Patient Electronic Medical Record Research Articles

Uses of VEGF inhibitor bevacizumab in appendiceal adenocarcinoma.

831 Background: Systemic treatment of metastatic appendiceal adenocarcinoma (AA) has been challenging due to a lack of well-established AA chemotherapy regimens and historical reliance on colorectal cancer (CRC) protocols. In the United States, but less commonly in Europe, bevacizumab is frequently incorporated in treatment of AA given its approved use for CRC. However, previously there have been no studies evaluating if there is a survival benefit attributable to bevacizumab in patients with AA. Methods: The Palantir Foundry system was used to extract data from the MD Anderson Cancer Center (MDA) electronic medical record for patients with biopsy-proven AA who received chemotherapy at MDA from 2015 to 2024. Only patients with complete staging and histopathology data were included in the analysis. Results: We identified 203 patients with AA who received chemotherapy at MDA and had complete tumor data. Of these, 43% (n=87) received bevacizumab at some point in their treatment. Patients who received bevacizumab were demographically similar to patients who received non-bevacizumab chemotherapy in terms of age at diagnosis, race, and sex; mucinous histology was more frequent in the bevacizumab cohort (52%, n=45 vs. 39%, n=45 in non-bevacizumab cohort). The 87 patients who received bevacizumab were treated with 1-6 lines of therapy per patient (mean = 1.57). The most frequently used bevacizumab-containing regimens were FOLFOX + bevacizumab (34%, n=46), FOLRIRI + bevacizumab (29%, n=40), 5-FU + bevacizumab (15%, n=21), and atezolizumab + bevacizumab (11%, n=15), with less common irinotecan + bevacizumab, TAS-102 + bevacizumab, and FOLFOXIRI + bevacizumab. Three regimens containing bevacizumab were discontinued due to complications: one instance of hand-foot syndrome attributed to xeloda, one instance of cardiomyopathy attributed to immunotherapy, and one bowel perforation with abdominal wall abscess attributed to bevacizumab. To determine if bevacizumab was associated with overall survival (OS) benefit we performed Kaplan-Meier analysis, with OS calculated from start of first line chemotherapy to death, in patients with metastatic AA who received either 5-FU doublet therapy alone or 5-FU doublet therapy with bevacizumab. Patients who received bevacizumab trended toward better OS (median 52 vs 25 months for doublet therapy alone, HR: 0.53, p= 0.059). The effect of bevacizumab was particularly notable in patients with signet ring cell histology; where bevacizumab use was associated with significantly longer OS (median OS 50 vs 14 months for doublet therapy alone, HR: 0.24, p= 0.034). Conclusions: Bevacizumab is frequently added to cytotoxic chemotherapy in the treatment of AA. These retrospective data suggest an OS benefit to adding bevacizumab to doublet chemotherapy, particularly in the case of signet ring cell histology.

Metabolic Profiles of Critical Care Patients to Confirm Sepsis and Further Understand the Metabolic Phenotype of Sepsis.

Sepsis remains a major concern in health care globally. Despite decades of research, incidence is on the rise, and mortality remains high. Costs are staggering. Additionally, the outdated sepsis bundle established based on SIRS, remains the standard by which providers are held accountable. It is now accepted that organ dysfunction in sepsis is secondary to cellular metabolic dysregulation. Technology for metabolic monitoring should be explored for improved, early recognition of sepsis. We sought to investigate the underlying metabolic profile of patients with sepsis, to determine the value of continuous metabolic monitoring technology. The investigators partnered with industry, to trial noninvasive monitoring of the cellular metabolite carbon dioxide, under a prospective, observational design. During the 6-month trial, the investigators collected data from the electronic medical record of patients using the technology, to determine the specific metabolic differences between patients with and without sepsis. The investigators found serum carbon dioxide (paCO2) was significantly lower in patients with sepsis, and, low paCO2 had a significant inverse relationship to serum lactate. This finding supports the notion that paCO2 is low in sepsis secondary to metabolic dysregulation and not hyperventilation, which had historically explained low paCO2 under the SIRS model. Metabolic monitoring is available, easy to apply and manage, and contributes valuable information in the detection of sepsis. Further research should be done to understand trends in serum CO2 and its relationship to the development of sepsis. This study also provides important further support for the emerging understanding of the dysregulated host response in sepsis.

Correlation of tumoral collagen width with overall survival and tumoral collagen straightness with distant recurrence-free survival in patients with pancreatic ductal adenocarcinoma.

779 Background: Quantitative measurements of fibrillar collagen characteristics has been shown to correlate with survival in several types of malignancy. The aim of this study was to determine whether these characteristics correlate with survival in pancreatic ductal adenocarcinoma. Methods: Patients who underwent pancreatic resection for pancreatic ductal adenocarcinoma at an Allegheny Health Network hospital between 1/1/2019 and 12/31/2023, and for whom archived formalin-fixed paraffin-embedded tumor tissue was available, were included in the study. Clinical and pathologic characteristics were collected from the patient's electronic medical record. Survival data included overall survival (OS), local recurrence-free survival (RFS), and distant RFS. One section of tumor per patient was stained with Picrosirius Red and a representative digital image was obtained with a camera attached to a microscope at 100x magnification. Each image was analyzed with CT-FIRE software to determine averages of collagen fiber width, length, straightness, and angle. Descriptive statistics were initially computed. Log-rank tests were also conducted to compare the OS rate and RFS rate between four different groups (width, length, straightness, angle). Each group was divided into high and low groups, using the mean as cutoff. In the end, multivariate Cox regression was conducted by controlling the confounders including sex, perineural invasion, lymphovascular invasion, and presence of lymph node metastasis to examine the hazard ratios of OS, local RFS, and distant RFS for the four collagen fiber metrics. All statistical analyses were performed via SAS 9.4 under alpha level .05. Results: One hundred three patients met the inclusion criteria. Based on the results of log-rank test, OS was significantly different between high and low collagen width groups, p = .0251. The lower width group had higher survival rate than the upper width group. Also, distant recurrence-free survival was significantly different between high and low collagen straightness groups, p = .0053. The lower straightness group had higher distant RFS rate than upper group. The results of multivariate Cox regression were consistent with the Kaplan-Meier curves. Compared to the high collagen width group, the low collagen width group had a 57% lower chance of dying, hazard ratio = 0.43, 95% CI [0.23, 0.78], p = .0056. The low collagen straightness group had a 60% lower chance of distant recurrence than the high collagen straightness group, hazard ratio = 0.40, 95% CI [0.19, 0.85], p =.0163. Conclusions: Quantitative collagen fiber metrics could help identify patients with resected pancreatic adenocarcinoma who are at risk of earlier death and distant recurrence.

Herbal hepatotoxicity: Difficulties in the diagnosis and treatment of liver lesions by borage oil

Introduction: The use of herbal medicines has increased over the past 20 years as a complementary therapy for various diseases. However, the commercialization of these products is not preceded by a guarantee of safety. This article aims to report the use of borage oil or Borago officinalis (BO), beneficial for menopause-related symptoms, however, it may contain pyrrolizidine alkaloids (AP), a hepatotoxic toxin. Methodology: a study of the patient's electronic medical record was conducted. Case report: 53-year-old woman admitted to emergency room with jaundice, asthenia, hyporexia and pain in the right hypochondrium (HD) for 10 days after use of the herbal medicine Niolix® (BO), being initially diagnosed with acute hepatitis induced by BO. Liver biopsy revealed intense lymphocyte inflammatory infiltrate, in addition to plasma cells, neutrophils and macrophages, with aggression to the limiting plaque and hepatocytes. After the end of the corticosteroid treatment, there was a new increase in aminotransferases and the appearance of autoantibodies, leading to the hypothesis of autoimmune hepatitis triggered by BO. Immunosuppressive treatment was instituted, with significant improvement in the condition. Conclusion: this report exemplifies the diversity of liver lesions induced by herbs, as well as drugs, supplements, and medications, calling attention to the strict follow-up of cases, with possible changes in diagnosis and conduct during treatment.

Pre-Operative Anemia is an Unsuspecting Driver of Machine Learning Prediction of Adverse Outcomes after Lumbar Spinal Fusion.

Pre-operative risk assessment remains a challenge in spinal fusion operations. Predictive modeling provides data-driven estimates of post-surgical outcomes, guiding clinical decisions and improving patient care. Moreover, automated machine learning models are both effective and user-friendly, allowing healthcare professionals with minimal technical expertise to identify high-risk patients who may need additional pre-operative support. This study investigated the use of automated machine learning models to predict discharge disposition, length of hospital stay, and readmission post-surgery by analyzing pre-operative patient electronic medical record data and identifying key factors influencing adverse outcomes. Retrospective cohort study. The sample includes electronic medical records of 3,006 unique surgical events from 2,855 patients who underwent lumbar spinal fusion surgeries at a single institution. The adverse outcomes assessed were discharge disposition (non-home facility), length of hospital stay (extended stay), and readmission within 90 days post-surgery. We employed several inferential and predictive approaches, including the automated machine learning tool TPOT2 (Tree-based Pipeline Optimization Tool-2). TPOT2, which uses genetic programming to select optimal machine learning pipelines in a process inspired by molecular evolution, constructed, optimized and identified robust predictive models for all outcomes. Feature importance values were derived to identify major pre-operative predictive features driving optimal models. Adverse outcome rates were 25.9% for discharge to non-home facilities, 23.9% for extended hospital stay, and 24.7% for readmission within 90 days post-surgery. TPOT2 delivered the best-performing predictive models, achieving balanced accuracies ((Sensitivity [true positive rate] + Specificity [true negative rate)]) / 2) of 0.72 for discharge disposition, 0.72 for length of stay, and 0.67 for readmission. Notably, preoperative hemoglobin emerged as a consistently strong predictor in best-performing models across outcomes. Patients with severe anemia (hemoglobin <80g/dL) demonstrated higher associations with all adverse outcomes and common comorbidities associated with frailty (e.g., hypertension, type II diabetes, and chronic pain). Additional patient variables and comorbidities, including body mass index, age, and mental health status, influencing post-surgical outcomes were also highly predictive. This study demonstrates the effectiveness of automated machine learning in predicting post-surgical adverse outcomes and identifying key pre-operative predictors associated with such outcomes. While factors like age, BMI, insurance type, and specific comorbidities showed notable effects on outcomes, preoperative hemoglobin consistently emerged as a significant predictor across outcomes, suggesting its critical role in pre-surgical assessment. These findings underscore the potential of enhancing patient care and preoperative assessment through advanced predictive modeling.

Socio-Demographic and Clinical Characteristics of Patients with Substance Intoxication Receiving a Psychiatric Assessment in the Emergency Department of the Maggiore Della Carita Hospital, Novara, Italy.

Patients intoxicated with alcohol or other substances are often assessed and assisted in the context of the Emergency Department (ED) by emergency physicians, who usually require a psychiatric assessment. This study aims to analyse the characteristics of a sample of patients receiving a psychiatric consultation in the ED setting of the Maggiore della Carità University Hospital in Novara, Italy, in the period from 1 January 2021 to 31 December 2023, to find out whether and how patients screening positive for alcohol/drugs differ from those screening negative. Socio-demographic and clinical history information and clinical data related to the ED psychiatric consultations were extracted from the PsNet database, a collection of data extracted from the application that serves as the electronic medical record for patients accessing the ED. Statistical analyses were performed using SAS 9.4 and STATA version 17 software. Chi-square/Fisher tests, t-tests, and both univariate and multivariate logistic models were employed. Most of the findings regarding socio-demographic characteristics, symptoms observed during the 1362 psychiatric consultations, and treatments received by a total of 922 patients in the ED were consistent with the literature on this topic. However, some results only partially aligned with previous studies, particularly concerning the higher frequency of anxiety and psychotic symptoms, as well as cognitive impairments, observed in consultations for patients who tested negative for alcohol or substances. Interpreting these findings is complex and raises important questions, which may be addressed more effectively by expanding the sample size (extending the research to other EDs) and analysing its characteristics in greater detail. In this regard, improving diagnostic methods for detecting substance use through laboratory tests would also be beneficial.

Juridical Analysis on Infrigement against Patients' Electronic Medical Records at Telemedicine Services Based on Indonesia Regulation

In order to guarantee privacy protection for the health sector, regulations are needed that can bring benefits, balance and legal certainty in securing medical record data and innovation in health services. This research aims to describe the pattern of legal relations in the provision of telemedicine services, the regulatory capabilities of the health and cyber sectors in Indonesia in preventing and enforcing leaks and misuse of patient electronic medical record data. Next, this article will outline the shortcomings in terms of normative, structural and legal culture in enforcing existing rules in Indonesia regarding electronic medical record data. This research is included in qualitative research with a statutory and conceptual approach. The research results show that electronic medical record data is part of human rights which must be protected and recognized as special property rights in terms of civil law. Legal protection for the confidentiality of patient data in Electronic Medical Records (RME) in Indonesia is well accommodated by a number of regulations, including the Personal Data Protection Law, Minister of Health Regulation on RME, and the Civil Code with fairly good and complementary harmonization between regulations. However, Obstacles are still found in enforcement such as a lack of clear boundaries and procedures for opening medical record data and reporting data leaks, the legitimacy of the authority of law enforcers who have the authority to take action and the public's low understanding of the importance of data protection on medical records.

Associations of social vulnerability index with patient-reported outcomes in women treated with chemotherapy for early-stage breast cancer.

In a convenience sample of women scheduled for chemotherapy for early-stage breast cancer, we investigated associations of the Center for Disease Control and Prevention's neighborhood-level social vulnerability index (SVI) with pretreatment demographics and patient-reported outcome (PRO) measures (health behavior, function and quality of life, treatment toxicities during chemotherapy). The SVI Overall score is comprised of 4 themes: socioeconomic, household composition, minority status/language, and household type/transportation, with scores ranging from 0 = lowest to 1 = highest vulnerability neighborhoods. Participant SVI scores were derived from zip codes listed in the patient's address within the electronic medical record (EMR). Associations of study variables with SVI were evaluated using Spearman correlation for continuous variables and Kruskal-Wallis tests for categorical variables. In a sample of 309 women, the mean age was 56 years (range 23-83) and 75% White. Greater vulnerability SVI Overall score was associated with lower education (P =.02), nonmarriage (P ≤.0001), higher body mass index (P =.03), and prechemotherapy PRO measures such as fewer self-reported walking minutes/week (P ≤.001), history of smoking (P =.02) and alcohol use (P < .001), depression (P =.01), and lower emotional social support (P =.008). During chemotherapy, moderate, severe, or very severe symptoms were associated with greater vulnerability SVI Overall scores for hot flashes (P =.03), arthralgia (P =.02), myalgia (P =.02), peripheral neuropathy (P =.01), edema of limbs (P =.04), and nausea (P <.001). SVI scores derived from addresses in the patient's EMR can be used to generate information that adds to the patient's social history in ways that are informative for anticipating and monitoring chemotherapy-related toxicities.

Mapping Implementation Strategies to Address Barriers to Pre-Exposure Prophylaxis Use Among Women Through POWER Up (Pre-Exposure Prophylaxis Optimization Among Women to Enhance Retention and Uptake): Content Analysis.

Black cisgender women (hereafter referred to as "women") experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient). This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool. We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women. Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization. Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, "POWER Up") to improve PrEP uptake among women. RR2-10.1371/journal.pone.0285858.

Improving Access to Community-Based Services for Sexual Assault Survivors.

Emergency department (ED) encounters are often the only healthcare provider encounter for patients seeking care after a reported sexual assault (SA), making the encounter a crucial opportunity to connect patients to support services in the community. An opportunity existed at an urban Level II trauma center to standardize SA discharge planning. This quality improvement project aimed to improve access to SA support services. The Model for Improvement guided two plan-do-study-act (PDSA) cycles. Implementation included (a) creation of a QR-code-accessible SA resource website, (b) ED standardized patient print and electronic medical record after-visit summaries with follow-up guidelines and the QR code, (c) ED staff education, and (d) a community stakeholder survey to assess facilitators and barriers to support services. During the first PDSA cycle, 19 reported SA survivors were seen in the ED (18 adult, one pediatric) and 14 SA resource website visits. During the second PDSA cycle, 13 reported SA survivors (10 adult, three pediatric) were seen in the ED and 29 website visits. Stakeholder survey data revealed barriers to support services were transportation, overloaded support services, and survivor knowledge of existing services. The QR code intervention model is a discrete method of improving access to resources and is applicable to other vulnerable populations. The multiagency SA response team will utilize partner survey data to improve access to community resources such as housing and transportation.

Differences in Symptom Burden in Primary Brain Tumor Patients Based on Sex, Race, and Ethnicity: a Single-Center Retrospective Study.

Symptom burden affects quality of life and prognosis in primary brain tumor (PBT) patients. Knowing whether symptom burden varies based on sex, race, or ethnicity may affect the interpretation of the relationship between symptoms and survival may reveal issues with applying the tools to measure symptom burden to different groups and may identify inequities in symptom management that need to be addressed at a system level. To determine whether symptoms in PBT patients vary across demographic groups, we conducted a retrospective chart review of symptom burden collected as part of routine care in a diverse population. Patient demographics and scores on the MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT) module were extracted from the electronic medical record for patients seen in the Inova Neuro-oncology Clinic between March 2021 and June 2022. MDASI-BT scores were compared based on side of tumor, sex, race, and ethnicity for the entire population and for the subset with gliomas. We included 125 people, of whom 85 had gliomas. For both the entire group and the subgroup with gliomas, about 40% were female and about 40% were non-White race. No differences in symptom burden were seen between males and females. Pain and numbness/tingling symptom burden were higher in both the entire population and the glioma subgroup for people of Hispanic/Latino/Spanish ethnicity and for people of races other than White or Middle Eastern self-identification. Pain, weakness, and numbness/tingling varied significantly across racial and ethnic groups. Further research is needed to validate this finding in other populations and determine its cause.

Development of a novel multipoint traction device for gastric and colorectal endoscopic submucosal dissection and evaluation of its efficacy and safety.

Proper traction allows safer and easier endoscopic submucosal dissection; however, single-point traction may not be sufficient. In this study we assessed the safety, efficacy, and feasibility of our newly developed multipoint traction device. During an ex vivo study using a Konjac training model, two experts and two trainees resected 80 mock lesions of 20-mm diameter by performing endoscopic submucosal dissection with and without multipoint traction. The primary outcome was the success rate of the procedure involving traction. The secondary outcomes were the submucosal dissection time, dissection speed, and perforation during endoscopic submucosal dissection. During the in vivo study, to clarify the initial clinical outcomes, we used data from the electronic medical record of patients at our institution who underwent gastric and colorectal endoscopic submucosal dissection, which was performed by experts with our newly developed multipoint traction device, from March to December 2022. The ex vivo study indicated that all traction procedures were successful. Higher resection speeds were observed with endoscopic submucosal dissection with traction than without traction (P < 0.001). Perforations were not observed. During the first in vivo clinical study, traction was feasible during 20 gastric and colorectal endoscopic submucosal dissection procedures. No adverse events occurred. Our multitraction device can increase the submucosal dissection speed and simplify endoscopic submucosal dissection techniques, thus safely reducing technical challenges. The application of this device for endoscopic submucosal dissection could lead to safer and more efficient procedures. Clinical registration UMIN Clinical Trials Registry, Japan (registration number UMIN000053384).

Endobiogenic Biology of Function Indices in a Cohort of Kidney Transplant Recipients.

Background and Objectives: Endobiogeny is a global systems approach to human biology based on the concept that the endocrine system manages the metabolism. Biology of function (BoF) indices are diagnostic tools in endobiogenic medicine that reflect the action of the endocrine system on the cells and the metabolic activity of an organism. Kidney transplant recipients are a very specific patient population due to their constant use of immunosuppressive agents such as steroids and anamnesis of chronic kidney disease. The aim of this study was to assess the tendencies of endobiogenic BoF indices in a kidney transplant recipient population and to determine the relationship between BoF index values and histology-proven kidney transplant rejection. Materials and Methods: A total of 117 kidney transplant recipients undergoing surveillance or indication allograft biopsy were included in this study. Endobiogenic BoF indices were calculated from complete blood count tests taken before the kidney biopsy. Histology samples were evaluated by an experienced pathologist according to the Banff classification system. Clinical and follow-up data were collected from an electronic patient medical record system. Results: Overall, <35% of the patients had BoF index values assumed to be normal, according to the general population data. Additionally, >50% of the patients had lower-than-normal adaptation, leucocyte mobilization, genital, and adjusted genital ratio indices, while the Cata-Ana, genito-thyroid ratio, adrenal gland, and cortisol indices were increased in >50% of the transplant recipients. The adaptation index was significantly higher in patients with biopsy-proven transplant rejection and demonstrated an AUC value of 0.649 (95%CI 0.540-0.759) for discriminating rejectors from patients without transplant rejection. Conclusions: Most of the kidney transplant recipients had abnormal BoF index values, reflecting increased corticotropic effects on their cells. The adaptation index distinguished patients with biopsy-proven transplant rejection from those without it.

Impact of a multi-disciplinary team-based care model for patients living with diabetes on health outcomes: a mixed-methods study

BackgroundIndividuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centered approach to treating individuals with diabetes.MethodsSemi-structured interviews were conducted with staff (n = 15) and patients (n = 18). Clinical data were extracted from the electronic medical record of patients (n = 1,599) seen at a safety-net health system in Chicago, Illinois, United States. The mixed methods study was guided by implementation science and participatory research principles. Staff interviews were 60 min and covered patient care activities, work flow, perceived patient experience, and facilitators/barriers to care coordination. Patient interviews were 60 min and covered satisfaction, attitudes about diabetes management, quality of life, and technology. Patient interviews were co-analyzed by research staff and members of a patient advisory committee. Clinical data were collected at an index visit, two years prior and at one-year follow up (n = 1,599).ResultsFour themes emerged from the interviews: (1) patients perceived the TBC model to be patient centered and of high quality; (2) technology can be an innovative tool, but barriers exist; (3) diabetes management is a complex process; and (4) staff communication enhances care coordination, but misinterpreting roles reduces care coordination. From pre-enrollment to the follow-up period, we found a statistically significant increase in missed visits, decrease in hemoglobin A1c (HbA1c), decrease in body mass index, and decrease in the percent of patients with high blood pressure. We found that each medical visit during the follow-up period was associated with an HbA1c decrease of 0.26 points.ConclusionsA TBC model is a patient-centered approach to providing care to patients with complex health needs, such as diabetes, patients were satisfied with the care they were receiving, and the model was associated with an improvement in clinical outcomes.

Osteoporosis Management in Patients with Hip Fracture post Fall

Introduction: Osteoporosis increases the risk of fragility fracture. Hip fractures are associated with poor outcomes. Men are under-screened and under-treated for osteoporosis, which tends to be secondary, and men have higher mortality and worse outcomes after hip fracture than do women. This study aimed to describe patients admitted with hip fracture following minimal trauma and to explore any gender differences in calcium and vitamin D deficiency and use of osteoporosis medication before admission. Methods: A retrospective cross-sectional study included all patients admitted to Bankstown-Lidcombe Hospital with a fracture of the hip post fall, with or without surgery, from January 1, 2019, to December 31, 2019. Each patient's electronic medical record was reviewed to collect data. The data were extracted and analysed using GraphPad Prism 9.5.1. Unpaired Student's t-tests and Fisher's exact test were used in the analysis. Results: A total of 203 patients were included with a mean age of 83.5 ± 8.8 years and a range of 40 to 103 years, with over half (51.2%) aged 81 to 90 years. Fifty-nine (29.1%) were male. Of 196 patients with vitamin D levels available, 78 (39.8%) had a deficiency, including 30 of 57 (52.6%) males and 48 of 139 (34.5%) females. Males were twice as likely to be vitamin D deficient as were females on admission (OR 2.106; 95% CI 1.143 to 3.939; p = 0.0243). Of 203 patients, 39 (19.2%) were on osteoporosis treatment before admission, including 6 of 59 (10.2%) male and 33 of 144 (22.9%) female patients. Males were 2.6 times more likely to have had no osteoporosis treatment before admission than were females (OR 2.626; 95% CI 1.059 to 6.340; p = 0.0486). Conclusions: Males were more likely to have vitamin D deficiency and not be prescribed osteoporosis medication before admission in a cohort of patients admitted to the hospital with hip fracture post minimal trauma. To prevent hip fracture and resultant hospitalization, increased awareness is needed in diagnosing and managing osteoporosis in men, ideally occurring in the community.

IUD Insertion Under Conscious Sedation: Patient Characteristics with Clinical Decisions

Study ObjectiveUptake of intrauterine devices (IUDs) in the adolescent population may be limited by anxiety and pain anticipated during the insertion procedure. Our institution offers conscious sedation for IUD insertion to mitigate this concern. The objective of this study was to identify characteristics and outcomes of teens choosing between two types of conscious sedation for insertion of a levonorgestrel IUD. MethodsThis was a single-site, retrospective cohort study over a one-year period reviewing the electronic medical record of patients who had an attempted IUD insertion using conscious sedation. Conscious sedation included nitrous gas (termed “light” sedation) or intravenous midazolam and fentanyl (termed “moderate” sedation). Patient demographics, medical and gynecological histories were analyzed. ResultsThere were 69 attempted IUDs insertions during the study period. Most (75.36%) were placed under light sedation, and 92.75% were successfully inserted. The only significant factor associated with choice in type of conscious sedation was prior sexual activity, which increased odds by 10.0 that they would choose light sedation (95% CI 1.23 – 81.34, p=0.031). Differences between other factors (age, history of sexual assault, tampon use, and gender identity) were not statistically significant between successful and failed insertions. ConclusionsIn conclusion, a history of sexual activity significantly differed between patients in our cohort who selected light sedation over moderate sedation. No other factors influenced choice in sedative or success of IUD insertion. Knowing the characteristics of patients who choose nitrous versus IV sedation, and how it relates to successful insertion, may help guide pre-procedural counseling for patients regarding sedation for IUD insertion.

Trauma in the lives of parents experiencing severe perinatal mental illness.

The perinatal period is a time of 'high risk' for new and recurrent episodes of mental illness with 0.1-0.2% of birthing parents requiring admission to specialist mental health units in the months after birth. The prevalence and role of trauma in the lives of birthing parents (most commonly mothers) experiencing severe perinatal mental illness is not well known. In a new perinatal mental health unit in Sydney Australia, a retrospective audit of trauma prevalence was undertaken using patient completed questionnaires and electronic medical record data. Descriptive analysis was undertaken. Prevalence of trauma in the lives of mothers with severe mental illness was found to be higher than that reported in general or community mental health settings, with 76% of mothers reporting lifetime trauma exposure and 24% meeting criteria for complex PTSD. The majority reported trauma experiences likely to impact attachment and also reported difficulties in responding to their infants' cues and needs. The findings suggest a need for more research, awareness, and consideration of the role of trauma in experiences of perinatal mental illness, with implications for developing trauma informed models for responding to parental mental illness.

Redesigning Diabetes Care for Treatment Inertia: A Population Health Model.

In the past 2 decades, health care has witnessed technological and pharmacological advancements leading to innovations in diabetes management. Despite these advances, published guidelines, and treatment algorithms, most people with diabetes remain above glycemic targets. Thus, the authors designed a novel care model aimed at improving several causative factors, including therapeutic inertia, limited access to endocrinology and cardiovascular specialists, time constraints, and complexity in incorporating clinical practice guidelines. The model involves collaboration between the diabetes specialty team and primary care providers (PCPs). The intervention reviewed uncontrolled diabetes data and the patient's electronic medical record (EMR) and sent personalized, evidence-based recommendations to the provider using the task function in the EMR. Other services (eg, diabetes education) were utilized to optimize patient care to achieve optimal glycemic targets and address cardiometabolic risk. The overall mean hemoglobin A1c (HbA1c) decreased pre-post intervention by almost 1%, and 52.1% (347 of 666) of the cohort had ≥-0.5% change in HbA1c post-intervention. All pathways exhibited a decrease in HbA1c. Team-based approaches to managing diabetes patient care were the most effective. The interventions effectively utilized the resources across the health system without placing additional load or burden on primary care or diabetes specialty care teams. In the future, the authors hope to address the limitations of the current gap caused by increasing diabetes numbers, decreasing availability of PCPs and endocrinologists, and fee-for-service models using the innovative specialty consultant-primary care connection and knowledge exchange offered by this novel model, which can only be sustained with payer's support.

Abstract 559: Investigating DDX3X as a target to improve outcomes in Black and Native American endometrial cancer patients

Abstract Introduction: The goal of this project was to identify and test a new molecular target that will help reduce the worse outcomes of endometrial cancer, especially in Black and Native American patients. Endometrial cancer is rapidly on the rise in the developed world. It has overtaken many other types of cancer in both incidence and mortality. Black populations are disproportionately impacted by endometrial cancer, both in Oklahoma and across the United States. In Oklahoma specifically, Native Americans are the most heavily impacted group. Methods: Machine learning techniques were used to analyze comprehensive metabolic panel (CMP) data from electronic medical record of patients in the University of Oklahoma (OU) network of hospitals and clinics. This data was broken down by endometrial cancer status, race, and age. Plasma samples of endometrial cancer patients were collected from the OU Health Sciences Center Biobank. These samples were analyzed by mass spectrometry. Endometrial cancer cell lines Ishikawa (low-grade) and ARK-1 and ARK-4 (high grade) were cultured in EMEM. For treating the cells, we used RK-33, a small molecule inhibitor of DDX3X. MTT assays were performed in 96-well plates at increasing concentrations of RK-33 for 48 hours. Western blots were used to determine effect of the drug on cellular DDX3X and yH2AX protein levels. Results: Machine learning analysis EMR data revealed a difference between races in albumin levels of women with endometrial cancer. Black and Native American patients had lower albumin, which is known to correlate to worse outcomes. IPA analysis of plasma proteomics revealed several proteins that were differentially expressed between races. Among these was DDX3X, the X-linked form of DDX3, a DEAD-box RNA helicase which is involved in DNA damage repair. Patient data indicated that patients with high DDX3X expression tended to have lower survival rates. MTT analysis determined that Ishikawa has a lower IC50 than the high-grade cell lines, but all responded. Western blotting confirmed that treatment with RK-33 reduced the amount of DDX3X in the cells and increased y-H2AX, indicating more DNA damage. Conclusions: This study demonstrates that DDX3X is a valid molecular target in endometrial cancer. The differential expression across race groups indicates that Black and Native Americans may stand to benefit the most from a novel drug targeting this difference. Because DDX3X is involved in DNA damage repair, combining the treatment with a DNA-damaging drug may increase response to the drug as well. Citation Format: James D. Lausen, Doris M. Benbrook. Investigating DDX3X as a target to improve outcomes in Black and Native American endometrial cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 559.

Nurse-Led Cardiac Rehabilitation Care Coordination Program: Improving Functional Outcomes for Patients Through Automatic Referral and Effective Care Coordination.

The aim of this investigation was to evaluate the impact of automated cardiac rehabilitation (CR) referral and nurse care coordination on patient and program outcomes. Specifically, the aim was to identify whether differences exist in physical and psychological function at CR Phase 2 enrollment and completion and CR Phase 2 participation and completion for hospitalized patients who receive in-person CR nurse visits versus phone consultation. Using a retrospective pre-/post-intervention descriptive design, a purposive sampling technique was used to select groups with matching clinical attributes. Dates were selected to mitigate the impact of COVID-19 on CR program enrollment and completion. Data were abstracted from the patient electronic medical record, telemetry documentation, and CR referral tracking tool. Patient descriptors included age, sex, cardiac diagnosis/procedure (post-coronary artery bypass graft surgery, myocardial infarction, percutaneous coronary intervention, heart failure, and aortic valve repair and replacement) and cardiac risk stratification category. Patient functional outcomes included the 6-min walk test and metabolic equivalents of task levels for functional capacity; psychological function was measured by the Patient Health Questionnaire assessment. Program outcomes included discharge to CR Phase 2 enrollment, CR sessions, and completion. Each group had 52 patients. Age was 64 ± 12yr, 68% were male. Perhaps indications for CR included coronary artery bypass graft surgery (44%), myocardial infarction (19%), percutaneous coronary intervention (20%), heart failure (10%), aortic valve repair and replacement (8%). Cardiac risk was low in 30%, intermediate in 65%, and high in 5%. The post-intervention group compared with the pre-intervention group had a shorter discharge to CR Phase 2 enrollment (35 ± 18 d vs 41 ± 28 d, P = .078) and significantly fewer sessions required for CR completion. Automated CR referral and nurse care coordination visits for hospitalized patients decreased the transition period between CR Phase 1 and 2. Patients were physically and psychologically prepared for earlier CR Phase 2 enrollment and successfully completed the program in fewer days than the pre-intervention group.