A blinded evaluation of privacy preserving record linkage with Bloom filters

Background Privacy preserving record linkage (PPRL) methods using Bloom filters have shown promise for use in operational linkage settings. However real-world evaluations are required to confirm their suitability in practice. Methods An extract of records from the Western Australian (WA) Hospital Morbidity Data Collection 2011–2015 and WA Death Registrations 2011–2015 were encoded to Bloom filters, and then linked using privacy-preserving methods. Results were compared to a traditional, un-encoded linkage of the same datasets using the same blocking criteria to enable direct investigation of the comparison step. The encoded linkage was carried out in a blinded setting, where there was no access to un-encoded data or a ‘truth set’. Results The PPRL method using Bloom filters provided similar linkage quality to the traditional un-encoded linkage, with 99.3% of ‘groupings’ identical between privacy preserving and clear-text linkage. Conclusion The Bloom filter method appears suitable for use in situations where clear-text identifiers cannot be provided for linkage.

Morbidade Hospitalar por Insuficiência Cardíaca no Nordeste Brasileiro (2010-2014) / Hospital Morbidity for Cardiac Insufficiency in Northeastern Brazil (2010-2014)

Resumo: O Objetivo foi analisar o perfil de morbidade das internações por Insuficiência Cardíaca na região Nordeste do Brasil e sua relação com as variáveis sociodemográficas. Método: Estudo Ecológico compreendendo o período de 2010 a 2014. Os dados foram retirados do Sistema de Informações Hospitalares do Sistema Único de Saúde. Resultados: No período analisado, foram realizadas 297.751 internações por Insuficiência Cardíaca. A taxa padronizada por 100.000 habitantes sofreu redução em todos os Estados. Quando considerado apenas o número bruto de hospitalizações, alguns Estados tiveram pequena redução ou aumento nos casos. O sexo masculino (53,65%), com 60 anos ou mais (68,78%), atendidos em regime de urgência (94,57%) e no setor público (56,21%), de cor parda (44,6%), foi o predominante. Na maioria das faixas etárias o domínio foi do sexo masculino. Conclusão: Embora haja tendência de queda, ainda são altas as prevalências de hospitalização por Insuficiência Cardíaca nos Estados nordestinos. Palavras-chave: Insuficiência Cardíaca; Perfil de Saúde; Hospitalização; Morbidade; Epidemiologia. Abstract: The objective was analyze the morbidity profile of hospitalizations for heart failure in the Northeast region of Brazil and its relationship with sociodemographic variables. Method: Ecological Study covering the period from 2010 to 2014. Data were taken from the Hospital Information System of the Unified Health System. Results: During the analyzed period, 297,751 admissions due to Heart Failure were carried out. The standardized rate per 100,000 inhabitants was reduced in all states. When considering only the gross number of hospitalizations, some states had a small reduction or increase in cases. Predominance in cases involved: Males (53.65%), aged 60 years or more (68.78%), treated in an emergency room (94.57%) and in the public sector (56.21%), brown (44, 6%). In most age groups the domain was male. Conclusion: Although there is a downward trend, the prevalence of hospitalization due to heart failure is still high in the northeastern states.Keywords: Heart Failure. Health Profile. Hospitalization. Morbidity. Epidemiology.

The epidemiology of falls in Portugal: An analysis of hospital admission data

Background Falls are a common cause of injury and pose an increased risk of morbidity, mortality, and lifelong disability. Falls encompass a troublesome definition and can pose challenges in epidemiological studies. Data on fall-related hospital admissions in Portugal remain unpublished. This study aimed to examine the epidemiology of fall-related hospital admissions in the Portuguese population between 2010 and 2018. It also aimed to examine annual rates of fall-related hospital admissions using three methodological approaches. Methods The Portuguese Hospital Morbidity Database was used to identify all cases resulting in one or more inpatient admission in public hospitals related to falls from 2010 to 2018. Fall-related hospital admissions were described by age groups, sex, geographical area of residence, and type of fall. Annual rates were computed using three approaches: i) based on the number of inpatient admissions with an ICD code of fall, ii) based on the number of patients admitted to inpatient care with an ICD code of fall, and iii) based on the number of inpatient admissions with a principal diagnosis of injury. Results Between 2010 and 2018, 383,016 fall-related admissions occurred in 344,728 patients, corresponding to 2.1% of the total number of hospitalizations during the same period. Higher rates were seen among the younger (20–25) and the oldest age groups (+85), males until the age of 60, females from the age of 60, and areas of residence with a higher aging index. An overall rate of falls per 100,000 population was estimated at 414 (based on number of admissions), 373 (based on number of patients) and 353 (based on number of admissions with a principal diagnosis of injury). Conclusions This study provides an overall picture of the landscape of falls in a scarcely explored setting. The results aim to contribute to identifying appropriate preventive interventions and policies for these populations.

Comparison of Post-Operative Morbidity and Mortality in Patients Undergoing On-Pump versus Off-Pump CABG

Objective: The aim of this study is to compare in hospital morbidity and mortality in on pump versus off pump CABG. Methodology: All the patients undergoing CABG surgery were enrolled after taking informed consent. Demographic and postoperative variables were entered in the predesigned questionnaire and patients were followed for early outcomes after surgical procedure. Results: A total of 470 patients wasdivided in two groups 235 (on pump and off pump).The mean age of patients was 54.85 ± 9.57 (23-85).There were 400(85.1%) males and 70(14.9%) females. The total data of 470 patients was divided in two groups 235 in on Pump and 235 in off pump CABG.The mean age of patients was 54.85 ± 9.57 (23-85). There were 400(85.1%) males and 70(14.9%) females. Different clinical outcomes were compared in both groups (On-Pump versus Off-Pump CABG) by using Euro Score, we found Peripheral Disease in On-Pump CABG group compared with Off-Pump CABG as 11(4.68% vs 12(5.11%) with p-value=0.831 which was statistically insignificant, current data assessed lung disease in both groups as 11(4.68%) vs 13(5.53%) with statistically insignificant p-value (0.675). and unstable angina were 12(5.11%, p-value 1.00) patients founded and Peri and post myocardial infarction also assessed in both groups with p-value (0.74 & 1.20). respectively.Data regarding in hospital mortality was analyzed and found that 7(2.98%) in on pump group compare with off pump group was According to our research mean number of grafts placed in On-Pump CABG were 9(3.83%) with statistically insignificant p-value (0.611). Conclusion:Proof is presented that surgery on beating heart (Off-Pump) is as safe and effective as Conventional CABG, and cheaper than conventional surgery. However, it is uncertain whether the cost savings are sustained over a longer period of time. Keywords: Coronary artery Bypass grafting surgery, On Pump Off Pump

Prevention and Nursing Management for Central Line Associated Blood Stream Infection

Central line associated blood stream infection (CLABSI), is a substantial contributor to in-hospital morbidity and death, as well as increased cost and length of stay in the intensive care unit (ICU). CLABSIs are one of the most deadly for each infection is expected to have a mortality rate of 12-25 percent. CLABSI prevention is important, and nurses play a vital role. Nurses are required to complete initial training as well as annual competence tests for central venous catheter protocol and other skills to ensure that they are delivering direct care to patients using the most up-to-date evidence-based practices. Conclusion: CLABSI prevention bundles are the best method for implementing many interventions at once in addition to standardizing practice. Standard prevention bundles in addition to routine CLABSI education for staff are the most effective methods for preventing infection; it is inevitable that compliance with bundles will vary across healthcare institutions.

Clinical implementation of a machine learning system to detect deteriorating patients reduces time to response and intervention

Introduction: Acute physiological deterioration is a major contributor to in-hospital morbidity and mortality. Early detection and intervention of deteriorating patients is key to improving patient outcomes. Prior research has demonstrated the effectiveness of Early Warning Systems and other algorithmic approaches in automatically identifying these patients from passively monitoring vital signs. Methods: In this work, we conduct a prospective pilot study of clinical deployment of the Mayo Clinic Bedside Patient Rescue (BPR) system using an escalating alerting logic enabled by machine learning. Among four units where the BPR system was deployed, time to response and time to intervention for deteriorating patients were significantly reduced relative to matched control units. Results: In pilot units, time to response decreased by 35.4% (from 63.2 minutes to 40.8 minutes) and time to intervention decreased by 48.5% (from 106.3 minutes to 55.9 minutes). No significant differences were observed in counterbalance metrics of mortality, ICU transfer rate, and Rapid Response Team activation rate. Furthermore, the automated alerting system was well-received by clinicians participating in the pilot study, as assessed by survey. Discussion: These results demonstrate a successful clinical deployment of a practice-changing machine learning alert system with demonstrable impact on improving patient care.

SP3.1.8 What happens to patients with acutely symptomatic hernia in the UK? Findings from the MASH study

Aims Acutely symptomatic abdominal wall and groin hernias (ASH) are a common reason for acute surgical admissions in the UK. There is limited data to guide the treatment of such presentations. This study aimed to assess outcomes of emergency hernia surgery, and identify common management strategies, to improve care for these high risk patients. Methods A 12 week, UK-based, multi-centre, collaborative, prospective cohort study (NCT04197271) recruited adults with ASH. Data on investigations, specific surgical intervention, in-hospital morbidity and mortality, and quality of life was measured. 30 and 90-day follow-up phone calls collected complications and quality of life. Descriptive analyses were performed to describe population and outcomes. Results Twenty-three acute Trusts recruited 264 patients. Inguinal (37.9%) and umbilical (37.1%) were the most common hernia locations. 17% were awaiting elective surgery and 17% had been previously declined intervention. CT was performed in 47%. 82% of patients had surgery within 48 hours, with 95% of procedures performed open and 93% under general anaesthesia. 3/11 laparoscopic procedures were converted to open. Mesh was used in 55%, this was typically synthetic non-absorbable (86%). Complications were infrequent; 2% developed pneumonia or delirium. Surgical site infection occurred in 3% and mortality was 1.2%. Quality of life improved between baseline and 30-days following repair. Conclusions There is variation in the management of ASH in the UK, particularly with repair techniques, use of mesh and laparoscopy. One in five patients was awaiting repair; this might indicate a need for expedited pathways and reprioritising of elective hernia repair.