Taoyuan Chang Gung Memorial Hospital

End-of-life care enhances quality of life and alleviates suffering in patients with life-limiting illnesses, and its practice is shaped by cultural contexts. With East Asia comprising more than one-fifth of the global population, research in this region is essential. This scoping review explored nurses' experiences of providing end-of-life care in East Asia between 2015 and 2024. A total of 49 studies published in English or Chinese were selected from seven electronic databases, based on criteria involving direct care by registered nurses, and the review followed standard scoping methodology. Three themes were identified-requirements, transformation, and culture-encompassing seven categories: readiness, patient-centered, challenges, emotion, coping, transformation, and culture. A conceptual map was developed to visually present the findings. This review highlights the complexity of end-of-life care in East Asia and offers key insights into the real-world challenges and needs of nurses. Collectively, our results show that end-of-life care requires enhanced clinical readiness, recognition of nurses' emotional and professional transformation, and sensitivity to cultural and family-centered values. These findings highlight priorities for advancing training, emotional support, and culturally aligned care strategies in East Asia.

Real-world evidence regarding the use of dacomitinib as a first-line therapy for advanced non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations remains limited. This multicenter, retrospective cohort study aimed to evaluate the clinical outcomes of dacomitinib as a first-line treatment in patients with untreated advanced EGFR-mutant NSCLC without brain metastases. This retrospective analysis included 161 patients with stage IIIB/IV EGFR-mutant NSCLC without brain metastasis at baseline who received first-line dacomitinib between October 2020 and August 2023 at four Taiwanese cancer centers. The primary outcomes included the objective response rate (ORR), progression-free survival (PFS), overall survival (OS), predictive risk factors for PFS, and adverse events (AEs). The ORR was 64.0%, and the disease control rate (DCR) reached 91.3%. The median PFS was 20.93 months (95% CI: 17.55-24.32), and the median OS was 41.27 months (95% CI: 31.71-50.82). Multivariate analysis revealed that an Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥ 2, bone metastasis, and liver metastasis were independent predictors of shorter PFS. Among patients who experienced disease progression and underwent rebiopsy, the secondary T790M mutation rate was 50.6%. Most treatment-related AEs were grade 1-2 and manageable. Dacomitinib demonstrated favorable efficacy and tolerability as a first-line therapy in advanced NSCLC patients with common EGFR mutations (exon 19 deletion or L858R). A baseline ECOG PS ≥ 2 and the presence of bone or liver metastases were significantly associated with worse PFS, suggesting a need for additional therapeutic strategies in these subgroups.

485 Background: The Eastern Cooperative Oncology Group performance status (ECOG PS) is fundamental for prognostication in advanced biliary tract cancer (BTC). The albumin-bilirubin (ALBI) score objectively reflects hepatic reserve; however, its value in combination with ECOG PS for patients treated with durvalumab plus gemcitabine-cisplatin (GCD) remains unclear. Methods: We analyzed consecutive patients with advanced BTC treated with first-line GCD at three Taiwanese institutions between August 2021 and March 2025. Patients were stratified into cohort-specific ALBI tertiles (Q1–Q3). Survival outcomes were estimated using Kaplan–Meier and Cox regression analyses. Tumor response and adverse events were assessed using RECIST v1.1 and CTCAE v5.0, respectively. Predictive accuracy for 6- and 12-month overall survival (OS) was compared among ECOG PS, ALBI, and their combination using time-dependent area under the receiver operating characteristic curves (AUC) and the Akaike information criterion (AIC). Results: Among 172 patients, the median OS was 13.8 months and progression-free survival (PFS) was 5.1 months. OS decreased progressively from ALBI Q1 to Q3 (24.0, 14.4, and 5.9 months; p < 0.001). In multivariate analysis, ALBI Q3 (vs. Q1) remained independently associated with poorer OS (adjusted hazard ratio [HR] 2.16, p = 0.016). ALBI correlated with ECOG PS (p = 0.004), but each maintained independent prognostic value. Combined ALBI + ECOG yielded higher AUCs (0.750 at 6 months; 0.683 at 12 months) and lower AICs than either model alone. The median OS ranged from 24.0 months in patients with ECOG 0–1 and ALBI Q1 to 2.4 months in those with ECOG 2–3 and ALBI Q3. Higher ALBI scores predicted lower response rates and increased toxicities ≥ grade 3. Conclusions: Baseline ALBI score independently predicted survival, tumor response, and toxicity risk in patients with advanced BTC treated with GCD. Combining ALBI with ECOG PS improves prognostic discrimination and may guide treatment and stratification in advanced BTC.

Infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) are increasingly contributing to mortality in ICU patients. The study aimed to evaluate outcomes, identify mortality predictors, and assess antibiotic strategies for treating KPC-Kp bloodstream infections (BSIs) in critically ill ICU patients. This retrospective study at Chang Gung Memorial Hospital, Taiwan, from January 2017 to December 2021, analyzed 168 adult ICU patients with KPC-Kp BSIs. All patients experienced respiratory failure and were on mechanical ventilation. The 30-day mortality rate was 61.9%. Patients who died had higher Pitt bacteremia (7.0 ± 2.6 vs. 4.2 ± 2.9, P < 0.001) and SOFA scores (12.0 ± 4.1 vs. 6.2 ± 3.8, P < 0.001), greater need for renal replacement therapy (27.9% vs. 9.4%, P < 0.002), and higher intra-abdominal infection prevalence (9.6% vs. 0%, P < 0.001). Lower platelet counts (93.7 ± 84.7 vs. 171.1 ± 120.2, P < 0.001) and higher CRP levels (131.3 ± 92.3 vs. 88.7 ± 81.0, P < 0.003) were observed in deceased patients. Multivariate analysis identified CRP levels and SOFA scores as independent mortality predictors, while ceftazidime-avibactam treatment and appropriate antibiotic therapy within 48 h post-BSI onset correlated with better outcomes. Early appropriate antibiotic treatments and ceftazidime-avibactam use are crucial for reducing mortality in critically ill ICU patients. Not applicable.

IntroductionThis study aimed to figure out the relationship between hip morphology and chondral injury.Materials and MethodsPatients who received hip arthroscopy in our institution from 2013 to 2022 was reviewed, and patients under 40 years old with chondral injury under arthroscopy and without osteoarthritis change in preoperative X-ray were enrolled. Plain film and CT were used to evaluate the hip morphology.Results60 patients were enrolled in our study with mean age of 31 years old. Acetabulum cartilage injury is related with smaller lateral center edge angle (LCEA)(38.3° vs 31.7°, p=0.031), and the smaller posterior acetabular sector angle (PASA) is risk factor of severe chondral wear (89.55° vs 69.34°, p=0.002). In addition, the severity of femoral chondral injury is related with the larger LCEA (29.86 vs 40.45, p=0.001) and smaller PASA (94.36° vs 42.4°, p<0.001). Full thickness of chondral injury indicated less favorable clinical outcomes including pain scale and patient reported outcomes than no or partial thickness injury group.DiscussionPatients with poor posterior coverage of acetabulum would present with more severe chondral injury in both femur and acetabulum articular surface, which might be related to the lower stability of hip joint during motion, But the more excessive coverage acetabulum may cause more femoral chondral injury. The depth of chondral injury caused worse clinical outcomes.ConclusionThe posterior and superior coverage of acetabulum is related with the chondral injury of hip joint in young patient group and the severity of chondral injury also caused poor clinical outcomes.