Kaohsiung J Med Sci
-
Kaohsiung J Med Sci · Jan 2013
Expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 in recurrent chronic rhinosinusitis with nasal polyposis.
Matrix metalloproteinase (MMP) is involved in the upper airway remodeling process. We hypothesized that MMP had an additive effect on the formation of recurrent nasal polyp. We also investigated the association between the functional promoter polymorphism of MMPs and the intensity of labeling index. ⋯ Genetic polymorphism of MMP-2 and MMP-9 functional promoters was not associated with the intensity of labeling index. These results suggested that up-regulation of MMP-9 in gland and MMP-2 in surface epithelium was characteristic of both recurrent and nonrecurrent nasal polyps. Pathogenesis of recurrent nasal polyps may involve a mechanism other than MMP.
-
Kaohsiung J Med Sci · Jan 2013
Outcomes of the patients in the respiratory care center are not associated with the seniority of the caring resident.
Although many studies show that the experience level of physicians is significantly associated with the outcomes of their patients, little evidence exists to show whether junior residents provide worse care than senior residents. This study was conducted to analyze whether the experience level of residents may affect the outcomes of patients cared for in a well-organized setting. We conducted a 7-year retrospective study utilizing statistical data from a respiratory care center (RCC) in a medical center between October 2004 and September 2011. ⋯ Although the weaning rate in the RCC gradually improved over time (p < 0.001), there was no significant difference in the monthly weaning rate between the groups after adjusting for time and disease severity (p > 0.7). Thus, we concluded that in a well-organized setting, the levels (experiences) of residents did not significantly affect patient outcomes. This result may be attributed to the well-developed weaning protocol and teamwork processes in place, which avoid a large effect from any single factor and provide stable and high-quality care to the patients.
-
Kaohsiung J Med Sci · Oct 2012
Correlation between the ossification of nuchal ligament and clinical cervical disorders.
This is a correlation analysis between severity of the ossification of the nuchal ligament (ONL) and clinical cervical disorders including neck dysfunction, cervical malalignment, and morphologic changes of the cervical neural foramen (CNF). The clinical effects of ONL on active range of motion (AROM) of neck, cervical radiculopathy, abnormal cervical curvature, and the degree of CNF stenosis in patients with painful neck stiffness are investigated. Studies have investigated the predisposing factors to cervical dysfunction and degenerative disorders; however, few studies have examined the influence of the ONL on neck function and cervical spine. ⋯ Most patients had moderate loss of cervical lordotic curve despite there being no significant correlation between ONL CSA and cervical curvature. Moreover, CNF stenosis ratio significantly negatively correlated with ONL CSA. Patients with larger ONL had more severe cervical radiculopathy, more stiffness in flexion-extension direction, more complex degenerative change of spine, and worse CNF stenosis.
-
Kaohsiung J Med Sci · Sep 2012
Prescriptions for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and monitoring of serum creatinine and potassium in patients with chronic kidney disease.
Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are commonly used in patients with chronic kidney disease (CKD). We studied the status of ACEI/ARB prescriptions and serum creatinine (Scr) and potassium monitoring in CKD patients. A retrospective observational study was conducted on patients who had at least two sets of Scr data at outpatient visit. ⋯ Renal function status was the independent factor for monitoring of Scr and potassium. In conclusion, prescription of ACEIs/ARBs was common in all stages of CKD. Most patients underwent Scr monitoring, but potassium monitoring was less frequent, and this should be improved in clinical practice.
-
Kaohsiung J Med Sci · Aug 2012
A comparison of Trachway intubating stylet and Airway Scope for tracheal intubation by novice operators: a manikin study.
The Trachway is a recently developed intubation device that resembles an illuminating stylet and incorporates a video-assisted system. This study evaluated the use of this system for tracheal intubation by novice operators. This randomized cross-over study compared the Trachway and the Airway Scope in simulated routine and difficult intubation scenarios. ⋯ The overall success rates of the Trachway and Airway Scope (96.3% and 98.6%, respectively) did not differ significantly (p = 0.13). Preference for the Airway Scope was greater in both scenarios, and particularly in the difficult airway scenario (p < 0.001). Although the devices are comparable in terms of ease of use and intubation time in normal scenarios, the ease of using the Airway Scope makes it more suitable for inexperienced operators in difficult intubation scenarios.