scholarly journals Reducing clinical review burden for insertable cardiac monitors

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
RS Gardner ◽  
F Quartieri ◽  
TR Betts ◽  
M Afzal ◽  
H Manyam ◽  
...  
Keyword(s):  
Patient Care ◽  
Transmission Rate ◽  
Diagnostic Delay ◽  
Ventricular Rate ◽  
Selection Strategy ◽  
Clinical Workflow ◽  
Care Network ◽  
Remote Transmission ◽  
Funding Sources ◽  
Transmission Period

Abstract Funding Acknowledgements Type of funding sources: None. Background The insertable cardiac monitor (ICM) is an essential tool for the ambulatory diagnosis of arrhythmias. However, definitive diagnoses still rely on time-consuming, manual adjudication of electrograms (EGMs) transmitted to the patient care network. This EGM review burden may be minimized by automatically selecting a subset of EGMs for fast review without delaying the diagnosis. Purpose Develop EGM selection strategies to reduce the EGM review burden without delaying diagnoses. Methods A retrospective analysis of 1,000 randomly selected Abbott Confirm Rx devices with 90+ days of remote transmission history was performed, regardless of transmission frequency, and all EGMs were adjudicated as either true or false positive (TP, FP). Up to 3 EGMs per day per arrhythmia type were prioritized for review based on ventricular rate and episode duration, with rules specific to each arrhythmia type: atrial fibrillation (AF), tachycardia, bradycardia, and pause. The resulting reduction in EGM review burden and TP days (patient-days with at least 1 TP EGM), as well as any diagnostic delay from the first transmitted TP, were calculated relative to reviewing all transmitted EGMs. Results In this population and transmission period, at least one AF, tachycardia, bradycardia, and pause EGM was transmitted by 424, 343, 190, and 325 unique devices, respectively, with a total of 35,723, 12,239, 19,752, and 28,002 EGMs, and a total of 6,163, 1,572, 1,438, and 646 TP days. For these patients with ≥1 EGM, the median [IQR] EGM transmission rate was 2.6 [0.7, 11.6], 1.1 [0.4, 4.7], 2.1 [0.6, 10.7], and 3.4 [0.6, 29.9] EGMs/patient/month, respectively. The optimal EGM selection strategy reduced this EGM review burden by 43%, 67%, 76%, and 50%, while only missing 3.4%, 2.2%, 0.3%, and 0.2% of TP days, respectively. Ultimately, 97%, 99%, 99%, and 99% of devices with a TP AF, tachycardia, bradycardia, or pause EGM exhibited no diagnostic delay vs. reviewing all transmitted EGMs. Conclusion EGM prioritization rules for selecting up to 3 episodes/day significantly reduced EGM burden across all patients, not just "frequent fliers," with no delay-to-diagnosis in >97% of patients who exhibited a true arrhythmia. Implementing these rules on the patient care network may improve clinical workflow and ICM patient management. Abstract Figure.

scholarly journals Reducing the Electrogram Review Burden Imposed by Insertable Cardiac Monitors

2021 ◽  
Author(s):  
Roy S. Gardner ◽  
Fabio Quartieri ◽  
Tim Betts ◽  
Muhammad Afzal ◽  
Harish Manyam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Patient Care ◽  
False Positive ◽  
Diagnostic Delay ◽  
Clinical Impact ◽  
Ventricular Rate ◽  
Clinical Workflow ◽  
Require Time ◽  
Remote Transmission ◽  
Episode Duration

Background: Insertable cardiac monitors (ICMs) are essential for ambulatory arrhythmia diagnosis. However, definitive diagnoses still require time-consuming, manual adjudication of electrograms (EGMs). Objective: To evaluate the clinical impact of selecting only key EGMs for review. Methods: Retrospective analyses of randomly selected Abbott Confirm Rx devices with ≥90 days of remote transmission history was performed, with each EGM adjudicated as true or false positive (TP, FP). For each device, up to 3 “key EGMs” per arrhythmia type per day were prioritized for review based on ventricular rate and episode duration. The reduction in EGMs and TP days (patient-days with at least 1 TP EGM), and any diagnostic delay (from the first TP), were calculated vs. reviewing all EGMs. Results: In 1,000 ICMs over a median duration of 8.1 months, at least one atrial fibrillation (AF), tachycardia, bradycardia, or pause EGM was transmitted by 424, 343, 190, and 325 devices, respectively, with a total of 95716 EGMs. Approximately 90% of episodes were contributed by 25% of patients. Key EGM selection reduced EGM review burden by 43%, 66%, 77%, and 50% (55% overall), while reducing TP days by 0.8%, 2.1%, 0.2%, and 0.0%, respectively. Despite reviewing fewer EGMs, 99% of devices with a TP EGM were ultimately diagnosed on the same day vs. reviewing all EGMs. Conclusions: Key EGM selection reduced the EGM review substantially with no delay-to-diagnosis in 99% of patients exhibiting true arrhythmias. Implementing these rules in the Abbott patient care network may accelerate clinical workflow without compromising diagnostic timelines.

scholarly journals Creation and implementation of a novel clinical workflow based on the AAST uniform anatomic severity grading system for emergency general surgery conditions

2020 ◽  
Vol 5 (1) ◽  
pp. e000552 ◽  
Author(s):  
Kovi E Bessoff ◽  
Jeff Choi ◽  
Sylvia Bereknyei Merrell ◽  
Aussama Khalaf Nassar ◽  
David Spain ◽  
...  
Keyword(s):  
Patient Care ◽  
General Surgery ◽  
Qualitative Interviews ◽  
Grading System ◽  
Clinical Workflow ◽  
Emergency General Surgery ◽  
Level Of Evidence ◽  
Severity Scores ◽  
Severity Grading ◽  
The Impact

ObjectiveEmergency general surgery (EGS) conditions encompass a variety of diseases treated by acute care surgeons. The heterogeneity of these diseases limits infrastructure to facilitate EGS-specific quality improvement (QI) and research. A uniform anatomic severity grading system for EGS conditions was recently developed to fill this need. We integrated this system into our clinical workflow and examined its impact on research, surgical training, communication, and patient care.MethodsThe grading system was integrated into our clinical workflow in a phased fashion through formal education and a written handbook. A documentation template was also deployed in our electronic medical record to prospectively assign severity scores at the time of patient evaluation. Mixed methods including a quantitative survey and qualitative interviews of trainees and attending surgeons were used to evaluate the impact of the new workflow and to identify obstacles to its adoption.ResultsWe identified 2291 patients presenting with EGS conditions during our study period. The most common diagnoses were small bowel obstruction (n=470, 20.5%), acute cholecystitis (n=384, 16.8%), and appendicitis (n=370, 16.1%). A total of 21 qualitative interviews were conducted. Twenty interviewees (95.2%) had a positive impression of the clinical workflow, citing enhanced patient care and research opportunities. Fifteen interviewees (75.0%) reported the severity grading system was a useful framework for clinical management, with five participants (25.0%) indicating the system was useful to facilitate clinical communication. Participants identified solutions to overcome barriers to adoption of the clinical workflow.ConclusionsThe uniform anatomic severity grading system can be readily integrated into a clinical workflow to facilitate prospective data collection for QI and research. The system is perceived as valuable by users. Educational initiatives that focus on increasing familiarity with the system and its benefits will likely improve adoption of the classification system and the clinical workflow that uses it.Level of evidenceLevel III.

scholarly journals Combining molecular and imaging metrics in cancer: radiogenomics

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Roberto Lo Gullo ◽  
Isaac Daimiel ◽  
Elizabeth A. Morris ◽  
Katja Pinker
Keyword(s):  
Genetic Testing ◽  
Patient Care ◽  
Prospective Studies ◽  
Imaging Biomarkers ◽  
Main Body ◽  
Clinical Workflow ◽  
Prognosis And Prediction ◽  
Lung Malignancies ◽  
The Difference ◽  
Accurate Imaging

Abstract Background Radiogenomics is the extension of radiomics through the combination of genetic and radiomic data. Because genetic testing remains expensive, invasive, and time-consuming, and thus unavailable for all patients, radiogenomics may play an important role in providing accurate imaging surrogates which are correlated with genetic expression, thereby serving as a substitute for genetic testing. Main body In this article, we define the meaning of radiogenomics and the difference between radiomics and radiogenomics. We provide an up-to-date review of the radiomics and radiogenomics literature in oncology, focusing on breast, brain, gynecological, liver, kidney, prostate and lung malignancies. We also discuss the current challenges to radiogenomics analysis. Conclusion Radiomics and radiogenomics are promising to increase precision in diagnosis, assessment of prognosis, and prediction of treatment response, providing valuable information for patient care throughout the course of the disease, given that this information is easily obtainable with imaging. Larger prospective studies and standardization will be needed to define relevant imaging biomarkers before they can be implemented into the clinical workflow.

The Patient-centred Oncology Information System – Automating your Oncology Workflow For Optimal Patient Care

2012 ◽  
Vol 08 (04) ◽  
pp. 206 ◽  
Author(s):  
Peter Enever ◽  
Keyword(s):  
Information System ◽  
Radiation Therapy ◽  
Patient Care ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Critical Role ◽  
Advanced Treatment ◽  
Clinical Workflow ◽  
Treatment Techniques ◽  
Optimal Patient Care

Radiation therapy has become among the safest and most effective methods for treating cancer. Technology continues to play a critical role in managing and supporting advanced treatment techniques and ensuring safer practice. For clinicians, the ability to tailor the technology to meet their specific oncology workflows is a challenge. This article discusses how, by being able to automate clinical workflow in the electronic medical record (EMR), not only delivers greater department efficiency but can help support better outcomes through optimising patient care, before, during and after treatment.

scholarly journals Slow VT treatment in a contemporary population of primary prevention ICD recipients

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Angeletti ◽  
M Ziacchi ◽  
C Martignani ◽  
M Massaro ◽  
G Statuto ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Ventricular Rate ◽  
Antitachycardia Pacing ◽  
Funding Sources ◽  
Consensus Document ◽  
Independent Expert ◽  
Multiple Shocks ◽  
Expert Consensus Document ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardioverter defibrillator (ICD) is an effective therapy for sudden cardiac death (SCD). 2015 HRS/EHRA/APHRS/SOLAECE expert consensus document suggests long VT detection, above 185 bpm, as optimal ICD programming to reduce unnecessary therapies in primary prevention (PP). Purpose The aim of our study is to evaluate incidence, safety and efficacy of ICD treatment for VT arrhythmias below 185 bpm, in a contemporary population of PP ICD recipients with long detection intervals (LDI), morphological discrimination algorithm and antitachycardia pacing therapies (ATP) before shock. Methods We conducted a single centre retrospective study enrolling 236 patients implanted with a primary-prevention indication from January 2013 to June 2019. Patients were implanted with single or dual chamber single-lead transvenous ICD. All patients had standard device setting with long (at least 20 s in VT and 7 s in VF) VT/VF detection above 150 bpm and therapies starting from 171 with up to 5 ATP and multiple shocks. PainFREE-like bursts and Schaumann-like ramps ATP were always set in VT zone. Of each patient we collected a detailed report of up to five appropriate events and three inappropriate events. Arrhythmia diagnosis was confirmed from 3 independent expert physicians.  Date of the event, cycle length, type of morphology (polymorphic or monomorphic), therapies with their effect were collected. Results During a mean follow-up of 42 months, 47 (20 %) and 18 (8%) patients had at least one appropriate and inappropriate activation, respectively. The detailed-events analysis shows that 16 (7%) patients had 38 (30%) appropriate events with rate <188 bpm. At these rate ATP were 97% effective. 14 (38%) of inappropriate activations were caused by arrythmias with ventricular rate below 188 bpm and half of these received a shock; 30% of inappropriate shocks were due to arrhythmia with rate <188 bpm. 73% of treated events, with rate <188 bpm, were appropriate. Only 5.6% (n = 10) of ATP attempts cause arrhythmia acceleration. Conclusions One third of detected arrhythmias had a rate below 188 bpm and 73% were true VT. In this slow VT zone, ATP had a high success rate with low percentage of acceleration.

scholarly journals Estimating the reproductive number and the outbreak size of COVID-19 in Korea

2020 ◽  
Vol 42 ◽  
pp. e2020011 ◽  
Author(s):  
Sunhwa Choi ◽  
Moran Ki
Keyword(s):  
Transmission Rate ◽  
Transmission Model ◽  
Reproductive Number ◽  
Onset Date ◽  
The Public ◽  
Start Date ◽  
Patient Symptom ◽  
Number Of Patients ◽  
Transmission Period ◽  
Novel Coronavirus

OBJECTIVES: Since the first novel coronavirus disease 2019 (COVID-19) patient in Korea was diagnosed on January 20, 2020, 30 patients were diagnosed until February 17, 2020. However, 5,298 additional patients were confirmed until March 4, 2020. Therefore, our objective was to estimate the reproduction number (<i>R</i>) and evaluate the effectiveness of preventive measures.METHODS: A COVID-19 transmission model (SEIHR) was established to suit the Korean outbreak. The number of daily confirmed cases in Daegu and North Gyeongsang Province (NGP), the main area of outbreak, was used. The first patient’ symptom onset date in the Daegu/NGP outbreak was assumed as January 22, 2020. The <i>R</i> according to the start date of the effect of preventive measures was estimated.RESULTS: The estimated <i>R</i> in Hubei Province, China, was 4.0281, whereas the estimated initial <i>R</i> in Korea was 0.555, but later in Daegu/NGP, the value was between 3.472 and 3.543. When the transmission period decreases from 4-day to 2-day, the outbreak ends early, but the peak of the epidemic increases, and the total number of patients does not change greatly. It was found that, if transmission rate decreases, the outbreak ends early, and the size of the peak and the total number of patients also decreases.CONCLUSIONS: To end the COVID-19 epidemic, efforts to reduce the spread of the virus, such as social distancing and wearing masks, are absolutely crucial with the participation of the public, along with the policy of reducing the transmission period by finding and isolating patients as quickly as possible through the efforts of the quarantine authorities.

scholarly journals Patient to healthcare personnel transmission of MRSA in the non–intensive care unit setting

2020 ◽  
Vol 41 (5) ◽  
pp. 601-603
Author(s):  
Gita Nadimpalli ◽  
Lyndsay M. O’Hara ◽  
Lisa Pineles ◽  
Karly Lebherz ◽  
J. Kristie Johnson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Patient Care ◽  
Transmission Rate ◽  
Intensive Care Unit Setting ◽  
Healthcare Personnel ◽  
Direct Patient Care ◽  
Methicillin Resistant ◽  
Contact Precautions

AbstractThe transmission rate of methicillin-resistant Staphylococcus aureus (MRSA) to gloves or gowns of healthcare personnel (HCP) caring for MRSA patients in a non–intensive care unit setting was 5.4%. Contamination rates were higher among HCP performing direct patient care and when patients had detectable MRSA on their body. These findings may inform risk-based contact precautions.

scholarly journals Secondary Attack Rate among Non-Spousal Household Contacts of Coronavirus Disease 2019 in Tsuchiura, Japan, August 2020–February 2021

2021 ◽  
Vol 18 (17) ◽  
pp. 8921
Author(s):  
Tsuyoshi Ogata ◽  
Fujiko Irie ◽  
Eiko Ogawa ◽  
Shifuko Ujiie ◽  
Aina Seki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Attack Rate ◽  
Transmission Rate ◽  
Diagnostic Delay ◽  
Household Size ◽  
Household Contacts ◽  
Size Number ◽  
Mixed Regression ◽  
Household Members ◽  
Linear Mixed Regression Model

Household secondary attack rate (HSAR) by risk factor might have a higher transmission rate between spouses. We investigated risk factors for the HSAR among non-spousal household contacts of patients with coronavirus disease 2019 (COVID-19). We studied household contacts of index cases of COVID-19 in Tsuchiura, Japan, from August 2020 through February 2021. The HSARs of the whole household contacts and non-spousal household contacts were calculated and compared across risk factors. We used a generalized linear mixed regression model for multivariate analysis. We enrolled 496 household contacts of 236 index COVID-19 cases. The HSAR was higher for spousal household contacts (37.8%) than for other contacts (21.2%). The HSAR was lower for non-spousal household contacts with a household size (number of household members) of two (18.2%), compared to the HSAR for contacts with a household size ≥4. The HSAR was higher for non-spousal household contacts of index patients with ≥3 days of diagnostic delay (period between onset and diagnosis) (26.0%) compared to those with ≤2 days’ delay (12.5%) (p = 0.033). Among non-spousal household contacts, the HSAR was low for those with a household size of two and was high for contacts of index patients with a long diagnostic delay.

scholarly journals Sequencing using a two-steps strategy reveals high genetic diversity in the S gene of SARS-CoV-2 after a high transmission period in Tunis, Tunisia.

2021 ◽  
Author(s):  
Wasfi Fares ◽  
Kais Ghedira ◽  
Mariem Gdoura ◽  
Anissa Chouikha ◽  
Sondos Haddad-Boubaker ◽  
...  
Keyword(s):  
Whole Genome Sequencing ◽  
Genome Sequencing ◽  
Transmission Rate ◽  
Whole Genome ◽  
High Genetic Diversity ◽  
Middle Income ◽  
High Transmission ◽  
S Gene ◽  
Molecular Tests ◽  
Transmission Period

Recent efforts have reported numerous variants that influence SARS-CoV-2 viral characteristics including pathogenicity, transmission rate and ability of detection by molecular tests. Whole genome sequencing based on NGS technologies is the method of choice to identify all viral variants; however, the resources needed to use these techniques for a representative number of specimens remain limited in many low and middle income countries. To decrease sequencing cost, we developed a couple of primers allowing to generate partial sequences in the viral S gene allowing rapid detection of numerous variants of concern (VOCs) and variants of interest (VOIs); whole genome sequencing is then performed on a selection of viruses based on partial sequencing results. Two hundred and one nasopharyngeal specimens collected during the decreasing phase of a high transmission COVID-19 wave in Tunisia were analyzed. The results reveal high genetic variability within the sequenced fragment and allowed the detection of first introduction in the country of already known VOCs and VOIs as well as others variants that have interesting genomic mutations and need to be kept under surveillance.

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