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Objective. To investigate whether early rehabilitation reduces the occurrence of posttotal hip arthroplasty (THA) complications, adverse events, and medical expenses within one postoperative year. Method. We retrospectively retrieve data from Taiwan’s National Health Insurance Research Database. Patients who had undergone THA during the period from 1998 to 2010 were recruited, matched for propensity scores, and divided into 2 groups: early rehabilitation (Early Rehab) and delayed rehabilitation (Delayed Rehab). Results. Eight hundred twenty of 999 THA patients given early rehabilitation treatments were matched to 205 of 233 THA patients given delayed rehabilitation treatments. The Delayed Rehab group had significantly (all p<0.001) higher medical and rehabilitation expenses and more outpatient department (OPD) visits than the Early Rehab group. In addition, the Delayed Rehab group was associated with more prosthetic infection (odds ratio (OR): 3.152; 95% confidence interval (CI): 1.211–8.203; p<0.05) than the Early Rehab group. Conclusions. Early rehabilitation can significantly reduce the incidence of prosthetic infection, total rehabilitation expense, total medical expenses, and number of OPD visits within the first year after THA. [ABSTRACT FROM AUTHOR]

Identifying the concerns of terminal cancer patients and respecting their wishes is important in clinical decision-making concerning the provision of artificial nutrition and hydration (ANH). The aim of this study was to discover terminal cancer patients'' wishes and determine influencing factors toward the provision of ANH. One hundred and ninety-seven patients with terminal cancer, admitted to a palliative care unit in Taiwan over a two-year period, completed a questionnaire interview, which included demographic characteristics, knowledge and attitudes on ANH, the health locus of control, subjective norms, and the wishes to use ANH. One hundred and fifty-four patients (78.2%) used ANH in the past month. A knowledge test on issues related to ANH showed the rates of accurate responses were ranked as: peripheral intravenous route can only provide hydration (48.7%), excessive artificial nutrition may increase the proliferation of cancer cells (32%), ANH can prolong life expectancy for all patients (17.3%), and ANH can prevent all patients from starving to death (5.6%). The strongest attitude of patients toward the potential benefit of ANH was “it can provide the body need with nutrition and hydration when inability to eat or drink occurs.” Otherwise, the strongest attitude toward the potential burdens of ANH was “gastrostomy makes the illness worse.” One hundred and twenty-two of 197 patients (62.9%) expressed their wishes to have ANH. The results of logistic regression analysis showed that the experience of using a nasogastric tube and intravenous fluids, and subjective norms were the most significant variables related to the wishes of patients to use ANH (odds ratio [OR] = 11.11, 95% confidence interval [CI] = 3.20–38.64; OR = 2.51, 95% CI = 1.22–5.15, OR = 1.30, 95% CI = 1.05–-1.60, respectively). However, the use of artificial nutrition was negatively affected by the knowledge of ANH (OR = 0.53, 95% CI = 0.37–0.84). In conclusion, Taiwanese patients with terminal cancer have insufficient knowledge about AHN and still believe in the benefits of ANH, especially in avoiding dehydration or starvation. The findings of this study indicate the importance of medical professional training and decision-making in the initial consideration of using ANH. By improving the knowledge about ANH among patients, more appropriate decisions can be achieved. [Copyright &y& Elsevier]

An analysis of the geographical distribution of typhoid incidence rates, based on various statistical approaches such as trend surface, spatial autocorrelation, spatial correlation and spatial regression, was carried out at the county level in Jiangsu province, People's Republic of China. Temperature, moisture content, proximity to water bodies and the normalized difference vegetation index in the autumn were the four underlying factors found to contribute the most to the development of the epidemic. Typhoid infection was most severe in the south-eastern region of Jiangsu and a significant hotspot with high positive autocorrelation was detected in Taicang county in the south-east of the province. To improve the typhoid situation, intervention efforts should be concentrated in the south-eastern region of the province, targeting the hotspot and include reduction of lake pollution.

We prospectively identified prognostic factors and developed a prognostic scale in 356 Taiwanese terminal cancer patients (training set). Demographic data, severity of symptoms/signs, and survival were statistically analyzed to create the scale, which was tested in another 184 patients (testing set). In the training set, liver and lung metastases, functional performance status, weight loss, edema, cognitive impairment, tiredness, and ascites were independently associated with shorter survival (multivariate analysis). The scale ranged from 0.0 (no altered variables) to 8.5 (maximal alteration for all variables). When scores were < 3.5, 2-week survival was predicted with 0.72 and 0.61 accuracy for the training and testing sets, respectively. With scores < 6.0, 1-week survival was predicted with 0.72 and 0.66 accuracy, respectively. This scale, which includes lung and liver metastases and severity of symptoms/signs, may help in identifying the stage of dying and its corresponding symptoms/signs and also in improving survival prediction in terminal cancer patients., (Copyright 2004 U.S. Cancer Pain Relief Committee)

Patient-related barriers and their solution in the planning of discharge to palliative home care were investigated through a nationwide survey conducted in Taiwan. Of 250 questionnaires sent to palliative care workers at 15 hospices in Taiwan, 229 valid questionnaires (91.6%) were retrieved. Most of the respondents were nursing staff (72.5%) while only 38 were physicians (16.6%). Canonical correlation analysis was used to examine the association between the barriers and solutions, and revealed that the value of the first variate was 0.49 ( P<0.05). The barriers and canonical loadings were: unable to manage emergent medical conditions (0.83), the quality of care in the hospital is better (0.74), and insufficient number of caregivers (0.72). The effective solutions that correlated significantly with the above factors were ranked as: to reassure the patient about the possibility of smooth readmission (0.84), to arrange palliative home care programs (0.68), and to educate family members on taking care of the patient at home (0.64). In conclusion, to solve patient-related barriers in the planning of the discharge of patients with terminal cancer, the results suggest that (1). health professionals involved in the care of patients with terminal cancer should have adequate knowledge of palliative care, particularly communication skills, (2). an effective referral system among general or oncology and palliative care units should be established, (3). inpatient care facilities and home-care programs should be provided, and (4). patients and families should be educated as to what may happen and how to manage these conditions at home and should be assured of the availability of medical help.

The study investigated the puzzling factors and solutions of family-related barriers to truthfulness with patients with terminal cancer through a nationwide survey conducted in Taiwan. Two-hundred twenty-nine valid questionnaires were retrieved (91.6%) from 250 palliative care workers at 15 Taiwan hospices. Most of the respondents were nursing staff (72.5%), and only 38 respondents were physicians (16.6%). Canonical correlation analysis was used to examine the association between the puzzling factors and solutions, which revealed that the value of the first variate was 0.39 (P < .05). Results showed that the puzzling factors of barriers and canonical loadings were families do not know how to tell the truth (.85), families believe it is unnecessary to tell aged patients the truth (.71), and patients can be happier without knowing the truth (.70). The valid solutions correlated significantly with the above puzzling factors and were ranked in the following order: communicate with and encourage families to accept patients' prognoses (.83), discuss the sickness gently with patients and determine what patients know (.76), and tell the families about the possible emotional reactions in patients and how to provide support (.72). In conclusion, for solving family-related barriers to truthfulness in cases of terminal cancer, the results suggest that health professionals communicate with families first and discuss the possible emotional reactions from patients, give patients enough time to reflect on their sicknesses and discuss further what patients have been told, and then disclose information based on patients' expectations and support them.