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Huang CT, Lin CH, Lin SY, Huang SS, Lien WC. A feasibility study of a handmade ultrasound-guided phantom for paracentesis. BMC Med Educ 2024; 24:351. [PMID: 38553674 PMCID: PMC10981280 DOI: 10.1186/s12909-024-05339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/22/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Simulation-based training is effective for ultrasound (US)-guided procedures. However, commercially developed simulators are costly. This study aims to evaluate the feasibility of a hand-made phantom for US-guided paracentesis. METHODS We described the recipe to prepare an agar phantom. We collected the US performance data of 50 novices, including 22 postgraduate-year (PGY) residents and 28 undergraduate-year (UGY) students, who used the phantom for training, as well as 12 emergency residents with prior US-guided experience. We obtained the feedback after using the phantom with the Likert 5-point scale. The data were presented with medians and interquartile ranges (IQRs) and analyzed by the Wilcoxon rank sum test. RESULTS While emergency residents demonstrated superior performance compared to trainees, all trainees exhibited acceptable proficiency (global rating of ≥ 3, 50/50 vs. 12/12, p = 1.000) and comparable needle steadiness [5 (5) vs. 5 (5), p = 0.223]. No significant difference in performance was observed between PGYs [5 (4-5)] and UGYs [5 (4-5), p = 0.825]. No significant differences were observed in terms of image stimulation, puncture texture, needle visualization, drainage simulation, and endurance of the phantom between emergency residents and trainees. However, experienced residents rated puncture texture and draining fluid as "neutral" (3/5 on the Likert scale). The cost of the paracentesis phantom is US$16.00 for at least 30 simulations, reducing it to US$6.00 without a container. CONCLUSIONS The paracentesis phantom proves to be a practical and cost-effective training tool. It enables novices to acquire paracentesis skills, enhances their US proficiency, and boosts their confidence. Nevertheless, further investigation is needed to assess its long-term impact on clinical performance in real patients. TRIAL REGISTRATION NCT04792203 at the ClinicalTrials.gov.
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Affiliation(s)
- Chien-Tai Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Chih-Hsien Lin
- Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Shao-Yung Lin
- Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Sih-Shiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Ho YJ, Sung CW, Chen YC, Lien WC, Chang WT, Huang CH. Performance of Intra-arrest Echocardiography: A Systematic Review. West J Emerg Med 2024; 25:166-174. [PMID: 38596913 PMCID: PMC11000560 DOI: 10.5811/westjem.18440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/08/2023] [Accepted: 12/21/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Intra-arrest transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) have been introduced in adult patients with cardiac arrest (CA). Whether the diagnostic performance of TTE or TEE is superior during resuscitation is unclear. We conducted a systematic review following PRISMA guidelines. Methods We searched databases from PubMed, Embase, and Google Scholar and evaluated articles with intra-arrest TTE and TEE in adult patients with non-traumatic CA. Two authors independently screened and selected articles for inclusion; they then dual-extracted study characteristics and target conditions (pericardial effusion, aortic dissection, pulmonary embolism, myocardial infarction, hypovolemia, left ventricular dysfunction, and sonographic cardiac activity). We performed quality assessment using the Quality Assessment of Diagnostic Accuracy Studies Version 2 criteria. Results A total of 27 studies were included: 14 studies with 2,145 patients assessed TTE; and 16 with 556 patients assessed TEE. A high risk of bias or applicability concerns in at least one domain was present in 20 studies (74%). Both TTE and TEE found positive findings in nearly one-half of the patients. The etiology of CA was identified in 13% (271/2,145), and intervention was performed in 38% (102/271) of patients in the TTE group. In patients who received TEE, the etiology was identified in 43% (239/556), and intervention was performed in 28% (68/239). In the TEE group, a higher incidence regarding the etiology of CA was observed, particularly for those with aortic dissection. However, the outcome of those with aortic dissection in the TEE group was poor. Conclusion While TEE could identify more causes of CA than TTE, sonographic cardiac activity was reported much more in the TTE group. The impact of TTE and TEE on the return of spontaneous circulation and further survival was still inconclusive in the current dataset.
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Affiliation(s)
- Yi-Ju Ho
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
| | - Chih-Wei Sung
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University Hsin-Chu Hospital, Department of Emergency Medicine, Hsinchu, Taiwan
| | - Yi-Chu Chen
- National Taiwan University, Institute of Epidemiology and Preventive Medicine, College of Public Health, Taipei, Taiwan
| | - Wan-Ching Lien
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Wei-Tien Chang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
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Chen CC, Huang CS, Yen HT, Lien WC. A visualization of ejection fraction change after adjusting the area of maximal compression. Resuscitation 2024; 194:110097. [PMID: 38128870 DOI: 10.1016/j.resuscitation.2023.110097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Chia-Ching Chen
- Department of Emergency Medicine, Chang Bing Show-Chwan Memorial Hospital, Changhua County, Taiwan
| | - Chia-Szu Huang
- Department of Emergency Medicine, Chang Bing Show-Chwan Memorial Hospital, Changhua County, Taiwan
| | - Hung-Tsang Yen
- Department of Emergency Medicine, Chang Bing Show-Chwan Memorial Hospital, Changhua County, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Lee HY, Lien WC. Effects of COVID-19 vaccine type on Guillain-Barré syndrome: Two cases and a literature review. Hum Vaccin Immunother 2023; 19:2171231. [PMID: 36919452 PMCID: PMC10026858 DOI: 10.1080/21645515.2023.2171231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Guillain-Barré syndrome (GBS) is a rare but severe complication of COVID-19 vaccination. We report two cases of GBS following vaccination with the adenovirus vector vaccine ChAdOx1 nCoV-19 (Vaxzevria, AstraZeneca) and review the relevant literature. Relevant studies published between December 2020 and May 2022 including 881 patients with GBS were reviewed. GBS incidence and the need for mechanical ventilation were reported at a higher level among patients receiving Vaxzevria (n = 400). However, incidence cannot be accurately estimated from case reports. Thus, the true GBS rates following COVID-19 vaccination should be determined by population-based data.
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Affiliation(s)
- Hsin-Yu Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Lien WC, Lin P, Chang CH, Wu MC, Wu CY. The effect of e-learning on point-of-care ultrasound education in novices. Med Educ Online 2023; 28:2152522. [PMID: 36433837 PMCID: PMC9707377 DOI: 10.1080/10872981.2022.2152522] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 05/30/2023]
Abstract
BACKGROUND Current studies assessed the learning efficacy of e-learning in ultrasound (US) training using questionnaires, or simulation in well-controlled conditions. This study investigates the effect of e-learning on the clinical US performance of the first postgraduate year (PGY-1) residents. METHODS In this prospective observational study, we enrolled PGY-1 and second postgraduate year (PGY-2) residents. The e-learning was introduced on the first day and each PGY-1 was authorized to access the e-learning platform. The point-of-care ultrasound (PoCUS) curriculum for the focused assessment of sonography for trauma (FAST) was conducted on the 7th day for PGY-1 and the objective structured clinical examination (OSCE) followed. The PGY-2 received bedside one-to-one random learning before the study and did not have the authorization to access the e-learning. The FAST examinations performed by the PGY-1 and PGY-2 were collected on the 30th day. The clinical FAST performance was assessed by the instructor not involved in the curriculum and blinded to the use of e-learning, including numbers, image quality, and diagnostic accuracy between PGY-1 e-learning users, non-users, and the PGY-2. RESULTS One hundred and seventy PGY-1 with 736 FAST examinations and 53 PGY-2 residents with 134 examinations were included. Seventy PGY-1 used e-learning with a median time spent of 13.2 mins (IQR, 6.5-21.1 mins) at the first access. The PGY-2 had more PoCUS experience than the PGY-1, however, the 70 e-learning users performed more FAST examinations than the PGY-2 (median [IQR], 4 [2-6] vs. 2 [1-3], p = 0.0004) and had better image quality than the PGY-2 (3 [3-3.2] vs. 3 [2.7-3], p = 0.044). There were no significant differences in the diagnostic accuracy between the PGY-1 and PGY-2. CONCLUSIONS E-learning has a positive effect on US learning. The PGY-1 users had comparable performance with the PGY-2 and even better image acquisition although the PGY-2 had more PoCUS experience. TRIAL REGISTRATION NCT03738033 at ClinicalTrials.gov.
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Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Phone Lin
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chih-Heng Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Diversion of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Fu-Jen Catholic University Hospital, New Taipei, Taiwan
| | - Meng-Che Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Huang SS, Lin KW, Liu KL, Wu YM, Lien WC, Wang HP. Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:54. [PMID: 38037062 PMCID: PMC10687940 DOI: 10.1186/s13017-023-00524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic performance of US for AC. METHODS A systematic review was conducted following PRISMA guidelines. We meticulously screened articles from MEDLINE, Embase, and the Cochrane Library, spanning from inception to August 2023. We employed the search strategy combining the keywords "bedside US", "emergency US" or "point-of-care US" with "AC". Two reviewers independently screened the titles and abstracts of the retrieved articles to identify suitable studies. The inclusion criteria encompassed articles investigating the diagnostic performance of US for AC. Data regarding diagnostic performance, sonographers, and sonographic findings including the presence of gallstone, gallbladder (GB) wall thickness, peri-GB fluid, or sonographic Murphy sign were extracted, and a meta-analysis was executed. Case reports, editorials, and review articles were excluded, as well as studies focused on acalculous cholecystitis. The study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS Forty studies with 8,652 patients were included. The majority of studies had a low risk of bias and applicability concerns. US had a pooled sensitivity of 71% (95% CI, 69-72%), a specificity of 85% (95% CI, 84-86%), and an accuracy of 0.83 (95% CI, 0.82-0.83) for the diagnosis of AC. The pooled sensitivity and specificity were 71% (95% CI, 67-74%) and 92% (95% CI, 90-93%) performed by emergency physicians (EPs), 79% (95% CI, 71-85%) and 76% (95% CI, 69-81%) performed by surgeons, and 68% (95% CI 66-71%) and 87% (95% CI, 86-88%) performed by radiologists, respectively. There were no statistically significant differences among the three groups. CONCLUSION US is a good imaging modality for the diagnosis of AC. EP-performed US has a similar diagnostic performance to radiologist-performed US. Further investigations would be needed to investigate the impact of US on expediting the management process and improving patient-centered outcomes.
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Affiliation(s)
- Sih-Shiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Kai-Wei Lin
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Hsiu-Po Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Huang CT, Chang CH, Chen JY, Ling DA, Lee AF, Wang PH, Wu CK, Ko YC, Hsiao YT, Lien WC, Chang WT, Huang CH. The effect of point-of-care ultrasound on length of stay and mortality in patients with chest pain/dyspnea. Ultraschall Med 2023; 44:389-394. [PMID: 37072032 DOI: 10.1055/a-2048-6274] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This study aims to investigate the effects of point-of-care ultrasound (PoCUS) on length of stay (LOS) and mortality in hemodynamically stable patients with chest pain/dyspnea. MATERIALS AND METHODS The prospective study was conducted from June 2020 to May 2021. A convenience sample of adult non-traumatic patients with chest pain/dyspnea was included and evaluated by PoCUS. The primary outcome was the relationship between the door-to-PoCUS time and LOS/mortality categorized by the ST-segment elevation (STE) and non-STE on the initial electrocardiogram. The diagnostic accuracy of PoCUS was computed, compared to the final diagnosis. RESULTS A total of 465 patients were included. 3 of 18 patients with STE had unexpected cardiac tamponade and 1 had myocarditis with pulmonary edema. PoCUS had a minimal effect on LOS and mortality in patients with STE. In the non-STE group, the shorter door-to-PoCUS time was associated with a shorter LOS (coefficient, 1.26±0.47, p=0.008). After categorizing the timing of PoCUS as 30, 60, 90, and 120 minutes, PoCUS had a positive effect, especially when performed within 90 minutes of arrival, on LOS of less than 360 minutes (OR, 2.42, 95% CI, 1.61-3.64) and patient survival (OR, 3.32, 95% CI, 1.14-9.71). The overall diagnostic performance of PoCUS was 96.6% (95% CI, 94.9-98.2%), but lower efficacy occurred in pulmonary embolism and myocardial infarction. CONCLUSION The use of PoCUS was associated with a shorter LOS and less mortality in patients with non-STE, especially when performed within 90 minutes of arrival. Although the effect on patients with STE was minimal, PoCUS played a role in discovering unexpected diagnoses.
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Affiliation(s)
- Chien-Tai Huang
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Heng Chang
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Yu Chen
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Dean-An Ling
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - An-Fu Lee
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Hsiu Wang
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Kai Wu
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Chih Ko
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Tse Hsiao
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Tien Chang
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Hua Huang
- Emergency Department, National Taiwan University Hospital, Taipei, Taiwan
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Huang CH, Liu KL, Lim ZJ, Sung CW, Wang HP, Chen IC, Lien WC, Huang CH. Colonic Diverticulitis Location Affects the Diagnostic Accuracy of Point-of-Care Ultrasound: A Multicenter, 10-Year Study. Ultrasound Med Biol 2023; 49:1611-1615. [PMID: 37032239 DOI: 10.1016/j.ultrasmedbio.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 03/12/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Point-of-care ultrasound (PoCUS) has high sensitivity and specificity in diagnosing uncomplicated colonic diverticulitis in Western patients. Evidence regarding the accuracy of PoCUS in Asian patients in which diverticulitis frequently occurs in the right-side colon is lacking. This multicenter, 10-y study was aimed at evaluating the diagnostic accuracy of PoCUS in various locations of uncomplicated diverticulitis among Asians. METHODS A convenience sample of patients with suspected colonic diverticulitis who had undergone computed tomography (CT) were eligible. Patients undergoing PoCUS before CT were included. The primary outcome was the diagnostic accuracy of PoCUS in the various locations, compared with the final diagnosis made by the expert physicians. The sensitivity, specificity, positive predictive value and negative predictive value were computed. The logistic regression model was used to investigate the possible factors related to the accuracy of PoCUS. RESULTS A total of 326 patients were included. The overall accuracy of PoCUS was 92% (95% confidence interval [CI]: 89.1%-95.0%) and was lower in the cecum (84.3%, 95% CI: 77.8%-90.8%), compared with other locations (p < 0.0001). Nine of 10 false positives had the final diagnosis of appendicitis: 5 had an outpouching structure whose origin in the cecum could not be traced and 4 had elongated "diverticula." Moreover, body mass index was negatively associated with the accuracy of PoCUS in cecal diverticulitis (odds ratio: 0.79, 95% CI: 0.64-0.97) after adjusting for other covariates. CONCLUSION Point-of-care ultrasound exhibits high diagnostic accuracy in diagnosing uncomplicated diverticulitis in the Asian population. However, the accuracy varies according to location, and was relatively low in the cecum.
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Affiliation(s)
- Chun-Hsiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Zi-Jiang Lim
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - I-Chung Chen
- Department of Emergency Medicine, Yun-Lin Branch, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Lee HY, Lien WC, Wang HP. A man with right flank pain. Emerg Med J 2023; 40:498-517. [PMID: 37348973 DOI: 10.1136/emermed-2022-212635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 06/24/2023]
Affiliation(s)
- Hsin-Yu Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Chong KM, Yang HW, He HC, Lien WC, Yang MF, Chi CY, Chen YP, Huang CH, Ko PCI. The Effectiveness of Online-Only Blended Cardiopulmonary Resuscitation Training: Static-Group Comparison Study. J Med Internet Res 2023; 25:e42325. [PMID: 37018023 PMCID: PMC10131976 DOI: 10.2196/42325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Basic life support (BLS) education is essential for improving bystander cardiopulmonary resuscitation (CPR) rates, but the imparting of such education faces obstacles during the outbreak of emerging infectious diseases, such as COVID-19. When face-to-face teaching is limited, distance learning-blended learning (BL) or an online-only model-is encouraged. However, evidence regarding the effect of online-only CPR training is scarce, and comparative studies on classroom-based BL (CBL) are lacking. While other strategies have recommended self-directed learning and deliberate practice to enhance CPR education, no previous studies have incorporated all of these instructional methods into a BLS course. OBJECTIVE This study aimed to demonstrate a novel BLS training model-remote practice BL (RBL)-and compare its educational outcomes with those of the conventional CBL model. METHODS A static-group comparison study was conducted. It included RBL and CBL courses that shared the same paradigm, comprising online lectures, a deliberate practice session with Little Anne quality CPR (QCPR) manikin feedback, and a final assessment session. In the main intervention, the RBL group was required to perform distant self-directed deliberate practice and complete the final assessment via an online video conference. Manikin-rated CPR scores were measured as the primary outcome; the number of retakes of the final examination was the secondary outcome. RESULTS A total of 52 and 104 participants from the RBL and CBL groups, respectively, were eligible for data analysis. A comparison of the 2 groups revealed that there were more women in the RBL group than the CBL group (36/52, 69.2% vs 51/104, 49%, respectively; P=.02). After adjustment, there were no significant differences in scores for QCPR release (96.9 vs 96.4, respectively; P=.61), QCPR depth (99.2 vs 99.5, respectively; P=.27), or QCPR rate (94.9 vs 95.5, respectively; P=.83). The RBL group spent more days practicing before the final assessment (12.4 vs 8.9 days, respectively; P<.001) and also had a higher number of retakes (1.4 vs 1.1 times, respectively; P<.001). CONCLUSIONS We developed a remote practice BL-based method for online-only distant BLS CPR training. In terms of CPR performance, using remote self-directed deliberate practice was not inferior to the conventional classroom-based instructor-led method, although it tended to take more time to achieve the same effect. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Kah Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | | | - Hsien-Chin He
- Department of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Mei-Fen Yang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chien-Yu Chi
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yen-Pin Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei City, Taiwan
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Ling DA, Chen JY, Chen YC, Ko YC, Chang CH, Lien WC, Chang WT, Huang CH. Ratio of optic nerve sheath diameter to eyeball transverse diameter in cardiac arrest survivors. Emerg Med J 2023; 40:285-286. [PMID: 36754612 DOI: 10.1136/emermed-2022-212459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Dean-An Ling
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chu Chen
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Chih Ko
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Heng Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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12
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Lin KW, Tseng WC, Lien WC. Adolescent Woman With Earlobe Pain. Ann Emerg Med 2023; 81:e57-e58. [PMID: 36948697 DOI: 10.1016/j.annemergmed.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 03/24/2023]
Affiliation(s)
- Kai-Wei Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chieh Tseng
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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13
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Lien WC, Chang YC, Chou HH, Lin LC, Liu YP, Liu L, Chan YT, Kuan FS. Detecting Hydronephrosis Through Ultrasound Images Using State-of-the-Art Deep Learning Models. Ultrasound Med Biol 2023; 49:723-733. [PMID: 36509616 DOI: 10.1016/j.ultrasmedbio.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
The goal of this study was to assess the feasibility of three models for detecting hydronephrosis through ultrasound images using state-of-the-art deep learning algorithms. The diagnosis of hydronephrosis is challenging because of varying and non-specific presentations. With the characteristics of ready accessibility, no radiation exposure and repeated assessments, point-of-care ultrasound becomes a complementary diagnostic tool for hydronephrosis; however, inter-observer variability still exists after time-consuming training. Artificial intelligence has the potential to overcome the human limitations. A total of 3462 ultrasound frames for 97 patients with hydronephrosis confirmed by the expert nephrologists were included. One thousand six hundred twenty-eight ultrasound frames were also extracted from the 265 controls who had normal renal ultrasonography. We built three deep learning models based on U-Net, Res-UNet and UNet++ and compared their performance. We applied pre-processing techniques including wiping the background to lessen interference by YOLOv4 and standardizing image sizes. Also, post-processing techniques such as adding filter for filtering the small effusion areas were used. The Res-UNet algorithm had the best performance with an accuracy of 94.6% for moderate/severe hydronephrosis with substantial recall rate, specificity, precision, F1 measure and intersection over union. The Res-UNet algorithm has the best performance in detection of moderate/severe hydronephrosis. It would decrease variability among sonographers and improve efficiency under clinical conditions.
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Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chung Chang
- Department of Computer Science and Engineering, National Chi Nan University, Nantou, Taiwan
| | - Hsin-Hung Chou
- Department of Computer Science and Engineering, National Chi Nan University, Nantou, Taiwan.
| | - Lung-Chun Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yueh-Ping Liu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medical Affairs Ministry of Health and Welfare, Taipei, Taiwan
| | - Li Liu
- Show Chwan Health Care System, Taipei, Taiwan
| | - Yen-Ting Chan
- Department of Research Planning of Omni Health Group Inc., Taipei, Taiwan
| | - Feng-Sen Kuan
- Department of Business Development, Huasin H. T. Limited, Taipei, Taiwan
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14
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Lien WC, Chong KM, Chang CH, Cheng SF, Chang WT, Ma MHM, Chen WJ. Impact of Ultrasonography on Chest Compression Fraction and Survival in Patients with Out-of-hospital Cardiac Arrest. West J Emerg Med 2023; 24:322-330. [PMID: 36976608 PMCID: PMC10047717 DOI: 10.5811/westjem.2023.1.58796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/22/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Whether ultrasonography (US) contributes to delays in chest compressions and hence a negative impact on survival is uncertain. In this study we aimed to investigate the impact of US on chest compression fraction (CCF) and patient survival. METHODS We retrospectively analyzed video recordings of the resuscitation process in a convenience sample of adult patients with non-traumatic, out-of-hospital cardiac arrest. Patients receiving US once or more during resuscitation were categorized as the US group, while the patients who did not receive US were categorized as the non-US group. The primary outcome was CCF, and the secondary outcomes were the rates of return of spontaneous circulation (ROSC), survival to admission and discharge, and survival to discharge with a favorable neurological outcome between the two groups. We also evaluated the individual pause duration and the percentage of prolonged pauses associated with US. RESULTS A total of 236 patients with 3,386 pauses were included. Of these patients, 190 received US and 284 pauses were related to US. Longer resuscitation duration was observed in the US group (median, 30.3 vs 9.7 minutes, P<.001). The US group had comparable CCF (93.0% vs 94.3%, P=0.29) with the non-US group. Although the non-US group had a better rate of ROSC (36% vs 52%, P=0.04), the rates of survival to admission (36% vs 48%, P=0.13), survival to discharge (11% vs 15%, P=0.37), and survival with favorable neurological outcome (5% vs 9%, P=0.23) did not differ between the two groups. The pause duration of pulse checks with US was longer than pulse checks alone (median, 8 vs 6 seconds, P=0.02). The percentage of prolonged pauses was similar between the two groups (16% vs 14%, P=0.49). CONCLUSION When compared to the non-ultrasound group, patients receiving US had comparable chest compression fractions and rates of survival to admission and discharge, and survival to discharge with a favorable neurological outcome. The individual pause was lengthened related to US. However, patients without US had a shorter resuscitation duration and a better rate of ROSC. The trend toward poorer results in the US group was possibly due to confounding variables and nonprobability sampling. It should be better investigated in further randomized studies.
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Affiliation(s)
- Wan-Ching Lien
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei City, Taiwan, Republic of China
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei City, Taiwan, Republic of China
| | - Kah-Meng Chong
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei City, Taiwan, Republic of China
| | - Chih-Heng Chang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei City, Taiwan, Republic of China
| | - Su-Fen Cheng
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei City, Taiwan, Republic of China
| | | | | | - Wen-Jone Chen
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei City, Taiwan, Republic of China
- National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei City, Taiwan, Republic of China
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15
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Huang CH, Sim SS, Lien WC. Cardiac arrest caused by ruptured nonaneurysmal infectious aortitis. CAN J EMERG MED 2023; 25:90-92. [PMID: 36260217 DOI: 10.1007/s43678-022-00401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/12/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Chun-Hsiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan
| | - Shyh-Shyong Sim
- Department of Emergency Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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16
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Chen YC, Lien WC, Su SY, Jhuang JR, Chiang CJ, Yang YW, Lee WC. Birth Cohort Effects in Breast Cancer Incidence: Global Patterns and Trends. Am J Epidemiol 2022; 191:1990-2001. [PMID: 35774004 DOI: 10.1093/aje/kwac116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/18/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
Breast cancer is the most common neoplasm in the world among women. The age-specific incidences and onset ages vary widely between Asian and Western countries/regions. Invasive breast cancer cases among women from 1997 to 2011 were abstracted from the International Agency for Research on Cancer and the Taiwan Cancer Registry. Age-period-cohort analysis was performed to examine the trends. The cohort effect was prominent in South Korea, Taiwan, Japan, and Thailand, possibly related to the timing of westernization. The risk of breast cancer initially rose with the birth cohorts in Hong Kong and India (both former British colonies), peaked, and then declined in recent birth cohorts. Unlike other Asian countries/regions, virtually no birth cohort effect was identified in the Philippines (a Spanish colony in 1565 and the first Asian country to adopt Western cultural aspects). Moreover, an at-most negligible birth cohort effect was identified for all ethnic groups (including Asian immigrants) in the United States. This global study identified birth cohort effects in most Asian countries/regions but virtually no impact in Western countries/regions. The timing of westernization was associated with the birth cohort effect.
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17
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Huang SS, Sung CW, Wang HP, Lien WC. The outcomes of right-sided and left-sided colonic diverticulitis following non-operative management: a systematic review and meta-analysis. World J Emerg Surg 2022; 17:56. [PMID: 36320045 PMCID: PMC9628071 DOI: 10.1186/s13017-022-00463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
Abstract
Background There is no sufficient overview of outcomes in right-sided and left-sided colonic diverticulitis (CD) following non-operative management. This systematic review was conducted to evaluate the recurrence/treatment failure in right-sided and left-sided CD. Methods A systematic review was conducted following PRISMA guidelines. MEDLINE, Embase, and Cochrane Library from inception to Dec 2021 were searched. The study characteristics, recurrence/treatment failure, and risk factors for recurrence/treatment failure were extracted. Proportional meta-analyses were performed to calculate the pooled recurrent/treatment failure rate of right-sided and left-sided CD using the random effect model. Logistic regression was applied for the factors associated with the recurrence/treatment failure. Results Thirty-eight studies with 10,129 patients were included, and only two studies comprised both sides of CD. None of the studies had a high risk of bias although significant heterogeneity existed. The pooled recurrence rate was 10% (95% CI 8–13%, I2 = 86%, p < 0.01) in right-sided and 20% (95% CI 16–24%, I2 = 92%, p < 0.01) in left-sided CD. For the uncomplicated CD, the pooled recurrence rate was 9% (95% CI 6–13%, I2 = 77%, p < 0.01) in right-sided and 15% (95% CI 8–27%, I2 = 97%, p < 0.01) in the left-sided. Age and gender were not associated with the recurrence of both sides. The treatment failure rate was 5% (95% CI 2–10%, I2 = 84%, p < 0.01) in right-sided and 4% (95% CI 2–7%, I2 = 80%, p < 0.01) in left-sided CD. The risk factors for recurrence and treatment failure were limited. Conclusion Non-operative management is effective with low rates of recurrence and treatment failure for both right-sided and left-sided CD although left-sided exhibits a higher recurrence. The recurrence rates did not differ between patients receiving antibiotics or not in uncomplicated CD. Age and sex were not associated with the recurrence although other risk factors were dispersing. Further risk factors for recurrence and treatment failure would be investigated for precise clinical decision-making and individualized strategy.
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Affiliation(s)
- Sih-Shiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hsin-Chu Hospital, Hsinchu City, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Emergency Medicine, National Taiwan University College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
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18
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Huang SS, Lien WC. Successful Nonoperative Management of a Traumatic Bilateral Thyroid Hemorrhage Following Blunt Neck Trauma. J Emerg Trauma Shock 2022; 15:186-187. [PMID: 36643771 PMCID: PMC9838652 DOI: 10.4103/jets.jets_157_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/29/2021] [Accepted: 02/18/2022] [Indexed: 01/17/2023] Open
Abstract
Traumatic thyroid hemorrhage is a rare but potentially life-threatening condition. Bilateral thyroid hemorrhage is even rarer. Herein, we report a case of traumatic bilateral thyroid hemorrhage treated with nonoperative management. A 49-year-old woman with preexisting goiter presented to the emergency department after a traffic accident. She had neck swelling and tenderness; however, no stridor or respiratory distress was noted. Traumatic bilateral thyroid hemorrhage with mild tracheal deviation to the right was diagnosed after computed tomography. Nonoperative management and intensive monitoring were applied for no signs of airway compromised. The patient was discharged after 5 days of hospital stay uneventfully. 6-month follow-up revealed stationary condition and normal thyroid function tests. This rare case demonstrated successful nonoperative management on the blunt injury of the neck, complicated with bilateral thyroid hemorrhage.
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Affiliation(s)
- Sih-Shiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
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19
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Lien WC, Chang CH, Chong KM, Wu MC, Wu CY, Wang HP. Clinical utilization of point-of-care ultrasound by junior emergency medicine residents. Med Ultrason 2022; 24:270-276. [PMID: 35045138 DOI: 10.11152/mu-3425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
AIM Little is known regarding the actual utilization of point-of-care ultrasound (PoCUS) after training. This study aims to investigate the clinical utilization of PoCUS by first post-graduate year (PGY-1) residents after training. MATERIAL AND METHODS This prospective study was conducted at the emergency department (ED). A PoCUS curriculum was implemented and the objective structured clinical examination (OSCE) scores were obtained after training. The sonographic examinations performed by the residents were collected. The primary outcomes were the numbers, imaging quality, and accuracy of the sonographic examinations after the curriculum, compared with those before the curriculum. RESULTS Two hundred and thirtynine residents participated with the median OSCE score of 4 (IQRs, 4-5) and 170 (71%) used PoCUS during clinical practice. The number that each resident performed increased [before vs. after, 0 (0-1) vs. 3 (0-5), p<0.0001], the image quality was better [before vs. after, 3 (2-3) vs. 3 (3), p<0.0001] and the accuracy improved (before vs. after, 117/129 vs. 730/772, p<0.0001) after the curriculum. The residents were categorized into 4 groups based on the utilization: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not use. No significant differences existed in the OSCE score between the 4 groups. Group 1 performed more examinationswith better image quality and groups 1 and 2 used ≥2 applications after the curriculum. However, nearly 30% of residents did not use PoCUS, and "chose other imaging priorities" (40/69, 58%) was the main feedback. CONCLUSIONS A PoCUS training had a positive impact on the clinical utilization by the novice residents. More than 70% of residents integrated PoCUS into clinical practice and used self-formatted US techniques. The OSCE scores could not predict further utilization.
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Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chih-Heng Chang
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
| | - Kah-Meng Chong
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
| | - Meng-Che Wu
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
| | - Hsiu-Po Wang
- Department of internal medicine, National Taiwan University Hospital, Taipei, Taiwan.
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20
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Lien WC, Chen JY, Wang PH, Ling DA, Wang HP. An effective AsK ultrasound protocol for patients with abdominal distention. Eur J Emerg Med 2022; 29:236-238. [PMID: 35483371 DOI: 10.1097/mej.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital
- Department of Emergency Medicine, College of Medicine, National Taiwan University
| | - Jia-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital
| | - Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital
| | - Dean-An Ling
- Department of Emergency Medicine, National Taiwan University Hospital
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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21
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Huang CH, Lien WC, Wang HP. Man With Epigastric Pain. Ann Emerg Med 2022; 79:e107-e108. [DOI: 10.1016/j.annemergmed.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Indexed: 11/01/2022]
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22
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Wang PH, Chen JY, Ling DA, Lee AF, Ko YC, Lien WC, Huang CH. Earlier point-of-care ultrasound, shorter length of stay in patients with acute flank pain. Scand J Trauma Resusc Emerg Med 2022; 30:29. [PMID: 35449010 PMCID: PMC9021562 DOI: 10.1186/s13049-022-01017-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background The effects of early integration of point-of-care ultrasound (PoCUS) into patient care are uncertain. This study aims to investigate the effects of early PoCUS on patients with acute flank pain. Methods Adult non-traumatic patients with acute flank pain receiving PoCUS were enrolled. Expert physicians reviewed the medical records and made the “final diagnosis” for the cause of acute flank pain. The primary outcome was the relationship between the door to ultrasound (US) time and length of stay (LOS). The secondary outcomes included the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the sonographic diagnosis, compared with the final diagnosis. Results Eight hundred and eighty-eight patients were included in the analysis. Patients receiving early PoCUS (≤120 min) had a shorter LOS (128 vs. 217 min, p < 0.0001). Patients in the late POCUS group (> 120 min) had a trend to receive more CT scans. The disease distribution, sensitivity, specificity, PPV, and NPV were similar in patients receiving early or late PoCUS for target diagnoses. After adjusting for the confounders, early PoCUS (OR, 2.77, 95% CIs, 1.93–3.98) had a positive impact on shorter LOS. In addition, the effect of early PoCUS became more prominent (OR, 4.91, 95% CIs, 3.39–7.13) on LOS in less than 3 h. Conclusions Early integration of PoCUS is significantly related to shorter LOS in patients with acute flank pain without increasing morbidity and mortality. Our results suggested “PoCUS early” in these patients to possibly alleviate emergency department crowding. Trial registration NCT04149041 at the ClinicalTrial.gov.
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Affiliation(s)
- Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Jia-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Dean-An Ling
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - An-Fu Lee
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Ying-Chih Ko
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan. .,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan.,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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23
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Chong KM, Yang CY, Lin CC, Lien WC. Severe immune thrombocytopenia following COVID-19 vaccination (Moderna) and immune checkpoint inhibitor: A case report. Am J Emerg Med 2022; 56:395.e1-395.e3. [PMID: 35339338 PMCID: PMC8932008 DOI: 10.1016/j.ajem.2022.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
Safe and effective prophylactic vaccines are urgently needed to contain the coronavirus disease 2019 (COVID-19) pandemic. However, several vaccination-related adverse effects have been reported. Here, we report a rare case of severe immune thrombocytopenia occurring 3 days after receiving the mRNA-1273 (Moderna) COVID-19 vaccine in an Asian woman with a history of refractory lung adenocarcinoma treated with durvalumab, an immune checkpoint inhibitor. Treatment with platelet transfusion (12 units) and oral prednisolone (1 mg/kg per day) significantly improved her hemoptysis with thrombocytopenia. To the best of our knowledge, this is the first case of ITP following Moderna inoculation among Asians. This study highlights a potential adverse effect of mRNA-based COVID-19 vaccines in cancer patients receiving immune checkpoint inhibitors.
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Affiliation(s)
- Kah-Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Yao Yang
- Division of Pulmonology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Chin Lin
- Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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24
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Sung CW, Liu KL, Wang HP, Chen IC, Huang EPC, Lien WC, Huang CH. Colonic diverticulitis location is a risk factor for recurrence: a multicenter, retrospective cohort study in Asian patients. Sci Rep 2022; 12:4559. [PMID: 35296787 PMCID: PMC8927129 DOI: 10.1038/s41598-022-08708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/11/2022] [Indexed: 11/09/2022] Open
Abstract
Evidence regarding the recurrence of diverticulitis is limited in Asian patients. This study aims to investigate recurrence rates and identify predictive factors for the recurrence of diverticulitis following successful nonoperative treatment in Asian patients. A multicenter, retrospective cohort study was conducted between 2012 and 2018. Adult patients with computed tomography (CT)-proven colonic diverticulitis were included. The primary outcome was the recurrence of diverticulitis, which was defined as another episode of occurrence of the infection after index hospital stay. Cumulative recurrence rates were calculated using the Kaplan-Meier method. Cox regression models were employed to identify parameters that significantly and independently predicted recurrence. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. A total of 929 patients were included. Diverticulitis in the cecum/ascending occurred in 675 (72.6%) patients. The average follow-up period was 651 days. Recurrence was observed in 115 (12.4%) patients and most significantly observed in patients with sigmoid diverticulitis (HR, 2.24; 95% CIs 1.59-3.97), followed by those with descending colon diverticulitis (HR, 1.92; 95% CIs 1.17-3.25). Although most of the Asian patients had right-sided colonic diverticulitis, those with sigmoid diverticulitis had the highest risk of recurrence.
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Affiliation(s)
- Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - I-Chung Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Taipei, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hsin-Chu Hospital, Hsinchu, Taiwan.,Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
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25
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Huang CY, Sun JT, Wu CY, Lien WC. Point-of-care Ultrasound Helps Differentiate the Causes of Unilateral Lower Limb Swelling with Rapid Progression: A Case Report with Literature Review. J Med Ultrasound 2022; 30:291-293. [PMID: 36844765 PMCID: PMC9944809 DOI: 10.4103/jmu.jmu_136_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/12/2021] [Accepted: 10/06/2021] [Indexed: 12/28/2022] Open
Abstract
Unilateral lower limb swelling is a common complaint among emergency department (ED) patients. However, an isolated intramuscular hematoma is an uncommon cause of lower limb swelling. We present a case of left thigh swelling after a traffic accident in which an intramuscular hematoma was diagnosed using point-of-care ultrasound. A literature review was also conducted.
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Affiliation(s)
- Chun-Yen Huang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan,Address for correspondence: Dr. Wan-Ching Lien, Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan. E-mail:
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Wang PH, Huang CH, Chen IC, Huang EPC, Lien WC, Huang CH. Survival factors in patients of high fall - A 10-year level-I multi-trauma center study. Injury 2022; 53:932-937. [PMID: 34972562 DOI: 10.1016/j.injury.2021.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aims to investigate the characteristics of patients after free falls at the Level-I trauma centers. The factors associated with survival were differentiated. METHODS This retrospective study was conducted at the National Taiwan University Hospital, the Hsin-Chu branch, and the Yun-Lin branch, all accredited as Level-I trauma centers between January 2010 and September 2020. Adult patients with falls from height of more than one story (i.e. 3.6 m) were included. Clinical data were obtained from electronic medical records. Odds ratios (OR) were computed with 95% confidence intervals (CIs) for significant parameters for survival. RESULTS A total of 371 patients were included. Only 2 survived to discharge with poor neurologic outcomes in 101 patients with OHCA. The overall mortality rate was 98% and 11% in patients with and without OHCA. A higher falling height with a one-meter increase (OR, 1.14, 95% CI, 1.10-1.19) was significantly related to OHCA, especially the height over 6 m (OR, 3.07, 95% CI, 1.19-7.94). A higher trauma injury severity score (TRISS) was significantly related to survival among patients without OHCA (OR, 1.07, 95% CI, 1.04-1.11), especially TRISS≧0.945 (OR, 5.21, 95% CI, 1.28-21.24). Patients without severe head/neck injury of Abbreviated Injury Scale (AIS)≧3 (OR, 0.17, 95% CI, 0.07-0.42) were positively associated with survivors among patients without OHCA. CONCLUSION Patients with traumatic OHCA following falls had a high mortality rate of 98% and dismal outcomes, compared with non-traumatic OHCA. Falling heights, especially over 6 m was associated with OHCA. Patients without OHCA had a mortality rate of 11%. Patients with a higher TRISS, especially more than 0.945, or without severe head injury had more chances to survive in the non-OHCA group. The study provided the evidence to guide termination of high futility resuscitation for traumatic OHCA secondary to falls to conserve the clinical resources.
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Affiliation(s)
- Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Hsiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Chung Chen
- Department of Emergency Medicine, Yun-Lin Branch, National Taiwan University Hospital, Yunlin, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, Hsin-Chu Branch, National Taiwan University Hospital, Hsinchu, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Chi CY, Chen YP, Yang CW, Huang CH, Wang YC, Chong KM, Wang HC, Lien WC, Yang MF, Ma MHM, Huang CH, Chen ZC, Ko PCI. Characteristics, prognostic factors, and chronological trends of out-of-hospital cardiac arrests with shockable rhythms in Taiwan - A 7-year observational study. J Formos Med Assoc 2022; 121:1972-1980. [PMID: 35216883 DOI: 10.1016/j.jfma.2022.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/24/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The study aimed to explore the characteristics, predictors, and chronological trends of outcomes for adult out-of-hospital cardiac arrests (OHCAs) with shockable rhythms. METHODS A 7-year, community-wide observational study using an Utstein-style registry was conducted. Patients who were not transported, those who experienced trauma and those who lacked electronic electrocardiography data were excluded; those with initial shockable rhythms of ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) were included. Outcomes were survival of discharge (SOD) and favorable neurological status (CPC 1-2). The outcome predictors, chronological trends, and their relationship with system interventions were analyzed. RESULTS Of the 1544 shockable OHCAs (incidence 12.6%) included, 97.6% had VF and 2.4% had pVT. VF showed better outcomes than pVT. Predictors for both outcomes (SOD; CPC 1-2) were chronological change (adjusted odds ratio [aOR]: 1.133; 1.176), younger age (aOR: 0.973; 0.967), shorter response time (aOR: 0.998; 0.999), shorter scene time (aOR: 0.999; 0.999), witnessed collapse (aOR: 1.668; 1.670), and bystander cardiopulmonary resuscitation (BCPR) (aOR: 1.448; 1.576). Predictors for only SOD were public location (aOR: 1.450) and successful prehospital defibrillation (aOR: 3.374). The use of the supraglottic airway was associated with adverse outcomes. Chronologically with system interventions, BCPR rate, the proportion of shockable OHCA, and improved neurological outcomes increased over time. CONCLUSIONS The incidence of shockable OHCA remained low in Asian community. VF showed better outcomes than pVT. Over time, the incidence of shockable rhythm, BCPR rate and patient outcomes did improve with health system interventions. The number of prehospital defibrillations did not predict outcomes.
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Affiliation(s)
- Chien-Yu Chi
- Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Yen-Pin Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Wei Yang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | - Kah-Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-Chih Wang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mei-Fen Yang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
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Lin XX, Lin P, Yeh EH, Liu GR, Lien WC, Fang Y. RAPIDEST: A Framework for Obstructive Sleep Apnea Detection. IEEE Trans Neural Syst Rehabil Eng 2022; 31:387-397. [PMID: 36423308 DOI: 10.1109/tnsre.2022.3224474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The traditional polysomnography (PSG) examination for Obstructive Sleep Apnea (OSA) diagnosis needs to measure several signals, such as EEG, ECG, EMG, EOG and the oxygen level in blood, of a patient who may have to wear many sensors during sleep. After the PSG examination, the Apnea-Hypopnea Index (AHI) is calculated based on the measured data to evaluate the severity of apnea and hypopnea for the patient. This process is obviously complicated and inconvenient. In this paper, we propose an AI-based framework, called RAre Pattern Identification and DEtection for Sleep-stage Transitions (RAPIDEST), to detect OSA based on the sequence of sleep stages from which a novel rarity score is defined to capture the unusualness of the sequence of sleep stages. More importantly, under this framework, we only need EEG signals, thus significantly simplifying the signal collection process and reducing the complexity of the severity determination of apnea and hypopnea. We have conducted extensive experiments to verify the relationship between the rarity score and AHI and demonstrate the effectiveness of our proposed approach.
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Affiliation(s)
- Xin-Xue Lin
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei City, Taiwan, R.O.C
| | - Phone Lin
- Department of Computer Science and Information Engineering, Graduate Institute of Networking and Multimedia, Institute of Medical Device and Imaging, and Internet of Things Research Center, National Taiwan University, Taipei City, Taiwan, R.O.C
| | - En-Hau Yeh
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei City, Taiwan, R.O.C
| | - Gi-Ren Liu
- Department of Mathematics, National Cheng Kung University, Tainan City, Taiwan, R.O.C
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan, R.O.C
| | - Yuguang Fang
- Department of Computer Science, City University of Hong Kong, Hong Kong, China
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Wang PH, Lin HY, Chang PY, Lien WC. Focused Assessment with Sonography for Trauma. J Med Ultrasound 2021; 29:151-153. [PMID: 34729321 PMCID: PMC8515623 DOI: 10.4103/jmu.jmu_128_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/22/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Hao-Yang Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Yuan Chang
- General Medicine Training and Demonstration Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.,General Medicine Training and Demonstration Center, National Taiwan University Hospital, Taipei, Taiwan
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30
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Lee AF, Liu CH, Chang PY, Lien WC. Ultrasound for the Abdominal Aorta. J Med Ultrasound 2021; 29:154-156. [PMID: 34729322 PMCID: PMC8515618 DOI: 10.4103/jmu.jmu_129_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- An-Fu Lee
- Department of Emergency, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Heng Liu
- Department of Emergency, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Yuan Chang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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31
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Huang CT, Lin CH, Wang HP, Lien WC. Spontaneous cervical epidural hematoma in a patient with end-stage renal disease. Hemodial Int 2021; 26:E5-E7. [PMID: 34227217 DOI: 10.1111/hdi.12970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022]
Abstract
Spontaneous spinal epidural hematoma (SEH) is extremely rare in patients with end-stage renal disease (ESRD). We report a case of a 71-year-old man with ESRD presented with progressive left limb weakness. Magnetic resonance imaging (MRI) revealed spinal cervical SEH involving C3-5 level. The patient received emergent decompression laminectomy with the evacuation of the epidural hematoma.
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Affiliation(s)
- Chien-Tai Huang
- Department of Emergency Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Hao Lin
- Department of Emergency Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University, National Taiwan University Hospital, Taipei, Taiwan
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32
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Chong KM, Chen JW, Lien WC, Yang MF, Wang HC, Liu SSH, Chen YP, Chi CY, Wu MCH, Wu CY, Liao ECW, Huang EPC, He HC, Yang HW, Huang CH, Ko PCI. Attitude and behavior toward bystander cardiopulmonary resuscitation during COVID-19 outbreak. PLoS One 2021; 16:e0252841. [PMID: 34161378 PMCID: PMC8221461 DOI: 10.1371/journal.pone.0252841] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on bystander cardiopulmonary resuscitation (BCPR) for fear of transmission while breaking social distancing rules. The latest guidelines recommend hands-only cardiopulmonary resuscitation (CPR) and facemask use. However, public willingness in this setup remains unknown. Methods A cross-sectional, unrestricted volunteer Internet survey was conducted to assess individuals’ attitudes and behaviors toward performing BCPR, pre-existing CPR training, occupational identity, age group, and gender. The raking method for weights and a regression analysis for the predictors of willingness were performed. Results Among 1,347 eligible respondents, 822 (61%) had negative attitudes toward performing BCPR. Healthcare providers (HCPs) and those with pre-existing CPR training had fewer negative attitudes (p < 0.001); HCPs and those with pre-existing CPR training and unchanged attitude showed more positive behaviors toward BCPR (p < 0.001). Further, 9.7% of the respondents would absolutely refuse to perform BCPR. In contrast, 16.9% would perform BCPR directly despite the outbreak. Approximately 9.9% would perform it if they were instructed, 23.5%, if they wore facemasks, and 40.1%, if they were to perform hands-only CPR. Interestingly, among the 822 respondents with negative attitudes, over 85% still tended to perform BCPR in the abovementioned situations. The weighted analysis showed similar results. The adjusted predictors for lower negative attitudes toward BCPR were younger age, being a man, and being an HCP; those for more positive behaviors were younger age and being an HCP. Conclusions Outbreaks of emerging infectious diseases, such as COVID-19, have negative impacts on attitudes and behaviors toward BCPR. Younger individuals, men, HCPs, and those with pre-existing CPR training tended to show fewer negative attitudes and behaviors. Meanwhile, most individuals with negative attitudes still expressed positive behaviors under safer measures such as facemask protection, hands-only CPR, and available dispatch instructions.
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Affiliation(s)
- Kah-Meng Chong
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jiun-Wei Chen
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mei-Fen Yang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui-Chih Wang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sot Shih-Hung Liu
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Yen-Pin Chen
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Yu Chi
- Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Marvin Chih-Hsien Wu
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Edward Che-Wei Liao
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Hsien-Chin He
- Department of Family Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsiang-Wen Yang
- Graduate Computer-Aided Engineering Group, Civil Engineering, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Chen JY, Liu YC, Lee PC, Lien WC. The specialty-variation effect on the utilization of outpatient service at the COVID-contained hospitals in Taiwan. J Formos Med Assoc 2021; 120:1926-1927. [PMID: 33965259 PMCID: PMC8099732 DOI: 10.1016/j.jfma.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Jia-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chuan Liu
- National Health Insurance Administration, Ministry of Health and Welfare, Taiwan
| | - Po-Chang Lee
- National Health Insurance Administration, Ministry of Health and Welfare, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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34
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Chen YC, Chow-In Ko P, Lee WC, Lien WC. Ecological fallacy in COVID-19 epidemiological inference: Influenza vaccination rate as an example. J Formos Med Assoc 2021; 120:1655-1656. [PMID: 33781655 PMCID: PMC7972645 DOI: 10.1016/j.jfma.2021.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yi-Chu Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Nursing, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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35
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Chou EH, Wang CH, Hsieh YL, Namazi B, Wolfshohl J, Bhakta T, Tsai CL, Lien WC, Sankaranarayanan G, Lee CC, Lu TC. Clinical Features of Emergency Department Patients from Early COVID-19 Pandemic that Predict SARS-CoV-2 Infection: Machine-learning Approach. West J Emerg Med 2021; 22:244-251. [PMID: 33856307 PMCID: PMC7972393 DOI: 10.5811/westjem.2020.12.49370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction Within a few months coronavirus disease 2019 (COVID-19) evolved into a pandemic causing millions of cases worldwide, but it remains challenging to diagnose the disease in a timely fashion in the emergency department (ED). In this study we aimed to construct machine-learning (ML) models to predict severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection based on the clinical features of patients visiting an ED during the early COVID-19 pandemic. Methods We retrospectively collected the data of all patients who received reverse transcriptase polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 at the ED of Baylor Scott & White All Saints Medical Center, Fort Worth, from February 23–May 12, 2020. The variables collected included patient demographics, ED triage data, clinical symptoms, and past medical history. The primary outcome was the confirmed diagnosis of COVID-19 (or SARS-CoV-2 infection) by a positive RT-PCR test result for SARS-CoV-2, and was used as the label for ML tasks. We used univariate analyses for feature selection, and variables with P<0.1 were selected for model construction. Samples were split into training and testing cohorts on a 60:40 ratio chronologically. We tried various ML algorithms to construct the best predictive model, and we evaluated performances with the area under the receiver operating characteristic curve (AUC) in the testing cohort. Results A total of 580 ED patients were tested for SARS-CoV-2 during the study periods, and 98 (16.9%) were identified as having the SARS-CoV-2 infection based on the RT-PCR results. Univariate analyses selected 21 features for model construction. We assessed three ML methods for performance: of the three methods, random forest outperformed the others with the best AUC result (0.86), followed by gradient boosting (0.83) and extra trees classifier (0.82). Conclusion This study shows that it is feasible to use ML models as an initial screening tool for identifying patients with SARS-CoV-2 infection. Further validation will be necessary to determine how effectively this prediction model can be used prospectively in clinical practice.
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Affiliation(s)
- Eric H Chou
- Baylor Scott & White All Saints Medical Center, Department of Emergency Medicine, Fort Worth, Texas
| | - Chih-Hung Wang
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.,National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Yu-Lin Hsieh
- Danbury Hospital, Department of Internal Medicine, Danbury, Connecticut
| | - Babak Namazi
- Baylor Scott & White Research Institute, Dallas, Texas
| | - Jon Wolfshohl
- Baylor Scott & White All Saints Medical Center, Department of Emergency Medicine, Fort Worth, Texas
| | - Toral Bhakta
- Baylor Scott & White All Saints Medical Center, Department of Emergency Medicine, Fort Worth, Texas
| | - Chu-Lin Tsai
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.,National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Wan-Ching Lien
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.,National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Ganesh Sankaranarayanan
- Baylor University Medical Center, Center for Evidence Based Simulation, Dallas, Texas.,Texas A&M Health Science Center, Department of Surgery, Dallas, Texas
| | - Chien-Chang Lee
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.,National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
| | - Tsung-Chien Lu
- National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.,National Taiwan University, College of Medicine, Department of Emergency Medicine, Taipei, Taiwan
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36
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Chang HCH, Lien WC, Chang WT, Huang CH. Advanced life support 2.0-Echo-assisted life support (eALS)? Resuscitation 2021; 160:103-105. [PMID: 33548361 DOI: 10.1016/j.resuscitation.2021.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Herman Chih-Heng Chang
- Department of Emergency and Critical Care Medicine, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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37
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Lien WC, Chang CH, Chang WT, Chen WJ. Ultrasonographic Assessment During Cardiopulmonary Resuscitation. J Vis Exp 2020. [PMID: 33165330 DOI: 10.3791/59144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The US-CAB (Ultrasound, Circulation/Airway/Breathing) protocol integrates several sonographic techniques into a structured assessment of the circulation, airway, and breathing status of a patient during cardiopulmonary resuscitation (CPR) in an advanced life support-compliant manner. US-C provides a subxiphoid view of the heart, to look for potentially reversible causes of disease, such as pericardial effusion, pulmonary embolism, hypovolemia, and acute coronary thrombosis. Sonographic cardiac activity during CPR not only helps differentiate pseudo-pulseless electrical activity (PEA) from true PEA but also represents a higher chance of the return of spontaneous circulation (ROSC) and survival. Evaluation of the inferior vena cava (IVC) shows the fluid status of the patient and indicates the best methods to use for fluid resuscitation. If aortic dissection is suspected, a subxiphoid view of the aorta is suggested for identifying an intimal flap. Once intubation is done, tracheal ultrasound (US-A) at the suprasternal notch helps differentiate endotracheal intubation (one air-mucosal interface with one comet-tail) from esophageal intubation (double tract sign). Immediately following US-A, bilateral lung US (US-B) should be done to confirm proper bilateral ventilation using the lung sliding sign. In addition, US-C can be serially followed to see the dynamic changes in the cardiac chambers and IVC, or any cardiac contraction suggestive of ROSC. US-B can also detect coexisting lung or pleural pathologies without interfering with the performance of CPR. The main concern when implementing this method is maintaining high-quality CPR without delays in chest compressions when performing US-CAB. Rigorous training and continued practice are key to minimize any interruptions during resuscitation.
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Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine
| | - Chih-Heng Chang
- Department of Emergency Medicine, National Taiwan University Hospital Chin-Shan Branch
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine; Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine;
| | - Wen-Jone Chen
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine; Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine
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Affiliation(s)
- Chun-Hsiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Chan WH, Sung CW, Chang HCH, Ko PCI, Huang EPC, Lien WC, Huang CH. Measurement of subglottic diameter and distance to pre-epiglottic space among Chinese adults. PLoS One 2020; 15:e0236364. [PMID: 32706821 PMCID: PMC7380620 DOI: 10.1371/journal.pone.0236364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022] Open
Abstract
Proper endotracheal tube (ETT) size selection and identification of potentially difficult airways are important to reduce laryngeal injury during intubation. However, controversies exist concerning transverse subglottic diameter—the narrowest part of the airway—and the distance to pre-epiglottic space. Because few studies have reported the distance from skin to the midpoint of the epiglottis (DSE) among normal individuals, whether the DSE varies between individuals and by ethnicity remains uncertain. The present study aims to investigate the sonographic subglottic diameter and DSE among healthy Chinese adults. Healthy volunteers were recruited at National Taiwan University Hospital between October and November 2019. Exclusion criteria included pre-existing airway or respiratory diseases, neck tumors, and a history of neck operation. Age, sex, height, weight, body mass index (BMI), sonographic DSE, and transverse subglottic diameter were recorded. A total of 124 participants were enrolled. The average age was 32.5 ± 10.4 years and 63 participants (51%) were males. The subglottic diameter was positively associated with sex (males, 14.40 mm; females, 11.10 mm, p < 0.001) and BMI (underweight, 12.13 mm; normal weight, 12.47 mm; overweight, 13.80 mm; obese, 13.67 mm, p = 0.007). Moreover, the DSE was shorter in males (male, 16.18 mm; females, 14.54 mm, p < 0.001) and participants with increased BMI (underweight, 13.70 mm; normal weight, 15.06 mm; overweight, 16.58 mm; obese, 18.18 mm, p < 0.001). As compared with other ethnicity, a smaller size of subglottic diameter and a shorter DSE were noted among Chinese participants, and we suggest that a relatively smaller size of endotracheal tube selection should be considered in tracheal intubations.
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Affiliation(s)
- Wai-Ho Chan
- Department of Emergency Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Herman Chih-Heng Chang
- Department of Emergency Medicine, Jinshan branch, National Taiwan University Hospital, New Taipei City, Taiwan
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Edward Pei-Chuan Huang
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
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40
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Hsiao YT, Lien WC. Man with trauma after fall from height. J Am Coll Emerg Physicians Open 2020; 1:304-305. [PMID: 33000053 PMCID: PMC7493546 DOI: 10.1002/emp2.12058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/15/2020] [Accepted: 03/11/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yu-Tse Hsiao
- Department of Emergency Medicine National Taiwan University Hospital Taipei Taiwan
| | - Wan-Ching Lien
- College of Medicine National Taiwan University Taipei Taiwan
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41
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Lien WC, Wu JL, Tseng WP, Chow-In Ko P, Chen SY, Tsai MS, Chang WT, Huang CH, Chen SC. Fight COVID-19 Beyond the Borders: Emergency Department Patient Diversion in Taiwan. Ann Emerg Med 2020; 75:785-787. [PMID: 32334881 PMCID: PMC7151359 DOI: 10.1016/j.annemergmed.2020.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jhong-Lin Wu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Pin Tseng
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shey-Ying Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Shan Tsai
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Lien WC, Chang WT. A Potential Pitfall of Tracheal Ultrasound for the Confirmation of Endotracheal Intubations. J Ultrasound Med 2020; 39:407-408. [PMID: 31328287 DOI: 10.1002/jum.15094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Abstract
Background Point-of-Care Ultrasound (PoCUS) is considered as an extension of clinicians’ patient care and can be integrated into daily clinical practice. Dyspnea is a common presentation in uremic patients. With the aids of PoCUS and integrated assessments of lung, heart and inferior vena cava (IVC), the etiology of dyspnea in uremic patients can be determined earlier. Case presentation A 67-year-old woman presented with progressive shortness of breath and bilateral legs edema for 3 weeks. The laboratory data revealed marked elevated level of serum creatinine and blood urea. A large amount of pericardial effusion was timely detected by PoCUS. Uremic pericarditis was suspected. Emergent hemodialysis was initiated and her symptoms improved. Conclusions PoCUS is a noninvasive and cost-effective imaging modality and it has been popular in the emergency department (ED). In uremic patients presenting with dyspnea, the integration of PoCUS into traditional physical examinations help emergency physicians narrow down the differential diagnoses.
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Affiliation(s)
- Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University,
- No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University,
- No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
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Kuo R, Cheng W, Lien WC, Yang T. Application of genetic algorithm-based intuitionistic fuzzy neural network to medical cost forecasting for acute hepatitis patients in emergency room. IFS 2019. [DOI: 10.3233/jifs-190554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- R.J. Kuo
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - W.C. Cheng
- Microsoft Taiwan Corporation, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan
| | - T.J. Yang
- Department of Emergency Medicine, Sijhih Cathay General Hospital, Taipei, Taiwan
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Huang CY, Sun JT, Lien WC. Early Detection of Superior Mesenteric Artery Dissection by Ultrasound: Two Case Reports. J Med Ultrasound 2019; 27:47-49. [PMID: 31031536 PMCID: PMC6445036 DOI: 10.4103/jmu.jmu_81_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022] Open
Abstract
Superior mesenteric artery (SMA) dissection is a rare disease. Most of the cases are diagnosed through contrast-enhanced computed tomography. The use of emergent bedside ultrasound has been described to diagnose aortic dissection. However, evidence is limited regarding the use of bedside ultrasound for diagnosing SMA dissection, which is a known risk factor for aortic dissection. We present two case reports: one case of isolated SMA dissection and one case of SMA dissection complicated with aortic dissection. Both cases were initially diagnosed through bedside ultrasound and confirmed through contrast-enhanced computed tomography.
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Affiliation(s)
- Chun-Yen Huang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
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Huang CY, Chen PA, Sun JT, Lien WC. Ultrasound imaging of pneumatosis intestinalis. J Med Ultrasound 2019; 27:211-212. [PMID: 31867198 PMCID: PMC6905249 DOI: 10.4103/jmu.jmu_18_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/08/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022] Open
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Wang CH, Wu CY, Lien WC, Liu KL, Wang HP, Wu YM, Chen SC. Early percutaneous cholecystostomy versus antibiotic treatment for mild and moderate acute cholecystitis: A retrospective cohort study. J Formos Med Assoc 2018; 118:914-921. [PMID: 30293928 DOI: 10.1016/j.jfma.2018.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/06/2018] [Accepted: 09/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Percutaneous cholecystostomy (PC) is an effective treatment for severe acute cholecystitis (AC). Guidelines recommend PC as rescue therapy for patients with mild or moderate AC who do not receive emergent cholecystectomy. This study aims to investigate whether PC could be a first-line treatment for these patients. METHODS Adult patients admitted through the emergency department between October 2004 and December 2013 were retrospectively reviewed. Patients with mild or moderate AC who did not undergo emergent cholecystectomy were included. Early PC was defined as a PC tube inserted within 24 h of diagnosis. The outcomes were compared between patients who received antibiotics plus early PC (early PC group) and those who received antibiotic treatment alone (antibiotic group). RESULTS A total of 698 patients were included. The mean age was 63.4 years. There were 171 patients in the early PC group and 527 patients in the antibiotic group. Multivariable logistic regression analyses indicated that early PC was significantly associated with a decreased rate of prolonged fever (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.16-0.57; p < 0.001). Early PC also correlated with both increased short-term (OR, 15.95; 95% CI, 5.73-44.38; p < 0.001) and long-term treatment success (OR, 4.27; 95% CI, 2.55-7.15; p < 0.001). CONCLUSION For patients with mild/moderate AC without emergent cholecystectomy, early PC might expedite sepsis resolution and improve the treatment success rate compared with antibiotic treatment alone. This result should be deemed as hypothesis-generating and should be examined in a randomized controlled trial.
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Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Cheng-Yi Wu
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC.
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Yao-Ming Wu
- Department of Surgery, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, National Taiwan University and National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan, ROC
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Chang WT, Lien WC, Chen WJ. Response to “The wider implications of AD-related AR and pulmonary edema”. Am J Emerg Med 2018; 36:1497-1498. [DOI: 10.1016/j.ajem.2018.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/15/2022] Open
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Lien WC, Hsu SH, Chong KM, Sim SS, Wu MC, Chang WT, Fang CC, Ma MHM, Chen SC, Chen WJ. Data on evaluation of proficiency for the US-CAB curriculum. Data Brief 2018; 17:965-968. [PMID: 29876452 PMCID: PMC5988426 DOI: 10.1016/j.dib.2018.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/12/2018] [Indexed: 12/03/2022] Open
Abstract
Data presented in this article relates to the research article entitled “US-CAB protocol for ultrasonographic evaluation during cardiopulmonary resuscitation: validation and potential impact” (Lien et al., in press). The article provides data regarding proficiency of the 10 emergency residents attending the US-CAB curriculum. Assessments included immediate evaluation at the end of training and re-evaluation 6 months later. A written test, and the ultrasound image acquisition were required in the immediate evaluation The re-evaluation included the written test and performance on the same healthy volunteer.
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Affiliation(s)
- Wan-Ching Lien
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Hsien Hsu
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Kah-Meng Chong
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Shyh-Shyong Sim
- Department of Emergency Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Meng-Che Wu
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Tien Chang
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Chung Fang
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Shyr-Chyr Chen
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Jone Chen
- Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan
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Chang CH, Lien WC. Palpebral emphysema following a dental procedure. Am J Emerg Med 2018; 36:908.e1-908.e2. [DOI: 10.1016/j.ajem.2018.01.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022] Open
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