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[[alternative]]The impact of the Long-term Care 2.0 policy on the long-term care market in Taiwan
No full text[[abstract]]隨著全球人口高齡化趨勢日益嚴峻，特別是亞洲地區，臺灣亦面臨相似挑戰。由於醫療水平提升及低出生率，臺灣的老年人口比例迅速增加，預計在2025年進入超高齡社會，對於長期照顧服務需求急劇上升，我國先後提出因應的相關政策與法條，並於2017年1月推動長照2.0政策，旨在應對人口老化、家庭照顧功能逐漸弱化的挑戰，並提供多元化的社區及家庭照護服務。政策強調以居家及社區照護為主，機構照護為輔，改變民眾對長期照護的需求取向，對居家服務帶來了顯著的轉變和提升，而各縣市長照機構資源利用效率是否因此受到影響，以及是否存在擁擠效應等問題仍需做進一步探討。 本研究探討臺灣2017至2019年19個縣市中的長照機構，在長照2.0政策下的資源利用效率差異及其影響因素，並找出改善資源利用效率的方法。採用動態資料包絡分析法 (Dynamic Data Envelopment Analysis) 進行分析，以機構床位數、機構內工作人員數及老人長期照顧與安養機構數為投入變數，產出變數為實際入住人數，並以65歲以上人口數作為結轉變數，用以評估各縣市長照機構利用效率，分析是否存在資源過剩的擁擠效果。 研究結果顯示，六都的長照機構資源利用效率相對較高，推測原因包括人口密度較高、需求穩定及資源配置相對充足。相較之下，偏遠地區的資源利用效率較低，主要原因是人口嚴重流失、照護人力短缺，惡性循環下民眾的入住意願較低，導致資源閒置。此外部份地區出現資源投入過多，反而引發擁擠效應，降低了整體資源的利用效率。建議以改善長照資源配置及提升整體服務效能為目標，確保政策的有效執行與老年人口的照護品質。[[abstract]]As the global trend of population aging becomes increasingly severe, especially in Asia, Taiwan is also facing similar challenges. Due to advancements in medical standards and low birth rates, the proportion of elderly in Taiwan is increasing rapidly. Also, Taiwan is heading into a super-aged society by 2025, leading a dramatic rise in the demand for long-term care services. In response, Taiwan has implemented relevant policies and regulations, including the Long-term Care 2.0 (LTC 2.0) policy which launched in January 2017. This policy aims to address the challenges posed by population aging and the gradual weakening of family care functions by providing diversified community and family care services. The policy emphasizes home and community-based care as the primary approach, supplemented by institutional care, thus changing the public's demand orientation for long-term care. brought significant transformations and improvements to home care services. However, it remains necessary to further explore whether the utilization efficiency of long-term care resources in various counties and cities has been affected and if there are issues such as congestion effects. This study explores the differences in resource utilization efficiency among long-term care institutions in Taiwan's 19 counties and cities from 2017 to 2019 under the Long-Term Care 2.0 policy and identifies influencing factors and methods for improving resource utilization efficiency. Dynamic Data Envelopment Analysis (Dynamic DEA) method is employed for analysis, using the number of institution beds, staff, and the number of elderly long-term care and nursing institutions as input variables. The output variable is the actual number of residents, and the number of people aged 65 and above is used as a carryover variable to assess the utilization efficiency of long-term care institutions in each county and city, analyzing whether there is a congestion effect due to resource surplus or shortage. The results indicate that the resource utilization efficiency of long-term care institutions in the six major municipalities is relatively high, which can be attributed to higher population density, stable demand, and relatively adequate resource allocation. In contrast, the resource utilization efficiency in remote areas is lower, mainly due to severe population outflow and a shortage of caregiving staff, leading to idle resources. Additionally, some regions experience excessive resource input, causing a congestion effect that reduces overall resource utilization efficiency. The recommendation is to focus on improving the allocation of long-term care resources and enhancing overall service efficiency, while ensuring the effective policy implementation and maintaining the quality of care for the elderly population
[[alternative]]The research on the effects of work stress, leisure participation and sleep quality on physical and mental health of firefighters - An example of firefighters in Northern Taiwan
No full text[[abstract]]隨著時代變遷、科技發達，壓力已成為生活中的一部分。以消防人員為例，特殊的工作性質、長時間處於高壓的狀態、輪班制度導致作息日夜顛倒，以及在工作現場需要迅速的臨場反應，皆是在日常生活中的壓力來源，長期下來必然對生理和心理健康產生負擔。近年來的學術研究對於工作壓力、休閒參與、睡眠品質、身心健康的研究不計其數，各類群體皆有，但以消防人員為研究對象卻略微鮮少，因此探討消防人員之工作壓力、休閒參與、睡眠品質對身心健康的影響誠屬重要。本研究主要目的在於探討消防人員工作壓力、休閒參與、睡眠品質對身心健康之影響，研究法使用問卷調查法，至各分隊發放Google網路問卷，總計發出372份問卷，有效問卷為345份，無效問卷為27份，回收率達92%。研究工具包含工作壓力量表、休閒參與量表、中文版匹茲堡睡眠品質量表、身心健康量表(GHQ-12中文版)。使用李克特五點尺度進行衡量，採用獨立樣本t檢定、ANOVA以及多元線性迴歸分析探討各類變項間之關係。研究結果為：消防人員的工作壓力對身心健康為負向影響；休閒參與對身心健康為正向影響；睡眠品質對身心健康為負向影響。以上研究結果未來可提供相關主管機關、消防業務單位及消防人員參考，以利未來進行管理及訓練輔導之應用。[[abstract]]With the changes in times and the advancement of technology, stress has become an integral part of life. Taking firefighters as an example, the unique nature of their work, prolonged exposure to high-pressure situations, shift schedules leading to disrupted sleep patterns, and the need for rapid on-site responses all contribute to stress in their daily lives. Over time, this inevitably burdens both their physical and mental health. In recent years, academic research on work stress, leisure participation, sleep quality, and overall well-being has proliferated across various demographics. However, studies focusing on firefighters as subjects are relatively scarce. Therefore, examining the impact of work stress, leisure participation, and sleep quality on the physical and mental health of firefighters is of paramount importance.The main purpose of this study is to examine the effects of job stress, leisure participation, and sleep quality on physical and mental health among firefighters. The research method employed a questionnaire survey, distributing Google online surveys to various fire brigades. A total of 372 questionnaires were distributed, with 345 valid responses and 27 invalid ones, achieving a response rate of 92%. The research tools include the Job Stress Scale, Leisure Participation Scale, Chinese version of the Pittsburgh Sleep Quality Index, and the General Health Questionnaire (GHQ-12 Chinese version). Measurements were taken using a five-point Likert scale. Independent sample t-tests, ANOVA, and multiple linear regression analyses were used to explore the relationships between various variables.The research findings are: work stress among firefighters has a negative impact on their physical and mental health; leisure participation has a positive impact on their physical and mental health; sleep quality has a negative impact on their physical and mental health. These research findings can provide reference for relevant supervisory authorities, fire service units, and firefighters, facilitating the application of management and training counseling in the future
[[alternative]]Using KAP Theory to Examine Risk Awareness Among Special Leisure Participants in Folk Temple Activities: A Case Study of the Pilgrimage Processions of Beishiliao Baoan Temple in Fangliao Township
No full text[[abstract]]臺灣的廟會活動是重要的宗教文化盛事，但是卻存在不少安全風險。尤其是相對小型的地區性宗教活動，儘管參與人數較少，醫療資源卻也相對較薄弱，一旦發生大規模事故，可能會對當地的醫療系統造成嚴重衝擊。本研究目的在於瞭解廟會活動參與者對於活動風險的知識、態度與預防行為，同時探討參與者對於活動風險的關係。研究方法採用問卷調查法，研究對象為18歲以上並曾經參與過「三月十五」遶境活動者，採網路問卷和實體發放問卷混合模式調查，調查期間為2024年1至3月，共回收365份有效問卷，使用SPSS統計軟體進行分析與檢驗假設。研究結果發現，教育程度較高的群體在知識上表現較佳；角色和教育程度是影響態度差異最主要的因素；性別是影響預防行為差異最主要的因素，且知識、態度和預防行為間皆存在正相關。本研究可以提供政府單位制訂集會遊行之健康政策、宣導方向和未來研究人員對於大眾集會風險研究的參考依據。[[abstract]]Temple festivals are an important religious and cultural event in Taiwan. However, there are many safety risks associated with these events, especially regional religious activities. Although the number of participants is relatively small, the medical resources are also relatively weak. Once a large-scale accident occurs, it may have a serious impact on the local medical system. The purpose of this study is to understand the knowledge, attitudes, and preventive behaviors of temple activity participants towards the risks of the activities, and to explore the relationship between the participants' perception of risks.This study employed a questionnaire survey to investigate participants aged 18 and above who had participated in the "Lunar March 15th" pilgrimage. A mixed-mode survey method was used, combining online and paper questionnaires. The survey was conducted from January to March 2024, and a total of 365 valid questionnaires were collected. SPSS statistical software was used for data analysis and hypothesis testing.The results of the study found that:1. Participants with higher education levels had better knowledge of the risks.2. Role and education level were the main factors influencing differences in attitudes.3. Gender was the main factor influencing differences in preventive behaviors.4. There were positive correlations between knowledge, attitudes, and preventive behaviors.The study can provide reference for government agencies to formulate health policies and promotion directions for mass gatherings, and for future researchers on the study of risks in mass gatherings
[[alternative]]Analysis of Consistency and Interoperability in ART Data Elements: A Case Study of IVF Record Forms of Eight Domestic and Foreign Fertility Centers.
No full text[[abstract]]背景：隨著全球人工生殖技術需求的持續增加，資料交換需求也相應上升。試管嬰兒（In Vitro Fertilization，IVF）療程歷史紀錄對於病人照護連續性至關重要。將紙本病歷轉換為電子病歷（Electronic Medical Record，EMR）已成為該領域的主流趨勢，但各電子病歷系統（EMR systems，EMRs）間資料格式及介接方式未統一，以及不同機構提供的資料格式和完整性不一致，多數人工生殖機構仍主要依賴紙本形式進行資料蒐集與交換。目的：本研究旨在分析不同機構所提供的 IVF 紀錄資料欄位定義的一致性與語義可互操作性現況，並應用國際醫療資訊標準—加速健康照護可互操作資源（Fast Healthcare Interoperability Resources，FHIR）—標準化 IVF 紀錄資料欄位，並檢視標準化後格式可改善資料欄位定義一致性與語義可互操作性之程度。方法：本研究蒐集了來自八家跨國機構 IVF 紀錄表單之資料欄位，以量性指標測量其一致性與語義可互操作性。研究中對應FHIR®R5的資源(Resources)，建立 IVF 紀錄資料欄位的規範文件(Profile)及資料邏輯模型。結果：八家機構之37個共同欄位及12個重要欄位，標準化前，各資料欄位定義種類平均為5.27（標準差1.45）種，平均一致性為0.34（標準差0.18），標準化後一致性增加至1.00（標準差0）。語義可互操作性從標準化前介於0.00至0.54間，標準化後增加到1.00。標準化前後資料欄位定義一致性及語義可互操作性皆達顯著差異(p<.0001)。結論：本研究應用FHIR建立標準化IVF紀錄邏輯模型，開啟人工生殖領域資料標準化的第一步，期許透過本研究拋磚引玉，加速完成人工生殖資料標準化實作，以實現全球跨系統和應用程式間的動態資料無縫交換。本研究結果可作為未來衛福部國健署人工生殖通報系統資料標準化及各人工生殖機構及相關供應商未來整合開發人工生殖醫療資訊系統時之參考。[[abstract]]Background. As the global demand for assisted reproduction continues to grow, so does the need for data exchange. In Vitro Fertilization (IVF) procedure records are critical for continuity of patient care. The conversion of paper-based medical records to electronic medical records (EMR) has become a mainstream trend in this field. However, the data format and interface between EMR systems (EMRs) are not standardized, and the format and completeness of the data provided by different organizations are inconsistent. Most of the fertility centers still rely on paper-based data collection and exchange. Objective. The aim of this study is to assess the current level of consistency and semantic interoperability of data element definitions within IVF records supplied by various institutions. Additionally, the study aimed to implement the Fast Healthcare Interoperability Resources (FHIR), an international health information standard, to standardize data elements in IVF records and evaluate the potential improvement in consistency and semantic interoperability. Methods: This study collected the data elements of IVF record forms of eight multinational fertility centers and measured the consistency and semantic interoperability with quantitative indicators. Mapping to FHIR® R5 Resources, create profiles and logic model of the IVF record data elements. Results. For the 37 common elements and 12 important elements of the eight fertility centers, the average number of definition types for each data field was 5.27±1.45, the average consistency was 0.34±0.18 before standardization, and the consistency increased to 1.00±0.00 after standardization. The semantic interoperability ranged from 0.00-0.54 before standardization and increased to 1.00 after standardization. Both consistency and semantic interoperability of data element definition reached significant differences (p<.0001). Conclusion: This study uses FHIR to establish a standardized IVF record data element profiles, and logic model, which is the first step in the field of assisted reproduction medicine. The results of this study can be used as a reference for the standardization of the assisted reproduction register system of the Ministry of Health and Welfare and the integration and development of assisted reproduction medical information systems by various fertility centers and related vendors in the future
[[alternative]]Application ofExplainable Machine Learning for SinusitisDiagnosis through Voice Feature Extraction and Analysis
No full text[[abstract]]鼻竇炎是一種常見的慢性疾病，其症狀包含鼻塞流鼻水、濃稠鼻涕、發燒頭痛、臉部脹痛、喉嚨痛、嗅覺減退及口臭，長期感染的情況下可能會產生耳朵悶塞感、中耳積水、氣喘、腦膜炎等問題，使得生活品質方面容易受到影響，並增加醫療上的負擔。在全球，鼻竇炎的盛行率相當高，尤其在氣溫變化大的地區更為嚴重。目前，鼻竇炎的診斷主要依賴患者的主訴和醫學影像檢查，如電腦斷層掃描、內視鏡等，然而，這些診斷方式中存在著缺點。本研究探討以無鼻音短文(Oral Passages)、混合短文(Oro-nasal Passages)及鼻音短句(Nasal Sentences)三段不同的語料(Speech Material)類型及其組合，以短時傅立葉變換(Short-Time Fourier Transform, STFT)將語音轉換為頻域，藉由長期平均頻譜做為特徵值，使用多種機器學習演算法對特徵進行分類及訓練，以找出最佳預測模型，並透過模型特徵重要性、總頻譜平均和語音低高音功率比進行驗證，並找出對鼻竇炎具重要影響之語音頻段。研究結果發現，使用無鼻音短文、混合短文、鼻音短句三種組合以及混合短文加上鼻音短句兩種組合方式的ANN模型準確率皆超過90%，分別為93.11%以及91.30%。此外，在各項驗證結果中，語音約於300Hz至400Hz時對模型影響最大，該結果與醫師臨床經驗相符合，由於鼻竇炎患者鼻腔堵塞，導致聲音在通過鼻腔時能量相較於健康者較低。藉此結果顯示本研究使用語音結合機器學習對鼻竇炎分類之方法，能提供醫師及患者準確且可信賴的決策建議。[[abstract]]Sinusitis is a common chronic condition with symptoms including nasal congestion, runny nose, thick nasal discharge, fever, headache, facial pain, sore throat, reduced sense of smell, and bad breath. Prolonged infection can lead to additional issues such as ear fullness, middle ear effusion, asthma, and meningitis, which negatively impact patients' quality of life and increase medical burdens. Globally, the prevalence of sinusitis is quite high, especially in regions with significant temperature fluctuations. Currently, the diagnosis of sinusitis primarily relies on patients' complaints and medical imaging examinations, such as CT scans and endoscopy. However, these methods have their limitations. This study investigates the use of three different types of speech materials—oral passages, oro-nasal passages, and nasal sentences—and their combinations, converting speech to the frequency domain using Short-Time Fourier Transform (STFT). Long-term average spectrum (LTAS) is used as a feature value, and various machine learning algorithms are employed to classify and train these features to identify the best predictive model. The model's feature importance, total spectrum average, and speech low-high power ratio are used for validation, identifying the speech frequency bands most significantly affected by sinusitis.The study results show that ANN models using combinations of oral passages, oro-nasal passages, and nasal sentences, as well as a combination of oro-nasal passages and nasal sentences, achieve accuracies exceeding 90%, specifically 93.11% and 91.30%, respectively. Additionally, validation results indicate that speech frequencies around 300Hz to 400Hz have the most significant impact on the model. This finding aligns with clinical experience, as the nasal blockage in sinusitis patients leads to lower energy in the nasal passage compared to healthy individuals. Therefore, this study demonstrates that using speech combined with machine learning for sinusitis classification can provide accurate and reliable decision-making support for physicians and patients
[[alternative]]Impacts of an Emotional Expression-based Chatbot on Nursing Stuffs’ Learning Performance in Palliative Care
No full text[[abstract]]自從1982年以來癌症一直高居台灣十大死因之首，癌症的發生率已日益漸增，照護的品質上也越顯重要，面對癌症患者的疼痛或副作用產生時，尤其是化、放療後或術後之患者的症狀變化，即便與醫師討論並且能夠評斷護理診斷給予正確的護理措施，但是不同於一般常見內外科疾病應有的症狀反應及緩解程度有差異時，容易感到不知所措及挫敗感。癌末病人症狀之發生比率與其嚴重度排序前三項，生理症狀為「疼痛」、「呼吸困難」與「虛弱」，臨床上許多具備教師證照的資深教學人員，能提供護理人員廣泛的專業知識教學。然而，近年來，臨床護理人力嚴重不足，加上護理工作性質需要輪班，已經影響護理人員參與傳統教育的學習成效及態度，成為教育訓練的一大挑戰。此外，護理人員需要具備安寧照護知識能力，做到回應患者減輕症狀負擔的需求，非僅是背誦口訣或瞭解其中概念。本研究以美國臨床腫瘤學會指引、癌症照護指引為指引，發展以情感表達設計之聊天機器人應用於安寧照護課程，探討不同教學模式之聊天機器人學習系統對於學習成就、自我效能、學習態度與同理心的影響。本研究採用類實驗研究、雙組重複測量設計，研究對象為北部某區域教學醫院之臨床護理人員。實驗組59人使用「以情感表達設計之聊天機器人學習模式」，控制組59人使用「一般聊天機器人學習模式」。研究結果發現，採用「以情感表達設計之聊天機器人學習模式」之護理人員，其安寧症狀照護專業知識、自我效能、及同理心之換位思考程度與痛苦面向顯著優於使用「一般聊天機器人學習模式」，採用「以情感表達設計之聊天機器人學習模式」或「一般聊天機器人學習模式」之學習態度則無顯著差異。關鍵詞：安寧照護、聊天機器人、情感表達[[abstract]]Since 1982, cancer has consistently been the leading cause of death in Taiwan, with its incidence rate increasing over the years. This makes the quality of care even more crucial. When addressing the pain or side effects experienced by cancer patients, especially after chemotherapy, radiotherapy, or surgery, healthcare providers may feel confused and frustrated due to the differences in symptom response and relief compared to common medical-surgical diseases, even when discussing with doctors and providing accurate nursing diagnoses and interventions. Among terminal cancer patients, the top three most frequent and severe physiological symptoms are "pain," "dyspnea," and "weakness." Many senior teaching staff with teaching certificates can offer extensive professional knowledge to nursing personnel. However, in recent years, the severe shortage of clinical nursing staff, coupled with the shift-based nature of nursing work, has impacted the effectiveness and attitude towards traditional educational participation, posing a significant challenge to educational training. Additionally, nursing staff need to possess knowledge and skills in palliative care to respond to patients' needs for symptom burden relief, which requires more than just memorizing mnemonics or understanding concepts.This study, guided by the American Society of Clinical Oncology guidelines and cancer care guidelines, developed an emotionally expressive chatbot applied to palliative care courses. It aimed to explore the effects of different teaching modes of chatbot learning systems on learning achievement, self-efficacy, learning attitude, and empathy. The study employed a quasi-experimental design with a two-group repeated measure. The subjects were clinical nursing staff from a regional teaching hospital in northern Taiwan. The experimental group of 59 participants used the "emotionally expressive chatbot learning mode," while the control group of 59 participants used the "general chatbot learning mode." The results showed that nursing staff using the "emotionally expressive chatbot learning mode" had significantly better professional knowledge of palliative symptom care, self-efficacy, and empathy (perspective-taking and compassionate aspects) compared to those using the "general chatbot learning mode." There was no significant difference in learning attitudes between those using the "emotionally expressive chatbot learning mode" and those using the "general chatbot learning mode."Keywords: palliative care, chatbot, emotioanl expressio
[[alternative]]Effective Factors of Primary Caregivers on Medical Compliance and Prognosis in Patients with Type 2 Diabetes and Chronic Renal Failure
No full text[[abstract]]對於糖尿病的族群，血糖控制能有效預防糖尿病所產生的合併症發生，最好的方法是堅持服藥和改變生活方式，在低醫療遵從性的行為中，「忘記服藥」是很重要影響因素，其可藉由主要照顧者的協助下有效預防發生，而糖尿病病人的飲食習慣也受家庭飲食行為的影響，由此可知主要照顧者對於病人的疾病控制扮演著重要角色。因此本研究想運用Q方法探討主要照顧者對於第二型糖尿病合併慢性腎衰竭住院患醫療遵從性及預後之影響因素。 本研究在採臨床觀察及非結構式訪談，以開放性問題進行訪問10位意見母群體，由意見母群中以建構Q陳述句並做為擬定 Q 陳述句，經由專家效度確認共40句Q陳述句，再邀請30位受試者進行Q陳述句的排列，並以Q Method Software Online and Analysis線上軟體進行Q歸類 (Q-sort)統計軟體進行因素分析。 研究結果可得知四種因素類型：「放任順從型」之主要照顧者照顧態度容易放任行為而導致被照顧的病人遵從性差；「理性溝通型」之主要照顧者以理性情緒面對，採取同理病人並尊重其不遵從的行為，其被照顧的病人醫療遵從性相對較好；「好言相勸型」之主要照顧者採取遵循意願並盡力的勸說，透過理解跟重複勸說來讓病人達到醫療遵從；「自我要求型」之主要照顧者對自我要求高，照顧行為謹慎細心並希望能做得更好，但此類型所被照顧的病人也相對遵從度高，因此主要照顧者態度並未影響其遵從性。 本研究發展的Q陳述句可以代表照護此族群時的困境及因應技巧，也能呈現出不同的主要照顧者族群其不同的照顧態度，透過研究結果可提早介入改善措施於預後差或需要幫助的族群，未來Q陳述句也能發展成可量化的勾選式量表或問卷，用以分析母群體更大的相同族群來加以了解多變的臨床情境。[[abstract]]For patients with diabetes, controlling blood sugar is crucial to prevent complications. The effective methods are adhering to medication and lifestyle changing Among factors in adherence, forgetting to take medication significant cause which can be effectively managed with caregiver support.Patients' eating habits could also be influenced by family dietary behaviors, thus, highlighting the critical role of caregivers in disease management is important. This study uses the Q-methodology to explore factors affecting medical adherence and prognosis in hospitalized patients with type 2 diabetes and chronic renal failure.The study involved clinical observation and unstructured interviews with 10 key informants to construct Q-statements, which were validated by experts, resulting in 40 Q-statements. There are 30 participants then sorted these statements, and factor analysis was conducted using Q Method Software Online and Analysis.This study identified four caregiver types: "Permissive type" where lenient attitudes lead to poor patient adherence; "Rational Communication type" where rational and empathetic approaches result in better adherence; "Persuasive type " where understanding and repeated persuasion improve adherence; and "Self-Demanding type " where meticulous and high self-expectations result in high adherence, unaffected by caregiver attitudes. The study's Q-statements reflect common caregiving challenges and strategies, helping to identify at-risk groups for early intervention and potentially developing into quantitative tools for broader analysis
[[alternative]]Effects of Intervention on Hope, Anxiety, and Attitudes and Behavioral Intentions of Advance Care Planning in Older Adults with Cancer
No full text[[abstract]]背景：預立醫療照護計畫(advance care planning, ACP)對維護個人的自主權至關重要。然而，目前鮮少研究關注於ACP 介入後對罹癌老人的希望、焦慮、態度以及行為意向影響的探討。目的：探討ACP 介入對於65 歲以上罹癌老人之希望、焦慮、ACP 態度及行為意向的影響。方法：採隨機控制試驗。研究對象為北台灣癌醫中心門診的罹癌老人（N=72）。在介入前進行基線測量（T0），並在介入後兩週（T1）及四週時（T2）進行追蹤測量。實驗組以卡通版「高齡預立醫療照護諮商」手冊引導ACP 進行，介入過程約30 至40 分鐘；對照組則採常規照護。評估工具包括赫氏希望指標(Herth Hope Index, HHI)、中文版情境焦慮量表的情境焦慮部分(Chinese Version of State-Trait Anxiety Inventory, STAIS)、ACP 態度量表以及行為意向量表。資料分析以廣義估計方程式(Generalizedestimating equations, GEE)，探討實驗組和對照組於組間及時間序列上的變化。結果：實驗組及對照組分別為37 人與35 人，平均年齡為71.1 歲與73.4 歲。兩組在介入前無論基本資料和主要變項上皆無顯著差異。介入後，實驗組與對照組的焦慮於組間無顯著差異，但兩組的焦慮都隨時間顯著下降(T0 to T1, B=-3.857, p=0.003; T0 toT2, B=-3.971, p=0.002 )。雙組的希望與ACP 態度得分無論於組間、或組間與時間的交互作用沒有顯著差異。實驗組的ACP 行為意向比對照組於T0 得分相比有顯著差異(T0 to T1, B=2.412, p <0.001; T0 to T2, B=2.694, p <0.001)。結論：ACP 介入並不會減少癌症老人的希望。定期回門診接受治療及追蹤的罹癌老人，門診期間是進行ACP 合適的時機。發展個人化ACP 介入措施，降低癌症老人的焦慮是未來所需。[[abstract]]Background: Advance Care Planning (ACP) is essential for preserving individual autonomy. However, current research has limited to explores the impact of ACP interventions on hope, anxiety, attitudes, and behavioral intentions among older adults with cancer.Objective: This study aims to investigate the effects of ACP interventions on hope, anxiety, ACP attitudes, and behavioral intentions among older adults with cancer aged 65 and older.Methods: A randomized controlled trial was conducted with elderly cancer patients at a cancer center in Northern Taiwan. The experimental group received an ACP conversation lasting 30 to 40 minutes through a cartoon version of the "Advance Care Planning for the Seniors" brochure guide. The control group received standard care. Instruments used included the Herth Hope Index (HHI), the situational anxiety portion of the Chinese Version of the State-Trait Anxiety Inventory (STAI-S), the ACP attitude, and behavioral intentions scale. Baseline measurements (T0) were taken before the intervention, followed by assessments at two weeks (T1) and four weeks (T2) post-intervention. Data were analyzed using Generalized Estimating Equations (GEE) to examine changes over time and between groups.Results: The experimental and control groups comprised 37 and 35 participants, respectively, with average ages of 71.1 and 73.4 years. There were no significant differences in demographic data or primary variables at baseline. Post-intervention, there was no significant difference in anxiety between the groups, but anxiety levels significantly decreased over time in both groups (T0 to T1, B=-3.857, p=0.003; T0 to T2, B=-3.971, p=0.002). No significant differences were found in hope or ACP attitudes either between groups or in the interaction between group and time. However, ACP behavioral intentions were significantly higher in the experimental group than in the control group from the baseline (T0 to T1, B=2.412, p <0.001; T0 to T2, B=2.694, p <0.001).Conclusion: ACP interventions do not reduce hope among older adults with cancer. Regular outpatient visits for treatment and follow-up are appropriate times for conducting ACP. Developing personalized ACP interventions to reduce anxiety among elderly cancer patients is necessary for the future
[[alternative]]The Study of Physical activity level on the Relationships among Sleep Quality, Fatigue and Quality of Life in HIV Infected Patients
No full text[[abstract]]台灣HIV(human immunodeficiency virus)感染者已達4萬餘例，隨著醫藥進步大幅降低HIV感染者死亡率，轉變為慢性疾病，使生活品質成為重要的議題，研究顯示活動對感染者健康可能具關鍵性影響，與疲憊、睡眠品質也具關聯性，故本研究目的為探討HIV感染者活動量、睡眠品質、疲憊及生活品質之相關。 採橫斷式研究設計，樣本來自北部某醫學中心之感染科門診，收案條件需符合:經感染科醫師診斷HIV感染者、自知為確診者、年齡為18歲以上、服用或曾服用抗病毒藥物者、意識清楚、能國台語溝通者，識字者。研究工具包括國際身體活動量表(The International Physical Activity Questionnaire)台灣中文版、中文版匹茲堡睡眠品質量表(Pittsburgh Sleep Quality Index ,CPSQI)、中文版HIV相關疲憊量表(HIV-related Fatigue Scale, C-HRFS)、中文版HIV生活品質量表(WHOQOL-HIV-Bref)，資料以SPSS 20.0版進行分析。共收案150位男性，平均年齡為37.9歲，教育程度以大學居多(61.3%)，有固定職業(87.3%)，罹病平均為7.39年。活動量結果顯示，超過五成受訪個案的一週身體活動量程度屬「高度身體活動量」，與睡眠品質、疲憊與生活品質並無顯著相關;睡眠品質總分平均7.46±3.66分，68% HIV感染者睡眠品質不良;疲憊；疲憊平均182.8分，31-40歲族群疲憊程度最高，疲憊與藥物副作用、睡眠品質達顯著正相關(r = .40，p < .001)，與生活品質達顯著負相關(r = -.51，p < .001);生活品質14.38分，屬於中等偏好，無職業、年齡越高、接受雞尾酒療法時間長、藥物副作用少者，生活品質越佳;疲憊與睡眠品質為生活品質預測因子，疲憊程度、睡眠困擾越高時，生活品質則會越差。對於HIV感染者臨床照護應關注用藥的副作用、疲憊及睡眠品質問題，建議活動量不足者建立運動的習慣，至少達一週3000 MET-minute，以提升HIV感染者的生活品質和整體健康狀態。[[abstract]]There are more than 40,000 HIV patients in Taiwan. With medical advances significantly reducing the mortality rate of HIV patients, HIV has transformed to a chronic disease. The quality of life has become an important issue for HIV patients. Research indicates that physical activity has a critical impact on health, which is also related to fatigue and sleep quality. Therefore, the purpose of this study is to explore the correlation between activity levels, sleep quality, fatigue, and the quality of life of HIV patients.This study was conducted by a cross-sectional research design. The samples were obtained from the infectious disease outpatient clinic of a medical center in northern Taiwan. The inclusion criteria were: diagnosed with HIV infection, aware of their HIV status, 18 years or older, on antiviral medication, clear consciousness, able to communicate in Mandarin and Taiwanese, and literate. The questionnaire used included the Taiwan Mandarin version of “The International Physical Activity Questionnaire,” the Mandarin version of the “Pittsburgh Sleep Quality Index (CPSQI),” the Mandarin version of the “HIV-related Fatigue Scale (C-HRFS),” and the Mandarin version of the “HOQOL-HIV-Bref.”The data were analyzed using SPSS version 20.0. There were 150 valid samples, predominantly male, with an average age of 37.9 years, mostly college-educated (61.3%), employed (87.3%), with an average infectious period of 7.39 years. More than 50% of the samples had a “high level of physical activity” per week, showing no significant correlation between the quantity of physical activity and sleep quality, fatigue, and quality of life. The average sleep score was 7.46±3.66 points, indicating that 68% of HIV patients have poor sleep quality. The average fatigue score was 182.8, with the 31-40 year old group experiencing higher fatigue levels than other age groups, showing a significant positive correlation with drug side effects and sleep quantity (r = .40, p<0.01). There was a significant negative correlation between fatigue and quality of life (r = -5.1, p<0.01).The quality of life score was 14.38. Those without a job, older individuals, those who have been on combination therapy for a longer period, and those experiencing fewer drug side effects tend to have a better quality of life. Fatigue and sleep quality are predictors of quality of life; higher levels of fatigue and sleep disturbances are associated with a lower quality of life. Predictors of quality of life were fatigue and sleep quality, showing that higher levels of fatigue and sleep disturbances corresponded to worse quality of life. Clinical care should focus on drug side effects, fatigue, and quality of sleep issues. To improve the quality of life and overall health of HIV patients, it is recommended that those who are not active enough should develop an exercise habit of at least 3000 MET-minutes per week
[[alternative]]Informational Needs of Primary Caregivers of Patients with Stroke Receiving Integrated Medicine
No full text[[abstract]]研究背景與動機：為了照顧罹患腦中風的家人，主要照顧者需要獲得照護相關的資訊。台灣民眾罹患疾病時，除了接受西醫治療之外，常同時尋求中醫的幫助。研究目的：探討中西醫結合治療腦中風病人的主要照顧者之資訊需求及其影響因素。研究方法：於北部某區域教學醫院招募照顧中西醫結合治療腦中風病人的主要照顧者參與研究。以個別訪談收集質性資料，做為發展問卷的依據。再以問卷收集研究對象特性、被照顧者屬性及主要照顧者的資訊需求。收集到的資料以獨立樣本t檢定、單因子變異數分析與複迴歸等分析研究對象特性、被照顧者屬性與資訊需求之間的關係。研究結果：根據2021年09月20日至2022年05月11日，個別訪談10位研究對象所得，發展出內含中西醫結合治療資訊需求與一般腦中風照護資訊需求兩個部分的「中西醫結合治療腦中風病人主要照顧者的資訊需求問卷」，每個題項以Likert四點量表計分。自2023 年04月29日至2024年01月09日， 共115位研究對象完成問卷調查。近70%為女性，60%以上有工作，大於60%被照顧者的日常生活功能60分以下及失能嚴重度4～5分。主要照顧者的資訊需求問卷平均得分為3.31±0.40。中西醫結合治療有關的資訊需求(3.43±0.56)，顯著高於一般腦中風照護的資訊(3.19±0.53)。一年可請假天數、沒有與被照顧者同住，及被照顧者身上有管路、慢性病數等為影響主要照顧者資訊需求的因素。結論/實務應用：本研究呈現照顧同時使用中西醫結合治療腦中風病人的主要照顧者希望獲得的資訊需求，也探討了主要影響資訊需求的因素。除了就醫地點近外，我們的分析還凸顯了期望獲得能提供整合中醫和多種西醫科別醫療服務的醫療院所之資訊。這些結果可作為臨床實務與修訂整合醫療相關政策之參考。[[abstract]]Background and Motivation: The primary caregiver needs care-related information to care a family member with stroke. When Taiwanese people suffer from diseases, in addition to receiving Western medical treatment, they often seek help from traditional Chinese medicine.Purpose: To explore the informational needs and influencing factors of primary caregivers of patients with stroke receiving integrated medicine.Methods: The primary caregivers of patients with stroke receiving integrated medicine were recruited from a regional teaching hospital in northern Taiwan to participate in the study. Based on the qualitative data from individual interviews, a questionnaire was developed to collect the characteristics of the research object, the attributes of the care recipient, and the informational needs of the primary caregiver. The collected data were analyzed using independent sample t-test, one-way ANOVA of variation and multiple regression analysis to analyze the relationship between the characteristics of the research object, the attributes of the care recipient and the informational needs.Results: From September 20, 2021 to May 11, 2022, 10 research subjects were interviewed. According to the informational needs they mentioned and literatures, a questionnaire developed to ingury the informational needs of primary caregivers of patients with stroke receiving integrated medicine. From April 29, 2023 to January 9, 2024, 115 subjects completed the survey. Nearly 70% are women, more than 60% are employed, and more than 60% of the care recipients have a daily living function score of less than 60 points and a disability severity of 4 to 5 points. The mean score of the primary caregiver's informational needs was 3.31±0.40. The means score for the subscale of integrate-using western medicine and traditional chinese medicine (3.43±0.56) are significantly higher than those on general stroke care (3.19±0.53). Annual leave per year and living situation of primary caregivers, intubation and comorbidities of patients are the main factors of the informational needs.Conclusion / Practical Application: This study indicates the primary caregivers expected to obtain the information related to general stroke care and integrate-using western medicine and traditional chinese medicine. The major factors affecting the informational needs are presented. Beside the essential spatial accessibility of healthcare systems, our analysis shows it is important for primary caregivers to know which institutions afford healthcare services integrated diverse medical disciples, including Neurology, Rehabilitation, and TCM and so on. These findings can serve as a reference for clinical practice and for the government to revise medical policies