scholarly journals SARS-CoV-2 vaccine effectiveness and breakthrough infections in maintenance dialysis patients

2021 ◽  
Author(s):  
Harold J Manley ◽  
Gideon Aweh ◽  
Caroline M Hsu ◽  
Daniel E Weiner ◽  
Dana Miskulin ◽  
...  
Keyword(s):  
At Risk ◽  
Observational Study ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Lower Risk ◽  
Vaccine Effectiveness ◽  
Dialysis Patients ◽  
Maintenance Dialysis ◽  
Ig G ◽  
Igg Level

Background: SARS-CoV-2 vaccine effectiveness during the Delta period and immunogenicity threshold associated with protection against COVID-19 related hospitalization or death in the dialysis population is unknown. Methods: A retrospective, observational study assessed SARS-CoV-2 vaccine effectiveness and immunogenicity threshold in all adult maintenance dialysis patients without COVID-19 history treated between February 1 and October 2, 2021. All COVID-19 infections, composite of hospitalization or death following COVID-19 and available SARS-CoV-2 anti-spike immunoglobulin (Ig) G values were extracted from electronic medical record. COVID-19 cases per 10,000 days at risk and vaccine effectiveness during pre-Delta and Delta periods were determined. Results: Of 15,718 patients receiving dialysis during the study period, 11,191 (71%) were fully vaccinated, 733 (5%) were partially vaccinated and 3,794 (24%) were unvaccinated. 967 COVID-19 were cases identified: 511 (53%) occurred in unvaccinated patients and 579 (60%) occurred during the Delta period. COVID-19 related hospitalization or death was less likely among vaccinated versus unvaccinated patients for all vaccines (adjusted HR 0.19 [0.12, 0.30]) and for BNT162b2/Pfizer, mRNA-1273/Moderna, and Ad26.COV2.S/Janssen (adjusted HR=0.25 [0.16, 0.40], 0.14 [0.08, 0.22], and 0.34 [0.17, 0.68] respectively). Among those with anti-spike IgG levels, those with IgG level ≥ 7 had significantly lower risk of a COVID-19 diagnosis (HR=0.25 [0.15, 0.42]) and none experienced a COVID-related hospitalization or death. Conclusions: Among maintenance dialysis patients, SARS-CoV-2 vaccination was associated with a lower risk of COVID-19 diagnosis and associated hospitalization or death. Among vaccinated patients, low anti-spike IgG level is associated with worse COVID-19 related outcomes.

scholarly journals Interdisciplinary Plans of Care, Electronic Medical Record Systems, and Inpatient Mortality

ACI Open ◽  
2018 ◽  
Vol 02 (01) ◽  
pp. e21-e29
Author(s):  
Joseph Bonner ◽  
Brandon Stange ◽  
Mindy Kjar ◽  
Margaret Reynolds ◽  
Eric Hartz ◽  
...  
Keyword(s):  
Observational Study ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Patient Outcomes ◽  
Odds Ratio ◽  
Experimental Setting ◽  
Inpatient Mortality ◽  
Quasi Experimental ◽  
Electronic Medical Record Systems ◽  
Guide Care

Background Interdisciplinary plans of care (IPOCs) guide care standardization and satisfy accreditation requirements. Yet patient outcomes associated with IPOC usage through an electronic medical record (EMR) are not present in the literature. EMR systems facilitate the documentation of IPOC use and produce data to evaluate patient outcomes. Objectives This article aimed to evaluate whether IPOC-guided care as documented in an EMR is associated with inpatient mortality. Methods We contrasted whether IPOC-guided care was associated with a patient being discharged alive. We further tested whether the association differed across strata of acuity levels and overall frequency of IPOC usage within a hospital. Results Our sample included 165,334 adult medical/surgical discharges for a 12-month period for 17 hospitals. All hospitals had 1 full year of EMR use antedating the study period. IPOCs guided care in 85% (140,187/165,334) of discharges. When IPOCs guided care, 2.1% (3,009/140,187) of admissions ended with the patient dying while in the hospital. Without IPOC-guided care, 4.3% (1,087/25,147) of admissions ended with the patient dying in the hospital. The relative likelihood of dying while in the hospital was lower when IPOCs guided care (odds ratio: 0.45; 99% confidence interval: 0.41–0.50). Conclusion In this observational study within a quasi-experimental setting of 17 community hospitals and voluntary usage, IPOC-guided care is associated with a decreased likelihood of patients dying while in the hospital.

2.16 Electronic Medical Record Identification of At-Risk Patients in a Child Psychiatry Fellow Outpatient Clinic

2017 ◽  
Vol 56 (10) ◽  
pp. S182
Author(s):  
Rebecca Reilly ◽  
Courtney Demuth ◽  
Katie Gallagher ◽  
Luann French ◽  
Oscar Gary Bukstein ◽  
...  
Keyword(s):  
At Risk ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Child Psychiatry ◽  
Outpatient Clinic ◽  
Risk Patients

Using the electronic medical record to identify and follow survivors of pediatric malignancies.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 302-302
Author(s):  
Elizabeth Bell ◽  
Robert Michael Cooper ◽  
Lisa Mueller
Keyword(s):  
At Risk ◽  
Cancer Treatment ◽  
Childhood Cancer ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Late Effects ◽  
Kaiser Permanente ◽  
Pediatric Malignancies ◽  
Group 2 ◽  
Group 1

302 Background: There are currently more than 328,000 survivors of pediatric malignancies in the United States (NCI, The Childhood Cancer Survivor Study: An Overview, http://www.cancer.gov/cancertopics/coping/ccss . 6/6/2012). These survivors are at risk for significant late effects from their cancer treatments (Childhood Cancer Survivors Study (Oeffinger, et al, NEJM 2006)). The Kaiser Permanente health care system has good insurance retention of patients treated for pediatric malignancies. Kaiser also uses an electronic medical record, which improves our ability to identify survivors and follow them over time to identify and manage late effects of cancer treatment. The Children’s Oncology Group (COG) has released a summary of cancer treatment form and specific guidelines for follow-up based on patients’ treatment. Methods: In 2010, we queried the Kaiser Permanente Southern California Cancer Registry for all patients who were diagnosed with a malignancy under the age of 18 from 1980 to 2009. This was cross-referenced with list of current Kaiser members as of 2010. We created a database of the current members and their diagnosis, treatment center, age at diagnosis, date of diagnosis, current age, years of survivorship, and sex. We divided the patients into priority groups: (1) more than 5 years from diagnosis and over age 18, (2) more than 5 years from diagnosis and less than age 18, and (3) less than 5 years from diagnosis. We began to prepare summaries of cancer treatment for the groups using the COG form. Results: We identified 1,267 survivors of pediatric malignancies who were Kaiser members in 2010. 54% are still Kaiser members 10 years after diagnosis. There were 611 in Group 1, 293 in Group 2, and 363 in Group 3. We have prepared summaries of cancer treatment including late effects for 400 of the survivors, 360 from Group 1, and 40 from Group 2. Conclusions: The combination of an electronic medical record and insurance retention allows us to identify and track survivors of pediatric malignancies into adulthood. With completed summaries of cancer treatment we will be able to quickly identify at-risk populations for monitoring and potential interventions.

An Automated Model to Identify Heart Failure Patients at Risk for 30-Day Readmission or Death Using Electronic Medical Record Data

Medical Care ◽  
2010 ◽  
Vol 48 (11) ◽  
pp. 981-988 ◽  
Author(s):  
Ruben Amarasingham ◽  
Billy J. Moore ◽  
Ying P. Tabak ◽  
Mark H. Drazner ◽  
Christopher A. Clark ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Medical Record Data ◽  
Heart Failure Patients ◽  
Electronic Medical Record Data ◽  
Record Data ◽  
Patients At Risk

scholarly journals FROM BRAIN DISEASE TO BRAIN HEALTH: PRIMARY PREVENTION OF ALZHEIMER’S DISEASE AND RELATED DISORDERS IN A HEALTH SYSTEM USING AN ELECTRONIC MEDICAL RECORD-BASED APPROACH

2017 ◽  
pp. 1-8
Author(s):  
A.M. Fosnacht ◽  
S. Patel ◽  
C. Yucus ◽  
A. Pham ◽  
E. Rasmussen ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
At Risk ◽  
Primary Prevention ◽  
Health System ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Brain Disease ◽  
Brain Health ◽  
Risk Patients

Background: Alzheimer’s disease and aging brain disorders are progressive, often fatal neurodegenerative diseases. Successful aging, modern lifestyles and behaviors have combined to result in an expected epidemic. Risks for these diseases include genetic, medical, and lifestyle factors; over 20 modifiable risks have been reported. Objectives: We aim to primarily prevent Alzheimer’s disease and related disorders through electronic medical record (EMR)-based screening, risk assessments, interventions, and surveillance. Design: We identified modifiable risks; developed human, systems and infrastructural resources; developed interventions; and targeted at-risk groups for the intervention. Setting: A Community Based Health System. Participants: In year one (June 2015 to May 2016), 133 at-risk patients received brain health services with the goal of delaying or preventing Alzheimer’s disease and related disorders. Measurements: We created mechanisms to identify patients at high risk of neurodegenerative disease; EMR-based structured clinical documentation support tools to evaluate risk factors and history; evidence-based interventions to modify risk; and the capacity for annual surveillance, pragmatic trials, and practice-based and genomic research using the EMR. Results: This paper describes our Center for Brain Health, our EMR tools, and our first year of healthy but at-risk patients. Conclusion: We are translating research into primary prevention of Alzheimer’s disease and related disorders in our health system and aim to shift the paradigm in Neurology from brain disease to brain health.

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