Taiwan University Hospital Yun-Lin Branch Research Articles

An indoor location-based hospital Porter management system and trace analysis.

Porters play an important role in supporting hospital operations. Their responsibilities include transporting patients and medical equipment between wards and departments. They also need to deliver specimens, drugs, and patients' notes to the correct place at the right time. Therefore, maintaining a trustworthy and reliable porter team is crucial for hospitals to ensure the quality of patient care and smooth the flow of daily operations. However, most existing porter systems lack detailed information about the porter movement process. For example, the location of porters is not transparent to the dispatch center. Thus, the dispatcher does not know if porters are spending all their time providing services. The invisibility makes it difficult for hospitals to assess and improve the efficiency of porter operations. In this work, we first developed an indoor location-based porter management system (LOPS) on top of the infrastructure of indoor positioning services in the hospital National Taiwan University Hospital YunLin Branch. The LOPS provides real-time location information of porters for the dispatcher to prioritize tasks and manage assignments. We then conducted a 5-month field trial to collect porters' traces. Finally, a series of quantitative analyses were performed to assess the efficiency of porter operations, such as the movement distribution of porters in different time periods and areas, workload distribution among porters, and possible bottlenecks of delivering services. Based on the analysis results, recommendations were given to improve the efficiency of the porter team.

PD01-08 COMPARISON OF SENHANCE ROBOT-ASSISTED RADICAL PROSTATECTOMY AND DA VINCI ROBOT-ASSISTED RADICAL PROSTATECTOMY: LEARNING CURVE, COST ANALYSIS AND SHORT-TERM SURGICAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023PD01-08 COMPARISON OF SENHANCE ROBOT-ASSISTED RADICAL PROSTATECTOMY AND DA VINCI ROBOT-ASSISTED RADICAL PROSTATECTOMY: LEARNING CURVE, COST ANALYSIS AND SHORT-TERM SURGICAL OUTCOMES Yen Chun Lin, Lun-Hsiang Yuan, Shi-Wei Huang, Yu-Wen Huang, and Chao-Yuan Huang Yen Chun LinYen Chun Lin More articles by this author , Lun-Hsiang YuanLun-Hsiang Yuan More articles by this author , Shi-Wei HuangShi-Wei Huang More articles by this author , Yu-Wen HuangYu-Wen Huang More articles by this author , and Chao-Yuan HuangChao-Yuan Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003218.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Senhance® robotic system (Asensus Surgical Inc, USA) is a new laparoscopy-based robotic platform which has been increasingly used. Currently, there are limited papers discussing the application of Senhance radical prostatectomy (SRP). Here, we compared the SRP learning curve, short-term surgical outcomes and cost analysis with the da Vinci RP (DRP) cases METHODS: From Aug 2019 to April 2022, 65 cases of SRP were performed in National Taiwan University Hospital Yunlin branch. We compared peri-operative data with a prospectively collected 60 cases DRP cohort and a retrospectively collected cohort of initial 60 DRP cases enrolled from the National Taiwan University Hospital. Inclusion criteria was patients with biopsy confirmed prostate cancer, American Association of Anesthesiologists Score ≦3 and without evidence of metastasis. RESULTS: The operative and pathological outcomes of the three cohorts are shown in Table 1. The SRP showed non-inferior results in positive margin rate, blood loss and operative time(OT) than the DRP. We used simple OT to analyze the learning curve. Figure 1-A, 1-B and 1-C represents the OT of experienced LRP-SRP surgeon, LRP-naive SRP surgeons and DRP surgeon respectively. The OT curve showed a much quicker downward trend in the experienced LRP-SRP and DRP surgeons than LRP-naive SRP surgeons. Median cost for each SRP in our hospital was $4170, which was lower than $7675 in the DRP. CONCLUSIONS: Safety and short-term outcomes are comparable between SRP and DRP. For experienced laparoscopic RP surgeon, using Senhance system to perform RP is rather straightforward. With a more affordable price as its biggest advantage, Senhance system may serve as a safe and effective alternative for robotic RP. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e66 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yen Chun Lin More articles by this author Lun-Hsiang Yuan More articles by this author Shi-Wei Huang More articles by this author Yu-Wen Huang More articles by this author Chao-Yuan Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

Exploring Usability and Patient Attitude towards a Smart Hospital Service with the Technology Acceptance Model.

The demand for health care has increased with the development of global technology and the rise of public health awareness, and smart service systems have also been introduced to medical care to relieve the pressure on hospital staff. However, the survey found that patients’ willingness to use smart services at the time of consultation has not improved. The main research purpose of this study was to understand the willingness of patients from various groups to use smart medical service systems and to explore the influencing factors on patients’ use of smart service systems in hospitals through the technology acceptance model. This study distributed questionnaires in the outpatient area of National Taiwan University Hospital Yunlin Branch, and a total of 202 valid questionnaires were obtained. After related research and regression analysis, it was found that patients paid more attention to the benefits and convenience brought by smart services. If patients believed that smart services were trustworthy and beneficial to themselves, their usage intention and attitude would be positive. The results of this study are summarized by the following four points: (1) Designed according to the cultural conditions of different regions; (2) think about design from the patient’s perspective; (3) strengthen the explanation and promotion of smart services; and (4) add humanized care and design. This study could be used as a reference for hospitals to improve their service quality and systems in the future.

Frailty as an Independent Risk Factor for Depression in Patients With End-Stage Renal Disease: A Cross-Sectional Study.

BackgroundDepression confers substantial disease burden globally, especially among those with chronic kidney disease (CKD). The presence of depression significantly impairs one's quality of life. Risk factors for depression in patients with CKD remain under-appreciated, and whether frailty, a geriatric phenotype, constitutes a risk factor for depression in this population is unknown.MethodsWe prospectively enrolled patients with end-stage renal disease (ESRD) undergoing hemodialysis for >3 months from National Taiwan University Hospital Yunlin Branch between 2019 and 2021. Clinical, physical, functional, and performance parameters were recorded, followed by frailty/sarcopenia assessment. Depression was screened for using the Geriatric Depression Scale. We analyzed the independent relationship between frailty and depression in these patients, using multiple regression analyses.ResultsTotally 151 patients with ESRD were enrolled (mean 61.1 years, 66.9% male), among whom 16.6% had screening-identified depression. ESRD participants with depression did not differ from those without regarding most parameters except serum creatinine, functional indices, and sarcopenia/frailty status. We found that having greater frail severities was independently associated with a higher probability of depression; having FRAIL- (odds ratio [OR] 5.418) and SOF-based (OR 2.858) frailty independently correlated with a higher depression probability. A linear relation exists between a greater frail severity and the probability of depression. Using a more relaxed criterion for detecting depression, higher SOF scores remained significantly associated with an increased depression risk.ConclusionsIn patients with CKD, frailty independently correlated with a higher probability of having depression. Strategies aiming to attenuate frailty may be able to benefit those with depression simultaneously in this population.

Trends in the seeking of emergency service for ischemic stroke and its risk factors during the COVID-19 pandemic, a study from Taiwan

Background & Objectives: COVID-19 may influence the health seeking behavior of acute ischemic stroke patients. This study aimed to determine the characteristics of the patients who visited the emergency room in a centre designated for stroke care in Taiwan. Methods: This was a retrospective database-based study comparing the severity of ischemic stroke, intracerebral hemorrhage (ICH), and risk factors of patients seen between 2019 and 2020 in the National Taiwan University Hospital Yunlin Branch. Patients with or without thrombolysis therapy were analysed. Results: The median NIHSS of ischemic stroke patients were lower in 2019 than in 2020 (p = 0.015). The difference was seen in non-thrombolysis patients (2019: 3[1-6] vs. 4 [2-7.5], p = 0.012) but not in thrombolysis patients. The frequency of minor stroke was higher in 2019 (45.1%) than in 2020 (37.9%, p = 0.038). The discharge mRS was lower overall (p = 0.004) and in non-thrombolysis patients (0.003), but not in thrombolysis patients in 2019. As for the ICH patients, the severity of ICH score (p = 0.021) and discharge mRS (p = 0.001) were also lower in 2019. The frequencies of risk factors of stroke were higher in 2019 than in 2020, including smoking (24% vs. 18.2%, p = 0.046), alcohol (11.9% vs. 7.5%, p = 0.039), hypertension (72.9% vs. 66.2%, p = 0.039), history of stroke (16.5% vs. 11.6%, p = 0.047), and atrial fibrillation (11.9% vs. 7.5%, p = 0.039). Conclusions: This study in Taiwan revealed a decline in the willingness to seek emergency services under the influence of COVID-19 among patients with lower stroke severity, especially those with more risk factors.

Development of the Houston-Apollo model for older people living in remote areas in Taiwan.

Senior healthcare is challenging in remote areas, particularly in an economically disadvantaged population. This study examined the benefits of a combined healthcare system (Houston-Apollo model) in improvements of physical performance and medical care utilization of local older people. People aged ≥65 years who participated in congregate meal services were recruited. Using concepts of telemedicine and community health records, participants received consultation from local general physicians, who provided advice or arranged referrals to the National Taiwan University Hospital Yunlin Branch. Physical parameters including blood pressure, body mass index, grip strength, walking speed, and five times sit-to-stand test (FTSST) were transferred to the National Taiwan University Hospital Yunlin Branch and local doctors in a timely manner. Changes in physical parameters and utilization of healthcare facilities were measured at the beginning of recruitment and 1 year later. In the 470 registered participants, 66% had hypertension, 50% had weakness in grip strength, 58% were slow at FTSST and 78% had disability in 6-meter walking speed. In total, 97 participants were followed up at 1 year. The systolic and diastolic blood pressure (mmHg) decreased from 137.4 to 133.3 (P = 0.019) and from 76.9 to 74.4 (P = 0.008), respectively. The time of FTSST (s) decreased from 11.3 to 10.4 (P = 0.011). The walking speed (m/s) increased from 0.71 to 0.74 (P = 0.039). Medical and dental outpatient usage increased by 2 and 1.14 times, respectively. The Houston-Apollo model could provide benefits for the physical status of older adults, promote proactive and preventive healthcare utilization, and contribute to medical equality. Geriatr Gerontol Int 2021; ••: ••-••.

ARBIN: Augmented Reality Based Indoor Navigation System

Due to the popularity of indoor positioning technology, indoor navigation applications have been deployed in large buildings, such as hospitals, airports, and train stations, to guide visitors to their destinations. A commonly-used user interface, shown on smartphones, is a 2D floor map with a route to the destination. The navigation instructions, such as turn left, turn right, and go straight, pop up on the screen when users come to an intersection. However, owing to the restrictions of a 2D navigation map, users may face mental pressure and get confused while they are making a connection between the real environment and the 2D navigation map before moving forward. For this reason, we developed ARBIN, an augmented reality-based navigation system, which posts navigation instructions on the screen of real-world environments for ease of use. Thus, there is no need for users to make a connection between the navigation instructions and the real-world environment. In order to evaluate the applicability of ARBIN, a series of experiments were conducted in the outpatient area of the National Taiwan University Hospital YunLin Branch, which is nearly 1800 m2, with 35 destinations and points of interests, such as a cardiovascular clinic, x-ray examination room, pharmacy, and so on. Four different types of smartphone were adopted for evaluation. Our results show that ARBIN can achieve 3 to 5 m accuracy, and provide users with correct instructions on their way to the destinations. ARBIN proved to be a practical solution for indoor navigation, especially for large buildings.

The Impact of a Social Networking Service-Enhanced Smart Care Model on Stage 5 Chronic Kidney Disease: Quasi-Experimental Study.

BackgroundStage 5 chronic kidney disease (CKD) presents a high risk for dialysis initiation and for complications such as uremic encephalopathy, uremic symptoms, gastrointestinal bleeding, and infection. One of the most common barriers to health care for patients with stage 5 CKD is poor continuity of care due to unresolved communication gaps.ObjectiveOur aim was to establish a powerful care model that includes the use of a social networking service (SNS) to improve care quality for patients with CKD and safely delay dialysis initiation.MethodsWe used a retrospective cohort of CKD patients aged 20-85 years who received care between 2007 and 2017 to evaluate the efficacy of incorporating an SNS into the health care system. In 2014, author F-JY, a nephrologist at the National Taiwan University Hospital Yunlin Branch, started to use an SNS app to connect with stage 5 CKD patients and their families. In cases of emergency, patients and families could quickly report any condition to F-JY. Using this app, F-JY helped facilitate productive interactions between these patients and the health care system. The intention was to safely delay the initiation of dialysis therapy. We divided patients into four groups: group 1 (G1) included patients at the study hospital during the 2007-2014 period who had contact only with nephrologists other than F-JY; group 2 (G2) included patients who visited F-JY during the 2007-2014 period before he began using the SNS app; group 3 (G3) included patients who visited nephrologists other than F-JY during the 2014-2017 period and had no interactions using the SNS; and group 4 (G4) included patients who visited F-JY during the 2014-2017 period and interacted with him using the SNS app.ResultsWe recruited 209 patients with stage 5 CKD who had been enrolled in the study hospital’s CKD program between 2007 and 2017. Each of the four groups initiated dialysis at different times. Before adjusting for baseline estimated glomerular filtration rate (eGFR), the G4 patients had a longer time to dialysis (mean 761.7 days, SD 616.2 days) than the other groups (G1: mean 403.6 days, SD 409.4 days, P=.011 for G4 vs G1; G2: 394.8 days, SD 318.8 days, P=.04; G3: 369.1 days, SD 330.8 days, P=.049). After adjusting for baseline eGFR, G4 had a longer duration for each eGFR drop (mean 84.8 days, SD 65.1 days) than the other groups (G1: mean 43.5 days, SD 45.4 days, P=.005; G2: mean 42.5 days, SD 26.5 days, P=.03; G3: mean 3.8.7 days, SD 33.5 days, P=.002).ConclusionsThe use of an SNS app between patients with stage 5 CKD and their physicians can reduce the communication gap between them and create benefits such as prolonging time-to-dialysis initiation. The role of SNSs and associated care models should be further investigated in a larger population.

Survival Impact and Clinical Predictors of Acute Gastrointestinal Bleeding in Patients With Bloodstream Infection.

The impact of gastrointestinal bleeding (GIB) on outcomes of patients with bloodstream infection (BSI) has not been studied. We aim to evaluate the risk factors and survival impact of GIB on the outcome of BSI. This study was conducted prospectively at National Taiwan University Hospital Yunlin Branch between January 1, 2015, and December 31, 2016. Patients aged ≥18 years for who BSI was confirmed by blood cultures were enrolled and followed for 90 days. Risk factors of GIB were identified by univariable and multivariable logistic regression models. The survival impact of GIB on BSI was evaluated with the Cox proportional hazards model with inverse probability of treatment weighting. Of the 1034 patients with BSI, 79 (7.64%) developed acute GIB. We identified 5 independent predictors of GIB. Patients with BSI complicated with GIB had an increased 90-day mortality compared to patients without GIB (hazard ratio 1.74, 95% confidence interval: 1.14, 2.65). Gastrointestinal bleeding had an adverse impact on the short-term survival in patients with BSI. The clinical predictors may help identify patients who may benefit from active prevention and treatment of GIB.

Magnetic Resonance Imaging-Derived Radiomic Signature Predicts Locoregional Failure after Organ Preservation Therapy in Patients with Hypopharyngeal Squamous Cell Carcinoma

Background: To develop and validate a magnetic resonance imaging (MRI)-derived radiomic signature (RS) for the prediction of 1-year locoregional failure (LRF) in patients with hypopharyngeal squamous cell carcinoma (HPSCC) who received organ preservation therapy (OPT). Methods: A total of 800 MRI-based features of pretreatment tumors were obtained from 116 patients with HPSCC who received OPT from two independent cohorts. The least absolute shrinkage and selection operator regression model were used to select the features used to develop the RS. Harrell's C-index and corrected C-index were used to evaluate the discriminative ability of RS. The Youden index was used to select the optimal cut-point for risk category. Findings: The RS yielded a 1000 times bootstrapping corrected C-index of 0.803 and 0.782 in the experimental (n = 82) and validation cohorts (n = 34), respectively. With respect to the subgroup of patients with stage III/IV and cT4 disease, the RS also showed good predictive performance with corrected C-indices of 0.760 and 0.754, respectively. The dichotomized risk category using an RS of 0.0326 as the cut-off value yielded a 1-year LRF predictive accuracy of 79.27%, 79.41%, 76.74%, and 71.15% in the experimental, validation, stage III/IV, and cT4a cohorts, respectively. The low-risk group was associated with a significantly better progression-free laryngectomy-free and overall survival outcome in two independent institutions, stage III/IV, and cT4a cohorts. Interpretation: The RS-based model provides a novel and convenient approach for the prediction of the 1-year LRF and survival outcome in patients with HPSCC who received OPT. Funding: This study was supported by the following research grants MOST 107-2314-B-002-217-MY3 from the Ministry of Science and Technology, Taiwan, NTUH 108-S4143 from National Taiwan University Hospital, Taiwan, and NTUHYL 106.S006 from the National Taiwan University Hospital Yun-Lin Branch. Declaration of Interest: All authors of this paper declare no conflict of interest. Ethical Approval: The Research Ethical Committee of the Chang-Gung Memorial Hospital and the National Taiwan University Hospital approved the retrospective study protocol.

Hypertension Is Associated with a Higher Progression Rate of Insulin Resistance and the Incidence of Diabetes

Background: Hypertension is a risk factor of diabetes. However, the underlying mechanisms are not fully elucidated. Therefore, we investigated this issue in a prospective cohort in Taiwan. Methods: A total of 1177 subjects without diabetes at baseline were enrolled from 20to 2016 at National Taiwan University Hospital Yun-Lin branch with a median follow-up period of 4.5 years. Diabetes was diagnosed by the results of OGTT and HbA1c, or if antidiabetic agents were used. Insulin resistance index by the Homeostatic model assessment 2 (HOMA2-IR) were used to estimate insulin resistance. Results: Subjects with hypertension by the JNC7 criteria had higher HOMA-IR at baseline and was associated with increased incidence of diabetes, adjusted for HOMA2-%B, HOMA2-IR, BMI, HbA1c, plasma triglyceride, age, gender, family history of diabetes and plasma CRP (adjusted HR 1.51, 95% CI 1.04-2.20, p=0.030). Subjects with treated hypertension had the highest risk of diabetes, followed by subjects with newly-diagnosed hypertension, compared with subjects with pre-hypertension and normal subjects. The progression rate of HOMA2-IR every 5 years (δHOMA2-IR/5 year) was higher in subjects with hypertension than in subjects without hypertension (adjusted p=0.001). Subjects with treated hypertension had the highest δHOMA2-IR/5 year, followed by subjects with newly-diagnosed hypertension, compared with normal subjects (adjusted p for trend=0.05). However, hypertension by the 2017 ACC/AHA criteria was not significantly associated with incident diabetes in adjusted models. The δHOMA2-IR/5 year for hypertension by this criteria was lower than that by the JNC7 criteria. Conclusion: Hypertension is associated with an accelerated progression of insulin resistance and an increased risk of diabetes. Application of 2017 ACC/AHA criteria for hypertension attenuates the associations. Disclosure C. Lin: None. H. Li: None.

Reply

Wang et al. summarized published reports and reached a result to support a potential negative association between thiazolidinediones (TZD) therapy and risk of liver cancer among type 2 diabetes patients. Evidence suggests that nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for hepatocellular carcinoma (HCC). Several clinical trials demonstrate that TZD therapy may lead to improvements in certain metabolic and histological parameters in patients with NAFLD.1 However, the long-term RECORD and PROactive trials failed to find any difference in liver cancer occurrence between either rosiglitazone or pioglitazone and the active comparison group, probably because patients with chronic liver disease were excluded from the trials. Southeast Asia, including China, Taiwan, and Hong Kong, is the endemic area for chronic viral hepatitis. Our case-control study2 and Lai et al.'s cohort study,3 both using Taiwan's National Health Insurance Research Database, demonstrated that the use of TZD was associated with a reduced risk for HCC. There has been a concern that several methodological limitations, in particuluar, the inability to control for important clinical and behavioral factors, might affect the validity of observational studies that were based on large healthcare claims databases. In a recently published report, Yang et al. analyzed the Hong Kong Diabetic Registry and found that TZD was associated with lower overall cancer risk in a dose-response manner after controlling for potential confounding factors.4 However, the small number of TZD users did not allow a further exploration of the association between TZD use and site-specific cancers. Although some evidence suggests a potentially beneficial role of TZD against liver cancer, many questions need to be answered. For patients with NAFLD, does TZD therapy that leads to decrease in aminotransferace, reduction of steatosis, hepatocyte ballooning, or fibrosis result in decreased HCC risk? Among high-risk patients with chronic viral hepatitis B or C, does TZD therapy improve liver pathology and further reduce liver cancer risk? What is the potential role of TZD along with antiviral therapy? Is there any possible effect modification by viral genotypes?5 Is there any difference in risk reduction between rosiglitazone and pioglitazone? Are there any clinical, metabolic, or pathological factors that can predict response? We agreed with the researchers that all these questions have to be answered by well-designed studies with meticulously collected information on metabolic, biochemical, virological, and histological parameters. Randomized, controlled trials with intermediate outcomes may provide more solid evidence in support of the potential beneficial effects associated with TZD. Chia-HsuinChang M.D., D.Sc. Jou-Wei Lin M.D., M.P.H., Ph.D. Mei-Shu Lai M.D., Ph.D. Lee-Ming Chuang M.D., Ph.D. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Taiwan Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Corrigendum to “Environmental exposure to dioxin-like compounds and the mortality risk in the U.S. population” [Int. J. Hyg. Environ. Health 215 (2012) 541–546

Department of Environmental and Occupational Health, University of North Texas Health Science Center, Fort Worth, TX 76107, United States Department of Integrative Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, United States Department of Safety, Health and Environmental Engineering, National Kaohsiung First University of Science and Technology, Kaohsiung, Taiwan Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, GA 30333, United States Department of Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76107, United States Cardiovascular Center and Health Management Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin, Taiwan

The administration of deferasirox in an iron‐overloaded dialysis patient

Hemodialysis InternationalVolume 17, Issue 1 p. 131-133 Letter to the Editor The administration of deferasirox in an iron-overloaded dialysis patient Ching-Wei Tsai, Ching-Wei Tsai Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSearch for more papers by this authorFeng-Jung Yang, Feng-Jung Yang Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSearch for more papers by this authorChun-Chieh Huang, Chun-Chieh Huang Department of Medical Imaging, Far Eastern Memorial Hospital, Taipei, TaiwanSearch for more papers by this authorChin-Chi Kuo, Chin-Chi Kuo Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSearch for more papers by this authorYung-Ming Chen, Yung-Ming Chen Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSearch for more papers by this author Ching-Wei Tsai, Ching-Wei Tsai Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSearch for more papers by this authorFeng-Jung Yang, Feng-Jung Yang Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSearch for more papers by this authorChun-Chieh Huang, Chun-Chieh Huang Department of Medical Imaging, Far Eastern Memorial Hospital, Taipei, TaiwanSearch for more papers by this authorChin-Chi Kuo, Chin-Chi Kuo Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSearch for more papers by this authorYung-Ming Chen, Yung-Ming Chen Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSearch for more papers by this author First published: 02 May 2012 https://doi.org/10.1111/j.1542-4758.2012.00704.xCitations: 7 Correspondence to: Y.-M. Chen, MD, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin 640, Taiwan. E-mail: chenym@ntuh.gov.tw Potential conflicts of interest. All authors: no conflicts. Funding: No funding sources. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume17, Issue1January 2013Pages 131-133 RelatedInformation

Comparison of artificial neural network and logistic regression models for predicting mortality in elderly patients with hip fracture

Purpose Older patients with hip fracture have a mortality rate one year after surgery of 20–30%. The purpose of this study is to establish a predictive model to assess the outcome of surgical treatment in older patients with hip fracture. Methods A database of information from 286 consecutive cases of surgery for hip fracture from the Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, was utilised for model building and testing. Both logistic regression and artificial neural network (ANN) models were developed. Cases were randomly assigned to training and testing datasets. A testing dataset was utilised to test the accuracy of both models ( n = 89). Results The areas under the receiver operator characteristic curves of both models were utilised to compare predictability and accuracy. The logistic regression training and testing datasets had an area of 0.938 (95% CI: 0.904, 0.972) and 0.784 (95% CI: 0.669, 0.899), respectively, below the 0.998 (95% CI: 0.995, 1.000) and 0.949 (95% CI: 0.857, 1.000) of the final ANN model. Conclusion Overall, ANNs have higher predictive ability than logistic regression, perhaps because they are not affected by interactions between factors. They may assist in complex decision making in the clinical setting.

Upper Endoscope for Colonoscopy: Evidence Is Still Too Sparse to Utilize

TO THE EDITOR: We read with interest the article by Park et al. in the November issue of this journal (1). We applaud their efforts to highlight the possibility of implementing a small-caliber scope to achieve individualized and successful colonoscopy, especially with the current global need for screening for colorectal cancer. However, we would like to add constructive comments on this study. In this single-operator study, the colonoscopy withdrawal time was not mentioned. Adequate withdrawal time has been suggested to decrease the adenoma miss rate (2, 3), and at least 6 min of withdrawal time is recommended (3). In addition, the authors did not clarify whether a one-man maneuver or two-man maneuver was adopted in colonoscopic insertion, since a two-man maneuver is still popular in many Asian countries. Comparison of the use of a two-man maneuver with a standard colonoscope and the use of a one-man maneuver with an upper endoscope may exaggerate the advantage of the upper endoscope. Likewise, the question of whether a small-caliber upper endoscope (9.2 mm) can be inadvertently withdrawn faster than a large-caliber standard colonoscope (12.2 mm) remains to be answered. Another question concerns patients with past histories of abdominal or pelvic surgery. Kozarek et al. have reported the usefulness of a small-caliber endoscope after unsuccessful standard colonoscopy because of stenosis or angulation (4). It would be interesting to see the comparative performance in these specific subgroups to test a potentially beneficial role of an upper endoscope in these patients. In this study, multivariate logistic regression analysis revealed three independent predictors of painful colonoscopy: using an upper endoscope, female gender, and lower BMI. Our previous work has similarities and dissimilarities with this study (5, 6). Patient characteristics are similar and so is the number of polyps detected in each examinee (1.7 per examinee in our study) (5). In our previous prospective study on the factors determining postcolonoscopy abdominal pain (6), female gender similarly increased the likelihood of postcolonoscopy abdominal pain, as did the duration of colonoscopy. However, BMI (23.76 ± 3.29 kg/m2 in our participants) did not contribute significantly to pain in our study. A major dissimilarity is that up to 88% of our colonoscopies were under conscious sedation in a screening setting. Application of this study to all colonoscopists might have some limitations since only one operator was included (1). As cases of colorectal cancers are increasing worldwide, more studies and discussions on high-quality colonoscopy for individualized patients are certainly needed. Yet, the evidence for routine use of an upper endoscope in colonoscopy may still be too sparse to utilize. Tsung-Chun Lee, M.D.1 Han-Mo Chiu, M.D.2 Yi-Chia Lee, M.D.2 Hsiu-Po Wang, M.D.3 Shih-Pei Huang, M.D., Ph.D.2 Ming-Shiang Wu, M.D., Ph.D.2 Jaw-Town Lin, M.D., Ph.D.2 1Department of Internal Medicine National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan Departments of 2Internal Medicine and 3Emergency Medicine, National Taiwan University Hospital and College of Medicine National Taiwan University Taipei, Taiwan

Applying a Multiple Screening Program Aided by a Guideline-driven Computerized Decision Support System—A Pilot Experience in Yun-Lin, Taiwan

Although preventive tools decrease morbidity and mortality and promote health, these services are often underutilized. The purpose of this study was to create a workflow for an outpatient setting that incorporated a computerized decision support system to implement preventive recommendations as well as to evaluate its impacts on facilitating preventive care. Subjects visiting National Taiwan University Hospital Yun-Lin Branch were evaluated by a questionnaire, which contained items to trigger production rules to check the eligibility of screening for high coronary risk, diabetes mellitus, lipid disorder, hypertension, obesity, tobacco use, depression, colorectal cancer, breast cancer, cervical cancer, and osteoporosis. Patients were given health information about the diseases they were at risk for and the merits of preventive measures, scheduled for a clinic visit, and arranged to have access to screening tools. Physicians were prompted with clinical reminders on the encounter. The over-all effectiveness of 11 components in this screening program was evaluated in terms of expected life saving. The cost-effectiveness ratio was represented in US dollars per life-year saved. A total of 283 men and 199 women were identified to need one to six preventive interventions during a 2-month period. Preventive consultation was arranged and screening tools were performed. It was estimated that 412-1014 subjects would be needed to attend the program so as to save one life. The cost-effectiveness ratio ranged from 30,000 US dollars to 40,000 US dollars per life-year saved. A computer-aided screening program driven by the US Preventive Services Task Force recommendations has been successfully implemented in Yun-Lin, Taiwan, and provided useful information about local epidemiology and implications for future health policy making.

Pediatric in–intensive-care-unit cardiac arrest: New horizon of extracorporeal life support

Department of Surgery, National Taiwan University Hospital YunLin Branch, National Taiwan University Hospital, Taipei, Taiwan