Effects of a modified Singh's algorithm care bundle on cannulation success rate in patients with neurological sequelae.

AIM: Prolonged tracheostomy tube placement leads to depression, communicative inconvenience, reduced life quality, and health complications. We retrospectively examined the effects of a modified Singh's algorithm (MOSA) care bundle in tracheostomy tube removal in patients with neurological sequelae. METHODS: We retrieved medical records of 22 tracheostomized patients admitted to our early rehabilitation ward from 1 January 2018 to 31 December 2020 and compared their clinical outcomes before and after the MOSA introduction. We used a decannulation checklist and outcomes of decannulation training to judge the decannulation opportunity in the intervention group. In the control group, the patients received decannulation based on professional judgments. RESULTS: Age, gender, body mass index, and admission diagnosis were not significantly different between the two groups. While 10 of 13 patients (76.9%) successfully decannulated in the intervention group, only 1 of 9 patients in the control group succeeded (11.1%; p = 0.008). The decannulation evaluation checklist revealed no statistically significant difference between the two groups except that the intervention group received more airway patency evaluations (p = 0.027). None of the decannulated patients required tracheostomy tube reinsertion before discharge, and no complications appeared. CONCLUSION: Our study supports the feasibility of MOSA in aiding decannulation among patients with neurological illnesses. Further cluster randomized controlled trials and studies of decision aids and shared decision-making are warranted to help promote active decannulation.

Assessment of functioning using the WHODAS 2.0 among people with stroke in Taiwan: A 4-year follow-up study.

BACKGROUND: Stroke is a leading cause of long-term disability and is considered a major global health burden. OBJECTIVES: We aimed to explore the 4-year changes in disability among patients with stroke under the existing health care system in Taiwan. METHODS: We used the "Taiwan Data Bank of Persons with Disability" (TDPD), which collects data on candidates nationwide who want to apply for government benefits or social welfare. We included adults>18 years with stroke who were registered between July 11, 2012 and October 31, 2018. This was a longitudinal follow-up study with 2 times of assessments. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) was used to evaluate function initially and at 4-year follow-up. Generalized estimating equations (GEE) were used to analyse changes in disability over 4 years and interaction effects. RESULTS: A total of 3506 participants (2080 men) with mean age 62.2 (12.5) years and followed up for more than 4 years were included. Generally, participants with stroke showed improved function over the 4 years. Domain scores of mobility, participation, life activities, and overall score significant improved from 55.9 to 54.3, 53.0 to 43.6, 70.9 to 67.4, and 49.8 to 47.3, respectively (P<0.05). With respect to upper- and lower-limb motor deficiency, participants who required assistance or who were dependent showed significant improvement (P<0.05) in most of the WHODAS 2.0 domains except cognition. Younger patients (<65 years) tended to have significantly better outcomes, and institutionalized residents tended to show a significant and considerable deterioration in all WHODAS 2.0 domains. CONCLUSION: Participants with stroke showed an improvement in levels of functioning, specifically in mobility, participation, and life activities, over 4 years of follow-up.

Relationship between serum total bilirubin levels and mortality in uremia patients undergoing long-term hemodialysis: A nationwide cohort study.

BACKGROUND AND AIMS: Previous studies show that serum bilirubin has potent antioxidant effect and is associated with protection from kidney damage and reduce cardiovascular events. The aim of this study was to examine the association of serum total bilirubin level and mortality in uremia patients who underwent hemodialysis. METHODS: This is a nationwide retrospective long-term cohort study. Patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012. A total of 115,535 hemodialysis patients were surveyed and those with valid baseline total bilirubin (TB) data were enrolled. All-cause mortality was the primary outcome. RESULTS: A total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 groups according to different baseline serum total bilirubin levels (0.1-0.3, 0.3-0.7, 0.7-1.2 mg/dL). Mean age was 61.4 ± 13.6 years, 50% were male, 13% were hepatitis B carriers, and 20% were hepatitis C carriers. Primary outcome was the 3-year mortality. The TB level 0.7-1.2 mg/dL group had high mortality, statistically significant hazard ratio of mortality was 1.14 (crude HR, 95% 1.07-1.20, p < 0.01), and adjusted HR was 1.18 (model 1, 95% CI 1.11-1.25), 1.21 (model 2, 95% CI 1.14-1.29, p < 0.01), 1.44 (model 3, 95% CI 1.06-1.96, p < 0.01), respectively. Sensitivity test showed that after excluding 14,899 patients with hepatitis B or C, or abnormal liver function, the highest level of TB associated with higher significant mortality was still robust. CONCLUSIONS: In our study, high TB level is associated with mortality in uremia patients undergoing long-term hemodialysis, but further studies of the different effects of unconjugated or conjugated bilirubin on hemodialysis patients are needed.