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Frequent attenders (FAs) have an impact on the medical resources and the quality of care. In Taiwan, the characteristics of FAs remain unclear in primary care. Outpatient data were screened from a central clinic within six surrounding fishing villages in northeastern Taiwan in 2017. FAs were defined as those who made &gt, 18 visits in one year, and those who made &le, 18 visits were defined as non-frequent attenders (NFAs). Data of FAs and NFAs were collected and compared. The major diagnoses were reported using International Classifications of Diseases, Tenth Edition (ICD-10) codes. A total of 1586 subjects and 9077 visits were enrolled, including 119 FAs and 1467 NFAs. FAs had a more advanced age compared to NFAs. Both FAs and NFAs had more visits in summer. FAs had consumed high prescriptions and related costs. FAs also had higher therapeutic and first visit costs than NFAs. Comparing with age- sex-matched NFAs, FAs were positively associated with musculoskeletal diseases (M00-M99), hematological diseases (D50-D89), endocrine diseases (E00-E90), and mental disorders (F00-F99). Large-scale local datasets and suitable definitions of FAs for Taiwanese subjects are needed.

Although aerosol delivery through mechanical ventilators has been used to administer various medications, little is known of administration with colistin. This in vitro evaluation aimed to evaluate size distribution of colistin delivery by different types of nebulizers and concentrations during mechanical ventilation. Colistin methanesulfonate (colistin) for injection was dissolved in 6 mL of distilled water to produce a low concentration (L, 156 mg) and a high concentration (H, 312 mg). A dose volume of 6 mL was placed in a vibrating mesh nebulizer (VMN) and a jet nebulizer (JN). The inhaled mass (mean &plusmn, SD) of the VMN-L (53.80 &plusmn, 14.79 mg) was greater than both the JN-L (19.82 &plusmn, 3.34 mg, P = 0.001) and JN-H (31.72 &plusmn, 4.48 mg, P = 0.017). The nebulization time of the VMN-L (42.35 &plusmn, 2.30 min) was two times longer than the JN-L (21.12 &plusmn, 0.8 min) or JN-H (21.65 &plusmn, 0.42 min, P &lt, 0.001). The mass median aerodynamic distal to the endotracheal tube was within a similar range at 2.03 to 2.26 &mu, m (P = 0.434), independent of neb or formulation concentration. In conclusion, the VMN-L yields greater inhaled mass than the JN with either concentration. Therefore, a standard nominal dose of colistin results in a higher delivered dose during mechanical ventilation with a VMN compared with a JN and may be considered the preferred device. If JN must be used, multiple doses of low concentration colistin may compensate for poor delivery performance.

Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan&ndash, Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p &lt, 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (&ge, 60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults.