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  • 1
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 5 ( 2023-05), p. e106-e114
    Abstract: We performed a systemic review and meta‐analysis to evaluate the diagnostic accuracy of monocyte distribution width (MDW) and to compare with procalcitonin and C‐reactive protein (CRP), in adult patients with sepsis. DATA SOURCES: A systematic literature search was performed in PubMed, Embase, and the Cochrane Library to identify all relevant diagnostic accuracy studies published before October 1, 2022. STUDY SELECTION: Original articles reporting the diagnostic accuracy of MDW for sepsis detection with the Sepsis-2 or Sepsis-3 criteria were included. DATA EXTRACTION: Study data were abstracted by two independent reviewers using a standardized data extraction form. DATA SYNTHESIS: Eighteen studies were included in the meta‐analysis. The pooled sensitivity and specificity of MDW were 84% (95% CI [79–88%] ) and 68% (95% CI [60–75%]). The estimated diagnostic odds ratio and the area under the summary receiver operating characteristic curve (SROC) were 11.11 (95% CI [7.36–16.77] ) and 0.85 (95% CI [0.81–0.89]). Significant heterogeneity was observed among the included studies. Eight studies compared the diagnostic accuracies of MDW and procalcitonin, and five studies compared the diagnostic accuracies of MDW and CRP. For MDW versus procalcitonin, the area under the SROC was similar (0.88, CI = 0.84–0.93 vs 0.82, CI = 0.76–0.88). For MDW versus CRP, the area under the SROC was similar (0.88, CI = 0.83–0.93 vs 0.86, CI = 0.78–0.95). CONCLUSIONS: The results of the meta-analysis indicate that MDW is a reliable diagnostic biomarker for sepsis as procalcitonin and CRP. Further studies investigating the combination of MDW and other biomarkers are advisable to increase the accuracy in sepsis detection.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2034247-0
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  • 2
    In: Cancers, MDPI AG, Vol. 16, No. 4 ( 2024-02-16), p. 804-
    Abstract: Purpose: To develop and internally validate a novel prediction score to predict the occurrence of arterial–esophageal fistula (AEF) in esophageal cancer bleeding. Methods: This retrospective cohort study enrolled patients with esophageal cancer bleeding in the emergency department. The primary outcome was the diagnosis of AEF. The patients were randomly divided into a derivation group and a validation group. In the derivation stage, a predictive model was developed using logistic regression analysis. Subsequently, internal validation of the model was conducted in the validation cohort during the validation stage to assess its discrimination ability. Results: A total of 257 patients were enrolled in this study. All participants were randomized to a derivation cohort (n = 155) and a validation cohort (n = 102). AEF occurred in 22 patients (14.2%) in the derivation group and 14 patients (13.7%) in the validation group. A predictive model (HEARTS-Score) comprising five variables (hematemesis, active bleeding, serum creatinine level 〉 1.2 mg/dL, prothrombin time 〉 13 s, and previous stent implantation) was established. The HEARTS-Score demonstrated a high discriminative ability in both the derivation and validation cohorts, with c-statistics of 0.90 (95% CI 0.82–0.98) and 0.82 (95% CI 0.72–0.92), respectively. Conclusions: By employing this novel prediction score, clinicians can make more objective risk assessments, optimizing diagnostic strategies and tailoring treatment approaches.
    Type of Medium: Online Resource
    ISSN: 2072-6694
    Language: English
    Publisher: MDPI AG
    Publication Date: 2024
    detail.hit.zdb_id: 2527080-1
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  • 3
    In: Journal of the Formosan Medical Association, Elsevier BV, ( 2024-4)
    Type of Medium: Online Resource
    ISSN: 0929-6646
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 2250901-X
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  • 4
    In: BMC Cancer, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2022-12)
    Abstract: Acute, catastrophic bleeding in patients with head and neck cancer (HNC) is challenging and also a burden for their families and frontline physicians. This study analyzed the risk factors for rebleeding and long-term outcomes in these patients with HNC. Methods Patients who presented to the emergency department (ED) with HNC bleeding were enrolled in this study ( N  = 231). Variables of patients with or without rebleeding were compared, and associated factors were investigated using Cox’s proportional hazard model. Results Of the 231 patients enrolled, 112 (48.5%) experienced a recurrent bleeding event. The cumulative rebleeding incidence rate was 23% at 30 days, 49% at 180 days, and 56% at 1 year. Multivariate Cox regression analyses demonstrated that overweight-to-obesity (HR = 0.52, 95% CI 0.28–0.98, p  = 0.043), laryngeal cancer (hazard ratio [HR] = 2.13, 95% confidence interval [CI] 1.07–4.23, p  = 0.031), chemoradiation (HR = 1.49, 95% CI 1.001–2.94, p  = 0.049), and second primary cancer (HR = 1.75, 95% CI 1.13–2.70, p  = 0.012) are significant independent predictors of rebleeding, and the prognostic factors for overall survival included underweight (HR = 1.89, 95% CI 1.22–2.93, p  = 0.004), heart rate  〉  110 beats/min (HR = 1.58, 95% CI 1.04–2.39, p  = 0.032), chemoradiation (HR = 2.31, 95% CI 1.18–4.52, p  = 0.015), and local recurrence (HR = 1.74, 95% CI 1.14–2.67, p  = 0.011). Conclusions Overweight-to-obesity is a protective factor, while laryngeal cancer, chemoradiation and a second primary cancer are risk factors for rebleeding in patients with HNC. Our results may assist physicians in risk stratification of patients with HNC bleeding.
    Type of Medium: Online Resource
    ISSN: 1471-2407
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2041352-X
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  • 5
    Online Resource
    Online Resource
    Institute of Electrical and Electronics Engineers (IEEE) ; 2018
    In:  IEEE Access Vol. 6 ( 2018), p. 37775-37783
    In: IEEE Access, Institute of Electrical and Electronics Engineers (IEEE), Vol. 6 ( 2018), p. 37775-37783
    Type of Medium: Online Resource
    ISSN: 2169-3536
    Language: Unknown
    Publisher: Institute of Electrical and Electronics Engineers (IEEE)
    Publication Date: 2018
    detail.hit.zdb_id: 2687964-5
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  • 6
    Online Resource
    Online Resource
    Elsevier BV ; 2021
    In:  The Journal of Emergency Medicine Vol. 60, No. 4 ( 2021-04), p. 536-537
    In: The Journal of Emergency Medicine, Elsevier BV, Vol. 60, No. 4 ( 2021-04), p. 536-537
    Type of Medium: Online Resource
    ISSN: 0736-4679
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2006769-0
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  • 7
    Online Resource
    Online Resource
    Cambridge University Press (CUP) ; 2019
    In:  Prehospital and Disaster Medicine Vol. 34, No. s1 ( 2019-05), p. s139-s140
    In: Prehospital and Disaster Medicine, Cambridge University Press (CUP), Vol. 34, No. s1 ( 2019-05), p. s139-s140
    Abstract: On February 6, 2018, a magnitude 6.2 earthquake struck Hualien, Taiwan. Over 150 patients crammed into the emergency department of nearby hospitals within two hours. Mass casualty incident (MCI) management was activated. During the recovery phase, little attention was paid to the mental health of hospital staff. Aim: To analyze the prevalence of post-traumatic stress disorder (PTSD) among healthcare providers (HCPs) and explore the possible risk factors. Methods: 63 HCPs in the emergency department of the single tertiary hospital near the epicenter were included. The Chinese version of the Davidson Trauma Scale (DTS-C) was used to evaluate the prevalence of PTSD. Questionnaires were sent to explore the possible contributing factors. Results: The average age of the HCPs was 32.7 years (30.3 years for nurses; 40.4 years for physicians). The prevalence of PTSD was 3.2% eight months after the incident. The mean DTS-C score was 8.9/136. Nurses had a higher score than physicians (10.8 and 4.7). HCPs with 6-10 years working experience had the highest score (14.2), while those with less than 3 years experience had the lowest (4.8). Discussion: We found HCPs had a lower prevalence of PTSD compared with earthquake survivors (Chou 2007), and physicians had longer working years and lower DTS-C scores. The professional training may help HCPs going through psychological impacts during the disaster. HCPs with 6-10 years of experience in the emergency department were found to have a higher risk of developing PTSD. Most of them were taking the responsibility of a team leader during the MCI, which may cause significant stress to these staff. Adequate training regarding MCI management could help to relieve tension and frustration, hoping to prevent the development of PTSD. Based on our study, PTSD among HCPs is an ignored issue, and we should follow-up HCPs’ psychological condition in the future.
    Type of Medium: Online Resource
    ISSN: 1049-023X , 1945-1938
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2162069-6
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  • 8
    Online Resource
    Online Resource
    Wiley ; 2017
    In:  Medical Physics Vol. 44, No. 3 ( 2017-03), p. 886-901
    In: Medical Physics, Wiley, Vol. 44, No. 3 ( 2017-03), p. 886-901
    Abstract: Dual‐energy CT ( DECT ) enhances tissue characterization because of its basis material decomposition capability. In addition to conventional two‐material decomposition from DECT measurements, multimaterial decomposition ( MMD ) is required in many clinical applications. To solve the ill‐posed problem of reconstructing multi‐material images from dual‐energy measurements, additional constraints are incorporated into the formulation, including volume and mass conservation and the assumptions that there are at most three materials in each pixel and various material types among pixels. The recently proposed flexible image‐domain MMD method decomposes pixels sequentially into multiple basis materials using a direct inversion scheme which leads to magnified noise in the material images. In this paper, we propose a statistical image‐domain MMD method for DECT to suppress the noise. Methods The proposed method applies penalized weighted least‐square ( PWLS ) reconstruction with a negative log‐likelihood term and edge‐preserving regularization for each material. The statistical weight is determined by a data‐based method accounting for the noise variance of high‐ and low‐energy CT images. We apply the optimization transfer principles to design a serial of pixel‐wise separable quadratic surrogates ( PWSQS ) functions which monotonically decrease the cost function. The separability in each pixel enables the simultaneous update of all pixels. Results The proposed method is evaluated on a digital phantom, Catphan©600 phantom and three patients (pelvis, head, and thigh). We also implement the direct inversion and low‐pass filtration methods for a comparison purpose. Compared with the direct inversion method, the proposed method reduces noise standard deviation ( STD ) in soft tissue by 95.35% in the digital phantom study, by 88.01% in the Catphan©600 phantom study, by 92.45% in the pelvis patient study, by 60.21% in the head patient study, and by 81.22% in the thigh patient study, respectively. The overall volume fraction accuracy is improved by around 6.85%. Compared with the low‐pass filtration method, the root‐mean‐square percentage error ( RMSE (%)) of electron densities in the Catphan©600 phantom is decreased by 20.89%. As modulation transfer function ( MTF ) magnitude decreased to 50%, the proposed method increases the spatial resolution by an overall factor of 1.64 on the digital phantom, and 2.16 on the Catphan©600 phantom. The overall volume fraction accuracy is increased by 6.15%. Conclusions We proposed a statistical image‐domain MMD method using DECT measurements. The method successfully suppresses the magnified noise while faithfully retaining the quantification accuracy and anatomical structure in the decomposed material images. The proposed method is practical and promising for advanced clinical applications using DECT imaging.
    Type of Medium: Online Resource
    ISSN: 0094-2405 , 2473-4209
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 1466421-5
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  • 9
    In: World Journal of Emergency Surgery, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2020-12)
    Abstract: Triage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI. Methods We retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge. Results We enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%). Conclusions The present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.
    Type of Medium: Online Resource
    ISSN: 1749-7922
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2233734-9
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  • 10
    In: Medicina, MDPI AG, Vol. 58, No. 3 ( 2022-03-07), p. 401-
    Abstract: Background and Objectives: Septic arthritis is a medical emergency associated with high morbidity and mortality. The incidence rate of septic arthritis among dialysis patients is higher than the general population, and dialysis patients with bacteremia frequently experience adverse outcomes. The aim of this study was to identify the clinical features and risk factors for longer hospital length of stay (LOS), positive blood culture, and in-hospital mortality in dialysis patients with septic arthritis. Materials and Methods: The medical records of 52 septic arthritis dialysis patients admitted to our hospital from 1 January 2009 to 31 December 2020 were analyzed. The primary outcomes were bacteremia and in-hospital mortality. Variables were compared, and risk factors were evaluated using linear and logistic regression models. Results: Twelve (23.1%) patients had positive blood cultures. A tunneled cuffed catheter for dialysis access was used in eight (15.4%) patients, and its usage rate was significantly higher in patients with positive blood culture than in those with negative blood culture (41.7 vs. 7.5%, p = 0.011). Fever was present in 15 (28.8%) patients, and was significantly more frequent in patients with positive blood culture (58.3 vs. 20%, p = 0.025). The most frequently involved site was the hip (n = 21, 40.4%). The most common causative pathogen was Gram-positive cocci, with MRSA (n = 7, 58.3%) being dominant. The mean LOS was 29.9 ± 25.1 days. The tunneled cuffed catheter was a significant predictor of longer LOS (Coef = 0.49; Cl 0.25–0.74; p 〈 0.001). The predictors of positive blood culture were fever (OR = 4.91; Cl 1.10–21.83; p = 0.037) and tunneled cuffed catheter (OR = 7.60; Cl 1.31–44.02; p = 0.024). The predictor of mortality was tunneled cuffed catheter (OR = 14.33; Cl 1.12–183.18; p = 0.041). Conclusions: In the dialysis population, patients with tunneled cuffed catheter for dialysis access had a significantly longer hospital LOS. Tunneled cuffed catheter and fever were independent predictors of positive blood culture, and tunneled cuffed catheter was the predictor of in-hospital mortality. The recognition of the associated factors allows for risk stratification and determination of the optimal treatment plan in dialysis patients with septic arthritis.
    Type of Medium: Online Resource
    ISSN: 1648-9144
    Language: English
    Publisher: MDPI AG
    Publication Date: 2022
    detail.hit.zdb_id: 2088820-X
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