Tainan Municipal Hospital

Tainan, Taiwan

Tainan Municipal Hospital

Tainan, Taiwan
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Chiang J.-K.,Buddhist Dalin Tzu Chi Hospital | Kao Y.-H.,Tainan Municipal Hospital
BMC Cancer | Year: 2017

Background: Studies have indicated a pervasive pattern of decreasing healthcare costs during elderly patients' last year of life. The aim of this study was to explore the predictors of high healthcare costs (HC) in elderly liver cancer patients in Taiwan during their last month of life (LML). Methods: Costs of hospitalization, outpatient visits, aggressiveness of care, and associated costs for elderly (age ≥ 65 y) patients with liver cancer in the LML were analyzed using a national insurance database. An HC was defined as being greater than the 90th percentile (US $5093) in the LML, amounting to 38.95% of total healthcare costs. Results: We enrolled 2121 subjects who died during 1997-2011. Mean healthcare costs per person in their LML were US $8042 ± 3477 in the HC group and US $1407 ± 1464 in the non-HC group (p < 0.001). For patients receiving aggressive end-of-life (EOL) cancer care (e.g. intensive care, cardiopulmonary resuscitation, anticancer treatment, and a high number of admission days), comorbidities of chronic kidney disease, esophageal bleeding, and receiving opioids in the LML, were significantly independent positive predictors of HCs; but admission times, comorbidities of ascites, and hypertension were negative predictors. Conclusion: These findings could inform healthcare providers by avoiding aggressive treatments during EOL for elderly patients with liver cancer and to save on healthcare costs. Shorter admission days and more admission times in the last month of life could decrease healthcare costs. © 2017 The Author(s).


Fang C.-C.,Tainan Municipal Hospital | Jao Y.T.F.N.,Tainan Municipal Hospital
American Journal of Case Reports | Year: 2017

Objective: Rare disease Background: Development of a true coronary aneurysm after percutaneous coronary intervention is a rare event, and a coronary aneurysm resulting in acute myocardial infarction is even rarer. Coronary aneurysm formation after bioresorbable vascular scaffold (BVS) implantation, eventually leading to thrombosis, embolization, and myocardial infarction, has never been reported before in the literature. Case Report: A 62-year-old man received an elective BVS for a proximal left anterior descending lesion. Two months later, he suffered from a non-ST-segment myocardial infarction. Coronary angiography showed a non-significant distal stent edge restenosis over the left anterior descending artery and a small aneurysm after the first diagonal branch. A XIENCE Xpedition stent was used to cover both lesions and final angiography showed shrinkage of the aneurysm and resolution of the restenosis. Conclusions: Since a consensus or an established treatment guideline for treating coronary aneurysms is currently lacking, each case should be treated with caution and should be guided by the accompanying circumstances presented during the procedure. Although size, rapidity of growth, and the presence of high-risk features are the main determinants of whether to treat the lesion, the inherent risk of restenosis or reocclusion after use of drugeluting stents and the coronary intervention procedure itself should also be taken into consideration. However, one must not take lightly a small coronary aneurysm when discovered, as the abnormal fluid dynamics inside may result in thrombus formation and embolization. The fundamental technical aspects of stent deployment, such as avoiding overstretching during lesion preparation, use of balloons shorter than the implanted device, and normal-to-normal or healthy “landing zone” of the device, should be followed. © Am J Case Rep, 2017.


Yen C.-F.,Kaohsiung Medical University | Chou W.-J.,Chang Gung University | Liu T.-L.,Kaohsiung Medical University | Yang P.,Kaohsiung Medical University | Hu H.-F.,Tainan Municipal Hospital
Comprehensive Psychiatry | Year: 2014

Conclusions Prevention and intervention programs for Internet addiction in adolescents with ADHD should take anxiety, depression, and self-esteem into consideration.Method A total of 287 adolescents aged between 11 and 18 years who had been diagnosed with ADHD participated in this study. Their severity of Internet addiction symptoms was assessed using the Chen Internet Addiction Scale. Anxiety and depression symptoms and self-esteem were assessed using the Taiwanese version of the Multidimensional Anxiety Scale for Children (MASC-T), the Center for Epidemiological Studies Depression Scale (CES-D), and the Rosenberg Self-Esteem Scale (RSES), respectively. The association between the severity of Internet addiction symptoms and anxiety and depression symptoms and self-esteem were examined using multiple regression analyses.Background The aims of this study were to examine the associations of the severity of Internet addiction symptoms with various dimensions of anxiety (physical anxiety symptoms, harm avoidance, social anxiety, and separation/panic) and depression symptoms (depressed affect, somatic symptoms, interpersonal problems, and positive affect) and self-esteem among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in Taiwan.Results The results indicated that higher physical symptoms and lower harm avoidance scores on the MASC-T, higher somatic discomfort/retarded activity scores on the CES-D, and lower self-esteem scores on the RSES were significantly associated with more severe Internet addiction symptoms. © 2014 Elsevier Inc. All rights reserved.


Huang T.-T.,Chang Gung University | Yeh C.-Y.,Health Station of Taoyuan City | Tsai Y.-C.,Tainan Municipal Hospital
Midwifery | Year: 2011

Objective: to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum, or from birth to six months post partum, on weight retention among Taiwanese women. Design: a randomised controlled trial assigned participants to two experimental groups [from pregnancy to six months post partum (EP) and from birth to six months post partum (EPP)] and one comparison group. Setting: a 3900-bed medical centre in northern Taiwan with around 3000 births annually. Participants: a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre. Interventions: the comparison group received the routine outpatient department obstetric educational programme. The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum, and received on brochure. The EPP group received the same educational intervention as the EP group from 24-48 hours after birth to six months post partum. Measurements: body weight, body mass index, health-promoting behaviour and psycho-social variables (self-efficacy, body image, depression and social support). Findings: average gestational weight gain was 14.02, 15.27 and 16.22. kg in the three EP, EPP and comparison groups respectively, and average weight retention at six months post partum was 2.34, 4.06 and 5.08. kg in the three groups, respectively. Key conclusions: a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention. Implications for practice: the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle. © 2009 Elsevier Ltd.


Wu H.-H.,Tainan Municipal Hospital | Jao Y.T.F.N.,Tainan Municipal Hospital | Wu M.-H.,Tainan Municipal Hospital
American Journal of Case Reports | Year: 2014

Objective: Rare diseaseBackground: Glomus tumors are usually found over the dermis of the extremities, particularly over the subungual region of the fingers, and occurrence in the trachea is an extremely rare event. To date, only 29 cases of tracheal and 2 main bronchus glomus tumors have been reported in the English literature. Our patient is the first ever reported case in Taiwan that was managed by spiral tracheoplasty.Case Report: A 58-year-old woman was admitted to our hospital because of hemoptysis. Computed tomographic (CT) scan revealed a mass over the posterior wall of the trachea. Surgical resection with spiral tracheoplasty was performed due to uncontrolled bleeding and airway compromise. Histopathology and immunostaining confirmed a glomus tumor. Postoperative course was unremarkable and she was discharged in improved condition after 9 days of hospital stay.Conclusions: Although chronic symptom presentation is the rule for tracheal glomus tumors, airway obstruction and bleeding are life-threatening presentations. Histopathological examination and staining are important to differentiate it from hemangiopericytoma or carcinoid tumors. Spiral tracheoplasty after tangential resection may be tried, as this preserves more tracheal tissue, decreases tension, and prevents postoperative leakage at the anastomotic site. © Am J Case Rep, 2014.


Wu M.-H.,Tainan Municipal Hospital | Wu H.-Y.,Tainan Municipal Hospital
Surgery Today | Year: 2014

Acute esophageal necrosis, also called "black esophagus" because of its characteristic appearance on endoscopy, is a life-threatening disease; however, its temporal evolution on endoscopy is not well understood. We describe the serial changes in acute esophageal necrosis in two patients, who underwent four upper endoscopic examinations each. Serial endoscopy demonstrated progressive necrosis extending from the lower esophagus proximally to involve the middle or upper thoracic esophagus in both patients. The first patient was treated with transhiatal esophagectomy, followed by esophageal reconstruction, and medical control of repeated duodenal ulcer bleeding. The second patient died of esophageal perforation, as a complication of Sengstaken-Blakemore tube stent placement to control esophageal bleeding. We report these cases to demonstrate the importance of early detection and prompt surgical treatment of acute esophageal necrosis. © 2013 Springer Japan.


Chou D.-W.,Tainan Municipal Hospital | Chung K.-M.,Tainan Municipal Hospital | Lee C.-T.,Tainan Municipal Hospital
American Journal of Tropical Medicine and Hygiene | Year: 2014

Prototheca wickerhamii, an environmental alga, rarely causes human infections. We present a case of Prototheca wickerhamii cutaneous and systemic infections in an 85-year-old male with adrenal insufficiency. This organism was identified by morphological features and microbiological tests. The patient was successfully treated with ketoconazole. Copyright © 2014 by The American Society of Tropical Medicine and Hygiene.


Roan J.-N.,Tainan Municipal Hospital | Wu M.-H.,E Da Hospital
Journal of Cardiothoracic Surgery | Year: 2010

Background: Esophageal perforation after external air-blast trauma is rarely presented in the emergency room. The diagnosis is often delayed more than 24 hours.Methods: We review the literature and report a case of esophageal perforation caused by external air-blast injury.Results: Including the present case, a total of 5 cases of esophageal perforation were caused by external air-blast injury in English literature. Of them, the common presentations were chest pain and dyspnea. The treatment methods varied with each case. One patient died before diagnosis of esophageal perforation and the others survived after proper surgical management.Conclusions: Early diagnosis and proper surgical management can reduce the morbidity and mortality of patients who suffered from esophageal perforation caused by external air-blast injury. © 2010 Roan and Wu; licensee BioMed Central Ltd.


Yan Y.-H.,Tainan Municipal Hospital
Studies in Health Technology and Informatics | Year: 2016

Organizational culture refers to the beliefs and values that have existed in an organization for a long time, and to the beliefs of the staff and the foreseen value of their work that will influence their attitudes and behavior. It is therefore essential to understand the relationship between organizational cultures and organizational effectiveness. Methods. A cross-sectional study was undertaken that focused on hospital nurses in Taiwan. Data was collected using a structured questionnaire; 900 questionnaires were distributed and 473 valid questionnaires were returned. Results. Organizational cultures were significantly (positively) correlated with organizational effectiveness (p<0.001). Conclusions. When the interaction between the leadership and employees is good, the latter will make a greater contribution to team communication and will also be encouraged to accomplish the mission and objectives assigned by the organization, thereby enhancing organizational effectiveness. © 2016 IMIA and IOS Press.


Wu M.H.,Tainan Municipal Hospital
Surgery today | Year: 2013

This article describes a simple pyloroplasty procedure using a linear stapler in surgery for esophageal cancer. Simple pyloroplasty was carried out using a linear stapler in a total of 22 patients, whose stomachs were used as esophageal substitutes in the surgery for esophageal cancer. Endoscopy was performed and the pyloric diameter was measured perioperatively. A barium meal study was conducted 1 month after the surgery. Stapling enlarged the diameter of the pylorus by nearly 10 %. Endoscopy revealed a smooth inner surface of the pylorus, enlargement of pyloric channel, and fewer spasms of the pylorus at the 1-month follow-up. Postoperative barium meal studies showed good patency of all of the patients' gastric outlets. Simple pyloroplasty is a time-saving and non-soiling technique used to perform the drainage of the gastric conduit for resection of esophageal cancer.

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