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Tseng H.-M.,Chang Gung University | Lee C.-H.,Chang Gung Memorial Hospital | Chen Y.-J.,Chang Gung Memorial Hospital | Hsu H.-H.,Kidney Research Center | And 4 more authors.
Quality of Life Research | Year: 2016

Purpose: To develop a measure of medication-related quality of life (MRQoL) and to validate the measure in a hospital-based population of patients with polypharmacy. Methods: The Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0) included 14 items developed on the basis of interviews with elderly patients with polypharmacy, defined as taking five or more medications simultaneously. This scale was tested in 219 outpatients (99 with polypharmacy and 120 without polypharmacy). Two measures were used to establish construct validity the Psychological Distress Checklist, for convergent validity, and the Medication Adherence Behavior Scale (MABS), for discriminant validity. Results: The 14-item scale was found to be both reliable and valid. Internal consistency reliability evaluated using Cronbach’s alpha for this scale was 0.91. Scores on the MRQoLS-v1.0 correlated statistically significantly and negatively with those on the Psychological Distress Checklist. Discriminant validity was demonstrated by low correlation with MABS, indicating that the MRQoLS-v1.0 measured concepts different from medication adherence. Significant differences in the MRQoLS-v1.0 between patients with polypharmacy and those without polypharmacy provided evidence for known-group validity. Conclusions: The study presents a psychometric evaluation of a measure used to assess MRQoL of patients with polypharmacy. The instrument is practical to administer in clinics and provides a valuable adjunct to the outcome measurement for patients with polypharmacy. Further research on the sensitivity of this instrument to medication change in multi-medicated patients is warranted. © 2015, Springer International Publishing Switzerland. Source

Chen Y.-L.,National Chung Hsing University | Yang T.-Y.,Taichung Veterans General Hospital | Chen K.-C.,Taichung Veterans General Hospital | Wu C.-L.,Taichung Veterans General Hospital | And 3 more authors.
Cellular Oncology | Year: 2016

Background: Non-small cell lung cancers (NSCLCs) frequently exhibit resistance to therapeutic drugs, which seriously hampers their treatment. Here, we set out to assess the roles of the multidrug resistance protein 1 (MRP1) and P-glycoprotein (P-gp) in the doxorubicin (DOX) resistance of NSCLC cells, as well as the putative therapeutic efficacy of MRP1 and P-gp blockers on DOX-treated NSCLC cells. Methods: The impact of DOX on cell survival, DOX efflux and MRP1 and P-gp expression was assessed in 5 different NSCLC-derived cell lines (parental CH27, A549, H1299, H460, and DOX resistant CH27) in the absence or presence of MK571 (MRP1 inhibitor) or Verapamil (P-gp inhibitor), under both normoxic and hypoxic conditions. Results: We found that in response to DOX treatment, NSCLC cells that express high levels of MRP1 and P-gp (such as CH27) showed a better DOX efflux and a higher DOX resistance. MK571 and Verapamil were found to abolish DOX resistance and to act as chemosensitizers for DOX therapy in all cell lines tested. We also found that hypoxia could inhibit MRP1 and P-gp expression in a HIF-1α-dependent manner, abolish DOX resistance and boost the chemosensitizer effect of MK571 and Verapamil on DOX treatment of all the NSCLC cells tested, except the DOX-resistant CH27 cells. Conclusions: From our data we conclude that MRP1 and P-gp play critical roles in the DOX resistance of the NSCLC cells tested. MRP1 and P-gp targeted therapy using MK571, Verapamil, CoCl2 or ambient hypoxia appeared to be promising in abolishing the DOX efflux and DOX resistance of the NSCLC cells. The putative therapeutic efficacies of MRP1 and/or P-gp blockers on NSCLC cells are worthy of note. © 2016 International Society for Cellular Oncology Source

Wang T.-J.,Chia yi Branch | Lin C.-H.,Taichung Veterans General Hospital | Chang S.-N.,Taichung Veterans General Hospital | Cheng S.-B.,Taichung Veterans General Hospital | And 11 more authors.
Transplantation Proceedings | Year: 2016

Background The aims of this study were to identify the incidence of renal failure requiring dialysis and to investigate the long-term outcome after renal failure in liver transplantation (LT) patients. Methods The primary database used was the Taiwan National Health Insurance Research Database. Subjects with LT from 1997 to 2009 were included. Patients were grouped into the dialysis cohort if they once received hemodialysis owing to any pattern of renal failure during peri-transplantation periods or after LT. Otherwise, they were categorized into the nondialysis cohort. We conducted a retrospective observational study on the correlation of renal failure requiring dialysis and its effect on LT recipients. Results The analysis included data of 1,771 LT recipients with a mean follow-up time of 3.8 ± 2.9 years. The mean age was 43.2 ± 19.3 years, and 69.4% were male. Overall patient survival was 86.2% at 1 year, 82.2% at 3 years, and 80.5% at 5 years. Renal failure requiring dialysis had developed in the 323 patients (18.2%). Among them, 26 individuals (1.5%) had progressed to end-stage renal disease without renal recovery after perioperative hemodialysis. Individuals who developed renal failure requiring dialysis had a higher mortality compared with LT recipients never requiring dialysis (hazard ratio, 8.75; 95% confidence interval, 7.0-10.9). Conclusions Renal failure requiring dialysis development after LT is common and carries high mortality in Chinese liver allograft recipients. Recognizing risk factors permits the timely institution of proper treatment, which is the key to reducing untoward outcomes. © 2016 Elsevier Inc. All rights reserved. Source

Wang Y.-S.,Center for Quality Management | Wang Y.-S.,Chang Jung Christian University | Huang W.-Y.,Chang Jung Christian University
Taiwan Journal of Public Health | Year: 2013

Objectives: The aim of this study is to investigate the influence of high-risk pregnancy factors and birth weight on newborn inpatient expenditure. Methods: The study design is that of a secondary cohort study. The subjects are admitted patients with ages of 28 days or less from the 2008 National Health Insurance Research Database. This study analyzed the influence of highrisk pregnancy factors and birth weight on newborn inpatient expenditure by t-test, ANOVA and multiple regression. Results: The multiple regression results showed that a maternal age of 35 years or more at delivery (β=0.078), alcohol consumption during pregnancy (β=1.004), diabetes mellitus (β=0.181), renal disease (/3=0.761), lung disease (β=0.599), anemia (β=0.119), giving birth to three or more babies (β=0.323), undergoing prolonged labor (β=0.176), suffering from oligohydramnios or polyhydramnios (β=0.290), having meconium stained amniotic fluid (β=0.259), having a prolapsed cord (β=0.414), undergoing a caesarean section (β=0.308), having a gestational age of less than 37 weeks (β=0.354), having a birth weight of less than l,500g (β=1.428) and having a birth weight of l,500-2,499g (β=0.432) increases newborn inpatient expenditure significantly (p<0.05). Conclusions: Certain risk conditions associated with highrisk pregnancies as well as low birth weight increase newborn inpatient expenditure. This study suggests that when the Bureau of National Health Insurance modifies the Taiwan DiagnosisRelated Groups classification framework of Newborns and Other Neonates with Conditions Originating in the Perinatal Period (MDC 15), they should take into consideration various risk conditions that are associated with high-risk pregnancy in addition to birth weight. (Taiwan J Public Health. 20I3;32(3):240-250). Source

Huang L.-Y.,Center for Quality Management | Huang L.-Y.,Chang Gung University | Guo S.-E.,Chang Gung University | Tsai C.-C.,Chang Gung University | And 2 more authors.
Taiwan Journal of Public Health | Year: 2014

Although a permanent pacemaker (PPM) is the treatment of choice for patients with symptomatic bradycardia, little is understood about the effectiveness of a patient education intervention for this population. Methods: A quasi-experimental design was utilized to determine the effects of a systematic patient education intervention on PPM self-care knowledge, attitudes and behavior among patients with permanent pacemakers. Two groups were randomly assigned interventions: the PPM education group (n=37), received one-on-one lessons, and the control group (n=35), received usual care on the ward. Pre-test data were collected one day before implantation of the PPM, while post-test of questionnaires that includes PPM self-care knowledge, attitudes and behaviors were collected one week after discharge. The intervention effect was evaluated using one way analysis of covariance (ANCOVA). Results: A systematic patient education intervention significantly increased patients' self-care knowledge (F= 16.99; p<0.001). Improvement was also observed in self-care attitudes and behavior but the differences were not statistically significant. Conclusions: Systematic patient education intervention can significantly increase patients' self-care knowledge about PPMs. Instructional materials can be provided to support patient education in clinical settings. Source

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