Patient Electronic Medical Record Research Articles

COVID-19 and Neurologic Manifestations: An Experience at Major New York City Hospitals.

Introduction: The exact incidence of neurologic manifestations in coronavirus disease 2019 (COVID-19) patients is not clear. The New York City Hospital system has been severely affected by the COVID-19 pandemic between December 2019 and 202. A large number of patients were treated at these centers. This study aims to investigate the incidence of such neurologic manifestations. Secondly, we wanted to find out if there is a correlation between comorbidities and neurologic manifestations in patients with COVID-19.Methodology: A retrospective analysis of 5,455 Electronic Medical Records of patients with a positive polymerase chain reaction (PCR) result admitted to Elmhurst Hospital, Queens Hospital Center, Jacobi Medical Center, and North Central Bronx Hospitals, four of the 11 teaching hospitals in the NYCHH (New York Health + Hospitals) between 3-1-2020 to 8-31-2020 was carried out. Comprehensive data were collected using medical documentation in five categories: demographic details, comorbidities, symptoms, laboratory findings, and radiologic examinations. All neurologic manifestation keywords were provided to the statisticians by two trained and board-certified physiatrists. Neurologic manifestations were categorized into central nervous system (CNS) manifestations and peripheral nervous system (PNS) manifestations.Results; Out of the 5,455 patients, 285 patients (5.2%) had central nervous system manifestations, a prevalence in people older than 50, and had a high incidence of comorbidities. We found increased D-dimer and high C reactive protein levels. Our findings agree with two of the three authors with significant case volume.

Fusion of fully integrated analog machine learning classifier with electronic medical records for real-time prediction of sepsis onset

The objective of this work is to develop a fusion artificial intelligence (AI) model that combines patient electronic medical record (EMR) and physiological sensor data to accurately predict early risk of sepsis. The fusion AI model has two components—an on-chip AI model that continuously analyzes patient electrocardiogram (ECG) data and a cloud AI model that combines EMR and prediction scores from on-chip AI model to predict fusion sepsis onset score. The on-chip AI model is designed using analog circuits for sepsis prediction with high energy efficiency for integration with resource constrained wearable device. Combination of EMR and sensor physiological data improves prediction performance compared to EMR or physiological data alone, and the late fusion model has an accuracy of 93% in predicting sepsis 4 h before onset. The key differentiation of this work over existing sepsis prediction literature is the use of single modality patient vital (ECG) and simple demographic information, instead of comprehensive laboratory test results and multiple vital signs. Such simple configuration and high accuracy makes our solution favorable for real-time, at-home use for self-monitoring.

Patient survey superior to EMR extraction for eliciting positive symptoms at COVID-19 illness onset.

Context: COVID-19 has ravaged nations around the world, with New York City (NYC) and the NYC suburbs being particular epicenters of COVID-19 infection. Suffolk County, NY, has reported over 200,000 cases and 3,000 deaths to date. Most initial COVID-19 research concerned hospitalized patients. Presenting symptomology in the outpatient setting was poorly characterized, as were the implications of specific presenting symptoms, beyond respiratory distress or hypoxia, for eventual disease severity. This made it difficult for primary care physicians to predict which patients would require hospitalization for COVID-19 disease or decompensate while being managed at home during a time when hospital and ICU beds were limited. Objective: To characterize presenting symptoms of COVID-19 infection in the outpatient setting and evaluate for correlation with severity, duration, and chronicity of disease. Study Design and Analysis: We collected survey data from both patient telephone interviews and electronic medical record (EMR) extraction. Patient characteristics were described using means and percentages when appropriate. Percentage of symptoms by severity level, symptom duration, COVID-19 testing and escalating medical care were calculated. To evaluate association of risk factors with positive testing, severity, duration and chronicity of symptoms, logistic regression was used. Patient characteristics, medications and repeat measures were evaluated as risk factors in logistic regression. Setting or Dataset: 107 patients with suspected and confirmed COVID-19 cases at the 3 primary care practices of Stony Brook University Hospital between March and December, 2020. Population Studied: adult, English speaking primary care patients with suspected or confirmed COVID-19 Intervention/Instrument: patient self report telephone survey, EMR data extraction survey Outcome Measures: symptom duration, symptom severity, persistence of symptoms at 3 month time point Significant Results: Patient self-report survey elicited nearly twice as many symptoms described at illness onset vs. those recorded in the EMR. Conclusions: Early in the setting of newly emerging infectious diseases, particularly those such as COVID-19 which involve multiple organ systems, patient self report of symptoms of illness rather than EMR extraction alone may be crucial both for identifying cases and in order to characterize pathophysiology of disease in real time.

Abstract P4-12-12: Assessing the impact of the COVID-19 pandemic on cancer treatment decision-making and care experiences

Abstract BACKGROUND: While the COVID-19 pandemic has reshaped how oncology is practiced, we sought to understand itseffects on treatment decision-making and care experiences amongst cancer patients at the Tom BakerCancer Centre in Calgary, Canada. METHODS: A 24 item, cross-sectional survey was developed based on literature review and iterative feedback fromoncology physicians, nurses, and a patient advisor. Survey domains included fear of COVID-19 andperceived risk, uptake of COVID-19 public health measures, cancer treatment decision-making duringthe pandemic, and cancer care experiences during the pandemic. Demographic, cancer and treatment-related information was obtained from the electronic medical record for patients who consented andcompleted the survey. In the first quarter of 2021, 161 patients accrued including 44 breast cancerpatients. The cohort characteristics and survey responses were summarized using descriptive statistics. RESULTS: For the 44 participants with breast cancer, all were female and the median age was 59 years (range 35-83 years). Our breast cancer cohort was almost evenly split between those with stage I-III (45.5%) andthose with metastatic disease (54.5%). Time since diagnosis was as follows: less than 1 year (17patients), 1-3 years (10 patients), 3-5 years (5 patients), and more than 5 years (9 patients). Treatmentsreceived since declaration of the pandemic included: surgery (21 patients), radiation (17 patients),chemotherapy (25 patients), endocrine therapy (25 patients), and other systemic therapies such as boneand anti-HER2 agents (15 patients). Just over half of the participants (54.5%) agreed or strongly agreedthat they were at increased risk of contracting COVID19; however, fewer patients expressed beinguncomfortable thinking about COVID-19 (45.4%), afraid of COVID-19 (38.6%), or fearful of dying fromCOVID19 (31.8%). The vast majority (>93%) of patients followed public health recommendations formitigating the risk of contracting COVID-19 (i.e. masking, frequent hand washing/sanitization, and socialdistancing) and 70.4% expressed a willingness to receive the vaccine when available. Of therespondents, 19 had undergone testing for COVID-19 at least once and 3 tested positive. Only 2 patientsreported that their surgical course was altered due to the pandemic and no patients declinedtreatments or perceived delays or modifications in therapies otherwise. Of 25 breast participants whohad experienced a cancer-related telehealth appointment during the pandemic, 21 (84%) agreed orstrongly agreed with being satisfied with the encounter. CONCLUSION: The COVID-19 pandemic caused minimal perceived disruption to care amongst a small cohort of breastcancer patients being treated at our centre. While experience with a cancer-related telehealthappointment was not universal, our findings support acceptability of its use. Citation Format: Noura Alsafar, Desiree Hao, Nimira Alimohamed, Sunil Samnani, Sasha Lupichuk. Assessing the impact of the COVID-19 pandemic on cancer treatment decision-making and care experiences [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-12.

P365 Weight gain after initiation of adalimumab in patients with Crohn’s disease

Abstract Background Overweight and obesity are associated with increased risk of metabolic chronic diseases including cardiovascular disease and metabolic associated fatty liver disease. Weight gain post initiation of anti-tumour necrosis factor-alpha (TNFα) inhibitor medication is anecdotally common. This project aimed to determine whether weight gain occurs after inititiation of anti-TNFα inhibitor adalimumab. Methods A hospital database of, 277 patients that started on adalimumab between November, 2015 and November, 2020 to manage Crohn’s disease was retrospectively audited. Demographic and clinical data were extracted from the electronic medical record of patients. Weight and height prior to, and after, initiation of adalimumab were recorded and body mass index (BMI) was calculated. Anthropometric data was analysed using paired t-tests and statistical significance was assumed at p<0.05. Results Patients initiated on adalimumab were mostly of New Zealand European ethnicity, 216/277 (78%), 159/277 (56%) were female, 129/277 (47%) had ileocolonic Crohn’s disease and, 199/277 (72%) had non-stricturing, non-penetrating disease. Weight before and after starting adalimumab was available for, 160/277 (58%) patients and increased by a mean of, 3.19 ±, 7.62% from, 74.74 ±, 18.98 kg to, 76.91 ±, 19.53 kg (2.18 kg (95% CI:, 1.31 to, 3.06, p < 0.0001). Height (cm) was documented in, 97 (35%) patients. Mean BMI pre-adalimumab was, 25.89 kg/m2 (range, 16.05 to, 45.94 kg/m2) and increased by a mean of, 0.74 kg/m2 (95% CI:, 0.34 to, 1.13, p < 0.001). Post-initiation of adalimumab patients with a BMI <, 18.5 kg/m2 fell from five to three (3.1%) patients and the number of patients with a BMI ≥, 30.0 kg/m2 increased from, 18 to, 21 (21.6%) patients. Conclusion This single centre audit of patients starting adalimumab for management of Crohn’s disease found that significant weight gain is common. Less than two thirds of patients had weight documented at follow up appointments and height was documented in approximately a third of patients. Interventions to limit unintentional weight gain on initiation of adalimumab are warranted.

P115 Implementation of a vaccination tool in the electronic patient health record significantly increases vaccination coverage

BackgroundPatients with immune-mediated inflammatory diseases (IMID) are at higher risk for infectious diseases. Despite this increased risk and the available guidelines1, we reported a sub-optimal vaccination rate of 27.4% of IMID patients in 2018. In the meantime, a vaccination module was introduced in the electronic patient health record of our hospital to accurately document and monitor vaccination status of patients. The impact of this new module on vaccination coverage was re-evaluated in the same IMID patients in 2021.MethodsBetween Aug and Oct 2021, the vaccination status of 1448 (out of the original 1488) IMID patients (44.8% male, median age 53.6 years) was collected (798 patients with IBD, 612 with rheumatological, and 38 with dermatological inflammatory conditions) and compared to that of 2018. The vaccination status was obtained mainly through the patients’ electronic medical records. Missing data were added after contacting patients or their general practitioner.ResultsFrom 2018 to 2021, the overall vaccination coverage of all IMID patients significantly increased from 27.4% to 51.9% (p<0.001, Figure 1).The vaccination coverage in IBD patients increased significantly from 75.9% to 86.3% for influenza (p<0.001), from 72.9% to 88.7% for pneumococci (p<0.001), from 66.0% to 80.2% for hepatitis B (p<0.001), from 79.9% to 85.7% for tetanus (p=0.041) and from 42.2% to 60.4% overall (p<0.001) (Figure 1 and Table 1).Similarly, the vaccination coverage significantly increased for rheumatology patients, namely from 69.3% to 78.3% for influenza (p<0.001), from 34.5% to 85.0% for pneumococci (p<0.001), from 32.8% to 36.5% for hepatitis B (p<0.001) and from 7.8% to 32.6% overall (p<0.001) (Figure 1 and Table 1).For patients with dermatological inflammatory conditions, vaccination coverage significantly increased from 60.5% to 81.6% for pneumococci (p=0.031) and from 47.1% to 55.3% for hepatitis B (p=0.002) (Table 1). ConclusionThe suboptimal vaccination rate measured in 2018 and the COVID-19 pandemic stressed the importance of vaccination recommendations to patients and healthcare professionals. We here show that the implementation of a vaccination tool integrated in the electronic medical record of patients is correlated with a significant increase in specific vaccination rates and also in the total amount of IMID patients that were fully vaccinated according to guidelines.Reference1. Rahier JF, Magro F, Abreu C, et al. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2014;8:443–468.

The effect of biologic therapy for immune-mediated inflammatory diseases on clinical outcomes of COVID-19 in the greater Houston area: A retrospective chart review

The effect of biologic therapy for immune-mediated inflammatory diseases on clinical outcomes of COVID-19 in the greater Houston area: A retrospective chart review

Pre-Visit Patient Instructional Video for the Virtual Orthopedic Foot and Ankle Examination: Technique Tip

Category:Other; Ankle; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; TraumaIntroduction/Purpose:The COVID-19 pandemic has brought a major increase in telemedicine utilization to conserve resources and maintain social distancing. The rapid transition over a short period of time has exposed challenges and limitations of virtual visits, especially with regards to performing an effective and efficient physical examination. Within months, orthopedic telemedicine guides were published for patient education and facilitating the musculoskeletal examination. These publications, however, included only a short video clip to explain to the patient how to participate in the examination during a telemedicine visit. In the foot and ankle subspecialty, the closely adjacent complex anatomy compared to other areas of the body presents unique challenges for physical exam.Methods:To optimize the efficiency and efficacy of the examination portion of the visit for both patients and providers, we designed and recorded an instructional video that is sent to all patients by email a minimum of 1 week prior to their appointment. This video consists of a step-by-step guide on how to take suitable photos and videos of their feet and ankles for the physical examination portion of their visit. These media files are then directly uploaded by the patients into their EMR or emailed to the physician's office to be uploaded for access by the provider before and during the virtual visit. Along with the video, patients are given a link to test their microphone and camera in advance of the visit to ensure adequate functionality and positioning.Results:Our pre-appointment instructional video has been effective to methodically replicate the most important aspects of an in-person foot and ankle evaluation. Both physicians and patients appear to benefit from the tutorial video by having more time during the telemedicine visit to focus on history, assessment, and plan. Patients are more actively involved in the clinical data collection process because they are educated on what to expect and how to best prepare and participate in telemedicine visits. Moreover, having a set of systematic and detailed photos and recordings of the patient's foot and ankle beforehand better focuses interaction and discussion with the patient during the telemedicine encounter. Additionally, these are saved into the patient's electronic medical record, available for reference and later review.Conclusion:Physical examination plays a critical role in diagnosis and treatment in the orthopedic foot and ankle subspecialty. More research is needed to discern how best to utilize virtual modalities as they become more commonplace, not just from the imposition from the COVID pandemic but also from the standpoint of patient convenience and time efficiency. Here we have described our creation of a pre-visit educational video to guide and engage patients on acquiring invaluable physical examination information for the orthopedic foot and ankle telemedicine encounter.

Evaluacija kliničkih i biohemijskih parametara hospitalizovanih bolesnika sa infekcijom kovid 19 - retrospektivna studija iz Bosne i Hercegovine

Background/Aim. For the first time, we evaluated and presented the socio-demographic characteristics, clinical manifestations and laboratory findings of hospitalized coronavirus disease 2019 (COVID-19) patients from Canton Sarajevo, Bosnia and Herzegovina. Methods. This retrospective, single-centre study included 159 RT-PCR verified COVID-19 patients (92 mild/moderate; 67 severe/critical) consecutively hospitalized at the General Hospital "Prim. dr Abdulah Nakaš" in Sarajevo, Bosnia and Herzegovina. Socio-demographic, clinical, and laboratory data on admission were retrospectively obtained from each patient's electronic medical record and patient files by two experienced physicians. Results. 43.4% of the patients belonged to the age range of 46-65 years; 71.1% were men, and 68.6% had comorbidities; hypertension was the most prevalent comorbidity (100%), followed by diabetes (91.7%) and ischemic heart disease (35.8%). The leading clinical symptoms were fever (87.44%), tiredness (77.8%), and body/muscle aches (70.3%). There was significant reduction of blood oxygen saturation (p = 0.005), and significant elevation of D-dimer (p = 0.003), CRP (p = 0.044), and fasting plasma glucose (p = 0.047) in the severe/critical patients group compared to mild/moderate group. Conclusion. Older age, the male gender, confirmed comorbidities, decreased blood oxygen saturation, increased levels of CRP, D-dimer, and fasting plasma glucose, together with symptoms of chest pain/shortness of breath and/or diarrhea occurred more frequently in severe/critical than mild/moderate COVID-19 patients.

Evaluation of Pharmacotherapies for Alcoholic Liver Disease: A Retrospective Real-World Evidence Study

Background: Ursodeoxycholic acid (UDCA), a hepatoprotective agent demonstrates several beneficial effects on liver biochemistry measures and thus, it might be useful for the management of Alcoholic liver disease (ALD). Objective: To evaluate the pharmacotherapies for ALD using retrospective real-world evidence. Methods: In this retrospective study, the Electronic Medical Records (EMRs) of patients with ALD who were prescribed various pharmacotherapies between January 2021 and April 2021 at two Indian healthcare settings were reviewed. The effectiveness outcomes were assessed in terms of mean difference and proportion of patients showing improvement in the levels of liver enzymes (Aspartate aminotransferase [AST], Alanine aminotransferase [ALT] and γ-glutamyl transferase [GGT]) and conjugated bilirubin from baseline to 30-days follow-up. Results: A total of 298 patients were included and divided into two study groups - scientific and herbal groups. The scientific group included patients prescribed with drugs like UDCA, pentoxifylline, ademetionine, metadoxine, and nutritional supplementation. The herbal group included patients prescribed with four different Herbal Preparations. Of 193 patients in the scientific group, a majority (76.7%; n=148/193) of the patients received UDCA; of these, 107 patients' data were available at the 30-days follow-up. In the herbal group (n=105), a majority (62.9%; n=66/105) of the patients received Herbal Preparation 1, and 78 patients had data at follow-up. The elevated levels of liver enzymes (AST, ALT, GGT) at baseline were significantly reduced (p&lt;0.05) at follow-up in patients prescribed with UDCA vs. Herbal Preparation 1. The change from baseline to 30 days in conjugated bilirubin was significantly higher in the UDCA vs. Herbal Preparation 1 (-45.2% vs. -33.5%, p&lt;0.001). There was considerable improvement in the proportion of patients with elevated AST and ALT in the UDCA group. No serious adverse events were reported in either of the groups. Conclusion: The present study demonstrates that UDCA and Herbal Preparation 1 are majorly used in the management of ALD. UDCA has shown a substantial hepatoprotective effect as evident by significant improvements in the liver biochemistry of ALD patients as compared to the Herbal Preparation 1. Overall, the data from the current study suggests the use of UDCA as an initial therapy for ALD patients with altered liver enzymes.

The impact of a student pharmacist‐led inpatient medication counseling initiative on medication safety in kidney transplant recipients

AbstractIntroductionEngaging student pharmacists as pharmacist extenders to facilitate medication education may represent a unique pathway for preventing medication safety issues and mitigating downstream consequences in the high‐risk kidney transplant (KTX) population. The aim of this study was to describe the implementation and impact of a student pharmacist‐led counseling initiative designed to promote patient and caregiver understanding of transplant medications.MethodsThis is a single‐center, retrospective quality improvement initiative comparing adult KTX recipients who received interventional student pharmacist‐led education vs a historical cohort. Data on clinical outcomes, including the incidence of medication errors (MEs), adverse drug events (ADEs), and readmissions, was extracted from the patient's electronic medical record. In the intervention cohort, attendee satisfaction was assessed based on responses obtained from surveys distributed to patients and caregivers on the day they attended the student pharmacist‐led class.ResultsA total of 311 KTX recipients were included in this analysis; 149 in the intervention cohort and 162 in the historical cohort. Patients in the intervention cohort experienced more MEs than those in the historical cohort (31 vs 11; P &lt; .001). Rates of ADEs within the first 30 days post‐transplant were comparable across cohorts (56 vs 52; P = .406). No significant difference in readmissions at days 7, 14, and 30 was observed between groups. Attendee satisfaction was high across all survey response fields.ConclusionThe results of this study demonstrate that KTX recipients who participated in student‐pharmacist led medication counseling had comparable rates of ADEs and readmissions to those who did not, but were more likely to experience MEs. Future research is needed to explore the role of structured medication counseling and the utility of student pharmacists in the clinical setting.

Synthesizing time-series wound prognosis factors from electronic medical records using generative adversarial networks

Wound prognostic models not only provide an estimate of wound healing time to motivate patients to follow up their treatments but also can help clinicians to decide whether to use a standard care or adjuvant therapies and to assist them with designing clinical trials. However, collecting prognosis factors from Electronic Medical Records (EMR) of patients is challenging due to privacy, sensitivity, and confidentiality. In this study, we developed time series medical generative adversarial networks (GANs) to generate synthetic wound prognosis factors using very limited information collected during routine care in a specialized wound care facility. The generated prognosis variables are used in developing a predictive model for chronic wound healing trajectory. Our novel medical GAN can produce both continuous and categorical features from EMR. Moreover, we applied temporal information to our model by considering data collected from the weekly follow-ups of patients. Conditional training strategies were utilized to enhance training and generate classified data in terms of healing or non-healing. The ability of the proposed model to generate realistic EMR data was evaluated by TSTR (test on the synthetic, train on the real), discriminative accuracy, and visualization. We utilized samples generated by our proposed GAN in training a prognosis model to demonstrate its real-life application. Using the generated samples in training predictive models improved the classification accuracy by 6.66–10.01% compared to the previous EMR-GAN. Additionally, the suggested prognosis classifier has achieved the area under the curve (AUC) of 0.875, 0.810, and 0.647 when training the network using data from the first three visits, first two visits, and first visit, respectively. These results indicate a significant improvement in wound healing prediction compared to the previous prognosis models.

Patient-Reported Outcomes Integrated Within an Electronic Medical Record in Patients With Head and Neck Cancer.

Patient-reported outcome (PRO) tools lead to clinical benefits, including improved overall survival for patients with cancer. However, routine implementation of PROs in clinical practice within the electronic medical record (EMR) by integrated health care delivery systems remains limited. We studied the use of a PRO tool for patients with head and neck cancer (HNC) integrated in an EMR at Kaiser Permanente in Northern California. Between August 2017 and December 2019, patients with newly diagnosed HNC were surveyed at baseline, then every 3 months using the Functional Assessment of Cancer Therapy-General 7 and Functional Assessment of Cancer Therapy-Head and Neck (version 4). A medical assistant performed a baseline survey on diagnosis and then notified patients electronically per surveillance protocol. Patients who did not respond to online PRO surveys could complete them via telephone or in-person appointments with medical assistants. Abnormal findings on PRO surveys were referred to appropriate members of the care team or the treating Otolaryngology-Head and Neck Surgery physicians. Two hundred ninety patients received baseline surveys. Patients received up to a maximum of eight subsequent surveys. Of a total of 597 electronic surveys, 585 (97.9%) were completed. The percentage of patients completing each interval survey ranged from 92% to 100%. Multivariate Poisson regression analysis showed patients with English as their primary language and an online secure account were the most likely to complete surveys compared with those patients with non-English as a primary language and without an online account. PRO tools can be effectively used within the EMR for patients with HNC with a high response rate provided there is strong engagement from a dedicated member of the care team. This has important implications for designing clinical trials and symptom monitoring in clinical practices that incorporate EMRs.

Observations from Implementation of the ERAS Protocol after DIEP Flap Breast Reconstruction.

The Enhanced Recovery After Surgery (ERAS) protocol is a multivariate intervention requiring the help of several departments, including anesthesia, nursing, and surgery. This study seeks to observe ERAS compliance rates and obstacles for its implementation at a single academic institution. This is a retrospective study looking at patients who underwent deep inferior epigastric perforator (DIEP) flap breast reconstruction from January 2016 to September 2019. The ERAS protocol was implemented on select patients early 2017, with patients from 2016 acting as a control. Thirteen points from the protocol were identified and gathered from the patient's electronic medical record (EMR) to evaluate compliance. Two hundred and six patients were eligible for the study, with 67 on the control group. An average of 6.97 components were met in the pre-ERAS group. This number rose to 8.33 by the end of 2017. Compliance peaked with 10.53 components met at the beginning of 2019. The interventions most responsible for this increase were administration of preoperative medications, goal-oriented intraoperative fluid management, and administration of scheduled gabapentin postoperatively. The least met criterion was intraoperative ketamine goal of >0.2 mg/kg/h, with a maximum compliance rate of 8.69% of the time. The introduction of new protocols can take over a year for full implementation. This is especially true for protocols as complex as an ERAS pathway. Even after years of consistent use, compliance gaps remain. Staff-, patient-, or resource-related issues are responsible for these discrepancies. It is important to identify these issues to address them and optimize patient outcomes.

High Rate of Recurrent Venous Thromboembolism Is Children with Sickle Cell Disease and History of VTE: Analysis of the Trinetx Research Network Database

Background: Sickle Cell Disease (SCD) is associated with a chronic prothrombotic state that increases the risk of venous thromboembolism (VTE). The rate of VTE in hospitalized children with SCD is nearly 2%, substantively higher than the 0.2-0.6% rate seen in the general pediatric population. 1-3 The frequency and risk factors associated with the development of recurrent VTE in this population are vastly unknown. This knowledge gap hinders the development of disease-specific guidelines for the management and secondary prevention of VTE in pediatric SCD.Aim: To investigate the frequency of recurrent VTE in children birth to 21 years of age (inclusive) with SCD and history of prior VTE.Methods: We analyzed patient-level data from the TriNetX Research Network Database, a global federated network of electronic medical record (EMR) data from 42 health care organizations. Children ≤21 years of age with a diagnosis of SCD and history of VTE between January 1 2008 to March 31 2021 were included in the analysis. Index VTE was defined as the first diagnosis of VTE in the patient's EMR. Recurrent VTE was defined as an acute VTE diagnosis that occurred 90 days after the index VTE discharge date in a different anatomic location from the index VTE. Patient demographic and clinical characteristics were summarized using counts and percentages. Missing values were not imputed. Overall, one year and five-year recurrence VTE are reported with the corresponding 95% confidence intervals (CI).Results: A total of 119 children with SCD and VTE were included. Table 1 shows the patients baseline characteristics. Mean age at the time of index VTE diagnosis was 16.7 years (standard deviation 5.5 years). The majority of patients were Black (87%) and female (61%). The most frequent index VTE diagnosis was pulmonary embolism (42%) followed by lower (23%) and upper (22%) extremity VTE. Of the 119 patients,10 (8.4%, 95%CI=4-15%) developed recurrent VTE within 1-year and 25 (21.0%, 95%CI=14-29%) developed recurrent VTE within 5-years from index VTE. Compared to patients without recurrent VTE, patients with recurrent VTE were more frequently female (50% vs. 68%, respectively), and slightly older (mean age 16.6 years vs. 17.2 years, respectively). The most frequent anatomic location for VTE recurrence was the upper extremity (32%)Conclusions: This retrospective database analysis identified, for the first time, high rates of recurrent VTE of 8.4% and 21% at 1- and 5-years post-VTE in children with SCD. These rates stand in contrast with the 3% VTE recurrence at 1-year reported for the general pediatric VTE population. 4 Further analyses of the database are ongoing to identify risk factors for recurrent VTE in this population. These initial findings highlight the need for cooperative multicenter prospective studies to reliably establish rates of- and prognostic factors associated with recurrent VTE in children with SCD, in order to generate evidence for disease-specific treatment guidelines, and to inform future prognostically-stratified interventional trials designed to optimize VTE outcomes in pediatric SCD.1.Kumar R, Stanek J, Creary S, et al. Prevalence and risk factors for venous thromboembolism in children with sickle cell disease: an administrative database study. Blood Adv 2018;2:285-291.2. Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001to 2007. Pediatrics 2009;124:1001-8.3. Setty BA, O'Brien SH, Kerlin BA. Pediatric venous thromboembolism in the United States: a tertiary care complication of chronic diseases. Pediatr Blood Cancer 2012;59:258-64.4. Goldenberg NA, Schulman S, Kittelson JM, et al, Kids-DOTT Trial Investigators and the ATLAS Group. A Six-week versus Three-month Duration of Anticoagulation for Acute Provoked Venous Thromboembolism in Patients < 21 Years Old: Results of the Multinational Kids-DOTT Randomized Controlled Trial. [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). [Display omitted] DisclosuresHankins: Global Blood Therapeutics: Consultancy; Vindico Medical Education: Consultancy; UpToDate: Consultancy; Bluebird Bio: Consultancy. Goldenberg: Bristol Myers Squibb: Membership on an entity's Board of Directors or advisory committees; Daiici: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees; Anthos: Membership on an entity's Board of Directors or advisory committees.

Injury patterns of concussion/mild traumatic brain injury in children presenting to a major Australian paediatic trauma centre

Background: Children commonly present to emergency departments for concussion/mild traumatic brain injury(mTBI), yet little is known of this pattern of paediatric injury. The aim of the study was to estimate the incidence, demographics and injury pattern of concussion/mTBI in children coming to a major Australian paediatic trauma centre for emergency care. Methods: This is a single centre retrospective study of children 0-16 years old, with a diagnosis of concussion/mTBI presenting for emergency care over a 6-year period (Jan 2014-Jan 2020). The patient electronic Medical Records (eMR) were accessed using the diagnostic codes S0.09+; these codes being for head and neck injury. Data was retrieved on 37,000 emergency department visits, with only those visits fulfilling criteria for concussion/mTBI being eligible for comprehensive review of the eMR. Simple descriptive statistics were used. Results: Of the 37,000 paediatric visits in the 6-year sample, there were 10,530 concussion/mTBI giving an approximate rate of 1,755 visits annually for concussion/mTBI; 39% being sports-related. The mean age of patients was 12.9 years, with males accounting for 69% of patients and 39% sports-related injuries. Of this total cohort, 28% were discharged without specific instructions to follow-up with an out-patient provider for further management. Three main injury patterns were revealed upon further review. In 70.8% of cases, the injury was a single isolated injury, with rapid symptom recovery and a mean hospital stay of 6.6 hours, and in 1% a parent or caregiver insisted upon imaging. The remaining 29.2% of cases were complex injuries. Of these, approximately one-third of patients were predominantly male and clinically important, having either altered mental state, significant amnesia, symptom spiking and/or a seizure. Almost all cases were imaged and hospitalised with a mean stay of 28.8 hour and needed specialist follow-up. The remaining two-thirds of patients with complex injury had a complicated recovery course marked by high symptom burden with possible co-morbidity; 18.9% were imaged. Almost all cases were hospitalised with a mean stay of 26.5 hours and given specialist follow-up. Discussion: In our institution, approximately 1,800 paediatric patients present with a concussion/mTBI each year for emergency care. Simple injuries are rapidly assessed with little burden placed on the system, while complex injuries place a significant burden on the health system with most needing specialty follow-up care. This construct is being used to form the framework of a common concussion/mTBI pathway for use in paediatric emergency care and enable planning for essential health services. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.

Telemedicine and artificial intelligence related to vision screening

Purpose. This paper aims to evaluate whether telemedical models or examination and prevention models based on artificial intelligence offer German optometrists a chance to increase their status as vision care providers and to provide better eye care in Germany. Material and Methods. Both a systematic literature review and an expert survey were conducted. Study results of deep learning vision screening applications in the fields of glauco- ma, age-related macular degeneration, and diabetic retino- pathy as well results of expert interviews are discussed. Results. The study results and expert interviews demonstrate that cooperation between optometrists and ophthalmologists in a telemedical network is an essential tool for improving the eye health care of the population and relieves ophthalmo- logists of routine tasks. The first telemedical cooperative pro- gram between German optometrists and ophthalmologists demonstrates a successful cooperation. Conclusion. Artificial intelligence (AI) is increasingly finding its way into the field of vision screening. Telemedicine and the electronic patient medical record play a unique role. They en- able German optometrists to secure and expand high-quality service offerings in the field of optometry. Keywords telemedicine, artificial intelligence, vision screening, age- related macular degeneration diabetic retinopathy

An audit of inter‐hospital transfers of children with abdominal pain and their associated medical imaging findings

AbstractIntroductionUltrasound is a common first‐line examination in acute abdominal pain in children. In rural and regional areas, ultrasound is an important factor in decisions to transfer paediatric patients for tertiary care. Transfers can be over a considerable distance, by road and air, and at great cost. This audit reviewed ultrasound findings in children transferred to an Australian paediatric hospital for acute abdominal pain.MethodsChildren transferred for acute abdominal pain between July 2018 and June 2019 was identified. Imaging findings at the transferring and receiving facility were reviewed, along with the patient's electronic medical record. Suspected and final diagnoses were recorded, and the accuracy of imaging evaluated.ResultsThere were 172 transfers identified, mean age was 6 years 1 month, 66.3% were boys. Mean transfer distance was 55.4 km. The majority were suspected acute appendicitis (63.9%), followed by intussusception (20.3%), and hypertrophic pyloric stenosis (14.5%). The majority of suspected diagnoses were ultimately false positives including pyloric stenosis, 52.0%; appendicitis, 50.9% and ileo‐colic intussusception, 74.3% of cases negative.ConclusionImproved diagnostic accuracy in evaluating causes of acute paediatric abdominal pain with ultrasound, particularly appendicitis, pyloric stenosis, and intussusception is required. Targeted education and clinical support mechanisms may reduce potentially unnecessary inter‐hospital transfers and their considerable associated costs.

Application of Bayesian network and regression method in treatment cost prediction

Charging according to disease is an important way to effectively promote the reform of medical insurance mechanism, reasonably allocate medical resources and reduce the burden of patients, and it is also an important direction of medical development at home and abroad. The cost forecast of single disease can not only find the potential influence and driving factors, but also estimate the active cost, and tell the management and reasonable allocation of medical resources. In this paper, a method of Bayesian network combined with regression analysis is proposed to predict the cost of treatment based on the patient's electronic medical record when the amount of data is small. Firstly, a set of text-based medical record data conversion method is established, and in the clustering method, the missing value interpolation is carried out by weighted method according to the distance, which completes the data preparation and processing for the realization of data prediction. Then, aiming at the problem of low prediction accuracy of traditional regression model, this paper establishes a prediction model combined with local weight regression method after Bayesian network interpretation and classification of patients' treatment process. Finally, the model is verified with the medical record data provided by the hospital, and the results show that the model has higher prediction accuracy.

Patterns and predictors of smartphone ownership in a cardiology inpatient population

Abstract Introduction Mobile health (mHealth) interventions have grown in popularity, particularly for chronic disease management. Uptake of these interventions depends on patient smartphone ownership. Purpose To examine the smartphone ownership rate among cardiac inpatients and identify the associated demographic factors. Methods Between February 2019 and March 2020, 565 patients were screened for potential enrolment in the TeleClinical Care (TCC) pilot study at two hospitals in Australia. All patients had an admission diagnosis of acute coronary syndrome or heart failure. Mobile phone ownership was documented at the time of screening. Retrospectively, each patient's electronic medical record was examined for: age, sex, primary diagnosis, suburb of residence, private health insurance subscription, smoking status and occupation. Continuous variables were analysed using a multinomial logistic regression model. Categorical variables were analysed using a generalised linear model. Results Mobile phone ownership was documented for 523 patients (92.6%). 60.6% of all patients owned smartphones, and 14.9% owned basic mobile phones. 24.5% of patients did not own any mobile phone. The average age of participants was 70.8 years. Smartphone ownership rates were high among patients in the 18–49 (96%), 50–59 (89%) and 60–69 (85%) year groups. The differences between these groups were not statistically significant. In the age group 70–79 years, however, smartphone ownership fell to 56.5% (p&amp;lt;0.001, figure 1). The relative risk (RR) of not owning a smartphone increased by 12% for each additional year of age. Overall, smartphone ownership was less more common in women than men [79/179 (44.1%) vs. 238/344 (69.2%), RR 0.78, 95% CI 0.67–0.91, P=0.003, age-adjusted) driven by a difference in patients aged 70 or above [36/131 (27.5%) vs. 82/168 (48.9%), RR 0.66, 95% 0.49–0.90, p&amp;lt;0.001]. After adjustment for age and sex, patients with a primary diagnosis of ACS were more likely to own a smartphone compared to those with HF [227/316 (71.8%) vs. 90/207 (43.5%), RR 1.22, 95% CI 1.04–1.43, P=0.015]. Patients with private health insurance were more likely to own a smartphone than those who were uninsured [68.9% (162/235) v 54.0% (154/285), RR 1.28, 95% CI 1.13–1.43, P&amp;lt;0.001, figure 2). Smartphone ownership was significantly higher in those who were currently working, compared to those who were retired (117/119, 98.3% vs. 56/87, 64.3%, RR 0.76, 95% CI 0.64 – 0.89, P=0.001), even after adjustment for age. Patients living in the region with lowest average household income had the lowest rate of smartphone ownership (52.4%). There was no significant difference in smartphone ownership based on type of occupation. Conclusion Smartphone ownership was common in this inpatient population. Patients who are older, female and of lower socioeconomic background are less likely to own smartphones, and future mHealth programs should be cognizant of this. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Prince of Wales Hospital, Department of Cardiology Figure 1. Smartphone ownership by ageFigure 2. Insurance status