis B virus-endemic areas such as Taiwan. This study was to examine the effect of hospital and surgeon volume on 5-year survival and to determine whether hospital or surgeon volume is the stronger predictor in patients with hepatocellular carcinoma after hepatic resection in Taiwan.Methods: Using the 1997-1999 Taiwan National Health Insurance Research Database and the 1997-2004 Cause of Death Data File, we identified 2,799 patients who underwent hepatic resection and 1,836 deaths during the 5-year follow-up period. The Cox proportional hazard regressions were performed to adjust for patient demographics, comorbidity, physician, and hospital characteristics when assessing the association of hospital and surgeon volume with 5-year survival.Results: When we examined the effect of physician and hospital volumes separately, both physician and hospital volumes significantly predicted 5-year survival after adjusting for characteristics of patient, surgeon, and hospital. However, after we adjusted for characteristics of physician and hospital, only physician volume remained a significant predictor of the 5-year survival.Conclusions: Physician volume is a stronger predictor of 5-year survival in hepatocellular carcinoma patients receiving hepatic resection. [ABSTRACT FROM AUTHOR]

Abstract: Cancer patients often experience multiple symptoms concurrently, a phenomenon called symptom clustering. Different symptom clusters have been identified by various symptom assessment tools, as well as by different research methods, but no study has reported whether these identified symptom clusters can be replicated in a new sample. The severity of nine symptoms in 321 cancer patients was assessed using a Taiwanese version of the M.D. Anderson Symptom Inventory. The fit between these data and a model with three symptom factors (sickness, gastrointestinal, and emotional) was evaluated using confirmatory factor analysis. Most fitness indices demonstrated a satisfactory fit between the data and a prespecified three-factor model except one; the root mean square error of approximation was <0.06. A modified model with one symptom (lack of appetite) double loaded in the sickness and gastrointestinal factors demonstrated a significantly better fit between the data and the model. Higher scores in each of the three symptom factors were associated with poorer functional status. Metastatic disease and receiving both chemotherapy and radiation therapy were associated with higher scores in sickness and gastrointestinal factors, but not in the emotional factor. Only hospitalization affected patients'' scores in emotional factors. Our findings confirmed the prespecified structure of symptom clusters. A modified model showed a better fit. Patients'' complex symptom experience may be better represented by subscale scores based on meaningful clusters rather than on an overall score across all symptoms. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to validate the Taiwanese version of the M. D. Anderson Symptom Inventory (MDASI-T) in a sample of 556 Taiwanese patients with multiple diagnoses of cancer. The internal consistency Cronbach alpha was 0.89 for symptom severity items and 0.94 for interference items. The test-retest reliability was 0.97 for the severity composite score and 0.96 for the interference composite score over a 3-day interval in a sample of 12 patients. Construct validity was established by factor analysis, which revealed a two-factor structure. Concurrent validity was examined by correlating the MADSI-T scores and scores of the Medical Outcome Study 36-Item Short-Form Health Survey. Known-group validity was established by comparing MDASI-T scores between patients having low functional status and those having high functional status (Karnofsky Performance Status scores ≤50 or >50, respectively) and between inpatients and outpatients. The MDASI-T''s sensitivity (its ability to detect small differences in reporting variations) was examined by comparing the MDASI-T composite symptom scores and composite interference scores before, during, and one week after treatment in a sample of 20 breast cancer patients receiving chemotherapy. The MDASI-T is a reliable, valid, and sensitive instrument for measuring the severity and interference with daily life of cancer-related symptoms among Taiwanese cancer patients. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to explore concerns about reporting pain and using analgesics and also to explore whether these concerns were related to the dosage of analgesics used among Taiwanese postoperative patients with pain. The three subscales receiving the highest scores on the BQT-S were time interval, tolerance, and injection. Patients who had hesitated to report pain had significantly higher scores on time interval, fear of tolerance, wound healing, fear of distracting one’s physician from treating the disease, a desire to be a good patient, fatalism, and the total BQT-S score than those patients who had not hesitated to report pain. Patients who had hesitated to take medications reported significantly higher scores on time interval, wound healing, fear of distracting one’s physician from treating the disease, a desire to be a good patient, fatalism, and the total BQT-S score than did those patients who had not hesitated to use analgesics. BQT-S scores were significant positively in relation to pain intensity and pain interference but were negatively related to dosage of analgesics used. Perspective: This study documented postoperative patient concerns about reporting pain and using analgesics and their impact on adequate management of postoperative pain. Education about pain management for patients and clinicians could be an effective intervention to improve the management of postoperative pain in Taiwan. [Copyright &y& Elsevier]

Abstract: We validated the Taiwanese version of the Brief Fatigue Inventory (BFI-T) in a sample of 439 Taiwanese patients with multiple cancer diagnoses. Internal consistency was indicated by Cronbach alphas of 0.96 for fatigue-related severity and 0.95 for interference. Test-retest reliability was 0.89 for fatigue severity and 0.91 for interference. Factor analysis revealed a one-factor structure. Convergent validity was examined by correlating the BFI-T worst fatigue and fatigue severity composite scores with POMS vigor and fatigue subscales scores. Known-group validity was established by comparing BFI-T worst fatigue and severity composite scores between patients with low functional status and high functional status and between inpatients and outpatients. The BFI-T''s sensitivity was examined by comparing BFI-T severity and interference composite scores before, during, and after chemotherapy treatment in a subsample of 20 breast cancer patients. The BFI-T is reliable, valid, and sensitive for measuring cancer-related fatigue severity and interference among Taiwanese cancer patients. [Copyright &y& Elsevier]

The purposes of this study were: 1) to compare performance status, mood states, and level of hope between patients with cancer pain and patients without cancer pain; and 2) to determine the relationships of pain intensity and pain interference with daily life to performance status, mood states, and level of hope. A total of 233 Taiwanese cancer patients with pain and 251 without pain participated. The self report instruments consisted of the Chinese version of the Profile of Mood States (POMS) short form, the Chinese version of the Herth Hope Index, the Brief Pain Inventory-Chinese version (BPI-C), the Chinese version of the Karnorfsy Performance Scale (KPS), and a demographic questionnaire. The major findings of this study were that cancer patients with pain reported significantly lower levels of performance status and higher levels of total mood disturbance than did cancer patients who did not experience pain after controlling for sex, disease stage, and recruitment site. In addition, patients with cancer pain experienced significantly more anger, fatigue, depression, confusion, and lethargy than did patients without pain after controlling for sex, disease stage, and recruitment site. Among patients with pain, pain intensity was significantly correlated with performance status and mood state, but not with level of hope. Pain interference with daily life was significantly correlated both with performance status, mood state, and level of hope. Pain intensity and pain interference were significantly correlated with each mood state as well as with total mood disturbance. This study has demonstrated the effect of cancer pain on patients'' physical, psychological, and spiritual life and has supported the multidimensional notion of the cancer pain experience in Taiwanese patients. [Copyright &y& Elsevier]

Dyspnea, a prevalent and debilitating symptom in patients with advanced lung cancer, negatively affects symptom burden and prognosis. Physical activity has emerged as a promising non-pharmacological intervention for managing dyspnea. This study compared the effectiveness of two widely-recognized physical activity modalities, namely Tai Chi (TC) and aerobic exercise (AE) for treating dyspnea in patients with advanced lung cancer. Patients with advanced lung cancer (n=226) were randomized into TC, AE, or control groups. There was no baseline dyspnea requirement for patients. The AE group received two 60-minute supervised sessions and home-based exercises per month, the TC group received 60-minute sessions twice weekly, and the control group received exercise guidelines for 16 weeks. The primary outcome (sleep quality) of the study has been previously reported. In this secondary analysis, we focused on dyspnea outcomes, including overall and lung cancer-specific dyspnea. Assessments were conducted at baseline (T0), 16 weeks (T1), and one year (T2). Compared to the control group, TC significantly improved overall dyspnea at T1 (between-group difference, −8.69; P =0.03) and T2 (between-group difference, −11.45; P =0.01), but not AE. Both AE (between-group difference, −11.04; P =0.01) and TC (between-group difference, −14.19; P <0.001) significantly alleviated lung cancer-specific dyspnea at T2 compared with the control group. Both TC and AE alleviate dyspnea severity in patients with advanced lung cancer, and continuous exercise can yield substantial improvements. Due to its multi-component nature, Tai Chi has a greater effect on dyspnea. [ABSTRACT FROM AUTHOR]

Exercise has promising effects on sleep disturbances and quality of life among cancer patients. Aerobic exercises (AE) and mind-body exercises (MBE) have different mechanisms for improving sleep, but whether they are effective remains unclear. This systematic review and meta-analysis is the first to examine the effectiveness of AE and MBE on sleep outcomes, specifically among cancer patients with sleep disturbances. A systematic search of several databases, from inception to January 2018, was conducted. The pooled effect sizes suggested that both AE (standardized mean difference (SMD) = 0.33, 95% confidence intervals (CI): 0.11, 0.54) and MBE (SMD = 0.18, 95% CI: 0.06, 0.30), improved sleep outcomes in cancer patients with poor sleep quality post-intervention. The effects remained significant after 3-6 months for AE, but not MBE. Due to the heterogeneity in AE, future studies should establish the optimal AE prescription. For MBE, future research should study essential components that make the intervention effect sustainable. [ABSTRACT FROM AUTHOR]

Making decisions regarding end-of-life care is particularly challenging for patients and their family caregivers. Studies have advocated that family involvement in advance care planning is important to provide goal-concordant care and to increase family caregivers' preparation for surrogate decision-making. However, there is a lack of evidence to examine the effectiveness of advance care planning using the patient-caregiver dyadic approach. To evaluate the effectiveness of dyadic advance care planning. A literature search was systematically carried out in 7 databases from inception to March 2023. All randomized controlled trials with advance care planning interventions for mentally competent adults and their family caregivers were included. Meta-analysis was conducted for available quantitative data related to end-of-life care; Otherwise, narrative syntheses were performed. In total, 14 randomized controlled trials were included. The main contents of all interventions were summarized into five categories, namely sharing illness experience and perception, introducing knowledge about advance care planning and end-of-life care, discussing individual's/dyads' values, goals, and care preferences, addressing dyads' discordance, and providing supports to complete advance care planning behaviors. The meta-analysis showed that dyadic advance care planning had significant effects on advance directive documentation (OR = 7.58, 95% CI [1.41, 40.63], P = 0.02) and proactive communication with doctors (OR = 2.42, 95% CI [1.42, 4.12], P = 0.001). In addition, interventions may improve dyad's congruence on end-of-life care, family caregivers' confidence in surrogate decision-making, and quality of end-of-life communication. This review supports that dyadic advance care planning is a promising approach to preparing patients and their family caregivers for end-of-life communication and decision-making. Given that this multifaceted process is influenced by multiple factors within the socio-cultural context, future studies are warranted to identify the barriers and facilitators to implement dyadic advance care planning in real-world settings. [ABSTRACT FROM AUTHOR]

To determine the association of palliative care for progressive neurologic diseases with patient- and caregiver-centered outcomes. Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies, including pilot studies. Adults with progressive neurologic diseases (dementia, multiple sclerosis, Parkinson's disease, motor neuron disease, multiple system atrophy, and progressive supranuclear palsy) and their caregivers. MEDLINE, EMBASE, CINAHL PLUS, Cochrane CENTRAL, and PubMed were searched from inception to September 2021. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tools. Narrative synthesis was conducted. Patient quality of life (QoL), symptom burden, caregiver burden, and satisfaction with care were meta-analyzed using a random-effects model. Fifteen trials provided data on 3431 patients (mean age, 73.9 years). Compared with usual care, palliative care was statistically significantly associated with lower symptom burden [standardized mean difference (SMD), −0.34 (95% Cl, −0.59 to −0.09)] and higher caregiver satisfaction [SMD, 0.41 (95% Cl, 0.12 to 0.71)] and patient satisfaction [SMD, 0.43 (95% Cl, −0.01 to 0.87)]. However, the associations were not significant after excluding studies with high risk of bias. Insignificant associations of palliative care with caregiver burden [SMD, −0.09 (95% Cl, −0.21 to 0.03)] and patient QoL [SMD, 0.19 (95% Cl, −0.07 to 0.44)] were observed. Palliative care is likely to improve symptom burden and satisfaction with care among patients with progressive neurologic diseases and their caregivers, while its effects on QoL and caregiver burden remains inconclusive. Specific intervention components including interdisciplinary team, palliative care physicians, home visits, and spiritual care appeared to be associated with increased effects on improving palliative outcomes. More rigorous designed studies are warranted to examine the effects of neuropalliative care, effective intervention components, optimal timing, and symptom triggers of palliative care referrals. [ABSTRACT FROM AUTHOR]

Abstract: Background: Sleep disturbance remains a common symptom among cancer patients. Assessment of sleep disturbance in cancer patients is hindered by infrequent use of standardized tools for sleep management. Objectives: The purposes of this study were to validate the Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-T) and to determine detection cut-off points in cancer patients. Design: A cross-sectional and descriptive correlational design. Participants: A sample of 205 Taiwanese patients with various cancer diagnoses. Methods: The survey included the Pittsburgh Sleep Quality Index-Taiwanese version, the MD Anderson Symptom Inventory-Taiwanese version, the Brief Fatigue Inventory-Taiwanese version, the seven-day sleep log, and Manual of Mental Disorders, Fourth Edition. Results: The internal consistency Cronbach''s alpha for the PSQI was 0.79. Test–retest reliability was 0.91 for the global score over a 20- to 28-day interval in a sample of 16 patients. Construct validity was established by a significant relationship of the PSQI-T global score to the total symptom severity score and the fatigue severity score. Convergent validity was examined by correlating the PSQI-T scores and scores of the DSM-IV and scores on the seven-day sleep log. Known-group validity was established by comparing PSQI-T scores for patients having low fatigue levels and those having high fatigue levels. Receiver-operating characteristic (ROC) curves were used to determine the detection cut-off points. Conclusions: We found that a PSQI-T global score of 8 generates the best sensitivity and specificity for measuring sleep disturbance in cancer patients. The PSQI-T is a reliable, valid, and sensitive instrument for measuring sleep quality among Taiwanese cancer patients. [Copyright &y& Elsevier]

Abstract: Background: A comprehensive assessment of patient hesitancy to use analgesics and accurate knowledge related to the promotion of analgesic adherence is necessary for effective pain management. Unfortunately, there has been a lack of a short and concise questionnaire to assess patients’ hesitancy to use analgesics in clinical practice. Objective: This paper is a report of the development and psychometric properties of the short version of the Barriers Questionnaire-Taiwan form (S-BQT). Design: This study employed a descriptive design. Setting: A convenience sample was recruited from oncology clinics at two medical centers in Taiwan. Participants: One hundred and eighty-three (N =183) patients receiving analgesics for cancer pain participated in the study. Methods: Instruments included the Barriers Questionnaire-Taiwan form (BQT), the Taiwanese version of the Morisky Medication Adherence Measure-Taiwan form (MMAM-T). Two self-administered questionnaires were performed at the same time, and the ratio of analgesic usage was computed over a two-week period. Reliability was established by calculating Cronbach''s α and test–retest reliability. The validity was estimated by construct validity, criterion-related validity, and known group validity. Results: To develop the S-BQT, we used reliability analysis to extract nine items from nine subscales. Internal consistency of the S-BQT was indicated by a Cronbach''s alphas score of 0.86. Test–retest reliability was assessed as 0.83 over a two-week interval. Factor analysis revealed two factor structures. Criterion-related validity was examined by correlating the S-BQT score, and MMAM-T score, and the ratio of analgesic use. Known group validity was examined by comparing the S-BQT scores of patients with hesitancy to report pain and take analgesics vs. patients demonstrating no such hesitancy in the previous week. Known group validity was also established by comparing the S-BQT scores among patients with low, moderate, and high adherence to the usage of medication. Conclusions: The S-BQT shows excellent reliability and validity. The use of this instrument can help to improve communication between patients and clinicians regarding the use of analgesics in the management of pain. [Copyright &y& Elsevier]

Abstract: Context: It is well known that insomnia is highly prevalent in cancer patients. Although various studies have used the Athens Insomnia Scale (AIS) for insomnia assessment, it has never been applied to cancer patients with insomnia. Objectives: The purpose of this study was to establish the reliability and validity of the Taiwanese AIS version (AIS-T) and evaluate the severity of insomnia among cancer patients in Taiwan. Methods: Using a cross-sectional research design, 195 cancer patients (n =195) were recruited from outpatient oncology clinics. Results: Cronbach’s alpha for internal consistency was 0.83, and the test-retest reliability was 0.94 over an interval of three days, based on a sample of 30 patients. Moreover, concurrent validity could be evaluated by significant correlations of the AIS-T with the Pittsburgh Sleep Quality Index-Taiwan form (PSQI-T) (r =0.82, P <0.001) and sleep efficiency measured by Actiwatch parameters (r =−0.54, P <0.001). Construct validity could be established by the Brief Fatigue Inventory-Taiwan form (r =0.56, P <0.001) and Medical Outcomes Study Short Form-36-Taiwanese version (physical component summary: r =−0.52, P <0.001; mental component summary: r =−0.53, P <0.001). The AIS-T could detect significant known-group validity from sleep quality (PSQI-T ≥5 or <5, respectively). The Actiwatch parameters are consistent with the results of the AIS-T, and both data sets indicate that patients experienced sleep disturbances. The prevalence of insomnia, as defined by the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th ed., was 22.56%; 49.2% subjects had significant insomnia at the score ≥6 at AIS-T. Conclusion: This study concludes that the AIS-T is a reliable and valid instrument for assessing insomnia among cancer patients in Taiwan. [Copyright &y& Elsevier]

Summary: The purposes of this study were to examine postoperative levels of physical and psychological distress and, also, care needs and their related factors in newly diagnosed oral cavity cancer patients. A cross-sectional survey was conducted to assess symptom distress, psychological distress (anxiety, depression, and disease impact), care needs, and disease-/treatment-related characteristics in 112 hospitalized oral cavity cancer patients receiving surgery. The major results showed that patients had moderate-to-severe levels of distress and high overall care needs in five domains, with the highest level in the “physical and daily living” domain. Factors related to overall need and each unmet domain were identified. Overall care needs were predicted by anxiety, depression, cancer stage, performance status, and age. Among the three categories of psychological distress, anxiety contributed the most to predicting three domains of care needs. The results strongly suggest the need for systematic assessment and future longitudinal research. [Copyright &y& Elsevier]

Context: Organizations such as Asia Pacific Hospice Palliative Care Network functions to promote quality palliative care development through training and education, research collaboration and variety relevant projects and events for all in the Asia and Pacific region.Objectives: To summarise and further compare existing development indicators used in Asia Pacific region for palliative care.Methods: The current review used Whittemore and Knafl 's framework for integrative reviews. PubMed, Embase, CINAHL and Google Scholar databases were searched for eligible studies. This review focused on palliative care development according to the domains and indicators identified by the World Health Organization Public Health Strategy and ATLANTES Palliative Care Research Group. Joanna Briggs Institute critical appraisal checklists were adopted to assess the methodological quality of included studies.Results: Ten studies were included and two main findings were identified: 1) There was a strong evidence of educational preparation, use of medicines and service provision for palliative care development in Asia Pacific and 2) Professional activities and policy geared towards palliative care development were limited and had relative emphasis at a country-level in Asia Pacific.Conclusion: Palliative care development is largely influenced by policies and funding structures as well as by cultural views and beliefs of stakeholders. It is expected that individuals, stakeholders and practitioners in Asia Pacific might have differing views and cultural beliefs when compared to the European or western counterparts. The lack of details and documentation in the region and inadequate reporting measures impacts on the development of strong palliative care framework. [ABSTRACT FROM AUTHOR]

Support care is rarely assessed and offered to people with long-term neurologic conditions, particularly Parkinson's disease. This study aimed to assess the symptom burden and unmet support care needs in people with mild to severe Parkinson's disease. Cross-sectional study. Patients with Parkinson's disease were recruited from neurologic outpatient clinics from 3 East and Southeast Asian regions, including Hong Kong, Taiwan, and Thailand. A standardized set of questionnaires assessing unmet care needs [Palliative care Outcome Scale (POS)], disease-specific symptom burden (POS–Symptoms–Parkinson's Disease), generic health-related quality of life (HRQOL) (EQ-5D-3L), and sociodemographic and clinical background. Completed questionnaires (n = 186) were collected from 64 Hong Kong Chinese, 64 Taiwanese, and 58 Thai patients. Their mean age was 67.23 ± 8.07, 54% were female, and 80% had mild-to-moderate disease. Their mean POS score was 10.48 ± 6.38, indicating moderate unmet support needs. Two-thirds of the participants rated constipation, fatigue, leg problem, and daytime somnolence as the most prevalent and burdensome symptoms. Patients from Hong Kong and Taiwan prioritized psychosocial and spiritual support, whereas Thai patients prioritized physical needs and emotional concerns. Multivariate adjustment for demographics and clinical characteristics showed that high psychological, spiritual, and practical burdens are associated with young age, male gender, and advanced disease stages. Patients experience significant symptom burden and moderate unmet support needs at the early to middle stage of Parkinson's disease. Routine assessment of changes in symptom burden should start early. The timely referral of support care services should provide appropriate psychospiritual and practical support in addition to motor training. Planning for support care services should consider cultural and health service contexts. [ABSTRACT FROM AUTHOR]

Context: At the end of life, chronic obstructive pulmonary disease (COPD) and lung cancer (LC) patients exhibit similar symptoms; however, a large-scale study comparing end-of-life health care utilization between these two groups has not been conducted in East Asia.Objectives: To explore and compare end-of-life resource use during the last six months before death between COPD and LC patients.Methods: Using data from the Taiwan National Health Insurance Research Database, we conducted a nationwide retrospective cohort study in COPD (n = 8640) and LC (n = 3377) patients who died between 1997 and 2013.Results: The COPD decedents were more likely to be admitted to intensive care units (57.59% vs 29.82%), to have longer intensive care unit stays (17.59 vs 9.93 days), and to undergo intensive procedures than the LC decedents during their last six months; they were less likely to receive inpatient (3.32% vs 18.24%) or home-based palliative care (0.84% vs 8.17%) and supportive procedures than the LC decedents during their last six months. The average total medical cost during the last six months was approximately 18.42% higher for the COPD decedents than for the LC decedents.Conclusion: Higher intensive health care resource use, including intensive procedure use, at the end of life suggests a focus on prolonging life in COPD patients; it also indicates an unmet demand for palliative care in these patients. Avoiding potentially inappropriate care and improving end-of-life care quality by providing palliative care to COPD patients are necessary. [ABSTRACT FROM AUTHOR]

Context: No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings.Objectives: To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCUs) or intensive care units (ICUs).Methods: A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU. Data were collected on their concerns regarding PST during recruitment. Grief levels were assessed at three days and one month after the patient's death with the Texas Revised Inventory of Grief.Results: Families' major concern about sedated patients in the PCU was that "there might be other ways to relieve symptoms" (90.2%), whereas families of ICU sedated patients gave the highest ratings to "feeling they still had something more to do" (93.55%), and "the patient's sleeping condition was not dignified" (93.55%). Family members recruited from the ICU tended to experience more grief than those from the PCU (P = 0.005 at Day 3 and < 0.001 at Month 1). PST use predicted higher levels of grief in family members recruited from the PCU (P < 0.001 at Day 3 and Month 1).Conclusion: Family experiences with the use of PST in terminally ill patients varied in different settings. Supportive care should address family concerns about PST use, and regular attention should be paid to the grief of individuals at higher risk. [ABSTRACT FROM AUTHOR]

Context: Stroke is the second leading cause of death and the primary cause of disability worldwide. It is uncertain what care patients with stroke receive in their end of life and what trends in care are in recent years.Objectives: The objective of this study was to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with stroke in their last month of life during 2000-2010.Methods: Analysis of claims data of 55,930 patients with stroke obtained from the National Health Insurance Research Database was performed to investigate the changes in the use of intensive and supportive procedures for Taiwanese patients with stroke in their last month of life during 2000-2010.Results: Over the whole study period, 25.4% of patients with stroke were admitted to intensive care units in their last month of life. The percentages of patients receiving mechanical ventilation (77.4%-67.9%), cardiopulmonary resuscitation (53.8%-35.8%), and inotropic agents (73.5%-64.3%) decreased over time. The percentages of patients receiving artificial hydration and nutrition (65.9%-73.3%) and sedative or analgesic agents (34.7%-38.6%) increased over time. Patients under 85 years old were more likely to be admitted to intensive care units. Men were more likely to receive mechanical ventilation and cardiopulmonary resuscitation than women.Conclusion: Over time, the use of supportive procedures increased, and the use of intensive procedures decreased in patients with stroke in the last month of life. This study highlights a need for research, guidelines, and training in how to provide palliative care for end-stage patients with stroke. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare incidences of adverse events of special interest (AESI) and delirium in 3 cohorts: after COVID-19 vaccination, prepandemic, and SARS-CoV-2 polymerase chain reaction (PCR) test positive. This is a population-based cohort study using electronic medical records linked with vaccination records in Hong Kong. A total of 17,449 older people with dementia received at least 1 dose of CoronaVac (n = 14,719) or BNT162b2 (n = 2730) between February 23, 2021, and March 31, 2022. Moreover, 43,396 prepandemic and 3592 SARS-CoV-2 test positive patients were also included in this study. The incidences of AESI and delirium up to 28 days after vaccination in the vaccinated dementia cohort were compared with the prepandemic and SARS-CoV-2 test positive dementia cohorts by calculating incidence rate ratios (IRRs). Patients who received multiple doses were followed up separately for each dose, up to the third dose. We did not detect an increased risk of delirium and most AESI following vaccination compared to the prepandemic period and those tested positive for SARS-CoV-2. No AESI group nor delirium incidence exceeded 10 per 1000 person-days in vaccinated individuals. The findings provide evidence for the safe use of COVID-19 vaccines in older patients with dementia. In the short run, benefit appears to outweigh the harm due to vaccine; however, longer follow-up should be continued to identify remote adverse events. [ABSTRACT FROM AUTHOR]

Advance care planning is a communication and decision-making process during which people express their wishes for future healthcare and treatment decisions. Advance care planning is particularly relevant to frail older adults. Recently, more advance care planning interventions have been implemented in nursing homes using randomised controlled trial approaches; however, no meta-analysis has been performed evaluating and synthesising the effect of advance care planning in nursing homes. To determine the effect of advance care planning interventions on end-of-life outcomes in nursing home populations. Systematic review and meta-analysis of randomised controlled trials. Medline, EMBASE, Cochrane Library, Medical database, British Nursing Index, PsycInfo and CINAHL Plus from inception to March 2021. Randomised controlled trials or cluster randomised controlled trials implementing advance care planning interventions in nursing homes, and studies reporting end-of-life outcomes and published in English were included. Studies in which advance care planning was part of a more comprehensive intervention were excluded. The outcomes were evaluated using pooled odds ratios (ORs) or standardised mean differences (SMDs) with random-effects meta-analysis models. A meta-regression was performed to evaluate the heterogeneity of the included studies. The Cochrane Risk of Bias Tool 2.0 was used to assess the methodological quality of the included studies. Nine trials were identified with 2905 participants, with sample sizes ranging from 87 to 1292. The number of nursing homes involved ranged from 1 to 64. The types of advance care planning intervention differed, with most studies adopting formal education or training for nursing home staff, while the remainder adopted train-the-trainer approaches. The quality of the included studies varied, with two out of nine scoring low in overall risk of bias. Our comprehensive meta-analysis indicated with moderate heterogeneity that advance care planning interventions significantly increased the documentation of end-of-life care preferences (OR = 1.95, 95% CI: 1.64, 2.32), but not satisfaction with end-of-life care from families' perspectives (SMD = 0.08, 95% CI: − 0.08, 0.23). The meta-regression did not identify any variables in advance care planning interventions to explain the heterogeneity. Advance care planning intervention yielded beneficial effects in nursing home residents by increasing the number of documented end-of-life care wishes but demonstrated no effect on satisfaction with end-of-life care from family caregivers' perspectives. This review highlights the need for more rigorously designed implementation studies to examine the effects of advance care planning interventions on healthcare outcomes among frail older adults in nursing homes. [ABSTRACT FROM AUTHOR]

Summary: The purposes of this study were to (1) examine changes in symptom severity and depression within 3months of first undergoing radiation therapy (RT) or concurrent chemoradiation therapy (CCRT), and (2) identify factors involved in changes in symptom severity in newly diagnosed oral cavity cancer patients undergoing post-operative RT or CCRT. A prospective panel survey was conducted to assess changes in symptoms, depression, and disease- or treatment-related characteristics within 3months of beginning RT or CCRT (pre-treatment and 1, 2, and 3months from first receiving RT). A total of 76 eligible oral cavity cancer patients were recruited from the outpatient radiation department of a medical center in northern Taiwan. The results showed mild-to-moderate overall symptom and depression levels during treatment, with the five most distressing symptoms being swallowing difficulty, poor appetite, oral mucositis, pain, and fatigue. The severity of symptoms and depression peaked at ∼2months from beginning RT or CCRT (T3). Changes in overall symptom severity were found to be significantly related to patients’ radiation dose and depression level. These results can help advance understanding of changes in symptoms and facilitate prevention and management of symptoms associated with RT or CCRT. Psychological distress, particularly, depression, requires careful monitoring and management in oral cavity cancer patients undergoing RT or CCRT. [Copyright &y& Elsevier]

Background: Acupressure on the Shenmen point (indexed as HT7) can improve insomnia, but there has been no longitudinal study to evaluate its efficacy for residents of long-term care facilities. No evidence from the existing literature indicates how long its efficacy can be maintained after stopping acupressure. Objective: The aim of this study was to evaluate the effectiveness of acupressure on the Shenmen point for residents of long-term care facilities with insomnia. Methods: Fifty residents with insomnia in long-term care facilities were enrolled in a randomized controlled trial, with 25 participants allocated to the experimental group and 25 participants to the control group. For a 5-week period, the experimental group received standard acupressure on the HT7 points of both wrists, whereas the control group received only light touch on the same places. Insomnia was measured with the Athens Insomnia Scale-Taiwan form (AIS-T). Participants’ self-reported scores were done at baseline, during the 5-week period, and after intervention. This study was analyzed on an intention-to-treat procedure. Results: The experimental group has significantly better scores on the AIS-T compared to the control group, not only during the intervention period, but also extending after intervention, as shown by generalized estimating equations (p <0.05). Conclusions: Offering acupressure on a regular basis has the potential to improve insomnia in residents of long-term care facilities. Acupressure on the HT7 point may improve insomnia for up to 2 weeks after the intervention. [Copyright &y& Elsevier]

Summary: The purposes of this study were to examine and compare the levels of care information needs, information preferences, unmet information needs, and predictive factors between newly diagnosed and surgically treated oral cavity cancer patients. Patients were divided into two groups comprising: (a) diagnosed patients and (b) surgically treated patients. A cross-sectional survey was conducted to assess information needs about care, disease-/treatment-related characteristics, and physical performance function in 109 diagnosed and 113 surgically treated oral cavity cancer patients. The two groups had statistically different levels of care information needs, information preferences about benefits, and side effects of treatment/ surgery. There were clinically meaningful differences in their information concerns. The diagnosed patients’ information needs were predicted by previous serious illness experiences, prior alcohol use, anxiety level, education level, time since diagnosis, psychological impact, and religion. The surgically treated patients’ information needs were predicted by previous serious illness experiences, prior alcohol use, anxiety level, psychological impact, education level, and marital status. Conclusion: This study revealed differences in information needs between diagnosed patients and surgically treated oral cavity cancer patients. Results suggest that healthcare professionals should design a protocol to guide development of a comprehensive pre- and postoperative information package to be given to these patients. [Copyright &y& Elsevier]

Abstract: Background: Young adults aged from 18 to 44 years comprise a large portion of the population suffering from depression. Yet few studies have compared the likelihood of dying of natural causes or by suicide among depressed patients. This study uses a case–control approach to compare the likelihood of dying of natural causes and by suicide for depressed and non-depressed patients based on a representative national sample in Taiwan. Method: A retrospective case–control study design was used to analyze two nationwide population-based datasets: the National Health Insurance Research Database (NHIRD) and the official Cause of Death data file in Taiwan. The study cohort consisted of 827 patients from 18 to 44 years old who were hospitalized with a primary diagnosis of depressive disorder from 1998–2003. A comparison cohort of patients hospitalized for appendectomies was matched with the study sample in terms of age and gender (N =2481). Results: After adjusting for the age and comorbid medical disorders, the hazard of dying during the five-year follow-up period was 1.72 times greater for depressed patients than for appendectomy patients. Depressed patients were more likely to die by suicide during the follow-up period, as no significant difference in odds of dying from natural causes was observed between these two cohorts. Conclusion: Further studies should be initiated to identify specific risk factors for suicide among younger adults, while prevention strategies might focus on stresses associated with particular life stages, taking age and gender patterns into account. [Copyright &y& Elsevier]

Abstract: The purposes of this study were (1) to examine the psychometric properties of the Taiwanese version of the Morisky Medication Adherence Measure (MMAM), including its validity and reliability, (2) to investigate levels of analgesic regimen adherence, and (3) to explore the predictors of adherence to the analgesic regimen in a sample of Taiwanese cancer patients with pain. One hundred thirty-five patients receiving analgesics for cancer pain participated in this study. Instruments consisted of the Taiwanese version of the MMAM, the Barriers Questionnaire-Taiwan form, the Chinese version of the Brief Pain Inventory, the American Pain Society Outcome Questionnaire, Karnofsky Performance Status, and a demographic questionnaire. Analgesic use ratios were calculated. The Taiwanese version of the MMAM had good psychometric properties for measuring adherence with the analgesic regimens taken by Taiwanese cancer pain patients. Reliability was supported by good internal consistency Cronbach α and test-retest coefficients. Validity was corroborated by good known group validity, construct validity, and criterion-related validity. The majority of the patients (51%) showed low levels of medication adherence. The significant predictors for the medication adherence score were age, the Barriers Questionnaire score, and satisfaction with pain management by clinicians after entering pain severity, pain interference with daily life, age, gender, education, types of analgesics used, functional status, and satisfaction with pain management as independent variables. The model accounted for 63% of the variance in the medication adherence score. The Taiwanese version of the MMAM shows excellent reliability and validity. The use of this reliable, valid, simple, and easily administered tool can improve communication between patients and clinicians about use of analgesics and further improve the analgesic regimen adherence. [Copyright &y& Elsevier]