Abstract Chen W-Y, Jang Y, Wang J-D, Huang W-N, Chang C-C, Mao H-F, Wang Y-H. Wheelchair-related accidents: relationship with wheelchair-using behavior in active community wheelchair users. Objective ...To report the prevalence, mechanisms, self-perceived causes, consequences, and wheelchair-using behaviors associated with wheelchair-related accidents. Design A case-control study. Setting Community. Participants A sample of experienced, community-dwelling, active manual and powered wheelchair users (N=95) recruited from a hospital assistive technology service center. Interventions Not applicable. Main Outcome Measures Wheelchair-using behaviors, wheelchair-related accidents over a 3-year period, and the mechanisms and consequences of the accidents. Results Among the 95 participants, 52 (54.7%) reported at least 1 accident and 16 (16.8%) reported 2 or more accidents during the 3 years prior to the interview. A total of 74 accidents, were categorized into tips and falls (87.8%), accidental contact (6.8%), and dangerous operations (5.4%). A logistic regression found individuals who failed to maintain their wheelchairs regularly (odds ratio OR=11.28; 95% confidence interval CI, 2.62–48.61) and used a wheelchair not prescribed by professionals (OR=4.31; 95% CI, 1.10–16.82) had significantly greater risks of accidents. In addition to the risk factor, lack of regular wheelchair maintenance, the Poisson regression corroborated the other risk factor, seat belts not used (incident rate ratio=2.14; 95% CI, 1.08–4.14), for wheelchair-related accidents. Conclusions Wheelchair-related accidents are closely related to their wheelchair-using behaviors. Services including professional evaluation, repair, maintenance, and an educational program on proper wheelchair use may decrease the risks of wheelchair accidents.
Abstract Chang F-H, Wang Y-H, Jang Y, Wang C-W. Factors associated with quality of life among people with spinal cord injury: application of the International Classification of Functioning, ...Disability and Health Model. Objective To identify the factors that influence an individual's quality of life (QOL) after spinal cord injury (SCI) based on the International Classification of Functioning, Disability and Health (ICF) framework. Design Cross-sectional exploratory study. Setting Taiwan community. Participants Community-dwelling adults (N=341) who had suffered an SCI at least 1 year previously and were between the ages of 18 and 60 years. Interventions Not applicable. Main Outcome Measure(s) A combination of self-report questionnaire and interview. The dependent variable, QOL, was measured by the abbreviated version of the World Health Organization Quality of Life, while the independent variables—participation, activity, impairment, and contextual factors—were measured using the Frenchay Activity Index, Barthel Index, and a demographic form. Results Multivariate analysis results indicated that participation, activity, and marital status are significant factors in the QOL outcome. Results also indicated that among the various factors that affect each domain of QOL (physical health, psychological health, social relationships, and environment), participation was the strongest determinant. Conclusions The ICF provided an excellent framework with which to explore the factors influencing QOL after SCI. The results demonstrated that marital status, participation, and activity exert the strongest influence on QOL, while impairment and other variables do not directly influence QOL.
To investigate the efficacy and safety of fractionated boron neutron capture therapy (BNCT) for recurrent head and neck (H&N) cancer after photon radiation therapy.
In this prospective phase 1/2 ...trial, 2-fraction BNCT with intravenous L-boronophenylalanine (L-BPA, 400 mg/kg) was administered at a 28-day interval. Before each fraction, fluorine-18-labeled-BPA-positron emission tomography was conducted to determine the tumor/normal tissue ratio of an individual tumor. The prescription dose (D80) of 20 Gy-Eq per fraction was selected to cover 80% of the gross tumor volume by using a dose volume histogram, while minimizing the volume of oral mucosa receiving >10 Gy-Eq. Tumor responses and adverse effects were assessed using the Response Evaluation Criteria in Solid Tumors v1.1 and the Common Terminology Criteria for Adverse Events v3.0, respectively.
Seventeen patients with a previous cumulative radiation dose of 63-165 Gy were enrolled. All but 2 participants received 2 fractions of BNCT. The median tumor/normal tissue ratio was 3.4 for the first fraction and 2.5 for the second, whereas the median D80 for the first and second fraction was 19.8 and 14.6 Gy-Eq, respectively. After a median follow-up period of 19.7 months (range, 5.2-52 mo), 6 participants exhibited a complete response and 6 exhibited a partial response. Regarding acute toxicity, 5 participants showed grade 3 mucositis and 1 participant showed grade 4 laryngeal edema and carotid hemorrhage. Regarding late toxicity, 2 participants exhibited grade 3 cranial neuropathy. Four of six participants (67%) receiving total D80 > 40 Gy-Eq had a complete response. Two-year overall survival was 47%. Two-year locoregional control was 28%.
Our results suggested that 2-fraction BNCT with adaptive dose prescription was effective and safe in locally recurrent H&N cancer. Modifications to our protocol may yield more satisfactory results in the future.
Abstract Objective To apply the International Classification of Functioning, Disability and Health (ICF) model to fall prevention by developing an ICF core set for fall risks in acute rehabilitation ...settings. Design Fall risk factors were identified based on a systematic review of the literature and linked to ICF categories. A consensus process was conducted using a Delphi-based evaluation technique. Setting University-based hospital. Participants Multidisciplinary participants (N=20) from different institutions. Interventions Not applicable. Main Outcome Measures A 5-point Likert-type scale was used to weigh the importance of each risk category. The level of agreement for each consensus was assessed based on Spearman rho and semi-interquartile range indices. Categories with a mean score ≥4 in the third round of evaluation were included in this ICF core set. Results The core set comprised 34 fall risk categories that were distributed as follows: 18 categories on body functions, 2 on body structures, 8 on activities and participation, 4 on environmental factors, and 2 categories on personal factors. Conclusions An ICF core set for falls in acute rehabilitation settings was developed in this study. Further validation is required.
Abstract Chiu H-T, Wang Y-H, Jeng J-S, Chen B-B, Pan S-L. Effect of functional status on survival in patients with stroke: is independent ambulation a key determinant? Objective To investigate the ...effect of functional status, measured using the Modified Rankin Scale (MRS), at 3 months after stroke on survival in patients with stroke. Design Cohort study. Setting Referral medical center. Participants Patients with stroke (N=1032). Interventions Not applicable. Main Outcome Measure Survival after stroke. Results The Kaplan-Meier survival curves stratified by the 3-month MRS score showed 2 clear groups of patients with 3-month MRS scores of 0 to 3 (able to walk without assistance) and 4 or 5 (unable to walk without assistance). Accordingly, we grouped the patients into a high function (HF) group (3-month MRS≦3) and a low function (LF) group (3-month MRS≧4). Multiple Cox regression analysis showed that the LF group had significantly poorer survival (adjusted hazard ratio=4.69; 95% confidence interval CI, 2.89–7.60; P <.001) than the HF group. Other significant risk factors of higher mortality were older age, history of diabetes mellitus, and heart disease. Conclusions This study showed a significant influence of the 3-month MRS score on stroke survival. Moreover, independent ambulation may be a major determinant of a favorable survival prognosis. This finding suggests a potential role of rehabilitation in promoting stroke survival by maximizing ambulation function.
Background A variety of complications occur in patients with pulmonary tuberculosis. The feasibility of a thoracoscopic approach to anatomic lung resection for the complications of mycobacterial ...infection has not been well evaluated. Methods We retrospectively analyzed chest computed tomography (CT) scans of patients who underwent anatomic lung resections without additional procedures for tuberculosis between January 2007 and September 2009. Image characteristics on chest CT scans were classified as bullae, pleural thickening, peribronchial lymph node calcification, tuberculoma, cavity, aspergilloma, atelectasis, and bronchiectasis, and graded according to the number of the lesions and degree of lobar involvement. Patients were divided into two groups, video-assisted thoracoscopic surgery (VATS) and thoracotomy for anatomic lung surgery, according to the eventual operative procedure. The variables between these two groups were compared using the Student t test; the image characteristics were compared using a χ2 test. Results Fifty patients were enrolled; 21 given VATS and 29 given a thoracotomy. The VATS group had significantly lower gradings in pleural thickening, peribronchial lymph node calcification, tuberculoma, cavity, and aspergilloma than did the thoracotomy group ( p = 0.000, 0.015, 0.001, 0.023, and 0.022, respectively). Mean operative time, blood loss, and complication rate were not significantly different, but the mean hospital stay was significantly shorter (10.00 days versus 14.96 days, p = 0.048) in the VATS group. Conclusions Multiple cavities, multiple aspergillomas, multilobar tuberculoma, extensive pleural thickening, and peribronchial lymph node calcification preclude VATS. It is reasonable to attempt a thoracoscopic approach in patients without these preoperative image characteristics.
Background Autonomous secretion of aldosterone in patients with primary aldosteronism increases glomerular filtration rate and causes kidney damage. The influence of a mild decrease in kidney ...function on residual hypertension after adrenalectomy is unexplored. Study Design Nonconcurrent prospective study. Setting & Participants The study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database. 150 patients (61 men; overall mean age, 47.2 ± 11.6 years) with a diagnosis of aldosterone-producing adenoma had undergone unilateral adrenalectomy at National Taiwan University Hospital from July 1999 to January 2007. Predictor Presurgery estimated glomerular filtration rate (eGFR). Outcomes & Measurements Residual hypertension after adrenalectomy, defined either as less than 75% of recorded blood pressure measurements with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg or requiring antihypertensive medications during the first year after surgery. Results Before surgery, 27 (18%), 72 (48%), and 51 (34%) patients had moderately to severely decreased (<60 mL/min/1.73 m2 ), mildly decreased (60 ≤ eGFR < 90 mL/min/1.73 m2 ), or nondecreased eGFR (≥90 mL/min/1.73 m2 ), respectively. After surgery, 16 (59.3%), 29 (40.3%), and 10 (19.3%) patients in each category had postsurgery residual hypertension. Compared with patients without decreased eGFR before surgery, adjusted odds ratios for postsurgery residual hypertension were 2.7 (95% confidence interval, 1.03 to 7.0; P = 0.04) and 2.8 (95% confidence interval, 1.05 to 9.3) for mildly and moderately to severely decreased eGFR, respectively. Limitations Arbitrary definition for residual hypertension. Conclusions Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy. Kidney function impairment, even mild, appears to be associated with a high incidence of postsurgery residual hypertension.
Abstract Hou W-H, Chen J-H, Wang Y-H, Wang C-H, Lin J-H, Hsueh I-P, Ou Y-C, Hsieh C-L. Development of a set of functional hierarchical balance short forms for patients with stroke. Objective To ...develop a set of 3 hierarchical balance short forms (HBSF; containing sitting, standing, and stepping forms) to measure balance function in patients with stroke. Design First, we developed the HBSF, based on a previous data set, with each short form containing 6 items. Second, we examined the psychometric properties and efficiency of the HBSF. Setting Six teaching hospitals. Participants Patients with stroke (n=764) for the first part of this study; inpatients and outpatients (n=85) for the second part of this study. Interventions Not applicable. Main Outcome Measures We used the item bank (9 sitting-related, 14 standing-related, and 13 stepping-related items) from the Balance Computerized Adaptive Test to develop the HBSF. Both the HBSF and the Berg Balance Scale (BBS) were administered to patients, to determine the concurrent validity and time needed for administration of both measures. Each patient was assessed by 1 of the 3 short forms selected by a rater. Results The reliability of the HBSF was relatively high (reliability coefficients, .94–.95). The scores of the HBSF were highly correlated with those of the BBS (Spearman ρ=.80–.91), supporting the concurrent validity of the HBSF. The average time needed to administer the HBSF was 122 seconds (ie, about 40% of that for the BBS). Conclusions Our results provide sufficient evidence that the HBSF is an efficient, reliable, valid, and practical way to measure balance function in patients with stroke.
Abstract Liang H-W, Wang Y-H, Pan S-L, Wang TG, Huang T-S. Asymptomatic median mononeuropathy among men with chronic paraplegia. Objectives To compare electrophysiologic abnormalities of the median ...nerve in asymptomatic paraplegic subjects and able-bodied controls and to examine the influence of personal factors on these parameters. Design Cross-sectional survey. Setting University hospital. Participants Forty-seven men with paraplegia and 36 able-bodied controls underwent nerve conduction studies on both upper limbs. All were free of hand numbness in the past month, diabetic mellitus, or neuromusculoskeletal injuries to the upper limbs. Interventions Not applicable. Main Outcome Measure Nerve conduction studies of the bilateral median and ulnar nerves. Results Although the 2 groups were of comparable age and had a similar body mass index (BMI), the subjects with paraplegia had a significantly higher proportion of asymptomatic median mononeuropathy than the controls (25.5% vs 5.6%, P =.02). The spinal cord injury (SCI) group had a prolonged median distal latency and a slowed digit-wrist sensory nerve conduction velocity. Multivariate general linear model analysis showed that prolonged motor and sensory latencies of the median nerve were associated with the SCI group and with greater BMI. Conclusions The asymptomatic subjects with paraplegia had a significantly higher frequency of median mononeuropathy than the able-bodied controls. There was also an association between BMI and distal latency of the median nerve.
Background We performed an assessment of an independent rapid flu clinic service (RFCS) unit, which was set up outside the emergency department (ED) during the 2009 H1N1 pandemic season. The unit was ...able to relieve the crowding of regular ambulatory and emergency services. Methods Between August and December 2009, a total of 6,152 patients with influenza-like illness were enrolled in this observational retrospective study. Patients with positive influenza tests were interviewed to evaluate the efficiency of RFCS. Results The mean length of stay (LOS) for the RFCS was 50 minutes, which was shorter than the LOS for ambulatory services (1 hour) and regular ED services (3.5 hours). Overall, 88% of patients were satisfied with the RFCS. Of 6,152 patients receiving flu tests, 1,235 (20%) had a positive result. Fever (odds ratio OR, 4.28, 95% confidence interval CI: 3.11-5.89), fever combined with cough and sore throat (OR, 2.52; 95% CI: 2.18-2.92), fever combined with sore throat (OR, 2.42; 95% CI: 2.13-2.75), history of contacting confirmed flu patients within 7 days (OR, 2.40; 95% CI: 2.07-2.78), fever combined with cough (OR, 2.19; 95% CI: 1.92-2.47), sore throat (OR, 2.03, 95% CI: 1.79-2.30); and cough (OR, 1.91, 95% CI: 1.69-2.17) were significantly associated with positive influenza tests. Conclusion Setting up the RFSC was beneficial to health care facilities during a pandemic flu season.
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