Publications by authors named "Yue-Cune Chang"

153 Publications

Explore the Effects of Pharmacological, Psychosocial, and Alternative /Complementary Interventions in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Meta-regression Approach.

Int J Neuropsychopharmacol 2021 Jun 4. Epub 2021 Jun 4.

Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.

Background: Till now, there have been various therapies for attention-deficit/hyperactivity disorder (ADHD), but the previous meta-analysis of ADHD efficacy remains unclear. This study aims to systemically meta-regress the effect sizes of psychostimulant pharmacotherapy (methylphenidate and lisdexamfetamine), non-stimulant pharmacotherapy (atomoxetine and alpha-2 agonists), psychosocial therapy (parental behavioral therapy [PBT]), combination therapy (psychostimulant plus PBT), and alternative/complementary interventions to determine the right treatment for ADHD.

Methods: We searched various ADHD interventions from the MEDLINE and PubMed databases (National Center for Biotechnology Information) between January 1, 1980 and July 30, 2018. Following the meta-analysis of random effects, the meta-regression analyses were used to explore factors potentially influencing treatment efficacy. The confounding variables included type of treatment, type of study, age, type of symptom scale used, and year of publication.

Results: A total of 107 trials (N = 9883 participants) were included. After adjustment, compared to the psychostimulant therapy (28 trial, 2134 participants), non-stimulant pharmacotherapy (28 trials, 4991 participants) and alternative/complement intervention (25 trials, 1195 participants) were less effective by the effect sizes (ES) of -0.384 (p = 0.004) and -0.419 (p = 0.028) respectively. However, compared to psychostimulant, PBT (19 trials, 1122 participants; ES = -0.308, p = 0.095) and combination of psychostimulant and PBT (7 trials, 441participants; ES = -0.196, p = 0.209) did not differ significantly.

Conclusions: Psychostimulant therapy surpassed non-stimulant pharmacotherapy and alternative/complement intervention. Psychostimulant therapy, PBT, and combination of psychostimulant therapy and PBT appear to be similar in efficacy according to this meta-regression.
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http://dx.doi.org/10.1093/ijnp/pyab034DOI Listing
June 2021

Hypoperfusion of the infrapatellar fat pad and its relationship to MRI T2* relaxation time changes in a 5/6 nephrectomy model.

Sci Rep 2021 May 11;11(1):9924. Epub 2021 May 11.

Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan.

The purpose of present study was to longitudinally investigate the alterations in infrapatellar fat pad (IPFP) vascularity in 5/6 nephrectomized rats by using dynamic contrast enhanced (DCE) MRI and IPFP degeneration by using MRI T2* relaxation time. Twelve male Sprague-Dawley rats were assigned to a control group and a 5/6 nephrectomy CKD group. The right knees of all rats were longitudinally scanned by 4.7 T MRI, and serial changes in the IPFP were assessed at 0, 8, 16, 30, and 44 weeks by DCE-MRI (parameters A, k and k) and MRI T2* mapping. After MRI measurements, knee specimens were obtained and evaluated histologically. The CKD group had IPFPs with lower blood volume A and lower permeability k values from 16 weeks (p < 0.05), lower venous washout k value from 30 weeks (p < 0.001), and significantly higher T2* values reflecting adipocyte degeneration beginning at 16 weeks (p < 0.05). The histopathological results confirmed the MRI findings. Hypoperfusion and adipocytes degeneration related to CKD were demonstrated in a rodent 5/6 nephrectomy model. DCE parameters and MRI T2* can serve as imaging biomarkers of fat pad degeneration during CKD progression.
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http://dx.doi.org/10.1038/s41598-021-89336-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8113578PMC
May 2021

Psychometric properties and development of the competency inventory for Taiwanese nurse managers across all levels.

J Nurs Manag 2021 Apr 25. Epub 2021 Apr 25.

Deputy Chief Strategy Officer, Taipei City Hospital, Taipei, Taiwan.

Aims: To describe the development and psychometric testing of the competency inventory for nurse managers across all levels in Taiwan.

Background: The competency-based approach to develop nursing leadership and management competencies for the health care context is still insufficiently explored in terms of professional development in nursing administration.

Methods: This study used mixed methods, including qualitative study for generating the preliminary inventory and a cross-sectional survey of 573 nurse managers for psychometric properties of the inventory.

Results: Exploratory factor analysis revealed four domains with 23 items that explained 58.21% of the overall variance. The overall Cronbach's alpha coefficient was 0.93. Confirmatory factor analysis showed a well-fitting goodness-of-fit statistics. The construct validity was adequate, with an average variance extracted of 0.68 and composite reliability of 0.90.

Conclusions: Across different levels, nurse managers have 23 essential competencies. The competency inventory demonstrates adequate psychometric properties with good construct validity and internal consistency, thereby reliable and valid for guiding the competency development of nurse managers.

Implications For Nursing Management: The essential competencies of the inventory serve as a criterion-referenced measurement for competence proficiency in professional development of nursing administration and contribute to performance improvement of nurse managers in practice.
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http://dx.doi.org/10.1111/jonm.13344DOI Listing
April 2021

Effectiveness of Theory-Based Health Information Technology Interventions on Coronary Artery Disease Self-Management Behavior: A Clinical Randomized Waitlist-Controlled Trial.

J Nurs Scholarsh 2021 07 12;53(4):418-427. Epub 2021 Apr 12.

Lambda Beta-at-large, Associate Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan.

Purpose: Secondary prevention of coronary artery disease, self-management behavior, and blood pressure control are important to cardiovascular event prevention and promotion of quality of life (QOL), but they are underutilized. The purpose of this study was to investigate the effects of a self-efficacy theory-based health information technology intervention implemented through blood control and patient self-management.

Design: A clinical randomized waitlist-controlled trial.

Methods: The study was conducted at a medical center in Taipei, Taiwan. A total of 60 subjects were randomly assigned to either the immediate intervention (experimental) group or the waitlist control group. The primary endpoint was systolic blood pressure at 3 months; secondary end points included self-management behavior and QOL. Treatment for the immediate intervention group lasted 3 months, while the waitlist control group received routine care for the first 3 months, at which point they crossed over to the intervention arm and received the same intervention as the experimental group for another 3 months. Both groups were evaluated by questionnaires and physiological measurements at both 3 and 6 months postadmission. The results were analyzed using generalized estimating equations.

Results: Systolic blood pressure significantly improved for the intervention group participants at 3 months, when there was also significant improvement in self-management behavior and QOL. There was no significant or appreciable effect of time spent in the waitlist condition, with treatments in the two conditions being similarly effective.

Conclusion: The use of a theory-based health information technology treatment compared with usual care resulted in a significant improvement in systolic blood pressure, self-management behavior, and QOL in patients with coronary artery disease.

Clinical Relevance: This treatment would be a useful strategy for clinical care of cardiovascular disease patients, improving their disease self-management. It also may help guide further digital health care strategies during the COVID-19 pandemic.
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http://dx.doi.org/10.1111/jnu.12661DOI Listing
July 2021

Renal protective effect of sacubitril/valsartan in patients with heart failure.

Sci Rep 2021 Feb 25;11(1):4593. Epub 2021 Feb 25.

Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.

Sacubitril/valsartan is a combined neprilysin inhibitor/angiotensin II receptor blocker designed for treatment of heart failure (HF). Nonetheless, its renal protective effect remained an issue of debate. This retrospective cohort study investigated the renal protective effect of sacubitril/valsartan in HF patients. HF patients on sacubitril/valsartan or valsartan for > 30 days were matched for gender, age, estimated glomerular filtration rate (eGFR), and left ventricular ejection fraction (LVEF) to be enrolled into analysis. The follow-up period was 18 months. The outcomes included end eGFR, renal function decline defined as 20% reduction of eGFR, mortality, and HF-related hospitalization. Each group had 137 patients after matching. The mean age was 72.7 years and 65.7% were male. Mean eGFR was 70.9 mL/min/1.73 m and LVEF was 54.0% at baseline. Overall, the eGFR of sacubitril/valsartan groups was significantly higher than valsartan group at the end (P < 0.01). Subgroup analysis showed that the difference in eGFR was significant in subgroups with LVEF ≥ 40% or eGFR ≥ 60 mL/min/1.73 m. Multivariate Cox regression model showed that sacubitril/valsartan group had significantly reduced risk for renal function decline (hazard ratio: 0.5, 95% confidence interval: 0.3-0.9). Kaplan-Meier curve showed no difference in the risk for cardiovascular mortality, all-cause mortality or HF-related hospitalization. We showed renal protective effect of neprilysin inhibition in HF patients and specified that subgroups with LVEF ≥ 40% or eGFR ≥ 60 mL/min/1.73 m were sensitive to this effect, suggesting an optimal subgroup of this treatment.
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http://dx.doi.org/10.1038/s41598-021-84118-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907094PMC
February 2021

Proposing and Validating the Diagnosis Scale for Internet Gaming Disorder in Taiwanese ADHD Adolescents: Likert Scale Method Based on the DSM-5.

Int J Environ Res Public Health 2021 02 4;18(4). Epub 2021 Feb 4.

Department of Psychiatry, Mackay Memorial Hospital, Taipei 104, Taiwan.

The paper aims to adjust the Taiwanese version of Internet gaming disorder-short form Likert scale with Likert (IGD-SF-T-L) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to a Likert scale model and test its psychometric property among children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). Confirmatory factor analysis (CFA) was conducted for validity and the Cronbach's α for reliability of IGD-SF-T-L. The ROC (receiver operating curves) was used to propose the cut-off point for assessing the instrument's psychometric properties and its corresponding indices for the diagnostic accuracy. In total, 102 children and adolescents with ADHD were recruited. The construct validity of IGD-SF-T by CFA was model well fitted with excellent reliability (Cronbach's α = 0.918). The ROC using the Chen's CIAS > 56 as the state variable for IGD diagnosis showed the AUC (areas under the curves) was 0.918. The cut-off point proposed for IGD-SF-T-L to indicate a diagnosis of IGD was ≥ 10. The corresponding indices of accuracy: sensitivity, specificity, LR (likelihood ratio) +, LR-, and AUC were 0.893, 0.826, 5.134, 0.130, and 0.859, respectively. The proposed IGD-SF-T-L is an adequate, standardized psychometrical measurement for diagnosing IGD among Taiwanese adolescents with ADHD. More attention should be paid toward recent ADHD youth with Internet gaming disorder and their family.
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http://dx.doi.org/10.3390/ijerph18041492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915797PMC
February 2021

Quality of life in patients with comorbid serious mental illness and chronic diseases: A structural equation model.

J Adv Nurs 2021 Mar 24;77(3):1271-1283. Epub 2020 Nov 24.

School of Nursing, National Defense Medical Center, Taipei City, Taiwan.

Aims: To investigate the factors affecting the quality of life among adults with comorbid serious mental illness and chronic diseases.

Design: Descriptive, cross-sectional study design.

Methods: In total, 204 patients with serious mental illness were recruited from two hospitals. Self-reported data were collected using the Brief Psychiatric Rating Scale, Internalised Stigma of Mental Illness, Patient Activation Measure and brief version of the World Health Organization Quality of Life Instrument. Data were collected between July 2018 - January 2019. The structural equation model was applied to examine the associations among the study variables.

Results: Internalized stigma (β = -0.479, p = .002) had the greatest direct effect on quality of life, followed by patient activation (β = 0.238, p = .002), severity of comorbidities (β = -0.207, p = .002) and psychiatric symptoms (β = -0.186, p = .006). In addition, psychiatric symptoms directly influenced the severity of comorbidities, which in turn directly influenced internalized stigma and then in turn directly influenced patient activation and ultimately influenced quality of life.

Conclusion: The relationship between internalized stigma and quality of life is significantly mediated by patient activation. This finding provides a theoretical basis for developing patient activation interventions for patients with comorbid mental and chronic diseases, which potentially improve the quality of life of this population.

Impact: Multiple comorbidities cause impaired quality of life in patients with serious mental illnesses. We found that patient activation plays an important role in the management of chronic diseases for achieving more favourable quality of life, but this is negatively affected by internalized stigma. These findings can help mental health professionals develop tailored intervention strategies to enhance quality of life by promoting patient activation and reducing internalized stigma, psychiatric symptoms, and comorbidity severity in patients with comorbid serious mental illnesses and chronic diseases.
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http://dx.doi.org/10.1111/jan.14663DOI Listing
March 2021

Knowledge and attitudes of pediatric clinicians regarding pediatric pain management.

J Spec Pediatr Nurs 2020 10 6;25(4):e12302. Epub 2020 Jul 6.

Neonatal Intensive Care Unit, Taichung Veterans General Hospital, Taichung, Taiwan.

Background: The professional knowledge and personal attitudes of pediatric clinicians regarding pediatric pain are the most important factors impacting pediatric pain relief care. Few studies have investigated the knowledge and attitudes regarding pediatric pain management of clinicians in Taiwan.

Purpose: Research purposes were to evaluate the knowledge and attitudes of pediatric clinicians regarding pain management and to describe the barriers of applying pain management across pediatric and neonatal settings.

Design And Methods: A cross-sectional descriptive comparative design was used. Pediatric clinicians from two medical centers and three general hospitals in Taiwan were recruited to complete a questionnaire.

Results: A total of 264 clinicians participated. On 33 questions measuring knowledge of pain management, the average correct response rate was 23.67. A significantly positive relationship was identified between clinicians' knowledge and prior training experience. Professional degree attainment significantly impacted clinicians' attitudes about pediatric pain management. Clinicians at pediatric wards showed more positive attitudes than did clinicians at either pediatric intensive care units or neonatal intensive care units. Five barriers to pediatric pain management were found.

Conclusion: The findings of this study suggest that pediatric clinicians in Taiwan need further education regarding pediatric pain management. This study will also helpful in implementing multidisciplinary pediatric pain management programs to improve the quality of pediatric practice in pediatric care settings of hospitals.
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http://dx.doi.org/10.1111/jspn.12302DOI Listing
October 2020

Benzoate treatment for adolescent anti-NMDAR encephalitis.

Schizophr Res 2020 08 25;222:472-473. Epub 2020 Jun 25.

Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University Medical College, Taichung, Taiwan; Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan. Electronic address:

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http://dx.doi.org/10.1016/j.schres.2020.06.014DOI Listing
August 2020

Effects of Combined Use of Mother's Breast Milk, Heartbeat Sounds, and Non-Nutritive Sucking on Preterm Infants' Behavioral Stress During Venipuncture: A Randomized Controlled Trial.

J Nurs Scholarsh 2020 09 20;52(5):467-475. Epub 2020 Jun 20.

Lambda Beta-At-Large, Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, R.O.C.

Purpose: Even routine procedures can cause pain and stress, and can be harmful to the fast-growing brain of preterm infants. Mitigating pain and stress with sucrose and analgesics has side effects; thus, an alternate choice is the use of natural breast milk and infants' sensory capabilities. Therefore, this study examined the effects of different integrations of sensory experiences-mother's breast milk odor and taste (BM-OT), heartbeat sounds (HBs), and non-nutritive sucking (NNS)-on preterm infant's behavioral stress during venipuncture.

Design: This study was a prospective, randomized controlled trial.

Methods: Infants born preterm (<37 weeks' gestational age) were enrolled in the study through convenience sampling, and randomly assigned to the following conditions: (condition 1) routine care (n = 36); (condition 2) BM-OT (n = 33); (condition 3) BM-OT + HBs (n = 33); or (condition 4) BM-OT + HBs + NNS (n = 36). Crying duration from puncture to recovery period was recorded using a voice recorder. Facial actions and body movements were measured using an infant behavioral coding scheme and transformed into frequencies during seven stages: baseline (stage 0), disinfecting (stage 1), venipuncture (stage 2), and the recovery period for 10 minutes (stages 3-6).

Findings: Data were analyzed for 138 preterm infants. The corresponding median times to stop crying for conditions 1, 2, 3, and 4 were 137, 79, 81, and 39 s, respectively; the instantaneous occurrence rates of stopping crying for conditions 2, 3, and 4 were 1.469, 1.574, and 2.996 times greater than for condition 1, respectively. Infants receiving conditions 3 and 4 had significantly fewer occurrences of facial actions (stage 6 and stages 4-6, respectively) and body movements (stages 3-6 for both); however, there were no significant reductions in stress behaviors for condition 2 (BM-OT).

Conclusions: The combination of BM-OT, HBs, and NNS could be provided to preterm infants as interventions to prevent and reduce behavioral stress, and facilitate pain recovery during venipuncture procedures.

Clinical Relevance: Clinicians should be educated about how to recognize preterm infants' behavioral stress, and to incorporate different sensory combinations of respective mothers' BM, HBs, and NNS into painful procedures to help preterm infants recover from distress.
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http://dx.doi.org/10.1111/jnu.12571DOI Listing
September 2020

Rethinking potentially inappropriate medication use in nursing homes within the Chinese population.

Geriatr Nurs 2020 Nov - Dec;41(6):724-729. Epub 2020 May 24.

Department of Computer Science and Information Engineering, Chang Gung University, Tao-Yuan, Republic of China.

This study aimed to understand the prevalence of Chinese medicine and other potentially inappropriate medications and to examine if there are relationships with emergency room visits, hospital admissions, and falls in a Chinese nursing home population. This cross-sectional descriptive study was a secondary analysis of data from 531 nursing home residents in Taiwan. Cox proportional hazard regression models were used in the analysis. Use of Chinese medicine in combination with Western medicine was observed in approximately 1% of residents. For every additional Chinese medicine used, the hazard ratio was 3.09 (p=.26) for emergency room visits and 3.22 (p=.21) for hospital admissions. For every additional nonsteroidal antiinflammatory agent used, the hazard ratio for falls was 5.42 (p=.006). Further studies with larger sample sizes are required to understand the appropriate time intervals required between administration of Chinese and Western medicine as well as to understand the drug-drug interactions.
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http://dx.doi.org/10.1016/j.gerinurse.2020.05.001DOI Listing
May 2020

Treatment Efficacy of Internet Gaming Disorder With Attention Deficit Hyperactivity Disorder and Emotional Dysregulaton.

Int J Neuropsychopharmacol 2020 06;23(6):349-355

Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.

Background: Recent youth with Attention Deficit Hyperactivity Disorder (ADHD) noticed emotional dysregulation if they had Internet Gaming Disorder (IGD). This study aims to understand the treatment efficacy of IGD with ADHD and emotional dysregulaton.

Method: A total of 101 ADHD youths were recruited. We used the Chen Internet Addiction Scale and IGD criteria of the diagnotsic statistical manual (DSM)-5 to confirm IGD. The Swanson, Nolan, and Pelham questionnaire Version IV was used for symptoms of ADHD and oppositional defiant disorder. Disruptive mood dysregulation disorder was assessed by psychiatrist.

Results: There is a new phenomenon that emotional dysregulation has been frequently noticed in severely gaming-addicted ADHD youth. Treatment efficacy of IGD is good when the underlying symptom of ADHD is controlled. Symptom scores of disruptive mood dysregulation (DMDD) were significantly reduced by 71.9%, 74.8%, and 84.4% at week 2, 3, and 4, respectively (P ≤ .001) after adjusting baseline symptom severity.

Conclusion: IGD may strongly arouse emotional dysregulation. Future DSM criteria could consider these gaming-addicted youth as a specific subclass of ADHD.
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http://dx.doi.org/10.1093/ijnp/pyaa010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311645PMC
June 2020

Effects of a smartphone-based videoconferencing program for older nursing home residents on depression, loneliness, and quality of life: a quasi-experimental study.

BMC Geriatr 2020 Jan 28;20(1):27. Epub 2020 Jan 28.

Department of Mathematics, Tamkang University, New Taipei City, Republic of China.

Background: Smartphones can optimize the opportunities for interactions between nursing home residents and their families. However, the effectiveness of smartphone-based videoconferencing programs in enhancing emotional status and quality of life has not been explored. The purpose of this study was to evaluate of the effect of a smartphone-based videoconferencing program on nursing home residents' feelings of loneliness, depressive symptoms and quality of life.

Methods: This study used a quasi-experimental research design. Older residents from seven nursing homes in Taiwan participated in this study. Nursing homes (NH) were randomly selected as sites for either the intervention group (5 NH) or the control group (2 NH); NH residents who met the inclusion criteria were invited to participate. The intervention group was comprised of 32 participants; the control group was comprised of 30 participants. The intervention group interacted with their family members once a week for 6 months using a smartphone and a "LINE" application (app). Data were collected with self-report instruments: subjective feelings of loneliness, using the University of California Los Angeles Loneliness Scale; depressive symptoms, using the Geriatric Depression Scale; and quality of life using the SF-36. Data were collected at four time points (baseline, and at 1-month, 3-months and 6-months from baseline). Data were analysed using the generalized estimating equation approach.

Results: After the intervention, as compared to those in the control group, participants in interventional group had significant decreases in baseline loneliness scores at 1 months (β = - 3.41, p < 0.001), 3 months (β = - 5.96, p < 0.001), and 6 months (β = - 7.50, p < 0.001), and improvements in physical role (β = 36.49, p = 0.01), vitality (β = 13.11, p < 0.001) and pain scores (β = 16.71, p = 0.01) at 6 months. However, changes in mean depression scores did not significantly differ between groups.

Conclusions: Smartphone-based videoconferencing effectively improved residents' feelings of loneliness, and physiological health, vitality and pain, but not depressive symptoms. Future investigations might evaluate the effectiveness of other media-based technologies in nursing homes as well as their effectiveness within and between different age cohorts.
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http://dx.doi.org/10.1186/s12877-020-1426-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986028PMC
January 2020

A comparison of quality of life between patients treated with different dialysis modalities in Taiwan.

PLoS One 2020 6;15(1):e0227297. Epub 2020 Jan 6.

School of Nursing, National Defense Medical Center, Taipei City, Taiwan (R.O.C.).

Purpose: This study compared the quality of life (QOL) of hemodialysis (HD) and peritoneal dialysis (PD) patients in Taiwan.

Methods: This cross-sectional study recruited end-stage renal disease patients from 34 Taiwanese hospitals or clinics. Patient characteristics, diagnoses, and laboratory data were extracted from charts. The Chinese version of the Quality of Life Index-Dialysis version (QLI-D) was used. Multiple linear regression analysis showed the effects of dialysis modality on QOL. P<0.05 indicated statistical significance.

Results: In total, 600 HD and 387 PD patients were included. The mean health and functioning, social and economic, psychological/spiritual, and family subscale scores and total QOL scores were significantly lower in HD patients than PD patients. After adjusting for region, hospital level, age, education level, marital status, and Karnofsky Performance Scale, the total QOL was 2.81 points higher for PD patients than for HD patients visiting medical centers (p<0.001). The total QOL was 2.53 points lower in PD patients than in HD patients for those visiting clinics.

Conclusion: Compared to HD patients, PD patients had better QOL in Taiwanese medical centers. The current survey improves our understanding of the QOL of patients undergoing different dialysis modalities in Taiwan.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227297PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944387PMC
May 2020

A Web-Based Self-Titration Program to Control Blood Pressure in Patients With Primary Hypertension: Randomized Controlled Trial.

J Med Internet Res 2019 12 5;21(12):e15836. Epub 2019 Dec 5.

Department of Mathematics, Tamkang University, Taipei, Taiwan.

Background: Hypertension is a major cause of mortality in cardiac, vascular, and renal disease. Effective control of elevated blood pressure has been shown to reduce target organ damage. A Web-based self-titration program may empower patients to control their own disease, share decisions about antihypertensive dose titration, and improve self-management, ultimately improving health-related quality of life.

Objective: Our primary aim was to evaluate the effects of a Web-based self-titration program for improving blood pressure control in patients with primary hypertension. Our secondary aim was to evaluate the effects of that program on improving health-related quality of life.

Methods: This was a parallel-group, double-blind, randomized controlled trial with assessments at baseline, 3 months, and 6 months. We included patients with primary hypertension (blood pressure>130/80 mm Hg) from a cardiology outpatient department in northern Taiwan and divided them randomly into intervention and control groups. The intervention group received the Web-based self-titration program, while the control group received usual care. The random allocation was concealed from participants and outcome evaluators. Health-related quality of life was measured by the EuroQol five-dimension self-report questionnaire. We used generalized estimating equations to evaluate the effects of the intervention.

Results: We included 222 patients and divided them equally into intervention (n=111) and control (n=111) groups. Patients receiving the Web-based self-titration program showed significantly greater improvement in the systolic and diastolic blood pressure control than those who did not receive this program, at 3 months (-21.4 mm Hg and -5.4 mm Hg, respectively; P<.001) and 6 months (-27.8 mm Hg and -9.7 mm Hg, respectively; P<.001). Compared with the control group, the intervention group showed a significant decrease in the overall defined daily dose at both 3 (-0.202, P=.003) and 6 (-0.236, P=.001) months. Finally, health-related quality of life improved significantly in the intervention group compared with the control group at both 3 and 6 months (both, P<.001).

Conclusions: A Web-based self-titration program can provide immediate feedback to patients about how to control their blood pressure and manage their disease at home. This program not only decreases mean blood pressure but also increases health-related quality of life in patients with primary hypertension.

Trial Registration: ClinicalTrials.gov NCT03470974; https://clinicaltrials.gov/ct2/show/NCT03470974.
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http://dx.doi.org/10.2196/15836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923762PMC
December 2019

Integration of Different Sensory Interventions From Mother's Breast Milk for Preterm Infant Pain During Peripheral Venipuncture Procedures: A Prospective Randomized Controlled Trial.

J Nurs Scholarsh 2020 01 25;52(1):75-84. Epub 2019 Nov 25.

Lambda Beta-At-Large, Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, R.O.C.

Purpose: To compare the effects of integrating mother's breast milk (BM) with three different combinations of sensory stimuli on preterm infant pain during peripheral venipuncture procedures.

Design: A prospective, repeated-measures randomized controlled trial.

Methods: Preterm infants (gestational age between 28 and 37 weeks, and in stable condition) needing venipuncture were recruited by convenience sampling (N = 140) and randomly assigned to four treatment conditions: (a) routine care (condition 1); (b) BM odor or taste (condition 2); (c) BM odor or taste + heartbeat sounds (HBs; condition 3), and (d) BM odor or taste + HBs + non-nutritive sucking (NNS; condition 4). Pain scores were assessed based on the Premature Infant Pain Profile-Revised (PIPP-R) over nine phases: baseline (phase 0, 5 min without stimuli before venipuncture), disinfecting (phase 1), during venipuncture (phase 2), and a 10-min recovery (phases 3-8).

Findings: Infants who received BM odor or taste + HBs + NNS had significantly lower increases in pain scores from baseline compared with controls across phases 1 through 8. Infants treated with either condition 2 or 3 demonstrated significant reductions in mild pain during disinfecting and recovery phases, as compared with the controls. When condition 2 was used as the reference, there were no significant differences in pain scores between the infants receiving condition 3 across the nine phases, suggesting mothers' HBs have only mild analgesic effects on venipuncture pain.

Conclusions: Integration of mother's BM odor or taste, HBs, and tactile NNS should be considered as an intervention for alleviation of procedural pain for preterm infants.

Clinical Relevance: Clinicians should incorporate the integrated sensory intervention into caregiving support for preterm infants undergoing short painful procedures.
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http://dx.doi.org/10.1111/jnu.12530DOI Listing
January 2020

Autism Associated With Anti-NMDAR Encephalitis: Glutamate-Related Therapy.

Front Psychiatry 2019 21;10:440. Epub 2019 Jun 21.

Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.

The purpose of this review is to correlate autism with autoimmune dysfunction in the absence of an explanation for the etiology of autism spectrum disorder. The anti-N-methyl-D-aspartate receptor (anti-NMDAR) autoantibody is a typical synaptic protein that can bind to synaptic NMDA glutamate receptors, leading to dysfunctional glutamate neurotransmission in the brain that manifests as psychiatric symptoms (psychosis, hallucinations, and personality changes). Detection of autoantibodies, cytokines, decreased lymphocytes, serum immunoglobulin level imbalance, T-cell mediated immune profile, maternal infection history, and children's infection history can all be vital biological markers of autoimmune autism. Diagnosing autoimmune encephalitis sooner can increase the effectiveness of curative treatments-such as immune therapy or immune modulatory therapy-that may prevent the long-term consequence of being misdiagnosed with autism spectrum disorder. Glutamate therapy primarily normalizes glutamate neurotransmission and can be a new add-on intervention alongside antipsychotics for treating autoimmune autism.
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http://dx.doi.org/10.3389/fpsyt.2019.00440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598425PMC
June 2019

Factors Affecting Self-care Maintenance and Management in Patients With Heart Failure: Testing a Path Model.

J Cardiovasc Nurs 2019 Jul/Aug;34(4):297-305

Hui-Wan Chuang, RN PhD Candidate, Graduate Institute of Medical Sciences, National Defense Medical Center; and Registered Nurse, Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan. Chi-Wen Kao, PhD, RN Director, Department of Nursing, Tri-Service General Hospital; and Associate Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan. Wei-Shiang Lin, MD Director, Division of Cardiology, Department of Medicine, Tri-Service General Hospital; and Professor, School of Medicine, National Defense Medical Center, Taipei, Taiwan. Yue-Cune Chang, PhD Professor, Department of Mathematics, Tamkang University, New Taipei City, Taiwan.

Background: Self-care is indispensable for health maintenance and well-being. This naturalistic decision-making process involves behavioral choices to maintain physiological stability (self-care maintenance) and response to occurring symptoms (self-care management). However, several factors affect self-care, but some have contradictory results.

Objective: We aimed to examine how depressive symptoms, social support, eHealth literacy, and heart failure (HF) knowledge directly and indirectly affect self-care maintenance and management and to identify the mediating role of self-care confidence in self-care maintenance and management.

Methods: The study included a total of 141 patients with HF (average age, 65.2 years; male, 55.3%). We analyzed their data, including demographic and clinical characteristics, obtained from the Patient Health Questionnaire-9, Multidimensional Scale of Perceived Social Support, eHealth Literacy Scale, Dutch Heart Failure Knowledge Scale, and Self-Care of Heart Failure Index. Furthermore, path analysis was conducted to examine the effects of the study variables on self-care maintenance and management.

Results: Self-care confidence significantly and directly affected self-care maintenance and management and mediated the relationships between factor variables (depressive symptoms, social support, and HF knowledge) and outcome variables (self-care maintenance and management). Specifically, depressive symptoms had a negative and direct effect on self-care maintenance, whereas eHealth literacy had significant and direct effects on self-care management and HF knowledge.

Conclusion: Self-care confidence decreases the negative effects of depressive symptoms on self-care. This study underscores the need for interventions targeting patients' self-care confidence to maximize self-care among patients with HF.
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http://dx.doi.org/10.1097/JCN.0000000000000575DOI Listing
October 2020

Gamma knife radiosurgery for the treatment of cavernous sinus meningiomas: post-treatment long-term clinical outcomes, complications, and volume changes.

J Neurooncol 2019 Jun 24;143(2):261-270. Epub 2019 Apr 24.

Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.

Purpose: To evaluate the outcomes of patients who underwent Gamma Knife radiosurgery (GKRS) for the treatment of cavernous sinus (CS) meningiomas.

Methods: We retrospectively reviewed the clinical and radiological outcomes of 95 patients with CS meningiomas at Taipei Veterans General Hospital between 1993 and 2011. The study cohort comprised 27 men and 68 women with a median age of 50 years (range 29-79 years). The median pre-GKRS tumor volume was 6.6 ml (range 0.9-35.7 ml). The median margin dose was 12 Gy (range 11-21 Gy). The clinical factors related to favorable outcomes were assessed.

Results: The median follow-up period was 59 (range 12-209) months. At the final follow-up, the tumor volume regressed in 70 patients (74%) and progressed in eight (8%). Kaplan-Meier analysis revealed that the progression-free survival rates at 5 and 10 years were 92.7% and 81.2%, respectively. Three patients (3.2%) experienced exacerbated cranial nerve dysfunction following radiosurgery. Confined tumors were found to be an independent prognostic factor for tumor control and shorter times to regression in the multivariable analyses. No risk factor for tumor progression was identified in either the univariate or multivariate analyses.

Conclusions: GKRS provides good long-term tumor control and is associated with low cranial nerve-related morbidity development rates in patients with small- to medium-sized CS meningiomas. Confined tumor could be an independent prognostic factor for tumor control and shorter times to regression in multivariate analysis. Life-long follow-up is mandatory in such settings, even for outpatients with shrunken or stabilized tumors.
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http://dx.doi.org/10.1007/s11060-019-03090-6DOI Listing
June 2019

Effect of Home Medication Titration on Blood Pressure Control in Patients With Hypertension: A Meta-Analysis of Randomized Controlled Trials.

Med Care 2019 03;57(3):230-236

Department of Mathematics, Tamkang University, Taipei, Taiwan.

Background: Medication titration has been used in home blood pressure (BP) control, with the expectation of enabling patients with hypertension to better manage their BP.

Objective: The study goal was to estimate the effects of medication titration intervention in lowering the systolic blood pressure and diastolic blood pressure of patients with hypertension.

Methods: The meta-analysis included randomized controlled trials on adults diagnosed with hypertension and BP≧130/80 mm Hg, having a medication-titration intervention, and using a home BP measurement. We systematically searched PubMed, CINAHL, Ovid-Medline, and the Cochrane Library, for studies published from 1997 to 2017. The quality of the studies was evaluated by the Modified Jadad scale. Statistical heterogeneity among the trials was evaluated using Q statistics and I. Publication bias was assessed with the funnel plot and Rosenthal's fail-safe N.

Results: The meta-analysis included 4 studies randomizing 1335 participants. Medication-titration intervention significantly assisted hypertensive patients to improve BP control; systolic blood pressure was reduced by 6.86 mm Hg [95% confidence interval (CI), 4.80-8.93, P<0.0001] and diastolic blood pressure by 3.03 mm Hg (95% CI, 2.07-3.99, P<0.0001), did not significantly affect EQ-5D scores (mean difference, 0.02; 95% CI, -0.01 to 0.04, P=0.13).

Conclusions: Our findings suggest home medication titration of antihypertensive medication for hypertensive patients significantly improved home BP control. However, the strategy did not enhance quality of life in patients with hypertension.
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http://dx.doi.org/10.1097/MLR.0000000000001064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410972PMC
March 2019

Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure.

PLoS One 2018 14;13(11):e0205953. Epub 2018 Nov 14.

Department of Mathematics, Tamkang University, Taipei, Taiwan.

Uncertainty in illness is regarded as a source of stress in many chronic diseases and is negatively related to health-related quality of life (HRQoL). However, studies on the relationship between uncertainty and HRQoL in patients with heart failure are limited. This study used Mishel's theory of uncertainty in illness to investigate the mediating role of uncertainty in illness and depressive symptoms between symptom distress and HRQoL in patients with heart failure. This study used a cross-sectional correlation design. Participants were recruited by convenience sampling from outpatient services and medical wards of cardiology departments of a medical center in northern Taiwan. Data were collected for uncertainty, depressive symptoms, symptoms distress of heart failure, and HRQoL using self-report questionnaires. Demographics and clinical characteristics were analyzed with descriptive statistics. The mutual effects of disease characteristics, symptom distress, uncertainty in illness, depressive symptoms and HRQoL, as well as the overall model fitness, were analyzed by with structural equation modeling. We collected 147 qualified questionnaires. The mean score for the Mishel Uncertainty in Illness Scale for patients with heart failure was 73.5 (SD = 18.55); 65.3% of participants had a score of ≧13 on the Beck Depressive Inventory-II, indicating mild depression. Uncertainty, depressive symptoms, and HRQoL were directly related to symptom distress. Symptom distress and depressive symptoms were both mediators between uncertainty and depressive symptoms. Depressive symptoms also mediated emotional support and HRQoL. Uncertainty and depressive symptoms were important factors in the pathway between symptom distress and HRQoL for heart failure patients. We suggest providing heart failure patients with tailored interventions for effective self-management of symptoms based on Mishel's theory of uncertainty in illness, which could help control disease symptoms, alleviate uncertainty and depression as well as improve HRQoL.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205953PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235604PMC
April 2019

Risk factors and prediction model for persistent breast-cancer-related lymphedema: a 5-year cohort study.

Support Care Cancer 2019 Mar 14;27(3):991-1000. Epub 2018 Aug 14.

School of Medicine, Fu Jen Catholic University, No.510 Zhongzheng Road, Xinzhuang District, Taipei City, 242, Taiwan.

Purpose: Breast-cancer-related lymphedema (BCRL) can be a transient or persistent condition. The aims of this study were to (1) identify and weigh the risk factors for persistent lymphedema (PLE) among all patients with BCRL and (2) establish a prediction model for the occurrence of PLE.

Methods: A cohort of 342 patients with BCRL with a median follow-up of 5 years after the onset of swelling was analyzed. PLE was defined as a hardening of the subcutaneous tissue, the persistence of the circumferential difference (CD) between arms, or a flare-up of swelling during follow-up. Multiple logistic regression was used to identify risk factors for PLE, including tumors, treatments, and patient-related factors. The prediction accuracy of the model was assessed using the area under the receiver operating characteristic curve (AUC).

Results: Of the 342 patients with BCRL, 229 (67%) had PLE. Multiple logistic regression analysis revealed that the number of lymph node metastases (p = 0.012), the maximal CD between arms at the first occurrence of swelling (p < 0.001), and the largest difference during follow-up (p < 0.001) were significant predictors for PLE. The corresponding AUC was 0.908. Although inclusion of body weight gains (p = 0.008) and maximal CD at the latest follow-up (p = 0.002) increased the analytical accuracy (AUC = 0.920), the resulting AUC values (p = 0.113) were not significantly different.

Conclusions: BCRL is persistent in two thirds of patients. Patients with more lymph node metastases, weight gain, and larger CD since the onset of swelling and during follow-up have an increased likelihood of developing PLE.
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http://dx.doi.org/10.1007/s00520-018-4388-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373263PMC
March 2019

Pharmacologically upregulated carcinoembryonic antigen-expression enhances the cytolytic activity of genetically-modified chimeric antigen receptor NK-92MI against colorectal cancer cells.

BMC Immunol 2018 08 3;19(1):27. Epub 2018 Aug 3.

Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, No.95, Wenchang Road, Shilin District, Taipei, Taiwan.

Background: The natural killer cell line, NK-92MI, is cytotoxic against various types of cancer. The aim of this study was to develop chimeric antigen receptor-modified (CAR) NK-92MI cells targeting carcinoembryonic antigen-expressing (CEA) tumours and increase killing efficacy by pharmacologically modifying CEA-expression.

Result: We generated anti-CEA-CAR NK-92MI cells by retroviral vector transduction. This genetically-modified cell line recognised and lysed high CEA-expressing tumour cell lines (LS174T) at 47.54 ± 12.60% and moderate CEA-expressing tumour cell lines (WiDr) at 31.14 ± 16.92% at a 5:1 effector: target (E/T) ratio. The cell line did not lyse low CEA-expressing tumour cells (HCT116) as they did their parental cells (NK-92MI cells). The histone deacetylase-inhibitor (HDAC) sodium butyrate (NaB) and the methylation-inhibitor 5-azacytidine (5-AZA), as epigenetic modifiers, induced CEA-expression in HCT116 and WiDr cells. Although the IC of 5 fluorouracil (5-FU) increased, both cell lines showed collateral sensitivity to anti-CEA-CAR NK-92MI cells. The cytolytic function of anti-CEA-CAR NK-92MI cells was increased from 22.99 ± 2.04% of lysis background to 69.20 ± 11.92% after NaB treatment, and 69.70 ± 9.93% after 5-AZA treatment, at a 10:1 E/T ratio in HCT116 cells. The WiDr cells showed similar trend, from 22.99 ± 4.01% of lysis background to 70.69 ± 10.19% after NaB treatment, and 59.44 ± 10.92% after 5-AZA treatment, at a 10:1 E/T ratio.

Conclusions: This data indicates that the effector-ability of anti-CEA-CAR NK-92MI increased in a CEA-dependent manner. The combination of epigenetic-modifiers like HDAC-inhibitors, methylation-inhibitors, and adoptive-transfer of ex vivo-expanded allogeneic-NK cells may be clinically applicable to patients with in 5-FU resistant condition.
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http://dx.doi.org/10.1186/s12865-018-0262-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091054PMC
August 2018

Evaluation of Comfort and Confidence of Neonatal Clinicians in Providing Palliative Care.

J Palliat Med 2018 11 23;21(11):1558-1565. Epub 2018 Jul 23.

6 Department of Nursing, Chang Gung University of Science and Technology, Chang Gung Memorial Hospital , Chiayi, Taiwan.

Background: Research found that low levels of professional confidence and personal comfort among neonatal clinicians regarding palliative care may indicate a lack of competence and hesitancy to offer neonatal palliative care services.

Purpose: This study evaluated the factors associated with the confidence and comfort levels of neonatal clinicians providing neonatal palliative care.

Methods: A cross-sectional survey and questionnaire were used to investigate the confidence and comfort levels of neonatal clinicians regarding neonatal palliative care.

Results: Research subjects included 154 neonatal clinicians. Clinicians' confidence in providing neonatal palliative care was significantly impacted by age, marital status, years of professional experience (p < 0.05), and prior palliative care training. Comfort levels were significantly impacted by educational degree, marital status, and years of working experience. Clinicians with a supportive workplace reported increases in both professional confidence (r = 0.286, p < 0.001) and personal comfort (r = 0.521, p < 0.001).

Conclusion: Research reveals the importance of neonatal palliative education and suggests further development of interdisciplinary neonatal palliative care teams to improve clinicians' professional confidence and personal comfort.
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http://dx.doi.org/10.1089/jpm.2018.0102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211820PMC
November 2018

Propofol-based Total Intravenous Anesthesia Is Associated with Better Survival Than Desflurane Anesthesia in Colon Cancer Surgery.

Anesthesiology 2018 11;129(5):932-941

From the Departments of Anesthesiology (Z.-F.W., C.-H.L., Y.-S.H., H.-C.L.) Radiation Oncology (K.-T.L.), Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China the School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China (M.-S.L., Y.-S.L., C.L.) the Division of Anesthesiology, Cathay General Hospital, Taipei, Taiwan, Republic of China (C.-S.W.) the Department of Mathematics, Tamkang University, New Taipei City, Taiwan, Republic of China (Y.-C.C.).

What We Already Know About This Topic: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Previous research has shown different effects of anesthetics on cancer cell growth. Here, the authors investigated the association between type of anesthetic and patient survival after elective colon cancer surgery.

Methods: A retrospective cohort study included patients who received elective colon cancer surgery between January 2005 and December 2014. Patients were grouped according to anesthesia received: propofol or desflurane. After exclusion of those who received combined propofol anesthesia with inhalation anesthesia or epidural anesthesia, survival curves were constructed from the date of surgery to death. After propensity matching, univariable and multivariable Cox regression models were used to compare hazard ratios for death. Subgroup analyses were performed for tumor-node-metastasis staging and postoperative metastasis.

Results: A total of 706 patients (307 deaths, 43.5%) with desflurane anesthesia and 657 (88 deaths, 13.4%) with propofol anesthesia were eligible for analysis. After propensity matching, 579 patients remained in each group (189 deaths, 32.6%, in the desflurane group vs. 87, 15.0%, in the propofol group). In the matched analyses, the propofol-treated group had a better survival, irrespective of lower tumor-node-metastasis stage (hazard ratio, 0.22; 95% CI, 0.11 to 0.42; P < 0.001) or higher tumor-node-metastasis stage (hazard ratio, 0.42; 95% CI, 0.32 to 0.55; P < 0.001) and presence of metastases (hazard ratio, 0.67; 95% CI, 0.51 to 0.86; P = 0.002) or absence of metastases (hazard ratio, 0.08; 95% CI, 0.01 to 0.62; P = 0.016). Simple propensity score adjustment produced similar findings.

Conclusions: Propofol anesthesia for colon cancer surgery is associated with better survival irrespective of tumor-node-metastasis stage.
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http://dx.doi.org/10.1097/ALN.0000000000002357DOI Listing
November 2018

Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study.

Eur Child Adolesc Psychiatry 2019 Feb 5;28(2):247-255. Epub 2018 Jun 5.

Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK.

Parents of children with attention deficit hyperactivity disorder (ADHD) have been found to prefer sensory integration (SI) training rather than guideline-recommended ADHD treatment. This study investigated whether SI intervention for children with ADHD was associated with a reduced risk of subsequent mental disorders. From children < 8-years-old newly diagnosed with ADHD in a nationwide population-based dataset, we established a SI cohort and a non-SI cohort (N =  1945) matched by propensity score. Incidence and hazard ratios of subsequent psychiatric disorders were compared after a maximum follow-up of 9 years. The incidence of psychiatric disorders was 1.4-fold greater in the SI cohort, with an adjusted hazard ratio of 1.41 (95% confidence interval 1.20-1.67), comparing to the non-SI cohort. Risks were elevated for emotional disturbances, conduct disorders, and adjustment disorders independent of age, gender, or comorbidity. Among children with only psychosocial intervention, the incidence of psychiatric disorders was 3.5-fold greater in the SI cohort than in the non-SI cohort. To our knowledge, this is the first study to report an increased risk of developing psychiatric disorders for children with ADHD who received SI compared to those who did not. Potential adverse effects of SI for ADHD children should be carefully examined and discussed before practice.
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http://dx.doi.org/10.1007/s00787-018-1171-7DOI Listing
February 2019

Immune modulating therapy: An effective add-on intervention for psychosis of anti-N-methyl-d-aspartate receptor encephalitis in Taiwan.

Psychiatry Clin Neurosci 2018 Aug 14;72(8):624-625. Epub 2018 Jun 14.

Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.

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http://dx.doi.org/10.1111/pcn.12679DOI Listing
August 2018

[Diabetic Foot Neuropathy and Related Factors in Patients With Type 2 Diabetes Mellitus].

Hu Li Za Zhi 2018 06;65(3):28-37

PhD, RN, Associate Professor, School of Nursing, National Defense Medical Center, and Consultant, Department of Nursing, Taiwan, ROC.

Background: Patients with type 2 diabetes mellitus (T2DM) face a higher risk of diabetic foot neuropathy, which increases the risk of death. The early detection of factors that influence diabetic neuropathy reduces the risk of foot lesions, including foot ulcerations, lower extremity amputation, and mortality.

Purpose: To explore the demographic, disease-characteristic, health-literacy, and foot-self-care-behavior factors that affect diabetic foot neuropathy in patients with T2DM.

Methods: A case-control study design was employed in which cases (Michigan Neuropathy Screening Instrument, MNSI) ≥ 2 were matched to controls based on age and gender in a medical center. A total of 114 patients diagnosed with T2DM in a medical center were recruited as participants. Data were collected using a structured questionnaire. The collected data were analyzed using Fisher's exact test, Mann-Whitney U test, and logistic regression.

Results: The results of multiple logistic regression showed that glycated hemoglobin (B = 1.696, p = .041) and communication and critical health literacy (B = -0.082, p = .034) were significant factors of diabetic foot neuropathy.

Conclusions / Implications For Practice: The findings of this study suggest that nurses should assess the health literacy of patients with T2DM before providing health education and should develop a specific foot-care intervention for individuals with poor glycemic control.
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http://dx.doi.org/10.6224/JN.201806_65(3).06DOI Listing
June 2018

Sonographic median nerve change after steroid injection for carpal tunnel syndrome.

Muscle Nerve 2018 09;58(3):402-406

Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Beitou District, Taipei City, 11217, Taiwan.

Introduction: The sonographic changes of the median nerve after steroid injection for carpal tunnel syndrome (CTS) still require investigation.

Methods: Sixty-two patients with CTS were included. The Boston Carpal Tunnel Questionnaire was administered, and ultrasonographic examinations were performed before and at 2, 6, and 12 weeks after steroid injection. At 12 weeks, general improvement was scored on a 6-point Likert scale.

Results: After treatment, the cross-sectional area (CSA) of the median nerve was significantly reduced at 2-, 6-, and 12-week follow-ups (for each, P < 0.001, analysis of variance). The "significant improvement" group (n = 39) had a significantly greater reduction in the CSA at the carpal tunnel inlet (P = 0.014) and CSA in the proximal carpal tunnel (P = 0.003) compared with the "little/no improvement" group (n = 23).

Discussion: Sonographic measurement of CSA may be considered complementary to the standard clinical evaluation in monitoring of treatment response in patients with CTS. Muscle Nerve 58: 402-406, 2018.
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http://dx.doi.org/10.1002/mus.26171DOI Listing
September 2018