Buddhist Dalin Tzu Chi Hospital

Chiayi, Taiwan

Buddhist Dalin Tzu Chi Hospital

Chiayi, Taiwan
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Chiang J.-K.,Buddhist Dalin Tzu Chi Hospital | Kao Y.-H.,Tainan Municipal Hospital
BMC Cancer | Year: 2017

Background: Studies have indicated a pervasive pattern of decreasing healthcare costs during elderly patients' last year of life. The aim of this study was to explore the predictors of high healthcare costs (HC) in elderly liver cancer patients in Taiwan during their last month of life (LML). Methods: Costs of hospitalization, outpatient visits, aggressiveness of care, and associated costs for elderly (age ≥ 65 y) patients with liver cancer in the LML were analyzed using a national insurance database. An HC was defined as being greater than the 90th percentile (US $5093) in the LML, amounting to 38.95% of total healthcare costs. Results: We enrolled 2121 subjects who died during 1997-2011. Mean healthcare costs per person in their LML were US $8042 ± 3477 in the HC group and US $1407 ± 1464 in the non-HC group (p < 0.001). For patients receiving aggressive end-of-life (EOL) cancer care (e.g. intensive care, cardiopulmonary resuscitation, anticancer treatment, and a high number of admission days), comorbidities of chronic kidney disease, esophageal bleeding, and receiving opioids in the LML, were significantly independent positive predictors of HCs; but admission times, comorbidities of ascites, and hypertension were negative predictors. Conclusion: These findings could inform healthcare providers by avoiding aggressive treatments during EOL for elderly patients with liver cancer and to save on healthcare costs. Shorter admission days and more admission times in the last month of life could decrease healthcare costs. © 2017 The Author(s).


Chiang J.-K.,Buddhist Dalin Tzu Chi Hospital | Kao H.-H.,Kaohsiung Medical University | Kao Y.-H.,Tainan Municipal Hospital
Journal of Stroke and Cerebrovascular Diseases | Year: 2017

Background and Purpose: Cardioembolic stroke accounts for approximately 15%-20% of all ischemic strokes. Atrial fibrillation constitutes one-half to two-thirds of all cardioembolic stroke events. The association of paroxysmal supraventricular tachycardia (PSVT) with ischemic stroke remains unclear. A national case-control study was conducted to identify the risk factors, including PSVT, for ischemic stroke in Taiwan. Methods: We designed a national case-control study comprising patients diagnosed with ischemic stroke (n = 5633) from 1997 to 2011; each patient from the case group was randomly matched with the control group (n = 30,895) in Taiwan. Data were retrospectively collected from Taiwan's National Health Insurance Research Database, which contains not only claims data on hospitalization, emergency room visits, and outpatient department visits, but also patient characteristics. Results: Logistic regression analysis was used to identify the risk factors for ischemic stroke. Independent risk factors for ischemic stroke included age (in 5-year intervals; odds ratio [OR], 1.76; 95% confidence interval [CI], 173-1.78), the male sex (versus the female sex; OR, 1.88; 95% CI, 1.74-2.01), chronic kidney disease (OR, 3.09; 95% CI, 2.67-3.57), PSVT (OR, 2.05; 95% CI, 1.30-3.19), and aspirin use (OR, .04; 95% CI, .03-0.05). Conclusions: Our study is the first in Taiwan to identify PSVT as a significant risk factor for ischemic stroke. New antithrombotic regimens, including aspirin, can be recommended for the primary prevention of stroke and for reducing the burden of stroke for patients with PSVT. © 2017 The Authors.


Chiang J.-K.,Buddhist Dalin Tzu Chi Hospital | Kao Y.-H.,Tainan Municipal Hospital
Supportive Care in Cancer | Year: 2015

Purpose: The aim of this study was to compare health-care expenditures and survival of these terminally ill patients receiving or not receiving hospice care in their last month of life. Methods: Using Taiwan’s National Health Insurance Claims Database, we analyzed hospitalizations, OPD visits, associated costs, and survival. Logistic regression was used to identify predictors of high cost. Results: We identified 3850 liver cancer patients who died during the 1997–2011 study period, 644 (16.6 %) of whom were hospice care patients. No significant difference was found in mean survival time between the hospice and non-hospice groups (1.77 ± 2.44 vs. 1.84 ± 2.37 years, p = 0.217). The mean health-care expenditures per person were US$2370 ± 3421 and US$2072 ± 1900 (p = 0.130). A total of 385 patients (10 %) received high-cost care (above US$5422) using 38.6 % of the total health-care expenditures spent on the entire population. The significant predictors of high costs were non-hospice care [odds ratio (OR) = 3.06, 95 % confidence interval (CI) 2.09–4.60], days of admission [risk increase per admission day being (OR = 1.19, 95 % CI 1.17–1.21)], admission into an intensive care unit (OR = 3.17, 95 % CI 1.94 to 5.15), use of ventilator (OR = 3.54, 95 % CI 1.91–6.52), cancer therapy (OR = 1.82, 95 % CI 1.33–2.48), hemodialysis (OR = 2.62, 95 % CI 1.07–6.02), and higher socioeconomic status (OR = 1.65, 95 % CI 1.10–2.45). Conclusion: Hospice care did not significantly affect survival, and hospice patients had lower per-patient expenditures and were less likely to require high-cost medical care than their non-hospice counterparts. © 2014, Springer-Verlag Berlin Heidelberg.


Chiang J.-K.,Buddhist Dalin Tzu Chi Hospital | Kao Y.-H.,Tainan Municipal Hospital
Japanese Journal of Clinical Oncology | Year: 2014

Objective: Pain control helps improve quality of life for advanced cancer patients, yet it is unknown whether opioid use increases risk of death. Analyzing the association between timevarying pain medication and the risk of death presents a challenge. This prospective observational study examined the predictability of the patients' survival by variations of daily opioid dosage during the last few days of life. Methods: Of the 231 cancer patients admitted to a hospice ward between July 2007 and June 2008 was conducted using Cox's model and adjusting for the effects of demography, clinical symptoms/signs, intravenous fluid supplements, antibiotics use and laboratory tests. Results: We found a 3-day negative slope in daily oral morphine equivalent 1 day before each death event to be an independently significant predictor of short time to death (hazard ratio = 1.55; 95% confidence interval: 1.06-2.27). The other significant predictors including faster heart-rate (hazard ratio = 1.01, 95% confidence interval: 1.00-1.02), comorbidity with diabetes (hazard ratio = 1.57, 95% confidence interval: 1.00-2.47), Eastern Cooperative Oncology Group with performance status of 3 or 4 (hazard ratio = 1.78, 95% confidence interval: 1.23-2.58), jaundice (hazard ratio = 2.01, 95% confidence interval: 1.29-3.15), hypercalcemia (hazard ratio = 2.05, 95% confidence interval: 1.40-3.00) and higher serum creatinine level (hazard ratio = 1.36, 95% confidence interval: 1.18-1.57), but use first generation of cephalosporin was a negative predictor of short time to death (hazard ratio = 0.44, 95% confidence interval: 0.28-0.68). Conclusion: A reduction of daily oral morphine equivalent over three consecutive days suggests worsening physical condition significantly and independently predicting imminent death ~1 day later. © The Author 2014. Published by Oxford University Press. All rights reserved.


Chiang J.-K.,Buddhist Dalin Tzu Chi Hospital | Kao Y.-H.,Tainan Municipal Hospital
Journal of Palliative Medicine | Year: 2016

Background: The effectiveness of home hospice care was helping patients to die at home, and reducing symptom burden. Objective: The study objective was to explore the impact of home hospice care on death at home, end-of-life (EOL) care, and health care costs among patients with advanced lung cancer in their last month of life. Methods: Using Taiwan's National Health Insurance Claims Database, we analyzed factors associated with home hospice care using logistic regression analysis. Results: We enrolled 568 patients with advanced lung cancer under hospice care who died during 1997-2011, of which 238 (41.9%) received home hospice care. Compared with the inpatient hospice (IH) group, the home hospice (HH) group had a larger portion die at home (55.5% versus 22.1%, p < 0.001), but a smaller portion stayed in hospital more than 14 days in their last month of life (67.3% versus 40.8%, p < 0.001). The mean health care cost was less in the HH group than in the IH group (US $1,385.00 ± $1,370.00 and US $2,155.00 ± $1,739.00 [p < 0.001], respectively). Female patients' (p = 0.001) decreased hospital stay in the last month of life (p < 0.001) and longer hospice care duration (p = 0.003) were predictors of receiving home hospice care in advanced lung patients. Conclusion: Home hospice care enables patients with advanced lung cancer to increase the 33.4% chance of dying at home, to spend an average of eight-days less in hospital stay, and to save 35.7% health care costs in the last month of life, compared with their counterparts with only inpatient hospice care. Female patients' decreased hospital stay and longer hospice care duration were the predictors of receiving home hospice care. © Copyright 2016, Mary Ann Liebert, Inc. 2016.


Kao Y.-H.,Tainan Municipal Hospital | Chiang J.-K.,Buddhist Dalin Tzu Chi Hospital
BMC Palliative Care | Year: 2015

Background: Quality of near end-of-life (EOL) care is typically evaluated using six accepted quality indicators (QIs). Research has yet to evaluate the quality of EOL care for liver cancer patients in Taiwan. We evaluated the effect of hospice care on the quality of EOL care for patients with advanced liver cancer. Methods: Using claims data obtained from the Taiwan National Health Insurance Research Database, we analyzed the QIs of EOL care for patients who died between 2000 and 2011. Logistic regression was performed to identify predictors for QIs of EOL care. Results: A total of 3092 adult patients died of liver cancer during the study period. The patients were divided into those who received hospice care for a period longer than 1 month (long-H group), shorter than 1 month (short-H group), and not at all (non-H group). There was no significant difference in survival probability among the three groups (p = 0.212). Compared with the non-H group, the long- and short-H groups exhibited a significantly lower risk of being admitted to an intensive care unit (ICU) (odds ratios [ORs] = 0.25 and 0.26, respectively, p < 0.001) and requiring cardiopulmonary resuscitation (CPR) during the final month of life (ORs = 0.21 and 0.09, respectively, p < 0.001). Compared with the non-H group, the short-H group had a higher risk of more than one emergency room (ER) visit, and more than one hospital admission (OR = 1.97, p = 0.003; and OR = 1.56, p = 0.001, respectively), but the long-H group did not differed significantly from the non-H group on these measures. Conclusions: Patients with liver cancer who received hospice care were less likely to be admitted to ICUs or require CPR compared with those who received no hospice care. A longer duration of hospice care was associated with reduced risks of more than one ER visit and more than one hospital admission. We conclude that EOL cancer care in Taiwan might be improved by implementing policies encouraging early hospice referral programs. © 2015 Kao and Chiang.


Chuang T.L.,Buddhist Dalin Tzu Chi Hospital
Clinical nuclear medicine | Year: 2014

We present a case of permanent catheter infection demonstrated by gallium SPECT/CT. The patient is a 71-year-old woman with a history of end-stage renal disease under hemodialysis via permanent catheter due to arteriovenous graft occlusion. This time, she had fever, chills, and leukocytosis. Whole-body gallium scan showed uptake to the right clavicular region, and the SPECT/CT study showed that the uptake area was localized to the catheter line of the right neck permanent catheter. Culture of the removed catheter grew coagulase-negative staphylococci.


Lu C.-M.,Buddhist Dalin Tzu Chi Hospital
Journal of Medical Case Reports | Year: 2013

Abstract. Introduction. Most bladder stones develop in patients with bladder outlet obstruction. Intravesical stone formation after surgery outside the urinary bladder is rare. Case presentation. A 54-year-old Taiwanese woman with lower urinary tract symptoms following a hysterectomy 14 years ago presented to our hospital. The intravesical calculus had developed from non-absorbable sutures and hung on the dome of the urinary bladder. The stone and residuum of the suture were retrieved by performing an endoscopic procedure. Conclusions: The presence of an intravesical stone should be suspected in patients with a history of hysterectomy who have symptoms in the lower urinary tract. A hanging stone on the dome of the urinary bladder implies that suture materials migrate into the urinary bladder. The complication can be prevented by the routine use of absorbable material and double-checking with cystoscopy. © 2013 Lu; licensee BioMed Central Ltd.


Chiang J.-K.,Buddhist Dalin Tzu Chi Hospital
Journal of Clinical Sleep Medicine | Year: 2014

Background: Elevated plasma levels of high-sensitivity C-reactive protein (hs-CRP) have been associated with increased adverse health outcomes. The aim of this study was to investigate the association of sleep duration with risk of elevated hs-CRP levels in Taiwanese adults. Methods: We examined the association between sleep duration and hs-CRP in 353 healthy adults recruited from the physical examination center at a regional hospital in southern Taiwan. Elevated hs-CRP was defined as a plasma level ≥ 0.20 mg/dL. Short sleep duration was defined as ≤ 5.5 h per day. Multiple logistic regression analysis was used to assess the association of short duration of sleep with elevated hs-CRP levels. Results: In this study, short duration of sleep (odds ratio [OR] = 2.20; 95% confidence interval [CI]: 1.11-4.30), aged 70 years or older (OR = 4.58; 95% CI: 1.70-12.66), menopause (OR = 2.81; 95% CI: 1.52-5.3), higher heart rate (OR = 1.38; 95% CI: 1.10-1.75), higher body mass index (OR = 1.20; 95% CI: 1.09-1.34), higher white blood cell count (OR = 1.38; 95% CI: 1.14-1.66), and higher uric acid level (OR = 1.31; 95% CI: 1.06-1.63) were significantly associated with an increased risk of elevated hs-CRP levels. Conclusions: In this study of healthy Taiwanese adults, short duration of sleep was significantly associated with elevated hs-CRP levels. Activation of pro-inflammatory pathways might represent a mechanism by which short sleep duration affects health.


Chuang T.L.,Buddhist Dalin Tzu Chi Hospital
Clinical nuclear medicine | Year: 2014

A 44-year-old woman had a history of papillary thyroid carcinoma and underwent total thyroidectomy and I ablation therapy. During the follow-up, 2-mCi I cancer workup showed an unusual shape of uptake in the pelvic region. Hybrid SPECT/CT revealed uptake posterior to the uterus, where sonography showed an 85.4-mm right ovarian endometrioma just corresponding to the location. Laparoscopic salpingo-oophorectomy showed right ovarian endometrioma (7 cm) and left ovarian cyst (4 cm). Pathologic findings showed bilateral endometriosis. After that survey, follow-up I cancer workup showed left supraclavicular, pretracheal, and right hilar metastatic lymphadenopathy with pulmonary metastasis, but no pelvic uptake was noted.

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