A simple, organized web-based system improved the transfer efficiency and patient outcomes for endovascular thrombectomy in regional stroke network.

BACKGROUND: Endovascular thrombectomy (EVT) is a time-sensitive treatment for acute ischemic stroke with large vessel occlusion. To optimize transfer efficiency, a web-based platform was introduced in the Tainan Stroke Network (TSN). We assessed its application and effectiveness in regional stroke care. METHOD: This new web-based platform containing a questionnaire-style interface was introduced on October 1, 2021. To assess the transfer efficiency and patient outcomes, acute stroke patients transferred from PSCs to CSC for EVT from April 01, 2020, to December 30, 2022, were enrolled. The patients were classified into the traditional transferal pathway (TTP) group and the new transferal pathway (NTP) group depending on mode of transfer. Patient characteristics, time segments after stroke onset and outcome were compared between groups. RESULT: A total of 104 patients were enrolled, with 77 in the TTP group and 27 in the NTP group. Compared to the TTP group, the NTP group had a significantly shorter onset-to-CSC door time (TTP vs. NTP: 267 vs. 198 min; p = 0.041) and a higher EVT rate (TTP vs. NTP: 18.2% vs. 48.1%, p = 0.002). Among EVT patients, those in the NTP group had a significantly shorter CSC door-to-puncture time (TTP vs. NTP: 131.5 vs. 110 min; p = 0.029). The NTP group had a higher rate of good functional outcomes at 3 months (TTP vs. NTP: 21% vs. 61.5%; p = 0.034). CONCLUSION: This new web-based EVT transfer system provides notable improvements in clinical outcomes, transfer efficiency, and EVT execution for potential EVT candidates without markedly changing the regional stroke care paradigm.

Correction to: Depressive symptom trajectories in the first 10 years of diabetes diagnosis: antecedent factors and link with future disability in Taiwan.

The original article can be found online at.

A Population-Based Cohort Study on the Ability of Acupuncture to Reduce Post-Stroke Depression.

Objective: Post-stroke depression (PSD) is common and has a negative impact on recovery. Although many stroke patients in Taiwan have used acupuncture as a supplementary treatment for reducing stroke comorbidities, little research has been done on the use of acupuncture to prevent PSD. Accordingly, our goal is to investigate whether using acupuncture after a stroke can reduce the risk of PSD. Method: This population-based cohort study examined medical claims data from a random sample of 1 million insured people registered in Taiwan. Newly diagnosed stroke patients in the period 2000-2005 were recruited in our study. All patients were followed through to the end of 2007 to determine whether they had developed symptoms of depression. A Cox proportional hazard model was used to estimate the relative risk of depression in patients after being diagnosed as having had a stroke, with a focus on the differences in those with and without acupuncture treatment. Results: A total of 8487 newly-diagnosed stroke patients were included in our study; of these, 1036 patients received acupuncture more than five times following their stroke, 1053 patients received acupuncture 1-5 times following their stroke and 6398 did not receive acupuncture. After we controlled for potential confounders (e.g., age, sex, insurance premium, residential area, type of stroke, length of hospital stay, stroke severity index, rehabilitation and major illness-related depression), we found that acupuncture after stroke significantly reduced the risk of depression, with a hazard ratio (HR) of 0.475 (95% CI, 0.389-0.580) in frequent acupuncture users and 0.718 (95% CI, 0.612-0.842) in infrequent acupuncture users, indicating that acupuncture may lower the risk of PSD by an estimated 52.5% in frequent users and 28.2% in infrequent users. Conclusions: After we controlled for potential confounders, it appears that using acupuncture after a stroke lowers the risk of depression. Additional strictly-designed randomized controlled trials are needed to better understand the specific mechanisms relating acupuncture to health outcomes.

Parkinson disease and musculoskeletal pain: an 8-year population-based cohort study.

The aim of this study was to evaluate the incidence and clinical features of musculoskeletal pain (MSP) in patients with Parkinson disease (PD) compared with a control group without the disease. The retrospective cohort study used a subset of the Taiwan National Health Insurance Research Database (NHIRD) comprising information on 1 million beneficiaries randomly sampled from the entire population of Taiwan. A total of 490 patients aged 50 and above with newly diagnosed Parkinson disease were identified during a period from 2000 to 2005. Among them, 199 developed MSP after PD. The control group consisted of 1960 participants without PD over the study period randomly selected by matching PD cases according to the date of PD incidence, age, and sex. The study groups were then followed to the end of 2007. Musculoskeletal pain was the end point. The incidence rate ratios of MSP were higher in the PD group than in the control group, representing an adjusted hazard ratio of 1.31 (95% confidence interval 1.09 to 1.58). PD was associated with a significantly elevated risk of MSP in all sex and age stratifications, with the highest hazard ratio noted for middle-aged male patients with PD, followed by older male patients with PD. This study showed that the PD may significantly increase the risk of developing MSP. The risk of developing MSP seems to be greatest for middle-aged male patients with PD. Clinicians should be more alert for MSP in patients with PD, and early intervention should be considered.

Depressive symptom trajectories in the first 10 years of diabetes diagnosis: antecedent factors and link with future disability in Taiwan.

PURPOSE: This study identified depressive symptom trajectories in the years after diabetes diagnosis, examined factors that predict the probability for people following a specific trajectory, and investigated how the trajectories are associated with subsequent disability. METHODS: We drew data from a nationally representative survey in Taiwan to identify adults aged 50 and older diagnosed with diabetes; 487 patients newly diagnosed with diabetes during 1996-2007 were included. Time axis was set to zero when diabetes was first reported in any given wave in the survey, and data related to depressive symptoms after that were recorded. We used group-based semi-parametric mixture models to identify trajectories of depressive symptoms and multinomial logistic regressions to examine factors associated with the trajectories. RESULTS: Older adults with newly diagnosis of diabetes in Taiwan follow different trajectories of depressive symptoms over time. Being female, lower educated, not married/partnered, with lower self-rated health, hospitalizations, more limitations in physical function, less regular exercise before diagnosis, and not regularly using anti-diabetic medication at the beginning of their diagnosis were factors associated with increasing or high stable depressive symptom trajectories. Those who experienced high depressive symptoms were more likely than individuals with stable depressive symptoms to have physical limitations in the last follow-up interview. CONCLUSIONS: Depressive symptom trajectories after diabetes diagnosis were associated with select sociodemographic, health, and lifestyle factors before diagnosis, and also predicted subsequent disability. Risk groups identified in the present study may be used for personalized diabetes care that prevents diabetes-related distress and future disability.

Age-Related Trajectories of Memory Function in Middle-Aged and Older Adults with and without Hearing Impairment.

BACKGROUND: To examine age-related trajectories of memory function associated with hearing status and to explore potential confounding by sociodemographic, physiological, and behavioral factors in that link. METHODS: A national representative sample of Taiwanese adults ≥50 years with and without hearing impairment in 1996 (n = 4,707) were interviewed every 3-4 years until 2007. Cross-sectional and prospective associations between hearing impairment and memory function were determined using multilevel modeling. RESULTS: In bivariate analyses, hearing impairment was associated not only with poor memory function but also with sociodemographic, behavioral and self-rated health status and chronic conditions. These factors, however, did not confound the relationship of hearing impairment with the level or rate of change in the modified Rey Auditory Verbal Learning Test (m-RAVLT) score - hearing impairment increased the age-related differences in the intercept of the memory function by 25.6%, and that the association was significantly greater in older people than in younger people, but hearing impairment was not associated with the slope of the cognitive trajectory over time. CONCLUSION: Hearing impairment and the m-RAVLT score at any point in time may have partially combined pathologic mechanisms with age. The vascular risk covariates we considered might also share the etiological pathways and be part of important prevention strategies for guarding against age-related memory decline in the future.

The Short- and Long-Term Effects of Psychobehavioral Correlates in Buffering Diabetes-Related Cognitive Decline.

BACKGROUND/PURPOSE: The short- and long-term impacts of behavioral and psychological factors on the diabetes and cognitive function relationship are not fully understood. This study examined levels and rates of change in age trajectories of cognitive function in middle-aged and older adults with and without diabetes who participated in different health behaviors. METHODS: Participants aged 53 and above with and without diabetes were drawn from the 1999 Taiwan Longitudinal Study of Aging (N = 4076, mean age 69.3, SD = 9.1). Cognitive function was measured with the 9-item Short Portable Mental Status Questionnaire (SPMSQ) in 1999, 2003, and 2007. Lifestyle and psychosocial variables were measured in 1996, 1999, and 2003 as lagged time-varying covariates in random effects model analyses. RESULTS: Adults with diabetes had significantly lower levels of (ßdiabetes = -.212, p < .001) cognitive function, compared to those without diabetes, net of the effects of key sociodemographic and comorbidity covariates. The addition of exercise, social support, and depressive symptoms to the analytic models reduced the diabetes impact to non-significance. Exercise alone explained 33 % of the variation in the age trajectory. Only diet behavior showed a significant interaction effect with age (ßdiet*age = .011, p < .05). CONCLUSIONS: This population-based longitudinal study provides evidence for the prospective effects of psychobehavioral factors in preserving cognitive function for at least 3 to 4 years in adults with or without diabetes, a result supporting psychoneuroendocrinology studies linking stress and stress hormones to cognitive function, potentially informing treatment options for diabetes care.