Human Error Analysis and Modeling of Medication-Related Adverse Events in Taiwan Using the Human Factors Analysis and Classification System and Logistic Regression.

Medical institutions worldwide strive to avoid adverse medical events, including adverse medication-related events. However, studies on the comprehensive analysis of medication-related adverse events are limited. Therefore, we aimed to identify the error factors contributing to medication-related adverse events using the Human Factors Analysis and Classification System (HFACS) and to develop error models through logistic regression. These models calculate the probability of a medication-related adverse event when a healthcare system defect occurs. Seven experts with at least 12 years of work experience (four nurses and three pharmacists) were recruited to analyze thirty-seven medication-related adverse events. The findings indicate that decision errors, physical/mental limitations, failure to correct problems, and organizational processes were the four factors that most frequently contributed to errors at the four levels of the HFACS. Seven error models of two types (error occurrence and error analysis pathways) were established using logistic regression models, and the relative probabilities of failure factor occurrences were calculated. Based on our results, medical staff can use the error models as a new analytical approach to improve and prevent adverse medication events, thereby improving patient safety.

Increased Risk of Common Orthopedic Surgeries for Patients with Rheumatic Diseases in Taiwan.

Background and Objectives: Rheumatic diseases, including rheumatoid arthritis, ankylosing spondylitis, psoriasis, and systemic lupus erythematosus (SLE), are characterized by chronic arthritis or spondyloarthritis, which can lead to joint and spine destruction. Our previous studies showed that the risk of common orthopedic surgeries, including total knee replacement (TKR), total hip replacement (THR), or spine surgery, was increased in patients with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and SLE. The aim of this review was to summarize the risk of TKR, THR, cervical spine, and lumbar spine surgery on the basis of studies conducted using data from Taiwan's National Health Insurance Research Database (NHIRD). Materials and Methods: The risk of TKR, THR, cervical spine surgery, and lumbar spine surgery in patients with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and SLE was summarized from the results of our previous studies and unpublished findings based on NHIRD data. Results: Patients with rheumatoid arthritis and psoriasis and men with ankylosing spondylitis showed an increased risk of TKR. Patients with rheumatoid arthritis, ankylosing spondylitis, and women with SLE showed an increased risk of receiving THR. Only patients with ankylosing spondylitis had an increased risk of cervical spine surgery, and patients with rheumatoid arthritis or ankylosing spondylitis showed an increased risk of lumbar spine surgery. Although the risk of THR, TKR, or spine surgery in these patients has declined in the era of biologics use, direct evidence for the effects of biologics agents is not yet available. Conclusions: There was an increased risk of common orthopedic surgery in patients with rheumatoid arthritis, ankylosing spondylitis, psoriasis, and SLE. Clinicians should be vigilant to reduce the increased risk of TKR and THR in young and middle-aged patients with rheumatoid arthritis, THR in young patients with ankylosing spondylitis, and young female patients with SLE, as well as cervical spine surgery in young patients with ankylosing spondylitis.

A Simulation-Based Study of the Effect of Brake Light Flashing Frequency on Driver Brake Behavior from the Perspective of Response Time.

To prevent vehicle crashes, studies have proposed the use of flashing signals (brake lights or other light indicators) to improve the driver's response time when the leading vehicle is braking. However, there are no consistent results on the ideal flashing frequency of the brake lights. This study aimed to investigate different brake light flashing frequencies to assess their impact on braking response time. Twenty-four participants aged 25 to 30 were recruited. Two driving speed environments (50 and 80 km/h), three deceleration rates (0.25, 0.6, and 1 g), and four brake light flashing frequencies (0, 2, 4, and 7 Hz) were examined. Braking response time, average braking force, and braking response time ratio were used to evaluate the driving behavior. The results showed that the braking response time and average braking force were affected by the deceleration rate in the 50 km/h driving environment. In the 50 and 80 km/h driving environments, although there were no significant differences among the three deceleration rates, the braking response time decreased by 3-7% under the flashing brake light condition. These findings can be used as a reference for safety designs as well as future studies on driving behavior.

Decreased Risk of Low Back Pain During Pregnancy Associated With the Use of Orthopedic Manual Therapy: A Nested Case-Control Study.

Background: Recent evidence suggests that the use of orthopedic manual therapy (OMT) may lessen the subsequent risk of low back pain (LBP), but this association has not been examined among pregnant women who are at higher risk of LBP. This study aims to determine whether the addition of OMT to conventional LBP treatment before pregnancy could decrease the subsequent risk of LBP during pregnancy. Methods: From Taiwan's National Health Insurance Research Database, we identified 68,960 women, 20-55 years of age, with first pregnancy between 2001 and 2012. We then performed a nested case-control study in which 3,846 women with newly diagnosed LBP were matched to 3,846 controls according to age and cohort entry year. Multivariate conditional logistic regression was employed to estimate the association between OMT use before pregnancy and LBP during pregnancy. Results: OMT users had a lower risk of LBP than did non-users, with an adjusted OR of 0.86 (95% CI, 0.78-0.93). Subgroup analysis showed that women with high intensity use of OMT treatment prior to pregnancy reported the lowest level of LBP during pregnancy by nearly 30%. Conclusion: The pre-pregnancy use of OMT treatment significantly decreased LBP risk during pregnancy, especially with high-intensity use. Thus, clinicians may consider recommending OMT for pregnant women to avoid possible obstetric complications during the pregnancy.

Stature estimation from various three-dimensional anthropometric foot measurements of Taiwanese female population.

Predicting a victim's stature from a dismembered body or human remains is a challenge in forensic practice. Lower extremity dimensions, such as the foot, are essential measurements for stature estimation. However, there is no available information on stature prediction generated from Taiwanese female foot measurements in the forensic science field. Hence, this study aims to investigate the correlations between various foot dimensions and stature and develop population-specific stature-prediction equations for Taiwanese females. Bilateral data of 12 foot dimensions were collected from 1058 females aged from 18 to 59 years using three-dimensional scanning. A pairedt-test is performed to evaluate bilateral differences, and linear and stepwise regression analyses are performed to generate stature predictions. The results indicate significant bilateral differences in the majority of the foot measurements. All measurements are positively correlated with stature (p < .05). Higher correlation coefficients with stature are observed in length-related foot dimensions, followed by girth- and breadth-related dimensions. The foot length on both sides is selected as an accurate and reliable parameter to conduct linear stature-predicting regression for Taiwanese females because it exhibits the highest explanation rate (right: 54.1%; left: 50.8%) and lowest estimating standard error (right: 3.883 cm, left: 4.020 cm) among the 12 foot measurements. Based on the results of the stepwise regression analysis, several stature-prediction equations consisting of various foot measurements are established. The findings of this study can provide helpful information for predicting the stature of Taiwanese females from fragmentary foot remains.

Effect of Environmental Noise, Distance and Warning Sound on Pedestrians' Auditory Detectability of Electric Vehicles.

With developments in science and technology, the number of electric vehicles will increase, and they will even replace ICE vehicles. Thus, perceiving the presence of approaching electric vehicles on the road has become an important issue. In this study, the auditory detectability of the electric vehicle warning sound at different volumes, distances, and environmental noise levels was investigated. To this end, the detection rate was recorded in experiments with three environmental noise levels (50, 60, and 70 dBA), two sound pressure levels (SPLs) of the warning sound (46 and 51 dBA), three frequency combinations of the warning sound (5000, 2500, 1250, and 630 Hz for high frequencies; 2500, 1250, 630, and 315 Hz for medium frequencies; and 1250, 630, 315, and 160 Hz for low frequencies), and five distances (2, 4, 6, 8, and 10 m). The main results showed that the detection rate at 51 dBA was significantly higher than that at 46 dBA under a high-frequency warning sound; however, the detection rates were similar under medium- and low-frequency warning sounds. The participants' rates of detection for warning sounds were less than 20% under all experimental conditions, and a high-frequency warning sound was not affected by environmental noise. With regard to distances, no significant effects were observed between the distances and the detection rate at any of the three frequencies. In addition, auditory thresholds based on high-, medium-, and low-frequency warning sounds were found through logistic regression analysis results. The results of this study can be used as a reference for the future design of warning sounds.

An Investigation of Human Errors in Medication Adverse Event Improvement Priority Using a Hybrid Approach.

The aim of this study was to analyze and provide an in-depth improvement priority for medication adverse events. Thus, the Human Factor Analysis and Classification System with subfactors was used in this study to analyze the adverse events. Subsequently, the improvement priority for the subfactors was determined using the hybrid approach in terms of the Analytical Hierarchy Process and the fuzzy Technique for Order of Preference by Similarity to Ideal Solution. In Of the 157 medical adverse events selected from the Taiwan Patient-safety Reporting system, 25 cases were identified as medication adverse events. The Human Factor Analysis and Classification System and root cause analysis were used to analyze the error factors and subfactors that existed in the medication adverse events. Following the analysis, the Analytical Hierarchy Process and the fuzzy Technique for Order of Preference by Similarity to Ideal Solution were used to determine the improvement priority for subfactors. The results showed that the decision errors, crew resource management, inadequate supervision, and organizational climate contained more types of subfactors than other error factors in each category. In the current study, 16 improvement priorities were identified. According to the results, the improvement priorities can assist medical staff, researchers, and decisionmakers in improving medication process deficiencies efficiently.

Effect of correlated colour temperature and illuminance levels on user's visual perception under LED lighting in Taiwan.

This study aimed to utilise the characteristics of light-emitting diode (LED) lighting, including the adjustable correlated colour temperature (CCT) and illuminance levels, to evaluate the effects of various CCT and illuminance level combinations on visual perception and their patterns under different lighting conditions. Five white light balances with different CCTs were created together with four levels of illuminance. Based on the patterns of visual perception, when the CCT increased with the illuminance levels, the participants' visual perception changed from dim, boring, and sleepy to intense, vivid, energetic, and bright. As the CCT decreased, the participants gradually perceived the lighting as warm and relaxing. As illuminance levels increased, dim and unpleasant feelings progressively changed to bright and pleasant ones. The study attempted to identify lighting combinations that can respond to different psychological needs and can be used as a guide in the future design of lighting equipment. Practitioner summary: Appropriate lighting conditions could aid individuals in increasing the quality of life. This study conducted an experiment to evaluate the effects of various correlated colour temperature and illuminance level combinations on visual perception by using LED lighting. The results showed the effect of the different lighting combinations on the visual perception of the participants. Abbreviation: LED: light-emitting diode; CCT: correlated colour temperature; K: Kelvin; lx: Lux; CIE: Commission Internationale de l'Eclairage; ANSI: American National Standards Institute.

Increased risks of psychiatric disorders in patients with primary Sjögren's syndrome-a secondary cohort analysis of nationwide, population-based health claim data.

INTRODUCTION/OBJECTIVES: Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease. The aim of this study was to investigate the risk of five common psychiatrist-diagnosed disorders in patients with pSS. METHOD: Using Taiwan's National Health Insurance Research Database, 688 patients with newly diagnosed pSS between 2000 and 2012 were identified. Two comparison cohorts were assembled, namely, 3440 patients without pSS and 1302 newly diagnosed patients with rheumatoid arthritis. The incidences of depressive disorder, anxiety disorder, bipolar disorder, sleep disorder, and schizophrenia between the pSS cohort and the comparison cohorts were compared using Poisson regression models. RESULTS: Patients with pSS exhibited a significantly higher risk of developing depressive disorder (adjusted incidence rate ratio [aIRR] = 2.11, p < 0.001), anxiety disorder (aIRR = 2.20, p < 0.001), and sleep disorder (aIRR = 1.76, p = 0.012) when compared with the non-pSS cohort. The risks of developing depressive, anxiety, and sleep disorders were also significantly increased when compared to the rheumatoid arthritis comparison cohort. When the analyses were stratified by sex, depressive disorder (aIRR = 2.10, p < 0.001), anxiety disorder (aIRR = 2.02, p = 0.001), and sleep disorder (aIRR = 1.74, p = 0.022) were found to be significantly increased in female patients with pSS. However, only anxiety disorder (aIRR = 4.88, p = 0.044) was also significantly increased in male patients with pSS. The peak age group of developing depressive disorder was 65-80 years old (aIRR = 3.46, p < 0.001). CONCLUSIONS: In this retrospective cohort study based on population-based claim data, significantly increased incidences of depressive disorder, anxiety disorder, and sleep disorder were observed in patients with pSS. Key Points • Patients, particularly women, with primary Sjögren's syndrome exhibited a significantly higher risk of developing depressive disorder, anxiety disorder, and sleep disorder. • The peak age group of developing depressive disorder was 65-80 years old.

Latent human error analysis and efficient improvement strategies by fuzzy TOPSIS in aviation maintenance tasks.

The purposes of this study were to develop a latent human error analysis process, to explore the factors of latent human error in aviation maintenance tasks, and to provide an efficient improvement strategy for addressing those errors. First, we used HFACS and RCA to define the error factors related to aviation maintenance tasks. Fuzzy TOPSIS with four criteria was applied to evaluate the error factors. Results show that 1) adverse physiological states, 2) physical/mental limitations, and 3) coordination, communication, and planning are the factors related to airline maintenance tasks that could be addressed easily and efficiently. This research establishes a new analytic process for investigating latent human error and provides a strategy for analyzing human error using fuzzy TOPSIS. Our analysis process complements shortages in existing methodologies by incorporating improvement efficiency, and it enhances the depth and broadness of human error analysis methodology.

Risk of Sjögren's syndrome in Taiwanese female adults with irregular menstrual cycles: a population-based case-control study.

Primary Sjögren's syndrome (pSS) is a progressive systemic autoimmune disorder with a strong female predominance. Hormonal influences are thought to play a role in the development of pSS. However, no studies have specifically evaluated the association between irregular menstrual cycles and pSS. Therefore, using a health claims database, this study investigated the risk of pSS in women with irregular menstrual cycles. We conducted a case-control study using the Taiwan's National Health Insurance Research Database. A total of 360 patients diagnosed with pSS (International Classification of Diseases, ninth revision, clinical modification, ICD-9-CM code 710.2) between 2001 and 2012 were identified. Controls were frequency-matched at a rate of 5:1 to the cases by five-year age interval and index year. Both cases and controls were retrospectively traced back until 2001 for the diagnosis of irregular menstrual cycles (ICD-9-CM code 626.4). The risk of pSS was assessed using multivariate logistic regression analyses. Irregular menstrual cycles were significantly associated with pSS [adjusted odds ratio, (AOR) = 1.38, p = 0.027], after adjusted for insured amount, urbanization level, and thyroid disorder. In addition, when the data were stratified by three age categories, only the patients in the age category of 45-55 years showed significant association between irregular menstrual cycles and pSS (AOR = 1.74, p = 0.005). In this nationwide, population-based case-control study, we found a significant increased risk of pSS in female patients with irregular menstrual cycles, particularly those in their mid-forties to mid-fifties.