Yu Chuan Jack Li

mHealth: An updated systematic review with a focus on HIV/AIDS and tuberculosis long term management using mobile phones

OBJECTIVE To evaluate the utilization of mobile phone technology for treatment adherence, prevention, education, data collection, monitoring long-term management of HIV/AIDS and TB patients. METHODS Articles published in English language from January 2005 until now from PubMed/MEDLINE, EMBASE, Web of Science, WHO databases, and clinical trials were included. Data extraction is based on medication adherence, quality of care, prevention, education, motivation for HIV test, data collection from HIV lab test results and patient monitoring. Articles selected for the analysis cover RCTs and non RCTs related to the use of mobile phones for long-term care and treatment of HIV/AIDS and TB patients. RESULTS Out of 90 articles selected for the analysis, a large number of studies, 44 (49%) were conducted in developing countries, 24 (26%) studies from developed countries, 12 (13%) are systematic reviews and 10 (11%) did not mention study location. Forty seven (52.2%) articles focused on treatment, 11 (12.2%) on quality of care, 8 (9%) on prevention, 13 (14.4%) on education, 6 (6.6%) on data collection, and 5 (5.5%) on patient monitoring. Overall, 66 (73%) articles reported positive effects, 21 (23%) were neutral and 3 (4%) reported negative results. CONCLUSIONS Mobile phone technology is widely reported to be an effective tool for HIV/AIDS and TB long-term care. It can substantially reduce disease burden on health care systems by rendering more efficient prevention, treatment, education, data collection and management support.

LabPush: a pilot study of providing remote clinics with laboratory results via short message service (SMS) in Swaziland, Africa - a qualitative study.

BACKGROUND Developing countries are confronting a steady growth in the prevalence of the infectious diseases. Mobile technologies are widely available and can play an important role in health care at the regional, community, and individual levels. Although labs usually able to accomplish the requested blood test and produce the results within two days after receiving the samples, but the time for the results to be delivered back to clinics is quite variable depending on how often the motorbike transport makes trips between the clinic and the lab. OBJECTIVE In this study, we seek to assess factors facilitating as well as factors hindering the adoption of mobile devices in the Swazi healthcare through evaluating the end-users of the LabPush system. METHODS A qualitative study with semi-structured and in-depth one on one interviews were conducted over two month period July-August 2012. Purposive sampling was used; participants were those operating and using the LabPush system at the remote clinics, at the national laboratory and the supervisors of users at Swaziland. Interview questions were focused on perceived of ease of use and usefulness of the system. All interviews were recorded and then transcribed. RESULTS This study had aimed its primary focus on reducing TAT, prompt patient care, reducing bouncing of patients and defaulting of patients which were challenges that the clinicians have always had. Therefore, the results revealed several barriers and facilitators to the adoption of mobile device by healthcare providers in the Swaziland. The themes Shortens TAT, Technical support, Patient-centered care, Mindset, Improved communication, Missing Reports, Workload, Workflow, Security of smart phone, Human error and Ownership are sorted by facilitators to barriers. CONCLUSION Thus the end-users perspective, prompt patient care, reduced bouncing of patients, technical support, better communication, willing participant and social influence were facilitators of the adoption m-health in the Swazi healthcare.

A Probabilistic Model for Reducing Medication Errors

Background Medication errors are common, life threatening, costly but preventable. Information technology and automated systems are highly efficient for preventing medication errors and therefore widely employed in hospital settings. The aim of this study was to construct a probabilistic model that can reduce medication errors by identifying uncommon or rare associations between medications and diseases. Methods and Finding(s) Association rules of mining techniques are utilized for 103.5 million prescriptions from Taiwan’s National Health Insurance database. The dataset included 204.5 million diagnoses with ICD9-CM codes and 347.7 million medications by using ATC codes. Disease-Medication (DM) and Medication-Medication (MM) associations were computed by their co-occurrence and associations’ strength were measured by the interestingness or lift values which were being referred as Q values. The DMQs and MMQs were used to develop the AOP model to predict the appropriateness of a given prescription. Validation of this model was done by comparing the results of evaluation performed by the AOP model and verified by human experts. The results showed 96% accuracy for appropriate and 45% accuracy for inappropriate prescriptions, with a sensitivity and specificity of 75.9% and 89.5%, respectively. Conclusions We successfully developed the AOP model as an efficient tool for automatic identification of uncommon or rare associations between disease-medication and medication-medication in prescriptions. The AOP model helps to reduce medication errors by alerting physicians, improving the patients’ safety and the overall quality of care.

Improving trustworthiness for the codes of International Classification of Diseases 11th version and reducing hospital readmissions in order to improve healthcare services

Happy New Year greetings to all our readers. This first issue of 2016 by the International Journal for Quality in Health Care (IJQHC) presents two interesting editors choices focused on topics including International Classification of Diseases 11th version and on the promising effect of hospital readmissions reduction program in US hospitals. Since the World Health …

A personalized medication management platform (PMMP) to improve medication adherence

OBJECTIVES Medication non-adherence caused by forgetting and delays has serious health implications and causes substantial expenses to patients, healthcare providers, and insurance companies. We assessed the effectiveness of a personalized medication management platform (PMMP) for improving medication adherence, self-management medication, and reducing long-term medication costs. METHODS We developed a mobile PMMP to reduce delayed and missed medications. A randomized control trial was conducted of three medical centers in Taiwan. A total 1198 participants who aged over 20 years, received outpatient prescription drugs for a maximum period of 14 days. 763 patients were randomly assigned to intervention group as receiving daily SMS reminders for their medications and 434 patients in control group did not. The primary outcome was change in delaying and forgetting medication between before and after intervention (after 7 days). RESULTS Medication delays were reduced from 85% to 18% (67% improvement) after SMSs for the intervention group and from 80% to 43% (37% improvement) for the control group. Patients forgot medications were significantly reduced from 46% to 5% (41% improvement) for the experimental group after SMSs and from 44% to 17% (27% improvement) for the control group. The SMSs were considered helpful by 83% of patients and 74% of them thought SMSs help in controlling diseases. 92% of patients would recommend this system to their family and friends. CONCLUSIONS A timely and personalized medication reminder through SMS can improve medication adherence in a nationalized healthcare system with overall savings in medication costs and significant improvements in health and disease management. TRIAL REGISTRATION ClinicalTrials.gov: NCT02197689.

Gout drugs use and risk of cancer: A case-control study

OBJECTIVE Firm conclusion about whether short and long-term gout medications use has an impact on cancer risk remain inconclusive. The aim of this study was to investigate the association between gout drugs use and risk of cancer. METHODS We conducted a retrospective longitudinal population-based case-control study in Taiwan. Cases were identified all patients who were aged 20years or above, and had a first time diagnosis of cancers for the period between 2001 and 2011. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated by using conditional logistic regression. RESULTS We examined 601,733 cases and 2,406,932 matched controls. The adjusted odd ratio for any gout drugs use and overall cancer risk was 1.007 (95% CI: 0.994-1.020). There was a significant risk of leukemia (AOR: 1.34, 95% CI: 1.20-1.50), endometrial cancer (AOR: 1.33, 95% CI: 1.12-1.57), non-Hodgkins (AOR: 1.24, 95% CI: 1.13-1.35), female breast cancer (AOR: 1.21, 95% CI: 1.13-1.29), cervical cancer (AOR: 1.21, 95% CI: 1.07-1.37). However, no association was observed in male group (AOR: 0.97, 95% CI: 0.95-0.98) but female showed a significantly increased risk of cancer at any site (AOR: 1.107, 95% CI: 1.08-1.13). CONCLUSION In summary, our results suggest that gout drugs increase risk of the most common cancers, particularly in leukemia, non-Hodgkins, endometrial, breast and cervical cancer.

Exploring the Association between Statin Use and the Risk of Parkinson’s Disease: A Meta-Analysis of Observational Studies

Background: Parkinson’s disease (PD) is a progressive disorder of the central nervous system. The prevalence of PD varies considerably by age group; it has a higher prevalence in patients aged 60 years and more. Several studies have shown that statin, a cholesterol-lowering medication, reduces the risk of developing PD, but evidence for this is so far inconclusive. The objective of this study is to evaluate the association between statin use and the risk of developing PD. Methods: PubMed, EMBASE, and the bibliographies of articles were searched for studies published between January 1, 1990, and January 1, 2017, which reported on the association between statin use and PD. Articles were included if they (1) were published in English, (2) reported patients treated with statin, and the outcome of interest was PD, (3) provided OR/HR with 95% CI or sufficient information to calculate the 95% CI. All abstracts, full-text articles, and sources were reviewed, with duplicate data excluded. Summary relative risk (RRs) with 95% CI was pooled using a random-effects model. Subgroup and sensitivity analyses were also conducted. Results: We selected 16 out of 529 unique abstracts for full-text review using our selection criteria, and 13 out of these 16 studies, comprising 4,877,059 persons, met all of our inclusion criteria. The overall pooled RR of PD was 0.70 (95% CI 0.58–0.84) with significant heterogeneity between estimates (I2 = 93.41%, p = 0.000) for the random-effects model. In subgroup analysis, the greater decreased risk was found in studies from Asia (RR 0.62 95% CI 0.51–0.76), whereas a moderate reduction was observed in studies from North America (RR 0.69 95% CI 0.47–1.00), but less reduction was observed in studies from Europe (RR 0.86 95% CI 0.80–0.92). Also, long-term statin use, simvastatin, and atorvastatin showed a higher rate of reduction with significance heterogeneity. Conclusion: Our results showed that statin use is significantly associated with a lower risk of developing PD. Physicians should consider statin drug therapy, monitor its outcomes, and empower their patients to improve their knowledge, therapeutic outcomes, and quality of life. However, preventive measures and their associated mechanisms must be further assessed and explored.

iSlide: a ‘big picture’ interactive teledermatopathology e‐learning system

Dermatopathology training is often limited by facilities and a dearth of specialists. Advancements in information and communication technologies have made possible the adoption of innovative learning techniques, especially in places where specialists are lacking.

Effect of implementation of a coded problem list entry subsystem

OBJECTIVES Complete patient problem lists may improve the quality of care. To improve the completeness of the lists at our institution, we implemented the coded problem list entry subsystem (CPLES) in our electronic medical record system. Subsequently, physicians used the CPLES instead of handwritten notes to document coded problem lists and progress notes. We evaluated the effect of implementing the CPLES on the completeness of problem lists. METHODS We compared the completeness of coded problem lists input after CPLES implementation with that of problem lists handwritten before CPLES implementation and determined the differences. Moreover, the efficiency and usability of the CPLES were evaluated. RESULTS The efficiency and usability of CPLES were acceptable. However, the completeness of problem lists was reduced after CPLES implementation. The possible reasons for this reduction, namely system usability, efficacy, incentives, leadership, and education, were crucial for successful CPLES implementation and are discussed in the text. CONCLUSION CPLES implementation reduced the completeness of problem lists. Institutions may learn from our experience and carefully implement their own coded problem list systems to avoid this consequence.

The impact of different surgical procedures on hypoparathyroidism after thyroidectomy: A population-based study

Abstract The main objective of this study is to investigate the outcome between surgical procedures and the risk of development of hypoparathyroidism followed by surgical procedure in patients with thyroid disorders. We analyzed the data acquired from Taiwans Bureau of National Health Insurance (BNHI) research database from 1998 to 2011 and found 9316 patients with thyroid surgery. Cox regression model was used to calculate the hazard ratio (HR). A count of 314 cases (3.4%) of hypoparathyroidism was identified. The 9 years cumulated incidence of hypoparathyroidism was the highest in patient undergone bilateral total thyroidectomy (13.5%) and the lowest in the patient with unilateral subtotal thyroidectomy (1.2%). However, in the patients who had undergone unilateral subtotal, the risk was the highest in bilateral total (HR: 11.86), followed by radical thyroidectomy with unilateral neck lymph node dissection (HR: 8.56), unilateral total (HR, 4.39), and one side total and another side subtotal (HR: 2.80). The extent of thyroid resection determined the risk of development of hypoparathyroidism. It is suggested that the association of these factors is investigated in future studies.