Thomas K. S. Wong

Effects of treatments for symptoms of painful diabetic neuropathy: systematic review

Objective To evaluate the effects of treatments for the symptoms of painful diabetic neuropathy. Design Systematic review. Data sources Articles (English and full text) on double blind randomised trials found by searching with the key words anticonvulsant, antidepressant, non-steroidal anti-inflammatory drugs, tramadol, opioid, ion channel blocker, diabetic neuropathy, diabetic peripheral neuropathy, peripheral neuropathy, and neuropathy. The search included Medline, Embase, EMB reviews-AP Journal club, and the Cochrane central register of controlled trials. Study selection Randomised controlled trials comparing topically applied and orally administered drugs with a placebo in adults with painful diabetic neuropathy. Data extraction Data were extracted to examine quality of methods, characteristics of studies and patients, efficacy, and side effects. The primary outcome was dichotomous information for 50% or moderate reduction of pain. Secondary outcomes were 30% reduction of pain and withdrawals related to adverse events. Results Odds ratios were calculated for achievement of 30%, 50%, or moderate pain relief and for withdrawals related to adverse effects. Twenty five reports were included and seven were excluded. The 25 included reports compared anticonvulsants (n=1270), antidepressants (94), opioids (329), ion channel blockers (173), N-methyl-D-aspartate antagonist (14), duloxetine (805), capsaicin (277), and isosorbide dinitrate spray (22) with placebo. The odds ratios in terms of 50% pain relief were 5.33 (95% confidence interval 1.77 to 16.02) for traditional anticonvulsants, 3.25 (2.27 to 4.66) for newer generation anticonvulsants, and 22.24 (5.83 to 84.75) for tricylic antidepressants. The odds ratios in terms of withdrawals related to adverse events were 1.51 (0.33 to 6.96) for traditional anticonvulsants, 2.98 (1.75 to 5.07) for newer generation anticonvulsants, and 2.32 (0.59 to 9.69) for tricylic antidepressants. Insufficient dichotomous data were available to calculate the odds ratios for ion channel blockers. Conclusion Anticonvulsants and antidepressants are still the most commonly used options to manage diabetic neuropathy. Oral tricyclic antidepressants and traditional anticonvulsants are better for short term pain relief than newer generation anticonvulsants. Evidence of the long term effects of oral antidepressants and anticonvulsants is still lacking. Further studies are needed on opioids, N-methyl-D-aspartate antagonists, and ion channel blockers.

Predicting pressure sore risk with the Norton, Braden, and Waterlow scales in a Hong Kong rehabilitation hospital

BACKGROUND Numerous pressure sore risk calculators have been developed since the 1960s. Each scale is claimed to have predictive value and applicability in various clinical settings, but it has not been determined which one is more relevant for adoption in a rehabilitation setting. OBJECTIVES To compare the predictive power of the three most commonly adopted pressure sore risk calculators: Norton, Braden, and Waterlow scales. METHOD One hundred six patients, free of pressure sores at admission, were assessed using the three scales by independent assessors within 48 hours of admission, followed by a daily monitoring of skin condition for at least 14 days to detect any sore that developed. RESULTS Both the Norton and Waterlow scales had relatively high sensitivity (81% and 95%, respectively), whereas the Braden Scale had both high sensitivity (91%) and specificity (62%). All three scales had relatively high negative predictive values (>90%), but the Braden Scale had better positive predictive value. CONCLUSIONS The Braden Scale is more suitable for use in a rehabilitation hospital.

Effectiveness of auricular therapy on sleep promotion in the elderly

Sleep disturbances are a particularly common problem in the elderly. The purpose of this study was to examine the effectiveness of auricular therapy on sleep behaviors in the elderly. One hundred and twenty participants of 60 years old or above and who were suffering from sleep disturbances were invited to participate in this study. Eligible participants were randomly allocated to receive auricular therapy using Junci Medulla (Group A = 30), Semen Vaccariae (Group B = 30) or magnetic pearls (Group C = 60). Groups A and B were the control groups, while Group C was the experimental group. Seven auricular points which are thought to have an effect on promoting sleep were selected. The total treatment course lasted for three weeks. Objective measurement using actigraphic monitoring was performed before the therapy commenced, in the middle period of the therapy, and within one week after the therapy had been completed. After the therapy, there were significant differences among the three groups in terms of the nocturnal sleep time (NST) (F(2,117) = 6.84, p < 0.05) and sleep efficiency (SE) (F(2,117) = 7.69, p < 0.05). Significant improvement in the sleep behaviors was observed in the experimental group using magnetic pearls. In a backward multiple regression, the effect of auricular therapy on SE after allowing for age in female participants is of high statistical significance (F(3,106) = 9.04, p < 0.001). The paper concludes that auricular therapy using magnetic pearls is an effective means of improving the quantity and quality of sleep in the elderly.

Individual Empowerment among Chinese Cancer Patients in Hong Kong

Among the various chronic diseases, cancer is the leading cause of death in Hong Kong. This article presents the process of how cancer patients are being enabled and strengthened to overcome powerlessness based on the interviewfindings of 12 participants. Interviews were analyzed using constant comparison. The basic social process of empowerment included finding meaning in life, seeking mastery over illness, and acceptance of illness. This study’s unique findings suggest that the process of empowering cancer patients consists of more than giving patients control, choice, or resources, such as knowledge and skills. Nurses have an important role in facilitating patients to find meaning in life, as well as in the transformation of thoughts and attitudes. Nurses’ personal qualities and skills embedded in the nurse-patient relationship constitute an important source of empowerment for patients.

Needs of Chinese Parents of Children with Developmental Disability

Parenting children with developmental disability requires specialized caring skills and knowledge. The aim of this study is to explore the experiences of Chinese parents in caring for these children. The focus group research approach was adopted. Twenty-three parents of children hospitalized with developmental disability from a Maternal and Children Hospital, Guangzhou, China participated in four focus group interviews. Validity of interpretation was ascertained. Inter-coder reliability was established with inter-coder agreement at 0.77. Data were fully transcribed, coded and analysed by content analysis. Eventually, five categories of needs were identified: parental, informational, attitude towards the child, coping and support. Parents needed to be equipped with practical parenting skills and information on developmental disability, and they needed to have realistic expectations for the child. They also needed professional support to cope with caring tasks and activities. Education is recommended as a fundamental strategy to enhance parents’ caring competency.

The long-term effects of auricular therapy using magnetic pearls on elderly with insomnia.

OBJECTIVE To examine the long-term effect of auricular therapy using magnetic pearls administered for the elderly suffering from insomnia. DESIGN A follow-up study after a randomized controlled trial. SETTINGS Four hostels for the elderly in Hong Kong. INTERVENTIONS This paper focuses on reporting the long-term effect of auricular therapy using magnetic pearls in the experimental group of a randomized controlled study. Fifteen volunteer participants were followed up at 1-, 3-, and 6-month intervals after a 3-week treatment course. OUTCOME MEASURES Objective sleep parameters using actigraphic monitoring were collected at different intervals of time after the therapy. RESULTS Results of RANOVA demonstrate that there was a significant difference of nocturnal sleep time (F(2.30,29.90)=3.63, P<0.05) and marginally differences of sleep efficiency (F(4,52)=2.52, P=0.05) at baseline, immediately after the therapy, and at the three time intervals at 1, 3 and 6 months. The results illustrate that the mean nocturnal sleep time (F=4.95, P=0.30, R(2)=0.91) and the mean sleep efficiency (F=13.50, P=0.19, R(2)=0.96) also remained constant over the 6-month follow up period. The results of least square polynomial regression analysis also illustrate that the mean NST (F=4.95, P=0.30, R(2)=0.91) and the mean sleep efficiency (F=13.50, P=0.19, R(2)=0.96) remained constant over the 6-month follow up period. CONCLUSION The results of this follow up study indicate that auricular therapy using magnetic pearls could have a long-term effect, at least within the observed period of time, on improving the quality as well as the quantity of sleep among the elderly.

Drawing a qualitative distinction of caring practices in a professional context: the case of Chinese nursing.

How to draw a qualitative distinction between nursing work and the work of a servant has been a major concern for nurses in China. This article explains the ways in which nurses in China articulate the meaning of caring in practice situations. Seventy nurses in Beijing were invited to share their experience about what caring meant to them as nurses and examples of caring in practice situations. Van Kaams phenomenologic method of controlled explication was used to analyze the data. The findings reveal that these Chinese nurses are able to articulate the cheng and jing versions of caring practices that emphasize flexible, pluralist, contextualized, individualized, and subjectively informed practices. To further this study, we would suggest nurses be more proactive in starting a dialogue with society so as to seek nursings legitimate practice that can foster responsive care to patients and society on the one hand and the professional integrity of nursing on the other.

Impact of Fabric Moisture Transport Properties on Physiological Responses when Wearing Protective Clothing

This purpose of this study was to investigate the impact of fabric moisture transport properties (MTP) on physiological responses when wearing protective clothing. Ten healthy subjects wore two kinds of personal protective equipment (PPE) ensembles and exercised on a treadmill, worked on a computer, and moved a mannequin in an environment that simulated where health carers work. PPE1 consisted of cotton underwear and 100% polyethylene outerwear. PPE2 consisted of cotton underwear with moisture management function and outerwear made of waterproof breathable fabric. The results showed that there were significantly higher cumulative one-way transport capacity, liquid moisture management capacity, and wetting time in PPE2 than in PPE1 underwear. There was significantly higher water vapor permeability (WVP) in PPE2 than in PPE1 outerwear. Deep ear canal temperature, mean skin temperature, and chest wall skin and clothing microclimates (temperature and humidity) were significantly lower with PPE2 than PPE1. The level of plasma oxygen saturation was significantly higher with PPE 2 than PPE1. In the present study, due to the MTP of the fabrics, liquid sweat transferred from the skin surface to the opposite surface quickly and speeded up the processes of evaporation and heat dissipation. It was concluded that the fabrics MTP, when incorporated into protective clothing, is the main physiological mechanism for reduced heat stress.

Stabilizing and destabilizing forces in the nursing work environment: A qualitative study on turnover intention

Abstract Background The nursing work environment, which provides the context of care delivery, has been gaining increasing attention in recent years. A growing body of evidence points to an inseparable link between attributes of the nursing work environment and nurse and patient outcomes. While most studies have adopted a survey design to examine the workforce and work environment issues, this study employed a phenomenological approach to provide empirical evidence regarding nurses’ perceptions of their work and work environment. Aim The aim of this study was to advance our understanding of the phenomenon of increasing nurse turnover through exploring frontline registered nurses’ lived experiences of working in Hong Kong public hospitals. Methods and participants A modified version of Van Kaams controlled explication method was adopted. Individual semi-structured interviews were conducted with 26 frontline nurses recruited from ten acute regional, district and non-acute public hospitals in Hong Kong. Their perspectives in regard to their work and work environment, such as workload, manpower demand and professional values, were extensively examined, and a hypothetical description relating the nursing work environment with nurses’ turnover intention was posited. Results Contemplation of nurses’ experiences revealed the vulnerable aspects of nursing work and six essential constituents of the nursing work environment, namely staffing level, work responsibility, management, co-worker relationships, job, and professional incentives. These essential constituents have contributed to two sets of forces, stabilizing and destabilizing forces, which originate from the attributes of the nursing work environment. Nurses viewed harmonious co-worker relationships, recognition and professional development as the crucial retaining factors. However, nurses working in an unfavorable environment were overwhelmed by destabilizing forces; they expressed frustration and demonstrated an intention to leave their work environment. Conclusions The nursing work environment is a complex entity comprising multiple constituents; its attributes affect nurses’ perceptions of their work and work environment, which warrant special attention in addressing the phenomenon of increasing nurse turnover.

Self-worth therapy for depressive symptoms in older nursing home residents.

AIM The aim of this study is to report the effects of self-worth therapy on depressive symptoms of older nursing home residents. BACKGROUND Depression in older people has become a serious healthcare issue worldwide. Pharmacological and non-pharmacological therapies have been shown to have inconsistent effects, and drug treatment can have important side-effects. METHOD A quasi-experimental design was used. Older people were sampled by convenience from residents of a nursing home in northern Taiwan between 2005 and 2006. To be included in the study participants had to: (i) have no severe cognitive deficits; (ii) test positive for depressive status and (iii) take the same anti-depressant medication in the previous 3 months and throughout the study. Participants in the experimental group (n = 31) received 30 minutes of one-to-one self-worth therapy on 1 day a week for 4 weeks. Control group participants (n = 32) received no therapy, but were individually visited by the same research assistant, who chatted with them for 30 minutes on 1 day/week for 4 weeks. Depressive status, cognitive status and functional status were measured at baseline, immediately after the intervention and 2 months later. Data were analysed by mean, standard deviations, t-test, chi-squared test and univariate anova. FINDINGS Self-worth therapy immediately decreased depressive symptoms relative to baseline, but not relative to control treatment. However, 2 months later, depressive symptoms were statistically significantly reduced relative to control. CONCLUSION Self-worth therapy is an easily-administered, effective, non-pharmacological treatment with potential for decreasing depressive symptoms in older nursing home residents.