ABSTRACT
Purpose: Earlier literature has reported on the utility of diagnostic codes and demographic information for identifying transgender patients. We aim to assess which method identifies the most transgender patients utilizing readily available tools from within the electronic health record (EHR). Methods: A de-identified patient database from a single EHR that allows for searching any discrete data point in the EHR was used to query International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnostic codes and demographic data specific to transgender patients from January 2011 to April 2019. Results: Demographic data and ICD-10 codes yielded 1494 individual EHRs with transgender-specific data domains. ICD-10 diagnostic codes alone identified 942 (63.05%) unique EHRs. Demographics alone identified 218 (14.59%) unique EHRs. A total of 334 (22.36%) unique EHRs had both ICD-10 and demographic identifiers. Of those identified by transgender-specific demographic data (552), 294 (53.26%) were trans masculine, 215 (38.95%) were trans feminine, and 43 (7.79%) were nonbinary. Of the 552 demographic-identified transgender patients, 141 (25.86%) were identified by a two-part gender identity demographic question. Conclusions: ICD-10 diagnostic codes, not demographic data, identified the most transgender patient records, but neither diagnostic codes alone nor demographic data captured the full population. Only 26.36% of the charts identified as transgender patients had both ICD-10 codes and demographic data. We recommend that when identifying transgender populations through EHR domains, a combination of diagnostic codes and demographic data be used. Furthermore, research is needed to optimize disclosure and collection of demographic information for gender minority populations.
ABSTRACT
The primary impetus for the work reported in this paper is to develop efficient overmoded waveguides (OMWGs) that employ broadband downtaper transitions that would be compatible with the severe space constraints in high-field NB magnets. Further, it is essential these would be readily manufacturable, as high precision corrugated metallic downtapers for the sub-mmw regime are very difficult to produce. We have simulated numerous alternatives to corrugated circular OMWGs, including most of the previously reported alternatives (except for many of the low-power fiberoptics options) and several novel designs. We conclude that corrugated circular metallic OMWGs are the best of the reported options to date (except from a cost perspective) for diameters down to ~1.5λ, but the corrugation parameters for small OMWGs need to be significantly different from the previously published guidelines that have worked well for large OMWGs. With numerically optimized small OMWGs, easily manufacturable smooth downtapers appear to work as well as corrugated downtapers in many cases relevant to MAS-DNP probes. Our example simulations will be for the 170-230 GHz range, but the lessons and results should be readily applicable to other ranges by simple scaling.
ABSTRACT
Objective: The purpose of this study was to determine whether an electronic health record-based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis. Materials and Methods: We performed a patient-level interrupted time series study of emergency department patients with severe sepsis or septic shock between January 2013 and April 2015. The intervention, introduced in February 2014, was a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Primary outcomes were length of stay (LOS) and in-hospital mortality; other outcomes included time to first lactate and blood cultures prior to antibiotics. We also assessed sensitivity, positive predictive value (PPV), and clinician response to the alerts. Results: Mean LOS for patients with sepsis decreased from 10.1 to 8.6 days (P < .001) following alert introduction. In adjusted time series analysis, the intervention was associated with a decreased LOS of 16% (95% CI, 5%-25%; P = .007, with significance of α = 0.006) and no change thereafter (0%; 95% CI, -2%, 2%). The sepsis alert system had no effect on mortality or other clinical or process measures. The intervention had a sensitivity of 80.4% and a PPV of 14.6%. Discussion: Alerting based on simple laboratory and vital sign criteria was insufficient to improve sepsis outcomes. Alert fatigue due to the low PPV is likely the primary contributor to these results. Conclusion: A more sophisticated algorithm for sepsis identification is needed to improve outcomes.
