Applying the Modified Delphi Method to Identify the Taiwanese Electronic Health Record Systems Evaluation Framework and Instrument

The aim of this research is to design an appropriate conceptual evaluation framework with a draft instrument for validating the structure of the Taiwanese EHR systems evaluation framework. According to the knowledge of “Triangulation research method” and both quantitative and qualitative approaches, the modified Delphi method was applied to refine the proposed instrument into practicable for real medical environment based on a quantitative approach. In addition, by calculating content validity index for items (I-CVI) and content validity index for scales (S-CVI), it also indicates the degree of consensus between and within questions in the proposed instrument. In short, an appropriate instrument for achieving its target was generated in this research

C-reactive protein concentration as a significant correlate for metabolic syndrome: a Chinese population-based study. Endocrine 43

Abstract Increasing evidence suggests that chronic, lowgrade inflammation may be a common soil involving the pathogenesis of metabolic syndrome (MetS) and cardiovascular disease. We examined the association between C-reactive protein (CRP) concentration, an extensively studied biomarker of low-grade inflammation, and the MetS in a representative sample of Chinese adults in Taiwan. We performed a cross-sectional analysis of data from 4234 subjects [mean (±SD) age, 47.1 (±18.2) years; 46.4 % males] who participated in a population-based survey on prevalences of hypertension, hyperglycemia, and hyperlipidemia in Taiwan. CRP levels were measured by the immunoturbidimetric CRP-latex high-sensitivity assay. The MetS was defined by an unified criteria set by several major organizations. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated with logistic regression model. Overall, there were 938 subjects with MetS among 4,234 participants, resulting in a prevalence rate of 22.1 %. A significantly progressive increase in the prevalence of MetS across quartiles of CRP was observed (p for trend \0.001). Participants in the second, third, and upper quartiles of CRP had significantly higher risk of having MetS when compared with those in the lowest quartile [adjusted ORs (95 % CIs) were 2.18 (1.62-2.94), 4.39 (3.31-5.81), and 7.11 (5.39-9.38), respectively; p for trend \0.001]. Furthermore, there was a strong stepwise increase in CRP levels as the number of components of the MetS increased. The prevalence of MetS showed a graded increase according to CRP concentrations. The possible utility of CRP concentration as a marker for MetS risk awaits further evaluation in prospective studies

Identifying the Taiwanese electronic health record systems evaluation framework and instrument by implementing the modified Delphi method

The aim of this research is to design an apporpriate conceptual evaluation framework with a draft instrument to validate the structure of the Taiwanese EHR systems evaluation framework. The modified Delphi method was applied to refine the proposed instrument for practicality in real medical environment. The degree of consensus between and within questions in the proposed instrument by calculating both content validity index for items (I-CVI) and content validity index for scales (S-CVI) were presented inthis chapter. An appropriate instrument for achieving its research purpose was achieved in this research

Endosonography for suspected obstructive jaundice with no definite pathology on ultrasonography

Ultrasonography (US) cannot demonstrate all the etiologies of biliary tract dilatation in patients with jaundice. Thus, we evaluated the etiologic yield of endosonography (EUS) for suspected obstructive jaundice when no definite pathology was found on US. Additionally, we sought to identify the predictors of the most common etiologies. Methods: We performed a retrospective review of 123 consecutive patients who had undergone EUS for suspected obstructive jaundice when no definite pathology was identified on US. Results: The most common diagnoses included no pathological obstruction (n = 43), pancreatobiliary malignancy (n = 41), and choledocholithiasis (n = 28). Pancreatobiliary malignancy was associated with common bile duct (CBD) dilatation, and fever and elevated alanine aminotransferase were predictors of choledocholithiasis (p  0.05). Conclusion: Marked CBD dilatation (≥12 mm) should remind us of the high risk of malignancy, and the presence of CBD dilatation and fever is suggestive of choledocholithiasis. Negative EUS findings cannot assure any pathological obstruction in patients with clinically suspected obstructive jaundice

The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study.

OBJECTIVE: This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality among patients with bipolar disorder. METHODS: This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 16,821 patients with bipolar disorder and 67,284 age- and sex-matched control participants without bipolar disorder. The participants who had experienced a stroke between 1999 and 2003 were excluded and were randomly selected from the NHIRD. The incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups using data from the NIHRD between 2004 and 2010. A Cox proportional-hazards model was used to compare the seven-year stroke-free survival rate and all-cause mortality rate across the two cohorts after adjusting for confounding risk factors. RESULTS: A total of 472 (2.81%) patients with bipolar disorder and 1,443 (2.14%) controls had strokes over seven years. Patients with bipolar disorder were 1.24 times more likely to have a stroke (95% CI = 1.12-1.38; p<0.0001) after adjusting for demographic characteristics and comorbid medical conditions. In addition, 513 (26.8%) patients who had a stroke died during the follow-up period. The all-cause mortality hazard ratio for patients with bipolar disorder was 1.28 (95% CI = 1.06-1.55; p = 0.012) after adjusting for patient, physician and hospital variables. CONCLUSIONS: The likelihood of developing a stroke was greater among patients with bipolar disorder than controls, and the all-cause mortality rate was higher among patients with bipolar disorder than controls during a seven-year follow-up period

Sampling from the NHIRD.

<p>Sampling from the NHIRD.</p

Demographic characteristics and comorbid medical disorders of patients with bipolar disorder and matched controls.

<p>Demographic characteristics and comorbid medical disorders of patients with bipolar disorder and matched controls.</p

Adjusted hazard ratio of death within the seven-year follow-up period after the onset of stroke (n = 1915).

*<p>Deceased bipolar patients with stroke, n = 155(32.84%).</p><p>Deceased non-bipolar patients with stroke, n = 358(24.81%).</p

Adjusted hazard ratio of developing stroke during the seven-year follow-up period for patients with bipolar disorder and the matched controls (n = 84105).

*<p>Bipolar patients who suffered from stroke, n = 472(2.81%).</p><p>Non-bipolar patients who suffered from stroke, n = 1443(2.14%).</p