Search

BACKGROUND As new variants keep emerging and threatening public health achievements, it is of great importance for governments to keep track of potential country-level pandemic indicators and traverse appropriate COVID-19 control remedies effectively and quickly. OBJECTIVE This study aims to compare COVID-19 average weekly infection fatality rate (AWIFR) and investigate factors associated with COVID-19 AWIFR over two periods of Delta and Omicron variants. Additionally, the study is to explore the factors linked to the increase in COVID-19 AWIFR between two periods of Delta and Omicron variants. METHODS We carried out an ecological study of 110 countries over the first twelve weeks during two periods of Delta and Omicron variant dominance, using publicly available databases. We calculated the AWIFR in aggregate data of twelve weeks in each period. Multivariable linear regression models were utilized to determine the factors associated with AWIFR and the increase in AWIFR between two periods. RESULTS The Omicron period was found to have a lower AWIFR than Delta period, although it exhibited greater rates of average weekly infection and average weekly fatality. During the Delta variant period, region, high government indicators, and proportion of the population fully vaccinated were significantly associated with a lower AWIFR, and high death rates caused by diabetes and kidney diseases were linked to higher AWIFR. During the Omicron variant period, countries with a high proportion of the population vaccinated with a booster dose had a significantly lower AWIFR, whereas the proportion of the population over 65, income levels, and years lived with disability (YLDs) caused by metabolic diseases were adversely linked with AWIFR. Over two periods of Delta and Omicron, we found a lower increase in AWIFR in countries with high levels of government effectiveness index and stringency index. In contrast, the countries with high death rates caused by diabetes and kidney, and the proportion of people aged over 65 were linked to a greater increase in AWIFR. CONCLUSIONS Our findings suggest that government needs to keep fostering the rates of vaccine coverage, enhancing coordination between the intensity and duration of non-pharmaceutical interventions, strengthening interventions for chronic diseases, and implementing more assessments on metabolic disorders to alleviate the COVID-19 outcomes.

Highlights • Taiwan implemented on-board quarantine measures COVID-19on a cruise ship for the first time. • Throat swabs were collected based on specific recent symptoms or travel histories among passengers and crew. • Passengers and crew with negative tests disembarked and took 14-day self-health management measures., To early detect and prevent coronavirus disease 2019 from spreading via international cruise ships, Taiwan Central Epidemic Command Center implemented on-board quarantine measures on a cruise ship at Port of Keelung, Taiwan, on February 8, 2020. Quarantine officers, medical professionals and administrative staff of competent authorities conducted fever screening, investigated present illness and travel history of 1,738 passengers and 776 crew members on the ship. Throat swabs were collected from 128 (5.1%) passengers and crew members with fever or respiratory symptoms in the past 14 days or travel history to China, Hong Kong or Macao within 30 days. All swabs tested negative for severe acute respiratory syndrome coronavirus 2 by the national reference laboratory. The whole process, from on-board preparation to completion of testing, took 9 hours. All passengers and crew were permitted to disembark and were required to take mandatory 14-day self-health management measures. No cases were reported by the end of self-health management period.

ObjectivesTo establish a training programme to cultivate trainee mediation skills through time investment, skill incorporation and formation of in-house mediation services.DesignA four-round consensus conference was conducted by a number of seasoned experts selected in the manner of purposive sampling to determine core competences and relevant curricula through the modified Delphi process.SettingResponses collected from enrolled experts through four rounds of the Delphi process from 11 November 2018 to 17 May 2019.ParticipantsOnboard seasoned mediators with different specialties.Outcome measuresItems with a median rating of 4 or more on a Likert scale of 1–7 points and 70% or more in agreement were identified as core competence and curricula.ResultsEleven enrolled experts reached the consensus about the training syllabus based on the 4-round agreement with four pillars of core competence, including ‘knowledge base of law’, ‘internalisation of the denotative and connotative meanings of care’, ‘effective, smooth and timely communication’ and ‘conflict resolution’. To grasp the dynamics and diversity of medical disputes on target, it is necessary to have sufficient knowledge and skills. We arrange our course in the order of teaching materials with pure didactics in the former two and with mixed contents comprising lectures and field exercises in the rest two.ConclusionsThe sample developed a syllabus to train apprentices to take intermediate responses to medical disputes through the skills of conflict resolution and establishment of effective communication to improve the relationship between patients/relatives and medical staff, as a result of eventually reducing the conversion rate from dispute into litigation or alternative pathway. Policy-makers in healthcare and top management in healthcare institutions can use this syllabus to guide their future education and training programme.

BackgroundThis study examined whether corneas from bacteremic donors could be used for corneal transplant.MethodsCorneas donated to the National Eye Bank of Taiwan between 1 January 2014 and 30 June 2017 were included in this study. All the corneas had corneoscleral rim cultures during the retrieval process and were hypothermic preserved in the Optisol-GS storage medium. A microbial work-up flow chart was used for the sterility check of all grafts. Bacteremic donors were defined as those whose last blood culture before corneal donation was positive. The microbial contamination rates, the endothelial cell densities, the tissue utility rates and early complications after transplants were compared between the corneas from bacteremic versus non-bacteremic donors.Results697 corneas from 356 donors were analysed, 70 of which were from bacteremic donors. The microbial contamination rates of the corneas from bacteremic and non-bacteremic donors (7.1% vs 9.1%)(p=0.30) were close. None of the contaminated corneas grew the same bacterial strains as those from their blood cultures. The corneas from bacteremic donors and non-bacteremic donors have similar endothelial cell densities (2931±297 cells/mm2 vs 2903 ± 470 cells/mm2) (p=0.63). Corneas from bacteremic and non-bacteremic donors shared a similar utility rate (98.6% vs 99.4%)(p=0.41). None of the corneas caused infectious complications after transplants.ConclusionOur study showed that corneas from bacteremic and non-bacteremic donors have equally low contamination rates and are of the same quality in terms of endothelial cell density and safety.

Background: In most of the world, corneas from hepatitis B surface antigen (HBsAg)-positive donors have been considered unsuitable for transplantation because of assumed risk of disease transmission. Methods: In Taiwan, an HBV endemic area, corneas from HBsAg-positive donors can be allocated to recipients who are seropositive for HBsAg or antibody against HBsAg (anti-HBs). Between January, 2015 and December, 2019, we evaluated HBV DNA in serum and corneo-scleral rims retrieved from HBsAg-positive and HBsAg-negative donors. We assessed donor serum HBsAg, anti-HBs, hepatitis B core antibody (anti-HBc) and HBV DNA to predict the presence of their corneo-scleral HBV DNA. We conducted a look-back study of recipients transplanted with corneo-scleral HBV DNA-positive donor grafts. Their HBV serological profiles were examined to identify possible post-transplantation hepatitis B transmission. Findings: Forty-five and 125 corneal grafts from 28 HBsAg-positive and 85 HBsAg-negative donors, respectively, were included. The donor corneo-scleral rim HBV DNA-positive rate was significantly greater in HBsAg-positive donor grafts (80·0%) compared to that of the HBsAg-negative grafts (6·4%, [ P

Long work hours among physicians is a worldwide issue in the healthcare arena. Previous studies have largely focused on the work hours of resident physicians rather than those of attending physicians. The purpose of this study was to investigate total work hours and the composition of those work hours for attending physicians across different hospital settings and across different medical specialties through a nationwide survey. This included examining differences in physician workload and its composition with respect to different hospital characteristics, and grouping medical specialties according to the work similarities. A cross-sectional self-reported nationwide survey was conducted from June to September of 2018, and the two questionnaires were distributed to all accredited hospitals in Taiwan. The number of physician work hours in different types of duty shifts were answered by medical specialty in each surveyed hospital. Each medical specialty in a hospital filled only one response for its attending physicians. The findings reveal that the average total work hours per week of an attending physician is around 69.1 h, but the total work hours and their composition of different duty shifts varied among hospital accreditation levels, geographic locations, emergency care responsibilities, and medical specialties. Because of the variance in the number and composition of attending physicians’ work hours, adjusting physician work hours to a reasonable level will be a major challenge for health authority and hospital managers.

Background Taiwan is geographically located in a zone that is vulnerable to earthquakes, typhoons, floods, and landslide hazards and has experienced various disasters. Six Regional Emergency Medical Operation Centers (REMOCs) are integrated and administered by the Ministry of Health and Welfare (MOHW) to be responsible for emergency situations during disastrous events, such as the emission of chemical toxicants, traffic accidents, industrial materials containment, and typhoons. Objective To analyze events reported by the six REMOCs during the 2014 to 2018 for the government policy reference. Methods Data were collected from injured and death toll reports provided by local designated hospitals in the emergency medical reporting system. Disaster events were categorized into three categories: natural disaster (NDs), disasters associated with technology (DTs), and disasters associated with security/violence/others (DSVOs). The three categories were further subdivided into sub-categories. Variables considered for trend analyses included the number of wounded and deaths, event characteristics, date/time, and triage. The frequency of disaster events among the six REMOCs was compared using the chi-square test. We used the global information system (GIS) to describe the distribution of events in Taiwan metropolitan cities. The α-level was set at 0.05. Results Of 580 events during the study period, the distribution of disaster characteristics in the jurisdictions of the six REMOCs were different. The majority of disaster events were DTs (64.5%), followed by NDs (24.5%) and DSVOs (11.0%). Events for the three disaster categories in the six REMOCs were different (χ2-test, p Conclusion Our data revealed that extreme weather precautions reported in the Taipei branch were increasing. Disaster characteristics were different in each metropolitan city. Upgrading the ability to respond to natural disasters is ineluctable.

The paper aims to introduce the current status of shared decision making (SDM) in Taiwan under its mixed health care system and single-payer health insurance system. With experiences in promoting both evidence based medicine and patient safety, the Joint Commission of Taiwan has implemented a nationwide SDM program under the aegis of the Ministry of Health and Welfare since 2016, incorporating multiple approaches such as developing patient decision aids (PDAs), executing the Medical Decision Aids Campaign, establishing a SDM platform, and integrating SDM in clinical practice. In this article, we share the positive and negative responses to the SDM program from hospitals, health care providers, and patients.

In Taiwan, migrants come mostly for marriage and work. Several researchers have conducted health-related studies of marital migrants and migrant workers, but the access of the two groups to healthcare has not been studied. Therefore, our study investigated the factors associated with migrants&rsquo, access to healthcare, with the main foci being marital migrants and migrant workers in Taiwan. A structured and cross-sectional questionnaire was anonymously self-administered by migrants recruited to participate in this survey on a voluntary basis from 11 medical centers and 11 migrant-helping associations in Taiwan between May 1st and September 21st, 2018. A total of 753 questionnaires were analyzed. The majority of marital migrants (n = 243) and migrant workers (n = 449) surveyed were enrolled in Taiwan&rsquo, s National Health Insurance system (92.7 vs. 93.5%, p = 0.68). More of the migrant workers (n = 205) than the marital migrants (n = 42) encountered language barriers while seeking medical services (48.0 vs. 17.1%, p &lt, 0.001). A professional interpreter at the point of care was considered important by more of the migrant workers (n = 316) than the marital migrants (n = 89) (70.2 vs. 39.6%, p &lt, 0.001). Although more than 90% of the surveyed migrants were enrolled in the health insurance system in Taiwan, many, especially among the migrant workers, still faced language barriers while seeking medical services.

Background/Purpose Epidemiology data of medical adverse events (MAEs) are crucial for patient safety policymaking. However, no epidemiological data on MAE exist in Taiwan. In this study, we aimed to investigate the incidence of MAEs at a major medical center in northern Taiwan. Methods The Harvard Medical Practice Study methodology was modified using a criterion-based screening algorithm and critical medical record review process to investigate the risks and incidences of MAEs. A Criterion-Based Screening for Medical Adverse Events (CBSMAE) checklist was developed, and a three-tier strategy was applied to screen and review 2007 inpatient hospitalizations from a single institution. Results A total of 2934 charts was sampled (Tier 1) and 950 possible MAEs were identified (Tier 2). One hundred and sixty-one probable MAE cases were subsequently critically reviewed (Tier 3). Nineteen (0.7%) MAE cases were confirmed. The MAEs involved 10 women and nine men (mean age, 70 years). Most MAEs were from the surgery department [11 (57.9%) patients]. The major admission diagnoses were cardiac diseases [7 (36.8%) patients] with a cardiac problem [13 (31.7%) patients] as the major comorbidity. Major MAE attributes were a staff technique problem [12 (46.2%) patients] and patients' underlying conditions (likelihood rating, 2.2). Eight (42.1%) patients required additional medical management, four (21.1%) patients had a disability, and five (26.3%) patients had in-hospital mortality. Night MAEs (47.4%) were considered preventable. Conclusion Surgical patients with cardiac conditions were at risk of MAE, particularly patients who received invasive procedures. The epidemiology information from this study can serve as baseline data to monitor a patient safety improvement campaign.

Objective: Strong earthquakes often cause massive structural and nonstructural damage, timely assessment of the catastrophe related massive casualty incidents (MCIs) for deploying rescue resource a...

Background To examine the association between health literacy, level of disease knowledge, and adherence behavior among patients with type 2 diabetes. Methods A cross-sectional survey study of 1059 Mandarin- and Taiwanese-speaking patients aged 20 years or older with type 2 diabetes was conducted. The demographic profiles of the sample strata were determined by analyzing the Taiwanese National Health Insurance Database. Participants were enrolled and completed questionnaires between April and November of 2015. The patients were assessed using a self-developed questionnaire with high internal consistency (KR-20 = .84). Results Construct validity was supported by Confirmatory Factor Analysis. Respondents scored lowest in diet-related knowledge. Health literacy and diabetes knowledge were significantly greater when patients cared for themselves with additional caretaker assistance. Patient age, gender, and educational attainment were associated with adherence behavior. Conclusion This study conducted a nation-wide survey of patients with diabetes and the results showed that respondents possessed fairly strong diabetes-specific health literacy and knowledge. However, health literacy shouldn’t be assessed as an isolated concept. Instead, it should be assessed in conjunction with adherence behavior.

Background/purpose The purpose of this study was to understand the overall conditions of dental teaching and training by dental departments in Taiwan's hospitals. Materials and methods In 2007–2008, a questionnaire survey (evaluation form) about dental teaching and training criteria was mailed to 165 hospital dental departments in Taiwan. After the questionnaires were mailed back, a field survey of dental departments of these hospitals was carried out. Each hospital was visited to check the answers to the questionnaire. The survey return rate was 62%. This research examined 28 criteria concerned with dental teaching and training, and the results were analyzed. Scores of the criteria in the questionnaire (evaluation form) were on a five-point scale, from high to low: A = totally achieved; B = above the average standard; C = the average standard; D = below the average standard; and E = not suitable. If an item was not applicable, then the respondent could choose NA. The percentages of A–E and NA were analyzed according to the location of the dental department (i.e., in a medical center, regional hospital, or district hospital), then for every respective criterion, and finally for the entire dataset. Results For overall dental teaching and training, 65% of medical centers received an A, 24% of regional hospitals received a C level, and 67% of district hospitals received NA. Dental departments that received above C were 98% of medical centers, 56% of regional hospitals, and 26% of district hospitals. Conclusion For overall dental teaching and training, our study showed medical centers were superior to regional hospitals, which were superior to district hospitals. Medical centers (98% above average standard) provided satisfactory teaching and training in their dental departments.

Objective The aim of this study is to create a national database to record incidents that endanger patient safety. We try to identify systemic problems in hospitals in order to avoid safety incidents in the future and improve the quality of healthcare. Method The Taiwan Patient Safety Reporting System employs a voluntary notification model. We define 13 types of patient safety incidents, and the reports of different types of incidents are recorded using common terminology. Statistical analysis is used to identify the incident type, time of occurrence, location, person who reported the incident, and possible reasons for frequently occurring incidents. Results There were 340 hospitals that joined this program from 2005 to 2010. Over 128,271 incident events were reported and analyzed. The three most common incidents were drug-related incidents, falls, and endo tube related incidents. By analyzing the time of occurrence of incidents, we found that drug-related incidents usually occurred between 8 and 10am. Falls and endo tube incidents usually occurred between 4 and 6am. The most common location was wards (57.6%), followed by intensive care areas (13.5%), and pharmacies (9.1%). Among hospital staff, nurses reported the highest number of incidents (68.9%), followed by pharmacists (14.5%) and administrative staff (5.5%). The number of incidents reported by doctors was much lower (1.2%). Most staff members who reported incidents had been working for less than five years (58.1%). Conclusion The unified reporting system was found to improve the recording and analysis of patient safety incidents. To encourage hospital staff to report incidents, hospitals need to be assisted in establishing an internal report and management system for safety incidents. Hospitals also need a protection mechanism to allow staff members to report incidents without the fear of punishment. By identifying the root causes of safety incidents and sharing the lessons learned across hospitals is the only way such incidents can be stopped from happening again.

In June 2015, nearly 500 concert attendees suffered injuries from smoke inhalation and severe burns following a color-dust explosion at a waterpark in Taiwan. We report on the progressions of the incident and government responses, share cross-departmental mobilization and case management lessons, and reflect on clinical and complex policy issues emerged. The timely and coordinated emergency responses, a high-quality universal health care system, and dedicated clinicians voluntarily working overtime resulted in an unprecedented 2.4% mortality rate (international statistics predicted 26.8%).

Objective. In 2004, the Taiwan Department of Health set the national patient safety goals. To date, however, there has been no evaluation of these goals. This study aimed to develop a method to evaluate the status of the national patient safety goals in Taiwan. Design. A cross-sectional questionnaire surveys to measure achievements on Taiwan’s national patient safety goals. This survey was also followed up with an onsite audit to ensure accuracy. Setting. All hospitals in Taiwan. Participants. A total of 361 hospitals in Taiwan respond to questionnaire survey and 80 randomly selected hospitals for onsite audit. Intervention(s). None. Main Outcome Measure(s). Average scores on achievements of the national patient safety goals. Results. Among the 516 hospitals to which the questionnaire was sent, 361 (70%) responded. A total of 80 hospitals were randomly selected according to geographic location and size for onsite audit. The results show that the longer the period of implementation, the higher the average scores on achievements of the goals. After stratified analysis by hospital size, the large hospitals were found to have a higher average score in every goal, especially in the new goals. Furthermore, in terms of the difference between self-report results and the onsite audit, the score in the self-report was higher than the score given by experts upon onsite audit; however, they were similar. Most items were approximately the same in the self-report score and the onsite judgment, and those that differed were merely either one rank higher or lower. Conclusion. The self-report questionnaire combined with an onsite audit appears to be a promising approach for measuring scores on achievements of the national patient safety goals. The Department of Health could conduct this program annually to evaluate the progress and propose coping strategies.

Objective The aim of this study was to evaluate the factors related to outcome regarding in–intensive care unit (ICU) cardiac arrest (IICA) in a university hospital. Patients and Methods Adult nontraumatic ICU patients who sustained IICA were prospectively enrolled. Several patient and event-related variables, as well as outcomes, were recorded and summarized based on the revised Utstein-style template. Results A total of 202 episodes of IICA happened during the study period. Return of spontaneous circulation (ROSC) was achieved in 127 patients (62.9%), whereas the overall survival-to-discharge rate was 15.3% (31 patients). In univariate analysis, a shorter duration of resuscitation and pulseless ventricular tachycardia/ventricular fibrillation (VT/VF) as initial arrest rhythm represented better outcomes. Independent predictors of survival to hospital discharge were VT/VF as the initial rhythm (odds ratio [OR], 3.81; 95% confidence interval [CI], 1.50-9.67; P = .005), lower Acute Physiology and Chronic Health Evaluation II score (OR 0.92, 95% CI 0.87-0.98, P = .008), and shorter resuscitation durations (OR 0.91, 95% CI 0.87-0.96, P Conclusion Shorter resuscitation duration and initial VT/VF are predictors for both ROSC and hospital survival, whereas lower Acute Physiology and Chronic Health Evaluation II scores predict the latter.

To evaluate the effects of change of ambient temperature on emergency department (ED) patient visits.This prospective observational study was conducted in the ED of National Taiwan University Hospital from January 2002 to January 2007. The daily ED patient numbers of different triage levels in different service specialties were collected and correlated with the daily average temperature (T) and change in temperature (deltaT) compared with the previous day. A univariate analysis was performed with the Pearson correlation and a multivariate analysis with multiple linear regression analysis.A total of 505,224 patient visits were included in this study. On univariate analysis, there was no significant correlation between T and the ED volume (r = 0.012, p = 0.608), but there was a significant correlation between deltaT and ED volume (r = 0.109, p0.001). On multivariate analysis, deltaT and holidays were identified as independent predictors of ED volume. We established the following formula in predicting the ED patient number: y = 265.42 + (0.06 x T) + (2.57 x deltaT) + (59.77 x holiday). There was a positive association between T and the trauma patient number, while there was a negative association between T and medical and paediatric patient numbers. On the triage level, a low T was associated with increased patient triage level, while no significant association was noted between deltaT and the proportion in any triage level.Our study demonstrated that ambient temperature had differential effects on ED patient visits of different specialties and severities.

The design, MEMS fabrication and characterization of the ZnO pyroelectric sensor for improvement of responsivity are presented. Three groups of the sensor with various layer thickness, effective area, partially and fully covered electrode (FCE) were fabricated and investigated. The partially covered electrode (PCE) covers 50–65% area of the exposed surface for incident energy absorption. The un-covered ZnO will directly receive the incident laser energy and improve the absorption efficiency of the sensor. The measured data show that the partial-electroded sensors exhibits at least 4 times higher responsivity in the frequency range of 10–1000 Hz than the full-electroded sensors. The effects of other design parameters such as thickness of ZnO, SiO 2 and Si 3 N 4 on the responsivity are also discussed.

Introduction:Disaster is a collective responsibility requiring coordinated response from all parts of society. This theme focused on coordination and management issues in a diverse range of scenarios.Methods:Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Although the main points developed in Themes 1 and 4 were different from each other (as reported in the Results section), their implementation was similar. Therefore, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates.Results:The main points developed during the presentations and discussions included: (1) the need for evidence-based assessments and planning, (2) the need for a shift in focus to health-sector readiness, (3) empowerment of survivors, (4) provision of relief for the caregivers, (5) address the incentives and disincentives to attain readiness, (6) engage in joint preparation, response, and training, (7) focus on prevention and mitigation of the damage from events, and (8) improve media relations. There exists a need for institutionalization of processes for learning from experiences obtained from disasters.Discussion:Action plans presented include: (1) creation of an Information and Data Clearinghouse on Disaster Management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) act on lessons learned from evidence-based research and practical experience.Conclusions:There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.

Taiwan's worst hospital fire in history on October 23rd, 2012 at Sinying Hospital's Bei-Men Branch resulted in 13 elderly patient deaths and over 70 injuries. The heavy casualties were due in part to the serious condition of patients. Some patients on life-support machines were unable to move or be moved. This disaster highlights the issue of fire safety in small-scale hospitals that have transformed existing hospital space into special care environments for elderly patients. Compared with medical centers and general hospitals, these small-scale health facilities are ill equipped to deal properly with fire safety management and emergency response issues due to inadequate fire protection facilities, fire safety equipment, and human resources. Small-scale facilities that offer health care and medical services to mostly immobile patients face fire risks that differ significantly from general health care facilities. This paper focuses on fire risks in small-scale facilities and suggests a strategy for fire prevention and emergency response procedures, including countermeasures for fire risk assessment, management, and emergency response, in order to improve fire safety at these institutions in Taiwan.署立新營醫院北門分院火災看我國醫院照護環境防火安全適逢日本311大地震暨海嘯發生滿週年，正當大家在為上萬個罹難者哀悼的同時，令人隱憂的是天災過後倖存者所產生的創傷後壓力症候群才是另一項困難且急迫需要重建的工作。對患者及其家人而言不僅是漫長的煎熬，對社會及醫療更是免不了的重擔。本文嘗試整理過去對創傷後壓力症候群的實證照護，瞭解護理照護在創傷後壓力症候群的具體範疇為何，並萃取「以家庭為中心照護」的功能及成效，期望護理專業能將觸角伸入，運用家庭的支持功能提升創傷後壓力症候群者的復原力，讓護理角色的發揮不僅提供了創傷後壓力症候群照護的另一個機會，也給了這類患者重生的另一線契機。

Since the IOM's report "To err is human" in 1999, patient safety has become an important issue internationally. Many countries have established reporting systems for patient safety. Department of Health, Executive Yuan, ROC (Taiwan) introduced a nationwide reporting system, "Taiwan Patient-safety Reporting system (TPR)" in December 2003. This study analyzes the 4-year data (2005-2008) of medication events from TPR.

Summary Purpose of the study The Web-Based Registry System on In-hospital Resuscitation (WRSIR) is the first prospective, web-based, multi-site, and Utstein-based reporting system in Taiwan. This study was conducted to evaluate the feasibility of the system in one of the participating hospitals and identify prognostic factors associated with survival. Material and methods The WRSIR is an on-line registry system coded with the active server page (ASP) programming method. Information was gathered and entered on-line by trained staff using spreadsheets that could be automatically created according to the updated Utstein in-hospital template. Through the implementation of the system, in a tertiary teaching hospital we evaluated all adults with in-hospital cardiac arrest receiving cardiopulmonary resuscitation between 1 October 2004 and 30 September 2005. The main outcome measures were return of spontaneous circulation (ROSC), survival to hospital discharge, and cerebral performance category score at the time of discharge. Logistic regression analysis was performed to determine independent predictors of survival. Results A total of 330 cases experienced in-hospital resuscitation. ROSC occurred in 233 cases (71%) and 61 patients (18%) survived to hospital discharge. Thirty-five patients (58%) had a good neurological outcome with the cerebral performance category (CPC) score of 1 or 2 among survivors. The major predictor of ROSC was initial rhythm of VT/VF (adjusted OR 0.36, 95% CI 0.16–0.78). Conclusion This study examined the feasibility of a web-based registry system on in-hospital resuscitation using the Utstein style in an oriental country. It provides a comprehensive and standardised method for on-line registry of data collection, allowing individual hospitals to track each case for quality improvement. A further nationwide registry will enforce the possibility of data analysis and future perspective research of in-hospital resuscitation.

Life is priceless, so pre-hospital evaluation and management is important in emergency medical service. To enhance the quality of emergency medical service, the mobile hospital emergency medical system (MHMES) is designed to provide for e-prepared services. This system could improve the communication among the ambulance, the dispatch and mission control center and the emergency department of the hospital via a wireless network, and provide comprehensive service during pre-hospital resuscitation and transportation of the patients. The MHMES consists of three sub-systems located in three sites respectively, dispatch and mission control center, emergency department of hospital and ambulance. It includes electrical map to track the ambulances and transfer patients situation and histories with the hospital to follow the symptom. Therefore, this system would be able to reduce the mortality during transportation and enhance the safety and quality of emergency medical service. It structures an emergency informatics system of National Taiwan University Hospital to provide a application of wireless network in a medical emergency service network.