Medical Institutions In Taiwan Research Articles

Possible Myths of the Regulation of Medical Institutions in Taiwan

Possible Myths of the Regulation of Medical Institutions in Taiwan

Predicting new-onset post-stroke depression from real-world data using machine learning algorithm.

Post-stroke depression (PSD) is a serious mental disorder after ischemic stroke. Early detection is important for clinical practice. This research aims to develop machine learning models to predict new-onset PSD using real-world data. We collected data for ischemic stroke patients from multiple medical institutions in Taiwan between 2001 and 2019. We developed models from 61,460 patients and used 15,366 independent patients to test the models' performance by evaluating their specificities and sensitivities. The predicted targets were whether PSD occurred at 30, 90, 180, and 365 days post-stroke. We ranked the important clinical features in these models. In the study's database sample, 1.3% of patients were diagnosed with PSD. The average specificity and sensitivity of these four models were 0.83-0.91 and 0.30-0.48, respectively. Ten features were listed as important features related to PSD at different time points, namely old age, high height, low weight post-stroke, higher diastolic blood pressure after stroke, no pre-stroke hypertension but post-stroke hypertension (new-onset hypertension), post-stroke sleep-wake disorders, post-stroke anxiety disorders, post-stroke hemiplegia, and lower blood urea nitrogen during stroke. Machine learning models can provide as potential predictive tools for PSD and important factors are identified to alert clinicians for early detection of depression in high-risk stroke patients.

Cancer-Associated Thrombosis: A Taiwanese Perspective on Therapeutic Options with Focus on Non-Vitamin K Antagonist Oral Anticoagulants.

Cancer-associated thrombosis (CAT) is a common complication of malignancies. Patients with CAT are at risk of venous thromboembolism recurrence, but also at risk of bleeding while anticoagulated. Taiwanese patients are perceived to have a lower incidence of CAT, likely leading to false reassurance for Taiwanese patients with cancer. Because of this, oncologists and cardiologists from multiple medical institutions in Taiwan have set forth to provide clinical consensus guidelines on the management of CAT, based on local clinical practices and guided by predominant international clinical practice guidelines. This paper aims to describe the current disease burden of cancer-associated venous thromboembolism in Taiwanese cancer patients, and discusses the unmet needs and gaps in the management of this medical complication. It also outlines diagnostic and management strategies relevant to the different treatment options available, such as non-vitamin K antagonist oral anticoagulants.

Terminally ill patients’ and their relatives’ experiences and behaviors regarding complementary and alternative medicine utilization in hospice palliative inpatient care units: a cross-sectional, multicenter survey

BackgroundTerminally ill patients often experience exacerbations of diseases that render mainstream medicine ineffective in relieving symptoms, prompting attempts at complementary and alternative medicine (CAM). This study collected data from terminally ill patients and their relatives to determine differences between CAM use, behavioral patterns, and perceptions of health information about CAM.MethodsA cross-sectional design using a self-administered questionnaire was adopted. Eight medical institutions in Taiwan with inpatient hospice palliative care units were chosen. Ninety-two terminally ill patients and 267 relatives met the inclusion criteria. The questions concerned the experience of CAM use, the kinds of products/services CAM provided, the purpose of CAM use, the source of CAM information, and the perceptions and attitudes toward CAM.ResultsBoth terminally ill patients and their relatives have a high proportion of lifetime and one-year prevalence of CAM use (88.0% vs. 88.4%; p = 0.929). CAM use for musculoskeletal and neurological discomfort is higher among terminally ill patients than among their relatives. Relatives/friends are the most frequent sources of information on CAM (53.3% vs. 62.2%; p = 0.133). The percentage of terminally ill patients who discontinued mainstream medical treatment because of CAM use was higher than that of their relatives (18.5% vs. 9.3%; p = 0.026). More than half the terminally ill patients and their relatives had never been asked about CAM by medical staff (64.1% vs. 66.7%), nor had they informed medical professionals about the use of CAM products and services (63% vs. 66.9%). Random inquiries by medical professionals may be associated with increased disclosure of CAM use (terminally ill patients: odds ratio, 9.75; 95% confidence interval, 1.97–48.35 vs. relatives: odds ratio, 5.61; 95% confidence interval, 2.66–11.83).ConclusionsThe high prevalence and concealment of CAM use in terminally ill patients should be considered. Medical professionals should establish a friendly and barrier-free communication model, encourage patients to share CAM experiences, and provide evidence-based information on the use of CAM products and services, to reduce the potential damage caused by harmful use.

Applying the Balanced Scorecard to Build Service Performance Measurements of Medical Institutions: An AHP-DEMATEL Approach.

The main purpose of this study is to explore the application of the balanced scorecard (BSC) to service performance measurements of medical institutions using the analytic hierarchy process (AHP) and decision making and trial evaluation laboratory (DEMATEL). According to the concept of BSC, a total of four evaluation dimensions and twenty-two indicators of medical service performance measurements were developed. To collect data, this study delivered expert questionnaires to medical-related professional supervisors, deans, and heads of medical institutions in Taiwan. By combining the AHP and DEMATEL, the priority and causality of service performance standards in medical institutions were obtained. The results of this study show that the customer dimension is the most important service performance measurement dimension for medical institutions. The seven key service performance measurement indicators that are most important for medical institutions, in order, are "complete and comfortable equipment", "competitiveness of the medical profession", "continuity of patient-to-hospital treatment", "classification of medical profession according to customers (VIP system)", "complete medical service", "complete salary, remuneration, and policy", and "medical incomes of institutions". In terms of causality, provided the complete services of medical institutions are improved, the continuity of patient-to-hospital treatment, the competitiveness of the medical profession, and the medical incomes of institutions would be influenced.

2022 Survey on the Developmental Trend of Smart eHealth in Taiwan

<p>世界衛生組織不僅將智慧醫療（eHealth）定義為資通訊科技在醫療及健康領域的應用 ，亦認為數位科技（Digital technologies）有助於推進全民健康覆蓋以及健康福祉相關的永續發展目標 ，衛生福利部第九期醫療網，亦將創造具韌性且智能的醫療照護體系訂為總目標之一。財團法人醫院評鑑暨醫療品質策進會持續於本（2022）年度進行全國醫院智慧醫療發展問卷普查。在疫情影響下，視訊診療、數位學習系統及遠距教學等導入比率較高，而環境管理智慧化導入則相較門急住診等應用要來得低。AI技術的應用是醫學中心未來一年的發展重點，非醫學中心則放在資訊安全。醫院政策、醫療人員需求及衛生政策分別為前三項推動的關鍵因素，差別在於地區醫院更看重醫院政策與衛生政策。</p> <p> </p><p>The World Health Organization defined eHealth as “the use of information and communications technology in support of health and health-related fields”, and it considered digital technologies conducive to promoting universal health coverage as well as to sustainable development goals related to health and welfare. The ninth phase of the medical network of the Ministry of Health and Welfare has established one of its overall goals as establishing a healthcare system that is resilient and smart. As in the past, in 2022, the Joint Commission of Taiwan continued to conduct a census of the development of eHealth in medical institutions in Taiwan. Affected by the COVID-19 pandemic, video teleconferencing for disease diagnosis and treatment, digital learning systems, and distant teaching have been more widely introduced compared to the application of environmental smart management in outpatient clinics, emergency departments, and inpatient clinics. In the following year, the application of artificial intelligence technology will be a key development point for medical centers; by contrast, the focus of non-medical centers will be information security. The top three key factors for promoting eHealth among medical institutions will be hospital policies, medical personnel demands, and health policies, with the only difference being that local community hospitals will focus more on hospital policies and health policies.</p> <p> </p>

Comparative effectiveness of valproic acid in different serum concentrations for maintenance treatment of bipolar disorder: A retrospective cohort study using target trial emulation framework.

SummaryBackgroundThere is a lack of consensus on the optimal serum valproic acid (VPA) concentration for maintenance therapy in bipolar disorder (BD). We aimed to investigate the association between serum VPA levels and risk of mood episode recurrence.MethodsWe enrolled patients with BD from multiple medical institutions in Taiwan between January 1, 2001 and December 31, 2019. Patients were divided into three groups according to their serum VPA concentrations (< 50 μg/ml, 50–74 μg/ml, and 75–104 μg/ml). Adjusted hazard ratios (aHR) with 95% confidence intervals (CIs) compared times to mood episode recurrence using the < 50 μg/ml group as reference. A systematic review found relevant articles published before February 2022 (PROSPERO: CRD42022309661), and corresponding results were compared.FindingsThis cohort included 896 patients for an intention-to-treat analysis. Compared with the < 50 μg/ml group, a non-significantly lower risk of mood episode recurrence was found in the 50–74 μg/ml (aHR, 95% CI: 0·86, 0·71–1·05) and 75–104 μg/ml (0·91, 0·71–1·18) groups. A per-protocol analysis of 481 patients found a significant risk reduction in the 50–74 μg/ml group (0·76, 0·60–0·97), with inconclusive results in the ≥ 75 μg/ml group (1·03, 0·73–1·46). A meta-analysis including two studies (254 patients) and our cohort found a similar significantly lower risk of mood episode recurrence in the 50–74 μg/ml group (HR, 95% CI: 0·83, 0·69–0·99), while risk reduction in the 75–99 μg/ml group (0·62, 0·26–1·48) did not differ significantly from that in the < 50 μg/ml group or the 50–74 μg/ml group.InterpretationThe combined results of this cohort and previous studies suggest that VPA between 50–74 μg/ml may be a more effective concentration to prevent acute mood episodes during maintenance therapy in patients with BD compared with VPA < 50 μg/ml.FundingMinistry of Science and Technology, Taiwan, and Chang Gung Medical Research Project.

Impact of Using a Non-Rebreathing Mask in Patients With Respiratory Failure

BackgroundLiberal oxygen therapy might increase the mortality rate of patients. Non-rebreathing masks (NRM) are a high-flow, non-invasive oxygen device that can provide oxygen concentration up to 95%. This study aimed to determine the impact of using NRM in patients with respiratory failure. MethodsThis retrospective cohort study was conducted in four medical institutions in Taiwan from January 2010 to December 2016. The association between mortality and NRM use before receiving ventilator support in patients with respiratory failure in the emergency department was analyzed. Patients were divided into the NRM treatment and no NRM treatment groups. A 1:4 propensity score matching was conducted. Regarding the duration of NRM use, treatments were grouped as 0 h, 0–1 h, 1–2 h, and >2 h. ResultsA total of 18,749 patients were included, with 1074 using NRM. After propensity score matching, 1028 patients using NRM (0–1 h: 508, 1–2 h: 193, and >2 h: 327) and 4112 patients not using NRM were analyzed. The 30-day mortality rates were 29.1%, 28.5%, 27.5%, and 35.5% in the 0 h, 0–1 h, 1–2 h, and >2 h treatment groups, respectively. Patients with respiratory failure due to pulmonary disease using NRM over 2 h had a higher mortality rate than patients not using NRM (hazard ratio: 1.3, 95% CI: 1.01–1.66). ConclusionsProlonged use of NRM in patients with respiratory failure due to pulmonary disease possibly increases mortality.

Association between liberal oxygen therapy and mortality in patients with paraquat poisoning: A multi-center retrospective cohort study

Paraquat (N, N'-dimethyl-4, 4'-bipyridinium dichloride, PQ) intoxication is a common cause of lethal poisoning. This study aimed to identify the risk of using liberal oxygen therapy in patients with PQ poisoning. This was a multi-center retrospective cohort study involving four medical institutions in Taiwan. Data were extracted from the Chang Gung Research Database (CGRD) from January 2004 to December 2016. Patients confirmed to have PQ intoxication with a urine PQ concentration ≥ 5 ppm were analyzed. Patients who received oxygen therapy before marked hypoxia (SpO2 ≥ 90%) were defined as receiving liberal oxygen therapy. The association between mortality and patient demographics, blood paraquat concentration (ppm), and liberal oxygen therapy were analyzed. A total of 416 patients were enrolled. The mortality rate was higher in the liberal oxygen therapy group (87.8% vs. 73.7%, P = 0.007), especially in 28-day mortality (adjusted odds ratio [aOR]: 4.71, 95% confidence interval [CI]: 1.533-14.471) and overall mortality (aOR: 5.97, 95% CI: 1.692-21.049) groups. Mortality in patients with PQ poisoning was also associated with age (aOR: 1.04, 95% CI: 1.015-1.073), blood creatinine level (aOR: 1.49, 95% CI: 1.124-1.978), and blood paraquat concentration (ppm) (aOR, 1.51; 95% CI: 1.298-1.766). Unless the evidence of hypoxia (SpO2 < 90%) is clear, oxygen therapy should be avoided because it is associated with increased mortality.

Association of prior fluoroquinolone treatment with survival outcomes of immune checkpoint inhibitors in Asia

Gut microbiota plays an important role in shaping immune responses. Several studies have reported that antibiotics may alter gut microbiota diversity and compromise the therapeutic response to immune checkpoint inhibitors (ICIs). Nevertheless, the impact of a specific class of antibiotics on ICIs therapy is still not known. The aim of this study was to analyse the influence of antibiotics on the clinical outcomes of non-small cell lung cancer (NSCLC) patients treated with ICIs and to compare the effects of fluoroquinolones vs. other broad-spectrum antibiotics. This retrospective cohort study (n=340) analysed data from Chang Gung Research Database, which comprises work from seven medical institutions in Taiwan. Patients with NSCLC who received ICIs between January 2016 and March 2019 were evaluated. The data of patients who received antibiotics (ie fluoroquinolone) within 30days prior to ICIs therapy were analysed. Overall survival (OS) was the goal of our study and was calculated from the time the ICIs therapy start. Survival analysis was estimated using the Kaplan-Meier and Cox statistics. A total of 340 patients were identified for analysis. Of the 340 patients, only over one third (38%) of patients received antibiotics 30days prior to ICI therapy. These patients exhibited a shorter OS compared with those not receiving antibiotics (median OS, 266days vs. 455days; hazard ratio (HR), 2.9; 95% confidence interval (CI), 1.1-8.1, p=0.003). In this study, 127 out of 128 patients who were exposed to antibiotics had received at least one broad-spectrum antibiotic. We observed patients who had received fluoroquinolone had a shorter OS compared with those receiving other broad-spectrum antibiotics (median OS, 121days vs. 370days; HR, 1.582; 95% CI 1.007-2.841; p=0.047). Antibiotic treatment, especially fluoroquinolone, prior to ICIs therapy was associated with poorer clinical efficacy in NSCLC patients. Antibiotics should not be withheld when there is a clear need for them despite the possibility of interfering with the microbiome, which may, in turn, adversely affect the ICI's effectiveness. However, one should consider avoiding the use of fluoroquinolones antibiotics.

Benefits of Early In-Hospital Antivenom Administration to Patients with Protobothrops mucrosquamatus Envenomation.

Protobothrops mucrosquamatus is one of the common venomous snakes in Southeast Asia. This retrospective cohort study conducted in six medical institutions in Taiwan aimed to obtain information on the optimal management strategies for P. mucrosquamatus snakebite envenomation. Data were extracted from the Chang Gung Research Database from January 2006 to December 2016. The association between early antivenom administration and patient demographics, pain requiring treatment with analgesic injections, and hospital length of stay was analyzed. A total of 195 patients were enrolled; 130 were administered antivenom within 1 hour after emergency department arrival (early group), whereas 65 were treated later than 1 hour after arrival (late group). No in-hospital mortality was identified. The difference in surgical intervention rates between the early and late groups was statistically insignificant (P = 0.417). Compared with the early group, the late group showed a higher rate of antivenom skin test performance (46.9% versus 63.1%, respectively, P = 0.033), longer hospital stay (42 ± 62 hours versus 99 ± 70 hours, respectively, P = 0.016), and higher rate of incidences of pain requiring treatment with analgesic injections (29.2% versus 46.2%, respectively, P = 0.019). After adjusting for confounding factors, early antivenom administration was associated with decreased pain requiring treatment with analgesic injections (adjusted odds ratio: 0.51, 95% CI: 0.260-0.985). Antivenom administration within 1 hour of arrival was associated with a decreased likelihood of experiencing pain and hospital length of stay in patients with P. mucrosquamatus snakebites. Antivenom skin testing was associated with delays in antivenom administration.

Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users.

BackgroundInjury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan.ObjectiveThis study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users.MethodsA cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment.ResultsA total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6% (338/361) of participants had no experience using mHealth technology for wound care.ConclusionsOur study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes.

Risk factors associated with snake antivenom reaction and the role of skin test

Antivenom reactions are a common complication of snake antivenom. This study aimed to identify predicators of antivenom reaction and the involvement of antivenom skin test in antivenom reaction development. This retrospective cohort study was conducted in six medical institutions in Taiwan. Data were extracted from the Chang Gung Research Database (CGRD) from January 2006 to December 2016. The association between antivenom reaction and patient demographics, type and dose of antivenom, and skin test results was analyzed. The study enrolled 799 patients, including 219 who developed antivenom reactions. Compared to patients receiving both freeze-dried hemorrhagic (FH) and freeze-dried neurotoxic (FN) antivenom, those administered a single type had a lower antivenom reaction risk (adjusted odds ratios [aORs]: 0.5 and 0.4, 95% confidence interval [CI]: 0.35–0.74 and 0.24–0.69, FH and FN respectively). Patients administered a higher antivenom dose (≥ 5 vials) had higher antivenom reaction risk (aOR: 1.8, 95% CI: 1.23–2.76). A positive skin test result was also associated with antivenom reaction (aOR: 16.7, 95% CI: 5.42–51.22). The skin test showed high specificity (98.5%, 95% CI: 97.49%–99.83%) but low sensitivity (17.5%, 95% CI: 10.74%–24.18%). The antivenom skin test should be abolished because of the extremely low sensitivity and possible misinterpretation of results because of the limitation of this examination.

Safeguarding Medication Use Through Interprofessional Collaboration: Example of Inpatient Medication Management and Use

The majority of patient safety incidents cited in the latest Taiwan Patient Safety Reporting System Annual Report were medication-related, with human factors and communication issues identified as the key underlying causes of these incidents. Focusing on inpatient settings, the complex yet multiprofessional-linked drug supply scheme currently in place in medical institutions in Taiwan is described, with the aim of facilitating the accessibility and appropriateness of medication use by detailing the responsibilities of each professional role. Institutional medication management and use comprise several sequential and interconnected stages, including formulary management and drug procurement, medication storage, physician prescribing, pharmacist dispensing, nurse administration, and efficacy-and-safety monitoring and reporting. The principal tasks and personnel duties at each stage are addressed. In summary, institutional drug distribution and control is an intricate process that involves multiple processes and a diverse array of professionals and administrative staff. It is imperative to actively engage the relevant parties, especially through in-service training, in order to understand their essential roles and responsibilities and to enable communication and collaboration among stakeholders in the drug distribution chain. Implementing the appropriate initiatives in a timely manner will help establish an effective and robust safe-medication-use system.

Perspectives of patients with non-insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study.

To explore experiences of self-monitoring of blood glucose among patients with non-insulin-treated type 2 diabetes. Self-monitoring of blood glucose is essential to diabetes care and facilitates glycaemic control. Patients' perspectives of self-monitoring of blood glucose have seldom been discussed in the literature, and engagement in self-monitoring of blood glucose is consistently low. The descriptive phenomenological method was used. Purposive sampling was conducted to recruit participants from the endocrinology departments of medical institutions in Taiwan based on the following criteria: (i) having a medical diagnosis of type 2 diabetes, (ii) not being treated with insulin, (iii) having engaged in self-monitoring of blood glucose at least once within the preceding 6months, (iv) being at least 20years old and (v) not having any major mental or cognitive disorders. Data were collected in outpatient consultation rooms, the participants' homes and other settings where the participants felt secure and comfortable. In-depth interviews were conducted to collect data from 16 patients with diabetes. The participants perceived that lifestyle affected blood glucose levels and did not know how to handle high or low blood glucose levels. Their willingness to continue self-monitoring of blood glucose depended on whether healthcare professionals checked or discussed their blood glucose levels with them. The patients' knowledge regarding blood glucose variation and healthcare professionals' attitudes affected the patients' self-monitoring of blood glucose behaviours. The empirical findings illustrated self-monitoring of blood glucose experiences and recommended that healthcare professionals' closely attend to patients' requirements and responses to diabetes and incorporate the self-monitoring of blood glucose into therapy plans. Healthcare professionals should reinforce patients' knowledge on appropriate responses to high and low blood glucose levels, intervene appropriately, discuss self-monitoring of blood glucose results with patients and track these results.

Analysis of drug abuse data reported by medical institutions in Taiwan from 2002 to 2011

Drug abuse has become a global issue of concern. It affects not only individual users, but also their families and communities. Data were retrieved from the database of the Taiwan Surveillance System of Drug Abuse and Addiction Treatment (SSDAAT) from 2002 to 2011, and 147,660 cases reported by medical institutions in Taiwan were reviewed. This study showed that the top five reported abused drugs by medical institutions during the last decade were heroin, methamphetamine, benzodiazepines, ketamine, and zolpidem. Heroin and methamphetamine continued to be the first two abused drugs reported by medical institutions. Heroin abuse was significant, but has shown a downward trend. However, emerging abused drugs, such as ketamine and zolpidem, presented upward trends. 3,4-Methylenedioxy-N-methylamphetamine (MDMA) abuse seems to have re-emerged and has increased gradually since 2010. Injection without needle sharing has become the most common route of administration of abused drugs since 2002. The majority of causes for these reported drug abuses were drug dependence, followed by peer influence and stress relief. Hepatitis C was the most commonly reported infectious disease, followed by hepatitis B and AIDS in the drug abusers reported by medical institutions. It should be noted that access to drugs via the Internet increased year by year, and this is clearly an area needing constant monitoring.

The Effects of Personal Background and Occupational Stress on the QOL of Vietnamese Care Attendants Working at Medical Institutions in Taiwan

Background: With the rapid increase in the elderly population, there is a growing demand for care attendants at medical institutions in Taiwan The rapid growth in the number of foreign care attendants is significant and the quality of care provided by these foreign care attendants is directly related to the quality of care received by elderly people. However, few studies have addressed the relationship between occupational stress and quality of life (QOL) for foreign care attendants in Taiwan. Purpose: This study explored the relations between personal background and occupational stress and QOL of Vietnamese care attendants in Taiwan. Methods: This cross-sectional study recruited Vietnamese care attendants currently working at regional hospitals in Kaohsiung City and County who had worked in Taiwan for at least three months. We distributed a structured questionnaire to potential participants and collected 264 valid completed questionnaires between January and April 2010.Results: Significant statistical differences were detected in the QOL of Vietnamese care attendants of various ages and educational levels, in the number of non-work days in a month, the number of daily work hours, and the number of patients cared for. A negative correlation was found between the various levels of occupational stress and the eight dimensions of wellness for Vietnamese care attendants, indicating that higher occupational stress led to lower QOL. In addition, we developed a regression model for overall QOL (SF-36), a physical component summary (PCS) and a mental component summary (MCS). By entering the variables “workload and work procedures,” “number of daily work hours,” and “relationships with management supervisors” into our regression model, we calculated the variance for “overall QOL (SF-36),” “QOL for PCS,” and “QOL for MCS” to be 44.9%, 38.3%, and 41.7%, respectively. Conclusions: Higher levels of occupational stress led to a lower QOL for Vietnamese care attendants. Of all the factors, “workload and work procedures,” “number of daily work hours,” and “relationships with management supervisors” wielded the greatest influence on QOL.

The Determinants of Voluntary Financial Disclosure by Nonprofit Organizations

Encouraging organizations to be more open has been a key issue in contemporary debates over nonprofit accountability. However, our understanding of what motivates organizations to the disclosure decision is weak. We aim to enhance our understanding of this critical issue by developing and testing a model of the determinants of voluntary disclosure decision making, using data gathered on the population of not-for-profit medical institutions in Taiwan during a period where the government encouraged—but did not require—disclosure on a centralized website. As a result, we are able to conduct a “natural experiment” of the voluntary disclosure behavior of an important population of non-donor-dependent organizations. We find voluntary disclosure is more likely in organizations that are smaller, have lower debt/asset ratios, and are run by larger boards with more inside members. Our data suggest that, from a policy perspective, voluntary disclosure regimes are not an especially effective means of promoting public accountability.

Research on the development of acupuncture-moxibustion in Taiwan in 1970s

The government has launched a program to promote the research on acupuncture and moxibustion since 1972. It was mainly through the join effort of the National Science Council and Department of health that funds were made available to major medical institutions in Taiwan for research in the theoretical and clinical application of acupuncture-moxibustion. Moreover, the emphasis has been laid on the application of modern medical knowledge and technology to traditional acupuncture-moxibustion in order to explore the mechanism of acupuncture analgesia and to determine the effectiveness of acupuncture-moxibustion in the treatment of diseases. The efforts of such studies have resulted in conferences and symposia at the national and/or international levels from 1970s to 1980s. Development and progress of acupuncture-moxibustion research in Taiwan since 1970s are reported and discussed in the article.