Ching-Wen Chien

Publications (14)34.67 Total impact

• Article: A population-based study on the association between acute renal failure (ARF) and the duration of polypharmacy.

  Yi-Ping Chang, San-Kuei Huang, Ping Tao, Ching-Wen Chien
  [show abstract] [hide abstract]
  ABSTRACT: Because of the rapid growth in elderly population, polypharmacy has become a serious public health issue worldwide. Although acute renal failure (ARF) is one negative consequence of polypharmacy, the association between the duration of polypharmacy and ARF remains unclear. We therefore assessed this association using a population-based database. Data were collected from the Taiwan National Health Insurance Research Database (NHIRD) from 2003 through 2006. The case group included patients hospitalized for ARF during 2006, but not admitted due to trauma, surgery, burn trauma, car accident, transplantation, or infectious diseases; the control group included patients hospitalized without ARF. The cumulative number of days of polypharmacy (defined as more than 5 prescriptions per day) for 1 year prior to admission was determined, with patients further subdivided into 4 categories: less than 30 days, 31-90 days, 91-180 days, and over 181 days. The dependent variable was ARF, and the control variables were age, gender, comorbidities in patients hospitalized for ARF, stay in ICUs during ARF hospitalization and site of operation for prior admissions within one month of ARF hospitalization. Of 20,790 patients who were admitted to hospitals for ARF in 2006, 12,314 (59.23 %) were male and more than 60 % were older than 65 years. Of patients with and without ARF, 16.14 % and 10.61 %, respectively, received polypharmacy for 91-180 days and 50.22 % and 24.12 %, respectively, for over 181 days. A statistical model indicated that, relative to patients who received polypharmacy for less than 30 days, those who received polypharmacy for 31-90, 91-180 and over 181 days had odds ratios of developing ARF of 1.33 (p<0.001), 1.65 (p<0.001) and 1.74 (p<0.001), respectively. We observed statistically significant associations between the duration of polypharmacy and the occurrence of ARF.
  BMC Nephrology 08/2012; 13(1):96. · 2.18 Impact Factor
• Article: Association between rehabilitation timing and major complications of total knee arthroplatsy.

  Hui-Wen Chen, Hui-Ming Chen, Yu-Chun Wang, Po-Yu Chen, Ching-Wen Chien
  [show abstract] [hide abstract]
  ABSTRACT: To investigate the association between rehabilitation timing and the occurrence of post-total knee arthroplasty complications and related medical service utilization. Data from Taiwan's National Health Insurance Research Database from 2003-2006 were used to perform a retrospective study on patients who received their initial total knee arthroplasty during 2004-2005 (a total of 21,143 subjects). All subjects were divided into 1 of 3 groups based on the timing of their rehabilitation after total knee arthroplasty, namely, the within 2 weeks group, the after 2 weeks group or the no-rehabilitation group. We found that patients in the no-rehabilitation group and the after 2 weeks group had higher incidences of prosthetic infection (odds ratio (OR) =1.29, p=0.0409; OR=1.66, p=0.0012) and deep venous thrombosis (OR=1.51, p=0.0099; OR=2.07; p=0.0007) than in the within-2-weeks group. In addition, compared with the within-2-weeks group, the after 2 weeks group had higher total medical expenses (exponentiated regression coefficient: Exp. (β) =1.07, p=0.0211), and the no-rehabilitation group had lower total medical expenses (Exp. (β) =0.01, p<0.0001). The results of this study indicated that, because the incidence rates of complications and medical service utilization among total knee arthroplasty patients in the within 2 weeks group were lower than in the after 2 weeks group, the timing of rehabilitation may be 1 factor affecting post-TKA complications and promoting high levels of medical service utilization. These findings could be useful for clinicians and health policymakers attempting to improve total knee arthroplasty services.
  Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 06/2012; 44(7):588-92. · 1.88 Impact Factor
• Article: Effects of increased payment for ventilation tube insertion on decision making for paediatric otitis media with effusion.

  Mao-Che Wang, Chung-Kai Huang, Ying-Piao Wang, Ching-Wen Chien
  [show abstract] [hide abstract]
  ABSTRACT: The National Health Insurance (NHI) in Taiwan raised the physician fee for myringotomy with ventilation tube insertion (VTI) from $61.5 to $117.6 in July 2004. This study aimed to evaluate if the increased payment affected the decision making of physicians. This study is a retrospective analysis by using NHI databank in Taiwan. All children less than 12 years old who underwent VTI from 1 July 2003 to 30 June 2006 were included. Waiting time and case numbers before and after the increased VTI payment were compared. The waiting time between public and private hospitals was also examined. From the 7408 cases evaluated, there was no difference in waiting time before and after the raise of VTI payment, and no difference within each year group. The case number of VTI increased significantly after the increase in VTI payment (P < 0.05). The waiting time of VTI performed in private hospitals was shorter than that in public hospitals (P = 0.0001). The waiting time of VTI for children with otitis media with effusion (OME) has not been shortened after the increase in VTI payment. Waiting time in private hospitals is shorter than that in public hospitals. Increased payment for VTI has no effect on the physicians' decision making regarding to waiting time for children with OME in Taiwan.
  Journal of Evaluation in Clinical Practice 08/2011; 18(4):919-22. · 1.23 Impact Factor
• Article: The delivery mode and seasonal variation are associated with the development of postpartum depression.

  Szu-Nian Yang, Lih-Jong Shen, Tao Ping, Yu-Chun Wang, Ching-Wen Chien
  [show abstract] [hide abstract]
  ABSTRACT: Previous studies have indicated that mode of delivery and/or season of delivery might be risk factors for postpartum depression (PD). However, only a few studies have provided support for this supposition. This study aim was to confirm the association between mode of delivery and/or season of delivery and PD. We analyzed 2003-2006 Taiwan National Health Insurance Research Database (NHIRD). A group of 2107 mothers who were diagnosed with PD within 6months of delivery in 2005 were selected as the case group and another 8428 mothers without PD during the same timeframe were selected as the control group. Logistic regression was performed after controlling for age, antepartum comorbidities and postpartum complications to confirm the degree of association with the risk of PD. The results of the logistic regression analysis showed that the risk of acquiring PD was lower in mothers with a normal vaginal delivery or an instrumental vaginal delivery compared to mothers with an emergency caesarean section (odds ratio [OR]=0.67, p<0.0001; OR=0.56, p<0.0001). But the women who elected to have a caesarean section was higher risk than an emergency caesarean section (OR=1.48, p=0.0168). In addition, the risk of PD for winter deliveries was higher compared to other seasons. This study provides a reference for gynecologists, obstetricians and health providers that should help with the prevention of PD among pregnant women and mothers.
  Journal of affective disorders 03/2011; 132(1-2):158-64. · 3.76 Impact Factor
• Source

  Available from: PubMed Central

  Article: Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study.

  Chih-Chieh Yang, Nai-Ching Shih, Wen-Chiung Chang, San-Kuei Huang, Ching-Wen Chien
  [show abstract] [hide abstract]
  ABSTRACT: The economic burden of ventilator-associated pneumonia (VAP) during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term. This is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 2004. All subjects underwent endotracheal intubation in the emergency room (ER) on the day of admission or the day before admission, were transferred to the intensive care unit (ICU) and were mechanically ventilated for 48 hours or more. A total of 943 patients who developed VAP were included as the case group, and each was matched with two control patients without VAP by age ( ± 2 years), gender, diagnosis, date of admission ( ± 1 month) and hospital size, resulting in a total of 2,802 patients in the study. Using robust regression and Poisson regression models we examined the effect of VAP on medical utilization including hospitalization expenses, outpatient expenses, total medical expenses, number of ER visits, number of readmissions, number of hospitalization days and number of ICU days, during the index hospitalization and during the following 2-year period. Patients in the VAP group had higher hospitalization expenses, longer length of stay in hospital and in ICU, and a greater number of readmissions than the control group patients. VAP has a significant impact on medical expenses and utilization, both during the index hospitalization during which VAP developed and in the longer term.
  BMC Health Services Research 01/2011; 11:289. · 1.66 Impact Factor
• Article: Comparison of comorbid conditions between open-angle glaucoma patients and a control cohort: a case-control study.

  Herng-Ching Lin, Ching-Wen Chien, Chao-Chien Hu, Jau-Der Ho
  [show abstract] [hide abstract]
  ABSTRACT: To determine the prevalence of selected comorbidities in patients with open-angle glaucoma (OAG) and whether these comorbidities are more prevalent among individuals with OAG than those without OAG. A retrospective, nationwide, case-control study using an administrative database. The study group comprised 76,673 OAG patients. The comparison group comprised 230,019 subjects matched to the study cohort. Data were collected retrospectively from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of OAG (International Classification of Diseases, 9th Revision, Clinical Modification codes 365.1-365.11) in 2005 (n = 76,673). The comparison cohort comprised randomly selected patients (3 for every 1 OAG patient; n = 230,019) matched with the study group in terms of age, gender, urbanization level, and monthly income. In total, 31 medical comorbidities were selected based mainly on the Elixhauser Comorbidity Index. Separate conditional logistic regression analyses were used to estimate the adjusted odds ratio for each of the medical comorbidities between patients with and without OAG. The prevalences of selected comorbidities. More than half (50.5%) of the OAG patients had hypertension, and more than 30% had hyperlipidemia or diabetes (30.5% and 30.2%, respectively). The prevalences of 28 of 31 comorbidities were significantly higher for OAG patients than subjects without glaucoma after adjusting for age, gender, urbanization level, and monthly income. The adjusted odds ratio was more than 1.50 for hypertension, hyperlipidemia, systemic lupus erythematosus, diabetes, hypothyroidism, fluid and electrolyte disorders, depression, and psychosis. Among the studied comorbidities, the prevalence difference of the OAG group minus the control group was 3% or higher for hypertension, hyperlipidemia, stroke, diabetes, liver disease, and peptic ulcer. Open-angle glaucoma patients are significantly more likely to have comorbidities, many of which can be life threatening or can affect the quality of life appreciably. The author(s) have no proprietary or commercial interest in any materials discussedin this article
  Ophthalmology 11/2010; 117(11):2088-95. · 5.45 Impact Factor
• Source

  Available from: vghtpe.gov.tw

  Article: Health effects of medical radiation on cardiologists who perform cardiac catheterization.

  Mei-Kang Yuan, Ching-Wen Chien, San-Kan Lee, Nai-Wei Hsu, Shih-Chieh Chang, Shu-Ju Chang, Gau-Jun Tang
  [show abstract] [hide abstract]
  ABSTRACT: We investigated the health effects of low-dose radiation on cardiologists exposed to scattered radiation while performing cardiac catheterization (CC) in a hospital setting from 2003 to 2006. We performed a 4-year retrospective study on 2, 292 medical doctors, using claims data from all contracted hospitals of the Bureau of National Health Insurance, Taiwan. We gathered statistical data regarding radiation-related diseases using the International Classification of Diseases, 9(th) Revision, Clinical Modification record numbers of each doctor. Of the 2,292 doctors evaluated, 1,721 were aged 35-50 years and the remaining 571 were aged 51-65 years. There were 892 cardiologists who performed CC (experimental group), and the majority of these (733/892, 82.17%) were aged 35-50 years. There were 1,400 medical doctors who performed no CC from 2003 to 2006 (control group). A total of 988 of these belonged to the 35-50 years age group and 412 to the 51-65 years group. In the 35-50 years group, the controls had significantly more medical visits for hematological and thyroid cancer (p <0.05), skin disease (p <0.001), and acute upper respiratory tract infection (p <0.001) compared with the experimental group. In contrast, cardiologists who performed catheterization had more cataracts compared with the control group, but this difference was not significant. Doctors who did not perform CC had more visits for radiation-related diseases than those who performed catheterization. In the experimental group, cardiologists aged 35-50 years who were exposed to radiation during CC had more visits for cataracts than the control group. We recommend that radiation protection concepts be emphasized to cardiologists, and that hospital managers be obligated to upgrade angiography equipment because the newer models have less scattered radiation.
  Journal of the Chinese Medical Association 04/2010; 73(4):199-204. · 0.79 Impact Factor
• Article: Herpes zoster ophthalmicus and the risk of stroke: a population-based follow-up study.

  Herng-Ching Lin, Ching-Wen Chien, Jau-Der Ho
  [show abstract] [hide abstract]
  ABSTRACT: To investigate the risk of stroke development following a diagnosis of herpes zoster ophthalmicus (HZO). Data were retrospectively collected from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients with a diagnosis of HZO (ICD-9-CM code 053.2) in 2003 and 2004 (n = 658). The comparison cohort was comprised of randomly selected patients (3 for every HZO patient, n = 1974) matched with the study group in terms of age and gender. Patients were tracked from their index visits for 1 year. The Kaplan-Meier method was utilized to compute the 1-year stroke-free survival rate. Cox proportional hazard regressions were carried out to compute the adjusted 1-year stroke-free survival rate after adjusting for possible confounding factors. Stroke developed in 8.1% of patients with HZO and 1.7% of patients in the comparison cohort during the 1-year follow-up period. HZO patients had significantly lower 1-year stroke-free survival rates than patients in the comparison cohort. After adjusting for patients' demographic characteristics, selected comorbidities, and medication habits, HZO patients were found to have a 4.52-fold (95% confidence interval 2.45-8.33) higher risk of stroke than the matched comparison cohort. There was no significant difference in the rate of stroke development between patients who had received systemic antiviral treatment and those who had not. Herpes zoster ophthalmicus may represent a marker of increased risk of stroke development during the 1-year follow-up period.
  Neurology 03/2010; 74(10):792-7. · 8.31 Impact Factor
• Article: A cost and benefit study of esophagectomy for patients with esophageal cancer.

  Chih-Cheng Hsieh, Ching-Wen Chien
  [show abstract] [hide abstract]
  ABSTRACT: The incidence of esophageal cancer is increasing all over the world but the cost-and-benefit of esophagectomy for esophageal cancer patients was rarely studied. The aim of this study is to compare the cost-and-benefit of esophagectomy in different stages of esophageal cancer. Clinical and utilization data, including medical expenses and reason for treatment, of esophageal cancer patients were collected, summed and followed up for 5 years. The patients were divided into two groups according to their treatments, with or without esophagectomy. The monthly medical expense and relative expense performance index (REPI) were then calculated. Factors influenced total and monthly medical expense and survival time were further analyzed. A total of 310 esophageal cancer patients, 281 male and mean age of 64.3, were included in this study. One hundred forty-nine patients had undergone esophagectomy. The 5-year survival rate, total and monthly medical expense for two groups was 36.0% and 10.2% (p<0.001), USD $22,532.8 vs. 12,256.4 (p<0.001) and USD $2,101.65 vs. 2,033.94 (p=0.831), respectively. The REPIs in four different stages were 7.573, 2.422, 2.446 and 0.705. Both esophagectomy and tumor stage were the sole factors that could influence total and monthly medical expense respectively. Both esophagectomy and tumor stage could influence a patient's survival time. Esophagectomy has better performance than non-esophagectomy for patients with stages I to III esophageal cancer. Therefore, adding economical considerations, esophagectomy is recommended for patients, at least earlier than stage III.
  Journal of Gastrointestinal Surgery 07/2009; 13(10):1806-12. · 2.83 Impact Factor
• Article: Mass screening of suspected febrile patients with remote-sensing infrared thermography: alarm temperature and optimal distance.

  Ming-Fu Chiang, Po-Wei Lin, Li-Fong Lin, Hung-Yi Chiou, Ching-Wen Chien, Shu-Fen Chu, Wen-Ta Chiu
  [show abstract] [hide abstract]
  ABSTRACT: Detection of fever has become an essential step in identifying patients who may have severe acute respiratory syndrome (SARS) or avian influenza. This study evaluated infrared thermography (IRT) and compared the influence of different imagers, ambient temperature discrepancy, and the distance between the subject and imager. IRT-digital infrared thermal imaging (IRT-DITI), thermoguard, and ear drum IRT were used for visitors to Municipal Wang Fang Hospital, Taipei, Taiwan. The McNemar and Chi-squared test, standard Pearson correlation, ANOVA, intraclass correlation coefficient (ICC), and receiver operating characteristic curve (ROC) analysis were used to calculate the alarm temperature for each imager. A total of 1032 subjects were recruited. Different distances and ambient temperature discrepancy had a significant influence on thermoguard, and lateral and frontal view DITI. By ICC analysis, a significant difference was found at 10 m distance between ear drum IRT and thermoguard (r = 0.45), lateral view DITI (r = 0.37), and frontal view DITI (r = 0.44). With ROC analysis, the optimal preset cut-off temperatures for the different imagers were: 36.05 degrees C for thermoguard (area under the curve [AUC], 0.716), 36.25 degrees C for lateral view DITI (AUC, 0.801), and 36.25 degrees C for frontal view DITI (AUC, 0.812). The temperature readings obtained by IRT may be used as a proxy for core temperature. An effective IRT system with a strict operating protocol can be rapidly implemented at the entrance of a hospital during SARS or avian influenza epidemics.
  Journal of the Formosan Medical Association 01/2009; 107(12):937-44. · 1.13 Impact Factor
• Article: Prediction of successful weight reduction after bariatric surgery by data mining technologies.

  Yi-Chih Lee, Wei-Jei Lee, Tian-Shyug Lee, Yang-Chu Lin, Weu Wang, Phui-Ly Liew, Ming-Te Huang, Ching-Wen Chien
  [show abstract] [hide abstract]
  ABSTRACT: Surgery is the only long-lasting effective treatment for morbid obesity. Prediction on successful weight loss after surgery by data mining technologies is lacking. We analyze the available information during the initial evaluation of patients referred to bariatric surgery by data mining methods for predictors of successful weight loss. 249 patients undergoing laparoscopic mini-gastric bypass (LMGB) or adjustable gastric banding (LAGB) were enrolled. Logistic Regression and Artificial Neural Network (ANN) technologies were used to predict weight loss. Overall classification capability of the designed diagnostic models was evaluated by the misclassification costs. We studied 249 patients consisting of 72 men and 177 women over 2 years. Mean age was 33 +/- 9 years. 208 (83.5%) patients had successful weight reduction while 41 (16.5%) did not. Logistic Regression revealed that the type of operation had a significant prediction effect (P = 0.000). Patients receiving LMGB had a better weight loss than those receiving LAGB (78.54% +/- 26.87 vs 43.65% +/- 26.08). ANN provided the same predicted factor on the type of operation but it further proposed that HbAlc and triglyceride were associated with success. HbAlc is lower in the successful than failed group (5.81 +/- 1.06 vs 6.05 +/- 1.49; P = NS), and triglyceride in the successful group is higher than in the failed group (171.29 +/- 112.62 vs 144.07 +/- 89.90; P = NS). Artificial neural network is a better modeling technique and the overall predictive accuracy is higher on the basis of multiple variables related to laboratory tests. LMGB, high preoperative triglyceride level, and low HbAlc level can predict successful weight reduction at 2 years.
  Obesity Surgery 10/2007; 17(9):1235-41. · 3.29 Impact Factor
• Article: An analysis of job satisfaction among physician assistants in Taiwan.

  Chi-Ming Liu, Ching-Wen Chien, Pesus Chou, Jorn-Hon Liu, Victor Tze-Kai Chen, Jeng Wei, Ying-Yu Kuo, Hui-Chu Lang
  [show abstract] [hide abstract]
  ABSTRACT: The physician assistant (PA) is a relatively new medical specialty that developed to manage the shortage of resident physicians and to ensure that patients receive high-quality health care in today's increasingly complex and demanding medical environment. PAs in Taiwan are not governed by laws and regulations, and the absence of legislation to define their roles and responsibilities can lead to confusion in the work environment and potential communication barriers with coworkers and supervising physicians. The purpose of this exploratory study was to examine the environmental and sociodemographic factors that influence job satisfaction and job-related communication among PAs in Taiwan. The data source, a self-administered mail survey, was sent to 196 PAs working within medical facilities in northern, central, and southern Taiwan. The response rate to the survey was 71.01%. There was a strong correlation between communication satisfaction and job satisfaction among respondents. The PAs' overall position in the hospital, relationships with coworkers (doctors, nurses, and other medical staff), and ability to perform his or her duties while working with the supervising physician were the major environmental factors that influenced job and communication satisfaction. In addition, the number of working years and marital status were important demographic factors influencing job satisfaction. Demographic and environmental factors influencing job satisfaction are analyzed, and ways in which the roles and responsibilities of PAs can be clarified, strengthened, and improved are discussed in an overall effort to provide management strategies for the current PA system in Taiwan.
  Health Policy 08/2005; 73(1):66-77. · 1.51 Impact Factor
• Article: Factors determining the financial performance of rural hospitals in Iowa /

  Ching Wen. Chien
  [show abstract] [hide abstract]
  ABSTRACT: Thesis (Ph. D.)--University of Iowa, 1991. Includes bibliographical references (p. 129-137). Photocopy.
• Article: The application of artificial neural networks and decision tree model in predicting post-operative complication for gastric cancer patients.

  Ching-Wen Chien, Yi-Chih Lee, Tsochiang Ma, Tian-Shyug Lee, Yang-Chu Lin, Weu Wang, Wei-Jei Lee
  [show abstract] [hide abstract]
  ABSTRACT: Gastric cancer remains a leading cause of death worldwide. Post-operative complication is one important factor which causes mortality of gastric cancer patients after gastrectomy. Better prediction of post-operative complication before gastrectomy can significantly reduce post-operative mortality and morbidity. Therefore, 3 data mining techniques were applied in this study on improving prediction of post-operative complication. A retrospective study was performed on 521 patients from 3 over 2,000 acute-bed medical centers in Taiwan during February 2002 to October 2004. Pre- and post-operative clinical data were collected and analyzed by applying 3 data mining techniques, included Artificial Neural Networks (ANN), Decision Tree (DT) and Logistic Regression (LR). Results of this study indicated that ANN was a better technique than DT and LR in predicting post-operative complication. Nutritious status, pathological characteristics and operational characteristics were important predictors of post-operative complication. Further study on predicting postoperative complication in gastric cancer patients is still important. However, how to combine different data mining techniques to improve accuracies of prediction will be another important issue for clinicians and researchers.
  Hepato-gastroenterology 55(84):1140-5. · 0.66 Impact Factor