• 期刊

台灣老年癌末病患的症狀

The suffering of elderly with terminal cancer is gaining increasing attention in the field of health care delivery system. In order to investigate the symptoms which are distressing the elder patients with terminal cancer. This study was conducted to examine the prevalence and severity of symptoms in elder patients with terminal cancer. In addition, to compare the changes of severity after admission. Two hundred and twenty eight terminal cancer patients more than 65 years old, admitted to palliative care unit in National Taiwan University Hospital from September 1997 to April 1999, were enrolled. A structured data collection form was used daily to evaluate symptoms, which were analyzed at the time of admission, 1 week after admission and 48h before death. There were equal number in both gender. Mean age of all patients was 73.9±6.3 years; their mean survival time was 21.3±34.8 days. More than eighty percent (82.5%) of patients, whose ECOG performance was grade 3 or 4. Patients averaged 9.9 symptoms each at the time of admission. The prevalence of some of the symptoms was: weakness (88.5%), anorexia (88.1%), pain (77.9%), weight loss (72.0%); these were predominant symptoms of cancer in most primary sites. After one week in hospice pain was improved (p＜0.05); the mean scores of dyspnea, nausea, vomiting, insomnia, dry mouth decreased but didn’t have statistical significance (p＞0.05). However, all symptoms except pain tended to worse in the 48h before death. In conclusion, elder patients with terminal cancer were polysymptomatic. The high prevalence of symptoms distressed the elder patients and reduced their quality of life. Management of these symptoms are usually complicated due to the characteristics of elderly such as deteriorating organ function and poor physical performance. Symptom control and care of dying in elderly with terminal cancer will be a challenge in the field of geriatric and palliative medicine.

• 期刊

中風病人姿勢控制評估量表之心理計量特性

The Postural Assessment Scale for Stroke Patients (PASS) was developed in 1999 to measure balance function in stroke patients. However, the psychometric characteristics of the PASS have rarely been examined. The purpose of this study was to examine the reliability (inter-rater reliability and internal consistency), validity (concurrent validity, convergent validity, and discriminant validity) and responsiveness of the PASS in the acute stage of stroke patients. Eighty-two patients (with a mean age of 71) on the 7th and 14th days after stroke onset participated in this study. The internal consistency and inter-rater reliability of the PASS were good (Cronbach’s alpha = 0.96, intraclass correlation coefficient = 0.93, respectively). The PASS scores closely correlated with scores of the Berg balance scale, Barthel index (measuring self-care) and Fugl-Meyer motor test (Spearman’s rho=0.93, 0.84 and 0.75, respectively, p＜0.0001), indicating a high level of validity for the PASS. The results of effect size (0.78) and Wilcoxon’s matched-pairs signed-rank tests (Z=6.32, p＜0.001) demonstrated that this measure also had good responsiveness. These results showed very acceptable levels of reliability, validity, and responsiveness of the PASS for both clinicians and researchers.

• 期刊

台灣小兒職能治療與自覺執業能力之評量

小兒職能治療服務領域的拓展與成長，使轉介至小兒職能治療的個案種類及年齡層有明顯的變化。然而有關臨床上小兒職能治療常見之個案種類、評估與治療時所採用的理論架構、以及治療師的評估和治療能力之自我評量等相關文獻資料皆付諸闕如。本研究目的乃為了解台灣小兒職能治療服務對象的診斷種類，常用的治療理論架構，以及小兒職能治療師評估和治療能力的自我評量和自我成長需求。本調查研究以郵寄問卷的方式，調查台灣地區之小兒職能治療師，共寄發103個單位，包含303名治療師，共回收205份問卷（回收率68%），有效問卷197份。此份調查於2000年6月至8月執行。結果顯示，臨床上常見的個案種類為發展遲緩（43.1%）；治療師最常在初評後3-6個月內執行再評（47.8%）；結束療程方面，最多比例的治療師（30.6%）在一年至兩年內停止治療計劃；最常用的理論架構則是感覺統合理論（90.2%）；在自我評量方面，對評估與治療個案的能力感到滿意的是感覺統合障礙，而感到不滿意的則是高危險新生兒、自閉症及過動兒；學歷或年資與自我評量或建議課程著重理論或臨床的相關性均未達到顯著的差異性。研究結果不僅可以瞭解國內小兒職能治療臨床現況，更有助於職能治療系所教師瞭解臨床之需，以修訂課程。亦可作為舉辦繼續教育的參考，使已在執業的治療師有機會再提昇服務個案所需之相關評估與治療能力。

• 期刊

中文版西雅圖心絞痛問卷之信度與效度

The aim of this study was to validate a translated version of the Seatle Angina Questionnaire (SAQ) in Chinese speaking populations. The SAQ was translated into Chinese from its English version and its wording and meaning were modified based on the recommendations of five experts and 11 patients. Before its use in patients, the Chinese version was translated back into English by an independent translator in order to recheck whether equivalent to the original English version. Sixty patients who were diagnosed with coronary artery disease and completed stress exercise test were recruited at out patient department. Both Chinese version SAQ and Taiwan version Short Form–36 (SF-36) were administrated to them in the first visit time. About 4 weeks later, the Chinese SAQ were administrated again by mail. The responsive rate was 73.3% (44/60). In validation study, the physical function scales of Chinese version SAQ were correlated moderately to highly with the duration of stress exercise test (r=0.44), physical function scales (r=0.84) and standardized physical component scales (r=0.59) of Taiwan version SF-36. The disease perception scales were also correlated with the general health perception scales of Taiwan version SF-36 (r=0.51). The Cronbach’s alpha were 0.43 to 0.84 in assessing internal consistency of each Chinese SAQ’s domain. Test-retest reliability was assessed by comparing serial responses of 33 patients with stable angina over a 4-weeks interval. No significant differences of 2-times responses were found in all domain scales and their intraclass correlation coefficients ranged from 0.44 to 0.79. The Chinese SAQ was sensitive to subtle clinical change of cardiac patients, especially in angina stability scale and disease perception scale. In summary, The Chinese version of Seatle Angina Questionnaire is a reliable and valid instrument for evaluating the health-related quality of life of the individuals with coronary artery disease in Chinese speaking population.

• 期刊

氣喘兒童母親用藥相關因素的探討

This study was to explore knowledge, technique, self-efficacy and related factors of the mothers on use of asthmatic medication in children. A study design based on investigation was adopted. Constructive questionnaires from 82 mothers were collected from a pediatric allergy clinic of a medical center in Taipei. This study ultimately revealed the mothers’ knowledge and ability to use inhaling devices is rough and self efficacy is insufficient. There show a significant positive correlation between knowledge and self efficacy (p＜0.001), ability to use inhaling devices and self efficacy (p＜0.001), and show a negative correlation between knowledge and health status, ability to use inhaling devices and health status, self efficacy and health status, but no significantly. Nurses’ can adopt the results of study as a reference for instruction to mothers’ of children with asthma.

• 期刊

比較呼吸照護病房與居家照護對長期呼吸器依賴病患之成效

The design was descriptive comparative analysis. The purpose of this study was to compare the effects between ventilator-dependent patients cared at respiratory care ward (RCW) and at home (HC). A purposive sampling was used to collect data from stable long-term ventilator-dependent patients who met the criteria for national insurance coverage integrated care plan and lived in central areas of Taiwan. A structured questionnaire and regular 2-3 months home or telephone interviews were used to understand the differences in care costs, care outcomes, and caregivers' satisfaction. Thirty patients from RCW and 30 from HC were recruited in this study. The results indicated as follows. 1.A statistical significant difference was found between RCW and HC in which patients in RCW were older, higher education, more married, and more number of children, but less months of ventilator used than HC patients. 2.The total cost of RCW (NT154,696) was higher than those cared at home (NT64,742). The health care costs were the major costs of RCW and possessed 87 % of total costs. 3. A statistical significant difference was found in both infection rate and returned rate between these two groups (p＜0.02). The infection rate was reported 3.7 times per person for patients at RCW and 1.32 times per person at HC. For the returned rate, the RCW (M=0.13) was lower than those of patients cared at home (M=0.76). 4. For the main caregiver's satisfaction, although the score of satisfaction was slightly higher at RCW, it was not reach the significant level. Only emergency care, respiratory therapists, professional physicians, overall care, and economic burden of the family were shown significant differences between these two groups (p＜ 0.05). Because the HC for long-term ventilator-dependent patients was more cost-effective, the results may provide valuable information for policy decision-making in planning long-term ventilator-dependent care. Moreover, encouraging home care is needed to improve the quality of long-term ventilator-dependent care and to reduce the health care expenditure in the future.

• 期刊

都市與鄉村社區老人健康狀態

本研究以隨機及集束抽樣方式選取台北縣都市型社區新莊市及鄉村型社區萬里鄉六十五歲以上老人共507人（新莊市395位、萬里鄉112位）為研究對象。以健康檢查及問卷搜集資料。健康檢查包括身體理學檢查、血球計數、血液生化檢查、尿液檢查、心電圖、胸部及腹部放射線檢查。問卷內容包括人口學變項、主要慢性疾病史、長期用葯、醫療資源運用狀況、日常生活功能評估、心智功能、情緒狀況、家庭相處情況、社會資源、以及個人健康行為如運動、抽煙、飲酒等。由醫師及受訓之訪員做身體檢查及訪問。配合全民健保老年人預防保健服務，進行詳細健康檢查及老人健康需求與自我照顧的問卷評估。共有507位老人完成完整的健康檢查與問卷調查。萬里鄉老人自訴無慢性病比率較新莊市多（36.6% vs. 25.4%），但未達統計學有意義差距。慢性病病史前五名為高血壓、心血管疾病、糖尿病、消化性潰瘍及牙周病；兩社區只有排序略有不同。新莊市的肺病史較多、萬里鄉的牙周病較多。健康檢查結果僅10%的老人完全正常；健康問題以高膽固醇血症（52.5%）、高血壓（41.0%）、齲齒（26.1%）、腎功能異常（25.3%）、貧血（24.6%）、肝功能異常（16.4%）、糖尿病（10.1%）及牙周病（19.1%）為多。牙周病、齲齒、高血壓、腎功能異常、心臟聽診異常、腹部檢查異常、直腸肛門檢查異常比率以新莊市為多, 貧血與球蛋白異常以萬里鄉為多。胸部X光異常比率沒有差別，心電圖異常比率以新莊市為高，腹部X光異常比率（主要為腰椎病變）以萬里鄉為高。心智功能以新莊市老人較佳，其中男性又高於女性。兩地老人的日常生活功能則並無差異。新莊市老人有較多健康行為及較少不健康行為。但都市老人較常跌倒，服藥比率也較高。鄉村與都市老人的健康好壞有明顯的差異，亦各有其獨特的健康問題。部分原因可能與生活環境與方式的不同有關，不過仍需進一步研究求證。都市與鄉村老人健康的需求上有所不同，在提供醫療照顧時必須考慮城鄉的差異，以提供更適切的服務。

• 期刊

癌症住院病患憂鬱狀態的盛行率及預測因素

本研究採橫斷式描述性相關設計，共收集96位癌症住院病患的資料進行分析，研究目的在於：（1）了解臺灣癌症住院病患憂鬱的樣本盛行率，及（2）檢測疾病及人口學相關變項預測憂鬱發生的能力。研究中對憂鬱個案的界定為精神科醫師以迷你國際神經精神醫學面談問卷輔以DSM-Ⅳ診斷準則進行結構式會談所得到的診斷結果中之重鬱症、輕鬱症、憂鬱型適應性疾患及混合型適應性疾患的病患。研究結果顯示研究對象的憂鬱盛行率為33.3%。單因子邏輯迴歸分析發現憂鬱的發生分別和病患的身體功能狀態、自覺疾病治療效果、教育程度及家庭經濟狀況有關。進一步以多因子邏輯迴歸之前向條件法進行分析，發現癌症住院病患憂鬱的最佳預測模式包括身體功能狀態、家庭經濟狀況及自覺疾病治療效果三項預測因子，而使用此模式來預測癌症住院病患憂鬱的發生之準確性為77%；其中身體功能狀態較差、家庭經濟狀況較差及自覺疾病治療無效者罹患憂鬱的機率較高。結果中也發現疼痛的有無與憂鬱的發生並沒有相關，但進一步對有疼痛的樣本進行分析，發現疼痛型態與憂鬱有關。對於50位有疼痛的癌症住院病患而言，包括自覺疾病治療效果、疼痛型態及身體功能狀態三個預測因子的迴歸模式，其預測憂鬱發生之正確性達88%。由以上結果可知癌症住院病患有相當高的憂鬱盛行率；而身體功能狀態較差、自覺疾病治療無效、教育程度較低、家庭經濟狀況較差及持續性疼痛為癌症住院病患發生憂鬱疾患的危險因素。因此臨床上對於這些危險因子必須要仔細地評估，並對憂鬱的高危險群提供更多的身體及心理社會的支持。

• 期刊

高脂血症之雙重過濾血漿分離療法

Recent researchers have demonstrated regular plasmapheresis is effective in the treatment of patients with severe hyperlipidemia on the aspects of the reduction of serum low-density lipoprotein (LDL) level, the regression of atherosclerotic plaques and concomitant improvement in the ischemic changes on electrocardiograph. We treated 7 severe hyperlipidemic male patients with double-filtration plasmapheresis (DF) for single session and compared the hematological changes before and after treatment. The removal rate was highest for triglyceride (53.8%), followed by cholesterol (39.9%) and globulin (21.4%). There were no significant changes in albumin, high-density lipoprotein cholesterol and platelet. A mild increase of white blood cell count was noted after DF treatment. LDL cholesterol level could not measured exactly in 6 out of 7 patients due to the interference of lipemia. The transmembrane pressure (TMP) had been above the ideal level (50 mmHg) during the first half period of treatment in 6 patients. In the 5 patients with TMP ＞130 mmHg, 2 patients got hemolysis and 1 patient had to renew the second plasma separator for further plasmapheresis. In contrast, the pressure of plasma fractionator had been kept within normal limits in all cases. As compared to the literature, the removal rates of serum lipid were lower in our series, which might be related to the early saturation of the plasma separator resulted from the extremely high level of triglyceride-containing lipoproteins (very low density lipoprotein or chylomicron). Therefore, plasmapheresis with centrifugation method may be more suitable in the initial treatment of severe hypertriglyceridemia to prevent the plugging phenomenon with filtration method. Besides, then the plasma fractionator with a smaller pore size may be more efficient for the removal of serum lipids.

• 期刊

根管充填後疼痛因素之探討

The aim of this study was to investigate whether certain factors, namely patient age and sex, size of apical lesion, tooth arch, tooth position, tooth number and quality of root canal filling, could be associated with post-obturation pain. A follow-up study of patients who had undergone obturation procedures was done over a half-year period from October 2000 to March 2001. In this study, each patient was returned to NTUH endodontic department for follow-up study after root canal filling. This study included a total of 260 patients involving 329 teeth. These factors, including size of apical lesion, age, sex, tooth arch tooth position, tooth number, quality of root canal filling and post-obturation pain were statistically analyzed by Chi- square (P＜0.05). It was found that the size of the apical lesion and post-obturation pain were significantly correlated. It was also found that post-obturation pain was rare when procedures were done on mandibular anterior teeth and when fistula was present. Patients below the age of twenty were reported to have less pain than those between the ages of forty and fifty. Finally, but not surprisingly, the longer the follow-up period, the fewer the clinical symptoms that may be found in the patients.