Taoyuan, Taiwan
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Chang Y.-P.,Taoyuan Veterans Hospital | Huang S.-K.,Bureau of National Health Insurance | Tao P.,Taipei Veterans General Hospital | Tao P.,National Yang Ming University | Chien C.-W.,National Yang Ming University
BMC Nephrology | Year: 2012

Background: Because of the rapid growth in elderly population, polypharmacy has become a serious public health issue worldwide. Although acute renal failure (ARF) is one negative consequence of polypharmacy, the association between the duration of polypharmacy and ARF remains unclear. We therefore assessed this association using a population-based database. Methods: Data were collected from the Taiwan National Health Insurance Research Database (NHIRD) from 2003 through 2006. The case group included patients hospitalized for ARF during 2006, but not admitted due to trauma, surgery, burn trauma, car accident, transplantation, or infectious diseases; the control group included patients hospitalized without ARF. The cumulative number of days of polypharmacy (defined as more than 5 prescriptions per day) for 1 year prior to admission was determined, with patients further subdivided into 4 categories: less than 30 days, 3190 days, 91180 days, and over 181 days. The dependent variable was ARF, and the control variables were age, gender, comorbidities in patients hospitalized for ARF, stay in ICUs during ARF hospitalization and site of operation for prior admissions within one month of ARF hospitalization. Results: Of 20,790 patients who were admitted to hospitals for ARF in 2006, 12,314 (59.23 %) were male and more than 60 % were older than 65 years. Of patients with and without ARF, 16.14 % and 10.61 %, respectively, received polypharmacy for 91180 days and 50.22 % and 24.12 %, respectively, for over 181 days. A statistical model indicated that, relative to patients who received polypharmacy for less than 30 days, those who received polypharmacy for 3190, 91180 and over 181 days had odds ratios of developing ARF of 1.33 (p<0.001), 1.65 (p<0.001) and 1.74 (p<0.001), respectively. © 2012 Chang et al.; licensee BioMed Central Ltd.


Tu C.-Y.,National Yang Ming University | Tu C.-Y.,Taoyuan Veterans Hospital | Chen T.-J.,National Yang Ming University | Chen T.-J.,Taipei Veterans General Hospital | Chou L.-F.,National Chengchi University
PLoS ONE | Year: 2011

Background: The free choice of health care facilities without limitations on frequency of visits within the National Health Insurance in Taiwan gives rise to not only a high number of annual ambulatory visits per capita but also a unique "one-stop shopping"phenomenon, which refers to a patient' visits to several specialties of the same healthcare facility in one day. The visits to multiple physicians would increase the potential risk of polypharmacy. The aim of this study was to analyze the frequency and patterns of one-stop visits in Taiwan. Methodology/Principal Findings: The claims datasets of 1 million nationally representative people within Taiwan's National Health Insurance in 2005 were used to calculate the number of patients with one-stop visits. The frequent itemsets mining was applied to compute the combination patterns of specialties in the one-stop visits. Among the total 13,682,469 ambulatory care visits in 2005, one-stop visits occurred 144,132 times and involved 296,822 visits (2.2% of all visits) by 66,294 (6.6%) persons. People tended to have this behavior with age and the percentage reached 27.5% (5,662 in 20,579) in the age group ≥80 years. In general, women were more likely to have one-stop visits than men (7.2% vs. 6.0%). Internal medicine plus ophthalmology was the most frequent combination with a visited frequency of 3,552 times (2.5%), followed by cardiology plus neurology with 3,183 times (2.2%). The most frequent three-specialty combination, cardiology plus neurology and gastroenterology, occurred only 111 times. Conclusions/Significance: Without the novel computational technique, it would be hardly possible to analyze the extremely diverse combination patterns of specialties in one-stop visits. The results of the study could provide useful information either for the hospital manager to set up integrated services or for the policymaker to rebuild the health care system. © 2011 Tu et al.


Tsai S.-J.,Taipei Veterans General Hospital | Tsai S.-J.,National Yang Ming University | Hong C.-J.,Taipei Veterans General Hospital | Hong C.-J.,National Yang Ming University | And 6 more authors.
Neurobiology of Aging | Year: 2010

Interleukin-1 beta (IL-1 beta), a proinflammatory cytokine, plays a significant role in age-related changes in long-term potentiation (a biological substrate for learning and/or memory) in the hippocampus of experimental animals. This study tests the hypothesis that a biallelic functional polymorphism in the promoter region (position-511) (rs16944) of the IL-1 beta gene is associated with cognitive performance in elderly males without dementia. A total of 161 elderly male subjects without major psychiatric disorders or dementia participated in this research. Cognitive functions were assessed by the Cognitive Abilities Screening Instruments (CASI) test as well as The Wechsler Digit Span Task test. A significant association was found between the IL-1 beta C-511T polymorphism and CASI score (p=0.008), particularly in the abstraction and judgment subtest (p=0.010), and the backward digit span test (p=0.004). Post hoc tests indicated that the C/C genotype gained better cognitive function test results than T/T carriers, mainly in the non-apolipoprotein E allele epsilon 4 carriers. These results suggest that genetic variants of the IL-1 beta C-511T polymorphism may play a role in specific cognitive functions in normal aged males. Considering that cognitive decline in the elderly is associated with local inflammation processes, genetic variants of cytokines and their receptors should be tested to improve gene-based prediction of general cognitive function in the elderly. © 2008 Elsevier Inc.


Liu W.-C.,Taoyuan Veterans Hospital | Liu W.-C.,National Yang Ming University | Lee S.-M.,National Yang Ming University | Lee S.-M.,Taipei Veterans General Hospital | And 2 more authors.
Cornea | Year: 2011

Purpose: To determine whether corneal biomechanical properties and intraocular pressure (IOP) are affected by eye rubbing and breath holding. Methods: Corneal hysteresis, corneal resistance factor, corneal compensated IOP (IOPcc), and Goldmann equivalent IOP (IOPg) were measured on both eyes of 40 subjects. Measurements were taken at baseline before eye rubbing (ER 0) and before breath holding (BH0), immediately after 2 episodes of eye rubbing (ER1 and ER2), and during 2 episodes of breath holding (BH1 and BH2). Results: Corneal hysteresis, corneal resistance factor, and IOPg were significantly lower after ER1 compared with ER0 and were significantly lower after ER2 compared with ER1. In contrast, IOPcc did not decrease significantly. There were no significant differences among BH0, BH1, and BH2 in any of the 4 outcomes. Conclusions: Eye rubbing should be avoided before measurements of corneal biomechanical properties and IOPg. In contrast, breath holding during measurements is not likely to cause a significant change in IOPg and IOPcc or corneal biomechanical properties. Copyright © 2011 by Lippincott Williams & Wilkins.


PubMed | Taoyuan Veterans Hospital and Taipei Veterans General Hospital
Type: Journal Article | Journal: Hemodialysis international. International Symposium on Home Hemodialysis | Year: 2016

Catheter-related blood stream infection (CRBSI) is a major complication in hemodialysis patients. We assessed the efficacy of systemic daptomycin (DPT) plus DPT antibiotic lock therapy (DPT-ALT) for catheter salvage in patients with Gram-positive CRBSIs. This is a retrospective study of hemodialysis patients with tunneled and cuffed hemodialysis catheters. All patients were from a single institution in Taipei and received systemic DPT plus DPT-ALT for the treatment of Gram-positive CRBSI. Successful resolution of CRBSI was implemented. Resolution of fever within 48 hours, negative result of repeated blood cultures after resolution of fever, no clinical evidence of CRBSI relapse and no need for catheter removal were measured. Fifteen hemodialysis patients received DPT-ALT for CRBSI, nine with coagulase-negative Staphylococcus (CONS), two with methicillin-resistant Staphylococcus aureus (MRSA), three with methicillin-sensitive Staphylococcus aureus (MSSA) and one with polymicrobial infections. Systemic DPT plus DPT-ALT cured 11 patients (73.3%). Treatment failed in all three MRSA cases (two with MRSA and one with MRSA+Enterococcus faecalis). Retrospective design and small sample size were the limitations of this study. Systemic DPT plus DPT-ALT appears to be a promising treatment for CRBSI from CONS and MSSA, but not for MRSA CRBSI. Systemic DPT plus DPT-ALT should be considered for patients with CRBSIs caused by certain species.


PubMed | Taoyuan Veterans Hospital, National Tsing Hua University, Taipei Veterans General Hospital and Nanjing University of Aeronautics and Astronautics
Type: Clinical Trial, Phase I | Journal: International journal of radiation oncology, biology, physics | Year: 2016

To investigate the efficacy and safety of fractionated boron neutron capture therapy (BNCT) for recurrent head and neck (H&N) cancer after photon radiation therapy.In this prospective phase 1/2 trial, 2-fraction BNCT with intravenous L-boronophenylalanine (L-BPA, 400 mg/kg) was administered at a 28-day interval. Before each fraction, fluorine-18-labeled-BPA-positron emission tomography was conducted to determine the tumor/normal tissue ratio of an individual tumor. The prescription dose (D80) of 20 Gy-Eq per fraction was selected to cover 80% of the gross tumor volume by using a dose volume histogram, while minimizing the volume of oral mucosa receiving >10 Gy-Eq. Tumor responses and adverse effects were assessed using the Response Evaluation Criteria in Solid Tumors v1.1 and the Common Terminology Criteria for Adverse Events v3.0, respectively.Seventeen patients with a previous cumulative radiation dose of 63-165 Gy were enrolled. All but 2 participants received 2 fractions of BNCT. The median tumor/normal tissue ratio was 3.4 for the first fraction and 2.5 for the second, whereas the median D80 for the first and second fraction was 19.8 and 14.6 Gy-Eq, respectively. After a median follow-up period of 19.7 months (range, 5.2-52 mo), 6 participants exhibited a complete response and 6 exhibited a partial response. Regarding acute toxicity, 5 participants showed grade 3 mucositis and 1 participant showed grade 4 laryngeal edema and carotid hemorrhage. Regarding late toxicity, 2 participants exhibited grade 3 cranial neuropathy. Four of six participants (67%) receiving total D80 > 40 Gy-Eq had a complete response. Two-year overall survival was 47%. Two-year locoregional control was 28%.Our results suggested that 2-fraction BNCT with adaptive dose prescription was effective and safe in locally recurrent H&N cancer. Modifications to our protocol may yield more satisfactory results in the future.


Chen Y.-C.,Taoyuan Veterans Hospital | Shih C.-L.,National Taiwan University | Wu C.-H.,Taipei Medical University | Chiu C.-H.,Taipei Medical University
Surgical Innovation | Year: 2014

The decreasing availability of surgical physicians is a concern in most countries. In the past decade, total physician manpower in Taiwan increased by 12%, but the number of surgical physicians decreased by 11%. Medical students are not inclined to choose surgery as a career - this study examines the factors involved in students' career choices. This study was conducted from January 2011 to April 2011. In total, 401 interns successfully completed questionnaires; this population makes up 34% of all interns in Taiwan. The structural questionnaire was designed to investigate factors affecting specialty decisions, with additional open-ended questions to investigate students' preferences in career specialty. Based on the research findings, the 3 most relevant factors in decreasing order of priority are personal interest, career-oriented lifestyle, and specialty characteristics (including workload and stress). For students likely to become surgical physicians, concerns about the work environment include the balance between work and family, wages that are incompatible with the workload, and the shortage of manpower on duty. Addressing the following concerns would increase medical students' likelihood of choosing a career in surgery: the need for a facilitator to help mitigate medical disputes and legal problems, decreased work hours, and decreased on-call duty hours. This study shows both motivating and discouraging factors affecting whether medical students choose surgery as a career. The purpose of this study is to strengthen the incentives for medical students to choose surgery as a career and to minimize the influence of factors that negatively affect such a choice. © 2014 The Author(s).


PubMed | Taoyuan Veterans Hospital, Taipei Medical University and National Taiwan University
Type: Journal Article | Journal: Surgical innovation | Year: 2014

The decreasing availability of surgical physicians is a concern in most countries. In the past decade, total physician manpower in Taiwan increased by 12%, but the number of surgical physicians decreased by 11%. Medical students are not inclined to choose surgery as a career--this study examines the factors involved in students career choices. This study was conducted from January 2011 to April 2011. In total, 401 interns successfully completed questionnaires; this population makes up 34% of all interns in Taiwan. The structural questionnaire was designed to investigate factors affecting specialty decisions, with additional open-ended questions to investigate students preferences in career specialty. Based on the research findings, the 3 most relevant factors in decreasing order of priority are personal interest, career-oriented lifestyle, and specialty characteristics (including workload and stress). For students likely to become surgical physicians, concerns about the work environment include the balance between work and family, wages that are incompatible with the workload, and the shortage of manpower on duty. Addressing the following concerns would increase medical students likelihood of choosing a career in surgery: the need for a facilitator to help mitigate medical disputes and legal problems, decreased work hours, and decreased on-call duty hours. This study shows both motivating and discouraging factors affecting whether medical students choose surgery as a career. The purpose of this study is to strengthen the incentives for medical students to choose surgery as a career and to minimize the influence of factors that negatively affect such a choice.


Hwang D.-K.,Taoyuan Veterans Hospital | Hwang D.-K.,National Yang Ming University | Chou Y.-J.,National Yang Ming University | Pu C.-Y.,National Yang Ming University | Chou P.,National Yang Ming University
Ophthalmology | Year: 2012

Purpose: This study aimed to investigate the incidence and prevalence of uveitis in Taiwan, and then analyzed the risk factors related to uveitis using multivariate regression. Design: Population-based cohort study using medical claims data. Participants: We randomly selected 1 000 000 residents from the Taiwan National Health Insurance Research Database. All participants with correct registry data (96%) were included in the study. The study period was from 2000 to 2008. Methods: All types of uveitis were identified using the International Classification of Diseases, 9th revision, Clinical Modification diagnostic codes. The annual incidence and cumulative prevalence of uveitis were calculated. A univariate and a multivariate Poisson regression were used to determine the risk factors associated with uveitis. Main Outcome Measures: The first diagnosis of uveitis noted during the study period. Results: The annual cumulative incidence rate of uveitis ranged from 102.2 to 122.0 cases per 100 000 persons over the study period, and the average incidence density was 111.3 cases per 100 000 person-years (95% confidence interval, 108.4-114.1). The cumulative prevalence was found to have increased from 318.8 cases per 100 000 persons in 2003 to 622.7 cases per 100 000 persons in 2008. Anterior uveitis was the most common location and accounted for 77.7% of all incident cases, which was followed by panuveitis, posterior uveitis, and intermediate uveitis. Multivariate regression analysis showed that males, the elderly, and individuals who lived in an urban area had higher incidence rates for uveitis. Conclusions: The epidemiology of uveitis in Taiwan differs from most previous studies in other countries. The incidence of uveitis in Taiwan has increased significantly recently. The elderly and individuals living in urban areas are the populations that are most commonly affected by uveitis. These findings are consistent with suggestions found in several recent studies. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. © 2012 American Academy of Ophthalmology.


Peng S.-Y.,National Yang Ming University | Peng S.-Y.,Taichung Veterans General Hospital | Peng S.-Y.,Chung Shan Medical University | Chuang Y.-C.,Taichung Veterans General Hospital | And 2 more authors.
European Journal of Neurology | Year: 2010

Background and purpose: Risk-stratification models based on patient and disease characteristics are useful for aiding clinical decisions and for comparing the quality of care between different physicians or hospitals. In addition, prediction of mortality is beneficial for optimizing resource utilization. We evaluated the accuracy and discriminating power of the random forest (RF) to predict 30-day mortality of spontaneous intracerebral hemorrhage (SICH). Methods: We retrospectively studied 423 patients admitted to the Taichung Veterans General Hospital who were diagnosed with spontaneous SICH within 24 h of stroke onset. The initial evaluation data of the patients were used to train the RF model. Areas under the receiver operating characteristic curves (AUC) were used to quantify the predictive performance. The performance of the RF model was compared to that of an artificial neural network (ANN), support vector machine (SVM), logistic regression model, and the ICH score. Results: The RF had an overall accuracy of 78.5% for predicting the mortality of patients with SICH. The sensitivity was 79.0%, and the specificity was 78.4%. The AUCs were as follows: RF, 0.87 (0.84-0.90); ANN, 0.81 (0.77-0.85); SVM, 0.79 (0.75-0.83); logistic regression, 0.78 (0.74-0.82); and ICH score, 0.72 (0.68-0.76). The discriminatory power of RF was superior to that of the other prediction models. Conclusions: The RF provided the best predictive performance amongst all of the tested models. We believe that the RF is a suitable tool for clinicians to use in predicting the 30-day mortality of patients after SICH. © 2010 EFNS and PNS.

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