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Informal caregivers are essential in supporting stroke survivors' recovery, but it is unclear whether community interventions can promote healthy eating behaviors and social participation among stroke survivors and their caregivers. The Train-Your-Brain (TYB) program's impact on adherence to national dietary guidelines and social participation among informal caregivers and stroke survivors were assessed in a quasi-experimental study. The TYB program had nine sessions, with one focusing on healthy lifestyle. Participants were prompted to discuss the topics covered, leading to social participation. Dietary habits were assessed using fruits and vegetables consumption questions, while social participation was measured using the Social Impact Measurement Framework. Mann-Whitney U-test and Wilcoxon Signed Rank Test were utilized to analyze the data. Eighteen informal caregivers and 27 stroke survivors participated in the program. Results showed a significant increase in fruit and vegetable intake and social participation in informal caregivers after the program, but there were no significant changes in stroke survivors. Informal caregivers play a crucial role in stroke survivors' lifestyle habits and in encouraging social connections with other stroke survivors. Thus, healthcare professionals should prioritize caregiver support and education to facilitate long-term dietary and social changes that can positively impact stroke survivor's recovery and quality of life.

Background Trigger finger is a common hand condition that occurs when movement of a finger flexor tendon through the first annular (A1) pulley is impaired by degeneration, inflammation, and swelling. This causes pain and restricted movement of the affected finger. Non-surgical treatment options include activity modification, oral and topical non-steroidal anti-inflammatory drugs (NSAIDs), splinting, and local injections with anti-inflammatory drugs. Objectives To review the benefits and harms of non-steroidal anti-inflammatory drugs (NSAIDs) versus placebo, glucocorticoids, or different NSAIDs administered by the same route for trigger finger. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, CNKI (China National Knowledge Infrastructure), ProQuest Dissertations and Theses, www.ClinicalTrials.gov, and the WHO trials portal until 30 September 2020. We applied no language or publication status restrictions. Selection criteria We searched for randomised controlled trials (RCTs) and quasi-randomised trials of adult participants with trigger finger that compared NSAIDs administered topically, orally, or by injection versus placebo, glucocorticoid, or different NSAIDs administered by the same route. Data collection and analysis Two or more review authors independently screened the reports, extracted data, and assessed risk of bias and GRADE certainty of evidence. The seven major outcomes were resolution of trigger finger symptoms, persistent moderate or severe symptoms, recurrence of symptoms, total active range of finger motion, residual pain, patient satisfaction, and adverse events. Treatment effects were reported as risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs). Main results Two RCTs conducted in an outpatient hospital setting were included (231 adult participants, mean age 58.6 years, 60% female, 95% to 100% moderate to severe disease). Both studies compared a single injection of a non-selective NSAID (12.5 mg diclofenac or 15.0 mg ketorolac) given at lower than normal doses with a single injection of a glucocorticoid (triamcinolone 20 mg or 5 mg), with maximum follow-up duration of 12 weeks or 24 weeks. In both studies, we detected risk of attrition and performance bias. One study also had risk of selection bias. The effects of treatment were sensitive to assumptions about missing outcomes. All seven outcomes were reported in one study, and five in the other. NSAID injection may offer little to no benefit over glucocorticoid injection, based on low- to very low-certainty evidence from two trials. Evidence was downgraded for bias and imprecision. There may be little to no difference between groups in resolution of symptoms at 12 to 24 weeks (34% with NSAIDs, 41% with glucocorticoids; absolute effect 7% lower, 95% confidence interval (CI) 16% lower to 5% higher; 2 studies, 231 participants; RR 0.83, 95% CI 0.62 to 1.11; low-certainty evidence). The rate of persistent moderate to severe symptoms may be higher at 12 to 24 weeks in the NSAIDs group (28%) compared to the glucocorticoid group (14%) (absolute effect 14% higher, 95% CI 2% to 33% higher; 2 studies, 231 participants; RR 2.03, 95% CI 1.19 to 3.46; low-certainty evidence). We are uncertain whether NSAIDs result in fewer recurrences at 12 to 24 weeks (1%) compared to glucocorticoid (21%) (absolute effect 20% lower, 95% CI 21% to 13% lower; 2 studies, 231 participants; RR 0.07, 95% CI 0.01 to 0.38; very low-certainty evidence). There may be little to no difference between groups in mean total active motion at 24 weeks (235 degrees with NSAIDs, 240 degrees with glucocorticoid) (absolute effect 5% lower, 95% CI 34.54% lower to 24.54% higher; 1 study, 99 participants; MD -5.00, 95% CI -34.54 to 24.54; low-certainty evidence). There may be little to no difference between groups in residual pain at 12 to 24 weeks (20% with NSAIDs, 24% with glucocorticoid) (absolute effect 4% lower, 95% CI 11% lower to 7% higher; 2 studies, 231 participants; RR 0.84, 95% CI 0.54 to 1.31; low-certainty evidence). There may be little to no difference between groups in participant-reported treatment success at 24 weeks (64% with NSAIDs, 68% with glucocorticoid) (absolute effect 4% lower, 95% CI 18% lower to 15% higher; 1 study, 121 participants; RR 0.95, 95% CI 0.74 to 1.23; low-certainty evidence). We are uncertain whether NSAID injection has an effect on adverse events at 12 to 24 weeks (1% with NSAIDs, 1% with glucocorticoid) (absolute effect 0% difference, 95% CI 2% lower to 3% higher; 2 studies, 231 participants; RR 2.00, 95% CI 0.19 to 21.42; very low-certainty evidence). Authors' conclusions For adults with trigger finger, by 24 weeks' follow-up, results from two trials show that compared to glucocorticoid injection, NSAID injection offered little to no benefit in the treatment of trigger finger. Specifically, there was no difference in resolution, symptoms, recurrence, total active motion, residual pain, participant-reported treatment success, or adverse events.

Aim: To test the feasibility of our ultrasound protocol in evaluating the physiological changes during breast milk expression, and the impact of breast massage on temperature, blood flow and tension.Method: Breast massage was used for the right breast, and the left breast had no massage. Temperature was measured at baseline, post massage (for right breast), and post pump. The ultrasound scans were performed using a Toshiba Aplio 500 system (Toshiba Medical Systems, Otawara, Japan). B-mode, doppler ultrasound and shear wave elastography (SWE) were used. Blood flow of the IMA and LTA were measured at baseline, post massage (for right breast), 10 minutes into pump (relaxation and tension phase), and post pump. SWE was used to measure breast tension during the tension and relaxation phase of breast pump, after the breast milk was completely drained.Results: There was a slight decrease in breast temperature post massage, and further decreased post pump. With breast massage, the SWE values were higher at relaxation phase compared to no massage (left breast). However, with massage, the tension phase also showed less increase of SWE values compared to no massage, and appeared to be lower than no massage. Blood flow of IMA did not appear to follow a particular trend, with and without massage. Conclusion: Breast massage prior to pumping breast milk helped to reduce the temperature of the breast, showing that it has an effect in relieving breast engorgement. Massage also reduced the tension of the breast during the pump tension (suction) phase. There was no observable trend of massage on blood flow in both the IMQ and LTA.

BACKGROUND Electric breast pump could be more effective than manual pumps or hand expression of milk. OBJECTIVE This study aims to evaluate the effectiveness of current electric breast pumps, which have additional functions such as massage and ability to vary the rate and pressure. The study will also evaluate the impact of electric pump on breast engorgement, which is a common postpartum complication. METHODS A three-group randomised controlled trial (RCT) will be conducted on Mothers who are breastfeeding and using breast pumps. Adult Mothers who are 21-39 years old will be included. We propose a medium effect size of 0.40 for the study. Taking into account of about 20% dropout rate, 180 participants will be recruited (60 in each group). In addition, 120 control participants who are not using breast pump or not breastfeeding will be recruited. Data collection will include baseline maternal data and clinical data, quantity of expressed milk and duration taken, complications of breast pumping/feeding, and psychosocial data. Quantitative outcomes will be analysed using STATA, using univariate analyses, Pearson’s correlations, generalised estimating equation and two-way ANOVA repeated measures. RESULTS Na CONCLUSIONS Na CLINICALTRIAL Not required

During acupuncture treatment, tonification (reinforcing) and sedation (reduction) techniques are used to maximise treatment effectiveness.1 Needle manipulation is highly individualised among acupuncturists, and there is no established standard. Quantification of needle movements during insertion and manipulation has also been a challenge.2 However, recent three-dimensional (3D) motion tracking technology using an infrared system (Acusensors)3 4 and an electromagnet (trakSTAR)5 has enabled the quantification of needle movement. Through the measurement of displacement, rotation, torque and force, studies have found significant variations in amplitude and duration of needling between practitioners when instructed to perform acupuncture in their own fashion, but the movement was consistent between acupuncturists.3 4 In addition to the displacement, the aim of our study was to analyse the magnitude and speed of needle movement during the lifting and thrusting movements of tonification and sedation. The participants were recruited from both public and private Traditional Chinese Medicine (TCM) clinics in Singapore. Ethics approval was sought from the Singhealth’s Centralised Review Institutional Review Board (CIRB Ref: 2016/2765). ### The experiment The acupuncture needle insertion was conducted on floral foam (figure 1A). A 0.30×50 mm disposable stainless steel acupuncture needle was used. The acupuncturists were instructed to perform the following needle insertion techniques: (1) heavy thrusting and light lifting; and (2) light lifting and heavy thrusting. Each technique …

This study aims to identify differences in demographics, clinical and laboratory data between wrist septic arthritis and non-septic arthritis in patients admitted for wrist inflammation. A retrospective review of inpatients from May 2012 to April 2015 was conducted. Seventy-seven patients were included. Non-septic arthritis patients were more likely to have chronic kidney disease, pre-existing gout, or both. All septic arthritis patients had normal serum uric acid levels, and two or more raised inflammatory markers (white cell count, C-reactive protein, erythrocyte sedimentation rate). In patients with isolated wrist inflammation, the mean C-reactive protein in the septic arthritis group was significantly higher compared with the non-septic arthritis group (mean difference 132 mg/L, 95% CI 30.9–234). In this study, polyarticular involvement did not exclude a septic cause; nor did it imply a non-septic aetiology. Diabetic or immunosuppressed patients were not more likely to develop septic arthritis. The presence of chondrocalcinosis on wrist radiographs was virtually diagnostic of non-septic arthritis. Level of evidence: IV

Color Doppler imaging (CDI) can be used to noninvasively create images of human blood vessels and quantitatively evaluate blood flow in real-time. The purpose of this study was to assess the effects of acupuncture on the blood flow of the peripheral, mesenteric, and retrobulbar arteries by CDI. Statistical significance was defined as P values less than 0.05. Blood flow in the radial and brachial arteries was significantly lower during needle stimulation on LR3 than before in healthy volunteers, but was significantly higher after needle stimulation than before. LR3 stimulation also resulted in a significant decrease in the vascular resistance of the short posterior ciliary artery and no significant change of blood flow through the superior mesenteric artery (SMA) during acupuncture. In contrast, ST36 stimulation resulted in a significant increase in blood flow through the SMA and no significant change in the vascular resistance of the retrobulbar arteries. Additionally, acupuncture at previously determined acupoints in patients with open-angle glaucoma led to a significant reduction in the vascular resistance of the central retinal artery and short posterior ciliary artery. Our results suggest that acupuncture can affect blood flow of the peripheral, mesenteric, and retrobulbar arteries, and CDI can be useful to evaluate hemodynamic changes by acupuncture.

BACKGROUND Caring for a family member with advanced cancer at home is demanding as the ill family member is likely to have complex physical and emotional needs. There is a paucity of studies on the experience of home family caregivers of people with advanced cancer in the Asian region. OBJECTIVE The aim of this study was to describe the experiences of family caregivers caring for a person with advanced cancer at home in Singapore. METHODS This was a qualitative study; data were collected by semistructured interviews and analyzed using content analysis. A purposive sample of 19 family caregivers who were taking care of a family member with advanced cancer were recruited from home hospice care services in Singapore. RESULTS Most of the caregivers were female (n = 14), ranging in age from 21 to 64 years (mean, 46.4 [SD, 10.5] years). Four themes were generated from the data: (1) caregiving challenges, (2) negative emotions, (3) ways of coping, and (4) positive gains of caregiving. CONCLUSIONS This study generated insights into the challenges, emotions, and coping of Asian family caregivers caring for patients with advanced cancer. Such understanding could help in developing appropriate intervention for caregivers to reduce their burden and stress. IMPLICATIONS FOR PRACTICE Caregivers require knowledge on resolving family conflicts and about communicating and enhancing closeness with the ill family member. Support from healthcare professionals is essential even if caregivers have support from family members and friends; nurses can make conscious efforts to show concern for caregivers as well as for patients.

Objective:Our aim was to evaluate caregivers' perceptions of a video, telephone follow-up, and online forum as components of a psychoeducational intervention.Method:Qualitative semistructured face-to-face interviews were conducted with 12 participants two weeks post-intervention. The study was conducted from September of 2012 to May of 2015. Family caregivers were recruited from four home hospice organizations (HCA Hospice Care, Metta Hospice, Singapore Cancer Centre, and Agape Methodist Hospice) and the National Cancer Centre outpatient clinic in Singapore. A purposive sample was employed, and participants were recruited until data saturation. Qualitative interviews were transcribed verbatim. Transcripts were coded and analyzed using content analysis. Two of the research team members were involved in the data analysis.Results:Two-thirds of participants were females (n= 8). Their ages ranged from 22 to 67 (mean = 50.50,SD= 11.53). About two-thirds were married (n= 7). Most participants were caring for a parent (n= 10), one for a spouse, and one for her mother-in-law. Caregivers favored the use of video for delivery of educational information. They liked the visual and audio aspects of the video. The ability to identify with the caregiver and scenarios in the video helped in the learning process. They appreciated telephone follow-ups from healthcare professionals for informational and emotional support. The online forum as a platform for sharing of information and provision of support was not received well by the caregivers in this study. The reasons for this included their being busy, not being computer savvy, rarely surfing the internet, and not feeling comfortable sharing with strangers on an online platform.Significance of Results:This study provided insight into caregivers' perceptions of various components of a psychoeducational intervention. It also gave us a better understanding of how future psychoeducational interventions and support for caregivers of persons with advanced cancer could be provided.

Acupuncture has been found to relieve muscle stiffness effectively, especially after physical exercise.1 2 Previous studies have measured muscle stiffness pre- and post-acupuncture using a pressure scale1 or ‘muscle hardness meter’.2 Both of these methods estimate muscle stiffness based on the pressure required to compress muscle. Limitations of these devices include potential inaccuracy of measurement, as the distribution of muscle stiffness may be heterogeneous, as well as inability to visualise the muscle. Furthermore, changes in muscle stiffness during acupuncture needling cannot be evaluated. An ultrasound-based shear wave imaging technique has recently been developed to measure muscle stiffness.3 Benefits of using ultrasound include the ability to visualise the muscle under investigation and to quantify changes in muscle stiffness over time. Ultrasound as an imaging modality has many potential uses in acupuncture research and education,4 and can be successfully used to explore its physiological and physical effects.5 The aim of this study was to measure the effects of acupuncture needling on muscle stiffness using shear wave elastography. ### Acupuncture needle insertion We performed acupuncture needle insertion on two healthy volunteers (one male, one female) who were part of the study team. The acupuncture point used …

Location of traditional acupuncture points has historically been based on surface anatomical landmarks. In recent years, Western medical education has utilised X-rays1 and CT2 of cadavers to enable students to better comprehend human anatomy, with positive responses. In a previous study, we explored the potential use of ultrasonography for the location of anatomical points.3 The aim of the present study was to use X-rays to examine the relationship between acupuncture needles and bony structures and to consider the addition of bony landmarks as a means to locate acupuncture points. This study was conducted on a human cadaveric hand. A 25×40 mm disposable stainless steel acupuncture needle was inserted at PC8 ( Laogong ), SI3 ( Houxi ) and TE4 ( Yangchi ), based on an acupuncture text.4 PC8 is situated within the interosseous muscle space between the second and third metacarpal bones, next to the metacarpophalangeal joint (MCPJ). After making a loose fist, SI3 is found proximal to the fifth MCPJ, at the end of the transverse crease of the hypothenar muscle, on the …

Background Hand conditions are common in elderly persons. Purpose To assess the prevalence of common hand conditions in elderly persons in a community setting, specifically osteoarthritis of the hand, trigger finger, and carpal tunnel syndrome. Methods The elderly persons were recruited from community groups for elderly persons. Data collection included participants' demographic and clinical data; quick disability, arm, shoulder, and hand (QuickDASH) questionnaire; and presence of hand conditions. Results Of the 55 elderly persons recruited, almost a third of them presented with a hand condition (n = 17, 30.8%). Hand conditions were more common in females (39% in females, 7% in males; χ = 4.97, p = .04). Quick-DASH scores were higher in those with hand conditions, indicating lower levels of function (greater disability) (t =-4.61, p = .002). Conclusions Most elderly persons did not seek medical attention for their hand condition until the late stages. Nurses can play an important role in providing community hand assessment, education on hand symptoms, information about available treatment, and adaptive approaches to maximize functioning.

We assessed the efficacy of ketorolac trometamol injections compared with triamcinolone acetonide injections in trigger digits. Patients with trigger digits were randomized to receive either ketorolac or triamcinolone. They were followed up at 3, 6, 12 and 24 weeks, and monitored for resolution of triggering, pain and total active motion. One hundred and twenty-one patients with single trigger digits were recruited (59 ketorolac, 62 triamcinolone). At 6 weeks, 54% of patients in the triamcinolone group had complete resolution of trigger, whereas no patients in the ketorolac group had resolution. At 12 weeks, 58% of patients in the triamcinolone group had complete resolution of trigger compared with 6.7% in the ketorolac group. At 24 weeks, both groups had comparable rates of resolution at 26% and 25%, respectively. Patients in the triamcinolone group had significantly better resolution of pain at 3, 6 and 12 weeks. But at 24 weeks, there was no significant difference in pain between both groups. Significantly less flexion deformity was reported at 3 weeks and 6 weeks in the triamcinolone group. In the short term, ketorolac was less effective in relieving symptoms of trigger digit than triamcinolone. Level of evidence: I

Purpose/Objectives: To evaluate the effectiveness of a psychoeducational intervention, the Caring for the Caregiver Programme (CCP).Design: A pilot randomized, controlled trial, two-group pretest, and repeated post-tests.Setting: Four home hospice organizations and an outpatient clinic in Singapore.Sample: 80 caregivers were randomized into experimental and standard care groups.Methods: Outcomes were measured at baseline, week 4, and week 8 after the intervention. The standard care group received routine home hospice care, and the intervention group received the CCP in addition to routine care.Main Research Variables: Quality of life (QOL), social support, stress and depression, self-efficacy in self-care, closeness with the patient, rewards, and knowledge.Findings: Compared to the standard care group, the intervention group reported significantly higher QOL, social support satisfaction and number of supported people, closeness with the patient, self-efficacy in self-care, rewards of caregiving, and knowledge, and lower stress and depression.Conclusions: The CCP had positive effects on family caregivers of patients with advanced cancer.Implications for Nursing: A psychoeducational intervention potentially could help caregivers cope with the demands of caregiving.

Quantification of needle movements during insertion and manipulation has been a challenge for acupuncturists.1 Needle manipulation includes lifting and thrusting of the needle and/or needle rotation after insertion. Such movements are critical for the elicitation of de qi and maximisation of treatment effectiveness. However, needle manipulation is highly individualised among acupuncturists, and this could have implications for treatment outcomes. Two studies have explored the displacement, rotation, torque and force exerted during needle manipulation using motion sensors (Acusensors).2 ,3 However, they did not include the speed of needle insertion and rotation. Our study aimed to analyse the trajectory of acupuncture needle motion from insertion to rotation manipulation to achieve de qi . We performed acupuncture needle insertion on a study team member. The team member signed an institutional informed consent form acknowledging that he knew the procedure involved during acupuncture, and understood the possible risks and complications. The acupuncture was performed by a certified acupuncturist with more than 20 years …

Ultrasound has been commonly used to guide clinical procedures in Western medicine, such as peripheral nerve blocks, biopsies, and fluid aspiration. Ultrasound is a useful tool because it is non-invasive, allows real-time visualisation of body images, and poses no risk to the human body, as it uses sound waves that are generally safe. In addition to guiding clinical procedures, ultrasound has been used to train medical students to perform clinical examinations.1 From a review of the literature, only one study has explored the use of ultrasound for acupuncture, and this focused on detecting soft-tissue displacement from movement of the needle.2 No study has explored the use of ultrasound in demonstrating the relationship between an acupuncture needle and the surrounding anatomical structures real-time in vivo. The aim of our study was to evaluate its feasibility and to discuss the implications for education and research. This study was conducted on a human cadaveric hand. Ultrasound scans were conducted using a Siemens Acuson P300 ultrasound system with a …

This study reviews the surgical outcomes of using dorsal buttress plate for open reduction and internal fixation of ulnar (5th, or 4th and 5th) CMCJ fracture subluxation or dislocations. A retrospective review of 11 patients at our center who underwent operative fixation with dorsal buttress plating technique was performed. The surgery was performed between February 2012 and March 2017. Outcome measurements include radiographic evaluation of time to union, grip strength, and range of motion of the wrist. Of 11 patients in our case series, eight had injuries involving both 4th and 5th CMCJs, while three had isolated involvement of 5th CMCJ. Mean time to union on radiographs was 48 days (IQR 17.0; range 30–88). The median palmar flexion and dorsiflexion of the wrist were 56° (IQR 11.3; range 50°–80°) and 65° (IQR 10.0; range 60°–80°) respectively. Patients regained a median of 79% of grip strength (IQR: 36.0, range 43–100). All fingers achieved full range of motion, and no patient had scissoring of the fingers. Two patients had temporary mild numbness over the dorsoulnar aspect of the hand in the region of the 4th webspace. Five patients underwent removal of implants due to plate breakage (n = 2), or mild pain or pain with cold (n = 3). All patients were well after plate removal, and all the patients with pain had resolution of pain after implant removal. The dorsal buttress plate is a viable option for fixation of ulnar CMCJ fracture dislocations to allow early mobilization.

Clinical assessment of the hand is important for diagnosing underlying hand disorders. Using a case study approach, the clinical assessment for three disorders of the hands is presented: trigger finger (stenosing tenosynovitis), carpal tunnel syndrome, and ulnar-sided wrist injury (styloid impingement). We assess the annular one pulley and finger range of motion for patients with trigger finger. To diagnose for carpal tunnel syndrome, assessment for Tinel's sign, Phalen's sign, abductor pollicis brevis muscle bulk, two-point discrimination, and obtaining a nerve conduction study are performed. Assessment for ulnar-sided wrist injury includes wrist range of motion, assessment of distal radial ulnar joint stability, provocation tests, grip strength, x-ray, and magnetic resonance imaging. This article begins with a description of the hand and wrist anatomy. For each case study, the clinical history is described, followed by a discussion of the pathophysiology, clinical assessments, and diagnostic tests.

Background: Caregiving for a person with cancer at end of life can be stressful physically and emotionally. Understanding the predictors of change in family caregivers' quality of life (QoL) is important in facilitating the development of interventions to help these family caregivers. Objective: The aim of this study was to examine the change in QoL of family caregivers of home hospice patients in Singapore near the end of life with advanced cancer from baseline to after 2 months. Methods: This was a longitudinal survey. Ninety-three caregivers were surveyed. Instruments included the Caregiver Quality of Life Index-Cancer, Social Support Questionnaire, and Spiritual Perspective Scale. Results: Caregivers' spiritual-related interactions scores increased from baseline to 2 months using paired t test (t = 2.33, P = .02). Multivariate regression analysis showed that caregivers with higher social support satisfaction (beta = .60, P = .000) and who had a religion predicted (beta = .55, P = .001) higher QoL. Caregivers of patients diagnosed with breast cancer and cancer in the female reproductive organs (beta = -.33, P = .03) predicted lower QoL. Conclusion: This study elucidated the importance of caregivers' social support satisfaction during their caregiving journey. There is a need to enhance spiritual care for caregivers. Implications for practice: Support for caregivers could be increased by organizing mutual support groups and having volunteers to befriend caregivers. Spiritual care could be enhanced by regular assessment of spiritual needs, offering open discussions and sharing on spirituality and religion, and facilitating contacts with religious groups if caregivers required.

Background The effects of cold cabbage leaves and cold gel packs on breast engorgement management have been inconclusive. No studies have compared the effects of these methods on breast engorgement using a rigorous design. Objectives To examine the effectiveness of cold cabbage leaves and cold gel packs application on pain, hardness, and temperature due to breast engorgement, the duration of breastfeeding and satisfaction. Design A randomised controlled three-group pre-test and repeated post-test study. Setting A private maternal and children's hospital in Singapore. Participants Mothers (n=227) with breast engorgement within 14days after delivery. Methods The mothers were randomly assigned into either cold cabbage leaves, cold gel packs, or the control group. Pain, hardness of breasts, and body temperature were measured before treatment. Two sets of post-test assessments were conducted at 30min, 1h, and 2h after the first and second application. The duration of breastfeeding was measured up to 6 months. IBM SPSS 23.0 was used to analyse the data. Results Mothers in the cabbage leaves and gel packs groups had significant reductions in pain at all post-intervention time points compared to the control group, starting from 30min after the first application of cabbage leaves (mean difference=−0.38, p=0.016) or gel packs (mean difference=−0.39, p=0.013). When compared to the control group, mothers in the cabbage leaves group had significant reductions in the hardness of breasts at all post-intervention time points, and mothers in the gel packs group had significant reductions in the hardness of breasts at two time points (1h and 2h after the first and second application, respectively). Mothers in the cabbage leaves group had significant reductions in pain (mean difference=−0.53, p=0.005) and hardness of breasts (mean difference=−0.35, p=0.003) at 2h after the second application compared to those in the gel packs group. Both interventions had no impact on body temperature. There was no significant difference in the durations of breastfeeding for mothers among the three groups at 3-month and 6-month follow-up. More mothers were very satisfied/satisfied with the breast engorgement care provided in the cabbage leaves group compared to the other groups. Conclusion While cold cabbage leaves and cold gel packs can relieve pain and hardness in breast engorgement, the former had better effect, which can be recommended to postnatal mothers to manage breast engorgement.

Needle breakage, although rare, is a potential adverse event of acupuncture, which has been highlighted by systematic reviews of case reports in the Western,1 Chinese2 and Japanese3 literature. A Western review of case reports between 2000 and 2011 identified two cases of needle breakage,1 while a Chinese review between 1980 and 2009 found only one.2 By contrast, a Japanese review found a total of 48 needle breakage events from 1987 to 1999, of which 16 were accidental.3 Needle breakage can be potentially life threatening if the broken needle is left in the body, and an operation may be required to remove the embedded needle. The WHO4 has suggested that the most common site of needle breakage is the root of the needle. Suggested causes of needle breakages included poor quality manufacture, erosion between the shaft and the handle, strong muscle spasm or sudden movement of the …

Background: Terminally ill people have complex physical and psychological needs. As a result, their caregivers may experience high levels of burden, and some caregivers are unable to cope with the burden. Thus, it is important to determine the various factors that may influence caregiver burden, so that healthcare professionals may implement strategies to reduce caregiver burden. In this review, "caregiver burden" was expanded to include "caregiver stress" and "caregiver strain", as the two terms were related to caregiver burden.The objective of this systematic review was to identify the factors that may influence caregiver burden of a terminally ill adult in the home setting.Types of participants: This review considered adult participants (above age 18) who were the main caregivers of a terminally ill adult in the home setting, and providing care for the terminally ill person at the point of participation in the study.Types of intervention: There was no specific intervention of interest for the study.Types of outcomes: The focus of study was the factors that affected caregiver burden of the terminally ill person.Types of studies: Quantitative studies such as randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs), controlled before after designs (CBAs), observational design (cohort, case-control), and descriptive surveys were included in the study.This review was limited to papers in English and Mandarin. A literature search from the inception of the database to October 2010 was conducted using major electronic databases. The databases used were CINAHL, MEDLINE, PsycINFO (Ovid), Scopus, SpringerLink, ScienceDirect, Web of Science, Mosby's Nursing Consult, Mednar: Deep web medical search, Proquest Dissertations and Theses and China Journal Net.Methodological quality: The quality of the potential studies was assessed by two independent reviewers using the critical appraisal checklists for descriptive/case studies from the JBI-MAStARI (Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument).Quantitative data were extracted from included papers using standardised data extraction tools from the JBI-MAStARI.Findings were presented in narrative form, as statistical pooling was not possible.Seven studies were included in the review. All the studies used a cross-sectional descriptive survey for the collection of data. Four main factors that influenced caregivers' perception of caregiving burden were identified: 1. Caregiver characteristics, 2. Patient characteristics, 3. Social support, and 4. Caregivers' personal protective resources.Caregiver characteristics, patient characteristics, social support, and attitude of caregiver towards the caregiving situation, were found to influence caregivers' perceived caregiving burden.Additional support is required for caregivers who are employed, known to have financial difficulties, caring for patient indicating symptom distress, and caring for a patient at the terminal stage (Level III).Future studies may attempt to develop a framework to identify factors that impact on caregiver burden. More studies on caregiver burden in males, caregiver burden of patients who were at the terminal stages of the various chronic illnesses should be explored.

Successful aging can occur through promoting physiological, psychosocial, physical, cognitive functioning, and engagement in social and productive activities. The study aims to describe the development of a group music therapy programme for healthy elderly living in the community. Group music therapy was conducted for elderly above 60 years old. The intervention consists of four weekly sessions which lasted one-hour each. A certified music therapist conducted all the sessions.An evaluation of the music therapy programme was conducted at the end of the four sessions. Three music therapy groups were conducted, and 20 elderly participated. The mean age of the participants was 68.7±4.6 years (range: 60 to 76 years old). All participants expressed they enjoyed the music therapy sessions. The main activity preferences were hand chimes, hand percussion, musical bingo and lyric substitution. All participants found the one-hour session to be too short, and suggested to increase the session duration to 1.5 or 2 hours. Our music therapy programme was well-received by the elderly in the community. The activities helped to increase physical activity and social engagement, and potentially reduced cognitive decline and depression. It could be proposed as a regular activity in the community.