Practical Decision Algorithms for the Use of the Cardiovascular Polypill in Secondary Prevention in Europe

The main objective of cardiovascular disease (CVD) prevention is to reduce morbidity and mortality. Despite recommendations on evidence-based pharmacological treatment and lifestyle changes, the control of CV risk factors such as hypertension or dyslipidaemia is not optimal. The use of a CV polypill, including guideline-recommended drugs, as a baseline therapy, may contribute to improving risk factors control either by improving the treatment adherence or by the synergistic effect of its components. The CNIC-Polypill is the first CV polypill approved in Europe as an effective strategy for secondary prevention, which contains acetylsalicylic acid, atorvastatin (in two optional doses), and ramipril (in three optional doses) in a single pill. The present practical clinical document aims to provide a guide for patient management after an acute coronary syndrome (ACS) or with chronic CVD (CCVD) with a strategy based on the CNIC-Polypill, also considering the need to add other therapies for a personalized treatment. The most suitable clinical scenarios for the CNIC-Polypill use are discussed: (a) in patients after an ACS at discharge, (b) in patients with CCVD (chronic coronary syndrome, stroke, or peripheral artery disease) with uncontrolled low-density lipoprotein cholesterol (LDL-c) and/or blood pressure levels and (c) in patients with CCVD with well-controlled risk factors to simplify treatment and reduce polypharmacy in the context of CCVD prevention.

964 Telemedicine: Speedy Triage Tool or Clinical Record?

Introduction St. George’s University Hospitals NHS Foundation Trust is a tertiary plastic surgery centre serving a population of 3.5 million in and around South West London. Telemedicine Referral Image Portal System (TRIPS) is integral to our service, allowing triage of patients in remote locations. During Covid, TRIPS helped in reducing footfall and streamlining out of hospital referrals to reduce unnecessary transfer. The aim of this project was to assess the quality of clinical documentation for emergency referrals to plastic surgery via TRIPS. Method We performed a retrospective review of all patients referred to plastic surgery via TRIPS during April 2020. Documentation standards were determined from national guidance. After introduction of a condensed guide, a second review was performed four months later. Results In April, 131 referrals were recorded on TRIPS. Only 22.9% of records met the standard. The most common omission was treatment advice. Following introduction of guidance, 215 TRIPS records were reviewed. The quality of clinical documentation improved in all aspects with a compliance rate of 89%. Conclusions Although TRIPS remains a useful tool for triage, it is a clinical document and must meet the standards of clinical record keeping. Introduction of clear guidelines improves overall compliance.

Towards a New Paradigm of Federated Electronic Health Records in Palestine

While efforts are underway to create a sound system of electronic health records in Palestinian health institutions, there remain obstacles and challenges. Given modern day demands on health systems, we propose a federated electronic health system based on the clinical document architecture (CDA) that is compliant within the Palestine context. This architecture also brings a normalized electronic health record and a structure of blockchain to enhance interoperability with scalability, fault tolerance, privacy, and security. The new architecture and technologies will enhance services by allowing health care players, patients, and others to have the opportunity to obtain improved access and control of their health services. This may also serve as a useful model for other low-middle income countries.

Generalized Zero-Shot Text Classification for ICD Coding

The International Classification of Diseases (ICD) is a list of classification codes for the diagnoses. Automatic ICD coding is a multi-label text classification problem with noisy clinical document inputs and long-tailed label distribution, making it difficult for fine-grained classification on both frequent and zero-shot codes at the same time, i.e. generalized zero-shot ICD coding. In this paper, we propose a latent feature generation framework to improve the prediction on unseen codes without compromising the performance on seen codes. Our framework generates semantically meaningful features for zero-shot codes by exploiting ICD code hierarchical structure and reconstructing the code-relevant keywords with a novel cycle architecture. To the best of our knowledge, this is the first adversarial generative model for generalized zero-shot learning on multi-label text classification. Extensive experiments demonstrate the effectiveness of our approach. On the public MIMIC-III dataset, our methods improve the F1 score from nearly 0 to 20.91% for the zero-shot codes, and increase the AUC score by 3% (absolute improvement) from previous state of the art. Code is available at https://github.com/csong27/gzsl_text.

Enabling health information exchange at a US Poison Control Center

Objective The objective of this project was to enable poison control center (PCC) participation in standards-based health information exchange (HIE). Previously, PCC participation was not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow. Materials and Methods We adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. We used rapid prototyping to determine requirements for an HIE dashboard for use by PCCs and developed software called SNOWHITE that enables poison center HIE in tandem with a poisoning information system. Results We successfully implemented the process and software at the PCC and began sending outbound C-CDAs from the Utah PCC on February 15, 2017; we began receiving inbound C-CDAs on October 30, 2018. Discussion With the creation of SNOWHITE and initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah Poison Control Center, we accomplished the first participation of PCCs in standards-based HIE in the US. We faced several challenges that are also likely to be present at PCCs in other states, including the lack of a robust set of patient identifiers to support automated patient identity matching, challenges in emergency department computerized workflow integration, and the need to build HIE software for PCCs. Conclusion As a multi-disciplinary, multi-organizational team, we successfully developed both a process and the informatics tools necessary to enable PCC participation in standards-based HIE and implemented the process at the Utah PCC.