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Background: Few of the interventions currently available for family caregivers (FCGs) of persons with dementia (PWDs) with long-term follow-ups have a grounding in theory and incorporate multicomponent case management formats., Purpose: Based on Pearlin's Caregiving and Stress Process model, this study was developed to examine the effectiveness of a family-centered case management program for PWDs with early to moderate dementia in terms of reducing PWDs behavioral problems and improve FCG outcomes, including distress, self-efficacy, depression, caregiver burden, and health-promoting behaviors., Methods: This randomized, single-blind, parallel-controlled trial included 76 dyads of PWDs and their FCGs. The dyads were recruited from outpatient clinics at dementia centers in three district hospitals in northern Taiwan. The dyads were randomly assigned to the intervention group (IG, n = 39) and control group (CG, n = 37). The dyads in the IG received a four-month intervention with two home or clinic visits and two telephone interviews. The multi-component interventions provided assessment, education, consultations, support, and referrals to long-term care resources. The CG received routine care and two social phone calls. Data were collected upon enrollment (T0 = baseline) and at 4-,6-, and 12-months post-intervention (T1, T2, and T3, respectively). Generalized estimating equations were conducted to analyze the effects of the intervention., Results: By controlling for the interaction between group and time, we made a comparison between IG and the CG. The results showed significant improvements from baseline measures in behavioral problems in the PWDs for mood, psychosis, and social engagement, and improvements in the FCGs for distress and self-efficacy for obtaining respite as well as for better control of distressing thoughts, feelings of depression, caregiver burden, and overall health promoting behaviors at T1 and T2 (p < 0.5). Significant improvements were also found in the IG for psychomotor regulation among PWDs and the self-efficacy of FCGs in managing the PWDs' disturbing behaviors and health promotion behaviors for nutrition at T1 (p < 0.5). There were no significant improvements in the outcome variables at T3., Conclusions / Implications for Practice: Significant interactions between group and time were found at the 6-month assessment (T2) for improvements in problem behaviors of PWDs and depression, caregiver burden, and distress in the FCGs. Positive effects on self-efficacy and health promotion behaviors among the FCGs were also achieved. The results suggest that a multicomponent case management intervention should be referenced in dementia care policymaking for FCGs and PWDs.

Background: The prognosis of patients with liver cirrhosis often involves multiple complications and repeated admissions, which may significantly burden and reduce the quality of life of the primary caregivers of these patients., Purpose: The purpose of this correlational study was to explore the relationship between the burden of caregivers of liver cirrhosis patients and their quality of life., Methods: A structured questionnaire, which included the Primary Caregiver Burden Scale, Coping Behaviors Scale, the WHOQOL-BREF, and a caregiver demographic datasheet, was used to collect data. Descriptive and inferential statistics (independent t-test, one-way ANOVA, Pearson's product-moment correlation, and stepwise regression analysis) were used to analyze data., Results: A total of 113 participants were recruited from a medical center in northern Taiwan. The results revealed: (1) The highest average scores for caregiver burden were in the financial domain, while the lowest average scores were in the physical domain. The highest average scores for quality of life were observed in the environment domain, while the lowest average scores were in the physical health domain. (2) Most of the caregivers adopted a problem-solving oriented strategy to care for their patient. (3) Overall care burden correlated negatively with overall quality of life (r = -.223, p < .05). The caregivers' "self-assessed health", "financial load", and "daily care hours" were significant factors affecting overall quality of life (F = 52.78, p < .05), accounting for 58% of the total variance in the results., Conclusions: The results of this study may help nurses better understand and work to reduce the burden of caregivers in order to enhance their quality of life. Nurses should assess caregiver burden, especially in cases where caregivers themselves are in a poor financial situation or have poor self-assessed health, in order to provide necessary support and assistance.

The long-term care of cognitively impaired patients with concomitant behavioral problems brings great stress and burdens to family caregivers. The present article describes a family caregiver with multiple chronic diseases who concurrently shouldered primary care responsibilities for her husband, a patient with mild cognitive impairment, problematic behaviors, and medication non-adherence issues. The period of care was between September 23rd and December 29th, 2015. Data on physiological, psychological, and social burdens were collected based on a stress process model for family caregiving. We then applied a home-based, individually tailored intervention, which included nursing education, skills training, listening/counseling, and resource connecting, that effectively helped the family caregiver reduce her burdens. Our assessment identified nursing-care-related problems as the primary source of caregiver burden in this case, with identified stressors including a lack of knowledge regarding patient care, medication management problems, sleep disorders, and inadequate social resources. Using continuous care interactions, we established a trust relationship with the family caregiver, prioritized her needs, and provided dementia care knowledge and skills, which gradually improved her caregiving competence. Our instruction included increasing caregiver understanding of the disease course of dementia, related problematic behaviors, and medication management. Our intervention enhanced the disease awareness of the caregiver and helped her become more positive about her caregiving tasks. Therefore, the negative impacts on her family were reduced. Social support and long-term care resources further reduced her burden and improved her quality of life.

Background: Chronic liver disease and cirrhosis are collectively ranked as the ninth most prevalent cause of death in Taiwan. Ascites is the most common comorbidity associated with liver cirrhosis. Different body postures affect pulmonary ventilation and arterial oxygen partial pressure. Thus, ensuring proper body posture in patients is an important clinical nursing intervention that significantly affects the recovery of patients., Purpose: This study investigates the effects of head posture on oxygenation saturation, comfort, and dyspnea in patients with liver cirrhosis-related ascites., Methods: A quasi-experimental study design was used. A total of 252 participants were recruited from a medical centre hospital in Taiwan. Participants were allocated randomly into three groups of bed-elevation angles: 15 degrees, 30 degrees, and 45 degrees. The physiological indices were measured at 5, 10, 15, 20, 25, and 30 minutes in order to investigate the change in oxygenation saturations that were attributable to the different angles. Data were analyzed using descriptive statistics. The generalized estimating equation (GEE) was used for statistical analysis, with the level of significance set at: α = .05., Results: After controlling for confounding variables, the results showed that patients in the three groups earned similar scores for the degree of difficulty in the oxygen values. The supine group earned significantly different scores than the other two groups in terms of blood oxygen values related to time to change the angle of the three groups at five minutes after adjusting the angle (p < .01). This study found no differences among the three groups in terms of comfort. In terms of breathing, this study found a significant difference between 45-degree and 15-degree supine dyspnea (p < .05). Therefore, patients with ascites at 15 degrees supine and with better access to better oxygen saturation had superior results to their peers at 30 degrees and 45 degrees supine. Furthermore, this group was less likely to perceive breathing difficulties., Conclusions / Implications for Practice: The results of this study may guide health education and care for nurses in order to improve the quality of care for patients with chronic liver disease / cirrhosis with concomitant ascites.

Background: In Taiwan, eighty-five percent of dementia patients are cared for by family caregivers (FCGs), who have indicated insomnia to be a prevalent personal health problem., Purpose: The aim of this study was to explore sleep disturbance and associated factors among FCGs caring for dementia patients., Methods: A purposive sample of 180 dementia patient dyads and their FCGs was recruited from northern Taiwan. Dementia patients neuropsychiatric symptoms were assessed using the Chinese Neuropsychological Inventory (CNPI). FCG distress, depressive symptoms, and sleep disturbance were assessed using the CNPI Caregiver Distress Scale, Center for Epidemiological Studies-Depression Scales, and Lee's General Sleep Disturbance Scale, respectively., Results: Sleep disturbance was reported as interfering with the daily lives of 13.3% of FCGs. The hierarchical regression model indicated (1) relationships between patients and FCGs and (2) FCG depressive symptoms as two significant predictors of sleep disturbance in FCGs, explaining 45.8% of variance. FCG depressive symptoms represented the most significant single predictor - contributing 31% of variance., Conclusions: Sleep disturbance in FCGs is predicted by the patient-FCG relationship and FCG depressive symptoms. To better care for FCGs of dementia patients, nurses should assess patients behavioral problems, FCG distress, and FCG depressive symptoms. Nurses may also better allocate social resources based on the specific relationships between FCGs and their dementia patients. In addition, nurses should redirect FCG attention toward positive thinking in order to alleviate depressive symptoms and decrease sleep disturbance.

This study was designed to evaluate the reliability and validity of the Chinese version of the diagnostic and statistical manual (DSM) of mental disorders written by Ely et al as a confusion assessment method for the intensive care unit (CAM-ICU) for diagnosing delirium. Purposive sampling was used to recruit 31 patients in a southern medical center ICU. Data were collected by two interviewers who used CAM-ICU to test inter-rater consistency. DSM served as the delirium diagnosis standard to test CAM-ICU validity and calculate sensitivity and specificity. The inter-rater reliability Kappa value for CAM-ICU applied to delirium diagnosis was .48 (p< .01). The validity PABAK value was .48 (p< .01) and McNemar's test value was p = .72. The sensitivity achieved by the two interviewers was 89%, versus 96% for the doctor. The CAM-ICU is a method that helps ICU nursing staff to detect occurrences of delirium rapidly and easily, permitting early intervention treatment with fewer complications.

Microcolon is a radiological finding of a colon of tiny caliber on barium enema examination. There are no absolute standards for measurement of this condition which is probably caused in utero by lack of appropriate distention of the colon with intramural content. A review was undertaken of 228 barium enema examinations of newborns admitted to Mackay Memorial hospital from January 1987 to December 1988. Twenty cases (8.7%) were regarded by the same radiologist as microcolon. Among them, ileal atresia was found in nine cases (45%); colonic atresia in two cases (10%); total colon agangliosis in three cases (15%); prenatal volvulus in two cases (10%); meconium ileus in two cases (10%); duplication of ileum in one case (5%): and megacystis-microcolon-intestinal hypoperistasis (MMIHS) in one case (5%). The characteristic features of plain abdomen and barium enema study were discussed. The finding of a microcolon on contrast enema study in newborn with lower gastrointestinal obstruction signifies that it may rise from lower gastrointestinal obstruction above colon, external compression, or motility disorder of the intestine itself. The outcome of microcolon seems to depend on its underlying causes. In those caused by obstruction, only the caliber may return to normal within days after removal of the obstruction.

To investigate the referral patterns of group practice centers in Taiwan, 18 group practice centers were studied. These study sites were sampled in a stratified random method over four districts (eastern, northern, central, and southern) in Taiwan. The study period took place between July 1989 and June 1990. Prospective referral forms were applied in every study site during the 12-month period. A computer-assisted data base for referral contents was established to follow up referral cases. During the study period, 1,647 referrals were generated from 735,534 patient visits, for an overall referral rate of 0.22 percent of all office visits. According to the International Classification of Health Problems in Primary Care, 2nd edition, most of the problems that needed referral were signs, symptoms, ill-defined conditions, digestive system diseases, genitourinary system diseases, circulatory system diseases, neoplasms and musculoskeletal, connective tissue diseases. The top 6 consulting specialties were internal medicine, surgery, obstetrics & gynecology, orthopedics, urology and pediatrics. Periodic evaluation of the dynamic referral contents is a useful method to improve the quality of primary medical care.

Propionic acidemia is a rare hereditary disease which is an autosomal recessive disorder. Defect of propionyl CoA carboxylase results in abnormal accumulation of propionate and its metabolites which interfere the pathway of glycine cleavage and the urea cycle. This organic acidemia is characterized by a wide spectrum of clinical and biochemical findings, including recurrent vomiting, difficult feeding, lethargy, hypotonia, metabolic ketoacidosis, hyperglycinemia and hyperammonemia during the acute episodes. We present a male newborn infant who sustained this disorder and was managed successfully with blood exchange transfusion, peritoneal dialysis, supplemented with sodium benzoate and sodium bicarbonate therapy. Urine gas chromatography disclosed significant elevation of propionate and its metabolites which subsided 2 days after peritoneal dialysis. Special designed formula was then given with restriction of protein intake and supplement with sodium benzoate and sodium carbonate. Prenatal genetic counseling is necessary in further pregnancy. Diagnosis can be obtained when propionyl CoA carboxylase activity is low in cultured amniotic fluid cells or chorion villi sample or when there is abnormally high methylcitrate level in amniotic fluid.