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Background: Palliative care has historically been under-utilized in patients with glioblastoma. Furthermore, literature on the utilization of healthcare and life-sustaining interventions during the late-stage of glioblastoma has been limited. Aim: To identify and compare healthcare utilization and life-sustaining interventions between patients with glioblastoma who received palliative care and who did not based on patients identified retrospectively from Taiwan Cancer Registry between January 2007 and December 2017. Design: In this study, palliative care was defined on the basis of claims submitted to the National Health Insurance, which has a specific code for it. Variables included demographic characteristics, the utilization of healthcare services, and invasive life-sustaining interventions. Setting/participants: Of the 1994 patients with glioblastoma identified, 1784 fulfilled the inclusion criteria, 613 (34%) of whom received palliative care. Results: The survival of patients with glioblastoma under palliative care was significantly longer than that of those without palliative care. Those without palliative care had significantly more frequent intensive care unit admissions and a longer cumulative length of intensive care unit stay. Regarding cardiopulmonary or respiratory treatments, patients without palliative care had significantly more invasive interventions than those with palliative care. Patients receiving palliative care had significantly lower odds than those without life-sustaining interventions. Conclusions: Our retrospective analysis reveals that glioblastoma patients without palliative care had greater odds of receiving life-sustaining treatments within 1 year before their death, although no gains in survival as compared to those that received palliative care. These findings highlight the urgent need for palliative care in caring for patients with glioblastoma. [ABSTRACT FROM AUTHOR]

Patients with juvenile myoclonic epilepsy (JME) may not achieve seizure freedom despite optimal treatment with antiseizure medications (ASMs). The aim of this study was to investigate the clinical and social features of patients with JME, and to determine the factors associated with outcomes. We retrospectively identified 49 patients with JME (25 females, mean age 27.6 ± 8.9 years) who were assessed at the Epilepsy Centre of Linkou Chang Gung Memorial Hospital in Taiwan. The patients were divided into two groups, those who were seizure-free and those with ongoing seizures according to their seizure outcome at the last follow-up for one year. Clinical features and social status were compared between these two groups. Twenty-four (49%) of the JME patients were seizure-free for at least one year, while 51% continued to experience seizures despite being treated with multiple ASMs. The presence of epileptiform discharges in the last electroencephalogram and seizures during sleep were significantly associated with worse seizure outcomes (p < 0.05). The patients who were seizure-free had a higher employment rate compared to those who continued to experience seizures (75% vs. 32%, p = 0.004). Despite receiving ASM treatment, a considerable proportion of the patients with JME continued to have seizures. Moreover, poor seizure control was associated with a lower employment rate, which may lead to negative socioeconomic consequences related to JME. [ABSTRACT FROM AUTHOR]

Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS) use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years) and nonelderly (<65 years). Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05) fewer (28 (9.2%)) nontransport calls than did the nonelderly (136 (21.4%)). In the transport calls, 276 (35.6%) were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now. [ABSTRACT FROM AUTHOR]

Physicians in Taiwan have a heavy workload and a stressful workplace, both of which may contribute to cardiovascular disease. However, the risk of acute myocardial infarction (AMI) in physicians is not clear. This population-based cohort study used Taiwan’s National Health Insurance Research Database. We identified 28,062 physicians as the case group and randomly selected 84,186 nonmedical staff patients as the control group. We used a conditional logistic regression to compare the AMI risk between physicians and controls. Subgroup analyses of physician specialty, age, gender, comorbidities, area, and hospital level were also done. Physicians have a higher prevalence of HTN (23.59% versus 19.06%, P<0.0001) and hyperlipidemia (21.36% versus 12.93%, P<0.0001) but a lower risk of AMI than did the controls (adjusted odds ratio (AOR): 0.57; 95% confidence interval (CI): 0.46–0.72) after adjusting for DM, HTN, hyperlipidemia, and area. Between medical specialty, age, and area subgroups, differences in the risk for having an AMI were nonsignificant. Medical center physicians had a lower risk (AOR: 0.42; 95% CI: 0.20–0.85) than did local clinic physicians. Taiwan’s physicians had higher prevalences of HTN and hyperlipidemia, but a lower risk of AMI than did the general population. Medical center physicians had a lower risk than did local clinic physicians. Physicians are not necessary healthier than the general public, but physicians, especially in medical centers, have a greater awareness of disease and greater access to medical care, which permits timely treatment and may prevent critical conditions such as AMI induced by delayed treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: A negative sputum smear from a patient with history, physical examination, and chest x-ray findings suggestive of tuberculosis (TB) presents a diagnostic dilemma. We investigated the possible factors associated with a misdiagnosis and inappropriate treatment of TB among such patients. METHODS: We reviewed the records of 193 patients whose diagnoses with TB included conflicting test results and were reported to the Taiwan Centers for Disease Control in 2004. When other conditions were found to underlie the initial abnormal chest x-ray finding, the diagnosis was revised. RESULTS: Mycobacterium tuberculosis was isolated from sputum samples in 72 of 193 patients (37%), nontuberculous mycobacteria from 4 (2%), and no bacteriologic evidence of M. tuberculosis from 117 (61%). The initial diagnosis of TB was revised for 26 (13.5%) patients. Patients with positive M. tuberculosis culture had a lower incidence of revised diagnoses (4.2%, P < .001) than those negative for mycobacterial culture (17.1%) and those with nontuberculous mycobacteria (75%). Chest cavitations in this study were not a significant predictor of revised diagnosis (odds ratio 0.30, P = .08). CONCLUSIONS: An incorrect diagnosis of TB despite a negative sputum smear result is more likely to be made for patients positive for nontuberculous mycobacteria culture and less likely for patients with positive M. tuberculosis culture. [ABSTRACT FROM AUTHOR]

The authors sought to explore the prevalence and factors related to nonalcoholic fatty liver disease (NAFLD) among occupational population in Taipei, Taiwan. A total of 8347 healthy adults voluntarily admitted to annual physical check-up. Blood samples and ultrasound-proved fatty liver sonography results were collected. The results showed that the prevalence of NAFLD was 48.4% and revealed a statistically significant increase with increasing population age. Males exhibited a greater prevalence of NAFLD than did females (57.8% vs 32.4%, P < .001). Using multiple logistic regression analysis, in addition to male gender, older age, higher body mass index, higher aspartate aminotransferase level, higher alanine aminotransferase level, presence of hypertension, presence of hyperuricemia, presence of hypercholesterolemia, higher fasting plasma glucose, and presence of hypertriglyceridemia were the significant factors associated with NAFLD. The differences in occupational professions were revealed. In conclusion, occupational populations are asymptomatic, and the diagnosis of NAFLD should be considered with older age, hyperuricemia, higher aspartate aminotransferase level, higher alanine aminotransferase level, and metabolic risk factors. [ABSTRACT FROM PUBLISHER]