Hospital Information System Research Articles

The Use of ICD-9-CM Coding to Identify COVID-19 Diagnoses and Determine Risk Factors for 30-Day Death Rate in Hospitalized Patients in Italy: Retrospective Study.

In Italy, it has been difficult to accurately quantify hospital admissions of patients with a COVID-19 diagnosis using the Hospital Information System (HIS), mainly due to the heterogeneity of codes used in the hospital discharge records during different waves of the COVID-19 pandemic. The objective of this study was to define a specific combination of codes to identify the COVID-19 hospitalizations within the HIS and to investigate the risk factors associated with mortality due to COVID-19 among patients admitted to Italian hospitals in 2020. A retrospective study was conducted using the hospital discharge records, provided by more than 1300 public and private Italian hospitals. Inpatient hospitalizations were detected by implementing an algorithm based on specific International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code combinations. Hospitalizations were analyzed by different clinical presentations associated with COVID-19 diagnoses. In addition, 2 multivariable Cox regression models were performed among patients hospitalized "due to COVID-19" from January 1 to December 31, 2020, to investigate potential risk factors associated with 30-day death and the temporal changes over the course of the pandemic; in particular, the 30-day death rates during the first and the second waves were analyzed across 3 main geographical areas (North, Center, and South and Islands) and by discharge wards (ordinary and intensive care). We identified a total of 325,810 hospitalizations with COVID-19-related diagnosis codes. Among these, 73.4% (n=239,114) were classified as "due to COVID-19," 14.5% (n=47,416) as "SARS-CoV-2 positive, but not due to COVID-19," and 12.1% (n=39,280) as "suspected COVID-19" hospitalizations. The cohort of patients hospitalized "due to COVID-19" included 205,048 patients, with a median age of 72 years and a higher prevalence of male patients (n=124,181, 60.6%). The overall 30-day death rate among hospitalized patients due to COVID-19 was 9.9 per 1000 person-days. Mortality was lower for women (hazard ratio [HR]=0.83; P<.001) and for patients coming from high migration pressure countries, especially Northern Africans (HR=0.65; P<.001) and Central and Eastern Europeans (HR=0.66; P<.001), compared to patients coming from Italy and high-income countries. In the southern regions and the Islands, mortality was higher compared to the northern regions (HR=1.17; P<.001), especially during the second wave of COVID-19 among patients with a transfer to intensive care units (HR=2.52; P<.001). To our knowledge, the algorithm is the first attempt to define, at a national level, selection criteria for identifying COVID-19 hospitalizations within the HIS. The implemented algorithm will be used to monitor the pandemic over time, and the patients selected in 2020 will be followed up in the next years to assess the long-term effects of COVID-19.

Prevalence of inappropriateness of elemene injection for hospitalized cancer patients: a multicenter retrospective study.

Background: Elemene injection could provide clinical benefit for the treatment of various cancers, but the clinical evidence is weak. Thus, its wide use in China has raised concerns about the appropriateness of its use. Methods: This was a multicenter retrospective study to evaluate the prevalence of inappropriateness of elemene injection for hospitalized cancer patients. Patients who met the inclusion criteria were retrospectively included, and demographic characteristics were extracted from the hospital information systems. The inappropriateness of elemene injection use was assessed using the preset criteria, and the prevalence was calculated. Multivariate logistic analysis was applied to identify any factors associated with inappropriate use. Results: A total of 275 patients were included in the analysis. The median age was 62years, and 30.9% were females. The most common cancer was lung cancer (24.0%), and 68.2% of the patients were receiving chemotherapy. The overall prevalence of inappropriateness was 61.8%. The most common reason for inappropriateness was inappropriate indications, and the second was inappropriate doses. Age and oncological department were significant risk factors associated with inappropriate use, while lung cancer, liver cancer and admission to cardiothoracic surgery were associated with a low risk of inappropriate use. Conclusion: The prevalence of inappropriateness among hospitalized elemene injection users was high. More efforts, especially those to improve the appropriateness of indications, should be made to improve the rational use of elemene, as well as other complementary medicines. Physicians should take caution to avoid inappropriate use when prescribing drugs with limited clinical evidence.

Diagnostic Accuracy Study of Direct and Formula Based Method for Estimation of LDL Cholesterol

Introduction: Increased LDL-C is a well-known risk factor for cardiovascular disease. Also, LDL-C is used for risk stratification and in planning appropriate treatment. This requires the accurate measurement of LDL-C. Though β quantification is the reference method for LDL-C estimation it can’t be used routinely. Even though homogenous assays are available, some clinical laboratories use the Friedewald formula, which has its disadvantages. Aim &amp; Objectives: To identify which LDL-C formula best correlates with direct LDL-C among various levels of TG. Study Design: A retrospective diagnostic accuracy study. Materials and Methods: Complete lipid data of 15,094 was obtained from the hospital information system. Based on TG level data, it was grouped into TG &lt;100 mg/dl (N=6022) and TG 100-200 mg/dl (9072). Direct homogenous assay was used to measure LDL-C. LDL-C was calculated using seven formulae (Friedewald, Hattori, de Cordova, Vujovic, Anandaraja, Chen, and Sampson). Results: Correlation between direct and formula-based LDL-C by ICC showed maximum correlation by Vujovic (0.978). Bland Altman plot between Vujovic and the direct method shows a bias of -0.38 and it may overestimate or underestimate by 23 mg/dl. Conclusion: LDL-C calculated using Vujovic showed maximum correlation with direct homogenous assay when TG &lt;200 mg/dl.

Sistem Pengendalian Internal Penerimaan Kas Studi Kasus pada Rumah Sakit ABC

This study aims to evaluate the internal control system for cash receipts at ABC Hospital by comparing it with the framework proposed by the Committee of Sponsoring Organizations (COSO). Good internal control is considered crucial for a company to achieve its goals and maintain the security of its cash assets. A qualitative research method with a comparative descriptive approach was used, with primary data collected through observation. The results of the observation analysis show that although internal control over cash receipts at ABC Hospital is effective, there are several aspects that need improvement, such as the need for written procedures and official policies regarding cash receipts and disbursements. In addition, problems occur in processing information and documents when there is a power outage or an error in the hospital management information system. Conclusion, that certain improvements are needed to ensure the efficiency and security of the cash receipts internal control system. Keywords: Cash Receipts, Internal Control System, Accounting Information System

Epidemiology, clinical profile, and outcomes of CSF-diversion catheter-related infections – Prospective cohort study results from a single quaternary neurosurgery referral centre

BackgroundDevice-associated CNS infections is a major subgroup of healthcare associated CNS infections. Healthcare-associated ventriculitis or meningitis differs considerably from community-acquired meningitis in its epidemiology, pathogenesis, clinical presentation and management. ObjectivesThis study aimed to identify the infection rates, the associated risk factors, and outcomes of these life-threatening infections. MethodsThis was a 2-year single center prospective cohort study. Patient's clinical data, laboratory parameters, treatment and their outcomes were collected using data collection tool, and device days were collected from the hospital information system (HIS). Patients were categorised using IDSA criteria as contamination or colonisation or infection. Cox regression model was used for multivariate analysis to estimate hazard risk. ResultsA total of 578 CSF diversion catheters were inserted in 472 patients. The average rate for EVD and LD infection were 11.12 and 11.86 per 1000 device days respectively. The average infection rates for VP and LP shunts were 6% and 5.2% per procedure, respectively. The commonest etiological agent causing CSF diversion catheter-related infection (CDRI) was Klebsiella pneumoniae (n = 14, 40%). The risk factors which were independently associated with increased infection risk by cox regression analysis were drain insertion ≥7 days [HR:11.73, p −0.03], posterior approach of EVD insertion (occipital) [HR:9.53, p - 0.01], pre-OP ASA score>3 [HR:8.28, p - 0.013] presence of EVD/LD leak [HR: 17.24, p < 0.0001], male gender [HR:2.05, p-0.05] and presence of associated peri-operative scalp infections [HR:3.531, p-0.005]. Shift to narrow spectrum surgical prophylactic antibiotic [Coefficient: −1.284, p-0.03] and reduction in CSF sampling frequency [Coefficient: −1.741, p-0.02] were found to be negatively associated with CDRI. ConclusionsThe study demonstrated drain insertion ≥7 days, posterior approach of EVD insertion, presence of EVD/LD leak, male gender and presence of associated peri-operative scalp skin and soft tissue infections were associated with increased risk of infection.

Blood transfusions per hospitalization in the local public health network of Belo Horizonte between 2008 and 2021: A time series analysis

Background: Blood transfusion rates are increasing worldwide. This work was a longitudinal retrospective study conducted with data referent to the use of blood components between January 2008 and December 2021 in the local public health network of Belo Horizonte, Minas Gerais, at Hospital Risoleta Tolentino Neves (HRTN), Hospital Metropolitano Dr. Célio de Castro (HMDCC), and Hospital Metropolitano Odilon Behrens (HMOB). Objective: This study sought to describe the time series of the number of blood transfusions and blood transfusion rates per general hospitalization through a time series analysis. Methods: Through data from the Hospital Information System of the Unified Health System (HIS-SUS), this study formulated six monthly time series of the number of blood transfusions and blood transfusion rates per hospitalization. The stationarity, trend, and seasonality of the time series were verified by the unit root test, using the Mann-Kendall and the Fisher tests, respectively. The normality hypothesis of the data was verified by the Shapiro-Wilk test. All of the statistical tests considered a significance level of 5%. Results: The average monthly blood transfusion rates per hospitalization observed in this study were 45.5%, 26.9%, and 26.3% at HRTN, HMDCC, and HMOB, respectively. The highest decrease in the number of blood transfusions was observed at HMDCC and the highest decrease in blood transfusion rates was observed at HRTN. Packed red blood cells were the most commonly used blood component at HRTN, HMOB, and HMDCC (54.6%, 58.3%, and 65.4%, respectively). The time series showed that they were non-stationary, with a downward trend and the presence of a 12-month seasonal component. Conclusion: The decline in the number of blood transfusions should be considered a positive phenomenon in public health due to best use and quality management, since a decrease in blood donation rates was also observed.

A real-world study on the features of postpartum hepatitis flares in pregnant women with chronic HBV infection

Objective: To analyze the clinical features of postpartum hepatitis flares in pregnant women with hepatitis B virus (HBV) infection. Methods: A retrospective study was conducted. Patients who met the enrollment criteria were included. Liver function and HBV virology tests were collected from pregnant women with chronic HBV infection at delivery, 6, 24, 36, and 48 weeks after delivery through the hospital information and test system. Additionally, antiviral therapy types and drug withdrawal times were collected. Statistical analysis was performed on all the resulting data. Results: A total of 533 pregnant women who met the inclusion criteria were included, with all patients aged (29.5±3.7) years old. A total of 408 cases received antiviral drugs during pregnancy to interrupt mother-to-child transmission. There was no significant difference in the levels of alanine aminotransferase (ALT, z = -1.981, P = 0.048), aspartate aminotransferase (AST, z = -3.956, P < 0.001), HBV load (z = -15.292, P < 0.001), and HBeAg (z = -4.77, P < 0.001) at delivery in patients who received medication and those who did not. All patients ALT, AST, total bilirubin, direct bilirubin, and albumin showed an upward trend within six weeks after delivery. A total of 231 cases developed hepatitis within 48 weeks after delivery. Among them, 173 cases first showed ALT abnormalities within six weeks postpartum. Conclusion: Hepatitis flare incidence peaked six weeks after delivery or six weeks after drug withdrawal in pregnant women with chronic HBV infection.

Germline RECQL gene mutations in Chinese patients with breast cancer.

Breast cancer is the most common malignant tumor in women, seriously threatening health and survival. TP-dependent DNA helicase Q1 (RECQL) is a breast cancer susceptibility gene with possible familial links. However, RECQL gene mutations among Chinese women with breast cancer have not been evaluated. Therefore, this study assessed RECQL mutations and their relationships with clinicopathological and epidemiological characteristics in Chinese women with breast cancer. Clinical information was also obtained via the hospital information system and a follow-up questionnaire. Peripheral venous blood (2 mL) was extracted from all patients and stored at -80°C for future use; the early venous blood samples were from our hospital's sample bank. RECQL gene sequencing were performed by the Shanghai Aishe Gene Company (China). We found that a RECQL mutation is a susceptibility factor for breast cancer. Moreover, patients with RECQL mutations were more likely to have a family history of breast cancer than those without. Also, patients with RECQL variants of uncertain significance (VUS) were less likely to develop invasive ductal carcinoma than those without. In addition, unexplained RECQL mutations occurred more often in patients with human epidermal growth factor receptor 2+ breast cancer than in those with other subtypes. These results provide a basis for creating screening criteria specific to Chinese women. However, the frequency of RECQL mutations was low, and the number of pathogenic mutations was too small and could not be analyzed. Thus, more extensive, long-term studies that include other functional experiments are needed to verify these results.

Health professionals' perceptions of the development needs of incident reporting software: A qualitative systematic review.

To systemically identify and synthesize information on health professionals' and students' perceptions regarding the development needs of incident reporting software. A systematic review of qualitative studies. A database search was conducted using Medline, CINAHL, Scopus, Web of Science and Medic without time or language limits in February 2023. A total of 4359 studies were identified. Qualitative studies concerning the perceptions of health professionals and students regarding the development needs of incident reporting software were included, based on screening and critical appraisal by two independent reviewers. A thematic synthesis was conducted. From 10 included studies, five analytical themes were analysed. Health professionals and students desired the following improvements or changes to incident reporting software: (1) the design of reporting software, (2) the anonymity of reporting, (3) the accessibility of reporting software, (4) the classification of fields and answer options and (5) feedback and tracking of reports. Wanted features included suitable reporting forms for various specialized fields that could be integrated into existing hospital information systems. Rapid, user-friendly reporting software using multiple reporting platforms and with flexible fields and predefined answer options was preferred. While anonymous reporting was favoured, the idea of reporting serious incidents with both patient and reporter names was also suggested. Health professionals and students provided concrete insights into the development needs for reporting software. Considering the underreporting of healthcare cases, the perspectives of healthcare professionals must be considered while developing user-friendly reporting tools. Reporting software that facilitates the reporting process could reduce underreporting. The ENTREQ reporting guideline was used to support the reporting of this systematic review. There was no patient or public contribution. The protocol is registered in the International Prospective Register of Systematic Reviews with register number CRD42023393804.

Exploring generative AI's role in alleviating nursing workload and burnout in Taiwan

The Taiwanese healthcare system, strained with increasing nursing workloads and burnout amplified by the pandemic, turns to Generative AI (GAI) for potential solutions. GAI, particularly through advanced language models, marks a shift from data analysis to content creation, thereby transforming patient care and improving efficiency. Central to this innovation is “A + Nurse,” a digital assistant streamlining nursing tasks and securing data. GAI's integration with hospital information systems can play a crucial role in reducing nursing workloads and burnout. While integrating GAI involves challenges like continuous adaptation and ethical considerations, its potential in elevating patient care and healthcare delivery is immense. Taiwan's adoption of GAI in nursing may signify a pivotal step towards a more effective, patient-centric healthcare model. (118 words).

New trends associated with disease activity in patients with ulcerative colitis

Background/Aim: The severity and extent of ulcerative colitis (UC) guide us in determining the treatment method for each case. It has been suggested in the literature that high neutrophil-lymphocyte and platelet-lymphocyte ratios can serve as markers of active ulcerative colitis. This study retrospectively analyzes the relationship between neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with clinical activity indices and endoscopic activity indices in predicting disease severity in patients with ulcerative colitis. There are few studies in the literature regarding the relationship between platelet-lymphocyte ratio (PLR) and disease activation in ulcerative colitis. This study contributes to the follow-up and outcomes of these patients, as there is a lack of sufficient retrospective studies on the platelet/lymphocyte ratio in patients diagnosed with UC in our country and worldwide. Methods: This study is a population-based, single-center, case-controlled study. It was conducted by retrospectively analyzing the hospital information system for data recorded during the routine diagnosis and treatment of ulcerative colitis patients followed and treated at Celal Bayar University Medical Faculty Gastroenterology Division between January 2014 and December 2021. A total of 135 patients with ulcerative colitis were included in the study. The patients were divided into 2 groups, active disease and disease in remission, based on clinical activity indices and endoscopic activity indices. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), hemoglobin (Hb), white blood cell (WBC), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) levels were checked during routine follow-up of patients with ulcerative colitis. These values were recorded at the first presentation to the hospital and 3 months after treatment. Results: Laboratory values at presentation were compared with those at the third month of treatment in a group of 113 patients with UC in remission: NLR (5.529 (3.485) and 4.374 (2.335), [P&lt;0.001]), erythrocyte sedimentation rate (26.81 (20.42) and 21.78 (19.32), [P=0.015]), C-reactive protein (4.087 (6.729) and 1.696 (3.525), [P&lt;0.001]), and white blood cell count (9,864 (3,514) and 8,067 (1,927), [P&lt;0.001]) were found to be lower than the baseline values. As expected, decreases in inflammatory markers were observed in patients in remission. In a group of 22 patients with active disease, values at presentation were compared with those at the third month of treatment: neutrophil count (8,508 (2,908) and 9,646 (3,265), [P=0.037]) and platelet count (289,591 (95,123) and 323,364 (127,647), [P=0.010]) were found to be high. Similarly, ESR (19.63 (15.43) and 27.89 (21.11), [P=0.036]) was found to be high. These values were higher in active disease compared to the time of admission. Conclusion: In our study, neutrophil-lymphocyte ratios and platelet-lymphocyte ratios were significantly higher in patients with active ulcerative colitis. The level of inflammatory markers in ulcerative colitis patients at the time of diagnosis and in the early stages of the disease is helpful in predicting the course of the disease, and this was shown to be related to clinical, endoscopic, and laboratory indices. These inflammatory markers can predict disease activity alone or in combination. However, a threshold value could not be calculated due to the insufficient number of patients, and thus, more comprehensive prospective studies are needed.

FINANCIAL STATEMENT ANOMALY DETECTION BASED ON BENFORD LAW AND BENEISH MODEL: CASE OF A PUBLIC SECTOR HOSPITAL

Public financial management reforms played an important role in the restructuring of social institutions and organizations. Researchers examined the effects of the reform according to their expertise. However, the research has focused on the results and the effects of the results rather than focusing on the starting point of the actions of the main actors who are the source of knowledge. In our research, first of all, the social life world of a public hospital was schematized. The hospital information management system (HIS) data, where the main actor actions are recorded at the starting point of the information source, was accessed and the accuracy of these data was analyzed with Benford’s Law, which can be considered as data mining. There are two databases (subsystems) in the public hospital where sales revenues are tracked. These are HIS and uniform accounting system (UAS). The information produced in HIS consists of unstructured data. By structuring this data with accounting information, HIS financial statement variables were created. Logit analysis, which is considered one of the machine learning techniques, was performed using the HIS financial statement variables and the existing UAS financial statement variables Beneish Model. It was found that there is a statistically significant difference between HIS financial statements and UAS financial statements. It is argued that this difference can be eliminated by using accounting language (accounting coding system).

Evaluasi Penerapan Sistem Informasi Manajemen Rumah Sakit (SIMRS) dengan Metode Hot Fit di RSU Mitra Sejati Medan

The Hospital Information System (SIMRS) is a system that integrates the collection, processing, reporting and use of data information needed to increase the efficiency and effectiveness of health services through better management at various levels of health services. The purpose of this research is to evaluate the implementation of the hospital management information system (SIMRS) at Mitra Sejati General Hospital with the Human Organization Technology (HOT) Fit Model method. The type of research used in this research is qualitative research with the Hot-Fit model method. The results of this study are that when viewed in terms of the human aspect, it is still not optimal, there are still many obstacles that occur in the field including the absence of an RME obligation, The organizational aspect is good, the hospital management has conducted training and is always holding retraining. The technological aspect is satisfactory enough for HR. Another obstacle that often occurs is related to the discipline of human resources for data input that is not in real time, SIMRS which is applied at Mitra Sejati General Hospital still has application deficiencies, the hospital management does not provide support in the form of repairs or strengthening the hospital network. Suggestions for hospitals need to develop medical records, HR discipline, develop existing SIMRS and improve network constraints.

Clinical Characteristics of Patients with Hematologic Malignancies and Invasive Aspergillosis: A Cross-sectional Clinical Report from Iran

Background: The incidence of invasive aspergillosis (IA) has significantly increased in recent decades. In patients with hematologic malignancies (HM), IA is associated with higher mortality rates. Objectives: This study aimed to assess the clinical features of IA in patients with HM. Methods: In this retrospective study, we used the hospital information system (HIS) database to extract clinical and paraclinical characteristics of patients with various HMs who received a diagnosis of probable or proven IA during their hospitalization at Imam Khomeini Hospital Complex in Tehran, Iran, between March 2018 and March 2022. Results: After evaluating 350 patients with HM, 51 patients with IA (14.6%) were identified, of whom 40 cases (78.4%) were probable and 11 (21.6%) were proven. Among these, 34 individuals (66.7%) were male. The most common symptoms were fever (n = 23, 62.7%), cough (n = 20, 39.2%), and fever that did not respond to antibiotic therapy (n = 16, 31.4%). The most prevalent malignancies were AML (n = 28, 54.9%), ALL (n = 16, 31.4%), and lymphoma (n = 7, 13.7%). Out of the 51 patients with HM and IA, 48 (94.1%) had abnormal findings on chest CT scans, with the majority (n = 31, 72.1%) showing a nodule with a halo sign. Aspergillus flavus (n = 19/24, 79.2%) was the most commonly isolated species. Initially, patients received liposomal amphotericin B or caspofungin as empiric antifungal therapy, which was then switched to voriconazole once the diagnosis of IA was probable or proven. Eight patients (15.6%) died. Conclusions: Patients with HM presenting with fever and cough should undergo close monitoring for IA. A higher incidence of IA is observed in AML patients, and voriconazole could be considered as antifungal prophylaxis in HM patients. A. flavus is likely the most frequent cause of IA in Iranian patients with HM.

Antecedents of perceived usefulness on the use of electronic hospital management information systems

Research aims: This study aims to analyze the factors that influence SIMRS and examine the mediating effect of perceived ease of use on the factors that affect SIMRS. Design/Methodology/Approach: This explanatory research used a quantitative approach through survey methods. The population in this study was doctors practicing in the outpatient polyclinic of XYZ Hospital, totaling 80 doctors using the total sampling. Data collection techniques employed a scale and analyzed utilizing Smart Partial Least Square (PLS). Research findings: According to the research findings, all examined indicators were found to be positively and substantially correlated with perceived ease of use by the following variables: computer self-efficacy, trustworthiness, technological risk, facilitating conditions, and degree of openness. Although all but the degree of openness exhibited a significant correlation with perceived usefulness, the remaining indicators did not. In relation to perceived usefulness, all factors exhibited a positive and statistically significant association with perceived ease of use as a mediator.Practical and Theoretical Contribution/Originality: In terms of practical and theoretical contributions, these findings offer valuable insights for hospitals, emphasizing the importance of enhancing doctors' knowledge, openness, and confidence in adopting SIMRS technology. Recommendations offered include increasing computer literacy among doctors, mitigating risks associated with SIMRS, and improving access to healthcare services.Research limitation: In this case, the research limitation stems from the need to explore further additional characteristics, such as computer self-efficacy, trustworthiness, technological risk, facilitating conditions, and perceived ease of use, as they may impact perceived usefulness across various variables. Future research should expand its scope and population, employing comprehensive data collection techniques to maximize research outcomes.

Convalescent Plasma Therapy for The Management of Covid‐19: A Single Center Experience of Chhattisgarh State of Central India

The recent outbreak of the coronavirus disease 2019 (COVID19) pandemic has caused a rethinking of the efficacy of previous convalescent plasma transfusions. In hospitalized patients with COVID-19, convalescent plasma (CP) is being used as a treatment along with other supportive therapy. There is a contradictory data on the effectiveness of CP in reducing COVID-19-related mortality to date. To evaluate the efficacy and safety of CP on mortality reduction in patients with COVID-19 admitted in intensive care unit. This retrospective observational study was carried out on patients treated in our institute at Nava Raipur, Chhattisgarh, from 1st April-2020 till 31st December 2020. A total of 138 adult patients with moderate and severe COVID-19 requiring oxygen, were reviewed. Of these, 119 patients were admitted to the intensive care unit. Out of these, 44 moderate to severely symptomatic patients received CP as well as the best supportive treatment, while the remaining 75 received only the best supportive care as either they did not consent for CP therapy or could not arranged CP donors. The data was collected from the Hospital Management Information System and analyzed to assess the effectiveness and safety of CP as well as the demographic information of the patients encountered. In the overall group of 119 patients who were admitted to the ICU, 44 received CP along with best supportive care of which 9 patients could not survived (20.45%) and 75 received only the best supportive care of which 32 patients were died (42.60%). Mortality was significantly lower in plasma group (20.45% vs 42.60%; P=0.0159; OR=0.3455 95% CI: 0.1457 to 0.8196). Mean age of the patient population was 56 years in the plasma group and 61 years in the other group. 34 patients (28.6%) had comorbidities in the form of Diabetes and Thyroid disorders and 7 patients had malignancy. Average duration of ICU stay in the CCP group was 9.1 days while in the Non CCP arm it was 7.7 days. The mean threshold value of oxygen requirement at which the CCP tx was requested - 6.6 lit/min. The mean signal cut off value (SCO) by Vitros-ECi for COVID IgG antibodies in CCP eligible donors was 9.1 (manufacturers cut off value &gt;1.0). In the survival group of CCP recipient, the average SCO value was 8.8 while in the other group it was 9.4. Mild allergic reactions noted in two patients during the CCP transfusion, which were managed conservatively with transfusion halt and anti-histaminic. Our study concluded that the use of COVID convalescent plasma was associated with the reduced mortality in moderately symptomatic COVID-19 patients who needed O2 support. The beneficial effect was associated with multiple factors including both patient as well as plasma donor related factors. Further research into the mechanism of actions of CP in COVID-19 may help predict the good responders.

MAIN CAUSES OF HOSPITAL ADMISSIONS OF CHILDREN AND ADOLESCENTS AGED 0 TO 18 IN THE CITY OF CAMPINA GRANDE/PB, FROM 2020 TO 2022: A CROSS-SECTIONAL STUDY

Introduction: Pediatric diseases and their main causes of hospitalization are directly related to simple outpatient measures, sensitive to basic care. However, there were changes in the epidemiological and clinical scenario of hospitalizations for these diseases, with the advent of the covid-19 pandemic. Objective: To study the causes of hospital admissions for children and adolescents aged 0 to 18 years old and their evolution from 2020 to 2022, in the city of Campina Grande/PB. Methodology: This is a descriptive, cross-sectional and retrospective study, carried out with data obtained from the Hospital Information System (SIH), searching for the main causes of hospital admissions for children and adolescents admitted to pediatric reference services in Campina Grande. The variables used were biological characteristics (sex, age) and clinical characteristics (number of hospitalizations; length of stay; hospital discharge conditions; deaths). Results: The main cause of hospitalization in the group of pediatric diseases in the three years studied was pneumonia due to non-specific microorganisms (PNM), corresponding to 9.9% of hospitalization cases in 2020; 12.5% in 2021 and 15.8% in 2022. Another important highlight was lymphoid leukemia (ALL), which accounted for 2.6% of cases in 2020; 4.2% in 2021 and 4.3% in 2022. In the group of neonatal and infant diseases, the main causes of hospitalizations were disorders related to short-term pregnancy and low birth weight, represented by 10.3% of cases in 2020, 7.4% in 2021 and 6.4% in 2022. Discussion: The consequences of the pandemic were the progressive increase in the incidence of respiratory diseases, with the return of classes and exposure to viruses and bacteria, after isolation prolonged social. In addition to the progressive increase in the incidence of premature births, directly related to teenage pregnancy, considered a public health problem. And the incidence of ALL, which was underdiagnosed in 2020, as most resources were directed to the pandemic. Conclusion: the pandemic impacted pediatric epidemiology, increasing the number and profile of hospitalizations, mainly due to respiratory diseases and oncological diseases.

Impacts of national volume-based drug procurement policy on the utilization and costs of antihypertensive drugs in a Chinese medicine hospital: an interrupted time series analysis of 5138 patients.

Objectives: The study aimed to estimate the effects of National Volume-based Drug Procurement (NVBP) policy on drug utilization and medical expenditures of hypertension patients in public medical institutions in mainland China. Methods: This study used patient-level data based on electronic health records retrieved from the hospital information system of Nanjing Hospital of Chinese Medicine. Data on patients with hypertension who received care at this institution between 2016 and 2021 was used for analysis. Segmented linear regression models incorporating Interrupted Time Series (ITS) analysis were adopted to examine the effects of NVBP policy on drug utilization and health expenditures of eligible patients. Drug utilization volume and health expenditures were the primary outcomes used to assess the policy effects, and were measured using the prescription proportion of each drug class and the overall per-encounter treatment costs. Results: After the implementation of NVBP policy, the volume of non-winning drugs decreased from 54.42% to 36.25% for outpatient care and from 35.62% to 15.65% for inpatient care. The ITS analysis showed that the volume of bid-winning drugs in outpatient and inpatient settings increased by 9.55% (p < 0.001) and 6.31% (p < 0.001), respectively. The volume changes in non-volume based purchased (non-VBP) drugs differed between outpatients and inpatients. The proportion of non-VBP drugs immediately increased by 5.34% (p = 0.002) overall, and showed an upward trend in the outpatient setting specially (p < 0.001) during the post-intervention period. However, no significant differences were observed in the proportion of non-VBP drugs in inpatient setting (p > 0.05) in term of level change (p > 0.05) or trend change (p > 0.05). The average per-visit expenditures of outpatients across all drug groups exhibited an upward trend (p < 0.05) post policy intervention. In addition, a similar increase in the overall costs for chemical drugs were observed in inpatient settings (coefficient = 2,599.54, p = 0.036), with no statistically significant differences in the regression slope and level (p = 0.814). Conclusion: The usage proportion of bid-winning drugs increased significantly post policy intervention, indicating greater use of bid-winning drugs and the corresponding substitution of non-winning hypertensive drugs. Drug expenditures for outpatients and health expenditures per visit for inpatients also exhibited an upward trend, suggesting the importance of enhanced drug use management in Traditional Chinese Medicine hospital settings.

Effectiveness of a Program to Raise Awareness About Pneumococcal Vaccination Among Physicians and Patients with Chronic Respiratory Diseases: A Multicenter Cohort Study.

There is a need to increase patient and clinician awareness on the effectiveness of pneumococcal vaccination in at-risk groups. The aim of the study was to evaluate the effect of reminders for physicians and patients using the vaccination tracking system created in the hospital information management system (HIMS) on the vaccination rate, and the effect of pneumococcal vaccination on pneumonia-related hospitalization and mortality over a 12-month period. This prospective observational cohort study was undertaken during a 2-year period in 3 tertiary care centers. Patients were followed up for 12 months following vaccination, and hospital admissions and mortality were recorded via HIMS. During the campaign, HIMS transmitted pneumococcal immunization reminder messages in accordance with guideline recommendations to physicians' computers and patients' mobile phones. Educational posters on pneumococcal vaccination were posted in outpatient clinics. Regular seminars on the evidence for pneumococcal vaccination were organized. All patients who were hospitalized during the follow-up period for chronic obstructive pulmonary disease (COPD), asthma, lung cancer, or pneumonia were analyzed in relation to their vaccination history regarding clinical outcomes. A total of 29530 patients were included in the study. During the study period, the annual vaccination rate increased by 74.4% and reached 4.8% in 3 hospitals (P = .001). The rates were 3.9% in patients older than 65 years without comorbidities and 5.2% in those with COPD and asthma (P = .002). In pneumococcal vaccine recipients, pneumonia-related hospital mortality was lower (relative risk (RR) = 0.19, CI 0.09-0.35, P < .001). It is possible to raise the rate of pneumococcal vaccination through awareness campaigns. Individuals with COPD and asthma are more willing to receive pneumococcal vaccination. Among patients hospitalized for pneumonia, prior pneumococcal vaccination is associated with lower mortalit.

Probabilistic Linkage Creates a Novel Database to Study Bronchiolitis Care in the PICU.

Lack of a comprehensive database containing diagnosis, patient and clinical characteristics, diagnostics, treatments, and outcomes limits needed comparative effectiveness research (CER) to improve care in the PICU. Combined, the Pediatric Hospital Information System (PHIS) and Virtual Pediatric Systems (VPS) databases contain the needed data for CER, but limits on the use of patient identifiers have thus far prevented linkage of these databases with traditional linkage methods. Focusing on the subgroup of patients with bronchiolitis, we aim to show that probabilistic linkage methods accurately link data from PHIS and VPS without the need for patient identifiers to create the database needed for CER. We used probabilistic linkage to link PHIS and VPS records for patients admitted to a tertiary children's hospital between July 1, 2017 to June 30, 2019. We calculated the percentage of matched records, rate of false-positive matches, and compared demographics between matched and unmatched subjects with bronchiolitis. We linked 839 of 920 (91%) records with 4 (0.5%) false-positive matches. We found no differences in age (P = .76), presence of comorbidities (P = .16), admission illness severity (P = .44), intubation rate (P = .41), or PICU stay length (P = .36) between linked and unlinked subjects. Probabilistic linkage creates an accurate and representative combined VPS-PHIS database of patients with bronchiolitis. Our methods are scalable to join data from the 38 hospitals that jointly contribute to PHIS and VPS, creating a national database of diagnostics, treatment, outcome, and patient and clinical data to enable CER for bronchiolitis and other conditions cared for in the PICU.