Chien Liang Chen

Imported Malaria in Southern Taiwan from 1991 to 2002: A Single Hospital's Experience

Malaria, a major public health problem worldwide, is a predominant infectious disease in most tropical and subtropical countries. Before 1965, Taiwan was a hyperendemic area, but most cases are now imported. We present our experience of dealing with various malaria infections. Charts of malaria patients visiting university hospitals in southern Taiwan between January 1991 and June 2002 were available for review. All diagnoses were made by positive blood smear and detailed history that included countries visited, paroxysm of symptoms, and medical treatment. Seventeen patients, 6 women and 11 men (mean age, 32.3 ± 11.8 years), were enrolled. Six were infected with Plasmodium falciparum, eight with Plasmodium vivax, two with a combination of P. falciparum and P. vivax, and one with an unidentified infection. All Taiwanese patients infected with P. falciparum (n = 5) contracted the disease in Africa or Indonesia. All Taiwanese patients infected with P. vivax (n = 4) contracted the disease in Southeast Asia or Oceania. Fever and chills were the leading symptoms of malaria. P. falciparum infection was treated with quinine and doxycycline/tetracycline, with the addition of artesunate for cerebral malaria. P. vivax infection was treated with chloroquine and primaquine. Maintaining a high degree of suspicion in patients with a history of travel to malaria‐endemic areas is the major cornerstone of malaria diagnosis. Erroneous diagnosis and improper treatment leads to greater morbidity and even mortality.

Factors influencing medical staff’s intentions to implement family-witnessed cardiopulmonary resuscitation: A cross-sectional, multihospital survey

Background: In Taiwan, the current status of family-witnessed resuscitation (FWR) and the factors associated with behavioural intentions to implement FWR have not been systematically examined using representative medical staff. Aim: We explored predictive factors for behavioural intentions to implement FWR among medical staff using constructs from the theory of planned behaviour. Methods: A survey of 1605 medical staff from five hospitals in southern Taiwan was conducted. Data were collected using a researcher-made questionnaire containing theory of planned behaviour constructs and demographic items. The dependent variable was intention to implement FWR, and the independent variables were three theory of planned behaviour constructs (attitudes, subjective norms, and perceived behavioural control) and the demographic characteristics. A generalized estimating equation was used to identify factors associated with the behavioural intentions. Results: In total, 1122 valid questionnaires revealed that only 3.7% of participants advocated FWR policies. The construct scores for intention to implement FWR were 2.96 (on a five-point Likert scale), and the theory of planned behaviour constructs that significantly predicted intention to implement FWR were positive attitudes and subjective norms (p<0.001). Classification of hospitals (p=0.018) and restrictive provisions for FWR (p=0.004) were additional significant predictors of intention to implement FWR. Moreover, medical staff employed at regional hospitals demonstrated higher intentions, positive attitudes and subjective norms than did those employed at the medical centre. Conclusion: According to the findings of this study, it may be desirable for administrators to prioritize the implementation of the FWR policy in regional hospitals. We recommend affording the factors of positive attitudes and subjective norms high priority to improve the medical staff’s behavioural intentions of FWR practice.

Comparison of Motion Sickness-Induced Cardiorespiratory Responses between Susceptible and Non-susceptible Subjects and the Factors Associated with Symptom Severity

This study aimed to examine the correlations between susceptibility to motion sickness and pulmonary function and aerobic capacity. We supposed that people with different susceptibilities to motion sickness differ in their cardiorespiratory responses. Thirteen healthy young men were recruited. They were asked to complete a motion sickness history questionnaire and were divided into susceptible and non-susceptible groups. A rotary chair was rotated for 10 minutes at 20 rpm to induce motion sickness. After the rotation, Graybiels diagnostic criteria were used to grade the severity of motion sickness. This study also conducted evaluations of cardiorespiratory responses. Participants underwent a pulmonary function test and an exercise test to evaluate aerobic capacity. A generalized estimating equation was used to analyze the correlation between Graybiels scores and the pulmonary function and exercise test results. The differences between the two groups were analyzed for the physiological parameters measured. The results indicated higher severities of motion sickness in participants with lower values of maximum voluntary ventilation (MVV). Moreover, the group of susceptible participants demonstrated significantly higher Graybiels scores and stronger cardiorespiratory responses, significant interaction effects were observed in oxygen consumption, carbon dioxide production (VCO2), ventilation, and respiratory rate. To summarize, MVV is proposed as a reference index for evaluating susceptibility to motion sickness. Severe motion sickness in susceptible participants is suggested to be related to hyperventilation, which causes excessive VCO2.

A Study of Learning Effectiveness in Disaster Nursing Course Based on Kirkpatrick’s Evaluation Model

This study aims to evaluate the course of disaster nursing through assessing nursing students’ satisfaction, knowledge and skills gain and impact on practices by the Kirkpatrick’s evaluation model. Seventy undergraduate nursing students were surveyed. The study adopted the Kirkpatrick’s evaluation model which contains four levels. Data were presented by descriptive statistics, Person correlation and t-test to conduct the analysis. Level 1 “Reaction”, the significant positively correlation existed between course satisfaction and teaching strategies. Level 2 “Learning”, post-test data was significantly higher than pre-test data. There was positively significant correlation existed between level 3 (Behavior) and level 4 (Result). Our course programs can be used as a reference for future nursing schools offer related courses to prepare the implementation of disaster nursing courses and teaching methods, establish suitable disaster nursing education programs for our national conditions.

Effect of far infrared radiation therapy on improving microcirculation of the diabetic foot

Diabetes is associated with many severe complications, such as heart disease and nerve damage. Diabetics have elevated blood glucose levels that result in peripheral neuropathy. As a result, diabetics always feel painful about their lower limbs and may need to have lower limb amputation. The diabetic foot ulcers are hard to heal and require extensive medical treatments and follow ups. The purpose of this study was to evaluate the effect of infrared radiation therapy using a heating pad with carbon fibers (LinkWin Technology Co., Taiwan) on the diabetic foot. Ten diabetics and 4 non-diabetics were recruited for this study. The participants were assessed for their microvascular function before and after the interventions in each month for three consecutive months. The results showed that surface temperature increase by 2° after using the pad in the first and third months (p < 0.05); and blood flow increase on the plantar foot (p < 0.05) but not on the dorsal foot. The increase in blood flow may alleviate diabetic-related complications. The results of autonomic nervous testing indicated that the activity of sympathetic nervous increased after using the pad. In conclusion, the use of heating pad with far infrared radiation could improve blood flow and autonomic nervous system in diabetics, therefore improving alleviating symptoms of diabetes-related complications.

The Influence of Dry Cupping of Differing Intensities on Heart Rate Variability

The aim of this study was to determine an appropriate range of negative pressure to ensure the treatment effect of cupping. Twenty healthy participants were enrolled to receive classic dry cupping treatments at three different pressure intensities (−100, −300, or −500 mmHg) for 10 min each. Heart rate variability (HRV) was measured before, during, and 10 min after cupping to assess changes in autonomic activity. Repeated measure ANOVA was used to analyze differences. Cupping at a pressure of −100 mmHg did not significantly change the HRV, but cupping at both −300 and −500 mmHg caused a significant improvement in HRV. The HRV responses did not differ significantly between cupping at −300 and at −500 mmHg, however. The significant increase in HRV occurred only during the recovery period after the cups were removed.

Three-dimensional elastography gradient of the plantar soft tissue: Methodology and preliminary study

Diabetic foot ulcers are a significant complication in people with diabetes mellitus. The changes of mechanical properties of plantar tissues associated with diabetes may contribute to a high incidence of diabetic foot ulcers. This study investigated the feasibility of using three-dimensional (3D) elastography to measure 3D elasticity of the fat pad and then calculate 3D elasticity gradients of the foot. This method may improve the detection of people at risk for diabetic foot ulcer. Elastography with a soft ratio measurement may provide a visualization of plantar soft tissues for clinicians to diagnose foot ulcer risk. In this study, we measured B-mode and elastic ultrasound images at the first metatarsal head in five volunteers. The soft tissue contains four layers, including inner layer (Q1, near bone surface), sub-inner layer (Q2), sub-outer layer (Q3), and outer layer (Q4, near skin surface). The elasticity values were significantly greater in the Q3 layer compared to the Q1 layer. The elasticity gradient values were significantly smaller in the Q3 layer compared to the Q2 layer. The correlation between the elasticity and elasticity gradient was r = −0.88 in the Q3 layer.

A Comparative Study of the Effects of Electrical Stimulation and Intermittent Compressive Forces on Soft Tissue Mechanical Properties

We aimed to investigate and compare the effects of electrical stimulation and intermittent compressive forces on soft tissue mechanical properties. Four healthy individuals were recruited into this study. A transcutaneous electrical stimulation device was used to apply a pulse duration of 2.5 ms, a frequency of 2 Hz, and the amplitude to a maximum of 30 mA. The intermittent compressive forces were applied at a period of 20 s with forces ranging from 0 to 70 mmHg. The effective Young’s modulus was calculated to characterize mechanical properties of forearm soft tissues. The results showed that forearm soft tissue properties might decrease effective Young’s modulus after the treatments of electrical stimulation and intermittent compressive forces.

Activation Sequence Patterns of Forearm Muscles for Driving a Power Wheelchair

The purpose of this study was to investigate muscle activities of the upper limbs while driving a power wheelchair. Eleven healthy individuals were recruited to perform four joystick control tasks, including forward, backward, left-turn, and right-turn. The results of this study would establish a norm for evaluating the controls of a power wheelchair in children with cerebral palsy. The surface electromyographic monitor (EMG) was used to record the contractions of extensor carpi ulnaris (ECU), flexor carpi ulnaris (FCU), and flexor carpi radialis (FCR). The integration of EMG signals was used to quantify the muscle efforts. The results showed that participants use more muscle efforts in ECU during backward early, but during left-turn later. The results of the forearm muscle activations can be used to guide training of children with cerebral palsy to drive a power wheelchair.

The Effects of Cupping Therapy on Reducing Fatigue of Upper Extremity Muscles—A Pilot Study

The aim of this study was to determine the effect of the cupping therapy on the muscles and autonomic nervous system. Five healthy participants were recruited for the arm cranking tests. The protocols include a 1st 12-min bout, 20-min recovery, and 2nd 12-min bout. The cupping therapy (negative pressure of 300–450 mmHg on the upper back and shoulder muscles) was applied during the recovery period of experimental trials. The median frequency (MDF) of electromyographic signals and the heart rate variability (HRV) were used to objectively quantify the degree of muscle fatigue and cardiovascular regulations. The repeated measures ANOVA was applied to determine the differences. Our results showed that MDF was significantly higher in the experimental trials but the HRV was not significantly different between the experimental and control trials. Our study indicates that the role of cupping therapy may reduce muscle fatigue but do not alter the cardiorespiratory controls.