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  • 1
    Online Resource
    Online Resource
    The impact of chronic hepatitis B infection on major adverse cardiovascular events and all-cause mortality in patients with diabetes: a nationwide population-based study from Taiwan
    BMJ ; 2017
    In:  BMJ Open Vol. 7, No. 8 ( 2017-08), p. e016179-
    Details
    In: BMJ Open, BMJ, Vol. 7, No. 8 ( 2017-08), p. e016179-
    Abstract: The association between hepatitis B virus (HBV) infection and cardiovascular disease remains uncertain. This study explored long-term hard endpoints (ie, myocardial infarction and ischaemic stroke) and all-cause mortality in diabetic patients with chronic HBV infection in Taiwan from 2000 to 2013. Design This study was retrospective, longitudinal and propensity score-matched. Setting Nationwide claims data for the period 2000–2013 were retrieved from Taiwan’s National Health Insurance Research Database. Participants The study included 40 162 diabetic patients with chronic HBV infection (HBV cohort) and 40 162 propensity score-matched diabetic patients without HBV infection (control cohort). Chronic HBV infection was identified based on three or more outpatient clinic visits or one hospital admission with a diagnosis of HBV infection. Main outcome measures Primary outcomes were major adverse cardiovascular events (MACE, including myocardial infarction and ischaemic stroke), heart failure and all-cause mortality. Results During the median follow-up period of 5.3±3.4 years, the HBV cohort had significantly lower risks of myocardial infarction (adjusted HR (aHR)=0.49; 95% CI 0.42 to 0.56), ischaemic stroke (aHR=0.61; 95% CI 0.56 to 0.67), heart failure (aHR=0.50; 95% CI 0.43 to 0.59) and all-cause mortality (aHR=0.72; 95% CI 0.70 to 0.75) compared with the control cohort. The impact of HBV infection on the sequential risk of MACE was greater in patients with fewer diabetic complications. Conclusions Chronic HBV infection was associated with decreased risk of MACE, heart failure and all-cause mortality in patients with diabetes. Further research is needed to investigate the mechanism underlying these findings.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    URL: Article
    DOI: 10.1136/bmjopen-2017-016179
    DOI: 10.1136/bmjopen-2017-016179.supp1
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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  • 2
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    Online Resource
    Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study
    BMJ ; 2017
    In:  BMJ Open Vol. 7, No. 9 ( 2017-09), p. e015022-
    Details
    In: BMJ Open, BMJ, Vol. 7, No. 9 ( 2017-09), p. e015022-
    Abstract: Pulmonary radiotherapy has been reported to increase a risk of pneumonopathy, including pneumonitis and secondary pneumonia, however evidence from population-based studies is lacking. The present study intended to explore whether postoperative irradiation increases occurrence of severe pneumonopathy in lung cancer patients. Design, setting and participants The nationwide population-based study analysed the Taiwan National Health Insurance Research Database (covered 〉 99% of Taiwanese) in a real-world setting. From 2000 to 2010, 4335 newly diagnosed lung cancer patients were allocated into two groups: surgery-RT (n=867) and surgery-alone (n=3468). With a ratio of 1:4, propensity score was used to match 11 baseline factors to balance groups. Interventions/exposure(s) Irradiation was delivered to bronchial stump and mediastinum according to peer-audited guidelines. Outcome(s)/measure(s) Hospitalised pneumonia/pneumonitis-free survival was the primary end point. Risk factors and hazard effects were secondary measures. Results Multivariable analysis identified five independent risk factors for hospitalised pneumonopathy: elderly ( 〉 65 years), male, irradiation, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Compared with surgery-alone, a higher risk of hospitalised pneumonopathy was found in surgery-RT patients (HR, 2.20; 95% CI, 1.93–2.51; 2-year hospitalised pneumonia/pneumonitis-free survival, 85.2% vs 69.0%; both p 〈 0.0001), especially in elderly males with COPD and CKD (HR, 13.74; 95% CI, 6.61–28.53; p 〈 0.0001). Unexpectedly, we observed a higher risk of hospitalised pneumonopathy in younger irradiated-CKD patients (HR, 13.07; 95% CI, 5.71–29.94; p 〈 0.0001) than that of elderly irradiated-CKD patients (HR, 4.82; 95% CI, 2.88–8.08; p 〈 0.0001). Conclusions A high risk of hospitalised pneumonopathy is observed in irradiated patients, especially in elderly males with COPD and CKD. For these patients, close clinical surveillance and aggressive pneumonia/pneumonitis prevention should be considered. Further investigations are required to define underlying biological mechanisms, especially for younger CKD patients.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2016-015022
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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  • 3
    Online Resource
    Online Resource
    Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system
    BMJ ; 2017
    In:  BMJ Open Vol. 7, No. 11 ( 2017-11), p. e017932-
    Details
    In: BMJ Open, BMJ, Vol. 7, No. 11 ( 2017-11), p. e017932-
    Abstract: Intra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited. Objective To perform a retrospective analysis of IHT-related events, human failures and unsafe acts. Setting A hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan. Participants All eligible IHT-related patient safety events between January 2010 to December 2015 were included. Main outcome measures Incidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts. Results There were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (p 〈 0.001). Of the events with human failures (n=186), the most common related process step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, p 〈 0.001) was associated with increased patient harm, whereas the presence of omission (OR 0.12, p 〈 0.001) was associated with less patient harm. Conclusions This study shows a need to reduce human failures to prevent patient harm during intra-hospital transportation. We suggest that the transportation team pay specific attention to the sub-process at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2017-017932
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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    Online Resource
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