臺灣博碩士論文加值系統

本研究的目的在瞭解長期照護機構住民便秘現況以及探討黑棗汁介入改善長期照護機構住民慢性便秘的程度。採類實驗性研究設計，研究對象來自新竹縣市四家長期照護機構（三家養護機構及一家安養機構），收案條件符合慢性便秘診斷住民、能清楚表達感受、能以國語、台語或客語溝通者；排除意識不清，無表達能力者、有飲水或低渣飲食限制者、服用黑棗汁後24小時內，出現解水便超過3次者、研究期間，排便藥物有調整劑量或有執行灌腸之住民。收案時間為2011年1月3日至2011年4月9日，共68位參與本研究，研究樣本隨機分派至實驗組及對照組，各有34位，完成本研究過程者實驗組31位及對照組30位。實驗組每天早上給予服用黑棗汁180c.c.，為期6天。對照組則維持常規性照護，未安排任何介入性措施。
評量工具包括基本資料表、排便相關日常生活記錄表、Bristol 糞便性質量表與病人自評便秘症狀量表；於黑棗汁介入措施實施前及介入後第3小時、第6小時、第9小時及第24小時進行兩組便秘指標1.腸蠕動次數2.排便次數3.排便性狀4.便秘不適症狀評量。以SPSS 17.0版之軟體進行資料分析，研究結果顯示：長期照護機構住民便秘發生率為64.2%。黑棗汁介入後，實驗組的後測便秘指標優於前測，達統計顯著差異（p＜.001）；對照組的前、後測便秘指標沒有顯著差異；實驗組前後測便秘指標的差異優於對照組前後測便秘指標的差異（p＜.001）。

The purpose of this study was to understand the status of constipation of long-term care facility residents and the effects of Prune Juices on their chronic constipation. A quasi-experimental research design was used. The subjects were recruited from residents of four long-term care facilities (three infirmary care centers and one domiciliary care center) in Hsinchu City. Those subjects who were diagnosed with chronic constipation, who could clearly expressed their feelings, could communicate with Mainland Chinese or Taiwanese languages were included. However, those subjects with consciousness, without ability to express, having drinking water or low-residue diet restrictions, having more than three times the solution by water during 24 hours after prune juices, having defecation drug dose adjustment or implementation of residents enema were excluded. The study ran from January 3rd to April 9th, 2011. A total of 68 residents participated. They were randomly assigned to either experimental or control groups. There were 31 subjects in the experimental group and 30 in the control group completed the study. Experimental group has taken the 180c.c. prune juices every morning per day during six days. Control group has remained routine care without intervention.

Assessment tools included basic information table, stool-related daily record sheet, the Bristol stool form scale and the patient assessment of constipation symptoms (PAC-SYM) questionnaires. The time of measurement was before and after the intervention, the first 3 hours, 6 hours, 9 hours and 24 hours after the administration of the prune juices. Both groups were assessed with their constipation indicators, including 1. peristalsis number, 2. defecation, 3. defecation traits, and 4. assessment of constipation symptoms. With SPSS 18.0 version of the software for data analysis, the results showed 64.2% of long-term care facility residents had problems with constipation. Post-test of constipation indicators were statistically significant better than pre-test in the experimental group (p < .001); the control group were not. Analyzing the differences of constipation indicators between pre- and post-tests, the experimental group were statistically significant better than the control group (p < .001).

目 錄
誌 謝…………………………………………………………………………Ⅰ
中文摘要…………………………………………………………………………Ⅱ
英文摘要…………………………………………………………………………Ⅲ-Ⅳ
目 錄…………………………………………………………………………Ⅴ-Ⅵ
圖表索引…………………………………………………………………………Ⅶ
第一章 緒論……………………………………………………………………1
第一節 研究動機………………………………………………………………1-2
第二節 研究重要性及目的……………………………………………………2-4
第二章 文獻查證………………………………………………………………5
第一節 便秘定義、診斷與盛行率……………………………………………5-6
第二節 便秘原因及症狀………………………………………………………7-10
第三節 便秘治療與處置………………………………………………………10-12
第四節 黑棗汁對便秘治療機轉及相關性研究………………………………13-15
第三章 研究方法………………………………………………………………16
第一節 研究設計………………………………………………………………16
第二節 研究架構………………………………………………………………17
第三節 研究假設………………………………………………………………18
第四節 研究對象與樣本………………………………………………………18-19
第五節 研究工具與變項………………………………………………………20-22
第六節 研究過程………………………………………………………………23-25
第七節 資料處理與分析………………………………………………………26-29
第八節 減少內外在效度威脅之研究控制……………………………………29-30
第四章 研究結果………………………………………………………………31-32
第一節 研究對象基本屬性……………………………………………………33-37
第二節 長期照護機構住民便秘的現況………………………………………38
第三節 黑棗汁介入對便秘改善程度之成效分析……………………………38-57
第五章 討論……………………………………………………………………58-63
第六章 結論與建議……………………………………………………………64
第一節 結論……………………………………………………………………64
第二節 研究限制與建議………………………………………………………64
參考文獻
中文部分…………………………………………………………………………65-66
英文部分…………………………………………………………………………67-75
附錄
附錄一 個人基本資料表………………………………………………………76-77
附錄二 排便相關日常生活記錄表……………………………………………78
附錄三 「Bristol糞便性質量表」原始及中文翻譯量表…………………79-80
附錄四 「Bristol糞便性質量表」中文翻譯量表的作者使用授權同意書81
附錄五 「病人自評便秘症狀量表」…………………………………………82
附錄六 「病人自評便秘症狀量表」原著作者使用授權同意………………83-84
附錄七 研究倫理審議證明書…………………………………………………85
附錄八 機構同意書……………………………………………………………86-89


圖 表 索 引
圖ㄧ 研究概念架構……………………………………………………………17
圖二 研究過程…………………………………………………………………24
圖三 研究步驟…………………………………………………………………25
圖四 研究流程…………………………………………………………………32
圖五 實驗組與對照組每一觀測時間，其腸蠕動次數平均值比較…………47
圖六 實驗組與對照組每天排便總次數比較…………………………………50
圖七 實驗組與對照組每天排便性狀平均值比較……………………………53
圖八 實驗組與對照組每一觀測時間，其便秘不適症狀平均得分比較……57
表ㄧ 研究變項與操作定義……………………………………………………21-22
表二 描述性統計………………………………………………………………27-28
表三 推論性統計………………………………………………………………29
表四 兩組研究對象基本資料屬性比較………………………………………35-37
表五 實驗組與對照組在黑棗汁介入後便秘指標（腸蠕動次數、排便次數
、排便性狀、便秘不適症狀）組內比較………………………………………43
表六 以GEE檢定實驗介入前後不同時間，腸蠕動次數之成效分析………45-46
表七 以GEE檢定實驗介入前後不同時間，排便次數之成效分析…………49
表八 以GEE檢定實驗介入前後不同時間，排便性狀之成效分析…………52
表九 以GEE檢定黑棗汁介入前後不同時間，便秘不適症狀之成效分析…55-56

中文部分
台灣地區食品營養成分資料庫（2010，3月29日）．食品成分表．2010年4月6日取自http://www.doh.gov.tw/FoodAnalysis/ingredients.htm
行政院衛生署中醫藥委會中草藥用藥安全（無日期）．大棗．2010年6月28日取自http://tcam.ccmp.gov.tw/meun_1_content.asp?aaa=3
向怡曄（2004）．膳食纖維對小鼠腸道生理及血脂質之影響．未發表的碩士論文，台中：中山醫學大學營養科學研究所。
林青怡（2004）．探討七種中草藥對腸道生理功能之影響．未發表的碩士論文，台北：國立中興大學食品科學研究所。
林聖敦、林柏松、王雪芳、蕭清娟（2005）．異麥芽寡糖戚風蛋糕對人體血液生化值、便秘及糞臭素之影響．臺灣營養學會雜誌，30（2），108-115。
林儀貞、顏妙芬、陳清惠（2010）．以實證護理探討老人便秘之處置．護理雜誌， 57（4）， 95-99。
陳綏涵（2004）．膳食纖維對培耶氏斑淋巴球增生與免疫反應之研究．未發表的碩士論文，台北：中國文化大學生物科技研究所。
黃建勳、蘇奕彰、洪壽宏、邱泰源、曾慶孝（2009）．老年人便秘的評估與處置． 台灣老年醫學暨老年學雜誌，4（1），15-26。
葉怡君、林昭卿、林榮志（2007）．運用穴位按壓緩解老人便秘之前趨研究．長期照護雜誌，11（4），357-369。
葉麗雪（2006）．腹部穴位刺激對改善護理之家老人便秘之先導試驗．未發表的碩士論文，台中：中山醫學大學醫學研究所。
張莉琴、戴玉慈、翁昭旼（2001）．住院老人便祕之危險因素．台灣醫學，5（6），607-614。
張詩莉（2009）．膳食性益生菌補充對於長期照護機構老年住民之排便情形的影響．未發表的碩士論文，台中：亞洲大學長期照護研究所。
傅櫻梅（2006）．改善長期照護機構住民照護品質之探討-以白木耳食療處理便秘問題為例．未發表的碩士論文，台中：亞洲大學長期照護研究所。
楊俊仁、黃富源（1996）．慢性便秘和大便失禁．當代醫學，23（3），46-50。
劉燕居、鄭翰鍾、王如雪、陳曉鈴（2005）．蒟蒻膳食纖維補充劑對健康成人排便特性及營養狀態之影響．中華民國營養學會雜誌，30（3），127-134。

英文部分
Addison, R., Davies, C., Haslam, D., Powell, M., & Stowers, L. (2003). A national audit of chronic constipation in the community. Nursing Times, 99(11), 34-35.
Allan, L., Hays, H., Jensen, N. H., Le Polain De Waroux, B., Bolt, M., Donald, R., et al. (2001). Randomised crossover trial of transdermal fentanyl and sustained release oral morphine for treating chronic non-cancer pain. British Medical Journal, 322(7295), 1154-1158.
Attar, A., Lemann, M., Ferguson, A., Halphen, M., Boutron, M. C., Flourie, B., et al. (1999). Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut, 44(2), 226-230.
Bassotti, G., de Roberto, G., Sediari, L., & Morelli, A. (2004). Colonic motility studies in severe chronic constipation: an organic approach to a functional problem. Techniques in Coloproctology, 8(3), 147-150.
Benninga, M. A., Voskuijl, W. P., & Taminiau, J. A. J. M. (2004). Childhood Constipation: Is There New Light in The Tunnel? Journal of Pediatric Gastroenterology and Nutrition, 39(5), 448-464.
Bosshard, W., Dreher, R., Schnegg, J. F., & Bula, C. J. (2004). The treatment of chronic constipation in elderly people: an update. [Review] [113 refs]. Drugs & Aging, 21(14), 911-930.
Camilleri, M., Cowen, T., & Koch, T. R. (2008). Enteric neurodegeneration in ageing. Neurogastroenterology and Motility, 20(3), 185-196.
Campbell, A. J., Busby, W. J., & Horwath, C. C. (1993). Factors associated with constipation in a community based sample of people aged 70 years and over. Journal Of Epidemiology And Community Health, 47(1), 23-26.
Chatoor, D., & Emmnauel, A. (2009). Constipation and evacuation disorders. Best Practice and Research: Clinical Gastroenterology, 23(4), 517-530.
Cheskin, L. J. & Schuster, M. M. (1994). Constipation. Principles in Geriatric Medicine and Gerontology (13), 1267-1273.
Culbert, P., Gillett, H., & Ferguson, A. (1998). Highly Effective Oral Therapy (Polyethylene Glycol/Electrolyte Solution) for Faecal Impaction and Severe Constipation. Clinical Drug Investigation, 16(5), 355-360.
Cummings, J. H. (1985). Cancer of the large bowel. In: Fibre, Fibre-Depleted Foods and Disease. Edited by H. Trowell, D. Burkhitt, and H. Keaton. London: Academic Press.
Davidson, M. H., & McDonald, A. (1998). Fiber: Forms and functions. Nutrition Research, 18(4), 617-624.
Drossman, D. A. (2006). The Functional Gastrointestinal Disorders and the Rome III Process. Gastroenterology, 130(5), 1377-1390.
Eastwood, M. (1990). Fiber and gastrointestinal disease. In: Dietary Fiber: Chemistry, Physiology, and Health Effects. Edited by D. Kritchevsky, C. Bonfield, and J. W. Anderson. New York: Plenum Press.
Eberhardie, C. (2003). Constipation: identifying the problem. Nursing Older People, 15(9), 22-26.
Everhart, J. E., & Ruhl, C. E. (2009). Burden of Digestive Diseases in the United States Part I: Overall and Upper Gastrointestinal Diseases. Gastroenterology, 136(2), 376-386.
Fallon, M., & O'Neill, B. (1997). ABC of palliative care: Constipation and diarrhoea. British Medical Journal, 315(7118), 1293-1296.
Fernández-Bañares, F. (2006). Nutritional care of the patient with constipation. Best Practice and Research: Clinical Gastroenterology, 20(3), 575-587.
Folden, S. L. (2002). Practice guidelines for the management of constipation in adults. [Review] [58 refs]. Rehabilitation Nursing, 27(5), 169-175.
Foxx-Orenstein, A. E., McNally, M. A., & Odunsi, S. T. (2008). Update on constipation: One treatment does not fit all. Cleveland Clinic Journal of Medicine, 75(11), 813-824.
Frank, L., Flynn, J., & Rothman, M. (2001). Use of a self-report constipation questionnaire with older adults in long-term care. Gerontologist, 41(6), 778-786.
Frank, L., Kleinman, L., Farup, C., Taylor, L., & Miner Jr, P. (1999). Psychometric validation of a constipation symptom assessment questionnaire. Scandinavian Journal of Gastroenterology, 34(9), 870-877.
Frank, L., Schmier, J., Kleinman, L., Siddique, R., Beck, C., Schnelle, J., et al. (2002). Time and economic cost of constipation care in nursing homes. Journal of the American Medical Directors Association, 3(4), 215-223.
Fuller, E., Welch, J. L., Backer, J. H., & Rawl, S. M. (2005). Symptom experiences of chronically constipated women with pelvic floor disorders. Clinical Nurse Specialist, 19(1), 34-40.
Gallagher, P., & O'Mahony, D. (2009). Constipation in old age. [Review] [74 refs]. Best Practice & Research in Clinical Gastroenterology, 23(6), 875-887.
Ginsberg, D. A., Phillips, S. E., Wallace, J., & Josephson, K. L. (2007). Evaluating and managing constipation in the elderly. [Review] [57 refs]. Urologic Nursing, 27(3), 191-200.
Heaton, K. W., & Thompson, W. G. (1999). Diagnosis. In: Heaton, K. W., Thompson, W. G.(eds) Irritable bowel syndrom (pp.27). Oxford: Health Press.
Higgins, P. D., & Johanson, J. F. (2004). Epidemiology of constipation in North America: a systematic review. [Review] [43 refs]. American Journal of Gastroenterology, 99(4), 750-759.
Hillemeier, C. (1995). An overview of the effects of dietary fiber on gastrointestinal transit. Pediatrics, 96(5 Pt 2), 997-999.
Hsieh, C. (2005). Treatment of constipation in older adults. [Review] [45 refs]. American Family Physician, 72(11), 2277-2284.
Huang, Y. A. L., Yen, G. C., Sheu, F., & Chau, C. F. (2008). Effects of water-soluble carbohydrate concentrate from Chinese jujube on different intestinal and fecal indices. Journal of Agricultural and Food Chemistry, 56(5), 1734-1739.
Imershein, N., & Linnehan, E. (2000). Nutrition management in home health and long-term care. Constipation: a common problem of the elderly. Journal of Nutrition for the Elderly, 19(3), 49-54.
James, L. G., ＆ Sareen, S. G. (1999). Advanced nutrition and human metabolish. (3rd ed., pp. 110-111). USA :Wadsworth.
Johanson, J. F., & Kralstein, J. (2007). Chronic constipation: a survey of the patient perspective. Alimentary Pharmacology & Therapeutics, 25(5), 599-608.
Khan, F., & Simon, C. (2010). Constipation in adults. [Article]. Innovait May, 3(5), 279-284.
Kinnunen, O. (1991). Study of constipation in a geriatric hospital, day hospital, old people's home and at home. Aging Clinical & Experimental Research, 3(2), 161-170.
Kinnunen, O., Winblad, I., Koistinen, P., & Salokannel, J. (1993). Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Pharmacology, 47(SUPPL. 1), 253-255.
Kobayashi, H. ＆ Fleming, S. E. (2001). The source of dietary fiber influences. Short-chain fatty acid production and concentrations in the large bowel. In: CRC handbook of dietary fiber in human nutrition (G. A. Spiller, 3rd ed., pp. 287-315). New York: CRC Press.
Krogh, K., & Laurberg, S. (2009). Constipation in the elderly: Investigation and management. Aging Health, 5(5), 671-682.
Kyle, G. (2007). Norgine risk assessment tool for constipation. Nursing Times, 103(47), 48–49.
Kyle, G. (2010). The older person: management of constipation. British journal of community nursing, 15(2), 58-64.
Lee, S.C., ＆ Prosky, L. (1994). Perspectives on new dietary fiber definition. Cereal Foods World, 39, 767-768.
Lembo, A., & Camilleri, M. (2003). Chronic constipation. [Review] [57 refs]. New England Journal of Medicine, 349(14), 1360-1368.
Leung, F. W. (2007). Etiologic factors of chronic constipation - Review of the scientific evidence. Digestive Diseases and Sciences, 52(2), 313-316.
Lewis, S. J., & Heaton, K. W. (1997). Stool Form Scale as a Useful Guide to Intestinal Transit Time. Scandinavian Journal of Gastroenterology, 32(9), 920-924.
Ling, J. (1999). Constipation, patients and lifestyles. European Journal of Pain, 3(Suppl.A), 17－22.
Locke Iii, G. R., Pemberton, J. H., & Phillips, S. F. (2000). American Gastroenterological Association medical position statement: Guidelines on constipation. Gastroenterology, 119(6), 1761-1766.
Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. (2006). Functional Bowel Disorders. Gastroenterology, 130(5), 1480-1491.
Marlett, J. A., McBurney, M. I., & Slavin, J. L. (2002). Position of the American Dietetic Association: Health implications of dietary fiber. Journal of the American Dietetic Association, 102(7), 993-1000.
McCrea, G. L., Miaskowski, C., Stotts, N. A., Macera, L., & Varma, M. G. (2009). A Review of the Literature on Gender and Age Differences in the Prevalence and Characteristics of Constipation in North America. Journal of Pain and Symptom Management, 37(4), 737-745.
McRorie, J. W., Daggy, B. P., Morel, J. G., Diersing, P. S., Miner, P. B., & Robinson, M. (1998). Psyllium is superior to docusate sodium for treatment of chronic constipation. Alimentary Pharmacology & Therapeutics, 12(5), 491-497.
Mendoza, J., Legido, J., Rubio, S., & Gisbert, J. P. (2007). Systematic review: The adverse effects of sodium phosphate enema. Alimentary Pharmacology and Therapeutics, 26(1), 9-20.
Mercadante, S., Casuccio, A., Fulfaro, F., Groff, L., Boffi, R., Villari, P., et al. (2001). Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: A prospective study. Journal of Clinical Oncology, 19(11), 2898-2904.
Müller-Lissner, S. A., Kamm, M. A., Scarpignato, C., & Wald, A. (2005). Myths and misconceptions about chronic constipation. American Journal of Gastroenterology, 100(1), 232-242.
Naftali, T., Feingelernt, H., Lesin, Y., Rauchwarger, A., & Konikoff, F. M. (2008). Ziziphus jujuba extract for the treatment of chronic idiopathic constipation: A controlled clinical trial. Digestion, 78(4), 224-228.
Navarro-Rodriguez, T., Dantas Jr, J. P., & Moraes-Filho, J. P. P. (2009). Functional intestinal constipation. Revista Brasileira de Medicina, 66, 77-84.
Nehra, V., Bruce, B. K., Rath-Harvey, D. M., Pemberton, J. H., & Camilleri, M. ( 2000 ). Psychological disorders in patients with evacuation disorders and constipation in a tertiary practice. American Journal of Gastroenterology, 95(7), 1755-1758.
Nyrop, K. A., Palsson, O. S., Levy, R. L., Korff, M. V., Feld, A. D., Turner, M. J., et al. (2007). Costs of health care for irritable bowel syndrome, chronic constipation, functional diarrhoea and functional abdominal pain. Alimentary Pharmacology and Therapeutics, 26(2), 237-248.
Passmore, A. P., Wilson-Davies, K., Stoker, C., & Scott, M. E. (1993). Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination. British Medical Journal, 307(6907), 769-771.
Petticrew, M., Rodgers, M., & Booth, A. (2001). Effectiveness of laxatives in adults. Quality in Health Care, 10(4), 268-273.
Phillips, C., Polakoff, D., Maue, S. K., & Mauch, R. (2001). Assessment of constipation management in long-term care patients. Journal of the American Medical Directors Association, 2(4), 149-154.
Potter, J., & Wagg, A. (2005). Management of bowel problems in older people: an update. [Review] [3 refs]. Clinical Medicine, 5(3), 289-295.
Richmond, J. (2003). Prevention of constipation through risk management. Nursing standard (Royal College of Nursing (Great Britain) : 1987), 17(16), 39-46.
Robertson-Malt, S., Hodgkinson, B., & Joanna Briggs, I. (2008). Management of constipation in older adults. Australian Nursing Journal, 16(5), 32-35.
Robson, K. M., Kiely, D. K., & Lembo, T. (2000). Development of constipation in nursing home residents. Diseases of the Colon & Rectum, 43(7), 940-943.
Schiller, L. R. (2004). New and emerging treatment options for chronic constipation. Reviews in Gastroenterological Disorders, 4(SUPPL. 2).
Schneeman, B. O. (1998). Dietary fiber and gastrointestinal function. Nutrition Research, 18(4), 625-632.
Schug, S. A., Zech, D., Grond, S., Jung, H., Meuser, T., & Stobbe, B. (1992). A long-term survey of morphine in cancer pain patients. Journal of Pain & Symptom Management, 7(5), 259-266.
Shariati, A., Maceda, J. S., & Hale, D. S. (2008). High-fiber diet for treatment of constipation in women with pelvic floor disorders. Obstetrics & Gynecology, 111(4), 908-913.
Slavin, J. (2003). Impact of the proposed definition of dietary fiber on nutrient databases. Journal of Food Composition and Analysis, 16(3), 287-291.
Spiller, G. A. (1986). Suggestion for a basis on which to determine a desirable intake of dietary fiber. In: Handbook of Dietary Fiber in Human Nutrition. (G. A. Spiller, ed., pp. 281-284). USA： CRC Press, Boca Raton.
Stephens, A. (1985). Constipation. In: Fibre, Fibre-Depleted Foods and Disease. Edited by H. Trowell, D. Burkhitt, and H. Keaton. London: Academic Press.
Stessman, M. (2003). Biofeedback: its role in the treatment of chronic constipation. Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates, 26(6), 251-260.
Tack, J., & Müller-Lissner, S. (2009). Treatment of Chronic Constipation: Current Pharmacologic Approaches and Future Directions. Clinical Gastroenterology and Hepatology, 7(5), 502-508.
Talley, N. J., Fleming, K. C., Evans, J. M., O'Keefe, E. A., Weaver, A. L., Zinsmeister, A. R., et al. (1996). Constipation in an elderly community: A study of prevalence and potential risk factors. American Journal of Gastroenterology, 91(1), 19-25.
Tariq, S. H. (2007). Constipation in long-term care. [Review] [118 refs]. Journal of the American Medical Directors Association, 8(4), 209-218.
Thomas, D. R., Forrester, L., & Gloth, M. F. (2003). Clinical consensus: The constipation crisis in long-term care. Ann Long-Term Care(SUPPL.), 3-14.
Thompson, W. G., Longstreth, G. F., Drossman, D. A., Heaton, K. W., Irvine, E. J., & Müller-Lissner, S. A. (1999). Functional bowel disorders and functional abdominal pain. Gut, 45(0 suppl.), II43-II47.
Trowell, H. C., Southgate, D. A. T., Wolever, T. M. S., Leeds, A. R., Gassull, M. A. ＆ Jankins, D. J. A. (1976). Dietsry fiber redefind. Lancet, 1, 967.
Volicer, L., Lane, P., Panke, J. A., & Lyman, P. (2004). Management of constipation in residents with dementia: Sorbitol effectiveness and cost. Journal of the American Medical Directors Association, 5(4), 239-241.
Wisten, A., & Messner, T. (2005). Fruit and fibre (Pajala porridge) in the prevention of constipation. Scandinavian Journal Of Caring Sciences, 19(1), 71-76.
Wong, S. W., & Lubowski, D. Z. (2007). Slow-transit constipation:evaluation and treatment. Australian and New Zealand Journal of Surgery 77(5), 320-328.