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[Purpose] Virtual reality has been increasingly used to improve the balance performance of older adults; however, the effect remains inconclusive. This study aimed to examine the effects of virtual reality on the balance performance of older adults through a systematic review and meta-analysis. [Methods] The PubMed, MEDLINE, CINAHL, Cochrane Library, and PEDro electronic databases were searched. Only randomized clinical trials published in English from January 1st, 1980, to September 30, 2022, were included and reviewed. Outcome measures included the Berg Balance Scale, Timed Up and Go Test and Activity-specific Balance Confidence scale. [Results] The results showed that virtual reality training for older adults led to significant improvements in Berg Balance Scale scores and Timed Up and Go Test times compared with non-virtual reality training. However, such an outcome was not observed with regard to the Activity-specific Balance Confidence scale. [Conclusion] Virtual reality training is effective in improving both static and dynamic balance among older adults. However, its effect on their self-confidence regarding balance is not significant.
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University nursing students have been shown to experience psychological stress. A mindfulness-based intervention (MBI) may be a helpful tool for stress management. The aim of this study was to examine the effects of a MBI on improving mindfulness and reducing perceived stress in nursing students. A quasi-experimental study was conducted between July 2021 and February 2022. The intervention group participated in an 8-week mindfulness awareness course, which included 50 min of training and practice in mindfulness meditation techniques each week. Over the same 8 weeks, the control group watched a 50-min film each week. The mindful attention awareness scale (MAAS) and perceived stress scale (PSS) were administered before the intervention, intervention completion, and 2 and 6 months after the intervention. Data were analyzed using t test and generalized estimating equation. Overall, that the MBI showed a substantial effect on felt stress in comparison to the control group. When compared to the control group, the MBI showed a substantial impact on trait mindfulness. The MBI was beneficial for nursing students and could be considered a viable approach in nursing education to enhance mental wellbeing. It could be an effective method of relieving stress in a high-stress population.
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Atenção Plena , Estresse Psicológico , Estudantes de Enfermagem , Humanos , Atenção Plena/métodos , Estudantes de Enfermagem/psicologia , Estresse Psicológico/terapia , Feminino , Masculino , Adulto Jovem , Adulto , Universidades , Meditação/métodos , Meditação/psicologiaRESUMO
In tuberculosis (TB), chest radiography (CXR) patterns are highly variable, mimicking pneumonia and many other diseases. This study aims to evaluate the efficacy of Google teachable machine, a deep neural network-based image classification tool, to develop algorithm for predicting TB probability of CXRs. The training dataset included 348 TB CXRs and 3806 normal CXRs for training TB detection. We also collected 1150 abnormal CXRs and 627 normal CXRs for training abnormality detection. For external validation, we collected 250 CXRs from our hospital. We also compared the accuracy of the algorithm to five pulmonologists and radiological reports. In external validation, the AI algorithm showed areas under the curve (AUC) of 0.951 and 0.975 in validation dataset 1 and 2. The accuracy of the pulmonologists on validation dataset 2 showed AUC range of 0.936-0.995. When abnormal CXRs other than TB were added, AUC decreased in both human readers (0.843-0.888) and AI algorithm (0.828). When combine human readers with AI algorithm, the AUC further increased to 0.862-0.885. The TB CXR AI algorithm developed by using Google teachable machine in this study is effective, with the accuracy close to experienced clinical physicians, and may be helpful for detecting tuberculosis by CXR.
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Algoritmos , Aprendizado Profundo , Radiografia Torácica , Tuberculose Pulmonar , Humanos , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico , Radiografia Torácica/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Área Sob a CurvaRESUMO
Rationale and objectives: To develop a prognostic nomogram using mammography data and AJCC staging to predict breast cancer survival. Materials and methods: A prognostic nomogram was created using data from 1000 women diagnosed with breast cancer at a medical cancer center in Taiwan between 2011 and 2015. The variables included age at diagnosis (≤60 or > 60 years), mammography purpose (screening or diagnostic), mammography modality (digital mammogram or digital breast tomosynthesis), and the 7th American Joint Committee on Cancer (AJCC) stage. The outcome predicted was breast cancer-related mortality. The nomogram utilized Kaplan-Meier analysis for all subsets and Cox proportional hazards regression analysis for prediction. The nomogram's accuracy was internally validated using the concordance index and receiver operating characteristic (ROC) curve analysis, focusing on 3-year and 5-year survival predictions. Results: Participants' mean age at breast cancer diagnosis was 54 years (SD = 11.2 years). The 1-year, 3-year, and 5-year overall survival (OS) rates were found to be 99.7%, 95.3%, and 91.4%, respectively. The bootstrap-corrected concordance indices indicated the following: nomogram, 0.807 and AJCC, 0.759. A significant difference was observed between the nomogram's area under the curve (AUC) and the AJCC stage in predicting the probability of 5-year survival (p = 0.005). A nomogram, constructed based on mammography and AJCC, demonstrated excellent calibration through internal validation using bootstrapping. Conclusion: The utilization of a nomogram that incorporates mammography data and the AJCC registry data has been demonstrated to be a reliable predictor of breast cancer survival.
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BACKGROUND: The percentage of and factors associated with the regression of Barrett's esophagus (BE) or its characteristic intestinal metaplasia (IM) remain unclear, and conflicting results have been reported because of diverse regression and sampling error definitions. Thus, we investigated the rates of IM regression, sampling error, and associated factors. METHODS: Forty-two patients with proven short-segment BE with IM who underwent two follow-up endoscopies with biopsies of Barrett's mucosa were retrospectively analyzed. Additional Alcian blue and MUC2 staining were done on the biopsy specimens without IM in hematoxylin-eosin staining. Only patients with negative hematoxylin-eosin, Alcian blue, and MUC2 staining for IM in both follow-up endoscopies were considered to have true regression. When all three stains were negative for IM in the first, but positive in the second follow-up endoscopy, we considered IM persisting and declared sampling error. RESULTS: Among the 18 patients without IM at the first follow-up endoscopy, only five (11.9%) were judged to have true regression. Prolonged proton-pump inhibitor use was significantly associated with regression. Limited experience of the endoscopist, and insufficient biopsy number were significantly related to sampling error. Receiver operating characteristic (ROC) curve analysis showed the best cut-off value of the biopsy number/maximal-length (cm) ratio to predict sampling error was 2.25. CONCLUSION: In our patients with short-segment BE, 11.9% experienced regression of IM. Prolonged proton-pump inhibitors treatment was associated with regression. An insufficient biopsy number was related to a missed IM, which may be eliminated by maintaining biopsy number/maximal-length (cm) ratio ≥2.25.
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Esôfago de Barrett , Gastroenteropatias , Humanos , Azul Alciano , Amarelo de Eosina-(YS) , Seguimentos , Hematoxilina , Estudos Retrospectivos , Viés de Seleção , Endoscopia , Inibidores da Bomba de Prótons/uso terapêutico , MetaplasiaRESUMO
Colorectal cancer (CRC) is a prevalent cancer globally, including in Vietnam where its incidence is rapidly increasing. The aim of this study was to evaluate the awareness of signs, symptoms, and risk factors of colorectal cancer among outpatients at Hoa Hao Medic Company Limited, Ho Chi Minh City, Vietnam. A cross-sectional study was conducted, and a total of 441 people who visited Hoa Hao Medic Company Limited for a general health check-up and voluntarily agreed to participate in this study were recruited through the convenience sampling method. Data were collected through face-to-face structured interviews using the Bowel CAM questionnaire. According to the results, the highest percentage of well-recalled warning signs were "change in bowel habit" (36.7%) followed by abdominal pain (35.4%). Other warning signs such as weight loss and rectal bleeding were reported by 19.0% and 18.1% of participants, respectively. Over 42% of participants stated that they were unaware of any signs or symptoms. The most commonly identified risk factors for CRC were pollution (66.9%), genetics (50.6%), and an unhealthy/poor diet (53.7%) for unprompted questions. The overall awareness score of participants was 3.46/9 (SD ± 2.91) for signs and symptoms of CRC and 5.90/10 (SD ± 1.62) for risk factors. Univariate linear regression identified education level and occupation as predictors of higher CRC awareness. In conclusion, this study highlights that overall awareness of CRC is low among outpatients at Hoa Hao Medic Company Limited. Strategies to increase awareness, knowledge, and education programs are necessary to promote early detection of CRC and reduce its burden in Vietnam.
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Carbodicarbene (CDC) has become an emerging ligand in many fields due to its strong σ-donating ability.
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BACKGROUND: Motor recovery following a stroke is related to the initial stroke severity and corticospinal tract integrity. One of the outcomes representing corticospinal tract integrity is the motor evoked potential (MEP). This study aimed to investigate the predictive value of MEP for motor recovery in patients with acute ischemic stroke. PATIENTS AND METHODS: Patients with hemiparesis secondary to initial acute ischemic stroke were enrolled. MEPs of the upper limb were assessed as preserved (MEP+) or absent (MEP-) response ≤10 days post-stroke. Fugl-Meyer assessment (FMA) was performed at baseline and post-stroke at 30 and 90 days. A modified Rankin scale (mRS) was conducted at 90 days post-stroke. Patients were divided into two groups according to the highest FMA score of MEP- patients. Generalized estimating equations and logistic regression were used for our study analysis. RESULTS: Sixty-one participants were included in this study. The highest FMA score of MEP- patients ≤10 days after stroke was 38. Among patients with an initial FMA score ≤38, FMA scores at 30 and 90 days post-stroke were significantly higher in MEP + patients than in MEP- patients. Proportional recovery at 30 and 90 days post-stroke was significantly higher in MEP + patients than in MEP- patients. MEP + patients had a higher percentage of good functional outcomes than MEP- patients, without statistical difference. Among patients with initial FMA score >38, FMA scores were 60.4 ± 4.8 and 63.9 ± 2.9 and proportional recovery was 65.2 ± 27.0% and 83.7 ± 24.6% at 30 and 90 days post-stroke, respectively. CONCLUSIONS: Among patients with moderate-to-severe ischemic stroke, MEP + patients had better motor recoveries (approximately 70%) than MEP- patients at 90 days post-stroke. MEP + patients had better functional outcomes than MEP- patients.
Key MessagesAmong patients with moderate-to-severe ischemic stroke, those with positive motor-evoked potentials (MEPs) had better motor recovery than those with negative MEPs at 90 days post-stroke.Assessment of motor-evoked potentials is a reliable method for predicting motor recovery in patients with moderate-to-severe ischemic stroke.Corticospinal tract function of patients with acute ischemic stroke was tested with transcranial magnetic stimulation.
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AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Potencial Evocado Motor , Acidente Vascular Cerebral/complicações , Paresia/diagnóstico , Paresia/etiologiaRESUMO
(1) Background: Currently, Taiwan has adopted a "person-centered" approach to Advance Care, including Hospice Palliative Care and Advance Decisions, both of which are intended to enhance the right of individuals to choose their own end-of-life care; however, it is extremely challenging and difficult to implement the principle of autonomy for psychiatric patients. (2) Methodology: The aim in this study is to investigate the factors affecting the intention of day ward patients to sign up for hospice and palliative care by using the questionnaire content of the "Survey on Knowledge, Attitude Toward, Experience, and Behavior Intention to Sign Up for Hospice and Palliative Care". A cross-sectional design compliant with STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) was employed. An independent sample t-test, Pearson's correlation analysis, and stepwise regression analysis were used to determine the factors influencing the intention of psychiatric patients to sign up for advanced care planning. (3) Results: The relationships between knowledge of and attitude toward advanced care planning, knowledge of and behavior intention to sign up for advanced care planning, and attitude toward and behavior intention to sign up for advanced care planning were all positive (p-value < 0.001). The final three most relevant indicators were attitude toward hospice and palliative care, hospitalization of family members during the previous five years, and death of a close friend within the previous five years. (4) Conclusions: The results of the study show that the hospice and palliative care attitude and past experience of psychiatric patients affect the intention to sign up, reminding us that psychiatric patients are at an increased risk of decision-making disability as their illness progresses and that, in addition to initiating the discussion of Advance Care Planning as soon as possible, it may be an opportune time for medical professionals to actively promote Advance Care Planning among their patients.
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This study aims to determine the effects of normal and angel wing on morphological and histological characteristics of white Roman geese. Angel wing is a torsion of a wing at the carpometacarpus all the way down to the end, stretching outward away from the body lateral. In this study, 30 geese were raised for observing the whole appearance, including stretched wings and morphologies of defeathered wings at 14 wk old. A group of 30 goslings was raised to observe the feature of conformation development of wing bones from 4 to 8 wk old by X-ray photography. The results show that normal wing on angles of the metacarpals and radioulnar bones has a trend greater than the angel wing group (P = 0.927) at the age of 10 wk. According to 64-slice images of computerized tomography scanner on a group of 10-wk-old geese, the interstice at the carpus joint of the angel wing was larger than that of the normal wing. The slight to moderate dilated space of the carpometacarpal joint was found in the angel wing group. In conclusion, the angel wing is torqued outward away from the body laterals at the carpometacarpus and has a slight to moderate dilated space in the carpometacarpal joint. The normal wing geese exhibited an angel that is 9.24% greater than those of angel wing geese at the age of 14 wk (130 vs. 118.5°).
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Galinhas , Gansos , Animais , Gansos/anatomia & histologia , Asas de AnimaisRESUMO
INTRODUCTION: Diabetic nephropathy (DN) is a severe diabetes mellitus (DM) complication that contributes to medical and financial burdens. This study aimed to investigate risk factors for DN among type 2 diabetes mellitus (T2DM) patients by stratifying the participants based on the presence of metabolic syndrome (MetS). MATERIALS AND METHODS: Between June 2017 and June 2022, Taiwan Hospital was chosen for this retrospective case-control study. Following the completion of a standardized interview and the donation of blood samples for this study, participants were divided into two groups according to whether they had MetS. We contrasted how the potential DN-related factors impacted these two groups. RESULTS: A total of 1212 patients were included, and 639 patients (52.7%) had MetS. Multivariable analysis showed that the level of educational qualifications, fasting glucose, and uric acid (UA) were associated with DN. However, chewing betel nut behavior, higher systolic blood pressure (SBP), and higher glycated hemoglobin (HbA1c) were found to be risk factors of DN among the patients who had both T2DM and MetS. Notably, betel nut chewing increased the chance of DN in T2DM patients with MetS. CONCLUSIONS: This study found that the level of education, chewing betel nut behavior, HbA1c, fasting glucose, SBP, and UA were significant risk factors for the development of DN in diabetic individuals with concurrent MetS. Our research reveals that managing the aforementioned risk factors is crucial to lowering the prevalence of DN, particularly in individuals with lower levels of education.
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Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Síndrome Metabólica , Humanos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/complicações , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/etiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobinas Glicadas , Estudos Retrospectivos , Estudos de Casos e Controles , Complicações do Diabetes/complicações , GlucoseRESUMO
High-efficiency particulate air (HEPA) filters is a potential tool used to remove fine particles and improve indoor air quality. This study aims to analyze the real-world efficacy of portable HEPA air cleaners in a household environment. Laser light dispersion PM2.5 sensors are used to continuously monitor the indoor and outdoor PM2.5 level before and after HEPA air cleaner filtration. Overall, HEPA air cleaners significantly reduce the indoor PM2.5 level (33.5 ± 10.3 vs. 17.2 ± 10.7 µg/m3, mean difference (MD) = -16.3 µg/m3, p < 0.001) and indoor/outdoor PM2.5% (76.3 ± 16.8 vs. 38.6 ± 19.8%, MD = -37.7%, p < 0.001). The efficacy to reduce PM2.5 is strongest in three machines with medium-flow setting group (indoor PM2.5 MD: -26.5 µg/m3, indoor/outdoor PM2.5 percentage MD: -56.4%). Multiple linear regression demonstrates that outdoor PM2.5, machine number, airflow speed, and window ventilation are significant factors associated with indoor PM2.5 concentrations (R = 0.879) and percentage of the indoor/outdoor PM2.5 ratio (R = 0.808). HEPA air cleaners can effectively improve indoor PM2.5 air pollution. Adequate air cleaner machine numbers, appropriate airflow, and window ventilation limitations are important to achieve the best efficacy of the HEPA air cleaner.
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Filtros de Ar , Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Ar Condicionado , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/análise , Poluição do Ar em Ambientes Fechados/prevenção & controle , Poeira , Material Particulado/análiseRESUMO
BACKGROUND: Patients with chronic stroke have reduced capacity for performing activities of daily living (ADLs) and are at increased risk for falls during walking due to long-term changes to muscle tone and force, as well as movement control. RESEARCH QUESTION: To investigate the efficacy of lateral stair walking training on muscle strength of affected lower extremities, balance, ADLs, and gait ability in patients with chronic stroke. METHODS: The experimental group received 15 min of lateral stair walking exercise along with 15 min of traditional physiotherapy, whereas the control group received only traditional physiotherapy for 30 min. Both groups received the intervention once a week for 12 weeks. Outcome measurements included muscle strength, postural assessment scale for stroke patients (PASS), Fugal-Meyer assessment for lower extremity (FMA-LE), Barthel index (BI), timed up and go test (TUG), and the gait parameters which were determined by the Reha-Watch system. RESULTS: A total of 24 participants completed the study. The experimental group showed significant improvements in hip extensor, flexor, and abductor strength of the affected limb, FMA-LE, BI, TUG, and gait parameters of stride length, velocity, and cadence. Significant differences in affected limb ankle plantar strength (p = 0.024), PASS (p = 0.017), BI (p = 0.039), TUG (p = 0.049), and gait velocity (p < 0.001) were observed between the 2 groups. SIGNIFICANCE: Lateral stair walking training alongside physical therapy resulted in significant improvements in hip muscle strength and gait parameters in patients with chronic stroke. Our results support the incorporation of lateral stair walking training into clinical rehabilitation programs. Lateral stair walking training in patients with chronic stroke can be used as an effective treatment to improve gait, balance performance, and ADLs.
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Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Terapia por Exercício , Marcha , Humanos , Projetos Piloto , Equilíbrio Postural , Estudos de Tempo e Movimento , Resultado do Tratamento , CaminhadaRESUMO
Patients with influenza infection may develop acute respiratory distress syndrome (ARDS), which is associated with high mortality. Some patients with ARDS receiving extracorporeal membrane oxygenation (ECMO) support die of infectious complications. We aimed to investigate the risk factors affecting the clinical outcomes in critically ill patients with influenza. We retrospectively reviewed the medical records of influenza patients between January 2006 and May 2016 at the Kaohsiung Veterans General Hospital in Taiwan. Patients aged below 20 years or without laboratory-confirmed influenza were excluded. Critically ill patients who presented with ARDS (P = 0.004, odds ratio (OR): 8.054, 95% confidence interval (CI): 1.975-32.855), a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (P = 0.008, OR: 1.102, 95% CI: 1.025-1.184), or higher positive end-expiratory pressure (P = 0.008, OR: 1.259, 95% CI: 1.061-1.493) may have a higher risk of receiving ECMO. Influenza A (P = 0.037, OR: 0.105, 95% CI: 0.013-0.876) and multiple organ failure (P = 0.007, OR: 0.056, 95% CI: 0.007-0.457) were significantly associated with higher mortality rates. In conclusion, our study showed critically ill influenza patients with ARDS, higher APACHE II scores, and higher positive end-expiratory pressure have a higher risk of receiving ECMO support. Influenza A and multiple organ failure are predictors of mortality.
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Influenza Humana , Síndrome do Desconforto Respiratório , Adulto , Idoso , Estado Terminal , Mortalidade Hospitalar , Humanos , Estudos Retrospectivos , Taiwan/epidemiologiaRESUMO
Taiwan has been an aged society since March 2018, and the elderly population suffer from multiple comorbidities and long duration of disability. Therefore, the service of discharge planning of long-term care 2.0 is an important stage before patients go back to the community. Strengthening the sensitivity when identifying predisabled patients is a principal development of discharge planning. In the current study, we analyzed the characteristics and predictive factors of patients who used the service of long-term care 2.0 from the perspective of discharge planning. In this retrospective study, we included patients who received the discharge planning service in a hospital located in southern Hualien during November 2017 to October 2018. The data were collected and classified as predisposing factors, enabling factors, and need factors according to the analysis architecture of the Andersen Behavioral Model. There were 280 valid patients included in this current study; age, medical accessibility, possession of a disability card, and cerebrovascular diseases, cardiovascular diseases, and diabetes mellitus were the vital factors which influenced the coherence and cohesion between discharge planning and the service of long-term care 2.0. Among them, the most influencing factor was age. We hope that the current study will make policymakers in hospitals pay attention to the usage of the discharge planning service to link long-term care 2.0 and effectively promote the usage of long-term care 2.0.
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Assistência de Longa Duração , Alta do Paciente , Idoso , Estudos Transversais , Hospitais , Humanos , Estudos Retrospectivos , TaiwanRESUMO
Diabetic retinopathy (DR), caused by small vessel disease, is the main cause of blindness in persons with diabetes. Taiwan is one of the Asian countries with the highest prevalence rate of DR. The purpose was to investigate the related risk factors of DR in elderly patients with type 2 diabetes mellitus (T2DM), in Lee's Endocrinology Clinic. 792 T2DM patients over 60 years old were invited to have an outpatient visit at least every three months, and all of them were asked to undergo a standardized interview and collect their blood samples. Significant factors were being female (adjusted hazard ratio (HR): 1.287; 95% CI, 1.082-1.531), higher glycated hemoglobin (HbA1c) (HR: 1.067; 95% CI: 1.016-1.119), higher mean low density of lipoprotein cholesterol (LDL-c) (HR: 1.004; 95% CI: 1.001-1.006), and chewing betel nut (HR: 1.788; 95% CI: 1.362-2.347). This study showed that gender, the behavior of chewing betel nut, HbA1c, and LDL-c are important factors for the development of DR in elderly patients with T2DM. It is suggested that patients should control their HbA1c and LDL-c and quit chewing betel nut to prevent DR. This suggestion applies especially to female patients.
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Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Idoso , Ásia , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/epidemiologia , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologiaRESUMO
INTRODUCTION: Colorectal cancer (CRC) is rapidly increasing in developed countries. In Taiwan, the incidence rate of CRC has increased during the past decade, but the 5-year survival has remained at approximately 63%. In this study, we sought to determine the 5-year survival rate of patients diagnosed with colon and rectum cancer and to determine factors affecting survival. MATERIAL AND METHODS: All patients from the Taiwan Cancer Database of the medical center hospital in North Taiwan between 2007 and 2013 were identified. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable. RESULTS: A total of 869 patients were included: 554 (63.8%) patients had colon cancer and 315 (36.2%) had rectum cancer. The mean survival time was 71.27 ±1.27 months (colon group: 71.90 ±1.58 months; rectum group: 67.88 ±1.95 months). There was no significant difference (p = 0.493) between patients who had colon or rectum cancer. The forward stepwise Cox regression analysis results indicated that perineural invasion, distant metastasis, age, pathological differentiation grade, and obstruction were statistically significant for patients who had CRC, colon cancer or rectum cancer. CONCLUSIONS: The long-term survival from CRC, colon cancer and rectum cancer remains promising, as 68.66%, 69.11% and 67.90% of patients are alive 5 years after being diagnosed, respectively. Perineural invasion was found to be an important factor related to the survival of patients who have CRC. Thus, early detection of CRC may help improve survival.
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BACKGROUND: This nationwide study was performed to evaluate the evolution of distributions of patients with COPD according to the 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines and to assess the concordance between the prescribed medications and the pharmacological management recommended by the two distinct classification systems in Taiwan. SUBJECTS AND METHODS: Data were retrospectively retrieved from stable COPD patients in 11 participating hospitals across Taiwan. Patients were grouped according to GOLD 2011 and 2017 guidelines respectively. Definitions of undertreatment and overtreatment were based on the pharmacological recommendations in the individual guidelines. RESULTS: A total of 1,053 COPD patients were included. The percentages of patients in GOLD 2011 groups A, B, C and D were 18.4%, 40.6%, 6.7% and 34.2%, respectively. When reclassified according to the GOLD 2017, the percentages of group A and B increased to 23.3% and 63.2%, and groups C and D decreased to 1.9% and 11.6%, respectively. Up to 67% of patients in GOLD 2011 groups C and D were reclassified to GOLD 2017 groups A and B. The pharmacological concordance rate was 60.9% for GOLD 2011 and decreased to 44.9% for GOLD 2017. Overtreatment was found in 29.5% of patients according to GOLD 2011 and the rate increased to 46.1% when classified by the GOLD 2017. The major cause of overtreatment was unnecessary inhaled corticosteroids and the main cause of undertreatment was a lack of maintenance long-acting bronchodilators. CONCLUSION: The distribution of COPD patients in Taiwan was more uneven with the GOLD 2017 than with the GOLD 2011. A pharmacological discordance to the guidelines was identified. Updated guidelines with reclassification of COPD patients resulted in more discordance between prescribed medications and the guidelines. Physicians should make proper adjustments of the prescriptions according to the updated guidelines to ensure the mostly appropriate treatment for COPD patients.
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Corticosteroides/administração & dosagem , Broncodilatadores/administração & dosagem , Fidelidade a Diretrizes/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Idoso , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , TaiwanRESUMO
BACKGROUND: Colorectal cancer is one of the most common malignancies in developed countries. The incidence of colorectal cancer (CRC) in Taiwan is rising. We aimed to determine the five-yr survival rate of patients diagnosed with CRC and determine factors affecting survival. METHODS: All patients were identified from the Taiwan Cancer Data Base of the Medical Center Hospital in North Taiwan from 2007 to 2013. Data were collected using medical records and the cancer database. In all, 869 patients with CRC were included. Survival analysis was performed using Kaplan-Meier curves, and differences between the curves were analyzed using the log-rank test. Cox proportional hazards regression models were used to analyze survival by each variable. RESULTS: The five-yr survival rate and the mean survival time after cancer diagnosis were 68.7% and 71.27±1.27 months. Perineural nerve invasion, distant metastasis, age, pathological differentiation grade, obstruction and regional lymph node metastasis were found to be independent predictors of the survival and prognosis of patients with CRC. CONCLUSION: Perineural nerve invasion was an important factor related to the survival of CRC patients. Thus, the earlier detection of CRC might help improve survival.
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BACKGROUND: Due to studies on calorie requirement in mechanically ventilated critically ill elderly patients are few, and indirect calorimetry (IC) is not available in every intensive care unit (ICU). The aim of this study was to compare IC and Harris-Benedict (HB) predictive equation in different BMI groups. METHODS: A total of 177 mechanically ventilated critically ill elderly patients (â§65 years old) underwent IC for measured resting energy expenditure (MREE). Estimated calorie requirement was calculated by the HB equation, using actual body weight (ABW) and ideal body weight (IBW) separately. Patients were divided into four BMI groups. One-way ANOVA and Pearson's correlation coefficient were used for statistical analyses. RESULTS: The mean MREE was 1443.6 ± 318.2 kcal/day, HB(ABW) was 1110.9 ± 177.0 kcal/day and HB(IBW) was 1101.5 ± 113.1 kcal/day. The stress factor (SFA = MREE ÷ HB(ABW)) was 1.43 ± 0.26 for the underweight, 1.30 ± 0.27 for the normal weight, 1.20 ± 0.19 for the overweight, and 1.20 ± 0.31 for the obese. The SFI (SFI = MREE ÷ HB(IBW)) was 1.24 ± 0.24 for the underweight, 1.31 ± 0.26 for the normal weight, 1.36 ± 0.21 for the overweight, and 1.52 ± 0.39 for the obese. MREE had significant correlation both with REE(ABW) = HB(ABW) × SFA (r = 0.46; P < 0.0001) and REE(IBW) = HB(IBW) × SFI (r = 0.43; P < 0.0001). CONCLUSION: IC is the best accurate method for assessing calorie requirement of mechanically ventilated critically ill elderly patients. When IC is not available, using the predictive HB equation is an alternative choice. Calorie requirement can be predicted by HB(ABW) × 1.20-1.43 for critically ill elderly patients according to different BMI groups, or using HB(IBW) × 1.24-1.52 for patients with edema, ascites or no available body weight data.