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Liu C.-H.,Chang Gung University | Lin S.-C.,Taiwan Adventist Hospital | Lin J.-R.,Chang Gung University | Yang J.-T.,Chiayi Chang Gung Memorial Hospital | And 6 more authors.
European Journal of Neurology | Year: 2014

Background and purpose: Our aim was to investigate the influence of admission dehydration on the discharge outcome in acute ischaemic and hemorrhagic stroke. Methods: Between January 2009 and December 2011, 4311 ischaemic and 1371 hemorrhagic stroke patients from the stroke registry of Chang Gung healthcare system were analyzed. The eligible patients were identified according to inclusion/exclusion criteria. In total, 2570 acute ischaemic and 573 acute hemorrhagic stroke patients were finally recruited. According to the blood urea nitrogen (BUN) to creatinine (Cr) ratio (BUN/Cr), these patients were divided into dehydrated (BUN/Cr ≥ 15) and non-dehydrated (BUN/Cr < 15) groups. Demographics, admission costs and discharge outcomes including modified Rankin scale (mRS) and Barthel index (BI) were examined. Data were analyzed using multivariate analysis of two-stage least squares including logistic and linear regression. Results: Acute ischaemic stroke with admission dehydration had higher infection rates (P = 0.006), worse discharge BI (62.8 ± 37.4 vs. 73.4 ± 32.4, P < 0.001, adjusted P < 0.001), worse mRS (2.7 ± 1.6 vs. 2.3 ± 1.5, P < 0.001, adjusted P = 0.009) and higher admission costs (2470.8 ± 3160.8 vs. 1901.2 ± 2046.8 US dollars, P < 0.001, adjusted P = 0.013) than those without dehydration. However, acute hemorrhagic stroke with or without admission dehydration showd no difference in admission costs (P = 0.618) and discharge outcomes (BI, P = 0.058; mRS, P = 0.058). Conclusion: Admission dehydration is associated with worse discharge outcomes and higher admission costs in acute ischaemic stroke but not in hemorrhagic stroke. © 2014 EAN.

Mei-Hsuen C.,Chiayi Chang Gung Memorial Hospital | Shu-Yuan L.,Kaohsiung Medical University
Journal of Nursing and Healthcare Research | Year: 2012

Background: Urinary tract infection (UTI) is one of the most prevalent infections in long-term care facilities. Catheter-associated urinary tract infection (CAUTI) is the major cause of UTI in these facilities. Nurses' knowledge of CAUTI in many free-standing long-term care facilities is inadequate due to resource limitations. Purpose: This study assessed the effect on CAUTI knowledge of multimedia CD-ROM instruction by comparing the CAUTI knowledge of nurses who received such instruction and those who did not. Methods: Researchers used a quasi-experimental pretest - posttest control group design; This study was conducted from April to June 2010; Data were collected from 72 nurses working in 24 assisted-living facilities and one hospitalaffiliated nursing home in Kaohsiung. Group assignment was based on nursing home administrator choice. The experimental group received one month of multimedia CD-ROM instruction, and the control group received no CD-ROM instruction. Both groups completed a CAUTI knowledge questionnaire prior to and after the intervention. Results: There was no significant pre-test difference in CAUTI knowledge between the two groups (p = .18). Post-test improvement in CAUTI knowledge in the experimental group nurses was significantly larger than in the control group (p < .01). Using pre-test CAUTI knowledge, marriage, age and work experience as covariates, experimental group nurses had significantly better CAUTI knowledge compared to control group nurses at post-test (p < .01). Conclusions: Multimedia CD-ROM instruction can increase CAUTI knowledge in nurses, which may lead to improved nurse CAUTI care behavior and decreased CAUTI incidence. We suggest promoting multimedia CD-ROM teaching as a continuing education strategy in long-term care facilities.

Yeh C.-H.,Chiayi Chang Gung Memorial Hospital | Yang S.-T.,National Chiayi University | Chen C.-H.,National Chiayi University
Process Biochemistry | Year: 2011

In our previous study, Calvatia lilacina, which is an edible medicinal mushroom, was shown to have anti-cancer effects in some human colon cancer cells by inducing apoptosis. In this paper, we demonstrate the potential mechanism by which C. lilacina protein extract (CL) induces apoptosis through endoplasmic reticulum (ER) stress in human colon cancers. Treatment of human SW480, HT-29, and DLD-1 colon cancer cells with CL induced the formation of ER stress-related cytoplasmic vacuoles. Treatment of SW480 cells with CL also induced eukaryotic initiation factor-2alpha (eIF-2alpha) phosphorylation, cleavage of caspase-4 and -9, expression of activating transcription factor (ATF)4, ATF3, CCAAT/enhancer-binding protein-homologous protein (CHOP) and glucose-regulated protein78 (GRP78). We also showed that CL activated c-Jun NH(2)-terminal kinase (JNK) and increased cytoplasmic calcium. N-Acetylcysteine (NAC) or SP600125 inhibited CHOP expression in CL-treated SW480 cells, suggesting that CL-induced ER stress is dependent on intracellular glutathione (GSH) depletion and JNK activation. Pretreatment with salubrinal, SP600125, and BAPTA partially protected cells from CL-induced apoptosis. Taken together, these data suggest that the anti-cancer mechanism of CL is at least in part attributed to its ability to induce ER stress, JNK activation, and cytoplasmic calcium accumulation in human colon cancer cells. © 2011 Elsevier Ltd.

Chiu H.-F.,Kaohsiung Medical University | Tsai S.-S.,I - Shou University | Weng H.-H.,Chiayi Chang Gung Memorial Hospital | Weng H.-H.,Chang Gung Institute of Technology | And 2 more authors.
Journal of Toxicology and Environmental Health - Part A: Current Issues | Year: 2013

This study was undertaken to determine whether there was an association between fine particles (PM2.5) levels and number of emergency room (ER) visits for cardiac arrhythmias in Taipei, Taiwan. ER visits for cardiac arrhythmias and ambient air pollution data for Taipei were obtained for the period 2006-2010. The relative risk (RR) of ER visits was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased numbers of ER cardiac arrhythmia visits were significantly associated with PM2.5 on both warm days (>23°C) and cool days (< 23°C), with an interquartile range rise associated with a 10% (95% CI =-15%) and 4% (95% CI = 0-8%) elevation in number of ER visits for cardiac arrhythmias, respectively. In the two-pollutant models, PM2.5 levels remained significant after inclusion of sulfur dioxide (SO2) or ozone (O3) on both warm and cool days. This study provides evidence that higher levels of PM2.5 increase the risk of number of ER visits for cardiac arrhythmias. © 2013 Taylor and Francis Group, LLC.

Lee C.-H.,Chang Gung Memorial Hospital | Lin Y.-J.,Resource Center for Clinical Research | Lin C.-C.,Chang Gung Memorial Hospital | Yen C.-L.,Keelung Chang Gung Memorial Hospital | And 6 more authors.
Liver International | Year: 2015

Background & Aims: Thrombocytosis is associated with metastasis in many human cancers. Most hepatocellular carcinomas (HCC) develop in cirrhotic livers, which are characterized by thrombocytopenia. We aimed to elucidate the pretreatment platelet count in prediction of extrahepatic metastasis of HCC during the follow-up. Methods: Three cohorts containing 1660, 480 and 965 HCC patients enrolled from three hospitals were used for discovery and validation respectively. Pretreatment clinical factors associated with extrahepatic metastasis during follow-up up to 5 years were identified using multivariate Cox regression model. Results: In early-stage HCC (BCLC stage 0-A), pretreatment platelet count (hazard ratio [HR], 1.04 per 10,000/μl; 95% CI, 1.01-1.07; P = 0.010) and serum alpha-foetoprotein (AFP) >100 ng/ml (HR, 1.70; 95% CI, 1.04-2.78; P = 0.033) were the only two independent factors associated with extrahepatic metastasis. Receiver operating characteristic evidenced that pretreatment platelet count predicted metastasis better than AFP did. Survival tree analysis identified platelet counts <118,000/μl (HR, 0.49; 95% CI, 0.38-0.63; P < 0.001) or >212,000/μl (HR, 2.12; 95% CI, 1.67-2.70; P < 0.001) to categorize patients into low and high risk of metastasis subgroups, which were verified using both validation cohorts. Conclusions: Pretreatment platelet count is a reliable marker to predict extrahepatic metastasis of early-stage HCC following curative treatment. Cirrhotic thrombocytopenia contributes to relatively low metastasis incidence of HCC than many other cancers. High platelet count identifies a subgroup of HCC patients at high risk of metastasis, who might benefit from adjuvant therapies following initial curative treatment. © 2015 John Wiley & Sons A/S.

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