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Biomedical subjects

L Chiu

Publications and source records attributed to L Chiu.

At least 37 records · Page 2Linked to original sources
PubMed1998

Analysis of costs borne by families of patients hospitalized for stroke.

BACKGROUND: Studies focusing on the economic impact of cancer on families have emphasized that costs of chronic disease are substantial for patients and their families. However, little effort has been devoted to measuring the costs of care for families of patients hospitalized with stroke. METHODS: A total of 215 stroke patients and their families from four teaching hospitals in the Taipei metropolitan area were monitored from the date of the patient's admission to hospital until the date of discharge. The value of labor contributed by families was estimated by assigning the current monetary market rate of providing health aide to the time families spent caring for patients in hospital. Lost earnings of patients and families, expenditure for medical care, and expenses for food, clothes, adult diapers, transportation and other miscellaneous items were determined and summed to arrive at the total family cost of providing care. RESULTS: The average cost of care for one family per inpatient day was NT$4,358.20. A total of 98.6% of the families incurred labor costs, which accounted for about half of family costs for providing care. Hospital bills accounted for almost 19% of total family costs. The income loss for families and patients accounted for about 25% of total family costs. Expenses for food, clothes, transportation, diapers and other illness-related miscellaneous items accounted for about 12% of total family costs. Multiple regression analyses demonstrated that the number of family members involved in giving care and the length of stay are important predictors for the total cost of care. Average total family costs per day increased by 24.3% when an additional family member was involved in providing care. Total family costs increased 2.5% for each hospital day. CONCLUSIONS: If direct and indirect nonmedical costs are not included in the total cost calculation for providing hospital care to stroke patients, the economic impact of care on families is likely to be underestimated.

Adult↗
PubMed1997

A cost-effectiveness analysis of home care and community-based nursing homes for stroke patients and their families.

A prospective study designed for 336 hospitalized patients with stroke and their families, who were followed from the discharge day to the third month after being discharged, was carried out in order to compare the costs and effectiveness of home care with the community-based nursing homes for stroke patients with different physical function disabilities in terms of ADL scores and their families. The ADL scores of the patients with severe physical function disability did not improve with or without long-term care; however, the patients with moderate physical function disability were significantly improved at the end of the third month, even without interventions from long-term care. The family costs of the patients in nursing homes were substantially lower than the costs for the patients who stayed at home, and the relationship of the family costs of the patients cared for in their own homes was proportional to the patients' physical function status. The labour input from family caregiving accounted for at least 60% of the total family costs of the patients who stayed at home, and the paid for long-term care services accounted for at least 60% of total family costs when the patients stayed in nursing homes. The multiple linear regression demonstrated that the degree of caregiving from families was a predictor of the amount of the costs families incurred for patients with severe physical function disability; as a result the ADL scored on discharge significantly influenced the average total family costs for the patients cared for in their own homes.

Activities of Daily Living↗
PubMed1997

Family caregiver's satisfaction with home care in the Taipei metropolitan area.

This research was designed to evaluate the quality of home care by examining family caregiver's satisfaction with home care services received. The sample for this study were 110 families using home care from the Taipei Metropolitan Area. Data were collected from interviews of the family members. The degree of satisfaction with each attribute of services was measured using a Likert scale with 5 responses. The degree of general satisfaction with home care was averaged across 19 attributes. More than 91.0% of the family caregivers believed that the respect, consideration, concern for questions, and acceptance for suggestions from home care workers did not need any improvement. In contrast, at least two-thirds of the family caregivers felt the speedy provision of services in an emergency and the degree of ease of contacting home care workers by telephone needed improvement. The number of desired attributes that were received was a significant determinant of general satisfaction with home care services received. Family caregivers who received at least 14 attributes tended to be more satisfied with home care services than the respondents who received fewer than 14 attributes of home care services. Overall, subjects receiving home care services were satisfied. The more desired attributes of home care received, the higher the satisfaction with home care.

Adult↗
PubMed1997

The management of intermittent claudication.

Intermittent claudication is a common symptom. It is a marker of generalised antherosclerotic disease and may herald other cardiovascular catastrophes. The aim of management is to reduce the total cardiovascular morbidity and mortality. The functional status and quality of life of severely affected patients can be improved by endovascular and surgical interventions.

Journal Article↗
PubMed1997

Factors determining family caregiver's satisfaction with home care in the Taipei metropolitan area.

BACKGROUND: Among all types of long-term care, many studies have shown that home care is preferable. The increasing growth of an aging population with a predictable increase in chronic illnesses emphasizes the need to re-evaluate the current long-term care system. Because long-term care requires family members to participate as caregivers, there are resulting emotional, physical, and financial burdens, while to interacting with patients who suffer severe functional impairment. As these burdens exacerbate through time, family caregivers often seek assistance from home-care services. Evaluating the quality of home care provides an opportunity to adjust future planning and to envision a more ideal and effective home care plan in the Taipei metropolitan area. METHODS: This research was designed to evaluate the quality of home care by examining family caregivers' satisfaction with home-care services they render. Nineteen attributes of home-care services are cited in this study. The degree of satisfaction with each attribute of services was measured, using the Likert method of five response alternatives from "does not need to be improved at all" to "needs to be improved completely", coding from 5 to 1. The degree of general satisfaction with home care was reflected by averaging respondents' replies across 19 attributes. RESULTS: More than 91.0% of the family caregivers believed that respect from, consideration of, concern for questions by and acceptance of suggestions from home-care workers did not need any improvement. In contrast, at least two-thirds of the family caregivers felt the speedy provision of services in an emergency and the degree of ease of contact with home-care workers by telephone were acceptable only to some degree. For general satisfaction, 79.3% of the family caregivers scored in the range of 4.00-5.00 which indicated a need for mile improvement in services. The number of attributes desired which were in fact received was a significant determinant of general satisfaction with home-care services provided. Family caregivers who were credited with at least 14 attributes tended to be more satisfied with home-care services than the respondents who received fewer than 14. CONCLUSIONS: Overall, subjects receiving home-care services were generally satisfied. However, they were less satisfied with the ease of contacting home care workers by telephone and the speed of receiving needed services in an emergency. The more desired attributes of home care received reflected higher satisfaction with home-care services.

Adult↗
PubMed1997

The effectiveness of systematic stroke care.

A coordinated, multidisciplinary approach had been applied to enhance the effectiveness of stroke care with varying enthusiasm; however, the effectiveness of this kind of stroke treatment model was noted in many studies. This study was designed to measure the effectiveness of systematic stroke management on the physical-functional outcome in terms of Activities of Daily Living (ADLs) scores. The higher the ADLs score, the higher the degree of physical disability, i.e., the higher the degree of dependence. Eighty-six stroke patients from the Department of Neurology in a medical center, and 88 stroke patients from the Department of Medicine in a local hospital were followed from the admission day to the discharged date. The effectiveness of stroke care in each hospital was measured by the comparisons between ADLs scores at discharge and ADLs scores at admission. Two-sample tests show that demographic characteristics, length of stay, average time elapsed since the occurrent stroke, number of families in caregiving, and ADLs scores at admission and at discharge did not differ much between these two groups. The improved ADLs scores for stroke patients treated in the Department of Neurology of the medical center were changed from the 14.1 +/- 4.9 at admission to 12.1 +/- 5.2 at discharge, and the changes of ADLs scores for patients treated in the Department of Medicine of the regional hospital was from 12.8 +/- 5.1 to 12.3 +/- 5.5 according to the degree of improvement. The significant finding was that the degree of improvement of ADLs scores for CVA patients from the medical center was significant (Wilcoxon Matched-Pairs Signed-Ranks Test, Z = -2.8, p < 0.01). Moreover, the degree of improvement of ADLs scores strongly differed between these two groups (Repeated measures of two-way ANOVA, F = 6.0, p < 0.05). The information presented here informs us that degree of physical-functional status of stroke patients should be improved because of the systematic stroke management.

Activities of Daily Living↗
PubMed1997

Family caregivers' priorities for home care: a need assessment study.

BACKGROUND: Many studies have demonstrated that patients prioritize some attributes of health care over others. However, little effort has been devoted to measure which service attributes are most important to consumers, regardless of their satisfaction, in the field of home care. Moreover, home care requires family members to participate as caregivers. Thus, evaluating the needs of family caregivers who also provide home care should provide an opportunity to envision an effective home care system. METHODS: This study was designed to measure family caregivers' need for auxiliary home care services by examining their priorities for attributes of home care services. The respondents were asked to select 5 attributes, which were most important for them, from 19 choices of home care services, and then to rank 5 attributes in decreasing order of importance to determine their priorities, coded from 1 (the first priority) to 5 (the last important priority). The degree of satisfaction from a single attribute, whether or not the desired attribute was in fact provided, personal data of family caregivers, and types of patient's insurance were also included in this study. RESULTS: The interviewees were inclined to assign high priority to the ease of contacting home care nurses by telephone (73.6%) and the timeliness of obtaining needed services in an emergency (63.6%); they were less likely to attach high priority to provision of spiritual support (6.3%), respect given by home care nurses (5.4%), and acceptance of suggestions (4.5%). Whether a single attribute was selected as a top five priority was significantly associated with family caregiver's education level, degree of satisfaction with the attribute and whether the desired attribute was actually received. CONCLUSIONS: The interviewees had different priorities for attributes of home care, and they assigned high importance to the attributes less satisfied and received; examples are the timeliness of obtaining needed services in an emergency, and the ease of contacting home care nurses by telephone.

Adult↗
PubMed1996

Flow cytometric ratio analysis of the Hoechst 33342 emission spectrum: multiparametric characterization of apoptotic lymphocytes.

The apoptotic response to various stimuli is an important part of immune regulation, and the ability to identify apoptotic lymphocytes within a complex population is a prerequisite to a more detailed understanding of its role in vivo, We described a flow cytometric technique which utilizes viable cells and enables simultaneous identification of apoptotic cells and analyses of immunophenotype, cell cycle progression, membrane integrity and light scatter properties. It is based upon analysis of two regions of the emission spectrum of the DNA-binding vital dye hoechst 33342. We established a precise correlation between the ratio of red to blue fluorescence emission and apoptosis based upon nuclear morphology and the presence of characteristic DNA degradation patterns. In human peripheral blood lymphocytes (PBL) and mouse thymocytes we incorporated light scatter properties, cell cycle stage, relevant cell surface immunophenotypic markers (CD25 or CD4) and CD8) and a marker of plasma membrane integrity (merocyanine 540) to enable multiparametric phenotyping of apoptotic cells. We show that staurosporine-induced apoptosis of ConA-stimulated PBL is not correlated with cell cycle stage but is selective for activated cells since the frequency of large, CD25+ cells is decreased by staurosporine. Dexamethasone and ionomycin differ in their ability to induce apoptosis selectively in murine thymocyte subsets. Dexamethasone kills a broad spectrum of the CD4/8 immunophenotypes with no selectively for cell cycle stage. Ionomycin selectively deplete CD4+8+ cells, especially those in the Go/G1 region of the cell cycle, and spared CD4-8+ cells. This technique is broadly advantageous for in vitro and ex vivo models of apoptosis in that it interrogates individual viable cells and correlates membrane and nuclear apoptotic changes with standard flow cytometric immunophenotyping.

Alkaloids↗
PubMed1996

Platelet lysis and functional perturbation by 13-methyl myristate. The major fatty acid in Flavobacterium ranacida.

Flavobacterium ranacida consisted of 75% of 13-methyl myristate in total fatty acids. The acid at > 60 microM caused the lysis of gel-filtered platelets (GFP) in both time- and concentration-dependent manners. Scanning electron microscopy showed that: 1). GFP in 40 microM of the acid changed the morphology to speculate discoid shape at 15 sec, and to ellipsoids after 30 sec; and 2), the cells gradually swelled to spherical forms as the concentration of the acid increased. At nonlytic concentration, the acid inhibited platelet responses to various agonists with differential concentrations. The order of inhibitory potency was U46619 > low dose collagen > ADP-fibrinogen > phorbol ester > high dose collagen. The results demonstrated that 13-methyl myristate exhibited both cell lytic activity and perturbation on membrane function.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1996

Enhancement of the expression of progesterone receptor on progesterone-treated lymphocytes after immunotherapy in unexplained recurrent spontaneous abortion.

PROBLEM: The immunological mechanism of an effective immunotherapy with paternal lymphocytes for unexplained recurrent spontaneous abortion (RSA) is not yet clear. Previous studies revealed that progesterone plays an important role in maintaining normal pregnancy and lower expression of progesterone receptor (PGR) on lymphocytes was found in RSA. Therefore, it was of interest to investigate whether immunotherapy for RSA would be able to enhance the expression of PGR on lymphocytes of RSA. METHOD: PGR expression on lymphocytes was analyzed with indirect immunofluorescence using flow cytometry. RESULTS: There was no change of PGR expression on PBL of RSA between pre- and post-immunotherapy (P > 0.05), while in the presence of 10.0 micrograms/ml progesterone for 24 h, PGR expressed on PBL on post-immunotherapy was increased significantly as compared with that of pre-immunotherapy in successful cases (P < 0.05) and decreased in abortive cases (P < 0.05). Most PGR was expressed on both CD4+ and CD8+ lymphocyte subsets. In successful cases, CD8+PGR+ subset of post-immunotherapy was found to be increased significantly (P < 0.05) in comparison with that of pre-immunotherapy. CONCLUSION: The data in the present study suggest that immunotherapy for RSA induced a higher expression of PGR on progesterone-treated lymphocytes, which may be involved in successful pregnancy.

Abortion, Habitual↗
PubMed1994

Proteolytic processing of human prorenin in renal and non-renal tissues.

Previous studies have demonstrated that the mouse proprotein convertase PC1 (mPC1) accurately cleaves human prorenin to generate active renin and that this processing event appears to require co-packaging in secretory granules. In the current study, we have tested human PC1 (hPC1; also called PC3) for its ability to activate human prorenin. Our results suggest that while hPC1 is capable of carrying out the specific cleavage of human prorenin, it does so at a reduced efficiency as compared to mPC1. This difference is due to sequences in the carboxy-terminus of PC1 as demonstrated by the activity of hybrid hPC1/mPC1 molecules. These studies demonstrate that PC1 cleavage of prorenin can occur in humans and identify a functionally important region in the hPC1 protein for this interaction. Moreover, the localization of PC1 in human tissues suggests that it may participate in the generation of active renin in the adrenal medulla and possibly in certain adrenal tumors.

Animals↗
PubMed1993

Gadolinium magnetic resonance imaging dacryocystography.

A 1:100 solution of 48% gadopentolate in liquid tear solution was used in magnetic resonance dacryocystography to image the canaliculi, nasolacrimal sac, and nasolacrimal duct. It was administered as an eyedrop, one drop every minute for five minutes, immediately before scanning in six normal and five abnormal nasolacrimal outflow systems. In cases of nasolacrimal obstruction, the dilute gadolinium solution was injected through the canaliculus immediately before scanning. A three-inch surface coil enhanced the detail of soft-tissue structures such as the canaliculi and lacrimal sac. In the evaluation of complex tearing disorders such as congenital, neoplastic, postsurgical, and posttraumatic nasolacrimal obstruction, gadolinium lacrimal contrast adds useful information to magnetic resonance images of the lacrimal outflow system. Because of the expense of the test, we do not recommend it as a routine examination.

Contrast Media↗
PubMed1992

Cognition and the corpus callosum: verbal fluency, visuospatial ability, and language lateralization related to midsagittal surface areas of callosal subregions.

Normal volunteers (28 women), 20-45 years old, completed tests of visuospatial ability, verbal fluency, and language lateralization, and the midsagittal surface areas of the splenium, isthmus, midregion, and genu of the corpus callosum were measured from inversion recovery magnetic resonance images. Multivariate statistics were used to analyze patterns of correlations. Verbal fluency correlated positively with the area of the splenium and with the area of a posterior callosal factor defined largely by the splenium. The posterior callosum, particularly the splenium, also correlated negatively with language lateralization. There were no other consistent brain-behavior relationships. These results are relevant to understanding factors involved in the development of cognitive characteristics that show sex differences and to understanding the neural basis of language lateralization and verbal abilities.

Adult↗
PubMed1991

Spurious hyperkalaemia associated with severe thrombocytosis and leukocytosis.

A patient with marked thrombocytosis and leukocytosis associated with myelofibrosis was found to have spurious hyperkalaemia caused by in vitro cell lysis. Initial failure to recognize the cause of the hyperkalaemia led to an inappropriate and potentially harmful intervention in an effort to optimize the patient's preoperative status.

Aged↗
PubMed1991

Transport of asparagine by rat brain synaptosomes: an approach to evaluate glutamine accumulation.

Isolated rat brain synaptosomes accumulated L-asparagine with a Km value of 348 microM and a Vmax value of 3.7 nmol/mg of protein/min at 28 degrees C. Uptake of L-asparagine was inhibited by the presence of L-glutamine, whereas transport of L-glutamine was blocked by L-asparagine. Alanine, serine, cysteine, threonine, and, in particular, leucine were also inhibitory whereas alpha-(methylamino)isobutyrate, ornithine, lysine, arginine, and glutamate were much less effective blockers. Transport of L-asparagine had a substantial sodium-dependent component, whereas that of the D-stereoisomer was almost unaffected by the presence or absence of the cation. L-Asparagine was accumulated to a maximal gradient, [L-Asn]i/[L-Asn]o, of 20-30, and this value was reduced to 5-6 by withdrawal of sodium or addition of high [KCI]. A plot of log [Na+]o/[Na+]i against the log [L-Asn]i/[L-Asn]o had a slope close to I, which indicates that a single sodium ion is transported inward with each asparagine molecule. It is postulated that uptake of L-asparagine occurs, to a large extent, in cotransport with Na+ and that it utilizes the sodium chemical gradient and the membrane electrical potential as the source of energy. The similarity between the L-asparagine and L-glutamine transport systems and the reciprocal inhibition of influx of the two amino acids suggest that the same mechanism is responsible for glutamine accumulation. This could explain the high [Gln]i maintained by the brain in vivo.

Amino Acids↗
PubMed1990

In vivo moment arm calculations at the ankle using magnetic resonance imaging (MRI).

In vivo moment arm lengths for the Achilles tendon and tibialis anterior (TA) were determined in 10 adult male subjects. Moment arms were measured as the perpendicular distance between the joint center of rotation (CR) and the center of the muscle's tendon on a series of sagittal plane magnetic resonance images. The first set of calculations used a fixed CR and the second a moving CR. The position of the CR was determined using a modification of the graphical method of Reuleaux. For both moving and fixed CR conditions, moment arms increased by approximately 20% for the Achilles tendon and decreased by approximately 30% for the TA when the ankle moved from maximum dorsiflexion to maximum plantarflexion. Moment arms averaged 3.1% greater for the Achilles tendon and 2.5% greater for the TA when calculated using a fixed CR. These data suggest that the averaged moment arm lengths for the Achilles tendon and the TA were relatively unaffected by the use of a fixed vs moving CR.

Achilles Tendon↗
PubMed1990

MRI and diabetic foot infections.

The role of magnetic resonance imaging and plain radiographs in evaluating osteomyelitis in the diabetic foot was studied. Fifty patients were prospectively examined by magnetic resonance imaging and plain radiographs to determine the extent of infection. Thirty-seven patients had positive MRI for osteomyelitis and 19 were positive with conventional radiography. Thirteen patients had negative MRI healed with short course of antibiotics. Five patients with positive MRI received four weeks' course of intravenous antibiotics with two still having persistent infection in the six weeks follow-up. Thirty-two patients underwent surgery with favorable results. Sixty-two bone specimens were obtained for histologic evaluation of osteomyelitis. In cases with histologic proof of diagnosis, magnetic resonance sensitivity was 99%, specificity was 81%, and accuracy was 94%. Thus magnetic resonance imaging was shown to have a high sensitivity, specificity, and accuracy in detecting osteomyelitis.

Adult↗