Patient Electronic Medical Record Research Articles

19 Development of the Puerto Rico Neoplasm and CNS Tumor Registry (PUNCTURE)

OBJECTIVES/GOALS: To describe and compare clinical data and outcomes for patients with CNS tumors and tumor mimics in Puerto Rico who are undergoing surgical and nonsurgical management. Thus, increasing data from an underrepresented group which can serve as a foundation for investigating determinants of outcomes. METHODS/STUDY POPULATION: This proposal will examine patient charts, radiology and pathology reports, financial data, and treatment details from the electronic medical record of patients receiving surgical and nonsurgical treatment for CNS tumors and mimics in the University of Puerto Rico Medical Sciences Campus and all associated institutions. Data will be analyzed retrospectively between January 1, 2014 and June 30, 2022, and prospectively for ten years until December 31, 2032. Patients with primary and metastatic CNS tumors and tumor mimics in the brain, meninges, ventricles, spinal cord, cranial nerves, orbit, facial sinuses, bony skull, vasculature will be included. The registry will include patients from birth onward. RESULTS/ANTICIPATED RESULTS: We plan to compare different surgical and non-surgical techniques and devices in terms of technical and clinical outcomes after surgical interventions for CNS tumors. We are collaborating with the CNS Tumor Outcome Registry at Emory (CTORE) and plan to continue collaboration with other institutions. Combining our data, we aim to develop predictive models of patient outcomes after surgical and nonsurgical intervention for CNS pathologies using supervised and unsupervised machine learning strategies. DISCUSSION/SIGNIFICANCE: There is a significant lack of literature on CNS intervention outcomes in Puerto Rico. This registry will provide the platform for cost-analysis studies for techniques and clinical protocols applicable to pre-operative, intra-operative, post-operative, and conservative management of patients, in Puerto Rico and beyond.

In-sensor artificial intelligence and fusion with electronic medical records for at-home monitoring.

This work presents an artificial intelligence (AI) framework for real-time, personalized sepsis prediction four hours before onset through fusion of electrocardiogram (ECG) and patient electronic medical record. An on-chip classifier combines analog reservoir-computer and artificial neural network to perform prediction without front-end data converter or feature extraction which reduces energy by 13× compared to digital baseline at normalized power efficiency of 528 TOPS/W, and reduces energy by 159× compared to RF transmission of all digitized ECG samples. The proposed AI framework predicts sepsis onset with 89.9% and 92.9% accuracy on patient data from Emory University Hospital and MIMIC-III respectively. The proposed framework is non-invasive and does not require lab tests which makes it suitable for at-home monitoring.

A study of disparities in access to genetic care pre- and post-pandemic.

We aimed to explore the delivery of pediatric genetic care before and during the COVID-19 pandemic and assess if disparities in care existed or emerged. We retrospectively reviewed the electronic medical record for patients 18 years old or younger seen in the Division of Pediatric Genetics between September 2019-March 2020 and April-October 2020. Outcomes included time between referral and new visit, recommendation and completion of genetic testing and/or follow-up visit within 6 months, and telemedicine versus in-person format. Outcomes were compared pre- and post-COVID-19 emergence across ethnicity, race, age, health insurance, socioeconomic status (SES), and use of medical interpretation services. Three hundred thirteen total records were reviewed with comparable demographics between cohorts. Cohort 2 had shorter times between referral and new visit, greater telemedicine utilization, and a greater proportion of testing completed. Younger patients tended to have shorter times between referral and initial visit. In Cohort 1, those with Medicaid insurance or no coverage had longer referral-initial visit times. In Cohort 2, there were differences in testing recommendation based on age. For all outcomes, no disparities were observed across ethnicity, race, SES, or use of medical interpretation services. This study characterizes the impact of the pandemic on pediatric genetics care delivery at our center and may have wider implications.

Secure and Fast Emergency Road Healthcare Service Based on Blockchain Technology for Smart Cities

Road accidents occur everywhere in the world and the numbers of people dead or injured increase from time to time. People hope that emergency vehicles and medical staff will arrive as soon as possible at the scene of the accident. The development of recent technologies such as the Internet of Things (IoT) allows us to find solutions to ensure rapid movement by road in emergencies. Integrating the healthcare sector and smart vehicles, IoT ensures this objective. This integration gives rise to two paradigms: the Internet of Vehicles (IoV) and the Internet of Medical Things (IoMT), where smart devices collect medical data from patients and transmit them to medical staff in real time. These data are extremely sensitive and must be managed securely. This paper proposes a system design that brings together the three concepts of Blockchain technology (BC), IoMT and IoV to address the problem mentioned above. The designed system is composed of three main parts: a list of hospitals, patient electronic medical record (EMR) and a network of connected ambulances. It allows the road user in the case of an accident to report their position to the nearby health services and ambulances.

COPD, diabetes, lymphopenia, and increased LDH cause higher mortality in hospitalized COVID-19 patients.

COPD, diabetes, lymphopenia, and increased LDH cause higher mortality in hospitalized COVID-19 patients.

Patients with Laryngeal Disorders Who Undergone Microlaryngeal Surgery at The Dr. Soetomo General Hospital Surabaya

Objective: To describe laryngeal abnormalities undergoing microlaryngeal surgery (MLS). Material and Methods: A retrospective analytical study by examining the central medical record and electronic medical record of patients with laryngeal disorders in the otorhinolaryngology head and neck surgery (ORL-HNS) Outpatient Unit and the Teratai ORL-HNS Surgery Inpatient Care Unit at Dr. Soetomo General Hospital, Surabaya, from January 1 until December 31, 2019, utilizing the chi-square test followed by the Wald test. Results: The number of patient visits from January 1 until December 31, 2019, amounted to 80 patients, most of whom were male and belonged to the 19-60 age group. The histopathology results of patients with neoplasms indicated moderately differentiated squamous cell carcinoma, while the same procedure applied to patients without neoplasms mainly indicated vocal nodules. In this case, the most used technique was a biopsy. Patients with smoking risk factors amounted to 38, while those without smoking risk factors amounted to 42. Conclusion: MLS is used as a means of diagnosis and therapy, including cases of benign and malignant neoplasms.

The Impact of the COVID-19 Pandemic on the Registration and Care Provision of Mental Health Problems in General Practice: Registry-Based Study.

The impact of the COVID-19 pandemic on mental health in general practice remains uncertain. Several studies showed an increase in terms of mental health problems during the pandemic. In Belgium, especially during the first waves of the pandemic, access to general practice was limited. Specifically, it is unclear how this impacted not only the registration of mental health problems itself but also the care for patients with an existing mental health problem. This study aimed to know the impact of the COVID-19 pandemic on (1) the incidence of newly registered mental health problems and (2) the provision of care for patients with mental health problems in general practice, both using a pre-COVID-19 baseline. The prepandemic volume of provided care (care provision) for patients with mental health problems was compared to that from 2020-2021 by using INTEGO, a Belgian general practice morbidity registry. Care provision was defined as the total number of new registrations in a patient's electronic medical record. Regression models evaluated the association of demographic factors and care provision in patients with mental health problems, both before and during the pandemic. During the COVID-19 pandemic as compared to before the COVID-19 pandemic, the incidence of registered mental health problems showed a fluctuating course, with a sharp drop in registrations during the first wave. Registrations for depression and anxiety increased, whereas the incidence of registered eating disorders, substance abuse, and personality problems decreased. During the 5 COVID-19 waves, the overall incidence of registered mental health problems dropped during the wave and rose again when measures were relaxed. A relative rise of 8.7% and 40% in volume of provided care, specifically for patients with mental health problems, was seen during the first and second years of the COVID-19 pandemic, respectively. Care provision for patients with mental health problems was higher in older patients, male patients, patients living in center cities (centrumsteden), patients with lower socioeconomic status (SES), native Belgian patients, and patients with acute rather than chronic mental health problems. Compared to prepandemic care provision, a reduction of 10% was observed in people with a low SES. This study showed (1) a relative overall increase in the registrations of mental health problems in general practice and (2) an increase in care provision for patients with mental health problems in the first 2 years of the COVID-19 pandemic. Low SES remained a determining factor for more care provision, but care provision dropped significantly in people with mental health problems with a low SES. Our findings suggest that the pandemic in Belgium was also largely a "syndemic," affecting different layers of the population disproportionately.

Cardiac Incidental Findings on Abdominopelvic Computed Tomography: Prevalence and Association with Subsequent Cardiovascular Events

The aim of this study was to assess the prevalence of reportable cardiac findings detected on abdominopelvic CTs and the association with subsequent cardiovascular events. We performed a retrospective search of electronic medical record of patients who underwent abdominopelvic CT between November 2006 and November 2011 with a clinical history of upper abdominal pain. A radiologist blinded to the original CT report reviewed all 222 cases for the presence of pertinent reportable cardiac findings. The original CT report was also evaluated for documentation of pertinent reportable cardiac findings. The following findings were recorded on all CTs: presence of coronary calcification, fatty metaplasia, ventricle wall thinning and thickening, valve calcification or prosthesis, heart/chamber enlargement, aneurysm, mass, thrombus, device, air within ventricles, abnormal pericardium, prior sternotomy, and adhesions if prior sternotomy. Medical records were reviewed to identify cardiovascular events on follow-up in patients with the presence or absence of cardiac findings. We compared the distribution findings in patients with and without cardiac events using the Wilcoxon test (for continuous variables) and the Pearson's chi-squared test (for categorical variables). Eighty-five of 222 (38.3%) patients (52.7% females, median age 52.5 years) had at least one pertinent reportable cardiac finding on the abdominopelvic CT, with a total of 140 findings in this group. From the total 140 findings, 100 (71.4%) were not reported. The most common findings seen on abdominal CTs were: coronary artery calcification (66 patients), heart or chamber enlargement (25), valve abnormality (19), sternotomy and surgery signs (9), LV wall thickening (7), device (5), LV wall thinning (2), pericardial effusion (5), and others (3). After a mean follow-up of 43.9 months, 19 cardiovascular events were found in the cohort (transient ischemic attack, cerebrovascular accident, myocardial infarction, cardiac arrest, acute arrhythmia, palpitation, syncope and acute chest pain). Only 1 event occurred in the group of patients with no incidental pertinent reportable cardiac findings (1/137=0.73%). All other 18 events occurred in patients with incidental pertinent reportable cardiac findings (18/85=21.2%), which was significantly different (p < 0.0001). One out of the total 19 events in the overall group (5.24%) occurred in a patient with no incidental pertinent reportable cardiac findings while 18 of 19 total events (94.74%) occurred with patients with incidental pertinent reportable cardiac findings, which was also significantly different (p < 0.001). Fifteen of the total events (79%) occurred in patients in whom the incidental pertinent reportable cardiac findings were not reported, which was significantly different (p < 0.001) from the four events that occurred in patients in whom the incidental pertinent reportable cardiac findings were reported or had no findings. Incidental pertinent reportable cardiac findings are common on abdominal CTs and are frequently not reported by radiologists. These findings are of clinical relevance since patients with pertinent reportable cardiac findings have a significantly higher incidence of cardiovascular events on follow-up.

Intra-articular and soft-tissue corticosteroid injections and risk of infections: Population-based self-controlled-risk-interval design.

Chronic and short-term treatment with oral corticosteroids is associated with an increased risk of infection. However, the potential risk of infection that may be associated with intra-articular and soft-tissue injections of corticosteroids has not been reported. The aim of this study was to assess the risk for infection following intra-articular or soft-tissue corticosteroid injections. Self-controlled-risk-interval study with 15 732 adults who were treated with intra-articular or soft-tissue corticosteroid injections during 2015-2018. The study was conducted in a large Israeli Health Maintenance Organization. We self-matched the participants and analyzed the incidence of infection over three periods: an exposure-period of 90 days following the injection, and two 90-day control periods. We identified the occurrence of several common infections in the patient's electronic medical record and analyzed the incidence rates of all infections (composite end-point) as well as each infection separately. The incidence of any infection was higher during postexposure period compared with the control periods (46.5 vs. 42.1 events per 1000 persons), number needed to harm was 227 persons. Self-matching analysis showed increased incidence-rate-ratio (IRR) for the combined incidence of infections in the post-exposure period compared with the control periods (IRR=1.10, 95% confidence interval [CI] 1.01-1.21). A sensitivity analysis showed that the highest IRR was during the first 30 days (IRR=1.19, 95% CI 1.03-1.38), with higher IRR for patients aged 65 years and older (IRR=1.37, 95% CI 1.08-1.73). Intra-articular and soft-tissue corticosteroids injections may be associated with an increased risk of infections; however, the absolute risk increase is low.

Initial experience with Scepter Mini dual lumen balloon for embolization of cerebrovascular diseases.

Endovascular treatment of cerebrovascular diseases is often challenging due to small caliber, tortuous distal vessels. Several devices and techniques have evolved to overcome these challenges. Recently, a low profile dual lumen microballoon catheter, specifically designed for distal navigation is employed for neurovascular procedures. Due to its recent advent, scarce data is available on clinical utility and safety of Scepter Mini. The aim of this case series is to report our initial experience with Scepter Mini in the management of various cerebrovascular diseases. All interventional neurovascular cases performed using Scepter Mini between January 2020 till April 2021 were included. Data regarding patient demographics, procedural details and complications was retrospectively collected from patient's electronic medical record and procedure reports. Total twelve embolization procedures were performed in eleven patients, including six brain arteriovenous malformation, two dural arteriovenous fistula, one vein of Galen malformation and three hyper-vascular glomus tumor embolizations. All procedures were successfully performed with adequate penetration of the embolic agent. Complete embolization was performed in six procedures, while intended partial embolization was performed in the rest of procedures. Scepter Mini was solely used in ten procedures, however in the other two embolization procedures it was used as an additional conjunct tool to complete the intended embolization. No balloon related complication was observed in any procedure. Scepter Mini dual lumen microballoon catheter is safe and feasible for delivery of liquid embolic agents for cerebrovascular embolization procedures.

Suicidal ideations and Psycho-Education Compliance at a Transplant Center

Objective: To assess the frequency of compliance to provide psycho-education in patients suffering from suicidal ideations. Study Design: Retrospective Descriptive cross-sectional study. Place and Duration: Pakistan Kidney and Liver Institute and Research Center, Lahore from 1st January 2021 to 31st December, 2021. Methodology: Electronic medical record of patients visiting psychiatric clinic at Pakistan Kidney and Liver Institute and Research Center from 1st January 2021 to 31st December 2021. Results: Among the total 487 patients majority (34%) were consulted for pre-transplant assessment. The ideations were reported by 6.8% patients only, whereas in 1.4% of patients the record regarding suicidal ideations were not found. The mental health team provided psycho-education in 93% of all patients with ideations. The data suggests that medications were prescribed in all patients who reported suicidal ideation. Conclusion: The suicidal ideations are essential to ask in the clinical encounter. It is concluded that patients report ideations but to enquire is essential. The suicidal risk assessment is not dependent on the clinical site, i.e. whether a tertiary care center or a transplant center. We also conclude that documentation is pertinent and this can be achieved by selecting suicidal risk assessment as department’s Key Performance Indicator (KPI). Keywords: Suicidal Ideations, Compliance, Psychoeducation, Outpatient, Mental Health, Risk Management, Transplant Patients How to Cite This: Khan F, Munawar S, Nawaz N, Bhimani M. Suicidal ideations and Psycho-Education compliance at a Transplant Center. Isra Med J. 2022; 14(3): 113-116. DOI: https://doi.org/10.55282/imj.oa1334

Insurance Status, Comorbidity Diagnosis, and Hepatitis C Diagnosis Among Antibody-Positive Patients: A Retrospective Cohort Study.

In California, laboratories report all hepatitis C (HCV)-positive antibody tests to the state; however, that does not accurately reflect active infection among those patients without a viral load test confirming a patient's HCV diagnosis. These public health surveillance disease incident records do not include patient details such as comorbidities or insurance status found in electronic medical records (EMRs). This research seeks to understand how insurance type, insurance status, patient comorbidities, and other sociodemographic factors related to HCV diagnosis as defined by a positive viral load test among HCV antibody-positive persons from January 1, 2010 to March 1, 2020. HCV antibody-positive individuals reported to the California Reportable Disease Information Exchange (CalREDIE), with a medical record number associated with the University of California, Irvine Medical Center, and an unrestricted EMR (n = 521) were extracted using manual chart review. HCV diagnosis as indicated in a patient's EMR in the problem list or disease registry. Less than a quarter of patients in this sample were diagnosed as having HCV in their EMR, with 0.4% of those diagnosed (5/116) patients with indicated HCV treatment in the medication field of their charts. After adjusting for multiple comorbidities, a multinomial logistic regression found that the relative risk ratios (RRRs) of HCV diagnosis found that patients with insurance were more likely to be diagnosed compared to those without insurance. When comparing uninsured patients to those with government insurance at the P < .05 level (RRR = 10.61 (95% confidence interval (CI): 4.14-27.22)) and those uninsured to private insurance (RRR = 6.79 (95% CI: 2.31-19.92). These low frequencies of HCV diagnosis among the study population, particularly among the uninsured, indicate a need for increased viral load testing and linkage to care. Reflex testing on existing samples and improving HCV screening and diagnosis can help increase linkage to care and work towards eliminating this disease.

Methamphetamines and Serious Injection-Related Infections: Opioid Use Care Continuum and Opportunities to End Alabama's Drug Crisis.

Increasingly, injection opioid use and opioid use disorder (OUD) are complicated by methamphetamine use, but the impact of stimulant use on the care of people who inject drugs (PWID) with serious injection-related infections (SIRIs) is unknown. The objective of this study was to explore hospital outcomes and postdischarge trends for a cohort of hospitalized PWID to identify opportunities for intervention. We queried the electronic medical record for patients hospitalized at the University of Alabama at Birmingham with injection drug use-related infections between 1/11/2016 and 4/24/2021. Patients were categorized as having OUD only (OUD), OUD plus methamphetamine use (OUD/meth), or injection of other substance(s) (other). We utilized statistical analyses to assess group differences across hospital outcomes and postdischarge trends. We determined the OUD continuum of care for those with OUD, with and without methamphetamine use. A total of 370 patients met inclusion criteria-many with readmissions (98%) and high mortality (8%). The majority were White, male, and uninsured, with a median age of 38. One in 4 resided outside of a metropolitan area. There were significant differences according to substance use in terms of sociodemographics and hospital outcomes: patients with OUD/meth were more likely to leave via patient-directed discharge, but those with OUD only had the greatest mortality. Comorbid methamphetamine use did not significantly impact the OUD care continuum. The current drug crisis in AL will require targeted interventions to engage a young, uninsured population with SIRI in evidence-based addiction and infection services.

Active screening technological model of cardiac rhythm disturbances (experience of Moscow polyclinic)

Introduction. This article is devoted to the study of the structure of cardiac arrhythmias detected in the process of active screening using a portable ECG recorder in patients of the State Budgetary Institution of Healthcare "Consultative and Diagnostic Polyclinic No. 121 of the DZM" (hereinafter – KDP No. 121). Carried out as part of the project of the Department of Health of the city of Moscow "Scientific laboratory" Moscow Polyclinic ".&#x0D; &#x0D; Materials and methods. In a continuous cross-sectional screening study using a Cardiochair with a built-in electrocardiograph, in which the model of active screening of cardiac arrhythmias was implemented, all interested patients of the polyclinic took part: before seeing a doctor or receiving any medical procedure from 01/14/2022 to 08/03/2022 in KDP No. 121.&#x0D; &#x0D; Results. The study involved 5352 patients aged 18 to 105 years: men – 1723 (32.2%), women – 3629 (67.8%). Based on the results of the analysis of the obtained ECGs, 1610 HPS were detected: sinus tachycardia in 1324 (24%), bradycardia in 25 (1.4%), ventricular extrasystole in 135 (2%), supraventricular extrasystole in 33 (2%), atrial fibrillation in 118 (2%) – permanent AF in 62 (52%), paroxysmal AF in 56 patients (48%). In addition, interval changes were recorded: PQ shortening in 762 (14%) patients, PQ prolongation in 89 (1.7%), QRS widening in 545 (10%), QTc prolongation in 387 (7%). It was found that with age, adherence to ECG screening in men decreases, in women it increases. The most important advantage of the technological screening model using the Cardiochair with a built-in electrocardiograph was the timely verification of cardiac arrhythmias in patients, including primary patients. ECG data with interpretation was automatically displayed in the EMIAS patient's electronic medical record.&#x0D; &#x0D; Conclusions. The active screening of cardiac arrhythmias using the Cardiochair with an integrated electrocardiograph in KDP No. 121 is an example of the use of a digital health technology model for early diagnosis and management of chronic conditions for health management purposes.

Inferencing Bulk Tumor and Single-Cell Multi-Omics Regulatory Networks for Discovery of Biomarkers and Therapeutic Targets.

There are insufficient accurate biomarkers and effective therapeutic targets in current cancer treatment. Multi-omics regulatory networks in patient bulk tumors and single cells can shed light on molecular disease mechanisms. Integration of multi-omics data with large-scale patient electronic medical records (EMRs) can lead to the discovery of biomarkers and therapeutic targets. In this review, multi-omics data harmonization methods were introduced, and common approaches to molecular network inference were summarized. Our Prediction Logic Boolean Implication Networks (PLBINs) have advantages over other methods in constructing genome-scale multi-omics networks in bulk tumors and single cells in terms of computational efficiency, scalability, and accuracy. Based on the constructed multi-modal regulatory networks, graph theory network centrality metrics can be used in the prioritization of candidates for discovering biomarkers and therapeutic targets. Our approach to integrating multi-omics profiles in a patient cohort with large-scale patient EMRs such as the SEER-Medicare cancer registry combined with extensive external validation can identify potential biomarkers applicable in large patient populations. These methodologies form a conceptually innovative framework to analyze various available information from research laboratories and healthcare systems, accelerating the discovery of biomarkers and therapeutic targets to ultimately improve cancer patient survival outcomes.

Postoperative photography reduces incorrect wound breakdown diagnoses in tracheostomy

PurposeThis study was performed to investigate the effect of including immediate postoperative photographs of a tracheostomy site on diagnoses (correct and incorrect) of wound breakdown in a pediatric patient population. Materials and methodsChart review was performed of all patients from 2017 to 2019 who underwent a tracheostomy. Within this time span, the practice of the hospital changed such that postoperative photography was taken of the tracheostomy site. There were no changes in in-service training protocols over this time. Wound breakdown diagnoses were examined prior to and after the intervention. Diagnoses were categorized by severity according to the National Pressure Ulcer Advisory Board. Diagnoses were then divided into correct or incorrect based on examination by physician teams at the time of the diagnosis. ResultsForty five patients underwent a tracheostomy during the study period. When comparing the two groups, there was a reduction in all wound breakdown diagnosis by 91 %, and those diagnoses which were entered into the chart after the photos were verified as correct. ConclusionsWithout appropriate context as to the nature of tracheostomy wounds, many providers may incorrectly grade a healthy wound as wound degradation, which can affect care, reimbursement, and hospital ratings. We present our findings of placing an intraoperative wound photo in the patient's electronic medical record as a reference should wound concerns arise. We believe this is an easy action which can enhance patient care, decrease unnecessary work, and provide an accurate documentation of tracheostomy care pathways and results.

TERTIAN: Clinical Endpoint Prediction in ICU via Time-Aware Transformer-Based Hierarchical Attention Network.

Accurately predicting the clinical endpoint in ICU based on the patient's electronic medical records (EMRs) is essential for the timely treatment of critically ill patients and allocation of medical resources. However, the patient's EMRs usually consist of a large amount of heterogeneous multivariate time series data such as laboratory tests and vital signs, which are produced irregularly. Most existing methods fail to effectively model the time irregularity inherent in longitudinal patient medical records and capture the interrelationships among different types of data. To tackle these limitations, we propose a novel time-aware transformer-based hierarchical attention network (TERTIAN) for clinical endpoint prediction. In this model, a time-aware transformer is introduced to learn the personalized irregular temporal patterns of medical events, and a hierarchical attention mechanism is deployed to get the accurate patient fusion representation by comprehensively mining the interactions and correlations among multiple types of medical data. We evaluate our model on the MIMIC-III dataset and MIMIC-IV dataset for the task of mortality prediction, and the results show that TERTIAN achieves higher performance than state-of-the-art approaches.

413: COST ANALYSIS OF EMPIRIC COVERAGE FOR PATIENTS WITH MDR GRAM-NEGATIVE INFECTIONS

Introduction: Gram-negative resistance to empiric antibiotic therapy has been associated with increased mortality rate, prolonged hospital length of stay and increase cost. The objective of this study is to compare total hospital costs associated with the appropriate and inappropriate empiric antibiotic therapy for critically ill patients with documented Gram-negative infections. Methods: Single-center, retrospective, cohort study conducted at a tertiary academic medical center. Data was collected from the electronic medical record for patients admitted from January 2015 to December 2017. Patients ≥18 years of age with culture-positive Gram-negative infection during the first 2 days of admission and started on antibiotics were included. Appropriate empiric coverage was defined as antibiotics with microbiological activity against the organism subsequently isolated in cultures within 24 hours collection. The primary outcome was the total hospital costs (fixed and variable) for the entire hospital stay. Descriptive statistics were performed and Mann-Whitney U, Fisher’s exact test, and χ-square test were conducted, where appropriate. Results: 832 patients were included in this study with 79 (9.5%) of the patients characterized as receiving inappropriate empiric antibiotics. There were no differences between patients receiving appropriate and inappropriate empiric therapy. Hospital and ICU length of stay were also statistically similar. There were significantly lower pharmacy costs incurred in patents receiving appropriate empiric therapy compared to inappropriate ($1,893 [3,319] vs. $2,252 [5,629], p=0.016). Total hospital costs incurred by patients receiving appropriate empiric therapy were numerically lower ($20,848 [30,377] vs. $23,006 [39,222], p=0.052). Conclusions: Inappropriate empiric antibiotics for patients with culture-positive Gram-negative infections was associated with significant increase in overall pharmacy cost and charges and numerically greater total hospital cost and charges.

ODP199 Full Implementation of Automated Self-Adjusting Subcutaneous Insulin Algorithm

Abstract Background - We programmed a self-adjusting subcutaneous insulin algorithm (SQIA) in the electronic medical record for patients who are NPO, on total parenteral nutrition (TPN), or on continuous tube feedings (CTF). The SQIA only requires a nurse to enter a patient's current glucose value and then calculates the next insulin dose based on previous dose, and current and previous glucoses. The SQIA titrates for a goal glucose of 120 -180 mg/dL. The advantage of this automated algorithm is that no new orders are required, even if insulin is added to TPN or tube feeding rate is changed. We previously reported results of a pilot study with 67% of blood glucoses in the 80-180 mg/dL range without any hypoglycemia (glucose &amp;lt; 60 mg/dL). Hypothesis - Following the successful pilot, the SQIA was instituted in September 2020 at our institution's three adult hospitals. We hypothesized that glucose control with the SQIA will be non-inferior to previous inpatient glycemic management and successfully maintain blood glucoses in the goal range. Methods - The SQIA was implemented on September 3, 2020 for patients who were NPO, on TPN, or on CTF. Any clinician placing insulin orders could select the SQIA as an alternate to ordering standard fixed aspart dosing or a sliding scale at four-hour intervals. We performed a prospective analysis on all patients managed with the SQIA during the first year of implementation (9/3/2020–9/2/2021) to evaluate use of the SQIA and resulting glycemic control. Results were compared to patients during the preceding one-year period (9/3/2019-9/2/2020) who were ordered for standard subcutaneous insulin aspart dosing while being NPO, on TPN, or on CTF. Results During the study period, the SQIA was utilized during 2691 time intervals within 1774 hospitalizations. The average duration for each interval was 56.4 hours and glucoses were checked every 3.9 hours while on the SQIA. Average point-of-care blood glucose while on SQIA was 157.5 ± 52.6 mg/dL. In a similar set of 1987 hospitalized patients in the preceding year who were on standard subcutaneous insulin orders, the average blood glucose was 159.4 ± 55.1 mg/dL. Conclusions - A self-adjusting SQIA effectively maintained glucose within the goal inpatient range during our first year of implementation and was non-inferior to prior glycemic control using standard dosing protocols. The SQIA provided an avenue for effective glycemic control while eliminating the need for insulin dosage titration by clinicians. Hospitals and health systems should consider pursuing similar innovations to improve the ease of inpatient glycemic control while continuing to meet glycemic targets. Presentation: No date and time listed

Tibiofemoral lift-off and resulting laxity following total knee arthroplasty: Frequency in a series of 906 continuous cases and functional consequences at 4 years’ follow-up in a case-control study

BackgroundTibiofemoral instability is one reason for early revision of total knee arthroplasty. It can be the consequence of tibiofemoral laxity, especially in the coronal plane with tibiofemoral lift-off. But does femoral condyle lift-off on conventional postoperative radiographs suggest the presence of laxity or potential instability? To our knowledge, this question has not yet been answered. This led us to conduct a retrospective study to evaluate (1) the frequency of lift-off on postoperative radiographs, (2) the relationship between lift-off and laxity in the short term and (3) the functional consequences of lift-off. HypothesisPostoperative lift-off is a rare event that is predictive of laxity. MethodsWe carried out a single-center retrospective study using postoperative radiographs from patients who underwent primary total knee arthroplasty between 2014 and 2016. The sample consisted of 906 patients. Lift-off was defined as a tibiofemoral angle of 3° or more on immediate postoperative radiographs (day 0) that were non-weightbearing and had no stress applied. The functional outcomes were determined in the 17 patients identified as having lift-off who had been operated in the first year (2014) to ensure the follow-up was long enough. These patients were compared to 34 matched control patients who were operated the same year and chosen randomly among patients not having lift-off. The matching ratio was 2 controls to 1 case. Preoperative and surgical data were compiled from each patient's electronic medical record. Patients were evaluated at 4 years postoperatively using the subjective Oxford-48, objective HSS score, IKS score, overall patient satisfaction and stress radiographs of the knee. The cases of lift-off observed in 2014 (n=17) were paired with a control group of patients selected randomly during 2014. ResultsThe frequency of the lift-off event was 63/906 or 7%. The frequency was consistent over the three years studied: 7.1% in 2014 (19/269), 6.2% in 2015 (22/354) and 7.8% in 2016 (22/283). There was no significant difference between the two groups (17 with lift-off and 34 without) in the sex, age, body mass index and coronal plane deformity (preoperative HKA angle). At a mean follow-up of 4 years (range 12–49 months), the knees with postoperative lift-off had more laxity (p=0.002), particularly laxity when varus stress was applied (p=0.009). There were no other significant differences in the outcomes. DiscussionImmediate postoperative lift-off after total knee arthroplasty is not a rare event, with a 7% frequency in our study. While it reveals that laxity is present in the particular compartment, there is no evidence of functional consequences at 4 years’ follow-up; however, a long-term assessment is required to verify this finding. Level of evidenceIII – case-control study.