Yaw-Wen Chang

National Defense Medical Center · School of Medicine

The purpose of this study was to identify the incidence of frailty and to investigate the relationship between frailty status and health-related quality of life (HRQoL) in the community-dwelling elderly population who utilize preventive health services. People aged 65 years and older who visited a medical center in Taipei City from March to August...

Metabolic syndrome (MetS) increases the risk of cardiovascular events. Heart rate variability (HRV) represents autonomic functioning, and reduced HRV significantly increases cardiovascular mortality. The aims of the present paper are to assess the prevalence of MetS in adults with intellectual disabilities (ID), the difference in short-term HRV bet...

In current health examination setting, people frequently undergo heart rate variability (HRV) analysis and colonoscopy on the same day. However, it remains unclear whether the bowel preparation before colonoscopy affects HRV. This study aimed to evaluate the association between HRV and bowel preparation. We conducted a cross-sectional observational...

Introduction: The purpose of this study was to analyse the experience and perception of medical students participating in longitudinal integrated clerkship (LIC). Methods: In 2014, twelve M5 medical students participated in the LIC. Each of the students wrote a reflective journal each month. A total of 62 reflective journals were subsequently colle...

Unlabelled: Metabolic syndrome (MetS) increases the risk of the subsequent development of cardiovascular disease. This study aimed to determine if the harmonic indexes of finger photoplethysmography (PPG) waveforms can be used to discriminate different arterial pulse transmission conditions between MetS and healthy subjects. Three-minute PPG signa...

Background Central venous catheterization (CVC) is a critical clinical procedure. To avoid complications, possessing good knowledge regarding the CVC care bundle and skills for the proper insertion and maintenance of CVC are important. Objectives To evaluate the effectiveness of an educational intervention and the use of an interactive response sy...

目的：面對困難病人乃至於困難醫病溝通不論是對於醫學生或是執業多年的醫師都是個挑戰，理解醫學生和專家對於應對困難醫病溝通認為所需技能的看法可以幫助教育者訂定教學策略。 方法：本研究分二部分：學生面是針對九十九份五年級醫學生的書面報告，以質性研究的主題分析法分析書寫內容，在編碼後進行文意歸類與出現次數計算。專家面則是由八位專家組成共識會議，以名義團體法進行討論，以投票數的高低決定所需技能的重要度分數。 結果：醫學生認為同理心、溝通技巧、了解病人需求、專業知識和堅守底線是面對困難醫病溝通時最需要的技能。而專家則強調傾聽技巧、同理心、邏輯思辨、開放態度和自我覺察的重要性，並且認為法律素養、跨團隊資源的運用、關心他人、多元文化觀念等素養也相當重要。 結論：醫學生和專家都同意同理心是重要的技能，學生更重...

Background Longitudinal integrated clerkships (LICs) and traditional block rotations (TBRs) employ different designs that provide various learning experiences for students. In this study, we explored students’ clinical participation and interpersonal interactions in LICs and TBRs at 2 metropolitan hospitals in Taiwan. Methods In April 2018, we enr...

Background Despite the importance of discharge planning in physicians’ education, currently in most countries, no identical training is provided. Difficulties in promoting physician discharge planning education in Taiwan are still noted. This study aims to find the physicians’ role of discharge planning training in educating post graduate year resi...

This study described a rare case of necrotizing fasciitis presenting as neural dysfunction. The patient's serum ammonia level was significantly elevated; however, no liver function impairment was observed. Hyperammonemia is frequently related to the liver's ammonia metabolism failure. In literature reviews, infections also induce critical complicat...

Background The Discharge Planning Curriculum (DPC) is a 4-hour course for penultimate-year medical students at a tertiary teaching hospital in Taiwan. The course begins with a 30-minute introduction, followed by the students shadowing discharge planning case managers as they visit patients on the wards. After patient visits, the students engaged in...

Background The establishment of laws has had a tremendous impact on holistic medical care. The Patient Right to Autonomy (PRA) Act and the Same-Sex Marriage Act have been passed in Taiwan, and both have sparked intense societal debate. The Same-Sex Marriage Act and PRA Act (SMPRA) teaching module was created for the Gender, Medicine, and Law (GML)...

Background: Longitudinal integrated clerkships (LICs) and traditional block rotations (TBRs) employ different designs that provide various learning experiences for students. In this study, we explored students’ clinical participation and interpersonal interactions in LICs and TBRs at 2 metropolitan hospitals in Taiwan. Methods: In April 2018, we e...

Background The “draw-and-talk” technique has become popular in medical training, as it can help healthcare practitioners develop empathic understanding of patients and contribute to personal transformation. We adopted this method to make the teaching of transitional care planning more relevant to post-graduate residents undergoing their internal me...

Table 2 and 3 in English

Objectives Falls in older adults during hospitalization are a significant cause of morbidity and mortality and are preventable in two thirds of the cases. However, it needs a multifactorial fall risk assessment and intervention for acute elderly inpatients. The purpose of our research is to investigate the reliability of Tw-FRHOP performed by a we...

Introduction: Both self‑rated health (SRH) and the cardiovascular health (CVH) metrics of the American Heart Association have been reported as predictors of cardiovascular events. However, a longitudinal study of the relationships between these metrics has not been conducted before. Objectives: We investigated the association between SRH and CVH...

Purpose: An increasing number of medical schools are implementing longitudinal integrated clerkships (LICs), but less is known about LICs in tertiary teaching hospitals. This study compares the learning experiences of LIC and traditional block rotation (TBR) students and explores the principle of educational continuity at a metropolitan tertiary te...

Background Physical activity can improve health-related quality of life (HRQoL) in older adults. However, the differential effects of gender on quality of life are unclear. Aims: To determine the association between physical activity and HRQoL in men and women.Methods This was a cross-sectional study conducted from March to August 2011. Community-d...

Background Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students’ clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care, e...

Purpose: In 2015, the Accreditation Council for Graduate Medical Education and the American Board of Family Medicine jointly initiated the Family Medicine Milestone Project aiming to establish a milestone-based framework for assessing the competencies of family medicine residents at various levels from beginner to professional. Based on the project...

The author adopted the ACGME Family Medicine Milestones revision 2 and composited the competency of "Providing whole person health care".

Background: Longitudinal integrated clerkships (LICs) are a model of clinical education growing rapidly in Western contexts. LICs use educational continuity to benefits students’ clinical learning and professional identity formation. Patient-centered care is a core component of medical professionalism in the West. To support patient-centered care,...

Introductionhe prevalence of frailty defined by FRAIL-NH varies among different studies in nursing homes, ranging from 19.0% to 75.6%. This study investigated the prevalence of frailty in a nursing home in Taiwan using different diagnostic criteria for frailty.Methods The 7-item FRAIL-NH scale was used for assessing frailty. There are 7 components:...

The main objectives of this study were to explore the influence of Laughing Qigong on health promotion using spectral heart rate variability (HRV) analysis as well as whether any changes in autonomic nervous activity occurred after participating. This study employed a cross-sectional research design and recruited participants into a Laughing Qigong...

Background: Determine factors influencing the continuance intention of the Quit & Win smartphone app based on the technology acceptance model (TAM). Methods: This cross-sectional study was conducted on volunteer military personnel who smoke. Participants were asked to download a smoking cessation app and use it for 15-20 minutes before completing a...

Background: Sarcopenia and cognitive impairment are two of the most prevalent causes of disability in the aging population. Despite the vast amount of research that has been done to quantify the association between these two conditions, extensive systematic reviews and meta-analyses remain limited. Methods: We performed a systematic review using...

Background: Anthropometric parameters have been widely applied in evaluating muscle mass, insulin resistance (IR), and cardiometabolic diseases. Arm circumference (AC) and calf circumference (CC) are used as informative markers for sarcopenia. However, few studies concern the correlation between AC, CC and IR. The aim of the present survey is to i...

The prevalence of obesity was increasing and became a growing problem worldwide. Obesity increased the risk of developing metabolic abnormalities and was associated adverse health outcomes. Our aim was to examine the associations among different combinations of obesity phenotypes (high body mass index > 27 kg/m2 (O), high waist circumference (male...

Accumulating evidence indicates the association between obesity and lung function. However, no previous study has examined whether obesity affects lung function in normal weight participants with high body fat. We hypothesized that subjects with normal weight obesity (NWO) were inversely associated with lung function in Taiwan. The study sample was...

Background: The prevalence of diverticulosis has increased in our aging population, but the risk factors for diverticulosis are not fully understood. The role of hypertension in the risk of diverticulosis remains uncertain. This study investigated whether hypertension is associated with asymptomatic colorectal diverticulosis. Methods: This study...

Objectives To use the extended theory of planned behaviour (TPB) to predict smoking cessation counsellors’ intentions to offer smoking cessation support. Design Cross-sectional study Setting Taiwanese military Participants A survey of 432 smoking cessation counsellors was conducted in 2017. Primary and secondary outcome measures All participant...

Background and objective: Preventing patients from falls can reduce medical cost and increase quality of care. A comprehensive fall risk assessment, essential for hospital fall prevention, provides information about prevalence and severity of risk factors of falls to help healthcare professionals develop effective prevention strategies. This study...

Osteoporosis is one of the major complications in chronic hepatitis B virus (HBV) and hepatitis C (HCV) infection. However, few studies had examined the relationship between hepatic viral infection with bone loss. Our aim was to investigate the association between hepatic viral infection with bone mineral density (BMD) in a cross-sectional study. P...

Emerging studies have shed light on the association between Helicobacter pylori (HP) infection and cardiometabolic risk. However, there is no evidence to support a causal link for the relationship in the general population. Our aim was to determine whether HP infection is associated with the risks of incident type II diabetes mellitus (DM) in a pop...

Abstract The association between anthropometric indices with chronic kidney disease (CKD) was examined previously. However, the effect of body fat on renal function was not determined clearly. Our aim was to investigate the association of percent body fat (PBF) and renal function in adult population from health examination in Tri-Service General Ho...

Objective The effect of obesity-induced metabolic abnormalities on bone mineral density (BMD) and osteoporosis are well established. However, the association between metabolically healthy obesity (MHO) and BMD remains unclear. Our aim was to investigate whether different obesity phenotypes in MHO were associated with BMD in a cross-sectional study....

Adverse systemic effect caused by betel nut had been reported for decades. Our aim was to determine whether betel nut had detrimental impact on the development of colorectal polyps in general population. Participants who attended health examinations at the Tri-Service General Hospital (TSGH) from 2010 to 2016 were included in the study. The habit o...

Background and purpose: Geriatric syndromes include unsteady gait, falls, malnutrition, incontinence, delirium and cognitive dysfunction. Effective prevention and intervention of geriatric syndromes depends on the comprehensive assessments and high-quality nursing care. The purpose of this study was to investigate the prevalence of geriatric syndro...

Family history was one of the major risk factors for developing adverse health outcomes such as metabolic syndrome (MetS), type 2 diabetes mellitus (DM) and hypertension (HTN). Our aim was to examine the relationship between different family histories and cardiometabolic events, including DM, stroke, myocardial infarction (MI), and HTN. Participant...

Accumulated evidence has suggested associations between glucose abnormalities and insulin resistance with hepatitis C virus (HCV) and hepatitis B virus (HBV) infections. However, few studies have reported the effect of hepatitis virus infections on body composition. Our aim was to explore the association of hepatitis virus infections with percent b...

A growing amount of evidence suggests that thyroid-stimulating hormone (TSH) is associated with cardiometabolic risk. However, there have been few longitudinal studies. The aim of this study was to explore the causal relationship between TSH and metabolic syndrome (MetS) in a large population-based longitudinal study. From 2010 to 2016 at the Healt...

Fibrocystic breast change (FBC) is extremely common and occurrs in 90% of women during their lives. The association between body composition and risk of breast cancer is well established. We hypothesized that the effect might exist during the development of FBC. Our aim was to examine the relationships of total lean mass (TLM) and percent body fat...

This study performed skin-surface measurements with the aim of verifying if complexity and spectral analyses applied to laser-Doppler-flowmetry (LDF) signals can be used to discriminate control subjects and patients with metabolic syndrome (MetS) and patients with premetabolic syndrome (pre-MetS). The study participants ( n=142 ) were assigned to t...

Purposed: This study examined the associations between 25-hydroxyvitamin D [25(OH)D] and common anthropometric parameters. Methods: The data were derived from the National Health and Nutrition Examination Survey from 2001 through 2004. We divided all subjects into two groups with a cut-off point for body mass index set at 30. The primary outcome...

PurposeObstructive sleep apnea (OSA) and metabolic syndrome (MetS) are common chronic disorders associated with cardiovascular morbidity and mortality. The goal of our research is to identify the associations between OSA and MetS, including different components of MetS, in adults. Methods We used data from the 2007–2008 National Health and Nutritio...

Context Calf circumference (CC) was a useful anthropometric tool, but there was limited study on the effect of CC on metabolic syndrome (MetS) for cardiovascular risk. Objective The objective of our study was to determine whether additional component of CC refined MetS in correlating with cardiovascular, all-cause and cancer mortality. Design, Se...

Background Frailty is a geriatric syndrome that is generally represented as a universal issue in the aging population and may lead to adverse health-related events. The most widely used definition of frailty was proposed by Fried et al., wherein frailty is characterized by low physical activity, involuntary weight loss, exhaustion, poor muscle stre...

Psoriasis, a skin inflammatory disease, originates from dysregulated interactions of the immune system. Cadmium, an environment pollutant, increases the levels of inflammation markers and influences the immune system. To clarify the relationship between cadmium and psoriasis, 5,927 participants, ≥20 years, in the National Health and Nutrition Exami...

Background: Recent epidemiological studies have shown that sarcopenia is associated with non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis in an Asian population. We investigated whether NAFLD is associated with a higher risk of sarcopenia using a different definition in elderly patients. Methods: A population-based cross-sectional...

The platelet-to-lymphocyte ratio (PLR) has been extensively studied in oncologic diseases. However, the correlation between PLR and sarcopenia remains unknown. In this cross-sectional analysis, we enrolled 3,671 non-institutionalized individuals from the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) aged ≥60 years and wh...

Disability became increasingly common with age, and crude rates of disability were rising around the globe. The aim of this study was to investigate the association between calf circumference (CC) and disability in the U.S. elderly population. From the 1999–2006 National Health and Nutrition Examination Survey, a total of 4,245 participants with an...

Background The National Defense Medical Center started the longitudinal integrated clerkship (LIC) since 2010. It is an urban academic hospital program which enrolled about twelve M5 students (~10% of the class) each year. The length is about 5-6 months (~90% of the clerkship). The program covers the majority of disciplines, including internal medi...

Background: NDMC longitudinal integrated clerkship (LIC) is the only one LIC in Taiwan. It co-exists with a traditional rotation-based clerkship (RBC) in a metropolitan tertiary academic hospital. The aim of this study is to explore the students’ learning experiences during clerkship and to contrast the differences between two curriculums. Summary...

A comprehensive fall risk assessment can provide information for effective prevention and intervention measures and reduce falls among hospitalized elderly people. The purpose of this study was to develop a Chinese version of an inpatient fall risk assessment tool and evaluate its validity and reliability. This study employed the Falls Risk for Hos...

The mechanism of cellular aging likely involves decreased telomere length and is associated with age-related diseases such as cardiovascular disease. Metabolic syndrome (MetS) is an important risk factor for CVD. The purpose of this study was to investigate the association between LTL and MetS. We evaluated 7370 participants in the National Health...

Background and purpose: To investigate the risk factors associated with falls in the elderly in Neihu district, Taipei City, and compare the difference of falling risk factor between the elderly who with or without falling down episode. Method: This is a observational and cross-sectional study, the study population is the voluntary elderly(＞65 year...

A shorter telomere length is associated with several systemic disorders. Telomere length may be an informative biomarker for the maintenance of the overall health status and mortality. There are a limited number of empirical studies concerning the effect of anthropometric parameters on telomere length. The data are derived from the National Health...

The aim of this study was to investigate the association between postprandial glucose and intraocular pressure in a relatively healthy population. We examined 1,439 adults getting a health check-up in a health promotion center at Tri-Service General Hospital (TSGH) in Taiwan between 2012 and 2013. All participants underwent examinations to measure...

The minimal data set underlying the findings in our study. (SAV)

The direct relationship between metabolic syndrome (MetS) and function disability has not been established. The aim of the present study was to investigate the relationship between MetS and functional disability in the elderly. This retrospective observational study included 1,778 participants aged 60–84 years from the National Health and Nutrition...

Preserving physical and cognitive function becomes an important issue as people age. A growing number of studies have found that the correlation between body mass index (BMI) and cognitive function changes in different age groups. It is obvious that higher educational status is linked to higher cognitive function in terms of numerous risk factors t...

Metabolic syndrome (MetS) has been reported with an increased risk of depression. MetS was also associated with insulin resistance. This study aimed to evaluate whether MetS components might contribute to depression in participants with insulin resistance (IR) or not. Methods. This study included 3,331 participants ≥18 years in the NHANES 2009-2010...

INTRODUCTION: A variety of inflammatory disorders influence the serum white blood cell (WBC) count. Elevated systemic inflammatory insult may contribute to impaired lung function, such as obstructive or restrictive lung disease. The aim of our study is to investigate the correlation between WBC count and pulmonary function.

The National Defense Medical Center has launched the longitudinal integrated clerkship (LIC) since 2010 and is the first and only medical college in Taiwan that offers the LIC curriculum. This program is conducted in the Tri-Service General Hospital which is a 1300-bed medical center in Taipei City, Taiwan. Each year, about twelve M5 students are e...

Introduction Empathy and patient-centeredness are essential part of a meaningful patient-physician relationship. The purpose of this study was to assess the change of physician’s empathy and patient-centeredness between genders during the clerkship year. Method The study was conducted before and after one-year rotational-based clerkship in 2013-14....

Hearing loss was a common, chronically disabling condition in the general population and had been associated with several inflammatory diseases. Metabolic syndrome, which was associated with insulin resistance and visceral obesity, was considered a chronic inflammatory disease. To date, few attempts had been made to establish a direct relationship...

Emerging evidences showed impaired muscle strength was prevalent in older adults with mild cognition impairment or dementia. However, little was known about the role of quadriceps strength in the cognition decline among older population. The objective of our study was to investigate the relation between quadriceps strength and cognitive performance...

A variety of inflammatory disorders influence the serum white blood cell (WBC) count. Elevated systemic inflammatory insult may contribute to impaired lung function, such as obstructive or restrictive lung disease. The aim of our study is to investigate the correlation between WBC count and pulmonary function. Eligible participants aged ≥ 18 years...

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