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Background/purpose: This study aimed to analyze the long-term outcomes of hypofractionated whole-breast irradiation (WBI) (HF-WBI) compared with those of conventionally fractionated WBI (CF-WBI) for early breast cancer treated with breast-conservation surgery (BCS) and adjuvant WBI in Taiwan.Methods: This study included patients treated at our institution between 2012 and 2016. All patients with early breast cancer received BCS (pT1-2, pN0, M0) and adjuvant WBI through one of two treatment schemes. Propensity score matching analysis was conducted to create comparable cohorts. The major result is ipsilateral breast tumor recurrence (IBTR) rates and overall survival rates.Results: A total of 869 patients with early-stage breast cancer received adjuvant HF-WBI or CF-WBI were included. After matching, 718 patients were separated into two groups of the same number. With a median follow-up of 66 months, seven cases of IBTR were noted (three for CF, four for HF). There were no significant differences between the HF-WBI and CF-WBI groups in 5-year IBTR rates (0.9% vs 0.6%, P = 0.3887, 95% CI [0.25-7.79]) and 5-year overall survival rates (98.1% vs 98.9%, P = 0.4702, 95% CI [0.32-3.49]). In our institution, the use of HF-WBI increased significantly from 5% before 2012 (Q3) to 92% in 2016 (Q4). There was no significant difference in grade 1-2 toxicity between the two treatment groups. Fewer cases of grade 3 skin toxicity noted in the HF-WBI group (zero vs four events).Conclusion: HF-WBI had similar IBTR, OS and toxicity to CF-WBI. [ABSTRACT FROM AUTHOR]

Purpose: To explore the life experiences of patients with type 1 diabetes transition from adolescence into adulthood in Taiwan. Methods: Descriptive phenomenological design was used. Fourteen participants were individually interviewed using a semi-structured interview. Results: The life experiences of patients with type 1 diabetes transition from adolescence into adulthood experience a metamorphosis from awareness of responsibility to figuring out a way to care for themselves. Six themes emerged: (1) hibernation: awareness of responsibility; (2) emergence: attempts to take responsibility; (3) perseverance: encountering difficulties; (4) anxiety: multiple worries; (5) hesitation: back-and-forth," and (6) exit: finding a way out." Conclusions: During the transition phase, the participants experienced the trials of various situations. Regardless of whether they are able to independently bear the responsibilities of self-management, they all hope to turn around the challenges of disease control and take ownership of their disease. Like a butterfly that emerges from a cocoon, they hoped to overcome the dangers of taking flight through trial and error and navigating the world. The results of this study can serve as a reference for clinical care and developing localized intervention strategies targeted to the transition period between adolescence and young adulthood. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to improve medication reconciliation and reduce the occurrence of duplicate prescriptions by pharmacists and physicians within 72 hours of hospital admission using an intelligent prescription system combined with the National Health Insurance PharmaCloud system to integrate the database with the medical institution computerized physician order entry (CPOE) system. Methods: This 2‐year intervention study was implemented in the geriatric ward of a hospital in Taiwan. We developed an integrated CPOE system linked with the PharmaCloud database and established an electronic platform for coordinated communication with all healthcare professionals. Patients provided written informed consent to access their PharmaCloud records. We compared the intervention effectiveness within 72 hours of admission for improvement in pharmacist medication reconciliation, increased at‐home medications documentation and decreased costs from duplicated at‐home prescriptions. Results: The medication reconciliation rate within 72 hours of admission increased from 44.0% preintervention to 86.8% postintervention (relative risk = 1.97, 95% confidence interval [CI]: 1.69–2.31; P < .001). The monthly average of patients who brought and took home medications documented in the CPOE system during hospitalization increased by 7.54 (95% CI 5.58–20.49, P = .22). The monthly average of home medications documented increased by 102.52 (95% CI 38.44–166.60; P = .01). Savings on the monthly average prescription expenditures of at‐home medication increased by US$ 2,795.52 (95% CI US$1310.41–4280.63; P < .01). Conclusion: Integrating medication data from PharmaCloud to the hospital's medical chart system improved pharmacist medication reconciliation, which decreased duplicated medications and reduced in‐hospital medication costs. [ABSTRACT FROM AUTHOR]

Aims and objectives: To determine prehospitalised diabetes‐related foot ulcer (DFU) self‐management behaviours and explore the factors associated with these behaviours. Background: Although there are many studies that explore DFU prevention and treatment, to our knowledge, there are no quantitative studies of DFU self‐management behaviours. Design: Cross‐sectional design. Methods: From June 2015–June 2016, 199 hospitalised patients with DFU were given a survey questionnaire at a medical centre in northern Taiwan. DFU self‐management behaviours, diabetes foot self‐care behaviours, beliefs in regard to barriers to DFU self‐management behaviours, and knowledge regarding warning signs of DFU deterioration were assessed by well‐designed measurement tools. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used to ensure quality reporting during this observational study (see Supporting Information Appendix S1). Results: The results revealed that 62.8% of participants never monitored their blood glucose level when they had foot ulcers, and 63.8% never sought treatment for their wounds when their wounds were not painful. After controlling for demographic and medical variables, stepwise multiple regression analysis revealed that the following eight significant variables were associated with DFU self‐management behaviours: two DFU self‐management barrier beliefs, foot self‐care behaviour, no treatment for diabetes, poor financial status, employment, knowledge regarding the warning signs of DFU deterioration, and number of DFU hospitalisations. Conclusions: Diabetes‐related foot ulcer self‐management behaviours were insufficient. Some modifiable factors and high‐risk groups for insufficient DFU self‐management behaviour were identified. Relevance to clinical practice: Diabetes‐related foot ulcer self‐management behaviours should be promoted. Interventions that modify the risk factors that were identified in this study can be designed to promote the performance of DFU self‐management behaviours. [ABSTRACT FROM AUTHOR]

Aims To measure the effectiveness of an education empowerment program on primary (self-efficacy and self-care competence) and secondary outcomes (Activities of Daily Life, mobility, depressive mood and quality of life) for older adults with total hip replacement surgery. Background Degenerative arthritis is a common and serious chronic illness that impacts the quality of life of older adults. As joints continue to degenerate and the hip damaged by arthritis, activities of daily life will be difficult to perform due to severe hip pain and joint stiffness. Therefore, hip replacement surgery should be considered and effective nursing care should be provided to improve the recovery of older adults. Design A prospective randomized control trial. Methods A trial was conducted from September 2013 - May 2014 in two hospitals in northern Taiwan. 108 participants were random assigned to either the education empowerment group or in the comparison group. The researchers collected baseline data at admission and outcomes on the day of discharge, one month after and three months after the discharge. Results After the interventions, the education empowerment group participants demonstrated significantly higher self-care competence and self-efficacy and lower depressive inclinations compared with those in the comparison group. Participants in both groups significantly improved on activities of daily life, mobility and quality of life over the course of the interventions. Conclusion This education empowerment intervention was very effective in enhancing participants' outcomes. Moreover, involving both older adults and their caregivers for the participation this program is recommended for a greater impact. [ABSTRACT FROM AUTHOR]

A project management model is developed for constructing a renewable energy plant in this research. Program evaluation and review technique (PERT) is applied first to find the critical activities when constructing the plant and to calculate the total project cost and total duration time for the project under normal condition. When some activities are crashed, the total duration time can be reduced. The total project cost and the total duration time for crashing various activities are calculated. The fuzzy PERT model is developed by the fuzzy multiple objective linear programming, and the model can devise the project implementation plan to maximize the total degree of satisfaction while minimizing total project cost and total duration time. A case study of a wind turbine construction in Taiwan is presented to show the practicality of the proposed models. [ABSTRACT FROM AUTHOR]

Objectives:Although the fear of falling is common among elderly residents in long-term care facilities, interventions developed for fear of falling management is very rare. Of these limited interventions, most were exercise interventions with only limited testing. The cognitive-behavioural intervention can decrease the fear of falling; however no intervention of the kind was developed and assessed to decrease fear of falling among the elderly in long-term care facilities. The purpose of this study was to examine the effectiveness of cognitive-behavioural strategies either with or without exercise in reducing fear of falling among elderly residents in nursing homes. Method:A prospective randomized control trial was conducted in six nursing homes in northern Taiwan. Seventy-five elderly participants were randomly assigned to one of the three groups: the comparison group, the cognitive-behavioural strategies with or without exercise group. The fear of falling, falls, depressive inclination, mobility, and muscle strength of extremities were collected at the two-month and five-month follow-up sessions, in which the progress of the patients were assessed. Results:The mixed model analysis revealed that elderly adults in the combination experimental group had significant improvements compared with the other two groups on fear of falling, depressive inclination, mobility, and muscle strength at five months. The incidences of falls, post intervention, in both experimental groups were significantly lower than those in the comparison group. Conclusions:The results suggest that the combination intervention helped elderly residents manage their fear of falling and falls, decrease their depressive inclination, and enhance their mobility and muscle strength. [ABSTRACT FROM PUBLISHER]

Aims and objectives. To develop and examine the effectiveness of individualised intervention to reduce constipation among older adults in nursing homes. Background. In long-term care facilities, approximately 60-80% of the residents have symptoms of constipation. Constipation may lead to haemorrhoids, faecal impaction, ulcers, intestinal bleeding and can also lead to a decrease in quality of life. Although a high prevalence of constipation in older adults can be seen, there is a lack of empirical evidence for delivering interventions based on individual risk factors of constipation. Many factors cause constipation but the risk factors are different for each individual. Design. A prospective, randomised control trial conducted in northern Taiwan. Methods. Nursing home residents (n = 43) were randomly assigned to either the control group or the experimental group. The control group received no extra care from the researcher while the experimental group received an individualised intervention and an eight-week follow-up. Participants were assessed using the Bristol Stool Form Scale, the Patient Assessment of Constipation Symptoms, types and dosages of laxative, and bowel sound observations. Data were taken at baseline, four weeks as well as eight weeks after the intervention. Results. The participants in the experimental group had a significantly higher increase in the frequency of defecation (group effect, p = 0-029) and in bowel sounds (interaction effect, p = 0-010) compared to those in the control group. However, the two groups did not differ significantly in symptoms and the severity of the constipation symptoms, Bristol Stool Form and use of laxatives. Conclusions. The results of this trial suggest that the individualised intervention may be appropriate for decreasing constipation among nursing home residents and encourage further study and confirmation. Relevance to clinical practice. Using individualised intervention to enhance the self-care ability related to constipation among older adults is recommended. [ABSTRACT FROM AUTHOR]

Aims To evaluate the self-perception of diabetes control associated with physical indicators and with practicing exercise and a healthy diet, among rural residents. Background It remains unclear whether a subject's self-perception of diabetes control increases its deleterious effects. Design Cross-sectional, correlational. Methods We recruited 715 participants from 18 primary healthcare centres in the rural regions of Chiayi County, Taiwan. Data were collected between 1 January 2009-30 June 2010. Logistic regression was conducted to identify the determinant factors associated with perceptions of diabetes control. Results A high percentage of participants overestimated their fasting blood glucose and HbA1C status. Total cholesterol, triglyceride, low density lipoprotein cholesterol, blood pressure, and waist circumference exceeded the medical standard in the 'feel good' group, and many did not adopt a healthy diet and undertake physical activity. The final logistic regression model demonstrated that residents with diabetes who exercised frequently had normal fasting glucose, and normal HbA1C tended to perceive 'feel good' control. Conclusion Misperception and unawareness of diabetes control were prevalent among rural residents. Addressing misperceptions among rural residents with diabetes and increasing their knowledge of professional advice could be important steps in improving diabetes control in an elder population. [ABSTRACT FROM AUTHOR]

The article reports a study which was conducted to develop a diabetes foot self-care behavior scale (DFSBS) and to test its validity and reliability in patients with diabetes and peripheral neuropathy. A DFSBS containing seven items: checking the bottom of the feet and between toes, washing between toes, applying lotion was developed. The DFSBS demonstrated adequate validity and reliability and may be used by researchers to assess foot self-care behaviors or as a screening instrument.

Aims and objectives To identify the effects of health belief model factors on daily foot-exam practice among diabetes mellitus patients with peripheral neuropathy. Background Daily foot exams are one of the most important self-care behaviours that prevent the occurrence of diabetic foot ulcers and subsequent amputation. Although daily foot exams were under-practiced in patients with peripheral neuropathy, few studies have explored modifiable social-psychological factors related to daily foot exams. Design A cross-sectional survey was used to collect the data. Methods A total of 277 patients with diabetes and peripheral neuropathy were recruited from two hospitals in northern Taiwan. The Family APGAR and Diabetic Foot Ulcer Health Belief Scale ( DFUHBS) were used to measure family support and health belief factors respectively. Data on foot-exam practice, perceived self-efficacy and action cues were collected through the use of structured questionnaires. The data were analysed using logistic regression. Result The regression model revealed that select action cues (recommendations from family, friends, or health professionals), perceived self-efficacy and perceived barriers interactively influenced the participants' daily foot-exam practice. Conclusion Factors related to daily foot-exam practice were identified. Specifically, action cues played a significant role in motivating daily foot-exam practice in this group. Relevance to clinical practice This study recognises modifiable factors that influence the daily foot-exam practice of patients with diabetes and peripheral neuropathy. Using the findings of this study, health professionals can design interventions that aim to modify the above factors as a means to promote daily foot-exam practice. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify factors potentially associated with asthma self-care behavior among adult asthma patients. A correlational descriptive study was conducted with a convenience sample of 220 adults identified as having moderate-to-severe asthma and receiving outpatient care at a medical center in northern Taiwan. Participants were interviewed by questionnaires. The study found that asthma self-care behaviors were predicted by 5 factors: (1) younger age, (2) not smoking history, (3) better social support, (4) better knowledge, and (5) better skills regarding asthma self-care, accounting for 51.5% of the total variance. The study also showed that the initial model could be modified to obtain a recursive model with good fit. Determinant factors identified by the analysis highlight the need to educate adult asthma patients about self-care to minimize mortality and promote their quality of life. [ABSTRACT FROM AUTHOR]

Abstract: Development of the geriatric fear of falling measure (GFFM) was based on a previous qualitative study of Taiwanese community-dwelling elders. Relevant parameters or items for assessing subscales were identified and tested in a three-stage process: item development, content validity testing and reliability testing. The GFFM was tested on two groups of community-dwelling elders in Taiwan ( and 384) to examine validity and reliability. Good test–retest, internal consistency and inter-rater reliability were found. Confirmatory factor analysis and good overall model fits supported construct validity of the GFFM. Although these data are preliminary, the GFFM could be used as a quick screening instrument to evaluate fear of falling and an outcome indicator of nursing interventions. [Copyright &y& Elsevier]

No previous studies have evaluated an oral health programme, before swallowing therapy, in patients with stroke and dysphagia in Taiwan. This randomised controlled trial evaluated the effect of an oral health programme (i.e., sputum assessment, Bass method-based tooth brushing, and tooth coating with fluoride toothpaste) before swallowing therapy. Sixty-six patients with stroke (23 female, 43 male) in our rehabilitation ward, who underwent nasogastric tube insertion, were assigned randomly to an oral care group ( n = 33) and a control group ( n = 33). Demographic data, oral health assessment, Functional Oral Intake Scale (FOIS) scores, Mini-Nutritional Assessment-Short Form (MNA-SF) scores, and nasogastric tube removal rates were compared between groups. We evaluated outcomes using generalised estimating equation analysis. Three weeks post-implementation, the oral care group had significant oral health improvements relative to the control group (95% CI = -2.69 to -1.25, Wald χ 2 = 29.02, p < 0.001). There was no difference in the FOIS (95% CI = -0.16 to 0.89, Wald χ 2 = 1.86, p > 0 .05), MNA-SF (95% CI = -0.35 to 0.53, Wald χ 2 =-0.17, p > 0 .05), and nasogastric tube removal ( p > 0 .05) between groups. The oral care group had a higher, but non-significant FOIS score (3.94 vs 3.52) (p > 0.05). Routine oral health programmes implemented during stroke rehabilitation in patients with dysphagia may promote oral health and maintain oral intake., Competing Interests: The authors declare no conflicts of interest.

Purpose: This study sought to evaluate the Chinese version of the eight-item Parkinson's Disease Questionnaire (PDQ-8), through standard psychometric techniques., Methods: A cross-sectional study was conducted on 100 Parkinson's disease patients attending a Movement Disorders Unit. Neurologists' assessments were based on Hoehn and Yahr, Schwab and England and Unified Parkinson's Disease Rating Scales. Patients' self-evaluations included the Taiwanese Depression Questionnaire, the 39-item Parkinson's Disease Questionnaire (PDQ-39) and PDQ-8, pain, and Pittsburgh Sleep Quality Index. Analyses for internal consistency, inter-rater reliability, and construct validity were performed., Results: There was no evidence of floor or ceiling effects. The alpha coefficient was 0.81. Correlation of social support and bodily discomfort with the PDQ-8 was modest (0.46 and 0.36, respectively). PDQ-8 convergent validity with the PDQ-39 was very high (r = 0.96), and known-groups validity proved satisfactory., Conclusions: The results of this study suggest the PDQ-8 is a valid and reliable disease-specific health-related quality-of-life instrument for Parkinson's disease in Taiwan when used independently of the PDQ-39.

Aim: To examine the effectiveness of cognitive-behavioural strategies with/without intense Tai Chi exercise in reducing fear of falling among community-dwelling elderly adults. Background.  Fear of falling is a major health problem among community-dwelling older persons. The prevalence of this fear ranges from 29% to 77%, indicating the importance of developing effective strategies to reduce fear of falling among elderly adults., Methods: Data were collected from January to December 2007. A randomized controlled trial with three groups (control, cognitive-behavioural and cognitive-behavioural with Tai Chi). Participants were assessed at baseline for demographic data, falls-related history, and fear of falling. Data on these variables plus falls, mobility, social support behaviour and satisfaction, and quality of life were also collected at 2 and 5 months after interventions., Results: Participants in the three groups differed significantly in both measures of fear of falling (F = 20·89, P < 0·001; F = 6·09, P < 0·001) and mobility (F = 30·33, P < 0·001), social support behaviour and satisfaction (F = 3·32, P < 0·05 and F = 6·35, P < 0·001, respectively), and quality of life (F = 16·66, P< 0·001). In addition, participants who received the cognitive-behavioural intervention with Tai Chi had significantly lower fear of falling scores (P < 0·001) and higher mobility (P < 0·001), social support satisfaction (P < 0·01) and quality of life (P < 0·001) than the cognitive-behavioural alone and control groups at 5 months. The three groups did not differ significantly in falls., Conclusion: The results of this trial suggest that the cognitive-behavioural intervention with Tai Chi exercise helped community-dwelling elderly adults to enhance their mobility, to manage their fear of falling and to increase their quality of life., (© 2011 Blackwell Publishing Ltd.)

Aim and Objectives: To explore the underlying theoretical framework for the role adaptation of family caregivers for ventilator-dependent patients after transferring from respiratory care ward to home., Background: The number of ventilator-dependent patients has been increasing worldwide. Under Taiwan's National Health Insurance policy, if ventilator-dependent patients are stable, they should be transferred from an acute care hospital to a subacute unit or home., Design: A qualitative design based on grounded theory was adopted for this study., Methods: One-on-one, in-depth interviews were conducted with a purposive sample of 15 family caregivers who were caretaking ventilator-dependent patients at their home two months after hospital discharge. Theoretical sampling was used until concepts emerging in data analysis were saturated. Analysis of audio-taped interview transcripts generated a process of role adaptation for family caregivers of a ventilator-dependent patient., Results: The caregiver's transition to the care-giving role is a dynamic process with consequences that are impacted by level of support from the family, affective rewards from the patient, patient's health condition and a balanced life schedule for the caregiver., Conclusions: The results of this study can provide respiratory care professionals with skills to assess the needs of caregivers for ventilator-dependent patients and individualise interventions to caregivers' specific needs., Relevance to Clinical Practice: The findings of this study contribute to nurses' understanding and promotion of role adaptation for family caregivers among ventilator-dependent patients.

Objective: to understand postpartum weight retention among women of different body sizes at pre-pregnancy, and to explore factors influencing this weight retention., Design: a comparative, descriptive study. Pre-pregnancy body mass indices (BMIs) were determined from hospital records. Dependent variables were measured by self-report questionnaires., Setting: a 3,900-bed medical centre in northern Taiwan that delivers approximately 4,000 children each year., Participants: a systematic sample of 810 women who had delivered children at a medical centre. In total, 602 valid questionnaires were collected., Findings: the average pre-pregnancy and six month postpartum BMIs were 21.5 [standard deviation (S.D.)=3.32] and 22.48 (S.D.=3.39), respectively. Overweight (OW) and obesity (OB) increased from 18.27% before pregnancy to 27.57% at six months postpartum. Gestational weight gain (GWG) was 14.36, 14.37, 13.07 and 11.15kg among women in the underweight (UW), normal weight (NW), OW and OB groups, respectively; and six month postpartum weight retention was 3.32, 2.57, 1.67 and -0.29kg. GWG was the most significant predictor of postpartum weight change across groups., Key Conclusions: women with different body sizes at pre-pregnancy have common and specific risks for postpartum weight retention., Implications for Practice: individualised interventions should be developed to manage postpartum weight for women of different body sizes. Interventions should establish criteria for GWG and provide strategies to improve body image and modify lifestyle. The overall goal should be to manage postpartum weight gain and to promote women's health., (Copyright 2008 Elsevier Ltd. All rights reserved.)

Background: Several approaches have emerged for measuring self-reported fear of falling. A comparison of measurement scales' psychometric properties is needed for researchers to choose the proper scale for their study., Objectives: To compare the psychometric properties of the Falling Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC) and the Geriatric Fear of Falling Measurement (GFFM)., Design: Secondary analysis using baseline and 8-week data from a randomized, controlled trial on fall and fear of falling prevention., Settings: Rural area northeast of Taiwan with assessments conducted in participants' homes., Participants: Population-based sample of 168 community-dwelling older adults aged 60 and older., Methods: During a home visit, a nurse administered the Tinetti Mobility Scale, and asked about the FES, ABC, GFFM, WHOQOL, falls, chronic illnesses and medicines taken., Results: Baseline internal consistency measured using Cronbach's alpha was 0.98 for the FES, 0.96 for the ABC and 0.88 for the GFFM. Baseline concurrent validity between the FES, ABC and GFFM measured using a correlation coefficient was 0.88 (FES vs. ABC), -0.55 (FES vs. GFFM), and -0.57 (ABC vs. GFFM), respectively, p<.001. All three instruments scores were significantly correlated at baseline with physical performance tests and WHOQOL. The GFFM demonstrated responsiveness to change at 8 weeks., Conclusions: The FES, ABC and GFFM demonstrated strong internal consistency reliability. The GFFM had stronger associations with physical and psychosocial functioning and may be more appropriate for studies focused on improving all aspects of fear of falling. Both FES and ABC instruments demonstrated ceiling effects, which may explain the lack of responsiveness to change in relatively non-frail older community-dwelling adults. Instruments sensitive to measuring lower levels of fear of falling are needed to capture the full range of this phenomenon in this population.

Aim: This paper is a report of a trial to examine the effectiveness of individualized self-care education programmes in older adults with moderate-to-severe asthma., Background: Asthma is a common chronic disease in adults and a major cause of frequent work absences, emergency room visits, and hospitalization. The results of studies of self-care education programmes have been largely supportive and suggest that they have positive outcomes for people with asthma. However, for older people with asthma, the effectiveness of computer-aided, self-learning video programmes has been controversial., Methods: Older adult patients with asthma (N = 148) were randomly assigned to one of three groups: usual care, individualized education, or individualized education with peak flow monitoring, and followed for 6 months. Data were collected from January to December 2006. The variables studied included demographic data, asthma self-care competence, asthma self-efficacy, and asthma self-care behaviour. FINDINGS. Patients in both individualized education groups reported higher asthma self-care competence scores (F = 334.06 and 481.37, P < 0.001) and asthma self-care and self-efficacy scores (F = 104.08 and 68.42, P < 0.001) than patients in the usual care group. In addition, patients who received individualized education with peak flow monitoring had statistically significantly higher asthma self-care behaviour and self-efficacy scores (P < 0.001) and asthma control indicators (P = 0.025) than the education alone group. No differences were found among the three groups in unscheduled health service usage., Conclusion: Our results suggest that individualized education helps older people with asthma to enhance their self-care behaviours, manage their disease, and increase their quality of life.

The majority of persons who experience hip fracture do not regain their prefracture functional level. Independence may be compromised; however, there is little information on ways to maintain independence among elders who experience hip fracture. The aim of this study was to explore ways that elders maintain independence while coping with hip fractures. A qualitative approach with semistructured interviews was used in this study. A purposeful sample of 15 community-dwelling elders who had experienced a hip fracture in the previous year were interviewed. The data show 3 major ways that independence was maintained: through social support, resilience, and acceptance of the natural process. Clinicians need to determine how they can best foster social support to help elders maintain resilience and engage with them in conversations about the positive and negative aspects of the aging process to promote independence.

The purpose of this study was to identify factors potentially associated with weight retention measured 6 months after childbirth. A descriptive correlative design was used to systematically women who had given birth at a medical center located in northern Taiwan. Questionnaires were mailed to 810 subjects and a total of 602 valid questionnaires were collected, representing a response rate of 74.32%. The results of this study included: The average body mass index (BMI) was 21.5 (SD = 3.32) at pre-pregnancy, and 22.48 (SD = 3.39) at 6 months after childbirth. Average weight retention was 2.42 kg. Overweight and obese conditions increased among subjects from 18.27% pre-pregnancy to 27.57% at 6 months after childbirth. Significant predictors of weight retention identified in this study included gestational weight gain (GWG), perceived body image satisfaction, and pre-pregnancy weight, which, together, explained 34.5% of postpartum weight retention variance. Determinant factors identified by the analysis highlight the need for bodyweight management intervention during pregnancy as well as through the first 6-month postpartum as a way to reduce obesity and the incidence of obesity-related diseases.

Aim: The objective of this study was to examine the effectiveness of a discharge plan in hospitalized elderly patients with hip fracture due to falling., Background: Hip fractures are an important cause of morbidity and mortality among older people. Hip fracture patients require ongoing medical and long-term care services. Discharge plan services can play a very important role for these patients, since the services improved their outcome conditions., Methods: Hip fracture patients aged 65 years and older (n = 126), hospitalized due to falling and discharged from a medical centre in northern Taiwan, were randomly assigned to either a comparison group (the routine care) or experimental group (the discharge planning intervention). The outcomes used to determine the effectiveness of the intervention were: length of hospitalized stay, rate of readmission, repeat falls and survival, and activities of daily living., Results: The discharge planning intervention decreased length of stay, rate of readmission and rate of survival and improved activities of daily living for intervention group compared with those of control group. Mean total SF-36 scores of patients in the experimental group were higher than for the control group and both groups had improved quality of life., Conclusion: The discharge planning benefited older people with hip fractures., Relevance to Clinical Practice: A discharge planning intervention by a nurse can improve physical outcomes and quality of life in hip fracture patients.

The purpose of this study is to explore the underlying theoretical framework of managing fear of falling (FOF) among elders. A grounded theory approach was used. A purposive sample of 25 community-dwelling elders who admitted FOF was interviewed. Theoretical sampling was used to saturate the emergent concepts. Analysis of audiotaped interview transcripts generated a managing FOF process. Managing FOF is a dynamic process with consequences that are impacted by the level and which strategies are used with satisfaction by the elderly and supported by family/significant others. The study findings suggest that understanding the process of managing FOF from the perspective of elders is a significant first step in assisting them to prevent from falling.

The purposes of this study were to determine the prevalence and variables that best predict home environmental hazards among the community-dwelling elderly in Taiwan. An assessment was made of the home environments of 1212 people aged 65 years and older, chosen by cluster sampling from registered households in northern Taiwan. Environmental hazards were found in the majority of homes ( 60.4 % ) where community-dwelling elderly people lived. The bathroom was the most common site for environmental hazards. Significant predictors of potential home environmental hazards were: living in an urban area ( OR = 4.36, 95 % confidence interval ( CI = 3.29, 5.76 ) , poor awareness of one ' s health status ( OR = 1.86, 95 % CI = 1.31, 2.64 ) , family dysfunction ( OR = 1.77, 95 % CI = 1.21, 2.59 ) , fear of falling ( OR = 1.65, 95 % CI = 1.19, 2.28 ) , being older ( >/= 75 years, OR = 1.47, 95 % CI = 1.11, 1.96 ) , poor gait ( OR = 10.76, 95 % CI = 4.48, 25.84 ) and poor balance ( OR = 3.03, 95 % CI = 1.14, 8.09 ) . Most elderly persons do not live in a risk-free home environment. The recognition and removal of environmental hazards is imperative to the well-being of the elderly.

The purpose of this research was to examine the effect of a multifactorial intervention to prevent falls by increasing self-efficacy to prevent falls, improving the knowledge of medication safety, and decreasing the number of environmental risks in older persons dwelling in the community. A sample of 120 cognitively intact residents of this community who were 65 years of age and older were recruited into a two-group pretest-post-test experimental design and randomly assigned to an experimental group and a comparison group (60 in each group). The intervention was delivered, and data were collected during three home visits in a 4-month period. (1) Experimental subjects improved their fall self-efficacy, environmental safety, and knowledge of medication safety significantly (p < 0.01) as compared with those in the comparison group at post-test; (2) the incidence of falls was reduced at post-test in both groups compared to pretest scores, and the falling was more serious in the comparison group at post-test compared to that in the experimental group. The results can help community health professionals to individualize their interventions to the specific needs of the elderly, thus helping to prevent falls among community-dwelling elders.