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Background Coronavirus Disease 2019 (COVID-19) spread all over the world in 2020. In the face of the sudden pandemic, workforce mobilization has been of critical concern to medical institutions. During the pandemic, the public's behaviors of seeking medical assistance have also changed. Using the real-world data of a large medical center in Taiwan, this study aimed to analyze the fluctuations of outpatient visits among various departments and divisions in the early phase of the COVID-19 pandemic and to provide suggestions for staff allocation in similar future events. Methods Data of outpatient visits at Taipei Veterans General Hospital were obtained for analysis. The weekly fluctuations of outpatient visits among 36 departments or divisions were computed for the 8 weeks from February 3 to March 29, 2020, the early phase of the pandemic. The monthly data of outpatient visits by department and division in March 2020 were also extracted for comparison with those in March 2019. A simple regression equation was used to calculate the weekly trends. Results Average outpatient visits decreased by 26% in the 2 months following the outbreak. Among the 36 departments or divisions, ophthalmology, orthopedics, and cardiology underwent marked declines after the outbreak; the slopes of the simple regression equation were -110.8, -100.7, and -99.2, respectively. By contrast, transfusion medicine, toxicology, transplantation surgery, pediatric surgery, chest surgery, technical aid, and oncology were divisions less influenced. In the year-over-year comparison, infection was the only department or division with positive growth (20.5%), whereas all others exhibited negative growth. Conclusion In the future, we can fulfil the additional personnel needs during a pandemic by redeploying physicians from departments experiencing a reduced workload. Hospitals should also establish preparatory employee training programs to ensure that the reassigned personnel are adequately equipped to serve in their new positions.

BACKGROUND: Visitors to hospitalized patients during an epidemic might themselves be carriers and are therefore likely to spread the disease in wards. Although measures were taken to restrict hospital visits, traditional paper-based registration is insufficient to screen and monitor the numbers of visitors to a large hospital. METHODS: Throughout March 2020, during the coronavirus disease 2019 crisis, a computer system was deployed in the 2800-bed Taipei Veterans General Hospital (Taipei, Taiwan) to register, screen, and monitor inpatient visitors. This system comprised three parts: online registration form, entrance check-in interface, and registration database. The early utilization of this newly deployed system was then analyzed. RESULTS: A total of 22,336 visits were recorded between March 11, 2020, and March 31, 2020, with 1064 a day on average. Out of these visits, 18.1% (n = 4049) had made online reservations within 48 hours. On the other hand, of all 4941 online reservations, 18.1% (n = 892) were no-shows. In the last 12 days of the study period, eight prospective visitors were identified as ineligible by the computer system, and so their visits were denied. CONCLUSION: Using a computer system, the hospital was able to enforce restrictions on hospital visits. Although the online registration system had not been fully used yet in the early phase of adoption, its superiority from the standpoint of disease control should enable hospital managers to consider abolishing on-site visitor registration.

Background: The coronavirus disease 2019 (COVID-19) had spread rapidly since late December 2019. Personal protective equipment was essential to prevent transmission. Owing to shortage of face masks, Taiwan government began to implement quasi rationing on February 6, 2020, by allowing each resident to purchase two masks in seven days. Taiwan National Health Insurance Administration offered online data with real-time updates on face mask availability in all contracted pharmacies and selected local health centers. Based on the open data, numerous software applications quickly emerged to assist the public in finding sales locations efficiently. Methods: Up until March 15, 2020, the Public Digital Innovation Space of Taiwan government had recorded 134 software applications of face mask availability, and 24 software applications were excluded due to defect, duplicate, and unavailability. These applications were analyzed according to platform, developer type, and display mode. Results: Of the 110 valid software applications, 67 (60.9%) applications were deployed on websites, followed by 21 (19.1%) on social networking sites, 19 (17.3%) as mobile applications, and 3 (2.7%) in other modes. Nearly two thirds (n = 70) of applications were developed by individuals, one third (n = 37) by commercial companies, only two applications by central and local governments, and one by a nongovernmental organization. With respect to the display mode, 47 (42.7%) applications adopted map-view only, 41 (37.3%) adopted table-view only, and 19 (17.3%) adopted both modes. Of the remaining three applications, two offered voice user interfaces and one used augmented reality. Conclusion: Taiwan’s open data strategy facilitated rapid development of software applications for information dissemination to the public during the COVID-19 crisis. The transparency of real-time data could help alleviate the panic of the public. The collaborative contributions from the grassroots in disasters were priceless treasures.

Background Differential item functioning (DIF) means the interference of some demographic characteristic or grouping of the tight relationship between trait levels. DIF threatens precise interpretations of survey results and makes them unreliable. The aim of this study was to examine whether the succinct version of Taiwan Patient Safety Culture (TPSC-S) survey is free from DIF and to mitigate its impact if needed. Methods The TPSC-S survey results of 2964 respondents in a public hospital in Taiwan were analyzed. The existence, type, and effect size of DIF were examined for each TPSC-S item using a proportional-odds logistic regression method between characteristic groups, including gender, work experience, job types, management roles, employment status, and safety reporting experiences. Results The study results revealed that several items of TPSC-S showed statistically significant DIF between characteristic groups. Nevertheless, the magnitude of these DIF was small, and their influence to TPSC-S survey was not significant. The domain-level DIF impact was completely insignificant for all characteristic groups. Conclusion This study revealed that the 24-item TPSC-S survey was free from DIF in six characteristic groups. The difference in survey scores between groups stems from the real difference that hospital safety managers want to measure.

Visitors to hospitalized patients during an epidemic might themselves be carriers and are therefore likely to spread the disease in wards. Although measures were taken to restrict hospital visits, traditional paper-based registration is insufficient to screen and monitor the numbers of visitors to a large hospital.Throughout March 2020, during the coronavirus disease 2019 crisis, a computer system was deployed in the 2800-bed Taipei Veterans General Hospital (Taipei, Taiwan) to register, screen, and monitor inpatient visitors. This system comprised three parts: online registration form, entrance check-in interface, and registration database. The early utilization of this newly deployed system was then analyzed.A total of 22,336 visits were recorded between March 11, 2020, and March 31, 2020, with 1064 a day on average. Out of these visits, 18.1% (n = 4049) had made online reservations within 48 hours. On the other hand, of all 4941 online reservations, 18.1% (n = 892) were no-shows. In the last 12 days of the study period, eight prospective visitors were identified as ineligible by the computer system, and so their visits were denied.Using a computer system, the hospital was able to enforce restrictions on hospital visits. Although the online registration system had not been fully used yet in the early phase of adoption, its superiority from the standpoint of disease control should enable hospital managers to consider abolishing on-site visitor registration.

BACKGROUND During pandemics, acquiring outpatients’ travel, occupation, contact, and cluster histories is one of the most important measures in assessing the disease risk among incoming patients. Previous means of acquiring this information in the examination room have been insufficient in preventing disease spread. OBJECTIVE This study aimed to demonstrate the deployment of an automatic system to triage outpatients over the internet. METHODS An automatic system was incorporated in the existing web-based appointment system of the hospital and deployed along with its on-site counterpart. Automatic queries to the virtual private network travel and contact history database with each patient’s national ID number were made for each attempt to acquire the patient’s travel and contact histories. Patients with relevant histories were denied registration or entry. Text messages were sent to patients without a relevant history for an expedited route of entry if applicable. RESULTS A total of 127,857 visits were recorded. Among all visits, 91,195 were registered on the internet. In total, 71,816 of them generated text messages for an expedited route of entry. Furthermore, 65 patients had relevant histories, as revealed by the virtual private network database, and were denied registration or entry. CONCLUSIONS An automatic triage system to acquire outpatients’ relevant travel and contact histories was deployed rapidly in one of the largest academic medical centers in Taiwan. The updated system successfully denied patients with relevant travel or contact histories entry to the hospital, thus preventing long lines outside the hospital. Further efforts could be made to integrate the system with the electronic medical record system.

In previous studies, the frequency of error factors associated with medical adverse events seems to be the only criterion for understanding the distribution of error factors in hospitals. However, the types of error that occur most frequently in hospitals are not necessarily the most important. Therefore, this study integrated human error analysis and fuzzy TOPSIS to reconcile this discrepancy. The purpose of the study is to identity the important human error factors in emergency departments (ED) in Taiwan. Human factors analysis and classification system (HFACS) was used to analyze 35 ED adverse events to define the error factors. Multiple criteria decision making (MCDM) methods such as analytic hierarchy process (AHP) and fuzzy Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) were applied to evaluate the importance of error factors. Results showed that decision errors, crew resource management, inadequate supervision, and resource management were the important human error factors related to ED adverse events. This study recommends that MCDM should be applied to further analyze the results based on the criteria.

Background During pandemics, acquiring outpatients’ travel, occupation, contact, and cluster histories is one of the most important measures in assessing the disease risk among incoming patients. Previous means of acquiring this information in the examination room have been insufficient in preventing disease spread. Objective This study aimed to demonstrate the deployment of an automatic system to triage outpatients over the internet. Methods An automatic system was incorporated in the existing web-based appointment system of the hospital and deployed along with its on-site counterpart. Automatic queries to the virtual private network travel and contact history database with each patient’s national ID number were made for each attempt to acquire the patient’s travel and contact histories. Patients with relevant histories were denied registration or entry. Text messages were sent to patients without a relevant history for an expedited route of entry if applicable. Results A total of 127,857 visits were recorded. Among all visits, 91,195 were registered on the internet. In total, 71,816 of them generated text messages for an expedited route of entry. Furthermore, 65 patients had relevant histories, as revealed by the virtual private network database, and were denied registration or entry. Conclusions An automatic triage system to acquire outpatients’ relevant travel and contact histories was deployed rapidly in one of the largest academic medical centers in Taiwan. The updated system successfully denied patients with relevant travel or contact histories entry to the hospital, thus preventing long lines outside the hospital. Further efforts could be made to integrate the system with the electronic medical record system.

Background While migrants in Taiwan are entitled to universal health care, barriers to health care services exist. We aimed to explore challenges encountered by migrants when accessing health care services and potential strategies to overcome these barriers. Methods Invitations to participate in the study were sent to all hospitals, 12 migrant organizations, one language school, and one language service company in Taiwan, and convenience sampling was used to recruit study participants. Focus group interviews were held with 111 migrants, clinicians, migrant organization coordinators, and representatives from the medical institutions, language school and language service company. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using a thematic approach. Results The study participants acknowledged that the current support system for migrants in the health care sector is inadequate. Barriers to health care services were noted in three areas - language and information, sociocultural and economic, and policy and resources. Potential strategies to overcome these barriers included the provision of on-site or distant interpreting services, provision of multilingual instruction notes and forms, and establishing a multilingual medical assistance hotline. Conclusion While migrants benefit from the current support and welfare system, our study found substantial gaps that need to be filled including a lack of professional medical interpreters and training programs, a lack of legal framework for medical interpreting, and inadequacy in the dispersal of information on existing resources that may facilitate the integration of migrants into society and the health care system. Overcoming these barriers may improve migrants' access to health services.

Understanding the topography of hospital safety culture is vital for developing, implementing, and monitoring the effectiveness of tailored safety programs. Since 2009, the Chinese version of the Safety Attitudes Questionnaire (SAQ-C) has been introduced and administered to providers in many Taiwanese hospitals. The mean percentage of SAQ survey respondents who demonstrate attitudinal agreement within each of the SAQ domains, the percent agreement (PA) score, is used worldwide as the main parameter of safety culture surveys. However, several limitations within PA scoring have been identified. Our study sought to improve scoring methodology and develop a new graph layout for cultural topography presentation. A total of 37,163 responses to a national SAQ-C administration involving 200 Taiwan hospitals were retrospectively analyzed. To understand the central tendency and spread of safety culture scores across all participating hospitals, the median and interquartile range (IQR) of PA scores to the SAQ&rsquo, s teamwork domain were calculated, plotted, and named &ldquo, safety culture grid.&rdquo, Study results denote limitations in the current PA scoring scheme, suggest SAQ analysis modification, and introduce a visualization graph layout that can provide richer information about safety culture dissemination than that available from currently utilized tools.

In Taiwan, migrants come mostly for marriage and work. Several researchers have conducted health-related studies of marital migrants and migrant workers, but the access of the two groups to healthcare has not been studied. Therefore, our study investigated the factors associated with migrants&rsquo, access to healthcare, with the main foci being marital migrants and migrant workers in Taiwan. A structured and cross-sectional questionnaire was anonymously self-administered by migrants recruited to participate in this survey on a voluntary basis from 11 medical centers and 11 migrant-helping associations in Taiwan between May 1st and September 21st, 2018. A total of 753 questionnaires were analyzed. The majority of marital migrants (n = 243) and migrant workers (n = 449) surveyed were enrolled in Taiwan&rsquo, s National Health Insurance system (92.7 vs. 93.5%, p = 0.68). More of the migrant workers (n = 205) than the marital migrants (n = 42) encountered language barriers while seeking medical services (48.0 vs. 17.1%, p &lt, 0.001). A professional interpreter at the point of care was considered important by more of the migrant workers (n = 316) than the marital migrants (n = 89) (70.2 vs. 39.6%, p &lt, 0.001). Although more than 90% of the surveyed migrants were enrolled in the health insurance system in Taiwan, many, especially among the migrant workers, still faced language barriers while seeking medical services.

BACKGROUND Missed appointments mean appointments neither attended nor canceled by patients. Missed appointments belong to one of the important subjects of hospital management because they would incur the inactivity of medical professionals and devices, occupy the health resources for other patients, and thus impair the quality of healthcare services. The aim of this study was to explore the factors of missed appointments at the outpatient department of an academic medical center in Taiwan. METHODS This was a cross-sectional study based on registration records of an academic medical center in Northern Taiwan in 2015. Fifteen variables of patients, appointments, and weathers were taken into analysis. Logistic regression was used to calculate the adjusted odds ratio of each variable. For nonfirst visits, we further built a logistic regression model with the five most influential variables and the personal attendance pattern of the previous three appointments. RESULTS Of 2 132 577 eligible appointments in 2015, the overall no-show rate was 16.9%. The influential factors included the following: (1) patient characteristics: younger than 40 years, ≤6 visits, and a no-show rate between 50% and 75% in the previous year; (2) appointment characteristics: Saturdays, evenings, on the last third of the waiting list, only one appointment on the same day, online appointments, appointment-to-visit intervals (wait time) in 7 to 14 days, appointments to obstetrics/gynecology or pediatrics, first-time appointments, and the interval between the appointed visit and the previous visit in

Patient safety culture is important in preventing medical errors. Thus, many instruments have been developed to measure it. Yet, few studies focus on the data processing step. This study, by analyzing the Chinese version of the Safety Attitudes Questionnaire dataset that contained 37,163 questionnaires collected in Taiwan, found critical issues related to the currently used mean scoring method: The instrument, like other popular ones, uses a 5-point Likert scale, and because it is an ordinal scale, the mean scores cannot be calculated. Instead, Item Response Theory (IRT) was applied. The construct validity was satisfactory and the item properties of the instrument were estimated from confirmatory factor analysis. The IRT-based domain scores and mean domain scores of each respondent were estimated and compared. As for resolution, the mean approach yielded only around 20 unique values on a 0 to 100 scale for each domain, the IRT method yielded at least 440 unique values. Meanwhile, IRT scores ranged widely at each unique mean score, meaning that the precision of the mean approach was less reliable. The theoretical soundness and empirical strength of IRT suggest that healthcare institutions should adopt IRT as a new scoring method, which is the core step of processing collected data.

Background No study to date has systematically examined use, expenditure, and outcomes associated with extracorporeal membrane oxygenation (ECMO) use in Taiwan. The aim of this study was to examine ECMO use, expenditure, and outcomes during an 11-year period in Taiwan. Methods Claims data were collected from the Taiwan National Health Insurance Research Database for patients who received ≥1 ECMO treatment between January 2000 and December 2010. Measurements included demographics, indications for ECMO use, length of hospital stay, outcome, and expenditure. Results A total of 3969 patients received ECMO during the study period (median age: 54.6 years). The number of patients receiving ECMO increased from 52 in 2000 to 1045 in 2010. The major indication for ECMO was cardiovascular disease (68.7%), followed by respiratory disease (17.9%). Median length of hospital stay was 13 days in 2000 and 17 days in 2010. Median expenditure (New Taiwan dollars) was $604 317 in 2000 and $673 888 in 2010. Some variables significantly differed by age, sex, hospital setting, calendar year, and indication for ECMO, and were associated with in-hospital and after-discharge mortality. Conclusions ECMO use has increased dramatically in Taiwan over the last decade. The high mortality rate of ECMO users suggested that ECMO may be being used in Taiwan for situations in which it provides no added benefit. This situation may be a reflection of the current reimbursement criteria for National Health Insurance in Taiwan. Refinement of the indications for use of ECMO is suggested.

Background: Over the last decade, the use of mobile phone apps in the health care industry has grown rapidly. Owing to the high penetration rate of Internet use in Taiwan, hospitals are eager to provide their own apps to improve the accessibility of medical care for patients. Objective: The aims of this study were to provide an overview of the currently available hospital-owned apps in Taiwan and to conduct a cross-hospital comparison of app features. Methods: In May 2017, the availability of apps from all 414 hospitals in Taiwan was surveyed from the hospital home pages and the Google Play app store. The features of the downloaded apps were then examined in detail and, for each app, the release date of the last update, download frequency, and rating score were obtained from Google Play. Results: Among all the 414 hospitals in Taiwan, 150 (36.2%) owned Android apps that had been made available for public use, including 95% (18/19) of the academic medical centers, 77% (63/82) of the regional hospitals, and 22.0% (69/313) of the local community hospitals. Among the 13 different functionalities made available by the various hospital-owned apps, the most common were the doctor search (100%, 150/150), real-time queue monitoring (100%, 150/150), and online appointment scheduling (94.7%, 142/150) functionalities. The majority of apps (57.3%, 86/150) had a rating greater than 4 out of 5, 49.3% (74/150) had been updated at some point in 2017, and 36.0% (54/150) had been downloaded 10,000 to 50,000 times. Conclusions: More than one-third of the hospitals owned apps intended to increase patient access to health care. The most common app features might reflect the health care situation in Taiwan, where the overcrowded outpatient departments of hospitals operate in an open-access mode without any strict referral system. Further research should focus on the effectiveness and safety of these apps. [JMIR Mhealth Uhealth 2018;6(1):e22]

Various survey instruments have been used to measure patient safety culture. Many of these instruments use a (usually5-point) Likert scale. This studyused the Safety Attitudes Questionnaire-Korean version (SAQ-K), consisting of 34 items in six domains, to examine whether other scales, such as dichotomized and trichotomized scales, present equivalent estimates to the currently used 5-point Likert scale (1=disagree strongly, 2=disagree slightly, 3=neutral, 4=agree slightly, 5=agree strongly). For each item, we generated a 3-point scale by collapsing responsesfor 1 and 2 into one category and 4 and 5 into another category, yielding a scale of 1=disagree, 2=neutral, and 3=agree. A dichotomized scale was generated by collapsing responses for 1 through 3 from the original scale to 0=disagree and 4 and 5 to 1=agree. Correlations among the results from the five measurement scales for each respondent, as the unit of analysis, for each of the six domains were estimated: currently used simple mean of item scoreson a 5-point scale, empirical Bayes (EB) estimate from a 5-point graded response model (GRM), EB estimate from a 3-point GRM, EB estimate of a 2-parameter (2PL) item response theory (IRT) model, and EB mean of a 1-parameter (1PL) IRT model. All correlation coefficients were statistically significant (p

encouraged give a lower score to an item about self-confidence than those from a country where more self-assured people are well-respected, even when their underground trait levels of selfconfidence are the same. In more psychometric terminology, this phenomenon—namely, unequal responding patterns among groups—is called differential item functioning (DIF), which is a profound bias threatening survey-based research [3]. If DIF is in doubt, we naturally question whether a difference in survey scores between two groups stems from the real difference in the trait that we want to measure or DIF between the groups, at least to a certain degree [4]. Thus, it is essential to ensure equivalence in the responding pattern for survey items among groups before moving forward to any group-to-group comparison of survey scores and more sophisticated analysis. Unfortunately, however, more often than not, this step is omitted in survey-based studies [5]. In this series of Safety Attitudes Questionnaire–Korean Version (SAQ-K) articles, we have intentionally postponed the discussion on DIF [6-9] because we planned to utilize item response theory (IRT) for DIF detection. Using IRT is known to be a superior method given its conditional invariance property, which enables better decisions on DIF than traditional sum scores of a questionnaire [10]. We waited for the successful application

Years have passed since patient safety culture began to be measured. Several measurement instruments have been developed and used in the field, including the Safety Attitudes Questionnaire (SAQ). Validation is an essential step when administering these instruments to health care professionals. The problem is that confirmatory factory analysis (CFA) has mainly been used for the validation, despite the fact that CFA only works well with continuous responses. Yet SAQ and its variants, including the Korean version, use a 5-point Likert scale, which is by definition not a continuous, but a categorical measure. To resolve this conflict, we used item response theory (IRT) graded response model (GRM), an extension of CFA to categorical variables, to revalidate the SAQ-K and unravel the properties of each item and the SAQ-K instrument as a whole. We calculated difficulty and discriminating parameters for all items first. Then, based on the results, we estimated the expected score of each domain along the latent trait continuum, showing how the current SAQ behaves. We also used the itemlevel and domain-level information function, which can enlighten us on how to improve the precision of the current instrument. Most importantly, we obtained IRT-based empirical Bayes estimates of the latent trait level of each person and compared them with the traditional 0 to 100 SAQ arithmetic mean domain score scale. The correlation coefficients were very high, but when plotted we observed a considerable discrepancy between them. This finding led to the validity of the traditional scoring method in question. We expect the results and methodology of this study to bring about active discussions on the use of such safety culture instruments and help future studies on improving patient safety.

The purpose of this study was to quantify morbidity burdens of children with intellectual disability (ID) and to examine its association with total medical utilization and expenditure on a national basis in Taiwan. People under 18 years of age that had been continuously enrolled in the National Health Insurance (NHI) between year 2008 and 2010 were selected from one million randomly-sampled NHI beneficiaries. The Johns Hopkins Adjusted Clinical Group (ACG) System was applied to evaluate an individual's morbidity burden using 2008-2010 claims data, including age, sex, diagnosis, pharmacy, ambulatory, and inpatient utilization and expenditure (in New Taiwan Dollars, NTDs). The ID prevalence rate was 0.69% for people aged under 18. People with ID could be assigned to 20 mutually exclusive ACGs and to five simplified morbidity categories: healthy (0.1%), low (1.5%), moderate (31.9%), high (44.0%), and very high (22.4%). People with ID had more per capita visits (108.4 vs. 51.5, p0.001), hospital admission (27.7% vs. 13.1%, p0.001), pharmacy (NTD 21,069 vs. 4983, p0.001) and total expenditure (NTD 144,962 vs. 29,764, p0.001) than those without ID over 3 years. Those who assigned to the high-morbid categories cost more in ambulatory and inpatient services than those with low to moderate morbidities. In conclusion, the morbidity burdens of people with ID can be quantified by the ACG System based on readily available data. Regularly evaluating morbidity burdens and medical utilization has particular relevance for planning high-quality and efficient care. People's disabilities and comorbid illnesses shall be treated by integrated multidisciplinary teams.

Aim: That geriatric evaluation and management (GEM) is associated with better quality of care for elderly patients has been reported by previous studies, but evidence supporting that GEM can reduce the burden of morbidity (BOM) was lacking. The aim of this study was to evaluate the benefits of outpatient GEM on reducing BOM and medical utilization in Taiwan. Methods: Data of this retrospective case–control study were obtained from the 2004–2006 Taiwan National Health Insurance Research Database (NHIRD). Patients who attended the outpatient GEM program for over 6 months in a tertiary medical center in 2005 were enrolled as the case group, and a 1:5 age and gender-matched control group was formed by randomly-selected patients from the same medical center for comparisons. BOM was obtained by applying the Adjusted Clinical Group (ACG) program, and medical utilization variables were totalled for each patient from the NHIRD. Patients were further reassigned to two morbidity categories, the low (resource utilization bands ≤ 3) and high (resource utilization bands > 3) morbidity category, according to their degree of morbidity before statistical analyses. Results: Data of 4254 elderly patients (709 cases, 3545 controls) were included in the study. BOM and medical utilization were increased in both groups in both morbidity categories during the study period. However, the growth of BOM, total medical expenditure, number of emergency department visit, and days and expenditure of hospitalization were significantly reduced in the case than the control group in the low morbidity category, not the high morbidity category. Conclusion: Outpatient GEM could effectively reduce growth of BOM and medical utilization for relatively healthy elderly patients in Taiwan where elderly patients haverelatively free access to general and specialty care. The results of this study implied the potential benefits of systematically implementing GEM in primary health-care settings to improve the quality of care and slow down the growth of BOM for elderly patients. Geriatr Gerontol Int 2012; ••: ••–••.

Background: Social media advertising has become increasingly influential in recent years. Because Facebook has the most active users worldwide, many hospitals in Taiwan have created official Facebook fan pages. Our study was to present an overview of official Facebook fan pages of hospitals in Taiwan. Methods: All 417 hospitals were surveyed about their use of Facebook fan pages in December 2017. The last update time, posts in the past 30 days, number of &ldquo, Likes&rdquo, and other features were analyzed and stratified according to the accreditation statuses of the hospitals. Results: In Taiwan, only 51.1% (n = 213) of the hospitals had an official Facebook fan page. Among these hospitals, 71.8% (n = 153) had updated their pages in the past 30 days, although 89.2% (n = 190) provided online interactions. Academic medical centers tended to have more &ldquo, than regional and local community hospitals (on average 5947.4, 2644.8, and 1548.0, respectively). Conclusions: In spite of the popularity of Facebook among the general population, most hospitals in Taiwan do not seem to make good use of this kind of social media. The reasons for the use and nonuse of Facebook on the part of both hospitals and patients deserve further investigation.

Background: The adjusted clinical group (ACG) is a diagnosis-based case-mix adjustment system, which has been widely evaluated in several countries other than Taiwan. The aim of this study was to assess the performance of the ACG system on the National Health Insurance (NHI) population in Taiwan. Methods: We conducted longitudinal data analysis using the claims data of 1% of randomly sampled NHI enrollees from 2000 to 2004. The ACG software was used to assign each individual to 1 ACG category based on age, gender and aggregating diagnoses in each year from 2000 to 2004, respectively. The ACG distribution patterns and their relationships to expenditure were examined. Explanatory ability as measured by adjusted R 2 of the ACG system for same-year and next-year ambulatory and inpatient expenditure were examined by multivariate regression models for each year. Results: The quality of NHI claim data was satisfactory in that 98.1% of the population could be assigned to ACG categories. The population’s ACG patterns were substantially consistent but unequally distributed across the 5 years. Eighty percent of NHI expenditure were spent on people assigned to 21 ACGs. The explanatory abilities of individual’s ACG and its components with respect to the variance of same-year and next-year 99% truncated visits, ambulatory expenditure, inpatient expenditure, and total NHI expenditure were quite consistent across years and were superior to age and gender. The explanatory performance was better for ambulatory than inpatient expenditure and was comparable to the statistics demonstrated in other countries. Conclusion: The ACG system worked well for Taiwanese ambulatory visits and expenditure across years. Health care authorities can introduce the ACG system to quantify the population’s morbidity burdens and medical needs. [J Chin Med Assoc 2008;71(4):191–199]

Background: It has been suggested that increased blood haemoglobin attenuates splanchnic vasodilatation in portal-hypertensive rats by nitric oxide inactivation. However, the haemodynamic effect of anaemia in cirrhotic patients of varying severity has been rarely discussed. The aim of this study was to evaluate the influence of anaemia on systemic and splanchnic haemodynamics in cirrhotic patients of differing severity. Methods: Two hundred and twenty-five cirrhotic patients were included in this study. All biochemical and haemodynamic results were utilized for analysis. Anaemia was defined as a haemoglobin level below the cut-off value of 12g/dL, which might best predict low systemic vascular resistance. Results: Compared with non-anaemic patients, anaemic patients had decreased mean arterial pressure (90 ± 1 vs 95 ± 1 mmHg, P = 0.002), and decreased systemic vascular resistance (1022 ± 25 vs 1227 ± 30, P < 0.0001), and increased cardiac index (4.3 ± 0.1 vs 3.8 ± 0.1 L/min per m2, P < 0.0001) and increased hepatic venous pressure gradient (16.7 ± 0.5 vs 14.4 ± 0.6 mmHg, P = 0.006). Haemoglobin concentration exerted an influence on the degree of vasodilatation in cirrhotic patients, with Child–Pugh’s A class (but not in Child–Pugh’s B and C classes), and in patients without ascites (but not in patients with ascites). Conclusions: It was concluded that anaemia has a negative effect on hyperdynamic circulation in patients with early cirrhosis which is not observed in patients with advanced cirrhosis.

Losartan, a highly selective angiotensin II type 1 receptor antagonist, has been reported to have a significant portal hypotensive effect in cirrhotic patients. A recent study also showed that losartan exerted a dramatic natriuretic effect in preascitic cirrhosis. The influence of losartan on renal hemodynamics and sodium homeostasis in cirrhotic patients with ascites is unclear. This study was undertaken to evaluate the renal effects of 1-week losartan treatment in cirrhotic patients with and without ascites. Methods. All 12 patients in the study received a daily oral dose of 25 mg losartan for 7 consecutive days. Effective renal plasma flow, urine volume, creatinine clearance, 24h urine sodium excretion and fractional excretion of sodium, blood urea nitrogen, and serum creatinine were measured before and after treatment. Results. In cirrhotic patients without ascites, creatinine clearance, 24-h urinary sodium excretion, and fractional excretion of sodium were significantly increased after losartan administration. Effective renal plasma flow and serum creatinine showed almost no change after treatment. In cirrhotic patients with ascites, creatinine clearance, 24-h urinary sodium excretion, fractional excretion of sodium, and effective renal plasma flow were significantly increased after losartan administration. In addition, the magnitudes of the increases in the fractional excretion of sodium and in the 24-h urinary sodium excretion were greater in cirrhotic patients with ascites than in those without ascites. Conclusions. One-week treatment with losartan increases sodium excretion in association with an improvement of renal function in cirrhotic patients with and without ascites. The natriuretic effect was more profound in cirrhotic patients with ascites than in those without ascites.

Hyperamylasemia with a presumptive diagnosis of acute pancreatitis has been reported following organophosphate poisoning but there are no large-scale studies incorporating more specific diagnostic criteria.Retrospective review of the medical records of 159 patients with a diagnosis of organophosphate poisoning over 3 years. Serum amylase, pancreatic amylase, salivary amylase, lipase and cholinesterase levels, and the clinical manifestations were analyzed.Serum amylase data was available for 121 of the 159 study patients. Hyperamylasemia (amylaseor = 360 U/L) was found in 44 patients (36%). Lipase was measured in 28 patients with hyperamylasemia; 9 of 28 had hyperlipasemia (lipaseor = 380 U/L). The finding of hyperamylasemia was closely related to clinical severity and presence of shock. A presumptive diagnosis of painless acute pancreatitis was diagnosed by hyperlipasemia associated with hyperamylasemia, clinical severity, serum LDH, and leukocyte counts. Two patients with presumptive pancreatitis died. Shock, coma, and hypoalbuminemia were the factors predicting fatality.Hyperamylasemia is frequent in severe organophosphate poisoning. However, hyperamylasemia is not synonymous with acute pancreatitis and pancreatic amylase is not a reliable parameter in the diagnosis of organophosphate-induced pancreatitis due to its low sensitivity and specificity. Lipase assay is indicated in patients with hyperamylasemia for early diagnosis of pancreatitis. Proper image studies and even pathological examination are also needed to confirm the extent of pancreatic injury. With prompt diagnosis and appropriate treatment, a complete recovery can be anticipated unless the patient has otherwise unrelated complications.