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Pingtung, Taiwan

Wang R.-H.,Kaohsiung Medical University | Hsu H.-C.,Kaohsiung Medical University | Lee Y.-J.,Lees Endocrinology Clinic | Shin S.-J.,Kaohsiung Medical University | And 2 more authors.
Patient Education and Counseling | Year: 2016

Objective: To examine association of interactions between patient empowerment (PE) and health literacy with 1-year-later self-management behaviors in patients with type 2 diabetes (T2DM). Methods: A prospective design was employed in this study. Overall, 395 patients with T2DM completed self-reported questionnaires at baseline and 1. year later. A hierarchical multiple regression was used to identify the association of interactions between PE and health literacy at baseline with the 1-year-later self-management behaviors. Results: Interactions between PE and communicative and critical health literacy (CCHL) at baseline significantly associated with the 1-year-later global self-management behaviors in patients with T2DM. Among the participants who exhibited high PE at baseline, the scores of 1-year-later global self-management behaviors of the participants with a high CCHL at baseline were significantly higher than those with a low CCHL at baseline. Nevertheless, among the participants who exhibited low PE at baseline, no significant differences were identified in the 1-year-later global self-management behaviors between the participants with high vs. low CCHL at baseline. Conclusions: PE may improve self-management behaviors in patients with high CCHL, but may prove useless in patients with low CCHL. Practice implications: Healthcare providers should ensure that patients with T2DM have adequate CCHL prior to empowering them. © 2016 Elsevier Ireland Ltd. Source

Lee Y.-J.,Lees Endocrinology Clinic | Shin S.-J.,Kaohsiung Medical University | Wang R.-H.,Kaohsiung Medical University | Lin K.-D.,Kaohsiung Municipal Ta Tung Hospital | And 2 more authors.
Patient Education and Counseling | Year: 2016

Objective: To validate a hypothesized model exploring the influencing pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycosylated hemoglobin (HbA1c) levels in patients with type 2 diabetes (T2DM). Methods: Overall, 295 patients with T2DM were recruited from five endocrine clinics in Taiwan through convenience sampling. Data regarding personal characteristics, empowerment perceptions, health literacy, self-efficacy, self-care behaviors, and HbA1c levels were collected. A structural equation modeling was used to validate the hypothesized model. Results: Significant direct pathways were determined from empowerment perceptions to health literacy, from health literacy to self-efficacy, from self-efficacy to self-care behaviors, and from self-care behaviors to HbA1c levels. Conclusions: The empowerment perceptions and health literacy relatively influenced self-efficacy and self-care behaviors. Self-efficacy and self-care behaviors relatively influenced glycemic control in patients with T2DM. Practice implications: Modifying self-care behaviors have been demonstrated to be the most essential for improving glycemic control. To improve self-care behaviors, healthcare providers should target improving self-efficacy, and enhancing health literacy can be considered to be a potential strategy for improving self-efficacy. To enhance health literacy, healthcare providers could use an empowerment approach rather than an authoritative approach that emphasizes patient compliance in managing patients with T2DM. © 2015 Elsevier Ireland Ltd. Source

Wu C.-C.,National Cheng Kung University | Wu C.-C.,I - Shou University | Lin H.-Y.,I - Shou University | Wang C.-P.,I - Shou University | And 7 more authors.
BMC Urology | Year: 2015

Background: Prostate cancer remains the most common cancer in men. Qualitative or semi-quantitative immunochromatographic measurements of prostate specific antigen (PSA) have been shown to be simple, noninvasive and feasible. The aim of this study was to evaluate an optimized gold immunochromatographic strip device for the detection of PSA, in which the results can be analysed using a Chromogenic Rapid Test Reader to quantitatively assess the test results. Methods: This reader measures the reflectance of the signal line via a charge-coupled device camera. For quantitative analysis, PSA concentration was computed via a calibration equation. Capillary blood samples from 305 men were evaluated, and two independent observers interpreted the test results after 12 min. Blood samples were also collected and tested with a conventional quantitative assay. Results: Sensitivity, specificity, positive and negative predictive values, and accuracy of the PSA rapid quantitative test system were 100, 96.6, 89.5, 100, and 97.4 %, respectively. Reproducibility of the test was 99.2, and interobserver variation was 8 % with a false positive rate of 3.4 %. The correlation coefficient between the ordinary quantitative assay and the rapid quantitative test was 0.960. Conclusions: The PSA rapid quantitative test system provided results quickly and was easy to use, so that tests using this system can be easily performed at outpatient clinics or elsewhere. This system may also be useful for initial cancer screening and for point-of-care testing, because results can be obtained within 12 min and at a cost lower than that of conventional quantitative assays. © 2015 Wu et al. Source

Wang C.-P.,Divisions of Cardiology | Lu Y.-C.,Divisions of Endocrinology and Metabolism | Tsai I.-T.,E DA Hospital | Tang W.-H.,Kaohsiung Medical University | And 7 more authors.
Dermatology | Year: 2016

Background: Pruritus is a common and distressing symptom that affects patients with chronic kidney disease (CKD). Indoxyl sulfate (IS) and p-cresylsulfate (PCS) are uremic toxins with similar protein binding, dialytic clearance, and proinflammatory features. Pruritus in CKD may correlate better with uremic toxins than the glomerular filtration rate (GFR), suggesting that uremic toxins either in the central nervous system or peripherally may play an important role in the pathophysiology. Objective: We sought to investigate the potential contribution of serum total IS and PCS to the pathogenesis of pruritus. Methods: The serum levels of total IS and PCS concentrations were measured in all patients by using the Ultra Performance LC System. The characteristics of pruritus were assessed using a visual analog scale score and an interview questionnaire. Results: Among the 320 CKD patients, 35% had pruritus. The patients with pruritus were older and had a higher frequency of diabetes mellitus, higher uric acid, calcium, phosphorus, creatinine, high-sensitivity C-reactive protein, and total IS and PCS levels, and lower albumin concentrations and estimated GFR (eGFR) than those without pruritus. Increasing concentrations of total PCS were independently and significantly associated with pruritus. Multiple logistic regression analysis revealed total PCS as an independent association factor for pruritus, even after full adjustment of known biomarkers. Furthermore, serum total PCS levels were positively associated with calcium, phosphorus, blood urea nitrogen, creatinine, and white blood cell count, and negatively associated with eGFR, hemoglobin, and hematocrit. Conclusion: Our results indicate that total PCS may play a role in the pathogenesis of pruritus. © 2016 S. Karger AG, Basel. Source

Shih Y.-T.,Lees Endocrinology Clinic | Hsu H.-C.,Lees Endocrinology Clinic | Chen S.-Y.,Tri Service General Hospital | Hsieh C.-H.,National Defense Medical Center | And 3 more authors.
International Journal of Clinical and Experimental Medicine | Year: 2016

Aims: To investigate the effect of the Conversation Map™ (CM) program in patients with poor glycemic control with type 2 diabetes mellitus (T2DM). Methods: T2DM patients who: (1) had A1C>8.0% with no more than a 0.5% A1C reduction for at least half a year; (2) hadparticipated in the individualized diabetes education care pro­gram for ≥1 year; (3) were being treated with ≥2 OADs/or with basal insulin, or with multiple daily insulin injections were included. Visual maps of “healthy eating and being active” and “starting insulin” were chosen as the primary interventions. Results: Ninety-nine patients fulfilled the inclusion criteria, and 56 patients participated in the CM program. In contrast to the usual care group, in which the glycemic control remained static (A1C from 9.3 ± 1.1% to 9.3 ± 1.5%), the CM group showed an improvement in A1C from 9.8 ± 1.4% to 8.9 ± 1.5% (P<0.001) after 3 months. Improvements in blood glucose monitoring, weekly activity, insulin intensification, insulin perception, dietary knowl­edge and healthy eating behavior were also observed in the CM group. Conclusions: CM may be helpful for T2DM patients with poor glycemic control when participating in the individualized diabetes care program. © 2016, E-Century Publishing Corporation. All rights reserved. Source

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