Browsing by Author "Yang, Yi-Ting"

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Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery A Cluster Randomized Clinical Trial
(2017-09-01)
Chen, Cheryl Chia-Hui
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Li, Hsiu-Ching
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Liang, Jin-Tung
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Lai, I-Rue
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Purnomo, Jerry Dwi Trijoyo
IMPORTANCE Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS). OBJECTIVE To examine whether a modified Hospital Elder Life Program (mHELP) reduces incident delirium and LOS in older patients undergoing abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial of 577 eligible patients enrolled 377 older patients (>= 65 years of age) undergoing gastrectomy, pancreaticoduodenectomy, and colectomy at a 2000-bed urban medical center in Taipei, Taiwan, from August 1, 2009, through October 31, 2012. Consecutive older patients scheduled for elective abdominal surgery with expected LOS longer than 6 days were enrolled, with a recruitment rate of 65.3%. Participants were cluster randomized by room to receive the mHELP or usual care. INTERVENTIONS The intervention (implemented by an mHELP nurse) consisted of 3 protocols administered daily: orienting communication, oral and nutritional assistance, and early mobilization. Intervention group participants received all 3 mHELP protocols postoperatively, in addition to usual care, as soon as they arrived in the inpatient ward and until hospital discharge. Adherence to protocols was tracked daily. MAIN OUTCOMES AND MEASURES Presence of delirium was assessed daily by 2 trained nurses who were masked to intervention status by using the Confusion Assessment Method. Data on LOS were abstracted from the medical record. RESULTS Of 577 eligible patients, 377 (65.3%) were enrolled and randomly assigned to the mHELP (n = 197; mean [SD] age, 74.3 [5.8] years; 111 [56.4%] male) or control (n = 180; mean [SD] age, 74.8 [6.0] years; 103 [57.2%] male) group. Postoperative delirium occurred in 13 of 196 (6.6%) mHELP participants vs 27 of 179 (15.1%) control individuals, representing a relative risk of 0.44 in the mHELP group (95% CI, 0.23-0.83; P = .008). Intervention group participants received the mHELP for a median of 7 days (interquartile range, 6-10 days) and had a shorter median LOS (12.0 days) than control participants (14.0 days) (P = .04). CONCLUSIONS AND RELEVANCE For older patients undergoing abdominal surgery who received the mHELP, the odds of delirium were reduced by 56% and LOS was reduced by 2 days. Our findings support using the mHELP to advance postoperative care for older patients undergoing major abdominal surgery.
Human Recognition Based on Kinematics and Kinetics of Gait
(2011)
Lin, Yu-Chih
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Yang, Bing-Shiang
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Lin, Yu-Tzu
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Yang, Yi-Ting
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機械工程學系
Human recognition based on gait is a new biometric method that considers both spatial and temporal features which tracks the gait of a human being from a distance. The most widely used techniques for gait recognition at present can be divided into two categories: the model-free method and the model-based method. Both these methods process images of a moving body. Although some effort has been devoted to gait recognition, a high identification rate and low computational cost still need to be achieved. In this study, we investigated gait recognition in terms of biomechanics, which is often overlooked in the fields of computer science and electronics. We present a method for people recognition by using both the three-dimensional parameters for lower limb joints, i.e., kinematic and kinetic parameters. Dynamic data are acquired by tracking marker positions using a motion capture system with force plates. Although a marker-free and cable-free biometric system is more applicable for security purposes, acquiring data by marker tracking is one of the most precise methods currently available. The results obtained from marker tracking can clarify the relationship between the recognition rate and dynamic data of normal walking. In this study, 350 trials were conducted for 10 subjects. For each subject, 20 trials were conducted for training and the remaining 15 were for testing. A self-organizing map (SOM) neural network was employed for data classification. The importance of a specific variable in each dimension for each joint is discussed in detail to investigate the major factors that cause the differences in human gait according to a biomechanical approach. Experimental results showed that gait is a reliable feature for individual identification since a high recognition rate can be achieved by choosing appropriate joints or dynamic parameters in some dimensions of a gait. Kinematic variables in the frontal and transverse planes of the knee or hip joints are recommended due to their higher recognition rates. These findings can be applied to both biomedicine and computer science.
People Recognition by Kinematics and Kinetics of Gait
(2009)
Lin, Yu-Chih
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Yang, Bing-Shiang
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Yang, Yi-Ting
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機械工程學系
;
腦科學研究中心
Human recognition by gaits is a new biometric method which considers both spatial and temporal features by tracking the gait at a distance. Most researches use image processing methods to analyze the moving object, while some use the model-based methods. Although some efforts have been devoted to the gait recognition, a high identification rate and a low computational cost still need to be achieved. This paper tends to investigate the gait recognition from the biomechanical point of view, which is lacking in the computer science and electronics communities. We present the method of people recognition by using both three-dimensional parameters of lower limb joints, namely, kinematic parameters (including joint angles and angular velocities) and kinetic parameters (joint forces). Dynamic data are acquired by tracking the maker positions using a motion capture system. 350 trials for 10 subjects are conducted, in which we use 20 trials for each one of these for training and the remaining 15 for testing. Additional 35 trials for another one subject not in the training set are conducted for testing the adventitious people. SOM neuron networks are employed for data classification. The importance of specific joints and variables is discussed in detail to investigate the major factors that cause the differences in human gait through a biomechanical approach. Experimental results show that gait is a reliable feature for individual identification since a high recognition rate can be achieved by choosing the proper joints or dynamic parameters of a gait. It also suggests that some joints and dynamic parameters dominate the differences in the walking style of people, which can be applied to both the biomedical and the computer vision fields.
Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial
(2019-05-01)
Chen, Cheryl Chia-Hui
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Yang, Yi-Ting
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Lai, I-Rue
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Lin, Been-Ren
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Yang, Ching-Yao
Objective: To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery. Design: Cluster randomized trial. Setting: Two 36-bed GI wards at a university-affiliated medical center in Taiwan. Participants: Older patients (>= 65 years, N = 377) were recruited if they were scheduled for elective GI surgery with an expected length of hospital stay > 6 days. After transferring to the GI ward after surgery, participants were randomly assigned to the mHELP or control group (1: 1) by room rather than individually because most patient units are double-or triple-occupancy rooms. Intervention: The mHELP protocols (early mobilization, oral and nutritional assistance, and orienting communication) were administered daily with usual care by a trained nurse until hospital discharge. The control group received usual care only. Measures: Outcomes were in-hospital nutritional decline, measured by body weight and Mini-Nutritional Assessment (MNA) scores, and Fried's frailty phenotype. Return of GI motility was examined as a potential mechanism contributing to observed outcomes. Results: Participants (mean age = 74.5 years; 56.8% male) primarily underwent colorectal (56.5%), gastric (21.2%), and pancreatobiliary (13.8%) surgery. Participants who received the mHELP [for a median of 7 days (interquartile range = 6-10 days)] had significantly lower in-hospital weight loss and decline in MNA scores (weight -2.1 vs -4.0 lb, P = .002; score -3.2 vs -4.0, P =.03) than the control group. The mHELP group also had significantly lower rates of incident frailty during hospitalization (12.0% vs 21.7%, P = .022), and persistent frailty (50.0% vs 92.9%, P = .03). Participants in the mHELP group had trends toward an accelerated return of GI motility. Conclusion and Implications: The mHELP effectively reduced nutritional decline, prevented new frailty, and promoted recovery of frailty present before admission. These nurse-administered protocols might be useful in other settings, including conditions managed at home or in nursing facilities. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.