Medical Record Numbers Research Articles

Rates of Laboratory Adverse Events By Chemotherapy Course for Pediatric Acute Leukemia Patients within the Leukemia Electronic Abstraction of Records Network (LEARN)

Introduction: Adverse events (AEs) are often under- or misreported on clinical trials, leading to an incomplete understanding of therapy-associated toxicities. We previously demonstrated that laboratory result data can be extracted from the electronic health record (EHR), cleaned, and processed to ascertain laboratory AEs with high accuracy compared to gold standard chart abstraction at a single institution. We sought to employ this methodology at three large children's hospitals to demonstrate scalability and describe laboratory AE rates during therapy for pediatric acute myeloid and acute lymphoblastic leukemia (AML, ALL). Methods: The Leukemia Electronic Abstraction of Records Network (LEARN) comprises data from patients with AML and ALL treated at the Children's Hospital of Philadelphia (CHOP) from 2006 to 2014, Children's Healthcare of Atlanta from 2010 to 2018, and Texas Children's Hospital from 2008 to 2014. Risk classification, clinical trial enrollment status, and chemotherapy course start and end dates for all patients were collected via manual chart abstraction. After manual input of medical record numbers and course dates, a package we developed in the R programming language (ExtractEHR) was employed to extract laboratory results from the Epic EHR at each site. De-identified laboratory result data were cleaned centrally at CHOP to remove falsely abnormal results, including hemolyzed specimens and results that normalized within 1 hour for electrolytes and hematology tests and within 12 hours for liver function tests (LFTs). Laboratory results were processed and graded according to Common Terminology Criteria for Adverse Events (CTCAE) v5 definitions for 22 AEs. The highest grade of each AE in each course was calculated and results were tabulated by chemotherapy course for ALL and AML separately. Only chemotherapy courses with complete start and end dates were included; courses that were ongoing at time of abstraction were excluded. Highest grades for each AE over all chemotherapy courses combined were stratified by leukemia risk classification and trial enrollment status and were compared using chi square tests. CTCAE grade 5 definitions are not numerically based, so were excluded. Results: Laboratory result data on 1687 patients (AML: 282, ALL: 1405) who experienced 6652 courses (AML: 909, ALL: 5743) were extracted, processed and graded. For the purposes of these results, AEs indicate grades 3-4. More than 95% of AML courses had anemia, neutropenia and thrombocytopenia (Table). AML patients experienced the most laboratory AEs during Induction I and Intensification III (prevalence of grade 3-4 AEs was ≥10% for 10 AEs evaluated). Apart from hematologic AEs, hypokalemia (17.9-44.9% of courses) and increased LFTs (7.7-18.6% of courses) were the most common AEs in AML courses. While AML patients experienced higher rates of hematologic AEs, ALL patients had higher rates of electrolyte and LFT AEs over all courses. These AEs were distributed across all courses; in each course there were 7-9 AEs with a prevalence of ≥10%. Increased alanine aminotransferase was common in every ALL course (17.4-66.2%). For both for AML and ALL, AE rates were similar among patients enrolled on trials and those who were not. AE rates were similar for all AML risk classifications. In contrast, for ALL there were significantly higher rates (p<0.05) among intermediate/high risk compared to standard risk patients for 17 AEs, including AEs in all laboratory categories. Conclusions: The ExtractEHR tool is scalable for extracting laboratory result data from the EHR at multiple hospitals. These data can be processed centrally using a series of electronic code to describe comprehensive laboratory AE rates during chemotherapy, which does not otherwise exist in the literature. The lack of difference by trial enrollment status indicates that these results apply to all patients with AML and ALL. These data therefore describe expected AE rates for patients during each chemotherapy phase that can be used to provide clinical guidance and serve as a baseline comparison for experimental agents in clinical trials. These data and LEARN provide a granular resource for clinical epidemiology research focused on evaluating factors associated with incidence and resolution of laboratory AEs. Efforts are ongoing to incorporate medication and outcome data to investigate the impact of these AEs on clinical experience and outcomes. Disclosures Fisher: Pfizer: Research Funding; Astellas: Other: Data Safety Monitoring Board Chair for an antifungal study; Merck: Research Funding.

Phosphorus Levels in Iron Deficient Children Treated with Ferric Carboxymaltose

INTRODUCTION Intravenous iron therapy in children with iron deficiency anemia (IDA) has previously been limited to those with severe or refractory anemia. However, increased availability of intravenous iron preparations with improved safety profiles has increased its utilization in both the adult and pediatric patient populations. Ferric carboxymaltose (FCM) was approved for adult patients by the Food and Drug Administration (FDA) in 2014 and has lower rates of severe allergic reactions. However, literature on adult patients has reported the development hypophosphatemia in up 50% of those receiving the drug. In early stages, hypophosphatemia can lead to abnormal bone mineral metabolism and hypercalciuria. Rickets and osteomalacia can result after prolonged hypophosphatemia. Severe, prolonged hypophosphatemia (<1 mg/mL) is associated with neurologic, cardiopulmonary, muscular, and hematologic complications. Although not FDA approved for pediatric use, FCM is increasingly being utilized for IDA in children. Hypophosphatemia in children treated with FCM has not been formally evaluated or described. We sought to assess available phosphorus levels in children treated with FCM at a tertiary care center. METHODS This was a single center retrospective cohort study of all children who received FCM over the initial 2.5 year period for which the drug was added to our institution's formulary (November 1, 2016 through April 30, 2019). Pharmacy records of all FCM infusions administered over this period were obtained. Medical record numbers of all patients who received an infusion were then searched for any available phosphorus testing. Patients were included in the review if they had phosphorus laboratory results available from 1 to 6 weeks post-receipt of FCM and were less than 21 years of age at the time of infusion. Hypophosphatemia was defined as a phosphorus level below the lower limit of normal for age as delineated by our institution's central laboratory. Changes in phosphorus levels were calculated in those patients in whom pre-infusion phosphorus levels were also available within the 4 weeks prior to drug infusion. When multiple phosphorus levels were available within the post-infusion window, the lowest value was selected to calculate changes in levels. The electronic medical record (EMR) was reviewed in all patients in whom hypophosphatemia was identified to assess for administration of supplemental phosphorus, as well as other clinical factors that may affect phosphorus levels such as the administration of total parental nutrition (TPN) and/or renal medications (i.e. furosemide), as these are known risk factors for hypophosphatemia. RESULTS From November 1, 2016 through April 30, 2019, 1,081 infusions of FCM were administered in 656 patients. Post-infusion phosphorus testing was available in 165 patients in whom 247 infusions were administered (range 1 to 6). Patients' median age was 4.6 years (range 4 months to 20.6 years) and 56% (n=92) were female. Hypophosphatemia occurred after 36 (15%) infusions in 32 unique patients (19%). Six patients (19%) received potassium phosphorus supplementation (Table). In the 23 patients in whom phosphorus testing was available at 6 weeks, 15 (65%) continued to have phosphorus levels below the normal value for age. Of the entire cohort, pre- and post-infusion phosphorus levels were available relative to 197 infusions (80%) in 136 unique patients (82%). The median change in phosphorus was -0.6 mg/dL (IQR -0.1, -1.6). CONCLUSIONS The assessment of serum chemistries, including phosphorus, is not routinely performed in otherwise healthy children with iron deficiency. While over 650 children received over 1000 infusions of FCM during a 2.5 year period, only 165 patients had phosphorus testing available during the stated time frame of the infusion. In those in whom testing was available, and in which hypophosphatemia occurred, the majority were patients admitted to the hospital with co-morbid conditions or complex clinical care for which phosphorus levels may be affected. Our center has developed a clinical protocol to obtain baseline phosphorus levels in all children in whom intravenous FCM is being considered. Post FCM therapy, phosphorus monitoring is being performed to better identify those patients who may be at risk for hypophosphatemia and in whom phosphorus supplementation may be indicated. OffLabel Disclosure: Ferric carboxymaltose is FDA approved for treatment of iron deficiency in adults. This presentation will discuss the use of ferric carboxymaltose to treat iron deficiency in pediatric patients.

Identifikasi Penerapan Family Numbering System di Puskesmas Wilayah Dinas Kesehatan Kota Surakarta

Implementation of numbering in the Health District of Dinas Kesehatan Kota Surakarta 1 applies Personal Numbering and 16 health centers implement Family Numbering. The number classification used is 8 digits consisting of 2 initial digits as a regional code, 4 digits as the serial number of the head of the family, 2 digits of the final digit status in the family. However, in the implementation of area code numbering, it has not yet been utilized for the index, but it has not been used for mapping the spread of disease, even if it is used, it helps in making decisions in reducing morbidity. The qualitative analysis research method is a case study approach. Samples of 16 puskesmas with purposive sampling technique. Data collection is done by observation, interview, documentation study and Focus Group Discussion (FGD). The results of the numbering research in the Surakarta City Health Department Area Health Center consists of 8 and 10 digits. Classification of 2 digits area / village / kelurahan code, 4-6 digits sequence number of head of family, final 2 digits of family status code / sequence of visits in one family. The difference in the middle number is due to the different number of patient visits. Utilization of number classification is used to facilitate storage, the percentage of visits, mapping the spread of disease. Policy should be made regarding the implementation of numbering in accordance with the agreement, namely numbering the Unit Numbering Sytem or Family Numbering with personal indexes and the use of 2 digit front numbers and 2 digit final numbers as needed. A tracer is needed to reduce misfolders with data on medical record numbers, patient names, loan dates and borrowing units.

The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project

BackgroundConducting post-fall huddles is considered an integral component of a fall-risk-reduction program. However, there is no evidence linking post-fall huddles to patient outcomes or perceptions of teamwork and safety culture. The purpose of this study is to determine associations between conducting post-fall huddles and repeat fall rates and between post-fall huddle participation and perceptions of teamwork and safety culture.MethodsDuring a two-year demonstration project, we developed a system for 16 small rural hospitals to report, benchmark, and learn from fall events, and we trained them to conduct post-fall huddles. To calculate a hospital’s repeat fall rate, we divided the total number of falls reported by the hospital by the number of unique medical record numbers associated with each fall. We used Spearman correlations with exact P values to determine the association between the proportion of falls followed by a huddle and the repeat fall rate. At study end, we used the TeamSTEPPS® Teamwork Perceptions Questionnaire (T-TPQ) to assess perceptions of teamwork support for fall-risk reduction and the Hospital Survey on Patient Safety Culture (HSOPS) to assess perceptions of safety culture. We added an item to the T-TPQ for respondents to indicate the number of post-fall huddles in which they had participated. We used a binary logistic regression with a logit link to examine the effect of participation in post-fall huddles on respondent-level percent positive T-TPQ and HSOPS scores. We accounted for clustering of respondents within hospitals with random effects using the GLIMMIX procedure in SAS/STAT.ResultRepeat fall rates were negatively associated with the proportion of falls followed by a huddle. As compared to hospital staff who did not participate in huddles, those who participated in huddles had more positive perceptions of four domains of safety culture and how team structure, team leadership, and situation monitoring supported fall-risk reduction.ConclusionsPost-fall huddles may reduce the risk of repeat falls. Staff who participate in post-fall huddles are likely to have positive perceptions of teamwork support for fall-risk reduction and safety culture because huddles are a team-based approach to reporting, adapting, and learning.

Development and Evaluation of Record Linkage Rules in a Safety-Net Health System Serving Disadvantaged Communities

Background There is a need for flexible, accurate record-linkage systems with transparent rules that work across diverse populations. Objectives We developed rules responsive to challenges in linking records for an urban safety-net health system; we calculated performance characteristics for our algorithm. Methods We evaluated encounters during January 1, 2012 through September 30, 2018. We compared our algorithm, using name (first-last), date-of-birth (DOB), and last four of social security number to our electronic health record (EHR) system's reconciliation process. We applied our algorithm to unreconciled real-time Admission-Discharge-Transfer registration data, and compared match results to reconciled identities from our enterprise data warehouse. We manually validated matches for randomly sampled discordant pairs; we calculated sensitivity/specificity. We evaluated predictors of discordance, including census tract information. Results Of 771,477 unique medical record numbers, most (95%) were concordant between systems; a substantial minority (5%) was discordant. Of 38,993 discordant pairs, most (n = 36,539; 94%) were detected by our local algorithm. The sensitivity of our algorithm was higher than the EHR process (99% vs. 81%), but with lower specificity (98.6% vs. 99.9%). Our highest-yield rules, beyond full first and last name plus complete DOB match, were first three initials of first name, transposed first-last names, and DOB offsets (+1 and +365 days). Factors associated with discordance were homelessness (adjusted odds ratio [aOR] = 2.4; 95% confidence interval [CI], 2.2–2.6) and living in a census tract with high levels of poverty (aOR = 1.4; 95% CI, 1.3–1.4). Conclusion Our algorithm had superior sensitivity compared to our EHR process. Homelessness and poverty were associated with unmatched records. Improved sensitivity was attributable to several critical input-variable processing steps useful for similar difficult-to-link populations.

Hospital Information Technology Considerations for No Notice Disasters

Introduction:Modern hospital systems are highly dependent on computerized information technology (IT) systems. The integration of laboratory and radiology ordering and resulting cannot be easily replicated with a “paper” processes. This poses challenges for no-notice events, where the rapid registration of patients is a must for effective clinical care. This weakness in hospital response has been demonstrated in events such as the Boston Marathon bombing, the Aurora Theater (to be discussed), and Las Vegas shootings.Aim:To discuss lessons learned in configuring IT systems for disasters.Results:A integrated system of IT system preparation was implemented at the University of Colorado Hospital. This system has been demonstrated to be effective in multiple real-world events.Discussion:Four areas of IT preparedness are needed for hospital IT response to disasters. First is rapid disaster registration with prepared disaster medical record numbers and packets. The medical records must be active in the hospital IT environment, and a visit or case number must be preassigned or rapidly generated. The medical record number alone in the IT environment will allow the initiation of test ordering. The packet should include preprinted labels, a demographic data sheet, and downtime charting and ordering forms. The second item for response is templated order sets to allow rapid ordering of multiple studies such as laboratory, and especially radiology, without having to reenter clinical information. The third is a method of patient care charting scalable, from paper to electronic, depending on the patient volume, acuity, and workstation access. The fourth is a method for patient care in the IT downtime in a disaster setting. Simple inexpensive measures will allow rapid placement of patients in the IT environment and therefore allow rapid and accurate test ordering and resulting.

Anxiety prevalence in type 2 diabetes patients in Taif Saudi Arabia

Background: Type 2 diabetes (T2D) is a major health problem worldwide, and anxiety is a serious psychiatric problem that can lead to serious consequences such as substance abuse. The prevalence of anxiety has been found to be high in T2D patients in several studies; data in Saudi Arabia are scarce; however, our primary goal was to identify the prevalence of anxiety among T2D patients and to examine the impact of anxiety on glycemic control, measured cardiovascular markers, and T2D-related complications. Methods: This cross-sectional, interview-based study was conducted from October 2015 to July 2016 in Taif City, Saudi Arabia. Researchers took anthropometric measures, and the laboratory results were taken from the patients' electronic files using medical record numbers. For anxiety screening, we used the Generalized Anxiety Disorder-7 (GAD-7) scale. Results: The prevalence of anxiety was 45.45%, and it was not significantly associated with socioeconomic factors. Neither hemoglobin A1c level nor lipid profile levels were affected by anxiety. After adjusting for multiple variables, retinopathy and neuropathy were negatively correlated with GAD-7 score. Conclusion: Anxiety was highly prevalent among the screened T2D patients. Although the anxiety diagnosis did not correlate with worse glycemic control or cardiovascular markers, it was negatively associated with T2D-related microvascular complications.

Phlebitis after Parenteral Iron Sucrose Administration in Postpartum Women

Introduction: Multiple studies in industrialized countries indicate that postpartum anemia affects 20-50% of patients immediately after delivery (Barroso F et al Eur J Obstet Gynecol Reprod Biol 2011; Bergmann RL et al Eur J Obstet Gynecol Reprod Biol 2010; Urquizu IBX et al Med Clin (Barc) 2016). A growing body of literature suggests that intravenous (IV) iron improves time to anemia recovery in postpartum patients (Breymann C et al. Int J Gynaecol Obstet. 2008; Seid MH et al, Am J Obstet Gynecol 2008). We therefore developed recommendations for the use of IV iron on our Labor and Delivery (L&D) service to treat postpartum anemia. Three months after initiation of the IV iron recommendations, we performed an audit to assess its use.Methods: The UCSF pharmacy identified medical record numbers for obstetrical patients given IV iron sucrose 5/1/17 - 10/31/17, which spans 3 months pre-release of the IV iron protocol through the first 3 months after protocol release. Seventy-one patients were identified and their charts were individually reviewed to determine the dose and number of IV iron infusions received, interval between infusions when more than one infusion was given, the IV location for each infusion, and whether phlebitis was reported. Phlebitis was considered to have occurred if a physician or nursing note indicated that the patient had pain, swelling or erythema in an arm correlating to documented site of IV iron infusion. This study was conducted under UCSF Institutional Review Board approval number 17-22831.Results: Patients received 100 mg, 200 mg, or 300 mg of iron sucrose per infusion. Each infusion was administered over 30-90 minutes and patients received 1, 2, or 3 IV iron infusions. Venofer® is the only IV iron sucrose product received by patients in this study. The overall incidence of phlebitis was 9.9% (7 of 71 patients), higher than expected based on the previously published safety data and the published experience using IV iron sucrose in the postpartum setting (Breymann C et al. Eur J Clin Invest. 2000; Westad S et al. Acta Obstet Gynecol Scand. 2008). In addition, we found an increase in phlebitis incidence with increasing number of IV infusions: phlebitis was seen in 2 of 18 (11%) patients who received 2 iron infusions on consecutive days via a single IV site, while patients who received 300 mg iron sucrose on 3 consecutive days (5 out of 16 patients; Table 1) had a 31% incidence of phlebitis. Importantly, the phlebitis incidence was 50% for the 10 patients who received 3 infusions of 300 mg iron sucrose at a single IV site. Interestingly, in 6 patients who received 3 infusions of 300 mg iron sucrose on 3 consecutive days but had their peripheral IV re-sited between infusions, none developed phlebitis. No phlebitis was reported in 37 patients who received a single infusion of iron sucrose (100 - 300 mg dose range). Of the 7 phlebitis cases, 3 patients were readmitted to the hospital for evaluation and treatment. Three patients returned to our OB clinic or to L&D Triage for evaluation. One patient communicated her symptoms by telephone encounter.Discussion. IV iron safety analyses have historically focused on dose limitations and the risk for infusion reaction and anaphylaxis. We identified an increasing incidence of post-infusion phlebitis with increasing number of infusions of daily iron sucrose in patients admitted to our L&D service, an adverse event not previously highlighted in published safety literature for iron sucrose. We found the phlebitis events to be clinically significant for the patient, and to result in increased healthcare utilization post-infusion. It is our opinion that this adverse effect deserves attention because of the patient discomfort, inconvenience, and increased healthcare resource utilization. Physicians treating patients for iron-deficiency anemia, including hospitalists, hematologist, and OB-Gyn providers, should be aware of post-infusion phlebitis as a possible complication of iron sucrose therapy. Based on our findings, we recommend against daily IV iron sucrose infusions through a single peripheral venous access site. In addition, other formulations that allow for complete iron replacement in a single infusion session offer a convenience advantage to doctor and patient and may minimize the risk of phlebitis we observed with serial daily iron infusions. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

A Prospective Evaluation of the Effect of Supervised Hand Therapy After Carpal Tunnel Surgery.

Background: The objective of this investigation is to examine the effect of postoperative therapy after routine carpal tunnel release. Our hypothesis was that supervised hand therapy does not improve outcomes after routine carpal tunnel release. Methods: Patients with carpal tunnel syndrome were randomly assigned to one of 3 groups based on the last digit of their medical record numbers to one of 3 groups: standard 6-week postoperative rehabilitation (standard therapy), expedited one-session postoperative rehabilitation group (expedited therapy), and no postoperative rehabilitation group (no therapy). The primary outcome measures were Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and return to work. The outcome questionnaire was completed preoperatively, at the 2-week follow-up visit, and monthly to 6 months after surgery. Results: All 3 treatment groups had similar mean QuickDASH scores preoperatively. At 1- to 6-month follow-up, all 3 groups had similar QuickDASH scores at each visit, and all showed a significant decline from baseline (preoperative) QuickDASH score. Overall, QuickDASH score decreased significantly from a preoperative visit mean of 42.7 to a final postoperative (visit 8) mean of 6.69. There was no significant difference in the mean QuickDASH score among all 3 groups at 6-month follow-up. There was no significance in the time of return to work among the 3 groups (standard therapy, 21.8 days; expedited therapy, 20.9 days; no therapy, 16.6 days). Conclusions: This investigation adds evidence that supervised hand therapy does not improve the outcomes of routine carpal tunnel surgery as measured by QuickDASH and return to work.

Patient Clinical Data Integration in Integrated Electronic Medical Record System for Health Care Facilities in Indonesia

Complete patient service requires continuous support of clinical history. This can be realized by integrating electronic medical record data. The limitation is the wide variety of software, formats, and data dictionaries used in healthcare facilities. This was a descriptive analysis study with cross sectional approach to find open source electronic medical record integration model for clinical data exchange between health care facilities. Respondents were doctors, nurses, pharmacists, laboratory staffs, and person in charge of hospital information system as informant for content analysis. From the study, we managed a web-based service portal to implement clinical data integration that can be accessed by clinician registered within the Ministry of Health. The patients clinical history is stored in the hospital database and requires unique OpenIDRM code on the Health Service Server to integrate it. OpenIDRM contains all of the patients medical record number, as one patient may have several different medical record numbers in several hospitals. In conclusion, clinician can access the patients clinical history by opening a web portal system through a unique OpenIDRM code.

Increasing Incidence of Blastomycosis Infection in Vermont

Background Blastomycosis is an invasive infection caused by the ubiquitous fungus Blastomyces. The clinical presentation ranges from limited cutanenous infections to pneumonia and disseminated disease. Endemic areas in the United States include: midwestern, south-central, and southeastern states; yearly incidence is <0.3 cases per 100,000. Diagnosis is based on recovery of the organism on fungal culture. A urine antigen test is available for the detection of blastomycosis which has a sensitivity of 92.9% and specificity of 79.3%. Anecdotally, an increasing number of patients are presenting to the University of Vermont Medical Center (UVMMC) with disseminated blastomycosis – an area in which the fungus is rare. We hoped to determine the incidence of blastomycosis in Vermont over a 10-year period and examine the sensitivity of the urine antigen in our patient population.Methods After IRB approval, medical record numbers of all patients who had BD-glucan, blastomyces urine antigen, culture, or pathology positive for blastomyces during a 10-year period (2006–2016) were obtained. Chart review completed for all patients with diagnosis of blastomycosis. Data collected on demographic characteristics: zip code, comorbidities, site of infection, HIV, BD-glucan, blastomyces urine antigen, fungal culture, and treatment duration.ResultsForty-one blastomycosis cases were found; 39 cases in Vermont residents. The incidence rate Vermont was 0.7 cases per 100,000. Mean age was 49 years, 60% of patients were male. Most patients had pulmonary (37%) or disseminated infection (37%). 17% of patients had localized cutaneous disease, bone and joint infection (7%) or CNS disease (2%). Urine antigen was positive in 78% overall, and in 90% with disseminated infection. Three deaths, none attributed to blastomycosis.Conclusion Vermont appears to have a higher incidence than what has been reported in the US overall. This increase may have to do with better reporting and testing rather than a true increase in disease. Most common disease presentation was localized pulmonary or disseminated disease. Urine antigen sensitivity ranged from 78% (overall) to 90% (disseminated disease). This appears consistent with what has been reported in other studies, but is lower than the overall reported sensitivity.Disclosures All authors: No reported disclosures.

Changes in Intestinal Parasitosis Over a 12-Year Period in Rural Guatemala

Introduction: Guatemala in recent years has experienced steady improvement in water and sanitation systems, as well as community awareness of public health practices such as handwashing and food safety. Such factors have likely changed the epidemiology of luminal infections in this setting. We performed a serial cross-sectional study in one district hospital comparing the prevalence of intestinal parasite infections in the period from 2005-2011 to that of the period from 2014-2016. Methods: We examined the medical records of adult ambulatory patients at Hospitalito Atitlan in Western Guatemala from January 1, 2005- December 31, 2010 (early period) and January 1, 2014-March 31, 2016 (late period). Paper charts were sampled from random blocks of medical record numbers from each study period in a 1:1 ratio. We abstracted stool microscopy results from charts with ≥1 visit for a GI-related complaint to the primary care clinic or the emergency department. Proportions of patients in each period with a positive parasite result were compared with chi-square or Fisher's exact tests. Results: 1610 charts were reviewed, describing 892 GI visits in the early period and 886 in the late period. The early cohort had significantly fewer parasite tests performed, but significantly greater proportion of patients positive for parasites (Table 1). This was especially true of parasites with known pathogenicity (Entamoeba histolytica, Dientamoeba fragilis, Giardia spp, Ascaris lumbricoides, Trichuris trichiura, hookworm, Strongyloides stercoralis or Taenia solium). Some non-pathogenic parasites were detected more frequently in the late cohort (Entamoeba coli, Blastocystis hominis), but these estimates were less precise (Table 2). If proportions of ordered tests (not proportions of GI patients) were compared, the significant differences remained, with 52.6% of early versus 24.8% of late period tests revealing any parasite. 47.4% of early and 10.2% of late period stool tests were positive for a pathogenic parasite.Table: Table. Comparison of Cohorts and Intestinal Parasite Tests in a Rural Guatemalan Hospital from 2005-2010 to 2014-2016Table: Table. Prevalence of Specific Parasites in a Rural Guatemalan Hospital in 2005-2010 versus 2014-2016Conclusion: Rural Guatemala still experiences a high burden of luminal infections, but the prevalence of infection with pathogenic parasites has dramatically decreased over the past decade. Further studies should examine the factors behind this decline, to identify the responsible public health interventions that can be translated to other developing settings. In the meantime, providers should be aware of a decreasing yield of stool microscopy for parasites in the evaluation of GI complaints.

Resident responses to after-hours otolaryngology patient phone calls: An overlooked aspect of residency training?

Otolaryngology residents are often responsible for triaging after-hours patient calls. However, residents receive little training on this topic. Data are limited on the clinical content, reporting, and management of otolaryngology patient calls. This study aimed to characterize the patient concerns residents handle by phone and their subsequent management and reporting. Retrospective review. Five hundred consecutive after-hours patient calls in a tertiary pediatric hospital were reviewed. Data collected included patient and caller demographics, clinical concerns, surgical history, recommendations, and subsequent emergency department (ED) visits. On average, 3.7 calls occurred per shift, 2.8 on weekday and 5.9 on weekend shifts. Mean patient age was 6.6 years. Mothers (71%) called most frequently. The majority of calls were postoperative (64.2%). Of postoperative calls, most occurred within 3 days of surgery (52.3%). Most calls were for surgical site bleeding (19.9%). Residents recommended ED evaluation for 17.2% of calls, of which 20.9% returned to the primary institution ED. ED evaluation was recommended more frequently for postoperative patients (P = .040), particularly following adenotonsillectomy (51.2%) or surgical site bleeding (18.6%). With respect to documentation, 32.8% of medical record numbers were absent, 11.8% had name errors, and 2.2% of patients could not be identified. This is the first study to analyze the management and reporting of patient calls by otolaryngology residents. A wide array of clinical concerns are triaged by phone conversations. The study has implications for both resident and patient education. 4. Laryngoscope, 128:E163-E170, 2018.

Probabilistic Matching Approach to Link Deidentified Data from a Trauma Registry and a Traumatic Brain Injury Model System Center.

There is no civilian traumatic brain injury database that captures patients in all settings of the care continuum. The linkage of such databases would yield valuable insight into possible care interventions. Thus, the objective of this article is to describe the creation of an algorithm used to link the Traumatic Brain Injury Model System (TBIMS) to trauma data in state and national trauma databases. The TBIMS data from a single center was randomly divided into two sets. One subset was used to generate a probabilistic linking algorithm to link the TBIMS data to the center's trauma registry. The other subset was used to validate the algorithm. Medical record numbers were obtained and used as unique identifiers to measure the quality of the linkage. Novel methods were used to maximize the positive predictive value. The algorithm generation subset had 121 patients. It had a sensitivity of 88% and a positive predictive value of 99%. The validation subset consisted of 120 patients and had a sensitivity of 83% and a positive predictive value of 99%. The probabilistic linkage algorithm can accurately link TBIMS data across systems of trauma care. Future studies can use this database to answer meaningful research questions regarding the long-term impact of the acute trauma complex on health care utilization and recovery across the care continuum in traumatic brain injury populations.

Development of a trauma and emergency database in Kigali, Rwanda

IntroductionInjuries account for 10% of the global burden of disease, resulting in approximately 5.8 million deaths annually. Trauma registries are an important tool in the development of a trauma system; however, limited resources in low- and middle-income countries (LMIC) make the development of high-quality trauma registries challenging. We describe the development of a LMIC trauma registry based on a robust retrospective chart review, which included data derived from prehospital, emergency centre and inpatient records.MethodsThis paper outlines our methods for identifying and locating patients and their medical records using pragmatic and locally appropriate record linkage techniques. A prehospital database was queried to identify patients transported to University Teaching Hospital – Kigali, Rwanda from December 2012 through February 2015. Demographic information was recorded and used to create a five-factor identification index, which was then used to search OpenClinic GA, an online open source hospital information system. The medical record number and archive number obtained from OpenClinic GA were then used to locate the physical medical record for data extraction.ResultsA total of 1668 trauma patients were transported during the study period. 66.7% were successfully linked to their medical record numbers and archive codes. 94% of these patients were successfully linked to their medical record numbers and archive codes were linked by four or five of the five pre-set identifiers. 945 charts were successfully located and extracted for inclusion in the trauma registry. Record linkage and chart extraction took approximately 1256 h.ConclusionThe process of record linkage and chart extraction was a resource-intensive process; however, our unique methodology resulted in a high linkage rate. This study suggests that it is feasible to create a retrospective trauma registry in LMICs using pragmatic and locally appropriate record linkage techniques.

Point-of-Care Ultrasonography in a Domestic Mass Casualty Incident: The Boston Marathon Experience

Background: The role of Point-of-Care (POC) ultrasonography in domestic Mass Casualty Incidents (MCI) has not been well established. On April 15th, 2013, two improvised explosive devices were detonated near the finish line of the Boston Marathon injuring 264 patients and killing 3. These patients were rapidly stabilized and transported to Boston area hospitals. Objectives: To examine the role of POC ultrasonography during the Emergency Department response to a large-scale domestic MCI, and to identify successful processes as well as barriers to care delivery in order to best prepare for future events. Methods: An online survey containing multiple-choice and open-response questions was distributed to Emergency Medicine housestaff, physician assistants, fellows and attending physicians in the Boston area Emergency Departments who cared for patients during the Boston Marathon MCI. Results: There were 50 respondents from 6 hospitals who were directly involved with patient care. 23 respondents (46%) performed POC ultrasounds during the MCI, but only 8 of these respondents (35%) documented findings in the usual fashion by saving images including patients medical record numbers. Many respondents altered documentation patterns due to lack of patient information/registration data and to time constraints. Focused assessment with sonography in trauma (FAST) exams were reported as the most useful application (96%), followed by lung sliding (36%), and soft tissue/foreign body exams (18%). Respondents noted that POC ultrasound provided clinical information sooner then plain films and computed tomography (CT) scans, as these traditional imaging resources were significantly overwhelmed. Many described the value of POC ultrasound in resource allocation and triage once acute intra-abdominal and thoracic injuries had been excluded. Respondents reported being hindered by too few ultrasound systems or systems with long boot-up times and/or lack of battery power. Conclusions: Though limited by our retrospective survey-based methodology, our findings indicate that POC ultrasound was utilized in the hospital-based response to a large-scale domestic MCI. POC ultrasound was especially useful given delays in traditional imaging. Our findings highlight the difficulties with normal documentation patterns during such events, and suggest that specific planning for POC ultrasound should be incorporated into future MCI preparedness.

Application effects of evidence-based nursing on the functional training compliance and postoperative recovery effect in patients with breast cancer

Objective To explore the application effects of evidence-based nursing on the functional training compliance and postoperative recovery effect in patients with breast cancer. Methods The study investigated 120 patients after breast cancer operation and the participants were divided into the intervention group (n=60) and the control group (n=60) using random number table according to patients′ medical record numbers. Based on the functional training of the upper limb, the control group received routine care and the intervention group received evidence-based nursing care. The quality of nursing, patients′ compliance and recovery effects were compared between the two groups. Results The compliance and qualified rate were 93.3% (56/60) and 91.7%(55/60) in the intervention group, which were better than those in the control group [83.3%(50/60), 80.0%(48/60)], but there′s no statistically significant differences (P>0.05). The scores of nursing quality and motor function were (92.7±2.6) and (63.1±4.3), which were significantly higher than that of the control group [(84.4±5.2), (48.5±3.7)] (P<0.05). Conclusions The evidence-based nursing is a scientific and widely used method that can significantly improve the nursing quality and patients′ compliance. Key words: Evidence-based nursing; Postoperative breast cancer; Functional training; Compliance; Recovery effect

Lower Gastrointestinal Bleeding in Saudi Patients: A Retrospective Longitudinal Study

Aims/Objectives: The epidemiology of lower gastrointestinal bleeding (LGIB) in western populations has been well documented but there are scant reports about this condition in Saudi Arabia. This research studied the demographic characteristics of LGIB and assessed the specific colonoscopy findings in Saudi national patients who attended a large population based hospital in Riyadh, the capital city of Saudi Arabia. Methods: The present study took place at King Saud medical city, Riyadh, Saudi Arabia. A longitudinal retrospective analysis of patient endoscopy records was carried out covering the period from 2004 through to 2015. The patients included were Saudis aged 18 years and above who were receiving first time colonoscopy for an unknown etiology of bleeding. The patients were from a number of sources: emergency room (ER), inpatients or referred from other centres. Data were entered into Excel and then transferred to SPSS for statistical analysis. Results: A total of 1,137 patients were included in the study. 178 patients were excluded due to missed or incomplete medical record numbers leaving a total of 959 patients, consisting of 574 (60%) males and 385 (40%) females, with a median age of 51.9 years (SD 18.4, range 18 to 113 years). Most patients were in-patients/ER (346, 42.5%), or out patients (350, 43%), while 137 (14.5%) were referred from other centers. In all colonoscopy findings of LGIB there were significantly more male than female patients, with a male to female ratio of 1.5:1. The most common colonoscopy findings of LGIB were hemorrhoids (369) 38.5%, colitis (78) 8.1%, diverticulosis (116) 12.1%, neoplasm (95) 9.9% and polyps (47) 4.9%, respectively. The colon was normal in (140) 14.6% patients. Conclusions: Our research showed that hemorrhoids, rectal ulcers, colitis, diverticulosis and tumors were the most common colonoscopy findings of LGIB in a Saudi adult population, with men more predisposed to LGIB than women. These findings are broadly similar to those reported in western populations.

Terrorist attacks in the largest metropolitan city of Pakistan: Profile of soft tissue and skeletal injuries from a single trauma center.

Pakistan has been hugely struck with massive bomb explosions (car and suicide bombs) resulting in multiple casualties in the past few years. The aim of this study is to present the patterns of skeletal and soft tissue injuries and to review the outcome of the victims who presented to our hospital. This is a retrospective chart review from January 2008 to December 2012. The medical record numbers of patients were obtained from the hospital Health Information and Management Sciences (HIMS) as per the ICD-9 coding. During the study period, more than 100 suicide and implanted bomb blast attacks took place in the public proceedings, government offices, residential areas and other places of the city. Altogether 262 patients were enrolled in the study. The mean age of the patients was 31±14 years. The shrapnel inflicted wounds were present on to the upper limb in 24 patients and the lower limb in 50. Long bone fractures were the most common skeletal injuries. The fractures were complicated by penetrating fragments and nails which result in post operative infections and prolonged hospital stay.

P003: TRANSLATING HLA DATA FROM THE LABORATORY TO THE ELECTRONIC MEDICAL RECORD, THE BUMPY ROAD OF EPIC IMPLEMENTATION

Aim YNHH initiated EPIC Go Live to enable electronic medical record (EMR) data capture for all patients last year. Since an attractive feature of this system is the ability to provide electronic access to data not only for clinical but research use, the aim of our project was to develop the process for all histocompatibility data to populate EPIC. Methods The Laboratory uses Histotrac (Systemlink), as the laboratory management system. An interface (HL7 manager) was required for data migration into EPIC, and Histotrac latest version software was updated. Significant firewall issues were encountered since the Lab is university based and data required two way migration between hospital and university, as well as vendor. Significant steps were taken to ensure that the data was represented in intelligible form by EPIC, which required significant programming, test definition, and error tracking. All existing patients required new medical record numbers as a consequence of EPIC adoption, and every patient sample received without an electronic order required review and problem solving prior to testing. Order sets were created to simplify the ordering process for coordinators and reduce order entry errors. Extensive code and definitions were developed to allow for antibody testing (single antigen, ID, cytotoxicity), along with titration, pretreatment, and donor specific antibody data in a presentation format that is informative to clinicians. Results All histocompatibility data is now available in EPIC. This project has required one full time FTE, as well as training of all staff on use of EPIC. Hurdles encountered include ensuring all patient samples (including monthly sera from dialysis) have EPIC orders in place, identifying when discrete data elements can be transmitted and when imaged data is preferred. Solutions involving PDF creation, transmission and representation were necessary for specific data elements. Conclusion In conclusion, all data on active patients is now available in EPIC, and technologists use the EMR as the source for all data, reducing transcriptional errors. Next steps include paper data elimination, billing through EPIC, and creating a strategy to handle deceased donor data reporting. G. Manley: Employee; Company/Organization; SystemLink.