Purpose
The Chang Gung Research Database (CGRD), the largest multi‐institutional electronic medical records (EMR) collection in Taiwan, provides good access for researchers to efficiently use the ...standardized patient‐level data. This study evaluates the capacity and representativeness of the CGRD to promote secondary use of EMR data for clinical research with more accurate estimates.
Methods
The National Health Insurance Research Database (NHIRD) which covers over 99.9% of the Taiwanese population served as the comparator in this study. We compare the data components of the CGRD with the NHIRD, including records for health care facilities, patients, diagnoses, drugs, and procedures. Using the chi‐square test, we compared the distributions of age categories and sex of patients, and the rates of their health conditions between NHIRD and CGRD based on the year 2015.
Results
The CGRD contains more clinical information such as pathological and laboratory results than the NHIRD. The CGRD includes 6.1% of outpatients and 10.2% of hospitalized patients from the NHIRD. We found the CGRD includes more elderly outpatients (23.5% vs 12.5%) and pediatric inpatients (19.7% vs 14.4%) compared with the NHIRD. We found patients' sex distributions were similar between CGRD and NHIRD, but coverage rates of severe conditions, such as cancer, were higher than other health conditions in CGRD.
Conclusions
The CGRD could serve as the basis for accurate estimates in medical studies. However, researchers should pay special attention to selection biases since patients' characteristics from CGRD differ from those of the national database.
Taiwan's National Health Insurance Research Database (NHIRD) exemplifies a population-level data source for generating real-world evidence to support clinical decisions and health care policy-making. ...Like with all claims databases, there have been some validity concerns of studies using the NHIRD, such as the accuracy of diagnosis codes and issues around unmeasured confounders. Endeavors to validate diagnosed codes or to develop methodologic approaches to address unmeasured confounders have largely increased the reliability of NHIRD studies. Recently, Taiwan's Ministry of Health and Welfare (MOHW) established a Health and Welfare Data Center (HWDC), a data repository site that centralizes the NHIRD and about 70 other health-related databases for data management and analyses. To strengthen the protection of data privacy, investigators are required to conduct on-site analysis at an HWDC through remote connection to MOHW servers. Although the tight regulation of this on-site analysis has led to inconvenience for analysts and has increased time and costs required for research, the HWDC has created opportunities for enriched dimensions of study by linking across the NHIRD and other databases. In the near future, researchers will have greater opportunity to distill knowledge from the NHIRD linked to hospital-based electronic medical records databases containing unstructured patient-level information by using artificial intelligence techniques, including machine learning and natural language processes. We believe that NHIRD with multiple data sources could represent a powerful research engine with enriched dimensions and could serve as a guiding light for real-world evidence-based medicine in Taiwan.
Climate change and increasing water demand due to population growth pose serious threats to surface water availability. The biggest challenge in addressing these threats is the gap between climate ...science and water management practices. Local water planning often lacks the integration of climate change information, especially with regard to its impacts on surface water storage and evaporation as well as the associated uncertainties. Using Texas as an example, state and regional water planning relies on the use of reservoir “Firm Yield” (FY)—an important metric that quantifies surface water availability. However, this existing planning methodology does not account for the impacts of climate change on future inflows and on reservoir evaporation. To bridge this knowledge gap, an integrated climate‐hydrology‐management (CHM) modeling framework was developed, which is generally applicable to river basins with geographical, hydrological, and water right settings similar to those in Texas. The framework leverages the advantages of two modeling approaches—the Distributed Hydrology Soil Vegetation Model (DHSVM) and Water Availability Modeling (WAM). Additionally, the Double Bias Correction Constructed Analogues method is utilized to downscale and incorporate Coupled Model Intercomparison Project Phase 6 GCMs. Finally, the DHSVM simulated naturalized streamflow and reservoir evaporation rate are input to WAM to simulate reservoir FY. A new term—“Ratio of Firm Yield” (RFY)—is created to compare how much FY changes under different climate scenarios. The results indicate that climate change has a significant impact on surface water availability by increasing reservoir evaporation, altering the seasonal pattern of naturalized streamflow, and reducing FY.
Plain Language Summary
Under conditions of climate change, it is important to have actionable climate information for local water management and surface water planning. By investigating the impacts of climate change on surface water availability over a representative metropolitan area (and its water supply reservoirs), this research helps to bridge the gap between climate science and the necessary information for sound water management decisions. First, the coarse resolution information from global climate models was translated into the finer spatial scales suitable for application into the long‐range water supply planning tools commonly used in Texas. Second, a climate‐hydrology‐management (CHM) modeling framework was developed to simulate future surface water availability under different climate scenarios. The results indicate that the changes in reservoir evaporation rates and streamflow patterns play an important role in reducing future surface water availability. The projected hydrological and water availability information can guide decisions related to local and long‐range water planning. The study framework is also applicable to other river basins for improving the estimation of future water availability under climate change.
Key Points
The assessment of future available surface water is improved by explicitly accounting for projected reservoir evaporation and naturalized streamflow
An open‐water evaporation module was used to represent the enhanced reservoir evaporation loss in future climate scenarios
An ensemble of future reservoir Firm Yield (FY) values under different climate change scenarios is generated for supporting water supply risk management decisions
•Two adjacent basins were compared to evaluate the urbanization effects on floods.•Urbanization reduces lag time significantly and elevates flood peaks (up to 30%).•When land cover barely changes, ...changing climate is the major driver of floods.•Fast urbanization can alter the timing of the Change Point (CP).•The mean flood peaks in the urbanized basin increased drastically after the CP.
The increased occurrence of flood events resulting from urbanization and global climate change is a great threat to water security. To systematically evaluate the impacts of urbanization on floods, we applied a paired catchments approach to two adjacent river basins in south-central Texas — the San Antonio River Basin (SARB), with fast urbanization; and the Guadalupe River Basin (GRB), with little land cover change. A physics-based distributed hydrological model — the Distributed Hydrology Soil Vegetation Model, embedded with a multi-purpose reservoir module (DHSVM-Res) — was used to simulate streamflow and reservoir storage. The simulations were conducted under different land cover scenarios, including a newly developed continuous land cover series (CLCS). Holistic analyses were then conducted for the paired basins using three methods: analyzing the selected flood events, detecting change points (CP) of monthly floods, and testing the elasticity of long-term flood regimes. The results suggest that: (1) urbanization may reduce lag time and elevate flood peaks significantly by 3–30% in our study area; (2) when there is little land cover change, changing climate is the major driver of variations in the monthly maximum streamflow (MMS); (3) fast urbanization can amplify streamflow variability, increase MMS significantly, and thus alter the timing of CP; and (4) the mean MMS of observed streamflow in the SARB has increased by as much as 75.7% from the pre-CP to post-CP periods. This comprehensive study fills in a gap in our current understanding of the isolated impacts of urbanization on flooding and is expected to support future explorations of anthropogenic influences on floods.
We conducted a multi-institutional study in Taiwan and a systematic review of the literature for reports of Guillain-Barré syndrome after coronavirus disease vaccination. This condition, mostly the ...classic form and the acute inflammatory demyelinating polyneuropathy subtype, has been reported in 39 cases and has occurred within 2 weeks of vaccine administration.
Aims
To investigate the risk of diabetic macular oedema (DMO) associated with the use of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM).
Materials ...and Methods
We conducted a retrospective cohort study by analysing a large multi‐institutional electronic medical records database in Taiwan. We included adult patients with T2DM without DMO newly receiving either SGLT2 inhibitors or glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) during the period 2016 to 2018. We used propensity scores with inverse probability of treatment weighting to generate comparable groups. The study outcome was incident DMO, determined by clinical diagnosis during outpatient visits or admissions. We followed patients from the index date to either DMO occurrence, last clinical visit, patient death, or December 31, 2020. We performed Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of DMO.
Results
We included 9986 new users of SGLT2 inhibitors (mean SD age 59.6 (12.1) years, median interquartile range {IQR} glycated haemoglobin HbA1c 70 (61‐81)mmol/mol, estimated glomerular filtration rate eGFR 89.1 71.4‐108.7 mL/min/1.73 m2 and urine albumin‐creatinine ratio UACR 26.1 9.7‐117.6 mg/g) and 1067 new users of GLP‐1RAs (mean SD age 58.4 (41.5) years, median IQR HbA1c 73 64‐84 mmol/mol, eGFR 91.6 68.6‐114.0 mL/min/1.73 m2 and UACR 37.6 11.1‐153.2 mg/g) with similar baseline characteristics. Lower DMO risks were observed among patients newly receiving SGLT2 inhibitors (7.9/1000 person‐years), compared to those receiving GLP‐1RAs (10.7/1000 person‐years) with an HR of 0.75 (95% CI 0.64‐0.88).
Conclusions
Our findings suggest use of SGLT2 inhibitors was associated with lower risk of DMO in T2DM patients in clinical practice, compared to use of GLP‐1RAs. Future studies are necessary to confirm this observation.
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