Medical Record Information Research Articles

Risk Factors of COVID-19 among Patients Attending a Tertiary Care Centre in Delhi: A Case Control Study

Introduction: COVID-19 is an infectious disease caused by a newly discovered coronavirus Severe Acute Respiratory Syndrome Corona Virus-2 (SARS CoV-2). Therefore, there is paucity of data on risk factors of COVID-19 in India which will help in designing preventive measures. Objective: To determine the risk factors of COVID-19 patients attending a tertiary care institution. Methods: The study was conducted at tertiary care hosipital in South Delhi, India among the patients admitted in Covid-19 wards or visiting the hospital for testing of SARS CoV-2 infection. Contact data of test results was collected from the medical record and detailed information was collected through telephone calls. 103 cases were selected who were found test positive by RT PCR and 103 negatives were selected as controls. Data was collected using pre-tested Questionnaire. The data were first captured in paper-based case record form and then entered in a Microsoft Excel and analyzed in SPSS Software version 21.0. Result: The mean age of all the participants was 37.63±15.32 years. On comparing cases and controls, it was found that symptoms like fever, general weakness, cough, sore throat, breathlessness and headache were significantly associated with cases, having an odds ratio of greater than 1 and p value< 0.05. On analysing various underlying medical conditions amongst controls and cases, it was found that there was a significant difference among cases and controls who had Diabetes Mellitus (DM) and Hypertension (p-value: 0.001) with a high odds ratio of 6.130 and 5.964 respectively. Around half of the cases (54.4%) and 23.3% of controls reported to have faced discrimination or changed attitude of their neighbours after revealing their RT-PCR report and this difference was statistically significant (p-value 0.001). Conclusion: Study revealed that majority of symptoms were not predictors of COVID-19 and only occupations and history of contact remained significant risk factors of COVID-19 in multivariate analysis. A multicenter research study is required to learn more about risk factors.

RANCANG BANGUN APLIKASI REKAM MEDIS BAGI PASIEN UNIT KESEHATAN KAMPUS BERBASIS WEB (Studi Kasus: Universitas Muhammadiyah Ponorogo)

To improve health care and processing data for medical records at the Muhammadiyah Ponorogo University campus health unit, a modern medical record information system is needed. The current medical record-recording process in the Muhammadiyah University campus medical unit of Ponorogo is still done by hand, which is by writing in a book and a patient's treatment card. This is running less optimal because an official has to retrieve and retrieve the data that will be needed in a patient's books and treatment cards, so it takes little time and space. The aim of this study is to develop an existing medical record system, becoming a web-based modern medical record system for patients to record clearly and more efficiently. The study begins with observation, study literature, and then follows the design method using the waterfall model, the context diagram design, the flow diagram (DFD), entity relathionship diagram (erd), system interface design and application testing. With the design of this application for medical records, it is hoped to be beneficial and can improve health care at UKK Muhammadiyah University Ponorogo. The design of this medical record application is still in short supply, and few improvements and innovations that the age has developed need to be made.

Tinjauan Pelepasan Informasi Rekam Medis Berdasarkan Aspek Hukum Keamanan dan Kerahasiaan Rekam Medis untuk Pendidikan di RSUD Sleman

Regional general hospital of sleman (RSUD) is a hospital located in Sleman Regency with type B education. As a teaching education, Sleman District Hospital often borrows medical records for research (Education) related to the release of medical record information with third parties necessary. Because the character of medical record documents and their contents are confidential, the hospital must guarantee the confidentiality of the contents of the medical record file and legal protection for patients and hospitals. This research was aimed to find out how the release of medical record information based on legal aspects of the security and confidentiality of medical records for education in Sleman Hospital. This type of research is qualitative by collecting data using interviews, observation and documentation. The results of research at the Sleman Hospital in the application of releasing medical record information for educational purposes in the Sleman Hospital are still not by existing regulations related to the unavailability of expedition books or medical record file borrowing books where the book is very important in knowing the existence of medical record files that come out. And a special place for researchers when researching medical record files is not yet available due to limited space in the medical record unit of Sleman District Hospital.

Pembuatan Sistem Informasi Rekam Medis Bagian Filing di Rumah Sakit Citra Husada Kabupaten Jember

The Filing medical records information system is a computerized information that can also be used to help medical records officers in the filing unit when borrowing and returning medical record files and to help them when doing a retention. Filing information system at Citra Husada Hospital, of Jember Regency is still using a manual system for recording the loan file of medical record and also there is no recording date system for returning medical record file. The purpose of this study was to design and create a medical record information system for the filing section at Citra Husada Hospital, Jember Regency using the waterfall method. Data collection uses interviews, observation and FGD (Focus Group Discussion). In the process of designing this system using a Flowchart System, Context Diagrams, Data Flow Diagrams, Entity Relationship. Digram and in implementing programs using Microsoft Visual Basic 2010. The results of this study are the making of a medical record information system for filing to facilitate officers in controlling medical record documents in filing through borrowing, repayment and retention. The next researcher is expected to be able to integrate with the existing SIMRS so that filling in the medical record data can automatically appear when in the filing section

Intraocular Pressure Reduction after Phacoemulsification: A Matched Cohort Study

Phacoemulsification has been linked to lowered intraocular pressure (IOP) in patients with glaucoma, ocular hypertension, anatomic narrow angles, and in glaucoma suspects, but the magnitude of change has varied. Retrospective cohort study. Patients with glaucoma treated from June 2010 through May 2015 who underwent phacoemulsification (surgical group) were matched to patients who did not (nonsurgical group) for age, gender, type of glaucoma, baseline IOP, and number and type of glaucoma medications. Electronic medical record information was used to compare the matched surgical and nonsurgical groups. Change in IOP, change in number of glaucoma medications, and likelihood of a glaucoma procedure within 36 months after phacoemulsification. Intraocular pressure measures were obtained from Goldmann applanation tonometry when available (45%), and otherwise with the iCare tonometer (iCare USA, Raleigh, NC), the Tono-Pen (Reichert Technologies, Depew, NY), noncontact tonometry, and pneumotonometry. Among 16 169 matched pairs, average IOP after the index date was lower in the surgical than nonsurgical group throughout follow-up to 36 months. The difference was greatest during months 1 through 18, during which IOP increased by 0.22 mmHg from 16.49 mmHg in the average nonsurgical patient and decreased by 0.99 mmHg from 16.50 mmHg in the average surgical patient (difference in difference, 1.21 mmHg; 95% confidence interval [CI], 1.12-1.30 mmHg). The difference in difference was greatest for patients with ocular hypertension (2.00 mmHg) and for patients with preoperative IOP of 20 mmHg or more (2.46 mmHg). By 30 to 36 months, 5% (95% CI, 4%-6%) fewer surgical patients used an ophthalmic medication. In the surgical group, the odds of selective laser trabeculoplasty were reduced in patients with ocular hypertension (odds ratio [OR], 0.27; 95% CI, 0.10-0.74) or glaucoma suspects (OR, 0.31; 95% CI, 0.20-0.47), whereas the odds of glaucoma surgery were elevated in surgical patients with primary open-angle glaucoma (OR, 1.48; 95% CI, 1.08-2.01). The association of phacoemulsification for cataract with IOP reduction was lower than in past referral-based studies. Surgeons should expect to reduce IOP approximately 1 to 2 mmHg with phacoemulsification in patients with preoperative IOP of less than 20 mmHg.

Assessment of the Financial Status in Adult Diabetic Patients Attending the Diabetic Clinic in Bankura Sammilani Medical College, Bankura

Introduction: Diabetes and its complications impose significant economic consequences on individuals,families, health systems and countries. People living with diabetes and their families feel the impact ofdiabetes most directly, often through the expenses of diabetes treatment and loss of family income whendiabetes interferes with work.Objective: To assess the financial status of adult diabetic patients attending the diabetic clinic of BankuraSammilani Medical College, Bankura.Materials and Method: It is an Institution based, Cross-sectional, descriptive Study. Complete enumerationof all patients attending Diabetic clinic of Bankura Sammilani Medical College and hospital, Bankura, WestBengal was done. Eligible consenting of adult patients (> 18 years of age) who were diagnosed as a caseof diabetes at least 1 year back and on treatment were interviewed with review of medical record and Outof pocket expenditure information was collected in terms of INR. It views the cost of NCDs as the sum ofseveral categories of direct and indirect costs. The study was preceded after obtaining ethical clearance.Data were entered in MS Excel spread sheet. Calculation was done with the help of software SPSS 22.0 freeversion.Results: Majority of annual treatment expenses of study subjects were in Drugs and consumables (66.73%)followed by Investigation cost 15.19% and others. The average INR for annual total diabetes care was13,733.17±13,389.86.Conclusion: Drugs and consumables, investigation and transportation cost leads to more than 90.0% of outof pocket expenditure causing financial burden on both adult diabetic patient and its family.

Outcomes of Patients With Hospital-Acquired Influenza

Background: Hospital-acquired influenza (HA flu) lacks a consensus definition. However, it is known to be associated with increased inpatient morbidity and mortality. Objective: To describe the clinical course of HA flu in a cohort population. Methods: A retrospective cohort study was conducted at a tertiary-care adult and pediatric teaching hospital. Patients with HA flu during 3 seasons, 2016 through 2019, were identified from medical record information based on timing of the onset of signs and symptoms and positive virologic testing >72 hours after admission. Influenza infection was confirmed by multiplex respiratory PCR, influenza A/B PCR, or direct fluorescent antibody tests. Chart review was performed to abstract patient demographics and comorbidities, length of stay, testing, and timing to antiviral administration as well as diagnosis of pneumonia, coinfections, and 30-day mortality. Escalation of care during hospitalization was defined as a new requirement of supplemental oxygen, invasive or noninvasive ventilation, and transfer to an intensive care unit. Results: During the 3 flu seasons, 132 patients were identified with HA flu; 76 (58%) were women, 6 (4.6%) were aged <18 years, and 126 (95.4%) were adults. Annually, HA-flu patients accounted for 5%–7.8% of all patients hospitalized with laboratory-proven influenza. The median duration between hospitalization and positive flu test was 15 days, and the median length of stay after influenza diagnosis was 6 days. Antiviral treatment was received by 96% of the patients. In total, 41 patients (31%) showed radiographic evidence for pneumonia. Coinfection with either a viral or bacterial pathogen was identified in 25% of the cases. In addition, 26% of the patients experienced an escalation of care, and 20 patients (15%) were transferred to the intensive care unit after HA flu diagnosis. Furthermore, 4 deaths (3%) were attributed to influenza during their hospitalization. Conclusions: HA flu was a frequent cause for escalation in care and was associated with a mortality rate substantially higher than is typically seen in community-based populations with influenza. Coinfection was mostly related to bacteremia and pneumonia, yet not all pneumonias had an associated microbiological diagnosis other than influenza, and there was no significant association between coinfection and mortality. Future work should explore more precise definitions for HA flu as well as its complications.Funding: NoneDisclosures: None

Accuracy Implementation of Medical Record Management Information System with Waterfall Design System and ISO 9126

Aims: Based on the observations of researchers, some health facilities still use manual processes / have not been documented by the information system resulting in slow service, this study aims to improve health services with a medical record information system.
 Methodology: The method used in this study is an analysis of information systems with the waterfall method and accuracy testing with ISO 9126.
 Results: The results of this medical record management information system run well based on black-box testing and white box results obtained both from an average value of 82 based on the ISO 9126 scale conversion table.
 Conclusion: Based on the results of the average value obtained from the validation test carried out on 3 expert examiners, it can be concluded that the application for the validation system for the validation and distribution of this letter has met the ISO 9126 standard with an average good interpretation of a total value of 82, and according to be able to simplify the process of Patient Medical Record Data Management without neglecting the safety aspects of the validation and distribution process, minimizing data loss, simplifying the reporting process and facilitating the processing of patient medical record data.

Sedentary Behavior, Physical Inactivity, and Metabolic Syndrome: Pilot Findings From the Rapid Assessment Disuse Index Study.

The Rapid Assessment Disuse Index (RADI) is a brief tool aimed to promptly assess primary care patients' overall physical inactivity and sedentary behavior. This study examines the relation between physical inactivity and sitting time (RADI) to cardiometabolic risk among primary care patients. Survey data and electronic medical record information were collated to explore the association between RADI scores (cumulative and sitting) to metabolic syndrome (and components) among women and men, using multivariable logistic regression. Among women, the cumulative RADI score was not significantly associated with metabolic syndrome. However, the RADI sitting score was related to low high-density lipoprotein cholesterol and metabolic syndrome. That is, a transition to a higher RADI sitting score by 1 unit (vs remaining in the score) was related with a 1.4 and 1.3 times higher odds for having low high-density lipoprotein cholesterol (95% confidence interval, 1.05-1.87) and metabolic syndrome (95% confidence interval, 1.02-1.64), respectively. Among men, no significant relations were found. The RADI sitting score is positively and significantly related to high-density lipoprotein and metabolic syndrome among women, yet not men. Due to the RADI's potential clinical utility, future research should attempt to examine these relations in larger, more robust samples and adjudicated outcomes using a prospective design.

Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study.

IntroductionAn increased risk of sexual health problems is seen among patients with chronic illnesses. The background is likely to be multifactorial, but it remains poorly understood.AimTo investigate the sexual health and functioning of patients with rheumatoid arthritis (RA) and to examine gender differences, general population comparisons, and possible somatic, psychological, and disease-specific determinants.MethodsA cross-sectional study using a digital questionnaire distributed among 380 patients diagnosed with RA in a Danish university hospital outpatient setting.Main Outcome MeasureA range of patient-reported outcomes were obtained, including scores from the validated rating scale Changes in Sexual Functioning Questionnaire. Furthermore, individual medical record information was collected.ResultsA total of 329 patients (250 women and 79 men) were included (age range: 25–73 years; mean age: 57.2 years). The Changes in Sexual Functioning Questionnaire scoring indicated an overall sexual dysfunction in 33.8% of men and 58.1% of women.More than one-third (37.6%) of patients felt that RA had made their sex life more complicated, and 32.4% feared that this might someday be the case. In total, 29.2% patients had experienced sexual problems due to their RA treatment. Of the respondents who experienced RA-related fatigue, 46.5% reported that this impacted negatively on their sexual activity. The risk of one or more sexual health adversities was significantly correlated with female gender, older age, moderate or severe depression, moderate to moderately high loneliness, more than 2 comorbidities, and a fatigue score above 75 out of 100 on a visual analogue scale. Compared to the general population, significantly fewer patients with RA considered their sex life important, and significantly fewer patients appraised their current sex life as good or very good. Moreover, significantly more women with RA (32.1%) than women from the general population (15.7%) had not had any sex life during the past year. A vast majority of patients with RA (93.5% of women and 85.5% of men) had not discussed sexual issues with a health-care professional during the last 5 years. Of all, 32.5% would like health-care professionals to address sexual topics in the consultation occasionally.ConclusionSexual dysfunction is highly prevalent in patients with RA, but the problems are not regularly addressed in consultations provided by the rheumatology department.Bay LT, Graugaard C, Nielsen DS, et al. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sex Med 2020;8:615–630.

PENGARUH PENYULUHAN KESEHATAN TERHADAP PENGETAHUAN PENCEMARAN SAMPAH MAKROPLASTIK DAN MIKROPLASTIK PADA MAHASISWA PRODI DIII PEREKAM DAN INFORMASI KESEHATAN STIKes IMELDA

Health education is one of the techniques to increase someone’s knowledge level due to the aim of improving knowledge and well understanding regarding microplastic and microplastic pollution. This research aimed to analyze the effect of health education towards the knowledge regarding macroplastic and microplastic pollution among students at the medical record and health major in the college of health sciences Imelda in terms of health education. This research used a quantitative approach with a Quasi-Experimental Study Design of a non-equivalent control group. The population was all the students with the medical record and health information major. The sampling technique used was purposive sampling, all the first-year students. The group of the sample consisted of two groups- the intervention and the control group. The intervention group consisted of 73 people who have given health education. Control group consisted of 73 people who have not given any health education. The statistic test used was the Wilcoxon test. The statistic result on the knowledge variable among the experiment group who had a good knowledge level refer to the pre-test score only 4.1 %. After given health education, the increasing number of people who had a good knowledge level (76.1%). The good knowledge level among the control group only showed 1.4% (pre-test and post-test). The result showed there was a significant increase after given health education among the experiment group (p=0.00). However, another result showed there was no significant difference among the control group (p=1.00). Health education towards macroplastic and microplastic pollution had a significant influence to the knowledge level for students. It is recommended for further research to examine the role of knowledge towards attitudes and behaviors or actions in the management of macro and microplastic waste pollution. Based on the results of the pre-test where respondents still have less and moderate knowledge while the issue of plastic waste in Indonesia requires full attention and more participation from the community from society, it is necessary to get the attention of educational institutions to further elaborate and educate students in pollution macro-plastic and microplastic waste.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Improving clinical records: their role in decision-making and healthcare management – COVID-19 perspectives

ABSTRACT Background: The ability of healthcare system to face the COVID-19 pandemic requires a professional competency in maintaining medical records to increase information and healthcare services quality. This study analyses the competency influence to medical record and health information management on planning and decision-making of healthcare services. A case study was conducted to explore this phenomenon. The COVID-19 has impacted to the clinical records is also discussed. Methods: The study uses a quantitative method to analyse correlation between medical record professional competencies, the quality and decision-making of healthcare services. Data analysis was used the structural equation model. The data were collected through purposive sampling of 49 respondents in case study hospital in Padang, Indonesia. Results: The medical record competency construct has a less significant effect on the decision-making construct, although the latter is positively related to competency. The quality construct is positively related to and has a significant effect on the decision-making construct. Conclusion: In the case study hospital revealed the competent medical record professional had a small influence on decision-making. In the COVID-19 pandemic situation, the new tools or systems such as telehealth or telemedicine might be an alternative by the healthcare service provider to improve their clinical record management information systems.

Urinary tract infection in pregnant females attending antenatal clinics among middle socioeconomic settings.

Objectives: To determine the frequency of Urinary tract infection (UTI) and the antibiotic sensitivity patterns of isolated uropathogens in pregnant females among middle socioeconomic settings. Study Design: Retrospective Cross Sectional study. Setting: Jinnah Medical College Hospital Karachi. Period: From Jan 2017 to Dec 2017. Material & Methods: This retrospective study was carried out in Jinnah Medical College Hospital (JMCH) Karachi after taking ethical review board approval. All the pregnant women who were registered in antenatal clinics from January 2017 to December 2017 was included. Data was taken from medical record department and information about age, parity, gravida, miscarriages, microorganisms of the urine samples and their antibiotic susceptibility pattern was noted. Results: Five hundred and sixty-four pregnant women of age 17-44 years were registered in the hospital in antenatal clinics during the year 2017. Out of 564 females, 48 (8.50%) presented with urinary tract infection some time during their pregnancy period. Majority of patients (54.2%) were infected with Escherichia coli (E coli), followed by Klebsiella pneumonia (16.77%), Pseudomonas spp. (12.5%), Enterococcus spp. (8.3%) and Staphylococus aureus (8.3%). These etiologic agents vary in their sensitivity pattern to antibiotics. Piperacillin-tazobactam had the highest overall sensitivity of (89.6%). This was followed by Meropenem (87.5%), Nitrofurantoin (87.5%) and Fosfomycin (81.3%). Cefixime, Cefotaxime and Amoxicillin/ clavulanic acid had overall sensitivities above 50%. Conclusion: E coli was the common organisms followed by others gram negative and positive organisms. Enteroococus spp. was also a significant bacterial isolates in this settings. Meropenem, Piperacillin-tazobactam, Nitrofurantoin, Fosfomycin were the highly effective antibiotics against isolated uropathogens. Amoxicillin/clavulanic acid and Cephalosporin also had a good results.

Comparison of Visual Outcomes between Panretinal Photocoagulation and Panretinal Photocoagulation Plus Intravitreal Bevacizumab in Proliferative Diabetic Retinopathy Patients Treated at Northen Zonal Hospital

Introduction: Diabetic retinopathy is one of the rigorous microvascular complications of diabetes mellitus is the significant cause of visual impairment and consequently blindness affecting about 36% of the diabetic population. Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are two prime manifestations of DR that are responsible for visual morbidity. The basis of the treatment in PDR is Laser photocoagulation as accomplished by Diabetic retinopathy treatment study (DRS) and early treatment diabetic retinopathy study (ETDRS) for the last two decades. The dawn of intravitreal anti-VEGF agents has revolutionized the management of diabetic eye disease for more than the last decade. The aim of the study is to compare the visual outcomes of diabetic retinopathy patients between pan-retinal photocoagulation and pan-retinal photocoagulation plus intravitreal Bevacizumab.
 Methodology: A hospital-based cross-section study using medical record information for all DR patients treated by PRP and IVB at the KCMC eye. Data were analyzed using SPSS version 20.
 Results: A number of 204 patients were included in the study. The mean age was 59.26 (SD=9.6) years; 75.4% were male. Most of the patients 71.1% are from Arusha and Kilimanjaro. Among all, 51% had PRP alone and the duration of Diabetes was 5-10 years in the majority. The mean VA for PRP alone was 0.89 (SD=0.89) before treatment while it was 1 (SD=0.99) in PRP plus Bevacizumab. At 3 months after treatment VA for PRP alone was 0.947 (SD=0.93) and 0.96 (SD=1.01) for PRP plus Bevacizumab. The mean difference was not statistically significant. VA improved by 49% and it deteriorated by 27.7%. The majority had early proliferated DR 49.7%, 42.8% high risk proliferated DR and advanced proliferated DR was 7.5%. The complications were found in 5.6% and they included: vitreous hemorrhage (4.6%) and retinal detachment (1%) in PRP plus Bevacizumab and none in PRP alone.
 Conclusion: With respect to this study there is no significant difference in visual outcome for PRP alone and PRP plus injection Bevacizumab, though PRP plus Bevacizumab in treatment of DR had better visual outcome over PRP alone. PRP plus injection Bevacizumab is associated with a higher and early rate of regression of active NVs than PRP alone in patients with PDR. Further studies will be needed to determine whether IVB plus PRP is a satisfactory treatment for the prevention of vision-threatening complications such as vitreous hemorrhage and tractional retinal detachment.

Formulating the Business Case for Hospital Information Systems – Analysis of Kaiser Permanente Investment Choice

This research paper focusses on the business case for the Hospital Information Systems (HIS) which represents the businesses that contemplate the fundamental investment in the Electronic Medical Record (EMR) information technology framework. In that case, Kaiser permanent framework is tasked with the obligation to maintain social mission which will develop the medical fields and can be applied by medical practitioners to effectively develop the clinical sector. Nonetheless, Kaiser framework might be stimulated to underscore just like many investment organizational cases, the data presented in this framework signifies our ‘effective thinking’ at a certain timeframe in relation to limited information. This represents both the internalized Kaiser Permanent information and the paucity of the essential sets of data in the wide-range medical and bioinformatics sector. We project that this research contributes to the upcoming measure of EMR to the clinical aspect of communities and patients. Moreover, there are critical analyses that have been executed in relation to the medical information technology and has been designed based on the framework’s cost and benefit analysis for the electronic HIS.

Sharing reports about domestic violence and abuse with general practitioners: a qualitative interview study

BackgroundDomestic violence and abuse (DVA) is common and damaging to health. UK national guidance advocates a multi-agency response to DVA, and domestic homicide reviews consistently recommend improved information-sharing between agencies. Identification of patients experiencing DVA in general practice may come from external information shared with the practice, such as police incident reports and multi-agency risk assessment conference (MARAC) reports. The aim of this study was to explore the views of general practitioners (GPs) and the police about sharing reports about DVA with GPs.MethodsQualitative semi-structured interviews were conducted with GPs, police staff and a partnership manager. Participants were located across England and Wales. Thematic analysis was undertaken.ResultsInterviews were conducted with 23 GPs, six police staff and one former partnership manager. Experiences of information-sharing with GPs about DVA varied. Participants described the relevance and value of external reports to GPs to help address the health consequences of DVA and safeguard patients. They balanced competing priorities when managing this information in the electronic medical record, namely visibility to GPs versus the risk of unintended disclosure to patients. GPs also spoke of the judgements they made about exploring DVA with patients based on external reports, which varied between abusive and non-abusive adults and children. Some felt constrained by short general practice consultations. Some police and GPs reflected on a loss of control when information about DVA was shared between agencies, and the risk of unintended consequences. Both police and GPs highlighted the importance of clear information and a shared understanding about responsibility for action.ConclusionGPs regarded external reports about DVA as relevant to their role, but safely recording this information in the electronic medical record and using it to support patients required complex judgements. Both GPs and police staff emphasised the importance of clarity of information and responsibility for action when information was shared between agencies about patients affected by DVA.

Artificial intelligence and lung cancer treatment decision: agreement with recommendation of multidisciplinary tumor board.

BackgroundIBM Watson for Oncology (WFO) is a cognitive computing system helping physicians quickly identify key information in a patient’s medical record, surface relevant evidence, and explore treatment options. This study assessed the possibility of using WFO for clinical treatment in lung cancer patients.MethodsWe evaluated the level of agreement between WFO and multidisciplinary team (MDT) for lung cancer. From January to December 2018, newly diagnosed lung cancer cases in Chonnam National University Hwasun Hospital were retrospectively examined using WFO version 18.4 according to four treatment categories (surgery, radiotherapy, chemoradiotherapy, and palliative care). Treatment recommendations were considered concordant if the MDT recommendations were designated ‘recommended’ by WFO. Concordance between MDT and WFO was analyzed by Cohen’s kappa value.ResultsIn total, 405 (male 340, female 65) cases with different histology (adenocarcinoma 157, squamous cell carcinoma 132, small cell carcinoma 94, others 22 cases) were enrolled. Concordance between MDT and WFO occurred in 92.4% (k=0.881, P<0.001) of all cases, and concordance differed according to clinical stages. The strength of agreement was very good in stage IV non-small cell lung carcinoma (NSCLC) (100%, k=1.000) and extensive disease small cell lung carcinoma (SCLC) (100%, k=1.000). In stage I NSCLC, the agreement strength was good (92.4%, k=0.855). The concordance was moderate in stage III NSCLC (80.8%, k=0.622) and relatively low in stage II NSCLC (83.3%, k=0.556) and limited disease SCLC (84.6%, k=0.435). There were discordant cases in surgery (7/57, 12.3%), radiotherapy (2/12, 16.7%), and chemoradiotherapy (15/129, 11.6%), but no discordance in metastatic disease patients.ConclusionsTreatment recommendations made by WFO and MDT were highly concordant for lung cancer cases especially in metastatic stage. However, WFO was just an assisting tool in stage I–III NSCLC and limited disease SCLC; so, patient-doctor relationship and shared decision making may be more important in this stage.

Developing model biobanking consent language: what matters to prospective participants?

BackgroundEfforts to improve informed consent have led to calls for providing information a reasonable person would want to have, in a way that facilitates understanding of the reasons why one might or might not want to participate. At the same time, advances in large-scale genomic research have expanded both the opportunities and the risks for participants, families, and communities. To advance the use of effective consent materials that reflect this landscape, we used empirical data to develop model consent language, as well as brief questions to assist people in thinking about their own values relative to participation.MethodsWe conducted in-person interviews to gather preliminary input on these materials from a diverse sample (n = 32) of the general population in Nashville, Tennessee. We asked them to highlight information they found especially reassuring or concerning, their hypothetical willingness to participate, and their opinions about the values questions.ResultsConsent information most often highlighted as reassuring included the purpose of the biobank, the existence and composition of a multidisciplinary oversight committee, the importance of participants’ privacy and efforts to protect it, and controlled access to a scientific database. Information most often highlighted as concerning included the deposition of data in a publicly accessible database, the risk of unintended access to data, the potential for non-research use of data, and use of medical record information in general. Seventy-five percent of participants indicated initial willingness to participate in the hypothetical biobank; this decreased to 66% as participants more closely considered the information over the course of the interview. A large majority rated the values questions as helpful.ConclusionsThese results are consistent with other research on public perspectives on biobanking and genomic cohort studies, suggesting that our model language effectively captures commonly expressed reasons for and against participation. Our study enriches this literature by connecting specific consent form disclosures with qualitative data regarding what participants found especially reassuring or concerning and why. Interventions that facilitate individuals’ closer engagement with consent information may result in participation decisions more closely aligned with their values.

Forecasting a Crisis: Machine-Learning Models Predict Occurrence of Intraoperative Bradycardia Associated With Hypotension.

Predictive analytics systems may improve perioperative care by enhancing preparation for, recognition of, and response to high-risk clinical events. Bradycardia is a fairly common and unpredictable clinical event with many causes; it may be benign or become associated with hypotension requiring aggressive treatment. Our aim was to build models to predict the occurrence of clinically significant intraoperative bradycardia at 3 time points during an operative course by utilizing available preoperative electronic medical record and intraoperative anesthesia information management system data. The analyzed data include 62,182 scheduled noncardiac procedures performed at the University of Washington Medical Center between 2012 and 2017. The clinical event was defined as severe bradycardia (heart rate <50 beats per minute) followed by hypotension (mean arterial pressure <55 mm Hg) within a 10-minute window. We developed models to predict the presence of at least 1 event following 3 time points: induction of anesthesia (TP1), start of the procedure (TP2), and 30 minutes after the start of the procedure (TP3). Predictor variables were based on data available before each time point and included preoperative patient and procedure data (TP1), followed by intraoperative minute-to-minute patient monitor, ventilator, intravenous fluid, infusion, and bolus medication data (TP2 and TP3). Machine-learning and logistic regression models were developed, and their predictive abilities were evaluated using the area under the ROC curve (AUC). The contribution of the input variables to the models were evaluated. The number of events was 3498 (5.6%) after TP1, 2404 (3.9%) after TP2, and 1066 (1.7%) after TP3. Heart rate was the strongest predictor for events after TP1. Occurrence of a previous event, mean heart rate, and mean pulse rates before TP2 were the strongest predictor for events after TP2. Occurrence of a previous event, mean heart rate, mean pulse rates before TP2 (and their interaction), and 15-minute slopes in heart rate and blood pressure before TP2 were the strongest predictors for events after TP3. The best performing machine-learning models including all cases produced an AUC of 0.81 (TP1), 0.87 (TP2), and 0.89 (TP3) with positive predictive values of 0.30, 0.29, and 0.15 at 95% specificity, respectively. We developed models to predict unstable bradycardia leveraging preoperative and real-time intraoperative data. Our study demonstrates how predictive models may be utilized to predict clinical events across multiple time intervals, with a future goal of developing real-time, intraoperative, decision support.