Hospital Information System Research Articles

A Clinicopathological Analysis of Membranous Nephropathy and Its Correlation With the Immunohistochemical Expression of Phospholipase A2 Receptor (PLA2R) in Renal Biopsies in a Tertiary Care Center.

Background Membranous nephropathy (MN) is the second most common adult-onset nephrotic syndrome worldwide. Traditionally, these were classified as primary and secondary, with primary causes showing higher positivity for various antigens, includingM-typephospholipase A2 receptor (PLA2R), a key antigen located in the podocyteagainstwhich antibodies are directed. Aim The aim of this study is to analyze the cases diagnosed as MN with clinicopathological parameters and PLA2R positivity by immunohistochemistry in renal biopsies. Methods A retrospective observational study of 65 cases of MN diagnosed in renal biopsiesby light microscopy and confirmed by ancillary studies from the Department of Pathology, Sri Ramachandra Medical College and Research Institute over a period of three years (2021-2023). The demographic profile and patient details were obtained from the hospital information system and archival case files.The description of categorical variables was expressed as frequency and percentage. The Chi-squared test and Fisher's exact test were employed to compare the distribution of qualitative variables between the groups. Results This case study includes 65 membranous nephropathy cases, of which 47.7% were diagnosed as primary MN and 52.3% as secondary MN. Of these, serum antinuclear antibody (ANA) positivity was seen in 80.6% of cases of primary MN and 58.8% of cases of secondary MN. Elevated serum C3/C4 levels were noted in 51.6% of primary MN and 47.1% of secondary MN (Ref. C3 = 90-180mg/dl; C4 = 10-40mg/dl). Immunofluorescence for IgG showed a nonspecificassociation between primary and secondary MN. Immunohistochemistry (IHC) for PLA2R showed positivity in 72.3% of primary MN cases and 27.7% of secondary MN cases. The Chi-squared test and Fisher's exact test showed statistical significance for these parameters. Conclusion This study signifies that primary MN is more frequently associated with positive immunohistochemical expression of PLA2R. These findings help in characterizing these cases as antigen-specific and have helped in the ongoing validation ofPLA2R IHC as a diagnostic marker, which aids in monitoring the disease progression, remission, and recurrence. Despite the availability ofvarious modalities for estimating the levels of anti-PLA2R, diagnostic challenges persist. Hence, most renal laboratories continue to adopt renal biopsy stainingfor IHC PLA2R to identify and monitor the disease progression.

Younger and rural children are more likely to be hospitalized for SARS-CoV-2 infections.

To identify characteristics of SARS-CoV-2 infection that are associated with hospitalization in children initially evaluated in a Pediatric Emergency Department (ED). We identified cases of SARS-CoV-2 positive patients seen in the Arkansas Children's Hospital (ACH) ED or hospitalized between May 27, 2020, and April 28, 2022, using ICD-10 codes within the Pediatric Hospital Information System (PHIS) Database. We compared infection waves for differences in patient characteristics and used logistic regressions to examine which features led to a higher chance of hospitalization. We included 681 pre-Delta cases, 673 Delta cases, and 970 Omicron cases. Almost 17% of patients were admitted to the hospital. Compared to Omicron-infected children, pre-Delta and Delta-infected children were twice as likely hospitalized (OR = 2.2 and 2.0, respectively; p<0.0001). Infants under one year were >3 times as likely to be hospitalized than children ages 5-14 years regardless of wave (OR = 3.42; 95%CI = 2.36-4.94). Rural children were almost three times as likely than urban children to be hospitalized across all waves (OR = 2.73; 95%CI = 1.97-3.78). Finally, those with a complex condition had nearly a 15-fold increase in odds of admission (OR = 14.6; 95%CI = 10.6-20.0). Children diagnosed during the pre-Delta or Delta waves were more likely to be hospitalized than those diagnosed during the Omicron wave. Younger and rural patients were more likely to be hospitalized regardless of the wave. We suspect lower vaccination rates and larger distances from medical care influenced higher hospitalization rates.

Automated Sample Annotation for Diabetes Mellitus in Healthcare Integrated Biobanking

Healthcare integrated biobanking describes the annotation and collection of residual samples from hospitalized patients for research purposes. The central idea of the current work is to establish an automated workflow for sample annotation, selection and storage for diabetes mellitus.This is challenging due to incomplete data at the time of sample selection. The study evaluates a machine learning (ML) and natural language processing (NLP) based two-step procedure for timely and precise sample annotation for diabetes mellitus.Electronic health record data of 785 persons were extracted from the hospital information system. In the first step, a conditional inference forest (CIF) model was trained and tested based on laboratory values from the first 72hours of the hospital stay using test- (n=550) and training data sets (n=235). Performance was compared with a simple laboratory cut-off classifier (LCC) and a logistic regression (LR) model. Algorithms based on laboratory values, ICD-10 codes or information from discharge summaries extracted by a natural language processing software (NLP-DS) were evaluated as a second (review) step designed to increase the precision of annotations.For the first step, recall/precision/F1-score/accuracy were 71%/86%/0.78/0.82 for CIF and 77%/70%/0.74/0.75 for LR compared to 73%/68%/0.70/0.72 for LCC. NLP-DS was the best performing second (review) step (93%/100%/0.97/0.97). Combining first-step models with NLP-DS increased precision to 100% for all procedures (66%/100%/0.80/0.85 for CIF&NLP-DS 72%/100%/0.84/87.2 for LR&NLP-DS and 66%/100%/0.80/0.85 for LCC&NLP-DS). The number of samples removed by the NLP-DS analysis was higher for LR&NLP-DS and LCC&NLP-DS(removal rate 35% and 38% of initially selected samples) compared to CIF&NLP-DS (removal rate of 20%).The developed two-step procedure is an efficient implementable method for timely and precise annotation of samples from diabetic hospitalized patients.

Road traffic injury among elderly people and its determinant factors: a cross-sectional study.

Injuries from Road Traffic Accidents (RTAs), particularly among vulnerable groups such as the elderly, are considered a significant public health concern. The aim of this study was to show epidemiology of RTIs among the elderly people in the Eastern Azerbaijan province of Iran. This cross-sectional study included all patients over 60 years old who admitted to the Shohada Hospital from 2006 to 2016. Data were extracted from the Hospital Information System. Injuries types were classified based on the International Classification of Diseases (ICD-10). Descriptive statistics (Mean, median and frequency) and inferential statistics (The Pearson Chi-square test) were used for data analysis through SPSS-24 software. A total of 3509 RTAs involving patients over 60 years old from 2006 to 2016. These traffic-related injuries comprised 15% of all recorded injuries (23,321 cases). The mean age of the patients was 69.91 ± 7.61 years, with a predominant male representation (2324 patients, 64.74%). The median Length of Stay (LOS) in hospital was 3 days. Injuries most commonly affected the knee and lower leg regions (27.5%). The most frequent types of accidents were those involving car passengers (40.47%) and pedestrians (36.33%). The majority of RTAs occurred during the summer season. There was a significant difference in the rate of RTAs based on variables such as sex, age, season, and LOS (p < 0.001). The study highlights traffic-related injuries among the elderly, mostly affecting the knee and lower leg regions, especially during the summer season. The efforts should include enhancing safety measures for car passengers and pedestrians, particularly during the high-risk summer months. Also, it emphasizes the need for public transportation to improve safety for older people due to lower accident rates and senior-friendly features.

Clinical Characteristics and Outcomes of Interstitial Lung Disease Patients with Acute Respiratory Failure Admitted to the ICU

Abstract Background: Acute respiratory failure is a dreaded complication of interstitial lung disease (ILD) and is the most significant reason for mortality in most forms of ILDs. Knowledge of outcome predictors that can be assessed early after intensive care unit (ICU) admission would help guide the use of specific treatments. The present study attempts to identify the baseline characteristics of ILD patients admitted due to acute respiratory failure to ICU and to evaluate the cause of acute respiratory failure in these patients, management, and the outcomes. Materials and Methods: An observational cohort study was carried out in a tertiary care center in North India on 50 previously diagnosed patients of ILD hospitalized due to acute respiratory failure between January and December 2022. All relevant clinical, investigational, and treatment data were collected from the hospital information system. Results: The baseline mean FVC and 6-min walk distance were lower for non-survivors. The baseline mean DLCO was significantly lower among non-survivors. Comparatively, the radiology pattern of both groups showed that the usual interstitial pneumonia (UIP) pattern was associated with highest mortality. However, this difference was not statistically significant. Mortality was higher in those with lower PaO2/FiO2 ratio than among the survivors. Sputum culture positivity had a statistically significant impact on mortality. The mean hospital stay time was considerably higher in patients with idiopathic pulmonary fibrosis (IPF) and in patients with Type 2 respiratory failure. Conclusion: Baseline lung function tests, comorbidities, and exacerbating factors are invaluable in predicting the clinical outcomes. It is essential to perform all the diagnostic examinations at the earliest to ensure prompt initiation of the most appropriate therapy and lower hospital mortality. Distinguishing those patients who have a known cause for their ILD from those who do not was found to be crucial for deciding the most appropriate management.

Development of a minimum data set for a blockchain-based personal health records (PHRs), for patient/physician interaction in family medicine

BACKGROUND: The primary requirement for a capable patient health record (PHR) that can interact appropriately with the family medicine system and collect and share qualified data is a minimum data set (MDS) aligned with family medicine’s functions and goals. The aim of this research was to determine the MDS for a blockchain-based PHR system that can effectively interact with family medicine providers and collect and share qualified data. This MDS is intended to be applicable to all members of the community covered by family medicine. MATERIALS AND METHODS: This applied study was conducted in 2022 in a cross-sectional and descriptive approach in three phases. In the first phase, a content analysis related to the research objectives was conducted in scientific databases, search engines, and websites of the centers and scientific research organizations with publications and policy-making in this field. Consequently, 11 studies were selected for use in the second and third phases. In the second phase, to determine information needs, a researcher-developed questionnaire including 17 classes was given to 50 people under the cover of the family medicine plan in Shiraz city. By choosing one of the two options “Yes” or “No” by them, the necessary data classes were determined. In the third phase, the second researcher-developed questionnaire was designed and administered to 100 family physicians in Shiraz city. This questionnaire included the data elements corresponding to the data classes approved in the previous phase. The family physicians were asked to rate the importance of each data element using a Likert scale with five options, ranging from “very unimportant” to “very important.” The necessary data elements were determined based on these scores. RESULTS: In the first questionnaire, 16 of the 17 data classes received approval from individuals covered by the family medicine plan. Consequently, a questionnaire comprising 16 classes and 105 data elements was administered to the family physicians. Ultimately, the MDS was determined to include 16 classes and 72 data elements. CONCLUSIONS: Determining essential data elements, especially for patient/physician interaction in family medicine, should be such that they can be managed by the person while being comprehensive and providing sufficient help to the physician during the treatment process. This MDS can be used to interact with and refer PHRs to other physicians and specialists, as well as help interoperability between the PHR and other health systems, such as hospital information systems (HIS) and electronic health records (EHRs).

The PrescIT platform: An interoperable Clinical Decision Support System for ePrescription to Prevent Adverse Drug Reactions and Drug-Drug Interactions.

Preventable medication errors have been proven to cause significant public health burden, and ePrescription is a key part of the process where medication errors and adverse effects could be prevented. Information systems and "intelligent" computational approaches could provide a valuable tool to prevent such errors with profound impact in clinical practice. The PrescIT platform is a Clinical Decision Support System (CDSS) that aims to facilitate the prevention of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in the phase of ePrescription in Greece. The proposed platform could be relatively easily localized for use in other contexts too. The PrescIT platform is based on the use of Knowledge Engineering (ΚΕ) approaches, i.e., the use of Ontologies and Knowledge Graphs (KGs) developed upon openly available data sources. Open standards (i.e., RDF, OWL, SPARQL) are used for the development of the platform enabling the integration with already existing IT systems or for standalone use. The main KG is based on the use of DrugBank, MedDRA, SemMedDB and OpenPVSignal. In addition, the Business Process Management Notation (BPMN) has been used to model long-term therapeutic protocols used during the ePrescription process. Finally, the produced software has been pilot tested in three hospitals by 18 clinical professionals via in-person think-aloud sessions. The PrescIT platform has been successfully integrated in a transparent fashion in a proprietary Hospital Information System (HIS), and it has also been used as a standalone application. Furthermore, it has been successfully integrated with the Greek National ePrescription system. During the pilot phase, one psychiatric therapeutic protocol was used as a testbed to collect end-users' feedback. Summarizing the feedback from the end-users, they have generally acknowledged the usefulness of such a system while also identifying some challenges in terms of usability and the overall user experience. The PrescIT platform has been successfully deployed and piloted in real-world environments to evaluate its ability to support safer medication prescriptions.

Analysis of registered clinical trials in Italy regarding dermatology (2003-2022): a cross-sectional study on historical trend and prospects for industry investments.

This cross-sectional analysis intends to evaluate trend and outlook of industry clinical research in Italy regarding dermatology and its prospects for the next few years. A computerized search of ClinicalTrial.gov database was carried out considering the 20-year period 2003-2022 using the following string: "Skin Diseases OR Skin cancer OR Skin Neoplasms OR Skin Infection OR Skin Lesion OR Skin Ulcer OR Skin Laxity OR Skin toxicity OR Dermatologic Complication OR Skin abnormalities". During the last 20 years 690 Industry Clinical Trials (IndCTs) were conducted in Italy regarding dermatological investigations, almost entirely funded by non-Italian pharmaceutical companies, involving 4497 centers, and recruiting an average of 13.0 subjects per site. The number of controlled and randomized studies has grown quite regularly and in the last 5 years they represented 79.6% of IndCTs initiated. Countries most frequently sharing with Italy international protocols were Spain (75.0%), Germany (71.8%), France (68.5%), the USA (67.4%), and the UK (54.8%). These data point to a historical involvement of Italy in dermatology IndCTs lower than in the major European countries. However, the war in Ukraine has deprived IndCTs of the contribution of Russia, Ukraine, and Belarus, meaning a mean of about 40 new IndCTs per year in a population of 200 million inhabitants. In contrast, many indicators point to Italy as a country with potential in dermatology wider than used in the past: an efficient health care system accessible to any citizen or resident, 4.6 million dermatological interventions per year, low density of IndCTs concerning dermatology, good production of scientific papers in indexed medical journals, relatively low cost of services and labour and geopolitical stability. The European Clinical Trials Information System's (CTIS), mandatory for the EU member states since early 2023 allows common, simplified, and harmonized regulatory procedures over the life cycle of clinical trials in Europe (EMA, 2023) and plays in favor of Italy's greater competitiveness in clinical research.

Predictors and potential risk factors of iatrogenic ureteral injury following common obstetric and gynecological surgeries: A single-center retrospective study

Objectives: As iatrogenic ureteral injury carries a high burden and is associated with increased postoperative morbidity and mortality, the purpose of this study is to determine the incidence and potential risk factors of iatrogenic ureteral injury following common obstetric and gynecological surgeries in King Abdulaziz Medical City. Methods: This was a single-center retrospective cohort study based on data extracted from an electronic hospital information system conducted in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Three thousand four hundred and sixty-four cases of cesarean section (C-section) and hysterectomy from January 1, 2021, to December 31, 2022, were reviewed. All cases of C-section and hysterectomy in which the urology department was consulted for suspected iatrogenic ureteric injuries were included in the study. All cases other than C-sections and hysterectomy in which the urology department was consulted for suspected iatrogenic ureteric injuries were excluded from the study. Results: A total of 45 patients for whom urology was consulted for suspected ureteral injury were included in this study. Approximately (35.6%) one-third of the patients had positive findings of ureteral injury following common obstetric and gynecological surgeries. About 41.2% of these patients had previous gynecological surgeries. Other potential risk factors were tested such as age and body mass index. Older patients were slightly at higher risk of iatrogenic ureteral injury (P &lt; 0.05). Conclusion: Ureteral injury in obstetric and gynecological surgeries is rare yet serious complication. The findings of this study suggest that the incidence of iatrogenic ureteral injury was relatively associated with older age.

An in vitro experimental study on the interference of glyphosate on the urease enzyme

Purpose: Exposure to glyphosate is increasing due to the density of agricultural areas in Türkiye. In this study, the possible interference effect of glyphosate on urease, an enzyme that is frequently used in the diagnosis and follow-up of many diseases and in the measurement of urea in biological samples was examined. Materials and Methods: First, glyphosate was observed to have a negative interference in experiments using solutions of varying concentrations of urea. Second, blood samples were examined using the urease-glutamate dehydrogenase (GLDH) and indirect nesslerization procedures to determine the effects of glyphosate on the results before and after its addition. To determine the morphological and chemical alterations, scanning electron microscope (SEM) and Fourier-transform infrared spectroscopy (FTIR) analyses were conducted, and binding patterns were established through molecular docking. Urea measurements conducted with urease-GLDH and indirect nesslerization demonstrated a negative interference on the results with glyphosate concentrations of 10–3, 10–4, and 10–5 M. Results: Morphological changes observed in the SEM analysis were supported by the 3228.25 (O-H), 1642.08 (C=C), and 1531.20 (N-O) cm–1 bonds formed in the FTIR analysis. Furthermore, the molecular docking analysis showed that glyphosate affected the urease via hydrogen bonding (Gly13, Ser12, Lys14, Thr15, and Asp37) and hydrophobic interactions (Val10, Asp37, and Glu98). It was hypothesized that these interacting amino acids limit the accessibility of the urease’s active catalytic conformation and/or impact the stability of the catalytic transition state. Conclusion: Glyphosate leads to negative interference in human serum urea assays, leading to incorrect test results in clinical biochemistry, microbiology, and agricultural laboratories. This effect should be considered when conducting analysis, and clinicians as well as hospital information management systems should be informed ahead of time, with special emphasis devoted to this interference.

The Impact of Customized Screening Intervals on the Burden of Drug-Drug Interaction Alerts: An Interrupted Time Series Analysis.

Fixed and broad screening intervals for drug-drug interaction (DDI) alerts lead to false positive alerts, thereby contributing to alert fatigue among healthcare professionals. Hence, we aimed to investigate the impact of customized screening intervals on the daily incidence of DDI alerts. An interrupted time series analysis was performed at the University Hospitals Leuven to evaluate the impact of a pragmatic intervention on the daily incidence of DDI alerts per 100 prescriptions. The study period encompassed 100 randomly selected days between April 2021 and December 2022. Preceding the intervention, a fixed and broad screening interval of 7 days before and after prescribing an interacting drug was applied. The intervention involved implementing customized screening intervals for a subset of highly prevalent or clinically relevant DDIs into the hospital information system. Additionally, the sensitivity of the tailored approach was evaluated. During the study period, a mean of 5731 (± 2909) new prescriptions per day was generated. The daily incidence of DDI alerts significantly decreased from 9.8% (95% confidence interval (CI) 8.4;11.1) before the intervention, to 6.3% (95% CI 5.4;7.2) afterwards, p < 0.0001. This corresponded to avoiding 201 (0.035*5731) false positive DDI alerts per day. Sensitivity was not compromised by our intervention. Defining and implementing customized screening intervals was feasible and effective in reducing the DDI alert burden without compromising sensitivity.

Leveraging SWOT Analysis in IS/IT Strategy for Enhancing Hospital Quality

The research conducted at the Datu Sanggul Hospital in Rantau focuses on developing a strategic plan for enhancing the quality of healthcare services through Information System (IS) and Information Technology (IT) implementation. The study aims to address the challenges faced by the hospital in optimizing its Management Information System and Medical Record (SIM &amp; RM) unit. By utilizing the Ward &amp; Peppard framework, the research progresses through stages including problem formulation, data collection, and strategy formulation. Through interviews, focus group discussions, and data analysis, the current business strategies and IT infrastructure are evaluated. External factors such as PEST analysis and Five Forces analysis are also considered to understand the hospital's position in the industry. The findings from these analyses serve as inputs for the SWOT analysis, which helps in identifying the hospital's current standing and areas for improvement. The study further delves into developing IS business strategies and IT roadmap planning based on critical success factors and business needs. By aligning IS/IT strategies with business goals, the research aims to provide recommendations for enhancing the hospital's information system infrastructure and management practices.

External validation of the MiGUTS nomogram for the prediction of bleeding control intervention after renal trauma.

The American Association for the Surgery of Trauma (AAST) renal trauma grading leads to a variable management of patients with high-grade renal injuries. For a better prediction of the risk for bleeding interventions, Keihani et al. introduced the multi-institutional genito-urinary trauma study (MiGUTS) renal trauma nomogram in 2019. The aim of this study was to conduct an external validation and generalization for all kidney trauma cases of the nomogram with a European cohort of a Swiss level 1 trauma center. We collected data from the clinical information system of the Kantonsspital Graubünden, Chur, Switzerland. All patients ≥ 18 years of age from 01.01.2008 to 01.12.2020 with a renal trauma who underwent computed tomography imaging of the abdomen were included. The descriptive analysis was performed by a t-test/Wilcoxon signed-rank test and a Chi-square test. The predictions of the nomogram were analysed by the Pearson correlation coefficient. The threshold of prediction of a bleeding intervention was optimized by a ROC analysis. Overall, 166 patients were included. Most patients were male (80.7%) with a median age of 44 years. Using the prediction from the MiGUTS nomogram developed by Keihani et al. we were able to identify a threshold with a sensitivity of 1.00, specificity of 0.87, positive predictive value of 0.44, negative predictive value of 1.00 and accuracy of 0.88. The MiGUTS nomogram by Keihani et al. demonstrated to be reliable in the prediction of an intervention for bleeding control in our validation study in a European cohort.

Enhancing Discharge Letter Completeness: Consultant Review via Encrypted Medical App

Abstract Background Ensuring comprehensive discharge letters is crucial for safe transitions from acute hospitals to community care. The 2013 National Standard for Patient Discharge Summary Information of the Health Information and Quality Authority (HIQA) 2013 outlines what items of information ought to be included in discharge summaries. On the wards, junior doctors often complete discharge documentation without consultant review. With technological advancements, tools like encrypted chat apps for medical care offer potential solution to improve communication and access to specialized reviews. We aimed to evaluate whether a specific app to access Consultant review could enhance discharge letter completeness. Methods We conducted a retrospective audit of discharge letters for inpatients admitted and discharged under a geriatric team between September 1st and December 23rd, 2023. The letters were divided in two groups: intervention, reviewed by a medical consultant, and control, including letters only signed off by non-consultant hospital doctors. Data access and approval were obtained from the hospital's Clinical Audit Committee; data collection utilized hospital information systems and Excel database, with minimal demographic data collected. SPSS facilitated data analysis. Each discharge letter was assessed for various items outlined in the HIQA guideline. The prevalence of inclusion of each item in each group was compared using non-paired Student t-test. Results We analysed 89 discharge letters, with 34 (38.2%) in the intervention group and 55 (61.7%) in the control group. Although most items showed no statistically significant difference between groups, the inclusion of investigation results significantly differed (91% in the intervention group versus 23% in the control group). Conclusion Our audit observed improved completeness of inclusion of investigation results in the intervention group. Future research should involve a larger sample from various teams to assess whether access to senior letter review via an encrypted app can consistently enhance discharge letter completeness.

Systematic development of a patient-reported ONCOlogical-ROUTinE-Screening (ONCO-ROUTES) procedure at the University Cancer Center Regensburg.

The evaluation of treatment success and progression in oncology patient-reported outcomes (PROs) is playing an increasingly important role. Meanwhile, PROs are a component of the certification requirements of the German Cancer Society for oncology centers. PROs are used to provide supportive therapy. There is currently no instrument that fully covers the requirements. At the University Hospital Regensburg (UKR), a digital ONCOlogical-ROUTinE-Screening (ONCO-ROUTES) procedure was developed in order to assess the need for supportive therapy in a standardized way and to provide patients with supportive interventions tailored to their needs. On the basis of current requirements and guidelines, the development of ONCO-ROUTES was supported by experts in focus groups and interviews, and digitalization was carried out in connection with the IT infrastructure. A Needs-based, Quality-of-life (QoL) and Symptoms Screening (NQS2) tool already established in the routine at the UKR was further developed into ONCO-ROUTES, which is made up of the domains therapy phase, nutrition, tobacco use, alcohol use, quality of life, general condition/functional status, physical activity, psychooncology, social services, and further support needs. By linking the digitized questionnaire to the hospital information system, the results are available for immediate use in routine operations and thus for the referral of patients for further supportive therapy. The digital PRO application ONCO-ROUTES is designed to involve patients in monitoring additional supportive needs and thus, improves supportive interdisciplinary treatment.

COVID-19 inpatient care performance in the unified health system, São Paulo state, Brazil: an application of standardized mortality ratio for hospitals’ comparisons

ObjectiveTo evaluate the variation in COVID-19 inpatient care mortality among hospitals reimbursed by the Unified Health System (SUS) in the first two years of the pandemic in São Paulo state and make performance comparisons within periods and over time.MethodsObservational study based on secondary data from the Hospital Information System. The study universe consisted of 289,005 adult hospitalizations whose primary diagnosis was COVID-19 in five periods from 2020 to 2022. A multilevel regression model was applied, and the death predictive variables were sex, age, Charlson Index, obesity, type of admission, Brazilian Deprivation Index (BrazDep), the month of admission, and hospital size. Then, the total observed deaths and total deaths predicted by the model’s fixed effect component were aggregated by each hospital, estimating the Standardized Mortality Ratio (SMR) in each period. Funnel plots with limits of two standard deviations were employed to classify hospitals by performance (higher-than-expected, as expected, and lower-than-expected) and determine whether there was a change in category over the periods.ResultsA positive association was observed between hospital mortality and size (number of beds). There was greater variation in the percentage of hospitals with as-expected performance (39.5 to 76.1%) and those with lower-than-expected performance (6.6 to 32.3%). The hospitals with higher-than-expected performance remained at around 30% of the total, except in the fifth period. In the first period, 64 hospitals (18.3%) had lower-than-expected performance, with standardized mortality ratios ranging from 1.2 to 4.4, while in the last period, only 23 (6.6%) hospitals were similarly classified, with ratios ranging from 1.3 to 2.8. A trend of homogenization and adjustment to expected performance was observed over time.ConclusionDespite the study’s limitations, the results suggest an improvement in the COVID-19 inpatient care performance of hospitals reimbursed by the SUS in São Paulo over the period studied, measured by the standardized mortality ratio for hospitalizations due to COVID-19. Moreover, the methodological approach adapted to the Brazilian context provides an applicable tool to follow-up hospital’s performance in caring all or specific-cause hospitalizations, in regular or exceptional emergency situations.

Changes in Child Psychiatry Presentations in the Second Wave of Coronavirus Disease 2019 Pandemic Compared to the Pre-pandemic Period and the First Wave: A Follow-up Study.

It is to examine how child psychiatry admissions, diagnosis and treatment trends in the second wave (September-December 2020/SD20) of the coronavirus disease 2019 (COVID-19) pandemic change compared to the pre-pandemic (SD19) and the first wave (March-June 2020/MJ20). Our study was planned as a multicenter, retrospective cross-sectional. Data were obtained from hospital computer systems databases. All patients admitted to the child psychiatry clinic on SD19 and SD20 constituted the study sample. In total, 5244 admissions were assessed. Of the admissions, 1459 were repeat exams, and 3785 were cases. 50.9% (n = 1927) of the cases came in SD19 and 49.1% (n = 1858) in SD20. In 2019, 37% (n = 825) of cases were girls, compared to 41.6% (n = 646) in 2020 (P = .004). The mean age of those who came in 2019 was 9.61 ± 4.08; The mean age of those who came in 2020 was 10.15 ± 5.38 (P = .002). In 2020, oppositional defiant conduct disorder, major depressive disorder, social anxiety disorder, obsessive-compulsive disorder, sleep-wake disorder, and dysthymia were significantly higher, while specific learning disorders, separation anxiety disorder, and intellectual disability were found to be lower. The decrease in second-wave admissions is less than in the first wave. In the second wave, externalizing and internalizing problems have increased. Drug therapy was prioritized. Postponing admissions was less in the second wave.

Evaluation of Serum Biochemical Parameters Primarily Liver Functions in Smokers: A Case-control Study

We investigated the effects of smoking on serum biochemical parameters primarily liver functions and metabolism. This is a case-control study. The case and control groups were formed by clinical randomization by using the data obtained from the hospital information system and patient records, including age, gender, height, and weight. Smokers were identified as the case group, while non-smokers were identified as the control group. In the comparisons of rates Chi-square tests were used and in the comparisons of averages, independent sample t and MANCOVA tests were used. When covariance factors such as age, gender, body mass index, and alcohol use were taken into consideration, it found that AST, ALT, and GGT were higher in smokers, whereas vitamin D, vitamin B12, and TSH were higher in non-smokers. We found that smoking has a negative effect on liver and bile functions, and vitamin D values are affected secondary to this negative effect

Data quality in hospital information systems: Lessons learned from analyzing 30 years of patient data in a regional German hospital

Background: The integration of Hospital Information Systems (HIS) into healthcare delivery has significantly enhanced patient care and operational efficiency. Nonetheless, the rapid acceleration of digital transformation has led to a substantial increase in the volume of data managed by these systems. This emphasizes the need for robust mechanisms for data management and quality assurance.Objective: This study addresses data quality issues related to patient identifiers within the Hospital Information System (HIS) of a regional German hospital, focusing on improving the accuracy and consistency of these administrative data entries.Methods: Employing a combination of data analysis and expert interviews, this study reviews and programmatically cleanses a dataset with over 2,000,000 patient data entries extracted from the HIS. The areas of investigation are patient admissions, discharges, and geographical data.Results: The analysis revealed that roughly 25% of the dataset was rendered unusable by errors and inconsistencies. By implementing a thorough data cleansing process, we significantly enhanced the utility of the dataset. In doing so, we identified the primary issues affecting data quality, including ambiguities among similar variables and a gap between the intended and actual use of the system.Conclusion: The findings highlight the critical importance of enhancing data quality in healthcare information systems. This study shows the necessity of a careful review of data extracted from the HIS before it can be reliably utilized for machine learning tasks, thereby rendering the data more usable for both clinical and analytical purposes.

Therapeutic Drug Monitoring for Sirolimus in Children with Vascular Anomalies: What Can We Learn from a Retrospective Study.

Objectives: Sirolimus (SRL), a mammalian target of rapamycin inhibitor, has been widely used to treat patients with vascular anomalies (VAs). The objectives of this study were to summarize the routine blood SRL monitoring data for VAs children, to investigate the factors contributing to the variable blood SRL concentrations and to evaluate the efficacy and safety of SRL therapy. Methods: VAs patients with routine blood SRL monitoring from July 2017 to April 2022 at the Department of Burns and Plastic Surgery, Children's Hospital of Nanjing Medical University were retrospectively collected. Clinical data were obtained from the hospital information system. Results: In total, 67 children (35 females) were enrolled. The therapeutic drug monitoring data showed that the range of measured blood trough concentrations (Ctrough) was 3.6-46.8 ng/mL. At the initial measurements, only 33% of patients were in the target concentration range (10-15 ng/mL). But this proportion became 54% at the last measurements. The whole blood-Ctrough-to-daily dose (Ctrough/Dose) ratio was significantly associated with age and body weight (BW). The patients' laboratory results did not change significantly after SRL treatment. Although the incidence of adverse events was relatively high (44.8%), most of them were mild and tolerable. 70.3% patients had total responses to SRL, whereas 29.7% children exhibited stable disease or progressive disease. No significant differences were found in Ctrough between the total response group and non-response group. Conclusions: This retrospective study revealed a high variability in SRL blood concentrations in Chinese children with VAs. Of note, pediatric patients with older age and a higher BW had a lower Ctrough/Dose ratio. It is a concern whether the range of 10-15 ng/mL is feasible for Chinese children based only on our study. Further studies recruiting more patients are required to redefine the target reference range for children with VAs.