Hospitalists Research Articles

Lower extremity MRI: are their requests always appropriate in France?

The primary aim is to assess current lower extremity MRI requests' relevance with a secondary focus on the knee. Using data from the National Health Data System (SNDS), we conducted an observational study of adults (18+) who underwent lower extremity MRI between July 1 and December 31, 2021. This study included analyzing medical consultations and imaging procedures (particularly X-rays) in the 6 months before and after the index MRI, as well as medical procedures and hospitalizations related to knee procedures within 6 months post-MRI. During the study period, 779,721 adults underwent lower extremity MRI, marking a 76% increase compared to a previous study conducted in 2012. General practitioners requested MRI in 70.5% of cases, often as the primary imaging modality. Notably, 52.1% of patients had not undergone lower extremity X-rays in the 6 months preceding MRI, and 13% underwent at least two MRI examinations within a year. Focusing on the knee, most patients (80%) did not undergo any outpatient medical procedure or hospitalization involving the knee within the 6 months post MRI. In France, lower extremity MRI, particularly knee MRI, is frequently used as a first-line imaging procedure, unlike what is recommended. Question How often are requests for lower extremity MRI examinations appropriate? Findings Lower extremity MRI is often performed as a first-line imaging procedure, even though it is not recommended. Clinical relevance The study findings underscore the importance of disseminating guidelines regarding lower extremity MRI appropriateness to increase its availability for appropriate purposes, thereby improving patient care.

Ventilator-Associated Pneumonia in Intensive Care Units: A Comparison of Pre-Pandemic and COVID-19 Periods

Background/Objectives: The COVID-19 pandemic has significantly increased the burden of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) globally. However, epidemiological data on VAP in Slovak ICUs, particularly in the context of the pandemic, remain limited. This study aimed to evaluate the incidence, microbial profiles, and risk factors of VAP in Slovak ICU settings, particularly during the COVID-19 pandemic. Methods: A retrospective analysis of VAP data was conducted for respiratory intensive care unit (ICU) patients in a Slovak university hospital, comparing data from the pre-pandemic and pandemic periods. The CDC/NHSN definitions for VAP were applied, and statistical analyses were performed using STATISTICA 13.1. Results: A total of 803 patients were analyzed, representing 8385 bed days and 5836 mechanical ventilator days. VAP rates increased significantly during the pandemic by 111%, from 8.46 to 17.86 events per 1000 MV days (p < 0.001). VAP rates in non-COVID-19 patients increased by 86% during the pandemic compared to pre-pandemic levels. Pandemic conditions also increased ICU mortality from 25.66% to 40.52% (p < 0.001). VAP was identified as a critical determinant of ICU mortality, contributing to a 21.62% higher mortality rate among patients during the pandemic. Younger age, prolonged mechanical ventilation, and medical (vs. surgical) hospitalizations were associated with higher VAP incidence. Gram-negative bacteria dominated the pathogen profiles, with significant increases observed in Pseudomonas aeruginosa (183%), Klebsiella pneumoniae (150%), and Acinetobacter spp. (100%). Conclusions: The COVID-19 pandemic has significantly affected the incidence and epidemiology of VAP in Slovak ICUs, highlighting systemic vulnerabilities in HAI surveillance and IPC practices.

Clinical Outcomes Among Adolescents Diagnosed With Anorexia Nervosa During the COVID-19 Pandemic.

The COVID-19 pandemic was associated with a significant rise in the incidence of anorexia nervosa (AN) and atypical anorexia nervosa (AAN), longer wait times and reduced opportunities for in-person medical services. How these changes affected clinical outcomes among adolescents newly diagnosed with AN/AAN remains largely unknown. We performed a retrospective analysis of standardized intake and follow-up data from a pediatric eating disorder program to compare clinical outcomes among adolescents newly diagnosed with AN/AAN during pre-pandemic (July/2017-December/2018) and pandemic (July/2020-December/2021) periods. Clinical data were collected at the time of diagnosis and at 1-, 3-, 6-, and 12-month intervals. The primary outcomes were unscheduled AN/AAN-related emergency department visits and need for medical hospitalization. Overall, 253 patients were included (pre-pandemic = 77; pandemic = 176). By 12-months following diagnosis, 18.8% (95% CI 13.3%-25.3%) of patients diagnosed during the pandemic had unscheduled AN/AAN-related emergency department visits, compared to 7.8% (95% CI 2.9%-16.2%, p = 0.03) of those diagnosed pre-pandemic. Medical hospitalization was required more frequently in the pandemic group (35.8%; 95% CI 28.7%-43.4%) compared to pre-pandemic (15.6%; 95% CI 8.3%-25.6%, p = 0.001). Mean weight gain at 12-months did not differ between groups (8.1 kg pre-pandemic vs. 8.8 kg pandemic; p = 0.35) however the mean time to target weight was longer in the pandemic group (2.7 vs. 4.4 months; p = 0.002). Patients newly diagnosed with AN/AAN during the pandemic had significantly more AN/AAN-related emergency department visits and hospitalizations and took longer to achieve target weight than those diagnosed pre-pandemic. These findings suggest a more complicated treatment course among adolescents diagnosed with AN/AAN during the pandemic.

Abstract TP158: Collaboration Between Neurology and Endocrine Improves Uncontrolled Diabetes for Patients with Acute Ischemic Stroke

Background: Research suggests that the absolute number of strokes among people with diabetes is increasing as the population with diabetes grows. Stroke patients with poorly controlled diabetes are more likely to experience poor functional recovery, longer recovery times, recurrent stroke, and higher risk of death. In response to a finding from the 2021 Joint Commission survey for not addressing an HbA1c=9.3, we launched a quality improvement project to enhance diabetic management among patients admitted for ischemic stroke. Methods: This interdisciplinary collaboration involved endocrinology, hospital medicine, and neurology. For patients admitted to our Thrombectomy-Capable Stroke Center for ischemic stroke with an HbA1c ≥ 9.0% or blood glucose glucoses≥250mg/dl, a mandatory inpatient endocrine consult would be provided, in addition to diabetic educator consult. The patient’s HbA1c levels were followed every 3 months for a year. Results: A total of 66 patients were admitted in 2022 (n=32) and 2023 (n= 34) for ischemic stroke with HbA1c ≥ 9.0%. The median HbA1C for 2022 cohort dropped from 11.2% (range 9.0% – 16.6%) to 8.5% (range 5.0% - 14.1%) in a year (p<0.05); and 10.3% (range 9.0% - 14.6%) to 7.75% (range 6.0% - 11.7%) in a year (p<0.05). 2024 data showed similar improvement with drop of HbA1c from 10.55% to 9.75% at 3 months and 9.45% at 6 months. Conclusion: Inpatient endocrinology involvement for high-risk stroke patients with previously uncontrolled diabetes improves diabetic control over time. Endocrinologists can offer personalized treatment plans considering various factors such as comorbid conditions, patient lifestyle, and specific diabetes complications. This single center intervention is congruent with published data showing that patients under specialist care often experience HbA1c reductions of 0.5% to 1.0% or more compared to those managed by general practitioners. In high risk and high complexity cases, this improvement may potentially lead to reduced risk of stroke recurrence and complications. We postulate that this improvement is attributed to the endocrinologist’s expertise in complex diabetes management, advanced treatment options, personalized care approaches, and resources in post-discharge management. If confirmed in a multicenter clinical study, it can become a generalizable approach to improve the quality of care and outcomes of high-risk stroke patients.

Abstract TP139: Coordinating Stroke and Sleep Care with Field Staff and Champions: Difference-Makers in a Quality Improvement Program Addressing Sleep Apnea in Stroke Patients

Background: The Addressing Sleep Apnea Post-Stroke/TIA (ASAP) clinical trial aimed to enhance OSA management at six VA medical centers through a hybrid implementation trial, requiring coordination across hospital medicine, sleep medicine, nursing, and neurology in both inpatient and outpatient settings. This analysis evaluated the trial’s efforts to standardize early OSA screening in stroke/TIA patients. Methods: This mixed-methods evaluation used configurational comparative methods (CCMs) to identify key contextual factors for successful implementation, examining the joint effects of multiple factors. The stepped-wedge trial ran from May 2019 to January 2024 across three implementation waves. The primary outcome was the Group Organization (GO) score, which measured team cohesion in managing sleep apnea among cerebrovascular patients. Data sources included observational data, qualitative interviews, and administrative data across three periods (A, B, C), calibrated into dichotomous or multi-value categories for analysis. Results: Four key difference-makers distinguished more successful sites (GO score ≥6) from others: routines for ordering inpatient OSA tests, patient care coordination during hospitalization, involvement of field staff, and strong local champions. The ability to order and complete sleep studies was crucial for timely OSA diagnosis. Field staff (e.g., respiratory technicians, polysomnographic technologists, research) played a critical role in coordinating care during inpatient stays and post-discharge. Key pathways to success included active field staff engagement and strong champion support, particularly in the final phase. Less successful sites faced barriers like geographic separation and staff shortages. The figure describes the values for each of these factors at the 4 more successful versus 2 less successful sites. Conclusions: The study highlights the importance of flexibility in integrating new practices, particularly in stroke care requiring multi-specialty coordination. Findings provide a roadmap for healthcare systems implementing similar interventions, emphasizing leadership, coordinated care, and robust tracking for program success.

Household Food Security, Feeding Practices, and Anthropometric Failure Among Children Aged 6–23 Months: A Hospital-Based Study

Abstract Background: Household food security (HHFS) and age-appropriate complementary feeding (CF) conceptually play an important role in growth of a child. This study aims to assess the status of HHFS, age-appropriate CF, and undernutrition among children of 6–23 months and their association (if any). Materials and Methods: This institution-based cross-sectional study was conducted among children attending Pediatric OPD of College of Medicine and Sagore Dutta Hospital. Children were assessed regarding age-appropriate complementary feeding using infant and young child feeding (IYCF) practices indicator, nutritional status using composite index of anthropometric failure indicators, and HHFS using standardized and validated HHFS short Bengali version questionnaire. Mothers/primary caregivers were the respondents. Categorical variables were expressed in frequency and percentages. Statistical analysis was done in Jamovi (v2.2.5). Results: 430 mother-child dyads participated in the study with 83.26% of them having low or very low food security. Minimum acceptable diet (MAD) was absent in 74.65% of children and 42.09% of children had single/multiple anthropometric failure(s). Children aged 6–8 months had higher odds of not having MAD (AOR = 3.6, 1.5–8.3). Male gender (AOR = 2.7, 1.7–4.2) and lack of MAD (AOR = 2.7, 1.6–4.7) were associated with anthropometric failure. However, HHFS was not found to be associated with either lack of MAD or anthropometric failure in this study population. Conclusion: Improper transition from exclusive breast feeding to CF may be responsible for higher odds of having lack of MAD in 6–8 months age group, which require strengthening of IEC activity related to IYCF practices on or before initiation of complementary feeding.

Perspectives of Hospital Medicine Providers on the Management of Oropharyngeal Dysphagia in Patients with Dementia.

Oropharyngeal dysphagia (dysphagia) is a common (up to 86%) and devastating syndrome in hospitalized older adults with dementia. To describe the perspectives of dysphagia management in hospitalized patients with dementia among hospital medicine providers (i.e., hospitalists, internal medicine residents, and advanced practice providers, APPs). An anonymous cross-sectional survey study across a large health system in the greater New York metropolitan area PARTICIPANTS: Surveys were distributed to hospitalists, internal medicine residents, and APPs via a multimodal approach. Survey questions were created by an interprofessional team consisting of hospitalists, a geriatrician, and a geriatrics-trained APP. Survey questions assessed current practices and perceptions of dysphagia management in patients with dementia. Of 104 surveys completed, 62.1% were hospitalists, 24.3% were APPs, and 13.6% were residents. Nursing report (61.0%) was the most common way providers found out about suspected dysphagia. The vast majority (85.0%) always/often consulted a Speech-Language Pathologist (SLP) for suspected dysphagia evaluation. Over a third (39.8%) rarely/never discussed goals of care before consulting a SLP. Provider perceptions of the risks/benefits of dysphagia diets varied widely: dysphagia diets in patients with dementia improve quality of life (strongly disagree/disagree 33.0%, neither agree or disagree 31.1%, strongly agree/agree 35.9%); dysphagia diets in patients with dementia reduce the risk of mortality (strongly disagree/disagree 33.0%, neither agree or disagree 22.3%, strongly agree/agree 44.7%). Lastly, only 64% thought there was enough evidence to recommend against a PEG in patients with advanced dementia. Our study highlights the need for standardizing dysphagia management best practices in hospitalized patients with dementia, the importance of addressing goals of care, and provider education on the risks and benefits of dysphagia diets and artificial nutrition via PEG tube.

P-412. Staphylococcus aureus Hand Colonization in 321 Adult Inpatients

Abstract Background Staphylococcus aureus (SA) hand colonization is understudied. Table 1. shows the total number of subjects with each stated characteristic, as well as the number and percent of subjects with each characteristic stratified among those with positive enrollment hand cultures and those with negative hand enrollment cultures. Methods We tested 328 adults in 2 general medicine hospital units < 3 days after admission, and for 219 of them < 2 days before discharge, for SA colonization of hands, nares, inguinal skin, and oropharynx, by direct plating and broth enrichment. Comorbidities were assessed by ICD-10 codes.Figure 1.Venn Diagram showing distribution of positive S. aureus enrollment cultures from 4 body sites in 138 colonized adult inpatients Venn diagram showing 138 of 328 (42.1%) study subjects who were found to have colonization with S. aureus at one or more of the following 4 body sites: throat (T), inguinal skin/groin (G), hand (H), or nares (N). Shows each study subject in a mutually exclusive group of single-site or multibody-site colonization. For example, 15 (4.6%) had only hand (H) colonization, while 26 (7.9%) had colonization at all 4 body sites. Results The median age was 57.5 years (IQR 39.5-70.5), 55.8% were male, 32.9% had diabetes mellitus, 78.4% had a cardiovascular diagnosis, median study enrollment was for 3 days (IQR 1-7) and 42.1% had SA colonization at 1 or more site. 36.0% (118/328) were administered 1 or more antimicrobial drug; IV vancomycin (32%) and cefepime (25%) were most common (Table 1). SA grew from 28.4% (91/321) of enrollment and 25.6% (56/219) of discharge hand cultures. Enrollment hand colonization (HCe) was associated with carriage at each other tested body site (p< 0.001). The nose was most (65/91, 71%) and the groin, least (42/91, 46%) commonly co-colonized with HCe (Fig. 1). Of those with groin colonization, 85% (42/49) also had HCe (Fig. 1). HCe was more common in younger patients (median 49 vs. 60 years, p=0.045) and in patients without circulatory disease (26/67, 38%, p=0.03). There was a non-significant trend toward lower rates of HCe among patients with an infectious diseases diagnosis (25/113, 22.1%, p=0.064). For those with HCe, hand colonization was present in 67% (37/55) tested at last culture, with a mean LOS of 7.6 days. Additionally, 11% (18/161) gained hand colonization at last culture (GHCLC) which was not associated with age, sex, race, any specific comorbid condition, duration of stay, nor IV vancomycin, cefepime, or metronidazole use. GHCLC was less likely for those who received ceftriaxone (0/40 vs. 17/115, p=0.007) during their hospital stay. Among 100 subjects tested at enrollment and 7 days, HCe persisted in 13/22 (59%) and was acquired by 8/78 (10%) others; 5/8 who gained hand colonization at 7 days were colonized at enrollment at another body site. Conclusion Hand S. aureus colonization is common in hospitalized adults, particularly among patients who were younger, had groin colonization, and those without circulatory disease. New hand colonization occurred before discharge and was less common in those who received ceftriaxone. Disclosures Michael Z. David, MD PhD, Covance: Grant/Research Support|GSK: Grant/Research Support|Johnson & Johnson: Advisor/Consultant

P-1480. Staphylococcus aureus Susceptibilities Among Patients Who Use Illicit Fentanyl in Philadelphia, Pennsylvania

Abstract Background Patients who use drugs are at high risk for Staphylococcus aureus infection. Within the Northeastern United States, fentanyl has become the prominent substance in the illicit opioid supply. We developed a S. aureus antibiogram among patients who use fentanyl (PWUF) presenting with acute S. aureus skin or skin structure infections (SSSI) in Philadelphia, Pennsylvania. Table 1 In vitro susceptibility of S. aureus clinical isolates from the wounds of people who use fentanyl. Susceptibilities presented as a proportion of total isolates tested for each antibiotic. Methods In this retrospective, multi-center study, patients presenting to one of four Penn Medicine hospitals with an acute S. aureus SSSI and illicit fentanyl use within the previous year were included. Susceptibilities of S. aureus isolated from skin and skin structure cultures were described among the PWUF cohort and compared to the health system’s outpatient wound antibiogram. Opioid withdrawal parameters were compared between patients who left the hospital prior to and after the availability of S. aureus susceptibilities. Table 2 In vitro susceptibility of S. aureus clinical isolates from the wounds of people who use fentanyl compared to S. aureus isolated from wounds of all outpatients in the health system. Susceptibilities presented as a proportion of total isolates tested for each antibiotic. Results Among 131 S. aureus isolates from 131 PWUF presenting with an acute SSSI, 35/131 (26.7%) were susceptible to oxacillin, 73/121 (60.3%) were susceptible to clindamycin, 77/122 (63.1%) were susceptible to tetracycline, and 119/126 (94.4%) were susceptible to trimethoprim-sulfamethoxazole (Table 1). PWUF displayed significantly reduced susceptibility to oxacillin and tetracycline compared to the health system’s outpatient wound S. aureus antibiogram (Table 2). Seventy (53.4%) patients were discharged prior to the availability of S. aureus susceptibilities, 46 (65.7%) of which were patient-directed discharges. Compared to patients discharged prior to the availability of susceptibilities, a greater proportion of patients discharged after the reporting of susceptibilities were administered buprenorphine or methadone in the hospital (82.0% vs 51.4%, p< 0.001). Conclusion High rates of non-susceptibility to clindamycin and tetracycline suggest these agents should not be prescribed as empiric therapy for acute S. aureus SSSI in PWUF. PWUF would benefit from joint management by infectious diseases and addiction medicine experts to prevent premature discharge and ensure prescription of active therapy. Disclosures Christina Maguire, PharmD, Viiv: Advisor/Consultant

Improving Quality of Care for Neonatal Hyperbilirubinemia Admissions After Birth Hospitalization.

Infants with neonatal hyperbilirubinemia (NH) often require admission after their birth hospitalization for treatment with phototherapy. Our aim was to align local practice with updated national guidelines to promote efficiency and decrease length of stay (LOS) for this patient population by ∼ 10% over a 15-month period using quality improvement methodology. Our improvement initiative included infants younger than age 14 days born at more than 35 weeks' gestation admitted to the hospital medicine service with an NH diagnosis. Baseline data were collected from November 2021 to December 2022. A current state analysis highlighted targets for interventions. Interventions included aligning the local practice pathway with 2022 American Academy of Pediatrics guidelines for NH, adding additional phototherapy lights, and leveraging the electronic health record to improve inter-provider communication over 3 Plan-Do-Study-Act (PDSA) cycles between January 2023 and March 2024. Statistical process control was used for analysis. There were 130 patients included during the 15-month intervention period. After 3 PDSA cycles, there was no special cause variation in the primary outcome measure, LOS. There was special cause variation in the primary process measure, total serum bilirubin at discharge. Readmissions for phototherapy, tracked as a balancing measure, did not change during the study period. Successive interventions aimed at optimizing efficiency during NH admissions did not result in decreased LOS. It can be challenging to use LOS as an outcome measure given the influence of various systemic factors that may not be controlled or reasonably changed.

Effectiveness of using implementation frameworks to facilitate the implementation of a stroke management guideline in the traditional Chinese medicine hospitals in China: protocol for a factorial randomised controlled trial

IntroductionTraditional Chinese medicine (TCM) is commonly used alongside Western medicine for stroke management in China. However, there is significant variation in TCM practice, and the utilisation of evidence-based clinical practice...

The effect of blood parameters measured in the emergency department on 30-day mortality in patients with proximal femur fractures: A retrospective analysis

Proximal femur fractures (PFF) are a common and significant health problem in the elderly population, often leading to morbidity and mortality. This study aims to investigate the association between hematological and biochemical parameters measured at admission and 30-day mortality by retrospectively evaluating patients diagnosed with PFF in the emergency department. This retrospective study includes 344 patients over the age of 65 who admitted to the Emergency Medicine Department of Afyonkarahisar Health Science University Faculty of Medicine Hospital and were diagnosed with PFF between January 1st, 2018, and July 1st, 2023. The patients' demographic characteristics, PFF-related features, and their hematological and biochemical parameters at presentation, were recorded. Specific parameters were proportionally analyzed in accordance with relevant literature. The relationship between these findings and 30-day mortality was evaluated. Of the included patients, 59.6% were female, with a mean age of 81.88 ± 7.76 years. The 30-day mortality rate was 7%. A significant difference was observed in the mortality group regarding ICU admission history, length of hospital stays, glucose/potassium ratio, WBC, neutrophil, hemoglobin, and RDW levels. According to ROC analysis, the AUC for hemoglobin was 0.641 (95% CI: 0.589–0.690), with a cutoff value of <12.8, yielding a sensitivity of 87.5% and specificity of 36.0% (p=0.01). For RDW, the AUC was 0.721 (95% CI: 0.672–0.767), with a cutoff value of >16.2, resulting in a sensitivity of 54.2% and specificity of 86.7% (p=0.001). Hemoglobin, red cell distribution width, and glucose/potassium ratio levels in the emergency department are associated with 30-day mortality in patients diagnosed with PFF. Evaluating these parameters in clinical practice may aid in the early identification of high-risk patients and facilitate the planning of appropriate treatment strategies. Future research should validate these findings through larger-scale studies.

Cohort study on the treatment of BRAF V600E mutant metastatic colorectal cancer with integrated Chinese and western medicine

BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer (mCRC) have a low incidence rate, poor biological activity, suboptimal response to conventional treatments, and a poor prognosis. In the previous cohort study on mCRC conducted by our team, it was observed that integrated Chinese and Western medicine treatment could significantly prolong the overall survival (OS) of patients with colorectal cancer. Therefore, we further explored the survival benefits in the population with BRAF V600E mutant mCRC. AIM To evaluate the efficacy of integrated Chinese and Western medicine in the treatment of BRAF V600E mutant metastatic colorectal cancer. METHODS A cohort study was conducted on patients with BRAF V600E mutant metastatic colorectal cancer admitted to Xiyuan Hospital of China Academy of Chinese Medical Sciences and Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2022. The patients were divided into two cohorts. RESULTS A total of 34 cases were included, with 23 in Chinese-Western medicine cohort (cohort A) and 11 in Western medicine cohort (cohort B). The median overall survival was 19.9 months in cohort A and 14.2 months in cohort B, with a statistically significant difference (P = 0.038, hazard ratio = 0.46). The 1-3-year survival rates were 95.65% (22/23), 39.13% (9/23), and 26.09% (6/23) in cohort A, and 63.64% (7/11), 18.18% (2/11), and 9.09% (1/11) in cohort B, respectively. Subgroup analysis showed statistically significant differences in median OS between the two cohorts in the right colon, liver metastasis, chemotherapy, and first-line treatment subgroups (P < 0.05). CONCLUSION Integrated Chinese and Western medicine can prolong the survival and reduce the risk of death in patients with BRAF V600E mutant metastatic colorectal cancer, with more pronounced benefits observed in patients with right colon involvement, liver metastasis, combined chemotherapy, and first-line treatment.

Computed tomographic analysis of the frontal sinus morphology and structures that affect the size of the frontal sinus outflow tract in Vietnamese people

The frontal recess is a relatively small and narrow area with many neighboring structures and is very diverse in each body. Surgical intervention in this area is still challenging for surgeons. The International Frontal Sinus Anatomy Classification (IFAC) helps classify frontal cells on computed tomography (CT) scans for surgical purposes and anatomical accuracy. This study aims to investigate the morphology of the frontal sinus, the anteroposterior (A-P) diameter of the frontal sinus ostium and the A-P diameter of the frontal recess, the frontal cells classified by IFAC and the relationships between frontal sinus characteristics and A-P diameter of frontal sinus ostium and frontal recess on CT scans. Descriptive cross-sectional study on all CT scans of nasal cavities and paranasal sinuses of patients ≥ 20 years old at the Examination Department of Minh Duc Hospital — Ben Tre and Can Tho University of Medicine and Pharmacy Hospital. In terms of morphology, we found that the most common type was large-sized frontal sinus (40.7%), followed by medium (35.4%) and small (23.9%), respectively. The three dimensions of the frontal sinus in men were larger than in women (p<0.05). The mean A-P diameter of frontal sinus ostium was 6.41±2.66 mm. The mean A-P diameter of frontal sinus recess was 3.23 ± 2.59 mm. The agger nasi cells accounted for the highest proportion (93.6%) and supraorbital ethmoid cells accounted for the lowest proportion (2.9%). There was a statistically significant relationship between ostium diameter and frontal sinus morphology with p<0.001. The A-P diameter of the frontal sinus ostium and frontal recess became narrower with the appearance of the frontal cells. From the study’s results about the frontal sinus morphology, the relationship between the frontal recess cells and the structures affecting the anteroposterior diameter of the frontal sinus drainage pathway can assist surgeons in planning effective and safe surgical interventions in the frontal sinus area.

Ten Machine Learning Models for Predicting Preoperative and Postoperative Coagulopathy in Patients With Trauma: Multicenter Cohort Study.

Recent research has revealed the potential value of machine learning (ML) models in improving prognostic prediction for patients with trauma. ML can enhance predictions and identify which factors contribute the most to posttraumatic mortality. However, no studies have explored the risk factors, complications, and risk prediction of preoperative and postoperative traumatic coagulopathy (PPTIC) in patients with trauma. This study aims to help clinicians implement timely and appropriate interventions to reduce the incidence of PPTIC and related complications, thereby lowering in-hospital mortality and disability rates for patients with trauma. We analyzed data from 13,235 patients with trauma from 4 medical centers, including medical histories, laboratory results, and hospitalization complications. We developed 10 ML models in Python (Python Software Foundation) to predict PPTIC based on preoperative indicators. Data from 10,023 Medical Information Mart for Intensive Care patients were divided into training (70%) and test (30%) sets, with 3212 patients from 3 other centers used for external validation. Model performance was assessed with 5-fold cross-validation, bootstrapping, Brier score, and Shapley additive explanation values. Univariate logistic regression identified PPTIC risk factors as (1) prolonged activated partial thromboplastin time, prothrombin time, and international normalized ratio; (2) decreased levels of hemoglobin, hematocrit, red blood cells, calcium, and sodium; (3) lower admission diastolic blood pressure; (4) elevated alanine aminotransferase and aspartate aminotransferase levels; (5) admission heart rate; and (6) emergency surgery and perioperative transfusion. Multivariate logistic regression revealed that patients with PPTIC faced significantly higher risks of sepsis (1.75-fold), heart failure (1.5-fold), delirium (3.08-fold), abnormal coagulation (3.57-fold), tracheostomy (2.76-fold), mortality (2.19-fold), and urinary tract infection (1.95-fold), along with longer hospital and intensive care unit stays. Random forest was the most effective ML model for predicting PPTIC, achieving an area under the receiver operating characteristic of 0.91, an area underthe precision-recallcurve of 0.89, accuracy of 0.84, sensitivity of 0.80, specificity of 0.88, precision of 0.88, F1-score of 0.84, and Brier score of 0.13 in external validation. Key PPTIC risk factors include (1) prolonged activated partial thromboplastin time, prothrombin time, and international normalized ratio; (2) low levels of hemoglobin, hematocrit, red blood cells, calcium, and sodium; (3) low diastolic blood pressure; (4) elevated alanine aminotransferase and aspartate aminotransferase levels; (5) admission heart rate; and (6) the need for emergency surgery and transfusion. PPTIC is associated with severe complications and extended hospital stays. Among the ML models, the random forest model was the most effective predictor. Chinese Clinical Trial Registry ChiCTR2300078097; https://www.chictr.org.cn/showproj.html?proj=211051.

A new score for predicting intracranial hemorrhage in patients using anticoagulant drugs

ObjectivesThe use of anticoagulants in patients increases the risk of intracranial hemorrhage (ICH). Our aim was to identify factors associated with cerebral hemorrhage in patients using anticoagulants and to develop a predictive model that would provide an effective tool for the clinical assessment of cerebral hemorrhage.MethodsIn our study, indications for patients receiving anticoagulation included AF, VTE, stroke/TIA, arteriosclerosis, peripheral vascular diseases (PVD), prosthetic mechanical valve replacement, etc. Data were obtained from the patient record hospitalization system. Logistic regression, area under the curve (AUC), and bar graphs were used to build predictive models in the development cohort. The models were internally validated, analytically characterized, and calibrated using AUC, calibration curves, and the Hosmer-Lemeshow test.ResultsThis single-center retrospective study included 617 patients treated with anticoagulants. Multifactorial analysis showed that male, leukoaraiosis, high risk of falls, APTT ≥ 45.4 s, and FIB ≥ 4.2 g/L were independent risk factors for cerebral hemorrhage, and β-blockers were protective factors. The model was constructed using these six factors with an AUC value of 0.883. In the validation cohort, the model had good discriminatory power (AUC = 0.801) and calibration power. Five-fold cross-validation showed Kappa of 0.483.ConclusionPredictive models based on a patient’s medical record hospitalization system can be used to identify patients at risk for cerebral hemorrhage. Identifying people at risk can provide proactive interventions for patients.

P0715 Experience with Ustekinumab and Vedolizumab in Inflammatory Bowel Disease Patients: Single-Center Data

Abstract Background Ustekinumab and vedolizumab are used for patients with moderate to severe inflammatory bowel disease (IBD) who do not respond to anti-TNF therapy. This study aims to evaluate the effectiveness of ustekinumab and vedolizumab in this patient group and to assess response rates in both drug groups. Methods The study included a total of 134 patients, 67 of whom were on vedolizumab and 67 on ustekinumab, who were followed at the Gazi University Faculty of Medicine Hospital between January 2017 and October 2024. Age, gender, previous treatments, pre-treatment Harvey-Bradshaw index, Mayo score/disease activity index, and CRP values were recorded. Patients who did not respond clinically, in laboratory results, or endoscopically within the first 24 weeks were considered primary non-responders, while those who did not respond within the first 52 weeks were classified as secondary non-responders. Results Of the 134 patients, 77 (57.5%) were female, and 57 (42.5%) were male. A total of 71 (53%) patients had Crohn’s disease. Among the patients, 85 (63.4%) had previously used Infliximab, and 48 (35.8%) had used Adalimumab as anti-TNF therapy. In patients continuing Vedolizumab treatment, the average duration of use was 22.8 months for those with ulcerative colitis (UC) and 25.5 months for those with Crohn’s disease (CD). For those on Ustekinumab, the average duration was 15 months for UC patients and 21.1 months for CD patients. Response Rates • Primary Non-Response (24 weeks): For Ustekinumab, 6.9% (1 UC, 3 CD patients) and for Vedolizumab, 10.1% (4 UC, 2 CD patients). • Secondary Non-Response (52 weeks): For Ustekinumab, 3.4% (1 UC, 1 CD patient) and for Vedolizumab, 18.6% (5 UC, 6 CD patients). No statistically significant difference in non-response rates was observed between the two drug groups. Conclusion Both Ustekinumab and Vedolizumab exhibit comparable efficacy in IBD patients who are resistant to prior anti-TNF therapies, with no statistically significant differences in primary and secondary non-response rates between the groups.

The effect of Schroth Therapy combined with spinal manipulation for the treatment of adolescent idiopathic scoliosis

Objective: To evaluate the effectiveness of the Schroth method combined with spinal manipulation treatment in patients with adolescent idiopathic scoliosis (AIS). Methods: This was a single-center retrospective study performed between January 2023 and February 2024, in which 150 patients with AIS were treated with Schroth method with or without spinal manipulation at Wenzhou Traditional Chinese Medicine Hospital. Patients were classified into a study group and a control group with 50 patients in each group after screening. Intervention effects, maximum Cobb angle, clavicle angle before and after the treatment, trunk rotation angle, vertebral rotation angle, and lumbar range of motion (range of motion for lumbar extension and flexion) were compared between the two groups. Results: The overall efficacy of intervention in the study group was higher than that in the control group (96.00% versus 84.00%) (P<0.05). After the treatment, the maximum Cobb angle, clavicle angle, angle of trunk rotation (ATR), and vertebral rotation angle of the two groups decreased compared to pretreatment levels and were significantly smaller in the study group compared to the control group (P<0.05). After the treatment, the degree of lumbar extension and flexion in both groups increased compared to before treatment and was markedly greater in the study group (P<0.05). Conclusions: In patients with AIS, combining the Schroth method and spinal manipulation treatment was more effective in reducing the maximum Cobb and clavicle angles, trunk rotation angle, and vertebral rotation angle and restoring the lumbar range of motion compared to the Schroth method alone. doi: https://doi.org/10.12669/pjms.41.2.11355 How to cite this: Chen H, Zhang C. The effect of Schroth Therapy combined with spinal manipulation for the treatment of adolescent idiopathic scoliosis. Pak J Med Sci. 2025;41(2):409-414. doi: https://doi.org/10.12669/pjms.41.2.11355 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The diagnostic accuracy of umbilical cord procalcitonin in predicting early-onset neonatal infection.

To determine the threshold of umbilical cord blood procalcitonin for early-onset neonatal infection diagnosis. This prospective study was conducted on 126 neonates in the neonatal care unit of Hue University of Medicine and Pharmacy Hospital, Vietnam, from June 01, 2023 to August 31, 2024. All neonates showed signs at birth or risk factors for early-onset infection (EOI) and were divided into two groups: EOI group and non-EOI group. Umbilical cord blood samples were collected for procalcitonin analysis immediately after birth. The median procalcitonin (PCT) levels in umbilical cord blood were significantly higher in the EOI group (0.154 ng/ml [0.092-0.197]) compared to the non-EOI group (0.097 ng/ml [0.082-0.134]; p < 0.001). Receiver operating characteristic (ROC) curve determined the optimal threshold value of PCT of 0.142 ng/ml with an AUC 0.751 (95% CI: 0.661-0.841, p<0.001) in the total population. At this cut-off, the Se, Sp, PPV, and NPV were 68.2%, 76.8%, 61.2%, and 81.8%, respectively. The optimal cut-off value for preterm neonates was 0.122 ng/ml (AUC: 0.785, 95% CI: 0.658-0.911, p<0.001) corresponding a Se of 79.2%, Sp of 74.1%, PPV of 73.1%, and NPV of 80.0%. In term group, the optimal cut-off value was 0.150 ng/ml (AUC: 0.726, 95% CI: 0.583-0.860, p<0.01), with a Se of 60.0%, Sp of 80.4%, PPV of 52.2%, and NPV of 84.9%. Umbilical cord blood PCT concentration were elevated in neonates with EOI. PCT could be a valuable marker for the early diagnosis of EOI.

Improving Newborn Professional Billing at a Community Hospital.

In community hospital medicine programs, newborns often represent a large patient population with diverse clinical needs. Capturing the care provided through professional billing provides the foundation for division revenue; however, provider knowledge on how to optimally bill is often lacking. Our group underused Hospital Care current procedural terminology (CPT) evaluation and management (E/M) codes for newborns requiring increased monitoring, diagnostic interventions, or therapy. Our aim was to increase use of Level 2 and 3 Hospital Care CPT E/M codes for newborns from 1% to 15%. The process improvement project was conducted from October 2022 through October 2023 in the mother-baby unit of a community hospital with approximately 1800 births per year. Key drivers for underuse of Hospital Care CPT E/M codes were identified, and interventions were developed that included educational sessions, real-time guidance, and improved access to the billing codes. All newborn initial and subsequent care professional billing codes were included. We used retrospective chart review to determine whether clinical care and documentation supported the use of the codes. The proportion of Level 2 and 3 Hospital Care CPT E/M codes increased to 17%. This increase represented a 7% increase in work relative value units and an estimated increase in revenue of $37 805 per 10 000 billing encounters. Review of select charts demonstrated appropriate documentation to support use of the codes 72% of the time. Providing education and tools on professional billing for newborns improved appropriate billing code use and optimized revenue at 1 community hospital.