Impact of nosocomial infections on medical costs, hospital stay, and outcome in hospitalized patients.

BACKGROUND AND PURPOSE: Nosocomial infections have been shown to be associated with increased attributable mortality, length of hospital stay, and health care costs in studies mainly conducted in western populations. However, the health care system in Taiwan differs from the typical situation in western countries, with longer hospitalization times and lower daily costs. The purpose of this study was to understand the economic and clinical impacts of nosocomial infections in Taiwan. METHODS: Between June 1, 2001 and December 31, 2001, every hospitalized patient (age >/= 16 years) with nosocomial infections (case group) and matched control patients without nosocomial infections of the same age, gender, underlying medical illness, clinical diagnosis at admission and disease severity (control group) were recruited. Demographic characteristics, length of hospitalization, costs and final outcomes of both groups were collected for analysis. RESULTS: A total of 482 patient-pairs with median age of 68 years were studied. The median length of hospital stay was 40 days for the case group and 22 days for the control group (p < 0.0001). The median hospital cost for the case group was 363,425 New Taiwan Dollars (NTD) and 165,965 NTD for the control group (p < 0.0001). The median additional hospital stay for patients with nosocomial infection was 15 days, which amounted to 127,354 NTD. The extra hospital costs were not only associated with accommodation but also fees for materials, and costs relating to pharmacy, laboratory tests and diet. Patients with nosocomial infections were more likely to have shock, organ failure and death (all p < 0.0001). Additional hospital stay and costs were not related to various infection sites and bacterial pathogens causing nosocomial infections; however, medical costs attributable to nosocomial fungal infection were higher than that of bacterial infections. CONCLUSIONS: Nosocomial infections have a significant impact on the length of hospital stay and medical care cost. Extra costs of nosocomial infections resulted not only from prolongation of hospital stay, but also other medical costs. Infection control for preventing nosocomial infections may play an important role in reducing medical costs, hospital stay, and mortality in hospitalized patients.     

Intervals before tuberculosis diagnosis and isolation at a regional hospital in Taiwan.

BACKGROUND/PURPOSE: Nosocomial tuberculosis (TB) infection is still a problem in many Taiwanese hospitals. The objectives of this study were to explore the intervals before TB diagnosis and isolation at a regional hospital in Taiwan, and to provide useful knowledge to hospitals for the purpose of TB infection control. METHODS: From 2002 to 2005, we included a total of 343 patients with culture-positive pulmonary TB in a regional hospital in Southern Taiwan for this study. Their medical records were reviewed, and the time intervals between patient-hospital contact points and isolation were recorded. RESULTS: Of 343 culture-positive pulmonary TB patients, the majority were male, over 40 years old, and unemployed. The mean interval between the first admission and isolation was 20.5 days (median, 2.0 days). The mean intervals between the first admission from outpatient clinics, emergency department and hospitalization and suspected TB were < 1 day, 6.07 days and 25.53 days, respectively. The mean accumulated exposure time was 0.35 days, 0.61 days and 10.09 days in outpatient clinics, the emergency department and hospitalization, respectively; 75.5% of patients had their diagnosis confirmed at the chest department of the department of internal medicine. CONCLUSION: Delayed diagnosis was most likely in the case of hospitalized patients and least likely in outpatient clinics. Delayed diagnosis in hospitalized patients also contributed more severely to TB exposure time than others. Enhancing the quality, speed and ability of specialists and physicians to diagnose TB, especially in emergency departments and in hospitalized patients, is essential.     

Term delivery after hospitalization for preterm labor: incidence and costs in california

Objective: To determine the incidence and costs for cases of idiopathic preterm labor followed by term delivery.Study Design: Patients hospitalized with preterm labor (N = 28,845) were identified in a dataset linking antepartum and delivery discharge abstracts of all women in California (N = 404,466) with a delivery related diagnosis from 1/1/93 to 11/19/93. Patients with multiple gestations, PROM, abruption, placenta previa, uterine anomalies, and other morbidities were excluded, leaving 19,897 study subjects. Birth outcomes were classified as term or preterm (<37 weeks). The incidence, hospital costs, and risk factors for hospitalization for preterm labor followed by term delivery were then determined using a retrospective nested case control design. Indirect costs of subsequent bedrest were estimated using data from the California Disability Insurance Fund.Results: Thirty-four percent of patients hospitalized with idiopathic preterm labor had term deliveries accounting for 2% of the pregnant population. Eighty-one percent of patients who were discharged undelivered after hospitalization delivered at term. These patients were significantly more likely to be Caucasian, privately insured, and older than patients who delivered preterm. A minimum of 45% of cases were estimated to be false diagnoses based on the relative risk of post-dates pregnancy between patients hospitalized with preterm labor and term controls. Costs totalled $4,995 per case with $2,335 in hospital costs and $2,497 in indirect costs from an average of 4 weeks of bedrest. Statewide costs for California were estimated to range from 24 to 48 million dollars annually for these potentially avertible hospitalizations.Conclusions: Hospitalization for idiopathic preterm labor with delivery at term is common, costly, and probably due to false diagnosis in a significant proportion of cases.     

Trends in asthma mortality in Taiwan, 1981-2000.

BACKGROUND AND PURPOSE: The prevalence and mortality rates of asthma in many countries have increased in the past 2 decades. The purpose of this study was to determine the trends of asthma mortality in Taiwan from 1981 through 2000. METHODS: Data from the National Health Statistics for Taiwan identifying asthma [International Classification of Disease (ICD)-9 code 493] as the underlying cause of death were collected. Age-specific and age-adjusted mortality rates of asthma were calculated and the 20-year trends were analyzed. RESULTS: The crude mortality rate of asthma decreased from 8.17 to 4.53 per 100,000 general population, and the age-adjusted mortality rate decreased from 8.17 to 2.37 per 100,000 during the 20-year period. This trend of decreasing mortality was most obvious for age groups older than 35 years, i.e., from 4.05 to 1.20 per 100,000 in those aged 35 to 54 years and from 47.43 to 13.44 per 100,000 in those aged 55 to 74 years. The mortality rate for asthma in those aged 15 to 34 years remained the same, around 0.40 to 0.35 per 100,000 population. For those below 15 years of age, the mortality rates for asthma fluctuated between 0.30 and 0.10 per 100,000 population. CONCLUSIONS: The mortality rate of asthma has steadily decreased in Taiwan in the past 20 years, especially in the age groups above 35 years.     

Immunogenicity of oral poliovirus vaccine in Taiwan.

Previous studies have shown that the immune response to trivalent oral poliovirus vaccine (OPV) varies widely from country to country. However, there has been no report on the immunogenicity of this vaccine in Taiwanese children. In this study, 98 children were followed up for 17 months to study the antibody responses following four doses of trivalent OPV. The results showed that, after two doses of vaccine, all children were protected against poliovirus type 1 and 2. All except two children also developed protective antibodies against poliovirus type 3. After three doses, the antibody levels in all subjects were above protective concentrations. The fourth dose, given at 18 months of age, further boosted the antibody titers. These findings show that the OPV currently used in Taiwan is highly immunogenic in Taiwanese children.     

The cost of prematurity: quantification by gestational age and birth weight

OBJECTIVE: To determine gestational age- and birth weight-related pregnancy outcomes and resource use associated with prematurity in surviving neonates. METHODS: A data set linking birth certificates with maternal and newborn hospital discharge records from hospitals in California (from January 1, 1996, to December 31, 1996) was examined for all singleton deliveries by gestational age (weekly, from 25 to 38 weeks) and birth weight (by 250-g increments from 500 to 3000 or more g). Records were examined for respiratory distress syndrome (RDS), use of mechanical ventilation, length of hospital stay in days, and hospital costs. RESULTS: As expected, RDS, ventilation, length of hospital stay, and costs per case decreased exponentially with increasing gestational age and birth weight. Specifically, neonatal hospital costs averaged 202,700 dollars for a delivery at 25 weeks, decreasing to 2600 dollars for a 36-week newborn and 1100 dollars for a 38-week newborn. Neonatal costs were 224,400 dollars for a newborn at 500-700 g, decreasing to 4300 dollars for a newborn at 2250-2500 g and 1000 dollars for a birth weight greater than 3000 g. For each gestational age group from 25 to 36 weeks, total neonatal costs were similar, despite increasing case numbers with advancing gestational age. Neonatal RDS and need for ventilation were significant at 7.4% and 6.3%, respectively, at 34 weeks' gestation. Significant "excess" costs were found for births between 34 and 37 weeks' gestational age when compared with births at 38 weeks. CONCLUSION: Prematurity, whether examined by gestational age or birth weight, is associated with significant neonatal hospital costs, all of which decrease exponentially with advancing gestational age. Because total costs for each gestational age group from 25 to 36 weeks were roughly the same (38,000,000 dollars), opportunity for intervention to prevent preterm delivery and decrease costs is potentially available at all preterm gestational ages.     

Pregnancy-associated assault hospitalizations

OBJECTIVE: To determine the rate of pregnancy-associated hospitalized assaults in a multistate population and whether they have any increased assault risk versus nonpregnant counterparts. METHODS: An International Classification of Diseases, 9th Revision (ICD-9-CM) pregnancy and injury criterion was applied to 1997 statewide hospital discharge data from 19 states (52% of the female population age 15-49 years). Cases were classified as assault-related with and without pregnancy-associated diagnoses. Pregnancy-associated and all women were compared using demographic specific rate ratios and severity stratification. RESULTS: There were 7402 assault-related injuries among all women ages 15-49; 745 (10%) were pregnancy-associated. The incidence of assaults involving hospitalizations was 65 per 100,000 person-years for pregnant women versus 21 per 100,000 for all women (rate ratio 3.14; 95% confidence interval [CI] 2.04, 3.39). Pregnant women were younger (mean age 24.2 versus 30.8 years), their average length of stay was shorter (2.6 versus 4.0 days), their mean injury severity score was less (2.5 versus 4.9), and the median charge per stay was lower ($3351 versus $6775). Unadjusted age-specific rate ratios (pregnant versus all women) for assaults were significantly higher for younger women 15-19 (rate ratio 7.22; 95% CI 4.81, 8.38), but when restricted to cases with injury severity scores of at least 4, most differences in rate ratios disappeared, except in the youngest women. CONCLUSION: While pregnant women were more likely to be hospitalized for assaults, most of the increase is associated with their lower hospital admission threshold and increased rates of both pregnancy and assaults among young and nonwhite women. Practitioners should perhaps think of pregnant women more as a "sensitive" rather than a "high-risk" group.     

Autoimmune thyroiditis in children with Turner syndrome.

PURPOSE: To determine the frequency of autoimmune thyroiditis (AIT) and the risk of development of thyroid dysfunction in children with Turner syndrome. METHODS: From 1988 to 1998, 77 children with Turner syndrome were prospectively followed up at National Taiwan University Hospital. The mean (+/- standard deviation) age of these patients was 10.0 +/- 4.7 years at diagnosis of Turner syndrome and 17.4 +/- 5.2 years at the end of the present study. Antithyroglobulin antibody, antimicrosomal antibody, and thyroid function were assessed once every 6 months during the study period. RESULTS: Thyroid autoantibodies were detected in 21 of the 77 (27%) patients. The mean age at the detection of thyroid autoantibodies was 12.2 +/- 5.2 years. The cumulative frequency of AIT at 10 years after diagnosis of Turner syndrome was 36%. Both patients with a ring X chromosome developed AIT. Three of the 21 patients (14%) with AIT developed thyroid dysfunction. One patient developed hypothyroidism at the time of the detection of thyroid autoantibody. Two other patients were noted to have hyperthyroidism 0.5 and 2.5 years, after the detection of thyroid autoantibodies, respectively. CONCLUSIONS: Our data demonstrated a high frequency of AIT in Taiwanese children with Turner syndrome. Some of these patients later developed thyroid dysfunction. Hence, this study has confirmed that regular follow-up assessment of thyroid autoantibody and thyroid function in Taiwanese children with Turner syndrome regardless of their age is necessary for timely diagnosis of thyroid dysfunction and administration of appropriate treatment.     

Cost analysis of myomectomy,hysterectomy, and uterine artery embolization

OBJECTIVE: The purpose of this study was to compare inpatient hospital costs of different treatments of uterine fibroid tumors, including myomectomy, hysterectomy, and uterine artery embolization in a teaching hospital. STUDY DESIGN: We reviewed the hospital database of 545 women with uterine fibroid tumors who were treated with abdominal myomectomy, total abdominal hysterectomy, vaginal hysterectomy, and uterine artery embolization between April 1997 and October 2001. RESULTS: Women who underwent hysterectomies and uterine artery embolization were significantly older than the women who underwent myomectomy. Uterine artery embolization was associated with the shortest hospital stay, although the hospital stay in the vaginal hysterectomy group was shorter than in the abdominal myomectomy and the total abdominal hysterectomy groups. Compared with other groups, the inpatient cost of nursing in the uterine artery embolization group was the lowest. The total inpatient cost of uterine artery embolization ($1,007.44 +/- $60.65 [Canadian dollars]) was significantly lower than the cost of total abdominal hysterectomy ($1,933.37 +/- $47.68 [Canadian dollars]), abdominal myomectomy ($1,781.73 +/- $47.16 [Canadian dollars]), and vaginal hysterectomy ($1,515.39 +/- $66.72 [Canadian dollars]; P <.001). Sixteen of the 85 patients (18.8%) were hospitalized after uterine artery embolization, mainly for abdominal pain. CONCLUSION: Compared with abdominal myomectomy, abdominal hysterectomy, and vaginal hysterectomy, uterine artery embolization is associated with a lower hospital cost and a shorter hospital stay. Hospitalization after uterine artery embolization is mainly for abdominal pain after the procedure. A better method of pain control to reduce the rate of hospitalization and its cost is needed.     

Endometriosis: what is the risk of hospital admission, readmission, and major surgical intervention?

STUDY OBJECTIVE: To describe trends in hospital utilization and surgical rates for endometriosis and to estimate the probability of hospital readmission over 4 years among women with early-stage disease. DESIGN: Population-based, retrospective cross-sectional and longitudinal analysis of 53,385 hospital admissions for same-day surgery or inpatient treatment of endometriosis from fiscal years 1994/95 through 2001/02 (Canadian Task Force classification III). SETTING: All hospital discharge records that listed endometriosis as the most-responsible diagnosis in the province of Ontario, Canada, from fiscal years 1994-1995 through 2001-2002. PATIENTS: Ontario female patients 15 years of age or older admitted to the hospital for treatment of endometriosis. INTERVENTIONS: Surgical treatments were classified as minor, intermediate, or major depending on the extent of the surgery. MEASUREMENTS AND MAIN RESULTS: Age-standardized annual discharge rates were calculated and trends in surgical treatment described. The records of 7993 women who received minor or intermediate surgery on their index hospital visit were linked, and the likelihood and predictors of readmission were calculated using survival analysis and logistic regression. During the observation period, the standardized discharge rates fell significantly from 172.9 per 100,000 women aged 15 to 70 to 137.1 per 100,000 (p<.05). Age-specific rates were highest for women aged 15 to 39 (approximately 200 per 100,000). The proportion of hospitalizations involving minor surgeries dropped (from 27% to 17%), and the proportion involving intermediate surgeries increased (from 40% to 53%). The likelihood of hospital readmission within 4 years for additional surgical treatment was 27% and of having a hysterectomy was 12%. CONCLUSION: Fewer women are being hospitalized for minor surgical procedures for endometriosis with hospital-based care being reserved for more extensive procedures. Nonetheless, about a quarter of women hospitalized for initial surgical treatment for endometriosis will undergo additional surgical treatment within 4 years, and one in 10 will have a hysterectomy.     

Nosocomial bloodstream infection in human immunodeficiency virus-infected patients in Taiwan: descriptive epidemiology and risk factors for mortality.

BACKGROUND AND PURPOSE: Nosocomial bloodstream infection (NBSI) is common in patients with human immunodeficiency virus (HIV) infection. This study evaluated the incidence, causative pathogens, and outcome of NBSIs in hospitalized HIV-infected patients at a university hospital in Taiwan. METHODS: The medical records of all HIV-infected patients who developed NBSIs from June 1994 to June 2003 were retrospectively reviewed. A standardized case record form was used to collect demographic, clinical, laboratory, and microbiologic data. RESULTS: During the study period, 57 episodes of NBSIs occurred in 51 HIV-infected patients whose median age was 37 years (range, 23 to 60 years). All of the patients were at HIV infection stage C. The incidence of NBSIs was 2.3 per 1000 person-days of hospitalization (41.4 per 1000 discharges). More than three-fourths of the 57 episodes (77.2%) were classified as primary NBSIs. Other infection foci included respiratory tract (6 episodes), urinary tract (3), surgical site (2), and skin (2). Staphylococcus species were the leading pathogens (42.1%). The crude and attributable mortality rates in patients with NBSIs during the study period were 38.6% and 26.1%, respectively. Multivariate analysis using a logistic regression model revealed that shock and hypoalbuminemia at the onset of NBSIs were the 2 factors predictive of mortality. CONCLUSIONS: NBSIs in hospitalized patients in the late stage of HIV infection were associated with a high attributable mortality rate. Staphylococcus species were the leading pathogen responsible for NBSIs. Presentations of shock and hypoalbuminemia were predictive of mortality.     

Clinical characteristics of Taiwanese hereditary non-polyposis colorectal cancer kindreds.

BACKGROUND AND PURPOSE: The prevalence of colorectal cancer in Taiwan has increased gradually in recent years. Around 5% to 15% of colorectal cancer is hereditary, and hereditary nonpolyposis colorectal cancer (HNPCC) is the most common form of hereditary colorectal cancer. This study aimed to determine the clinical characteristics of Taiwanese HNPCC kindreds. PATIENTS AND METHODS: We reviewed the chart records of all HNPCC kindreds followed-up in our hospital during the period from 1996 to 1999. Their clinical characteristics were recorded and analyzed. RESULTS: There were 10 families, including a total of 202 persons, who met the Amsterdam criteria for HNPCC. Fifty-two persons in these families had a diagnosis of cancer, including 26 women and 26 men. There were 40 colorectal cancers, five endometrial cancers, five gastric cancers, two ovarian cancers, two hepatocellular carcinomas, and one each of lung cancer, breast cancer, thyroid cancer, and pancreatic cancer (six patients had two cancers). The mean age at cancer diagnosis was 42.1 years. Among the 12 occurrences in 11 colorectal cancer patients with complete clinical and pathological findings, most cancers (67%) were located proximal to the splenic flexure (right-side colon). One patient had metachronous colorectal cancer. CONCLUSIONS: This is the first report of the general clinical characteristics of Taiwanese HNPCC. The clinical characteristics of HNPCC in Taiwan were similar to those in Western countries. The genetic bases of Taiwanese HNPCC patients remain to be determined.     

小儿肺炎继发腹泻相关因素分析及微生态制剂的预防作用

目的探讨小儿肺炎继发腹泻的危险因素及应用微生态制剂(培菲康)预防的效果。 方法调查2002年1月至2004年5月在福建医科大学附属第一医院住院治疗的小儿肺炎314例，以住院期间抗生素治疗同时应用微生态制剂(培菲康)的患儿为病例组，仅使用抗生素治疗或住院72h后因出现继发腹泻才开始应用微生态制剂(培菲康)的患儿为对照组，对肺炎患儿的临床特征、微生态制剂的应用情况与继发腹泻的关系进行单因素卡方分析和非条件Logistic回归模型多因素分析。 结果病例组114例，住院治疗期间继发腹泻病21例，发生率为184%；对照组200例，继发腹泻79例，发生率395%。单因素卡方分析显示：患儿发病年龄、住院天数、住院后有无侵入性操作、微生态制剂的应用、居住地、病情严重程度、血中性粒细胞、血红蛋白数量、激素应用与小儿肺炎继发腹泻有关联。非条件Logistic多因素回归分析筛选出3个危险因素，即患儿年龄(χ2=14120,P=0000)、住院天数(χ2=11532,P=0001)、入院后接受侵入性操作(χ2=6827,P=0009)和1个保护因素：微生态制剂应用(χ2=12943,P=0000)。 结论肺炎患儿年龄越小、住院时间越长或进行侵入性操作可增加继发腹泻的发生率；微生态制剂能够降低小儿肺炎继发腹泻的发生率，提示具有预防作用。     

Continuous subcutaneous terbutaline administration prolongs pregnancy after recurrent preterm labor

OBJECTIVE: This study was undertaken to study the effectiveness of continuous subcutaneous terbutaline (SQT) in the home after recurrent preterm labor (RPTL). STUDY DESIGN: Women with RPTL at less than 32 weeks' gestation were treated with continuous SQT administered in the home compared with matched control patients. RESULTS: Fifteen SQT patients were compared with 45 women (3:1) treated with no tocolytic therapy after hospitalization. Gestational age at delivery more than 37 weeks (53% vs 4%), percentage delivered at less than 32 weeks (0% vs 47%), overall and pregnancy prolongation (49.8 +/- 19.2 days vs 24.5 +/- 12.8 days) were all significantly better in the study group (P <.001). The total number of maternal hospital days (9.8 +/- 2.1 vs 15.9 +/- 7.4, P <.0001), duration of NICU stay (1.9 +/- 4.9 vs 19.8 +/- 29.3 days, P <.001), and total cost for newborn care (6,995 +/- 14,822 US dollars vs 62,033 +/- 89,978 US dollars, P <.002) favored the study patients. For every dollar spent on SQT, there was a savings of 4.67 US dollars in newborn hospital costs for control patients. CONCLUSION: In this small study, the use of SQT significantly prolongs pregnancy, decreases serious neonatal complications, and reduces the duration of hospitalization for both mother and infant, as well as neonatal costs.     

Cost-effectiveness of treatments for dysfunctional uterine bleeding

OBJECTIVE: To compare the cost-effectiveness of treatments for dysfunctional uterine bleeding (DUB). STUDY DESIGN: The decision analytic model used a third-party payer perspective and 18-month horizon to compare treatment of DUB patients > or = 40 years old with no desire for fertility. Treatments were oral contraceptives (OCs) vs. surgery (first-/second-generation ablation or hysterectomy) after 3-9 months of OCs. Costs were based on publications and expert opinion. Efficacy measures were based on months with pictorial blood loss assessment chart (PBAC) score < 100 and number of months of amenorrhea. RESULTS: Treatment costs were estimated at 513 dollars per patient per year (OCs), 3,500 dollars (first-generation ablation), 3,000 dollars (second-generation ablation) and 7,500 dollars (hysterectomy). Adverse event costs ranged from 12 dollars per year or episode (OCs, second-generation ablation) to 164 dollars per episode (hysterectomy). To achieve PBAC < 100, second-generation ablation after 3 months of OCs was the most cost-effective (7.6 additional DUB-free months vs. OCs, 215 dollars per additional month). Second-generation ablation was less costly and more effective than first-generation ablation. Early treatment with hysterectomy was more effective than ablation, but at substantial cost. When using the end point of amenorrhea, hysterectomy was most cost-effective. Results were not sensitive to variations in costs, effectiveness or length of OC use. CONCLUSION: A short OC trial followed by second-generation ablation is the most cost-effective strategy for women with DUB, although hysterectomy is more cost-effective to achieve amenorrhea. Hysterectomy cost-effectiveness might improve if evaluated over more time. Cost-effectiveness and patient preference must all play a role in treatment decisions.     

Feeding method and rehospitalization in newborns less than 1 month of age

OBJECTIVE: To examine the relationship between feeding method and hospitalization in a group of newborns under 1 month of age. DESIGN: Retrospective chart review based on admission diagnoses. SETTING: Academic Medical Center and Tertiary Children's Hospital in the same northwest city. PATIENTS: 143 newborns divided into three groups based on feeding method at hospital admission: breastfed, bottle-fed, and breastfed with supplements. RESULTS: A nearly equal number of males and females who were just as likely to be first born as later born experienced a mean weight loss of 8.5% and were hospitalized an average of 4.4 days. The breast-fed and supplemented newborns were younger and experienced greater weight loss, and the majority had no positive findings with the diagnostic workups. They responded quickly to increased caloric intake. The bottle-fed newborns had a higher incidence of positive diagnostic results and a longer hospital stay. CONCLUSIONS: The results of this study support the observation that many healthy but hungry breastfed newborns are being hospitalized. Other than breast-feeding difficulties, most newborns had few problems beyond hyperbilirubinemia, which may be exacerbated by inadequate feeding. The monetary and psychological costs of unnecessary hospitalizations and the potential for early discontinuation of breastfeeding may be preventable.     

Accuracy of diabetes diagnosis in health insurance claims data in Taiwan.

BACKGROUND AND PURPOSE: There are limited data from Taiwan about the accuracy of National Health Insurance (NHI) claims data. This study assessed the accuracy of NHI claims data for diabetes and its associated factors. METHODS: Insurance claims data for patients with a diagnosis of diabetes were extracted from the records of the Bureau of National Health Insurance, including detailed files of the outpatient, emergency, inpatient and pharmacy treatment records from January 1, 2000 to December 31, 2000. A stratified, 2-staged, probability proportional to size and equal probability method was used to sample 9000 diabetes patients. The accuracy of the diabetes diagnosis was assessed based on patient responses to questionnaire items. Subjects with negative or uncertain questionnaire answers who had hypoglycemic agents in pharmacy claims data were also classified as diabetic. RESULTS: A total of 1350 questionnaires were returned and an accurate diagnosis was verified from data in 1007 (74.6%) of these subjects. Univariate analysis showed that level of accreditation of the hospital, age, gender, follow-up department, type of complication, number of outpatient visits, emergent visit, as well as hospitalization were significant factors associated with an accurate diagnosis of diabetes. Multivariate logistic regression analysis revealed that number of outpatient visits, hospitalization, age, and the level of accreditation of the hospital were significant independent factors. The odds ratio of an accurate diagnosis increased with the number of outpatient visits and hospitalization. The probability of accurate diagnosis of diabetes among patients with >/= 4 outpatient visits was 99.16 times greater than that of patients with /= 1 hospitalization was 5.26 times that of patients who had not been hospitalized. CONCLUSIONS: This study found that the accuracy of diabetes diagnosis in NHI claims data in Taiwan was 74.6%. Further attention to the association of inaccurate claims in cases with infrequent outpatient visits, young age and those attending non-accredited hospitals is needed in order to address the efficiency of diagnosis and surveillance of diabetes in Taiwan.     

Pain control in Taiwanese patients with cancer: a multicenter, patient-oriented survey.

BACKGROUND AND PURPOSE: Under-treatment of cancer pain remains a common problem in Taiwan. Prior studies were mainly in hospitalized patients and limited to one or a few centers. This prospective, multicenter, patient-focused survey assessed the prevalence, severity and management of cancer pain in oncology clinic outpatients. Analgesic use and patient satisfaction with analgesic therapy were also evaluated. METHODS: A total of 480 Taiwanese patients receiving outpatient treatment at 15 different outpatient clinics were included in this study. There were 263 males and 217 females with a mean age of 62.13 years. Patients completed a 4-question survey about the presence or absence of pain, pain severity, analgesic therapy, and satisfaction or dissatisfaction with the degree of analgesia. RESULTS: Pain was reported by 257 patients (54%). Severe pain was reported by 35% and moderate pain by 35.4% of patients. Only 149 of the patients who reported pain (58%) were receiving analgesic medication, with a roughly equivalent number of males and females. Most (95 of 149, 64%) reported being satisfied or very satisfied with pain control although this percentage was higher among males than females (68.23% vs 57.8%). Major variation in the results was noted among study centers. CONCLUSIONS: The results of this survey of Taiwanese outpatients with cancer confirm that cancer pain is under-treated in oncology clinics in Taiwan. A major goal of cancer management is to achieve high rates of patient satisfaction and compliance with treatment which maintains or improves quality of life.     

Safety and immunogenicity of heptavalent pneumococcal conjugate vaccine booster in taiwanese toddlers.

BACKGROUND/PURPOSE: Pneumococcal infection causes high morbidity and mortality in children. Prevention of pneumococcal diseases by effective vaccination is an urgent need. This study evaluated the safety and immunogenicity of heptavalent pneumococcal conjugate (7VPnC) vaccine (serotypes 4, 6B, 9V, 14, 18C, 19F, 23F) booster dose administered at 15-20 months of age in Taiwanese toddlers. METHODS: Fifty-eight healthy Taiwanese toddlers who were primed with three doses of the 7VPnC vaccine in infancy received a booster dose in an open-label, noncomparative trial. Routine oral polio vaccine and diphtheria toxoid, tetanus toxoid, and pertussis vaccine were administered concomitantly. Surveillance for safety was conducted after vaccination. Antibody concentration to each of the seven pneumococcal serotypes was measured before and 1 month after the booster dose. RESULTS: Mild to moderate local reactions were common (45-50%). Fever, fussiness, restlessness, and loss of appetite were the most frequent systemic reactions (31-50%). Before the booster dose of vaccine, 68% (for serotype 18C) to 100% (for serotype 14) of subjects had antibody concentrations >or= 0.2 microg/mL to different pneumococcal serotypes. After the booster dose, the geometric mean concentration of IgG increased significantly (p < 0.001) for all seven serotypes indicating the induction of immunologic memories. Ninety-eight percent of the toddlers had antibody concentration >or= 0.2 microg/mL against all serotypes after the booster. CONCLUSION: The 7VPnC vaccine containing the prevalent serotypes in Taiwan is safe and effective in boosting immunity against pneumococcal disease in Taiwanese children.