Assessing the facilities and healthcare services for heart failure: Taiwan versus European countries.

BACKGROUND/PURPOSE: The present study was designed to evaluate the local cardiology infrastructure and services for heart failure (HF) care in Taiwan hospitals and to compare the HF care with the hospitals in European countries. METHODS: Available data from a total of 98 medical centers and regional hospitals in Taiwan were analyzed. Each facility was given a single copy of the questionnaire between September and December 2019, and service records were extracted from the National Health Insurance Database. European data were adopted from the 2017 European Society of Cardiology Atlas. RESULTS: The number of cardiologists per million populations in Taiwan was 57.4, and it was lower than the European median (72.8). The median percentages of interventional and electrophysiologists among cardiologists were 64% and 15% in Taiwan, which were both higher than the European median values (12% and 5%, respectively). The accessibility rates to implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) in Taiwan were both higher (3.4 and 3.0 centers per million populations) comparing to those in European countries (median 1.6 and 1.5 centers per million populations). Comparing to 67 hospitals without HF care teams in Taiwan, 31 hospitals (31.6%) with HF teams have significantly more cardiology staff, enhanced procedural capabilities with more alternatives on oral or intravenous HF relevant medications. CONCLUSION: Our analysis clearly demonstrated discrepancies in cardiology subspecialties and CRT/ICD accessibilities between European countries and Taiwan. Variations in HF-focused services and facilities plus HF-directed medications have demonstrated significant differences among Taiwanese hospitals with or without HF care team.

Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits.

Reablement services are approaches for maintaining and improving the functional independence of older adults. Previous reablement studies were conducted in a home environment. Due to the limited evidence on the effects of multicomponent interventions and reablement in a community-based context, this study aimed to develop and evaluate the effect of community-based physical-cognitive training, health education, and reablement (PCHER) among rural community-dwelling older adults with mobility deficits. The trial was conducted in rural areas of New Taipei City, Taiwan. Older adults with mild to moderate mobility deficits were recruited from six adult daycare centers, and a cluster assignment was applied in a counterbalanced order. The experimental group (n = 16) received a PCHER intervention, comprising 1.5 h of group courses and 1 h of individualized reablement training, while the control group (n = 12) underwent PCHE intervention, comprising 1.5 h of group courses and 1 h of placebo treatment. A 2.5-h training session was completed weekly for 10 weeks. The outcome measures contained the de Morton Mobility Index (DEMMI), the Saint Louis University Mental Status (SLUMS) Examination, the Barthel Index (BI), the Short Physical Performance Battery (SPPB), and the Canadian Occupational Performance Measure (COPM). The PCHER significantly improved the DEMMI, SLUMS, BI, SPPB, and COPM (all p < 0.05), with medium-to-large effect sizes. PCHER also showed an advantage over PCHE in terms of the SPPB (p = 0.02). This study verified that combining individualized reablement with group-based multicomponent training was superior to group courses alone in enhancing the functional abilities of community-dwelling older adults with mobility deficits.

Hypoglycemia associated with bacteremic pneumococcal infections.

OBJECTIVES: To evaluate the prevalence and associated presentations of hypoglycemia in bacteremic pneumococcal infections, and serotypes of the isolates. METHODS: This was a retrospective study of 70 episodes of pneumococcal bacteremia that occurred in 2004 and 2005. RESULTS: We found hypoglycemia (plasma glucose<3.05 mmol/l)) in six (8.6%) episodes. The patients were three children (mean age 3 years 1 month; range 1 year 5 months-4 years 5 months) and three adults (mean age 73.3 years; range 63-84 years). One child with asplenia and cyanotic heart disease had primary pneumococcal bacteremia. Of the other two children, one had meningitis and the other pneumonia. All the adults had cancer with previous chemotherapy and multilobar pneumonia, which progressed rapidly to respiratory failure. All patients developed their first hypoglycemic episode within two hours after presentation. The average plasma glucose during hypoglycemia was 1.78+/-0.78 mmol/l (range 0.33-2.94 mmol/l). One child and all of the adults died. Serotypes of isolates were those usually associated with severe pneumococcal infection: 6B and 19F in the children; 3, 14, and 23F in the adults. Only the asplenic child had received pneumococcal vaccine. CONCLUSIONS: Hypoglycemia occurred in 8.6% of bacteremic pneumococcal infections and was associated with high mortality and serotypes that cause severe invasive disease. All patients suspected of having septicemia should have their glucose checked to avoid missing hypoglycemia leading to a worsening of their already poor condition.