Hospital Record Research Articles

P-673. Respiratory Syncytial Virus (RSV) Hospitalizations During Off-Season Months Among Infants in US

Abstract Background The CDC currently recommends two prevention options to help protect infants against RSV-associated lower respiratory tract disease during a typical RSV season, defined as October through March. However, annual and geographic variability in RSV seasonality exists. The study evaluated the burden of RSV hospitalizations occurring outside a typical season (i.e., April – September). Methods Infants aged < 12 months old hospitalized with RSV were identified from the PINC AI Healthcare Database (7/1/2018 to 6/30/2023) for this descriptive cohort study. Because age is reported in years, a prior birth hospitalization record was required to determine age in months for RSV hospitalization. A surveillance year was defined by the period of July 1 of each year to June 30 of the following year. Monthly RSV hospitalizations were tallied for each of the 9 U.S. census divisions and by age group (< 3, 3-5, 6-8, 9-11 months). Seasonality of RSV cases among all infants < 1 year, regardless of the ability to identify age in months, was evaluated as a sensitivity analysis. Results A total of 56,425 RSV hospitalizations were identified among infants < 1 year of age, of which, 36% (n=20,531) of patients had a birth record. RSV hospitalization counts during the 5 surveillance years were 4,574 (2018/19), 4,926 (2019/20), 452 (2020/21), 4,344 (2021/22), and 6,235 (2022/23). Overall, 22% (n=4,510) of RSV hospitalizations occurred during off-season months, with 83% of these off-season cases occurring in June – September across various divisions (Fig. 1). Of all RSV hospitalizations that occurred during off-season, 45.5% (n=2,054) were among infants < 3 months. Seasonal patterns were similar across age groups (Fig. 2). A sensitivity analysis showed consistent seasonal patterns among all infants < 1 year of age. Conclusion This large-scale, real-world database analysis showed over 1 in 5 infants hospitalized with RSV were infected during off-season with varying rates by geography. The current recommendations may limit protection options for infants exposed to RSV outside the typical season. Disclosures Amy W. Law, PharmD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Jay Lin, PHD, MBA, Pfizer: Advisor/Consultant Jennifer Judy, MS, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Alejandro D. Cane, MD, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)|Pfizer: Stocks/Bonds (Public Company) Sarah J. Pugh, PhD, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company)

Evaluation of Hydatid Cyst Cases: A Single-center Retrospective Study.

Cystic echinococcosis (CE) is a zoonotic condition that can be encountered, particularly in developing countries, and leads to significant economic losses. This study was planned to observe the treatment options, complications, in the patients we followed. Patients aged 18 and over who were diagnosed with hydatid cyst and followed in our hospital between January 2018 and December 2023 were included in the study. Data were obtained from the hospital's record system. The patients with CE were retrospectively evaluated in terms of age, gender, cyst location, treatment method applied, presence of relapse, and complications. A total of 30 patients, with a mean age of 42.8 years (range: 19-68), were included in the study; 13 (43.3%) were male and 17 (56.7%) were female. The most common presenting complaint was abdominal pain (n=14, 46.7%), and 6 patients (20.0%) were asymptomatic. Sixteen patients had multiple cysts in the same region, and 6 patients had cysts in different regions. The most common site of involvement was the liver (n=21, 70.0%), followed by the lungs in 4 patients (13.3%). Single cases of brain, spinal cord, spleen, kidney, and bone involvement were observed. Diagnosis was made by ultrasonography in 16 patients (53.3%), magnetic resonance imaging in 8 patients (26.7%), and computed tomography in 6 patients (20.0%). Surgical intervention was performed in 20 patients (66.7%), and percutaneous drainage in 3 patients (10.0%). All patients received albendazole treatment. Complications included intra-abdominal abscess in three patients (10.0%) and rupture in one patient. One patient with intracranial involvement died. Although observed worldwide, CE maintain their importance in terms of morbidity and mortality, particularly in developing countries.

Extreme hot weather events and risk of hospitalisation for cardiovascular and respiratory diseases in older people in Hong Kong in 2012 to 2018.

The older population is more vulnerable to the impact of extreme hot weather events (EHWEs), while the impact on the frailer institutionalised older population was seldom assessed. Our objective was to assess the relationship between EHWEs and hospitalisation risks among institutionalised and community-dwelling older people. We used territory-wide hospitalisation record of Hong Kong from year 2012 to 2018 to assess the associations between EHWEs and cardiovascular and respiratory disease hospitalisations in the population aged 65 or above. A very hot day (VHD) was defined as the daily maximum temperature ≥ 33°C, and a hot night (HN) was defined as the daily minimum temperature ≥ 28°C. We assessed whether prolonged exposure to high temperatures (defined as 3 consecutive VHDs (3VHD) or HNs (3HN)) was related to higher risk of hospitalisation over a lag period of 0-21 days. Time-stratified case-crossover design was used. Analyses were stratified by old age home (OAH) residence status. Exposure to 3VHDs was related to higher risk of cardiovascular disease admissions for community-dwelling older people [relative risk (RR): 1.09; 95% confidence interval (95%CI): 1.03 to 1.14 (lagged 4 days, i.e. delayed manifestation up to 4 days)] while for OAH residents, the association could have a lag of 18 days (RR: 1.28; 95%CI 1.05 to 1.54). For respiratory disease admissions, such relatively long delayed relationship was not clearly observed. The warming climate could increase healthcare demand in the long run. Frailer patients could present with a generally more marked and delayed onset of cardiovascular disease aggravation than the community-dwelling population.

Cancer Incidence Among People With a Prior Hospital Record of Depression in Scotland, 1991-2019: A Cohort Study.

Current evidence on the association between depression and cancer risk is conflicting, with little understanding of how associations vary by time period or sociodemographic factors. We aimed to compare cancer incidence in people with versus without a previous hospital admission record for depression, by sociodemographic factors and over time. We conducted a cohort study using national linked data in Scotland from 1991 to 2019. We calculated sex-stratified age standardised incidence rates for all cancers, lung, female breast, colorectal and prostate cancer, and used quasi-Poisson regression models to obtain sex-specific estimates of cancer incidence and relative risks of cancer in those with versus without a prior hospital admission record of depression. There were 128,654 people with a hospital record of depression with 12,802 incident cancers and 847,656 cancers among those without depression. Age-standardised cancer incidence rates were higher in both males and females with versus without depression. Depression was associated with a 20%-30% increased risk of all cancers combined, a difference that did not vary by sex, age or deprivation and persisted over three decades. Depression was associated with higher risks of lung (RR 1.79, 95% CI 1.70-1.88) and colorectal cancer (RR 1.12, 95% CI 1.05-1.19), but not breast or prostate cancer. We identified an entrenched disparity in cancer incidence by depression status. Further research should identify underlying mechanisms and inform cancer prevention strategies in this vulnerable group. Meanwhile, health care professionals have a key role to play in optimising physical health care for people with depression.

Analysis of Technology Acceptance Model (TAM) on The Use of Electronic Medical Records in Hospitals

Hospitals have begun adopting Electronic Medical Record (EMR) systems to enhance healthcare services and meet service standards. The Technology Acceptance Model (TAM) has been widely utilized in research related to technology implementation in the healthcare sector, including electronic medical record systems. This research aims to analyze the acceptance of EMR systems in public hospitals (RSUD) using TAM, focusing on the main variables of perceived ease of use and perceived usefulness. A qualitative approach was employed, with data collected through literature review and in-depth interviews with medical staff at RSUD. The results indicate that perceived ease of use significantly influences the initial adoption of EMR, as medical personnel are more likely to embrace technology that they find easy to use. Additionally, perceived usefulness plays a crucial role in determining the sustained use of EMR, particularly when medical staff experience increased work efficiency and accuracy in managing patient data. This research also reveals that the implementation of EMR positively impacts patient satisfaction, enhancing service quality and the speed of information access. In conclusion, the factors of ease of use and usefulness are essential in ensuring the successful acceptance and sustainable use of EMR in public hospitals, as well as contributing to patient satisfaction.

Unveiling The Incidence and Associated Factors of Needle Stick and Sharp Injuries Among Health Care Workers

Background: Accidents with sharp objects and needlesticks are a global issue. Healthcare workers are frequently vulnerable to a range of hospital-acquired infections. Objectives: The study aimed to determine the incidence rate and associated factors of needlesticks and sharps injuries among healthcare workers. Methods: A descriptive retrospective cross-sectional study design study was conducted in five public hospitals in Rania governorate, Iraq. The data was retrieved from the hospital's record of the infection prevention and control department from August 2022 to February 2023 period. The healthcare workers are based on the three categories (Nurses, Physicians, and Laboratory staff). Data was collected using a self-report questionnaire, which was developed based on previous studies with similar objectives and validated by experts in the field. Results: The study discovered that the frequency of needlestick and sharps injuries was 58.6% among healthcare workers and most of them were injured 2-5 times 58.9%. The highest number of needlestick and sharps injury cases were reported among nurses 66.7%. Syringe needle was the predominant medical tool involved in the injuries, accounting for 82%. A minority of the study participants experienced medical sharp cutting of 15%. The major medical sharp objectives involved in the incident were; ampules 66.7%. There was a significant difference between needle stick and sharp injury with some associated fosters like a unit of work, specialty, and experiences. Conclusion: The study concluded that the prevalence of needle sticks and sharp injuries among healthcare workers in Rania City was high and most of them were nurses. Regular training about the prevention of needle sticks and sharps injuries is needed to increase workplace safety and protect healthcare workers.

PENYELENGGARAAN MIGRASI RETENSI DATA REKAM MEDIS ELEKTRONIK RSUD NGUDI WALUYO WLINGI BLITAR

In the era of digitalization, hospitals in Indonesia face challenges in migrating electronic medical record data from the old system to the new system. At Ngudi Waluyo Wlingi Blitar Regional Hospital, an efficient and effective electronic medical record data migration process is the main issue that needs to be addressed to ensure the successful implementation of the Looker Studio web-based system. This research uses descriptive quantitative methods. This research shows that although the process of migrating electronic medical record data at Ngudi Waluyo Wlingi Blitar Regional Hospital is generally successful, there are several technical and training obstacles that must be corrected. This research aims to identify the challenges faced, the effectiveness of the procedures implemented, and the impact of implementing an electronic medical record system on the efficiency and accuracy of medical data storage. Recommendations for improvement include increasing training for officers, strengthening IT infrastructure, and more detailed planning for future data migration stages.

Effectiveness and User Satisfaction of Electronic Medical Records in Private Hospital

The implementation of Electronic Medical Records (EMRs) in hospitals offers numerous benefits, including enhanced healthcare quality and safety, improved access to information, increased healthcare professional productivity, and reduced healthcare costs. Despite these advantages, the effectiveness and user satisfaction of EMRs can be hindered by challenges such as high implementation costs, user resistance, and complex integration processes. This study aims to investigate the effectiveness and user satisfaction of EMRs in the inpatient room of Siti Khodijah Muhammadiyah Hospital Branch of Sepanjang. This study employed a cross-sectional approach, involving 86 healthcare workers (HCWs) in November 2023. The Technology Acceptance Model (TAM) was applied to assess the effectiveness of EMR implementation, while the ServQual method measured user satisfaction. This study revealed that the relevance (P = 0.001) and accuracy (P = 0.001) of the EMR system are critical factors that significantly influence HCWs’ satisfaction. Users who found the EMR system relevant and accurate reported higher levels of satisfaction. However, aspects such as the timeliness (P = 0.404), completeness of data (P = 0.053) and support system (P = 0.670), while important, did not show a statistically significant impact on user satisfaction. Ensuring the relevance and accuracy of the system is essential to enhance user satisfaction. Practically, improving these aspects can lead to better HCW engagement with EMRs, and future research should explore strategies to address the non-significant factors for a comprehensive understanding of EMR effectiveness.

Clinical predictors and correlates of viral suppression among adults accessing care at the HIV clinic in federal medical center, Abeokuta, Ogun state, Nigeria: a retrospective cohort study

BackgroundGlobally, Human Immune-deficiency Virus (HIV) continues to be one of the world’s most significant public health issues. At the end of 2022, 39.0 million people were living with HIV (PLHIV) worldwide with 9% resident in Nigeria. Viral suppression is associated with a reduction in HIV disease progression. However, Nigeria is yet to achieve the UNAIDS 2020 third 95, community wide viral suppression for elimination of global HIV epidemic. This study assessed the clinical predictors and correlates of viral suppression among adults accessing care at HIV clinic in Federal Medical Center, Abeokuta, Ogun State, Nigeria.MethodsThe study design was a facility-based retrospective cohort study that was conducted among adults on antiretroviral therapy (ART) at HIV clinic from May 2016 to October 22, 2021, Federal Medical Center of Abeokuta (FMCA), Ogun State Nigeria. Two thousand one hundred and seventy-six (2176) case records were explored within the study period, but only one thousand five hundred and twenty (1520) met the inclusion criteria. Variables in the participants’ hospital record (secondary data) were extracted into Microsoft Excel which were exported into Stata MP 17 for data cleaning and recoding, and analysis. Stepwise model selection was done for factors associated with viral suppression and binary logistic regression was used to investigate the predictors of viral suppression among participants at p-value < 0.05.ResultsOne thousand five hundred and twenty (1520) were included in the study. Majority (1116 − 73.4%) of the study participants were females and 241(15.9%) were aged 25–34 years. One thousand three hundred and eighty-six (1386- 90%) of the clients achieved viral suppression. Predictors of viral suppression were older age group of 25–34 years (OR: 2.62, 95% CI: 1.19–5.78, p < 0.017) and > 45 years (OR: 2.42, 95% CI: 1.11–5.28, p < 0.026), and active on ART (OR: 6.05, 95% CI: 4.10–8.91, p < 0.000).ConclusionThis study showed a significant viral suppression among the study participants. Being active on ART and age 25 years and above were the only significant clinical predictor and correlate of viral suppression respectively. Improving viral suppression should be a focus among adults HIV under age 25 years and loss to follow-up (LTFU) category.

A retrospective clinico epidemiological study of pattern of dermatosis involving trigeminal distribution in a tertiary care center

Trigeminal nerve is the principal sensory nerve of face. Many dermatological conditions known occur in relation to trigeminal nerve distribution clinically presenting as unilateral facial lesions with strict midline demarcation. To study the clinical pattern and epidemiological determinants of dermatoses along trigeminal nerve among the patients of both the sexes, involving all the age groups. Thirty two patients presenting with skin lesions along trigeminal nerve presenting to Dermatology department of a tertiary care center, Bangalore, Karnataka, are selected for the study. Study design is retrospective hospital record based study conducted from January 2023 to January 2024. In this study, out of 32 patients most common dermatoses along trigeminal nerve were infection of which herpes zoster was seen thirteen (40.62%) patients, followed by nevi (n=6, 18.75%), pigmentary disorders (n=5, 15.62%), vascular disorder (n=4, 12.5%) and auto inflammatory disorder (n=4, 12.5%) was seen. Most common branch affected was ophthalmic followed maxillary branch .Females were more common and mean age was 24 years. Small sample size and rare clinical cases are included Studies focusing on the pattern of dermatoses involving the trigeminal nerve contribute to the advancement of medical knowledge and facilitate the development of novel diagnostic techniques and therapeutic modalities. By elucidating the underlying pathophysiological mechanisms and identifying potential risk factors, research in this field can lead to the development of more effective treatment strategies tailored to the specific needs of patients.

First fracture in rheumatoid arthritis: analysis by fracture site, gender, age, and comorbidities.

Rheumatoid arthritis RA is a potentially devastating osteoimmunological disorder, predisposing to osteoporosis (OP), fragility fracture (FF), and major osteoporotic fractures (MOF). As few studies incorporate statistical matching, comorbidity and non-MOF sites, we compared the incidence of first FF, MOF, and non-MOF in RA patients with a matched control cohort adjusting for comorbidities. This longitudinal cohort study uses routinely collected administrative data from the West Australian Rheumatic Disease Epidemiological Registry (WARDER) between 1980 and 2015. RA patients, as defined using International Classification of Disease (ICD) codes, were compared to hospitalised patients free of rheumatic disease. Case-control matching adjusted for age, gender, and comorbidities (Charlson Comorbidity Index). Incidence rates (IR) per 1000 person years (PY) with 95% confidence intervals (CI) were compared by incidence rate ratios (IRR). In RA patients from 2000 to 2010, the first fracture IR was 18.3 (15.7-21.2) for an IRR of 1.32 (1.10-1.60). Upper limb, lower limb, and axial IR were 5.56 (95% CI 4.18-7.26), 10.60 (95% CI 8.66-12.87), and 2.47 (95% CI 2.58-3.68) with IRR of 1.18 (95% CI 0.84-1.65), 1.44 (95% CI 1.19-1.86), and 1.01 (95% CI 0.61-1.63) respectively. The first fracture IR increased 6years before first RA hospital record (RR 1.58, CI 1.05-2.39). After age, gender, and comorbidity adjustment, RA is associated with a 32% higher incidence of first fracture, increased MOF, and a fracture incidence that is already increased before a first recorded RA diagnosis. This suggests a need for early attention to prevention of all fractures in RA patients.

Exploring the association between mental health and extreme weather events related to climate change: a scoping review

BackgroundThe aim is to assess the association between mental health and extreme weather events related to climate change and identify resilience-based interventions to support mental health for those affected by extreme weather events related to climate change. Methods In November 2022, we undertook a scoping review following standard guidelines, searching databases MEDLINE, EMBASE, SCOPUS, CINAHL, Cochrane, and Web of Science. We reported study demographics, climate change-related exposures, mental health-related outcomes, and resilience outcomes. The methodological quality of included studies was not assessed as this is not a requirement for scoping reviews. FindingsTwenty-seven studies published between 2011–22 (three on the overall impact of climate change, 11 on ambient temperature, nine on hurricanes, three on flooding, and one on wildfire) were included that assessed the association between extreme weather events related to climate change and mental health. Studies included cross-sectional surveys (n=14), secondary data analysis (n=12, with 8 studies based on clinic or hospital record data), and longitudinal data collection (n=1). Mental health-related outcomes included depression, anxiety, post-traumatic stress disorder (PTSD)/ related stress disorders, schizophrenia, and other mental health conditions. Eight studies reported resilience outcomes. We reported which extreme weather events related to climate change are more likely to be associated with which kind of mental health problem. Ambient temperature showed an association with mental health-related hospital or emergency department visits or hospital admissions in both new cases and people with existing mental health conditions. Extreme weather events such as hurricanes and floods showed associations with depression, anxiety, and/or PTSD. Apart from one longitudinal study evaluating a psycho-social support program, we did not identify any interventions to support people's mental health when faced with extreme weather events. InterpretationThough all included studies reported an association between extreme weather events related to climate change and mental health conditions, there is a lack of related interventions. As specific extreme weather events seem to be associated with specific kinds of mental health problems, there is a need for interventions that will be tailored both to the specific nature of extreme weather events, the kinds of impact they create, and the needs and circumstances of those who are impacted and should be culturally adapted to make them acceptable, engaging, and effective. FundingNone.

A needs assessment of hospital management and leadership training among Indian medical undergraduates

BackgroundMedical undergraduate students are often unaware of the managerial aspects of operating a healthcare facility. This leads to confusion and a sense of being lost when they assume administrative roles, highlighting the need for hospital management and leadership training. This prompted us to evaluate the needs of medical undergraduates concerning these crucial aspects.MethodsAn exploratory study was conducted on 240 medical undergraduate students to assess the medical undergraduates’ need to learn about hospital management and leadership training, their views about the importance and their self-perceived knowledge of the various elements of hospital management and leadership training. A meticulously validated questionnaire, comprising three essential parts, based on the Likert scale was effectively employed in the study. Part A asked students to evaluate the importance of 15 selected elements of hospital management and leadership training, ranging from not important to very important, in their role as a doctor. Part B required the students to assess their self-perceived knowledge levels on a scale from no knowledge to very adequate for the same 15 elements. Part C inquired about the students’ opinions on including these topics in their curriculum and, if so, the appropriate timing.ResultsNearly 75% of the students felt that time management, stress management, and patient safety issues were very important for their role as doctor. Closely following these were communication/ public relation skills, hospital information system & record keeping, quality improvement/assurance, law, ethics & code of conduct. Only 25% of the students reported their self-perceived knowledge as very adequate for almost all the elements. For inclusion in the curriculum, the majority wanted to learn about these elements and throughout the course was the preferred timing.ConclusionThe students felt that hospital management and leadership training were pivotal for their roles as doctors. They expressed a lack of sufficient knowledge in these areas and the need for these important aspects to be included in their curriculum as a longitudinal course.

Epidemiological, clinical, paraclinical, evolutionary, and therapeutic aspects of hypertensive patients infected by COVID-19: about 702 patients in our city

Abstract Introduction Hypertension (HT) is a major cardiovascular risk factor frequently observed in COVID-19 patients. This study aimed to determine the frequency of hypertensive patients infected with COVID-19 at a national hospital, describe their epidemiological, clinical, paraclinical, and therapeutic profile, their disease progression, and identify factors associated with death. Methodology A retrospective, descriptive, and analytical study was conducted over 24 months and 4 days, from 27 March 2020 to 30 March 2022, at national hospital. Included were hospitalized patients at a hospital with a confirmed COVID-19 diagnosis, known hypertensives, regardless of gender, and with a hospitalization record. COVID-19 diagnosis was based on a positive SARS-CoV-2 RT-PCR or a positive COVID Rapid Diagnostic Test. Data were collected using a survey form, with a p-value less than 0.05 considered statistically significant for bivariate analysis. Results The study enrolled 702 patients, a hospital frequency of 23.95%. The average age was 65.14 ± 12.24 years with a sex ratio of 0.81. Comorbidities were predominantly diabetes (40.5%) and dyslipidemia (4.8%). Common symptoms included cough (65%), dyspnea (42.3%), fever (47.4%), and asthenia (35.9%). Blood pressure was normal in 15.2%, high-normal in 16.8% of patients. HT was Grade I in 12.1%, Grade II in 10%, and Grade III in 6.8% of the population, with blood pressure unmeasurable in 0.3% of known hypertensive patients. SARSCOV2 infection was mild in 34.2% and moderate in 42.8% of cases. CT scans showed extensive (31.8%), severe (25.9%), moderate (25.6%), critical (8.5%), and minimal (7.9%) lung damage. Treatment mainly consisted of ACE inhibitors (29%), ACE inhibitors in combination with another antihypertensive (8.4%), and ARBs in combination with an antihypertensive (). The average hospital stay was 12.85 days with a favorable outcome in 81% and a mortality rate of 15.5%. Factors associated with death included not being vaccinated against COVID-19 (HR: 11.70; 95% CI: 1.324-103.519), critical clinical form (HR: 11.70; 95% CI: 1.324-103.519), pulmonary consolidation (HR: 8.87; 95% CI: 7.539-24.207), high creatinine (HR: 4.69; 95% CI: 1.360-16.181), critical CT thoracic level (HR: 2.42; 95% CI: 1.020-5.745), and not taking ARBs (HR: 6.02; 95% CI: 2.812-12.889). Conclusion HT can be associated with COVID-19, impacting the disease's prognosis with significant mortality. Preventing its incidence and morbidity/mortality is crucial.

Peadiatric amputation from traditional bone setters’ gangrene in Ibadan: a malady

Background: Pediatric amputations resulting from gangrene pose a significant medical challenge, especially in resource-limited settings. In Nigeria, traditional bone setters (TBS) often serve as the first point of contact for musculoskeletal injuries, but their practices can lead to severe complications, including gangrene. Our hospital manages many of such cases. This study aims to explore the epidemiology, clinical presentation, and outcomes of pediatric patients who developed gangrene requiring amputation following TBS treatment, with the goal of informing public health strategies and improving pediatric care quality. Methods: The study is a retrospective study which seek to extract the data from the hospital record all the patient who underwent amputation due to gangrene after initial TBS treatment. All the case notes were retrieved and data was extracted and analyzed using descriptive statistics. The study adhered to ethical standards and anonymized data to protect patient confidentiality, ensuring the study's integrity. Results: The study involved 33 pediatric patients aged 8.3 years, with a significant gender disparity. Most patients were from the Yoruba ethnic group and practiced Islam. 87.9% of parents had no formal education. Gangrene was most common in the left hand, and falls were the leading cause of initial injury. The average surgery time was 81.2 minutes, with a 13-day hospital stay. Post-operative complications occurred in 43.5% of patients, with surgical site infections (SSI) being the most common. Only 8.7% received occupational therapy. Conclusions: The study highlights post-operative care challenges in pediatric amputations, including high complications and limited access to services. It suggests targeted interventions, infection control, and public health campaigns to improve outcomes. Future research should include long-term follow-up studies.

Association of age to nutritional status and muscle mass in children with transfusion-dependent β-thalassemia: a cross-sectional study.

Transfusion-dependent β-thalassemia (TDT) is a hereditary blood disorder that often leads to complications affecting growth, nutritional status, and muscle mass in children. This study aims to investigate the associations between age, nutritional status, and muscle mass in children with TDT, providing insights into the progressive impact of age on these parameters. One hundred twenty-two children with TDT from March 2023 to March 2024 were enrolled in this cross-sectional study. Their nutritional status was assessed using the 2006-2007 World Health Organization (WHO) Growth Charts, and their muscle mass was measured using bioelectrical impedance analysis (BIA). Data related to age, gender, weight, height, fat-free mass (FFM), skeletal muscle mass (SMM), and soft lean mass (SLM) of children were collected for comparative analysis from the hospital record room. Furthermore, Spearman's rank correlation coefficients and regression analyses were utilized to investigate the associations between age and both nutritional status and muscle mass. The results of this study revealed negative correlations between age and wasting (r = -0.26, p < 0.001), stunting (r = -0.28, p < 0.001), FFM (r = -0.3, p < 0.001), SMM (r = -0.23, p < 0.01), and SLM (r = -0.36, p < 0.001). The regression analysis indicated that age was an independent predictor of wasting, stunting, and reduced muscle mass in these children (all p < 0.001). Our study observed a trend of worsening stunting, wasting, and muscle loss in children with TDT as they age. These findings highlight the importance of monitoring both nutritional and muscular health in TDT patients. Early detection and comprehensive nutritional management may improve outcomes in this population.

Expansion of Medicaid Coverage of Continuous Glucose Monitor Reduces Health Disparity in Children and Young Adults With Type 1 Diabetes.

Continuous glucose monitor (CGM) usage improves glycemia in people with type 1 diabetes (PWD) and is accepted as the standard of care. The CGM utilization is lower in patients with public insurance and minorized ethnicities. In 2022, California Medicaid reduced its barriers to obtaining CGM coverage for PWD. It is unknown whether this policy change is sufficient to increase CGM usage. We hypothesize that the change in Medicaid coverage improved CGM uptake in children and young adults with T1D. Data were extracted from electronic medical record of a large urban children's hospital in 2021 and 2022. The CGM usage was determined based on clinician documentation or the presence of CGM downloads. Kruskal-Wallis tests, Wald tests, and χ2 tests were used to test hypothesis (P < .05). Mixed effects logistical regression analyses were performed. We included 878 and 892 PWD (age ≤ 21 years) in 2021 and 2022, respectively. In 2022, Medicaid insured 59.3% of patients. Between 2021 and 2022, CGM usage did not change for privately insured patients (84%) but increased from 41% to 58% for patients receiving Medicaid. In our mixed effects logistic regression model, CGM usage was higher in 2022 and in English speakers. Public insurance, black race, and patients' age were negatively associated with CGM usage. Our results suggest that Medicaid expansion of CGM coverage increases its utilization for pediatric PWD but did not eliminate the disparity. Future studies are needed to identify barriers that preclude equity in technology uptake.

Internet-based surveillance to track trends in seasonal allergies across the United States.

Over a quarter of adults in the United States suffer from seasonal allergies, yet the broader spatiotemporal patterns in seasonal allergy trends remain poorly resolved. This knowledge gap persists due to difficulties in quantifying allergies as symptoms are seldom severe enough to warrant hospital visits. We show that we can use machine learning to extract relevant data from Twitter posts and Google searches to examine population-level trends in seasonal allergies at high spatial and temporal resolution, validating the approach against hospital record data obtained from selected counties in California, United States. After showing that internet-derived data can be used as a proxy for aeroallergen exposures, we demonstrate the utility of our approach by mapping seasonal allergy-related online activity across the 144 most populous US counties at daily time steps over an 8-year period, highlighting the spatial and temporal dynamics in allergy trends across the continental United States.

EP452 - Outcomes of Appendiceal Cancer Over 10 Years in a District General Hospital

Abstract Aims To evaluate outcomes of appendiceal tumour patients at a district general hospital. Methods A retrospective review was performed to detect patients (16 years or older) with positive histology findings of appendiceal cancers post appendicectomy or colectomy between January 2014 to January 2024. Data was collected from a prospectively maintained electronic patient hospital record (Meditech, Version 6, USA). Results 13 patients were diagnosed to have appendiceal tumours between January 2014 – January 2024. Median age of presentation was 53 (IQR 43).Total Patient Number13Male30.8%Female69.2%Appendiceal Tumour TypePercentage of Appendiceal Tumour PatientsCarcinoid (Neuroendocrine)76.9%Adenocarcinoma7.7%Low Grade Mucinous15.4%High Grade Mucinous0% Median length of stay was 2.5 days (IQR 2.25). Emergency presentations made up 76.9% of admissions. Appendicectomy was the primary operation for 92.3%. 75% of tumours were &amp;lt;1cm, with 25% of tumours &amp;gt;1cm. Location of tumour was predominantly involving the tip in 61.5% of cases, with body and base involvement being 23.1% and 15.4% respectively. Tertiary referral was made for 84.6% of patients. 15.4% had evidence of metastatic disease. Subsequently 15.4% of patients had hyperthermic intraperitoneal chemotherapy (HIPEC), with 7.7% having HIPEC and systemic chemotherapy and radiotherapy. Conclusions Carcinoid (neuroendocrine) was the most common type of appendiceal tumour, mostly presenting as an emergency appendicitis. It was more commonly diagnosed in females. While appendiceal cancers are very rare, outcomes remained good with 100% five-year survival, demonstrating the importance of prompt tertiary referral if further treatment is required.

Competing institutional logics in healthcare organizations: theorising digitalism

PurposeThe digitalisation of healthcare services has proven to be difficult, with numerous negative effects. We argue that the reason for the problem is not poor project management, but a clash of different institutional logics. The aim of this article is to explore, define and theorise the concept of digitalism, as a term for a new institutional logic in contrast to other, more known logics in organisations, such as managerialism and professionalism, to better understand processes of digitalisation.Design/methodology/approachWe illustrate our arguments with a case study of a process of organizational development before and after the implementation of centralised large-scale IT systems at a large Norwegian hospital. Data was extracted from documents and observations from January 2015 to January 2016 during an organizational audit. In addition, a follow-up study was conducted in 2019 and 2024 by interviewing eight key personnel who were involved in the implementation process.FindingsThe implementation of a new digital health record in a Norwegian hospital is a process of social restructuring that involves new actors, logics and control systems. The process of digitalisation shows us how digitalism create tensions, diverges and merges with other institutional logics.Practical implicationsUnderstanding digitalism as a sensitising concept offers insights into how large-scale technology and organizations are tied together and can help to reduce organizational dysfunctionalities and improve the implementation of IT systems.Originality/valueThis study contributes to a new understanding of digitalisation processes and links an ongoing theoretical debate on the digitalisation of organizations with empirical findings.