The Changhua Journal of Medicine最新文献

{"title":"The Effects of an Infection Educational Program in Nursing Students in Taiwan","authors":"Chang-Hua Chen, Chu-Ling Chang, Yu-Jun Chang","doi":"10.6501/CJM.1301.002","DOIUrl":"https://doi.org/10.6501/CJM.1301.002","url":null,"abstract":"The aim of this study was to assess the effects of an educational training program provided for students studying infection control at Hungkuang University (HKU) in Taichung. The study was conducted at HKU in Taichung, central Taiwan. This was a case-control study designed to evaluate the effects of an infection control educational program (ICEP) in nursing students studying at HKU from the beginning of July 2011 to January 2014. Two tools were used for data collection: a structured interview questionnaire and a self-reported questionnaire. Descriptive statistics and Spearman's correlations were calculated. A total of 166 students participated in the study and were categorized into two groups. One-hundred and thirty-six students participated in the experimental group, and 30 students participated in the control group. Almost half of the participants were aged 20~30 years. Of the 166 participants, 9 (6.9%) were male, 98.6% were single, 55.8% had no nursing experience, and 91.6% had less than one year of experience. In the experimental group, performance in the cognition/knowledge modules improved; this included improvements in knowledge of the epidemiology of urinary tract infection (p=0.0041), the epidemiology of dengue (p=0.046), airborne precautions (p=0.014), Middle East respiratory syndrome coronavirus (MERS-CoV)/severe acute respiratory syndrome (SARS) (p=0.003), and antibiotics (p=0.026) between the pre-and post-test assessments.Improvements in performance in the attitude modules were also observed in the experimental group; these included improvements in enthusiasm (p=0.014) and the perception of nursing care (p＜0.001) between the pre- and post-test assessments. Improvements in the behavior modules were also observed in the experimental group in the identification and observation of infection (p=0.045) between the pre-and post-test assessments. The overall performance in the cognition/knowledge and attitude modules improved in the entire sample; this included improvements in the epidemiology (p=0.012), hand washing (p=0.014), Middle East respiratory syndrome coronavirus/severe acute respiratory syndrome (p=0.012), attitude (p=0.014), and responsibility (p=0.012) modules between the preand post-test assessments. Spearman's correlation coefficients between cognition/knowledge and attitude (r^2=0.095, p＜0.001), cognition/knowledge and behavior (r^2=0.004, p＜0.05), and behavior and attitude (r^2=0.012, p＜0.05) revealed linear positive associations between the scores in these module types in the total sample of nursing students (p＜0.001). Individual factors affecting the implementation of infection control, for example, compliance with hand washing, were related to multiple processes. In conclusion, Cognition/knowledge affected the attitudes of the participants, which in turn affected their behavior. Students gave fewer correct answers in the pretest assessment than in the post-test assessment, and the percentage of correct answers related to t","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130202120","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":"Pulmonary Alveolar Proteinosis and Occupational Exposure: Case Analysis","authors":"Meimei Wu, P. Huang, K. Yeh, Sh Ho, G. Thériault","doi":"10.6501/CJM.1301.001","DOIUrl":"https://doi.org/10.6501/CJM.1301.001","url":null,"abstract":"Pulmonary alveolar proteinosis (PAP), an extremely rare disease, is potentially caused by occupational exposure. Identifying the occupational etiology may help to avoid recurrence of the disease by refraining from further work exposure. In this study, PAP cases with pathological confirmation in a tertiary medical center diagnosed between 1995 and 2006 were identified through a review of medical records. A descriptive analysis of relevant characteristics was carried out and the relationship between PAP and occupational exposure was explored. In total, three male and two female patients were identified. Dyspnea on exertion and a cough were the main symptoms. Bronchoalveolar lavage was performed in all patients and proved to be an effective treatment. Two men were exposed to silica sand at work. One was a foundry worker who became ill after 20 years of work, and two of his coworkers presented with similar symptoms. The other male patient was a sandblaster who developed symptoms within three months of starting work. As silica-like birefringent substances were found in the lung tissues of these two men, their PAP was highly suspected to be work-related. As for the other three patients, significant exposure could not be identified either at work or at home. The causes of their diseases remained unclear. In conclusion, occupational exposure is one possible cause of PAP. A detailed occupational history helps to identify potential causes and to avoid further exposure, so that recurrence of the disease can be prevented.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114901472","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":"Nationwide Population-based Epidemiological Study of Intracranial and Intraspinal Abscesses in Taiwan","authors":"Yen-Yu Chen, Wenfu Wang, C. Lai","doi":"10.6501/CJM.1204.001","DOIUrl":"https://doi.org/10.6501/CJM.1204.001","url":null,"abstract":"Little is known about the epidemiology of intracranial and intraspinal abscesses in Taiwan. Therefore, we conducted the first population-based epidemiological study of these diseases in Taiwan. Cases of intracranial and intraspinal abscesses were retrieved from the National Health Insurance Research Database of Taiwan using any of the 5 main discharge diagnostic codes beginning with 324 in the International Classification of Diseases, Ninth Revision, Clinical Modification during 2000 ~ 2007. There were 6,658 patients with intracranial or intraspinal abscesses who utilized 9,812 inpatient services during the study period. The average incidence rate was 3.68 per 100,000 person-years. There was a higher incidence rate among men than women, with a male/female incidence ratio of 2.2. The age-specific incidence rate peaked at age 65 ~ 69 for men and 70 ~ 74 for women. Septicemia, osteomyelitis and type 2 diabetes mellitus were the most common co-existing diagnoses. The average cost of treating one patient with the disease was 334,131 New Taiwan Dollars. The mean acute ward stay was 28.5 days. This was the first nationwide, population-based epidemiologic study of intracranial and intraspinal abscesses. Our data revealed the high medical costs and long hospital course involved in treating the disease.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114603115","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":"Gastrointestinal Stromal Tumor Presenting as Intra-abdominal Abscess: A Case Report and Literature Review","authors":"H. Yen, F. Siao, Chih-Jung Chen","doi":"10.6501/CJM.1204.007","DOIUrl":"https://doi.org/10.6501/CJM.1204.007","url":null,"abstract":"This case report describes an unusual presentation of gastrointestinal stromal tumor. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the entire gastrointestinal tract. The stomach and small intestine are the two most commonly involved sites. The presenting symptoms of GIST depend on the size and location of the tumor. The tumors may be found asymptomatically during endoscopic examination, and symptomatic patients present with common symptoms including abdominal pain, a palpable mass, anemia, or overt gastrointestinal bleeding. Herein, we report an unusual case of GIST presenting as an intra-abdominal abscess. This is an unusual presenting symptom of GIST and is difficult to diagnose preoperatively. The preoperative X-ray and abdominal CT images suggested the patient to have a gas-forming abscess from perforated peptic ulcer disease, and emergency surgery was performed. The post-operative finding was a gastric GIST with marked tumor necrosis that mimicked an intra-abdominal abscess. A literature review revealed only 6 similar cases. Although rare, clinicians should consider the possibility of an infected GIST in the differential diagnosis of acute abdominal pain with fever. It may be difficult to use radiological examination alone to determine the etiology of an unexplained intra-abdominal perforation or abscess. Adequate antibiotic treatment and surgical intervention are required for the successful treatment of infected GIST.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127131697","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":"Gastric Adenocarcinoma in a Patient with Type 1 Diabetes and Celiac Disease","authors":"Yuling Cheng, S. Hsu, Hon-Ke Sia, Shi‐Dou Lin","doi":"10.6501/CJM.1204.006","DOIUrl":"https://doi.org/10.6501/CJM.1204.006","url":null,"abstract":"Celiac disease is a gluten-sensitive enteropathy that is more prevalent among patients with type 1 diabetes than in the general population. In addition, patients with celiac disease have a higher incidence of malignancy than those without the disease. Screening for celiac disease should be performed in patients with type 1 diabetes with typical symptoms, and early intervention may prevent disease progression. Here, we report a patient with type 1 diabetes who presented with intermittent watery diarrhea without fever since he was a child, and these symptoms had worsened in recent weeks. Diagnoses of celiac disease and gastric adenocarcinoma were confirmed subsequently. The patient with type 1 diabetes and celiac disease developed gastric adenocarcinoma, which has not been reported in the literature previously.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129338630","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":"Stress-induced Cardiomyopathy Precipitated by Triathlon Competition: A Case Report","authors":"Choy H. Lee, Yung-Ming Chang","doi":"10.6501/CJM.1204.004","DOIUrl":"https://doi.org/10.6501/CJM.1204.004","url":null,"abstract":"Stress-induced cardiomyopathy in post-menopausal women is transient and typically precipitated by severe emotional or physical stress. We report a rare case of stressinduced cardiomyopathy mimicking acute coronary syndrome in a middle-aged female triathlete. The initial presentation included chest tightness and dyspnea; however, acute pulmonary edema and cardiogenic shock developed shortly after admission. Electrocardiography showed non-specific ST-T changes and echocardiography revealed severe left ventricular dysfunction with regional wall motion abnormalities. Coronary angiography did not reveal significant coronary artery obstruction. The patient was placed on ventilatory support and administered diuretics and an angiotensin-converting enzyme inhibitor. Follow-up echocardiography on day 3 showed nearly normal left ventricular wall motion with a 54% ejection fraction, and follow-up radiography of the chest revealed no evidence of pulmonary edema. The endotracheal tube was removed on the third day of hospitalization and the patient was discharged two days later without complications.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122080981","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":"Glass-Fiber Related Conjunctival Granuloma: A Case Report","authors":"Yan-Ting Chen, Yu-ling Liu, Yueh-Min Lin, Chang-Ping Lin","doi":"10.6501/CJM.1204.003","DOIUrl":"https://doi.org/10.6501/CJM.1204.003","url":null,"abstract":"We report a rare case of bilateral conjunctival masses in a patient who is a worker in a glass-fiber manufacturing factory. Slit-lamp examination revealed multiple congested mass-lesions over the bilateral lower palpebral conjunctivas characterized by tiny needle-shaped protrusions on the surface. Moderate epithelial abrasions were also found in the bilateral corneas. Microscopically, the granulation tissues showed lymphoplasmacytic and eosinophilic infiltration with multinuclear giant cells and birefringent fiber-like foreign bodies. This is the first case of conjunctival granulomas with a glass-fiber-related occupational history, and appropriate prevention measures for anyone who may be exposed to glassfibers are suggested.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126292755","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":"Radiation Colitis of the Hepatic Flexure: A Rare Complication of Radiotherapy for Portal Vein Thrombosis Associated with Hepatoma","authors":"Lisa Wu, H. Yen, Yang‐Yuan Chen, M. Soon","doi":"10.6501/CJM.1204.005","DOIUrl":"https://doi.org/10.6501/CJM.1204.005","url":null,"abstract":"Radiation colitis is a common side effect of radiotherapy for cervical, bladder, prostate and ovarian cancer, and the rectosigmoid colon is the most commonly involved anatomical area. Here, we report a rare case of radiation colitis, involving the transverse colon, following radiotherapy for portal vein thrombosis associated with hepatoma. The patient presented with acute lower gastrointestinal bleeding. Successful endoscopic therapy with argon plasma coagulation resulted in hemostasis. To our knowledge, this is the first case report of this rare complication in the literature.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115946891","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":"Reliability Testing of a Communication Skills Teaching Video","authors":"Ya-Wen Lee, Chih-Cheng Huang, L. Tsao, Chin-Yi Huang, Yung-Sung Wen","doi":"10.6501/CJM.1203.001","DOIUrl":"https://doi.org/10.6501/CJM.1203.001","url":null,"abstract":"Background and Purpose: It is important to cultivate clinical teachers' communication skills in a domestic clinical teaching environment, which can be achieved using a reliable teaching video. Therefore, the purpose of this study was to develop and test the reliability of a domestic communication skills teaching video. Methods: A two-phase development study was conducted in a medical center in 2010 and 2011. In phase I the communication skills teaching video was created, while in phase II a pilot study of the video was carried out. The participants were 47 third year resident physicians, and the evaluation tool was a communication process skills instrument (CPSI). Two reliability tests were used: (1) Internal consistency reliability was tested using Cronbach’s α value and (2) inter-rater reliability was tested using the intra-class correlation coefficient (ICC). Results: The Cronbach's α value of a 28-item CPSI used by the resident physicians was 0.99 (p＜0.05). The overall ICC of the 28 items was 0.94 (p＜0.05), with subscales ranging from 0.75~0.94 (p＜0.05). Conclusion: This preliminary study was conducted to determine the acceptable reliability of a communication skills teaching video. The video described in this study could provide clinical educators with a valuable tool for training and evaluating clinical teachers objectively.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121606687","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":"Innovation Method for Sealing Bone Bleeding in Percutaneous Endoscopic Interlaminar Discectomy","authors":"Chih-I Chen, Yen-Po Cheng, Chun-Yuan Cheng, Chien-Min Chen, Dueng-Yuan Hueng","doi":"10.6501/CJM.1203.006","DOIUrl":"https://doi.org/10.6501/CJM.1203.006","url":null,"abstract":"Background: Adequate hemostasis to prevent postoperative epidural hematoma and its consequences such as cauda equina syndrome is important in lumbar spine surgery. However, in percutaneous endoscopic interlaminar discectomy (PEID), due to its tiny incision wound only allows for endoscopy and its sheath entered, adequate hemostasis could be difficult. Herein, we proposed an innovation way of applying bone wax to stop bone bleeding in PEID. Materials and Methods: A working channel with a beveled opening was introduced over the dilator and a rigid endoscope was inserted after the removal of the obturator. Endopunch was used to cut the ligamnetum flavum to expose underlying dura margin and nerve root. To avoid overtraction of the nerve root, we use an endoscopic high speed burr or endoscopic kerrison punch to remove partial medial facet and inferior margin of lamina to gain more room for instrument inside. Some bone bleeding causing unclear vision occurred as we proceeded. We thus use endoscopic nerve retractor to push the bone wax to the surface of the bone to seal the bleeding. Results: Intraoperative adequate hemostasis was achieved with clear endoscopic vision after the bone wax sealed the bleeding site. Conclusion: Using an endoscopic nerve retractor with bone wax to stop bone bleeding in percutaneous endoscopic interlaminar discectomy is an efficient way to provides us with immediate clear vision during the surgery.","PeriodicalId":404480,"journal":{"name":"The Changhua Journal of Medicine","volume":"809 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123048091","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}