Effect of population-based training programs on bystander willingness to perform cardiopulmonary resuscitation

Objective. This study was performed to determine the factors related to unwillingness of bystanders to perform cardiopulmonary resuscitation (CPR), and improvement of willingness among the lay public after CPR training. Design. Retrospective design Methods. We collected questionnaires received from laypersons attending CPR training courses implemented by the CPR Improvement Program of Chang Gung Memorial Foundation. Pre- and post-training questionnaires were given to participants attending CPR training courses between September 2013 and January 2014. Results. Among the 401 respondents at pre-training, higher educational level (odds ratio, 3.605; 95% confidence interval [CI], 3.055 – 8.284) and previous CPR training (odds ratio, 1.754; 95% CI, 1.049 – 2.932) were significantly associated with willingness to perform bystander CPR. Significant improvements in willingness to perform conventional CPR and hands-only CPR on a stranger were observed after training (P = 0.016 and P < 0.0001, respectively). Approximately half of the respondents claimed that fear of doing further harm was the primary reason for their lack of willingness to administer conventional CPR on a stranger. Conclusions. We showed that CPR training significantly increased the rate of willingness to perform CPR on strangers as well as acquaintances among the lay public. This study also showed that fear of doing further harm was the most significant barrier after training. This concern should be addressed in future training programs

Factors Affecting Psychological and Health-Related Quality-of-Life Status in Children and Adolescents with Congenital Heart Diseases

Congenital heart disease (CHD), a severe cardiac defect in children, has unclear influences on young patients. We aimed to find the impacts of differently structure heart defects and various treatments on psychology and health-related quality of life (HRQoL) in CHD children and adolescents. CHD patients aged between 6 and 18 years old visited our hospital from 1 May 2018 to 31 September 2018, and their principal caregivers were asked to participate. We used two validated questionnaires, Children Depression Inventory-TW (CDI-TW) and Child Health Questionnaire—Parent Form 50 (CHQ-PF 50), to evaluate CHD patients’ psychological and HRQoL conditions. Participants were grouped based on their cardiac defects and previous treatments. We analyzed the results via summary independent-samples t-test with post hoc Bonferroni correction and multivariant analysis. Two hundred and seventy-seven children and their principal caregivers were involved. There was no apparent depressive condition in any group. Single cardiac defect patients exhibited similar HRQoL to controls; simultaneously, those with cyanotic heart disease (CyHD), most multiple/complex CHDs children and adolescents, and those who received invasive treatments had poorer HRQoL. CyHD impacted the most on patients’ psychological and HRQoL status. Patients with sole cardiac defect could live near-normal lifes; on the other hand, CyHD had the worst effects on patients’ psychology and HRQoL

plosone_AFT.csv

MBD patient

Dynamic Relationship Between Time and Serum Cholinesterase in Organophosphate-Poisoned Patients with Linear Mixed Model

簡介 — 有機磷在世界各地廣泛地被使用於農業及環境衛生上，而中毒事件也層出不窮。其主要機轉為身體膽鹼酯酶受有機磷抑制導致乙醯膽鹼過度刺激結後神經元或器官受器產生如腺體分泌物增加、肌肉無力、甚至昏迷等種種症狀。有機磷中毒病患血清膽鹼酯酶(SChE)在中毒後隨時間的變化相當程度代表了病患復元的情況，但每位病人的SChE具重覆測量的特性，相同病人檢驗值間將會出現相關性問題。線性混合模型為醫學上常用來處理重覆測量資料的方法之一，最主要是在模型中加入隨機效應來克服組內資料之間的相關性，並由隨機誤差中加以分離。本研究主旨為利用統計混合模型來探討有機磷中毒病患血清膽鹼酯酶(SChE)的恢復情形。 方法 —本研究之假說為有機磷中毒病患血清膽鹼酯酶與時間呈某種程度的相關性；不同病人血清膽鹼酯酶的初值與上升速度存在著個體差異；以及部份相關臨床因子會對膽鹼酯酶上升趨勢有影響。利用回溯性研究設計，收集自2000年至2010年因急性有機磷中毒至某醫學中心急診就診之成人病患共212位，由排除條件刪除81位餘下131位病患相關資料及共859筆SChE濃度資料。並收集病患個人基本資料、第一次生命徵象及嚴重度評估、各項檢查檢驗數據、中毒相關因素、接受的治療、各次SChE檢驗時間與結果、及預後等變項作分析。統計方法使用混合模型中的隨機係數模型，加入個人隨機截距效應及時間的隨機斜率，再放入臨床相關因子，並與一般線性回歸模型作比較。 結果 —有機磷中毒病患不論中毒物質種類、過去病史、就醫時間、症狀等等均存在很大的差異性，但多數病人的初次SChE濃度均有明顯的降低。SChE的分析呈現右偏分佈，經過對數轉換後(LSChE)分佈趨於對稱。LSChE的相關性矩陣顯示出各次測量值間確有正相關，且相關性由相鄰測量開始依測量間隔時間增加而逐漸遞減。混合模型的模型配適度顯著地較固定效應模型改善許多，可見中毒病患的嚴重度及復原過程的確存在很大的個人差異。混合模型配適的結果顯示病人LSChE濃度高低與時間、有機磷種類、初次測量值有關，而其隨著時間上升的斜率則與有機磷種類、初次測量值、及疾病嚴重度有關。在有機磷種類方面怖飛松(profenophos)有較低的SChE濃度、陶斯松(chlorpyrifos)的SChE上升趨勢較緩慢、達馬松(methamidophos)則上升趨勢較快。疾病嚴重程度較高、初次測量值較高的病患有較平緩的上升趨勢。性別、前24小時解毒劑2-PAM使用劑量、延遲就醫時間、與時間二次方均與上升趨勢相關性不顯著。 結論 — 本論文探討了有機磷中毒病患血清膽鹼酯酶濃度在復元過程的上升趨勢，研究結果可作為未來建構有機磷中毒病患復元模式的基礎。Introduction—Organophosphate poisoning (OPP) occurs worldwide, accounting for 200,000 deaths annually in developing countries. Organophosphorus compounds inhibit the activity of cholinesterase and result in the over-activation of acetylcholine on autonomic ganglia and end organs. Serum cholinesterase (SChE) is of diagnostic value in OPP patients and often checked repeatedly during the treatment course. Most of the previous studies on OPP patients focused on mortality and disease severity, while the recovery pattern of SChE has been rarely addressed. To deal with the repeated measured SChE, correlation within the same patient must be taken into account. The linear mixed model is one of the most commonly used methods in repeated measures of normal data. It adds random effects in order to capture variance resulting from between-cluster level as well as intra-cluster correlation. This study aimed to investigate the dynamic relationship between SChE and time in OPP patients using linear mixed models. Material and Methods—This study is a retrospective cohort study, utilizing medical records from a medical center in Taoyuan, Taiwan. A total of 212 adult patients who visited the emergency room between 2000 and 2010 due to acute OPP were included, and 131 patients were analyzed after exclusion of 81 patients by criteria. Information regarding basic personal characteristics, first vital signs and severity scores, lab data, type and ingestion amount of organophosphate, treatment, and serial SChE value were collected. Random coefficient model with random intercept and random slope of time were added to address the dynamic relationships of SChE with time and associated factors. Results—Organophosphate-poisoned patients differ significantly in baseline characteristics, but most patients had lowered initial SChE levels. The histogram of SChE revealed a positively skewed distribution and thus log-transformed SChE (LSChE) was used as the dependent variable. Serial LSChE showed a positive correlation with decreasing magnitude as the time gap increased. The goodness of fit significantly improved after random intercepts and random slopes of time were added to a linear mixed model. Time, type of organophosphate, and first LSChE level were independently related with LSChE level, while type of organophosphate, first LSChE level, and disease severity score were significantly related with the slope of time. Profenophos has lowest LSChE levels among all types of organophosphate. Chlorpyrifos and methamidophos had significant slower and faster rates of LSChE recovery compared with other organophosphates, respectively. Sex, dose of 2-PAM during the initial 24 hours, delay of medical assistance, and quadratic form of time did not significantly affect the recovery of LSChE. Conclusion—This study constructed a model for recovery of SChE in OPP patients. Several major determinants responsible for the recovery of SChE were also identified. It can be used as a prototype model in further studies on OPP. Clinicians may also make use of such information to guide clinical decisions during initial period of treatment

Emergency residents' self-perceived readiness for practice: the association of milestones, entrustable professional activities, and professional identities—a multi-institutional survey

BackgroundAs a successful innovation, competency-based medical education and its assessment tools continue to be a key strategy in training future doctors and tracking their performance trajectories. Linked to professional identity, evidence suggests that clinical competence is related to thinking, acting and feeling like a physician. Thus, incorporating the values and attitudes of healthcare professions as part of their professional identity in the clinical workplace improves professional performance.MethodsThrough a cross-sectional study, we examined the association of milestone, entrustable professional activities (EPA) and professional identity using self-reported tools among emergency medicine residents from 12 teaching hospitals across Taiwan. Milestone, EPA and professional identity were assessed using the Emergency Medicine Milestone Scale, Entrustable Professional Activity Scale and Emergency Physician Professional Identity and Value Scale, respectively.ResultsThe results of a Pearson correlation indicated a significant positive correlation between milestone-based core competencies and EPAs (r = 0.40 ~ 0.74, p &lt; 0.01). The professional identity domain of skills acquisition, capabilities and practical wisdom was positively correlated with milestone-based core competencies of patient care, medical knowledge, practice-based learning and improvement, and system-based practice (r = 0.18 ~ 0.21, p ≤ 0.05), and six items of EPA (r = 0.16 ~ 0.22, p &lt; 0.05). Additionally, the professional identity domain of professional recognition and self-esteem was positively correlated with practice-based learning and improvement, and system-based practice milestone competencies (r = 0.16 ~ 0.19, p &lt; 0.05).ConclusionThis study demonstrates milestone and EPA assessment tools are highly linked and therefore, can be synergistically used by supervisors and clinical educators to evaluate clinical performance during residency training. Emergency physicians’ professional identity is partly influenced by the advancement of skills and a resident’s ability to learn, effectively perform tasks and make appropriate medical decisions at the system level in their clinical practice. Further research is warranted to understand the importance of residents’ competency in relation to their professional identity development trajectory during clinical training

An investigation of snakebite antivenom usage in Taiwan

Four types of antivenom are used to treat snakebites by the six species of venomous snakes native to Taiwan. Research into antivenom use in Taiwan and its outcomes, as well as the utility of current Taiwan Poison Control Center guidelines for antivenom use, has been limited. We aimed to provide increased understanding by investigating the treatment and outcomes of patients treated for snakebite in Taiwan. Methods: On the basis of data collected from the 2009 Taiwan National Health Insurance database, patients with snakebites were identified and categorized into two sets of groups according to types of antivenom administered. The relationships between antivenom types, dosage and the variables of antibiotic use, surgical intervention, acute respiratory failure acute, renal failure, antivenom-related allergic reaction, mortality, need for hospital admission, and length of hospitalization were analyzed by multivariate logistic regression and the Kruskal–Wallis test. Results: The majority of patients were successfully treated by administration of 1 vial of antivenom and discharged without complications. However, patients treated for neurotoxic-type venom snakebite required administration of larger doses of antivenom and > 30% required surgical intervention, particularly those treated for Chinese cobra snakebite. Approximately 10% of patients were administered two types of antivenom. Conclusion: The results partially support Taiwan Poison Control Center guidelines for treating the hemorrhagic-type venom snakebite. However, deficit in the guidelines for treatment of neurotoxic-type venom snakebite is obvious and new guidelines for treatment of neurotoxic-type venom snakebite and diagnosis should be developed

The Progress of Emergency Medicine in Taiwan, China, and Hong Kong: Perspective from Publications in Emergency Medicine Journals, 1992–2011

Study Objective. The progress of emergency medicine (EM) in Taiwan, China, and Hong Kong was evaluated from the perspective of publications in EM journals. Methods. This was a retrospective study. All articles published from 1992 to 2011 in all journals in the EM category in the 2010 Journal Citation Reports (JCR) were included. A computerized literature search was conducted using the SciVerse Scopus database. The slope (β) of the linear regression was used to evaluate the trends in the numbers of articles as well as the ratios to the total number of EM journal articles. Results. The trends in the numbers of articles from Taiwan, China, and Hong Kong were 6.170, 1.908, and 2.835 and the trends in the ratios of their publication numbers to the total number of EM journal articles were 15.0 × 10−4, 4.60 × 10−4, and 6.80 × 10−4, respectively. All P-values were <0.01. The mean, median, and 75th percentiles of the number of citations in all EM journals were greater than those of these three areas. Conclusions. The publications from Taiwan, China, and Hong Kong have increased at a higher rate than those of the overall EM field in the past 20 years and indicated the rapid progress in these three areas

SARS-CoV-2 rapid antigen testing positive rate in community testing stations as an indicator for COVID-19 epidemic trend, Taipei, Taiwan, May to August 2021

Background: Real-time surveillance of COVID-19 in large-scale community outbreaks presents challenges. Simple counts of the daily confirmed cases can be misleading due to constraints from bottlenecks in access to care or laboratory testing. This study aimed to investigate the role of the SARS-CoV-2 antigen rapid diagnostic test (Ag-RDT) in addressing these challenges for real-time COVID-19 surveillance. Methods: This study included the results of 86,933 SARS-CoV-2 Ag-RDT and real-time reverse transcription polymerase chain reaction (RT-PCR) tests. These were conducted at four community testing stations within the Taipei metropolitan area during a community COVID-19 outbreak spanning from May 17, 2021, to August 9, 2021. We examined the correlation between the positive rates of Ag-RDT tests and the epidemic curve of laboratory-confirmed COVID-19 cases by onset date to examine its role in real-time surveillance. Results: During the 85-day study period, the trend of Ag-RDT test positive rates paralleled that of the epidemic curve. The correlation between the Ag-RDT positive rate and the number of cases (Pearson correlation coefficient: 0.968) is comparable to that of the RT-PCR positive rate (Pearson correlation coefficient: 0.964). The Ag-RDT positive rate exhibited a more advanced leading trend, with Ag-RDT leading by 3 days in comparison to the 2-day lead for RT-PCR. Conclusion: The positive rate of SARS-CoV-2 Ag-RDT tests at community testing stations serves as a good surrogate for assessing virus activity within the community and a useful tool for real-time COVID-19 surveillance. It is a robust indicator of the outbreak trend and near-term numbers of cases. This finding may facilitate the management of subsequent outbreaks of emerging infectious diseases

Predicting Length of Stay among Patients Discharged from the Emergency Department-Using an Accelerated Failure Time Model.

BACKGROUND:Emergency department (ED) crowding continues to be an important health care issue in modern countries. Among the many crucial quality indicators for monitoring the throughput process, a patient's length of stay (LOS) is considered the most important one since it is both the cause and the result of ED crowding. The aim of this study is to identify and quantify the influence of different patient-related or diagnostic activities-related factors on the ED LOS of discharged patients. METHODS:This is a retrospective electronic data analysis. All patients who were discharged from the ED of a tertiary teaching hospital in 2013 were included. A multivariate accelerated failure time model was used to analyze the influence of the collected covariates on patient LOS. RESULTS:A total of 106,206 patients were included for analysis with an overall medium ED LOS of 1.46 (interquartile range = 2.03) hours. Among them, 96% were discharged by a physician, 3.5% discharged against medical advice, 0.5% left without notice, and only 0.02% left without being seen by a physician. In the multivariate analysis, increased age (>80 vs <20, time ratio (TR) = 1.408, p<0.0001), higher acuity level (triage level I vs. level V, TR = 1.343, p<0.0001), transferred patients (TR = 1.350, p<0.0001), X-rays obtained (TR = 1.181, p<0.0001), CT scans obtained (TR = 1.515, p<0.0001), laboratory tests (TR = 2.654, p<0.0001), consultation provided (TR = 1.631, p<0.0001), observation provided (TR = 8.435, p<0.0001), critical condition declared (TR = 1.205, p<0.0001), day-shift arrival (TR = 1.223, p<0.0001), and an increased ED daily census (TR = 1.057, p<0.0001) lengthened the ED LOS with various effect sizes. On the other hand, male sex (TR = 0.982, p = 0.002), weekend arrival (TR = 0.928, p<0.0001), and adult non-trauma patients (compared with pediatric non-trauma, TR = 0.687, p<0.0001) were associated with shortened ED LOS. A prediction diagram was made accordingly and compared with the actual LOS. CONCLUSIONS:The influential factors on the ED LOS in discharged patients were identified and quantified in the current study. The model's predicted ED LOS may provide useful information for physicians or patients to better anticipate an individual's LOS and to help the administrative level plan its staffing policy