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Tsai J.C.H.,Cheng Ching General Hospital | Tsai J.C.H.,National Yang Ming University | Chen W.-Y.,Nan Kai University of Technology | Liang Y.-W.,National Taichung Nursing College
Health Policy | Year: 2011

Objectives: To explore the magnitude of nonemergent emergency department visits under the Taiwan National Health Insurance program and to identify significant factors associated with these visits. Methods: A cross-sectional analysis of the 2002 Taiwan National Health Insurance Research Database was used to identify nonemergent emergency department conditions according to the New York University algorithm. The data contained 43,384 visits, of which 83.89% could be classified. Multivariate logistic regression identified individual and contextual factors associated with nonemergent emergency department visits. Results: Nearly 15% of all emergency department visits were nonemergent; an additional 20% were emergent-preventable with primary care. Patients likely to make nonemergent emergency department visits were older, female, categorized as a Taiwan National Health Insurance Category IV beneficiary, and without major illness. Hospital accreditation level, teaching status, and location were associated with an increased likelihood of nonemergent emergency department visits. Conclusion: Understanding the factors leading to nonemergent emergency department visits can assist in evaluating the overall quality of a health care system and help reduce the use of the emergency department for nonemergent conditions. Policy makers desiring cost-effective care should assess emergency department visit rates in light of available resources for specific populations. © 2010 Elsevier Ireland Ltd.

Juang D.-F.,Meiho University | Yang P.-C.,Cheng Ching General Hospital | Chou H.-Y.,Meiho University | Chiu L.-J.,Meiho University
Biotechnology Letters | Year: 2011

Four microbial fuel cells (MFCs) inoculated with different bacterial species were constructed. The species were Pseudomonas putida, Comamonas testosteroni, Corynebacterium gultamicum, and Arthrobacter polychromogenes. The MFCs were operated under identical continuous flow conditions. The factors affecting the capabilities of the MFCs for treating organic matter and generating power were evaluated and compared. The factors include microbial species type, organic loading, and substrate degradation rate. For all four MFCs, power output increased with the organic loading rate. Power density also increased with the substrate degradation rate. These findings implied that more organic matter was utilized for power generation at higher organic loading and substrate degradation rates. However, coulombic efficiency increased with decreased organic loading and substrate degradation rates. Apparently, all four MFCs had low efficiencies in generating power from organic matter. These low efficiencies are attributed to the long distance between the anode and the cathode, as well as to the small ratio of the proton exchange membrane surface area to the anode chamber surface area. These features may have caused most of the protons produced in the anode chamber to leave the chamber with the effluent, which led to the low power generation performance of the MFCs. © 2011 Springer Science+Business Media B.V.

Wei C.-Y.,Cheng Ching General Hospital
Formosan Journal of Surgery | Year: 2012

Amputation of facial tissue presents difficult management problems, including cosmetic, functional, and psychological effects for the patient. A case of successful microsurgical replantation of a bitten-off vermilion of the lower lip is hereby reported. The outcome in this case was both functionally and cosmetically acceptable. A comprehensive review of the literature on the subject of lip replantation is also made in this communication. © 2012.

Hsu H.-T.,Kaohsiung Medical University | Chou S.-H.,Kaohsiung Medical University | Chen C.-L.,Cheng Ching General Hospital | Tseng K.-Y.,Kaohsiung Medical University | And 3 more authors.
Anaesthesia | Year: 2013

We compared direct laryngoscopy with a Macintosh blade vs indirect bronchoscopy with a Trachway® stylet, for endobronchial intubation with a left-sided double-lumen tube. We allocated participants scheduled for thoracic surgery and who had normal predicted laryngoscopy, 30 to each group. The mean (SD) intubation times with laryngoscope and Trachway were 48 (11) s vs 28 (4) s, respectively, p < 0.001. The rates of hoarseness on the first postoperative day, categorised as none/mild/moderate/severe, were 10/12/7/1 and 22/6/2/0, respectively, p = 0.008, without differences on subsequent days. Left endobronchial intubation with a double-lumen tube is slower using direct laryngoscopy and causes more hoarseness than indirect bronchoscopy with a Trachway stylet. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Tsai J.C.-H.,Cheng Ching General Hospital | Tsai J.C.-H.,National Yang Ming University | Liang Y.-W.,National Taichung Nursing College | Pearson W.S.,Centers for Disease Control and Prevention
Journal of the Formosan Medical Association | Year: 2010

Background/Purpose: We investigated the factors associated with emergency department (ED) use among patients with non-urgent medical problems, with a focus on convenience and preference to use the ED instead of primary care clinics. Methods: A five-level triage system was adopted by research nurses to decide each patient's triage level and the maximum time to physician interview. Patients who had a maximum time to physician interview of more than 60 minutes were assumed to be non-urgent in this study. Results: More than half of ED visits were considered to be non-urgent. Non-urgent patients were more likely to be unmarried, government employees, visit the ED due to trauma, have a history of chronic illness, and present in the day time or at the weekend. ED visits were also more likely to occur in patients who took less than 15 minutes to reach the ED, chose the ED for its convenience, agreed that they could have chosen another facility for their visit, did not agree that the ED was convenient for receiving medical care. Multivariate logistic regression showed that marital status, time of presentation, time needed to get to the ED, and occupation were associated with non-urgent ED visits. Conclusion: Preference for using EDs for medical care and their convenience might contribute to non-urgent ED visits. A five-level triage system reliably stratified patients with different admission rates and utilization of medical resources, and could be helpful for reserving limited medical resources for more urgent patients. © 2010 Formosan Medical Association & Elsevier.

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