Patient preferences for diabetes-related complications in Taiwan.

Background: As the prevalence of diabetes mellitus (DM) continues to increase rapidly, there has been a rising need not only to assess the clinical outcomes but also the impact of DM on the health-related quality of life (HRQoL) of affected individuals. Most previous studies have found that having complications is strongly associated with decreased HRQoL in DM patients. As such, it is crucial to measure individuals' preferences for DM-related complications in order to assess the magnitude of complications' effect on overall HRQoL. In addition, preference scores are an essential component of cost-utility analyses (CUAs), which studies can incorporate healthcare costs, HRQoL and clinical outcomes of DM into one analysis.Objective: The aims of this study were to assess the preference scores of DM-related complications using both the standard gamble (SG), a choice-based method, and visual analogue scale (VAS), a scaling method. We also aimed to assess several possible factors that might be associated with the preference scores of the complications.Methods: This is a cross-sectional interview-administered survey, and 213 patients with type 2 DM were interviewed. The respondents' preference scores of eleven DM-related complications were obtained using VAS and SG techniques. Demographic information, clinical characteristics and risk attitudes were also collected to explore factors that may affect patients' preference scores.Results: Nearly one quarter of participants in Taiwan ranked at least one of the complications worse than death. The mean VAS scores ranged from 0.004 (amputation) to 0.47 (nocturnal hypoglycemia) while the mean adjusted SG scores ranged from 0.30 (blindness) to 0.66 (nocturnal hypoglycemia). There were significant differences in all of the complications' preference scores depending on risk attitudes.Conclusion: Both the VAS and SG methods were used to elicit the preference scores of DM-related complications, and the preference scores derived could be useful for future cost utility analyses.

Healthcare costs and utilization of diabetes-related complications in Taiwan: A claims database analysis.

To estimate the healthcare utilization and costs of major diabetes mellitus (DM)-related complications in Taiwan in the year of first occurrence and in subsequent years.This study is a retrospective claim database analysis using the longitudinal cohort of diabetes patients (LHDB) with 2012 as the base year. Occurrences of 8 DM-related complications of interest were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Annual healthcare costs and utilization of these DM-related complications in the LHDB cohorts of the years 2004 to 2009 were examined, and the generalized linear model was used to estimate annual total healthcare costs for each complication.DM patients with complications were more likely to have at least 1 emergency room (ER) visit and at least 1 hospitalization (both P < .001), and they also had more outpatient visits, higher hospitalization costs, higher outpatient costs, and higher ER costs (all P < .001) than those without. The mean annual total healthcare cost of the patients with DM-related complications was US $4189, whereas the mean annual cost of those patients without complication was $1424 (P < .001). The complications with the greatest event costs were amputation ($7877; 95% confidence interval [CI]: $6628-$9322) and fatal MI ($4067; 95% CI: $3001-$5396) while the complication with the greatest state costs was end-stage renal disease (ESRD) ($2228; 95% CI: $2155 to $2302).DM-related complications could significantly increase healthcare utilization and costs. The results of this study provide data that are useful for local economic evaluations of DM treatments.

Translation, revision, and validation of the Chinese version of the Satisfaction with Oral Anti-Diabetic Agent Scale (C-SOADAS) in patients with type 2 diabetes mellitus.

OBJECTIVE: The aim of this study was to translate, adapt, and validate the Satisfaction with Oral Anti-Diabetic Agent Scale (SOADAS) in type 2 diabetes mellitus (DM) patients taking oral antidiabetic drugs (OADs) in Taiwan. PATIENTS AND METHODS: The SOADAS was translated to Chinese and was modified based on reviews of two physicians, five diabetes educators, and two patient focus groups. A cross-sectional interviewer-administered survey was conducted in adult patients with type 2 DM who were taking OADs. The Chinese version of the SOADAS (C-SOADAS), the EuroQol 5 dimensions 3-level (EQ-5D-3L) questionnaire, and a demographic questionnaire were administered to participants. Instrument structure, internal consistency, convergent validity, and known-group validity were assessed. RESULTS: A total of 260 DM patients were recruited. The mean score of an individual item ranged from 3.6 to 3.9, while the mean total score (out of 25 possible points) was 18.7 points. Overall, floor and ceiling effects were negligible. The Cronbach's α value was 0.81. All the four predetermined hypotheses for known-group validity assessment were fulfilled. In convergent validity testing, the C-SOADAS total scores were found to be correlated with EuroQol-Visual Analog Scale (EQ-VAS) scores (r = 0.2; p < 0.01) but not with EuroQol 5 dimensions (EQ-5D) index scores (r = 0.02; p = 0.81). CONCLUSION: The 5-item C-SOADAS appears to be a psychometrically acceptable measure of OAD treatment satisfaction among type 2 DM patients in Taiwan. The tool may be incorporated into clinical practice to quickly assess treatment outcomes from patients' perspectives.

Association of adenoid hyperplasia and bacterial biofilm formation in children with adenoiditis in Taiwan.

The adenoid is a bacterial reservoir that contributes to chronic otolaryngologic infections. Staphylococcus aureus (S. aureus) is a common pathogen in the adenoid. The increase of antibiotic resistance in S. aureus has become an important issue in public health. The aim of this study was to compare adenoid hyperplasia and biofilm formation in children with S. aureus adenoiditis in Taiwan. The patients were divided into methicillin-resistant and methicillin-sensitive S. aureus groups according to the S. aureus obtained from adenoid tissue after antibiotic susceptibility testing. Adenoid hyperplasia was assessed by lateral cephalometry, and the severity of sinusitis was evaluated by Water's view. Microbiological investigation of available S. aureus isolates was performed by in vivo morphological observation and an in vitro bacterial biofilm assay. Sixty isolates of S. aureus were identified in 283 children (21.2%) after adenoidectomy, of which 21 (35%) were methicillin-resistant S. aureus (MRSA). The severity of adenoid hyperplasia and extensive biofilm formation were more prominent in patients infected with methicillin-resistant S. aureus than in those infected with methicillin-sensitive S. aureus (MSSA). The primary outcome of this study was to provide evidence that S. aureus constituted a significant portion of the adenoidal pathogens. The secondary outcome of this study was that MRSA adenoiditis may be associated with adenoid hyperplasia and biofilm formation.

Effectiveness of theta-burst repetitive transcranial magnetic stimulation for treating chronic tinnitus.

OBJECTIVES: Repetitive transcranial magnetic stimulation (rTMS), a noninvasive method for altering cortical excitability, is becoming a therapeutic strategy in auditory research institutions worldwide. Application of inhibiting rTMS on these overactive cortical regions can result in effective tinnitus suppression. The aim of this study is to investigate the efficacy of theta-burst rTMS in patients with chronic tinnitus. STUDY DESIGN: Parallel randomized control study. SETTING: Tertiary referral center. PATIENTS: We enrolled 2 female and 20 male patients in this study. The evaluative tools included tinnitus frequency- and loudness-matching, tinnitus questionnaires (TQ), and the Tinnitus Handicap Inventory (THI). METHODS: The orthogonal projection of the auditory cortex on the scalp was focalized. A figure-eight coil was placed on the surface of the skull over the targeted region with the intensity setting at 80% of the resting motor threshold. We delivered 900 pulses of theta-burst rTMS daily for 10 business days. MAIN OUTCOME MEASURES: Nine of twelve patients (75%) in the active-stimulation group reported tinnitus suppression following treatment with rTMS. The treatment led to reductions of 8.58 and 8.33 in the mean TQ global and THI scores, respectively. Tinnitus loudness also decreased significantly after delivering rTMS. RESULTS: Descriptive analysis of the TQs revealed that patients experienced significant improvements in emotional distress levels and somatic symptoms. CONCLUSIONS: Our preliminary results demonstrate that theta-burst rTMS treatments offer a method of modulating tinnitus. Patients could benefit from emotional improvements, even more than auditory perceptive relief. Further studies are needed to establish a standard protocol and to clarify nervous propagation along the auditory and psychological projection following treatment with rTMS.

Improvement in otitis media with effusion in patients undergoing tracheostomy after prolonged endotracheal intubation.

OBJECTIVES: Otitis media with effusion (OME) has a higher incidence in adult intensive care unit (ICU) patients. This observational study sought to examine the effect of tracheostomy on OME in critically ill patients and explore the predisposing factors. MATERIALS AND METHODS: Twenty-seven ICU patients who had undergone prolonged intubation (more than 14 days) received traditional tracheostomies. Otoscopic examination, tympanometry, and spectral gradient acoustic reflectometry were performed both at the time of the tracheostomy and 7 days later. We collected data on the patients' demographics (age and gender), underlying diseases, duration of intubation prior to the tracheostomy, history of gastroesophageal reflux disease, length of antibiotic use, level of consciousness, and presence of nasogastric tubes. RESULTS: At the time of the tracheostomy, 25 (46%) ears from 14 (52%) patients were classified as cases of OME, 17 (31%) ears and 7 (26%) patients as normal cases, and 12 (11%) ears from 6 (11%) patients as cases of negative pressure in the tympanic cavity. Seven days after the tracheostomy, OME was resolved in 17 (68%) ears and persisted in 6 (24%) ears, whereas negative pressure developed in 2 (8%) ears. Our data showed that the incidence of OME reduced from 46% to 22% after tracheostomy was performed on the patients. CONCLUSION: The incidence of OME in adult ICU patients who were intubated for more than 14 days was found to reduce after tracheostomy. Notably, the rate of improvement in the conscious patients was significantly higher than that in the unconscious patients.

High resolution computed tomography analysis of the temporal bone.

Detailed radiological assessment by high resolution computed tomography (HRCT) of temporal bone is demanded before any temporal bone or skull base surgery. The aim of this study was to measure the relations between the anatomical landmarks of the temporal bone and to assist the otolaryngologist in establishing accurate preoperative evaluation. We enrolled 43 patients who underwent temporal bone HRCT between February 2004 and May 2004. Contiguous axial and coronal images at 1.0 mm thickness were obtained. Some landmarks such as the superior and inferior lips of the internal acoustic canal (IAC), the malleoincus joint, and the posterior semicircular canal were labeled in the coronal and axial views. Then we measured the distance between them. Average IAC diameter in the coronal and axial views was 5.33 mm and 6.92 mm. Average IAC length in the coronal and axial views was 12.29 mm and 11.09 mm. The thickness of the retrolabyrinthine bone was 3.78 mm. The incidence of thinning bone overlying the superior semicircular canal was 2.3%. Our data could be applied to normal distribution because there were no statistical differences between the measurements of normal ears and diseased ears. Several specific measurements can be applied to the preoperative evaluation of vestibular schwannoma including the retrosigmoid approach, the translabyrinthine approach and the middle fossa approach.