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Dietary problems are frequently reported in cancer patients and survivors which may reduce quality of life and cancer survival. Nurses' role in dietary management is recognized as important, but review evidence on nurse-led dietary interventions for cancer patients and survivors is lacking. This review aims to summarize evidence on nurse-led dietary interventions for cancer patients and survivors. Ten electronic databases (PubMed, CINAHL, CENTRAL, EMBASE, Web of Science, Ovid, CNKI, Wan Fang, CQVIP, Index to Taiwan Periodical Literature System) were searched from inception dates to November 11, 2021, using the key search terms "cancer/nutrition/nurse-led/intervention." Eligible studies were experimental studies on nurse-led dietary interventions for improving dietary intake in cancer patients and survivors published in peer-reviewed journals in English or Chinese. The methodological quality of the included studies was evaluated using the revised Cochrane risk-of-bias assessment tool. Data were extracted and summarized descriptively. Three randomized controlled trials on nurse-led dietary counseling published between 2005 and 2018 were included, with an overall high risk of bias. Two studies found positive intervention effects in improving fruit and vegetable intake, while the other study demonstrated an increase in energy intake. This is the first systematic review to summarize the evidence on nurse-led dietary interventions for cancer patients and survivors. Although available studies are limited, a positive trend was identified in that nurse-led dietary interventions are effective in increasing dietary intake in cancer patients and survivors. Additional studies in this field are required to further explore nurses' role in the development of nutritional oncology care.

Context. There are no available data regarding pain-associated clusters among nursing home residents and older adults receiving home care with chronic pain. Objectives To identify and describe pain-associated clusters in nursing home residents and older adults receiving home care with chronic pain, and to explore associations with clusters in both settings. Methods We surveyed 137 nursing home residents and 205 older adults receiving home care. Clusters were identified using hierarchical agglomerative cluster analysis, utilizing Ward’s method with Squared Euclidean Distances in the proximities matrix. The clusters were characterized based on socio-demographic and clinical characteristics. Multinomial logistic regression was used to identify variables associated with different clusters. Results In each setting, we identified three clusters: pain-relieved, pain-impaired, and suffering severe pain. In the nursing home study and the home care study, respectively, the participant distributions were 46.72% and 11.71% in the pain-relieved cluster, 22.63% and 33.66% in the pain-impaired cluster, and 30.66% and 54.63% in the severe-pain cluster. Appropriate pain medication was only detected among pain-relieved nursing home residents. Conclusion Overall, differences in pain management exist within the two care settings presented here. There is potential for improvement in both settings. Moreover, there exists a need for clinical interventions aiming at shifting from pain-affected clusters to pain-relieved status.

Chronic pain is common in nursing home residents, who may have difficulty seeking out pain management strategies. Peer support model show promise as a strategy for managing chronic conditions. This was a clustered randomized controlled trial. A peer-led pain management program was provided for the experimental group. Pain situation, depression, quality of life, non-drug strategies used, and pain knowledge were measured. A total of 262 participants joined the study (146 were allocated as experimental group and 116 as control group). Before our intervention, the mean pain score reported was as high as 6.36 on a 10-point Likert Scale. The high intensity of their pain very much interfered with the daily activities of the participants. Pain interference was high and the participants had poor coping as indicated by the low pain self-efficacy. Depression and a low quality of life score was found. Upon completion of our PAP, there was a significant increase in pain self-efficacy, pain interference as well as quality of life for the participants in the experimental group and not in the control group, and this improvement sustained in 3-month follow up. The present study used a peer support models and proven to be effective in managing pain and pain related situations for nursing home residents with chronic pain. The peer volunteers involved in the pain management program taught relevant pain knowledge and pain management strategies to help our participants.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03823495, NCT03823495.

This study tracks wellbeing of a large cohort of first-year engineering students at a large Canadian university over a remotely-delivered academic year. This continues a similar tracking study completed with inperson instruction the previous year. Data were collected through short, weekly surveys rotating through the student cohort. Overall, the results show relatively consistent stressors across the year, driven primarily by academics, and very similar to data from the previous year delivered in person. Wellbeing scores (measured through the Warwick-Edinburgh Mental Wellbeing Scale) declined slightly through the year, and were overall lower than the previous academic year delivered in-person. Considering factors of EDI, female students showed slightly lower wellbeing scores than male students, while international students showed slightly higher scores than Canadian students.

Background: Chronic pain is a major health problem among older adults and their informal caregivers, which has negative effects on their physical and psychological status. The dyadic pain management program (DPMP) is provided to community-dwelling older adults and informal caregivers to help the dyads reduce pain symptoms, improve the quality of life, develop good exercise habits, as well as cope and break the vicious circle of pain. Methods: A pilot randomized controlled trial was designed and all the dyads were randomly divided into two groups: the DPMP group and control group. Dyads in the DPMP group participated in an 8-week DPMP (4-week face-to-face program and 4-week home-based program), whereas dyads in the control group received one page of simple pain-related information. Results: In total, 64 dyads participated in this study. For baseline comparisons, no significant differences were found between the two groups. After the interventions, the pain score was significantly reduced from 4.25 to 2.57 in the experimental group, respectively. In the repeated measures ANOVA, the differences in pain score (F = 107.787, p &lt, 0.001, d = 0.777) was statistically significant for the group-by-time interaction. After the interventions, the experimental group participants demonstrated significantly higher pain self-efficacy compared with the control group (F = 80.535, p &lt, 0.001, d = 0.722). Furthermore, the elderly increased exercise time significantly (F = 111.212, p &lt, 0.001, d = 0.782) and reported developing good exercise habits. Conclusions: These results provide preliminary support for the effectiveness of a DPMP for relieving the symptoms of chronic pain among the elderly.

Background: 80% of nursing home residents have reported chronic pain, which is often accepted by older adults as part of aging. Peer support models are being used to help individuals manage their chronic conditions and overcome the challenges of limited healthcare resources. The aims of this study were: (i) to examine the effectiveness of a 12 week peer-led pain management program (PAP) for nursing home residents and (ii) to evaluate their experiences. Methods: A cluster randomized controlled trial (RCT) was used. The 12 week pain management program was provided for the experimental group. Outcomes were measured at three time points. The participants&rsquo, satisfaction and acceptance were evaluated by a semi-structured interview after the program was completed. Results: Pain self-efficacy, pain intensity, pain interference, pain knowledge, and depression levels improved after the completion of the 12 week peer-led PAP. The pain-intensity level reported at week 12 was significantly lower in the experimental group than in the control group. Semi-structured interviews showed that the nursing home residents were satisfied with the pain education that they received. Conclusions: The 12 week peer-led PAP appeared to improve the pain-related and psychological outcome measures in nursing home residents, and the feedback on the peer-led PAP from the nursing home residents was positive.

Introduction The objectives of this review paper were to synthesize the data from randomized controlled trials in the literature to come to a conclusion on the effects of e-health interventions on promoting physical activity in older people. Methods The Medline, CINAHL, Embase, PsycINFO, and SportDiscus databases were searched for articles about studies that 1) recruited subjects with a mean age of > 50 years, 2) tested e-health interventions, 3) employed control groups with no or less advanced e-health strategies, 4) measured physical activity as an outcome, 5) were published between 1st January 2008 and 31st May 2019, and 6) employed randomized controlled trials. The risk of bias in individual studies was assessed using the Physiotherapy Evidence Database scale. To examine the effects of the interventions, variables quantifying the amount of physical activity were extracted. The within-group effects of individual studies were summarized using Hedges g and 95% confidence intervals. Between-group effects were summarized by meta-analyses using RevMan 5.0 with a random effect model. Results Of the 2810 identified studies, 38 were eligible, 25 were included in the meta-analyses. The within-group effect sizes (Hedges g) of physical activity in the intervention group at T1 ranged from small to large: physical activity time (0.12 to 0.84), step counts (− 0.01 to 11.19), energy expenditure (− 0.05 to 0.86), walking time (0.13 to 3.33), and sedentary time (− 0.12 to − 0.28). The delayed effects as observed in T2 and T3 also ranged from small to large: physical activity time (0.24 to 1.24) and energy expenditure (0.15 to 1.32). In the meta-analysis, the between-group effect of the e-health intervention on physical activity time measured by questionnaires, physical activity time measured by objective wearable devices, energy expenditure, and step counts were all significant with minimal heterogeneity. Conclusion E-health interventions are effective at increasing the time spent on physical activity, energy expenditure in physical activity, and the number of walking steps. It is recommended that e-health interventions be included in guidelines to enhance physical activity in older people. Further studies should be conducted to determine the most effective e-health strategies.

Objectives To examine (1) the intra-rater, interrater, and test-retest reliabilities of the timed Up and Go test with a motor task (TUGmotor) in terms of the number of steps taken in the test and completion time in a population with chronic stroke; (2) the relation between stroke-specific impairments and the number of steps taken in the test and the completion time; (3) the minimum detectable change in TUGmotor times; and (4) the cutoff time that best discriminates the performance of people with stroke from that of older adults without stroke. Design Cross-sectional study. Setting University-based rehabilitation center. Participants A sample (N=65) of chronic stroke survivors (n=33) and healthy older adults (n=32). Interventions Not applicable. Main Outcome Measures TUGmotor times and number of steps taken; Fugl-Meyer Assessment for the Lower Extremities score; handheld dynamometer measurements of hip abductor, knee flexor and extensor, and ankle dorsiflexor and plantar flexor muscle strength; 5-times sit-to-stand test time, Berg Balance Scale score; conventional timed Up and Go test time, and Activities-specific Balance Confidence scale and Community Integration Measure questionnaire scores. Results The TUGmotor completion times and number of steps demonstrated excellent intra-rater, interrater, and test-retest reliabilities. The TUGmotor times correlated significantly with the Fugl-Meyer Assessment for the Lower Extremities and Berg Balance Scale scores, with hip abductor, knee flexor, ankle dorsiflexor and plantar flexor strength on the paretic side, with 5-times sit-to-stand test times, and with times on the conventional timed Up and Go test. The minimum detectable change in TUGmotor time was 3.53 seconds in stroke survivors. A TUGmotor cutoff time of 13.49 seconds was found to best discriminate the performance of stroke survivors from that of older adults without stroke. Conclusions The TUGmotor is a reliable, valid, and easy-to-administer clinical tool for assessing advanced functional mobility after a stroke.

OBJECTIVES To investigate: (i) the intra-rater, inter-rater and test-retest reliabilities of completion times and step counts on the Standardized Walking Obstacle Course test (SWOC); (ii) correlations between SWOC scores and stroke-specific impairments; (iii) the cut-off SWOC completion times and step counts for distinguishing differences in obstacle negotiation ability in people with chronic stroke and healthy older adults. DESIGN Cross-sectional study. SETTING University-based rehabilitation centre. SUBJECTS Twenty-nine people with stroke and 30 healthy older adults. METHODS SWOC completion times and step counts were measured under 3 conditions: (i) normal walking; (ii) walking with a tray; and (iii) walking with dark-glasses. The Fugl-Meyer Assessment of lower extremity, the Five-Times-Sit-to-Stand Test, the Berg Balance Scale, the Timed Up and Go Test (TUG), and the Community Integration Measure questionnaire, were also administered. RESULTS SWOC completion times and step counts showed very satisfactory to excellent reliabilities (intraclass correlation coefficient; ICC = 0.851-0.993). TUG times correlated significantly with SWOC completion times and step counts under the 3 conditions (r = 0.586-0.815, p

BACKGROUND Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear. OBJECTIVE We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA. METHODS An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ≥60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately. RESULTS We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85%). The recruitment rate was 33% (33/99), the participant retention rate was 91% (30/33), and the attendance rate of all the face-to-face sessions was 100% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1%). ActiGraph (58/66 days, 88%) and smartphone (54/56 days, 97%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group. CONCLUSIONS Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects. CLINICALTRIAL HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756

Pain management is a fundamental to nursing care for most of patients with chronic conditions.

Background: Chronic pain is common among older adults and is associated with adverse physical and psychological outcomes. Given the expected burden and limited healthcare resources, an innovative and cost-effective method to manage chronic pain should be developed. Peer volunteers (PVs) have been used as an affordable alternative to professional services to help patients manage their chronic conditions including pain with success and acceptance. The aim of this paper is to explore the experiences and perceptions of PVs in a peer-led pain management program among nursing home residents. Methods: This longitudinal study formed part of a wider research study, a clustered randomised controlled trial, which investigates the effectiveness of a 12-week peer-led pain management program (PAP) in relieving chronic pain and enhancing pain self-efficacy among nursing home residents. Quantitative data were collected from questionnaires (demographics, pain situation and pain knowledge) for all PVs. Qualitative data (PVs’ experiences in leading the PAP, their perceived benefits, limitations and barriers encountered, its usefulness to the participants and recommendations for improving the PAP) were collected from focus group for a selected sample at baseline (before attending the training) and at week 12 (upon completion of the PAP). Data were analysed using the Statistical Package for Social Sciences and NVivo 8. Results: A total of 46 PVs were recruited (34 female, 74%), with mean±SD age of 61.0±5.1 years. Thirty-one PVs reported to have chronic pain. Before the training, self-rated pain knowledge was 39.1±20.4 (maximum 100 points). When actual pain knowledge was assessed, a mean pain knowledge score of 86.1±10.6 points was found. There was a significant difference between the self-rated pain knowledge and the pain knowledge score (p

Background Pain is a common public health concern, and the pain situation among the general population is serious in mainland China. Working adults commonly experience pain because of long sitting times, a lack of free time, and exercise. A lack of pain-related knowledge is also a significant factor. Educational and therapeutic programs delivered online were used more often in Western countries, and accessible programs in China are limited, especially for pain management. Therefore, we carried out an online pain education program for working adults to self-manage pain. The program was delivered through WeChat, a popular and secure social media with a large population base in China. Objective This study aimed to (1) provide pain-related knowledge and self-relief strategies, (2) help participants reduce pain and improve pain-related emotional well-being, and (3) explore participants’ learning performance and the acceptability of the online pain education program. Methods This was a randomized controlled trial. Chinese adults aged between 16 and 60 years with full-time employment, with pain in the past 6 months, and without any mental illness were recruited using snowball sampling through the internet and were randomly allocated to an experimental group and a control group in 1:1 ratio after the baseline assessment. The 4-week educational program that included basic knowledge of pain, pharmacological and nonpharmacological treatments, and related resources was provided only to the experimental group. Outcomes of pain, depression, anxiety, stress, and pain self-efficacy were measured at baseline (T0), posttreatment (T1), and 1-month follow-up (T2). Participants’ acceptability and satisfaction were explored after completing the educational program. Results In total, 95 eligible participants joined in the program: 47 in the experimental group and 48 in the control group. Neck and shoulder, head, and back were most commonly reported pain sites with high pain scores. Pain intensity and interference of the experimental group were significantly reduced after the educational program. Depression, anxiety, and stress clinically improved and pain self-efficacy improved after the educational program. The difference in depression, anxiety, stress, and pain self-efficacy within a group or between groups was not statistically significant; however, clinical improvements were demonstrated. A significant correlation between dosage of the intervention and pain intensity and depression was demonstrated. After completing the educational program, more than half of the participants showed acceptance of and satisfaction with the program, and they were willing to recommend the program to others. Conclusions Our findings highlight the significant potential of this online education program in the treatment of pain. Trial Registration ClinicalTrials.gov NCT03952910; https://clinicaltrials.gov/ct2/show/NCT03952910

Pain management for older adults should be provided through both pharmacological and non-pharmacological interdisciplinary methods. Healthcare students’ perspectives regarding pain management might influence the quality of future care they provide to older adults. This study explored pain management strategies, knowledge, and education by surveying Japanese university students specializing in the healthcare sciences. We obtained 661 (44.4%) responses. The preferable strategy was a combination of pharmacological and non-pharmacological care (38.7%), particularly among nursing students (51.5%). A total of 563 (87.7%) students had not received pain management education during the past two years, and 404 (63.7%) desired more education. Pain medication knowledge was low to moderate; it was higher among medical students (p < 0.05). Poor pain management knowledge may affect the quality of care students provide to older adults after graduation. Support for older adults should be improved by further developing pain management education by considering the differences among disciplines.

Introduction: According to the records of the Hong Kong Athletic Gala for the Elderly, some sports events have been won by the same group of elderly participants for several consecutive years. What made these elderly athletes different from others? Method: This was a retrospective quantitative study. The health profile data on a total of 125 elderly participants were collected. 36 and 29 were the winners and losers of the Hong Kong Athletic Gala for the Elderly between 2008 and 2010, respectively. The remaining 60 were non-participants. The non-participants came from six elderly centers in different districts in Hong Kong. Health profile parameters were measured using the Health-Promoting Lifestyle Profile II, which is used to measure healthy behaviors such as physical activity level, nutrition, stress management, health responsibility, interpersonal relations and spiritual growth. Results: About 41.7% (n = 15) and 80.0% (n = 48) of the elderly (mean age = 74 ± 9.0) in the winner and non-participant groups with chronic diseases. There were significant (p

Aims and objectives To examine the pain prevalence in community-dwelling older adults and to explore the relationships between pain and physical and psychological parameters. Background Uncontrolled chronic pain is one of the barriers preventing older people from achieving active ageing. Effective pain management can enhance their mobility, increasing the happiness level and thus the quality of life. Design Exploratory cross-sectional study. Method Cognitively intact community-dwelling older persons aged over 60 in Hong Kong were invited for a 20–25-minute interview. Results A total of 173 participants were recruited, with a mean age of 73·2. The average pain intensity was 3·97 ± 1·80. Oral analgesic drugs were used by 47·1% of participants, and 86·0% used nonpharmacological methods to relieve pain. Compared with participants free of chronic pain, participants with pain had lower happiness levels (p

Aims and objectives To examine the effectiveness of an integrated motivational interviewing and physical exercise programme on pain, physical and psychological function, quality of life, self-efficacy, and compliance with exercise for community-dwelling older persons with chronic pain. Background Chronic pain is common among older persons. Indeed, motivation for managing pain is poor, and may cause negative consequences. Motivational interviewing maybe effective in treating chronic pain. Design Single-blinded randomised control study. Methods Older persons with chronic pain (n = 56) were recruited from two elderly community centres. They were blinded from the group allocation. The programme was conducted by an motivational interviewing-trained physiotherapist and registered nurses. Participants in the experimental group received an 8-week integrated motivational interviewing and physical exercise programme, while the control group received regular activities in the centre. Motivational interviewing used open-ended questions to encourage participants to express and recognise their pain and behaviours and professional feedback was given accordingly. Pain intensity, pain self-efficacy, anxiety, happiness, depression, mobility and quality of life were measured before and after the motivational interviewing and physical exercise programme. Attendance and compliance rate of the programme was calculated in the experimental group. Results Significant improvements in pain intensity, pain self-efficacy, anxiety, happiness and mobility after the motivational interviewing and physical exercise programme (all p

To evaluate the feasibility and preliminary effects of an individualized exercise programme with and without behavioural change enhancement strategies for frail older people with fatigue.A three-arm, single-blinded, quasi-experimental pilot study.Community health centres.A total of 79 frail older people with fatigue, mean age 79.32 years (±7.72).The combined group received a 16-week combined intervention consisting of exercise training and a behavioural change enhancement programme. The exercise group received exercise training and health talks, whereas the control group received only health talks.Feasibility was assessed through the participants' recruitment, retention, attendance and adherence, feedback, and reports of adverse events. The preliminary effects were assessed by the participants' level of fatigue, physical endurance, self-efficacy, and self-perceived compliance with exercise.Feasibility was achievable with high recruitment (87.2%) and low overall attrition (7.1%) rates. A similar reduction in fatigue was identified in all groups, but a trend of greater improvement in physical endurance was observed in the combined group than in the other two groups. The combined group also had a significantly better attendance rate [F(2,76) = 5.64, p 0.01)] and higher self-perceived exercise compliance than the exercise group.The combined intervention has the potential to enhance the participants' adherence to exercise regimens by improving their attendance in training sessions and their self-perceived exercise compliance. They are important to maintaining an appropriate level of engagement in daily exercises, especially at the beginning stages of behavioural change, when the participants are establishing the habit of exercising daily.

[Purpose] To investigate the inter-rater and test-retest reliability of the sitting-rising test (SRT), the correlations of sitting-rising test scores with measures of strength, balance, community integration and quality of life, as well as the cut-off score which best discriminates people with chronic stroke from healthy older adults were investigated. [Subjects and Methods] Subjects with chronic stroke (n=30) and healthy older adults (n=30) were recruited. The study had a cross-sectional design, and was carried out in a university rehabilitation laboratory. Sitting-rising test performance was scored on two occasions. Other measurements included ankle dorsiflexor and plantarflexor strength, the Fugl-Meyer assessment, the Berg Balance Scale, the timed up and go test, the five times sit-to-stand test, the limits of stability test, and measures of quality of health and community integration. [Results] Sitting-rising test scores demonstrated good to excellent inter-rater and test-retest reliabilities (ICC=0.679 to 0.967). Sitting-rising test scores correlated significantly with ankle strength, but not with other test results. The sitting-rising test showed good sensitivity and specificity. A cut-off score of 7.8 best distinguished healthy older adults from stroke subjects. [Conclusions] The sitting-rising test is a reliable and sensitive test for assessing the quality of sitting and rising movements. Further studies with a larger sample are required to investigate the test's validity.

tse m., leung r. & ho s. (2012) Pain and psychological well-being of older persons living in nursing homes: an exploratory study in planning patient-centred intervention. Journal of Advanced Nursing 68(2), 312–321. Abstract Aim. This article is a report on a study to examine the pain situation, the use of oral analgesics and non-pharmacological strategies and the psychological well-being of older patients living in nursing homes; the relationships between pain and psychological well-being were also explored. Background. Pain is common among older adults world-wide, and tends to be under-treated. Indeed, the high prevalence of pain may further hinder the fulfilment of psychological needs in a Maslow hierarchy of needs model. Method. It was a quantitative cross-sectional study; older adults from six nursing homes were invited to join the study in 2007–2009, with a response rate of 100%. Pain was measured using the Geriatric Pain Assessment, happiness using the Subjective Happiness Scale, life satisfaction using the Life Satisfaction Index – A Form, loneliness using the Revised UCLA Loneliness Scale and depression was measured using the Geriatric Depression Scale. Results. A convenience sample of 302 older patients (213 females and 89 males aged from 60 to 101, mean age of 84·99) joined the study. The majority of them had experienced pain in the previous 3 months, with a pain intensity of 4·51 on a 10-point scale. Pain sites were mainly the knee, back, shoulder and musculoskeletal areas. Only 50% of them took oral analgesics, and 70% used non-pharmacological measures for pain relief. The pain group reported significantly more loneliness and depression when compared with their no-pain counterparts. Conclusions. As the number of older patients increases, so does the need for alternative accommodation; thus, pain management education is urgently needed for staff and nursing home residents.

Aim. To provide a physical exercise programme for older adults living in nursing homes. Background. Pain is common among older persons and for those already in long-term care and having difficulty in coping with pain will be at risk of further reducing their optimal independent function. Design. A quasi-experimental single group pretest-posttest design. Method. Older persons from a nursing home were invited to join an eight-week physical exercise programme. Each session lasted an hour and sessions were conducted once a week by physiotherapist and nurses. Physical exercise programme consisted of stretching, strengthening, balancing, towel dancing and self-administered massage to various acupressure points. On completion of each session, older persons were given a pamphlet with pictures to illustrate the exercise of the day and they were encouraged to practise these exercises by themselves. Outcome measures including pain intensity, range of movement, activities of daily living and mobility were collected before and after the physical exercise programme. Results. There were 75 older adult participants (57 female and 18 male, mean age 85·14 SD 5·30). Seventy-three percent (n = 55) of them had pain in the previous three months and were referred as pain group, while 25% (n = 20) were no pain group. Pain scores of 4·89 (on a 10-point scale) indicated medium pain intensity before the intervention for the pain group; the location of pain was mainly in the knee, back and shoulder. On completion of the physical exercise programme, there was a significant decrease in pain intensity to 2·89 (SD 2·14) (p

CCN3 (NOV), a putative ligand for integrin receptors, is tightly associated with the extracellular matrix and mediates diverse cellular functions, including cell adhesion and proliferation. CCN3 has been shown to negatively regulate growth although it promotes migration in a cell type-specific manner. In this study, overexpression of CCN3 reduces growth and increases intercellular adhesion of breast cancer cells. Interestingly, CCN3 overexpression also led to the formation of multiple pseudopodia that are enriched in actin, CCN3, and vinculin. Breast cancer cells preincubated with exogenous CCN3 protein also induced the same phenotype, indicating that secreted CCN3 is sufficient to induce changes in cell morphology. Surprisingly, extracellular CCN3 is internalized to the early endosomes but not to the membrane protrusions, suggesting pseudopodia-enriched CCN3 may derive from a different source. The presence of an intracellular variant of CCN3 will be consistent with our finding that the cytoplasmic tail of the gap junction protein connexin43 (Cx43) associates with CCN3. Cx43 is a channel protein permitting intercellular communication to occur. However, neither the channel properties nor the protein levels of Cx43 are affected by the CCN3 protein. In contrast, CCN3 proteins are down-regulated in the absence of Cx43. Finally, we showed that overexpression of CCN3 increases the activity of the small GTPase Rac1, thereby revealing a pathway that links Cx43 directly to actin reorganization.

To meet the needs of frail older people and to promote functional longevity, providing health education and disease prevention to the elderly is important. The present study describes the development, implementation, and evaluation of an e-health program for older persons. The objective of the 4-week e-health program was to improve elders' autonomous access to and use of health-related information in the form of physical exercise videography from a government-sponsored Web site. The content of the program included participants' mastery of basic computing skills and accessing and enhancing participants' interest in seeking health-related knowledge and information via the Internet. Data were collected in weeks 1 (pretest) and 4 (posttest) using questionnaires and open-ended questions. Thirty older people participated in the study (9 males, 21 females, aged 65-80 years, with the mean age of 72). Participants' mastery of basic computer operating skills increased significantly (p < 0.05); they were able to access health information via the Internet and had gained health-related knowledge by week 4 posttest (p < 0.05). The overall learning experience was positive. In conclusion, the collaboration of community partners in sponsoring a technology-based e-health program would be an effective way to provide health education to older people.

Background: Nutrition plays an important role throughout the life span. It is the interaction of nutrition and health that form part of the aging process. Nutrition affects the maintenance of physiological and biological process of aging, also, the risk of development of acute and chronic diseases.Objective: To examine dietary-related behaviors and lifestyle factors among non-institutionalized older persons in a local Chinese community.Design, setting & participants: It was a cross-sectional qualitative descriptive design. A convenience sample of 36 older persons (mean + SD age, 75±7.8 years) in a community center were approached and invited to complete a questionnaire regarding their dietary-related profile and the self-perceived nutritional and health status.Results: Results showed that 40% (n=14) of the older persons lived alone and ate alone on a regular basis, taking few fruit and vegetables per day, inadequate fluid and no dairy or bean curd products, and 48% (n=17) were overweight or obese. The self-perceived nutritional status correlated directly with perceived health status, which was high.Clinical relevance: The clinical relevance of this study is highlighted by the far from optimal dietary behaviors among this group of older persons. Nurses and health care providers working in the community should provide education on healthy diet and nutrition-related health problems, especially to older persons, for health maintenance and disease prevention.

The Internet is becoming the preferred place for finding information. Millions of people go online in search of health and medical information. Likewise, health care professionals must be able to retrieve and manage information in an efficient, effective manner. The development of health technology and informatics (HTI) has been rapid, yet little is known about the knowledge and attitudes of nursing students with regard to using HTI. Therefore, the objective of the present study was to explore nursing students' knowledge of and attitudes toward using HTI and to use an e-learning workshop to enhance the effective use of HTI. In Phase I, 115 first-year full-time nursing students were invited to complete a 13-item questionnaire regarding knowledge of and attitudes toward computer and Internet use, knowledge of HTI, and attitudes toward the future development of HTI. Participants perceived themselves to be knowledgeable in computer and Internet use, while knowledge of HTI was perceived to be low and attitudes toward the future development of HTI were generally positive. Phase II was an e-learning HTI workshop; topics included an introduction to HTI, examples of HTI in use, and the application and implementation of various HTI projects. There were 30 participants in the E-learning workshop, and their feedback was positive. Nurses and all health care professionals must be prepared to participate in the development of health technology and informatics. Teaching and learning activities should be geared toward mastery of HTI in the nursing education curriculum in order to enhance health care quality and safety.

The Internet is becoming a preferred place to find information. Millions of people go online in the search of health and medical information. Likewise, the demand for Web-based courses grows. This article presents the development, utilization and evaluation of a web-based pharmacology course for nursing students. The course was developed based on 150 commonly used drugs. There were 110 year 1 nursing students took part in the course. After attending six hours face to face lecture of pharmacology over three weeks, students were invited to complete a questionnaire (pre-test) about learning pharmacology. The course materials were then uploaded to a WebCT for student's self-directed learning and attempts to pass two scheduled online quizzes. At the end of the semester, students were given the same questionnaire (post-test). There were a significant increase in the understanding compared with memorizing the subject content, the development of problem solving ability in learning pharmacology and becoming an independent learner (p ,0.05). Online quizzes yielded satisfactory results. In the focused group interview, students appreciated the time flexibility and convenience associated with web-based learning, also, they had made good suggestions in enhancing web-based learning. Web-based approach is promising for teaching and learning pharmacology for nurses and other health-care professionals.

Effective pain management requires accurate knowledge, attitudes and assessment skills. To determine the current knowledge level and attitudes of nurses in pain management, 1,604 registered nurses working in three different hospitals in Hong Kong were invited to participate in this study. The sample consisted of 601 registered nurses, 63 nursing officers, and 14 nursing specialists (N = 678). The response rate was 43%. The Nurses' Knowledge and Attitudes Survey Instrument questionnaire developed by McCaffery and Ferrell was translated into Chinese and used with permission. To ensure the contextual relevancy and consistency of the questionnaire, content validity and test-retest reliability tests were performed. The content validity index was 0.87 and the test-retest reliability (Spearman's p coefficient) was 0.812. The percentage of correctly answered questions was 44%. There was statistical significant in educational preparation and clinical experiences with correct scores. The findings of our study suppo...

Severe acute respiratory syndrome (SARS) has affected many areas of the world recently and is becoming a global problem. Hong Kong and China have been most severely affected by this new infectious disease. The elderly population is highly vulnerable, and mortality in those older than 65 years is more than 50%. In our study, 27 health care workers and 40 elderly residents in a nursing home were interviewed to investigate their level of knowledge of SARS and its prevention. Most of the elderly residents knew little regarding SARS and prevention strategies, despite access to outside news by TV, radio, and visitors. Also, the worry and fear of an outbreak of SARS among staff working in the nursing home was considered to be high. Tailored education programs to promote awareness and prevention of SARS for the elderly are needed. Also, more in-service training, support, and counseling are strongly indicated for staff to promote disease prevention and improve quality of care.

For many hospital patients, the experience brings pain and anxiety. Unfamiliar surroundings, various diagnostic and therapeutic procedures, and the sight and sounds of medical procedures exacerbate pain and anxiety. To block off the anxiety-inducing sights and sounds of hospital surroundings and create a pleasing environment, the therapeutic potential of visual stimulation as a nursing intervention was investigated. In a randomized, controlled, cross-over study, pain was produced by a modified tourniquet technique in 46 healthy volunteers. Subjects were randomly allocated to two groups (Group V and Group B) with subsequent cross-over. Those in Group V watched a soundless video display of natural scenery during tourniquet inflation, whereas in Group B subjects watched a static blank screen. Pain threshold was defined as the time when subjects reported the first detectable pain, whereas pain tolerance was the time the pain was reported to be intolerable and deflation of the tourniquet was requested. With the use of visual stimuli, there was a significant increase in pain threshold (P < 0.05) and pain tolerance (P < 0.01). Gender and the sequence of visual stimuli did not have any significant effect on pain threshold and pain tolerance. Further studies specifically addressing level of anxiety and physiological data correlated with pain scores and visual stimuli are needed. The findings have implications for nurses and other healthcare professionals to use various visual stimuli as positive adjuncts to other methods of pain relief and for different pain conditions in clinical areas.

Objectives To investigate (1) the intrarater, interrater, and test-retest reliability of the times and scores generated in the parallel walk test (PWT); (2) their correlations with impairments and activity limitations of individuals with stroke; and (3) the cutoff times that best discriminate individuals with stroke from healthy elderly subjects. Design Cross sectional study. Setting University-based rehabilitation center. Participants Participants (N=72) comprised individuals with stroke (n=37) and healthy individuals (n=35). Interventions Not applicable. Main Outcome Measures The PWT was administered along with the Fugl-Meyer Motor Assessment of the Lower Extremities (FMA-LE), handheld dynamometer measurements of ankle dorsiflexor and plantarflexor muscle strength, the 5-Times-Sit-to-Stand Test, the Berg Balance Scale (BBS), a limits of stability (LOS) test, the 10-m walk test (10-MWT), and the timed Up and Go (TUG) test. Results PWT times and scores showed good to excellent intrarater, interrater, and test-retest reliability in individuals with stroke. PWT times using paths of 3 different widths significantly correlated with FMA-LE scores, 5-Times-Sit-to-Stand Test times, BBS scores, some LOS test results, 10-MWT gait speed, and TUG test times. PWT times of 6.30 to 7.48 seconds, depending on the path width, were shown reliably to discriminate individuals with stroke from healthy individuals. Conclusion The PWT is a reliable, easy-to-administer clinical tool for assessing dynamic walking balance in individuals with chronic stroke.

To examine the effectiveness of an aromatherapy programme for older persons with chronic pain. The community-dwelling elderly people who participated in this study underwent a four-week aromatherapy programme or were assigned to the control group, which did not receive any interventions. Their levels of pain, depression, anxiety, and stress were collected at the baseline and at the postintervention assessment after the conclusion of the four-week programme. Eighty-two participants took part in the study. Forty-four participants (37 females, 7 males) were in the intervention group and 38 participants (30 females, 8 males) were in the control group. The pain scores were 4.75 (SD 2.32) on a 10-point scale for the intervention group and 5.24 (SD 2.14) for the control group before the programme. There was a slight reduction in the pain score of the intervention group. No significant differences were found in the same-group and between-group comparisons for the baseline and postintervention assessments. The depression, anxiety, and stress scores for the intervention group before the programme were 11.18 (SD 6.18), 9.64 (SD 7.05), and 12.91 (SD 7.70), respectively. A significant reduction in negative emotions was found in the intervention group (P<0.05). The aromatherapy programme can be an effective tool to reduce pain, depression, anxiety, and stress levels among community-dwelling older adults.

Inadequate infection control knowledge about enteral feeding (EF) practices among nursing home staff may lead to contamination of EF systems.To investigate the effectiveness of an infection control programme (ICP) on knowledge and practice of EF of nursing home staff, and to explore the correlation between the ICP and bacterial contamination of the hands of staff and feeding equipment.Using a quasi-experimental pre-post-test control design, each intervention and control group consisted of 15 residents and 10 staff. EF knowledge and practice were assessed by questionnaire and observation. The intervention group received an ICP. Samples were collected from the hands of staff, enteral feed, flow regulators, feeding tube hubs, and the nasopharynx and gastric fluid of residents, and analysed for total bacterial counts and presence of meticillin-resistant Staphylococcus aureus (MRSA) before and after the ICP.The intervention group showed a significant improvement in knowledge and practice after the ICP (P 0.05). Pretest samples from the hands of staff, tube hubs, and the nasopharynx and gastric fluid of residents were contaminated with10(4) colony-forming units/mL. Contamination was significantly lower in the post-test samples of the intervention group (P 0.05), and remained unchanged in the control group. The mean (± standard deviation) number of MRSA-positive samples decreased from 2.1 ± 1.6 to 0.4 ± 0.7 (P 0.05) in the intervention group. MRSA hand contamination was highly correlated with contamination of regulators, gastric fluid, tube hubs and enteral feed (P 0.05), illustrating the close relationship between contaminated feed and poor hand hygiene.An effective ICP can significantly reduce the contamination of enteral feed. The provision of ICPs is strongly recommended in nursing homes.

This article is a report on a study to examine the pain situation, the use of oral analgesics and non-pharmacological strategies and the psychological well-being of older patients living in nursing homes; the relationships between pain and psychological well-being were also explored.Pain is common among older adults world-wide, and tends to be under-treated. Indeed, the high prevalence of pain may further hinder the fulfilment of psychological needs in a Maslow hierarchy of needs model.It was a quantitative cross-sectional study; older adults from six nursing homes were invited to join the study in 2007-2009, with a response rate of 100%. Pain was measured using the Geriatric Pain Assessment, happiness using the Subjective Happiness Scale, life satisfaction using the Life Satisfaction Index - A Form, loneliness using the Revised UCLA Loneliness Scale and depression was measured using the Geriatric Depression Scale.A convenience sample of 302 older patients (213 females and 89 males aged from 60 to 101, mean age of 84·99) joined the study. The majority of them had experienced pain in the previous 3 months, with a pain intensity of 4·51 on a 10-point scale. Pain sites were mainly the knee, back, shoulder and musculoskeletal areas. Only 50% of them took oral analgesics, and 70% used non-pharmacological measures for pain relief. The pain group reported significantly more loneliness and depression when compared with their no-pain counterparts.As the number of older patients increases, so does the need for alternative accommodation; thus, pain management education is urgently needed for staff and nursing home residents.

This study was to investigate the effectiveness of an Infection Control Programme (ICP) in knowledge and practice of enteral feeding of nursing home staff, and to explore any enteral feed contamination and correlation among nursing home staff, residents and feeding equipment devices.

The purpose of this exploratory cross-sectional study was to explore the health-related profile and quality of life among older persons living with and without pain in nursing homes. Ten nursing homes were approached, and 535 older persons were invited to join the study from 2009 to 2011. The nursing home residents' demographic information and information regarding their pain situation and the use of oral analgesic drug and nondrug therapy among the older residents with chronic pain were also collected. Residents' physical health (using the Barthel Activities of Daily Living (ADL) and Elderly Mobility Scores); psychologic health, including happiness, life satisfaction, depression, and loneliness (using the Happiness Scale, the Life Satisfaction Scale, the Geriatric Depression Scale, and the UCLA Loneliness Scale); and quality of life were investigated. Among the 535 nursing home residents, 396 (74%) of them suffered from pain, with mean pain scores of 4.09 ± 2.19, indicating medium pain intensity a remaining 139 (26%) reported no pain. The location of pain was mainly in the knees, back and shoulders. Our results demonstrated that, with the exception of the no-pain group (p.05), nursing home residents' pain affected both their psychologic health, including happiness, life satisfaction, and depression, and their physical quality of life. Nevertheless, only one-half of the older persons with pain used oral analgesic drug or nondrug therapy to relieve their pain. Pain had a significant impact on their mobility and ADL, was positively correlated with happiness and life satisfaction, and was negatively correlated with loneliness and depression. Pain management is a high priority in elderly care; as such, innovative and interdisciplinary strategies are necessary to enhance quality of life particularly for older persons living in nursing homes.

This study enhanced nutritional knowledge in an education program and encouraged healthy dietary habits and regular physical activity among teenagers. A total of 203 adolescents from a secondary school in Hong Kong took part in the study. Their Body Mass Index, dietary habits, and physical exercise pattern were recorded and examined before and after the health education program. The prevalence of overweight and obesity, together with the fat composition, were high among the participants before the nutrition education program. There was a marked gain in knowledge upon its completion. A follow-up action conducted 3 months later revealed positive outcomes in relation to the diet and physical activity level. The teenagers were able to take control of their health and requested the tuck shop to sell more healthy food and reduce the supply of unhealthy items. The educational initiatives in dietary habits and physical activities proved to be effective in encouraging the teenagers to eat more healthily and to adopt an active lifestyle.

The Internet is becoming the preferred place to find information. Millions of people go online in search of health and medical information. Likewise, the demand for Web-based courses is growing. This paper presents the development, utilization, and evaluation of a Web-based e-learning course for nursing students, entitled Integration of Pathophysiology into Pharmacology. The pathophysiology component included cardiovascular, respiratory, central nervous and immune system diseases, while the pharmacology component was developed based on 150 commonly used drugs. One hundred and nineteen Year 1 nursing students took part in the course. The Web-based e-learning course materials were uploaded to a WebCT for students' self-directed learning and attempts to pass two scheduled online quizzes. At the end of the semester, students were given a questionnaire to measure the e-learning experience. Their experience in the e-learning course was a positive one. Students stated that they were able to understand rather than memorize the subject content, and develop their problem solving and critical thinking abilities. Online quizzes yielded satisfactory results. In the focus group interview, students indicated that they appreciated the time flexibility and convenience associated with Web-based learning, and also made good suggestions for enhancing Web-based learning. The Web-based approach is promising for teaching and learning pathophysiology and pharmacology for nurses and other healthcare professionals.

Objectives. To explore nursing home-related beliefs among older Hong Kong Chinese and identify strategies that make nursing homes a better place to live. Background. Increased life expectancy has markedly increased the prevalence of age-related disease and disability, which limits the self-caring ability of older persons. Nursing home placement offers one possible alternative. However, the perspectives of older persons on nursing home admission have been seriously neglected and under-reported. Methods. The research was a qualitative descriptive study. Clients of a community centre for older people were approached and invited for an interview. Results. Participants included 118 older persons (61 female and 57 male) age from 60–89 years. Ninety per cent had chronic diseases and needed regular follow-up. Half of participants had never visited a nursing home. Of them, 85% would not want to live in a nursing home upon getting old and their nursing home-related beliefs were found to be negative. Participants expressed the feeling of being abandoned by their family members, insecure and lonely regarding the nursing home placement. Living in a nursing home was considered as ‘living in jail’ and that their privacy would be lost. Nevertheless, positive aspects of nursing home placement were mentioned, and strategies were explored that would make nursing homes a better place for older people to live. Relevance to Clinical Practice. Positive aspects of nursing home placement need to be promoted. Nurses should be advocates for the health of the elderly, and help make nursing homes a better place to live.

For most age-related disorders there is no cure, and treatment is expensive and often ineffective. Thus, disease prevention is an issue of increasing concern and importance. Nurses form the largest professional healthcare group in the world, and the professional code of the modern day nurse advocates health promotion as a primary role. Nurses, by virtue of their close, direct interaction with their community and clients, are in a strong position to disseminate and reinforce the message of health promotion with the aim of achieving functional longevity in our aging population. This requires that nurses themselves increase their awareness, knowledge and understanding of relevant interdisciplinary research findings. In the current review, the influence of diet on the risk of four of the most prevalent age-related diseases (cancer, cardiovascular disease, dementia and diabetes) is presented, and the underlying mechanisms of influence are discussed, with particular focus on antioxidant-rich foods.