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| 期刊 | 怡仁綜合醫院圖書館 | Vol.10 N.1 (Browse shelf(Opens below)) | Vol.10 N.1 | Available | Background: Emergency department (ED) revisits may be associated with a higher percentage of adverse events and increased costs. Our hospital is a university affiliation hospital accepted regional referral patients, and located in the region in Taiwan with the highest percentage of elderly people. In this study, we attempted to identify whether old age was a risk factor of ED revisit. Methods: Patients who visited the ED from July 2011 to June 2016 were included. Factors associated with revisit were collected from medical information database. A total of 239,405 patients were included in our study, with 13,272 having ED revisits within 72 hours. Chi square and independent t test were applied for univariable factors, and a logistic regression model was used for multivariable analysis. Results: Old age (age ≥ 65 years) was found to be a risk factor for ED revisit (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.09-1.19). Diagnosis, pulse rate, diastolic blood pressure, fever, pain management, paracentesis, triage level, registration category, male gender, discharge status, and major illness may have some effect on ED revisit. Conclusions: In our patients, old age is a risk factor for ED revisit; however, only a weak association was found. | F00053 | ||
| 期刊 | 怡仁綜合醫院圖書館 | Vol.10 N.2 (Browse shelf(Opens below)) | Vol.10 N.2 | Available | Background: To investigate the association of clinical and hematological parameters with return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). Methods: Clinical data of successive non-traumatic adult OHCA patients with available laboratory data of complete blood count and peripheral blood smear at emergency department (ED) arrival were requested. Hematological parameters were collected and calculated, and logistic regression and survival analysis were performed for association of ROSC with the parameters. Results: From December 2015 to December 2016, a total of 188 OHCA patients transported to our ED were enrolled. In ROSC group, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were significantly higher and smudge cell count was significantly lower when compared with non-ROSC group. In the univariate regression, NLR more than 2.0 (odds ratio [OR]: 2.40, 95% confidence interval [CI]: 1.31-4.41; p = 0.004) and smudge cell count less than 0.45 × 10^9/L (OR: 0.33, 95% CI: 0.15-0.71; p = 0.004) were significantly associated with ROSC in OHCA. In logistic regression, bystander witnessed (OR: 3.15, 95% CI: 1.59-6.27; p = 0.001) and prehospital epinephrine use (OR: 2.15, 95% CI: 1.10-4.23; p = 0.026) were significantly associated with ROSC in OHCA. NLR and smudge cell count were also seemingly related to ROSC in OHCA, but without statistical significance. In survival analysis, neither NLR nor smudge cell count was associated with patient survival to discharge in OHCA. Conclusions: NLR and smudge cell count at ED arrival could be potential indicators of ROSC in OHCA. | F00054 | ||
| 期刊 | 怡仁綜合醫院圖書館 | Vol.10 N.4 (Browse shelf(Opens below)) | Vol.10 N.4 | Available | Background: Patient admissions beyond the capacity of emergency departments (EDs) have been reported since the coronavirus disease (COVID-19) pandemic. Thus, laboratory parameters to predict the readmission of patients discharged from the ED are needed. For this purpose, we investigated whether C-reactive protein (CRP) level and neutrophil-to-lymphocyte ratio (NLR) could predict the readmission of patients with COVID-19. Methods: Patients aged ＞18 years who visited the ED in October 2020 and had positive polymerase chain reaction test results were evaluated. Among these patients, those who were not hospitalized and were discharged from the ED on the same day were included in the study. The patients' readmission status within 14 days after discharge, age, sex, complaint on admission, comorbidity, systolic blood pressure, diastolic blood pressure, fever, pulse, oxygen saturation level, CRP level, blood urea nitrogen level, creatinine level, neutrophil count, lymphocyte count, and NLR were recorded. Data were compared between the groups. Results: Of the 779 patients who were included in the study, 359 (46.1%) were male. The median age was 41 years (range, 31-53 years). Among these patients, those who were not hospitalized and were discharged from the ED on logistic regression analysis, age, CRP level, NLR, loss of smell and taste, and hypertension had odds ratios of 2.494, 2.207, 1.803, 0.341, and 1.879, respectively. Conclusions: The strongest independent predictor of readmission within 14 days after same-day ED discharge was age ＞ 50 years. In addition, CRP level and NLR were the laboratory parameters identified as independent predictors of ED readmission. | F00005 | ||
| 期刊 | 怡仁綜合醫院圖書館 | Vol.11 N.1 (Browse shelf(Opens below)) | Vol.11 N.1 | Available | COVID-19 has changed our lives as we knew it. The world is not naive to infectious disease outbreaks, having experienced pandemics such as the H1N1 outbreak in 2009 with up to 400,000 deaths, and the ＂Spanish flu＂ in 1919 with up to 50 million deaths worldwide respectively (https://www.euro.who.int/en/health-topics/communicable-diseases/influenza/pandemic-influenza/past-pandemics). However, this outbreak caused by the severe acute respiratory syndrome coronavirus-2 has taken the world by storm since it was first reported in end 2019. With the numbers of confirmed cases of COVID-19 and death toll rising every day, it raises the question of when will we be fully equipped to handle a pandemic of such a mammoth scale. A multi-pronged approach has to be undertaken by not only healthcare organisations and pharmaceuticals, but also government agencies and legislation in order to overcome the repercussions and mitigate the effects of an infectious disease outbreak. In this article, we share our experience in Singapore and Singapore General Hospital against COVID-19 and our ongoing efforts to keep the virus at bay. | F00055 | ||
| 期刊 | 怡仁綜合醫院圖書館 | Vol.11 N.2 (Browse shelf(Opens below)) | Vol.11 N.2 | Available | Background: This study adopts the Situation-Behavior-Impact-Action (SBIA) model to examine the compliance of narrative feedback in the Entrustable Professional Activities (EPAs)-based e-Portfolio system for clinical preceptors in the emergency department of a regional teaching hospital, and analyzes the applicability of its application in emergency clinical training to increase the feasibility of improving the quality of clinical preceptors' feedback content. Methods: Application of data mining technique to analyze 928 data points was recorded by 14 clinical teachers from April 2017 to May 2019. These data points were narrative feedback from workplace direct observation, which was recorded in the EPAs-based e-Portfolio. Results: The majority of the narrative feedback consisted of only one component, behavior observed (53.99%) and action suggestion (17.24%). Some feedback consisted of two to three components; which were behavior observed-action suggestion (20.37%) and situation description-behavior observed-action suggestion (1.29%). Only a few feedbacks consisted of all four components: situation description-behavior observed-possible impact-action suggestion (0.75%). Conclusions: The current narrative feedback is from the basic appearance of SBIA, but there still got room for improvement. The narrative feedback should be given according to SBIA model in order to provide a comprehensive and constructive learning outcome. The narrative feedback recorded in EPAs-based e-Portfolio provides the delay of feedback effect. Thus, multiple feedbacks from various clinical teachers could make the assessments more concrete and outline the authentic clinical condition of the trainees. | F00056 | ||
| 期刊 | 怡仁綜合醫院圖書館 | Vol.11 N.3 (Browse shelf(Opens below)) | Vol.11 N.3 | Available | Background: Optimal management for trauma-induced coagulopathy (TIC) is a clinical conundrum. In conjunction with the transfusion of fresh-frozen plasma (FFP), additional administration of prothrombin complex concentrate (PCC) was proposed to bring about further coagulative benefit. However, investigations evaluating the efficacy as well as corresponding side effects were scarce and inconsistent. The aim of this study was to systematically review current literature and to perform a meta-analysis comparing FFP+PCC with FFP alone. Methods: Web search followed by manual interrogation was performed to identify relevant literatures fulfilling the following criteria, subjects as TIC patients taking no baseline anticoagulants, without underlying coagulative disorders, and reported clinical consequences. Those comparing FFP alone with PCC alone were excluded. Comprehensive Meta-analysis software was utilized, and statistical results were delineated with odd ratio (OR), mean difference (MD), and 95% confidence interval (CI). I^2 was calculated to determine heterogeneity. The primary endpoint was set as all-cause mortality, while the secondary endpoint consisted of international normalized ratio (INR) correction, transfusion of blood product, and thrombosis rate. Results: One hundred and sixty-four articles were included for preliminary evaluation, 3 of which were qualified for meta-analysis. A total of 840 subjects were pooled for assessment. Minimal heterogeneity was present in the comparisons (I^2 ＜ 25%). In the PCC + FFP cohort, reduced mortality rate was observed (OR: 0.631; 95% CI: 0.450-0.884, p = 0.007) after pooling. Meanwhile, INR correction time was shorter under PCC + FFP (MD: -608.300 mins, p ＜ 0.001), whilst the rate showed no difference (p = 0.230). The PCC + FFP group is less likely to mandate transfusion of packed red blood cells (p ＜ 0.001) and plasma (p ＜ 0.001), but not platelet (p = 0.615). The incidence of deep vein thrombosis was comparable in the two groups (p = 0.460). Conclusions: Compared with FFP only, PCC + FFP demonstrated better survival rate, favorable clinical recovery and no elevation of thromboembolism events after TIC. | F00006 | ||
| 期刊 | 怡仁綜合醫院圖書館 | Vol.12 N.1 (Browse shelf(Opens below)) | Vol.12 N.1 | Available | Background: Snakebites constitute a common medical emergency in tropical and subtropical regions. Pediatric snake envenomation is a special category that has not been well studied. This study investigated the management and prognostic factors of snake envenomation in children using a Taiwanese national database. Methods: This observational study used the National Health Insurance database of all pediatric snake envenomation patients treated from 2005 to 2009. Patients' demographic data, antivenom types and doses, medical and surgical interventions, and prognostic variables were collected. Comparisons were made according to the envenomation types, age groups, and whether the patients were hospitalized using univariate and multivariate methods. Results: A total of 106 patients' data were collected. Of the patients, 73 (68.9%) were male, 62 (58.5%) were under the age of 12, 69 (65.1%) received intravenous (IV) antibiotic treatment, 38 (35.9%) were hospitalized, 5 (4.72%) required surgical intervention, and none died. Compared with non-hospitalized patients, the patients who required hospitalization were more likely to have suffered hemorrhagic envenomation (p = 0.035), receive IV antibiotic treatment (p = 0.0078), and require surgical intervention (p = 0.005). In the multivariate analysis, hemorrhagic envenomation was an independent predictor for hospitalization (odds ratio: 3.47, 95% confidence interval: 1.18-10.21) after adjusting for other covariates. No significant differences were observed between age groups in total antivenom usage (p = 0.2880), IV antibiotic usage (p = 0.3190), hospitalization (p = 0.3988), and surgical intervention (p = 0.1874). Conclusions: In this Taiwanese population-based national database study, antivenom treatment of pediatric snakebite patients resulted in zero mortality and a low surgical intervention rate. Patients with hemorrhagic envenomation were associated with a higher probability of hospitalization. | F00007 |
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| RA412.5.T28 D574 Digital health care in Taiwan | RC685.C53 Devices for Cardiac Resynchronization | Vol.10 N.1 Journal of Acute Medicine | Vol.10 N.2 Journal of Acute Medicine | Vol.11 lssue.1 台灣實證醫學學會會刊 = | Vol.11 N.1 Journal of Acute Medicine | Vol.11 N.2 Journal of Acute Medicine |
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