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Background: While the impact of telephone follow-up (TFU) for older emergency department (ED) patients is controversial, its effects on the Asian population remain uncertain. In this study, we evaluated the effectiveness of a novel computer assisted TFU model specifically for this demographic. Methods: At a Taiwanese tertiary medical center, we developed a TFU protocol that included a referral and case management system within the ED hospital information system. We provided TFU to older discharged patients between April 1, 2021, and May 31, 2021. We compared this cohort with a non-TFU cohort of older ED patients and analyzed demographic characteristics and post-ED discharge outcomes. Results: The TFU model was successfully implemented, with 395 patients receiving TFU and 191 without TFU. TFU patients (median age: 76 years, male proportion: 48.9%) differed from non-TFU patients (median age: 74 years, male proportion: 43.5%). Compared with the non-TFU cohort, the multivariate logistic regression analysis revealed that the TFU cohort had a lower total medical expenditure < 1 month (adjusted odds ratio [AOR]: 0.32; 95% CI: 0.21 − 0.47 for amounts exceeding 5,000 New Taiwan Dollars), and higher satisfaction (AOR: 2.80; 95% CI: 1.46 − 5.36 for scores > 3 on a five-point Likert Scale). However, the TFU cohort also had a higher risk of hospitalization < 1 month (AOR: 2.50; 95% CI: 1.31 − 4.77) compared to the non-TFU cohort. Conclusion: Computer-assisted TFU appears promising. Further research involving a larger number of patients and validation in other hospitals is necessary to bolster the evidence and extend the findings to a broader context. [ABSTRACT FROM AUTHOR]

People with dementia (PwD) who receive home healthcare (HHC) may have distressing symptoms, complex care needs and high mortality rates. However, there are few studies investigating the determinants of mortality in HHC recipients. To identify end-of-life care needs and tailor individualized care goals, we aim to explore the mortality rate and its determinants among PwD receiving HHC. We conducted a retrospective cohort study using a Taiwanese national population database. People with new dementia diagnosis in 2007–2016 who received HHC were included. We calculated the accumulative mortality rate and applied Poisson regression model to estimate the risk of mortality for each variable (adjusted risk ratios, aRR) with a 95% confidence interval (CI). We included 95,831 PwD and 57,036 (59.5%) of them died during the follow-up period (30.5% died in the first-year). Among comorbidities, cirrhosis was associated with the highest mortality risks (aRR 1.65, 95% CI 1.49–1.83). Among HHC-related factors, higher visit frequency of HHC (> 2 versus ≦1 times/month, aRR 3.52, 95% CI 3.39–3.66) and higher level of resource utilization group (RUG, RUG 4 versus 1, aRR = 1.38, 95% CI 1.25–1.51) were risk factor of mortality risk. Meanwhile, HHC provided by physician and nurse was related to reduced mortality risk (aRR 0.79, 95% CI 0.77–0.81) compared to those provided by nurse only. Anticipatory care planning and timely end-of life care should be integrated in light of the high mortality rate among PwD receiving HHC. Determinants associated with increased mortality risk facilitate the identification of high risk group and tailoring the appropriate care goals. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020. [ABSTRACT FROM AUTHOR]

Aims: A computerized tool and interdisciplinary care were implemented to develop a novel model for older patients with delirium in the emergency department (ED). Methods: We developed a computerized tool using a delirium triage screen and brief confusion assessment in the hospital information system, performed education for the healthcare providers, and developed a continuous care protocol. Comparisons for outcomes between pre- and post-intervention periods were performed. Results: Compared with the pre-intervention period, patients in the post-intervention period had shorter hospitalization stay, lower expenditure of hospitalization, more likely to return home, lower ED revisits of ≤ 3 days, re-hospitalization of ≤ 14 days, and mortality of ≤ 1 month. All mentioned differences were not statistically significant. Conclusions: A novel model was successfully developed for delirium management in older patients in the ED. Outcome differences were not significant; however, the result is promising, which gives us an important reference in the future. [ABSTRACT FROM AUTHOR]

Aim: Home healthcare (HHC) provides continuous care for disabled patients. However, HHC referral after the emergency department (ED) discharge remains unclear. Thus, this study aimed its clarification. Methods: A computer-assisted HHC referral by interdisciplinary collaboration among emergency physicians, case managers, nurse practitioners, geriatricians, and HHC nurses was built in a tertiary medical center in Taiwan. Patients who had HHC referrals after ED discharge between February 1, 2020 and September 31, 2020, were recruited into the study. A non-ED HHC cohort who had HHC referrals after hospitalization from the ED was also identified. Comparison for clinical characteristics and uses of medical resources was performed between ED HHC and non-ED HHC cohorts. Results: The model was successfully implemented. In total, 34 patients with ED HHC and 40 patients with non-ED HHC were recruited into the study. The female proportion was 61.8% and 67.5%, and the mean age was 81.5 and 83.7 years in ED HHC and non-ED HHC cohorts, respectively. No significant difference was found in sex, age, underlying comorbidities, and ED diagnoses between the two cohorts. The ED HHC cohort had a lower median total medical expenditure within 3 months (34,030.0 vs. 56,624.0 New Taiwan Dollars, p = 0.021) compared with the non-ED HHC cohort. Compared to the non-ED HHC cohort, the ED HHC cohort had a lower ≤ 1 month ED visit, ≤ 6 months ED visit, and ≤ 3 months hospitalization; however, differences were not significant. Conclusion: An innovative ED HHC model was successfully implemented. Further studies with more patients are warranted to investigate the impact. [ABSTRACT FROM AUTHOR]

An efficient urban environmental design considers appropriate thermal comfort condition, shaded space, and activity intensity. Physiologically equivalent temperature (PET) and visible sky, i.e., the sky view factor (SVF), are usually used as indicators to determine the outdoor thermal comfort and amount of shaded space, respectively. The activity intensity in urban parks, which is dependent on culture and micrometeorological conditions, was represented inappropriately by attendance density in Taiwan. To optimize the park design and improve the park utilization rate in Taiwan, several environmental factors such as sound pressure levels and numbers of park visitors were measured, and PET values and SVF values were calculated from primary micrometeorological data such as wind speed and globe temperature. This study proposed equivalent continuous sound pressure level (Leq) as a novel indicator to represent park activity intensity and investigated the correlation between Leq and SVF at different PET values. Leq was more appropriate than was attendance density in representing the park activity intensity in Taiwan. In addition, Leq was highly negatively correlated with SVF when visitors felt that the outdoor thermal comfort condition was hot or very hot. In other words, a lower degree of shading in the park resulted in lower activity intensity. Park visitors tended to engage in activities in the shaded regions because of more favorable thermal comfort conditions (i.e., neutral PET). The established quantitative relationships among Leq, PET, and SVF can serve as a reference for park planning. [ABSTRACT FROM AUTHOR]

Thermal comfort is a subjective psychological perception of people based also on physiological thermoregulation mechanisms when the human body is exposed to a combination of various environmental factors including air temperature, air humidity, wind speed, and radiation conditions. Due to the importance of gender in the issue of outdoor thermal comfort, this study compared and examined the thermal comfort-related differences between male and female subjects using previous data from Taiwanese questionnaire survey. Compared with males, the results indicated that females in Taiwan are less tolerant to hot conditions and intensely protect themselves from sun exposure. Our analytical results are inconsistent with the findings of previous physiological studies concerning thermal comfort indicating that females have superior thermal physiological tolerance than males. On the contrary, our findings can be interpreted on psychological level. Environmental behavioral learning theory was adopted in this study to elucidate this observed contradiction between the autonomic thermal physiological and psychological-behavioral aspects. Women might desire for a light skin tone through social learning processes, such as observation and education, which is subsequently reflected in their psychological perceptions (fears of heat and sun exposure) and behavioral adjustments (carrying umbrellas or searching for shade). Hence, these unique psychological and behavioral phenomena cannot be directly explained by autonomic physiological thermoregulation mechanisms. The findings of this study serve as a reference for designing spaces that accommodates gender-specific thermal comfort characteristics. Recommendations include providing additional suitable sheltered areas in open areas, such as city squares and parks, to satisfy the thermal comfort needs of females. [ABSTRACT FROM AUTHOR]