Unraveling the multiple chronic conditions patterns among people with Alzheimer's disease and related dementia: A machine learning approach to incorporate synergistic interactions.

INTRODUCTION: Most people with Alzheimer's disease and related dementia (ADRD) also suffer from two or more chronic conditions, known as multiple chronic conditions (MCC). While many studies have investigated the MCC patterns, few studies have considered the synergistic interactions with other factors (called the syndemic factors) specifically for people with ADRD. METHODS: We included 40,290 visits and identified 18 MCC from the National Alzheimer's Coordinating Center. Then, we utilized a multi-label XGBoost model to predict developing MCC based on existing MCC patterns and individualized syndemic factors. RESULTS: Our model achieved an overall arithmetic mean of 0.710 AUROC (SD = 0.100) in predicting 18 developing MCC. While existing MCC patterns have enough predictive power, syndemic factors related to dementia, social behaviors, mental and physical health can improve model performance further. DISCUSSION: Our study demonstrated that the MCC patterns among people with ADRD can be learned using a machine-learning approach with syndemic framework adjustments. HIGHLIGHTS: Machine learning models can learn the MCC patterns for people with ADRD. The learned MCC patterns should be adjusted and individualized by syndemic factors. The model can predict which disease is developing based on existing MCC patterns. As a result, this model enables early specific MCC identification and prevention.

Impact of Daycare Service Interruption during COVID-19 Pandemic on Physical and Mental Functions and Nutrition in Older People with Dementia.

This study evaluated changes of cognitive, physical, and nutritional status before and after the interruption and resumption of daycare services during the COVID-19 pandemic in older dementia people in a daycare center. Comprehensive geriatric assessment data were analyzed before and after the lockdown of daycare center services, including mini-mental state examination, activities of daily living (ADL) scores, mini-nutritional assessment-short forms (MNA-SF), and timed up-and-go (TUG) tests. Among 19 dementia people participating in daycare services, 17 participants were enrolled in the study with, finally, two excluded because of incomplete follow-ups. They had a median age of 81 years; their MNA-SF scores and TUG values deteriorated significantly after a 3-month closure of daycare services (p < 0.05), and after resumption of daycare services the MNA-SF scores and TUG values recovered to near the pre-lockdown levels (p < 0.05). Besides, baseline ADL scores predicted a decline and recovery of TUG and MNA-SF values. Our findings suggest that planning continuous support for older dementia adults is important for daycare facilities during COVID-19 pandemic confinement.

The Mediating Effect of Fatigue on the Nature Element, Organisational Culture and Task Performance in Central Taiwan.

In the current dynamic business environment, managing the physical working environment of the workforce has become an important part of the company. This study seeks to investigate the effects of the nature element and organisational culture on the task performance of employees with fatigue as a mediator, based on a sample of 103 white-collar employees who work in the central district of Taichung City during the spring and using a purposive sampling method. The data were collected through a self-administered subjective measurement instrument questionnaire and were analysed using Structural Equation Modelling (SEM) path analysis. The results show that organisational culture and task performance were significantly positive. The mediating effect of fatigue caused this relationship to become negative. It was also found that there was a negative relationship between nature elements and task performance. The results provide insights into the importance of employers in providing a healthy workplace which promotes collaboration, health, safety, and the wellbeing of the employee in line with the recommendations of the World Health Organisation (WHO). The study concludes that future international comparative studies can be performed to identify the best workplace design that can reduce employees' fatigue and alleviate their current work performance.

Impact of day care services on physical and cognitive functions in old people with dementia in a medical center in central Taiwan.

BACKGROUND: Day care service (DCS) provides various activities in a professional environment to meet the old people with functional limitations. However, relatively little is known about the effects of DCS on physical and mental functions. METHODS: This was a retrospective study that we used a comprehensive geriatric assessment to evaluate the changes before and after DCS among participants in a hospital-affiliated geriatric day care center in Taiwan. The burden of the participants' families was also assessed. RESULTS: The 18 participants with a median age of 80.9 (interquartile range (IQR) 75.2-86.6 y/o) were enrolled and followed up for 6 months. Based on the clinical dementia rating (CDR), disease stage was very mild in 3 participants, mild in 10, moderate in 3, and severe in 2. The activities of daily living (ADL) scores of the participants improved significantly from 75 (IQR 60.0-80.0) at baseline to 77.5 (IQR 65.0-90.0) at the 6 month (p < 0.001), and mini-mental state examination (MMSE) scores from 15 (IQR 11.5-20.0) to 18 (IQR 15.8-24.0) (p = 0.026). There was a positive correlation of baseline mini-nutritional assessment-short form score and the 3-level version of the European Quality of Life-5 dimensions utility index with both ADL and MMSE scores at the 6-month follow-up. In addition, the family burden scale was reduced from 22 to 15 (p = 0.002). CONCLUSIONS: The physical and cognitive functions in old people with dementia who received DCS were maintained or partially improved, and their families' stress burden was alleviated.

Influence of Risk of Drug⁻Drug Interactions and Time Availability on Patient Trust, Satisfaction, and Cooperation with Clinical Pharmacists.

Patients with multiple diseases requiring several medications often face the risk of drug-drug interactions (DDIs). Such patients need more care and services from clinical pharmacists. Given the importance of this issue in clinical medicine, the present study aims to investigate how DDIs and time availability affect patient trust in clinical pharmacists and how patient trust influences patient satisfaction and cooperation between patients and clinical pharmacists. Sample data of 741 patients in central Taiwan hospitals were analyzed, and the results of structural equation modeling showed that DDIs and time availability positively affect patient trust, which, in turn, positively influenced patient satisfaction and cooperation between patients and clinical pharmacists. Overall, the results indicated that patient satisfaction is an important predictor of cooperation between patients and clinical pharmacists.

Developing a Measurement Scale of Gender-Friendly Hospital Environments: An Exploratory Study of Customer Perceptions in Taiwan.

According to the United Nations, males and females should be given equal treatment in physical and psychological services, and healthcare institutions should exert greater efforts to reduce the gap in gender equality. However, this issue has been largely ignored in previous literature on healthcare environments. Designing a hospital environment that focuses on gender differences is critical to academic researchers and practical managers in all healthcare institutions. Thus, as an exploratory effort, this study aims to develop a measurement to assess customer perceptions of gender-friendly hospital environments. To identify and refine the structure of the instrument, two studies are conducted at different hospitals in Taiwan. The exploratory evidence shows there are five factors (i.e., physical design, functional design, marking design, gender perception, and gender-friendly services) and 28 items in the measurement scale of gender-friendly hospital environments. Results also show that gender-friendly hospital environments affect customers' loyalty and willingness to pay. Based on our findings, hospital practitioners and researchers can adopt the measurement instrument used in this study to deal with the gap of gender equality in healthcare environments.

Construction and application of an intelligent air quality monitoring system for healthcare environment.

Indoor air quality monitoring in healthcare environment has become a critical part of hospital management and policy. Manual air sampling and analysis are cost-inhibitive and do not provide real-time air quality data and response measures. In this month-long study over 14 sampling locations in a public hospital in Taiwan, we observed a positive correlation between CO(2) concentration and population, total bacteria, and particulate matter concentrations, thus monitoring CO(2) concentration as a general indicator for air quality could be a viable option. Consequently, an intelligent environmental monitoring system consisting of a CO(2)/temperature/humidity sensor, a digital plug, and a ZigBee Router and Coordinator was developed and tested. The system also included a backend server that received and analyzed data, as well as activating ventilation and air purifiers when CO(2) concentration exceeded a pre-set value. Alert messages can also be delivered to offsite users through mobile devices.

Prescription-filling process reengineering of an outpatient pharmacy.

Shortening waiting times is the most obvious and effective method of increasing service quality. As the workforce is limited, it is necessary to reform current systems of medical care and improve the efficiency of medical care. After process reengineering was proposed in 1990s, however, this concept has not yet been commonly applied to medical centers. The subject of this study was an outpatient pharmacy in a medical center. This study applied the methods of a time study to measure field observations and as an analytic tool in process reengineering. The results show that the pharmacists were hindered in filling prescriptions for the following reasons: the preparation of certain prescription units, the menial sorting of medicines and also storage issues related to medicines. Improving the process will decrease time wasted by 10.41% and enhance service by 8.95%. The reengineering process resulted not only in a reduction in outpatients' waiting time but also enhanced the quality and competitiveness of the Hospital's medical treatment.

Career needs, career development programmes, organizational commitment and turnover intention of nurses in Taiwan.

AIM: This study divided nursing careers into four stages: exploration, establishment, maintenance and disengagement. Besides exploring whether nurses have different career needs at different career stages, this study also examines the gap between career needs and career development programmes, and its relationship with organizational commitment and turnover intention of nurses in Taiwan. BACKGROUND: Although previous studies have recognized that nurses' careers have different stages, a few studies have identified nurses' career needs or offered programmes to respond to nurses' needs. METHOD: Through a literature review and in-depth interviews, this study developed a scale to measure career needs of nurses at different stages and identify the appropriate career development programmes. Additionally, regression analyses were implemented to explore the relationships objectively. RESULTS: Nurses were found to have different career needs at different career stages, and the gap between career needs and career development programmes influenced turnover intention caused by the decline in nurses' commitment towards the hospital. CONCLUSIONS: If hospitals' administrators can provide career development programmes to satisfy career needs of nurses at different career stages, then nurses' commitment to the hospital may increase and nurses' turnover intention may decrease, which may lead to reciprocity between the hospital and the nurses.

Designing career development programs through understanding of nurses' career needs.

A nurse's career can be divided into the exploration, establishment, maintenance, and disengagement stages. Because nurses have varied career needs at different career stages, this article uses literature review and in-depth interviews with nurses to understand the features of career stages. The authors detail nurses' career needs in different stages and infer appropriate career development programs in the hospital system.