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Williams, Cheyenne, Aditi Rao, Justin B. Ziemba, Jennifer S. Myers, and Neha Patel. "Text Messaging Real-Time COVID-19 Clinical Guidance to Hospital Employees." Applied Clinical Informatics 12, no. 02 (March 2021): 259–65. http://dx.doi.org/10.1055/s-0041-1726117.
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Abstract Background During the initial days of the coronavirus disease 2019 (COVID-19) pandemic, hospital-wide practices rapidly evolved, and hospital employees became a critical population for receiving consistent and timely communication about these changes. Objectives We aimed to rapidly implement enterprise text messaging as a crisis communication intervention to deliver key COVID-related safety and practice information directly to hospital employees. Methods Utilizing a secure text-messaging platform already routinely used in direct patient care, we sent 140-character messages containing targeted pandemic-related updates to on-duty hospital employees three times per week for 13 weeks. This innovation was evaluated through the analysis of aggregate “read” receipts from each message. Effectiveness was assessed by rates of occupational exposures to COVID-19 and by two cross-sectional attitudinal surveys administered to all text-message recipients. Results On average, each enterprise text message was sent to 1,997 on-duty employees. Analysis of “read” receipts revealed that on average, 60% of messages were consistently read within 24 hours of delivery, 34% were read in 2 hours, and 16% were read in 10 minutes. Readership peaked and fell in the first week of messaging but remained consistent throughout the remainder of the intervention. A survey administered after 2 weeks revealed that 163 (79%) users found enterprise texts “valuable,” 152 (73%) users would recommend these texts to their colleagues, and 114 (55%) users preferred texts to email. A second survey at 9 weeks revealed that 109 (80%) users continued to find texts “valuable.” Enterprise messaging, in conjunction with the system's larger communication strategy, was associated with a decrease in median daily occupational exposure events (nine events per day premessaging versus one event per day during messaging). Conclusion Enterprise text messages sent to hospital-employee smartphones are an efficient and effective strategy for urgent communications. Hospitals may wish to leverage this technology during times of routine operations and crisis management.
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Peimann, C. J. "Modeling Hospital Information Systems with Petri Nets." Methods of Information in Medicine 27, no. 01 (January 1988): 17–22. http://dx.doi.org/10.1055/s-0038-1635515.
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SummaryIn the development of hospital information systems it is difficult to describe data and activities simultaneously and equivalently. Most of the methods used so far are only suitable for either data structures or functional modeling. In particular, it is not possible to comprehend the functional interdependence of hospital procedures.In this paper it is shown that Petri Nets are well suited for the development of complex software systems. Their exceptional properties are, on the one hand, the simulative capacities which allow to visualize interlinked and interdependent procedures of the real world. On the other hand, it is pointed out that Petri Nets comply with the demands of software engineering. In order to make these characteristics clear, two models from real developments are used: Firstly the organizational model of a small hospital and secondly the model of the data entry in the follow-up of tumor patients.
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Canfell, Oliver J., Yasaman Meshkat, Zack Kodiyattu, Teyl Engstrom, Wilkin Chan, Jayden Mifsud, Jason D. Pole, Martin Byrne, Ella Van Raders, and Clair Sullivan. "Understanding the Digital Disruption of Health Care: An Ethnographic Study of Real-Time Multidisciplinary Clinical Behavior in a New Digital Hospital." Applied Clinical Informatics 13, no. 05 (October 2022): 1079–91. http://dx.doi.org/10.1055/s-0042-1758482.
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Abstract Background Understanding electronic medical record (EMR) implementation in digital hospitals has focused on retrospective “work as imagined” experiences of multidisciplinary clinicians, rather than “work as done” behaviors. Our research question was “what is the behavior of multidisciplinary clinicians during the transition to a new digital hospital?” Objectives The aim of the study is to: (1) Observe clinical behavior of multidisciplinary clinicians in a new digital hospital using ethnography. (2) Develop a thematic framework of clinical behavior in a new digital hospital. Methods The setting was the go-live of a greenfield 182-bed digital specialist public hospital in Queensland, Australia. Participants were multidisciplinary clinicians (allied health, nursing, medical, and pharmacy). Clinical ethnographic observations were conducted between March and April 2021 (approximately 1 month post-EMR implementation). Observers shadowed clinicians in real-time performing a diverse range of routine clinical activities and recorded any clinical behavior related to interaction with the digital hospital. Data were analyzed in two phases: (1) content analysis using machine learning (Leximancer v4.5); (2) researcher-led interpretation of the text analytics to generate contextual meaning and finalize themes. Results A total of 55 multidisciplinary clinicians (41.8% allied health, 23.6% nursing, 20% medical, 14.6% pharmacy) were observed across 58 hours and 99 individual patient encounters. Five themes were derived: (1) Workflows for clinical documentation; (2) Navigating a digital hospital; (3) Digital efficiencies; (4) Digital challenges; (5) Patient experience. There was no observed harm attributable to the digital transition. Clinicians primarily used blended digital and paper workflows to achieve clinical goals. The EMR was generally used seamlessly. New digital workflows affected clinical productivity and caused frustration. Digitization enabled multitasking, clinical opportunism, and benefits to patient safety; however, clinicians were hesitant to trust digital information. Conclusion This study improves our real-time understanding of the digital disruption of health care and can guide clinicians, managers, and health services toward digital transformation strategies based upon “work as done.”
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Moorman, Liza Prudente. "Principles for Real-World Implementation of Bedside Predictive Analytics Monitoring." Applied Clinical Informatics 12, no. 04 (August 2021): 888–96. http://dx.doi.org/10.1055/s-0041-1735183.
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AbstractA new development in the practice of medicine is Artificial Intelligence-based predictive analytics that forewarn clinicians of future deterioration of their patients. This proactive opportunity, though, is different from the reactive stance that clinicians traditionally take. Implementing these tools requires new ideas about how to educate clinician users to facilitate trust and adoption and to promote sustained use. Our real-world hospital experience implementing a predictive analytics monitoring system that uses electronic health record and continuous monitoring data has taught us principles that we believe to be applicable to the implementation of other such analytics systems within the health care environment. These principles are mentioned below:• To promote trust, the science must be understandable.• To enhance uptake, the workflow should not be impacted greatly.• To maximize buy-in, engagement at all levels is important.• To ensure relevance, the education must be tailored to the clinical role and hospital culture.• To lead to clinical action, the information must integrate into clinical care.• To promote sustainability, there should be periodic support interactions after formal implementation.
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Rajaram, Akshay, Daniel Thomas, Faten Sallam, Amol A. Verma, and Shail Rawal. "Accuracy of the Preferred Language Field in the Electronic Health Records of Two Canadian Hospitals." Applied Clinical Informatics 11, no. 04 (August 2020): 644–49. http://dx.doi.org/10.1055/s-0040-1715896.
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Abstract Background The collection of race, ethnicity, and language (REaL) data from patients is advocated as a first step to identify, monitor, and improve health inequities. As a result, many health care institutions collect patients' preferred languages in their electronic health records (EHRs). These data may be used in clinical care, research, and quality improvement. However, the accuracy of EHR language data are rarely assessed. Objectives This study aimed to audit the accuracy of EHR language data at two academic hospitals in Toronto, Ontario, Canada. Methods The EHR language was compared with a patient's stated preferred language by interview. Language was dichotomized to English or non-English. Agreement between language documented in the EHR and patient-reported preferred language was calculated using sensitivity, specificity, and positive predictive value (PPV). Results A total of 323 patients were interviewed, including 96 with a stated non-English preferred language. The sensitivity of the EHR for English-language preference was high at both hospitals: 100% at hospital A with a PPV of 88%, and 99% at hospital B with a PPV of 85%. However, the sensitivity of the EHR for non-English preference differed greatly between the two hospitals. The sensitivity was 81% with a PPV of 100% at hospital A and the sensitivity was 12% with a PPV of 60% at hospital B. Conclusion The accuracy of the EHR for identifying non-English language preference differed greatly between the hospitals studied. Language data must be accurate for it to be used, and regular quality assurance is required.
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Kim, Sollip, Soo Jin Yoo, and Jeonghyun Chang. "Importance of Susceptibility Rate of ‘the First’ Isolate: Evidence of Real-World Data." Medicina 56, no. 10 (September 28, 2020): 507. http://dx.doi.org/10.3390/medicina56100507.
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Background and objectives: For proper antimicrobial therapy, cumulative antibiograms should be representative of geographic region and be accurate. Clinical and Laboratory Standards Institute (CLSI) guidelines recommend that only the first isolates (FI) of a species per patient are used when reporting cumulative antibiograms. However, >50% of hospitals in the United States report antibiograms of all isolates. We compared antibiograms from the FI with those from total isolates (TI). Materials and Methods: Antimicrobial data of all isolates identified in the Microbiology unit of Ilsan Paik Hospital in 2019 were retrospectively acquired from the hospital information system. The susceptibility rates to antimicrobials of Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis were analyzed by FI and TI, respectively. Isolate counts and susceptibility rates of each species for the reported antimicrobials were compared. Results: The numbers of isolates by FI/TI were as follows: 1824/2692 E. coli, 480/1611 A. baumannii, and 662/1306 K. pneumoniae, and 407/953 P. aeruginosa for gram-negative bacteria and 649/1364 S. aureus, 211/313 E. faecium, and 323/394 E. faecalis for gram-positive bacteria. All antimicrobial agents showed higher susceptibility rates when calculated as FI than as TI in gram-negative bacteria except colistin: 3.7% for E. coli, 14.5% for A. baumannii, 8.3% for K. pneumoniae, and 7.9% for P. aeruginosa. In S. aureus, 8/11 antimicrobial agents revealed higher susceptibility rates for FI than for TI. E. faecalis and E. faecium showed lower susceptibility rates for 7/10 antimicrobial agents for FI than for TI. The oxacillin susceptibility rates of S. aureus were 36.6%/30.2% with FI/TI and vancomycin susceptibility rates for E. faecium were 54.1% and 49.5%, respectively. Conclusions: When comparing cumulative antibiograms by FI with TI using real-world data, there is a large gap for critical species requiring hospital infection control. Although FI calculation is difficult, antibiograms must be calculated as FI for proper preemptive antimicrobial therapy because FI provides proper antimicrobial susceptibility data.
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Gladkov, N. V., and O. A. Fokht. "Hospital information system and quality control of treatment." Manager Zdravoochranenia, S (December 1, 2022): 50–62. http://dx.doi.org/10.21045/1811-0185-2022-s-50-62.
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The article presents an approach to quality control of treatment at the present stage. A trend of today – the use of a medical information system for quality control of the medical and diagnostic process (with special attention paid not to reporting to higher authorities, but to the organization of internal control in a medical organization). Possible tools and benefits are considered. P u r p o s e . Determining the capabilities of Hospital Information System for quality control of medical care. M a t e r i a l s a n d m e t h o d s . We analyzed the requirements of regulatory acts for the control of medical care, as well as the real needs of HIS users. An experiment on the formation of a set of tools for quality control of treatment was carried out using the example of Hospital Information System Interin PROMIS Alpha. We considered the prospects taking into account the results of the research of Ailamazyan Program Systems Institute of RAS in the field of working with clinical data banks. R e s u l t s . General requirements for internal quality control include 5 levels of control. The use of HIS is most in demand in the following areas: compliance with medical care standards, internal control tools (analysis of compliance with clinical recommendations, expert assessment of the quality of treatment, quality and safety of medical activities, format and logic control, etc.) and ensuring patient safety. The use cases of the HIS in these areas are illustrated by the example of the Hospital Information System Interin PROMIS Alpha. The prospects of the development of the direction consisting in transferring the main load from a person to an HIS and in attracting AI technologies and neural networks are considered. F i n d i n g s . The main problems of quality control are the need for the participation of highly qualified specialists and the high complexity of the process. These problems can be solved by shifting the control regulations from «after the fact» to «proactive» and «in real time» by using HIS, as well as involving knowledge-intensive technologies in this process with the involvement of artificial intelligence and neural networks
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Sherer, David, Chukwuma Onyeije, Peter Bernstein, Peter Kovacs, and Frank Manning. "Utilization of Real-Time Ultrasound on Labor and Delivery in an Active Academic Teaching Hospital." American Journal of Perinatology 16, no. 06 (1999): 303–7. http://dx.doi.org/10.1055/s-2007-993876.
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Ball, M., C. Boyer, P. L. Elkin, K. Ishikawa, C. Jaffe, A. March, H. Marin, et al. "Hospital and Health Information Systems – Current Perspectives." Yearbook of Medical Informatics 20, no. 01 (August 2011): 73–82. http://dx.doi.org/10.1055/s-0038-1638741.
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SummaryTo celebrate over 30 years of health information systems’ (HIS) evolution by bringing together pioneers in the field, members of the next generation of leaders, and government officials from several developing nations in Africa to discuss the past, present, and future of HISs.Participants gathered in Le Franschhoek, South Africa for a 2 ½ day working conference consisting of scientific presentations followed by several concurrent breakout sessions. A small writing group prepared draft statements representing their positions on various topics of discussion which were circulated and revised by the entire group.Many new tools, techniques and technologies were described and discussed in great detail. Interestingly, all of the key themes identified in the first HIS meeting held over 30 years ago are still of vital importance today: Patient Centered design, Clinical User Support, Real-time Education, Human-computer Factors and Measuring Clinical User Performance, Meaningful use.As we continue to work to develop next-generation HISs, we must remember the lessons of the past as we strive to develop the solutions for tomorrow.
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Dreyfus, Jill, Elizabeth Begier, Holly Yu, Alvaro Quintana, Julie Gayle, and Margaret A. Olsen. "1228. Incidence of Staphylococcus aureus Infection after Elective Surgeries Among Adults in US Hospitals." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S372—S373. http://dx.doi.org/10.1093/ofid/ofy210.1061.
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Abstract Background Staphylococcus aureus is a leading cause of postsurgical infections. National estimates of these infections after elective surgeries based on microbiology data are limited. This study assessed 180-day postsurgical S. aureus incidence in real-world hospital settings. Methods Adults (≥18 years) who underwent elective surgery during a hospital-based outpatient or inpatient encounter from July 1, 2010–June 30, 2015 at one of 181 hospitals reporting microbiology results in the Premier Healthcare Database (PHD). Eighty-seven surgical categories were defined using ICD-9-CM and CPT procedure codes according to National Hospital Surveillance Network groupings plus additional categories. Microbiology results and ICD-9-CM diagnosis codes were used to identify invasive (e.g., deep incisional and organ-space SSI, bloodstream) and overall (i.e., invasive, superficial incisional, urinary tract, respiratory) S. aureus infections. Cumulative 180-day S. aureus infection rates were calculated as number of infections divided by number of discharges with elective surgeries. National infection volumes were calculated by multiplying infection rates by national inpatient elective surgery estimates using surgery counts in the entire PHD (665 hospitals) and weights based on hospital characteristics. Results Following 1,116,994 hospital-based outpatient elective surgeries, 180-day S. aureus incidence was 1.19% overall, with 0.38% complicated by invasive S. aureus infections. Among 884,803 inpatient elective surgeries, overall and invasive 180-day S. aureus infection incidence was 1.35% and 0.53%, respectively. This translated to an estimated 57,200 S. aureus infections (22,400 invasive) among an estimated 4.2 million elective inpatient surgeries annually in the US methicillin-resistance (MRSA) was observed in 45% and 46% of S. aureus infections after inpatient and outpatient surgeries, respectively. Figure 1 shows cumulative S. aureus incidence rates at each time point after outpatient and inpatient elective surgeries. Figure 2 delineates the incidence rates for each type of S. aureus infection. Conclusion Our study indicated similar S. aureus infection rates after inpatient and outpatient elective surgeries. The results highlight the much larger burden of disease of S. aureus infection in the United States beyond inpatient surgeries. Disclosures J. Dreyfus, Premier, Inc.: Employee and Shareholder, Salary. E. Begier, Pfizer, Inc.: Employee and Shareholder, Salary. H. Yu, Pfizer, Inc.: Employee and Shareholder, Salary. A. Quintana, Pfizer, Inc.: Employee and Shareholder, Salary. J. Gayle, Premier, Inc.: Employee, Salary. M. A. Olsen, Pfizer: Consultant, Consulting fee.
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Zhao, Xi, and Bing Lu. "Constructing a Financial Risk Early Warning Model for Chinese Public Hospitals Based on Machine Learning." International Journal of Economics and Finance 16, no. 3 (February 5, 2024): 64. http://dx.doi.org/10.5539/ijef.v16n3p64.
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In today’s increasingly complex healthcare environment, China’s public hospitals face enormous financial challenges. The high degree of uncertainty and suddenness of financial risks make public hospitals need more sophisticated and real-time financial risk early warning mechanisms. To address this challenge, machine learning algorithms are introduced as a powerful tool to construct more accurate and efficient financial risk early warning models.the purpose of this dissertation is to summarize the recent research progress in constructing financial risk early warning models for Chinese public hospitals based on machine learning algorithms. The establishment of financial risk early warning models can not only help hospital management better understand the financial situation, but also identify potential risks in advance, which can provide powerful support for timely adjustment of strategies and countermeasures.
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Paunfase, Puja Banduji, Samynathan Ramkumar, Marappan Ganesan, and Veeraraghavan Usha. "Detection of Streptococcus mutans and Streptococcus sobrinus in Human Dental Plaque Samples by Using Semi-Quantitative Real-Time Polymerase Chain Reaction." Biosciences Biotechnology Research Asia 20, no. 3 (October 5, 2023): 1081–87. http://dx.doi.org/10.13005/bbra/3159.
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Dental caries, a highly prevalent infectious disease in humans is caused by the bacterial plaque that coats the teeth surface and is a serious public health concern. Recently, the formation of dental plaque has been associated with the occurrence of various other systemic diseases, Alzheimer's disease, Cardiovascular diseases, Rheumatoid Arthritis, Respiratory diseases, Bacteremia and Cancer. Despite the fact that both Streptococcus mutans and Streptococcus sobrinus are the major etiologic agents of dental caries, S. mutans is more prevalent than S. sobrinus in dental plaque. Early detection of S. mutans and S. sobrinus was carried out from five caries affected dental plaque samples collected from Sri Ramakrishna Dental College and Hospital, Coimbatore, by using semi-quantitative real-time PCR. Specific primers for gtfB and gtfI genes of S. mutans and S. sobrinus respectively were used for the quantification of cariogenic bacteria in the given dental plaque samples. The Biopro Oral Microbiome transport media was prepared to carry dental plaque samples from the hospital to the laboratory. Genomic DNA extraction was done by employing magnetic beads and spin columns provided in the Biopro DNA isolation kit. Various biochemical tests were performed on the bacterial cultures isolated from dental plaque.
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Sfreddo, Ericson. "Implantação do Sistema de Procedimentos de Alta Complexidade em Neurocirurgia. Resultados." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 26, no. 02 (June 2007): 60–63. http://dx.doi.org/10.1055/s-0038-1625511.
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Resumo Objetivo: Demonstrar a maneira como foi implementado o Serviço de Alta Complexidade em Neurocirurgia num município da região metropolitana de Porto Alegre e seus resultados benéficos à população, aos neurocirurgiões e à Instituição Hospitalar. Material e método: São demonstrados os argumentos que o grupo de neurocirurgiões adotou para convencer a direção do Hospital Municipal de Novo Hamburgo (HMNH) a investir na especialidade antes mesmo de ter noção real das vantagens e dos lucros que adviriam. Resultados: Foi constatado que havia uma evasão mensal de aproximadamente 30 pacientes dos municípios que compunham a região para outro centro de referência (“Hospital Referência”). Essa evasão propiciaria um rendimento em torno de R$ 57 mil. Foi demonstrado que o “Hospital Referência” havia saltado de um faturamento de pouco mais de R$ 100 mil para aproximadamente R$ 500 mil após a implantação do Sipac-Neuro, e que a média de valores das autorizações de internações hospitalares (AIH) desse hospital era de R$ 1.056,12 contra R$ 382,84 do HMNH. A seguir, descrevem-se os passos que foram necessários para o credenciamento junto ao Ministério da Saúde, a implantação do serviço e os futuros investimentos que se pretende realizar em função dos novos aportes financeiros proporcionados pela Alta Complexidade. Os resultados financeiros iniciais após o credenciamento foram significativos. Conclusão: A organização e demonstração real, com exemplos de outras instituições, são instrumentos úteis e facilitadores para o convencimento das direções de hospitais que ainda são céticos quanto às vantagens proporcionadas pelo Sipac-Neuro.
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Kuruvilla, Philip, Juhi Husain, Henry J. Conter, William To-Dang, Margaret Balcewicz, and Stephen Reingold. "Real World Experience of Ibrutinib in an Ethnically Diverse Canadian Community Hospital." Blood 142, Supplement 1 (November 28, 2023): 6549. http://dx.doi.org/10.1182/blood-2023-172977.
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Chronic Lymphocytic Leukemia (CLL) is an indolent lymphoproliferative disorder commonly managed in community centers. Ibrutinib revolutionized the management of patients with CLL (2). Ibrutinib was initially considered an easy to administer, well tolerated oral medication with excellent efficacy. It was the first clinically available Bruton's Tyrosine Kinase (BTK) inhibitor widely used to treat CLL (3). Recently there have been concerns about cardiovascular toxicities leading to the use of alternative BTK inhibitors (5). Where alternative BTK inhibitors are available these toxicity concerns have led to a decline in the use of ibrutinib to treat CLL. The population served is ethnically diverse consisting of 52% South East Asian with a significant population of African origin. We suspected that the concerns regarding Ibrutinib toxicity were not seen in our patient population prompting a retrospective review of our experience. Ibrutinib therapy A total of 106 CLL patients treated with Ibrutinib were identified from which data was extracted. The mean age was 63.4 years. Patients with CLL treated with Ibrutinib from 2014 to 2021 were identified using OPIS and Meditech and data was extracted manually. Table 1 60% of patient received their initial drug funding through compassionate access, 2% via private insurance and the remaining 38% through the provincial health system. The majority of patients who received funding through compassionate access were eventually transitioned to the provincial health system for drug funding. Toxicity and outcomes Table 2 81% of treated patients never required a dose adjustment of Ibrutinib. The majority of dose reductions were of a temporary nature. We were unable to obtain accurate response data in our retrospective review. 82 of the 106 patients continue on ibrutinib therapy. It is presumed that these patients continue to benefit from therapy without disease progression although response data details were poorly recorded in the medical record. Conclusions There is a lack of data of community real world experience with Ibrutinib particularly in the Canadian setting. Community centers generally are lacking in information technology required to do retrospective audits. Our data shows that ibrutinib therapy for CLL is a reasonable and effective option with good tolerability in a patient population with high cardiovascular risk. The data is limited by the retrospective data collection. The efficacy of therapy is likely comparable to that of the published literature. These data suggest that the tolerability of Ibrutinib therapy seems better than that of the published literature (1) with a low incidence of atrial fibrillation, dose adjustments and low drug discontinuation rate. Of note Richter's transformation was also uncommon in our patient population. This is particularly of interest as our study did capture patients in the early days of ibrutinib therapy when there were concerns that Richter's transformation was more common than seen today. Many of the patients who were treated with ibrutinib would not have received the drug today because of cardiovascular concerns (4). At that time, it was the only available oral targeted agent for the treatment of chronic lymphocytic leukemia. Other agents such as Venetoclax, Acalabrutinib, Zanubrutinib and novel combinations were unavailable at that time or were not funded. These lack of options likely contribute to the persistence of Ibrutinib therapy in our patients. These data suggest that ibrutinib can be used in a high cardiovascular risk population with good efficacy and tolerability. 1.Alloucjery, M., Tomowiak, C., Lombard, T., & et al. (2021). Safety Profile of Ibrutinib: An Analysis of the WHO Pharmacovigilance Database. Front Pharmacology, 12:769315. 2.Byrd, J. C., Brown, J. R., O'Brien, S., & et al. (2014). Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. NEJM, 371(3):213-223. 3.Byrd, J. C., Furman, R. R., & Coutre, S. S. (2013). Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia. NEJM, 369(1):32-42. 4.Lovell, A. R., Jammal, N., & Bose, P. (2022). Selecting the optimal BTK inhibitor therapy in CLL: rationale and practical considerations. Therapueltic Advances in Hematology, 13:1177/20406207221116577. 5.Salem, J. E., Manouchehri, A., & Bretagne, M. (2019). Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia. J Am Coll Cardiol, 74:1667-1678.
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Wu, Christine Xia, Ernest Suresh, Francis Wei Loong Phng, Kai Pik Tai, Janthorn Pakdeethai, Jared Louis Andre D'Souza, Woan Shin Tan, et al. "Effect of a Real-Time Risk Score on 30-day Readmission Reduction in Singapore." Applied Clinical Informatics 12, no. 02 (March 2021): 372–82. http://dx.doi.org/10.1055/s-0041-1726422.
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Abstract Objective To develop a risk score for the real-time prediction of readmissions for patients using patient specific information captured in electronic medical records (EMR) in Singapore to enable the prospective identification of high-risk patients for enrolment in timely interventions. Methods Machine-learning models were built to estimate the probability of a patient being readmitted within 30 days of discharge. EMR of 25,472 patients discharged from the medicine department at Ng Teng Fong General Hospital between January 2016 and December 2016 were extracted retrospectively for training and internal validation of the models. We developed and implemented a real-time 30-day readmission risk score generation in the EMR system, which enabled the flagging of high-risk patients to care providers in the hospital. Based on the daily high-risk patient list, the various interfaces and flow sheets in the EMR were configured according to the information needs of the various stakeholders such as the inpatient medical, nursing, case management, emergency department, and postdischarge care teams. Results Overall, the machine-learning models achieved good performance with area under the receiver operating characteristic ranging from 0.77 to 0.81. The models were used to proactively identify and attend to patients who are at risk of readmission before an actual readmission occurs. This approach successfully reduced the 30-day readmission rate for patients admitted to the medicine department from 11.7% in 2017 to 10.1% in 2019 (p < 0.01) after risk adjustment. Conclusion Machine-learning models can be deployed in the EMR system to provide real-time forecasts for a more comprehensive outlook in the aspects of decision-making and care provision.
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Dias, Moises, Luiz Felipe Pinto, Marcus Vinícius Pinto, Renata Gervais, Paula Accioli, Gabriela Amorim, Mariana Guedes, Carlos Perez Gomes, Roberto Coury Pedrosa, and Márcia Waddington-Cruz. "Real-life experience with inotersen at CEPARM, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro." Arquivos de Neuro-Psiquiatria 82, no. 04 (April 2024): 001–7. http://dx.doi.org/10.1055/s-0044-1781463.
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Abstract Background Hereditary transthyretin amyloidosis (ATTRv) is an inherited, progressive, and fatal disease still largely underdiagnosed. Mutations in the transthyretin (TTR) gene cause the TTR protein to destabilize, misfold, aggregate, and deposit in body tissues, which makes ATTRv a disease with heterogeneous clinical phenotype. Objective To describe the long-term efficacy and safety of inotersen therapy in patients with ATTRv peripheral neuropathy (ATTRv-PN). Methods Patients who completed the NEURO-TTR pivotal study and the NEURO-TTR OLE open-label extension study migrated to the present study and were followed-up for at least 18 more months to an average of 67 months and up to 76 months since day 1 of the inotersen therapy (D1–first dose of inotersen). Disease progression was evaluated by standard measures. Results Ten ATTRv-PN patients with Val30Met mutation were included. The mean disease duration on D1 was of 3 years, and the mean age of the patients was of 46.8 years. During an additional 18-month follow up, neurological function, based on the Neuropathy Impairment Score and the Polyneuropathy Disability Score, functionality aspects (Karnofsky Performance Status), and nutritional and cardiac aspects were maintained. No new safety signs have been noted. Conclusion The treatment with inotersen was effective and well tolerated for the average of 67 months and up to 76 months. Our results are consistent with those of larger phase-III trials.
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Cockfield, Joshua D., Smriti Pathak, Jonathan D. Edgeworth, and Jodi A. Lindsay. "Rapid determination of hospital-acquired meticillin-resistant Staphylococcus aureus lineages." Journal of Medical Microbiology 56, no. 5 (May 1, 2007): 614–19. http://dx.doi.org/10.1099/jmm.0.47074-0.
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Multilocus sequence typing (MLST) and multi-strain microarray analysis have shown that most human Staphylococcus aureus strains belong to ten dominant clonal complexes (CCs) or lineages, each with unique surface architecture. Meticillin-resistant S. aureus (MRSA) strains currently belong to six of these lineages (CC1, CC5, CC8, CC22, CC30 and CC45), each of which has independently acquired mobile genetic elements (MGEs) carrying antibiotic resistance genes. MLST and microarrays are expensive and time consuming methods for routine determination of S. aureus lineage. A restriction-modification (RM) test has now been developed that is rapid, simple, inexpensive and accurately determines lineage of hospital-acquired MRSA. The RM test is based on three PCRs for hsdS gene variants, as hsdS genes likely control the independent evolution of S. aureus lineages. The RM test correctly identified 102 MRSA isolates as belonging to one of the six lineages/CCs. Real-time MRSA typing can be used to identify and track changes in local MRSA outbreaks, and provide support for targeting infection control strategies. Simple and accurate typing methods will also support large scale epidemiological studies, and could lead to greater understanding of the carriage, spread and virulence of different MRSA lineages.
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Revillard, C., F. Borst, M. Berthoud, C. Lovis, and J. R. Scherrer. "Medical Office Automation Integrated into the Distributed Architecture of a Hospital Information System." Methods of Information in Medicine 33, no. 02 (1994): 174–79. http://dx.doi.org/10.1055/s-0038-1635011.
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Abstract:Patient histories, discharge summaries, and medical consultant reports are made up of written texts. Therefore, the gathering and archiving of these texts in machine-readable form has many characteristics of computer-based medical records. In Geneva, approximately 1,540 PCs are connected to the Hospital Information System DIOGENE 2, with the possibility of accessing all the functions offered by the system without losing any of their MS-DOS word processing capabilities. The UNIDOC system, presented in this paper, takes all these features into account, a real marriage of technologies between the MS-DOS environment and the distributed client-server architecture. The INGRES database management system supports the entire archiving process of the medical patient texts, structured by prelabelled paragraphs and automatically indexed. Both the quality and accessibility of the records are enhanced, while the archiving capacity is neither too limited nor too expensive.
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Farrington, Joseph M., Martin Utley, Samah Alimam, Wai Keong Wong, and Kezhi Li. "Deep Reinforcement Learning for Managing Platelets in a Hospital Blood Bank." Blood 142, Supplement 1 (November 28, 2023): 2311. http://dx.doi.org/10.1182/blood-2023-178306.
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Introduction The inventory management of platelets is complicated by their short shelf-life. In many hospitals, ordering policies are set by staff based on their experience rather than through forecasting or mathematical modelling. A data-driven approach may help to reduce wastage while ensuring the right unit is available for the right patient at the right time. Finding optimal policies for managing perishable inventory is known to be computationally challenging due to the large number of “observation states” required to represent the age profile of the stock. Reinforcement learning (RL) is a subfield of machine learning in which agents learn how to solve a sequential decision-making task through interaction with an environment. Deep reinforcement learning (DRL) uses deep neural networks to efficiently learn a policy (a mapping between an observed state and an action) for problems with many observation states. We demonstrate, with both simulated and real-life demand data, that DRL can be used to learn effective platelet replenishment policies for a hospital blood bank. Methods We implemented the platelet replenishment scenario from a recent study (Rajendran & Srinivas, 2020) as an RL environment using the OpenAI gym Python package. Daily demand is stochastic, sampled from day-of-the-week specific Poisson distributions. The reward is the negative cost incurred, comprised of fixed and variable order costs, holding costs, shortage costs and wastage costs. We reimplemented the four heuristic replenishment policies described in that study, with policy parameters fit using stochastic mixed integer linear programming (SMILP), where the ordering decision is based on the total number of units in stock and the order quantity is either fixed or the difference between current stock and a target stock level. We trained DRL policies using two popular methods: Deep Q-Networks (DQN) and Proximal Policy Optimization (PPO) using the RL environment. We compared the performance of these six policies, in addition to the optimal policy found using value iteration (VI) and a policy with perfect foresight, on 1,000 randomly generated evaluation episodes each 365 days long. We repeated the analysis using real demand data obtained from the blood transfusion laboratory at University College London Hospital, a large tertiary level care hospital in the United Kingdom, fitting the policies using daily demand data from 2015 and 2016, and evaluating their performance on data from 2017. Results & Discussion The DRL policies incurred consistently lower mean daily costs on the simulated evaluation episodes than the four policies fit using SMILP. PPO incurred a lower mean daily cost than DQN in 96% of the evaluation episodes and performed near optimally - its mean daily cost was only 0.3% higher than that of the VI policy and 8% higher than the policy with perfect foresight. The best performing heuristic policy fit using SMILP, (s, S), incurred a mean daily cost 1.2% higher than the VI policy. The VI policy could be represented as an (s, S) heuristic policy, with different parameters to those found using SMILP. Therefore, in this case, the advantage of DRL over SMILP appears to be the fact it can efficiently learn from many more example sequences of demand, rather than its ability to represent more complex functions. PPO incurred the lowest mean daily cost on the real demand data from 2017 of the six SMILP and DRL policies, 10% higher than a policy with perfect foresight. Holding costs were the main difference between PPO and the policy with perfect foresight when using both simulated and real demand data. In both experiments PPO achieved mean wastage of 0% and suffered a shortage, which would have required placing an additional rush order, on 3.2% of days with simulated demand data and 2.7% of days with real demand data. Conclusion DRL can be used to learn near-optimal policies for a simplified platelet replenishment task, consistently outperforming a previously reported approach. This suggests it may be a viable method for finding policies that can be applied in practice to improve the management of platelet inventory and reduce wastage. In future work, the ability of DRL to learn how to act in large observation space states will enable consideration of additional aspects of the real problem, such as the fact that not all units arrive fresh and not all requested units are transfused, where existing methods become computationally infeasible or impractical.
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Raza, Muhammad Ahmer, Shireen Aziz, Sana Shahzad, and Shahid Masood Raza. "Post-COVID Recovery Assessment Clinics: A Real Need of Time." INNOVATIONS in pharmacy 12, no. 1 (February 5, 2021): 7. http://dx.doi.org/10.24926/iip.v12i1.3693.
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COVID-19 is an infectious respiratory and vascular disease caused by SARS-CoV-2. This virus was first identified in Wuhan, China and caused an ongoing pandemic. The World Health Organization (WHO) declared the outbreak a public health emergency of international concern in January 2020 and a pandemic in March 2020. Reports suggest that patients experience persistent deficits in pulmonary and cognitive functioning, as well as multifaceted health issues and worsened quality of life. From records in Italy and France, COVID-19 survivors experience the return of symptoms. COVID-19 survivors need specialist investigation once they have been discharged from hospital. No proper guidelines are recommending that COVID-19 survivors should be under assessment. We intended to provide a model to assist local healthcare systems to establish post-COVID recovery assessment clinic(s) for CVOID-19 survivors. Our model will enable COVID-19 patients’ access to multi-professional advice, so that they are put onto the right clinical pathway to treat their symptoms. Furthermore, the findings of different specialties in post-COVID recovery assessment clinic(s) may help doctors determine the best discharge plan for COVID-19 patients.
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de la Parra, Miguel, and Javier Montaño. "Remote Monitoring of Perforator Flaps Using an Innovative Device with an Application for Mobile Phone: A Pilot Study." Journal of Reconstructive Microsurgery Open 02, no. 01 (January 2017): e37-e41. http://dx.doi.org/10.1055/s-0036-1585087.
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Background Surveillance and monitoring of perforator flaps has been well established for many years as a reliable method to detect early changes in the blood flow of the flap. In this manner, early flap revisions could be performed in cases of probable thrombosis. Methods We performed a pilot study that included the first 12 patients to use this device. A temperature sensor electrode was used for remote monitoring of perforator flaps using a mobile phone in real time via a general pocket radio service and short messages developed by the authors, allowing the surgeon to check the temperature from any location. Results The device continually displays the temperature of the flaps in real time performing a curve with measurements every 5 minute using the web page. A significant difference (p < 0.05) is shown between flaps with sufficient flow and flaps with venous thrombosis. Conclusion Real-time direct thermography via the surgeon's mobile phone is a reliable method for flap monitoring, facilitating monitorization during the time when the surgeon is away from the hospital.
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Lim, Han Chang, Jodie A. Austin, Anton H. van der Vegt, Amir Kamel Rahimi, Oliver J. Canfell, Jayden Mifsud, Jason D. Pole, et al. "Toward a Learning Health Care System: A Systematic Review and Evidence-Based Conceptual Framework for Implementation of Clinical Analytics in a Digital Hospital." Applied Clinical Informatics 13, no. 02 (March 2022): 339–54. http://dx.doi.org/10.1055/s-0042-1743243.
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Abstract Objective A learning health care system (LHS) uses routinely collected data to continuously monitor and improve health care outcomes. Little is reported on the challenges and methods used to implement the analytics underpinning an LHS. Our aim was to systematically review the literature for reports of real-time clinical analytics implementation in digital hospitals and to use these findings to synthesize a conceptual framework for LHS implementation. Methods Embase, PubMed, and Web of Science databases were searched for clinical analytics derived from electronic health records in adult inpatient and emergency department settings between 2015 and 2021. Evidence was coded from the final study selection that related to (1) dashboard implementation challenges, (2) methods to overcome implementation challenges, and (3) dashboard assessment and impact. The evidences obtained, together with evidence extracted from relevant prior reviews, were mapped to an existing digital health transformation model to derive a conceptual framework for LHS analytics implementation. Results A total of 238 candidate articles were reviewed and 14 met inclusion criteria. From the selected studies, we extracted 37 implementation challenges and 64 methods employed to overcome such challenges. We identified common approaches for evaluating the implementation of clinical dashboards. Six studies assessed clinical process outcomes and only four studies evaluated patient health outcomes. A conceptual framework for implementing the analytics of an LHS was developed. Conclusion Health care organizations face diverse challenges when trying to implement real-time data analytics. These challenges have shifted over the past decade. While prior reviews identified fundamental information problems, such as data size and complexity, our review uncovered more postpilot challenges, such as supporting diverse users, workflows, and user-interface screens. Our review identified practical methods to overcome these challenges which have been incorporated into a conceptual framework. It is hoped this framework will support health care organizations deploying near-real-time clinical dashboards and progress toward an LHS.
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Kadri, Sameer S., Yi Ling Lai, Sarah Warner, Jeffrey R. Strich, Emily Ricotta, D. Rebecca Prevots, Cumhur Y. Demirkale, et al. "1333. Utility of Admission Procalcitonin Level in Patients Presenting to the Hospital with Bloodstream Infection: Real-World Evidence from 250 US Hospitals." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S482—S483. http://dx.doi.org/10.1093/ofid/ofz360.1197.
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Abstract Background Serum procalcitonin (PCT) may aid in early detection and treatment of bacterial bloodstream infections (BSI), yet evidence for this indication is inconclusive. We leveraged real-world data to examine biological variability in PCT across host and pathogen factors and its utility for ruling out BSI on admission. Methods PCT measurements within 24 hours of admission were examined in patients presenting with monomicrobial BSI to 250 hospitals in the Cerner Healthfacts Database. The reliability of admission PCT for ruling out BSI at hospital presentation was assessed using two different thresholds (<0.5 and <0.25ng/mL) and then stratifying results by presence vs. absence of sepsis (using CDC Adult Sepsis Event criteria), fever or hypothermia vs. normothermia, various presumed sources of BSI, and organism taxon. Results Between 2007 and 2017, PCT was measured on admission in 4,358/42,465 (10.3%) adults with BSI present on admission at 60 hospitals. Of these, 870 (20%) met CDC surveillance criteria for sepsis. The median admission PCT was 4.89 [0.93, 23.98] and varied by taxon, BSI source, patient temperature, and the presence and severity of sepsis; acute illness severity was the greatest driver of high PCT levels (Fig 1). Using a threshold of ≥ 0.50 ng/mL, the sensitivity of PCT for detection of BSI was 84% for all patients. Notably, BSI without sepsis was 4-fold more likely to yield a false negative PCT (<0.5ng/mL) than bacteremic sepsis. Sensitivity ranged from 77% with normothermia to 83% with fever/hypothermia (P = 0.06), between 81 and 88% across sources of BSI (P = 0.13) and more widely between 64 and 91% across taxa (P = 0.02). Enterococcal BSI was 2- and 4-fold more likely to have a falsely negative PCT than S. aureus or S. pneumoniae BSIs, whereas non-glucose fermenters other than P. aeruginosa had a 2 and 3-fold higher likelihood of being missed compared with P. aeruginosa and Enterobacteriaceae BSIs respectively (Fig 2). Pathogen-level variation in PCT sensitivity was also observed for BSI without sepsis (62–90%; P = 0.02) and upon using a stricter rule-out threshold of <0.25 ng/mL (P = 0.01). Conclusion PCT levels and the reliability of this test for ruling out bacteremia at hospital presentation varies by pathogen, presenting signs, and presence vs. absence of sepsis. Disclosures All authors: No reported disclosures.
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Dahl, Y. "“You Have a Message Here”: Enhancing Interpersonal Communication in a Hospital Ward with Location-based Virtual Notes." Methods of Information in Medicine 45, no. 06 (2006): 602–9. http://dx.doi.org/10.1055/s-0038-1634124.
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Summary Objectives: This paper aims to explore how computerized interpersonal information can be mediated through the physical environment of hospital wards. Specifically, it focuses on a communication service (location-based virtual notes) that allows hospital workers to leave short digital messages at relevant physical locations (e.g. by a patient bed), so that intended colleagues can pick them up later when entering such a location. In a work setting where personnel move between various locations mainly as a result of work priority, improving timeliness of information and reducing the number of work interruptions is essential. Our objective is to provide a set of user-motivated design guidelines that address important usability aspects of the proposed communication service. Methods: To get end user feedback, a prototype was built and tested in simulated scenarios with real hospital workers. The material gathered from the usability testing and following interviews was reviewed to identify critical usability issues. Results: We identified a number of relevant usability issues concerning the applied design metaphor, posting of digital messages, role-based contact, and user control. These issues formed the basis for a set of preliminary design principles. Conclusions: We view the preliminary usability guidelines as an incentive for more extensive research. Based on feedback from the test participants, we conclude that the location-based virtual notes have promising potential to improve timeliness of ad hoc information exchange between hospital workers.
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Salvagno, Gian Luca, Gianluca Gianfilippi, Laura Pighi, Simone De Nitto, Brandon M. Henry, and Giuseppe Lippi. "Real-world assessment of Fluorecare SARS-CoV-2 Spike Protein Test Kit." Advances in Laboratory Medicine / Avances en Medicina de Laboratorio 2, no. 3 (May 24, 2021): 409–12. http://dx.doi.org/10.1515/almed-2021-0041.
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Abstract Objectives Since commercial SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) antigen rapid detection tests (Ag-RDTs) display broad diagnostic efficiency, this study aimed to evaluate the clinical performance of Fluorecare SARS-CoV-2 Spike Protein Test Kit in a real-life scenario. Methods The study population consisted of a series of patients undergoing SARS-Cov-2 diagnostic testing at Pederzoli Hospital of Peschiera del Garda (Verona, Italy). A nasopharyngeal swab was collected upon hospital admission and assayed with molecular (Altona Diagnostics RealStar® SARSCoV-2 RT-PCR Kit) and antigen (Fluorecare SARS-CoV-2 Spike Protein Test Kit) tests. Results The study population consisted of 354 patients (mean age, 47 ± 20 years; 195 women, 55.1%), 223 (65.8%) positive at molecular testing. A significant correlation was found between Fluorecare SARS-CoV-2 Spike Protein Test Kit and Altona (both S and E genes: r=−0.75; p<0.001). The cumulative area under the curve in all nasopharyngeal samples was 0.68. At ≥1.0 S/CO manufacturer’s cut-off, the sensitivity, specificity, negative and positive predictive values were 27.5, 99.2, 41.5 and 98.5%, respectively. Considerable improvement of sensitivity was observed as Ct values decreased, becoming 66.7% in samples with mean Ct values <30, 90.5% in those with mean Ct values <25, up to 100% in those with mean Ct values <20. Conclusions The modest sensitivity and negative predictive value of Fluorecare SARS-CoV-2 Spike Protein Test Kit makes unadvisable to use this assay as surrogate of molecular testing for definitively diagnosing SARS-CoV-2 infection, though its suitable sensitivity at high viral load could make it a reliable screening test for patients with higher infective potential.
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Ho, C. M. B., J. H. Ha, S. J. Hwang, and S. J. Park. "Real-time sleep monitoring system for nursing hospitals." Gerontechnology 21, s (October 23, 2022): 1. http://dx.doi.org/10.4017/gt.2022.21.s.525.pp1.
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Haddad-Boubaker, Sondes, Marwa Lakhal, Cyrine Fathallah, Aida Bouafsoun, Maher Kharrat, Monia Khemiri, Amel Kechrid, and Hanen Smaoui. "Molecular diagnosis of bacterial meningitis by multiplex real time PCR in Tunisian children." Journal of Infection in Developing Countries 12, no. 04 (April 30, 2018): 235–43. http://dx.doi.org/10.3855/jidc.9650.
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Introduction: Bacterial meningitis is a medical emergency requiring a fast and reliable diagnosis. Molecular methods such as real-time PCR (rt-PCR) offer an attractive alternative. Thus, this study aims to establish multiplex rt-PCRs detecting N. meningitidis, S. pneumoniae and H. influenzae b from cerebrospinal fluid in Tunisian children beyond neonatal age.
Methodology: Using bioinformatic tools and experimentation, we validated the specificity and optimal criteria of PCRs for primers and probes of plyA (S. pneumoniae), ctrA and sodC (N. meningitidis) and bexA genes (H. influenzae b). We performed one multiplex RT-PCR for detection of S. pneumoniae and N. meningitidis targeting plyA and ctrA, sodC genes respectively, simultaneously with a singleplex RT-PCR for H. influenzae b. The sensitivity and specificity of our methods were assessed. Then, we tested our methods for 122 CSF samples collected from suspected meningitis cases between 2014 and 2016 in Bechir Hamza Children’s Hospital of Tunis.
Results: Our results have shown the sensitivity of the designed PCRs was up to 10-4 DNA dilution and the specificity was 100%. PCR evaluation has shown 51 positive samples: 38 of pneumococcal cases, 12 meningococcal cases, 1 case of H. influenzae b with 8.57% and 50% of supplementary positive cases rates respectively.
Conclusions: Our assay proved to be very sensitive, specific and rapid for bacterial meningitis diagnosis. In the recent context of Hib vaccination, the possibility of detecting S. pneumoniae and N. meningitidis separately constitute an attractive opportunity. Nevertheless, simultaneous detection of Hib remains relevant in specific clinical context and for epidemiologic study.
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Aguilera Serrano, Carlos, Carmen Heredia Pareja, and Antonio Heredia Rufián. "El impacto de la Beneficencia en la gestión, tratamiento y cuidado de los dementes alcalaínos en el s. XIX." Nº 9 Diceimbre de 2019, no. 9 (December 12, 2019): 22–28. http://dx.doi.org/10.35761/reesme.2019.9.04.
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During the 19th century, in Spain, different laws and orders for the establishment and organization of the Charity Public took place, being the public authorities who were to exercise social charity to the most vulnerable. In this context, further influenced by the emergence of Moral Treatment, a new philosophical and action concept was activated in management, treatment and care for the mentally ill, considered then insane and/or madness. Health care placed a greater emphasis on occupational activity as therapy, as well as improving healthiness and hygienic conditions. However, many factors made it impossible to consummate change, leading to the emergence of new asylum institutions with a marked asylating and custodial character. The aim of this historical study is to try to know the situation in health care to the demented of Alcalá la Real (Jaén) of the time. In the sources used, two fundamental pillars stand out in our study: the Municipal Archive of Alcalá la Real and the Archive of the Provincial Council of Granada. Fromthe data collected it is outlinedhowin the first two decades of the second half of the nineteenth century the madmen alcalaínos were transferred to the Hospital of Madness of Granada, section of the Royal Hospital. The absence of a hospital for these patients in Jaén justified such transfers. The latter were accompanied by a long bureaucratic process that began on the Municipal Board of Charity and ended with the approval of the governor of Jaén. Keywords: historiography, psychiatry, history, 19th century, madness, charity policy, nursing care.
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Fanikos, John, Debra Murwin, Fredrik Gruenenfelder, Igor Tartakovsky, Lionel Riou França, Paul A. Reilly, Pawel Kermer, Fredrik von Wowern, Deirdre A. Lane, and Ken Butcher. "Global Use of Idarucizumab in Clinical Practice: Outcomes of the RE-VECTO Surveillance Program." Thrombosis and Haemostasis 120, no. 01 (August 30, 2019): 027–35. http://dx.doi.org/10.1055/s-0039-1695771.
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AbstractIdarucizumab was approved for the reversal of dabigatran in 2015. We investigated whether postapproval usage patterns of idarucizumab in a real-world setting reflect those observed in the pivotal trials. No safety or efficacy data were collected in this medical record-based observational study. RE-VECTO, a global postapproval, international, surveillance program, involved hospital pharmacies in countries where idarucizumab was licensed and dispensed (August 2016–June 2018). Characteristics of sites prescribing idarucizumab and of eligible patients (≥ 18 years old and receiving idarucizumab regardless of prior oral anticoagulant use), as well as idarucizumab utilization data, were collected and analyzed descriptively. Sixty-one sites enrolled 359 patients. Most pharmacies (85.2%) were centralized, and the median idarucizumab units stocked per hospital was 2.0 (interquartile range, 1.0–3.0). Almost three-quarters of patients were elderly (74.9% aged > 70 years), and only four (1.1%) had received idarucizumab before. Nearly all patients were treated with dabigatran (97.5%). There was a low frequency of unapproved dabigatran dosage regimens (3.3%). Life-threatening or uncontrolled bleeding was the most frequent indication for idarucizumab (57.7%), followed by emergency surgery/urgent procedure (35.9%). Of the life-threatening bleeding events, the most frequent were gastrointestinal tract (44.4%) and intracranial (38.6%). Most patients (95.0%) were given the full dose of two vials (2 × 2.5 g) of idarucizumab initially, and very few (1.7%) received a second dose. Of those patients requiring emergency or scheduled/planned surgery/procedures, 25.5% underwent gastrointestinal and/or abdominal surgery/procedures. Real-world usage patterns of idarucizumab provide valuable insights into emergency reversal strategies. Off-label use was minimal.
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Belderbos, Tim, Martijn van Oijen, Leon Moons, and Peter Siersema. "Implementation of real-time probe-based confocal laser endomicroscopy (pCLE) for differentiation of colorectal polyps during routine colonoscopy." Endoscopy International Open 05, no. 11 (November 2017): E1104—E1110. http://dx.doi.org/10.1055/s-0043-117948.
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Abstract Background and aims Probe-based confocal laser endomicroscopy (pCLE) is used to differentiate between neoplastic and non-neoplastic colorectal polyps during colonoscopy. We aimed to assess the accuracy of two endoscopists starting to use real-time pCLE for differentiation of colorectal polyps and to determine the negative predictive value (NPV) for neoplasia in polyps ≤ 5 mm. Methods Patients undergoing colonoscopy in a tertiary hospital were included in this prospective trial. After a training session, two colonoscopists assessed 50 polyps between August 2012 and April 2014. They sequentially used narrow-band imaging (NBI) and real-time pCLE to differentiate non-adenomatous, adenomatous, and carcinomatous polyps during colonoscopy. Histologic diagnosis by a gastrointestinal pathologist was the gold standard. Results were compared to post-hoc pCLE by a panel of gastroenterologists and pathologists. Results The accuracy of real-time pCLE was 76 %, compared to 73 % for NBI, and was not significantly different between the first 50 cases (74 %) and the last 50 cases (78 %, P = 0.64). The accuracy in polyps > 5 mm was 87 % versus 59 % in polyps ≤ 5 mm (P = 0.04) and increased from 45 % (13/29) in poor quality images to 86 % (44/51) in fair quality images and 95 % (19/20) in good quality images (P < 0.01). The post-hoc pCLE accuracy was 62 %. The NPV for polyps ≤ 5 mm was 58 % for real-time pCLE and 54 % for post-hoc pCLE. Conclusion Although a fair accuracy of real-time pCLE for differentiation of colorectal polyps can be achieved within 50 cases, low NPV and difficulty in obtaining high-quality pCLE images hamper implementation in routine clinical practice.
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Sorrentino, Sabato, Usman Baber, Bimmer Claessen, Anton Camaj, Birgit Vogel, Samantha Sartori, Paul Guedeney, et al. "Determinants of Significant Out-Of-Hospital Bleeding in Patients Undergoing Percutaneous Coronary Intervention." Thrombosis and Haemostasis 118, no. 11 (October 12, 2018): 1997–2005. http://dx.doi.org/10.1055/s-0038-1673687.
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Background Although several variables have been identified as bleeding determinants (BDs), their occurrence and predictive value in patients undergoing percutaneous coronary intervention (PCI) in the real world remain unclear. We aimed to characterize the rate of BDs in patients undergoing PCI with stent implantation in a large volume tertiary centre. Methods We included patients undergoing coronary stenting at our institution from January 2012 to December 2016, and defined post-discharge bleeding (PDB) as bleeding requiring hospitalization or transfusion. Several BDs, identified by the PARIS bleeding and PRECISE-DAPT scores and inclusion criteria of the LEADERS FREE trial, were analysed. Results In a population of 10,406 subjects who underwent PCI, 2,938 patients (28.2%) had 1, 2,367 (22.8%) had 2 and 2,913 (28.0%) had ≥3 pre-specified BD. Compared with patients without PDB, subjects who experienced PDB were older (70.43 ± 11.94 vs. 65.90 ± 11.54 years, p < 0.0001) with a higher prevalence of common cardiovascular risk factors. One-year PDB occurred in 177 patients (2.4%), and consistently increased according to the number of BDs involved (1.12, 2.11 and 4.35%, respectively; p < 0.0001). Analogously, 1-year rates of post-discharge myocardial infarction or stent thrombosis increased according to the number of BDs (2.44, 3.38 and 4.87%, respectively; p < 0.0001). Only 7 BDs remained independently associated with PDB at 1 year, with anaemia, oral anticoagulant at discharge and malignancy representing the strongest predictors of such risk. Conclusion Many risk factors predispose to PDB; they were often clustered together and conferred additive PDB risk at 1-year of follow-up.
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Kyritsi, Maria, Alexandros Vontas, Ioanna Voulgaridi, Alexia Matziri, Apostolos Komnos, Dimitris Babalis, Antonios Papadogoulas, et al. "Rapid Test Ag 2019-nCoV (PROGNOSIS, BIOTECH, Larissa, Greece); Performance Evaluation in Hospital Setting with Real Time RT-PCR." International Journal of Environmental Research and Public Health 18, no. 17 (August 30, 2021): 9151. http://dx.doi.org/10.3390/ijerph18179151.
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Introduction: Rapid antigen tests (RATs) are convenient for SARS-CoV-2 detection because they are simpler and faster than nucleic acid amplification tests (NAATs). This study aimed to assess the accuracy of a locally manufactured test; Rapid Test Ag 2019-nCoV (PROGNOSIS, BIOTECH, Larissa, Greece) in a clinical setting and during mass screening. Methods: Nasopharyngeal samples from 624 individuals were analyzed. The results of the rapid test were compared to real-time reverse-transcription quantitative polymerase chain reaction (RT-qPCR). At the end of the test’s procedure, positive test strips were scanned in an S-Flow reader in order to roughly estimate the antigen concentration. Results: The lower limit of detection of the test was 468.75 genome copies/mL. The PROGNOSIS rapid test displayed a sensitivity of 85.5% (141/165) (95%CI: 79.1–90.5) and a specificity of 99.8% (458/459) (95%CI: 98.8–100.0%). The general inter-rater agreement was 0.89 (95%CI: 85.1–93.3). The regression analysis between the S-flow reader measurements (viral antigen) and the viral load of the positive samples demonstrated a weak correlation (R2 = 0.288, p < 0.001). Conclusion: The Rapid Test Ag 2019-nCoV demonstrated sufficient sensitivity, excellent specificity and could be available to be used with low overall cost. Thus, it could be used as point of care test, but also for mass screening for rapid detection of infected persons (e.g., for travelers).
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Cunha, Marcelo, and Luiza Grosbelli. "Profile of Patients with Intracranial Tumors Undergoing Surgical Resection at a Neuro-oncology Referral Hospital." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 37, no. 01 (March 2018): 19–26. http://dx.doi.org/10.1055/s-0038-1639588.
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Objectives To analyze the epidemiological aspects of primary and metastatic tumors of the central nervous system (CNS) among patients operated on by a single surgeon dedicated to neuro-oncology at Hospital Regional do Oeste, in Chapecó (Santa Catarina, Brazil), between 2013 and 2016. Methods Cross-sectional, retrospective, and observational analysis of 347 patients undergoing surgery due to intracranial tumors. The patients' data were obtained from the hospital registry, medical records, and pathology reports. Results Primary CNS tumors comprised 72.1% of the sample. There was a predominance of females (52.7%), and the mean age was 49.3 years, with a peak of incidence between the ages of 25 and 64 years. Gliomas were the most common primary brain tumors (23.7%), followed by meningiomas (17.0%). Lung cancer (15.3%), breast cancer (4.9%), and melanoma (3.5%) were, in descending order, the most frequent primary sites of metastases, which were recorded in 97 cases (27.9%). Conclusion The lack of standardization in the process of notification of tumor diseases imposes challenges in the establishment of estimates close to the real ones, preventing improvement of public health care policies to protect patients with neuro-oncological conditions. Based on the current model, regionalization of the data seems to be the best option in the management of this subgroup of patients.
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Hulu, Putri Miseri Cordias Domini, and Oktafiana Manurung. "ASUHAN KEBIDANAN BAYI BARU LAHIR PADA BAYI NY. S USIA 1 HARI DENGAN CAPUT SUCCEDANEUM DI RUMAH SAKIT ELISABETH LUBUK BAJA BATAM DESEMBER TAHUN 2018." Elisabeth Health Jurnal 3, no. 1 (June 11, 2018): 50–59. http://dx.doi.org/10.52317/ehj.v3i1.233.
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According to Word Health Organization (WHO) data, infant mortality caused by Succedaneum Caput infection decreased by 0.05% from 4 million infants who died at 30 days (advanced neonatal). While in Indonesia the infant mortality rate due to infection of Caput succedaneum in 2013 amounted to 11% from 35 per 1000 live births. Goals: To have real experience in implementing Care of Newborn Gynecology Born on By. Mrs. S age of 1 day with Caput Succedaneum at Santa Elisabeth Lubuk Baja Batam Hospital in 2017. Method: Based on a case study on By. Mrs. S, the method uses Varney Midwifery Management approach, for data collection that is primary data consisting of physical examination include examination of caput extension, general condition, vital signs, and anthropometry. Result: Based on By case. Mrs. S with Caput Succedaneum performed handling and treatment for 4 days at Santa Elisabeth Hospital Batam. After the treatment of Caput Succedaneum and giving 20 gram Trombophop gel therapy, the baby's condition has improved and the caput problem has been resolved. Conclusion: Based on By case. Mrs. S after the management of Succedaneum Caput and minimize the removal of baby's head, the baby's condition has improved.
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Austin, Jodie A., Michael A. Barras, and Clair M. Sullivan. "Safe and Effective Digital Anticoagulation: A Continuous Iterative Improvement Approach." ACI Open 05, no. 02 (July 2021): e116-e124. http://dx.doi.org/10.1055/s-0041-1736631.
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Abstract Background Anticoagulant drugs are the leading cause of medication harm in hospitals and prescribing errors are common with traditional paper prescriptions. Electronic medicines management can reduce prescribing errors for many drugs; however, little is known about the impact of e-prescribing on anticoagulants. Our case study reports on the lessons learned during conversion from paper to e-prescribing and the ongoing optimization process. Methods The iterative implementation of an anticoagulant prescribing platform in an integrated electronic medical record (ieMR) and ongoing continuous enhancements was applied across five digital hospital sites utilizing a single domain. The collaborative management of each class of anticoagulant, optimization strategies, governance structures, and lessons learned is described. An analysis of the rate of errors and adverse events pre- and post-go live is presented. Results The transition to e-prescribing relied on a strong inter-disciplinary governance framework to promote the safe management of anticoagulants. There was no increase in overall prescribing errors, however unfamiliarity with the new system caused a transient increase in errors with unfractionated heparin (1.8/month pre-ieMR vs. 5.5/month post-ieMR). A dedicated real-time surveillance dashboard was introduced. The iterative nature of changes indicated the complexities involved with anticoagulants and the need for an interactive, optimization approach. This led to a significant decrease in anticoagulant related hospital acquired complications (12.1/month pre-ieMR vs. 7.8/month post-ieMR, p = 0.01). Conclusion Digitizing anticoagulant prescribing led to an overall reduction in errors, but a continuous iterative optimization approach was needed to achieve this outcome. The knowledge presented can help inform optimal therapeutic anticoagulation ieMR design strategies.
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Bergmeijer, Thomas, Mathijs van Oevelen, Paul Janssen, Thea Godschalk, Robert Lichtveld, Johannes Kelder, Michiel Voskuil, Arend Mosterd, Gilles Montalescot, and Jurriën ten Berg. "Safety of Ticagrelor Compared to Clopidogrel after Prehospital Initiation of Treatment." TH Open 02, no. 04 (October 2018): e357-e368. http://dx.doi.org/10.1055/s-0038-1673389.
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Objectives The objective of this registry was to study the safety of prehospital initiation of ticagrelor compared with clopidogrel. Background Ticagrelor has replaced clopidogrel in many hospitals as the routinely used antiplatelet drug in patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, in the PLATelet inhibition and patient Outcomes (PLATO) trial, ticagrelor was associated with an increase in non-CABG (non–coronary artery bypass grafting)-related major bleeding. Data comparing the safety of ticagrelor and clopidogrel after prehospital initiation of treatment are not available. Methods A retrospective, multicenter registry was performed. Selection criteria were the administration of a prehospital loading dose of ticagrelor or clopidogrel according to the ambulance STEMI treatment protocol and the presentation to a percutaneous coronary intervention–capable hospital in our region between January 2011 and December 2012. Follow-up was performed using the electronic patient files for the time period between the antiplatelet loading dose and hospital discharge. The data were analyzed using a primary bleeding end point (any bleeding) and a secondary thrombotic end point (all-cause mortality, spontaneous myocardial infarction, definite stent thrombosis, stroke, or transient ischemic attack). Results Data of 304 clopidogrel-treated and 309 ticagrelor-treated patients were available for analysis. No significant difference in bleeding rate was observed between both groups, using univariate (17.8 vs. 20.1%; p = 0.47; odds ratio, 1.16 [95% confidence interval, 0.78–1.74]) and multivariate (p = 0.42) analysis. Also for the secondary thrombotic end point (6.3 vs. 4.9%, p = 0.45), no significant differences were observed. Conclusion In this real-world registry, no significant differences in bleeding or thrombotic event rate were found between ticagrelor and clopidogrel after prehospital initiation of treatment.
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Joubert, M., D. Fieschi, M. Fieschi, and P. Staccini. "Confidentiality Issues within a Clinical Information System: Moving from Data-driven to Event-driven Design." Methods of Information in Medicine 38, no. 04/05 (1999): 298–302. http://dx.doi.org/10.1055/s-0038-1634412.
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AbstractWithin a hospital, the moving of medical information systems from retrospective data-gathering methods to prospective clinical information systems raises the question of the confidentiality of patient data. A method of improving the traditional matrix model usually used to achieve access controls is described. The event-driven model refers to the way a security system ensures that a given user has a valid »need-to« relationship to a given patient. Events are defined as the occurrence of specific data that trigger the creation or the updating of the relationship between the identity of a user and the identity of a patient (e. g., admission, discharge, transfer, prescription, and report). The creation and the deletion of the relationships between users and patients are based on numerous repositories and working lists of patients. This implementation requires an organization of the hospital activities which is able to manage, in a real-time manner, those repositories as closely as possible to the steps occurring during the patient’s care process. Although this approach seems to reasonably fit the dynamic of the care process, it adds significant organizational constraints.
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Magalhães, Marcelo José Silva de, Graciella Lopes Araújo, Letícia Pinheiro de Almeida, Wanessa Santos Soares, Daniel Santos Martins, Guilherme Duraes Martins, Isadora Fonseca de Vasconcelos, Lara Cristina Lima Delgado, Henrique Nunes Pereira Oliva, and Aline Almeida de Magalhães. "The Impact of Inflation on the Medical and Hospital Money Transfers of the Neurosurgical Procedures of the Brazilian Unified Healthcare System from 2008 to 2017." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 39, no. 04 (June 1, 2018): 249–55. http://dx.doi.org/10.1055/s-0038-1657764.
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Abstract Introduction There are more than 1,500 hospital procedures included in the Brazilian Unified Healthcare System's (SUS, in the Portuguese acronym) table, which is the reference for service payment provided by establishments serving the public health network, and they are stagnant. The underfinancing of procedures is so dramatic that in some cases the amounts paid by the SUS are even lower than the taxes generated by the costs of the same procedures in Brazilian private hospitals. This article aims to compare the evolution of the compensation of neurosurgical procedures by calculating the percentile of the lag in the values transferred to both neurosurgeons and hospitals, according to the SUS table, establishing the ideal and real values according to the current inflation, in a retrospective 9-year comparison. Methodology This is an observational, comparative, retrospective study, based on the values of medical and hospital money transfers of 25 neurosurgical procedures in 2008, which were corrected according to the 2017 National Consumer Price Index (IPCA, in the Portuguese acronym). Results Through this study, from 2008 to 2017, the transfers of medical fees regarding neurosurgical techniques are almost completely outdated. As examples, we can mention: the external/subgaleal ventricular shunt, with a deficit of 43.6%; the electrode implant for brain stimulation, with - 41.67%; and decompressive craniotomy, with - 32.21% in relation to the corrected value. Only 4 of the 25 neurosurgeries present a value above that predicted by the IPCA, one of them being cerebral aneurysm embolization larger than 1.5 cm with a narrow neck (+ 8.0%). Regarding the money transfers to hospitals, all procedures are 43.6% lower than expected, since there was no readjustment in the amounts paid to the institutions in the analyzed period. For example, in 2008, for the transposition of the cubital nerve, R$ 267.30 were transferred, and the same amount was maintained in 2017; and, for the surgical treatment of compressive syndrome in osteofibrous tunnel at carpal level (R$ 145.18), the amount also remained fixed throughout these 9 years. Conclusion Because they did not follow the evolution of the economy, in 80% of the surgeries, the neurosurgeons did not have their economic demands met regarding the procedures performed through SUS. And the data became even more alarming when the money transfers to hospitals were evaluated, since there was no evolution in the money transfers for any of the neurosurgeries evaluated.
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Seamer, Paul, Simon Brake, Patrick Moore, Mohammed A. Mohammed, and Steven Wyatt. "Did government spending cuts to social care for older people lead to an increase in emergency hospital admissions? An ecological study, England 2005–2016." BMJ Open 9, no. 4 (April 2019): e024577. http://dx.doi.org/10.1136/bmjopen-2018-024577.
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ObjectivesGovernment spending on social care in England reduced substantially in real terms following the economic crisis in 2008, meanwhile emergency admissions to hospitals have increased. We aimed to assess the extent to which reductions in social care spend on older people have led to increases in emergency hospital admissions.DesignWe used negative binomial regression for panel data to assess the relationship between emergency hospital admissions and government spend on social care for older people. We adjusted for population size and for levels of deprivation and health.SettingHospitals and adult social care services in England between April 2005 and March 2016.ParticipantsPeople aged 65 years and over resident in 132 local councils.Outcome measuresPrimary outcome variable—emergency hospital admissions of adults aged 65 years and over. Secondary outcome measure—emergency hospital admissions for ambulatory care sensitive conditions (ACSCs) of adults aged 65 years and over.ResultsWe found no significant relationship between the changes in the rate of government spend (£’000 s) on social care for older people within councils and our primary outcome variable, emergency hospital admissions (Incidence rate ratio (IRR) 1.009, 95% CI 0.965 to 1.056) or our secondary outcome measure, admissions for ACSCs (IRR 0.975, 95% CI 0.917 to 1.038).ConclusionsWe found no evidence to support the view that reductions in government spend on social care since 2008 have led to increases in emergency hospital admissions in older people. Policy makers may wish to review schemes, such as the Better Care Fund, which are predicated on a relationship between social care provision and emergency hospital admissions of older people.
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Goto, Tetsuya, Yosuke Hara, Kazuhiro Hongo, and Toshihiro Ogiwara. "Real-Time Navigation-Guided Drilling Technique for Skull Base Surgery in the Middle and Posterior Fossae." Journal of Neurological Surgery Part B: Skull Base 79, S 04 (July 17, 2018): S334—S339. http://dx.doi.org/10.1055/s-0038-1667044.
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Objective The usefulness of the bony surface registration method for navigation system image-guided surgery in the lateral or prone position has been reported. This study was performed to evaluate the efficacy of our new real-time navigation-guided drilling technique with bony surface registration for skull base surgery in the middle and posterior fossae. Methods The study included 29 surgeries for skull base tumors that required drilling of the petrous bone between January 2015 and December 2017 in Shinshu University Hospital. A navigation system was used for drilling of the petrous bone as follows: (1) some labyrinthine structures were marked by color in the source image and superimposed on the navigation image on the workstation preoperatively; (2) bony surface registration was performed with a three-dimensional (3D) skull reconstruction model in the operating room; (3) the petrous bone was drilled under navigation guidance with real-time view-through confirmation of 3D color-marked labyrinthine structures with observation under a microscopic operative view. Results Real-time identification of some structures in the petrous bone was performed, and adequate and precise drilling of the petrous bone was achieved without the risk of labyrinthine perforation or stress. Using this method, surgeons do not need to alternate their gaze between the surgical field and the navigation screen. Conclusions Due to the development of bony surface registration, this new technique is useful for drilling petrous bone in the middle and posterior fossa skull base surgeries.
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Faes, Livia, Amit V. Mishra, Veronika Lipkova, Konstantinos Balaskas, Chrystie Quek, Robin Hamilton, Ulrike Held, Dawn Sim, Sobha Sivaprasad, and Dun Jack Fu. "Visual and Anatomical Outcomes of a Single Intravitreal Dexamethasone in Diabetic Macular Edema: An 8 Year Real-World Study." Journal of Clinical Medicine 12, no. 12 (June 6, 2023): 3878. http://dx.doi.org/10.3390/jcm12123878.
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Importance: Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetes mellitus. Intravitreal dexamethasone is a treatment option for patients unsuitable for or non-responsive to anti-angiogenic agents. Objective: To quantify visual and anatomical outcomes from an initial intravitreal dexamethasone injection over the expected 6-month period of dexamethasone release by the implant. Design and enrolment: This is a retrospective cohort study using electronic medical records of patients reviewed between 1 January 2012 and 1 April 2022. Setting: A tertiary eye-care center in London, United Kingdom; Moorfields Eye Hospital National Healthcare System Foundation Trust. Participants: The cohort comprised 418 adult patients with DME who received an initial treatment of 700 µg intravitreal dexamethasone in the study period. Of these, 240 patients met the inclusion criteria of ≥2 hospital visits following initial injection (≥1 beyond 6 months) and no previous ocular corticosteroid treatment or missing assessment at baseline. Exposure(s): Intravitreal dexamethasone implant (700 µg). Main Outcome(s) and Measure(s): Probability of a positive visual outcome, defined as ≥5 or ≥10 Early Treatment Diabetic Retinopathy Study (ETDRS)-letter gain after treatment when compared to baseline (Kaplan–Meier models). Results: From the initial intravitreal dexamethasone injection alone, we observed a >75% chance of gaining ≥5 ETDRS letters and >50% chance of gaining ≥10 ETDRS letters within 6 months. There was less than a 50% chance of sustaining either positive visual outcome beyond 4 months. Conclusions and Relevance: Most patients can be expected to have a positive visual outcome following an initial injection of dexamethasone implants that subsides within 4 months. Real-world re-treatment was observed to be delayed until after visual benefits were lost in half of the cohort. Further research will be needed to study the effects of delays in re-treatment.
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Bona, Roberta, Emanuele Meliga, Davide Capodanno, Alon Schaffer, Angelo Bongo, Giovanni Gaudio, Luigina Guasti, et al. "Early P2Y12 Inhibitors Escalation in Primary PCI Patients: Insights from the RENOVAMI Registry." Thrombosis and Haemostasis 118, no. 05 (April 4, 2018): 852–63. http://dx.doi.org/10.1055/s-0038-1635578.
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Background Early escalation from clopidogrel to new generation P2Y12 inhibitors is common practice in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Real-world data about this strategy, however, are limited. Methods From 2012 to 2015, 1,057 consecutive STEMI patients treated with pPCI in an Italian hub-and-spoke network were prospectively included in an observational registry (RENOVAMI, ClinicalTrials.gov Identifier: NCT01760382). We compared the prevalence, predictive factors and in-hospital outcomes of patients escalated to a new generation P2Y12 inhibitor within the first 24 hours from pPCI with those continuing on admission antiplatelet therapy. Results In the first 24 hours after pPCI, 165 patients (15.6%) were escalated from clopidogrel to a new generation P2Y12 inhibitor, while de-escalation to clopidogrel was occasional (19 patients, 1.8%) and switch between new generation P2Y12 inhibitors was rare (8 patients, 0.8%, all from ticagrelor to prasugrel). Drug eluting stent use (adjusted odds ratio [OR], 2.19, 95% confidence interval [CI], 1.55–3.08, p = 0.0002) and impaired renal function (adjusted OR, 0.19, 95% CI, 0.05–0.77, p = 0.02) were the only independent predictive factors for the decision to escalate. After adjustment for potential confounders, escalation did not predict in-hospital outcomes, whereas the overall use of new generation P2Y12 inhibitors was correlated with a better in-hospital survival (adjusted hazard ratio, 0.47, 95% CI, 0.25–0.91, p = 0.03). Moreover, escalation did not influence bleeding rates. Conclusions In this prospective registry of STEMI patients treated with pPCI and contemporary antiplatelet therapy, early escalation to a new generation P2Y12 inhibitor appeared safe and did not significantly affect in-hospital bleeding rates.
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Rehman, Bushra, Hira Ikram, Rabiya Nasir, Aiman Umar, and Seema Nawaz. "Comparative Analysis of MRSA Isolation, Biofilm Formation, and Molecular Characteristics: Hospital-Acquired Versus Community-Acquired Strains." Global Pharmaceutical Sciences Review VIII, no. II (June 30, 2023): 82–99. http://dx.doi.org/10.31703/gpsr.2023(viii-ii).15.
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The current study was to look into the molecular characterisation and biofilm development of MRSA in patients who visited the Khyber Teaching Hospital, Hayatabad Medical Complex, and Lady Reading Hospital in Peshawar. Antibiotic susceptibility tests identify Methicillin-resistant Staphylococcus aureus in confirmed isolates of S. aureus. PCR was used to identify a gene, which proved that the MRSA isolates were real. HA- and CA-MRSA were distinguished by SCC mec typing. The microtiter plate assay was employed to look for signs of biofilm formation. 133 (82.60%) of the 161 samples that were positive for S. aureus. Of them, 32 (19.87%) had MSSA isolates, 28 (17.39%) were culture-negative, and 101 (62.73%) were determined to carry MRSA. To confirm all positive isolates one more time, Mec A gene analysis was performed. Twenty-one (20.79%) of the eighty (79.20%) confirmed isolates were classified as undistinguishable MRSA isolates, twenty-six (32.5%) as HA-MRSA isolates, and fifty-five (67.5%) as CA-MRSA isolates.
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Morgan, Jennifer, Takondwa Zuze, Shekinah Nefreteri Cluff Elmore, Matthew Painschab, Yolanda Gondwe, Richard Nyasosela, Chifundo Kajombo, Agness Manda, Katherine Elizabeth Reeder-Hayes, and Tamiwe Tomoka. "Prospective cohort of real-world, curative-intent breast cancer treatment patterns in Malawi." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18736-e18736. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18736.
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e18736 Background: Despite increasing availability of curative-intent breast cancer treatment in concordance with the National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for Sub-Saharan Africa (SSA), few descriptions of their application in SSA are available. Our aim was to describe patterns of curative-intent treatment including neoadjuvant (NAC) and/or adjuvant chemotherapy (AdC) and surgery (S) by stage and HIV status, and the association between guideline-concordant treatment completion and overall survival (OS). Methods: We enrolled newly diagnosed breast cancer patients in a prospective cohort study at Kamuzu Central Hospital in Malawi from Dec 2016 – Oct 2018. Unadjusted odds ratios (OR) with 95% CI were calculated to identify factors associated with completion of guideline-concordant treatment, defined as S and at least 4 cycles of NAC or AdC. A logistic regression model was performed using variables with p<0.1. Survival analysis was performed with Kaplan Meier methods and log-rank test. Results: 67 non-metastatic patients were included. 12 (18%) were HIV+; 13 (19%) were Stage II and 54 (81%) Stage III. 46 (69%) began treatment with NAC, of which 39 (85%) were Stage III and 7 (15%) Stage II. 12 (18%) began treatment with S+AdC, of which 5 (42%) were Stage II and 7 (58%) were Stage III. 2 (3%) Stage III patients were treated with palliative chemotherapy (PC). 7 (10%) never received treatment. Overall, 41 (61%) underwent S. In bivariate analysis, factors associated with failure to complete treatment were HIV+ (OR 0.25 CI (0.06-0.99), Stage III (OR 0.10 CI (0.01-0.89) and ER/PR-/HER2+ (OR 0.07 CI (0.01-0.49). In adjusted analysis, ER/PR-/HER2+ (OR 0.12 (0.01-0.97) was associated with failure to complete treatment. HIV+ patients received less NAC than HIV- (2.5 vs 4 cycles; p=0.07) and similar AdC as HIV- (6 vs 6 cycles; p=0.7). Median OS for those who began treatment with NAC was shorter than with S+AdC (28.5 vs 40 months; p=0.01). Median OS for HIV+ vs HIV- who received NAC was 19.7 vs 32.7 months (p=0.10) and received S+AdC was unreached vs 37.1 months (p=0.27). Conclusions: When applying NCCN Harmonized Guidelines for SSA to Malawi, most patients received NAC for curative breast cancer treatment and had significantly shorter OS compared to those receiving upfront S+AdC. Stage III, HIV+, and ER/PR-/HER2+ patients were less likely to complete guideline-concordant treatment which may reflect advanced disease or poor treatment tolerability. Further study is needed to identify barriers to guideline-concordant treatment and inform interventions to improve breast cancer treatment outcomes in Malawi and SSA.[Table: see text]
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Di Tano, Giuseppe, Andrea Di Lenarda, Massimo Iacoviello, Fabrizio Oliva, Stefano Urbinati, Nadia Aspromonte, Manlio Cipriani, et al. "ANMCO POSITION PAPER: Use of sacubitril/valsartan in hospitalized patients with acute heart failure." European Heart Journal Supplements 23, Supplement_C (August 1, 2021): C176—C183. http://dx.doi.org/10.1093/eurheartj/suab078.
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Abstract Sacubitril/valsartan (S/V) has been shown to reduce the risk of cardiovascular death or heart failure hospitalization and improve symptoms in chronic heart failure with reduced ejection fraction compared with enalapril. After 7 years since the publication of the results of PARADIGM-HF, further insight has been gained with potential new indications. Two prospective randomized multicentre studies (PIONEER-HF and TRANSITION) in patients hospitalized for acute heart failure (AHF) have shown an improved clinical outcome and biomarker profile as compared with enalapril, and good tolerability, safety, and feasibility of initiating in-hospital administration of S/V. Furthermore, some studies have highlighted the favourable effects of S/V in attenuating adverse myocardial remodelling, supporting an early benefit after treatment. Observational data from non-randomized studies in AHF report that in-hospital and pre-discharge prescription of evidence-based drugs associated with better survival still remain suboptimal. Additionally, the COVID-19 pandemic has also negatively impacted on outpatient activities. Therefore, hospitalization, a real crossroad in the history of heart failure, must become a management and therapeutic opportunity for our patients. The objective of this ANMCO position paper is to encourage and facilitate early S/V administration in stabilized patients during hospitalization after an AHF episode, with the aim of improving care efficiency and clinical outcome.
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Rodrigues de Oliveira, Luiz Fernando, Millene Rodrigues Camilo, Luisa Franciscatto, Guilherme Gozzoli Podolsky-Gondim, Frederico Fernandes Alessio Alves, Rui Kleber do Vale Martins Filho, Francisco Antunes Dias, Koji Tanaka, Benedicto Oscar Colli, and Octávio Marques Pontes-Neto. "Outcomes of decompressive craniectomy for malignant middle cerebral artery stroke in an academic hospital in Brazil." Arquivos de Neuro-Psiquiatria 81, no. 09 (September 2023): 778–84. http://dx.doi.org/10.1055/s-0043-1772602.
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Abstract Background Ischemic stroke is an important cause of death in the world. The malignant middle cerebral artery infarction (MMCAI) has mortality as high as 80% when clinically treated. In this setting, decompressive craniectomy is a life-saving measure, in spite of high morbidity among survivors. Objective To evaluate the outcomes of patients with MMCAI treated with decompressive craniectomy in a Brazilian academic tertiary stroke center. Methods A prospective stroke database was retrospectively evaluated, and all patients treated with decompressive craniectomy for MMCAI between January 2014 and December 2017 were included. The demographics and clinical characteristics were evaluated. The functional outcome, measured by the modified Rankin Scale (mRS), was assessed at hospital discharge, after 3-months and 1-year of follow-up. Results We included 53 patients on the final analysis. The mean age was 54.6 ± 11.6 years and 64.2% were males. The median time from symptoms to admission was 4.8 (3–9.7) hours and the mean time from symptoms to surgery was 36 ± 17 hours. The left hemisphere was the affected in 39.6%. The median NIHSS at admission was 20 (16–24). The in-hospital mortality was 30.2%. After a median of 337 [157–393] days, 47.1% of patients had achieved favorable outcome (mRS ≤ 4) and 39.6% had died. Conclusion Decompressive craniectomy is a life-saving measure in the setting of MMCAI, and its effects remains important in the scenario of a middle-income country in real-world situations.
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Guchhait, Partha, Bhaskar Narayan Chaudhuri, and Satadal Das. "Bloodstream Infections with Opportunistic Pathogens in COVID-19 Era: A Real Challenge Necessitates Stringent Infection Control." Journal of Laboratory Physicians 15, no. 01 (March 2023): 131–38. http://dx.doi.org/10.1055/s-0043-1764476.
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Abstract Background: Bloodstream infections (BSI) due to opportunistic microbes in the coronavirus disease 2019 (COVID-19) pandemic lead to high morbidity and mortality among hospitalized patients. Thus, it is vital to find out the risk factors of BSI and to learn the ways to mitigate it. Aim: The aim of this study was to evaluate important risk factors of BSI due to opportunistic pathogens and to assess the role of the rigid infection control program to deal with this issue. Methods: A prospective, cross-sectional study was performed for 6 months on 150 patients admitted in both COVID-19 and non-COVID-19 intensive care units of our hospital. BSI was confirmed by the BACTEC and Vitek 2 compact system. Prospective surveillance and environmental sampling were carried out for source tracking along with rigorous infection control measures and the outcome was analyzed. Findings: Burkholderia cepacia, Elizabethkingia meningoseptica, Candida auris, vancomycin-resistant Enterococcus, and Achromobacter xylosoxidans were the common opportunistic pathogens isolated from a single or paired blood sample(s) in our study. Key risk factors were prolonged intensive care unit stay, central venous access, mechanical ventilation, immune-compromised condition, and use of biologics. Reverse osmosis water and used normal saline bottles were the common environmental source of infection. Following the implementation of precise infection control measures, there was a sharp decline in BSI cases, which was not attributed to the downfall of COVID-19 cases. Conclusion: Combined prospective surveillance and environmental sampling helped to find out the sources and implementation of an intensive and insistent infection control program that are needed to control opportunistic pathogens mediated BSI.
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Zhang, Chen, Zhilei Fan, Feng Ma, Da Li, Yingyao Chen, and Yan Wei. "Comparative Effect of Multi-Dose Contrast Median on Contrast-Enhanced Computed Tomography Workflow of Nurses and Hospital Efficiency: A Multi-CenterReal-World Prospective Observational Study in China." Emergency Medicine International 2022 (December 13, 2022): 1–8. http://dx.doi.org/10.1155/2022/1168973.
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Objective. This study aims to evaluate and compare computed tomography (CT)-contrast operational workflow and hospital imaging efficiency when using a multi-dose bulk IV contrast delivery system and when using a single-dose packaging contrast. Materials and Methods. A multi-center prospective observational study was conducted in six regions in China. The operating time and workflow of radiology nursing staff were evaluated and observed using an investigational tool and recorded by the investigators using a stopwatch. Nursing staff’s knowledge and the imaging capabilities of hospitals were collected using a questionnaire. Rate, t-test, χ2 test, and partial correlation analysis were used to describe the knowledge of nursing staff. The operation time and frequency of the two contrast agent packages were further compared using the Stata 15.0 software. Results. A total of 42 radiology nurses and 1,167 CT contrast-operating procedures in six provinces in China were evaluated. The total operating times for the 100 ml contrast agent versus the 200 ml contrast agent were 80.67 s and 63.81 s, respectively ( P < 0.01 ). According to the average annual hospital CT scans (49,807 scans) and the power injector (PI) market share, approximately 233 h yearly could be saved in a hospital. Regarding CT contrast knowledge, approximately 57.14% nurses expressed their willingness to use multi-dose packaging contrast agents. Conclusion. Through difference and correlation analysis on real-world data, this study suggests that, considering safety, the use of a multi-dose bulk IV contrast agent is more time-saving and efficient for Chinese nurses and medical institutions compared with that of a single-dose package.
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Li, Ming, and Shu Yuan Yang. "Design and Implementation of the Hospital Information Management System Based on the ASP.NET." Applied Mechanics and Materials 644-650 (September 2014): 3166–69. http://dx.doi.org/10.4028/www.scientific.net/amm.644-650.3166.
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The existing hospital information management system generally does not support remote access and the information sharing is low. In order to adapt to the needs of the development of medical information management, the hospital information management system should be developed based on B/S structure. The system should store staff basic information, outpatient and hospitalization reimbursement detail in the database; can timely reflect the patient fee in arrears; draw graphical statistics of the use of funds, the incidence of disease, drug usage information; can set reimbursement policy according to the conditions and can automatically submit an expense account settlement, fund collection, decomposition of annual and carry forward; show the real-time dynamic tracking information for ins and outs of supplies, equipment, and drugs, reduce the backlog and shortages.AFS.NET technology.
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Aouati, Hanane, Linda Hadjadj, Farida Aouati, Amir Agabou, Mariem Ben Khedher, Hacène Bousseboua, Chafia Bentchouala, Jean-Marc Rolain, and Seydina M. Diene. "Emergence of Methicillin-Resistant Staphylococcus aureus ST239/241 SCCmec-III Mercury in Eastern Algeria." Pathogens 10, no. 11 (November 18, 2021): 1503. http://dx.doi.org/10.3390/pathogens10111503.
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In this paper, we investigate the epidemiology of infections-associated Staphylococcusaureus (S. aureus) from the Medical Intensive Care Unit (MICU) at University Hospital Center of Constantine (UHCC) in Algeria, with a special emphasis on methicillin-resistant strains (MRSA) revealed by cefoxitin disks (30 μg), then confirmed by penicillin-binding protein (PBP2a) agglutination and real-time polymerase chain reaction (RT-PCR) targeting mecA and mecC genes. Staphylococcal Cassette Chromosome mec (SCCmec type), staphylococcal protein A (spa-type), multilocus sequence type (MLST), Panton–Valentine Leucocidin (PVL), and toxic shock syndrome toxin-1 (TSST-1) were further investigated in all isolates, and whole genome sequencing was performed for a selected subset of three hospital-acquired MRSA (HA-MRSA) isolates. A measurement of 80% out of the 50 S. aureus isolates were identified as HA-MRSA harbouring the mecA gene, and 72.5% of them were multidrug resistant (MDR). Twelve STs, four different SCCmec cassettes, fourteen spa types, ten isolates Panton–Valentine Leukocidin (PVL)-positive, and three isolates TSST-1 were identified. Interestingly, there was a high prevalence (n = 29; 72.5%) of a worrisome emerging clone: the HA-MRSA ST239/241 SCCmec-III mercury with PVL negative, resistant to β-lactams, aminoglycosides, quinolones, and tetracyclines. Other clones of HA-MRSA isolates were also identified, including PVL-positive ST80 SCCmec-IV/SCCmec-unknown (22.5%), ST34 SCCmec-V with TSST-1 positive (2.5%), and PVL-negative ST72 SCCmec-II (2.5%). Genome analysis enables us to describe the first detection of both PVL-negative HA-MRSA ST239/241 SCCmec-III mercury carrying ccrC, as well as SCCmec-V cassette, which dramatically changes the epidemiology of S. aureus infections in one of the hospitals in eastern Algeria.