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Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.
In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.
Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.
During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.
Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
On February 6, 2018, a magnitude 6.2 earthquake struck Hualien, the eastern part of Taiwan. The quake resulted in 17 deaths and more than 300 people injured. Four buildings completely collapsed and hundreds of houses were damaged.
The aim of this research was to use the patient data to analyze the reasons for visits, the trauma sites, and the severity.
We obtained the patient information from the Taiwan Eastern Medical Emergency Operation Center. Medical records were reviewed to analyze the primary diagnosis, the trauma mechanisms, and the sites of injury. Injury severity score (ISS) was used to assess trauma severity.
Two hundred and eighty patients were included in the study, with 90.3% being traumatic patients. Among them, 18.2% was geriatric trauma, 4.7% was pediatric trauma, and 0.4% was obstetric trauma. The most common injury site was lower extremities (33.2%), followed by head (31.4%) and upper extremities (27.1%). The mean injury severity score (ISS) was 1.9. The geriatric population had an average ISS of 2.4, and the pediatric group had a mean ISS of 1.2.
In our study, the majority of the patients had minor trauma. Lower extremities may be more vulnerable during the evacuation of an earthquake, and thus, became the most common injury site. The elderly patients had a higher ISS, which may be explained by their immobility and fragility of the body. In the future, it is critical to educate citizens about self-protection during earthquakes, focusing on protecting the head and the extremities. Healthcare providers and emergency medical technicians need to be well-trained to handle geriatric trauma since it poses unique challenges and is associated with increased mortality.
Cellulitis is a common infection of the skin and soft tissue. Susceptibility to cellulitis is related to microorganism virulence, the host immunity status and environmental factors. This retrospective study from 2001 to 2013 investigated relationships between the monthly incidence rate of cellulitis and meteorological factors using data from the Taiwanese Health Insurance Dataset and the Taiwanese Central Weather Bureau. Meteorological data included temperature, hours of sunshine, relative humidity, total rainfall and total number of rainy days. In otal, 195 841 patients were diagnosed with cellulitis and the incidence rate was strongly correlated with temperature (γS = 0.84, P < 0.001), total sunshine hours (γS = 0.65, P < 0.001) and total rainfall (γS = 0.53, P < 0.001). The incidence rate of cellulitis increased by 3.47/100 000 cases for every 1° elevation in environmental temperature. Our results may assist clinicians in educating the public of the increased risk of cellulitis during warm seasons and possible predisposing environmental factors for infection.
This study presents an optimal design procedure including topology optimization and size–shape optimization methods to maximize mechanical advantage (which is defined as the ratio of output force to input force) of the synthesized compliant mechanism. The formulation of the topology optimization method to design compliant mechanisms with multiple output ports is presented. The topology-optimized result is used as the initial design domain for subsequent size–shape optimization process. The proposed optimal design procedure is used to synthesize an adaptive compliant gripper with high mechanical advantage. The proposed gripper is a monolithic two-finger design and is prototyped using silicon rubber. Experimental studies including mechanical advantage test, object grasping test, and payload test are carried out to evaluate the design. The results show that the proposed adaptive complaint gripper assembly can effectively grasp irregular objects up to 2.7 kg.
Research suggests an association between metabolic disorders, such as type 2 diabetes mellitus (T2DM), and schizophrenia. However, the risk of metabolic disorders in the unaffected siblings of patients with schizophrenia remains unclear.
Using the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects were included and followed up to the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified.
The unaffected siblings of schizophrenia probands had a higher prevalence of T2DM (3.4% vs. 2.6%, p = 0.010) than the controls. Logistic regression analyses with the adjustment of demographic data revealed that the unaffected siblings of patients with schizophrenia were more likely to develop T2DM (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.10–1.75) later in life compared with the control group. Moreover, only female siblings of schizophrenia probands had an increased risk of hypertension (OR: 1.47, 95% CI: 1.07–2.01) during the follow-up compared with the controls.
The unaffected siblings, especially sisters, of schizophrenia probands had a higher prevalence of T2DM and hypertension compared with the controls. Our study revealed a familial link between schizophrenia and T2DM in a large sample. Additional studies are required to investigate the shared pathophysiology of schizophrenia and T2DM.
To determine the efficacy of 2 types of antimicrobial privacy curtains in clinical settings and the costs involved in replacing standard curtains with antimicrobial curtains.
A prospective, open-labeled, multicenter study with a follow-up duration of 6 months.
This study included 12 rooms of patients with multidrug-resistant organisms (MDROs) (668 patient bed days) and 10 cubicles (8,839 patient bed days) in the medical, surgical, neurosurgical, orthopedics, and rehabilitation units of 10 hospitals.
Culture samples were collected from curtain surfaces twice a week for 2 weeks, followed by weekly intervals.
With a median hanging time of 173 days, antimicrobial curtain B (quaternary ammonium chlorides [QAC] plus polyorganosiloxane) was highly effective in reducing the bioburden (colony-forming units/100 cm2, 1 vs 57; P < .001) compared with the standard curtain. The percentages of MDRO contamination were also significantly lower on antimicrobial curtain B than the standard curtain: methicillin-resistant Staphylococcus aureus, 0.5% vs 24% (P < .001); carbapenem-resistant Acinetobacter spp, 0.2% vs 22.1% (P < .001); multidrug-resistant Acinetobacter spp, 0% vs 13.2% (P < .001). Notably, the median time to first contamination by MDROs was 27.6 times longer for antimicrobial curtain B than for the standard curtain (138 days vs 5 days; P = .001).
Antimicrobial curtain B (QAC plus polyorganosiloxane) but not antimicrobial curtain A (built-in silver) effectively reduced the microbial burden and MDRO contamination compared with the standard curtain, even after extended use in an active clinical setting. The antimicrobial curtain provided an opportunity to avert indirect costs related to curtain changing and laundering in addition to improving patient safety.
Bipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.
Among the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.
FDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.
Our study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.
Attention-deficit hyperactivity disorder (ADHD) increases the risk of suicidal behaviours through psychiatric comorbidities; however, a significant direct association has not been observed between ADHD and suicide attempts.
To evaluate the risk of suicide attempt in adolescents and young adults with ADHD.
Using a nationwide, population-based insurance claims database, this longitudinal cohort study enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009. Any suicide attempt was identified from enrolment to 31 December 2011. The association between ADHD medications and the likelihood of suicide attempt was assessed.
ADHD was an independent risk factor for any suicide attempt (hazard ratio = 3.84, 95% CI = 3.19–4.62) and repeated suicide attempts (hazard ratio = 6.52, 95% CI = 4.46–9.53). Subgroup analyses of men, women, adolescents and young adults demonstrated the same trend. Methylphenidate or atomoxetine treatment did not increase the risk of suicide attempt or repeated suicide attempts. Long-term methylphenidate treatment was associated with a significantly decreased risk of repeated suicide attempts in men (hazard ratio = 0.46, 95% CI = 0.22–0.97).
ADHD was a risk factor for suicide attempt and a stronger predictor of repeated suicide attempts, independent of comorbidities. Further investigation is warranted to explore the mechanism underlying the association between ADHD and suicidal behaviours.
To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.
A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.
One core theme emerged: “protective preparation.” This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.
Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI.
Beginning in 2007, all newly diagnosed cancer patients at the Koo Foundation Sun Yat-Sen Cancer Center (KF–SYSCC) were screened for psychosocial distress. Our social workers, as part of the psychosocial care team (PCT), have engaged in proactive outreach with patients identified as distressed. The goal of the present study was to assess the prevalence of psychosocial distress and the extent of contact between the PCT and distressed patients.
Newly diagnosed patients who were treated at KF–SYSCC between 2007 and 2010 for cancer were eligible if there were at least 100 patients with the same type of cancer. Before treatment began, they were screened with the Pain Scale and the Distress Thermometer (DT) and had the option to specify a desire for help. The rates of distress were analyzed by cancer type and by probable related factors. Information regarding contact with the PCT was retrieved from computerized databases.
Overall, some 5,335 cancer patients representing 12 major cancer types were included in our study. Of these, 1,771 (33.20%) were significantly distressed. By multivariate logistic regression, younger age, female gender, higher pain score, and disease stage, but not cancer type, were found to be associated with higher rates of distress. Among these distressed patients, 628 (36%) had some contact with the PCT.
Significance of results:
This Taiwanese study with a large sample size revealed a prevalence rate of psychosocial distress similar to rates found in Western countries. Contact with the PCT was established in only 36% of significantly distressed patients, despite a proactive outreach program. It is very important to have screening results made available in a timely fashion to the psycho-oncology team so that appropriate care can be offered promptly.
Several previous cross-sectional studies have shown that vegetarians have a better metabolic profile than non-vegetarians, suggesting that a vegetarian dietary pattern may help prevent chronic degenerative diseases. However, longitudinal studies on the impact of vegetarian diets on metabolic traits are scarce. We studied how several sub-types of vegetarian diets affect metabolic traits, including waist circumference, BMI, systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose, total cholesterol (TC), HDL, LDL, TAG and TC:HDL ratio, through both cross-sectional and longitudinal study designs. The study used the MJ Health Screening database, with data collected from 1994 to 2008 in Taiwan, which included 4415 lacto-ovo-vegetarians, 1855 lacto-vegetarians and 1913 vegans; each vegetarian was matched with five non-vegetarians based on age, sex and study site. In the longitudinal follow-up, each additional year of vegan diet lowered the risk of obesity by 7 % (95 % CI 0·88, 0·99), whereas each additional year of lacto-vegetarian diet lowered the risk of elevated SBP by 8 % (95 % CI 0·85, 0·99) and elevated glucose by 7 % (95 % CI 0·87, 0·99), and each additional year of ovo-lacto-vegetarian diet increased abnormal HDL by 7 % (95 % CI 1·03, 1·12), compared with non-vegetarians. In the cross-sectional comparisons, all sub-types of vegetarians had lower likelihoods of abnormalities compared with non-vegetarians on all metabolic traits (P<0·001 for all comparisons), except for HDL and TAG. The better metabolic profile in vegetarians is partially attributable to lower BMI. With proper management of TAG and HDL, along with caution about the intake of refined carbohydrates and fructose, a plant-based diet may benefit all aspects of the metabolic profile.
Previous evidence has shown positive associations between post-traumatic
stress disorder (PTSD) and hypertension, dyslipidaemia and diabetes
mellitus, which are all risk factors for stroke, but the role of PTSD in
the subsequent development of stroke is still unknown.
To investigate the temporal association between PTSD and the development
Identified from the Taiwan National Health Insurance Research Database,
5217 individuals aged 18 years, with PTSD but with no history of stroke,
and 20 868 age- and gender-matched controls were enrolled between 2002
and 2009, and followed up until the end of 2011 to identify the
development of stroke.
Individuals with PTSD had an increased risk of developing any stroke
(hazard ratio (HR) 3.37, 95% CI 2.44–4.67) and ischaemic stroke (HR =
3.47, 95% CI 2.23–5.39) after adjusting for demographic data and medical
comorbidities. Sensitivity tests showed consistent findings (any stroke
HR = 3.02, 95% CI 2.13–4.28; ischaemic stroke HR = 2.89, 95% CI
1.79–4.66) after excluding the first year of observation.
Individuals with PTSD have an increased risk of developing any stroke and
ischaemic stroke. Further studies are required to investigate the
By any criteria, major parties and the party system in newly democratized Taiwan are fairly institutionalized. The two leading parties – the Nationalist Party or Kuomintang (KMT) and the Democratic Progressive Party (DPP) – are enduring, resilient, and well embedded in their support bases. Factions have existed within each party, and factional conflict can be acute, but factionalism has not undermined party coherence or identity. During the extended period of democratic transition, the two leading parties – at times, in accord with their affiliated partners – have competed fiercely but principally at the ballot box rather than in the streets or under the shadow of democracy-inhibiting forces such as the military or insurgents. By and large, the two political camps have accepted electoral competition as the only legitimate avenue to power, the emotional confrontation on the street over the contested result of the presidential election in 2004 being a notable exception. The magnitude of electoral volatility has been small by comparison with other young democracies in the region. Typically, the dominant KMT ebbed and the DPP flowed, both incrementally rather than abruptly. With the deepening of democratization, electoral volatility increased, especially in recent elections, but the spikes were transitional, caused by a major electoral reform that has effectively eliminated all small parties.
We are interested in finding the entire solutions of non-quasi-monotone delayed non-local reaction–diffusion equations. It is well known that the comparison principle is not applicable for such equations. To overcome this difficulty, we introduce two auxiliary quasi-monotone equations and establish some comparison arguments for the three systems. Some new types of entire solutions are then constructed using the comparison argument, the travelling wavefronts and a spatially independent solution of the auxiliary equations. We also extend our arguments to a delayed cellular neural network with non-monotonic output functions and a delayed non-local lattice differential equation with non-monotonic birth functions.
Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.
We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.
In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.
This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.
This study demonstrates the feasibility of introducing a TaN thin film as a copper diffusion barrier for p-type (BiSb)2Te3 thermoelectric material. Compared to conventional Ni diffusion barrier, remarkably little void generation in Cu bulk or near Cu/TaN interface originated from Cu penetration is observed for TaN barrier after suffering the thermal budget of close to soldering. Diffusion behaviors of the barriers were analyzed by transmission electron microscopy (TEM) and energy dispersive spectrometry (EDS) to make a deep understanding in clarifying interface diffusion effects among the Cu electrode, the barrier layer, and the (BiSb)2Te3thermoelectric layer.