Stress on caregivers providing prolonged mechanical ventilation patient care in different facilities: A cross-sectional study.

PURPOSE: Taiwan has implemented an integrated prospective payment program (IPP) for prolonged mechanical ventilation (PMV) patients that consists of four stages of care: intensive care unit (ICU), respiratory care center (RCC), respiratory care ward (RCW), and respiratory home care (RHC). We aimed to investigate the life impact on family caregivers of PMV patients opting for a payment program and compared different care units. METHOD: A total of 610 questionnaires were recalled. Statistical analyses were conducted by using the chi-square test and multivariate logistic regression model. RESULTS: The results indicated no associations between caregivers' stress levels and opting for a payment program. Participants in the non-IPP group spent less time with friends and family owing to caregiver responsibilities. The results of the family domain show that the RHC group (OR = 2.54) had worsened family relationships compared with the ICU group; however, there was less psychological stress in the RCC (OR = 0.54) and RCW (OR = 0.16) groups than in the ICU group. In the social domain, RHC interviewees experienced reduced friend and family interactivity (OR = 2.18) and community or religious activities (OR = 2.06) than the ICU group. The RCW group felt that leisure and work time had less effect (OR = 0.37 and 0.41) than the ICU group. Furthermore, RCW interviewees (OR = 0.43) were less influenced by the reduced family income than the ICU group in the economic domain. CONCLUSIONS: RHC family caregivers had the highest level of stress, whereas family caregivers in the RCW group had the lowest level of stress.

Large-scale data analysis for robotic yeast one-hybrid platforms and multi-disciplinary studies using GateMultiplex.

BACKGROUND: Yeast one-hybrid (Y1H) is a common technique for identifying DNA-protein interactions, and robotic platforms have been developed for high-throughput analyses to unravel the gene regulatory networks in many organisms. Use of these high-throughput techniques has led to the generation of increasingly large datasets, and several software packages have been developed to analyze such data. We previously established the currently most efficient Y1H system, meiosis-directed Y1H; however, the available software tools were not designed for processing the additional parameters suggested by meiosis-directed Y1H to avoid false positives and required programming skills for operation. RESULTS: We developed a new tool named GateMultiplex with high computing performance using C++. GateMultiplex incorporated a graphical user interface (GUI), which allows the operation without any programming skills. Flexible parameter options were designed for multiple experimental purposes to enable the application of GateMultiplex even beyond Y1H platforms. We further demonstrated the data analysis from other three fields using GateMultiplex, the identification of lead compounds in preclinical cancer drug discovery, the crop line selection in precision agriculture, and the ocean pollution detection from deep-sea fishery. CONCLUSIONS: The user-friendly GUI, fast C++ computing speed, flexible parameter setting, and applicability of GateMultiplex facilitate the feasibility of large-scale data analysis in life science fields.

Effect of the Integrated Prospective Payment Program on Family Members' Knowledge and Acceptance of Hospice Care of Patients on Prolonged Mechanical Ventilation.

BACKGROUND: We sought to evaluate the effect of an integrated prospective payment program (IPP) on knowledge of hospice care and willingness to participate in hospice care among family members of patients on prolonged mechanical ventilation (PMV). METHODS: Between November 2013 and April 2014, we used paper-based survey questionnaires from 64 institutions to evaluate knowledge, willingness, and related factors among the main caregivers of patients on PMV regarding hospice care and to determine whether their decisions for the patients were affected by the IPP. RESULTS: The average ages of the respondents and patients on PMV were 51.9 y and 70.8 y respectively; 70.6% of the respondents knew about the Hospice Palliative Care Act (HPCA), and 42.3% of the medical staff had introduced hospice care-related information to patients and caregivers in Taiwan. Among the caregiver respondents, 67.6% agreed to write a letter of intent regarding the choice of hospice care or limited life-sustaining treatment. In total, 66.2% (16.1 + 50.1%) of the respondents agreed to hospice care for their family members (ie, the patients on PMV) when the condition was terminal. The factors of greater HPCA knowledge among the patients on PMV were IPP participation, female sex, and coma status. Factors leading to higher levels of HPCA knowledge included age ≥ 65 y being married, higher income, awareness of the law, and being introduced to hospice care by medical staff. CONCLUSIONS: High levels of hospice care knowledge were unrelated to willingness to participate. HPCA knowledge was greater in the IPP group than in the non-IPP group; however, there was no significant difference in the willingness to agree to hospice care. It is recommended that individuals be encouraged to express their medical decisions.

Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery?

BACKGROUND: The effectiveness of Incentive spirometry (IS) in patients undergoing video-assisted thoracic surgery (VATS) remains lacking. We conducted a population-based study to investigate the effectiveness of IS on patients with lung cancers following VATS. METHODS: We identified patients newly diagnosed with lung cancer who underwent surgical resection by VATS or thoracotomy from the years 2000 to 2008 in the Longitudinal Health Insurance Database. Exposure variable was the use of IS during admission for surgical resection by VATS or thoracotomy. Primary outcomes included hospitalization cost, incidence of pneumonia, and length of hospital stay. Secondary outcomes included the frequency of emergency department (ED) visits and hospitalizations at 3-month, 6-month, and 12-month follow-ups after thoracic surgery. RESULTS: We analyzed 7549 patients with lung cancer undergoing surgical resection by VATS and thoracotomy. The proportion of patients who were subjected to IS was significantly higher in those who underwent thoracotomy than in those who underwent VATS (68.4% vs. 53.1%, P < 0.0001). After we controlled for potential covariates, the IS group significantly reduced hospitalization costs (- 524.5 USD, 95% confidence interval [CI] = - 982.6 USD - -66.4 USD) and the risk of pneumonia (odds ratio = 0.55, 95% CI = 0.32-0.95) compared to the non-IS group following VATS. No difference in ED visit frequency and hospitalization frequency at 3-month, 6-month, and 1-year follow-up was noted between the IS and the non-IS groups following VATS. CONCLUSIONS: The use of IS in patients with lung cancers undergoing VATS may reduce hospitalization cost and the risk of pneumonia.

Propensity score-matching analyses on the effectiveness of integrated prospective payment program for patients with prolonged mechanical ventilation.

OBJECTIVES: An integrated delivery system with a prospective payment program (IPP) for prolonged mechanical ventilation (PMV) was launched by Taiwan's National Health Insurance (NHI) due to the costly and limited ICU resources. This study aimed to analyze the effectiveness of IPP and evaluate the factors associated with successful weaning and survival among patients with PMV. METHODS: Taiwan's NHI Research Database was searched to obtain the data of patients aged ≥17 years who had PMV from 2006 to 2010 (N=50,570). A 1:1 propensity score matching approach was used to compare patients with and without IPP (N=30,576). Cox proportional hazards modeling was used to examine the factors related to successful weaning and survival. RESULTS: The related factors of lower weaning rate in IPP participants (hazard ratio [HR]=0.84), were older age, higher income, catastrophic illness (HR=0.87), and higher comorbidity. The effectiveness of IPP intervention for the PMV patients showed longer days of hospitalization, longer ventilation days, higher survival rate, and higher medical costs (in respiratory care center, respiratory care ward). The 6-month mortality rate was lower (34.0% vs. 32.9%). The death risk of IPP patients compared to those non-IPP patients was lower (HR=0.91, P<0.001). CONCLUSIONS: The policy of IPP for PMV patients showed higher survival rate although it was costly and related to lower weaning rate.

Factors Associated With Re-Intubation Within 14 Days After Ventilator Liberation.

BACKGROUND: According to Taiwan's integrated delivery system policy, ventilator-dependent patients are successfully liberated from mechanical ventilation in accordance with step-down care. However, premature discharge affects the 14-d readmission quality index. Therefore, we explored the risk and related factors of subjects liberated from mechanical ventilation who were re-intubated within 14 d. METHODS: This retrospective study analyzed a cohort of ventilator-dependent subjects 17 y of age and older using a population-based database from the Taiwan National Health Research Institutes Database from 2006 to 2010. Chi-square test and logistic regression analyses were used to explore whether subjects liberated from mechanical ventilation were re-intubated within 14 d and to investigate the related factors. RESULTS: A total of 15,840 ventilator-dependent subjects were liberated from mechanical ventilation, and 449 subjects were re-intubated within 14 d; the total re-intubation rate was 2.83%. The factors related to a higher risk of re-intubation were also the reasons for ventilator use, including complications, hospital accreditation level, and the ventilator weaning care stage. A higher risk of re-intubation was identified in subjects with COPD (odds ratio [OR] 1.32, 95% CI 1.02-1.7, P = .035) or pneumonia (OR 1.4, 95% CI 1.07-1.86, P = .02) and in subjects who stayed at a district hospital (OR 3.53, 95% CI 2.48-5.01, P < .001). Liberation from mechanical ventilation in the respiratory care ward and home respiratory care were associated with the highest risk of re-intubation, which was 2.32 times that of ICU subjects (P < .001). CONCLUSIONS: Factors associated with re-intubation within 14 d after ventilator liberation are related to the level and quality of the care setting; thus, to prevent re-intubation, more attention should be paid to higher-risk ventilator-dependent subjects after they are liberated from mechanical ventilation.

The Risk and Related Factors for Readmission to an ICU Within 7 Days in Mechanically Ventilated Subjects--A Nationwide Population-Based Cohort Study.

BACKGROUND: Readmission of mechanically ventilated patients to an ICU within 7 d reflects not only patient safety but also the quality of care of the ICU. This study aimed to investigate the risk and related factors for readmission to an ICU within 7 d in mechanically ventilated subjects. METHODS: A total of 658,452 mechanically ventilated subjects discharged from an ICU whose age was ≥ 17 y old were obtained from the Taiwan National Health Insurance Research Database for the period from January 1, 2005, to December 31, 2011. The study applied a generalized estimating equation logistic regression model to explore whether the mechanically ventilated subjects were readmitted within 7 d or not and the related factors. RESULTS: A total of 29,657 subjects were readmitted to the ICU within 7 d; the total readmission rate was 4.5%. Also, 64.8% of the subjects with the same diagnosis were returned to the ICU within 7 d. Generalized estimating equation logistic regression model results showed that the factors related to higher risk of readmission were male sex, old age, higher comorbidity score, complications (eg, pneumothorax, subcutaneous emphysema, pneumonia, oxygen toxicity, pulmonary embolism, or pulmonary edema), use of a private hospital ICU, ICU stay ≥21 d, transfer to a respiratory care center and respiratory care ward, and subsequent transfer to the regional hospital or district hospital. CONCLUSIONS: The risk and related factors of a mechanically ventilated subject whose age is ≥ 17 y old being readmitted to the ICU within 7 d include subject characteristics, health status, hospital attributes, and the length of ICU stay. Therefore, higher risk subjects should receive attention and assessment before transfer or discharge from the ICU to prevent readmission.

Association of inflammatory bowel disease with asthma risk: A nationwide cohort study.

OBJECTIVE: We evaluated the risk of asthma development in adult patients with inflammatory bowel disease (IBD) in a nationwide population. METHODS: A retrospective cohort study was conducted by using data retrieved from the Taiwan National Health Insurance Research Database. Patients, ages 20 year or older, with newly diagnosed IBD between 2000 and 2005 were identified and randomly frequency-matched (based on sex, age, and index year) with four times the number of enrollees without IBD from the general population. Both cohorts were followed up until the end of 2011 to examine the incidence of asthma. Cox proportional hazard regression analysis was used to measure the hazard ratios (HR) of asthma in the IBD cohort compared with that in the non-IBD cohort. RESULTS: The IBD and non-IBD cohorts comprised 5260 patients with IBD and 21,040 participants, respectively. After adjustment for covariates, the IBD cohort exhibited a 1.50-fold increased risk for asthma (HR 1.50, [95% confidence interval {CI}, 1.32-1.71]). Further analysis according to the two major forms of IBD revealed that the adjusted HR of asthma was 1.46 (95% CI, 1.03-2.07) and 1.50 (95% CI, 1.31-1.72) in patients with ulcerative colitis and Crohn's disease, respectively, compared with the non-IBD cohort. CONCLUSION: After adjustment for comorbidities, patients with IBD were associated with a higher subsequent risk of asthma.

Association between obstructive sleep apnea and deep vein thrombosis / pulmonary embolism: a population-based retrospective cohort study.

BACKGROUND: Obstructive sleep apnea (OSA) is a major contributor to cardiovascular disease, and may cause severe morbidity and mortality. Recent studies have indicated that OSA patients exhibited elevated platelet activity, fibrinogen levels, and platelet aggregation. OBJECTIVES: We investigated the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients diagnosed with OSA compared with age- and sex-matched unaffected people. PATIENTS/METHODS: This longitudinal, nationwide, population-based cohort study was conducted using data from Taiwan National Health Insurance Research Database (NHIRD) recorded between January 2000 and December 2011. The study consisted of 3511 patients with OSA and 35110 matched comparison individuals. A Cox proportional hazard regression was used to compute the risk of DVT and PE in patients with OSA compared with those without OSA. RESULTS: The DVT and PE risks were 3.50- and 3.97-fold higher (95% CI=1.83-6.69 and 1.85-8.51) respectively, in the OSA cohort than in the reference cohort after we adjusted for age, sex, and comorbidities. CONCLUSION: This nationwide population-based cohort study indicates that patients with OSA exhibit a higher risk of subsequent DVT and PE.

Impact of Taiwan's integrated prospective payment program on prolonged mechanical ventilation: a 6-year nationwide study.

OBJECTIVE: The integrated prospective payment program (IPP), which encourages the integrated care of mechanically ventilated patients in order to reduce the heavy utilization of high-cost ICUs, has been implemented by Taiwan's Bureau of National Health Insurance since July 2000. The aim of this study was to assess the impact of this program on weaning, hospital stay, mortality, and cost for patients requiring prolonged mechanical ventilation (PMV). METHODS: A data set of 1,000,000 randomly selected insurance holders from the National Health Research Insurance Database, Taiwan, was retrospectively analyzed. We enrolled 7,967 adult patients (age ≥ 17 y) who required PMV (duration ≥ 21 d) over a 6 year period. RESULTS: There were 3,275 patients on PMV before (1997-1999) and 4,692 patients on PMV after (2001-2003) the IPP implementation. After IPP implementation, PMV was found to be required in patients with a significantly higher age, lower urbanization level, higher income status, and a higher prevalence of neuromuscular disease (P < .001). In-hospital mortality was similar between the 2 periods (17.2% before vs 16.2% after, P = .26), but the weaning rate was significantly lower in the latter period (68.1% vs 64.2%, P < .001). Total hospital stay (75.3 d vs 95.1 d, P < .001) and duration of mechanical ventilation usage (55.8 d vs 71.6 d, P < .001) were both significantly higher after the IPP implementation. Total hospitalization cost in the PMV patients was significantly lower after IPP implementation. CONCLUSIONS: Implementation of the IPP program reduced the total hospitalization cost, increased the duration of mechanical ventilation usage and stay, and reduced the weaning rate in PMV patients.

Association of DNA double-strand break gene XRCC6 genotypes and lung cancer in Taiwan.

AIM: The DNA repair gene X-ray repair complementing defective repair in Chinese hamster cells 6 (XRCC6) is thought to play an important role in the repair of DNA double-strand breaks. It is known that defects in double-strand break repair capacity can lead to irreversible genomic instability. However, the association of polymorphic variants of XRCC6 with lung cancer susceptibility has never been reported. In this hospital-based case-control study, the association of XRCC6 promoter T-991C (rs5751129), promoter G-57C (rs2267437), promoter G-31A (rs132770), and intron 3 (rs132774) polymorphisms with lung cancer risk in a Taiwanese population, was studied. MATERIALS AND METHODS: In total, 358 patients with lung cancer and 716 healthy controls recruited from the China Medical Hospital in Taiwan were genotyped. RESULTS: The results showed that there were significant differences between lung cancer and control groups in the distribution of their genotypic (p=3.7×10(-4)) and allelic frequency (p=2.7×10(-5)) in the XRCC6 promoter T-991C polymorphism. Individuals who carried at least one C allele (TC or CC) had a 2.03-fold increased odds ratio of developing lung cancer compared to those who carried the wild-type TT genotype (95% conference internal=1.42-2.91, p=0.0001). For the other three polymorphisms, there was no difference between the case and control groups in the distribution of either genotypic or allelic frequency. CONCLUSION: In conclusion, the XRCC6 promoter T-991C, but not the promoter C-57G, promoter G-31A or intron 3, is associated with lung cancer susceptibility.

Interaction of CCND1 genotype and smoking habit in Taiwan lung cancer patients.

AIM: Cyclin D1 (CCND1) is critical in the transition of the cell cycle from G1 to S phase and unbalanced cell cycle regulation is a hallmark of carcinogenesis. The study aimed at investigating the association of CCND1 genotypes with lung cancer risk in Taiwan and examining the interaction between CCND1 genotype and smoking habit. PATIENTS AND METHODS: CCND1 A870G (rs9344) and C1722G (rs678653) genotypes were determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) analysis of DNA from the blood of 358 lung cancer patients and 716 cancer-free healthy controls. RESULTS: The results showed that there were significant differences between lung cancer and control groups in the distribution of the genotypes (p=0.0003) and allelic frequency (p=0.0007) in the CCND1 rs9344 genotype. Individuals who carried AG or GG genotype had 0.59- and 0.52-fold risk, respectively, of developing lung cancer compared to those who carried the AA genotype (95% CI=0.44-0.78 and 0.35-0.79, respectively). There was also an obvious interaction of CCND1 rs9344 genotype with personal smoking habit on lung cancer risk (p=0.0009). CONCLUSION: These findings support the conclusion that cell cycle regulation may play a role in lung cancer development and that CCND1 rs9344 polymorphism together with smoking habit maybe a useful biomarker for lung cancer prediction.

Interaction of cyclooxygenase 2 genotype and smoking habit in Taiwanese lung cancer patients.

AIM: The aim of this study was to evaluate the association and interaction of genotypic polymorphisms in the cyclooxygenase 2 (Cox-2) gene with smoking habits with lung cancer patients in Taiwan. Six polymorphic variants of Cox-2 were analysed in association with their effect on lung cancer susceptibility, and their joint effects with smoking habits on lung cancer risk is discussed. MATERIALS AND METHODS: Three hundred and fifty-eight patients with lung cancer and 716 healthy controls from the China Medical Hospital in central Taiwan were genotyped. RESULTS: The Cox-2 intron 6 (rs2066826) genotypes were distributed differently between the lung cancer and control groups. The A allele of Cox-2 intrin 6 was found more frequently in the cancer patient group than in the controls. Furthermore, the interactions of smoking with genetic factors were significant for the Cox-2 intron 6 genotypes. Patients who smoked and had the Cox-2 intron 6 AG or AA genotype had an increased risk of 2.21 (95% confidence interval=1.53-3.27) for developing lung cancer. CONCLUSION: These results provide evidence that the A allele of Cox-2 intron 6 may be associated with the development of lung cancer and may be a useful marker for early detection and treatment of lung cancer.

Cost-utility analysis for endoscopic sinus surgery.

OBJECTIVE: To undertake cost-utility analysis for endoscopic sinus surgery (ESS) in order to analyze the cost-effectiveness of different chronic sinusitis severity groups. METHODS: One hundred ninety-two patients with chronic sinusitis were evaluated with a Chronic Sinusitis Survey (CSS) before and 1-year after ESS. Direct health care cost data during the first year after operation were retrieved. The utility gain is defined as change in the CSS total score. The cost-utility ratio was defined as cost per utility gain. Patients are stratified by disease severity using the Harvard Staging System. RESULTS: The average total direct cost attributable to ESS is 40,829 NT dollars in the first postoperative year and the average cost-utility ratio is 2194.42 NT dollars. The high cost-utility ratio of 3246.45 NT dollars for pansinusitis cases is due to the higher cost and limited utility gain. CONCLUSIONS: Treating mild and moderate chronic sinusitis are most cost-effective because of their favorable utility gain and relatively reasonable cost. However, there is no proportional linear relationship between disease severity and cost-utility ratio.

Use of patient satisfaction data in a continuous quality improvement program for endoscopic sinus surgery.

OBJECTIVE: Continuous quality improvement (CQI) is an effort by health care providers to improve the quality of service by continuously exceeding patients' expectations. Patient satisfaction is one of the measures of the quality of care. The aims of this study were to report the patients' evaluation of endoscopic sinus surgery (ESS) and to explore the feasibility in using patient satisfaction data in the CQI program for ESS. METHODS: Eighty-three patients completed a validated patient satisfaction survey (PSS) 1 month after undergoing ESS. Logistic regression models were applied to determine the confounders of patient satisfaction. RESULTS: In general, 72% of patients were very satisfied with the services. Education level and milder disease correlated with higher overall satisfaction levels (P

Quality of life in Taiwanese adults with chronic rhino-sinusitis.

BACKGROUND AND PURPOSE: Chronic rhino-sinusitis (CRS) is a disease in prevalence. This study evaluates the impact of this disorder to Taiwanese patients' general and sinus-related health status among Taiwanese patients with CRS. METHODS: A total of 201 consecutive CRS patients (male:female: 107:94, mean age: 40.1 +/- 14.6 years) seeking otolaryngological care at a tertiary referral medical center were recruited. Quality of life was measured by a Taiwan Standard Version of the Medical Outcome Study 36-Item Short Form Health Survey (SF-36) and a Chinese version Chronic Sinusitis Survey (CCSS). Patients were administered with the SF-36 and CCSS preoperatively. RESULTS: CRS has a significant impact on patients in seven of the eight domains of SF-36: role-physical (88.9 +/- 24.7), bodily pain (70.3 +/- 22.6), general health (56.1 +/- 11.6), social functioning (79.3 +/- 21.6), vitality (56.4 +/- 19.1), role-emotional (57.7 +/- 42.1), and mental health (48.4 +/- 17.2) subscores of CRS patients are all in significant decrement (p < 0.05) as compared with the data derived from Taiwanese general population. Physical functioning is the only domain without impact. Significant decrements (p < 0.05) are also observed in symptom subscale (43.3 +/- 27.8), medication subscale (80.3 +/- 26.4), and total survey score (63 +/- 20.3) of the CCSS as compared to the healthy subjects. The severity of CRS is significantly predictive (p < 0.05, R2 = 0.34) of CCSS. CONCLUSIONS: CRS has considerable impacts on a patient's sinus-related quality of life, as well as on their general health status.

Validation assessment of the Chinese-version Chronic Ear Survey: a comparison between data from English and Chinese versions.

The Chronic Ear Survey (CES) is a valid, disease-specific measure for the evaluation of health status and treatment effectiveness for adults with chronic suppurative otitis media (CSOM). This study compares the validation properties of the English and Chinese versions of the CES. The CES was translated into Mandarin Chinese by means of a parallel model. The Chinese version of the CES (CCES) was administered to 103 patients in a prospective manner, then was validated according to established criteria for reliability, validity, and longitudinal sensitivity. The CCES demonstrated good test-retest reliability and internal consistency (Cronbach's a = 0.81). The CCES significantly correlated with the Mandarin Chinese (Taiwan) version of the generic 36-Item Short-Form Health Survey (TSF-36). The standardized response mean for the CCES total score was 2.1, indicating excellent sensitivity to clinical change. This validation study demonstrated that the performance characteristics of the CCES were equivalent to those of the English-version CES. The CCES is a valid tool for evaluation of adults with CSOM among the Chinese-speaking population.

Validation of a Chinese version of the Epworth sleepiness scale.

Epworth sleepiness scale (ESS) is widely used to evaluate degree of somnolence among Chinese patients with sleep-disordered breathing. Yet no Mandarin-Chinese translation has ever reported its validation data. In this study we translated and validated the ESS into Mandarin Chinese (CESS). We found, in 31 bilingual patients' responses to the CESS and the English ESS obtained 1-2 weeks apart did not differ significantly (10.5 +/- 3.7 vs. 9.6 +/- 3.9, p = 0.32, Wilcoxon's signed rank test) and were significantly correlated (Spearman's p = 0.67, p = 0.0004). A total of 359 sleep-disordered breathing subjects were enrolled into the validation study in a prospective manner. The CESS showed acceptable internal consistency (Cronbach's alpha = 0.81). Thirty out of these patients answered CESS twice at an interval of 2-4 weeks, to yield an acceptable level of test-retest reliability (p = 0.74, p = 0.001). The respiratory disturbance indices obtained from 251 out of 359 subjects were significantly correlated with their CESS scores (p = 0.22, p < 0.001). The standard response mean of CESS was 0.86 as obtained from 94 out of 359 subjects who had initial control of their symptoms at 3 months after radio-frequency palate surgery. We conclude that the CESS is reliable in both a linguistic and a test-retest sense, and appears to be valid and sensitive to clinical change. The CESS could be used to advantage among other Mandarin-speaking subjects as a standardised screening test of sleepiness in daily life.

Validation assessment of the Chinese version of the Snore Outcomes Survey.

The aim of this study was to use a parallel model to translate the Snore Outcomes Survey (SOS) into Mandarin Chinese language by comparing performing characteristics and statistical properties of the original and Chinese versions SOS. The Chinese version SOS (CSOS) was validated in a prospective, non-randomized manner. A total of 359 patients with sleep-disordered breathing (SDB) aged 18 years and older diagnosed as having SDB participated in the study at entry. Reliability, validity, and longitudinal sensitivity data for CSOS were obtained. CSOS demonstrated good test-retest reliability (Intra-class correlation coefficient = 0.751). The Cronbach's alpha coefficient was 0.86. The item-total correlation coefficients varied from 0.30 to 0.99. The CSOS correlated well with polysomnogram (PSG) parameters including respiratory distress index (RDI), lowest arterial O2 saturation (LAST). CSOS also yielded significant correlations with vitality subscale of Chinese Taiwan version SF-36 (r = 0.4, p = 0.0011). The standard response mean (SRM) for CSOS was 1.33. The validation demonstrated only minor effects of language; the statistical properties of the CSOS were equivalent to the English version. The CSOS is a valid tool to evaluate adults with SDB among Chinese-speaking population.

Translation and validation assessment of the Chinese version of the chronic sinusitis survey.

BACKGROUND: The Chronic Sinusitis Survey (CSS) is a valid, disease-specific measure for evaluating the health status and treatment effectiveness of adults with chronic rhinosinusitis (CRS). In this study, we developed a Chinese version of the CSS (CCSS) which provides the psychometric properties of the Chinese CSS. METHODS: The CSS was translated into Chinese using a parallel model. The CCSS was administered to 198 patients in a prospective manner, and was validated in order to establish its reliability and validity. RESULTS: The CCSS demonstrated good test-retest reliability (correlation coefficient = 0.6-0.89, p=0.0001) and internal consistency (Cronbach's alpha =0.76). The CCSS results were significantly correlated with bodily pain (BP), general health (GH), role-emotional (RE), and mental health (MH) subscales of the Chinese (Taiwan) version of the generic 36-item Short-Form Health Survey (TSF-36). The standardized response mean for the CCSS total score was 0.75, indicating good sensitivity to clinical change. CONCLUSIONS: This validation study demonstrates that the performance characteristics of the CCSS meet the criteria for a valid measure. The CCSS is a valid tool to evaluate adults with CRS among Mandarin-speaking populations.