An overview of the Publicly Funded Medical Education System in Taiwan

Jen-Hung Yang,Chung-Liang Shih 대한의사협회 의료정책연구소 2020 의료정책포럼 Vol.18 No.3

저자 楊仁宏教授(Jen-Hung Yang, MD, Ph D)는 대만 양명의대 공비생으로 입학하여 피부과 전문의가 되고 이후 대학교수와 타이완 ‘추치(慈濟 Tzu Chi) 의대학장’을 역임하고, 현재 彰化基督教醫院의 교육주임과 카오슝의과대학 교수로 재직하고 있다. 우리나라에서 논의되고 있는 공공의대를 몸소 경험하고 졸업생으로서 공공의대에 대한 의견을 기술하고 있다. 타이완은 1975년 정부 주도로 취약지역과 제대 군인을 위한 ‘원호 의료’ 등을 목적으로 하는 현재 우리나라의 공공의료대학의 설립취지와 동일한 ‘국립양명의대(國立陽明大學)’를 설립하였다. 양명의대는 입학생 모두를 ‘공비(公費) 장학생’으로 선발하였고 등록금과 생활비까지 지원했다. 그럼에도 1988년에 자비로 부담하는 일반 학생의 입학도 허용하기 시작하였고 이후 단독 의과대학에서 여러 보건의료계열을 거느린 국립양명대학교로 지난 1994년에 개편되었다. 저자는 현재까지 3가지 유형의 공비장학생과정에 대한 자세한 설명을 도표와 함께 하고 있다. 그럼에도 공통적인 것은 6년간의 의무기간 중 4년은 전공의교육 그리고 2년이 실제 취약지역, 공중보건, 국제보건 등의 직무를 위한 의무 복무 기간 이었다. 과거 별도로 1년간의 군복무 의무도 부여되었으나 지금은 군복무 기간이 4개월로 줄어들었다고 한다. 2년간의 의무 복무기간 면허는 개인 소유가 아니어서 양명대 학생들은 이에 헌법소원을 제기하였으나 2년간의 의무 복무기간 중 정부 차원의 면허의 관리는 ‘합헌’으로 판정받기도 하였다. 과거 장학금에 대한 1:1 배상을 하면 의무복무도 면제되었으나 최근 2016부터 자신이 공비(公費)로 받은 금액의 4배를 배상하여야 해제된다고 한다. 이것은 2016년부터 속칭 비인기과 전공을 지원하는 정책으로 입학전형이 바뀌었기 때문이다. 공비 장학생은 점차 줄기 시작하여 2009년에 와서는 소수 몇 명의 도서지방 출신 학생을 제외하고 학생 전원 자비 교육생으로 바뀌었다고 한다. 34년간의 공비학생제도가 자비학생으로 전환되었던 이유는 2년의 의무 복무로 더 이상 졸업생들을 보낼 지역이 없었다는 점이다. 지난 1982년~2017년 사이 양명대 졸업생 4,111명을 대상으로 한 취업 현황 파악을 살펴보면, 약 31.7%는 의료원에서, 38.5%는 지역병원, 29.8%는 1차(기층) 진료에 종사하고 있는 것으로 분석됐다. 총 6,557명의 졸업생 중 84%는 도시에 남았고, 전체 16%만이 취약지에 남았다. 양 교수는 도시와 시골간의 불균형은 공공의대로 해결할 수 없는 문제라고 지적하고 있다. 보다 더 정교한 공공성이 강화된 의학교육제도의 구축과 혁신이 필요함을 주장하고 있다. We briefly review the origin, planning, development, and outcome of the publicly funded medical education program (PFMP) in Taiwan. The general PFMP was launched in National Yang-Ming University School of Medicine in 1975. Approximately 6,600 PFMP graduates filled the gap of medical needs at that time, and at least a part (16%) of graduates still served at medically underserved areas. We demonstrated the contributions of the PFMPs to improve the healthcare in medically underserved areas and our public health system. We recognize that PFMP alone cannot overhaul the inadequacy of healthcare resources and physician supplies between the urban and rural underserved areas. We need more efforts and innovations to construct a more sophisticated public-funded medical education system to achieve an even and fair distribution of good healthcare resources.

Novel Patched 1 Mutations in Patients with Gorlin-Goltz Syndrome Strategic Treated by Smoothened Inhibitor

( Shih-wen Hsu ),( Chien-yio Lin ),( Chuang-wei Wang ),( Wen-hung Chung ),( Chih-hsun Yang ),( Yao-yu Chang ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.5

We studied a family with Gorlin-Goltz syndrome. The novel mutations of our cases were located on the 21st exon of the PTCH1 gene (c.3450C>G). The father, who received a strategic 56-day vismodegib treatment for disease control, was the first patient with Gorlin syndrome treated with the hedgehog inhibitor in Taiwan. The lesions regressed gradually, with scar formation, and were subsequently removed via a wide excision. Further details are provided below. (Ann Dermatol 30(5) 597∼601, 2018)

Grey Neural Network-Based Forecasting System for Vision-Guided Robot Trajectory Tracking

Shih-Hung Yang,Chung-Hsien Chou,Chen-Fang Chung,Wen-Pang Pai,Tse-Han Liu,Yung-Sheng Chang,Jung-Che Li,Huan-Chan Ting,Yon-Ping Chen 제어로봇시스템학회 2011 제어로봇시스템학회 국제학술대회 논문집 Vol.2011 No.10

This paper presents a grey neural network-based forecasting system (GNNFS) in solving the prediction problem. GNNFS adopts a grey model to predict the signal and a neural network (NN) to forecast the prediction error of the grey model. A sequential batch learning (SBL) is developed to adjust the weights of the NN. The proposed GNNFS is applied to a binocular robot, called an Eye-Robot, for human-robot interaction which involved predicting the trajectory of a participant’s hand and tracking the hand. By applying the SBL, the GNNFS can gradually learn to predict the trajectory of the hand and track it well. The experimental results show that the GNNFS can carry out the SBL in real-time for vision-guided robot trajectory tracking.

Positive Symptoms in Antipsychotic-naïve Schizophrenia are Associated with Increased Body Mass Index after Treatment

Shih-Hsien Lin,Huai-Hsuan Tseng,Hsin Chun Tsai,Mei Hung Chi,I Hui Lee,Po See Chen,Kao Chin Chen,Yen Kuang Yang 대한정신약물학회 2021 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.19 No.1

Objective: Weight gain is an important risk factor for morbidity and mortality among patients with schizophrenia. We speculated that positive symptoms, related to dopaminergic hyperactivity and altered mesolimbic function, are associated with weight gain. Methods: Twenty-two antipsychotic-naïve, first-episode patients with schizophrenia were enrolled. The Positive and Negative Syndrome Scale was completed at enrollment and follow-up. Body mass index (BMI) was also measured. Results: The increase in BMI, after 6.04 ± 2.16 years of follow-up, was associated with positive symptoms, but not negative symptoms, before treatment with antipsychotics in antipsychotic-naïve patients with schizophrenia. Conclusion: This finding implied that dopaminergic hyperactivity could be an important factor to predict the treatment outcome. Body weight control is important for the health management of patients with schizophrenia with more severe positive symptoms.

Effect of dietary supplementation of Bacillus subtilis TLRI 211-1 on laying performance, egg quality and blood characteristics of Leghorn layers

Tsai Ming-Yang,Shih Bor-Ling,Liaw Ren-Bao,Chen Wen-Tsen,Lee Tsung-Yu,Hung Hsi-Wen,Hung Kuo-Hsiang,Lin Yih-Fwu 아세아·태평양축산학회 2023 Animal Bioscience Vol.36 No.4

Objective: TLRI 211-1 is a novel Bacillus subtilis strain. This experiment was to investigate dietary supplementation of TLRI 211-1 on laying performance, egg quality and blood characteristics of layers. Methods: One hundred and twenty 65-wk-old Leghorn layers were divided into four treatment groups for 8 weeks experiment. Each treatment had three replicates. The basal diet was formulated as control group with crude protein 17% and metabolizable energy 2,850 kcal/kg and supplemented with TLRI 211-1 0.1%, 0.3%, and commercial Bacillus amyloliquefaciens 0.1% as treatment 2, 3 and 4 groups, respectively. Both TLRI 211-1 and commercial Bacillus amyloliquefaciens were adjusted to contain 1×109 colony-forming unit (CFU)/mL (g), hence the 0.1% supplemental level was 1×109 CFU/kg. Results: The results showed that TLRI 211-1 0.3% and commercial B. amyloliquefaciens groups had higher weight gain than the other groups; TLRI 211-1 0.1% group had better feed to eggs conversion ratio than the control and commercial B. amyloliquefaciens groups (p<0.05). Bacillus subtilis supplementation increased yolk weight (p<0.05). In egg quality during storage, TLRI 211-1 0.1% had higher breaking strength than the control group at the second week of storage (p<0.05). At the third week of storage, TLRI 211-1 0.3% had higher Haugh unit (p<0.05). Hens fed diets supplemented with TLRI 211-1 0.3% significantly decreased blood triglyceride levels and increased blood calcium levels (p< 0.05). TLRI 211-1 0.3% group had lower H2S (p<0.05) and hence had less unpleasant odor in excreta of hens. Conclusion: In conclusion, supplementation with 0.1% TLRI 211-1 can significantly improve feed to eggs conversion ratio. TLRI 211-1 supplementation also can maintain eggs at their optimum quality level during storage. The study showed that B. subtilis TLRI 211-1 can be used as feed additives for improving egg production performance and egg quality.

Synthesis of ginsenoside Rb₁-imprinted magnetic polymer nanoparticles for the extraction and cellular delivery of therapeutic ginsenosides

Liu, Kai-Hsi,Lin, Hung-Yin,Thomas, James L.,Shih, Yuan-Pin,Yang, Zhuan-Yi,Chen, Jen-Tsung,Lee, Mei-Hwa The Korean Society of Ginseng 2022 Journal of Ginseng Research Vol.46 No.5

Background: Panax ginseng (ginseng) is a traditional medicine that is reported to have cardioprotective effects; ginsenosides are the major bioactive compounds in the ginseng root. Methods: Magnetic molecularly imprinted polymer (MMIP) nanoparticles might be useful for both the extraction of the targeted (imprinted) molecules, and for the delivery of those molecules to cells. In this work, plant growth regulators were used to enhance the adventitious rooting of ginseng root callus; imprinted polymeric particles were synthesized for the extraction of ginsenoside Rb₁ from root extracts, and then employed for subsequent particle-mediated delivery to cardiomyocytes to mitigate hypoxia/reoxygenation injury. Results: These synthesized composite nanoparticles were first characterized by their specific surface area, adsorption capacity, and magnetization, and then used for the extraction of ginsenoside Rb₁ from a crude extract of ginseng roots. The ginsenoside-loaded MMIPs were then shown to have protective effects on mitochondrial membrane potential and cellular viability for H9c2 cells treated with CoCl₂ to mimic hypoxia injury. The protective effect of the ginsenosides was assessed by staining with JC-1 dye to monitor the mitochondrial membrane potential. Conclusion: MMIPs can play a dual role in both the extraction and cellular delivery of therapeutic ginsenosides.

Harm Avoidance is Correlated with the Reward System in Adult Patients with Attention Deficit Hyperactivity Disorder: A Functional Magnetic Resonance Imaging Study

Tsung-Hua Lu(Tsung-Hua Lu),Shih-Hsien Lin(Shih-Hsien Lin),Mei Hung Chi(Mei Hung Chi),Ching-Lin Chu(Ching-Lin Chu),Dong-Yu Yang(Dong-Yu Yang),Wei Hung Chang(Wei Hung Chang),Po See Chen(Po See Chen),Yen 대한정신약물학회 2023 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.21 No.1

Objective: Hypoactivity in the reward system among patients with attention deficit hyperactivity disorder (ADHD) is a well-known phenomenon. Whether the activity in the reward pathway is related to harm avoidance, such as in sensitivity to punishment, is unclear. Evidence regarding the potential difference between ADHD patients and controls in terms of this association is scarce. Methods: Event-related functional magnetic resonance imaging was conducted on subjects performing the Iowa gambling test. Fourteen adults with ADHD and 14 controls were enrolled in the study. Results: Harm avoidance was found to be positively correlated with the activities of the bilateral orbitofrontal cortex and right insula in individuals with ADHD. A group difference was also confirmed. Conclusion: Understanding the roles of harm avoidance and brain activation during risk tasks is important.

BRCA1/2 mutation status in patients with metachronous breast and ovarian malignancies: clues towards the implementation of genetic counseling

Angel Chao,Yi-Hao Lin,Lan-Yan Yang,Ren-Chin Wu,Wei-Yang Chang,Pi-Yueh Chang,Shih-Cheng Chang,Chiao-Yun Lin,Huei-Jean Huang,Cheng-Tao Lin,Hung-Hsueh Chou,Kuan-Gen Huang,Wen-Ling Kuo,Ting-Chang Chang,Ch 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.3

Objective: The characteristics of patients with metachronous breast and ovarian malignancies and the pathogenic role of BRCA1/2 mutations remain poorly understood. We investigated these issues through a review of hospital records and nationwide Taiwanese registry data, followed by BRCA1/2 mutation analysis in hospital-based cases. Methods: We retrospectively retrieved consecutive clinical records of Taiwanese patients who presented with these malignancies to our hospital between 2001 and 2017. We also collected information from the Data Science Center of the Taiwan Cancer Registry (TCR) between 2007 and 2015. Next-generation sequencing and multiplex ligation-dependent probe amplification were used to identify BRCA1/2 mutations and large genomic rearrangements, respectively. When BRCA1/2 mutations were identified in index cases, pedigrees were reconstructed and genetic testing was offered to family members. Results: A total of 12,769 patients with breast cancer and 1,537 with ovarian cancer were retrieved from our hospital records. Of them, 28 had metachronous breast and ovarian malignancies. We also identified 113 cases from the TCR dataset. Eighteen hospital-based cases underwent BRCA1/2 sequencing and germline pathogenic mutations were detected in 7 patients (38.9%, 5 in BRCA1 and 2 in BRCA2). All BRCA1/2 mutation carriers had ovarian high-grade serous carcinomas. Of the 12 patients who were alive at the time of analysis, 5 were BRCA1/2 mutation carriers. All of them had family members with BRCA1/2-associated malignancies. Conclusions: Our results provide pilot evidence that BRCA1/2 mutations are common in Taiwanese patients with metachronous breast and ovarian malignancies, supporting the clinical utility of genetic counseling.

Direct comparison of biopsy techniques for hepatic malignancies

( Shang-chin Huang ),( Ja-der Liang ),( Shih-jer Hsu ),( Tzu-chan Hong ),( Hung-chih Yang ),( Jia-horng Kao ) 대한간학회 2021 Clinical and Molecular Hepatology(대한간학회지) Vol.27 No.2

Background/Aims: The core needle biopsy (CNB), fine needle aspiration cytology (FNAC) and touch imprint cytology (TIC) are commonly used tools for the diagnosis of hepatic malignancies. However, little is known about the benefits and criteria for selecting appropriate technique among them in clinical practice. We aimed to compare the sensitivity of ultrasound-guided CNB, FNAC, TIC as well as combinations for the diagnosis of hepatic malignancies, and to determine the factors associated with better sensitivity in each technique. Methods: From January 2018 to December 2019, a total of 634 consecutive patients who received ultrasound-guided liver biopsies at the National Taiwan University Hospital was collected, of whom 235 with confirmed malignant hepatic lesions receiving CNB, FNAC and TIC simultaneously were enrolled for analysis. The clinical and procedural data were compared. Results: The sensitivity of CNB, FNAC and TIC for the diagnosis of malignant hepatic lesions were 93.6%, 71.9%, and 85.1%, respectively. Add-on use of FNAC or TIC to CNB provided additional sensitivity of 2.1% and 0.4%, respectively. FNAC exhibited a significantly higher diagnostic rate in the metastatic cancers (P=0.011), hyperechoic lesions on ultrasound (P=0.028), and those with depth less than 4.5 cm from the site of needle insertion (P=0.036). Conclusions: The sensitivity of CNB is superior to that of FNAC and TIC for the diagnosis of hepatic malignancies. Nevertheless, for shallow (depth <4.5 cm) and hyperechoic lesions not typical for primary liver cancers, FNAC alone provides excellent sensitivity. (Clin Mol Hepatol 2021;27:305-312)

Assessing the role of everolimus in reducing hepatocellular carcinoma recurrence after living donor liver transplantation for patients within the UCSF criteria

Ashok Thorat,Long-Bin Jeng,Horng-Ren Yang,Chun-Chieh Yeh,Shih-Chao Hsu,Te-Hung Chen,Kin-Shing Poon 한국간담췌외과학회 2017 Annals of hepato-biliary-pancreatic surgery Vol.21 No.4

Backgrounds/Aims: The protective effect of everolimus (EVR) in hepatocellular carcinoma (HCC) patients who receive liver transplantation in terms of reducing the recurrence has not been sufficiently investigated in clinical trials. In this second stage of our ongoing study, we intend to analyze the effects of EVR as an immunosuppressant, when it is started in the early phase after living donor liver transplantation (LDLT), on HCC recurrence in patients with HCC within the University of California at San Francisco (UCSF) criteria. Methods: From January 2011 to June 2013, a total of 250 patients underwent LDLT for HCC at our institute. The patients with HCC within the UCSF criteria were included in the study and divided in two groups depending upon the postoperative immunosuppression. Group A: HCC patients that received EVR+TAC based immunosuppressive regimen (n=37). Group B: HCC patients that received standard TAC based immunosuppressive regimen without EVR (n=29). The target trough level for EVR was 3 to 5 ng/ml while for TAC it was 8-10 ng/ml. Results: For group A patients, the mean trough level of the EVR was 3.47±1.53 ng/ml (range, 1.5-11.2) with a daily dose of 1.00±0.25 mg/day. For group A and B, the average TAC trough levels were 6.97±3.98 ng/ml (range, 2.50 to 11.28 ng/ml) and 6.93±2.58 (range, 2-16.30), respectively. The 1-year, 3-year and 4-year overall survival achieved for Group A patients was 94.95%, 86.48% and 86.48%, respectively while for Group B patients it was 82.75%,68.96%, and 62.06%, respectively (p=0.0217). Conclusions: EVR use in liver transplant recipients in the early stage after transplantation reduces the HCC recurrence rates in HCC patients within the UCSF criteria.