INFORMED CONSENT FOR TRAUMA PATIENTS: AN EXPERIMENT TO IMPROVE TAIWANESE PATIENT KNOWLEDGE AND SATISFACTION AFTER INFORMED CONSENT FOR DEBRIDEMENT OF COMPLICATED WOUNDS

Background: Valid informed consent is an ethical fundamental element and a prerequisite of law and regulation for clinical treatment. Trauma patients with physical pain and emotional stress under an environment of time constraint in emergency settings usually have difficulty in understanding the information presented to them. It is vital that physicians convey any complicated treatment information to patients, and patients need to have adequate knowledge about the treatment to facilitate individual choice. Aims: The study has three aims. The first aim is to explore what the current state of art for informed consent is, and how we can improve the quality of the informed consent process for trauma patients in the emergency department. The second aim is to develop an audiovisual video containing the information for the informed consent process in trauma patients undergoing the surgery, and to develop and validate a knowledge measure instrument to quantify the understanding of trauma patients for informed consent to surgery. The third aim is to compare the understanding and satisfaction of trauma patients between video and routine informed consent groups. Methods: To address the first aim, a systematic review is conducted to identify relevant articles. To address the second aim, an audiovisual video including information about the surgical procedure, benefits, risks, and alternatives is developed. One panel of experts is invited to develop the script for the video based upon the consensus from the modified Delphi technique. Furthermore, the development of the knowledge measure instrument is based on the literature and the consensus of experts. To address the third aim, a prospective randomized controlled trial is conducted in the emergency department, and a convenience sample of targeted trauma patients is enrolled. Findings: From the literature, it is found that trauma patients have poor recall of risks and complications, while written information, pamphlets or video have positive effect on patients’ understanding and satisfaction. Modified Delphi technique is a useful method to collect and reach experts’ consensus to develop the contents of informed consent. Moreover, the audiovisual video containing information about informed consent to surgery for trauma patients was developed and pilot-tested as well as the knowledge measure instrument for evaluating the understanding of trauma patients. Furthermore, by using the educational video, patients were found to have better information, more understanding and higher satisfaction. The video-assisted method is, accordingly, a good vehicle for improving the informed consent process for trauma patients in the emergency department. Conclusion: The content of informed consent should be developed by integrating a variety of experts’ opinions, especially patients. Using educational videos is a good tool for improving informed consent process for the surgery in trauma patients. Future studies should be conducted to develop a structured and standardized informed consent process and evaluate the effectiveness in combination with healthcare providers, patients, and informed consent experts. Institutions should give top priority to ensure patient-centered health care and improved quality of care for trauma patients

Seismic Fragility Analysis for Sheet Pile Wharves — Case Study of the Hualien Harbor in Taiwan

The seismic fragility curves represent the conditional probabilities that the structural damage meets or exceeds the specified damage states at various levels of the ground motion parameters, such as peak ground acceleration (PGA). In this study, the seismic fragility analysis for the sheet pile wharves of the Hualien Harbor in Taiwan was performed. The finite element analysis software PLAXIS was adopted for the nonlinear dynamic analysis. The time histories of several representative earthquake events that actually occurred in Taiwan, including the 1999 Chi-Chi Earthquake, were scaled to various PGA levels as the input motions. Then the seismic responses of the sheet pile wharves subjected to these earthquakes of different intensities were obtained. It is assumed that the maximum residual displacement at the top of the sheet pile wall is lognormal distributed. Thus, the conditional exceedance probabilities of each specified damage state at different levels of PGA were estimated according to the displacement threshold value of each damage state, and the fragility curves were deduced. Moreover, these fragility curves were parameterized assuming they can be well approximated by the lognormal cumulative probability function, which is important for the rapid estimation of earthquake loss

The Announcement Effect of Monetary Policy on the Corporate Bond Markets

This study investigates the impact of the central bank’s monetary policy announcements on the perceptions of yield spread in corporate bond markets under the event of extreme events. These results highlight that the coronavirus pandemic has caused a market panic in the global economy. This caused investors to withdraw their money from bond markets, which caused a liquidity crisis in bond markets. The Fed announcements caused statistically significant tightening on US and global investment grades and high-yield corporate bond spreads. The Euro investment grade and high-yield corporate bond spread narrowed when the Fed took additional actions to provide more funds and expanded the buying scope to support market liquidity. These results suggest that forward guidance that emphasizes the Fed’s monetary policy causes stronger information effects

The association between problematic cellular phone use and risky behaviors and low self-esteem among Taiwanese adolescents

<p>Abstract</p> <p>Background</p> <p>Cellular phone use (CPU) is an important part of life for many adolescents. However, problematic CPU may complicate physiological and psychological problems. The aim of our study was to examine the associations between problematic CPU and a series of risky behaviors and low self-esteem in Taiwanese adolescents.</p> <p>Methods</p> <p>A total of 11,111 adolescent students in Southern Taiwan were randomly selected into this study. We used the Problematic Cellular Phone Use Questionnaire to identify the adolescents with problematic CPU. Meanwhile, a series of risky behaviors and self-esteem were evaluated. Multilevel logistic regression analyses were employed to examine the associations between problematic CPU and risky behaviors and low self-esteem regarding gender and age.</p> <p>Results</p> <p>The results indicated that positive associations were found between problematic CPU and aggression, insomnia, smoking cigarettes, suicidal tendencies, and low self-esteem in all groups with different sexes and ages. However, gender and age differences existed in the associations between problematic CPU and suspension from school, criminal records, tattooing, short nocturnal sleep duration, unprotected sex, illicit drugs use, drinking alcohol and chewing betel nuts.</p> <p>Conclusions</p> <p>There were positive associations between problematic CPU and a series of risky behaviors and low self-esteem in Taiwanese adolescents. It is worthy for parents and mental health professionals to pay attention to adolescents' problematic CPU.</p

Immunomodulatory properties of human adult and fetal multipotent mesenchymal stem cells

In recent years, a large number of studies have contributed to our understanding of the immunomodulatory mechanisms used by multipotent mesenchymal stem cells (MSCs). Initially isolated from the bone marrow (BM), MSCs have been found in many tissues but the strong immunomodulatory properties are best studied in BM MSCs. The immunomodulatory effects of BM MSCs are wide, extending to T lymphocytes and dendritic cells, and are therapeutically useful for treatment of immune-related diseases including graft-versus-host disease as well as possibly autoimmune diseases. However, BM MSCs are very rare cells and require an invasive procedure for procurement. Recently, MSCs have also been found in fetal-stage embryo-proper and extra-embryonic tissues, and these human fetal MSCs (F-MSCs) have a higher proliferative profile, and are capable of multilineage differentiation as well as exert strong immunomodulatory effects. As such, these F-MSCs can be viewed as alternative sources of MSCs. We review here the current understanding of the mechanisms behind the immunomodulatory properties of BM MSCs and F-MSCs. An increase in our understanding of MSC suppressor mechanisms will offer insights for prevalent clinical use of these versatile adult stem cells in the near future

Commentary on: Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research : Excessive behaviors are not necessarily addictive behaviors

Background and Aims The commentary aims to provide clarity to the article “Are we overpathologizing everyday life? A tenable blueprint for behavioral addiction research.” Methods We provide another viewpoint for the important issues of behavior addiction. Result The course of behavior addiction should be further studied. The criteria of withdrawal and tolerance of behavior addiction are ill-defined and need to be further evaluated. Conclusions The etiology, course, presentation, and functional impairment of behavior addiction should be validated by evidencebased data before being defined as a disorder

Persistent and multisite homophobic harassment during childhood and adolescence and its association with school difficulties in gay and bisexual men in Taiwan

Background: Homophobic harassment can compromise mental health of sexual minority youths. Objectives: This study examined the rates of persistent and multisite homophobic harassment and their associations with school difficulties during childhood and adolescence among gay and bisexual men in Taiwan. Methods: Participants were recruited through advertisements on the Facebook, Bulletin Board Systems, and the home pages of health promotion and counseling centers for the gay, lesbian, and bisexual community. The experiences of traditional and cyber harassment based on gender role nonconformity and sexual orientation of 500 gay or bisexual men were examined. The associations of multisite and persistent harassment victimization with school difficulties were evaluated. Results: A total of 239 (47.8%) and 131 (26.2%) participants experienced persistent and multisite harassment victimization, respectively. Harassment victimization was significantly associated with low satisfaction with academic performance in any stage of study. Moreover, the participants who were harassed in senior high schools were more likely to miss classes or be truant than those who were not harassed. The victims of multisite harassment at senior high schools were more likely to miss classes or be truant than those of school-only harassment. Discussion: Prevention and intervention programs are warranted to reduce homophobic harassment in sexual minority youths