Recording System Research Articles

Recent Advances in Intraoral Scanners.

Intraoral scanners (IOSs) have emerged as a cornerstone technology in digital dentistry. This article examines the recent advancements and multifaceted applications of IOSs, highlighting their benefits in patient care and addressing their current limitations. The IOS market has seen a competitive surge. Modern IOSs, featuring continuous image capture and advanced software for seamless image stitching, have made the scanning process more efficient. Patient comfort with IOS procedures is favorable, mitigating the discomfort associated with conventional impression taking. There has been a shift toward open data interfaces, notably enhancing interoperability. However, the integration of IOSs into large dental institutions is slow, facing challenges such as compatibility with existing health record systems and extensive data storage management. IOSs now extend beyond their use in computer-aided design and manufacturing, with software solutions transforming them into platforms for diagnostics, patient communication, and treatment planning. Several IOSs are equipped with tools for caries detection, employing fluorescence technologies or near-infrared imaging to identify carious lesions. IOSs facilitate quantitative monitoring of tooth wear and soft-tissue dimensions. For precise tooth segmentation in intraoral scans, essential for orthodontic applications, developers are leveraging innovative deep neural network-based approaches. The clinical performance of restorations fabricated based on intraoral scans has proven to be comparable to those obtained using conventional impressions, substantiating the reliability of IOSs in restorative dentistry. In oral and maxillofacial surgery, IOSs enhance airway safety during impression taking and aid in treating conditions such as cleft lip and palate, among other congenital craniofacial disorders, across diverse age groups. While IOSs have improved various aspects of dental care, ongoing enhancements in usability, diagnostic accuracy, and image segmentation are crucial to exploit the potential of this technology in optimizing patient care.

Short communication: Do veterinary diagnoses coming from electronic recording system of veterinary treatments have the potential to be used for breeding in small populations? The case of the dual-purpose Alpine Grey cattle breed

In cattle breeding, emphasis has historically been placed on productive traits, so-called primary traits, while health and fitness traits have been overlooked due to their low heritability and partly negative genetic correlations with productivity. In addition, the recording of phenotypes caused problems due to a lack of high-quality information and / or high costs of recording. This oversight has additionally led to increased incidences of fertility issues and health problems in cattle populations, resulting in economic losses and consumer concerns regarding animal welfare and food safety. This study investigates the potential use of veterinary diagnoses, collected via the Italian electronic recording system of veterinary treatments, for breeding decisions in the local dual-purpose Alpine Grey cattle breed for which the consideration of functional traits in breeding has also become imperative over the last years. The dataset comprised 97 821 records spanning from 2021 to 2023, representing 8 273 individuals and 18 110 lactations of the Alpine Grey breed. Each record documented the administration of treatments for mammary, respiratory, and urogenital pathologies. After data editing and model development, heritability estimates were obtained for each pathology using univariate linear animal models and gibbs sampling algorithms. Results indicate that mammary pathologies affected the highest number of cows (11%), followed by respiratory (4%) and urogenital (5%) pathologies. Heritability estimates ranged from 0.01 to 0.04 across all traits, confirming generally low heritability values. Respiratory pathologies exhibited the highest heritability (0.04; sd 0.04), followed by mammary (0.03; sd 0.01) and urogenital (0.01; sd 0.01) pathologies. This study, although preliminary, provides valuable insights into the health status of local dual-purpose Alpine Grey cattle and highlights the potential of considering veterinary diagnoses for improving animal health and welfare in dairy cattle breeding. However, the low heritability of these traits, which is consistent with literature data, clearly shows the current limitations of using them for breeding. Further, the diagnostic key of the Italian electronic recording system of veterinary treatments should be specified for the use of health data for breeding purposes, as it is formulated in too general manner in its current form. Nevertheless, their significance for animal welfare and economic sustainability underlines the need for their consideration in dairy cattle breeding. Therefore, further research with larger sample sizes and consideration of additional indicators, such as somatic cell counts, is recommended to enhance the accuracy of genetic evaluations and improve breeding strategies for sustainable cattle production.

Areas for Improvement and Barriers Identified in Measuring the Quality of Nursing Care: Perceptions of Patients and Professionals.

Quality indicators in healthcare are essential to raising awareness about the appropriateness of nursing care. However, identifying the key indicators continues to pose a challenge, above all if one wants to include users and professionals. Identify which aspects of nursing care should be measured to assess the results of nursing care and how to do so. Interpretive qualitative exploratory study. The participants were users and professionals of an autonomous regional health service in Spain. The information was collected by means of two focus groups and eight semi-structured interviews conducted between November 2022 and March 2024. The data were analysed thematically using the Braun and Clarke process. The users and professionals agreed on the need to measure emotional skills and attitudes such as empathy, respect, and warmth when dealing with patients. The professionals highlighted workload and inefficiency of the current record system as barriers to adequately reflecting their work. They proposed improvements in the recording tool and the need for more human resources, as well as leadership that is more focused on quality. It is crucial to develop indicators that reflect both the emotional and technical aspects of nursing care. The participation by patients and professionals alike in this design and selection will make it possible to improve the quality of care and advances in the nursing profession. This study was not registered.

Development and validation of a nomogram to predict acute postoperative urinary retention in ischemic stroke patients following femoral artery puncture.

Acute postoperative urinary retention (POUR) is a common complication in patients with ischemic stroke following femoral artery puncture (FAP), leading to discomfort, delayed hospital discharge, and increased patient morbidity. The relevant risk factors are unclear; thus, a predictive tool is required to guide treatment decisions. To develop and validate a nomogram to predict acute POUR in patients with ischemic stroke following FAP. We retrospectively collected cases from 1729 patients with ischemic stroke from the electronic record system of Jiangmen Central Hospital from January 2021 to December 2023. A total of 731 patients were randomly divided into development (n = 511, 70%) and validation (n = 220, 30%) groups. Univariate and multivariate logistic regression analyses with backward stepwise regression were used to select the predictive variables, and a nomogram was developed. The discrimination was evaluated based on the area under the curve (AUC). Calibration was assessed using calibration plots and the Hosmer-Lemeshow test. Clinical applications were evaluated using decision curve analysis (DCA). The incidence of acute POUR was 12.72%. Preoperative statin use within 24 h, operation type, intraoperative infusion, postoperative water intake within 3 h, postoperative pain, and postoperative anxiety were included in the nomogram. The AUC values were 0.764 [95% confidence interval (CI): 0.705-0.825] in the development group and 0.741 (95% CI: 0.615-0.856) in the validation group. The calibration plots showed good calibration. The p values in the Hosmer-Lemeshow tests were 0.962 and 0.315 for the development and validation groups, respectively. The DCA showed that patients could benefit from this nomogram. A nomogram was developed to successfully predict acute POUR in patients with ischemic stroke following FAP. This nomogram is a convenient and effective tool for clinicians to aid in the prevention and early intervention of acute POUR.

The BIAD Standards: Recommendations for Archaeological Data Publication and Insights From the Big Interdisciplinary Archaeological Database

Abstract This article presents a series of recommendations for the publication of archaeological data, to improve their usability. These 12 recommendations were formulated by archaeological data experts who mined thousands of publications for different data types (including funerary practices, accelerator mass spectrometry dating, stable isotopes, zooarchaeology, archaeobotany and pathologies) during the initial construction of the Big Interdisciplinary Archaeological Database (BIAD). We also include data harmonisation vocabularies utilised for the integration of data from different recording systems. The case studies we cite to illustrate the recommendations are grounded in examples from the published literature and are presented in a problem/solution format. Though practically oriented towards the facilitation of efficient databasing, these recommendations – which we refer to as the BIAD Standards – are broadly applicable by those who want to extract scientific data from archaeological information, those who work with a specific region or theoretical focus and journal editors and manuscript authors. We anticipate that the use of the BIAD Standards will increase the usability, visibility, interoperability and longevity of published data and also increase the citations of those publications from which data were mined. The Standards will also help frame a unified foundation to support the continued integration of the natural sciences with archaeological research in the future.

8309 Injectable Estradiol Dosing Regimens; A Retrospective Review of Hormone Therapy for Gender-Diverse Adults Assigned Male at Birth

Abstract Disclosure: M. Kanin: None. M. Slack: None. R. Patel: None. K. Chen: None. N. Jackson: None. K. Williams: None. S. Grock: None. Introduction: Many gender incongruent individuals assigned male at birth (AMAB) seek hormone therapy to achieve physical and emotional changes. Hormone therapy typically includes estradiol, with or without an anti-androgen. However, limited data with relatively weak justifications support the currently recommended regimens. In particular, dosing schedules for injectable estradiol can vary considerably. UCSF guidelines recommend initiating estradiol valerate at 5 mg parenterally weekly or estradiol cypionate 2 mg weekly. Endocrine Society Guidelines recommend estradiol valerate or cypionate parenterally 5-30 mg every 2 weeks or 2-10 mg weekly. Our clinical observations led to the concern that current guideline-based dosing of injectable estradiol can result in supratherapeutic estradiol levels. Thus, we designed a retrospective cohort study to evaluate injectable estradiol dosing requirements for gender diverse individuals at our institution. Hypothesis: We hypothesize that low dose estradiol injections can lead to therapeutic estradiol levels (100-200 pg/mL) and suppressed testosterone (<50 ng/dL). Design: We performed a retrospective cohort study of gender diverse individuals AMAB aged 18-89 who were newly prescribed injectable estradiol by a single clinic from January 2017 to March 2023. Exclusion criteria included history of orchiectomy or estradiol use within the previous six months. Patients were identified using structured query language to extract data from our institution’s electronic health record system. A total 33 patients were identified, 29 of whom were eligible for inclusion. Data was collected for 15 months after estradiol initiation. Results: All individuals were prescribed estradiol valerate except for 1 who was prescribed estradiol cypionate. Estradiol dose ranged from 2.5 to 10 mg weekly and an average initial dose of 4.26 mg weekly. Mean initial estradiol level obtained while on treatment for at least 30 days was 349.8 pg/mL, which is supratherapeutic. Mean initial testosterone level was 25.3 ng/dL, which is suppressed. Mean estradiol dose at completion of data collection was 3.68 mg with a mean final estradiol level of 245.2 pg/mL. Testosterone levels reached less than 50 ng/dL for everyone in the sample with a mean final testosterone of 23.3ng/dL despite significant reductions in estradiol dose (change=-0.58 mg per week, p=0.001) Conclusion: Our study demonstrates lower dosages of estradiol can be used to achieve therapeutic estradiol levels in gender incongruent patients seeking estrogen therapy. Using lower dosages can avoid supratherapeutic estradiol levels and the associated risks. Further prospective studies are needed with the aim to reevaluate current guideline dosing recommendations for injectable estradiol. Presentation: 6/2/2024

8091 Clinical Features Associated with ICU Admission and Mortality in Thyroid Storm and Impending Thyroid Storm

Abstract Disclosure: E.D. Zhang: None. I. Hussain: None. Introduction: Thyroid storm is a rare, life-threatening manifestation of thyrotoxicosis characterized by a clinical syndrome of acute multi-organ failure, which can result in significant morbidity and mortality. Impending thyroid storm is a stage of thyrotoxicosis that may progress to thyroid storm if untreated. The aim of this study was to evaluate the demographics and outcomes of patients with thyroid storm at our institution and determine the clinical features associated with severe complications and mortality. We also evaluated the differences in clinical features and outcomes in patients diagnosed with impending thyroid storm versus thyroid storm. Methods: This was a retrospective single-center cohort study evaluating patients aged 18 years or older who were clinically diagnosed with thyroid storm or impending storm at two affiliated tertiary academic centers from 2008-2021. A search of the electronic medical record system using ICD-10 codes for thyroid storm identified patient charts which were reviewed for eligibility. Results: This study included 121 admissions, with 75 (62.0%) patients with thyroid storm and 46 (38.0%) patients with impending thyroid storm. Our study cohort was notably more racially and ethnically diverse than prior U.S. studies with 5.0% non-Hispanic White, 52.9% Black, 33.9% Hispanic, and 8.3% Asian patients. The mortality rate was 4.7%, with all patient deaths occurring in the thyroid storm group. Multivariable logistic regression analysis showed atrial fibrillation (OR 4.09, 95% CI 1.21, 13.85, p=0.02) and acute respiratory failure (OR 22.18, 95% CI 2.29, 215.19, p=0.008) to be significantly associated with a composite outcome of intensive care unit (ICU) admission or death. Comparison of impending storm and thyroid storm groups showed fever (p=0.02), acute respiratory failure (p=0.03), and ICU admission (p=0.02) to be significantly different between groups. Conclusions: This study describes the largest published single-center cohort of patients treated for thyroid storm in the United States. Furthermore, our study contributes importantly to the data for racial/ethnic minorities who are under-represented in prior studies. The mortality rate in this study is lower than most recent studies. The presence of atrial fibrillation and acute respiratory failure were noted to be significantly associated with a composite outcome of ICU admission or death, and the five fatal cases had high rates of cardiac arrest and shock. These findings suggest that complications involving cardiopulmonary compromise are clinically important in predicting severe disease and poor outcomes. Acute respiratory failure was also noted to be significantly different between impending storm and thyroid storm groups indicating that while not currently included in existing diagnostic systems, it is an important complication of thyroid storm that may have prognostic value. Presentation: 6/2/2024

8309 Injectable Estradiol Dosing Regimens; A Retrospective Review of Hormone Therapy for Gender-Diverse Adults Assigned Male at Birth

Abstract Disclosure: M. Kanin: None. M. Slack: None. R. Patel: None. K. Chen: None. N. Jackson: None. K. Williams: None. S. Grock: None. Introduction: Many gender incongruent individuals assigned male at birth (AMAB) seek hormone therapy to achieve physical and emotional changes. Hormone therapy typically includes estradiol, with or without an anti-androgen. However, limited data with relatively weak justifications support the currently recommended regimens. In particular, dosing schedules for injectable estradiol can vary considerably. UCSF guidelines recommend initiating estradiol valerate at 5 mg parenterally weekly or estradiol cypionate 2 mg weekly. Endocrine Society Guidelines recommend estradiol valerate or cypionate parenterally 5-30 mg every 2 weeks or 2-10 mg weekly. Our clinical observations led to the concern that current guideline-based dosing of injectable estradiol can result in supratherapeutic estradiol levels. Thus, we designed a retrospective cohort study to evaluate injectable estradiol dosing requirements for gender diverse individuals at our institution. Hypothesis: We hypothesize that low dose estradiol injections can lead to therapeutic estradiol levels (100-200 pg/mL) and suppressed testosterone (<50 ng/dL). Design: We performed a retrospective cohort study of gender diverse individuals AMAB aged 18-89 who were newly prescribed injectable estradiol by a single clinic from January 2017 to March 2023. Exclusion criteria included history of orchiectomy or estradiol use within the previous six months. Patients were identified using structured query language to extract data from our institution’s electronic health record system. A total 33 patients were identified, 29 of whom were eligible for inclusion. Data was collected for 15 months after estradiol initiation. Results: All individuals were prescribed estradiol valerate except for 1 who was prescribed estradiol cypionate. Estradiol dose ranged from 2.5 to 10 mg weekly and an average initial dose of 4.26 mg weekly. Mean initial estradiol level obtained while on treatment for at least 30 days was 349.8 pg/mL, which is supratherapeutic. Mean initial testosterone level was 25.3 ng/dL, which is suppressed. Mean estradiol dose at completion of data collection was 3.68 mg with a mean final estradiol level of 245.2 pg/mL. Testosterone levels reached less than 50 ng/dL for everyone in the sample with a mean final testosterone of 23.3ng/dL despite significant reductions in estradiol dose (change=-0.58 mg per week, p=0.001) Conclusion: Our study demonstrates lower dosages of estradiol can be used to achieve therapeutic estradiol levels in gender incongruent patients seeking estrogen therapy. Using lower dosages can avoid supratherapeutic estradiol levels and the associated risks. Further prospective studies are needed with the aim to reevaluate current guideline dosing recommendations for injectable estradiol. Presentation: 6/2/2024

Tinjauan Sistem Informasi Akuntansi Persediaan Barang Dagang Pada PT DAYA HIDUP SEMESTA

PT Daya Hidup Semesta is a trade company whose main activity is to buy, store as stock and sell health and safety products under the 4Life brand. The supply of goods is a very important factor for a trading company because the main activity of the trading company is to sell the supply of Goods to the customer in his business to make a profit or profit. Therefore, the supervision of the management of goods and services should be carried out in accordance with the procedures of registration, the procedure of demand and the procedure for the production of the goods have been applied according to the theory of which there has been adequate separation of tasks, the process of authorization of documents and the system of recording of the application of computerized supplies and there is internal verification independently. Keywords: accounting system, and merchandise supplies

Improving knowledge of the acoustic factors involved in railway noise annoyance: first results of a pilot field survey of sixty-two local residents

Railway transportation contributes to the objectives of decarbonization but also generates negative externalities, including noise. Energy noise indicators used to characterize population exposure do not adequately reflect the repetitive nature of railway noise peaks. The GENIFER pilot study aims to test a protocol designed to characterize railway noise events according to the instantaneous perceived annoyance when the train is passing, in order to improve understanding of the influence of acoustic factors on annoyance. The first phase of the survey was carried out in 2023 among 62 residents of a pilot site. An electronic device was used to collect around 5,000 ratings, ranging from 1 to 10, assessing the instantaneous annoyance induced by train noise at passing trains. The site instrumentation included sixteen sound level meters and two video recording systems, enabling annoyance ratings to be associated with the acoustic characteristics of railway noise events. A questionnaire aimed at identifying co-determinants of long-term annoyance was also administered to participants. Feedback on the field implementation of this survey and initial results concerning acoustic measurements, instantaneous annoyance ratings and questionnaire responses will be presented.

A Multimodal Intervention to Improve Guideline-Based Screening for Alpha-1 Antitrypsin Deficiency in a Community Health Setting.

Evidence-based guidelines recommend screening all individuals with chronic obstructive pulmonary disease (COPD) for the genetic disorder alpha-1 antitrypsin deficiency (AATD). However, it is estimated that only 5% of people with COPD have been tested for AATD, and a large fraction of the estimated 70,000 to 100,000 Americans with AATD have not yet been diagnosed. Low familiarity with AATD and limited knowledge about diagnostic tests and available treatments contribute to suboptimal screening rates. To address barriers to and improve rates of guideline-based AATD diagnostic testing among racially and ethnically diverse patients with COPD at a large community health center. A quality improvement initiative consisting of educational sessions and electronic health record (EHR) system interventions was implemented to improve the adoption of guideline-based screening for AATD in patients with COPD. An analysis of EHR data demonstrated that of patients with a COPD diagnosis (N = 1,030), 22.2% (n = 229) were screened for AATD in the 12 months following the start of the quality improvement initiative compared with 1.3% (n = 13) of patients with a COPD diagnosis (N = 972) seen in the 12 months prior to the start of the quality improvement initiative (P < 0.001). A quality improvement initiative consisting of educational sessions and EHR system modifications was successful in increasing clinicians' knowledge and diagnostic screening rates for AATD in patients with COPD at a large community health center.

Outcomes of pediatric in-hospital cardiac arrest in the emergency department of a tertiary referral hospital in Tanzania: a retrospective cohort study

BackgroundCardiopulmonary resuscitation (CPR) is an emergency procedure performed to restore heart function to minimize anoxic injury to the brain following cardiac arrest.Despite the establishment of emergency department and training on Pediatric Advanced Life Support (PALS) at Muhimbili National Hospital (MNH) the outcomes of pediatric in-hospital cardiac arrest have not been documented. We ought to determine the outcomes and factors associated with 24-h survival after pediatric in-hospital cardiac arrests at MNH in Tanzania.MethodsWe conducted a retrospective study of all patients aged 1 month to 18 years who had in-hospital cardiac arrests (IHCA) prompting CPR in the Emergency Medicine Department (EMD) at MNH, Tanzania from January 2016 to December 2019. Data was collected from electronic medical record (Wellsoft) system using a standardized and pretested data collection form that recorded clinical baseline, pre-arrest, arrest, and post-arrest parameters. Bivariate and multivariable logistic regression analyses were performed to assess the influence of each factor on 24-h survival.ResultsA total of 11,951 critically ill patients were screened, and 257 (2.1%) had cardiac arrest at EMD. Among 136 patients enrolled, the median age was 1.5 years (interquartile range: 0.5–3 years) years, and the majority 108 (79.4%) aged ≤ 5 years, and 101 (74.3%) had been referred from peripheral hospitals. Overall stained return of spontaneous circulation was achieved in 70 (51.5%) patients, 24-h survival was attained in 43 (31.3%) of patients, and only 7 patients (5.2%) survived to hospital discharge. Factors independently associated with 24-h survival were CPR event during the day/evening (p = 0.033), duration of CPR ≤ 20 min (p = 0.000), reversible causes of cardiac arrest being identified (p = 0.001), and having assisted/mechanical ventilation after CPR (p = 0.002).ConclusionIn our cohort of children with cardiac arrest, survival to hospital discharge was only 5%. Factors associated with 24-h survival were CPR events during the daytime, short duration of CPR, recognition of reversible causes of cardiac arrest, and receiving mechanical ventilation. Future studies should explore the detection of decompensation, the quality of CPR, and post-cardiac arrest care on the outcomes of IHCA.

A human-centered approach for designing a social care referral platform.

Health Information Technology (HIT) is increasingly being used to help providers connect patients with community resources to meet health related social needs (e.g., food, housing, transportation). Research is needed to design efficient, simple, and engaging interfaces during a sensitive process that involves multiple stakeholders. Research is also needed to understand the roles, expectations, barriers, and facilitators these different stakeholders (i.e., patients, providers, and Community-based Organizations (CBOs) face during this process. We applied the Human-Centered Design approach to develop a multi-interface social care referral platform. This approach allowed us to understand the needs of each stakeholder and address potential workflow concerns. This paper reports on the research team's understanding of the design process from 48 different user tests. We conducted three rounds of user testing on an interactive prototype(s) and adapted the prototype after each round. Our results summarize a number of key findings useful for patients, clinical teams, and staff of CBOs when designing a social care referral platform. Our user testing highlighted that patient-facing interfaces offer tremendous opportunities to allow patients to be the leader of the social care referral process. CBOs have varying needs that must be addressed, and providing CBO staff with opportunities to connect with patients is critical. Finally, healthcare teams have more structured workflows. Integration within the electronic health record system provides opportunities for healthcare staff to support their patients more easily given these barriers.

Effect of an educational intervention based on health belief model on preventive behaviors against malaria in over 18-year-old Afghan immigrants living in Parsian

BackgroundMalaria disease is one of the most dangerous protozoan parasitic infections with a high mortality rate in developing countries. Malaria is a public health issue, especially in Hormozgan province, and is highly affected by foreign immigrants (Pakistani and Afghani); thus, the present study aimed to evaluate the effect of an intervention based on the health belief model (HBM) on the promotion of malaria prevention behaviors in Afghani immigrants over the age of 18. The participants resided in Persian city in Hormozgan province.MethodsThe present quasi-experimental study was conducted on 200 Afghans immigrants over 18 years of age who visited four comprehensive health service centers in Parsian city, south of Iran in June until December 2023. Sampling was by cluster method. In this way, the health centers were considered as clusters, and then 4 centers were randomly selected from among them (two centers of the control group and two centers of the intervention group) and participants were selected by a systematic random method by list of records in the National Integrated Health Record System (called SIB) (100participants control group, 100 participants intervention group). The data were collected using a researcher-made questionnaire based on the HBM before and after the educational intervention An educational program was designed and implemented to promote preventive behaviors against malaria in five sessions using different strategies and based on the HBM for the intervention group. The data were analyzed using independent-samples T-test, paired-samples T-test, Pearson’s correlation coefficient, analysis of covariance and linear regression. All statistical analyses and hypothesis testing were done in IBM SPSS version 25, at a significance level of 0.05.ResultsIn the intervention group, there was a significant difference in the mean scores of knowledge (6.48, 95% CI: 5.9,7.05), perceived susceptibility (10.57, 95% CI: 10.03, 11.1), perceived severity (16.61, 95% CI: 15.83, 16.83), perceived self-efficacy (18.26, 95% CI: 17.55, 18.96), perceived benefits (15.43, 95% CI: 14.68, 16.17), perceived barriers (-22.49, 95% CI: -23.63, -21.30), cues to action (15.06, 95% CI: 14.36, 15.75), and preventive behaviors (20.05, 95% CI: 19.44, 20.65), before and after the educational intervention. P-value < 0.001. The regression analysis showed that the constructs of perceived susceptibility (T = 4.72, P < 0.001), cues to action (T = 5.30, P < 0.001)and perceived self-efficacy (T = 4.93, P < 0.001) led to the greatest change in malaria prevention behaviors(R-Square = 0.549).ConclusionThe present findings showed that the HBM -based intervention was effective in preventive behaviors against malaria in Afghans. It is recommended to design suitable educational interventions in order to increase the perceived susceptibility, cues to action and self-efficacy in order to improve preventive behaviors against malaria in Afghans.

A-113 Evaluation of Cystatin C Ordering Trends in a Quaternary Care Health System

Abstract Background Cystatin C is an alternative and adjunct kidney biomarker to creatinine in the estimation of glomerular filtration rate (eGFR). The National Kidney Foundation and American Society of Nephrology have called for increased use of cystatin C in the evaluation of kidney function. Our institution brought cystatin C testing in-house in August 2021. The goal of this study was to evaluate the utilization and longitudinal ordering trends of cystatin C within our quaternary care health system. Methods Cystatin C is measured on a Roche cobas® c502 using an assay traceable to IFCC-certified reference material. The electronic health record system (Epic) was queried using Epic SlicerDicer to identify ordering trends within our academic medical center between July 2021 and January 2024. The frequency of unique (one-time) cystatin C orders and concomitant orders with creatinine was also conducted. An in-depth analysis and chart review was performed over a one-month period to evaluate ordering locations, underlying clinical conditions, including previous diagnosis of kidney disease, and correlations between cystatin C and creatinine measurements. Results Between July 2021 and January 2024, 11,577 tests were performed from 8,415 unique patients. Cystatin C orders remained stable since April 2022, with an average 370 orders (363-378) per month. Eighty percent of cystatin C test requests were accompanied with creatinine testing during the same encounter. In a detailed analysis of a one month period, cystatin C testing was primarily performed in patients with an existing diagnosis of kidney disease (66%) and in the evaluation of renal function in patients with a cancer diagnosis (23%). Conclusions There has been sustained adoption of cystatin C by providers at our institution. The majority of orders have occurred in patients with an underlying renal diagnosis, as well as comorbid or chronic conditions that may affect kidney function.

The current diagnosis and treatment situation of rare disease in the pediatric intensive care unit

Objective: To analyze the diagnosis and treatment of children with rare diseases in the pediatric intensive care unit (PICU), the distribution of disease types and populations, clinical characteristics, and the use of orphan drugs. Methods: A retrospective case summary was conducted. Data were collected from 105 children aged 29 days to <18 years with a confirmed diagnosis of rare diseases according to the "First Batch of Rare Disease Catalogue in China" who were admitted to the PICU of Beijing Children's Hospital, Capital Medical University from January 2020 to December 2022. Data including general information, auxiliary examinations, and treatment details for each patient were collected from the hospital's electronic medical record system. Patients were divided into age groups: infancy (29 days to<1 year), early childhood (1 to <3 years), preschool age (3 to<7 years), school age (7 to<13 years), and adolescence (13 to<18 years). The chi-square test was used to compare gender distribution differences among various rare diseases. Results: A total of 105 patients with 130 cases meeting the diagnostic criteria were included, accounting for 4.7% (130/2 754) of the total admissions to the PICU. The age at PICU admission was 5.3 (0.8, 9.5) years and there were 81 cases in male. The 3 most common types of diseases were endocrine, nutritional, and metabolic diseases (37 cases); followed by neurological disorders(32 cases); and congenital malformations, deformities, and chromosomal abnormalities(17 cases). The 5 most common rare diseases were methylmalonic acidemia (14 cases), mitochondrial encephalomyopathy (14 cases), atypical hemolytic uremic syndrome (12 cases), autoimmune encephalitis (12 cases), and idiopathic cardiomyopathy (9 cases). The distributions of common rare diseases varied among different age groups. In infants, atypical hemolytic uremic syndrome was most common (6 children). There was no statistically significant difference regarding gender among children with mitochondrial encephalomyopathy (13.6% (11/81) vs. 6.1% (3/49), χ2=1.77, P=0.184). Respiratory failure (36 cases) was the primary reason for rare diseases children to be admitted to the PICU. A total of 95 cases underwent mechanical ventilation, 39 cases received multidisciplinary collaborative diagnosis and treatment, and only 6 children received orphan drug therapy during their stay in the PICU. Conclusions: Rare diseases are not uncommon in PICU. Endocrine, nutritional and metabolic disorders, neurological disorders, congenital malformations, deformities, and chromosomal abnormalities were common. Methylmalonic acidemia, mitochondrial encephalomyopathy, atypical hemolytic uremic syndrome and autoimmune encephalitis have higher cases. Many children with rare diseases in the PICU have complex conditions those are challenging to treat, requiring multidisciplinary collaboration. The utilization rate of orphan drugs among children with rare diseases in PICU needs to be improved.

ID: 325628 The Brain Interchange System for preclinical ECoG recording and stimulation research in the ovine model

ID: 325628 The Brain Interchange System for preclinical ECoG recording and stimulation research in the ovine model

Hip Fracture Management in a Major Trauma Centre: The Impact of 'Smart Phrase' Integration Into Electronic Clerking on Culture and Adherence to Guidelines.

The National Institute for Health and Care Excellence (NICE) introduced guidelines in 2011 for the management of hip fractures in patients over the age of 65. NICE CG124 recommended different procedures depending on the demographics of the patient and fracture pattern. In terms of compliance in 2019, Addenbrooke's Hospital (ADH) was found to be in line with the national average, although room for improvement was noted. The aim of this study was to identify and address areas of substantial non-compliance at ADH. A total of 1636 patients who sustained a hip fracture between 2017 and 2020 and who subsequently underwent surgery at ADH were retrospectively analysed. We collected data from the National Hip Fracture Database (NHFD), digital medical records, and digital imaging systems. We then amended the clerking proforma by adding a 'smart phrase' and re-analysed another 543 patients who attended ADH following hip fracture between 2021 and 2022, using the same data collection methods. From 2017-2020, total adherence to CG124, Section 1.6, was 76.04%. Our results demonstrated that 56.43% of all hip fracture patients indicated for total hip arthroplasty (THA) did not have documented consideration for the procedure. In 2021-22, following the addition of our 'smart phrase,' we made to the clerking proforma, total adherence improved to 87.43%, with only 42.11% of THA-indicated patients lacking documented consideration of the procedure, down from 65.41% in 2020. The use of our smart phrase decreased during the follow-up without a corresponding drop in compliance. In January 2023, NICE CG124 underwent changes, rendering our ADH changes outdated. However, we have demonstrated that we can increase NICE guideline compliance by standardising and encouraging formal documentation of the decision-making process. As electronic patient record (EPR) systems become more widespread, we have shown how 'smart phrases' can be used to generate change and increase compliance, even over a short period of time.

AN ETHEREUM-BASED ELECTRONIC HEALTH RECORD SYSTEM WITH SQL QUERY SUPPORT

Blockchains’ power of decentralization, immutability, and transparency has found its application in many fields. The blockchain is an append-only structure. As the blockchain grows, accessing blocks from the past in an efficient manner has become a challenging task. Further, blockchains were not initially envisioned to be read-heavy systems. With the passage of time, more and more applications are using blockchains and therefore blockchains need to provide active support for high read loads concerning the history state as well. To facilitate data querying in blockchain, we have proposed an SQL query processing feature in the Ethereum blockchain through a decentralized application. More specifically, we build an Ethereum-based Electronic Health Record (EHR) system with SQL query support. The following approaches for query processing have been explored and implemented: (i) linearly scanning blockchain, (ii) scanning only from a user-specified block, (iii) replication in database, (iv) indexing in a database, and (v) using smart contracts. Our timing analysis across these implementations reveals that the smart contracts-based approach has reasonable performance gains compared the other approaches.

Use of implementation mapping to develop a multifaceted implementation strategy for an electronic prospective surveillance model for cancer rehabilitation

BackgroundElectronic Prospective Surveillance Models (ePSMs) remotely monitor the rehabilitation needs of people with cancer via patient-reported outcomes at pre-defined time points during cancer care and deliver support, including links to self-management education and community programs, and recommendations for further clinical screening and rehabilitation referrals. Previous guidance on implementing ePSMs lacks sufficient detail on approaches to select implementation strategies for these systems. The purpose of this article is to describe how we developed an implementation plan for REACH, an ePSM system designed for breast, colorectal, lymphoma, and head and neck cancers.MethodsImplementation Mapping guided the process of developing the implementation plan. We integrated findings from a scoping review and qualitative study our team conducted to identify determinants to implementation, implementation actors and actions, and relevant outcomes. Determinants were categorized using the Consolidated Framework for Implementation Research (CFIR), and the implementation outcomes taxonomy guided the identification of outcomes. Next, determinants were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy of strategies using the CFIR-ERIC Matching Tool. The list of strategies produced was refined through discussion amongst our team and feedback from knowledge users considering each strategy’s feasibility and importance rating via the Go-Zone plot, feasibility and applicability to the clinical contexts, and use among other ePSMs reported in our scoping review.ResultsOf the 39 CFIR constructs, 22 were identified as relevant determinants. Clinic managers, information technology teams, and healthcare providers with key roles in patient education were identified as important actors. The CFIR-ERIC Matching Tool resulted in 50 strategies with Level 1 endorsement and 13 strategies with Level 2 endorsement. The final list of strategies included 1) purposefully re-examine the implementation, 2) tailor strategies, 3) change record systems, 4) conduct educational meetings, 5) distribute educational materials, 6) intervene with patients to enhance uptake and adherence, 7) centralize technical assistance, and 8) use advisory boards and workgroups.ConclusionWe present a generalizable method that incorporates steps from Implementation Mapping, engages various knowledge users, and leverages implementation science frameworks to facilitate the development of an implementation strategy. An evaluation of implementation success using the implementation outcomes framework is underway.