Christian Hospital Research Articles

Timely Hospitality and Cholera Care in Mary Seacole’s Wonderful Adventures

Abstract: In Wonderful Adventures of Mrs Seacole in Many Lands (1857), Mary Seacole investigates assumptions about where bodies should be and how they should be treated during times of cholera epidemic, negotiating ideas promoted by race science and maintained within the disciplined orderings of certain nineteenth-century medical spaces. Offering an alternative to these temporal orderings, Seacole revives antiquated formations of medicine, centered on the early Christian hospital, while also drawing upon diasporic knowledge cast outside the bounds of medical modernity. In doing so, Wonderful Adventures illustrates that “progress” does not necessarily entail ethical advancements. Seacole’s hotels, medical praxis, and theories of nature and disease simultaneously borrow from and offer alternatives to the liberal, linear orderings of a history written in European centers of science.

Improving Computer-Aided Thoracic Disease Diagnosis through Comparative Analysis Using Chest X-ray Images Taken at Different Times.

Medical professionals in thoracic medicine routinely analyze chest X-ray images, often comparing pairs of images taken at different times to detect lesions or anomalies in patients. This research aims to design a computer-aided diagnosis system that enhances the efficiency of thoracic physicians in comparing and diagnosing X-ray images, ultimately reducing misjudgments. The proposed system encompasses four key components: segmentation, alignment, comparison, and classification of lung X-ray images. Utilizing a public NIH Chest X-ray14 dataset and a local dataset gathered by the Chiayi Christian Hospital in Taiwan, the efficacy of both the traditional methods and deep-learning methods were compared. Experimental results indicate that, in both the segmentation and alignment stages, the deep-learning method outperforms the traditional method, achieving higher average IoU, detection rates, and significantly reduced processing time. In the comparison stage, we designed nonlinear transfer functions to highlight the differences between pre- and post-images through heat maps. In the classification stage, single-input and dual-input network architectures were proposed. The inclusion of difference information in single-input networks enhances AUC by approximately 1%, and dual-input networks achieve a 1.2-1.4% AUC increase, underscoring the importance of difference images in lung disease identification and classification based on chest X-ray images. While the proposed system is still in its early stages and far from clinical application, the results demonstrate potential steps forward in the development of a comprehensive computer-aided diagnostic system for comparative analysis of chest X-ray images.

Is chest tube omission safe for patients with primary spontaneous pneumothorax scheduled for video-assisted thoracoscopic surgery?

Primary spontaneous pneumothorax (PSP) is a sudden pleural disease predominantly affecting healthy adolescents and young adults, making it a prevalent thoracic disorder within this demographic. This study evaluated the necessity of preoperative chest tube insertion for PSP patients and reassessed current clinical practices. We conducted a retrospective analysis of medical records for individuals aged 14-30 years diagnosed with PSP who underwent video-assisted thoracoscopic surgery (VATS) at Wonju Severance Christian Hospital from January 2016 to December 2022. Patients were categorized retrospectively into two groups based on their initial treatment: Those who had a chest tube inserted and those who did not. We collected and compared clinical data, including demographics, treatment specifics, and outcomes. The study included 128 PSP cases. There was no difference in preoperative clinical data between the two groups, and there were no differences in operation time, number of wedge resections, and number of mechanical pleurodesis. However, the use of single-port surgery was significantly higher in the nonchest tube group (P = 0.001). The nonchest tube group had a significantly shorter hospital stay (P < 0.001), attributed to the absence of preoperative chest tube insertions. There were no significant differences in postoperative complications or recurrence rates between the groups. In young PSP patients, proceeding directly to VATS without prior chest tube insertion in stable individuals does not lead to serious complications or negatively affect outcomes. This approach may offer an effective alternative for PSP management.

Influence of care modes and social resources on psychotropic medication use in community-dwelling dementia patients.

Optimal use of psychotropic medications for people living with dementia is important. By finding potentially modifiable factors, dementia care teams may find solutions to achieve the appropriate use of psychotropic drugs. This study aimed to elucidate patient and caregiver factors associated with the use of psychotropic drugs listed in the potentially inappropriate medications (PIMs) in community-dwelling people with dementia. This cross-sectional study enrolled 808 patients newly diagnosed with dementia, and their caregivers, from a dementia clinic at Changhua Christian Hospital. Patient and caregiver characteristics, care mode, and social resource usage were recorded. Multivariate logistic regression was used to identify factors associated with prescribing psychotropic medications. Of all the participants, 39.1% used at least one of psychotropic medication categorized as PIM. Patients with frontotemporal dementia, with behavior or psychological symptoms, or cared by sole foreign care workers; caregivers with higher depression scores, employed or non-spouse caregivers carried a higher risk of prescription of psychotropic medications listed in PIMs. Psychotropic drug prescriptions are associated with patient and caregiver factors. Therefore, implementing appropriate interventions, especially those targeting potentially modifiable factors, is important to reduce psychotropic medication use.

Attitudes to medication and effects of IBD nursing service among patients with inflammatory bowel disease in Taiwan

AbstractMedication adherence is crucial in inflammatory bowel disease (IBD). This study aimed to evaluate attitudes to medication and the effects of IBD nursing services in a Taiwanese cohort. Sixty four adult patients with IBD were invited to complete a questionnaire at Changhua Christian Hospital between October 2020 and June 2021. All the patients (32 with Crohn's disease and 32 with ulcerative colitis) completed the questionnaire. Regarding medication adherence, most patients were highly or moderately adherent and reported never or sometimes forgetting to take medication (100% for steroids and 90.7% to 91.2% for other medications). Regarding worries about adverse reactions, 38.8%, 40.3%, 12.8%, and 6.1% of patients never or rarely, sometimes, often, and always felt worried about adverse reactions, respectively. Regarding the usefulness of IBD nursing service for disease education, medication education, and scheduling of an outpatient clinic, approximately 10.9% to 12.5% of patients felt useful, and 78.1% felt very useful. Our study showed a higher adherence rate and lower worries about adverse reactions, which may be the effects of IBD nursing service at our institution.

Evaluation of Induced Sputum against Gastric Juice Aspirate in the Diagnosis of Tuberculosis in Children: A Cross-sectional Study

Introduction: Diagnosing Tuberculosis (TB) in children is difficult as they do not expectorate sputum on their own, and the sample is usually paucibacillary. Hence, alternative sampling methods like Gastric juice Aspiration (GA), which is the widely accepted method, and Induced Sputum (IS) collection, a more novel approach, are used. The IS method has several advantages, such as being less invasive, not requiring inpatient admission, causing less discomfort, and not necessitating overnight fasting, compared to the GA method. Aim: To evaluate IS against GA for diagnosing TB using XpertMTB/ RIF assay, as well as mycobacterial culture, in children aged between 2 and 15 years. Materials and Methods: This cross-sectional study was conducted in the Department of Paediatrics at Christian Medical College and Hospital, Vellore, Tamil Nadu, India from June 2019 to March 2020, involving 138 children aged between 2 and 15 years who were being evaluated for TB. GA samples were collected after an overnight fast, and on the same day, atleast two hours later, IS samples were collected by trained staff. Both samples underwent mycobacterial smear and culture using the Mycobacteria Growth Indicator Tube (MGIT) method and Xpert MTB/RIF assay. Confirmation of pulmonary TB was based on atleast one of these tests being positive. The ‘Wong-Baker’ Visual Analogue Scale (VAS) was individually administered to each patient to compare the discomfort associated with GA and IS procedures. The differences in yield between IS and GA were tested for significance using the Two-sample test of proportions with a significance level set at 5%. McNemar's χ2 test was employed to compare matched observations. The MannWhitney test was used for comparing continuous variables, and the Chi-Square test for categorical variables. Cohen’s Kappa (κ) was used to assess interobserver agreement between the sampling methods using the different tests. Results: Out of the 138 cases recruited with suspected pulmonary TB, the diagnosis was microbiologically confirmed in 13 cases (9.4%). The overall diagnostic yield was 12/138 (8.7%) for GA and 10/138 (7.2%) for IS. In children under 10 years, GA outperformed IS with all three cases being positive by GA and none by IS. For those aged 10 years and above, 10 children (100%) tested positive with IS, while nine children (90%) were positive with GA. According to the Wong-Baker VAS measuring discomfort during the procedure, IS was favoured over GA (p-value&lt;0.0001). Conclusion: IS performs similarly or better than GA in children over 10 years, while GA performs better than IS in children under 10 years of age. IS is reported to cause less discomfort than GA on the Wong-Baker VAS.

Effects of 4 mg and 8 mg Dexamethasone Added to Intrathecal Bupivacaine on Perioperative Analgesia Among Adult Orthopedic Patients at Sodo Christian Hospital: A Prospective Cohort Study.

Background: Several adjuvant drugs have been tried to prolong spinal anesthesia block. Currently, dexamethasone appears to be effective in extending the duration of sensory block and enhancing analgesia during surgery. It is unclear, however, whether administering dexamethasone at a dose of 8 mg offers any advantages over administering it at a dose of 4 mg. Objective: To compare the effect of adding 4 and 8 mg dexamethasone to intrathecal bupivacaine on perioperative analgesia among adult orthopedic patients at Sodo Christian Hospital from June 1 to October 31, 2021. Methodology: A total of 178 adult patients undergoing elective orthopedic surgery were randomly assigned to one of the two groups through a prospective cohort research design. A systematic random sampling method was used. For analysis, data were imported into EpiData v.4.6 and exported to SPSS v.25. Levene's test was used to verify homogeneity of variance, whereas the Shapiro-Wilk test was used to assess data distribution. The Mann-Whitney test and the independent sample t-test were employed to compare numerical variables between study groups. Category variables were determined using the chi-square test. p values were deemed statistically significant if they were less than 0.05. Result: Between groups, the perioperative and demographic features were similar. The mean durations of sensory block (347.42 ± 91.06 versus 341.46 ± 68.84), motor block (308.36 ± 80.91 versus 310.84 ± 75.50), and overall analgesia (421.51 ± 121.62 versus 412.40 ± 107.0) minutes did not show a statistically significant difference between the groups. In addition, there was no significant difference (p > 0.05) in postoperative analgesic use, initial analgesia rescue time, or pain severity, as measured by the Numerical Rating Scale (NRS). The addition of dexamethasone did not result in any issues, nor was there a statistically significant difference in the onset time between the two groups. Conclusion: Dexamethasone at a dose of 4 mg extends the duration of sensory, motor, and overall analgesia in a manner similar to that of 8 mg dexamethasone with comparable durations for both the initial analgesic request and overall analgesic use.

The Effectiveness of the Case Manager-Centered Collaborative Care Model with Computer-Assisted Assessment on Quality Indicators for the Care of Dementia.

This study aimed to investigate the influence of case management and its corresponding computer-assisted assessment system on the quality improvement of dementia care. This observational study enrolled 2029 patients and their caregivers at Changhua Christian Hospital in Taiwan. Physicians who made the diagnosis of dementia would introduce the patient and caregiver dyad to the case manager-centered collaborative care team after obtaining agreement. The achievement rates of 11 quality indicators (QIs) comprising timely diagnostic evaluations, regular screens of cognition and neuropsychiatric symptoms, caregiver support, and proper medication prescriptions were counted. Different timeframes (≤4 months, 4 months-1 year, 1-2 years, 2-3 years, or ≥3 years) from diagnosis of dementia to collaborative care intervention were compared. A significantly higher attainment rate was achieved for patients with earlier entry into the collaborative team model, including QIs about timely diagnosis and regular screening, and caregiver support. The QIs regarding dementia medication prescriptions and documentation of the risk of antipsychotics remained similar regardless of the time of entry into the model. The completion rates of QIs also improved after the information system was launched. Physician-case manager co-management in the setting of a collaborative care model with a computer-assisted assessment system helps improve QI achievement for dementia care.

Molecular Characterization of High and Low Virulent Escherichia coli Clinical Strains Isolated from Patients with Urinary Tract Infections with or without Bacteremia in Southern Taiwan.

The most common extraintestinal pathogen and infection site is uropathogenic Escherichia coli (UPEC), which causes urinary tract infections (UTIs). UPEC is also a common pathogen in bloodstream infections; in severe cases, it can lead to death. Although host and bacterial virulence factors have been demonstrated to be associated with UTI pathogenesis, the role of the related contributing factors in UTI and urinary source bacteremia is not yet fully understood. This study aimed to compare and analyze the factors contributing to urinary bacteremia in patients with UTI. A total of 171 E. coli strains collected from patients with UTI and urinary source bacteremia at Chiayi Christian Hospital were used. Phylogenetic groups and virulence factors were determined using PCR. Drug resistance patterns were determined using the disk diffusion assay. Previous studies have demonstrated that fimbriae and papGII may be associated with first-step infections and severe UTIs, respectively. As expected, highly virulent E. coli strains (belonging to the phylogenetic B2 and D groups) were dominant in the bacteremic UTI (90%) and UTI (86.27%) groups. However, our results showed that the UTI group had a significantly higher prevalence of sfa/focDE (belonging to the S and FIC fimbriae) than the bacteremic UTI group (29.4% vs 12.5%; p=0.008). In the bacteremic group, we found that sfa/focDE was only detected in highly virulent strains. The bacteremic UTI group had a significantly higher prevalence of papGII (belonging to P fimbriae) than the UTI group (55.8% vs 37.3%; p=0.026). In addition, the P fimbriae gene cluster, including papC, papEF, and papGII, was predominant in highly virulent strains. Notably, our results show that multidrug-resistant (MDR) strains were significantly less virulent than non MDR strains. Taken together, our results provide insights into the contributing factors in patients with UTI and urinary bacteremia.

Deciphering the complex links between inflammatory bowel diseases and NAFLD through advanced statistical and machine learning analysis

Background and Objective:Accurate classification of liver disease stages provides crucial insights into patient prognosis, aiding in the prediction of disease outcomes and influencing clinical decision-making. There is an urgent need for non-invasive methods to diagnose various stages of liver dysfunction and uncover hidden pattern based on individual disease characteristics. Method:One popular and effective approach is collecting serum biomarker samples. The study was conducted on collected serum biomaker samples of 81 patients with Inflammatory Bowel Disease (IBD) of Changhua Christian Hospital in China, including 36 with Crohn’s disease (CD) and 45 with Ulcerative Colitis (UC) using Latent Semantic Analysis(LSA) and machine learning (ML) techniques.Machine Learning algorithms Random Forest (RF), Logistic Regression (LR), XGBoost (XGB), and Support Vector Classifier (SVC), were utilized to predict liver risk associated with conditions including Hepatitis, Autoimmune Hepatitis (AIH), Alcoholic Liver Disease (ALD), and Non-Alcoholic Fatty Liver Disease (NAFLD). Models’ accuracy was assessed using K-Fold Cross-Validation (CV).Distinct pattern were identified using Latent Semantic Analysis(LSA). Furthermore, SHAP plots were utilized for enhanced interpretability, highlighting essential features for liver dysfunction levels. Results:The inflammatory profile, mixed disease profile, and healthy profile were the three distinct clusters were identified with LSA. The RF model achieved high accuracy of 0.94±0.06. Serum Glutamate Pyruvate Transaminase (GPT), Age at Diagnosis (AAD), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP) were found the most key important features in liver disease staging increment. Conclusion:The research significantly contributes to the fields of biomedical informatics and clinical decision-making. The developed model offers valuable decision-making tools for clinicians, enabling early and targeted interventions.

Artificial intelligence system for the detection of Barrett's esophagus.

Barrett's esophagus (BE), which has increased in prevalence worldwide, is a precursor for esophageal adenocarcinoma. Although there is a gap in the detection rates between endoscopic BE and histological BE in current research, we trained our artificial intelligence (AI) system with images of endoscopic BE and tested the system with images of histological BE. To assess whether an AI system can aid in the detection of BE in our setting. Endoscopic narrow-band imaging (NBI) was collected from Chung Shan Medical University Hospital and Changhua Christian Hospital, resulting in 724 cases, with 86 patients having pathological results. Three senior endoscopists, who were instructing physicians of the Digestive Endoscopy Society of Taiwan, independently annotated the images in the development set to determine whether each image was classified as an endoscopic BE. The test set consisted of 160 endoscopic images of 86 cases with histological results. Six pre-trained models were compared, and EfficientNetV2B2 (accuracy [ACC]: 0.8) was selected as the backbone architecture for further evaluation due to better ACC results. In the final test, the AI system correctly identified 66 of 70 cases of BE and 85 of 90 cases without BE, resulting in an ACC of 94.37%. Our AI system, which was trained by NBI of endoscopic BE, can adequately predict endoscopic images of histological BE. The ACC, sensitivity, and specificity are 94.37%, 94.29%, and 94.44%, respectively.

Assessing the Professional Knowledge of Long Term Care Stations around the Blocks Personnel from the Perspective of Integrated Care for older People (ICOPE): An Example from Puli Christian Hospital

&lt;p&gt;C級巷弄長照站是長者照護的最前端場域，目前整合照護資源及服務素質不齊，影響長照2.0照護之實踐。本文以世衛組織高齡整合照護指南為基準，檢視埔基巷弄長照站現況與人才培育困境。埔基長照站宜再補強的知能包括：建立高齡整合照護的評估系統及追蹤報告，宜增加老人虐待、老人歧視，以及衛生教育技能課程，宜增強制定完整的照顧計畫，以及強化志工服務量。在行政上應加強：應建立長輩一站式整合服務模式、建立正式通報及轉診之服務系統，以及結合多元輔助產品，用於知能教學或服務品質。政府公共政策建議：宜加強照顧服務員之知能；以區域為基礎，盤點可提供之服務，以達公平性服務；提供跨專業整合及全面的照護計畫；鼓勵由下而上發展政策。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The Long Term Care (LTC) Stations around the Blocks is the primary prevention front for the elderly in the community. However, the resources and quality of multidisciplinary integrated care vary. According to the implementation framework of ICOPE, the current ability of the LTC station around the blocks to implement procedures outlined by ICOPE and impediments to staff training are examined in this study. Puli LTC Station staff should enhance their knowledge and skills in various areas, including systematic recruitment and case screening, implementing an ICOPE evaluation system with follow-up tracking, providing new training content on elder abuse and discrimination against the elderly, and improving health education for staff to create comprehensive care plans, expand volunteer recruitment, and increase volunteer training and service hours. Public policy recommendations aim to strengthen care abilities and promote regional equity, to provide integrate interdisciplinary care plans and advocate bottom-up policy development for adaptive service models.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

To study the clinical utility of WHO modified and paperless partograph in the management of labour and its outcome

Early detection of abnormal progress of labour and prevention of prolonged labour significantly improves pregnancy outcomes. Partograph is a simple and important tool which can provide a continuous pictorial overview of labour on a single sheet of paper and is essential to monitor labour. (1) To study the progress of labour using WHO modified partograph in terms of alert line and action line and using paperless partograph in terms of alert and action estimated time of delivery and detect any deviation from normal progress of labour. (2) To evaluate the duration of labour, mode of delivery and perinatal outcome in both the groups.It was a prospective observational study which was conducted over a period of 18months on 200 antenatal patients admitted to the Department of Obstetrics and Gynaecology at Christian Medical College and Hospital, Ludhiana. Antenatal patients with singleton term pregnancy with cephalic presentation in active phase of labour were included in the study. The WHO modified partograph was plotted for 100 cases (Group I) and the paperless partograph was recorded for the other group of 100 patients (Group II) and their outcomes were compared. The p value &amp;#60;0.05 was considered to be significant.In our study we noted that the findings were similar in the WHO modified partograph group and the paperless partograph group in terms of duration of labour, progress of labour, mode of delivery and neonatal outcomes with no statistically significant difference between both the groups.Our study concluded that the paperless partograph is as good as the WHO modified partograph in predicting the labour outcomes and identifying labour abnormalities. The paperless partograph does not need graphical representation and therefore can be adopted as an alternative to the WHO modified partograph in busy labour room settings.

평양의 여성병원

KoangHyoeNyoWon (廣惠女院, Women's Hospital of Extended Grace) was opened in Pyengyang in 1898. I looked into the process of the dispensary's establishment, and some of its medical service activities, its personnel and financial operations, and the history of the changes KoangHyoeNyoWon had undergone.&#x0D; KoangHyoeNyoWon was established in Pyengyang by the WFMS (Woman’s Foreign Missionary Society) to provide medical services for women as an independent medical enterprise. The first attempt to open a women’s clinic failed in 1894, but in 1898, KoangHyoeNyoWon began operations. It built a system of medical services in cooperation with Giholbyeowon (the Hall Memorial Hospital), which was another clinic established by the Methodist Church. In addition, it tried to extend the medical services not only to women and children, but also to the poor and the disabled; therefore, it had the characteristics of a social welfare center. These facts led KoangHyoeNyoWon to rely on the support of the WFMS. The WFMS had provided KoangHyoeNyoWon with manpower, personnel expenses, medicine, medical facilities, and fees for maintenance, fuel, insurance, etc. In addition, the WFMS had covered the cost of rebuilding and reequipping the dispensary.&#x0D; But Jahye Clinic, a colonial medical center, opened in 1910 and competed with KoangHyoeNyoWon, which explains why the dispensary for women had to make changes. By the 1910s, gender discrimination in Joseon had lessened and women were more likely to use hospitals such as Jahye Clinic and Giholbyeowon; at the same time, demands for KoangHyoeNyoWon to become financially independent increased as the financial situation of the WFMS deteriorated. By 1914, there was talk of closing KoangHyoeNyoWon. However, it began to seek solutions to overcome the crisis and to gain financial independence. Several attempts were made to improve medical facilities, support medical education to supply independent manpower, and diversify medical services. Gradually, KoangHyoeNyoWon became a maternity clinic and offered medical care in conjunction with other clinics.&#x0D; In the 1920s, KoangHyoeNyoWon was merged with other hospitals—Giholbyeowon (Methodist Church) and Caroline Memorial Hospital (Presbyterian Church). It resulted from the willingness of the missionary society in Joseon to build a large and strong Christian hospital in order to compete with the colonial and national hospitals that wereexpanding aggressively. As a result, KoangHyoeNyoWon became the women’s ward of the United Christian Hospital. Through the merger, women were able to receive better and more comprehensive medical services, making KoangHyoeNyoWon the best choice for women in need. Now it was time for the question of why and how there should be a women’s clinic.

Analysis of dental traumatic patterns in standing electric scooter-related accidents

BackgroundThere have been several studies about the increasing accident risks and injuries of standing electric scooters, but there is no study about the dental traumatic injuries related with standing electric scooter so far. ObjectivesThe purpose of this study is to report the overall dental traumatic patterns, and compare the patterns of standing electric scooter-related dental trauma with other traumatic causes. Also, considerations about minimizing the risks of electric scooter-related trauma will be discussed. MethodsData on patients who visited Region Trauma Center of Wonju Severance Christian Hospital with dental emergency from January 2020 to December 2022 were collected. ResultsThe crown-root fracture and avulsion occurred significantly higher in electric scooter-related accidents than others. Furthermore, relatively minor dental injuries including concussion and subluxation showed higher percentage to be occurred as combined injuries in electric scooter-related accidents. The prevalence of traumatized posterior teeth was significantly higher in electric scooter-related trauma than others. Most of patients were teenagers and twenties. Also, the electric scooter-related accidents mostly occurred at evening and night. Furthermore, the number of patients wearing a helmet in electric scooter accidents was 1 out of 33. ConclusionThe standing electric scooter-related dental trauma resulted in an increased prevalence of relatively severe dental trauma. Supplementation and reinforcement of the related policies as well as strict enforcement of the laws on electric scooter users will be needed to prevent severe dental and craniofacial trauma.

Acupuncture for ventilator-dependent patients at a hospital-based respiratory care center: A randomized controlled trial

BackgroundIn intensive care units, mechanical ventilation is an important therapy to help patients with dyspnea. However, long-term ventilator dependence would consume huge medical resources and increase the risk of morbidity and mortality. The aim of the study was to examine the efficacy of the acupuncture combined with western medical care on ventilator parameters in ventilator-dependent patients. MethodsIn this clinical trial, 80 ventilator-dependent patients aged 20 to 80 years old were randomly assigned to acupuncture group and control group in the respiratory care center (RCC) of Changhua Christian Hospital. Besides regular medical care and therapy, participants in the acupuncture group received acupuncture therapy at the same 17 acu-points for 20 minutes once a day, a total of 12 sessions. The ventilator parameters were recorded to evaluate the respiratory efficiency for all participants. The primary outcome was rapid shallow breathing index (RSBI), and secondary outcomes were respiratory rate (RR), tidal volume (TV) and ventilation per minute (MV), ResultsThough there was no significant difference in the parameter between the acupuncture group and the control group, we found the trend of decreasing RSBI in the acupuncture group. In subgroup analyses, the mean of RSBI significantly decreased 16.02 (with the SD in 60.84) in acupuncture group, while it increased 17.84 (with the SD in 39.38) in control group (p=0.036) after 12 sessions. ConclusionAcupuncture treatment can improve breathing ability of patients with respirator dependence in respiratory care center.

A pilot study: handgrip as a predictor in the disease progression of SCA3

BackgroundSpinocerebellar ataxia type 3 (SCA3) is an inherited, autosomal, and rare neurodegenerative disease. Serum/plasma biomarkers or functional magnetic resonance imaging used to assess progression, except for neurological examinations, is either inconvenient or expensive. Handgrip strength (HGS) may be considered as a biomarker to predict the progress of SCA3 and align with the alteration of plasma neurofilament light chain (NfL) and Scale for the Assessment and Rating of Ataxia (SARA).MethodsPatients with SCA3 and healthy subjects were recruited from Changhua Christian Hospital. SARA, body mass index (BMI), and NfL were obtained for both groups. HGS was measured using a Jamar Plus + hand dynamometer.ResultsThis study recruited 31 patients and 36 controls. HGS in the SCA3 group revealed a profound decrease (P < 0.001) compared with normal subjects. HGS also had a negative correlation with SARA (r = − 0.548, P = 0.001), NfL (r = − 0.359, P = 0.048), and a positive correlation with BMI (r = 0.680, P < 0.001). Moreover, HGS/BMI ratio correlated with SARA (r = − 0.441, P = 0.013). Controlling for gender and age, HGS still correlated with the above clinical items. The initial hypothesis was also proved in SCA3 84Q transgenic mice, showing grip strength weakness compared to normal mice.ConclusionsHGS can be an alternative tool to assess the clinical severity of SCA3. Further research is needed to investigate the underlying mechanisms.

Addressing the mental health needs of India's aging population: Understanding depression prevalence and social risk factors in tertiary care outpatients.

Depression is a major public health problem among older persons. Identifying the prevalence and recognizing modifiable risk factors of depression in older persons is essential for early diagnosis and appropriate management. Apart from traditional risk factors, medical comorbidities, chronic illness, and social factors can contribute to depression in the older person. This study aimed to estimate the prevalence of depression and identify the medical and social risk factors associated with depression in older persons attending a geriatric outpatient clinic. Consecutive patients aged over 60 years presented to the geriatric outpatient clinic of the Christian Medical College (CMC) and Hospital, Vellore, were screened using the Physical Health Questionnaire-2 (PHQ-2) and Geriatric Depression Scale (GDS). Medical, social, and financial information were collected. Following a detailed clinical interview, the Clinical Interview Schedule-Revised (CIS-R) was administered and the ICD-10 diagnosis of depression was derived. A total of 171 participants were recruited. The prevalence of depression was found to be 53.2% with PHQ-2 and 35.6% with GDS. Using CIS-R, 41.5% had an ICD-10 diagnosis of depression. The risk factors associated with depression in older persons were female gender, financial insecurity, lack of pension, and financial dependence. This study revealed a high prevalence of depression among older persons attending a geriatric outpatient clinic. Financial insecurities, particularly lack of pension or financial dependence, were identified as significant social risk factors for depression. Addressing these risk factors may help prevent the onset or progression of depression, thus improving their quality of life.

Associations between doses of fall-risk-increasing drugs (FRIDs) and falls of hospitalized patients

Falls are a serious public health problem in the aging population because of the associated clinical and socioeconomic impact. Although previous studies have investigated fall-risk-increasing drugs (FRIDs), few studies have focused on dosage among adult inpatients. This study aimed to evaluate associations between fall risk and dosage of different FRIDs classes in hospital inpatients. Inpatients who experienced falls at medical or surgical wards of Changhua Christian Hospital from January 2017 to December 2021 were identified and matched by age, sex, and hospital ward to randomly selected controls (four per case). Anonymous patient data were extracted from the hospital medical data repository, including demographic characteristics, comorbidities, fall-risk scores, and drug prescriptions. Medication dosages were computed using the anatomical therapeutic chemical classification and the defined daily dose system of the World Health Organization. A total of 852 cases and 3408 controls were identified as eligible. Reducing the use of CNS-active medications, administering lower doses of sedative-hypnotics, prescribing sufficient dopaminergic anti-Parkinson agents, and using NSAIDs instead of opioids are imperative in preventing falls among hospitalized patients according to the findings in the study.

Newly diagnosed ANCA-associated vasculitis after COVID-19 infection: a case report

BackgroundAntineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a systemic autoimmune disease characterized by mononuclear cell infiltration and small and medium-sized blood vessel destruction leading to renal failure. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been shown to have the potential to induce the presentation or exacerbation of autoimmune disease. This report describes the clinical features of a case of newly diagnosed ANCA-associated vasculitis after COVID-19 Infection.Case presentationDuring the COVID-19 pandemic, a 67- year-old female Japanese was undergoing treatment for interstitial pneumonia, diabetes mellitus, and hypertension at her local doctor. About 2 months ago, she was diagnosed with COVID-19 and went to a hotel for treatment, and her condition improved. But a month later, after her COVID-19 infection, she presented with a fever and cough and visited Yodogawa Christian Hospital in Osaka, Japan. The reverse transcription-polymerase chain reaction was negative. She underwent extensive radiological and laboratory investigations. Serologies revealed a high perinuclear-ANCA titer with a specific anti-myeloperoxidase antibody titer of 31.7 units/mL. We suspected ANCA-associated vasculitis and performed a renal biopsy. Renal biopsy showed evidence of crescentic glomerulonephritis, which was consistent with ANCA-associated vasculitis. The patient was referred to the Department of Rheumatology and Clinical Immunology for steroid pulse and cyclophosphamide treatment.ConclusionsDelayed screening may lead to progression of the autoimmune disease, so prompt diagnosis is necessary. In this case, we could make an immediate diagnosis and refer the patient to the Department of Rheumatology and Clinical Immunology.