Taiwan's System Research Articles

Functioning performance trajectory and its associated factors for people with disability—A 4-year national study

BackgroundHumans experience functioning difficulties in daily life, which are dependent on the interaction between health conditions and barriers in life. In general, functioning is an umbrella term and a dynamic concept. Thus, identifying the factors associated with long-term functioning would be beneficial to the development of specific health policies and quality of life for people with disabilities. However, previous studies are mainly cross-sectional ones, and fewer studies focus on the long-term effect of changes in functioning for people with disabilities. The current study aims to examine functioning performance trajectory and the associated factors for people with disabilities.MethodsA longitudinal study was conducted over four years, for which data were retrieved from the National Disability Eligibility Determination System in Taiwan. The assessment methods used are as follows: activity and participation rated using the WHO Disability Assessment Schedule 2.0 (with high scores indicating increased limitations in daily life), personal factors, body function and structure, and environmental factors. Statistical analysis was conducted using latent growth curve models.ResultsWe recruited 3,720 people with disabilities. We found that females, people with moderate and severe disability level, and those who were employed were associated with rapid increases in functioning scores every year. Conversely, improved social participation was linked to relatively slow increases in functioning scores regardless of the type of disability (p <.05).ConclusionsDetermining the factors associated with long-term functioning can serve as a reference for the development of health policies and improvement of quality of life for people with disabilities.

Preventable hospitalizations through ED: does the number of hospital beds matter under the global budget in a single-payer system in Taiwan?

Taiwan implemented global hospital budgeting with a floating-point value, which created a prisoner's dilemma. As a result, hospitals increased service volume, which caused the floating-point value to drop to less than one New Taiwan Dollar (NTD). The recent increase in the number of hospital beds and the call to enhance the floating-point value to one NTD raise concerns about the potential for increased financial burden without adding value to patient care if hospitals expand their bed capacity for volume-based competition. The present study aimed to examine the relationship between the supply of hospital beds and hospitalizations following an emergency department (ED) visit (called ED hospitalizations) by using diabetes-related ambulatory care sensitive conditions (ACSCs) that are preventable and discretionary as an example. The study was a pooled cross-sectional design analyzing 2011-2015 population-based claims data in Taiwan. The dependent variable was a dummy variable representing an ED hospitalization, with a treat-and-leave ED visit as the reference group. The key independent variable is the number of hospital beds per 1,000 populations. Multivariate logistic regression models with and without a clustering function were used for the analyses. Approximately 59.26% of diabetes-related ACSCs ED visits resulted in ED hospitalizations. The relationship between the supply of hospital beds and ED hospitalizations was statistically significant (OR = 1.12; 95% CI: 1.09-1.14; P < 0.001) in the model without clustering but was statistically insignificant in the model with clustering (OR = 1.03; 95% CI: 0.94-1.12; P > 0.05). Several social risk factors were positively associated with the likelihood of ED hospitalizations, such as low income and the percentage of the population without a high school diploma. In contrast, other factors, such as female patients and the Charlson comorbidity index, were negatively associated with the likelihood of ED hospitalizations. Under hospital global budgeting with a floating-point value mechanism, increases in hospital beds likely motivate hospitals to admit ED patients with preventable and discretionary conditions. Our study emphasizes the urgent need to add value-based incentive mechanisms to the current global budget payment. The value-based incentive mechanisms may encourage providers to focus on quality of patient care by addressing social risk factors rather than engage in volume-based competition, which would improve population health while reducing preventable ED visits and hospitalizations.

2025 Expert Consensus Recommendations for the Diagnostic Requirements in Routine Practices of Transthoracic Echocardiography.

Transthoracic echocardiography plays a crucial role in clinical diagnosis and is increasingly being used around the world. Comprehensive echocardiographic examinations require accurate measurements and the operators to have excellent technical skills. Despite the availability of several published echocardiographic guidelines, the absence of recommended operational manuals in daily practice has resulted in significant variation in the content of echocardiography reports across different medical institutions. This variability has created communication barriers between medical institutions and also hampered the development of a national echocardiography database in Taiwan. Balancing quality and efficiency is a critical concern in echocardiography, and most published guidelines for echocardiography primarily focus on disease categorization. In the current document, we focus on information about the scanning sequence, including scanning techniques, common pitfalls, simple disease interpretation, and the recommended intensity. Based on a growing body of research, we particularly emphasize right-sided imaging and measurement information. We also discuss equipment settings, which have often been overlooked but are essential to obtaining good imaging and accurate measurements. Our recommendations could enhance clinicians' and sonographers' understanding of the core aspects of echocardiography and were developed with consideration of the health-care payment system in Taiwan. Implementing our recommendations may subsequently enable the establishment of a national echocardiography database in Taiwan.

Evaluation, Calibration, and Application of Probabilistic 100-m Wind Speed Forecasts Produced by the WRF Ensemble Prediction System in Taiwan

Abstract The use of renewable energy is on the rise; however, it brings more challenges for grid operations and unit scheduling due to the intermittent nature and limitations in predicting renewable power generation. High-quality meteorological forecasts play a critical role in the effective application and management of renewable energy resources. This study evaluates the quality and economic benefits of probabilistic forecasts for 100-m wind speeds from the Weather Research and Forecasting Model ensemble prediction system (WEPS). A multiple linear regression (MLR) method for calibration is also used to improve forecast quality. Additionally, this study explores the application of probabilistic hub-height wind speed forecasts in conjunction with an economic value analysis to determine whether wind turbines should be shut down during typhoon periods. The findings reveal that the forecast in the central offshore region of Taiwan exhibits the highest reliability and discrimination ability compared to those in the northern and southern regions. Additionally, employing the MLR calibration method significantly improved the reliability and discrimination ability of the probabilistic forecasts compared to the raw forecasts. Furthermore, during the typhoon seasons, almost all users, regardless of their cost–loss ratio, can benefit from basing their decisions on WEPS forecasts compared to using a single deterministic forecast. Importantly, decision-makers can benefit more from probabilistic forecasts than the ensemble mean forecasts when both are derived from the same ensemble prediction system, since the former incorporates forecast uncertainty. Significance Statement High-quality meteorological forecasts significantly influence the efficient utilization and management of renewable energy resources. Therefore, this study uses a simple yet effective approach to correct systematic bias in probabilistic wind speed forecasts over Taiwan, aiming to provide decision-makers with more reliable forecasts for hub-height wind speeds. Given that strong winds during typhoon periods pose safety concerns for wind turbine operation, we use an economic value analysis to assist turbine operators in deciding whether to shut down wind turbines. Furthermore, our research demonstrates that ensemble probabilistic forecasts can yield greater economic benefits for decision-makers when compared to the commonly used ensemble mean forecasts.

The Sociopolitical Foundations of Health Sector Solidarity: A Cross-Sectional Study of Public Attitudes Toward the Health System in Taiwan.

Publicly-funded health systems have traditionally been presumed to be underpinned by solidarity among theusers. To which extent such solidarity presents and associates with what factors is understudied in the non-western countries. This article explores the distribution of health sector solidarity and its relationships with sociopolitical factors in Taiwan. Data was collected in 2021 through a national representative, cross-sectional survey with a sample size of 1272included in the final analysis. The survey showsthat solidarity regarding the National Health Insurance in Taiwan was prevalent in 2021, with 76.6% of Taiwanese willing to carry the cost to enhance the quality of care through the system, while ten years ago, in 2011, that figure was only 49.1%. Nationalist sentiments, belief in differentiated social responsibility, and political partisanship are found to be the main factors associated with this supportive attitude, while familial values are not. The supportive attitude toward the health system remains strong and has increased during the past ten years, implying that the clinical and social effectiveness of the system itself may help further forgehealth sector solidarityin Taiwan.

Value Framework Based on Multiple-Criteria Decision Analysis for Assessment of New Health Technologies Under Universal Healthcare Coverage System in Taiwan.

Given the lack of a value framework for assessing health technologies in Asian settings, a value framework incorporating multiple-criteria decision analysis for new drugs under universal healthcare coverage in Taiwan was established. The development process included (1) the adoption of 5 value domains (ie, Overall clinical benefit, Disease burden, Alignment with patient concerns, Economic value, and Feasibility of adoption into the health system) and 26 corresponding indicators, derived from the literature and expert discussions; (2) the creation of separate weighting schemes for 3 drug types-new oncology, new orphan, and other new drugs-based on inputs from multiple stakeholders (n= 86) using various weighting methods; and (3) the application of the value framework to cases of new oncology drugs. Overall clinical benefit had the highest preference weight, irrespective of drug type, (ie, mean values [95% CIs] for new oncology, new orphan, and other new drugs: 32.5 [30.4-34.6], 30.6 [28.1-33.1], and 30.6 [28.7-32.6], respectively), weighting method, and stakeholder type. The 5 domain-derived weights (from the point allocation method) were comparable to the 26 indicator-derived weights (from the direct rating method), suggesting that the value framework with a short-form (domain-derived) weighting scheme is sufficient to support decision making under time and resource constraints. A country-specific value framework incorporating multiple-criteria decision analysis for new drugs was developed in an Asian setting under universal healthcare coverage. It allows multiple stakeholders to systematically appraise all drug value attributes and provides a structured process for adapting and refining value assessments.

HTA152 A Value Framework Based on Multiple Criteria Decision Analysis for New Health Technologies Assessment Under Universal Healthcare Coverage System in Taiwan

HTA152 A Value Framework Based on Multiple Criteria Decision Analysis for New Health Technologies Assessment Under Universal Healthcare Coverage System in Taiwan

Development of an Education and Training Program for New Intensive Care Unit Staff: Ladders to Success

The nursing manpower shortage intensified during the COVID-19 pandemic. Moreover, inadequate clinical internship durations during this period led to recent nursing graduates reflecting insufficient clinical skills. These issues, coupled with the inherent complexity of work in intensive care units (ICUs), have increased stress and decreased self-confidence among new staff, leading to higher turnover rates. This study was designed to develop and then evaluate the effectiveness of a tailored ladderized training program for improving clinical care skills and self-confidence in new ICU staff. An individualized ladderized training program for new staff was developed based on the conceptual PDDRO (plan, design, do, review, outcome) framework. In addition to the program, a 3-stage critical care training regimen was implemented to strengthen technical, physical assessment and judgment, and communication and teamwork skills. A multivariate evaluation approach was employed to evaluate the level to which participants improved in terms of clinical skills and self-confidence, and a competency-related personalized training model was used to guide their progress until all of the training goals were achieved. Fifty new staff members completed the 3-stage critical care training program. In terms of program effectiveness, mean scores increased from 79.3 (pretest) to 92.3 (posttest) for awareness and 1.69 to 2.53 for work competency self-confidence. These increases were significant, and indicated the participants had collectively improved from "some self-confidence" to "a lot of self-confidence". Moreover, the retention rate of new staff increased from 75% before the intervention to 84% afterward. Interviews with the participants found the program had improved their mastery of clinical care skills and confidence in their future ability to perform care tasks. Advance implementation of ladderized training can facilitate the establishment of a new nursing staff training system in hospitals to improve the post-pandemic recovery and reconstruction of nursing manpower systems in Taiwan. This program may serve as a successful model for training new staff and retaining human resources as part of the ongoing effort to promote a stable and high-quality workplace environment for nurses.

Abstract Su607: Which would be major? witnessed collapse or bystander resuscitation?

Background: Witnessed collapse and bystander cardiopulmonary resuscitation (CPR) are two variables commonly used to predict outcomes in out-of-hospital cardiac arrest (OHCA). Some published studies have shown that bystander CPR were not significantly associated with outcomes after confounders adjusted. This may imply that witnessed collapse would be a superior prognostic factors beyond bystander CPR. Hypothesis: Witnessed collapse and bystander CPR may not contribute equally to prehospital return of spontaneous circulation (ROSC), and the former may be major. Aims: To investigate four prediction models for prehospital ROSC using stratification of the witnessed collapse and bystander CPR. Methods: The study enrolled OHCA patients treated by the emergency medical service (EMS) from January 2010 to December 2022 in three EMS systems in Taiwan. Data were extracted from the records of each medical service encounter, including patient demographics, dispatch timing, prehospital management, witnessed collapse and bystander CPR. The primary outcome was any prehospital ROSC. Patients were stratified into four groups by witnessed collapse (with/without) and bystander CPR (with/without) status, namely W+B+, W-B+, W+B- and W-B-. Prehospital ROSC prognostication were identified using multivariable logistic regression analysis. Results: The analysis comprised 17,323 patients, among whom 1,165 (6.7%) achieved prehospital ROSC. The W+B+ group demonstrated the highest prehospital ROSC rate at 13.0%, as compared with the other groups significantly (9.0%, 3.4%, and 4.1%, as depicted in Image 1). Stratification of the prehospital ROSC model (Image 2) indicated that the W+B+ group had several common predictors including age, traumatic arrest, no-flow time, public access defibrillation (PAD), and resuscitation events. However, certain predictors in other groups were removed during regression process. Notably, no-flow time significantly influenced prehospital ROSC only in the W+B+ and W+B- groups. Conversely, in the W-B- group, most variables had minimal impact on prehospital ROSC, reflecting the limited effectiveness of traditional predictors within this subgroup. Conclusion: The significance of witnessed collapse as a prognostic factor may be equal to or even greater than that of bystander CPR. Further studies are needed to confirm.

Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Liver Cirrhosis.

Comparing direct oral anticoagulants (DOACs) and warfarin's efficacy and safety in patients with nonvalvular atrial fibrillation (AF) and liver cirrhosis (LC). Evidence of the pharmacodynamics of DOACs is limited in patients with AF and LC. A retrospective cohort study was conducted in the largest hospital system in Taiwan, involving patients with AF and LC for the years 2012 to 2021. Hazards of thromboembolic events (ischemic stroke, transient ischemic attack, and systemic embolism), intracranial hemorrhage, gastrointestinal, major bleeding, and all-cause mortality were investigated with a new-user, active comparator design. Inverse probability of treatment weighting was applied to balance potential confounders between treatment groups. In total, 478 DOAC users and 247 warfarin users were included. DOACs and warfarin demonstrated similar trends in preventing thromboembolic events, namely ischemic stroke [adjusted hazard ratio (aHR), 1.05 (95% CI: 0.42-2.61)], transient ischemic attack [aHR, 1.36 (95% CI: 0.18-10.31)], and systemic embolism [aHR, 0.49 (95% CI: 0.14-1.70)]. DOAC use was associated with a similar risk of intracranial hemorrhage [aHR, 0.65 (95% CI: 0.26-1.59)] and gastrointestinal bleeding [aHR, 0.64 (95% CI: 0.39-1.03)], a decreased risk of major bleeding [aHR, 0.64 (95% CI: 0.42-0.99)], and a reduction in mortality [aHR, 0.73 (95% CI: 0.54-0.99)]. DOAC users exhibited a significant reduction in major bleeding risk in patients with Child-Pugh class A (aHR, 0.48; 95% CI: 0.33-0.70). DOACs showed potential safety advantages over warfarin for patients with nonvalvular AF and LC, particularly in reducing major bleeding risk in those with Child-Pugh class A.

Use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation across five stages of chronic kidney diseases

Abstract Background Although non-vitamin K antagonist oral anticoagulants (NOACs) were more and more commonly prescribed in the daily practice, data about the use of NOACs in atrial fibrillation (AF) patients with stage 4 and 5 chronic kidney diseases (CKD) are limited. In the present study, we compared the clinical outcomes of AF patients receiving NOACs and those receiving warfarin or non-OACs in different stages of CKD. Methods A total of 39217 AF patients aged &amp;gt;20 years whose data about creatinine clearance (CCr) were available were identified from the electronic health record database of a multi-center healthcare system in Taiwan. Patients were categorized into stage 1 to stage 5 CKDs, and the composite risks of ischemic stroke/systemic embolism, major bleeding and mortality were compared between non-OACs, warfarin and NOACs. Results Around 12.7% and 9.4% of study patients had a stage 4 and stage 5 CKD, respectively. Compared to non-OACs, the use of OACs (either warfarin or NOACs) were consistently associated with a lower risk of composite events from stage 1 to stage 4 CKD, but not for stage 5 CKD (warfarin: aHR 0.912, 95%CI 0.742-1.121; NOACs: aHR 0.993, 95%CI 0.653-1.537)(Figure 1). Compared to warfarin, NOACs were associated with a lower risk of adverse events for patients with stage 2 (aHR 0.630), stage 3 (aHR 0.712) and stage 4 CKD (aHR 0.749). However, the risk did not differ between warfarin and NOACs for stage 1 and stage 5 CKD (Figure 2). Conclusions Although data of the clinical trials for AF patients with stage 4 CKD were relatively lacking, NOACs should still be considered for this AF population. More data are necessary to guide optimal stroke prevention strategy for patients with stage 5 CKD.

Multi-Agent Deep Reinforcement Learning-Based Distributed Voltage Control of Flexible Distribution Networks with Soft Open Points

The increasing number of distributed generators (DGs) leads to the frequent occurrence of voltage violations in distribution networks. The soft open point (SOP) can adjust the transmission power between feeders, leading to the evolution of traditional distribution networks into flexible distribution networks (FDN). The problem of voltage violations can be effectively tackled with the flexible control of SOPs. However, the centralized control method for SOP may make it difficult to achieve real-time control due to the limitations of communication. In this paper, a distributed voltage control method is proposed for FDN with SOPs based on the multi-agent deep reinforcement learning (MADRL) method. Firstly, a distributed voltage control framework is proposed, in which the updating algorithm of the intelligent agent of MADRL is expounded considering experience sharing. Then, a Markov decision process for multi-area SOP coordinated voltage control is proposed, where the control areas are divided based on electrical distance. Finally, an IEEE 33-node test system and a practical system in Taiwan are used to verify the effectiveness of the proposed method. It shows that the proposed multi-area SOP coordinated control method can achieve real-time control while ensuring a better control effect.

An Examination on the Planning and Practice of Bilingual Education in Primary and Secondary Schools in Taiwan

Over the past few years, several reforms in language education have been outlined to implement the full-scale bilingualization of the education system in Taiwan. Among the 3392 public primary and secondary schools, nearly one-third of them have been implementing bilingual education in certain subjects. The vast majority of these schools have adopted Immersion, CLIL, or EMI as models for bilingual education. It has been argued that these exotic models cannot be “transplanted” to the education context of Taiwan, and he proposes the FERTILE model. Adopting this model as the theoretical framework, this qualitative study aims to examine how school practitioners plan and practice bilingual education in Taiwan. Data were collected through the document analysis of the progress reports from thirty-five primary and secondary schools and three focus group discussions (FGDs) with nine subject teachers. The findings show that the participants made considerable efforts to construct a bilingual environment and have an identical understanding about the strategies for bilingual instruction that emphasize subject knowledge and students’ comprehension. However, the participants experienced a diverse ecology of bilingual teacher learning communities and received differential support from the principals. Qualified and stable teaching manpower was identified as the key to sustain bilingual education. Implications to different education stakeholders are also discussed.

No One Is Willing to Work for Free: On the Dilemma of Taiwan's System for Applying for the Appointment of Inspectors

No One Is Willing to Work for Free: On the Dilemma of Taiwan's System for Applying for the Appointment of Inspectors

Assessing the environmental impact and advantages of a commercial aquaponic system in Taiwan through life cycle assessment

Taiwan highly depends on food imports and has only limited arable land available as an island. Food production is projected to decrease due to climate change, while food demand is expected to increase on account of ongoing population growth. Current agriculture practices negatively affect the environment and human health, mainly by utilizing fossil fuels, chemical fertilizers, and pesticides. Hence, the development and optimization of innovative agriculture are necessary to address the adverse effects of conventional food production systems, such as nutrient pollution, to improve sustainability.Aquaponics, the combination of hydroponics and aquaculture, potentially serves as a sustainable food production method. It has become increasingly popular in recent years, as aquaponics can have a lower environmental impact than other agriculture types. Therefore, exploring the environmental impact of local aquaponic systems can contribute to food security in Taiwan.In this regard, the current study used the life cycle assessment (LCA) tool to evaluate the environmental impact of the production of fish and lettuce in an aquaponic farm in Yilan, Taiwan. From a cradle-to-farmgate perspective, two functional units, 1 kg fish and 1 kg lettuce, were investigated.The results were compared with literature studies on traditional agriculture, hydroponics, aeroponics, and aquaculture. The LCA found that aquaponics had a higher impact in almost all categories regarding lettuce production and performed comparably to other aquaculture systems, except for showcasing higher GWP and CED. However, the analysis of environmental sustainability scenarios suggested that the environmental impact could be significantly reduced for both functional units, respectively. As shown in this study, potential reductions could be achieved by replacing fertilizer with aquaponic sludge (−23 % FWE), introducing Black Soldier Fly larvae as fish feed (−11 % MWE, −14 % LU, and − 5 % WC), and integrating a solar power system (−70 % GWP, −35 % TA & FWE, and − 16 % MWE) on the greenhouse rooftop. By implementing these sustainability measures, fish production in aquaponics would outperform most aquaculture systems considered. Therefore, aquaponics represents a promising sustainable alternative to other aquaculture systems, thus potentially contributing to Taiwan's food security.

A glance at the COVID-19 epidemic control system in Taiwan: implications for organizational crisis management and leadership in black swan events

Abstract The COVID-19 pandemic caused substantial impacts and uncertainty in the world. For human resource leaders compelled into new roles in light of the pandemic, this paper used an exemplary case – Taiwan – to (1) discuss lessons and takeaways from the Taiwanese government’s and organizations’ response to the pandemic and (2) identify the structure of a pandemic control model and effective leadership behaviours at the national level that may be adopted in business settings to decrease the disruptive effects of a crisis. While efficient subsystems in organizational governance, policy, leadership, and culture are essential to combat a crisis, the evidence from Taiwan’s case in these contexts highlights the importance of various infrastructures and communication pathways in crisis management. The study aims to advance the understanding of effective responses and leadership skills in times of crisis and contribute to human resource literature and policy development in business settings. Human resource professionals and leaders play an important role as change agents to reduce the disruptive effects of a black swan event and can benefit from this study to be prepared for future crises. Implications for international human resource interventions in crisis management and leadership and recommendations for future research are provided.

Integration of LoRa-enabled IoT infrastructure for advanced campus safety systems in Taiwan

Amid rising concerns about campus safety in Taiwan, particularly with the global trend towards smart cities, integrating the Internet of Things (IoT) into institutional security frameworks has become pivotal. The paper discusses the implementation of using iBeacons and Long Range (LoRa) technology to locating the student position and ensure his safety in the school campus. It uses Internet of Things (IoT) approach in real time to monitor and locate the student presence in the school compound. This paper unveils an innovative design for a campus security system that harnesses the LoRa technology. In the system, the students are equipped with devices containing Bluetooth Low Energy (BLE) beacons to capture and transmit real-time location data. The system response time to locating student in abnormal locations such as cornered and concealed areas is about one second. By extending this system to cover all individuals on campus, a closely monitored environment and areas is enabled that significantly bolstering the security measures. This not only furnishes a dynamic protective layer for educational institutions but also serves as a proactive deterrent against potential security breaches. Ultimately, this research underscores the transformative potential of merging IoT with campus security to ushering in a new era of student safety. LoRa technology offers advantages in battery life, cost-effectiveness, deployment flexibility, and network coverage etc. Therefore, this paper ultimately provides a method of how to utilize the LoRa technology to develop a campus security system. Unlike artificial intelligence (AI)-based image recognition, which raises concerns about privacy and human rights; the features of LoRa’s long-range communication and low power consumption make it a more suitable choice.

Influence of citizen relationship management system on citizen participation in Taiwan: A participatory politics perspective

Although studies have investigated the development of citizen relationship management (CRM) systems in various cities, no understanding exists regarding how CRM systems operate and how they influence citizen participation. Moreover, limited studies have been conducted regarding the political factors that influence citizen participation through CRM systems. Drawing from data obtained through interviews with key stakeholders involved in the implementation of a CRM system in Taiwan, the present study comprehensively analyzed the primary political characteristics and effects of this system, outlined the political factors influencing system use, and formulated suggestions for mitigating the influence of politics on the system. The findings reveal that the development of the citizen relationship management system was constrained by potential political factors in public policy development. These factors included the dynamics of power relations between citizens and local governments, the politicization of policy processes, conflicts in policy decision-making models involving top-down and bottom-up approaches, the political intentions and motives of stakeholders, and the influence of potential policy actors. Considering the case of the Taiwanese citizen relationship management system, this study provides suggestions and guidance for policymakers aiming to minimize political influence on citizen participation, with a focus on tailoring these approaches to meet the specific public service needs of citizens.

Empowering Family Nurse Practitioners for Sustainable Community Health

&lt;p&gt;醫療自主權於現今醫療環境中日趨重要，以病人為中心照護的重要環節，就是鼓勵病患積極參與醫療決策，以提升照護品質與滿度度。台灣衛生福利部自2016年開始推行醫病共享決策（shared decision making, SDM），期望促使病人積極參與醫療決策，以提升醫病關係、醫療品質及病人安全。推動至今，共享決策已廣泛運用於臨床實務中。但是，偏鄉及高齡長者，其就醫習慣、喜好、價值觀和醫療新知取得與都市居民有極大的差異。傳統以「醫生」作決策的觀念深植，參與SDM之意願以及推廣策略，值得探討。因此，本文將從專科護理師之角色去探討共享決策於偏鄉醫院推動影響因素，推行過程所遇到困境與經驗，綜整考量偏鄉居民特質及觀念，因應出不同之SDM推行之道。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Various challenges, such as a nursing workforce shortage, an aging society, and health inequality,seriously affect the sustainable development of Taiwan. Although the specialized nursing system represents a significant milestone in nursing development in Taiwan, it is mainly focused on hospital training, neglecting community health needs. Community health care can be effectively enhanced by promoting the family nurse practitioner system, especially in rural areas. Family nurse practi-tioners provide medical care services, boost local economies, increase employment opportunities, and strengthen community cohesion. The cultivation and investment in family nurse practitioners are crucial for improving the efficiency and quality of medical services. With the adjustment of the med-ical training system in Taiwan, nurse practitioners could redefine their roles and responsibilities in a new environment, and eventually contribute to the sustainability of Taiwan&amp;rsquo;s primary health care and improve community health. Through the empowerment of family nurse practitioners, Taiwan will be better equipped to address challenges and achieve sustainable development goals&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Decentralized Multi-Area Economic Dispatch in Power Systems Using the Consensus Algorithm

A multi-area power system requires coordination to enhance reliability and reduce operating costs. Economic dispatch in such systems is crucial because of the uncertainties associated with variable loads and the increasing penetration of renewable energy sources. This paper presents a hierarchical consensus algorithm designed to determine the economic dispatch in a multi-area power system, accounting for the uncertainties in load and renewable generation. The proposed algorithm, which utilizes distributed agents, operates across three levels. Level 1 coordinates all areas, while levels 2 and 3 form a leader–follower consensus algorithm for overall economic dispatch. Breadth-first search is employed to identify the leader agent within each area. To address the uncertainties in loads and renewable generation, Monte Carlo simulations are performed. The efficacy of the proposed method is validated using the IEEE 39-bus and 118-bus systems, as well as a realistic 1968-bus power system in Taiwan. The traditional equal lambda method is employed to verify that the proposed approach is suitable for multi-area power systems using distributed computation.