Mabel Qi He Leow

Predictors of change in quality of life of family caregivers of patients near the end of life with advanced cancer

Background: Caregiving for a person with cancer at end of life can be stressful physically and emotionally. Understanding the predictors of change in family caregivers’ quality of life (QoL) is important in facilitating the development of interventions to help these family caregivers. Objective: The aim of this study was to examine the change in QoL of family caregivers of home hospice patients in Singapore near the end of life with advanced cancer from baseline to after 2 months. Methods: This was a longitudinal survey. Ninety-three caregivers were surveyed. Instruments included the Caregiver Quality of Life Index–Cancer, Social Support Questionnaire, and Spiritual Perspective Scale. Results: Caregivers’ spiritual-related interactions scores increased from baseline to 2 months using paired t test (t = 2.33, P = .02). Multivariate regression analysis showed that caregivers with higher social support satisfaction (&bgr; = .60, P = .000) and who had a religion predicted (&bgr; = .55, P = .001) higher QoL. Caregivers of patients diagnosed with breast cancer and cancer in the female reproductive organs (&bgr; = −.33, P = .03) predicted lower QoL. Conclusion: This study elucidated the importance of caregivers’ social support satisfaction during their caregiving journey. There is a need to enhance spiritual care for caregivers. Implications for practice: Support for caregivers could be increased by organizing mutual support groups and having volunteers to befriend caregivers. Spiritual care could be enhanced by regular assessment of spiritual needs, offering open discussions and sharing on spirituality and religion, and facilitating contacts with religious groups if caregivers required.

A Pilot Randomized, Controlled Trial of the Effectiveness of a Psychoeducational Intervention on Family Caregivers of Patients With Advanced Cancer

PURPOSE/OBJECTIVES To evaluate the effectiveness of a psychoeducational intervention, the Caring for the Caregiver Programme (CCP).
 DESIGN A pilot randomized, controlled trial, two-group pretest, and repeated post-tests.
 SETTING Four home hospice organizations and an outpatient clinic in Singapore.
 SAMPLE 80 caregivers were randomized into experimental and standard care groups.
 METHODS Outcomes were measured at baseline, week 4, and week 8 after the intervention. The standard care group received routine home hospice care, and the intervention group received the CCP in addition to routine care.
 MAIN RESEARCH VARIABLES Quality of life (QOL), social support, stress and depression, self-efficacy in self-care, closeness with the patient, rewards, and knowledge.
 FINDINGS Compared to the standard care group, the intervention group reported significantly higher QOL, social support satisfaction and number of supported people, closeness with the patient, self-efficacy in self-care, rewards of caregiving, and knowledge, and lower stress and depression. 
 CONCLUSIONS The CCP had positive effects on family caregivers of patients with advanced cancer. 
 IMPLICATIONS FOR NURSING A psychoeducational intervention potentially could help caregivers cope with the demands of caregiving. 


Ultrasonography in acupuncture: potential uses for education and research

Ultrasound has been commonly used to guide clinical procedures in Western medicine, such as peripheral nerve blocks, biopsies, and fluid aspiration. Ultrasound is a useful tool because it is non-invasive, allows real-time visualisation of body images, and poses no risk to the human body, as it uses sound waves that are generally safe. In addition to guiding clinical procedures, ultrasound has been used to train medical students to perform clinical examinations.1 From a review of the literature, only one study has explored the use of ultrasound for acupuncture, and this focused on detecting soft-tissue displacement from movement of the needle.2 No study has explored the use of ultrasound in demonstrating the relationship between an acupuncture needle and the surrounding anatomical structures real-time in vivo. The aim of our study was to evaluate its feasibility and to discuss the implications for education and research. This study was conducted on a human cadaveric hand. Ultrasound scans were conducted using a Siemens Acuson P300 ultrasound system with a …

The Challenges, Emotions, Coping, and Gains of Family Caregivers Caring for Patients With Advanced Cancer in Singapore: A Qualitative Study.

Background: Caring for a family member with advanced cancer at home is demanding as the ill family member is likely to have complex physical and emotional needs. There is a paucity of studies on the experience of home family caregivers of people with advanced cancer in the Asian region. Objective: The aim of this study was to describe the experiences of family caregivers caring for a person with advanced cancer at home in Singapore. Methods: This was a qualitative study; data were collected by semistructured interviews and analyzed using content analysis. A purposive sample of 19 family caregivers who were taking care of a family member with advanced cancer were recruited from home hospice care services in Singapore. Results: Most of the caregivers were female (n = 14), ranging in age from 21 to 64 years (mean, 46.4 [SD, 10.5] years). Four themes were generated from the data: (1) caregiving challenges, (2) negative emotions, (3) ways of coping, and (4) positive gains of caregiving. Conclusions: This study generated insights into the challenges, emotions, and coping of Asian family caregivers caring for patients with advanced cancer. Such understanding could help in developing appropriate intervention for caregivers to reduce their burden and stress. Implications for Practice: Caregivers require knowledge on resolving family conflicts and about communicating and enhancing closeness with the ill family member. Support from healthcare professionals is essential even if caregivers have support from family members and friends; nurses can make conscious efforts to show concern for caregivers as well as for patients.

Exploring the physiological and physical effects of acupuncture using ultrasound

The physiological changes in blood flow during acupuncture needle insertion have been explored using different forms of Doppler imaging including laser Doppler perfusion imaging,1 laser Doppler flowmetry,2 and ultrasound colour Doppler.3 However, a review of the literature found no study exploring the effects of acupuncture on blood vessel size and muscle strain. With advances in ultrasound technology, these variables can be easily studied. We aimed to analyse the real-time changes in blood vessel size, blood flow velocity and volume, and muscle strain, before and after acupuncture needle insertion, and following needle removal. We performed acupuncture needle insertion on two healthy volunteers who were part of the study team. Both team members signed an institutional informed consent form acknowledging the potential adverse effects, risks and complications. The acupuncture was performed by a certified acupuncturist with >20 years’ experience. Volunteer 1 was a male who had been exposed to acupuncture regularly. Volunteer 2 was a female with no previous exposure to acupuncture. Scans were conducted using a Philips iu22 system …

Treatment of primary palmar hyperhidrosis using glycopyrrolate iontophoresis: Intensity of electrical current used, efficacy and side effects

Sir, Hyperhidrosis is caused by a dysfunction in the regulation of sweating by the sympathetic nervous system, resulting in a higher production of sweat. It is characterized by excessive sweating, which typically occurs on the palms, soles and axillae.1 Iontophoresis is a form of electrical stimulation that can treat hyperhidrosis of the hands, feet and axillae.2 The addition of glycopyrronium bromide, an anticholinergic agent, can increase the effectiveness of this treatment.3,4 There are limited studies conducted on the effectiveness of iontophoresis in the treatment of hyperhidrosis. The aim of this study was to evaluate and correlate the intensity of electrical current used with the efficacy and side effects of the treatment with glycopyrronium bromide iontophoresis, in primary palmar hyperhidrosis.

Do caregivers of cancer patients receiving care in home hospice services have better quality of life? An exploratory investigation in Singapore.

Haikel A. Lim, Konstadina Griva, Russell K. L. Yoong, Joanne Chua, Mabel Q. H. Leow, Moon Fai Chan, Sally W. C. Chan, Ee Heok Kua and Rathi Mahendran* Department of Psychological Medicine, National University of Singapore, Singapore Department of Psychology, National University of Singapore, Singapore Department of Psychological Medicine, National University Hospital, Singapore Nursing Department, National Skin Centre, Singapore Lui Che Woo College, University of Macau, China School of Nursing and Midwifery, University of Newcastle, Australia Duke-NUS Graduate Medical School, Singapore

Quantifying needle motion during acupuncture: implications for education and future research

Quantification of needle movements during insertion and manipulation has been a challenge for acupuncturists.1 Needle manipulation includes lifting and thrusting of the needle and/or needle rotation after insertion. Such movements are critical for the elicitation of de qi and maximisation of treatment effectiveness. However, needle manipulation is highly individualised among acupuncturists, and this could have implications for treatment outcomes. Two studies have explored the displacement, rotation, torque and force exerted during needle manipulation using motion sensors (Acusensors).2 ,3 However, they did not include the speed of needle insertion and rotation. Our study aimed to analyse the trajectory of acupuncture needle motion from insertion to rotation manipulation to achieve de qi . We performed acupuncture needle insertion on a study team member. The team member signed an institutional informed consent form acknowledging that he knew the procedure involved during acupuncture, and understood the possible risks and complications. The acupuncture was performed by a certified acupuncturist with more than 20 years …

Application of cabbage leaves compared to gel packs for mothers with breast engorgement: Randomised controlled trial

BACKGROUND The effects of cold cabbage leaves and cold gel packs on breast engorgement management have been inconclusive. No studies have compared the effects of these methods on breast engorgement using a rigorous design. OBJECTIVES To examine the effectiveness of cold cabbage leaves and cold gel packs application on pain, hardness, and temperature due to breast engorgement, the duration of breastfeeding and satisfaction. DESIGN A randomised controlled three-group pre-test and repeated post-test study. SETTING A private maternal and childrens hospital in Singapore. PARTICIPANTS Mothers (n=227) with breast engorgement within 14days after delivery. METHODS The mothers were randomly assigned into either cold cabbage leaves, cold gel packs, or the control group. Pain, hardness of breasts, and body temperature were measured before treatment. Two sets of post-test assessments were conducted at 30min, 1h, and 2h after the first and second application. The duration of breastfeeding was measured up to 6 months. IBM SPSS 23.0 was used to analyse the data. RESULTS Mothers in the cabbage leaves and gel packs groups had significant reductions in pain at all post-intervention time points compared to the control group, starting from 30min after the first application of cabbage leaves (mean difference=-0.38, p=0.016) or gel packs (mean difference=-0.39, p=0.013). When compared to the control group, mothers in the cabbage leaves group had significant reductions in the hardness of breasts at all post-intervention time points, and mothers in the gel packs group had significant reductions in the hardness of breasts at two time points (1h and 2h after the first and second application, respectively). Mothers in the cabbage leaves group had significant reductions in pain (mean difference=-0.53, p=0.005) and hardness of breasts (mean difference=-0.35, p=0.003) at 2h after the second application compared to those in the gel packs group. Both interventions had no impact on body temperature. There was no significant difference in the durations of breastfeeding for mothers among the three groups at 3-month and 6-month follow-up. More mothers were very satisfied/satisfied with the breast engorgement care provided in the cabbage leaves group compared to the other groups. CONCLUSION While cold cabbage leaves and cold gel packs can relieve pain and hardness in breast engorgement, the former had better effect, which can be recommended to postnatal mothers to manage breast engorgement.

A randomized controlled trial comparing ketorolac and triamcinolone injections in adults with trigger digits

We assessed the efficacy of ketorolac trometamol injections compared with triamcinolone acetonide injections in trigger digits. Patients with trigger digits were randomized to receive either ketorolac or triamcinolone. They were followed up at 3, 6, 12 and 24 weeks, and monitored for resolution of triggering, pain and total active motion. One hundred and twenty-one patients with single trigger digits were recruited (59 ketorolac, 62 triamcinolone). At 6 weeks, 54% of patients in the triamcinolone group had complete resolution of trigger, whereas no patients in the ketorolac group had resolution. At 12 weeks, 58% of patients in the triamcinolone group had complete resolution of trigger compared with 6.7% in the ketorolac group. At 24 weeks, both groups had comparable rates of resolution at 26% and 25%, respectively. Patients in the triamcinolone group had significantly better resolution of pain at 3, 6 and 12 weeks. But at 24 weeks, there was no significant difference in pain between both groups. Significantly less flexion deformity was reported at 3 weeks and 6 weeks in the triamcinolone group. In the short term, ketorolac was less effective in relieving symptoms of trigger digit than triamcinolone. Level of evidence: I