Performance evaluation on the implementation of Pre-established Medical Processes for nurse practitioners in the hospitals

In 2015, Taiwan announced the establishment of “Pre-established Medical Processes” and related regulations to assist nurse practitioners in the clinical tasks, maintain medical quality and patient safety, and provide protection in clinical practice. However, the effectiveness of implementation still needs to be improved and strengthened. This study adopts the TAM and the TTF as the research framework, and a cross-sectional design. The questionnaires are administered to the professional nurse practitioners in the hospitals of central Taiwan. A total of 300 questionnaires were distributed, and Smart PLS 3.0 and SPSS 24.0 were both applied to verify interpretability. The questionnaire recovery rate was 88.3%, and the overall predictive power was 65.2%. Technological characteristics and TTF had a significant impact on perceived usefulness

The Effectiveness of Traditional Chinese Medicine in Treating Patients with Leukemia

Leukemia is the most common malignancy among all childhood cancers and is associated with a low survival rate in adult patients. Since 1995, the National Health Insurance (NHI) program in Taiwan has been offering insurance coverage for Traditional Chinese Medicine (TCM), along with conventional Western medicine (WM). This study analyzes the status of TCM utilization in Taiwan, in both pediatric and adult patients with leukemia. A retrospective cohort study was conducted using population-based National Health Insurance Research Database of Registry of Catastrophic Illness, involving patient data from 2001 to 2010 and follow-up data through 2011. The effectiveness of TCM use was evaluated. Relevant sociodemographic data showed that both pediatric and adult patients who were TCM users one year prior to leukemia diagnosis were more likely to utilize TCM services for cancer therapy. A greater part of medical expenditure of TCM users was lower than that of TCM nonusers, except little discrepancy in drug fee of adult patients. The survival rate is also higher in TCM users. Altogether, these data show that TCM has the potential to serve as an adjuvant therapy when combined with conventional WM in the treatment of patients with leukemia

Herb-Drug Pharmacokinetic Interaction of a Traditional Chinese Medicine Jia-Wei-Xiao-Yao-San with 5-Fluorouracil in the Blood and Brain of Rat Using Microdialysis

According to a survey from the National Health Insurance Research Database (NHIRD), Jia-Wei-Xiao-Yao-San (JWXYS) is the most popular Chinese medicine for cancer patients in Taiwan. 5-Fluorouracil (5-FU) is a general anticancer drug for the chemotherapy. To investigate the herb-drug interaction of JWXYS on pharmacokinetics of 5-FU, a microdialysis technique coupled with a high-performance liquid chromatography system was used to monitor 5-FU in rat blood and brain. Rats were divided into four parallel groups, one of which was treated with 5-FU (100 mg/kg, i.v.) alone and the remaining three groups were pretreated with a different dose of JWXYS (600, 1200, or 2400 mg/kg/day for 5 consecutive days) followed by a combination with 5-FU. This study demonstrates that 5-FU with JWXYS (600 mg/kg/day or 1200 mg/kg/day) has no significant effect on the pharmacokinetics of 5-FU in the blood and brain. However, JWXYS (2400 mg/kg/day) coadministered with 5-FU extends the elimination half-life and increases the volume of distribution of 5-FU in the blood. The elimination half-life of 5-FU in the brain for the pretreatment group with 2400 mg/kg/day of JWXYS is significantly longer than that for the group treated with 5-FU alone and also reduces the clearance. This study provides practical dosage information for clinical practice and proves the safety of 5-FU coadministered with JWXYS

High ERCC1 expression predicts cisplatin-based chemotherapy resistance and poor outcome in unresectable squamous cell carcinoma of head and neck in a betel-chewing area

<p>Abstract</p> <p>Background</p> <p>This study was to evaluate the effect of excision repair cross-complementation group 1(ERCC1) expression on response to cisplatin-based induction chemotherapy (IC) followed by concurrent chemoradiation (CCRT) in locally advanced unresectable head and neck squamous cell carcinoma (HNSCC) patients.</p> <p>Methods</p> <p>Fifty-seven patients with locally advanced unresectable HNSCC who received cisplatin-based IC followed by CCRT from January 1, 2006 through January 1, 2008. Eligibility criteria included presence of biopsy-proven HNSCC without a prior history of chemotherapy or radiotherapy. Immunohistochemistry was used to assess ERCC1 expression in pretreatment biopsy specimens from paraffin blocks. Clinical parameters, including smoking, alcohol consumption and betel nuts chewing, were obtained from the medical records.</p> <p>Results</p> <p>The 12-month progression-free survival (PFS) and 2-year overall survival (OS) rates of fifty-seven patients were 61.1% and 61.0%, respectively. Among these patients, thirty-one patients had low ERCC1 expression and forty-one patients responded to IC followed by CCRT. Univariate analyses showed that patients with low expression of ERCC1 had a significantly higher 12-month PFS rates (73.3% vs. 42.3%, p < 0.001) and 2-year OS (74.2 vs. 44.4%, p = 0.023) rates. Multivariate analysis showed that for patients who did not chew betel nuts and had low expression of ERCC1 were independent predictors for prolonged survival.</p> <p>Conclusions</p> <p>Our study suggest that a high expression of ERCC1 predict a poor response and survival to cisplatin-based IC followed by CCRT in patients with locally advanced unresectable HNSCC in betel nut chewing area.</p

Self-supervised learning-based general laboratory progress pretrained model for cardiovascular event detection

The inherent nature of patient data poses several challenges. Prevalent cases amass substantial longitudinal data owing to their patient volume and consistent follow-ups, however, longitudinal laboratory data are renowned for their irregularity, temporality, absenteeism, and sparsity; In contrast, recruitment for rare or specific cases is often constrained due to their limited patient size and episodic observations. This study employed self-supervised learning (SSL) to pretrain a generalized laboratory progress (GLP) model that captures the overall progression of six common laboratory markers in prevalent cardiovascular cases, with the intention of transferring this knowledge to aid in the detection of specific cardiovascular event. GLP implemented a two-stage training approach, leveraging the information embedded within interpolated data and amplify the performance of SSL. After GLP pretraining, it is transferred for TVR detection. The proposed two-stage training improved the performance of pure SSL, and the transferability of GLP exhibited distinctiveness. After GLP processing, the classification exhibited a notable enhancement, with averaged accuracy rising from 0.63 to 0.90. All evaluated metrics demonstrated substantial superiority (p < 0.01) compared to prior GLP processing. Our study effectively engages in translational engineering by transferring patient progression of cardiovascular laboratory parameters from one patient group to another, transcending the limitations of data availability. The transferability of disease progression optimized the strategies of examinations and treatments, and improves patient prognosis while using commonly available laboratory parameters. The potential for expanding this approach to encompass other diseases holds great promise.Comment: published in IEEE Journal of Translational Engineering in Health & Medicin

Deep Learning-based Fall Detection Algorithm Using Ensemble Model of Coarse-fine CNN and GRU Networks

Falls are the public health issue for the elderly all over the world since the fall-induced injuries are associated with a large amount of healthcare cost. Falls can cause serious injuries, even leading to death if the elderly suffers a "long-lie". Hence, a reliable fall detection (FD) system is required to provide an emergency alarm for first aid. Due to the advances in wearable device technology and artificial intelligence, some fall detection systems have been developed using machine learning and deep learning methods to analyze the signal collected from accelerometer and gyroscopes. In order to achieve better fall detection performance, an ensemble model that combines a coarse-fine convolutional neural network and gated recurrent unit is proposed in this study. The parallel structure design used in this model restores the different grains of spatial characteristics and capture temporal dependencies for feature representation. This study applies the FallAllD public dataset to validate the reliability of the proposed model, which achieves a recall, precision, and F-score of 92.54%, 96.13%, and 94.26%, respectively. The results demonstrate the reliability of the proposed ensemble model in discriminating falls from daily living activities and its superior performance compared to the state-of-the-art convolutional neural network long short-term memory (CNN-LSTM) for FD

Maximizing Science Outreach on Facebook: An Analysis of Scientists’ Communication Strategies in Taiwan

The internet, and especially social media platforms, offer scientists new opportunities to connect with a broader public. While many studies have focused on science communication on Twitter, surprisingly few have analyzed how scientists use Facebook, even though it is an essential platform for the general public in many countries. A possible explanation for this lack of research is that scientists keep their Facebook profiles separate from their work life and are more active on Twitter in their professional roles. Our study challenges this assumption by focusing on Taiwan as a peculiar case. Due to the local culture, Twitter is less popular there, and scientists are more active on Facebook, even in their professional roles. In our study, we analyzed 35 public pages of scientists on Facebook and assessed the factors explaining the reach of their communication using content analysis in combination with a multilevel model that allowed us to test predictors on the page level, such as the number of fans, in combination with predictors on the post level, such as the complexity of the language used. Our study shows that Facebook can play an influential role in science outreach. To effectively communicate with the audience on Facebook, it is best to use strategies that appeal to new and existing followers. Posts that address current issues and include opinions are likely to be shared widely, while humor or personal self-disclosure is likely to engage the existing audience. Our study contributes to the current debate about alternatives to Twitter in science communication

ATP-Binding Cassette Transporter VcaM from Vibrio cholerae is Dependent on the Outer Membrane Factor Family for Its Function.

Vibrio cholerae ATP-binding cassette transporter VcaM (V. cholerae ABC multidrug resistance pump) has previously been shown to confer resistance to a variety of medically important drugs. In this study, we set to analyse its properties both in vitro in detergent-solubilised state and in vivo to differentiate its dependency on auxiliary proteins for its function. We report the first detailed kinetic parameters of purified VcaM and the rate of phosphate (Pi) production. To determine the possible functional dependencies of VcaM on the tripartite efflux pumps we then utilized different E. coli strains lacking the principal secondary transporter AcrB (Acriflavine resistance protein), as well as cells lacking the outer membrane factor (OMF) TolC (Tolerance to colicins). Consistent with the ATPase function of VcaM we found it to be susceptible to sodium orthovanadate (NaOV), however, we also found a clear dependency of VcaM function on TolC. Inhibitors targeting secondary active transporters had no effects on either VcaM-conferred resistance or Hoechst 33342 accumulation, suggesting that VcaM might be capable of engaging with the TolC-channel without periplasmic mediation by additional transporters. Our findings are indicative of VcaM being capable of a one-step substrate translocation from cytosol to extracellular space utilising the TolC-channel, making it the only multidrug ABC-transporter outside of the MacB-family with demonstrable TolC-dependency