Electronic Data Management System Research Articles

Prevalence and epidemic pattern of ecdemic multidrug-resistant tuberculosis during 2012–2022 in Hangzhou, China: implication for public health strategies

BackgroundTo assess the prevalence and epidemic pattern of multidrug-resistant tuberculosis in Hangzhou City, Zhejiang Province, China during 2012–2022.MethodsAll the tuberculosis cases undergoing drug susceptibility testing during 2012–2022 were included in this study. De-identified information was extracted from the electronic database Tuberculosis Information Management System for analysis of drug resistance prevalence in Hangzhou and ecdemic multidrug-resistant tuberculosis which originated from other regions. Chi-square tests were used to compare drug resistance rates between different groups, while Chi-square tests for trend were used to evaluate the change of drug resistance rates over the years of 2012–2022. The sources and destinations of ecdemic multidrug-resistant tuberculosis were illustrated using a Sankey diagram.ResultsOf 21,127 cases included in this study, 1119 (5.3%) were multidrug-resistant tuberculosis. A significant decline in multidrug-resistant tuberculosis rates was observed during 2012–2022. There was a significant difference in multidrug-resistant tuberculosis rates among immigrant population and local residents in Hangzhou City. Of 1119 multidrug-resistant tuberculosis cases, 515(46%) were ecdemic multidrug-resistant tuberculosis cases, of which 277(53.8%) were from other parts of Zhejiang Province and 238(46.2%) were from other provinces in China. Anhui, Jiangxi and Sichuan were among top three provinces which were the source of ecdemic multidrug-resistant tuberculosis cases. Three districts including Xiaoshan, Shangcheng and Linping districts had the most cases in Hangzhou. The proportion of ecdemic multidrug-resistant tuberculosis cases in Binjiang, Xiaoshan, Qiantang and Linping districtalso exceeded 30% of total cases.ConclusionsMultidrug-resistant tuberculosis prevalence has been declining in Hangzhou. Migrant population contributed to a significant potion of cases in Hangzhou. Interventions should be tailed to local and migrant residents.

FORECASTING CONSUMER PRICE INDEX USING MACROECONOMIC VARIABLES: A COMPARATIVE ANALYSIS OF MACHINE LEARNING AND DEEP LEARNING APPROACHES

The Turkish economy has faced many economic difficulties throughout it's history. At this point, predicting inflation accurately is very important for policy makers, businesses, investors and consumers. This study aims to estimate the Turkish Consumer Price Index. Producer price index, M1 money supply, gold price, dollar price, natural gas price and interest rate variables were used to estimate the CPI for Turkey. The variables used in the research were obtained through EVDS, the Central Bank's Electronic Data Management System. Monthly data from January 2003 to August 2023 was used in the study. The obtained data were estimated using DDPG, XGBoost, SVR, KNN and CNN-BiLSTM methods. Model performances were compared using RMSE, MSE, MAE, MAPE and R2 statistical coefficients. When model performances were evaluated, the best CPI prediction for Turkey was obtained by the SVR method.

Managing macromolecular crystallographic data with a laboratory information management system.

Protein crystallography is an established method to study the atomic structures of macromolecules and their complexes. A prerequisite for successful structure determination is diffraction-quality crystals, which may require extensive optimization of both the protein and the conditions, and hence projects can stretch over an extended period, with multiple users being involved. The workflow from crystallization and crystal treatment to deposition and publication is well defined, and therefore an electronic laboratory information management system (LIMS) is well suited to management of the data. Completion of the project requires key information on all the steps being available and this information should also be made available according to the FAIR principles. As crystallized samples are typically shipped between facilities, a key feature to be captured in the LIMS is the exchange of metadata between the crystallization facility of thehome laboratory and, for example, synchrotron facilities. On completion, structures are deposited in the Protein Data Bank (PDB) and the LIMS can include the PDB code in its database, completing the chain of custody from crystallization to structure deposition and publication. A LIMS designed for macromolecular crystallography, IceBear, is available as a standalone installation and as a hosted service, and the implementation of key features for the capture of metadata in IceBear is discussed as an example.

An intervention to improve lumbar puncture rates for meningitis surveillance in children at four secondary health facilities in Malawi: A before/after analysis.

A lumbar puncture (LP) procedure plays a key role in meningitis diagnosis. In Malawi and other sub-Saharan African countries, LP completion rates are sometimes poor, making meningitis surveillance challenging. Our objective was to measure LP rates following an intervention to improve these during a sentinel hospital meningitis surveillance exercise in Malawi. We conducted a before/after intervention analysis among under-five children admitted to paediatric wards at four secondary health facilities in Malawi. We used local and World Health Organization (WHO) guidelines to determine indications for LP, as these are widely used in low- and middle-income countries (LMIC). The intervention comprised of refresher trainings for facility staff on LP indications and procedure, use of automated reminders to perform LP in real time in the wards, with an electronic data management system, and addition of surveillance-specific clinical officers to support existing health facility staff with performing LPs. Due to the low numbers in the before/after analysis, we also performed a during/after analysis to supplement the findings. A total of 13,375 under-five children were hospitalised over the 21 months window for this analysis. The LP rate was 10.4% (12/115) and 60.4% (32/53) in the before/after analysis, respectively, and 43.8% (441/1006) and 72.5% (424/599) in the supplemental during/after analysis, respectively. In our intervention-specific analysis among the three individual components, there were improvements in the LP rate by 48% (p < 0.001) following the introduction of surveillance-specific clinical officers, 10% (p < 0.001) following the introduction of automated reminders to perform an LP and 13% following refresher training. This analysis demonstrated a rise in LP rates following our intervention. This intervention package may be considered for planning future facility-based meningitis surveillances in similar low-resource settings.

A prospective study on evaluation of antibiotics usage in patients with sepsis at a tertiary care hospital

Background: Most developing countries are adopting antibiotic usage in sepsis. This study was conducted to evaluate the antibiotic usage in patients and to study medical adherence in high-risk patients. The study in particular aims to evaluate antibiotic usage in sepsis patients along with their related ADR’s. The study also aims to optimize the usage of antibiotics in high-risk patients at a tertiary care hospital. Methods: Study was prospective and observational review of patients record in the hospital. Clinical notes, medication chart and electronic data management system at the hospital were used to analyse usage of antibiotics. Culture and sensitivity reports were obtained from relevant departments. Observations were then compiled and documented. Results: Out of 40 cases collected 22 (55%) patients were male and 18 (45%) were female. Majority of the study population belongs to 71 years and above with 15 (37.5%) followed by age group of 41-60 years with 14 (35%). Most frequently prescribed antibiotics were found to be meropenem 16 (21.33%) and piperacillin tazobactam 14 (18.67%). The most resistant antibiotic was found to be cotrimazole in 35 (87.5%). ADRs were found in 35% of all cases. Conclusions: Prescribing patterns for antibiotics need to be optimized. Adherence to and update of the policy is also recommended. It was found that the adherence to hospital antibiotic policy is low.

Mass distribution campaign of long-lasting insecticidal nets (LLINs) during the COVID-19 pandemic in Uganda: lessons learned

BackgroundUganda implemented its third mass campaign to distribute long-lasting insecticidal nets (LLINs) in 2020 during the COVID-19 pandemic. This context necessitated modification of implementation guidelines. The mass campaign's objective was to ensure that at least 85% of the targeted population had access to LLINs.MethodsRevised implementation guidelines were followed while conducting the LLIN distribution campaign. Lessons learned were captured from documented activities and reports.ResultsA total of 27,789,044 mosquito nets were distributed in 11,287,392 households, with an average of 5.1 persons per household. Household coverage of the LLIN distribution was 94.1%. The 2020/2021 campaign design was modified to follow COVID-19 Standard Operating Procedures (SOPs). These included using Personal Protective Equipment (PPE), e-platforms for training and briefing meetings, electronic data management systems and door-to-door household registration and distribution of LLINs.ConclusionsCampaign modifications due to the COVID-19 pandemic were effective in implementing mass distribution of LLINs despite the disruptions and restrictions. The campaign’s net coverage far exceeded its objective. Electronic data management was critical in monitoring and reporting distribution activities.

Clinical Review on Head and Neck CBCT Images

Optimal quality assurance is vital in head and neck (HN) radiotherapy (RT), as inferior dosimetry has proven to compromise survival in HN cancer patients. Image guidance using cone-beam computed tomography (CBCT) has enabled precise matching of tumor targets. The objective was to analyze the translational and rotational shifts obtained from HN CBCT in order to develop the 6D HN imaging protocol, henceforth to achieve the best precision radiotherapy. Sixty patients who received treatment from January 2021 to September 2022 were randomly selected - 10 from each sub-site (paranasal sinuses, nasopharynx, oropharynx, oral cavity, larynx-hypopharynx-thyroid and early-stage glottis). Weekly CBCT obtained were analyzed using offline automatic image registration (IR) on an electronic patient information management system. First, 2 regions of interests (ROIs) were defined; one was based on departmental HN IGRT protocol and the other covered the entire planning target volume (PTV). Subsequently, IR was performed with 2 different algorithms; Maximum Mutual Information (MMI) (soft tissue-based) and Chamfer (bone-based). Each CBCT was inspected manually by an individual to avoid inter-observer variability. The shifts were reported as mean ± standard deviation (SD). Paired t-test was used to analyze the variances in translational and rotational displacements between the different ROIs and algorithm. Early-stage glottis was excluded in the ROI comparison as the treatment field was small and the ROI covered the entire PTV. Overall setup errors were 1.2 ± 1.1mm for the translational shifts and 0.7 ± 0.6° for the rotational. The overall frequency of displacement was 95.2% ≤2° and 99.5% ≤5mm. MMI was more constant than Chamfer for HN CBCT matching as reflected by a considerably smaller translational (1.09 ± 1.05mm vs 1.26 ± 1.16mm, p<0.001) and rotational (0.67 ± 0.57° vs 0.77 ± 0.70°, p<0.001) shifts. The comparison of defining ROIs (PTV vs Protocol) was insignificant in the translational shifts (p = 0.057). However, a substantial difference was observed in the rotational displacements (p = 0.003). The analysis was fundamental in identifying the optimal matching tool and it supports the HN 6D imaging protocol. This audit validated the current 5mm tolerance for translational shift and further established a 2° tolerance for the rotational shift for HN 6D CBCT matching. Profoundly, soft tissue localization is of the utmost importance for highly conformal modulated RT, and adaptation of soft tissue matching is strongly encouraged for HN tumors located in these regions.

Anesthesia quality indicators to measure and improve your practice: a modified delphi study

BackgroundImplementation of the new competency-based post-graduate medical education curriculum has renewed the push by medical regulatory bodies in Canada to strongly advocate and/or mandate continuous quality improvement (cQI) for all physicians. Electronic anesthesia information management systems contain vast amounts of information yet it is unclear how this information could be used to promote cQI for practicing anesthesiologists. The aim of this study was to create a refined list of meaningful anesthesia quality indicators to assist anesthesiologists in the process of continuous self-assessment and feedback of their practice.MethodsAn initial list of quality indicators was created though a literature search. A modified-Delphi (mDelphi) method was used to rank these indicators and achieve consensus on those indicators considered to be most relevant. Fourteen anesthesiologists representing different regions across Canada participated in the panel.ResultsThe initial list contained 132 items and through 3 rounds of mDelphi the panelists selected 56 items from the list that they believed to be top priority. In the fourth round, a subset of 20 of these indicators were ranked as highest priority. The list included items related to process, structure and outcome.ConclusionThis ranked list of anesthesia quality indicators from this modified Delphi study could aid clinicians in their individual practice assessments for continuous quality improvement mandated by Canadian medical regulatory bodies. Feasibility and usability of these quality indicators, and the significance of process versus outcome measures in assessment, are areas of future research.

An international study to explore the feasibility of collecting standardised outcome data for Complex Regional Pain Syndrome: recommendations for an international clinical research registry.

Complex Regional Pain Syndrome (CRPS) is a persistent pain condition with low prevalence. Multi-centre collaborative research is needed to attain sufficient sample sizes for meaningful studies. This international observational study: (1) tested the feasibility and acceptability of collecting outcome data using an agreed core measurement set (2) tested and refined an electronic data management system to collect and manage the data. Adults with CRPS, meeting the Budapest diagnostic clinical criteria, were recruited to the study from 7 international research centres. After informed consent, a questionnaire comprising the core set outcome measures was completed: on paper at baseline (T1), and at 3 or 6 months (T2) using a paper or e-version. Participants and clinicians provided feedback on the data collection process. Clinicians completed the CRPS severity score at T1 and optionally, at T2. Ethical approval was obtained at each international centre. Ninety-eight adults were recruited (female n=66; mean age 46.6 years, range 19-89), of whom 32% chose to receive the T2 questionnaire in an electronic format. Fifty-five participants completed both T1 and T2. Eighteen participants and nine clinicians provided feedback on their data collection experience. This study confirmed the questionnaire core outcome data are feasible and practicable to collect in clinical practice. The electronic data management system provided a robust means of collecting and managing the data across an international population. The findings have informed the final data collection tools and processes which will comprise the first international, clinical research registry and data bank for CRPS.

Internship Model 'Freedom Learns Independent Campus' for Nursing Students in the Digital Era of Industry 4.0

This research aims to develop and apply the Internship Model 'Freedom Learns Independent Campus' (MBKM) specifically for nursing students in the digital era of Industry 4.0. This study acknowledges that the role of technology in nursing is increasingly important and that the use of technology in nursing student internships will increase their understanding of patient-centered health care. This study used a mixed approach involving both quantitative and qualitative methods. The research sample consisted of nursing students who are currently undergoing higher education programs and have access to digital technology. Data will be collected through surveys and interviews, which will be analyzed using statistical approaches and thematic analysis. The MBKM Internship Model will include the use of technology such as simulation, electronic data management, telemedicine, and mobile applications in the clinical practice of nursing students. Students will be given training in the use of these technologies and will have the opportunity to apply them in simulated and hands-on nursing situations. During the internship period, nursing students will work with clinical mentors who are experienced in integrating technology into patient care. They will be involved in the collection and analysis of clinical data using electronic data management systems, as well as conducting telemedicine consultations for guidance and feedback from experienced healthcare professionals. It is hoped that the results of this study will provide insight into the effectiveness of the MBKM Internship Model in preparing nursing students to face the challenges and opportunities offered by the digital era of Industry 4.0. In addition, the results of this study can become the basis for the development of curricula and nursing education programs that are more up-to-date and relevant to technological developments.

The Use of Open Data Kit (ODK) in Characterizing the Cacao Industry Sites in Panay Island

Cacao is one of the world's most valuable export commodities and cash crops. Western Visayas, along with the other regions in the Philippines, has committed to participate in national efforts to strengthen the production capacity of the cacao industry and address prospects and opportunities for the industry growth and development. This paper presents the results of a region-wide study that mapped out and assessed key cacao-producing areas in Western Visayas, specifically Aklan, Antique, Capiz, and Iloilo. The study sought their current production levels, important agricultural properties of farming areas, production densities, and growth potentials. Geospatial data was generated, analyzed, and mapped using Open Data Kit (ODK), an electronic data management system. Findings revealed that cacao plantations are not evenly distributed in Panay Island. Most cacao farms are located in the Province of Iloilo, however, tree density was highest at farms in the Province of Capiz. The geophysical characteristics of most cocoa-producing areas were consistent with the geophysical elements mentioned in the literature. These findings can be used for science-based decisions for promoting the emerging cacao industry in Panay Island.

Measures by Organisations to Counter Challenges in the Use of Information Technology in Protecting Personal and Business Data in Nairobi County, Kenya

Globally, most states have adopted new technologies that have seen many process improvements and cost optimisations and enabled them to provide value-added services to their citizens, thereby improving quality of life and achieving rapid growth and development in various sectors of the nation. Kenya is one of the developing countries that has benefited from adopting modern ICT in recent years. Despite government efforts to ensure the successful integration of ICT into various state departments and the private sector to protect and manage data, cases of document loss from individuals and institutions have been on the rise. This paper examined measures by organisations that could be adopted to counter challenges in using information technology to protect personal and business data in Nairobi County. The study’s target population comprised employees from Kenya Revenue Authority and Kenya Data Networks in Nairobi headquarter offices, police officers deployed at NPS offices headquarters and members of the public. The findings established that implementing electronic data management systems in organisations was more appropriate for controlling data loss. In addition, training employees on using the data management system is critical in preventing data loss in an organisation. Creating awareness of electronic data management systems was an effective measure to protect against data loss among organisations. Based on the findings, the paper concludes that strategies that help solve information challenges must be implemented to prevent data loss at personal and organisational levels.

Endocrine Abnormalities in Children With Traumatic Brain Injury at a Tertiary Care Center.

Objective Accidental traumatic brain injury (TBI) can lead to severe complications such as endocrine abnormalities and long-term morbidities and can negatively impact patient lives. These conditions are also associated with a high cost of treatment over a lifetime, a significant concern in low-to-middle-income countries (LMICs). In Pakistan, the prevalence of children with endocrine abnormalities secondary to TBI remains largely unexplored. We conducted a retrospective cross-sectional study to estimate the burden of endocrine abnormalities due to TBI among children in our population. Methods Twenty patients previously admitted with head injury between September and October 2019 were retrospectively reviewed with tests for baseline serum sodium, plasma osmolality, cortisol, adrenocorticotropin (ACTH), free thyroxine (fT4), growth hormone (GH), insulin growth factor-1 (IGF-1), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), prolactin, estradiol, and testosterone. Data were collated from the electronic Health and Information Management System (HIMS) and analyzed using SPSS v25. Chi-square and t-tests were used to identify associations between variable groups. Outcomes of interest included correlations between hormonal levels and demographic factors, interventions and hormonal levels, and complication rates and hormonal levels. Results Our study reports three (15% of the total cohort) patients with pituitary hormone deficits (two with low IGF-1 and one with low TSH). High serum IGF-1 and ACTH levels were also observed in three (15%) children. High IGF-1 was associated with female gender (p=0.007), mechanical ventilation (p=0.038), and falls (p=0.028). IGF-1 (p=0.035) and GH (p=0.049) levels were associated with improvement in Extended Glasgow Outcome Scale (GOS-E) score. Testosterone was positively correlated with a high percentile for height (p=0.005) and GOS-E scores on follow-up (p=0.030). High testosterone levels (592.12 ± 102.28 ng/dl) were associated with good functional outcomes in post-pubescent patients (p<0.05). Serum fT4 was linked with a high GOS-E score at discharge in prepubescent patients (p=0.034). Neurosurgical decompression was the only risk factor for hormone deficiency, comprising 67% of the group with hormone deficiencies (p=0.028). The learning difficulties were observed exclusively in children with hormonal deficiencies (7 patients, p=0.000). Conclusion Hormonal dysfunction due to TBI in children can lead to poor outcomes. High serum IGF-1, testosterone, and free T4 levels were associated with improved functional outcomes in children with TBI. Limited follow-up and resources in LMICs are significant barriers to addressing the morbidity associated with these conditions and need to be addressed at a health policy level.

Data collection and outcome measurement in student counseling services in Irish higher education institutions: Counselors’ views on challenges and facilitators.

With increasing concerns around student mental health, student counseling services (SCSs) in higher education are being challenged to show evidence of their contribution to the personal and academic development of students through evidence-based approaches including systematic data collection and standardized outcome measurement. This study aims to document data collection and measurement processes in SCSs in higher education institutions (HEIs) in Ireland and to explore the opinions of staff in SCSs on the feasibility and functionality of a standardized national database for SCSs to enhance robust data collection and measurement across the sector. Twenty-three interviews were conducted and thematically analyzed with staff in SCSs in 22 HEIs (85% of publicly funded HEIs). Findings revealed that the process of data collection in SCSs is mainly focused on individual counseling with variations among SCSs in collecting clients' demography, presenting issues, and clinical and educational outcomes. Lack of human and financial resources, no access to an electronic data management system, negative opinions about standardized outcome measures, and concerns over data protection and misuse of data were impeding factors for systematic data collection in SCSs. There is strong support among SCSs for the establishment of a national database which is facilitated by secured funding from the Higher Education Authority, a strong sense of community and trust among student counselors, and a history of data collection through the Psychological Counsellors in Higher Education Ireland association. Findings offer insights into challenges and facilitators for robust data collection and measurement at a national level. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Minimum Information Standards in Chemistry: A Call for Better Research Data Management Practices.

Research data management (RDM) is needed to assist experimental advances and data collection in the chemical sciences. Many funders require RDM because experiments are often paid for by taxpayers and the resulting data should be deposited sustainably for posterity. However, paper notebooks are still common in laboratories and research data is often stored in proprietary and/or dead-end file formats without experimental context. Data must mature beyond a mere supplement to a research paper. Electronic lab notebooks (ELN) and laboratory information management systems (LIMS) allow researchers to manage data better and they simplify research and publication. Thus, an agreement is needed on minimum information standards for data handling to support structured approaches to data reporting. As digitalization becomes part of curricular teaching, future generations of digital native chemists will embrace RDM and ELN as an organic part of their research.

35. The development, testing, and validation of an automatic LIMS import method for NGS myeloid panel results

For oncology genetic testing, there is a critical need for patient results to be readily available and accessible for the ordering pathologist's review. After an initial genetic testing workup, emergency treatment or follow-up testing may be required, thus accessibility of results is a key feature in providing patient-focused laboratory testing. Ideally, genetic testing results would be incorporated into a LIMS data management system in order to have a permanent record of testing and to allow for the results to be easily accessible, searchable, and transferable by the clinical or pathology team working on behalf of the patient. For maximum impact, Next Generation Sequencing (NGS) reports should be electronically integrated into the patient's electronic health record. NGS reports uploaded as PDF attachments constrain health record searches. Additionally, data in PDF reports often are not able to be transferred to a comprehensive pathology report and may require cumbersome manual entry. Our team has recently completed a project to create an automatic import method for our Myeloid Complete NGS Panel report into our electronic patient data management system. Our data management system is interfaced with our client's LIMS platform enabling the direct and automatic transfer of orders coming in as well as delivery of the resultant NGS report into the patients' health records. We will present the steps taken to create, test, troubleshoot, and validate the automatic upload system. We will also detail critical components of the NGS LIMS report and challenges that were addressed during this project.

Implementation of a Dedicated HDR Peer Review Program can Result in Improved Total Treatment Times for Gynecological Patients

<h3>Purpose/Objective(s)</h3> Total treatment times (TTT) >56 days(d) has demonstrated worse outcomes for cervical cancer patients¹. Each extra day of treatment beyond 6-8 weeks can result in a loss of 0.6% per day pelvic control². With appropriate quality assurance programs set in place, teams can achieve TTT success 85% of the time and 53d median time to complete¹. At UT Health SA from September 2016 to 2019 our non-cylinder HDR median TTT was 64d, with only 30% of patients completing </=56d. We hypothesized that creation of a dedicated brachytherapy (HDR) team could significantly improve total treatment times. <h3>Materials/Methods</h3> Starting 10/2019 we implemented an HDR peer review program. Every patient to receive HDR was reviewed before or at the initiation of EBRT as well as after subsequent imaging prior to HDR. Process mapping from start to end of therapy was put in place following the patient from initial review to completion of therapy (graph 1). Data were collected from both an electronic patient information management system and EPIC EMRs. TTT was calculated as the elapsed time between the first day of external beam and the last day of either external beam radiation (EBRT) or HDR, whichever is the latest. Nodal boost and patient attendance to scheduled activities was recorded as variables that could extend TTT. <h3>Results</h3> From 10/1/2019 to 12/1/2021 a total of 63 patients underwent EBRT and non-cylinder HDR. Non-cylinder HDR included 28 tandem and ovoid (39%), 11 utrecht (15%), 30 syed procedure (42%) and 2 combined (3%). The median TTT for patients post implementation of peer review was 53d versus 64d before. Forty-five patients (71%) finished TTT in </=56d compared to 30% before peer review. Eighteen patients (29%) completed TTT in > 56d versus 70% before peer review. Completion times falling outside of 56d by TTT (volume) include: 57d (3), 58 (3), 59 (4), 60(1), 62(1), 63(1), 64(1), 65(1), 67(1), 69(1), 71(1). Only 21% of patients exceeding TTT >56d had a nodal boost versus 55% in of those patients with TTT <=56d. Seventy-six percent of patients with TTT >56d missed an EBRT treatment, range 1 to 22d, average 5.8d. Thirty-nine percent of patients with TTT </=56d missed EBRT treatments, range 1-6d, average 2.2. <h3>Conclusion</h3> Establishing a dedicated HDR peer review program improved median TTT from 64d to 53d. The percentage of patients with TTT </=56d improved from 30% to 71%. Noncompliance with scheduled treatments was the single most significant factor in TTT exceeding 56d. In all cases of TTT >56d, subtracting scheduled but missed EBRT treatment days from TTT results in 92% of patients completing TTT </= 56d. Our data suggests that a dedicated HDR peer review process is beneficial towards achieving the 56d goal. We believe further investigation into interventions that could potentially reduce poor compliance with scheduled treatments is warranted.

Implementation of a Dedicated Concurrent Chemotherapy and Radiation (C-XRT) Coordination Process can Result in Improved C-XRT Synchronization

<h3>Purpose/Objective(s)</h3> C-XRT has been shown to improve overall survival rates and local control for some cancer patients. The successful coordination of the start of chemotherapy and radiation is important to optimize treatment outcomes. Interprofessional teams are essential to providing best results¹. We hypothesized that developing a C-XRT coordination process that includes key stakeholders communicating about pertinent data elements would improve coordination of C-XRT. <h3>Materials/Methods</h3> Starting November 2019, we implemented a chemo-coordination group that involved chemotherapy and radiation nurses, dosimetry, and radiation therapists. A process was put in place utilizing both two electronic patient information management systems. This process began with a request to coordinate C-XRT initiated by the physician on the CT simulation order. This request would create an electronic notification to nursing to coordinate as well as notification to dosimetry and therapy to make them aware. The need for chemo-coordination was also displayed on departmental electronic dashboard. An in-basket was setup to allow nursing teams to communicate in the patient EMR. Nursing, dosimetry, and therapy would meet weekly to review current patient planning process. Successful coordination of C-XRT occurred when electronic notification of task completion was within 24 hours of the initiation of radiation. <h3>Results</h3> From 11/26/2019 to 12/14/2021 a total of 411 orders for chemo-coordination were placed. The success rate for all orders was 94% (386 patients). The physician order date on 5 orders to coordinate came after the start of radiation. Removing these orders to coordinate improved the total successful coordination rate to 95%. Six percent (25 patients) chemo was coordinated after the initiation of treatment. Range of failures were 2-44 days after the start of therapy. For patients with highest days of failure, days 23, 35, and 44, all had orders to coordinate after the start of radiation. Only 2% of patients had coordinated chemo 7 days after the initiation of radiation. Eight percent of patients had completed coordination within first 24 hours after the initiation of radiation. The disease site breakdown for requests were as follows: Bone (12), Breast (9), CNS (65), HN (98), Lung (35), GU (13), GI (90), Heme (2), Unspecified (1). Coordination effort success rates were as follows: Bone (83%), Breast (89%), CNS (92%), HN (97%), Lung (94%), GU (100%), GI (85%), Heme (50%). <h3>Conclusion</h3> We successfully demonstrated that when correctly implemented, a C-XRT coordination process with regular team huddles can result in 95% successfully coordinated C-XRT. We are now working to improve the timeliness of coordinate C-XRT physician orders.

Research on early warning of renal damage in hypertensive patients based on the stacking strategy

BackgroundAmong the problems caused by hypertension, early renal damage is often ignored. It can not be diagnosed until the condition is severe and irreversible damage occurs. So we decided to screen and explore related risk factors for hypertensive patients with early renal damage and establish the early-warning model of renal damage based on the data-mining method to achieve an early diagnosis for hypertensive patients with renal damage.MethodsWith the aid of an electronic information management system for hypertensive out-patients, we collected 513 cases of original, untreated hypertensive patients. We recorded their demographic data, ambulatory blood pressure parameters, blood routine index, and blood biochemical index to establish the clinical database. Then we screen risk factors for early renal damage through feature engineering and use Random Forest, Extra-Trees, and XGBoost to build an early-warning model, respectively. Finally, we build a new model by model fusion based on the Stacking strategy. We use cross-validation to evaluate the stability and reliability of each model to determine the best risk assessment model.ResultsAccording to the degree of importance, the descending order of features selected by feature engineering is the drop rate of systolic blood pressure at night, the red blood cell distribution width, blood pressure circadian rhythm, the average diastolic blood pressure at daytime, body surface area, smoking, age, and HDL. The average precision of the two-dimensional fusion model with full features based on the Stacking strategy is 0.89685, and selected features are 0.93824, which is greatly improved.ConclusionsThrough feature engineering and risk factor analysis, we select the drop rate of systolic blood pressure at night, the red blood cell distribution width, blood pressure circadian rhythm, and the average diastolic blood pressure at daytime as early-warning factors of early renal damage in patients with hypertension. On this basis, the two-dimensional fusion model based on the Stacking strategy has a better effect than the single model, which can be used for risk assessment of early renal damage in hypertensive patients.

Management Information Systems Capabilities and Performance of Teachers Service Commission of Kenya

The need for Teacher Service Commission (TSC) to perform better, become more efficient operationally and more responsive towards its stakeholders’ needs in service delivery has seen increased automation of services through adoption of Management Information Systems (MIS) in the institution. This study sought to establish the influence of MIS capabilities on performance of the institution. The specific objectives were to establish the influence of communication capabilities, payment capabilities, human resource management capabilities and data management capabilities on performance of Teachers Service Commission of Kenya. The study was anchored on Unified Theory of Acceptance and Use of Technology, Resource Based view theory, and Theory of Planned Behavior. The study adopted a descriptive research design. The target population consisted of 1,30 0 staff in various departments in TSC headquarters, Nairobi. The population was grouped into population into two sub - populations, namely - the management and the support staff. The study employed stratified random sampling technique for purpose of choosing a sample size of 130. The study used primary data which was collected with the help of the questionnaire. The questionnaire had both closed and open-ended questions. A pilot test was carried out to ensure that the questions in the questionnaire were thoroughly reviewed to ensure clarity and eliminated any form of ambiguity. The data was analyzed using descriptive and inferential analysis. The study found out that communication capabilities, accounting information systems, human resource management systems, and electronic data management system influenced performance of TSC. The study concluded that communication capabilities influenced performance of TSC in terms of speedy delivery of information and efficiency. The study also concluded that accounting capabilities had a positive influence on performance of TSC. It was concluded that human resource management capabilities had positive and significant influence on performance of TSC. The study recommended that TSC should continually adopt and implement management information systems in service delivery. The top management should continually support the adoption and implementation of MIS through budget allocation and also ensure proper orientation to the staff at all levels to ensure they have proper and adequate knowledge to use MIS effectively. The study will be of benefit to the management and staff of TSC; to other public institutions in Kenya who wants to adopt ICT in delivery of services; to the government of Kenya as the policy maker; and to researchers.