Quoted text in the mental healthcare electronic record: an analysis of the distribution and content of single-word quotations

ObjectiveTo investigate the distribution and content of quoted text within the electronic health records (EHRs) using a previously developed natural language processing tool to generate a database of quotations.Designχ2 and logistic regression were used to assess the profile of patients receiving mental healthcare for whom quotations exist. K-means clustering using pre-trained word embeddings developed on general discharge summaries and psychosis specific mental health records were used to group one-word quotations into semantically similar groups and labelled by human subjective judgement.SettingEHRs from a large mental healthcare provider serving a geographic catchment area of 1.3 million residents in South London.ParticipantsFor analysis of distribution, 33 499 individuals receiving mental healthcare on 30 June 2019 in South London and Maudsley. For analysis of content, 1587 unique lemmatised words, appearing a minimum of 20 times on the database of quotations created on 16 January 2020.ResultsThe strongest individual indicator of quoted text is inpatient care in the preceding 12 months (OR 9.79, 95% CI 7.84 to 12.23). Next highest indicator is ethnicity with those with a black background more likely to have quoted text in comparison to white background (OR 2.20, 95% CI 2.08 to 2.33). Both are attenuated slightly in the adjusted model. Early psychosis intervention word embeddings subjectively produced categories pertaining to: mental illness, verbs, negative sentiment, people/relationships, mixed sentiment, aggression/violence and negative connotation.ConclusionsThe findings that inpatients and those from a black ethnic background more commonly have quoted text raise important questions around where clinical attention is focused and whether this may point to any systematic bias. Our study also shows that word embeddings trained on early psychosis intervention records are useful in categorising even small subsets of the clinical records represented by one-word quotations.

EP.WE.1026Pathways to the Upper GI MDT; an evaluation of the factors influencing patient routes to diagnosis of oesphago-gastric cancer

Aims To review the characteristics of the patient group referred to Barts Health with Oesphago-gastric (OG) Cancer in one year (2018-19). To evaluate demographic trends in patients presenting as emergency referrals and the effect of language on patients’ pathway to diagnosis. Methods We collated a list of patients referred to the Upper GI MDT with OG cancer in one year (2018-2019). We collected relevant pre-determined data points from the trust electronic record system. Patients with missing or insufficient data were excluded. Results Our population of 125 patients (median age 69) included 51% White British, 11% Bangladeshi, 10% Afro-Caribbean and 4% Pakistani; proportions which are significantly different to that of the UK average (p < 0.002). 46% of patients presented by GP 2WW referrals and 32% emergency referrals. The 29% of the population that did not have English as a first language were not shown to be more likely to present acutely (p = 0.49). 18.7% of patients had more than 62 days between referral and MDT discussion; themes of delay were inappropriate referral type, histology delay and atypical presentation. Conclusions Our OG cancer population has a significantly different ethnic makeup compared to UK average. Our data shows higher acute presentations and lower GP 2WW referrals. We did not demonstrate that language as a single parameter was linked to acute presentation. A number of modifiable delays to diagnosis were identified particularly the need for repeat biopsies. Further analysis is required using more sophisticated socio-economic parameters to assess how ethnicity can influence presentation of OG cancer.

65 Complication rate of cuffed versus uncuffed PICC lines placed by interventional radiology in pediatric patients

Primary Subject area Paediatric Radiology Background Peripherally inserted central catheters are commonly used in pediatrics to offer stable access for administering prolonged courses of antibiotics, chemotherapy, parenteral nutrition, or other intravenous fluids. Objectives To assess the complication rates of cuffed versus uncuffed PICCs in a pediatric tertiary referral centre. Design/Methods Research ethics board approval was sought and granted. A dual arm study design was employed with a retrospective chart review of PICCs inserted between June 2017 - June 2018, and a prospective chart review of PICCS inserted between January 2019 - June 2019 at a large tertiary pediatric referral center. Data collected from the electronic record included age, weight, and diagnosis. Line type, size, location, insertion and removal dates, and indications were recorded. Primary outcome was removal of PICC after completion of therapy or premature removal due to the following complications: infection, thrombosis, or mechanical failure (defined as catheter breakage, blockage, or dislodgement). Results The study included 266 patients. Across all patients weighing < 10 kg, 90.5% of those with cuffed PICCs and 65% of those with uncuffed catheters completed therapy. The predominant complication resulting in premature removal was mechanical failure, but this was only observed in patients with uncuffed catheters (25%). Infection was also observed only in uncuffed catheters (10%), and thrombosis (4.8%) was only in the cuffed lines. For patients weighing ≥ 10 kg, 86% of those with cuffed PICCs and 77.2% with uncuffed catheters completed therapy. More complications were observed in uncuffed catheters (infection 7.7%, mechanical failure 6.6%, thrombosis 5%). Infection resulting in premature removal occurred in 7% of cuffed catheters. There was no reported mechanical failure or thrombosis in the cuffed group. The distribution of diagnoses was relatively homogenous between the groups for most diagnoses. However, there was a higher percentage of oncology patients in the uncuffed group (23%) than the cuffed group (7%) due to the need for power-injectable lines, which were not available in a cuffed variant during this study. Conclusion All-cause pediatric PICC-associated complications rate in the neonate group for patients < 10kg in the uncuffed group is 35% and in the cuffed group is 4.8%. Whereas in the pediatric group ≥ 10kg, all-cause pediatric PICC-associated complications rate in the uncuffed group is 19.3% and in the cuffed group is 7%. There were no mechanical complications in the cuffed group and the vast majority of lines made it to completion of therapy. This work supports utilization of cuffed PICC lines in selected pediatric patients.

Impact of COVID-19 pandemic on surgical care of patients with acute aortic conditions

Background The outbreak of COVID-19 pandemic catastrophically interrupted medical care systems causing substantial decrease in the admission of patients and consecutively a sharp decline in the number of surgeries and interventions. In several European countries, the nationwide lockdown severely restricted movement which may have contributed to this phenomenon on top of anxiety of patients to contract COVID-19 when admitted to hospital. Purpose The aim of this analysis was to evaluate the impact of the COVID-19 pandemic onto acute and elective thoracic aortic surgeries and interventions and to compare the data with the same period in 2019 in a single aortic centre. Methods Information on admission and surgery/intervention was extracted from hospital electronic record system. Patients who were admitted for treatment of aortic conditions between January 1st to June 30th both in 2019 and 2020 were identified and selected for this analysis. The time from referral to admission and surgery/intervention was noted for service delay analysis. Aortopathies were classified as type A aortic dissection, type B aortic dissection, aortic aneurysm and others. In a daily central hub meeting, urgency was defined as emergent (operation required before the next working day), urgent (operation needed within 48 hours), and elective. Patients' condition and comorbidities were represented by ACEF II score. Results Total case volume of 81 in 2019 reference period was reduced to 70 in 2020 (−14%). Elective cases significantly declined from 59 (72.8%) in 2019 to 30 (42.8%) in 2020 (−49%). Urgent and emergent cases were performed more frequently in 2020 with 40 cases versus 22 in 2019 (+45%). The ACEF II score showed no difference for patients in both periods (2.1±1.9 vs. 2.5±2.1, p=0.221), however, a trend to higher ACEF II score in 2020 consistent with a higher proportion of urgent and emergent cases. The overall in-hospital delay (from admission to surgery) was not significant affected with 1 (IQR 1–2) versus 1 (IQR 0–2); p=0.991. However, with the official declaration of a pandemic and introduction of restrictions, no in-hospital delay was documented. In-hospital mortality was observed lower in 2019 as compared in 2020 (6.1% vs 11.4%, P=0.251). Conclusion The first wave of COVID-19 pandemic disrupted the aortic service, however, acute care for urgent thoracic aortic conditions and subsequent procedures even increased compared to 2019 as a result of both centralised allocation system and decline of elective cases. Acute aortic syndromes were managed despite COVID-19 according to current guidelines. FUNDunding Acknowledgement Type of funding sources: None. Impact of COVID on aortic case load

Epidemiology and Clinical Characteristics of Staphylococcal Bacteremia in Bahrain

Background and Objectives: Staphylococcus aureus bacteremia (SAB) is a significant health problem with high morbidity & mortality. The aim of this study was to evaluate the epidemiology of SAB in Bahrain along with withs clinical characteristics and outcomes. Methods: This study was conducted at Salmaniya medical complex (SMC) microbiology laboratory including all patients with SAB for one year period (2019). Demographic, lab data & outcomes were obtained from the electronic record system of patients. Results: A total of 164 episodes of SAB were identified during the study period. About 137 were encountered among inpatients, while 27 cases among outpatients attending hemodialysis unit. Bahraini nationality & male gender were predominant (141, 85.98% & 108, 65.85% respectively). Nosocomial SAB accounts for only 29.37%, while the majority of SAB cases were of community-onset (116, 70.37%), but among such community-onset cases; 83 (50.61% of total) were of health care-associated category (56 had prior hospitalization and 27 were on regular dialysis). Among all patients with SAB, diabetes was the commonest risk factor encountered, followed by dialysis dependence and sickle cell diseases (SCD). Mortality rate was 25.6% (42 patients). Among the 122 survivors of the initial SAB episode, recurrence of bacteremia was documented among 26 cases (21.3%). Conclusion: SAB was a significant health problem among the Bahraini. Diabetes Mellitus, SCD and dialysis dependence were found to be important risk factors. Recurrence of bacteremia was a common complication among the patient’s dependant on hemodialysis Keywords: Staphylococcus aureus, Bacteremia, Nosocomial, Community onset, Hemodialysis

1503 Review of Electronic Theatre Coding System & Documentation of Neurosurgical Activity

Introduction It was noticed that the current electronic theatre coding system was limited in its reflection of departmental theatre activity and discrepancies in discharge letters compared to the actual operations performed. To prevent this from recurring, a standardised neurosurgical operation note was developed, and an audit of the electronic coding system was undertaken to see if the correct operation matched that of the code listed. Method A 6-month retrospective analysis from March to September 2020 was completed using the electronic theatre coding system, patients’ electronic records and the patient handover list. Results 232 operations performed and only 10.3% of procedures were correctly coded by the current coding system. 11 operations were not on the theatre system although performed in theatres. The current system only coded for 82 procedures and did not show the full range of operations. There was wide variety of operation notes and only 185 operation notes were found on the patients’ electronic record. Frequently the procedure was not clearly identified so juniors relied on the inaccurate electronic code on the theatre list for the patients’ operation hence explaining the problem identified in discharge letters. Conclusions A new coding list for the electronic theatre system was created with 228 procedures divided into correct subcategories. A standardised template for operation notes was also developed and implemented so that full neurosurgical departmental activity is reflected, and accurate discharge letters are completed so that complete data collection can be done for audit purposes.

Negative Appendectomy Rate and Its Correlation with Use of Radiology; a Clinical Audit of Our Department

Introduction; Appendectomy is the most common surgical emergency and negative appendectomy is a one of recognized consequence of appendectomy. Recently an increased use of radiology is seen in diagnosing appendicitis and it has significantly decreased the rate of negative appendectomy. Every effort should be made to establish an exact diagnosis. If, however, this is impossible and a suspicion of appendicitis exists, exploration is mandatory. It is far better to subject a moderate number of patients to a theoretically unnecessary operation than to let one patient suffer perforation. Aim; Recently we have seen an increased use of radiology in our department for diagnosing appendicitis. The idea of conducting this audit was to calculate our negative appendectomy rate by correlating it with use of radiology and to compare it with international figures and to set up guide lines for use of radiology in diagnosing appendicitis on basis of results of our audit . Methods; Records of all patients who underwent appendectomy in Dubai Hospital, UAE from jan 2018 to jan 2019 were retrospectively analyzed using electronic record system. Clinical diagnosis and radiological findings were compared with histopathology as gold standard for negative appendectomy rate. The sensitivity and specificity of different radiological procedures was calculated as well. Results; Total 165 patients underwent appendectomy in specified duration. Over all negative appendectomy rate was 17 % with male being 9.7 % and female rate 31% . CTSCAN was found to be 100% specific and 91.4 % sensitive in diagnosing appendicitis while clinical diagnosis was accurate in 88.5 % cases.

A system architecture for ensuring interoperability in a South African national electronic health record system

ountries such as South Africa have attempted to leverage eHealth by digitising patients' medical records with the aim of improving the delivery of healthcare. This involves the use of an electronic health record (EHR) which is a longitudinal electronic record of a patient's information. The EHR includes all the patient's encounters that have been made with different health facilities. In the national context, the EHR is also known as a national EHR, which enables the sharing of patient information between points of care. However, a lack of interoperability exists between many South African health information systems making communication between these disparate systems impossible. As a result, the sharing of patient information is inhibited and the benefit of improving healthcare delivery cannot be realised. This paper proposes a system architecture for addressing interoperability challenges and indicates how interoperability can be ensured in a national EHR system. The proposed system architecture is differentiated from other national EHR system architectures found in the literature in order to emphasise its novelty. Secondary data obtained from a systematic literature review was analysed using content analysis, resulting in 9482 tags which informed the development of the proposed system architecture.

Assessing Electronic Medical Records Readiness for Service Delivery in State Hospitals in Southwest Nigeria

Electronic Medical Records (EMR) is an important communications channel relating to patient health conditions. Unfortunately, many hospitals in Africa, including Nigeria, have not implemented EMR. The few Hospitals that have some level of EMR continues are still struggling with the use of paper and hybrid medical records, which has led to inadequate medical follow-up, medical error, and long waiting time for patients. A sample size of three hundred and ninety-seven (397) was determined using krejcie and morgan models, comprising of strategic managers, and the operational staff drawn from a population of 2889 in the selected hospitals. At the hospital level, purposive sampling was applied in picking strategic managers, while stratified random sampling was method was used to select operational health workers. Questionnaires were used for data collection. The study adopted a descriptive statistical analysis method to describe the existing medical records systems. The finding indicated that the systems in the hospitals are mainly paper-based. The hospitals are also using hybrid system with a few treatment areas having fully electronic medical records systems. In the area where EMR has been implemented, the finding indicates poor penetration of the EMR system, limited modules, staff readiness and poor performance in the treatment area, among others. The study concluded that hospitals that have implemented, EMR is not serving the classical purpose of medical record of supporting treatment and follow up. The study recommended that the selected hospitals should ensure there is the availability of fund, staff training, and technical infrastructures like electronic record managers, ICT support staff, and computer compatible medical devices, among others.

Effects of cannabis ingestion on endometriosis-associated pelvic pain and related symptoms.

Background The use of cannabis for symptoms of endometriosis was investigated utilising retrospective archival data from Strainprint Technologies Ltd., a Canadian data technology company with a mobile phone application that tracks a range of data including dose, mode of administration, chemovar and their effect on various self-reported outcomes, including pelvic pain. Methods A retrospective, electronic record-based cohort study of Strainprint™ users with self-reported endometriosis was conducted. Self-rated cannabis efficacy, defined as a function of initial and final symptom ratings, was investigated across the included symptom clusters of cramps, pelvic pain, gastrointestinal pain, nausea, depression, and low libido. Cannabis dosage form, dose and cannabinoid ratio information was also recorded. Results A total number of 252 participants identifying as suffering endometriosis recorded 16193 sessions using cannabis between April 2017 and February 2020. The most common method of ingestion was inhalation (n = 10914, 67.4%) with pain as the most common reported symptom being treated by cannabis (n = 9281, 57.3%). Gastrointestinal symptoms, though a less common reason for cannabis usage (15.2%), had the greatest self-reported improvement after use. Inhaled forms had higher efficacy for pain, while oral forms were superior for mood and gastrointestinal symptoms. Dosage varied across ingestion methods, with a median dose of 9 inhalations (IQR 5 to 11) for inhaled dosage forms and 1 mg/mL (IQR 0.5 to 2) for other ingested dosage forms. The ratio of THC to CBD had a statistically significant, yet clinically small, differential effect on efficacy, depending on method of ingestion. Conclusions Cannabis appears to be effective for pelvic pain, gastrointestinal issues and mood, with effectiveness differing based on method of ingestion. The greater propensity for use of an inhaled dosage delivery may be due to the rapid onset of pain-relieving effects versus the slower onset of oral products. Oral forms appeared to be superior compared to inhaled forms in the less commonly reported mood or gastrointestinal categories. Clinical trials investigating the tolerability and effectiveness of cannabis for endometriosis pain and associated symptoms are urgently required.