Framing the virus: The political, economic, biomedical and social understandings of the COVID-19 in Taiwan.

The purpose of this paper is to study how people use texts and languages to interpret or make sense of the COVID-19 pandemic. We draw on the theoretical literature of framing perspectives to formulate our arguments that consider the virus a socially constructed reality. We use Taiwan as an empirical case study, using topic modeling analysis of newspaper articles. Our findings show that the language of the COVID-19 coverage combines the four frames of political evaluation, economic impact, biomedical science and social life in varying proportions. These frames are subject to changes in pandemic conditions. Implications for theory and practice are presented.

Effectiveness of Digital Flipped Learning Evidence-Based Practice on Nurses' Knowledge, Attitude, and Practice: A Quasi-Experimental Trial.

Background: Evidence-based care has become critical in raising the quality of medical facilities. The implementation of evidence-based practice helps medical practitioners make better clinical decisions. Objective: The objective of this study was to investigate whether the innovative flipped teaching model could be as effective as the conventional teaching model in terms of knowledge, attitude, and practice and to confirm the continuous effect. Design: A quasi-experimental design using the flipped and conventional learning groups concurrently with repeat measurements was used. Setting: The setting was a 475-bed regional teaching hospital in Taiwan, from March to July 2020. Participants: The study included 114 licensed nurses who had worked longer than three months, with 57 participants each in two groups. Methods: The participants were assigned to two groups using a block randomization method. All participants completed questionnaires related to knowledge, attitude, and practice of EBP at four-time points: pre-test (T0) and immediately after intervention (T1), at month 1 (T2), and at month 3 (T3). Analysis of repeated generalized estimating equations was used. Results: The flipped and conventional learning groups had significant differences in knowledge, attitude, and practice at the T0 and T1 (p < 0.05). The flipped group was higher than the conventional group at T3 in the knowledge score (p = 0.001) and lower than the conventional group at T2 in the attitude score (p = 0.010). There were no significant differences between the two groups' practice scores at different time points. There were no significantly different score changes for knowledge, attitude, and practice (p > 0.05). The interaction term only at T3 vs. T0 in the knowledge score was slightly different (p = 0.049) in primary outcome. Conclusion: The intervention methods of both groups were effective. Flipped learning is more flexible and has more time for discussion, which nurses favor. Under the policy promoted in the hospital, EBP combined with the nursing advancement system was standardized, and conventional learning also improved the learning effect.

Overview of drug treatment for paroxysmal supraventricular tachycardia in Taiwan emergency departments: Adenosine using trend from 2000 to 2012.

BACKGROUND: Before 2010, guidelines recommended adenosine 6, 12, and a repeat dose of 12 mg for paroxysmal supraventricular tachycardia (PSVT). After 2010, these doses were reduced to two. This study aims to outline adenosine using trend from 2000 to 2012 in Taiwan emergency departments (EDs). METHODS: This was an ecological study. PSVT were drawn from one million individuals of the National Health Insurance Database. The χ2 test was used to determine an association between different adenosine doses and other antiarrhythmic drugs (OADs), including verapamil, diltiazem, amiodarone, digoxin, and labetalol. RESULTS: There were 3361 PSVT visits from 2000 to 2012; 834 (24.8%) did not receive an antiarrhythmic drug, and 2527 (75.2%) did, either adenosine with/without OADs or OADs alone. The use of an OAD was significantly different between the adenosine 6-18 mg and 19 + mg groups. CONCLUSIONS: Most PSVT episodes converted with adenosine within 18 mg, and the success conversion rate was 62.2%. It could be up to 65.2% if they received more. Of the patients who did not have their PSVT reverted with< 18 mg, 37.8% could have been successfully treated with more doses. The necessity of using the 3rd dose of adenosine is needed to be further explored.

A direct connection promotes time efficiency for transfer of ST-elevation myocardial infarction patients.

INTRODUCTION: Reducing the delay in time to primary percutaneous coronary intervention (PCI) for acute coronary syndrome patients in the non-urban emergency department (ED) is of critical importance. Conventionally, physicians in a non-PCI-capable, non-urban local emergency department (LED) require approval from a tertiary university hospital emergency department (TUH-ED) prior to transferring eligible STEMI patients for PCI procedures. To reduce the ED delay time, this study developed a direct connection between the LED and the cardiac catheterisation laboratory in the TUH (TUH cath lab). METHODS: ST-elevation myocardial infarction (STEMI) patients' medical records for 2014 to 2017, from a non-PCI regional hospital located in one of the rural counties in central Taiwan and a TUH-ED in a metropolitan area in the centre of Taiwan, were retrospectively collected and classified into two categories: the LED referral (group A) and the TUH-non-referral (group B). This study compared the ED delay time between TUH non-referral patients in the TUH and LED referral patients in the LED, to determine whether a direct connection reduces current LED delay time. RESULTS: A total of 214 patients (group A, n=62; group B, n=152) who underwent PCI procedures at the TUH were enrolled in the study. ED delay times in the LED were significantly less than the TUH-ED (45.0 v 66.0 min, p<0.01.) Conclusion: The direct connection between the LED and the TUH cath lab effectively shortened the ED delay time in the LED, allowing for earlier primary PCI procedures for the transferred STEMI patients.

Dural Arteriovenous Fistula With Sinus Thrombosis and Venous Reflux Presenting as Parkinsonism: A Case Report.

The occurrence of dural arteriovenous fistula (DAVF) is rare. The clinical manifestation varies and depends on the location and venous drainage pattern. We present a case of a 57-year-old man with a left transverse sinus DAVF along with sigmoid thrombosis, cortical venous reflux, and congestion, that initially presented as parkinsonism. The patient was alert and fully oriented; however, decreased facial expressions were noted. His left forearm showed rigidity and bradykinesia, and it was difficult for the patient to smoothly perform rapid alternating movement testing. His complaints about hearing a rhythmic bruit above the left ear, particularly when lying down, alerted the physician of the presence of vascular lesions. Magnetic resonance imaging and angiography confirmed the diagnosis of DAVF. The patient received a combined surgical and endovascular approach to permanently block the fistula blood flow. The motion and movement of his left upper limb improved after fistula embolization. Images at the 1-month follow-up showed a decrease in the volume of tortuous vessels, and the fistula was completely occluded.

Tamoxifen use correlates with increased risk of hip fractures in older women with breast cancer: A case-control study in Taiwan.

AIM: This study aimed to evaluate the association between tamoxifen use and hip fractures in older women with breast cancer in Taiwan. METHODS: We carried out a retrospective nationwide case-control study using the database of the Taiwan National Health Insurance Program. A total of 762 female patients with breast cancer aged ≥65 years newly diagnosed with hip fractures from 2000 to 2011 were identified for inclusion in the study. Additionally, 7620 female patients with breast cancer aged ≥65 years without hip fractures were randomly selected as controls. Patients were defined as having used tamoxifen if they had an existing prescription for tamoxifen before the index date. Patients were defined as having never used tamoxifen if they had never been given a prescription for tamoxifen before the index date. We used an unconditional logistic regression model to calculate the odds ratio and 95% confidence interval for the association between tamoxifen use and risk of hip fractures. RESULTS: After adjustment for confounding variables, compared with patients who did not use tamoxifen, the adjusted odds ratio of hip fracture was 2.29 for those who had used tamoxifen (95% confidence interval 1.92, 2.72). Furthermore, adjusted odds ratios were 2.74 (95% confidence interval 2.19, 3.42) among patients with a cumulative duration of tamoxifen use of >3 years. CONCLUSION: Tamoxifen use is associated with increased risk of hip fractures among older women with breast cancer in Taiwan. Geriatr Gerontol Int 2019; 19: 56-60.

Using proton pump inhibitors correlates with an increased risk of chronic kidney disease: a nationwide database-derived case-controlled study.

Background: Those taking proton pump inhibitors (PPIs) might have a higher risk of acute kidney injury. The long-term safety, especially the PPI-associated chronic kidney disease (CKD) is the subsequent concern. Objective: This study explores the potential relationship between using PPIs and CKD in Taiwan. Methods: Using a database collated by the Taiwan National Health Insurance programme, we conducted a population-based case-controlled study to identify 16 704 cases of patients aged 20 years or older with newly diagnosed CKD between 2000 and 2013. 16 704 controls were randomly selected and were matched by sex, age and comorbidities. 'Use' of PPIs was defined as when subjects had received at least a prescription for PPIs before the index date. 'Non-use' was defined as subjects who had never received a prescription for PPIs before the index date. The odds ratio (OR) for CKD associated with the use of PPIs was estimated by a logistic regression model. Results: The OR for CKD was 1.41 for subjects using PPIs [95% confidence interval (CI) 1.34, 1.48] compared with subjects who had never used PPIs. Almost all major types of PPIs present a weak association with increased odds of CKD in cumulative duration and dosage regression analysis. The OR in relation to cumulative duration (per month) of PPIs use was 1.02 (95% CI 1.01, 1.02) and the OR in relation to cumulative dosage (per microgram) of PPIs use was 1.23 (95% CI 1.18, 1.28). Conclusions: Using PPIs presented 1.4-fold higher odds of CKD in Taiwan health insurance claims data analysis.

Use of Selective Serotonin Reuptake Inhibitors and Risk of Hip Fracture in the Elderly: A Case-Control Study in Taiwan.

BACKGROUND: This population based study investigated the relationship between use of selective serotonin reuptake inhibitors (SSRIs) and hip fractures in the elderly in Taiwan. METHODS: Analysis of a random sample of 1 million insurance enrollees' data identified 4,891 patients with newly diagnosed hip fractures and 4,891 controls without hip fracture between 2000 and 2011. Both cases and controls were ≥65 years of age and were matched by sex, age, comorbidities, and index year of hip fracture diagnosis. Patients were considered current SSRI users if their last SSRI tablet was taken ≤7 days before the hip fracture diagnosis. Late use of SSRIs was defined as taking the last SSRI tablet ≥8 days before the hip fracture diagnosis. Non-SSRI users comprised individuals who never had an SSRI prescription. Odds ratios (ORs) and 95% confidence intervals (CIs) for hip fracture associated with SSRI use was estimated by multivariate unconditional logistic regression. RESULTS: After adjustment for covariants, multivariate regression analysis showed that the adjusted OR of hip fracture was 2.17 for current SSRI users (95% CI: 1.60-2.93) compared with those who never used SSRIs. The adjusted OR was 1.11 for individuals with late use of SSRIs (95% CI: 0.96-1.28) and was not significant. CONCLUSIONS: Current use of SSRIs was associated with a 2.17-fold increase in the odds of hip fracture in the elderly in Taiwan. Clinicians should consider the possibility of SSRI-associated hip fracture among old people currently taking SSRIs.

Non-traumatic out-of-hospital cardiac arrest in rural Taiwan: A retrospective study.

OBJECTIVE: Out-of-hospital cardiac arrest (OHCA) studies are usually conducted at metropolitan medical centres. Because rural studies are rare, our study aimed to assess non-traumatic OHCA prevalence and resuscitation outcomes in rural Taiwan. DESIGN: A retrospective observational study. SETTING: All seven designated community hospital emergency departments (ED) in Nantou County, Taiwan. PARTICIPANTS: All OHCA patients from May 2011 to March 2013. MAIN OUTCOME MEASURES: Any return of spontaneous circulation (ROSC) and survival for ED discharge. RESULTS: In the 23-month period, 850 OHCA cases were reported; 741 (87.2%) were non-traumatic. The overall ROSC achievement rate was 19.7%, with 16.4% case survival for ED discharge. Logistic regression identified that arrest in public (OR: 2.62, 95% CI: 1.19-5.78), witness when collapsed (OR: 2.14, 95% CI: 1.28-3.60), and cardiopulmonary resuscitation (CPR) by bystander (OR: 2.09, 95% CI: 1.02-4.26) might increase the likelihood of any ROSC; arrest in public (OR: 2.68, 95% CI: 1.10-6.50), witnessed collapse (OR: 2.26, 95% CI: 1.24-4.09) and CPR by bystander (OR: 2.79, 95% CI: 1.28-6.05) might also increase the likelihood of survival. For non-traumatic OHCA patients conveyed to EDs via emergency medical service system (EMS), a shorter response time (OR: 1.09, 95% CI: 1.01-1.18) and travelling time (OR: 1.04, 95% CI: 1.00-1.09) might also increase the chance of survival. CONCLUSION: Compared to previous data from metropolitan areas, ROSC achievement rate was lower in rural Taiwan. Witness presence, response and travelling times affect ROSC achievement in non-traumatic OHCA patients in rural Taiwan.

Chest compression fraction in ambulance while transporting patients with out-of-hospital cardiac arrest to the hospital in rural Taiwan.

INTRODUCTION: Maintaining the standard two-handed chest compression is difficult in high-speed ambulances in rural areas. METHODS: A retrospective, video-based, observational study was conducted from June to September 2013 in Nantou, a rural county of central Taiwan, to evaluate the chest compression fraction in an ambulance carriage during the travel from the scene to the hospital. The chest compression fraction was calculated as the chest compression time period divided by the ambulance travelling time period; the one-handed and two-handed chest compression fractions were also calculated. RESULTS: During the 4-month study period, a total of 102 videos that were recorded in an ambulance carriage were reviewed, including 97 cases of manual chest compressions. When there was only one emergency medical technician (EMT) in the carriage, the combined chest compression fraction was 50.6±20.7%; when there were two EMTs, the fraction was 58.3±16.0% and the fraction was 58.3±21.0% in a three-EMT scenario (p=0.221). Moreover, in the carriage, EMTs usually performed one-handed chest compressions. CONCLUSIONS: The chest compression fraction was low for patients with out-of-hospital cardiac arrest in a moving ambulance, irrespective of the number of providers. Reasons for this observation, as well as the effectiveness of the one-handed chest compression require further evaluation.

Nabumetone use and risk of acute pancreatitis in a case-control study.

BACKGROUND: It remains unknown whether nabumetone increases or decreases acute pancreatitis risk. To investigate this, we conducted a population-based case-control study using the database from the Taiwan National Health Insurance Program. METHODS: We analysed 5384 cases aged 20-84 years who had their first attack of acute pancreatitis during 1998-2011 and 21,536 controls without acute pancreatitis, and matched them according to sex, age and year in which acute pancreatitis was diagnosed. Never use of nabumetone was defined as subjects who had never received a nabumetone prescription; active use as subjects receiving a minimum of one prescription for nabumetone within 7 days before acute pancreatitis diagnosis and non-active use of nabumetone as subjects who did not receive a prescription for nabumetone within 7 days before but received at least one prescription for nabumetone ≥8 days before. The odds ratio and 95% confidence interval (CI) were estimated to investigate the risk of acute pancreatitis associated with nabumetone use, using the multivariable unconditional logistic regression model. RESULTS: The adjusted odds ratio of acute pancreatitis was 3.69 (95%CI 1.69, 8.05) for subjects with active use of nabumetone compared with those with never use. The odds ratios decreased to 1.0 (95%CI 0.88, 1.12) for subjects with non-active use. CONCLUSIONS: Active use of nabumetone may increase the risk of acute pancreatitis.

Use of celecoxib correlates with increased relative risk of acute pancreatitis: a case-control study in Taiwan.

OBJECTIVES: This study evaluated whether there is an association between the use of celecoxib and acute pancreatitis in Taiwan. METHODS: We conducted a case-control study using the database of the Taiwan National Health Insurance Program. The participants comprised 5,095 subjects, aged 20-84 years, with a first admission episode of acute pancreatitis from 2000 to 2011 as the cases and 20,380 randomly selected sex-matched and age-matched subjects without acute pancreatitis as the controls. The absence of celecoxib prescription was defined as "never used." Current use of celecoxib was defined as subjects who had received at least one prescription for celecoxib within 3 days before diagnosis with acute pancreatitis. A multivariate unconditional logistic regression model was used to calculate the odds ratio (OR) and 95% confidence interval (CI) for acute pancreatitis associated with the use of celecoxib. RESULTS: Compared with subjects who never used celecoxib, the adjusted OR of acute pancreatitis was 5.62 in subjects with current use of celecoxib (95% CI=3.33-9.46). CONCLUSIONS: The current use of celecoxib is associated with an increased risk of acute pancreatitis.

Association between comorbidities and dementia in diabetes mellitus patients: population-based retrospective cohort study.

AIMS: Most diabetes mellitus (DM) patients have several comorbidities; the correlation of these comorbidities with dementia in DM requires clarification. METHODS: Using claims data from Taiwan National Health Insurance, we identified 33,709 DM adults before the year 2000 and randomly selected 67,066 non-DM patients matched by sex and age. Subjects were followed until diagnosis with dementia, excluded due to death/withdrawal from the insurance program, or followed until 2011. We compared the incidence and hazard ratio (HR) for dementia in both cohorts. RESULTS: Comorbidities were more prevalent in DM patients, including hypertension, hyperlipidemia, stroke, coronary artery and/or kidney disease. The HR was higher for the DM cohort with comorbidities than those without: 1.88 vs. 1.46 with hypertension; 1.56 vs. 1.39 with hyperlipidemia; 1.73 vs. 1.37 with coronary artery disease; 2.36 vs. 2.29 with stroke and 1.88 vs. 1.50 with kidney disease. The HR for dementia in diabetics rose from 1.41 in those without comorbidities to 2.49 in those with ≥4 comorbidities. In the DM cohort, HR was 1.22 for non-insulin-users and 1.41 for insulin-users, and 1.49 for type 1 DM and 1.23 for type 2 DM. CONCLUSION: Diabetic patients have an elevated risk of dementia, and comorbidity increases this risk.

Hearing Loss is Associated With Risk of Alzheimer's Disease: A Case-Control Study in Older People.

BACKGROUND: It remains unknown whether hearing loss increases the risk of Alzheimer's disease. This study aimed to examine the association between hearing loss and risk of Alzheimer's disease in older people in Taiwan. METHODS: Analyzing the database from Taiwan's National Health Insurance Program, this case-control study enrolled 488 subjects ≥65 years old with newly diagnosed Alzheimer's disease as a case group and 1952 subjects without Alzheimer's disease as a control group from 1998-2011. Patients with Alzheimer's disease and other comorbidities were identified by analyzing ICD-9 coding in claims data. The association of hearing loss, other comorbidities, and risk of Alzheimer's disease were compared between groups. RESULTS: After controlling for confounders, multivariable logistic regression showed an adjusted odds ratio of Alzheimer's disease of 1.39 in people with hearing loss (95% CI, 1.05-1.84) versus those without. Parkinson's disease (OR 4.44; 95% CI, 2.54-7.78), head injury (OR 2.31; 95% CI, 1.46-3.66), depression (OR 1.68; 95% CI, 1.19-2.39), hypertension (OR 1.40; 95% CI, 1.10-1.79), and age (each year, OR 1.03; 95% CI, 1.01-1.05) also showed strong links with Alzheimer's. CONCLUSIONS: Hearing loss is associated with increased risk of Alzheimer's disease in older people in Taiwan.

Risk factors associated with symptomatic cholelithiasis in Taiwan: a population-based study.

BACKGROUND: Cholelithiasis has become a major health problem in Taiwan. The predominant type of gallstone found in Asian populations differs from that in the West, indicating possible differences in the etiology and risk factors for cholelithiasis. The aim of this study is to investigate the risk factors for cholelithiasis using data representative of the general population. METHODS: We performed a population-based, case-control study in which we analyzed medical data for 3725 patients newly diagnosed with cholelithiasis and 11175 gender- and age-matched controls with no history of cholelithiasis, using information obtained from the 2005 Registry for Beneficiaries of the National Health Insurance Research Database. Coexisting medical conditions were included in the analysis. Relative risks were estimated by adjusted odds ratio (OR) and 95% confidence interval (CI) using a multivariate logistic regression analysis. RESULTS: After controlling for the other covariates, multivariate logistic regression analysis identified the following as risk factors for cholelithiasis (in descending order of contribution): Among all patients - hepatitis C (OR = 2.78), cirrhosis (OR = 2.47), hepatitis B (OR = 2.00), obesity (OR = 1.89), and hyperlipidemia (OR = 1.54); Among women - hepatitis C (OR = 3.05), cirrhosis (OR = 1.92), obesity (OR = 1.91), menopause (OR = 1.61), hepatitis B (OR = 1.54), and hyperlipidemia (OR = 1.49). Diabetes mellitus appeared to have a marked influence on the development of cholelithiasis but was not identified as a significant independent risk factor for cholelithiasis. CONCLUSIONS: The risk factors for cholelithiasis were obesity, hyperlipidemia, hepatitis B infection, hepatitis C infection, and cirrhosis in both genders, and menopause in females. Despite differences in the predominate type of gallstone in Asian versus Western populations, we identified no unique risk factors among the population of Taiwan.

Ultra-miniature wireless temperature sensor for thermal medicine applications.

This study presents a prototype design of an ultra-miniature, wireless, battery-less, and implantable temperature-sensor, with applications to thermal medicine such as cryosurgery, hyperthermia, and thermal ablation. The design aims at a sensory device smaller than 1.5 mm in diameter and 3 mm in length, to enable minimally invasive deployment through a hypodermic needle. While the new device may be used for local temperature monitoring, simultaneous data collection from an array of such sensors can be used to reconstruct the 3D temperature field in the treated area, offering a unique capability in thermal medicine. The new sensory device consists of three major subsystems: a temperature-sensing core, a wireless data-communication unit, and a wireless power reception and management unit. Power is delivered wirelessly to the implant from an external source using an inductive link. To meet size requirements while enhancing reliability and minimizing cost, the implant is fully integrated in a regular foundry CMOS technology (0.15 µm in the current study), including the implant-side inductor of the power link. A temperature-sensing core that consists of a proportional-to-absolute-temperature (PTAT) circuit has been designed and characterized. It employs a microwatt chopper stabilized op-amp and dynamic element-matched current sources to achieve high absolute accuracy. A second order sigma-delta (Σ-Δ) analog-to-digital converter (ADC) is designed to convert the temperature reading to a digital code, which is transmitted by backscatter through the same antenna used for receiving power. A high-efficiency multi-stage differential CMOS rectifier has been designed to provide a DC supply to the sensing and communication subsystems. This paper focuses on the development of the all-CMOS temperature sensing core circuitry part of the device, and briefly reviews the wireless power delivery and communication subsystems.