Kai-Kuen Leung

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).

Can a Good Death and Quality of Life Be Achieved for Patients with Terminal Cancer in a Palliative Care Unit

BACKGROUND Lack of evidence supporting the claim that palliative care can improve quality of life and promote good death in patients with terminal cancer. OBJECTIVES This study was designed to evaluate the change of quality of life and quality of death over time and between patients of long and short survival in a palliative care unit. METHODS Patient demography, cancer sites, Eastern Cooperative Oncology Group (ECOG) status were collected at admission. Quality of life, including physical and psychological symptoms, social support, and spirituality was assessed daily after admission. Quality of death was assessed by a Good Death Scale (GDS) at admission and retrospectively for 2 days before death. RESULTS A total of 281 patients (52% women) were admitted and died in the study period. One hundred forty-five patients (51.6%) died within 3 weeks. Although those with short survival (<3 weeks) had more physical symptoms during the first week, there was no difference in quality of life dimensions at admission, at 1 week, and at 2 days before death between survival groups. Physical conditions deteriorated with time but other dimensions continued to improve until death. GDS and subdimensions continued to improve until death. Although those with long survival (≥3 weeks) have better scores for awareness, acceptance, timeliness, comfort, and GDS at admission, there was no difference between the two groups at 2 days before death. CONCLUSION Under comprehensive palliative care, patients with terminal cancer can have good quality of life and experience a good death even with short survival.

A quick dementia screening tool for primary care physicians

The accuracy and consuming-time of screening methods are important factors in the early diagnosis of dementia. In this study, we aimed to know whether the eight-item test (including three-item recall, attention and calculation, subtracted from the mini-mental state examination (MMSE), clock drawing test (CDT), and instrumental activities of daily living (IADL) impairment or any combination of the above tests can be used as a quick and effective dementia screening tool. A total of 188 seniors aged over 60 years were enrolled at a geriatric clinic. The result revealed that a cutoff score of 6/7 in an eight-item scale had a sensitivity of 94.9% and a specificity of 59.1% in the detection of dementia. In terms of sensitivity and specificity, the eight-item scale performed better than a score of two in three-item recall (51.3%/87.3%), a score of one in three-item recall (83.3%/53.6%), CDT (39.0%/96.9%), mini-cognitive assessment instrument (Mini-Cog) test (53.7%/95.5%), a score of less than three in attention/calculation test (74.7%/77.3%), impairment of transportation or medication in IADL (67.2%/90.6%), and any impairment in IADL (77.2%/67.9%). In subgroup analysis, a cutoff score of 5/6 were adjusted for the low-education group. We conclude that an eight-item test is a sufficient and simple tool for the screening of early dementia in primary-care clinics focused on older people care.

What do laypersons consider as a good death

GoalsThis study was designed to understand laypersons’ attitude of good death.Materials and methodsA 53-item Good-Death Questionnaire (GDQ) was generated by applying “good-death principles” and past research on good death in Chinese people.Main resultsA total of 184 adults completed the questionnaire. The Cronbach’s alpha for the GDQ was 0.96. Factor analysis produced five factors: autonomy and choice, wish fulfillment, death preparation, spiritual support and afterlife, and symptom control. Elderly people had higher scores in “autonomy” than people aged ≤40 (52.71 ± 5.94 vs. 56.71 ± 3.82, P = 0.012). Chaplains had higher scores in “death preparation” than volunteers (76.09 ± 4.44 vs. 70.46 ± 6.49, P = 0.011) and higher scores in “spiritual support” than volunteer and farmers–workers–businessmen (32.97 ± 2.49 vs. 28.08 ± 5.06 and 29.69 ± 5.05, P = 0.002). People with Buddhist religious belief had higher scores in “spiritual support” than people without religious belief (31.10 ± 3.99 vs. 25.73 ± 3.13; P < 0.001). Religious devotion was positively related to “death preparation” and “spiritual support.” People who had witnessed death had lower scores of “autonomy and choice” than the inexperienced (55.41 ± 4.81 vs. 57.06 ± 3.85; P = 0.032).ConclusionsOur results identified some major characteristics of good-death attitude among laypersons. Religious devotion has a positive impact on the attitude of good death.

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.

Correlates of Fatigue Phenomenon in Palliative Care Patients with Advanced Cancers in Taiwan

BACKGROUND Fatigue is a multidimensional phenomenon that has different meanings according to different societal and cultural settings. This study aims to decipher fatigue in Taiwanese patients with cancer. METHODS We recruited 440 patients with advanced cancer admitted consecutively to the palliative care unit of a major medical center in Taiwan. The data were collected at admission, 1 and 2 weeks after admission, and 2 days before death. RESULTS The subject group consisted of 51.8% males and 48.2% females with a median age of 67 years (ranging from 27 to 93 years). The leading primary tumor sites among these patients were lung (20.2%), liver (18.0%), and colon-rectum (10.7%), and the median survival was 15 days, with a range of 1 to 418 days. All symptoms improved 1 week after admission, but most of them significantly worsened 2 days before death. In general, the physical signs manifested variation patterns similar to those of symptoms. The severity of psychosocial distress and death fear was lower after admission and retained the same level at 2 days before death, defying the consistent patterns found in other symptoms and signs. In the correlation analysis, most symptoms were correlated with fatigue during admission, with weakness being the most significant one. Although self-efficacy and emotion were correlated with fatigue both on admission and 1 week after admission, social support and death fear were not correlated with fatigue at all times. CONCLUSION The meaning of fatigue is mainly associated with physical factors among these patients. Education of complexities in fatigue in tandem with psychosocial and spiritual care may help alleviate this symptom, and promote quality of life.

The development and validation of a dementia behavior disturbance inventory.

OBJECTIVE To develop an instrument that measures observable problematic behaviors in patients with dementia. METHODOLOGY We used focus group interviews to identify the problematic behaviors of patients with dementia. Eighty-two behaviors grouped into 12 domains were generated from the data collected from five different focus groups. After conducting a content validation process, a 72-item Dementia Behavior Disturbance Inventory (DBDI) rated by a frequency and a disturbance scale was formed. The DBDI was administered to 200 institutionalized elderly patients with dementia by formal caregivers for psychometric evaluation. RESULTS Inter-item correlation of items in each domain was performed for item reduction. Forty-eight items remained after this procedure. Exploratory factor analysis obtained nine factors that explained 59.2% and 59.6% of the total variance in the frequency and disturbance scales, respectively. Cronbachs alpha of the entire 48-item frequency and disturbance scales was 0.88 and 0.91, respectively. Most of the factors had acceptable internal consistency reliability. Test-re-test reliability coefficients of the frequency and disturbance scales were 0.78 and 0.64, respectively. The DBDI was weakly but positively related to functions of daily activities and ambulation. CONCLUSION The DBDI demonstrates promising psychometrical properties as an instrument to assess problematic behaviors in elderly people with dementia.

Biopsychosocial Risk Factors of High Blood Pressure among College Students

A total of 51 students with high blood pressure were compared with 59 controls. Factors examined were parental histories of hypertension, degree of obesity, cigarette smoking, exercise patterns, emotional reactivity, and number and self-perceived severity of stressful experiences. The results indicated that high blood pressure was strongly correlated with parental histories of hypertension and degree of obesity (p＜0.005 and p＜0.001 respectively), but not with cigarette smoking, exercise patterns, emotional reactivity, and stressful experiences.