Effect of national pre-ESRD care program on expenditures and mortality in incident dialysis patients: A population-based study.

Inadequate care of chronic kidney disease (CKD) is common and may be associated with adverse outcomes after dialysis. The nationwide pre-end-stage renal disease pay for performance program (P4P) has been implemented in Taiwan to improve quality of CKD care. However, the effectiveness of the P4P program in improving the outcomes of pre-dialysis care and dialysis is uncertain. We conducted a longitudinal cohort study. Patients who newly underwent long-term dialysis (≥3 mo) between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. Based on the patient enrolment of the P4P program, they were categorized into P4P or non-P4P groups. We analysed pre-dialysis care, healthcare expenditures, and mortality between two groups. Among the 26 588 patients, 25.5% participated in the P4P program. The P4P group received significantly better quality of care, including a higher frequency of glomerular filtration rate measurement and CKD complications survey, a higher rate of vascular access preparation, and more frequent use of arteriovenous fistulas than the non-P4P group did. The P4P group had a 68.4% reduction of the 4-year total healthcare expenditure (excluding dialysis fee), which is equivalent to US$345.7 million, and a significant 22% reduction in three-year mortality after dialysis (hazard ratio 0.78, 95% confidence interval: 0.75-0.82, P < 0.001) compared with the non-P4P group. P4P program improves quality of pre-dialysis CKD care, and provide survival benefit and a long-term cost saving for dialysis patients.

Prostate Cancer Mortality-To-Incidence Ratios Are Associated with Cancer Care Disparities in 35 Countries.

The variation in mortality-to-incidence ratios (MIRs) among countries reflects the clinical outcomes and the available interventions for colorectal cancer treatments. The association between MIR of prostate cancer and cancer care disparities among countries is an interesting issue that is rarely investigated. For the present study, cancer incidence and mortality rates were obtained from the GLOBOCAN 2012 database. The rankings and total expenditures on health of various countries were obtained from the World Health Organization (WHO). The association between variables was analyzed by linear regression analyses. In this study, we estimated the role of MIRs from 35 countries that had a prostate cancer incidence greater than 5,000 cases per year. As expected, high prostate cancer incidence and mortality rates were observed in more developed regions, such as Europe and the Americas. However, the MIRs were 2.5 times higher in the less developed regions. Regarding the association between MIR and cancer care disparities, countries with good WHO ranking and high total expenditures on health/gross domestic product (GDP) were significant correlated with low MIR. The MIR variation for prostate cancer correlates with cancer care disparities among countries further support the role of cancer care disparities in clinical outcome.

Gastroprotective potential against indomethacin and safety assessment of the homology of medicine and food formula cuttlebone complex.

Cuttlebone complex (CBC), a homology of medicine and food formula, is comprised of five herbal medicines (Endoconcha Sepiae, Radix Paeoniae Rubra, fresh ginger, Fructus Amomi, and Radix Glycyrrhizae) and two food ingredients (Zingiber zerumbet and chitosan). Herein, the gastroprotective potential against indomethacin and a safety assessment of CBC were investigated. In a gastroprotective model, CBC effectively decreased the indomethacin-increased gastric ulcerous lesions, and increased the indomethacin-decreased prostaglandin E2 levels in the gastric mucosa. In genotoxicity tests, CBC treatment did not increase the numbers of revertant colonies in five Salmonella typhimurium strains and chromosome aberrations in Chinese hamster ovary CHO-K1 cells, with or without S9 metabolic activation. The oral supplementation of CBC did not increase micronucleus formation in the peripheral blood of mice. In a subacute toxicity study, the body weight and blood biochemical parameters observed in CBC-treated rats were normal. In conclusion, CBC was considered as a non-toxic formula and could be used to remedy indomethacin-induced gastric damage.

Confidentiality modelling and simulation and validation in a simplified database access.

In a simplified secured database access model, privileged group and public group can access data with any distribution. In order to secure the database, the confidentiality policy must be applied. Often, the management of the database privacy is neglected because data integrity has a higher priority in an environment dealing with insensitive data. This paper looked into the data confidentiality management and suggested use semi-Markov chains to model the security policy. A simulation experiment was used to validate the model.

Intensive care unit staff nurses: predicting factors for career decisions.

AIMS AND OBJECTIVES: The aim of this study was to understand the factors related to intention to leave their job among intensive care unit (ICU) nurses in eastern Taiwan and to make between-group comparisons between an intention to leave and an intention to stay as well as to predict the influencing factors that affect ICU staff nurses' intention to leave. BACKGROUND: Nurses' intention to leave their job may have an important impact on the actual turnover of nurses. The issue has always been of concern to nursing executives. Only limited empirical studies in the area have been investigated in an Asian culture context and particularly the eastern Taiwan region. METHODS: A cross-sectional predictive study was performed during 2005 with 130 nurses recruited from two ICUs at a medical centre. A researcher-designed questionnaire based on the Cooper's model with structured interviews was used to determine each nurse's characteristics and their intention to leave their job. Multiple logistic regression analysis was employed to investigate the various factors associated with this. RESULTS: The overall response rate was 100%; 63 (48.9%) revealed that they intended to leave their jobs. The findings were that their self-rated health status, the number of diseases, the level of happiness, the presence of depression, job satisfaction, sleep quality, type of license and their unit were significantly associated with an intention to leave (p = 0.05-0.001). Depression and sleep quality proved to be the most significant predictors of ICU staff nurses' intention to leave their job. CONCLUSIONS: The findings suggest that there is a need to take steps to improve nurses' health-related quality of life and to develop effective strategies to improve nurse retention. RELEVANCE TO CLINICAL PRACTICE: A succinct validated instrument would help identify the important factors that predict ICU nurses' intention to leave their job, which may result in job disengagement. Predictors found in this study may be used as outcome variables for developing such an effective method of improving nurse retention in ICUs.

Assessment of salivary function change in nasopharyngeal carcinoma treated by parotid-sparing radiotherapy.

PURPOSE: The purpose of this study was to evaluate function of major salivary glands, subjective xerostomia, and correlation between subjective and objective xerostomia scoring after precision-oriented radiotherapy for nasopharyngeal carcinoma. MATERIALS AND METHODS: From 2000 to 2002, 34 patients with histologically proven non-metastatic nasopharyngeal carcinoma received definitive therapy by parotid-sparing radiotherapy, which included intensity-modulated radiotherapy (33 patients>60 Gy), 3D-conformal radiotherapy, and brachytherapy boost. Salivary function was assessed by sialoscintigraphy pre-irradiation and post-irradiation at 1, 6, 12, and 18 months. The salivary stimulated secretion ratio (SSR) was used to evaluate function of submandibular and parotid glands. Subjective and objective xerostomia was monitored by the LENT/SOMA system. RESULTS: The median dose to parotid gland was 34.6 Gy (interquartile range, 32.9-36.5 Gy). The median dose to submandibular gland was 60.5 Gy (interquartile range, 58.1-61.5 Gy). Parotid-gland post-irradiation median SSR at 1 (0.01, P=0.000) and 6 (0.08, P=0.002) months showed significant reduction compared with pre-irradiation data (0.30). After 12 months, parotid-gland median SSR (12 months, 0.22, P = 0.734; 18 months, 0.16, P=0.885) lost significance compared with pre-irradiation data. Submandibular-gland post-irradiation median SSR at 1 (P=0.000), 6 (P=0.000), 12 (P=0.000), and 18 (P=0.000) months all showed significant reduction compared with pre-irradiation data. There were significant correlations between LENT/SOMA subjective and objective xerostomia scores at 6 months (r=0.657, P=0.000), 12 months (r=0.480, P=0.013), and 18 months (r=0.591, P=0.002). CONCLUSIONS: With parotid-sparing radiotherapy for nasopharyngeal carcinoma, gland function can recover significantly 12 months after radiotherapy. There were significant rank-order correlations between LENT/SOMA subjective and objective (analytic) grading scores at 6 to 18 months' follow-up.