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Huang HL, Chen PJ, Mori M, Suh SY, Wu CY, Peng JK, Shih CY, Yao CA, Tsai JS, Chiu TY, Hiratsuka Y, Kim SH, Morita T, Yamaguchi T, Tsuneto S, Hui D, Cheng SY. Improved Symptom Change Enhances Quality of Dying in Patients With Advanced Cancer: An East Asian Cross-Cultural Study. Oncologist 2024; 29:e553-e560. [PMID: 37758042 PMCID: PMC10994251 DOI: 10.1093/oncolo/oyad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Symptom burdens tend to increase for patients with cancer and their families over the disease trajectory. There is still a lack of evidence on the associations between symptom changes and the quality of dying and death. In this context, this research investigated how symptom changes influence the quality of dying and death. METHODS This international prospective cohort study (the East Asian Collaborative Cross-Cultural Study to Elucidate the Dying Process (EASED), 2017-2019) included 22, 11, and 4 palliative care units across Japan, South Korea, and Taiwan. Eligible participants were adults (Japan and Korea, ≥18 years; Taiwan, ≥20 years) with locally advanced or metastatic cancer. Physical and psychological symptoms were assessed by physicians upon admission and within 3 days before death. Death quality was assessed using the Good Death Scale (GDS), developed in Taiwan. Univariate and multivariate regression analyses were used to identify correlations between symptom severity changes and GDS scores. RESULTS Among 998 patients (542 [54.3%] men and 456 [45.7%] women; mean [SD] age = 70.1 [± 12.5] years), persistent dyspnea was associated with lower GDS scores when compared to stable dyspnea (β = -0.427, 95% CI = -0.783 to -0.071). Worsened (-1.381, -1.932 to -0.831) and persistent (-1.680, -2.701 to -0.659) delirium were also significantly associated with lower GDS scores. CONCLUSIONS Better quality of dying and death was associated with improved symptom control, especially for dyspnea and delirium. Integrating an outcome measurement for the quality of dying and death is important in the management of symptoms across the disease trajectory in a goal-concordant manner.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Family Medicine, School of Medicine, Kaohsiung Medical University, Kaohsiung, Republic of China
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Sang-Yeon Suh
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, School of Medicine, Dongguk University, Seoul, South Korea
| | - Chien-Yi Wu
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Republic of China
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Republic of China
| | - Jen-Kuei Peng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chih-Yuan Shih
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Tatsuya Morita
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Yamaguchi
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Republic of China
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Chen PJ, Yao CA, Chien PC, Tsai HJ, Chen YR, Chuang JH, Chou PL, Lee GC, Lin W, Lin Y. Paeonol Derivative, 6'-Methyl Paeonol, Attenuates Aβ-Induced Pathophysiology in Cortical Neurons and in an Alzheimer's Disease Mice Model. ACS Chem Neurosci 2024; 15:724-734. [PMID: 38290213 DOI: 10.1021/acschemneuro.3c00633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Herbs themselves and various herbal medicines are great resources for discovering therapeutic drugs for various diseases, including Alzheimer's disease (AD), one of the common neurodegenerative diseases. Utilizing mouse primary cortical neurons and DiBAC4(3), a voltage-sensitive indicator, we have set up a drug screening system and identified an herbal extraction compound, paeonol, obtained from Paeonia lactiflora; this compound is able to ameliorate the abnormal depolarization induced by Aβ42 oligomers. Our aim was to further find effective paeonol derivatives since paeonol has been previously studied. 6'-Methyl paeonol, one of the six paeonol derivatives surveyed, is able to inhibit the abnormal depolarization induced by Aβ oligomers. Furthermore, 6'-methyl paeonol is able to alleviate the NMDA- and AMPA-induced depolarization. When a molecular mechanism was investigated, 6'-methyl paeonol was found to reverse the Aβ-induced increase in ERK phosphorylation. At the animal level, mice injected with 6'-methyl paeonol showed little change in their basic physical parameters compared to the control mice. 6'-Methyl paeonol was able to ameliorate the impairment of memory and learning behavior in J20 mice, an AD mouse model, as measured by the Morris water maze. Thus, paeonol derivatives could provide a structural foundation for developing and designing an effective compound with promising clinical benefits.
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Affiliation(s)
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei, 100225, Taiwan
| | | | | | | | | | - Pei-Li Chou
- Department of Family Medicine, National Taiwan University Hospital, Taipei, 100225, Taiwan
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Cheng YH, Yao CA, Yang CC, Hsu SP, Chien CT. Sodium thiosulfate through preserving mitochondrial dynamics ameliorates oxidative stress induced renal apoptosis and ferroptosis in 5/6 nephrectomized rats with chronic kidney diseases. PLoS One 2023; 18:e0277652. [PMID: 36795670 PMCID: PMC9934356 DOI: 10.1371/journal.pone.0277652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/01/2022] [Indexed: 02/17/2023] Open
Abstract
Chronic kidney disease (CKD) progression may be evoked through dysregulated mitochondrial dynamics enhanced oxidative stress and inflammation contributing to high cardiovascular morbidity and mortality. Previous study has demonstrated sodium thiosulfate (STS, Na2S2O3) could effectively attenuate renal oxidative injury in the animal model of renovascular hypertension. We explored whether the potentially therapeutic effect of STS is available on the attenuating CKD injury in thirty-six male Wistar rats with 5/6 nephrectomy. We determined the STS effect on reactive oxygen species (ROS) amount in vitro and in vivo by an ultrasensitive chemiluminescence-amplification method, ED-1 mediated inflammation, Masson's trichrome stained fibrosis, mitochondrial dynamics (fission and fusion) and two types of programmed cell death, apoptosis and ferroptosis by western blot and immunohistochemistry. Our in vitro data showed STS displayed the strongest scavenging ROS activity at the dosage of 0.1 g. We applied STS at 0.1 g/kg intraperitoneally 5 times/week for 4 weeks to these CKD rats. CKD significantly enhanced the degree in arterial blood pressure, urinary protein, BUN, creatinine, blood and kidney ROS amount, leukocytes infiltration, renal 4-HNE expression, fibrosis, dynamin-related protein 1 (Drp1) mediated mitochondrial fission, Bax/c-caspase 9/c-caspase 3/poly (ADP-ribose) polymerase (PARP) mediated apoptosis, iron overload/ferroptosis and the decreased xCT/GPX4 expression and OPA-1 mediated mitochondrial fusion. STS treatment significantly ameliorated oxidative stress, leukocyte infiltration, fibrosis, apoptosis and ferroptosis and improved mitochondrial dynamics and renal dysfunction in CKD rats. Our results suggest that STS as drug repurposing strategy could attenuate CKD injury through the action of anti-mitochondrial fission, anti-inflammation, anti-fibrosis, anti-apoptotic, and anti-ferroptotic mechanisms.
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Affiliation(s)
- Yu-Hsuan Cheng
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Chih-Ching Yang
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan, ROC
- Office of Public Relation of Ministry of Health and Welfare, Taipei, Taiwan, ROC
- Center for General Education, Mackay College of Medicine, Nursing and Management, New Taipei City, Taiwan, ROC
| | - Shih-Ping Hsu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
- Department of Industrial Management, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
| | - Chiang-Ting Chien
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan, ROC
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Yang CJ, Lu CW, Chiang CH, Chang HH, Yao CA, Huang KC. Traveler's knowledge, attitude, and practice about travel health insurance: A community-based questionnaire study. PLoS One 2023; 18:e0281199. [PMID: 36757921 PMCID: PMC9910690 DOI: 10.1371/journal.pone.0281199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/30/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Travel, especially international travel, has become one of the most popular leisure activities in the world. The risk of accidents and travel-related illnesses, including infectious and non-communicable diseases, should not be neglected. To provide a more comprehensive pre-travel consultation to international travelers, this study aimed to investigate the knowledge, attitude, and practice of travelers about travel health insurance. METHODS This was a cross-sectional study. Anonymous structured questionnaires were distributed to 1000 visitors to the Taiwan International Travel Fair in May 2019. RESULTS The top three important travel health insurances were accidental death and disablement insurance (92%), accidental medical reimbursement (90.4%), and 24-hour emergency assistance (89%). In addition to education level, travel-associated illness, and special activities during travel, a significant association was observed between the willingness to buy various travel health insurances and the willingness of pre-travel consultation. CONCLUSIONS Most travelers would buy travel health insurance; however, disproportional respondents understood the content of travel health insurance. Most travelers considered travel clinics to be the most reliable information source regarding travel health insurance. Therefore, travel medicine specialists are encouraged to offer more information about travel health insurance during pre-travel consultation.
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Affiliation(s)
- Chia-Jung Yang
- Department of Family Medicine, Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan
- Department of Family Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Chia-Wen Lu
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Hsieh Chiang
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Community and Family Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Hao-Hsiang Chang
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
- * E-mail:
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Yao CA, Chen IL, Chen CY, Torng PL, Su TC. Association between Wakeup Frequency at Night and Atherogenic Dyslipidemia: Evidence for Sex Differences. J Atheroscler Thromb 2023; 30:87-99. [PMID: 35444101 PMCID: PMC9899702 DOI: 10.5551/jat.63254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AIM This study aimed to determine whether sleep disturbance, defined as the wakeup frequency at night, is associated with atherogenic dyslipidemia and to explore possible sex differences. METHODS A total of 1,368 adults aged 19-70 years were included in the study of lifestyles and atherogenic dyslipidemia at the National Taiwan University Hospital in the period of 2008-2012. They completed a questionnaire regarding lifestyle information and sleep quality, including sleep hour duration, use of sleeping pills, and wakeup frequency during nighttime sleep. The measured lipid profiles included total cholesterol, triglycerides, low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), non-HDL-C, and small dense LDL-C (sdLDL-C). Multivariate logistic regression was performed to determine habitual interrupted sleep and the odds ratio of atherogenic dyslipidemia following adjustment for conventional risk factors and for sex-based subgroup analysis. RESULTS A wakeup frequency ≥ 3 times per night was independently associated with an increased risk [odds ratio (95% confidence interval)] of dyslipidemia was 1.96 (1.17-3.28), and non-HDL-C ≥ 160 mg/dL was 1.78 (1.09-2.89). A higher wakeup frequency was associated with increased atherogenic dyslipidemia in women than in men. The multivariate adjusted relative risks for non-HDL ≥ 160 mg/dL and cholesterol ≥ 200 mg/dL were 3.05 (1.27-7.34) and 4.01(1.29-12.45) for female individuals with insomnia and those with a wakeup frequency ≥ 2 times per night, respectively. CONCLUSION A higher wakeup frequency was associated with atherogenic dyslipidemia in Taiwanese adults, particularly in women. This study also provided another evidence of increasing cardiovascular diseases in subjects with habitual interrupted sleep.
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Affiliation(s)
- Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Ling Chen
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Yen Chen
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan,Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pao-Ling Torng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Chen Su
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan,Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan,Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Cheng YH, Li HK, Yao CA, Huang JY, Sung YT, Chung SD, Chien CT. Negative air ions through the action of antioxidation, anti-inflammation, anti-apoptosis and angiogenesis ameliorate lipopolysaccharide induced acute lung injury and promote diabetic wound healing in rat. PLoS One 2022; 17:e0275748. [PMID: 36288391 PMCID: PMC9604953 DOI: 10.1371/journal.pone.0275748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
Negative air ions (NAIs) being bioactive and negative charged molecules may confer antioxidant and anti-inflammatory activity. We assessed the effect of NAIs on two inflammatory diseases in animal models including lipopolysaccharide (LPS) induced acute lung injury (ALI) and wound healing in diabetic rats. We used intra-tracheal infusion of LPS to induce ALI and made a full-thickness cutaneous wound in streptozotocin-induced diabetic female Wistar rats. We evaluated NAIs effects on reactive oxygen species amount, leukocyte infiltration, wound healing rate, western blot, and immunohistochemistry in the lungs of ALI and skin sections of wounds. Our data found NAIs exposed saline displayed higher antioxidant activity vs. non-exposed saline. NAIs exposure did not significantly affect arterial blood pressure and respiratory frequency in control and LPS treated groups. LPS increased leukocyte infiltration, caspase 3/Poly-ADP-ribose-polymerase-mediated apoptosis formation and decreased Beclin-1/LC3-II-mediated autophagy in lungs. NAIs exposure conferred pulmonary protection by depressed leukocyte infiltration and caspase 3/Poly-ADP-ribose-polymerase mediated apoptosis and enhanced LC3-II-mediated autophagy in LPS induced ALI. NAIs treatment resulted in a significantly accelerated wound closure rate, decreased erythrocyte accumulation and leukocyte infiltration mediated oxidative stress and inflammation, and upregulated expression of skin collagen, vascular endothelial growth factor receptor-2 (VEGFR-2) and factor transforming growth factor-beta 1 (TGF-β1) vs non-treated group. Based on these results, it is suggested that NAIs conferred a protection through the upregulating LC3-II-dependent autophagy mechanism and downregulating leukocyte infiltration mediated inflammation and caspase 3/Poly-ADP-ribose-polymerase signaling in the LPS-treated ALI and promoted diabetic wound healing through the enhancing skin collagen synthesis, VEGFR-2 and TGF-β1 pathways.
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Affiliation(s)
- Yu-Hsuan Cheng
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Hung-Keng Li
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jing-Ying Huang
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yi-Ting Sung
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
| | - Shiu-Dong Chung
- Division of Urology, Department of Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Nursing, College of Healthcare & Management, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
- General Education Center, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
- * E-mail: (CTC); (SDC)
| | - Chiang-Ting Chien
- Department of Life Science, School of Life Science, College of Science, National Taiwan Normal University, Taipei, Taiwan
- * E-mail: (CTC); (SDC)
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Chou TJ, Wu YR, Tsai JS, Cheng SY, Yao CA, Peng JK, Chiu TY, Huang HL. Telehealth-Based Family Conferences with Implementation of Shared Decision Making Concepts and Humanistic Communication Approach: A Mixed-Methods Prospective Cohort Study. Int J Environ Res Public Health 2021; 18:ijerph182010801. [PMID: 34682545 PMCID: PMC8535301 DOI: 10.3390/ijerph182010801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/10/2021] [Accepted: 10/12/2021] [Indexed: 01/14/2023]
Abstract
Smartphone-enabled, telehealth-based family conferences represent an attractive and safe alternative to deliver communication during the COVID-19 pandemic. However, some may fear that the therapeutic relationship might be filtered due to a lack of direct human contact. The study aims to explore whether shared decision-making model combining VALUE (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions) and PLACE (Prepare with intention, Listen intently and completely, Agree on what matters most, Connect with the patient’s story, Explore emotional cues) framework can help physicians respond empathetically to emotional cues and foster human connectedness in a virtual context. Twenty-five virtual family conferences were conducted in a national medical center in Taiwan. The expression of verbal emotional distress was noted in 20% of patients and 20% of family members, while nonverbal distress was observed in 24% and 28%, respectively. On 10-point Likert scale, the satisfaction score was 8.7 ± 1.5 toward overall communication and 9.0 ± 1.1 on meeting the family’s needs. Adopting SDM concepts with VALUE and PLACE approaches helps physicians foster connectedness in telehealth family conferences. The model has high participant satisfaction scores and may improve healthcare quality among the pandemic.
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Affiliation(s)
- Tzu-Jung Chou
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (T.-J.C.); (J.-S.T.); (S.-Y.C.); (C.-A.Y.); (J.-K.P.); (T.-Y.C.)
| | - Yu-Rui Wu
- Department of Family Medicine, Taitung Christian Hospital, Taitung 950, Taiwan;
| | - Jaw-Shiun Tsai
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (T.-J.C.); (J.-S.T.); (S.-Y.C.); (C.-A.Y.); (J.-K.P.); (T.-Y.C.)
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
- New Southbound Health Center, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (T.-J.C.); (J.-S.T.); (S.-Y.C.); (C.-A.Y.); (J.-K.P.); (T.-Y.C.)
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
- New Southbound Health Center, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (T.-J.C.); (J.-S.T.); (S.-Y.C.); (C.-A.Y.); (J.-K.P.); (T.-Y.C.)
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (T.-J.C.); (J.-S.T.); (S.-Y.C.); (C.-A.Y.); (J.-K.P.); (T.-Y.C.)
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
- New Southbound Health Center, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (T.-J.C.); (J.-S.T.); (S.-Y.C.); (C.-A.Y.); (J.-K.P.); (T.-Y.C.)
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
- New Southbound Health Center, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hsien-Liang Huang
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan; (T.-J.C.); (J.-S.T.); (S.-Y.C.); (C.-A.Y.); (J.-K.P.); (T.-Y.C.)
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei 100, Taiwan
- New Southbound Health Center, National Taiwan University Hospital, Taipei 100, Taiwan
- Correspondence: ; Tel.: +886-2-2312-3456 (ext. 66832)
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Wu YR, Chou TJ, Wang YJ, Tsai JS, Cheng SY, Yao CA, Peng JK, Hu WY, Chiu TY, Huang HL. Smartphone-Enabled, Telehealth-Based Family Conferences in Palliative Care During the COVID-19 Pandemic: Pilot Observational Study. JMIR Mhealth Uhealth 2020; 8:e22069. [PMID: 33021483 PMCID: PMC7595749 DOI: 10.2196/22069] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 12/16/2022] Open
Abstract
Background In the palliative care setting, infection control measures implemented due to COVID-19 have become barriers to end-of-life care discussions (eg, discharge planning and withdrawal of life-sustaining treatments) between patients, their families, and multidisciplinary medical teams. Strict restrictions in terms of visiting hours and the number of visitors have made it difficult to arrange in-person family conferences. Phone-based telehealth consultations may be a solution, but the lack of nonverbal cues may diminish the clinician-patient relationship. In this context, video-based, smartphone-enabled family conferences have become important. Objective We aimed to establish a smartphone-enabled telehealth model for palliative care family conferences. Our model integrates principles from the concept of shared decision making (SDM) and the value, acknowledge, listen, understand, and elicit (VALUE) approach. Methods Family conferences comprised three phases designed according to telehealth implementation guidelines—the previsit, during-visit, and postvisit phases. We incorporated the following SDM elements into the model: “team talk,” “option talk,” and “decision talk.” The model has been implemented at a national cancer treatment center in Taiwan since February 2020. Results From February to April 2020, 14 telehealth family conferences in the palliative care unit were analyzed. The patients’ mean age was 73 (SD 10.1) years; 6 out of 14 patients (43%) were female and 12 (86%) were married. The primary caregiver joining the conference virtually comprised mostly of spouses and children (n=10, 71%). The majority of participants were terminally ill patients with cancer (n=13, 93%), with the exception of 1 patient with stroke. Consensus on care goals related to discharge planning and withdrawal of life-sustaining treatments was reached in 93% (n=13) of cases during the family conferences. In total, 5 families rated the family conferences as good or very good (36%), whereas 9 were neutral (64%). Conclusions Smartphone-enabled telehealth for palliative care family conferences with SDM and VALUE integration demonstrated high satisfaction for families. In most cases, it was effective in reaching consensus on care decisions. The model may be applied to other countries to promote quality in end-of-life care in the midst of the COVID-19 pandemic.
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Affiliation(s)
- Yu-Rui Wu
- Department of Family Medicine, Taitung Christian Hospital, Taitung, Taiwan
| | - Tzu-Jung Chou
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yi-Jen Wang
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Wen-Yu Hu
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Hsien-Liang Huang
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
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Yao CA, Chen CC, Wang NP, Chien CT. Correction: Yao, C.A., et al. Soy-Based Multiple Amino Acid Oral Supplementation Increases the Anti-Sarcoma Effect of Cyclophosphamide. Nutrients 2016, 8, 192. Nutrients 2020; 12:nu12092732. [PMID: 32911614 PMCID: PMC7551119 DOI: 10.3390/nu12092732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Chien-An Yao
- Department of Life Science, No. 88, Sec. 4, Tingzhou Road, National Taiwan Normal University, Taipei 11677, Taiwan;
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chin-Chu Chen
- Biotechnology Center, Grape King Inc., Chung-Li 320, Taiwan;
| | - Nai-Phog Wang
- Department of Orthopedic, Kuang-Tien General Hospital, Taichung 433, Taiwan
- Correspondence: (N.-P.W.); (C.-T.C.); Tel.: +886-4-26625111 (ext. 2001) (N.-P.W.); +886-2-77346312 (C.-T.C.); Fax: +886-2-29312904 (C.-T.C.)
| | - Chiang-Ting Chien
- Department of Life Science, No. 88, Sec. 4, Tingzhou Road, National Taiwan Normal University, Taipei 11677, Taiwan;
- Correspondence: (N.-P.W.); (C.-T.C.); Tel.: +886-4-26625111 (ext. 2001) (N.-P.W.); +886-2-77346312 (C.-T.C.); Fax: +886-2-29312904 (C.-T.C.)
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10
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Huang HL, Tsai JS, Yao CA, Cheng SY, Hu WY, Chiu TY. Shared decision making with oncologists and palliative care specialists effectively increases the documentation of the preferences for do not resuscitate and artificial nutrition and hydration in patients with advanced cancer: a model testing study. BMC Palliat Care 2020; 19:17. [PMID: 32019540 PMCID: PMC7001377 DOI: 10.1186/s12904-020-0521-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 01/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communication in do not resuscitate (DNR) and artificial nutrition and hydration (ANH) at the end of life is a key component of advance care planning (ACP) which is essential for patients with advanced cancer to have cares concordant with their wishes. The SOP model (Shared decision making with Oncologists and Palliative care specialists) aimed to increase the rate of documentation on the preferences for DNR and ANH in patients with advanced cancer. METHODS The SOP model was implemented in a national cancer treatment center in Taiwan from September 2016 to August 2018 for patients with advanced cancer visiting the oncology outpatient clinic. The framework was based on the model of shared decision making as "choice talk" initiated by oncologists with "option talk" and "decision talk" conducted by palliative care specialists. RESULTS Among 375 eligible patients, 255 patients (68%) participated in the model testing with the mean age of 68.5 ± 14.7 years (mean ± SD). Comparing to 52.3% of DNR documentation among patients with advanced cancer who died in our hospital, the rate increased to 80.9% (206/255) after the decision talk in our model. Only 6.67% (n = 17) of the participants documented their preferences on ANH after the model. A worse Eastern Cooperative Oncology Group Performance Status was the only statistically significant associating factor with a higher rate of DNR documentation in the multiple logistic regression model. CONCLUSIONS The SOP model significantly increased the rate of DNR documentation in patients with advanced cancer in this pilot study. Dissemination of the model could help the patients to receive care that is concordant with their wishes and be useful for the countries having laws on ACP.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National 7 Chung-Shan South Road, Taipei, 100, Taiwan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National 7 Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National 7 Chung-Shan South Road, Taipei, 100, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National 7 Chung-Shan South Road, Taipei, 100, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National 7 Chung-Shan South Road, Taipei, 100, Taiwan.
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11
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Conklin AI, Yao CA, Richardson CG. Chronic sleep deprivation and adolescent health: Two longitudinal studies of youth in Western Canada. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic exposure to insufficient sleep may increase depression and poor health in adolescents who are particularly vulnerable to changes in sleep and neuro-cognitive development. The cumulative effects of persistent sleep deprivation on adolescent physical and mental health, and potential gender differences, are unknown. We investigated whether cumulative sleep deprivation is linked to sub-optimal health or depression in youth (13-18 y).
Methods
Longitudinal self-reported data (2011-2012) included three measures of sleep times and two of self-rated health (SRH) and depression (CESD). Missing data were multiply imputed using variables related to primary and secondary analyses for SRH (n = 3104) and CESD (n = 3071). Multivariable regression models with interaction terms estimated gender-specific associations; post-estimation calculated adjusted mean depression scores across levels of cumulative sleep deprivation.
Results
We found 11% of youth (56% females) in BC were chronically sleep deprived. Cumulative exposure to sleep deprivation was not associated with SRH in adolescents (all P-values ≥ 0.097), but was associated with increased risk of depression in young women only. Young women reporting chronic sleep deprivation had higher mean CESD scores (19.48 [17.59-21.38]), compared to counterparts reporting no history of sleep deprivation (16.59 [15.72-17.45]). No associations were seen in young men. Findings were robust to changes in model re-specification.
Conclusions
Results indicated that chronic sleep deprivation may be an important determinant of mental health outcomes in adolescents, particularly young women, although there was little support for effects on overall health status. Chronically impaired quality of sleep should be considered in future longitudinal work. Public health efforts to promote mental health for young people may require relevant strategies to support young women in achieving recommended amounts of sleep.
Key messages
Chronic sleep deprivation showed no association with adolescents’ self-rated health. Chronic sleep deprivation was linked to a higher risk of depression in young women only.
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Affiliation(s)
- A I Conklin
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
| | - C A Yao
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
| | - C G Richardson
- Centre for Health Evaluation and Outcome Sciences, Providence Health Research Institute, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
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12
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Abstract
RATIONALE Patients with end-stage kidney disease (ESKD) receiving maintenance dialysis experience an overall burden of physical and emotional symptoms. However, there were limited alternative treatments to dialysis. PATIENT CONCERNS A 79-year-old woman with chronic kidney disease stage 5 (CKD5) and gout had refused to be on dialysis. She also had hypoglycemia, hypertension, and heart disease. DIAGNOSES The patient had received the ultrasonography, the renal biopsy and biochemical examinations, confirming the diagnosis of renal impairment, primary hypertension, and chronic nephritic syndrome with unspecified morphologic changes. INTERVENTIONS She was administered with 20 mL Eefooton (a liquid formula of herbal extracts: Astragalus membranaceus 3 g, Codonopsis pilosula 3 g, Ligustrum lucidum 3 g, Panax quinquefolius 1.3 g, and Rhodiola sacra 1.3 g) orally twice a day for 6 months in addition to her regular medications. OUTCOMES The patient was followed up for 3 months after the completion of the Eefooton adjuvant treatment. The patient's renal function was improved, and CKD progression was alleviated. After Eefooton treatment, the sizes of both kidneys in the patient increased by 8% while blood urea nitrogen (BUN) and serum creatinine concentrations were decreased. In addition, further reduction in BUN concentration was observed 2 months posttreatment. LESSONS This case demonstrated that Eefooton has potential therapeutic significance in patients with CKD5 who chose conservative treatment over dialysis.
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Affiliation(s)
- Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei City
| | - Chih-Hui Lin
- Gerent Biotech R&D Center No. 20, Jen Yi St., Taichung City, Taiwan (R.O.C.)
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Kuo LC, Song YQ, Yao CA, Cheng IH, Chien CT, Lee GC, Yang WC, Lin Y. Ginkgolide A Prevents the Amyloid-β-Induced Depolarization of Cortical Neurons. J Agric Food Chem 2019; 67:81-89. [PMID: 30541279 DOI: 10.1021/acs.jafc.8b04514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Utilizing the N-methyl-d-aspartate (NMDA) receptor antagonist as a strategy, memantine is the only agent available for clinically treating mild to severe Alzheimer's disease (AD). Our aim was to develop novel similar herb-based drugs. Using a screening platform, ginkgolide A (GA), a pure compound extracted from Ginkgo biloba, was found to attenuate amyloid β (Aβ)-induced abnormal depolarization in mouse primary cortical neurons. Using receptor agonists, it was determined that GA inhibits both NMDA receptors and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors. Furthermore, the Aβ-induced increase in c-Jun N-terminal kinase phosphorylation in neurons was prevented by GA. Body weight, glutamate oxaloacetate transaminase, glutamic-pyruvic transaminase, liver histology, and kidney histology were similar when the wild-type/AD animal model mice with and without GA treatment were compared. This pure compound improves the memory of wild-type mice. Our findings indicate that GA has great potential clinically for the treatment of AD because it might target NMDA receptors just like memantine.
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Affiliation(s)
- Li-Chen Kuo
- Department of Life Science , National Taiwan Normal University , Taipei 116 , Taiwan
| | - Yan-Qing Song
- Department of Life Science , National Taiwan Normal University , Taipei 116 , Taiwan
| | - Chien-An Yao
- Department of Life Science , National Taiwan Normal University , Taipei 116 , Taiwan
- Department of Family Medicine , National Taiwan University Hospital , Taipei 100 , Taiwan
| | - Irene H Cheng
- Institute of Brain Science , National Yang-Ming University , Taipei 112 , Taiwan
| | - Chiang-Ting Chien
- Department of Life Science , National Taiwan Normal University , Taipei 116 , Taiwan
| | - Guan-Chiun Lee
- Department of Life Science , National Taiwan Normal University , Taipei 116 , Taiwan
| | - Wen-Chin Yang
- Agricultural Biotechnology Research Center , Academia Sinica , Taipei 115 , Taiwan
| | - Yenshou Lin
- Department of Life Science , National Taiwan Normal University , Taipei 116 , Taiwan
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14
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Huang HL, Yao CA, Hu WY, Cheng SY, Hwang SJ, Chen CD, Lin WY, Lin YC, Chiu TY. Prevailing Ethical Dilemmas Encountered by Physicians in Terminal Cancer Care Changed After the Enactment of the Natural Death Act: 15 Years' Follow-up Survey. J Pain Symptom Manage 2018; 55:843-850. [PMID: 29221846 DOI: 10.1016/j.jpainsymman.2017.11.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Abstract
CONTEXT Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients. OBJECTIVES To identify the prevailing ethical dilemmas among terminal care physicians 15 years after the Natural Death Act was enacted in Taiwan. METHODS This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan. RESULTS Among the 500 physicians surveyed, 383 responded (response rate 76.6%) and 346 valid questionnaires were included in the final analysis (effective response rate 69.2%). The most frequently identified ethical dilemma was "place of care," followed by "use of antimicrobial agents" and "artificial nutrition and hydration." The dilemma of "truth telling," which ranked first in the 2005-2006 survey, now ranked at the fourth place. Stepwise logistic regression analysis revealed that female gender and knowledge of palliative care were negatively correlated with the extent of dilemmas regarding issues of "life and death." CONCLUSION The prevailing ethical dilemmas have changed in Taiwan 15 years after the enactment of the Natural Death Act, supporting that some previous strategies had worked. Our results suggest that education on the core values of palliative care, improvement of community-based hospice care program, and creating treatment guidelines with prognostication may resolve the current dilemmas. This type of survey should be adapted by individual countries to guide policy decisions on end-of-life care.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Dao Chen
- Department of Family Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wen-Yuan Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Chun Lin
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan.
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Yao CA, Ortiz-Vega S, Sun YY, Chien CT, Chuang JH, Lin Y. Association of mSin1 with mTORC2 Ras and Akt reveals a crucial domain on mSin1 involved in Akt phosphorylation. Oncotarget 2017; 8:63392-63404. [PMID: 28968999 PMCID: PMC5609931 DOI: 10.18632/oncotarget.18818] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/02/2017] [Indexed: 12/15/2022] Open
Abstract
mSin1 is a unique component within the mammalian target of rapamycin (mTOR) complex 2 (mTORC2), which is responsible for cellular morphology and glucose metabolism. The association between mSin1 and other mTORC2 components, as well as their functions, has been explored previously; nevertheless, the mapping of the various binding domains of the components is lacking. Based on an evolutionary analysis of the gene, we constructed various fragments and truncated-forms of mSin1. We characterized the individual binding sites of mSin1 with its various partners, including mTOR, Rictor, Ras, and Akt. mTOR and Rictor bind to the amino acid (aa) 100-240 region of mSin1, which is different to the Ras binding site, the aa 260-460 region. A reciprocal examination found that mSin1 associated with the aa 2148-2300 region of mTOR, which is within the kinase domain, and with the carboxyl terminus of Rictor. Interestingly, Akt was found to associate with mSin1 in a region that slightly overlapped with the mTOR/Rictor complex binding site, namely aa 220-260. When only the Akt binding site was deleted from mSin1, phosphorylation of Akt S473 was greatly reduced. Furthermore, the association between Akt and mTOR can be regulated by serum, insulin and LY294002, but not by rapamycin or MAPK kinase inhibitors. Taken together, mSin1 would seem to act as a hub that allows mTORC2 to phosphorylate Akt S473. Our findings should facilitate future proteomic and crystallographic studies, help the development of dominant inhibitors and promote the identification of new drug targets.
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Affiliation(s)
- Chien-An Yao
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.,Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Sara Ortiz-Vega
- Diabetes Unit and Medical Services and The Department of Molecular Biology, Massachusetts General Hospital and The Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Yun-Ya Sun
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Chiang-Ting Chien
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Jen-Hua Chuang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
| | - Yenshou Lin
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
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16
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Shao YY, Hsiue EHC, Hsu CH, Yao CA, Chen HM, Lai MS, Cheng AL. National Policies Fostering Hospice Care Increased Hospice Utilization and Reduced the Invasiveness of End-of-Life Care for Cancer Patients. Oncologist 2017; 22:843-849. [PMID: 28408618 DOI: 10.1634/theoncologist.2016-0367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/19/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In 2011, two national policies aiming to foster hospice services for terminal cancer patients took effect in Taiwan. The single-payer National Health Insurance of Taiwan started to reimburse full hospice services. The national hospital accreditation program, which graded all hospitals, incorporated hospice utilization in its evaluation. We assessed the impact of these national policies. METHODS A cohort of 249,394 patients aged ≥18 years who died of cancer between 2008 and 2013 were identified from the National Death Registry. We retrieved utilization data of medical services and compared the health care utilization in the final month of life before and after the implementation of the new policies. RESULTS After the policy changes, hospice utilization increased from 20.8% to 36.2%. In a multivariate analysis adjusting for patient demographics, cancer features, and hospital characteristics, hospice utilization significantly increased after 2011 (adjusted odds ratio [AOR] 2.35, p < .001), accompanied by a decrease in intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV), and cardiopulmonary resuscitation (CPR; AORs 0.87, 0.75, and 0.80, respectively; all p < .001). The patients who received hospice services were significantly less likely to receive ICU admissions, IMV, and CPR (AORs 0.20, 0.12, and 0.10, respectively; all p < .001). Hospice utilization was associated with an adjusted net savings of U.S. $696.90 (25.2%, p < .001) per patient in the final month of life. CONCLUSION The national policy changes fostering hospice care significantly increased hospice utilization, decreased invasive end-of-life care, and reduced the medical costs of terminal cancer patients. IMPLICATIONS FOR PRACTICE National policies fostering hospice care significantly increased hospice utilization, decreased invasive end-of-life care, and reduced the medical costs of terminal cancer patients.
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Affiliation(s)
- Yu-Yun Shao
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Cancer Center, Taipei, Taiwan
| | | | - Chih-Hung Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ho-Min Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Shu Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Taiwan Cancer Registry, Taipei, Taiwan
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Cancer Center, Taipei, Taiwan
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Yao CA, Chen CC, Wang NP, Chien CT. Soy-Based Multiple Amino Acid Oral Supplementation Increases the Anti-Sarcoma Effect of Cyclophosphamide. Nutrients 2016; 8:192. [PMID: 27043621 PMCID: PMC4848661 DOI: 10.3390/nu8040192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/08/2016] [Accepted: 03/22/2016] [Indexed: 12/16/2022] Open
Abstract
The use of a mixture of amino acids caused a selective apoptosis induction against a variety of tumor cell lines, reduced the adverse effects of anti-cancer drugs and increased the sensitivity of tumor cells to chemotherapeutic agents. We evaluated the effects and underlying mechanisms of soy-derived multiple amino acids' oral supplementation on the therapeutic efficacy of low-dose cyclophosphamide (CTX) and on tumor growth, apoptosis, and autophagy in severe combined immunodeficiency (SCID) mice that were injected with sarcoma-180 (S-180) cells. 3-methyladenine or siRNA knockdown of Atg5 was used to evaluate its effect on sarcoma growth. A comparison of mice with implanted sarcoma cells, CTX, and oral saline and mice with implanted sarcoma cells, CTX, and an oral soy-derived multiple amino acid supplement indicated that the soy-derived multiple amino acid supplement significantly decreased overall sarcoma growth, increased the Bax/Bcl-2 ratio, caspase 3 expression, and apoptosis, and depressed LC3 II-mediated autophagy. Treatment with 3-methyladenine or Atg5 siRNA elicited similar responses as CTX plus soy-derived multiple amino acid in downregulating autophagy and upregulating apoptosis. A low dose of CTX combined with an oral soy-derived multiple amino acid supplement had a potent anti-tumor effect mediated through downregulation of autophagy and upregulation of apoptosis.
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Affiliation(s)
- Chien-An Yao
- Department of Life Science, No. 88, Sec. 4, Tingzhou Road, National Taiwan Normal University, Taipei 11677, Taiwan.
- Department of Family Medicine, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Chin-Chu Chen
- Biotechnology Center, Grape King Inc., Chung-Li 320, Taiwan.
| | - Nai-Phog Wang
- Department of Orthopedic, Kuang-Tien General Hospital, Taichung 433, Taiwan.
| | - Chiang-Ting Chien
- Department of Life Science, No. 88, Sec. 4, Tingzhou Road, National Taiwan Normal University, Taipei 11677, Taiwan.
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Chih AH, Su P, Hu WY, Yao CA, Cheng SY, Lin YC, Chiu TY. The Changes of Ethical Dilemmas in Palliative Care. A Lesson Learned from Comparison Between 1998 and 2013 in Taiwan. Medicine (Baltimore) 2016; 95:e2323. [PMID: 26735533 PMCID: PMC4706253 DOI: 10.1097/md.0000000000002323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The current ethical dilemmas met by healthcare professionals were never compared with those 15 years ago when the palliative care system was newly developing in Taiwan. The aim of the study was to investigate the ethical dilemmas met by palliative care physicians and nurses in 2013 and compare the results with the survey in 1998. This cross-sectional study surveyed 213 physicians and nurses recruited from 9 representative palliative care units across Taiwan in 2013. The compared survey in 1998 studied 102 physicians and nurses from the same palliative care units. All participants took a questionnaire to survey the "frequency" and "difficulty" of 20 frequently encountered ethical dilemmas, which were grouped into 4 domains by factor analysis. The "ethical dilemma" scores were calculated and then compared across 15 years by Student's t tests. A general linear model analysis was used to identify significant factors relating to a high average "ethical dilemma" score in each domain. All of the highest-ranking ethical dilemmas in 2013 were related to insufficient resources. Physicians with less clinical experience had a higher average "ethical dilemma" score in clinical management. Physicians with dissatisfaction in providing palliative care were associated a higher average "ethical dilemma" score in communication. Nurses reported higher "ethical dilemma" scores in all items of resource allocation in 2013. Further analysis confirmed that, in 2013, nurses had a higher average "ethical dilemma" score in resource allocation after adjustment for other relating factors. Palliative care nursing staff in Taiwan are more troubled by ethical dilemmas related to insufficient resources than they were 15 years ago. Training of decision making in nurses under the framework of ethical principles and community palliative care programs may improve the problems. To promote the dignity of terminal cancer patients, long-term fundraising plans are recommended for countries in which the palliative care system is in its early stages of development.
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Affiliation(s)
- An-Hsuan Chih
- From the Health Center, Office of Student Affairs, National Taiwan University (A-HC); Department of Audiology and Speech-Language Pathology, Mackay Medical College (P-JS); Department of Family Medicine, Mackay Memorial Hospital (P-JS); School of Nursing (W-YH); and Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taiwan (C-AY, S-YC, Y-CL, T-YC)
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Shih CY, Hu WY, Cheng SY, Yao CA, Chen CY, Lin YC, Chiu TY. Patient Preferences versus Family Physicians' Perceptions Regarding the Place of End-of-Life Care and Death: A Nationwide Study in Taiwan. J Palliat Med 2015; 18:625-30. [PMID: 25927818 DOI: 10.1089/jpm.2014.0386] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Enabling people to die in their preferred place is important for providing high-quality end-of-life care. OBJECTIVE The study objective was to explore patients' preferences regarding the place of end-of-life care and death and to compare these preferences with the perceptions of their family physicians. METHODS This cross-sectional study used stratified random sampling, surveying 400 registered patients and 200 of their family physicians nationwide, with a five-part, structured, self-report questionnaire. RESULTS Of the selected population, 310 patients (response rate 77.5%) and 169 physicians (response rate 84.5%) responded. Regarding the preferred place for end-of-life care, most of the patients would choose to receive care at home (60.6%) if home care services were available. Additionally, home was the most frequently preferred (66.5%) place of death. The family physicians' survey showed that a higher proportion of physicians selected home as the preferred place for end-of-life care and death (71.6% and 87.2%, respectively). The results of logistic regression analysis showed that patients younger than 50 years of age who believed in Chinese folk religion and who resided in a rural area were more likely to prefer to die at home. CONCLUSIONS The most commonly preferred place for end-of-life care and death is the patient's home. Establishing a community-based palliative care system should be encouraged to allow more individuals to die in their preferred locations. There were discrepancies in the preferred place of end-of-life care and death between the patients' preferences and their family physicians' perceptions. More effective physician-patient communication regarding end-of-life care is needed.
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Affiliation(s)
- Chih-Yuan Shih
- 1 Department of Family Medicine, National Taiwan University Hospital Jin-Shan Branch , New Taipei City, Taiwan
| | - Wen-Yu Hu
- 2 School of Nursing, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Shao-Yi Cheng
- 4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Chien-An Yao
- 4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Ching-Yu Chen
- 3 Division of Gerontology Research, National Health Research Institutes , Zhunan, Miaoli County, Taiwan .,4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Yen-Chun Lin
- 4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Tai-Yuan Chiu
- 4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
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Huang HL, Cheng SY, Yao CA, Hu WY, Chen CY, Chiu TY. Truth Telling and Treatment Strategies in End-of-Life Care in Physician-Led Accountable Care Organizations: Discrepancies Between Patients' Preferences and Physicians' Perceptions. Medicine (Baltimore) 2015; 94:e657. [PMID: 25906093 PMCID: PMC4602689 DOI: 10.1097/md.0000000000000657] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Providing patient-centered care from preventive medicine to end-of-life care in order to improve care quality and reduce medical cost is important for accountable care. Physicians in the accountable care organizations (ACOs) are suitable for participating in supportive end-of-life care especially when facing issues in truth telling and treatment strategy. This study aimed to investigate patients' attitudes toward truth telling and treatment preferences in end-of-life care and compare patients' attitudes with their ACOs physicians' perceptions.This nationwide study applied snowball sampling to survey physicians in physician-led ACOs and their contracted patients by questionnaire from August 2010 to July 2011 in Taiwan. The main outcome measures were beliefs about palliative care, attitudes toward truth telling, and treatment preferences.The data of 314 patients (effective response rate = 88.7%) and 177 physicians (88.5%) were analyzed. Regarding truth telling about disease prognosis, 94.3% of patients preferred to be fully informed, whereas only 80% of their physicians had that perception (P < 0.001). Significant differences were also found in attitudes toward truth telling even when encountering terminal disease status (98.1% vs 85.3%). Regarding treatment preferences in terminal illness, nearly 90% of patients preferred supportive care, but only 15.8% of physicians reported that their patients had this preference (P < 0.001).Significant discrepancies exist between patients' preferences and physicians' perceptions toward truth telling and treatment strategies in end-of-life care. It is important to enhance physician-patient communication about end-of-life care preferences in order to achieve the goal of ACOs. Continuing education on communication about end-of-life care during physicians' professional development would be helpful in the reform strategies of establishing accountable care around the world.
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Affiliation(s)
- Hsien-Liang Huang
- From the Department of Family Medicine (HLH), Cardinal Tien Hospital, and Fu-Jen Catholic University, New Taipei City; Department of Family Medicine (SYC, CAY, CYC, TYC); and School of Nursing (WYH), College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Yao CA, Chen LK, Huang KC. The immunogenicity and safety of zoster vaccine in Taiwanese adults. Vaccine 2015; 33:1515-7. [PMID: 25681662 DOI: 10.1016/j.vaccine.2015.01.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 01/22/2015] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
The efficacy and safety of ZOSTAVAX in subjects 60 years of age and older was established in the Shingles Prevention Study (SPS) and in subjects 50 to 59 years of age in the ZOSTAVAX Efficacy and Safety Trial (ZEST). We evaluated the safety and immunogenicity of ZOSTAVAX in a total of 150 Taiwanese subjects ≥50 years of age, who received a single dose of ZOSTAVAX. gpELISA was used to determine geometric mean titers (GMT) of the varicella-zoster virus (VZV) antibody. The geometric mean fold rise (GMFR) of the VZV antibody from the pre-vaccination to the 4 week post-vaccination time point was calculated. There was an overall increase in GMT from 128.45 to 391.85 at 4 weeks post-vaccination. The estimated GMFR was 3.05 (95% CI: 2.60 to 3.57).There were no serious adverse events for 28 days following vaccination. This study demonstrated the safety and immunogenicity of ZOSTAVAX among healthy Taiwanese adults.
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Affiliation(s)
- Chien-An Yao
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Kuo-Chin Huang
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Tsai TF, Yao CA, Yu HS, Lan CC, Chao SC, Yang JH, Yang KC, Chen CY, White RR, Psaradellis E, Rampakakis E, Kawai K, Acosta CJ, Sampalis JS. Herpes zoster-associated severity and duration of pain, health-related quality of life, and healthcare utilization in Taiwan: a prospective observational study. Int J Dermatol 2014; 54:529-36. [PMID: 25209019 DOI: 10.1111/ijd.12484] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Tsen-Fang Tsai
- Department of Dermatology; National Taiwan University Hospital; Taipei Taiwan
| | - Chien-An Yao
- Department of Family Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Hsin-Su Yu
- Department of Dermatology; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Cheng-Che Lan
- Department of Dermatology; Kaohsiung Medical University; Kaohsiung Taiwan
- Kaohsiung Municipal Ta-Tung Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Sheau-Chiou Chao
- Department of Dermatology; National Cheng Kung University Hospital; College of Medicine; National Cheng Kung University; Tainan Taiwan
| | - Jen-Hung Yang
- Department of Dermatology; Buddist Tzu Chi General Hospital; Tzu Chi University School of Medicine; Hualien Taiwan
- Department of Dermatology; Chung Shan Medical University Hospital; Taichung Taiwan
| | - Kuo-Chia Yang
- Department of Dermatology; Changhua Christian Hospital; Changhua Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine; National Taiwan University Hospital; Taipei Taiwan
| | | | | | | | | | | | - John S. Sampalis
- JSS Medical Research; St-Laurent QC Canada
- McGill University; Montreal QC Canada
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Yang CC, Yao CA, Yang JC, Chien CT. Sialic acid rescues repurified lipopolysaccharide-induced acute renal failure via inhibiting TLR4/PKC/gp91-mediated endoplasmic reticulum stress, apoptosis, autophagy, and pyroptosis signaling. Toxicol Sci 2014; 141:155-65. [PMID: 24973090 DOI: 10.1093/toxsci/kfu121] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lipopolysaccharides (LPS) through Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) activation induce systemic inflammation where oxidative damage plays a key role in multiple organ failure. Because of the neutralization of LPS toxicity by sialic acid (SA), we determined its effect and mechanisms on repurified LPS (rLPS)-evoked acute renal failure. We assessed the effect of intravenous SA (10 mg/kg body weight) on rLPS-induced renal injury in female Wistar rats by evaluating blood and kidney reactive oxygen species (ROS) responses, renal and systemic hemodynamics, renal function, histopathology, and molecular mechanisms. SA can interact with rLPS through a high binding affinity. rLPS dose- and time-dependently reduced arterial blood pressure, renal microcirculation and blood flow, and increased vascular resistance in the rats. rLPS enhanced monocyte/macrophage (ED-1) infiltration and ROS production and impaired kidneys by triggering p-IRE1α/p-JNK/CHOP/GRP78/ATF4-mediated endoplasmic reticulum (ER) stress, Bax/PARP-mediated apoptosis, Beclin-1/Atg5-Atg12/LC3-II-mediated autophagy, and caspase 1/IL-1β-mediated pyroptosis in the kidneys. SA treatment at 30 min, but not 60 min after rLPS stimulation, gp91 siRNA and protein kinase C-α (PKC) inhibitor efficiently rescued rLPS-induced acute renal failure via inhibition of TLR4/PKC/NADPH oxidase gp91-mediated ER stress, apoptosis, autophagy and pyroptosis in renal proximal tubular cells, and rat kidneys. In response to rLPS or IFNγ, the enhanced Atg5, FADD, LC3-II, and PARP expression can be inhibited by Atg5 siRNA. Albumin (10 mg/kg body weight) did not rescue rLPS-induced injury. In conclusion, early treatment (within 30 min) of SA attenuates rLPS-induced renal failure via the reduction in LPS toxicity and subsequently inhibiting rLPS-activated TLR4/PKC/gp91/ER stress/apoptosis/autophagy/pyroptosis signaling.
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Affiliation(s)
- Chih-Ching Yang
- Department of Internal Medicine, National Yang-Ming University, Taipei 11221, Taiwan Department of Family Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chien-An Yao
- National Taiwan University Hospital and College of Medicine, Taipei 10016, Taiwan
| | - Jyh-Chin Yang
- Department of Life Science, National Taiwan Normal University, Taipei 11677, Taiwan
| | - Chiang-Ting Chien
- Department of Planning, Ministry of Health and Welfare, Executive Yuan, Taipei 11558, Taiwan
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Yao CA, Hsieh MY, Chiu TY, Hu WY, Hung SH, Chen CY, Lee LT. Wishes of Patients With Terminal Cancer and Influencing Factors Toward the Use of Antibiotics in Taiwan. Am J Hosp Palliat Care 2014; 32:537-43. [DOI: 10.1177/1049909114540033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: The use of antibiotics is a common ethical dilemma in palliative care, thus identifying the concerns of patients with terminal cancer and respecting their wishes are important in making an ethically justified decision. Objectives: The aim of this study was to understand wishes of patients with terminal cancer and determine influencing factors toward the use of antibiotics. Methods: Two hundred and one patients with terminal cancer, admitted to a palliative care unit in Taiwan, completed a structured questionnaire interview, including demographic characteristics, knowledge and attitudes on antibiotics, the health locus of control, subjective norms, and the wishes to use antibiotics. Results: The most common misconception was “Antibiotics use is helpful to all terminal patients with infection,” which only 13.4% respondents disagreed. Of the 201patients, 92 (45.8%) expressed their wishes to use antibiotics even in the very terminal stage, and around one-fourth (26.4%) of patients wished not to use antibiotics, the remaining 27.8% were unclear. The most influential persons were medical professionals. The results of logistic regression analysis that showed familiarity with antibiotics, subjective norms, and the attitude toward burdens of antibiotics were the most significant predicting variables for those wishing to use antibiotics (odds ratio [OR] = 4.133, 95% confidence interval [CI] = 1.012-16.880; OR = 1.890, 95% CI = 1.077-3.317; and OR = 1.255, 95% CI = 1.047-1.503). Conclusion: This study indicated the responsibility of medical professionals to convey burdens of using antibiotics to patients and family. Otherwise, by enhancing professional training and performing effective communication with patients, we can reach a more appropriate decision in the use of antibiotics.
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Affiliation(s)
- Chien-An Yao
- Department of Family Medicine, Hospital and Medical College, National Taiwan University, Chong-Cheng District, Taipei City, Taiwan
| | - Meng-Yun Hsieh
- Department of Family Medicine, Hospital and Medical College, National Taiwan University, Chong-Cheng District, Taipei City, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, Hospital and Medical College, National Taiwan University, Chong-Cheng District, Taipei City, Taiwan
| | - Wen-Yu Hu
- School of Nursing, Hospital and Medical College, National Taiwan University, Chong-Cheng District, Taipei City, Taiwan
| | - Shou-Hung Hung
- Department of Community and Family Medicine, Yun-Lin Branch Hospital and Medical College, National Taiwan University, Douliou City, Yunlin County, Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine, Hospital and Medical College, National Taiwan University, Chong-Cheng District, Taipei City, Taiwan
| | - Long-Teng Lee
- Department of Family Medicine, Hospital and Medical College, National Taiwan University, Chong-Cheng District, Taipei City, Taiwan
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Chih AH, Lee LT, Cheng SY, Yao CA, Hu WY, Chen CY, Chiu TY. Is It Appropriate To Withdraw Antibiotics in Terminal Patients with Cancer with Infection? J Palliat Med 2013; 16:1417-22. [DOI: 10.1089/jpm.2012.0634] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- An-Hsuan Chih
- Health Center, Office of Student Affairs, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Long-Teng Lee
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Lee HTS, Melia KM, Yao CA, Lin CJ, Chiu TY, Hu WY. Providing hospice home care to the terminally ill elderly people with cancer in Taiwan: family experiences and needs. Am J Hosp Palliat Care 2013; 31:628-35. [PMID: 23921288 DOI: 10.1177/1049909113499603] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We explored caregivers' experiences and needs when providing hospice home care to their terminally ill elderly patients with cancer in Taiwan for 1 year. A total of 44 caregivers were interviewed using a semistructured interview once monthly during hospice home care visits until the patients' deaths. Content analysis of the interviews revealed 5 themes, hoping for a cure, experiencing fluctuating emotions, accepting the patient's dying, regarding the patient's death as a good death, and needing emotional support and information. Caregivers in hospice home care who experienced difficulties tended to seek emotional support and information throughout the entire caregiving process. With a greater understanding of caregivers' experiences and needs, nurses can alleviate caregivers' negative emotional reactions by actively attending to their needs during this process.
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Affiliation(s)
- Hsin-Tzu Sophie Lee
- Department of Nursing, National Taiwan University, Taipei, Taiwan, ROC Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan, ROC
| | - Kath M Melia
- Department of Social and Preventive Medicine, University of Manchester, Manchester, United Kingdom School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Chien-An Yao
- Graduate Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC Department of Family Medicine, College of Medicine & Hospital, National Taiwan University, Taipei, Taiwan, ROC
| | - Chun-Ju Lin
- Department of Nursing, Taipei Medical University, Taipei, Taiwan, ROC Palliative Care Unit of National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Tai-Yuan Chiu
- Department of Family Medicine, College of Medicine & Hospital, National Taiwan University, Taipei, Taiwan, ROC Department of Community Health School of Medicine, University of Tokyo, Tokyo, Japan
| | - Wen-Yu Hu
- Department of Nursing, National Taiwan University, Taipei, Taiwan, ROC
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Huang HL, Cheng SY, Lee LT, Yao CA, Chu CW, Lu CW, Chiu TY, Huang KC. On the trail of preventing meningococcal disease: a survey of students planning to travel to the United States. J Travel Med 2013; 20:243-6. [PMID: 23809075 DOI: 10.1111/jtm.12038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 01/24/2013] [Accepted: 01/28/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND College freshmen living in dormitories are at increased risk for meningococcal disease. Many students become a high-risk population when they travel to the United States. This study surveyed the knowledge, attitudes toward, and behavior surrounding the disease among Taiwanese college students planning to study in the United States, and to identify factors that may affect willingness to accept meningococcal vaccination. METHODS A cross-sectional survey of college students going to study in the United States was conducted in a medical center-based travel medicine clinic. Background information, attitudes, general knowledge, preventive or postexposure management, and individual preventive practices were collected through a structured questionnaire. RESULTS A total of 358 students were included in the final analysis. More than 90% of participants believed that preventing meningococcal disease was important. However, fewer than 50% of students accurately answered six of nine questions exploring knowledge of the disease, and only 17.3% of students knew the correct management strategy after close contact with patients. Logistic regression analysis showed that students who understood the mode of transmission (odds ratio: 3.21, 95% CI = 1.117-9.229), medication management (1.88, 1.045-3.38), and epidemiology (2.735, 1.478-5.061) tended to be vaccinated. CONCLUSIONS Despite an overall positive attitude toward meningococcal vaccination, there was poor knowledge about meningococcal disease. Promoting education on the mode of transmission, epidemiology, and pharmacological management of the disease could increase vaccination rates. Both the governments and travel medicine specialists should work together on developing an education program for this high-risk group other than just requiring vaccination.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan
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Huang HL, Chiu TY, Lee LT, Yao CA, Chen CY, Hu WY. Family experience with difficult decisions in end-of-life care. Psychooncology 2012; 21:785-91. [PMID: 22619164 DOI: 10.1002/pon.3107] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 09/11/2010] [Accepted: 12/01/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The difficult decisions encountered by family caregivers in the process of care for patients with terminal cancer are seldom studied. Investigating their experiences with difficult decisions may help relieve their psychological distress. The purpose of this study was to determine the frequency and difficulty of decisions experienced in end-of-life care and to identify related factors. METHODS A cross-sectional study using questionnaires was conducted with family caregivers of patients who died of cancer in a university hospital. Difficulty of decisions and relevant influencing variables including demographic data, knowledge in palliative care and the Natural Death Act, and beliefs on the Natural Death Act were measured. RESULTS A total of 302 bereaved family caregivers were included in the final analysis. The most difficult decisions commonly encountered in both hospice and non-hospice wards related to truth telling, place of care, and alternative treatments. Logistic regression analysis demonstrated that older age (odds ratio = 0.92, 95% confidence interval = 0.89-0.95), not being the main family caregiver (0.20, 0.06-0.62), and less perception of burdens regarding the Natural Death Act (0.61, 0.37-0.99) were negatively correlated with the difficulty of decisions. CONCLUSIONS Families frequently encountered difficult decisions while caring for terminally ill loved ones. Better communication with family members, particularly the main caregiver, to diminish negative perceptions of the Natural Death Act could help to decrease psychological distress.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Shih CY, Hu WY, Lee LT, Yao CA, Chen CY, Chiu TY. Effect of a compassion-focused training program in palliative care education for medical students. Am J Hosp Palliat Care 2012; 30:114-20. [PMID: 22584149 DOI: 10.1177/1049909112445463] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Compassion is the key value of humanities perspective. Little is known, however, concerning the impact of enhancing compassion on ethical decision making in end-of-life care. METHODS A total of 251 preclinical medical students were enrolled in a palliative care training course. A structured self-report questionnaire was administered before and after training. RESULTS Experience with caring for patients with terminal cancer was positively related to improvement in the decision of "truth telling is helpful to a good death." In addition, improvement in the perception of "compassionate care" was correlated with higher improvement in the decision of "discharge planning and home care." CONCLUSION Compassion-focused training program can be helpful to improve medical students' competence in making more appropriate ethical decisions in end-of-life care.
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Affiliation(s)
- Chih-Yuan Shih
- Department of Family Medicine, National Taiwan University Hospital Jin-shan Branch, Taipei, Taiwan
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Abstract
BACKGROUND Health-care professionals can help travelers by providing accurate pre-travel counseling for mosquito-transmitted diseases such as malaria, yellow fever, and dengue fever. Governments and international organizations will benefit from knowledge survey among health professionals in this field to promote the development of travel health profession. This study investigates physicians' and nurses' knowledge regarding malaria, yellow fever, and dengue fever. METHODS A cross-sectional questionnaire survey was distributed to physicians and nurses in Taiwan interested in travel medicine between April and September of 2008. The self-administered, single-choice questionnaire evaluated knowledge regarding epidemiology, prophylactic medication for malaria, yellow fever, and dengue fever, and vaccinations for yellow fever as well as background information of participants. RESULTS Complete information was collected from 82 physicians and 203 nurses. (Out of 289, effective response rate = 99.9%). The mean percentage of accurate responses was similar for all three diseases: malaria 67.3% (range, 16.8%-90.5%); yellow fever 65.4% (39.6%-79.3%); and dengue fever 74.4% (14.4%-96.5%). The items with the lowest accuracy were (1) behavior of the dengue fever vector Aedes aegypti mosquito (14.4%) and (2) incubation period of malaria (16.8%). There were 60.4% participants who did not know the current revaccination interval for the yellow fever vaccine. The average knowledge scores for all three diseases were statistically significantly higher in the physician group. CONCLUSIONS Analysis of the results revealed significant deficits in travel medicine knowledge among health-care providers. Emphasis on continuing medical education for disease vector behavior, prophylactic drug prescription, and preventative vaccination is important to travel safety. Health professionals in Taiwan should actively participate in the International Society of Travel Medicine to follow the international standard of travel medicine practitioners. This type of survey should be adopted in other countries which would be helpful in improving the quality of care for travelers.
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Affiliation(s)
- Hsien-Liang Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, No. 7 Chung-Shan South Road, Taipei, Taiwan
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Shih CY, Chiu TY, Lee LT, Yao CA, Chen CY, Hu WY. What Factors Are Important in Increasing Junior Doctors' Willingness To Provide Palliative Care in Taiwan? An Educational Intervention Study. J Palliat Med 2010; 13:1245-51. [DOI: 10.1089/jpm.2010.0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chih-Yuan Shih
- Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - Long-Teng Lee
- Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-An Yao
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
- Division of Gerontology Research, National Health Research Institutes, Taiwan
| | - Wen-Yu Hu
- School of Nursing, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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Abstract
Purpose The study aimed to investigate prevailing ethical dilemmas in terminal care for patients with cancer nationwide and identify related factors after the enactment of the Natural Death Act in Taiwan. Methods This multicenter study surveyed 800 physicians and nursing staff of oncology wards and hospices through a set questionnaire. A total of 505 respondents (63.1%) who had taken care of patients with terminal cancer were analyzed. Results The most frequently encountered ethical dilemmas were truth-telling (mean ± SD = 1.30 ± 0.63; range [never, occasional, often], 0 to 2) and place of care (1.19 ± 0.69), both of which were related to communication issues. Dilemmas related to clinical management were artificial nutrition and hydration (1.04 ± 0.66) and use of antimicrobial agents (0.94 ± 0.70). Logistic regression analyses revealed that positive attitudes about the Natural Death Act was negatively related to the extent of ethical dilemmas (odds ratio, 0.426; 95% CI, 0.256 to 0.710]. Conclusion The enactment of the Natural Death Act in Taiwan would contribute to improving the quality of end-of-life care, which suggests that this kind of law should be adopted in other countries. Educating cancer care professionals in building positive beliefs toward the act is strongly encouraged.
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Affiliation(s)
- Tai-Yuan Chiu
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Wen-Yu Hu
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Hsien-Liang Huang
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Chien-An Yao
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
| | - Ching-Yu Chen
- From the Department of Family Medicine and School of Nursing, College of Medicine and Hospital, National Taiwan University; and Department of Family Medicine, North Coast Jin-Shan Hospital, Taipei, Taiwan
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Abstract
BACKGROUND Family physicians in Taiwan have expressed low willingness to provide palliative home care. OBJECTIVE To explore the medical needs of terminal cancer patients in home care and thus clarify the role and tasks of family physicians in providing palliative home care. METHODS Seventy-seven terminal cancer patients discharged from a palliative care unit from July 2003 to July 2004 who had received family physician home visits were enrolled. A structured assessment form was applied to each visit. RESULTS Under the collaboration by the palliative home care team and family physicians, the average interval from discharge to the first physician visit was 20.3 days and the average interval between physician visits was 37.9 days. The patients had an average of 5.9 active medical problems: the most frequent problem was pain (58.4%), followed by anorexia (42.9%) and constipation (42.9%). Forty-four patients (58.7%) died at home, while 31 patients (41.3%) eventually died in the hospital. Through multiple logistic regression analysis, patients who had never been rehospitalized [odds ratio (OR) = 12.95, 95% confidence interval (CI) = 3.41-49.19], who preferred to die at home (OR = 4.68, 95% CI = 1.21-18.09) and who were most functionally dependent with an Eastern Cooperative Oncology Group scale = 4 (OR = 4.36, 95% CI = 1.02-18.64) were found to be most likely to die at home under this care model. CONCLUSION Through palliative home care with the participation of family physicians, patients' preference could be a significant determinant of home death. Our finding can be helpful to the establishment of an ethical care model for terminal cancer patients.
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Affiliation(s)
- Jen-Kuei Peng
- Department of Community and Family Medicine, National Taiwan University Hospital Yun-Lin Branch, Taiwan
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Abstract
BACKGROUND The prevalence of the metabolic syndrome (MetS) is high among the elderly. However, evidence that mortality increases with MetS is rare. In this study, we investigated the relationship between MetS, cardiovascular disease (CVD) and all cause mortality in the elderly. MATERIALS AND METHODS A total 10 547 participants, aged 65 years and older, of baseline cohort were recruited from four nationwide Health Screening Centres in Taiwan from 1998 to 1999. The metabolic syndrome was defined according to the America Heart Association/National Heart Lung Blood Institute definition. Cox proportional hazards regression analyses were used to estimate the relative risks (RRs) of CVD and all cause mortality for those with MetS for up to 8 years of follow-up. RESULTS The baseline prevalence of MetS was 50.1% (45.6% in men and 54.4% in women, respectively). A total of 1312 participants died; of these, 300 participants died from CVD. Adjusted for age, gender, smoking, total cholesterol and estimated glomerular filtration rate, the RRs for CVD and all cause mortality among participants with MetS were 1.48 (95% confidence interval = 1.16-1.90) and 1.16 (1.03-1.30), respectively, for participants compared to those without MetS. The mean RRs for CVD, however, ranged from 1.21 to 5.31 among different combinations of MetS components. CONCLUSION The elderly with MetS, compared to those without MetS, had a higher CVD and all cause mortality in Taiwan. Furthermore, different combinations of MetS components posed different risks to the mortality, which deserves further research in the future.
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Affiliation(s)
- C J Wen
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
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35
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Abstract
OBJECTIVES Over half of all terminal cancer patients in Taiwan are 65 or older, thus demonstrating the importance of terminal care for elderly people. This study investigates the good death status of elderly patients with terminal cancer, comparing the differences in the degree of good death among elderly and younger groups, and exploring the factors related to the good death score. METHODS Three hundred and sixty-six patients with terminal cancer admitted to a palliative care unit were enrolled. Two structured measurements, the good death scale and the audit scale for good death services, were used as the instruments in the study. RESULTS The scores of individual items and of the good death scale were increased significantly in both elderly (n = 206, 56.3%) and younger (n = 160, 43.7%) groups from the time of admission to just prior to death. However, the elderly group had significantly lower scores in 'awareness' (t = -3.76, P < 0.001), 'propriety' (t = -2.92, P < 0.01) and 'timeliness' (t = -2.91, P < 0.01) than the younger group prior to death. Furthermore, because of a lack of truth-telling, the elderly group also had significantly lower scores than the younger group in both 'respect for autonomy' and 'decision-making participation' (t = -2.17, P < 0.05; t = -2.21, P < 0.05, respectively). Multiple regression analysis revealed that 'respect for autonomy' (OR = 1.22, 95% CI = 0.76-1.67) and 'verbal support '(OR = 0.93, 95% CI = 0.34-1.51) were two independent correlates of the good death score in the elderly group. CONCLUSION The dilemma of truth-telling compromises the autonomy of the elderly patients with terminal cancer and consequently affects their good death scores. The palliative care team should emphasize the issue of truth-telling in the process of caring for terminally ill cancer patients, especially elderly patients.
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Affiliation(s)
- S Y Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei
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36
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Yao CA, Hu WY, Lai YF, Cheng SY, Chen CY, Chiu TY. Does dying at home influence the good death of terminal cancer patients? J Pain Symptom Manage 2007; 34:497-504. [PMID: 17629664 DOI: 10.1016/j.jpainsymman.2007.01.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 01/09/2007] [Accepted: 01/10/2007] [Indexed: 11/21/2022]
Abstract
To investigate whether dying at home influences the likelihood that a terminal cancer patient will achieve a good death despite the limited medical resources available in many communities, this study investigated the relationship between the achievement of a good death and the performance of good-death services in two groups with different places of death, and explored the possible factors associated with this relationship. Three hundred and seventy-four consecutive patients with terminal cancers admitted to a palliative care unit were enrolled. Two instruments, the good-death scale and the audit scale for good-death services, were used in the study. Mean age of the 374 patients was 65.45 +/- 14.77 years. The total good-death score in the home-death group (n=307) was significantly higher than that in the hospital-death group (n=67), both at the time of admission (t= -5.741, P<0.001) and prior to death (t= -3.027, P<0.01). However, the score of item "degree of physical comfort" assessed prior to death in the home-death group was lower than that in the hospital-death group (P=0.185). As to the audit scale for good-death services, each subscale score and total scores in the home-death group were significantly higher than that in the hospital-death group, with the exception of the subscale "continuity of social support" (4.72 vs. 4.61, P=0.132). Bereavement support (odds ratio=1.01, 95% confidence interval=0.62-1.39; multiple regression), alleviation of anxiety (0.81, 0.46-1.15), decision-making participation (0.61, 0.26-0.95), fulfillment of last wish (0.45, 0.08-0.82), and survival time (0.00, 0.00-0.01) were independent correlates of the good-death score (35.8% of explained variance). However, the place of death was not in the model. The study conclusively suggests the necessity for palliative home care to strengthen the competence of physical care. Moreover, earlier incorporation of palliative care into anticancer therapies can lead to better death preparation and good-death services, and thus be helpful to achieve a good death.
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Affiliation(s)
- Chien-An Yao
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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37
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Abstract
OBJECTIVE Impaired lung function is associated with obesity and insulin resistance. In this study, we investigated the relationship between metabolic syndrome and impaired lung function in adults. RESEARCH METHODS AND PROCEDURES A total of 46,514 subjects 20 years and over (21,669 men and 24,845 women, mean age = 37.3 +/- 11.2 and 37.0 +/- 11.3 years, respectively) were recruited from four nationwide MJ Health Screening Centers in Taiwan from 1998 to 2000. Metabolic syndrome was defined using the National Cholesterol Education Panel (NCEP) metabolic syndrome criteria or America Heart Association/National Heart Lung Blood Institute (AHA/NHLBI) criteria. The relationship between metabolic syndrome and lung function test was examined using multivariate logistic regression analysis. RESULTS The prevalence of impaired lung function was 11.1% in men and 14.0% in women. The prevalence of metabolic syndrome was 5.8% using NCEP criteria and 12.8% using AHA/NHLBI criteria. In multivariate logistic regression analysis with adjustment for age, gender, BMI, smoking, alcohol drinking, and physical activity, restrictive lung impairment was independently associated with increased risk of having metabolic syndrome (p < 0.01, odds ratios = 1.221 using NCEP criteria and 1.150 using AHA/NHLBI criteria). DISCUSSION Obesity and metabolic syndrome were associated with impaired lung function in adults in Taiwan. Our results imply that obesity and insulin resistance may be the common pathways underlying lung function impairment and metabolic syndrome. Moreover, lung function test may be applied as an additional evaluation for metabolic syndrome in a clinical setting.
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Affiliation(s)
- Wen-Yuan Lin
- Department of Family Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan 100
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38
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Abstract
This study prospectively assessed dyspnea and related bio-psycho-social-spiritual factors--including severity, cause, psychological distress, and fear of death--that were possibly related to dyspnea in 125 terminal cancer patients at admission and two days before their death. At admission, 74 patients had dyspnea, which improved but later worsened. Causes included cachexia, anemia, pleural effusion, and lymphangitis. Quality of life, anxiety, depression, and fear of death improved after admission; anxiety was correlated with dyspnea before death (r = 0.211, P < 0.05, univariate analysis). Lung infection (odds ratio = 2.29, 95% confidence interval = 0.68-3.90; multiple regression), airway obstruction (2.27, 1.41-3.13), acidemia (1.82, 0.72-2.98), and pericardial effusion (1.38, 0.44-2.32) were independent correlates of dyspnea severity at admission (42.8% of explained variance). Before death, airway obstruction, esophageal cancer, pericardial effusion, lung infection, and mediastinal mass were independent correlates of severity (42.7% of explained variance). Comprehensive care, including improved psychospiritual status, can help in controlling dyspnea and enhancing patients' quality of life.
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Affiliation(s)
- Tai-Yuan Chiu
- Hospice and Palliative Care Unit, Departments of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
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