Journal of the Formosan Medical Association最新文献

Purpose: To evaluate whether animation-assisted learning (AAL) enhances caregiver's knowledge of anticipatory guidance (AG) for children and determine the influence of the socioeconomic status during a well-child clinical visit.

Methods: We prospectively enrolled caregivers who presented for well-child checkups at a tertiary care center. Participants completed a pre-test, watched a 25-min animation on specific AG topics, and then completed a post-test. We collected information on the caregivers' gender, parity number, educational level, age, and employment status and then analyzed test accuracy relative to select socio-demographic factors.

Results: We enrolled 150 caregivers (75 in the ≤3-month group, and 75 in the >3-month-to-7-year group). The pre- and post-AAL accuracy rates were 68.7% ± 14.5% vs. 88.2% ± 9.9% for the ≤3-month and 75.9% ± 13.1% vs. 92.3% ± 10.0% for the >3-month-to-7-year groups. Women, non-primipara caregivers, and college graduates in the ≤3-month group had better pre-test accuracy than their counterparts (p = 0.002, 0.002, and 0.004, respectively). Irrespective of socio-demographic factors, all caregivers demonstrated significantly improved AG knowledge post-AAL. Furthermore, college graduates or unemployed caregivers in the ≤3-month group showed improvements with AAL (p = 0.001 and 0.006, respectively).

Conclusions: Caregiver's knowledge level further improved post-AAL regardless of their socio-demographic backgrounds, highlighting AAL's effectiveness across diverse populations. The most substantial improvements were observed among higher-educated or unemployed caregivers with infants aged ≤3 months.

Background: Early detection and accessible monitoring of dementia are crucial for timely intervention. However, traditional neuropsychological assessments are resource-intensive, and with the growing aging population, scheduling delays increased. The Cogstate Brief Battery (CBB) offers a promising, rapid screening tool, though its validation in Mandarin-speaking populations has been limited.

Methods: This prospective, multi-center study assessed the validity of the CBB in distinguishing between mild cognitive impairment (MCI) and dementia compared to healthy controls (HC) in Taiwan. Participants from three tertiary medical centers underwent comprehensive cognitive evaluation using the CBB, including the Learning/Working Memory Brain Performance Index (Lrn/WM BPI), Attention/Psychomotor Brain Performance Index (Attn/Psychomotor BPI), combined BPI, and Brain Age.

Results: Of 192 participants (mean age 68.7 ± 8.2 years, mean education level 11.0 ± 3.9 years, 59.9% female), the CBB showed strong discriminatory power across groups. The combined BPI demonstrated the highest AUC (0.95) for distinguishing dementia from HC, followed by 0.92 for Lrn/WM BPI, 0.91 for Brain Age difference, and 0.88 for Attn/Psychomotor BPI. A combined BPI cut-off score of 41.25 effectively differentiated between HC and cognitive impairment groups.

Conclusion: This first validation of the CBB in Mandarin-speaking populations highlights its utility as a reliable screening tool for early cognitive impairment detection. Its use could enhance timely diagnoses, helping to streamline clinical pathways and improve patient outcomes, addressing a critical gap in dementia care in Taiwan's healthcare system.

Background: Thoracotomy is a highly painful surgical procedure, with thoracic epidural analgesia (TEA) serving as the gold standard for postoperative pain management. However, TEA can induce significant hypotension, especially when combined with general anesthesia. The ultrasound-guided erector spinae plane block (ESPB) has emerged as a complementary technique for enhancing analgesia while minimizing side effects. This study compares the analgesic efficacy and intraoperative hemodynamic outcomes of preoperative TEA with and without ESPB in patients undergoing thoracotomy.

Methods: This retrospective cohort study was conducted at a tertiary university hospital, including patients who underwent thoracotomy for tumor resection between March 2017 and March 2023. Patients receiving ESPB prior to TEA were compared with those receiving TEA alone. Postoperative pain intensity and intraoperative hemodynamic stability were assessed. The primary outcome was postoperative pain scores, while secondary outcomes included intraoperative mean arterial pressure and postoperative outcomes such as length of hospital stay.

Results: A total of 64 patients were enrolled in the study, including 43 who received TEA alone and 21 who received a combination of TEA and ESPB. After propensity score matching, 21 patients were matched 1:1 in each group for comparative analysis. Patients who received ESPB in addition to TEA had significantly lower pain scores at 1 h and 24 h postoperatively (p < 0.001). Additionally, they demonstrated higher intraoperative mean arterial pressures (p = 0.036) compared to the TEA-only group. However, there were no significant differences in postoperative outcomes.

Conclusions: The combination of preoperative ESPB and TEA provides superior early postoperative pain control and enhances intraoperative hemodynamic stability in thoracotomy patients compared to TEA alone.

Background/purpose: To predict outcomes for patients with hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) by assessing the ablative margin.

Methods: We retrospectively analyzed 163 HCC patients with complete RFA treatment at National Taiwan University Hospital (NTUH) from 2015 to 2020. Local tumor progression (LTP) is defined as the reappearance of HCC around the ablative zone. Various ablative margins (AM) are measured on post-RFA computed tomography (CT), including the minimal and maximal AM covering or not covering the liver surfaces (AMCLSmin, AMCLSmax, AMULSmin, AMULSmax). Average ablative margins (AMCLSavg, AMULSavg) are calculated from the minimal and maximal AM. Tumors at high-risk locations, including subdiaphragmatic, subcapsular, and perivascular regions, were further analyzed. The Kaplan-Meier method was utilized to analyze the recurrence-free survival (RFS) of different groups of patients. Patients were grouped by their ablative margin width with a cutting-off value of 3 mm or 5 mm.

Results: Of the 163 HCC patients enrolled, 29 had LTP within two years, and 20 had LTP after two years. AMULSmin and AMULSavg were shown to be significant factors contributing to local tumor recurrences. Patients with AMULSmin≧3 mm had significantly better RFS than those with AMULSmin<3 mm (p = 0.0236). In high-risk locations, AMULSavg ≧5 mm had better RFS in subdiaphragmatic and subcapsular regions, and AMULSavg ≧3 mm had better RFS in perivascular region.

Conclusion: Measuring the ablative margin without covering the liver surface (especially AMULSmin, AMULSavg) in the post-RFA CT may be helpful prognosis indicators of LTP and RFS in HCC patients.

Purpose: To investigate the incidences of newly diagnosed arsenic-related bladder cancer (BC), upper urinary tract UC (UTUC), and renal cell carcinoma (RCC) in Taiwan.

Methods: Cancer data for 1979-2019 were extracted from the Taiwan Cancer Registry Database. According to birth residency, individuals were divided into Z0, Z1, Z2, and Z3 areas according to the groundwater As levels in the 1970s and whether BFD was endemic to an area. New diagnosis rates were analyzed. The investigation period was divided into early (1979-1999) and late (2000-2019) periods to compare the changes after the As-contaminated water use stopped.

Results: 26,908, 59,838, and 34,245 newly diagnosed cases of RCC, BC, and UTUC, respectively, were identified. Age-standardized incidence showed the RCC and BC patients were predominantly male. As contamination was not correlated with RCC incidence. Regarding BC and UTUC in Z3, higher As groundwater levels accompanied with higher incidence rates in both sexes. When comparing late to early period, reverse change with decreased incidence was noted in BC and UTUC in Z3 populations. (BC male: mean ± SD: 45.1 ± 10.8 vs 69.7 ± 10.4, ∗∗∗P < 0.0001, female: mean ± SD: 32.2 ± 8.9 vs 50.4 ± 13.4, ∗∗P < 0.007; UTUC male: mean ± SD: 35.73 ± 8 vs 46 ± 13.4, ∗∗P < 0.007; female: mean ± SD: 30.7 ± 7.2 vs 38.5 ± 6,2, ∗∗P < 0.007).

Conclusion: Exposure of arsenic is related to incidence of BC and UTUC but RCC in Taiwan. After stopping drinking As-containing groundwater since 1980s, significant decrease in BC and UTUC incidence was also noted.