Impact of CYP2R1, CYP27A1 and CYP27B1 genetic polymorphisms controlling vitamin D metabolism on susceptibility to hepatitis C virus infection in a high-risk Chinese population.

CYP27A1, CYP2R1 and CYP27B1 hydroxylases are involved in the synthesis of 1, 25-hydroxyvitamin D3, which plays a role in the immune regulation and pathogenesis of hepatitis C virus (HCV) infection. The aim of the present study was to investigate the relationships between polymorphisms in vitamin D pathway genes and HCV infection outcomes in a Chinese population. Nine single-nucleotide polymorphisms (SNPs) of CYP27A1, CYP2R1 and CYP27B1 were genotyped in a high-risk Chinese population. The distributions of these SNPs were compared among groups with different outcomes of HCV infection, including 863 cases of persistent HCV infection, 524 cases of spontaneous clearance, and 1079 uninfected controls. The results showed that the CYP2R1 rs12794714-G, rs10741657-A, rs1562902-C, and rs10766197-G alleles were significantly associated with increased susceptibility to HCV infection (all PFDR < 0.05, in additive/dominant models), and the combined effect of the four unfavorable alleles was related to an elevated risk of HCV infection in a locus-dosage manner (Ptrend = 0.008). Moreover, haplotype analysis suggested that, compared with the most frequent haplotype (Ars12794714Grs10741657Trs1562902Ars10766197), the haplotype containing four unfavorable alleles, GACG, was associated with a higher risk of HCV infection. The results of our study suggest that genetic variants in CYP2R1 may be biomarkers for predicting the susceptibility to HCV infection in the Chinese population.

[The Promotion of Resources Integration in Long-Term Care Service: The Experience of Taipei City Hospital].

The home-based medical care integrated plan under Taiwan National Health Insurance has changed from paying for home-based medical care, home-based nursing, home-based respiratory treatment, and palliative care to paying for a single, continuous home-based care service package. Formerly, physician-visit regulations limited home visits for home-based nursing to providing medical related assessments only. This limitation not only did not provide practical assistance to the public but also caused additional problems for those with mobility problems or who faced difficulties in making visits hospital. This 2016 change in regulations opens the door for doctors to step out their 'ivory tower', while offering the public more options to seek medical assistance in the hope that patients may change their health-seeking behavior. The home-based concept that underlies the medical service system is rooted deeply in the community in order to set up a sound, integrated model of community medical care. It is a critical issue to proceed with timely job handover confirmation with the connecting team and to provide patients with continuous-care services prior to discharge through the discharge-planning service and the connection with the connecting team. This is currently believed to be the only continuous home-based medical care integrated service model in the world. This model not only connects services such as health literacy, rehabilitation, home-based medical care, home-based nursing, community palliative care, and death but also integrates community resources, builds community resources networks, and provides high quality community care services.

Genetic variations in vitamin D receptor were associated with the outcomes of hepatitis C virus infection among Chinese population.

Vitamin D has been considered as an immune modulator, and exerted the effect through the vitamin D receptor (VDR). This study investigated the associations of single-nucleotide polymorphisms (SNPs) of VDR with the outcomes of Hepatitis C virus (HCV) infection. Three SNPs (rs2228570, rs757343 and rs739837) were genotyped by TaqMan assay among Chinese population, including 538 HCV spontaneous clearance subjects, 834 persistent infection subjects and 1030 uninfected subjects. Binary logistic analyses were used to control the effects of confounding factors. The results showed that subjects with the rs757343 A allele and rs739837 A allele had the significantly reduced risk of HCV susceptibility (all PBonferroni<0.05 in dominant/additive model). In the stratified analysis, the protection of rs757343 A allele and rs739837 A allele against HCV infection remained effective in some subgroups. In addition, patients carrying rs739837 CA genotype were less prone to develop persistent infection (PBonferroni=0.033) and such effect still work in several subgroups in the stratified analysis. Furthermore, haplotype analysis indicated that when compared with the most frequent GC haplotype, the haplotype carrying AA (odds ratio (OR)=0.66, 95% confidence interval (CI)=0.56-0.78) and GA (OR=0.64, 95% CI=0.47-0.85) suggested a protective effect. Our findings indicated that the polymorphisms of VDR are associated with the outcomes of HCV infection among Chinese population.

Human Leukocyte Antigen Class II Alleles Are Associated with Hepatitis C Virus Natural Susceptibility in the Chinese Population.

Human leukocyte antigen (HLA) class II molecule influences host antigen presentation and anti-viral immune response. The aim of this study was to investigate whether single nucleotide polymorphisms (SNPs) within HLA class II gene were associated with different clinical outcomes of hepatitis C virus (HCV) infection. Three HLA class II SNPs (rs3077, rs2395309 and rs2856718) were genotyped by TaqMan assay among Chinese population, including 350 persistent HCV infection patients, 194 spontaneous viral clearance subjects and 973 HCV-uninfected control subjects. After logistic regression analysis, the results indicated that the rs2856718 TC genotype was significantly associated with the protective effect of the HCV natural susceptibility (adjusted OR: 0.712, 95% CI: 0.554-0.914) when compared with reference TT genotype, and this remained significant after false discovery rate (FDR) correction (p = 0.024). Moreover, the protective effect of rs2856718 was observed in dominant genetic models (adjusted OR: 0.726, 95% CI: 0.574-0.920), and this remained significant after FDR correction (p = 0.024). In stratified analysis, a significant decreased risk was found in rs2856718C allele in the male subgroup (adjusted OR: 0.778, 95% CI: 0.627-0.966) and hemodialysis subgroup (adjusted OR: 0.713, 95% CI: 0.552-0.921). Our results indicated that the genetic variations of rs2856718 within the HLA-DQ gene are associated with the natural susceptibility to HCV infection among the Chinese population.

Impacts of COVID-19 pandemic prevention measures to the palliative care in Taiwan.

Background: Prevention measures for palliative care and the provision of discharge planning services for inpatients in Taiwan before and during the COVID-19 pandemic had not been investigated. This study was aimed to investigate the factors associated with heightened palliative care needs and increased mortality rates. Methods: This research adopts a retrospective case-control study design. The investigation encompasses patients admitted before the pandemic (from January 1, 2019, to May 31, 2019) and during the COVID-19 pandemic (from January 1, 2020, to May 31, 2020). The case group consisted of 231 end-of-life inpatients during the pandemic, control group was composed of the pool of inpatients with pre-pandemic and matched with cases by sex and age in a 1:1 ratio. Results: The results showed that the prevalence of respiratory failure symptoms (p = 0.004), residing in long-term care facilities (p = 0.017), palliative care needs assessment scores (p = 0.010), as well as the provision of guidance for nasogastric tube feeding (p = 0.002), steam inhalation (p = 0.003), turning and positioning (p < 0.001), percussion (p < 0.001), passive range of motion (p < 0.001), and blood pressure measurement (p < 0.001). Furthermore, the assessment of the necessity for assistive devices, including hospital beds, also exhibited statistically significant variations (p < 0.001). Further investigation of the factors associated with high palliative care needs and the risk of mortality for both the case and control groups. Risk factors for high palliative care needs encompassed assessments of daily activities of living, the presence of pressure ulcers, and the receipt of guidance for ambulation. Risk factors for mortality encompassed age, a diagnosis of cancer, palliative care needs assessment scores, and the provision of guidance for disease awareness. Conclusion: This research highlights the heightened risk of COVID-19 infection among end-of-life inpatients during the COVID-19 pandemic. The findings of this study may advance care planning to alleviate avoidable suffering. To meet the needs of inpatients during pandemic, healthcare professionals should undergo comprehensive palliative care training and receive policy support.

Self-efficacy, self-care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: A cross-sectional survey.

The relationships between self-efficacy, self-care behavior, anxiety, and depression for Taiwanese individuals with type 2 diabetes were determined in this study. Depression and anxiety are common symptoms that can contribute toward adverse medical outcomes. A descriptive, cross-sectional, correlational design was used. The sample comprised 201 patients with type 2 diabetes from diabetes outpatient clinics at three teaching hospitals in Taiwan. The results of this study revealed that people with diabetes who had received diabetes health education, regularly made clinical visits, underwent treatment, and did not smoke demonstrated a high self-efficacy score (P < 0.05). Self-efficacy among people with diabetes positively correlated with illness duration (P < 0.05), treatment (P < 0.01), and self-care behavior (P < 0.01). Self-efficacy among people with diabetes negatively correlated with anxiety and depression (P < 0.01). Self-efficacy can be a predictor of anxiety and depression (P < 0.01). This study revealed that enhancing self-efficacy levels might reduce anxiety and depression. Self-efficacy-enhancing programs should be held regularly in clinical practices. Conducting psychological research on diabetes drives policy and healthcare system change.

Effectiveness of a community-based health promotion program targeting people with hypertension and high cholesterol.

The purpose of this study was to evaluate the effectiveness of a community-based health promotion program targeting people with hypertension and high cholesterol. A pre-experimental study was conducted. A total of 60 residents were recruited to participate. Participants were assessed at baseline and at a 6 month follow up at a regional hospital in northern Taiwan. The questionnaires used for data collection consisted of an assessment of self-efficacy, self-care activities, health outcomes, and physical fitness. Several teaching resources were used, including a DVD, a self-care booklet, group support (exercise and counseling sessions), and telephone follow up. A significant decrease in waist circumference (t = 2.20, P = 0.03) and high density lipoprotein-cholesterol level (t = 4.71, P < 0.00) was found at follow up. Moreover, the level of physical fitness activity, and sit-ups specifically (t = 3.10, P < 0.00), was increased. Participants also showed significant increases between baseline and 6 month follow up in their efficacy expectation score (t = -5.81, P < 0.00), outcome expectation scores (t = -4.76, P < 0.00) and self-care behavior scores (t = -2.78, P = 0.007). The community-based health promotion program is an effective means of helping people with hypertension and high cholesterol and should be instituted regularly and evaluated in clinical practice.

Self-efficacy, professional commitment, and job satisfaction of diabetic medical care personnel.

The purpose of this study was to investigate the relationships among the self-efficacy, professional commitment, and job satisfaction of diabetic health-care personnel. The research design was cross-sectional. Three teaching hospitals, one from each of northern, middle and southern parts of Taiwan, were selected for data collection and used questionnaires to collect data; 202 participants were recruited. The demographic data for job title and job satisfaction were not significantly different (F = 2.13, P = 0.090). Self-efficacy was significantly positively correlated with professional commitment (r = 0.29, P = 0.000) and with job satisfaction (r = 0.14, P = 0.041). A total of 34.1% of the variance in job satisfaction was explained by age, years of service in the medical or nursing field, the actual number of years caring for patients with diabetes, self-efficacy, and professional commitment. Understanding the self-efficacy and professional commitment of medical and nursing personnel can help increase job satisfaction and improve the quality of medical and nursing care.

Effects of an osteoarthritis self-management programme.

AIM: The aim of this study was to assess the effectiveness of a self-management programme among osteoarthritis knee sufferers. BACKGROUND: Osteoarthritis of the knee is a major cause of loss of function and is common in the older people. A self-management programme is an effective way to increase arthritis self-efficacy, and helps with mastering self-management practices. METHOD: This study was carried out from January 2008 to December 2008 and included 205 participants, with 114 in the intervention group and 91 in the control group. The 4-week trial was followed by an 8-week follow-up assessment. The outcome measures included assessments of arthritis self-efficacy, pain beliefs, unplanned medical consultations, pain days and disability days using the Mann-Whitney U-test and Friedman test. FINDINGS: At post-intervention, significant differences were found in pain beliefs (P<0·001) and pain days (P<0·004). At 8-week follow-up, there was a significant improvement in arthritis self-efficacy: pain and other symptoms subscales (P<0·001 and 0·049, respectively), pain beliefs (P<0·001) and number of unplanned medical consultations (P<0·010). CONCLUSION: The study supports the hypothesis that a self-management programme enhances arthritis-related self-efficacy and pain beliefs. A decrease in the number of unplanned medical consultations, pain days and disability days suggests that the programme might help reduce healthcare costs. This programme has introduced a significant result about self-efficacy and self-management to a chronic disease population in Taiwan. In short, there were great beneficial effects on self-management among persons who are affected by knee osteoarthritis.

Development of the Readiness for Home-Based Palliative Care Scale (RHBPCS) for Primary Family Caregivers.

In Chinese or Eastern society, most end-of-life (EOL) patients still choose to die at home. However, primary family caregivers usually do not prepare themselves to face the death of patients. Therefore, a measurement of the readiness for home-based palliative care for primary family caregivers is needed. In this study, the readiness for home-based palliative care scale (RHBPCS) for primary family caregivers was developed to assess the readiness of primary family caregivers. This study recruited 103 participants from five branches of one municipal hospital system. The reliability and validity of the RHBPCS was evaluated using expert validity examination, confirmatory factor analysis (CFA), and item analysis. The results showed that the RHBPCS had strong goodness-of-fit and good reliability and validity. In summary, the RHBPCS is suggested for assessing the readiness for home-based palliative care of primary family caregivers.

The Life Experiences Among Primary Family Caregivers of Home-Based Palliative Care.

BACKGROUND: An increasing number of patients with terminal illnesses prefer to die in their own homes due to aging, high medical payments, a limited number of hospitalization days, and the ability to receive care from family members. However, few studies have been conducted on the subjective perception and value of caregivers for home-based palliative care (HBPC). OBJECTIVE: To identify common themes and topics of primary family caregivers' lived experiences with HBPC when taking care of terminally ill family members. METHODS: We conducted audio-recorded transcripts of one-on-one in-depth interviews of primary family caregivers of HBPC. Through a purposive sampling method, the participants were all interviewed; these interviews were transcribed verbatim and analyzed using a grounded theory approach. RESULTS: A total of 22 primary family caregivers participated in the study. "Wholeheartedly accompanying one's family to the end of life at home" was the core category. Six main themes describing caregivers' experiences emerged from the interviews: (1) learning the basic skills of end-of-life home care, (2) arranging the sharing and rotation of care, (3) preparing for upcoming deaths and funerals, (4) negotiating the cultural and ethical issues of end-of-life home care, (5) ensuring a comfortable life with basic life support, and (6) maintaining care characterized by concern, perseverance, and patience. CONCLUSIONS: Primary family caregivers of HBPC need support and must learn home care skills by means of the holistic approach. It is crucial to establish assessment tools for caregivers' preparedness for HBPC, including biopsychosocial and cultural considerations.

Impact of the COVID-19 Pandemic on the Utilization of Hospice Care Services: A Cohort Study in Taiwan.

CONTEXT: Hospice care focuses on improving the quality of end-of-life care and respecting patients' preferences regarding end-of-life treatment. The impact of coronavirus disease 2019 (COVID-19) on the utilization of hospice services is unknown. OBJECTIVES: To investigate the utilization of hospice care services before and during the COVID-19 pandemic. METHODS: All patients (n = 19,900) cared for at Taipei City Hospital from January 2019 to April 2020 were divided into three time points: January-April 2019 (before COVID-19), May-December 2019 (interim), and January-April 2020 (during COVID-19). This cohort study compared the monthly utilization of hospice services before and during the COVID-19 pandemic. RESULTS: There was no significant difference in hospice home visits (194 vs. 184; P = 0.686) and new enrollments (15 vs. 14; P = 0.743) to hospice home care before and during the pandemic. However, the bed occupancy rate in hospice units in the hospital was significantly reduced from 66.2% before the pandemic to 37.4% during the pandemic (P = 0.029), whereas that in nonhospice units had a nonsignificant decrease from 81.6% before the pandemic to 71.8% during the pandemic (P = 0.086). During the pandemic, the number of inpatient days was affected more severely in hospice units than in nonhospice units (-42.4% vs. -10.9%; P = 0.029). CONCLUSIONS: This study suggests that hospice home care services were maintained during the COVID-19 pandemic, while the utilization of hospice inpatient care services reduced. Home care for hospice patients is an essential component of palliative care during a pandemic.

Health-promotion interventions enhance and maintain self-efficacy for adults at cardiometabolic risk: A randomized controlled trial.

OBJECTIVES: To investigate whether a community-based intervention program, based on self-efficacy theory, might improve older adults' self-care behaviors as well as health outcomes related to hypertension and dyslipidemia. METHODS: This randomized controlled trial was conducted in Taipei, Taiwan, From October 16, 2011 to July 31, 2014. Residents identified during community screening for the over 50 s were invited to participate if their blood pressure was 120-139/80-89 mmHg, high-density lipoprotein cholesterol was <40 mg/dL (men) or <50 mg/dL (women), or low-density lipoprotein cholesterol was 130-159 mg/dL. The intervention group participated in a special health promotion program; the control group received conventional health education. Participants' demographic and anthropometric data were recorded, and each completed semi-structured questionnaires about hypertension and cholesterol management, and gave blood samples for biochemical analyses before the intervention and 6 months after it ended. RESULTS: From 90/98 eligible subjects who enrolled, 84 completed the study: 41/43 and 43/47 respectively in intervention and control groups. Body mass index, blood pressure, hyperglycemia, and high-density lipoprotein cholesterol in the intervention group improved significantly from baseline. The Self-Efficacy Scale (P = 0.020), Self-Care Activities Questionnaire (P = 0.014) and Perceived Therapeutic Efficacy Scale (P = 0.023) scores improved significantly. CONCLUSION: This health promotion intervention program enhanced self-efficacy among older adults, with sustained effect through 6-months' follow-up. These findings are consistent with studies that evaluated the effect of a diabetes education program on self-efficacy. The beneficial effect on a population at high-risk for hypertension and hypercholesterolemia, may serve as a model for developing and implementing such interventions.

Ink-jet patterning of graphene by cap assisted barrier-guided CVD.

Barrier-guided CVD growth could provide a new route to printed electronics by combining high quality 2D materials synthesis with scalable and cost-effective deposition methods. Unfortunately, we observe the limited stability of the barrier at growth conditions which results in its removal within minutes due to hydrogen etching. This work describes a route towards enhancing the stability of an ink-jet deposited barrier for high resolution patterning of high quality graphene. By modifying the etching kinetics under confinement, the barrier film could be stabilized and high resolution barriers could be retained even after 6 hours of graphene growth. Thus produced microscopic graphene devices exhibited an increase in conductivity by 6 orders of magnitude and a decrease in defectiveness by 48 times yielding performances that are superior to devices produced by traditional lithographical patterning which indicates the potential of our approach for future electronic applications.

CYP24A1 genetic variants in the vitamin D metabolic pathway are involved in the outcomes of hepatitis C virus infection among high-risk Chinese population.

BACKGROUND AND AIMS: It has been demonstrated that 1,25-hydroxyvitamin-D3-24-hydroxylase, encoded by CYP24A1 gene, is a key enzyme that neutralizes the active vitamin D3 metabolite 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] in response to hepatitis C virus (HCV) infection. This study aimed to investigate whether CYP24A1 genetic variation is associated with HCV infection outcomes. METHODS: 848 HCV chronically infected subjects, 507 natural clearance subjects, and 1017 uninfected controls were enrolled. Nine single nucleotide polymorphisms (SNPs) in theCYP24A1 gene were genotyped using the Sequenom MassARRAY platform. RESULTS: After adjusting for age, gender, and routes of infection, logistic regression analyses showed that rs6013897-A was associated with an elevated risk of HCV infection (P<0.05). In addition, this study has also demonstrated that rs6068816-T significantly reduced the risk of chronic HCV infection, while rs3787557-C, rs6022999-G, and rs2248359-T significantly increased the risk of chronic HCV infection (all P<0.05). Haplotype analysis suggested that, compared to the most frequent Trs6068816Trs3787557Ars6022999Crs2248359 haplotype, the CTGT haplotype (adjusted OR=1.376, 95% CI=1.092-1.735, P=0.007) and CCAC haplotype (adjusted OR=1.483, 95% CI=1.139-1.929, P=0.003) were associated with an increased risk of chronic HCV infection. CONCLUSION: These findings indicate that SNPs in CYP24A1 gene may contribute to the risk of HCV infection and chronic HCV infection among a high-risk Chinese population.

Vitamin D binding protein polymorphisms influence susceptibility to hepatitis C virus infection in a high-risk Chinese population.

Vitamin D binding protein (VDBP) plays an important role in the immune modulation and pathogenesis of hepatitis C viral (HCV) infection by influencing serum vitamin D levels. The present study aims to evaluate the association of VDBP genetic polymorphisms with susceptibility to and chronicity of HCV infection in a high-risk Chinese population. Seven genetic variants in the VDBP gene were genotyped in a case-control study of 886 patients with HCV persistent infection, 539 subjects with spontaneous clearance, and 1081 uninfected controls. Logistic regression analysis was used to assess the effects of these variants on HCV infection outcomes. The results showed that two variants rs7041-G and rs3733359-T alleles were significantly associated with increased susceptibility of HCV infection, and the combined effect of the two unfavorable alleles was related to an elevated risk of HCV infection in a locus-dosage manner (Ptrend = 8.16 × 10-4). Interaction analysis manifested that rs7041-GT/GG and rs3733359-CT/TT jointly increased risk of HCV infection. Moreover, haplotype analysis suggested that compared with the most frequent TC haplotype, the haplotype carrying GT indicated a risk effect of HCV infection [odds ratio (OR) = 1.464]. However, no significant associations were observed for the other five variants. These findings implied that VDBP rs7041-G and rs3733359-T variants may contribute to increased susceptibility to HCV infection in a high-risk Chinese population.

An Empirical Study on the Successful Implementation of Nursing Information System.

This study investigated the major NIS implementation factors and their capability of predicting the effectiveness of NIS implementation by using the clinical information systems success model. The triangulation method was employed in this study. A total of 348 nurses were recruited from regional hospitals in two districts of Taipei through purposive sampling. Research data were collected through questionnaires and focus group interviews 3 and 6 months after an NIS was implemented at their hospital. The result show the explanatory power of use dependence, use satisfaction, and net benefits in predicting NIS effectiveness was approximately 64.5%-89.4%. The explanatory power of net benefits in predicting NIS effectiveness after 3 and 6 months exceeded 80%. The nurses reported that NIS implementation changed their workflow and positively influenced medication administration safety. This study empirically identified the critical factors that affect the successful implementation of NISs and reported the nurses' experience of NIS use.

The effectiveness of a self-management program on quality of life for knee osteoarthritis (OA) patients.

PURPOSE: To evaluate the effectiveness of the Taipei Osteoarthritis Program (TOAP) for community elderly persons who suffer from knee OA. METHODS: A quasi-experimental study was conducted between January 2008 and December 2008. Two hundred and five community-dwelling individuals aged 67±10 years with knee OA were recruited from four districts in Taipei City and randomized. By a clustered randomization according to the districts, 114 participants were in the intervention group (IG) with a 4-week TOAP program and 91 participants were in the control group (CG) with routine care. The main outcome measures included health-related quality of life (HRQOL) and disability level, which were assessed by the Short Form-36 Taiwan Version (T-SF36) and the Western Ontario McMaster Universities Arthritis Index Taiwan Version (T-WOMAC), respectively, and were repeatedly measured at the baseline, post invention (4 weeks after baseline), and follow-up (8 weeks after baseline). RESULTS: Subjects in the IG increased their changes of GH scores from baseline to post-intervention and follow-up, which were significantly more than those of subjects in the CG (p=0.011 and 0.005, respectively). Significant difference of changes was also found at follow-up for the mental component scale between the groups (p=0.013). There was no change in disability level. CONCLUSIONS: The arthritis self-management program improved the psychological outcomes among the participants, but it had no significant effect on a self-reported disability level.

Integrated care for severely disabled long-term care facility residents: is it better?

The demands of long-term care facilities (LTCFs) residents are complex which usually require a range of professionals and caregivers to provide treatment and care. To reduce this fragmentation of care, integrated care models are developed in modern health care system, and a gradual change from traditional LTCF care to integrated care has occurred in many countries. Although integrated care is assumed to improve the quality of care, evidences supporting these effects are insufficient. We recruited 7 private LTCF (74 residents) in northern Taipei and randomized them into integrated care model (N=42, mean age=82.8+/-8.0 years, 54.8% males) and traditional model (N=32, 81.7+/-8.8 years, 43.8% males). Integrated care model group was provided an actively working interdisciplinary team in addition to traditional nursing and personal care in traditional model group. Physical function, nutritional status and several quality indicators (unplanned feeding tube replacement, unplanned urinary catheter replacement, pneumonia, urinary tract infection and so on) were compared with both groups. Overall, LTCF residents in the integrated care model group showed significant improvement in serum levels of albumin (3.78+/-0.32 vs. 3.60+/-0.45, p=0.004) and hemoglobin (12.62+/-1.58 vs. 12.03+/-1.24, p=0.004) during the study period. Among selected quality indicators, subjects in integrated care model group were similar to traditional model group except that integrated care model group had a significantly reduced unplanned feeding tube replacement rate. In conclusion, the clinical effectiveness of integrated care model among severly disabled LTCF residents is minimal and a further cost-effectiveness study is needed to promote optimal quality of care in this setting.