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Emergence of Incidentalomas Following Chest CT Screening for COVID-19 Infection: A Multicenter Cross-Sectional Study.

Background The COVID-19 pandemic has raised several questions about its potential long-term impacts. During the pandemic, computed tomography (CT) chest scans were frequently employed for the diagnosis of COVID-19 pneumonia. The increased utilization of CT scans as a diagnostic tool has facilitated the detection of subtle abnormalities that may not have been easily discernible previously. Aim The primary objective of the present study was to investigate the prevalence of non-COVID-19 lung incidental pathologies in chest CT scans performed to screen for COVID-19, with a focus on autoimmune conditions related to interstitial lung disease (ILD) following COVID-19 infection, as determined by positive chest CT results. Methods This retrospective observational study included all adult patients (aged ≥ 16 years) in Al Ain, a city in the United Arab Emirates, between June 2020 and June 2021. Patients who underwent high-resolution computed tomography (HRCT) or chest CTduring this timeframe and exhibited lung pathologies beyond the typical changes associated with COVID-19 infection followed by at least one pulmonary consultation were eligible for inclusion whileall typical COVID-19-related changes reported in lung pathologies were excluded from consideration in this study. The hospital's electronic medical system was used to obtain patient information and subsequent management approaches. Results Among a total of 3,000 CT scan reports, 318 individuals fit our inclusion criteria. Their mean age was 63 years, and 52% were female (n = 165). Of the patients, 12% (n = 38) were smokers and 17% (n = 54) were ex-smokers. A total of 231 (72.6%) of the patients exhibited incidental lung nodules while 87 (27.4%) displayed lung pathologies other than lung nodules, with 75 (23.6%) being diagnosed with pleural effusion, 63 (19.8%) with bronchiectasis, and 19 (5.9%) with emphysema. Furthermore, three patients (0.9%) had cavitary lung lesions and one was diagnosed with tuberculosis while two others were undergoing surveillance follow-up. Only one patient (0.3%) was identified with a lung mass, which was attributed to primary lung adenocarcinoma. The remaining eight patients (2.5%) had ILD findings (two had non-specific interstitial pneumonia, five had usual interstitial pneumonia, and one had hypersensitivity pneumonitis). All of the patients with ILD findings underwent investigations for autoimmune-related ILD; however, no cases of autoimmune-related conditions were identified during the subsequent follow-up. Conclusions This cross-sectional chest CT-based study provides insights into incidental lung abnormalities. A small percentage (10.6%) of the participants exhibited lung incidentalomas.

Sistem Informasi Administrasi Pasien Rawat Jalan dan Rawat Inap Berbasis Web

Hospitals, as public service institutions, require an accurate, reliable, and adequate information system to enhance their services to patients and related environments. Given the extensive scope of services, many complex issues arise in the hospital's service processes. The numerous variables involved in hospital operations influence the speed of information flow required by both users and the hospital environment. Manual data management in hospitals presents significant drawbacks, including slow processing time and a high risk of errors. With the support of current information technology, manual data management can be replaced by a computerized information system. In addition to being faster and easier, data management becomes more accurate. Accurate data processing results in accurate information, which is crucial for decision-making, both for management and others. The purpose of this study is to facilitate patient registration for outpatient and inpatient visits, ease report generation, and assist the hospital management in improving service quality and decision-making processes. Based on the research conducted at Zainoel Abidin General Hospital in Aceh, the implementation of the outpatient and inpatient patient administration information system has proven to be precise and accurate, particularly in the pharmacy department. The system has also made it easier to obtain patient information and has addressed frequent issues such as challenges in monitoring and supervising patients and medical records. The system development lifecycle (SDLC) was utilized in designing this system.

The Assessment and Response of Rehabilitation Professionals to Sudden Deterioration in Symptoms: An Analysis of the National Database in Japan.

There are few analyses of the current status of and responses to acute deteriorations encountered by physiotherapists, occupational therapists, and speech-language pathologists (rehabilitation professions [RPs]). The purpose of this study was to analyze the responses of RPs to acute deterioration in patients using the functional resonance analysis method (FRAM) based on the descriptions in "the Medical Accident Database". Subjects were 413 cases with medical incidents reported by RPs to the database from 2012 to 2021. Life-threatening cases with changes in consciousness, circulation, and respiration were selected. Descriptions regarding findings assessed by RPs and support team, and requests for assistance were extracted. We also attempted to construct appropriate respond in RPs by using the FRAM. Thirty-nine cases of acute deterioration were included in the analysis, and descriptions by RPs of consciousness (35 cases), circulation (18 cases), and respiration (36 cases) were identified. Blood pressure and percutaneous oxygen saturation measurement were frequently presented in the assessment by RPs, whereas the support team assessed cardiac arrest and respiratory arrest in high frequency. The FRAM analysis indicated that appropriate and rapid post-response by RPs requires patient information in prior, appropriate assessment and integration/interpretation. We attempted to identify problems analyzing the response by RPs to acute deterioration using the database and construct an appropriate response model. It resulted that RPs need to obtain patient information in advance and integrate/interpret it appropriately based on accurate assessment of conscious, circulation and respiration for rapid response. A model including integration/interpretation for appropriate post-response by RPs was constructed using the FRAM.

Prevalence of Latent Tuberculosis Infection Among Rheumatology Patients and Management Practices in the United Arab Emirates: A Single-Center Retrospective Cohort Study.

Introduction Prior to immunosuppression, rheumatology patients are routinely screened for latent tuberculosis (TB) infection using interferon-gamma release assays (IGRAs). Variability in the management of latent and indeterminate IGRA results across institutionslimited long-term outcome data. A retrospective study was conducted at Tawam Hospital, United Arab Emirates, to investigate the incidence and management protocols associated with positive and indeterminate IGRAresults, as well as TBinfection, among patients with rheumatic conditions. Methods A single-center retrospective observational study was performed at Tawam Hospital, Abu Dhabi, UAE. Ethical approval for this study was obtained from the Tawam Human Research Ethics Committee. Laboratory records and the hospital's electronic medical system were used to obtain information about IGRA results over a 12-year period (April 2010-April 2022). The hospital's electronic medical system was used to obtain patient information and subsequent management approaches of positive and indeterminate IGRAs.Moreover, long-term follow-up data were collected to determine the risk of TB reactivation in the cohort. Results We found a total of 1,012 positive and 223 indeterminate IGRA test results within the 12-year period. Within the rheumatology department, 123 positive and 39 indeterminate IGRA results were identified. In the indeterminate IGRA group, the majority were women (n = 24, 61.5%) and UAE nationals (n = 22, 56.4%), and their mean age was 38.6 years. Systemic lupus erythematosus was the most prevalent rheumatologic condition (n = 21, 53.8%). Thirteen (33.3%) were on disease-modifying anti-rheumatic drugs (DMARDs) and 26 (66.7%) were on corticosteroids during IGRA testing. A total of eight patients (20.5%) received anti-TB medications. In the positive IGRA group, the mean age was 55.7 years and the female-to-male ratio was 3:1. The most common rheumatologic condition was rheumatoid arthritis (n = 69, 56%). Sixty-five (52.8%) patients were on conventional DMARDs, 43 (34.9%) were on corticosteroids during IGRA testing, and 74 (60%) received anti-TB medications. Two cases (1.6%) of active TB infections were detected among patients with positive IGRA tests, both of whom were receiving anti-tumor necrosis factor alpha inhibitor treatment in combination with methotrexate. No cases of active TB infection were observed in the indeterminate IGRA group. Conclusion Long-term data on the risk of TB activation in positive and indeterminate IGRA results for rheumatological conditions are low. It is recommended to reassess the choice of using anti-TNF-α, with a positive IGRA result if no other feasible alternatives can be offered. Our findings stress the importance of age, underlying diseases, and immunosuppressive treatments in interpreting IGRA results and guiding patient management. A large multicenter study is needed to understand the differences and outcomes of such patients in TB endemic and nonendemic geographical areas.

Clinical characteristics and outcomes of an exogenous thyrotoxicosis epidemic in prison

IntroductionAn outbreak of exogenous thyrotoxicosis is an uncommon cause of thyrotoxicosis. This study aimed to investigate the characteristics and outcomes of exogenous thyrotoxicosis and electrolyte imbalance in a prison during...

A Privacy-Preserving Symptoms Retrieval System with the Aid of Homomorphic Encryption and Private Set Intersection Schemes

This work presents an efficient and effective system allowing hospitals to share patients’ private information while ensuring that each hospital database’s medical records will not be leaked; moreover, the privacy of patients who access the data will also be protected. We assume that the thread model of the hospital’s security is semi-honest (i.e., curious but honest), and each hospital hired a trusted medical records department administrator to manage patients’ private information from other hospitals. With the help of Homomorphic Encryption- and Private Set Intersection -related algorithms, our proposed system protects patient privacy, allows physicians to obtain patient information across hospitals, and prevents threats such as troublesome insider attacks and man-in-the-middle attacks.

Prevalence and Risk Factors of Hypertension in Hargeisa, Somaliland: A Hospital-Based Cross-Sectional Study

Hypertension is the leading risk factor for cardiovascular diseases and represents a major public health challenge worldwide. There is a paucity of information regarding the hypertension status of adults in Somaliland. We aimed to assess the magnitude of, and factors associated with, hypertension among adult patients seeking care at Hargeisa group hospital in Hargeisa city, Somaliland. We conducted a health facility-based cross-sectional study enrolling adult outpatients. We used the World Health Organization (WHO) STEPwise surveillance approach to obtain patient information. A total of 319 participants (54.2% males; mean age 40.4 ± 14.0 years) had complete data records. The prevalence of hypertension was 22.6% (95% confidence interval; 18.2-27.6%). The prevalence of hypertension increased with age and was higher in males (24.9%) than in females (19.9%). Age, cholesterolaemia and obesity were significantly associated with hypertension. Separate analyses for females and males revealed that obesity was significantly associated with hypertension in females but not in males. On the contrary, cholesterolaemia was significantly associated with hypertension in males but not in females. We found a high prevalence of hypertension and multiple risk factors for non-communicable diseases (NCDs) in outpatients seeking care in Hargeisa. Our findings emphasise the need for enhanced focus on the prevention and management of NCDs in Somaliland.

Clinical study of vacuum phenomenon in closed pelvic fracture

BackgroundThis study aimed to examine the prevalence and clinical findings of the vacuum phenomenon (VP) in closed pelvic fractures.MethodsWe retrospectively reviewed 352 patients with closed pelvic fractures who presented to our institution from January 2017 to December 2020. Pelvic fractures were diagnosed by plain radiography and computed tomography (CT). The default “bone window” was used for inspection in the cross section. Electronic medical records were consulted by two orthopedic physicians to obtain patient information. The VP of pelvic fracture, fracture classification, injury mechanism, and image data were evaluated, and the demographic parameter data were statistically analyzed. The follow-up time was 12–18 months.ResultsAmong them, 169 were males and 183 were females with ages ranging from 3 to 100 years, with an average of 49.6 ± 19.3 years. VP in pelvic fractures was detected by CT in 109 (31%) of the 352 patients with pelvic fractures. Patients were divided into the high-energy trauma group (278 cases) and fragility fractures of the pelvis (FFP) group (74 cases) according to the injury mechanism. In the high-energy trauma group, 227 cases were treated surgically and 201 cases had bony healing. The healing time was 9.8 ± 5.3 weeks. In the FFP group, 54 cases were treated surgically and 49 cases had bone healing. The healing time was 9.3 ± 3.8 weeks. Fractures progressed in nine patients. VP was mostly located in the sacroiliac joint in our study.ConclusionsThe incidence of VP in pelvic fractures is statistically high and is affected by many factors, such as examination technique, joint position, population composition, etc. Therefore, the VP is not a reliable sign of pelvic injury. Clinically, we need to determine the nature of VP in conjunction with gas patterns, laboratory tests, history, and physical examination.

A nationwide survey of human metapneumovirus-associated encephalitis/encephalopathy in Japan

BackgroundAs there have been no comprehensive reports of human metapneumovirus-associated encephalopathy (hMPVE), this study examined the clinical features of hMPVE in children in Japan. MethodA nationwide survey of children with hMPVE was conducted using a structured research form. An initial survey asked pediatricians about children with hMPVE treated between 2014 and 2018. A second survey obtained patient information from hospitals that responded to the initial survey and those identified as having treated cases from a literature search. We collected demographic data, symptoms of hMPV infection, neurological symptoms, laboratory data, treatment, and outcomes. Outcomes were determined using the Pediatric Cerebral Performance Category Score. ResultClinical information was available for 16 children. Their median age was 37 months. Six had preexisting neurological disorders. The interval between the onsets of infection and hMPVE was 4 days. Outcomes were good in 11 patients and poor in 5. There were no significant differences in demographic data, neurological symptoms, or laboratory data between the patients with good and poor outcomes. The encephalopathy subtypes were acute encephalopathy with biphasic seizures and late reduced diffusion in 3, clinically mild encephalitis/encephalopathy with a reversible splenial lesion in 3, hemorrhagic shock and encephalopathy syndrome in 2, and others in 8. ConclusionThe outcomes of children with hMPVE were not very different from those of acute encephalopathy due to other viruses. We found no factors associated with poor outcomes.

Association of ABO Blood Group Antigen and Neurological Tumors

Abstract Background Various risk factors for tumors such as smoking, alcohol consumption, diet, and radiation, etc., were already identified. ABO blood group antigens are also present on epithelia, endothelia, and neurons. Recent evidence suggested the role of ABO antigens in the pathogenesis of certain malignancies. Materials and Methods A retrospective observational study was conducted in a tertiary care neurosurgical center in North India from January 2016 to December 2018. The hospital information system was used to obtain patient information while the blood center information system was used to collect blood group information. Brain tumors were majorly divided into cavernoma, glioma, meningioma, neuroma, pituitary adenoma, schwannoma, and others. Results We found a total of 1,970 patients with brain tumors admitted during our study period. Most patients had glioma (33.55%), followed by pituitary adenoma (20.05%) and neuroma (2.23%). B blood group individuals had more prevalence of cavernoma, glioma, meningioma, pituitary adenoma, schwannoma, and others followed by O, A, and AB. Only association of O blood group with neuroma tumor was found statistically significant. Conclusions Our patient population had blood group distribution similar to our general population and no significant association was observed by blood group antigens and brain tumors. Although neuroma was significantly associated with blood group O but the prevalence of neuroma in our patient population is very low hence large sample study is required to draw a firm conclusion regarding this association.

Retrospective Study of the Reasons and Time Involved for Dental Providers' Medical Consults.

BackgroundPatient-reported medical histories and medical consults are primary approaches to obtaining patients' medical histories in dental settings. While patient-reported medical histories are reported to have inconsistencies, sparse information exists regarding the completeness of medical providers' responses to dental providers' medical consults. This study examined records from a predoctoral dental student clinic to determine the reasons for medical consults; the medical information requested, the completeness of returned responses, and the time taken to receive answers for medical consult requests.MethodsA random sample of 240 medical consult requests for 179 distinct patients were selected from patient encounters between 1 January 2015 and 31 December 2017. Descriptive statistics and summaries were calculated to determine the reasons for the consult, the type of information requested and returned, and the time interval for each consult.ResultsThe top two reasons for medical consults were to obtain more information (46.1%) and seek medical approval to proceed with treatment (30.3%). Laboratory and diagnostic reports (56.3%), recommendations/medical clearances (39.6%), medication information (38.3%), and current medical conditions (19.2%) were the frequent requests. However, medical providers responded fewer times to dental providers' laboratory and diagnostic report requests (41.3%), recommendations/medical clearances (19.2%), and current medical conditions (13.3%). While 86% of consults were returned in 30 days and 14% were completed after 30 days.ConclusionsThe primary reasons for dental providers' medical consults are to obtain patient information and seek recommendations for dental care. Laboratory/diagnostic reports, current medical conditions, medication history, or modifications constituted the frequently requested information. Precautions for dental procedures, antibiotic prophylaxis, and contraindications included reasons to seek medical providers' recommendations. The results also highlight the challenges they experience, such as requiring multiple attempts to contact medical providers, the incompleteness of information shared, and the delays experienced in completing at least 25% of the consults.Practical ImplicationsThe study results call attention to the importance of interdisciplinary care to provide optimum dental care and the necessity to establish systems such as integrated electronic dental record-electronic health record systems and health information exchanges to improve information sharing and communication between dental and medical providers.

Area Deprivation Index and Rurality in Relation to Financial Toxicity among Breast Cancer Surgical Patients: Retrospective Cross-Sectional Study of Geospatial Differences in Risk Profiles.

Financial toxicity (FT) depicts the burden of cancer treatment costs and is associated with lower quality of life and survival in breast cancer patients. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT. A single-institution, cross-sectional study was performed on adult female surgical breast cancer patients using survey data retrospectively collected between January 2018 and June 2019. Chart reviews were used to obtain patient information, and FT was identified using the COmprehensive Score for Financial Toxicity questionnaire, which is a validated instrument. Patients' home addresses were used to determine rurality using the Rural Urban Continuum Codes and linked to national ADI score. ADI was analyzed in tertiles for univariate statistical analyses, and as a continuous variable to develop multivariable logistic regression models to evaluate the independent associations of geospatial location with FT. A total of 568 surgical breast cancer patients were included. Univariate analyses found significant differences across ADI tertiles with respect to race/ethnicity, marital status, insurance type, education, and rurality. In multivariable analysis, advanced cancer stage (odds ratio [OR] 2.26, 95% CI 1.15 to 4.44) and higher ADI (OR 1.012, 95% CI 1.01 to 1.02) were associated with worsening odds of FT. Increasing age (continuous) (OR 0.976, 95% CI 0.96 to 0.99), married status (vs unmarried) (OR 0.46, 95% CI 0.30 to 0.70), and receipt of bilateral mastectomy (OR 0.56, 95% CI 0.32 to 0.96) were protective of FT. FT was significantly associated with areas of greater socioeconomic deprivation as measured by the ADI. However, in adjusted analyses, rurality was not significantly associated with FT. ADI can be useful for preoperative screening of at-risk populations and the targeted deployment of community-based interventions to alleviate FT.

Using information technology to optimize the identification process for outpatients having blood drawn and improve patient satisfaction

BackgroundThis study explored the application effect of information technology in optimizing the patient identification process.MethodsThe method for optimizing the identification process involved in drawing blood among outpatients using information technology was executed from July 2020. In this paper, 959 patients who had blood drawn from January to June 2020 were included as the pre-optimization group, and 1011 patients who had blood drawn from July to December 2019 were included as the post-optimization group. The correct rate of patient identification, waiting time, and patient satisfaction before and after the optimization were statistically analyzed. The changes in these three indexes before and after the optimization implementation, as well as the application effects, were compared.ResultsThe correct rate of patient identification after optimization (99.80%) was higher than before optimization (98.02%) (X2 = 13.120; P < 0.001), and the waiting time for having blood drawn was also significantly shortened (t = 8.046; P < 0.001). The satisfaction of patients was also significantly improved (X2 = 20.973; P < 0.001).ConclusionsBy combining information technology with the characteristics of blood collection in our hospital, using the call system to obtain patient information, then scan the QR code of the guide sheet for automatic verification, and finally manually reconfirm patient information, which can significantly reduce the occurrence of identification errors, improve work efficiency and improve patients' satisfaction.

Abstract P4-10-13: Area deprivation index and rurality in relation to financial toxicity among breast cancer surgical patients - Investigating geospatial differences in risk profiles

Abstract Background: Financial toxicity (FT) depicts the burden of cancer treatment-costs and is associated with lower quality-of-life and survival in breast cancer survivors. We examined the relationship between geospatial location, represented by rurality and Area Deprivation Index (ADI), and risk of FT.Study Design: A single-institution, cross-sectional study was performed on adult female surgical breast cancer patients. Chart reviews were used to obtain patient information while FT was identified using a validated instrument. Patients’ home addresses were used to determine rurality using the Rural Urban Continuum Codes and linked to national ADI score. Tertile ADI groups enabled statistical analysis and multivariate logistic regression models were developed to determine the independent effects of geospatial location and FT.Results: A total of 568 surgical breast cancer patients were included. Univariate analyses showed significant differences across ADI tertiles with respect to race/ethnicity, marital status, insurance type, education, and rurality. Following multivariate analysis, advanced cancer stage (OR 2.26, CI: 1.15-4.44), and escalating ADI (OR 1.012, CI:1.005-1.020) were associated with worsening FT. Increasing age (OR 0.976, CI: 0.96- 0.992), marital status (OR 0.458, CI: 0.299-0.699), receipt of bilateral mastectomy (OR 0.558, CI: 0.323-0.964) were protective of FT. Increasing ADI was also significantly associated with use of coping strategiesConclusion: FT was significantly associated with areas of higher socioeconomic deprivation as measured by the ADI. However, rurality was not found to be a significant predictor of FT. ADI may be used to facilitate pre-operative screening of at-risk populations and the deployment of community-based interventions to alleviate FT. Multivariate logistic regression analysis results. Citation Format: Joseph P Corkum, Victor Zhu, Victor Agbafe, Carrie Chu, Jessica Suarez Colen, Rachel Greenup, Anaeze C. Offodile. Area deprivation index and rurality in relation to financial toxicity among breast cancer surgical patients - Investigating geospatial differences in risk profiles [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-13.

An Efficient Deadlock Handling Model Based on Neutrosophic Logic: Case Study on Real Time Healthcare Database Systems

The adoption of electronic patient records in hospitals will provide numerous benefits, but it will also present new issues. One of these is the creation of deadlocks, which causes delays in conducting tasks such as obtaining patient information. If the underlying system is distributed, the deadlock situation gets even more problematic. The strategy for preventing deadlock requires basic information from the transaction structure and requested resources. However, in most circumstances, this information is either unavailable or ambiguous. Because the cost of processing and storing sophisticated structures (e.g., wait-for graphs) is so high for a system in comparison to an array of structures, most discovery and resolved-deadlock protocols use them. Due to imprecise knowledge in specifying the transactions&#x2019; attributes, distributed deadlock resolution methods present a new problem in dealing with uncertainty. To address this problem, a variety of fuzzy logic-based techniques have been proposed. However, very little attention has been paid to dealing with ambiguous, vague, incomplete, and inconsistent information about transaction attributes in a single framework. In this paper, we used neutrosophic logic, a generalization of fuzzy logic, to solve the problem of uncertainty in distributed real-time deadlock-resolving systems. The proposed method is structured to reflect multiple types of knowledge and relations among all features and tripartitions the transactions&#x2019; features include validation factor degree, slackness degree, degree of deadline-missed transaction based on the degree of membership of truthiness, degree of membership of indeterminacy, and degree of membership of falsity. We developed a tool set and conducted experiments using benchmark datasets. There is an increase in detection rate and a large drop in rollback rate when this new strategy is used. Our technology resolved all database deadlocks and significantly increased database performance by up to three orders of magnitude.

Understanding Anterior Shoulder Instability Through Machine Learning: New Models That Predict Recurrence, Progression to Surgery, and Development of Arthritis.

Background:Management of anterior shoulder instability (ASI) aims to reduce risk of future recurrence and prevent complications via nonoperative and surgical management. Machine learning may be able to reliably provide predictions to improve decision making for this condition.Purpose:To develop and internally validate a machine-learning model to predict the following outcomes after ASI: (1) recurrent instability, (2) progression to surgery, and (3) the development of symptomatic osteoarthritis (OA) over long-term follow-up.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:An established geographic database of >500,000 patients was used to identify 654 patients aged <40 years with an initial diagnosis of ASI between 1994 and 2016; the mean follow-up was 11.1 years. Medical records were reviewed to obtain patient information, and models were generated to predict the outcomes of interest. Five candidate algorithms were trained in the development of each of the models, as well as an additional ensemble of the algorithms. Performance of the algorithms was assessed using discrimination, calibration, and decision curve analysis.Results:Of the 654 included patients, 443 (67.7%) experienced multiple instability events, 228 (34.9%) underwent surgery, and 39 (5.9%) developed symptomatic OA. The ensemble gradient-boosted machines achieved the best performances based on discrimination (via area under the receiver operating characteristic curve [AUC]: AUCrecurrence = 0.86), AUCsurgery = 0.76, AUCOA = 0.78), calibration, decision curve analysis, and Brier score (Brierrecurrence = 0.138, Briersurgery = 0.185, BrierOA = 0.05). For demonstration purposes, models were integrated into a single web-based open-access application able to provide predictions and explanations for practitioners and researchers.Conclusion:After identification of key features, including time from initial instability, age at initial instability, sports involvement, and radiographic findings, machine-learning models were developed that effectively and reliably predicted recurrent instability, progression to surgery, and the development of OA in patients with ASI. After careful external validation, these models can be incorporated into open-access digital applications to inform patients, clinicians, and researchers regarding quantifiable risks of relevant outcomes in the clinic.

A National Survey of EMR Usability: Comparisons between medical and nursing professions in the hospital and primary care sectors in Australia and Finland

BackgroundElectronic Medical Record Systems (EMRs) are now part of nursing and medical professionals daily work in the acute and primary care sectors in Australia. Usability is an important factor in their successful adoption and impacts upon clinical workflow, safety and quality, communication, and collaboration. This study replicates a significant body of work conducted by Finnish researchers applying a usability focused survey to understand medical and nursing professionals’ experiences in the Australian context. As we implement EMRs across health systems, their usability and design to support clinicians to effectively deliver and document care, is essential. MethodsWe conducted an observational study using a cross sectional survey, the National Usability-Focused HIS Scale (NuHISS) developed and validated by Finnish researchers. For this study 13 usability statements collected clinician impressions of EMRs related to technical quality, ease of use, benefits, and collaboration. We report the responses from medical and nursing professionals working in clinical practice settings in Australia, including primary care and hospital sectors in 2020. ResultsNursing and medical professionals have different experiences with EMR usability. This depends on the sector they work in and the usability feature measured. In our sample, technical quality features were more positively experienced by doctors in the primary care sector than nurses as well as ease of obtaining patient information and prevention of errors. In the hospital sector nurses experiences with EMRs were more positive with respect to support for routine task completion, learnability, ease of obtaining patient information and entry of patient data. ConclusionsThe NuHISS is a suitable tool for measuring the usability experiences of Australian clinicians and the EMRs utilised. Differences in usability experiences were noted between professional groups and sectors. A focus on the usability perspectives of clinicians when enhancing or developing EMR solutions is advocated.

Intraprofessional collaboration between enrolled and registered nurses in the care of clinically deteriorating ward patients: A qualitative study

BackgroundNurses' role in vital signs monitoring places them in an ideal position to recognise and respond to clinical deterioration in general wards. However, enrolled nurses (ENs) and registered nurses (RNs) do not always work collaboratively, and this can lead to delays in recognition and escalation of clinical deterioration in general wards. ObjectivesThe aim of the study was to explore the collaboration experiences between ENs and RNs in recognising and responding to clinical deterioration in general ward settings. MethodsA qualitative descriptive study involving 12 ENs and 11 RNs was conducted in a 1250-bed tertiary hospital in Singapore using semistructured interviews. Interviews were transcribed and thematically analysed. FindingsThree main themes emerged from the data analysis. The first, “reaching a collective understanding of patients' conditions’, identifies nursing shift handover as the primary method of obtaining patient information essential for ENs and RNs to work collaboratively to deliver safe patient care. However, the dissociation of ENs during the handover process created information gaps on patients at risk of clinical deterioration. The second, “role expectations of each other”, describes expectations that both groups of nurses had for each other's functions and responsibilities and the importance of mutual support in the nursing teamwork process. The third, “lacking in shared decision-making”, depicts a top-down approach in decision-making, wherein ENs were often not engaged in the decision-making process related to patient care. ConclusionsA less-than-optimal collaborative EN–RN relationship was observed in this study, which sometimes caused delays in recognising and responding to deteriorating ward patients. This study illuminates the need for intraprofessional learning opportunities in prelicensure nursing programmes and the workplace to foster effective EN–RN collaborative practice. Nurse managers and educators are instrumental in fostering EN–RN collaboration and providing ongoing education on nursing teamwork skills and competencies.

Machine learning based tissue analysis reveals Brachyury has a diagnosis value in breast cancer.

Background: The aim of the present study was to confirm the role of Brachyury in breast cancer and to verify whether four types of machine learning models can use Brachyury expression to predict the survival of patients.Methods: We conducted a retrospective review of the medical records to obtain patient information, and made the patient’s paraffin tissue into tissue chips for staining analysis. We selected 303 patients for research and implemented four machine learning algorithms, including multivariate logistic regression model, decision tree, artificial neural network and random forest, and compared the results of these models with each other. Area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the results.Results: The chi-square test results of relevant data suggested that the expression of Brachyury protein in cancer tissues was significantly higher than that in paracancerous tissues (P=0.0335); patients with breast cancer with high Brachyury expression had a worse overall survival (OS) compared with patients with low Brachyury expression. We also found that Brachyury expression was associated with ER expression (P=0.0489). Subsequently, we used four machine learning models to verify the relationship between Brachyury expression and the survival of patients with breast cancer. The results showed that the decision tree model had the best performance (AUC = 0.781).Conclusions: Brachyury is highly expressed in breast cancer and indicates that patients had a poor prognosis. Compared with conventional statistical methods, decision tree model shows superior performance in predicting the survival status of patients with breast cancer.

The effectiveness of germicidal wipes and ultraviolet irradiation in reducing bacterial loads on electronic tablet devices used to obtain patient information in orthopaedic clinics: evaluation of tablet cleaning methods

Electronic tablet devices are commonly used in outpatient clinics to obtain patient information for both clinical and research purposes. These devices are often colonized with bacteria; there are many cleaning methods to reduce this bacterial load. The primary purpose of this study was to evaluate whether regular cleaning with either germicidal wipes or ultraviolet (UV) irradiation leads to lower bacterial levels compared with irregular cleaning. A randomized blinded trial was conducted of tablet cleaning strategies between each patient encounter in orthopaedic clinics. The cleaning method was randomized to either germicidal wipes, UV irradiation, or cleaning only when the tablet was visibly soiled. Research assistants (blinded to the treatment) obtained bacterial cultures from the tablets at the beginning and end of each clinic day. Using germicidal wipes between each patient encounter vs no routine cleaning resulted in a marked decrease in the amount of bacterial contamination (risk ratio (RR)= 0.17 (0.04-0.67)). Similarly, using UV irradiation between each patient encounter led to significantly lower bacterial contamination rates (RR= 0.29 (95% confidence interval (CI)= 0.09-0.95)) compared with no routine cleaning. The majority of bacteria identified were normal skin flora. No meticillin-resistant Staphylococcus aureus was identified and only sparse colonies of meticillin-sensitive S.aureus. Electronic tablets used in orthopaedic trauma clinics are colonized with bacteria if no routine cleaning is performed. Routine use of either UV irradiation or germicidal wipes significantly decreases this bacterial burden. Providers should implement routine cleaning of tablets between each patient encounter to minimize exposure to potential pathogens.