[The transformation of medical statistic during pandemic of new coronavirus infection (COVID-19)].

The pandemic of new coronavirus infection (COVID-19) directly effected medical statistics service. The amendments to the Federal Law "On the Official Statistical Accounting and the System of State Statistics in the Russian Federation" adopted in December 2020, regulated the provision of primary statistical data according forms of Federal and industrial statistical observation in the format of electronic document signed with electronic signature. This required the development of system of collecting and processing statistical data at the Federal level applying new technological solutions. The purpose of the study. To analyze the changes in the system of collecting and processing annual reporting on medical statistics for 2020 during the pandemic of new coronavirus infection COVID-19. The analysis was made concerning both normative legal base regulating implementation of information systems and system of receiving annual reports for current and previous years. Also content analysis was applied and materials distributed Internet were used. In conditions of new coronavirus infection (COVID-19) pandemic, instead of classical system of informational interaction at face-to-face coordination of annual report data, in extremely short terms new model of informational interaction of remote coordination and processing of annual report data was developed. The updated technological scheme was applied that included data transmission, remote coordination in VKS format, informing thriugh Telegram-channels and signing finalized forms with enhanced electronic digital signature. The complicated epidemiological situation regarding morbidity of new coronavirus infection (COVID-19) and as well as adoption of amendments in Federal legislation regarding provision of statistical observation forms in format of electronic document signed with electronic signature, required revision of format of statistical reports reception in 2020. The application of developed technology of collecting and processing annual reports data on medical statistics in online format permitted to dispense with both provision of hard copies versions of forms and reports and business trips of specialists from the subjects of the Russian Federation to Moscow that reduced expenses of the subjects of the Russian Federation when submitting annual reports. The developed mechanism of signing with unqualified electronic digital signature permitted to control data integrity. The applied mechanism for signing finalized concerted forms with enhanced electronic digital signature of public authority of the subject of the Russian Federation in the field of health protection ensured juridical significance of document provided. The establishment of base for further modernization of system of collecting statistical information from primary data, including subsequent implementation of structured electronic medical documents is proposed.

Risk factors and outcomes of critically ill patients with acute brain failure: A novel end point.

OBJECTIVE: To determine the incidence, risk factors and outcomes of acute brain failure (ABF) in a mixed medical and surgical cohort of critically ill patients and its effect on ICU & hospital mortality. DESIGN: Observational electronic medical record (EMR) based retrospective cohort study of critically ill patients admitted to the ICU between 2006 and 2013. SETTING: Tertiary academic medical center. PATIENTS: Consecutive adult (>18years) critically ill patients admitted to medical and surgical ICUs. Patients admitted to the Neuroscience, Pediatric and Neonatal ICUs were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: ABF was defined by the presence of delirium (positive CAM-ICU) or depressed level of consciousness (by abnormal GCS and FOUR scores) in the absence of deep sedation (RASS<-3). Severity of ABF was categorized as grade I if there was delirium with GCS consistently >8 and grade II if the GCS was ≤8 with or without delirium during the ICU hospitalization. ABF duration was not used for this study. Univariate and multivariable analyses were used to access the factors associated with the development of ABF and its effect on short and long term mortality. Of 67,333 ICU patients included in the analysis, ABF was present in 30,610 (44.6%). Patients with ABF had an isolated delirium in 1985 (6.5%) patients, isolated depressed consciousness in 18,323 (59.9%), and both delirium and depressed consciousness in 10,302 (33.6%) patients. When adjusted for comorbidities and severity of illness ABF was associated with increased hospital (OR 3.47; 95% CI 3.19-3.79), and at one year (OR 2.36; 95% CI 2.24-2.50) mortality. Both hospital and one year mortality correlated with the increased severity of ABF. The factors most strongly associated with ABF were pre-admission dementia (OR 7.86; 95% CI 6.15-10.19) and invasive ventilation (OR 2.32; 95% CI 2.24-2.40) but older age, female sex, presence of liver disease, renal failure, diabetes mellitus, malignancy and COPD were also associated with increased risk of ABF. CONCLUSIONS: ABF is a common complication of critical illness and is associated with increased short and long term mortality. The risk of ABF was particularly high in older patients with baseline dementia, COPD, diabetes, liver and renal disease and those treated with invasive mechanical ventilation.

Identification of acute brain failure using electronic medical records.

PURPOSE: Up to 80% of critically ill patients have acute neurologic dysfunction syndromes. We evaluated interrater reliability between the examination by the investigator and the charted assessment by the nurse because the accuracy and reliability of detailed data sets extracted from the electronic medical records represents a keystone for creating EMR-based definitions. MATERIALS AND METHODS: We conducted a prospective observational study of intensive care unit (ICU) patients to assess the reliability of charted Confusion Assessment Method for the ICU, Glasgow Coma Scale (GSC), Full Outline of Unresponsiveness, and Richmond Agitation Sedation Scale (RASS) scores, and a composite measure of ABF defined as new-onset coma or delirium. Trained investigator blinded to nursing assessments performed the neurologic evaluations that were compared with nursing documentation. RESULTS: A total of 202 observations were performed in 55 ICU patients. Excellent correlation was noted for GCS and Full Outline of Unresponsiveness scores on Bland-Altman plots (Pearson correlation 0.87 and 0.92, respectively). Correlation for Confusion Assessment Method for the ICU was also high (κ= 0.86; 95% confidence interval [CI], 0.70-1.01). Richmond Agitation Sedation Scale had good agreement when scores were dichotomized as oversedated (less than -2) vs not oversedated, with κ= 0.76 (95% CI, 0.54-0.98). Investigator assessment and nurse charting were highly concordant (κ= 0.84; 95% CI, 0.71-0.99). CONCLUSION: Neurologic assessments documented on the EMR are reliable.