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BackgroundFrontline health care workers, including physicians, are at high risk of contracting coronavirus disease (COVID-19) owing to their exposure to patients suspected of having COVID-19. ObjectiveThe aim of this study was to evaluate the benefits and feasibility of a double triage and telemedicine protocol in improving infection control in the emergency department (ED). MethodsIn this retrospective study, we recruited patients aged ≥20 years referred to the ED of the National Taiwan University Hospital between March 1 and April 30, 2020. A double triage and telemedicine protocol was developed to triage suggested COVID-19 cases and minimize health workers’ exposure to this disease. We categorized patients attending video interviews into a telemedicine group and patients experiencing face-to-face interviews into a conventional group. A questionnaire was used to assess how patients perceived the quality of the interviews and their communication with physicians as well as perceptions of stress, discrimination, and privacy. Each question was evaluated using a 5-point Likert scale. Physicians’ total exposure time and total evaluation time were treated as primary outcomes, and the mean scores of the questions were treated as secondary outcomes. ResultsThe final sample included 198 patients, including 93 cases (47.0%) in the telemedicine group and 105 cases (53.0%) in the conventional group. The total exposure time in the telemedicine group was significantly shorter than that in the conventional group (4.7 minutes vs 8.9 minutes, P

Background: To estimate the burden of invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia, and acute otitis media before and after inclusion of the 13-valent pneumococcal vaccine (PCV13) into Taiwan's Childhood Immunization Program in 2015. Methods: Episodes of eligible children aged < 18 years hospitalized with invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia, or acute otitis media between 1 January 2011 and 31 December 2019 were identified from the National Health Insurance Research Database. Annual hospitalized incidence rate, case fatality rate, and healthcare resource utilization and costs were estimated. Incidence time trends were assessed with interrupted time series analyses. Results: 1,284 invasive pneumococcal disease episodes, 25,074 non-bacteremic pneumococcal pneumonia episodes, and 23,139 acute otitis media episodes were identified. The overall annual incidence rates of invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia, and acute otitis media were 3.31, 64.61, and 59.62 episodes per 100,000 person-years, respectively. Interrupted time series analyses results showed a significantly lower baseline incidence rate (incidence rate ratio [IRR]:0.58, p-value = 0.001) for invasive pneumococcal disease, and significantly higher baseline incidence rate (IRR:1.17, p-value < 0.001) for non-bacteremic pneumococcal pneumonia in the post-PCV13 period. Baseline incidence rates between the two periods were comparable for acute otitis media. A significant increase in trend of incidence rate was observed for all three diseases. Case fatality rate was 1.79%, 0.09%, and 0.00% for invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia, and acute otitis media, respectively. Median length of hospitalization per inpatient visit was comparable between the two periods for invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia, but significantly shorter in the post-PCV13 period for acute otitis media. In the post-PCV13 period, average total costs per episode was lower for invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia, but higher for acute otitis media. Conclusions: Residual clinical and economic burden of pneumococcal diseases remained substantial after PCV13 inclusion into Taiwan's Childhood Immunization Program. To further reduce the disease burden among children, additional research to investigate the cause of increasing trends of hospitalized invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia and acute otitis media in the post-PCV13 era will be required. [ABSTRACT FROM AUTHOR]

Polychlorinated diphenyl ethers (PCDEs), persistent environmental pollutants, are found in flue gas from incinerators. While air pollution control systems (APCSs) capture pollutants, the resulting sludge/fly ash (SFA) requires further treatment due to residual PCDEs and other harmful substances. This study investigated a hazardous waste thermal treatment system (HAWTTS) utilizing flameless combustion technology alongside a multistage APCS (scrubbers, cyclone demisters, bag houses). SFA from the APCS was recirculated for secondary combustion. PCDE levels were measured before and after each unit within the HAWTTS. The HAWTTS achieved a remarkable overall PCDE removal efficiency of 99%. However, the incinerator alone was less effective for low-chlorine PCDEs. Scrubbers and bag houses exhibited lower removal efficiencies (17.8% and 30.9%, respectively) due to the memory effect. Conversely, the cyclone demister achieved a high removal rate (98.2%). Following complete APCS treatment, PCDE emissions were significantly reduced to 1.02 ng/Nm3. While SFA still contained some PCDEs, the flameless combustion's uniform temperature distribution enhanced combustion efficiency, minimizing overall PCDE emissions. This system demonstrates significant potential for mitigating PCDE pollution from incinerators. Further research could focus on optimizing treatment processes to address residual PCDEs in SFA. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 frontline nurses' stress‐reduction programme by the cooperation of manager with the nurses is not‐well developed. Aim: This study aimed to examine the effect of an emergency nurse‐led stress‐reduction project on reducing stress levels during the COVID‐19 pandemic. Methods: The action research was conducted using online and person‐to‐person group brainstorming strategies. The online survey was used to evaluate emergency nurses' stress levels, causes of stress and needs at the 50th, 80th and 110th days of the pandemic from March to May 2020. Results: The numbers of nurses participating in three‐time survey were 160, 166 and 160, respectively. There was a decrease in the nurses' work‐related stress after implementing the improvement strategies. Stress from personal protective equipment (PPE), information about infection control and family's worry about being infected reduced across 2 months. Needs regarding PPE, COVID‐19 information and a forum for sharing experiences of COVID‐19 care decreased whereas needs of allowing more days off increased. Conclusions: The stress‐reduction project targeting at nurses' views of their needs can reduce their stress during the COVID‐19 pandemic. Implications for Nursing Management: The online and person‐to‐person group brainstorming building a good partnership between nurses and managers can be an effective nursing management. [ABSTRACT FROM AUTHOR]