Enid Wai-yung Kwong

Pressure ulcer development in older residents in nursing homes: influencing factors

AIM This paper is a report of a study assessing pressure ulcer incidence and factors affecting pressure ulcer development among older nursing home residents. BACKGROUND Previous researchers have shown that demographic, clinical, health status, risk and human resources factors affect pressure ulcer development among older people in various healthcare settings, but none has investigated their interactive effects among older nursing home residents. METHOD This was a prospective cohort study involving 346 residents aged 65 years or over from four private nursing homes in Hong Kong. We collected information on participant demographics and assessed their clinical characteristics, health status and pressure ulcer risk factors. Subsequently, we assessed their skin condition every 2 days for 4 weeks to detect pressure ulcers that developed after the initial assessment. The data were collected between December 2006 and September 2007. RESULTS The pressure ulcer incidence was 25.16%. The model in which the factors of clinical characteristics, health status, pressure ulcer risk and human resources were controlled was more reliable in predicting pressure ulcer development than the other two models. It showed that bedfast or chairfast residents, especially those with co-morbidities (renal failure and stroke) and living in nursing homes where there were no nurses but more nursing assistants, were at higher risk for pressure ulcer development. CONCLUSION Evidence-based interventions should be adopted to minimize the possible problems of pressure, malnutrition, friction and shear force, and the decreased pain perception of bedfast or chairfast residents in nursing homes, especially those with renal failure or stroke.

Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting

AIMS AND OBJECTIVES To assess and compare the predictive validity of the modified Braden and Braden scales and to identify which of the modified Braden subscales are predictive in assessing pressure ulcer risk among orthopaedic patients in an acute care setting. BACKGROUND Although the Braden scale has better predictive validity, literature has suggested that it can be used in conjunction with other pressure ulcer risk calculators or that some other subscales be added. To increase the predictive power of the Braden scale, a modified Braden scale by adding body build for height and skin type and excluding nutrition was developed. DESIGN A prospective cohort study. METHOD A total of 197 subjects in a 106-bed orthopaedic department of an acute care hospital in Hong Kong were assessed for their risk for pressure ulcer development by the modified Braden and Braden scales. Subsequently, daily skin assessment was performed to detect pressure ulcers. Cases were closed when pressure ulcers were detected. RESULTS Out of 197 subjects, 18 patients (9.1%) developed pressure ulcers. The area under the receiver operating characteristic curve for the modified Braden scale was 0.736 and for the Braden scale was 0.648. The modified Braden cut-off score of 19 showed the best balance of sensitivity (89%) and specificity (62%). Sensory perception (Beta = -1.544, OR=0.214, p = 0.016), body build for height (Beta = -0.755, OR = 0.470, p = 0.030) and skin type (Beta = -1.527, OR = 0.217, p = 0.002) were significantly predictive of pressure ulcer development. CONCLUSION The modified Braden scale is more predictive of pressure ulcer development than the Braden scale. RELEVANCE TO CLINICAL PRACTICE The modified Braden scale can be adopted for predicting pressure ulcer development among orthopaedic patients in an acute care setting. Specific nursing interventions should be provided, with special attention paid to orthopaedic patients with impaired sensory perception, poor skin type and abnormal body build for height.

Effect of a life review program for Chinese patients with advanced cancer: a randomized controlled trial.

BACKGROUND Empirical data suggest that life review is an effective psychospiritual intervention. However, it has not been applied to Chinese patients with advanced cancer, and its effects on this population remain unknown. OBJECTIVE The aim of the study was to determine the effect of a life review program on quality of life among Chinese patients with advanced cancer. METHODS In this prospective randomized controlled trial, a total of 80 patients were randomly assigned to the life review program group and the control group. The 3-weekly life review program included reviewing a life and formulating a life review booklet. Outcome data were assessed by a collector who was blinded to group assignment before and immediately after the program and at a 3-week follow-up. RESULTS Significantly better scores in overall quality of life, support, negative emotions, sense of alienation, existential distress, and value of life were found in the life review group immediately after the program and at the 3-week follow-up. CONCLUSION This study provides additional data on the potential role of a life review in improving quality of life, particularly psychospiritual well being; it also indicates that the life review program could enable Chinese patients with advanced cancer to express their views on life and death. IMPLICATIONS FOR PRACTICE The life review program offers advanced cancer patients an opportunity to integrate their whole life experiences and discuss end-of-life issues, which lays the ground for further active intervention in their psychospiritual distress. The program could be integrated into daily home care to enhance the psychospiritual well-being of Chinese patients with advanced cancer.

Considerations and design on apps for elderly with mild-to-moderate dementia

Many elderly people suffer from dementia in their daily life. The symptoms of dementia include impairments in thinking, communicating and recalling things of the past. Dementia can be caused by brain damage incurred from stroke (brain infarct), injury or other diseases. Recently, research has indicated a potential rehabilitative role for touchscreen technology in dementia. Elders can use apps to aid recall in order to support activities of daily living. Memory and activity apps can be developed for people suffering from early dementia. This paper presents the current state of development in the field of cognitive tests. It has also presented the many considerations and design issues related to the development of apps for people with dementia.

The Anti-Inflammatory and Antibacterial Action of Nanocrystalline Silver and Manuka Honey on the Molecular Alternation of Diabetic Foot Ulcer: A Comprehensive Literature Review

Honey and silver have been used since ancient times for treating wounds. Their widespread clinical application has attracted attention in light of the increasing prevalence of antibiotic-resistant bacteria. While there have been a number of studies exploring the anti-inflammatory and antibacterial effects of manuka honey and nanocrystalline silver, their advantages and limitations with regard to the treatment of chronic wounds remain a subject of debate. The aim of this paper is to examine the evidence on the use of nanocrystalline silver and manuka honey for treating diabetic foot ulcers through a critical and comprehensive review of in vitro studies, animal studies, and in vivo studies. The findings from the in vitro and animal studies suggest that both agents have effective antibacterial actions. Their anti-inflammatory action and related impact on wound healing are unclear. Besides, there is no evidence to suggest that any topical agent is more effective for use in treating diabetic foot ulcer. Overall, high-quality, clinical human studies supported by findings from the molecular science on the use of manuka honey or nanocrystalline silver are lacking. There is a need for rigorously designed human clinical studies on the subject to fill this knowledge gap and guide clinical practice.

Predicting Systolic Blood Pressure Using Machine Learning

In this paper, a new study based on machine learning technique, specifically artificial neural network, is investigated to predict the systolic blood pressure by correlated variables (BMI, age, exercise, alcohol, smoke level etc.). The raw data are split into two parts, 80% for training the machine and the remaining 20% for testing the performance. Two neural network algorithms, back-propagation neural network and radial basis function network, are used to construct and validate the prediction system. Based on a database with 498 people, the probabilities of the absolute difference between the measured and predicted value of systolic blood pressure under 10mm Hg are 51.9% for men and 52.5% for women using the back-propagation neural network With the same input variables and network status, the corresponding results based on the radial basis function network are 51.8% and 49.9% for men and women respectively. This novel method of predicting systolic blood pressure contributes to giving early warnings to young and middle-aged people who may not take regular blood pressure measurements. Also, as it is known an isolated blood pressure measurement is sometimes not very accurate due to the daily fluctuation, our predictor can provide another reference value to the medical staff. Our experimental result shows that artificial neural networks are suitable for modeling and predicting systolic blood pressure.

Views of Adults on Shopping Trolleys: Implications for the Development of a Shopping Trolley

Expert recommendations regarding trolley specifications and customer expectations of trolley features are equally important in the development of a customer-oriented shopping trolley that minimizes the risk of musculoskeletal injuries. However, little is known about such customer expectations, and hence this study aimed to examine the views of Hong Kong adults on shopping trolleys. A cross-sectional survey was conducted with a sample of 140 Chinese adults aged 40 or over with no cognitive or communication impairments. These adults were approached in markets, supermarkets, and public parks in Hong Kong. Individual face-to-face interviews using a questionnaire were used to collect the data. Fifty-six (40%) of the participants were current users, 32 (23%) were ex-users, and 52 (37%) were non-users of shopping trolleys. More of the user and ex-user participants perceived shopping trolleys to be energy saving and protective of the joints. Lightness and easy storage, a pulling and pushing motion, suitability for use on stairs, and adjustable handle height were the trolley features most frequently expected by the participants. The user and ex-user participants rated lightness, a pushing motion and changeable trolley bags to be comparatively more important than the non-user participants. The findings have implications for the development of an evidence-based shopping trolley design. Close cooperation is needed between ergonomists and design and engineer experts to develop an ergonomically designed shopping trolley that prioritizes the health and safety of its users.

An individualized exercise programme with and without behavioural change enhancement strategies for managing fatigue among frail older people: a quasi-experimental pilot study

Objective: 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. Design: A three-arm, single-blinded, quasi-experimental pilot study. Setting: Community health centres. Participants: A total of 79 frail older people with fatigue, mean age 79.32 years (±7.72). Interventions: 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. Main outcome measure(s): 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. Results: 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. Conclusion: 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.

Beliefs and knowledge about vaccination against AH1N1pdm09 infection and uptake factors among Chinese parents.

Vaccination against AH1N1pdm09 infection (human swine infection, HSI) is an effective measure of preventing pandemic infection, especially for high-risk groups like children between the ages of 6 months and 6 years. This study used a cross-sectional correlation design and aimed to identify predicting factors of parental acceptance of the HSI vaccine (HSIV) and uptake of the vaccination by their preschool-aged children in Hong Kong. A total of 250 parents were recruited from four randomly selected kindergartens. A self-administered questionnaire based on the health belief framework was used for data collection. The results showed that a number of factors significantly affected the tendency toward new vaccination uptake; these factors included parental age, HSI vaccination history of the children in their family, preferable price of the vaccine, perceived severity, perceived benefits, perceived barriers, and motivating factors for taking new vaccines. Using these factors, a logistic regression model with a high Nagelkerke R2 of 0.63 was generated to explain vaccination acceptance. A strong correlation between parental acceptance of new vaccinations and the motivating factors of vaccination uptake was found, which indicates the importance of involving parents in policy implementation for any new vaccination schemes. Overall, in order to fight against pandemics and enhance vaccination acceptance, it is essential for the government to understand the above factors determining parental acceptance of new vaccinations for their preschool-aged children.

Bio-medical Application on Predicting Systolic Blood Pressure Using Neural Networks

This paper presents a new study based on artificial neural network, which is a typical technique for processing big data, for the prediction of systolic blood pressure by correlated factors (gender, serum cholesterol, fasting blood sugar and electrocardiography signal). Two neural network algorithms, back-propagation neural network and radial basis function network, are used to construct and validate the bio-medical prediction system. The database of raw data is divided into two parts: 80% for training the neural network and the remaining 20% for testing the performance. The experimental result shows that artificial neural networks are suitable for modeling and predicting systolic blood pressure. This novel method of predicting systolic blood pressure contributes to giving early warnings to adults who may not take regular blood pressure measurements. Also, as it is known that an isolated blood pressure measurement is sometimes not very accurate due to the daily fluctuation, our predictor can provide another reference value to the medical staff.