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Hsiao C.-L.,Kaohsiung Municipal Ta Tung Hospital | Chiou C.-J.,Kaohsiung Medical University
Journal of Nursing and Healthcare Research

Background: Taiwan's rapidly aging population is increasing demand for long-term care delivered by primary caregivers. It is important to understand the care experience of primary caregivers in order to enhance quality of care. Purpose: The study explored the caregiving experiences of primary caregivers and assessed predictors of positive and negative caregiving experiences. Methods: Researchers conducted a cross-sectional study and recruited 120 primary caregivers of patients receiving home nursing care from hospital-based home care agencies. Structured questionnaires were used to collect data on subject personal attributes, health status, family function and caregiving experience as well as the disease status of patients. Content validity (CVI=.91) and internal consistency (Cronbach's α=.80-.91) were used to examine scale reliability. Results: Caregivers reported having both positive and negative experiences in caregiving, with "I really want to care for the patient" reflecting the most positive and "I complain about taking care of the patient" reflecting the most negative experiences. In terms of negative care experiences, "timing" earned the highest and "lack of family support" the lowest scores. Predictors of positive caregiving experiences included health status, emotional relationship with patient, and family function, which together explained 26.6% of variance; Predictors of negative caregiving experiences included health status and weekly frequency of care matters, which together explained 34.0% of variance. Conclusions / Practical application: The study suggests the positive and negative caregiving experiences among primary caregivers of patients receiving home care nursing are affected by personal health status, emotional relationship with patient, family function, and frequency of care. In clinical practice, medical staff should be aware of the status of primary caregiver and give praise and encouragement in order to reduce negative caregiver feelings toward their caregiving experience. Source

Chang W.-Y.,Kaohsiung Medical University | Chang W.-Y.,I - Shou University | Huang A.,National Central University | Yang C.-Y.,National Taiwan University Hospital | And 5 more authors.

Background: Computer-aided diagnosis (CADx) software that provides a second opinion has been widely used to assist physicians with various tasks. In dermatology, however, CADx has been mostly limited to melanoma or melanocytic skin cancer diagnosis. The frequency of non-melanocytic skin cancers and the accessibility of regular digital macrographs have raised interest in developing CADx for broader applications. Objectives: To investigate the feasibility of using CADx to diagnose both melanocytic and non-melanocytic skin lesions based on conventional digital photographic images. Methods: This study was approved by an institutional review board, and the requirement to obtain informed consent was waived. In total, 769 conventional photographs of melanocytic and non-melanocytic skin lesions were retrospectively reviewed and used to develop a CADx system. Conventional and new color-related image features were developed to classify the lesions as benign or malignant using support vector machines (SVMs). The performance of CADx was compared with that of dermatologists. Results: The clinicians' overall sensitivity, specificity, and accuracy were 83.33%, 85.88%, and 85.31%, respectively. New color correlation and principal component analysis (PCA) features improved the classification ability of the baseline CADx (p = 0.001). The estimated area under the receiver operating characteristic (ROC) curve (Az) of the proposed CADx system was 0.949, with a sensitivity and specificity of 85.63% and 87.65%, respectively, and a maximum accuracy of 90.64%. Conclusions: We have developed an effective CADx system to classify both melanocytic and non-melanocytic skin lesions using conventional digital macrographs. The system's performance was similar to that of dermatologists at our institute. Through improved feature extraction and SVM analysis, we found that conventional digital macrographs were feasible for providing useful information for CADx applications. The new color-related features significantly improved CADx applications for skin cancer. © 2013 Chang et al. Source

Huang C.-F.,Kaohsiung Municipal Ta Tung Hospital | Chuang W.-L.,Kaohsiung Medical University | Yu M.-L.,Kaohsiung Medical University
Kaohsiung Journal of Medical Sciences

The prevalence of chronic hepatitis C virus (HCV) tends to be higher in the elderly in many countries. Aging is regarded as an unfavorable factor for liver disease progression and treatment outcome in HCV infection. The efficacy and safety of treating elderly patients remain a source of significant debate. Discrepancies in results may be attributed to dissimilarities in study design and treatment regimens. The long-term benefits of administering interferon-based therapy to elderly patients with HCV infection is a critical issue when taking the patient's remaining life expectancy into consideration. Rapid virological response is the most notable on-treatment response factor that is predictive of treatment success in elderly patients. A shortened treatment course may reduce drug-related side effects and promote treatment adherence, especially in the elderly. A regimen tailored towards super-responders might provide insights for treatment strategies in elderly patients. © 2011 Elsevier Ltd. All rights reserved. Source

Kuo Y.-H.,Kaohsiung Municipal Ta Tung Hospital | Chang C.-H.,Kaohsiung Medical University
Dermatologica Sinica

Mycosis fungoides (MF) is a form of cutaneous T cell lymphoma defined by epidermotropism of a clonal T helper memory/effector subset. Erythrodermic MF usually presents a chronic course of MF with generalized erythema or poikiloderma but no systemic involvement, as in Sezary syndrome. Here we report a case of a 73-year-old Taiwanese male with a rapid progression of erythrodermic MF within 1.5 years. It was diagnosed after his fifth skin biopsy, which demonstrated a positive clonal band in the T cell receptor Dβ-Jβ and Vγf1-Jγ gene. The sequential skin manifestations were eczema and contact dermatitis-like well-defined skin lesions over the back with the pathological characters of interface dermatitis and psoriasiform dermatitis, respectively. He was treated with oral bexarotene (prescribed in the United States) but found the side effects intolerable. We administered low-dose methotrexate (MTX, 7.5-15 mg/wk) and 311 nm UV-B for the erythrodermic MF. After 3 years of treatment, the skin lesions completely subsided, and a skin biopsy showed no more clonal T cells. Flow cytometry analysis revealed the decline of the HLA-DR+ T helper cell ratio in peripheral blood during MTX administration and parallel with the cutaneous improvement. Inhibition of histone deacetylase activity has been identified to be a novel function of MTX. We propose that MTX can be an effective and safe treatment for erythrodermic MF. The mechanisms of MTX in cutaneous T cell lymphoma, especially the role of immunomodulation and histone deacetylase inhibition, are reviewed. © 2015, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC. Source

Hsieh Y.-W.,Chang Gung University | Lin K.-C.,National Taiwan University | Lin K.-C.,National Taiwan University Hospital | Horng Y.-S.,Foundation Medicine | And 4 more authors.
Journal of Neurology

Robot-assisted therapy (RT) and constraint-induced therapy (CIT) both show great promise to improve stroke rehabilitation outcomes. Although the respective treatment efficacy of RT and CIT has been validated, the additive effects of RT combined with CIT remain unknown. This study investigated the treatment effects of RT in sequential combination with a distributed form of CIT (RT + dCIT) compared with RT and conventional rehabilitation (CR). Forty-eight patients with stroke were enrolled and randomized to receive one of the three interventions for 4 weeks. Primary outcomes assessed the changes of motor impairment and motor function on the Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT). Secondary outcomes, including the Motor Activity Log (MAL) and accelerometers, examined functional performance during daily activities. The three treatment groups improved significantly on most primary and secondary outcomes over time. The combined RT + dCIT group exhibited significantly greater improvement on the FMA and functional ability subscale of the WMFT than the RT and CR groups. The improvements on the MAL and accelerometers were not significantly different among the three groups. RT in sequential combination with CIT led to additive effects on participants' motor ability and functional ability to perform motor tasks after stroke, which support that combined therapy can be an effective means to intensify outcomes. Further research investigating the potential long-term effects of combination therapy, especially on real-life performance, would be valuable. © 2014 Springer-Verlag. Source

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