Journal of the Formosan Medical Association最新文献

Implication of heart rhythm complexity in predicting long-term outcomes in pulmonary hypertension. 心律复杂性对预测肺动脉高压长期预后的影响。

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-06 DOI: 10.1016/j.jfma.2024.10.027

Shu-Yu Tang, Chen Lin, Hsi-Pin Ma, Tsung-Yan Chen, Men-Tzung Lo, Ping-Hung Kuo, Hsao-Hsun Hsu, Cho-Kai Wu, Chung-Kang Peng, Yen-Tin Lin, Cheng-Hsuan Tsai, Yen-Hung Lin

{"title":"Implication of heart rhythm complexity in predicting long-term outcomes in pulmonary hypertension.","authors":"Shu-Yu Tang, Chen Lin, Hsi-Pin Ma, Tsung-Yan Chen, Men-Tzung Lo, Ping-Hung Kuo, Hsao-Hsun Hsu, Cho-Kai Wu, Chung-Kang Peng, Yen-Tin Lin, Cheng-Hsuan Tsai, Yen-Hung Lin","doi":"10.1016/j.jfma.2024.10.027","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.10.027","url":null,"abstract":"<p><p>Pulmonary hypertension (PH) is a serious disease, however simple tools to predict outcomes are lacking. In our previous investigation, we found that heart rate variability (HRV) and heart rhythm complexity (HRC) were associated with the detection and severity of PH, however their association with PH mortality remains unclear. The aim of this study was to investigate these metrics as a tool for determining long-term outcomes in PH patients. We enrolled 74 Asian PH patients with WHO PH group 1 or 4 at a single hospital in Taiwan between March 2012 and June 2018. After a median follow-up duration of 58 months (to January 2023), 22 patients had died. The patients who died had a significantly lower lean body mass index (BMI), impaired renal function, higher N-terminal pro B-type natriuretic peptide (NT-proBNP) level, lower very low-frequency (VLF), lower short-term detrended fluctuation analysis α1 (DFAα1), and lower multiscale entropy scale 5 value. In multivariable analysis, BMI, VLF and multiscale entropy scale 5 were significantly associated with survival. The best cut-off VLF and scale 5 values were 115.13 and 0.738, respectively. We then categorized the study population into three groups: both elevated VLF/scale 5 (group 1), either depressed VLF or depressed scale 5 (group 2), and both depressed VLF/scale 5 (group 3). The results showed that group 1 had the best outcomes, whereas group 3 had the worst survival (P < 0.001). Combining HRV and HRC metrics appears to be a good non-invasive tool to predict the long-term outcomes of patients with PH.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lifestyle modifications and non-pharmacological management in elderly hypertension. 老年高血压的生活方式调整和非药物治疗。

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-05 DOI: 10.1016/j.jfma.2024.10.022

Hao-Yuan Tsai, Hung-Jui Chuang, Wei-Hsiang Liao, Yi-Jie Wang, Pei-Hsuan Li, Wen-Ting Wang, Shih-Cheng Liao, Chih-Fan Yeh, Pey-Rong Chen, Tai-Hsuan Lai, Hung-Ju Lin, Shao-Yi Cheng, Wen-Jone Chen, Yen-Hung Lin, Yi-Yao Chang

{"title":"Lifestyle modifications and non-pharmacological management in elderly hypertension.","authors":"Hao-Yuan Tsai, Hung-Jui Chuang, Wei-Hsiang Liao, Yi-Jie Wang, Pei-Hsuan Li, Wen-Ting Wang, Shih-Cheng Liao, Chih-Fan Yeh, Pey-Rong Chen, Tai-Hsuan Lai, Hung-Ju Lin, Shao-Yi Cheng, Wen-Jone Chen, Yen-Hung Lin, Yi-Yao Chang","doi":"10.1016/j.jfma.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.10.022","url":null,"abstract":"<p><p>Many studies have examined the effectiveness of lifestyle modifications such as exercise, diet, weight loss, and stress reduction in controlling hypertension in elderly individuals, and several meta-analyses have reported that both aerobic and resistance exercise can reduce blood pressure in this population. In addition, the higher sensitivity to sodium in elderly individuals highlights the importance of restricting salt intake for blood pressure control. Low-sodium salt or potassium supplementation can help with blood pressure control in elderly individuals with hypertension. Several clinical trials have shown that both the Dietary Approaches to Stop Hypertension (DASH) and a Mediterranean diet pattern are effective in reducing blood pressure in older hypertensive patients. Although moderate alcohol consumption does not appear to negatively impact blood pressure control in older adults, blood pressure increases along with heavy alcohol intake. Some studies have indicated that coffee intake increases blood pressure in elderly hypertensive subjects, especially for those who consume more than 3 cups a day. Clinical studies have shown that weight loss through exercise and diet control is beneficial for controlling hypertension in elderly individuals. Anxiety, depression and insomnia also appear to have an impact on elderly hypertension. In this review, we discuss the effectiveness of lifestyle modifications and non-pharmacological management of these factors and their impact on hypertension in elderly individuals, and how to effectively implement them in real-world settings.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cutaneous T-cell lymphoma: Consensus on diagnosis and management in Taiwan. 皮肤 T 细胞淋巴瘤：台湾诊断和管理共识。

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-03 DOI: 10.1016/j.jfma.2024.11.001

Tai-Chung Huang, Chung-Hsing Chang, Pa-Fan Hsiao, Chao-Kai Hsu, Chien-Yio Lin, Chien-Shan Wu, Su-Peng Yeh, Tsen-Fang Tsai

引用次数: 0

Characteristics and outcomes of ICU-admitted COVID-19 patients in the Omicron and Alpha-dominated periods. 重症监护室接收的 COVID-19 患者在 Omicron 和 Alpha 主导期的特征和预后。

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-02 DOI: 10.1016/j.jfma.2024.10.025

Chih-Jung Chang, Jhong-Ru Huang, Hsiao-Chin Shen, Chuan-Yen Sun, Ying-Ting Liao, Hung-Jui Ko, Yuh-Min Chen, Wei-Chih Chen, Jia-Yih Feng, Kuang-Yao Yang

{"title":"Characteristics and outcomes of ICU-admitted COVID-19 patients in the Omicron and Alpha-dominated periods.","authors":"Chih-Jung Chang, Jhong-Ru Huang, Hsiao-Chin Shen, Chuan-Yen Sun, Ying-Ting Liao, Hung-Jui Ko, Yuh-Min Chen, Wei-Chih Chen, Jia-Yih Feng, Kuang-Yao Yang","doi":"10.1016/j.jfma.2024.10.025","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.10.025","url":null,"abstract":"<p><strong>Background: </strong>Comparing the outcomes of intensive care unit (ICU) admitted COVID-19 patients during the Alpha and Omicron-dominated periods.</p><p><strong>Methods: </strong>Patients with critical COVID-19 disease, requiring ICU admission from May to September 2021 and February to August 2022, were enrolled from a single medical center in Northern Taiwan. Clinical demographics, comorbidities, disease severity, and management strategies were recorded. The 28-day mortality from the two periods were compared both in the original and propensity score (PS)-matched cohort.</p><p><strong>Results: </strong>Of 231 patients, 72 (31.2%) were from the Alpha period and 159 (68.8%) from the Omicron period. Patients in the Omicron period were older, had a lower body mass index, more comorbidities, higher disease severities, and increased 28-day mortality (26.4% vs. 13.9%, p = 0.035). In multivariable analysis, the Omicron-dominated period was not identified as an independent factor associated with increased 28-day mortality. COVID-19 patients in Alpha- and Omicron-dominated periods had comparable 28-day mortality in PS-matched cohort (12.1% vs. 18.2%, p = 0.733). Independent factors associated with 28-day mortality were a lower PF ratio (PF ratio <100, adjusted odds ratio [aOR] 2.68, 95% confidence interval, CI 1.21-5.94), septic shock ([aOR] 2.39, 95% CI 1.12-5.09) and absence of remdesivir ([aOR] 0.36, 95% CI 0.16-0.83).</p><p><strong>Conclusion: </strong>While patients in the Omicron period exhibited greater severity, the variant was not independently linked to higher 28-day mortality in ICU-admitted patients.</p>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Copyright transfer statement 版权转让声明

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-01 DOI: 10.1016/S0929-6646(24)00503-5

引用次数: 0

Reflection on 30 years of Taiwanese national health insurance: Analysis of Taiwanese health system progress, challenges, and opportunities 台湾全民健保 30 年的反思：台湾医疗系统的进步、挑战和机遇分析。

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-01 DOI: 10.1016/j.jfma.2024.07.030

Sian Hsiang-Te Tsuei

{"title":"Reflection on 30 years of Taiwanese national health insurance: Analysis of Taiwanese health system progress, challenges, and opportunities","authors":"Sian Hsiang-Te Tsuei","doi":"10.1016/j.jfma.2024.07.030","DOIUrl":"10.1016/j.jfma.2024.07.030","url":null,"abstract":"<div><div>On the eve of Taiwan's National Health Insurance's 30th birthday, this study reviews the policy and performance trajectory of the Taiwanese health system. Taiwan has controlled their health spending well and grown increasingly reliant on private financing. The floating-point global budget payment preferentially rewards outpatient-based services, but this has not affected the hospital-centric market composition, which persists despite several primary-care friendly developments. The outcomes suggest improving health care workforce and resource availability, good patient-centredness, respectable technical efficiency, and impressive patient care satisfaction. However, there are worrisome trends for financial barriers to access and allocative efficiency. Evidence on clinical quality suggests that hospitals are performing well though the primary care setting might not be. Overall, the public remains satisfied despite signs of lagging improvement in health outcomes, worsening maternal mortality rate, and persistently incomplete financial risk protection. Identifying what drives the worsening financial barriers of access and persistent financial risk is necessary for further discussions on potential financing adjustments. Improving allocative efficiency could draw on a combination of supporting the functions and quality of primary care alongside patient-oriented education and incentives. Further data on causes of slow health status improvement and rebounding maternal mortality rate is necessary.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Taiwan’s community health care evolution: Navigating pandemic challenges and shaping the future 台湾社区医疗的演变：应对大流行挑战，塑造美好未来。

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-01 DOI: 10.1016/j.jfma.2024.08.009

Tsan-Yu Wu , Chih-Yuan Shih , Chyi-Feng Jan , Shao-Yi Cheng

{"title":"Taiwan’s community health care evolution: Navigating pandemic challenges and shaping the future","authors":"Tsan-Yu Wu , Chih-Yuan Shih , Chyi-Feng Jan , Shao-Yi Cheng","doi":"10.1016/j.jfma.2024.08.009","DOIUrl":"10.1016/j.jfma.2024.08.009","url":null,"abstract":"<div><div>The COVID-19 pandemic has significantly shaped population dynamics and healthcare systems. Primary care clinics in Taiwan demonstrated remarkable resilience in managing the pandemic. This adaptability is reflected in rigorous screening processes, proactive vaccination efforts, and the seamless integration of telehealth services. Noteworthy shifts have been observed in the redistribution of primary care clinics and a decline in preventive healthcare measures. In response to these challenges, Taiwan has embraced a multifaceted approach, with telehealth services, home-based clinical care initiatives, community-based care, and innovative programs, like the Hospital at Home initiative, assuming central roles in mitigating the impact of the pandemic. These strategies underscore a forward-thinking healthcare delivery approach that prioritizes patient well-being.</div><div>Critical solutions include ongoing reforms in clinical practices, the contingency plans for preventive healthcare, the promotion of telehealth services, the adoption of home-based clinical care, and the enhancement of the integration of practice. Taiwan's visionary initiatives, including digital intelligent healthcare approaches, serve as a robust foundation for building a resilient and patient-centered healthcare system. These concerted efforts and healthcare innovations are necessary for shaping a comprehensive, accessible, and responsive future. Taiwan is setting a noteworthy example for global healthcare systems to follow by prioritizing the well-being of the population.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Checklist 核对表

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-01 DOI: 10.1016/S0929-6646(24)00501-1

引用次数: 0

Challenges and resilience of Taiwan's health care system after Covid-19 pandemic 台湾医疗保健系统在 Covid-19 大流行后面临的挑战和复原力。

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-01 DOI: 10.1016/j.jfma.2024.10.012

Chang-Chuan Chan

引用次数: 0

Effective prevention in clinical practice may save human capital loss: Real-world evidence from Taiwan's National Health Insurance 临床实践中的有效预防可避免人力资本损失：来自台湾国民健康保险的真实证据。

IF 2.6 3区医学

Journal of the Formosan Medical Association Pub Date : 2024-11-01 DOI: 10.1016/j.jfma.2024.10.011

Fuhmei Wang , Wen-Yen Huang , Yu-Tzu Chang , Szu-Chun Yang , Jung-Der Wang

{"title":"Effective prevention in clinical practice may save human capital loss: Real-world evidence from Taiwan's National Health Insurance","authors":"Fuhmei Wang , Wen-Yen Huang , Yu-Tzu Chang , Szu-Chun Yang , Jung-Der Wang","doi":"10.1016/j.jfma.2024.10.011","DOIUrl":"10.1016/j.jfma.2024.10.011","url":null,"abstract":"<div><h3>Background/Purpose</h3><div>Effective prevention could protect the health of the workforce, save human capital loss, and maintain employee productivity as well as economic growth.</div></div><div><h3>Methods</h3><div>Using real-world data of patients with end-stage kidney disease (ESKD) and lung cancer, we multiplied their lifetime survival functions with employment ratios and working salaries to estimate the lifetime employment durations and earnings. They were compared with corresponding age-, sex-, and calendar year-matched referents to assess the differences in loss of lifetime employment duration and earnings. From 2000 to 2017, 83,358 patients with end-stage kidney disease (ESKD) were associated with 32–66% lifetime productivity losses. Similarly, we collected 24,904 incident cases of lung adenocarcinoma during 2011–2018 and estimated the potential savings in human capital due to early detection. Based on the evolving trends of ESKD incidence rates in Taiwan, we calculated the lifetime human capital losses of ESKD patients in GDP (gross domestic product) percentages during 2000–2020.</div></div><div><h3>Results</h3><div>The aggregate lifetime productivity losses of ESKD in terms of GDP% varied between 0.000398% and 0.01% for male patients and between 0.0001% and 0.009% for female patients. The younger the patients, the bigger the losses in GDP%. Similarly, early detection of lung adenocarcinoma saved lives and productivity to some extent.</div></div><div><h3>Conclusions</h3><div>Successful prevention of catastrophic illnesses at early stages would save the lifetime employment duration and productivity of the workforce. Future reform on the NHI could consider closer coordination between public health and healthcare organizations, focusing on effective prevention of diseases and complications to save productivity loss.</div></div>","PeriodicalId":17305,"journal":{"name":"Journal of the Formosan Medical Association","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0