Using the Clinical Frailty Scale to Predict the Length of Stay in Otolaryngology Unit in Taiwan

Frailty was a common syndrome in geriatric clinic and general internal medical wards. Some authors had identified the Clinical Frailty Scale (CFS) as a predictor of length of stay in the acute medicine unit. However, the role of the Clinical Frailty Scale in the length of stay in otolaryngology unit had not been well studied. The objective of this study was to find out the correlation of the CFS in elderly patients admitted to otolaryngology unit and their length of stay. A retrospective medical chart review of 203 elderly patients admitted to the otolaryngology ward from January, 2014 to December, 2018 was performed. These patients were hospitalized for treating otorhinolaryngological (ENT) disease or for otorhinolaryngological surgery except for those of ENT related malignancies at Kaohsiung Municipal United Hospital (KMUH). Patients\u27 demographics, CFS scores, Charlson comorbidities Index (CCI), and length of stay (LOS) were recorded. All the participants were divided into three groups: non-frail (CFS 1- 4), mildtomoderately frail (CFS 5- 6), and severely frail (CFS7- 8). Severely frail group had longer lengths of stay (mean= 8.76±0.97 days), comparing to mild to moderate frail group (mean=6.25±0.72 days), and non-frail group (mean= 3.93±0.38 days, p=0.000). For the length of stay stratified by each individual CFS score, it was significant that patients with higher CFS scores had longer lengths of stay (p=.000). The group with higher CFS scores had higher CCI when compared with non-frail group (6.76±1.35 for severely frail, vs. 5.41±1.10 for mild to moderately frail vs. 3.02±0.95 for non-frail, p=0. 000). The use of the CFS for assessment of the elderly patients could help the otolaryngologist to predict the length of stay in otolaryngology unit in Taiwan

Tissue-engineered constructs for urethral regeneration

AbstractThose who have urethral injury, long-distance urethral stricture, hypospadias, or epispadias need tissue for urethral repair. Tissue engineering is one of the solutions for urethroplasty. Three components essential for tissue engineering are cells, scaffolds, and bioactive factors. Several animal studies of tissue-engineered urethras have been conducted and progressed to human clinical trials by 1999. These studies have shown that the maximum distance for normal tissue regeneration in tubularized urethral replacement with unseeded matrices is 0.5cm. Although autologous tissue-engineered tabularized urethras have been successful in clinical trials, this method could be an alternative treatment for urethral reconstruction

Effects of implementation of an online comprehensive antimicrobial-stewardship program in ICUs: A longitudinal study

AbstractBackground/purposeThe long-term effects of antimicrobial-stewardship programs in the intensive care units (ICUs) have not been adequately examined. We evaluated the impact of an online comprehensive antimicrobial stewardship program (OCASP) on the outcomes of patients in 200-bed medical/surgical ICUs over the course of 11 years.MethodsWe analyzed the records of adult patients admitted to ICUs during the 5 years before (n = 27,499) and the 6 years after (n = 33,834) implementation of an OCASP. Antimicrobial consumption, expenditures, duration of treatment, incidence of healthcare-associated infections (HAIs), prevalence of HAIs caused by antimicrobial-resistant strains, and crude or sepsis-related mortality of patients were analyzed. Segmented regression analyses of interrupted time series were used to assess the significance of changes in antimicrobial use.ResultsCompared to the patients in the pre-OCASP period, the patients in the post-OCASP period were older, had greater disease severity, longer ICU stays, and were more likely to receive antimicrobials, but had lower antimicrobial expenditures and crude and sepsis-related mortality. The trend of overall antimicrobial use [slope of defined daily dose/1000 patient-days vs. time) increased significantly before OCASP implementation (p < 0.001), but decreased significantly after implementation (p < 0.01). The administration duration of all classes of antibiotics were significantly shorter (p < 0.001) and the incidences of HAIs were significantly lower (p < 0.001) after implementation. However, there was an increase in the proportion of HAIs caused by carbapenem-resistant Acinetobacter baumannii relative to all A. baumannii infections.ConclusionImplementation of an OCASP in the ICUs reduced antimicrobial consumption and expenditures, but did not compromise healthcare quality

The Information-Leveling Role of Voluntary Disclosure Quality in Facilitating Investment Efficiency

This study examines whether and under what conditions voluntary disclosure quality plays an information-leveling role in facilitating investment efficiency. Measuring voluntary disclosure quality as the (inverse) standard deviation of managers’ prior earnings forecast errors (i.e., management forecast consistency), we document a positive association between management forecast consistency and investment efficiency that strengthens when the information environment becomes more constrained and when there are negative shocks to financial reporting quality. We also find that the management forecast consistency/investment efficiency association strengthens when firms are younger, faster growing, and financially constrained, but not when firms are weakly governed and financially unconstrained, which suggests that voluntary disclosure quality facilitates investment efficiency by mitigating adverse selection (but not moral hazard) frictions. Last, when we employ a changes-based model, we find that increases in management forecast consistency are associated with increases in investment efficiency, which mitigates concerns that voluntary disclosure quality’s empirical link to investment efficiency is purely driven by managers’ inherent forecasting abilities. Overall, we show that voluntary disclosure quality can facilitate investment efficiency when financial reporting and other elements of the information environment are constrained in their ability to mitigate market frictions that impede efficiency

KINETIC AND EMG ANALYSIS OF THE NEW DEDIGN STEPWISE LOADING SYSTEM

The great muscle strength and power are important factors for successful sport performance. Many strength coaches instructed their athletes to move the weight for developing muscle strength. However, most weight training systems consist of lifting a steady load, this having the drawback of nol accounting for the change in strength with the change in muscle length. In order to solve this problem, this study developed a stepwise weight training system using linkage which is capable of increasing the load in isotonic contraction, then compared kinetics and muscle activation between the stepwise contraction and the traditional isotonic contraction. The results showed that both the normalized peak tension and the angle of peak tension of the stepwise contraction were significantly larger than traditional isotonic contraction. The normalized impulse and the integrated EMG of the stepwise contraction was more than traditional isotonic contraction but not reached the significance The findings suggest that stepwise loading system can provide greater stimulus to muscle training effect than traditional weight training systems