Multiple cerebral monitoring system, an essential facility in neurocritical care units, monitors ... more Multiple cerebral monitoring system, an essential facility in neurocritical care units, monitors several vital parameters, including intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), partial oxygen pressure of artery(PaO_2), jugular vein oxygen saturation(SjvO_2) and end tidal CO_2 pressure (PetCO_2). In addition to these modalities, brain tissue oxygen monitoring is also essential in understanding the oxygen transport and cerebral metabolism in patients with traumatic brain injury. The brain tissue oxygen monitor is a reliable and effective way to measure oxygen supply and demand along with oxygen saturation in the brain. However, many controversial issues remain unsolved, like the best timing to use the monitor and whether all TBI patients should receive monitoring, regardless of their injury severity. There is also no consensus on the optimal site or the duration of monitoring, and whether it improves the prognosis. The present article attempts to discuss these issues in extensive details. From the perspective of evidence-based medicine, all patients who are at risk of disastrous secondary brain injury following the primary traumatic brain injury, are indicated for brain tissue oxygen monitoring. Multiple cerebral monitoring systems, is not only a safe, robust, and highly sensitive diagnostic tool, but can also lower the overall mortality rates by avoiding cerebral ischemia after traumatic brain injury.
To evaluate sex differences in mild traumatic brain injury (MTBI) with working memory functional ... more To evaluate sex differences in mild traumatic brain injury (MTBI) with working memory functional magnetic resonance (MR) imaging. Materials and Methods: Research ethics committee approval and patient written informed consent were obtained. Working memory brain activation patterns were assessed with functional MR imaging in 30 patients (15 consecutive men and 15 consecutive women) with MTBI and 30 control subjects (15 consecutive men and 15 consecutive women). Two imaging studies were performed in patients: the initial study, which was performed within 1 month after the injury, and a follow-up study, which was performed 6 weeks after the first study. For each participant, digit span and continuous performance testing were performed before functional MR imaging. Clinical data were analyzed by using Kruskal-Wallis, Mann-Whitney U, Wilcoxon signed rank, and Fisher exact tests. Within-and between-group differences of functional MR imaging data were analyzed with one-and two-sample t tests, respectively.
Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of... more Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of anxiety or depression. To explore the potential biomarkers for emotional disorders in mTBI patients, we analyzed the frequency domain of heart rate variability (HRV) and serum concentrations of four neurohormones. We assessed mTBI patients on their first visit and follow-up. Symptoms were evaluated by the Beck Anxiety Inventory and the Beck Depression Inventory, respectively. Serum levels of adrenocorticotropic hormone (ACTH), melatonin, cortisol, and insulin-like growth factor (IGF)-1 and HRV follow-ups were measured and compared. mTBI patients were more vulnerable to symptoms of anxiety or depression than healthy controls. Reduced HRV was noted in mTBI patients compared to healthy controls. The mTBI patients demonstrated higher serum levels of ACTH, lower IGF-1 compared to healthy controls. In correlation analysis, only IGF-1 was positively correlated with HRV in mTBI patients. Both HRV and IGF-1 were correlated with symptom of depression while only HRV was correlated with symptom of anxiety in mTBI patients. We infer that HRV may be more significantly correlated with emotional disorders than is IGF-1 in mTBI patients. The study is relevant for specific diagnostic markers in mTBI patients.
Discussion: High PM. concentrations and low temperatures are risk factors for TIH in patients wit... more Discussion: High PM. concentrations and low temperatures are risk factors for TIH in patients with TBI. High NO X concentrations are associated with a lower TIH risk.
Background: Emergency medicine has generally been considered a high risk specialty. The purpose o... more Background: Emergency medicine has generally been considered a high risk specialty. The purpose of this study is to assess the risk of being sued in the district courts for caring emergency room (ER) patients from the perspective of epidemiology. Methods: This research was designed to be a retrospective population based cohort study. We intended to find out the incidence of litigations arising from ER patients and that of birth inpatients in Taiwan, and computed their relative risks. The inclusion criterion was set to be incidents transpired in the time period of 1998 to 2002. The study materials included the reimbursement claim dataset of the National Health Insurance from 1998 to 2002, and the district court decision database of the Judicial Yuan from 1999 to 2006. Results: The average annual incidence rate of becoming a plaintiff for ER patients is 0.86 per million, and for birth patients is 33.5 per million. There is a statistically significant difference between birth patients and ER patients. The relative risk comparing ER patients against birth inpatients is 0.03. Conclusion: The findings of this population based study indicate that the patient population emergency physicians are facing in Taiwan have relatively lower risks of developing litigation in comparison with the patients that come to give birth. Due to the large volume of ER patients, malpractice still pose a major threat in the emergency department, and misdiagnosis remains the major complaint of plaintiffs in subsequent litigations.
Objective: Several variants of SARS-CoV-2 have emerged since its first appearance in 2019, greatl... more Objective: Several variants of SARS-CoV-2 have emerged since its first appearance in 2019, greatly impacting healthcare systems across the globe. Previous literature indicated a substantial decline in emergency department (ED) visits in hospitals since the start of the COVID-19 pandemic. However, little research has been done to compare different variants’ (Ancestral, Alpha, Delta, Omicron, etc.) impact on patients presenting to the ED. Thus, the purpose of this retrospective observational study is to compare the changes in total ED volume following four major peaks of SARS-CoV-2 infection within a multi-hospital health system.Methods: Utilizing electronic healthcare record (EHR) data, total ED visits (484,268) and COVID-19 case counts (24,358) were collected and analyzed to compare ED census and COVID-19 trends across four years and four variant peak periods, from January 2019 to June 2022.Results: Results showed that ED visits declined after the first two major peaks (Ancestral an...
Bioresorbable devices are particularly useful for skull bone reconstruction. Different systems ar... more Bioresorbable devices are particularly useful for skull bone reconstruction. Different systems are now commercially available. The aim of this trial was to compare the clinical outcomes of bone flap fixation using a new bioresorbable system (Bonamates(superscript ®)) and a traditional titanium plate/screw system. Patients diagnosed with a head injury, brain tumor, or cerebral vascular stroke and who received a craniotomy in our hospital in 2003 and 2004 were randomly allocated to 2 treatment groups for skull flap fixation (study group A: Bonamates(superscript ®): n=4; control group B: titanium plate: n=4). Treatment outcomes and complication rates were compared between these 2 groups. In total, 8 patients (study groups A and B) were followed-up for at least 6 months after surgery. All patients in the study group A whose bone flap was fixed with bioresorbable plates/screws were reviewed postoperatively. Uneventful healing occurred during the entire follow-up period for all 4 patients...
Background: Epidural neuroplasty have emerged as minimally invasive techniques for treatment of l... more Background: Epidural neuroplasty have emerged as minimally invasive techniques for treatment of low back pain and lower extremity pain due to contained herniated discs when conservative management has failed. A few studies have examined their effects on functional activity and pain medication use. Outcomes of the procedure to treat the ailment were not analyzed over time. Methods: The aim of our study was to evaluate the outcome of epidural neuroplasty in patients with chronic discogenic pain or sciatica due to nerve root compression by a single-level, contained herniated disc. Patients were assessed before and 3, 6, and 12 months after treatment by a blinded investigator. In our retrospective, non-randomized case series, 26 patients with therapy of epidural neuroplasty were included. Patients were evaluated at 3, 6, and 12 months postoperatively, and were asked to quantify their pain using a visual analog scale. Patients were also surveyed in regards to their pain medication use, a...
Multiple cerebral monitoring system, an essential facility in neurocritical care units, monitors ... more Multiple cerebral monitoring system, an essential facility in neurocritical care units, monitors several vital parameters, including intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), partial oxygen pressure of artery(PaO_2), jugular vein oxygen saturation(SjvO_2) and end tidal CO_2 pressure (PetCO_2). In addition to these modalities, brain tissue oxygen monitoring is also essential in understanding the oxygen transport and cerebral metabolism in patients with traumatic brain injury. The brain tissue oxygen monitor is a reliable and effective way to measure oxygen supply and demand along with oxygen saturation in the brain. However, many controversial issues remain unsolved, like the best timing to use the monitor and whether all TBI patients should receive monitoring, regardless of their injury severity. There is also no consensus on the optimal site or the duration of monitoring, and whether it improves the prognosis. The present article attempts to discuss these issues in extensive details. From the perspective of evidence-based medicine, all patients who are at risk of disastrous secondary brain injury following the primary traumatic brain injury, are indicated for brain tissue oxygen monitoring. Multiple cerebral monitoring systems, is not only a safe, robust, and highly sensitive diagnostic tool, but can also lower the overall mortality rates by avoiding cerebral ischemia after traumatic brain injury.
To evaluate sex differences in mild traumatic brain injury (MTBI) with working memory functional ... more To evaluate sex differences in mild traumatic brain injury (MTBI) with working memory functional magnetic resonance (MR) imaging. Materials and Methods: Research ethics committee approval and patient written informed consent were obtained. Working memory brain activation patterns were assessed with functional MR imaging in 30 patients (15 consecutive men and 15 consecutive women) with MTBI and 30 control subjects (15 consecutive men and 15 consecutive women). Two imaging studies were performed in patients: the initial study, which was performed within 1 month after the injury, and a follow-up study, which was performed 6 weeks after the first study. For each participant, digit span and continuous performance testing were performed before functional MR imaging. Clinical data were analyzed by using Kruskal-Wallis, Mann-Whitney U, Wilcoxon signed rank, and Fisher exact tests. Within-and between-group differences of functional MR imaging data were analyzed with one-and two-sample t tests, respectively.
Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of... more Patients who have experienced a mild traumatic brain injury (mTBI) are susceptible to symptoms of anxiety or depression. To explore the potential biomarkers for emotional disorders in mTBI patients, we analyzed the frequency domain of heart rate variability (HRV) and serum concentrations of four neurohormones. We assessed mTBI patients on their first visit and follow-up. Symptoms were evaluated by the Beck Anxiety Inventory and the Beck Depression Inventory, respectively. Serum levels of adrenocorticotropic hormone (ACTH), melatonin, cortisol, and insulin-like growth factor (IGF)-1 and HRV follow-ups were measured and compared. mTBI patients were more vulnerable to symptoms of anxiety or depression than healthy controls. Reduced HRV was noted in mTBI patients compared to healthy controls. The mTBI patients demonstrated higher serum levels of ACTH, lower IGF-1 compared to healthy controls. In correlation analysis, only IGF-1 was positively correlated with HRV in mTBI patients. Both HRV and IGF-1 were correlated with symptom of depression while only HRV was correlated with symptom of anxiety in mTBI patients. We infer that HRV may be more significantly correlated with emotional disorders than is IGF-1 in mTBI patients. The study is relevant for specific diagnostic markers in mTBI patients.
Discussion: High PM. concentrations and low temperatures are risk factors for TIH in patients wit... more Discussion: High PM. concentrations and low temperatures are risk factors for TIH in patients with TBI. High NO X concentrations are associated with a lower TIH risk.
Background: Emergency medicine has generally been considered a high risk specialty. The purpose o... more Background: Emergency medicine has generally been considered a high risk specialty. The purpose of this study is to assess the risk of being sued in the district courts for caring emergency room (ER) patients from the perspective of epidemiology. Methods: This research was designed to be a retrospective population based cohort study. We intended to find out the incidence of litigations arising from ER patients and that of birth inpatients in Taiwan, and computed their relative risks. The inclusion criterion was set to be incidents transpired in the time period of 1998 to 2002. The study materials included the reimbursement claim dataset of the National Health Insurance from 1998 to 2002, and the district court decision database of the Judicial Yuan from 1999 to 2006. Results: The average annual incidence rate of becoming a plaintiff for ER patients is 0.86 per million, and for birth patients is 33.5 per million. There is a statistically significant difference between birth patients and ER patients. The relative risk comparing ER patients against birth inpatients is 0.03. Conclusion: The findings of this population based study indicate that the patient population emergency physicians are facing in Taiwan have relatively lower risks of developing litigation in comparison with the patients that come to give birth. Due to the large volume of ER patients, malpractice still pose a major threat in the emergency department, and misdiagnosis remains the major complaint of plaintiffs in subsequent litigations.
Objective: Several variants of SARS-CoV-2 have emerged since its first appearance in 2019, greatl... more Objective: Several variants of SARS-CoV-2 have emerged since its first appearance in 2019, greatly impacting healthcare systems across the globe. Previous literature indicated a substantial decline in emergency department (ED) visits in hospitals since the start of the COVID-19 pandemic. However, little research has been done to compare different variants’ (Ancestral, Alpha, Delta, Omicron, etc.) impact on patients presenting to the ED. Thus, the purpose of this retrospective observational study is to compare the changes in total ED volume following four major peaks of SARS-CoV-2 infection within a multi-hospital health system.Methods: Utilizing electronic healthcare record (EHR) data, total ED visits (484,268) and COVID-19 case counts (24,358) were collected and analyzed to compare ED census and COVID-19 trends across four years and four variant peak periods, from January 2019 to June 2022.Results: Results showed that ED visits declined after the first two major peaks (Ancestral an...
Bioresorbable devices are particularly useful for skull bone reconstruction. Different systems ar... more Bioresorbable devices are particularly useful for skull bone reconstruction. Different systems are now commercially available. The aim of this trial was to compare the clinical outcomes of bone flap fixation using a new bioresorbable system (Bonamates(superscript ®)) and a traditional titanium plate/screw system. Patients diagnosed with a head injury, brain tumor, or cerebral vascular stroke and who received a craniotomy in our hospital in 2003 and 2004 were randomly allocated to 2 treatment groups for skull flap fixation (study group A: Bonamates(superscript ®): n=4; control group B: titanium plate: n=4). Treatment outcomes and complication rates were compared between these 2 groups. In total, 8 patients (study groups A and B) were followed-up for at least 6 months after surgery. All patients in the study group A whose bone flap was fixed with bioresorbable plates/screws were reviewed postoperatively. Uneventful healing occurred during the entire follow-up period for all 4 patients...
Background: Epidural neuroplasty have emerged as minimally invasive techniques for treatment of l... more Background: Epidural neuroplasty have emerged as minimally invasive techniques for treatment of low back pain and lower extremity pain due to contained herniated discs when conservative management has failed. A few studies have examined their effects on functional activity and pain medication use. Outcomes of the procedure to treat the ailment were not analyzed over time. Methods: The aim of our study was to evaluate the outcome of epidural neuroplasty in patients with chronic discogenic pain or sciatica due to nerve root compression by a single-level, contained herniated disc. Patients were assessed before and 3, 6, and 12 months after treatment by a blinded investigator. In our retrospective, non-randomized case series, 26 patients with therapy of epidural neuroplasty were included. Patients were evaluated at 3, 6, and 12 months postoperatively, and were asked to quantify their pain using a visual analog scale. Patients were also surveyed in regards to their pain medication use, a...
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