Fen-Yu Tseng

Accuracy of Diabetes Diagnosis in Health Insurance Claims Data in Taiwan

BACKGROUND AND PURPOSE There are limited data from Taiwan about the accuracy of National Health Insurance (NHI) claims data. This study assessed the accuracy of NHI claims data for diabetes and its associated factors. METHODS Insurance claims data for patients with a diagnosis of diabetes were extracted from the records of the Bureau of National Health Insurance, including detailed files of the outpatient, emergency, inpatient and pharmacy treatment records from January 1, 2000 to December 31, 2000. A stratified, 2-staged, probability proportional to size and equal probability method was used to sample 9000 diabetes patients. The accuracy of the diabetes diagnosis was assessed based on patient responses to questionnaire items. Subjects with negative or uncertain questionnaire answers who had hypoglycemic agents in pharmacy claims data were also classified as diabetic. RESULTS A total of 1350 questionnaires were returned and an accurate diagnosis was verified from data in 1007 (74.6%) of these subjects. Univariate analysis showed that level of accreditation of the hospital, age, gender, follow-up department, type of complication, number of outpatient visits, emergent visit, as well as hospitalization were significant factors associated with an accurate diagnosis of diabetes. Multivariate logistic regression analysis revealed that number of outpatient visits, hospitalization, age, and the level of accreditation of the hospital were significant independent factors. The odds ratio of an accurate diagnosis increased with the number of outpatient visits and hospitalization. The probability of accurate diagnosis of diabetes among patients with >/= 4 outpatient visits was 99.16 times greater than that of patients with </= 1 outpatient visit. The probability of accurate diagnosis in patients with >/= 1 hospitalization was 5.26 times that of patients who had not been hospitalized. CONCLUSIONS This study found that the accuracy of diabetes diagnosis in NHI claims data in Taiwan was 74.6%. Further attention to the association of inaccurate claims in cases with infrequent outpatient visits, young age and those attending non-accredited hospitals is needed in order to address the efficiency of diagnosis and surveillance of diabetes in Taiwan.

Deep neck infection: analysis of 185 cases.

This study reviews our experience with deep neck infections and tries to identify the predisposing factors of life‐threatening complications.

Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults

OBJECTIVES This study sought to evaluate the relationship between subclinical hypothyroidism (SCH) and all-cause and cardiovascular disease (CVD) mortality. BACKGROUND SCH may increase the risks of hypercholesterolemia and atherosclerosis. The associations between SCH and all-cause or CVD mortality are uncertain, on the basis of the results of previous studies. METHODS A baseline cohort of 115,746 participants without a history of thyroid disease, ≥20 years of age, was recruited in Taiwan. SCH was defined as a serum thyroid-stimulating hormone (TSH) level of 5.0 to 19.96 mIU/l with normal total thyroxine concentrations. Euthyroidism was defined as a serum TSH level of 0.47 to 4.9 mIU/l. Cox proportional hazards regression analysis was used to estimate the relative risks (RRs) of death from all-cause and CVD for adults with SCH during a 10-year follow-up period. RESULTS There were 3,669 deaths during the follow-up period; 680 deaths were due to CVD. Compared with subjects with euthyroidism, after adjustment for age, sex, body mass index, diabetes, hypertension, dyslipidemia, smoking, alcohol consumption, betel nut chewing, physical activity, income, and education level, the RRs (95% confidence interval) of deaths from all-cause and CVD among subjects with SCH were 1.30 (1.02 to 1.66), and 1.68 (1.02 to 2.76), respectively. CONCLUSIONS Adult Taiwanese with SCH had an increased risk for all-cause mortality and CVD death.

Deep neck infection in diabetic patients : Comparison of clinical picture and outcomes with nondiabetic patients

OBJECTIVE: To compare the difference in the clinical picture and outcomes between diabetic and nondiabetic patients with deep neck infections. STUDY DESIGN AND SETTING: We retrospectively reviewed the records of patients who were diagnosed with deep neck infections and who received treatment at the Department of Otolaryngology of National Taiwan University Hospital between 1997 and 2002. One hundred eighty-five patients were included in our study. Fifty-six patients with diabetes mellitus were enrolled for further analysis (diabetic group) and compared with the other 129 patients without diabetes mellitus (nondiabetic group) in demography, etiology, bacteriology, treatment, duration of hospital stay, complications, and outcome. RESULTS: The parapharyngeal space was the space most commonly involved in both the diabetic (33.9%) and nondiabetic groups (40.3%). Odontogenic infections and upper airway infections were the 2 leading causes of deep neck infection in diabetic and nondiabetic groups. Streptococcus viridans is the most commonly isolated organism in the nondiabetic group (43.7%). However, the most common organism in the diabetic group was Klebsiella pneumoniae (56.1%). There were 89.3% of diabetic patients, versus 71.3% of nondiabetic patients, with abscess formation (P = 0.0136). Surgical drainage was performed more frequently in the diabetic group than in the nondiabetic group (86.0% versus 65.2%, P = 0.0142). In comparison with the nondiabetic group, the diabetic group tended to have older mean age (57.2 y versus 46.2 y, P = 0.0007), longer duration of hospital stay (19.7 days versus 10.2 days, P >0.0001), more frequent complications (33.9% versus 8.5%, P >0.0001), and more frequent tracheostomy or intubation (19.6% versus 6.2%, P = 0.0123). CONCLUSIONS: Patients with diabetes mellitus are susceptible to deep neck infection. We should pay more attention when dealing with deep neck infections in patients with diabetes mellitus because those patients tend to have complications more frequently and a longer duration of hospital stay. Empirical antibiotics should cover K. pneumoniae in patients with deep neck infection who have diabetes mellitus.

Factors affecting the bacteriology of deep neck infection: a retrospective study of 128 patients

Conclusions. Broad-spectrum antibiotics are advocated for treating deep neck infection. Anaerobic coverage is necessary, especially in odontogenic cases. The presence of diabetes, infection of the parotid space and an obvious odontogenic source of infection can aid in determining the causative organisms. Objectives: This study aimed to analyze the bacteriology in deep neck infections and identify the factors that influenced the causative pathogens. Materials and methods. The records of 212 patients who were diagnosed as having deep neck infections at the National Taiwan University Hospital between 1997 and 2003 were reviewed; 128 patients with bacterial isolation from their pus cultures were enrolled. Results. The cultures of 46 patients (35.9%) were polymicrobial. Viridans Streptococcus was the most commonly isolated organism (38.3%), followed by Klebsiella pneumoniae (32.0%) and Peptostreptococcus (17.2%). The most common organism in 44 diabetic patients was K. pneumoniae (54.5%), versus viridans streptococcus (48.8%) in 84 nondiabetic patients. In patients with dental sources of infections, the culture rate of anaerobes was 59.3%; in upper airway infections and other sources of infections they were 22.7% and 21.5%, respectively (χ2 test, p = 0.0008). The differences in age, sex, and climate did not show any significant changes in the common causative pathogens. Common pathogens in the infection of parapharyngeal, submandibular, and extended spaces were the same as viridans streptococcus, but in the parotid space K. pneumoniae was the most common pathogen.

Thyroglossal duct cyst: a comparison between children and adults

PURPOSE The purpose of the study was to evaluate the differences in the clinical characteristics of thyroglossal duct cysts (TGDC) between children and adults and to find a method for optimizing management of TGDC. MATERIALS AND METHODS This study consisted of a retrospective chart review of patients with a diagnosis of TGDC from 1997 to 2002. All records were reviewed for age and sex, season of first visit, diagnostic methods, sizes and locations of cysts, surgical management, and recurrences. Differences between children and adults were analyzed. RESULTS A total of 84 patients (32 children, 52 adults) were recruited. There were no significant differences in sex in either group. Compared with children, more adult patients had left-sided and infrahyoid cyst locations. The cyst sizes were significantly larger in adults. In this review, 90.4% of adults and 75% of children underwent a Sistrunk operation, whereas the others underwent cyst excision. There was a total of 5 recurrences, 2 in children and 3 in adults. CONCLUSION Although the recurrence rates between children and adults and between different surgical managements were not significantly different, a Sistrunk procedure is recommended as the main operation of choice, especially in adults in whom a more extended tract resection should be performed.

Clinical features of sudden sensorineural hearing loss in diabetic patients.

Objectives: Clinical studies of sudden sensorineural hearing loss (SSNHL) rarely focus on diabetic patients. We attempted to elucidate the clinical features of SSNHL in diabetic patients and to evaluate the factors influencing hearing deficits.

Ultrasound-guided fine needle aspiration cytology of parathyroid lesions. A review of 72 cases.

OBJECTIVE To elucidate the specific cytomorphologic patterns and diagnostic pitfalls in fine needle aspiration cytology (FNAC) of parathyroid lesions. STUDY DESIGN Seventy-two cases of surgically excised and pathologically verified hyperparathyroidism (20 cases of parathyroid hyperplasia, 51 of parathyroid adenoma and one of parathyroid carcinoma) received preoperative, ultrasound-guided FNAC examination for enlarged parathyroid glands. The smears were reviewed and analyzed. RESULTS Parathyroid lesions were diagnosed cytologically in 60 cases (83.3%). The presence of colloidlike substance, macrophages or follicular structures in smears led to six cases (8.3%) being misinterpreted as thyroid lesions. The cellularity of the smears was insufficient for interpretation in six cases (8.3%); however, two of these cases were diagnosed by determination of parathyroid hormone (PTH) levels in the fluid. Parathyroid hyperplasia had more tightly cohesive cell clusters with monomorphism, while parathyroid adenoma had more dispersed or loosely cohesive cells with pleomorphism and anisokaryosis. High PTH concentration in an aspirate was noted in all four cases of cystic lesions.

Outcomes of malignant external otitis: survival vs mortality

Conclusions. In patients with malignant external otitis (MEO), mortality was not related to age, sex, degree of glucose tolerance, duration of diabetes mellitus (DM), microorganism, comorbid disease, or involvement of a single cranial nerve. Severe complications such as skull base osteomyelitis, intracranial extension, and involvement of multiple cranial nerves were correlated with mortality. Objectives. To analyze the factors that affect the survival of patients with MEO in todays era of advanced antibiotics. Patients and methods. Patients with a diagnosis of MEO from 1993 to 2005 were collected. Results. A total 26 patients with a mean age of 63.7±10.2 years were included. All had a history of DM. Pseudomonas aeruginosa (26.9%), Klebsiella pneumoniae (19.2%), and fungus (15.4%) were most frequently found in pus cultures. Cranial nerves were involved in 11 patients: the facial nerve was most frequently (38.46%) involved. Complications such as osteomyelitis (11 patients) and intracranial involvement (3 patients) were noted in this series. Mastoidectomy was performed in 12 patients. A total of five patients died.

Diabetic effects on microchambers and macrochambers tissue properties in human heel pads.

BACKGROUND The study attempted to highlight the differences of mechanical properties in microchambers and macrochambers between patients with type 2 diabetes mellitus and age-matched healthy volunteers. METHODS A total of 29 heels in 18 diabetic patients and 28 heels in 16 age-matched healthy participants were examined by a loading device consisting of a 10-MHz compact linear-array ultrasound transducer, a Plexiglas cylinder, and a load cell. Subjects in both groups were on average about 55 years old with a body mass index of approximately 25 kg/m(2). A stepping motor was used to progressively load the transducer on the tested heels at a velocity of 6mm/s from zero to the maximum stress of 78 kPa. Unloaded thickness, strain, and elastic modulus in microchambers, macrochambers and heel pads were measured. FINDINGS Microchambers strain in diabetic patients was significantly greater than that in healthy subjects (0.291 (SD 0.14) vs. 0.104 (SD 0.057); P<0.001). Macrochambers strain in diabetic patients was significantly less than that in healthy subjects (0.355 (SD 0.098) vs. 0.450 (SD 0.092); P=0.001). Microchambers stiffness in diabetic patients was significantly less than that in healthy persons (393 (SD 371)kPa vs. 1140 (SD 931)kPa; P<0.001). Macrochambers stiffness in diabetic patients was significantly greater than that in healthy persons (239 (SD 77)kPa vs. 181 (SD 42)kPa; P=0.001). INTERPRETATION Heel pad tissue properties are altered heterogeneously in people with diabetes. Increased macrochambers but decreased microchambers stiffness may cause diminished cushioning capacities in diabetic heels.