PubMed Health⌕ Search

Biomedical subjects

C H Chi

Publications and source records attributed to C H Chi.

At least 19 recordsLinked to original sources
PubMed2004

Impact of an outbreak of severe acute respiratory syndrome on a hospital in Taiwan, ROC.

STUDY OBJECTIVE: To estimate the impact of the severe acute respiratory syndrome (SARS) outbreak in early 2003 on a tertiary care hospital in Taiwan, ROC. METHODS: The study estimated the utilisation of resources related to infection control, SARS related medical services, and routine medical services, and SARS related medical outcomes at National Cheng Kung University Hospital (NCKUH) from 25 March to 16 June 2003 through a cross sectional survey of hospital records. RESULTS: A mean of 5100 persons per day (95%CI 4580 to 5610) underwent fever screening at the outpatient and emergency department (ED) entrances to the hospital, of which 35 per day (95% CI 30 to 40) were referred for further evaluation for suspected or probable SARS. ED isolation surge capacity was created via 12 new beds outside the ED: eight for SARS assessment, three for patients awaiting in hospital bed assignment, and one for resuscitation. A total of 382 patients were fully evaluated for suspected or probable SARS outside the ED, of which 27 were admitted. The mean numbers of outpatient clinic patient visits, ED visits, ED trauma patient visits, ED admissions, hospital admissions, and operative procedures decreased during the outbreak. Thirty eight patients were hospitalised with suspected SARS, of which three received the final diagnosis of probable SARS. Two patients with probable SARS died. No cases of nosocomial SARS transmission occurred. CONCLUSIONS: This SARS outbreak was associated with substantial use of hospital and ED resources aimed at infection control, comparatively less use of resources related to the medical care of patients with suspected or probable SARS, and decreased use of routine medical services.

Bed Occupancy↗
PubMed2001

Validation of the Chinese-version MPSS-R for occupational stress among emergency nurses.

The aim of this study was to examine the reliability and validity of a Chinese-version stress instrument among emergency nurses. The study sample comprised of 113 nurses whose age ranged from 21 to 47 years old. The Chinese version of Medical Personnel Stress Survey (MPSS-R) was answered in 1996 through self-administered questionnaires. The instrument demonstrated excellent convergent and discriminant validity. Cronbach's alpha (reliability) coefficients ranged from.57 to.77. Factorial analysis yielded four principal components, corresponding to job dissatisfaction, team relationship, organization support, and somatic distress. Validation by independent variable was also consistent with theory. Thus, the Chinese-version MPSS-R retained excellent psychometric properties when used in an emergency nurses group.

Adult↗
PubMed2001

Emergency medical technicians' disaster training by tabletop exercise.

The objective of this study was to assess the attitudes of emergency medical technicians (EMTs) toward tabletop drills to determine the effect of tabletop simulation on the EMT student perception of disaster preparedness and management. In November 1998 and April 1999, 59 firefighters underwent 260 hours of EMT intermediate level training at the National Cheng Kung University Hospital in Tainan, Taiwan. All participants had experience in field disaster exercise training before they attended this EMT training course. The EMT courses included a disaster and mass-casuality incident program. A 9-item questionnaire was completed by the 59 EMTs before (for field exercise) and after undergoing the tabletop drills. The results of the survey revealed that the field operation exercise could not provide adequate provisions to link the results of disaster exercises to appropriate changes in terms of training, equipment, supplies, and plans. Field operation failed to show the ability of others to fill in during the absence of key officials. Tabletop drilling provided better performance for these 2 issues. Tabletop exercise also provided a better chance than field exercise to evaluate the response without the use of telephones, which are not always reliable in real emergency situation. For disaster exercises, limitations of field operation drills such as communications, coordination, assignment of responsibilities, and postevent mitigation priorities were noted, and tabletop drills provided additional benefits for these settings. Large-scale effect evaluation of different drills may be necessary to design future disaster preparedness programs.

Adult↗
PubMed2001

Characteristics of repeated ambulance use in an urban emergency medical service system.

BACKGROUND AND PURPOSE: Although many studies have examined the reasons for repeated use of emergency medical service (EMS), little information is available concerning repeated ambulance use in Taiwan. This study evaluated the characteristics of repeated EMS ambulance use in an urban EMS system in Taiwan. METHODS: Data from a local EMS computerized database for the period from January 1996 through December 1998 were collected for analysis. All calls to the dispatch center that resulted in EMS transports were included. Repeat users were identified by matching the user name, sex, age, and home address. Transports were categorized according to how many times the patient was transported by ambulance during the 3-year period: single use, one time; repeated use, two or three times; or frequent use, more than three times. RESULTS: During the 36-month study period, there were 41,792 calls, with 13,076 non-transports (a non-transport rate of 31.3%). Of the 28,716 transports during the study period, 2,101 represented repeated or frequent use (7.3%); the rate of frequent use was 1.4% (406/28,716). The frequency of repeated use reached a daily first peak at 8:00 AM, with the second and third peaks at 1:00 PM and 7:00 PM. The mean age increased with increasing repeated use of transport (37.25 +/- 0.24 vs 41.55 +/- 1.03 vs 46.23 +/- 1.57 years, respectively; p < 0.001). The percentage of non-trauma missions increased with increasing repeated use of transport (26.3% vs 55.6% vs 73.2%; p < 0.001). Response time significantly increased for repeated use (analysis of variance [ANOVA], p < 0.001). The on-scene interval (time from arrival until departure) in the single-use group was shorter than in the repeated and frequent use groups (ANOVA, p < 0.005). CONCLUSIONS: The results of this study indicate that the characteristics of repeat users of EMS transport differ from those of single users. Characteristics of service time, reason for transport, and interval to each subsequent call varied among different groups of users. Studies of repeat use under a wider range of conditions such as in rural EMS systems and after implementation of a priority-dispatch system are needed to determine the implications of repeated ambulance use.

Ambulances↗
PubMed2000

Clinical presentations and prognostic factors of a glyphosate-surfactant herbicide intoxication: a review of 131 cases.

OBJECTIVE: Suicide attempts with agricultural chemicals are common in southern Taiwan. Among them, glyphosate-surfactant herbicide (GlySH) intoxication has been encountered with increasing frequency. Although a number of reports have described the clinical course and outcomes following ingestion, predictors of serious complications and mortality have not been elucidated. The purpose of this study was to define predictors of serious complications and probable mortality. METHODS: This was a retrospective study of 131 GlySH-intoxicated patients treated at the National Cheng Kung University Hospital from 1988 to 1995. Medical charts were reviewed and clinical and laboratory variables were abstracted, looking for predictors of mortality. RESULTS: The most common symptoms included sore throat (79.5%), and nausea with or without vomiting (73.8%). The most common laboratory findings were leukocytosis (68.0%), low serum bicarbonate (48.1%), and acidosis (35.8%). Overall, 11 of 131 patients (8.4%) died; the mean +/- SEM time to death was 2.8 +/- 0.8 days after presentation. When comparing the clinical and laboratory characteristics among the survivor and fatality groups, significant differences were identified. Respiratory distress, pulmonary edema, respiratory distress necessitating intubation, shock (systolic blood pressure less than 90 mm Hg), altered consciousness, abnormal chest x-ray, renal failure necessitating hemodialysis, larger amount of ingestion (>200 mL), and hyperkalemia were predictors highly associated with poor outcomes and mortality. Using multiple logistic regression, three predictors were identified, which may predict mortality in severely intoxicated patients. CONCLUSIONS: In managing patients who have larger amount of GlySH ingestion, airway protection, early detection of pulmonary edema, and prevention of further pulmonary damage and renal damage appear to be of critical importance.

Female↗
PubMed1999

Emergency department-based telemedicine.

Although many studies have been published concerning clinical telemedicine, little information is available about emergency department (ED)-based telemedicine programs. An ED-based telemedicine program was initiated in April 1996 involving the National Cheng Kung University Hospital (NCKUH) and the Provincial Peng-Hu Hospital (PPHH) under a pilot project supported by the Department of Health. This is the first telemedicine program for remote offshore island service in Taiwan. The program is synchronous in nature to the practice of telemedicine. The role of the emergency physician includes giving initial suggestions, arranging consultations, coordination, and the organization of other medical tasks, such as accompanying some of the transfers. During the 12-month period, this system was used in 275 consultations, including 24 specialty and/or subspecialty department/sections, and more than 100 members of the medical staff have participated in this project since. In a survey, 89.4% of physicians in the PPHH and 82.2% of the physicians in NCKUH rated the system as very comfortable to work with and satisfactory. According to these observations, an ED-based telemedicine program is a feasible method for carrying out remote consultations. Successful development of the partnership and program of telemedicine is based on the active participation and coordination of the medical personnel and technicians between the cooperating hospitals.

Emergency Medicine↗
PubMed1999

Hemodynamic abnormalities in sodium monofluoroacetate intoxication.

Hypotension is one of the most important predictors of mortality in sodium monofluoroacetate (SMFA) intoxication. This paper reports the hemodynamic response in one fatal and another survival case of SMFA intoxication. Despite correction of hypovolemia and with inotropic support, the patients remained in shock. Hemodynamic observations have provided evidence that shock after SMFA intoxication is due to diminished systemic vascular resistance and increased cardiac output. This is the first report in which such an invasive hemodynamic investigation has been recorded in a clinical case of SMFA intoxication.

Adult↗
PubMed1997

Valtrac-secured intracolonic bypass device: an experimental study.

PURPOSE: The intracolonic bypass tube has been used both experimentally and clinically to protect the anastomotic site. A newly designed intracolonic bypass, the Valtrac-secured intracolonic bypass, which consisted of a biofragmentable anastomosis ring (BAR) and was connected with a soft, thin vinyl tube, was used in the colon approximately 5 to 10 cm proximal to the anastomotic site. The distal end of the vinyl tube is passed through the colonic anastomosis to the anus to bypass the fecal stream. METHODS: Eighteen piglets were divided into three groups of six each. Group A piglets underwent colon resection and rough anastomosis with large gaps between sutures, followed by Valtrac-secured intracolonic bypass. Group B piglets underwent the same procedures, but a colonic outlet obstruction also was done with pursestring sutures tied over the anus. Group C piglets underwent colon resection and rough anastomosis, but no intracolonic bypass tube was inserted (as in the control group). RESULTS: All Group A and Group B piglets survived. Passage of the BARs occurred approximately two weeks later. As the barium enema passed through the bypass tube, it showed a patent BAR-secured tube and intact anastomosis with no leakage. In Group C, anastomotic leakage occurred in four of six piglets, three of which died. Barium enema showed leakage at the anastomotic site. CONCLUSIONS: In the animal model we used, our new intracolonic bypass device proved to be a simple, safe, reliable means of protecting the anastomotic site and, thereby, eliminated the need for a diverting colostomy. Still we need further steps to test its potential in clinical use.

Anastomosis, Surgical↗
PubMed1997

Effects of norepinephrine infusion and exercise on blood pressure in rats.

Two experiments were conducted to test the hypotheses that norepinephrine (NE) infusion would increase blood pressure and wheel running activity level, and, secondly, that voluntary exercise would lower NE-induced increases in blood pressure. NE-bitartrate was infused into male Sprague-Dawley rats using an implanted osmotic pump (3.75 micrograms/kg/min in 0.9% saline). Control rats received the vehicle solution. Systolic blood pressure was measured by the tail-cuff method. Voluntary wheel running activity expressed as wheel revolutions per 24 hr was measured on the 5th, 9th, and 13th day. Blood pressure on the 13th day and wheel running activity on the 9th day were significantly higher in NE-infused rats. The NE content of heart tissue was not altered, but urinary excretion of NE and epinephrine was increased in the NE-infused animals. Food intake, body weight gain, and kidney weight per 100 g body wt were not changed but heart weight per 100 g body wt was increased by NE infusion. Urinary total calcium excretion was higher in the NE-infused rats. Spontaneous voluntary exercise in running wheels attenuated increases of blood pressure in NE-infused rats. The results of the present study suggest that rats receiving exogenous NE exhibit increased blood pressure and voluntary wheel running activity. Voluntary wheel running exercise also reduces blood pressure in NE-infused rats.

Animals↗
PubMed1997

Seizure: a rare and transient cause of portal venous gas.

Gas in the hepatic portal venous system has been noted to be a complication of a wide range of intra-abdominal catastrophes that involve damage to bowel mucosa. We describe a patient who, after a seizure, was found to have portal venous gas on sonography and CT. The search for other possible causes revealed negative results. This case demonstrates a rare cause of hepatic portal venous gas that is self-resolving and clinically benign.

Adult↗
PubMed1996

Bacterial density of Helicobacter pylori predicts the success of triple therapy in bleeding duodenal ulcer.

BACKGROUND: We studied whether different initial bacterial densities of Helicobacter pylori would alter the eradication rate of H. pylori by triple therapy (amoxicillin 500 mg t.i.d. and metronidazole 500 mg t.i.d. for 14 days; bismuth subcitrate 120 mg t.i.d. for 28 days) in patients with duodenal ulcer bleeding. METHOD: One hundred thirty-six cases with duodenal ulcer bleeding and H. pylori infection (proved by rapid urease test and histology during emergency endoscopy) were studied. One hundred twenty-seven of these patients completed a course of triple therapy. In each case, anti-H. pylori IgG titer, gastric biopsies for H. pylori density (score 1 to 5), and evaluation of severity of gastritis were collected at the first endoscopy and 1 month after completion of the triple therapy. RESULTS: The ulcer healing rate was 84.3% (107 of 127) at the time of the second evaluation. The eradication rate of H. pylori was 76.4% (97 or 127). Eradication for H. pylori failed in 30 cases. In these eradication failure cases, initial serologic titer and density of H. pylori were higher than those of eradication success cases. The eradication rate of H. pylori decreased as the initial density of H. pylori increased (density of H. pylori: 1, 88.3%; 2, 83.8%; 3, 74.2%; 4, 68%; 5, 50%). At the second evaluation, the serologic titer was lower and continued to decline in eradication success cases whose mean residual titer ratio (100% x follow-up titer/initial titer) was lower than that of eradication failure cases (57.1% +/- 14.6% vs 107.1% +/- 24.1%, p < 0.001). The mean residual titer ratio also disclosed an upward trend as the density of H. pylori increased (density of H. pylori 1 to 5: 57.5%, 66.6%, 73.5%, 75.3%, 81.8%, respectively). CONCLUSIONS: We suggest routine gastric biopsy to detect both the presence of H. pylori and its density inasmuch as quantitative results may predict the usefulness of triple therapy. The higher the H. pylori density, the less effective triple therapy will be at successful eradication of H. pylori.

Adult↗
PubMed1996

C-reactive protein for the evaluation of acute abdominal pain.

The diagnostic value of C-reactive protein (CRP) was established in 143 patients with acute abdominal pain, 67 men and 76 women with mean age of 48 +/- 20 years old. Clinical and laboratory variables were collected after the patients' arrival at the emergency department. The attending clinicians did not consider the CRP value during the study period and did not use it for their management. When patients were grouped by final disposition, which was according to severity, only CRP and leukocyte count were identified as significant quantitative variables by multivariate analysis. CRP can detect the serious conditions, ie, in 79% of the hospitalized group, although specificity was 64%, the total accuracy was 73%. When elevated CRP was combined with leukocytosis, the diagnostic value was much improved, with specificity of 89% and positive predictive value of 88%. The sensitivity was improved to 90% when elevated CRP or leukocytosis was used. It is thus concluded that CRP is a helpful quantitative variable for disposition decision-making in patients with acute abdominal pain.

Abdomen, Acute↗
PubMed1996

Clinical presentation and prognostic factors in sodium monofluoroacetate intoxication.

BACKGROUND: The diagnosis of sodium monofluoroacetate intoxication in humans is usually based on a history of ingestion and clinical findings. Although several previous reports have described the clinical course and outcome of patients who ingested this drug, prognostic indicators of short-term survival are not available. METHODS: A retrospective study of 38 consecutive cases of sodium monofluoroacetate poisoning at the National Cheng Kung. University Hospital, 1988-1993, to analyze the clinical findings and to predict mortality. RESULTS: Seven of 38 patients (18%) died. The most common symptom was nausea or vomiting (74%). The most frequent ECG finding was nonspecific ST-T and T wave abnormalities (72%). Hypocalcemia (42%) and hypokalemia (65%) were the common electrolyte abnormalities. The clinical and laboratory characteristics were compared for the survival and mortality groups. Significant differences in hypotension, respiratory rate, pulse rate, creatinine, potassium, elevated alanine aminotransferase, pH, PCO2, APACHE II score, and subjective respiratory distress were noted. Discriminant analysis identified hypotension, increased serum creatinine, and decreased pH as the most important predictors of mortality, with sensitivity of 86% and specificity of 96%. CONCLUSIONS: Hypotension and the early onset of metabolic acidosis and increased serum creatinine are associated with poor short-term survival. These prognostic variables can be useful in the care of patients with suspected sodium monofluoroacetate intoxication. It is suggested that all such patients should be observed intensively for at least 48 h.

Adult↗
PubMed1996

[119 emergency medical transport of the elderly].

A retrospective analysis of emergency ambulance transports in the EMS-Tainan was made to evaluate the utilization of emergency medical system by the elderly and to determine the factors that may influence these transports. The study group consisted of 4,090 emergency ambulance transports from 1/1/1195 to 30/4/1995. 1,017 patients (24%) were aged over 65. The main characteristics of these elderly patients were as follows: more non-trauma cases, higher severity of triage, and longer total transport time (23.0 +/- 0.5 vs. 18.9 +/- 0.2 minutes) were noted. In addition, 136 (13.4%) of the elderly patients were not received by the EMS network hospital. The most important factors that affect the total transport time in the elderly group were triage classification and trauma, which determined that speed of transport. In the elderly group, female patients tend to be older, of more severe triage classification, more nontrauma-related, have longer total transport time, and have less access to the EMS than male patient. Based on these results, we recommended make efficient transport in order to provide better emergency care for the elderly. A network linking the elder users with EMS dispatch center should improve the efficiency in fulfilling the EMS calls, and further investigation about the value of such a network is warranted. It is also important to establish a competent and countrywide database for EMS users and to pursue ongoing planning in order to evaluate and investigate the needs of EMS for elderly patients in the future.

Aged↗
PubMed1995

Endoscopic variceal ligation versus conservative treatment for patients with hepatocellular carcinoma and bleeding esophageal varices.

BACKGROUND: Endoscopic variceal ligation (EVL) is currently a favored treatment for control of bleeding from esophageal varices. However, little is known about the treatment of bleeding varices in hepatocellular carcinoma. METHODS: EVL was performed in 16 patients with bleeding esophageal varices due to concomitant hepatocellular carcinoma. Treatment results were compared with those of another 23 patients who were conservatively treated. RESULTS: Comparing the two groups, ligation significantly reduced the risk of fatal bleeding (44% vs 70%; P < 0.05). Significantly fewer patients in the ligation group died at the time of the index hemorrhage (11% vs 52%; P < 0.05). Rebleeding occurred in 44% of the ligation group and 73% in the control group (P > 0.05). The mean days of survival were 40 +/- 20 (range, 7 to 103) in the ligation group and 20 +/- 30 (range, 1 to 136) in the control group (P = 0.08). In the absence of portal vein thrombosis, ligation significantly reduced the rebleeding rate (17% vs 50%, P < 0.05) and the mortality rate (0% vs 100%, P < 0.05). CONCLUSION: EVL is a good choice for palliation in patients with esophageal variceal bleeding and hepatocellular carcinoma. Aggressive use of EVL may be tried in those patients without portal venous thrombosis.

Adult↗
PubMed1995

Severe hepatocellular damage induced by chlormezanone overdose.

Chlormezanone is a widely prescribed muscle relaxant (1-3) whose pharmacology is well known (4-6), but the clinical effect of overdose still remains relatively obscure (1, 7, 8). We here report a recent case of a patient who had severe liver function impairment and other associated findings typical of chlormezanone overdose. The ingested dose (at least 12 g) is much larger than those of previous record (1, 2, 7, 8); thus, her critical presentation deserves to be reviewed.

Adult↗