Lin GH, Wang YC, Lee SC
… +3 more, Chi WC, Liu JH, Hsieh CL
J Formos Med Assoc
· 2026 May · PMID 42069499
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BACKGROUND: Disability assessment in dementia is important for care planning, but the full World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is time-intensive and may limit clinical use. This stud...BACKGROUND: Disability assessment in dementia is important for care planning, but the full World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is time-intensive and may limit clinical use. This study developed machine learning (ML)-based short forms of the WHODAS 2.0 and examined their reliability, concurrent validity, and responsiveness. METHODS: Using data from 51,245 persons with dementia (training set: n = 31,952; validation set: n = 19,293), we developed two ML-based short forms, ML-WHODAS-16 and ML-WHODAS-10, with Extreme Gradient Boosting and bootstrap-based item selection under a lock-down training/validation workflow. Their performance was compared with the full WHODAS-32 and the conventional 12-item short form adapted to 11 items after excluding work-related items (Standard-12). Anchor-based longitudinal validity was also examined using deterioration in official Disability Severity Grade. RESULTS: Both ML short forms showed high internal consistency (α = 0.96 for ML-WHODAS-16 and 0.93 for ML-WHODAS-10) and excellent concurrent validity with the full WHODAS-32 (r = 0.98 for both). Compared with the Standard-12, they showed lower error, negligible Bland-Altman bias, and met predefined equivalence criteria, including ±0.5 points. Anchor-based Responsiveness was broadly comparable to the Disability Severity Grade (anchor) (r = 0.66-0.67; standardized response mean = 0.37-0.40). Anchor-based minimal clinically important differences were 9.26 for ML-WHODAS-16 and 9.95 for ML-WHODAS-10. CONCLUSION: The ML-WHODAS-16 and ML-WHODAS-10 substantially reduced assessment burden while maintaining scores that closely reflected those of the full WHODAS-32, particularly for group-level assessment and longitudinal monitoring. These findings support their use as practical, low-burden alternatives in dementia disability assessment. However, external validation, validation against harder clinical outcomes, formal non-inferiority testing, and clinically anchored longitudinal thresholds remain needed before individual-level interchangeability can be inferred.
Ma TL, Huang CY, Kuo CY
… +9 more, Sung KY, Chiu YT, Wu PR, Lee FJ, Liang KS, Wu KW, Chen YT, Liou YP, Chang CY
J Formos Med Assoc
· 2026 May · PMID 42069497
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BACKGROUND AND AIM: Proton pump inhibitor-based therapies remain the mainstream standard for Helicobacter pylori (H. pylori) eradication because of their lower cost and accessibility. Among these, 14-day sequential thera...BACKGROUND AND AIM: Proton pump inhibitor-based therapies remain the mainstream standard for Helicobacter pylori (H. pylori) eradication because of their lower cost and accessibility. Among these, 14-day sequential therapy (S-14) is a widely established and effective regimen with a relatively lower pill burden. Recently, 14-day vonoprazan-amoxicillin dual therapy (VA-14) has emerged as a promising alternative with similar therapeutic advantages. This study compared the efficacy and safety of VA-14 versus S-14 as first-line therapy. METHODS: This single-center, prospective, randomized, non-inferiority trial enrolled 337 treatment-naïve adults. Participants were assigned to VA-14 (vonoprazan 20 mg plus amoxicillin 1000 mg twice daily for 14 days) or S-14 (lansoprazole 30 mg plus amoxicillin 1000 mg twice daily for 7 days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 7 days). The primary endpoint was eradication rate assessed by urea breath test. Secondary outcomes included adverse events (AEs) and adherence. RESULTS: Intention-to-treat eradication rates were 83.9% with VA-14 and 74.0% with S-14. Per-protocol rates were 90.9% and 85.6%, respectively, demonstrating non-inferiority (P < 0.001). AEs were significantly less frequent with VA-14 (42.8% vs 78.3%, P < 0.01), including severe AEs (4.2% vs 14.3%, P < 0.01). Full adherence was higher with VA-14 (93.8% vs 90.0%, P = 0.04). CONCLUSIONS: Fourteen-day vonoprazan-amoxicillin dual therapy is non-inferior to sequential therapy for first-line H. pylori eradication and offers better tolerability and adherence, representing a simplified and viable low pill burden option. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT06156085.
J Formos Med Assoc
· 2026 Apr · PMID 42067464
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PURPOSE: To compare outcomes of imported precut corneas and domestic surgeon-prepared corneas in Descemet stripping automated endothelial keratoplasty (DSAEK) and non-DSAEK (nDSAEK). METHODS: This retrospective comparati...PURPOSE: To compare outcomes of imported precut corneas and domestic surgeon-prepared corneas in Descemet stripping automated endothelial keratoplasty (DSAEK) and non-DSAEK (nDSAEK). METHODS: This retrospective comparative interventional case series included forty consecutive eyes that underwent DSAEK or nDSAEK by a single surgeon between November 2017 and December 2024. Donor corneas were either imported precut from U.S. eye banks (n = 31) or prepared domestically by the surgeon (n = 9). Donor and recipient characteristics, best-corrected visual acuity (BCVA), endothelial cell density (ECD), graft survival, and complications were compared. RESULTS: Imported grafts were thinner (108.7 ± 16.7 vs. 181.1 ± 15.5 μm; P < 0.001) and had longer death-to-operation intervals (10.1 ± 1.9 vs. 6.3 ± 1.1 days; P < 0.001). Both groups achieved significant postoperative BCVA improvement. Mean initial ECD loss was greater with imported grafts but not statistically significant (26.1% vs. 19.6%; P = 0.286). At 6 months and 5 years, mean ECD loss was 23.8% and 37.3% for imported grafts and 15.4% and 52.9% for domestic grafts, respectively. Two primary failures occurred in the imported group, both in the same eye. One late failure occurred in each group-related to a retained anterior chamber intraocular lens and to messenger RNA COVID-19 vaccination, respectively. Outcomes were similar between DSAEK and nDSAEK. Postoperative BCVA was significantly better in Fuchs' endothelial corneal dystrophy (0.31 ± 0.15 LogMAR). CONCLUSION: Despite potentially greater initial ECD loss, imported precut corneas achieved comparable outcomes to domestic surgeon-prepared corneas, supporting their safety and efficacy.
Seng GJ, Lin JY, Chiu YN
… +6 more, Tsai WC, Li SC, Hsiao MN, Soong WT, Gau SS, Shang CY
J Formos Med Assoc
· 2026 Apr · PMID 42062172
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BACKGROUND: Group-based early intervention was widely implemented for autistic children, yet the impact on group adaptive functioning remained under-investigated. These abilities were critical for successful transition i...BACKGROUND: Group-based early intervention was widely implemented for autistic children, yet the impact on group adaptive functioning remained under-investigated. These abilities were critical for successful transition into preschool environments. This study examined the effectiveness of a group-based early intervention program in a public health daycare setting on both developmental outcomes and group adaptive functioning, and explored potential predictors of treatment response. METHOD: We conducted a retrospective chart review of autistic children aged 2-6 years who attended a group-based early intervention program in a daycare setting. Developmental outcomes were assessed using the Chinese Child Development Inventory (CCDI), group adaptive functioning using a newly developed Group Adaptive Function Index (GAFI), and overall symptom severity using the Clinical Global Impression-Severity (CGI-S). Psychometric and convergent validity of the GAFI were examined. Pre- and post-intervention changes were analyzed, and their associations with age at admission, treatment duration, and baseline developmental profiles were explored. We also compared good and poor responders to identify potential predictors of treatment response. RESULTS: Results showed significant improvements in expressive language, concept comprehension, general developmental quotients, and all GAFI subscales. CGI-S scores also showed a significant decrease, indicating overall symptom improvement. The GAFI demonstrated acceptable validity. Baseline developmental levels, particularly expressive language, concept comprehension, and general development, predicted better treatment response. CONCLUSION: Group-based early intervention in a daycare setting effectively improved both developmental and group adaptive functioning in autistic children. The GAFI might serve as a clinically relevant outcome measure, and baseline developmental profiles might inform clinical decision-making.
Wu YJ, Yeh CF, Hsu CY
… +12 more, Lin CF, Huang CC, Tang SC, Huang YC, Lin CY, Yu CH, Huang CY, Wang CY, Huang PH, Yeh HI, Li YH, Liu PY
J Formos Med Assoc
· 2026 Apr · PMID 42055832
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Statins are the cornerstone of lipid-lowering therapy for the prevention of atherosclerotic cardiovascular disease (ASCVD); however, many patients are unable to achieve guideline-recommended low-density lipoprotein chole...Statins are the cornerstone of lipid-lowering therapy for the prevention of atherosclerotic cardiovascular disease (ASCVD); however, many patients are unable to achieve guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets because of suboptimal tolerance to statins. The 2026 Taiwan Society of Lipid and Atherosclerosis (TSLA) Consensus Statement presents an updated, evidence-based framework for the identification and management of patients receiving suboptimally tolerable statins (STS)-a pragmatic concept that extends beyond the traditional and restrictive definition of statin intolerance (SI). STS encompasses patients who are unable to maintain recommended statin intensity because of real or perceived adverse effects, even when formal SI criteria are not met, thereby addressing a major treatment gap in real-world practice in Taiwan. This consensus integrates contemporary international evidence and Taiwanese guidelines, including the 2025 Taiwan cholesterol management pathway, and proposes structured, risk-based algorithms for STS management. A tiered therapeutic strategy is recommended: extremely high-risk patients should receive early combination therapy with ezetimibe and bempedoic acid, with prompt escalation to PCSK9 inhibition-based agents if LDL-C targets (<55 mg/dL) are not achieved. In high- and very high-risk patients, ezetimibe is the first-line add-on therapy, followed by bempedoic acid and PCSK9-targeted agents as needed, while lifestyle intervention and shared decision-making are emphasized in lower-risk groups. Non-pharmacological options are also reviewed; however, robust cardiovascular outcome data remain limited. By bridging conceptual and policy gaps between SI and STS, this consensus promotes a patient-centered, precision-based approach to improving LDL-C goal attainment and reducing residual ASCVD risk.
J Formos Med Assoc
· 2026 Apr · PMID 42049566
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INTRODUCTION: Driven by a desire to maintain quality of life and avoid a hopeless and undignified end, an increasing number of people worldwide advocate for euthanasia and physician-assisted death. Despite this, signific...INTRODUCTION: Driven by a desire to maintain quality of life and avoid a hopeless and undignified end, an increasing number of people worldwide advocate for euthanasia and physician-assisted death. Despite this, significant debates persist, with many physicians opposing assisted death. AIM: This study aims to conduct a systematic review integrating global literature on physicians' attitudes toward assisted death. DESIGN: Systematic review. DATA SOURCES: Searches were conducted in five databases: PubMed, Cochrane, EBSCO, EMBASE, and Airiti Library. RESULTS: A total of 40 studies, all in English, were identified. Among terminal patients, physician support for euthanasia ranged from 7.1% to 90.4%, and for physician-assisted death, from 5% to 77%. For non-terminal patients, support for euthanasia ranged from 2% to 18%, and for physician-assisted death, from 4% to 31.7%. CONCLUSIONS: Physicians' acceptance of physician-assisted suicide is higher in countries where assisted death is legalized compared to those where it is not. However, due to limited data, trends in euthanasia acceptance in countries with legalized assisted death remain difficult to compare.