Medical Record Data Research Articles

Provider Burden Associated With Apremilast Adverse Events

Introduction: In December 2021, the US Food and Drug Administration (FDA) expanded its initial approval for apremilast to include moderate and severe cases of psoriasis. However, real-world epidemiology data regarding the use of apremilast, the influence of adverse events (AEs), and the burden of AEs on managing physicians, has been lacking. This retrospective, observational, multisite study aimed to describe real-world patient characteristics, AEs (including diarrhea, nausea, and headache), and healthcare provider-level burden associated with the psoriasis treatment apremilast in the US. Methods: Dermatologists abstracted medical record data for adults treated with apremilast on or after January 1, 2018, who had ≥3 months of data available. Dermatologist and patient characteristics, including demographics and clinical characteristics, AEs, and provider burden in managing AEs were summarized using descriptive statistics. Results: Forty-seven dermatologists nationwide responded to a survey and conducted a chart review of 308 patients. Dermatologists practiced in various US geographic regions. The most common practice setting was in a private community with 2 to 5 physicians (34.0%). Most patients were White (74.4%), non-Hispanic (86.0%), and male (55.2%). The mean age at diagnosis was 43.6 years (SD, 16.8 years). AEs occurred in 29.2% of patients, with the most common being diarrhea (16.2%), followed by nausea (13.6%) and headache (4.9%). Diarrhea mostly occurred ≤30 days into treatment (87.2%) and resulted in 1 additional office visit (39.5%) and 3 phone calls per patient to their providers (34.9%). Nausea mostly occurred within 30 days (70.2%) and resulted in 1 additional visit (29.7%) and 1 phone call per patient (35.1%). The burdens of managing both diarrhea and nausea were similar, although diarrhea resulted in more phone calls to the healthcare provider. Conclusion: Diarrhea and nausea were common and resulted in an additional time and resource burden on dermatologists and their staff. Future research on the AE burden on providers and patients related to apremilast is needed.

The Relationship Between Type 2 Diabetes Mellitus and The Incidence of Acute Ischemic Stroke

Background: Ischemic stroke is a cerebrovascular disease characterized by focal or global neurological deficits with clinical signs lasting 24 hours or more caused by disruption of blood supply to the brain. Stroke is the second leading cause of death in the world with 6.7 million deaths every year. The prevalence of stroke in Indonesia according to Riskesdas in 2018 reached 10.9%, namely around 2,120,362 people in Indonesia. Type 2 diabetes mellitus is a major risk factor for ischemic stroke. Data from the International Diabetes Federation (IDF) shows that in 2021 there will be 537 million cases of DM in adults aged 20-79 years, with an estimated increase to 643 million in 2030. With the estimated number of sufferers of type 2 diabetes mellitus continuing to increase, it can be concluded that ischemic stroke sufferers also continue to increase. Methods: Observational analytic with cross-sectional design. Sampling was taken from medical record data at the Regional General Hospital. Dr. Chasbullah Abdulmadjid Bekasi City with a total of 87 patients who met the inclusion criteria Results: The results of research conducted using Chi-Square Analysis showed that there was no significant relationship between type 2 diabetes mellitus and acute ischemic stroke with a P value of 0.698. The results of the Pearson Chi-Square analysis and Fisher exact test accepted H0 and rejected H1 (there was no relationship). Conclusions: There is no significant relationship between type 2 diabetes mellitus and the incidence of acute ischemic stroke Keywords: Type 2 diabetes mellitus, Ischemic, Stroke

Characteristics of Hypertensive Patients at Medan Johor Community Health Center: An Analysis Based on Age, Occupation, and Body Mass Index

According to the World Health Organization (WHO), approximately 1.13 billion people worldwide suffer from hypertension. In Indonesia alone in 2018, the prevalence of hypertension reached 34.1% in people over 18 years of age. Knowledge of the relationship between hypertension characteristics and the degree of hypertension in the Medan Johor area will help the community health center in the prevention and management of hypertension. This study used a cross-sectional design with hypertension patients who participated in the referral program at the Medan Johor health center. The data collection technique used secondary data in the form of medical record data at the Medan Johor health center. Data analysis was performed using chi-square analysis. The results showed that gender (p=0.131) and uric acid levels (p=0.182) did not have a significant relationship with the degree of hypertension. While age (p=0.008), occupation (p<0.001), body mass index (p=0.013), total cholesterol level (p<0.001) and blood sugar level (p=0.031) have a significant relationship with the degree of hypertension.

An Electronic Medical Record-Based Prognostic Model for Inpatient Falls: Development and Internal-External Cross-Validation.

Effective fall prevention interventions in hospitals require appropriate allocation of resources early in admission. To address this, fall risk prediction tools and models have been developed with the aim to provide fall prevention strategies to patients at high risk. However, fall risk assessment tools have typically been inaccurate for prediction, ineffective in prevention, and time-consuming to complete. Accurate, dynamic, individualized estimates of fall risk for admitted patients using routinely recorded data may assist in prioritizing fall prevention efforts. The objective of this study was to develop and validate an accurate and dynamic prognostic model for inpatient falls among a cohort of patients using routinely recorded electronic medical record data. We used routinely recorded data from 5 Australian hospitals to develop and internally-externally validate a prediction model for inpatient falls using a Cox proportional hazards model with time-varying covariates. The study cohort included patients admitted during 2018-2021 to any ward, with no age restriction. Predictors used in the model included admission-related administrative data, length of stay, and number of previous falls during the admission (updated every 12 hours up to 14 days after admission). Model calibration was assessed using Poisson regression and discrimination using the area under the time-dependent receiver operating characteristic curve. There were 1,107,556 inpatient admissions, 6004 falls, and 5341 unique fallers. The area under the time-dependent receiver operating characteristic curve was 0.899 (95% CI 0.88-0.91) at 24 hours after admission and declined throughout admission (eg, 0.765, 95% CI 0.75-0.78 on the seventh day after admission). Site-dependent overestimation and underestimation of risk was observed on the calibration plots. Using a large dataset from multiple hospitals and robust methods to model development and validation, we developed a prognostic model for inpatient falls. It had high discrimination, suggesting the model has the potential for operationalization in clinical decision support for prioritizing inpatients for fall prevention. Performance was site dependent, and model recalibration may lead to improved performance.

Impact of major depressive disorder on breast cancer outcomes: a national retrospective cohort study.

Establishing whether women with major depressive disorder (MDD) who develop breast cancer (BC) have poor outcomes is key to optimizing care for this population. To address this, we examined associations between MDD and BC recurrence and mortality. Using medical record data from the Veterans Affairs Healthcare System, we established a retrospective cohort of women with local or regional stage invasive BC between 2010 and 2019 and followed through 2022. We used a two-year window to identify women diagnosed with MDD prior to BC diagnosis. We used multivariable Cox-proportional hazards regression to estimate associations between MDD and BC recurrence and mortality while accounting for competing-risks and adjusting for sociodemographic, clinical, lifestyle, and tumor characteristics. We identified 6,051 women with BC, of whom 1,754 (29%) had MDD. The mean age at BC diagnosis was 57 years (standard deviation = 11). In multivariable analyses, women with MDD had a 37% (hazard ratio (HR)=1.37; 95% confidence interval (CI): 1.19-1.57) higher risk of recurrence and a 30% (HR = 1.30; 95% CI: 1.02-1.64) higher risk of BC mortality. The association between MDD and recurrence was stronger among women with estrogen receptor-positive BC. In secondary analyses, there were significant interactions between MDD and multiple exposures with respect to recurrence, including current smoking, substance abuse, and non-receipt of screening mammography. Women with MDD had inferior BC outcomes compared to women without a history of MDD. Research is needed to investigate underlying mechanisms linking depression to BC progression and evaluate interventions to improve outcomes in this high-risk population.

Abstract 4137810: Association of Sociodemographic Characteristics on Costs of Care in Patients with Obstructive Hypertrophic Cardiomyopathy

Introduction: No evidence exists on the impact of sociodemographic characteristics on costs of care for obstructive hypertrophic cardiomyopathy (oHCM). Therefore, we evaluated 5-year cumulative costs by age, sex, and race/ethnicity. Methods: Retrospective cohort study of adults diagnosed with oHCM (January 2013 to December 2021) using Optum claims and electronic medical record data. Patients with ≥2 claims for HCM (ICD-9 and-10) at least 30 days apart (index date = earliest oHCM claim) with ≥1 additional oHCM claim or septal reduction therapy, 6-months pre-index and 5-year post-index continuous enrollment were included. HCM-related cumulative costs (2022 CPI adjusted) were reported for medical (ambulatory [AB]: office [OV] visits, outpatient [OP] visits); emergency room [ER] visits; inpatient admissions (IP); and pharmacy (Rx). Results: Among 5,129 patients with oHCM, 52% were female (mean age 63.9 ± 14.3 years; 77.6% non-Hispanic White; 40% Medicare). Compared to females (Table), male patients had greater costs including total ($71,581 vs $63,710, p= 0.014), medical ($70,395 vs $62,455, p= 0.013), ambulatory ($16,024 vs $10,776, p<0.001), OV ($1,906 vs $1,573, p<0.001), and OP ($14,118 vs $9,202, p<0.001). Compared with White patients, Black patients had significantly greater IP costs ($54,572 vs $42,686, p= 0.01), Hispanic patients had greater ER costs ($1,724 vs $791, p<0.001), and Asian patients had greater OV costs ($2,094 vs $1,800, p<0.001). Patients aged 18-39 years had greater costs across all categories (p<0.001; IP=NS), except Rx. Patients aged 40-54 years had the highest Rx costs ($1,557, p<0.001), followed by 18-39, 55-64, 65-74, 75+ years ($1,528; $1,329; $1,197; $867), respectively. Conclusions: For oHCM patients , being male and age 18-39 years was associated with increased HCM-related healthcare costs. Differences in cost across race/ethnicity exist, including greater IP and ER costs for Black and Hispanic patients, respectively. Future research is required to understand the source of these differences among oHCM patients.

Real-world use of androgen-deprivation therapy intensification for metastatic hormone-sensitive prostate cancer: a systematic review.

To conduct a systematic literature review of real-world data (RWD) studies to summarise treatment patterns among men with metastatic hormone-sensitive prostate cancer (mHSPC).While androgen-deprivation therapy (ADT) is a primary treatment strategy for mHSPC, ADT intensification with androgen receptor pathway inhibitors (ARPIs) and/or chemotherapy is recommended by current guidelines and has improved clinical outcomes in the last decade. We searched electronic databases (PubMed; Excerpta Medica dataBASE [EMBASE]) for eligible studies (retrospective or prospective observational RWD studies examining mHSPC treatment patterns) between database inception and July 2023, and manually screened the past 2 years of relevant conference proceedings. Of 2336 retrieved citations, 29 studies met the inclusion criteria, covering North America (United States, n = 21; Canada, n = 2), Europe (n = 8), and Asia (n = 6). Most studies utilised retrospective cohorts (n = 26) and included men with a median age of ≥70 years (n = 20). ADT monotherapy was predominantly used across geographies, followed by ADT + ARPI and ADT + docetaxel in the United States and Europe but not in Asia, where use of each combination remained low. Studies with recent electronic medical record data from cancer centres/registries showed >40% use of ADT + ARPI in the United States and Europe. Abiraterone was the most frequently used ARPI, followed by enzalutamide. Quantitative factors associated with ADT intensification were high disease burden, younger age, Eastern Cooperative Oncology Group performance status score of 0 to 1, fewer comorbidities, and oncologist physician specialty; qualitative factors were patient preference, unsatisfactory response to ADT, ability to tolerate adverse events, and absence of cost barriers. While there was an increasing trend in ADT intensification for mHSPC over the study period across geographies, use remained suboptimal considering the high proportion of patients who were still receiving ADT monotherapy only. These findings highlight the need for interventions to further optimise current mHSPC therapies with high guideline concordance.

Genetic variants for Alzheimer's disease and comorbid conditions.

Alzheimer's disease and related dementias (ADRD) frequently co-occur with comorbidities such as diabetes and cardiovascular diseases in elderly populations. Utilize a life-course approach to identify genetic variants that are associated with the co-occurrence of ADRD and another comorbid condition. Research data from African American participants of the Indianapolis-Ibadan Dementia Project (IIDP) linked with electronic medical record (EMR) data and genome-wide association study (GWAS) data were utilized. The age of onset for ADRD was obtained from longitudinal follow-up of the IIDP study. Age of onset for comorbid conditions was obtained from EMR. The analysis included 1177 African Americans, among whom 174 were diagnosed with ADRD. A semi-parametric marginal bivariate survival model was used to examine the influence of single nucleotide polymorphisms (SNPs) on dual time-to-event outcomes while adjusting for sex, years of education, and the first principal component of GWAS data. Targeted analysis of 20 SNPs that were reported to be associated with ADRD revealed that six were significantly associated with dual-disease outcomes, specifically congestive heart failure and cancer. In addition, eight novel SNPs were identified for associations with both ADRD and a comorbid condition. Using a bivariate survival model approach, we identified genetic variants associated not only with ADRD, but also with comorbid conditions. Our utilization of dual-disease models represents a novel analytic strategy for uncovering shared genetic variants for multiple disease phenotypes.

Change in frailty among older COVID-19 survivors.

COVID-19 survivors are at greater risk for new medical conditions. Among older adults, where multimorbidity and functional impairment are common, frailty measurement provides a tool for understanding how infection impacts future health beyond a one-disease-at-a-time approach. We investigated whether COVID-19 was associated with change in frailty among older Veterans. Data were from the Veterans Affairs (VA) COVID-19 Observational Research Collaboratory, which extracted VA medical record data. We included Veterans who had COVID-19 from March 1, 2020, to April 30, 2021 and matched uninfected controls. We excluded those <50 years at index or did not survive 12 months after. Frailty was assessed at the index date and 12 months using the VA Frailty Index (VA-FI). We assessed the number of new VA-FI deficits over 12 months. Analysis was done by negative binomial regression adjusted for age, gender, race, ethnicity, and BMI. Coefficients are given as the ratio of the mean number of new deficits in COVID-19 cases versus controls during follow-up. We identified 91,338 COVID-19-infected Veterans and an equal number of matched controls. Median (IQR) age was 68.9 years (60.3-74.2), 5% were female, 71% were White, and baseline VA-FI was 0.16 (0.10, 0.26). Median (IQR) number of new deficits at 1 year was 1 (0-2) for infected and 0 (0-1) for uninfected controls. After adjustment, those with COVID-19 accrued 1.54 (95% CI 1.52-1.56) times more deficits than those who did not. The five most common new deficits were fatigue (9.7%), anemia (6.8%), muscle atrophy (6.5%), gait abnormality (6.2%), and arthritis (5.8%). We found a greater increase in frailty among older Veterans with COVID-19 compared with matched uninfected controls, suggesting that COVID-19 infection has long-term implications for vulnerability and disability among older adults. Functional impairments such as fatigue, impaired mobility, and joint pain may warrant specific attention in this population.

Racial and Ethnic Disparities in Referral Rejection from Postacute Care Facilities among People with Opioid Use Disorder in Massachusetts.

The aim of the study was to examine the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection from private postacute care facilities among hospitalized individuals with opioid use disorder (OUD). In this retrospective cohort study, we linked electronic postacute care referrals from Boston Medical Center in 2018 to electronic medical record data, which we used to ascertain OUD status and race and ethnicity. Using multivariable logistic regression, we examined the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection, adjusting for individual-level characteristics including medication for opioid use disorder treatment type and for facility-level factors using facility random effects. We identified 159 hospitalizations from 141 individuals with OUD referred to private postacute medical care, corresponding to 1272 referrals to 244 facilities. Hospitalizations comprised 53 (33%) non-Hispanic Black, 28 (18%) Hispanic or Latino, and 78 (49%) non-Hispanic White individuals. In adjusted analyses, referrals for non-Hispanic Black individuals had significantly higher odds of rejection compared to referrals for non-Hispanic White individuals (adjusted odds ratio 1.83, 95% confidence interval [1.24, 2.69], P = 0.002). There were no significant differences between referrals for Hispanic or Latino individuals and non-Hispanic White individuals (adjusted odds ratio 1.11, 95% confidence interval [0.67, 1.84], P = 0.69). Among people with OUD referred to private postacute care in Massachusetts, non-Hispanic Black individuals were more likely to be rejected compared to non-Hispanic White individuals, demonstrating racism in postacute care admissions. Efforts to address discrimination against people with OUD in postacute care admissions must also address racial equity.

Promoting Race and Ethnic Diversity in a Hospital-Based Randomized Clinical Trial to Address Untreated Alcohol Use Disorder: Initial Lessons Learned.

This study aimed to describe initial experiences and lessons learned conducting a trial focused on recruiting racially and ethnically diverse hospitalized patients with untreated alcohol use disorder (AUD). The parent trial is comparing the effectiveness of strategies including Brief Negotiation Interview (BNI), facilitated initiation of medications for AUD, and computer-based training for cognitive behavioral therapy (CBT4CBT) on AUD treatment engagement post-hospitalization. Guided by the Framework for Reporting Adaptations and Modifications-Enhanced, we catalogued protocol changes and evaluated outcomes using study and electronic medical record data during the first 18 months of recruitment. Recipients: (1) Selected entry criterion to intentionally include individuals most likely impacted by structural racism, (2) developed multipronged recruitment approaches, and (3) selected bilingual, multicultural, and ethnically diverse research staff. Intervention: (1) Added scripts in the BNI to consider how cultural factors influence and how racism may impact, alcohol use, and AUD treatment engagement, (2) offered tablets as a compensation alternative with support for CBT4CBT initiation (as relevant), and (3) anticipate and troubleshoot internet access challenges. Setting: (1) Identified community-based AUD treatment options with Spanish-speaking services and (2) identified resources to address social determinants of health. Study: (1) Audited data to monitor whether diverse enrollment is occurring. Among n = 132 randomized as of March 1, 2024, 25% endorsed Black, 24% endorsed Latine, 58% endorsed White, 1% endorsed Indigenous, and 15% endorsed race not listed or declined to disclose. We observed no difference by race or ethnicity in recruitment or retention experiences. Multilevel practices within a hospital-based AUD-focused trial can promote recruitment and retention of a racially and ethnically diverse sample.

092. Overview of the Prevalence of Chronic Kidney Disease (CKD) in Kidney and Ureter Stones at Zainoel Abidin Hospital Banda Aceh, 2021

Background: Kidney stones are a predictor and risk factor for CKD and the prevalence rate is 5-10% with comorbid factors which can increase the risk of CKD events. Chronic Kidney Disease (CKD) is a serious complication of urinary tract stones. Chronic kidney disease can occur as a result of urological procedures, obstruction or due to causes inherent in stone formation. Methods: This type of research is descriptive research using secondary data in the form of medical record data. The design of this research is cross sectional with data collection carried out retrospectively. The samples in this study were patients diagnosed with CKD in patients with ureteral stones or kidney stones at Zainoel Abidin Hospital, Banda Aceh. Samples were taken using the total sampling method. Results: In this study, 70 samples were taken and the results of this study based on gender are majority were found to be men 48 samples (68.6%), the most common age category was 41 - 50 years with 28 samples (40.0% ), the most common comorbid factor causing CKD was hypertension in 30 samples (42.5%), the type of urinary tract stones most often found was ureter stones, namely 34 samples (49.0%), and the most common location or urinary tract was ureter stones. bilateral, namely 22 samples (31.4%). Conclusion: The male gender most often experiences CKD due to complications from urinary tract stones, where the age range of 41 - 50 years is the age that experiences the most complications. The most common type of urinary tract stone is ureteral stone with a bilateral location.

Lipoprotein (a) Testing in Patients With Atherosclerotic Cardiovascular Disease in 5 Large US Health Systems.

Lipoprotein (a) is an independent risk factor for atherosclerotic cardiovascular disease. However, lipoprotein (a) testing remains variable and it is unclear what factors influence testing and if testing changes clinical management. A retrospective study using electronic medical record data from 5 health systems identified an atherosclerotic cardiovascular disease cohort divided into those with and without a lipoprotein (a) test between 2019 and 2021. Baseline characteristics and lipid-lowering therapy patterns were assessed. Multivariable regression modeling was used to determine factors associated with lipoprotein (a) testing. Among 595 684 patients with atherosclerotic cardiovascular disease, only 2587 (0.4%) were tested for lipoprotein (a). Those who were older or Black individuals were less likely to have lipoprotein (a) testing, while those with familial hypercholesterolemia, ischemic stroke/transient ischemic attack, peripheral artery disease, prior lipid-lowering therapy, or low-density lipoprotein cholesterol ≥130 mg/dL were more likely to be tested. Those with a lipoprotein (a) test, regardless of the lipoprotein (a) value, were more frequently initiated on any statin therapy (30.3% versus 10.6%, P < 0.001), ezetimibe (7.65% versus 0.8%, P < 0.001), or proprotein convertase substilisin/kexin type 9 inhibitor (6.7% versus 0.3%, P < 0.001) compared with those without a test. Those with an elevated lipoprotein (a) level more frequently initiated ezetimibe (11.5% versus 5.9%, P < 0.001) or proprotein convertase substilisin/kexin type 9 inhibitor (10.9% versus 4.8%, P < 0.001). Lipoprotein (a) testing in patients with atherosclerotic cardiovascular disease is infrequent, with evidence of disparities among older or Black individuals. Testing for lipoprotein (a), regardless of level, is associated with greater initiation of any lipid-lowering therapy, while elevated lipoprotein (a) is associated with greater initiation of nonstatin lipid-lowering therapy. There is a critical need for multidisciplinary and inclusive approaches to raise awareness for lipoprotein (a) testing, and its implications on management.

The early COVID-19 pandemic period and associated gestational weight gain.

The aim of this study was to investigate if gestational weight gain was altered during the early COVID-19 pandemic period. This a retrospective cohort study evaluating gestational weight gain among individuals delivering during the early COVID-19 pandemic epoch (March 10-December 31,2020) compared to temporally matched pre-pandemic (matched months in 2018 and 2019) controls using electronic medical record data from a large tertiary care hospital. The primary outcome was gestational weight gain defined as a categorical measure representing below, meeting, or above Institute of Medicine (IOM) criteria with further adjustment for gestational age at delivery. The early-pandemic exposure group was also categorized by gestational age at the start period (<14weeks' and 14-20weeks') to assess if duration of exposure affected gestational weight gain risks with the use of multinominal logistic regression. Among 5,377 individuals 3,619 (67.3 %) and 1,758 (32.7 %) were in the pre and early pandemic epochs respectively. Overall, 934 (17.4 %) individuals gained below recommended, 1,280 (23.8 %) met recommendations, and 3,163 (58.8 %) gained above IOM recommended gestational weight gain. Compared to the pre-pandemic epoch, the early pandemic period was not associated with weight gain below (OR 1.06, 95 % Cl 0.89-1.27) or above (OR 1.03, 95 % Cl 0.89-1.19) IOM recommendations. This was also true when the early pandemic group was stratified based on gestational age at the start of the early pandemic period (<14weeks' and 14-20weeks'). This study demonstrated no significant difference in maternal weight gain between pre and early COVID-19 pandemic periods.

100. Epidemiology of Mandibular Fracture Cases for Mataram University General Surgery Resident Competence in Hospital Education Center

Introduction: WHO (2024) estimates that 20–50 million individuals get non-fatal injuries and over 1.2 million people globally pass away on traffic accidents. craniomaxillofacial fracture cases can be done by multidisciplinary, depend on diagnosis and competence of surgeons. Methods: This study is quantitative descriptive study using medical record data of craniofacial trauma patients NTB Province General Hospital from January 2022 to September 2024, patients who experienced or who had been diagnosed of craniofacial trauma. Results: 388 patients were diagnosed with craniofacial trauma at NTB Province Hospital. There were had 99 lower face fractures, 120 mid face fractures, and 169 with upper face fractures. It was found male gender was more than female, age range of 21-30 years. the 99 patients with mandibular fractures, 66 simple mandibular fractures obtained that could be done by general surgery resident. In 2022-2023, Unram general surgery residents are not yet in the advanced surgical phase, cannot participate in mandibular fracture surgery. But this data can provide an overview that mandibular fracture cases are sufficient in number for they operative cases. Conclusions: This study, there are 66 cases of mandibular os fracture that can be performed operatively by unram general surgery residents according to competence of general surgeons as stated in the Decree Minister of Health. So that can help in help cranio maxilo facial cases in good interdisciplinary cooperation to get optimal results.

Early Elevated Inflammatory Markers in SARS-CoV-2 Vaccinated Patients Are Associated with Reduced Mortality, Morbidity, and Lung Injury

Background The development of vaccines against SARS-CoV-2 has proved to be a highly successful strategy. In this work, the aim is to study the effects of the SARS-CoV-2 vaccine on the production of inflammatory markers and how this affect morbidity and mortality. Electronic medical record (EMR) data from 210 patients diagnosed with COVID-19 from November 2020 to June 2021 were collected. The admitted patients were divided into three groups, the one-dose vaccinated, two-dose vaccinated, and the non-vaccinated. All patients were moderate or severe in disease level as defined by the WHO classification. The results show that CRP was 101 ± 5.3, 97 ± 10.8, and 145 ± 17.3 (p &lt; 0.05), fibrinogen 529 ± 16.3, 397 ± 33.8, and 610 ± 15 (p &lt; 0.05), D-dimer 1244 ± 89, 1279 ± 297, and 1615 ± 224 (p &lt; 0.05), ferritin was 1170 ± 122, 999 ± 202, and 1663 ± 409 (p &lt; 0.05), IL-6 was 196 ± 12, 96 ± 5, and 580 ± 402 (NS), for the non-vaccinated, one-dose vaccinated, and two-dose vaccinated groups, respectively. The high level of CRP up to 150–200 mg/dL was more common among the surviving vaccinated patients. Oxygen supplementation, mechanical ventilation, and mortality were higher in the non-vaccinated group. Blood urea nitrogen (BUN) level was higher in the vaccinated patients, 25 ± 0.14 vs. 33 ± 6.15, respectively (p &lt; 0.05). Inflammation markers were significantly higher in the vaccinated groups compared to non-vaccinated groups. On the other hand, extremely high levels of CRP (&gt;200 mg/dL) were correlated with high mortality incidence.

Research on Predicting Survival in Heart Failure Patients of Logistic Regression Models

Abstract. The purpose of this paper is to study a logistic regression model for predicting the survival of patients with heart failure. Heart failure is a serious clinical syndrome that usually develops from multiple heart diseases, and its inadequate pumping function of the heart poses a significant threat to the life and health of the patient and a significant economic burden on the healthcare system. Using medical record data from 299 patients with heart failure in the UCI database, this research utilized logistic regression models to identify the critical factors influencing the survival of heart failure patients and to forecast their survival outcomes. This paper found that age, ejection fraction, serum creatinine concentration and follow-up period are significant factors affecting survival in patients with heart failure. By adopting backward elimination method to optimize the model, the accuracy of prediction is further improved. The optimized logistic regression model yields an area under the Receiver Operating Characteristic (ROC) curve of 0.845, showing high prediction accuracy. The conclusions of this study provide a new perspective for the early diagnosis, risk assessment and personalized treatment of heart failure.

Comparing Pain Outcomes and Treatment Adherence Between In-Person and Virtual Interdisciplinary Pain Rehabilitation Programs at the San Francisco VA Health Care System.

This study compares clinical pain outcomes between patients in a pain treatment program that was conducted in-person, compared to a virtual program. In-Person (N=127) and Virtual (N=101) pain treatment programs were compared based on patient-reported, practitioner-collected, and medical record data. The patients were measured at baseline and post treatment (week 12 for In-Person and week 8 for Virtual patients). We employed last observation carried forward (LOCF) to handle missing data. Both the In-Person and Virtual groups were similar in regard to all baseline outcomes, except the In-Person group having significantly more co-morbidities at baseline, with particularly more cases of mental, behavioral, or neurodevelopmental diseases. Both groups demonstrated significant improvements in the pain-related measurements of pain interference and pain catastrophizing thoughts, but neither group displayed a change in average pain across treatment. Further, both groups improved significantly on emotional well-being scores, but not on physical functioning scores. No significant differences existed between groups on outcomes, except for pain catastrophizing, which was higher in the Virtual group at both time points. The Virtual group had lower rates of dropouts compared to In-Person, while the In-Person group had a larger proportion reach a clinically meaningful change in pain-related outcomes, defined as a >30% improvement. While some changes were unique to the In-Person program, overall, patients in the Virtual program achieved similar treatment outcomes, suggesting that it can successfully treat Veterans seeking pain management, with less need for in-person facilities for both patients and clinicians.

Risk Factors of Agitation Among Schizophrenia Patients in Dr. Amino Gondohutomo Semarang Regional Psychiatric Hospital: A Cross-Sectional Study

Introduction: Schizophrenia is a severe mental disorder associated with deterioration in the functions of daily life and social functions because it can reduce a person’s quality of life. In the acute phase, many schizophrenic patients have agitated behavior where this behavior will risk injuring themselves and others because of that treatment costs increase. to determine the risk factors for agitation in schizophrenic patients in terms of age, gender, marital status, occupation, genetic history, and presence or absence of stressors. Methods: This research is a descriptive analytic using a cross-sectional design. The population in this study were schizophrenic patients at Dr. Amino Gondohutomo Semarang Regional Psychiatric Hospital. Research subjects will be taken using consecutive sampling techniques that meet the inclusion and exclusion criteria. Data collection used medical record data and the PANNS EC score to determine whether there was agitation. Data analysis included descriptive analysis with frequency and percentage distributions as well as hypothesis testing using the Chi Square test and logistic regression. Results: From the results of the Chi Square test and logistic regression, it was found that the factors of young age, male sex, unmarried, and unemployed were significant for PANSS EC with a prevalence value of 3.40 (1.13 – 10.22), 2.01 (1.14 – 3.56), 2.39 (1.36 – 4.20), and 2.07 (1.12 – 3.83). Conclusion: Factors of young age &lt;40 years, male sex, unmarried, and unemployed are risk factors for the occurrence of agitation in schizophrenic patients at Dr. Amino Gondohutomo Semarang Regional Psychiatric Hospital.

045. The Prevalence and Overview of Cholelithiasis at Achmad Mochtar Hospital, Bukittinggi

Background: Cholelithiasis (gallstone disease) is one of the most common diseases of the digestive tract.1 The incidence of Cholelithiasis in Indonesia certainly unknown, in China the incidence of all diseases is 10.7% and in Asia 3-10%.2 The risk factors for cholelithiasis have been generally known, namely the four "F": female, fat, forty, and fertile, (female, obesity, age 40 years, fertile age).3 Achmad Mochtar Hospital is a Provincial Hospital located in Bukittinggi city area which is famous for its history and cuisine. This study aims to obtain a profile of Cholelithiasis within the scope of Achmad Mochtar Hospital Bukittinggi. Methods: This study is a descriptive cross-sectional study. The subjects of the study were taken from medical record data of Cholelithiasis patients at Achmad Mochtar Hospital Bukittinggi in August 2023 - June 2024 that get in the inclusion criteria, all Cholelithiasis patients recorded in the medical records at Achmad Mochtar Hospital Bukittinggi in August 2023 - June 2024. The research variables are age, gender, and patient address. All data obtained are then analyzed using SPSS version 23 for Windows. Results: the results of the study obtained a total of 197 patients with ages &lt;40: 56 (28%), and &gt;40 : 141 (72%). The majority of patients are women 125 (63%) and men 72 (36%), demographically the most patients are from the Bukittinggi city (26%). Conclusion: Cholelithiasis patient at Achmad Mochtar Hospital Bukittinggi August 2023 - June 2024 were 197 people, the majority were aged &gt;40 years with women being the most patient and a lot of patient come from Bukittinggi suspected because Bukittinggi is tourism city.