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Shared decision making is a patient-centered clinical decision-making process that allows healthcare workers to share the existing empirical medical outcomes with patients before making critical decisions. This study aims to explore a project in a medical center of developing a mobile SDM in Taiwan. Chi Mei Medical Center developed the mobile SDM platform and conducted a survey of evaluation from healthcare workers. A three-tier platform that based on cloud infrastructure with seven functionalities was developed. The survey revealed that healthcare workers with sufficient SDM knowledge have an antecedent effect on the three perceptive factors of acceptance of mobile SDM. Resistance to change and perceived ease of use show significant effect on behavioral intention. We provided a comprehensive architecture of mobile SDM and observed the implementation in a medical center. The majority of healthcare workers expressed their acceptancem; however, resistance to change still present. It is, therefore, necessary to be eliminated by continuously promoting activities that highlight the advantages of the Mobile SDM platform. In clinical practice, we validated that the mobile SDM provides patients and their families with an easy way to express their concerns to healthcare workers improving significantly their relationship with each other.

Background/Purpose: To explore the association of patient injury patterns and entrapped locations inside damaged buildings in the 2016 Taiwan earthquake. Methods: A retrospective analysis was conducted using the Tainan incident registry system. Residents inside nine conjunctive, 16-story (49.3 m in height) reinforced concrete buildings were categorized as non-injured, injured, and dead. Residents were classified into different groups according to their entrapped locations in height and the severity of building damage. The field triage acuity and trauma severity among groups were compared. Statistical significance was set at the level of 0.05. Results: There were 309 enrollees with 76 (24.6%) non-injured, 118 (38.2%) injured, and 115 (37.2%) dead. Residents either in the high floors (odds ratio [OR] = 2.9, 95% CI: 1.5–5.8, p = 0.003) or in the collapsed buildings (OR = 18.2, 95% CI: 7.6–43.6, p

A patient-centered communication platform which lays the foundations for implementing shared decision making is indispensible for and can facilitate interprofessional collaboration for optimal patient care. To that end, we proposed a project to develop a patient-centered platform to support shared decision making (SDM) in a Taiwanese medical center. This SDM platform lay special focuses on patient care area and communication area, allowing the stakeholders to participate in deciding and choosing the most suitable treatment option for the patients. After the implementation of this SDM platform, patients and their relatives reveal a higher percentage of satisfaction and interest in such a joint decision model regarding how patients get their appropriate treatments.

Idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) is defined as a set of symptoms perceived by individuals when they are exposed to electromagnetic fields (EMF).Th...

The 81-year-old male presented with progressive headache and was diagnosed as bilateral chronic subdural hemorrhage (SDH). He has history of hypertension, coronary artery disease and hyperlipidemia. Burr-hole craniostomy for removal of SDH was performed. However, deteriorated consciousness and seizure happened after removal of bilateral external ventricular drainage (EVD) on postoperative Day 3. The brain computed tomography (CT) scan showed bilateral tension pneumocephalus with significant mass effect and Mount Fuji sign. The patient underwent an emergency burr hole operation and the insertion of bilateral EVD. During the operation, the air bubbled out when the dura was opened. The patient’s consciousness subsequently improved and postoperative CT imaging showed considerable reduction in the pneumocephalus with relieved mass effect. Finally, the patient discharged with recovery neurological condition on the admission Day 11.

The standard treatment of peritoneal dialysis peritonitis (PD peritonitis) is intraperitoneal antibiotic therapy. In patients with PD peritonitis complicated by bacteremia, intraperitoneal antibiotics combined with elective removal of the infected intraperitoneal catheter may be inadequate. We collected data of all patients with PD peritonitis admitted to Chi-Mei Medical Center during a 4-year period. We reviewed the medical records of the study cohort and collected their in-hospital details. Patients with positive blood culture results were assigned to the bacteremia group, whereas those with negative blood culture results were assigned to the peritonitis-only group. We discovered that 11.0% of patients with PD peritonitis had bacteremia complications, and immunocompromised comorbidities were more common in the bacteremia group than in the peritonitis-only group (66.7% vs 37.2%, P = .022). Additionally, the bacteremia group exhibited higher temperatures, greater respiratory rates, and lower serum sodium levels than the peritonitis-only group (temperature, 37.7 vs 37.2 °C, P = .014; respiratory rate, 19.1 vs 17.9 rate/min, P = .008; serum sodium level, 130.3 vs 132.7 mEq/L, P = .031). No mortality was found in patients with PD peritonitis complicated by bacteremia after intravenous and intraperitoneal antibiotic therapy. More than 1 in 10 patients with PD peritonitis was complicated by bacteremia, which resulted in extensive systemic derangements. Patients with immunocompromised comorbidities carried a higher risk of developing bacteremia, resulting in prolonged hospital stays. Combination of intraperitoneal and intravenous antibiotics therapies achieved fair prognoses in patients with PD peritonitis complicated by bacteremia.

To evaluate the associations between exposure to arsenic in drinking water and the progression of chronic kidney disease (CKD), we conducted a study in Taiwan. We recruited 8854 participants from a nationwide health screening program from 2000 to 2009 who were at least 20 years old and had two checkups in a 24-month period with at least 12 months apart. We defined CKD as having an estimated glomerular filtration rate (eGFR) 5ml/min/1.73m2/year. Arsenic levels were assessed on the basis of a governmental nationwide survey. Of the 8854 participants, 1341 exhibited rapid progression. Participants who lived in areas with arsenic levels≥50μg/L had a higher risk of rapid progression, with an odds ratio of 1.22 (95% confidence interval: 1.05-1.42, p

A 67-year-old woman presented with a protruding mass in the umbilical region. The patient had a history of hepatitis virus C related liver cirrhosis and hepatocellular carcinoma (HCC) post resection. In addition, one episode of HCC rupture occurred 1 year ago. Physical examination was unremarkable except a palpable mass without tenderness over the umbilicus. Bedside abdominal ultrasonography showed a liver-like …

BACKGROUND Accurate diagnosis of infected aortic and iliac aneurysms is often delayed, hampering timely treatment and potentially resulting in a fatal consequence. The aim of this study was to discover useful clinical features that can help physicians to identify these patients. METHODS We reviewed the discharge notes from two hospitals and identified all patients who had a diagnosis of infected aneurysms of the thoracoabdominal aorta and iliac arteries between July 2009 and December 2013. Eighteen patients, aged from 41 to 93, were reviewed. Only 6 patients were diagnosed accurately in their first visit to our ED. RESULTS Most patients had at least one underlying illness, and it took 1 to 30 (9.9±6.5) days for physicians to diagnose their infected aneurysm. Localized pain and fever were the two most commonly presented symptoms. The majority (92%) of isolated microorganisms were gram-negative bacilli, including Salmonella spp, Klebsiella pneumoniae, and Escherichia coli. Two of the 3 patients who underwent non-operative therapy died, and all of the patients who underwent a combination of medical and operative therapies survived. CONCLUSION We suggest that physicians liberally use computed tomography scans on patients with unknown causes of pain and inflammatory processes. A combination of surgical and medical treatments is indicated for all patients with infected aortic and iliac aneurysms.

Introduction: Electromagnetic hypersensitivity syndrome (EHS) is defined as perceived symptoms when an individual is exposed to electromagnetic field (EMF). The magnetic resonance imaging (MRI) exa...

A 42-year-old man presented with abdominal pain, fever and chills for days at emergency department. The patient had a history of alcoholic liver cirrhosis, and intravenous drug abuse. On arrival, his vital signs were a temperature of 38.2°C, pulse rate of 105/min, respiratory rate of 16/min, and blood pressure of 104/68 mmHg. Physical examinations showed a diastolic murmur over right upper sternal border, several non-tender erythematous nodular lesions – Janeway lesion on the fingers …

Two series of 3-substituted polythiophenes and poly(4-methylthiophene)s having the substituents containing 8 atoms in the backbone with oxygen as the first atom bonded to the thiophene ring, C 7 H 15 O-, C 4 H 9 OC 2 H 4 O-, and CH 3 OC 2 H 4 OC 2 H 4 O- for the former series and having the first two substituents for the latter series were synthesized by chemical polymerization using FeCl 3 as the oxidizing agent.

Poly(3-ether substituted thiophene)s are prepared from chemical oxidation with FeCl3 and have the structures: where (i) X  H; Y  (OC 7 H 15 ) 1 , (O(CH 2 ) 2 OC 4 H 9 ) 2 , (O(CH 2 )O(CH 2 )OCH 3 ) 3 ; (ii) X  CH 3 ; Y  (OC 7 H 15 ) 4 , (O(CH 2 ) 2 OC 4 H 9 ) 5 ; (iii) X  H; Y  (CH 2 OC 6 H 13 ) 6 ; (iv) X  H; Y  ((CH 2 ) 2 OC 5 H 11 ) 7 . The polymers of type (i) are crosslinked; only their oligomers are soluble. The polymer of type (iii) can not be obtained from its monomer by the present chemical method, since its monomer contains an allylic oxygen, which is easy to be attacked. The polymers of type (ii) and (iv) are soluble and have high molecular weight. FeCl3-doped polymer 7 at the doping level 0.04 is soluble and can be cast into flexible free standing film with a conductivity of 10−4S /cm. Those with an oxygen atom in the repeated unit of the side chain (polymers 4 and 7) have lower conjugation length in solution and solid forms in comparison with poly(3-octylthiophene) (P3OT) and have no appreciable thermochromism. The oxidation potential of polymer 7 is 1.0 V/SCE which is comparable with that of P3OT (1.01 V/SCE). Polymer 5, which has two oxygen atoms in the repeated unit, has higher conjugation length (λmax=535 nm) and lower oxidation potential (0.6 V/SCE) compared to P3OT (λmax = 500 nm, 1.01 V/SCE).