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[[alternative]]Blockchain-based Personal Health Record Management and Dietary Recommendation System
No full text[[abstract]]依據衛生福利部國民健康署國民營養健康狀況變遷調查提出國人的飲食中有多項低於國家建議指南，市民營養認知調查發現民眾雖大多數有正常的營養認知，但仍然有飲食迷思的問題，衛生福利部2023年國人十大死因統計結果顯示出國人十大死因中有七項死因與飲食息息相關，因此建立良好的飲食概念及飲食攝取是幫助人們提升生活品質及健康狀態，本研究建立一套系統提供飲食紀錄管理與透過個人健康紀錄資料設計飲食建議菜單。由於個人健康紀錄為高度機密且隱私的資料，避免在使用過程中遭到竄改及濫用，本研究所開發之系統使用區塊鏈技術驗證個人健康紀錄資料，透過區塊鏈的加密技術、不可篡改性及可追朔性，讓個人健康紀錄資料在存取過程中透過雜湊值驗證資料的完整性，且上傳的資料皆為不可任意刪除修改的，以此維持個人健康紀錄取用的完整性。此外，醫療資訊標準化日益受到重視，透過建立標準化的個人健康紀錄可提升資料的互通性，並可在未來介接其他醫療相關系統做更全面的發展，本系統以新一代國際醫療資料交換標準FHIR作為資訊存取格式，透過標準化的資料格式可不受到不同系統間資料傳輸的限制，增加系統的可用性，在未來可以無縫介接至其他系統，做出更全面的系統發展。本研究結合區塊鏈技術、標準化之個人健康紀錄，建立出透過區塊鏈技術驗證個人健康紀錄驗證資料完整性，並依照標準化之個人健康紀錄取出個人相關疾病紀錄調整營養素攝取比例提出飲食建議菜單及提供分析已攝入之飲食紀錄的營養資料，設計出一套可驗證資料完整性且具有資料互通性的個人化飲食建議系統。[[abstract]]According to the results of the Nutrition and Health Survey in Taiwan (NAHSIT) by the Health Promotion Administration, Ministry of Health and Welfare (HPA) in Taiwan, some dietary and nutritional habits of residents are below national guidelines. Although most citizens generally have adequate knowledge of nutrition, they still have misunderstandings about healthy dietary patterns. The Ministry of Health and Welfare (MOHW) has announced that nearly 70% of the diseases among the Top 10 Causes of Death in 2023 are closely related to dietary factors. Therefore, developing a strong grasp of nutrition and managing dietary intake can significantly enhance people's quality of life and overall health. This study establishes a system to provide dietary record management and based on personal health record data design dietary recommendations. Due to the highly confidential and private nature of personal health records, protecting against tampering and misuse during usage is essential. The system developed in this study employs blockchain technology to verify personal health record data. By leveraging the encryption, immutability, and traceability of blockchain, the integrity of personal health record data is verified through hash values during the access process. Furthermore, the uploaded data cannot be arbitrarily deleted or modified, thereby ensuring the integrity of personal health records throughout their usage.Furthermore, the standardization of medical information is increasingly recognized as important. By establishing standardized personal health records, data interoperability can be enhanced, facilitating more comprehensive development through integration with other medical-related systems in the future. This system adopts the new generation international standard for medical data exchange, Fast Healthcare Interoperability Resources(FHIR), as the information access format. The standardized data format eliminates the limitations of data transmission between different systems, increasing the system's usability and enabling seamless integration with other systems in the future, thus allowing for more comprehensive system development.This study combines blockchain technology and standardized personal health records (PHRs) to establish a system that verifies the integrity of personal health records through blockchain technology. Based on standardized personal health records, the system retrieves individual disease records to adjust nutrient intake ratios provides dietary recommendations and analyzes the nutritional data of dietary records. Develop a personalized dietary recommendation system that can verify data integrity and have data interoperability
[[alternative]]Develop a User-definable Common Interface to Create Medical Information Records that Comply with FHIR Standards
No full text[[abstract]]近年來，台灣面對數位醫療的迅速發展和COVID-19疫情影響，遠距醫療興起，以及醫療資訊軟體需要能快速的介接互通，為達到在不同機構之間更有效的數據交換，一個規範完整的標準能有效促進資料共享。對於國內醫療體系而言，可以整合相關機構傳遞資訊的格式；對於國際間，統一標準可以實現跨境的數據流通，促進更多研究合作及討論的機會。近年國際流行的醫療交換標準HL7 FHIR即快捷式醫療服務互操作資源（Fast Healthcare Interoperability Resources）受到廣大的重視。由於COVID-19的影響許多國家都推出疫苗護照，而國際間使用到的疫苗護照交換格式正是FHIR標準，這也使台灣醫療界更加關注到醫療標準轉為FHIR的重要性。在這樣的趨勢下，為促進和國際間更好的資料互通，台灣衛福部有意將現有醫療資料標準轉換為FHIR標準。本研究基於FHIR標準，開發一個符合FHIR標準的資料處理系統，利用獲取FHIR的資源結構內容來設計系統，達到在讀取、建立、修改、刪除資料的動作時，皆符合FHIR標準的資料規範，取代人工刻劃需要顯示欄位的耗費時間成本，藉由抓取資源結構確保系統中資料的一致性和互通性。此外，本研究也針對到現今醫療需求和情境的多樣性，不同的角色及不同的醫療情境下皆有不同的需求，系統在遵循FHIR標準下處理資料外，也需要一個高度靈活可以應對不同情境需求的系統建立介面。因此，為應對各種醫療情境，系統設計為能根據特定需求選擇需要的FHIR資源和欄位內容，同時考慮到使用者操作偏好及工作流程，自由調整欄位名稱和位置，藉由儲存介面設定，以利往後在遇到相同情境時，使用者無需再花時間重新設定需要的資料內容。最後，為求資料安全管理以及法規遵循，本研究納入SMART on FHIR框架，以打造安全追蹤與授權之資料管理環境。[[abstract]]In recent years, Taiwan has faced rapid development of digital medicine and the impacts of the COVID-19 pandemic. This has led to the rise of telemedicine and a growing need for healthcare information software that can quickly integrate and communicate seamlessly. In order to achieve more effective data exchange between different institutions, a comprehensive standard can effectively help data sharing. For the domestic medical system, integrating information formats among relevant institutions allows for quick and comprehensive understanding of patient conditions. For the international community, a unified standard enables cross-border data exchange, facilitating the transfer and comparison of clinical data from different regions and fostering more research collaborations and discussions. In recent years, the internationally popular medical exchange standard HL7 FHIR (Fast Healthcare Interoperability Resources) has received widespread attention. Due to the impact of COVID-19, many countries have introduced vaccine passports to prove that people have been vaccinated to speed up the steps and time for entry and exit. The international format for these vaccine passports is based on the FHIR standard, which has heightened the focus on adopting FHIR in Taiwan's healthcare sector. Under this trend, to promote better data interoperability with international standards, Taiwan's Ministry of Health and Welfare intends to convert existing healthcare data standards to the FHIR standard.This research is based on the FHIR standard and develops a data processing system that complies with the FHIR standard. It uses the resource structure content of FHIR to design the system so that the actions of reading, creating, modifying, and deleting data comply with the data specifications of the FHIR standard, replacing the time-consuming cost of manually marking display fields, and ensuring the consistency and interoperability of data in the system by capturing the resource structure.Furthermore, this research addresses the diversity of current medical needs and scenarios. Different roles and medical situations have different needs, so the system must be highly flexible to meet these varied requirements while following the FHIR standard. Users can select the necessary FHIR resources and field contents based on specific needs and adjust field names and positions according to their operational preferences and workflows. By saving interface settings, users can avoid reconfiguring required data content for similar future scenarios. Finally, in order to achieve data security management and regulatory compliance, this study incorporates the framework of SMART on FHIR to create a data management environment for secure tracking and authorization
[[alternative]]The Effects of 8-week Programed Physical Activity on the Children’s Development in Cognitive, Emotional, and Body Movement -A Case Study in Taipei’s Preschool
No full text[[abstract]]本研究旨在探討8週計劃性體能活動對幼兒認知、情緒和身體動作發展的影響，研究採用準實驗設計，分組依據園內編班制度採用立意抽樣，以4-6歲為研究對象，分成實驗組和控制組，兩組先使用「專注力、數感、工作記憶」檢測認知、用「幼兒情緒能力量表」觀察情緒變化，以及「學前兒童粗大動作品質量表」 (PGMQS) 檢測動作發展，隨後實驗組執行8週計劃性體能活動，每週5次、每次30-40分鐘，在第9週時，兩組執行後測，隨後將採集到的數據使用描述性統計、成對樣本t檢定和獨立樣本t檢定進行分析，歸納出以下結果：一、體能活動介入讓4-5歲幼兒專注力提升，讓5-6歲幼兒工作記憶和專注力增加；二、體能活動介入對幼兒情緒各面向表現發展有所幫助；三、體能活動介入提升幼兒身體動作整體發展和物品傳接能力。依據以上結果，8週計劃性體能活動為幼兒發展各面向帶來諸多助益，課程教案可提供幼教現場老師做為課程設計之參考。[[abstract]]This study aims to explore the impact of 8 weeks of planned physical activity with practical application on the cognitive, emotion and physical development of young children. The study adopts a quasi-experimental design. The children were recruited from the kindergarten class system with purposive sampling method. The research subjects are 4-6 years old, allocated into an experimental group and a control group, and evaluated by cognition (concentration, number sense, and working memory), emotional changes (Preschooler Gross Motor Quality Scale, PGMQS), and physical development (Preschooler Gross Motor Quality Scale, PGMQS). The planned physical activities were designed and performed for 8 weeks, 5 times a week, and 30-40 minutes each time. These assessments will be evaluated before and after 9-week programed physical activities, and the descriptive statistics and inferential statistics (paired t and independent t test) will be performed for data analysis. The results showed physical activity intervention can improve the concentration of 4-5 years old children, and indicated increase the working memory and concentration of 5-6 years old children. In addition, physical activity intervention showed benefits for the development of children's emotional expression and overall development of physical activities in all aspects. Based on the above results, 8-week programed physical activity can bring many benefits to all aspects of children's development and the programs could be provided to educators in preschool as reference
[[alternative]]Effect of exercise and Lactobacillus kefiranofaciens K6 supplementation on the physiological regulations with sleep deprivation animal model
No full text[[abstract]]睡眠剝奪會導致晝夜節律失調，造成壓力及發炎反應的發生，提高罹患心血 管、代謝性與神經疾病的風險，同時引發心理憂鬱與焦慮表現;運動健康促進的 觀點，定期的運動訓練能提高胰島素的敏感性有效調控血糖穩定，增加新陳代謝、 增強肌肉骨骼、改善心理情緒表現、提升免疫功能和預防慢性疾病達到健康益處; 益生菌補充可透過腸道菌相平衡與其代謝物，進而促進腸道健康、疾病改善與健 康促進之效益，更可藉由生理軸線達到生理與心理調控之效益。本研究使用改良 版多平台進行睡眠剝奪誘導，使 C57BL/6J 雄性小鼠產生慢性睡眠剝奪相關病 理特徵，進而探討益生菌 Lactobacillus kefiranofaciens K6 補充與規律運動介入是 否能改善慢性睡眠剝奪所引發的生理代謝功能、運動表現、節律基因與神經心理 行為之負面影響。研究結果顯示，為期 4 週改良版多平台之慢性睡眠剝奪模式， 在睡眠剝奪下會導致生理調控的失衡及運動表現下降。益生菌補充可顯著改善睡 眠剝奪下耐力下降之表現，同時對於血糖的穩定與運動耐力表現具有顯著效益。 益生菌可能調節肝臟與肌肉組織節律基因的表達(BMAL-1 及 CLOCK)，進而 降低發炎反應與相關組織的損傷，並改善睡眠剝奪所造成之心理憂鬱與焦慮表現， 達到健康促進與生理調適之效果。本研究證實益生菌補充後能改善睡眠剝奪下之 運動表現、生理適應、節律基因與神經心理行為等，並做為健康促進之應用策略。 睡眠剝奪下，益生菌是否藉由影響腸道菌相並進一步調控生理軸線(腸腦軸與腸 肌軸)達到生理調控之效益，仍須進一步評估。[[abstract]]Sleep deprivation can lead to circadian rhythm disturbances, resulting in stress and inflammatory responses, increasing the risk of cardiovascular, metabolic, and neurological diseases, as well as causing psychological depression and anxiety. From the perspective of health promotion through exercise, regular physical training could enhance insulin sensitivity, effectively regulate blood glucose stability, increase metabolism, strengthen muscles and bones, improve psychological well-being, boost immune function, and prevent chronic diseases, thereby achieving health benefits. Probiotic supplementation could promote gut health, disease improvement, and health benefits through the balance of gut microbiota and their metabolites. It can also achieve physiological and psychological regulatory benefits through multiple physiological axes. This study used a modified multiple platform method to induce sleep deprivation, causing chronic sleep deprivation-related pathological features in male C57BL/6J mice. It aimed to explore whether supplementation with the probiotic Lactobacillus kefiranofaciens K6 and regular exercise intervention could improve the negative impacts of chronic sleep deprivation on physiological homeostasis, exercise performance, circadian genes, and neuropsychological behaviors. The study results indicated that a 4-week chronic sleep deprivation model using a modified multiple platform method led to an inflammation dysregulation and a decline in exercise performance under sleep deprivation. Probiotic supplementation significantly improved endurance performance under sleep deprivation, and it had significant benefits for blood glucose stability and exercise endurance performance. Probiotics may regulate the expression of circadian genes (BMAL-1 and CLOCK) in liver and muscle tissues, thereby reducing inflammatory responses and related tissue damage, and improving psychological depression and anxiety caused by sleep deprivation,iiachieving health promotion and physiological adaptation effects. This study demonstrated that probiotic supplementation could improve exercise performance, physiological adaptation, circadian gene expression, and neuropsychological behaviors under sleep deprivation, serving as a health promotion strategy. Further evaluation is needed to determine whether probiotics can achieve physiological regulatory benefits by affecting gut microbiota and further regulating physiological axes (gut-brain axis and gut-muscle axis) under sleep deprivation
[[alternative]]The impact of somatosensory game courses on functional physical fitness of middle-aged and elderly people.
No full text[[abstract]]背景： 中高齡長者最大的健康風險就是功能性衰退， 身體機能日趨衰弱，肌力與肌耐力的下降使跌倒風險增高。如何促進長者身心的健康，減緩高齡者身體功能退化，此為重要課題之一。 鑒於近年體感式互動遊戲機盛行，多功能性的體感遊戲運動模式，透過趣味性的遊戲能激發人類樂於參與運動的動機。 目的： 本研究旨在探討以科技的互動式體感遊戲運動， 對中高齡者功能性體適能之影響。 方法：本研究招募受試者 30 名， 平均年齡 56.7±6.34 歲，進行 12 週實驗。對照組維持原有的生活型態 12 週；實驗組進行 12 週體感式互動遊戲運動介入，每週進行 2 次運動課程，每次 60 分鐘。 運動介入前、後兩組進行體適能檢測， 檢測項目包括肌力、 肌耐力、 心肺功能、柔軟度、身體組成。 結果： 12 週體感運動遊戲課程後，檢測肌耐力的仰臥起坐次數增加 (p<.05)、 左側上肢柔軟度顯著提升 (p<.05)、實驗組內檢測肌力的握力顯著提升 (p<.05)， 心肺功能、 上肢柔軟度右側及身體組成則未達顯著效益。 結論： 12 週的 Switch 健身環運動遊戲，有效增強中高齡者肌耐力， 提升上肢柔軟度左側、 下肢柔軟度。身體組成沒有得到改善。 體感式遊戲運動提升部分功能性體適能， 是中高齡者提升健康的有效策略。[[abstract]]Background and Purpose: The primary health risk for middle-aged and elderlyindividuals is functional decline, characterized by increasing physical frailty and reducedmuscle strength and endurance, leading to an elevated risk of falls. Promoting thephysical and mental health of older adults and mitigating the decline in their physicalfunctions is a critical issue. In recent years, the popularity of somatosensory game hassurged. Objective: This study aims to investigate the effects of technology-basedsomatosensory gams on functional fitness in middle-aged and elderly adults. Method:A total of 30 participants were recruited for this study, with an average age of 56.7 ±6.34 years, undergoing a 12-week intervention. The control group maintained their usuallifestyle for 12 weeks, while the experimental group engaged in a 12-week interventionof interactive motion gaming exercise, participating in two 60-minute sessions per week.Both groups underwent fitness assessments before and after the intervention, measuringvariables including muscle strength, muscular endurance, cardiorespiratory fitness,flexibility, and body composition. Results: After the 12-week somatosensory gameprogram, significant improvements were observed in muscular endurance as evidencedby increased sit-up (p < .05). The experimental group showed a significant increase ingrip strength (p<.05), and the left side upper limb flexibility displayed a positiveincrease (p<.05). However, no significant benefits were observed in cardiorespiratoryfitness, right-side upper limb flexibility, and body composition. Conclusion: The 12-week somatosensory game intervention enhanced muscular endurance and improvedleft-side upper and lower limb flexibility among middle-aged and elderly individuals.The incorporation of somatosensory game exercises is an effective strategy forenhancing certain aspects of functional fitness among middle-aged and elderlyiiipopulations, thereby promoting their overall health
[[alternative]]Postpartum massage therapy for women and infants: The effect on maternal depression, stress, fatigue and infant temperament
No full text[[abstract]]ABSTRACTBackground: Mother-and-infant massage, a complementary therapy, has the potential to alleviate depression, stress, and fatigue, as well as to convert difficult infant temperaments into more manageable ones.Aim: To examine the effect of massage therapy on mother-infant dyads to reduce postpartum depression, stress, fatigue, and infant temperament. Methods: This study used a quasi-experimental study with a two-group pre-test and post-test design. A total of 102 respondents from four Community Health centers in Sleman were recruited. Over five weeks, twice each week, the experimental groups received 10 times massages in total. The research instruments included the Edinburgh Postnatal Depression Scale (EPDS), Perceive Stress Scale (PSS), Perceive Fatigue Scale (PFS), and Infant Temperament (IT). The content Validity Index and Cronbach’s alpha were utilized to analyze the validity and reliability of the instrument's translation. Bivariate analysis, including Independent t-test, chi-square, and Fisher exact test, was used to analyze the comparison of the demographic data between intervention and waitlist control groups. Pearson correlation and independent t-tests were used to analyze the relationship between demographic data and obstetric information with the outcome variables. A Generalized Estimating Equation (GEE) was used to analyze the effect between the intervention and waitlist control group and the covariate variable. Results: Age, education, marital status, employment status, number of children, type of childbirth, and pregnancy planning do not indicate a statistically significant distinction (p > .05) with the outcomes. There were significant differences in depression and fatigue in the pretest, post-test 1, and post-test 2 (p<.001); stress had a significant difference in post-test 1 and 2 (p<.05). Infant temperament had no significant difference in the pretest, post-test 1, and post-test 2. There was a relationship between age (r = -.14; p = .014), stress (r =.24; p <.001), fatigue (r = .45; p < .001), and infant temperament (r = .40; p < .001) with depression. Stress correlates with fatigue (r = .29; p <.001) and infant temperament (r = .15; p = .007). The GEE analysis showed that massage therapy has an impact on depression (p<.001), fatigue, and infant temperament (p<.05).Conclusion: Massage therapy has a substantial impact on maternal biopsychological health and infant temperament, which is a valuable complementary treatment that alleviates depression, fatigue, and infant temperament. Immediate implementation of a health policy emphasizing the early detection and treatment of postpartum depression is necessary. Additionally, training in the early detection and management of postpartum depression is compulsory for healthcare providers. Keywords: Postpartum Depression, Stress, Fatigue, Infant Temperament, Massage Therap
[[alternative]]The Role of Diabetes Medicine SGLT2 Inhibitor on the Heart Failure Early Screening Biomarkers BNP and NT-proBNP in Heart Failure and Type 2 Diabetes Mellitus
No full text[[abstract]]背景：糖尿病患者罹患心臟衰竭的風險比一般人高二至五倍，一旦心臟衰竭，住院和死亡的風險均上升，血糖控制越差，則心衰竭發生率越高，第二型鈉-葡萄糖運輸蛋白抑制劑（SGLT2 inhibitor, SGLT2i）的研究發現，不管是預防或治療都有效果，可顯著減少心衰竭惡化、住院、心血管死亡事件，並已核准用於低收縮分率心衰竭（Heart Failure with reduced Ejection Fraction, HFrEF）與正常收縮分率心衰竭（Heart Failure with preserved Ejection Fraction, HFpEF），成為第一個跨足到心血管領域的降血糖藥物。BNP與NT-proBNP濃度是診斷與評估心衰竭病人的重要且有效的指標，專科護理師作為臨床照護的第一線，除了健康篩檢、改善疾病問題與醫療轉介外，疾病追蹤也是相當重要，確立一個合適的追蹤指標，亦可幫助臨床上的決策依據。目的：使用系統性文獻回顧與統合分析，探討SGLT2 inhibitor對於心衰竭合併第二型糖尿病患者血清B型利鈉利尿胜肽（BNP）及N端前B型利鈉利尿胜肽（NT-proBNP）濃度之影響。方法：搜尋2012年1月至2022年12月期間所有發表在PubMed、Cochrane Library、Embase、CINAHL、華藝中文電子期刊資料庫、台灣碩博士論文加值系統資料庫等六個中英文資料庫。檢索策略以PICO為指引，並使用醫學標題關鍵字進行系統性的搜尋，以布林邏輯將同義字以OR聯集，關鍵字再以AND交集，文獻篩選後，納入文獻使用Comprehensive Meta-Analysis（CMA）3.0軟體進行統合分析，對於連續性的結果，以標準化平均差異（standardized mean difference, SMD）及95%信賴區間（95% confidence interval, 95% CI）來評估綜合效應（pooled effect）。結果：共12篇文獻符合納入標準，研究參與者總共7,491人，內含隨機對照試驗（RCT）8篇、前瞻隨機對照試驗（Prospective RCT）1篇、交叉隨機對照試驗（Crossover RCT）3篇，其中研究以BNP作為評值指標有3篇，納入199人，而NT-proBNP則有10篇，則納入7,351人。整體風險評估（overall risk-of-bias），具高風險偏差之研究6篇、低風險偏差4篇、部分偏差風險2篇。整體而言，本研究結果顯示SGLT2i可有效降低心衰竭合併第二型糖尿病患者血清BNP與NT-proBNP level（p= 0.029; p< 0.001），門診患者相較於住院患者，SGLT2i對於降低血清BNP較不顯著，合併使用環形利尿劑，可能間接影響SGLT2i降低BNP level的效果，但SGLT2i有助於減少環形利尿劑劑量的趨勢。NT-proBNP level起始值的不同會影響SGLT2i對於降低血清NT-proBNP level的結果，SGLT2i對於降低血清NT-proBNP level的成效，HFrEF（EF<40%）族群有顯著差異（p= 0.001），合併血清NT-proBNP level起始值高（≧400 pg/mL）患者使用SGLT2i具有顯著差異（p< 0.001）；SGLT2i降低血清NT-proBNP level之成效，推論短期使用即具有顯著差異，然而第2~6週無顯著差異（p= 0.252），在超過24週後具顯著差異（p= 0.001）。結論：作為臨床上第一線照護人員，對於心衰竭合併第二型糖尿病患者，特別是HFrEF、合併血清NT-proBNP level起始值高（≧400 pg/mL）、HF Stage C-D、急性失代償性心衰竭之族群，除了常規血液、生化、心電圖、胸部X光、心臟超音波檢查外，若剛開始使用SGLT2i（2週內），或一段時間後（24週後），可建議主治醫師於急性病房治療期間或門診場域，追蹤病患NT-proBNP level作為疾病治療評值、藥物處方調整的參考之一，專科護理師也可以此生物標記作為病患臨床評估的工具之一，並同時衛教病患藥物注意事項、可能的副作用與心衰竭自我照護準則，達到良好的醫療照護品質。[[abstract]]Background: Diabetes mellitus increases the risk of heart failure up to 2 to 5-fold. Once heart failure happened, the risks of hospitalization and death also increase. The worse the glycemic control, the higher the incidence of heart failure. Studies of sodium-glucose cotransporter inhibitors (SGLT2 inhibitor, SGLT2i) has been reported that effect of prevention and treatment, also can significantly reduce the worsening in heart failure, hospitalization, and cardiovascular death events. It has been approved for heart failure with reduced ejection fraction and preserved ejection fraction. Therefore, SGLT2i became the priority oral antidiabetic agents to enter the cardiovascular field. Serum levels of BNP and NT-proBNP are important and effective indicators for heart failure. In addition to health screening, improvement of health problems and medical referrals, nurse practitioners play an important role in patient’s condition monitoring. The appropriate tracking indicators could also be instrumental in the decision-making of clinical practice.Aim: We conducted a systematic review and meta-analysis to explore effects of SGLT2 inhibitors on serum level of BNP or NT-proBNP in heart failure with type 2 diabetes mellitus (T2DM).Method: We search literature published in Mandarin and English databases including PubMed, Cochrane Library, Embase, CINAHL, Airiti Library, National Digital Library of Theses and Dissertations in Taiwan, from January 2012 to December 2022.Searching strategy is guided by PICO, keywords, and medical subject headings, and use Boolean logic method to combine synonyms with OR, and keywords with AND intersection. After screening the searched literature, eligible literatures were analyzed using Comprehensive Meta-Analysis (CMA) 3.0 software. For continuous variables, standardized mean difference (SMD) and 95% confidence interval were calculated to evaluate the pooled effects.Results: A total of 12 articles met the inclusion criteria for meta-analysis, involving 7,491 participants. These included 8 randomized controlled trials (RCTs), 1 prospective RCT, and 3 crossover RCTs. Among them, 3 studies utilized BNP as the assessment indicator, involving 199 participants, while NT-proBNP was used in 10 studies, involving 7,351 participants. Overall risk-of-bias assessment revealed 6 studies with high risk of bias, 4 with low risk of bias, and 2 with some risk of bias. Overall, this study demonstrated that the effect of SGLT2i in reducing the serum BNP and NT-proBNP levels in heart failure with type 2 diabetes mellitus. However, outpatients, who generally have more stable clinical conditions compared to inpatients, show less significant reductions in serum BNP levels due to lower baseline levels. The concurrent use of loop diuretics might indirectly affect the effectiveness of SGLT2i in reducing BNP levels, but the study indicates a trend towards reducing the dosage of loop diuretics when SGLT2 inhibitor using. The differences in baseline NT-proBNP levels affect the outcomes of SGLT2i in reducing serum NT-proBNP levels. SGLT2i exhibit more significant differences in reducing serum NT-proBNP levels in patients with HF with reduced ejection fraction (HFrEF) (EF< 40%). Among patients with EF< 40% and high baseline serum NT-proBNP levels (≧400 pg/mL), the SGLT2i users showed significant differences. The Effect of SGLT2i in reducing serum NT-proBNP levels is presumed to be significant in the short term. Despite no differences observed during weeks 2 to 6, significant differences emerged after 24 weeks of treatment.Conclusions: As medical personnels in clinical primary care, for patients with heart failure combined with T2DM, especially those with high baseline serum NT-proBNP levels (≧400 pg/mL), HFrEF at heart failure Stage C-D, and those experiencing acute decompensated heart failure. In addition to routine blood tests, biochemical analyses, electrocardiograms, chest X-rays, and echocardiographic examinations, it is advisable for physicians to monitor the NT-proBNP levels of patients during hospitalization or in outpatient settings when initiating SGLT2i (within 2 weeks) or after a period (after 24 weeks). NT-proBNP levels could serve as one of the indicators for evaluating disease progression and adjusting medication prescriptions. Nurse practitioner can also use this biomarker as a tool for clinical assessment of patients and educate patients on medication precautions, side effects, and self-care for heart failure according to guidelines, to achieve optimal quality of medical care
[[alternative]]The impact of smart diabetic foot care application development on case knowledge and self-management
No full text[[abstract]]研究背景：糖尿病是一種全球流行的慢性代謝性疾病，足部潰瘍是糖尿病的常見併發症之一，但它被認為是最可預防的。常規的足部評估在預防潰瘍和減少糖尿病相關的發病率與死亡率方面具有重要作用。目前在Google Play和App Store上的糖尿病照護應用程式主要集中於血糖監測和營養飲食介紹，但很少有針對足部健康照護的應用。研究的目：是開發一個糖尿病足部護理指導應用程式，並探討使用該應用後對患者足部評估認知及自我照護行為的影響。研究方法：本研究在北區醫院收集資料，共計102人參與，並開發糖尿病足部護理指導應用程式。採用單組前後測及單組等候名單（Wait List Control）設計，並使用IBM SPSS for Windows 26.0進行資料分析。研究結果：使用糖尿病足部護理應用程式後，個案在足部評估認知及自我照護行為方面均有顯著改善。個案對此應用程式的滿意度高達99％，希望它能提供專業的足部照護，取代傳統的健康教育方式，並成為有效且可用的足部照護評估工具，為及時訊息照護提供參考依據。研究結論：將足部自我檢測推廣至居家環境，可以提高糖尿病患者對自身疾病風險的認識和管理能力。此外，在照護指導影片中加入簡短的居家運動指南，能提升患者對應用程式的使用意願和效果。[[abstract]]Research Background: Diabetes is a globally prevalent chronic metabolic disease, with foot ulcers being one of the common complications. However, foot ulcers are considered highly preventable. Routine foot assessments play a crucial role in preventing ulcers and reducing diabetes-related morbidity and mortality. Currently, diabetes management apps available on Google Play and the App Store primarily focus on blood sugar monitoring and nutritional guidance, but there are few dedicated to foot health care.Objective: The goal of this research is to develop a diabetic foot care guidance application and to examine the impact of its usage on patients' foot assessment knowledge and self-care behaviors.Methodology: Data was collected at a hospital in the Northern district, with a total of 102 participants. A diabetic foot care guidance application was developed. The study employed a single-group pre-post test and a wait-list control design. Data analysis was conducted using IBM SPSS for Windows 26.0.Results: After using the diabetic foot care application, there was a significant improvement in both foot assessment knowledge and self-care behaviors among the participants. The satisfaction rate with the application was as high as 99%, with participants expressing a desire for it to provide professional foot care, replace traditional health education methods, and become an effective and usable tool for foot care assessment and timely information for care.Conclusion: Promoting foot self-assessment in the home environment can enhance diabetic patients' awareness and management of their disease risks. Additionally, including brief home exercise guides in the instructional videos can improve patients' willingness to use the application and its effectiveness
[[alternative]]To explore the effect of improved modified care meals to improving the Quality of Life of the Pre-Frailty chewing disorders of the older adult
No full text[[abstract]]背景台灣2020年已邁入高齡社會，老化的過程中，身體會隨著年紀的增長而衰退，口腔衰弱和口腔健康問題，會造成長者咀嚼和吞嚥障礙在老年族群中極為普遍。咀嚼障礙與口腔疾病問題有關，會造成感染、疼痛、營養攝取不足、外觀受影響、生活品質下降及死亡率有關。目前台灣多以剪碎、烹飪軟爛或是將食物攪打的方式提供給長者，但當食物外觀喪失食物原有的色香味，視覺和味覺上無法改變長者的食慾並使得用餐的滿意度下降，會造成食物攝取不足、營養不均、生活品質下降的風險，若能將餐食的外觀修飾，餐食變得多樣化，能增加長者的用餐滿意度，營養狀態，維持長者的生活品質及能健康地老化。方法本研究採隨機對照試驗(Randomized controlled trial，RCT)的雙組前後測設計(two-group pretest-posttest design)，目的是探討改良式照護餐食方案手冊的介入是否能改善口腔健康、營養狀態、生活品質及用餐滿意度，提供30天的咀嚼障礙改良式照護餐食食譜。本研究於東部某地區醫院門診區≧65歲以上老年人為研究對象，先篩檢出衰弱前期之長者，再以口腔健康功能狀態、吞嚥量表及咀嚼測驗的方式評估長者的吞嚥及咀嚼狀況，若出現咽喉部吞嚥功能異常長者予以排除並協助提供資訊及轉介至語言治療進行評估及診斷，僅以有口腔期吞嚥異常個案進入研究收案。資料收集採單盲設計，招募研究對象60位，以單雙週的方式進行隨機分派，分為單週實驗組、雙週控制組，共篩選實驗組30位、控制組30位。實驗組以改良式照護餐食照護方案手冊介入：IDDSI餐食食譜、IDDSI工具檢測質地執行方式、口腔健康衛生照護，每週以家訪方式教導研究對象或主要照顧者餐食的製作方式，及以電訪的方式記錄及追蹤使用手冊的狀況；控制組以則提供一般咀嚼障礙照護餐食食譜手冊，每週一次電訪的方式記錄及追蹤使用狀況，兩組於介入前、介入後第6週、第12週觀察咀嚼功能狀態、口腔健康功能狀態、營養狀態、口腔健康生活品質、用餐滿意度，以作為此介入方案成效分析。結果 在十二週改良式照護餐食介入後，實驗組及控制組各完成30人，流失0人。以廣義估計方程式(GEE)進行兩組與時間的交互作用下，分析實驗組在介入後第一、二次後測成效指標：口腔健康評估工具量表(OHAT) (p=0.071 ; p<0.05)；迷你營養評估量表(MNA-SF)(p=0.05 ; p<0.001)；台灣口腔健康衝擊量表(OHIP-14) (p<0.001 ; p<0.001)；老年口腔健康評估指數(GOHAI) (p<0.001 ; p<0.001)；用餐滿意度(p<0.001 ; p<0.001)皆達統計顯著差異。結論本研究證實在經十二週的改良式照護餐食介入後，口腔健康評估工具量表(OHAT)、迷你營養評估量表(MNA-SF)、台灣口腔健康衝擊量表(OHIP-14)、老年口腔健康評估指數(GOHAI)、用餐滿意度，兩次後測均有達到統計顯著的差異。從研究中可以發現長者的口腔健康管理差，咀嚼功能異常帶給長者餐食上有許多負面影響，介入改良式照護餐食手冊方案能提升長者的口腔生活品質、用餐滿意度，建議未來可將本研究改良式照護餐食方案介入推廣至更多老年族群及照顧機構。[[abstract]]BackgroundTaiwan has become an aging society in 2020. In the aging process, the human body will decline with age. Oral weakness and oral health problems will cause chewing and swallowing disorders, which are extremely common among the older adult. Chewing disorders are associated with oral diseases and problems and can cause infection, pain, insufficient nutritional intake, affected appearance, reduced quality of life and increased mortality. In the current practice in Taiwan, food is mostly served to the older adult in the chopped, overcooked or stirred form. However, when the appearance of the food loses its original colors, aromas, and tastes, it fails to induce the appetite of the older adult and makes the meal dissatisfactory. This situation will cause the risks of insufficient food intake, unbalanced nutrition, and reduced quality of life. If the appearance of meals can be modified and the meal combinations can be diversified, it is possible to increase the older adult’s meal satisfaction, improve their nutritional status, maintain their quality of life, and help them age healthily.MethodThis Randomized Controlled Trial (RCT) using two-group pretest-posttest design aims to investigate whether the intervention of modified care meals can improve oral health, nutritional status, quality of life, and meal satisfaction. This study provided a 30-day modified care meals manual for chewing disorders. This study enrolled the older adult aged 65 and above at the outpatient clinic in a certain regional hospital in the eastern Taiwan as the research subjects. Firstly, this study screened out the older adult at the early stages of frailty. Secondly, this study used oral health functional status, swallowing scale, and chewing test to evaluate the swallowing and chewing conditions of the older adult. This study excluded the elderly with abnormal swallowing function of the throat, assisted in providing information, and referred them to language therapy for assessment and diagnosis. This study only enrolled the older adult with oral phase swallowing abnormalities. This study collected the data using single-blind design. This study enrolled 60 research subjects, who were randomized in a weekly or biweekly manner. The subjects were divided into weekly experimental group and biweekly control group. A total of 30 subjects were screened in the experimental group and 30 in the control group. The experimental group received the intervention of modified care meals: This study used the IDDSI meal recipes and IDDSI tools to test the implementation method and oral healthcare. This study offered a weekly home visit to teach the research subjects or primary caregivers how to cook the meals. Besides, this study used telephone interviews to record and follow-up on the use of the manual. The control group were offered the meal recipe manual for general chewing disorders. This study used weekly telephone interviews to record and follow-up on the use of the manual. This study observed the chewing functional status, oral health functional status, nutritional status, oral health quality of life, and meal satisfaction of the two groups before the intervention and at Week 6 and Week 12 after the intervention to analyze the effectiveness of the intervention scheme.ResultsAfter the intervention of the 12-week modified care meals, 30 subjects in each of the experimental group and control group completed the study, with a zero attrition rate. This study used Generalized Estimating Equation (GEE) to analyze the effectiveness indicators in the first and second posttests after the intervention in both the control and experimental groups under the interactions with time: Oral Health Assessment Tool (OHAT) (p=0.071; p <0.05); Mini Nutritional Assessment-short form (MNA-SF)( p =0.05; p <0.001); Taiwan Oral Health Impact Profile (OHIP-14) (p <0.001; p <0.001); Geriatric Oral Health Assessment Index (GOHAI) (p <0.001; p <0.001); meal satisfaction (p <0.001; p <0.001) all reached statistically significant differences.ConclusionsThis study verified that after the intervention of the 12-week modified care meals, Oral Health Assessment Tool (OHAT), Mini Nutritional Assessment-short form (MNA-SF), Taiwan Oral Health Impact Profile (OHIP-14), Geriatric Oral Health Assessment Index (GOHAI), and meal satisfaction all reached statistically significant differences in the two posttests. This study found that poor oral health management and chewing functional abnormalities have negative effects on the meal intake of the older adult. The intervention scheme of modified care meal manual improved the oral quality of life and meal satisfaction of the older adult. It is recommended to promote the modified care meal intervention scheme proposed in this study to more older adult populations and care institutions
[[alternative]]The effect of acupoint stimulation on the physiological, psychological and quality of life of postoperative patients with degenerative knee arthritis
No full text[[abstract]]背景：退化性膝關節炎根據統計數據全球約有5.28億人罹病。膝關節置換術是最終的治療方法，然而術後不僅伴隨著疼痛，也間接造成了患者的關節活動意願降低、心理焦慮提升及生活品質下降。儘管術後使用止痛藥物來控制疼痛，但其副作用，使患者在使用上有所考量。而穴位刺激簡單、安全、無侵入性。本研究旨在探討穴位刺激對退化性膝關節炎術後患者生心理及生活品質改善之成效。研究方法：採隨機對照試驗，在某區域醫院符合選樣條件之患者，依照隨機分派分為三組，實驗組A、實驗組B及對照組常規治療。研究工具基本屬性、視覺類比尺度量表、量角器、貝克焦慮量表、臺灣簡明版世界衛生組織生活品質問卷。資料收集後使用SPSS 20.0統計軟體進行資料處理與分析。結果：本研究顯示三組在人口學及疾病屬性問卷上無顯著差異（P > .05）；生理方面，兩組實驗組在介入措施後，術後疼痛指數及關節活動度均顯著改善（P .05). In terms of physical outcomes, both experimental groups showed significant and encouraging improvements in postoperative pain and joint mobility after intervention (P < .05). Psychologically, significant differences were found in seven items (p < .05). Quality of life significantly improved in the two experimental groups following the intervention (P < .05).Conclusions and Discussion: This study demonstrates that acupoint stimulation can significantly reduce postoperative pain, enhance joint mobility, decrease anxiety, and improve the Quality of life in patients with degenerative knee osteoarthritis. Acupoint stimulation is recommended as a potential clinical improvement strategy, and future research should consider extending the follow-up period to assess long-term benefits more accurately