Predicting survival in locally advanced gastric cancer using prognostic factors - neoadjuvant rectal score and downstaging depth score.

BACKGROUND: Clinical prediction models are needed to accurately predict the prognosis of patients with gastric cancer who have received neoadjuvant therapy and to determine the best treatment strategies. The aim of this study is to determine the role of two prognostic factors, the neoadjuvant rectal (NAR) score and the downstaging depth score (DDS), in predicting survival in patients with gastric cancer who received neoadjuvant therapy and underwent curative gastrectomy. METHODS: We reviewed the medical records of 129 patients who had been diagnosed with primary gastric cancer and underwent radical gastrectomy after receiving neoadjuvant therapy. We calculated the NAR score and DDS values for each patient and conducted a survival analysis to assess the accuracy of these prognostic factors in predicting overall survival. RESULTS: The median overall survival time of the patients was found to be 29 months. Patients with low NAR scores and high DDS had significantly longer overall survival. Univariate analyses based on clinical and laboratory characteristics showed that gender, surgery type, resection type, neural invasion, grade, adjuvant radiotherapy, lymphocyte level, carcinoembryonic antigen (CEA) level, NAR score, and DDS were associated with survival. Moreover, multivariate analyses showed that lymphocyte level, DDS, and NAR score were independent prognostic factors. CONCLUSION: In summary, our research indicates that NAR score and DDS may serve as useful prognostic markers for predicting overall survival in patients with locally advanced gastric cancer who receive neoadjuvant chemotherapy followed by curative surgery. Patients with high DDS and low NAR scores were found to have better prognoses.

Improving medical record completeness at Wallaga University Referral Hospital: a multidimensional quality improvement project.

BACKGROUND: Appropriately documented medical records enhance coordination, patient outcomes and clinical research. OBJECTIVE: The aim of this project was to improve Wallaga University Referral Hospital's (WURH) medical record completeness rate from 53% to 80% from 1 January 2023 to 31 August 2023. METHODS: A hospital-based interventional study was conducted at WURH. The Plan-Do-Study-Act cycle was used to test change ideas. A fishbone diagram and a driver diagram were used to identify root causes and address them. Key interventions consisted of supportive supervision, developing and distributing standardised formats, orientation for staff, establishing a chart audit team and assigning data owners. RESULT: On the completion of the project, the overall implementation of inpatient medical record completeness increased from 53% to 82%. This improvement varies from department-to-department. It increased from 51% to 79%, 53% to 79%, 46% to 81% and 64% to 91% in the departments of internal medicine, paediatrics, obstetrics and gynaecology and surgery, respectively. The project brought improvements in the completeness of physician notes (84% to 100%), physician order sheet (54% to 84%), nursing care plan (26% to 69%), admission sheet (76% to 98%), discharge summary (94% to 98%), progress note (38% to 91%), medication administration (80% to 100%), appropriate attachment of documents (78% to 93%) and documentation of vital signs (50% to 100%). CONCLUSION AND RECOMMENDATION: The rate of medical record completeness was significantly improved in the study area. This was achieved through the application of multidimensional change ideas related to health professionals, supplies, health management information systems and leadership. However, in some of the parameters, the national targets were not met. Therefore, we recommend providing regular technical updates, conducting frequent chart audits and providing supportive supervision for the enhancement of medical record completeness. It is also advisable for the hospital management to work on its sustainability.

The Environmental Impacts of Electronic Medical Records Versus Paper Records at a Large Eye Hospital in India: Life Cycle Assessment Study.

BACKGROUND: Health care providers worldwide are rapidly adopting electronic medical record (EMR) systems, replacing paper record-keeping systems. Despite numerous benefits to EMRs, the environmental emissions associated with medical record-keeping are unknown. Given the need for urgent climate action, understanding the carbon footprint of EMRs will assist in decarbonizing their adoption and use. OBJECTIVE: We aimed to estimate and compare the environmental emissions associated with paper medical record-keeping and its replacement EMR system at a high-volume eye care facility in southern India. METHODS: We conducted the life cycle assessment methodology per the ISO (International Organization for Standardization) 14040 standard, with primary data supplied by the eye care facility. Data on the paper record-keeping system include the production, use, and disposal of paper and writing utensils in 2016. The EMR system was adopted at this location in 2018. Data on the EMR system include the allocated production and disposal of capital equipment (such as computers and routers); the production, use, and disposal of consumable goods like paper and writing utensils; and the electricity required to run the EMR system. We excluded built infrastructure and cooling loads (eg. buildings and ventilation) from both systems. We used sensitivity analyses to model the effects of practice variation and data uncertainty and Monte Carlo assessments to statistically compare the 2 systems, with and without renewable electricity sources. RESULTS: This location's EMR system was found to emit substantially more greenhouse gases (GHGs) than their paper medical record system (195,000 kg carbon dioxide equivalents [CO2e] per year or 0.361 kg CO2e per patient visit compared with 20,800 kg CO2e per year or 0.037 kg CO2e per patient). However, sensitivity analyses show that the effect of electricity sources is a major factor in determining which record-keeping system emits fewer GHGs. If the study hospital sourced all electricity from renewable sources such as solar or wind power rather than the Indian electric grid, their EMR emissions would drop to 24,900 kg CO2e (0.046 kg CO2e per patient), a level comparable to the paper record-keeping system. Energy-efficient EMR equipment (such as computers and monitors) is the next largest factor impacting emissions, followed by equipment life spans. Multimedia Appendix 1 includes other emissions impact categories. CONCLUSIONS: The climate-changing emissions associated with an EMR system are heavily dependent on the sources of electricity. With a decarbonized electricity source, the EMR system's GHG emissions are on par with paper medical record-keeping, and decarbonized grids would likely have a much broader benefit to society. Though we found that the EMR system produced more emissions than a paper record-keeping system, this study does not account for potential expanded environmental gains from EMRs, including expanding access to care while reducing patient travel and operational efficiencies that can reduce unnecessary or redundant care.

Outcomes of ultraminipercutaneous nephrolithotomy in infants: our experiences at a single center in an endemic region.

OBJECTIVE: In this study, we aimed to contribute to the literature by sharing the perioperative and postoperative outcomes of infants (0-24 months) who underwent ultra-mini percutaneous nephrolithotomy (PNL) for kidney stones in our clinic. METHODS: Infants under 24 months old with kidney stones of 2 cm and larger, who applied to our clinic between January 2018 and May 2023, were included in the study. The patients' demographic and clinical characteristics were obtained from the medical records. The collected data were analyzed retrospectively. RESULTS: A total of 26 patients were included in the study. The mean age of the patients was 17.3 ± 3.90 (12-24) months. The mean operation time was 50.7 ± 6.43 min. The mean stone size was 2.66 ± 0.59 cm. Stone-free was achieved in 23 patients (88.5%). In one patient (3.8%) with residual fragments, SWL was performed, and in two patients (7.7%), RIRS was performed to achieve stone-free. Postoperatively, fever was observed in 3 patients (11.5%). There were no patients requiring blood transfusion. CONCLUSIONS: In experienced centers, ultra-mini-PNL performed by experienced surgeons is an effective and reliable treatment option for infants under 24 months of age with kidney stones larger than 2 cm. It provides high-stone clearance rates and low complication rates.

Applications of artificial intelligence in the field of oral and maxillofacial pathology: a systematic review and meta-analysis.

BACKGROUND: Since AI algorithms can analyze patient data, medical records, and imaging results to suggest treatment plans and predict outcomes, they have the potential to support pathologists and clinicians in the diagnosis and treatment of oral and maxillofacial pathologies, just like every other area of life in which it is being used. The goal of the current study was to examine all of the trends being investigated in the area of oral and maxillofacial pathology where AI has been possibly involved in helping practitioners. METHODS: We started by defining the important terms in our investigation's subject matter. Following that, relevant databases like PubMed, Scopus, and Web of Science were searched using keywords and synonyms for each concept, such as "machine learning," "diagnosis," "treatment planning," "image analysis," "predictive modelling," and "patient monitoring." For more papers and sources, Google Scholar was also used. RESULTS: The majority of the 9 studies that were chosen were on how AI can be utilized to diagnose malignant tumors of the oral cavity. AI was especially helpful in creating prediction models that aided pathologists and clinicians in foreseeing the development of oral and maxillofacial pathology in specific patients. Additionally, predictive models accurately identified patients who have a high risk of developing oral cancer as well as the likelihood of the disease returning after treatment. CONCLUSIONS: In the field of oral and maxillofacial pathology, AI has the potential to enhance diagnostic precision, personalize care, and ultimately improve patient outcomes. The development and application of AI in healthcare, however, necessitates careful consideration of ethical, legal, and regulatory challenges. Additionally, because AI is still a relatively new technology, caution must be taken when applying it to this industry.

The Scottish Medical Imaging Archive: 57.3 Million Radiology Studies Linked to Their Medical Records.

Keywords: MRI, Imaging Sequences, Ultrasound, Mammography, CT, Angiography, Conventional Radiography Published under a CC BY 4.0 license. See also the commentary by Whitman and Vining in this issue.

Exploring the Documentation of Delirium in Patients After Cardiac Surgery: A Retrospective Patient Record Study.

Delirium is a common disorder for patients after cardiac surgery. Its manifestation and care can be examined through EHRs. The aim of this retrospective, comparative, and descriptive patient record study was to describe the documentation of delirium symptoms in the EHRs of patients who have undergone cardiac surgery and to explore how the documentation evolved between two periods (2005-2009 and 2015-2020). Randomly selected care episodes were annotated with a template, including delirium symptoms, treatment methods, and adverse events. The patients were then manually classified into two groups: nondelirious (n = 257) and possibly delirious (n = 172). The data were analyzed quantitatively and descriptively. According to the data, the documentation of symptoms such as disorientation, memory problems, motoric behavior, and disorganized thinking improved between periods. Yet, the key symptoms of delirium, inattention, and awareness were seldom documented. The professionals did not systematically document the possibility of delirium. Particularly, the way nurses recorded structural information did not facilitate an overall understanding of a patient's condition with respect to delirium. Information about delirium or proposed care was seldom documented in the discharge summaries. Advanced machine learning techniques can augment instruments that facilitate early detection, care planning, and transferring information to follow-up care.

Validation of an ICD-10 case-finding algorithm for endometrial cancer in US insurance claims.

PURPOSE: To evaluate the positive predictive value (PPV) of an endometrial cancer case finding algorithm using International Classification of Disease 10th revision Clinical Modification (ICD-10-CM) diagnosis codes from US insurance claims for implementation in a planned post-marketing safety study. Two algorithm variants were evaluated. METHODS: Provisional incident endometrial cancer cases were identified from 2016 through 2020 among women aged ≥50 years. One algorithm variant used diagnosis codes for malignant neoplasms of uterine sites (C54.x), excluding C54.2 (malignant neoplasm of myometrium); the other used only C54.1 (malignant neoplasm of endometrium). A random sample of medical records of recent incident provisional cases (2018-2020) was requested for adjudication. Confirmed cases showed biopsy evidence of endometrial cancer, documentation of cancer staging, or hysterectomy following diagnosis. We estimated the PPV of the variants with 95% confidence intervals (CI) excluding cases that had insufficient information. RESULTS: Of 294 provisional cases adjudicated, 85% were from outpatient settings (n = 249). Mean age at diagnosis was 69.3 years. Among the 294 adjudicated cases (identified with the broader algorithm variant), the same 223 were confirmed endometrial cancer cases by both algorithm variants. The PPV (95% CI) for the broader algorithm variant was 84.2% (79.2% and 88.3%), and for the variant using only C54.1 was 85.8% (80.9% and 89.8%). CONCLUSION: We developed and validated an algorithm using ICD-10-CM diagnosis codes to identify endometrial cancer cases in health insurance claims with a sufficiently high PPV to use in a planned post-marketing safety study.

Clinical signs, causes, and outcome of central cord syndrome in 22 cats.

OBJECTIVE: To describe the signalment, clinical findings, presumptive or definitive diagnosis, and outcome in cats with central cord syndrome (CCS). ANIMALS: 22 cats. CLINICAL PRESENTATION: Cats evaluated for CCS at 7 referral hospitals between 2017 and 2021 were included. Information retrieved from medical records included signalment, physical and neurological examination findings, diagnostic investigations, definitive or presumptive diagnosis, treatment, and follow-up. RESULTS: Median age at presentation was 9 years. Two neuroanatomical localizations were associated with CCS: C1-C5 spinal cord segments in 17 (77.3%) cats and C6-T2 spinal cord segments in 5 (22.7%) cats. Neuroanatomical localization did not correlate with lesion location on MRI in 8 (36.3%) cats. The most common lesion location within the vertebral column was over the C2 and C4 vertebral bodies in 6 (27.2%) and 5 (22.7%) cats, respectively. Peracute clinical signs were observed in 11 (50%) cats, acute in 1 (4.5%), subacute in 4 (18%), and chronic and progressive signs were seen in 6 (40.9%) cats. The most common peracute condition was ischemic myelopathy in 8 (36.3%) cats, whereas neoplasia was the most frequently identified chronic etiology occurring in 5 (22.7%) cats. Outcome was poor in 13 (59%) cats, consisting of 4 of 11 (36.6%) of the peracute cases, 3 of 4 (75%) of the subacute cases, and 6 of 6 of the chronic cases. CLINICAL RELEVANCE: Central cord syndrome can occur in cats with lesions in the C1-C5 and C6-T2 spinal cord segments. Multiple etiologies can cause CCS, most commonly, ischemic myelopathy and neoplasia. Prognosis depends on the etiology and onset of clinical signs.

Maxillofacial infections of dental origin: risk factors for hospital admission

Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length

Perfil sociodemográfico e laboratorial dos pacientes submetidos à hemodiálise em um centro de referência do Estado do Ceará / Sociodemographic and laboratory profile of patients undergoing hemodialysis in a reference center in the State of Ceará / Perfil sociodemográfico y de laboratorio de dos pacientes sometidos a hemodiálisis en un centro de referencia del Estado de Ceará

A Doença Renal Crônica (DRC) é uma importante redução da função renal que causa alterações no metabolismo dos indivíduos. Para acompanhar a progressão da DRC e prevenir possíveis complicações, foi realizada uma pesquisa para avaliar o perfil sociodemográfico, bioquímico e hematológico de pacientes com Insuficiência Renal Crônica (IRC) submetidos a hemodiálise. Esta pesquisa foi quantitativa, descritiva e transversal de caráter retrospectivo, realizada por meio da análise de dados secundários contidos nos prontuários dos pacientes. A coleta de dados ocorreu no Centro de Hemodiálise da cidade de Russas, no Ceará. A amostra foi constituída por 161 pacientes com DRC, sendo 63,35% do sexo masculino e 85,71% pardos, com uma idade média de 54,39 anos. Desses, 63,97% tinham entre 2 e 10 anos de tratamento e 57,76% possuíam ensino fundamental incompleto. 19,25% residiam em Russas. Resultados: Após a hemodiálise, os resultados mostraram 44 mg/dL de Ureia, 48,44% dos pacientes com valores normais. A hemoglobina e hematócrito médios foram 11,8 g/dL e 33,7%, respectivamente, sendo que 63,35% tiveram valores reduzidos. 85,10% dos pacientes tiveram contagem de plaquetas normal, 72,04% níveis adequados de ferro e albumina, 52,79% tiveram níveis elevados de ferritina, 23,61% redução de transferrina e níveis lipídicos satisfatórios. 79,50% apresentaram níveis séricos de potássio dentro da normalidade, 12,42% de fósforo acima do normal, 85,09% de cálcio dentro dos valores normais, 39,13% de PTHi normais e 86,33% de glicose dentro dos valores considerados normais. Com base nos resultados, concluiu-se que todos os pacientes em tratamento hemodialítico apresentam diversas alterações em decorrência da DRC e do próprio processo de tratamento. Portanto, a realização de exames para avaliar ou monitorar possíveis complicações da IRC é essencial para criar estratégias e intervenções mais eficazes, que melhorem a assistência prestada a esses pacientes e, consequentemente, da qualidade e expectativa de vida dos mesmos.

Chronic Kidney Disease (CKD) is an important reduction in kidney function that causes changes in the metabolism of individuals. To monitor the progression of CKD and prevent possible complications, a survey was carried out to assess the sociodemographic, biochemical and hematological profile of patients with Chronic Renal Failure (CRF) undergoing hemodialysis. This research was quantitative, descriptive and cross-sectional with a retrospective character, carried out through the analysis of secondary data contained in the patients' medical records. Data collection took place at the Hemodialysis Center in the city of Russas, Ceará. The sample consisted of 161 patients with CKD, 63.35% male and 85.71% brown, with an average age of 54.39 years. Of these, 63.97% had between 2 and 10 years of treatment and 57.76% had incomplete primary education. 19.25% resided in Russas. Results: After hemodialysis, the results showed 44 mg/dL of Urea, 48.44% of patients with normal values. Average hemoglobin and hematocrit were 11.8 g/dL and 33.7%, respectively, with 63.35% having reduced values. 85.10% of the patients had normal platelet counts, 72.04% had adequate levels of iron and albumin, 52.79% had high levels of ferritin, 23.61% had reduced transferrin and satisfactory lipid levels. 79.50% had serum levels of potassium within the normal range, 12.42% of phosphorus above normal, 85.09% of calcium within normal values, 39.13% of PTHi normal and 86.33% of glucose within the values considered normal. Based on the results, it was concluded that all patients on hemodialysis have several changes due to CKD and the treatment process itself. Therefore, carrying out tests to assess or monitor possible complications of CRF is essential to create more effective strategies and interventions that improve the care provided to these patients and, consequently, their quality and life expectancy.

La Enfermedad Renal Crónica (ERC) es una reducción importante de la función renal que provoca cambios en el metabolismo de los individuos. Para monitorizar la evolución de la ERC y prevenir posibles complicaciones, se realizó una encuesta para evaluar el perfil sociodemográfico, bioquímico y hematológico de los pacientes con Insuficiencia Renal Crónica (IRC) en hemodiálisis. Esta investigación fue cuantitativa, descriptiva y transversal con carácter retrospectivo, realizada a través del análisis de datos secundarios contenidos en las historias clínicas de los pacientes. La recolección de datos ocurrió en el Centro de Hemodiálisis de la ciudad de Russas, Ceará. La muestra estuvo constituida por 161 pacientes con ERC, 63,35% del sexo masculino y 85,71% pardos, con una edad media de 54,39 años. De estos, 63,97% tenían entre 2 y 10 años de tratamiento y 57,76% tenían primaria incompleta. El 19,25% residía en Russas. Resultados: Posterior a la hemodiálisis los resultados arrojaron 44 mg/dL de Urea, 48,44% de los pacientes con valores normales. La hemoglobina y el hematocrito medios fueron 11,8 g/dl y 33,7 %, respectivamente, con un 63,35 % con valores reducidos. El 85,10% de los pacientes presentaba plaquetas normales, el 72,04% presentaba niveles adecuados de hierro y albúmina, el 52,79% presentaba niveles elevados de ferritina, el 23,61% presentaba transferrina reducida y niveles satisfactorios de lípidos. El 79,50% presentaba niveles séricos de potasio dentro de la normalidad, el 12,42% de fósforo por encima de lo normal, el 85,09% de calcio dentro de los valores normales, el 39,13% de PTHi normal y el 86,33% de glucosa dentro de los valores considerados normales. Con base en los resultados, se concluyó que todos los pacientes en hemodiálisis tienen varios cambios debido a la ERC y al propio proceso de tratamiento. Por tanto, la realización de pruebas para evaluar o monitorizar las posibles complicaciones de la IRC es fundamental para crear estrategias e intervenciones más eficaces que mejoren la atención a estos pacientes y, en consecuencia, su calidad y esperanza de vida.

The association of environmental factors with neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia (ALL).

PURPOSE: To investigate the association of environmental factors, rehabilitation services during therapy and socioeconomic status (SES - insurance type), with neurocognitive outcomes at the end of therapy for survivors of childhood acute lymphoblastic leukemia (ALL). METHODS: Survivors (n = 236) treated on the St. Jude Total Therapy Study 16 completed end of therapy testing with performance measures (IQ, attention, processing speed, fine motor skills, academics) and caregiver ratings (attention, executive function, adaptive skills). Environmental factors were abstracted from the medical record. RESULTS: Distribution of sex (47.3% female, p = 0.399), treatment arm (45.5% low risk, 54.5% standard/high risk p = 0.929), insurance type (47.7% private, 52.3% public/none, p = 0.117), and mean age at diagnosis (7.7 vs. 6.8 years, p = 0.143) were similar for groups with (n = 110; 46.6%) and without (n = 126; 53.6%) rehabilitation services during therapy. Compared to those without rehabilitation, the rehabilitation group (n = 110; 46.4%) had more caregiver reported problems with attention (Z = -0.28 vs. 0.43, p = 0.022), executive function (Z = -0.50 vs. -0.08, p = 0.003), and adaptive skills (Z = -0.41 vs.-0.13, p = 0.031). Among the rehabilitation group, there was no difference in outcomes by insurance status. Among those without rehabilitation, those with public insurance had worse neurocognitive outcomes than those with private insurance in IQ (Z = -0.04 vs. -0.45, p = 0.0115), processing speed (Z = -0.10 vs. -0.75, p = 0.0030), reading (Z = 0.18 vs. -0.59, p < 0.0001), and math (Z = -0.04 vs. -0.50, p = 0.0021). CONCLUSION: Participation in rehabilitation services during early intensive therapy is associated with end of therapy caregiver-reported neurocognitive outcomes in daily life.

Comprehensive evaluation of disease coding quality in gastroenterology and its impact on the diagnosis-related group system: a cross-sectional study.

OBJECTIVE: According to the diagnosis-related group (DRG) requirement, issues of diagnosis and procedure coding in the gastroenterology department of our hospital were analyzed and improvement plans were proposed to lay the foundation for effective implementation of DRGs. METHODS: The title page of case-history of 1600 patients admitted to the Department of Gastroenterology of this hospital from January 1, 2021 to December 31, 2021 was sampled as a data source, and the primary and other diagnostic codes, operation or procedure codes involved in the title page of case-history were categorized and statistically analyzed. RESULTS: Of the 531 cases treated with gastrointestinal endoscopy in our hospital in 2021, coding errors were identified in 66 cases and unsuccessful DRG enrollment in 35 cases, including 14 cases with incorrect coding of the primary diagnosis (8 cases with unsuccessful DRG enrollment), 37 cases with incorrect coding of the primary operation (23 cases with unsuccessful DRG enrollment), and 8 cases with incorrect coding of both the primary diagnosis and the primary operation (4 cases with unsuccessful DRG enrollment). Analysis of 66 inpatient cases with coding problems showed a total of 167 deficiencies, including 36 deficiencies in major diagnoses, 84 deficiencies in other diagnoses, and 47 deficiencies in surgery or operation coding. CONCLUSION: The accuracy of coding of disease diagnosis and surgical operation is the basis for the smooth implementation of DRGs. The medical staff of this hospital has poor cognition of DRGs coding and fails to recognize the important role of the title page of case-history quality to DRGs system, and their attention to DRGs and knowledge base of disease classification coding should be improved. In addition, the high incidence of coding errors, especially the omission of disease diagnosis, requires increased training of physicians and nurses on clinical knowledge and requirements for DRGs medical records, thereby improving the quality of medical cases and ensuring the accuracy of DRGs information.

Adherence to heart rate training zones in an exercise training program in adults with coronary artery disease

Objectives: To investigate the effect of exercise intensity on functional capacity in individuals with coronary artery disease, assess adherence to the heart rate training zone (HRTZ), and relationship between trained intensity and functional capacity. Methods: Retrospective study led with medical records of 54 outpatients with coronary artery disease in a public hospital. The prescribed intensity started at 50 ­60% of heart rate reserve, increasing monthly to 70 ­80% by the third month. Spearman's test was used to assess the correlation between improvement in distance in the incremental shuttle walk test (ISWT), exercise intensity, and rating of perceived exertion (Borg­RPE). Adherence was classified as 'below' when HRTZ was not achieved in any phase of the program, 'intermediate' when HR was within the HRTZ for one or two months, and 'above' when HR was at or higher than HRTZ two months. Improvement was tested with t-test and one-way ANOVA. Results: 51.9% of participants had an increase in ISWT of ≥70 m (p < 0.0001). In at least one month, 50.9% trained below HRTZ. Trained intensity did not go below 8.6% of the prescribed minimal threshold of HRTZ. Changes in ISWT were not significantly correlated with exercise intensity (p = 0.87) or Borg­RPE (p = 0.16). Conclusion: While a significant increase in functional capacity was found, considerable heterogeneity in changes were observed. This may, in part, be related to adherence to HRTZ with progressive exercise intensity and to the variability in exercise volume incardiovascular rehabilitation programs.

Pain management in children with burns before admission to the ward: Analysis of selected parts of pre-hospital medical records.

BACKGROUND: The extent of pre-hospital medical care (PHMC) given to burned patients affects both the patient's condition and the effectiveness of treatment. OBJECTIVES: To improve the quality of PHMC of burns in children, based upon an analysis of the selected parts of pre-hospital medical records, with particular emphasis on analgesia. MATERIAL AND METHODS: Medical records were used to analyze how PHMC was given to 117 burned children aged 0-18 years, treated at the Pediatric Surgery Ward between January 1, 2014 and December 31, 2017. RESULTS: In 41/85 cases, PHMC was delivered by Emergency Medical Teams (EMTs), in 42 in Emergency/Admission Rooms (ARs) and in 2 by Primary Health Care (PHC). Monotherapy was predominant. Medical records from ARs included the following information: the administration of analgesics with the name in 95% (21) of the cases, the route of drug administration in 45% (10), insertion of intravenous access and dressing in 33% (14), and fluid transfusion in 43% (6) cases. The way in which the EMTs provided assistance was described in 34% (14/41) of medical records, the administration of analgesics in 86% (12) cases, cooling and dressing in 43% (6), and the establishment of intravenous access with fluid transfusion in 36% (5) cases. CONCLUSION: In burned children, access to analgesic and combined pain therapy is still random, limited and deviates from current recommendations. Prior to the admission to the ward, pain relief with 1 agent administered rectally prevails. There is a need to standardize the procedures for pre-hospital medical assistance provided to burned children, including the method of pain management in line with the Polish recommendations. It is necessary to make the medical staff aware of the obligation to keep medical records in a reliable and legal manner.

Validation of the Swedish Quality Register for Ear Surgery - SwedEar.

BACKGROUND: The Swedish Quality Register for Ear Surgery (SwedEar) is a national register monitoring surgical procedures and outcomes of ear surgery to facilitate quality improvement. The value of the register is dependent on the quality of its data. SwedEar has never been validated regarding data quality or missing entries. Therefor, the purpose of this study was to assess coverage, completeness and response rate in the register and validate the physicians' reported data accuracy. METHODS: In this validation study, the completeness, response rate and missing registrations were analysed. Data in SwedEar were compared with the yearly collected statistics of otosurgical procedures in The Swedish Otosurgical Society and the comparison of rates between groups was calculated with Fisher's exact test. Validation of registered data accuracy was performed on every 20th registered case during a five-year period. Data were reabstracted from medical records and compared with the original registration. Interrater agreement, reliability measures, Cohen's kappa, Gwet's AC1 and positive predictive value were calculated. RESULTS: SwedEar has a coverage of 100%. The completeness of registered cases was 84% and the response rate was 74%. The validation of data accuracy assessed 13 530 variables, including audiograms. Less than 3% of incorrect or missing variables were identified. For most of the pre- and postoperative variables the Kappa and Gwet´s AC1 results show an almost perfect agreement (> 0.80). For audiogram data the ICC shows an excellent reliability (> 0.9) for all but one value. CONCLUSION: This validation shows that SwedEar has excellent coverage, high completeness, and that the data in the register have almost perfect reliability. The data are suitable for both clinical and research purposes. Further efforts to improve completeness are warranted.

Comportamento Auditivo e Validação no Diagnóstico Audiológico e Intervenção em Bebês e Crianças com Deficiência Auditiva / Auditory Behavior and Validation in Audiological Diagnosis and Intervention in Infants and Children with Hearing Impairment / Comportamiento auditivo y validación en el diagnóstico e intervención audiológicos en bebés y niños con deficiencia auditiva

Introdução: A atuação profissional com bebês e crianças pequenas com deficiência auditiva exige conhecimento e técnica específica no que diz respeito à prescrição e adaptação do aparelho de amplificação sonora individual (AASI) e ao processo de desenvolvimento de linguagem. Limitações e imprecisões ao longo do processo diagnóstico poderão comprometer todos os procedimentos subsequentes do processo de intervenção. Objetivo: Analisar a validação do processo de diagnóstico audiológico e intervenção em bebês e crianças com deficiência auditiva a partir da análise comparativa de exames audiológicos, comportamento auditivo e aplicação do princípio de verificação cruzada após adaptação de AASI. Método: Foram sujeitos da pesquisa 12 crianças de até 36 meses de idade, com diagnóstico de perda auditiva neurossensorial bilateral, selecionados a partir da disponibilidade de acesso ao serviço para a avaliação e agrupados em G1 (sujeitos com Índice de Inteligibilidade de Fala - SII 65 dB até 35%) e G2 (sujeitos com Índice de Inteligibilidade de Fala - SII 65 dB acima de 54%). Resultados: A média de idade do diagnóstico audiológico foi de 4,33 meses. Os resultados audiológicos de todas as crianças tiveram correspondência entre si, com exceção de dois sujeitos do G2. Conclusão: O comportamento auditivo não só permitiu a validação dos processos de diagnóstico e intervenção auditiva dos sujeitos da pesquisa, como também permitiu a identificação de comportamentos não compatíveis com a audibilidade devido ao uso inconsistente dos AASI. A aplicação dos instrumentos de acompanhamento de desenvolvimento mostrou-se adequada para o monitoramento do desenvolvimento de habilidades de audição e linguagem em crianças pequenas. (AU)

Introduction: Professional work with infants and young children with hearing impairment requires specific knowledge and technique regarding the prescription and adaptation of the individual sound amplification device (PSAD) and the language development process. Limitations and inaccuracies throughout the diagnostic process may compromise all subsequent procedures of the intervention process. Purpose: To analyze the validation of the process of audiological diagnosis and intervention in infants and children with hearing impairment based on the comparative analysis of audiological tests, auditory behavior and application of the cross-checking principle after adaptation of hearing aids. Method: The research subjects were 12 children aged up to 36 months, with a diagnosis of bilateral sensorineural hearing loss, selected from the availability of access to the service for the evaluation and grouped into G1 (subjects with Speech Intelligibility Index - SII 65 dB up to 35%) and G2 (subjects with Speech Intelligibility Index - SII 65 dB above 54%). Results: The average age of the audiological diagnosis was 4.33 months. The audiological results of all children corresponded to each other, except for two subjects from G2. Conclusion: The auditory behavior not only allowed the validation of the processes of diagnosis and auditory intervention of the research subjects, but also allowed the identification of behaviors that are not compatible with audibility due to the inconsistent use of hearing aids. The application of developmental monitoring instruments proved to be adequate for monitoring the development of hearing and language skills in young children. (AU)

Introducción: El trabajo profesional con lactantes y niños pequeños con discapacidad auditiva requiere conocimientos y técnica específicos respecto a la prescripción y adaptación del dispositivo individual de amplificación del sonido (PSAD) y el proceso de desarrollo del lenguaje. Las limitaciones e imprecisiones a lo largo del proceso de diagnóstico pueden comprometer todos los procedimientos posteriores del proceso de intervención. Propósito: Analizar la validación del proceso de diagnóstico e intervención audiológica en lactantes y niños con discapacidad auditiva a partir del análisis comparativo de pruebas audiológicas, conducta auditiva y aplicación del principio de cruce tras adaptación de audífonos. Método: Los sujetos de investigación fueron 12 niños de hasta 36 meses, con diagnóstico de hipoacusia neurosensorial bilateral, seleccionados de la disponibilidad de acceso al servicio para la evaluación y agrupados en G1 (sujetos con Índice de inteligibilidade del Habla - SII 65 dB hasta 35%) y G2 (sujetos com Índice de inteligibilidade del Habla - SII 65 dB por encima del 54%). Resultados:La edad promedio del diagnóstico audiológico fue de 4,33 meses. Los resultados audiológicos de todos los niños se correspondieron entre sí, a excepción de dos sujetos del G2. Conclusión: La conducta auditiva no sólo permitió validar los procesos de diagnóstico e intervención auditiva de los sujetos de investigación, sino que también permitió identificar conductas no compatibles con la audibilidad debido al uso inconsistente de audífonos. La aplicación de instrumentos de seguimiento del desarrollo demostró ser adecuada para controlar el desarrollo de las habilidades auditivas y lingüísticas en niños pequeños. (AU)

Effects of extracorporeal circulation with different time on platelet count after cardiac surgery: a retrospective study based on medical records.

Our objective was to observe the effects of extracorporeal circulation (ECC) with different time on platelet count in patients undergoing cardiac surgery. A total of 427 patients who underwent elective cardiac surgery under ECC in affiliated hospital of north Sichuan medical college from January 1, 2018 to July 31, 2021 were divided into three groups according to ECC time. We concluded that thrombocytopenia was common after ECC, maximum drop of the platelet counts after ECC was usually seen on the second day after ECC, and platelet counts started to recover on the fifth day after ECC. With the extension of ECC time, the drop in platelet counts is more pronounced, the volume of perioperative blood loss and blood products transfusion are more, and the recovery level and speed of platelet counts is lower.

Incidence and prevalence of neurofibromatosis type 1 and 2: a systematic review and meta-analysis.

OBJECTIVE: To obtain updated estimates of the incidence and prevalence of neurofibromatosis type 1 (NF1) and type 2 (NF2). STUDY DESIGN: We conducted a systematic search of NF1 and NF2 incidence or prevalence studies, in OVID Medline, OVID Embase, Web of Science, and Cinahl. Studies were appraised with the Joanna Briggs Institute Prevalence Critical Appraisal tool. Pooled incidence and prevalence rates were estimated through random-effects meta-analysis. RESULTS: From 1,939 abstracts, 20 studies were fully appraised and 12 were included in the final review. Pooled NF1 prevalence was 1 in 3,164 (95%CI: 1 in 2,132-1 in 4,712). This was higher in studies that screened for NF1, compared to identification of NF1 through medical records (1 in 2,020 and 1 in 4,329, respectively). NF1 pooled birth incidence was 1 in 2,662 (95%CI: 1 in 1,968-1 in 3,601). There were only 2 studies on NF2 prevalence, so data were not pooled. Pooled NF2 birth incidence was 1.08 per 50,000 births (95%CI: 1 in 32,829-1 in 65,019). CONCLUSION: We present updated estimates of the incidence and prevalence of NF1 and NF2, to help plan for healthcare access and allocation. The prevalence of NF1 from screening studies is higher than from medical record studies, suggesting that the disease may be under recognized. More studies are needed regarding the prevalence of NF2.