Hospital In Taiwan Research Articles

Widespread Adoption of Microincision Vitrectomy Surgery Improves Visual Outcomes in Endogenous Endophthalmitis with Poor Initial Vision: A 21-Year Experience in Taiwan

ABSTRACT Purpose To review the presentation and visual prognostic factors of patients with endogenous endophthalmitis before and after the introduction of microincision vitrectomy surgery (MIVS), at a tertiary referral hospital in Taiwan, over a 21-year period. Methods We retrospectively analyzed medical records of patients diagnosed with endogenous endophthalmitis before and after the introduction of MIVS between January 2002 and December 2022. Results Data were collected from 147 patients. Diabetes mellitus was the most common comorbidity (59.9%). Liver abscess (32.7%) was the leading source of infection, followed by urinary tract infection (15.0%), and infective endocarditis (5.4%). Klebsiella pneumoniae (50.4%) was the most common pathogen, followed by Staphylococcus aureus (13.5%), and Candida albicans (8.3%). Poor initial visual acuity worse than counting fingers (CF) (p < 0.001) and diabetes mellitus (p = 0.008) were significantly associated with poor visual outcomes. In the treatment of 98 patients with poor initial visual acuity worse than CF, the proportion of vitrectomy surgeries performed increased from 13/56 (23.2%) to 24/42 (57.1%) (p = 0.001) after the introduction of MIVS. Final visual acuity of CF or better increased from 7/56 (12.5%) to 12/42 (28.6%) after the introduction of MIVS (p = 0.046). Vitrectomy was a better prognostic factor for final visual outcome in patients with poor initial visual acuity of worse than CF (p = 0.011) than other factors. Conclusion In endogenous endophthalmitis patients presenting with poor initial visual acuity, vitrectomy was a better visual prognostic factor. MIVS has allowed more patients to undergo vitrectomy and improved visual outcomes.

Enhancing Robust Liver Cancer Diagnosis: A Contrastive Multi-Modality Learner with Lightweight Fusion and Effective Data Augmentation

This article explores the application of self-supervised contrastive learning in the medical domain, focusing on classification of multi-modality Magnetic Resonance (MR) images. To address the challenges of limited and hard-to-annotate medical data, we introduce multi-modality data augmentation (MDA) and cross-modality group convolution (CGC). In the pre-training phase, we leverage Simple Siamese networks to maximize the similarity between two augmented MR images from a patient, without a handcrafted pretext task. Our approach also combines 3D and 2D group convolution with a channel shuffle operation to efficiently incorporate different modalities of image features. Evaluation on liver MR images from a well-known hospital in Taiwan demonstrates a significant improvement over previous methods. This work contributes to advancing multi-modality contrastive learning, particularly in the context of medical imaging, offering enhanced tools for analyzing complex image data.

An ensemble model for predicting dispositions of emergency department patients

ObjectiveThe healthcare challenge driven by an aging population and rising demand is one of the most pressing issues leading to emergency department (ED) overcrowding. An emerging solution lies in machine learning’s potential to predict ED dispositions, thus leading to promising substantial benefits. This study’s objective is to create a predictive model for ED patient dispositions by employing ensemble learning. It harnesses diverse data types, including structured and unstructured information gathered during ED visits to address the evolving needs of localized healthcare systems.MethodsIn this cross-sectional study, 80,073 ED patient records were amassed from a major southern Taiwan hospital in 2018–2019. An ensemble model incorporated structured (demographics, vital signs) and pre-processed unstructured data (chief complaints, preliminary diagnoses) using bag-of-words (BOW) and term frequency-inverse document frequency (TF-IDF). Two random forest base-learners for structured and unstructured data were employed and then complemented by a multi-layer perceptron meta-learner.ResultsThe ensemble model demonstrates strong predictive performance for ED dispositions, achieving an area under the receiver operating characteristic curve of 0.94. The models based on unstructured data encoded with BOW and TF-IDF yield similar performance results. Among the structured features, the top five most crucial factors are age, pulse rate, systolic blood pressure, temperature, and acuity level. In contrast, the top five most important unstructured features are pneumonia, fracture, failure, suspect, and sepsis.ConclusionsFindings indicate that utilizing ensemble learning with a blend of structured and unstructured data proves to be a predictive method for determining ED dispositions.

Exosomal miRNA Changes Associated with Restoration to Sinus Rhythm in Atrial Fibrillation Patients.

We aimed to identify serum exosomal microRNAs (miRNAs) associated with the transition from atrial fibrillation (AF) to sinus rhythm (SR) and investigate their potential as biomarkers for the early recurrence of AF within three months post-treatment. We collected blood samples from eight AF patients at Chang Gung Memorial Hospital in Taiwan both immediately before and within 14 days following rhythm control treatment. Exosomes were isolated from these samples, and small RNA sequencing was performed. Using DESeq2 analysis, we identified nine miRNAs (16-2-3p, 22-3p, 23a-3p, 23b-3p, 125a-5p, 328-3p, 423-5p, 504-5p, and 582-3p) associated with restoration to SR. Further analysis using the DIABLO model revealed a correlation between the decreased expression of miR-125a-5p and miR-328-3p and the early recurrence of AF. Furthermore, early recurrence is associated with a longer duration of AF, presumably indicating a more extensive state of underlying cardiac remodeling. In addition, the reads were mapped to mRNA sequences, leading to the identification of 14 mRNAs (AC005041.1, ARHGEF12, AMT, ANO8, BCL11A, DIO3OS, EIF4ENIF1, G2E3-AS1, HERC3, LARS, NT5E, PITX1, SLC16A12, and ZBTB21) associated with restoration to SR. Monitoring these serum exosomal miRNA and mRNA expression patterns may be beneficial for optimizing treatment outcomes in AF patients.

Effect of compassion fatigue on emotional labor in female nurses: Moderating effect of self-compassion.

A two-stage survey design with a convenience sample. Participants were female nursing staff recruited from emergency departments, intensive care units, ward nursing units, and outpatient departments of medical centers, regional hospitals, and district hospitals in Taiwan. A total of 300 questionnaire copies in each of the first and second stages were distributed, and 272 pairs of responses were retrieved (valid response rate = 91%). The reliability and validity of the questionnaire were tested, and confirmatory factor analysis was conducted with AMOS 21. The proposed hypotheses were verified using hierarchical regression conducted with SPSS version 25.0. This study revealed that compassion fatigue positively predicted surface acting (β = 0.12, p < 0.05) and negatively predicted deep acting (β = -0.18, p < 0.01) and expression of genuine emotions (β = -0.31, p < 0.01). In addition, self-compassion negatively moderates the relationships between compassion fatigue and surface acting (β = -0.12, p < 0.05), and positively moderates the relationships between compassion fatigue and expression of genuine emotions (β = 0.15, p < 0.01). To avoid excessive consumption of emotional resources, nurses with high compassion fatigue may employ surface acting by engaging in emotional labor without making an effort to adjust their feelings. Nurses need also be sympathized with, and such sympathy can come from hospitals, supervisors, colleagues, and, most crucially, the nurses themselves. Hospital executives should propose improvement strategies that can prevent the compassion fatigue on nurses, such as improving nurses' self-compassion.

Predicting factors for acute encephalopathy in febrile seizure children with SARS-CoV-2 omicron variant: a retrospective study

BackgroundSARS-CoV-2 posed a threat to children during the early phase of Omicron wave because many patients presented with febrile seizures. The study aimed to investigate predicting factors for acute encephalopathy of children infected by SARS-CoV-2 Omicron variant presenting with febrile seizures.MethodsThe retrospective study analyzed data from pediatric patients who visited the emergency department of Chang Gung Memorial Hospital in Taiwan between April and July 2022. We specifically focused on children with COVID-19 who presented with febrile seizures, collecting demographic, clinical, and laboratory data at the pediatric emergency department, as well as final discharge diagnoses. Subsequently, we conducted a comparative analysis of the clinical and laboratory characteristics between patients diagnosed with acute encephalopathy and those with other causes of febrile seizures.ResultsOverall, 10,878 children were included, of which 260 patients presented with febrile seizures. Among them, 116 individuals tested positive for SARS-CoV-2 and of them, 14 subsequently developed acute encephalopathy (12%). Those with acute encephalopathy displayed distinctive features, including older age (5.1 vs. 2.6 years old), longer fever duration preceding the first seizure (1.6 vs. 0.9 days), cluster seizure (50% vs. 16.7%), status epilepticus (50% vs. 13.7%) and occurrences of bradycardia (26.8% vs. 0%) and hypotension (14.3% vs. 0%) in the encephalopathy group. Besides, the laboratory findings in the encephalopathy group are characterized by hyperglycemia (mean (95% CI) 146 mg/dL (95% CI 109–157) vs. 108 mg/dL (95% CI 103–114) and metabolic acidosis (mean (95% CI) pH 7.29(95% CI 7.22–7.36) vs. 7.39 (95%CI 7.37–7.41)).ConclusionsIn pediatric patients with COVID-19-related febrile seizures, the occurrence of seizures beyond the first day of fever, bradycardia, clustered seizures, status epilepticus, hyperglycemia, and metabolic acidosis should raise concerns about acute encephalitis/encephalopathy. However, the highest body temperature and the severity of leukocytosis or C-reactive protein levels were not associated with poor outcomes.

Abstract 5651: Personalized transcriptomic profiling for advanced prostate cancer: Guiding second-generation hormonal drug selection

Abstract Introduction: Second-generation hormonal drugs have demonstrated significant efficacy in extending the survival of patients with advanced prostate cancer. These drugs operate through two distinct molecular mechanisms: inhibition of androgen biosynthesis and blockade of the androgen receptor. However, due to concerns of side effects, concurrent usage of multiple drugs is not recommended. A notable challenge is the eventual development of drug resistance, rendering all second-generation hormonal therapies ineffective. Currently, there is a lack of guidelines for helping patients choose the most suitable drug. In the context of pharmacogenomics, genetic differences can influence drug susceptibility and efficacy, with variations in genomic sequences and regulatory mechanisms impacting drug response at the transcriptional and translational levels. Considered the rapid processing capabilities of Affymetrix transcriptomic microarrays, we hypothesized that distinct gene signatures in patients who respond well or poorly to second-generation hormonal drugs could be identified and could act as a companion diagnostic tool. Methods: We enrolled 180 advanced prostate cancer patients, who fulfilled Taiwan national health insurance criteria of using second-generation hormonal drugs, from seven medical centers or regional hospitals in Taiwan at 3 time points: prior to drug administration, 3 months after treatment started and drug resistance developed. The RNA expression data and clinical parameters were analyzed, and classification models were built using IPA and R. Good or poor responders were defined by 3-month prostate-specific antigen (PSA) lowered by 90 percent. Results:: Differential expression and enrichment analyses post-treatment highlighted the activation of NF-kappa B signaling and various immune cell pathways. Notably, pathways related to primary immunodeficiency and IL-17 became prominent following the development of drug resistance. At the initial stages, distinct alterations in cell cycle pathways, particularly G1/S and G2/M, were observed between good and poor responders. This was elucidated through principal component analysis and subsequent dbscan clustering. To further distinguish between these responder groups, we utilized an integrative approach for feature selection, combining support vector machine, random forest classifier, and lasso regression. Despite the innovative approach, the model's error rate stood at approximately 15%, attributed mainly to the limited number of cases. Conclusion: Our study highlights the potential of using transcriptomic analysis to predict responses to second-generation hormonal drugs in advanced prostate cancer, paving the way for personalized treatment strategies. However, the need for larger cohort studies is evident to refine these predictive models and enhance their accuracy. Citation Format: Li-Hsin Chang, Hao-Han Chang, Xin-Yi Lin, Shu-Chi Wang, Chih-Pin Chuu, Deng-Neng Chen, Shu-Pin Huang, Chia-Yang Li. Personalized transcriptomic profiling for advanced prostate cancer: Guiding second-generation hormonal drug selection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5651.

Abstract 7308: Induction of apoptosis via the regulation of pro-apoptotic and anti-apoptotic proteins in pancreatic adenocarcinoma BxPC-3 cells by Chinese medicinal herbs Scutellaria barbata and Oldenlandia diffusa

Abstract Apoptosis is a controlled program cell death process that the body uses to combat cancer development. Pancreatic cancer is a devastating disease with a poor prognosis. It is usually symptom-free during development and is advanced at diagnosis. BxPC-3 is a pancreatic adenocarcinoma cell derived from a 61-year-old female with adenocarcinoma. Scutellaria barbata (SB) and Oldenlanda diffusa (OD) have been used in traditional Chinese medicine for treating liver, lung, and rectal cancers. They are included in most herbal cancer treatment formulas in Taiwan hospitals. We previously demonstrated that aqueous extracts of SB and OD selectively induced apoptosis in colon HCT 116 cancer cells but not in colon CCD 841 CoN normal epithelial cells by modulating the pro-apoptotic and anti-apoptotic proteins. They also induced and regulated apoptosis in pancreatic ductal carcinoma PANC-1 Cells. This study used the green/red/blue fluorescent Apoptosis/Necrosis Detection Kit and the Human Apoptosis Antibody Array - Membrane [43 Targets] Test (Abcam). Our fluorescent apoptosis data showed that a 2-hour treatment with 1.5 mg/mL and 3.0 mg/mL aqueous extract of SB and OD induced a statistically significant percentage of apoptosis in BxPC-3 cells (SB: 42.5 ± 3.5%, 48.5 ± 0.5% &amp;gt; 14.0% ± 4.0%, p &amp;lt; 0.05; OD: 72.0 ± 2.0%, 37.5 ± 1.5%&amp;gt; 14.0% ± 4.0%, p &amp;lt; 0.05) as compared to the negative control respectively. Similar results were obtained with the 4-hour incubation period (SB: 46.0 ± 8.0%, 54.5 ± 2.5% &amp;gt; 9.5% ± 2.5%, p &amp;lt; 0.05; OD: 49.0 ± 7.0%, 37.0 ± 0.0%&amp;gt; 9.5% ± 2.5%, p &amp;lt; 0.05). From the antibody array-membrane experiments, significant up-regulation of various pro-apoptotic proteins such as Bid, Bim, Bad, Bax, C3, C8, CD40, HTRA, IGFBP-4, IGFBP-4, p53, TNF-α, and TRAIL-2 as compared to the negative controls were observed; and regulation of anti-apoptotic proteins HSP27, IGF-II, and Survivin were also revealed. These results suggest that SB and OD contain phytochemicals that induce apoptosis in pancreatic adenocarcinoma BxPC-3 cells by regulating various apoptotic protein productions. Further study of their specific modulation effects of apoptosis is warranted to reveal their potential chemopreventive and therapeutic properties against pancreatic and other cancers. Citation Format: Christine Choi, Sarah Wolf, Rekha Isaac, Elim Choi, Abigail Shim, Angel Campana, Padma T. Uppala, Ryan Hayes, Brian Yuen Yau Wong. Induction of apoptosis via the regulation of pro-apoptotic and anti-apoptotic proteins in pancreatic adenocarcinoma BxPC-3 cells by Chinese medicinal herbs Scutellaria barbata and Oldenlandia diffusa [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7308.

Are Current Survival Prediction Tools Useful When Treating Subsequent Skeletal-related Events From Bone Metastases?

Are Current Survival Prediction Tools Useful When Treating Subsequent Skeletal-related Events From Bone Metastases?

An Investigation of Patient Preferences and Gender Dynamics of Neurosurgeon Selection in Taiwan: A Mixed-Method Study

ObjectiveTo investigate the influence of gender on patient preferences during the selection of neurosurgeons. MethodsA mixed-method, cross-sectional study was conducted at Linkou Chang Gung Memorial Hospital in Taiwan, involving 60 patients. The study encompassed both structured questionnaires and in-depth interviews, administered post patient-surgeon interactions to assess the nuanced effect of surgeon gender on patient choice. A balanced representation of both genders was ensured among the neurosurgeons involved. Thematic analysis was employed for textual data, while numeric data were analyzed using descriptive and Chi-square statistics. ResultsThe majority of participants (n=40, 66.7%) expressed no preference regarding the gender of their neurosurgeon during outpatient consultations. Nonetheless, a notable fraction, predominantly female, preferred female neurosurgeons (n=20, 33.3%). Statistical analysis highlighted a significant correlation between the gender of the patients and their preferred neurosurgeon's gender, with female patients predominantly favouring female neurosurgeons (p < .05). Qualitative insights indicate that, although professional skill and experience are primary factors in selecting a neurosurgeon, a latent gender preference exists, influenced by perceived privacy, empathetic care, and the surgical finesse associated with female neurosurgeons. ConclusionsAlthough expertise and professionalism are of paramount importance, there is a clear preference for female neurosurgeons, especially among female patients. These findings underscore the importance of recognizing and accommodating patients’ preferences to ensure neurosurgical care aligns with patient comfort, expectations, and the broader movement towards gender equality.

10-Day versus 14-day bismuth quadruple therapy for first-line eradication of Helicobacter pylori infection: a randomised, open-label, non-inferiority trial

Bismuth quadruple therapy is currently consensus recommendation for first-line Helicobacter pylori (H. pylori) treatment; however, the optimal duration is unknown. We compared the efficacy of 10-day bismuth quadruple therapy with that of 14-day bismuth quadruple therapy for first-line eradication. For our multicentre, parallel randomised, open-label, and non-inferiority study, we recruited H.pylori treatment-naïve patients from one medical centre and one teaching hospital in Taiwan. Patients were randomly assigned (1:1) to receive 10-day (PBMT-10) or 14-day (PBMT-14) bismuth quadruple therapy. The primary outcome was the eradication rate as determined by intention-to-treat (ITT) and per-protocol (PP) analyses. The eradication rates between the two groups were compared using a one-sided α value of 0.025 and a non-inferiority margin of 7%. The secondary outcomes were the rate of adverse effects. The trial is registered with ClincialTrials.gov (NCT04527055). From August 3, 2020 to April 28, 2023, 313H.pylori treatment-naïve patients (PBMT-10=157; PBMT-14=156) were enrolled. 35 patients were excluded from PP analyses. The eradication rates (95% CI) for PBMT-10 and PBMT-14 were respectively 92.4% (88.2%-96.5%) and 92.9% (88.9%-97.0%) by ITT analyses, and 97.9% (95.5%-100.0%) and 99.3% (97.8%-100.0%) by PP analyses. The eradication rates for PBMT-10 were non-inferior to those for PBMT-14 (absolute difference [lower boundary of the one-sided 97.5% CI]-0.6% [-6.7%], PNI=0.020 in ITT analyses,-1.4% [-5.8%], PNI=0.007 in PP analyses). The rates of overall adverse effects (54.1% versus 57.1%, P=0.604) were similar between the two groups; nevertheless, the rates of dizziness (18.5% versus 34.0%, P=0.003) and vomiting (4.5% versus 12.8%, P=0.008) were lower in PBMT-10 than in PBMT-14. The 10-day bismuth quadruple therapy was non-inferior to the 14-day therapy as a first-line treatment for eradicating H.pylori infection and had no different rates of overall adverse effects, but less serious adverse events in terms of dizziness and vomiting. The National Science and Technology Council and Ministry of Health and Welfare, Taiwan.

An Approach for Personalized Dynamic Assessment of Chronic Kidney Disease Progression Using Joint Model.

Chronic kidney disease (CKD) poses significant challenges to public health and healthcare systems, demanding a comprehensive understanding of its progressive nature. Prior methods have often fallen short in capturing the dynamic and individual variability of renal function. This study aims to address this gap by introducing a novel approach for the individualized assessment of CKD progression. A cohort of 1042 patients, comprising 700 with stage 3a and 342 with stage 3b to stage 5 CKD, treated at a veteran general hospital in Taiwan from 2006 to 2019, was included in the study. A comprehensive dataset spanning 12 years, consisting of clinical measurements, was collected and analyzed using joint models to predict the progression to hemodialysis treatment. The study reveals that the estimated glomerular filtration rate (eGFR) can be considered an endogenous factor influenced by innate biochemical markers. Serum creatinine, blood pressure, and urinary protein excretion emerged as valuable factors for predicting CKD progression. The joint model, combining longitudinal and survival analyses, demonstrated predictive versatility across various CKD severities. This innovative approach enhances conventional models by concurrently incorporating both longitudinal and survival analyses and provides a nuanced understanding of the variables influencing renal function in CKD patients. This personalized model enables a more precise assessment of renal failure risk, tailored to each patient's unique clinical profile. The findings contribute to improving the management of CKD patients and provide a foundation for personalized healthcare interventions in the context of renal diseases.

Application of a multiplex molecular pneumonia panel and real-world impact on antimicrobial stewardship among patients with hospital-acquired and ventilator-associated pneumonia in intensive care units

BackgroundThe optimal timing for applying the BioFire FilmArray Pneumonia Panel (FAPP) in intensive care unit (ICU) patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) remains undefined, and there are limited data on its impact on antimicrobial stewardship. MethodsThis retrospective study was conducted at a referral hospital in Taiwan from November 2019 to October 2022. Adult ICU patients with HAP/VAP who underwent FAPP testing were enrolled. Patient data, FAPP results, conventional microbiological testing results, and the real-world impact of FAPP results on antimicrobial therapy adjustments were assessed. Logistic regression was used to determine the predictive factors for bacterial detection by FAPP. ResultsAmong 592 respiratory specimens, including 564 (95.3%) endotracheal aspirate specimens, 19 (3.2%) expectorated sputum specimens and 9 (1.5%) bronchoalveolar lavage specimens, from 467 patients with HAP/VAP, FAPP testing yielded 368 (62.2%) positive results. Independent predictors for positive bacterial detection by FAPP included prolonged hospital stay (odds ratio [OR], 3.14), recent admissions (OR, 1.59), elevated C-reactive protein levels (OR, 1.85), Acute Physiology and Chronic Health Evaluation II scores (OR, 1.58), and septic shock (OR, 1.79). Approximately 50% of antimicrobial therapy for infections caused by Gram-negative bacteria and 58.4% for Gram-positive bacteria were adjusted or confirmed after obtaining FAPP results. ConclusionsThis study identified several factors predicting bacterial detection by FAPP in critically ill patients with HAP/VAP. More than 50% real-world clinical practices were adjusted or confirmed based on the FAPP results. Clinical algorithms for the use of FAPP and antimicrobial stewardship guidelines may further enhance its benefits.

Fourteen-year trends in prescribing patterns for patients with bipolar mania discharged from a public psychiatric hospital in Taiwan.

Bipolar disorder is a complex mental illness. Pharmacological therapy, including antipsychotics and mood stabilizers, is the primary treatment approach for manic episode. The study aimed to analyze prescribing patterns over a 14-year period for patients with bipolar mania discharged from a psychiatric hospital in Taiwan. Patients with bipolar mania discharged from the study hospital between 2006 and 2019 (n = 2956) were included in the analysis. Prescribed drugs for the treatment of manic episode, included mood stabilizers (i.e., lithium, valproate, carbamazepine) and any antipsychotics (i.e., second- and first-generation antipsychotics; SGAs & FGAs). Monotherapy, simple polypharmacy, and complex polypharmacy were also examined. Simple polypharmacy was defined as being prescribed 2 different bipolar drugs (lithium, valproate, carbamazepine, and any antipsychotics), while complex polypharmacy at least 3 bipolar drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test. The prescription rates of valproate, SGAs, and complex polypharmacy significantly increased over time, whereas the prescription rates of any mood stabilizers, FGAs, and simple polypharmacy significantly decreased. Prescription rates of lithium and monotherapy did not significantly change. The study highlights the shifts in prescribing practices for bipolar mania. SGAs were prescribed more while FGAs declined, likely due to SGAs' favorable properties. Complex polypharmacy increased, reflecting the complexity of treating bipolar disorder. Long-term outcomes of these changes require further research.

Hematologic and Serum Biochemical Values Associated With Different Stages of Hospital-Acquired Pressure Injuries in Patients: A Retrospective Study.

The primary purpose of this study was to determine whether hematologic and serum biochemical values used as indicators of nutritional status, anemia, and/or infection were associated with the risk of hospital-acquired pressure injuries (PIs) and stage of PIs in patients. A retrospective review of medical records. Data were collected from medical records including official PI records and PI incident reports of inpatients at a teaching hospital in Taiwan between January 2019 and October 2020. We collected demographic variables of the inpatients and their hematologic and serum biochemical values within 1 day of PI occurrence (including the day of PI occurrence), 6 to 7 days before PI occurrence, and 13 to 14 days before PI occurrence. Among the 309 inpatients with official PI records, 105 (34.0%) had Stage 1 PIs, 131 (42.4%) had Stage 2 or 3 PIs, and 73 (23.6%) had unstageable or suspected deep tissue injuries. After controlling for the type of department where PIs occurred and length of hospital stay up to the day of PI occurrence, we found significant differences in levels of hemoglobin (odds ratio [OR] = 0.47, P = .009) within 1 day of PI occurrence and in albumin (OR = 0.30, P = .001) 13 to 14 days before PI occurrence. Study findings suggest that lower hemoglobin levels on the day of PI occurrence and lower albumin levels 2 weeks before PI occurrence resulted in a significantly higher risk of developing unstageable or suspected deep tissue injuries than of developing Stage 1 PIs.

Inflammatory and Nutritional Biomarkers in Patients With Esophageal Squamous Cell Carcinoma Undergoing Neoadjuvant Chemotherapy and Radiation Therapy.

To investigate the relationship between pretreatment inflammatory and nutritional biomarkers in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemotherapy and radiation therapy (nCRT). 213 patients with newly diagnosed stage II-III ESCC who received nCRT at an academic hospital in Taiwan. Electronic health record data were used. Records on inflammatory and nutritional biomarkers and clinical outcomes were extracted. Logistic regression analysis was used to predict treatment-related adverse events, Cox regression was used for survival outcomes, and receiver operating characteristic curve analysis was used to determine optimal cutoff values. There was a significant association between low prognostic nutritional index (PNI) and nCRT toxicities and survival. Advanced cancer stage, high platelet-to-lymphocyte ratio, and occurrence of pneumonia/infection were linked to survival outcomes. PNI shows promise in predicting prognosis, helps identify high-risk patients, and enables nurses to apply tailored interventions.

A comparison of in-hospital stroke and community- onset stroke outcomes after endovascular thrombectomy at a tertiary level hospital in Taiwan

Background: While acute-phase thrombectomy is a recognized treatment for main cerebral artery occlusion, variability exists in outcomes for in-hospital stroke and community-onset stroke patients undergoing endovascular thrombectomy. This study investigates the prognostic differences between in-hospital stroke and community-onset stroke patients in an Asian context, with a focus on the impact of patient transfer processes on treatment outcomes. Methods: Data were collected from in-hospital stroke patients who underwent endovascular thrombectomy in a tertiary medical center between January 2017 and December 2020. Propensity score matching with a ratio of 1:4 was performed to compare in-hospital stroke and community-onset stroke patients based on sex, age, NIHSS, and occluded vessel location. Results: The study included 20 in-hospital stroke and 80 community-onset stroke patients, with no significant difference in successful recanalization rates, complications, mortality rates, and NIHSS and mRS scores between the groups. The community-onset stroke group had longer times to treatment, particularly among transferred patients. A high proportion of in-hospital stroke patients had undergone surgery before their stroke, and a greater incidence of heart failure was noted in this group. Conclusion: Despite pre-stroke surgical treatments and a higher rate of heart failure in in-hospital stroke patients, prompt endovascular thrombectomy resulted in comparable outcomes to community- onset stroke patients. The study underscores the importance of reducing treatment times, especially for transferred patients, to improve stroke care efficacy.

Taiwan Society of Cardiology Heart Failure Registry 2020: Rationale and Design.

Heart failure (HF) is a significant public health problem worldwide. Death and rehospitalization rates are similar across different HF phenotypes. However, the existing Taiwanese HF registries mainly enrolled inpatients with HF and reduced ejection fraction (HFrEF) before 2019, so their results may not apply to outpatients or patients with HF with mildly reduced ejection fraction (HFmrEF) and HF with preserved ejection fraction (HFpEF) phenotypes. The Taiwan Society of Cardiology Heart Failure Registry 2020 is a prospective, multicenter, observational registry that will enroll patients with HF from 27 hospitals in Taiwan between 2020 and 2022 and will be followed for two years. Patients eligible for enrollment include those admitted due to acute decompensated heart failure or outpatients with a history of hospitalization for heart failure within the past six months. The registry will collect patient demographics, medical history, HF diagnosis, medication use, examination results, and comorbidities. The registry plans to enroll 3,370 patients, with the distribution of HFrEF/HFmrEF/HFpEF as 59%/13%/28%. Follow-up intervals will occur every six months for up to two years to monitor clinical outcomes and major cardiac interventions. The registry will conclude in December 2024. The Taiwan Society of Cardiology Heart Failure Registry 2020 is a comprehensive and meticulous effort to demonstrate the epidemiology, adherence to guidelines, clinical outcomes, and disease progression of Taiwanese patients with HF in contemporary clinical practice.

Effectiveness of Pressure Relief Pads in Preventing Bi-Level Positive Airway Pressure- Related Injuries: A Secondary Database Analysis

&lt;p&gt;目的：透過雙相型陽壓呼吸器(BiPAP)通報資料庫分析，探討減壓墊於BiPAP相關壓傷之預防成效。方法：方便取樣南部某區域教學醫院成人內科加護病房之BiPAP通報資料庫，次級資料分析減壓墊於BiPAP相關壓傷之預防成效。結果：減壓墊組的壓傷發生率為6.06%，無減壓墊組為7.78%，兩組無統計顯著差異(p =.5863)。壓傷個案相關變項比較，減壓墊組比無減壓墊組平均延緩21.18小時產生壓傷(p =.8660)，平均減少0.12個壓傷(p =.5501)、減少1.96 cm2的壓傷表面積(p =.7334)，較低的重度壓傷發生風險(risk ratio = 0.44, p =.1666)，然礙於臨床發生壓傷的個案數偏少，故成效比較尚未達顯著差異。結論：兩組比較雖未達顯著差異，但次級資料庫的真實世界數據顯示減壓墊組具有較佳的預防壓傷臨床效益，建議臨床仍可善用減壓墊於預防BiPAP相關壓傷。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;&amp;quot;Purpose: To compare the effectiveness of pressure relief pads in preventing bi-level positive airway pressure-related injuries by analyzing data from a medical reporting database. Methods: The authors took a convenience sample of records from the medical reporting database of the adult medical intensive care unit of a regional teaching hospital in southern Taiwan. Secondary database analysis was employed to examine the effectiveness of pressure relief pads in preventing pressure injuries. Results: The incidence of pressure-related injuries in the pressure relief pads group was 6.06%, whereas the incidence in the no relief pads group was 7.78% (p = .5863). Pressure relief pads delayed the occurrence of pressure injuries by 21.18 hours (p = .8660), reduced the number of pressure injury lesions by 0.12 (p = .5501), reduced the surface area of pressure injuries by 1.96 cm2 (p = .7334), and reduced the risk of severe pressure injury (risk ratio = 0.44, p = .1666). Due to the small number of clinical incident pressure injuries reported, the comparison of effectiveness did not reach statistical significance. Conclusion: Although no significant difference was observed between the two groups, real-world data from the secondary database revealed that the pressure relief pads effectively and safely prevented pressure injuries.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

The impact of the fluconazole trailing effect on the persistence of Candida albicans bloodstream infection when treated with fluconazole

ObjectivesThe trailing effect of Candida species is a phenomenon characterized by reduced but persistent growth at antifungal concentrations above the MIC. We assessed the impact of trailing growth on the persistence of Candida albicans candidemia in patients receiving fluconazole (FLC) therapy. MethodsWe retrospectively investigated candidemia isolates at three hospitals in southern Taiwan between 2013 and 2020. Patients treated with FLC for FLC-susceptible C. albicans candidemia were enrolled. The degree of trailing was determined as the average growth above the MIC divided by the measured growth at the lowest drug concentration using the EUCAST method and classified into four categories: residual (0.1–5%), slight (6–10%), moderate (11–15%), and heavy trailers (>15%). ResultsAmong isolates from 190 patients, the proportions of heavy trailers at 24 hours, 48 hours, and 72 hours were 63.7% (121/190), 63.2% (120/190), and 74.7% (142/190), respectively. Persistent candidemia was observed in 17 (8.9 %) patients. The proportion of persistent C. albicans candidemia in heavy trailing isolates at 48 hours was higher than in isolates without heavy trailing (13.3% [16/120] vs. 1.4% [1/70], p = 0.007). A multivariate analysis showed that immunosuppression (OR = 7.92; 95% CI: 2.38–26.39, p = 0.001), hospitalization days after the index date of C. albicans identification (OR = 1.03; 95% CI: 1.01–1.05, p = 0.011), and heavy trailing isolates at 48 hours (OR = 10.04; 95% CI: 1.27–79.88, p = 0.029) were independent factors for persistent candidemia. DiscussionThe current study revealed that heavy trailing in C. albicans isolates is associated with persistent candidemia in patients receiving FLC treatment.