Correlation Between Lipoprotein-Related Phospholipase A2 and Metabolic Syndrome.

Background: Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been recognized as a valuable biomarker for identifying the risk of cardiovascular diseases and inflammation. Furthermore, there is strong evidence to suggest that metabolic syndrome is closely associated with chronic inflammation. Accordingly, the present study endeavors to examine the potential correlation between metabolic syndrome and the levels of Lp-PLA2. Methods: To explore the relationship between Lp-PLA2 levels and metabolic syndrome, and to establish the predictive cut-off value of Lp-PLA2, a retrospective analysis was conducted using medical data from a sample of 3549 Chinese adults (comprising 2182 men and 1367 women) aged between 18 and 50 years, who had undergone health check-ups. In addition, the study also sought to investigate any potential differences in Lp-PLA2 levels based on sex and age. Results: The analysis of the data indicated that participants had a mean age of 44.2 years, a mean Lp-PLA2 level of 589 IU/L, and a metabolic syndrome prevalence of 22%. Lp-PLA2 levels were significantly different between males and females, and a significant correlation was observed between Lp-PLA2 levels and clinical and metabolic characteristics, including BMI, cholesterol, and triglycerides. Interestingly, Lp-PLA2 demonstrated potential as an indicator of metabolic syndrome, particularly in females, despite other biomarkers, such as TG/HDL-C and WHR, exhibiting better area under the curve. Conclusion: Our findings suggest that Lp-PLA2 may serve as a useful biomarker for identifying individuals at risk of developing metabolic syndrome, particularly in females. Further research is needed to explore the potential of Lp-PLA2 as a diagnostic and therapeutic target for metabolic syndrome.

Efficacy and Safety of 7-Day Non-Bismuth Concomitant Quadruple Therapy for First-Line Helicobacter pylori Eradication in the Elderly.

BACKGROUND: Aging may affect the efficacy of Helicobacter pylori eradication. The aim of our study was to assess the efficacy and safety of 7-day non-bismuth concomitant quadruple therapy as a first-line H. pylori infection eradication regimen in elderly individuals. METHODS: We retrospectively analyzed a cohort with prospectively collected data from January 2013 to December 2019 at Chang Gung Memorial Hospital in Kaohsiung. There were 408 naive infected subjects aged 20 years or older who were treated with 7 days of concomitant therapy as a first-line H. pylori eradication regimen. We divided the patients into an elderly group (aged ≥ 65 years) and a control group (aged < 65 years). Two patients were lost during follow-up in the elderly group and 29 patients were lost in the control group, resulting in 56 in the ≥ 65-year age group and 321 in the control group. The patients were asked to perform urea breath tests 8 weeks later. RESULTS: The eradication rates for the elderly and control groups were 93.1% (95% confidence interval (CI): 83.3-98.1) and 84.0% (95% CI 79.7-87.7) (p = 0.070), respectively, in the intention-to-treat analysis, and 96.4% (95% CI 87.6-99.6) and 91.6% (95% CI 88.0-94.4) (p = 0.210), respectively, in the per-protocol (PP) analysis. The adverse event rates were 8.9% in the elderly group and 12.8% in the control group (p = 0.417). The compliance was 100% in both groups. No significant difference was seen in antibiotic resistance in either group. Multivariate analysis revealed that metronidazole resistance (odds ratio (OR) 6.870, 95% CI 1.182-39.919, p = 0.032) and dual-therapy resistance (OR 7.188, 95% CI 1.326-38.952, p = 0.022) were independent factors for eradication failure. CONCLUSIONS: The efficacy of non-bismuth concomitant quadruple therapy in the elderly cohort was comparable with that in the non-elderly cohort for first-line H. pylori eradication with acceptable adverse effects.

Peptic Ulcer Disease Associated with Central Obesity.

This retrospective cross-sectional study aimed to evaluate associations between peptic ulcer disease (PUD), bone mineral density, and metabolic syndrome (MetS) and its components in healthy populations. Data were collected from the health examination database of a tertiary medical center in southern Taiwan from January 2015 to December 2016. Subjects who had undergone metabolic factors assessment, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scans were enrolled. In total, 5102 subjects were included, with mean age 52.4 ± 12.0 years. Among them, 1332 (26.1%) had PUD. Multivariate logistic regression analysis showed that age (OR 1.03, p < 0.001), male (OR 1.89, p < 0.001), diabetes (OR 1.23, p = 0.004), BMI (OR 1.03, p = 0.001), and GOT (OR 1, p = 0.003) are risk factors for PUD. Regarding MetS parameters, larger waist circumference (OR 1.26, p = 0.001) is associated with PUD, and high triglycerides (OR 1.20, 95% CI 1.01−1.43) is associated with gastric ulcer, while low HDL (OR 1.31, 95% CI 1.07−1.59) and osteoporosis (OR 1.44, 95% CI 1.08−1.91) are associated with duodenal ulcer. In conclusion, central obesity is associated with PUD in a middle-aged healthy population. Subjects with high triglycerides are prone to gastric ulcers, and those with osteoporosis and low HDL are prone to duodenal ulcers.

Factors Associated with Colorectal Polyps in Middle-Aged and Elderly Populations.

Colorectal polyps are the precursor lesions of most colorectal cancers. This study aimed to evaluate associations between bone mineral density (BMD), metabolic syndrome (MetS), and gastrointestinal diseases with colorectal polyps in middle-aged and elderly populations. A retrospective cross-sectional study was performed using data from the health examination database of a tertiary medical center in southern Taiwan in 2015. Subjects aged 50 years and older who had been assessed for metabolic factors and had undergone colonoscopy, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scan (DEXA) were included. Factors associated with colorectal polyps were evaluated using univariate and multivariate logistic regression. In total, 1515 subjects were included, with mean age 60.1 years. Among them, 710 (46.9%) had colorectal polyps. Multivariate logistic regression analysis showed that high fasting glucose (OR = 1.08, p = 0.001), high triglycerides (OR = 1.02, p = 0.008), high total cholesterol (OR = 1.004, p = 0.009), reflux esophagitis (OR = 1.44, p = 0.002), duodenal polyps (OR = 1.75, p = 0.026), gastric ulcer (OR = 1.38, p = 0.024), duodenal ulcers (OR = 1.45, p = 0.028), osteopenia (OR = 1.48, p = 0.001), and MetS (OR = 1.46, p < 0.001) were independently associated with colorectal polyps. In conclusion, hyperglycemia, hypercholesterolemia, hypertriglyceridemia, MetS, duodenal polyps, gastric and duodenal ulcers, reflux esophagitis, and low BMD are independent risk factors associated with colorectal polyps in the middle-aged and elderly Taiwanese population.

A Pilot Study of the Effects on an Inpatient Geriatric Consultation Team on Geriatric Syndrome Patients.

Purpose: To evaluate the effect of comprehensive geriatric assessment performed by an inpatient aging consultation team on older patients with geriatric syndromes. Methods: Fifty-nine patients with ≧65 years, Barthel Index score ≦60, at least one geriatric syndrome, and admitted to non-geriatric wards were enrolled. By their preference, 16 were in the intervention group with comprehensive geriatric assessment and instructions from the consultation team. And 43 were in the control group, receiving standard care from non-geriatric-specialist physicians. Outcomes were readmission and mortality within one year after discharge. Results: The mean age of the intervention and control groups was 78.35 (8.54) and 80.23 (6.36) years (p = 0.36), with female of 62.5% and 60.5%, respectively. Compared to control, intervention is not significantly associated with attenuated risk for readmission (adjusted hazard ratio (aHR): 0.256, 95% confidence interval (CI): 0.12-1.78, p = 0.256) and mortality (aHR: 2.13, 95% CI: 0.29-15.7, p = 0.457) within one year after discharge. Multivariate analysis showed that patients with a fall history ≧1 in the past one year had a lower risk of readmission (aHR: 0.28, 0.07-0.6, p = 0.004) or mortality (aHR: 0.11, 95% CI: 0.01-0.97, p = 0.047), and disability is associated with mortality (aHR: 5.37, 95% CI: 0.87-33.12, p = 0.07). Conclusion: Intervention is not significantly associated with outcomes in our pilot study. But fall history ≧1 in the recent one year is associated with a lower risk of readmission and mortality among all included patients. More participants and longer follow-up are needed for better elucidation.

Factors associated with hyperhomocysteinemia in relatively healthy Taiwanese adults: A retrospective medical record study.

ABSTRACT: Elevated homocysteine levels have been proposed as a risk factor for cardiovascular disease. The aim of this study was to evaluate factors associated with hyperhomocysteinemia in relatively healthy Taiwanese adults.A retrospective cross-sectional study was conducted using data from the health examination database in a medical center located in southern Taiwan. Hyperhomocysteinemia was defined as a plasma homocysteinemia level >15 µmol/L. Factors associated with hyperhomocysteinemia were evaluated using univariate and multiple stepwise logistic regression analyses.A total of 817 adults with a mean age of 55.5 years were included in the present study, and of them, 67 (8.2%) had hyperhomocysteinemia. Results from multiple logistic regression analysis showed that male sex (Odd ratio [OR] = 12.28, 95% CI = 2.94-51.27, P  = .001), advanced age (OR = 1.37 per 10 years, 95% CI = 1.06-1.77, P = .017), triglycerides (OR = 1.02 per 10 mg/dL, 95% CI = 1.01-1.04, P = .010), and uric acid (OR = 1.27, 95% CI = 1.09-1.49, P = .004) were significantly and independently associated with hyperhomocysteinemia.In this retrospective medical record study, male sex, advanced age, higher plasma level of triglyceride, and uric acid were significantly associated with hyperhomocysteinemia in relatively healthy Taiwanese adults.

Relationship between Helicobacter pylori infection and bone mineral density: a retrospective cross-sectional study.

BACKGROUND: Helicobacter pylori (H. pylori) infection can induce individual inflammatory and immune reactions which associated with extra-digestive disorders. Our aim is to investigate the association between H. pylori infection and bone mineral density. METHODS: This retrospective cross-sectional study was performed by using the data from the health examination database in a medical center of southern Taiwan in 2013. We investigated the relationship between sex, age, body mass index (BMI), waist circumstance, lipid profile, H. pylori infection, the findings of upper gastrointestinal endoscopy and bone mineral density (BMD). Because of nonrandomized assignment and strong confounding effect of age on BMD, the 1:1 propensity score match was applied for age adjustment. The simple and multiple stepwise logistic regression analysis were performed to assess the risk factors of decreased BMD in these well-balanced pairs of participants. RESULTS: Of the 867 subjects in final analysis with the mean age of 55.9 ± 11.3 years, 381 (43.9%) subjects had H. pylori infection, and 556 (64.1%) subjects had decreased BMD. In decreased BMD group, the portion of woman was higher than a normal BMD group (37.2% versus 29.6%, P = 0.023), the age was significantly older (59.4 ± 9.8 versus 49.8 ± 11.3, p < 0.001) and BMI was significantly lower (24.7 ± 3.5 versus 25.4 ± 3.7, p = 0.006) than the normal BMD group. The prevalence of H. pylori infection was 39.9% and 46.2% in the normal BMD group and the decreased BMD group respectively (P = 0.071). The multivariate analysis which was used for these possible risk factors showed that only advanced age (OR 1.09, 95% CI 1.08-1.11, P < 0.001), and low BMI (OR 0.91, 95% CI 0.87-0.95, P < 0.001) were independently significantly associated with decreased BMD in this nonrandomized study. In the propensity score-matched participants, the multiple stepwise logistic regression analysis revealed H. pylori infection (OR 1.62, 95% CI 1.12-2.35, P = 0.011) and low BMI (OR 0.92, 95% CI 0.87-0.97, P = 0.001) were independently significantly associated with decreased BMD. CONCLUSIONS: H. pylori infection and low BMI were independently significantly associated with decreased BMD in selected propensity score-matched populations after age adjustment.

Chronic kidney disease associated with decreased bone mineral density, uric acid and metabolic syndrome.

OBJECTIVE: The relationship between decreased bone mineral density (BMD) and chronic kidney disease (CKD) is controversial. The associations among metabolic syndrome (MetS), serum uric acid and CKD are also unclear. We aimed to investigate the relationship between decreased BMD, MetS, serum uric acid and CKD in a general population. METHODS: A total of 802 subjects who visited a medical center in Southern Taiwan and underwent a BMD measured by dual-energy X-ray absorptiometry (DEXA) during a health examination were enrolled in this retrospective cross-sectional study. Either osteopenia or osteoporosis was defined as decreased BMD. CKD was defined as the estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2. Simple and multivariate logistic regression analyses were used to investigate the association between variables, decreased BMD and CKD. RESULTS: Of the 802 subjects with a mean age of 54.4±10.2 years, the prevalence of decreased BMD was 62.9%, and CKD was 3.7%. Simple logistic analysis showed that sex (OR 3.50, 95% CI 1.21-10.12, p = 0.021), age (OR 1.14, 95% CI 1.07-1.21, p<0.001), BMI (OR 1.11, 95% CI 1.01-1.22, p = 0.028), waist circumference (OR 1.06, 95% CI 1.02-1.10, p = 0.002), SBP (OR 1.03, 95% CI 1.01-1.04, p = 0.003), DBP (OR 1.03, 95% CI 1.00-1.06, p = 0.030), HDL-C (OR 0.97, 95% CI 0.94-1.00, p = 0.026), uric acid (OR 1.84, 95% CI 1.49-2.27, p<0.001), metabolic syndrome (OR 2.68, 95% CI 1.29-5.67, p = 0.009), and decreased BMD (OR 3.998, 95% CI 1.38-11.57, p = 0.011) were significantly associated with CKD. Multivariate analysis showed that age (OR 1.05, 95% CI 1.03-1.07, p<0.001), decreased BMD (OR 0.64, 95% CI 0.45-0.91, p = 0.013), and uric acid (OR 1.40, 95% CI 1.24-1.59, p<0.001) were significantly independently associated with CKD. CONCLUSIONS: Decreased BMD, uric acid and MetS were significantly associated with CKD.. Further large and prospective cohort studies are necessary to investigate whether management of osteoporosis, hyperuricemia, or MetS might prevent the progression of CKD.

Association between metabolic syndrome and bone mineral density in a Taiwanese elderly population.

Previous studies have demonstrated uncertainty regarding the effect of metabolic syndrome (MetS) on bone. In the present work, we investigated the association between MetS, its components, and decreased bone mineral density (BMD) in a cross-sectional study of patients who underwent BMD measurement by dual-energy X-ray absorptiometry during a health examination. Decreased BMD was defined as either osteopenia or osteoporosis. MetS components and body mass index (BMI) were compared between individuals with normal and decreased BMD, and simple and multivariate logistic regression analyses were used to evaluate the association between the variables and decreased BMD in women and men. Among 1162 subjects in the study, the mean age was 59.9 ± 7.3 years, and 59.5% were men. The prevalence of MetS and osteoporosis was 34.2 and 19.6%, respectively. MetS was positively associated with BMD in men, while in women it was negatively associated with BMD. Regarding the relationship between MetS components and BMD, we found that in women, waist circumference (WC) and systolic and diastolic blood pressure were negatively associated with BMD, while high-density lipoprotein cholesterol (HDL-C) was positively associated. In men, WC and fasting glucose were positively associated with BMD, while HDL-C was negatively associated. We also found that an increase in the number of MetS components resulted in a significantly increased positive association with BMD, both before and after adjusting for age, in men but not in women, revealing a gender difference in the correlation between MetS components and BMD.

Homocysteine and C-reactive protein as useful surrogate markers for evaluating CKD risk in adults.

BACKGROUND/AIMS: This study aimed to evaluate the effectiveness of homocysteine and C-reactive protein (CRP) as potential markers for chronic kidney disease (CKD) in adults in Taiwan, and to identify associations between these factors and CKD, stratifying by gender. METHODS: This cross-sectional study analyzed multi-center data retrospectively. Data were collected from 22,043 adult Taiwanese at Chang-Gung Memorial Hospital from 2005 to 2011. Smoking/drinking history, personal medical/medication history, pregnancy, fasting times as well as laboratory parameters, including homocysteine and CRP were measured and analyzed. RESULTS: Significant differences were observed between four homocysteine and CRP quartiles in eGFR and CKD. For males, only one model showed significant associations between plasma homocysteine and CKD, while in females, all three models showed significant associations with CKD. On the contrary, the gender difference in the case of CRP was opposite. Combined homocysteine and CRP were associated with CKD in males but not in females. CONCLUSION: Among Taiwanese adults, plasma homocysteine is associated with CKD in females and plasma hsCRP is associated with CKD in males. High hsCRP/high homocysteine is associated with elevated CKD risk in male. Our results suggest that homocysteine and hsCRP may be useful surrogate markers for evaluating CKD risk in adults.

Erosive esophagitis associated with metabolic syndrome, impaired liver function, and dyslipidemia.

AIM: To investigate whether erosive esophagitis is correlated with metabolic syndrome and its components, abnormal liver function, and lipoprotein profiles. METHODS: We conducted a cross-sectional, case control study of subjects who underwent upper endoscopy during a health examination at the Health Management and Evaluation Center of a tertiary medical care facility located in Southern Taiwan. Metabolic syndrome components, body mass index (BMI), liver function, dyslipidemia, and cardiovascular risk factors, as defined by the ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C), and the ratio of low-density lipoprotein cholesterol to HDL-C were compared between individuals with and without erosive esophagitis. Risk factors for erosive esophagitis were evaluated by multivariate logistic regression. RESULTS: Erosive esophagitis was diagnosed in 507 of 5015 subjects who were individually age and sex matched to 507 esophagitis-free control subjects. In patients with erosive esophagitis, BMI, waist circumference, blood pressure, fasting plasma glucose, triglyceride levels, aspartate aminotransferase, alanine aminotransferase, the ratio of total cholesterol to HDL-C, and the ratio of low-density lipoprotein cholesterol to HDL-C were significantly higher and HDL-C was significantly lower compared to patients without erosive esophagitis (all P < 0.05). In a multivariate analysis, central obesity (OR = 1.38; 95%CI: 1.0-1.86), hypertension (OR = 1.35; 95%CI: 1.04-1.76), hypertriglyceridemia (OR = 1.34; 95%CI: 1.02-1.76), cardiovascular risk factors as defined by a ratio of total cholesterol to HDL-C > 5 (OR = 1.45; 95%CI: 1.06-1.97), and aspartate aminotransferase (OR = 1.59; 95%CI: 1.08-2.34) were significantly associated with erosive esophagitis. CONCLUSION: Metabolic syndrome, impaired liver function, and a higher ratio of total cholesterol to HDL-C were associated with erosive esophagitis.

Waist-to-height ratio, waist circumference, and body mass index as indices of cardiometabolic risk among 36,642 Taiwanese adults.

PURPOSE: We aimed to investigate the association of body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with cardiometabolic risk. METHODS: In this cross-sectional study, 21,038 men and 15,604 women who participated in a health check-up were included. RESULTS: In both men and women, the area under the curve (AUC) of WHtR was significantly greater than that of BMI or WC in the prediction of diabetes, hypertension, high total cholesterol, high triglycerides, and low HDL-cholesterol (P < 0.05 for all). The AUC for WHtR in the prediction of metabolic syndrome (MS) was also highest in the women (P < 0.05). After adjustment for potential confounders, the odds ratios and 95% confidence intervals for MS for each standard deviation increase in BMI, WHtR, and WC were 1.47 (1.46-1.49), 1.32 (1.31-1.33), and 1.19 (1.18-1.19), respectively. Finally, patients of either sex with a normal BMI or WC level, but with an elevated WHtR, had higher levels of various cardiometabolic risk factors in comparison with their normal BMI or WC, but low WHtR, counterparts (P < 0.05 for all). CONCLUSION: Among Taiwanese adults, a WHtR greater than 0.5 is a simple, yet effective indicator of centralized obesity and associated cardiometabolic risk, even among individuals deemed 'healthy' according to BMI and WC.

Impact of combined hospice care on terminal cancer patients.

BACKGROUND: Many patients with advanced cancer will develop physical and psychological symptoms related to their disease. These symptoms are infrequently treated by conventional care. Palliative care programs have been developed to fill this gap in care. However, there are limited beds in hospice units. To allow more terminal cancer patients to receive care from a hospice team, a combined hospice care system was recently developed in Taiwan. This study is a report of our experiences with this system. PATIENTS AND METHODS: From January to December 2009, terminal cancer patients who accepted consultation from a hospice team for combined hospice care were enrolled in the study. Demographic data, clinical symptoms, referring department, type of cancer, and outcome were analyzed. RESULTS: A total of 354 terminal cancer patients in acute wards were referred to a hospice consulting team. The mean patient age was 61 years, and the proportion of males was 63.28%. After combined hospice care, there was a significant improvement in the sign rate of do-not-resuscitate (DNR) orders from 41.53% to 71.47% (p < 0.0001), and awareness of disease prognosis from 46.05% to 57.69% (p = 0.0006). Combined hospice care also enabled 64.21% of terminal cancer patients who were not transferred to hospice ward to receive combined care by a hospice consulting team while in acute wards, thus increasing the hospice utilization of terminal cancer patients. The major symptoms presented by the patients were pain (58%), dyspnea (52%), constipation (45%), and fatigue (23%). CONCLUSIONS: Through the hospice consulting system, hospice combined care has a positive effect on the utilization of hospice care, rate of DNR signing and quality of end-of-life care for terminal cancer patients.

Differences between inpatient hospice care and in-hospital nonhospice care for cancer patients.

BACKGROUND: Decisions for the type of palliative care are affected by multiple factors. Currently, most patients die without palliative care, and hospice patients receive only a brief period of services before death. OBJECTIVE: This study aimed to compare palliative terminal cancer care in inpatient hospice and nonhospice care units in Taiwan for type of cancer, cost, stay, and selected demographic and clinical characteristics. METHODS: A retrospective study of terminally ill cancer patients hospitalized in a hospice unit (410 patients) or a general cancer ward (3005 patients) in a hospital in Taiwan was conducted. Patient demographic information, length of stay, cost of treatments, interventions and diagnostic testing, and types of cancer were analyzed. The factors associated with hospice care were revealed by multivariate stepwise regression. RESULTS: In the hospice group, the total cost was lower; there were more female, and more head, neck, and lung tumor patients. The most tumors in nonhospice group are hepatomas. The patients in hospice group received fewer interventions and had a long hospital stay (>14 days) before death; however, most of them were discharged from the hospital due to death. CONCLUSIONS: Utilization of hospice care varies by sex and type of cancer. Compared with the nonhospice service, hospice care needs a lower total cost and fewer interventions. IMPLICATIONS FOR PRACTICE: Hospice care in Taiwan should provide more services and facilities specific for sex (female) and tumors (head and neck).

Risk factors for seizures after first-time ischemic stroke by magnetic resonance imaging.

BACKGROUND: Seizures are important neurological complications of ischemic stroke. There is a need to further clarify the risk factors of seizures following ischemic stroke and predict those who will require treatment. METHODS: One hundred and forty-three (143) first-time ischemic stroke patients were enrolled in this one-year (2002) retrospective study. Prognostic variables were analyzed based on the Cox's proportional hazards model after a minimum follow-up period of six years. RESULTS: Seizures occurred in 13 first-time ischemic stroke patients, including acute symptomatic seizures in two (1.4%) and unprovoked seizures in 11 (7.7%). Only one progressed to status epilepticus during hospitalization. After six years of follow-up, the median (inter-quartile range) Glasgow Outcome Scale (GOS) was 3 (3,4) for patients with seizures and 4 (3,4) for those without seizures. Regarding seizure control after discharge in the 13 cases, 12 were seizure-free with or without anti-epileptic drugs and one had 1-3 seizures per year. Only the presence of cortical distribution of ischemic infarction (p=0.009, OR=5.549, 95% CI=1.53-20.19) was independently associated with seizures by the Cox's proportional hazards model. DISCUSSION: The incidence of seizures following first-time ischemic stroke is low and may have delayed manifestation. Cortical distribution of the ischemic infarction is a risk factors for seizures.

Candida peritonitis due to peptic ulcer perforation: incidence rate, risk factors, prognosis and susceptibility to fluconazole and amphotericin B.

Sixty-two cases of peritonitis due to peptic ulcer perforation were diagnosed between January 2000 and December 2000. Of these 62 cases, 23 isolates of Candida in 23 cases (CP) were cultured from peritoneal fluid. Cultures of peritoneal fluid of 10 (BP) of the remaining 39 cases was positive for bacteria only. Cultures of peritoneal fluid of the remaining 29 cases was negative. Comparison of CP, BP and culture-negative cases did not reveal any significant risk factor. Of the 23 Candida isolates, the Candida species and 48-h MICs of fluconazole and amphotericin B (mean, range ug/ml) were C. albicans 18 (0.688, 0.125-1.0; 0.297, 0.031-0.5), C. glabrata 3 (0.542, 0.125-1.0; 0.25, 0.125-0.5), C. tropicalis 1 (0.25; 0.5), C. intermedia 1 (1.0; 0.125) respectively. Mortality rates of CP, BP and culture-negative peritonitis due to infection were 5/23(21.7%), 0/10 and 1/29(3.4%) respectively. Without effective antifungal therapy, the mortality rate of CP was not low.

Evaluation of nurse-physician inter-observer agreement on triage categorization in the emergency department of a Taiwan medical center.

BACKGROUND: To examine nurse-physician inter-observer agreement on triage categorization and analyze their differences for future reference. METHODS: A retrospective observational study was performed. Patients entering a 3500-bed medical center emergency department (ED) from July 1 to 31, 1998 were randomly selected. We compared triage assignments made by nurses and 2 ED physicians, and examined them for inter-observer agreement (kappa-statistic) within each illness category. RESULTS: We found that the overall nurse-physician agreement on triage categorization had a kappa-value of 0.32 (99% confidence interval, 0.27-0.37). The level of inter-observer agreement was not consistent across all illness categories. Agreement was better when assigning critical patients, but it was poor when assigning non-emergency patients. CONCLUSION: The overall nurse-physician agreement with triage categorization was poor. The lack of agreement on triage decision making has important implications for EDs in which the priority of care is based on nursing triage categorization. Detailed chart recording and continued work is necessary to improve the agreement between nurse-physician triage categorization.