Crowdsource authoring as a tool for enhancing the quality of competency assessments in healthcare professions.

The current Objective Structured Clinical Examination (OSCE) is complex, costly, and difficult to provide high-quality assessments. This pilot study employed a focus group and debugging stage to test the Crowdsource Authoring Assessment Tool (CAAT) for the creation and sharing of assessment tools used in editing and customizing, to match specific users' needs, and to provide higher-quality checklists. Competency assessment international experts (n = 50) were asked to 1) participate in and experience the CAAT system when editing their own checklist, 2) edit a urinary catheterization checklist using CAAT, and 3) complete a Technology Acceptance Model (TAM) questionnaire consisting of 14 items to evaluate its four domains. The study occurred between October 2018 and May 2019. The median time for developing a new checklist using the CAAT was 65.76 minutes whereas the traditional method required 167.90 minutes. The CAAT system enabled quicker checklist creation and editing regardless of the experience and native language of participants. Participants also expressed the CAAT enhanced checklist development with 96% of them willing to recommend this tool to others. The use of a crowdsource authoring tool as revealed by this study has efficiently reduced the time to almost a third it would take when using the traditional method. In addition, it allows collaborations to partake on a simple platform which also promotes contributions in checklist creation, editing, and rating.

Competitive advantages of organizational project management maturity: A quantitative descriptive study in Australia.

The purpose of this study is to examine whether organizational project management maturity in the project management consultancy industry offers any competitive advantages to a business when it tenders for contracts. We collected 150 responses from both members and former members of professional Australian project management associations in order to examine and understand any potential effects of project management maturity on management and organizations. The statistical software SPSS was used to analyze the data collected with the confidence interval (alpha) set at 5%. The results of this study reveal that organizational project management maturity has an effect on competitive advantages as noted by the project managers (p < .0001; 99.99%; H0 -rejected). The study also shows that the perception of competitive advantages for organizational project management maturity is based on the level of maturity reached. It also reveals that an organization is winning contracts/jobs due to various other competencies, particularly soft skills such as client relationships, stakeholder management, communications skills, and modes of client engagement.

A Preliminary Study on Self-Healing and Self-Health Management in Older Adults: Perspectives From Healthcare Professionals and Older Adults in Taiwan.

The human body has tremendous self-healing capacity and regeneration after injuries and pathogen invasions. These factors are particularly important in older adults which take longer to heal and recover physically. In addition to clinical investigations, perspectives from both experts in the field and the living experiences of the general public could play significant roles to enhance the body's healing mechanisms in older adults. A semi-structured interview was conducted which included 15 participants (9 experts and 6 older adults aged 65 years and older). Content analysis with an inductive approach was employed about participants' experiences and perspectives. All participants in this study revealed that self-healing mechanisms can be enhanced through physiological, psychological, and socio-environmental factors. When more of these factors can be integrated into a recovery management plan, it can hasten self-healing in older adults. Social capability has a profound impact on an individual's mental health while oral health and hygiene significantly affect the nutritional intake status. In regards to physical aspects, regular daily activity patterns, nutritious eating, moderate exercise, and sleep quality are significant, while psychological aspects such as cheerfulness, positive attitudes, and good interpersonal relationships can help control chronic diseases.

Depression and young age impact on hip fracture subsequent to stroke: A population-based cohort study.

AIMS: The purpose of this study is to identify whether depression and other associated factors in stroke are related to subsequent hip fracture. BACKGROUND: There are very few studies that focus on depression and demographic impact on subsequent hip fracture after a stroke. DESIGN: This a retrospective cohort study design. METHODS: The Taiwan Longitudinal Health Insurance Database between 1997 and 2010 was used. Two stroke patient cohorts were analysed: (1) depression within 1 year after newly diagnosed strokes; (2) without depression within 1 year after newly diagnosed strokes. Demographic characteristics, comorbidities, and hip fracture were compared using the Fine and Gray regression model for subdistribution hazard ratios. RESULTS/FINDINGS: Patients with depression showed a higher risk of hip fracture (95% CI, 0.99-1.66). Depression was associated with increased risk of hip fracture for patients below 50 years old (95% CI, 1.45-7.34). Comorbidities and gender showed no significant correlation with hip fracture risk in the depressed or nondepressed groups. CONCLUSION: Poststroke depression was a significant contributor to hip fracture in patients who suffered strokes and had more negative impact on the younger population, regardless of the gender and presence of comorbidities.

Using modified information delivery to enhance the traditional pharmacy OSCE program at TMU - a pilot study.

BACKGROUND AND OBJECTIVE: Objective Structured Clinical Examination (OSCE) has been used in many areas of healthcare training over the years. However, it constantly needs to be upgraded and enhanced due to technological and teaching changes. We aim at implementing an integrative OSCE method which employs informatics via the virtual patient within the pharmacy education curriculum at Taipei Medical University to enhance the pharmacy students' competence for using and disseminating information and to also improve critical thinking and clinical reasoning. METHODS: We propose an integrated pharmacy OSCE which uses standardized patients and virtual patients (DxR Clinician). To evaluate this method, we designed four simulated stations and pilot tested with 19 students in the first year of the Master in Clinical Pharmacy program. Three stations were simulated as the inpatient pharmacy: 1) History and lab data collection; 2) Prescription review; 3) Calling physician to discuss potential prescription problems. The fourth was simulated as the patient ward station to provide patient education. A satisfaction questionnaire was administered at the end of the study. RESULTS: Students rated their ability of 2.84, 2.37, 2.37, and 3.63 of 5 for each of the four stations, with the second and third being the most difficult stations. The method obtained an average rating of 4.32 of 5 for relevance, 4.16 for improving clinical ability, 4.32 for practicality in future healthcare work, and 4.28 for willing to have another similar learning experience. CONCLUSION: The integration of Virtual Patient in this study reveals that this assessment method is efficient and practical in many aspects. Most importantly, it provides the test taker with a much closer real-life clinical encounter. Although it is in many ways more difficult, it also provides for better "learning from mistakes" opportunities for test-takers.

Physical activity: A primary health quality determinant among community-dwelling geriatric women in Taiwan.

OBJECTIVE: To investigate the associations between frailty, physical activity and depression in community-dwelling geriatric women. DESIGN: A cross-sectional research design. SETTING: Community geriatric women in Illan County, Taiwan. STUDY PARTICIPANTS: Of note 216 participants, 65 years and older with full mobility, independent and able to communicate in Mandarin or Taiwanese Hokkien. MAIN OUTCOME MEASURES: An average weekly physical activity score International Physical Activity Questionnaire-Short Form (IPAQ-SF) and Taiwan Geriatric Depression Scale. Classification and regression tree (CART) analysis was used to perform decision analysis. RESULTS: The average IPAQ-SF score for the 216 participants was 9109.52. When an IPAQ-SF score of 4452 or below was obtained by participants, 38% of them encountered depression-like syndromes, regardless of their frailty status. Diabetes, high risk of metabolic syndrome and lower education were the risk factors found to cause depression among participants with low physical activity levels. CONCLUSIONS: As women have a longer life expectancy and experience twice the rates of depression of men particularly after menopause, healthcare providers should emphasize exercise and lifestyle changes in order to improve the quality of health in geriatric women.

A personalized medication management platform (PMMP) to improve medication adherence: A randomized control trial.

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.

The effect of an integrated education model on anxiety and uncertainty in patients undergoing cervical disc herniation surgery.

BACKGROUND: Educating patients about receiving surgical procedures is becoming an important issue, as it can reduce anxiety and uncertainty while helping to hasten decisions for undergoing time sensitive surgeries. We evaluated a new integrated education model for patients undergoing cervical disc herniation surgery using a quasi-experimental design. METHODS: The participants were grouped into either the new integrated educational model (n = 32) or the standard group (n = 32) on the basis of their ward numbers assigned at admission. Anxiety, uncertainty, and patient satisfaction were measured before (pre-test) and after the educational intervention (post-test-1) and post-surgery (post-test-2) to assess the effectiveness of the model in this intervention. RESULTS: We found that the generalized estimating equation modeling demonstrated this new integrated education model was more effective than the conventional model in reducing patients' anxiety and uncertainty (p <0.05). Patients were also more satisfied with our newly developed model as it takes a more holistic approach to individual health. CONCLUSION: This novel systemic educational model enhances patient's understanding of the medical condition and surgery while promoting patient-caregiver interaction for optimal patient health outcomes. We present a comprehensive and consistent platform for educational purposes in patients undergoing surgery as well as reducing the psychological burden from anxiety and uncertainty. Integrating medicine, nursing, and new technologies into an e-practice and e-learning platform offers the potential of easier understanding and usage. It could revolutionize patient education in the future.

Managing mass events and competitions with difficult-to-access locations using mobile electrocardiac monitoring.

OBJECTIVE: Using mobile wireless technology to monitor ECG in participants of mass events and sports taking place in difficult-to-access location could both prevent and easier detect arrhythmias as well as provide real-time monitoring for any type of injury. We assessed the effectiveness of mobile wireless monitoring technology and IT in detecting possible emergencies during a skyscraper race. METHODS: We attached specially designed wireless surveillance biopatches on 120 individuals participating to monitor their continuous ECG and location during a skyscraper run-up race at Taipei 101 building, Taiwan. The outcomes of interest were detection of abnormal heartbeats and QRS waves indicative of possible cardiac problems and the exact location of participants during the occurrence of emergencies. RESULTS: The devices accurately sent over 50 warnings to our monitoring platform when both, danger limits were reached by competitors (<60 or >195 beats per minute) or competitors stopped moving, proving very effective in quickly detecting abnormities and alerting staff of possible emergencies at exact locations. CONCLUSION: This efficient and inexpensive monitoring method can also prevent arrhythmias in unscreened competitors, the danger of collision among staff and competitors, and preserves oxygen by eliminating additional on-foot monitoring staff. Additionally, it could have multipurpose usage, especially during disasters and accidents occurring in difficult-to-access locations, in military exercises and personal monitoring.

Using hemoglobin A1C as a predicting model for time interval from pre-diabetes progressing to diabetes.

OBJECTIVE: The early identification of subjects at high risk for diabetes is essential, thus, random rather than fasting plasma glucose is more useful. We aim to evaluate the time interval between pre-diabetes to diabetes with anti-diabetic drugs by using HbA1C as a diagnostic tool, and predicting it using a mathematic model. METHODS: We used the Taipei Medical University Affiliated Hospital Patient Profile Database (AHPPD) from January-2007 to June-2011. The patients who progressed and were prescribed anti-diabetic drugs were selected from AHPPD. The mathematical model used to predict the time interval of HbA1C value ranged from 5.7% to 6.5% for diabetes progression. RESULTS: We predicted an average overall time interval for all participants in between 5.7% to 6.5% during a total of 907 days (standard error, 103 days). For each group found among 5.7% to 6.5% we determined 1169.3 days for the low risk group (i.e. 3.2 years), 1080.5 days (i.e. 2.96 years) for the increased risk group and 729.4 days (i.e. 1.99 years) for the diabetes group. This indicates the patients will take an average of 2.49 years to reach 6.5%. CONCLUSION: This prediction model is very useful to help prioritize the diagnosis at an early stage for targeting individuals with risk of diabetes. Using patients' HbA1C before anti-diabetes drugs are used we predicted the time interval from pre-diabetes progression to diabetes is 2.49 years without any influence of age and gender. Additional studies are needed to support this model for a long term prediction.

Empowering village doctors and enhancing rural healthcare using cloud computing in a rural area of mainland China.

BACKGROUND: China's healthcare system often struggles to meet the needs of its 900 million people living in rural areas due to major challenges in preventive medicine and management of chronic diseases. Here we address some of these challenges by equipping village doctors (ViDs) with Health Information Technology and developing an electronic health record (EHR) system which collects individual patient information electronically to aid with implementation of chronic disease management programs. METHODS: An EHR system based on a cloud-computing architecture was developed and deployed in Xilingol county of Inner Mongolia using various computing resources (hardware and software) to deliver services over the health network using Internet when available. The system supports the work at all levels of the healthcare system, including the work of ViDs in rural areas. An analysis done on 291,087 EHRs created from November 2008 to June 2011 evaluated the impact the EHR system has on preventive medicine and chronic disease management programs in rural China. RESULTS: From 2008 to 2011 health records were created for 291,087 (26.25%) from 1,108,951 total Xilingol residents with 10,240 cases of hypertension and 1152 cases of diabetes diagnosed and registered. Furthermore, 2945 hypertensive and 305 diabetic patients enrolled in follow-up. Implementing the EHR system revealed a high rate of cholecystectomies leading to investigations and findings of drinking water contaminated with metals. Measures were taken to inform the population and clean drinking water was supplied. CONCLUSIONS: The cloud-based EHR approach improved the care provision for ViDs in rural China and increased the efficiency of the healthcare system to monitor the health status of the population and to manage preventive care efforts. It also helped discover contaminated water in one of the project areas revealing further benefits if the system is expanded and improved.

An integrative OSCE methodology for enhancing the traditional OSCE program at Taipei Medical University Hospital--a feasibility study.

BACKGROUND: Continuous development and use of new technologies and methodologies are key features in improving the learning, performance, and skills of medical students and students of all health care professions. Although significant improvements in teaching methodologies have been made in all areas of medicine and health care, studies reveal that students in many areas of health care taking an objective structured clinical examination (OSCE) express difficulties. Thus, this study was planned as a feasibility study to assess the educational effectiveness of an integrated objective structured clinical examination (iOSCE) using both standardized patients and virtual patients. METHODS: Thirty (30) medical students in their first year of internship at Taipei Medical University volunteered to be part of a feasibility study for demonstrating the concept of iOSCE. They divided themselves into five groups of six students each and were requested to evaluate two cases: 1) a patient with abdominal pain and 2) a patient with headache using a combination of a standardized patient and a virtual patient. For each of the two cases, five stations were designed in which students were given ten minutes per station leading to a final diagnosis and concluded with a debriefing. The five stations were: Station 1) Interacting with the standardized patient. Station 2) Writing the patient note and developing a differential diagnosis. Station 3) Selecting appropriate laboratory and imaging studies. Station 4) Making a final diagnosis and stating the evidence for it. Station 5) Having the debriefing. Each group of 6 students was assigned 2 hours per day for each case. All participants completed a survey regarding the usefulness and efficiency of the iOSCE. RESULTS: All medical students (30/30; 100%) found the iOSCE program to be very satisfactory, and all expressed that they would like to have further iOSCE experiences if given the opportunity. In terms of ease and helpfulness, the students rated the program an average of 4.4 for the 1st case (abdominal pain) and 4.5 for the 2nd case (headache) on a scale of 1-5, with 5 being the highest and 1 being the lowest score. CONCLUSIONS: The participants felt that the iOSCE program can offer certain advantages over the traditional OSCE with the SP alone. They cited that the iOSCE provided improved clarity of what was being assessed as well as providing an opportunity to improve their diagnostic reasoning.

The role of adherence in the relationship between self-efficacy and self-management in diabetic patients undergoing CABG in Taiwan.

OBJECTIVES: To determine the role of adherence and its significance in the relationship between self-efficacy and self-management of diabetic patients undergoing coronary artery bypass graft (CABG) in Taiwan. DESIGN: Descriptive and correlational survey design. SETTING: Three outpatient clinics in Taiwan. PARTICIPANTS: Patients diagnosed with diabetes undergoing CABG at least 6 months before the study, 18 years of age or older, able to communicate verbally without any psychiatric problems, and with a life expectancy longer than 1 year. MAIN OUTCOME MEASURES: Self-management assessment (self-efficacy for managing disease and adherence to guidelines and medication measured on a scale of 0-8), the higher aspects of self-management (keeping appointments, taking medication properly and keeping follow-up appointments) and the lower aspects of self-management (inability to share decisions with primary physician, inability to take correct actions when symptoms worsen and inability to adapt habits to improve health). RESULTS: The mean score obtained for self-management among the 166 participants was 6.48, with 57 (34.3%) of them showing non-adherent behaviour. Self-efficacy accounts for 38% (R(2)=0.380, F(1,103)=63.124, p < 0.001), and 54% of good self-management was explained by self-efficacy and adherence in managing disease (R(2)=0.540, F(2,102)=56.937, p<0.001). Adherence accounts for 16% of better self-management, age and education combined account for 4.9% (R(2)=0.589, F(6.98)=23.399, p<0.001), and lifestyle items account for 5.2% (R(2)=0.641, F(14,90)=11.457, p<0.001). Disease-related variables contribute 3.4% (R(2)=0.674, F(17,87)=10.599, p<0.001). Thus self-efficacy, adherence, age, education, primary care provider and systolic pressure are considered significant predictors of self-management. With the exception of adherence, none of the variables had a statistically significant mediating effect. CONCLUSIONS: The results confirm strong relationships between self-efficacy, adherence and self-management, with adherence having a significant mediating effect in post-CABG patients with diabetes in Taiwan.

TSCC: Two-Stage Combinatorial Clustering for virtual screening using protein-ligand interactions and physicochemical features.

BACKGROUND: The increasing numbers of 3D compounds and protein complexes stored in databases contribute greatly to current advances in biotechnology, being employed in several pharmaceutical and industrial applications. However, screening and retrieving appropriate candidates as well as handling false positives presents a challenge for all post-screening analysis methods employed in retrieving therapeutic and industrial targets. RESULTS: Using the TSCC method, virtually screened compounds were clustered based on their protein-ligand interactions, followed by structure clustering employing physicochemical features, to retrieve the final compounds. Based on the protein-ligand interaction profile (first stage), docked compounds can be clustered into groups with distinct binding interactions. Structure clustering (second stage) grouped similar compounds obtained from the first stage into clusters of similar structures; the lowest energy compound from each cluster being selected as a final candidate. CONCLUSION: By representing interactions at the atomic-level and including measures of interaction strength, better descriptions of protein-ligand interactions and a more specific analysis of virtual screening was achieved. The two-stage clustering approach enhanced our post-screening analysis resulting in accurate performances in clustering, mining and visualizing compound candidates, thus, improving virtual screening enrichment.