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Objective To investigate and compare the efficacy of endoscopic-assisted hematoma evacuation and burr hole hematoma drainage combined with urokinase in the treatment of septated chronic subdural hematoma (CSDH). Methods A total of 38 patients with septated CSDH who were admitted in Peking Union Medical College Hospital and received endoscopic-assisted hematoma evacuation (endoscopy group, n = 19) or burr hole drainage combined with urokinase (burr hole group, n = 19) from January 2022 to December 2023. The change rate of the hematoma cavity was calculated, the modified Rankin Scale (mRS) and Barthel Index (BI) were used to evaluate neurological function prognosis and abilities of daily living. In addition, postoperative drainage time, postoperative hospitalization time, total hospitalization cost and incidence of cerebrospinal fluid leakage were recorded. Results The two treatment modalities did not show differences in the change rate of the hematoma cavity (t = 0.858, P = 0.396). Both endoscopy group (Z = -4.116, P = 0.000) and burr hole group (Z = -4.195, P = 0.000) had lower mRS scores on discharge than on admission, while the difference between the 2 groups on discharge was not significant (Z = -0.502, P = 0.616). The endoscopy group (Z = -1.557, P = 0.119) and burr hole group (Z = -0.091, P = 0.928) had no significant difference in BI scores on discharge versus on admission, and the difference in BI scores between the 2 groups on discharge was also not statistically significant (Z = -0.853, P = 0.394). Postoperative drainage time was longer in the endoscopy group (t = -2.488, P = 0.018), but postoperative hospitalization time was longer in the burr hole group (t = -3.894, P = 0.000). Total hospitalization cost in both 2 groups (t = 1.175, P = 0.248) and the incidence of cerebrospinal fluid leakage (Fisher's exact probability: P = 0.313) were not statistically significant. Conclusions Both neuroendoscopic surgery and burr hole drainage combined with urokinase treatment are safe and effective in treating septated CSDH. They can clear the hematoma and improve neurological function; neuroendoscopic surgery can faster improve the neurological function and shorter postoperative hospitalization time. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate and compare facility workers’ and family caregivers’ perceptions toward closed-circuit television (CCTV) in long-term care facilities. Methods: The participants included 70 family caregivers and 66 facility workers in nine long-term care facilities. A structured questionnaire gathered participants’ perceptions of CCTV in long-term care facilities. Data were analyzed using descriptive statistics, t-test, chi-squared test, and Fisher’s exact test with SPSS 26.0. Results: Family caregivers positively perceived both the function (p<.001) and compulsory installation (p<.001) of CCTV in long-term care facilities compared to facility workers. Also, family caregivers highly perceived the necessity of two improvement plans for CCTV application: “the agreement on a video-data-application plan” (p=.032), and “the necessity of a video-analytics expert” (p=.001) compared to facility workers. Conclusion: Family caregivers were more likely to recognize the importance of CCTV in long-term care facilities than facility workers. Further education on the necessity of CCTV, its positive functions, and various usage methods is required considering that the discussion on CCTV installation in long-term care facilities will become more prevalent. In addition, the legal regulations related to CCTV installation should be prepared in detail. Furthermore, it is necessary to understand that CCTV is not a solution to elder abuse, and long-term care facilities should consider future uses of AI-CCTV. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficiency and safety of endovascular thrombectomy for acute ischemic stroke caused by acute large vessel occulsion. Methods A total of 41 patients with acute ischemic stroke caused by acute large vessel occulsion were treated with endovascular thrombectomy. Time from onset to admission, from admission to femoral artery puncture, from onset to recanalization were recorded. Modified Thrombolysis in Cerebral Infarction (mTICI) was used to assess the recanalization immediately after operation. National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological function at 24 h after operation. Modified Rankin Scale (mRS) was used to evaluate clinical prognosis at 90 d after operation. Perioperative procedure-related complications and occurrence rate of symptomatic intracranial hemorrhage within at 90 d after operation were recorded. American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) Collateral Flow Grading System (ACG) was used to assess collateral compensation of anterior circulation. BATMAN score was used to assess collateral compensation of posterior circulation. Results Among 41 patients, 12 (29.27%) were treated with recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolysis. There were 32 patients (78.05%) achieved successful recanalization, including 20 patients (80%, 20/25) in anterior circulation and 12 (12/16) in posterior circulation, and no significant difference was seen between them (adjusted χ2 = 1.424, P = 0.706). At 24 h after operation, 28 patients (68.29%) had better neurological function than preoperation (NIHSS decreasing ≥ 4 score), including 18 patients (72%, 18/25) with anterior circulation occlusion and 10 (10/16) with posterior circulation occlusion, and there was no significant difference between them (χ2 = 0.407, P = 0.524). Eleven patients (26.83%) died within 90 d after operation, including 4 patients (16%, 4/25) with anterior circulation occlusion and 7 (7/16) with posterior circulation occlusion, and there was no significant difference between them (adjusted χ2 = 2.130, P = 0.144). Among the 11 dead, 3 died of complicated pulmonary infection and respiratory failure, and 8 died of ischemic stroke. The other 30 patients were followed up for 3 months to one year, average (231.92 ± 95.36) d. At 90 d after operation, 14 patients (34.15%) had good outcome (mRS ≤ 2 score), including 10 patients (47.62%, 10/21) with anterior circulation occlusion and 4 (4/9) with posterior circulation occlusion, and there was no significant difference between them (adjusted χ² = 0.493, P = 0.483). Among 41 patients, 6 patients (14.63% ) had symptomatic intracranial hemorrhage, including 4 patients (16%, 4/25) with anterior circulation occlusion and 2 (2/16) with posterior circulation occlusion, and no significant difference was seen between them (adjusted χ² = 3.303, P = 0.856). Collateral compensation was evaluated in 33 patients (20 with anterior circulation occlusion and 13 with posterior patients circulation occlusion). In 20 patients with anterior circulation occlusion, 14 patients (70%) had good collateral compensation, in whom 9 (9/14) had good outcome 90 d after operation, while the other 6 patients (30%) had poor collateral compensation and then had good outcome 90 d after operation, and significant difference was seen between them (Fisher exact probability: P = 0.014). Among 13 patients with posterior circulation occlusion, 3 patients (3/13) had good collateral compensation and had good outcome 90 d after operation, while the other 10 (10/13) had poor collateral compensation, in whom one (1/10) had good outcome 90 d after operation, and significant difference was seen between them (Fisher exact probability: P = 0.014). Conclusions Endovascular thrombectomy is an efficient and safe method for acute ischemic stroke caused by acute large vessel occlusion. Rigorously master the indication and preoperative evaluation, and perfect acute rescue procedure and treatment for stroke may increase the efficacy of endovascular thrombectomy. [ABSTRACT FROM AUTHOR]

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Background and purpose Higher reperfusion rates have been established with endovascular treatment of acute ischemic stroke (AIS). There are limited data on the comparative performance of mechanical thrombectomy devices. Methods A retrospective single-center analysis was undertaken of all consecutive patients who underwent thrombectomy using Merci, Penumbra or stent retrievers (SR) from September 2010 to November 2012. Baseline characteristics, rates of successful recanalization (modified Thrombolysis in Cerebral Infarction (mTICI) score 2b - 3), symptomatic intracerebral hemorrhage (sICH), final infarct volume, 90-day mortality and independent functional outcomes at 90 days were compared across the three devices. Results Our cohort included 287 patients. There were mild imbalances in baseline characteristics with trends towards higher National Institutes of Health Stroke Scale (NIHSS) score in patients in the Merci group (SR=18 vs Merci=21 vs Penumbra=19, p=0.06) and lower Alberta Stroke Program Early CT Score (ASPECTS) in patients in the SR group (>7: SR=51% vs Merci=61% vs Penumbra=62%, p=0.12). On univariate analysis there were no differences in the rate of sICH (SR=7% vs Merci=7% vs Penumbra=6%, p=0.921) and infarct volume (SR=61.5 mL vs Merci=69.5 mL vs Penumbra=59.2 mL, p=0.621). Trends towards better functional outcomes were found with Penumbra and SR vs Merci (41% vs 36% vs 25%, respectively, p=0.079). Complete or near complete reperfusion (mTICI 2b - 3) was higher in the SR and Penumbra groups than in the Merci group (86% vs 78% vs 70%, respectively, p=0.027). Binary logistic regression showed that SR was an independent predictor of good functional outcome (OR 2.27, 95% CI 1.018 to 5.048; p=0.045). Conclusions Although our initial data confirm the superiority of SR technology over the Merci device, there was no significant difference in near complete/complete reperfusion, final infarct volumes or clinical outcomes between SR and Penumbra thromboaspiration. [ABSTRACT FROM AUTHOR]

Background: Uncontrolled blood pressure (BP) attributed to medication non-adherence may increase the risks of complications and of death. Purpose: This study aimed to identify factors that influence poor medication adherence in hypertensive patients and to establish the relationship between BP and medication adherence. Methods: This cross-sectional study enrolled 546 outpatients with hypertension from a regional hospital in eastern Taiwan. Data collected from participants included BP measurements and answers to a structured questionnaire. Descriptive statistics were performed for all measures as appropriate. Assessments of differences in adherence were based on demographic, medical history, and BP. Chi-Square test and Fisher's exact test for categorical variables or independent i-test for continuous variables were performed. The relationship between adherence and BP was analyzed using multiple regression analysis. All data were analyzed using SPSS 20.0 statistical analysis software. Results: A total of 30% of patients were classified in the poor adherence category. A significant difference was found between adherence and poor adherence groups in terms of: type of medication, side effects, and sources of medications. No significant difference, however, was found across the two adherence groups in terms of: number of pills, medication schedule, duration of hypertension and its related complications, and use of complementary-and-alternative medicine (CAM). The diastolic blood pressure (DBP) and mean arterial pressure (MAP) differed significantly between the two groups. However, no significant difference in systolic blood pressure (SBP) was identified between the two groups. When SBP and DBP were considered separately, the number of patients who had good and poor control of SBP and DBP differed significantly between the two groups. Side effects and sources of medications were significant predictors of adherence (p < .05). Adherence was a significant predictor of SBP and DBP (p < .05). Conclusions: Side effects and sources of medications were identified as factors that influence the medication adherence of Taiwanese patients, which was identified as a reliable predictor of BP outcome. [ABSTRACT FROM AUTHOR]

Background: Clear directions and explanations from nurses related to health behaviors and discharge procedures have been shown to effectively reduce the risk of patient readmission. Nurses thus need to develop good communication skills in order to ensure that their communications help patients become better-informed and less anxious about discharge procedures. Purpose: This research evaluates the communication skills of nurses following two different education interventions. Methods: Experimental design principles for education interventions were followed in this research. Medical nurses certified at the N to N2 level in a municipal hospital in Taipei City were enrolled as participants (N = 78) and divided into an experimental group and control group using stratified purposive randomization. The experimental group received clinical scenario-based simulation education for communication. The control group received standard class-based education for communication. Both groups received a pre-test evaluation and an OSCE post-test evaluation. Results were analyzed using SPSS 17.0 software. Results: Independent t-test results revealed significant increases in communication skills (t = 3.406, p < .05) in both groups, with the increase in the experimental group (M = 5.00, SD = 0.82) significantly greater than the increase in the control group (M = 4.11, SD = 1.41). However, the mean scores from the post-test standardized patient survey found no significant differences between the two groups in terms of communication skills. Conclusion: The results indicate that the clinical scenario-based simulation education intervention is more effective than traditional class-based education in enhancing the communication skills of nurses. [ABSTRACT FROM AUTHOR]

The procedure included chart review, the repetitive saliva swallowing test (RSST), and the modified water swallowing test (MWST). Dysphagia was defined as either RSST or MWST abnormal. JMP 9.0 was used to perform descriptive statistics, t-test, chi-square test and logistic regression analysis Results: At clinical examination, 53.61% of the study subjects demonstrated dysphagia. Chi-square analysis showed that five abnormal signs (could not close mouth with water, without mastication, food stuck in the throat, obvious sputum sound, and choking after swallowing) are all associated with dysphagia. Multiple logistic regression analysis revealed choking is a significant predictor variable of dysphagia. Conclusion: Over half of the rehabilitation unit stroke patients in this study had dysphagia. Nurses are the primary care providers for dysphagia patients. Therefore, there is a need for ward nurses to have skills to assess, recognize, and manage dysphagia and to enhance patient safety. [ABSTRACT FROM AUTHOR]

Background: Limited disease knowledge is frequently the cause of disease-related anxiety in myocardial infarction patients. The ability to communicate effectively serves multiple purposes in the professional nursing practice. By communicating effectively with myocardial infarction patients, nurses may help reduce their anxiety by keeping them well informed about their disease and teaching them self-care strategies. Purpose: This research evaluates the communication skills of nurses following scenario-based simulation education in the context of communication with myocardial infarction patients. Methods: This study used an experimental design and an educational intervention. The target population comprised nurses of medicine (clinical qualified level N to N2 for nursing) working at a municipal hospital in Taipei City, Taiwan. A total 122 participants were enrolled. Stratified block randomization divided participants into an experimental group and a control group. The experimental group received clinical scenario-based simulation education for communication. The control group received traditional class-based education for communication. Both groups received a pre-test and a Communication Skills Checklist post-test assessment. Results were analyzed using SPSS 17.0 for Windows software. Results: A t-test showed significant increases in communication skills (p < .001) in the experimental group and ANCOVA results identified significant between-group differences (p < .001) in communication skills following the education intervention. Conclusions: The results indicate that clinical scenario-based simulation education for communication is significantly more effective than traditional class-based education in enhancing the ability of nurses to communicate effectively with myocardial infarction patients. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that cardiovascular rehabilitation exercise improves quality of life in post-coronary-bypass-surgery patients. However, the rate of participation in this exercise by this patient group in Taiwan has increased only 8.2% during the past 13 years (from 61.9% in 1996 to 70.1% in 2009). Little is known about the factors that influence patient motivation to participate in cardiovascular rehabilitation exercise. Purpose: This study explores the factors that influence patient participation in rehabilitation exercise following coronary bypass surgery. Methods: This cross-sectional, correlational study recruited a convenience sample of 253 patients who had undergone coronary bypass surgery at a medical center in southern Taiwan. Structured questionnaires, including a patient rehabilitation exercise experience questionnaire, Short Form-36 Health Survey-Taiwan Form, and cardiac rehabilitation exercise design factors questionnaire were used for data collection. SPSS19.0 was used to analyze data. Results: The variables "healthcare provider recommendation of rehabilitation exercise", "exercise program accessibility", "physical health status", and "patient post-surgical exercise patterns" each had a significant influence on participant participation in post-surgical rehabilitation exercise. Binary logistic regression analyses identified "receiving information on rehabilitation exercise", "level of patient-perceived importance of rehabilitation exercise", and "having post-surgical exercise patterns" as important predictors of participation in a rehabilitation exercise program, with OR ratios of 112, 7.86, and 3.23 times respectively. These 3 factors accounted for 90.1% of the total variance. Conclusion: Patient education on coronary bypass post-surgical rehabilitation exercise programs should be emphasized during pre-surgical consultation and care in order to facilitate the recovery of normal life functions following coronary bypass surgery. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to develop a health education program for preschoolers who have defected from North Korea with their mothers, and to evaluate the effects on health knowledge and behavior. Methods: A non-equivalent control group pre-post test design was used with 58 preschoolers who were assigned to either the experimental or control group (29 for each group). The program was composed of five sessions in health education and contracts. To test the effectiveness of the intervention, health knowledge and behaviors, and total bacterial colony counts on hands were measured at one pretest and two post tests (1 week and 4 weeks after the intervention ended). Data were analyzed using the SAS program. Results: Health knowledge and behavior in the experimental group increased significantly compared to the control group. The effects of the intervention were evident even at 4 weeks after the intervention ended. Total bacterial colony counts in the experimental group decreased significantly at the 1 and 4 week posttest intervention compared to the control group. Conclusion: Results indicate that this program is effective in improving health knowledge and behavior in these children and therefore can be utilized to ensure efficient management their health care. [ABSTRACT FROM AUTHOR]

Background and objective Targeted therapy in non-small cell lung cancer (NSCLC) had become a research hotspot. Both of gefitinib and erlotinib had already been recommended as first line treatment in epidermal growth factor receptor (EGFR) mutant advanced NSCLC patients. The study aimed to compare the effectiveness and prognosis of advanced NSCLC with gefitinib or erlotinib, as well as the cost-effectiveness ratio of the two drugs. Methods Data of 66 EGFR mutant NSCLC patients who were included in Guangzhou medical insurance were analyzed. The efficacy and adverse reactions were evaluated. All the patients were followed-up regularly and the cost of the treatment was recorded. Results The median progression free survival (PFS) of all patients was 15.0 months. 49 patients received gefintib and 17 patients had erlotinib. The PFS for the two groups of patients was 17.5 month and 13 months, respectively (P=0.459). 31 (62.3%) patients had rash in gefitinib group, 16 (94.1%) in erlotinib group. Cost-effectiveness ratio (CER) in gefitinib group was 3,027 RMB per month, while 6,800 RMB in erlotinib group. The incremental cost-effectiveness ratio (ICEA) of erlotinib was 2.25 times of gefitinib. Conclusion For EGFR mutant advanced NSCLC patients, equal efficacy and survival benefit were observed in patients with gefitinib and erlotinib. The adverse reaction was milder in gefitinib group than that of erlotinib group. And with Guangzhou medical insurance, gefitinib had a superior cost-effectiveness ratio. [ABSTRACT FROM AUTHOR]