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Saragih ID, Hsiao CT, Fann WC, Hsu CM, Saragih IS, Lee BO. Impacts of interprofessional education on collaborative practice of healthcare professionals: A systematic review and meta-analysis. Nurse Educ Today 2024; 136:106136. [PMID: 38422794 DOI: 10.1016/j.nedt.2024.106136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/01/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To investigate and statistically synthesise data on the effects of interprofessional education on healthcare professionals' collaborative practice among healthcare professionals. DESIGN A systematic review and meta-analysis. DATA SOURCES Seven databases and the grey literature were searched to collect relevant studies from database inception to 15 May 2023. REVIEW METHODS A random-effects model was used to assess the pooled effect size. Each pooled analysis was tested for publication bias using Egger's regression test. RESULTS Eleven studies were included in the final analysis. The evaluation of pooled results showed that interprofessional education significantly enhanced attitudes towards or mutual respect among healthcare professionals (pooled standardized mean difference: 0.14; 95 % Confidence Interval: 0.01-0.28; p = 0.04) and interprofessional knowledge (pooled standardized mean difference: 0.43; 95 % Confidence Interval: 0.22-0.65; p < 0.001). CONCLUSIONS Interprofessional education is a feasible approach to enhance attitudes towards or mutual respect among healthcare professionals as well as their interprofessional knowledge. Future research is needed to consider the inclusion of a module designed to develop mutual interests and communication to enhance students' perspectives on the importance of the interprofessional education approach.
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Affiliation(s)
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Chih-Mimng Hsu
- Medical education Department, Chang Gung Memorial Hospital, Chiayi, Taiwan; National Chung Cheng University, Minhsiung, Chiayi, Taiwan.
| | | | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan; Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Taiwan.
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2
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Fann WC, Hsu CM, Hsiao CT, Lee BO. Exploring Experiences of Conflict within Medical Teams in an Emergency Department: A Focus Group Approach during the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:727. [PMID: 38610149 PMCID: PMC11012193 DOI: 10.3390/healthcare12070727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/29/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The factors related to conflicts in emergency departments (EDs) have been studied for decades. The post-pandemic digital era may transform the medical landscape in EDs, potentially changing the patterns of conflict between healthcare professionals. This study used focus group interviews to explore conflicts in EDs. Four groups, each with 4-6 participants, took part in this study. Semi-structured interviews were conducted using six research questions. Summative content analysis was used to analyze the data. The participant's average age was 37.82 years, and the average number of working years was 12.12. The following five themes emerged: multiple patterns of internal conflict; external conflicts arising from cross-departmental coordination; conflicts due to unclear job boundaries; adapting to conflicts in diverse ways; and seeking hospital arbitration. The results of this study suggest extending interdisciplinary collaborative practice from emergency departments to all coordinating departments. An inclusive environment for equality between professions and open communication should be promoted by hospitals.
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Affiliation(s)
- Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (W.-C.F.); (C.-T.H.)
| | - Chih-Mimng Hsu
- Medical Education Department, Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
- Department of Business Administration, College of Management, National Chung Cheng University, Minhsiung, Chiayi 621301, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (W.-C.F.); (C.-T.H.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Bih-O Lee
- School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Chiayi 621301, Taiwan
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3
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Saragih ID, Suarilah I, Hsiao CT, Fann WC, Lee BO. Interdisciplinary simulation-based teaching and learning for healthcare professionals: A systematic review and meta-analysis of randomized controlled trials. Nurse Educ Pract 2024; 76:103920. [PMID: 38382335 DOI: 10.1016/j.nepr.2024.103920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
AIM This study aimed to investigate the effects of interdisciplinary simulation-based teaching and learning on the interprofessional knowledge of healthcare professionals. BACKGROUND Interdisciplinary simulation-based teaching and learning have been employed to prepare learners to collaborate in clinical settings. This strategy could help healthcare professionals to better understand each other, develop interdisciplinary shared values and promote mutual respect between professions, while reducing errors and adverse events in hospital. A meta-analysis was performed to investigate the effects of interdisciplinary simulation-based teaching and learning on healthcare professionals. DESIGN A systematic review and meta-analysis. METHODS A systematic search was conducted of databases including Academic Search Complete, CINAHL Plus with full text, Cochrane Library, Embase, Medline Complete, PubMed and Web of Science from their inception to September 5, 2023. The study included randomized controlled trials that provided interdisciplinary simulation-based education to healthcare professionals. Protocol trials or studies that did not include median or mean and standard deviation were excluded. The pooled standardized mean differences of outcomes were analyzed using a DerSimonian-Laird random-effects model. Heterogeneity was assessed using I2. Egger's regression test was used to examine publication bias indicated in forest plots. RESULTS Ten randomized control trials with a total of 766 participants were included in the pooled analyses. Interdisciplinary simulation-based teaching and learning positively enhanced the interprofessional knowledge of healthcare professionals (pooled SMD = 0.30; 95% CI = 0.10-0.50; p < 0.001). Egger's regression test results were non-significant, indicating that publication bias had little impact on the pooled SMDs. CONCLUSION Interdisciplinary simulation-based teaching and learning for health professionals appear to be significantly beneficial for increasing their interprofessional knowledge. This strategy highlights the importance of providing a well-developed scenario with relevant properties, which applies valid and rigorous instruments, to measure behavioral changes induced by interdisciplinary simulation-based teaching and learning.
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Affiliation(s)
| | - Ira Suarilah
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Bih-O Lee
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC; Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Taiwan, ROC.
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4
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Wang HS, Hsiao CT, Fann WC, Chang CP. Predictor of gram-negative bacteremia in cirrhotic patients with skin and soft-tissue infections. Medicine (Baltimore) 2023; 102:e34075. [PMID: 37443511 DOI: 10.1097/md.0000000000034075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Cirrhosis always goes with profound immunity compromise, and makes those patients easily be the target of skin and soft-tissue infections (SSTIs). Cirrhotic patients with SSTIs have a dramatically increased mortality. To recognize the risk factors of gram-negative infections are critical for improving survival rate. A retrospective cohort study of hospitalized cirrhotic patients with SSTIs and gram-negative bacteremia (GNB) was conducted in 2 tertiary hospitals in southern Taiwan between March 2015 and January 2020. Another group were matched by controls with non-GNB based on time, demographics and immune status. Data such as infectious location, comorbidities, and laboratory findings were recorded and compared. Receiver operating curve and the area under the curve were used to evaluate its discriminating ability. A total of 186 patients were included, 62 in GNB group and 124 in non-GNB group. Comorbidities that were significant risk factors for gram-negative bacteremia included acute kidney injury. Significant risk factors evident in laboratory evaluations included higher model for end-stage liver disease score, higher serum lactate, higher C-reactive protein and higher creatinine level. This study found acute kidney injury, or those exhibiting hyperlactatemia (>16 mg/dL), high MELD score (>14), high CRP (>50 mg/dL), and high creatinine (>2.0 mg/dL) were risk factors associated with gram-negative bacteremia. Cirrhotic patients with SSTIs with aforementioned risk factors should pay more attention by clinicians due to higher mortality.
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Affiliation(s)
- Hung-Sheng Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
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5
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Wang CC, Yang CHO, Hsu CP, Liu CC, Yu JS, Lo CH, Fann WC, Chen YC, Lin CC. Taiwan cobra envenoming: serum venom concentration before and after specific treatment and relationship with debridement of necrotic wound tissue. J Venom Anim Toxins Incl Trop Dis 2023; 29:e20220027. [PMID: 36721427 PMCID: PMC9851669 DOI: 10.1590/1678-9199-jvatitd-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023] Open
Abstract
Background Bivalent freeze-dried neurotoxic (FN) antivenom has been the primary treatment since the 1980s for Taiwan cobra (Naja atra) envenomation in Taiwan. However, envenomation-related wound necrosis is a significant problem after cobra snakebites. In the present study, we analyzed the changes in serum venom concentration before and after antivenom administration to discover their clinical implications and the surgical treatment options for wound necrosis. Methods The patients were divided into limb swelling and wound necrosis groups. The clinical outcome was that swelling started to subside 12 hours after antivenom treatment in the first group. Serum venom concentrations before and after using antivenoms were measured to assess the antivenom's ability to neutralize the circulating cobra venom. The venom levels in wound wet dressing gauzes, blister fluids, and debrided tissues were also investigated to determine their clinical significance. We also observed the evolutional changes of wound necrosis and chose a better wound debridement timing. Results We prospectively enrolled 15 Taiwan cobra snakebite patients. Males accounted for most of this study population (n = 11, 73%). The wound necrosis group received more antivenom doses than the limb swelling group (4; IQR:2-6 vs 1; IQR:1-2, p = 0.05), and less records of serum venom concentrations changed before/after antivenom use (p = 0.0079). The necrotic wound site may release venom into circulation and cause more severe envenomation symptoms. Antivenom can efficiently diminish limb swelling in cobra bite patients. However, antivenom cannot reduce wound necrosis. Patients with early debridement of wound necrosis had a better limb outcome, while late or without debridement may have long-term hospital stay and distal limb morbidity. Conclusions Antivenom can efficiently eliminate the circulating cobra venom in limb swelling patients without wound necrosis. Early debridement of the bite site wound and wet dressing management are suggestions for preventing extended tissue necrosis and hospital stay.
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Affiliation(s)
- Chia-Cheng Wang
- Department of Traumatology and Emergency Surgery, Chang Gung
Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiang Ou Yang
- Department of Traumatology and Emergency Surgery, Chang Gung
Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Po Hsu
- Department of Traumatology and Emergency Surgery, Chang Gung
Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chun Liu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan,
Taiwan
| | - Jau-Song Yu
- Molecular Medicine Research Center, Chang Gung University, Taoyuan,
Taiwan.,Department of Cell and Molecular Biology, College of Medicine, Chang
Gung University, Taoyuan, Taiwan.,Liver Research Center, Chang Gung Memorial Hospital, Linkou,
Taiwan.,Research Center for Food and Cosmetic Safety, Research Center for
Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science
and Technology, Taoyuan, Taiwan
| | - Chih-Hong Lo
- Department of General Surgery, Chang Gung Memorial Hospital,
Taoyuan, Taiwan
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chiayi Chang Gung Memorial
Hospital, Chiayi, Taiwan
| | - Yen-Chia Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital,
Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, National
Yang-Ming University, Taipei, Taiwan
| | - Chih Chuan Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Linkou Chang Gung Memorial
Hospital, Taoyuan, Taiwan.,Correspondence:
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Fann WC, Hung CC, Chaboyer W, Lee BO. Effectiveness of a Nurse-Delivered Intervention on Illness Perceptions and Quality of Life in Patients With Injury. J Nurs Res 2021; 29:e163. [PMID: 34091568 DOI: 10.1097/jnr.0000000000000439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Research has shown that nursing interventions are able to affect short-term outcomes in patients with injury. However, evidence based on a comprehensive nurse-led intervention may be beneficial for trauma care. PURPOSE This study was designed to assess the effect of a nursing intervention on the illness perceptions and quality of life of patients with injury. METHODS A two-group experimental design and a follow-up period of 12 months were used. Ninety-four patients were randomly assigned to either the experimental group or the control group. A nurse-led cognitive behavioral therapy intervention was used to improve outcomes. RESULTS The illness perception variables of "personal control" and "treatment control" were found to be significantly improved in the experimental group at 3 months after discharge, whereas "emotional perception" was significantly improved at 6 months after discharge. The intervention was also shown to improve "social quality of life" at 6 and 12 months after injury. CONCLUSIONS This study adds new knowledge related to nursing interventions for patients with injury in terms of the intervention achieving longer-term effects than the interventions examined in previous studies. The results highlight the importance of providing interprofessional collaborative care. However, the intervention protocol should be tested further in future studies.
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Affiliation(s)
- Wen-Chih Fann
- MSc, MD, Attending Physician, Department of Emergency Medicine, Chia-Yi Chang Gung Memorial Hospital, Taiwan
| | - Chang-Chiao Hung
- PhD, RN, Associate Professor, Department of Nursing, Chang Gung University of Science and Technology, and Associate Research Fellow, Department of Nursing, Chia-Yi Chang Gung Memorial Hospital, Taiwan
| | - Wendy Chaboyer
- PhD, RN, Professor, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Bih-O Lee
- PhD, RN, Professor, College of Nursing, Kaohsiung Medical University, Taiwan, and Adjunct Professor, Faculty of Nursing, Universitas Airlangga, Indonesia
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7
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Hsiao CT, Chang CP, Huang TY, Chen YC, Fann WC. Prospective Validation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Necrotizing Fasciitis of the Extremities. PLoS One 2020; 15:e0227748. [PMID: 31978094 PMCID: PMC6980593 DOI: 10.1371/journal.pone.0227748] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The Laboratory Risk Indicator for Necrotizing Fasciitis score was developed as a clinical decision tool for distinguishing necrotizing fasciitis from other soft tissue infections. We prospectively evaluated the performance of the Laboratory Risk Indicator for Necrotizing Fasciitis score for the diagnosis of patients with necrotizing fasciitis in the extremities. METHODS We conducted a prospective and observational cohort study of emergency department patients with necrotizing fasciitis or severe cellulitis in the extremities between April 2015 and December 2016. The Laboratory Risk Indicator for Necrotizing Fasciitis score was calculated for every enrolled patient. The sensitivity, specificity, positive predictive value, and negative predictive value of cut-off scores of 6 and 8 were evaluated. The accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was expressed as the area under the receiver operating characteristic curve. RESULTS A total of 106 patients with necrotizing fasciitis and 825 patients with cellulitis were included. With an Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score ≥6, the sensitivity was 43% (95% confidence interval 34% to 53%), specificity was 83% (95% confidence interval 80% to 86%), positive predictive value was 25% (95% confidence interval 20% to 30%), and negative predictive value was 92% (95% confidence interval 91% to 93%); with an Laboratory Risk Indicator for Necrotizing Fasciitis cut-off score ≥8, the sensitivity was 27% (95% confidence interval 19% to 37%), specificity was 93% (95% confidence interval 91% to 94%), positive predictive value was 33% (95% confidence interval 25% to 42%), and negative predictive value was 91% (95% confidence interval 90% to 92%). The area under the receiver operating characteristic curve for accuracy of the Laboratory Risk Indicator for Necrotizing Fasciitis score was 0.696 (95% CI 0.640 to 0.751). CONCLUSION The Laboratory Risk Indicator for Necrotizing Fasciitis score may not be an accurate tool for necrotizing fasciitis risk stratification and differentiation between severe cellulitis and necrotizing fasciitis in the emergency department setting based on our study.
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Affiliation(s)
- Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medical, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology Chiayi Campus, Chiayi, Taiwan
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
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Huang TY, Peng KT, Hsiao CT, Fann WC, Tsai YH, Li YY, Hung CH, Chuang FY, Hsu WH. Predictors for gram-negative monomicrobial necrotizing fasciitis in southern Taiwan. BMC Infect Dis 2020; 20:60. [PMID: 31959118 PMCID: PMC6972015 DOI: 10.1186/s12879-020-4796-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a rare and life-threatening necrotizing skin and soft-tissue infection. Infectious pathogens of NF must be detected early and treated rapidly to prevent loss of limb or a fatal outcome. This study aimed to detect more reliable predictors between gram-negative and gram-positive monomicrobial NF of limbs. METHODS A total of 100 patients with limb monomicrobial NF were diagnosed prospectively from April 2015 to July 2018. These monomicrobial NF pathogens can be divided into gram-negative and gram-positive groups according to the result of Gram staining and final bacterial reports. Data such as demographics, seawater or seafood contact history, infectious location, comorbidities, presenting signs and symptoms, and laboratory findings were recorded and compared. RESULTS A total of 55 patients were infected with gram-negative organisms and 45 patients with gram-positive organisms. Among the 55 cases of monomicrobial gram-negative NF, 48 (87.3%) were caused mainly by Vibrio spp. (38, 69.1%) and Aeromonas spp. (10, 18.2%). A higher incidence of chronic kidney disease, cerebrovascular accident, tachypnea, and septic shock; a higher rate of band forms of leukocytes of more than 3%, serum lactate of more than 20 mg/dL, and C-reactive protein level of less than 150 mg/dL; prolonged prothrombin time; and a lower fibrinogen level were observed in patients with gram-negative infection. In a multivariate analysis, a higher incidence of seawater or seafood contact history (odds ratio [OR]: 66.301; 95% confidence interval [CI]: 7.467-588.702), a higher rate of hyperlactatemia (OR: 7.904; 95% CI: 1.231-50.744), and a low fibrinogen level (OR: 1.013; 95% CI: 1.004-1.023) indicated gram-negative infection. CONCLUSIONS In southern Taiwan, NF of limbs mainly affected the lower limbs, exhibited monomicrobial infection, and was predominated by gram-negative bacteria. Gram-negative monomicrobial NF of limbs often occurred in individuals with the more seawater or seafood contact history, hyperlactatemia, and low fibrinogen levels.
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Affiliation(s)
- Tsung-Yu Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Ti Peng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan.,Department of Medicine, School of Medicine, Chang Gung University, Tao Yuan, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hung Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan
| | - Yen-Yao Li
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan
| | - Chien-Hui Hung
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fang-Yi Chuang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 6, West section, Chia-Pu Road, Pu-Zih city, Chiayi, 61363, Taiwan. .,Department of Medicine, School of Medicine, Chang Gung University, Tao Yuan, Taiwan.
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9
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Fann WC, Lee BO, Hsiao CT, Chuan YS, Kuo CY. Do Emergency Nurses Spend Enough Time on Nursing Activities? The Relationship Between Actual and Expected Patient Care Nursing Time. J Acute Med 2019; 9:161-171. [PMID: 32995246 DOI: 10.6705/j.jacme.201912_9(4).0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background The overcrowded environments of emergency departments (EDs) lead to increased clinical workloads for nurses and infl uences the quality of patient care. This study aimed to evaluate whether the quality of patient care meets the expectations of emergency nurses in Taiwan by measuring the amount of time nurses spend on patient care activities. Methods The direct observation study was conducted in one suburban academic hospital with approximately 80,000 annual ED visits. This study observed emergency nurses and the time they spent on their nursing activities. The directly measured times and nurse expected patient care nursing times were compared. Results For all 88 types of nursing activities recorded, each measured nursing time was less than the expected nursing time. On average, the measured nursing time was 82% less than the expected nursing time (2.0 ± 0.3 minutes vs. 11.6 ± 1.5 minutes, p < 0.01). Among the 88 types of nursing activities recorded, the average measured time spent on 76 types (86%) was less than 3 minutes. The nursing activity on which the longest time was spent was cerebrospinal fl uid study nursing (7 minutes). The most frequent nursing activity was documentation. Conclusion The nursing time spent on patient-care activities in EDs was much less than the nurses expected. The results may provide a basis for nursing quality measurements and manpower calculations for EDs.
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Affiliation(s)
- Wen-Chih Fann
- Chiayi Chang Gung Memorial Hospital Department of Emergency Medicine Chiayi Taiwan
| | - Bih-O Lee
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan.,Chang Gung University of Science and Technology, Taoyuan Taiwan
| | - Cheng-Ting Hsiao
- Chiayi Chang Gung Memorial Hospital Department of Emergency Medicine Chiayi Taiwan.,Chang Gung University School of Traditional Chinese Medicine Taoyuan Taiwan
| | - Yu-Shan Chuan
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan
| | - Chiu-Ya Kuo
- Chiayi Chang Gung Memorial Hospital Department of Nursing Chiayi Taiwan.,Chang Gung University of Science and Technology, Taoyuan Taiwan
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10
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Lin CN, Hsiao CT, Chang CP, Huang TY, Hsiao KY, Chen YC, Fann WC. The Relationship Between Fluid Accumulation in Ultrasonography and the Diagnosis and Prognosis of Patients with Necrotizing Fasciitis. Ultrasound Med Biol 2019; 45:1545-1550. [PMID: 31031033 DOI: 10.1016/j.ultrasmedbio.2019.02.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/16/2019] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
Necrotizing fasciitis is a severe soft-tissue infection with a high mortality rate. There is little literature on the relationship between the ultrasonographic finding of fluid accumulation along the deep fascia and the diagnosis and prognosis of necrotizing fasciitis. This retrospective study showed that when fluid accumulation was present along the deep fascia, patients with clinically suspected necrotizing fasciitis had a higher probability of having necrotizing fasciitis. The ultrasonographic finding of fluid accumulation with a cutoff point of more than 2 mm of depth had the best accuracy (72.7%) for diagnosing necrotizing fasciitis. In regard to the prognosis of necrotizing fasciitis, when fluid accumulation was present along the deep fascia, patients with necrotizing fasciitis had a longer length of hospital stay and were at risk of amputation or mortality. Ultrasonography is a point-of-care imaging tool that facilitates the diagnosis and prognosis of necrotizing fasciitis.
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Affiliation(s)
- Chun-Nan Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsung-Yu Huang
- Department of Internal Medicine, Division of Infectious Diseases, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuang-Yu Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Yi-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chang CP, Fann WC, Wu SR, Lin CN, Hsiao CT. Lactate on emergency department arrival as a predictor of in-hospital mortality in necrotizing fasciitis: a retrospective study. J Orthop Surg Res 2019; 14:73. [PMID: 30841912 PMCID: PMC6402084 DOI: 10.1186/s13018-019-1108-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 02/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background Hyperlactatemia is known to be associated with adverse outcome in critical illness. In this study, we attempted to identify if hyperlactatemia on emergency department (ED) arrival is a reliable predictor for in-hospital mortality in necrotizing fasciitis (NF) patients. Method A prospective cohort study of hospitalized patients with NF was conducted in two tertiary teaching hospitals in Taiwan between March 2010 and March 2018. Blood samples were collected in the ED upon arrival, and the lactate levels were determined. Sequential organ failure assessment (SOFA) scores were calculated during the first 24 h after admission. All collected data were statistically analyzed. Result Of the 707 NF patients, 40 (5.66%) died in the hospital. The median (interquartile range) blood lactate level in all NF patients was 3.6 mmol/l (2.2–4.8). The blood lactate level upon ED arrival was significantly associated with mortality (odds ratio [OR] = 1.35; 95% confidence interval [CI], 1.30–1.46; P < 0.001), even after adjustment for age and SOFA score (OR = 1.27; P < 0.001). Multivariate regression analysis showed that a high blood lactate level (OR = 1.17; 95% CI, 1.07–1.29; P = 0.001) and a high SOFA score (OR = 1.15; 95% CI, 1.11–1.20; P < 0.001) were independent risk factors for in-hospital mortality in NF. Blood lactate achieved an area under-the-receiver-operating-characteristic curve (AUC) of 0.79 (P < 0.001) for predicting mortality that was similar to that of SOFA score (AUC = 0.82; P < 0.001). Blood lactate displayed a sensitivity of 62% and a specificity of 86% in predicting mortality at the optimal cutoff value of 5.80 mmol/l. Conclusion In necrotizing fasciitis patients, hyperlactatemia on ED arrival is independently associated with in-hospital mortality. NF patients with hyperlactatemia on ED arrival should be closely monitored for signs of deterioration and consider early and aggressive intervention to prevent mortality.
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Affiliation(s)
- Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 613, Taiwan, Republic of China
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 613, Taiwan, Republic of China.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Ruei Wu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Nan Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 613, Taiwan, Republic of China
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No.6, Sec. W., Jiapu Rd., Puzi City, Chiayi County, 613, Taiwan, Republic of China. .,Department of Medicine, Chang Gung University, Taoyuan, Taiwan.
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12
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Chang CP, Hsiao CT, Fann WC. Risk factors associated with bacteremia correlated with mortality in patients with acute bacterial skin and skin structure infection. Intern Emerg Med 2019; 14:259-264. [PMID: 30361848 DOI: 10.1007/s11739-018-1973-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/17/2018] [Indexed: 01/10/2023]
Abstract
Acute bacterial skin and skin structure infections (ABSSSI) is a common cause of acute admissions worldwide, but the disease is not well understood epidemiologically with respect to factors that determine positive blood cultures or patient mortality. To understand the utility of blood cultures and the association between bacteremia and mortality in patients with ABSSSI, we conducted a retrospective study to investigate factors associated with positive blood cultures and mortality in patients with ABSSSI. A retrospective cohort study of hospitalized adult patients with ABSSSI was conducted in a tertiary hospital in Taiwan between March 2015 and December 2016. A total of 1322 hospitalized patients with ABSSSI are included. The overall mortality rate is 2.1% (28/1322), and 122 patients had positive blood culture results. Comorbidities that are significant risk factors for a positive blood culture include diabetes mellitus and chronic kidney disease. Significant risk factors evident in laboratory evaluations include high C-reactive protein (CRP) level (> 20 mg/dL), hyperglycemia, and hypoalbuminemia. Bacteremia is also a significant factor associated with mortality. A blood culture should be considered for patients with ABSSSI with diabetes mellitus or chronic kidney disease or those exhibiting abnormal CRP, glucose, or albumin levels because of the positive correlation between bacteremia and mortality.
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Affiliation(s)
- Chia-Peng Chang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, Sec. W., Jiapu Rd., Puzi, Chiayi, 613, Taiwan, ROC
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, Sec. W., Jiapu Rd., Puzi, Chiayi, 613, Taiwan, ROC
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, Sec. W., Jiapu Rd., Puzi, Chiayi, 613, Taiwan, ROC.
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13
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Liu CC, Yu JS, Wang PJ, Hsiao YC, Liu CH, Chen YC, Lai PF, Hsu CP, Fann WC, Lin CC. Development of sandwich ELISA and lateral flow strip assays for diagnosing clinically significant snakebite in Taiwan. PLoS Negl Trop Dis 2018; 12:e0007014. [PMID: 30507945 PMCID: PMC6292642 DOI: 10.1371/journal.pntd.0007014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/13/2018] [Accepted: 11/21/2018] [Indexed: 01/01/2023] Open
Abstract
Taiwan is an island located in the south Pacific, a subtropical region that is home to 61 species of snakes. Of these snakes, four species—Trimeresurus stejnegeri, Protobothrops mucrosquamatus, Bungarus multicinctus and Naja atra—account for more than 90% of clinical envenomation cases. Currently, there are two types of bivalent antivenom: hemorrhagic antivenom against the venom of T. stejnegeri and P. mucrosquamatus, and neurotoxic antivenom for treatment of envenomation by B. multicinctus and N. atra. However, no suitable detection kits are available to precisely guide physicians in the use of antivenoms. Here, we sought to develop diagnostic assays for improving the clinical management of snakebite in Taiwan. A two-step affinity purification procedure was used to generate neurotoxic species-specific antibodies (NSS-Abs) and hemorrhagic species-specific antibodies (HSS-Abs) from antivenoms. These two SSAbs were then used to develop a sandwich ELISA (enzyme-linked immunosorbent assay) and a lateral flow assay comprising two test lines. The resulting ELISAs and lateral flow strip assays could successfully discriminate between neurotoxic and hemorrhagic venoms. The limits of quantification (LOQ) of the ELISA for neurotoxic venoms and hemorrhagic venoms were determined to be 0.39 and 0.78 ng/ml, respectively, and the lateral flow strips were capable of detecting neurotoxic and hemorrhagic venoms at concentrations lower than 5 and 50 ng/ml, respectively, in 10–15 min. Tests of lateral flow strips in 21 clinical snakebite cases showed 100% specificity and 100% sensitivity for neurotoxic envenomation, whereas the sensitivity for detecting hemorrhagic envenomation samples was 36.4%. We herein presented a feasible strategy for developing a sensitive sandwich ELISA and lateral flow strip assay for detecting and differentiating venom proteins from hemorrhagic and neurotoxic snakes. A useful snakebite diagnostic guideline according to the lateral flow strip results and clinical symptoms was proposed to help physicians to use antivenoms appropriately. The two-test-line lateral flow strip assay could potentially be applied in an emergency room setting to help physicians diagnose and manage snakebite victims. Snakebite is a public health issue that causes life-threatening medical emergencies. Rapid diagnosis of snakebite in the clinic is a critical necessity in many tropical and subtropical countries, where various venomous snakes are common. Venoms from different snake species contain distinct protein components that require treatment with different antivenoms. However, given the similarity in clinical symptoms among some snake envenomations, it is often challenging for physicians to precisely define the snake species responsible for envenomation. Thus, a reliable method or assay for rapidly diagnosing envenoming species is urgently needed. Here, we present a two-step affinity purification procedure for generating species-specific antibodies (SSAbs) from antivenom, followed by the development of a sandwich ELISA (enzyme-linked immunosorbent assay) and lateral flow strip assay using these SSAbs. This feasible and cost-effective strategy allowed us to develop workable assays for distinguishing between venom proteins from hemorrhagic and neurotoxic snakes in Taiwan. The usefulness of this strategy was demonstrated in the clinic, where both diagnostic assays were shown capable of detecting venoms in blood samples from snakebite patients. Together with the observation of clinical symptoms, the two-test-line lateral flow strip assay is potentially applicable in an emergency room setting to improve snakebite diagnosis and management.
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Affiliation(s)
- Chien-Chun Liu
- Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan
| | - Jau-Song Yu
- Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan
- Department of Cell and Molecular Biology, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan
- Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
| | - Po-Jung Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Yung-Chin Hsiao
- Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan
- Liver Research Center, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan
| | - Chien-Hsin Liu
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - Yen-Chia Chen
- Department of Emergency medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Emergency Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Fang Lai
- Department of Emergency, Buddihist Tzu Chi Hospital, Hualien, Taiwan
| | - Chih-Po Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan
| | - Wen-Chih Fann
- Department of Emergency Medicine, Chia-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Chuan Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- * E-mail:
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Fann WC, Chiang IJ, Hsiao CT, Hong YC, Chen IC. Predicting the mortality of necrotizing fasciitis with blood pressure and white blood cell count. Surgical Practice 2012. [DOI: 10.1111/j.1744-1633.2012.00598.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - I-Jen Chiang
- Graduate Institute of Biomedical Informatics; Taipei Medical University; Taipei
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Chiu FH, Chuang CH, Li WC, Weng YM, Fann WC, Lo HY, Sun C, Wang SH. The association of leptin and C-reactive protein with the cardiovascular risk factors and metabolic syndrome score in Taiwanese adults. Cardiovasc Diabetol 2012; 11:40. [PMID: 22533665 PMCID: PMC3471043 DOI: 10.1186/1475-2840-11-40] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 02/13/2012] [Indexed: 12/12/2022] Open
Abstract
Background Serum C-reactive protein (CRP) and leptin levels have been independently associated with the cardiovascular risk factors. The aim of the present study was to determine if their serum levels were associated with cardiovascular risk factors or metabolic syndrome as well as their correlation in the Taiwanese population. Methods This retrospective study included 999 subjects (> 18 y), who underwent a physical examination in Chang-Gung Memorial Hospital-Linkou and Chiayi in Taiwan. The associations between CRP and/or leptin levels and cardiovascular risk factors and metabolic syndrome were determined using independent two sample t-tests to detect gender differences and chi-square tests to evaluate differences in frequencies. To compare the means of the variables measured among the four groups (high and low leptin and high and low CRP), analysis of variance (ANOVA) was used. Results Both CRP and leptin levels were independently associated with several cardiovascular risk factors, including diabetes, hypercholesterolemia and metabolic syndrome in both men and women (P < 0.05). In addition, a positive correlation between leptin and CRP levels was observed in both genders. Both high-CRP and high-leptin were associated with high blood glucose, waist circumference and serum triglyceride. Whereas increased metabolic syndrome incidence was observed in males with elevated leptin regardless of CRP levels, females with elevated CRP or leptin had increased incidence of metabolic syndrome. Conclusion Both leptin and CRP levels were associated with cardiovascular risk factors as well as metabolic syndrome score in both men and women although gender-specific differences were observed. Thus, CRP and leptin may represent useful biomarkers for predicting the onset of cardiovascular disease or metabolic syndrome in Taiwanese adults. Trial registration IRB/CGMH 100-3514B
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Affiliation(s)
- Feng-Hsiang Chiu
- Department of Occupation Medicine, Chang-Gung Memorial Hospital, Keelung Branch, No, 222 Maijin Rd., Keelung, Taiwan
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Chen IC, Li WC, Hong YC, Shie SS, Fann WC, Hsiao CT. The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis. Crit Care 2011; 15:R152. [PMID: 21693053 PMCID: PMC3219026 DOI: 10.1186/cc10278] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 05/27/2011] [Accepted: 06/21/2011] [Indexed: 11/23/2022]
Abstract
Introduction Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. We investigated the correlation of mortality in NF with bloodstream infection and with the presence of co-morbidities. Methods In this retrospective study, we analyzed 323 patients who presented with necrotizing fasciitis at two different institutions. Bloodstream infection (BSI) was defined as a positive blood culture result. The patients were categorized as survivors and non-survivors. Eleven clinically important variables which were statistically significant by univariate analysis were selected for multivariate regression analysis and a stepwise logistic regression model was developed to determine the association between BSI and mortality. Results Univariate logistic regression analysis showed that patients with hypotension, heart disease, liver disease, presence of Vibrio spp. in wound cultures, presence of fungus in wound cultures, and presence of Streptococcus group A, Aeromonas spp. or Vibrio spp. in blood cultures, had a significantly higher risk of in-hospital mortality. Our multivariate logistic regression analysis showed a higher risk of mortality in patients with pre-existing conditions like hypotension, heart disease, and liver disease. Multivariate logistic regression analysis also showed that presence of Vibrio spp in wound cultures, and presence of Streptococcus Group A in blood cultures were associated with a high risk of mortality while debridement > = 3 was associated with improved survival. Conclusions Mortality in patients with necrotizing fasciitis was significantly associated with the presence of Vibrio in wound cultures and Streptococcus group A in blood cultures.
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Affiliation(s)
- I-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No,6, W, Sec,, Jiapu Rd,, Puzih City, Chiayi County 613, Taiwan
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Lin LC, Fann WC, Chou MH, Chen HW, Su YC, Chen JC. Urine specific gravity as a predictor of early neurological deterioration in acute ischemic stroke. Med Hypotheses 2011; 77:11-4. [PMID: 21444157 DOI: 10.1016/j.mehy.2011.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 03/07/2011] [Indexed: 11/18/2022]
Abstract
We previously found that a blood urea nitrogen/creatinine (BUN/Cr) ratio>15 is an independent predictor of early neurological deterioration after acute ischemic stroke, which suggests that dehydration may be a cause of early deterioration. The aim of this study was to determine whether urine specific gravity, which is another indicator of hydration status and one that is more easily obtained, is also an independent predictor of early deterioration or stroke-in-evolution (SIE). Demographic and clinical data were recorded at admission from patients with acute ischemic stroke who were prospectively enrolled from October 2007 to June 2010. We compared patients with and without stroke-in-evolution (based on an increase of 3 points or more points on the National Institutes of Health Stroke Scale within 3 days). Univariate and multivariate statistical analyses were carried out. A total of 317 patients (43 SIE and 274 non-SIE) were enrolled; the first 196 patients comprised the cohort of our previous study. The only two independent predictors of early deterioration or SIE were BUN/Cr>15 and urine specific gravity>1.010. After adjusting for age and gender, patients with a urine specific gravity>1.010 were 2.78 times more likely to develop SIE (95% CI=1.11-6.96; P=0.030). Urine specific gravity may be useful as an early predictor of early deterioration in patients with acute ischemic stroke. Patients with urine specific gravity ≤ 1.010 therefore may have a reduced likelihood of early neurological deterioration.
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Affiliation(s)
- L C Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan, ROC
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Lin LC, Yang JT, Weng HH, Hsiao CT, Lai SL, Fann WC. Predictors of early clinical deterioration after acute ischemic stroke. Am J Emerg Med 2010; 29:577-81. [PMID: 20825831 DOI: 10.1016/j.ajem.2009.12.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 12/18/2022] Open
Abstract
The measurements for predicting early deterioration of stroke patients is controversial. We studied laboratory measurements and previously identified risk factors to identify factors or predictors of early deterioration after stroke. A prospective observational study of 196 patients with first-time acute ischemic stroke was performed. Demographic data, patient histories, laboratory measurements, and initial stroke severity assessments were recorded. Patients with early deterioration in National Institutes of Health Stroke Scale scores (increase ≥3 points within 3 days) were defined as having stroke-in-evolution (SIE). Thirty patients were diagnosed with SIE. An initial National Institutes of Health Stroke Scale score of 12 or higher, a Glasgow Coma Scale score of 12 or lower, d-dimers more than 1000, or blood urea nitrogen/creatinine (BUN/Cr) ratio higher than 15 were more frequent in SIE patients. After multivariate analysis, only a BUN/Cr higher than 15 was independent predictor of SIE. These patients were 3.41-fold more likely to have SIE (P = .008). These findings suggest that BUN/Cr may be a novel predictor of SIE, potentially useful in emergency departments.
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Affiliation(s)
- Leng C Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan
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Kao JK, Fann WC, Chou MC, Wu MR, Wu YC, Dhundup N, Lin CY. The growth of Tibetan monks in south India--compared to the boys in Taiwan 10 years ago. Acta Paediatr Taiwan 2006; 47:243-8. [PMID: 17352312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Studies comparing the growth of children between Tibetan and Han ethnic groups have not been reported. OBJECTIVE To increase the understanding regarding the growth status of children and the growth difference between the Tibetan and Han ethnic groups. METHODS Body weight, body height, and BMI of 894 Tibetan monks aged from 8-17 years old, residing in South India were collected, while growth information for boys in Taiwan was obtained from the Taiwan growth chart developed in 1997. RESULTS In the 50th percentile, the median height difference between those boys 8 and 17 years of age was 46.8 cm, with a 5-6 cm increase each year. The median weight difference between 8- and 17-year-old groups was 33 kg, with a 0-6.5 kg increase each year. Each year, the BMIs of monks in the 5th, 50th, and 95th percentiles had 3.0-5.4%, 1.6-10%, and 3.1-8.8% increased rates, respectively. The differences of height and weight between the two groups increased between the ages of 9 and 14 years of age, but Taiwan boys and Tibetan monks had nearly the same height and weight at 17 years old. Based on the BMI-for-age curve, there were more Taiwanese boys overweight or obese than Tibetan monks. CONCLUSIONS Even after using the data of ten years ago in Taiwan, Taiwanese boys had superior nutrition and growth status compared with Tibetan monks between the ages of eight and seventeen years, inclusive. In addition, racial differences might also play a significant factor in growth.
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Affiliation(s)
- Jun-Kai Kao
- Department of Pediatrics, Children's Hospital, Changhua Christian Hospital, Taiwan
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