Cost effectiveness of implantable cardioverter defibrillators for 1.5 primary prevention of sudden cardiac arrest in China: an analysis from the Improve SCA study.

OBJECTIVES: Implantable cardioverter defibrillator (ICDs) for primary prevention (PP) of sudden cardiac arrest (SCA) is underutilized in developing countries. The Improve SCA study has identified a subset of 1.5 primary prevention (1.5PP) patients with a higher risk of SCA and a significant mortality benefit from ICD therapy. From the perspective of China's healthcare system, we evaluated the cost-effectiveness of ICD therapy vs. no ICD therapy among 1.5PP patients with a view to informing clinical and policy decisions. METHODS: A published Markov model was adjusted and verified to simulate the course of the disease and describe different health states of 1.5PP patients. The patient characteristics, mortality, utility and complication estimates were obtained from the Improve SCA study and other literature. Cost inputs were sourced from government tender prices, medical service prices and clinical experts' surveys in 9 Chinese public hospitals. For both ICD and no ICD therapy, the total medical costs and quality-adjusted life-years (QALYs) were modelled over a lifetime horizon and the incremental cost-effectiveness ratio (ICER) was calculated. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. We used the willingness-to-pay (WTP) threshold recommended by China Guidelines for Pharmacoeconomic Evaluations, one to three times China's GDP per capita (CNY85,698-CNY257,094) in 2022 Chinese Yuan. RESULTS: The incremental cost effectiveness ratio (ICER) of ICD therapy compared to no ICD therapy is 139,652 CNY/QALY, which is about 1-2 times China's GDP per capita. The probability that ICD therapy is cost effective was 92.1%. Results from sensitivity analysis supported the findings of the base case. CONCLUSIONS: ICD therapy compared to no ICD therapy is cost-effective for the 1.5PP patients in China.

Assessment of neoadjuvant chemotherapy with docetaxel, cisplatin, and fluorouracil in patients with oral cavity cancer.

BACKGROUND: Chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF) has been studied in patients with head and neck cancer. Its impact on patients with oral cavity cancer was not specified. METHODS: We consecutively reviewed medical files of patients with untreated oral cavity cancer who received neoadjuvant TPF chemotherapy in our department from January 2017 to April 2020. Outcomes included the objective response to TPF chemotherapy, factors associated with the response, and progression and survival in different response groups. RESULTS: A total of 167 patients were included, with half of stage IV disease. Complete or partial response was observed in 51 patients. A total of 91 patients had stable disease, and 25 patients had progressive disease. The response was not associated with age, sex, anatomic subsite, and the tumor's T stage. It was related with N stage (p < 0.001) and clinical stage (p = 0.004). Most patients with bulky nodes or nodes with obvious necrosis showed low response or even progressed after neoadjuvant TPF chemotherapy. The planned surgery was conducted in 159 patients. Disease relapse mostly occurred in 2 years after treatment. The 2-year overall survival and the progression-free survival were 89.0% and 85.2% for patients with complete or partial response, 62.4% and 55.6% for patients with stable disease, and 12.5% and 4.2% for patients with progressive disease, respectively. CONCLUSIONS: The response of neoadjuvant TPF chemotherapy in patients with oral cavity cancer is related to disease stage, especially the nodal stage. Patients with complete or partial response developed less progression events and better survival.

Estimate of Health Burden on Smoking-associated Oral Cancer in Shanghai and its Surrounding Areas.

OBJECTIVE: To evaluate the temporal trend of inpatients with smoking-associated oral cancer in Shanghai and its surrounding areas and to forecast the public health burden in the next decade. METHODS: Data of inpatients with oral cancer were retrieved from Shanghai Ninth People's Hospital during a 15-year period. The annual numbers of inpatients were compared by Chi-test. The hospitalization expenditures were compared by Student's t test. The trend analysis and inpatient forecasting were performed by exponential smoothing, regression models, and the forecasting function in Excel software. The financial burden of smoking-associated oral cancer was calculated by polynomial equation. RESULTS: The annual number of inpatients with oral cancer increased during the study period. Most male patients were reported to have a smoking habit. Among the three estimation methods, polynomial regression model was most fitted to the existing data. By a conservative estimation, the public health burden of smoking-associated oral cancer patients will be 120 million RMB by the year 2026, not including the cost by prevalent patients and the patients' family members. CONCLUSION: Smoking-associated oral cancer will cost a lot of public resource in the next decade. Efforts should be made to lower the amount of tobacco consumption.

Quality assessment of reporting of randomization, allocation concealment, and blinding in traditional Chinese medicine RCTs: a review of 3159 RCTs identified from 260 systematic reviews.

BACKGROUND: Randomized controlled trials (RCTs) which are of poor quality tend to exaggerate the effect estimate and lead to wrong or misleading conclusions. The aim of this study is to assess the quality of randomization methods, allocation concealment and blinding within traditional Chinese medicine (TCM) RCTs, discuss issues identified for current TCM RCTs, and provide suggestions for quality improvement. METHODS: We searched Chinese Biomedical Database (CBM, 1978 to July 31, 2009) and the Cochrane Library (Issue 2, 2009) to collect TCM systematic reviews and meta-analyses according to inclusion/exclusion criteria, from which RCTs could be identified. The quality assessment involved whether the randomization methods, allocation concealment and blinding were adequate or not based the study reported. Stratified analyses were conducted of different types of diseases published in different journals (both Chinese and foreign) using different interventions. SPSS 15.0 software was used for statistic analyses. RESULTS: A total of 3159 RCTs were included, of which 2580 were published in Chinese journals and 579 in foreign journals. There were 381 (12%) RCTs which used adequate randomization methods; 207 (7%) RCTs which used adequate allocation concealment and 601 (19%) which used adequate blinding; there were 130 (4%) RCTs which both used adequate randomization methods and allocation concealment; and there were only 100 (3%) RCTs which used adequate randomization methods, allocation concealment, as well as blinding. In the RCTs published in foreign journals, the adequate randomization methods, allocation concealment and blinding accounted for a relatively large proportion (25%, 26%, and 60%, respectively) and increased with years, while in the RCTs published in Chinese journals, only the adequate randomization methods improved over time. The quality of non-drug intervention (chiefly acupuncture) RCTs was higher than that of drug intervention RCTs. In drug intervention, the quality of listed drugs is higher than the others. The quality of all included RCTs of all types of diseases was generally poor and no studies that were large in size and of high quality were found. CONCLUSION: The quality of the current TCM RCTs as judged by their publications is generally poor, especially those published in Chinese journals. In future, researchers of TCM RCTs should attach more importance to experimental design and methodological quality, receive relevant training, and improve reporting quality using the Consolidated Standards of Reporting Trials (CONSORT) statement, so as to improve the quality of TCM clinical research and ensure truth and reliability of conclusions.

An exploration of spiritual needs of Taiwanese patients with advanced cancer during the therapeutic processes.

AIMS AND OBJECTIVES: This study explores the spiritual needs of patients with advanced cancer during their therapeutic process in Taiwan and analyses the influence of Chinese culture in addressing their spiritual needs. BACKGROUND: Many nurse clinicians have concerns about the difficulties of providing spiritual care for ethnic-Chinese cancer clients within their cultural context, possibly as a result of lack of knowledge and training. There has been little research exploring the potential impact of Chinese cultural values on the spiritual needs of patients with advanced cancer. DESIGN: Explorative qualitative enquiry was used. METHODS: Data were collected through participant observation and in-depth face-to-face interviews. Transcribed interview data were analysed by using qualitative content analysis. The purposive sample (n = 33) was drawn from a leading medical center (n = 19) with 3000 beds in the capital and a community-based rural teaching hospital (n = 14) with 581 beds in Taiwan. RESULTS: Four spiritual needs emerged from the analysis: the need to foster hope for survival and obtain a peaceful mindset, to fulfil the meanings of life and preserve one's dignity, to experience more reciprocal human love and finally, to receive assistance in facing death peacefully. CONCLUSION: This research has shown that patients with advanced cancer need caregivers, friends and the help of their religion to meet their spiritual needs during the therapeutic processes. RELEVANCE TO CLINICAL PRACTICE: The findings of this study could assist health professionals to detect the unmet spiritual needs of ethnic-Chinese patients with cancer in the context of their cultural or religious background as early as possible.

Asia-Pacific nursing scholarship development: qualitative exploration of nurse scholars in Taiwan (Republic of China).

AIM: From the perspective of scholars, to describe a contemporary view of the development, facilitators of and barriers to nursing scholarship in Taiwan, to enhance policy-making about research, education and practise development. BACKGROUND: Nursing scholarship in the Asia-Pacific region is in different stages of development, depending on in-country resources and socio-economic conditions. Little is known about the facilitators or barriers to nursing scholarship in some of these countries, including Taiwan, where nursing education has changed considerably over the last decade. DESIGN: A qualitative exploratory design. METHOD: The study used snowballing to identify scholars who underwent semi-structured in-depth interviews. These were digitally recorded, transcribed verbatim and subjected to content analysis. RESULTS: Interviews were held with 12 scholars and six major themes arose: 'fulfilling our missions'; 'active research productivity'; 'low levels of collaborative research'; 'increasing demands on time'; 'gender issues' and 'developing effective collaborative networks across Taiwan and Asia'. Participants described Taiwanese scholarship development in terms of fulfilling the missions of universities; trying to balance work and culturally relevant family responsibilities, against a background of decreasing pressures to produce more qualified nurses and being more research productive in rapidly changing and challenging work environments. CONCLUSIONS: Taiwan's nursing scholarship is in a dynamic early stage of development, with increasing graduate programmes and research productivity, evidenced by rising international publications and the research productivity indexes of academics. However, scholars are facing increasing pressure because of high workloads and balancing family and work responsibilities. RELEVANCE TO CLINICAL PRACTICE: Understanding scholarship development and its facilitators and barriers in Taiwan helps inform policy makers, the higher education sector and nurses in the country and across the region about what needs to be done to improve nursing practice, raise health outcomes and enhance nursing research productivity and education.

Religiosity influences on bereavement adjustments of older widows in Taiwan.

AIMS: To describe difficulties encountered by older widows in Taiwan and the impact of intrinsic or extrinsic religiosity on their coping strategies during early widowhood. BACKGROUND: There is very limited information about how Taiwan's widows cope with their bereavement and no studies reporting the relationship between religious beliefs and healthy adjustment during this distressing period. DESIGN: Between-method qualitative and quantitative triangulation was used. Semi-structured interviews were conducted and transcribed data were analysed by critical thematic analysis. RESULTS: Twenty women in Taiwan, >65 years old, (mean = 72.95) were interviewed within three years of being widowed. There were two informant groups: those with intrinsic religious beliefs and those with extrinsic religious beliefs. They all reported intrapersonal and interpersonal problems. Several major coping strategies arose: 'practising positive or negative attitudes for adaptation'; 'using person-focused actions'; and 'taking the initiative or passively seeking help from others or helping others'. Informants with intrinsic religious beliefs reported fewer coping problems by holding positive attitudes and taking multiple actions for adaptation. The extrinsic religious group had more negative adaptation attitudes, such as withdrawal and low self-esteem and practised less faith religious activities in worshipping ancestors, experiencing fatalism and using divination. They reported more coping problems than the intrinsic religious group. CONCLUSION: Widows in Taiwan have different coping problems and strategies in postbereavement adjustment, affected by their different religious beliefs systems. More research is required to establish the generalisabilty of these findings. RELEVANCE TO CLINICAL PRACTICE: Widows in Taiwan need to be assessed for their religious belief systems and how this affects their ability to cope during bereavement. Clinicians should actively provide grief support and encourage new methods of social adaptation, especially with widows with extrinsic religious beliefs who may have less self-esteem and negative adaptation behaviours.

Health Needs Instrument for hospitalized single-living Taiwanese elders with heart disease: triangulation research design.

AIM: The aims of this study were (a) to explore the health needs of hospitalized Taiwanese older people with heart disease who live alone in the community; (b) to develop an instrument to assess their health needs and (c) to examine relationships among their health needs. DESIGN: Three phases were involved in this between-method triangulation design. METHODS: The first phase explored the contextual content of the health needs from the perspectives of a purposive sampling of 34 subjects by the use of an explorative qualitative method. The second phase developed the Health Needs Instrument (HNI) and established its reliability and validity. The last phase implemented the instrument in a cohort and examined their appraisals of each type of health need as well as the relationships among different types of health needs. RESULTS: The HNI encompasses the following five types of health needs: help in managing tangible things, psychological support, medical support, obtaining health information and participation in decision-making. In the last phase, a purposive sample of 54 subjects (48 men and 6 women) with an average age of 75.3 years was obtained. Subjects' health needs were ranked as obtaining health information (100%), participation in decision-making (96%), managing tangible issues (87%), medical support (86%) and psychological support (67%). Detailed items for each type of health need were revealed. By examining the relationship between their health needs, the psychological needs in confronting the subjects' physical discomfort had a significant correlation with medical support (r = 0.469, P < 0.01), with tangible needs after surgery or an invasive examination (r = 0.460, P < 0.01), with informational needs (r = 0.393, P = 0.034) and with tangible needs of maintaining daily living activities during the hospitalization period (r = 0.290, P = 0.034). The need for tangible help in maintaining daily living activities during the hospitalization period was significantly correlated with the need for medical support (r = 0.341, P = 0.012), with help in managing admissions and discharge procedures (r = 0.374, P = 0.05) and with help after an invasive examination or in the postsurgery period (r = 0.334, P = 0.013). CONCLUSION: Finally, a conceptual framework was developed to depict this phenomenon. With the help of this HNI, both Eastern and Western health care providers can be empowered to detect the complex health needs of this particular population earlier and more accurately in order to promote their well-being as well as their health-related quality of life. RELEVANCE TO CLINICAL PRACTICE: Empowering nurse clinicians to assess health needs of hospitalized single-living Taiwanese elders with heart disease.