Fei-Ran Guo

Review of telemedicine projects in Taiwan

Taiwan is a heavily populated country, with a small land area and many mountains and isolated islands. Because medical resources are unequally distributed, high quality accessible medical care is a major problem in rural areas. Medical personnel are unwilling to practice in rural areas because of fear of isolation from peers and lack of continuing medical education (CME) in those areas. Telemedicine provides a timeless and spaceless measure for teleconsultation and education. The development of telemedicine in Taiwan began under the National Information Infrastructure (NII) Project. Distance education and teleconsultation were the first experimental projects during the initiation research stage. The cost and effectiveness of the hardware and network bandwidth were evaluated. In the promotion research stage, applications in different medical disciplines were tested to promote multipoint videoconference, electronic journals and VOD. Investigation of user satisfaction put on more emphasis on improving application functions. In 1998, a new Cyber Medical Center (CMC) international collaboration project was begun, integrating technologies of multimedia, networking, database management, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the web. A Taiwan mirror site of Virtual Hospital and two international telemedicine trials through Next Generation Internet (NGI) were done at the end of 1998. In the future, telemedicine systems in Taiwan are expected to combine the Internet and broadband CATV, ADSL, and DBS networking to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend to every household.

Integrated medical informatics with small group teaching in medical education

National Taiwan University College of Medicine (NTUCM) introduced small groups of teaching and basic-clinical integrated courses for medical students in 1992. By using computer network and multimedia techniques, this study tried to overcome barriers to learning in small group teaching. The Department of Medical Informatics of NTUCM established campus networking and computer classrooms and provided Internet and intranet network services including mail, netnews, bulletin board systems (BBS), world wide web (WWW), gopher, ftp and local file servers. To implement an interactive learning environment, the authors first tried mail lists, newsgroups and BBS. Next an integrated learning system prototype on the WWW was developed to provide functions including online syllabus, discussion boards simulated to BBS, online talk, interactive case studies, virtual classroom with video on demand (VOD) and Internet medical resources. The results showed that after the medical students completed the required course of medical informatics and had good network access using a network to communicate with each other became a daily practice. In the future, the system will extend to the tutoring of clinical practice and continuing medical education. The authors expect a national medical education network and more international cooperation and exchange.

The evaluation of a Taiwanese training program in smoking cessation and the trainees' adherence to a practice guideline

BackgroundThe Taiwanese government began reimbursement for smoking cessation in 2002. Certification from a training program was required for physicians who wanted reimbursement. The program certified 6,009 physicians till 2007. The objective of this study is to evaluate the short- and long term efficacy of the training program.MethodsFor short term evaluation, all trainees in 2007 were recruited. For long term evaluation, computer randomly selected 2,000 trainees who received training from 2002 to 2006 were recruited. Course satisfaction, knowledge, confidence in providing smoking cessation services and the adherence to a practice guideline were evaluated by questionnaires.ResultsTrainees reported high satisfaction with the training program. There was significant difference between pre- and post-test scores in knowledge. Confidence in providing services was lower in the long term evaluation compared to short term evaluation. For adherence to a practice guideline, 86% asked the status of smoking, 88% advised the smokers to quit, 76% assessed the smokers willingness to quit, 59% assisted the smokers to quit, and 60% arranged follow-up visits for smokers. The incentive of reimbursement was the most significant factor affecting confidence and adherence.ConclusionsThe training program was satisfactory and effective. Adherence to a practice guideline in our study was better than studies without physician training in other countries.

Plasma zinc α2-glycoprotein levels are elevated in smokers and correlated with metabolic syndrome

Smoking is a strong risk factor of metabolic syndrome. Zinc α2‐glycoprotein (ZAG) is a protein involved in metabolic syndrome. This study aims to investigate the effect of smoking on plasma ZAG levels and its relations to metabolic syndrome.

Changes of serum adiponectin and soluble intercellular adhesion molecule-1 concentrations after smoking cessation.

Abstract Background: This study aims to investigate the effect of increased serum adiponectin concentration during smoking cessation on soluble intercellular adhesion molecule-1 (sICAM-1) concentration. Methods: One hundred and sixty-six eligible smokers were assessed at baseline and were followed up at the 1st, 5th, and 9th weeks after smoking cessation. Demographic data, body weight and blood pressure of these participants were obtained; serum glucose biochemical data, sICAM-1 and adiponectin concentrations were measured. Repeated measures analysis paired t-tests and generalized estimating equations for balanced repeated measures were used for statistical analyses. Results: Forty-one individuals completed the 2-month smoking cessation program. The mean cigarette consumption dramatically decreased (p<0.0001) and the cotinine concentration also decreased significantly (p<0.0001) among the quitters. Serum adiponectin concentration significantly increased (p=0.0186) and sICAM-1 significantly decreased (p<0.0001) in quitters after smoking cessation. The elevation of serum adiponectin concentration significantly correlated with lowering of sICAM-1 (p=0.0001) concentration. Body weight changes at the end of 2-month smoking cessation was inversely correlated with adiponectin increment from baseline (p=0.0003). Conclusions: An increase in serum adiponectin concentration is an independent factor correlated with lowering of sICAM-1 concentration during smoking cessation.

Integrated telehome care with community-based health information system

Even as the 21st Century dawns, Taiwan has already become an aging society. As of 2007, more than 10% of the population is composed of elderly people over 65 years of age. Due to a decrease in total fertility rate to 1.1 in 2008, the proportion of elderly people in the general population will increase more rapidly in the next two decades. The increasingly elderly population, coupled with a corresponding shortage of productive manpower, means that many elderly people are living alone or without a designated caregiver during the day. In this study, a health management center with a community-based health information system platform was integrated with a community hospital and primary care family doctors to provide telehome care for elderly people with chronic diseases or disabilities.