Nasogastric tube feeding versus assisted hand feeding in-home healthcare older adults with severe dementia in Taiwan: a prognosis comparison.

BACKGROUND: All individuals with severe dementia should be offered careful hand feeding. However, under certain circumstances, people with severe dementia have a feeding tube placed. In Taiwan, tube feeding rate in demented older home care residents is increasing; however, the benefits of tube feeding in this population remain unknown. We compared the clinical prognosis and mortality of older patients with severe dementia receiving nasogastric tube feeding (NGF) or assisted hand feeding (AHF). METHODS: Data from the in-home healthcare system between January 1 and December 31, 2017 were analyzed to identify 169 participants over 60 years of age in this retrospective longitudinal study. All subjects with severe dementia and complete functional dependence suffered from difficulty in oral intake and required either AHF or NGF. Data were collected from both groups to analyze pneumonia, hospitalization, and mortality rates. RESULTS: A total of 169 subjects (56 males and 113 females, aged 85.9 ± 7.5 years) were analyzed. 39 required AHF and 130 NGF. All subjects were bedridden; 129 (76%) showed Barthel index < 10. Pneumonia risk was higher in the NGF group (48%) than in the AHF group (26%, p = 0.015). After adjusting for multiple factors in the regression model, the risk of pneumonia was not significantly higher in the NGF group compared with the AHF group. One-year mortality rates in the AHF and NGF groups were 8 and 15%, respectively, and no significant difference was observed after adjustment with logistic regression (aOR = 2.38; 95% CI, 0.58-9.70). There were no significant differences in hospitalization rate and duration. CONCLUSIONS: For older patients with dementia requiring in-home healthcare, NGF is not associated with a significantly lower risk of pneumonia than AHF. Additionally, neither mortality nor hospitalization rates decreased with NGF. On the contrary, a nonsignificant trend of increased risk of pneumonia was observed in NGF group. Therefore, the benefits of NGF are debatable in older patients with severe dementia requiring in-home healthcare. Continued careful hand feeding could be an alternative to NG feeding in patients with severe dementia. Furthermore, large-scale studies on in-home healthcare would be required to support these results.

Effect of music interventions on anxiety during labor: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Anxiety is commonly experienced during the delivery process and has shown to have adverse effects on maternal and infant health outcomes. Music interventions tend to reduce the effects of anxiety in diverse populations, are low cost, are easily accessible, and have high acceptability. The aim of this review and meta-analysis was to assess the effectiveness of music interventions in reducing anxiety levels among women during labor. METHODS: Seven databases from inception to the end of December, 2018, without any language or time restriction including Embase, PubMed, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, PsycINFO, Airiti Library, and PerioPath: Index to Taiwan Periodical Literature were searched using key terms related to pregnancy, anxiety, and music. Randomized controlled trials that assessed the effect of music during labor and measured anxiety levels as an outcome were included. Meta-analyses were conducted to assess anxiety reduction following a music intervention compared to that after placebo treatment. RESULTS: A total of 14 studies that investigated a total of 1,310 participants were included in this review. The meta-analyses indicated that those in the intervention group had a significant decrease in anxiety scores (standardized mean difference = -2.40, 95% confidence interval (CI) [-3.29 to -1.52], p < 0.001; I 2 = 97.66%), heart rate (HR) (difference in means = -3.04 beats/min, 95% CI [-4.79 to -1.29] beats/min, p = 0.001; I 2 = 0.00%), systolic blood pressure (SBP) (difference in means = -3.71 mmHg, 95% CI [-7.07 to -0.35] mmHg, p = 0.031; I 2 = 58.47%), and diastolic blood pressure (DBP) (difference in means = -3.54 mmHg, 95% CI [-5.27 to -1.81] mmHg, p < 0.001; I 2 = 0.00%) as compared to the women in the control group. CONCLUSIONS: Music interventions may decrease anxiety scores and physiological indexes related to anxiety (HR, SBP, and DBP). Music interventions may be a good non-pharmacological approach for decreasing anxiety levels during labor.

The molecular epidemiology of serial Candida tropicalis isolates from ICU patients as revealed by multilocus sequence typing and pulsed-field gel electrophoresis.

The genetic profiles of 50 Candida tropicalis isolates serially collected from 14 patients during a prospective surveillance study in adult intensive care units (ICUs) were characterized by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) of NaeI restriction fragments. A total of 21 diploid sequence types (DSTs) and 43 genotypes were differentiated by MLST and PFGE, respectively. Significant correlations were found between PFGE genotypes and DST types (P<0.05). Dendrograms generated by either MLST or PFGE-NaeI showed that most isolates from the same patient co-clustered with high similarity regardless of the anatomical source of isolation. Maintenance, microvariation or replacement of C. tropicalis isolates could be observed within the individual patients by further analysis of variations in MLST sequence data. Antifungal susceptibility testing revealed that 17 (34%) of 50 isolates presented high MICs to flucytosine (MIC> or =8 microg/mL). Sixteen (94%) of these isolates belonged to DST 164, and these were collected from four patients with different PFGE genotypes. Isolates sharing the same DST may represent a common clone that underwent extensive mutation over time to cope with drug selection pressure, different hosts or different geographic environments.

Multilocus sequence typing of Candida tropicalis shows clonal cluster enriched in isolates with resistance or trailing growth of fluconazole.

Multilocus sequence typing (MLST) was used to characterize the genetic profiles of 52 Candida tropicalis isolates collected from 10 hospitals in Taiwan. A total of 33 diploid sequence types (DSTs) were differentiated among the 52 isolates and all were novel to the Internet C. tropicalis DST database (http://pubmlst.org/ctropicalis/). Eleven (33.3%) of the 33 DSTs could be assigned to 3 major clonal clusters (1-3) based on eBURST calculation. Only clonal cluster 1 co-clustered isolates from UK and the United States. Clonal cluster 2 was enriched with isolates with resistance or trailing growth of fluconazole (14/20, 70%). Furthermore, there are a number of pulsed-field gel electrophoresis subtypes associated with the isolates in this cluster, demonstrating that possibly more than one clone with resistant or trailing property have emerged and spread in Taiwan in 1999.

Association between fluconazole susceptibility and genetic relatedness among Candida tropicalis isolates in Taiwan.

Among the 162 Candida tropicalis isolates collected in the Taiwan Surveillance of Antimicrobial Resistance of Yeasts in 1999, 23 (14.2 %) had fluconazole MICs > or = 64 mg l(-1), and thus fulfilled the definition of resistance. Random amplified polymorphic DNA assay showed that all 23 fluconazole-resistance C. tropicalis isolates collected from different hospitals around Taiwan were closely related. Two distinct pulsotypes associated with fluconazole susceptibility were identified when these 23 resistant isolates, along with 13 susceptible ones, were analysed by PFGE.

Isolation and characterization of marine luminous bacteria from shallow coastal waters of Taiwan.

BACKGROUND AND PURPOSE: Marine luminous bacteria were isolated and identified from samples in shallow coastal waters of Taiwan during the relatively warm seasons. METHODS: Identification of the luminous isolates was performed based on differences of phenotypic and genotypic characteristics together with data from phylogenetic analysis. RESULTS: Twenty seven strains of marine luminous bacteria were isolated. They were divided into five types based on differences of phenotypic characteristics. However, they could be clustered into only two genotypes according to the analysis of restriction patterns of polymerase chain reaction-amplified 16S rRNA genes digested with various restriction enzymes. The characterization data together with the 16S rRNA gene-based phylogenetic analysis revealed that the isolates included in phenotype I (seven isolates) could be Photobacterium leiognathi, and those included in phenotypes II-V (twenty isolates) might be classified as Vibrio harveyi. However, phylogeny based on gyrB sequences indicated that phenotypes II-V could be classified into two species, V. harveyi and Vibrio campbellii. CONCLUSION: Culturable luminous bacteria in the shallow coastal waters of Taiwan during the sampling period are dominated by V. harveyi/campbellii and P. leiognathi, and the former species appeared to be more prevalent and numerous than the latter species in general.

Suitable restriction enzymes for pulsed-field gel electrophoresis analysis of Candida tropicalis.

This study was designed to pursue the identification of optimal restriction enzyme for pulsed-field gel electrophoresis (PFGE) analysis of Candida tropicalis. Twelve restriction enzymes were tested on C. tropicalis strains. Our results indicate that BssHII, NaeI, and RsrII were useful enzymes for PFGE analysis, and NaeI was the best for PFGE analysis of C. tropicalis isolates.