Medical Record Information Research Articles

Metode Seni Drama Dalam Pembelajaran Simulasi Pelayanan Rumah Sakit Dalam Lab. Administrasi Rumah Sakit STIKES DONA Palembang

The notion of drama is something that is known so far, which for example states that drama is a story or an imitation of human behavior that is staged which is not wrong. This is because when viewed from the words of the drama itself, the definition of drama above is considered appropriate. In dramaturgy, form is taken into account as an overall concept of how to experience a role so that we can give the concept according to what we want in the event. It should be remembered, in dramatugi it is necessary to study human behavior in context to achieve its goals and not to study the results of its behavior in these events. In dramaturgy, it is necessary to understand that in interactions between humans is behavior that is approved and can lead to the ultimate goal of the purpose of social interaction in the event. In general, this research uses a descriptive method, namely a method that is as relative as possible to explain and describe, analyze, and interpret as well. Qualitative research is data collected by researchers in the form of words, sentences or pictures that have a more meaningful meaning so that they are able to trigger a real understanding of any description of something that is not just a presentation of numbers and also frequency. In addition to primary data, there are also observations in drama learning in the fourth semester of the Medical Record and Health Information Study Program at Stikes Dona Palembang. Secondary data is in the form of writings related to drama learning with the art method of playing drama based on project learning obtained from various sources in the form of simulations carried out in the administrative laboratory of the RMIK Stikes Dona Palembang hospital. In drama learning it is also necessary to appreciate drama not only focusing on cognitive aspects which involve affective and psychomotor aspects by carrying out activities such as during administrative services to develop the imagination and readiness of the students themselves in activities in designing hospital administration. Keywords: method, drama, service

SOCIALIZATION OF MEDICAL RECORD DESTRUCTION PROCEDURE AT PUBLIC HEALTH CENTER WORKING AREA OF KULON PROGO HEALTH DEPARTMENT

Medical record is a document that is used as a media record in serving patients at the health center. Theimplementation of recording using paper media turned out to have several weaknesses including the needfor storage space. Storage space in each public health center has limitations due to the area of the room,the number of rooms, and the availability of storage shelves. The number of medical records will continueto increase at any time, so it is necessary to carry out activities to destroy medical records according toapplicable policies. The results of a preliminary study with the Head of the DPC PORMIKI Kulon Progo andthe Head of 6 public health center Installation, the obstacles faced by the public health center in the KulonProgo Health Office work area are 1) There is no special room for storing inactive medical records due tolimited space, 2) It cannot be destroyed because there are several extermination procedures that involveexternal parties, namely archivists, 3) Lack of medical record and health information graduates in eachhealth center, so they do not understand the procedure and management of medical record disposal. Thisactivity was attended by 120 participants which was held online and offline while adhering to healthprotocols during the Covid-19 Pandemic. The method of implementing this activity is by conductingoutreach to HIM at the Kulon Progo Health Center. This activity includes the presentation of material byresource persons as PMIK experts and resource persons from the Archives and discussions withparticipants. The resulting outputs are 1) procedures and procedures for the destruction of medical records2) optimization and ease of knowledge of PMIK officers in the destruction process which can involve theauthorities.

Classification of Medical Image Notes for Image Labeling by Using MinBERT

The lack of labeled image data poses a serious challenge to the application of artificial intelligence (AI) in medical image diagnosis. Medical image notes contain valuable patient information that could be used to label images for machine learning tasks. However, most image note texts are unstructured with heterogeneity and short-paragraph characters, which fail traditional keyword-based techniques. We utilized a deep learning approach to recover missing labels for medical image notes automatically by using a combination of deep word embedding and deep neural network classifiers. Bidirectional encoder representations from transformers trained on medical image notes corpus (MinBERT) were proposed. We applied the proposed techniques to two typical classification tasks: Medical image type identification and clinical diagnosis identification. The two methods significantly outperformed baseline methods and presented high accuracies of 99.56% and 99.72% in image type identification and of 94.56% and 92.45% in clinical diagnosis identification. Visualization analysis further indicated that word embedding could efficiently capture semantic similarities and regularities across diverse expressions. Results indicated that our proposed framework could accurately recover the missing label information of medical images through the automatic extraction of electronic medical record information. Hence, it could serve as a powerful tool for exploring useful training data in various medical AI applications.

Design of an Integrated Medical Record Information System at Puskesmas Kota Banjar

Perkembangan pemanfaatan ilmu pengetahuan dan teknologi memberikan dampak yang dapat digunakan diberbagai bidang salah satunya Puskesmas. Salah satu pengembangan yang dilakukan puskesmas yaitu mengembangkan untuk meningkatkan kualitas manajemen pelayanan kesehatan dengan menerapkan sistem informasi puskesmas berbasis teknologi informasi. Pencatatan apabila dilakukan dengan cara ditulis pada buku pasien merupakan cara lama yang digunakan. Maka perlu adanya suatu sistem yang membantu untuk memudahkan pencatatan. Metode pengembangan pada sistem informasi yang akan di ajukan ini yaitu dengan metode Waterfall. Menghasilkan Sistem Informasi Rekam Medis yang terintegrasi untuk mempermudah pihak Puskesmas di daerah Kota Banjar dalam mengolah data jika terdapat pasien yang sebelumnya belum pernah mengunjungi puskesmas tersebut maka akan terdapat Rekam Medis. Sistem Informasi mempermudah dalam mengelola data Rekam Medis sehingga tidak perlu mencari catatan yang begitu banyak dikarenakan data nya sudah tersimpan dalam database. Sistem Informasi Rekam Medis terintegrasi maka data pasien akan terlihat di semua Puskesmas yang ada di Kota Banjar. Pengujian dalam penelitian dilakukan dengan tahapan metode System Usability Scale (SUS) mendapat nilai akhir yaitu 73,1 dan Hasil pengujian menghasilkan nilai rekomendasi dalam kategori Acceptable.The development of the use of science and technology has an impact that can be used in various fields, one of which is the Puskesmas. One of the developments carried out by the puskesmas is developing to improve the quality of health service management by implementing an information technology-based puskesmas information system. Recording when it is done by writing it in the patient book is the old way used. So, it is necessary to have a system that helps to facilitate recording. The development method for the information system that will be proposed is the Waterfall method. Producing an integrated Medical Record Information System to make it easier for the Puskesmas in the Banjar City area to process data. If there are patients who have never visited the puskesmas before, there will be Medical Records. The Information System makes it easy to manage Medical Record data so there is no need to search for so many records because the data is already stored in the database. The Medical Record Information System is integrated so that patient data will be visible in all Community Health Centers in Banjar City. Testing in the study was carried out using the System Usability Scale (SUS) method, obtaining a final score of 73.1 and the test results yielded a recommendation value in the Acceptable category.

Prediction of the risk of cytopenia in hospitalized HIV/AIDS patients using machine learning methods based on electronic medical records.

Cytopenia is a frequent complication among HIV-infected patients who require hospitalization. It can have a negative impact on the treatment outcomes for these patients. However, by leveraging machine learning techniques and electronic medical records, a predictive model can be developed to evaluate the risk of cytopenia during hospitalization in HIV patients. Such a model is crucial for designing a more individualized and evidence-based treatment strategy for HIV patients. The present study was conducted on HIV patients who were admitted to Guangxi Chest Hospital between June 2016 and October 2021. We extracted a total of 66 clinical features from the electronic medical records and employed them to train five machine learning prediction models (artificial neural network [ANN], adaptive boosting [AdaBoost], k-nearest neighbour [KNN] and support vector machine [SVM], decision tree [DT]). The models were tested using 20% of the data. The performance of the models was evaluated using indicators such as the area under the receiver operating characteristic curve (AUC). The best predictive models were interpreted using the shapley additive explanation (SHAP). The ANN models have better predictive power. According to the SHAP interpretation of the ANN model, hypoproteinemia and cancer were the most important predictive features of cytopenia in HIV hospitalized patients. Meanwhile, the lower hemoglobin-to-RDW ratio (HGB/RDW), low-density lipoprotein cholesterol (LDL-C) levels, CD4+ T cell counts, and creatinine clearance (Ccr) levels increase the risk of cytopenia in HIV hospitalized patients. The present study constructed a risk prediction model for cytopenia in HIV patients during hospitalization with machine learning and electronic medical record information. The prediction model is important for the rational management of HIV hospitalized patients and the personalized treatment plan setting.

Effect of different delivery modes on the level of protein, glucose and blood lipids in cord artery and vein blood

To explore whether there are differences in the levels of protein, glucose and blood lipids in umbilical vein and umbilical artery blood of newborns with different delivery modes, and to evaluate their value as indicators of fetal intrauterine nutrition and nutritional support. A total of 89 pairs of mothers and infants who were delivered in Danyang People's Hospital of Jiangsu Province from June to September 2021 were selected as the study subjects, including 38 cases of spontaneous delivery and 51 cases of cesarean section. The basic information of pregnant women, pregnancy information, newborn delivery and physical examination information were extracted from the medical record information system of the hospital. According to the mode of delivery, HITACHI 7600 automatic biochemical analyzer was used to measure the levels of protein, glucose and blood lipids in umbilical vein and umbilical artery blood, including total protein(TP), albumin(ALB), glucose(GLU), total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C). The data were statistically analyzed using IBM SPSS Statistics 26.0 statistical software. The levels of TP, ALB, GLU, TC, TG, HDL-C and LDL-C in the umbilical vein blood of the spontaneous delivery group were(56.40±5.83)g/L, (38.41±3.43)g/L, (4.55±1.53)mmol/L, (1.68±0.42)mmol/L, (0.25±0.11)mmol/L, (0.84±0.17)mmol/L and(0.69±0.23)mmol/L, respectively. The levels of TP, ALB, GLU, TC, TG, HDL-C and LDL-C in umbilical artery blood were(56.49±9.91)g/L, (37.72±4.77)g/L, (4.07±1.52)mmol/L, (1.60±0.42)mmol/L, (0.24±0.10)mmol/L, (0.80±0.18)mmol/L and(0.68±0.24)mmol/L, respectively. The levels of TP, ALB, GLU, TC, TG, HDL-C and LDL-C in umbilical vein blood of cesarean section group were(52.08±4.12)g/L, (36.12±2.13)g/L, (3.45±1.16)mmol/L, (1.61±0.39)mmol/L, (0.19±0.08)mmol/L, (0.82±0.18)mmol/L and(0.61±0.20)mmol/L, respectively. The levels of TP, ALB, GLU, TC, TG, HDL-C and LDL-C in umbilical artery blood were(51.49±7.59)g/L, (35.40±3.60)g/L, (3.09±1.15)mmol/L, (1.48±0.40)mmol/L, (0.19±0.08)mmol/L, (0.78±0.18)mmol/L and(0.60±0.20)mmol/L, respectively. The levels of TP, ALB, Glu and TG in cord vein blood and cord artery blood in spontaneous labor group were significantly higher than those in cesarean section group(P<0.05); The levels of Glu, TC, TG and HDL-C in cord vein blood were significantly higher in spontaneous labor group and cesarean section group than those in cord artery blood(P<0.05). The levels of protein, glucose and blood lipids in umbilical vein and umbilical artery blood were different among different delivery modes.

DESIGN OF DENTAL AND MOUTH CARE INFORMATION SYSTEM APPLICATION DESIGN

Background: Dental and oral health care services (Askesgilut) are planned care services within a certain period of time on an ongoing basis in the simple promotive, preventive, and curative fields to improve the degree of optimal dental and oral health in individual groups, and the community. by a dental and oral therapist (TGM). The results of the initial survey from the medical record or puskesmas information system show that there is no electronic record/recording of Askesgilut services, it is necessary to design an electronic Askesgilut record that is integrated with the information system. This study aims to obtain the design of the Askesgilut TGM information system at the Puskesmas
 Method: The design of the information system in this study uses a prototyping system design approach, namely a modern engineering-based design approach which is an interactive process that involves close working relationships between designers and users. The working relationship between designers and users is carried out through the Focus Group Discussion (FGD) method as well as in-depth interviews to obtain information/opinions/suggestions/inputs needed in designing the Askesgilut Information System application that will be used by TGM in Bandung City. This research involves the IT team as the main researcher. 
 Result: The results of making this application are the first step in developing the Askesgilut application in order to facilitate TGM in carrying out its main tasks.
 Conclusion: It is hoped that the design of the Askesgilut Information System will not only make it easier for TGM at the Puskesmas in carrying out their duties, but also can be used by the management at the puskesmas, which can then be directly connected to the Health Office to the Ministry of Health.

Feasibility Study of Implementation of Electronic Administration Systems in Hospitals

The manual approach is no longer the best option as healthcare services get more complex. As a result, several hospitals are beginning to implement IT to get around challenges and improve the efficacy and efficiency of their operations. This study aims to evaluate whether electronic administrative information systems can be implemented in hospitals. This study is a qualitative descriptive one that uses a literature review methodology. The author's choice of data for this study is secondary data. The collected data will undergo descriptive analysis. Based on the research findings, numerous advantages can be gained from installing electronic administration information systems at hospitals, notwithstanding any challenges or difficulties. Because they can improve the effectiveness and efficiency of hospital services in registering and storing patient data, registering, recording inpatient medical records, recording doctor data, recording room data, and producing administrative reports that management is required for decision-making and patient medical record information for insurance claims, electronic administrative information systems in hospitals are practical to implement. This study implies that hospital administrators who utilize electronic administration systems can use them as a reference source.

#4553 REAL WORLD DATA-DRIVEN IDENTIFICATION OF ANCA VASCULITIS RELAPSE

Abstract Background and Aims The relapsing-remitting, multi-system pattern of disease in ANCA vasculitis (AAV) results in incremental tissue injury. For those with renal involvement, there is a 9-fold increased risk of end-stage kidney disease after renal relapse. Relapse is defined by the Birmingham Vasculitis Activity Score (BVAS v3) >0, particularly in the clinical trial setting. However, this metric may be missing or incorrectly scored in real world registry data, resulting in incomplete or inaccurate ascertainment of this key outcome. Our aim was the development, internal validation and evaluation of a pragmatic data-driven algorithm to automate the retrospective identification of AAV relapse in real-world data. Method The Rare Kidney Disease (RKD) Registry is a national longitudinal, multi-centre cohort study, including 663 patients with AAV, of whom those with >6 months follow up post diagnosis were eligible for inclusion. We followed five steps to develop and validate the algorithm: 1) independent expert adjudication of encounters using primary medical record information to assign the reference probability of relapse (ground truth), 2) selection of data elements and corresponding value sets using literature review, expert opinion and with a consideration of likely data availability, 3) development of a computable phenotype definition, with an embedded logistic multi-level regression model using complete case analysis, 4) internal validation, 5) development of additional models (using the same method) to account for combinations of variable missingness (models described in Fig. 1). We also developed a Shiny web application to implement the final algorithm, which determines the appropriate model based on available variables, outputting an individualised probability of relapse, with a suggested binary interpretation. Results In the first step of the algorithm, encounters with diagnostic histopathology were labelled as relapse. For encounters without histopathological confirmation, we selected five objective data elements to build the model: change in ANCA level, suggestive blood/urine tests, suggestive imaging, immunosuppressive (IS) status at the time of the encounter and the change of this IS in response (‘IS response’) (Fig. 2). Development and validation datasets comprised 1209 and 377 separate encounters, respectively. An optimal cut-point of 0.48 was determined by maximising the F1-Score (0.85) for the complete 5-variable model. Sensitivity and specificity were 0.91 and 0.95 respectively. Performance metrics were stable across fifty random-split resamples. Calibration-in-the-large was satisfied. Where ‘IS response’ was missing, ‘suggestive bloods/urine’ (Data Element [DE]2) with at least either ‘ANCA level’ (DE1) or ‘suggestive imaging’ (DE3) was required to achieve an accuracy as good as gold standard BVAS (Fig. 1). Conclusion In settings where accurate BVAS may not be available, this algorithm accurately quantifies the individualised probability of AAV relapse using objective, readily accessible registry data. In addition to our web application, the model can be directly embedded in a registry database. This framework could serve as an exemplar for other relapsing-remitting diseases and for automating the identification of other key outcomes or cohorts in registry data.

PREVALENCE AND RISK FACTOR ANALYSIS OF ANEMIA IN PREGNANCY

Anemia is a condition in which the total amount of iron in the body is reduced. If iron deficiency is severe enough it can cause interference with the reproduction of red blood cells and cause anemia. This condition will cause weakness, become obstacles to activity and will also hinder the growth and development of children. This research aims to describe prevalence of anemia during pregnancy and determine the risk factors that can influence it. This research is included in the analytic descriptive study using a cross-sectional approach design. The target was pregnant women who had an examination at the Hasanah Clinic in September-November 2022. The data were collected by face-to-face interviews and information in medical record. The results showed that 15% of pregnant women had mild anemia and all predicted risk factors did not significantly influence anemia, such as gestational age (p value 0.074), number of gravidity (p value 0.495), and mid-upper arm circumference (p value 1.000). The provision of iron supplements and good nutritional intake can be one of the efforts to prevent and overcome anemia in pregnant women which develops worse

Who needs clinician attention first? A qualitative study of critical care clinicians’ needs that enable the prioritization of care for populations of acutely ill patients

BackgroundTo adequately care for groups of acutely ill patients, clinicians maintain situational awareness to identify the most acute needs within the entire intensive care unit (ICU) population through constant reappraisal of patient data from electronic medical record and other information sources.Our objective was to understand the information and process requirements of clinicians caring for multiple ICU patients and how this information is used to support their prioritization of care among populations of acutely ill patients. Additionally, we wanted to gather insights on the organization of an Acute care multi-patient viewer (AMP) dashboard. MethodsWe conducted and audio-recorded semi-structured interviews of ICU clinicians who had worked with the AMP in three quaternary care hospitals. The transcripts were analyzed with open, axial, and selective coding. Data was managed using NVivo 12 software. ResultsWe interviewed 20 clinicians and identified 5 main themes following data analysis: (1) strategies used to enable patient prioritization, (2) strategies used for optimizing task organization, (3) information and factors helpful for situational awareness within the ICU, (4) unrecognized or missed critical events and information, and (5) suggestions for AMP organization and content. Prioritization of critical care was largely determined by severity of illness and trajectory of patient clinical status. Important sources of information were communication with colleagues from the previous shift, bedside nurses, and patients, data from the electronic medical record and AMP, and physical presence and availability in the ICU. ConclusionsThis qualitative study explored ICU clinicians’ information and process requirements to enable the prioritization of care among populations of acutely ill patients. Timely recognition of patients who need priority attention and intervention provides opportunities for improvement of critical care and for preventing catastrophic events in the ICU.

The adjuvant oxaliplatin-irinotecan paradox.

e15655 Background: A pervasive pattern in oncology is that chemotherapeutic agents which achieve acceptance for adjuvant use are the ones that have shown superior efficacy in the treatment of metastatic disease. The greater the efficacy in metastatic disease, the greater the likelihood that adjuvant use will be statistically viable. Oxaliplatin is the exception to this, having paradoxically shown similar outcomes to irinotecan in metastatic colorectal cancer (CRC) but superiority in the adjuvant setting. In this study, the TriNetX research database was used to better evaluate the adjuvant efficacy of oxaliplatin use in real-world patients. Methods: The TriNetX research database was used for this study. The TriNetX platform provides access to anonymized medical record information on more than 91 million patients in 75 large healthcare organizations. Three cohorts of stage III colorectal patients were created for comparison, utilizing International Classification of Disease-10 (ICD-10) codes and medication codes provided in the TriNetX platform. All patients were required to have a diagnosis of colon cancer (C18) and lymph node involvement (C77), with the absence of any liver or lung metastases (C78.7 and C78.0, respectively). Adjuvant oxaliplatin use was identified by the presence of the oxaliplatin medication code within 9 months of CRC diagnosis. The adjuvant oxaliplatin cohort was compared to a cohort with no oxaliplatin exposure, identified by the exclusion of the oxaliplatin medication code for 12 months following CRC diagnosis. The cohorts were balanced for age, race, gender, and ethnicity. The endpoint of the comparisons was all-cause mortality at 5 years. Results: Adjuvant use of oxaliplatin was associated with a 2.3% absolute decrease in the risk of death at 5 years (risk ratio 0.88, 95% CI (0.79,0.97), p-value 0.01). See figure 1. Conclusions: This study shows that adjuvant use of oxaliplatin is associated with a 2.3% absolute survival advantage in stage III colorectal cancer patients. This small absolute benefit is likely why occasional retrospective analyses have been unable to replicate it. A controlled interrupted time series analysis from Huang, et. al. showed no benefit to adjuvant oxaliplatin in the stage III setting for Taiwanese patients. Such a small benefit may also explain why the ACHIEVE trial found three months of adjuvant oxaliplatin to be equivalent to six. When a benefit is very small, a shorter duration of treatment would be more likely to result in statistical equivalency than if the benefit was more substantial. [Table: see text]

Apixaban versus rivaroxaban for treatment of acute deep venous thrombosis in patients with cancer.

12113 Background: Direct oral anticoagulants (DOAC) such as Apixaban and Rivaroxaban are increasingly used for the treatment of acute venous thromboembolism (VTE) over traditional vitamin K antagonists. Malignant neoplasms predispose to acute VTE and clinical management necessitates anticoagulation to prevent further complications. We compare Apixaban to Rivaroxaban for the treatment of acute VTE in the setting of malignancy with the endpoint of chronic deep venous thrombosis (DVT) development after 2 years. Methods: The TriNetX Research network was used for this study. TriNetX provides access to anonymized medical record information on more than 107 million patients in 76 large healthcare organizations. Two cohorts were created for this study using the International Classification of Disease-10 (ICD-10) codes. All patients were required to have a diagnosis of breast (C50), lung (C34), colon (C18), or prostate cancer (C61). All were diagnosed with acute deep venous thrombosis (DVT) of the lower extremities (I82.409). One cohort was treated with rivaroxaban while the other was treated with apixaban within 3 days of DVT diagnosis. Each cohort was excluded from being treated with the other anticoagulant. The cohorts were balanced for age, race, gender, and ethnicity, then evaluated for the development of chronic DVT (I82.509) within the subsequent twelve months. Results: The development of chronic DVT was significantly more common in the apixaban cohort, with a risk ratio of 1.36 (95% CI (1.12,1.65), p-value 0.0015). See table. Conclusions: Patients with acute VTE in the setting of malignancy were at a significantly higher risk of developing chronic DVT following treatment with Apixaban compared to those who received Rivaroxaban at 2 years post-treatment. These results may contribute to increased discussion between physicians and patients when deciding between these two direct oral anticoagulants for the management of acute VTE. Diagnosis of chronic DVT in cancer patients treated with apixaban and rivaroxaban. [Table: see text]

Transcatheter-directed Y-90 radioembolization compared with chemoembolization for the treatment of hepatic metastases from colon cancer.

e15620 Background: Arterially directed embolic therapy has been a mainstay in the management of hepatic malignancy of both primary and metastatic origin. The benefits of transcatheter-directed Yttrium-90 radioembolization (TARE) and chemoembolization (TACE) in conjunction with systemic therapy are well documented, though only TARE is currently recommended for the management of hepatic metastases from colon cancer. We evaluated patients who underwent TARE or TACE to assess survival rates at 2 years post-procedure. Methods: The TriNetX Diamond network was used for this study. TriNetX provides access to anonymized medical record information on more than 213 million patients in 92 large healthcare organizations. Two cohorts of patients were created utilizing International Classification of Disease-10 (ICD-10) codes. All patients were required to have colon cancer (C18), liver metastases (C78.7), and liver-directed treatment (CPT code 37243). One cohort received chemoembolization (CPT 96420) while the other received Yttrium-90 microspheres (CPT 79445). The cohorts were balanced for age, race, gender, and ethnicity, resulting in 336 patients in each arm. They were then evaluated for risk of death at two years. Results: Patients who received Y-90 had a risk ratio for death of 1.23 compared to patients treated with chemoembolization. Figure 1. Conclusions: Patients who underwent TARE were at a significantly higher risk of mortality at 2 years post-procedure compared to those who underwent TACE. As only Y-90 radioembolization is currently recommended under NCCN guidelines for the treatment of hepatic metastatic lesions from colon cancer, we hope to further discussion among specialists to determine whether TACE may provide an alternative treatment option. [Table: see text]

Metabolic syndrome is independently associated with improved overall survival to first-line therapy with immune checkpoint inhibitors in non-small cell lung cancer.

Many co-existing medical conditions may affect the outcome in patients treated with immune checkpoint inhibitors for advanced cancer. There is currently not any information on whether metabolic syndrome (MetS) impacts the clinical outcome in patients treated with immune checkpoint inhibitors (ICIs) for advanced non-small cell line cancer (NSCLC). We carried out a single-center retrospective cohort study to determine the effects of MetS on first-line ICI therapy in patients with NSCLC. One hundred and eighteen consecutive adult patients who received first-line therapy with ICIs and had adequate medical record information for the determination of MetS status and clinical outcomes were included in the study. Twenty-one patients had MetS and 97 did not. There was no significant difference between the two groups in age, gender, smoking history, ECOG performance status, tumor histologic types, pre-therapy use of broad-spectrum antimicrobials, PD-L1 expression, pre-treatment neutrophil:lymphocyte ratio, or proportions of patients who received ICI monotherapy or chemoimmunotherapy. With a median follow-up of 9 months (range 0.5-67), MetS patients enjoyed significantly longer overall survival (HR 0.54, 95% CI: 0.31-0.92) (p = 0.02) but not progression-free survival. The improved outcome was only observed in patients who received ICI monotherapy and not chemoimmunotherapy. MetS predicted for higher probability of survival at 6 months (p = 0.043) and 12 months (p = 0.008). Multivariate analysis indicated that, in addition to the known adverse effects of use of broad-spectrum antimicrobials and the beneficial effects of PD-L1 (Programmed cell death-ligand 1) expression, MetS was independently associated with improved overall survival but not progression-free survival. Our results suggest that MetS is an independent predictor of treatment outcome in patients who received first-line ICI monotherapy for NSCLC.

Deploying the Red Cross Red Crescent Health Information System (RCHIS) into a Type-One Fixed EMT: How the Use of a Custom Built Application for Electronic Medical Records and Data Reporting Improves Patient Care and Mandatory Reporting.

Introduction:RCHIS is an Electronic Medical Record (EMR) and Health Information System (HIS) that has been purpose-built for use by Red Cross Red Crescent (RCRC) Emergency Response Units (ERUs), which are the equivalent of Type 1 (fixed and mobile) and Type 2 facilities in the Emergency Medical Teams (EMT) classification.Method:A three day in-person super user training was held with 13 participants: 9 first aid volunteers, 2 nurses and 2 medical doctors. Seven of the delegates had experience using an EMR. These super users served as trainers for staff at the pilot.The pilot occurred with the Portuguese Red Cross (PRC) for the Peregrinação de Fátima, where 200,000 people were in attendance. The PRC was part of a wider coordination cell with the civil defense authority, who required live reporting from the three Type 1 fixed clinics PRC had set up.Results:In total there were 77 user accounts, of which, 243 patients were consulted with and either discharged or referred throughout the four day pilot.The delegates shared feedback directly and through a survey. 88% stated that RCHIS was ‘very easy’ to use with the majority of delegates requiring less than 20 minutes of training to be using the application and inputting patient data related to their user role. Additionally, after their training 95% of delegates stated they had sufficient training to use RCHIS to its full extent. Informal feedback from delegates was hugely positive, indicating that it was improving patient care and also continuity of care when a patient returned the next day.The civil defense authorities were able to utilize the real-time reporting to assist in their operational response. The application was well received by the wider civil defense authority.Conclusion:The first RCHIS pilot was very successful from both a technical and organizational perspective.

From Two hours to Two Seconds: Using the Red Cross Red Crescent Health Information System (RCHIS) to Complete the WHO Emergency Medical Teams - Minimum Data Set Reporting

Introduction:Standardization of data collection and reporting within EMT’s is challenging. In past deployments, the Red Cross Red Crescent Type one and two facilities (Emergency Response Units- ERU’s) have collected data by hand using paper-based form and Excel spreadsheets. This process can be laborious, time consuming and often inaccurate.Method:RCHIS is both an electronic medical record (EMR) and health information system (HIS). RCHIS has been designed to produce pre-made reports including the MDS in seconds extracting data from the patient records. Through significant testing and pilot deployments in a domestic type one fixed clinic, the rapid production of reports such as the MDS has increased compliance and accuracy with reporting.Results:The utilization of an EMR and integrated HIS system for increasing compliance and accuracy with the MDS has been hugely successful. An in-depth analysis of the export data was done to confirm the 100% accuracy within the MDS report.Furthermore, feedback from users and managers within the ERU’s expressed the excitement for the ease of reporting not only to the EMTCC, but also to IFRC and back-donors. Moving forwards, this data collection will also be used to collect essential data to audit and improve the quality of care provided within the RCRC ERU’s.Conclusion:In conclusion, the utilization of RCHIS within a domestic ERU (equivalent to an EMT type one or two) has been hugely successful. The next steps will involve the deployment of RCHIS within an international deployment.

Involvement of folate and vitamin B12 deficiency in patients with normocytic anemia.

Deficiencies in folate (FA) and vitamin B12 (VB12) are causes of macrocytic anemia. However, in clinical practice, FA and/or VB12 deficiency can occur in patients with normocytic anemia. This study aimed to determine the prevalence of FA/VB12 deficiency in patients with normocytic anemia and the importance of vitamin replacement therapy in these patients. We retrospectively reviewed electronic medical record information of patients whose hemoglobin and serum FA/VB12 concentrations were measured at the Department of Hematology (N=1,388) and other departments (N=1,421) of Fujita Health University Hospital. In the Hematology Department, 530 (38%) patients showed normocytic anemia. Of these, 49 (9.2%) had FA/VB12 deficiency. Twenty of 49 (41%) patients had some hematological malignancies and 27 (55%) had benign hematological disorders. Of the nine patients who received vitamin replacement therapy, one showed a partial improvement in the hemoglobin concentration of ≥1g/dL. In the clinical setting, the measurement of FA/VB12 concentrations in patients with normocytic anemia may be useful. Replacement therapy may be a treatment option to consider in patients with low FA/VB12 concentrations. However, physicians need to pay attention to the presence of background diseases, and the mechanisms of this situation require further investigation.

Associated Factors of Red Blood Cell Alloimmunization among Solid Cancer Patients in Teaching Hospital in Malaysia

Background: Alloimmunization is a known complication following repeated red blood cell transfusions. However, the associated factors of RBC alloimmunization are different among blood recipient groups. This study aimed to determine the associated factors of red blood cell alloimmunization among solid cancer patients in Hospital USM. Material and Methods: This cross-sectional study involved 322 adult solid cancer patients screened for red cell alloantibodies in our centre from October 2016 until February 2019. The clinical and transfusion data were obtained from the patient’s medical record and laboratory information system (My Transfusi). The multiple logistic regression was used for analysis of potential associated factors of red blood cells alloimmunization, and p-value of less than 0.050 was considered statistically significant. Results: The patient’s mean age was 52.0 years old, with the majority were Malays (91.0%) and females (61.2%). The most common cancers were breast (32.3%) followed by gastrointestinal (16.8%) and head and neck (14.3%). The presence of metastases (adjusted OR=13.53, p=0.017), numbers of packed red cell transfusions (adjusted OR=1.12, p= 0.015), and blood group A (adjusted OR=7.45, p=0.003) were the associated factors of alloimmunization. Conclusions: Solid cancer patients with metastases, received a higher number of packed red cell transfusions, and blood group A were at higher risk for alloimmunization. Strategies to provide phenotype RBC should focus on this type of patient to prevent red blood cells alloimmunization in solid cancer patients. Bangladesh Journal of Medical Science Vol. 22 No. 02 April’23 Page : 379-384

A Validated Algorithm for Register-Based Identification of Patients with Relapse of Clinical Stage I Testicular Cancer.

The Danish Testicular Cancer (DaTeCa) database aims to monitor and improve quality of care for testicular cancer patients. Relapse data registered in the DaTeCa database rely on manual registration. Currently, some safeguarding against missing registrations is attempted by a non-validated register-based algorithm. However, this algorithm is inaccurate and entails time-consuming medical record reviews. We aimed (1) to validate relapse data as registered in the DaTeCa database, and (2) to develop and validate an improved register-based algorithm identifying patients diagnosed with relapse of clinical stage I testicular cancer. Patients registered in the DaTeCa database with clinical stage I testicular cancer from 2013 to 2018 were included. Medical record information on relapse data served as a gold standard. A pre-specified algorithm to identify relapse was tested and optimized on a random sample of 250 patients. Indicators of relapse were obtained from pathology codes in the Danish National Pathology Register and from diagnosis and procedure codes in the Danish National Patient Register. We applied the final algorithm to the remaining study population to validate its performance. Of the 1377 included patients, 284 patients relapsed according to the gold standard during a median follow-up time of 5.9 years. The completeness of relapse data registered in the DaTeCa database was 97.2% (95% confidence interval (CI): 95.2-99.1). The algorithm achieved a sensitivity of 99.6% (95% CI: 98.7-100), a specificity of 98.9% (95% CI: 98.2-99.6), and a positive predictive value of 95.9% (95% CI: 93.4-98.4) in the validation cohort (n = 1127, 233 relapses). The registration of relapse data in the DaTeCa database is accurate, confirming the database as a reliable source for ongoing clinical quality assessments. Applying the provided algorithm to the DaTeCa database will optimize the accuracy of relapse data further, decrease time-consuming medical record review and contribute to important future clinical research.