Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 1998
Objective To investigate the prevalence of nodular goiter and thyroid dysfunction in uremic patie... more Objective To investigate the prevalence of nodular goiter and thyroid dysfunction in uremic patients undergoing hemodialysis (HD) and peritoneal dialysis. Design Cross-sectional study. Setting Single dialysis unit and outpatient clinic. Patients The study included 221 patients [143 HD and 78 continuous ambulatory peritoneal dialysis (CAPD) patients] along with 135 consecutively selected outpatients as controls. Main Outcome Measures Ultrasonography was used to detect patients’ thyroid function and nodular goiter. Results Nodular goiter was detected in 54.8% of the uremic patients and in 21.5% of the controls. Uremic patients had higher prevalence of thyroid dysfunction, which included reduced serum concentration of total T3, total T4, and free T4, and increased serum level of TSH. Hypothyroidism was also observed more frequently in uremic patients than in the control group (5.4% vs 0.7%, p < 0.05). Nodular goiter was more frequently found in females than in males (63.5% vs 48%, p...
Change of ertapenem dosage from 500 mg daily to thrice weekly after each hemodialysis session can... more Change of ertapenem dosage from 500 mg daily to thrice weekly after each hemodialysis session can maintain the plasma concentration above 2 mg/L, and be practical in hemodialysis patients.
Background: The Pay-for-performance (P4P) program of diabetes care has demonstrated successful ou... more Background: The Pay-for-performance (P4P) program of diabetes care has demonstrated successful outcomes in patients with type 2 diabetes. However, the effectiveness of this multidisciplinary care model for psychiatric patients has never been evaluated. The objective of this study is to examine the effectiveness of P4P program of diabetes for psychiatric patients with diabetes. Methods: This study utilized a retrospective cohort design to examine the effectiveness of P4P program of diabetes care for psychiatric patients with diabetes. The participants’ HbA1c (hemoglobin A1c) data of the fourth quarter in 2018 were used as baseline value, while P4P program was not applied yet. HbA1c data of every quarter in 2019 were collected. Generalized estimating equations (GEE) was used to analyze the change of HbA1c level. Results: The HbA1c level increased slightly in the first quarter, and then decreased gradually since the second quarter. The HbA1c level was significantly lower in the fourth ...
International Journal of Environmental Research and Public Health
Objectives: To explore the influence of hospital and patient characteristics on deaths at home am... more Objectives: To explore the influence of hospital and patient characteristics on deaths at home among inpatients facing impending death. Method: In this historical cohort study, 95,626 inpatients facing impending death from 362 hospitals in 2011 were recruited. The dependent variable was the place of death. The independent variables were the characteristics of the hospitals and the patients. A two-level hierarchical generalized linear model was used. Results: In total, 41.06% of subjects died at home. The hospital characteristics contributed to 29.25% of the total variation of the place of death. Private hospitals (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.00–1.75), patients >65 years old (OR = 1.48, 95% CI. = 1.42–1.54), married (OR = 3.15, 95% CI. = 2.93–3.40) or widowed (OR = 3.39, 95% CI. = 3.12–3.67), from near-poor households (OR = 5.16, 95% CI. = 4.57–5.84), having diabetes mellitus (OR = 1.79, 95% CI. = 1.65–1.94), and living in a subcounty (OR = 2.27, 95% C...
Suicide in the older people is a serious problem worldwide; however the effect of psychiatric con... more Suicide in the older people is a serious problem worldwide; however the effect of psychiatric contact on the risk of suicide has not been fully explored. The aim of this study was to investigate the relationship between psychiatric contact and suicide in the older people in Taiwan. A population-based database was used in this national case-control study. Propensity score matching was used to match older people who did and did not commit suicide from 2010 to 2012 by calendar year, gender, age, and area of residence. The level of psychiatric contact in the preceding year was classified as &quot;no psychiatric contact,&quot; &quot;only outpatient psychiatric contact,&quot; &quot;psychiatric emergency room contact,&quot; or &quot;psychiatric hospital admission&quot;. Conditional logistic regression analysis was used to assess associations between variables and the risk of suicide. A total of 2528 older people committed suicide from 2010 to 2012, with a crude suicide mortality rate of 3.37/10,000. Compared to those who had no psychiatric contact in the preceding year, the adjusted odds ratios of suicide were 10.15 (95% CI=5.8-17.7) for those who had psychiatric emergency room contact, 6.57 (95% CI=3.7-11.6) for those who had psychiatric hospital admissions, and 3.64 (95% CI=3.0-4.4) for those with only outpatient psychiatric contact. The risk of suicide was higher in those who had depression (OR=3.49, 95% CI=2.2-5.4) and bipolar disorder (OR=1.98, 95% CI=1.1-3.6). Patients with cancer were associated with suicide (OR=8.96, 95% CI=5.6-14.4). The positive association with suicide and the level of psychiatric contact in the preceding year in older people indicated that the health personnel need to do a better job in determining possible risk for older people who had psychiatric contact, especially in emergency visit or psychiatric admission. A systematic approach to quality improvement in these settings is both available and necessary. Careful discharge planning and safe transitions of care to outpatient services are required for suicide prevention of high-risk patients after discharge.
Myofibroblasts are a main cell-type of collagen-producing cells during tissue fibrosis, but their... more Myofibroblasts are a main cell-type of collagen-producing cells during tissue fibrosis, but their origins remains controversial. While bone marrow-derived myofibroblasts in renal fibrosis has been reported, the cell origin and mechanisms regulating their transition into myofibroblasts remain undefined. In the present study, cell lineage tracing studies by adoptive transfer of GFP+ or dye-labelled macrophages identified that monocyte/macrophages from bone marrow can give rise to myofibroblasts via the process of macrophage-myofibroblast transition (MMT) in a mouse model of unilateral ureteric obstruction. The MMT cells were a major source of collagen-producing fibroblasts in the fibrosing kidney, accounting for more than 60% of α-SMA+ myofibroblasts. The MMT process occurred predominantly within M2-type macrophages and was regulated by TGF-β/Smad3 signalling as deletion of Smad3 in the bone marrow compartment of GFP+ chimeric mice prevented the M2 macrophage transition into the MMT c...
Sodium resin has been clinically administered against hyperkalemia widely, but its effects of low... more Sodium resin has been clinically administered against hyperkalemia widely, but its effects of lowering the serum calcium has never been documented. In our study, 7 patients with chronic renal failure were chosen at random to take sodium resin 30 g per day for 3 days. The sodium resin not only lowered the serum potassium level (p less than 0.05) but also brought down the level of serum calcium (p less than 0.05). The reduced ability of patients with chronic renal failure to absorb calcium from the gastrointestinal tract is well recognized, so its effects of lowering calcium will be more likely to aggravate the serum calcium imbalance further. If sodium resin has to be used for the maintainance of serum potassium in patients with chronic renal failure the serum calcium should be monitored closely in order to lighten the osteodystrophy and secondary hyperparathyroidism.
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 1998
Objective To investigate the prevalence of nodular goiter and thyroid dysfunction in uremic patie... more Objective To investigate the prevalence of nodular goiter and thyroid dysfunction in uremic patients undergoing hemodialysis (HD) and peritoneal dialysis. Design Cross-sectional study. Setting Single dialysis unit and outpatient clinic. Patients The study included 221 patients [143 HD and 78 continuous ambulatory peritoneal dialysis (CAPD) patients] along with 135 consecutively selected outpatients as controls. Main Outcome Measures Ultrasonography was used to detect patients’ thyroid function and nodular goiter. Results Nodular goiter was detected in 54.8% of the uremic patients and in 21.5% of the controls. Uremic patients had higher prevalence of thyroid dysfunction, which included reduced serum concentration of total T3, total T4, and free T4, and increased serum level of TSH. Hypothyroidism was also observed more frequently in uremic patients than in the control group (5.4% vs 0.7%, p < 0.05). Nodular goiter was more frequently found in females than in males (63.5% vs 48%, p...
Change of ertapenem dosage from 500 mg daily to thrice weekly after each hemodialysis session can... more Change of ertapenem dosage from 500 mg daily to thrice weekly after each hemodialysis session can maintain the plasma concentration above 2 mg/L, and be practical in hemodialysis patients.
Background: The Pay-for-performance (P4P) program of diabetes care has demonstrated successful ou... more Background: The Pay-for-performance (P4P) program of diabetes care has demonstrated successful outcomes in patients with type 2 diabetes. However, the effectiveness of this multidisciplinary care model for psychiatric patients has never been evaluated. The objective of this study is to examine the effectiveness of P4P program of diabetes for psychiatric patients with diabetes. Methods: This study utilized a retrospective cohort design to examine the effectiveness of P4P program of diabetes care for psychiatric patients with diabetes. The participants’ HbA1c (hemoglobin A1c) data of the fourth quarter in 2018 were used as baseline value, while P4P program was not applied yet. HbA1c data of every quarter in 2019 were collected. Generalized estimating equations (GEE) was used to analyze the change of HbA1c level. Results: The HbA1c level increased slightly in the first quarter, and then decreased gradually since the second quarter. The HbA1c level was significantly lower in the fourth ...
International Journal of Environmental Research and Public Health
Objectives: To explore the influence of hospital and patient characteristics on deaths at home am... more Objectives: To explore the influence of hospital and patient characteristics on deaths at home among inpatients facing impending death. Method: In this historical cohort study, 95,626 inpatients facing impending death from 362 hospitals in 2011 were recruited. The dependent variable was the place of death. The independent variables were the characteristics of the hospitals and the patients. A two-level hierarchical generalized linear model was used. Results: In total, 41.06% of subjects died at home. The hospital characteristics contributed to 29.25% of the total variation of the place of death. Private hospitals (odds ratio [OR] = 1.32, 95% confidence interval [CI] = 1.00–1.75), patients >65 years old (OR = 1.48, 95% CI. = 1.42–1.54), married (OR = 3.15, 95% CI. = 2.93–3.40) or widowed (OR = 3.39, 95% CI. = 3.12–3.67), from near-poor households (OR = 5.16, 95% CI. = 4.57–5.84), having diabetes mellitus (OR = 1.79, 95% CI. = 1.65–1.94), and living in a subcounty (OR = 2.27, 95% C...
Suicide in the older people is a serious problem worldwide; however the effect of psychiatric con... more Suicide in the older people is a serious problem worldwide; however the effect of psychiatric contact on the risk of suicide has not been fully explored. The aim of this study was to investigate the relationship between psychiatric contact and suicide in the older people in Taiwan. A population-based database was used in this national case-control study. Propensity score matching was used to match older people who did and did not commit suicide from 2010 to 2012 by calendar year, gender, age, and area of residence. The level of psychiatric contact in the preceding year was classified as &quot;no psychiatric contact,&quot; &quot;only outpatient psychiatric contact,&quot; &quot;psychiatric emergency room contact,&quot; or &quot;psychiatric hospital admission&quot;. Conditional logistic regression analysis was used to assess associations between variables and the risk of suicide. A total of 2528 older people committed suicide from 2010 to 2012, with a crude suicide mortality rate of 3.37/10,000. Compared to those who had no psychiatric contact in the preceding year, the adjusted odds ratios of suicide were 10.15 (95% CI=5.8-17.7) for those who had psychiatric emergency room contact, 6.57 (95% CI=3.7-11.6) for those who had psychiatric hospital admissions, and 3.64 (95% CI=3.0-4.4) for those with only outpatient psychiatric contact. The risk of suicide was higher in those who had depression (OR=3.49, 95% CI=2.2-5.4) and bipolar disorder (OR=1.98, 95% CI=1.1-3.6). Patients with cancer were associated with suicide (OR=8.96, 95% CI=5.6-14.4). The positive association with suicide and the level of psychiatric contact in the preceding year in older people indicated that the health personnel need to do a better job in determining possible risk for older people who had psychiatric contact, especially in emergency visit or psychiatric admission. A systematic approach to quality improvement in these settings is both available and necessary. Careful discharge planning and safe transitions of care to outpatient services are required for suicide prevention of high-risk patients after discharge.
Myofibroblasts are a main cell-type of collagen-producing cells during tissue fibrosis, but their... more Myofibroblasts are a main cell-type of collagen-producing cells during tissue fibrosis, but their origins remains controversial. While bone marrow-derived myofibroblasts in renal fibrosis has been reported, the cell origin and mechanisms regulating their transition into myofibroblasts remain undefined. In the present study, cell lineage tracing studies by adoptive transfer of GFP+ or dye-labelled macrophages identified that monocyte/macrophages from bone marrow can give rise to myofibroblasts via the process of macrophage-myofibroblast transition (MMT) in a mouse model of unilateral ureteric obstruction. The MMT cells were a major source of collagen-producing fibroblasts in the fibrosing kidney, accounting for more than 60% of α-SMA+ myofibroblasts. The MMT process occurred predominantly within M2-type macrophages and was regulated by TGF-β/Smad3 signalling as deletion of Smad3 in the bone marrow compartment of GFP+ chimeric mice prevented the M2 macrophage transition into the MMT c...
Sodium resin has been clinically administered against hyperkalemia widely, but its effects of low... more Sodium resin has been clinically administered against hyperkalemia widely, but its effects of lowering the serum calcium has never been documented. In our study, 7 patients with chronic renal failure were chosen at random to take sodium resin 30 g per day for 3 days. The sodium resin not only lowered the serum potassium level (p less than 0.05) but also brought down the level of serum calcium (p less than 0.05). The reduced ability of patients with chronic renal failure to absorb calcium from the gastrointestinal tract is well recognized, so its effects of lowering calcium will be more likely to aggravate the serum calcium imbalance further. If sodium resin has to be used for the maintainance of serum potassium in patients with chronic renal failure the serum calcium should be monitored closely in order to lighten the osteodystrophy and secondary hyperparathyroidism.
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