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The effects of ear acupressure on anxiety, pain and sleep quality in patients after spine surgery
No full text指導教授:陳靜修背景：多數脊椎手術病人面對術後自我照顧知識不足、擔心術後合併症或可能導致身體失能等，容易出現焦慮之心理反應，繼而影響術後復原情形。然而，針對此問題所進行之相關介入研究仍是偏少的。
目的：本研究目的旨在探討耳穴貼壓於脊椎手術病人在術後之焦慮、疼痛、睡眠品質與心率變異之改善成效。
方法：研究設計為隨機控制試驗 (Randomized Controlled Trial)，以塊狀隨機分派(Blocked Randomization)，將病人分為真耳穴組和假耳穴組。真耳穴組提供含王不留行籽之耳穴貼，假耳穴組僅提供外觀相同之膠帶貼，兩組耳穴點皆為神門、腎、肝、皮質下與枕穴，提供為期三天、每天3次之耳穴貼壓。兩組於介入措施前、術後第24、48小時與72小時，分別進行資料收集，以了解真耳穴組與假耳穴組之差異情形。資料分析以廣義估計式(generalized estimating equations, GEE)進行，統計顯著水準為0.05。
結果：共收案62位病人，真耳穴組與假耳穴組各為31位。在耳穴貼壓介入3天後，真耳穴組與假耳穴組在焦慮(β＝-7.1,Wald χ2=15.02, p 0.05)、低頻功率(β＝11.22,Wald χ2=0.001, p>0.05)、高頻/低頻比值(β＝-0.15,Wald χ2=0.31, p>0.05)、RMSSD(β＝1.79,Wald χ2=0.06, p>0.05)和PNN50(β＝1.70,Wald χ2=0.08, p>0.05)等指標，則未達顯著差異。
結論：本研究結果發現隨著耳穴貼壓介入時間之增加，對脊椎術後病人之焦慮、疼痛與睡眠品質改善情形越顯著，且真耳穴組優於假耳穴組。建議未來可再延長耳穴貼壓之時間，以檢視其延宕成效
Development of a Mortality Risk Model in Elderly Hip Fracture Patients by Different Analytical Approaches
No full textHip fracture is a major health issue that accompanies community aging. The most critical time after a hip fracture should be the first year. Care systems and surgical techniques for hip fractures have improved, so the trend of mortality in elderly hip fracture could be changed with them. Therefore, we observed the changes in the trend and critical factors for first-year mortality for the hip fractures in an elderly population in Taiwan, and mortality of prognosis prediction model was developed for the early diagnosis using a population-based database in Taiwan (National Health Insurance Research Database, NHIRD). A total of 166,274 elderly subjects with an age greater than 60-years-old from 2001 to 2010 were collected for this study. Cox proportional-hazards (PH) regression and logistic regression were calculated to odds ratio and hazard ratio for mortality of those patients and compared it. Data mining algorithms were also used to generate a risk stratification prediction model. The first-year mortality rate of the overall study group was 21.5% in 2001 and 15.0% in 2010 (p for trend < 0.001). In the male subgroup, the first-year mortality rate was 29.3% in 2001 and decreased to 17.3% in 2010; the trend of standardized mortality ratio was significantly decreased from 4.4 to 2.6 (p for trend < 0.001). By logistic regression, mortality significantly increased with age and male gender. Furthermore, gender, age, patients with diabetes mellitus (DM), cardiovascular (CV), and renal comorbidity, and surgical intervention can be variables for constructing the risk stratification model. The findings of the study will be used for helping related field physicians to predict the prognosis risk of hip fracture patients, and provide evidence-based tailored treatment recommendations for those patients. It may consider to build various models for predicting the prognosis of hip fracture or integrating prediction algorithms into the computerized physician order entry system, thus creating a practical clinical decision support system with warning functions
A Theory-Based Self-Management Training Program for Older Adult Peer Leaders with Diabetes: A Feasibility Assessment
No full textObjective: To improve the quality of peer leader training, this study developed a theory-based self-management training program for older adult peer leaders with diabetes and assessed its feasibility.
Background: Current self-management programs are designed mainly to be implemented by healthcare professionals, but healthcare staff may not fully perceive the needs and obstacles of older adults in disease management due to a lack of similar illness experience. To target this problem, peer leaders with successful self-management experiences, similar cultural backgrounds and languages, and related illness experiences are trained to guide and mentor peer patients in self-management programs.
Study design and methods: This study was conducted in two stages. In stage 1, a peer leader training program was developed based on experiential learning theory as the framework and self-regulation theory as the activity design strategy. In stage 2, program feasibility was assessed via participants' feedback toward the training program by three indicators: attendance, future willingness to lead the peer-led self-management program, and leadership skills evaluated by a peer leader training assessment tool.
Results: In this study, peer leaders demonstrated good leadership skills by expressing active willingness to lead self-management programs in the community. Peer leaders' feedback indicated that the program's training content was helpful in preparing peer leaders to guide older adults in learning self-management skills and in improving the abilities and confidence of peer leaders in mentoring self-management.
Conclusion: Findings in this study showed that peer leader training can impact the effectiveness and success of self-management in older adults with diabetes. Even in a small-scale study, the impact was evident, which demonstrated the feasibility of the program. More large-scale studies on the effectiveness of various peer leader training programs in diverse disciplines are recommended.
Clinical trials registry: ClinicalTrials.gov Identifier: NCT04298424 (the Peer-Led Self-Management Program)
The Impact of Subjective Feelings of Shared Decision-Making on Patient's Health Literacy : Patients with End-Stage Renal Disease
No full text指導教授:羅家倫當慢性腎臟病進展到末期不可逆階段，醫療團隊藉由醫病共享決策協助病人在充分了解之下，做出最適合自己治療方式的選擇，然而病人健康識能程度對於病人生、心理健康及生活品質，還有醫療資源利用都有很重要的影響，很多慢性腎臟病與醫病共享決策的相關文獻大多探討如何如何運用醫病共享決策，少有探討醫病共享決策與健康識能之間影響；因此，本研究探討末期腎臟病病人經過醫病共享決策後其主觀感受對健康識能影響，以橫斷式研究方法調查高雄某區域教學醫院末期腎臟病病人有參與醫病共享決策為樣本，研究工具包含「Share Decision Making，SDM-Q-9」中文量表問卷、「中文慢性腎臟病人者健康識能評量」。
資料收集期間由2020年10月1日至2020年10月31日進行問卷調查，共發出220份問卷，回收有效問卷179份，回收率81.4%。以SPSS 22.0軟體進行研究資料之分析與假設模型驗證。
研究結果顯示醫病共享決策與健康識能(r=.378，p<0.01)、疾病知識(r=.467，p<0.01)、醫病溝通(r=.602，p<0.01)呈現顯著正向相關；健康識能與疾病知識(r=.890，p<0.01)、醫病溝通(r=.290，p<0.01) 呈現顯著正向相關；醫病共享決策主觀感受與健康識能之關聯性影響程度：Adjusted R2為0.138，整體解釋能力達13.8%，F為29.585 (p<0.001)達到顯著正相關影響程度。醫病共享決策主觀感受與醫病溝通之關聯性影響程度：Adjusted R2為0.359，整體解釋能力達35.9%，F為100.80 (p<0.001)達到顯著正相關影響程度。醫病共享決策主觀感受與疾病知識之關聯性影響程度：Adjusted R2為0.21，整體解釋能力達21%，F為49.48 (p<0.001)達到顯著正相關影響程度。
證實在臨床上運用「醫病共享決策」措施，經醫病雙方良性溝通與共識，更強化病人自我的健康識能程度，增加病人對疾病照護的認知與技能，有助於延緩、增強遵從性以達到疾病控制和延緩併發症發生與疾病惡化，維持穩定的健康狀態。 關鍵詞：醫病共享決策、健康識能、末期腎臟病、醫病溝
Faster waning of the rubella specific immune response in young pregnant women immunized with MMR at 15 months
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