Chien-Tsai Liu

Taipei Medical University, T’ai-pei, Taipei, Taiwan

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Publications (27)32.83 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: End-stage renal disease (ESRD) patients are more prone to infectious disease because of their immunocompromised status. However, the association between pyogenic liver abscess (PLA) and ESRD remains not clear. The aim of our study is to evaluate the incidence, risk factors, and outcomes of PLA in ESRD patients. We recruited all incident ESRD patients from the Taiwan National Health Insurance database from 1998 to 2006. The incidence rate of PLA in ESRD patients was compared with that of a randomly selected non-ESRD control group matched for age, sex gender, Charlson comorbidity score, diabetes mellitus, and cirrhosis. Among the 57,761 incident dialysis patients, there were 538 cases of PLA. The incidence rate of PLA was 18.20 per 10,000 person-years in the ESRD cohort and 6.34 per 10,000 person-years in matched control cohort. The rate of PLA was significantly higher in the ESRD cohort (hazard ratio 3.63, 95% confidence interval 2.83-4.65, P < 0.001). The mortality rates of PLA were higher in the ESRD cohort than those in matched control cohort. Diabetes mellitus was an independent risk factor for mortality of PLA. Compared with non-ESRD patients, ESRD patients have a higher risk of PLA and poorer outcomes.
    Hemodialysis International 06/2014; · 1.44 Impact Factor
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    ABSTRACT: In this study, we developed an integrated hospital-associated urinary tract infection (HAUTI) surveillance information system (called iHAUTISIS) based on existing electronic medical records (EMR) systems for improving the work efficiency of infection control professionals (ICPs) in a 730-bed, tertiary-care teaching hospital in Taiwan. The iHAUTISIS can automatically collect data relevant to HAUTI surveillance from the different EMR systems, and provides a visualization dashboard that helps ICPs make better surveillance plans and facilitate their surveillance work. In order to measure the system performance, we also created a generic model for comparing the ICPs’ work efficiency when using existing electronic culture-based surveillance information system (eCBSIS) and iHAUTISIS, respectively. This model can demonstrate a patient's state (unsuspected, suspected, and confirmed) and corresponding time spent on surveillance tasks performed by ICPs for the patient in that state. The study results showed that the iHAUTISIS performed better than the eCBSIS in terms of ICPs’ time cost. It reduced the time by 73.27 seconds, when using iHAUTISIS (114.26 seconds) and eCBSIS (187.53 seconds), for each patient on average. With increased adoption of EMR systems, the development of the integrated HAI surveillance information systems would be more and more cost-effective. Moreover, the iHAUTISIS adopted web-based technology that enables ICPs to online access patient's surveillance information using laptops or mobile devices. Therefore, our system can further facilitate the HAI surveillance and reduce ICPs’ surveillance workloads.
    Computer Methods and Programs in Biomedicine. 01/2014;
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    ABSTRACT: The National Health Insurance Administration (NHIA) has adopted smart cards (or NHI-IC cards) as health cards to carry patients' medication histories across hospitals in Taiwan. The aims of this study are to enhance a computerized physician order entry system to support drug-drug interaction (DDI) checking based on a patient's medication history stored in his/her NHI-IC card. For performance evaluation, we developed a transaction tracking log to keep track of every operation on NHI-IC cards. Based on analysis of the transaction tracking log from 1 August to 31 October 2007, physicians read patients' NHI-IC cards in 71.01% (8,246) of patient visits; 33.02% (2,723) of the card reads showed at least one medicine currently being taken by the patient, 82.94% of which were prescribed during the last visit. Among 10,036 issued prescriptions, seven prescriptions (0.09%) contained at least one drug item that might interact with the currently-taken medicines stored in NHI-IC cards and triggered pop-up alerts. This study showed that the capacity of an NHI-IC card is adequate to support DDI checking across hospitals. Thus, the enhanced computerized physician order entry (CPOE) system can support better DDI checking when physicians are making prescriptions and provide safer medication care, particularly for patients who receive medication care from different hospitals.
    International Journal of Environmental Research and Public Health 01/2014; 11(2):1369-83. · 2.00 Impact Factor
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    ABSTRACT: Incorporating electronic learning (eLearning) system into professional experimental programs such as pharmacy internships is a challenge. However, none of the current systems can fully support the unique needs of clinical pharmacy internship. In this study we enhanced a commercial eLearning system for clinical pharmacy internship (The Clinical Pharmacy Internship eLearning System, CPIES). The KAP questionnaire was used to evaluate the performance of group A with the traditional teaching model and group B with the CPIES teaching model. The CPIES teaching model showed significant improvement in interns' knowledge and practice (p=0.002 and 0.031, respectively). The traditional teaching model only demonstrated significant improvement in practice (p=0.011). Moreover, professionalism, such as attitudes on cooperating with other health professionals, is developed by learning from a good mentor. The on-line teaching and traditional teaching methods should undoubtedly be blended in a complete teaching model in order to improve learners' professional knowledge, facilitate correct attitude, and influence good practice.
    Computer methods and programs in biomedicine 11/2013; · 1.56 Impact Factor
  • Yu-Sheng Lo, Wen-Sen Lee, Chien-Tsai Liu
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    ABSTRACT: In this study, we propose an approach to build a detection model for surveillance of healthcare-associated urinary tract infection (HA-UTI) based on the variables extracted from the electronic medical records (EMRs) in a 730-bed, tertiary-care teaching hospital in Taiwan. Firstly we mapped the CDC's HA-UTI case definitions to a set of variables, and identified the variables whose values could be derived from the EMRs of the hospital automatically. Then with these variables we performed discriminant analysis (DA) on a training set of the EMRs to construct a discriminant function (DF) for the classification of a patient with or without HA-UTI. Finally, we evaluated the sensitivity, specificity, and overall accuracy of the function using a testing set of EMRs. In this study, six surveillance variables (fever, urine culture, blood culture, routine urinalysis, antibiotic use, and invasive devices) were identified whose values could be derived from the EMRs of the hospital. The sensitivity, specificity and overall accuracy of the built DF were 100 %, 94.61 %, and 94.65 %, respectively. Since most hospitals may adopt their EMRs piece-by-piece to meet their functional requirements, the variables that are available in the EMRs may differ. Our approach can build a detection model with these variables to achieve a high sensitivity, specificity and accuracy for automatically detecting suspected HA-UTI cases. Therefore, our approach on one hand can reduce the efforts in building the model; on the other hand, can facilitate adoption of EMRs for HAI surveillance and control.
    Journal of Medical Systems 04/2013; 37(2):9923. · 1.78 Impact Factor
  • Cheng-Yi Yang, Chien-Tsai Liu
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    ABSTRACT: Population aging in the world causes medical expenses to soar. Preventive health care attracts people and government's close attention. Integrated electronic health records (EHRs) and Personal Health Records (PHRs) play a crucial role in providing continuous health care. Although, IHE (Integrating the Healthcare Enterprise) has developed the XDS (Cross Enterprise Document Sharing) integration profile for sharing clinical documents among computer systems in healthcare, the XDS integration profile may not directly support cloud computing environments where repository systems are heterogeneous and virtualized. In this paper, we propose a PHR cloud system architecture based on the cloud computing Service Model defined by the National Institute of Standards and Technology (NIST), and adopt the IHE XDS integration profile for system interoperability. To enhance computation power and system scalability we include Hadoop parallel computing model and implement a NoSQL storage layer in this PHR cloud architecture. Our approach presented here to PHR Systems Cloud architecture could be a paradigm for sharing documents in health care settings and supporting cloud computing as well.
    Social Computing (SocialCom), 2013 International Conference on; 01/2013
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    ABSTRACT: This study proposed a recognized system for electroencephalogram (EEG) data classification. In addition to the wavelet-based amplitude modulation (AM) features, the fuzzy c-means (FCM) clustering is used for the discriminant of left finger lifting and resting. The features are extracted from discrete wavelet transform (DWT) data with the AM method. The FCM is then applied to recognize extracted features. Compared with band power features, k-means clustering, and linear discriminant analysis (LDA) classifier, the results indicate that the proposed method is satisfactory in applications of brain-computer interface (BCI).
    Clinical EEG and neuroscience: official journal of the EEG and Clinical Neuroscience Society (ENCS) 01/2012; 43(1):32-8. · 1.82 Impact Factor
  • Cheng-Yi Yang, Chien-Tsai Liu
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    ABSTRACT: To ensure the effective communication of health promotion multimedia campaigns, we usually conduct copytests for the developed media. However, conducting traditional copytests takes time and costly. Nowadays the use of the internet is dramatically increasing. The internet is potential to be an effective survey tool. However, the challenge is how to recruit unbiased population samples over the internet. A website for questionnaire survey was developed. We used online social networks, such as micro blogs, bulletin board systems (BBS) and popular websites in Taiwan, to recruit as many participants to take the questionnaire survey as possible. The recruited participants could reach the questionnaire survey website by following the link enclosed in invitation emails or posted messages. During the survey period, the weblog of the website was activated to trace where the participants came from. A total of participants who completed the questionnaires was 2664. Based on the distribution of Taiwan's internet population the minimized sample size with 95% confidence level, the rate of the internet population (72.56%) and with 3% margin error, should be 1068. According to the age, gender and region distribution of Taiwan's internet population (refer to the 2010 report of the Taiwan Network Information Center), we used proportionate stratified random sampling method to selected 1068 from 2664 completed questionnaires. We further analyzed the weblog of the questionnaire survey website. The result revealed that 36.8%, 39.8%, 18.8%, and 4.6% of the participants came from micro blogs, BBS, Health99 and other websites, respectively. Interestingly, there were significantly differences in using online social networks based on their age, region and gender. Such findings can be used to choose appropriate online channels to recruit participants for a research study on the internet.
    139st APHA Annual Meeting and Exposition 2011; 10/2011
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    ABSTRACT: In Taiwan, national health insurance coverage began in 1994, and the Bureau of National Health Insurance has issued health smart cards since 2004. In addition to tracking medical reimbursements, these smart cards store healthcare information, including electronic prescriptions, medical procedure and vaccination records, drug allergy histories, and information about a patient's willingness to be an organ donor. We conducted this study 4 years after the smart cards had been introduced in order to review how drug allergy history is recorded using this system. Our results reveal that the drug allergy histories are incomplete in many cases, and the format used to record a patient's drug allergy history is not consistent. We offer suggestions to promote the standardization of drug allergy history records.
    Journal of Medical Systems 08/2011; 35(4):555-8. · 1.78 Impact Factor
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    ABSTRACT: Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one medication that might be duplicative to the prior prescriptions stored in NHI-IC cards. The rate of potential duplicate medication alerts for the Pediatric Department was higher than that for the Urology Department (2.78% versus 1.67%). However, the rate of revisions to prescriptions was higher in the Urology Department than the Pediatric Department. Overall, the rate of physicians reviewing and revising their prescriptions was 29.25%; the rate of physicians reviewing without revising their prescriptions was 43.62%; the rate of physicians turning off the alert screens right after the screens popped up (overridden) was 27.13%. Thus, physicians accepted alerts to review their prescriptions with patients in most situations (72.87%). Moreover, over the study period, the rate of total revisions made to prescriptions increased and the "overridden" rate decreased. Our approach enhances the capability of CPOE systems using NHI-IC cards as a nationwide infrastructure to provide more complete patient health information and medication history sharing among hospitals in Taiwan. Thus, our system can provide a better prescribing tool to help physicians detect potential duplicate medications for frequent doctor-shopping patients and hence enhance patient safety across hospital boundaries. However, the effectiveness of detecting duplicate medications with our approach is very much dependent on the completeness of NHI-IC cards, which in turn primarily depends on physician use of the cards when prescribing.
    International Journal of Medical Informatics 03/2011; 80(3):181-9. · 2.06 Impact Factor
  • Cheng-Yi Yang, Yu-Sheng Lo, Chien-Tsai Liu
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    ABSTRACT: In order to provide a more relaxing environment where the dental students can learn to memorize the fundamental knowledge as well as the processes and techniques in dental casting, we used the GBL concept as the basis to construct a system model. We had taken the process of dental lost-wax casting and integrated through gaming, the theories and practical skills in the dental casting course, to create this educational gaming program. The main functions of this program are to provide (1) a game involving dental casting simulation, (2) a game involving Q&A in dental casting theory, (3) user help during operation, (4) operation evaluation for user and (5) operation summary for user. In addition to the user interface in this program, We also incorporated an Haptic interactive device in wireless vibration feedback for more lively and diverse learning methods in dental casting for learners. This study aimed to establish a learning environment for dental casting through gaming that included the operation in dental lost-wax casting and the study of fundamental knowledge in dental casting.
    01/2010;
  • Yu-Sheng Lo, Chien-Tsai Liu
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    ABSTRACT: The guidelines for hospital-acquired infections (HAI) published by the Centers for Disease Control and Prevention (CDC) is most comprehensive and detailed. However, it requires a large amount of resources to implement the guidelines in hospital settings, particularly for data collection and analysis. HAI surveillance is time-consuming and costly, and hence HAI surveillance in many hospitals couldn't regularly be performed. Nowadays, most hospitals in Taiwan have adopted electronic medical record systems to support day-to-day clinical practice. As the result of popularity of EMRs, the daily HAI surveillance tasks can be eased and automated. According to that, we have established a HAI surveillance information system (HASIS) based on a service-oriented architecture (SOA) technology for integration of surveillance data, distributed in different hospital information systems. We also have developed the detection algorithms for detection suspicious cases. Thus, the HASIS can provide both abstract and complete electronic surveillance information, and detect suspected infection cases. Consequently, it can support infection control professionals' daily surveillance tasks more responsively and efficiently.
    01/2010;
  • International Conference on Bioinformatics & Computational Biology, BIOCOMP 2009, July 13-16, 2009, Las Vegas Nevada, USA, 2 Volumes; 01/2009
  • Cheng-Yi Yang, Yu-Sheng Lo, Chien-Tsai Liu
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    ABSTRACT: A blow torch or blow pipe is the most frequently used in the dental lost-wax casting technique. However, adjustment of the blow pipe is dangerous and difficult to a certain degree and hence requires repeated practice to do it well. Beginners cannot practice by themselves and need guidance from a teacher. Otherwise it will result in casting failure and cost losses. In a worst scenario, it may also lead to a serious public safety accident. This study uses the computer assisted instruction (CAI) with the visual interface and Wii remote haptic wireless interactive device developed by Nintendo to effectively simulate blow pipe adjustment and establish an assisted casting training environment that is authentic, intuitive, and can effectively monitor the learning process for students to learn spontaneously, cut down the teaching cost, enhance operation safety, and reduce the teacherpsilas burden.
    2009 International Conference on Education Technology and Computer, ICETC 2009, Singapore, 17-20 April 2009; 01/2009
  • International Conference on Bioinformatics & Computational Biology, BIOCOMP 2009, July 13-16, 2009, Las Vegas Nevada, USA, 2 Volumes; 01/2009
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    ABSTRACT: Background: At present, passive alarm system from culture reports and announced from groups outbreak events make cases investigate delayed. Is there any predict factor can be used to suggest active high capture sensitivity surveillance and alarm outbreak early? Objectives: Is there any predict factor can be used to get active high capture sensitivity surveillance of hospital-acquired infections (HAI) in acute hospitals. Can it give alarm of outbreak early? Can it decrease the number for direct patient examination or chart review. Methods : We performed three months retrospective study to identify predictors(urine routine, device as catheter or cystoscope, antibiotics, culture, etc.) about major HAI (urinary tract infections), as defined by the Centers for Disease Control and Prevention (CDC) criteria in a medical center (733 beds). We compared patients list of predictor(s) positive collected from electronic medical record by medical information department members with confirmed nosocomial UTI cases list given from infection control department. Results: 5533 admission patients were screened. The overall prevalence of HAI was 2.5% (141/5533); 1.4% (77/5533) of patients was nosocomial UTI. At presence of urine routine examination and devices guarantees 100% capture sensitivity in detecting nosocomial UTI but requires an assessment of 2763 patients (49.9%) of the population. At presence of antibiotics and devices guarantees 98.7% capture sensitivity and requires an assessment of 1921 patients (34.7%) of the population, whereas presence of antibiotics and urine routine examination has 98.7% capture sensitivity but requires an assessment of 3019 patients (54.7%) of the population. Conclusion: A capture system based on daily list of newly order about antibiotics, devices, urine routine examination, urine culture, blood culture, infection control department of hospital can decide which high predict value criteria suggesting checklist from medical information department for - infection control department member to perform active patient examination and decrease the number of direct patient examination and chart review, but still keep high capture sensitivity.
    Ninth IEEE International Conference on Bioinformatics and Bioengineering, BIBE 2009, June 22-24, 2009, Taichung, Taiwan; 01/2009
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    ABSTRACT: The purpose of this study was to evaluate patient satisfaction with an Internet-based integrated patient education system, and to identify the components of the system that affect patient satisfaction. The system has been operating in a university-affiliated hospital for outpatients with diabetes. For each patient visit, the system integrates his/her pharmaceutical education materials and medical care records such as laboratory test results, medication prescriptions and next visit appointments, into an individual medical folder. The integrated medical folders are then transformed into web structures for continuing patient education after leaving the hospital. The patients can easily access the knowledge required for medication care through the internet. In order to assess the satisfaction of patients with the system, we use the questionnaire developed by Doll and Torkzadeh for the measurement of end-user computing satisfaction, and translate it into Chinese. There were 81 participants selected from Diabetes patient who had used the system involved in the questionnaire survey. 50 participants returned their questionnaires. After analysis of the returned questionnaires, over 70% of patients were satisfied with the content, accuracy, format and timeliness of information provided by this system, and agreed easy of use with the system. This study also revealed that patient satisfaction was highly positively correlated with the number of logons and the number of accesses to the web pages. According to userspsila responses, information content and format of reports should be more flexible. The patients and their care giver would like to choose and combine the information to redesign the format of reports by themselves. Some of patientpsilas family point ldquoeasy of userdquo is important for the senior patients. They mention all of the information should be at the same page, because the senior patients couldn'tpsilat manipulate complicated procedure. Furthermore, both of - - privacy and security also were important issue in connection with patient satisfaction. Future research should explore and identify additional components of satisfaction that are specific to a web-based environment.
    e-health Networking, Applications and Services, 2008. HealthCom 2008. 10th International Conference on; 08/2008
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    ABSTRACT: To develop and evaluate a Web-based, patient-orientated diabetic education management (POEM) system. The POEM system has been developed to extend hospital patient education by integrating patients' medical care data into their education program components and presenting them on the Web. Since most patients are concerned about their medical care data, the POEM system can provide the incentives for patients to continuously and persistently log in and learn the required knowledge and skills, improving their clinical outcomes. A quasi-experimental method that uses control groups and pretests was used to evaluate the outcomes of the system intervention. We recruited patients with type-2 diabetes and alternatively assigned them to intervention and control groups. We compared laboratory test results including fasting blood glucose, HbA1c, total cholesterol, triglyceride (TG), and HDL between the two groups from the first visit through each follow-up visit. The study period progressed from September 2003 to May 2004 at the Metabolism Center of a medical teaching hospital in Taipei. In this study, we recruited 274 participants: 134 (57% males and 43% females) in the intervention group and 140 (46% males and 54% females) in the control group. The patients' laboratory test results from the first visit for fasting blood glucose, HbA1c, total cholesterol level, TG, and HDL in the intervention and control groups were respectively 187.54+/-77.10 and 189.99+/-73.49 mg/dl, 9.03 +/- 2.79% and 8.95 +/- 2.23%, 193.29 +/- 47.93 and 202.52 +/- 58.45 mg/dl, 152.48 +/- 70.85 and 157.37 +/- 74.88 mg/dl, and 44.97 +/- 12.09 and 45.32 +/- 12.08 mg/dl. There were three follow-up visits during the study period. We collected laboratory test results of the two groups through each of the following visits and analyzed them using ANCOVA. We discovered a significant difference in fasting blood glucose levels between intervention and control group as early as the first follow-up. At the second follow-up, both fasting blood glucose and HBA1c levels were significantly different between intervention and control group. At the third follow-up, there was a significant difference in fasting blood glucose, HBA1c, and total cholesterol between intervention and control group. We also monitored the number of logins for the patients in the intervention group during the follow-up period. The result showed the patients had consistently logged into the POEM system (about 8.5 +/- 3.7 logins per person per month after 3 months enrollment). Thus, the patients in the intervention group had better control of their fasting blood glucose, HbA1c and total cholesterol levels than those in the control group due to the assistance of the system. The POEM system can help patients control their glucose, HbA1c and total cholesterol levels to manage their diabetes, providing an easy and inexpensive way to extend hospital-based patient education services for community-based continuous patient education.
    International Journal of Medical Informatics 10/2007; 76(9):655-63. · 2.06 Impact Factor
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    ABSTRACT: It becomes very difficult for pooling and combining of patients' laboratory test results from different healthcare providers for integrated care when using different set of the codes. LOINC® (Logical Observation Identifier Names and Codes) has been developed to facilitate the transmission and storing of clinical laboratory results among different sources of clinical laboratories since 1994. Currently, the LOINC codes are most comprehensive for the identifiers of laboratory tests, and widely adopted internationals. Since National Health Insurance (NHI) codes have been used nationwide in Taiwan, most clinical laboratories and hospitals have a mapping database between their internal codes and the NHI codes. In this paper, we present methods to create a NHI-LOINC mapping database as an intermediate medium, and develop a web-based NHI-LOINC mapping system to facilitate the mapping from hospital internal codes to the LOINC codes. Our approach can reduce the learning curve and required domain knowledge for the LOINC due to familiarity of NHI codes. Hence, it can facilitate the adoption of LOINC codes in Taiwan.
    e-Health Networking, Application and Services, 2007 9th International Conference on; 07/2007
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    Min-Huei Hsu, Yu-Chuan Li, Chien-Tsai Liu
    Canadian Medical Association Journal 09/2006; 175(4):385. · 6.47 Impact Factor

Publication Stats

81 Citations
32.83 Total Impact Points

Institutions

  • 2004–2014
    • Taipei Medical University
      • • College of Medical Science and Technology
      • • Graduate Institute of Medical Informatics
      T’ai-pei, Taipei, Taiwan
  • 2006
    • National Chung Cheng University
      • Department of Information Management
      Xinying, Taiwan, Taiwan
  • 2005
    • Wan Fang Hospital
      T’ai-pei, Taipei, Taiwan