Record Information Research Articles

Preoperative Mobile Health Data Improve Predictions of Recovery From Lumbar Spine Surgery.

Neurosurgeons and hospitals devote tremendous resources to improving recovery from lumbar spine surgery. Current efforts to predict surgical recovery rely on one-time patient report and health record information. However, longitudinal mobile health (mHealth) assessments integrating symptom dynamics from ecological momentary assessment (EMA) and wearable biometric data may capture important influences on recovery. Our objective was to evaluate whether a preoperative mHealth assessment integrating EMA with Fitbit monitoring improved predictions of spine surgery recovery. Patients age 21-85 years undergoing lumbar surgery for degenerative disease between 2021 and 2023 were recruited. For up to 3 weeks preoperatively, participants completed EMAs up to 5 times daily asking about momentary pain, disability, depression, and catastrophizing. At the same time, they were passively monitored using Fitbit trackers. Study outcomes were good/excellent recovery on the Quality of Recovery-15 (QOR-15) and a clinically important change in Patient-Reported Outcomes Measurement Information System Pain Interference 1 month postoperatively. After feature engineering, several machine learning prediction models were tested. Prediction performance was measured using the c-statistic. A total of 133 participants were included, with a median (IQR) age of 62 (53, 68) years, and 56% were female. The median (IQR) number of preoperative EMAs completed was 78 (61, 95), and the median (IQR) number of days with usable Fitbit data was 17 (12, 21). 63 patients (48%) achieved a clinically meaningful improvement in Patient-Reported Outcomes Measurement Information System pain interference. Compared with traditional evaluations alone, mHealth evaluations led to a 34% improvement in predictions for pain interference (c = 0.82 vs c = 0.61). 49 patients (40%) had a good or excellent recovery based on the QOR-15. Including preoperative mHealth data led to a 30% improvement in predictions of QOR-15 (c = 0.70 vs c = 0.54). Multimodal mHealth evaluations improve predictions of lumbar surgery outcomes. These methods may be useful for informing patient selection and perioperative recovery strategies.

Integration of Wearable Sensors and Electrical Muscle Stimulation in Lower Limb Robotics for Gait Rehabilitation

Combining wearing devices with electrical muscle stimulation (EMS) in robotic lower limbs has shown promise in helping people learn how to walk again. This new method blends the benefits of smart technology and EMS to help people with neurological or joint problems improve their motor function and walking patterns. Wearable devices, like inertial measurement units (IMUs) and electromyography (EMG) monitors, record information about how the body moves and what muscles are doing while the person moves. These monitors give the user and the therapy team feedback in real time, which makes it possible for personalized and flexible recovery plans. Data from personal monitors can also be used to look at how people walk and see how they're doing over time. EMS is used to target certain muscles and make them stronger, more coordinated, and easier to control. By combining EMS with robots for the lower limbs, therapists can focus on certain muscle groups and make recovery routines more successful. EMS can also be timed to move with the robotic suit to help the person walk in a more natural and useful way. Wearable sensors and EMS work well together in lower limb robots for many reasons. EMS therapy can be made more specific and flexible because wearing monitors let doctors change the frequency and strength of the therapy in real time. The person is also encouraged to be more involved with this method because they get instant feedback on their actions and can see how they're doing over time. The combining wearing sensors and EMS in lower limb robots has a lot of promise to make gait therapy work better. Future study should focus on finding the best ways to combine these tools and looking at how they affect the quality of life and ability to walk for people who have movement problems in the long run.

Application of the ICF on students with disabilities at school in India

ICF serve as the basis for both the assessment and measurement of disability in many scientific, clinical, administrative and social policy contexts. However, few studies have used the application of ICF on students with disabilities in scientific and clinical context in India. The objective of this study is to identify the problems and record information by implementing the ICF as the basis for both the assessment and measurement of barriers/facilitator in students with disability in educational setting on clinical and social policy contexts. Method & procedure - A focus group of participants selected as to represent each level of school and each type of disability service provider working in rehabilitation institute. The group for the Identification Card included only teachers; that for the Functional Diagnosis was constituted only by multi-disciplinary health professionals from Disability Services; that for the Achievable Functional Goal Setting Profile and the Individual Educational Action Plan were mixed, including both teachers and operators from Disability Services. Results- In the school year 2021-23, the school sent 206 identification cards to disability services using the ICF model; the disability services issued 118 new disability certifications (57.3% of the received 206 identification cards). The school received 220 Functional Diagnosis from the disability services. The number of achievable functional goal setting profile stands at 132 and reached 54 number of Individual Educational Action Plan. Conclusion- In summary, the study suggested that to make any treatment effective for students with disabilities the medical, allied health expert like occupational therapist and the skilled teacher need to work hand in hand.

REVIEW OF TIME OF PROVISION OF MEDICAL RECORD DOCUMENTS IN POLY OUTPATIENT PATIENTS

Objectives: To find out the description of the Time of Providing Medical Record Documents for Outpatient Polyclinic Patients at Tk Hospital. IV Kencana Attack in 2022. Methodology: This research uses descriptive research with interview and observation methods. The subjects in this study were 6 people consisting of the head of the medical record, the medical record coordinator, the filing officer, the receiving/returning medical record document, the medical record distribution officer and the registration officer, and the object of this study was the patient's medical record document. outpatients borrowed from the inner poly with the average number of medical record documents borrowed per day is 20 medical record documents. The research instrument used observation sheets, interview guidelines, stopwatches, and recorders. Results: As many as 13 officers who play a role in providing outpatient medical record documents, only 1 has a D3 Medical Record and Health Information educational background. Standard Operating Procedures related to the Provision of Outpatient Medical Record Documents are not yet owned. As many as 81 medical record documents were observed, medical record documents that were in accordance with the SPM (≤10 minutes) were 39 (48%) with an average time of providing medical record documents of 8 minutes, while the number of medical record documents that were not in accordance with the SPM (>10 minutes) as many as 42 (52%) with an average time of providing medical record documents 14 minutes 12 seconds.

ChatGPT-4 generates orthopedic discharge documents faster than humans maintaining comparable quality: a pilot study of 6 cases.

Large language models like ChatGPT-4 have emerged. They hold the potential to reduce the administrative burden by generating everyday clinical documents, thus allowing the physician to spend more time with the patient. We aimed to assess both the quality and efficiency of discharge documents generated by ChatGPT-4 in comparison with those produced by physicians. To emulate real-world situations, the health records of 6 fictional orthopedic cases were created. Discharge documents for each case were generated by a junior attending orthopedic surgeon and an advanced orthopedic resident. ChatGPT-4 was then prompted to generate the discharge documents using the same health record information. The quality assessment was performed by an expert panel (n = 15) blinded to the source of the documents. As secondary outcome, the time required to generate the documents was compared, logging the duration of the creation of the discharge documents by the physician and by ChatGPT-4. Overall, both ChatGPT-4 and physician-generated notes were comparable in quality. Notably, ChatGPT-4 generated discharge documents 10 times faster than the traditional method. 4 events of hallucinations were found in the ChatGPT-4-generated content, compared with 6 events in the human/physician produced notes. ChatGPT-4 creates orthopedic discharge notes faster than physicians, with comparable quality. This shows it has great potential for making these documents more efficient in orthopedic care. ChatGPT-4 has the potential to significantly reduce the administrative burden on healthcare professionals.

Clinical characteristic, common sites, and geographical distribution of pediatric tuberculosis patients in Southwest China.

The data report of a large sample, dynamic epidemiology, and characteristic analysis of pediatric tuberculosis (TB) in Southwest China is not clear. Herein, we conducted descriptive dynamic epidemiology, characteristic analysis and geographical distribution study of pediatric TB inpatients in Southwest China for more than 20 years. Patients with pediatric TB were recruited from October 2002 to September 2022 in Southwest of China based on etiology or clinical confirmation. Extract hospitalization medical record information for each patient. The geographical distribution chart of cases is used to display the trend of case flow segmented every 5 years. Among 3,024 pediatric TB patients with an average age of 9.11 ± 4.39, 17.49% (529) had pulmonary tuberculosis (PTB), 9.06% (274) had extrapulmonary tuberculosis (EPTB), and 73.45% (2,221) had combined TB. The most common form of EPTB is disseminated TB (28.98%), followed by TB lymphadenitis (20.56%), pleural TB (19.72%), and TB meningitis (19.68%). Children aged 0-4 years had a high risk of TB meningitis and a severe symptoms, while children in the elderly age group had a high risk of pleural TB. In the past 20 years, hospitalized TB pediatric cases mainly came from Sichuan, Tibet, Qinghai, Yunnan and other places. The number of patients from ethnic minorities, especially Tibetans, showed an upward trend on a yearly basis (χ2 = 401.43, P < 0.001). Public health investment and effective management in pediatric TB should be further strengthened.

Analysis of Wet Pack Incidence in Steam Sterilization: A Study in a Chinese Medical Center.

BACKGROUND Central sterile supply departments (CSSDs) play a vital role in hospital infection control. We investigate the factors associated with wet pack occurrence after steam sterilization. MATERIAL AND METHODS We designed a log sheet to record information concerning sterilized packs. The data included the type of sterilized pack; outside weather (sunny, overcast, or rainy); the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been laid flat, upright, or leaning at an acute angle; which sterilizer was used for sterilization of the pack; whether the pack had been placed on the top or bottom shelf inside the sterilizer chamber; whether the pack had been loaded in compliance with guidelines; the drying time following sterilization; and cooling time after sterilization. The sterilized packs in our study were selected from all of the packs that were sterilized in the CSSD of the authors' institution during June to December 2021. RESULTS Factors associated with wet pack occurrence after steam sterilization include: outside weather on the day of sterilization; the item in the sterilized pack; packaging material; whether the item had been packaged in compliance with guidelines; whether the pack had been placed on the top or bottom shelf; and cooling time after sterilization. Statistically significant differences (P<0.05) in wet pack incidence were identified for all of these factors. CONCLUSIONS Various factors are associated with wet pack occurrence after steam sterilization. Recommendations for reducing the risk of wet packs include regular maintenance of the steam pipeline, regular replacement of thermal insulation materials for the steam pipeline, and extension of the drying time.

Distribution of the critically endangered fan mussel Pinna nobilis population in the Çanakkale Strait and Marmara Sea

This study was conducted with the primary objective of determining the presence of both healthy and impacted Pinna nobilis populations along the European coasts of the Sea of Marmara, followed by the identification of P. nobilis abundance and survival rates in the region encompassing the Çanakkale Strait and the southern coasts of the Sea of Marmara. Underwater surveys were randomly conducted at 19 distinct stations, including 8 stations along the European coasts of the Sea of Marmara, 7 stations along the southern coasts of the Sea of Marmara, and 6 stations within the Çanakkale Strait. SCUBA diving equipment was utilized to record information on habitat structure, water temperature, depth, and visibility at each station. The transect length during underwater surveys and the number of transects at each station were determined based on the condition of the seabed and the size of the area, respectively. Throughout the study period (September 2021 and October 2023), water temperature fluctuated between 17.5°C and 26.6°C. At the end of the study, a total of 395 individuals (147 live, 248 dead) were observed, with live individuals exhibiting total lengths ranging from 16.4 cm to 50.9 cm. This study represents the first investigation into the spatial distribution of P. nobilis along the European coast of the Marmara Sea. The study contributes significantly to enhancing our understanding of the ecology of P. nobilis populations in both the Sea of Marmara and the Çanakkale Strait. Additionally, recommendations for the rehabilitation of impacted populations and the conservation of healthy populations have been provided for decision-makers and fisheries managers.

Legal regulation of the implementation and protection of the rights of participants in surrogate motherhood legal relations in the conditions of war in Ukraine

On February 24, 2022, a full-scale war is taking place on the territory of Ukraine. Millions of people lost their homes and jobs. Children, as the most vulnerable category of the population, were particularly affected. Thousands of children were left without parental care, and some were not handed over to their legal parents at all. These events necessitated the study of the chosen research topic. The article is devoted to the rights of children who became victims of martial law on the territory of Ukraine as a result of the attack of the Russian Federation. The article shows the number of children affected by the war. The general principles of protection of children’s rights, defined by the international legislation are considered. An example of international experience in the protection of children in martial law is given. Particular attention is paid to the protection of the rights of children born to surrogate mothers during hostility in Ukraine. Problems of realization of the rights of participants of the specified legal relations are defined. It has been established that the fulfillment of the terms of the contract by the surrogate mother does not guarantee the protection of the interests of the child. The problems of the procedure of registration and documentation of the birth of children are mentioned. The provisions of the Family Code of Ukraine and other special legislation on the legal regulation of the procedure for registration of the birth of a child have been studied. It is noted that in conditions of martial law in the occupied territories, and in cities where hostilities continue, registration is impossible. Changes in the national legislation, introduction for the period of martial law in the field of the specified questions are considered. The author examines the possibility of adopting children born to surrogate mothers, as well as those left without care or evacuated to other countries. Conclusions were made about the impossibility of adopting these children under the accelerated procedure. Emphasis is placed on the need to comply with the adoption procedure established by national law. At the same time, it was noted about the need to strengthen the work of consulates in order to register children who are temporarily in another state. It is proposed in Ukraine to create appropriate registers of potential parents who apply to Ukrainian medical institutions for the birth of children from surrogate mothers. In order to record information about newborns and facilitate the search for biological parents of their own children, it is proposed to use the application “Diia”. In addition to these conclusions, the author stressed the need for Ukraine to ratify the Rome Statute.

DISCLOSURE OF MEDICAL RECORD INFORMATION TO GUARANTEE LEGAL ASPECTS OF CONFIDENTIALITY OF MEDICAL RECORDS IN TIRTAYASA PUSKESMAS

Background Medical Record according to Permenkes No.269/Menkes/Per/III/2008, Medical Record is a file that contains notes and documents about the patient's identity, examination results, treatment that has been given to the patient. Health facilities are responsible for protecting health information contained in medical records against possible loss, damage, falsification and unauthorized access. Maintaining information security, accuracy of information and ease of access to information are demands of health service organizations and health practitioners as well as authorized third parties. Meanwhile, parties who need information must always respect patient privacy. Overall, security, privacy, confidentiality and safety are devices that fortify information in medical records [1]. The purpose of this study was to determine the review of the release of medical record information in ensuring the legal aspects of the confidentiality of medical records at Kencana Hospital. Research method The research design used is descriptive research, which is a research method whose purpose is to present a complete picture of the social setting by describing a number of variables that are relevant to the problem and the unit under study among the phenomena being tested. This type of research is used to determine the process of providing medical record information and guaranteeing the legal aspects of medical record confidentiality at Kencana Hospital. The population in this study were all officers involved in the process of providing medical record information at Kencana Hospital which had 8 employees, which were divided into 3 medical record officers (1 head of medical records and 2 people served as distribution and retrieval officers), 2 people who handles related to insurance and 2 officers handles related to BPJS. In this study, the sample used was the party from the medical record unit, namely the medical record officer who has the authority in the process of providing patient medical information to a third party. The instruments used are Checklist Sheets and interview guidelines. In this study, the sampling used was purposive sampling technique because in sampling the authors considered certain things related to the research, The results of the research on StandardOperating Procedures related to providing patient medical information at the Kencana Hospital have an SOP. This SOP contains points for the process of releasing patient medical information, each point with a slightly different procedure depending on who the 3rd party is requesting. What is meant by 3rd parties here are patients, insurance companies, and legal institutions (courts). Each of these 3rd parties has made their respective procedures. The parties involved in the process of releasing patient medical information at Kencana Hospital are all medical record officers totaling15 people (8 officers in the filing section), (2 people in the distribution of medical record files), and (5 people in the registration section). The information released is in the form of a photocopy of a medical resume sheet. At Kencana Hospital, the only party who can decide on the release of patient medical information is the medical record officer. Kencana Hospital does not yet have special security related to the process of releasing patient medical information, but if a patient is represented in the process of requesting release of information, the representative must have a power of attorney from the patient concerned. If the request for release of information is not represented, the patient will be given a release approval form from the medical record unit. Suggestion It is better to make Standard Operating Procedures related to the Release of Patient Medical Information referring to the Regulation of the Minister of Health of the Republic of Indonesia Number 36 of 2012 concerning Medical Secrets and Guidelines for the Implementation and Procedures of Indonesian Hospital Medical Records issued by the Director General of Yanmed.

Comparison of outcomes after total hip arthroplasty between patients with osteonecrosis of the femoral head in Association Research Circulation Osseous stage III and stage IV: a five-year follow-up study

BackgroundNo large cohort study has evaluated the surgical outcomes of THA between different stages of ONFH patients. This study aimed to compare the surgical outcomes of ONFH patients who underwent THA in ARCO stage III versus IV, in terms of operative parameters, one-year hip function assessments and postoperative at least five-year complications, to inform optimized management of ONFH.MethodFrom our prospectively collected database, 876 patients undergoing THA between October 2014 and April 2017 were analyzed and divided into ARCO stage III group (n = 383) and ARCO stage IV group(n = 493). Details of demographics, medical record information, adverse events and clinical scores of both groups were collected and compared. Proper univariate analysis was used for the analysis.ResultThere were no statistically significant differences in baseline characteristics between the two groups. Compared to ARCO stage IV patients, ARCO stage III patients showed a shorter operative time (p < 0.01), less bleeding (p < 0.01), fewer one-year readmissions (p = 0.026) and complications (p = 0.040), and significantly higher HHS (p < 0.01) one year after THA. In addition, ARCO stage IV patients seem more likely to suffer prosthesis dislocation (p = 0.031).ConclusionAlthough ARCO stage IV patients in the study cohorts appeared to suffer more one-year complications, no significant difference was observed at long-term follow-up. Enhanced clinical guidance on preventing early prosthesis dislocation may help improve the prognosis of final-stage ONFH patients.

Heavy‐Mineral Grain Counting: Counting Techniques, Error Estimation, and the Number of Grains to be Counted

AbstractHeavy‐mineral assemblages of sediments and sedimentary rocks record information regarding provenance, including the source rocks involved, tectonic setting, climatic conditions, and modifications from source to sink. Drawing conclusions on provenance and provenance changes requires robust quantification of individual heavy‐mineral species contents, including error estimates. Nevertheless, it is common practice to count sub‐quantities of grains from aliquots and not considering the bias introduced by (a) counting similar numbers of grains from aliquots containing different total numbers of grains, and (b) using variable counting methods. Consequently, reported heavy‐mineral contents estimated from counting sub‐quantities are affected by errors of unknown extent, making it infeasible to determine whether intra‐ or intersample variations are statistically significant. Based on 65 heavy‐mineral aliquots of variable grain size, mineral species contents, total number of grains, and known composition determined by counting all grains (n = 80,393), here &gt;31 million countings of heavy‐mineral sub‐quantities are simulated using (a) ribbon counting with varying ribbon size, ribbon position, ribbon orientation, total number of counts, and ways of aggregating counts from multiple ribbons, and (b) a newly proposed counting technique called cluster counting. I show that (a) error estimation for a specific aliquot requires a finite population correction; (b) compared to adjacent ribbons, aggregating counts of spatially distant ribbons reduces the error; (c) cluster counting further reduces the error, showing the best fit with theory; and (d) the Wilson score interval enables error calculation as well as the number of grains to be counted to achieve an operator‐specific aim.

Association of Inflammatory Markers With Disease Progression and the Severity of COVID-19.

Introduction InDecember 2019, there was a massive outbreak of viral pneumonia, which had a high case fatality rate. Genetic sequencing of the virus showed similarity with severe acute respiratory syndrome coronavirus (SARS-CoV). It was later named novel coronavirus 2019 while the disease it caused was given the nomenclature of COVID-19. This deadly pneumonia outbreak was declared a pandemic by the World Health Organization (WHO). Aim To derive the strength of the correlation between blood levels of various inflammatory markers with the severity of COVID-19 pneumonia in patients affected with novel coronavirus 2019. Materials and methodology A prospective study was conducted on 300 confirmed cases of COVID-19 infection from August 2020 to July 2021 in SSG Hospital, Vadodara. Diagnosis of patients as confirmed cases of COVID-19 infection was done according to the WHO interim guidance for COVID-19. Their inflammatory markers were done for this study. All COVID-19-positive patients who had given negative consent for enrollment were excluded from the study. Patients were classified based on the severity of acute respiratory distress syndrome (ARDS). Comprehensive medical record information, encompassing biodata, clinical symptoms, comorbidities, and laboratory investigations, was systematically collected. Patients were given the standard treatment protocol as per guidelines. Patients were subjected to detailed investigations comprising complete blood counts and inflammatory markers like C-reactive protein (CRP), lactate dehydrogenase (LDH), serum ferritin, and D-dimer. Patients were further investigated by chest X-ray (posteroanterior view) or high-resolution computed tomography of the thorax. Results A total of 300 confirmed cases of COVID-19 infection were included in this study. Most of them were males (52%) with a mean age of 51 years and 48% were females with a mean age of 55 years. The majority of patients(40%) did not have ARDS, 23.3% of patients had mild, 16.7% of patients had moderate, and 20% of patients had severe ARDS. Higher CRP levels, serum ferritin, and serum D-dimer were significantly associated with the severity of COVID-19 infection as compared to those having no symptoms (p < 0.05). Increased levels were associated with severe clinical manifestations of COVID-19. The sensitivity of CRP is 69% and specificity is 100% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of ferritin is 88% and specificity is 81% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of D-dimer is 94% and specificity is 89% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. The sensitivity of LDH is 93% and specificity is 84% as a diagnostic marker for COVID-19 pneumonia in terms of ARDS. Conclusions Current evidence from our study showed that higher levels of inflammatory markers such as CRP, LDH, D-dimer, and ferritin are associated with the severity of COVID-19 in terms of ARDS and thus could be used as significant prognostic factors of the disease.These indicators might support clinical decisions to identify highfatality casesand poor diagnosis in the initial admission phase.

EFEKTIVITAS PERMAINAN ULAR NAGA PANJANG PADA TAHAP PERKEMBANGAN COOPERATIVE PLAY USIA 5-6 TAHUN

This research aims to 1) Introducing the traditional game of long dragon snakes to children as a characteristic of local culture 2) developing abilities in social-emotional aspects through playing long dragon snakes 3) The effectiveness of the long dragon snake game as a means to develop cooperative play skills and a game 4) Apply teamwork in a game activity. This research was conducted by analyzing several journals and reading sources such as books that discuss the effectiveness of long dragon snake games at the Cooperative play development stage for children aged 5-6 years. The writing of this journal uses a qualitative research method of literature review (Library research) or literature review study, which relies on activities to collect library data, read, and record and process information in the writing structure. The results of this study 1) Children can recognize traditional games as a characteristic of local culture 2) The long dragon snake game can be used as an alternative in providing stimulus for the development of children's social emotional abilities at the age of 5-6 years 3) The selection of long dragon snake games can develop abilities at the stage of play, namely cooperative play 4) Children are able to develop the ability to work together in teams and groups through fun game activities for children.

Peranan Notaris dalam Kepastian Hukum Prinsip Pemilik Manfaat (Beneficial Ownership) Berdasarkan Permenkumham Nomor 13 Tahun 2018

The increasingly rapid development of globalization will have good and even bad impacts on social life. This is in line with the process of the birth of a legal entity which confirms the evidence that law involves several stages, and the role of a notary is crucial in the initial stages of forming a legal entity. Beneficial Ownership can be a serious issue in the business world. A beneficial owner is an individual or entity who ultimately owns, controls, or obtains economic benefits from a company or business entity. In Indonesia, BO is regulated in the Minister of Law and Human Rights Regulation (Permenkumham) Number 13 of 2018. The aim of this research is to explain the role of notaries in legal certainty regarding the principle of beneficial ownership based on Permenkumham Number 13 of 2018. The research method uses descriptive , namely research that describes or explains the problems discussed. The results of this research are that based on Government Regulation Number 13 of 2018 concerning the Actual Beneficial Owners of Corporations, this is a regulation that stipulates the obligation to record and report information regarding the beneficial owners of a company. Notaries have the obligation to record information regarding beneficial owners in the deed of establishment of a company. This information includes the name, identification number, address and amount of ownership of the beneficial owner. The role of a notary in the principle of beneficial ownership covers various aspects that support legal certainty and transparency in the ownership of a company or business entity.

Clinical Outcomes and Medical Burdens of Neonatal Arrhythmias in Children's Hospitals in China: A Protocol for Multi-Center Retrospective Cohort Study.

Neonatal arrhythmias are significant contributors to infant mortality. Timely diagnosis and treatment are essential for neonates with non-benign arrhythmias to avoid severe complications, and ongoing treatment and follow-up are sometimes needed. The main objective of this study will be to understand the incidence and demographic characteristics of arrhythmias in hospitalized neonates in China and the related factors of outcomes. A secondary objective will be to establish the first follow-up system for neonatal arrhythmias in China. The medical burdens of neonatal arrhythmias in China will also be investigated. The data from the Futang Research Center of Pediatric Development (FRCPD) database between January 2016 and December 2021 were obtained. Newborns admitted to member hospitals with a discharge diagnosis of "neonatal arrhythmia" (ICD-10 code P29.151) or "arrhythmia" (ICD-10 code I49.904) were included. The medical record information was collected and classified into two groups: heart failure and non-heart failure. The differences between the two groups and independent risk factors for neonatal arrhythmias complicated with heart failure were analyzed. In addition, a follow-up study of patients discharged from Beijing Children's Hospital was conducted to evaluate their outcomes at the age of 3 years old. Factors influencing hospitalization costs were analyzed using rank-sum tests and multiple linear regression. It is anticipated that the study findings will provide new and comprehensive data on the health needs of neonatal arrhythmias in China. The study will establish the first follow-up system for neonatal arrhythmias in China. This study will help reduce the burden of patients and their families as well as the society.

Comparison of machine learning approaches for positive airway pressure adherence prediction in a veteran cohort

BackgroundAdherence to positive airway pressure (PAP) therapy for sleep apnea is suboptimal, particularly in the veteran population. Accurately identifying those best suited for other therapy or additional interventions may improve adherence. We evaluated various machine learning algorithms to predict 90-day adherence.MethodsThe cohort of VA Northeast Ohio Health Care system patients who were issued a PAP machine (January 1, 2010–June 30, 2015) had demographics, comorbidities, and medications at the time of polysomnography obtained from the electronic health record. The data were split 60:20:20 into training, calibration, and validation data sets, with no use of validation data for model development. We constructed models for the first 90-day adherence period (% nights ≥4 h use) using the following algorithms: linear regression, least absolute shrinkage and selection operator, elastic net, ridge regression, gradient boosted machines, support vector machine regression, Bayes-based models, and neural nets. Prediction performance was evaluated in the validation data set using root mean square error (RMSE).ResultsThe 5,047 participants were 38.3 ± 11.9 years old, and 96.1% male, with 36.8% having coronary artery disease and 52.6% with depression. The median adherence was 36.7% (interquartile range: 0%, 86.7%). The gradient boosted machine was superior to other machine learning techniques (RMSE 37.2). However, the performance was similar and not clinically useful for all models without 30-day data. The 30-day PAP data and using raw diagnoses and medications (vs. grouping by type) improved the RMSE to 24.27.ConclusionComparing multiple prediction algorithms using electronic medical record information, we found that none has clinically meaningful performance. Better adherence predictive measures may offer opportunities for personalized tailoring of interventions.

Analisis Efektivitas Biaya Penggunaan Kombinasi Doksetaksel Doksorubisin dan Kombinasi Siklofosfamid - Doksorubisin pada Pasien Kanker Payudara Stadium II di RSUD X Bungo Tahun 2022

Breast cancer is cancer that occurs in the mammary glands due to cell malignancy or uncontrolled growth of cells from the gland cells and their ducts.Cancer treatment has consumed BPJS funding of approximately 7.6 trillion rupiah at 2019 – 2020 years. This study is needed to determine the ratio of treatment effectiveness and the average cost comparison of the drug combinations Doxetaxel-Doxorubicin and Cyclophosphamide-Doxorubicin at X Bungo General Hospital in 2022. Cost Effectiveness Analysis Method (Cost Effectiveness Analysis) is an analysis by looking at the effectiveness of treatment seen from medical record information and calculating the value of ACER and ICER.The object of this study is the Regional General Hospital (RSUD) in Bungo Regency. It is known that the component of direct medical costs is in the form of BPJS payments. Based on the ACER value, it shows that Cyclophosphamide - Doxorubicin has a lower ACER value than the ACER value for Doxetaxel - Doxorubicin. It can be concluded that Cyclophosphamide - Doxorubicin has a cost-effectiveness value, namely cost-effective and effective therapy compared to Doxetaxel - Doxorubicin.

Mortality from decreased food intake in older adults in nursing homes: A retrospective cohort study using electronic care record data

AimTo our knowledge, no studies have examined the risk of mortality in nursing homes using the routinely collected electronic care record information. We aimed to assess the risk of mortality using food intake data documented in electronic care records from Japanese nursing homes. MethodsThis academic–industry collaborative research included 814 older adults from five nursing homes in Japan. The study period was from January 1, 2016 to June 23, 2020. We used the rate of food intake data recorded by care workers in the electronic care records of the residents. We defined decreased food intake as the percentage decrease between admission and 90 days after admission into the nursing home, with cutoffs of 10%, 20%, and 30%. ResultsThe number of older adults whose food intake decreased between admission and 90 days after admission was 114 (14.0%) at a 10% rate, 58 (7.1%) at a 20% rate, and 35 (4.3%) at a 30% rate. All three rates were significantly associated with mortality (10%: hazard ratio [HR] 2.02, 95% confidence interval [CI] 1.30–3.15; 20%: HR 3.03, 95% CI 1.68–5.47; and 30%: HR 4.50, 95% CI 2.15–9.44). ConclusionsWe found that the risk of mortality could conveniently be assessed from the food intake data collected routinely and comprehensively and documented in electronic care records in nursing homes. Our findings can be utilized in nursing homes, where medical staff are limited, to assess high-risk residents and to encourage a discussion regarding the management of end-of-life care.

Subduction plate interface shear stress associated with rapid subduction at deep slow earthquake depths: example from the Sanbagawa belt, southwestern Japan

Abstract. Maximum shear stress along an active deformation zone marking the subduction plate interface is important for understanding earthquake phenomena and is an important input parameter in subduction zone thermomechanical modeling. However, such maximum shear stress is difficult to measure directly at depths more than a few kilometers and is generally estimated by simulation using a range of input parameters with large associated uncertainties. In addition, estimated values generally represent maximum shear stress conditions over short observation timescales, which may not be directly applicable to long-timescale subduction zone modeling. Rocks originally located deep in subduction zones can record information about deformation processes, including maximum shear stress conditions, occurring in regions that cannot be directly accessed. The estimated maximum shear stress is likely to be representative of maximum shear stress experienced over geological timescales and be suitable to use in subduction zone modeling over timescales of millions to tens of millions of years. In this study, we estimated maximum shear stress along a subduction plate interface by using samples from the Sanbagawa metamorphic belt of southwestern (SW) Japan, in which slivers of mantle-wedge-derived serpentinite are widely distributed and in direct contact with metasedimentary rocks derived from the subducted oceanic plate. These areas can be related to the zone of active deformation along the subduction plate interface. To obtain estimates of maximum shear stress at the subduction interface, we focused on the microstructure of quartz-rich metamorphic rocks – quartz is the main component of the rocks we collected and its deformation stress is assumed to be roughly representative of the stress experienced by the surrounding rock and plate interface deformation zone. Maximum shear stress was calculated by applying deformation temperatures estimated by the crystallographic orientation of quartz (the quartz c-axis fabric opening-angle thermometer) and the apparent grain size of dynamically recrystallized quartz in a thin section to an appropriate piezometer. Combined with information on sample deformation depth, estimated from the P–T (pressure–temperature) path and deformation temperatures, it is suggested that there was nearly constant maximum shear stress of 15–41 MPa in the depth range of about 15–30 km, assuming plane stress conditions even when uncertainties related to the measurement direction of thin section and piezometer differences are included. The Sanbagawa belt formed in a warm subduction zone. Deep slow earthquakes are commonly observed in modern-day warm subduction zones such as SW Japan, which has a similar thermal structure to the Sanbagawa belt. In addition, deep slow earthquakes are commonly observed to be concentrated in a domain under the shallow part of the mantle wedge. Samples showed the depth conditions near the mantle wedge, suggesting that these samples were formed in a region with features similar to the deep slow earthquake domain. Estimated maximum shear stress may not only be useful for long-timescale subduction zone modeling but also represent the initial conditions from which slow earthquakes in the same domain nucleated.