Hospital Electronic Patient Research Articles

Introducing a Framework for Surgical Discharge Summaries to Improve Accuracy and Succinctness in a Busy District General Hospital.

Background Discharge summaries (TTOs) are essential documents in the effective communication between primary and secondary care, particularly in conveying critical post-discharge instructions to patients. Inconsistencies and omissions in TTOs can significantly undermine patient outcomes and disrupt continuity of care. This is particularly relevant to surgical patients, who often require specific follow-up care such as the removal of clips or drains shortly after discharge. Following the recent transition from paper-based to electronic records at a busy district general hospital (Royal Blackburn Hospital, Blackburn), the quality of TTOs was noted to be substandard.This quality improvement project aimed to enhance the accuracy and clarity of surgical TTOs. Methods A targeted framework was developed in collaboration with local consultants and the consideration of national guidelines to guide the content of surgical TTOs, focusing on five essential components: Reason for Admission, Intervention, Surgical Details, Discharge Plan, and Follow-up Instructions. Initial retrospective data analysis includedTTOs (n=60) across five surgical wards, evaluating their quality against the framework. The framework was then introduced via educational initiatives and integrated into the hospital's electronic patient record (EPR) system (CERNER). The impact of these interventions was assessed through data collection after two Plan-Do-Study-Act (PDSA) cycles. Results Baseline data highlighted significant deficiencies; 42 (70%) of TTOs were missing at least one key element, with missing follow-up details most often the reason. Many TTOs also included excessive or inappropriate information, and their format varied greatly depending on individual writing styles. Following the first PDSA cycle and the introduction of the framework, the numberof TTOs containing all essential data points increased by 14 (30% increase), while those missing two or more elements decreased by 16 (48% decrease). After the second cycle, further improvements were observed, with the number of TTOs missing one or more data points decreased by 6 (21%). Despite the overall progress, follow-up information continued to be the most frequently omitted element. Feedback from resident doctors was positive and the unanimous opinion was that the framework improved not only the quality of TTOs, but also how efficiently they were written. Conclusions Implementing a standardised framework significantly improved the quality of surgical TTOs, particularly by increasing the inclusion of critical information. These results are encouraging. However, anecdotal evidence suggests there is a lack of training in writing TTOs at both undergraduate and foundation levels. Ongoing efforts are required to address these areas to ensure a sustained improvement in quality.

Perceptions of hospital electronic health record (EHR) training, support, and patient safety by staff position and tenure

BackgroundHospitals rely on their electronic health record (EHR) systems to assist with the provision of safe, high quality, and efficient health care. However, EHR systems have been found to disrupt clinical workflows and may lead to unintended consequences associated with patient safety and health care professionals’ perceptions of and burden with EHR usability and interoperability. This study sought to explore the differences in staff perceptions of the usability and safety of their hospital EHR system by staff position and tenure.MethodsWe used data from the AHRQ Surveys on Patient Safety Culture® (SOPS®) Hospital Survey Version 1.0 Database and the SOPS Health Information Technology Patient Safety Supplemental Items (“Health IT item set”) collected from 44 hospitals and 8,880 staff in 2017. We used regression modeling to examine perceptions of EHR system training, EHR support & communication, EHR-related workflow, satisfaction with the EHR system, and the frequency of EHR-related patient safety and quality issues by staff position and tenure, while controlling for hospital ownership type and bed-size.ResultsIn comparison to RNs, pharmacists had significantly lower (unfavorable) scores for EHR system training (regression coefficient = -0.07; p = 0.047), and physicians, hospital management, and the IT staff were significantly more likely to report high frequency of inaccurate EHR information (ORs = 2.03, 1.34, 1.72, respectively). Compared to staff with 11 or more years of hospital tenure, new staff (less than 1 year at the hospital) had significantly lower scores for EHR system training, but higher scores for EHR support & communication (p < 0.0001). Dissatisfaction of the EHR system was highest among physicians and among staff with 11 or more years tenure at the hospital.ConclusionsThere were significant differences in the Health IT item set’s results across staff positions and hospital tenure. Hospitals can implement the SOPS Health IT Patient Safety Supplemental Items as a valuable tool for identifying incongruity in the perceptions of EHR usability and satisfaction across staff groups to inform targeted investment in EHR system training and support.

Outcome of meniscal repairs in paediatric population: A tertiary centre experience.

Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis. However, there is limited data in the literature on meniscal repair outcomes in skeletally immature patients. To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and adolescents. We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January 2018. All patients were under the age of 18 at the time of surgery. Procedures were all performed by a single surgeon. Information was gathered from our hospital Electronic Patient Records system. The primary outcome measure was re-operation rate (need for further surgery on the same meniscus). Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee (IKDC), Tegner and Lysholm scores. We identified 59 patients who underwent 66 All-inside meniscal repairs (32 medial meniscus and 34 Lateral meniscus). Meniscal repairs were performed utilizing FasT-Fix (Smith and Nephew) implants. There were 37 males and 22 females with an average age of 14 years (range 6-16). The average follow-up time was 53 months (range 26-140). Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal repair. There were no intra-operative complications. The re-operation rate for meniscal repairs was 16.6% (11 cases) with 2 patients requiring further meniscal repairs and 9 patients underwent partial meniscectomies. The mean postoperative IKDC score was 88 (44-100), Tegner score was 7(2-10) and Lysholm score was 94 (57-100). Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.

The hybrid ablation approach to treating long-standing persistent atrial fibrillation: real-world data from a tertiary institution

Abstract Background Pulmonary vein isolation(PVI) is effective treatment for atrial fibrillation(AF) but efficacy of endocardial ablation-alone for long-standing persistent AF is limited(1). Hybrid AF ablation may offer better outcomes but studies were on patients with paroxysmal/persistent-AF(2) and relied on Holter-alone to assess recurrences(3). Our hybrid-AF ablation patients were all long-standing persistent cases and monitored with implantable loop recorders(ILR). Aim Evaluate long-term outcomes of hybrid-AF ablation using ILR data. Methods The hybrid approach at our institution consisted of a first-stage minimally invasive surgical epicardial ablation of the left atrial posterior wall via radiofrequency (RF) ablation. An ILR was implanted at the same setting. A few months later, the second-stage endocardial catheter ablation was performed to ensure PVI and ‘touch-up’ of any residual conduction gaps in the left atrium. All epicardial ablation cases were performed at the cardiothoracic operating-room in our tertiary hospital (‘hub’) whilst the endocardial RF-cases were performed at either the hub or satellite centre(‘spoke’) as part of our institution’s ‘hub-and-spoke’ model. Inclusion criteria for hybrid AF-ablation were long-standing persistent AF, body mass index (BMI) &amp;lt;40 and standard indications for AF ablation as per ESC 2020 AF guidelines(4). Once both aspects of the hybrid approach were completed, patients were followed up in ILR remote monitoring clinics. AF recurrence was defined as AF/atrial tachycardia(AT) lasting &amp;gt;30s. All data were obtained retrospectively via hospital electronic patient records. Results 38 consecutive patients completed both aspects of hybrid ablation between December 2017-August 2023 with mean follow up of 19±13months(mean±SD). Baseline data, procedure characteristics and details of complications are shown in Table 1. ILR data was obtained in 36/38 patients(ILR implantation precluded in one due to previous breast cancer surgery. One had ILR battery depletion contributed by significant delay between the 2 stages of the hybrid ablation). AF/AT recurred in one third of patients during the blanking period(3 months) whilst 45% remained in sinus rhythm at 1-year; at 2yrs, 39% maintained SR and 25% at 3yrs (Figure 1). Post-hybrid ablation, two patients underwent re-do AF/AT ablation. The relatively high recurrence rate compared to other studies may be due to: very long duration of AF prior to hybrid-ablation(7.0±3.6years), significant delay between both stages of the procedure(9±11months) due to the pandemic and competing waiting list pressures, multiple comorbidities (82% had &amp;gt;2 comorbidities, 42% were obese) and the higher arrhythmia pickup rate with ILRs compared with intermittent rhythm monitoring. Conclusion Our study provides real world insight into the challenges of delivering a hybrid AF ablation service but highlights its utility in long-standing persistent AF patients.Table 1Figure 1

E002 The Psoriasis Epidemiology Screening Tool (PEST) as a mechanism for diagnosing psoriatic arthritis in dermatology practice: 5 year follow-up data from a quality improvement project

Abstract Background/Aims We carried out a QIP in 2018 as a collaboration between dermatology and rheumatology. 280 patients with psoriasis attending outpatient appointments in dermatology completed Psoriasis Epidemiology Screening Tool (PEST) forms between January and April 2018; results were recorded on the patient record. 110 patients (39%) had a positive PEST score, indicating a possible diagnosis of PsA. Of these, 48/110 were not already known to rheumatology services. Patients with a positive PEST were informed of the results and their GP was advised to refer to rheumatology if they had not previously been assessed. The pathway aimed to avoid duplication of assessments, and acknowledged that patients with psoriasis may have had a rheumatology assessment at another hospital, or even be under their ongoing care. Methods We reviewed the hospital electronic and regional patient records of the 48 patients in January 2023 in order to identify which of these had been referred for a rheumatology review and/or had a new diagnosis of psoriatic arthritis. Results One patient was excluded due to lack of access to local records. Of the remaining 47 patients, 31 had a PEST score of 3, 15 patients scored 4, and 1 patient scored 5. 5/47 (10%) patients were referred for a rheumatology opinion following a positive PEST score. 3/5 of these patients went on to be diagnosed with psoriatic arthritis. 7/47 (15%) patients had a diagnosis of psoriatic arthritis on GP records with no secondary care input. None of these patients were on treatment for PsA. 7/31 patients with PEST score of 3 were diagnosed with PsA, 2/15 patients with PEST score of 4 and the only patient with a score of 5 were diagnosed with PsA. Overall 10/47 (21%) patients were diagnosed with PsA. Conclusion A letter from dermatology to request review of joint disease and consideration of a rheumatology referral in response to a positive PEST score appears to have resulted in a low response in terms of rheumatology review. Others seemingly acquired a diagnosis of PsA without rheumatology review, potentially through the PEST score alone, which is concerning, and not how the PEST score should be used. Screening for PsA in psoriasis populations remains problematic. PEST score is recommended by dermatology guidelines, but lacks specificity and can result in high numbers of referrals, with potential duplication of work if referred repeatedly. It is important to recognise PsA in patients with psoriasis, but equally important that this is done efficiently and accurately, so patients are not inadvertently treated or inaccurately labelled with this diagnosis. Rheumatologists should work with dermatology and primary care colleagues to improve understanding of PsA and the PEST questionnaire, and consider the optimum pathways to ensure that PsA is recognised and treated promptly. Disclosure S. Ahmed: None. M. Babiker: None. M. Osama: None. M. Ahmed: None. K. Jobling: None. P. Hampton: None. B. Thompson: None.

E007 Novel signs to predict healthcare consumption following bone fracture: a clinical audit

Abstract Background/Aims Recovery following fracture is variable. Previously we have identified poor outcomes based upon baseline abnormal body scheme. We now aimed to determine whether these novel bedside tests measuring finger perception abnormalities and body scheme disruption can be used to predict healthcare utilisation post fracture. Methods We performed two bedside tests in patients who were in cast in the plaster room. We followed up clinical records for 2+ years and gathered data on the use of healthcare resources from both hospital and primary care electronic patient records. The novel tests were a finger perception (FP) and body scan (BS) assessment. The audit was approved by Cambridge University Hospitals (PRN8899). Results 46 patients were included. 2 had incomplete data and were excluded from the final analysis. 25 patients (group 1) had no abnormalities in their body scheme at baseline in the fracture room. 16 had a single abnormality and 3/44 (group 2, 7%) had both FP and BS. This final group consumed more analgesics, took longer to discharge and had a greater utilisation of healthcare resources (Table 1). Comparing the cost difference using NHS 2020 Reference costs between groups 1 and 2 was around £530/patient. Annually this equates to £175,000 for CUH. Conclusion FS and BS are easy to assess in patients with a bone fracture and predict a cohort which expressed more pain and health care consumption. Upscaling the difference between the normal and abnormal groups would incur an annual trust and primary care cost of £175,000. Disclosure R. Mudkavi: None. N. Shenker: None.

Spectrum of Genetic Variants in the Most Common Genes Causing Inherited Retinal Disease in a Large Molecularly Characterized United Kingdom Cohort

PurposeInherited retinal disease (IRD) is a leading cause of blindness. Recent advances in gene-directed therapies highlight the importance of understanding the genetic basis of these disorders. This study details the molecular spectrum in a large UK IRD patient cohort. DesignRetrospective study of electronic patient records. ParticipantsPatients with IRD who have attended the Genetics Service at Moorfields Eye Hospital between 2003 and July 2020, in whom a molecular diagnosis has been identified. MethodsGenetic testing was undertaken via a combination of single-gene testing, gene panel testing, whole exome sequencing, and more recently, whole genome sequencing. Likely disease-causing variants were identified from entries within the genetics module of the hospital electronic patient record (OpenEyes Electronic Medical Record, UK). Analysis was restricted to only genes listed in the Genomics England PanelApp R32 Retinal disorders panel (Version 3.24), which includes 412 genes associated with IRD. Manual curation ensured consistent variant annotation and included only plausible disease-associated variants. Main outcome measuresDetailed analysis was performed for variants in the five most frequent genes (ABCA4, USH2A, RPGR, PRPH2, BEST1), as well as for the commonest variants encountered in the IRD study cohort. ResultsWe identified 4415 individuals from 3953 families with molecularly diagnosed IRD (variants in 166 genes). 42.7% of families had variants in one of the five commonest IRD genes. Complex disease alleles contributed to disease in 16.9% of affected families with ABCA4-associated retinopathy. USH2A exon 13 variants were identified in 43% of affected individuals with USH2A-associated IRD. 71% of RPGR variants were clustered in the ORF15 region. PRPH2 and BEST1 variants were associated with a range of dominant and recessive IRD phenotypes. Of the 20 most prevalent variants identified, five were not in the commonest genes; these included founder variants in CNGB3, BBS1, TIMP3, EFEMP1 and RP1. ConclusionsWe describe the commonest pathogenic IRD alleles in a large single-center multi-ethnic UK cohort, and the burden of disease, in terms of families affected, attributable to these variants. Our findings will inform IRD diagnoses in future patients and helps delineate the cohort of patients eligible for gene-directed therapies under development.

Transfusion practice in Central Norway – a regional cohort study in patients suffering from major haemorrhage

BackgroundIn patients with major hemorrhage, balanced transfusions and limited crystalloid use is recommended in both civilian and military guidelines. This transfusion strategy is often applied in the non-trauma patient despite lack of supporting data. The aim of this study was to describe the current transfusion practice in patients with major hemorrhage of both traumatic and non-traumatic etiology in Central Norway, and discuss if transfusions are in accordance with appropriate massive transfusion protocols.MethodsIn this retrospective observational cohort study, data from four hospitals in Central Norway was collected from 01.01.2017 to 31.12.2018. All adults (≥18 years) receiving massive transfusion (MT) and alive on admission were included. MT was defined as transfusion of ≥10 units of packed red blood cells (PRBC) within 24 hours, or ≥ 5 units of PRBC during the first 3 hours after admission to hospital. Clinical data was collected from the hospital blood bank registry (ProSang) and electronic patient charts (CareSuite PICIS). Patients undergoing cardiothoracic surgery or extracorporeal membrane oxygenation treatment were excluded.ResultsA total of 174 patients were included in the study, of which 85.1% were non-trauma patients. Seventy-six per cent of all patients received plasma:PRBC in a ratio ≥ 1:2 (high ratio) and 59.2% of patients received platelets:PRBC in a ratio ≥ 1:2 (high ratio). 32.2% received a plasma:PRBC-ratio ≥ 1:1, and 23.6% platelet:PRBC-ratio ≥ 1:1. Median fluid infusion of crystalloids in all patients was 5750 mL. Thirty-seven per cent of all patients received tranexamic acid, 53.4% received calcium and fibrinogen concentrate was administered in 9.2%.ConclusionsMost patients had a non-traumatic etiology. The majority was transfused with high ratios of plasma:PRBC and platelet:PRBC, but not in accordance with the aim of the local protocol (1:1:1). Crystalloids were administered liberally for both trauma and non-trauma patients. There was a lower use of hemostatic adjuvants than recommended in the local transfusion protocol. Awareness to local protocol should be increased.

Analysis on the epidemiological and drug resistance characteristics of osteoarticular tuberculosis in South-central China.

Osteoarticular tuberculosis (OATB) is one of the most common forms of extrapulmonary tuberculosis; however, limited epidemiological data are available on this public health concern worldwide, especially in developing countries. This study aimed to analyze the clinical epidemiology and drug resistance characteristics of OATB cases in Hunan province which located in South-central China. We retrospectively enrolled OATB patients with Mycobacterium tuberculosis culture positive at Hunan Chest Hospital from January 2013 through March 31, 2022. The multiple demographic, clinical variables and drug susceptibility data of the patients were collected from the hospital's electronic patient records. Descriptive statistical methods, Chi-square test and logistic regression analysis were employed as statistical methods. Of the 269 OATB cases, 197 (73.23%) were males, 206 (76.85%) were farmers; patients' ages ranged from 5 to 85 years, 57 (21.19%) aged at 20-29 years old and 52 (19.33%) aged at 60-69 years old. In terms of the disease, 177 (65.80%) had spinal TB with most occurrence in lumbar vertebrae (26.02%, 70/269), multiple spinal sites (18.96%, 51/269) and thoracic vertebrae (15.24%, 41/269). Outside of the spine, OATB mainly occurred in the lower limb (13.38%, 36/269). In terms of drug resistance, 40 (14.87%) and 72 (26.77%) were resistant to rifampicin (RFP) and isoniazid (INH) respectively; 38 (14.13%) were multi-drug resistant (MDR), and a total of 78 (29.00%) isolates were drug resistant. OATB patients aged 40-49 years old (compared to those aged ≥70 years) and from the west of Hunan province, China (compared to those from the center of Hunan) were at risk for developing RR/MDR (ORs were 5.057 and 4.942, respectively; 95% CIs were 1.009-25.342 and 1.458-16.750, respectively). In South-central China, OATB mainly affected males, farmers and those aged 20-29 and 60-69 years old. Spinal TB is prone to occur in the lumbar and multiple spinal sites. The resistance situation of OATB was serious, and people aged 40-49 years old and patients from the west of Hunan were risk factors of RR/MDR. All these findings will help to improve the prevention, diagnosis and treatment strategies of OATB.

Analysis on epidemiological and drug resistance characteristics of lymph node tuberculosis from Hunan province, China.

To investigate the clinical epidemiological and drug resistance (DR) characteristics of lymph node tuberculosis (LNTB) in Hunan Province which locates in South-central China, and to provide scientific clues for effective prevention and treatment of LNTB. We retrospectively collected LNTB patients with Mycobacterium tuberculosis culture positive at Hunan Chest Hospital, the biggest TB reference hospital in South-central China, from January 2013 to December 2021. The multiple demographic, clinical and drug susceptibility data of patients were collected from the hospital's electronic patient records. Descriptive statistical methods, Chi-square test and logistic regression analysis were employed as statistical methods. Of the 577 LNTB cases, 373 (64.64%) were males, 352 (61.01%) were farmers; majority (161, 33.10%) aged at 20-29 years old; 147 (25.48%) had simple LNTB, 350 (60.66%) had LNTB combined with pulmonary TB (PTB) (defined as LNTB-PTB), and 80 (13.86%) had LNTB combined with other extrapulmonary TB (EPTB) (defined as LNTB-EPTB). A total of 345 (59.79%, 345/577) LNTB patients had cervical node infection, and the simple LNTB patients (81.63%, 120/147) had higher proportion of this infection than LNTB-PTB (51.71%, 181/350) and LNTB-EPTB (55.00%, 44/80) (both p values <0.017), respectively. LNTB-EPTB was more inclined to have abdominal tuberculous LNs (20%, 16/80) and at least four tuberculous lesions (22.50%, 18/80) than simple LNTB and LNTB-PTB. Seventy-seven (13.34%) and 119 (20.62%) were resistant to rifampicin (RIF) and isoniazid (INH), respectively; 72 (12.48%) were multi-drug resistant (MDR), and a total of 150 (26.00%) were DR (resistant to at least one of RIF, INH, ethambutol and streptomycin). LNTB patients aged 30-34 and 50-54 years old (compared to those aged <30 years) were independent predictors of RIF resistance (RR) (ORs were 3.47 and 2.83, respectively; 95% CIs were 1.64-7.35 and 1.08-7.46, respectively). Our study disclosed the epidemiological and DR characteristics of LNTB in Hunan Province, China. High LNTB prevalence was found in younger people while high RR LNTB prevalence was found in older ones, suggesting that we should conduct further studies to clarify the occurrence of RR in LNTB, meanwhile, strengthen the diagnoses and treatments of LNTB to prevent the emergence of RR.

Types, predictors, and consequences of medicines related problems (MRPs) in frail older adults admitted to hospital from primary care - A retrospective cohort study

IntroductionMedicines related problems (MRPs) can be common in frail older people due to age-compromised body systems and a propensity to be on multiple drugs concurrently. This group of people can also succumb to a rapid deterioration in health. Thus, it is important to investigate MRPs in frail older people. The objectives of the study were to evaluate prevalence of MRPs, types of MRPs, risk factors and deterioration that can be associated with MRPs in frail older people admitted to an English teaching hospital from primary care. MethodsIncluded in the sample were frail older adults, aged 65 years and over, admitted from primary care. Data was retrieved from the hospital's electronic patient record system, anonymised, and reviewed for MRPs. MRPs which were retrospectively identified at admission were coded with the WHO-ICD10,2016 (World Health Organisation-International Classification of Diseases version 10, 2016). Descriptive and inferential statistics were performed on the data using SPSS Version 25. Primary outcome was the prevalence of MRPs in frail older patients. Secondary outcome was the association of deterioration indicated as fall, delirium, or NEWs ≥3 with presence of MRPs. ResultsAmong the 507 frail older people (≥4 on Rockwood scale) that met criteria for inclusion, 262 (51.8%) were patients with MRPs and 244 (48.2%) without. The Median age of sample as a whole was 85 years (IQR = 80–89). Prevalence of MRPs was 33.28%. Types of MRPs were adverse drug reaction (ADR-20%), non-compliance (9.1%), unintentional poisoning (3.3%) and inappropriate polypharmacy (0.8%). In logistic regression, potentially inappropriate medicines (PIM), social support, number of comorbidities and winter were significant predictors of MRPs. Risk of deteriorating with delirium was two times higher in patients with MRPs than in patients without MRPs, RR 2.613 (95% CI, 1.049 to 6.510). ConclusionMRPs and risks of deterioration associated with MRPs in frail older people can be reduced. This is because factors associated with MRPs can be modified.

OGBN P47 Isolated Pneumoperitoneum following ERCP

Abstract Background An 84-year-old man underwent a difficult ERCP following biliary leak after laparoscopic converted to open cholecystectomy for acute cholecystitis. Postoperative scan was suggestive of bile leak from Cystic Duct stump and an ERCP-stenting had been requested to treat the problem. He needed urgent decompression for extensive pneumoperitoneum causing acute ventilatory dysfunction during the procedure. Post procedure CT showed pneumoperitoneum and pneumobilia suggesting air leak through Cystic Duct Stump. Methods The patient had been admitted for acute cholecystitis and had undergone treatment as an inpatient. An urgent abdominal decompression with a Veress needle after completing the procedure had resolved the acute respiratory distress. He needed a short stay in the intensive care after the ERCP before being safely stepped down to the wards. Records of the rare event was collected retrospectively from the hospital electronic patient record system. Results The patient recovered after continued monitoring and support in the Intensive Care. He needed transient respiratory support and treatment for lung collapse. The CT scan ruled out any duodenal injury - the initial suspected reason for the acute deterioration. The presumed cause of the pneumoperitoneum was air leak from an open Cystic Duct stump following canulation of the common bile duct. Conclusions Pneumoperitoneum after ERCP is usually secondary to duodenal injury. Our patient had no evidence of Free pneumoperitoneum causing respiratory compromise at ERCP - this is extremely rare. The patient was monitored till discharge for any sign of hollow viscus re-perforation Pneumoperitoneum due to air leak from Cystic Duct stump has not been reported before.

Prognosis of Zero Coronary Artery Calcium Score in Symptomatic Patients of South Asian Descent – An Experience From a Tertiary Care Center in Pakistan

Objectives: To estimate the prevalence of non-calcified coronary artery disease in patients with chest pain and a zero coronary artery calcium score, and to assess the prognostic significance of a zero coronary artery calcium score in these symptomatic patients.&#x0D; Methodology: All consecutive patients who underwent a CT coronary angiogram (CTCA) for evaluation of angina or angina-equivalent symptoms from 2009 to December 2020 were enrolled retrospectively. Patients with prior myocardial infarction, history of revascularization, and congenital heart disease were excluded. Follow-up data was collected by using the hospital's electronic patient record system and telephone communication. The endpoint, major-adverse cardiovascular events (MACE) was defined as the total of cardiac death, non-fatal myocardial infarction, and/or non-elective revascularization.&#x0D; Results: A total of 534 patients were enrolled after final exclusion. The mean age was 53 years ± 11. Males constituted 68.4% of the study population. Dyslipidemia was the most common co-morbid condition identified (50%), followed by diabetes (18.4%) and hypertension (3.6%). Chest pain was the most common presenting complaint (97.4%) followed by dyspnea. At least 28.8% of patients with zero CAC scores had the presence of coronary artery disease (soft plaque) of any degree. Obstructive CAD (&gt;50%) was present in 5.8% of patients. Follow-up was available for 61.4% of patients. The mean follow-up duration was 96.6 months ± 49.8 (range 21 – 194 months). All-cause Major Adverse Cardiovascular Event (MACE) was observed in 8.8% of patients. The most common MACE outcome was angina (3.96%) and all-cause mortality (3%). Only 2.7% required revascularization on follow-up with 1.2% having myocardial infarction and non-urgent revascularization. The baseline characteristics, all-cause MACE (p = 0.79), mortality (0.82), angina (p = 0.765), revascularization (p = 0.45), non-fatal MI, and non-elective revascularization (p = 0.6) did not differ significantly in patients with and without obstructive CAD. The baseline characteristics did not differ significantly between patients with and without MACE.&#x0D; Conclusion: The incidence of soft plaque in this South Asian cohort is higher than that reported in international studies. However, in symptomatic South Asians, a CAC score of zero carries a good long-term prognosis, irrespective of the degree of CAD.

A Datasheet for the INSIGHT University Hospitals Birmingham Retinal Vein Occlusion Data Set.

Retinal vein occlusion (RVO) is the second leading cause of visual loss due to retinal disease. Retinal vein occlusion increases the risk of cardiovascular mortality and the risk of stroke. This article describes the data contained within the INSIGHT eye health data set for RVO and cardiovascular disease. Data set descriptor for routinely collected eye and systemic disease data. All people who had suffered an RVO aged ≥ 18 years old, attending the Ophthalmology Clinic at Queen Elizabeth Hospital, University Hospitals Birmingham (UHB) National Health Service (NHS) Trust were included. The INSIGHT Health Data Research Hub for Eye Health is an NHS-led ophthalmic bioresource. It provides researchers with safe access to anonymized routinely collected data from contributing NHS hospitals to advance research for patient benefit. This report describes the INSIGHT UHB RVO and major adverse cardiovascular events data set, a data set of ophthalmology and systemic data derived from the United Kingdom's largest acute care trust. This data set consists of routinely collected data from the hospital's electronic patient records. The data set primarily includes structured data (relating to their hospital eye care and any cardiovascular data held for the individual) and OCT ocular images. Further details regarding the available data points are available in the supplementary information. At the time point of this analysis (September 30, 2022) the data set was composed of clinical data from 1521 patients, from Medisoft records inception. The data set includes 2196 occurrences of RVO affecting 2026 eyes, longitudinal eye follow-up clinical parameters, over 6217 eye-related procedures, and 982 encountered complications. The data set contains information on 2534 major adverse cardiovascular event occurrences, their subtype, number experienced per patient, and chronological relation to RVO event. Longitudinal follow-up data including laboratory results, regular medications, and all-cause mortality are also available within the data set. This data set descriptor article summarizes the data set contents, the process of its curation, and potential uses. The data set is available through the structured application process that ensures research studies are for patient benefit. Further information regarding the data repository and contact details can be found at https://www.insight.hdrhub.org/. Proprietary or commercial disclosure may be found after the references.

Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study

ObjectiveThis study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management...

O05 Management of acute desloughing of the oesophageal lining in patients with dystrophic epidermolysis bullosa: a case series of six paediatric patients

Abstract Dystrophic epidermolysis bullosa (DEB) is a subtype of inherited skin disorders characterized by skin and mucosal fragility due to collagen VII (COL7A1) gene mutations. Desloughing of the lining of the oesophagus has not been reported before. We retrospectively reviewed the hospital electronic patient records between 2008 and 2021 with regard to acute treatment and long-term management. Six patients with recessive DEB (RDEB) severe (n = 4), RDEB intermediate (n = 1) and dominant DEB (DDEB) were identified. The mean age at the time of the episode was 29.6 months. Most of the patients (n = 5) suffered from severe gastro-oesophageal reflux at the time of onset. Clinically, they presented with a coughing episode (n = 6), haematemesis (n = 6), vomiting (n = 6) and choking (n = 3) with a piece of mucosae coughed up. Four patients recovered with medical management including immediate hospitalization, no oral intake (nil by mouth, NBM), pain relief and optimization of the dose of proton-pump inhibitors. Due to severe persistent dysphagia, two patients required gastrostomy insertions for feeding; one also required a Nissen's fundoplication due to severe reflux. One patient had an aspiration pneumonia. Desloughing of varying lengths of segments of the oesophagus is an emergency. The lining coughed up needs to be cut at the mouth not pulled and the emergency services called immediately. On arrival, an urgent assessment and chest X-ray should be performed to rule out any signs of perforation. The patient should be kept NBM with intravenous fluids and pain relief. Expert multidisciplinary care is needed to manage this rare but extremely serious condition.

Rapid Expansion of a Teledermatology Web Application for Digital Dermatology Assessment Necessitated by the COVID-19 Pandemic: Retrospective Evaluation.

The COVID-19 pandemic necessitated a change in the provision of outpatient care in dermatology. A novel, asynchronous, digital consultation platform was codeveloped with 2 National Health Service dermatology teams to improve access and enhance choice in outpatient care. The rollout of the platform was accelerated during the initial COVID-19 lockdown, and its wider use across 2 Scottish health boards was retrospectively evaluated. Integrated with the hospital booking system and electronic patient record, the platform provides an alternative to face-to-face consultations, using information and images submitted by the patients. In total, 297 new patient consultations and 108 return patient consultations were assessed, and 80% (324/405) of the images submitted were of satisfactory quality. The consultations were, on average, 3 minutes shorter than equivalent face-to-face interactions, and a total of 5758 km of patient travel was avoided. Outcomes included web-based reviews (66/405, 16.3%), face-to-face reviews (190/405, 46.9%), biopsies (46/405, 11.4%), discharge (89/405, 22%), and other treatments or investigations (14/405, 3.5%). High levels of patient satisfaction (92/112, 82.1%) were reported. Digital dermatology assessments are now included in the choices for consultation types that are available to patients, helping to augment service capacity during pandemic recovery.

Retrospective Analysis of Characteristics, Indications and Outcomes of Endoscopic Retrograde Cholangiopancreatography (ERCP) in a Tertiary Referral Center in Saudi Arabia.

Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic procedure that is an essential tool in the management of pancreaticobiliary diseases. There is limited data available on the indications and outcomes of ERCP from this region. Therefore, we aim to report the characteristics of patients, indications and outcomes of ERCP in Saudi Arabia. Methods: We retrospectively looked at ERCP procedures done at a tertiary referral center covering the western region of Saudi Arabia from August 2018 until July 2020. Data were collected from the hospital's electronic patient record and endoscopy database. Of 1001 ERCPs performed, full data was available on 712 procedures on 581 patients that were included in the final analysis. Mean age was 53.1 years. Four hundred four (56.7%) were female. Board-certified consultants performed all ERCPs. The most common intervention was sphincterotomy, which was performed in 563(96.9%) patients who underwent first-ever ERCP, followed by dilatation and stenting. The commonest indication of ERCP was confirmed or suspected choledocholithiasis (52.6%), followed by replacement or removal of a biliary stent (15.7%), 55 (7.7%) for suspected ascending cholangitis, 54 (7.5%) for acute biliary pancreatitis and 15 (2%) for suspected sphincter of Oddi dysfunction. The commonest finding among all patients was choledocholithiasis in 57.9%, debris in 15.2% and biliary stricture in 14.8%. The commonest complication was pancreatitis in 22(3.1%) followed by post-sphincterotomy bleeding in 16(2.2%) and perforation in nine (1.2%). Bleeding was controlled by endoscopic intervention in four (25%) and one (6.2%) patient underwent surgery. One (0.14%) patienthad procedure-related mortalitysecondary to post-procedure pulmonary embolism and one had significant morbidity and prolonged hospitalization because of complicated perforation. The deeper common bile duct (CBD) cannulation rate was 97.3%. Our study results revealed that ERCP performed in the western region of Saudi Arabia has similar indications and findings as reported in theinternational literature. ERCP is successful in achieving the therapeutic objectives with complication rates consistent with published data.

Meniscus Work and Implant Selection Are Major Cost Drivers of Anterior Cruciate Ligament Reconstruction.

Background The current study examines the financial charges associated with primary anteriorcruciate ligament reconstruction (ACLR), specifically the contribution of graft choice, graft type, and concomitant meniscus surgery, in the outpatient hospital setting. Methods A retrospective financial billing review was performed on patients who underwent ACLR at a singleacademic medical center from January to December 2019. Age, BMI, insurance, length of operation, regional block, implants, meniscus surgery, graft type, and graft choice were extracted from hospital electronic patient records. Charges attributed with graft, anesthesia services, supplies, implants, surgeon fees, radiology charges, and total charges were collected. Total amount that insurance and patient paid were also obtained. Descriptive and quantitative statistics were performed. Results A total of 28 patients were studied (18 males, 10 females). The average age was 23.8 years. There were 20 concomitant meniscus surgeries. Six allografts and 22 autografts were used [eight bone-patellar tendon-bone (BPTB), eight hamstrings, six quadriceps]. The average and median total charge was $61,004 and $60,390, respectively (range: $31,403 to $97,914). The average insurance paid was $26,045 while out-of-pocket costs were $402. The average paid by privateinsurance was higher compared to government insurance($31,111 vs. $11,066, p<0.001). Graft choicesuch as allograft vs. autograft (p=0.035) and meniscus surgery (p=0.048) were significant factors to the overall cost. Conclusions Graft choice, specifically the quadrupled hamstring autograft, and concomitant meniscal surgery are major contributors to variations in ACLR charges. Decreasing implant and graft costs and limiting surgical time can decrease charges associated with ACLR.We hope these findings can help guide surgeon financial decisions, by demonstrating the need to take into account the increased total charges and amount paid associated with specific grafts, meniscus surgery, and prolonged OR time.

Design and validation of a new Healthcare Systems Usability Scale (HSUS) for clinical decision support systems: a mixed-methods approach

ObjectiveTo develop and validate a questionnaire to assess the usability of clinical decision support systems (CDSS) and to assist in the early identification of usability issues that may impact patient...