• Journals

運用加護病房活動量表協助長期呼吸器病人復健運動訓練之成效

長期使用呼吸器的病人常常因呼吸肌肉無力，使脫離呼吸器更加困難，單位人員對於肢體復健的方式缺乏一致性作法，因此激發團隊找尋不同介入等措施來提升肌肉力量。文獻回顧時，採用系統性文獻分析及實證文獻評析方法，以PICO方式找尋出3篇文獻之可用方案，並於確立方案後，運用於臨床並評估其成效。本次研究亞急性呼吸照護病房共20位呼吸器病人參與，並以加護病房活動量表（IMS），評估病人活動能力及設定給予漸進式之復健運訓練。訓練期間採用跨團隊合作方式，由復健師、護理師與呼吸治療師及家屬共同參與。執行期間為一年（2021年5月1日至2022年4月30日）共20位使用呼吸器病人，進行復健運動訓練，頻率為一週五次，一天2次，一次30分鐘。結果有18位病人成功脫離呼吸器，平均運動時間16.3天，11位病人加護病房活動功能量表等級由1進步到3－4，呼吸器使用天數平均為21.3天。本研究經漸進式復健運動介入，對呼吸器使用病人之身體活動功能是有幫助。

• Journals

Differences on Perception of Evidence-based Medicine among Medical Students of Graduate Entry Programs vis-à-vis High School Leaver Entry Program

Objective: To understand and compare the differences on perceptions of evidence-based medicine (EBM) among high school leaver medical students and post-baccalaureate medical students for better EBM curriculum design and implementation. Methods: A cross sectional survey was undertaken in two groups of medical students recruited from 2 different entry pathways at Kaohsiung Medical University. Group 1: First-year medical students of the 4-year graduate entry program, and Group 2: Third-year medical students of the 6-year high school-leaver entry program. Questions with five-point Likert scale relating to different EBM aspects were asked during EBM course introduction, using an interactive response system. The results were analyzed and compared by chi-square test. Results: A total of 211 students responded to the questions, group 1: 58 (27.5%), group 2: 153 (72.5%), male: female = 78.7%: 21.3%. There were no statistical differences between groups on: a) Awareness of the importance of EBM in clinical practice, b) Understanding EBM principles, or c) Intention to search in EBM databases to solve clinical problems. Group 1 students were more familiar with some of the secondary EBM databases such as Cochrane Library and UpToDate than group 2, while more group 1 students responded correctly to questions regarding validity of clinical trials according to a scenario given. Conclusion: Self-perceptions of EBM were mostly similar among medical students from different entry pathways. Graduate entry medical students had a higher familiarity with some of the secondary EBM databases by self-perception and were able to judge validity correctly than high school-leaver medical students in our study population.

• Journals

Squamous Cell Carcinoma Arising from a Large Epidermal Cyst in left Submandibular Space: A Case Report

Epidermal cysts are common benign neoplasms in the head and neck region with rare malignant changes. We report a case of moderately differentiated squamous cell carcinoma adjacent to an epidermal cyst in the left submandibular space in a 56-yearold man. The tumor was initially diagnosed as a ruptured epidermal cyst after the first biopsy by the GS doctor but proved to be malignant after the second biopsy performed due to the progressive enlargement of the tumor with skin invasion. The patient was referred to the OMS department for further evaluation and surgical intervention. The final pathology report showed squamous cell carcinoma arising from the epidermal cyst.

• Journals

Intramuscular Hemangioma Presenting as a Painful Cheek Lump: A Case Report

Intramuscular cavernous hemangioma is a benign soft tissue tumor consisting of proliferations of blood vessels, which is rare over the head and neck region according to the literature. In this case, we described an unusual intramuscular cavernous hemangioma over the buccinator muscle.

• Journals

Spontaneous Unilateral Otorrhagia During Laparoscopic Anterior Resection: A Case Report and Literature Review

Spontaneous perioperative otorrhagia is rare in non-otolaryngologic surgeries. The majority of the reported cases were linked to a steep Trendelenburg position and pneumoperitoneum. All of them happened during emergence or at least 60 minutes after the operation began. We introduce the first case of unilateral otorrhagia linked to the laparoscopic assisted colorectal procedure, which occurred immediately after putting the patient in a steep Trendelenburg position with laparoscopic insufflation. To the best of our knowledge, this is also the first case in Asia.

• Journals

老年族群的低鈉血症：病例報告

鈉離子是人體內重要的電解質之一，負責維持人體水分平衡，並幫助神經肌肉運作。正常人體血鈉的數值範圍介於135－145 mmol/L。低鈉血症（hyponatremia）的定義是血清鈉離子濃度小於135 mmol/L（mEg/L）。老年人發生水分與電解質平衡問題的機會比年輕人大很多，特別是低鈉血症其原因是多重的，低血鈉也是住院病人當中常見的現象之一，而低鈉血症往往會造成住院中的病人提高其死亡風險。老年人本身較易罹患慢性疾病也是其中的一個原因之一，隨著年齡的增長，除了影響體內水分與電解質的調節能力之外，也降低這些生理適應機制對外來藥物、疾病或生理壓力的承受能力。低血鈉的症狀包含輕度的低血鈉，可能會完全沒有明顯症狀，中度低血鈉則可能有倦怠、噁心、頭痛、嗜睡等症狀；但如果血漿鈉離子濃度快速下降至120 mEq/L以下（稱之為嚴重低血鈉），則可能發生中樞神經系統損害，而使死亡率增加。低血鈉的治療一般有限水、給予生理食鹽水、或抗利尿激素拮抗劑等方式改善水分滯留的現象，當然找出低血鈉的原因並治療原發性疾病也是相當重要的事情。

• Journals

大腸憩室疾病文獻回顧

人體大腸負責吸收腸道中的水分，而隨著年紀的增加，大腸的腸壁逐漸變厚、容積減少，腸蠕動異常、或飲食中缺乏纖維、腸內壓力增加等，大腸內壁較脆弱的黏膜被擠壓到腸壁肌肉層外，形成凸出的囊袋稱為大腸憩室。根據研究超過60歲族群中約有50%有大腸憩室炎（diverticulosis）。當糞便掉入大腸憩室成為糞石會刺激周圍組織、引起腸道細菌感染，此時大腸會出現明顯發炎，稱為大腸憩室炎（diverticulitis）；臨床上僅約15－20%的大腸憩室症患者會出現大腸憩室炎。病人第一次感染通常不會有太嚴重的後遺症；不過若是反覆感染就可能發生大腸膿瘍或穿孔，會引發比較嚴重的出血與感染症狀，可能引起腹膜炎或全身性感染，此時有致命風險需要手術治療。而腹膜炎的主要表現是腹痛及發燒、畏寒，可能伴隨噁心、嘔吐、腹瀉或是便祕等輕微腸胃不適的症狀，嚴重者可能出現呼吸急促、寡尿、低血壓，甚至休克死亡；誘發腹膜炎的病因包括腹內臟器的急性穿孔與破裂例如：急性闌尾炎、消化性潰瘍、胃潰瘍等。