Medicine Service Research Articles

Pharmacist-led new medicine service: a real-world cohort study in the Netherlands on drug-related problems, satisfaction, and self-efficacy in cardiovascular patients transitioning to primary care.

Patients transitioning from hospital to home while starting long-term cardiovascular medicines are likely to experience drug-related problems(DRPs). The New Medicine Service (NMS) may support readmission to primary care. To evaluate NMS in a real world setting, for patients transitioning from hospital to primary care with newly prescribed cardiovascular medicines on identifying DRPs, patient satisfaction with medication information and patient self-efficacy. Secondary objectives were identifying risk factors for DRPs and assessing first-fill discontinuation. A cohort study in an outpatient pharmacy and 14 community pharmacies in Almere, the Netherlands, involved patients ≥ 18years receiving new cardiovascular prescriptions. Usual pharmacy care was complemented with a telephone counselling two weeks post-dispensing to identify and address DRPs. Patient satisfaction and self-efficacy were assessed during a follow-up call. First-fill discontinuation was measured using dispensing data, and logistic regression identified risk factors for DRPs. Of 1647 eligible patients, 743 received NMS; 72.5% experienced ≥ 1 DRP. NMS improved patients' satisfaction with information and self-efficacy (p < 0.001). Outpatient visits (adj. OR 0.64), cardiovascular medicine use (adj. OR 0.65), and use of chronic medicines (adj. OR 1.71) influenced DRPs. First-fill discontinuation remained unchanged post-NMS, but patients with DRPs discontinued more often (14.8% vs. 8.6%, p = 0.030). Implementing the NMS in a real-world transitional care setting allowed pharmacists to identify DRPs and provide counselling tailored to patient needs. Patients reported higher satisfaction with information and increased self-efficacy. Priority should be given to at-risk patients for DRPs, and deploy other pharmacy staff to perform the NMS.

Screening and Telephone-Based Intervention for Unhealthy Alcohol Use in a Diverse Federally Qualified Health Center System in Texas.

Screening and brief intervention (BI) can reduce risky alcohol use but has not been widely implemented in primary care settings. We sought to implement a screening and telephone-based program within a Federally Qualified Health Center (FQHC). Prior to this program, adult patients were routinely screened using AUDIT-C with no further systematic follow-up. We designed a team-based, tele-care-centered program to (1) follow-up positive screening results or provider referrals with full AUDIT and (2) provide a social worker-administered two-session BI for patients with AUDIT 4-12; those with high AUDIT scores received BI and were offered pharmacotherapy and/or referral for additional support. Repeat AUDIT was administered at 3-6months. From March 2021 to May 2023, 3959 patients were screened using AUDIT-C, with 632 (16%) screening positive. Mean age was 44; 47% identified as female, 58% as Hispanic/Latino; 43% received care through the county-based Medical Access Program (MAP). Men, those with commercial insurance, and English-speakers were more likely to screen positive. Using telephone outreach to direct referrals and to those screening positive, trained counselors successfully administered the full AUDIT to 412 participants. Initial AUDIT scores were ≤ 12 (n = 281, 68.2%) and > 12 (n = 131, 31.8%). Among patients who completed the initial AUDIT, mean age was 46; 32% identified as female, 86% as Hispanic/Latino, and 66% were insured through MAP. Of the 412, 400 (97%) completed one counseling session and 297 (72%) completed two. Of the 131 with initial AUDIT > 12, 19 received pharmacotherapy and 13 had one or more visits with our addiction medicine service. For the 251 patients with AUDIT data at 3-6months, the mean score change was - 4.1 (95% CI - 3.4, - 4.7). Spanish-speaking patients showed larger decreases than English-speakers; there were no other statistically significant differences. Screening and telephone-based BI reduces unhealthy alcohol use in diverse adult FQHC patients.

Incorporating clinical and demographic data into the Elixhauser Comorbidity Model: deriving and validating an enhanced model in a tertiary hospital’s internal medicine department

Background and objectivesThe Elixhauser Comorbidity Model is a prominent, freely-available risk adjustment model which performs well in predicting outcomes of inpatient care. However, because it relies solely on diagnosis codes, it may not capture the full extent of patient complexity. Our objective was to enhance and validatethe Elixhauser Model by incorporating additional clinical and demographic data to improve the accuracy of outcome prediction.MethodsThis retrospective observational cohort study included 55,945 admissions to the internal medicine service of a large tertiary care hospital in Jerusalem. A model was derived and validated to predict four primary outcomes. The four primary outcomes measured were length of stay (LOS), in-hospital mortality, readmission within 30 days, and increased care.ResultsInitially, the Elixhauser Model was applied using standard Elixhauser definitions based on diagnosis codes. Subsequently, clinical variables such as laboratory test results, vital signs, and demographic information were added to the model. The expanded models demonstrated improved prediction compared to the baseline model. For example, the R2 for log LOS improved from 0.101 to 0.281 and the c-statistic to predict in-hospital mortality improved from 0.711 to 0.879.ConclusionsAdding readily available clinical and demographic data to the base Elixhauser model improves outcome prediction by a considerable margin. This enhanced model provides a more comprehensive representation of patients’ health status. It could be utilized to support decisions regarding admission and to what setting, determine suitability for home hospitalization, and facilitate differential payment adjustments based on patient complexity.

The New Medicines Service across borders - Lessons learnt from 14 years of implementation attempts.

The New Medicines Service across borders - Lessons learnt from 14 years of implementation attempts.

Understanding context for adapting the New Medicine Service for Switzerland using a convergent mixed methods design – myCare Start-I

Understanding context for adapting the New Medicine Service for Switzerland using a convergent mixed methods design – myCare Start-I

Research on resource allocation methods for traditional Chinese medicine services based on deep reinforcement learning

Research on resource allocation methods for traditional Chinese medicine services based on deep reinforcement learning

The Need For Marine Medicine Specialists for An Integrated Service Network Towards Advanced Indonesia 2045

Need for Marine Medicine Specialist Doctors: I. Hospital-Based Study Program, starting to run in 8 study programs, July 2024. II. Service Needs: 1) Regulations, 2) Development of Remote and Coastal Areas, 3) The existence of a Sea Highway, 4) The existence of marine tourism, 5) Fisheries, 6) Defense, 7) The existence of a New National Capital. III. Service Network: 1) Marine Medicine Service Center in the National Capital, 2) Frontline Areas, 3) Coastal Areas, 4) Hospital Ships. IV. Integrated Systems Network: 1) Defense System, 2) Transportation System, 3) Tourism System, 4) Fisheries System, 5) Telemedicine System, 6) Coastal Area Development, 7) Education, Research, Community Service and Innovation Systems. On August 25, 2023, the Marine Medicine Study Program was approved for a SCOR of 0.001/1,000 population, including efforts to accelerate the achievement of meeting needs. Calculation of Minimum Needs: calculated as 50% of the optimal value, 50% x 319 = 159.5 Rounded to 160, UNRAM and UHT Production Three more years: 3 +5 = 8, then it will only be achieved 20 to 40 years later. Proposed Solutions: 1) PRODI at UNRAM and UHT; There are 2 PRODIs with 3 classes: Regular, Parallel, and Scholarship, projected graduates 9+15 =24; 2) Immediately establish 10 Hospital Based PRODIs, this will meet the increasing needs, so produce 10 PRODIs, projected graduates 10 x 10 = 100; 3) Immediately form a Service Network and System Network, spread throughout Indonesia. 9 types, so there are 9 PRODI. Projection of graduates 9 x 10 = 90. Total projection: 24 + 100 + 90 = 214 per semester. Keywords: need for specialist doctors, study program, student class, graduate projections.

What does a consent conversation for whole genome sequencing look like in the NHS Genomic Medicine Service? An observational study.

Patient choice consent for whole genome sequencing (WGS) through the Genomic Medicine Service in England covers consent to diagnostic testing and an invitation to the National Genomic Research Library (NGRL). Little is known about what consent conversations for WGS look like in practice. We audio-recorded and analysed the content and structure of consent appointments (n = 26) between healthcare professionals (HCPs) and parents of children with rare disease across seven NHS Trusts. Appointments frequently covered the potential findings from testing, implications for family members, and DNA storage, but often omitted that data may be reanalysed in the future if a diagnosis is not made. Consent to the NGRL was typically sought during the same appointment; these discussions varied in content, but frequently included a background to the NGRL and data security. HCPs often tempered expectations around what WGS can achieve and asked questions to clarify parents' understanding, but less commonly elicited parents' values and concerns. Administrative tasks were time-consuming, but took less time when consent was recorded digitally. Future training should emphasise how to elicit patients' values and concerns. Digital infrastructure and hiring roles such as genomic associates to support consent may be important strategies to meet the workload demands of WGS.

Long-term serological response and boostability of intradermal rabies immunization: A retrospective chart review.

Rabies vaccines in Canada are currently labeled for intramuscular use only; however, intradermal vaccine administration may be equally effective. This study aims to assess the immediate and long-term (≥ 2years) serological response and boostability of intradermal administration of rabies vaccine for pre-exposure prophylaxis. This retrospective cohort study was conducted using data from electronic medical records at the Winnipeg Regional Health Authority Travel Health & Tropical Medicine Services Clinic. Individuals ≥ 18years of age at time of vaccination who received at least 3 × 0.1mL doses of intradermal rabies vaccine were included. All charts were reviewed to extract post-primary immunization and post-booster serology results, and t-tests were conducted to evaluate seroprotection (defined as serology ≥ 0.5IU/mL). A total of 324 individuals received an intradermal rabies primary pre-exposure vaccination series with follow-up serology within 90days. Seroprotection was observed in 96% (GMT = 3.36IU/mL, 95% CI 3.07-3.68). Of these, 68 had serology results 1.8-2.5years later, with seroprotection declining to 44% (GMT = 0.52IU/mL, 95%CI 0.41-0.65). However, 100% seroprotection was observed in those who received an intradermal booster dose at ≥ 2years with follow-up serology (n = 20, GMT = 4.7IU/mL, 95%CI 3.7-6.2). Intradermal administration of a primary pre-exposure rabies vaccine series demonstrates a strong serological response. While titers decline over time, the robust serological response demonstrated after a single intradermal booster vaccine dose suggests that a strong anamnestic immune response was maintained. This finding supports existing evidence that intradermal administration of rabies vaccines can be used effectively for rabies pre-exposure and post-exposure prophylaxis.

Implementation of a National Prenatal Exome Sequencing Service in England: Cost-Effectiveness Analysis.

Prenatal exome sequencing (pES) for diagnosing fetal structural anomalies commenced in the English National Health Service (NHS) in 2020. We evaluated cost-effectiveness to the healthcare system, and costs to families, of pES in addition to standard testing, compared to standard testing alone. A cost-effectiveness analysis combining costs, outcomes, parent and professional interview and professional survey data. The English NHS Genomic Medicine Service. 413 families with fetal anomalies with a suspected genetic cause referred for pES from 01 October 2021 to 30 June 2022. We costed the incremental resource required to deliver the pES clinical pathway. We calculated the diagnostic yield (proportion of cases with pathogenic variants). We divided the total incremental cost by the number of cases with a diagnosis to calculate cost-effectiveness. We estimated the annual NHS budget requirement based on case numbers. We determined parental costs from interviews. Incremental costs of pES to the NHS and families, incremental cost per additional diagnosis and NHS budget impact. Of 413 referred cases, 241 were tested, at a cost of £2331 (95% credibility interval £1894-£2856) per referred case or £3592 (£2959-£4250) per case that proceeded with testing. The incremental cost per diagnosis (yield 35.3%) was £11 326 (£8582-£15 361). Based on referrals data 01 October 2022 to 30 September 2023, pES costs the NHS £1.8 m annually. Family costs could not be separated from other pregnancy-related appointments but were not considered burdensome; most appointments were concurrent or remote. pES costs the English NHS £11 326 for each additional diagnosis. Incremental costs to families are negligible.

Red Blood Cell Transfusion Practices.

Opportunities to improve transfusion safety occur at lower hemoglobin (Hgb) thresholds and single-unit transfusions. Efforts to improve compliance with transfusion guidelines and single-unit transfusion practices reduce transfusions and lead to improved outcomes. To evaluate demographic and practice characteristics associated with lower Hgb thresholds and single red blood cell (RBC) unit transfusion practices. This study used the College of American Pathologists (CAP) Q-Probes format with the recent 2020 and 2017 surveys of participating institutions. High rates of transfusion review and compliance were observed with institutions reporting RBC transfusions meeting institutional guidelines. CAP inspection participants and those with a formal policy to encourage single-unit transfusions showed a trend toward greater compliance. Comparison of 2020 and 2017 survey results showed favorable downward trends in the Hgb threshold for transfusion compliance review and pretransfusion and posttransfusion Hgb values. Institutions reporting initiatives to decrease transfusions, teaching hospitals, and those with updated guidelines in alignment with recent literature reported lower pretransfusion Hgb levels in both studies. The 2020 study showed greater single-unit transfusion use among hospitals with patient blood management programs, larger institutions, and those training pathology residents. Single-unit transfusion rates varied by hospital service, with highest rates reported within hematology/oncology (99 of 138 [71.7%]), intensive care (147 of 215 [68.4%]), and medicine (419 of 666 [62.9%]) services. Transfusion practice improvement programs to decrease RBC transfusions include the use of single-unit transfusions and lower institutional pretransfusion Hgb thresholds. Opportunities to lower transfusion thresholds and increase single-unit transfusions exist in surgical and obstetrics services.

Comments on prescriptions of big data from outpatient and emergency services using R

Abstract. To explore the high-frequency influencing factors of unqualified prescriptions, and promote rational drug use, the author evaluated on prescriptions of 245,352 from outpatient and emergency services using R in a large 3A hospital in 2023. Among the 245,352 prescriptions, 1,327 were evaluated as unreasonable, with a percentage of 0.54%. There were 1,368 issues related to irrational drug usage. Among the irrational prescriptions identified, the most prominent issues were inappropriate indications (59.16%) and incomplete writing in clinical diagnosis (17.78%). The departments with relatively high rates included head and neck surgery (5.94%), general medicine (3.33%), and convenient outpatient service (2.02%). The top five drugs in irrational prescriptions were Atorvastatin calcium tablets, Aspirin enteric-coated tablets, Calcium carbonate D3 tablets, Rabeprazole sodium enteric-coated tablets, and Metformin tablets, which were commonly used in chronic diseases. There was no significant correlation between the irrational rate and the professional title of the prescribing doctor. Overall, the quality of prescriptions in the hospital was satisfied, but there were still cases of irrational drug use. Hospitals should strengthen prescription review and rational drug use management to ensure the safety and effectiveness of patient medication.

The Center for Health Outcomes in Medicine Scholarship and Service (HOMES): Fostering and Supporting Physician-Initiated Research

Abstract Problem The U.S. physician scholar workforce, currently comprising less than 1.5% of U.S. physicians, continues to decrease, threatening national status as a global biomedical research leader. Academic medical center (AMC) trends away from tenure-track physician faculty appointments toward clinical faculty appointments have contributed to this decrease, but AMCs have limited strategies to equip clinical faculty to conduct research. Infrastructure fostering clinical faculty research may establish new mechanisms for expanding physician scholar workforce and supporting academic goals of clinical faculty. This article presents one such model, the Center for Health Outcomes in Medicine Scholarship and Service (HOMES), from the Department of Internal Medicine, The Ohio State University College of Medicine. Approach Established in 2019, HOMES provides research infrastructure, support, and mentorship tailored to clinical faculty needs. Multidisciplinary core faculty support research across 5 cores: clinical networks, biostatistics and secondary data, qualitative methods, mixed methods, and research ethics. HOMES services include research consultation, mentorship, microgrants, a training toolkit, and symposia. Outcomes In 4 years, HOMES supported 50 faculty on 99 projects. Forty-five (90%) of these faculty have reported scholarly output, including 127 national presentations, authorship on 41 peer-reviewed articles, and 53 grant submissions. Forty HOMES-supported grant submissions have received funding, and 4 HOMES-supported physicians in training have pursued or plan to pursue AMC research careers. Next Steps HOMES has fostered scholarly productivity among AMC physicians, competitive grant applications, and research focus among physicians in training. As demand for HOMES services increases, HOMES will prioritize projects based on their innovation and research skill development potential. Academic medical centers can apply HOMES lessons through fostering clinical faculty collaboration with multidisciplinary research teams and increasing research training opportunities for residents and fellows. National expansion of funding opportunities dedicated to building biomedical research capacity and expertise among clinical faculty can facilitate sustainable scaling of HOMES-like models.

Abstract 4144549: Proof of Concept of a Novel Culinary Medicine Service Line to Address Diet-Related Cardiovascular Disease Risk Factors

Background: Poor diet has emerged as a top contributor to cardiovascular disease (CVD) in the United States. Evidence-based dietary strategies have been shown to decrease CVD risk by addressing comorbid conditions such as hypertension and diabetes, and there is a growing demand for practical nutrition guidance from health providers. However, implementation of nutrition support in healthcare settings remains limited due to lack of time, expertise, and reimbursement, necessitating creative interprofessional collaboration. Culinary Medicine (CM) combines medical nutrition education with culinary literacy and holds promise to address these challenges. Our study reports on the cascade implementation of a 3-prong CM service line which includes a CM eConsult, 1:1 CM specialty clinic, and shared medical appointment (group visit) in a teaching kitchen at a large, academic medical center from 2021 to 2024. Methods: A CM-specific eConsult was designed and launched on August 1 st 2021 utilizing existing eConsult workflows in the electronic health record. Next, an in-person, interprofessional CM specialty clinic launched at a community-based satellite clinic December 4 th 2022 open to referrals from physicians and patients. In April 2024, established patients in the CM clinic were invited to participate in six, biweekly cooking classes billed as shared medical appointments. A Microsoft PowerBI dashboard was developed to track patient demographics, referrals and participation, associated diagnoses, and billing data for the service line for continuous quality improvement. Results: In the first year of eConsults, 25 eConsults were completed with 19 (76%) reimbursed by insurance. In the first year from launch of the CM specialty clinic, 96 patients completed initial visits with a 100% insurance collections rate. In the recent launch of shared medical appointments, the initial cohort included 17 unique patients with 58% completing at least 4 of 6 classes. Referrals to the CM clinic included hypertension, hyperlipidemia, coronary artery disease, and type 2 diabetes as the top 4 associated diagnoses. Conclusions: We demonstrated proof-of-concept of a novel CM service line as an interprofessional, financially sustainable preventive strategy to target patients with diet-sensitive CVD risk factors such as diabetes, hypertension, and obesity. Future study will investigate the impact on biomarkers of CVD health for patients served by the CM service line.

Challenges in delivery of Bhutanese Traditional Medicine (Sowa Rigpa) services at Primary Healthcare Centres in Bhutan

Bhutanese Traditional Medicine (Sowa Rigpa) and allopathic medicine are integrated and state-funded in the three-tier healthcare system of Bhutan. Bhutanese Traditional Medicine services are available in all three levels of the healthcare system offering a range of services, from consultations to therapies and drug dispensations. Except for the National Traditional Medicine Hospital in Thimphu, all the centres across the country offer only outpatient services. Out of 81 traditional medicine centres, 55 centres are located at the primary level, serving people in different geographical areas of the country. Despite an increasing number of patients availing the traditional medicine services, the facilities at the primary level continue to face several challenges. The challenges include delayed and disruptive medicine supply chain, lack of an effective and systematic patient referral system, misconceptions and lack of awareness of traditional medicine services and inadequate infrastructure. All of these impede the provision of traditional medicine services in the communities. We recommend a technology-based drug delivery system in addition to resilient production centres, an effective patient referral system in traditional medicine practice by leveraging on the guideline and electronic patient information system, advocacies in the communities to dispel the myths and misconceptions regarding the Bhutanese Traditional Medicine, and adequate and architecturally smart infrastructure. Implementing these solutions could enhance access and utilization of traditional medicine services, leveraging the best use of this important component of the healthcare system.

Gene-eral survey to describe genomic education needs in hospital pharmacy departments in the West Midlands and Oxford

Abstract Introduction Genomic medicine is a rapidly developing field and a priority for the NHS to ensure it is embedded into Medicine Service Alliance is that the NHS staff have understanding and confidence to utilise genomics safely and effectively. Pharmacy professionals, as experts in medicines, will lead the implementation and delivery of pharmacogenomics and wider genomic medicine services across all healthcare sectors1. Aim To understand current levels of genomic education across NHS Trust Pharmacy Departments in the Central and South region, and preferences for types of future learning. Methods A MS Forms survey was distributed across the Pharmacy Departments of five NHS Trusts, emailed to all local pharmacy staff via the Education and Training lead pharmacists; all pharmacy staff were eligible to participate, and total numbers of staff were not available. The survey was based on a previously published national survey2, but reduced in content to allow completion within 5 minutes; content was agreed between the genomics specialist pharmacy team at C&amp;S. Ethics approval was not sought as this baseline evaluation formed part of a planned service improvement. Results One hundred and twenty-nine respondents participated in the survey, including pharmacists (62%), pharmacy technicians (29%) and assistant technical officers (5%). Seventy-one out of 127 respondents (56%) had more than 10 years of experience since qualified. Given a scale of ’very low-low-medium -high-very high’, the majority of the 127 respondents (63%) considered their knowledge about Genomic Medicine to be medium or high, and no responder considered themselves to have a very high level of knowledge about Genomic Medicine. Most participants saw the relevance of Genomic Medicine to their professions, particularly in areas like personalised medicine and 82% expressed an interest in learning more about Genomic Medicine and 15% answered ’Maybe’; the cohort had a preference for in-person meetings and seminars (32%), followed by on-line meetings (27%). Discussion / Conclusion Respondents saw the relevance of Genomic Medicine to their professions, and showed a mixture of enthusiasm, curiosity, and uncertainty about Genomic Medicine, with no respondent feeling they had a very high level of knowledge of Genomic Medicine. Most pharmacy staff in the 5 departments surveyed have an interest in furthering their knowledge of Genomic Medicine, with a marked preference for in-person meetings and seminars. Respondents recognised the potential benefits such as personalized medicine, improved treatment outcomes and reduced trial-and-error approaches in medication selection, with expectations that Genomic Medicine will improve patient care and outcomes, reducing adverse events and informing treatment decisions Limitations to this study include an inability to judge response rate due to lack of denominator data, however relatively similar numbers were obtained from each Department, with a good mix of respondent roles. An in-person training event with hybrid online options is being planned as a result of this work.

Position paper of DGKL and DIVI on requirements for laboratory services in intensive care and emergency medicine

The timely determination and evaluation of laboratory parameters in patients with acute life- or organ-threatening diseases and disease states in the emergency room or intensive care units can be essential for diagnosis, initiation of therapy, and outcome. The aim of the position paper is to define the time requirements for the provision of laboratory results in emergency and intensive care medicine. Requirements for point-of-care testing (POCT) and the (central) laboratory can be derived from the urgency. Expert groups from the DGKL (Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) developed a classification about the urgency for the determination of laboratory parameters as well as recommendations on the necessary organizational framework and quality assurance measures using national and international guidelines, review articles, and original papers. Three levels of urgency are defined, based on the turnaround time of the most common laboratory parameters: emergency 1, with a turnaround time of no more than 15 min; emergency 2, with a turnaround time of a maximum of 60 min; urgent case, with a turnaround time within 4 h. In addition, a recommendation is made when to provide the results for the main ward rounds in the intensive care unit and the emergency department. The recommendations allow the organizational and technical regulations for each hospital to be aligned with the urgency of the provision of the test results to the medical team based on the medical requirements.

Categorizing Care Delays and Their Impact on Hospital Length of Stay.

Unnecessary care delays of hospitalized patients increase the risk of hospital-related complications and drive up health care costs. While health systems focus on reducing the length of stay of hospitalized patients, not many studies looked at specific causes of the care delays that prolong length of stay. In this study, we sought to systematically identify and categorize the various care delays that contribute to prolonged length of stay on a hospital medicine service. We conducted a retrospective observational study looking at all inpatient encounters to the hospitalist service (N=6633) for the fiscal year 2021. Observation status, COVID-19 positive, and other services' discharged patients were excluded (N=2849) leaving 3784 eligible encounters. The resulting 5% stratified random sample accounted for 190 encounters accounting for a total of 1152 patient-days. Using a standardized data extraction tool, a day-by-day review of the sample encounters was performed for all care delays. These care delays were categorized into specific groups (System, Discharge, Provider, Patient/Family, or Consultant related) and subgroups based on predetermined criteria. The stratified sample was found to be comparable to the total patient population, with no statistically significant differences in key demographic and clinical metrics. About 30% of all patient-days had a care delay; 33% of these delays were attributable to system delays internal to the hospital such as waiting for imaging/procedures; 28% of delays were due to discharge barriers, driven overwhelmingly by a lack of available post-acute care beds, and about 20% of delays were attributable to the provider. Our study systematically looked at care delays that led to prolonged hospital length of stay. Most of these care delays were caused by either wait times for procedures and imaging studies or by a lack of post-acute care bed availability. Hospitals and health systems can use this approach to better determine which systemic changes are likely to be the most effective at reducing length of stay.

Ethyl alcohol consumption characteristics of deceased individuals in Lithuania

The number of alcohol-related deaths in Lithuania has fallen by almost one-third in the last decade; however, the number of deaths has been on the rise since 2019. Data on the postmortem investigation of victims between 2018 and 2022 were obtained from the Lithuanian State Forensic Medicine Service database. This study analyzed data from 1200 autopsies. The deceased victims were categorized based on their cause of death and blood alcohol concentration (sober, legally intoxicated, mild, medium, or heavy). The causes of death were diseases (54.17 %, n = 650), suicides (12.08 %, n = 145), homicides (2.5 %, n = 30), and accidents (31.25 %, n = 375). Toxicological tests for alcohol were performed in all cases. Alcohol levels in the blood and urine were measured using gas chromatography. A significant correlation was observed between blood alcohol concentration and age (r = −0.13, p = 0.007). A statistically significant difference was observed in the proportions of men and women who were intoxicated. Among the causes of death, the group of individuals who died because of accidents exhibited the highest average blood alcohol concentration. Alcohol intoxication is undoubtedly a contributing factor to fatalities resulting from accidents and homicides. These findings assist in determining the intoxication level of victims and in assessing any potential links that may contribute to or predispose victims to lethal outcomes in cases of disease, suicide, homicide, or accident.

Large-Scale Pharmacogenomics Analysis of Patients With Cancer Within the 100,000 Genomes Project Combining Whole-Genome Sequencing and Medical Records to Inform Clinical Practice.

As part of the 100,000 Genomes Project, we set out to assess the potential viability and clinical impact of reporting genetic variants associated with drug-induced toxicity for patients with cancer recruited for whole-genome sequencing (WGS) as part of a genomic medicine service. Germline WGS from 76,805 participants was analyzed for pharmacogenetic (PGx) variants in four genes (DPYD, NUDT15, TPMT, UGT1A1) associated with toxicity induced by five drugs used in cancer treatment (capecitabine, fluorouracil, mercaptopurine, thioguanine, irinotecan). Linking genomic data with prescribing and hospital incidence records, a phenome-wide association study (PheWAS) was performed to identify whether phenotypes indicative of adverse drug reactions (ADRs) were enriched in drug-exposed individuals with the relevant PGx variants. In a subset of 7,081 patients with cancer, DPYD variants were reported back to clinicians and outcomes were collected. We identified clinically relevant PGx variants across the four genes in 62.7% of participants in our cohort. Extending this to annual prescription numbers in England for the drugs affected by these PGx variants, approximately 14,540 patients per year could potentially benefit from a reduced dose or alternative drug to reduce the risk of ADRs. Validating PGx associations in a real-world data set, we found a significant association between PGx variants in DPYD and toxicity-related phenotypes in patients treated with capecitabine or fluorouracil. Reported DPYD variants were deemed informative for clinical decision making in a majority of cases. Reporting PGx variants from germline WGS relevant to patients with cancer alongside primary findings related to their cancer can be clinically informative, informing prescribing to reduce the risk of ADRs. Extending the range of actionable variants to those found in patients of non-European ancestry is important and will extend the potential clinical impact.