Diagnostic Accuracy of Delirium Assessment Tools in Critical Ill Patients: A Systematic Review and Meta-analysis

Abstract presented at The Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting, 13-15 May 2019, Adelaide, Australi

Association of combination antiretroviral therapy with risk of neurological diseases in patients with HIV/AIDS in Taiwan: a nested case-control study

Heterogeneous neurocognitive impairment remains an important issue, even in the era of combination antiretroviral therapy (cART), with an incidence ranging from 15% to 65%. Although ART drugs with higher penetration scores to the central nervous system (CNS) show better HIV replication control in the CNS, the association between CNS penetration effectiveness (CPE) scores and neurocognitive impairment remains inconclusive. To explore whether ART exposure is associated with the risk of neurological diseases among patients with HIV/AIDS, this study in Taiwan involved 2,571 patients with neurological diseases and 10,284 matched, randomly selected patients without neurological diseases between 2010 and 2017. A conditional logistic regression model was used in this study. The parameters for ART exposure included ART usage, timing of exposure, cumulative defined daily dose (DDD), adherence, and cumulative CPE score. Incident cases of neurological diseases, including CNS infections, cognitive disorders, vasculopathy, and peripheral neuropathy, were obtained from the National Health Insurance Research Database in Taiwan. Odds ratios (ORs) for the risk of neurological diseases were conducted using a multivariate conditional logistic regression model. Patients with a history of past exposure (OR: 1.68, 95% confidence interval [CI]:1.22–2.32), low cumulative DDDs (< 2,500) (OR: 1.28, 95% CI: 1.15–1.42), low adherence (0 < adherence (ADH) ≤ 0.8) (OR: 1.46, 95% CI: 1.30–1.64), or high cumulative CPE scores (>14) (OR: 1.34, 95% CI: 1.14–1.57) had a high risk of neurological diseases. When stratified by classes of ART drugs, patients with low cumulative DDDs or low adherence had a high risk of neurological diseases, including NRTIs, PIs, NNRTIs, INSTIs, and multi-drug tablets. Subgroup analyses also suggested that patients with low cumulative DDDs or low adherence had a high risk of neurological diseases when they had high cumulative CPE scores. Patients with high cumulative DDDs or medication adherence were protected against neurological diseases only when they had low cumulative CPE scores (≤ 14). Patients may be at risk for neurological diseases when they have low cumulative DDDs, low adherence, or usage with high cumulative CPE scores. Continuous usage and low cumulative CPE scores of ART drugs may benefit neurocognitive health in patients with HIV/AIDS

Women with endometriosis have higher comorbidities: Analysis of domestic data in Taiwan

AbstractEndometriosis, defined by the presence of viable extrauterine endometrial glands and stroma, can grow or bleed cyclically, and possesses characteristics including a destructive, invasive, and metastatic nature. Since endometriosis may result in pelvic inflammation, adhesion, chronic pain, and infertility, and can progress to biologically malignant tumors, it is a long-term major health issue in women of reproductive age. In this review, we analyze the Taiwan domestic research addressing associations between endometriosis and other diseases. Concerning malignant tumors, we identified four studies on the links between endometriosis and ovarian cancer, one on breast cancer, two on endometrial cancer, one on colorectal cancer, and one on other malignancies, as well as one on associations between endometriosis and irritable bowel syndrome, one on links with migraine headache, three on links with pelvic inflammatory diseases, four on links with infertility, four on links with obesity, four on links with chronic liver disease, four on links with rheumatoid arthritis, four on links with chronic renal disease, five on links with diabetes mellitus, and five on links with cardiovascular diseases (hypertension, hyperlipidemia, etc.). The data available to date support that women with endometriosis might be at risk of some chronic illnesses and certain malignancies, although we consider the evidence for some comorbidities to be of low quality, for example, the association between colon cancer and adenomyosis/endometriosis. We still believe that the risk of comorbidity might be higher in women with endometriosis than that we supposed before. More research is needed to determine whether women with endometriosis are really at risk of these comorbidities

Strategies to Improve the Knowledge and Clinical Skills for Recognition and Management of Delirium of Critical Care Nurses

Delirium is common among hospitalised individuals, particularly in intensive care units (ICUs). The complications of delirium among critically ill patients can lead to adverse outcomes. Critical care nurses are the frontline professionals providing direct care to critically ill patients. However, critical care nurses in Taiwan did not have adequate training or perform routine delirium assessment in their daily practice. Low awareness of delirium among critical care nurses contributes to a high incidence rate of ICU delirium. Therefore, the overall aim of this doctoral thesis was to develop an ICU-specific delirium care education programme to enhance the knowledge, confidence, competence and clinical performance of critical care nurses in Taiwan

Driving decision-making among older adults with dementia in Taiwan: A longitudinal study

[[abstract]]Background Driving is a complex skill that requires the integration of cognition and motor functions. However, these functions are all impacted by dementia. Aim We investigated the driving status among persons with dementia and the effects of a Dementia and Driving Decision Aid (DDDA) on changes in driving decisions, depressive symptoms and anxiety. Methods A longitudinal study with a 6-month observation was undertaken. Participants were clients in an Integrated Dementia Care Center (IDCC) who were diagnosed with a mild dementia. The primary outcome was changes in driving decisions; secondary outcomes included depressive symptoms, anxiety, and views on the booklet. Data were collected at four time points: baseline (T0), and 1 month (T1), 3 months (T2), 6 months (T3) after implementing DDDA. A logistic regression was used to examine changes in driving decisions, and a repeated-measures ANOVA was adopted to compare changes in secondary outcomes across time. Findings The number of participants who decided to continue driving significantly decreased (p < 0.001), while those who decided to drive less significantly increased (p < 0.001). A significant improvement in depressive symptoms was found in participants over time (F = 9.192; p < 0.001), the mean scores at all post-test time points were lower compared to the baseline measure. Discussion We report successful implementation of a DDDA booklet in an IDCC in Taiwan. In addition, participants’ satisfaction level toward the booklet was high. Conclusion We suggest the DDDA booklet can be widely utilised in community-based dementia care centres

Why has COVID-19 not hit the countries like Nepal yet?

Noble CORONA Virus (COVID-19) is an infectious disease similar form of pneumonia/ SARS-CoV-2- impacting globally. The fear of coronavirus looks pandemic, but its severity is uncertain. Nepal was one of the first nine countries outside of China to report a COVID-19 case. Also, its unpredictability of mode or range of surface, the lifespan of the virus, objects of transmission (a distance of air/air currents, living duration in air, humidity, duration on objects, surface). The first case was found in Wuhan in December 2019 in China. The purpose is to summarize the current information about COVID-19 and to explore in terms of why Nepal is not hitting severely, while other countries are on death toll? We summarized the published articles form the web sources and news, Academic Journals, Ministry of health and population Nepal, WHO/CDC update reports/guidelines, Google search engine. Thematic analysis is made to explore the situation. Although, Nepal has a lack of health services, testing kits, advance lab and protecting equipment (PPE), why COVID-19 does not hit Nepal than China, Europe and North America, it still tremendous uncertainty. Is lockdown, isolation, social distance and quarantine the best ways of prevention? The hypothesis is floating globally – do BCG vaccinated countries are safer than non-user OR due to not having enough kits to screen populations at risk for the virus – while lack of testing a big cause for missing case OR Nepalese have better immune systems? It has attracted global attention. We believe that the COVID-19 is still evolving and it is too early to predict of an outbreak in Nepal. The government needs to increase funding for local health departments, begin planning for future epidemics and be prepared to bolster the economy by supporting consumer spending the midst of a serious outbreak. COVID-19 is a serious health challenge for Nepal, but so far the number of death has been lower than was foretell. It is, therefore essential to carry out more scientific evidence to explore results. Nepalese health services need to maintain up than today and follow lockdown, isolation, social distance and an advance screening test kit through the country

Effectiveness of acupoint pressure on older people with constipation in nursing homes: A double-blind quasi-experimental study

Aims: To compare the differences between acupoint pressure, abdominal massage and laxatives in treatment of constipation for residents in two nursing homes. Background: There is lack of evidence on the utility of complementary therapies in the management of constipation among older adults. Design: Quasi-experimental. Methods: A total of 90 participants from two nursing homes in Taiwan were assigned to three groups: the control group (with laxatives only), group I (with laxatives and abdominal massage) and group II (with laxatives, acupoint pressure therapy [APT] and abdominal massage). The intervention was performed over 10 days. A double-blind technique was applied in both participants and the outcome assessors. Constipation as main outcome was evaluated and recorded for 10 days. Observation of the frequency of defecation and the consistency, particularly firmness of faeces over each 24 hours’ period was recorded. The Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist was utilised in reporting methods and findings. Results: Three variations were revealed as interface factors and showed significant differences in each group. The results showed a statistically significant decrease in constipation in the experimental groups I and II. The scores of defecation frequency, difficulty degree and time of defecation, stool quality and awareness of defecation were obviously improved after treatment. Conclusions: We concluded APT could be used in conjunction with laxatives and must be considered as a long-term intervention. The combination of APT, abdominal massage and laxatives is superior to both abdominal massage with laxatives and laxatives alone. Relevance to clinical practice: Acupoint pressure as an effective complementary therapy of constipation among older adults living in nursing home provides a non-pharmacological, independent nursing intervention that nurses could use. This is relevant to nursing home settings where nurses make autonomous decision on important clinical assessments and interventions