Hospital Electronic Medical Record Research Articles

Physical exercise and hypertension: A retrospective study in southern Sichuan.

This study aimed to scrutinize the relationship between physical exercise and hypertension, taking into account multiple variables such as age, body mass index (BMI), family history, smoking, and alcohol consumption in the Southern Sichuan population, China, using a retrospective approach based on hospital record data. This retrospective study analyzed data from 946 participants obtained from a hospital electronic medical record system. The data included information regarding participants' lifestyle factors, family history, and a clinical diagnosis of hypertension. Univariate and multivariate logistic regression models were employed to identify the association between lifestyle factors and hypertension. The study found a hypertension prevalence of 38.5% in the analyzed population. Multivariate analyses identified significant factors associated with hypertension as age (odds ratio [OR]: 1.045, 95% confidence interval [CI]: 1.036-1.054), BMI (OR: 1.107, 95% CI: 1.084-1.132), smoking (OR: 2.299, 95% CI: 1.674-3.157), alcohol consumption (OR: 0.644, 95% CI: 0.478-0.867), and physical exercise (OR: 0.682, 95% CI: 0.506-0.920). Findings from this hospital record-based retrospective study reinforce the multifactorial nature of hypertension. They highlight the significance of physical exercise, along with maintaining optimal BMI and encouraging healthy habits like nonsmoking and moderate alcohol consumption in hypertension prevention. Our findings also underscore the need for future prospective studies to establish causality and explore the generalizability of these results beyond the Southern Sichuan population.

Characteristics of Drug Poisonings Seen in the Emergency Department of an Urban Hospital.

Drug poisoning, either intentional or non-intentional, is a frequent diagnosis in the emergency department (ED), necessitating patient management from multiple services. To describe the drug poisonings seen in the ED of a large academic urban hospital. This retrospective descriptive study used 3 years of data (2018-2020) abstracted from the hospital's electronic medical record system and linked to validated, coded extracts from the Canadian Institute for Health Information Discharge Abstract Database. Patients with a diagnosis of acute drug poisoning who presented to the ED were identified on the basis of International Statistical Classification of Diseases and Related Health Problems, 10th revision, Canada (ICD-10-CA) codes, and data were collected for demographic characteristics, the drugs involved, in-hospital management, and inpatient outcomes. Patients with diagnosis of an acute drug reaction, inebriation, or nondrug or in-hospital poisoning were excluded. Data were stratified and analyzed in relation to the intent of drug poisoning. A total of 2983 visits for drug poisoning, involving 2211 unique patients (mean age 38.3 [standard deviation 16.2] years, 54.7% female), were included, yielding an overall incidence rate of 15.7 drug poisonings per 1000 ED visits (8.1 intentional, 6.4 non-intentional, and 1.3 unknown intent). Among the 1505 intentional drug poisonings, the most prevalent drug sources were antidepressants (n = 405, 26.9%), benzodiazepines (n = 375, 24.9%), and acetaminophen (n = 329, 21.9%); in contrast, opioids (n = 594, 48.1%) were most prevalent for the 1236 non-intentional poisonings. For 716 (24.0%) of the poisoning visits, the patient was admitted to acute care services, and the in-hospital mortality rate was 1.0% (n = 31). In addition, 111 patients (9.0%) with non-intentional drug poisoning left against medical advice. Finally, for 772 (25.9%) of the poisoning visits, the patient returned to the ED after discharge with a subsequent drug poisoning. Drug poisonings are a common cause of visits to urban EDs. They are rarely fatal but are associated with substantial utilization of hospital resources and considerable recidivism.

Factors inhibiting readiness to implement Electronic Medical Records (RME) in management information systems in hospitals: Literature review

Advances in communication and information technology have occurred in the health sector, especially in health services such as hospitals, one of which is Electronic Medical Records (RME). RME is the application of information technology used in collecting, storing data, processing data and accessing data as patient track records. The Ministry of Health is also targeting all health facilities to have implemented RME no later than December 2023. The challenges for implementing RME are so complex, it is necessary to identify factors inhibiting RME implementation and evaluate them. Research Objective: to identify factors inhibiting the implementation of Electronic Medical Records in hospitals. Method: Data collection was carried out through 4 data sources, namely, Google Scholar, ScienceDirect, PubMed, and Digital Referral Garba (Garuda) using the keywords " Barriers of Electronic Medical Record" OR "Readiness of Electronic Medical Record" AND "Electronic Medical Record Implementation" OR “Hospital Management Information System”. Results: Based on the screening , 4 Google Scholar articles were obtained , 2 ScienceDirect articles , 2 PubMed articles, 2 Digital Reference Garba (Garuda) articles. The results of a review of 10 journals on factors inhibiting the implementation of RME in hospitals are caused by individual readiness factors and organizational readiness factors. From all journals, the most frequently found results were individual unpreparedness to face changes and technological advances , lack of training. Conclusion: Barriers to implementing electronic medical records are influenced by two factors, namely individual readiness factors and organizational readiness factors which are divided into psychological factors and also structural factors.

Multidisciplinary user experience of a newly implemented electronic patient record in Ireland: An exploratory qualitative study

BackgroundImplementation of an Electronic Patient Record (EPR) in a key milestone in the digital strategy of modern healthcare organisations. The implementation of EPR systems can be viewed as challenging and complex. ObjectiveThe aim of the study was to investigate user perspectives and experiences of the implementation of an Electronic Medical Record in a major academic teaching hospital, with simultaneous ‘go-live’ across the whole hospital taking place. MethodsFocus groups and individual in-depth interviews were conducted with stakeholders and users (n = 105), approximately nine months post-EPR implementation. The study explored EPR users’ perceptions using an extended theoretical framework of the DeLone and McLean Information Systems Success Model (2003), which measured information systems, system quality, information quality, service quality, use/perceived usefulness & user satisfaction and net benefits. ResultsStaff engagement and satisfaction was high and the EPR is accepted as the new standard way of completing care. There was agreement that the EPR affords transparency, and greater accountability. There was some concern expressed regarding impact of the EPR on interprofessional and patient/provider interactions and communication. Physicians reported the inputting of social history through free text as an issue of concern and time consuming. The Big Bang approach with mandatory conversion was key to the successful adoption of EPR. There was consensus across professional and administrative respondents that there was no appetite to return to paper-based records. ConclusionThe successful roll out of the EPR reflects the digital readiness of healthcare providers and organisations. The potential for unintended consequences on work process requires continual monitoring. A key future benefit of the EPR will be the capacity to reach a broader understanding and analysis of variation in processes and outcomes within healthcare organisations. It is clear that skills in data analytics will be needed to mine data successfully.

Vital sign measurements demonstrate terminal digit bias and boundary effects.

The measurement and recording of vital signs may be impacted by biases, including preferences for even and round numbers. However, other biases, such as variation due to defined numerical boundaries (also known as boundary effects), may be present in vital signs data and have not yet been investigated in a medical setting. We aimed to assess vital signs data for such biases. These parameters are clinically significant as they influence care escalation. Vital signs data (heart rate, respiratory rate, oxygen saturation and systolic blood pressure) were collected from a tertiary hospital electronic medical record over a 2-year period. These data were analysed using polynomial regression with additional terms to assess for underreporting of out-of-range observations and overreporting numbers with terminal digits of 0 (round numbers), 2 (even numbers) and 5. It was found that heart rate, oxygen saturation and systolic blood pressure demonstrated 'boundary effects', with values inside the 'normal' range disproportionately more likely to be recorded. Even number bias was observed in systolic heart rate, respiratory rate and blood pressure. Preference for multiples of 5 was observed for heart rate and blood pressure. Independent overrepresentation of multiples of 10 was demonstrated in heart rate data. Although often considered objective, vital signs data are affected by bias. These biases may impact the care patients receive. Additionally, it may have implications for creating and training machine learning models that utilise vital signs data.

EDUKASI PENTINGNYA SIMRS DALAM PENERAPAN REKAM MEDIK ELEKTRONIK TERINTEGRASI DI RUMAH SAKIT UMUM SEMBIRING

The objective of this community service is to increase the understanding of the role of Hospital Management Information Systems (SIMRS) and how they contribute to the implementation of integrated Electronic Medical Records (RME) in hospitals. Key stakeholders, such as medical record personnel, IT staff, and hospital management, were involved in the counseling through Focus Group Discussion (FGD). The results of the Focus Group Discussion (FGD) showed that the application of SIMRS while implementing RME improved the quality of healthcare services and operational efficiency of the hospital. Key advantages found included better interdepartmental collaboration, accurate data management, and quick and easy patient access. Stakeholders agreed that education is the best way to maximize the benefits of this system. Medical personnel require specialized training to master the use of SIMRS and RME. The final conclusion of this community service activity is that the utilization of electronic medical records at the Sembirin Hospital facility in Deli Serdang Regency will facilitate employee activities.

Feasibility and Implementation of an out-of-Pocket Cost Calculator for Pre-Treatment Financial Counselling in Cancer Patients

Introduction Public healthcare in Singapore is funded by a combination of subsidies, insurance, which includes national basic coverage (MediShield, MSL) and optional private coverage, pensions (MediSave, MSV) and out of pocket (OOP) costs. In Sep 2022, spiraling cancer costs led to a shift in national policy with the introduction of a Cancer Drug List (CDL) of cost-effective treatments. OOP costs are now determined by multiple factors such as subsidy status, financial resources, insurance claim limits, residency status, drug subsidy tier, therapeutic indication, dose and cost. To simplify this complex manual process, we developed ChemoCalc, a digital calculator for individualized OOP estimates. We hypothesize that it will increase OOP cost estimate accuracy, improve efficiency and have high uptake. Methods The study was performed in a Singapore tertiary cancer center. ChemoCalc was developed with a multi-disciplinary team comprising physicians, pharmacists, operations administrators, patient service associates and medical social workers. Data sources were consolidated and hierarchical logic determined for calculating regimen and patient-specific OOP cost. Data sources included the CDL, hospital formulary, chemotherapy protocols, chemotherapy facility fees and various national subsidy schemes. These were encoded into an algorithm by a third-party developer. The user interface and experience (UI/UX) was envisioned by the team with iterations based on feasibility testing. FCs were trained on using ChemoCalc and data was collected pre and post-ChemoCalc implementation. Feasibility outcomes were demand, acceptability, practicality and integration (the extent to which ChemoCalc could be deployed in a secure hospital IT environment). These were assessed through employee focus groups (FG). Reporting officers were not present during the FG. Implementation outcomes were adoption (percentage of eligible users using ChemoCalc for FC), engagement (percentage of returning users), efficiency (median time taken to perform FC) and accuracy (percentage of bills which are within ±10% of the FC estimate). For accuracy, 10 bills were randomly selected each month and compared against the pre-treatment FC. Results Prior to the development of ChemoCalc, the demand for automated FC was identified through employee engagement. ChemoCalc (Figure 1) was developed and iterated from Aug - Sep 2022. Feasibility assessment identified that simplicity underscored a good UI/UX. To reduce UI clutter and improve ease-of-use, an algorithm was encoded to ensure that only variables relevant to a particular regimen need to be entered (Figure 2). All data fields were accessible via the hospital electronic medical record. The final version of ChemoCalc was deemed acceptable and practical by FG. It was integrated into the hospital environment seamlessly and accessible from all hospital computers and personal mobile devices. Data collection for implementation outcomes took place from 1 Oct 2022 to 31 Mar 2023. ChemoCalc was used by 72 different members of staff from all job groups. On average, the prices of 2,484 regimens (mean 11 regimens per patient) were generated each month, with a total of 17,385 price estimates generated. 91% of price estimates were for subsidized patients and 9% for private patients. For staff performing FC, the adoption and engagement rate was 100%. ChemoCalc improved efficiency for the FC process with an accuracy of 95% (baseline 35%, 270% increase). Time spent computing OOP reduced from a median of 8 min (range 4.5 - 13) to 44 seconds (range 15 - 20) for simple regimens, and 23 min (range 15.5 - 44) to 1 min (range 0.3 - 1.3) for complex regimens respectively. Due to the convenience and simplicity, there was 100% uptake for pre-treatment FC, as staff have been able to process more FC requests and spend more time addressing patients' financial concerns. It has also allowed patients to compare costs of different treatment regimens. Conclusion The implementation of ChemoCalc was successful with 100% adoption rate and significantly improved efficiency and accuracy. ChemoCalc's algorithm can easily be adjusted to accommodate country- or institution-specific reimbursements for implementation elsewhere. Further studies are required to investigate if pre-treatment FC addresses financial toxicity or influences healthcare costs.

Analysis of risk factors for community-acquired Clostridioides difficile diarrhea in children: a case-control study in Chenzhou, China.

Most previous studies on Clostridium difficile infection (CDI) mainly focused on adults with underlying diseases or critical illnesses. However, the number of CDI cases in children has also significantly increased, especially the growth of community-acquired CDI, which has attracted attention. This study was conducted to examine the toxin gene characteristics and the risk factors associated with community-acquired CDI (CA-CDI) in children with diarrhea. Children with diarrhea before admission or within 48 hours of hospitalization were included in the study. Stool samples were collected from children with community-acquired diarrhea who were treated at the Children's Hospital of the First People's Hospital of Chenzhou, China from June of 2021 to June of 2022. Fluorescence real-time polymerase chain reaction was utilized to detect Clostridioides difficile (CD) toxins A (tcdA) and B (tcdB) genes as well as binary toxin gene A (cdtA) and B (cdtB) in the specimens cultured for CD. Each child with CA-CDI was matched with four control children of the same sex, age, and place of residence. Necessary clinical data were extracted from the hospital's electronic medical record system. Then, a multivariate conditional logistic regression analysis was applied to identify potential risk factors for CA-CDI. Sixteen (8.3%) of the 193 stool specimens who tested positive for CD were selected for the case group, and their matching 64 control patients were in the study cohort. The breakdown of the CD genotypes of the 16 positive cases were follows: 14 (tcdA+ and tcdB+) (7.25%) and 2 (tcdA+ and tcdB-) (1.04%). The cdtA and cdtB binary toxin genes were negative in all. The results of multivariate conditional logistic regression analysis identified antibiotic use within the previous month [odds ratio (OR) =5.13; 95% confidence interval (CI): 1.65-15.91] and non-breastfeeding (OR =4.89; 95% CI: 1.11-21.53) as independent risk factors for CDI in pediatric patients experiencing community-acquired diarrhea. Children who had been treated with antibiotics and not breastfed were more susceptible to CDI. Therefore, in order to prevent and to control the spread of CD infection, being prudent to the aforementioned high-risk factors is strongly advocated in clinical practice.

Quantitative patient graph analysis for transient ischemic attack risk factor distribution based on electronic medical records

A transient ischemic attack (TIA) affects millions of people worldwide. Although TIA risk factors have been identified individually, a systemic quantitative analysis of all health factors relevant to TIA using electronic medical records (EMR) remains lacking. This study employed a data-driven approach, leveraging hospital EMR data to create a TIA patient health factor graph. This graph consisted of 737 TIA and 737 control patient nodes, 740 health factor nodes, and over 33,000 relations between patients and factors. For all health factors in the graph, the connection delta ratios (CDRs) were determined and ranked, generating a quantitative distribution of TIA health factors. A literature review confirmed 56 risk factors in the distribution and unveiled a potential new risk factor “rhinosinusitis” for future validation. Moreover, the patient graph was visualized together with the TIA knowledge graph in the Unified Medical Language System. This integration enables clinicians to access and visualize patient data and international standard knowledge within a unified graph. In conclusion, graph CDR analysis can effectively quantify the distribution of TIA risk factors. The resulting TIA risk factor distribution might be instrumental in developing new risk prediction machine learning models for screening and early detection of TIA.

[Characteristics of Inflammatory Markers in Diabetic Foot Patients and Their Relationship With Prognosis of Diabetic Foot Ulcers].

To explore the characteristics of baseline inflammatory markers in diabetic foot patients and their relationship with the prognosis of diabetic foot ulcers. The clinical data of diabetic foot patients (n=495) admitted to West China Hospital, Sichuan University since 2016 were retrospectively collected through the hospital electronic medical record system to analyze the characteristics of inflammatory markers and their relationship with the prognosis of diabetic foot ulcers. White blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels were significantly higher in patients defined as grade 4 on the Wagner Scale than those in patients defined as grade 0-3 on the Wagner Scale. Neutrophil percentage (NE%) was higher in Wagner grade-4 patients than those in Wagner grade-0 and grade-1 patients and higher in Wagner grade-3 patients than those in Wagner grade-0 patients. NE%, CRP, PCT, and IL-6 levels were positively correlated with the severity of diabetic foot, with the respective odds ratio (OR) at 95% confidence interval (CI) being 1.038 (1.019-1.056), 1.019 (1.012-1.026), 8.225 (2.015-33.576), and 1.017 (1.008-1.025). Using Wagner grade-0 patients as the reference, patients with higher WBC were more likely to progress to Wagner grade 2, 3, and 4, with the respective OR (95% CI) values being 1.260 (1.096-1.447), 1.188 (1.041-1.356), and 1.301 (1.137-1.490); patients with higher ESR were more likely to progress to Wagner grade 3 and 4, with the respective OR (95% CI) values being 1.030 (1.006-1.054) and 1.045 (1.019-1.071). Baseline ESR (P=0.008), CRP (P=0.039), and IL-6 (P=0.033) levels were lower in patients who had received antibiotics prior to their admission than those in patients who had not received antibiotics before admission. The levels of WBC, NE%, ESR, PCT, and IL-6 were lower in the full recovery group than those in the group of patients who did not respond to treatment. The higher the levels of NE% and IL-6, the worse the prognosis of diabetic foot ulcers became, with the respective OR (95% CI) values being 1.030 (1.010-1.051) and 1.008 (1.002-1.013). The severity of diabetic foot ulcers increased with the rise in baseline levels of inflammatory markers. Elevated baseline NE% and IL-6 levels suggest a poor prognosis. Our findings suggest that early assessment of diabetic foot infection and standardized antibiotic therapy should be implemented to improve the prognosis.

Treatment of Chronic Kidney Diseases with Darpeboetin can Ameliorate Kidney Functions: A Possible Clinical Relevance

Background: Erythropoietin (EPO) has been used clinically for the treatment of anemia as it was the first characterized hematopoietic factor. Erythropoietin is produced primarily by the kidneys (renal cortical fibroblasts) which induces proliferation and differentiation of erythroid progenitor cells. Previous studies suggested that erythropoietin may directly stimulates the regeneration of damaged tubular cells due to presence of erythropoietin receptors on renal tubular epithelial, mesangial and endothelial cells. EPO directly prevent glomerulosclerosis as a consequence of amelioration of podocyte injury. Therefore, to improve kidney function in chronic kidney disease (CKD), it is of critical importance to investigate clinically the beneficial reno-protective effects of EPO in patients with CKD. Methodology: The study was conducted at King Abdulaziz Medical City and included patients with chronic kidney diseases. Patients were under medical treatment with Darpeboetin for the first time. The administration frequency of Darpeboetin was single dose weekly. Kidney function tests including serum creatinine, serum urea, alkaline phosphatase, serum calcium, serum phosphorus, serum albumin and albuminuria were collected from the hospital electronic medical record system (BestCareR). Test values before and after treatment were compared. of the patients before starting treatment and at the end of treatment. The week before starting treatment was considered week 0 (baseline) Results: The results indicated that, treatment with a weekly single dose of Darpeboetin reduces blood urea nitrogen (BUN p=0.002) and serum uric acid level (p=0.009). The effect of treatment on serum calcium and potassium, showed a significant elevation of serum potassium (P<0.001), serum calcium (P<0.001) and adjusted calcium (P<0.001) levels parallel with significant decrease in serum phosphorus (p=0.004). Also treatment of chronic kidney disease patients significantly ameliorates serum albumin (P<0.001). Conclusion: Treatment with Darpeboetin may confirm the reno-protective potency. Darpeboetin is a promising drug to prevent or attenuate tissues kidney damage especially in chronic kidney disease

The SingHealth Perioperative and Anesthesia Subject Area Registry (PASAR), a large-scale perioperative data mart and registry.

To enhance perioperative outcomes, a perioperative registry that integrates high-quality real-world data throughout the perioperative period is essential. Singapore General Hospital established the Perioperative and Anesthesia Subject Area Registry (PASAR) to unify data from the preoperative, intraoperative, and postoperative stages. This study presents the methodology employed to create this database. Since 2016, data from surgical patients have been collected from the hospital electronic medical record systems, de-identified, and stored securely in compliance with privacy and data protection laws. As a representative sample, data from initiation in 2016 to December 2022 were collected. As of December 2022, PASAR data comprise 26 tables, encompassing 153,312 patient admissions and 168,977 operation sessions. For this period, the median age of the patients was 60.0 years, sex distribution was balanced, and the majority were Chinese. Hypertension and cardiovascular comorbidities were also prevalent. Information including operation type and time, intensive care unit (ICU) length of stay, and 30-day and 1-year mortality rates were collected. Emergency surgeries resulted in longer ICU stays, but shorter operation times than elective surgeries. The PASAR provides a comprehensive and automated approach to gathering high-quality perioperative patient data.

Abstract 278: Injuries and Outcomes Associated With Manual vs Mechanical CPR Post Out of Hospital Cardiac Arrest

Objectives: Mechanical CPR is increasingly being used for field out of hospital cardiac arrest (OHCA) care. However, existing literature does not identify a survival benefit of mechanical versus manual CPR. We hypothesized that CPR related injury may impact patient outcomes. For that reason, our primary objective is to compare mechanical and manual CPR-related injury in resuscitated OHCA patients. Our secondary objective is to compare hospital outcomes including length of stay (LOS) and survival between these two CPR methods. Methods: We performed a retrospective study of adult OHCA patients admitted to three teaching hospitals in Southeastern Michigan from 2017-2021. Resuscitated patients were matched to hospital electronic medical records (EMRs), included if they had CT imaging of chest or abdomen/pelvis, and then dichotomized by CPR method. Patients were excluded if no EMR match or CPR method was unknown. Hospital EMRs were queried for CT imaging results, LOS variables and survival to hospital discharge. Injuries are identified using hospital ICD-10 codes. Univariate statistics are reported. Results: There were 808 patients admitted after OHCA, with 235 (103 mechanical CPR, 132 manual CPR) meeting the inclusion criteria. Demographics between groups were similar in age, gender, or body mass index (BMI). There were no abdominal/visceral injuries and few patients (4) had a pneumothorax. CPR associated injury was more common with manual CPR (28.8% vs 15.5%, p=0.02) and an increased rate of rib(s), sternum, or thoracic spine fracture (27.3% vs 14.6%, p=0.02). . We identified no differences in survival to hospital discharge (39 (29.5%) vs. 29 (28.2%), p=0.8), median hospital LOS, ICU LOS, and ventilator time between groups. Paradoxically amongst survivors, mechanical CPR was associated with longer LOS (15.7 vs 11.0 days, p=0.012) and a non-significant increased ventilator time (143 vs 99 hours, p=0.23). Conclusion: We identified a higher rate of injury with manual CPR compared to mechanical CPR in resuscitated OHCA patients We also did not identify any association between CPR method and ICU LOS, ventilator time, and survival. Further work is needed to assess the impact on outcome of CPR method and injuries typically associated with resuscitation.

Sex-Based Differences and Risk Factors for Comorbid Nonalcoholic Fatty Liver Disease in Patients with Bipolar Disorder: A Cross-Sectional Retrospective Study.

Sex-based differences in patients with bipolar disorders (BD) are well recognized, and it is well known that the prevalence and severity of nonalcoholic fatty liver disease (NAFLD) are both higher in men than in women. Although metabolic disorders such as NAFLD are common in patients with BD, sex differences and risk factors for NAFLD comorbidity in these patients have not been thoroughly explored. This study aimed to investigate sex differences in patients with comorbid NAFLD and BD and associated risk factors. This retrospective cross-sectional study included 710 patients with BD. Clinical data of patients with BD, including information on fasting glucose, liver function-related enzymes, relevant lipid data, uric acid, the triglyceride-glucose index (TyG), and demographics, were derived from the hospital electronic medical record system from June 2020 to July 2022. We performed logistic regression analysis and calculated the odds ratios with 95% confidence intervals of factors using t-tests, χ²-tests, and receiver operating characteristic. NAFLD was diagnosed using liver ultrasonography. The prevalence of NAFLD was higher in male patients with BD than in female patients (50.9% vs 38.5%), and there were significant differences in the years of education and marital status (all P<0.05). Regression analysis showed that the risk factors for comorbidities were the body mass index (BMI), fasting glucose, and apolipoprotein B levels in male patients and the BMI, bipolar disease course, glutamine transpeptidase levels, and the TyG in female patients. Sex-based differences exist in risk factors and in the prevalence of comorbid NAFLD among patients with BD. BMI is a sex-independent risk factor, and clinical attention should be targeted to risk factors associated with comorbid NAFLD related to sex, especially in female patients with BD who presenting a high TyG index.

Benefits and challenges of adopting Electronic Medical Records in Nigerian Federal Capital Territory Hospitals-lessons learned

Electronic Medical Records (EMR) is a digital version of paper-based medical records designed to enhance patient outcomes. EMR in the healthcare system is fundamental to the continuity of patient care and the improvement of quality services. However, the lack of adequate and sustainable funding for health system utilization remains a significant challenge to the successful adoption of EMR. This study aims to identify the benefits and challenges associated with the adoption of Electronic Medical Records in the Federal Capital Territory (FCT) Hospitals in Abuja, Nigeria. A qualitative research method was employed to examine the benefits and challenges of adopting EMR in FCT hospitals. Questionnaires were administered to 310 participants, and collected data were analyzed using a thematic approach. The implementation of Electronic Medical Records (EMR) in FCT hospitals led to better healthcare services such as prompt tracking of patients’ records, and reduced costs associated with repetitive medical tests arising from the loss of patient files. Despite these benefits, a lack of sustainable funding and inadequate infrastructure technology were identified as major obstacles to the successful adoption of EMR in FCT hospitals. To ensure the continued use of EMR in FCT hospitals, it is essential to maintain efficient governance and regulation alongside upgrading the hospitals’ Information Communication Technology (ICT) infrastructures.

Effectiveness and Safety of Apatinib Plus Programmed Cell Death Protein 1 Blockades for Patients with Treatment-refractory Metastatic Colorectal Cancer: A Retrospective Exploratory Study.

This study aimed to investigate the efficacy and safety of apatinib plus programmed cell death protein 1 (PD-1) blockades for patients with metastatic colorectal cancer (CRC) who were refractory to the standard regimens. In this retrospective study, patients with metastatic CRC who received apatinib plus PD-1 blockades in clinical practice were included. The initial dosage of apatinib was 250 mg or 500 mg, and PD-1 blockades were comprised of camrelizumab, sintilimab and pembrolizumab. Efficacy and safety data were collected through the hospital's electronic medical record system. From October 2018 to March 2022, a total of 43 patients with metastatic CRC were evaluated for efficacy and safety. The results showed an objective response rate of 25.6% (95% CI, 13.5%-41.2%) and a disease control rate of 72.1% (95% CI, 56.3%-84.7%). The median progression-free survival (PFS) of the cohort was 5.8 months (95% CI, 3.81-7.79), and the median overall survival (OS) was 10.3 months (95% CI, 5.75-14.85). The most common adverse reactions were fatigue (76.7%), hypertension (72.1%), diarrhea (62.8%), and hand-foot syndrome (51.2%). Multivariate Cox regression analysis revealed that Eastern Cooperative Oncology Group (ECOG) performance status and location of CRC (left or right-side) were independent factors to predict PFS of patients with metastatic CRC treated with the combination regimen. Consequently, the combination of apatinib and PD-1 blockades demonstrated potential efficacy and acceptable safety for patients with treatment-refractory metastatic CRC. This conclusion should be confirmed in prospective clinical trials subsequently.

Impact of Podiatric Surgery Consultation for Foot and Ankle Wounds on Patient Outcomes in a Community Hospital

Previous studies have demonstrated that timely podiatric surgery consultation results in positive patient outcomes. However, there are limited studies focused on readmission rates in teaching community hospitals. The primary aim of this study is to determine if consulting podiatric services was associated with lower 30-day readmission rates and impact on length of stay in patients with lower extremity wounds. The secondary aim was to investigate medical and socio-economic factors associated with better outcomes. This study was a cross-sectional descriptive study. A retrospective chart review utilizing the hospital's electronic medical record system identified patients with lower extremity wounds (based on ICD-10 codes) admitted between July 2018 and December 2020. The results showed a 3-fold decrease in 30-day readmission rates in patients with podiatric surgery consultation compared to patients without consultation with lower extremity wounds (4.2% vs 11.3%, p=.03). Multivariate regression models showed patients with gangrene (AOR=7.61; p=.04) or osteomyelitis (AOR=9.07; p=.013) had a higher likelihood of readmission than patients with venous ulcer (reference category) after controlling for podiatric consultation. Among the group of patients with podiatric consultation, earlier podiatric consultations resulted in decreased length of stay. This study identifies prior amputation history and lack of podiatric consultation increased 30-day readmission rates.

Liver function test indices-based prediction model for post-stroke depression: a multicenter, retrospective study

BackgroundPost-stroke depression (PSD) was one of the most prevalent and serious neuropsychiatric effects after stroke. Nevertheless, the association between liver function test indices and PSD remains elusive, and there is a lack of effective prediction tools. The purpose of this study was to explore the relationship between the liver function test indices and PSD, and construct a prediction model for PSD.MethodsAll patients were selected from seven medical institutions of Chongqing Medical University from 2015 to 2021. Variables including demographic characteristics and liver function test indices were collected from the hospital electronic medical record system. Univariate analysis, least absolute shrinkage and selection operator (LASSO) and logistic regression analysis were used to screen the predictors. Subsequently, logistic regression, random forest (RF), extreme gradient boosting (XGBoost), gradient boosting decision tree (GBDT), categorical boosting (CatBoost) and support vector machine (SVM) were adopted to build the prediction model. Furthermore, a series of evaluation indicators such as area under curve (AUC), sensitivity, specificity, F1 were used to assess the performance of the prediction model.ResultsA total of 464 PSD and 1621 stroke patients met the inclusion criteria. Six liver function test items, namely AST, ALT, TBA, TBil, TP, ALB/GLB, were closely associated with PSD, and included for the construction of the prediction model. In the test set, logistic regression model owns the AUC of 0.697. Compared with the other four machine learning models, the GBDT model has the best predictive performance (F1 = 0.498, AUC = 0.761) and was chosen to establish the prediction tool.ConclusionsThe prediction model constructed using these six predictors with GBDT algorithm displayed a promising prediction ability, which could be used for the participating hospital units or individuals by mobile phone or computer.

Quality Improvement (QI) Framework to Examine Health Care Disparities in Behavioral Emergency Management in the Inpatient Medical Setting: A Consultation-Liaison (CL) Psychiatry Health Equity Project.

De-escalation of behavioral emergencies in the inpatient medical setting may involve restrictive clinical interventions that directly challenge patient autonomy. We describe a quality improvement framework used to examine associations between patient characteristics and behavioral emergency de-escalation strategies. This project may inform other Consultation-Liaison Psychiatry teams seeking to promote equity in care. We examined behavioral emergency response team (BERT) management at an urban, tertiary-care medical center in the United States over a 3-year period. BERT data from an existing dataset were combined with demographic information from the hospital's electronic medical record. Race and ethnic identities were categorized as Black, Hispanic, Asian, White, and unknown. BERT events were coded based on the most restrictive intervention utilized per unique patient. Cross-tabulations and adjusted odds ratios from multivariate logistic regression were used to identify quality improvement targets in this exploratory project. The sample included N= 902 patients and 1532 BERT events. The most frequent intervention reached was verbal de-escalation (n= 419 patients, 46.45%) and the least frequent was 4-point restraints (n= 29 patients, 3.2%). Half of BERT activations for Asian and a third for Hispanic patients required interpreter services. Anxiety and cognitive disorders and 2 BERT interventions, verbal de-escalation, and intramuscular/intravenous/ medications, were significantly associated with race/ethnic category. The most restrictive intervention for BERTs involving Black and Asian patients were verbal de-escalation (60.1%) and intramuscular/intravenous(53.7%), respectively. These proportions were higher compared with other race/ethnic groups. There was a greater percentage of patients from the unknown (6.3%) and Black (5.9%) race/ethnic groups placed in 4-point restraints compared with other groups (3.2%) that did not reach statistical significance. A logistic regression model predicting 4-point restraints indicated that younger age, multiple BERTs, and violent behavior as a reason for BERT activation, but not race/ethnic group, resulted in significantly higher odds. This project illustrates that a quality improvement framework utilizing existing clinical data can be used to engage in organizational introspection and identify potential areas of bias in BERT management. Our findings suggest opportunities for further exploration, enhanced education, and programmatic improvements regarding BERT intervention; 4-point restraints; interpreter services; and the influence of race on perception of psychopathology.

Paediatric hospital visit with laboratory-confirmed influenza improved family members' influenza vaccination.

Vaccination is the primary intervention to prevent influenza infection, yet vaccine uptake remains low among children and other at-risk patients. The aim of the study is to investigate the impact of a paediatric hospital visit with laboratory-confirmed influenza on the influenza vaccination behaviour of participants and their family members in the subsequent influenza season. This study compared the influenza vaccination coverage for participants < 18 years of age with a clinical suspicion of influenza in 2017-2018 during a hospital visit, in two subsequent influenza seasons. Data was retrieved from the hospital electronic medical record and a follow-up questionnaire (2018-2019) to ascertain the common reason(s) that families did not vaccinate their children the following year (2018-2019). The children were distributed into positive- (antigen and/or PCR) and negative-influenza groups. A total of 133 children were enrolled in our study. Participants' mean age was 4.6 years and 74 (55.6%) were males. Overall, 47 (35.3%) had confirmed influenza virus. A significant increase in influenza immunization was found among both positive- and negative-influenza participants between 2017-2018 and 2018-2019 (6.4% vs. 27.7%, p < 0.001; 8.1% vs. 29.1%, p < 0.001, respectively), as well as among family members of positive-influenza participants - siblings and parents (6.4% vs. 19.6%, p = 0.003; 0% vs. 17%, p < 0.001, respectively). Common reasons for failure to vaccinate included doubt in vaccine effectiveness, unlikely to get "flu", busy, and side effects. Our findings suggest that a paediatric hospital visit with laboratory-confirmed influenza increases vaccine uptake among families. Future studies should aim to evaluate evidence-based interventions to improve influenza vaccine uptake among children.