scholarly journals Processing of Electronic Medical Records for Health Services Research in an Academic Medical Center: Methods and Validation

10.2196/10933 ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. e10933 ◽  
Author(s):  
Nabilah Rahman ◽  
Debby D Wang ◽  
Sheryl Hui-Xian Ng ◽  
Sravan Ramachandran ◽  
Srinath Sridharan ◽  
...  
Keyword(s):  
Health Services Research ◽  
Health Services ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Services Research ◽  
Academic Medical

scholarly journals Comparison of Clinical and Thrombotic Outcomes in Sars-Cov-2- Pneumonia Versus Other Viral Pneumonia in an Urban Academic Medical Center

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 1956-1956
Author(s):  
Rachel N. Goldberg ◽  
Kevin Johns ◽  
William Ye ◽  
Jeff J. Mucksavage ◽  
John G. Quigley ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Renal Replacement Therapy ◽  
Medical Records ◽  
Research Funding ◽  
Medical Center ◽  
Academic Medical Center ◽  
Viral Pneumonia ◽  
Coagulation Cascade ◽  
Academic Medical ◽  
D Dimer

Abstract Title: Comparison of Clinical and Thrombotic Outcomes in SARS-CoV-2- Pneumonia versus Other Viral Pneumonia in an Urban Academic Medical Center Objective: To compare clinical and thrombotic outcomes in SARS-CoV-2 pneumonia versus other viral pneumonias. Introduction: Viral pneumonia (PNA) causes oxidative stress to the pulmonary vasculature, triggering endothelial dysfunction and activation of the coagulation cascade. Elevations in coagulation markers, including d-dimer and fibrinogen, have been observed. Recent studies indicate that SARS-CoV-2 infection causes endothelial cell injury, with activation of the coagulation cascade, and a high frequency of systemic thrombotic events. It remains unclear whether it is viral pneumonia itself, a specific viral strain (and/or viral load) that drives the clinical and thrombotic outcomes. Furthermore, limited data is available regarding clinical outcomes in a diverse patient population hospitalized with SARS-CoV-2 infection. This study is from a single urban medical center in Chicago, Illinois. Study Design: A retrospective cohort study evaluating the medical records of hospitalized adult patients admitted to University of Illinois Hospital and Health Sciences System (UIHHSS) with SARS-CoV-2 pneumonia or other viral (H1N1 or H3N2) pneumonia between 10/01/2017 and 09/01/2020. Methods: Patients were included if ≥18 years old, hospitalized, with a primary confirmed diagnosis of viral pneumonia (SARS-CoV-2, H1N1 or H3N2) based on ICD-10 code, viral diagnostic testing, diagnosis description, and appropriate clinical characteristics/imaging studies. Past medical history, inpatient medications, coagulation parameters, arterial/venous thrombotic outcomes, and other clinical outcomes (renal replacement therapy, mechanical ventilation, co-infection) were abstracted from UIHHSS electronic health record database. Results: Medical records of 257 patient with a primary diagnosis of pneumonia were reviewed, 199 patients with SARS-CoV-2 PNA (95 male, average age 58 years, 52% Hispanic, 37% non-Hispanic Black) and 58 patients with other viral PNA (24 male, average age 63 years, 21% Hispanic, 55% non-Hispanic Black; 34 with H3N2, 24 with H1N1). Coagulation parameters (maximum D-dimer, fibrinogen, INR) were similar in both groups; average D-dimer was >3x ULN. Anticoagulation therapy was similarly prescribed in both groups (SARS-CoV-2, 95% vs 84%, H1N1 or H3N2), with prophylactic dose anticoagulation prescribed most frequently (73% vs 62%) and with high average compliance rates (89% vs 83%). Admission to the intensive care unit (ICU; 32% vs 29%) and the median length of stay (10 vs 4 days) was similar in both groups. Thrombotic events (n = 6, 3%) occurred only in SARS-CoV-2 PNA patients in the ICU: 3 pulmonary embolism (PE), 1 distal lower extremity deep vein thrombosis (DVT), 2 non-ST elevated myocardial infarctions (NSTEMI). There was a significantly higher incidence of use of renal replacement therapy (8.5% vs 0%, p=0.016) and mortality (15.6% vs 3.4%, p=0.048) in the SARS-CoV-2 PNA group compared to the H3N2/H1N1 PNA group. There were no differences in the rates of mechanical ventilation, the incidence of major bleeding or co-infection. In a multivariable logistic regression analysis, age (aOR 1.07), the presence of SARS-CoV-2 PNA (aOR 11.37), and ICU admission (aOR 41.95) were significantly associated with risk of mortality during hospitalization. Race and ethnicity were not associated with mortality. Conclusion: The overall incidence of thrombotic events was low and occurred only in the SARS-CoV-2 PNA group. The low rate of venous thrombosis detected in this group, especially in the ICU setting, is likely related to the reduced use of diagnostic studies during the first COVID-19 pandemic in 2020 and to the high rates of anticoagulation prophylaxis orders and compliance. SARS-CoV-2 PNA was associated with a higher rate of renal failure and mortality compared to patients with H3N2/H1N1 viral pneumonia. There was no difference in mortality rates between Hispanic and non-Hispanic and between Black and non-Black patients. This study suggests that SARS-CoV-2 pneumonia leads to greater endothelial dysfunction than that observed in H3N2/H1N1 viral pneumonia and that race/ethnicity does not drive mortality outcomes. Disclosures Benken: BMS: Research Funding; CareDx: Research Funding; Transplant Genomics: Research Funding; Daiichi Sankyo: Research Funding; Verici Dx: Research Funding.

scholarly journals Effects of Intraoperative Reading on Vigilance and Workload during Anesthesia Care in an Academic Medical Center

2009 ◽  
Vol 110 (2) ◽  
pp. 275-283 ◽  
Author(s):  
Jason M. Slagle ◽  
Matthew B. Weinger
Keyword(s):  
Medical Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Direct Patient Care ◽  
General Anesthetic ◽  
Task Distribution ◽  
Anesthesia Providers ◽  
Academic Medical ◽  
Random Intervals ◽  
Manual Tasks

Background During routine cases, anesthesia providers may divert their attention away from direct patient care to read clinical (e.g., medical records) and/or nonclinical materials. The authors sought to ascertain the incidence of intraoperative reading and measure its effects on clinicians' workload and vigilance. Methods In 172 selected general anesthetic cases in an academic medical center, a trained observer categorized the anesthesia provider's activities into 37 possible tasks. Vigilance was assessed by the response time to a randomly illuminated alarm light. Observer- and subject-reported workload were scored at random intervals. Data from Reading and Non-Reading Periods of the same cases were compared to each other and to matched cases that contained no observed reading. The cases were matched before data analysis on the basis of case complexity and anesthesia type. Results Reading was observed in 35% of cases. In these 60 cases, providers read during 25 +/- 3% of maintenance but not during induction or emergence. While Non-Reading Cases (n = 112) and Non-Reading Periods of Reading Cases did not differ in workload, vigilance, or task distribution, they both had significantly higher workload than Reading Periods. Vigilance was not different among the three groups. When reading, clinicians spent less time performing manual tasks, conversing with others, and recordkeeping. Conclusions Anesthesia providers, even when being observed, read during a significant percentage of the maintenance period in many cases. However, reading occurred when workload was low and did not appear to affect a measure of vigilance.

scholarly journals Blastomycosis in Wisconsin: Beyond the Outbreaks

2017 ◽  
Vol 7 (1) ◽  
pp. 119-129 ◽  
Author(s):  
Katrina Thompson ◽  
Alana K. Sterkel ◽  
Erin G. Brooks
Keyword(s):  
Health Services ◽  
Medical Center ◽  
Pathogenic Fungus ◽  
Academic Medical Center ◽  
Common Source ◽  
Wisconsin Department ◽  
Department Of Health ◽  
Academic Medical ◽  
State History ◽  
Over Time

In the summer of 2015, many individuals visiting the Little Wolf River in Waupaca County were exposed to the pathogenic fungus, Blastomyces. Over time, 59 confirmed and 39 probable cases were reported to the Wisconsin Department of Health Services (W-DHS), making this one of the largest outbreaks in recent state history. Though most instances of blastomycosis are not associated with common source outbreaks, cases such as this highlight the need for vigilance regarding this preventable cause of death. In the state of Wisconsin, an average of 118.6 cases (range, 84-174) of confirmed blastomycosis are diagnosed annually; the majority of these cases are sporadic rather than outbreak-associated. In the current study, we review characteristics of blastomycosis cases diagnosed at our academic medical center, as well as examine statewide W-DHS data, in order to familiarize pathologists with the epidemiologic and histologic characteristics of this disease.

scholarly journals Development of Integrated Mental Health Services within pediatric ambulatory settings across an academic medical center

2016 ◽  
Vol 16 (6) ◽  
pp. 63
Author(s):  
Lidija Petrovic-Dovat ◽  
James Waxmonsky ◽  
Sarah Iriana ◽  
Benjamin Fogel ◽  
Timothy Zeiger ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Integrated Mental Health

scholarly journals The Melbourne East Monash General Practice Database (MAGNET): Using data from computerised medical records to create a platform for primary care and health services research

2016 ◽  
Vol 23 (2) ◽  
pp. 523 ◽  
Author(s):  
Danielle Mazza ◽  
Christopher Pearce ◽  
Lyle Robert Turner ◽  
Maria De Leon-Santiago ◽  
Adam McLeod ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Health Services Research ◽  
Health Services ◽  
Medical Records ◽  
Clinical Information ◽  
Quality Of Data ◽  
Services Research ◽  
Research Platform ◽  
General Practices

The Melbourne East MonAsh GeNeral PracticE DaTabase (MAGNET) research platform was launched in 2013 to provide a unique data source for primary care and health services research in Australia.  MAGNET contains information from the computerised records of 50 participating general practices and includes data from the computerised medical records of more than 1,100,000 patients.  The data extracted is patient-level episodic information and includes a variety of fields related to patient demographics and historical clinical information, along with the characteristics of the participating general practices.  While there are limitations to the data that is currently available, the MAGNET research platform continues to investigate other avenues for improving the breadth and quality of data, with the aim of providing a more comprehensive picture of primary care in Australia

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