Web Search Trends of Implementing the Patient Autonomy Act in Taiwan.

BACKGROUND: The Patient Autonomy Act was implemented in Taiwan on 6 January 2019. It is the first patient-oriented act in Taiwan, and also the first special act to completely protect patient autonomy in Asia. Our study aimed to investigate the web resources citizens were able to access on the eve of the implementation of the Patient Autonomy Act in Taiwan. METHODS: Patient Autonomy Act-related web resources were searched for by entering 10 related terms individually into the Google search engine in January 2019 and again in April 2019. Search activity data were analyzed using Google Trends. RESULTS: "Advance care planning" and "advance decision" were the most relevant keywords for finding information about the Patient Autonomy Act on the eve of the act's implementation in Taiwan. The main online information sources were non-governmental websites including news sites and online magazines. The related search volume only increased on the eve of implementation. CONCLUSIONS: Even though the Patient Autonomy Act was first published three years before its implementation, the related search volume only increased on the eve of its implementation. Therefore, whether the three-year buffer between its publication and implementation was necessary requires further investigation.

Features of Online Hospital Appointment Systems in Taiwan: A Nationwide Survey.

BACKGROUND: In the Internet era, many web-based appointment systems for hospitals have been established to replace traditional systems. Our study aimed to highlight the features of online appointment systems for hospitals in Taiwan, where patients can visit outpatient departments without a referral. METHODS: All hospitals online appointment systems were surveyed in October 2018. Features of first-visit registrations were analyzed and stratified according to the hospitals' accreditation levels. RESULTS: Of the 417 hospitals, 59.7% (249) had public online appointment systems. For first-visit patients, only 199 hospitals offered the option of making appointments online from 7 to 98 (mean 38.9) days prior to the appointment itself. Before appointments, 68 (34.2%) hospitals recommended specialties for patients to choose according to their symptoms, and only 11 (5.5%) had a function for sending messages to doctors. After appointments, 176 (88.4%) provided links to real-time monitoring of outpatient service progress. CONCLUSIONS: More than half of the hospitals in Taiwan have public online appointment systems. However, most of these systems simply fulfill the function of registration, and rarely take the opportunity to improve efficiency by gathering information regarding patients' medical history or reasons for making the appointment.

Use of Facebook by Hospitals in Taiwan: A Nationwide Survey.

Background: Social media advertising has become increasingly influential in recent years. Because Facebook has the most active users worldwide, many hospitals in Taiwan have created official Facebook fan pages. Our study was to present an overview of official Facebook fan pages of hospitals in Taiwan. Methods: All 417 hospitals were surveyed about their use of Facebook fan pages in December 2017. The last update time, posts in the past 30 days, number of “Likes”, and other features were analyzed and stratified according to the accreditation statuses of the hospitals. Results: In Taiwan, only 51.1% (n = 213) of the hospitals had an official Facebook fan page. Among these hospitals, 71.8% (n = 153) had updated their pages in the past 30 days, although 89.2% (n = 190) provided online interactions. Academic medical centers tended to have more “Likes” than regional and local community hospitals (on average 5947.4, 2644.8, and 1548.0, respectively). Conclusions: In spite of the popularity of Facebook among the general population, most hospitals in Taiwan do not seem to make good use of this kind of social media. The reasons for the use and nonuse of Facebook on the part of both hospitals and patients deserve further investigation.

Dentofacial changes after anterior crossbite correction using a lingual arch with finger springs.

BACKGROUND/PURPOSE: Anterior crossbite correction is common in orthodontic treatment; however, few studies have discussed the change with cephalometric measurements. The purpose of this study was to evaluate the dentofacial changes in anterior crossbite correction by using an upper lingual arch with finger springs. MATERIALS AND METHODS: This retrospective study included 30 patients (13 female and 17 male). According to the number of crossbite teeth, the patients were divided into three groups. We used paired t test, Kruskal-Wallis test, Mann-Whitney U test, and multiple regression analysis to perform statistical analysis. RESULTS: According to overall treatment changes, the dental changes included overjet increase, overbite decrease, upper incisor proclination, lower incisor retroclination and intrusion, upper molar distal tipping with extrusion, and lower molar intrusion. These dental changes resulted in clockwise mandibular rotation and lip position change. Anterior crossbite correction did not require increasing bite appliances. According to multiple regression analysis, the change in overjet was associated with the position of the upper and lower incisor crown tips. The mean rate of upper incisor movement in the horizontal direction was 2.5 mm/mo. The treatment duration exhibited no significant difference among the three groups. CONCLUSION: Lingual arch with finger springs was effective in anterior crossbite correction regardless of the number of crossbite teeth.

Unique attributes of orbital fibroblasts and global alterations in IGF-1 receptor signaling could explain thyroid-associated ophthalmopathy.

Tissue remodeling associated with thyroid-associated ophthalmopathy (TAO) involves the complex interplay between resident cells (endothelium, vascular smooth muscle, extraocular muscle, and fibroblasts) and those recruited to the orbit, including members of the "professional" immune system. Inflammation early in the disease can later culminate in fibrosis and diminished extraocular muscle motility. TAO remains a poorly understood process, in large part because access to tissues early in the disease is limited and because no robust and complete animal models of Graves' disease have yet been devised. Remaining uncertainty as to the identity of a pathogenic autoantigen(s) that underlies lymphocyte trafficking to the orbit complicates matters. These limitations in our understanding of extrathyroidal Graves' disease have resulted in poorly served patients with severe TAO. Therapies have targeted symptoms rather than the underlying disease processes. Our laboratory group has focused over the last several years on defining the peculiarities of the human orbital fibroblasts as a strategy for shedding more light on the pathologies occurring in TAO. We have reasoned that unique properties of these cells might ultimately prove the basis for why the manifestations of Graves' disease occur in an anatomically selective manner. In this brief review we attempt to survey our findings. We believe that they might provide a "roadmap" for further discovery into the pathogenesis of TAO. Clearly, more questions remain than those thus far answered.

Lysosome-related genes are regulated in the orbital fat of patients with graves' ophthalmopathy.

PURPOSE: The molecular mechanism involved in the hypertrophy of the orbital fat in patients with Graves' ophthalmopathy or thyroid eye disease (TED) remains unclear. Comparison of genome-wide expression profiles may help in the search for the gene sets involved in TED. METHODS: Twenty-five orbital adipose tissue specimens were obtained, from which the RNA was isolated. Four of the tissue specimens (from four individuals, two with TED and two control subjects) were subjected to cDNA microarray analysis. The data were analyzed by the gene set enrichment analysis (GSEA) to survey the biological pathways involved in the pathogenesis of TED. Messenger RNA levels of some top-ranked genes in GSEA-selected pathways are validated by quantitative PCR (QPCR). RESULTS: The expression of specific gene sets related to lytic vacuoles, lysosomes, and vacuoles were different between the specimens obtained from patients with TED and control subjects (P < 0.001). These three gene sets overlapped. For QPCR, four top-ranked genes were selected from these overlapping gene sets and another one that related to visual failure, using 21 independent samples of patients with TED (n = 15) and control subjects (n = 6). The results showed that ceroid-lipofuscinosis, neuronal 2, late infantile (CLN2; P = 0.044) and ceroid-lipofuscinosis, neuronal 3, juvenile (CLN3, which related to visual failure; P = 0.012) were significantly downregulated in the orbital fat of patients with TED. The expression of the beta subunit of hexosaminidase A (HEXB) was reduced as well, but the change did not reach statistical significance (P = 0.058). CONCLUSIONS: Lysosome-related genes, such as CLN2, CLN3, and HEXB, may be involved in the pathogenesis of adipose tissue hypertrophy in TED.

High frequency oscillatory ventilation for surgical patients with acute respiratory distress syndrome.

BACKGROUND: Numerous studies have suggested that high-frequency oscillatory ventilation (HFOV) used as rescue therapy may improve oxygenation in acute respiratory distress syndrome (ARDS) patients. The purpose of this study is to analyze the efficacy and safety of HFOV in surgical patients with ARDS. METHODS: A total of 16 surgical ARDS patients with severe oxygenation failure received HFOV, despite aggressive conventional mechanical ventilatory support. Mean airway pressure was initially set 3 to 5 cm H2O higher than that for conventional ventilation and was subsequently adjusted to maintain oxygen saturation > or = 90% and FiO2 < or =0.6. Oxygenation, ventilation, and hemodynamic parameters were measured during conventional ventilation before initiating HFOV and during HFOV support for a total of 40 hours. Other outcome measures included duration of HFOV, successful weaning rate, cause of failure, complications, survival rate, and cause of death. RESULTS: There was a considerable increase in Pao2/FiO2 ratio after 30 minutes, and this increase was maintained after 12 hours of HFOV throughout the study. There was a significant decrease in oxygenation index after 24 hours of HFOV support. There was no significant change in blood pressure associated with initiation and administration of HFOV. The successful weaning rate from HFOV to conventional ventilation was 75%. The intensive care unit survival rate was 43.8% and hospital survival rate was 37.5%. CONCLUSION: High-frequency oscillatory ventilation was effective and safe in correcting oxygenation failure associated with ARDS in surgical patients. Future research is warranted to identify the suitable patients, timing, and optimal strategy for applying HFOV.

Transforniceal lateral deep bone decompression--a modified technique to prevent postoperative diplopia in patients with disfiguring exophthalmos due to dysthyroid orbitopathy.

BACKGROUND/PURPOSE: Postoperative diplopia remains a significant complication of orbital decompression in dysthyroid orbitopathy. This study evaluated the results of orbital decompression treatment using a transforniceal approach to sculpt the lateral orbital deep bone area. METHODS: The two areas of bone in the deep lateral orbit (the basin of the inferior orbital fissure and the sphenoid door jamb) were exposed using a transforniceal swinging eyelid approach. An electric drill was used to sculpt these deep bone areas of the lateral orbit, and approximately 1 mL intraconal fat was removed simultaneously. Between October 1999 and March 2003, transforniceal lateral deep bone decompression was performed in 35 consecutive patients (62 orbits) with disfiguring dysthyroid orbitopathy. Data on proptosis reduction effect, new-onset diplopia and other complications of lateral wall decompression were analyzed. RESULTS: The average preoperative Hertel value was 21.2 +/- 1.3 mm (range, 18-23 mm) and decreased to 17.4 +/- 1.2 mm (range, 15-19.5 mm) postoperatively. The mean decrease in proptosis 3 months postoperatively was 3.8 +/- 0.91 mm (range, 1.5-4.6 mm). New-onset downgaze diplopia occurred in two (5.7%) of the 35 patients. Persistent trigeminal paresthesia was noted in one patient (2.8%). No cerebrospinal fluid leak, globe injury or vision deterioration was noted during 9.5 +/- 1.7 months of follow-up. The cosmetic appearance was improved in all patients after surgery. CONCLUSION: Transforniceal lateral deep bone decompression produces less new-onset, persistent diplopia than traditional inferomedial wall decompression, and provides good cosmesis by using a hidden small incisional wound. This approach appears to be a safe and effective procedure for patients with disfiguring exophthalmos, especially for Asian patients without crease fold.

A procedure to minimize lower lid retraction during large inferior rectus recession in graves ophthalmopathy.

PURPOSE: To determine whether complete detachment of the fascia of the capsulopalpebral head during large inferior rectus recession can help to prevent induced lower lid retraction in Graves ophthalmopathy. DESIGN: Retrospective consecutive case series. METHODS: Data from patients (39 eyes) with Graves ophthalmopathy undergoing inferior rectus recession were collected retrospectively. Inferior rectus recession was performed by limbus-based incision with adjustable suture. Simultaneous detachment of the fascia of the capsulopalpebral head was achieved by sharp dissection and severing of the fascia. Inferior rectus recession with simultaneous detachment of the fascia of the capsulopalpebral head was performed in 27 eyes and without detachment in 12 eyes. Margin reflex distance (MRD2) was documented preoperatively and 3 months postoperatively. RESULTS: Of the 39 eyes included in this study, four eyes with preexisting lower lid retraction in the detachment group improved after surgery. Eighteen eyes in the detachment group exhibited the same MRD2 values, and only five eyes showed increased MRD2 values. In contrast, all but one of the 12 eyes in the nondetachment group showed increased MRD2 values. The average change in the MRD2 value 3 months after surgery was 0.04+/-0.59 mm in the detachment group and 1.58+/-0.73 mm in the nondetachment group. There was a statistically significant difference between the two groups (P<.01). CONCLUSIONS: Simultaneous detachment of the fascia of the capsulopalpebral head during inferior rectus recession can minimize the possibility of lower lid retraction.

Molecular pathology of Muller's muscle in Graves' ophthalmopathy.

CONTEXT: Upper lid retraction is a common sign in Graves' ophthalmopathy (GO). Whether Müller's muscle is involved in upper lid retraction has not been fully elucidated. OBJECTIVE: The objective of the study was to understand the molecular pathology of Müller's muscle in GO. DESIGN/SETTING/PARTICIPANTS: A method for measurement of histological changes was developed and used to correlate severity and expression of cell-specific genes in GO. MAIN OUTCOME MEASURES: Histological changes, clinical severity of upper lid retraction, and mRNA expression in Müller's muscle in GO were measured. RESULTS: The degree of fibrosis correlates with severity of upper lid retraction. Macrophage infiltration was increased in fibrotic areas, consistent with higher levels of macrophage-colony stimulating factor mRNA. Levels of peroxisome proliferator-activated receptor-gamma mRNA were up-regulated and correlated with fat infiltration. Decreased muscle mass correlated with lower myocardin mRNA expression. The expression of c-kit levels was decreased in diseased muscles, consistent with diminished mast cell numbers. CONCLUSION: The pathological changes of Müller's muscle correlate with clinical severity of upper lid retraction in GO. Patterns of gene expression appear to correlate with the histopathological changes in this disease process.

Primary placement of a hydroxyapatite-coated sleeve in bioceramic orbital implants.

PURPOSE: To study a new surgical option of primary placement of a hydroxyapatite-coated sleeve into the Bioceramic implant during enucleation or evisceration. DESIGN: Retrospective, observational case series. METHODS: A standard enucleation or evisceration was performed, followed by the preplacement of a hydroxyapatite-coated sleeve into the Bioceramic implant. Care must be taken to ensure the sleeve has been positioned centrally when the implant is put inside the orbital socket. Complications such as sleeve exposure, Bioceramic implant exposure, and infection were closely observed. RESULTS: Twenty-seven patients were treated in above fashion with five enucleation and 22 evisceration procedures. Five of the sleeves have exposed spontaneously during 1 to 4 months after original surgery. They had no further complication, except for one sleeve around which there were visible Bioceramic spicules attributable to long-term corticosteroid usage. The remaining 22 sleeves that did not spontaneously expose pursued secondary exposure of the sleeve and peg insertion by the conjunctival cutdown procedure 3 months postoperatively. One sleeve was medially positioned far away from the implant center. Re-insertion of new sleeve and peg was scheduled 2 weeks later. One additional sleeve was obliquely positioned after conjunctival cutdown procedure. Fortunately, all 27 patients were successfully fitted with a peg-coupled prosthesis with good motility. CONCLUSIONS: Primary placement of a hydroxyapatite-coated sleeve into the Bioceramic implants has several advantages, including high patient acceptance, technical simplicity, and an office-based conjunctival cutdown pegging procedure. By avoiding the expense of postoperative imaging studies and additional prosthetic modification, a more rapid and efficient rehabilitation is possible.