Patient Medical Record Research Articles

Implications of Personal Data Protection Law in Consumer Health Data Management to Improve Secure and Confidential Handling in Indonesia

The purpose of this study is to understand the impact of the implementation of the Personal Data Protection Law (PDP Law) on the management of consumer health data in Indonesia, with a focus on enhancing secure and confidential handling. In the midst of the rapidly evolving digitalisation era, the management of personal data, especially those related to health information, requires strict and effective legal regulation. This is becoming increasingly urgent given the increasing incidents of data leaks and privacy violations, one of which occurred in the leak of the Indonesian Ministry of Health's server which collected 6 million patient medical record data. The research method used is normative juridical with a conceptual approach and a statutory approach, where secondary data is broken down into three different types of legal materials, namely primary, secondary, and tertiary legal materials. The PDP Law and Consumer Protection Law are the primary legal sources, accompanied by the use of relevant literature as secondary legal sources as well as dictionaries and encyclopedias as tertiary legal materials to further explain. The novelty of this research lies in the comprehensive analysis of the existing regulations and their applicability in the health context, as well as considering the increasing public awareness of their rights to personal data. The results show that although challenges such as uneven technological infrastructure and lack of awareness among health staff still exist, the measures taken through the PDP Law have created a strong foundation for better health data protection in the future, improving security and confidentiality in health data management.

Differences in Symptom Burden in Primary Brain Tumor Patients Based on Sex, Race, and Ethnicity: a Single-Center Retrospective Study.

Symptom burden affects quality of life and prognosis in primary brain tumor (PBT) patients. Knowing whether symptom burden varies based on sex, race, or ethnicity may affect the interpretation of the relationship between symptoms and survival may reveal issues with applying the tools to measure symptom burden to different groups and may identify inequities in symptom management that need to be addressed at a system level. To determine whether symptoms in PBT patients vary across demographic groups, we conducted a retrospective chart review of symptom burden collected as part of routine care in a diverse population. Patient demographics and scores on the MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT) module were extracted from the electronic medical record for patients seen in the Inova Neuro-oncology Clinic between March 2021 and June 2022. MDASI-BT scores were compared based on side of tumor, sex, race, and ethnicity for the entire population and for the subset with gliomas. We included 125 people, of whom 85 had gliomas. For both the entire group and the subgroup with gliomas, about 40% were female and about 40% were non-White race. No differences in symptom burden were seen between males and females. Pain and numbness/tingling symptom burden were higher in both the entire population and the glioma subgroup for people of Hispanic/Latino/Spanish ethnicity and for people of races other than White or Middle Eastern self-identification. Pain, weakness, and numbness/tingling varied significantly across racial and ethnic groups. Further research is needed to validate this finding in other populations and determine its cause.

Appropriateness of antibiotic prescribing among patients treated for dental diseases in Mekelle city, Northern Ethiopia: a cross sectional study

BackgroundLocal operative treatments are generally preferred for most dental diseases, with antibiotics only recommended as an adjunct in specific cases. Misuse and overuse of antibiotics has been shown to significantly contribute to the development of resistant bacteria. However, the antibiotic prescribing practices of dentists in Ethiopia have not been thoroughly studied. This study aimed to assess the appropriateness of antibiotic prescribing for patients with dental diseases at dental clinics in Mekelle City, Northern Ethiopia.MethodsA cross sectional study was conducted in April and May 2020 among patients visiting dental clinics in Mekelle City. Data were collected through patient medical record reviews and dentist interviews. The appropriateness of antibiotic prescription was evaluated based on guidelines from the American Dental Association and the European Society of Endodontology. Data were analyzed using SPSS Statistics, version 29. Binary logistic regression analysis was performed, and the results were presented as odds ratios with 95% confidence intervals. A p value less than 0.05 was considered statistically significant.ResultsTwo hundred and thirty-one patients with dental diseases participated in the study. The mean age was 30.6 years with a standard deviation of 16.1. Most participants had dental pulp related disease. 89% of patients were prescribed antibiotics, with amoxicillin being the most common. Inappropriate antibiotic prescribing was identified in 175 (75.8%) of the study participants. The most common inappropriate prescribing was unnecessary antibiotic prescribing for dental conditions without systemic signs, assessed in 141 (80.1%) participants. Patients diagnosed with pulp related disease without systemic signs and those who had tooth extractions were significantly associated with inappropriate antibiotic prescription (p value < 0.001).ConclusionsThe study findings show that antibiotics are over-prescribed for dental conditions in this resource constrained setting, especially in patients who have had tooth extractions. Dentists need training on appropriate antibiotic use and antimicrobial stewardship interventions should be implemented in dental setting to reduce unnecessary antibiotic prescriptions and prevent antibiotic resistance development.

Tinjauan Ketepatan Pengkodean Penyakit pada Rekam Medis Pasien di Rumah Sakit Tk. III Dr. R. Soeharsono Banjarmasin

Medical recorders in assigning disease codes appropriately according to the classification applied in Indonesia use the International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10) guidelines on diseases and medical actions in health services and management so that there are no errors in determining disease diagnoses and actions to be taken to patients. Determination of the diagnosis of the disease and the actions that will be taken to the patient. Based on preliminary studies conducted at the Tk. III Dr. R. Soeharsono Banjarmasin Hospital in January 2023, it was found that there were still incompletely written disease diagnoses and incorrect disease diagnosis codes with ICD-10. The purpose of this study was to determine the completeness of the writing of disease diagnoses and the accuracy of disease coding in patient medical records. This type of research is descriptive quantitative. The research design used a cross sectional approach. Sampling was carried out using purposive sampling method based on the number of patient medical records on January 2 - January 28, 2023 and obtained 96 patient medical records. Data collection methods using observation and questionnaires. The conclusion is that in 96 patient medical record files at the Tk. III Dr. R. Soeharsono Banjarmasin Hospital there are 12 incomplete diagnoses filled in and there are 3 incorrect disease diagnosis codes, the cause is because the diagnosis coder has never attended training related to coding competence.

Association between Fat Intake, Dietary Fiber Intake, Physical Activity with Triglyceride Levels among Type 2 Diabetes Mellitus Patients at Grogol Health Center, Sukoharjo

Background: Hyperlipidemia is closely associated with dietary intake and physical activity. Excessive dietary fat intake, inadequate dietary fiber, and low physical activity will increase the risk of obesity and lipid profile disorder among type 2 diabetics. Objectives: This study aimed to identify the association between fat intake, dietary fiber intake, and physical activity with triglyceride levels among type 2 diabetics. Methods: A cross-sectional study was conducted using Sequential Random Sampling on 31 patients with type 2 diabetes with dyslipidemia from Grogol Community Health Center, Sukoharjo, in March 2023. The 3x24-hour food recall nonconsecutive days was used to collect data on fat and fiber intake, the International Physical Activity Questionnaire-Short Form (IPAQ-SF) was employed to obtain physical activity data, and the patient's medical record for the last month was utilized to obtain fasting blood sugar and triglyceride levels. The statistical test was carried out using the Spearman Rank correlation test. Results: Around 54.8% of subjects had excessive fat intake (60.90 g/day); 96.8% of subjects had severe deficit fiber intake (9.74 g/day); 51.6% of subjects had low physical activity (894.74 METs/minute/week). A statistically significant association exists between fat intake and level of triglyceride (p=0.005; r=0.493), but there was no significant association between dietary fiber intake and triglyceride levels (p=0.897; r=0.024), and there was no significant association between physical activity and level of triglyceride (p=0.394; r=-0.159). Conclusions: There is a significant association between fat intake and the level of triglyceride. As such, it is necessary to decrease intakes of saturated fat and trans fatty acids; replacing them with unsaturated fatty acids could be beneficial in lowering triglyceride levels.

Analysis of Factors Inhibiting the Implementation of Patient Medical Record Retention and Destruction Activities at Waluyo Jati Hospital

Retention and destruction of medical record documents is a management aspect in health archives to reduce files that have been stored on the filling rack for a long time. This study aims to analyze the factors that hinder the implementation of retention and destruction of medical record documents at RSUD Waluyo Jati. Qualitative descriptive method was used to analyze these factors with data collection using the 5M approach. The results showed that the main obstacles were the lack of D3 Medical Record graduates and the lack of training related to document retention and destruction. RSUD Waluyo Jati does not have an SPO (Standard Operating Procedure) related to retention and planning document retention and destruction schedules and still uses the old ICU room to store inactive documents. Other problems include the lack of shredding and file transfer equipment, and the absence of a dedicated budget for these activities. The conclusion of this study emphasizes the importance of implementing retention and destruction of medical record documents in managing efficient archives. As a solution, efforts such as increased education and training for staff, the development of comprehensive SOPs, planning document retention schedules, improving infrastructure, collaboration with third parties, and proper budget allocation are needed to ensure the effectiveness of the medical record retention and destruction process.

MEGACÓLON PSICOGÊNICO EM PACIENTE PORTADOR DO TRANSTORNO DO ESPECTRO AUTISTA: UM RELATO DE CASO

Introduction: Psychogenic megacolon (PM) is a rare dysfunction usually found during childhood. This condition is characterized as an abnormal and irreversible dilation of the intestinal colon of psychogenic etiology, that is, such motility disorder is linked to some emotional disorder. A full understanding of this disorder is still a long way off due to its scarce description in the medical literature, however, authors such as Liu et al (2019) define it as a persistent dilation of the colon in the absence of any underlying organic or physiological causes, highlighting its diagnosis as purely eliminatory due to its symptomatic similarity with congenital megacolon (Hirschprung's disease). Objectives: The following case report aims at a retrospective and cross-sectional study, arising from the analysis of the patient's medical records, in order to lay scientific foundations for future research addressing the thematic axis of MP in conjunction with the development of new, more effective therapeutic proposals for the disease. Methods: The data provided in this study were obtained from the active collection of information from the patient's medical record, analyzed in line with others extracted from an interview with the person responsible, however, a literature review was carried out using data platforms as sources of good origin such as Scielo Platform, Google Scholar and PubMed. Results: The case describes a 3-year-old male patient, diagnosed with autism spectrum disorder (ASD) and with a history of previous hospitalizations related to urinary tract infection (UTI) and médium acute otitis (MAO). In the current history, the patient was admitted due to an acute infectious condition unrelated to MP, however, a distended and painless abdomen was found with increased peristalsis with decreased frequency of bowel movements and the presence of a large fecal cake. via ultrasound, with the diagnosis of megacolon, the clinic was related to the diagnosis of ASD and the patient's difficulty in adapting to the hospital environment, making the hypothesis of MP very likely. Conclusion: The report above describes a highly suggestive picture for MP, while this study seeks to raise the hypothesis of its correlation with ASD, while this neurodevelopmental disorder can influence the bowel habits of those patients historically included within the age group conducive to the manifestation of this disease.

A new form of the medical record of a patient receiving medical care in inpatient conditions, in a day hospital as a criterion for the quality and safety of medical activity

Objective: to conduct a comparative analysis of the previously valid “Card” with a new form of “Card” filled in for patients receiving medical care in a hospital setting with the focus of the attention of practitioners on the new paragraphs of this document.Materials and methods: a comparative analysis of the medical record of an inpatient patient approved by the order of the Ministry of Health of the USSR dated October 4, 1980 was carried out. No. 1030 “On Approval of Forms of primary Medical Documentation of healthcare institutions” and the Medical record of a patient receiving medical care in inpatient conditions, in a Day hospital, approved by the Order of the Ministry of Health of the Russian Federation dated August 5, 2022 No. 530n “On Approval of Unified Forms of medical documentation used in medical organizations providing medical care in inpatient conditions, in the conditions of the day hospital and the procedures for their management”.Results: based on the results of the study of two forms of “Cards”, the advantages of the new form have been established, which improve the quality of medical documentation and, as a result, taking into account the fact that the ECMP is carried out according to medical documentation, lead to a reduction in the risks of imposing financial sanctions on medical organizations during the relevant examinations. In particular, a number of shortcomings of the new form of the “Map” are indicated, requiring additional study and discussion with possible additions in the future.Conclusions: the relevance of the examination of the quality of medical care, which, as a rule, is carried out according to the medical documentation of completed cases, is reflected. It is noted that the correct filling in of all the provided graphs and lines will minimize the number of defects in the registration of medical documentation, which in turn will reduce the financial sanctions imposed on medical organizations during the ECMP.

SOCIALIZATION OF THE ACCURACY REGARDING THE CALCULATION OF RECAPITULATION FOR INPATIENTS BASED ON AGE, DISEASE AND GENDER AT CHARIS MEDIKA HOSPITAL

A hospital is one of the subsystems of health services that organizes two types of services for the community, namely health services and administrative services. Health services include medical services, medical rehabilitation and care services. Every health service or hospital should be proud if every patient who visits continues to increase, the increase in patients can be seen from the changes in the existing graph of the number of patient visits. The number of patient visits that continues to increase greatly affects the smooth running of each health service, because patients who often visit have high trust in the health service they visit. The number of visits for inpatients for postpartum care based on age, disease, and gender is 115 visits, the number of visits for care patients based on age, disease, and gender is 37 visits. It can be concluded that medical records officers should write down inpatient data completely and clearly in the register book, good communication between medical records officers and doctors treating patients should be good so that the diagnosis written by the doctor in the patient's medical record is easy to read.

Predicting whether patients in an acute medical unit are physiologically fit-for-discharge using machine learning: A proof-of-concept

IntroductionDelays in discharging patients from Acute Medical Units hamper patient flows throughout the hospital. The decision to discharge a patient is mainly based on the patients’ physiological condition, but may vary between physicians. An objective decision-support system based on patients’ physiological data may help minimizing unnecessary delays in discharge. The aim of this proof-of-concept study is to assess the feasibility of predicting whether patients in an Acute Medical Unit are physiologically fit-for-discharge using machine learning with commonly available hospital data. Furthermore, this study investigated how long before actual time of discharge from the Acute Medical Unit we could predict discharge fitness. Also, the predictive importance of features extracted from these data was assessed. MethodsElectronic Medical Records of patients who participated in a Randomized Controlled Trial conducted in an Acute Medical Unit were used retrospectively (N = 199). Only commonly available hospital data were used. Logistic Regression and Random Forest models were applied to predict every hour whether patients were physiologically fit-for-discharge. Nested 5-fold cross-validation with 5 repeats was used to optimize the model hyperparameters and to estimate the predictive performances. ResultsPhysiological discharge fitness was predictable with reasonable performance for Logistic Regression (mean AUROC: 0.67) and Random Forest (mean AUROC: 0.69). For an intuitively chosen classification threshold of 0.8, mean specificity was 93.3 % and sensitivity 14.1 %. Models could predict physiological discharge fitness more than 24 h earlier than actual time of discharge for most patients who were correctly predicted to be fit-for-discharge. Patient characteristics, vital signs and laboratory results were shown to be important predictors. ConclusionThis proof-of-concept study showed that it is feasible to predict with machine learning whether patients in an Acute Medical Unit are physiologically fit-for-discharge using commonly available hospital data.

Clinical Manifestation and Multidisciplinary Treatment Approaches for Primary Tracheal Carcinoma in Bangladesh: A Clinical and Therapeutic Review of 13 Patients.

Primary tracheal carcinoma is an exceptionally rare and life-threatening disease that presents significant diagnostic and therapeutic challenges. Delayed diagnosis due to misinterpretation of airway obstruction symptoms often leads to poorer prognoses for patients. This study aimed to explore the clinical manifestations and multidisciplinary treatment approaches for primary tracheal carcinoma in Bangladesh, with a focus on recent advancements in diagnosis and treatment. A retrospective observational study was conducted at Bangladesh Specialized Hospital Limited, involving patients aged over 30 who were diagnosed with tracheal carcinoma and underwent multidisiplinary treatment from July 2018 to June 2019. Data were collected through patient interviews and medical record reviews. Descriptive and inferential statistical analyses were performed to examine demographic characteristics, histological variations, tumor locations, clinical signs and symptoms, treatment approaches, and outcomes. The study illuminated varied clinical presentations and the successful application of multidisciplinary approaches among the 13 patients. Invasive squamous cell carcinoma and adenoid cystic carcinoma were the predominant histological subtypes. Symptomatology, including dyspnea, cough, and hemoptysis, highlighted the challenge of early detection. Despite the rarity and intricacies associated with primary tracheal carcinoma, the multidisciplinary strategy yielded generally positive outcomes, as evidenced by a 1-year survival rate of 92.31% and a 5-year survival rate of 76.92%. Kaplan-Meier survival curves underscored the superior efficacy of surgical interventions over non-surgical approaches. Despite some limitations, this study contributes crucial insights into the nuanced management of primary tracheal carcinoma in the Bangladeshi context. The demonstrated success of the multidisciplinary strategy, especially surgical interventions, accentuates the importance of definitive resection. The lone case of local recurrence emphasizes the necessity for vigilant follow-up.

The use of genetic algorithm and particle swarm optimization on tiered feature selection method in machine learning-based coronary heart disease diagnosis system

Coronary heart disease (CHD) is a leading global cause of death. Early detection is the right step to reduce mortality rates and treatment costs. Early detection can be developed using machine learning by utilizing patient medical record datasets. Unfortunately, this dataset has excessive features which can reduce machine learning performance. For this reason, it is necessary to reduce the number of redundant features and irrelevant data to improve machine learning performance. Therefore, this research proposes a tiered of feature selection model with genetic algorithm (GA) and particle swarm optimization (PSO) to improve the performance of the diagnosis model. The feature selection model is evaluated using parameters derived from the confusion matrix and using the CatBoost machine learning algorithm. Model testing uses z-Alizadeh Sani, Cleveland, Statlog, and Hungarian datasets. The best results for this model were obtained on the z-Alizadeh Sani dataset with 6 selected features from 54 features and the resulting performance for accuracy parameters was 99.32%, specificity 98.57%, sensitivity 100.00%, area under the curve (AUC) 99.28%, and F1-Score 99.37%. The proposed feature selection model is able to provide machine learning performance in the very good category. The diagnostic model proposed is of excellent standard.

Studi Penggunaan Obat pada Pasien Gastroesophageal Reflux Disease (GERD) Rawat Jalan di RS. Aura Syifa Kediri Periode Januari - November 2022

Background: Gastroesophageal Reflux Disease (GERD) is a pathological condition caused by reflux of contents from the stomach entering the esophagus, with various signs and symptoms involving the esophagus, pharynx, larynx and airway. Gastroesophageal Reflux Disease (GERD) has typical symptoms of heartburn and regurgitation. So that the symptoms that appear will interfere with all activities carried out by someone. Objective: This study is to determine the profile picture of drug use in outpatient Gastroesophageal Reflux Disease (GERD) patients at Aura Syifa Hospital Kediri and to determine the study of drug use in outpatient Gastroesophageal Reflux Disease (GERD) patients at Aura Syifa Hospital Kediri by analyzing the right indications and right doses. Method: This study is a descriptive observational study with retrospective data collection from patient medical record data. Results: The results of a study on the useof drugs in outpatient gastroesophageal reflux disease (GERD) patients at Aura Syifa Hospital Kediri for the period January-November 2022 by analyzing the right indications and correct doses, which were obtained as many as 175 patients. The most GERD patients were women as many as 114 patients and men as many as 61 patients. The most common age for GERD is 56-65 years old and &gt;65 years old. The most widely used drug class is the Proton Pump Inhibitor (PPI) class with a percentage of 38% and the drug in this class that is often used is lansoprazole with 167 prescriptions. The results of a study on drug use in outpatient gastroesophageal reflux disease (GERD) patients at Aura Syifa Hospital Kediri for the period January- November 2022 that meet the rationality of treatment based on the literature of the Indonesian GERD Consensus in 2013 or BNF 2017 or Pharmacotherapy A Pathophysiologic Approach 11th edition in 2020 or Medscape, where the indication is 100% (175 patients) and the right dose is 100% (175 patients).

Implementation of kidney palliative care-lessons learned from the US Department of Veterans Affairs.

Advanced kidney disease is a progressive life-limiting illness associated with high symptom burden, disability, and highly intensive care near the end of life. There is growing interest in integrating palliative care principles into the care of patients with advanced kidney disease to improve care and outcomes for these patients. The United States (US) Department of Veterans Affairs (VA) has been a leader in advancing palliative care initiatives across its health system and whose experience and approach may be instructive to other health systems seeking to develop kidney palliative care (KPC) services. Herein, we review current KPC programs in the VA and highlight the different models of care that programs have been adopted and how key components of goals of care conversations and advance care planning, symptom management, multidisciplinary care, patient selection, and quality improvement have been implemented across programs. VA KPC programs have adopted "parallel", "merged", and "embedded" models of KPC that reflect the different configurations of partnerships between nephrology and palliative care providers to deliver KPC. A primary service of VA KPC programs is providing goals of care conversations and advance care planning to referred patients and systematically documenting the outcomes of these discussions in standardized note templates in the electronic medical record. Symptom management is delivered by KPC providers through regular shared or sequential visits with patients' nephrology providers and is guided by patient responses to validated symptom surveys. Programs are staffed by allied health professionals, such as chaplains, pharmacists, social workers, and dieticians, to provide whole-person care and regularly huddle with nephrology staff to reach a shared understanding of each patient's care needs and plan. KPC programs implement champions who select patients in greatest need of KPC using a combination of clinical events that trigger referral for KPC and validated mortality risk prediction scores that are automatically generated in each patient's medical record. KPC programs also routinely collect clinical, patient-reported, process, and care quality measures to assess its services. The experiences of the VA highlight novel approaches that strive to close the care gaps in meeting the KPC needs of patients with advanced kidney disease.

Comparison of Severity in Diabetic Ulcer Patients with and Without Sepsis

Diabetes mellitus patients in Central Java grow yearly. According to data provided by the Central Java Health Department in 2019, Diabetes mellitus ranks second as the largest non-communicable disease (NCD), covering 13,4% of the total NCD patients. The prevalence of diabetic ulcers is 15-25% of all diabetes mellitus patients in Indonesia, which concerns the author regarding the possible increase of the diabetic ulcer population in Central Java. The severity of diabetic ulcers depends on various factors, including infection and complications. The most common complication is sepsis, a systemic infection often arising from local infections that are not appropriately treated, causing progressive damage and increasing mortality rates. This study aims to examine the comparison of ulcer severity in diabetic ulcer patients with sepsis and non-sepsis complications using Meggitt Wagner's criteria. This study utilizes an analytic observational study using a cross-sectional approach. The author sampled 126 patients diagnosed with Diabetic Ulcers in 2022 at Dr. Moewardi General Hospital for this study, using a purposive sampling method. The research was conducted by looking at the patient's medical record data, and data analysis using SPSS software. The test used in this research includes a Parametric T-independent test and a Pearson bivariate relationship test. This study shows that the comparison of ulcer severity in diabetic ulcer patients with sepsis and without sepsis was statistically significant (p-value = 0.000002). The mean of the group with sepsis (3.4127) was greater than the group without sepsis (2.5238). In conclusion, the comparison of ulcer severity in diabetic ulcer patients with sepsis and without sepsis is significant. We recommend future researchers include patients’ comorbidities, total hospitalization time, and detailed information on drug use and patient adherence to treatment in their research for more nuanced findings.

Functional assessment of knee osteoarthritis in the hospital outpatient care unit

Background: Osteoarthritis is a joint cartilage disease that affects a patient’s quality of life as it limits the patient’s movement, reduces the ability to work, increases emotions, and leads to long-term depression. Objective: To report the functional status of Knee OA in outpatient care at Ulin Hospital Banjarmasin, Indonesia. Method: A cross-sectional study was conducted with a functional assessment of the patient's medical record data. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) instruments were used. Fifty-one respondents participated in the study. Result: Most respondents were female (86.27%), 50–59 years old (33.33%), and suffered from OA for less than one year (35.29%). In addition, 24 patients (47%) suffered from mild OA, and 27 patients (53%) had moderate OA, reflecting that patients might have issues with their physical function. Of all participants, 60.78% had grade three OA by Kellgren Lawrence's severity classification; others had grade two. All patients received intraarticular injections of hyaluronic acid. Conclusion: There was no statistically significant difference between the WOMAC score and the gender, age, degree of OA and duration of OA. Hence, this illustrates that patients would suffer more from OA along with disease progression.

Development of a novel multipoint traction device for gastric and colorectal endoscopic submucosal dissection and evaluation of its efficacy and safety.

Proper traction allows safer and easier endoscopic submucosal dissection; however, single-point traction may not be sufficient. In this study we assessed the safety, efficacy, and feasibility of our newly developed multipoint traction device. During an ex vivo study using a Konjac training model, two experts and two trainees resected 80 mock lesions of 20-mm diameter by performing endoscopic submucosal dissection with and without multipoint traction. The primary outcome was the success rate of the procedure involving traction. The secondary outcomes were the submucosal dissection time, dissection speed, and perforation during endoscopic submucosal dissection. During the in vivo study, to clarify the initial clinical outcomes, we used data from the electronic medical record of patients at our institution who underwent gastric and colorectal endoscopic submucosal dissection, which was performed by experts with our newly developed multipoint traction device, from March to December 2022. The ex vivo study indicated that all traction procedures were successful. Higher resection speeds were observed with endoscopic submucosal dissection with traction than without traction (P < 0.001). Perforations were not observed. During the first in vivo clinical study, traction was feasible during 20 gastric and colorectal endoscopic submucosal dissection procedures. No adverse events occurred. Our multitraction device can increase the submucosal dissection speed and simplify endoscopic submucosal dissection techniques, thus safely reducing technical challenges. The application of this device for endoscopic submucosal dissection could lead to safer and more efficient procedures. Clinical registration UMIN Clinical Trials Registry, Japan (registration number UMIN000053384).

Endobiogenic Biology of Function Indices in a Cohort of Kidney Transplant Recipients.

Background and Objectives: Endobiogeny is a global systems approach to human biology based on the concept that the endocrine system manages the metabolism. Biology of function (BoF) indices are diagnostic tools in endobiogenic medicine that reflect the action of the endocrine system on the cells and the metabolic activity of an organism. Kidney transplant recipients are a very specific patient population due to their constant use of immunosuppressive agents such as steroids and anamnesis of chronic kidney disease. The aim of this study was to assess the tendencies of endobiogenic BoF indices in a kidney transplant recipient population and to determine the relationship between BoF index values and histology-proven kidney transplant rejection. Materials and Methods: A total of 117 kidney transplant recipients undergoing surveillance or indication allograft biopsy were included in this study. Endobiogenic BoF indices were calculated from complete blood count tests taken before the kidney biopsy. Histology samples were evaluated by an experienced pathologist according to the Banff classification system. Clinical and follow-up data were collected from an electronic patient medical record system. Results: Overall, <35% of the patients had BoF index values assumed to be normal, according to the general population data. Additionally, >50% of the patients had lower-than-normal adaptation, leucocyte mobilization, genital, and adjusted genital ratio indices, while the Cata-Ana, genito-thyroid ratio, adrenal gland, and cortisol indices were increased in >50% of the transplant recipients. The adaptation index was significantly higher in patients with biopsy-proven transplant rejection and demonstrated an AUC value of 0.649 (95%CI 0.540-0.759) for discriminating rejectors from patients without transplant rejection. Conclusions: Most of the kidney transplant recipients had abnormal BoF index values, reflecting increased corticotropic effects on their cells. The adaptation index distinguished patients with biopsy-proven transplant rejection from those without it.

Impact of a multi-disciplinary team-based care model for patients living with diabetes on health outcomes: a mixed-methods study

BackgroundIndividuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centered approach to treating individuals with diabetes.MethodsSemi-structured interviews were conducted with staff (n = 15) and patients (n = 18). Clinical data were extracted from the electronic medical record of patients (n = 1,599) seen at a safety-net health system in Chicago, Illinois, United States. The mixed methods study was guided by implementation science and participatory research principles. Staff interviews were 60 min and covered patient care activities, work flow, perceived patient experience, and facilitators/barriers to care coordination. Patient interviews were 60 min and covered satisfaction, attitudes about diabetes management, quality of life, and technology. Patient interviews were co-analyzed by research staff and members of a patient advisory committee. Clinical data were collected at an index visit, two years prior and at one-year follow up (n = 1,599).ResultsFour themes emerged from the interviews: (1) patients perceived the TBC model to be patient centered and of high quality; (2) technology can be an innovative tool, but barriers exist; (3) diabetes management is a complex process; and (4) staff communication enhances care coordination, but misinterpreting roles reduces care coordination. From pre-enrollment to the follow-up period, we found a statistically significant increase in missed visits, decrease in hemoglobin A1c (HbA1c), decrease in body mass index, and decrease in the percent of patients with high blood pressure. We found that each medical visit during the follow-up period was associated with an HbA1c decrease of 0.26 points.ConclusionsA TBC model is a patient-centered approach to providing care to patients with complex health needs, such as diabetes, patients were satisfied with the care they were receiving, and the model was associated with an improvement in clinical outcomes.

Liver Disease as a Potential Risk Factor for Colorectal Cancer: A Community Hospital Experience.

Liver disease (LD) is a common pathology worldwide. Many patients remain asymptomatic and undiagnosed. Colorectal cancer (CRC) is a prevalent neoplasm and a leading cause of cancer-related deaths globally. Multiple studies suggest that inflammation in the liver could drive the initiation of colorectal cancer. This five-year (2018-2022) case-control study included 274 patients diagnosed with CRC and adenomas at a community hospital in Houston, Texas. Each patient's medical record was reviewed for pre-existing LD, including steatosis, cirrhosis, primary biliary cirrhosis, and Hepatitis B and C infections. This study aims to investigate the association between LD and CRC risk and assess differences by gender, race, and ethnicity. The study cohort comprised 124 (45.3%) women and 150 (54.7%) men. Data were compared and analyzed using a Chi-squared test for independence and binomial logistic regression. A p-value of < 0.05 was considered statistically significant. Results: Patients with LD had a two-fold increase in the odds of developing CRC compared to those without LD, in both univariate and multivariate analyses (OR 2.13 {95% CI 1.30-3.49}, p = 0.003 / OR 2.30 {95% CI 1.37-3.87}, p = 0.002, respectively). The chi-square test revealed that the association between CRC and LD was stronger in women than in men (p = 0.018 and p = 0.056, respectively). Our study establishes a positive correlation between LD and CRC development, suggesting LD is a potential risk factor for CRC, particularly in women. Future research directions include exploring the underlying mechanisms of this association, evaluating the utility of early CRC screening in individuals with LD, and assessing the impact of interventions targeting LD on CRC incidence and mortality.