Journal of the Formosan Medical Association最新文献

{"title":"Quality and resilience of health care from a medical center perspective","authors":"Abel Po-Hao Huang ,&nbsp;Yi-Chia Lee ,&nbsp;Ming-Shiang Wu","doi":"10.1016/j.jfma.2024.09.014","DOIUrl":"10.1016/j.jfma.2024.09.014","url":null,"abstract":"<div><div>National Taiwan University Hospital (NTUH) has demonstrated exceptional resilience and adaptability in its response to the COVID-19 pandemic. Since the outbreak in early 2020, NTUH has been at the forefront of Taiwan's healthcare system, taking proactive measures to prepare for and manage the pandemic. The hospital swiftly established dedicated outpatient clinics and wards, which were crucial in isolating and treating COVID-19 patients. NTUH also played a pivotal role in assisting the government with the development of diagnostic reagents and vaccines and contributing to the global effort to combat the disease. To address the long-term effects of COVID-19, NTUH established a special clinic for integrated care in September 2021, offering physical, occupational, and speech therapy to help patients recover and return to normal life. NTUH also shared its pandemic prevention experience internationally, participating in video conferences to discuss its preventive measures and best practices. In caring for frontline healthcare workers, <span>NTUH</span> established interdisciplinary care teams to provide psychological support, assistance with basic daily needs, and effective social, psychological, and mental health support programs. In conclusion, NTUH demonstrated efficient response capabilities and care for healthcare workers during the COVID-19 pandemic, providing valuable insights for future challenges in dealing with emerging infectious diseases.</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":"142289955","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}

{"title":"Healthcare for all — A critical review of Taiwan's national health insurance system through a social institution lens","authors":"","doi":"10.1016/j.jfma.2024.07.003","DOIUrl":"10.1016/j.jfma.2024.07.003","url":null,"abstract":"","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":"141555128","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}

{"title":"Addition of neutrophil-to-lymphocyte ratio to Pre-DAA FIB-4 does not increase prediction value for de novo liver complications in hepatitis C.","authors":"Chun-Ming Hong, Tung-Hung Su, Shih-Jer Hsu, Tai-Chung Tseng, Chen-Hua Liu, Hung-Chih Yang, Jia-Horng Kao, Pei-Jer Chen, Pin-Nan Cheng, Chao-Hung Hung, Cheng-Yuan Peng, Chien-Hung Chen, Chun-Yen Lin, Hsing-Tao Kuo, Han-Chieh Lin, Yi-Hsiang Huang, Chi-Yi Chen, Chih-Lin Lin, Pei-Chien Tsai, Yu-Syuan Zeng, Chia-Yen Dai, Wan-Long Chuang, Jee-Fu Huang, Chung-Feng Huang, Ming-Lun Yeh, Ming-Lung Yu, Chun-Jen Liu","doi":"10.1016/j.jfma.2024.10.024","DOIUrl":"https://doi.org/10.1016/j.jfma.2024.10.024","url":null,"abstract":"<p><strong>Background and aims: </strong>Direct-acting antiviral agents (DAAs) achieve high sustained virologic response (SVR) in chronic hepatitis C patients; yet a proportion of patients still experience de novo liver complications after SVR. Identification of risk factors is clinically important. FIB-4 index is a useful noninvasive tool to assess fibrosis, while neutrophil-to-lymphocyte ratio (NLR) is a biomarker for systemic inflammation. Our study aimed to investigate whether the addition of NLR can increase the prediction power of pre-DAA FIB-4 for de novo liver complications after SVR.</p><p><strong>Methods: </strong>We recruited patients via The Taiwan HCV Registry (TACR) and National Health Insurance Registry Database. The inclusion criteria were patients who achieved SVR12 after DAA and were followed for at least 24 months after SVR12. Liver complications included ascites, hepatic encephalopathy, variceal bleeding, and HCC.</p><p><strong>Results: </strong>Totally 7657 patients were recruited from 2013 to 2018. Among them, 3674 patients (48.0%) had a FIB-4 value > 3.25 and 491 patients (6.4%) had a NLR >4 before DAA. After two-year of follow-up after SVR 12, 214 patients (2.8%) developed de novo liver complications. Factors associated with liver complications included male gender, diabetes mellitus, hyperlipidemia, chronic kidney disease, and pre-DAA FIB-4 >3.25 in multivariate analyses. Addition of NLR slightly did not increase the power of predicting liver complications.</p><p><strong>Conclusions: </strong>The overall incidence of de novo liver complications after SVR is low during short-term follow-up. Elevated pre-DAA FIB-4 is associated with de novo liver complications after SVR, whereas the addition of pre-DAA NLR does not increase the prediction power.</p>","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":"142564289","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}

{"title":"Exploring the challenges of taiwanese nurses in the COVID-19 post-pandemic era","authors":"","doi":"10.1016/j.jfma.2024.03.020","DOIUrl":"10.1016/j.jfma.2024.03.020","url":null,"abstract":"<div><div>In the wake of the COVID-19 pandemic, the fluctuating nurse resignation rates highlighted an understudied area in healthcare: post-pandemic challenges in clinical settings. This study, conducted from May to November 2023, employed a qualitative inquiry using focus groups to delve into these challenges. Six focus group sessions, involving 33 nurse participants recruited through snowball sampling from various hospital settings were conducted to explore their clinical experiences during and after the pandemic. Thematic analysis revealed two primary themes: the 'Invisibility of Nurses' within the healthcare system and the 'Moral Duty of Nursing Practice'. These findings illuminate a tension between the overlooked role of nurses and their ethical obligations, underscoring a critical need for policy reassessment. The study advocates for systemic changes, particularly in the undervaluation of the nursing profession and the National Health Insurance system, to address the poor working environment and mitigate long-term nursing shortages. This research deepens understanding of post-pandemic nursing workforce challenges in Taiwan, highlighting the need for policy evolution to enhance recognition and support for the nursing industry. It is suggested to provide tangible compensation to acknowledge nurses' daily care and health education for patients. A healthier working environment can be enhanced by collaborative efforts between healthcare institutions and nurses.</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":"140850093","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}

{"title":"Home-based advanced care is a solution to quality health care in rural Taiwan: Lessons learned during the COVID-19 pandemic","authors":"Sang-Ju Yu ,&nbsp;Fei-Ching Yang ,&nbsp;Ping-Jen Chen ,&nbsp;Hui-Chia Chan ,&nbsp;Jung-Yu Liao","doi":"10.1016/j.jfma.2024.08.010","DOIUrl":"10.1016/j.jfma.2024.08.010","url":null,"abstract":"<div><h3>Background/purpose</h3><div>The integrated home-based medical care (iHBMC) program has been implemented by the Taiwanese government since 2016. The pandemic of coronavirus disease 2019 (COVID-19) accelerated the shift from hospital-based to community-based healthcare, with a special focus on advanced home care for frail older adults. This study focuses on home-based advanced care, such as hospital at home (HaH), aiming to explore the feasibility and resilience of HaH within a home-based medical care model in a rural community in Taiwan.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of medical records from February 2020 to August 2022. Two clinical professionals reviewed and abstracted data from the electronic medical records of 189 patients receiving home healthcare during the COVID-19 pandemic. The HaH event was calculated if patients had any acute infection and received treatment at home.</div></div><div><h3>Results</h3><div>A total of 62 HaH events occurred during 2020–2022 and the average HaH events per person was 1.4. In these events, the top reason for patients receiving HaH was pneumonia, followed by urinary tract infection, soft tissue infection, and sepsis. 77.4% of patients completed the HaH treatment and did not experience any recurrent acute infections in the 30-day follow-up.</div></div><div><h3>Conclusion</h3><div>Different forms of home healthcare enhance the resilience of medical care provision in rural areas. As Taiwan approaches a hyper-aged society by 2025, it is crucial that National Health Insurance policies support various home-based care models that address transportation issues and maintain high care standards in underserved rural areas.</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":"141988261","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}

{"title":"Pharmaceutical procurement profits and universal health coverage: Reform to a sustainable healthcare and financing system","authors":"Weng-Foung Huang ,&nbsp;Jerry Kai-Chun Fu ,&nbsp;Chen-Han Chueh ,&nbsp;Hsin-Hung Chen ,&nbsp;Li-Jiuan Shen ,&nbsp;Yi-Wen Tsai","doi":"10.1016/j.jfma.2024.10.003","DOIUrl":"10.1016/j.jfma.2024.10.003","url":null,"abstract":"<div><h3>Background</h3><div>In this study, using Taiwan's National Health Insurance (NHI) as an example of a single-payer system, we examined the extent of pharmaceutical procurement profits (PPP) and evaluated their impact on the financial performance of healthcare institutions.</div></div><div><h3>Methods</h3><div>We extracted data from financial statements and healthcare service declarations of NHI-contracted hospitals from 2015 to 2021. Financial data concerning PPP, health service profits (HSP), and total operating profits (TOP) from each hospital were analyzed. The impact of PPP on hospitals with positive and negative HSP was further investigated.</div></div><div><h3>Results</h3><div>The total PPP across all hospitals studied gradually increased from NT$30.6 billion in 2015 to NT$47.0 billion in 2021. In 2021, 28.1% of all hospitals reported a deficit in HSP. PPP appeared to have a significantly positive impact on the financial performance of these hospitals. It not only enhanced positive profits, but also helped mitigate or completely offset the negative profits from HSP. The effect of PPP seems to be more pronounced for hospitals with larger HSP values, suggesting that larger hospitals benefit more from PPP in absolute terms.</div></div><div><h3>Discussion</h3><div>Average PPP increased during the study period, increasingly affecting hospitals’ financial stability across all strata. The gap between TOP and HSP in medical centers has gradually widened, suggesting an increase in non-health service profits. In this study, we propose a payment policy reform that fosters sustainability of the healthcare and financing system under universal health coverage and corrects the potential distortions caused by PPP.</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":"142391505","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}

{"title":"Enhancing Traditional Chinese Medicine healthcare system in Taiwan post-COVID-19 pandemic: A strategic focus on specialization","authors":"Shun-Ku Lin ,&nbsp;Jung-Nien Lai","doi":"10.1016/j.jfma.2024.09.012","DOIUrl":"10.1016/j.jfma.2024.09.012","url":null,"abstract":"<div><div>Despite the advancements in precision medicine, regenerative medicine, and smart healthcare, traditional Chinese medicine (TCM) remains vital in Taiwan, reflecting its cultural and historical heritage. TCM is commonly used in conjunction with or as an alternative to conventional medicine and is reimbursed by Taiwan's National Health Insurance, enabling the Taiwanese people to integrate traditional and modern treatments for comprehensive healthcare. This article explores the critical role of specialization in TCM amid evolving healthcare challenges. This highlights the need for specialized knowledge among TCM physicians to manage iatrogenic risks, such as drug-herb interactions, and to improve healthcare outcomes, particularly when integrating TCM with Western medicine. Specialization enhances treatment precision, patient outcomes, and clinical research quality. Drawing on South Korea's experience in establishing a specialist physician system for traditional Korean medicine, Taiwan's Ministry of Health and Welfare's initiatives to advance systematic TCM training and regulatory frameworks were examined, showcasing the development and implementation of a TCM specialist physician training program. In conclusion, specialized physician training in TCM improves patient care, optimizes healthcare utilization, and promotes long-term sustainability of the health insurance system by aligning TCM practices with modern healthcare needs.</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":"142289952","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}

{"title":"Guide for Authors","authors":"","doi":"10.1016/S0929-6646(24)00500-X","DOIUrl":"10.1016/S0929-6646(24)00500-X","url":null,"abstract":"","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":"142578216","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}

{"title":"Authorship statement","authors":"","doi":"10.1016/S0929-6646(24)00502-3","DOIUrl":"10.1016/S0929-6646(24)00502-3","url":null,"abstract":"","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":"142578218","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}

{"title":"Enhancing Taiwan's healthcare sustainability: A Delphi study on national medicines policy reforms","authors":"Chih-Fen Huang ,&nbsp;Kuan-Lin Chen ,&nbsp;Fang-Ju Lin ,&nbsp;Chi-Chuan Wang ,&nbsp;Churn-Shiouh Gau ,&nbsp;Li-Jiuan Shen","doi":"10.1016/j.jfma.2024.08.018","DOIUrl":"10.1016/j.jfma.2024.08.018","url":null,"abstract":"<div><h3>Background/purpose</h3><div>The National Medicines Policy (NMP) is crucial as it sets the framework for ensuring access to affordable, high-quality medicines and promoting their rational use, which is essential for public health and the efficiency of the healthcare system. This study aims to evaluate the current state of Taiwan's NMP, identify pressing issues for improvement, and establish actionable suggestions through expert consensus to ensure the sustainable provision and use of medications.</div></div><div><h3>Methods</h3><div>A modified two-round Delphi technique was employed. The first-round survey identified key issues and suggestions for policy improvement, while the second-round survey evaluated the feasibility and effectiveness of these suggestions. The expert panel, consisting of 50 specialists from pharmacy, medicine, public health, and the pharmaceutical industry, evaluated key issues related to the NMP's efficacy using a 4-point Likert scale.</div></div><div><h3>Results</h3><div>The first-round survey identified 13 key issues in Taiwan's NMP, primarily focusing on the rational use and accessibility of medications. The second-round survey proposed 54 policy improvement suggestions for these issues, of which 20 were considered strong suggestions and 23 were moderate suggestions. The policy recommendations cover medication reimbursement, pharmacy professional services, administration, legislation, and education.</div></div><div><h3>Conclusion</h3><div>The study highlights the urgent need for reforms in Taiwan's NMP, providing specific policy improvement suggestions to ensure high-quality medications and pharmaceutical services while supporting the sustainable operation of Taiwan's NHI system. The study underscores the significance of proactive measures to fortify healthcare sustainability in the face of evolving healthcare landscapes.</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":"142055957","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}