Tai-Yin Wu

Ten-year trends in hospital admissions for adverse drug reactions in England 1999–2009

Summary Objectives Adverse drug reactions (ADR) are an important cause of morbidity and mortality. We analysed trends in hospital admissions associated with ADRs in English hospitals between 1999 and 2008. Design Data from the Hospital Episode Statistics database were examined for all English hospital admissions (1999–2008) with a primary or secondary diagnosis of an ADR recorded. Setting All NHS (public) hospitals in England. Main outcome measures The number of admissions and in-hospital mortality rate with a primary (codes including ‘adverse drug reaction’, ‘drug-induced’, ‘due to drug’, ‘due to medicament’ or ‘drug allergy’) or secondary diagnosis of ADR (ICD-10 Y40-59) were obtained and analysed. Further analysis for the year 2008–2009 was performed with regard to age, gender, proportion aged >65 yrs and total bed-days. Results Between 1999 and 2008, there were 557,978 ADR-associated admissions, representing 0.9% of total hospital admissions. Over this period the annual number of ADRs increased by 76.8% (from 42,453 to 75,076), and in-hospital mortality rate increased by 10% (from 4.3% to 4.7%). In 2008, there were 6,830,067 emergency admissions of which 75,076 (1.1%) were drug-related. Systemic agents were most commonly implicated (19.2%), followed by analgesics (13.3%) and cardiovascular drugs (12.9%).There has been a near two-fold increase in nephropathy and cardiovascular consequences secondary to drugs and a 6.8% fall in mental and behavioural disorders due to drugs. Conclusions ADRs have a major impact on public health. Our data suggest the number of ADR admissions has increased at a greater rate than the increase in total hospital admissions; some of this may be due to improved diagnostic coding. However, in-hospital mortality due to ADR admissions also increased during the period. Our findings should prompt policymakers to implement further measures to reduce ADR incidence and their associated in-hospital mortality, and methods to improve the recording of ADRs.

An overview of the healthcare system in Taiwan

Taiwan adopted a national health insurance system in 1995. It is a government administered insurancebased national healthcare system. Although, like the UK, Taiwan has a single payer system for healthcare, there are several differences between the two systems. The characteristics of the Taiwanese system include good accessibility, comprehensive population coverage, short waiting times, relatively low costs and a national health insurance databank for planning, monitoring and evaluating health services. The weaknesses include variable quality of care, a weak gatekeeper role and increasing financial pressures.

Admission rates and in-hospital mortality for hip fractures in England 1998 to 2009: time trends study

BACKGROUND Fractures of the proximal femur are an important public health concern. The incidence of hip fractures is an index of osteoporosis burden. There have been no recent studies examining national trends in hip fractures in England. METHODS We used national data for 1998-2009 from the English Hospital Episode Statistics database. Patients with an admission for hip fracture (574,482 admissions) were identified. RESULTS Between 1998 and 2009, there was little change in age-standardized hip fracture rates (102.0-101.8 fractures per 100,000 person-years), but age-standardized in-hospital mortality decreased by 16.5% (95% CI (confidence interval): -18.5 to -8.4%) (126.9-106.0 deaths per 1000 hip fracture admissions). The majority of hip fractures and deaths occurred in females and older people. A socioeconomic gradient of 25.9% difference (95% CI: 15.7-36.1%) existed for mortality in 2008 (93.5-117.7 per 1000). CONCLUSIONS Hip fracture rates have not decreased in England since 1998, although inpatient mortality rates have declined. There is a socioeconomic gradient for in-hospital hip fracture deaths.

A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs.

Orientation of the hip cup is important in total hip arthroplasties. Orientation includes abduction (inclination) and anteversion. Anteversion can be considered as true (anatomic) and planar (radiographic) anteversion. Some measurement methods either are too complicated or are less precise. We developed a new protractor to measure cup orientation using postoperative anteroposterior radiographs centered at the hip. The new protractor measures true and planar anteversion and abduction easily and precisely. We verified its accuracy using a software simulator and simulated 45 radio- graphs of total hip arthroplasties with 15 different anteversions ranging from 15°-29° and 45 actual radiographs of total hip arthroplasties. We then measured the planar ante- version with our method and the method of Lewinnek et al. Maximal errors were 3° and 2.61°, respectively, and mean errors were 0.96° and 1.2°, respectively. The standard deviations were 0.74° with our method and 0.57° with the method of Lewinnek et al. For the real radiographs, the mean of absolute difference between the two methods was 1.34°, and the standard deviation was 1.13°. We found no difference between the two methods and no difference in our findings compared with those of Pradhan.Level of Evidence: Diagnostic study, level II.

Risk factors for single and recurrent falls: a prospective study of falls in community dwelling seniors without cognitive impairment.

OBJECTIVE The purpose of this study is to contribute evidence towards heterogeneity in risk factors for single and recurrent falls. METHOD This is a prospective study conducted in Taiwan. Participants were randomly selected from the examinees of the annual health examination in 2010. Participants were interviewed with a detailed questionnaire and followed up one year later. Predictor variables included socio-demographic characteristics, medical conditions, laboratory data, and risk factors for osteoporosis. The outcome was falls in the ensuing 12 months. RESULTS The mean age of the 653 completers was 75.6 ± 6.4. Half (48.7%) were women. Fallers and recurrent fallers comprised 14.5% and 6.0% of the participants, respectively. Blurred vision (adjusted odds ratio (aOR): 1.93, 95% confidence interval (CI): 1.02-3.67), minimal outdoor activities (aOR: 2.28, 95% CI: 1.06-4.88), and overactive thyroid/parathyroid (aOR: 3.49, 95% CI: 1.29-9.50) were associated with single falls. Frailty (aOR: 2.81, 95% CI: 1.11-7.09), decreased body height (aOR: 3.15, 95% CI: 1.52-6.54) and taking sedatives/hypnotics (aOR: 4.23, 95% CI: 2.06-8.67) were associated with recurrent falls. Previous falls (aOR: 2.64, 95% CI: 1.44-4.84 for single falls; aOR: 5.26, 95% CI: 2.61-10.60 for recurrent falls) were associated with all falls. CONCLUSION Different intervention strategies should be developed for single and recurrent fallers.

Measurement of the acetabular cup anteversion on simulated radiographs.

Widmer (J Arthroplasty 2004;19:387) reported a protractor for measuring the anteversion of acetabular cups on radiographs but with limited precision. We intended to improve its precision by trigonometric mathematics. We measured the anteversion of the acetabular cups on 336 simulated radiographs using aforementioned 2 methods. The anteversion measured by Widmers protractor ranged from 7 degrees to 41 degrees (mean +/- SD = 28.0 degrees +/- 9.8 degrees), and our methods, 5 degrees to 51 degrees (27.7 degrees +/- 13.2 degrees). The mean +/- SD of error by Widmers protractor was 5.2 +/- 2.5 degrees, and our protractor, 0.8 degrees +/- 0.8 degrees (Student t test, P b .0001). The interobserver study showed the difference between measurements less than 2 degrees for each method. Therefore, the smaller error of our method than that of Widmer implicated a potentially precise measurement of the anteversion (level of evidence: diagnostic study, level II).

A simple mathematical standardized measurement of acetabulum anteversion after total hip arthroplasty

We invented a standardization method to measure the cup’s anteversion after total hip arthroplasty without the influence of patient’s position. We measured 68 radiographs of 10 patients after total hip replacement (THR) and calculated the error of each measurement, defined as the difference with the average of the same measuring method on the same patient. We also calculated the repeatability standard deviation (RSD) of each method according to the American Society for Testing and Materials, ASTM E691. Mean absolute inter-examination angle error, defined as the average of the absolute deviations, was 0.758 for standardized anteversion (range 0.03– 2.518), as compared with those without standardization, 2.308 (range 0.04 – 13.048). The inter-examination measurement reliability (precision), defined as one RSD, was 0.998 for standardized anteversion, as compared with those without standarization, 3.508. There is no difference between patients four and five without (p ¼ 0.097). There is a significant difference with standardization (p , 0.0001). Our study demonstrated that this mathematical method is a precise tool to measure the anteversion of the acetabular cup. We hope that it can be used widely in the future.

Knowledge of the new Tobacco Hazards Prevention Act is associated with smokers' behavior of seeking help in smoking cessation in Taiwan.

Evidence that smoking area restrictions and raising cigarette taxes affect smokers’ behavior of seeking help in cessation is limited. The authors conducted a case-control study of 200 participants in Taipei City, Taiwan, from December 2008 to June 2009 to evaluate the association between knowledge on legislation and the behavior of seeking help in smoking cessation. They compared smokers who sought assistance in clinics/classes and smokers who did not, matching for age, gender, and recruitment time. In a univariate model, both banning smoking and increasing prices had positive effects on smokers’ behavior, but the effect size of the latter was larger (P = .021). A better knowledge of the regulations was associated with cessation effort (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.44-5.23), as were being more influenced by increased prices (OR = 2.44; 95% CI = 1.38-4.34) and by smoking bans (OR = 2.32; 95% CI = 1.29-4.16). Increased knowledge of the regulations is associated with seeking help for smoking.

Association of quality of life with laboratory measurements and lifestyle factors in community dwelling older people in Taiwan

Objectives: Little is known about the influence of routine laboratory measurements and lifestyle factors on generic quality of life (QOL) at older ages. We aimed to study the relationship between generic QOL and laboratory measurements and lifestyle factors in community dwelling older Chinese people. Methods: We conducted a cross-sectional analysis. Six hundred and ninety nine elders were randomly selected from the examinees of the annual health examination in Taipei City, Taiwan. Blood, urine and stool of the participants were examined and lifestyle data were collected. Participants completed the CASP-19 (control, autonomy, self-realization, pleasure) questionnaire, a 19-item QOL scale. The relationship between QOL and laboratory results and lifestyle factors was explored, using multiple linear regression and profile analysis. Results: The mean age of the participants was 75.5 years (SD = 6.5), and 49.5% were female. Male gender standardized β coefficients (β = 0.122) and exercise habit (β = 0.170) were associated with a better QOL, whereas advanced age (β = −0.242), blurred vision (β = −0.143), depression (β = −0.125), central obesity (β = −0.093), anemia (β = −0.095), rheumatoid arthritis (β = −0.073), Parkinsonism (β = −0.079), malignancy (β = −0.086) and motorcycle riding (β = −0.086) were associated with a lower QOL. Profile analysis revealed that young–old males, social drinkers, regular exercisers and car drivers had the best QOL (all p < 0.001). Conclusion: Of the many laboratory measurements, only anemia was associated with the lower QOL. By contrast, several lifestyle factors, such as social drinking, exercise habit and car driving, were associated with better QOL, whereas abdominal obesity and motorcycle riding were associated with lower QOL.

THR Simulator – the software for generating radiographs of THR prosthesis

BackgroundMeasuring the orientation of acetabular cup after total hip arthroplasty is important for prognosis. The verification of these measurement methods will be easier and more feasible if we can synthesize prosthesis radiographs in each simulated condition. One reported method used an expensive mechanical device with an indeterminable precision. We thus develop a program, THR Simulator, to directly synthesize digital radiographs of prostheses for further analysis.Under Windows platform and using Borland C++ Builder programming tool, we developed the THR Simulator. We first built a mathematical model of acetabulum and femoral head. The data of the real dimension of prosthesis was adopted to generate the radiograph of hip prosthesis. Then with the ray tracing algorithm, we calculated the thickness each X-ray beam passed, and then transformed to grey scale by mapping function which was derived by fitting the exponential function from the phantom image. Finally we could generate a simulated radiograph for further analysis.ResultsUsing THR Simulator, the users can incorporate many parameters together for radiograph synthesis. These parameters include thickness, film size, tube distance, film distance, anteversion, abduction, upper wear, medial wear, and posterior wear. These parameters are adequate for any radiographic measurement research. This THR Simulator has been used in two studies, and the errors are within 2° for anteversion and 0.2 mm for wearing measurement.ConclusionWe design a program, THR Simulator that can synthesize prosthesis radiographs. Such a program can be applied in future studies for further analysis and validation of measurement of various parameters of pelvis after total hip arthroplasty.