Electronic Chart Research Articles

Utilizing Triage Data for Medical Imaging Studies in the Emergency Department.

The use of radiological images is widespread in the emergency department (ED) as physicians commonly rely on them during initial evaluations to confirm diagnoses, contributing to prolonged waiting times. This study aimed to determine the relationship between commonly gathered triage data and the need for radiological imaging. Data were collected from electronic charts that contained routinely collected hospital data at the time of triage in the King Abdulaziz Medical City (KAMC) in Riyadh ED. The binary logistic regression results demonstrated a statistically significant relationship between age and radiological imaging ordered in the ED. Each one-unit increase in age corresponded to a 0.983-fold increase in the likelihood of ordering radiological imaging (odds ratio: 0.983, 95% confidence interval: 0.972-0.995, p = 0.004). In contrast, hypertension, diabetes, and heart failure were independent predictors of the need for radiological imaging in the ED (p >0.05). Patient data that are immediately available during ED triage can be used to predict the need for radiological imaging during ED visits. Such models can identify patients who may require radiological imaging during ED visits and expedite patient disposition.

A Spatial Relation Model of Three-Dimensional Electronic Navigation Charts Based on Point-Set Topology Theory

Spatial relation models are the basis for realising three-dimensional spatial analysis. More researchers are now focusing on models that combine topological relations with distance or directional relations; however, a model that unifies all three relations has not yet been developed. In particular, it is more effective to use different spatial relations between features with different spatial characteristics in three-dimensional electronic navigation charts (3D ENC). Therefore, this paper proposes a 3D ENC feature spatial relation model (3DSRM) based on point-set topology theory, which combines 3D topological relations, distance relations and directional relations, and uses a unified model framework to describe 64 topological relations of 3D ENC features from both horizontal and vertical directions. Through the comparison and derivation of feature topological relations, it is demonstrated that the model can distinguish 3D spatial topological relations more comprehensively, realise the mutual derivation between spatial relations and spatial features, and improve the robustness of spatial relations judgement. The model can be used to judge the topological relations between features, realise 3D topological relation checking and topological creation of complex features, and improve the accuracy and interactivity of 3D ENC.

Diabetic Foot Wounds with Concomitant Skin Malignancies

Background: Diabetic foot wounds are usually chronic and prone to infection. As chronic wounds can induce various malignancies, and malignancies can sometimes present as chronic wounds, the accurate diagnosis of concomitant skin malignancies requires careful attention. We report eight cases of skin malignancies presented with diabetic foot wounds.Methods: Patients who were diagnosed with skin cancer after receiving diabetic foot management from January 2008 to October 2017 at our diabetic foot clinic were selected for this retrospective study. Using an electronic chart review, patient data including age, sex, height, weight, wound characteristics, related systemic diseases, biopsy results, and applied treatments were collected.Results: A total of eight patients who had diabetic foot with concomitant skin malignancies were enrolled in a retrospective cohort study.Conclusion: Wounds that fail to heal for extended periods should be reassessed via tissue biopsy to determine the underlying pathology. We recommend that clinicians consider tissue biopsy for more cases of diabetic foot wounds that do not respond well to treatment.

Perioperative anesthetic management of premature neonates weighing less than 1500 grams undergoing transcatheter PDA (TC-PDA) closure: An institutional anesthetic experience

ObjectivesThe aim of our study is to describe the various anesthetic techniques and intraoperative management used during transcatheter closure of hemodynamically significant PDAs in VLBW premature infants weighing less than 1.5 kg and their potential impact on postoperative outcomes using a retrospective chart review. DesignA retrospective electronic medical chart review was performed in infants who underwent Transcatheter Patent Ductus Arteriosus (TC-PDA) closure at an academic institution between January 1, 2008 and October 4th 2019. Only premature patients with isolated PDA weighing less than 1500 g at the time of the procedure were included in the study. SettingSingle Institutional Hospital. ParticipantsPremature patients with isolated PDA weighing less than 1500 g at the time of the procedure. InterventionsNone. Measurements and main resultsInterprocedurally, there was no evidence of device embolization or clinically significant vascular obstruction on follow-up echocardiography, and inotropic or vasoactive infusions were not required. All patients survived and were discharged from the hospital after a mean of 86.4 ± 48.49 days (median 74, range 40–180) following initial admission to the NICU. At 7 post-operative days, freedom from ventilatory support reached 70% in all patients. Incidences of device embolization or clinically significant vascular obstruction were not noted on follow-up echocardiography. ConclusionsThough our preliminary findings show promising outcomes following TC-PDA closure relative to traditional surgical approaches, further investigations with higher patient volume are needed to validate these promising observations.

A Fair Concern about ECDIS

Digital technology introduced a lot of benefits in the shipping industry but the relation between the equipment and the operator remains paramount and essential. Ship’s Electronic Chart Display and Information System (ECDIS), being recently a cornerstone for navigation, is not an exception. Not only scientific reviews and articles, but also marine officer’s opinion exchange, in other words, ashore and on board, point out that there is a gap, which should be addressed as soon as possible. Operation of the ECDIS by the human factor is essential for safe navigation. The shortage of training and knowledge always leads to near misses and incidents. The marine society, all over the world, has to take appropriate measures in order to “fill in the gaps” and keep the safer practices. These measures should be applied by the efforts of certain participants: the educational community, the shipowners, the manufacturers and the legal aspect, International Maritime Organization and Flag Administrations. All the mentioned parties may engage in a cooperative collaboration among themselves. The aim of this article is to research the main difficulties experienced on board by the ECDIS users and the way to rectify certain shortcomings related to the ECDIS.

Composing a Standard for Electronic Chart Display and Information System Type Specific Training

Electronic Chart Display and Information System (ECDIS) training is accepted as extremely important for safety in modern navigation. At present, two types of training are required for deck officers. Operational use of ECDIS is mandatory training for deck officers and it is conducted according to the International Maritime Organization (IMO) Model course 1.27. This course provides general knowledge about ECDIS. Type specific training is indispensable for the officers to know all the capabilities, functions, and limitations of the ECDIS used onboard. The lack of regulations for this type of training allows the manufacturers of ECDIS to apply their own requirements. This can result in improper and insufficient training. Based on research of the opinion and experience of deck officers, the authors of the paper propose a model of a standard for type specific training.

Accuracy of GNSS Position Stored in Fishing Boat Location Transmitters in Comparison with That of DGPS Position

Fishing boat laws in Korea require fishing boats to be equipped with a location transmitter. Approximately 91% of registered fishing boats have V-pass terminals, whereas those with a gross tonnage of 10 t or more have either V-pass or automatic identification system (AIS) terminals (or use both). Most navigators, including the fishing boat location transmitter, rely on the satellite signals provided by the global navigation satellite system (GNSS) without considering the accuracy of the navigation instruments that indicate ship location. Many scholars are conducting research to analyze the accuracy of GNSS locations through continuous experiments; however, few of them focus on fishing boat location transmitters. Particularly, the location accuracy of V-pass equipment is unknown. Notably, the V-pass and AIS terminals used in fishing boats are mainly designed to locate fishing boats in need of assistance following a marine accident rather than to provide information on approaching ships and preventing collisions. Therefore, this study aimed to compare GNSS location storage data extracted from the location transmitter (V-pass and AIS terminal) of the accident fishing boat with the DGPS location information from the Electronic Chart Display and Information System to check the position error and use it for accident analysis and investigation.

P-756 Change of anti-Müllerian hormone (AMH) value for ovarian reserve after minimal invasive benign ovarian cystectomy: Da Vinci robotic system (Xi and SP) and laparoscopic system.

Abstract Study question To investigate impact on ovarian reserve after minimal invasive ovarian cystectomy using two platforms; Da Vinci robotic system (Xi and SP) and laparoscopic system. Summary answer Benign ovarian cystectomy using Da Vinci robotic system takes a long time, but it is an effective minimally invasive method to preserve ovarian function. What is known already With the development of minimally invasive surgical methods such as laparoscopic and robotic system, patient satisfaction has increased not only in terms of pain relief but also cosmetic aspects such as smaller scars. Protection of ovarian function during surgery is important in terms of fertility preservation, and this should be considered first in minimally invasive surgery. Serum anti-Müllerian hormone (AMH) is a widely used index to evaluate ovarian reserve. Study design, size, duration This study included patients who underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018 and September 30, 2022 at a single institution. A retrospective study was conducted through electronic medical chart review. Participants/materials, setting, methods A total of 128 patients were enrolled. Among them, 71 patients underwent laparoscopic surgery and 58 patients underwent robotic surgery. The preoperative AMH value was determined as the value within 4 weeks before surgery, and the postoperative AMH value was determined as the value from 1 month after surgery to within 1 year after surgery. The AMH change value (ΔAMH) was expressed as a percentage value; (postAMH – preAMH) x 100 / preAMH Main results and the role of chance There was no significant difference in preoperative age, BMI, parity, cyst size, and cyst position ratio. Estimated blood loss during operation, Hb drop, length of hospital day, adhesion detachment rate, and cyst rupture rate also showed no difference. However, the operation time was significantly shorter in the laparoscopic group. (68.51±30.99 minutes vs. 105.17±38.87 minutes, p < 0.01) The mean preoperative AMH was significantly higher in Da Vinci robotic system than laparoscopic system. (5.89±4.81 ng/mL vs. 4.02±3.61 ng/mL, p = 0.02) The mean postoperative AMH was also higher in Da Vinci robotic system. (4.31±3.34 ng/mL vs. 3.02±2.64 ng/mL, p = 0.02) But, the mean ΔAMH was not significantly different between two groups. (-19.55±40.67 % in laparoscopic system vs. -19.95±38.79 % in robotic system, p = 0.96) When the robot groups were divided into Xi system (N = 21) and SP system (N = 37) and compared, but ΔAMH did not show significant differences among the three groups. (-19.55±40.67 % in laparoscopic system vs. -14.63±47.80 % in Xi system vs. -22.97±32.97 % in SP system, p = 0.75) Even in the patient group with preoperative AMH below 2, ΔAMH was -9.50±57.58 % in the laparoscopic system (N = 20) and -11.72±60.92 % in the robotic system (N = 11), showing no significant difference between the two groups. (p = 0.92) Limitations, reasons for caution A limitation of this study is that the measurement period of AMH was set within a wide range within 1 year after surgery. In addition, the small sample size when divided into two systems, SP and Xi, is also a limitation. Wider implications of the findings Compared to the existing laparoscopic system, the robotic system does not show a significant difference in protection of the ovarian reserve, so it will be widely selected as an option for minimally invasive surgery. Trial registration number Not applicable

Analysis of Electronic Chart and Information Display, Ship Identification Systems and Radar in Order to Increase the Energy Efficiency of a Maritime Vessel

This paper puts into discussion the navigation integrated deck and its components. The role of AIS (Automatic Identification System) is presented. The radar with its characteristics is analyzed and starting from the block diagram, a characterization of its role within the integrated deck is carried out. An IT model for navigation radar and ECDIS (Electronic Chart Display and Information System) was developed.

P34 Gentamicin labels: improving the timing of gentamicin levels and reducing delay in dose administrations

Abstract Background Due to its narrow therapeutic index and significant risks of ototoxicity and nephrotoxicity, gentamicin requires meticulous prescribing, administration and monitoring. Despite readily available guidelines, gentamicin use continues to be associated with errors, with recent Datix reports within NHS Lothian recording incidents such as incorrectly prescribed doses or frequencies, missed levels, and delayed or omitted doses. In response to this, an audit was undertaken to investigate errors in gentamicin use within the Acute Medical Unit (AMU) at the Royal Infirmary of Edinburgh and evaluate the barriers to adherence to guidelines to unearth possible areas for improvement. Methods The initial audit studied patients prescribed gentamicin in AMU within a 3-week period, excluding those who received prophylactic or single one-off doses of gentamicin. The following parameters were examined both on their paper and electronic prescribing charts: (i) dose, (ii) dosing interval/frequency, (iii) time of level sampling, and (iv) administration times of the first and second gentamicin doses. After identifying issues with delayed gentamicin levels and subsequent dose administration times, we introduced the use of gentamicin labels in each AMU bay, in hopes of increasing staff awareness towards patients on gentamicin, thereby promoting timely level sampling and dose administration. The aforementioned parameters were re-audited for a further 3 weeks following this intervention. Results The baseline audit highlighted that only 23/31 (74%) patients had levels taken within the recommended window, and 23/31 (74%) received their second gentamicin doses at the right time. Following the introduction of the gentamicin labels, the second audit observed a slight improvement, with 31/40 (78%) patients having their levels taken within the recommended window, and 30/40 (75%) patients receiving their subsequent doses at the right interval. Noteworthily, in both the pre- and post-intervention groups, the majority of patients who had their second doses delayed received their first doses in the emergency department (ED) prior to admission to AMU. Conclusions In addition to improving staff awareness towards patients on gentamicin, a further overarching issue needs to be addressed: the delays in gentamicin administration which more commonly occurs for patients who transition from ED into AMU. Further interventions should therefore target improving the handover of time-critical medicines between ED and AMU.

An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study.

In sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. The purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d'Ivoire for diagnosing and managing skin NTDs and other skin diseases. A 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. The mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a "dermatosis." In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. The study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d'Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399.

#5803 ARTERIOVENOUS FISTULA BLOOD FLOW ESTIMATION THROUGH AI MODEL EXPLOITING THE PATIENT'S ROUTINELY COLLECTED DATA

Abstract Background and Aims Clinical monitoring and surveillance are key pillars of Arteriovenous Fistula (AVF) management in hemodialysis patients. They are aimed at limiting the risk of suboptimal dialysis dose and Vascular Access (VA) failure. AVF blood flow (Qa) is commonly used to assess VA function. Several methods have been proposed for the measurement of Qa including doppler ultrasound, and Body Thermal Monitor, among others. All these diagnostic tests are, in general, time-consuming for clinical staff, operator dependent, and costly for healthcare providers. To overcome limitations in the uptake of current Qa measurement techniques, we used data automatically recorded by dialysis machine sensors and medical information captured in electronic charts records to estimate Qa using a machine learning technique. Method For this historical cohort study, we analyzed electronic health records (EHR) of adult patients from four different European countries (Czech Republic, Portugal, Slovakia, and Spain), receiving in-center hemodialysis therapy in Fresenius Medical Care dialysis clinics between January 1st, 2015 and June 30th, 2022 registered in the European Clinical Database (EuCliD®). All patients consented their pseudo-anonymized data be used for secondary data analysis. The input dataset included 49 variables representing the health status of the patients, functional parameters of AVF function and the HD treatment parameters. The input variables were collected in the 90 days before the Qa measure. We constructed metrics representing the 90-day average and trend of each functional and medical parameter. Qa was classified in three levels: &amp;lt; 525 ml/h (very low), 525 ml/h - 925 ml/h (low), &amp;gt; 925 ml/h (normal). We estimated Qa as ordinal classification problem. Therefore, we used 2 binary classifiers based on the XGBoost algorithm. The estimation of the first-class, P(Qa&amp;lt;525), is given by the first classifier and the estimation of the third class, P(Qa≥925), is given by the second classifier. The probability of the middle class is computed as P(Qa≥525)⋅(1-P(Qa≥925)). The Qa estimation accuracy was assessed computing mean absolute error (MAE), precision and recall, F1-score and confusion matrix. Results Our dataset included 46,292 Qa measurements referred to 5,940 different hemodialysis patients. We obtained an overall precision of 0.77, a recall of 0.76, a F1-score of 0.76, a MAE of 0.27. The same metrics for each class are shown in Table 1. The model was able to detect fistula with “very low flow” with a precision of 0.9 and 16% of the missed “very low flow” AVFs are predicted as “low flow” and 4.7% are predicted as normal flow. The Confusion Matrix for each class is shown in Figure 1. Conclusion In this study we showed that clinically relevant Qa classes can be accurately predicted by resorting to routinely collected clinical data extracted from a electronic health record without any additional effort from healthcare professionals, training or instrumentation. Qa assessment is an important parameter in the evaluation of AVF function. Our algorithm accurately discriminated patients with “very low flow” that may be referred to vascular surgeon evaluation. It might help the AVF surveillance process, without adding time-consuming procedures for clinical staff or costs for healthcare provider.

Anticoagulation prescription among atrial fibrillation patients managed with and without an anticoagulant initiation pathway: a cohort study.

The Canadian Association of Emergency Physicians atrial fibrillation (AF) checklist advises that emergency physicians initiate anticoagulation therapy for patients with AF or flutter who are CHADS65 positive. The aim was to compare anticoagulation initiation rates between patients treated with and without an anticoagulation assessment pathway (the SAFE pathway). This was a retrospective cohort study. All emergency department patients were discharged home with a diagnosis of AF between June 2018 and May 2020 at two Canadian emergency departments. The SAFE pathway is a hard copy form which allows emergency physicians to document contraindications to anticoagulation, the positive components of the CHADS65 score, and details how to prescribe anticoagulation. Trained researchers abstracted data on the use of the SAFE pathway by the presence or absence of the completed, scanned pathway in the electronic medical chart. The exposure of interest was use of this pathway. Patients were followed forward in time for 90 days by electronic medical record review to document stroke, transient ischemic attack, arterial embolism and major bleeding events. All events were independently adjudicated. Adjusted odds ratios were calculated to compare outcomes between those managed with and without the SAFE pathway. In total, 766 patients were included, of whom 264 were already taking anticoagulation, 166 were CHADS65 negative and 65 had a contraindication to anticoagulation, leaving 271 patients eligible for anticoagulation prescription. Among the 271 eligible patients, 137/166 managed with the SAFE pathway were initiated on anticoagulation and 24/105 managed without the SAFE pathway started anticoagulation (adjusted odds ratio 25.9; 13.1-51.2). There was no statistically significant difference in the 90-day rate of stroke or bleeding. Use of the SAFE pathway was associated with a higher rate of anticoagulation prescription.

SARS-CoV-2 Infection, A Risk Factor for Pituitary Apoplexy? A Case Series and Literature Review.

Introduction: Pituitary apoplexy (PA) is a rare phenomenon, characterized by a hemorrhagic or ischemic event of the pituitary gland, most often in association with a pituitary lesion. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the strain of virus responsible for the internationally recognized global pandemic COVID-19. Multiple clinical manifestations associated with this virus have been described, ranging from asymptomatic, mild flu symptoms to acute respiratory distress syndrome, end-organ failure leading to death. Cases of patients with concomitant COVID-19 infections and PA are being further recognized in the literature, but the causal association between the 2 entities remains speculative. Objectives: The objectives of this case series are 3-fold: to describe additional cases of patients with concomitant COVID-19 infection and PA (1), to review the current evidence regarding this potential complication associated with a COVID-19 infection (2), and to discuss physiopathological hypotheses, treatments, and prognoses of this newly recognized association (3). Method: We conducted an electronic chart review of patients treated for PA with concomitant COVID-19 infection from March 2020 to December 2021. A literature review was performed using MEDLINE, Web of Science, and Embase databases to identify other cases of COVID-19-associated PA. Results: From March 2020 to December 2021, 3 patients presented to our center with PA following a symptomatic COVID-19 infection. Two of these patients developed PA symptoms days following the viral infection, whereas the third patient developed PA after a 2-month period. The 2 first patients were managed surgically because of persistent visual symptoms. Results from our literature review yielded 12 other cases of COVID-19-associated PAs. Conclusions: The association between COVID-19 infection and PA has been increasingly reported in the literature. With the addition of the 3 cases described in our article, a total of 15 cases have been published. Many contributing mechanisms may lead to PA following COVID-19 infection. Coagulopathy is probable major contributing cause responsible for hemorrhage or infarction of the pituitary gland. Our case series provides further arguments that PA may be a direct manifestation of a COVID-19 infection.

Age and Gender Adjusted FT3 Levels as Novel Predictors of Survival.

Lower levels of free T3 (FT3) occur during acute illness, as part of "euthyroid sick syndrome." A chronic form of this syndrome also exists. To determine whether thyroid hormone levels predict long-term survival. This was a "big-data" study of thyroid function tests from samples taken between 2008 and 2014. Data were crossed with electronic health records for morbidity and mortality. Test results were converted to age- and gender-adjusted percentiles (AGAPs). The hazard ratio for death was crossed with ranges of initial AGAPs and change in AGAPs for 2 subgroups: "not healthy" (subjects with at least 1 of 5 chronic conditions registered in their electronic health chart) and "healthy" (all others). 2 453 091 sets of thyroid function tests from 365 965 distinct patients were evaluated. 258 695 sets remained after excluding patients registered as taking thyroid preparations or anti-thyroid drugs. Hazard ratio for death, planned before data collection. The cohort included 151 868 not healthy and 106 827 healthy people. After a median of 6.8 years, 5865/151 868 (10.4%) of the not healthy had died and 2504/106 827 (2.3%) of healthy participants. Low initial FT3 AGAPs were predictive of poor survival. The hazard ratio for survival compared between the lowest 5 and highest 50 percentiles of initial FT3 AGAPs for not healthy participants was 5.71 [confidence interval (CI) 5.23-6.26, P < .001] and for healthy was 3.92 (CI 3.06-5.02, P < .001). Low FT3 AGAPs predicted poor survival, most strongly among not healthy people.

Prescribing Practices at a Residential Treatment Center – from Paper to Plastic (Computers)

ABSTRACT Medication prescription procedures were reviewed at psychiatric residential treatment centers (RTC), and a quality improvement project was conducted in order to implement integrated electronic medical records (EMR) and computerized provider order entry (CPOE). To assess the impact of preexisting prescribing practices on RTCs, surveys were sent anonymously to current and past providers of regional and local RTCs. The surveys assessed the impact of the prescribing protocol on workflow, the frequency of medication errors, the impact such errors had on patient care, the overall provider satisfaction, and the discrepancies between electronic and paper charts. Current providers were then re-surveyed after implementing the integrated CPOE system in May 2020, during the COVID-19 pandemic. The first round of provider survey results revealed that the majority of staff (n = 10, 70%) observed frequent medication errors and were largely dissatisfied with the current medication ordering and administration process (n = 10; 70%). Incident Response Improvement System (IRIS) reports revealed the most common medication errors were omissions, incorrect dosing, and incorrect medications administered. After the initiation and implementation of the CPOE, staff satisfaction increased with the process (n = 14; 50%) noting that medication errors were less frequent than before (n = 14; 50%).

Implementation of an early-stage lung cancer survivorship clinic in a comprehensive cancer center.

e13515 Background: Early-stage lung cancer survivors are a growing population. A comprehensive plan to address needs relevant to longer survival (e.g., psychological distress, persistent symptoms, physical function) and clinic capacity is necessary. How to deliver comprehensive survivorship care that meets national standards and results in improved patient outcomes is a challenge. Survivorship clinics staffed by advanced practice providers (APP) are an option to address these needs. Methods: In June 2019, Atrium Health Wake Forest Baptist Comprehensive Cancer Center (AHWFB-CCC) opened a dedicated survivorship clinic. Stakeholders from the lung cancer disease-oriented team developed a standard referral pathway for patients to survivorship. A standard workflow was developed in the electronic medical record (EPIC). Eligible lung cancer survivors were referred to the Lung Cancer Survivorship Clinic for a survivorship orientation visit (SOV) with a lung cancer specific APP. Prior to the SOV, a welcome video, disease-specific questionnaire, and electronic patient reported outcome (ePRO) tools (i.e., PROMIS-29 and Distress Thermometer) were sent to the patients’ electronic chart. At the SOV, the ePRO responses and survivorship care plan were reviewed. Analysis of survivor demographic and clinical characteristics (i.e., age, gender, race, residence according to rural-urban commuting area (RUCA) codes, treatment modality, and method used to complete ePROs) and ePRO responses was performed using several regression methods. Patients were offered a post visit survey. Results: From January 2020 to December 2022, 285 lung cancer patients completed a SOV. Most patients were able to complete the pre-visit questions via the electronic chart. AHWFB-CCC survivors reported improved PROMIS-29 T-Scores compared to the average United States (US) early-stage lung cancer survivor, with meaningfully better scores (≥ 3 pts) in five of the seven health-related domains measured. We found no significant interactions between T-Scores and a survivor’s demographic or clinical characteristic, except for gender (p &lt; .001). Most notably, we found a lack of interaction between PROMIS-29 T-Scores and treatment modality (p=.27). Most patients found the SOV helpful and expressed better understanding of their cancer treatment and side effects after the SOV. Conclusions: Our model of an optimized electronic medical record pathway paired with an APP led survivorship visit is feasible and can address current challenges in providing survivorship care to early-stage lung cancer survivors. Survivors had similar ePRO regardless of treatment modality, indicating their survivorship care could be consolidated. Future evaluation is needed to establish if this care model improves outcomes over subsequent visits, minimizes the effect of health disparities, or enhances care capacity.

DUODENAL‐TYPE FOLLICULAR LYMPHOMA, A RARE ENTITY: CLINICAL ASPECTS, TREATMENT AND OUTCOMES OF BRAZILIAN PATIENTS

Introduction: Duodenal-type follicular lymphoma (DFL) is a rare entity, presented mostly as localized disease and excellent long-term outcomes. Its pathogenesis and peculiar predilection for the duodenum is not clear. Wide use of endoscopy for several reasons seems to highlight this disease and increase its diagnosis, since many patients are asymptomatic. Environment aspects, such as diet and local infections, could play a role in its clinical presentation and evolution. Methods: We evaluated 53 patients with diagnosis of DFL based on the current WHO classification on lymphoid neoplasms. Reference Brazilian centers in hematology reported their cases to this retrospective analysis. Cases were reviewed in electronic charts after ethical approval by each center. Results: The median follow-up of the whole cohort was 2.9 years (range 0.1–11). Median age at diagnosis was 58.2 y (33–85). Using the Lugano TGI classification, 75% (n = 40) were stage I. There were 2 patients with concomitant involvement of the jejunum and 1 with colonic infiltration of follicular lymphoma. Endoscopic lesions were mainly nodules (56%) and in the second portion of the duodenum (85%). Bone marrow involvement (BMi) was present in 4 cases. Close to half of the population (51%) was asymptomatic and had the diagnosis after a screening endoscopy, while 45% had some form of mild gastrointestinal symptom that preclude the exam. Only one patient had constitutional symptoms. FLIPI 0-1 in 81% of patients, with LDH elevated in 3 patients (mean of 262.8, range 116–487). Most patients were followed with regular observation (watch and wait in 60.4%), rituximab monotherapy was administered for 15 patients (28.3%) and radiotherapy for 3 (5.7%). Only 3 patients received chemotherapy (one consolidated with radiotherapy). GI symptoms were the major cause (n = 8) for starting treatment, followed by nonspecific cause in 7 cases (many described by patient anxiety). Rituximab maintenance was performed in 9 patients, 7 treated with rituximab monotherapy and 2 with rituximab plus chemotherapy. Three patients had progression of disease (1 after watch and wait, 1 treated with rituximab monotherapy and no maintenance and 1 progressed after receiving chemotherapy for advanced disease). Within these patients, 2 had BMi. Table 1 summarize the main findings. No patient died. Within the watch and wait group, most patients didn’t perform a follow up endoscopy however three patients had a spontaneous complete remission observed by endoscopy. Conclusions: This is the first cohort of Brazilian or Latin American patients with DFL published so far. Most patients were asymptomatic or with mild gastrointestinal symptoms at diagnosis. Small multiple nodules in the second portion of the duodenum were the principal appearance. Patients tended to have low FLIPI, localized disease and good prognosis. Watch and wait strategy seems safe and spontaneous CR can occur. Keyword: indolent non-Hodgkin lymphoma No conflicts of interests pertinent to the abstract.

Concordance between admission and discharge diagnosis of a child and adolescent psychiatry inpatient unit.

Psychiatry is arguably the most medical practice that is affected by culture. The pediatric literature is sparse with respect to the differences between child psychiatric units in different cultures and different countries. In this study, we aim to investigate the discordance between admission diagnosis and discharge diagnosis for child psychiatric disorders. A retrospective analysis was conducted on 206 patients admitted to a university hospital inpatient child and adolescent psychiatry unit in Ontario, Canada. The data extracted from electronic charts were age, gender, DSM-IV-based diagnosis at admission, living arrangement before admission, length of stay (minimum one day), post-discharge diagnosis, and post-discharge outcomes. There was 75% agreement with the discharge diagnosis. We found strong negative and positive associations between conduct disorder at discharge and the prescription of antipsychotics (+), antidepressants (-), and stimulants (-), and there was a strong association between a conduct disorder (CD) diagnosis and medication-free status. The powerful effect size of stimulant medication was specific to the association between a primary diagnosis of ADHD (vs. not-ADHD) and stimulant medication (c2=127.5, df=1, phi=0.79, P<0.0001). We have found a significant agreement between admission and discharge diagnosis. It is suggested that the inpatient stay helped to refine the formulation and to improve the child's well-being.

Hypersensitivity reaction to taxanes following COVID-19 vaccination.

3092 Background: In oncology, many patients receive taxanes as part of their chemotherapy regimens to treat various types of cancers. The most commonly used taxanes, paclitaxel and docetaxel, are known to cause hypersensitivity reactions (HSRs) in 5-10% of cases. Providers at our institution perceived an increase in the frequency of HSR with taxanes after patients received vaccines against COVID-19. We aimed to compare the incidence of HSRs to taxanes among our oncology patients who have or have not received one or more COVID vaccine prior to initiation of either paclitaxel or docetaxel chemotherapy. Methods: Under an IRB-approved protocol, adult patients, ages ≥18, who had initial treatment with one or more infusions of paclitaxel or docetaxel for any type of cancer in 2020 or 2021 at a single cancer institute, were identified. Demographic, clinical and pathologic information was reviewed from electronic medical charts. The primary objective was to compare the rate of HSR reaction to taxanes among patients who had received any vaccine against COVID-19 prior to their initial taxane infusion versus patients who did not receive a COVID vaccine prior to the first taxane infusion. We also aimed to compare the different vaccine types and to describe, if an HSR occurred, if it was at the first or subsequent taxane infusion. Results: In this single-center retrospective cohort study, 355 patients that met the study criteria were analyzed. 204 patients received at least one COVID-19 vaccine prior to their first taxane infusion (58.8% Pfizer-BioNTech, 27.9% Moderna, 13.2% multiple vaccine types) and 151 patients received the vaccine either after their first taxane infusion or were unvaccinated (51.7% Pfizer-BioNTech, 23.8% Moderna, 2.6% Janssen, 21.9% unvaccinated). Of the patients vaccinated for COVID-19 prior to receiving their first taxane infusion, 11.8% had an HSR while 2.6% had an HSR in the post-taxane/unvaccinated group (p 0.003). Severity of HSR reactions was categorized as mild, moderate, or severe based on symptoms. If an HSR occurred, vaccinated patients were more likely to have a worse reaction (p 0.017). Of the 24 patients that had an HSR in the vaccinated group, 14 had a mild reaction, 8 had a moderate reaction, and 2 had a severe reaction. In the post-taxane/unvaccinated group, 3 had a mild reaction and 1 was moderate. 85.7% of HSR to taxanes occurred after the first cycle (24/28 reactions, p &lt;0.001). There was no difference among the vaccine types, though very few patients received the Janssen vaccine. Conclusions: Vaccination for COVID19 prior to initiation of taxane containing chemotherapy was associated with a higher risk of taxane related HSR and a higher risk for more severe reactions. Since vaccination against COVID-19 is highly encouraged, particularly among patients with cancer, it is important for clinicians to be aware of this potential association so that they can better monitor for, and promptly treat these events.