Bee-Horng Lue

Sedation for refractory symptoms of terminal cancer patients in Taiwan.

This study assessed sedation in terminal cancer patients in terms of three characteristics: frequency; relationship to intractable symptoms; and the extent to which medical staff, family, and patients found sedation to be ethically acceptable and efficacious. Two hundred seventy-six consecutive patients, who were admitted to the palliative care unit of National Taiwan University Hospital in Taiwan between August 1998 and the end of May 1999, were enrolled. A recording form was completed every day. This included demographic data, pain and common symptom scores, and the use of sedation in the terminal phase. Seventy (27.9%) of 251 patients who died received sedation. Sedation was administered to relieve agitated delirium in 40 (57.1%), dyspnea in 16 (22.8%), severe pain in 7 (10%) and insomnia in 5 (7.2%). The drugs used for sedation were haloperidol in 35 (50%), midazolam in 17 (24.3%), and rapidly increasing dosage of morphine in 9 (12.9%). In fewer than half (42.9%) of the patients, sedation was with the consent of both patient and family, and half (50%) had the consent of family alone. The overwhelming majority of medical staff and family felt the decision to use terminal sedation was ethically acceptable. There was no significant difference in survival time between sedated and non-sedated patients (28.49 vs. 24.71 days, t = -0.791, P = 0.430). Positive ethical acceptability and higher satisfaction with symptom control with terminal sedation were found in both medical staff and family in this study. Further work is needed to find the most appropriate time of intervention and to improve management of refractory symptoms in dying patients.

The prevalence of subjective frailty and factors associated with frailty in Taiwan

This study estimated the prevalence of frailty and identified the factors associated with frailty in Taiwan using data from the Survey of Health and Living Status of the Elderly. A nationwide probability sample including 2,238 individuals aged > or =65 years was interviewed in 2003. Based on the Cardiovascular Health Study conducted by Fried, five phenotypes of frailty were selected: poor appetite, exhaustion, low physical activity, poor walking ability, and poor twisting ability of fingers. Participants were classified as nonfrail, prefrail, and frail if they met 0, 1 or 2, and > or =3 criteria. The prevalences of nonfrailty, prefrailty, and frailty were 55.1%, 40.0%, and 4.9%, respectively. The prevalence of frailty increased with age and was greater in women. Frailty was associated with less education, no spouse, disability, higher rates of comorbid chronic diseases, depressive symptoms, and geriatric syndromes. Specific drug use, such as hypnotics, analgesics, herbal drugs, and parenteral fluid supplements was positively associated with frailty. The use of multivitamins, fish oil, and vitamin E was negatively associated with frailty. The prevalence of frailty is lower in Taiwan than in Western countries. Depressive symptoms, geriatric syndromes, and specific medication use are potential fields for frailty prevention in community-dwelling older adults.

Health, financial stresses, and life satisfaction affecting late-life depression among older adults: a nationwide, longitudinal survey in Taiwan.

The purpose of this study was to determine the incidence of depression in late life and to explore associated risk factors among Taiwanese elderly. The analyses were based on nationally representative data from the Survey of Health and Living Status of the Elderly in 1999 and 2003. A total of 1,487 respondents aged 65 years and older who completed the 10-item Center for Epidemiological Survey Depression (CES-D) scale in these two surveys and without depression in 1999 were included in the final analyses. Depression was defined as a CES-D score equal to or greater than 10. The independent variables included sociodemographic characteristics, occurrence of new diseases, social support, perceived health and financial stresses, life satisfaction, and functional condition. The incidence rate of depression over 4 years was 19.7%. Multivariate regression analyses revealed that women who perceived greater health or financial stress and who had greater life dissatisfaction or worsened functional condition were more likely to suffer depression. These findings imply that healthcare programs for older adults should include cognitive and behavioral interventions in order to prevent the development of depression in late life.

The use of focus groups in evaluating quality of life components among elderly Chinese people.

In Taiwan, to measure the quality of life (QOL) of elderly Chinese, one must rely on instruments developed in other Chinese or Western populations and not specifically for the elderly. The purpose of this study is to understand the components of QOL for elderly Chinese from Taiwan living in residential homes or in their communities. Forty-four elderly men and women divided into six focus groups were interviewed on video tape and the resultant recording was analyzed qualitatively by six independent researchers. The study yielded 15 QOL domains grouped into six dimensions: physical health (physical well-being, impact of illness, medical care), psychological health (mood states, life attitude and retrospection, philosophy of living, self-efficacy), social function (connectedness, exercise and leisure activities, social activities and services), living environment (living environment and arrangements, institutional factors), economic status, and religion and death (religion, death). For elderly Chinese in Taiwan, positive and negative life domains are equally important in the perception of life quality; person-environment interaction is a major consideration in the evaluation of QOL; family ties are an important component of QOL; traditional Chinese beliefs exert a positive influence on perceived QOL; and social functioning and vitality have a different meaning in Chinese compared to Western cultures.

Development of a teaching style inventory for tutor evaluation in problem-based learning

Objective To develop and validate a self‐rating instrument to assess teaching styles among tutors in problem‐based learning (PBL).

Self-efficacy Affects Blood Sugar Control Among Adolescents With Type I Diabetes Mellitus

BACKGROUND/PURPOSE Self-management is crucial to diabetes control. To investigate the effectiveness of self-management in reaching target hemoglobin A1c (HbA1c) level, we conducted a study among Taiwanese adolescents with type 1 diabetes mellitus (DM). METHODS Patients aged 12-20 years with type 1 DM participated in an annual integrated DM care clinic at a medical center in Taiwan. All patients completed a questionnaire that included demographic data and self-efficacy measured by the Perceived Diabetes Self-Management Scale (PDSMS) in February 2008. Laboratory tests were also done at the same visit. The target HbA1c was < 7.0% in accordance with the general standard of the American Diabetes Association for patients with type 1 DM. Logistic regression analysis was used to explore the relationship between age, sex, duration of diabetes, PDSMS score, and HbA1c level. RESULTS Fifty-two patients were enrolled. The mean age was 16.0 +/- 2.4 years, and mean HbA1c level was 8.6 +/- 1.6%. Pearson correlation analysis showed a positive correlation between body mass index and preprandial blood sugar level (r = 0.297, p < 0.05). Negative correlations were found between PDSMS scores and duration of diabetes (r = -0.365, p < 0.01) as well as HbA1c level (r = -0.295, p < 0.05). Logistic regression analysis demonstrated that sex and PDSMS scores significantly influenced glycemic control. In multivariate logistic regression analysis, patients with higher PDSMS scores were 1.63 times (95% confidence interval = 1.03-2.59) more likely to reach target diabetes control after adjustment for other variables. Male patients also had a higher probability (odds ratio = 19.80, 95% confidence interval = 1.34-291.93) of reaching target diabetes control. CONCLUSION This study demonstrates that adolescents with type 1 DM and higher self-efficacy, especially males, have a higher probability of reaching target diabetes control.

Stress, personal characteristics and burnout among first postgraduate year residents : a nationwide study in Taiwan

Background: Many studies have recognized that the first postgraduate year (PGY-1) of residency training is the most stressful year. Failing to cope with the stress will have negative impact on their work performance and the quality of patient care. Aims: To investigate stress and burnout in first postgraduate year (PGY-1) residents and to explore the relationship among stress, personal characteristics and burnout. Methods: A total of 555 PGY-1 residents completed the job stress questionnaire, a Chinese version of the Copenhagen Burnout Inventory, NEO-Five Factor Inventory, Positive and Negative Affectivity Schedule Scale and Coping Strategies Inventory. Working hours were also collected. The association among stress, burnout, personality, coping strategies and affectivity was examined by Pearson correlation. Hierarchical multiple regression was performed to analyze the contribution of predictors to burnout. Results: Residents identified their working environment and emotional pressures and demands from patients as their primary sources of stress. They exhibited less neuroticism, more conscientiousness and a propensity for positive affectivity, as well as a tendency to use engagement coping strategies. Burnout was positively correlated with stress, neuroticism, negative affectivity, disengagement coping and weekly work hours. Job stress and work hours explained 24.7% of variance in burnout; personality and coping strategies explained an additional 10.4% and 5.4% of variance, respectively. Besides job stress and work-hours, introversion, conscientiousness, having negative affectivity and using disengagement coping predicted burnout. Conclusions: Residents personal characteristics were closely related to stress and burnout. Therefore, in addition to assessing their work-related stress, exploring their personal characteristics should be taken into account for early identification of residents at risk of burnout.

Expressed Emotion and its Relationship to Adolescent Depression and Antisocial Behavior in Northern Taiwan

BACKGROUND/PURPOSE Despite widespread recognition of the occurrence of antisocial behavior and depression in adolescents, the specifics of the relationship between them have not been clarified. The purpose of this study was to investigate the role of expressed emotion as a proximal factor for depression and antisocial behavior among adolescents, by looking at direct and indirect relationships. METHODS Secondary data analysis using path analysis was carried out on 2004 data from the Child and Adolescent Behaviors in Long-term Evaluation project. The study sample consisted of 1599 seventh-grade students in Northern Taiwan. Variables included family factors, personal factors (sex and academic performance), expressed emotion [emotional involvement (EI) and perceived criticism (PC)], depression, and antisocial behavior. RESULTS We found that one dimension of expressed emotion, PC, directly influenced student depression and related indirectly to antisocial behavior. Depression was an important mediator between PC and antisocial behavior. Another dimension, EI, did not influence either depression or antisocial behavior. Sex was related directly to expressed emotion, depression, and antisocial behavior, and also indirectly to antisocial behavior through PC and depression. Academic performance was related directly to expressed emotion and indirectly to antisocial behavior through PC and depression. CONCLUSION Greater PC from parents directly contributed to higher levels of student depression and was related indirectly to more student antisocial behavior. It is suggested that parents should decrease overly critical parenting styles to promote adolescent mental health and avoid the development of antisocial behavior.

Development of a Chinese chronic illness-related stress inventory for primary care.

This study evaluates the construct validity and internal consistency of a Chronic Illness-Related Stress Inventory (CRSI) for primary care Chinese patients and studies the relationship between chronic illness-related stress and sociodemographic characteristics and indices of disease severity. A total of 301 patients were interviewed using a structured questionnaire. The responses to the CRSI were divided into a frequency scale and a severity scale. Six factors including physical integrity and discomfort, psychosocial function and economic burdens, self-fulfillment and daily life, sexual function, self-esteem, and diet limitations were obtained for each CRSI scale. Except for the last factor, all other factors and the scale as a whole for both scales have a Cronbach alpha of > 0.90. The results of the convergent and discriminant validity analysis were promising. In addition, chronic illness-related stress was related to insurance status and the self-perceived severity of disease.

Students' evaluation on a two-stage anatomy curriculum.

This study evaluated students’ perspectives of the two-stage anatomy course, which is designed to retain the time-honored tradition of cadaver dissection and to include innovative components into anatomy education. A total of 94 sixth-year medical students completed a questionnaire survey at the end of the second stage anatomy course. The results showed that more than half of the students were satisfied with the two-stage anatomy course. Students found that cadaver dissection was most helpful in learning anatomy. The two-stage anatomy course can enhance understanding and memory of anatomical knowledge. However, students disagreed on whether or not the two-stage course can reduce the burden of learning or that the parallel study of anatomy and the ‘Life and Death’ course could change their attitude toward death more effectively. National Licensing Examination revealed no obvious change after the implementation of the new anatomy course. Traditional and innovative components in anatomy curriculum could coexist in harmony. We provided an alternative for those who wanted to retain cadaver dissection in a reformed curriculum. Further study is needed to evaluate the adequacy of anatomy knowledge and student performance in the long run.