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Child neurology in Taiwan, ROC: past, present and future
ELSEVIER
Brain
Child neurology
& Development
in Taiwan,
ROC: past, present and future
Yu-Zen of f’ediatrics,
Deparfment
The status of child neurology in demarcation between the past and stage is reviewed from four aspects pattern, diagnostic procedure, and
1. PAST
(Before
College
of Medicine,
Shen * National
7hiwan
1988)
(1988-1994)
In 1988, a qualification system [2] for child neurologist subspecialties including board examinations, continuing onjob as well as continuing medical education, and renewal of certification and accreditation of training hospitals was implemented in Taiwan. Ten training hospitals are currently distributed in the northern. middle, and southern parts (Ta-
* Corresponding
author.
Fax: (886)
0387.7604/9.5/$09.50 0 1995 Elsevier SSDI 0387-7604(95)00050-X
Tarpel.
Taiwan
ble l), and the number of board certified child neurologists increased from the initial 7 to 74 at present (Table 2). These actions certainly promoted the advance of child neurology. Active
participation
(2) 341 2598. Science
B.V. All rights
reserved
in
International,
Asian
and
Oceanian
conventions, and ones of the Japanese Society of Child Neurology by our colleagues further accelerated the upgrading of child neurology in every aspect, i.c., teaching, training, research and quality assurance of patient care. The upgrading included:
enhancement
and
installation
of equipment
for
CT, MRI. PET, SPECT, evoked potentials, muscle laboratories, TDM, laboratory computerization, genetic and biochemical
laboratories
toring.
for
The
antiepileptic therapeutic
diagnostic
further drugs, quality.
workout
and
introduction
of
and rehabilitation This upgrading
follow-up
new
technics is reflected
moni-
antibiotics, improved by that
the the
total capacity and loads of hospitals increased; at least, the number of patients with infections, epilepsies, degenerative diseases and metabolic diseases has increased as well, although the number same as before (Fig. Table trainmg
Training
STATUS
Unkvrsity.
Taiwan is analysed as to three stages, i.e., past, present and future. The year of present is set arbitrarily at 1988, when the academic organization changed. Each -academic organization of subspecialty training and research, change in disease treatment.
No academic child neurology society existed. General pediatricians and adult neurologists were responsible for children with neurological problems, with the aid of neurological examination for workout and a few drugs, such as phenobarbital, trimethadione, phenytoin, primidone, chloral hydrate, and a combined tablet of pheno-barbital and phenytoin for epileptic patients. But some large hospitals (university and provincial hospitals) conducted electroencephalographic, pneumoencephalographic or cerebral angiographic examinations. Papers were presented mostly at pediatric society conventions. In 1977, a child neurology symposium was held in conjunction with the Annual Meeting of the Chinese Pediatric Association, to which Dr. Fukuyama was invited as a guest speaker. In the same year, the Neurological Society. R.O.C., was founded [l]. In 1983, the first conference of the Asian Oceanian Association of Child Neurology was held in Taipei in conjunction with the 6th Asian and Oceanian Congress of Neurology. In 1986, the Chinese Neurological Association approved the Division of Child Neurology. These academic activities benefited and triggered the advance of child neurology in Taiwan.
2. PRESENT
Q
(suppl): 20-l
1995; 17
1 Numbers
of
of disease 1). board
crrtrfred
entities
chdd
remains
neurologists
almost
m
10 major
centers
centers
National Taiwan University Hospital Veterans General Hospital, Taipei Veterans Genera1 Hospital, Taichung Veterans General Hospital, Kaohsiung Triservice General I hospital Chang-Gung Memorial Hospital, Taipei Kaohsiung Medical College Hospital Cheng-Kung Unviersity Hospital Mackay Memorial Hospital Cathay General Hospital Chang-Gung Memorial Hospital, Kaohsiung Total
No. of members 4 6 6 6 I 4 4 2 4 2 3 42
the
Y. Shen /Brain
73
74
1 :epilepsy 6:inborn
75
2:infection metabolic
Fig. 1. Annual
Table
2 Number
of board
certified
child
changes
neurologists
District
No. of members
Northern Taiwan Middle Taiwan Southern Taiwan Eastern Taiwan Total
46 11 14 3 14
3. FUTURE
& Derelopmenr
76
77
1995; I7 (suppi):
78
21
20-I
80
79
81
82
year 3:brain tumor 4:myopathy 5:malformation disorder 7:degenerative disease 8:neuropathy of neurological
of districts
PERSPECTIVE
Intensification of the Pediatric Neurology Association will be accomplished in the future by enrolling more colleagues to increase the manpower, and by actively promoting international mutual relationship, such as with the ICNA and AOCNA for the exchange of clinical as well as research experience. Pediatric neurology is going to become a formalized subdivision of the department of pediatrics in a modernized national children hospital, and hopefully thus more extensive nationwide collaborative work can be done for the understanding of pathogeneses, and the development of new diagnostic technology and therapeutic regimens. However, further integration and cooperation with other allied health sciences in the treatment of a patient as a whole should be
diseases
in pediatric
departments
(1984-1993).
reinforced. Rationalization of diagnostic workout by packaging procedures and therapeutic regimens after careful balancing of the side effects, and efforts for avoiding resource wasting must be considered on the eve of the implementation of a national healthcare insurance system, especially under the current status of outgrowing biological technology. The content of continuing medical education, the application of new technological products in clinical practice for our colleagues (servers), and social education for our people (clients) need adequate evaluation and revision as well. Fundamental and basic knowledge of neurology must be emphasized in continuing medical education for pediatric neurologists. In conclusion, by reviewing the development of child neurology in the past and present in Taiwan, to which many teachers, including Professor Fukuyama, contributed, hopefully we can create an extensive panorama in the future to benefit our patients.
REFERENCES 1. Chen, R.C. History of neurology in the Republic Neural Sin 1992; 1: 1-4. 2. Bulletin, Neurological Society, R.O.C. (Taiwan)
of China.
Acta
1991; 16: 124-8.
Brain
Child neurology
& Development
in Taiwan,
ROC: past, present and future
Yu-Zen of f’ediatrics,
Deparfment
The status of child neurology in demarcation between the past and stage is reviewed from four aspects pattern, diagnostic procedure, and
1. PAST
(Before
College
of Medicine,
Shen * National
7hiwan
1988)
(1988-1994)
In 1988, a qualification system [2] for child neurologist subspecialties including board examinations, continuing onjob as well as continuing medical education, and renewal of certification and accreditation of training hospitals was implemented in Taiwan. Ten training hospitals are currently distributed in the northern. middle, and southern parts (Ta-
* Corresponding
author.
Fax: (886)
0387.7604/9.5/$09.50 0 1995 Elsevier SSDI 0387-7604(95)00050-X
Tarpel.
Taiwan
ble l), and the number of board certified child neurologists increased from the initial 7 to 74 at present (Table 2). These actions certainly promoted the advance of child neurology. Active
participation
(2) 341 2598. Science
B.V. All rights
reserved
in
International,
Asian
and
Oceanian
conventions, and ones of the Japanese Society of Child Neurology by our colleagues further accelerated the upgrading of child neurology in every aspect, i.c., teaching, training, research and quality assurance of patient care. The upgrading included:
enhancement
and
installation
of equipment
for
CT, MRI. PET, SPECT, evoked potentials, muscle laboratories, TDM, laboratory computerization, genetic and biochemical
laboratories
toring.
for
The
antiepileptic therapeutic
diagnostic
further drugs, quality.
workout
and
introduction
of
and rehabilitation This upgrading
follow-up
new
technics is reflected
moni-
antibiotics, improved by that
the the
total capacity and loads of hospitals increased; at least, the number of patients with infections, epilepsies, degenerative diseases and metabolic diseases has increased as well, although the number same as before (Fig. Table trainmg
Training
STATUS
Unkvrsity.
Taiwan is analysed as to three stages, i.e., past, present and future. The year of present is set arbitrarily at 1988, when the academic organization changed. Each -academic organization of subspecialty training and research, change in disease treatment.
No academic child neurology society existed. General pediatricians and adult neurologists were responsible for children with neurological problems, with the aid of neurological examination for workout and a few drugs, such as phenobarbital, trimethadione, phenytoin, primidone, chloral hydrate, and a combined tablet of pheno-barbital and phenytoin for epileptic patients. But some large hospitals (university and provincial hospitals) conducted electroencephalographic, pneumoencephalographic or cerebral angiographic examinations. Papers were presented mostly at pediatric society conventions. In 1977, a child neurology symposium was held in conjunction with the Annual Meeting of the Chinese Pediatric Association, to which Dr. Fukuyama was invited as a guest speaker. In the same year, the Neurological Society. R.O.C., was founded [l]. In 1983, the first conference of the Asian Oceanian Association of Child Neurology was held in Taipei in conjunction with the 6th Asian and Oceanian Congress of Neurology. In 1986, the Chinese Neurological Association approved the Division of Child Neurology. These academic activities benefited and triggered the advance of child neurology in Taiwan.
2. PRESENT
Q
(suppl): 20-l
1995; 17
1 Numbers
of
of disease 1). board
crrtrfred
entities
chdd
remains
neurologists
almost
m
10 major
centers
centers
National Taiwan University Hospital Veterans General Hospital, Taipei Veterans Genera1 Hospital, Taichung Veterans General Hospital, Kaohsiung Triservice General I hospital Chang-Gung Memorial Hospital, Taipei Kaohsiung Medical College Hospital Cheng-Kung Unviersity Hospital Mackay Memorial Hospital Cathay General Hospital Chang-Gung Memorial Hospital, Kaohsiung Total
No. of members 4 6 6 6 I 4 4 2 4 2 3 42
the
Y. Shen /Brain
73
74
1 :epilepsy 6:inborn
75
2:infection metabolic
Fig. 1. Annual
Table
2 Number
of board
certified
child
changes
neurologists
District
No. of members
Northern Taiwan Middle Taiwan Southern Taiwan Eastern Taiwan Total
46 11 14 3 14
3. FUTURE
& Derelopmenr
76
77
1995; I7 (suppi):
78
21
20-I
80
79
81
82
year 3:brain tumor 4:myopathy 5:malformation disorder 7:degenerative disease 8:neuropathy of neurological
of districts
PERSPECTIVE
Intensification of the Pediatric Neurology Association will be accomplished in the future by enrolling more colleagues to increase the manpower, and by actively promoting international mutual relationship, such as with the ICNA and AOCNA for the exchange of clinical as well as research experience. Pediatric neurology is going to become a formalized subdivision of the department of pediatrics in a modernized national children hospital, and hopefully thus more extensive nationwide collaborative work can be done for the understanding of pathogeneses, and the development of new diagnostic technology and therapeutic regimens. However, further integration and cooperation with other allied health sciences in the treatment of a patient as a whole should be
diseases
in pediatric
departments
(1984-1993).
reinforced. Rationalization of diagnostic workout by packaging procedures and therapeutic regimens after careful balancing of the side effects, and efforts for avoiding resource wasting must be considered on the eve of the implementation of a national healthcare insurance system, especially under the current status of outgrowing biological technology. The content of continuing medical education, the application of new technological products in clinical practice for our colleagues (servers), and social education for our people (clients) need adequate evaluation and revision as well. Fundamental and basic knowledge of neurology must be emphasized in continuing medical education for pediatric neurologists. In conclusion, by reviewing the development of child neurology in the past and present in Taiwan, to which many teachers, including Professor Fukuyama, contributed, hopefully we can create an extensive panorama in the future to benefit our patients.
REFERENCES 1. Chen, R.C. History of neurology in the Republic Neural Sin 1992; 1: 1-4. 2. Bulletin, Neurological Society, R.O.C. (Taiwan)
of China.
Acta
1991; 16: 124-8.