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Aim Methods Results Conclusion To determine the incidence and presenting features of type 1 diabetes mellitus and diabetic ketoacidosis in a paediatric population serviced by a regional health service in Queensland, Australia.All patients less than 16 years old diagnosed with type 1 diabetes mellitus between 01 January 2015 and 31 December 2021 were included in this retrospective, observational study. The electronic medical records of each patient were reviewed to collect data on demographics, presentation and ongoing diabetes care.Sixty‐four paediatric patients were diagnosed with type 1 diabetes mellitus during the study period, giving an incidence of 25 cases per 100 000 person years. Half the patients presented with diabetic ketoacidosis, with 14 (22% of the total cohort) presenting in severe diabetic ketoacidosis. There was no significant increase in the incidence of type 1 diabetes mellitus or proportion of patients with diabetic ketoacidosis across the years of the study. Patients that had a delayed diagnosis had an increased likelihood of presenting with severe diabetic ketoacidosis.Incidence of type 1 diabetes mellitus in the paediatric population in this regional centre in Queensland, Australia, is similar to national data. High proportions of patients presenting with diabetic ketoacidosis and severe diabetic ketoacidosis were identified in the study population, with delayed diagnosis, a risk factor for severe diabetic ketoacidosis. [ABSTRACT FROM AUTHOR]

Plain language summary The American Cancer Society National Lung Cancer Roundtable strategic plan for provider engagement and outreach addresses barriers to the uptake of lung cancer screening, including lack of provider awareness and guideline knowledge about screening, concerns about potential harms from false‐positive examinations, lack of time to implement workflows within busy primary care practices, insufficient infrastructure and administrative support to manage a screening program and patient follow‐up, and implicit bias based on sex, race/ethnicity, social class, and smoking status. Strategies to facilitate screening include educational programming, clinical reminder systems within the electronic medical record, decision support aids, and tools to track nodules that can be implemented across a diversity of practices and health care organizational structures.The American Cancer Society National Lung Cancer Roundtable strategic plan to reduce deaths from lung cancer includes strategies designed to support health care professionals, to better understand lung cancer screening, and to support adults who are eligible for lung cancer screening by providing counseling, referral, and follow‐up. [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance The incidence of late‐onset epilepsy (LOE) is rising, and these patients may use an excess of health care resources. This study aimed to measure pre‐/post‐diagnostic health care use (HCU) for patients with LOE compared to controls.This was an observational open cohort study covering years 1998–2019 using UK population‐based linked primary care (Clinical Practice Research Datalink [CPRD]) and hospital (HES) electronic health records. The participants included patients with incident LOE enrolled in CPRD and 1:10 age‐, sex‐, and general practice–matched controls. The exposure was incident LOE (diagnosed at age ≥65) using a 5‐year washout. The main outcome was all HCU (primary care [PC], accident and emergency [A&E], admitted patient and outpatient care) using inverse proportional weighting to PC use and HCU by setting. An interrupted time‐series analysis was used to examine pre‐/post‐diagnostic HCU between patients with LOE and controls over 4 years either side of diagnosis/matching date. An adjusted mixed‐effects negative binomial regression was used for post‐diagnosis HCU interactions.Of 2 569 874 people ≥65 years of age, 1048 (4%) developed incident LOE. Mean weighted total HCU increased by 32 visits per patient‐year (95% confidence interval [95% CI]: 13–50, p = .003) until LOE diagnosis, and then dropped by a mean of 60 visits per patient‐year (95% CI: −81 to −40). There was an acute rise and fall over the 1–2 years immediately pre‐/post‐diagnosis. Incident HCU remained higher for LOE compared to controls post‐diagnosis (adjusted incidence rate ratio: 1.72; 95% CI: 1.65–1.70; p < .001), including A&E, outpatient, and admitted care.Health care use demonstrates an acute on chronic rise over the 4 years before diagnosis of LOE. To what extent the partial reversal of the acute pre‐diagnosis rise, and the mediators of the accelerated increase compared to controls are attributed to epilepsy, comorbid and bidirectional disease states, or a combination of both warrants further exploration. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The present study sought to investigate predictors of hospitalisation in adults diagnosed with non‐specific low back pain (LBP) and/or sciatica from an ED.A 5‐year, multicentre retrospective observational study was conducted across six public hospitals (metropolitan and regional) using data from electronic medical records. Patient presentations were identified using LBP diagnostic codes and key data extracted (patient demographics, clinical activity, discharge destination). Descriptive statistics and logistic regression were used to measure associations between identified variables and hospitalisation.There were 11 709 ED presentations across the study period. People aged ≥65 years (odds ratio [OR] 2.84, 95% confidence interval [CI] 2.61–3.10) and those who arrived at the ED via ambulance (age‐adjusted OR 2.68, 95% CI 2.44–2.95) were more likely to be hospitalised. People were also more likely to be hospitalised when triaged as more urgent, when blood tests or advanced spinal imaging were ordered, and when i.v./subcutaneous opioids or oral benzodiazepines were administered. Hospitalisation rates for LBP were lower in regional hospitals, in people residing in lower socioeconomic areas and in Indigenous Australians.Certain patient characteristics and ED clinical activity are associated with hospitalisations for LBP. Understanding these factors will better inform the design and delivery of appropriate high‐quality care. [ABSTRACT FROM AUTHOR]

Rationale, Aims, and Objectives Method Results Conclusion Medical device‐integrated electronic medical records (MDI‐EMR) pose significant challenges in ensuring effective usage, data security and patient safety. The complexities of MDI‐EMR necessitate applying various security mechanisms to safeguard against cyber threats. Therefore, we evaluated cyber threats to MDI‐EMR and the effectiveness of applied security controls using a proposed framework from sociotechnical and risk assessment perspectives.We conducted a qualitative case study evaluation in a general hospital in Saudi Arabia using interviews, observation, and document analysis from the perspectives of major MDI‐EMR stakeholders, including healthcare providers, IT professionals and cybersecurity specialists.The results showed the interplay among physical, technical and administrative security controls that maintained a secure posture of MDI‐EMR. The effectiveness of security controls is highly influenced by the staff's cybersecurity awareness and training. The perceived effectiveness of security controls varied among users, with some expressing satisfaction with the ease of use and reliability, while others highlighting challenges such as password complexity and access procedures. Understanding these diverse perspectives is crucial for tailoring security measures to meet the needs of different stakeholders effectively.Collaboration among the key stakeholders is crucial for implementing security controls for MDI‐EMR. Balancing security measures with usability concerns is essential, as highlighted by challenges in implementing technical controls. A comprehensive approach encompassing physical, technical and administrative controls, continuous education and awareness initiatives are significant to empower staff in recognising and mitigating cyber threats effectively to safeguard medical data and ensure the integrity of healthcare systems. [ABSTRACT FROM AUTHOR]

Preeclampsia is a pregnancy‐associated condition posing risks of both fetal and maternal mortality and morbidity that can only resolve following delivery and removal of the placenta. Because in its typical form preeclampsia can arise before delivery, but not after, these two events exemplify the time‐to‐event setting of "semi‐competing risks" in which a non‐terminal event of interest is subject to the occurrence of a terminal event of interest. The semi‐competing risks framework presents a valuable opportunity to simultaneously address two clinically meaningful risk modeling tasks: (i) characterizing risk of developing preeclampsia, and (ii) characterizing time to delivery after onset of preeclampsia. However, some people with preeclampsia deliver immediately upon diagnosis, while others are admitted and monitored for an extended period before giving birth, resulting in two distinct trajectories following the non‐terminal event, which we call "clinically immediate" and "non‐immediate" terminal events. Though such phenomena arise in many clinical contexts, to‐date there have not been methods developed to acknowledge the complex dependencies between such outcomes, nor leverage these phenomena to gain new insight into individualized risk. We address this gap by proposing a novel augmented frailty‐based illness‐death model with a binary submodel to distinguish risk of immediate terminal event following the non‐terminal event. The model admits direct dependence of the terminal event on the non‐terminal event through flexible regression specification, as well as indirect dependence via a shared frailty term linking each submodel. We develop an efficient Bayesian sampler for estimation and corresponding model fit metrics, and derive formulae for dynamic risk prediction. In an extended example using pregnancy outcome data from an electronic health record, we demonstrate the proposed model's direct applicability to address a broad range of clinical questions. [ABSTRACT FROM AUTHOR]

Objective Materials and Methods Results Conclusion This project demonstrates the feasibility of connecting medical imaging data and features, SARS‐CoV‐2 genome variants, with clinical data in the National Clinical Cohort Collaborative (N3C) repository to accelerate integrative research on detection, diagnosis, and treatment of COVID‐19‐related morbidities. The N3C curated a rich collection of aggregated and de‐identified electronic health records (EHR) data of over 18 million patients, including 7.5 million COVID‐positive patients, seen at hospitals across the United States. Medical imaging data and variant samples are important data modalities used in the study of COVID‐19.Imaging data and features are hosted on the Cancer Imaging Archive (TCIA), and sequenced variant samples are analyzed and stored at the NIH GenBank. The University of Arkansas for Medical Sciences (UAMS) published the first COVID‐19 data set of 105 patients on TCIA and 37 patients on GenBank. We developed a process to link imaging and genomic variants and N3C EHR data through Privacy Preserving Record Linkage (PPRL) using de‐identified cryptographic hashes to match records associated with the same individuals without using patient identifiers.The PPRL techniques were piloted using clinical and imaging data sets provided by UAMS. Developed software components and processes executed properly, and linked data were returned and processed for visualization.Linking across clinical data sources at the patient level provides opportunities to gain insights from data that may not be known otherwise. The PPRL prototype and the pilot serve as a model to link disparate and diverse data repositories to enhance clinical research. [ABSTRACT FROM AUTHOR]

Clinical prediction models have been widely acknowledged as informative tools providing evidence‐based support for clinical decision making. However, prediction models are often underused in clinical practice due to many reasons including missing information upon real‐time risk calculation in electronic health records (EHR) system. Existing literature to address this challenge focuses on statistical comparison of various approaches while overlooking the feasibility of their implementation in EHR. In this article, we propose a novel and feasible submodel approach to address this challenge for prediction models developed using the model approximation (also termed “preconditioning”) method. The proposed submodel coefficients are equivalent to the corresponding original prediction model coefficients plus a correction factor. Comprehensive simulations were conducted to assess the performance of the proposed method and compared with the existing “one‐step‐sweep” approach as well as the imputation approach. In general, the simulation results show the preconditioning‐based submodel approach is robust to various heterogeneity scenarios and is comparable to the imputation‐based approach, while the “one‐step‐sweep” approach is less robust under certain heterogeneity scenarios. The proposed method was applied to facilitate real‐time implementation of a prediction model to identify emergency department patients with acute heart failure who can be safely discharged home. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Computerized decision support systems (CDSSs) aim to prevent adverse drug events. However, these systems generate an overload of alerts that are not always clinically relevant. Anticoagulants are frequently involved in these alerts. The aim of this study was to investigate the efficiency of CDSS alerts on anticoagulants in Dutch hospital pharmacies.A multicentre, single‐day, cross‐sectional study was conducted using a flashmob design in Dutch hospital pharmacies, which have CDSSs that operate on both a national medication surveillance database and on self‐developed clinical rules. Hospital pharmacists and pharmacy technicians collected data on the number and type of alerts and time needed for assessing these alerts. The primary outcome was the CDSS efficiency on anticoagulants, defined as the percentage of alerts on anticoagulants that led to an intervention. Secondary outcomes where among other CDSSs efficiency related to any medications and the time expenditure. Descriptive data‐analysis was used.Of the 69 hospital pharmacies invited, 42 (61%) participated. The efficiency of CDSS alerts on anticoagulants was 4.0% (interquartile range [IQR] 14.0%) for the national medication surveillance database alerts and 14.3% (IQR 40.0%) for alerts from clinical rules. For any medication, the efficiency was lower: 1.8% (IQR 7.5%) and 13.4% (IQR 21.5%) respectively. The median time for assessing the relevance of all alerts was 2 (IQR 1:21) h/day for pharmacists and 6 (IQR 5:01) h/day for pharmacy technicians.CDSS efficiency is generally low, both for anticoagulants and any medication, while the time investment is high. Optimization of CDSSs is needed. [ABSTRACT FROM AUTHOR]

Background Aim Method Results Conclusion Pharmacist surgical preadmission review is common in adult healthcare settings, however there is little evidence of this practice in the paediatric setting. This research describes a pilot surgical preadmission pharmacist service in a paediatric hospital.To evaluate the impact of a surgical preadmission pharmacist service on patient flow and the quality of medication management.A retrospective review (2 months) was conducted to compare an intervention group (1 May 2019–30 June 2019) to historical baseline (1 October 2018–30 November 2018). Children and adolescents (aged 0–18 years) presenting for elective surgery and overnight admission were included. Relevant clinical data and timestamps were extracted from the electronic medical record. Multiple linear regression models were built to examine the difference in outcomes between the control and intervention groups. This project was exempt due to the local policy requirements that constitute research by the Queensland Children's Hospital Human Research Ethics Committee (Reference no: LNR/19/QCHQ/53406). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of an established standard of clinical care and involved the use of existing collections of records that contain only non‐identifiable patient data.In total, 135 patients were included in the baseline and 96 patients were included in the intervention group. The intervention group had statistically significant lower time to best possible medication history (BPMH) by 47.57 h (95% confidence interval [CI] −53.25 to −41.89, p < 0.001). Time to prescription of home medications was significantly reduced in the intervention group by 5.26 h (95% CI −10.45 to −0.08, p = 0.05). There was no difference in proportion of patients with home medications omitted (71–62%, p = 0.38) or requiring modification (14–12%, p = 0.58) between the two groups.Implementation of a surgical preadmission pharmacist service in our paediatric hospital demonstrated earlier BPMH documentation and prescription of home medications, without negative effects on perioperative patient flow. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Limited evidence exists to support any specific medication over others to prevent dementia in older patients with type 2 diabetes (T2D). We investigated whether treatment with sodium‐glucose cotransporter 2 (SGLT‐2) inhibitors is associated with a lower risk of incident dementia and all‐cause mortality, relative to dipeptidyl peptidase‐4 (DPP‐4) inhibitors and glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA).In this retrospective, active‐comparator cohort study, we used data from the TriNetX electronic health records network. Our primary cohort comprised patients with T2D aged ≥50 years, registered between January 2012 and December 2022. Patients with a history of dementia were excluded. We used Kaplan–Meier survival analysis to estimate the incidence of dementia and all‐cause mortality in our cohort after they had used glucose‐lowering drugs for at least 12 months. Propensity score matching was performed to balance the SGLT‐2 inhibitor, DPP‐4 inhibitor and GLP‐1 RA cohorts. Subgroup analyses for sex and age were also conducted.Our first cohort comprised 193 948 patients treated with metformin and SGLT‐2 inhibitors and an equal number of patients treated with metformin and DPP‐4 inhibitors. In this cohort, the risk of dementia and all‐cause mortality was lower in patients treated with SGLT‐2 inhibitors than in those treated with DPP‐4 inhibitors (hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.59–0.65, for dementia; HR: 0.54, 95% CI: 0.52–0.56, for all‐cause mortality).Our second cohort comprised 165 566 patients treated with metformin and SGLT‐2 inhibitors and an equal number of patients treated with metformin and GLP‐1 RAs. In this cohort, the risk of dementia and all‐cause mortality was lower in those treated with SGLT‐2 inhibitors than in those treated with GLP‐1 RAs (HR: 0.92, 95% CI: 0.87–0.98, for dementia; HR: 0.88, 95% CI: 0.85–0.91, for all‐cause mortality).The use of SGLT‐2 inhibitor was associated with a lower risk of incident dementia and all‐cause mortality in older adults with T2D compared to DPP‐4 inhibitor and GLP‐1 RA. [ABSTRACT FROM AUTHOR]

Aim Design, setting and participants Measurements Findings Conclusion This study: (1) estimated the effect of early discontinuation of medication for opioid use disorder (MOUD) on overdose probability and (2) measured the relationship between patient characteristics and early discontinuation probability for each MOUD type.This was a retrospective cohort using electronic health record data from the US Veterans Healthcare Administration. Participants were veterans initiating MOUD with buprenorphine (BUP), methadone (MET) or extended‐release naltrexone (XR‐NTX) from fiscal years 2012–19. A total of 39 284 veterans met eligibility with 22 721 (57.8%) initiating BUP, 12 652 (32.2%) initiating MET and 3911 (10.0%) initiating XR‐NTX.Measurements (1) determined whether the veteran experienced an overdose in the 365 days after MOUD initiation (primary) and (2) early discontinuation of MOUD, defined as discontinuation before 180 days (secondary). We assumed that unobserved patient characteristics would jointly influence the probability of discontinuation and overdose. and estimated the joint distribution with a bivariate probit model.We found that 9.0% of BUP initiators who experienced an overdose above the predicted 3.9% had no veteran‐discontinued BUP early; findings for XR‐NTX were similar, with 12.2% of initiators overdosing above the predicted 4.5%, but this was statistically inconclusive. We found no relationship between early discontinuation and overdose for MET initiators, probably due to the high risk of both events. The patient characteristics included in our post‐estimation exploratory analysis of early discontinuation varied by MOUD type, with between 14 (XR‐NTX) and 25 (BUP) tested. The only characteristics with at least one level showing a statistically significant change in probability of early discontinuation for all three MOUD types were geography and prior‐year exposure to psychotherapy, although direction and magnitude varied.Early discontinuation of buprenorphine, and probably extended‐release naltrexone, appears to be associated with a greater probability of experiencing a fatal or non‐fatal overdose among US veterans receiving medication for opioid use disorder (MOUD); methadone does not show the same association. There is no consistent set of characteristics among early discontinuers by MOUD type. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Radial head subluxation, known as pulled elbow or nursemaid's elbow, is a common presentation to the Paediatric Emergency Department (PED). Fifty per cent of children present following an unwitnessed injury or with an atypical history. Furthermore, examination can be difficult in an upset or frightened child meaning the precise location of the injury is not always easily identifiable. Many children receive upper limb x‐rays unnecessarily and others undergo attempted reduction for suspected pulled elbow when a fracture is the cause of their pain.To evaluate the ability of point‐of‐care ultrasound (POCUS) to correctly identify cases of suspected pulled elbow.A retrospective review of patients aged 0–5 years presenting to the PED of our large District General Hospital from November 2020 to November 2022. We reviewed the electronic medical records of all patients presenting with a triage category of ‘elbow Injury’. We excluded patients presenting with obvious deformity, significant swelling and history of road traffic collision or other major trauma mechanism such as a fall from a height. POCUS was carried out by the authors according to pre‐existing clinical protocols.Thirty‐seven patients underwent POCUS. Twenty‐nine had a typical history and all had a positive POCUS for pulled elbow. Of the remaining eight patients with an atypical history, three were found to have a positive POCUS compared to unaffected elbow. Five patients with an atypical history had negative POCUS findings and were diagnosed as soft tissue injuries after further assessment. All 32 with positive sonographic signs had a final diagnosis of pulled elbow, meaning the specificity was 100% (47.8–100) (P = 0.00003). The sensitivity was 100%.Use of POCUS by appropriately trained clinicians, as an extension of a clinical examination, in this retrospective study reliably confirmed pulled elbow. This has the potential to reduce both unnecessary radiation as well as the time in the emergency department for the child and their carers. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusion Abnormalities in specific echocardiographic parameters and cardiac biomarkers have been reported among individuals with diabetes. However, a comprehensive characterization of diabetic cardiomyopathy (DbCM), a subclinical stage of myocardial abnormalities that precede the development of clinical heart failure (HF), is lacking. In this study, we developed and validated a machine learning‐based clustering approach to identify the high‐risk DbCM phenotype based on echocardiographic and cardiac biomarker parameters.Among individuals with diabetes from the Atherosclerosis Risk in Communities (ARIC) cohort who were free of cardiovascular disease and other potential aetiologies of cardiomyopathy (training, n = 1199), unsupervised hierarchical clustering was performed using echocardiographic parameters and cardiac biomarkers of neurohormonal stress and chronic myocardial injury (total 25 variables). The high‐risk DbCM phenotype was identified based on the incidence of HF on follow‐up. A deep neural network (DeepNN) classifier was developed to predict DbCM in the ARIC training cohort and validated in an external community‐based cohort (Cardiovascular Health Study [CHS]; n = 802) and an electronic health record (EHR) cohort (n = 5071). Clustering identified three phenogroups in the derivation cohort. Phenogroup‐3 (n = 324, 27% of the cohort) had significantly higher 5‐year HF incidence than other phenogroups (12.1% vs. 4.6% [phenogroup 2] vs. 3.1% [phenogroup 1]) and was identified as the high‐risk DbCM phenotype. The key echocardiographic predictors of high‐risk DbCM phenotype were higher NT‐proBNP levels, increased left ventricular mass and left atrial size, and worse diastolic function. In the CHS and University of Texas (UT) Southwestern EHR validation cohorts, the DeepNN classifier identified 16% and 29% of participants with DbCM, respectively. Participants with (vs. without) high‐risk DbCM phenotype in the external validation cohorts had a significantly higher incidence of HF (hazard ratio [95% confidence interval] 1.61 [1.18–2.19] in CHS and 1.34 [1.08–1.65] in the UT Southwestern EHR cohort).Machine learning‐based techniques may identify 16% to 29% of individuals with diabetes as having a high‐risk DbCM phenotype who may benefit from more aggressive implementation of HF preventive strategies. [ABSTRACT FROM AUTHOR]

Introduction Purpose Methods Results Discussion Not all patients experience debilitating symptoms during Atrial Fibrillation (AF), some are asymptomatic. The reasons for this inter‐ and intrasubject variability is unknown.The study objective was NOAH characterize episode‐level and clinical characteristics associated with symptomatic versus asymptomatic episodes of AF in patients with an implantable cardiac monitor (ICM).Patients with an AF episode detected on an ICM between 2007 and 2021 with overlapping clinical data from aggregated Electronic Health Records in the Optum® deidentified data set were included. Symptomatic episodes were labeled in real‐time by the patient. Heart rate (HR) at onset, mean HR, AF Evidence Score (a measure of beat‐to‐beat irregularity), episode duration and Activity Index were evaluated for association with symptom status using multivariable regression modeling.11 267 patients had AF episodes with clinical data available. The 1776 (15.8%) patients who reported symptomatic AF episodes were younger (67 ± 12 years vs. 71 ± 11 years old, p < .001) and had fewer cardiovascular co‐morbidities than patients with asymptomatic AF exclusively. Symptomatic episodes were longer (5.5 [2.4, 14.4] h vs. 3.7 [1.7, 11] h, p < .001), had higher mean HR (103 ± 22 bpm vs. 88 ± 22 bpm, p < .001) and higher AF evidence scores (98 ± 27 vs. 82 ± 24, p < .001). These features were independently associated with symptomatic episodes on multivariable regression analysis and per‐subject analysis in patients who had both symptomatic and asymptomatic episodes.Episode‐level characteristics differed between symptomatic AF episodes versus asymptomatic episodes in patients with ICMs. Symptomatic patients also had less comorbidities. These parameters may be useful in understanding variable symptomatic manifestation and remote stratification of AF episodes. [ABSTRACT FROM AUTHOR]

Pushing selected information to clinicians, as opposed to the traditional method of clinicians pulling information from an electronic medical record, has the potential to improve care. A digital notification platform was designed by clinicians and implemented in a tertiary hospital to flag dysglycaemia. There were 112 patients included in the study, and the post‐implementation group demonstrated lower rates of dysglycaemia (2.5% vs 1.1%, P = 0.038). These findings raise considerations for information delivery methods for multiple domains in contemporary healthcare. [ABSTRACT FROM AUTHOR]

Objectives Research Design and Methods Results Conclusion To present the Real‐World Progression In Diabetes (RAPIDS) 2.0 Risk Engine, the only simulation model to study the long‐term trajectories of outcomes arising from dynamic sequences of glucose‐lowering treatments in type 2 diabetes (T2DM).The RAPIDS model's risk equations were re‐estimated using a Least Absolute Shrinkage and Selection Operator (LASSO)‐based regularization of features that spanned baseline data from the last two quarters of current time and interactions with age. These equations were supplemented with estimates for the impact of dipeptidyl peptidase‐4 inhibitors, glucagon‐like peptide‐1 receptor agonists, and sodium‐glucose cotransporter‐2 inhibitor classes of drugs as monotherapies and their combinations with metformin based on newer trial data and comprehensive meta‐analyses. The probabilistic RAPIDS 2.0 model was calibrated (N = 25 000) and validated (N = 263 816) using electronic medical records (EMR) data between 2008 and 2021 from a national network of US healthcare organizations.The EMR‐based cohort had a mean age of 61 years at baseline, with 50% women, 70% non‐Hispanic White individuals and 20% non‐Hispanic Black individuals, and was followed for 17.5 quarters (range: 3–50). The final RAPIDS 2.0 risk engine accurately predicted the long‐term trajectories of all nine biomarkers and nine outcomes in the hold‐out validation sample. Similar accuracies in predictions were observed in each of the 14 subgroups studied.The RAPIDS 2.0 model demonstrated valid long‐term predictions of outcomes in individuals with T2DM in the United States as a function of dynamic sequences of treatment use patterns. This highlights its potential to project long‐term comparative effectiveness between alternative sequences of glucose‐lowering treatment uses in the United States. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Post‐infectious disorders of gut‐brain interaction (PI‐DGBI) have significant impact on children and adolescents. The effect of COVID‐19 on PI‐DGBI‐associated symptoms in this population, however, is unknown.We performed electronic medical record searches to identify patients 8–17 years old with a SARS‐CoV2 PCR test at Lurie Children's Hospital between November 2020 and March 2021 (cohort 1) and April–October 2021 (cohort 2). Questionnaires were administered to assess symptoms prior to and 3 months following the test. This included the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS), questionnaire of pediatric gastrointestinal symptoms—Rome IV, Nausea Profile (NP), dyspepsia symptom survey (DSS), nausea severity profile (NSP), and Pediatric Quality of Life Inventory (PedsQL). We grouped patients based on the presence of symptoms prior to COVID‐19 test or the test result.One hundred and ninety‐six parent(s) or guardian(s) in cohort 1 and 274 in cohort 2 completed surveys and self‐reported their child's COVID‐19 result. Cohort 1 had increased PEESS and DSS scores, lower PedsQL scores, and increased frequency of abdominal pain disorders among patients with symptoms prior to COVID‐19 testing. Both cohorts had increased NP and NSP scores among patients with symptoms prior to COVID‐19 testing that was highest among patients with a positive COVID‐19 test. Abdominal pain and diarrhea prior to COVID‐19 testing predicted higher NP scores.Among symptomatic COVID‐19 tested children, we found increased severity of nausea‐associated somatic, emotional, and gastrointestinal symptoms in the 3 months following the test that was most increased among patients with a positive COVID‐19 test. [ABSTRACT FROM AUTHOR]

ABSTRACT In medical research, the accuracy of data from electronic medical records (EMRs) is critical, particularly when analyzing dense functional data, where anomalies can severely compromise research integrity. Anomalies in EMRs often arise from human errors in data measurement and entry, and increase in frequency with the volume of data. Despite the established methods in computer science, anomaly detection in medical applications remains underdeveloped. We address this deficiency by introducing a novel tool for identifying and correcting anomalies specifically in dense functional EMR data. Our approach utilizes studentized residuals from a mean‐shift model, and therefore assumes that the data adheres to a smooth functional trajectory. Additionally, our method is tailored to be conservative, focusing on anomalies that signify actual errors in the data collection process while controlling for false discovery rates and type II errors. To support widespread implementation, we provide a comprehensive R package, ensuring that our methods can be applied in diverse settings. Our methodology's efficacy has been validated through rigorous simulation studies and real‐world applications, confirming its ability to accurately identify and correct errors, thus enhancing the reliability and quality of medical data analysis. [ABSTRACT FROM AUTHOR]

The article presents a study on oral health assessment of newly diagnosed oncology patients by dental practitioners. Topics discussed include the aims of the study, the materials and methods used in the study, and the need for improvements in communication with oncology wards as shown in the percentage of patients who received dental referrals.

Background: The short Synacthen test (SST) is widely used to investigate adrenal insufficiency, but it can be time‐consuming, costly and labour‐intensive to perform and is not without risk of adverse events. Aim: To review SST requesting patterns and practices across public hospitals in Queensland. Methods: The electronic medical records of patients who underwent a SST with Pathology Queensland between January 2020 and December 2020 were reviewed to collect data regarding the indication for the test, the requesting speciality, SST results and any adverse events. Results: Six hundred and fifty‐two SSTs were identified, of which 363 individual patients were included in the analysis. The majority of the tests (n = 198, 54.5%) were performed in the inpatient setting. Endocrinology most commonly ordered SSTs (n = 188, 51.8%). The suspected aetiology of adrenal insufficiency was unclear in a large proportion of requests (n = 167, 46.0%). Static testing of morning cortisol prior to SST was performed in only 249 (68.6%) patients. Of 140 inpatients data, 17.9% (n = 25) showed a robust static cortisol of ≥400 nmol/L and were treated as having normal adrenal function, suggesting SST was unnecessary in these patients. Twenty‐two (6.1%) patients had a documented adverse event occurring during or after the SST. Conclusions: There was wide variability in requesting patterns and practices for SSTs across Queensland. More than one in six SSTs could have been avoided if a static morning cortisol had been performed prior. Clinician education and the adoption of a structured referral form may improve testing practices. [ABSTRACT FROM AUTHOR]

The article focuses on assessing whether sites of primary lesions in pemphigus vulgaris (PV) are more susceptible to relapse. It identifies the anatomical locations where initial lesions occur and determines if these same sites are more likely to experience relapses. It suggests that tissue-resident memory T cells may play a significant role in this phenomenon, potentially explaining why certain sites are recurrently affected.

Background: Age‐related changes in the gastrointestinal system are common and may be influenced by physiological aging processes. To date, a comprehensive analysis of esophageal motor disorders in patients belonging to various age groups has not been adequately reported. Methods: We conducted a retrospective assessment of high‐resolution manometry (HRM) studies in a multicenter setting. HRM parameters were evaluated according to the Chicago Classification version 4.0. Epidemiological, demographic, clinical data, and main manometric parameters, were collected at the time of the examination. Age groups were categorized as early adulthood (<35 years), early middle‐age (35–49 years), late middle‐age (50–64 years), and late adulthood (≥65 years). Results: Overall, 1341 patients (632, 47.0% male) were included with a median age of 55 years. Late adulthood patients reported more frequently dysphagia (35.2%) than early adulthood patients (24.0%, p = 0.035), early middle‐age patients (21.0%, p < 0.0001), and late middle‐aged patients (22.7%, p < 0.0001). Esophagogastric junction outflow obstruction was more prevalent in late adulthood (16.7%) than in early adulthood (6.1%, p = 0.003), and in early middle‐age (8.1%, p = 0.001). Patients with normal esophageal motility were significantly younger (52.0 years) than patients with hypercontractile esophagus (61.5 years), type III achalasia (59.6 years), esophagogastric junction outflow obstruction (59.4 years), absent contractility (57.2 years), and distal esophageal spasm (57.0 years), in multivariate model (p < 0.0001). Conclusion: The rate of esophageal motor disorders is higher in older patients, in particular esophagogastric junction outflow obstruction and hypercontractile esophagus. Future prospective studies are necessary to confirm our results and to find tailored strategies to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of statin treatment to reduce coronary events and mortality has been hardly examined considering goals of LDL‐C. We aimed to analyse such association in secondary cardiovascular prevention. Methods: Retrospective cohort analysis of electronic health records from the SIDIAP database, Catalonia‐Spain. Recruitment period was from 2006 to 2017 and study period finished at the end of 2018. We included 54,175 people aged ≥35 years in cardiovascular secondary prevention starting statin treatment. We analysed the association of achieved LDL‐C goals after statin initiation with coronary heart disease and all‐cause mortality. Results: Mean age was 69 years and 20,146 (37.2%) were women. Coronary heart disease occurred in 5687 (10.5%) participants, and 10,676 (19.7%) persons passed away. Median follow‐up lasted 5.7 years (interquartile range, 3.4–8.1). The coronary heart disease HRs (95% CI) for the LDL‐C goals of 70–100, <70–55 and <55 mg/dL were.86 (.81–.92),.83 (.76–.9) and.8 (.72–.88), respectively. They were.89 (.83–.96) in the group with 30%–40% reduction and.86 (.8–.93) in the groups with 40%–50% and ≥50% reduction. We observed no association with mortality. We observed no relevant differences by sex or age. Conclusions: This population‐level retrospective analysis of real‐world data observed that treatment with statins is effective to achieve certain LDL‐C goals and CHD reduction. The lack of significant difference between LDL‐C goals needs confirmation in additional studies with real‐world data. The LDL‐C target should consider the magnitude of the decrease in coronary events. [ABSTRACT FROM AUTHOR]

The role of germline genetic testing in urologic oncology has expanded in recent years. However, implementation of genetic testing in community practices remains a challenge, often due to limited access to qualified genetics trained providers. In this study, we report outcomes of a universal germline screening program in a community urology practice. Between November 2021 and September 2022, all patients referred for urology clinic visits at Frederick Health (Frederick, MD, USA) were provided an online genetics screening questionnaire prior to the visit. Responses were compared against National Comprehensive Cancer Network (NCCN) criteria for germline testing. Those who met criteria were provided educational materials at the end of the questionnaire, and then counseled by a trained urologic oncologist (HC) in the clinic or referred to a genetic counselor prior to testing. Testing was performed with a 36‐gene pan‐cancer panel (CancerNext) or a 14‐gene targeted prostate cancer panel (ProstateNext), with or without additional RNA analysis (RNAinsight) (Ambry Genetics, CA, USA). Demographic and clinical parameters, as well as genetic testing results, were retrospectively collected under IRB approval. In the study period, 765 patients were seen over 1370 clinic visits. Of these, 505 patients (66.0%) completed the screening questionnaire. The majority were completed via email (54.5%) with the remainder (45.5%) via text message. Of the patients who completed screening, 125/505 (24.7%) met NCCN criteria for germline testing. 58/125 patients (46.4%) who met criteria underwent germline testing, of whom 5/58 (8.6%) had distinct pathogenic mutations identified. These included actionable mutations in BRCA1, BRCA2, and CHEK2, as well as an additional pathogenic mutation in NBN. Variants of unknown significance were identified in 8/58 patients (13.8%) in 11 total genes. Challenges to implementation of this program included meeting institutional requirements for genetic testing consent, facilitating specimen collection in clinic, and integration of results into the electronic health record. Genetic risk assessment for high‐risk individuals is feasible as part of a universal screening program in a community urology practice. Approximately 8% of tested patients were found to have pathogenic germline mutations, which is consistent with contemporary tertiary referral cohorts. [ABSTRACT FROM AUTHOR]

The American College of Rheumatology and the US Food and Drug Administration co‐sponsored a public meeting in May 2022 about challenges in the clinical development of drugs for rheumatoid arthritis (RA) and psoriatic arthritis (PsA), focusing on innovative clinical trial designs, outcome measures, and data collection methods. Recommendations include early dose‐ranging studies and use of active comparators. Challenges and opportunities in assessing long‐term safety by leveraging real‐world data from electronic health records (EHRs) and claims data are discussed, along with insights from European registries and the evolving role of real‐world evidence and artificial intelligence in regulatory evaluations. Endpoints for assessing disease activity and outcome measures used in RA and PsA trials are explored, emphasizing challenges in defining remission, assessing clinical response, and evaluating structural progression. The need for outcome measures that better reflect treatment targets and the potential of advanced imaging in future trials are highlighted. Challenges with placebo‐controlled trials in RA are discussed and use of non‐inferiority clinical trial design, in which new drugs are evaluated with active comparators, is proposed. Pragmatic trials in RA and PsA, employing decentralized approaches, are highlighted for their real‐world relevance and administrative efficiencies. Strategies for identifying at‐risk populations for RA and the challenges of using EHRs and insurance claims data in drug development are discussed. Registry data and digital health technologies show promise in bridging the gap between clinical trials and real‐world effectiveness. [ABSTRACT FROM AUTHOR]

Aim: To compare the effectiveness of different basal insulins (BI) prescribed as an add‐on to or switch from glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) therapy. Materials and Methods: Retrospective, real‐world data from electronic medical records of 32 Italian diabetes clinics were used, after propensity score adjustment, to compare effectiveness after 6 months of treatment with second‐ versus first‐generation BI (2BI vs. 1BI) or glargine 300 U/ml versus degludec 100 U/ml (Gla‐300 vs. Deg‐100), when added to (ADD‐ON) or in substitution of (SWITCH) GLP‐1 RA. Only comparisons, including a minimum of 100 patients per group, were performed to ensure adequate robustness of the analyses. Results: In the ADD‐ON cohort (N = 700), greater benefits of 2BI versus 1BI were found in glycated haemoglobin {HbA1c; estimated mean difference: −0.32% [95% confidence interval (CI) −0.62; −0.02]; p =.04} and fasting blood glucose [FBG; −20.73 mg/dl (95% CI −35.62; −5.84); p =.007]. In the SWITCH cohort (N = 2097), greater benefits of 2BI versus 1BI were found in HbA1c [−0.22% (95% CI −0.42; −0.02); p =.03], FBG [−10.15 mg/dl (95% CI −19.04; −1.26); p =.03], and body weight [−0.67 kg (95% CI −1.30; −0.04); p =.04]. In the SWITCH cohort starting 2BI (N = 688), marked differences in favour of Gla‐300 versus Deg‐100 were documented in HbA1c [−0.89% (95% CI −1.26; −0.52); p <.001] and FBG [−17.89 mg/dl (95% CI −32.45; −3.33); p =.02]. Using propensity score matching as a sensitivity analysis, the benefit on HbA1c was confirmed [−0.55% (95% CI –1.02; −0.08); p =.02]. BI titration was suboptimal in all examined cohorts. Conclusions: 2BI are a valuable option to intensify GLP‐1 RA therapy. Switching to Gla‐300 versus Deg‐100 was associated with greater HbA1c improvement. [ABSTRACT FROM AUTHOR]

Introduction: Genetic aetiology is suspected in the development of early‐onset high myopia (spherical equivalent refractive error [SER] ≤−6.00 D at ≤6 years of age), considering that the role of environmental factors in inducing high myopia is improbable at an early age. Therefore, we aimed to understand if early‐onset high myopia is associated with parental myopia in a clinical setting. Methods: A retrospective study was conducted in which information about demographics, age of apparent onset of myopia, refractive error, axial length, number of myopic parents, time spent outdoors and time spent on near‐work was obtained from electronic medical records (EMR). It included 195 myopic individuals categorised into (1) Early‐onset high myopes (EOHM): SER ≤ −6.00 D with age of presentation ≤6 years, (2) Early‐onset low myopes (EOLM): SER > −6.00 D with age of apparent onset ≤6 years, (3) Late‐onset high myopes (LOHM): SER ≤ −6.00 D with age of presentation and age of apparent onset >6 years and (4) Late‐onset low myopes (LOLM): SER > −6.00 D with age of apparent onset >6 years. Results: Overall, 63% of individuals were found to have parental myopia. The proportion of individuals with EOHM, EOLM, LOHM and LOLM with parental myopia was 57%, 74%, 53% and 64%, respectively. After adjustment for age, gender and environmental factors, the odds of development of EOHM (Odds ratio: 0.78, 95% confidence interval: 0.25–2.48), EOLM (1.54, 0.65–3.67) or LOHM (0.70, 0.30–1.65) were similar in the presence of myopic parents, when compared with LOLM. The SER and axial length did not differ based on the number of myopic parents in any of these categories. Conclusion: This retrospective analysis reveals that the presence of parental myopia, which was self‐reported, did not induce additional risk for early‐onset high myopia. [ABSTRACT FROM AUTHOR]

Background: Physical restraint of patients in intensive care units (ICUs) has an estimated prevalence of 50%. Many medical centres do not have specific protocols for physical restraint, and the decision of whether to physically restrain a patient is up to the nursing staff. Disadvantages of physical restraint include injuries, exacerbation of agitation and an increased risk of developing post‐traumatic stress disorder (PTSD). Aim: To report prevalence and outcomes in terms of morbidity and mortality of physical restraint in general ICU patients in an 800‐bed secondary medical centre. Study Design: This retrospective study included 647 patients admitted to a general ICU in an 800‐bed secondary medical centre in Kfar Saba, Israel, between January and December 2020. Data included demographics, medical history, length of stay, need for mechanical ventilation, number of ventilation days, 28‐day mortality, reason for admission, agitation rate assessed by Richmond Agitation and Sedation Scale (RASS) score, need for physical restraint and need for anti‐psychotics. Results: Among the patients, 40% (256 of 647) required physical restraint. Older adult patients had a greater likelihood of being physically restrained along with those admitted because of sepsis or acute respiratory failure. Among the study sample, 11% (71 of 647) required anti‐psychotics. Patients who were restrained had longer duration of ventilation (5.9 ± 8.2 vs. 0.36 ± 1.4 days; p <.001) and higher 28‐day mortality (0.26 ± 0.45 vs. 0.07 ± 0.25, Z = 6.86, p <.001). There was no difference in medical history, except for chronic drug abuse, which was more frequent in the restraint group (18 [6.9%] vs. 11 [2.8%], respectively; p =.019), as well as the use of anti‐psychotic medications (24 [9.3%] vs. 19 [4.8%], respectively; p =.034) and anti‐depressants (55 [21.2%] vs. 59 [14.8%], respectively; p =.042). The restraint group had higher disease severity scores, as reflected in requirements for vasopressor support (174 [67.2%] vs. 69 [17.3%], respectively; p <.001) and need for dialysis (39 [15.1%] vs. 19 [4.8%], respectively; p <.001); higher frequency of in‐hospital anti‐psychotic treatment (60 [23.2%] vs. 11 [2.8%], respectively; p <.001); a greater tendency for agitation events and more severe agitation scores (episodes of RASS above zero [1.7 ± 4.0 vs. 0.04 ± 0.27, respectively; p <.001] and maximum RASS score [0.19 ± 1.6 vs. 0.01 ± 0.54, respectively; p <.001]). Overall, advanced age, number of ventilation days and need for dialysis were associated with increased 28‐day mortality. In the restraint group, advanced age, chronic use of diuretics and the use of dialysis during ICU admission were associated with increased mortality risk. Conclusions: Restrained patients tended to have higher morbidity and mortality during ICU and hospital stays, as well as a greater tendency for agitation events and more severe agitation scores, with an increased need for in‐hospital anti‐psychotic treatment. These findings regarding patient characteristics might be used to formulate treatment plans to reduce the rate of physical restraint in the ICU. Relevance to Clinical Practice: Because restrained ICU patients tend to have higher morbidity and mortality, treatment plans should be formulated to reduce the rate of physical restraint in the ICU. Clinical trial registration: NCT04771793. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease contribute significantly to societal and individual impact globally. High‐quality management of these long‐term health conditions is important to prevent deterioration of health, although potentially more complex for patients with intellectual disabilities in residential care. Disease management in this context particularly benefits from complete and accurate recording of disease management. Without complete records, long‐term health conditions are more difficult to track due to the level of uncertainty regarding which clinical examinations have and have not been performed. This study therefore aims to examine the recording routines of quality indicators for disease monitoring for chronically ill patients with intellectual disabilities in Dutch residential care. Methods: This retrospective study utilised medical record data from a large Dutch long‐term care provider. We assessed the occurrence of cardiovascular disease (ICPC‐2 codes K74, K75, K76, K89 and K90), type 2 diabetes mellitus (T90, T90.02) and/or COPD (R91, R95). For adults with intellectual disabilities and long‐term condition, we analysed data entries in an 18‐month period (between July 2020 and December 2021). Observed consultation rates were calculated and presented in median with interquartile range and contrasted against the baseline number of consultations in primary care. Information on recorded quality indicators was presented in frequencies and percentages. Findings: Of the three long‐term conditions investigated, the most common was type 2 diabetes mellitus (8.6%; n = 287), followed by cardiovascular disease (5.8%; n = 195) and COPD (3.0%; n = 101). Of those who received management for their long‐term condition from their contracted GP, patients with type 2 diabetes mellitus, cardiovascular disease, or COPD had fewer consultations in 2021 than the Dutch baseline. Discussion of lifestyle was often not recorded. Disease monitoring quality indicators were recorded more often but at a lower frequency than expected. Conclusions: Because of the infrequent recording of quality indicators, recording of management of long‐term conditions for patients with intellectual disabilities in long‐term care appears suboptimal. Although this may not directly harm individual patients, it may jeopardise the quality of management of long‐term conditions, as suboptimal recording limits opportunities for evaluation and improvement. Within a broader trend towards data‐driven work methods in healthcare, recording of quality indicators requires attention from practice, research and policy. We should watch over long‐term diseases to help people stay healthy. We run tests, like checking blood pressure. The results are written in their medical records. These tests are like quality checks.We wanted to see if and how these quality checks were used, mostly for people with a learning disability living in care homes who also have heart disease, diabetes, or lung problems.We looked at their medical papers to see if these checks were there. We also looked at how often they saw the doctor.We found that chronically ill people with a learning disability went to the doctor quite often. But not as often as we expected. Also, the checks were not always written down. The talks about their lifestyle with the doctors were not noted very often.This can impact how well doctors care for the health issues of people with learning disability. [ABSTRACT FROM AUTHOR]

The study is a part of a student research project on performance‐based evaluation of big data application in health sciences libraries. It presents a theoretical framework of the performance‐based evaluation system for health institutes' libraries in the digital environment. The health sciences libraries' systematic approach was judged based on the five main components (data culture, organisational infrastructure, responsibilities, skills and technology competence) of big data analytics (BDA). A comprehensive literature review of the published studies was undertaken related to BDA, including the diffusion of innovation theory, and the theoretical background of the technology acceptance model to produce an application‐based big data development framework for the health sciences libraries. The application‐based evaluation model integrates BDA in health sciences libraries for improving library services and performance. The study proposed a need for skilled professionals with the knowledge and experience both professionally and technically. Finally, the study proposed a model that will help to measure the organisation's ability to analyse vast amounts of data to empirically validate the association concerning big data analysis and analytical practices in health libraries. [ABSTRACT FROM AUTHOR]

Background: Small for gestational age (SGA) and large for gestational age (LGA) are designations given to neonates based solely on birthweight, with no distinction made for maternal height. However, there is a possibility that maternal height is significantly correlated with neonatal birthweight, and if so, SGA and LGA cutoffs specific to maternal height may be a more precise and useful tool for clinicians. To explore this possibility, we analyzed the association between maternal height and ethnicity and neonate birthweight in women with low‐risk, 37‐ to 40‐week gestation, singleton pregnancies who gave birth vaginally between 2010 and 2017 (n = 354,488). For this retrospective cohort study, we used electronic obstetric records obtained from the National Obstetrics Registry in Malaysia. Methods: National Obstetric Registry (NOR) data were used to calculate the 10th and 90th birthweight percentiles for each maternal height group by gestational age and neonatal sex. Multiple linear regression models, adjusted for maternal age, weight, parity, gestational age, and neonatal sex, were used to examine the association between neonate birthweight and maternal ethnicity and height. The following main outcome measures were assessed: small for gestational age (<10th percentile), large for gestational age (>90th percentile), and birthweight. Results: The median height was 155 cm (IQR, 152–159), with mothers of Chinese descent being the tallest (median (IQR): 158 cm (154–162)) and mothers of Orang Asli (Indigenous) descent the shortest (median (IQR): 151 cm (147–155)). The median birthweight was 3000 g (IQR, 2740–3250), with mothers of Malay and Chinese ethnicity and Others having, on average, the heaviest babies, followed by other Bumiputeras (indigenous) mothers, mothers of Indian ethnicity, and lastly, mothers of Orang Asli ethnicity. For infants, maternal age, height, weight, parity, male sex, and gestational age were positively associated with birthweight. Maternal height had a positive association with neonate birthweight (B = 7.08, 95% CI: 6.85–7.31). For ethnicity, compared with neonates of Malay ethnicity, neonates of Chinese, Indian, Orang Asli, and other Bumiputera ethnicities had lower birthweights. Conclusion: Birthweight increases with maternal height among Malaysians of all ethnicities. SGA and LGA cutoffs specific to maternal height may be useful to guide pregnancy management. [ABSTRACT FROM AUTHOR]

Background and aim: Communication is a key factor in intraprofessional collaboration between hospital nurses and homecare nurses in hospital‐to‐home transitions of older patients with complex care needs. Gaining knowledge of the nature of cross‐sectoral communication is crucial for understanding how nurses collaborate to ensure a seamless patient trajectory. This study explores how cross‐sectoral electronic health records communication influences collaboration between hospital nurses and homecare nurses when discharging older patients with complex care needs. Method: The study is based on qualitative group interviews with six hospital nurses and 14 homecare nurses working at different hospitals and municipalities across Denmark. Data were analysed using reflexive thematic analysis, as described by Braun and Clark. Findings: The themes Collecting pieces for the 'puzzle': Losing the holistic picture of the patient; Working blindfolded: limited provision of and access to critical information; and Bypassing the 'invisible wall': dialogue supports cohesion illustrate the impact of organisational structures within electronic health records have on hospital nurses' and homecare nurses' intraprofessional collaboration across sectors. Challenges with predefined and word‐limited elements in digital communication, and inadequate and limited access to significant medical information were identified. To compensate for the inadequacy of the electronic health records, direct contact and dialogue were emphasised as ways of fostering successful collaboration and overcoming the barriers created by electronic health records. Conclusion: Despite hospital nurses' and homecare nurses' desire to conduct holistic patient assessments, their ability to collaborate was hindered by failures in electronic health record communication resulting from restrictive organisational structures across sectors. Thus, it became necessary for hospital nurses and homecare nurses to bypass the electronic health record system and engage in dialogue to provide holistic care when discharging older patients with complex care needs. However, by hospital nurses and homecare nurses compensating for counter‐productive organisational structures, problems brought about by the electronic health record system paradoxically remain invisible. [ABSTRACT FROM AUTHOR]

This article discusses nonparametric estimation of a survival function in the presence of measurement errors on the observation of the failure time of interest. One situation where such issues arise would be clinical studies of chronic diseases where the observation on the time to the failure event of interest such as the onset of the disease relies on patient recall or chart review of electronic medical records. It is easy to see that both situations can be subject to measurement errors. To resolve this problem, we propose a simulation extrapolation approach to correct the bias induced by the measurement error. To overcome potential computational difficulties, we use spline regression to approximate the unspecified extrapolated coefficient function of time, and establish the asymptotic properties of our proposed estimator. The proposed method is applied to nonparametric estimation based on interval‐censored data. Extensive numerical experiments involving both simulated and actual study datasets demonstrate the feasibility of this proposed estimation procedure. [ABSTRACT FROM AUTHOR]

Aim: This study was designed to investigate the association between Charlson Comorbidity Index (CCI) and in‐hospital mortality and other clinical outcomes among patients with hyperglycemic crises. Method: This retrospective cohort study was conducted using data from electric medical records. A total of 1668 diabetic patients with hyperglycemic crises from six tertiary hospitals met the inclusion criteria. CCI < 4 was defined as low CCI and CCI ≥ 4 was defined as high CCI. Propensity score matching (PSM) with the 1:1 nearest neighbour matching method and the caliper value of 0.02 was used to match the baseline characteristics of patients with high CCI and low CCI to reduce the confounding bias. In‐hospital mortality, ICU admission, hypoglycemia, hypokalemia, acute kidney injury, length of stay (LOS), and hospitalisation expense between low CCI and high CCI were compared and assessed. Univariate and multivariate regression were applied to estimate the impact of CCI on in‐hospital and other clinical outcomes. Outcome: One hundred twenty‐one hyperglycemic crisis (HC) patients died with a mortality rate of 7.3%. After PSM, compared with low CCI, patients with high CCI suffered higher in‐hospital mortality, ICU admission, LOS, and hospitalisation expenses. After multivariate regression, age (aOR: 1.12, 95% confidence interval [CI]: 1.06−1.18, p < 0.001), CCI(aOR: 4.42, 95% CI: 1.56−12.53, p = 0.005), uninsured (aOR: 22.32, 95% CI: 4.26−116.94, p < 0.001), shock (aOR: 10.57, 95% CI: 1.41−79.09, p = 0.022), mechanical ventilation (aOR: 75.29, 95% CI: 12.37−458.28, p < 0.001), and hypertension (aOR: 4.34, 95% CI: 1.37−13.82, p = 0.013) were independent risk factors of in‐hospital mortality of HC patients. Besides, high CCI was an independent risk factor for higher ICU Admission (aOR: 5.91, 95% CI: 2.31−15.08, p < 0.001), hypoglycemia (aOR: 2.19, 95% CI:1.01−4.08, p = 0.049), longer LOS (aOR: 1.23, 95% CI: 1.19−2.27, p = 0.021), and higher hospitalisation expense (aOR: 2089.97, 95% CI: 193.33−3988.61, p = 0.031) of HC patients. Conclusion: CCI is associated with in‐hospital mortality, ICU admission, hypoglycemia, LOS, and hospitalisation expense of HC patients. CCI could be an ideal indicator to identify, monitor, and manage chronic comorbidities among HC patients. [ABSTRACT FROM AUTHOR]

This guide outlines general issues in searching for studies; describes the main sources of potential studies; and discusses how to plan the search process, design, and carry out search strategies, manage references found during the search process and document and report the search process. [ABSTRACT FROM AUTHOR]

Sodium‐glucose cotransporter‐2 (SGLT‐2) is expressed in the kidney and may contribute to anaemia and cardiovascular diseases. The effect of SGLT‐2 inhibition on anaemia and vascular endpoints in sickle cell disease (SCD) is unknown. A murine model of SCD was studied to determine the effects of the SGLT‐2 inhibitor, empagliflozin, on anaemia and stroke size. The University of Michigan's Precision Health Database was used to evaluate the effect of SGLT‐2 inhibitors on anaemia in humans with SCD. SCD mice treated with daily empagliflozin for 8 weeks demonstrated increases in haemoglobin, haematocrit, erythrocyte counts, reticulocyte percentage and erythropoietin compared to vehicle‐treated mice. Following photochemical‐induced thrombosis of the middle cerebral artery, mice treated with empagliflozin demonstrated reduced stroke size compared to vehicle treated mice. In the electronic health records analysis, haemoglobin, haematocrit and erythrocyte counts increased in human SCD subjects treated with an SGLT‐2 inhibitor. SGLT‐2 inhibitor treatment of humans and mice with SCD is associated with improvement in anaemic parameters. Empagliflozin treatment is also associated with reduced stroke size in SCD mice suggesting SGLT‐2 inhibitor treatment may be beneficial with regard to both anaemia and vascular complications in SCD patients. [ABSTRACT FROM AUTHOR]

Objective: The objective is to determine cervical cancer screening rates and factors associated with decreased cervical cancer screening in women with systemic lupus erythematosus (SLE). Methods: We conducted a cross‐sectional study that enrolled consecutive women (age 21–64 years) with SLE. We collected demographics, clinical characteristics, constructs of the Health Beliefs Model (HBM) (ie, susceptibility, severity, barriers, benefits, cues to action, and self‐efficacy), and self‐reported cervical cancer screening (confirmed with the electronic medical record). The primary outcome was adherence to cervical cancer screening according to current guidelines. Multivariable logistic regression models were used to examine the association between SLE disease activity and cervical cancer screening and explore mediation effects from HBM constructs. Results: We enrolled 130 women with SLE. The median age was 42 years (interquartile range 32–52 years). The cervical cancer screening adherence rate was 61.5%. Women with high SLE disease activity were less likely to have cervical cancer screening versus those with low disease activity (odds ratio 0.59, 95% confidence interval [CI] 0.39–0.89; P = 0.01), which remained statistically significant after adjusting for baseline demographics and drug therapy in a multivariable model (odds ratio 0.25, 95% CI 0.08–0.79; P = 0.02). Regarding the HBM constructs, increased perceived barriers to cervical cancer screening (r = −0.30, P < 0.01) and decreased self‐efficacy (r = −0.21, P = 0.02) correlated with decreased cervical cancer screening. Conclusion: Patients with SLE with high disease activity undergo cervical cancer screening less frequently than those with low disease activity. Perceived barriers to cervical cancer screening are moderately correlated with decreased screening. These data highlight the need to develop strategies to increase cervical cancer screening in this high‐risk patient population. [ABSTRACT FROM AUTHOR]

Objective: Quit Connect (QC), our specialty clinic smoking cessation intervention, supports clinic staff to check, advise, and connect willing patients to a state quit line or class. QC improved tobacco screening and quit line referrals 26‐fold in a predominantly White academic health care system population. Implementing QC includes education, electronic health record (EHR) reminders, and periodic audit feedback. This study tested QC's feasibility and impact in a safety‐net rheumatology clinic with a predominantly Black population. Methods: In this pre‐post study, adult rheumatology visits were analyzed 12 months before through 18 months after QC intervention (November 2019 through November 2021, omitting COVID‐19 peak April through November 2020). EHR data compared process and clinical outcomes, including offers, referrals to resources, completed referrals, and documented cessation. Clinic staff engaged in pre‐post focus groups and questionnaires regarding intervention feasibility and acceptability. Cost‐effectiveness was also assessed. Results: Visit‐level patients who smoked were 89.8% Black and 69.5% women (n = 550). Before intervention, clinic staff rarely asked patients about readiness to cut back smoking (<10% assessment). After QC intervention, staff assessed quit readiness in 31.8% of visits with patients who smoked (vs 8.1% before); 58.9% of these patients endorsed readiness to cut back or quit. Of 102 accepting cessation services, 37% (n = 17) of those reached set a quit date. Staff found the intervention feasible and acceptable. Each quit attempt cost approximately $4 to $10. Conclusion: In a safety‐net rheumatology clinic with a predominantly Black population, QC improved tobacco screening, readiness‐to‐quit assessment, and referrals and was also feasible and cost‐effective. [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation This study examines associations among fetal brain magnetic resonance imaging (MRI) injury patterns, etiologies, and outcomes in fetal intraparenchymal hemorrhage (IPH).This is a retrospective, single‐center cohort study of IPH diagnosed on fetal MRI (1996–2022). IPH and associated abnormalities were categorized by 2 pediatric neuroradiologists; electronic medical records were reviewed by 2 pediatric neurologists to classify etiology and outcomes including cerebral palsy, epilepsy, developmental delay, and death.Forty‐four fetuses with IPH were identified (34 singleton and 10 twin gestations) with MRI at median 24 weeks gestation (interquartile range [IQR] = 22–28 weeks). IPH was commonly supratentorial (84%) and focal (50%) or focal with diffuse injury (43%) and was often associated with germinal matrix hemorrhage (GMH; 75%) and/or intraventricular hemorrhage (IVH; 52%). An etiology was identified in 75%, including twin‐twin transfusion syndrome (TTTS, n = 10), COL4A1/2 variants (n = 8), or other fetal/maternal conditions (n = 15). COL4A1/2 variants were associated with focal IPH and the presence of hemorrhagic porencephaly, and intrauterine transfusion was associated with infratentorial hemorrhage. Twenty‐two fetuses were liveborn, and 18 pregnancies were terminated. Among those with follow‐up ≥ 12 months (median = 7 years), 12 of 13 had cerebral palsy, 6 of 13 had developmental delay, and 5 of 13 had epilepsy.An etiology for fetal IPH with or without GMH‐IVH is identified in most cases in our cohort and is commonly TTTS, COL4A1/2 variants, or other maternal/fetal comorbidities. Pattern of fetal IPH on MRI is associated with etiology. Cerebral palsy and neurodevelopmental impairment were common in liveborn infants. Genetic studies should be considered in cases of fetal IPH without an otherwise apparent cause. ANN NEUROL 2024 [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Studies of childhood diet diversity and allergic disease have not examined additional associations with an offspring allergy‐linked maternal diet index during pregnancy. We studied both associations in a pre‐birth cohort.Offspring allergic disease diagnoses were obtained from electronic medical records. Maternal and infant diet were self‐reported. Adjusted parametric Weibull time‐to‐event models assessed associations between maternal diet index, infant diet diversity and time to development of allergic rhinitis, atopic dermatitis, asthma, wheeze, IgE‐mediated food allergy, and a combined outcome of any allergic disease except for wheeze.Infant diet diversity at 1 year was associated with the risk of the combined outcome between 1 and 4 years of age (p = .002). While both maternal diet index and infant diet diversity at 1 year were associated with the risk of the combined outcome between 1 and 4 years of age (both p < .05), infant diet diversity at 1 year did not modify the association between maternal diet index and the risk of the combined outcome between 1 and 4 years of age (p = .5). The group with the lowest risk of the combined allergy outcome had higher maternal diet index and higher infant diet diversity.The novel finding that both maternal diet index during pregnancy and infant diet diversity at 12 months are associated with the risk of a combined allergic disease outcome points to two targets for preventive interventions: maternal diet index scores during pregnancy and offspring diet diversity during infancy. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions To investigate whether the physician‐encounter interval for patients with type 2 diabetes (T2D) can be optimized from 2–3 to 4–6 months among those with a calculated 10‐year cardiovascular disease (CVD) risk score of less than 20% without compromising their long‐term outcomes.Using territory‐wide public electronic medical records in Hong Kong, we emulated a target trial to compare the effectiveness of the physician‐encounter intervals of 4‐6 versus 2‐3 months for T2D patients without prior CVDs and with a predicted risk for CVDs of less than 20% (i.e. those patients not in the high‐risk category). Propensity score matching was used to emulate the randomization of participants at baseline, where 42 154 matched individuals were included for analysis. The marginal structural model was applied to estimate the hazard ratio (HR) for CVD incidence and all‐cause mortality, the incidence rate ratio of secondary and tertiary care utilization, as well as the between‐group differences in HbA1c, blood pressure and cholesterol levels.During a follow‐up period of up to 12 (average: 5.1) years, there was no significantly increased risk of CVD in patients with physician‐encounter intervals of 4‐6 months compared with those patients with physician‐encounter intervals of 2‐3 months (HR [95% confidence interval {CI}]: 1.01 [0.90, 1.14]; standardized 10‐year risk difference [95% CI]: −0.1% [−0.7%, 0.6%]), nor for all‐cause mortality (HR: 1.00 [0.84, 1.20]; standardized 10‐year risk difference: −0.1% [−0.5%, 0.3%]). Additionally, there was no observable difference in the utilization of secondary and tertiary care or key clinical parameters between these two follow‐up frequencies.For T2D patients with a calculated 10‐year CVD risk of less than 20%, the interval of regular physician encounters can be optimized from 2–3 to 4–6 months without compromising patients' long‐term outcomes and saving substantial service resources in primary care. [ABSTRACT FROM AUTHOR]

This research letter discusses the documentation of hearing difficulty during Medicare Annual Wellness Visits (AWVs) and its relationship to cognitive concerns. The study analyzed electronic medical record data from Medicare beneficiaries who reported hearing concerns during the AWV. The findings showed that healthcare providers were less likely to address hearing difficulty in their clinical notes for patients with diagnosed dementia or cognitive concerns, even when hearing loss was present. The study emphasizes the need for improved workflows and support for hearing care. The document includes a table presenting statistical data from a random sample of visits, providing further evidence for the study's findings. [Extracted from the article]

Background Methods Results Conclusions Plain Language Summary The use of electronic health record (EHR) data for research is limited by a lack of structure and a standard data model. The objective of the ICAREdata (Integrating Clinical Trials and Real‐World Endpoints Data) project was to structure key research data elements in EHRs using a minimal Common Oncology Data Elements (mCODE) data model to extract and transmit data.The ICAREdata project captured two EHR data elements essential to clinical trials: cancer disease status and treatment plan change. The project was implemented in clinical sites participating in Alliance for Clinical Trials in Oncology trials. Data were extracted from EHRs and sent by secure Fast Healthcare Interoperability Resource messaging (a standard for exchanging EHRs) to a database. Selected elements were compared with corresponding data from the trial's electronic data capture (EDC) system, Medidata Rave.By December 2023, data were extracted and transmitted from 10 sites for 35 patients, involving 367 clinical encounters across 15 clinical trials. Data through March 2023 demonstrated that concordance for the elements treatment plan change and cancer disease status was 79% and 34%, respectively. When disease evaluation was reported by both EHR and EDC (n = 15), there was 87% agreement on cancer disease status.Documentation, extraction, and aggregation of structured data elements in EHRs using mCODE and ICAREdata methods is feasible in multi‐institutional cancer clinical trials. EDC as a reference data set allowed assessment of the completeness of EHR data capture. Future initiatives will focus on elements with shared definitions in clinical and research environments and efficient workflows. Clinical trials use electronic case report forms to report data, and data must be manually entered on these forms, which is costly and time consuming. ICAREdata methods use structured, organized data from clinical trials that can be more easily shared instead having to enter free text into electronic health records. Clinical trials use electronic case report forms to report data, and data must be manually entered on these forms, which is costly and time consuming.ICAREdata methods use structured, organized data from clinical trials that can be more easily shared instead having to enter free text into electronic health records. [ABSTRACT FROM AUTHOR]

Background Method Results Conclusion Early initiation of targeted antibiotic therapy is important to achieve the best patient outcomes in intubated patients with pneumonia in the intensive care unit (ICU). This study aimed to investigate the applicability of multiplex polymerase chain reaction (PCR) in an ICU by comparing the test results to the results of conventional microbiological methods to assess the possible impact on antibiotic therapy.This retrospective study investigated adult patients with pneumonia on mechanical ventilation in the ICU. Tracheal aspirates were collected within 24h after intubation and the initiation of mechanical ventilation. Samples were initially tested by conventional microbiological methods and subsequently re‐evaluated with rapid multiplex PCR on stored samples. Concordance between the two methods was assessed. An intensivist and a microbiologist retrospectively reviewed the patients' electronic health records for relevant clinical details to evaluate the potential impact of multiplex PCR results on antibiotic therapy.In this study, 76 patients were enrolled and 55 (72.4%) tested positive for 95 pathogens using multiplex PCR, while conventional microbiological methods identified 40 pathogens in 32 (42.2%) patients. Concordance between the two methods was observed in 42 (55.3%) patients. Multiplex PCR detected 39 additional pathogens in 31 (40.7%) patients. Retrospective analysis indicated potential antibiotic de‐escalation in 35 (46.1%) patients and escalation in 4 (5.3%) patients. Multiplex PCR significantly reduced the turnaround time for test results.In ICU patients with suspected pneumonia, multiplex PCR identified a higher number of pathogens compared to CMM. A retrospective assessment indicates that the use of multiplex PCR could potentially have prompted the de‐escalation of antibiotic therapy in nearly half of the patients. Therefore, multiplex PCR may serve as a supplement to CMM in guiding antibiotic stewardship. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions More evidence for patterns of healthcare utilisation and associated costs among people receiving opioid agonist therapy (OAT) is needed. We investigated primary and secondary healthcare usage and costs among methadone and buprenorphine recipients in England.We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases of patients who were prescribed OAT between 1 January 2007 and 31 July 2019. The cohort was linked to Hospital Episode Statistics admitted patient care, outpatient and emergency department data, neighbourhood‐ and practice‐level Index of Multiple Deprivation quintiles and mortality records. Negative binomial regression models were applied to estimate weighted rate ratios (wRR) of healthcare utilisation. Total and mean costs were calculated using Unit Costs of Health and Social Care and the National Healthcare Service Payment by Results National Tariffs.Among 12,639 patients observed over 39,016 person‐years, we found higher rate of hospital admissions (wRR 1.18; 1.08–1.28) among methadone compared with buprenorphine recipients. The commonest hospital discharge diagnoses among methadone patients were infectious diseases (19.2%), mental and behavioural disorders (17.0%) and drug‐related poisoning (16.5%); the three commonest among buprenorphine patients were mental and behavioural diseases (21.5%), endocrine (13.8%) and genitourinary system diseases (13.1%). Methadone patients had similar mean costs compared with buprenorphine patients (cost difference: £539.01; 432.11–1006.69).Differences in healthcare utilisation frequency for methadone versus buprenorphine recipients were observed. The differences in associated costs were mainly driven by hospital admissions. These findings offer valuable insights for optimising care strategies and resource allocation for OAT recipients. [ABSTRACT FROM AUTHOR]

Objective Background Methods Results Conclusions To evaluate the effectiveness, tolerability, and safety of topical amitriptyline as a potential route of administration for the management of burning mouth syndrome.Burning mouth syndrome is a complex, idiopathic, and debilitating orofacial pain disorder that impairs quality of life, with a prevalence of up to 18% in menopausal women. Available drugs to alleviate its burning sensation have inconsistent and limited efficacy. Given its physicochemical properties, excellent tolerability, and ability to target peripheral pathways, topical amitriptyline seems a promising mechanistically specific analgesic drug for burning mouth syndrome.In this retrospective cross‐sectional real‐world evidence study, patients with burning mouth syndrome who were prescribed topical amitriptyline for 8 weeks were identified. Eligibility criteria stemmed from ICHD‐3, ICOP, and consensus definitions. The primary outcome measure was mean daily pain intensity (on a 0–10 scale); secondary outcomes included adverse events and patient global impression of improvement. Data are given as the mean ± SD.A total of 15 patients fulfilling the eligibility criteria were included and analyzed. Mean daily pain was 6.7 ± 2.1 at baseline and 3.7 ± 2.3 after treatment, with a mean reduction of 3.1 ± 2.8 (p = 0.002). Half of the patients experienced a decrease in pain by at least 50% (p = 0.008). Several mild adverse events were reported, such as somnolence or dry mouth.Topical amitriptyline may be a safe and potent route of administration in the treatment of burning mouth syndrome, a hypothesis to be tested in further controlled trials. [ABSTRACT FROM AUTHOR]

Purpose Methods Findings Conclusions Implications for nursing practice The purpose of this study was to examine knowledge, attitude, and barriers toward care planning documentation practices with standardized nursing languages (SNLs) of nurses and nursing students at a midwestern healthcare system, comparing student and nurse responses.Cross‐sectional surveys were given over a 2‐month period with nurses and nursing students at different sites in a midwestern healthcare system, using convenience sampling. The Knowledge, Attitude, and Barriers to Using Standardized Nursing Languages and Current Practices Survey was adapted for use and re‐tested for validity/reliability (Content Validity Index 0.81–1.00; Cronbach alpha = 0.82–0.99) with 28 Likert scale items measuring knowledge, attitude, and barriers. Descriptive statistics, composite scores, correlations, t‐tests, and multiple regression were used to analyze the concepts of the tool.134/400 RNs responded (34%); 109/116 students responded (93.9%). Data analyses indicate adequate to superior levels of knowledge related to SNLs and NANDA International, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), collectively referred to as NNN (NANDA, NIC, & NOC), positive attitudes toward SNLs/NNN and for adopting SNLs/NNN into documentation practices, but moderate to great barriers for implementation in practice. Barriers included lack of financial resources for change, lack of mentors, and lack of mandates to use SNLs. Students scored significantly higher than nurses in attitude only.Perceptions of nurses and student nurses for current documentation indicate awareness of inadequacy in existing systems and willingness to change existing systems for standardized languages, with perceived barriers to change/implementation of SNLs. Students were more positive about SNLs than nurses.Major implications for nursing are to reevaluate electronic documentation systems and determine how to insert and easily apply SNLs in these systems, such that nursing care documentation is standardized, interoperable, effective, time‐saving, and attainable. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Sacroiliac joint (SIJ) dysfunction can occur as a result of injury, degeneration, or inflammation. This dysfunction presents symptoms of pain at various locations, including the low back, hips, buttocks, and legs. The diagnosis of SIJ dysfunction is challenging and cannot be achieved solely with imaging studies such as X‐rays, MRI, or CT. The current gold standard diagnostic modality is intra‐articular SIJ blocks using two differing local anesthetics. Current treatments for SIJ dysfunction may be beneficial for short‐term relief but lack long‐term efficacy. The purpose of our study was to examine the outcomes of patients who underwent minimally invasive, posterior SIJ fusion using allograft at a single center.This was a retrospective study which received exemption from the WCG IRB. Data regarding preoperative and postoperative pain levels, surgical time, complications, and medication usage were obtained retrospectively from patient electronic medical records and prescription drug monitoring program reports. No mapping was completed prior to the procedure. Pain was assessed with the 11‐point (0–10) Visual Analogue Scale (VAS) and medication usage was assessed using Morphine Milligram Equivalents (MME). Patients were included if they had been diagnosed with SIJ dysfunction using two intra‐articular diagnostic blocks that resulted in at least an 80% decrease in pain and had failed conservative management. Patients with sacral insufficiency fractures were excluded.VAS scores reduced from 8.26 (SD = 1.09) at baseline to 2.59 (SD = 2.57), 2.55 (SD = 2.56), 2.71 (SD = 2.88), and 2.71 (SD = 2.88) at 3, 6, 9, and 12 months, respectively. MME reduced from 78.21 mg (SD = 51.33) to 58.95 mg (SD = 48.64), 57.61 mg (SD = 47.92), 61.71 mg (SD = 45.64), and 66.29 mg (SD = 51.65) at 3, 6, 9, and 12 months, respectively. All reductions in VAS scores and MME were statistically significant. No adverse events occurred, and the average operating room time was 40.16 min (SD = 6.27).Minimally invasive, posterior SIJ fusion using allograft is a safe and efficacious method for managing SIJ dysfunction. [ABSTRACT FROM AUTHOR]

Rationale Aims and Objectives Methods Results Conclusion Self‐measured blood pressure (SMBP) monitoring is crucial for hypertension management, yet its adoption, particularly among disadvantaged populations, remains low. ‘Love Your Heart’ is a quality improvement program providing free standard SMBP devices to hypertensive patients, aiming to enhance adoption and assess its impact on blood pressure control.This study evaluates the ‘Love Your Heart’ program's implementation success through assessing adoption rates and exploring changes in systolic blood pressure (SBP) among participants. We aim to understand factors influencing adoption and potential benefits of SMBP monitoring in a diverse, socially disadvantaged patient population.We retrospectively evaluated the ‘Love Your Heart’ program using electronic health records (EHR) at a primary care site in Chicago. Adult patients with hypertension were enroled in the 6‐month program, which included education sessions and free SMBP devices. Adoption was measured by participation in program components, and changes in SBP were analysed based on adoption status. Statistical analyses were conducted using SAS software, adhering to STROBE reporting guidelines.Of 621 eligible patients, 104 participated, with 83 included in the evaluation. Despite all participants receiving free SMBP devices, adoption rates were modest, with only 7% sharing readings with the care team. However, patients who received device instructions demonstrated greater decreases in SBP compared to those who did not. Although not statistically significant, clinically meaningful decreases in SBP were observed among adopters.The ‘Love Your Heart’ program highlights the challenges of promoting SMBP monitoring among disadvantaged patient populations. While providing free devices addresses access barriers, low reporting to the care team suggests the need for further support mechanisms. Future research should explore strategies to enhance SMBP adoption and integration into clinical care, particularly in settings lacking automated data transmission systems. [ABSTRACT FROM AUTHOR]