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Ensuring the success of medical students in post-baccalaureate training is crucial for providing sustainable, high-quality healthcare worldwide. However, international medical students encounter unique sustainability challenges that may affect their ability to learn and excel in medical schools. Therefore, this study aimed to investigate and assess the key attributes of learning styles and attitudes among first- and second-year medical students from a university in Southern Taiwan using the Attitudes Toward Thinking and Learning Survey (ATTLS). In November 2022, a cross-sectional survey and purposive sampling were used to recruit all 43 international medical students. Factor analysis was employed to identify and simplify complex personality traits associated with learning styles and attitudes. The resulting four-factor solution, which accounted for 70.364% of the total variance, was labeled as follows: Factor 1 “Understanding, Interaction Insights, and Empathy”, Factor 2 “Respect, Trust, and an Objective and Rational Vision of Multicultural Diversity”, Factor 3 “Comment, Debate, and Declare One’s Position”, and Factor 4 “Critical Thinking, Logical and Rational Problem Solving, and Rigorous Inference”. This study highlights the significance of connected knowers, who possess both Factor 1 and Factor 2, in providing holistic empathy and multicultural insight for future pedagogy. The four factors identified in this research can serve as a guide for developing teaching strategies that consider students’ diverse learning preferences and needs. By cultivating connected knowers, this research contributes to the sustainable improvement of pedagogical quality and the reduction of non-intellectual challenges in the classroom.

In a scenario of ongoing changes in the theory and methodology of teaching, student-centered practices are crucial in improving teaching and learning outcomes. This study aimed to evaluate whether the learning styles and attitudes (connected and separate knowing) associated with the curriculum differ among medical students. The research subjects consisted of 43 first- and second-year medical students attending a post-baccalaureate medical education program exclusively for foreign students at comprehensive university in Kaohsiung City, Taiwan. A self-administered Attitudes Toward Thinking and Learning Survey (ATTLS) was used to assess the differences in learning styles and attitudes among grade, gender, and nationality of these post-baccalaureate medical students. The reliability values of Cronbach Alpha coefficients for all items of ATTLS was 0.93. Significant higher connected knowing styles are reported than separate knowing among these medical students. The average score of the connected knowing for first-year students taking the "International Health" course is significantly higher than that of second-year students taking the "Population Health and Sustainable Development" course. There is no difference in the separate knowing between these two curricula. The learning styles and attitudes of students participating in the teaching process showed no difference in grade, gender, and nationality. The evidence that there is a significant interaction effect of grade, gender, and nationality examined in relation to the separate knowing, rather than the connected knowing, suggests that this heterogenicity of learning methodology needs to be considered and integrated into future teaching methods.

BackgroundA learning style is the complex manner to learn material most efficiently and effectively and also a good predicator of their preferred learning behaviors. This study explored the status of new medical students’ learning patterns between application and entrance examination.MethodsThis is a cross sectional analysis of learning styles among newly enrolled first year medical students in each first academic year from September 2015 to September 2017. The Memletic Learning Style Inventory was applied as instrument for assessment. Latent class analysis was applied to classify different classes among medical students. Result98 students underwent a national college entrance examination, and 150 students was enrolled through application. All medical students could be assigned into 4 classes according to learning styles, including logical type, solitary type, mix aural-verbal-visual type, and social type. Both gender and admission routes were strong predictors of latent class of learning styles. ConclusionThrough the interview process, we can screen out students with mix aural-verbal-visual class of learning styles through interview in application process. While examination route can select students with logical type and solitary type learning style. This study can improve our understanding of student learning patterns to design learner-specific courses and effective curricula.

Aim Radiation‐related injury in the general population due to accidents or incidents is a rare but significant event that merits serious study and planning in the health‐care system. Therefore, we developed different levels of training courses targeting medical emergency response and treatment for radiation‐related injury in patients, for different health‐care professionals and medical students. Methods The curriculum, teaching instructions, and objectives were based on the working group consensus of first responders of radiation‐related injury. The working group included different specialists from hospitals, medical schools, and government radiation emergency response agencies. Results Several different course levels, including lectures, group discussions, case and scenario discussions, hands‐on practice, tabletop drills, and drills were included. The curriculums have shown that developing different levels of courses for medical students and health‐care professionals was feasible. Conclusion Through the cooperation of different specialties and different interactive courses, the training programs were able to meet the initial education goals for medical emergency and radiation‐related injury for medical students and health‐care professionals., Different levels of education and training programs for radiation related injury patients with the cooperation from local healthcare facilities, fire department, regional response center, national authorities is feasible. Medical students, healthcare professionals, medical physicists and first responders were able to acquire the knowledge and have practice experiences on the management of radiation related injury.

Background Purpura fulminans secondary to Capnocytophaga canimorsus (C. canimorsus) infection without a wound is rare and often misdiagnosed initially. We report a patient who died due to C. canimorsus bacteremia with purpura fulminans and acute compartment syndrome of all extremities. Care presentation A 38-year-old Japanese man with a history of alcoholism presented with a 2-day history of gastroenteritis. The chief complaints were abdominal pain and diarrhea, and he had abdominal tenderness. Laboratory findings showed multiple organ failure. On day 2, pain in the lower extremities associated with motor and sensory dysfunction developed. On day 3, purpura on the whole body spread to all extremities. All four extremities became rigid, and acute compartment syndrome developed. The patient died due to uncontrolled hyperkalemia and lactic acidosis. Conclusions Capnocytophaga canimorsus transmission can occur through licking or even close contact with animals when a risk factor of C. canimorsus infection, such as alcoholism, is present.

Aim In Japan, the number of facilities introducing a rapid response system (RRS) has been increasing. However, many institutions have had unsuccessful implementations. In order to implement RRS smoothly, a plan that meets the needs of each hospital is needed. Methods Rapid response system teams from each hospital, including a physician and staff in charge of medical safety, from the RRS online registry were invited to attend a workshop. The workshop aimed to develop and implement RRS. The course curriculum was based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) developed in the USA. Participating facilities were required to formulate an RRS introduction plan referring to Kotter’s 8‐step change model to overcome barriers in the implementation of RRS. The change in medical emergency team activations comparing the intervention and control group hospitals was compared. Results Sixteen institutions were eligible for this study. After participating in the workshop, there was a tendency toward more frequent activation of medical emergency teams in the intervention group (P = 0.075). According to a self‐evaluation from each facility, there is great difficulty in overcoming the 5th step of Kotter’s model (empower people to act the vision). Conclusion This step‐by‐step evaluation clearly identified a problem with implementation and provided measures for resolution corresponding to each facility. There was a major barrier to overcome the 5th step of Kotter’s model in leading change, which represents the attitude toward implementing RRS in institutions., This study investigated the effectiveness of the rapid response system (RRS) promotion course based on TeamSTEPPS to overcome barriers to RRS implementation. We identified the 5th step as the major barrier to introducing RRS using Kotter’s 8‐step strategy to promote RRS.

A 70-year-old man presented to the emergency department with a 2-week history of watery diarrhea. Fecal materials were found in the Foley catheter. A computed tomography of the abdomen and pelvis revealed chronic diverticulitis with enterovesical fistula. The patient was treated with broad-spectrum antibiotics and underwent an urgent surgery with a transverse loop colostomy. The presence of fecaluria should raise the clinical suspicion of enterovesical fistula. Computed tomography is the choice of diagnostic modality.

Supplemental Digital Content is available in the text, Rapid response system (RRS) efficacy and national early warning score (NEWS) performances have largely been reported in inpatient settings, with few such reports undertaken in outpatient settings. This study aimed to investigate NEWS validity in predicting poor clinical outcomes among outpatients who had activated the RRS using single-parameter criteria. A single-center retrospective cohort study From April 1, 2014 to November 30, 2017 in an urban 350-bed referral hospital in Japan We collected patient characteristics such as activation triggers, interventions, arrival times, dispositions, final diagnoses, and patient outcomes. Poor clinical outcomes were defined as unplanned intensive care unit transfers or deaths within 24 hours. Correlations between the NEWS and clinical outcomes at the time of deterioration and disposition were analyzed. Among 31 outpatients, the NEWS value decreased significantly after a medical emergency team intervention (median, 8 vs 4, P

Workplace violence among Asian emergency medical services (EMS) has rarely been examined. A cross-sectional, mainly descriptive study using a standardized, paper-based, self-reported questionnaire survey was conducted between August and October 2018 among emergency medical technicians (EMTs) in the Tainan City Fire Bureau, Taiwan. A total of 152 EMT-paramedics responded to the questionnaire survey, constituting an overall response rate of 96.2%. The participants were predominantly male (96.1%), college-educated (4-year bachelor&rsquo, s degree) (49.3%), and middle-aged (35&ndash, 44 years old) (63.8%). Among them, 113 (74.3%) and 75 (49.3%) participants had experienced verbal and physical assaults at work, respectively. Only 12 (7.9%) participants were familiar with relevant regulations or codes. The assaults predominantly occurred during evening shifts (16:00&ndash, 24:00) and at the scene of the emergency. The most predominant violence perpetrators included patients, patients&rsquo, families, or patients&rsquo, friends. Nearly 10% of participants had experienced verbal assaults from hospital personnel. EMTs who encountered workplace violence rarely completed a paper report, filed for a lawsuit, or sought a psychiatric consultation. Fifty-eight (38.2%) and 16 (10.5%) participants were victims of frequent (at least once every 3 months) verbal and physical forms of violence, respectively, however, no statistically significant association was observed in terms of EMT gender, age, working years, education level, or the number of EMS deployments per month. The prevalence of workplace violence among Asian EMS is considerable and is comparable to that in Western countries. Strategies to prevent workplace violence should be tailored to local practice and effectively implemented.

Background : Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health concern worldwide. Healthcare workers (HCWs) are an important source of transmission of MRSA. We conducted a prospective study to define the frequency of S. aureus nasal colonization and emphasize on the carriage of MRSA in HCWs in relation to the intensity of patient contact. Methods: To evaluate the prevalence of S. aureus carriage and the relevance of transmission from community to the hospital, MRSA and methicillin-susceptible S. aureus (MSSA) nasal colonization in selected HCWs was compared. These included an emergency department, intensive care unit, out-of-hospital care emergency medical technicians and students, and a long-term care facility (LTCF). The MRSA isolates were further identified by their microbiological and molecular characteristics. Results: S. aureus was isolated from 63 of 248 HCWs (25.4%). The overall MRSA nasal carriage rate was 15/248, 6%. Most MRSA carriers were female (14/15, 93.3%), and HCWs who had worked for ≥5 years (11/15, 73.3%). LTCFs had the highest prevalence (3/25, 12%). In contrast, the overall carriage of MSSA was 48/248, 19.4%, and most carriers worked for ≥5 years (25/48, 52.1%). Hospital nurses had the highest rate of MSSA carriage (22/103, 21.4%). Most of the MRSA isolates were SCC mec IV/ST59 or ST45 (60%), and were resistant to erythromycin and clindamycin (53%). Only one MRSA was chlorhexidine resistant. All produced low level of biofilms. Conclusions: This study demonstrates hospital nurses have highest S. aureus nasal carriage, whereas HCWs worked in the LTCFs have the highest prevalence of nasal MRSA colonization. The differences in the characteristics of MRSA and MSSA nasal carriage among HCWs highlights the importance on inclusion of all strains of S. aureus in surveillance and infection control programs.

ObjectivesThe National Early Warning Score (NEWS) was originally developed to assess hospitalised patients in the UK. We examined whether the NEWS could be applied to patients transported by ambulance in Japan.DesignThis retrospective study assessed patients and calculated the NEWS from paramedic records. Emergency department (ED) disposition data were categorised into the following groups: discharged from the ED, admitted to the ward, admitted to the intensive care unit (ICU) or died in the ED. The predictive performance of NEWS for patient disposition was assessed using receiver operating characteristic curve analysis. Patient dispositions were compared among NEWS-based categories after adjusting for age, sex and presence of traumatic injury.SettingA tertiary hospital in Japan.ParticipantsOverall, 2847 patients transported by ambulance between April 2017 and March 2018 were included.ResultsThe mean (±SD) NEWS differed significantly among patients discharged from the ED (n=1330, 3.7±2.9), admitted to the ward (n=1263, 60.3±3.8), admitted to the ICU (n=232, 9.4±4.0) and died in the ED (n=22, 110.7±2.9) (pConclusionThe findings from this Japanese tertiary hospital setting showed that prehospital NEWS could be used to identify patients at a risk of adverse outcomes. NEWS stratification was strongly correlated with patient disposition.

Objectives. We develop an epidemiological approach to determine the emergency patients at high risk of severe dengue (SD), known as hemorrhagic fever (DHF) or dengue shock syndrome (DSS), and to fa...

Sports injuries are common among baseball players and may result in abnormal movement patterns, increased risks of future injury, and unsatisfactory performance. The Functional Movement Screen (FMS™) has been developed to detect abnormal functional movement patterns and can be used for predicting risks of sports injury. However, whether FMS™ scores are associated with athletic performance remains unclear. The goal of this study was to determine the association between functional movements and athletic performance in elite baseball players. Core stability, muscular strength and flexibility of the lower extremities, and FMS™, as well as athletic performance in sprinting, agility, and balance tests were assessed in 52 male collegiate Division I baseball players placed into two groups based on FMS™ scores. The high-scoring group demonstrated better athletic performance than the low-scoring group, with a shorter duration of the agility test. No group differences were found in core stability, muscular strength, or muscle flexibility, except for rectus femoris flexibility. Thus, the FMS™ score is associated with sprinting and agility performance in elite baseball players. These findings indicate that the FMS™ may have a role in predicting athletic performance and thereby help determine the goals of training regimens or return-to-play strategies.

Mechanical contact caused using excessive probe force produces an oversized scrubbing mark that may result in damage to the die pad and the silicon chip breaking for thin wafer. Therefore, investigating the relationship between the wafer thickness and the limited breaking stress of the wafer, and applying this relationship as a basis for establishing suitable design rules for a multilayer needle layout are crucial. In this paper, two experimental techniques, three-point-bending test and ball-on-ring, were setup and carried out to measure the force-displacement relation of various wafer thicknesses (100–25 $\mu $ m). The results from the testing then coupled with finite-element analysis to reverse finding the breaking stress/strain as a function of wafer thickness. In addition, experimental setup with a single tungsten needle probe contact with Al pad were employed to investigate the relations between the overdrive, beam length, and scrub mark length. A 3-D computational probing simulation model was developed and verified against the experimental data. The model is then used to examine the effects of the beam length, overdrive distance (OD), and shooting angle on the maximum stress induced within the wafer. Finally, a four-layer probe card needle shape design has been demonstrated as a practical application example; it is shown that for a wafer thickness of 25 $\mu $ m and an OD of 60 $\mu $ m, the allowable shooting angles of a four-layer needle probe card are as follows: 1500 $\mu $ m and 0°–4° (Layer 1); 2100 $\mu $ m and 0°–9° (Layer 2); 3500 $\mu $ m and 0°–15° (Layer 3); and 4000 $\mu $ m and 0°–15° (Layer 4).

Background Increasing chest compression rate during cardiopulmonary resuscitation can affect the workload and, ultimately, the quality of chest compression. This study examines the effects of compression at the rate of as-fast-as-you-can on cardiopulmonary resuscitation (CPR) performance. Methods A crossover, randomized-to-order design was used. Each participant performed chest compressions without ventilation on a manikin with 2 compression rates: 100 per minute (100-cpm) and “push as-fast-as you-can” (PF). The participants performed chest compressions at a rate of either 100-cpm or PF and subsequently switched to the other after a 50-minute rest. Results Forty-two CPR-qualified nonprofessionals voluntarily participated in the study. During the PF session, the rescuers performed CPR with higher compression rates (156.8 vs 101.6 cpm), more compressions (787.2 vs 510.8 per 5 minutes), and more duty cycles (51.0% vs 41.7%), but a lower percentage of effective compressions (47.7% vs 57.9%) and a lower compression depth (35.6 vs 38.0 mm) than they did during the 100-cpm session. The CPR quality deteriorated in numbers and percentile of effective compression since the third minute in the PF session and the fourth minute in the 100-cpm session. The percentile of compressions with adequate depth in the 100-cpm sessions was higher than that in the PF sessions during the second, third, and fourth minutes of CPR. Conclusion Push-fast technique showed a significant decrease in the percentile of effective chest compression compared with the 100-cpm technique during the 5-minute hand-only CPR. The PF technique exhibited a trend toward increased fatigue in the rescuers, which can result in early decay of CPR quality.

The objective was to compare the clinical characteristics of elderly and young adult patients with dengue in the emergency department (ED).Demographic characteristics, clinical presentation, disease severity, laboratory characteristics, and outcomes were analyzed prospectively as a case-control study.Of the 193 adults with serologically confirmed dengue disease in 2007, 31 (16.1%) were elderly patients (aged ≥65) and 162 were young adults (aged65). More dengue hemorrhagic fever (12.9% vs 2.5%, P = .02), a longer ED stay (13.3 vs 8.6 hours, P = .004), a longer hospital stay (7.4 vs 3.4 days, P.001), a higher Simplified Acute Physiology Score II in the ED (29.7 vs 17.4, P.001), and a higher rate of at least 1 comorbidity (61.8 vs 22.8%, P.001) were found in the elderly. However, the length of the intensive care unit stay (elderly 0.7 vs young adults 0.3 day, P = .47) and the 14-day mortality rate (0% vs 0.6%, P = 1.00) were similar. Of note, in terms of clinical presentations of dengue in the ED, there were more elderly patients with isolated fever (41.9% vs 17.9%, P = .003) and fewer with typical presentation (41.9% vs 75.9%, P =.001) than there were young adults.The present study found a higher number of atypical presentations, a longer hospitalization, and a higher degree of clinical illness in elderly patients with dengue.

Outcome prediction for out-of-hospital cardiac arrest (OHCA) is of medical, ethical, and socioeconomic importance. We hypothesized that blood ammonia may reflect tissue hypoxia in OHCA patients and conducted this study to evaluate the prognostic value of ammonia for the return of spontaneous circulation (ROSC).This prospective, observational study was conducted in a tertiary university hospital between January 2008 and December 2008. The subjects consisted of OHCA patients who were sent to the emergency department (ED). The primary outcome was ROSC. The prognostic values were calculated for ammonia levels and the partial pressure of ammonia (pNH(3)), and the results were depicted as a receiver operating characteristics curve with an area under the curve.Among 119 patients enrolled in this study, 28 patients (23.5%) achieved ROSC. Ammonia levels and pNH(3) in the non-ROSC group were significantly higher than those in the ROSC group (167.0 μmol/L vs 80.0 μmol/L, P.05; 2.61 × 10(-5) vs 1.67 × 10(-5) mm Hg, P.05, respectively). The predictive capacity of area under the curve for ammonia and pNH(3) for non-ROSC was 0.85 (95% confidence interval, 0.75-0.95) and 0.73 (95% confidence interval, 0.61-0.84), respectively. The multivariate analysis confirmed that ammonia and pNH(3) are independent predictors of non-ROSC. The prognostic value of ammonia was better than that of pNH(3). The cutoff level for ammonia of 84 μmol/L was 94.5% sensitive and 75.0% specific for predicting non-ROSC with a diagnostic accuracy of 89.9%.Hyperammonemia on ED arrival is independently predictive of non-ROSC for OHCA patients. The findings may offer useful information for clinical management.

To determine the impact of delayed admission to the intensive care unit (ICU) on the clinical outcomes of patients with acute respiratory failure (ARF) in the emergency department (ED).This retrospective cohort study included non-traumatic adult patients with ARF and mechanical ventilation support in the ED of a tertiary university hospital in Taiwan from January 1, 2013, to August 31, 2013. Clinical data were extracted from chart records. The primary and secondary outcome measures were a prolonged hospital stay (30 days) and the in-hospital crude mortality within 90 days, respectively.For 267 eligible patients (age range 21.0-98.0 years, mean 70.5±15.1 years; male 184, 68.9%), multivariate analysis was used to determine the significant adverse effects of an ED stay1.0 hour on in-hospital crude mortality (odds ratio 2.19, P.05), which was thus defined as delayed ICU admission. In-hospital mortality significantly differed between patients with delayed ICU admission and those without delayed admission, as revealed by the Kaplan-Meier survival curves (P.05). Moreover, a linear-by-linear correlation was observed between the length of ICU waiting time in the ED and the lengths of total hospital stay (r=0.152, P.05), ICU stay (r=0.148, P.05), and ventilator support (r=0.222, P.05).For patients with ARF who required mechanical ventilation support and intensive care, a delayed ICU admission more than 1.0 hour is a strong determinant of mortality and is associated with a longer ICU stay and a longer need for ventilation.

Dengue infection is a major health problem in tropical and subtropical countries. A prospective observational study in a university-affiliated hospital was conducted between August 2015 and September 2015. Patients who visited the emergency department (ED) with a presentation of any symptoms of dengue were eligible for the dengue non-structural protein 1 (NS1), IgM/IgG rapid immunochromatographic tests and real-time polymerase chain reaction (RT-PCR) to evaluate the performance of the rapid tests. Considering the RT-PCR as the gold standard for the dengue diagnosis, the ideal primary results of sensitivity (80–100%), specificity (60–84%), positive predicted value(75%-95%), and negative predicted value (70–100%) suggested that the NS1-based test with or without a combination of IgM and IgG tests have good diagnostic performances in detecting dengue infections, even in the afebrile or elderly populations.

To investigate the clinical characteristics and outcomes of adults with occult bacteraemia and the clinical impact of appropriate antibiotics.A case-control study was conducted to retrospectively analyse the bacteraemic adults visiting the emergency department (ED) during the period between January 2005 and August 2006. The patients with occult bacteraemia were the case group. Two control groups (CGs) were selected for comparisons: CG I, those with bacteraemia and the same Pittsburgh bacteremia score who were admitted at the first ED visit temporally near a case patient; and CG II, those with bacteraemia admitted at their first ED visit, irrespective of the Pittsburgh bacteraemia score.There were 119 adults composing of the case group, 119 matched adults as the CG I and 293 adults as the CG II. Demographic characteristics, clinical conditions and outcomes were retrieved from chart records. A lower 28-day death rate (5.0% vs 11.9%, p=0.03) and less critical illness (ie, Pittsburgh bacteremia score ≥4 points; 1.7% vs 22.2%; p0.001) were noted among case patients compared with those in CG II. However, no difference in the 28-day death rate (5.0% vs 5.9%; p=0.77) between the case group and CG I was discovered. Among the case patients, thrombocytopenia (100 000/mm(3); OR, 8.87; p=0.03) and inappropriate antibiotic therapy at the second ED or outpatient-clinic visit (OR 7.59; p=0.045) were the independent factors of 28-day mortality in the multivariate analysis. Moreover, the survival curve revealed a significant difference in the survival rate between those with occult bacteraemia receiving inappropriate and appropriate antibiotic therapy after index bacteraemic-onset (p=0.02).For adults with occult bacteraemia, a lower severity of illness and death rate than those of bacteraemic patients hospitalised for ED visit could be demonstrated, demonstrating the importance of appropriate antibiotic therapy.

Background/Purpose An intubating laryngeal mask airway (ILMA) is an alternative device for airway control, capable of providing effective ventilation in various situations. The purpose of this study is to compare the effects of the ILMA and bag-valve-mask (BVM) ventilation devices on out-of-hospital cardiac arrest (OHCA) patients. Methods An ILMA training course was conducted by emergency medical technicians (EMTs). Before training, OHCA patients had received BVM ventilation; these patients were defined as the BVM group. After training, all EMTs in the area being served were instructed to immediately use an ILMA on OHCA patients when possible; these patients were defined as the ILMA group. Demographics, transport time, first arterial blood gas data, and the short-term outcomes of these two groups were analyzed. Results A total of 398 OHCA patients (89 in the BVM group and 309 in the ILMA group) were analyzed. All of the EMTs passed the training course, and ILMAs were used in the emergency settings. The ILMA was applied to each OHCA patient for a longer-than-average field time than the BVM (9.5 vs. 7.8 minutes, p = 0.006). The 24-hour survival rate of the ILMA-treated patients was significantly higher than BVM-treated patients (36.2% vs. 24.7%, p = 0.033). Conclusion Well-trained EMTs were able to insert the ILMA and ventilate OHCA patients properly in prehospital settings, and ILMA-treated OHCA patients had better short-term outcomes than BVM-treated patients.

Viral etiologies of respiratory tract infections (RTIs) have been less studied in adult than in pediatric populations. Furthermore, the ability of PCR/electrospray ionization mass spectrometry (PCR/ESI-MS) to detect enteroviruses and rhinoviruses in respiratory samples has not been well evaluated. We sought to use PCR/ESI-MS to comprehensively investigate the viral epidemiology of adult RTIs, including testing for rhinoviruses and enteroviruses. Nasopharyngeal or throat swabs from 267 adults with acute RTIs (212 upper RTIs and 55 lower RTIs) who visited a local clinic or the outpatient or emergency departments of a medical center in Taiwan between October 2012 and June 2013 were tested for respiratory viruses by both virus isolation and PCR/ESI-MS. Throat swabs from 15 patients with bacterial infections and 27 individuals without active infections were included as control samples. Respiratory viruses were found in 23.6%, 47.2%, and 47.9% of the 267 cases by virus isolation, PCR/ESI-MS, and both methods, respectively. When both methods were used, the influenza A virus (24.3%) and rhinoviruses (9.4%) were the most frequently identified viruses, whereas human coronaviruses, human metapneumovirus (hMPV), enteroviruses, adenoviruses, respiratory syncytial virus, and parainfluenza viruses were identified in small proportions of cases (

We evaluate the effects of zolpidem use to develop dementia or Alzheimer disease from the Taiwan National Health Insurance Research Database (NHIRD). A retrospective population-based nested case–control study. Newly diagnosed dementia patients 65 years and older and controls were sampled. A total of 8406 dementia and 16,812 control subjects were enrolled from Taiwan NHIRD during 2006 to 2010. The relationships between zolpidem use and dementia were measured using odds and adjusted odds ratios. The relationship between the average cumulative doses for zolpidem and dementia was also analyzed. Zolpidem alone or with other underlying diseases, such as hypertension, diabetes, and stroke, was significantly associated with dementia after controlling for potential confounders, such as age, sex, coronary artery disease, diabetes, anti-hypertension drugs, stroke, anticholesterol statin drugs, depression, anxiety, benzodiazepine, anti-psychotic, and anti-depressant agents’ use (Adjusted OR = 1.33, 95% CI 1.24–1.41). Zolpidem use also has significant dose–response effects for most of the types of dementia. In patient with Alzheimer diseases, the effects of zolpidem among patients with Alzheimer's disease remained obscure. The adjusted OR for patients whose cumulative exposure doses were between 170 and 819 mg/year (adjusted OR: 1.65, 95% CI 1.08–2.51, P = 0.0199) was significant; however, the effects for lower and higher cumulative dose were not significant. Zolpidem used might be associated with increased risk for dementia in elderly population. Increased accumulative dose might have higher risk to develop dementia, especially in patients with underlying diseases such as hypertension, diabetes, and stroke.

Human immunodeficiency virus (HIV) tests are commonly performed in emergency departments (EDs) in the United States (US), but the experience and effectiveness of conducting rapid HIV tests in EDs in regions with low HIV seroprevalence outside the US have seldom been reported. An observational cross-sectional opt-in rapid HIV test and counseling program was conducted at an ED in a teaching hospital in Taiwan, a country with low seroprevalence, to determine the acceptance of rapid HIV tests as well as risky behaviors and illness presentations of people who agreed to undergo the tests. Among 7,645 ED patients between 20 and 55 years of age, 2,138 (28%) agreed to undergo rapid HIV tests, and only 2 (0.09%) tested positive. Patients diagnosed with urinary tract infections, respiratory tract infections, infectious diarrhea, and pelvic inflammatory disease were more likely to be willing to undergo rapid HIV tests in the ED. Stratified analysis revealed that sexually active patients were more likely to consent to HIV testing. Therefore, non-targeted opt-in HIV testing and counseling in the ED was feasible but was not effective in a region with low HIV seroprevalence.

The Diels–Alder cycloadditions of facially dissymmetric sesquibicyclo[2.2.2]octadiene-fused maleic anhydride 1 with exocyclic 1,3-butadienes have been studied. The reactions proceeded via syn-side (relative to the etheno-bridge in 1) attack of the diene upon 1.

Deliberate self-poisoning (DSP), the most common form of deliberate self-harm, is closely associated with suicide. Identifying risk factors of DSP is necessary for implementing prevention strategies. This study aimed to evaluate the relationship between benzodiazepine (BZD) treatment in psychiatric outpatients and DSP cases at emergency departments (EDs). We performed a retrospective nested case–control study of psychiatric patients receiving BZD therapy to evaluate the relationship between BZD use and the diagnosis of DSP at EDs using data from the nationwide Taiwan National Health Insurance Research Database. Regression analysis yielded an odds ratio (OR) and 95 % confidence interval (95 % CI) indicating that the use of BZDs in psychiatric outpatients was significantly associated with DSP cases at EDs (OR = 4.46, 95 % CI = 3.59–5.53). Having a history of DSP, sleep disorders, anxiety disorders, schizophrenia, depression, or bipolar disorder was associated with a DSP diagnosis at EDs (OR = 13.27, 95 % CI = 8.28–21.29; OR = 5.04, 95 % CI = 4.25–5.98; OR = 3.95, 95 % CI = 3.32–4.70; OR = 7.80, 95 % CI = 5.28–11.52; OR = 15.20, 95 % CI = 12.22–18.91; and OR = 18.48, 95 % CI = 10.13–33.7, respectively). After adjusting for potential confounders, BZD use remained significantly associated with a subsequent DSP diagnosis (adjusted OR = 2.47, 95 % CI = 1.93–3.17). Patients taking higher average cumulative BZD doses were at greater risk of DSP. Vigilant evaluation of the psychiatric status of patients prescribed with BZD therapy is critical for the prevention of DSP events at EDs.

To investigate the clinical impact of age on bacteremia among adults visiting the emergency department (ED).Bacteremic adults visiting the ED from January 2008 to December 2008 were identified retrospectively. Demographic characteristics, severity, bacteremic pathogens with in vitro susceptibility, antimicrobial agents, and outcomes determined from chart records were analyzed as a case-control study.Of 518 eligible bacteremic adults, 288 (55.6%) elderly patients (≥65 years old) were case patients and 230 younger patients (65 years) were regarded as control patients. The 28-day mortality rate was higher in the case patients than that in the control patients (11.8% vs 6.1%, P = .02). The proportion of inappropriate empirical antibiotic therapy between the survivors and nonsurvivors was similar in control patients (69.4% vs 64.3%, P = .77); but for the case patients, the proportion of inappropriate empirical antibiotic therapy in the survivors was lower than that in the non-survivors (27.6% vs 44.1%, P = .04). Of note, inappropriate empirical antibiotic therapy was also one of independent risk factors of 28-day mortality by the multivariate analyses in the case patients (odds ratio [OR] 3.65; P = .049). Other independent predictors of 28-day mortality in case patients included a high Pittsburgh bacteremia score (≥4 points; OR 22.16; P.001), bacteremia due to foci other than urinary tract infection (OR 9.07; P = .002), malignancy (OR 10.87; P.001), coronary artery disease (OR 5.68; P = .01), and high serum creatinine (1.5 mg/dL; OR 3.44; P = .04).For bacteremic adults, this study demonstrated the impact of inappropriate empirical antibiotic therapy on patients' outcome in the elderly was greater than that in the younger adults.

Objectives To investigate the clinical impact of inappropriate empirical antibiotics on patient outcome and determine the risk factors for mortality in bacteremic adults who visited the emergency department (ED). Methods Bacteremic adults visiting the ED from January 2007 to June 2008 were identified retrospectively. Demographic characteristics, clinical conditions, bacteremic pathogens, antimicrobial agents, and outcomes were determined from chart records. Results The total of 454 eligible bacteremic adults were included in the analysis; excluded from the study were another 261 patients with contaminated blood cultures and 64 patients with ED stays of less than 24 hours. Among the included individuals, the mean age was 64.6 years, with a small predominance of males (230 patients, 50.7%). Of a total 494 bacteremic isolates, Escherichia coli (206, 41.7%) and Klebsiella species (81, 16.4%) were the most frequently encountered microorganisms. A lower 28-day mortality rate was demonstrated in bacteremic patients treated with appropriate antibiotics than that in those with inappropriate antibiotics or that in those with no antibiotic therapy, as judged by Kaplan-Meier survival curves ( P = .01). Moreover, the differences among these three groups achieved higher significance ( P = .002) in critically ill patients (Pittsburgh bacteremia scores of ≥4 points). In multivariate analyses, inappropriate antibiotic therapy in the ED was associated independently with mortality at 28 days (odds ratio, 2.26; 95% confidence interval, 1.01-5.13; P = .04). Conclusions For bacteremic adults visiting the ED, their outcomes were favorable following appropriate antibiotics, compared to treatment with inappropriate antibiotics or no antibiotics.