Patient-Centered Ehealth Service Design: A Case Study in Chushang Show Chwan Hospital

Taiwan Executive Yuan promote eHealth, as one of the six emerging industries that Taiwan Executive Yuan would fully support and allocate budget. According to the World Health Organization, eHealth is the delivery and support of health care components through the use of information and communications technology. Top down to eHealth operations in one of the Taiwan Island wide Hospitals, ChuShang Show Chwan Hospital, the current trend can be as follows: patient-centric activities and processes, customized solutions, the focus of wellness, inclusion of individuals and families in the decision-making processes, and the focus of service quality. Although previous studies have discussed information and communications technology usage in eHealth, the use of information and communications technology is not the only feature of eHealth. The corresponding service features should also be taken into consideration. From the service organization’s perspective, a service must be designed with an appropriate mix of physical and non-physical components. It is important to know the critical features of a service in order to design appropriate eHealth services. Accordingly, we aim to discover the service features in eHealth that are valued by customers through a case study of ChuShang Show Chwan Hospital. We adopt the concept of symbolic adoption to do this research. We propose that the identification of service features should be differentiated based on different stages of adoption as different service features may have different focuses and utilities. Thus, in this research, we are interested in clarifying service features that have impacts on symbolic adoption, trial, and use adoption. The results can help healthcare organizations to design different strategies to take care of patients in different adoption stages

DESIGNING A SERVICE PORTFOLIO FOR A TAIWANESE HOSPITAL TELECARE CENTER

National Ministry of Health and Welfare defined Tele health care (Telecare) as a combination of medical care, ICT technology, electronic medical equipment, and other cross-cutting professional to allow people to get the health care and preventive health services in the community and familiar home environment and aging in place. To date, telecare has become the world medical technology and services industry trend. However, most elderly are significantly less familiar with technology use than the general population, inhibiting telecare adoption. Based on service portfolio concept, we design core and supplementary service elements for a Taiwanese telecare center. To further examine how patients perceive the values of these service elements in different adoption stages, we conduct surveys with potential clients and current patients of the telecare center. We take customers adoption process as an indicator of “value creation” and examine how the values of service elements vary across different adoption stages. Meanwhile, service quality and productivity should be properly integrated since quality focuses on the benefits created for the customer’s side of the equation, but productivity addresses the financial costs incurred by the hospital. If not properly integrated, these two foci can be in conflict. Thus, our service portfolio will consider not only the value of the services but also the available management resources to run the services. The results suggest approaches to re-allocating the limited resource to the most valuable service elements perceived by customers, and thus help hospitals to drive potential clients, sustain current patients, and maintain service quality of the hospital simultaneously

Drivers of eHealth Adoption: Linking eHealth Adoption to Service Concept

Researchers and practitioners are keenly interested in understanding what drives eHealth adoption in recent years. This is largely because, while eHealth can lead to cost-effective and quality health care, the actual adoption rate of eHealth remains low across countries. In prior literature, it was clearly indicated that well-designed eHealth services are critical to eHealth adoption. In this study, our findings further show that, what may motivate patients’ adoption is more strongly associated with the design of eHealth caring service, and the design of eHealth IT service is more likely to be associated with patients’ continual use

The Waveform Fluctuation and the Clinical Factors of the Initial and Sustained Erythropoietic Response to Continuous Erythropoietin Receptor Activator in Hemodialysis Patients

Objectives. Erythropoiesis-stimulating agents (ESA) are the main treatment for anemia in hemodialysis (HD) patients. We evaluated factors determining the response after treatment of a new ESA (continuous erythropoietin erythropoietin receptor activator (CERA)). Methods. 61 HD patients were classified by their response at two different timings. First, patients whose hematocrit (Hct) increased 1.5% in the first week were defined as initial responders (IR, n = 16). We compared several parameters between IR and the rest of the study subjects (non-IR, n = 45). Second, patients whose Hct increased 2% in the 4th week were defined as sustained responders (SR, n = 12), and we did a similar comparison. Results. The Hct showed a waveform fluctuation. Compared with the rest, IR had significantly lower platelet counts and higher levels of ferritin, total protein, total bilirubin, and serum sodium, while SR had significantly lower levels of C-reactive protein and low-density lipoprotein (All P < 0.05). In comparison with the rest, higher Hct persisted for 10 weeks in SR but only for two separate weeks (the 1st and 7th week) in IR. Conclusions. The initial and sustained erythropoietic responses are independent from each other and are associated with different factors. Treatment focusing on these factors may improve the response

Prevention and early management of carotid blowout syndrome for patients receiving head and neck salvage boron neutron capture therapy (BNCT)

Background/purpose The incidence rate of oral and pharyngeal cancers in Taiwan has increased gradually over the past few decades. The standard treatment strategy for oral and pharyngeal cancers includes surgery or radiotherapy, with concurrent chemotherapy in certain types of tumors. Unfortunately, in-field recurrence is sometimes inexorable. Furthermore, re-irradiation of the recurrence site may cause severe complications due to the tolerance of normal tissue to radiation therapy. One fatal complication is carotid blowout syndrome (CBS). Boron neutron capture therapy (BNCT) is a new modality of radiation therapy, which is also mentioned as targeted radiotherapy. It is a feasible treatment that has the potential to spare normal tissue from being damaged by irradiation while simultaneously treating the primary tumor. In this presentation, we will share our experience with BNCT in treating recurrent head and neck cancers, as well as the prevention and management of CBS. Materials and methods We evaluated 4 patients with head and neck cancers treated by BNCT in Taiwan. All patients had undergone surgery previously and had received postoperative concurrent chemoradiotherapy. Results The 4 patients in this study were diagnosed with head and neck malignancies. The median follow-up period after the first course of BNCT was 15.1 months. After BNCT, 2 patients developed impending CBS, and 1 of them died. The remaining 3 patients survived until the last date of follow-up. Conclusion Pre-BNCT carotid artery evaluation through computed tomography angiography and early intervention if necessary is crucial when treating patients with recurrent head and neck cancers by BNCT

Antiviral Ability of Kalanchoe gracilis Leaf Extract against Enterovirus 71 and Coxsackievirus A16

Pandemic infection or reemergence of Enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) occurs in tropical and subtropical regions, being associated with hand-foot-and-mouth disease, herpangina, aseptic meningitis, brain stem encephalitis, pulmonary edema, and paralysis. However, effective therapeutic drugs against EV71 and CVA16 are rare. Kalanchoe gracilis (L.) DC is used for the treatment of injuries, pain, and inflammation. This study investigated antiviral effects of K. gracilis leaf extract on EV71 and CVA16 replications. HPLC analysis with a C-18 reverse phase column showed fingerprint profiles of K. gracilis leaf extract had 15 chromatographic peaks. UV/vis absorption spectra revealed peaks 5, 12, and 15 as ferulic acid, quercetin, and kaempferol, respectively. K. gracilis leaf extract showed little cytotoxicity, but exhibited concentration-dependent antiviral activities including cytopathic effect, plaque, and virus yield reductions. K. gracilis leaf extract was shown to be more potent in antiviral activity than ferulic acid, quercetin, and kaempferol, significantly inhibiting in vitro replication of EV71 (IC50 = 35.88 μg/mL) and CVA16 (IC50 = 42.91 μg/mL). Moreover, K. gracilis leaf extract is a safe antienteroviral agent with the inactivation of viral 2A protease and reduction of IL-6 and RANTES expressions

Long-term results of intensity-modulated radiotherapy concomitant with chemotherapy for hypopharyngeal carcinoma aimed at laryngeal preservation

<p>Abstract</p> <p>Background</p> <p>The objective of this retrospective study is to investigate laryngeal preservation and long-term treatment results in hypopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) combined with chemotherapy.</p> <p>Methods</p> <p>Twenty-seven patients with hypopharyngeal carcinoma (stage II-IV) were enrolled and underwent concurrent chemoradiotherapy. The chemotherapy regimens were monthly cisplatin and 5-fluorouracil for six patients and weekly cisplatin for 19 patients. All patients were treated with IMRT with simultaneous integrated boost technique. Acute and late toxicities were recorded based on CTCAE 3.0 (Common Terminology Criteria for Adverse Events).</p> <p>Results</p> <p>The median follow-up time for survivors was 53.0 months (range 36-82 months). The initial complete response rate was 85.2%, with a laryngeal preservation rate of 63.0%. The 5-year functional laryngeal, local-regional control, disease-free and overall survival rates were 59.7%, 63.3%, 51.0% and 34.8%, respectively. The most common greater than or equal to grade 3 acute and late effects were dysphagia (63.0%, 17 of 27 patients) and laryngeal stricture (18.5%, 5 of 27 patients), respectively. Patients belonging to the high risk group showed significantly higher risk of tracheostomy compared to the low risk group (p = 0.014).</p> <p>Conclusions</p> <p>After long-term follow-up, our results confirmed that patients with hypopharyngeal carcinoma treated with IMRT concurrent with platinum-based chemotherapy attain high functional laryngeal and local-regional control survival rates. However, the late effect of laryngeal stricture remains a problem, particularly for high risk group patients.</p

Ankle-Brachial Index Is a Powerful Predictor of Renal Outcome and Cardiovascular Events in Patients with Chronic Kidney Disease

Ankle-brachial index (ABI) is an accurate tool to diagnose peripheral arterial disease. The aim of this study was to evaluate whether ABI is also a good predictor of renal outcome and cardiovascular events in patients with chronic kidney disease (CKD). We enrolled 436 patients with stage 3–5 CKD who had not been undergoing dialysis. Patients were stratified into two groups according to the ABI value with a cut point of 0.9. The composite renal outcome, including doubling of serum creatinine level and commencement of dialysis, and the incidence of cardiovascular events were compared between the two groups. After a median follow-up period of 13 months, the lower ABI group had a poorer composite renal outcome (OR = 2.719, P = 0.015) and a higher incidence of cardiovascular events (OR = 3.260, P = 0.001). Our findings illustrated that ABI is a powerful predictor of cardiovascular events and renal outcome in patients with CKD