Information For Management Of Patients Research Articles

Enhancing medical image security through machine learning and dual watermarking-based technique

ABSTRACT As the world becomes increasingly digital, healthcare is no exception. With the ease of sharing e-healthcare records over open networks, smart healthcare systems have become a popular way to manage patient information. But as the popularity of these systems has grown, so has the concern for their security. That's where image security techniques come in. In this paper we have developed a new approach to secure e-patient records like DICOM images. By combining the redundant discrete wavelets transform (RDWT), Hessenberg Decomposition (HD), and randomized singular value decomposition (RSVD). We developed a robust and dual watermarking scheme. This scheme uses multiple watermarks, including Electronic Patient Record (EPR) as text and images, to ensure high-level authentication. In order to attain a balance between imperceptibility and robustness, a PSO-based optimization of scale factor is employed and Turbo code is utilized to encode the EPR and minimize channel noise. Additionally, the marked image undergoes encryption using a 3D chaotic-based encryption technique, and the extracted watermark is denoised through a deep neural network. The result shows that the proposed scheme is both secure and reliable. With this dual watermarking scheme, we have made great strides in securing e-patient records.

Losing the Postcode Lottery: An Observational Study Examining the Association Between Patient Address and Delayed Discharge in a Rehabilitation Centre

Abstract Background Quality and Fairness: A Health System for You published by the HSE in 2001 stated, as one of its core principles “Access to healthcare should be fair. The system must respond to people’s needs rather than have access dependent on geographic location or ability to pay.”1 Twenty years on, experience at our rehab unit suggests that inequality exists in accessing care in the community for older persons based on their residential address. The aim of our study was to examine and quantify this inequity of access. Methods A retrospective study was designed. Using the local patient information management system, all discharges in 2023 were identified. Baseline demographics, admission and discharge date and residential address were recorded. Delayed discharges were defined as patients for whom their rehabilitation programme is complete as agreed at the multi-disciplinary team meeting. Delayed discharge data was obtained from medical social work department who input this data to the HSE weekly. Patients were assigned a community healthcare organisation (CHO) based on address. CHO ‘A’ included two CHOs with predominantly rural areas whilst CHO ‘B’ comprised of one predominantly urban CHO. Results 167 patients were included. 24 discharges were delayed (14.4%). Median age was 84. Total bed days lost: 935 (mean 40.6, range 3 – 232). All nine CHOs were represented. Patients living in CHO A had increased likelihood of having discharge delayed (OR: 4.82, CI 2.86 – 8.13). Conversely, those living in CHO B were less likely to have had a discharge delayed (OR: 0.39, CI 0.15 – 0.96) Conclusion Our study demonstrates that health inequity does exist. Patients residing in rural communities are 4 times more likely to have their discharge delayed awaiting community supports compared to urban dwellers. Ending of the discrimination of patients based on their postcode and ensuring access based on need is the very essence of Sláintecare.

8 Year Follow up of Patients Diagnosed with Dementia in a Tertiary Memory Service

Abstract Background Approximately 64,000 people live with dementia in Ireland with an expected increase to 150,000 by 2045. Time to presentation with symptoms of cognitive decline varies between cases. The heterogenous nature of dementia makes estimations of an individualised trajectory of decline challenging. Methods Retrospective analysis was undertaken patients (n=17) of those diagnosed with dementia in 2016 whereby outcomes were discernible from records of the organisation. Data were extracted from the clinic Excel database, Patient Information Management System and Electronic Patient Record portal. Diagnosis was verified using the clinic letter at time of diagnosis. Data was processed using Microsoft Excel. Results Mean age was 77 (range 64-84). Diagnostic breakdown was AD 35.2% (n=6); AD/VaD 41.1% (n=7); VaD 23.5% (n=4). Average survival was 64.8 months (range 16-100). The group averaged 6.2 medicines and 4.3 comorbidities – most common cited were Hypertension (13%) Osteoporosis (8.3%); Hypercholesterolaemia & IHD (6.9%); Hypothyroidism & T2DM (5.5%). Average Emergency Department admissions was 2.5 episodes with average 5 admissions. 5 remain alive, 12 RIP – 6 (LTC); 5 hospital and 1 at home. Two live at home, 3 in LTC. Average time living within their own home was 61.1 months (those who died in LTC) and 43.4 (those who died in Hospital). Longest length of admission pre death was 18 days (3-18). Conclusion A diagnosis of dementia affords a level of anxiety with regard to the future. The provision of a roadmap of decline is difficult as the journey of each patient is unique. Within this cohort, patients tended to live at home for long periods of time regardless of their age and despite multiple co morbidities. Where patients were admitted prior to their death, this was usually close to the end of their life. A valuable focus of hope should be placed on enjoying and living the years of possible life after diagnosis.

Internet of Things (IoT) Based Patient Information and Heart Beat Monitoring System for Health Information System

The integration of Internet of Things (IoT) technology into healthcare systems has revolutionized patient monitoring and Information management, leading to enhanced efficiency and improved patient outcomes. This research developed and implemented an IoT-enabled Patient Information and Heartbeat Monitoring System designed to improve Health Information System (HIS). The system employs a network of interconnected sensors and devices to continuously monitor vital signs, especially focusing on heartbeat data. These sensors transmit real-time data to a centralized cloud platform, where it is processed and analyzed. Healthcare professionals can access this data through a user-friendly interface, enabling timely and informed decision-making. The system not only ensures accurate and continuous monitoring but also provides critical alerts in case of abnormal heart rate variations, thereby facilitating prompt medical intervention. The deployment of this IoT-based solution demonstrates significant potential in improving patient care, reducing hospital readmissions, and optimizing resources utilization within healthcare facilities. Results from pilot implementations indicate a promising future for IoT-enabled patient monitoring in transforming modern healthcare practices.

Hubungan Kepuasan Tenaga Kesehatan dalam Penggunaan Sistem Informasi Management Puskesmas (Simpus) di Puskesmas Pakuniran Kecamatan Pakuniran Kabupaten Probolinggo

Introduction: Simpus puskesmas management application that simplifies and speeds up services to manage patient information starting from registration, registration, examination (diagnosis) and patient care. The satisfaction of health workers, the response or feedback from users about the use of the system, as well as the assessment of the good and bad sides of the system, is the starting point for system developers to improve the performance of the information system built. Purpose of the study: To determine the relationship between satisfaction of health workers in the use of the puskesmas management information system (Simpus) at the Pakuniran health center. Method: This study uses a quantitative descriptive approach using Nonprobability sampling technique using Total sampling technique using statistical test Spearman's rho correlation, with data collection instruments using questionnaires. This research was conducted at the Pakuniraan health center in July 2023. Research Results: The results of the spearman rank correlation statistical test obtained results namely (p = 0.000) because the p value <0.05 then Ho was rejected and Ha was accepted Conclusion: that there is a relationship between health worker satisfaction in using the puskesmas management information system (SIMPUS), which means that the better and more appropriate the puskesmas management information system, the higher the level of health worker satisfaction.

Biomarkers to inform the management of polycystic ovary syndrome: A review of systematic reviews.

Polycystic ovarian syndrome (PCOS) is the commonest endocrine condition affecting reproductive age women. Many biomarkers may aid assessment and management, however evidence is limited on their utility in clinical practice. We conducted a review of systematic reviews to identify the most useful biomarkers in the clinical management of PCOS. We searched MEDLINE, EMBASE, CENTRAL and HTA until August 2023 for reviews evaluating biomarkers in PCOS women compared to healthy controls. Methodological quality was assessed using the AMSTAR2 tool. We reported pooled evidence for each biomarker with 95% confidence intervals from the most recent, up-to-date, and best quality review. From 3360 citations, we included 75 systematic reviews (88 biomarkers, 191,792 women). Most reviews (50/75, 67%) were moderate quality, but reported high heterogeneity (66/75, 88%). We identified 63 abnormal biomarkers in women with PCOS versus healthy controls. Of these, 22 core biomarkers could help evaluate the multisystemic impact of PCOS and inform patient management and surveillance: dehydroepiandrosterone, prolactin, sex hormone-binding globulin, total and free testosterone, anti-Mullerian hormone, systolic and diastolic blood pressure, c-reactive protein, fibrinogen, oral glucose tolerance test, homoeostatic model assessment-insulin resistance index, fasting insulin, total cholesterol, triglycerides, lipoprotein(a), HDL, LDL, non-HDL-cholesterol, ferritin, iron, and 25-hydroxy-vitamin D. We identified 22 core biomarkers assessing the multisystemic impact of PCOS and inform its clinical management. Future research is required to establish validated healthcare pathways.

Cortical inexcitability in ALS: correlating a clinical phenotype

BackgroundCortical inexcitability, a less studied feature of upper motor neuron (UMN) dysfunction in amyotrophic lateral sclerosis (ALS), was identified in a large cross-sectional cohort of ALS patients and their demographic...

Sonographic assessment of ulno‐humeral joint instability

AbstractThe ulnar collateral ligament (UCL) of the elbow plays a crucial role in elbow stability, specifically as a valgus and rotational constraint. Injuries to the UCL are common in overhead‐throwing athletes resulting in elbow instability. A timely diagnosis of early ulno‐humeral joint space widening in the overhead‐throwing athlete is required, to inform patient management and return to play. Sonographic assessment and measurement of the ulno‐humeral joint space with and without stress, and comparison to the contralateral uninjured side provides a quantitative assessment of instability. A systematic sonographic technique for single operator stress ultrasound is outlined to improve consistency of assessment and reporting of findings.

Retinal Microstructural Changes Reflecting Treatment-Associated Cognitive Dysfunction in Patients with Lower-Grade Gliomas

PurposeTo determine whether microstructural retinal changes, tumor features, and Apolipoprotein E (APOE) ε4 polymorphism are correlated with clinically detectable treatment-associated cognitive dysfunction (TACD) in patients with lower-grade gliomas. DesignCohort study. Participants and ControlsSixteen lower-grade glioma patients at a U.S. academic Ophthalmology department between January 2021 and November 2023. Normal controls were recruited from convenient sampling. MethodsMontreal Cognitive Assessment (MoCA) scores and retinal changes were assessed in 6-months intervals. APOE genotyping was performed, and tumor details were recorded. Partial least-squares discriminant (PLSD) model was established to evaluate the association between TACD with APOE genotype, ophthalmic, and tumor features. Main Outcome MeasuresThe main outcome measure was cognitive status as measured by the MoCA score and analyzed in relation to ophthalmic measurements, tumor features, and APOE genotype. ResultsMedian time to first eye exam was 34 months (2–266) from tumor diagnosis and 23 months (0–246) from radiation. Nine patients (56%) had abnormal cognition (MoCA <26/30). MoCA scores were significantly worse in patients with temporal (22±7.2) than frontal lobe tumors (26±3.1, p=0.02) and those with oligodendrogliomas (22±4.1) than astrocytomas (26±3.6, =0.02). Patients with TACD had significant radial peripapillary capillary density loss (45%±4.6) compared to those with normal cognition (49%±2.6, p=0.02). A PLSD model correlated MoCA scores with retinal nerve fiber thickness, intraocular pressure, foveal avascular zone, best-corrected visual acuity, months since first diagnosis, and tumor pathology (oligodendroglioma or not). Using these features, the model identified patients with TACD with 77% accuracy. APOE genotyping showed: two ε2/ε3 (13%), ten ε3/ε3 (63%), and one ε3/ε4 (6%). ConclusionRetinal microstructural changes may serve as biomarkers for TACD in patients with lower-grade gliomas. Temporal lobe tumors and oligodendrogliomas may increase susceptibility to TACD. Utilization of retinal markers may enhance TACD diagnosis, progression monitoring, and inform management of lower-grade glioma patients. A larger study with serial eye exams is warranted to evaluate the role of APOE ε4 and develop a predictive model.

Attitude and utilization of ChatGPT among registered nurses: A cross-sectional study.

This study explores the influencing factors of attitudes and behaviors toward use of ChatGPT based on the Technology Acceptance Model among registered nurses in Taiwan. The complexity of medical services and nursing shortages increases workloads. ChatGPT swiftly answers medical questions, provides clinical guidelines, and assists with patient information management, thereby improving nursing efficiency. To facilitate the development of effective ChatGPT training programs, it is essential to examine registered nurses' attitudes toward and utilization of ChatGPT across diverse workplace settings. An anonymous online survey was used to collect data from over 1000 registered nurses recruited through social media platforms between November 2023 and January 2024. Descriptive statistics and multiple linear regression analyses were conducted for data analysis. Among respondents, some were unfamiliar with ChatGPT, while others had used it before, with higher usage among males, higher-educated individuals, experienced nurses, and supervisors. Gender and work settings influenced perceived risks, and those familiar with ChatGPT recognized its social impact. Perceived risk and usefulness significantly influenced its adoption. Nurse attitudes to ChatGPT vary based on gender, education, experience, and role. Positive perceptions emphasize its usefulness, while risk concerns affect adoption. The insignificant role of perceived ease of use highlights ChatGPT's user-friendly nature. Over half of the surveyed nurses had used or were familiar with ChatGPT and showed positive attitudes toward its use. Establishing rigorous guidelines to enhance their interaction with ChatGPT is crucial for future training. Nurse managers should understand registered nurses' attitudes toward ChatGPT and integrate it into in-service education with tailored support and training, including appropriate prompt formulation and advanced decision-making, to prevent misuse.

P-387 The use of cell-free DNA analysis to identify fetal aneuploidies in early pregnancy loss

Abstract Study question Can cell-free (cf) DNA-based analysis of a maternal blood sample be used to identify presence of fetal aneuploidies in early pregnancy loss (EPL) cases? Summary answer CfDNA analysis was able to detect fetal aneuploidies in EPL cases with 73.5% sensitivity and 100% specificity. What is known already Miscarriages occur in about 10%–20% of pregnancies, and the majority occur in the first trimester. About 50% of EPL cases result from the presence of fetal aneuploidy. Knowing the etiology of a miscarriage can be helpful for future reproductive planning along with providing a psychological benefit for patients. Although products of conception (POC) samples can be collected and assessed for presence of fetal aneuploidies, this is not always possible. Recent studies have shown that a noninvasive approach using cfDNA analysis of a blood sample can identify fetal aneuploidies in patients that experience EPL. Study design, size, duration In this prospective study, samples were collected from 78 patients across the United States from June 2021–December 2022. Blood specimens were collected for cfDNA analysis and maternal cell contamination analysis, and POC samples were collected following surgical evacuation for microarray analysis. Performance of the cfDNA assay was determined by comparing results from the cfDNA analysis against the gold standard of microarray results. Participants/materials, setting, methods Patients were recruited from six reproductive endocrinology/infertility practices. Eligible participants were between 5–20 weeks of gestation with miscarriage of a singleton pregnancy diagnosed by ultrasound and presence of pregnancy tissue in utero. Limited clinical information was collected, including demographics and expected clinical gestational age (GA) at sample collection. Blood samples underwent cfDNA analysis using an adapted version of a noninvasive prenatal test, which included establishment and use of pregnancy loss-specific log likelihood ratio thresholds. Main results and the role of chance Seventy-eight patients were recruited, of which two were excluded due to blood sample collection issues. Eleven of the 76 patients that underwent cfDNA analysis were excluded from performance calculations for several reasons including maternal cell contamination of POC samples and detection of triploidy by microarray. The final 65 samples included 49 affected and 16 unaffected samples based on POC microarray results; this included 42 with one fetal aneuploidy, six with two fetal aneuploidies, and one with three fetal aneuploidies. Average fetal fraction of these 65 samples was 4.9% (range: 0.6%–13.9%) and average expected clinical GA at time of sample collection was 8.7 weeks (range: 5.9–12.1 weeks). Performance of the cfDNA assay was determined by comparing cfDNA analysis results with POC microarray results using either a full concordance approach (correct classification of all affected chromosomes in an affected sample) or a partial concordance approach (correct classification of at least one affected chromosome in an affected sample). Based on the full concordance approach, sensitivity of the cfDNA assay was 69.4% and specificity was 100%. For the partial concordance approach, sensitivity of the cfDNA assay increased to 73.5% whilst specificity remained at 100%. The cfDNA assay failure rate was 0%. Limitations, reasons for caution Study limitations include a small study cohort, the inability of the cfDNA assay to detect triploidy or partial deletions/duplications &amp;lt;7 Mb and possibly mosaicism, and that this cfDNA analysis approach can only be used for EPL cases that are identified before complete expulsion of the products of conception. Wider implications of the findings This study provides further evidence of the ability of cfDNA analysis to detect fetal aneuploidies in EPL cases. A clinically available cost-effective noninvasive approach to determine the etiology of a miscarriage could help inform medical management of patients for future reproductive planning and could provide psychological benefits to patients. Trial registration number NCT04935138

Association between frailty and acute kidney injury after cardiac surgery: unraveling the moderation effect of body fat through an international, retrospective, multi-cohort study.

Acute kidney injury (AKI) is a common and serious complication after cardiac surgery that significantly affects patient outcomes. Given the limited treatment options available, identifying modifiable risk factors is critical. Frailty and obesity, two heterogeneous physiological states, have significant implications for identifying and preventing AKI. Our study investigated the interplay among frailty, body composition, and AKI risk after cardiac surgery to inform patient management strategies. This retrospective cohort study included three international cohorts. Primary analysis was conducted in adult patients who underwent cardiac surgery between 2014 and 2019 at Wuhan XX Hospital, China. We tested the generalizability of our findings with data from two independent international cohorts, the Medical Information Mart for Intensive Care IV (MIMIC-IV) and the eICU Collaborative Research Database. Frailty was assessed using a clinical lab-based frailty index (FI-LAB), while total body fat percentage (BF%) was calculated based on a formula accounting for BMI, sex, and age. Logistic regression models were used to analyze the associations between frailty, body fat, and AKI, adjusting for pertinent covariates. A total of 8785 patients across three international cohorts were included in the study. In the primary analysis of 3,569 patients from Wuhan XX Hospital, moderate and severe frailty were associated with an increased AKI risk after cardiac surgery. Moreover, a nonlinear relationship was observed between body fat percentage and AKI risk. When stratified by the degree of frailty, lower body fat correlated with a decreased incidence of AKI. Extended analyses using the MIMIC-IV and eICU cohorts (n=3,951 and n=1,265, respectively) validated these findings and demonstrated that a lower total BF% was associated with decreased AKI incidence. Moderation analysis revealed that the effect of frailty on AKI risk was moderated by the body fat percentage. Sensitivity analyses demonstrated results consistent with the main analyses. Higher degrees of frailty were associated with an elevated risk of AKI following cardiac surgery, and total BF% moderated this relationship. This research underscores the significance of integrating frailty and body fat assessments into routine cardiovascular care to identify high-risk patients for AKI and implement personalized interventions to improve patient outcomes.

MDB-31. THE CLINICAL SIGNIFICANCE OF SUB-TOTAL SURGICAL RESECTION IN CHILDHOOD MEDULLOBLASTOMA: A MULTI-COHORT ANALYSIS OF 1100 PATIENTS

Abstract BACKGROUND Medulloblastoma patients with sub-total surgical resection (STR; &amp;gt;1.5 cm2 primary tumour residuum) typically receive intensified treatment. However, the association of STR with poor outcomes has not been observed consistently, questioning the validity of STR as a high-risk disease feature. METHODS We collected extent of resection (EOR) data from 1110 patients (UK CCLG centres (n=416), published cohorts (n=694)), the largest cohort with clinico-molecular annotation assembled to specifically assess the significance of EOR to date. We performed association and survival analyses, assessing overall survival (OS) cohort-wide with reference to the consensus medulloblastoma molecular groups and clinico-molecular features. RESULTS STR was reported in 20% (226/1110) of the cohort and was enriched in patients (i) &amp;lt;5 years at diagnosis (p=0.021), (ii) with metastatic disease (p&amp;lt;0.0001) or (iii) with non-WNT tumours (p=0.047). In cohort-wide analysis, STR was associated with worse survival in univariable analysis (p&amp;lt;0.0001), though, outcomes for patients with STR as their only risk-feature were as per standard-risk disease. Examination of specific disease contexts showed STR was prognostic in univariate analysis for patients (i) receiving cranio-spinal irradiation (CSI) and chemotherapy (p=0.016) and (ii) with Group 3 tumours receiving CSI (p=0.039). In non-metastatic CSI treated patients, STR was not prognostic, independent of CSI dose. Crucially, STR was not independently prognostic in multivariable analyses when considered alongside established clinico-molecular high-risk features. CONCLUSIONS In a cohort of 1100 molecularly characterised medulloblastoma patients, STR (n=226) predicted significantly lower OS in univariable analysis, but was not an independent prognostic factor. Our data suggest that maximal safe resection can continue to be carried out for patients with medulloblastoma and suggest STR should not inform patient management when observed as a sole, isolated risk feature. These findings provide necessary evidence to inform the selection criteria for forthcoming risk-adapted medulloblastoma clinical trials.

Cranial Ultrasound Findings in Infants With Congenital Cytomegalovirus Infection in a Universal Newborn Screening Study in Minnesota.

Congenital cytomegalovirus (cCMV) is the most common infectious cause of neurodevelopmental deficits in US children. To inform patient management, it is important to define whether central nervous system (CNS) manifestations are present at birth. This study characterized neuroimaging findings in infants with cCMV identified by a universal screening study in Minnesota during February 2016-December 2022. Newborns with cCMV infection (confirmed by urine CMV polymerase chain reaction [PCR] testing, obtained following a positive screening saliva and/or dried blood spot result) underwent a diagnostic evaluation that included a cranial ultrasound (cUS) exam, laboratory studies, ophthalmological, and audiological evaluation. Neuroimaging findings and cCMV disease classification were interpreted based on international consensus guidelines. Among 87 newborns with confirmed cCMV, 76 underwent cUS. Of these, 53/76 (70%) had normal examinations, while 23/76 (30%) exhibited cUS findings: for 5 infants, these were clearly cCMV disease-defining, while for 18 infants, there were findings of uncertain significance. Magnetic resonance imaging (MRI) results (n = 10 infants) aligned with cUS cCMV disease-defining findings in 2 infants, while cCMV-specific abnormalities were noted by MRI in 2 of 6 infants with nondiagnostic/incidental cUS findings. Of 9 infants who had both cUS and MRI examination, the average time interval between studies was 220 days (range, 2-1061). Excluding infants with cCMV CNS disease-defining cUS abnormalities, incidental findings were observed more commonly in infants with clinical/laboratory features described in cCMV disease classification guidelines (9/13) than in newborns with completely asymptomatic infections (9/58; P < .0001). Among infants with cCMV identified in a universal screening study, the majority had a normal cUS. CNS disease-defining abnormalities were present in 7%, while 24% had findings of uncertain significance. We propose that many cUS findings are incidental, and not diagnostic of symptomatic cCMV infection. Although these findings may not be sufficient to define the presence of symptomatic cCMV disease involving the CNS, in our study they were more commonly observed in infants with other clinical and/or laboratory findings associated with symptomatic cCMV infection.

Spinal infection: Assessing comorbidities and costs to inform patient management and resource use strategies

BackgroundSpinal Infection (SI) is associated with various comorbidities. The interaction of these comorbidities and their impact on costs and complexity of care has not been fully assessed. MethodsThis is a retrospective cohort study of SI patients in an urban hospital system to characterize comorbidities and outcomes in adult patients with SI. Adult patients in our hospital system who were hospitalized with an initial diagnosis of SI between July 1, 2017 and June 30, 2019 were included. Outcomes measures included length of stay (LOS) of the index hospitalization for SI, charges and payments for the index hospitalization, and hospital readmissions within one year after discharge from the index hospitalization Data was obtained by querying our Electronic Data Warehouse (EDW) using ICD-10-CM and CPT procedure codes. Spearman's correlation was used to summarize the relationships between LOS, charges, and payments. Multivariable linear regression were used to evaluate associations of demographics, comorbidities, and other factors with LOS. Multivariable Cox regression were used to evaluate associations of demographics, comorbidities, and other factors with hospital readmissions. Results403 patients with a first diagnosis of SI were identified. The average number of comorbidities per patient was 1.3, 294 (73%) had at least one medical comorbidities, and 54 (13%) had three or more comorbidities. The most common medical comorbidities were diabetes mellitus (26%), intravenous drug use (IVDU, 26%), and malnutrition (20%). Twenty-eight percentage had a surgical site infection (SSI). DM (p < 0.001) and SSI (p = 0.016) were more common among older patients while IVDU was more common among younger patients (p < 0.001). Median LOS was 12 days. A larger number of medical comorbidities was associated with a longer LOS (p < 0.001) while the presence of a SSI infection was associated with a shorter LOS (p = 0.007) after multivariable adjustment. LOS was positive correlated with both charges (r = 0.83) and payments (r = 0.61). Among 389 patients discharged alive after the index hospitalization, 36% had a readmission within 1 year. The rate of readmission was twice as high for patients with three or more comorbidities than patients with zero comorbidities (hazard ratio: 1.95, p = 0.017). ConclusionsPatients with SI often have multiple comorbidities, and the specific type of comorbidity is associated with the patient's age. The presence of multiple comorbidities correlates with initial LOS, cost of care, and readmission rate. Readmission in the first year post-discharge is high.

Charlson’s comorbidity and remission outcomes in women diagnosed with epithelial ovarian cancer.

e17562 Background: Several prior studies have examined the role of comorbidity on overall survival in ovarian cancer (OC) patients and reported an association between comorbidity and inferior overall survival. However, it is unclear if the inferior survival was solely due to the excess mortality from the comorbidities, or that the comorbidities can impact OC treatment outcomes. Our objective was to determine whether pre-existing Charlson comorbidity index (CCI) was associated with lower likelihood of achieving complete remission. Methods: This retrospective cohort study included patients diagnosed with OC of epithelial subtype between 01/01/2017-06/30/2021 at a large integrated healthcare delivery system in the United States. OC patients were identified from the healthcare system’s cancer registry or via chart review of those with the ICD-10 diagnosis code. Patient’s CCI was determined based on data from the 12-month window prior to OC diagnosis. Patients’ remission outcomes, including complete remission and clinical remission (complete + partial remission) were ascertained via chart review, considering physician’s assessment, CA125 value and imaging evidence. Data on potential confounders (pandemic period, age, race/ethnicity, FIGO stage, prior length of membership, and time to treatment) were obtained from the healthcare system’s electronic medical records. Bivariate and multivariable modified Poisson regressions adjusting for potential confounders were used to evaluate the associations between CCI and achieving complete remission or clinical remission by end of therapy. Results: A total of 799 patients diagnosed with OC were included in our study. Overall, the cohort was racially/ethnically diverse with 46.2% White, 33.8% Hispanic, 12.4% Asian, and 7.6% Black patients. In the crude analysis, those with CCI score=1 and CCI≥2 had lower likelihood of achieving complete remission, compared with those with CCI=0 (no Charlson comorbidity) [RR= 0.84 (0.76-0.93) and RR=0.72 (0.64-0.81), respectively]. In the multivariable analysis, those with CCI=1 and CCI≥2 continued to have lower likelihood of achieving complete remission, compared with those with CCI= 0 [RR= 0.84 (0.77-0.92) and RR=0.81 (0.72-0.91), respectively]. Similar findings were observed for clinical remission, although the associations were attenuated: RR= 0.95 (0.89-1.01) for CCI=1 and RR=0.92 (0.86-1.00) for CCI≥2 vs. CCI=0. Conclusions: Having Charlson comorbidity was associated with lower likelihood of achieving complete remission in OC patients. This finding suggest that pre-existing comorbidities may contribute to inferior survival via, at least in part, adversely affecting the likelihood of achieving complete remission. The potential mechanisms underlying this association should be further studied to inform patient management.

Kinetics of SARS-CoV-2 infection biomarkers in a household transmission study

SARS-CoV-2 is the causative agent of COVID-19. Timely and accurate diagnostic testing is vital to contain the spread of infection, reduce delays in treatment and care, and inform patient management. Optimal specimen type (e.g. nasal swabs or saliva), timing of sampling, viral marker assayed (RNA or antigen), and correlation with viral infectivity and COVID-19 symptoms severity remain incompletely defined. We conducted a field study to evaluate SARS-CoV-2 viral marker kinetics starting from very early times after infection. We measured RNA and antigen levels in nasal swabs and saliva, virus outgrowth in cell culture from nasal swabs, and antibody levels in blood in a cohort of 30 households. Nine household contacts (HHC) became infected with SARS-CoV-2 during the study. Viral RNA was detected in saliva specimens approximately 1–2 days before nasal swabs in six HHC. Detection of RNA was more sensitive than of antigen, but antigen detection was better correlated with culture positivity, a proxy for contagiousness. Anti-nucleocapsid antibodies peaked one to three weeks post-infection. Viral RNA and antigen levels were higher in specimens yielding replication competent virus in cell culture. This study provides important data that can inform how to optimally interpret SARS-CoV-2 diagnostic test results.

Thrombophilia Screening: Not So Straightforward.

Although inherited thrombophilias are lifelong risk factors for a first thrombotic episode, progression to thrombosis is multifactorial and not all individuals with inherited thrombophilia develop thrombosis in their lifetimes. Consequently, indiscriminate screening in patients with idiopathic thrombosis is not recommended, since presence of a thrombophilia does not necessarily predict recurrence or influence management, and testing should be selective. It follows that a decision to undertake laboratory detection of thrombophilia should be aligned with a concerted effort to identify any significant abnormalities, because it will inform patient management. Deficiencies of antithrombin and protein C are rare and usually determined using phenotypic assays assessing biological activities, whereas protein S deficiency (also rare) is commonly detected with antigenic assays for the free form of protein S since available activity assays are considered to lack specificity. In each case, no single phenotypic assay is capable of detecting every deficiency, because the various mutations express different molecular characteristics, rendering thrombophilia screening repertoires employing one assay per potential deficiency, of limited effectiveness. Activated protein C resistance (APCR) is more common than discrete deficiencies of antithrombin, protein C, and protein S and also often detected initially with phenotypic assays; however, some centres perform only genetic analysis for factor V Leiden, as this is responsible for most cases of hereditary APCR, accepting that acquired APCR and rare F5 mutations conferring APCR will go undetected if only factor V Leiden is evaluated. All phenotypic assays have interferences and limitations, which must be factored into decisions about if, and when, to test, and be given consideration in the laboratory during assay performance and interpretation. This review looks in detail at performance and limitations of routine phenotypic thrombophilia assays.

Analysis of the Use of Hospital Management Information Systems with Jobs to be Done to Increase Innovation Simplifying Administrative Processes at CHP Hospitals

The Hospital Management Information System (HMIS) must be developed and implemented in every hospital, in accordance with Minister of Health Regulation Number 82 of 2013, to provide the best service to the Indonesian public, the quality of hospital services must be continuously improved. The management of patient information, data, data processing, and all activities related to a good hospital depend heavily on this. It is important to understand how the implementation of the Hospital Management Information System can improve healthcare service standards in Indonesia after its implementation. Thirty-two samples were used in this study, and SEM-PLS data were analyzed using the Jobs To Be Done approach. The findings indicate that human, organizational structure, and system usage within the Hospital Management Information System (HMIS) can enhance healthcare technology innovation by simplifying administration in hospital services.

An Electronic Health Record-Integrated Application for Standardizing Care and Monitoring Patients With Autosomal Dominant Polycystic Kidney Disease Enrolled in a Tolvaptan Clinic: Design and Implementation Study.

Tolvaptan is the only US Food and Drug Administration-approved drug to slow the progression of autosomal dominant polycystic kidney disease (ADPKD), but it requires strict clinical monitoring due to potential serious adverse events. We aimed to share our experience in developing and implementing an electronic health record (EHR)-based application to monitor patients with ADPKD who were initiated on tolvaptan. The application was developed in collaboration with clinical informatics professionals based on our clinical protocol with frequent laboratory test monitoring to detect early drug-related toxicity. The application streamlined the clinical workflow and enabled our nursing team to take appropriate actions in real time to prevent drug-related serious adverse events. We retrospectively analyzed the characteristics of the enrolled patients. As of September 2022, a total of 214 patients were enrolled in the tolvaptan program across all Mayo Clinic sites. Of these, 126 were enrolled in the Tolvaptan Monitoring Registry application and 88 in the Past Tolvaptan Patients application. The mean age at enrollment was 43.1 (SD 9.9) years. A total of 20 (9.3%) patients developed liver toxicity, but only 5 (2.3%) had to discontinue the drug. The 2 EHR-based applications allowed consolidation of all necessary patient information and real-time data management at the individual or population level. This approach facilitated efficient staff workflow, monitoring of drug-related adverse events, and timely prescription renewal. Our study highlights the feasibility of integrating digital applications into the EHR workflow to facilitate efficient and safe care delivery for patients enrolled in a tolvaptan program. This workflow needs further validation but could be extended to other health care systems managing chronic diseases requiring drug monitoring.