The quantified analysis of the correlation between medical humanities curriculums and medical students' performance.

BACKGROUND: A high-quality medical humanities (MH) education program is essential to developing a successful medical practitioner and can influence clinical performance. It is also vital to improve the evaluation of MH education to restore harmonious mutual relationships in medical care. However, studies have yet to discuss the correlation between the learning quality and quantity of medical humanities curriculums (MHC) and medical students' scores of clinical curriculums and clinical performance. The study aimed to assess the correlation between the learning quality and quantity of MHC and medical students' performance. METHODS: We conducted a retrospective cohort study by analyzing a dataset of students' learning records. After excluding students with missing demographic information (n = 1) and overseas Chinese students (n = 15), the study included six- and seven-year program medical school students (n = 354) at National Yang-Ming University who were admitted between 2012 and 2014. The correlation between learning quality and quantity in MHC and students' following performance was evaluated by multivariable-adjusted regression analyses. RESULTS: After adjusting for potential confounders (gender, residential area, age at enrollment, type of administration, and school program), the number of MHC with good learning outcomes was significantly correlated with clinical curriculum scores (p < 0.05), clerkship performance (p < 0.001), and weighted average mark (p < 0.001). CONCLUSIONS: Our study found a correlation between MHC with good learning outcomes and medical students' following performance. A future study of improving the quality of MH education is warranted.

The efficacy of pioglitazone for renal protection in diabetic kidney disease.

There is limited information on the efficacy of pioglitazone in diabetic kidney diseases (DKD). We evaluated whether pioglitazone exerts renal-protective effects in DKD patients. We designed a retrospective cohort study, which included 742 type 2 diabetes mellitus (T2DM) patients with DKD in Taiwan, with eGFR between 30 and 90 ml/min/1.73 m2 and UACR level 300-5000 mg/g. Patients not meeting the target range for HbA1c (above 7%) were given additional medication with pioglitazone (n = 111) or received standard care (non-pioglitazone group, n = 631). The primary endpoint was the occurrence of composite renal endpoints, which was defined as sustained eGFR<15 ml/min/1.73 m2 (confirmed by two measurements within 90 days); doubling of serum creatinine (compared to baseline); and the presence of hemodialysis or renal transplantation. The median follow-up duration was two years. At baseline, the mean HbA1C levels in the pioglitazone and non-pioglitazone groups were 8.8% and 8.1%, respectively; mean ages were 64.4 and 66.2 years old, respectively; diabetes durations were 14.3 and 12.3 years, respectively. Baseline eGFR showed no significant difference between the pioglitazone and non-pioglitazone groups (55.8 and 58.8 mL/min/1.73 m2, respectively). In terms of gender, 63% of patients were male in the pioglitazone group compared with 57% in the non-pioglitazone group. Pioglitazone use did not reduce the risk of composite renal endpoints in DKD patients (HR: 0.97, 95% CI = 0.53-1.77), including persistent eGFR<15 ml/min/1.73 m2 (HR = 1.07, 95% CI = 0.46-2.52), doubling of serum creatinine (HR = 0.97, 95% CI = 0.53-1.77), or ESRD (HR = 2.58, 95% CI = 0.29-23.04). The results were not changed after various adjustments. A non-significant albuminuria reduction was also noted after pioglitazone prescription in DKD patients. Further randomized controlled studies are needed to establish the effects of pioglitazone definitively.

Risk assessment and quality improvement of liquid waste management in Taiwan University chemical laboratories.

The policy of establishing new universities across Taiwan has led to an increase in the number of universities, and many schools have constructed new laboratories to meet students' academic needs. In recent years, there has been an increase in the number of laboratory accidents from the liquid waste in universities. Therefore, how to build a safety system for laboratory liquid waste disposal has become an important issue in the environmental protection, safety, and hygiene of all universities. This study identifies the risk factors of liquid waste disposal and presents an agenda for practices to laboratory managers. An expert questionnaire is adopted to probe into the risk priority procedures of liquid waste disposal; then, the fuzzy theory-based FMEA method and the traditional FMEA method are employed to analyze and improve the procedures for liquid waste disposal. According to the research results, the fuzzy FMEA method is the most effective, and the top 10 potential disabling factors are prioritized for improvement according to the risk priority number (RNP), including "Unclear classification", "Gathering liquid waste without a funnel or a drain pan", "Lack of a clearance and transport contract", "Liquid waste spill during delivery", "Spill over", "Decentralized storage", "Calculating weight in the wrong way", "Compatibility between the container material and the liquid waste", "Lack of dumping and disposal tools", and "Lack of a clear labels for liquid waste containers". After tracking improvements, the overall improvement rate rose to 60.2%.

Psychometric properties of the Chinese version of the attitudes towards cardiopulmonary resuscitation with defibrillation (ACPRD-C) among female hospital nurses in Taiwan.

INTRODUCTION: Nurses are often the first responders to in-hospital cardiac emergencies. A positive attitude towards cardiopulmonary resuscitation with defibrillation may contribute to early cardiopulmonary resuscitation and rapid defibrillation, which are associated with enhanced long-term survival. The aim of this study was to translate and adapt the 31-item attitudes towards cardiopulmonary resuscitation with defibrillation and the national resuscitation guidelines (ACPRD) instrument into Chinese and to evaluate its psychometric properties in a sample of Taiwanese hospital nurses. METHODS: The ACPRD instrument was translated into Chinese using professional translation services. Content validity index based on five experts to refine the translated instrument. The final instrument was applied to a sample of 290 female nurses, recruited from a regional hospital in southern Taiwan, to assess its internal consistency, factor structure, and discriminative validity. RESULTS: The Chinese ACPRD instrument showed good internal consistency (Cronbach's alpha=0.87). Seven factors emerged from the factor analysis. The instrument showed good discriminative validity and were able to differentiate the attitudes of nurses with more experience of defibrillation or cardiopulmonary resuscitation from those with less experience. Nurses working in emergency ward or intensive care unit also showed significantly higher overall scores compared to those working in other units. CONCLUSION: The Chinese ACPRD demonstrated adequate content validity, internal consistency, sensible factor structure, and good discriminative validity. Among Chinese-speaking nurses, it may be used as a tool for assessing the effectiveness of educational programs that aim to improve their confidence in performing cardiopulmonary resuscitation with defibrillation.

Risk management for outsourcing biomedical waste disposal - using the failure mode and effects analysis.

Using the failure mode and effects analysis, this study examined biomedical waste companies through risk assessment. Moreover, it evaluated the supervisors of biomedical waste units in hospitals, and factors relating to the outsourcing risk assessment of biomedical waste in hospitals by referring to waste disposal acts. An expert questionnaire survey was conducted on the personnel involved in waste disposal units in hospitals, in order to identify important factors relating to the outsourcing risk of biomedical waste in hospitals. This study calculated the risk priority number (RPN) and selected items with an RPN value higher than 80 for improvement. These items included "availability of freezing devices", "availability of containers for sharp items", "disposal frequency", "disposal volume", "disposal method", "vehicles meeting the regulations", and "declaration of three lists". This study also aimed to identify important selection factors of biomedical waste disposal companies by hospitals in terms of risk. These findings can serve as references for hospitals in the selection of outsourcing companies for biomedical waste disposal.

The use of failure mode and effects analysis to construct an effective disposal and prevention mechanism for infectious hospital waste.

In recent times, the quality of medical care has been continuously improving in medical institutions wherein patient-centred care has been emphasized. Failure mode and effects analysis (FMEA) has also been promoted as a method of basic risk management and as part of total quality management (TQM) for improving the quality of medical care and preventing mistakes. Therefore, a study was conducted using FMEA to evaluate the potential risk causes in the process of infectious medical waste disposal, devise standard procedures concerning the waste, and propose feasible plans for facilitating the detection of exceptional cases of infectious waste. The analysis revealed the following results regarding medical institutions: (a) FMEA can be used to identify the risk factors of infectious waste disposal. (b) During the infectious waste disposal process, six items were scored over 100 in the assessment of uncontrolled risks: erroneous discarding of infectious waste by patients and their families, erroneous discarding by nursing staff, erroneous discarding by medical staff, cleaning drivers pierced by sharp articles, cleaning staff pierced by sharp articles, and unmarked output units. Therefore, the study concluded that it was necessary to (1) provide education and training about waste classification to the medical staff, patients and their families, nursing staff, and cleaning staff; (2) clarify the signs of caution; and (3) evaluate the failure mode and strengthen the effects.

Optimal evaluation of infectious medical waste disposal companies using the fuzzy analytic hierarchy process.

Ever since Taiwan's National Health Insurance implemented the diagnosis-related groups payment system in January 2010, hospital income has declined. Therefore, to meet their medical waste disposal needs, hospitals seek suppliers that provide high-quality services at a low cost. The enactment of the Waste Disposal Act in 1974 had facilitated some improvement in the management of waste disposal. However, since the implementation of the National Health Insurance program, the amount of medical waste from disposable medical products has been increasing. Further, of all the hazardous waste types, the amount of infectious medical waste has increased at the fastest rate. This is because of the increase in the number of items considered as infectious waste by the Environmental Protection Administration. The present study used two important findings from previous studies to determine the critical evaluation criteria for selecting infectious medical waste disposal firms. It employed the fuzzy analytic hierarchy process to set the objective weights of the evaluation criteria and select the optimal infectious medical waste disposal firm through calculation and sorting. The aim was to propose a method of evaluation with which medical and health care institutions could objectively and systematically choose appropriate infectious medical waste disposal firms.

[Biomarkers in heart failure: BNP and NT-proBNP].

Used as biomarkers of heart failure (HF), BNP and NT-proBNP may be considered as the 'fatal finish line' for all cardiovascular disorders. The incidence of heart failure has increased steadily over the past several decades. High readmission rates for patients with acute decompensated heart failure have led to a search for biomarkers able to predict future clinical outcomes that would facilitate HF patient monitoring and help guide therapy. Molecular biomarkers play an important role in heart failure. From among several promising markers, the family of natriuretic peptides, especially B-type natriuretic peptide (BNP) and NT-proBNP, have been identified as potentially valuable diagnostic and prognostic tools. Not unexpectedly, BNP/NT-proBNP fails to fulfill all the criteria of an ideal biomarker. The development of additional biomarkers will be an important step toward improving diagnosis and treatment of patients with chronic and acute decompensated heart failure.

Psychometric evaluation of the Chinese version of the Minnesota Living with Heart Failure Questionnaire.

BACKGROUND: Health-related quality of life has emerged as an important outcome in treating and managing patients with heart failure (HF). However, there is no existing instrument for use in Chinese populations. OBJECTIVES: To translate the Minnesota Living With Heart Failure Questionnaire (MLHFQ) into a Chinese version and to validate it in the clinical setting. METHODS: This was a cross-sectional study. A convenience sample of 247 participants with New York Heart Association Class II to III chronic HF were recruited from a cardiovascular outpatient department in Taiwan. RESULTS: The content validity index was 0.98. Construct validity was supported by exploratory factor analysis, which showed three factors with 20 of 21 items loading above .50, explaining 71% of the variance. Total scale and subscale scores were correlated highly with the reference instruments, indicating satisfactory concurrent and convergent validity. The mean scores of the Chinese version of the MLHFQ were significantly higher among participants with HF than those from a non-HF comparison group. The instrument demonstrated high internal consistency (Cronbach's alpha of .95 for the scale and .93 to .95 for the subscales). CONCLUSION: The psychometric properties indicate that the Chinese version of the MLHFQ is a valid and reliable instrument for future research. This instrument provides a holistic approach for measuring health-related quality of life in New York Heart Association Class II and III HF patients.