1
|
Chou HC, Cheng SF, Jennifer Yeh SC, Tang PL. Effectiveness of a multicomponent activity and horticultural intervention for the hospitalized older adults: A randomized controlled trial: Effectiveness of Intervention for the Hospitalized Older Adults. Geriatr Nurs 2024; 55:112-118. [PMID: 37979470 DOI: 10.1016/j.gerinurse.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
This study evaluated the effectiveness of different intervention programs in improving function among hospitalized older individuals using the Comprehensive Geriatric Assessment (CGA). A randomized controlled trial consisted of three groups: routine care, horticulture, and multicomponent activities (n = 32 each). Horticultural and multicomponent activity interventions showed beneficial effects on the CGA in hospitalized older individuals, particularly regarding cognitive function and quality-of-life. Additionally, horticultural activities significantly contributed to the perception of older adults' health status. We recommend to select older patients in geriatric wards with long-term hospitalization and adjust the frequency of activities or choose a single intervention program to provide long-term and effective intervention effects.
Collapse
Affiliation(s)
- Hsueh-Chih Chou
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC); Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (ROC)
| | - Su-Fen Cheng
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC)
| | - Shu-Chuan Jennifer Yeh
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (ROC)
| | - Pei-Ling Tang
- School of Nursing, Fooyin University, Kaohsiung, Taiwan (ROC).
| |
Collapse
|
2
|
Chiang CH, Hung WT, Tai TH, Cheng CC, Lin KC, Kuo SH, Lin SC, Tang PL, Gao CE, Weng PY, Ko YL, Fu YJ, Kuo FY, Huang WC. The impact of end-stage kidney disease on mortality in patients after acute myocardial infarction: A nationwide study. J Chin Med Assoc 2023; 86:740-747. [PMID: 37399580 DOI: 10.1097/jcma.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the impact of end-stage kidney disease (ESKD) on mortality in patients with first-time acute myocardial infarction (AMI). METHODS This was a retrospective nationwide cohort study. Patients diagnosed with first-time AMI between January 1, 2000, and December 31, 2012, were included. All patients were followed-up until death or December 31, 2012, whichever occurred first. A one-to-one propensity score matching technique was used to match patients with ESKD to those without ESKD of similar sex, age, comorbidities, and coronary intervention (including percutaneous coronary intervention [PCI] and coronary artery bypass grafting [CABG]). Kaplan-Meier cumulative survival curves were constructed to compare AMI patients with and without ESKD. RESULTS A total of 186 112 patients were enrolled and 8056 patients with ESKD were identified. Propensity score matched 8056 patients without ESKD were included in the comparison. Overall, the 12-year mortality rate was significantly higher in patients with ESKD than in those without ESKD (log-rank p < 0.0001), including the sex, age, and PCI and CABG subgroups. In Cox proportional-hazard regression analysis, ESKD was an independent risk factor for mortality after patients suffered from first-time AMI (hazard ratio, 1.77; 95% CI, 1.70-1.84; p < 0.0001). A forest plot for subgroup analysis revealed that in AMI patients, ESKD had a higher impact on mortality in male; younger age; without comorbidities such as hypertension, diabetes mellitus, peripheral vascular disease, heart failure, cerebrovascular accident, and chronic obstructive pulmonary disease; and receiving PCI and CABG subgroups. CONCLUSION ESKD significantly increases the mortality risk in patients with first-time AMI, including both sexes, different ages, and whether PCI or CABG was performed. In patients with AMI, ESKD has a high impact on mortality in male, younger age, without comorbidities, and those undergoing PCI and CABG.
Collapse
Affiliation(s)
- Cheng-Hung Chiang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Cardiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Wan-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Ta-Hsin Tai
- Department of Cardiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan, ROC
| | - Chin-Chang Cheng
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
| | - Kun-Chang Lin
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Shu-Hung Kuo
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Su-Chiang Lin
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Pei-Ling Tang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chong-En Gao
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pei-Yu Weng
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Ling Ko
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Ju Fu
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Feng-Yu Kuo
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Wei-Chun Huang
- Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| |
Collapse
|
3
|
Wang SC, Chu NF, Tang PL, Pan TC, Pan LF. Using Healthcare Complaints Analysis Tool to Evaluate Patient Complaints during the COVID-19 Pandemic at a Medical Center in Taiwan. Int J Environ Res Public Health 2022; 20:310. [PMID: 36612630 PMCID: PMC9819617 DOI: 10.3390/ijerph20010310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
The purpose of this study is to evaluate patient complaints using the Healthcare Complaints Analysis Tool (HCAT) during the COVID-19 pandemic in 2021 in Taiwan. Additionally, the study examines the distribution and type of patient complaints before and during the COVID-19 pandemic to provide a better clinical procedure, hospital management and patient relationship. This study utilizes a cross-sectional design. We collected patient complaints from January 2021 to December 2021 at a medical center in Southern Taiwan. Using the Healthcare Complaints Analysis Tool (HCAT), the patient complaints are classified and coded into three major domains (clinical, management and relationship), and seven problem categories (quality, safety, environment, institutional process, respect and patient rights, listening and communication). We further compared and categorized the complaints based on whether they were COVID-19-related or not and whether it was before or during the COVID-19 pandemic to understand the differences in patient complaints. In total, we collected 584 events of patient complaints. Based on the HCAT domains, the complaints about management were the highest, at 52.9%, followed by complaints about relationship, about 37.7%. According to the types of problem, the complaints about the environment were the highest, about 32.5% (190/584), followed by communication at about 29.6% (173/584), and institutional process at about 20.4% (119/584). There were 178 COVID-19-related complaints and they were made more frequently during Q3 and Q4 (from mid-June to December) which was the pandemic period in 2021 in Taiwan. Among the COVID-19-related complaints, the most frequent were in the environment domain with 114 cases (about 65.7% of COVID-19-related complaints). The domains of patient complaints were statistically different between COVID-19-related and non-related (p < 0.001). During the COVID-19 pandemic, the proportion of COVID-19-related complaints increased 1.67 times (117/312 vs. 61/272, p < 0.001). Both prior to and during the COVID-19 pandemic, management-related complaints represented the highest domain. During the COVID-19 pandemic, the implementation of infectious disease prevention and control policies and actions may have developed some inconvenience and difficulty in seeking medical practice and process. These characteristics (complaints) are more prominent, and timely and patient-first consideration is required immediately to build up better clinical procedures, the healthcare environment and comprehensive communication. Using the HCAT can allow health centers or health practitioners to understand the needs and demands of patients through complaints, provide friendly medical and health services, avoid unequal information transmission, build trust in doctor−patient relationships and improve patients’ safety.
Collapse
Affiliation(s)
- Shu-Chuan Wang
- Department of Medical Affair Administration, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Nain-Feng Chu
- Division of Occupational Medicine, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
- School of Public Health, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Tzu-Cheng Pan
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Li-Fei Pan
- General Affairs Administration, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| |
Collapse
|
4
|
Hsu MF, Tang PL, Pan TC, Hsueh KC. Different traditional Chinese medicine constitution is associated with dietary and lifestyle behaviors among adults in Taiwan. Medicine (Baltimore) 2022; 101:e30692. [PMID: 36181077 PMCID: PMC9524912 DOI: 10.1097/md.0000000000030692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The World Health Organization states prevention of chronic diseases should be based on good lifestyle behaviors and healthy diets as they can reduce the risk of chronic diseases by 80%. The theory of traditional Chinese medicine constitution (TCMC) emphasizes the congenital differences of TCMC stem from the genes of parents, while acquired differences in TCMC are caused by factors as living environments, lifestyle behaviors, and dietary habits. From the perspective of preventive medicine, this study explores the correlation between dietary habits and lifestyle behaviors as potential risk factors for different types of TCMC-balanced constitution, Yang deficiency, Yin deficiency, and Phlegm stasis. Research data were collected from 2760 subjects aged 30 to 70 years participating in a survey conducted by Taiwan Biobank in 2012 to 2017. The survey included basic demographic characteristics, lifestyle behaviors, and dietary habits along with a Body Constitution Questionnaire. Compared to men, women were 3 to 4 times more likely to develop Yang-deficiency, Yin-deficiency, and Phlegm stasis. Variables that affected TCMC were smoking, midnight snack consumption, consumption of gravy-soaked or lard-soaked rice/noodles, deep-fried soybean products, bread spread, pickled vegetables as side dishes for the main course of a meal, and the dietary habit of vegetables or fruits instead of high-fat desserts. Poor dietary habits and lifestyle behaviors are the cause of unbalanced TCMCs. Understanding the specific TCMC of individual can provide useful information and predictions to maintain physical health and achieve early disease prevention to meet the goal of preventive medicine.
Collapse
Affiliation(s)
- Min-Fen Hsu
- Department of Nursing, Pingtung Veterans General Hospital, Pingtung, Taiwan (ROC)
- Department of Nursing, Meiho University, Pingtung, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC)
- School of Nursing, Fooyin University, Kaohsiung, Taiwan (ROC)
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan (ROC)
| | - Tzu-Cheng Pan
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC)
| | - Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC)
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan (ROC)
- *Correspondence: Kuang-Chieh Hsueh, Department of Family Medicine, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Road, Kaohsiung City 81362, Taiwan (ROC) (e-mail: )
| |
Collapse
|
5
|
Tang PL, Lin HS, Wang HH, Hu LY, Chou FH. Demoralization level fluctuated at various time frame of radiotherapy for patients with different cancers: a longitudinal observational study. BMC Palliat Care 2022; 21:143. [PMID: 35948925 PMCID: PMC9364497 DOI: 10.1186/s12904-022-01033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. It is affected by national characteristics, culture, disease characteristics and general conditions of the patient such as individual cultural features, nature of stress, personal expression preferences and social behavior. Compared with the results of previous studies on demoralization syndrome, patients with cancer in Taiwan exhibit a higher prevalence of demoralization. We aimed to investigate the prevalence of high demoralization and the changes in the level of demoralization in cancer patients during radiotherapy to explore the associated factors and the contributing factors to the high level of demoralization. Methods We used the Demoralization Scale-Mandarin Version to evaluate the demoralization level at six-time points in patients admitted for radiotherapy in a 3-month observational period. 101 patients allocated to three groups by cancer region completed the study. We applied the generalized estimating equation (GEE) to analyze the changes in the demoralization level among the three groups. The variables associated with the changes in the demoralization level were also investigated. Results In the analysis using univariate GEE, only patients in the chest and breast group exhibited significant changes at two different time points. The results obtained using multivariate GEE revealed that sociodemographic variables, stage of disease and use of surgery or chemotherapy had no impact on the changes in demoralization across three months. Conclusion The demoralization level certainly fluctuated in an extremely high range. The higher prevalence of demoralized patients may indicate that if medical staff neglect the importance of demoralization, demoralized patients with cancer may not receive appropriate care.
Collapse
Affiliation(s)
- Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC).,School of Nursing, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC).,School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC)
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC)
| | - Hsiu-Hung Wang
- School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC)
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, 201, Sec.2, ShihPai Rd., Beitou District., Taipei City, 11217, Taiwan (ROC).,Division of Psychiatry, National Yang-Ming University, 155, Sec.2, Linong St., Beitou District, Taipei City, 11221, Taiwan (ROC)
| | - Fan-Hao Chou
- School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC).
| |
Collapse
|
6
|
Yang CL, Yin YR, Chu CM, Tang PL. Does category of strength predict return-to-work after occupational injury? BMC Public Health 2022; 22:1472. [PMID: 35918669 PMCID: PMC9344704 DOI: 10.1186/s12889-022-13817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Occupational accidents may lead laborers to lose their working capacities, affecting their physical and mental health. Occupational rehabilitation helps improve the ability of patients with occupational accidents and suggests appropriate jobs to avoid second injuries. This study aimed to identify whether any of the functional capacity evaluation (FCE) strength subtests predicted successful return to work. Methods Data were collected of 84 patients receiving government-subsidized occupational rehabilitation between September 2016 and December 2018. A structured questionnaire was employed for pre- and post-training assessment, including basic information, information of the occupational accident, status of the laborer at the opening of the injury case, physical requirement for the job, and physical capacity. Eight subtests of strength were included in the physical capacity evaluation, i.e., carrying, lifting to several levels, power grip, and lateral pinch, to explore the association between the strength tests and return to work. Results The unadjusted model showed that for every additional kilogram in bilateral carrying strength before work hardening training, the odds of successful return to work increased (crude odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.01–1.24, p = 0.027). After adjustment for basic demographic information and pre-accident physical functional elements of work, the odds of successful return to work increased (adjusted OR = 1.27, 95% CI = 1.04–1.54, p = 0.02) for every additional kilogram in the pre-training bilateral carrying strength. There were no statistically significant differences observed in the other seven subtests. Conclusion Through thorough evaluation and work hardening training provided in the occupational rehabilitation, patients’ physical capacity can be understood and improved. However, a full evaluation of functional capacities is prolonged and time-consuming. This study provides evidence that pre-work-hardening bilateral carrying strength may be a promising predictor of return to work and we recommend to consider it as a prioritized test to assist in determining appropriate advice regarding return to work. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13817-2.
Collapse
Affiliation(s)
- Chia-Lin Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Yan-Ru Yin
- Department of Occupational Medicine, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Chuan-Man Chu
- Department of Occupational Medicine, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC). .,Department of Health-Business Administration, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC). .,College of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC).
| |
Collapse
|
7
|
Tai JF, Wang C, Lin LY, Tang PL. [Validity and Reliability of a Nursing Process Scale]. Hu Li Za Zhi 2022; 69:31-40. [PMID: 35644595 DOI: 10.6224/jn.202206_69(3).06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND A valid and reliable nursing record audit tool can simplify nursing records and provide a basis for quality auditing. PURPOSE To ensure the validity and reliability of the Nursing Process Scale to promote accurate monitoring of nursing record quality. METHODS This study employed structural equation modeling to examine the content validity and reliability of the current Nursing Process Scale. A total of 660 results from a medical center were used to revise the content and then the validity and reliability of the revised scale were analyzed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used in three stages, namely item generation and content validity testing, item analysis and validity testing, and reliability testing. RESULTS Validity, reliability, and organization based on clinical practice were used to identify and remove scale items with low factor loadings. The remaining items were organized under several factors in the revised Nursing Process Scale, which had good internal consistency with a Cronbach's α of .653 in the EFA, a Kaiser-Meyer-Olkin value of .614, and a significant Bartlett's test of sphericity value. Five factors and 22 questions were extracted from the original 32 questions. The CFA conducted after the model correction reduced the number of questions to 10 and the number of factors to 3, with each index reaching the ideal level. To improve ease-of-use in clinical settings, the important items were reduced from 32 to 22 questions, including the 10 questions suggested by the CFA. CONCLUSIONS The validity, reliability, and organization based on clinical practice were considered in the removal of items with low factor loadings. Axial conversion was used to generate a component matrix, which allowed item rearrangement across factors and the revision of the Nursing Process Scale. The development of simple valid and reliable audit tools will save auditor time and allow the effective evaluation of nursing record quality and improvement in record integrity. This revised scale was reviewed and approved for implementation in 42 clinical wards.
Collapse
Affiliation(s)
- Jui-Fen Tai
- MS, RN, Head Nurse, Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Chi Wang
- MSN, RN, Director, Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Li-Ying Lin
- PhD, RN, Supervisor, Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Pei-Ling Tang
- PhD, RN, Assistant Professor, Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| |
Collapse
|
8
|
Chen HH, Chern YB, Hsu CY, Tang PL, Lai CC. Kidney transplantation waiting times and risk of cardiovascular events and mortality: a retrospective observational cohort study in Taiwan. BMJ Open 2022; 12:e058033. [PMID: 35613763 PMCID: PMC9131177 DOI: 10.1136/bmjopen-2021-058033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Patients with end-stage renal disease (ESRD) are at a high risk of cardiovascular events (CVEs), and kidney transplantation (KT) has been reported to improve risk of CVEs and survival. As the association of KT timing on long-term survival and clinical outcomes remains unclear, we investigated the association of different KT waiting times with clinical outcomes. DESIGN Retrospective observational cohort study. SETTING We conducted an observational cohort study using data from the National Health Insurance Research Database in Taiwan. Adult patients who initiated KT therapy from 1997 to 2013 were included. PARTICIPANTS A total of 3562 adult patients who initiated uncomplicated KT therapy were included and categorised into four groups according to KT waiting times after ESRD: group 1 (<1 year), group 2 (1-3 years), group 3 (3-6 years) and group 4 (>6 years). PRIMARY OUTCOME MEASURES The main outcomes were composite of all-cause death, non-fatal myocardial infarction or non-fatal stroke, based on the primary diagnosis in medical records during hospitalisation. RESULTS Compared with group 1, the adjusted risk of primary outcome events (all-cause death, non-fatal myocardial infarction or non-fatal stroke) increased by 1.67 times in group 2 (95% CI: 1.40 to 2.00; p<0.001), 2.17 times in group 3 (95% CI: 1.73 to 2.71; p<0.001) and 3.10 times in group 4 (95% CI: 2.21 to 4.35; p<0.001). The rates of primary outcome events were 6.7%, 13.4% and 14.0% within 5 years, increasing to 19.5%, 26.3% and 30.8% within 10 years in groups 1, 2 and 3, respectively. CONCLUSIONS Our results demonstrate that early KT is associated with superior long-term cardiovascular outcomes compared with late KT in selected patients with ESRD receiving uncomplicated KT, suggesting that an early KT could be a better treatment option for patients with ESRD who are eligible for transplantation.
Collapse
Affiliation(s)
- Hsin-Hung Chen
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yahn-Bor Chern
- Division of Nephrology, Department of Medicine, E-DA Hospital, Kaohsiung, Taiwan
- School of medicine, College of medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Yang Hsu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Cheng Lai
- Department of Cardiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| |
Collapse
|
9
|
Wu KS, Lin PC, Chen YS, Pan TC, Tang PL. The use of statins was associated with reduced COVID-19 mortality: a systematic review and meta-analysis. Ann Med 2021; 53:874-884. [PMID: 34096808 PMCID: PMC8189130 DOI: 10.1080/07853890.2021.1933165] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Statins are widely used to treat people with metabolic and cardiovascular disorders. The effect of statins on coronavirus disease 2019 (COVID-19) is unclear. To investigate the association between statins and COVID-19 outcomes and, if possible, identify the subgroup population that benefits most from statin use. MATERIALS AND METHODS A systematic review and meta-analysis of published studies that included statin users and described COVID-19 outcomes through 10 November 2020. This study used the generic inverse variance method to perform meta-analyses with random-effects modelling. The main outcomes were evaluation of the need for invasive mechanical ventilator (IMV) support, the need for intensive care unit (ICU) care and death. All outcomes were measured as dichotomous variables. RESULTS A total of 28 observational studies, covering data from 63,537 individuals with COVID-19, were included. The use of statins was significantly associated with decreased mortality (odds ratio [OR] = 0.71, 95% confidence interval [CI]: 0.55-0.92, I2=72%) and the need for IMV (OR = 0.81, 95% CI: 0.69-0.95, I2=0%) but was not linked to the need for ICU care (OR = 0.91, 95% CI: 0.55-1.51, I2=66%). Subgroup analysis further identified five types of studies in which statin users had even lower odds of death. CONCLUSIONS The use of statins was significantly associated with a reduced need for IMV and decreased mortality among individuals with COVID-19. Statins may not need to be discontinued because of concern for COVID-19 on admission. Further randomized controlled trial (RCTs) are needed to clarify the causal effect between statin use and severe COVID-19 outcomes.Key messagesParticipants in five types of studies were shown to have even lower odds of death when taking statins.The use of statins was significantly associated with a reduced need for invasive mechanical ventilation and decreased all-cause mortality among individuals with COVID-19. However, statin use did not prevent participants from needing care in the intensive care unit.The results justify performing randomized controlled trials (RCTs) to validate the benefits of statins on COVID-19 outcomes.
Collapse
Affiliation(s)
- Kuan-Sheng Wu
- Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung City, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, ROC
| | - Pei-Chin Lin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung City, ROC
- Department of Pharmacy, School of Pharmacy, Kaohsiung Medical University, Kaohsiung City, ROC
| | - Yao-Shen Chen
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, ROC
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung City, ROC
| | - Tzu-Cheng Pan
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City, ROC
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City, ROC
- Department of Health-Business Administration, Fooyin University, Kaohsiung City, ROC
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, ROC
| |
Collapse
|
10
|
Chen SL, Tang PL, Wu TT. Result of intravitreal aflibercept injection for myopic choroidal neovascularization. BMC Ophthalmol 2021; 21:342. [PMID: 34551746 PMCID: PMC8459492 DOI: 10.1186/s12886-021-02088-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background The current study aimed to evaluate the efficacy of intravitreal aflibercept injections as the primary treatment for subfoveal/juxtafoveal myopic choroidal neovascularization (CNV) by using optical coherence tomography (OCT). Optical coherence tomography angiography (OCTA) was further used for some patients to detect the changes of CNV after treatment. Methods In the present study, 21 treatment-naive eyes of 21 patients with subfoveal/juxtafoveal myopic CNV received primary intravitreal aflibercept injections and were under follow-up for a minimum duration of 12 months. Among the 21 patients, 12 underwent OCTA to evaluate the changes in central foveal thickness, selected CNV area, and flow area. Results The mean best-corrected visual acuity (BCVA) pertaining to all the patients significantly improved from the baseline value of 0.7 to 0.3 logMAR after treatment for 12 months (P = 0.001). However, the improvements in the median BCVA after treatment for three and 12 months were not statistically significant in the younger group (< 50 years), compared to the older group (≥ 50 years). One aflibercept injection resolved the CNV in 47.6% (10/21) of the patients. The younger group displayed greater improvement in the median central foveal thickness, compared to the older group. OCTA revealed interlacing or disorganized pattern at the level of the outer retinal layer in 12 subjects with myopic CNV. After 3 months of treatment, both groups displayed a decrease in the size of the selected CNV area and flow area. The interlacing group displayed a trend towards better anatomical improvements. Conclusion Intravitreal aflibercept injection provides long-term improvement in visual acuity in patients with myopic CNV. Eyes with the interlacing pattern on OCTA displayed a greater decrease in size and flow after aflibercept injection. Trial registration Before data collection, written informed consent was obtained from each participant, whose identity information was protected by encryption and conversion to a non-identifiable format and removing data links. This study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital (KSVGH21-CT1–17).
Collapse
Affiliation(s)
- Shih-Lin Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., 813, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Section of Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., 813, Kaohsiung, Taiwan. .,School of Medicine, National Yang Ming University, Taipei, Taiwan.
| |
Collapse
|
11
|
Hsu MF, Wang C, Tzou SJ, Pan TC, Tang PL. Effects of Zentangle art workplace health promotion activities on rural healthcare workers. Public Health 2021; 196:217-222. [PMID: 34274696 DOI: 10.1016/j.puhe.2021.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/19/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Workplace health promotion activities have a positive effect on emotions. Zentangle art relaxes the body and mind through the process of concentrating while painting, achieving a healing effect. This study aimed to promote the physical and mental health of rural healthcare workers through Zentangle art-based intervention. STUDY DESIGN This was a quasi-experimental pilot study. METHODS A Zentangle art workshop was held from November 2019 to July 2020. A total of 40 healthcare workers were recruited. The participants were asked to provide baseline data, and the Brief Symptom Rating Scale (BSRS-5), work stress management effectiveness self-rating scale, General Self-Efficacy Scale (GSES), and Workplace Spirituality Scale (WSS) were administered before and after the workshop. SPSS 22.0 statistical package software was used to conduct the data analysis. RESULTS The median age (interquartile range [IQR]) was 32.00 years (23.00-41.75 years). The Wilcoxon signed-rank test revealed that the median (IQR) BSRS-5 postintervention score was 4.0 (1.25-5.0), which was lower than the preintervention score (P = 0.004). The postintervention score for the work stress management effectiveness self-rating scale was 36.5 (31.0-40.0), which was also lower than the preintervention score (P = 0.009). A higher score for the GSES or WSS indicated improvements in stress management and self-efficacy. The GSES postintervention score 25.00 (21.0-30.75) was significantly higher than the preintervention score (P = 0.010), and the WSS postintervention score 104.0 (88.0-111.75) was significantly higher than the preintervention score (P = 0.005). CONCLUSIONS The study provides evidence that painting therapy can effectively relieve stress, reduce workplace stress and frustration, enhance self-efficacy, and increase commitment to work among healthcare workers, thus improving their physical, mental, and spiritual well-being. Zentangle art provides employees with multiple channels for expressing their emotions and can improve the physical and mental health of healthcare workers in the workplace. It is beneficial and cost-effective and can serve as a benchmark for peer learning.
Collapse
Affiliation(s)
- M F Hsu
- Department of Nursing, Kaohsiung Veterans General Hospital-Pingtung Branch, 1, Anping Lane 1. Jausheng Rd., Neipu Shiang, Pingtung, 91245, Taiwan; Department of Nursing, Meiho University, 23, Pingguang Rd., Neipu, Pingtung, Taiwan
| | - C Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, 452, Huanqiu Rd. Luzhu Dist., Kaohsiung City, 82144, Taiwan
| | - S J Tzou
- Center of Teaching and Researching, Kaohsiung Armed Forces General Hospital, 2, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, 80284, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, 70, Lien-hai Rd., Kaohsiung City, 80424, Taiwan
| | - T C Pan
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan
| | - P L Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan; Department of Health-Business Administration, Fooyin University, 151, Jinxue Rd., Kaohsiung City, 83102, Taiwan; College of Nursing, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan.
| |
Collapse
|
12
|
Sun WC, Tang PL, Chen WC, Tsay FW, Wang HM, Tsai TJ, Kao SS, Cheng JS, Tsai WL. Hepatitis B Virus Screening Before Cancer Chemotherapy in Taiwan: A Nationwide Population-Based Study. Front Med (Lausanne) 2021; 8:657109. [PMID: 34336877 PMCID: PMC8319464 DOI: 10.3389/fmed.2021.657109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Reactivation of the hepatitis B virus (HBV) during cancer chemotherapy is a severe and sometimes fatal complication. In 2009, the National Health Insurance (NHI) in Taiwan recommended and reimbursed screening for HBV infection and prophylactic antiviral therapy before cancer chemotherapy. In this study, we determined the HBV screening rate in patients with cancer undergoing chemotherapy in Taiwan. Methods: We retrospectively collected data from the National Health Insurance Research Database on patients who received systemic chemotherapy for solid or hematologic cancers from January 2000 through December 2012. We defined HBV screening based on testing for serum HBsAg within 2 years of the first chemotherapy commencement. We calculated overall and annual HBV screening rates in all patients and subgroups of age, gender, cancer type, hospital level, physician's department, and implementation of NHI reimbursement for HBV screening before cancer chemotherapy. Results: We enrolled 379,639 patients. The overall HBV screening rate was 45.9%. The screening rates were higher in males, those with hematological cancer, those at non-medical centers and medical departments. The HBV screening rates before (2000–2008) and after the implementation of NHI reimbursement (2009–2012) were 38.1 and 57.5%, respectively (p < 0.0001). The most common practice pattern of HBV screening was only HBsAg (64.6%) followed by HBsAg/HBsAb (22.1%), and HBsAg/HBcAb/HBsAb (0.7%) (p < 0.0001). The annual HBV screening rate increased from 31.5 to 66.3% (p < 0.0001). The screening rates of solid and hematological cancers significantly increased by year; however, the trend was greater in solid cancer than in hematological cancer (35.9 and 26.2%, p < 0.0001). Conclusions: The HBV screening rate before cancer chemotherapy was fair but increased over time. These figures improved after implementing a government-based strategy; however, a mandatory hospital-based strategy might improve awareness of HBV screening and starting prophylactic antiviral therapy before cancer chemotherapy.
Collapse
Affiliation(s)
- Wei-Chih Sun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Wen-Chi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Woei Tsay
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huay-Min Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzung-Jiun Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sung-Shuo Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Shiung Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Lun Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| |
Collapse
|
13
|
Hsueh KC, Tang PL, McRobbie H. Effectiveness of Varenicline Versus Combination Nicotine Replacement Therapy for Smoking Cessation: One-Year Outcomes in a Smoking Cessation Clinic in Taiwan. Nicotine Tob Res 2021; 23:1094-1102. [PMID: 33538831 DOI: 10.1093/ntr/ntab018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/26/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Varenicline and combination nicotine replacement treatment (cNRT) have been recommended as the most effective pharmacotherapies, with equal abstinence rate for smoking cessation in a network meta-analysis of randomized trials, but data from real-world long-term follow-up studies are rare. This study aimed to compare the 12-month sustained abstinence rates of smokers using varenicline versus cNRT in their quit attempt. METHODS A total of 3569 smokers were recruited via the Department of Family Medicine outpatient department at Kaohsiung Veteran General Hospital between June 2013 and March 2019. Participants received counseling from a physician and chose either varenicline (N = 2870) or cNRT (N = 699) for smoking cessation. Both varenicline and cNRT users could receive a free 8-week supply and eight clinic visits over 90 days. Participants were followed-up by telephone at 12, 24, and 52 weeks from first visit. The primary outcome measure of the study was self-reported sustained abstinence up to 52 weeks. RESULTS Varenicline users had a significantly higher sustained abstinence rate at weeks 12-52, adjusted for baseline variables (15.2% vs 10.3%, p = .001; adjusted odds ratio = 1.47, 95% confidence interval: 1.05-2.05). Other significant predictors of 52 weeks sustained abstinence were being male, having a higher income, attending more clinical visits, and have lower nicotine dependence. CONCLUSION Varenicline appears to have higher sustained abstinence rates to 52 weeks compared with cNRT, in a smoking cessation clinic where smokers can choose their medication option. IMPLICATIONS Network meta-analysis of randomized trials suggests that varenicline and cNRT are similarly effective for smoking cessation. This study shows that 1-year sustained abstinence rates were significantly higher among smokers using varenicline, compared with smokers using cNRT, when used as part of a structured smoking cessation program. These findings are highly relevant to policy makers and service providers to help determine provision of smoking cessation treatment.
Collapse
Affiliation(s)
- Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Smoking Cessation Treatment and Management Center of Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Shu-Zen College of Medicine and Management, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia.,Lakes District Health Board, Rotorua, New Zealand
| |
Collapse
|
14
|
Tang PL, Lin HS, Hsu CJ. Predicting in-hospital mortality for dementia patients after hip fracture surgery - A comparison between the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index. J Orthop Sci 2021; 26:396-402. [PMID: 32482586 DOI: 10.1016/j.jos.2020.04.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/22/2020] [Accepted: 04/09/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Considerable in-hospital mortality was reported in geriatric patients with dementia sustaining femoral neck or inter-trochanteric fracture. We intended to establish a predictive model of in-hospital mortality for dementia patients after hip fracture surgery. METHODS We collected 8080 registrants ≧ 65 years old from the subset (LHID2000) of the National Health Insurance Research Database (NHIRD) that met the following inclusion criteria:1. Admitted with the ICD of hip fracture; 2. Underwent operation of hip fracture during the same hospitalization; 3. Co-existing diagnosis of dementia (ICD-9-CM codes 290). The co-morbidity was recorded according to validated Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) from the diagnoses of hospitalization. The main outcome measure was in-hospital mortality that was defined as death being reported during hospitalization. The comparison of predictability was conducted by Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) among different predictive models. RESULTS The Charlson Comorbidity Index (CCI) score and Elixhauser Comorbidity Index (ECI) score showed similar ability in predicting in-hospital mortality (AUC = 0.653, 95% CI = 0.611-0.695 for CCI; AUC = 0.624, 95% CI = 0.582-0.665 for ECI, p = 0.0717). By adding age grouping (≥80 yrs = 1, 65-80 yrs = 0) and gender difference (Male = 1, Female = 0), these two models were shifted to models CCI_new1 and ECI_new1. Consequently, the AUC greatly increased in the CCI_new1 (AUC = 0.682, 95% CI = 0.643-0.722). It therefore provided better prediction of in-hospital mortality than ECI_new1 (AUC = 0.651, 95% CI = 0.611-0.691) (p = 0.0444). CONCLUSIONS Utilizing the CCI with addition of grouping for age and gender provides a better prediction for in-hospital mortality than the ECI among elderly patients with concomitant dementia and hip fracture who underwent surgical intervention.
Collapse
Affiliation(s)
- Pei-Ling Tang
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan.
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan.
| | - Chien-Jen Hsu
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Nursing, Fooyin University, Kaohsiung, Taiwan.
| |
Collapse
|
15
|
Kuo FY, Huang WC, Tang PL, Cheng CC, Chiang CH, Lin HC, Chuang TJ, Wann SR, Mar GY, Liu CP, Cheng JT, Wu MC. Impact of statin on long-term outcome among patients with end-stage renal disease with acute myocardial infarction (AMI): a nationwide case-control study. Postgrad Med J 2021; 97:299-305. [PMID: 33452152 DOI: 10.1136/postgradmedj-2019-137292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/07/2020] [Accepted: 03/28/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Use of statin has been associated with reduced risk of cardiovascular diseases events and mortality. However, in patients with end-stage renal disease (ESRD), the protective effects of statin are controversial. To evaluate the impact of chronic statin use on clinical outcomes of patients with acute myocardial infarction (AMI) with ESRD. METHODS We enrolled 8056 patients with ESRD who were initially diagnosed and admitted for first AMI from Taiwan's National Health Insurance Research Database. Of which, 2134 patients underwent statin therapy. We randomly selected and use age, sex, hypertension, diabetes mellitus (DM), peripheral vascular diseases (PVD), heart failure (HF), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease, matched with the study group as controls (non-stain user). We compared the effects of statin use in term of all-cause death among patients with AMI with ESRD. RESULTS Statin use resulted in a significantly higher survival rate in patients ith AMI with ESRD compared with non-statin users. After adjusted the comorbidities the male patients and patients with DM, PVD, HF and CVA had lower long-term survival rate (all p<0.001). Patients who underwent percutaneous coronary intervention (p<0.001), ACE inhibitors/angiotensin II receptor blockers (p<0.001), β receptor blockers (p<0.001) and statin therapy (p=0.007) had better long-term survival rate. Patients with AMI with ESRD on statin therapy exhibited a significantly lower risk of mortality compared with non-statin users (p<0.0001). CONCLUSION Among patients with ESRD with AMI, statin therapy was associated with reduced all-cause mortality.
Collapse
Affiliation(s)
| | - Wei-Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Hung Chiang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiao-Chin Lin
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tzu-Jung Chuang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shue-Ren Wann
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Guang-Yuan Mar
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Peng Liu
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Juei-Tang Cheng
- Department of Food Science, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Ming-Chang Wu
- Department of Food Science, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | | |
Collapse
|
16
|
Chen SL, Hsueh KC, Tang PL. Association between dry eye and traditional Chinese medicine body constitutions: A Taiwanese adults study. Medicine (Baltimore) 2021; 100:e24265. [PMID: 33466213 PMCID: PMC7808499 DOI: 10.1097/md.0000000000024265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/12/2020] [Indexed: 01/05/2023] Open
Abstract
In the theory of traditional Chinese medicine (TCM), except for the balanced constitution, other constitutions are unbalanced and may lead to susceptibility to certain diseases. This study made the first efforts to explore the relationship between TCM constitutions and the dry eye condition.This cross-sectional study collected information from 2760 subjects aged 30 to 70 years who had participated in a questionnaire survey conducted by Taiwan Biobank (TWB) in 2012 to 2017. The questionnaire included questions on basic demographic characteristics, chronic diseases, depression, blood lipid levels, lifestyles, and drug allergies, as well as a TCM constitution scale developed by a research team of TCM constitution and syndrome at China Medical University College of Chinese Medicine.Unadjusted and stratified multiple logistic regression analyses were performed to explore the relationships between TCM constitutions and dry eye. The analysis revealed that subjects falling into the constitution category of Yang deficiency, Yin deficiency, or Phlegm stasis were more likely to develop dry eyes (crude odds ratio [OR] = 1.741, 95% confidence interval [CI] = 1.361-2.227; crude OR = 2.4821, 95% CI = 1.968-3.131; and crude OR = 2.082, 95% CI = 1.597-2.714, respectively). After adjusting for important risk factors (demographic characteristics, chronic diseases, blood lipid levels, lifestyles, depression, and drug allergies), subjects with an unbalanced constitution were 1.6 to 2.5 times more likely to develop dry eye than those with a balanced constitution.These results confirm a high correlation of TCM constitution with dry eye. Considering that the current treatment outcome is not fully satisfactory to the patients with dry eyes, integration of TCM and Western medicine may be an alternative treatment option. Individualized treatments and lifestyle recommended should be provided to patients with different TCM constitutions to alleviate dry eye symptoms.
Collapse
Affiliation(s)
- Shih-Lin Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital
- College of Medicine, Kaohsiung Medical University
| | - Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital
- Department of Nursing, Shu-Zen Junior College of Medicine and Management
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan (ROC)
| |
Collapse
|
17
|
Liao PH, Chu CH, Hung YM, Tang PL, Kuo TJ. Tumor subsites and risk of osteoradionecrosis of the jaw in patients with oral cavity cancer: a national-based cohort study. Eur Arch Otorhinolaryngol 2021; 278:3425-3433. [PMID: 33389009 DOI: 10.1007/s00405-020-06529-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The association between the tumor subsites of the oral cavity and the risk of osteoradionecrosis of the jaw (ORNJ) remains unclear. We study the correlation between oral cavity tumor subsites and the risk of ORNJ in a nationwide population-based database. METHODS We enrolled 16,701 adult patients with oral cavity cancers who were treated with radiotherapy between 2000 and 2013. The subsites of the oral tumor, treatments of oral cavity cancers, and the timing of tooth extraction were examined for their association with ORNJ in oral cancer patients. RESULTS 903 patients (5.40%) developed ORNJ. Of the relevant variables, pre-RT mandible surgery, tooth extraction either before or after RT, and tumor sites were associated with the risk of ORNJ. The adjusted HRs for ORNJ in the mouth floor, gums, retromolar, and buccal cancer were 2.056 (1.490-2.837), 1.909 (1.552-2.349), 1.683 (1.105-2.562), and 1.303 (1.111-1.528), respectively, compared with the risk of tongue cancer. There was no significant difference in the risk of ORNJ between the pre-RT extraction group, the during-RT extraction group, and the post-RT extraction (less than 6 months) group; the post-RT extraction (more than 6 months) group had a significantly higher risk of ORNJ. CONCLUSIONS This study demonstrated that oral cavity tumor subsite is an independent risk factor of ORNJ after RT. Post-RT extraction (less than 6 months) group did not carry a significantly higher risk of ORNJ compared with pre-RT extraction group or during RT extraction group.
Collapse
Affiliation(s)
- Pei-Hsun Liao
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chu
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Yao-Min Hung
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming University, Taipei, Taiwan.,Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsu-Jen Kuo
- School of Dentistry, Chung Shan Medical University, 110, Sec. 1, Chien-Kuo N. Rd., 40201, Taichung, Taiwan. .,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan. .,Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan. .,Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
18
|
Chen SL, Liu YT, Hsueh KC, Tang PL. Body constitution of traditional Chinese medicine caused a significant effect on depression in adult women. Complement Ther Clin Pract 2020; 42:101288. [PMID: 33310625 DOI: 10.1016/j.ctcp.2020.101288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND and purpose: Depression is a common mental disorder and reduces quality of life. As traditional Chinese medicine constitution (TCMC) has become an increasingly popular complementary and alternative approach for early detection and treatment of disease, this study investigated the relationship of female-related factors and constitution with depression. MATERIALS AND METHODS This cross-sectional study included 1423 women from the Taiwan Biobank. A questionnaire of 44 items was used covering a variety of factors and the Body Constitution Questionnaire. The constitution types were divided into Yang-deficiency, Yin-deficiency, and Phlegm stasis. RESULTS Yang (p = 0.022) or Yin (p = 0.017) deficiencies, being single (p = 0.027-0.033), previous use of women's health supplements (p = 0.005-0.008), and smoking (p = 0.033-0.036) were associated with a higher risk of depression. CONCLUSION Integration of TCMC with Western medicine may be an alternative option towards depression prevention and alleviation.
Collapse
Affiliation(s)
- Shih-Lin Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Kaohsiung City, 81362, Taiwan, ROC; College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan, ROC.
| | - Yun-Ting Liu
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, 386, Dazhong 1st Rd., Kaohsiung City, 81362, Taiwan, ROC; College of Nursing, Meiho University, 23, Pingguang Rd., Neipu, Pingtung, 912009, Taiwan, ROC.
| | - Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Kaohsiung City, 81362, Taiwan, ROC; Department of Nursing, Shu-Zen Junior College of Medicine and Management, 452, Huanqiu Rd., Luzhu Dist., Kaohsiung City, 821, Taiwan, ROC.
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Kaohsiung City, 81362, Taiwan, ROC; Department of Health-Business Administration, Fooyin University, 151, Jinxue Rd., Kaohsiung City, 83102, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung City, 80708, Taiwan, ROC.
| |
Collapse
|
19
|
Wang C, Cheng SF, Hung JL, Tang PL. Highly frequent utilization of outpatient services in a national health insurance system - analysis of associated factors and underlying co-morbidity. Curr Med Res Opin 2020; 36:1761-1767. [PMID: 33017273 DOI: 10.1080/03007995.2020.1832057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aimed to identify associated factors of highly frequent use of outpatient services and explore how they were impacted to provide policy references for government and medical institutes in their efforts to seek provision of reasonable medical services, continuous care and integrated outpatient services. METHODS The Taiwanese national health insurance database was used and 661,125 patients were identified in 2009. The patients with ≥100 internal medicine outpatient (IMO) visits were defined as the highly frequent group and they were matched at a ratio of 1:4 with patients of 1-99 IMO visits based on demographic characteristics. Multivariate logistic regression was used to estimate adjusted odds ratios with 95% confidence intervals. RESULTS Among 1 million patients in the outpatient department, 0.05% had at least 100 visits. These patients with highly frequent IMO visits had significantly higher rates of emergency department (ED) visits, hospitalization, psychiatric disorders and possession of a catastrophic illness card as well as a significantly lower level of continuity of care index (COCI). Multivariate analysis showed that ED visits (adjusted OR [AOR] = 1.63), psychiatric disorders (AOR = 7.13), low COCI (AOR = 1.69), and several comorbidities including peripheral vascular diseases (AOR = 4.33), dementia (AOR = 0.04), chronic pulmonary disease (AOR = 3.02), peptic ulcer diseases (AOR = 3.70), diabetes mellitus (AOR = 3.45) and renal disease (AOR = 2.43) were significant associated factors. CONCLUSIONS To rationalize use and distribution of medical resources, we suggest proper regular care and health education to those with mental disabilities and multiple chronic conditions, which may not only improve the situation of highly frequent hospital visits but also effectively control incidence of acute conditions and reduce their ED visits. In addition, improving the continuity of care is vital, and the best way to do this is to promote family medicine as the primary form of healthcare.
Collapse
Affiliation(s)
- Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Su-Fen Cheng
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Jui-Lan Hung
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan, ROC
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| |
Collapse
|
20
|
Liao PH, Chu CH, Tang PL, Wu PC, Kuo TJ. Preradiation tooth extraction and jaw osteoradionecrosis: Nationwide population-based retrospective study in Taiwan. Clin Otolaryngol 2020; 45:896-903. [PMID: 32738824 DOI: 10.1111/coa.13624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/06/2019] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Radiotherapy (RT) for head and neck cancer (HNC) within 7 days of tooth extraction is contraindicated because it may increase the risk of osteoradionecrosis of the jaw (ORNJ). However, delayed RT could compromise survival in patients with HNC. By using a national healthcare database, we reviewed the contraindications and analysed other risk factors for ORNJ. DESIGN A retrospective cohort study. SETTING By using Taiwan's National Health Insurance Research Database, 5,062 HNC patients with at least one tooth extraction 1-21 days before the first RT day (index day) and without any extractions during or after RT from 2000 to 2013 were included. The patients were divided into two groups according to the time of tooth extraction before the index day: 1-7 days and 8-21 days. PARTICIPANTS Taiwanese patients with head and neck cancer. MAIN OUTCOMES MEASURE Univariate and multivariate Cox proportional hazard regression models were used to evaluate the risk factors of ORNJ. RESULTS The overall incidence of ORNJ in the included patients was 1.03% (mean follow-up duration, 4.07 ± 3.01 years; range, 1.00-13.99 years). Tooth extraction within 7 days before RT was not associated with increased ORNJ risk (hazard ratio [HR] =0.734; P = .312). Significant risk factors for ORNJ included oral cancer (adjusted HR = 3.961), tumour excision surgery within 3 months before RT (adjusted HR = 3.488) and mandibulectomy within 3 months before RT (adjusted HR = 5.985; all P < .001). CONCLUSION In a mean follow-up of 4 years, tooth extraction within 7 days before RT for HNC treatment did not increase the ORNJ risk compared with tooth extraction 7-21 days before RT.
Collapse
Affiliation(s)
- Pei-Hsun Liao
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chu
- Department of Statistics, National Cheng Kung University, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Pei-Chen Wu
- Department of Molecular Biology and Human Genetics, Tzu Chi University, Hualien, Taiwan
| | - Tsu-Jen Kuo
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan.,Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan
| |
Collapse
|
21
|
Lin HS, Wang C, Chou FH, Tang PL. Tumor origin and symptom distress of radiotherapy affected fluctuation of purpose in life for cancer patients. PSYCHOL HEALTH MED 2020; 26:359-365. [PMID: 32156162 DOI: 10.1080/13548506.2020.1738017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study was to explore the change in purpose in life (PIL) and symptom distress among cancer patients with radiotherapy and associated risk factors. This was a longitudinal study.160 patients were recruited from a medical center in Southern Taiwan. Surveys were conducted one week before and one week after the patients had radiotherapy by questionnaire. Multivariate regression analysis were performed to analyze the data. The patients had significant changes in PIL after radiotherapy compared to before. They had low PIL scores when they were at stage IV, were unable to receive surgery, had tumors in sites other than the abdominal cavity and pelvic, or had high scores in symptom distress scale. Our findings empirically demonstrated that the sense of meaning is integrally associated with the physical and psychosocial effects of illness. Given that cancer patients who are at an advanced stage, unable to receive surgery and have tumors at sites that are not the abdominal cavity and pelvis are at a high risk for having low PIL after RT, care services should be directed to the patients under these conditions.
Collapse
Affiliation(s)
- Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan, ROC
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.,Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Pei-Ling Tang
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan, ROC.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.,Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| |
Collapse
|
22
|
Wang YC, Wang C, Shih PW, Tang PL. Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a Health Management Plan. Nutr Res Pract 2020; 14:218-229. [PMID: 32528629 PMCID: PMC7263898 DOI: 10.4162/nrp.2020.14.3.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/OBJECTIVES Type 2 Diabetes mellitus (T2DM) is a hereditary disease that is also strongly dependent on environmental factors, lifestyles, and dietary habits. This study explored the relationship between lifestyle habits and glycosylated hemoglobin management in T2DM patients to provide empirical outcomes to improve T2DM management and patient health literacy. SUBJECTS/METHODS This study enrolled 349 diabetic patients with more than 5 care visits to a Diabetes Mellitus care network under the Health Management Plan led by Taiwan Department of Health (DOH). Based on relevant literature, an Outpatient Record Form of Diabetes Mellitus Care was designed and lipid profile tests were conducted for data collection and analysis. RESULTS When modeling the data, the results showed that the odds for HbA1c > 7.5% in T2DM patients duration over 10 years was 3.785 (P = 0.002) times that in patients with disease duration of fewer than 3 years. The odds of HbA1c > 7.5% in illiterate patients was 3.128 (P = 0.039) times that in patients with senior high school education or above. The odds of HbA1c > 7.5% in patients with other chronic illness was 2.207 (P = 0.019) times that in participants without chronic illness. Among 5 beneficial lifestyle habits, the odds of HbA1c > 7.5% in patients with 2 or 3 good habits were 3.243 (P = 0.003) and 3.424 (P = 0.001) times that in patients with more than 3 good habits, respectively. CONCLUSION This empirical outcome shows that maintaining a good lifestyle improves T2DM management and patients' knowledge, motivation, and ability to use health information. Patients with longer disease duration, education, or good lifestyle habits had optimal HbA1c management than those in patients who did not. Thus, effective self-management and precaution in daily life and improved health literacy of diabetic patients are necessary to increase the quality of T2DM care.
Collapse
Affiliation(s)
- Ya-Chun Wang
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Food Science and Nutrition, Meiho University, Pingtung 91202, Taiwan (ROC)
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Ping-Wen Shih
- Nutrition and Food Service Department, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung City 81362, Taiwan (ROC).,Department of Health-Business Administration, Fooyin University, Kaohsiung City 83102, Taiwan (ROC).,College of Nursing, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan (ROC)
| |
Collapse
|
23
|
Liu YT, Lin LY, Tuan CW, Yang CY, Tang PL. Analyzing the Association HbA1c control by Depression, social participation and Utilizing Self-management Questionnaire. Diabetes Res Clin Pract 2019; 153:103-110. [PMID: 31175913 DOI: 10.1016/j.diabres.2019.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
AIMS In Taiwan, 24.7% of the population aged ≥65 years has been diagnosed with type 2 diabetes. Only 23% of diabetes patients effectively conduct self-management. This study focused on the effects of self-management among type 2 diabetes patients aged ≥65 years on the effectiveness of their HbA1c control. METHODS This cross-sectional study enrolled patients aged ≥65 years with type 2 diabetes who were admitted to a metabolic clinic at a medical center and treated over six months. 192 patients were recruited, and data were recorded using structured questionnaires. The HbA1c level of the recruited subjects was measured for statistical analysis. RESULTS Older age, education, living alone, and an above-average level of self-management were associated with increased HbA1c control effectiveness; patients who used insulin had worse HbA1c control effectiveness. CONCLUSION That cohabitants living with diabetes patients affected the effectiveness of HbA1c control, suggesting that family members should also participate in self-management education programs. Given the advances in information networks, a lively and interactive mode of health education animation for uneducated diabetes patients should be developed, and medical teams should be encouraged to establish a two-way communication channel with patients improve the effectiveness of HbA1c control in diabetes patients aged >65 years.
Collapse
Affiliation(s)
- Yun-Ting Liu
- Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Li-Ying Lin
- Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC; Department of Nursing, Meiho University, Kaohsiung, Taiwan, ROC.
| | - Chi-Wei Tuan
- Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Chun-Ying Yang
- Department of Nursing, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
| |
Collapse
|
24
|
Liu ES, Chiang CH, Hung WT, Tang PL, Hung CC, Kuo SH, Yang JS, Liu CP, Chen YS, Mar GY, Huang WC. TCTAP A-033 The Comparison of Mortality in Patients with Acute Myocardial Infarction Associated with or Without Sepsis. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Wang C, Kuo HC, Cheng SF, Hung JL, Xiong JH, Tang PL. Continuity of care and multiple chronic conditions impact frequent use of outpatient services. Health Informatics J 2019; 26:318-327. [PMID: 30702018 DOI: 10.1177/1460458218824720] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the association between care continuity and chronic conditions in relation to highly frequent use of outpatient service in order to find constructive suggestions to bring efficient, high-quality care for patients with multiple chronic conditions. The National Health Insurance database was used and 333,294 patients were identified from 2007 to 2009. The continuity of care index indicates the dispersion of a patient's ambulatory visits among providers. Multivariate logistic regression was used to estimate adjusted odds ratios with 95 percent confidence intervals. Continuity of care index was significantly associated with age, sex, urbanization level, socioeconomic status, emergency department visits, hospitalization, psychological disorders, chronic diseases, and catastrophic illness card; those with low continuity of care index were likely to use outpatient care highly frequently. Improving continuity of care is fundamental, and the best way is to advance the practice of family medicine for primary care.
Collapse
Affiliation(s)
| | | | | | | | | | - Pei-Ling Tang
- Meiho University; Kaohsiung Medical University; Kaohsiung Veterans General Hospital
| |
Collapse
|
26
|
Chang WS, Lin LT, Hsu LC, Tang PL, Tsui KH, Wang PH. Maternal pregnancy-induced hypertension increases the subsequent risk of transient tachypnea of the newborn: A nationwide population-based cohort study. Taiwan J Obstet Gynecol 2018; 57:546-550. [PMID: 30122576 DOI: 10.1016/j.tjog.2018.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To determine the association between pregnancy-induced hypertension (PIH) and transient tachypnea of the newborn (TTN) and to identify the predictive risk factors. MATERIALS AND METHODS Pregnant women with a newly diagnosed PIH (between 2000 and 2013) from the Taiwan National Health Insurance Research Database (NHIRD) were compared with a matched (with respect to age and year of delivery) cohort of pregnant women without PIH. The occurrence of TTN was evaluated in both cohorts. RESULTS Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. According to a multivariate analysis, PIH (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.69-2.03, p < 0.0001), age ≥ 30 years (OR = 1.38, 95% CI = 1.26-1.51, p < 0.0001), primiparity (OR = 1.37, 95% CI = 1.24-1.5, p < 0.0001), preterm birth (OR = 3.4, 95% CI = 3.09-3.75, p < 0.0001), multiple births (OR = 2.54, 95% CI = 2.24-2.89, p < 0.0001), and cesarean section (OR = 1.71, 95% CI = 1.56-1.88, p < 0.0001) were independent risk factors for the development of TTN. CONCLUSION Women with PIH have an increased risk of having infants who develop TTN compared with those without PIH. Additionally, age ≥30 years, primiparity, preterm birth, multiple births, and cesarean section were independent risk factors for the development of TTN.
Collapse
Affiliation(s)
- Wei-Shan Chang
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Li-Chuan Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Nursing, Meiho University, Ping-Tung, Taiwan; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Pharmacy and Graduate Institute of Pharmaceutical Technology, Tajen University, Pingtung County, Taiwan.
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| |
Collapse
|
27
|
Liu ES, Chiang CH, Hung WT, Tang PL, Hung CC, Kuo SH, Liu CP, Chen YS, Mar GY, Huang WC. Comparison of long-term mortality in patients with acute myocardial infarction associated with or without sepsis. Int J Infect Dis 2018; 79:169-178. [PMID: 30503653 DOI: 10.1016/j.ijid.2018.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/20/2018] [Accepted: 11/25/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Although the association between systemic infection and cardiovascular events has been identified, uncertainty remains regarding the incidence and prognosis of sepsis in acute myocardial infarction (AMI). The purpose of this research was to assess the impact of sepsis on survival after first AMI. METHODS This was a nationwide cohort study involving the analysis of data from the Taiwan National Health Insurance Research Database for the period 2000-2012, for patients with a primary diagnosis of first AMI. Among the 186112 prospective patients, sepsis was diagnosed in 13065 (7.0%). The propensity score matching technique was used to match 13065 controls to the patients with sepsis and AMI with similar baseline characteristics. Cox proportional hazards regression models, including sepsis, percutaneous coronary intervention (PCI), and comorbidities, were performed to further evaluate the different influences on the mortality risk in patients hospitalized for first AMI. RESULTS Overall, the 12-year survival rate was lower in AMI patients with sepsis than in those without sepsis (log rank p-value <0.001); this was also shown in the different age and sex groups. The AMI patients with sepsis had a longer length of hospital stay than those without sepsis (32.5days vs. 11.74 days, p<0.001). In the Cox proportional hazards regression analysis, sepsis was an independent risk factor for mortality in patients after AMI (hazard ratio 1.78; 95% confidence interval 1.72-1.83). Interventional management with PCI or coronary artery bypass grafting improved survival in both the sepsis and non-sepsis patients after first AMI. CONCLUSIONS In conclusion, sepsis significantly increased the mortality risk of patients after first AMI. PCI may improve the long-term survival of patients in comparison to those managed conservatively.
Collapse
Affiliation(s)
- En-Shao Liu
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng-Hung Chiang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Wang-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng Chung Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shu-Hung Kuo
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Peng Liu
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Shen Chen
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Guang-Yuan Mar
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
28
|
Wang MT, Tsai CK, Kuo SH, Huang WC, Lin KC, Hung WT, Cheng CC, Tang PL, Hung CC, Yang JS, Liang HL, Mar GY, Liu CP. The Dipyridamole Added to Dual Antiplatelet Therapy in Cerebral Infarction After First Acute Myocardial Infarction: A Nationwide, Case-Control Study. Front Neurol 2018; 9:1003. [PMID: 30538667 PMCID: PMC6277508 DOI: 10.3389/fneur.2018.01003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose: No previous study has compared the impact of dipyridamole-based triple antiplatelet therapy on secondary stroke prevention and long-term outcomes to that of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI) and previous stroke. This study aimed to evaluate the impact of dipyridamole added to DAPT on stroke prevention and long-term outcomes in patients with cerebral infarction after first AMI. Methods: This nationwide, case-control study included 75,789 patients with cerebral infarction after first AMI. A 1:4 propensity score matching ratio was adopted based on multiple variables. Finally, the data of 4,468 patients included in the DAPT group and 1,117 patients included in the Dipyridamole-DAPT group were analyzed. Primary outcome was overall survival. Secondary outcomes were cumulative event rate of recurrent MI or stroke, and cumulative intracerebral hemorrhage (ICH) and gastrointestinal bleeding rate. Results: Long-term survival rate was comparable between the two groups (log-rank P = 0.1117), regardless of sex analyses. However, after first year, DAPT subgroup revealed better survival over DAPT-dipyridamole subgroup (log-rank P = 0.0188). In age subgroup analysis, a lower survival rate was detected in younger patients from the Dipyridamole-DAPT group after first year (log-rank P = 0.0151), but no survival difference for older patients. No benefit of Dipyridamole-DAPT was detected for patients after AMI, regardless of the myocardial infarction type. DAPT was superior to Dipyridamole-DAPT in patients who underwent percutaneous coronary intervention (PCI) (log-rank P = 0.0153) and ST elevation myocardial infarction after first year (log-rank P = 0.0019). Dipyridamole-DAPT did not reduce cumulative event rate of recurrent MI or stroke in patients after AMI. Moreover, Dipyridamole-DAPT increased the cumulative ICH rate (log-rank P = 0.0026), but did not affect the cumulative event rate of gastrointestinal bleeding. In Cox analysis, dipyridamole did not improve long-term survival. Conclusions: This nationwide study showed that Dipyridamole-DAPT, compared with DAPT, did not improve long-term survival in patients with stroke after AMI, and was related to poor outcomes after 1 year. Dipyridamole-DAPT did not reduce recurrent rate of MI or stroke, but increased the ICH rate without impacting the incidence of gastrointestinal bleeding.
Collapse
Affiliation(s)
- Mei-Tzu Wang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng Ken Tsai
- Department of Cardiovascular Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,National Defense Medical Center, National Defense University, Taipei, Taiwan
| | - Shu-Hung Kuo
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Defense Medical Center, National Defense University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kun-Chang Lin
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wang-Ting Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng Chung Hung
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jin-Shiou Yang
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Hsin-Li Liang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Guang-Yuan Mar
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Peng Liu
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,National Defense Medical Center, National Defense University, Taipei, Taiwan
| |
Collapse
|
29
|
Zhao LY, Huo RR, Xiang X, Torzilli G, Zheng MH, Yang T, Liang XM, Huang X, Tang PL, Xiang BD, Li LQ, You XM, Zhong JH. Hepatic resection for elderly patients with hepatocellular carcinoma: a systematic review of more than 17,000 patients. Expert Rev Gastroenterol Hepatol 2018; 12:1059-1068. [PMID: 30145919 DOI: 10.1080/17474124.2018.1517045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND With the aging population and increasing incidence of hepatic malignancies in elderly patients, establishing the safety and efficacy of hepatic resection for elderly patients with hepatocellular carcinoma (HCC) is crucial. The present systematic review investigates postoperative morbidity, hospital mortality, median survival time, overall and disease-free survival in elderly patients with undergoing hepatic resection. METHODS Some databases were systematically searched for prospective or retrospective studies to reveal the safety and efficacy of hepatic resection for elderly patients with primary HCC. RESULTS Fifty studies involving 4,169 elderly patients and 13,158 young patients with HCC were included into analyses. Elderly group patients had similar rate of median postoperative morbidity (28.2% vs. 29.6%) but higher mortality (3.0% vs. 1.2%) with young group patients. Moreover, elderly group patients had slightly lower median survival time (55 vs. 58 months), 5-years overall survival (51% vs. 56%) and 5-years disease-free survival (27% vs. 28%) than young group patients. There was an upward trend in 5-years overall and disease-free survival in either elderly or young group. CONCLUSION Though old age may increase the risk of hospital mortality for patients with HCC after hepatic resection, elderly patients can obtain acceptable long-term prognoses from hepatic resection.
Collapse
Affiliation(s)
- Ling-Yun Zhao
- a Hepatobiliary Surgery Department , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , China
| | - Rong-Rui Huo
- a Hepatobiliary Surgery Department , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , China
| | - Xiao Xiang
- a Hepatobiliary Surgery Department , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , China
| | - Guido Torzilli
- b Department of Surgery, Division of Hepatobiliary and General Surgery , Humanitas University, Humanitas Research Hospital-IRCCS , Rozzano, Milan , Italy
| | - Ming-Hua Zheng
- c Department of Hepatology , Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Tian Yang
- d Department of Hepatobiliary Surgery , Eastern Hepatobiliary Surgery Hospital, Second Military Medical University , Shanghai , China
| | - Xin-Min Liang
- e Grade 2016 , Basic medical college of Guangxi Medical University , Nanning , China
| | - Xi Huang
- e Grade 2016 , Basic medical college of Guangxi Medical University , Nanning , China
| | - Pei-Ling Tang
- e Grade 2016 , Basic medical college of Guangxi Medical University , Nanning , China
| | - Bang-De Xiang
- a Hepatobiliary Surgery Department , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , China.,f Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center , Nanning , China
| | - Le-Qun Li
- a Hepatobiliary Surgery Department , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , China.,f Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center , Nanning , China
| | - Xue-Mei You
- a Hepatobiliary Surgery Department , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , China.,f Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center , Nanning , China
| | - Jian-Hong Zhong
- a Hepatobiliary Surgery Department , Affiliated Tumor Hospital of Guangxi Medical University , Nanning , China.,f Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center , Nanning , China
| |
Collapse
|
30
|
Lai YC, Tang PL, Kuo TJ, Hsu CJ. Different impacts of dementia on two-year mortality after osteosynthesis and hemiarthroplasty in treating geriatric hip fractures. Arch Gerontol Geriatr 2018; 79:116-122. [PMID: 30196144 DOI: 10.1016/j.archger.2018.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/22/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Geriatric hip fractures are mostly managed by internal fixation (IF) or hemiarthroplasty (HA). Survivorship of dementia patients following these surgeries has not been extensively compared in literature. By analysis of nationwide database, this study aimed to investigate the impact of dementia on two-year mortality after IF and HA in treating geriatric hip fractures. METHOD From retrospective review of Taiwan's National Health Insurance Research Database, we enrolled 153,623 subjects aged 65 years and older with hospitalization for first hip fracture operated by IF (93,029 cases) or HA (60,594 cases) between 2000 and 2011. Postoperative mortality was compared between subjects with and without dementia after adjustments of age, gender, Charlson comorbidity index and hospital level. RESULTS The prevalence of dementia was 5.24% in the IF and 5.29% in the HA group. In the IF group, dementia increased adjusted hazard ratio of one-year (1.06, 95%CI:1.00-1.13) and two-year mortality (1.10, 95%CI:1.05-1.16). However, short and long-term mortality following HA was not significantly impacted by dementia (in-hospital OR:0.79, 95%CI:0.60-1.03; three-month HR:0.99, 95%CI:0.87-1.12; one-year HR:1.01, 95%CI:0.93-1.10; two-year HR:1.03, 95%CI:0.96-1.09). In a subgroup of dementia patients, mortality following IF was 15% higher than HA in one (p = 0.004) and two years (p < 0.001). The negative prognostic factors included female (HR:1.10; 95%CI:1.03-1.18) and aging 65-84 years (HR:1.15; 95%CI:1.00-1.32). CONCLUSION Dementia increased one and two-year mortality following geriatric hip fracture treated by IF, rather than HA. Dementia patients undergoing HA, especially female or 65-84 years old, sustained better one and two-year survival than those receiving IF.
Collapse
Affiliation(s)
- Yu-Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Occupational Therapy, Shu Zen junior College of Medicine and Management, Kaohsiung, Taiwan; Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan.
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Nursing, Meiho Unervisity, Pingtung, Taiwan; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Tsu-Jen Kuo
- Department of Marine Biotechnology and Resources, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Stomatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Dental Technology, Shu-Zen junior College of Medicine and Management, Kaohsiung, Taiwan.
| | - Chien-Jen Hsu
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Nursing, Fooyin University, Kaohsiung, Taiwan.
| |
Collapse
|
31
|
Yang CC, Tang PL, Liu PY, Huang WC, Chen YY, Wang HP, Chang JT, Lin LT. Maternal pregnancy-induced hypertension increases subsequent neonatal necrotizing enterocolitis risk: A nationwide population-based retrospective cohort study in Taiwan. Medicine (Baltimore) 2018; 97:e11739. [PMID: 30075587 PMCID: PMC6081060 DOI: 10.1097/md.0000000000011739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The utero-placental ischemia induced by pregnancy-induced hypertension (PIH) could lead to fetal hypoxia and proinflammatory cytokine release, which are associated with the development of neonatal necrotizing enterocolitis (NEC). However, a few studies have investigated the relationship between PIH and neonatal NEC and have produced controversial results. Therefore, we attempted to assess the relationship between PIH and the subsequent neonatal NEC risk and identify predictive risk factors.Patients with newly diagnosed PIH were recruited from the Taiwan National Health Insurance Research Database (NHIRD). For each participant, 4 age- and delivery-year-matched participants without PIH were randomly selected. A multivariable logistic regression was performed for the identification of the predictive risk factors for neonatal NEC.Among the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. For the multivariable analysis, maternal PIH was associated with an increased risk of subsequent neonatal NEC development (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.08-3.21, P = .026). Furthermore, single parity (OR 2.06, 95% CI 1.12-3.77, P = .019), preterm birth (OR 5.97, 95% CI 3.49-10.20, P < .001), multiple gestations (OR 2.25, 95% CI 1.22-4.14, P = .010), and intrauterine growth restriction (IUGR) (OR 3.59, 95% CI 2.06-6.24, P < .001) were independent risk factors for the development of subsequent neonatal NEC.Maternal PIH increases the risk for developing neonatal NEC. Furthermore, primiparity, preterm birth, multiple gestations, and IUGR were independent risk factors for neonatal NEC.
Collapse
Affiliation(s)
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Po-Yen Liu
- Department of Pediatrics
- Institute of Medicine, Chung Shan Medical University, Taichung
| | - Wei-Chun Huang
- Section of Critical Care and Cardiovascular Medical Center
| | | | | | | | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| |
Collapse
|
32
|
Chen SN, Cheng CC, Tsui KH, Tang PL, Chern CU, Huang WC, Lin LT. Hypertensive disorders of pregnancy and future heart failure risk: A nationwide population-based retrospective cohort study. Pregnancy Hypertens 2018; 13:110-115. [PMID: 30177036 DOI: 10.1016/j.preghy.2018.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 05/01/2018] [Accepted: 05/26/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether hypertensive disorders of pregnancy (HDP) increased the risk of subsequent heart failure (HF) and identify possible risk factors. STUDY DESIGN A nationwide population-based retrospective cohort study. MAIN OUTCOME MEASURES Incidence of heart failure. RESULTS Among the 23.3 million individuals registered in the National Health Insurance Research Database in Taiwan, 29,186 patients with HDP and 116,744 matched controls were identified. The overall incidence of HF was greater in the HDP group than it was in the control group (9.83 vs. 1.67 per 10,000 person-years), with a significant incidence rate ratio (IRR = 5.88, 95% confidence interval [CI] 5.84-5.92, p < 0.0001). When stratified by age, parity, gestational age, gestational number, and follow-up years, the IRR for subsequent HF remained significantly higher in the HDP group in all stratifications. Additionally, the Kaplan-Meier analysis indicated that the cumulative incidence rate of HF was higher in the HDP group than it was in the control group. The Cox proportional-hazard model analysis showed that in addition to HDP, single parity, preterm and hypertension were independent risk factors for developing HF. Moreover, HF was more likely to develop within 5 years post-partum. Among patients with a history of HDP, the Cox proportional-hazard model showed that severe forms of HDP and increased HDP occurrences were independently associated with the subsequent development of HF. CONCLUSIONS Patients who have experienced HDP presented an increased risk for developing HF later in life. Moreover, among individuals with a history of HDP, those with severe forms of HDP or recurrent HDP displayed an increased subsequent risk of HF.
Collapse
Affiliation(s)
- San-Nung Chen
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung City, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung County, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chyi-Uei Chern
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Physical Therapy, Fooyin University, Kaohsiung City, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
| |
Collapse
|
33
|
Tang PL, Wang HH, Lin HS, Liu WS, Chen LM, Chou FH. Body Composition Early Identifies Cancer Patients With Radiotherapy at Risk for Malnutrition. J Pain Symptom Manage 2018; 55:864-871. [PMID: 29051113 DOI: 10.1016/j.jpainsymman.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/06/2017] [Accepted: 10/08/2017] [Indexed: 12/13/2022]
Abstract
CONTEXT The side effects of radiotherapy (RT) and the occurrence of comorbidity often result in appetite loss in patients, which leads to serious nutritional problems, significantly affecting the patients' treatment results and disease prognosis. OBJECTIVES We aimed to investigate changes in the body composition of patients with cancer from the time they received RT to three months after completion of RT. METHODS A total of 101 cancer patients who received RT, which included head or neck cancer, chest or breast cancer, and abdominal or pelvic cancer patients, were recruited. A longitudinal study design was adopted, in which the body composition analyzer In Body3.0 was used to obtain patient data at six different time points. The data were analyzed through generalized estimating equation. RESULTS All patients with cancer had the lowest body mass index at the end of RT. For head or neck cancer patients, their total body water and muscle mass decreased significantly in the fourth week of RT and at the end of RT. For chest or breast cancer patients, their body fat mass changed significantly in the second and fourth weeks of RT (β = -0.57, P = 0.0233; β = -3.23, P = 0.0254). For abdominal or pelvic cancer patients, their total body weight and muscle mass decreased significantly in the second week of RT and at the end of RT (β = -1.07, P = 0.0248; β = -5.13, P = 0.0017; β = -1.37, P = 0.0245; β = -6.50, P = 0.0016); their body fat mass increased significantly in the third month after RT (β = 4.61, P = 0.0072). CONCLUSION Body composition analysis can be used to promptly and effectively monitor changes in the nutritional status of patients with cancer during the cancer treatment period; changes in the body composition at different repetitions differ between patients with dissimilar cancers.
Collapse
Affiliation(s)
- Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (R.O.C.); Department of Nursing, Meiho University, Pingtung, Taiwan (R.O.C.); College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.); Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan (R.O.C.)
| | - Wen-Shan Liu
- Radiation Oncology Department, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (R.O.C.)
| | - Lih-Mih Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).
| |
Collapse
|
34
|
Kuo SH, Hung WT, Tang PL, Huang WC, Yang JS, Lin HC, Mar GY, Chang HT, Liu CP. Impact of hepatitis C virus infection on long-term mortality after acute myocardial infarction: a nationwide population-based, propensity-matched cohort study in Taiwan. BMJ Open 2018; 8:e017412. [PMID: 29374659 PMCID: PMC5829782 DOI: 10.1136/bmjopen-2017-017412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The influence of hepatitis C virus (HCV) infection on long-term outcomes of patients with acute myocardial infarction (AMI) is unclear. Therefore, this study aimed to analyse the impact of HCV infection on 12-year mortality rates after AMI using data from the Taiwan National Health Insurance Research Database (NHIRD). METHODS NHIRD data for approximately 23 000 000 patients between January 2000 and December 2012 were analysed. A total of 186 112 cases of first AMI admission were identified. A total of 4659 patients with HCV infection not receiving interferon therapy were enrolled and divided into those with (n=107) or without (n=4552) cirrhosis. Using one-to-one matching, 4552 matched controls were included in the final analysis. RESULTS The 12-year mortality rate was significantly higher in patients with AMI with HCV infection and cirrhosis than in those with HCV infection but without cirrhosis (P<0.0001) or controls (P<0.0001). Patients with HCV infection but without cirrhosis had significantly higher long-term mortality rates than the matched controls (P<0.0001). The HR for mortality was higher in patients with HCV infection (HR 1.12; 95% CI 1.06 to 1.18). HCV influenced outcomes among the subgroups of patients who were male (HR 1.15) and those who had hypertension (HR 1.14). CONCLUSIONS HCV infection influenced the 12-year mortality rates of patients with AMI, especially those who were male and those who had hypertension. Cirrhosis further increased the long-term mortality rates of patients with AMI with HCV infection.
Collapse
Affiliation(s)
- Shu-Hung Kuo
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wang-Ting Hung
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jin-Shiou Yang
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Hsiao-Chin Lin
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Guang-Yuan Mar
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hong-Tai Chang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Peng Liu
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
35
|
Lin KF, Wu HF, Huang WC, Tang PL, Wu MT, Wu FZ. Propensity score analysis of lung cancer risk in a population with high prevalence of non-smoking related lung cancer. BMC Pulm Med 2017; 17:120. [PMID: 28874145 PMCID: PMC5585962 DOI: 10.1186/s12890-017-0465-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/30/2017] [Indexed: 12/28/2022] Open
Abstract
Background Lung cancer has been the leading cause of cancer-related mortality worldwide among both men and women in recent years. There is an increase in the incidence of nonsmoking-related lung cancer in recent years. The purpose of the present study was to investigate multiple potential risk factors for nonsmoking-related lung cancer among Asian Ethnic Groups. Methods We used a propensity score-mated cohort analysis for this study. We retrospectively review the medical record of 1975 asymptomatic healthy subjects (40 ~ 80 years old) who voluntarily underwent low-dose chest CT from August 2013 to October 2014. Clinical information and nodule characteristics were recorded. Results A propensity score-mated cohort analysis was applied to adjust for potential bias and to create two comparable groups according to family history of lung cancer. For our primary analysis, we matched 392 pairs of subjects with family history of lung cancer and subjects without history. Logistic regression showed that female gender and a family history of lung cancer were the two most important predictor of lung cancer in the endemic area with high prevalence of nonsmoking-related lung cancer (OR = 11.199, 95% CI = 1.444–86.862; OR = 2.831, 95% CI = 1.000136–8.015). In addition, the number of nodules was higher in subjects with family history of lung cancer in comparison with subjects without family history of lung cancer (OR = 1.309, 95% CI = 1.066–1.607). Conclusions In conclusion, risk-based prediction model based on the family history of lung cancer and female gender can potentially improve efficiency of lung cancer screening programs in Taiwan.
Collapse
Affiliation(s)
- Kuei-Feng Lin
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Fu Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Wei-Chun Huang
- Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.,Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Ting Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,Faculty of Medicine, School of Medicine, Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan. .,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| |
Collapse
|
36
|
Tang PL, Chang HT, Cheng CC, Chen HC, Kuo SM, Hsiao KY, Chang KC. An Analysis of Emergency Department Visits and the Survival Rate for Colorectal Cancer Patients: A Nationwide Population-based Study. Intern Med 2017; 56:2125-2132. [PMID: 28781299 PMCID: PMC5596271 DOI: 10.2169/internalmedicine.7629-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective We examined the general characteristics, survival rate, and most common reasons for visiting the emergency department (ED) among colorectal cancer patients in Taiwan. We performed a population-based retrospective study and used data sourced from the National Health Insurance Research Database (NHIRD). Methods The colorectal cancer patient population, their diagnosis, and their medical management at the ED were identified using the Longitudinal Health Insurance Database 2000 (HV) codes and International Classification of Diseases, Ninth Revision, Clinical Modification system. We investigated their reasons for visiting the ED and the medications used there, analyzed their cumulative survival curves using the Kaplan-Meier method, and compared the survival curves with other colorectal cancer patients who had never visited the ED. Results Between 2000 and 2012, there were 6,532 ED visits by 3,347 colorectal patients, and the number per year increased gradually. The top three most common reasons for visiting ED were ill-defined conditions, abdominal pain, and intestinal obstruction. The overall survival rates of colorectal patients in the ED visit group at 3, 5, and 10 years, were 0.65, 0.56, and 0.47, respectively, without significant differences from the rates among colorectal cancer patients who did not visit the ED (p=0.2072). Conclusion We described the circumstances of ED visitation by colorectal cancer patients in Taiwan. Health care providers and researchers should pay more attention to improve medical care quality and investigate more details to predict the outcome among colorectal cancer patients.
Collapse
Affiliation(s)
- Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Taiwan
- College of Nursing, Kaohsiung Medical University, Taiwan
- Department of Nursing, Meiho University, Taiwan
| | - Hong-Tai Chang
- Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan
| | - Chin-Chang Cheng
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
| | - Hung-Chih Chen
- Department of Oromaxillofacial Surgery, Kaohsiung Veterans General Hospital, Taiwan
| | - Shyh-Ming Kuo
- Department of Biomedical Engineering, I-Shou University, Taiwan
| | - Kuan-Yin Hsiao
- Radiation Oncology Department, Kaohsiung Municipal United Hospital, Taiwan
| | - Kuo-Chen Chang
- Radiation Oncology Department, Kaohsiung Veterans General Hospital, Taiwan
| |
Collapse
|
37
|
Wang MT, Lin SC, Tang PL, Hung WT, Cheng CC, Yang JS, Chang HT, Liu CP, Mar GY, Huang WC. The impact of DPP-4 inhibitors on long-term survival among diabetic patients after first acute myocardial infarction. Cardiovasc Diabetol 2017; 16:89. [PMID: 28697774 PMCID: PMC5505012 DOI: 10.1186/s12933-017-0572-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/04/2017] [Indexed: 12/29/2022] Open
Abstract
Background Previous studies regarding the cardioprotective effects of dipeptidyl peptidase 4 (DPP-4) inhibitors have not provided sufficient evidence of a relationship between DPP-4 inhibition and actual cardiovascular outcomes. This study aimed to evaluate the impact of DPP-4 inhibitors on the survival of diabetic patients after first acute myocardial infarction (AMI). Methods This was a nationwide, propensity score-matched, case–control study of 186,112 first AMI patients, 72,924 of whom had diabetes. A propensity score, one-to-one matching technique was used to match 2672 controls to 2672 patients in the DPP-4 inhibitor group for analysis. Controls were matched based on gender, age, and a history of hypertension, dyslipidemia, diabetes, peripheral vascular disease, heart failure, cerebrovascular accident, end-stage renal disease, chronic obstructive pulmonary disease, and percutaneous coronary intervention. Results DPP-4 inhibitors improve the overall 3-year survival rate (log rank P < 0.0001), whether male or female. Cox proportional hazard regression showed DPP-4 inhibitor is beneficial in diabetes patients after AMI (HR = 0.86; 95% CI 0.78–0.95), especially in those patients with hypertension (HR = 0.87; 95% CI 0.78–0.97; P = 0.0103) and cerebrovascular disease (HR = 0.83; 95% CI 0.72–0.97; P = 0.018), but without dyslipidemia (HR = 0.78; 95% CI 0.67–0.92; P = 0.0029), without peripheral vascular disease (HR = 0.86; 95% CI 0.78–0.96; P = 0.0047), without heart failure (HR = 0.84; 95% CI 0.73–0.96; P = 0.0106), without end stage renal disease (HR = 0.86; 95% CI 0.77–0.95; P = 0.0035), and without chronic obstructive pulmonary disease (HR = 0.87; 95% CI 0.78–0.97; P = 0.0096). Conclusions DPP-4 inhibitor therapy improved long-term survival in diabetic patients after first AMI, regardless of gender.
Collapse
Affiliation(s)
- Mei-Tzu Wang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sheng-Che Lin
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wang-Ting Hung
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chin-Chang Cheng
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Jin-Shiou Yang
- Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Hong-Tai Chang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Peng Liu
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan
| | - Guang-Yuan Mar
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan. .,Section of Critical Care Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813, Taiwan.
| |
Collapse
|
38
|
Yang GCC, Tang PL, Yen CH. Removal of micropollutants from municipal wastewater by graphene adsorption and simultaneous electrocoagulation/electrofiltration process. Water Sci Technol 2017; 75:1882-1888. [PMID: 28452780 DOI: 10.2166/wst.2017.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this work the optimal operating conditions for removing selected micropollutants (also known as emerging contaminants, ECs) from actual municipal wastewater by graphene adsorption (GA) and simultaneous electrocoagulation/electrofiltration (EC/EF) process, respectively, were first determined and evaluated. Then, performance and mechanisms for the removal of selected phthalates and pharmaceuticals from municipal wastewater simultaneously by the GA and EC/EF process were further assessed. ECs of concern included di-n-butyl phthalate (DnBP), di-(2-ethylhexyl) phthalate (DEHP), acetaminophen (ACE), caffeine (CAF), cefalexin (CLX) and sulfamethoxazole (SMX). It was found that GA plus EC/EF process yielded the following removal efficiencies: DnBP, 89 ± 2%; DEHP, 85 ± 3%; ACE, 99 ± 2%; CAF, 94 ± 3%; CLX, 100 ± 0%; and SMX, 98 ± 2%. Carbon adsorption, size exclusion, electrostatic repulsion, electrocoagulation, and electrofiltration were considered as the main mechanisms for the removal of target ECs by the integrated process indicated above.
Collapse
Affiliation(s)
- Gordon C C Yang
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan E-mail: ; Center for Emerging Contaminants Research, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Pei-Ling Tang
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan E-mail:
| | - Chia-Heng Yen
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan E-mail:
| |
Collapse
|
39
|
Lin LT, Hu LY, Tang PL, Tsui KH, Cheng JT, Huang WC, Chang HT. Do racial differences exist in the association between pregnancy-induced hypertension and breast cancer risk? Hypertens Pregnancy 2017; 36:138-144. [PMID: 28102720 DOI: 10.1080/10641955.2016.1258411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Previous studies investigating the relationship between pregnancy-induced hypertension (PIH) and breast cancer risk have yielded inconsistent results. Unlike numerous Western studies, studies have reported that PIH may be a risk factor for breast cancer in Western Asian women. To confirm these results, we designed a retrospective population-based cohort study to assess the relationship between PIH and subsequent risk for breast cancer in Taiwan. METHODS Patients with newly diagnosed PIH were selected from the Taiwan National Health Insurance Research Database (NHIRD), and a 1:4 matched cohort of women without PIH based on age and the year of delivery was randomly selected from the same database as the comparison group. The incidence of new-onset breast cancer was assessed in both cohorts. RESULTS Among the 23.3 million individuals registered in the NHIRD, 26,638 patients with PIH and 106,552 matched controls were identified. The incidence rate of breast cancer was higher in patients with PIH than in the matched controls (incidence rate ratio = 1.09, 95% confidence interval [CI] = 1.09-1.10, p < 0.0001). However, the Kaplan-Meier analysis revealed a similar cumulative incidence rate of breast cancer between the PIH and comparison cohorts (log-rank p = 0.4303). Moreover, results from a multivariate analysis indicated that PIH was not a statistically significant independent risk factor for breast cancer (adjusted hazard ratio = 1.10, 95% CI = 0.87-1.39, p = 0.4247). CONCLUSIONS The present study demonstrated no significant temporal relationship between PIH and risk for subsequent breast cancer in Eastern Asian women.
Collapse
Affiliation(s)
- Li-Te Lin
- a Department of Obstetrics and Gynecology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,b Department of Biological Science , National Sun Yat-sen University , Kaohsiung , Taiwan.,c School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Li-Yu Hu
- c School of Medicine , National Yang-Ming University , Taipei , Taiwan.,d Department of Psychiatry , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan
| | - Pei-Ling Tang
- e Research Center of Medical Informatics , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,f College of Nursing , Kaohsiung Medical University , Kaohsiung , Taiwan.,g Department of Nursing , Meiho University , Ping-Tung , Taiwan
| | - Kuan-Hao Tsui
- a Department of Obstetrics and Gynecology , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,b Department of Biological Science , National Sun Yat-sen University , Kaohsiung , Taiwan.,c School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Jiin-Tsuey Cheng
- b Department of Biological Science , National Sun Yat-sen University , Kaohsiung , Taiwan
| | - Wei-Chun Huang
- c School of Medicine , National Yang-Ming University , Taipei , Taiwan.,h Critical Care Center and Cardiovascular Medical Center , Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.,i Department of Physical Therapy , Fooyin University , Kaohsiung , Taiwan
| | - Hong-Tai Chang
- j Department of Surgery , Kaohsiung Veterans General Hospital , Kaoh , Taiwan.,k College of Management National Sun Yat-sen University , General Hospital, Kaohsiung , Taiwan
| |
Collapse
|
40
|
Kuo TJ, Chu CH, Tang PL, Lai YC. Effects of geographic area and socioeconomic status in Taiwan on survival rates of head and neck cancer patients after radiotherapy. Oral Oncol 2016; 62:136-138. [PMID: 27865366 DOI: 10.1016/j.oraloncology.2016.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/16/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Tsu-Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan
| | - Chi-Hsiang Chu
- Department of Applied Mathematics, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Yu-Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Taiwan.
| |
Collapse
|
41
|
Lin LT, Wang PH, Tsui KH, Cheng JT, Cheng JS, Huang WC, Tang PL, Hu LY. Increased risk of systemic lupus erythematosus in pregnancy-induced hypertension: A nationwide population-based retrospective cohort study. Medicine (Baltimore) 2016; 95:e4407. [PMID: 27472738 PMCID: PMC5265875 DOI: 10.1097/md.0000000000004407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Dysregulation of the immune system plays a role in the pathogenesis of both, pregnancy-induced hypertension (PIH) and systemic lupus erythematosus (SLE). It is well known that SLE predisposes to be complicated with PIH. However, few studies have attempted to investigate whether PIH increased subsequent SLE risk.The objectives of this study were to assess the association between PIH and subsequent SLE risk and identify predictive risk factors.Patients with newly diagnosed PIH were selected from the Taiwan National Health Insurance Research Database (NHIRD) and compared with a matched cohort without PIH based on age and the year of delivery. The incidence of new-onset SLE was evaluated in both cohorts. The overall observational period was from January 1, 2000 to December 31, 2013.Among the 23.3 million individuals registered in the NHIRD, 29,091 patients with PIH and 116,364 matched controls were identified. The incidence of SLE was higher among patients with PIH than in the matched controls (incidence rate ratio [IRR] = 4.02, 95% confidence interval [CI] 3.98-4.05, P < 0.0001). The IRR for subsequent SLE development remained significantly higher in all stratifications during the follow-up years. The multivariate Cox regression model was performed and the results showed that PIH may be an independent risk factors for the development of subsequent SLE (hazard ratio [HR] = 2.87, 95% CI 2.07-3.98, P < 0.0001). Moreover, multivariate Cox regression model was used again among the PIH cohort only in order to identify the possible risk factors for subsequent SLE in the population with PIH.Patients with PIH may have higher risk of developing newly diagnosed SLE than those without PIH. In addition, among individuals who have experienced PIH, those younger than 30 years, having experienced preeclampsia/eclampsia, single parity, preterm birth, or chronic kidney disease, may display an increased subsequent risk of SLE.
Collapse
Affiliation(s)
- Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Peng-Hui Wang
- Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jiin-Tsuey Cheng
- Department of Biological Science, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jin-Shiung Cheng
- Department of Gastroenterology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Huang
- Section of Critical Care and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Correspondence: Li-Yu Hu, Pei-Ling Tang, Department of Psychiatry, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (e-mail: [L-YH]; Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan [P-LT])
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Correspondence: Li-Yu Hu, Pei-Ling Tang, Department of Psychiatry, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (e-mail: [L-YH]; Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan [P-LT])
| |
Collapse
|
42
|
Abstract
Increasing evidence suggests that certain types of cancers are more common in people with diabetes mellitus (DM). This study aimed to investigate the risk of skin cancer in patients with DM in Taiwan. In this retrospective cohort study using data from the Taiwan Longitudinal Health Insurance Research Database, the risk of developing overall skin cancer, including nonmelanoma skin cancer (NMSC) and melanoma, was compared by Poisson regression analysis and Cox regression analysis between the DM and non-DM cohorts. The DM cohort with newly diagnosed DM (n = 41,898) and a non-DM cohort were one-to-one matched by age, sex, index date, and comorbidities (coronary artery disease, hyperlipidemia, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and obesity). Compared with non-DM cohort statistically, for the people with DM aged ≥60 years, the incidence rates of overall skin cancer and NMSC were significantly higher (overall: DM/non-DM: number [n] = 99/76, incidence rate ratio [IRR] = 1.44, P = 0.02; NMSC: DM/non-DM: n = 94/66, IRR = 1.57, P = 0.005). By Cox regression analysis, the risk of developing overall skin cancer or NMSC was significantly higher after adjusting for sex, comorbidities, and overall diseases with immunosuppression status (overall: adjusted hazard ratio [AHR] = 1.46, P = 0.01; NMSC: AHR = 1.6, P = 0.003). Other significant risk factors were older males for skin cancer (overall: AHR = 1.68, P = 0.001; NMSC: AHR = 1.59, P = 0.004; melanoma: AHR = 3.25, P = 0.04), chronic obstructive pulmonary disease for NMSC (AHR = 1.44, P = 0.04), and coronary artery disease for melanoma (AHR = 4.22, P = 0.01). The risk of developing melanoma was lower in the DM cohort than in the non-DM cohort, but without significance (AHR = 0.56, P = 0.28; DM/non-DM: n = 5/10). The incidence rate and risk of developing overall skin cancer, including NMSC, was significantly higher in older adults with DM. Other significant risk factors for older adults with DM were males for NMSC and melanoma, chronic obstructive pulmonary disease for NMSC, and coronary artery disease for melanoma.
Collapse
Affiliation(s)
- Hui-Wen Tseng
- Department of Dermatology, Kaohsiung Veterans General Hospital
- Institute of Biomedical Sciences, National Sun Yat-Sen University
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-Sen University
| | | | - Wei-Chun Huang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang-Ming University, Taipei
- Department of Physical Therapy, Fooyin University
| | - Pei-Ling Tang
- Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Hing-Chung Lam
- Center for Geriatrics and Gerontology
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Correspondence: Hing-Chung Lam, Center for Geriatrics and Gerontology, and Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Veterans General Hospital, No. 386, Da-Zhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan (R.O.C.) (e-mail: )
| |
Collapse
|
43
|
Lin LT, Tsui KH, Cheng JT, Cheng JS, Huang WC, Liou WS, Tang PL. Increased Risk of Intracranial Hemorrhage in Patients With Pregnancy-Induced Hypertension: A Nationwide Population-Based Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e3732. [PMID: 27196496 PMCID: PMC4902438 DOI: 10.1097/md.0000000000003732] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pregnancy-induced hypertension (PIH) may be a major predictor of pregnancy-associated intracranial hemorrhage (ICH). However, the relationship between PIH and long-term ICH risk is unknown.The objective of the study was to determine the association between PIH and ICH and to identify the predictive risk factors.Patients with newly diagnosed PIH were recruited from the Taiwan National Health Insurance Research Database. PIH patients were divided into gestational hypertension (GH) and preeclampsia groups. The 2 groups were separately compared with matched cohorts of patients without PIH based on age and date of delivery. The occurrence of ICH was evaluated in both cohorts. The overall observational period was from January 1, 2000 to December 31, 2013.Among the 23.3 million individuals registered in the National Health Insurance Research Database, 28,346 PIH patients, including 7390 with GH and 20,956 with preeclampsia, were identified. The incidences of ICH were increased in both groups (incidence rate ratio [IRR] = 3.72 in the GH group, 95% confidence interval [CI] 3.63-3.81, P < 0.0001 and IRR = 8.21 in the preeclampsia group, 95% CI 8.12-8.31, P < 0.0001, respectively). In addition, according to the results of stratification of follow-up years, both groups were associated with a highest risk of ICH at 1 to 5 years of follow-up (IRR = 11.99, 95% CI 11.16-12.88, P < 0.0001 and IRR = 21.83, 95% CI 21.24-22.44, P < 0.0001, respectively). After adjusting for age, parity, severity of PIH, number of PIH occurrences, gestational age, and comorbidities in the multivariate survival analysis using Cox regression model, age ≥30 years (hazard ratio [HR] 1.99, 95% CI 1.27-3.10, P = 0.0026), patients with preeclampsia (HR 2.18, 95% CI 1.22-3.90, P = 0.0089), multiple PIH occurrences (HR 4.08, 95% CI 1.85-9.01, P = 0.0005), hypertension (HR 4.51, 95% CI 1.89-10.74, P = 0.0007), and obesity (HR 7.21, 95% CI 1.58-32.84, P = 0.0107) were independent risk factors for the development of ICH among patients with PIH.Patients with PIH, especially those with older age, preeclampsia, and multiple PIH occurrences, may have an increased risk of developing ICH later in life.
Collapse
Affiliation(s)
- Li-Te Lin
- From the Department of Obstetrics and Gynecology (L-TL, K-HT, W-SL), Kaohsiung Veterans General Hospital; Department of Biological Science (L-TL, K-HT, J-TC), National Sun Yat-sen University, Kaohsiung; Department of Obstetrics and Gynecology (L-TL, K-HT, W-SL), National Yang-Ming University School of Medicine, Taipei; Department of Gastroenterology (J-SC), Kaohsiung Veterans General Hospital; Section of Critical Care and Cardiovascular Medical Center (W-CH), Kaohsiung Veterans General Hospital, Kaohsiung; Department of Obstetrics and Gynecology (W-SL), National Defense Medical Center, Taipei; and Research Center of Medical Informatics (P-LT), Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | | | | | | | | | | |
Collapse
|
44
|
Tang PL, Mayer DK, Chou FH, Hsiao KY. The Experience of Cancer Stigma in Taiwan: A Qualitative Study of Female Cancer Patients. Arch Psychiatr Nurs 2016; 30:204-9. [PMID: 26992872 DOI: 10.1016/j.apnu.2015.08.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/22/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cancer is the leading cause of death in Taiwan. Because the causes of cancer are often difficult to identify, a diagnosis of cancer is occasionally attributed to karma and the concept of stigma. These feelings lead to a life predicament, and stigma influences these perceptions. OBJECTIVE This study intended to understand how stigma is formed in the disease-related experiences of women with cancer. METHODS Ten participants were interviewed at the time of a confirmed diagnosis of advanced cancer and completed cancer treatment with regular follow-up after treatment, and all subjects underwent 2-3 interviews. The number of interviews conducted was determined by data saturation. A content analysis method was used. RESULTS The stigma of cancer includes the concepts of "cancer equals death", including the feeling of death approaching and an awareness of disease severity. "Cancer equals menace to social life" suggests that social life is affected and includes other individuals' uncomfortable attitudes toward cancer (shame, sympathy, pity, suffering, and over-cautiousness) and external physical changes. "Cancer equals cancer-ridden life" includes being sensitive to the topics of death and calculating the number of remaining survival days. CONCLUSIONS The process from early diagnosis to the decision to receive treatment is complicated for patients with cancer. After the diagnosis is confirmed, the stigma of diagnosis significantly affects patients. Regarding social stereotypes, educating the public to resolve individuals' negative responses to cancer and further convey social and public information to women in society is necessary.
Collapse
Affiliation(s)
- Pei-Ling Tang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Deborah K Mayer
- University of North Carolina School of Nursing, Chapell Hill, NC
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Kuan-Yin Hsiao
- Radiation Oncology Department, Kaohsiung Municipal United Hospital, Kaohsiung City, Taiwan
| |
Collapse
|
45
|
Shen CC, Hu LY, Hu YW, Chang WH, Tang PL, Chen PM, Chen TJ, Su TP. The Risk of Cancer in Patients With Obsessive-Compulsive Disorder: A Nationwide Population-Based Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e2989. [PMID: 26945419 PMCID: PMC4782903 DOI: 10.1097/md.0000000000002989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Previous studies suggest a link between anxiety disorders and cancer. The aim of the study was to evaluate the risk of cancer among patients with obsessive-compulsive disorder (OCD) using a nationwide population-based dataset. We recruited newly diagnosed OCD patients without antecedent cancer from the Taiwan National Health Insurance Research Database between 2002 and 2011. The standardized incidence ratios (SIRs) were estimated for 22 specific cancer types among OCD patients and we determined the SIRs for subgroups according to age and sex group. In addition, because of a potential detection bias, a subgroup analysis stratified with the duration of the OCD diagnosis was carried out. Among the 52,656 OCD patients, who were followed up for 259,945 person-years (median follow-up = 4.9 years), there were 718 cases of cancer. Patients with OCD did not exhibit an increased overall cancer risk relative to the general population (SIR 1.05, 95% confidence interval [CI] 0.98-1.13). An increased SIR was observed among OCD patients only within the first year of OCD diagnosis (SIR 1.21, 95% CI 1.01-1.43).This study indicated that the overall cancer risk was not elevated among OCD patients. An increased SIR observed among OCD patients within the first year of OCD diagnosis may be caused by a surveillance bias, and because paraneoplastic manifestations presented with obsessive-compulsive behaviors. Prospective study is necessary to confirm these findings.
Collapse
Affiliation(s)
- Cheng-Che Shen
- From the Department of Psychiatry (L-YH), Kaohsiung Veterans General Hospital, Kaohsiung; Department of Psychiatry (C-CS), Chiayi Branch, Taichung Veterans General Hospital; Department of Information Management (C-CS), National Chung-Cheng University, Chiayi; School of Medicine (C-CS, L-YH, Y-WH), National Yang-Ming University; Cancer Center (Y-WH), Taipei Veterans General Hospital; Institute of Public Health (Y-WH, TJC, TPS), National Yang-Ming University; Department of Psychiatry (W-HC, TPS), Taipei Veterans General Hospital, Taipei; Research Center of Medical Informatics (P-LT), Kaohsiung Veterans General Hospital, Kaohsiung; Department of Psychiatry (P-MC), Yuanshan and Suao Branch, Taipei Veterans General Hospital; and Department of Family Medicine (T-JC), Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Kuo PL, Lin KC, Tang PL, Cheng CC, Huang WC, Chiang CH, Lin HC, Chuang TJ, Wann SR, Mar GY, Cheng JS, Liu CP. Contribution of Hepatitis B to Long-Term Outcome Among Patients With Acute Myocardial Infarction: A Nationwide Study. Medicine (Baltimore) 2016; 95:e2678. [PMID: 26844504 PMCID: PMC4748921 DOI: 10.1097/md.0000000000002678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Although a possible association between hepatitis B and cardiovascular disease has been identified, the impact of viral hepatitis B on long-term prognosis after an acute myocardial infarction (AMI) is uncertain. Therefore, the aim of our study was to evaluate the specific impact of viral hepatitis B on survival after a first AMI through a retrospective analysis of data from the Taiwan National Health Insurance Research Database.This was a nationwide, propensity score-matched case-control study of patients admitted to hospitals between January 2000 and December 2012 with a primary diagnosis of a first AMI. Among the 7671 prospective patients, 244 patients with a confirmed diagnosis of viral hepatitis B infection were identified. A propensity score, one-to-one matching technique was used to match 244 controls to the AMI group for analysis. Controls were matched on the following variables: sex, age, hypertension, dyslipidemia, diabetes, peripheral vascular disease, heart failure, cerebrovascular accidents, end-stage renal disease, chronic obstructive pulmonary disease, and percutaneous coronary intervention (PCI).Overall, viral hepatitis B infection did not influence the 12-year survival rate (P = 0.98). However, survival was lower in female patients with viral hepatitis B infection compared to those without (P = 0.03; hazard ratio, 1.79; 95% confidence interval, 1.08-2.94). Inclusion of percutaneous coronary management improved survival, independent of sex, age, or hepatitis B status.Hepatitis B infection might increase the mortality risk of female patients after a first AMI. PCI may improve the long-term survival of patients after a first AMI, regardless of sex, age, and hepatitis B status.
Collapse
Affiliation(s)
- Pei-Lun Kuo
- From the Critical Care Center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (P-LK, K-C L, P-LT, C-CC, W-CH, C-HC, H-CL, T-JC, S-RW, G-YM, C-PL); School of Medicine, National Yang-Ming University, Taipei, Taiwan (P-LK, C-CC, W-CH, C-HC, C-PL); Department of Physical Therapy, Fooyin University, Kaohsiung, Taiwan (C-CC, W-CH, C-HC); and Section of Gastroenterology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (J-SC)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
In this work graphene was used for evaluation of its adsorption behavior and performance in removing phthalate esters and pharmaceuticals in municipal wastewater. Di-n-butyl phthalate (DnBP), di-(2-ethylhexyl) phthalate (DEHP), acetaminophen (ACE), caffeine (CAF), cephalexin (CLX), and sulfamethoxazole (SMX) were emerging contaminants (ECs) with detection frequencies over 92% in a one-year monitoring of the occurrence of ECs in influent samples of a sewage treatment plant in Taiwan. Thus, these ECs were selected as the target contaminants for removal by graphene adsorption process. Experimental results showed that the adsorption isotherm data were fitted well to Langmuir model equation. It was also found that the adsorption process obeyed the pseudo-second-order kinetics. A graphene dosage of 0.1 g/L and adsorption time of 12 h were found to be the optimal operating conditions for the ECs of concern in model solutions in a preliminary study. By using the determined optimal operating conditions for removal of such ECs in actual municipal wastewater, removal efficiencies for various ECs were obtained and given as follows: (1) DnBP, 89%, (2) DEHP, 86%, (3) ACE, 43%, (4) CAF, 84%, (5) CLX, 81%, and (6) SMX, 34%.
Collapse
Affiliation(s)
- Gordon C C Yang
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan E-mail: ; Center for Emerging Contaminants Research, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Pei-Ling Tang
- Institute of Environmental Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan E-mail:
| |
Collapse
|
48
|
Tang PL, Wang HH, Chou FH. A Systematic Review and Meta-Analysis of Demoralization and Depression in Patients With Cancer. Psychosomatics 2015; 56:634-43. [PMID: 26411374 DOI: 10.1016/j.psym.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/09/2015] [Accepted: 06/09/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. Depression and demoralization syndrome in patients with cancer are closely related to suicidal behavior. OBJECTIVE The purpose of this study was to explore the factors affecting demoralization of patients with cancer from a depression perspective, to assist with distinguishing patient emotions and provide appropriate intervention as early as possible, thereby enabling patients to receive proper care. METHODS A systematic review and meta-analysis was employed in this study. The databases included Cumulative Index for Nursing and Allied Health Literature, Cochrane, PubMed/ MEDLINE, PsycINFO, and Centre for European Policy Studies, and reference lists of articles. Experts in this field also were contacted. Based on inclusion criteria, 2 investigators selected the research and reviewed each study's quality according to the Newcastle-Ottawa Scale. Five correlational studies with 32 subjects were identified. RESULTS The countries of studies included Australia, Germany, Taiwan, and the United States. There was a statistically significant difference in depression between patients with cancer in the high-demoralization group and those of the low-demoralization group (odds ratio = 9.65, 95% CI: 6.99-13.33, Z = 15.002, p < 0.0001). Four studies regarded demoralization and depression as distinguishable. CONCLUSIONS The demoralization of patients with cancer was highly correlated with depression. Therefore, the suicide risk of demoralized patients without depression must also be assessed to prevent patients with high suicide risk from being neglected. If medical staff can perceive patient's demoralization issues earlier, they can more effectively prevent patients' depression from occurring, which benefits suicide prevention.
Collapse
Affiliation(s)
- Pei-Ling Tang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC
| | - Hsiu-Hung Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC
| | - Fan-Hao Chou
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC.
| |
Collapse
|
49
|
Tang PL, Chen WL, Cheng SF. [Using logotherapy to relieve death anxiety in a patient with recurrent cancer: a nursing experience]. Hu Li Za Zhi 2013; 60:105-10. [PMID: 23922097 DOI: 10.6224/jn.60.3.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We used logotherapy concepts to manage the mental impact of recurrent cancer on a patient. The patient had received radiotherapy for nasopharyngeal carcinoma approximately one year prior to the March 9th - April 21st, 2011 nursing care period. The authors interacted with the patient during the care period via personal observation and telephone interview. Patient data was also collected from medical staff. Integral nursing assessment disclosed that the patient faced several major nursing issues, including death anxiety, pain, and sleep disturbance. This report describes how logotherapy was utilized to enable the patient better understand his condition and ultimately allow him to identify and pursue renewed meaning and happiness in life. Logotherapy helped alleviate the death anxiety caused by recurrent cancer and helped the patient self-reconfirm the meaning of life.
Collapse
Affiliation(s)
- Pei-Ling Tang
- College of Nursing, Kaohsiung Medical University, Taiwan, ROC.
| | | | | |
Collapse
|
50
|
Tai WM, Tang PL, Koo YX, Hou X, Tay KW, Quek R, Tao M, Lim ST. Do We Have the Right Prognostic Index for Diffuse Large B Cell Lymphoma (DLBCL) in the Era of Rituximab? Proceedings of Singapore Healthcare 2011. [DOI: 10.1177/201010581102000108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Whilst the addition of rituximab, a humanized monoclonal antibody to standard CHOP chemotherapy (R-CHOP) has improved the outcomes of DLBCL, the validity of the previously identified prognostic index based on clinical parameters is questioned. It is conceivable that prognostic model may alter with introduction of new therapeutics with differing efficacy and mechanisms of action. Methods: We conducted a retrospective analysis comparing the relevance of International Prognostic Index (IPI), Age-adjusted IPI and Revised International Prognostic Index (R-IPI) in 320 consecutive patients with DLBCL from 2003–2008 treated with R-CHOP chemotherapy with curative intent. We evaluated the prognostic factors determinant of survival in our group of patients. Results: Patients were followed up for a median of 2.70 years. IPI was only able to stratify patients into 3 main risk groups instead of 4. In addition, among patients <60, aa-IPI no longer seem a robust prognostic model. We showed that R-IPI was able to separate patients into 3 different prognostic groups and perhaps most relevant in the era of chemo-immunotherapy. Significant prognostic factors identified in multivariate analysis were performance status (P=0.004) and bone marrow involvement (P=0.026). Conclusion: The most robust prognostic index for patients with DLBCL in the era of rituximab remains uncertain. Incorporation of molecular markers into clinical parameters should be evaluated, a study we are embarking on.
Collapse
Affiliation(s)
- WM Tai
- Department of Medical Oncology, National Cancer Centre Singapore
| | - PL Tang
- Department of Medical Oncology, National Cancer Centre Singapore
| | - YX Koo
- Department of Medical Oncology, National Cancer Centre Singapore
| | - X Hou
- Division of Clinical Trials and Epidemiology Science
| | - KW Tay
- Department of Medical Oncology, National Cancer Centre Singapore
| | - R Quek
- Department of Medical Oncology, National Cancer Centre Singapore
| | - M Tao
- Department of Medical Oncology, National Cancer Centre Singapore
| | - ST Lim
- Department of Medical Oncology, National Cancer Centre Singapore
| |
Collapse
|