The implementation of electronic medical records (EMRs) has generally been thought to improve medical efficiency and safety, but consistent evidence of improved healthcare quality due to EMRs in population-based studies is lacking. We assessed the relationship between the degree of EMR adoption and patient outcomes. We performed an observational study using discharge data from Tri-service General Hospital from 2013 to 2018. The levels of EMR utilization were divided into no EMRs, partial EMRs and full EMRs. The primary healthcare quality indicators were inpatient mortality, readmission within 14 days, and 48-hour postoperative mortality. We performed a Cox proportional hazards regression analysis to evaluate the relationship between the EMR utilization level and healthcare quality. In total, 262,569 patients were included in this study. Compared with no EMRs, full EMR implementation led to lower inpatient mortality [adjusted hazard ratio (HR) 0.947, 95% confidence interval (CI): 0.897–0.999, P = ..049] and a lower risk of readmission within 14 days (adjusted HR 0.627, 95% CI: 0.577–0.681, P < .001). Full EMR implementation was associated was a lower risk of 48-hour postoperative mortality (adjusted HR 0.372, 95% CI: 0.208–0.665, P = .001) than no EMRs. Partial EMR implementation was associated with a higher risk of readmission within 14 days than no EMRs (HR 1.387, 95% CI: 1.298–1.485, P < .001). Full EMR adoption improves healthcare quality in medical institutions treating severely ill patients. A prospective study is needed to confirm this finding.

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BackgroundStudies of angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphisms and the risks of knee osteoarthritis (OA) have yielded conflicting results.ObjectiveTo determine the association between ACE I/D and knee OA, we conducted a combined case-control study and meta-analysis.MethodsFor the case-control study, 447 knee OA cases and 423 healthy controls were recruited between March 2010 and July 2011. Knee OA cases were defined using the Kellgren-Lawrence grading system, and the ACE I/D genotype was determined using a standard polymerase chain reaction. The association between ACE I/D and knee OA was detected using allele, genotype, dominant, and recessive models. For the meta-analysis, PubMed and Embase databases were systematically searched for prospective observational studies published up until August 2015. Studies of ACE I/D and knee OA with sufficient data were selected. Pooled results were expressed as odds ratios (ORs) with corresponding 95% confidence intervals (CI) for the D versus I allele with regard to knee OA risk.ResultsWe found no significant association between the D allele and knee OA [OR: 1.09 (95% CI: 0.76–1.89)] in the present case-control study, and the results of other genetic models were also nonsignificant. Five current studies were included, and there were a total of six study populations after including our case-control study (1165 cases and 1029 controls). In the meta-analysis, the allele model also yielded nonsignificant results [OR: 1.37 (95% CI: 0.95–1.99)] and a high heterogeneity (I2: 87.2%).ConclusionsThe association between ACE I/D and knee OA tended to yield negative results. High heterogeneity suggests a complex, multifactorial mechanism, and an epistasis analysis of ACE I/D and knee OA should therefore be conducted.

Recurrence of pressure ulcers following reconstructive surgery occurs frequently, causing a significant burden on the patient and the public health care system. We assessed risk factors for the recurrence of pressure ulcers based on the experience of a single surgeon at our medical centre. We retrospectively analysed patients admitted to our medical centre with stage III and IV pressure ulcers who underwent reconstructive surgery. The hospital database was searched for patients diagnosed with pressure ulcers who underwent reconstructive surgery. Patient characteristics analysed included age, sex, cause and location of defect, comorbidities, lesion size, wound reconstruction methods, operation time, debridement times, duration of hospital stay, and wound complications. Recurrence and mortality rates were retrospectively examined. One hundred and eighty‐nine patients were enrolled, and 166 patients with 176 pressure ulcers met our inclusion criteria. All 14 recurrences (7.95%) were followed for at least 1 year. Logistic regression analysis indicated that recurrence was associated with albumin levels (P = 0.001) and wound size (P = 0.043); however, no association was found for body mass index, bacterial profile, comorbidities, localisation, previous surgery, operation time, or time to admission for reconstruction. In conclusion, higher albumin levels were associated with lower recurrence rates in patients who underwent reconstructive surgery.

The copy-and-paste feature is commonly used for clinical documentation, and a policy is needed to reduce overdocumentation. We aimed to determine if the restricted use of copy and paste by doctors could improve inpatient healthcare quality. Clinical documentation in an inpatient dataset compiled from 2016 to 2018 was used. Copied-and-pasted text was detected in word templates using natural language programming with a threshold of 70%. The prevalence of copying and pasting after the policy introduction was accessed by segmented regression for trend analysis. The rate of readmission for the same disease within 14 days was assessed to evaluate inpatient healthcare quality, and the completion of discharge summary notes within 3 days was assessed to determine the timeliness of note completion. The relationships between these factors were used cross-correlation to detect lag effect. Poisson regression was performed to identify the relative effect of the copy and paste restriction policy on the 14-day readmission rate or the discharge note completion rate within 3 days. The prevalence of copying and pasting initially decreased, then increased, and then flatly decreased. The cross-correlation results showed a significant correlation between the prevalence of copied-and-pasted text and the 14-day readmission rate ( P < .001) and a relative risk of 1.105 ( P < .005), with a one-month lag. The discharge note completion rate initially decreased and not affected long term after restriction policy. Appropriate policies to restrict the use of copying and pasting can lead to improvements in inpatient healthcare quality. Prospective research with cost analysis is needed.