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Background: Radium-223 dichloride (Ra-223) prolongs overall survival (OS) in metastatic castration-resistant prostate cancer (mCRPC) with symptomatic bone metastases. However, there is considerable variation in outcomes among individuals. We aimed to evaluate the prognostic determinants associated with patient survival following National Health Insurance (NHI) reimbursement for Ra-223 therapy in Taiwan., Methods: Patients with mCRPC who underwent Ra-223 treatment at Taipei Veterans General Hospital were retrospectively enrolled. Each intravenous Ra-223 dose was administered at 55 kBq/kg at 4-week intervals. Clinical outcomes were obtained from medical records; potential prognostic factors for survival were assessed. Kaplan-Meier analysis was used to generate cumulative survival curves; between-group differences were evaluated using the Chi-squared test. Statistical significance was set at p < 0.05., Results: Seventy-six patients underwent Ra-223 therapy; 62 patients received NHI reimbursement and the remainder self-paid. Fifty patients (65.8%) completed six cycles of treatment; 26 (34.2%) received 1 to 5 cycles. Mortality occurred in 47 patients. Factors significantly associated with survival included ≤five bone metastases ( p = 0.0018), baseline prostate-specific antigen (PSA) ≤36 ng/mL ( p = 0.0004), baseline alkaline phosphate (ALP) <115 U/L ( p = 0.0007), and baseline hemoglobin (Hb) >12 g/dL ( p = 0.0029). Patients who completed six cycles of treatment achieved significantly higher OS compared to those who did not ( p < 0.0001). There has been a 4.4-fold increase in the number of patients since reimbursement began; there was no significant difference in OS between patients who received NHI reimbursement and those who self-paid., Conclusion: Administration of Ra-223 demonstrates considerable potential to extend the survival of patients with mCRPC. Survival outcomes may be influenced by various prognostic factors. However, no significant difference in OS was observed subsequent to reimbursement of Ra-223 therapy for mCRPC through the NHI system in Taiwan., Competing Interests: Conflicts of interest: Dr. William J. Huang, an editorial board member at Journal of the Chinese Medical Association , had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2024, the Chinese Medical Association.)

The LACE index and HOSPITAL score models are the two most commonly used prediction models identifying patients at high risk of readmission with limited information for home care patients. This study compares the effectiveness of these two models in predicting 30-day readmission following acute hospitalization of such patients in Taiwan. A cohort of 57 home care patients were enrolled and followed-up for one year. We compared calibration, discrimination (area under the receiver operating curve, AUC), and net reclassification improvement (NRI) to identify patients at risk of 30-day readmission for both models. Moreover, the cost-effectiveness of the models was evaluated using microsimulation analysis. A total of 22 readmissions occurred after 87 acute hospitalizations during the study period (readmission rate = 25.2%). While the LACE score had poor discrimination (AUC = 0.598, 95% confidence interval (CI) = 0.488-0.702), the HOSPITAL score achieved helpful discrimination (AUC = 0.691, 95% CI = 0.582-0.785). Moreover, the HOSPITAL score had improved the risk prediction in 38.3% of the patients, compared with the LACE index (NRI = 0.383, 95% CI = 0.068-0.697, p = 0.017). Both prediction models effectively reduced readmission rates compared to an attending physician's model (readmission rate reduction: LACE, 39.2%; HOSPITAL, 43.4%; physician, 10.1%; p < 0.001). The HOSPITAL score provides a better prediction of readmission and has potential as a risk management tool for home care patients., Competing Interests: The authors declare no conflicts of interest.

Background: People of Chinese ethnicity make up one of the largest populations in the world. Heart and vessel diseases remain the leading cause of morbidity and mortality in China. The research status in cardiology and cardiovasology among Chinese individuals in the three major regions of China--Mainland (ML), Hong Kong (HK) and Taiwan (TW)--are unknown. The outputs of cardiology and cardiovasology articles published in international journals from the three regions were compared in this study., Methods: Articles published in 83 journals related to cardiology and cardiovasology originating from the ML, TW and HK from 1998-2007 were retrieved from the PubMed database. The number of total articles, clinical trial, randomized controlled trial, case reports, impact factors (IF), citations, and articles published in top general medicine journals were conducted for quantity and quality comparisons., Results: The total number of articles from the three regions increased significantly from 1998 to 2007 (from 154 to 591). There were 2801 articles from ML (883), TW (1404) and HK (514) in the past ten years. The number of articles published per year from the ML (297) have exceeded those from TW (235) and HK (59) in 2007. The accumulated impact factor of the articles from TW (4082.736) was much higher than ML (2221.699) and HK (1673.049). HK had the highest average IF of cardiology and cardiovasology articles and the most articles published in top general medicine journals among the three regions., Conclusion: The total number of articles from the three major regions of China increased significantly from 1998 to 2007. The number of articles published per year from the ML have exceeded those from TW and HK. However, the quality of articles from TW and HK is better than that from ML., (Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.)