The distribution of different surgical types for female stress urinary incontinence among patients’ age,surgeons’ specialties and hospital accreditations in Taiwan: a descriptive 10-year nationwide study

This study aims to identify the changing trends of different surgical types for female stress urinary incontinence (SUI) and the distribution amongst various providers’ characteristics. A total of 17,532 women who had undergone surgery for SUI during 1996–2005 were identified from the National Health Insurance Research Database for analysis. Retropubic urethropexy (RPU) was the most common surgical type (43%), followed by tension-free mid-urethral sling (MUS; 24%), and traditional pubovaginal sling (15%). MUS had an annual growth rate of 20.5%, whilst traditional pubovaginal sling was reduced by 11.3% annually after 2002. RPU was the most common procedure by both gynecologists and urologists. Gynecologists performed more Kelly plications, whereas urologists performed more traditional pubovaginal sling. MUS was more commonly performed in medical centers than in regional and local hospitals. There has been a notable growth and changing trend in various surgical types for female SUI in Taiwan.     

Imaging Validation of Drug-Eluting Beads Transarterial Chemoembolization of Hepatocellular Carcinomas in Living Donor Liver Transplantation

Objective

The aim of this study is to determine whether post-transarterial chemoembolization imaging (computed tomography or magnetic resonance imaging) could accurately predict the tumors' necrosis on pathologic specimens.

Nationwide surveillance of antimicrobial resistance in invasive isolates of Streptococcus pneumoniae in Taiwan from 2017 to 2019

Background/purposeStreptococcus pneumoniae causes pneumonia and other invasive diseases, and is a leading cause of mortality in the elderly population. The present study aimed to provide current antimicrobial resistance and epidemiological profiles of S. pneumoniae infections in Taiwan.MethodsA total of 252 nonduplicate S. pneumoniae isolates were collected from patients admitted to 16 hospitals in Taiwan between January 2017 and December 2019, and were analyzed. The minimum inhibitory concentration of antibiotics was determined using the Vitek 2 automated system for antimicrobial susceptibility testing. Furthermore, epidemiological profiles of S. pneumoniae infections were analyzed.ResultsAmong the strains analyzed, 88% were recognized as invasive pneumococcal strains. According to the Clinical and Laboratory Standards Institute criteria for non-meningitis, the prevalence of penicillin-non-susceptible S. pneumoniae demonstrated a declining trend from 43.6% in 2017 to 17.2% in 2019. However, the rate of penicillin-non-susceptible S. pneumoniae was 85.7% based on the criteria for meningitis. Furthermore, the prevalence of ceftriaxone-non-susceptible S. pneumoniae was 62.7% based on the criteria for meningitis. Isolates demonstrated higher susceptibility toward doripenem and ertapenem than toward meropenem and imipenem. An increased rate of non-susceptibility toward levofloxacin was observed in southern Taiwan (15.1%) and elderly patients (≥65 years; 11.4%). Most isolates were susceptible to vancomycin and linezolid.ConclusionEmpirical treatment with ceftriaxone monotherapy for pneumococcal meningitis should be carefully monitored owing to its high non-susceptibility rate. The susceptibility rates of most isolates to penicillin (used for treating non-meningitis pneumococcal diseases), carbapenems (ertapenem and doripenem), respiratory quinolones (moxifloxacin and levofloxacin), vancomycin, and linezolid suggested the potential of these antibiotics in treating pneumococcal diseases in Taiwan.     

Bacillus Calmette-Guérin (BCG) osteomyelitis among children: Experience in a single tertiary center in central Taiwan

BackgroundThe insidious nature of BCG-osteomyelitis makes it challenging for clinicians to detect it early on.MethodsThis 12-year retrospective analysis was conducted at a single tertiary hospital in central Taiwan. Electronic medical records of pediatric patients treated for BCG-osteomyelitis were reviewed. Demographics, clinical features, and laboratory findings were compared with patients diagnosed with culture-proven pyogenic osteomyelitis.ResultsIn total, eight patients fulfilled our inclusion criteria. Their median age was 16 months, and no obvious gender prevalence was found. Six of the eight patients had lesions involving the lower extremities. When compared with the pyogenic osteomyelitis group, age of disease onset was found to be significantly younger in the BCG osteomyelitis group (p=0.038). Absence of fever and pain in the BCG osteomyelitis group was found to be statistically significant when compared with the pyogenic group (p=0.002 and p=0.026 respectively). CRP and ESR were found to be significantly higher in the pyogenic osteomyelitis group (p=0.000 and p=0.004 respectively).ConclusionBCG-related osteomyelitis must be considered when evaluating an afebrile child presenting with an unexplainable swelling or limp, and especially when the lesion is located on a lower limb. Laboratory studies may reveal normal WBC and CRP, with a normal to modest elevation of ESR. Imaging studies, including plain radiographs, magnetic resonance imaging (MRI), or computed tomography (CT) should be employed to rule out BCG-related osteomyelitis. Early diagnosis help minimize inappropriate antibiotics use, and may lead to a better outcome.     

Vocational rehabilitation case manager factors associated with vocational rehabilitation service program outcomes for people with disabilities in Taiwan – an exploratory study

Purpose The aim of this study is to explore whether/which vocational rehabilitation case manager (VRCMer) factors were significantly associated with the vocational rehabilitation service (VRS) program outcomes in Taiwan. Method This study used the 2011 VRS Program for People with Disabilities Database in a metropolitan city in Taiwan (N?=?466) to do a secondary data analysis using hierarchical logistic regression. Results This study found that the employment rate and stable employment rate created by the 2011 VRS program in a metropolitan city in Taiwan were 48.7% and 42.1%, respectively. For the predictors of employment/stable employment, “occurrences of the services provided by the VRCMer” variable was definitely dominant. In addition, “level of the disability” was the second-ranking predictor, and was significantly negatively correlated with both employment and stable employment outcomes. Conclusions Vocational rehabilitation case manager factors in this study were significantly correlated with VRS program outcomes for people with disabilities in Taiwan after controlling for the clients’ socio-demographic variables. The results indicate that greater input by VRCMers for people with disabilities equates to better employment outcomes in metropolitan Taiwan.

• Implications for Rehabilitation

• This is the first study to build an inferential statistical model in attempt to explain and predict the association between vocational rehabilitation case manager factors and vocational rehabilitation service program outcomes for people with disabilities in Taiwan.

• In cases of severe disability, a vocational rehabilitation case manager should seek out more in-kind and in-cash resources, and choose a suitable job coach to cooperate in assisting the client to become employed.

• Based on the findings, government has to continue implementing opportunities for people with disabilities to attain higher and better quality educational levels, for increasing their employment rate.

• Vocational rehabilitation case managers should raise the referral rate and cooperation with job coaches as this directly affects the quality of services and clients’ employment rate.

     

Impact of delayed admission to intensive care units on patients with acute respiratory failure

Background/Purpose

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).

Risk Factors Associated with Emergency Room Drug Abuse Admissions in Urban Taiwan, 1998-1999

The present study examined the risk factors associated with admissions for drug abuse among patients who visited an accident and emergency (A & E) department at a large metropolitan teaching hospital in Taipei, Taiwan. Two hundred and fifty-four consecutive patients reporting problems related to suspected intentional drug poisoning or acute intoxication from drugs of misuse were matched to 254 patients with internal medicine conditions unrelated to drug abuse by age within three years. Risk factors and drug use information was obtained by questionnaire. Between December 1998 and November 1999, 272 (0.7%) patients had visited the A & E for treatment of drug-related problems. Among these patients, 254 (93%) completed questionnaires and were enrolled in this study. Major reasons for hospital visits were suicide (51%), and acute drug poisoning (49%); primary drugs used were sedatives/hypnotics (81.7%) and narcotics (4.7%); most drugs came from pharmacies and drug stores (47.2%), hospitals and clinics (25.2%), or were bought from friends (7.1%) or others (11.1%). Being single (OR = 1.7, 95% CI 1.1-2.7), female (OR = 3.4, 95% CI 1.4-10.0), having an alcohol drinking habit (OR = 3.0, 95% CI 1.3-7.2), and having higher depressive scores (OR = 1.3, 95% CI 1.2-1.4) were independently associated with drug abuse. Important preventive measures against drug abuse included improving access to psychological counseling for users and controlling dispension of drugs at pharmacies.     

Functional independence of Taiwanese children with Prader–Willi syndrome

Prader–Willi syndrome (PWS) is a genetic disorder with obesity, developmental delay, short stature, and behavioral abnormalities. The study aimed to assess the functional independence in children with PWS. The Functional Independence Measure for Children (WeeFIM) was used to evaluate 81 children with PWS (44 boys and 37 girls) with a median age of 11 years 1 month (range 2 years 8 months to 20 years 2 months) were recruited between January 2013 and December 2016. The mean total WeeFIM score was 103.8 (maximum 126). Sixty‐five patients (80%) had deletion type PWS, 16 (20.0%) had nondeletion type. The scores were 103.6 ± 18.5 for deletion and 104.8 ± 18.3 for nondeletion type (p = .405), 104.8 ± 19.3 in boys and 102.6 ± 17.3 in girls (p = .293). The mean self‐care, mobility, and cognition scores were 47 (maximum 56), 33 (maximum 35), and 24 (maximum 35), respectively. All total scores and 18 subscores in the three functional domains were positively correlated with age (p < .05). Most children required assistance in problem‐solving, comprehension, and expression. The WeeFIM identified the strengths and limitations of children with PWS and confirmed that support and supervision were needed in cognitive and self‐care tasks.     

C-reactive protein levels can predict positive 18F-FDG PET/CT findings that lead to management changes in patients with bacteremia

Background/purpose

Bacteremia portends high rates of morbidity and mortality. Although ¹⁸F-fluorodeoxyglucose positron emission tomography and computed tomography (¹⁸F-FDG PET/CT) imaging has clinical value in assessing fever of unknown origin, its usefulness in bacteremia has not been entirely elucidated. We therefore designed the current single-center retrospective study to investigate 1) the clinical value of ¹⁸F-FDG PET/CT imaging in assessing bacteremia and 2) the association between laboratory data and imaging findings.