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1.
J Adv Nurs ; 76(6): 1355-1363, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32056269

RESUMO

AIMS: The purpose of this study was to validate patient's primary caregiver and their nurse's perception of patient discharge readiness assessment and their association with postdischarge medical consumption. DESIGN: The study employed a descriptive research, prospective longitudinal study design. METHOD: The study was performed in a ward of a medical centre in Taipei, Taiwan, from June 2017-May 2018. Obtained data were analysed using an independent t test, one-way ANOVA and logistic regression approach. RESULTS/FINDINGS: The number of comorbidities and the number of days of hospital stay were positively associated with post discharge emergency room visits. Caregiver readiness for hospital discharge had significant negative correlation with patient's 30-day readmission. Both caregiver and nurse readiness for the hospital discharge scale score were not factors associated with the patients' 30-day emergency room visit. CONCLUSION: Based on the research findings, to assess the discharge readiness as perceived by caregivers at patients' discharge is recommended. IMPACT: Caregiver and nurse scores on readiness for hospital discharge showed a significant positive correlation. The higher the score of a caregiver's readiness for a patient's hospital discharge, the lower the 30-day readmission rate. Family-centred care enables patients to safely pass though the transition phase from hospital to community and reduces the postrelease consumption of medical resources. The discharge readiness perceived by caregivers should be included in any decision-making.

2.
J Affect Disord ; 264: 425-429, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31767216

RESUMO

OBJECTIVE: This study aimed to investigate the association of psychiatric and physical illnesses with suicide in older adults in Taiwan. METHODS: A nationwide database in Taiwan was used for this matched case-control study. Elderly participants with and without intentional self-harm from 2010 to 2012 were matched by propensity score by calendar year, gender, age, and area of residence. Psychiatric and physical illnesses were identified by tracing back 1 year from the date of death in suicide and from July 1 of the previous year to June 30 of the observational year in the controls. Associations between illnesses and the risk of suicide was assessed by conditional logistic regression analysis. RESULTS: 2,528 older adults who died by suicide were studied, and the crude suicide mortality rate was 33.7 per 100,000. The risk of suicide in older adults with depression (AOR = 9.06, 95% CI = 6.07-13.52), cancer (AOR = 8.51, 95% CI = 5.39-13.45) and schizophrenia (AOR = 7.34, 95% CI = 2.65-20.33), were significantly higher than control group. Other illnesses, such as bipolar disorder, chronic obstructive pulmonary disease, stroke, chronic kidney disease, hypertension, and diabetes mellitus (AOR = 3.63, 2.41, 1.94, 1.73, 1.68, 1.45, respectively), showed lower risk but still significantly higher in older adults with suicide. CONCLUSIONS: Psychiatric and physical illnesses, especially depression, cancer, and schizophrenia, were found to be independently associated with suicide in older adults. The result of this study can help clinicians to identify older adults at risk of suicide and open avenues for prevention.

3.
BMC Musculoskelet Disord ; 20(1): 628, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881878

RESUMO

BACKGROUND: Hip hemiarthroplasty (HHA) is a common treatment for hip fractures in the elderly population. Because of the fatal effects of bone cement implantation syndrome, the safety of cement utilization to enhance implant firmness in the femur is controversial. The aim of this study was to investigate the postoperative survival of elderly patients receiving HHA with and without cement fixation. METHODS: Claim data from the National Health Insurance Database and the National Register of Deaths Database were used for analysis in this retrospective cohort study. From 2008 to 2014, 25,862 patients aged 80 years or older treated with hip hemiarthroplasty were included in the analysis. A Cox proportional risk model was used to analyse the effects of cement utilization on postoperative mortality. RESULTS: The cemented group had a significantly higher mortality risk than the non-cemented group within 7, 30, 180 days and 1 year after the operation. The effect of bone cement on postoperative mortality was significantly stronger within 7 days than within 30, 180 days and 1 year. In addition, the male gender, age > 85 years and higher score on the Charlson Comorbidity Index were also risk factors for mortality (p < 0.05). Patients who received HHA in lower-volume hospitals had higher mortality rates within 180 days and 1 year than those in higher-volume hospitals. Compared with patients who were operated on by high-volume surgeons, those who received surgery performed by lower-volume surgeons were more likely to die within 30 days (aHR = 1.22), 180 days (aHR = 1.16) and 1 year (aHR = 1.19), respectively. CONCLUSIONS: The postoperative mortality rate of elderly patients undergoing HHA was significantly higher in the cemented group than in the non-cemented group.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31757082

RESUMO

Objectives: To explore the influence of hospital and patient characteristics on deaths at home among inpatients facing impending death. Method: In this historical cohort study, 95,626 inpatients facing impending death from 362 hospitals in 2011 were recruited. The dependent variable was the place of death. The independent variables were the characteristics of the hospitals and the patients. A two-level hierarchical generalized linear model was used. Results: In total, 41.06% of subjects died at home. The hospital characteristics contributed to 29.25% of the total variation of the place of death. Private hospitals (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.00-1.75), patients >65 years old (OR = 1.48, 95% CI. = 1.42-1.54), married (OR = 3.15, 95% CI. = 2.93-3.40) or widowed (OR = 3.39, 95% CI. = 3.12-3.67), from near-poor households (OR = 5.16, 95% CI. = 4.57-5.84), having diabetes mellitus (OR = 1.79, 95% CI. = 1.65-1.94), and living in a subcounty (OR = 2.27, 95% CI. = 2.16-2.38) were all risk factors for a death at home. Conclusion: Both hospital and patient characteristics have an effect of deaths at home among inpatients facing impending death. The value of the inpatient mortality rate as a major index of hospital accreditation should be interpreted intrinsically with the rate of deaths at home.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31614615

RESUMO

Patients with chronic mental illness are highly vulnerable to chronic respiratory problems. We examined the influence of mental disability on respiratory infection-related utilization risk in individuals with and without mental disabilities. A population-based, retrospective cohort design and two-part model were used to analyze respiratory infection-related utilization in individuals with MDs (MD group) and a matched reference group. The respiratory infection-related utilization rate in one year was lower in the MD group (53.8%) than in the reference group (56.6%). The odds ratios (ORs) were significantly higher among individuals with profound MDs (aOR = 1.10; 95% CI 1.07-1.14) and those with a history of dental cavities (aOR = 1.16; 95% CI: 1.13-1.19) or periodontal disease (aOR = 1.22; 95% CI: 1.19-1.26) after controlling for covariables. The average number of visits was higher in the MD group (5.3) than in the reference group (4.0). The respiratory infection-related utilization rate and average number of visits were significantly higher in the mild, moderate and severe disabled groups with a history of periodontal disease, respectively, than that of the reference group. In conclusion, healthcare authorities must develop an incentive program to prevent respiratory infections among individuals with MDs.


Assuntos
Deficiência Intelectual/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doenças Periodontais/epidemiologia , Infecções Respiratórias/epidemiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoas com Deficiência Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-31527026

RESUMO

Change of ertapenem dosage from 500 mg daily to thrice weekly after each hemodialysis session can maintain the plasma concentration above 2 mg/L, and be practical in hemodialysis patients.

7.
Am J Manag Care ; 25(4): e126-e134, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30986022

RESUMO

OBJECTIVES: Continuity of care (COC) is a core element of primary care, which has been associated with improved health outcomes. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are potentially preventable if these conditions are managed well in the primary care setting. The aim of this article is to conduct a systematic review of literature on the association between COC and hospitalizations for ACSCs. STUDY DESIGN: Systematic literature review. METHODS: All published literature was searched for in PubMed and MEDLINE using PRISMA guidelines for collecting empirical studies. Studies published in English between 2008 and 2017 that measured the association between COC and at least 1 measure of ACSC hospitalizations were included in this review. RESULTS: A total of 15 studies met the inclusion criteria and applied claims data to examine the association between COC and ACSC hospitalizations. Most studies (93.3%) demonstrated a statistically significant association of higher COC in the outpatient setting with reduced likelihood of hospitalization for either all ACSCs or a specific ACSC. A strong association was observed among studies focusing on patients with a specific ACSC. Additionally, most studies used the Bice-Boxerman COC index to measure COC and measured COC before a period of measuring ACSC hospitalizations. CONCLUSIONS: This systematic review identified that increased COC in outpatient care is associated with fewer hospitalizations for ACSCs. Increasing COC is favorable for patients who are managing a specific ACSC.

8.
Int J Nurs Stud ; 96: 9-17, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30679035

RESUMO

BACKGROUND: Although hospice or palliative care for patients with advanced dementia has been implemented for more than 30 years, few studies have investigated the prognostic predictors of 6-month mortality in these patients. Prognostication has been a major obstacle, and 6-month prognostic predictors for patients with advanced dementia are still considered elusive. OBJECTIVES: To better understand the dying trajectories of patients with advanced dementia, we performed a longitudinal prospective cohort study to investigate the predictors of 6-month mortality for residents with advanced dementia in long-term care facilities in Taiwan. DESIGN: Prospective cohort study. SETTING: This study took place in 32 long-term care facilities selected from northern, central, and southern Taiwan. PARTICIPANTS: The study included 320 residents with advanced dementia. MEASUREMENTS: Measurements were obtained after determining study eligibility; the participants underwent follow-up assessments once every 3 months for 6 months or died during follow-up. The assessments included demographic characteristics, health and medical status characteristics, and death-related information. The Kaplan-Meier survival function estimation and the Cox proportional hazards model were used to estimate the survival rate and predict the prognostic factors. RESULTS: Baseline data from 320 residents with advanced dementia in long-term care facilities were obtained. The mean age was 82.7 years and 61.6% were female. The 6-month survival rate was 78.1%. The major cause of death was multiple organ failure related to pneumonia. The 6-month prognostic predictors were pneumonia (adjusted hazard ratio, 5.56; 95% confidence interval, 2.46-12.6; p-value < .001), reduction in nutrient intake >25% (adjusted hazard ratio, 5.05; 95% confidence interval, 2.37-10.8; p-value < .001), oxygen dependency (adjusted hazard ratio, 2.58; 95% confidence interval, 1.51-4.39; p-value = .001), treatment for electrolyte abnormalities (adjusted hazard ratio, 2.14; 95% confidence interval, 1.10-4.14; p-value = .025), severe pressure injuries (adjusted hazard ratio, 2.04; 95% confidence interval, 1.13-3.67; p-value = .018), and long-term indwelling urinary catheters (adjusted hazard ratio, 1.80; 95% confidence interval, 1.09-2.96; p-value = .021). CONCLUSION: Our results identified six prognostic predictors of 6-month mortality among residents with advanced dementia in Taiwan. These predictors may serve as risk assessment indicators for nursing staff who provide clinical care and can enable the identification of patients in recognized terminal decline, thereby allowing access to hospice palliative services.


Assuntos
Demência/mortalidade , Casas de Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Assistência de Longa Duração , Masculino , Prognóstico , Estudos Prospectivos , Taiwan
9.
J Adv Nurs ; 75(3): 640-651, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30375013

RESUMO

AIM: To determine whether acupressure can prevent or relieve the adverse drug reactions (ADRs) of anti-tuberculosis drugs. BACKGROUND: People receiving drug treatment for TB often experience ADRs that may cause them to stop taking their medication. Acupressure is a form of traditional Chinese medicine that can be applied to alleviate or prevent disease symptoms. DESIGN: A double-blinded, repeated-measures clinical trial in hospitals in Taiwan was carried out from April 2015 - May 2017. METHODS: Convenience sampling was used to select 32 people (15 for the experimental group and 17 for the control group) aged >20 years who were taking anti-tuberculosis drugs. The people were randomized to receive 4-week of true acupressure and 4-weeks of sham acupressure. Acupressure therapy was given by a researcher in all cases. Both groups received treatment once per day on weekdays, with 15 min for each acupressure session. Outcomes (gastrointestinal irritation and adverse skin reactions) were assessed according to the people feedback and the physicians' recordings during the treatment course, and during monthly follow-up visits for 6 months thereafter. RESULTS: Both groups typically experienced gastrointestinal irritation and adverse skin reactions within 2 months of beginning anti-tuberculosis drug treatment. The 4-weeks intervention involving relevant acupressure points successfully relieved both types of side effects in both immediate and delayed manner. CONCLUSIONS: When correctly implemented, acupressure can prevent and relieve the ADRs of anti-tuberculosis drugs, and motivate people to complete their treatment course.


Assuntos
Acupressão/métodos , Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , Erupção por Droga/fisiopatologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Trato Gastrointestinal/fisiopatologia , Tuberculose/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Taiwan , Resultado do Tratamento
10.
Ann Surg Oncol ; 26(2): 506-513, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30430325

RESUMO

BACKGROUND: The benefits of neoadjuvant chemoradiation (NCRT) compared to upfront esophagectomy (UE) in esophageal squamous cell carcinoma (ESCC) is controversial. Our purpose was to determine whether clinical stages based on the 8th edition American Joint Committee on Cancer Tumor-Node-Metastasis staging system could guide treatment decision. METHODS: Data from 2503 patients with clinical stages II and III ESCC diagnosed between 2008 and 2014 were obtained from a nationwide database. Propensity score matching was used to identify well-balanced pairs of patients. Cox proportional hazards regression and log-rank test were used in the survival analysis. The outcomes of patients receiving "NCRT followed by surgery" or "UE" strategies were compared. RESULTS: The treatment modality (UE or NCRT) was not a prognostic factor in clinical stage II ESCC (HR: 0.97; p = 0.778). In contrast, the UE group demonstrated a significantly worse outcome compared with the NCRT group in clinical stage III ESCC (HR: 1.39; p < 0.001). After matching, patients who underwent UE for clinical stage II ESCC had median survival/3-year overall survival (OS) rates of 27.8 months/39.2% compared with 32.7 months/49.8% in the NCRT group (p = 0.508). The patients who underwent UE for clinical stage III ESCC had median survival/3-year OS rates of 17.9 months/28.2% in the UE group compared with 24.0 months/41.8% in the NCRT group (p < 0.001). CONCLUSIONS: Our data suggest that NCRT strategy improved survival compared with UE in clinical stage III ESCC but not in clinical stage II tumors.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Quimiorradioterapia Adjuvante/mortalidade , Neoplasias Esofágicas/mortalidade , Esofagectomia/mortalidade , Terapia Neoadjuvante/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Taxa de Sobrevida
11.
Health Policy ; 123(2): 222-228, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30466799

RESUMO

OBJECTIVE: To investigate associations between continuity of care (COC) and emergency department (ED) visits and hospitalization for chronic obstructive pulmonary disease (COPD) or asthma among elderly adults with asthma-COPD overlap (ACO). METHODS: A retrospective cohort study was performed using the Taiwan National Health Insurance research database. A total of 1141 ACO patients aged ≥65 years during 2005-2011 were observed and followed for 2 years. The Bice and Boxerman COC index (COCI) was used to evaluate COC by considering ambulatory care visits duo to COPD or asthma in the first year; ED visits and hospitalization for COPD or asthma were identified in the subsequent year, respectively. The COCI was divided into three levels (COCI < 0.3= low, 0.3 ≤ COCI<1=medium, COCI = 1=high). The Cox model was used to estimate the hazard ratio (HR) for ED visits and hospital admissions due to COPD or asthma. RESULTS: The average COCI was 0.55. 21.3% patients received outpatient care from a single physician. Compared to patients with high COC, those with low and medium COC had a higher risk of ED visits (aHR = 2.80 and 2.69, P < .01) and admissions (aHR = 1.80 and 1.72, P < .05). CONCLUSION: Increasing COC is beneficial for elderly patients with ACO in disease management. Policymakers could create effective pay-for-performance programs for the elderly ACO population to enhance COC and improve care outcomes.

12.
Ann Thorac Surg ; 107(4): 1060-1067, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30571951

RESUMO

BACKGROUND: This study compared survival between definitive chemoradiotherapy (CRT) and esophagectomy alone among patients with locoregional esophageal squamous cell carcinoma (SCC). METHODS: Data were obtained from the Taiwan Cancer Registry between 2008 and 2014. Included were 5,487 patients with clinical I, II, or III esophageal SCC who received definitive CRT or esophagectomy alone. Patients were stratified according to clinical stage. Overall survival was compared between patients treated with definitive CRT versus esophagectomy alone, and between patients in the three different clinical stages. Propensity-matched analysis along with univariate and multivariate analysis were performed. RESULTS: Treatment was with definitive CRT in 4,251 patients (77.50%) and esophagectomy alone in 1,236 (22.50%). Propensity score matching produced 1,020 patients for comparison. The overall survival rates at 1, 2, and 3 years were 60.92%, 34.96%, and 26.14%, respectively, for propensity-matched patients treated with definitive CRT and were 71.15%, 56.50%, and 46.17%, respectively, for propensity-matched patients treated with esophagectomy alone (p < 0.001). Multivariate analysis showed treatment strategy was an independent prognostic factor. Esophagectomy alone was associated with significantly better overall survival than definitive CRT for patients with clinical stage I/II disease. There was no survival risk difference between definitive CRT and esophagectomy only for patients with clinical stage III disease. CONCLUSIONS: Esophagectomy alone could provide better survival than definitive CRT for patients with clinical stage I/II esophageal SCC. However, definitive CRT and esophagectomy yield similar overall survival rates in clinical stage III patients.


Assuntos
Quimiorradioterapia/mortalidade , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/mortalidade , Carcinoma de Células Escamosas do Esôfago/terapia , Esofagectomia/mortalidade , Idoso , Quimiorradioterapia/métodos , Estudos de Coortes , Intervalo Livre de Doença , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Esofagectomia/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Prognóstico , Pontuação de Propensão , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Taiwan , Resultado do Tratamento
13.
Ann Surg Oncol ; 25(13): 3820-3832, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30284131

RESUMO

BACKGROUND: Current esophageal treatment guidelines suggest that, when more than 15 lymph nodes are detected, dissection should be done as the minimum requirement for staging in esophageal squamous cell carcinoma (ESCC) patients undergoing esophagectomy without induction chemoradiotherapy (CRT). However, for neoadjuvant CRT, there is limited information. We sought to clarify the role of lymphadenectomy in ESCC patients with and without neoadjuvant CRT. PATIENTS AND METHODS: Data on 3156 ESCC patients receiving esophagectomy with (group 1, n = 1399) and without (group 2, n = 1757) neoadjuvant CRT between 2008 and 2014 were collected from a national cancer registry in Taiwan. The impact of the resected lymph nodes on overall survival was assessed according to pathologic stages. A Cox regression model was used to identify prognostic factors for overall survival. RESULTS: Five-year overall survival rates were 35.6% for the entire group, 30.32% for group 1, and 39.55% for group 2 (p < 0.0001 for group 1 vs group 2). The best cutoff value was 21 lymph nodes in both group 1 and group 2. In group 1, the independent prognostic factors included age ≥ 54 years, clinical N status, y-pathologic T, y-pathologic N, y-pathologic stage, grade, location, margin status, esophagectomy (thoracoscopic vs open), and number of total resected lymph nodes (≤ 21 vs > 21). For group 2, the independent prognostic factors were gender, clinical stage, pathologic T, pathologic N, tumor length, grade, and margin status. CONCLUSIONS: Extent of lymphadenectomy was associated with survival in patients with neoadjuvant CRT followed by esophagectomy. The optimum lymphadenectomy should be modulated by pathologic stage.


Assuntos
Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/secundário , Carcinoma de Células Escamosas do Esôfago/terapia , Excisão de Linfonodo , Linfonodos/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia Adjuvante , Esofagectomia , Feminino , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Gradação de Tumores , Estadiamento de Neoplasias , Neoplasia Residual , Sistema de Registros , Fatores Sexuais , Taxa de Sobrevida , Carga Tumoral , Adulto Jovem
14.
Cancer Med ; 7(9): 4193-4201, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30047253

RESUMO

The prognosis of esophageal squamous cell carcinoma is poor. In order to find out appropriate treatment for each group of patients, we aim to examine the prognostic factors influencing survival for esophageal cancer patients in Taiwan. Data were obtained from the Taiwan Society of Cancer Registry. There were 14,394 esophageal cancer patients analyzed between 2008 and 2014 in this retrospective review. The impact of the clinicopathologic factors on overall survival was assessed. The following clinic-pathologic factors were included to analyses: age, sex, tumor location, tumor length, histologic grade, clinical T, clinical N, clinical M, clinical stage, and all therapeutic methods within 3 months after diagnosis. The 5-year survival rate was 16.8%, with a median survival of 343 days. The distribution of patients by their clinical stage is as follows: stage 0 (n = 162; 1.1%); stage I (n = 964; 6.7%); stage II (n = 2392; 16.6%); stage III (n = 6636; 46.1%); and stage IV (n = 3661; 25.4%). In the multivariate analysis, age, sex, tumor location, tumor length, clinical T, clinical N, clinical M, and treatment remained independent prognostic factors. Our data indicated that age, sex, tumor location, tumor length, clinical T, clinical N, clinical M, and treatment remained independent prognostic factors. Patients who could receive surgery had significantly better outcomes.


Assuntos
Carcinoma de Células Escamosas do Esôfago/epidemiologia , Adulto , Idoso , Terapia Combinada , Neoplasias Esofágicas/epidemiologia , Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/diagnóstico , Carcinoma de Células Escamosas do Esôfago/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Modelos de Riscos Proporcionais , Vigilância em Saúde Pública , Taiwan/epidemiologia
15.
Sci Rep ; 8(1): 2180, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29391589

RESUMO

Adjuvant chemoradiation is reported to have a survival benefit for esophageal squamous cell carcinoma (ESCC). We evaluated the "upfront surgery and pathological stage-based adjuvant chemoradiation" strategy, in which adjuvant therapy is guided by pathological stage, in locally advanced ESCC. Data from 2976 clinical stage II/III ESCC patients, including 1735 in neoadjuvant chemoradiation and 1241 in upfront surgery groups, were obtained from a nationwide database. Patients in the upfront surgery group were further categorized into the "upfront surgery and pathological stage-based adjuvant chemoradiation" and "upfront surgery only" groups. The 3-year overall survival (OS) rates in the "neoadjuvant chemoradiation", "upfront surgery and pathological stage-based adjuvant chemoradiation", and "upfront surgery only" groups were 41.5%, 45.8%, and 28.5%, respectively. In propensity score matched patients, the 3-year OS rate was 41.7% in the neoadjuvant chemoradiation group, compared to 35.6% in the "upfront surgery and pathological stage-based adjuvant chemoradiation" group (p = 0.147), and 20.3% in the "upfront surgery only" group (p < 0.001). No survival difference was observed between the "neoadjuvant chemoradiation followed by surgery" protocol and the "upfront surgery and pathological stage-based adjuvant chemoradiation" strategy.


Assuntos
Carcinoma de Células Escamosas/terapia , Quimiorradioterapia Adjuvante/mortalidade , Neoplasias Esofágicas/terapia , Esofagectomia/mortalidade , Terapia Neoadjuvante/mortalidade , Carcinoma de Células Escamosas/patologia , Terapia Combinada , Neoplasias Esofágicas/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Taxa de Sobrevida , Resultado do Tratamento
16.
Ann Thorac Surg ; 105(5): 1516-1522, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29409986

RESUMO

BACKGROUND: The eighth edition of the American Joint Committee on Cancer Tumor-Node-Metastasis staging system separates classifications for the clinical (c), pathologic (p), and postneoadjuvant pathologic (yp) stages. We aimed to evaluate its application in patients with esophageal squamous cell carcinoma (ESCC). METHODS: Patient data were obtained from the Taiwan Cancer Registry database. Patients who underwent esophagectomy for c stage I to III ESCC were included for survival analysis. RESULTS: Data of 3,399, 1,805, and 1,594 patients were included for c, p, and yp staging, respectively. The 3-year overall survival (OS) rates for c stage I, II, and III were 67.4%, 46.7%, and 38.4%, respectively. The 3-year OS rates for p stage I, II, III, and IV were 70.7%, 49.8%, 30.8%, and 10.6%, respectively. The 3-year OS rates for yp stage I, II, III, and IV were 59.4%, 37.8%, 27.6%, and 3.7%, respectively. Survival curve analysis demonstrated a robust discriminatory capability and monotonicity of gradients of the new system. However, yp stage I was observed in a heterogeneous group of patients with substantial survival differences. Meanwhile, patients in the ypT0 N0 stage had a 5-year OS rate of 52.1%, which was equivalent to that of patients with p stage I (54.5%). The 5-year OS rate of patients in the ypTis-2N0 was 39.1%, which was equivalent to that of patients in p stage II (40.1%). CONCLUSIONS: The present study serves as an external validation of the newly released staging system in the prognostication of patients with ESCC and suggests subgrouping of the yp stage I into ypT0 N0 and non-ypT0 N0 in the future.


Assuntos
Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/mortalidade , Carcinoma de Células Escamosas do Esôfago/patologia , Estadiamento de Neoplasias , Adulto , Idoso , Bases de Dados Factuais , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida , Taiwan
17.
Health Policy ; 121(9): 1001-1007, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28751032

RESUMO

OBJECTIVE: To examine the effects of high continuity of care (COC) maintained for a longer time on the risk of avoidable hospitalization of patients with chronic obstructive pulmonary disease (COPD). METHODS: A retrospective cohort study design was adopted. We used a claim data regarding health care utilization under a universal health insurance in Taiwan. We selected 2199 subjects who were newly diagnosed with COPD. We considered COPD-related avoidable hospitalizations as outcome variables. The continuity of care index (COCI) was used to evaluate COC as short- and long-term COC. A logistic regression model was used to control for sex, age, low-income status, disease severity, and health status. RESULTS: Long-term COC had stronger effect on health outcomes than short-term COC did. After controlling for covariables, the logistic regression results of short-term COC showed that the medium COCI group had a higher risk of avoidable hospitalizations (adjusted odds ratio [AOR]: 1.89, 95% CI: 1.07-3.33) than the high COCI group did. The results of long-term COC showed that both the medium (AOR: 1.98, 95% CI: 1.0-3.94) and low (AOR: 2.03, 95% CI: 1.05-3.94) COCI groups had higher risks of avoidable hospitalizations than did the high COCI group. CONCLUSIONS: Maintaining long-term high COC effectively reduces the risk of avoidable hospitalizations. To encourage development of long-term patient-physician relationships could improve health outcomes.


Assuntos
Continuidade da Assistência ao Paciente , Hospitalização/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Taiwan/epidemiologia
18.
J Am Board Fam Med ; 30(3): 384-395, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28484073

RESUMO

BACKGROUND: Continuity of care (COC) is positively associated with health care outcomes. However, the effect of COC on the reduction of asthma-related emergency department (ED) visits among older asthmatic patients is not clearly understood. METHODS: We conducted a retrospective cohort study using the Taiwan nationwide health insurance claims database between 2004 and 2013. Patients aged 65 years with asthma during 2005 to 2011 were selected. The COC index (COCI) is used to measure the number of individual physicians a patient sees in the first year and we identified asthma-related ED visit in the subsequent year. Cox model was used to examine the hazard ratio (HR) between COC and an ED visit for asthma. RESULTS: Among a total of 3395 subjects, the overall mean COC was 0.73, and 48.5% of subjects had perfect COC (COCI = 1). After controlling for covariables, in the group of patients with low COC, the risk of having an asthma-related ED visit was higher compared with those with perfect COC (Adjusted HR, 2.11; 95% CI, 1.37-3.25). CONCLUSIONS: Elderly asthmatic patients with lower COC had a significantly higher likelihood of having asthma-related ED visits.


Assuntos
Assistência Ambulatorial/organização & administração , Asma/terapia , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Programas Nacionais de Saúde/organização & administração , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Masculino , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taiwan
19.
J Thorac Cardiovasc Surg ; 154(2): 732-740.e2, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28457536

RESUMO

OBJECTIVES: Although preoperative chemoradiation followed by surgery has been recognized as an efficient strategy for esophageal cancer treatments, several studies demonstrate survival benefits of postoperative chemoradiation for those undergoing upfront resection. The optimal sequence of surgery and chemoradiation remains unclear. METHODS: Data of 1647 patients with clinical stage II/III esophageal squamous cell carcinoma (ESCC), including 1245 receiving preoperative chemoradiation followed by esophagectomy (pre-OP CRT group) and 402 receiving primary esophagectomy followed postoperative chemoradiation (post-OP CRT group), were obtained from a nationwide database. Propensity score matching identified 286 well-balanced pairs for outcome comparison. RESULTS: In matched patients, the 3-year overall survival (OS) rates/median survival were not significantly different between the 2 groups (44.0% 3-year OS/26.0 months; 95% confidence interval [CI], 18.9-89 38.0 months) in the pre-OP CRT group, versus 37.9% 3-year OS/23.5 months (95% CI, 18.5-29.9 months) in the post-OP CRT group, P = .3152). The 3-year disease-free survival rates (DFS)/median survival after surgery were 38.7% 3-year DFS/16.7 months (95% CI, 11.9-29.6 months) in the pre-OP CRT group, compared with 30.2% 3-year DFS/10.4 months (95% CI, 7.6-14.0 months) in the post-OP CRT group (P = .0674). In patients who had complete resection, the freedom from recurrence rate at 1 year after surgery was 74.8% and 67.6% in pre-OP CRT and post-OP CRT groups, respectively (P = .2696). In the multivariable analysis, treatment modality (pre- or post-OP CRT) was not a significant factor for OS (P = .258) or disease-free survival (P = .521). CONCLUSIONS: Similar outcome can be achieved with postoperative chemoradiotherapy compared with preoperative chemoradiotherapy in patients with locally advanced ESCC. There is little difference between these 2 strategies.


Assuntos
Carcinoma de Células Escamosas/terapia , Quimiorradioterapia/métodos , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Análise de Sobrevida
20.
Compr Psychiatry ; 74: 189-195, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28213305

RESUMO

PURPOSE: Suicide in the older people is a serious problem worldwide; however the effect of psychiatric contact on the risk of suicide has not been fully explored. The aim of this study was to investigate the relationship between psychiatric contact and suicide in the older people in Taiwan. METHODS: A population-based database was used in this national case-control study. Propensity score matching was used to match older people who did and did not commit suicide from 2010 to 2012 by calendar year, gender, age, and area of residence. The level of psychiatric contact in the preceding year was classified as "no psychiatric contact," "only outpatient psychiatric contact," "psychiatric emergency room contact," or "psychiatric hospital admission". Conditional logistic regression analysis was used to assess associations between variables and the risk of suicide. RESULTS: A total of 2528 older people committed suicide from 2010 to 2012, with a crude suicide mortality rate of 3.37/10,000. Compared to those who had no psychiatric contact in the preceding year, the adjusted odds ratios of suicide were 10.15 (95% CI=5.8-17.7) for those who had psychiatric emergency room contact, 6.57 (95% CI=3.7-11.6) for those who had psychiatric hospital admissions, and 3.64 (95% CI=3.0-4.4) for those with only outpatient psychiatric contact. The risk of suicide was higher in those who had depression (OR=3.49, 95% CI=2.2-5.4) and bipolar disorder (OR=1.98, 95% CI=1.1-3.6). Patients with cancer were associated with suicide (OR=8.96, 95% CI=5.6-14.4). CONCLUSIONS: The positive association with suicide and the level of psychiatric contact in the preceding year in older people indicated that the health personnel need to do a better job in determining possible risk for older people who had psychiatric contact, especially in emergency visit or psychiatric admission. A systematic approach to quality improvement in these settings is both available and necessary. Careful discharge planning and safe transitions of care to outpatient services are required for suicide prevention of high-risk patients after discharge.


Assuntos
Bases de Dados Factuais/tendências , Transtornos Mentais/psicologia , Programas Nacionais de Saúde , Suicídio/psicologia , Suicídio/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitalização/tendências , Humanos , Masculino , Transtornos Mentais/epidemiologia , Alta do Paciente/tendências , Fatores de Risco , Taiwan/epidemiologia
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