Patient Record Analysis Research Articles

ThP3.9 - Direct to PET-CT in oesophagogastric cancers: A pilot project at a tertiary upper gastrointestinal surgical referral centre

Abstract Background Oesophageal cancer contributes to 18% of cancer mortalities worldwide. The aim of this pilot project was to offer direct positron emission tomography- computed tomography (PET-CT) imaging and observe any differences in time to investigation and treatment in the cohorts. Methods Patients referred with a diagnosis of oesophageal cancer between 1st January 2022 to 31st December 2022 were included. Data was collected from the electronic patient record and retrospective analysis was performed using Microsoft Excel. Results A total of 189 patients with OG cancer were included. There were 89 local and 100 network patients. Median age was 71[range 37 – 93]. Locally male female ratio was 52:37 and in the network 73:27 [“p” 0.03]. Of 35 patients who had direct PET-CT (A) 31(88%) were local and 4(12%) from the network. Among 115 patients who had a CT followed by PET scan (B) 29(25%) were local and 86 (75%) from the network [ “p” 0.00001]. Waiting times were 27 days for a PET-CT as compared to 32 days for PET after CT scan [ “p” 0.09]. Reports were available in a median 4 days in group A compared to 3.5 days in group B [ “p” 0.66]. In group A 12 (35%) had metastases with nodal metastases in 9(75%) and distant metastases in 3(25%). Conclusion Whilst direct to PET-CT improved patient experience there were no statistically significant differences in the time to investigations and treatment. Three patients with distant metastases offered direct PET-CT could have been diagnosed by CT.

Multi-head CRF classifier for biomedical multi-class named entity recognition on Spanish clinical notes.

The identification of medical concepts from clinical narratives has a large interest in the biomedical scientific community due to its importance in treatment improvements or drug development research. Biomedical named entity recognition (NER) in clinical texts is crucial for automated information extraction, facilitating patient record analysis, drug development, and medical research. Traditional approaches often focus on single-class NER tasks, yet recent advancements emphasize the necessity of addressing multi-class scenarios, particularly in complex biomedical domains. This paper proposes a strategy to integrate a multi-head conditional random field (CRF) classifier for multi-class NER in Spanish clinical documents. Our methodology overcomes overlapping entity instances of different types, a common challenge in traditional NER methodologies, by using a multi-head CRF model. This architecture enhances computational efficiency and ensures scalability for multi-class NER tasks, maintaining high performance. By combining four diverse datasets, SympTEMIST, MedProcNER, DisTEMIST, and PharmaCoNER, we expand the scope of NER to encompass five classes: symptoms, procedures, diseases, chemicals, and proteins. To the best of our knowledge, these datasets combined create the largest Spanish multi-class dataset focusing on biomedical entity recognition and linking for clinical notes, which is important to train a biomedical model in Spanish. We also provide entity linking to the multi-lingual Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) vocabulary, with the eventual goal of performing biomedical relation extraction. Through experimentation and evaluation of Spanish clinical documents, our strategy provides competitive results against single-class NER models. For NER, our system achieves a combined micro-averaged F1-score of 78.73, with clinical mentions normalized to SNOMED CT with an end-to-end F1-score of 54.51. The code to run our system is publicly available at https://github.com/ieeta-pt/Multi-Head-CRF. Database URL: https://github.com/ieeta-pt/Multi-Head-CRF.

Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis.

Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities.

Factors associated with sexual dysfunctions in Nairobi, Kenya.

Background: Sexual dysfunctions are associated with comorbidities, which can be the cause or theresult of the dysfunctions. Little research has been done to document comorbidities in Kenya. This studydocumented comorbidities associated with sexual dysfunctions in patients treated at the Sexology Clinicin Nairobi.Objective: To provide health service providers with evidence on what to investigate when patientspresent with sexual dysfunctions so that treatment is directed to the root causes.Methods: Quantitative retrospective analysis of records of patients presenting with sexual dysfunctionswas performed at the Sexology Clinic in Nairobi. Records analysis of patients’ files seen at the clinic for12 months were analyzed. A total of 396 files were reviewed (362 males and 34 females) using astandard tool. Biopsychosocial factors and treatment correlations were performed.Results: The commonest comorbidities in male sexual dysfunctions were metabolic diseases comprisinghypertension (19%), hyperlipidemia (17%), diabetes (14%), and obesity (9%). Hormonal disorders werealso common, with testosterone deficiency being the leading factor at 16% followed byhyperprolactinemia and thyroid hormone disorders each at 2% of all male dysfunctions. Medicines usedin treating metabolic disorders also adversely affect sexual function in males. Conversely, the mostcommon comorbidities in female sexual dysfunction were menopause and female genital cutting. In bothmales and females, comorbidities included infertility, cancer and its treatment, and psychological orpsychiatric problems. Sleep deprivation, alcohol and drug abuse, stressful lifestyles, and relationshipdisharmony were associated with sexual dysfunction in both sexes.Conclusions: Lifestyle diseases are commonly associated with sexual dysfunctions, which could beindicators for lifestyle diseases.Recommendations: Service providers should use sexual dysfunctions as an entry point for full patientassessment for commonly associated disease conditions.

Clinical-epidemiological characteristics and medical record analysis of patients with systemic arterial hypertension in primary health care

Clinical-epidemiological characteristics and medical record analysis of patients with systemic arterial hypertension in primary health care

Effectiveness and Tolerability of 12-Month Brivaracetam in the Real World: EXPERIENCE, an International Pooled Analysis of Individual Patient Records.

Real-world evidence studies of brivaracetam (BRV) have been restricted in scope, location, and patient numbers. The objective of this pooled analysis was to assess effectiveness and tolerability of brivaracetam (BRV) in routine practice in a large international population. EXPERIENCE/EPD332 was a pooled analysis of individual patient records from multiple independent non-interventional studies of patients with epilepsy initiating BRV in Australia, Europe, and the United States. Eligible study cohorts were identified via a literature review and engagement with country lead investigators, clinical experts, and local UCB Pharma scientific/medical teams. Included patients initiated BRV no earlier than January 2016 and no later than December 2019, and had ≥6 months of follow-up data. The databases for each cohort were reformatted and standardised to ensure information collected was consistent. Outcomes included ≥50% reduction from baseline in seizure frequency, seizure freedom (no seizures within 3 months before timepoint), continuous seizure freedom (no seizures from baseline), BRV discontinuation, and treatment-emergent adverse events (TEAEs) at 3, 6, and 12 months. Patients with missing data after BRV discontinuation were considered non-responders/not seizure free. Analyses were performed for all adult patients (≥16 years), and for subgroups by seizure type recorded at baseline; by number of prior antiseizure medications (ASMs) at index; by use of BRV as monotherapy versus polytherapy at index; for patients who switched from levetiracetam to BRV versus patients who switched from other ASMs to BRV; and for patients with focal-onset seizures and a BRV dose of ≤200mg/day used as add-on at index. Analysis populations included the full analysis set (FAS; all patients who received at least one BRV dose and had seizure type and age documented at baseline) and the modified FAS (all FAS patients who had at least one seizure recorded during baseline). The FAS was used for all outcomes other than ≥50% seizure reduction. All outcomes were summarised using descriptive statistics. Analyses included 1644 adults. At baseline, 72.0% were 16-49 years of age and 92.2% had focal-onset seizures. Patients had a median (Q1, Q3) of 5.0 (2.0, 8.0) prior antiseizure medications at index. At 3, 6, and 12 months, respectively, ≥50% seizure reduction was achieved by 32.1% (n=619), 36.7% (n=867), and 36.9% (n=822) of patients; seizure freedom rates were 22.4% (n=923), 17.9% (n=1165), and 14.9% (n=1111); and continuous seizure freedom rates were 22.4% (n=923), 15.7% (n=1165), and 11.7% (n=1111). During the whole study follow-up, 551/1639 (33.6%) patients discontinued BRV. TEAEs since prior visit were reported in 25.6% (n=1542), 14.2% (n=1376), and 9.3% (n=1232) of patients at 3, 6, and 12 months, respectively. This pooled analysis using data from a variety of real-world settings suggests BRV is effective and well tolerated in routine clinical practice in a highly drug-resistant patient population.

The importance of context—a qualitative study exploring healthcare practitioners’ experiences of working with patients at home after a stroke

BackgroundStroke significantly impacts individuals, leading to the need for long-lasting rehabilitation and adaptation to environmental demands. Rehabilitation after stroke is increasingly performed in patients’ homes, and it is argued that rehabilitation in this context is more person-centred and positively impacts client outcomes. However, the role of environmental factors in this process is largely unknown. The aim of this study was to explore how multidisciplinary healthcare practitioners working with rehabilitation in the home after stroke consider possibilities and challenges in the environment and how environmental factors are documented in patients’ records.MethodsEight multidisciplinary healthcare practitioners working with home-based rehabilitation after stroke participated in two semistructured focus group sessions. Thematic analysis was used to analyse the transcripts of recorded focus group discussions. Data were also collected from patient history records (N = 14) to identify interventions to increase patients’ opportunities to participate in activities inside and outside the home. These records were analysed using life-space mobility as a conceptual framework.ResultsThe analysis generated four overarching themes concerning possibilities and challenges in the environment: (1) the image of rehabilitation conflicts with place, (2) the person in the home reveals individual needs and capabilities, (3) environmental characteristics influence the rehabilitation practice, and (4) the person is integrated within a social context. The patient record analysis showed that most patients were discharged from hospital to home within four days. Assessments at the hospital mainly focused on basic activities of daily living, such as the patient’s self-care and walking ability. Also at home, the assessments and actions primarily focused on basic activities with little focus on participation in meaningful activities performed in different life situations outside the home.ConclusionsOur research suggests that one way to improve practice is to include the environment in the rehabilitation and consider the person´s life space. Interventions should focus on supporting out-of-home mobility and activities as part of person-centred stroke rehabilitation. This must be supported by clear documentation in the patient records to strengthen clinical practice as well as the communication between stakeholders.

Biomarker testing in patients diagnosed with advanced/metastatic medullary thyroid cancer in the USA.

Aim: To describe real-world testing patterns for RET in US patients with advanced/metastatic medullary thyroid cancer and determine consistency of real-world testing practices with national guidelines. Materials & methods: The authors performed a retrospective medical record analysis of patients with advanced/metastatic medullary thyroid cancer who initiated systemic therapy between 2013 and 2018. Seventy-five US-based oncologists collected the data using a customized electronic data collection form. Results: Atotal of 59.6% (121 of 203) of patients underwent testing for RET, and 37.2% (45 of 121) had a RET mutation, of which 55.6% were identified as RET mutation-positive before initial diagnosis. Overall, 90 (44.3%) patients were tested for biomarkers on or after initial diagnosis, with RET being the most tested (95.6%) biomarker. Conclusion: The authors' findings suggest an opportunity to improve testing rates in accordance with treatment guidelines.

Generative Artificial Intelligence-driven Healthcare Systems in Patient Record Analysis, in Disease Diagnosis and Monitoring, and in Customized Treatment Plans

Generative Artificial Intelligence-driven Healthcare Systems in Patient Record Analysis, in Disease Diagnosis and Monitoring, and in Customized Treatment Plans

Analysis of treatment sequence and outcomes in patients with relapsed malignant peripheral nerve sheath tumors.

Malignant peripheral nerve sheath tumors (MPNST) are aggressive soft tissue sarcomas originating from cellular components within the nerve sheath. The incidence of MPNST is highest in people with neurofibromatosis type 1 (NF1), and MPNST is the leading cause of death for these individuals. Complete surgical resection is the only curative therapeutic option, but is often unfeasible due to tumor location, size, or presence of metastases. Evidence-based choices of chemotherapy for recurrent/refractory MPNST remain elusive. To address this gap, we conducted a retrospective analysis of our institutional experience in treating patients with relapsed MPNST in order to describe patient outcomes related to salvage regimens. We conducted a retrospective electronic health record analysis of patients with MPNST who were treated at Johns Hopkins Hospital from January 2010 to June 2021. We calculated time to progression (TTP) based on salvage chemotherapy regimens. Sixty-five patients were included in the analysis. Upfront therapy included single or combined modalities of surgery, chemotherapy, or radiotherapy. Forty-eight patients received at least 1 line of chemotherapy, which included 23 different regimens (excluding active clinical studies). Most patients (n = 42, 87.5%) received a combination of doxorubicin, ifosfamide, or etoposide as first-line chemotherapy. Salvage chemotherapy regimens and their TTP varied greatly, with irinotecan/temozolomide-based regimens having the longest average TTP (255.5 days, among 4 patients). Patients with advanced or metastatic MPNST often succumb to their disease despite multiple lines of therapy. These data may be used as comparative information in decision-making for future patients and clinical trials.

A Breakthrough Improvement Collaborative Significantly Reduces Hospital Stay After Elective Colectomy for Cancer Across a Healthcare System.

Objective:This multicenter study aimed to assess (1) the effect of an improvement collaborative on enhanced recovery after surgery (ERAS) protocol adherence after elective colectomy and (2) the association between adherence and patient outcomes.Background:ERAS pathways provide a framework to standardize care processes and improve postoperative outcomes in patients after colon surgery. Despite growing evidence of its effectiveness, adherence to these guidelines remains a challenge.Methods:This prospective, multicenter collaborative was initiated throughout 11 hospitals in Flanders, Belgium. A structured audit tool was used to study patient outcomes and adherence to 12 ERAS components, defined by the collaborative. Three retrospective audits (based on patient record analysis) were conducted in 2017, 2019, and 2021, respectively.Results:Overall, 740 patients were included (45.4% female; mean±SD age, 71±12 years). The overall adherence increased from 42.8% in 2017 to 58.4% in 2019 and 69.2% in 2021. Compared with low adherence, length of stay was increasingly reduced by 1.3 days for medium [95% confidence interval (95% CI): −2.5; 0.0], 3.6 days for high (95% CI: −4.9; −2.2), and up to 4.4 days for very high adherence (95% CI: −6.1; −2.7). Corresponding odds ratios for postoperative complications were 0.62 (95% CI: 0.33; 1.17), 0.19 (95% CI: 0.09; 0.43), and 0.14 (95% CI: 0.05; 0.39), respectively. No increase in 30-day readmissions was observed.Conclusions:A peer-constructed improvement collaborative effectively increases adherence to an ERAS protocol in individual hospitals. Across time, length of stay and postoperative complications decreased significantly, and a dose-response relationship was observed.

Shortcomings of Administrative Data to Derive Preventive Strategies for Inhospital Drug-Induced Acute Kidney Failure-Insights from Patient Record Analysis.

Structured analyses of hospital administrative data may detect potentially preventable adverse drug events (ADE) and therefore are considered promising sources to prevent future harm and estimate cost savings. Whether results of these analyses indeed correspond to ADE that may be preventable in clinical routines needs to be verified. We exemplarily screened all adult inpatients admitted to a German University Hospital (n = 54,032) for International Classification of Diseases-10th revision (ICD-10) diagnoses coding for drug-induced kidney injury (AKI). In a retrospective chart review, we checked the coded adverse events (AE) for inhospital occurrence, causality to drug exposure, and preventability in all identified cases and calculated positive predictive values (ppv). We identified 69 inpatient cases of whom 41 cases (59.4%) experienced the AE in the hospital (ppv-range 0.43–0.80). Causality assessment revealed a rather likely causal relationship between AE and drug exposure in 11 cases (15.9, 11/69, ppv-range 0.17–0.22) whereby preventability measures could be postulated for seven cases (10.1%, 7/69). Focusing on drug-induced AKI, this study exemplarily underlines that ICD-10-code-based ADE prevention efforts are quite limited due to the small identification rate and its high proportion of primarily outpatient events. Furthermore, causality assessment revealed that cases are often too complex to benefit from generic prevention strategies. Thus, ICD-10-code-based calculations might overestimate patient harm and economic losses.

Mendelian steroid resistant nephrotic syndrome in childhood: is it as common as reported?

Primary steroid resistant nephrotic syndrome (SRNS) is thought to have either genetic or immune-mediated aetiology. Knowing which children to screen for genetic causes can be difficult. Several studies have described the prevalence of genetic causes of primary SRNS to be between 30 and 40%, but these may reflect a selection bias for genetic testing in children with congenital, infantile, syndromic or familial NS and thus may overestimate the true prevalence in a routine clinical setting. Retrospective electronic patient record analysis was undertaken of all children with non-syndromic SRNS and presentation beyond the first year of life, followed at our centre between 2005 and 2020. Of the 49 children who met the inclusion criteria, 5 (10%) had causative variants identified, predominantly in NPHS2. None responded to immunosuppression. Of the 44 (90%) who had no genetic cause identified, 33 (75%) had complete or partial remission after commencing second-line immunosuppression and 67% of these had eGFR > 90ml/min/1.73 m2 at last clinical follow-up. Of the children who did not respond to immunosuppression, 64% progressed to kidney failure. In our cohort of children with non-syndromic primary SRNS and presentation beyond the first year of life, we report a prevalence of detectable causative genetic variants of 10%. Those with identified genetic cause were significantly (p = 0.003) less likely to respond to immunosuppression and more likely (p = 0.026) to progress to chronic kidney disease. Understanding the genetics along with response to immunosuppression informs management in this cohort of patients and variant interpretation. A higher resolution version of the Graphical abstract is available as Supplementary information.

IDF21-0515 Clinical characteristics of T2DM patients diagnosed with HFpEF: An Indian pilot survey

Background: Heart failure with preserved ejection fraction (HFpEF) represents a significant unmet medical need and is associated with poor outcomes. Registry evidence suggests a mortality-rate of 40.8% at 3 years, in Indian patients with HFpEF. Timely diagnosis of HFpEF in patients with predisposing factors and indicators, is essential in improving care. Aim: The clinical profile of patients with HFpEF, is known to be different in South-Asian patients, as compared to other Asian or global population. This is a real-world analysis of patients with T2DM and co-existing HFpEF, in the Indian diabetes outpatient-setting. Method: A cross-sectional analysis of patient-records was performed across 3 diabetes outpatient departments across the cities of Kolkata and Mumbai, in India. Records of patients with T2DM and HFpEF, as defined in the recent guidelines were included for analysis. Clinical characteristics of patients were descriptively analyzed. For categorical variables, unpaired t-test was used, whereas for non-parametric variables, odds ratio was estimated. Results: Records of 99 patients with HFpEF and T2DM, were available for analysis. The age ranged from 45 to 87 years, with average age being 66.3 (SD 9.3) years. 22% of patients were aged <60 years. 48% of patients were females. Of the 97 patients with available information for duration of diabetes, the average duration was 14.1 (SD 7.6) years. 26% patients had T2DM of <10 years’ duration. The average BMI was 26.7 (SD 4.8) kg/m2. 57% of patients were obese. 34% of females and 50% of males had a history of IHD. History of atrial fibrillation was present in 9% of patients. The average age of patients with and without A-Fib was 72.7 (SD 6.0) years, and 65.7 (SD 9.4) years, respectively; the difference in mean was significant (p = 0.034). Mean SBP was 140.5 (SD 19.0) mmHg. SBP level of ≥130 mmHg was observed in 76% of patients, and ≥140 mmHg was observed in 53.5% of patients. The average NT-proBNP LEVEL was 1235.4 pg/mL. The NT-proBNP levels ranged from 51 to 23000 pg/mL. 44 (47%) had eGFR level <60 mL/min/1.73m2. Average HbA1c level was 8.1% (SD 1.95%). 78% of patients had LDL-c level <100 mg/dL, whereas 46% had LDL-c level <70 mg/dL. Discussion: The analysis represents clinical characteristics of patients with HFpEF, in the clinical setting of T2DM in India. Despite HFpEF being strongly associated with old age, we observed at-least 1 in 5 patients to be <60 years old. Of note, 43% of patients with HFpEF were not obese. Blood-pressure control remained inadequate, despite good control of HbA1c and LDL-cholesterol levels. It is essential to suspect and screen for underlying HFpEF in patients having these comorbidities with T2DM, and to aggressively manage the risk-factors, keeping in mind the possible inconsistencies like younger-age or lower BMI in substantial number of patients.

The outcome of radiocephalic after brachiocephalic and redo arteriovenous fistula.

Introduction:When created in appropriately selected patients, arteriovenous fistula requires fewer interventions and costs compared to arteriovenous graft. The outcome of radiocephalic after brachiocephalic and redo arteriovenous fistula is not studied well in the literature, and this study highlights the outcome of these arteriovenous fistulae.Methods:The retrospective, single-center study, based on patient record analysis of 1040 arteriovenous fistula, was created between January 2017 and October 2021. Thirty-nine (3.37%) patients met the inclusion criteria for radiocephalic after brachiocephalic arteriovenous fistula group, and 42 (4.04%) met the inclusion criteria for the redo arteriovenous fistula group. Preoperative Doppler ultrasound was performed by the operating surgeon in all patients. All patients were scheduled for a visit 2 months after surgery for assessment—only 34 of radiocephalic after brachiocephalic arteriovenous fistula and 35 of redo arteriovenous fistula patients presented for follow-up. The arteriovenous fistula was assessed for patency, maturation, and complications. SPSS version 22 (Chicago, USA) was used for data entry and analysis.Results:The redo arteriovenous fistula has a significantly lower maturation rate at 2 months of follow-up (62.85%) when compared to other brachiocephalic arteriovenous fistula (79.18%) (p-value = 0.0245). The radiocephalic after brachiocephalic arteriovenous fistula has no significant difference in maturation rate at 2 months of follow-up (61.67%) when compared to other distal forearms radiocephalic arteriovenous fistula (68.18%) (p-value = 0.5173). The incidence of some early complications was higher in the redo group.Conclusion:The feasibility of doing radiocephalic arteriovenous fistula after failed brachiocephalic arteriovenous fistula is generally overlooked. The redo arteriovenous fistula is more technically challenging, associated with higher complications, but it provides reliable access in a specific group of patients.

Team Dynamics in Hospital Workflows: An Exploratory Study of a Smartphone Task Manager.

BackgroundAlthough convenient and reliable modern messaging apps like WhatsApp enable efficient communication among hospital staff, hospitals are now pivoting toward purpose-built structured communication apps for various reasons, including security and privacy concerns. However, there is limited understanding of how we can examine and improve hospital workflows using the data collected through such apps as an alternative to costly and challenging research methods like ethnography and patient record analysis.ObjectiveWe seek to identify whether the structure of the collected communication data provides insights into hospitals’ workflows. Our analysis also aims to identify ways in which task management platforms can be improved and designed to better support clinical workflows.MethodsWe present an exploratory analysis of clinical task records collected over 22 months through a smartphone app that enables structured communication between staff to manage and execute clinical workflows. We collected over 300,000 task records between July 2018 and May 2020 completed by staff members including doctors, nurses, and pharmacists across all wards in an Australian hospital.ResultsWe show that important insights into how teams function in a clinical setting can be readily drawn from task assignment data. Our analysis indicates that predefined labels such as urgency and task type are important and impact how tasks are accepted and completed. Our results show that both task sent-to-accepted (P<.001) and sent-to-completed (P<.001) times are significantly higher for routine tasks when compared to urgent tasks. We also show how task acceptance varies across teams and roles and that internal tasks are more efficiently managed than external tasks, possibly due to increased trust among team members. For example, task sent-to-accepted time (minutes) is significantly higher (P<.001) for external assignments (mean 22.10, SD 91.45) when compared to internal assignments (mean 19.03, SD 82.66).ConclusionsSmartphone-based task assignment apps can provide unique insights into team dynamics in clinical settings. These insights can be used to further improve how well these systems support clinical work and staff.

Acute kidney injury in patients with Visceral Leishmaniasis in Northwest Ethiopia.

Visceral Leishmaniasis (VL) is a neglected tropical disease endemic to several countries including Ethiopia. Outside of Africa, kidney involvement in VL is frequent and associated with increased mortality. There is however limited data on acute kidney injury (AKI) in VL patients in East-Africa, particularly in areas with high rates of HIV co-infection. This study aims to determine the prevalence, characteristics and associated factors of AKI in VL patients in Northwest Ethiopia. A hospital based retrospective patient record analysis was conducted including patients treated for VL from January 2019 to December 2019 at the Leishmaniasis Research and Treatment Center (LRTC), Gondar, Ethiopia. Patients that were enrolled in ongoing clinical trials at the study site and those with significant incomplete data were excluded. Data was analyzed using SPSS version 20. P values were considered significant if < 0.05. Among 352 VL patients treated at LRTC during the study period, 298 were included in the study. All were male patients except two; the median age was 23 years (IQR: 20-27). The overall prevalence of AKI among VL patients was 17.4% (confidence interval (CI): 13.6%-22.2%). Pre-renal azotemia (57%) and drug-induced AKI (50%) were the main etiologies of AKI at admission and post-admission respectively. Proteinuria and hematuria occurred in 85% and 42% of AKI patients respectively. Multivariate logistic regression revealed HIV co-infection (adjusted odds ratio (AOR): 6.01 95% CI: 1.99-18.27, p = 0.001) and other concomitant infections (AOR: 3.44 95% CI: 1.37-8.65, p = 0.009) to be independently associated with AKI. AKI is a frequent complication in Ethiopian VL patients. Other renal manifestations included proteinuria, hematuria, and pyuria. HIV co-infection and other concomitant infections were significantly associated with AKI. Further studies are needed to quantify proteinuria and evaluate the influence of AKI on the treatment course, morbidity and mortality in VL patients.

Are the patients with drug sensitive tuberculosis screened for ocular manifestations? A five year analysis from a medical college hospital of Karnataka, India

BackgroundEarly diagnosis and prompt treatment may be sight-saving in patients with Ocular Tuberculosis (TB). Patients on anti tubercular treatment (ATT) also need ophthalmological examination at the start of the treatment and monitoring for toxic optic neuropathy regularly till the completion of treatment. This study is a situation analysis of the referral rates to ophthalmologist and clinical presentations of ocular TB among patients admitted with drug sensitive tuberculosis (DS TB). MethodsA five year record analysis (2013–2017) of patients admitted with DS TB in a medical college hospital setting was done. Demographic and clinical presentations of the patients were recorded. The details about the referral, clinical findings, any possible risk associated with ocular TB and ocular side effects of ATT were noted. Data was entered in Microsoft excel and analysed for descriptive statistics. ResultsAmong 225 inpatients, only 72 (32%) patients were referred to ophthalmologist. The referral rates increased over the period of five years. Intra ocular TB was diagnosed among 11 (15.3%) patients. Only 5 patients among these had complained of reduced vision and others were asymptomatic. ConclusionThe referral of DS TB patients to ophthalmologist was sub optimal. All the DSTB cases need ophthalmic evaluation keeping in mind the possibility of ocular TB and also the adverse effects of ATT.

Evaluation of Elastomeric Impression in Fixed Partial Denture-A Retrospective Analysis of Patient Records

Evaluation of Elastomeric Impression in Fixed Partial Denture-A Retrospective Analysis of Patient Records

Impact of Enhanced Recovery After Bariatric Surgery (ERABS) Protocol in Reducing Length of Stay and Hospitalization Costs: the Experience of a Philanthropic Hospital in Brazil.

The global prevalence of obesity and increase in bariatric surgeries are burdening the healthcare system. Enhanced recovery postoperative protocols are associated with a reduction in hospitalization costs and length of stay (LOS) and may be an alternative to reduce public health expenses. To assess the impact of implementing a customized Enhanced Recovery After Bariatric Surgery (ERABS) protocol on hospitalization costs (HC), LOS, and complication rates. Santa Marcelina Hospital, São Paulo, Brazil. A retrospective electronic health record analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy and who were cared for within a clinical pathway (CP) protocol (Jan. 2016-Aug. 2018) or after implementation of an ERABS protocol (Aug. 2018-Jun. 2019). The LOS, HC, and complication, readmission, and reoperation rates were compared between the two groups. Eighty-two patients were included in the study (CP, 56, 87.5% women; ERABS, 26, 92.3% women). Hospital LOS and total HC decreased significantly by 32.5% and 15.2%, respectively (both, p < 0.05), after implementation of ERABS. There were no significant differences in 30-day readmission, complication, or reoperation rates. The implementation of a standardized enhanced recovery program resulted in reduced LOS and HC without an increase in perioperative morbidity. The ERABS protocol is cost-effective and can help ease the healthcare burden.