Chen R.-C.,En Chu Kong Hospital
Journal of Nursing | Year: 2015
The duty of medical personnel is to save lives, cure diseases, relieve suffering, and promote health. Medical personnel care for their patients from birth to death. At the end of terminal care, medical personnel should maintain a religious / holistic commitment to their patients to "remove their suffering and provide happiness" as much as possible. Mackay Hospital opened the first hospice in Taiwan in 1990. Financial coverage of hospice care by the National Health Insurance, the enactment of the Hospice Palliative Act, the attention of Hospital Accreditation to hospice care, and the establishment of the system of clinical chaplaincy have all contributed to the development of hospice palliative care in Taiwan. Application of the Taiwan Coma Scale has been shown to decrease the use of futile life sustaining treatments in the ICU. The author hopes that nurses may further expand community hospice care services to help facilitate the peaceful dying of terminal patients at home.
Chen L.-P.,University of Taipei |
Chiang C.-K.,National Taiwan University Hospital |
Peng Y.-S.,Far Eastern Memorial Hospital |
Hsu S.-P.,Far Eastern Memorial Hospital |
And 3 more authors.
American Journal of Kidney Diseases | Year: 2011
Background The relationship between periodontitis and outcomes in patients treated with long-term hemodialysis is controversial. Our previous work suggests that periodontitis is associated with malnutrition and inflammation. Here, we hypothesize that periodontitis is associated with mortality in hemodialysis patients. Study Design Prospective observational study. Setting & Participants 253 patients undergoing hemodialysis at a single hospital-based dialysis facility. Predictor Severity of periodontal disease (mild, moderate, or severe based on oral examination of 6 teeth). Outcomes & Measurements All-cause and cardiovascular mortality during a 6-year follow-up after an oral health examination of index teeth. Results During the 6-year follow-up, 102 patients died. Death occurred in 70.6%, 41.8%, and 24.0% of patients with severe, moderate, and mild/no periodontitis, respectively. Using mild/no periodontitis as the reference group and adjustment for demographic characteristics, comorbid conditions, and selected laboratory values, HRs for all-cause mortality were 1.39 (95% CI, 0.83-2.34) and 1.83 (95% CI, 1.04-3.24) for moderate and severe periodontitis, respectively. HRs for cardiovascular mortality were not statistically significant. Limitations Single assessment of periodontal disease severity. Conclusions For patients undergoing long-term hemodialysis, periodontitis is associated with increased risk of death. Clinical trials are required to determine whether treatment of periodontitis decreases mortality. © 2011 National Kidney Foundation, Inc.
Sun Y.,En Chu Kong Hospital |
Chang Y.-H.,National Cheng Kung University |
Chen H.-F.,Far Eastern Memorial Hospital |
Chen H.-F.,Fu Jen Catholic University |
And 4 more authors.
Diabetes Care | Year: 2012
OBJECTIVE - We retrospectively assessed the age- and sex-specific incidence and relative risk of Parkinson disease (PD) in Taiwan's diabetic population. RESEARCH DESIGN AND METHODS - Study cohort included 603,416 diabetic patients and 472,188 nondiabetic control subjects. Incidence rate and relative risk of PD (ICD-9-CM 332.0) were evaluated. RESULTS - The incidence of PD was 3.59 and 2.15 per 10,000 person-years for the diabetic and control group, respectively, representing a covariate adjusted hazard ratio (HR) of 1.61 (95% CI 1.56-1.66), which was substantially reduced to 1.37 (1.32-1.41) after adjusting for medical visits. Diabetes was associated with a significantly elevated risk of PD in all sex and age stratifications except in young women, with the highest HR noted for young men aged 21-40 years (2.10 [1.01-4.42]), followed by women aged 41-60 (2.05 [1.82-2.30]) and >60 years (1.65 [1.58-1.73]). CONCLUSIONS - Diabetes is associated with an increased risk of PD onset in a Chinese population, and the relation is stronger in women and younger patients. © 2012 by the American Diabetes Association.
Hsu C.-J.,En Chu Kong Hospital |
Weng W.-C.,National Taiwan University Hospital |
Peng S.S.-F.,National Taiwan University Hospital |
Lee W.-T.,National Taiwan University Hospital
Stroke | Year: 2014
BACKGROUND AND PURPOSE - : Early-onset seizures are common in children with arterial ischemic stroke, but the clinical features and effects on the outcome of early-onset seizures have been less studied in children. METHODS - : Children aged 1 month to 18 years presenting with first-time and image-confirmed arterial ischemic stroke were identified for analysis. RESULTS - : A total of 78 survivors of arterial ischemic stroke were enrolled. Twenty (25.6%) had early-onset seizures, and 90% were initial presentation. Younger children (mean, 3.4±3.9 versus 9.0±6.2 years; P<0.001) and cortical involvement (5% versus 63.8%; P=0.01) are more likely to have early-onset seizures. Thirteen of 20 survivors with early-onset seizures had late-onset seizures after the acute stage, and 12 of them were diagnosed as poststroke epilepsy. CONCLUSIONS - : Early-onset seizures occurred in 25.6% of children with arterial ischemic stroke. Younger age and cortical involvement were risk factors for early-onset seizures. Sixty-five percent of children with early-onset seizures had late-onset seizures after the acute stage. © 2014 American Heart Association, Inc.
Fan L.-Y.,En Chu Kong Hospital |
Fan L.-Y.,Graduate Institute of Brain and Mind science |
Chiu M.-J.,Graduate Institute of Brain and Mind science |
Chiu M.-J.,Graduate Institute of Psychology |
Chiu M.-J.,National Taiwan University Hospital
Neuropsychiatric Disease and Treatment | Year: 2014
It has been estimated that 35.6 million people globally had dementia in 2010 and the prevalence of dementia has been predicted to double every 20 years. Thus, 115.4 million people may be living with dementia in 2050. Alzheimer's disease (AD) is the leading cause of dementia and is present in 60%-70% of people with dementia. Unfortunately, there are few approved drugs that can alleviate the cognitive or behavioral symptoms of AD dementia. Recent studies have revealed that pathophysiological changes related to AD occur decades before the appearance of clinical symptoms of dementia. This extended preclinical phase of AD provides a critical chance for disease-modifying agents to halt or delay the relentless process of AD. Although several trials targeting various pathological processes are ongoing, the examination of the combined use of different approaches to combat AD seems warranted. In this article, we will review current therapies, future strategies, and ongoing clinical trials for the treatment of AD with a special focus on combination therapies. Furthermore, preventive strategies for cognitively normal subjects in the presymptomatic stages of AD will also be addressed. In this review, we discuss current hypotheses of the disease process. In the decades since the approval of cholinesterase inhibitors, no new drug has ultimately demonstrated clear success in clinical trials. Given the difficulties that have been encountered in attempts to identify a single drug that can treat AD, we must pursue effective multi-target strategies, ie, combination therapies. The combination of cholinesterase inhibitors and memantine is considered well tolerated and safe, and this combination benefits patients with moderate-to-severe AD. In contrast, with the exception of adjuvant therapies of conventional drugs, combinations of different disease-modifying agents with different mechanisms may have promising synergic effects and benefit cognition, behavior, and daily living function.