輔仁醫學期刊最新文献

{"title":"老人日照中心的單元照護模式與夢之湖村照護模式之差異","authors":"吳炯麟 吳炯麟, 李光廷 Chiung-Lin Wu, 洪啓峯 Kuang-Ting Lee","doi":"10.53106/181020932022092003001","DOIUrl":"https://doi.org/10.53106/181020932022092003001","url":null,"abstract":"\u0000 背景及目的：「在地老化」一直是政府推動長期照護政策的目標，日間照顧中心可謂是支援需照護老人實現在地老化不可或缺的一環。但「大家一起來」般的制式化活動或參與是否真的符合不同個性的長者所需。本研究目的在於單元照護模式與夢之湖村式照護模式之差異研究，並針對日照中心提出具體之建議。方法：採質性研究之個案研究法(Case Study)，深度訪談老人日間照顧中心相關人士。結果與結論：針對4個單位、27位相關人士觀察以及深度訪談、資料整理後，發現日照中心長者雖然有安全照護等需求，但是自主與人際互動等需求則鮮少被重視，日照中心採用夢之湖村照護模式時，其長者之自主、互動以及人生意義等都比單元照護模式有較佳的表現。建議：建議日照中心1. 提供多元選擇，提升自主能力2. 妥善使用現有場地培養長者日常生活能力以及提高社會參與 3. 重新思考單元照護的意涵。\u0000 Introduction: “Aging in place” has always been the goal of the government to promote long-term care policies, of which the day service center is one of the most integral part supporting aging in place. However, the uniform activities and schedules designed by day service center should be reconsidered for their suitability. The purpose of this study is aimed to examine the differences of care model between “Unit Care” and “Yume-No-Mizuumi-Mura”. Method: The qualitative case study method was conducted to interview the stakeholders of the day service centers. Results & Conclusion: After observing four day service centers and depth interviewing 27 persons who related to the day ser-vice center, we find that although the elderly in the day center centers have needs such as safety care, the needs for autonomy and interpersonal interaction are seldom emphasized. When the day service center uses the “Yume-No-Mizuumi-Mura” model, people’s autonomy and interaction or meaning of life were better than the “Unit Care” model. Suggestion: Our results suggest that the day service centers have to provide a variety of choices to enhance autonomy, properly use existing venues to cultivate elderlies’ daily life skills and increase social participation, and rethink the meaning of unit care model.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"16 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114108416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"台灣老人下肢截肢","authors":"楊翊君 楊翊君, 武俊傑 Yi-Chun Yang, 郭懷璟 Chun-Chieh Wu, 李棟洲 Huai-Jing Guo","doi":"10.53106/181020932022092003002","DOIUrl":"https://doi.org/10.53106/181020932022092003002","url":null,"abstract":"\u0000 背景和目的：本研究將台灣過去18年間65歲以上下肢截肢老年患者分為65-74歲、75-84歲及85歲以上三組，討論他們截肢的特徵和醫療利用情況，並將他們與 65 歲以下的截肢者進行比較。方法：本研究為一項回顧性觀察研究。我們使用了 1996 年至 2013 年台灣全民健保參保人的全國代表性百萬抽樣檔作數據。分析截肢的基本特徵及其醫療使用數據。結果：65歲以上截肢患者，年齡越大則女性 (p = .002) 和因周圍血管疾病截肢 (p < .001) 的比例越高。截肢部位、住院透析、術後住院復健、手術費用和總住院費用則不同年紀組間無顯著差異。與 65 歲以下截肢者相比，65 歲以上下肢截肢老人中女性患者 (p < .001)、近端截肢 (p < .001)、非創傷性截肢 (p < .001) 和透析 (p < .001) 的比例更高。相比之下，接受術後復健治療的患者比例 (p < .001) 和相同截肢部位的手術費用 (p < .001) 低於 65 歲以下的患者。結論：在有截肢風險的老人中，年齡越大，須更關注女性和非糖尿病周圍血管疾病患者。很少老年截肢者接受住院復健，這提醒我們截肢復健不僅是義肢訓練。提高患者出院前的自我照護、轉位和活動能力的訓練不應受年齡限制。\u0000 Background and purpose: This study examines the characteristics and medical utilization of elderly patients with lower limb amputation in three different age groups, namely, young-old, old-old, and oldest-old, and compares them with amputees younger than 65. Methods: A retrospective study. We used data from a nationally representative sample of one million enrollees of the National Health Insurance in Taiwan from 1996 to 2013. The basic characteristics for amputation were identified, and the claims data for medical utilization were analyzed. Results: Among amputees older than 65, the higher the age, the higher the proportion of female (p = .002) and amputations due to peripheral vascular diseases (p = .000). There was no significant difference in amputation level, dialysis, inpatient rehabilitation, surgical cost, and hospital costs. Compared with amputees younger than 65, the proportion of females (p = .000), proximal amputations (p = .000), non-traumatic amputations (p = .000), and dialysis (p = .000) was higher in patients older than 65. In contrast, the proportion of patients receiving rehabilitation (p = .000) and the surgical cost of the same amputa-tion level (p = .000) were lower than for those younger than 65. Conclusion: In el-derly at risk of amputation, the higher the age, more attention must be paid to female and patient with non-diabetic peripheral vascular disease. Few elderly amputees re-ceived inpatient rehabilitation, which is a reminder that amputation rehabilitation is not simply prosthetic rehabilitation. Improving patients’ self-care, transfer, and mobil-ity skills before discharge should not be limited by age.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114888232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"腰椎偽性定位症候：病例報告及文獻回顧","authors":"王大鈞 王大鈞, 蔡明成 蔡明成","doi":"10.53106/181020932022092003004","DOIUrl":"https://doi.org/10.53106/181020932022092003004","url":null,"abstract":"\u0000 根據患者的臨床表現、仔細的神經學及影像學上的檢查可以很容易將病灶在病患身體的相對位置做出很好的定位。這即是醫學教育上所標榜的精準定位。越是精細的手術，術前精準的定位越是重要。手術前的定位標記就是為了避免開錯邊的手術發生。尤其對於目前被廣泛使用的脊椎微創內視鏡手術而言，錯誤的定位不僅將導致手術的失敗，更可能衍生出醫療糾紛。在本報告中，我們介紹了一個罕見的腰椎定位錯誤的病例。根據病患臨床表現及神經學檢查所定的位置竟然與核磁共振攝影的影像不同。這種差異帶給了微創手術莫大的困擾。我們探查之前曾發表過的文獻，對於發生於腰椎的這種偽性定位症候的病例報告極少。在本報告中，我們將探討其可能涉及的機制並進行相關文獻之回顧。\u0000 Based on a patient’s presentation, careful neurologic examinations and radiographic data may be employed to identify pathological lesions. From a surgical standpoint, the laterality of lesions always influences surgical planning and results. Precise localization is crucial for the success of the commonly preferred minimally invasive surgeries. False localization can undercut such efforts. Even though we strive to confirm lesions before operating, false localization may still occur. In this report, we present a case of a patient with false localizing signs on the lumbar spine. The signs of localization of lumbar radiculopathy differed between presenting symptoms and magnetic resonance imaging scans. This discrepancy posed difficulties in deciding on the surgical approach. There were no published case reports on false localization signs at the lumbar spine before. In this report, we discuss the possible mechanisms involved and review the relevant literature.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128142958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"右側顳骨內表皮囊腫：案例討論及文獻探討","authors":"呂冠廷 呂冠廷, 蔡明達 Kuan-Ting Lu, 李進成 Ming-Dar Tsai, 蕭振宇 Chin-Cheng Lee","doi":"10.53106/181020932022062002003","DOIUrl":"https://doi.org/10.53106/181020932022062002003","url":null,"abstract":"\u0000 顱骨內表皮囊腫是一種少見、生長緩慢的良性腫瘤，可能是先天性或是後天造成的，多數表皮囊腫位於硬腦膜內，少數長在顱骨之中。這些病灶通常以無疼痛、數年至數十年間緩慢增大的腫塊來表現。我們報告一個年輕女性患有右側顳骨內表皮囊腫接受完整手術療程的病例，並且整理相關文獻探討。\u0000 Intradiploic epidermoid cysts are uncommon, slow-growing, benign tumors, ac-counting for approximately 1% of intracranial tumors. They can be congenital or ac-quired; most of them are located intradurally and rarely in the scalp. These lesions usually manifest as painless, gradually enlarging masses over years or decades. They are clinically and radiographically difficult to differentiate from other calvarial lesions. Accurate radiological assessment and complete surgical excision of the lesion and its capsule play a crucial role in ensuring favorable long-term outcomes. We present a case of a young female diagnosed with an epidermoid cyst in the right temporal bone who underwent complete and successful surgical treatment. A complete imaging study was obtained including X-rays and computed tomography and magnetic resonance imaging scans, which demonstrated pathognomonic findings of an epidermoid cyst. We review the relevant literature, pathogenesis, radiographic characteristics, and di-agnosis of the epidermoid cysts.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"2 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123815257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"台北區指定應變醫院護理人員對新興傳染病照顧意願相關因素之探討","authors":"鄭鈺郿 鄭鈺郿, 劉翠瑤 Yu-Mei Jeng, 洪啓峯 Tsui-Yao Liu","doi":"10.53106/181020932022062002002","DOIUrl":"https://doi.org/10.53106/181020932022062002002","url":null,"abstract":"\u0000 目的：探討台北區指定應變醫院護理人員對新興傳染病照顧意願相關因素。方法：為橫斷性研究設計，於2021年7至8月對台北區應變（區域）醫院執業滿三個月之臨床護理人員共255位進行結構式問卷調查，包含個人屬性資料、護理人員專業承諾量表、自我效能量表、照顧態度量表及照顧意願以單因子變異數分析、相關係數與迴歸進行資料分析。結果：護理人員對於新興傳染病的照顧意願得分平均為6.7（標準差為2.55）其中與工作單位及是否有參與實務演練課程有統計上顯著差異；而護理人員專業承諾與照顧意願（相關係數為0.26，p＜.01）、自我效能與照顧意願（相關係數為=0.20，p＜.01）、照顧態度中的行為信念與照顧意願（相關係數為0.30，p＜.01）、照顧態度中的結果評價與照顧意願（相關係數為0.27，p＜.01）皆呈現低度正相關。廻歸分析結果，控制人口學變項後工作單位、專業承諾、照顧態度之行為信念構面，能一同解釋研究對象意願總變異量34.2%且皆達統計顯著差異。結論：護理人員六成以上都有照顧意願但研究發現其專業承諾量表平均值3.34較低（使用五分制），現今醫療及照護環境迅速改變，醫院面臨健保給付及護理人員流動或畢業後不想從事護理工作之問題，研究發現工作滿意度與專業承諾有正相關，而且工作滿意度與專業承諾的得分高低也隱含護理人員離開組織或是專業職場的預測力，且以目前世代之同仁重視歸屬感及希望被重視，積極提供護理人員成長空間與機會並同理工作表現給予適度的激勵及支持環境以提昇忠誠度及穩定度，促使護理人員有繼續為護理專業努力的意願。\u0000 Objective: To evaluate on the factors related to the willingness of nurses to take care of emerging infectious diseases in designated emergency hospitals in Taipei. Methods: Designed for a cross-sectional study, a structured questionnaire survey was conducted on a total of 255 clinical nursing staffs who had been practicing for three months in a designated (regional) hospital in Taipei from July to August 2021, in-cluding demographic attributes and nursing staff The professional commitment scale, self-efficacy scale, care attitude scale, and willingness to care were analyzed by single factor variance analysis, correlation coefficient and regression. Results: The average score of nursing staff’s willingness to care for emerging infectious diseases was 6.7 (standard deviation 2.55), which was statistically significantly different from their work units and whether they had participated in practical training courses; while nurses’ professional commitment and willingness to care (r = 0.26，p＜.01), self-efficacy and willingness to care (r = 0.20, p＜.01), behavioral beliefs and will-ingness to care (r =0.30, p＜.01) in care attitudes, results in care attitude Both evalua-tion and willingness to care (r =0 .27, p＜.01) showed a low degree of positive corre-lation. Based on the analysis results, the behavioral belief dimensions of work unit, professional commitment, and care attitude after controlling for the demographic changes can explain 34.2% of the total variation of the study subjects’ willingness and all reach statistically significant differences. Conclusion: More than 60% of nursing staff have the willingness to take care, but the study found that their professional commitment scale average is low as 3.34 (by Liker’s method). Nowadays, the medical and nursing environment is changing rapidly. The hospital is facing the problem of health insurance payment and nursing staff turnover or not wanting to engage in nursing work after graduation. The study found that job satisfaction and professional commitment are positively correlated, and the scores of job satisfaction and profes-sional commitment also imply the predictability of nursing staff to leave the organiza-tion or professional workplace. In view of the current generation’s emphasis on be-longing and the desire to be valued, nursing staff are activ","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127532734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"使用腕部Navicular view X-光投影診斷經舟狀骨半月骨周邊骨折合併遠端撓尺關節脫位","authors":"張淳昱 張淳昱","doi":"10.53106/181020932022062002004","DOIUrl":"https://doi.org/10.53106/181020932022062002004","url":null,"abstract":"\u0000 經舟狀骨半月骨周邊骨折合併遠端撓尺關節脫位（Trans-scaphoid perilunate fracture combined with distal radioulnar joint dislocation）是一種相對罕見的腕部外傷，在緊急情況下容易造成誤判而延誤治療時機，影響最終治療效果。診斷困難的可能原因是使用腕部X光正投影及正側面投影（腕部AP和Lat投影圖）較難顯示出手腕舟狀骨的骨折情形。作者在門診中使用腕部舟狀骨投影（Wrist Na-vicular View）篩檢由急診室轉診的腕部外傷病患，診斷出一位經舟狀骨半月骨周邊骨折合併遠端撓尺關節脫位案例。該女性患者的腕部AP和Lat投影圖檢查結果均為正常，本文對患者隨後的X光檢查結果和追蹤過程進行了分析。雖然治療此類型的骨科案例多以外科手術治療為主，但該案例接受手術治療意願偏低，因此只進行了石膏固定治療,其最終仍獲得良好成果。在緊急情況下，傳統的腕關節X光正投影及正側面投影通常已足以篩檢舟狀骨折情形，但針對隱匿性骨病變仍有遺漏的可能。本研究強調使用輔助性Wrist Navicular View對於診斷該類型案例的價值。\u0000 Trans-scaphoid perilunate fracture combined with distal radioulnar joint dislocation is a relatively rare wrist trauma condition and often missed in emergency setting. Traditional wrist anterior posterior and lateral Views X-ray are usually sufficient for screening writ injuries in emergency room, but occult bony lesions like these were occasionally missed out. Adjunct X-ray check with wrist navicular view would help tremendously in filling the gap.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121060425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"手術室發生之針扎與尖銳物傷害：原因分析與改善方案","authors":"朱文田 朱文田, 蘇洋立 蘇洋立, 雷宜芳 雷宜芳, Emily Lo Yi-Fan Lef, 羅崇杰 Emily Lo","doi":"10.53106/181020932022062002001","DOIUrl":"https://doi.org/10.53106/181020932022062002001","url":null,"abstract":"\u0000 背景與目的：近年來發生於醫院的針扎與尖銳物傷害逐漸被重視，同時安全針具的普及使用，這類的穿刺傷害雖然已有減少，但仍未能有效地被控制，尤其是發生在手術室裡的傷害。因此，本研究的宗旨是探討與分析某醫學中心五年內所發生的針扎與尖銳物傷害的事件，尋找危險因子與解決方案，以達到持續提升醫護人員的職場安全。研究方法：本研究收納在2016年1月至2020年12月發生於台灣北部某家醫學中心的針扎與尖銳物傷害的事件並依據發生於手術室內與醫院其他地點的這類傷害分為兩組。我們比較兩組病人的背景資料，受傷機轉，刺傷物品及臨床結果。統計學上有意義的標準則訂在p<0.05。研究結果：在五年的研究期間，共有157位醫療工作人員有針扎與尖銳物傷害，其中護理師佔了56.0％而醫師為37.6％。大部分的傷害發生在醫院年資少於三年的工作者身上（73.2％，115/157）。手術室以外的地點所發生的傷害均為個人的針扎行為。相比較之下，手術室內有21件（41.2％）是手術醫師對助手或護理師所造成的傷害，其中15件（71.4％）是由於不正確的傳遞尖銳物造成。結論：絕大部份發生在手術室的針扎與尖銳物傷害都是由於人為因素造成。要有效的減少這些傷害則必須透過人員的持續教育，確實執行使用尖銳物之作業流程，同時仔細檢討與根本分析每一件發生的事故傷害。\u0000 Introduction: Despite the increased awareness of needle sticks and sharps inju-ries and the development of safety needles, these injuries continue to occur not infre-quently in a hospital setting. The purpose of the study was to critically examine these incidences and to identify risk factors associated with them. Methods: We analyzed sharps injuries occurred between 2016 and 2020 in a tertiary medical center in Taiwan. We compared those that occurred in the operating rooms (OR) with those that oc-curred outside the OR. The demographics of the health care workers injured, the of-fending objects, and the mechanisms of injury were compared between two groups of patients. Significant level was determined when p<0.05. Results: Among 157 hospital workers injured during the study period, the group of workers most commonly injured was nurses (56.0%), followed by physicians and surgeons (37.6%). The majority of those injured had a working experience of fewer than three years (73.2%, 115/157). Injuries that occurred outside the OR were self-inflicted due to the inappropriate han-dling of needled syringes. In comparison, 21 (41.2%, 21/51) of injuries in the OR were inflicted by operating surgeons. Among them, 15 (71.4%) were due to inappropriate transfer of surgical sharps. Conclusions: Most sharps injuries that occurred in the OR were due to human factors and were preventable. Greater effort is needed to create a safer working environment in the OR through education of hospital personnel, development of stringent OR policies for handing of surgical instruments, and critical review of every incidence of injury.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130613900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"外科加護病房內使用紅血球血品之原因分析與改善方案","authors":"楊茜淳 楊茜淳, 施威祥 Chien-Chun Yang, Emily Lo Wei-Hsiang Shih, 羅崇杰 Emily Lo","doi":"10.53106/181020932022032001001","DOIUrl":"https://doi.org/10.53106/181020932022032001001","url":null,"abstract":"\u0000 背景與目的：雖然許多醫學會都有發表如何正確使用紅血球的血品的照顧指引，然而，臨床醫師決定輸血的動機，常是根據個人的喜好，或是多年類累積的經驗而非實證醫學。因此，本研究的宗旨是探討外科加護病房病人的輸血適應症是否遵循這些照顧指引，同時分析輸血的正確與合適性是否影響病人的臨床結果，與探討造成不正確輸血的因素，以達到持續提升病人照顧品質。研究方法：本研究收納在2015年7月至2016年6月中入住成人外科加護病房之病人，組成一個專家小組依回顧性的方式評估加護病房住院期間所有使用紅血球血品的適當性，並比較輸血的正確性與非正確性的兩組病人的背景資料及臨床結果。研究結果：研究期間共有617名病人入住外科加護病房，其中245名(39.7%)病人接受了紅血球血品。比起沒有手術的病人，較多的術後病人有接受輸血(87.3% vs. 75.8%)，同時輸血的病人有較高的APACHE II 分數(22.1 ± 8.5 vs. 15.5 ± 7.4)，更長的加護病房的住院天數(8.0 ± 9.1 vs. 3.0 ± 3.7天)，與較高的加護病房死亡率(14.3% vs. 6.2%)。在651次輸血當中，有38.4%符合適應症，但61.6%則未符合適應症。手術後在外科加護病房接受輸血的病人有顯著較高的比率病人在手術當中失血超過500 C.C. (P<0.05)。結論：目前醫院的努力措施仍無法有效的減少外科加護病房不必要的使用紅血球血品。除了持續加強教導醫護人員正確的使用血品之外，其他的方法例如強化資訊系統的提示與阻擋功能，也都是重要的努力方向。\u0000 Objectives: Despite the fact that many published guidelines for optimal usage of blood products are available, RBC transfusions are frequently guided by personal preference and tradition. The purpose of the study was to examine the appropriateness of RBC transfusions for surgical patients admitted to the SICU and how it might affect the clinical outcomes. Methods: We retrospectively reviewed all RBC transfusions that occurred in a general SICU between July 1, 2015 and June 30, 2016. Each RBC transfusion was critically ap-praised using four criteria to determine whether or not the transfusion was indicated. De-mographic data and clinical outcome measures of transfused and non-transfused patients as well as patients with indicated or non-indicated RBC transfusions were compared. Results: There were 617 patients admitted to the SICU and 245 (39.7%) of them required RBC transfusions. Transfused patients were more likely to have had operations prior to ICU ad-mission (87.3% vs. 75.8%) and have higher APACHE II scores (22.1 ± 8.5 vs. 15.5 ± 7.4). They also had longer ICU stays (8.0 ± 9.1 vs. 3.0 ± 3.7 days) and higher ICU mortality rates (14.3% vs. 6.2%). Among 651 transfusions, 38.4% of them fulfilled at least one crite-rion for transfusion and 61.6% were not considered appropriate. Patients who had non-indicated postoperative RBC transfusion were more likely to have had intraoperative blood loss ≥ 500 mL (p < 0.05). Conclusions: Our efforts to reduce unnecessary RBC transfusion in the SICU appear inadequate. Educating medical personnel is important, but additional measures should also be taken in order to improve compliance.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127256428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"中風病患姿勢控制評估量表及柏格氏平衡量表使用於可行走的慢性中風病患之比較","authors":"吳韋廷 吳韋廷, 韓紹禮 Wei-Ting Wu, 楊輝宏 Shao-Li Han, 楊韻臻 Hui-Hong Yang","doi":"10.53106/181020932022032001002","DOIUrl":"https://doi.org/10.53106/181020932022032001002","url":null,"abstract":"\u0000 臨床上中風病患姿勢控制評估量表及柏格氏平衡量表常被使用於評估中風病患的平衡功能，柏格氏平衡量表因為地板效應，並不適合用來評估急性中風或嚴重失能的中風病患。本研究聚焦於可行走的慢性中風病人，共收案23人，發現中風病患姿勢控制評估量表及柏格氏平衡量表之間具有統計學上的高度相關（斯皮爾曼等級相關係數為.93, P<0.05），但因中風病患姿勢控制評估量表更為全面並且施作更省時，對可行走的慢性中風病人是更好的選擇。另外我們也發現中風病患姿勢控制評估量表的動態項目與拿掉閉眼行走項目的柏格氏平衡量表之間具有更高度相關（斯皮爾曼等級相關係數為.99, P<0.05），是否能取代柏格氏平衡量表作為中風的預後因子需要未來更多的研究。\u0000 Background and purpose: We examined the correlation between the scores of the Postural Assessment Scale for Stroke Patients (PASS) and those of the Berg Balance Scale (BBS) among ambulatory patients with chronic stroke. If the PASS scores are strongly correlated with the BBS scores, the PASS would be a superior alternative for evaluation because it can be administered faster and is more comprehensive. Methods: The PASS and BBS scores of 23 independently ambulatory patients with chronic stroke were collected and analyzed using Spearman’s rank correlation. Because the BBS includes more items for assessing dynamic balance function, we also analyzed the correlation between the scores of the changing posture subscale of the PASS and the scores of the BBS. Results: The Spearman rank correlation coefficient (r) between the BBS and PASS scores was .93 (P<0.05), that between the changing posture scores and BBS scores was .87 (P <0.05). Conclusions: Our study indicated that among ambulatory patients with stroke, the PASS and BBS scores were strongly correlated. Thus, the PASS is a superior alternative for evaluating patients with stroke because it is faster to administer and more comprehensive. Contrary to our hy-pothesis, the degree of the correlation between the changing posture scores and the BBS scores was not higher than that of the correlation between the PASS and BBS scores. Nev-ertheless, we believe that the PASS is still a more effective test for evaluating balance func-tion among ambulatory patients with stroke.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123876952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"利用Gore-Tex®縫線對脫位人工水晶體進行固定手術","authors":"張心怡 張心怡, 王元聖 Hsin-Yi Chang, 鄭成國 Yuan-Sheng Wang","doi":"10.53106/181020932022032001005","DOIUrl":"https://doi.org/10.53106/181020932022032001005","url":null,"abstract":"\u0000 即便對經驗豐富的眼科醫師而言，人工水晶體脫位後重新固定亦是一場浩大的工程。雖然人工水晶體重新置入併以縫線固定手術已行之有年，要完成此手術仍必須將角膜傷口擴大才能將舊的人工水晶體取出而置入新的人工水晶體。因此術後除了造成傷口需更長的癒合時間外，也會造成角膜高度閃光之問題。本篇提出一項新的人工水晶體縫合固定手術，不需將舊有脫位之人工水晶體取出，而是將其直接固定在眼球內部，以減少前述之副作用。\u0000 Background and Purpose: This study is the first to examine whether the execu-tive functions (EFs) of children with high-functioning autism spectrum disorder (CWHFA) can be improved through figure skating (FS) experiences. Methods: In this single-case experimental study, a qualified FS coach trained two CWHFA by follow-ing the training system developed by the Ice Skating Institute. Multiple baselines of the two CWHFA were formed on several target indices, including EF subcomponents (Taiwanese Traditional-Chinese Childhood Executive Functioning Inventory) and repetition behaviors (Repetitive Behavior Scale-Revised). Social validation was also conducted via interviewing their mothers. Results: The results indicated that both of the CWHFA made progress on FS techniques during their 12 sessions of lessons in 6 weeks. The improved inhibitory control and repetitive behaviors were correlated with and might have probably been modiated by the FS experiences. The positive effects might have transferred to their daily lives. Conclusion: The results suggested that FS experiences helped the two CWHFA on their FS skills and bettered their inhibitory control as well as lowered their repetitive behaviors. Future randomised controlled trials further examining this effect are warranted.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131222838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}