166 results on '"Wang, Tzong-Luen"'
Search Results
152. The International Liaison Committee on Resuscitation-Review of the last 25 years and vision for the future.
- Author
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Perkins GD, Neumar R, Monsieurs KG, Lim SH, Castren M, Nolan JP, Nadkarni V, Montgomery B, Steen P, Cummins R, Chamberlain D, Aickin R, de Caen A, Wang TL, Stanton D, Escalante R, Callaway CW, Soar J, Olasveengen T, Maconochie I, Wyckoff M, Greif R, Singletary EM, O'Connor R, Iwami T, Morrison L, Morley P, Lang E, and Bossaert L
- Subjects
- Forecasting, Global Health, Humans, Life Support Care standards, Practice Guidelines as Topic standards, Consensus, International Cooperation, Resuscitation standards
- Abstract
2017 marks the 25th anniversary of the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to create a forum for collaboration among principal resuscitation councils worldwide. Since then, ILCOR has established and distinguished itself for its pioneering vision and leadership in resuscitation science. By systematically assessing the evidence for resuscitation standards and guidelines and by identifying national and regional differences, ILCOR reached consensus on international resuscitation guidelines in 2000, and on international science and treatment recommendations in 2005, 2010 and 2015. However, local variation and contextualization of guidelines are evident by subtle differences in regional and national resuscitation guidelines. ILCOR's efforts to date have enhanced international cooperation, and progressively more transparent and systematic collection and analysis of pertinent scientific evidence. Going forward, this sets the stage for ILCOR to pursue its vision to save more lives globally through resuscitation., (Copyright © 2017 Elsevier B.V. All rights reserved.)
- Published
- 2017
- Full Text
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153. Effect of preceding medications on resuscitation outcome of out-of-hospital cardiac arrest.
- Author
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Hung SW, Chu CM, Su CF, Tseng LM, and Wang TL
- Subjects
- Aged, Female, Humans, Logistic Models, Male, Multivariate Analysis, Survival Analysis, Treatment Outcome, Out-of-Hospital Cardiac Arrest, Premedication, Resuscitation
- Abstract
As evidence regarding the impact of preceding medications on resuscitation outcomes has been inconsistent, this study aimed to analyze the association between preceding medications and resuscitation outcomes in patients experiencing out-of-hospital cardiac arrest (OHCA). This retrospective study included patients with OHCA presenting to a tertiary care hospital by emergency medical service (EMS) between January 2006 and June 2011. Using the Utstein template, data were collected from EMS and hospital medical records for prehospital care, in-hospital care, and medications which were taken continuously for at least 2 weeks preceding OHCA. Primary outcome was the proportion of patients with a survived event. Multivariable logistic regression analyses were performed to evaluate the predictors of survived events. Among the 1381 included patients with OHCA, 552 (40.0%) patients achieved sustained return of spontaneous circulation and 463 (33.5%) patients survived after resuscitation, 96 (7.0%) patients survived until discharge, and 20 (1.4%) patients had a favorable neurological outcome at discharge. The multivariable analyses revealed that use of statins preceding OHCA was independently associated with a greater probability of a survived events (OR=2.09, 95% CI 1.08 to 4.03, p=0.028).Use of digoxin was adversely associated with survived events (OR=0.39, 95% CI 0.16 to 0.90, p=0.028) in patients with OHCA. The continuous use of statins preceding OHCA was positively associated with survived events, while use of digoxin was adversely related. It deserves more attention on medications preceding OHCA because of their potential effect on resuscitation outcomes., (Copyright © 2017 American Federation for Medical Research.)
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- 2017
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154. A 52-Year-Old Woman with a Palpable Abdominal Mass.
- Author
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Yang YJ, Wu CC, Wang TL, and Lin AC
- Published
- 2016
155. A 33-year-old Man with Abdominal Pain.
- Author
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Chen KC, Chor-Ming Lin A, Wu CC, Wang TL, and Chua CH
- Published
- 2016
156. A 78-Year-Old Woman with Fecaloid Vaginal Discharge.
- Author
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Tsai YF, Chen WY, Chiao CF, Wang TL, and Lin AC
- Published
- 2015
157. Hookworm infestation as unexpected cause of recurrent pancreatitis.
- Author
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Tseng LM, Sun CK, Wang TL, and Lin AC
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- Aged, 80 and over, Animals, Humans, Male, Recurrence, Anthelmintics therapeutic use, Hookworm Infections drug therapy, Pancreatitis drug therapy, Pancreatitis parasitology
- Abstract
Parasite infestation is still associated with significant morbidity and mortality. Hookworm infestation is a very rare cause of pancreatitis. This parasitic infestation might be asymptomatic. Acute pancreatitis as a result of the hookworms migrating into the ampulla of Vater with chronic inflammation was a very rare complication. Were port a case of hookworm infestation that was associated with significant complication of recurrent pancreatitis. The patient was treated with mebendazole. He was asymptomatic and had gained weight at the 3-month follow-up. Our case demonstrates that pancreatitis secondary to hookworm infection can occur and may resolve after anthelmintic treatment.
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- 2014
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158. Traumatic mediastinal hematoma: a potentially fatal condition that may be overlooked by traditional Focused Assessment with Sonography for Trauma.
- Author
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Hsu LW, Chong CF, Wang TL, and Wu BH
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- Accidents, Traffic, Aged, Hematoma surgery, Humans, Male, Mediastinal Diseases surgery, Tomography, X-Ray Computed, Ultrasonography, Hematoma diagnostic imaging, Hematoma etiology, Mediastinal Diseases diagnostic imaging, Mediastinal Diseases etiology, Wounds, Nonpenetrating complications
- Abstract
Mediastinal hematoma is an uncommon finding in blunt chest trauma. It may be caused by aortic injury, by mediastinal vascular injury such as aortic injury, and by fractures of the sternum and vertebral column. A huge mediastinal hematoma can result in extrapericardial cardiac tamponade by compressing the adjacent organs. Although Focused Assessment with Sonography for Trauma (FAST) can reliably assess the presence of pericardial effusion in the subxiphoid view, it may overlook mediastinal hematoma. We present a 67-year-old male victim of blunt chest trauma complicated with expanding anterior mediastinal hematoma that was undetectable with standard FAST protocol. The large mediastinal hematoma can only be seen in the parasternal long-axis view. When ultrasound is used to assess for anteriorly located mediastinal hematoma, the transducer should be positioned in the parasternal or precordial area to scan into the pericardium and mediastinum. However, these 2 views (parasternal and precordial) are not included in emergency department's traditional FAST examination. The subxiphoid view of FAST can easily miss a mediastinal hematoma. For trauma patients with probable mediastinal injuries, we suggest doing an extended FAST with parasternal long-axis view. Alternatively, one should consider lowering the threshold of thoracic computed tomographic scan in patients with persistent symptoms because a missed mediastinal hematoma could be insidious and fatal.
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- 2013
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159. A model to personalize scheduling of complex prescriptions.
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Wang TL, Wu LC, Huang YJ, Lee P, Chu TB, Chung-Jung F, Chen DR, Yang MC, Jian WS, and Li YC
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- Humans, Life Style, Patient Compliance, Drug Administration Schedule, Precision Medicine
- Abstract
Medication adherence tends to affect the recovery of patients. Patients having poor medication adherence show a worsening of their condition and/or increased complications. Unfortunately, between 20% and 50% of chronic patients are unable to manage their medications. This study proposes a model to improve the patients' medication compliance by reducing medication frequency. Published studies have shown that, based on the patients' lifestyle, simplification of the medication frequency and remodeling of the medication schedule is able to help improve medication adherence. Therefore, this study tried to simplify medication frequency by combining therapies. Moreover, by adjusting according to lifestyle, the study also tries to remodel medication timing in relation to mealtimes to create personal medication schedules. In this study, we used 19,393,452 outpatient prescriptions from the National Health Insurance Research Database to verify our system (algorithm optimized). At the same time, we examined the differences between the frequency summarized by general public and experts' advice medication behavior. Compared with the experts' advice method, this system has reduced the medication frequency in about 49% of prescriptions. Using combined medication to simplify medication frequency is able to reduce the medication frequency significantly and improve medication adherence. Furthermore, this should also improve patient recovery, reduce drug hazards and result in less drug wastage., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2011
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160. The role of emergency ultrasound for evaluating acute pyelonephritis in the ED.
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Chen KC, Hung SW, Seow VK, Chong CF, Wang TL, Li YC, and Chang H
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- Acute Disease, Adult, Chi-Square Distribution, Emergency Service, Hospital, Female, Humans, Kidney diagnostic imaging, Kidney Diseases diagnosis, Kidney Diseases diagnostic imaging, Kidney Diseases therapy, Male, Middle Aged, Pyelonephritis diagnosis, Pyelonephritis therapy, Retrospective Studies, Ultrasonography, Pyelonephritis diagnostic imaging
- Abstract
Background: Controversy remains over the imaging method of choice for evaluating acute pyelonephritis (APN) in the emergency department (ED)., Objective: The aim of the study was to determine the efficacy of ultrasound in the diagnosis and management of patients presented to the ED with APN., Methods: This was a retrospective study of prospectively collected data. A cohort of ED patients diagnosed as APN were prospectively registered, and their medical records were then retrospectively reviewed for the presence of complications (admitted >14 days, admission to intensive care unit, or received invasive procedures), significant abnormalities (hydronephrosis, polycystic kidney diseases, renal abscess, emphysematous pyelonephritis), and mild abnormalities (cysts, stones, swelling)., Results: The study included 243 patients. Most of the patients received one or more renal imaging studies (n = 206) and 39.5% of which were considered abnormal. The rates of significant abnormalities on different imaging methods were Kidney-ureter-bladder (KUB), 16.3%; emergency ultrasound (EUS), 39.6%; combination of KUB and EUS, 56.6%; and computed tomography, 58.8%. Factors contributed to complicated APN were elderly, male, a history of preexisting renal diseases, current use of catheters, previous renal calculi, and diabetes mellitus. Significant abnormalities can be identified by EUS in 61% of patients with complicated APN. In fact, the presence of significant sonographic abnormalities effectively diverted 34.3% of patients to receive surgical interventions (percutaneous nephrostomy, abscess aspiration, ureteroscopic stone manipulation, lithotripsy, or nephrectomy)., Conclusion: Structural abnormalities are not uncommon in ED patients with APN. Early assessment of these patients with EUS is likely to have a great impact on their diagnosis and management., (Copyright © 2011 Elsevier Inc. All rights reserved.)
- Published
- 2011
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161. Bedside ultrasonography as a safe and effective tool to diagnose acute epiglottitis.
- Author
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Hung TY, Li S, Chen PS, Wu LT, Yang YJ, Tseng LM, Chen KC, Wang TL, and Hung TY
- Subjects
- Emergency Service, Hospital, Female, Humans, Laryngoscopy, Middle Aged, Point-of-Care Systems, Radiography, Ultrasonography, Epiglottitis diagnostic imaging
- Abstract
Acute epiglottitis is a true airway emergency in the emergency department (ED). The patient may appear very toxic and rapidly progress to respiratory distress and life-threatening condition. The inflammatory process includes not only epiglottis but also the rest of the supraglottic area including the vallecula, aryepiglottic folds, and arytenoids. Soft tissue swelling over this windpipe area can be very dramatic. The criterion standard of diagnosis is direct inspection of cherry red and swollen epiglottis by laryngoscopy in the operation room with immediate access to anesthetists or ear, nose, and throat specialists. However, before the patients are well prepared, the clinical condition may critically go downhill; and any intention to visualize the throat can result in severe and fatal airway spasm. Thumbprint sign on lateral radiography of neck is typical, but it may be extremely risky to let a patient leave the consulting room for the study if respiratory distress has developed. We demonstrate a safe and practical way to investigate the epiglottis by bedside ultrasonography to visualize the "alphabet P sign" in a longitudinal view through thyrohyoid membrane by emergency physician in the ED.
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- 2011
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162. Submassive pulmonary embolism in a middle-age man with trivial avulsion fracture.
- Author
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Hung TY, Wang TL, Wang RF, and Hung TY
- Subjects
- Accidents, Traffic, Adult, Humans, Male, Pulmonary Embolism diagnosis, Pulmonary Embolism diagnostic imaging, Radiography, Fractures, Cartilage complications, Posterior Cruciate Ligament injuries, Pulmonary Embolism etiology
- Published
- 2010
- Full Text
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163. Rapid diagnosis of jejunojejunal intussusception by an emergency physician-performed bedside ultrasound.
- Author
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Chen KC, Hung TY, Wang TH, Wang TL, and Chong CF
- Subjects
- Aged, Emergency Service, Hospital, Humans, Male, Ultrasonography, Intussusception diagnostic imaging, Jejunal Diseases diagnostic imaging
- Published
- 2010
- Full Text
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164. The effect of different relieving methods on the outcome of out-of-hospital cardiac arrest patients with nontraumatic hemopericardium in the ED.
- Author
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Wang RF, Chao CC, Wang TL, Chen KC, Chong CF, Huang KH, and Chen CC
- Subjects
- Aged, Aged, 80 and over, Cardiopulmonary Resuscitation, Decompression, Surgical, Drainage, Emergency Medical Services, Female, Heart Arrest complications, Humans, Male, Middle Aged, Pericardial Effusion complications, Survival Analysis, Treatment Outcome, Catheterization, Heart Arrest therapy, Pericardial Effusion therapy, Pericardiectomy, Pericardiocentesis
- Abstract
Aims: This study aimed to assess the impact of different methods of draining nontraumatic hemopericardium on outcome from patients with out-of-hospital cardiac arrest (OHCA), identify independent predictors of return of spontaneous circulation (ROSC), and examine the ineffective rate of decompression based on subxiphoid pericardiotomy (SP) and percutaneous pericardial catheter drainage (PCD)., Methods: Adult patients with OHCA who presented to the ED between May 1, 2000, and October 30, 2006, with moderate to massive nontraumatic hemopericardium were recruited and stratified into 4 groups according to the relieving methods of hemopericardium. Charts were reviewed for various demographic data, resuscitation records, management, and outcome. Patient outcome was recorded as survival to hospital discharge and ROSC, as primary end points. Effective decompression was recorded as a secondary end point. We compared the outcome between the groups., Results: A total of 1491 OHCA resuscitation records were prospective collected. There were 23 OHCA patients with moderate to massive nontraumatic hemopericardium. The overall ROSC rate was 39.1% (9/23). There was a clear difference in the ROSC rate between 4 groups (P < .05). The overall rate of survival to hospital discharge was 4.3% (1/23). There was no significant difference in the rate of survival to hospital discharge between the groups. Relieving methods was an independent predictor of ROSC in OHCA patients with nontraumatic hemopericardium (odds ratio, 0.17; 95% confidence interval, 0.4-0.70). There was a significant statistical difference in adequate relief of hemopericardium based on SP and PCD (P < .01)., Conclusion: The early effective decompression method is associated with an increased rate of ROSC for OHCA patients with nontraumatic hemopericardium. Subxiphoid pericardiotomy has a better effective decompression of hemopericardium than PCD.
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- 2008
- Full Text
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165. Results of blind subxyphoid pericardiotomy (BSP) for cardiac tamponade.
- Author
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Wang RF, Chong CF, Wang TL, and Chen CC
- Subjects
- Cardiac Tamponade etiology, Humans, Pericardial Effusion complications, Treatment Outcome, Cardiac Tamponade surgery, Pericardial Effusion surgery, Pericardiectomy methods
- Published
- 2007
- Full Text
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166. Stratification of adverse outcomes by preoperative risk factors in coronary artery bypass graft patients: an artificial neural network prediction model.
- Author
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Chong CF, Li YC, Wang TL, and Chang H
- Subjects
- Cardiopulmonary Bypass, Coronary Disease complications, Coronary Disease physiopathology, Cross-Sectional Studies, Female, Humans, Logistic Models, Male, Middle Aged, Postoperative Complications, Prognosis, ROC Curve, Retrospective Studies, Risk Factors, Treatment Outcome, Coronary Artery Bypass adverse effects, Coronary Disease surgery, Neural Networks, Computer
- Abstract
We constructed and internally validated an artificial neural network (ANN) model for prediction of in-hospital major adverse outcomes (defined as death, cardiac arrest, coma, renal failure, cerebrovascular accident, reinfarction, or prolonged mechanical ventilation) in patients who received "on-pump" coronary artery bypass grafting (CABG) surgery. We retrospectively analyzed a 5-year CABG surgery database with a final study population of 563 patients. Predictive variables were limited to information available before the procedure, and outcome variables were represented only by events that occurred postoperatively. The ANN's ability to discriminate outcomes was assessed using receiver-operating characteristic (ROC) analysis and the results were compared with a multivariate logistic regression (LR) model and the QMMI risk score (RS) model. A major adverse outcome occurred in 12.3% of all patients and 18 predictive variables were identified by the ANN model. Pairwise comparison showed that the ANN model significantly outperformed the RS model (AUC = 0.886 vs.0.752, p = 0.043). However, the other two pairs, ANN vs. LR models (AUC = 0.886 vs. 0.807, p = 0.076) and LR vs. RS models (AUC = 0.807 vs. 0.752, p = 0.453) performed similarly well. ANNs tend to outperform regression models and might be a useful screening tool to stratify CABG candidates preoperatively into high-risk and low-risk groups.
- Published
- 2003
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