Journal of the Formosan Medical Association最新文献

{"title":"Response to comment on \"Impact of computed tomography noise and region of interest sizes on the characterization of homogeneous renal mass: a proof-of-concept study\".","authors":"Yao-Ting Lee, Chung-Ming Chen, Jeff S Chueh, Po-Ting Chen","doi":"10.1016/j.jfma.2026.09.030","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.030","url":null,"abstract":"","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative patient blood management program led and managed by anesthesiologists via a clinical pathway-focused approach: A single-center quality improvement study.","authors":"Chen-Fuh Lam, Yu Lin, Ya-Ling Mai, Hsu-Tang Liu, Chien-Yang Hsieh, Huei-Chen Tsai, Hsiu-Ching Cheng, Jin-Cherng Chen","doi":"10.1016/j.jfma.2026.09.022","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.022","url":null,"abstract":"<p><strong>Introduction: </strong>Despite its well-recognized benefits, patient blood management (PBM) during perioperative period has not yet been widely implemented due to a lack of coordinated management between surgical specialties and anesthesiologists.</p><p><strong>Methods: </strong>An anesthesiologist-led perioperative PBM program was implemented across all surgical specialties at a general hospital in Taiwan using a clinical pathway-focused approach beginning on 1 April 2023. All in-hospital patients who received elective or emergency operations were included in this program. In addition to the 3-pillar PBM strategies, this program introduced the 3-domain clinical pathway approach (patient-centered, shared decision-making and point-of-care) to optimize blood transfusion and preserve patients' own blood, and established an institutional transfusion consensus. A defined period before PBM implementation (1 Jan 2023 to 31 Mar 2023) served as the control cohort, and the post-PBM period was defined as 1 Jan 2025 to 30 Sep 2025.</p><p><strong>Results: </strong>Compared with the pre-PBM, perioperative RBC transfusions reduced from 849U/1000 surgeries to an average of 475U/1000 surgeries in the post-PBM period (% difference 0.374, 95% confidence interval [CI] 0.356 to 0.391; P < 0.001). Transfusions of other blood components were also significantly reduced by 67%. RBC transfusion rate reduced from 16.1% to 11.0% (relative risk 0.683, 95% CI 0.545-0.856; P = 0.001). Major postoperative complications and medical cost were lower after PBM implementation.</p><p><strong>Conclusion: </strong>A comprehensive PBM program initiated by the anesthesia team during the perioperative period effectively reduces blood transfusion and selected postoperative quality indicators were lower after implementation across all surgical specialties.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149062123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and pilot implementation of a digitally integrated frailty-triggered comprehensive geriatric assessment system for older inpatients.","authors":"Yi-Chun Chou, Shey-Ying Chen, Yu-Tzu Li, Chi-Ming Chang, Lu-Cheng Kuo, Chin-Ying Chen, Jen-Kuei Peng, Shao-Yi Cheng, Chiung-Jung Wen, Feng-Ping Lu, Kun-Pei Lin, Mu-Cyun Wang, Meng-Chen Wu, Jen-Hau Chen, Chia-Ti Tsai, Ding-Cheng Derrick Chan","doi":"10.1016/j.jfma.2026.09.023","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.023","url":null,"abstract":"<p><strong>Background: </strong>Frailty is prevalent among hospitalized older adults and associated with adverse outcomes, yet it is rarely assessed systematically in acute care. Comprehensive geriatric assessment (CGA), a key component of frailty care, remains underutilized. System-level integration of frailty identification with structured CGA may facilitate its implementation in routine care.</p><p><strong>Methods: </strong>We developed a digitally integrated frailty-triggered CGA system incorporating three steps: frailty identification using the Clinical Frailty Scale (CFS), stratified care pathways by CFS levels, and FINDNEEDS-based CGA for CFS 4-7. This retrospective observational study evaluated its pilot implementation in inpatient wards at a medical center between March and November 2025. Outcomes focused on process and implementation measures, including time to CFS assessment, frailty distribution, and management actions. In a subset with available clinician-led CGA, FINDNEEDS was compared with clinician-led CGA using Cohen's kappa for domain-level agreement and Spearman's correlation for the total number of abnormal domains.</p><p><strong>Results: </strong>CFS assessment was completed within 4 days in 71% of patients. Hospital outcomes varied across frailty levels, with longer length of stay and higher in-hospital mortality among more frail patients. Among those with CFS 4-7, the number of geriatric problems increased with frailty levels. FINDNEEDS showed varied agreement with clinician-led CGA across geriatric domains, with a modest correlation for total abnormal domains (ρ = 0.38, p < 0.001).</p><p><strong>Conclusions: </strong>This system demonstrates the feasibility of systematic frailty identification and structured geriatric assessment in selected inpatient wards. Its impact on patient outcomes should be evaluated in future controlled studies.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining hepatitis B screening and risk stratification in neuroinflammatory patients receiving immune therapy.","authors":"Fang Yang, Jinying Cheng","doi":"10.1016/j.jfma.2026.09.026","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.026","url":null,"abstract":"","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative magnetic resonance imaging for evaluating depth of invasion in oral tongue cancer: Precision and predictive value.","authors":"Ly Xuan Quang, Nguyen Tran Bao Nghi, Le Thao Ngoc Nhi, Luong Huu Dang","doi":"10.1016/j.jfma.2026.09.025","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.025","url":null,"abstract":"<p><strong>Background: </strong>Accurate evaluation of the depth of invasion (DOI) in oral tongue squamous cell carcinoma (OTSCC) is essential for staging and treatment planning. Magnetic resonance imaging (MRI) is increasingly used as a non-invasive method for preoperative DOI assessment, though further validation against histopathology is needed.</p><p><strong>Aim: </strong>This study aims to assess the precision and predictive value of MRI-derived DOI in preoperative evaluation of oral tongue cancer.</p><p><strong>Methods: </strong>Thirty-two patients underwent preoperative MRI, providing sufficient power to detect a strong correlation with pathological DOI (pDOI) (80% power, α = 0.05). DOI measurements were obtained from axial and coronal MRI sequences and compared to pDOI from postoperative histopathology. Accuracy of MRI-derived DOI was assessed against tumor staging and pathological parameters.</p><p><strong>Results: </strong>MRI-derived depth of invasion (rDOI) strongly correlated with pDOI, achieving a correlation coefficient of 0.89. MRI showed 81.3% accuracy in DOI-based staging, with high concordance in T1 and T4a tumors, but lower accuracy for intermediate lesions (DOI 5-10 mm). Factors significantly affecting rDOI accuracy included tumor morphology, boundary clarity, size, cervical nodal status, and invasiveness on MRI. ROC analysis demonstrated high predictive value for muscle invasion (optimal rDOI: 7.0 mm), moderate accuracy for perineural invasion (8.6 mm), and good prediction of nodal metastasis (10 mm). However, rDOI had limited sensitivity for detecting lymphovascular invasion.</p><p><strong>Conclusions: </strong>MRI-based DOI provides a reliable, non-invasive tool for preoperative assessment of OTSCC, with strong correlation to pathological findings. While effective in detecting local invasion and nodal risk, overestimation in intermediate-stage tumors warrants cautious interpretation in treatment-decision.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to \"Comment on 'Repetitive saliva swallowing test: Performance in aspiration: Clarifying RSST-informed MBSS administration and PAS assessment\".","authors":"Yu-Chung Chen, Nai-Hsin Meng","doi":"10.1016/j.jfma.2026.09.016","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.016","url":null,"abstract":"","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subclinical cardiomyopathy in premanifest carriers of late-onset hereditary transthyretin amyloidosis with polyneuropathy.","authors":"Te-Wei Wang, Mao-Yuan Su, Mei-Fang Cheng, Hsueh-Wen Hsueh, Yu-Sen Huang, Ming-Chang Chiang, Yen-Hung Lin, Jyh-Ming Jimmy Juang, Shiou-Ru Tzeng, Sung-Tsang Hsieh, Chi-Chao Chao","doi":"10.1016/j.jfma.2026.09.021","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.021","url":null,"abstract":"<p><strong>Background: </strong>Cardiac involvement is a common presentation of late-onset hereditary transthyretin amyloidosis with polyneuropathy (ATTRv-PN). This study explored phenotypes of cardiac amyloidosis and their clinical and neurological correlates in the premanifest stage.</p><p><strong>Methods: </strong>Premanifest carriers with the transthyretin p.A117S variant were enrolled. Healthy controls and ATTRv-PN patients with stage 1 polyneuropathy disability (PND) were enrolled for comparison. The risk of cardiomyopathy was estimated by the Mayo ATTR-CM score, and cardiomyopathy was evaluated by echocardiography, ^99mTc-pyrophosphate (PYP) single-photon emission computed tomography (SPECT) imaging, cardiac magnetic resonance imaging (CMR), and serum natriuretic peptide (NT-proBNP). Neuropathy was assessed using clinical questionnaires, skin biopsy, neurophysiology, and quantitative sensory testing.</p><p><strong>Results: </strong>Thirty-two premanifest carriers with transthyretin variants (31 p.A117s) were enrolled, along with 63 controls and 11 ATTRv-PN patients (9 p.A117S). None of the carriers had polyneuropathy or showed high-risk Mayo ATTR-CM score, while 38% had carpal tunnel syndrome and 16% had increased radiotracer uptake on ^99mTc-PYP SPECT imaging. Compared with controls, carriers demonstrated a greater extracellular volume (ECV), longer myocardial native T1, and greater left ventricular mass index on CMR, indicating subclinical cardiac amyloidosis. ATTRv-PN patients had markedly greater amyloid burden across these cardiac imaging. Among carriers, CMR parameters and ^99mTc-PYP SPECT uptake were significantly correlated with nerve degeneration. Higher ^99mTc-PYP SPECT uptake was associated with increased NT-proBNP, native T1, ECV, autonomic and sensory dysfunction, and presence of CTS.</p><p><strong>Conclusions: </strong>Subclinical cardiomyopathy, as shown by nuclear medicine imaging and CMR, is common and linked to neuropathic changes among ATTRv-PN premanifest carriers carrying predominant p.A117S variant, and may facilitate early and accurate diagnosis and intervention for ATTRv-PN.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"The association between pre-discharge factors and early unplanned readmissions in adult home mechanical ventilation patients in Taiwan\".","authors":"Yuhang Zhang, Xuehua Zhu","doi":"10.1016/j.jfma.2026.09.019","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.019","url":null,"abstract":"","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus on gene therapy for spinal muscular atrophy in Taiwan.","authors":"Yuh-Jyh Jong, Yin-Hsiu Chien, Wen-Chen Liang, Wen-Chin Weng, Ting-Rong Hsu, I-Jun Chou, Inn-Chi Lee, Shyi-Jou Chen, I-Ching Chou, Che-Sheng Ho, Yung-Ting Kuo, Shuan-Pei Lin, Li-Ping Tsai, Fuu-Jen Tsai, Ming-Yuh Chang, Kuang-Lin Lin, Wang-Tso Lee","doi":"10.1016/j.jfma.2026.09.018","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.018","url":null,"abstract":"<p><p>Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder caused by biallelic mutations in the SMN1 gene, leading to progressive motor neuron degeneration, muscle weakness and atrophy due to survival motor neuron (SMN) protein deficiency. The Taiwan Child Neurology Society convened 17 pediatricians with extensive clinical experience in SMA to establish a consensus on gene therapy for SMA in Taiwan. Epidemiological data indicate that approximately one in 48 individuals in Taiwan is an SMA carrier, and one in 17,181 newborns is affected. The advent of three FDA-approved disease-modifying therapies-onasemnogene abeparvovec, nusinersen, and risdiplam-has markedly improved therapeutic prospects. Early intervention in presymptomatic infants significantly enhances motor development and the ability to walk independently. In 2023, onasemnogene abeparvovec was officially included in Taiwan's National Health Insurance, reducing the financial burden on patients and improving prognosis. This consensus recommends incorporating SMA into the newborn screening program for early diagnosis and prompt treatment, and emphasizes that gene therapy should be evaluated based on SMN2 copy number and clinical condition. Presymptomatic treatment is critical for optimal motor outcomes, and multidisciplinary care teams are essential for comprehensive long-term management.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rome III-Rome IV prevalence discordance in Taiwan as a bridge to Rome V validation.","authors":"Hanchen Wu, Fei-Hu Yan","doi":"10.1016/j.jfma.2026.09.024","DOIUrl":"https://doi.org/10.1016/j.jfma.2026.09.024","url":null,"abstract":"","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}