Excess thyroid hormones have complex metabolic effects, particularly hyperthyroidism, and are associated with various cardiovascular risk factors. Previous candidate gene studies have indicated that genetic variants may contribute to this variable response. Electronic medical record (EMR) biobanks containing clinical and genomic data on large numbers of individuals have great potential to inform the disease comorbidity development. In this study, we combined electronic medical record (EMR) -derived phenotypes and genotype information to conduct a genome-wide analysis of hyperthyroidism in a 35,009-patient cohort in Taiwan. Diagnostic codes were used to identify 2,767 patients with hyperthyroidism. Our genome-wide association study (GWAS) identified 44 novel genomic risk markers in 10 loci on chromosomes 2, 6, and 14 (P < 5 × 10–14), including CTLA4, HCP5, HLA-B, POU5F1, CCHCR1, HLA-DRA, HLA-DRB9, TSHR, RPL17P3, and CEP128. We further conducted a comorbidity analysis of our results, and the data revealed a strong correlation between hyperthyroidism patients with thyroid storm and stroke. In this study, we demonstrated application of the PheWAS using large EMR biobanks to inform the comorbidity development in hyperthyroidism patients. Our data suggest significant common genetic risk factors in patients with hyperthyroidism. Additionally, our results show that sex, body mass index (BMI), and thyroid storm are associated with an increased risk of stroke in subjects with hyperthyroidism.
The study explores the key factors influencing Lean management and evaluates their individual weights to identify what leads to a successful hospital management. It adopts the 4P Excellence Model in Lean management to assess and measure the healthcare organizations from the five perspectives: leadership, people, partnership, processes, and products. To explore the potential factors, the study employs the analytic hierarchy process (AHP) method and multi-expert judgment to prioritize the significance of each factor. The study has led to a number of useful insights. Processes are crucial when hospitals advocate lean management. Among the 18 sub-factors in the five criteria, the most significant factors include patient-centered care, clearly defined work content, rewarding teamwork effort, continual learning and upgrading, and increasing the clinic quality. To satisfactorily carry out Lean management, a hospital should continuously strive for improvement, pursue perfection, engender organizational culture, strengthen teamwork, and create mutual trust among team members. Moreover, patient-centered care beliefs should be actively implemented. To provide seamless care, patients and their families should be the main foci. The results could be used by hospital managers to improve their skills and knowledge when implementing Lean management. In addition, the framework developed herein could potentially lend itself to many practical applications.
Background: Constitutional medicine was as an example of earlier medicine evidence of Chinese Medicine (CM). CM-Constitutional Questionnaire (CM-CQ) commonly considered as the observed various phenotypes as phenome. However, the comprehensive associations between self-reported disease outcomes and questionnaires of CM-CQ remained uncertain. Methods: Taiwan Biobank has begun the collection of these cancer-free volunteers, aged 30-70 with these questionnaires, self-reported disease history, clinical examinations, and genetic information from 2012 as baseline enrollment. This community-, cross-sectional study was conducted by part of Taiwan Biobank and compared the associations among CM-CQ, which reflect these constitutional variables as individual markers.Results: The present study conducted by using 1,998 volunteers (2 withdraw) from Taiwan Biobank. Which separately assessed the associations among 32 diseases and 44 items of CM-CQ questions using the binomial logistic regression model. There were 6 CM-CQ questions with a significant association of self-reported osteoporosis in all CM-CQ. Interestingly, we found that these 6 CM-CQ questions shown a significant association with osteoporosis, even which adjusted with false discovery rate (adjusted p <0.05). The Q1, Q22, and Q37 demonstrated with considerably adjusted p-value and the other CM-CQ, which involved in Q14, Q16, and Q21 shown borderline relation to self-reported osteoporosis, which was existed less residual effect with smoking and drinking habits. Conclusion: This study generated real-world evidence of national biobank for clarified associations between clinical symptom and self-reported diseases. The exploration of self-reported disease-related CM-CQ for further companion diagnostic indicators via comprehensive community-based Taiwan Biobank study should be a possibility.
Background Constitutional medicine was as an example of earlier medicine evidence of Chinese Medicine (CM). CM-Constitutional Questionnaire (CM-CQ) commonly considered as the observed various phenotypes as phenome. However, the comprehensive associations between self-reported disease outcomes and questionnaires of CM-CQ remained uncertain. Taiwan Biobank has begun the collection of these cancer-free volunteers, aged 30–70 with these questionnaires, self-reported disease history, clinical examinations, and genetic information from 2012 as baseline enrollment. Results This community-, cross-sectional study was conducted by part of Taiwan Biobank and compared the associations among CM-CQ, which reflect these constitutional variables as individual markers. The present study conducted by using 1,998 volunteers (2 withdraw) from Taiwan Biobank. Which separately assessed the associations among 32 diseases and 44 items of CM-CQ questions using the binomial logistic regression model. There were 6 CM-CQ questions with a significant association of self-reported osteoporosis in all CM-CQ. Conclusions Interestingly, we found that these 6 CM-CQ questions shown a significant association with osteoporosis, even which adjusted with false discovery rate (adjusted p < 0.05). The Q1, Q22, and Q37 demonstrated with considerably adjusted p-value and the other CM-CQ, which involved in Q14, Q16, and Q21 shown borderline relation to self-reported osteoporosis, which was existed less residual effect with smoking and drinking habits. This study generated real-world evidence of national biobank for clarified associations between clinical symptom and self-reported diseases. The exploration of self-reported disease-related CM-CQ for further companion diagnostic indicators via comprehensive community-based Taiwan Biobank study should be a possibility.
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