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Agreement between Patients with Parkinson’s Diseasend Their Caregivers in Measures of Patient''s Self Carebilities, Mental Health and Quality of Life
No full text巴金森氏症病患好發於中老年人，且常伴隨有焦慮或憂鬱之心理健康問題，進而影響病患之生活品質，主要的治療方式目前仍以藥物控制為主，且隨著疾病分期的進展，主要照護者對病患自我照顧能力、心理健康以及生活品質的評估愈顯重要，病患自評與主要照護者評估之間一致性愈佳，對醫療照護愈有益。但在臨床照護中發現，病患及主要照護者之間對於病患的自我照顧能力、心理健康狀況以及生活品質的評估並不一致，故引發本研究之目的在於瞭解巴金森氏症病患與其主要照護者對病患之自我照顧能力、心理健康及生活品質評估一致性之研究。 本研究採立意取樣，以北部某醫學中心之巴金森氏症門診以及「巴金森氏症暨運動障礙中心」之巴金森氏症病患與其主要照護者為研究對象，收案期間自民國97年12月中旬至98年3月底，共收案76位個案與其主要照護者，研究工具包括：巴氏量表、工具性日常生活活動量表、中國人健康量表以及臺灣簡明版世界衛生組織生活品質問卷，以問卷方式分別收集病患及其主要照護者資料。研究結果發現，身體外顯功能方面，病患與主要照護者評估巴氏量表平均一致性（Kappa值）為0.42；複雜性日常生活活動能力方面，工具性日常生活活動量表平均ㄧ致性（Kappa值）為0.46，亦為中等一致性。心理健康屬較為隱晦的狀況，中國人健康量表平均一致性（Kappa值）為0.05，一致性極低，以3分作為切分點，有61.8%的巴金森氏症病患自評有焦慮或憂鬱輕型精神症狀傾向，生活品質方面，病患自評及其主要照護者評估之平均一致性（Kappa值）為0.25，一致性低，且病患自評罹病後之生活品質明顯低於罹病前之生活品質(t=-12.14, p=0.00)。金森氏症病患自評結果顯示基本日常生活活動能力與複雜性日常生活活動能力呈顯著正相關(r=0.79, p=0.00)，基本日常生活活動能力與生活品質呈顯著正相關(r=0.55, p=0.00)，複雜性日常生活活動能力與生活品質呈現顯著正相關(r=0.48, p=0.00)，心理健康與基本日常生活活動能力(r=-0.44, p=0.00)、複雜性日常生活活動能力(r=-0.32, p=0.00)以及生活品質(r=-0.50, p=0.00)均呈現顯著負相關，且疾病分期不同，病患在基本日常生活活動能力(F(2,73)=8.68, p=0.00)、複雜性日常生活活動能力(F(2,73)= 8.57, p=0.00)的執行也顯著不同。 主要照護者以女性居多，共53人(69.7%)，關係多為配偶，且居住在一起。每日照顧病患時間愈久，評估病患在基本日常生活活動能力(r=-0.51, p=0.00)、複雜性日常生活活動能力(r=-0.49, p=0.00)愈需要協助，且評估病患之生活品質(r=-0.43, p=0.00)較差；照顧年限愈久者，評估病患之基本日常生活活動能力(r=-0.24, p=0.03)、複雜性日常生活活動能力(r=-0.26, p=0.03)愈需要協助。主要照護者之身分為病患之配偶、以及主要照護者特性為「無」收入者以及「無」工作者有較低估病患之基本日常生活活動能力以及複雜性日常生活活動能力的趨勢。心理健康方面，主要照護者為「無配偶」者、與病患關係為「非配偶者」、「無」收入以及不與病患同住者亦有較低估病患之心理健康狀態的趨勢。生活品質方面，婚姻狀況為「無配偶」者、與病患關係為「非配偶者」、「無」收入者、與病患不同住者以及「無」工作者有較高估病患之生活品質的趨勢。 巴金森氏症病患之生活品質影響因子為基本日常生活活動能力(β=0.32, p=0.01)與疾病分期(β=-0.31, p=0.01)，基本日常生活活動能力可解釋變異量為19%，而疾病分期可解釋變異量7%，共可解釋變異量為26% (Adjusted R2=0.26)。 藉由本研究之發現，病患自評與主要照護者評估於基本日常生活活動能力以及複雜性日常生活活動能力之一致性較心理健康以及生活品質之ㄧ致性佳，巴金森氏症病患自我照顧能力愈佳，對生活品質愈滿意，且心理健康狀況愈好。主要照護者對病患的支持與協助對病患是相當重要，藉由主要照護者對病患需求的確認，提供必要協助，並鼓勵病患主動表達出想法，除了可加強病患基本日常生活活動能力及複雜性日常生活活動能力外，尚可提升病患與家屬者之間的一致性，也可使醫護之間的溝通更為明確，相對可提升病患的心理健康以及生活品質。期望將本研究之研究結果應用於臨床護理實務上，使主要照護者獲得充分的資訊及協助可使病患獲得更適切之照護。Parkinson’s Disease (PD) occurs most among elderly people. Mental problems, namely anxiety and depression, significantly affect the Quality of Life (QOL) of patients with PD. Oral medication is currently the most widely used treatment for PD. Additionally, caregiver’s measures of patient’s self care abilities, mental health and QOL are essential for clinical decision making in patients in advanced stages of PD. Better agreements between patient self-rated and proxy lead to better treatment decisions. However, clinical experience indicates patients’ self-rated measures and reports from their caregivers often do not agree with each other. Hence, the main purpose of this investigation is to understand the agreement among reports in these factors. The data of 76 patients and their caregivers were recruited with purposive sampling from a PD out-patient clinical and center of Parkinsonism and movement disorder in a medical center in Taipei from December 2008 to March 2009. The data were accumulated using the Barthel Index, the Lawton Instrumental Activities of Daily Life, Chinese Health Questionnaire and WHOQOL-BREF Taiwan Version. The mean agreement values (Kappa) of Barthel Index and the Lawton Instrumental Activities of Daily Life in this study were 0.46 and 0.42, respectively, indicating moderate agreement. The mean Kappa value of Chinese Health Questionnaire was 0.05, signifying extremely low agreement. Using 3 as the cut-off point, 61.8% of the patients had non-psychotic mental disorders. The mean Kappa value of WHOQOL-BREF Taiwan Version was 0.25, demonstrating low agreement. The patient self-rated quality of life declined significantly after PD was diagnosed (t=−12.14, p=0.00). Significantly positive correlations were observed between patient’s self-rated basic activities of daily living (BADL) abilities and instrumental activities of daily living (IADL) abilities (r=0.79, p=0.00), BADL abilities and quality of life (r=0.55, p=0.00), and between IADL abilities and quality of life (r=0.48, p=0.00). Additionally, significantly negative correlations were noted between mental health and BADL abilities (r=−0.44, p=0.00), mental health and IADL abilities (r=−0.32, p=0.00), and between mental health and quality of life (r=−0.50, p=0.00). Patients in different stage of Parkinson’s disease have significant differences in BADL abilities (F(2,75)=8.68, p=0.00) and IADL abilities (F(2,75)= 8.57, p=0.00). Most caregivers in this investigation were female (n=53, 69.7%), spouses, and living with the patients. Significantly negative correlations were observed between the daily hours of care provided and patients’ BADL abilities, IADL abilities and quality of life measured by caregivers (r=−0.51, −0.49, −0.43, p=0.00, 0.00, 0.00, respectively). Caregivers who provided cared for patients for more hours per day rated their patients are more physically dependent and less satisfied with life. Additionally, significantly negative correlations were seen between the duration of care giving and BADL abilities and IADL abilities measured by caregivers (r=−0.24, −0.26, p=0.03, 0.03, respectively). Caregivers with longer durations of caregiving rated their patients as more physically dependent. Caregivers in the categories “patient’s spouse”, “having no income” and “unemployed” tended to underestimate patient’s BADL abilities and IADL abilities. Caregivers classed as “not married”, “not patient’s spouse”, “having no income” and “not living with the patient” tended to underestimate patient’s mental health. Caregivers who were “not married”, “not patient’s spouse”, “having no income” “not living with the patient” and “unemployed” tend to overestimate patient’s quality of life. Two variables, patient’s BADL abilities (β=0.32, p=0.01) and the stage (β= −0.31, p=0.01) were significant predictors for patient’s quality of life. The BADL abilities accounted for 19% of the variance, and the stage accounted for 7%. These two variables explained 26% of the total variance on patient’s quality of life. Analytical results demonstrate that BADL abilities and IADL abilities have better agreement than mental health and quality of life . Patients with better self-care abilities have better the mental health and quality of life. Furthermore, assistance and support from caregivers are important. Promoting the caregiver’s understanding of the patient’s needs, providing necessary assistance and encouraging patients to express their emotions, may improve the measures of agreement between the patients and the caregivers, and further enhance effective communication between physicians and caregivers, and thus improve the mental health and general quality of life of patients. Results of this investigation might be applied in clinical practice, by providing comprehensive information and assistance to equip caregivers with knowledge and skills, thus allowing the provision of appropriate care to patients.口試委員會審定書… i謝… ii文摘要… iii文摘要… v容目錄… viii目錄… x目錄… xi一章 緒論… 1一節 研究動機及重要性… 1二節 研究目的… 3三節 名詞定義… 4四節 研究架構… 6二章 文獻查證… 7一節 巴金森氏症簡介… 7二節 巴金森氏症對病患自我照顧能力、心理健康的影響… 10三節 自我照顧能力、心理健康與生活品質之關連及其相關因素… 15四節 病患與主要照護者對病患自我照顧能力、心理健康與生活品質評估之ㄧ致性及其相關因素… 21三章 研究方法… 26一節 研究設計… 26二節 研究對象… 26三節 研究工具… 27四節 資料收集過程… 33五節 資料分析… 33六節 研究倫理考量… 35四章 研究結果… 36一節 研究對象之基本屬性及主要測量變項得分分佈情形… 36二節 巴金森氏症病患及主要照護者對於病患自我照顧能力、心理健康及生活品質評估之ㄧ致性… 51三節 巴金森氏症病患自我照顧能力、心理健康及生活品質之相關性… 55四節 巴金森氏症病患社會人口學特性與疾病特性與其自評自我照顧能力、心理健康與生活品質之關連… 57五節 主要照護者之社會人口學特性與評估巴金森氏症病患之自我照顧能力、心理健康及生活品質之關連… 63六節 巴金森氏症病患社會人口學特性、疾病特性、自我照顧能力及心理健康對其生活品質之預測… 76五章 討論… 78一節 巴金森氏症病患及主要照護者對於病患自我照顧能力、心理健康及生活品質評估之一致性探討… 78二節 主要照護者社會人口學特性對評估病患之自我照顧能力、心理健康及生活品質一致性之探討… 82三節 巴金森氏症病患之自我照顧能力、心理健康及生活品質與其他神經疾患之比較… 85四節 巴金森氏症病患生活品質之預測因子… 89六章 結論與建議… 90一節 結論… 90二節 建議… 91三節 研究限制… 92amp;#63851;考文獻… 94文部分… 94文部分… 96件… …100件（一） 巴氏量表…100件（二） 工具性日常生活活動量表…102件（三） 中國人健康量表… 104件（四） 臺灣簡明版世界衛生組織生活品質問卷… 106件（五） 簡易心智功能量表… 112件（六） 個人基本資料… 113件（七） 主要照護者基本資料… 114件（八） 倫理委員會審查通過函… 116件（九） 中國人健康量表同意使用函… 118件（十） 臺灣簡明版世界衛生組織生活品質問卷同意使用函… 11
提升居家護理師性知識衛教指導率
No full text護理指導是護理人員執業的獨特功能，然而因為「性」常被國人視為禁忌的問題，因 此在居家護理個案中正確的性知識傳遞，不只是個案及照顧者不敢問，往往一般的護 理人員亦無能力指導。本專案的目的在瞭解現階段居家護理人員對性知識的正確認知 及其指導現況，將居家護理個案常遇到性問題，透過彙整各相關文獻並經各專業小組 討論,制作成衛教單張及性知識諮商準則，經由護理人員在職教育方式以提高居家護 理師性知識指導率。方案施行後，護理人員獲得性知識並具有衛教指導能力從25﹪提 升至100﹪，對個案性知識的指導率從6﹪提升至53﹪，護理記錄中具體呈現性指導記 錄者則從0%提升至100%。當個案及照顧者提出性方面的相關問題時，居家護理師不僅 能提供「知」的需求且也具「教」的能力，更助於照顧品質的提升
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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