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Medicine, Taiwan

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Ho C.-F.,Chang Gung University | Maa S.-H.,National Taitung University | Shyu Y.-I.L.,Chang Gung University | Lai Y.-T.,Saint Pauls Hospital | And 2 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2012

The use of rhythmic music is beneficial in assisting with the exercise intensity at home. This paper investigated the effects of paced walking to music at home with an 80 VO2 peak for patients with COPD. A prospective randomized clinical trial consisting of a treatment group (n 20) assigned to a 12-week period of paced walking to music at home, while the patients in the control group (n 21) were only given educational information. The treatment response was measured based on the patient's score in the maximal exercise capacity test using the incremental shuttle walking test (ISWT), lung function, health- related quality of life (HRQOL) using the Saint George Respiratory Questionnaire (SGRQ) and their health care utilization during baseline, 4, 8, 12 and 16 weeks. The treatment group increased their distance in the ISWT from 243.5 ± 135.4 at baseline to 16 weeks (306.0 ± 107.3, p < 0.001), Borg RPE-D decreased from 2.2 ± 1.3 at baseline to 0.8 ± 1.1 (p < 0.001) at 16 weeks, and Borg RPE-L decreased from 1.2 ± 1.4 at baseline to 0.3 ± 0.7 (p < 0.05) at 16 weeks, and improved all of the domains of the SGRQ, compared to the control group. The paced walking to music at home program helps patients to achieve a higher-intensity exercise. It is easily incorporated into the care of COPD patients, providing them with a convenient, safe and enjoyable exercise. © 2012 Informa Healthcare USA, Inc.


Chen L.-H.,Chang Gung University | Shieh S.-M.,Wei Gong Memorial Hospital | Yin W.-H.,Cheng Hsin Rehabilitation Medical Center | Chiou A.-F.,National Yang Ming University
Journal of Clinical Nursing | Year: 2010

Aims and objectives: The purpose of this study was to examine the level of fatigue perceived by patients with heart failure and to explore the potential factors influencing fatigue. Design: A cross-sectional, correlational design was used. Methods: A convenience sample of 105 patients was recruited between July and September 2003 in northern Taiwan. The patients were interviewed, and their perceived fatigue was assessed with the modified Piper Fatigue Scale. The factors influencing fatigue were determined using a stepwise linear regression model. Results: The majority of patients with heart failure experienced mild-to-moderate fatigue. Patients with higher levels of fatigue had worse physical functioning and more severe symptomatic and psychological distress. Symptomatic distress, psychological distress (depression and anxiety), New York Heart Association class, activities of daily living (ADL) and appraisal support by health care providers could explain 57·4% of the total variance of fatigue. Symptomatic distress was the strongest predictor of fatigue. Conclusion: Higher levels of fatigue were found in patients with heart failure who had symptomatic or psychological distress. Additional research focusing on developing effective methods to reduce fatigue in patients with heart failure is recommended. Relevance to clinical practice: Nurses should help patients with heart failure to monitor their symptoms and report them to health care providers. Early management of symptoms and support by health care providers may reduce patients' fatigue, help maintain their physical functioning and improve their quality of life. © 2010 Blackwell Publishing Ltd.


Hung S.-C.,Tzu Chi University | Kuo K.-L.,Tzu Chi University | Tarng D.-C.,National Yang Ming University | Tarng D.-C.,Taipei Veterans General Hospital | And 3 more authors.
Nephrology | Year: 2014

The introduction of erythropoiesis-stimulating agents (ESAs) markedly improved the lives of many anaemic patients with chronic kidney disease (CKD). In Taiwan, the strategy of management of anaemia in patients with CKD was different from many other parts of the world. In 1996, the National Health Insurance Administration of Taiwan applied a more restrictive reimbursement criteria for ESA use in patients with CKD. ESA is to be initiated when non-dialysis CKD patients have a serum creatinine >6 mg/dL and a hematocrit <28% to maintain a hematocrit level not exceeding 30%. The maximal dose of epoetin-α or β was 20 000 U per month. The target haemoglobin range and dose limitation for ESAs were the same for dialysis CKD patients. Thus, long before randomized controlled trials showing an increased risk for cardiovascular events at nearly normal haemoglobin concentrations and higher ESA doses in CKD, nephrologists in Taiwan had avoided the use of disproportionately high dosages of ESAs to achieve a haemoglobin level of 10-11 g/dL. Moreover, intravenous iron supplementation was encouraged earlier in Taiwan in 1996, when we reached consensus on the diagnostic criteria for iron deficiency (serum ferritin <300 ng/mL and/or transferrin saturation <30%). The experience of CKD anaemia management in Taiwan demonstrated that a reasonable haemoglobin target can be achieved by using the lowest possible ESA dose and intravenous iron supplementation. © 2014 Asian Pacific Society of Nephrology.


Tsai M.-T.,Taipei Veterans General Hospital | Tsai M.-T.,Wei Gong Memorial Hospital | Tsai M.-T.,National Yang Ming University | Hu F.-H.,Wei Gong Memorial Hospital | And 5 more authors.
American Journal of Nephrology | Year: 2014

Background: Protein-energy wasting (PEW) is common and associated with poor outcome in hemodialysis patients. In hemodialysis patients, geriatric nutritional risk index (GNRI) and decoy receptor 3 (DcR3) have been shown as the nutritional and inflammatory markers, respectively. The present study aimed to assess the predictive ability of GNRI and DcR3 for PEW status and long-term outcomes in chronic hemodialysis patients. Methods: A prospective cohort of 318 hemodialysis patients was conducted with a median follow-up of 54 months. Malnutrition-inflammation score (MIS) was used as the reference standard for the presence of PEW. Endpoints were cardiovascular and all-cause mortality. Results: Baseline GNRI had a strong negative correlation with DcR3 and MIS score. For patients with age < or ≥ 60, high DcR3 and low GNRI were independent predictors for the presence of PEW at baseline. At the end of the study, 81 patients died (27 cardiovascular deaths). The adjusted hazard ratios (95% confidence intervals) of low GNRI and high DcR3 were 1.93 (1.1- 4.8) and 2.53 (1.2-5.5) for cardiovascular mortality and 1.85 (1.1-3.2) and 2.37 (1.5-3.7) for all-cause mortality, respectively. While integrated into a model of conventional risk factors, GNRI together with DcR3 further significantly improved the predictability for overall mortality ( c statistic, 0.823). Conclusions: Low GNRI and high DcR3 were the alternatives for identifying hemodialysis patients at risk of PEW and overall mortality. Further studies are needed to verify whether timely recognition of hemodialysis patients with a high malnutrition- inflammation risk could reduce their mortality by appropriate interventional strategies. © 2014 S. Karger AG, Basel.


Tang M.-B.,Wei Gong Memorial Hospital | Chen C.-H.,Tatung University | Chen S.-C.,Tatung University | Chen S.-C.,Da Chien General Hospital | And 2 more authors.
BMC Infectious Diseases | Year: 2013

Background: The human norovirus (NV) circulates worldwide and is a major cause of epidemics, which have increased in Taiwan since 2002. NV in acute gastroenteritis (AGE) and non-acute gastroenteritis (asymptomatic) patients, including children and adults, have not been previously examined in Taiwan; therefore, we examined the epidemiology and phylogeny of NV in AGE and asymptomatic patients of all ages.Methods: 253 stool samples were collected from August 2011 to July 2012 (including 155 AGE and 98 asymptomatic samples in Taiwan) and analyzed using reverse transcription-polymerase chain reaction (RT-PCR) for NV. Primers targeting the RNA-polymerase gene were used for RT-PCR to allow DNA sequencing of Taiwan NV strains and phylogenetic analyses.Results: NV was detected in 24 (9.5%) of 253 stool specimens using RT-PCR. NV was isolated from all age groups (1 to 86 y) and those NV-positive samples were major identified from inpatients (79.2%, 19/24). Statistical analysis showed that the NV infectious rate of AGE patients was statistically significant (P < 0.05) for age, season and water type, respectively. Phylogenetic analyses of the RdRp region sequence showed that 24 NV isolates belonged to Genogroup II Genotype 4 (GII.4). They were closely related to the epidemic strain in Taiwan in 2006, the GII.4-2006b pandemic strain in 2006, and the GII.4-New Orleans strain in 2010.Conclusion: This study is the first to examine NV in sporadic AGE and asymptomatic patients in Taiwan. Furthermore, epidemic strains of isolated GII.4 were predominant in Taiwan during 2011 and 2012. © 2013 Tang et al.; licensee BioMed Central Ltd.


Liaw J.-J.,National Defense Medical Center | Zeng W.-P.,Tri Service General Hospital | Yang L.,Hsuan Chuang University | Yuh Y.-S.,National Defense Medical Center | And 4 more authors.
Journal of Pain and Symptom Management | Year: 2011

Context: Newborns are subject to pain during routine invasive procedures. Pain caused by immunization injections is preventable, but remains untreated in neonates. Objectives: The purpose of the study was to compare the effectiveness of three nonpharmacological pain relief strategies on newborns' pain, physiological parameters, and cry duration before, during, and after hepatitis B intramuscular (IM) injection. Methods: In this prospective, randomized clinical trial, we enrolled 165 newborns (gestational age, ≥36 weeks). The infants received IM injections and were randomized to three treatment groups: nonnutritive sucking (NNS), 20% oral sucrose, or routine care. Pain was measured by the Neonatal Facial Coding System, physiological signals by electrocardiogram monitors, and cry duration using a stopwatch. Results: Pain was significantly lower among infants in the NNS (B = -11.27, P < 0.001) and sucrose (B = -11.75, P < 0.001) groups than that in controls after adjusting for time effects, infant sleep/wake state, number of prior painful experiences, and baseline pain scores. Infants in the NNS and sucrose groups also had significantly lower mean heart and respiratory rates than the controls. Cry duration of infants receiving sucrose was significantly shorter than those in the NNS (Z = -3.36, P < 0.001) and control groups (Z = -7.80, P < 0.001). Conclusion: NNS and oral sucrose can provide analgesic effects and need to be given before painful procedures as brief as a one-minute IM injection. Sucrose orally administered two minutes before injection more effectively reduced newborns' pain during injection than NNS. Both nonpharmacological methods more effectively relieved newborns' pain, stabilized physiological parameters, and shortened cry duration during IM hepatitis injection than routine care. © 2011 U.S. Cancer Pain Relief Committee Published by Elsevier Inc. All rights reserved.


Hsieh C.-W.,Taichung Veterans General Hospital | Hsieh C.-W.,Chung Shan Medical University | Lee J.-W.,Wei Gong Memorial Hospital | Liao E.-C.,Taichung Veterans General Hospital | And 2 more authors.
International Journal of Molecular Sciences | Year: 2014

There are currently no diagnostic methods in vitro for aspirin-induced chronic urticaria (AICU) except for the provocation test in vivo. To identify disease markers for AICU, we investigated the single nucleotide polymorphism (SNP) of the promoter loci of high-affinity IgE receptor (FcεRIα) and CD203c expression level in Chinese patients with AICU. We studied two genotypic and allelic frequencies of rs2427827 (-344C/T) and rs2251746 (-66T/C) gene polymorphisms of FcεRIα in 20 patients with AICU, 52 subjects with airway hypersensitivity without aspirin intolerance, and 50 controls in a Chinese population. The results showed that the frequencies of two SNPs (-344C>T, -66C>T) were similar to the normal controls. The allele frequency of -344CC was significantly higher in the patients with AICU compared to those with airway sensitivity (p = 0.019). We also studied both histamine release and CD203c expression on KU812 cells to assess aspirin-induced basophil activation. We found that the activity of basophil activation of AICU was significantly higher in the patients with AICU compared to those with airway hypersensitivity without aspirin intolerance. The mean fluorescence intensity of the CD203c expression were 122.5 ± 5.2 vs. 103.3 ± 3.3 respectively, (p < 0.05), and the percentages of histamine release were 31.3% ± 7.4% vs. -24.0% ± 17.5%, (p < 0.05) respectively. Although the mean fluorescence intensity of CD203c expression and the percentage of histamine release were significantly up-regulated by aspirin, they were not affected by anti-IgE antibodies. These results suggest that a single SNP of FcεRIα (-344C>T) is less likely to develop AICU and the basophil activation activity in the sera by measuring CD203c expression can be applicable to confirm the diagnosis of AICU. © 2014 by the authors; licensee MDPI, Basel, Switzerland.


PubMed | National Yang Ming University and Wei Gong Memorial Hospital
Type: Journal Article | Journal: Journal of the Chinese Medical Association : JCMA | Year: 2016

The number of geriatric patients with end-stage renal disease undergoing maintenance hemodialysis has increased in Taiwan. However, protein-energy wasting is prevalent and associated with poor outcome in this patient population. It is generally well-known that geriatric nutritional risk index (GNRI) is a good survival predictor in general elderly patients. However, the association of GNRI with mortality in geriatric end-stage renal disease patients remains unclear. The present study aimed to assess the predictive ability of GNRI for overall mortality in elderly hemodialysis patients.GNRI was measured in a cohort of 104 hemodialysis patients aged 65years. Thereafter, these patients were followed for a median period of 38.5months. For all cases, all-cause mortality was the primary endpoint.Patients with baseline GNRI <92 had significantly lower body weight, body mass index, serum albumin, and hemoglobin level, but were administered a higher erythropoietin dose as compared to those with GNRI 92. Basal GNRI independently correlated with erythropoietin resistance index (=-1.97, p<0.001) and serum high-sensitivity C-reactive protein (=-0.71, p=0.021). By the conclusion of the study, 45 patients had died. High GNRI was associated with the lower risk of mortality after adjustment for other potential confounders [hazard ratio=0.41; 95% confidence interval (CI)=0.22-0.90; p=0.005].GNRI is a significant predictor for mortality in elderly hemodialysis patients, and may be adopted to improve assessment of the malnutrition-inflammation status.


Hu L.-W.,Tungs Taichung Metro Harbor Hospital | Ho Y.-F.,Wei Gong Memorial Hospital | Lin P.-C.,Taipei Medical University
Journal of Nursing and Healthcare Research | Year: 2012

Background: Nursing is a highly stressful job. Following a health-promoting lifestyle can assist nurses to reduce work stress and promote personal health. Purpose: The purpose of this study was to explore the health-promoting lifestyles of clinical nurses and related factors. Methods: We conducted a cross-sectional questionnaire survey on 297 nurses at a regional teaching hospital in central Taiwan. Results: Nurses gave themselves the highest scores on interpersonal support followed by self-actualization, stress management, nutrition, health responsibility, and exercise. Nurses who received more social support, had stronger self-efficacy, were happier, had more positive health conceptualization, and were more likely to have internal locus of control and authority outside control tended to follow a more health-promoting lifestyle. Self-efficacy, work shift, and age were significant predictors, explaining 48% of total health-promoting lifestyle variance. Conclusions/Implications for practice: Findings may provide a valuable reference for nurse administrators to create a health promotion culture in hospitals targeted to improve nurses' health.


Chen N.-C.,Wei Gong Memorial Hospital | Yeh C.-H.,Wei Gong Memorial Hospital | Hui C.-T.,Wei Gong Memorial Hospital | Lin R.-H.,Wei Gong Memorial Hospital
Acta Neurologica Taiwanica | Year: 2010

Purpose: A sudden elevation of the intervertebral disc pressure could result in injection of cartilaginous material into spinal small caliber vessels causing embolism of the underlying vessels is well documented but rarely occurs. Case report: Here we present a patient with sudden onset of weakness over left upper extremity several minutes after neck rotation exercise. The symptoms were progressive with quadra-paresis and urine incontinence without cranial nerve or sensory function deficit. The cervical spine MRI showed cervical spondylosis with degenerative osteophytes of lower cervical-spine with mild indentation of the thecal sac. There was also focal T2-high intensity edema of "H" gray matters of C3 spinal cord. According to the preliminary examination and clinical course, the symptoms of the patient can be explained by the ischemia of spinal cord secondary to fibrocartilaginous embolism(FCE) derived from intervertebral discs. After aspirin and IV dexamethasone treatment, the clinical condition of the patient improved significantly. Conclusion: Neck rotation exercise is common among all kinds of relaxation or physical rehabilitation activities. However, the potential unwanted effects of this exercise suggest that one should be aware of the potential adverse neurologic outcomes especially inappropriate non- professional method.

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