Objective: The purpose of this study is to highlight the prevalence of pain as a chief complaint in the emergency department (ED) nurse record. Besides, we would like to demonstrate how often ED nurses performed pain intensity assessments and whether the pain scales were used as tools for assessment.
Material and Methods: A retrospectively observational study was conducted in the ED at a medical center. All of the ED medical charts were reviewed from January 1 2004 through December 31 2004. Special attention was paid on the pain documentation addressed in the ED nurse record. Those who cannot verbally communicate or/and with procedure pain were excluded while we analyzed the documentation.
Results: There were 69,350 ED visits during our study period. 55,291 (79.7%) of them had a chief complaint of pain. All of the patients complained of pain had been stated in the nursing note whereas only 50.8% of them had been evaluated about the intensity. Descriptive words were used most often while documenting pain intensity. Only 1.3% had been evaluated by using of pain scales such as numerical rating scale (NRS) or visual analog scales (VAS). Chest pain was most frequently evaluated. Intensity of toothache and sore throat was less likely to be evaluated by ED nurses.
Conclusion: This study demonstrated a very high prevalence of pain as a chief complaint in the ED nurse record and revealed, overall, pain was poorly documented. We will secondary analyze our data to get a better understanding of the staffs' characteristics affect on pain assessment.
Backgrounds: Nuclear medicine and general surgery are often interacted in the management of patients with thyroid cancer. Although certain controversies exist regarding the therapy, (superscript 131) I ablation therapy plays a major role in the postoperative treatment regimen. Rationale that supports the use of (superscript 131) I ablation as an adjuvant therapy was evidenced in several studies. Also, the well established clinical practice guidelines for thyroid disease have been addressed in previous articles. However, neither relevant nor specific clinical pathway has been developed for the (superscript 131) I treatment. The purpose of this preliminary study is to develop the clinical pathway for the (superscript 131) I therapy.
Methods: By a systemic peer review of relevant articles, a clinical pathway was developed. Following that, a prospective analysis of medical records of patients who were diagnosed as thyroid carcinoma underwent (superscript 131) I therapy was implemented to determine the appropriateness of the pathway and track the variances.
Results: The pathway was appropriate for more than 60% of these patients. The most prevalent variance was caregiver-related. In such variance, patients stayed longer than the defined length of stay (LOS), thus, were not to be discharged on the target day. One of the possible reasons for this was because of the shortage of staffing during weekend. It could be considered as one of the factors determined the ideal staff-patient ratio.
Conclusion: Whether this 3-day pathway is available for a large dose of oral radio-iodine treatment remain to be determined. Further study could focus on analyzing cost-effectiveness and assessing patients' satisfaction as well as the comparison of the LOS between different doses administered.
Diaphragmatic rupture (DR) is usually diagnosed in patients with a history of thoraco-abdominal trauma. Symptoms are related to lung compression and abnormal radiologic findings. However, DR may be missed initially when the symptoms and signs are nonspecific or subtle. Delayed onset of DR, especially on the right side, may occur in some patients. We report a patient presenting with abdominal pain and dyspnea two weeks after blunt thoraco-abdominal trauma. The chest radiograph revealed opacities over the lower lung zones and elevation of the diaphragm on the right side. Computed tomography demonstrated extensive pneumoperitoneum without evidence of radiologic signs of DR. An exploratory laparotomy was performed under the impression of hollow organ perforation. Right-sided DR associated with ipsilateral rupture of the lung was eventually diagnosed. DR should be included in the differential diagnosis in patients with a history of thoraco-abdominal trauma and pneumoperitoneum even if there are no classic symptoms, signs or radiological findings.
No case infected with the Brucella melitensis has been reported in Taiwan over the last thirty years, yet two imported, confirmed brucellosis cases were reported within two consecutive weeks in May 2011. After investigation, it was determined that these two cases had no epidemiologic link. Case 1 was infected when traveling in North Africa, and Case 2 was infected while visiting relatives in Malaysia. The major risk factor for contracting Brucella melitensis is ingestion of uncooked beef or mutton, dairy products, or goat milk when traveling in high risk areas of brucellosis. In addition, Case 1 had a history of animal contact in high risk areas of brucellosis. Both cases sought medical care in different hospitals and were reported by physicians. Their specimens were collected and tested by Taiwan Centers for Disease Control and were positive for Brucella melitensis.
On June 26, 2013, an 8-day-old neonate suspected of enterovirus infection with severe complications was reported to Taipei Regional Center, Taiwan Centers for Disease Control (TCDC). This was the first case of severe complications associated with Echovirus 30 (E30) infection over the past 10 years. E30 was diagnosed by the hospital and confirmed by the laboratory at TCDC. This case developed fever four days after birth. Neonatal sepsis was highly suspected and disseminated intravascular coagulation was noticed. In spite of intensive care, the case expired about one month after symptom onset. After investigation, we found that the case's mother and some relatives and friends who visited the case had fever and other uncomfortable symptoms before and after birth of the case. Because enterovirus infections can be transmitted to neonates through placenta, during delivery or by postpartum exposure, pregnant women should pay attention to health conditions of themselves and other family members as well 14 days before the child's birth and around the delivery. If any symptom or sign of infections occur in pregnant women, doctors should be informed and isolation or quarantine measures for neonates should be taken. Healthcare workers should monitor health conditions of neonates and enhance infection control measures in baby rooms to prevent from spreading of infections.
During 2015 and 2016, 251 cases of acute hepatitis C were reported from six counties in Taipei Region, 169 were confirmed, 125 (74%) were male and 61 (36%) were HIV-infected. The median age of confirmed cases was 44 years-old (range: 20- 90 years-old). Nearly 73% of these cases were residing in Taipei City and New Taipei City. However, the age-adjusted standardized incidence per 100,000 populations in 2015 and 2016 revealed that Yilan County (3.18) and Keelung City (2.66) were the highest. Forty-five percent of infected cases co-infected with HIV were residing in the large metropolitan areas such as Taipei City and New Taipei City. Among them, one-third had unsafe sexual behavior in men having sex with men (MSM). Compared with Keelung and Yilan, the cases in Metropolitan area had a relatively high proportion of unsafe sexual behavior within 3 months, but a relatively low proportion of using intravenous drugs, needle/diluent sharing, or contacting blood through either wound or mucosa by accident. The analysis shows that unsafe MSM sexual behavior among HIV-infected people in large metropolitan areas poses high risk of hepatitis C infections, presumably due to anal mucous membrane damage caused by sexual behavior, which increases the risk of infection. Therefore, the public health department should arrange the appropriate prevention and control strategies as early as possible according to the demographic characteristics of different regions and the risk factors of the cases, in order to enhance the effectiveness of prevention and control.
During March 7-May 16, 2011, three waves of shigellosis outbreaks occurred in the dormitories of the Disabled Education Institute in Yilan County. A total of 21 residents, 2 staff members, and 1 service draftee had symptoms of diarrhea. Shigellosis infection was confirmed in 12 residents and 1 staff member.The epidemic curve, plotted by symptom onset dates of case-patients, indicates that the outbreak was likely propagated through person-to-person transmission. Control and preventive measures were applied. These included limiting contact between dormitories, assigning specific persons to clean and disinfect the dormitories, designating quarantine areas or infected case-patients, and closely monitoring daily health reports. As a result, disease transmission ceased on May 20(superscript th).
'/%3e%3cuse xlink:href='%23a' transform='rotate(60)'/%3e%3ccircle r='17' fill='%23000095'/%3e%3ccircle r='15' fill='%23fff'/%3e%3c/svg%3e)