Ching-Hsing Lee

The early prognostic factors of glyphosate-surfactant intoxication.

BACKGROUND AND PURPOSE The purpose of this study was to establish an early prognostic model of patients with glyphosate-surfactant (GlySH) herbicide intoxication. METHODS A case-control study was conducted. Data of GlySH-intoxicated patients were collected from 2 hospitals. Patients were admitted to the emergency departments (EDs) of Chang Gung Memorial Hospital from April 1996 to March 2003 and Taichung Veterans General Hospital from April 2000 to October 2003. Collected variables such as age, sex, estimated amount of ingestion, symptoms/signs including first vital signs, chest x-ray (CXR), and biochemical studies were analyzed for their role in the prognostic model of GlySH intoxication mortality. Univariate and odds ratio analyses were then performed. The prognostic model was then established by using logistic regression analysis and further stratified analysis. RESULTS Fifty-eight patients (19 men and 39 women; age, 48.8 +/- 15.8 years; P = .38) were enrolled in our study. Forty-one patients survived from GlySH intoxication and 17 died. After univariate analysis, 5 variables (respiratory distress needing intubation, metabolic acidosis, tachycardia, elevated creatinine (Cr) level, and hyperkalemia) were found to be highly associated with poor outcome and mortality. Then a multiple logistic regression model was established as follows: log(p/q) = -6.13 + 3.43 (abnormal CXR) + 2.53 (metabolic acidosis) + 2.55 (Cr) + 2.4 (tachycardia) + e. CONCLUSION GlySH poisoning is multiorgan toxicity. Pulmonary toxicity and renal toxicity seem to be responsible for its mortality. Metabolic acidosis, abnormal CXR, tachycardia, and elevated Cr level are useful prognostic factors for predicting GlySH mortality.

Prognostic indicators of open globe injuries in children

PURPOSE To determine the prognostic indicators of visual outcome in children with open globe injuries. BASIC PROCEDURES The charts of 62 patients, 16 years of age or younger, who had been treated for open globe injuries were reviewed. MAIN FINDINGS The types of injury included penetrating (30 eyes), rupture (20 eyes), intraocular foreign body (10 eyes), and perforation (2 eyes). Sharp objects, such as knives or scissors, were the most common causes of open globe injuries. A visual acuity (VA) of at least 20/40 was achieved in 80.8% (21/26) of eyes with a corneal injury only, in 45.5% (5/11) of eyes with additional lens damage, and in 17.4% (4/23) of eyes with extensive anterior and posterior injuries. CONCLUSIONS Unfavorable outcomes were related to the location of injury, the extent of injury, the initial presentation of hyphema, vitreous hemorrhage, retina detachment, cornea wound across the pupil, and the development of endophthalmitis.

Children with lethal streptococcal fasciitis after a minor contusion injury

Necrotizing fasciitis is a severe life-threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. Mortality as a result of streptococcal necrotizing fasciitis has been associated with the presence of hypotension, streptococcal toxic shock syndrome, or bacteremia in the literature. These infections are rare in children, and the diagnosis should be considered in the presence of any soft tissue infection presenting with signs of toxicity and marked wound edema. In addition, traumatic compartment syndrome has also gained public attention. This condition is also potentially lethal if diagnosis and management are delayed, especially in patients with swollen limbs without fracture. A high index of suspicion is most important when there is a paucity of specific cutaneous findings early in the course of the disease. The diagnosis of necrotizing fasciitis should be considered for any individual who has unexplained limb pain. Even for treating patients with minor trauma, the emergency department physician should keep a high level of suspicion of the possibility of a fatal outcome from the subsequent invasive streptococcal infection.

The Progress of Emergency Medicine in Taiwan, China, and Hong Kong: Perspective from Publications in Emergency Medicine Journals, 1992–2011

Study Objective. The progress of emergency medicine (EM) in Taiwan, China, and Hong Kong was evaluated from the perspective of publications in EM journals. Methods. This was a retrospective study. All articles published from 1992 to 2011 in all journals in the EM category in the 2010 Journal Citation Reports (JCR) were included. A computerized literature search was conducted using the SciVerse Scopus database. The slope (β) of the linear regression was used to evaluate the trends in the numbers of articles as well as the ratios to the total number of EM journal articles. Results. The trends in the numbers of articles from Taiwan, China, and Hong Kong were 6.170, 1.908, and 2.835 and the trends in the ratios of their publication numbers to the total number of EM journal articles were 15.0 × 10−4, 4.60 × 10−4, and 6.80 × 10−4, respectively. All P-values were <0.01. The mean, median, and 75th percentiles of the number of citations in all EM journals were greater than those of these three areas. Conclusions. The publications from Taiwan, China, and Hong Kong have increased at a higher rate than those of the overall EM field in the past 20 years and indicated the rapid progress in these three areas.

Top-cited publications on point-of-care ultrasound: The evolution of research trends

Study objectives: Point‐of‐care ultrasound (POCUS) has been a rapidly growing and broadly used modality in recent decades. The purpose of this study was to determine how POCUS is incorporated into clinical medicine by analyzing trends of use in the published literature. Methods: POCUS‐related publications were retrieved from the Web of Science (WoS) database. The search results were ranked according to the number of times an article was cited during three time frames and average annual number of citations. Of the top 100 most cited publications in the four rankings, information regarding the publication journal, publication year, first authors nationality, field of POCUS application, and number of times the article was cited was recorded for trend analysis. Results: A total of 7860 POCUS‐related publications were retrieved, and publications related to POCUS increased from 8 in 1990 to 754 in 2016. The top 148 cited publications from the four ranking groups were included in this study. Trauma was the leading application field in which POCUS was studied prior to 2001. After 2004, thorax, cardiovascular, and procedure‐guidance were the leading fields in POCUS research. >79% (118/148) of the top‐cited publications were conducted by authors in the United States, Italy, and France. The majority of publications were published in critical care medicine and emergency medicine journals. Conclusions: In recent years, publications relating to POCUS have increased. POCUS‐related research has mainly been performed in thorax, cardiovascular, and procedure‐guidance ultrasonography fields, replacing trauma as the major field in which POCUS was previously studied.

Challenges of feedback provision in the workplace: A qualitative study of emergency medicine residents and teachers

Abstract Background: Feedback is an effective pedagogical tool in clinical teaching and learning, but is often perceived as unsatisfactory. Little is known about the effect of a busy clinical environment on feedback-giving and -seeking behaviors. This study aims to determine the perceptions and challenges of feedback provision in a busy clinical setting, exemplified by an emergency department (ED). Methods: A qualitative semi-structured interview study design was employed. Thirty-six participants (18 attending physicians, 18 residents) were purposively sampled from three EDs in northern Taiwan between August 2015 and July 2016. Interviews were recorded, transcribed, and analyzed thematically. Results: Three major themes were identified with illustrative quotes: (1) the balance between patient safety and providing feedback, (2) variability in feedback, and (3) influential factors, barriers and enablers. Conclusions: In real practice, clinical duties competed with the impulse to provide feedback. The variety and complexity of feedback extended beyond style and content. Clinical and contextual factors – some of which may be presented as barriers – influenced how, when and whether a teacher or learner decided to give or seek feedback.