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Treatment patterns, healthcare resource use, economic, and survival outcomes associated with nonresectable advanced esophageal cancers in Taiwan
No full text[[abstract]]Background: In Taiwan, limited real-world data indicate that initial EC diagnosis tends to occur at an advanced stage with limited therapeutic options and poor prognosis. Methods: This was a retrospective ‘real world’ observational study using the Taiwan National Health Insurance Research Database (NHIRD). Patients having at least one hospital record with a primary ICD-9 or ICD-10 code of EC were selected from Jan 1st, 2013 through Dec 31st, 2018. The first date of EC diagnosis was defined as the index date. Patients were followed for a minimum ± 30 days from the index date and were stratified by staging, clinical presentation (i.e. resectable vs. non-resectable advanced) and tumor histotype (squamous cell carcinoma, adenocarcinoma, unknown). Key characteristics such as demographics, clinical parameters, medication utilization, health care resource utilization, costs incurred, and survival were tracked for the overall population, resectable and non-resectable, advanced cohorts. Results: Patients identified with non-resectable advanced EC (N = 4,340) had a mean (SD) age of 59.7 (12.3) years and the vast majority were male (n = 4,044, 93.2%). Approximately half (50.4%) had Stage 3 disease and an additional 36.2% with stage 4, with the remainder Stage 1, 2 or Unknown. The majority (91.8%) were diagnosed with squamous cell carcinoma. 71.3% of patients received first line (1L) chemotherapy, most commonly with fluorouracil + cisplatin (69.9% of 1L) or platinum monotherapy (13.8% of 1L). 36.3% of patients survived one year with mean (SD) annualized post-index EC-related costs of New Taiwan (NT) 582,663.8). Conclusions: In Taiwan, the most common 1L chemotherapeutic treatment modality for Taiwanese patients with EC were fluorouracil + cisplatin. The EC-related costs for these patients appear to be a substantial financial burden in Taiwan
Effects of physical and social environments on the risk of dementia among Taiwanese older adults: a population-based case-control study
No full text[[abstract]]Background: Physical and social environments may influence cognition health in older adults. However, evidence regarding physical and social environments linked to dementia is lacking, especially in Asia. This study aims to explore the influence of physical and social environments on the incidence of dementia through a population-based case-control design in Taiwan.
Methods: We identified 26,206 incident cases with dementia aged≧65 years in 2010, with the same no. of controls from National Health Insurance claims. Environmental measures were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CI) of the association between dementia incidence and the environmental measures at the township level.
Results: We observed a significant reduction of 12% in the odds ratios of dementia in areas with higher availability of playgrounds and sport venues (OR 0.88, 95% CI 0.81-0.95), after controlling for individual and other environmental characteristics. Community center availability was also significantly associated with an 8% decreased odds for dementia (OR 0.92, 95% CI 0.87-0.99), but the association was not significant after further consideration of individual-level characteristics. Although higher odds of dementia were found in areas with high median annual family income (OR 1.14, 95% CI 1.04-1.25), such a significant relationship did not appear in the full model.
Conclusions: Our study suggests that specific physical and social environmental features have different influences on the risk of dementia. Public health interventions may consider these environmental aspects for preventing dementia incidence
Risk of Developing Coronary Artery Disease in Patients with Type 2 Diabetes Receiving Traditional Chinese Medicine Therapy
No full text[[abstract]]Objectives: To compare risk of developing coronary artery disease (CAD) between diabetic patients receiving Traditional Chinese Medicine (TCM) therapy and those treated by Western medicine (WM).
Methods: This prospective cohort study included 13,655 diabetic patients receiving solely TCM and 435,165 patients treated exclusively by WM. Study patients were identified from Taiwan's National Health Insurance (NHI) ambulatory claims in 2000-2001. These patients were then linked to the 2000-2008 NHI inpatient claims, searching for possible new onset of hospitalization for CAD. A Cox proportional hazard model and logistic regression model were used to assess the hazard ratio of CAD admission and odds ratio (OR) of higher rates of admission for CAD in relation to TCM.
Results: During 9 years of follow-up, 2607 diabetic patients with TCM were hospitalized for CAD, representing a cumulative incidence rate of 19.1% and an incidence density of 50.5 per 1000 person-years. The corresponding figures for patients treated by WM were 24.1% and 72.7 per 1000 person-years. Compared with the patients treated by WM, those treated by TCM were associated with a slightly reduced, but insignificantly, adjusted OR of CAD admission (0.96; 95% confidence interval, 0.92-1.01). Moreover, the adjusted OR for a higher rate (≥0.212 admission per person-year) of CAD admission for the patients with TCM was also insignificantly decreased at 0.97.
Conclusions: After adjustment for prior co-morbidity score, risk or rate of CAD admission did not significantly differ between diabetic patients receiving TCM therapy and those treated by WM, suggesting that TCM is as efficacious as WM in preventing diabetes from being complicated with CAD
Risk of Alzheimer's disease in relation to diabetes: a population-based cohort study
No full text[[abstract]]Background/aims: Detailed information on the age- and sex-specific relationships between diabetes and Alzheimer's disease (AD) is scarce. This study aims to prospectively investigate the age- and sex-specific incidence density and relative hazards of AD in relation to diabetes.
Methods: A total of 615,529 diabetic patients and 614,871 age- and sex-matched random controls were linked to the claim data from 2000-2008 to identify the first occurrence of a primary or secondary diagnosis of AD. Incidence density was calculated under the Poisson assumption. We also assessed the age- and sex-specific risk of AD in relation to diabetes with the Cox proportional hazards regression model.
Results: Over nearly 9 years of follow-up, a total of 4,615 diabetic subjects developed AD, representing a cumulative incidence rate of 0.75% (n = 3,873; 0.63% in controls). The overall incidence densities of AD for diabetic men and women, respectively, were 0.82 and 1.15 per 1,000 person-years, which were higher than those for control men and women (0.63 and 0.89 per 1,000 person-years, respectively). Diabetic patients had a significantly higher hazard ratio (HR) of AD [1.45, 95% confidence interval (CI) 1.38-1.52]. Diabetic women ≥65 years had a higher HR (1.52, 95% CI 1.42-1.62) than diabetic women <65 years (1.34, 95% CI 1.15-1.56).
Conclusion: Diabetes may increase the risk of AD in both sexes and in all ages. A higher HR of AD was especially notable in older diabetic women
Birth Choice Decision Aids in Women Planning Vaginal Birth after Cesarean Delivery
No full text[[abstract]]剖腹產後陰道分娩（vaginal birth after cesarean, VBAC）對於曾有先前剖腹產的婦女而言，是一種安全且合理的選擇。台灣每年有超過1／3的婦女剖腹產，但VBAC比率歷年都不到0.5％。醫病共享決策（shared decision making, SDM）則是進行VBAC諮詢的最佳選擇，但在台灣卻仍未被期待運用。本研究旨在探討計畫剖腹產後陰道分娩婦女之生產共享決策過程。採質性研究，立意取樣於北台灣北部的一家地區醫院，招募曾經有過一次剖腹產的懷孕婦女。婦女於妊娠14－24週婦產科產檢時會收到生產決策輔助手冊，並帶回家與家人討論生產方式。在此期間，會提供至少兩次的線上諮詢。37－38週回診時，婦女會與產科醫師共同決定生產方式選擇。產後一個月邀請婦女進行一對一深度線上訪談，資料分析採不斷的比較分析技術。合計有29名婦女參與SDM，生產決策輔助工具介入後，有11位婦女計畫採VBAC生產，產後一個月共有八位婦女接受訪談。資料經歸納婦女的決策過程為：（1）確定生產方式偏好：比較生產方式優缺點、考量過去經驗、醫師專業分析；（2）嘗試剖腹產後陰道分娩：VBAC成功率評估、子宮破裂風險評估；（3）煎熬陰道分娩的不確定性：產程的進展性、醫療處置的可行性；（4）堅持或放棄VBAC選擇：醫生不一致的態度、重要他人的不支持。儘管SDM是理想的健康照護模式，但在台灣仍存在許多困難。孕期應致力於於文化的轉變，改變婦女和產科醫生對生產期待的決策關係。在醫學培訓中，應加強醫師有效及人性化的溝通技巧，並發展生動互動式電腦決策輔助工具，以增加產科醫師與婦女及家庭共同參與決策的意願
Psychosocial stress, self-esteem, and social adjustment: A moderated mediation analysis in Taiwanese adolescents with Tourette syndrome
No full text[[abstract]]Purpose: Recent studies have shown that tics and related comorbidities can cause poorer social adjustment, lower self-esteem, and higher psychosocial stress among adolescents with Tourette syndrome. This study explored the role of self-esteem in mediating the relationship between psychosocial stress and social adjustment among adolescents with Tourette syndrome, and the role of comorbidities in moderating the relationship between self-esteem and social adjustment.
Design and methods: In this descriptive cross-sectional study, 118 Taiwanese adolescents with Tourette syndrome aged between 12 and 20 years old were recruited via convenience sampling. Their demographic information, Yale Global Tic Severity Scale, stress index for children and adolescents with Tourette syndrome, social adjustment scale for adolescents with Tourette syndrome, and Self-Esteem Scale results were collected. Moderated mediation analysis of the study data was performed with the Hayes's PROCESS macro.
Results: Our results revealed that the self-esteem of adolescents with Tourette syndrome fully mediates the relationship between their psychosocial stress and social adjustment (B = -0.0703, 95% CI, [-0.0176, -0.001]), while comorbidities moderates the relationship between their self-esteem and social adjustment (B = -0.8416, 95% CI, [-1.4529, -0.2302]). The relationship between self-esteem and social adjustment was more pronounced in adolescents without comorbidities than those with comorbidities.
Conclusions: Psychosocial stress correlates negatively with social adjustment and self-esteem, and indirectly influences social adjustment through self-esteem, while comorbidities (particularly their absence) moderates the relationship between self-esteem and social adjustment.
Practice implications: Different self-esteem strengthening programs to enhance social adjustment for adolescents with Tourette syndrome may be developed in future studies
The Effectiveness of an Intervention for Fathers of Hospitalized Preterm Infants on Paternal Support and Attachment One Month after Discharge
No full text[[abstract]]This aim of this study was to evaluate the effectiveness of an early intervention program to reduce paternal stress and increase fathering ability after a preterm infant's admission to the special care nursery and to influence paternal support for the mother and the father's attachment to the infant 1 month later. A historical comparison study was designed and an empowerment intervention strategy for the fathers of preterm infants was implemented. Forty-one fathers of preterm infants in the control group received routine care, and 41 fathers of preterm infants in the intervention group received an early fatherhood intervention program in the special care nursery. Both groups were followed 1 month after discharge. Fathers in the intervention group had significantly lower stress and higher fathering ability at their infant's discharge, provided better support to the mother in child-rearing, and had better father-infant attachment 1 month after discharge than fathers in the control group. Under cultural and hospitals' common practices, such an intervention can help the father to establish his fatherhood early and later enhance his supporting role to the mother and his relationship to the preterm infant. Nurses should include teaching childcare to fathers of preterm infants
Myth of Neonatal Umbilical Cord Care
No full text[[abstract]]新生兒臍帶護理為新生兒出生後必須執行的一項護理常規，國內目前各醫療院所大多仍以傳統的酒精作為臍帶護理的方式，然而，由國外的文獻得知，還有使用其他不同製劑作為臍帶護理的方式，本文綜合過去探討不同臍帶護理方式之研究於臍帶脫落的時間、菌落叢聚、臍帶炎及主要照護者的觀點，提供臨床的護理人員參考，以選擇合宜的臍帶護理方式
創新教學法運用於兒科護理學實習護生之感受
No full text[[abstract]]「嚴重急性呼吸道症候群(Severe Acute Respiratory Syndrome, SARS)」此新興傳染病爆發造成當時在醫院進行實習課程的師生，撤離實習單位改採其他方式完成實習課程，因此兒科教師群研擬出模擬臨床情境之「實習教學活動」。教師們依臨床情境、疾病型態及不同年齡層研擬個案情境，以實習小組學習的方式進行案例討論、模擬病房及角色扮演等教學活動。師生們經由校內實施「實習教學活動」的經驗中，經歷有別於以往的實習方式。 本研究採質性研究法，深入訪談十二位護生了解學生於此次創新策略下實習之學習歷程，結果發現針對小組討論，護生正向的感受有：能統整學理知識、清楚護理過程之概念、反省自己的思考模式、重返病房實習時較能應用學理於實務；負向的感受則有：討論會時間冗長無趣、擔心被老師糾正而不敢發言、喜歡眞實情境的挑戰。在遊戲設計方面護生皆抱持正面肯定之反應，認為能發揮創意、成品能於實務情境應用。藉由觀看SARS研習光碟自學部份則認為能習得最新傳染病防護技能，然而負面回饋方面為光碟片畫質差、無臨場感。在模擬病房部份包括有角色扮演、拍攝錄影帶、技術演練及考核則可以引發主動參與之興趣、同儕合作及支持、不必擔心犯錯傷害到自己或病人、能增進人際互動溝通之技能。本研究以學習者為中心深入了解護生對於學習活動設計之回饋，得到的結果可作為護理教師於設計實習學習活動時的參考
A Correlation Study of Illness Knowledge, Self-Care Behaviors and Quality of Life in Elderly Heart Failure Patients
No full text[[abstract]]Background: Patients with heart failure experience adverse physical symptoms that affect quality of life. The number of patients with heart failure in Taiwan has been growing in recent years.
Purpose: This article examines correlations among illness knowledge, self-care behaviors, and quality of life in elderly patients with heart failure.
Methods: A cross-sectional research design using three questionnaires was adopted. The study was undertaken in an outpatient department of a teaching hospital in Taiwan from January to June 2008. Potential participants aged 65 years or older were selected by a physician based on several diagnostic findings of heart failure that included an International Classification of Diseases' code 4280 or 4289. Patients who were bedridden or had a prognosis of less than 6 months were excluded from consideration.
Results: One hundred forty-one patients with heart failure were recruited. Most participants were men (51.8%), older adults (49.6% older than 71 years old), and either educated to an elementary school level or illiterate (69.5%) and have New York Heart Association class II (61.0%). Participants had an average left ventricular ejection fraction of 41.1%. The illness knowledge of participants was poor (accuracy rate: 29.3%), and most were unaware of the significance of self-care. Illness knowledge correlated with both self-care behaviors (r = -.42, p < .01) and quality of life (r = -.22, p < .01). Illness knowledge and age were identified as significant correlated factors of self-care behaviors (R = .22); and functional class, living independently, and age were identified as significant correlated factors of quality of life (R = .41).
Conclusions/implications for practice: Participants in this study with higher self-reported self-care behaviors and quality of life were younger in age and had better illness knowledge. Furthermore, physical function and independence in daily living significantly affected quality of life. Care for patients with heart failure, particularly older adults, should focus on teaching these patients about heart failure illness and symptom management. Assisting elderly patients with heart failure to promote and maintain physical functions to handle activities of daily living independently is critical to improving patient quality of life