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Aim and Objectives: To assess (1) the experience, knowledge and preferences of end‐of‐life care among frail nursing home residents and (2) the preferences of residents' family caregivers. Background: Globally, nursing homes are becoming an important place where many older people will receive their end‐of‐life care. Thus, assessing the end‐of‐life care preferences among nursing home residents is crucial. Design: Cross‐sectional survey. Methods: Residents aged ≥65 years, with frail or pre‐frail status (n = 286) in 34 nursing homes were interviewed using a structured questionnaire. Descriptive statistics were used to describe the outcomes and regression analyses were used to evaluate factors related to the outcomes. Kappa statistics were used to examine the agreement between the preferences among 21 residents and their family caregivers. The manuscript was guided by the STROBE checklist. Results: 5.9% and 10.5% of the participants had heard of advance care planning and advance directive respectively. After explanations of the terms by the research team, 42.3% of the participants preferred advance care planning, whereas 22.0% preferred advance directive. The top reason for not preferring advance care planning/advance directive is perceiving them as 'not necessary'. Nursing homes were the most preferred place to receive end‐of‐life care (41.6%). Whereas hospitals were the most preferred place for death (36.0%). The agreement among resident and family caregiver dyads ranged from none to minimal in most outcomes. Conclusions: This study revealed the lack of awareness around advance care planning and advance directive among frail nursing home residents. Future research should focus on developing effective educational interventions to enhance the residents' awareness of these topics. Relevance to clinical practice: To increase awareness among nursing home residents, more educational programs should be implemented. Frail older residents might not see the relevance of advance care planning; interventions need to include both current and future care to increase its relevance. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of two commonly used moist dressings, Aquacel and Aquacel Foam (both ConvaTec Ltd., UK), in managing split-thickness skin graft (STSG) donor site wounds. Method: Patients undergoing STSG harvesting for reconstruction were eligible for this quasi-experimental study. After reconstruction surgery, the Aquacel (A) or Aquacel Foam (AF) dressings were applied on the donor site wound. The STSG donor site was assessed by two trained research nurses daily. Clinical outcomes including pain on dressing removal, use of intravenous analgesics, signs and symptoms of wound infection, incidence of exudate leakage and percentage healed were recorded in a standardised form. Cost of the dressing change was retrieved from the hospital billing system. Results: Of 50 patients recruited, 25 received dressing A and 25 received the AF dressing for their STSG donor site wound. The average pain score on dressing removal was significantly lower in the AF dressing group compared with the A dressing group (0.8±0.8 versus 3.1±1.5, respectively (p=0.04)). Regression analysis demonstrated that compared with dressing A, the AF dressing was associated with a lower average pain score (beta: –2.27, standard error: 0.33; p<0.001), lower likelihood of pro re nata (PRN) intravenous analgesic use (odds ratio (OR)=0.21, 95% confidence interval: 0.06–0.71; p=0.01) and lower likelihood of exudate leakage (OR=0.11, p=0.01). The differences in time to wound healing, infection and cost were not statistically significant between the two groups. Conclusion: In this study, the AF dressing demonstrated superior performance in pain response on dressing removal for STSG donor site wounds compared with dressing A. Large-scale randomised controlled trials should be conducted to confirm the findings. [ABSTRACT FROM AUTHOR]

This study aimed to revise and validate a Chinese version of Psychological Maltreatment of Women Inventory (C-PMWI). In the preparation phase, the PMWI was first revised for the possible cultural differences between Chinese and non-Chinese women. Supplementary items on use of electronic devices as a contemporary form of monitoring were added. Forward and back translated items were reviewed by a panel of intimate partner violence (IPV) experts, resulting in the scale-level content validity index of 0.94. Cognitive debriefing was conducted to confirm comprehensibility. The newly revised measure was administered to the sample of 1,198 Chinese women, recruited from community centers and shelters in Hong Kong. Exploratory factor analysis conducted on data from half the sample revealed a two-factor structure similar to the original English version: emotional-verbal and dominance-isolation. This structure was verified by confirmatory factor analysis with the other half of the sample. Known-groups validity was demonstrated by significant differences in scores between women with different relationship histories. Moderate-to-strong correlations of the C-PMWI with other forms of IPV, controlling behaviors, relationship satisfaction, and depression established convergent validity. The C-PMWI showed good internal consistency, with Cronbach's alpha >.9 for the entire scale and each subscale. The intraclass correlation across administrations 2 weeks was >.9, demonstrating test–retest reliability. The use of the comprehensive validation procedures in the present study provided evidence for both cultural appropriateness and satisfactory psychometric properties of the C-PMWI. The C-PMWI shows promise as a useful instrument for research and clinical practice with Chinese women. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship of exercise timing (exercising close to bedtime, exercising in daylight and maintaining fixed exercise schedule) with sleep quality, fatigue and rest–activity rhythms among lung cancer patients in Taiwan. Methods: Results from 43 lung cancer patients who were assigned and adhered to the exercise intervention in a 12‐week randomised controlled trial were analysed. The MD Anderson Symptom Inventory and Pittsburgh Sleep Quality Index (PSQI) were administered. Actigraphs were used to assess rest–activity rhythms (in‐bed less than out‐of‐bed dichotomy index, I < O) and objective sleep parameters, including total sleep time (TST) and sleep onset latency (SOL). Results: Patients who exercised >4 hr before bedtime had significant improvement in fatigue (p <.0001), sleep quality (p =.012 for PSQI; p =.037 for TST; p =.017 for SOL) and rest–activity rhythms (p =.048 for I < O). Furthermore, patients who exercised with daylight exposure had a significant improvement in fatigue (p =.037) and sleep quality (p =.039 for PSQI). Conclusions: Exercising >4 hr before bedtime with daylight exposure is associated with improvement in rest–activity rhythms, sleep quality and fatigue in lung cancer patients. The causal relationship requires further investigation with experimental design. [ABSTRACT FROM AUTHOR]

Objective: To test the acceptability and feasibility of self-administered acupressure as an intervention for knee pain among middle-aged and older adults with knee osteoarthritis (KOA). Methods: In this pilot randomized controlled trial, 35 participants with KOA were randomized to receive self-administered acupressure (n = 17, two self-administered acupressure training sessions followed by self-practice for 6 weeks) or knee health education (n = 18, two health education sessions about KOA management followed by self-care for 6 weeks). Current pain intensity (primary outcome) was measured using a Numeric Rating Scale (NRS) at baseline and weeks 1, 2, 4 and 6 (post-intervention). Secondary outcome measures included worst and least pain intensity, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM) of the knee joints and Short-Form Six-Dimension (SF-6D) scores for health-related quality of life. Results: Participants in both groups attended all training sessions. In the self-administered acupressure group, all subjects mastered the acupressure technique and passed a consistency check. Both groups showed a decreasing trend in current knee pain intensity measured using NRS post-intervention. A medium between-group effect size (0.40) was found, but between-group differences were not statistically significant. The other secondary outcome measures were also comparable between both groups post-intervention (all p > 0.05). Conclusion: A two-session self-administered acupressure training was acceptable to and feasible in participants with KOA. The data generated allowed for calculation of a sample size for a definitive randomized controlled trial (RCT) to confirm whether self-acupressure is effective for pain management in KOA. Furthermore trials with adequate power and longer follow-up periods are warranted. [ABSTRACT FROM AUTHOR]

Purpose: Hepatocellular carcinoma (HCC) is the second leading cause of cancer mortality worldwide. Sleep problems are common in HCC patients and may be attributable to disturbances in the circadian rhythm. Research into the role of circadian rhythms in sleep quality among HCC patients is lacking, however. This study investigated the relationship between the diurnal cortisol profile and sleep quality among HCC patients. We aimed to identify alterations in the diurnal cortisol profile in patients with HCC compared to healthy controls and investigate whether they were associated with poor sleep quality among HCC patients. Methods: Participants comprised 75 HCC patients and 33 healthy individuals. The Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-T) was administered to assess sleep quality. Saliva samples were collected on 3 consecutive days at five time points daily to measure diurnal cortisol levels. Results: In the HCC group, 89.3% of individuals were poor sleepers (PSQI-T > 5), whereas among healthy individuals, 30.3% were poor sleepers. While the healthy participants' diurnal cortisol profile followed a typical pattern that peaked 30 min after waking and declined gradually throughout the day, the cortisol level in the HCC patients rebounded at bedtime. Higher cortisol levels were marginally correlated with poor sleep quality (OR = 1.00007, p <.05). Conclusions: Our study suggests a potential association between disturbed circadian rhythm and poor sleep quality in HCC patients. Further investigation of the causal relationship between sleep and circadian rhythm is warranted. [ABSTRACT FROM AUTHOR]

eHealth has become popular worldwide, and it is transforming health care. However, studies examining the use of eHealth applications in the Chinese population are scarce. The study reports on the characteristics of eHealth applications in Hong Kong information and communication technology (ICT) users, their attitudes towards eHealth, and their reasons for not using eHealth applications. A cross-sectional random-digit dialing survey targeting adults using ICT was conducted in Hong Kong to elicit information on respondents' use of and attitudes towards eHealth. A total of 495 ICT users completed the survey, of whom 353 (71.3%) were eHealth users. A smartphone was the most frequent way of performing eHealth activities (71.7%). The most prevalent eHealth activity was reading about health/illness (86.4%), with 93.5% indicating that eHealth applications improved their understanding of health care issues. People with less education were less likely to use eHealth applications. Non-eHealth users indicated that the main reasons for not using eHealth applications were lack of interest in health information (49.3%) and lack of confidence in the reliability of online information (45.1%). Quality monitoring of health information available on ICTs and tailoring the design and readability are recommended to meet the needs of those seeking health resources and to promote eHealth. Evidence from the study demonstrates the potential of eHealth to improve the dissemination of health information in Hong Kong, and it provides a basis for improving eHealth integration. [ABSTRACT FROM AUTHOR]

A Qigong App was designed to promote a more flexible mode of delivering qigong training than face-to-face, with which individuals can access to this mind-body aerobic exercise more readily. The objective of the study was to examine the usability and acceptance of the App. Target participants were Cantonese- or Putonghua-speaking adults and owned a smartphone. First we conducted a pilot trial with 14 participants to examine the navigation feature of the App, followed by a main test. In the main test, another 100 participants reviewed the Qigong App and filled in a questionnaire on usability (System Usability Scale) and user acceptance (i.e., attitude, perceived ease of use, perceived usefulness, intention to use, and satisfaction), of which 89 completed the same questionnaire in a two-week interval. Qualitative feedback yielded from the pilot trial was summarized, and descriptive statistics, t-tests, and linear regressions were used in quantitative data analysis of the main test. The mean composite usability score in the main test was satisfactory (77.62 out of 100). Descriptive analyses showed that the majority of users found the Qigong App pleasant, user friendly, and useful for learning qigong. Participants indicated positive ratings for the items assessing usability and acceptance of the App. Regression results showed that certain characteristics predicted the ratings for some items, e.g., age as a predictor of scores of usability and perceived ease of use. The study provided researchers and practitioners with evidence of the usability and acceptance of an alternative qigong training mode that can enhance participants’ access and motivation to practice qigong. [ABSTRACT FROM AUTHOR]

We determined the long-term outcomes of adult intensive care unit (ICU) patients and investigated the predictors of successful discharge for ≥6 months among older adults aged ≥80 years in Taiwan. To identify the predictors of ICU admission in patients aged ≥80 years and the predictors of and optimal cutoff predictive discharge score (PDS) for ICU successful discharge in patients aged ≥80 years. A population-based retrospective cohort study. Medical records of 282,269 individuals aged ≥80 years collected from the Taiwan National Health Insurance Research Database from 2001 to 2013. Demographic and clinical parameters, Charlson's comorbidity index (CCI), hospital type, and post-discharge outcomes of ICU patients aged ≥80 years were obtained from their medical records. Multivariable logistic regression was used to analyze and identify the predictors of successful discharge and treatments received by critically ill patients aged ≥80 years admitted to the ICU. The optimal cutoff PDS for successful discharge in older adults were calculated by Youden Index. Results 65,756 ICU admissions were documented, of which 21% (n = 13,825) were for adults aged ≥80 years. The successful discharge rate among ICU patients aged ≥80 years (57.2%) was significantly lower than that among those aged 18–64 and 65–79 years (81.7% and 71.5%, respectively). Multivariable logistic regression analyses revealed the following predictors of successful discharge for ≥6 months after ICU admission in adults aged ≥80 years: younger age (adjusted odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.94–0.96), shorter ICU length of stay (adjusted OR = 0.90, 95% CI = 0.88–0.92), lower CCI (adjusted OR = 0.92, 95% CI = 0.90–0.93), and no life-sustaining treatments received (Cardiopulmonary resuscitation: adjusted OR = 0.75, 95% CI = 0.68–0.84; mechanical ventilation: adjusted OR = 0.63, 95% CI = 0.57–0.71; use of inotropic agents: adjusted OR = 0.37, 95% CI = 0.34–0.41). The optimal cutoff PDS in older adults was 6 (area under the receiver operating characteristic curve = 0.73, 95% CI = 0.72–0.74). This is the first population-based study investigating the post-discharge outcomes of ICU patients aged ≥80 years. Advanced age was a predictive factor of unsuccessful discharge from the ICU. Nevertheless, more than half of this vulnerable population survived for at least 6 months after discharge. Therefore, age should not be the sole criterion when considering ICU admission and deciding curative treatments for critically ill older adults. Comprehensive assessment and effective communication with patients and their families are also crucial in clinical decision-making for critically ill older adults. [ABSTRACT FROM AUTHOR]