Standardized Data Collection Tool Research Articles

Investigating Wilms\u2019 Tumours Worldwide: A Report of the OxPLORE Collaboration\u2014A Cross-Sectional Observational Study

BackgroundChildhood cancer is neglected within global health. Oxford Pediatrics Linking Oncology Research with Electives describes early outcomes following collaboration between low- and high-income paediatric surgery and oncology centres. The aim of this paper is twofold: to describe the development of a medical student-led research collaboration; and to report on the experience of Wilms’ tumour (WT).MethodsThis cross-sectional observational study is reported as per STROBE guidelines. Collaborating centres included three tertiary hospitals in Tanzania, Rwanda and the UK. Data were submitted by medical students following retrospective patient note review of 2 years using a standardised data collection tool. Primary outcome was survival (point of discharge/death).ResultsThere were 104 patients with WT reported across all centres over the study period (Tanzania n = 71, Rwanda n = 26, UK n = 7). Survival was higher in the high-income institution [87% in Tanzania, 92% in Rwanda, 100% in the UK (X2 36.19, p < 0.0001)]. Given the short-term follow-up and retrospective study design, this likely underestimates the true discrepancy. Age at presentation was comparable at the two African sites but lower in the UK (one-way ANOVA, F = 0.2997, p = 0.74). Disease was more advanced in Tanzania at presentation (84% stage III–IV cf. 60% and 57% in Rwanda and UK, respectively, X2 7.57, p = 0.02). All patients had pre-operative chemotherapy, and a majority had nephrectomy. Post-operative morbidity was higher in lower resourced settings (X2 33.72, p < 0.0001). Methodology involving medical students and junior doctors proved time- and cost-effective. This collaboration was a valuable learning experience for students about global research networks.ConclusionsThis study demonstrates novel research methodology involving medical students collaborating across the global south and global north. The comparison of outcomes advocates, on an institutional level, for development in access to services and multidisciplinary treatment of WT.

727 Clinical Epidemiology of Inflammatory Bowel Disease in Los Angeles County: A Study of a Predominantly Latino Population

INTRODUCTION: The body of research pertaining to the epidemiology, features, and treatment of inflammatory bowel disease (IBD) continues to grow; however, relatively little remains known about IBD in minority populations. Hispanics and Blacks have been understudied in most population studies, often comprising &lt;2% of the sample size. This disproportion limits the ability to formulate reliable conclusions regarding ethnoracial influences on incidence, phenotype, severity of disease, and outcomes in these minority groups. To help address this void, we initiated a population-based study of the clinical epidemiology of IBD in Los Angeles County Department of Health Services (LADHS), the second largest municipal healthcare system in the United States. The ethnoracial makeup of the county is comprised predominantly of Latino patients, which provides a unique opportunity to evaluate IBD in a population that has not been well-studied to date. METHODS: We conducted a retrospective cohort study of all biopsy-proven cases of IBD diagnosed between November 2015 and June 2018 at Olive View-UCLA Medical Center, one of three hospitals comprising LADHS. Patient and disease-related data such as age, gender, ethnicity, presenting symptoms and laboratory values, and complications, were collected using a standardized data collection tool and tabulated. RESULTS: One hundred and twenty-six cases of IBD were found, of which 42 were new diagnoses, suggesting an incidence and prevalence of 160 and 481 per 100,000 person-years, respectively. Among these 126 patients, 79% were Latino, with the average age of diagnosis at 36.4 years. 54% of patients were female. The most common diagnosis was ulcerative colitis (43%), with Crohn's and indeterminate colitis making up 29% and 28% of patients, respectively. The most common presenting symptoms were bloody diarrhea and abdominal pain, both of which occurred more frequently in patients diagnosed with Crohn's disease. CONCLUSION: Both the prevalence and incidence in this predominantly Hispanic cohort are significantly higher than reported rates for IBD by the Center of Disease Control (CDC), Furthermore, this cohort appears to have unique clinical characteristics, with UC more common in females, Crohn's disease more common in males, and a large proportion of patients having indeterminate colitis. Further evaluation is needed to better understand the characteristics, etiopathogenesis, and outcomes of IBD, as well as reduce healthcare disparities in this historically understudied population.

A Call to Standardize Definitions, Data Collection, and Outcome Assessment to Improve Care in Alcohol-Related Liver Disease.

Alcohol-related liver disease (ALD) is highly prevalent and appears to be increasingly reported with worsening mortality; thus, optimizing care in this patient population is imperative. This will require a multidisciplinary, multifaceted approach that includes recognizing alcohol use disorder (AUD) and existing treatments for AUD. We must also acknowledge the full spectrum of ALD clinically and histologically. For example, our current clinical definitions of alcohol-related hepatitis (AH) do not address that >95% of severe AH occurs in the setting of cirrhosis with <60% of liver explants having hepatitis. Given that the majority of ALD studies rely on clinical diagnosis and lack pathologic confirmation, prior data on the efficacy of medical treatment or use of transplantation are likely limited by intertrial and intratrial heterogeneity. Added limitations of the current field include the inconsistent reporting of relapse with the use of varying definitions and unreliable assessments. Moreover, studies fail to consistently capture the data variables that likely influence the main outcomes of interest in this population-mortality and relapse-and a global effort to create a standardized data collection tool moving forward could help effectively and efficiently aid in the advancement of this field. Conclusion: To optimize patient care and make best use of a limited resource, a systematic change in the approach to research in this population must be undertaken that creates consistent definitions for use in future research to generate reliable and reproducible results. With this in mind, we concisely reviewed the literature to summarize the current state of treating and managing ALD, the heterogeneity in definitions, and the significant opportunities for clinical and research improvement.

Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study

ObjectiveTo evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes. Study designA multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH < 7.05, the secondary outcomes were the prediction of Apgar scores<7 at 1st and 5th minutes and admission to the neonatal intensive care unit (NICU). We evaluated the correlation between the last FBS blood gas before birth and the umbilical cord blood and adjusted for time intervals. We constructed 2 × 2 tables to calculate the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and generated receiver operating curves to report on the Area Under the Curve (AUC). ResultsIn total, 1422 samples were included in the analysis; pH values showed no correlation (r = 0.001, p = 0.9) in samples obtained within an hour (n = 314), or within half an hour from birth (n = 115) (r=-0.003, p = 0.9). A suboptimal FBS pH value (<7.25) had a poor sensitivity (22%) and PPV (4.9%) to predict neonatal acidaemia with high specificity (87.3%) and NPV (97.4%). Similar performance was noted to predict Apgar scores <7 at 1st (sensitivity 14.5%, specificity 87.5%, PPV 23.4%, NPV 79.6%) and 5th minute (sensitivity 20.3%, specificity 87.4%, PPV 7.6%, NPV 95.6%), and admission to NICU (sensitivity 20.3%, specificity 87.5%, PPV 13.3%, NPV 92.1%). The AUC for FBS pH to predict neonatal acidaemia was 0.59 (95%CI 0.59–0.68, p = 0.3) with similar performance to predict Apgar scores<7 at 1st minute (AUC 0.55, 95%CI 0.51–0.59, p = 0.004), 5th minute (AUC 0.55, 95%CI 0.48–0.62, p = 0.13), and admission to NICU (AUC 0.58, 95%CI 0.52–0.64, p = 0.002).Forty-one neonates had acidaemia (2.8%, 41/1422) at birth. There was no significant correlation in pH values between the FBS and the umbilical cord blood in this subgroup adjusted for sampling time intervals (r = 0.03, p = 0.83). ConclusionsAs an adjunct tool to cardiotocography, FBS offered limited value to predict neonatal acidaemia, low Apgar Scores and admission to NICU.

Advancing Quality (AQ) hip fracture programme: A large scale programme to improve nutritional assessment in people with hip fractures

IntroductionAdvancing Quality (AQ) has high reliability and is effective at reducing unwarranted variation in care programme operated by the Advancing Quality Alliance (AQuA). Established in 2008, AQ aims to support NHS healthcare organisations toimprove the reliability of clinical practices so that every patient consistently receives the highest quality care possible, every time. Our work with dedicated clinical teams and managers aims to improve health outcomes for patients and the population whilst reducing unwarranted variation in highly prevalent conditions. MethodsThe population is identified retrospectively using ICD1-0 codes and a standardised data collection tool is used to assess management of people >60 years of age with a HFR, either on arrival to hospital or during their admission. Results7317 patients had a nutritional screen recorded using the MUST score between January 2015 and December 2016. In hospital mortality for patients receiving nutritional screen within 24 h was 6.1% compared to 9.3% for screens after 24 h, p < 0.001 (Fisher's exact test). Mortality rate for those patients without a risk score recorded was 9.4%.The number of patients receiving nutritional screen within 24 h, improved from 86% to 94%. ConclusionInpatient mortality was significantly lower in patients who had their MUST score within 24 h of admission. This is likely attributed to the improvement of the overall package of care if their assessment is performed early in those patients who are admitted to an orthopaedic or neck of femur ward. An early MUST score identifies nutritional deficiency and those at risk allowing measures can be taken to address malnutrition early during the inpatient stay.

S14.3: Moving maternal immunization forward with standardized definitions and data collection tools

American Journal of Reproductive ImmunologyVolume 81, Issue S1 p. 102-102 ABSTRACTS S14.3: Moving maternal immunization forward with standardized definitions and data collection tools First published: 31 May 2019 https://doi.org/10.1111/aji.43_13122Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume81, IssueS1Special Issue: The 39th Annual Meeting of the American Society for Reproductive Immunology, 12-15 June 2019, Grand Rapids, Michigan, USAMay 2019Pages 102-102 RelatedInformation

P013: A new efficient and accurate scanning protocol for traumatic pneumothorax

Introduction: According to the International Evidence-Based Recommendations for Point-of-Care Lung Ultrasound published in 2012, the sonographic technique for evaluating a patient for a pneumothorax (PTX) “consists of exploration of the least gravitationally dependent areas progressing more laterally” in the supine patient. However, there is a wide variety of scanning protocols in the literature with varying accuracy and complexity. We sought to derive an efficient and accurate scanning protocol for diagnosing pneumothorax using point of care ultrasound in trauma. Methods: We performed a retrospective chart review of a tertiary care trauma registry from Nov 2006 to Aug 2016. We included patients with a PTX diagnosed on computed tomography (CT). Patients were excluded if they did not have an identifiable PTX on the CT scan or if they underwent a tube thoracostomy prior to the CT scan. Penetrating and blunt trauma were eligible. Data were extracted with a standardized data collection tool and 20% of charts reviewed by two reviewers. Pre defined zones were used to map area of PTXs on CT. Sensitivity, specificity and 95% CI are reported for presence of PTXs in each individual or combination of lung zones as identified on CT scan. Results: Data were collection yielded 170 traumatic PTX on chest CT with an average age of 44.2 and 77.8% male. The kappa for data extraction was 0.88. 19.4% of patients had bilateral PTX leading to a total sample size of 203. The average ISS score was 20.7 and 93% of patients survived to discharge. The length of ICU stay and hospital stay was 3.7 and 11.2 days respectively. The most accurate and efficient protocol would involve scanning the inferior border of the clavicle at the para-sternal border and again at the mid-clavicular line down to the cardiac (left hemithorax) and liver lung points (right hemithorax). The sensitivity of this scanning area in the detection of PTXs was 91.6% (95% CI 86.9-95%,). Limiting the area to the most anterior point of the chest wall increased the risk of missing a PTX (Sensitivity 89.7% (95%CI 84.6-93.5)). Conclusion: We have derived an evidence-based standardized accurate and efficient scanning protocol to rule out a pneumothorax on point of care ultrasound.

MP54: The prevalence and pattern of drugs detected in injured drivers in four Canadian provinces

Introduction: Many drugs, including cannabis and alcohol, cause impairment and contribute to motor vehicle collisions (MVCs). Policy makers require knowledge of the prevalence of drug use in crash-involved drivers, and types of drugs used in order to develop effective prevention programs. This issue is particularly relevant with the recent legalization of cannabis. We aim to study the prevalence of alcohol, cannabis, sedating medications, and other drugs in injured drivers from 4 Canadian Provinces. Methods: This prospective cohort study obtained excess clinical blood samples from consecutive injured drivers who attended a participating Canadian trauma centre following a MVC. Blood samples were analyzed using a broad spectrum toxicology screen capable of detecting cannabinoids, cocaine, amphetamines (including their major analogues), and opioids as well as psychotropic pharmaceuticals (including antihistamines, benzodiazepines, other hypnotics, and sedating antidepressants). Alcohol and cannabinoids were quantified. Health records were reviewed to extract demographic, medical, and MVC information using a standardized data collection tool. Results: This study has been collecting data in 4 trauma centres in British Columbia (BC) since 2011 and was launched in 2 trauma centres in Alberta (AB), 1 in Saskatchewan (SK), and 2 in Ontario (ON) in 2018. In preliminary results from BC (n = 2412), 8% of injured drivers tested positive for THC and 13% for alcohol. Preliminary results from other provinces (n = 301) suggest a regional variation in prevalence of drivers testing positive for THC (10% - 27%), alcohol (17% - 29%), and other drugs. By May 2018, an estimated 4500 cases from BC, 600 from AB, 150 from SK, and 650 from ON will have been analyzed. We will report the prevalence of positive tests for alcohol, THC, other recreational drugs, and sedating medications, pre and post cannabis legalization. The number of cases with alcohol and/or THC levels above Canadian per se limits will also be reported. Results will be reported according to province, driver sex, age, single vs. multi vehicle crashes, and requirement for hospital admission. Conclusion: This will be among the largest international datasets on drug use by injured drivers. Our findings will provide patterns of drug and alcohol impairment in 4 Canadian provinces pre and post cannabis legalization. The significance of these findings and implication for impaired driving policy and prevention programs in Canada will be discussed.

MP51: Assessment of predictors of deterioration in mild traumatic brain injury with intracranial hemorrhage at emergency department

Introduction: Mild traumatic brain injury (mTBI) with intracranial hemorrhage (ICH) is a common cause of Emergency Department (ED) visits. Over the past years, several authors have debated the relevance of radiological and clinical follow-up of these patients, as the main challenge is to identify patients at risk of clinical deterioration. Objectives: To determine whether demographic, clinical or radiological variables can predict patient deterioration. Methods: Design: An historical cohort was constituted in two level-1 trauma centers (Chu de Quebec - Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal)). Participants: Medical records of mTBI patients aged ⩾16 with an ICH were reviewed using a standardized data collection tool. Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation. Measures: Deterioration was defined as either death, deterioration of the control CT scan according to the radiologist, clinical deterioration or neurosurgical intervention. Analyses: Logistic regression analyses were performed to ascertain predictors of deterioration. Interobserver agreement was calculated. Results: A total of 274 patients were included in our analyses. Mean age was 60.8 and 68.9% (n = 188) were men. Four variables were found to be associated with all outcomes: radiological deterioration, clinical deterioration, death, and neurosurgical intervention. Diabetes (odds ratio (OR) = 2.6, 95% CI [0.97-6.94]), confusion as an initial symptom (OR = 2.8, 95% CI [1.42-5.61]), anticoagulation (OR = 2.8, 95% CI [1.01-7.84]) and significant subdural hemorrhage (≥4 mm) (OR = 3.4, 95% CI [1.42-5.61]) seen on the first computed tomography scan were strongly associated with these outcomes. Age had a neutral effect (OR = 1.01, 95% CI [0.99-1.03]) while high initial Glasgow Coma score seemed to have a protective effect (OR = 0.4, 95% CI [0.24-0.69]). Radiological deterioration was not systematically associated with clinical deterioration. As for the 46 patients with a deterioration of CT scan, only 30.4% vs. 69.5% without deterioration (p = 0.0035) showed a clinical deterioration. Conclusion: Diabetes, anticoagulation, significant subdural hemorrhage and confusion as an initial symptom seem to be predictors of deterioration following a mild traumatic brain injury with positive CT scan.

P008: Evaluation of outcomes after implementation of a provincial prehospital bypass standard for trauma patients – an Eastern Ontario experience

Introduction: Trauma and injury play a significant role in the population's burden of disease. Limited research exists evaluating the role of trauma bypass protocols. The objective of this study was to assess the impact and effectiveness of a newly introduced prehospital field trauma triage (FTT) standard, allowing paramedics to bypass a closer hospital and directly transport to a trauma centre (TC) provided transport times were within 30 minutes. Methods: We conducted a 12-month multi-centred health record review of paramedic call reports and emergency department health records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness, step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as an urgent transport to hospital, that met one of the 4 steps of the FTT standard and would allow for a bypass consideration. We developed and piloted a standardized data collection tool and obtained consensus on all data definitions. The primary outcome was the rate of appropriate triage to a TC, defined as any of the following: injury severity score ≥12, admitted to an intensive care unit, underwent non-orthopedic operation, or death. We report descriptive and univariate analysis where appropriate. Results: 570 adult patients were included with the following characteristics: mean age 48.8, male 68.9%, attended by Advanced Care Paramedic 71.8%, mechanisms of injury: MVC 20.2%, falls 29.6%, stab wounds 10.5%, median initial GCS 14, mean initial BP 132, prehospital fluid administered 26.8%, prehospital intubation 3.5%, transported to a TC 74.6%. Of those transported to a TC, 308 (72.5%) had bypassed a closer hospital prior to TC arrival. Of those that bypassed a closer hospital, 136 (44.2%) were determined to be “appropriate triage to TC”. Bypassed patients more often met the step 1 or step 2 of the standard (186, 66.9%) compared to the step 3 or step 4 (122, 39.6%). An appropriate triage to TC occurred in 104 (55.9%) patients who had met step 1 or 2 and 32 (26.2%) patients meeting step 3 or 4 of the FTT standard. Conclusion: The FTT standard can identify patients who should be bypassed and transported to a TC. However, this is at a cost of potentially burdening the system with poor sensitivity. More work is needed to develop a FTT standard that will assist paramedics in appropriately identifying patients who require a trauma centre.

Capture-Recapture Among Men Who Have Sex With Men and Among Female Sex Workers in 11 Towns in Uganda.

BackgroundKey populations at higher risk for HIV infection, including people who inject drugs, men who have sex with men (MSM), and female sex workers (FSWs), are disproportionately affected by the HIV/AIDS epidemic. Empirical estimates of their population sizes are necessary for HIV program planning and monitoring. Such estimates, however, are lacking for most of Uganda’s urban centers.ObjectiveThe aim of this study was to estimate the number of FSWs and MSM in select locations in Uganda.MethodsWe utilized conventional 2-source capture-recapture (CRC) to estimate the population of FSWs in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, Busia, Tororo, Masaka, and Kabale and the population of MSM in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, and Mukono from June to August 2017. Hand mirrors and key chains were distributed to FSWs and MSM, respectively, by peers during capture 1. A week later, different FSWs and MSM distributors went to the same towns to collect data for the second capture. Population size estimates and 95% CIs were calculated using the CRC Simple Interactive Statistical Analysis.ResultsWe estimated the population of FSWs and MSM using 2 different recapture definitions: those who could present the object or identify the object from a set of photos. The most credible (closer to global estimates of MSM; 3%-5%) estimates came from those who presented the objects only. The FSW population in Mbale was estimated to be 693 (95% CI 474-912). For Jinja, Mukono, Busia, and Tororo, we estimated the number of FSWs to be 802 (95% CI 534-1069), 322 (95% CI 300-343), 961 (95% CI 592-1330), and 2872 (95% CI 0-6005), respectively. For Masaka, Mbarara, Kabale, and Wakiso, we estimated the FSWs population to be 512 (95% CI 384-639), 1904 (95% CI 1058-2749), 377 (95% CI 247-506), and 828 (95% CI 502-1152), respectively. For Kabarole and Gulu, we estimated the FSWs population to be 397 (95% CI 325-469) and 1425 (95% CI 893-1958), respectively. MSM estimates were 381 (95% CI 299-462) for Mbale, 1100 (95% CI 351-1849) for Jinja, 368 (95% CI 281-455) for Wakiso, 322 (95% CI 253-390) for Mbarara, 180 (95% CI 170-189) for Gulu, 335 (95% CI 258-412) for Kabarole, and 264 (95% CI 228-301) for Mukono.ConclusionsThe CRC activity was one of the first to be carried out in Uganda to obtain small town–level population sizes for FSWs and MSM. We found that it is feasible to use FSW and MSM peers for this activity, but proper training and standardized data collection tools are essential to minimize bias.

Transcatheter Arterial Embolization for Intra-abdominal Bleeding

Abstract Purpose Transcatheter arterial embolization (TAE) is increasingly used for managing hemorrhage. The evidence-base supporting the procedure is accumulating. This study investigated the safety and effectiveness of TAE for intra-abdominal bleeding at a large regional public health service in Australia. Materials and Methods Medical records of all patients undergoing TAE for intra-abdominal bleeding over a 7-year period were retrospectively reviewed, excluding gastric bleeding. Data were extracted into a standardized electronic data collection tool. Technical success of TAE was defined as cessation of active contrast media extravasation on post-procedure angiography. Complications were categorized as intra- and post-procedure. The severity of complications was rated according to the Society of Interventional Radiology Standards of Practice Committee Classifications of Complications by Outcome. Results Ninety-two cases were identified. TAE was technically successful in 70 (94.6%) of the 74 cases when visible contrast media extravasation was evident during angiograph. During procedures, six minor complications occurred such as transient symptomatic hypotension or moderate to severe abdominal pain. Following procedures, eight minor complications were reported: seven cases of hematoma at the catheter access point and one case of contrast reaction. One major complication, bowel ischemia requiring hemicolectomy, occurred post-TAE for a bleeding cecal aneurysm; however, widespread arterial spasm was noted on angiography prior to TAE and interventional colonoscopy had occurred 2 days prior to TAE, suggesting that ischemia was not primarily due to TAE. Conclusion This study supports the use of TAE for a diverse range of cases of intra-abdominal bleeding. TAE produced high rates of complete hemostasis with few complications.

Development and validation of a new standardised data collection tool to aid in the diagnosis of canine skin allergies

Canine atopic dermatitis (cAD) is a common hereditary clinical syndrome in domestic dogs with no definitive diagnostic tests, which causes marked morbidity and has a high economic impact internationally. We created a novel questionnaire for Labrador (LR) and Golden retriever (GR) owners to evaluate canine skin health with respect to clinical signs of cAD. 4,111 dogs had fully completed questionnaires (2,803 LR; 1,308 GR). ‘Cases’ (793) had a reported veterinary diagnosis of cAD, and ‘controls’ (1652) had no current or past clinical signs of cAD and were aged >3 years. Remaining dogs (1666) were initially categorised as ‘Other’. Simulated annealing was used comparing ‘Cases’ and ‘Others’ to select a novel set of features able to classify a known case. Two feature sets are proposed, one for use on first evaluation and one for dogs with a history of skin problems. A sum for each list when applied to the whole population (including controls) was able to classify ‘Cases’ with a sensitivity of 89% to 94% and specificity of 71% to 69%, respectively, and identify potentially undiagnosed cases. Our findings demonstrate for the first time that owner questionnaire data can be reliably used to aid in the diagnostic process of cAD.

Using research to prepare for outbreaks of severe acute respiratory infection

Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and...

Prevalence and treatment of gout among patients with chronic kidney disease in the Irish health system: A national study.

BackgroundGout is a common inflammatory arthritis associated with adverse clinical outcomes. Under treatment is common in the general population. The aim of this study was to determine the prevalence of gout and its treatment among patients with chronic kidney disease (CKD).MethodsWe conducted a multi-centre cross sectional study of patients (n = 522) who attended specialist nephrology clinics in Ireland. Standardized data collection tool recorded clinical characteristics and medication use at clinic visits and kidney function was assessed with standardised creatinine measurements and Estimated Glomerular Filtration Rate (eGFR). The prevalence of gout and the corresponding use of urate lowering therapies (ULT) were determined. Multivariate logistic regression explored correlates of gout expressed as Odds Ratios (OR) and 95% Confidence Intervals (CI) adjusting for demographic and clinical characteristics.ResultsOverall prevalence of gout was 16.6% and increased significantly from 7.5% in Stage 1–2 CKD to 22.8% in stage 4–5 CKD, P< 0.005. Prevalence increased with age (P < 0.005) and was higher in men than women (19.1% versus 10.3% P< 0.005). Overall, 67.9% of gout patients with CKD were treated with ULT, and the percentage increased with advancing stage of CKD from 55.6% in Stage 1–2 to 77.4% in Stage 4–5, P<0.005. Multivariable modelling identified men (vs women), OR, 1.95 (0.95–4.03), serum albumin, OR 1.09 (1.02–1.16) per 1 g/L lower, poorer kidney function, OR 1.11 (1.01–1.22) per 5 ml/min/1.73m2 lower, and rising parathyroid hormone levels, OR 1.38 (1.08–1.77) per 50 pg/ml higher as disease correlates.ConclusionsGout is common in CKD and increases with worsening kidney function in the Irish health system. Over two thirds of patients with gout were receiving ULT, increasing to 77% of patients with advanced CKD. Greater awareness of gout in CKD, its treatment and the effectiveness of treatment strategies should be vigorously monitored to improve patient outcomes.

Evaluation of Ebola virus disease surveillance system in Tonkolili District, Sierra Leone.

IntroductionThe Ebola Virus Disease (EVD) epidemic devastated West Africa, with Sierra Leone recording over 50% of the 28,610 cases across the three most affected countries. Enhanced surveillance system was developed for improved identification of cases and response in Sierra Leone. Here, we evaluated the surveillance system to determine its strengths and challenges in meeting the set objectives.MethodsThe EVD surveillance system in Tonkolili District, Sierra Leone, was assessed using the CDC updated guidelines for evaluating public health surveillance. In particular, the simplicity, stability, acceptability, flexibility, representativeness, sensitivity, positive predictive value and data quality of the system were assessed using EVD surveillance data and information from key informant interviews with program stakeholders.ResultsThe EVD surveillance system in Tonkolili District provided information and data on disease trends and outbreak report through official and rumours sources. Case definitions were well understood by participants, with willingness to continue surveillance activities after the EVD outbreak. Standardized data collection tools were in place and data communication was clear with feedback to surveillance units at all levels. The EVD surveillance was not operated within the Integrated Disease Surveillance and Response framework (IDSR). Data completeness was about 91%, consistency existed but data quality was poor (incompletely filled data and missing data existed). Regarding timeliness, samples arrived designated laboratory within 24 - 48 hours in 174 (84.9%). Sensitivity of the surveillance system was 88.5%. Predictive value positive was 25.8%. The stability was questionable since the government of Sierra Leone were not fully in charge of the system.ConclusionWhile the simplicity of the EVD surveillance system in Tonkolili District facilitated its implementation, users suggested that the system did not meet expectations in terms of timeliness, flexibility and acceptability. There was a need to channel efforts towards integrating EVD surveillance into the IDSR. Data completeness and timeliness needed more attention. The District Health Management Team need to take ownership of the surveillance system for sustainability.

1860. Small State, Big Collaboration: Creation of First New Hampshire Statewide Antibiogram Guides Stewardship Efforts

BackgroundAntibiotic-resistant infections have been identified as an urgent national health threat. In response, the New Hampshire Division of Public Health Services (DPHS) sought to develop a system for tracking antibiotic resistance statewide through use of hospital antibiograms to (1) proactively monitor resistance trends over time and geographic region, (2) promote antimicrobial stewardship in NH healthcare facilities, and (3) provide a tool for providers to help guide appropriate antibiotic prescribing.MethodsThrough statutory legislative authority, DPHS requires hospital laboratories to report antibiogram data annually. DPHS formed an advisory group, consisting of infectious disease, medical and pharmacy subject matter experts to develop a standardized data collection tool. DPHS validated reported data to confirm accuracy, and clarify aberrant data by comparing the susceptibilities among all hospitals. Any questionable data were verified with the respective laboratory. The combined data were reviewed by the clinical advisory group and recommendations were created from the antibiogram data to highlight appropriate antibiotic prescribing and the need for coordinated stewardship. The antibiogram and clinical recommendations were disseminated widely throughout the state.ResultsAll 26 hospitals in New Hampshire submitted data. A total of 42,519 and 21,306 bacteria were cultured from urine and non-urine sources, respectively. The clinical advisory group’s recommendations included interpretations and antibiotic therapy directives for common clinical syndromes. Dissemination was accomplished through a health alert, partnership with a state working group of stakeholders, widespread email communication and online publication.ConclusionThe small size of New Hampshire, centralized public health structure, and close working relationships with all hospitals allowed for efficient collection of these data. Our process may serve as a model for other states, and will inform more accurate, comprehensive antibiotic resistance surveillance. This antibiogram is the launch for a larger statewide public health antibiotic stewardship campaign and coincides with national efforts around antibiotic stewardship and resistance surveillance.Disclosures All authors: No reported disclosures.

Abstract 259: Characteristics of Patients With Sudden in Hospital Cardiac Arrest With a Shockable Initial Rhythm in a System With Mature Rapid Response and Code Blue Teams

Study Objectives: Every year 33,000 people suffer an IHCA with an initial shockable rhythm in the US. Rapid Response Teams may increase time to defibrillation and are not associated with lower in-hospital mortality. We sought to describe characteristics of sudden IHCAs with a shockable initial rhythm in a system with mature Rapid Response and Code Blue teams, in particular, time to defibrillation. Methods: Retrospective chart review at a large, urban teaching hospital with mature Rapid Response and Code Blue teams. Adults in whom a “Code Blue” was called with confirmed cardiac arrest between Jan 2017 and Mar 2018 were included. Codes with incomplete data or that occurred in the ED or ICU were excluded. The “Code Blue” team consists of 1-3 Nurse Responders, a nursing supervisor, a respiratory therapist, Anesthesiology, a critical care resident, and a surgical resident. Each ward has a defibrillator and standardized code cart. Trained and supervised research assistants used a standardized data collection tool to extract demographic information, comorbidities and event related data from code sheets, history and physical, progress notes, discharge and death summaries. Events were categorized by initial rhythm as shockable or non-shockable. Time to defibrillation was defined as the interval from reported time of initial recognition of cardiac arrest to the reported time of first attempted defibrillation. Fisher’s exact testing was used to test for statistical significance. Results: A total of 183 “Code Blues” met criteria. Demographics: 71% black; mean age 65; and 46% women. Fifty-five (30%) survived to hospital discharge. Forty (21.3%) had an initial shockable rhythm of whom 21 (52.5%) survived to hospital discharge. Of the 40 patients that had an initial shockable rhythm, 36 were defibrillated. Median time to defibrillation was 2 minutes [IQR = 1-4]. Of those defibrillated within 2 minutes, survival was 64% vs 33% (P = 0.102) among those defibrillated in &gt; 2 minutes. Of the 143 patients that had a nonshockable initial rhythm, 34 (23.8%) survived to hospital discharge. Conclusion: In a system with mature Rapid Response and Code Blue teams, time to defibrillation among IHCA patients with a shockable initial rhythm is 2 minutes.

Behavioural soothing interventions used for reducing crying in infants: a systematic review

ABSTRACTThe aim of this review is to identify the behavioural soothing interventions (BSIs) used for reducing infant crying and to determine their effect. Studies had to describe an experimental study addressing infant crying and BSIs in the first six months after birth. Searches were performed in Web of Science, Pubmed, Science Direct, EBSCOhost, PsycINFO, and COCHRANE. It was determined from the studies that massage, spinal manipulative therapy, and occipito-sacral decompression have a positive effect on the soothing of crying behaviour in infants. It was determined that BSIs are most effective when applied before the 8th week and that certain BSIs are effective in reducing the crying duration. It was revealed that there is a need for a standard data collection tool for the determination of the crying duration. Professionals interested in child health should be aware of irregularities in the crying of infants in the early period.

Using concept mapping to develop a human rights based indicator framework to assess country efforts to strengthen rehabilitation provision and policy: the Rehabilitation System Diagnosis and Dialogue framework (RESYST)

BackgroundRehabilitation is crucial for the realization of the right to health and a proper concern of global health. Yet, reliable information to guide rehabilitation service planning is unavailable in many countries in part due to the lack of appropriate indicators. To ensure universal health coverage and meet the central imperative of “leaving no one behind” countries must be able to assess key aspects of rehabilitation policy and provision and monitor how they have discharged their human rights responsibilities towards those most disadvantaged, including people with disability. This article describes the process of developing an expert guided indicator framework to assess governments’ efforts and progress in strengthening rehabilitation in line with the Convention on the Rights of Persons with Disabilities.MethodsA systems methodology - concept mapping - was used to capture, aggregate and confirm the knowledge of diverse stakeholders on measures thought to be useful for monitoring the implementation of the Convention with respect to health related rehabilitation. Fifty-six individuals generated a list of 107 indicators through online brainstorming which were subsequently sorted by 37 experts from the original panel into non overlapping categories. Forty-one participants rated the indicators for importance and feasibility. Multivariate statistical techniques where used to explore patterns and themes in the data and create the indicators’ organizing framework which was verified and interpreted by a select number of participants.ResultsA concept map of 11 clusters of indicators emerged from the analysis grouped into three broader themes: Governance and Leadership (3 clusters); Service Delivery, Financing and Oversight (6 clusters); and Human Resources (2 clusters). The indicator framework was comprehensive and well aligned with the Convention. On average, there was a moderately positive correlation between importance and feasibility of the indicators (r = .58) with experts prioritizing the indicators contained in the clusters of the Governance and Leadership domain. Two of the most important indicators arose from the Service Delivery, Financing and Oversight domain and reflect the need to monitor unmet needs and barriers in access to rehabilitation. In total, 59 indicators achieved above average score for importance and comprised the two–tiered priority set of indicators.ConclusionConcept mapping was successful in generating a shared model that enables a system’s view of the most critical legal, policy and programmatic factors that must be addressed when assessing country efforts to reform, upscale and improve rehabilitation services. The Rehabilitation Systems Diagnosis and Dialogue framework provides a data driven basis for the development of standardized data collection tools to facilitate comparative analysis of rehabilitation systems. Despite agreement on the importance and feasibility of 59 indicators, further research is needed to appraise the applicability and utility of the indicators and secure a realistic assessment of rehabilitation systems.