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Hsu Y.E.,Taipei Medical University | Hsu Y.E.,Golden Dream Think Tank and Research Center | Lin W.,Chang Jung Christian University | Tien J.J.,Tamkang University | Tzeng L.Y.,National Taiwan University
International Journal for Quality in Health Care | Year: 2016

Objective: To measure inequality in physician distributions using Gini coefficient and spatially adjusted Gini coefficients. Design: Measurements were based on the distribution of physician data from the Taiwan National Health Insurance Research Database (NHIRD) and population data from the Ministry of the Interior in Taiwan. Settings: The distribution of population and physicians in Taiwan from 2001 to 2010. Participants: This study considered 35 000 physicians who are registered in Taiwan. Main Outcome Measures: To calculate the Gini coefficient and spatially adjusted Gini coefficients in Taiwan from 2001 to 2010. Results: The Gini coefficient for each year, from 2001 to 2010, ranged from 0.5128 to 0.4692, while the spatially adjusted Gini coefficients based on travel time and travel distance ranged, respectively, from 0.4324 to 0.4066 and from 0.4408 to 0.4178. We found that, in each year, irrespective of the type of spatial adjustment, the spatially adjusted Gini coefficient was smaller than the Gini coefficient itself. Our empirical findings support that the Gini coefficient may overestimate the maldistribution of physicians. Conclusions: Our simulations demonstrate that increasing the number of physicians in mediumsized cities (such as capitals of counties or provinces), and/or improving the transportation time between medium-sized cities and rural areas, could be feasible solutions to mitigate the problem of geographical maldistribution of physicians. © The Author 2016.


Yang Y.-T.,National Taiwan University | Yang Y.-T.,Golden Dream Think Tank and Research Center | Yang Y.-T.,Taipei Medical University | Tai C.-J.,Taipei Medical University Hospital | And 10 more authors.
PLoS ONE | Year: 2016

Background The goal of this study was to perform a systematic review to examine the efficacy and safety of various salvage therapy regimens on patients with relapsed/refractory PTCL. Method The electronic searches were performed using PubMed, Cochrane Library, EMBASE, and Web of Science from inception through June 2015, with search terms related to relapsed/ refractory PTCL, salvage chemotherapy regimens, and clinical trials. An eligible study met the following inclusion criteria: (1) Patients had refractory or relapsed PTCL; (2) drug regimens were used for salvage therapy; (3) the study was a clinical trial; (4) the study reported on a series of at least 10 patients of PTCL. Results Of 35 records identified, a total of 14 studies were eligible for systematic reviews, and 12 different salvage regimens were investigated. A total of 618 relapsed/refractory PTCL patients were identified. The ORRs ranged from 22% for those treated with lenalidomide to 86% for those with brentuximab vedotin. By the three most frequent subtypes, the ORRs ranged from 14.2% to 71.5% for patients with the PTCL-NOS subtype, 8% to 54% for AITL subtypes, and 24% to 86% for the ALCL subtype. The medians of DOR, PFS, and OS ranged from 2.5 to 16.6 months, 2.6 to 13.3 months, and 3.6 to 14.5 months, respectively. The most frequently reported grade 3 or 4 adverse events (AEs) were hematological AEs, such as neutropenia and thrombocytopenia. Conclusion The efficacy of salvage therapy regimens is highly diverse for patients with relapsed/refractory PTCL; this heterogeneity in therapeutic effects might be due to the diversity in mechanisms, PTCL subtype distribution, and/or numbers/profiles of prior therapy. Comparative studies with matched pair analysis are warranted for more evidence of the salvage treatment effect on relapsed or heavily pretreated patients with PTCL. © 2016 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Yang Y.-T.,National Taiwan University | Yang Y.-T.,Golden Dream Think Tank and Research Center | Yang Y.-T.,Taipei Medical University | Elsa Hsu Y.-H.,Golden Dream Think Tank and Research Center | And 7 more authors.
International Journal for Quality in Health Care | Year: 2016

Objective: Population ageing is a global issue that affects almost every country.Most ageing researches focused on demand side and studies related to supply side were relatively scarce. This study selected quality enterprises focus on ageing health and analysed their patterns on providing quality services successfully. Design: Our study selected quality senior health enterprises and explored their success patterns through face-to-face semi-structured in-depth interviews with CEO of each enterprise in 2013. Setting: Thirty-three quality senior health enterprises in Taiwan. Participants: Thirty-three CEO's of enterprises were interviewed individually. Intervention: None. Main Outcome Measures: Core values and vision, historical development, organization structure, services/products provided, delivering channels, customer relationships and further development strategies. Results: Our results indicated success patterns for senior enterprises that there weremeeting diversified lifestyles and substitutive needs for the elderly and their caregivers, providing a total solution for actual/virtual integration and flexible one-stop shopping services. We classified these enterprises by used degree of clicks-and-mortar of services and residing situation of the elderly. Industry characteristics and policy implications were summarized. Conclusions: Our observations will serve as a primary evidenced base for enterprises developing their senior market, and also for opening dialogue between customers and enterprises to facilitate valuable opportunities for co-creation between the supply and demand sides. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care.


Yang Y.-T.,Taipei Medical University | Yang Y.-T.,National Taiwan University | Yang Y.-T.,Golden Dream Think Tank and Research Center | Iqbal U.,Taipei Medical University | And 9 more authors.
Computer Methods and Programs in Biomedicine | Year: 2015

Over the past two decades, the use of telemedicine as a way to provide medical services has grown as communication technologies advance and patients seek more convenient ways to receive care. Because developments within this field are still rapidly evolving, identifying trends within telemedicine literature is an important task to help delineate future directions of telemedicine research. In this study, we analyzed 7960 telemedicine-related publication records found in the Science Citations Index - Expanded database between 1993 and 2012. Bibliometric analyses revealed that while the total growth in telemedicine literature has been significant in the last twenty years, the publication activity per country and over time has been variable. While the United States led the world in the cumulative number of telemedicine publications, Norway ranked highest when we ordered countries by publications per capita. We also saw that the growth in the number of publications per year has been inconsistent over the past two decades. Our results identified that neuroscience neurology and nursing as two fields of research in telemedicine that have seen considerable growth in interest in this field, and are poised to be the focus of research activity in the near future. © 2015 Published by Elsevier Ireland Ltd.


Yang Y.-T.,National Taiwan University | Yang Y.-T.,Golden Dream Think Tank and Research Center | Yang Y.-T.,Taipei Medical University | Iqbal U.,Taipei Medical University | And 8 more authors.
International Journal for Quality in Health Care | Year: 2016

Objective: With global population aging, great business opportunities are driven by the various needs that the elderly face in everyday living. Internet development makes information spread faster, also allows elderly and their caregivers to more easily access information and actively participate in value co-creation in the services. This study aims to investigate the designs of value co-creation by the supply and demand sides of the senior industry.Design: This study investigated senior industry in Taiwan and analyzed bussiness models of 33 selected successful senior enterprises in 2013. We adopted series field observation, reviews of documentations, analysis of meeting records and in-depth interviews with 65 CEOs and managers.Setting: Thirty-three quality enterprises in senior industry.Participants: Sixty-five CEOs and managers in 33 senior enterprises.Intervention(s): None.Main Outcome Measure(s): Value co-creation design, value co-creating process.Results: We constructed a conceptual model that comprehensively describes essential aspects of value co-creation and categorized the value co-creation designs into four types applying for different business models: (i) interaction in experience spaces co-creation design, (ii) on-site interacting co-creation design, (iii) social networking platform co-creation design and (iv) empowering customers co-creation design. Through value co-creation platform design, the senior enterprises have converted the originally passive roles of the elderly and caregivers into active participants in the value co-creation process.Conclusions: The new paradigm of value co-creation designs not only promote innovative development during the interactive process, lead enterprises reveal and meet customers' needs but also increase markets and profits. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved.


Yang Y.-T.,National Taiwan University | Yang Y.-T.,Golden Dream Think Tank and Research Center | Iqbal U.,Taipei Medical University | Ko H.-L.,Golden Dream Think Tank and Research Center | And 10 more authors.
International Journal for Quality in Health Care | Year: 2015

Objective: The purpose of this study was to explore the relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan. Design: Cross-sectional study from 2007 Taiwan Longitudinal Study on Ageing (TLSA) survey. Setting: Community-based study. Participants: A total of 4249 middle-aged and elderly subjects were recruited. Intervention(s): None. Main Outcome Measure(s): Outpatient visits within 1 month, and hospitalization, emergency visits as well as to shop in pharmacy stores within 1 year, respectively. Results: Adjusting for important confounding variables, the middle-aged and elderly with National Health Insurance (NHI) and commercial insurance compared with those with NHI alone tended to have outpatient visits. The middle-aged and elderly with longer time to access healthcare facilities were less likely to shop in pharmacy stores compared with those with <30 min. The middle-aged and elderly who perceived inconvenient to access health care tended to shop in pharmacy stores compared with those with perceived convenience. Conclusions: Our study of Taiwan's experience could provide a valuable lesson for countries that are planning to launch universal health insurance system, locate budgets in health care and transportation. The middle-aged and elderly whowere facing more challenges in accessing health care, no matter in perceived accessibility or real time to access health care, had less outpatient visits and more drug stores shopping. Strategic policies are needed to improve accessibility in increasing patients' perception on access and escalating convenience of transportation systemfor improving accessibility. © The Author 2015.


Yang Y.-T.,National Taiwan University | Yang Y.-T.,Golden Dream Think Tank and Research Center | Yang Y.-T.,Taipei Medical University | Wang Y.-H.,Taipei Medical University | And 9 more authors.
Archives of Gerontology and Geriatrics | Year: 2015

Purpose: Few nationwide comprehensive studies analyzed the factors leading to the onset of depression in correlation with medical disease and other related factors concerning geriatric depression. This study examined medical diseases with other factors which lead to depression among the elderly. Methods: This Taiwan-based longitudinal study examined a collection of 1467 seniors aged over 65. Subjects who fit this criteria were initially interviewed in 2003, and then four years later. Independent variables included baseline demographics, chronic medical illnesses, and the change of subjects' self-perceived health status, functional limitations including ADL, IADL and mobility limitation factors. The dependent variable was the symptoms of incident depression, as ascertained by the ten-item questionnaire during the later session. The logistic regression analyses were used to examine some of the predictors related to depressive disorders. Results: The findings showed that heart conditions (adjusted OR = 1.55, 95% CI: 1.12-2.15, p= 0.008) and joint disorders (adjusted OR = 1.51, 95% CI: 1.09-2.09, p= 0.013), as well as functional limitations, particularly IADL (adjusted OR = 1.81, 95% CI: 1.24-2.65, p= 0.002) and ADL (adjusted OR = 1.77, 95% CI: 1.27-2.47, p= 0.001) were independently associated with the onset of depression among the elderly population. Conclusion: These findings indicated that when classifying symptoms of depression in geriatric patients with several underlying medical diseases, keen attention should be directed to the type of medical disorders and the functional deterioration in terms of daily activities and autonomic capabilities. © 2015.

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