Traditional Chinese medicine in patients with osteoarthritis of the knee

AbstractTo evaluate whether the use of traditional Chinese medicine (TCM; 中醫 zhōng yī) influences symptoms or functional outcomes in patients with osteoarthritis (OA) of the knee (膝關節炎 xī guān jié yán).A systematic review of randomized control trials was conducted. Searches for studies in PubMed that were performed between 1965 and August 2013, and retrieved studies were subjected to reference screening. The types of studies included in our review were 1) placebo-based or comparative studies; 2) open label, single-blinded or double-blinded studies; 3) studies evaluating the efficacy of TCM for treating OA of the knee; and 4) studies evaluating only TCM or combination preparations. Trials were conducted with participants over 18 years of age with knee pain and at least three of the following characteristics: 1) an age greater than 50 years; 2) morning stiffness lasting for fewer than 30 min; 3) a crackling or grating sensation; 4) bony tenderness of the knee; 5) bony enlargement of the knee; or 6) no detectable warmth of the joint to the touch. Studies were rated for risk of bias and graded for quality.After screening, 104 studies that satisfied the eligibility requirements were identified, and only 18 randomized control trials were included in the quantitative and qualitative synthesis. Upon review, we found “moderate-quality” evidence of effects from acupuncture (針灸 zhēn jiǔ) on pain, which was measured using a visual analogue scale, and physical function, which was measured using qigong (氣功 qì gōng) with motion. “Low-quality” evidence was found regarding the effects of acupuncture on physical function, and no evidence was found regarding the effects of herbal medicine on pain or physical function. Herbal patches (藥布 yào bù) appeared to affect pain and physical and function, but these effects were not found to be significant.The initial findings included in this review suggest that acupuncture is a promising intervention according to the primary outcome measure, pain, and qigong with motion is an effective method for treating physical function. However, according to the Grades of Recommendation, Assessment, Development, and Evaluation criteria, only moderate-quality evidence was found in these studies. Further rigorous studies are warranted to investigate the application of TCM in treating OA of knee

The prevalence of depressive disorder and its effect on acute exacerbation and mortality in patients with chronic obstructive pulmonary disease (COPD)

背景：慢性阻塞性肺病(COPD)是一個病情複雜、病程較長且合併許多共病症(Comorbidities)的慢性病。自2011年起，共病症已列入COPD治療指引以強調其重要性。然而，憂鬱症對於COPD急性發作及死亡之影響，本土資料仍顯不足。 目的：本研究目的為探討憂鬱症共病症在台灣COPD患者的盛行率及其對於COPD急性發作以及死亡之影響。 材料與方法：本研究為固定世代追蹤研究，資料來源為全民健康保險研究資料庫之「2005年百萬承保抽樣歸人檔(LHID2005)」。COPD之診斷必須符合在2005.1.1至2007.12.31當中，至少【兩次門診就診】或【至少一次住院】之出院診斷前三碼有ICD9-CM code: 491,492,496或A323；排除年紀在40歲以下或120歲以上、排除掉同時合併有氣喘之診斷【ICD-9CM code: 493, 至少兩次門診或一次以上住院診斷前三碼】以及排除掉在2008年1月1日以前死亡之個案。憂鬱症(Depression)共病症的診斷包括輕度憂鬱症及重度憂鬱症， ICD9-CM code：輕度憂鬱症(Minor depression)：300.4,309.0,309.1,311 以及重度憂鬱症(Major depression)：296.2,296.3。共病症之診斷時間為2007.1.1 -2007.12.31期間有門診三次以上或住院一次以上。觀察指標為：有無憂鬱症共病症對於【急性發作(2008.1.1-2008.12.31期間)】以及【死亡(2008.1.1-2011.12.31期間)】之影響。本研究亦使用不同的COPD用藥分組作為校正COPD疾病嚴重度模型，以探討憂鬱症在不同嚴重度的COPD對急性發作以及死亡之影響。整體資料以SAS 9.3版套裝軟體進行資料處理及統計分析。 結果：台灣地區憂鬱症共病症在COPD患者盛行率約為4.1%，遠低於目前大多數文獻研究報導的20-25%，且盛行率並未隨疾病嚴重度增高而上升。憂鬱症的有無並與急性發作之風險(adjusted HR=1.02, 95% CI, 0.77-1.35, p=0.909)以及死亡發生的風險(adjusted HR=1.07, 95% CI, 0.92-1.23, p=0.386)均未達顯著相關，在校正COPD疾病嚴重度後，憂鬱症仍未與急性發作或死亡發生具有顯著相關。 結論：相較於其他COPD常見的共病症，台灣COPD憂鬱症共病症診斷率遠低於其他國家，存在被低估的可能性，因此憂鬱症對於急性發作以及死亡之影響也可能因此而被低估。未來需要進一步結合醫院臨床診療系統進行前瞻性研究，並將憂鬱症評估納入COPD病患常規照護流程。Backgroud: Chronic obstructive pulmonary disease (COPD) is a chronic and complicated disease, which has a longer course and ofen merges many comorbidities. Since 2011, an additional chaper of comorbidities has been included in the COPD treatment guidelines in order to emphasize its importance. However, the impact of depression for COPD acute exacerbations and survival is still insufficient in Taiwan. Purpose: The purpose of current study is to investigate the prevalence of depressive disorder and its influence on the acute exacerbation and survial in patients with COPD in Taiwan. Materials and Methods: From Taiwan’s National Health Insurance Research Database, the Longitudinal Health Insurance Database (LHID) 2005, we collected data from 4 925 patients, including 985 COPD patients with depressive disorder and 3 940 age- and gender- matched (1:4) control COPD subjects without depressive disorder. Patients newly diagnosed as COPD (with more than 2 times of ambulatory visits diagnosed as COPD【ICD-9-CM: 491, 492, 496 or A323】or 1 times hospitalization with major diagnosis of COPD in 2005-2007 were included in the study. COPD patients aged younger than 40 years old or elder than 120 years old and those who have diagnosed as asthma at the same time were excluded. The comorbidity of depressive disorder included major【ICD-9-CM: 296.2,296.3】and minor depression【ICD-9-CM: 300.4, 309.0, 309.1, 311】were identified during the period of 1 Jan to 31 Dec in 2007. The severity of COPD was adjusted by the different formula of prescriptions. Cox proportional hazards model was performed to evaluate whether depressive disorder was the independent risk factors for acute exacerbation (in 2008) and survival (during 2008-2011) in patients with COPD. Results: The prevalence of depression comorbidity in patients with COPD is about 4.1%, which is far below most of the previous study reported in 20-25%. Meanwhile, the prevalence of depression was not in propotional to the severity of COPD. The findings of our study showed that the risk of acute exacerbation in COPD did not reach significant difference between depression and non-depression group (adjusted HR=1.02, 95% CI, 0.77-1.35, p=0.909). In addition, the results alos showed no significant difference in survival in COPD between depression and non-depression group (adjusted HR=1.07, 95% CI, 0.92-1.23, p=0.386). After adjusting the confounding factor of COPD severity, the influence of depressive disorder on the acute exacerbation and survial in COPD still not reached statistical significance. Conclusion: In comparision to the other common comorbidites in COPD, the prevalence of depressive comorbidity in Taiwan is far lower than other countries. COPD with depressive comorbidity did not increase the risk of acute exacerbation and death even adusting the severity of COPD. Whether this result is contributed to be underestimated of depressive comorbidity in COPD in Taiwan remans uncertain. Further investigation may be needed to corroborate the true prevalence of depressive comorbidity and its influence on COPD through intergrated COPD care process

Pulmonary Embolism and Severe Asthma: Case Report and Literature Review

Pulmonary embolism is a life-threatening disease. Its development is generally thought to be due to causes collectively known as the Virchow’s triad. Chronic inflammations are associated with the activation of coagulation and increased risks of venous thromboembolic events. Asthma is one of the chronic inflammatory diseases associated with procoagulants and antifibrinolytic activities in the airways. Coagulation is activated in patients with asthma with the following steps of pathophysiology: Increased tissue factor expression in various cell types, decreased activity of the anticoagulant protein C system and inhibition of fibrinolysis through over-production of plasminogen activator inhibitor type 1 (PAI-1). Asthma is therefore likely a risk factor for pulmonary embolism, especially in those patients with severe disease conditions together with frequent exacerbation. Here we present a case of severe asthma associated with coagulopathy and complicated by massive pulmonary embolism, presented with typical S1Q3T3 on electrocardiography (ECG) and massive thrombosis on computed tomography angiography, successfully treated with directed catheter thrombolytic therapy

Benefits of Cycling Wheelchair Training for Elderly with Physical Disability: A Prospective Cohort Study

Aim: In order to investigate the effect of cycling wheelchair training as an exercise for aged 65+ disabled patients on cognitive function, quality of life, aerobic capacity and physiological parameters. Methods: Participants in nursing home performed cycling wheelchair training for 30 min a day, 5 days a week, for a total of 4 weeks. The main outcome measure was the short form 12 survey (SF-12). Other outcome measures included the Mini-Mental State Examination (MMSE), aero bike work rate test, resting blood pressure, and heart rate. Results: In this study, 41 volunteers were recruited and no participants dropped out of the study voluntarily during training, and no serious adverse effect was identified. Physical and mental component summary total scores of SF-12 were significantly higher after training with statistical significance (p = 0.001). 8 subscales also showed significant improvements after training (p = 0.025 ~ <0.001). Total MMSE score has no difference before and after training. Attention/calculation (p = 0.018), short term memory (p = 0.041), and aerobic capacity (p < 0.001) as measured by subscales of MMSE and aero bike test showed marked improvements, while resting systolic blood pressure (p = 0.931) and heart rate (p = 0.793) did not change. Conclusions: Cycling wheelchair is practical for the disabled elderly to exercise, and a 4-week exercise program enhanced their quality of life and aerobic capacity

Using medication utilization information to develop an asthma severity classification model

Abstract Background Claims data are currently widely used as source data in asthma studies. However, the insufficient information in claims data related to level of asthma severity may negatively impact study findings. The present study develops and validates an asthma severity classification model that uses medication utilization in Taiwan National Health Insurance claims data. Methods The National Health Insurance Research Database was used for the years 2006–2012 and included a total of 7221 patients newly diagnosed with asthma in 2007 for model development and in 2008 for model validation. The medication utilization of patients during the first year after the index date was used to classify level of severity, and the acute exacerbation of asthma during the second through fourth years after the index date was used as the outcome variable. Three models were developed, with subjects classified into four, three, and two groups, respectively. The area under the receiver operating characteristic curve (AUC) and the Kaplan-Meier survival curve were used to compare the performances of the classification models. Results In development data, the distribution of subjects and acute exacerbation rate among the stage 1 to stage 4 were: 62.71%, 5.54%, 22.79%, and 8.96%, and 8.17%, 9.55%, 11.97%, and 14.91%, respectively. The results also showed the higher severity groups to be more prone to being prescribed oral corticosteroids for asthma control, while lower severity groups were more likely to be prescribed short-acting medication and inhaled corticosteroid treatment. Furthermore, the results of survival analysis showed two-group classification was recommended and yield moderate performance (AUC = 0.671). In validation data, the distribution of subjects, acute exacerbation rates, and medication uses among stages were similar to those in development data, and the results of survival analysis were also the same. Conclusions Understanding asthma severity is critical to conducting effective, scholarly research on asthma, which currently uses claims data as a primary data source. The model developed in the present study not only overcomes a gap in the current literature but also provides an opportunity to improve the validity and quality of claims-data-based asthma studies

Using medication utilization information to develop an asthma severity classification model

[[abstract]]Background: Claims data are currently widely used as source data in asthma studies. However, the insufficient information in claims data related to level of asthma severity may negatively impact study findings. The present study develops and validates an asthma severity classification model that uses medication utilization in Taiwan National Health Insurance claims data. Methods: The National Health Insurance Research Database was used for the years 2006-2012 and included a total of 7221 patients newly diagnosed with asthma in 2007 for model development and in 2008 for model validation. The medication utilization of patients during the first year after the index date was used to classify level of severity, and the acute exacerbation of asthma during the second through fourth years after the index date was used as the outcome variable. Three models were developed, with subjects classified into four, three, and two groups, respectively. The area under the receiver operating characteristic curve (AUC) and the Kaplan-Meier survival curve were used to compare the performances of the classification models. Results: In development data, the distribution of subjects and acute exacerbation rate among the stage 1 to stage 4 were: 62.71%, 5.54%, 22.79%, and 8.96%, and 8.17%, 9.55%, 11.97%, and 14.91%, respectively. The results also showed the higher severity groups to be more prone to being prescribed oral corticosteroids for asthma control, while lower severity groups were more likely to be prescribed short-acting medication and inhaled corticosteroid treatment. Furthermore, the results of survival analysis showed two-group classification was recommended and yield moderate performance (AUC = 0.671). In validation data, the distribution of subjects, acute exacerbation rates, and medication uses among stages were similar to those in development data, and the results of survival analysis were also the same. Conclusions: Understanding asthma severity is critical to conducting effective, scholarly research on asthma, which currently uses claims data as a primary data source. The model developed in the present study not only overcomes a gap in the current literature but also provides an opportunity to improve the validity and quality of claims-data-based asthma studies

Using medication utilization information to develop an asthma severity classification model

[[abstract]]Background: Claims data are currently widely used as source data in asthma studies. However, the insufficient information in claims data related to level of asthma severity may negatively impact study findings. The present study develops and validates an asthma severity classification model that uses medication utilization in Taiwan National Health Insurance claims data. Methods: The National Health Insurance Research Database was used for the years 2006–2012 and included a total of 7221 patients newly diagnosed with asthma in 2007 for model development and in 2008 for model validation. The medication utilization of patients during the first year after the index date was used to classify level of severity, and the acute exacerbation of asthma during the second through fourth years after the index date was used as the outcome variable. Three models were developed, with subjects classified into four, three, and two groups, respectively. The area under the receiver operating characteristic curve (AUC) and the Kaplan-Meier survival curve were used to compare the performances of the classification models. Results: In development data, the distribution of subjects and acute exacerbation rate among the stage 1 to stage 4 were: 62.71%, 5.54%, 22.79%, and 8.96%, and 8.17%, 9.55%, 11.97%, and 14.91%, respectively. The results also showed the higher severity groups to be more prone to being prescribed oral corticosteroids for asthma control, while lower severity groups were more likely to be prescribed short-acting medication and inhaled corticosteroid treatment. Furthermore, the results of survival analysis showed two-group classification was recommended and yield moderate performance (AUC = 0.671). In validation data, the distribution of subjects, acute exacerbation rates, and medication uses among stages were similar to those in development data, and the results of survival analysis were also the same. Conclusions: Understanding asthma severity is critical to conducting effective, scholarly research on asthma, which currently uses claims data as a primary data source. The model developed in the present study not only overcomes a gap in the current literature but also provides an opportunity to improve the validity and quality of claims-data-based asthma studies

Prognostic Factors to Predict ICU Mortality in Patients with Severe ARDS Who Received Early and Prolonged Prone Positioning Therapy

Early and prolonged prone positioning (PP) therapy improve survival in advanced ARDS; however, the predictors of mortality remain unclear. The study aims to identify predictive factors correlated with mortality and build-up the prognostic score in patients with severe ARDS who received early and prolonged PP therapy. A total of 116 patients were enrolled in this retrospective cohort study. Univariate and multivariate regression models were used to estimate the odds ratio (OR) of mortality. Factors associated with mortality were assessed by Cox regression analysis and presented as the hazard ratio (HR) and 95% CI. In the multivariate regression model, renal replacement therapy (RRT; OR: 4.05, 1.54–10.67), malignant comorbidity (OR: 8.86, 2.22–35.41), and non-influenza-related ARDS (OR: 5.17, 1.16–23.16) were significantly associated with ICU mortality. Age, RRT, non-influenza-related ARDS, malignant comorbidity, and APACHE II score were included in a composite prone score, which demonstrated an area under the curve of 0.816 for predicting mortality risk. In multivariable Cox proportional hazard model, prone score more than 3 points was significantly associated with ICU mortality (HR: 2.13, 1.12–4.07, p = 0.021). We suggest prone score ≥3 points could be a good predictor for mortality in severe ARDS received PP therapy