EVALUATION OF THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORD SYSTEM: CASE STUDY OF THE PRESBYTERIAN HOSPITAL AT DORMAA AHENKRO OF BONO REGION, GHANA

The main objective of this study is to evaluate the implementation of electronic health records at Presbyterian Hospital in Dormaa Ahenkro, Bono Region, Ghana. A total sample size of 50 staff and management of the hospital were sampled using the purposive sampling technique. Qualitative data was collected using questionnaires and observational checklists enlisting the workings of the facilities or technology, while quantitative data was captured using Key Informant Interview (KII) guides with key management staff of the hospital. Data analysis was done descriptively using the Statistical Package for Social Sciences software (SPSS version 21.0). The study revealed that factors such as expectancy of performance, anticipation or effort, facilitating conditions, and social influence highly influence the management of the hospital to adopt the technology. The study revealed that frequent power outages are the main challenge they are confronted with. The study recommended that management implement safeguards ensure the system stands against loss, destruction, interfering, and unlawful use of the EHR system. System safeguards must be in place. Management through the IT unit should consider procurement of an efficient backup system and regular change of passwords to maintain the security of the system.

Factors Predicting Chronic Opioid Use after Orthopedic Surgical Procedures

BACKGROUND: Opioid abuse has been an increasing problem since the 1990s. With over 47,000 opioid related deaths recorded in 2017 alone, concerns have been raised regarding the dangers of introducing opioids perioperatively to patients undergoing major surgeries. OBJECTIVES: The present study proposes to examine the frequency, amount, and trends in post-operative opioid consumption in patients undergoing orthopedic surgical procedures. STUDY DESIGN: This was a randomized, retrospective questionnaire-based study. SETTING: Patients who underwent any type of orthopedic surgery at the University of Pennsylvania Presbyterian Hospital from 1/1/2018 to 3/12/2019 were randomly selected and called during the summer of 2019. METHODS: In this retrospective questionnaire-based study, 828 patients were called by telephone in the summer of 2019. These patients were asked a variety of questions involving opioid consumption behavior post-surgery. The study ended after receiving responses from 200 patients. RESULTS: Nineteen (9.5%) patients reported positively for experiencing euphoria while taking opioids post-surgery. Of the 200 patients contacted, 6 patients (3%) reported switching to marijuana instead of opioids. Thirty-eight (19%) patients preferred to take no opioids at all post-surgery, and one patient was found to have given their prescription to a family member or friend. Twenty-one patients (10.5%) were found to have been taking opioids for non-severe pain. Blacks and whites were the most common racial demographics, making up 84 and 109 of the totals, respectively. The odds ratios for all of the predictors showed that the relative risk for opioid misuse was higher for black patients than white patients (OR = 3.034). There was no relationship between the intra- and post-operative opioid administration and long-term opioid misuse. LIMITATIONS: Patients are self-selected and had the option to opt out of the study when contacted. Some patients may not have been available to answer the phone when our study was being conducted. This study was only conducted for orthopedic patients and for patients who received surgery at the University of Pennsylvania Presbyterian Hospital, thus affecting the demographics for our research. CONCLUSIONS: Prescription opioid misuse is more common among the black population. The total opioid consumption is frequently lower than the quantity prescribed. Patients frequently use opioids even though they feel that pain is insufficient to deserve such an intervention. Euphoria is experienced by a significant number of patients taking prescription opioids Often patients do not take any opioids, although they had prescriptions. KEY WORDS: Opioids, post-operative pain, misuse, abuse

Universal Screening of Social Determinants of Health at a Large US Academic Medical Center, 2018

Universal screenings for social determinants of health (SDOH) are feasible at the health system level and enable institutions to identify unmet social needs that would otherwise go undiscovered. NewYork-Presbyterian Hospital implemented SDOH screenings together with clinical screenings in four outpatient primary care sites. Aligning SDOH screening with clinical screening was crucial for establishing provider buy-in and ensuring sustainability of screening for SDOH. Despite some challenges, universal screening for SDOH has allowed NewYork-Presbyterian Hospital to identify unmet needs to improve population health.

Virome of New York Presbyterian Hospital pediatric emergency

BackgroundViral infection of the respiratory tract is one of the major causes of hospital visits for young children. In this study, we report the occurrence and co-occurrence of different virus types and subtypes among the patients arriving at the pediatric emergency room of New York Presbyterian Hospital, a major urban hospital.MethodsWe collected nasal swabs from the patients and their accompanying persons. We also recorded the levels (None, Mild, High, and Severe) of their symptoms (Fever, Chill, Muscle Pain, Watery Eye, Runny Nose, Sneezing, Sore throat and Cough). The collected swabs were tested for the presence of common viruses infecting the respiratory tract.ResultsHuman Rhinovirus was the most common virus among the patients, followed Influenza and Respiratory Syncytial Virus. Human Rhinovirus was most common in summer, autumn and spring. In contrast, influenza was more common in winter. Further, Influenza A virus was more likely to co-occur with Corona Virus 229E. In comparison, Influenza was less likely to co-occur with Human Rhinovirus. Moreover, Influenza, Parainfluenza and Corona virus were associated with more severe symptoms, while Human Rhinovirus was associated with less severe symptoms. In addition, we observed that Influenza and Respiratory Syncytial Virus were more likely to infect a patient when these viruses also infected the accompanying person. We also found that it was difficult to distinguish among viruses based on the symptoms. The inability to distinguish among different virus types and subtypes is explained by the fact that multiple viruses lead to similar symptoms.ConclusionsThe findings of this study provide a better understanding of respiratory viral infections in small children presenting at a pediatric emergency room in New York.

Approaches to the life and influence of the Austro-American sports physician Hans Kraus (1905-1996)

The Austrian physician Hans Kraus was a central figure in the founding of the American fitness movement. His life and work are to this day almost unknown both within the Austrian scientific community and to a broader public.Kraus was born in Trieste in 1905 and obtained a doctorate in medicine from the University of Vienna in 1929. Subsequently he trained as an orthopedic surgeon at the Vienna General Hospital. After the annexation of Austria into Nazi Germany in 1938, he flew to the United States and worked at the prestigious Columbia Presbyterian Hospital (now the New York Presbyterian Hospital). His field of research was the physical performance and fitness of the American youth. At the beginning of the 1950s Kraus noted enormous deficits compared to the European youth. This attracted much public attention and led to significant public health interventions such as the founding of the "President's Council on Physical Fitness and Sports". This council should encourage the American population to engage in physical activity. In addition, Kraus gained great prominence as one of John F. Kennedy's doctors. On the occasion of his death in 1996, the New York Times described him as the "originator of sports medicine in U.S.". This study has two goals: Firstly, it will outline the migrant biography of Hans Kraus based on the work of Susan Schwartz (2005). Secondly, approaches for the classification of the scientific work of Kraus in the cultural history of fitness and physical enhancement will be presented. The theoretical background to this is Foucault's concept of biopolitics. The knowledge gained by physicians such as Kraus is interpreted as knowledge of power, which has a disciplining and regulating effect on the body and the population.

2282. Empiric Antimicrobial Therapy and Clinical Outcomes of Infections due to ESBL-producing Klebsiella pneumoniae

Background Currently, carbapenems are the treatment of choice for invasive infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E). However, clinical data supporting this practice are generated largely from cases caused by ESBL-producing Escherichia coli. We aimed to describe the empiric treatments and clinical outcomes of patients infected with ESBL-producing Klebsiella pneumoniae (ESBL-Kp) at UPMC Presbyterian Hospital in Pittsburgh, PA. Methods This retrospective study included all adult patients from inpatient admissions at UPMC Presbyterian Hospital who were diagnosed with ESBL-Kp infections. Carbapenem-resistant cases were excluded. Types of cultures included blood, respiratory, urine, and wound. Only one type of culture per patient was included. Demographic and clinical data were collected from the electronic medical records. The study was approved by the University of Pittsburgh IRB. Results One-hundred sixty-four patients had ESBL-Kp infection between September 2016 and August 2018. Excluded were those who were considered colonized by the organism and therefore not treated (n = 15); treated with non-carbapenems as definitive therapy (n = 29); or were discharged before final susceptibilities (n = 14). In total, 70 patients met inclusion criteria. Eighteen had bacteremia, 24 had pneumonia, 13 had UTI, and 12 had wound infections. Most common sources of bacteremia included catheter-associated, intra-abdominal infection, and pneumonia. Median age of patients was 62 years. Mean Charleston Comorbidity Index was 4.6. Empiric treatment was divided between three classes: BL-BLI (n = 27, 38.6%), cephalosporins (n = 21, 30%) and carbapenems (n = 18, 25.7%). Twelve patients (17.1%) died during hospitalization. Average hospital length-of-stay was 33.2 days. Conclusion Although infections with ESBL-Kp are relatively uncommon, patients have high mortality and prolonged hospitalizations. Treatment practices, including which infections are considered colonization vs. true infection, as well as choice of empirical therapy, vary widely at our institution. Data are still needed to assess mortality outcomes in patients treated empirically with carbapenems vs. non-carbapenems, particularly in high-inoculum infection sites such as pneumonia. Disclosures All authors: No reported disclosures.

Evaluation of Dyslipidaemia Using an Algorithm of Lipid Profile Measures among Newly Diagnosed Type II Diabetes Mellitus Patients: A Cross-Sectional Study at Dormaa Presbyterian Hospital, Ghana

Background and Objectives: Dyslipidaemia and its associated complications have been reported to increase mortality among type 2 diabetes mellitus (T2DM) patients. However, there is a dearth of data on the incidence of dyslipidemia among Ghanaian patients with T2DM. This study evaluated dyslipidemia among newly diagnosed T2DM patients at Dormaa Presbyterian Hospital, Ghana. Materials and Methods: This cross-sectional study recruited a total of 215 participants at the Presbyterian Hospital, Dormaa-Ghana. A well-structured questionnaire was administered to collect demographic data. Predisposing factors of dyslipidemia such as BMI, hypertension, and family history of diabetes were also obtained. Lipid profile was performed on the serum obtained from each respondent. Dyslipidaemia was defined as total cholesterol (TC) >200 mg/dL, triglyceride (TG) >150 mg/dL, low density lipoprotein cholesterol (LDL-c) >100 mg/dL, and high-density lipoprotein cholesterol (HDL-c) <40 in males and <50 mg/dL in females. Combinations of the individual parameters of dyslipidaemia were further evaluated. Results: Of the total (215) participants, 86 (40%) were males and 129 (60%) were females, representing a ratio of 1:1.5. High total cholesterol was more prevalent in females (69.0%) than males (53.5%). Generally, dyslipidaemia was predominant among those aged >40 years, with the exception of increased LDL-c (25.1%), which was higher among the 20–40 years age group. The male participants exhibited significantly (p < 0.001) higher percentages of all combined measures of dyslipidaemia—such as high TG and reduced HDL-c (77.9%), high TG and elevated LDL-c (75.6%) and high LDL and low HDL (65.1%). BMI was significantly associated with HDL levels (p = 0.02), whereas family history of diabetes was associated with TC (p = 0.004) and TG levels (p = 0.019). Conclusion: Combined dyslipidaemia is relatively high among newly diagnosed T2DM patients in Ghana, and in those >40 years. Gender is significantly associated with combined dyslipidaemia in T2DM, and males may be at a higher risk than females. BMI and family history of diabetes are potential risk factors of dyslipidaemia in T2DM.