Patient Records Research Articles

Real-world treatment patterns and outcomes for patients with neoadjuvant treatment between 2019-2022 for gastric or gastroesophageal junction cancer (GC/GEJC) in the US community setting.

345 Background: Treatment options for patients with early-stage GC/GEJC are still limited and the prognosis remains poor, despite recent therapy approvals. With the latest adoption of FLOT use in the US, it is important to understand patients’ characteristics, treatment patterns and outcomes in the US community oncology setting. Methods: This retrospective observational cohort study used electronic health records data from 278 adult patients with stage II-IVA GC/GEJC adenocarcinoma initiating neoadjuvant treatment (index) within The US Oncology Network between 1/1/2019 and 12/31/2022, based on Food and Drug Administration approval of FLOT in 2019. Patients were followed through 9/30/2023, last patient record or death, whichever occurred first. Descriptive analyses were conducted to evaluate patient and treatment characteristics. Kaplan-Meier was used to assess overall survival (OS) and event-free survival (EFS) from index. Adjusted Cox proportional hazard models were used to analyze the association of surgery as a time-dependent variable with OS and EFS. Results: Median (interquartile range [IQR]) age at index was 67.5 (58.2, 74.2) years; most patients were male (68.0%), and half were Caucasian (51.1%). Stage III was the most common initial stage (50.0%), followed by IIB (29.1%), and II (not otherwise specified)/IIA (19.8%). Most patients had an ECOG (0-1) 65.5%. Median (IQR) follow-up from index was 15.6 (8.6, 27.8) months. The most common neoadjuvant regimens were FLOT (51.1%), doublet (28.4%), and CROSS (18.0%). Median OS (months) (95% confidence interval [CI]) for patients with surgery was not reached (NR) (47.7, NR) and those without was 16.1 (8.6, 35.1). Patients with surgery had a longer median EFS (95% CI) (months) than those without 38.3 (25.0, NR) vs 5.6 (4.5, 6.5) (log rank p-value <0.0001). Adjusted hazard ratios (95% CI) for OS and EFS indicated that patients who received surgery were less likely to experience an event than those without, 0.252 (0.139, 0.456) and 0.268 (0.169, 0.426), respectively (p<0.0001). Conclusions: Study findings showed a high proportion of patients receiving FLOT since its approval in US, with a directional OS benefit similar to the FLOT4 trial. Also, receipt of surgery was a strong predictor for OS and EFS. While the results are promising, most patients who did not receive surgery progressed within 6 months and died a little over a year from index. However, given the small portion of patients who did not receive surgery, further research is needed to understand if there is an unmet need for this group. Variable Doublet CROSS FLOT N 79 50 142 Surgery Rate (%) 60.8% 62.0% 71.8% GC Rate (%) 79.8% <20% 85.9% OS, median (95% CI), months 26.0 (20.9, NR) 37.7 (27.8, NR) 52.1 (47.7, NR) EFS, median (95% CI), months 10.8 (8.4, 23.2) 20.9 (11.3, 26.3) 37.7 (18.0, NR)

Uses of VEGF inhibitor bevacizumab in appendiceal adenocarcinoma.

831 Background: Systemic treatment of metastatic appendiceal adenocarcinoma (AA) has been challenging due to a lack of well-established AA chemotherapy regimens and historical reliance on colorectal cancer (CRC) protocols. In the United States, but less commonly in Europe, bevacizumab is frequently incorporated in treatment of AA given its approved use for CRC. However, previously there have been no studies evaluating if there is a survival benefit attributable to bevacizumab in patients with AA. Methods: The Palantir Foundry system was used to extract data from the MD Anderson Cancer Center (MDA) electronic medical record for patients with biopsy-proven AA who received chemotherapy at MDA from 2015 to 2024. Only patients with complete staging and histopathology data were included in the analysis. Results: We identified 203 patients with AA who received chemotherapy at MDA and had complete tumor data. Of these, 43% (n=87) received bevacizumab at some point in their treatment. Patients who received bevacizumab were demographically similar to patients who received non-bevacizumab chemotherapy in terms of age at diagnosis, race, and sex; mucinous histology was more frequent in the bevacizumab cohort (52%, n=45 vs. 39%, n=45 in non-bevacizumab cohort). The 87 patients who received bevacizumab were treated with 1-6 lines of therapy per patient (mean = 1.57). The most frequently used bevacizumab-containing regimens were FOLFOX + bevacizumab (34%, n=46), FOLRIRI + bevacizumab (29%, n=40), 5-FU + bevacizumab (15%, n=21), and atezolizumab + bevacizumab (11%, n=15), with less common irinotecan + bevacizumab, TAS-102 + bevacizumab, and FOLFOXIRI + bevacizumab. Three regimens containing bevacizumab were discontinued due to complications: one instance of hand-foot syndrome attributed to xeloda, one instance of cardiomyopathy attributed to immunotherapy, and one bowel perforation with abdominal wall abscess attributed to bevacizumab. To determine if bevacizumab was associated with overall survival (OS) benefit we performed Kaplan-Meier analysis, with OS calculated from start of first line chemotherapy to death, in patients with metastatic AA who received either 5-FU doublet therapy alone or 5-FU doublet therapy with bevacizumab. Patients who received bevacizumab trended toward better OS (median 52 vs 25 months for doublet therapy alone, HR: 0.53, p= 0.059). The effect of bevacizumab was particularly notable in patients with signet ring cell histology; where bevacizumab use was associated with significantly longer OS (median OS 50 vs 14 months for doublet therapy alone, HR: 0.24, p= 0.034). Conclusions: Bevacizumab is frequently added to cytotoxic chemotherapy in the treatment of AA. These retrospective data suggest an OS benefit to adding bevacizumab to doublet chemotherapy, particularly in the case of signet ring cell histology.

Metabolic Profiles of Critical Care Patients to Confirm Sepsis and Further Understand the Metabolic Phenotype of Sepsis.

Sepsis remains a major concern in health care globally. Despite decades of research, incidence is on the rise, and mortality remains high. Costs are staggering. Additionally, the outdated sepsis bundle established based on SIRS, remains the standard by which providers are held accountable. It is now accepted that organ dysfunction in sepsis is secondary to cellular metabolic dysregulation. Technology for metabolic monitoring should be explored for improved, early recognition of sepsis. We sought to investigate the underlying metabolic profile of patients with sepsis, to determine the value of continuous metabolic monitoring technology. The investigators partnered with industry, to trial noninvasive monitoring of the cellular metabolite carbon dioxide, under a prospective, observational design. During the 6-month trial, the investigators collected data from the electronic medical record of patients using the technology, to determine the specific metabolic differences between patients with and without sepsis. The investigators found serum carbon dioxide (paCO2) was significantly lower in patients with sepsis, and, low paCO2 had a significant inverse relationship to serum lactate. This finding supports the notion that paCO2 is low in sepsis secondary to metabolic dysregulation and not hyperventilation, which had historically explained low paCO2 under the SIRS model. Metabolic monitoring is available, easy to apply and manage, and contributes valuable information in the detection of sepsis. Further research should be done to understand trends in serum CO2 and its relationship to the development of sepsis. This study also provides important further support for the emerging understanding of the dysregulated host response in sepsis.

Treating chronic kidney disease in Danish primary care: results from the observational ATLAS study

ObjectivesTo describe the clinical characteristics, comorbidity, and medical treatment in a primary care population with chronic kidney disease (CKD). Additionally, to investigate how primary care physicians (PCPs) diagnose, manage and treat impaired kidney function, including uptake of cardio-renoprotective renin–angiotensin–aldosterone system inhibitors (RAASis) and sodium glucose co-transporter 2 inhibitors (SGLT2is).DesignAn observational study of CKD prevalence, treatment patterns and comorbidities in primary care based on patient record data combined with a questionnaire on diagnosis, management and treatment of impaired kidney function in a real-world, primary care setting.SettingIn all 128 primary care clinics in Denmark of 211 randomly invited and a quetionnaire completed by 125/128 participating PCPs.MethodsA computerized selection identified 12 random individuals with CKD per clinic with ≥ 2 measurements of eGFR < 60 mL/min/1.73 m2 or UACR > 30 mg/g within two years (N = 1 497). Pre-specified data collected from individual electronic health records included demographics, clinical variables, comorbidities, and relevant prescribed medications.ResultsOf the CKD study population (N = 1 497), 80% had hypertension, 32% diabetes (DM), 13% heart failure (HF), 59% no DM/HF. ACEis/ARBs were prescribed to 65%, statins to 56%, SGTL2is to 14%, and MRAs to 8% of all individuals. Treatment patterns differed between individuals with varying comorbidities, e.g., ACEis/ARBs usage was higher in DM (76%) or HF (74%) vs. no DM/HF (58%), as was statin usage (76% in DM vs. 45% in no DM/HF). SGTL2i usage in no DM/HF was low. Most PCPs identified CKD using eGFR < 60 mL/min/1.73 m2 (62%) or UACR > 30 mg/g (58%) and 62% reported initiating treatment to retard kidney function decline.ConclusionsDespite good PCP awareness and wish to use relevant guidelines, a gap exists in implementation of cardio-renoprotective treatment, especially in individuals without DM/HF. This offers an opportunity for clear recommendations to PCPs to optimize early cardio-renal protection in individuals with CKD.

Evaluation of quantitative EEG markers for predicting outcome after the initial treatment with levetiracetam monotherapy in newly diagnosed epilepsy.

To develop a predictive model for the classification of seizure freedom under first-line monotherapy with levetiracetam in patients with newly diagnosed epilepsy. Clinical data and routine EEG recordings of patients with newly diagnosed epilepsy who were started on a first-line monotherapy with levetiracetam were analyzed retrospectively. EEG had been acquired prior to the initiation of treatment in all patients. Patients who had experienced no further seizures until the last follow-up were labeled as seizure-free. Spectral EEG features (band power, peak power, and peak frequency) and functional connectivity were computed in each patient and, together with clinical data, formed the input features for the classification procedure. The BiMM-forest algorithm was used for classification and 5-fold cross-validation was conducted to evaluate the model performance. Seventy-four patients were analyzed (43 (58.1%) female, 43/74 seizure-free. The mean classification accuracy was 75.5% (95%-CI=46.1-92.4%). The most predictive features for seizure-freedom were increased right frontal delta energy and delta peak energy as well as decreased central delta energy in the first routine EEG. While significant above-chance predictions were not achieved in this study, a promising framework for the classification of treatment response on first-line monotherapy with levetiracetam based on pre-treatment EEG data alone was provided. Although negative, our results show trends that should encourage future, larger studies to develop EEG-based frameworks for the prediction of treatment response under specific anti-seizure medications.

Monitoring of prostate-specific antigen in men with benign prostate enlargement receiving 5-alpha reductase inhibitors: a non-interventional, cross-sectional study of real-world practice of urologists in Spain and Brazil

BackgroundInconsistent monitoring of prostate-specific antigen in patients receiving 5-alpha reductase inhibitors for lower urinary tract symptoms/benign prostate enlargement may affect prostate cancer outcomes. This study evaluated real-world practice among urologists treating patients receiving 5-alpha reductase inhibitors.MethodsThis non-interventional, cross-sectional study collected data from urologists in Spain (N = 100) and Brazil (N = 100) via a self-reporting questionnaire and patient record forms. Endpoints included: frequency/methodology of prostate-specific antigen monitoring, concerns about the effect of 5-alpha reductase inhibitors on prostate-specific antigen monitoring, triggers of prostate biopsy, and concerns when switching 5-alpha reductase inhibitor formulation.ResultsOver half of urologists monitored prostate-specific antigen every 6 months (Spain 59%, Brazil 58%). Preferred methods were the “doubling rule” (Spain 66%, Brazil 41%) and “increase from nadir” (Spain 28%, Brazil 43%). A minority of urologists monitored unadjusted values (Spain 3%, Brazil 11%) or did not monitor prostate-specific antigen (Spain 1%, Brazil 3%). Most urologists ranked the potential for 5-alpha reductase inhibitors to mask prostate cancer as their top concern (Spain 65%, Brazil 56%). The most selected trigger for prostate biopsy was “if doubled (adjusted) prostate-specific antigen level after 6 months of treatment is > 4 ng/mL” (Spain 39%, Brazil 37%). Many urologists were moderately/very concerned about the effect on prostate-specific antigen when switching 5-alpha reductase inhibitor formulation.ConclusionsAn unmet need exists for standard guidance and continuous education to support optimal monitoring and interpretation of prostate-specific antigen in patients with lower urinary tract symptoms/benign prostate enlargement treated with 5-alpha reductase inhibitors.

2886 Video-based patient Records for Supporting Care Delivery for older adults with frailty: the Isla for frailty feasibility study

Abstract Introduction Written documentation and verbal handovers can be ineffective at communicating the specifics of frail, older patients’ complex functional abilities and support needs. Video-recordings of individual patients may help to convey a patient’s condition in a more nuanced, objective way, potentially improving safety at care transitions. The Isla platform interfaces with electronic health record systems, allowing care providers to capture video-recordings during patient care. We evaluated the acceptability, feasibility, and potential effectiveness of video-based patient records (the Isla platform) for supporting the care of older frail inpatients within the acute hospital setting and at care transitions. Method Over a three-month pilot period, a non-randomised, mixed-methods feasibility study of video-based patient records (alongside usual care) was conducted within three elderly medicine wards of a large acute hospital in England. Patient and public involvement and engagement (PPIE) was central to study design and implementation. Participant enrolment figures; semi-structured interview data; and video capture and view metrics were examined within an embedded process evaluation, appraising intervention acceptability among patients, carers, and ward staff; barriers and facilitators to intervention implementation; and perceived intervention impacts. Results The study enrolled 57 ward staff and 29 patients (56.9%); one patient withdrew. Enrolment figures and early interview analyses indicate apparent acceptability of video-based patient records to patients and carers. Intervention barriers (e.g. patient pain), facilitators (e.g. staff-patient rapport) and potential intervention impacts (e.g. improved person-centred care, team communication) were identified. Modal use-cases for video-recordings were to document patients’ transfers (n = 16), mobility (n = 13), and eating/drinking supports (n = 3); however, view metrics suggested limited engagement with videos once captured. Conclusion(s) Preliminary findings indicate the acceptability and feasibility of video-based patient records, although several implementation considerations warrant address. Perceived intervention impacts (e.g. improved person-centred care) were promising; although greater engagement with videos is a probable precondition to demonstrating efficacy in future research.

P-1321. The Infectious Disease Needs of Adult Ukrainian Refugees in a Tertiary Centre in the West of Ireland

Abstract Background Since February 2022 6.5 million have fled Ukraine; 104’ 870 to Ireland (2% of Irish population) [1, 2] The surge in those seeking temporary protection, coupled with infectious disease epidemiology in Ukraine; high prevalence of blood borne viruses and TB has placed strain on host countries' health services. [3, 4] 18 ‘840 (18% of National total, 0.37% of Irish population) are accommodated within our catchment area. The objective of this study was to evaluate case complexity, barriers to access and impact on service by this population. HIV, HCV and HBV prevalence, control and management Methods We performed a retrospective chart review using our electronic patient record, compiled data on a protected spreadsheet and results were collated. Tuberculosis prevalence, susceptibility, site and management Results 123 adult Ukrainian refugees have newly attended our service since February 2022 - April 2024, 2.03 new patients weekly; 63/123 (51.2%) are female. The mean age is 44.7 years (18 - 79). 76 (61.8%) have HIV (PLWH); 68 (89.5%) known diagnoses; 39 (57.3%) of whom were virally suppressed on ART and 27 (40%) were viraemic as a result of treatment interruption, 2 (2.9%) had no blood testing with us. 7 (5.7%) were newly diagnosed following arrival to Ireland; 4 (57%) with advanced disease (mean CD4 Count 285 IU/mL [28 - 753]). Thirty two (42%) PLWH are co-infected with HCV, 4 (5.3%) with HBV. 37 (30%) attended with HCV mono-infection, 9 (7.3%) with HBV mono-infection. 17 PLWH (22.4%) report previously treated TB. We have seen 4 (3.25%) cases of active TB; three of MDR pulmonary disease and results are pending for the fourth case. 4, 10.5% of women living with HIV in this cohort have had pregnancies; 2 (5.3% of WLH) are currently pregnant (both live in Donegal; average 165.6 miles from clinic). The average distance traveled to our clinic is 64.6 miles (Range 0.62 - 189); based on current geographic distribution of the group 50.4% (62/123) can access public transport that would allow them to reach our clinic within 2 hours. There was no significant association between access to public transport and missed clinic appointments (p = 0.64). 115/123 (93.5%) have a need for an interpreter. Since February 2022 26 (21%) have required hospital admission with an average length of stay of 22.9 days and a total of 597 bed days used. Conclusion We have identified significant case complexity and ongoing high ID service need for this cohort. Cohort Demographics Disclosures All Authors: No reported disclosures

Research data volume and quality derived from a specialist disease registry versus routine electronic health records

Objective This study aims to compare data availability and analytic results for patients using matched data items from a dedicated disease registry versus data extracted directly from an electronic patient record (EPR) system and a trusted research environment (TRE). Methods Data from patients enrolled in the National JDM Cohort and Biomarker Study (JDCBS) was compared with routine EPR data from the same patients attending a specialist children’s hospital between 2019-2021. Data from both sources were extracted, de-identified, and analysed within a trusted research environment adhering to NHS security standards. Descriptive statistics, visualizations, and statistical comparisons were performed. Results Of the 688 registry patients in total, 270 attended one specialist hospital with EPR data available. The EPR system yielded 328,527 data points on these patients compared to 40,673 from the registry, including 2-10 fold more data items across data categories. Diagnoses were more numerous in the EPR data, while registry data captured more comprehensive medication records. Laboratory test results were 10 times more frequent in EPR data, including a broader range of test types. Despite higher data volume in EPR, the clinical significance of the additional data points remains uncertain. Conclusion Routine EPR data can effectively replicate much disease registry data with a larger volume of data points, potentially offering additional analytical possibilities. However, specific targeted registry data collection remains valuable for certain data elements. A hybrid approach, utilizing both routine EPR data and focused registry collection, could optimise healthcare research by reducing costs and avoiding duplication.

BHSeP40 Robotic complex abdominal wall reconstruction is safe and cost-effective: analysis of introduction of robotic AWR to an NHS practice

Abstract Introduction Robotic assisted surgery is the latest advance in minimally invasive surgery, combining abdominal wall reconstruction and restoration of functional anatomy with reduced wound morbidity and recovery time. The aim of this article is to review the cost of robotic (rAWR) vs open abdominal wall reconstruction (oAWR), for complex hernias. Method We reviewed a prospective database of all AWR conducted since the start of performing rAWR. We collected data from the electronic patient record including demographics, theatre times, length of stay, length of planned/unplanned admission to HDU, ASA, Charleson-comorbidity index, primary vs recurrent hernia repair, complications, and mortality. All patients were followed-up for 30days post-op via the electronic record for complications and re-admissions. Results We collected data of 46 cases (28 robotic, 18 open). Median LOS was rAWR 1.5 days, oAWR 6.5 days. There were no incidences of mortality in either group in the 30 days of follow-up. There was one incidence of conversion to open from rAWR. For our cohort, the rAWR was £2123.14 cheaper per case than oAWR. This is due to savings in length of stay, reduced PCA usage, shorter and less complex anaesthesia. This per-procedure saving represents a significant cost saving, helping to offset the cost of the robotic system. Conclusion This is real-world data of the successful introduction of complex robotic AWR to NHS practice. Robotic cAWR is safe and cost saving and significantly reduces length of stay.

Transforming Patient Complaints: Strategic Layout and Operational Processes Enhancements at Pharmacy Unit

Hospital, as a healthcare provider, consists of various interrelated service units. Pharmaceutical services for outpatient, inpatient, and operating room are provided by the pharmacy units and they need good operational management to maintain the speed of service. However, with the increasing number of patients, there has been a drastic decline in pharmacy service speed, leading to a rise in patient complaints and a decrease in patient satisfaction index, which, if unaddressed, may result in patient loss. This study measured the impact of changes in room layout, workflow improvements, pharmacy unit manpower productivity, and alteration of drug packaging on complaint numbers and satisfaction index of the patients at Primaya Hospital Semarang. A Likert scale questionnaire was to assess patient satisfaction and record complaints received via WhatsApp, Google Reviews, email, Instagram, or directly to the customer service unit. The measurements were taken before the intervention and after implementation of the changes. The implementation of these four operational interventions decreased significantly the complaint numbers over time accompanied by an increase in patient satisfaction index.

The Parkinson’s Puzzle: Early Detection &amp; Diagnosis

Parkinson's disease is a neurological disorder that affects movement and becomes progressively worse over time. Currently, there is no cure for the disease, but early detection and appropriate management can significantly improve the patient's quality of life. This project presents a web-based application designed to detect Parkinson's disease based on the analysis of audio recordings of patient's voices. The application utilizes a machine learning model that has been trained on a dataset consisting of audio recordings from both Parkinson's disease patients and healthy individuals. The web application extracts relevant features from the audio recordings, employing machine learning algorithms to predict the probability of Parkinson's disease. The machine learning models used in this research are Logistic Regression, Linear Discriminant Analysis, K-Neighbors Classifier, MLP Classifier, Gaussian NB, XGB Classifier, Random Forest Classifier, and Cat Boost Classifier and stacked three models (XG Boost, Random Forest, and Cat Boost) using Stacking CV Classifier out of which the model with the highest performance will be chosen to develop the web application. Keywords: Parkinson’s Disease, Web Application, Ensemble Learning, Stacked Model

P1078 Weight-loss medications and bariatric surgery are infrequently used in obese patients with inflammatory bowel disease in North and East Devon in the United Kingdom (UK)

Abstract Background Obesity is increasingly prevalent in patients with IBD and has been linked to non-response to medical therapies and disease progression. In the last decade the management of obesity in the general population has undergone a paradigm shift following the widespread use of medical therapies and bariatric surgery. Few studies have assessed weight loss strategies used by obese patients with IBD. Methods We designed a Patient and Public Involvement and Engagement survey to assess past use and future interest in interventions for obesity. We also sought interest in a trial of a licensed weight loss medication as an adjunct to conventional IBD therapy. We used the MyChart application in our electronic patient record (EPIC) to distribute our questionnaire between 6th and 18th November 2024. The response rate was 31% (828/2700): 40.0% [322/828], 52.9% [426/828], 7.1% [57/828] patients were diagnosed with Crohn’s disease, UC and IBDU, respectively. Body mass indices were available in 97% (807/828) patients. Results The median [IQR] age was 54.0 (41.0 - 65.0) years, 58.5% (484/828) were female and 92.8% [768/828] were of white European ancestry. Overall, 29.0% (234/807) were overweight and 25.0% (202/807) were obese. 30.7% (254/828) were eligible for a medication for weight management, by having a BMI ≥30 kg/m2 or a BMI ≥27 kg/m2 in addition to one or more weight-related comorbidity. Amongst these patients prior experience with weight loss strategies included: 51.6% (131/254) self-directed dieting; 33.9% (86/254) calorie counting using a smartphone app; 38.2% (97/254) had attended a weight-loss group; 16.1% (41/254) had had advice from a dietician; 2.8% (7/254) had taken part in a formal exercise program; 5.9% (15/254) had used weight loss medications [6 orlistat, 14 GLP-1 agonist] and 1.6% (4/254) had had bariatric surgery. Of 14 patients treated with a GLP-1 agonist, 5 and 9 were prescribed by public and private healthcare professionals respectively. Amongst patients eligible for pharmacological treatment: 11.4% (29/254) expressed interest in future group-based support; 30.8% (78/254) in a formal exercise program; 37.4% (95/254) advice from a dietitian; 43.3% (110/254) drug treatment and 11.4% (29/254) endoscopic or surgical weight loss procedures. 72.8% (185/254) of patients expressed interest in participating in a trial of a licensed weight loss medication as an adjunct to conventional IBD treatment. Conclusion Obese patients living with IBD want access to weight loss interventions. However, previous use of weight loss medications was uncommon and usually accessed through private healthcare. Three quarters of obese patients expressed an interest in a trial of a licensed weight loss medication as an adjunct to conventional IBD therapy.

A new score for predicting intracranial hemorrhage in patients using anticoagulant drugs

ObjectivesThe use of anticoagulants in patients increases the risk of intracranial hemorrhage (ICH). Our aim was to identify factors associated with cerebral hemorrhage in patients using anticoagulants and to develop a predictive model that would provide an effective tool for the clinical assessment of cerebral hemorrhage.MethodsIn our study, indications for patients receiving anticoagulation included AF, VTE, stroke/TIA, arteriosclerosis, peripheral vascular diseases (PVD), prosthetic mechanical valve replacement, etc. Data were obtained from the patient record hospitalization system. Logistic regression, area under the curve (AUC), and bar graphs were used to build predictive models in the development cohort. The models were internally validated, analytically characterized, and calibrated using AUC, calibration curves, and the Hosmer-Lemeshow test.ResultsThis single-center retrospective study included 617 patients treated with anticoagulants. Multifactorial analysis showed that male, leukoaraiosis, high risk of falls, APTT ≥ 45.4 s, and FIB ≥ 4.2 g/L were independent risk factors for cerebral hemorrhage, and β-blockers were protective factors. The model was constructed using these six factors with an AUC value of 0.883. In the validation cohort, the model had good discriminatory power (AUC = 0.801) and calibration power. Five-fold cross-validation showed Kappa of 0.483.ConclusionPredictive models based on a patient’s medical record hospitalization system can be used to identify patients at risk for cerebral hemorrhage. Identifying people at risk can provide proactive interventions for patients.

P1161 Effects of janus-kinase inhibitor therapy on lipid parameters in patients with IBD

Abstract Background Janus-kinase (JAK) inhibitors are an oral, small molecule therapy used in the management of a range of inflammatory conditions and are associated with lipid profile changes (1-4). We evaluated whether our centre was following recommended lipid monitoring as well as the proportion and magnitude of lipid abnormalities detected. Methods We retrospectively collected data from all 244 patients with Inflammatory Bowel Disease (IBD) who were commenced on a JAK inhibitor, from November 2018 to January 2024, in our centre. Data was collected from our centre’s pharmacy database and the hospital’s electronic patient record. We assessed whether a baseline lipid profile was measured prior to initiating therapy and whether this was re-checked within 12 weeks of initiating therapy, as per industry recommendations. Changes in lipid parameters following therapy initiation – total cholesterol (TC) and non-HDL cholesterol (non-HDL-C) – were calculated. Where applicable, changes following the transition from a higher loading drug dose to a lower maintenance dose were quantified. Rates of initiation of lipid-lowering pharmacotherapy were also calculated. Results 117, 76 and 51 patients were initiated on tofacitinib, filgotinib and upadacitinib respectively, with 55%, 100% and 100% of patients having had their baseline lipid profile checked prior to commencing therapy. 30%, 86% and 82% of patients had their lipid parameters re-checked within 3 months of starting therapy. The average change in TC (mmol/L) was -0.22, 0.24, and 0.50 for tofacitinib (n=23), filgotinib (n=65) and Upadacitinib (n=42) respectively, and the average change in non-HDL-C (mmol/L) was -0.13, 0.06 and 0.32, respectively (Fig 1). Of the patients with an abnormal lipid profile whilst receiving either tofacitinib or upadacitinib, both of which necessitate a higher induction dosing, the average subsequent decrease in TC (mmol/L) was 0.33 and 0.24 for patients receiving tofacitinib (n=12) and upadacitinib (n=11), respectively, and the average decrease in non-HDL-C was 0.40 and 0.29, respectively (median at 5 months, range 1-18 months following first abnormal lipid profile check on therapy). For filgotinib (n=27), which has stable dosing, the average decrease in TC and non-HDL-C was 0.01 and 0.05, respectively. Statin therapy was commenced in 4/117 (3%), 2/76 (3%) and 4/51 (4%) of patients commenced on tofacitinib, filgotininb and upadacitanib, respectively, with the average reduction in TC (mmol/L) being 3.14, 1.60 and 2.00, respectively. Conclusion Increases in lipid parameters following the initiation of JAK inhibitor therapy in IBD patients appear to be modest, partially reversible on switching to maintenance dosing and responsive to statin therapy.

Review of practices concerning the delivery of an international implant card following the implantation of a medical device.

The European regulation 2017/745 requires the delivery of an international implant card to the patient following the implantation of implantable medical devices (IMD). Currently, there are no procedure to describe the process for providing traceability documents to patients in our institution. The objective of this work was to evaluate the practices of the various departments concerned in our institution and to think about actions to meet the current regulation. The evaluation of practices concerning the delivery of traceability documents to patients was evaluated through a questionnaire with 13 departments. Then, for each specialty, three Electronic Patient Record (EPR) were audited. Finally, IMD's suppliers were asked about their ability to provide an international implant card. 85% (11/13) of the departments sent an IMD traceability document to patients, and in 91% (10/11) of cases, this transmission was done with the international implant card or the operative report. However, 63% of the operative report analyzed did not contain the traceability data of the IMD. Finally, only 60% of the suppliers contactes accompanied their IMD with an international implant card. While waiting for the suppliers to send an international implant card, it was proposed to the departments to give patients the IMD traceability sheet from the IMD traceability software. However, this document does not allow us to be in full compliance with the European regulation to the absence of regulatory information (UDI), address and manufacturer's website).

Arthroscopic Removal of Traumatic Fractures of the Proximal Medial Trochlear Ridge of the Talus: A Retrospective Analysis of 18 Horses.

The objectives of this study were (1) to evaluate the need for flexed radiographs of the proximal medial trochlear ridge (PMTR) after trauma involving medial tarsus; (2) to evaluate outcome following arthroscopic removal of traumatic osteochondral fragments (TOCF) resulting from direct injury to PMTR. Records of patients with wounds to the medial tarsus were searched and those with TOCF of the PMTR included. Patient history, fracture etiology, preoperative diagnostics, and intraoperative findings were documented. Postoperative performance data were collected using Thoroughbred Racing database or a telephone questionnaire. All cases had wounds with concurrent synovial sepsis of the tarsocrural joint. Standard weight-bearing radiographs were performed preoperatively (n = 15), but most (n = 13) failed to identify PMTR pathology. When acquired (n = 8), flexed radiographs (including a uniquely described flexed plantaroproximolateral dorsodistomedial Pl30Pr45Lat-DoDiM oblique) identified PMTR lesions. PMTR TOCF were removed during the initial surgery (n = 15) or subsequent (n = 3) arthroscopy, performed due to unresolved synovial sepsis. Fifteen out of 16 horses with >6-month follow-up resumed full exercise. Flexed tarsal radiographs should be performed as part of a standard protocol for traumatic wounds involving the medial tarsus. Horses had excellent prognosis following arthroscopic removal of TOCF of the PMTR. Failure to recognize and remove TOCF resulted in refractory synovial sepsis for horses in this study.

Pneumococcal and Herpes Zoster Vaccination Rates Among U.S. Veterans With Chronic Inflammatory Disease on Biologic Medications: A Quality Improvement Project.

Patients with chronic inflammatory diseases are often treated with pharmacologic therapies that target the immune system and have an increased risk of infection. These risks can be reduced by vaccination against common pathogens. This quality improvement project aimed to increase pneumococcal and herpes zoster vaccination rates in patients with chronic inflammatory disease on biologic immunosuppressive therapy. This quality improvement project was developed and implemented at the Veteran Affairs (VA) hospital in Memphis, TN. A VA data warehouse query was used to identify veterans with an active prescription for a biologic immunosuppressant over 2 phases (phase 1 and phase 2) of the project. Clinical pathway and VA electronic medical record, e.g., Computerized Patient Record System order set for various biological agents and vaccines, were developed by the investigators over a period of 3 months before the activation of phase 1 and was approved by the Memphis VA Medical Center Pharmacy and Therapeutics Committee. The pathway and the order set were developed for providers prescribing biologic therapies to include a review of patient immunization status and the option to order vaccines before initiation of biologics. When a provider used the order set to order the biologic, the appropriate vaccine and laboratory tests were recommended on the order set to educate the provider to take the appropriate actions necessary before the medication was started. Charts of Veterans included in the study were reviewed to assess vaccination rates before and after the QI project implementation for each phase. Phase 1 occurred over a 1-year period (October 2018 to October 2019) and sought to increase pneumococcal vaccination (PV) rates in patients on biologic therapies compared to the preintervention period. Recombinant zoster vaccine was not included in this phase as it was not readily available at the Memphis VA Medical Center at that time. Phase 2 (November 2019 to April 2022) sought to increase pneumococcal and herpes zoster vaccination rates. During phase 1, pneumococcal vaccination rates improved from a 41% preintervention rate to 66% (P < .01). During phase 2, 73% of patients completed their pneumococcal vaccination series and 58% received PCV13, PPSV23 and at least 1 dose of Shingrix, compared to 30% in the preintervention period (P < .01). Provider education, clinical pathway, and Computerized Patient Record System order set can improve vaccination rates in patients with chronic inflammatory diseases on biologic immunosuppressive therapy.

Perspectives on which health settings geriatricians should staff: a qualitative study of patients, care providers and health administrators

BackgroundWith a shortage of geriatricians and an aging population, strategies are needed to optimise the distribution of geriatricians across different healthcare settings (acute care, rehabilitation and community clinics). The perspectives of knowledge users on staffing geriatricians in different healthcare settings are unknown. We aimed to understand the acceptability and feasibility (including barriers and facilitators) of implementing a geriatrician-led comprehensive geriatric assessment (CGA) in acute care, rehabilitation, and community clinic settings.MethodsA qualitative description approach was used to explore the experience of those implementing (administrative staff), providing (healthcare providers), and receiving (patients/family caregivers) a geriatrician-led CGA in acute care, rehabilitation and community settings. Semi-structured interviews were conducted in Toronto, Canada. The theoretical domains framework and consolidated framework for implementation research informed the interview guide development. Analysis was conducted using a thematic approach.ResultsOf the 27 participants (8 patients/caregivers, 9 physicians, 10 administrators), the mean age was 53 years and 14 participants (52%) identified as a woman (13 [48%] identified as a man). CGAs were generally perceived as acceptable but there was a divergence in opinion about which healthcare setting was most important for geriatricians to staff. Acute care was reported to be most important by some because no other care provider has the intersection of acute medicine skills with geriatric training. Others reported that community clinics were most important to manage geriatric syndromes before hospitalization was necessary. The rehabilitation setting appeared to be viewed as important but as a secondary setting. Facilitators to implementing a geriatrician-led CGA included (i) a multidisciplinary team, (ii) better integration with primary care, (iii) a good electronic patient record system, and (iv) innovative ways to identify patients most in need of a CGA. Barriers to implementing a geriatrician-led CGA included (i) lack of resources or administrative support, (ii) limited team building, and (iii) consultative model where recommendations were made but not implemented.ConclusionsOverall, participants found CGAs acceptable yet had different preferences of which setting to prioritise staffing if there was a shortage of geriatricians. The main barriers to implementing the geriatrician-led CGA related to lack of resources.Clinical trial numberNot applicable.

An algorithm for identifying causes of reoperations after orthopedic fracture surgery in health administrative data: a diagnostic accuracy study using the Danish National Patient Register.

Disease- or procedure-specific registers offer valuable information but are costly and often inaccurate regarding outcome measures. Alternatively, automatically collected data from administrative systems could be a solution, given their high completeness. Our primary aim was to validate a method for identifying secondary surgical procedures (reoperations) in the Danish National Patient Register (DNPR) within the first year following primary fracture surgery. The secondary aim was to evaluate the accuracy of the diagnosis and procedure codes used to determine the causes of these reoperations. Finally, we developed algorithms to enhance precision in identifying the reasons for reoperations. In a national cohort of 11,551 patients with primary fracture surgery, reoperations were identified through subsequent surgical procedure codes in the DNPR. Each patient record was reviewed to confirm the reoperations and causes. To improve accuracy, a stepwise algorithm was developed for each cause. We identified 2,347 possible reoperations; 2,212 were validated as true reoperations by review of patient record, i.e., a 94% positive predictive value (PPV). However, the coding for the causes of these reoperations was inaccurate. Our algorithm identified major reoperations with a sensitivity/PPV of 89/77%, minor reoperations 99%/89%, infections 77/85%, nonunion 82/56%, early re-osteosynthesis 90/75%, and secondary arthroplasties 95/87%. While the overall reported reoperations in the DNPR had a high PPV, the predefined diagnosis and procedure codes alone were not sufficient to accurately determine the causes of these reoperations. An algorithm was developed for this purpose, yielding acceptable results for all causes except nonunion.