Recommended assessment and management of sleep disordered breathing in patients with atrial fibrillation, hypertension and heart failure: Taiwan Society of Cardiology/Taiwan Society of sleep Medicine/Taiwan Society of pulmonary and Critical Care Medicine joint consensus statement.

Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients.

Comparison between COPD Assessment Test (CAT) and modified Medical Research Council (mMRC) dyspnea scores for evaluation of clinical symptoms, comorbidities and medical resources utilization in COPD patients.

BACKGROUND: The 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed a new severity assessment system for emphasizing clinical symptom evaluation by COPD Assessment Test (CAT) or modified Medical Research Council (mMRC) dyspnea scores. The aim of the study was to evaluate the effectiveness of two scoring systems in evaluating COPD patients. METHODS: A population based cross-sectional study employing computer-assisted telephone interviewing system (CATI) for surveying the epidemiology of COPD in Taiwan. Among 6600 subjects recruited (age > 40), 404 subjects (6.1%) were diagnosed as COPD. The comorbidities, COPD-related symptoms, health care resources utilization were compared between CAT and mMRC. RESULTS: There were significant differences in all co-morbidities, symptom severity in favor of CAT as compared to mMRC. When comparing health care resources utilization, CAT and mMRC have equal effectiveness in evaluating patients with regular medical treatment. There were significant differences in emergency room visit and hospitalization in favor of mMRC. However, CAT was more effective in evaluating patients with ICU admission (P = 0.005). CONCLUSION: Compared with CAT and mMRC, there are individual benefits in the evaluation of clinical symptoms, co-morbidities and medical resources utilization for ER, hospitalization and ICU admission in COPD patients.

Late chronotype and high social jetlag are associated with burnout in evening-shift workers: Assessment using the Chinese-version MCTQshift.

Chronotypes are associated with shift work tolerance and sleep in shift workers, and sleep mediates the impact of shift work on mental health. However, the role of chronotype in the association between shift work and mental health has not been clarified. In this study, we aimed to examine the association between chronotype and burnout in shift workers, using the validated Munich ChronoType Questionnaire for shift workers (MCTQshift). A total of 288 shift workers with irregular shift frequencies were recruited and completed the Chinese-version MCTQshift and the Morningness-Eveningness Questionnaire (MEQ). Chronotypes were assessed by the calculation of corrected mid-sleep time (MSFSC) from mid-sleep time on free days (MSF) based on their exact shift schedules. Another 26 evening-shift nurses were monitored with actigraphy for at least two consecutive evening shifts and the following two free days. Burnout was evaluated using the Copenhagen Burnout Inventory. We found that MSFESC, MSFE and mid-sleep time on workdays (MSWE) had normal distributions and correlated significantly with MEQ scores (r = - 0.47, -0.45 and -0.47, respectively; all p < 0.001). MSW was more closely correlated with actigraphy-derived mid-sleep time on the free day before workdays than that on workdays (r = 0.61 and 0.48, respectively, p < 0.05). Sleep duration was significantly longer on workdays among evening-shift workers who slept late on workdays than those who slept early (ß = 0.59, p < 0.001). After demographic and work characteristics were adjusted for in linear regression models, late chronotype and high social jetlag were associated with burnout scores in evening-shift workers. In conclusion, the Chinese-version MCTQshift is a valid tool for chronotype assessment. Interventions to improve sleep in shift workers should be tailored to chronotype due to variations in sleep behavior. Late chronotype may be an inherent feature of mental health problems, because the association with burnout was significant in both day workers in previous studies and shift workers.

COPD in Taiwan: a National Epidemiology Survey.

OBJECTIVES: To determine the prevalence of COPD in Taiwan and to document the disease characteristics and associated risk factors. METHODS: We conducted a random cross-sectional national survey of adults older than 40 years in Taiwan. Respiratory health screening questions identified subjects with diagnosed COPD or whose reported symptoms also fulfilled an epidemiological case definition; these were eligible to complete the survey, which also included indices of symptom severity and disability and questions on comorbidities, medical treatments, smoking habits, and occupations potentially harmful to respiratory health. Subjects with diagnosed COPD were subdivided by smoking status. Subjects who fulfilled the case definition of COPD and smoked were designated as "possible COPD". Participants who did not fit the case definition of COPD were asked only about their personal circumstances and smoking habits. Data from these groups were analyzed and compared. RESULTS: Of the 6,600 participants who completed the survey, 404 (6.1%) fulfilled the epidemiological case definition of COPD: 137 with diagnosed COPD and 267 possible COPD. The most common comorbidities of COPD were hypertension or cardiovascular diseases (36.1%). Subjects with definite COPD had significantly higher COPD Assessment Test scores than the possible COPD group (14.6±8.32 vs 12.6±6.49, P=0.01) and significantly more comorbid illnesses (P=0.01). The main risk factors contributing to health care utilization in each COPD cohort were higher COPD Assessment Test scores (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.04-1.26), higher modified Medical Research Council Breathlessness Scale scores (OR 1.97, 95% CI 1.11-3.51), and having more than one comorbidity (OR 5.19, 95% CI 1.05-25.61). CONCLUSION: With estimated prevalence of 6.1% in the general population, COPD in Taiwan has been underdiagnosed. Symptoms and comorbidities were independent risk factors for health care utilization in subjects with definite or possible COPD. There is an urgent need to raise awareness of the importance of early evaluation and prompt treatment for subjects with chronic airway symptoms.

A psychometric assessment of the St. George's respiratory questionnaire in patients with COPD using Rasch model analysis.

BACKGROUND: The St. George's Respiratory Questionnaire (SGRQ) was a widely used tool to assess disease impact on patients with obstructive airways disease. Although traditional methods have generally supported construct validity and internal consistency reliability of SGRQ, such methods cannot facilitate the evaluation of whether items are equivalent to different individuals. The purpose of this study is to rigorously examine the psychometric properties of the SGRQ in patients with chronic obstructive pulmonary disease (COPD) using Rasch model analysis. METHODS: A methodological research was conducted on SGRQ in a sample of 240 male patients with COPD recruited from the outpatient services in Central Taiwan. The psychometric properties of the SGRQ were examined using Rasch model analysis with a mixed rating scale and partial credit mode by Winsteps software. The level of matching between the item's difficulty and person's ability was analyzed by item-person targeting as well as ceiling and floor effects. Item-person maps were also examined for checking the location of the item's difficulty and person's measures along the same scale. Finally, the differential item functioning (DIF) was examined to measure group equivalence associated with age and disease's severity. RESULTS: Each of the three domains (Symptom, Activity, Impact) of the SGRQ was found to be unidimensionality. The person separation index ranged from 1.21 (Symptom domain) to 2.50 (Activity domain). There was a good targeting for the SGRQ domains, except the Impact domain (1.36). The percentage of ceiling and floor effects were below 10%, except the ceiling effect in the Impact domain (26.25%). From item-person maps, gaps of location of item corresponded to patient's ability were identified. The results have also showed that many items in SGRQ revealed age or severity related DIF. CONCLUSIONS: Except the Symptom domain of SGRQ, the others have a reliabile internal consistency and a good hierarchical structure. The results of Rasch model analysis can highlight aspects for scale improvement, such as gap, duplicate items or scale responses. There was some age or severity related DIF indicating somewhat unstable across different characteristics of group. IRB No.: DMR94-IRB-179.

Dynamic flow US, color Doppler US, and power Doppler US in the assessment of vessel signals of thoracic lesions abutting pulsatile organs.

RATIONALE AND OBJECTIVES: Dynamic flow ultrasound (DFUS) is a new color Doppler imaging method with better B-mode imaging and fewer blooming effects and color noises. This study was designed to compare the imaging quality of vessel signals in thoracic lesions using DFUS, color Doppler US (CDUS), and power Doppler US (PDUS). MATERIALS AND METHODS: Thirty-four patients with thoracic lesions abutting pulsatile organs [heart (n = 13), aorta (n = 14) and pulmonary artery (n = 7)] and undergoing complete chest US examinations were included to assess the imaging quality about vessel signals, blooming effect, color noise, and the influence of decision in needle biopsy between different US modes. RESULTS: Our results showed that DFUS, CDUS, and PDUS could all demonstrate the vessel signals clearly (all P > .05). However, when focusing on the blooming effect and color noise, DFUS showed the more superior imaging quality than CDUS and PDUS (all P < or = .001); and acceptable blooming effects/color noise were found with 100% (34/34)/97% (33/34), 35% (12/34)/68% (23/34), and 26% (9/34)/38% (13/34) in DFUS, CDUS, and PDUS, respectively. Especially, in the assessment of decision making for percutaneous needle biopsy, DFUS had the less influence than CDUS and PDUS (3% [1/33] versus 29% [10/34] and 3% [1/33] versus 38% [13/34], both P < .01). CONCLUSIONS: We concluded that DFUS has a clearly more superior imaging quality than CDUS and PDUS in demonstrating the vessel signals of thoracic lesions, with less blooming effect and color noise.

Pigtail tube drainage in the treatment of spontaneous pneumothorax.

We report our experience in using pigtail tube drainage in the treatment of spontaneous pneumothorax compared with traditional chest tube thoracotomy. One hundred two patients were included and analyzed. Fifty patients were treated with the pigtail tube and 52 patients were treated with the traditional chest tube. The extubation time, mean hospital stay, evacuation rate, and total cost were similar without a significant statistical difference. Among the chest tube group, 15 underwent surgical intervention as a result of delayed resolution and hemopneumothorax; and among the pigtail group, 15 had other procedures for pneumothorax, including chest tube insertion and surgical intervention. This verifies our initial suspicion that the effectiveness of the pigtail drainage system is no less than that of the chest tube. Therefore, when considering ambulatory ability and good patient compliance, the pigtail tube drainage system can be considered as the treatment of choice for spontaneous pneumothorax.