Elderly and long-term care trends and policy in Taiwan: Challenges and opportunities for health care professionals

The purpose of this article is to address the trends and policy of elderly and long-term care in Taiwan. In response to the increasing demand of an aging society, healthcare professionals play crucial roles in elderly and long-term care and quality assurance of services. This article focuses on the current situation of elderly health care, demands of long-term care, long-term care policy in Taiwan, draft of the Long-term Care Services Act, and draft of the Long-term Care Insurance Act. After the 10-year long-term care project was proposed by the Taiwan government, the supply of health care services and demand for long-term care have created many challenges and opportunities for innovative health professional development. Challenges consist of low old dependency ratio caused by low birth rate, lack of elderly and long-term care related manpower, services and education reform related to long-term care for the future society, and interprofessional collaboration and team work of long-term care. Opportunities include expanding the roles and the career pathways of healthcare professionals, promoting the concepts of active aging and good quality of life, and developing industrial cooperation related to long-term care services. Under these circumstances, healthcare professonals are actively involved in practice, education and research of long-term care services that ensure elderly and disabled people can live a healthier and better life.     

载溶菌酶聚乳酸-聚羟基乙酸共聚物微球的形成机制

目的：分析载溶菌酶聚乳酸-聚羟基乙酸共聚物微球的形成机制. 方法：实验于2005-03/07在暨南大学生物材料研究室完成.采用双乳液法（W/O/W法）制备聚乳酸-聚羟基乙酸共聚物微球.通过改变微球的制备条件[初乳时间（15,30,45,60,120 s）、初乳速度（6 000,10 000,14 000,18 000,22 000 r/min）、聚乙烯醇质量浓度（0,5,25,50,100 g/L）、复乳时间（0.5,2.5,5,8,11.5 h）、复乳速度（200,400,600,800,1 000 r/min）、初始药物质量浓度（0,20,40,60,80,100 g/L）、内/外水相添加剂（吐温-80、葡聚糖、蔗糖、氯化钠）、油相潜溶剂（丙酮、甲醇、乙醇、二甲基亚砜）],制备不同表面结构和内部结构的聚乳酸-聚羟基乙酸共聚物微球,扫描电镜下观察微球内/外部结构. 结果：制备出不同表面结构和内部结构的聚乳酸-聚羟基乙酸共聚物微球.微球表面主要呈3种状态：光滑致密、光滑多孔或粗糙多孔.微球的内部呈多孔洞或核壳结构.①初乳速度较低时（＜10 000 r/min）,微球表面以光滑为主,内部多孔,中间有一大的核心;初乳速度较高时（＞ 18 000 r/min）,微球表面较为粗糙,内部孔洞致密,呈蜂巢状.②不同初乳时间制备的微球仍以表面平滑为主,有的微球表面有孔洞,大小在几个微米左右,微球内部仍然是蜂巢状结构.③聚乙烯醇质量浓度影响复乳的稳定性,从而对微球的形成过程影响很大.④复乳时间对微球形成过程的影响较为明显,反应时间过短（＜0.5 h）,微球未充分固化,增加反应时间,球形度相对提高.⑤复乳速度直接影响到复乳体系的稳定.速度较低时（200 r/min）,形成的微粒体积较大,易形成不规整的大块聚集体.随着搅拌速度的增加,微粒球形度也相应提高.但是当速度过大时（1 000 r/min）,微粒容易破裂形成碎散的不规则聚集体.⑥初始药物质量浓度对微球形成过程的影响很大,药物质量浓度高时（100 g/L）,微球表面粗糙,碎片较多;药物质量浓度为60 g/L时,微球表面光滑,球形度很好.⑦不同的内水相添加剂（吐温-80、葡聚糖、蔗糖、氯化钠）制备的微球球形度均较好,微球表面平滑,但是存在部分微球相互粘连的情况.外水相添加蔗糖和氯化钠,微球的球形度较好,微球之间无粘连.但外水相添加吐温-80,形成的产物体积较大且形成许多不规则的聚集体.外水相添加葡聚糖形成的微球表面粗糙且含较多碎屑.⑧选用不同的油相潜溶剂（丙酮、甲醇、乙醇、二甲基亚砜）均存在部分的微球融合现象. 结论：从多角度系统阐述了载溶菌酶聚乳酸-聚羟基乙酸共聚物微球的形成机制.不同的制备条件对微球的结构影响各异,微球的尺寸分布及形态性能是初乳与复乳过程中各种影响因素综合作用的结果.     

Prescribed Opioids Adherence Among Taiwanese Oncology Outpatients

The purpose of this study was to evaluate adherence to prescribed opioids in Taiwanese oncology outpatients and to examine the associations between various demographic and medical characteristics and prescribed opioids adherence. Ninety-two outpatients who had taken prescribed opioid analgesics for cancer-related pain at least once in the past week participated in this study. Patients were asked to recall the dose of each opioid analgesic that they had taken in the past 24 hours. Mean adherence rates were calculated for analgesic adherence. For mean adherence rates, all opioid analgesics were converted to morphine equivalents. The results of this study reveal a priority issue of poor opioid analgesic adherence. The adherence rate of 63.6% for the around-the-clock opioid analgesics in this study is well below acceptable levels. Also, an adherence rate of 30.9% for the as-needed opioid analgesics is very low. This study identified that women tend to be less adherent to their prescribed opioid analgesic regimen than men. Findings of this study suggest that to improve pain control, efforts to promote patients’ opioid regimen adherence should be given high priority. Clinicians should be particularly aware that there may be some gender difference in adherence to prescribed opioid analgesics. There is a need for better programmatic efforts to improve analgesic adherence.