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Background Globally, geriatric patients are the dominant population requiring global medical care. We established a frailty index for geriatric trauma patients by retrospectively analysing electronic hospital records to identify patients with frailty characteristics and poor prognostic outcomes. Method Data were obtained from 2016 US National Emergency Department Sample and Shanghai Trauma Emergency Medical Association (2015–18). Overall, 141,267 hospitalised geriatric trauma patients (age ≥ 65 years) were included. We used a three-step method to construct geriatric trauma frailty index (GTFI) based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic codes. Systematic cluster analysis was used. The accuracy of GTFI was verified in national validation cohort, and its applicability to Chinese patients was assessed in local validation cohort. Results In development cohort (n  = 28,179), frail patients had longer lengths of stay and higher Charlson co-morbidity index than non-frail patients (18.2 ± 12.4 days, 5.59 ± 2.0 versus 5.3 ± 5.3 days, 5.33 ± 1.8, respectively). In national validation cohort (n  = 113,089), frail patients had longer lengths of stay (8.5 ± 8.8 days versus 4.5 ± 3.1 days) and higher in-hospital mortality than non-frail patients (2,795, 11.69% versus 589, 0.66%). Areas under the curves for GTFI for length of stay (>14 days) and in-hospital mortality were 0.848 (0.841, 0.854) and 0.885 (0.880, 0.891) in national validation cohort, and were 0.791 (0.779, 0.804) and 0.903 (0.885, 0.922) in local validation cohort (n  = 14,827). Conclusions The GTFI helps hospitals and emergency departments to identify geriatric trauma patients with poor prognostic outcomes, and has been proven to be useful in China. [ABSTRACT FROM AUTHOR]

Objectives. To report the long-term results of scleral buckling using 25-gauge chandelier illumination. Methods. The medical records of all patients presenting to Shanghai Tenth People's Hospital with simple rhegmatogenous retinal detachment (RRD) from June 2013 to Oct 2015 were retrospectively reviewed in this consecutive case series. All patients underwent preoperative and postoperative best corrected visual acuity (BCVA), B-ultrasound, fundus photography, and optical coherence tomography examination. Ultrasound biomicroscopy (UBM) was obtained postoperatively. Results. Ten patients (10 eyes) were included in the final analysis. Of 10 patients, the average age was 49.3 ± 18.9 years old, the average duration of RRD was 30.9 ± 53.3 days, and the mean follow-up period was 6.2 ± 0.9 years. There were nine eyes with myopia and four eyes with macular detachment. The primary anatomical success rate was 90%. Five eyes underwent 360-degree band with element surgery, and five eyes underwent element surgery alone. The average length of encircling band and element was 68.2 ± 1.3 mm and 10.5 ± 2.5 mm, respectively. There were no intraoperative or postoperative complications that occurred. The final BCVA was greater than or equal to 20/40 in nine eyes, of which four eyes achieved 20/20. UBM examination of the 25-gauge chandelier insertion site revealed no tissue proliferation. Conclusions. For simple rhegmatogenous retinal detachment treatment, 25-gauge chandelier illumination-assisted scleral buckling is a kind of effective and safe method. [ABSTRACT FROM AUTHOR]

Purpose: Standard treatment for nasopharyngeal carcinoma (NPC) is radiation therapy (RT); however, long-term effects of RT frequently include significant swallowing impairments (dysphagia; Gaziano, 2002; Hui, Chan, & Le, 2018). Our objective was to describe swallowing physiology in consecutive outpatients with a history of NPC following RT using standardized methods. Understanding dysphagia characteristics in this patient population could ultimately inform rehabilitation strategies and improve patient outcomes. Method: We conducted a retrospective, observational, descriptive study of consecutive outpatients undergoing videofluoroscopic swallowing (VFS) exams at our clinic, from 2009 to 2014. We included those with a diagnosis of NPC treated with RT. Those with other cancer diagnoses; previous tracheostomy; acute neurological injury; and progressive, degenerative neurological conditions were excluded. Two registered MBSImP clinicians, blinded to each other, reviewed and scored the VFS exams according to previously published methods (Martin-Harris et al., 2008). Following unblinding, a single reviewer collected demographic data from the electronic medical record. We reported overall impairment and MBSImP component scores descriptively. Results: Of 158 outpatients undergoing VFS, 6 (N) met our inclusion criteria. The median time from completion of RT to outpatient VFS was 21.0 years. Patients reported a variety of dysphagia symptoms. All patients had high oral and pharyngeal residue scores (scores = 2) and high impairment scores on components contributing to bolus transport and airway closure. Conclusions: All patients presented with impairments in oral-pharyngeal bolus transport and airway protection. Our results identify specific swallowing impairments for this patient group highlighting possible latent RT effects on swallowing. This population would benefit from dysphagia rehabilitation and maintenance programs informed by multimodal diagnostic approaches. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to investigate the usability level of Chinese hospital Electronic Health Records (EHRs) by assessing the completion times of EHRs for seven "meaningful use (MU)" relevant tasks conducted at two Chinese tertiary hospitals and comparing the results to those of relevant research conducted in US EHRs.Methods: Using Rapid Usability Assessment (RUA) developed by the National Center for Cognitive Informatics and Decision Making (NCCD), the usability of EHRs from two Peking University hospitals was assessed using a three-step Keystroke Level Model (KLM) in a laboratory environment.Results: (1) The total EHR task completion time for 7 MU relevant test tasks showed no significant differences between the two Chinese EHRs and their US counterparts, in which the time for thinking was relatively large and comprised 35.6% of the total time. The time for the electronic physician order was the largest. (2) For specific tasks, the mean completion times of the 2 hospital EHR systems spent on recording, modifying and searching (RMS) the medication orders were similar to those for the RMS radioactive tests; the mean time spent on the RMS laboratory test orders were much less. (3) There were 85 usability problems identified in the 2 hospital EHR systems.Discussion: In Chinese EHRs, a substantial amount of time is required to complete tasks relevant to MU targets and many preventable usability problems can be discovered. The task completion time of the 2 Chinese EHR systems was a little shorter than in the 5 reported US EHR systems, while the differences in smoking status and CPOE tasks were obvious; one main reason for these differences was the use of structured data entry.Conclusions: The efficiency of Chinese and US EHRs was not significantly different. The key to improving the efficiency of both systems lies in expediting the Computerized physician order entry (CPOE) task. Many usability problems can be identified using heuristic assessments and improved by corresponding actions. [ABSTRACT FROM AUTHOR]

Objective: This study aims to identify and evaluate the Hong Kong public's views, expectations, concerns and awareness of a proposed electronic health record (eHR) as well as to inform policy formulation regarding its community-wide implementation. The following questions are addressed: • To what extent is the public aware, supportive and willing to accept eHR? • What are the public's attitudes and access concerns towards eHR? • What cost per year will the public be willing to bear for eHR? • How are Hong Kong residents' perceptions and expectations similar or different from those in other health systems such as the United States, the United Kingdom and Canada? Methods: We randomly interviewed 888 pedestrians on selected street locations and neighbourhoods to ensure a meaningful representation of the community.Key outcome measures: Our study sought to measure the public's awareness of eHR; the perceived eHR impact on healthcare services; the likely impact of eHR on the individual; the facilitating conditions for eHR acceptance; and the level of public acceptance of eHR, including suggestions of an annual personal financial contribution to the community-wide eHR system. Results: Our findings showed that most Hong Kong residents support the new initiative and are willing to pay around HK$195 per year as their share for a community-wide eHR. Our results are generally similar to responses to most surveys in Western countries. Conclusions: The Hong Kong Government's determination to implement a community-wide eHR is very much in line with dominant health systems' development and has favourable support from the general public. [ABSTRACT FROM AUTHOR]

The theme of the 2017 WCPG Meeting, "Genes in Context," highlights the essential insights that become apparent when individual risk genes are considered in the context of polygenic background, epigenetic modifications in the cell, and environmental conditions and development. Similarly, the large-scale collection of genetic material integrated with the increasing availability of expansive phenotype information ("phenome") from electronic medical records (EMR) allows a broader context in which to study the genetics of neuropsychiatric phenotypes. Identifying correlated phenotypes and assessing the broader role of implicated variants/genes are only a few of the many ways in which these studies could provide a unique lens through which to interpret genetic findings. The potential for these datasets to scale (e.g. 500k individuals for UK biobank) and the comprehensiveness of the captured phenome offers opportunities that are difficult to achieve in disease focused cohort studies. Initial work on these extraordinary datasets is already yielding exciting new findings with promising translational implications. Rigorous analysis of biobank data requires integrating multiple disciplines including genomics, epidemiology, informatics, ethics and the clinical domain of interest. We have assembled a diverse roster of researchers who bring expertise in these areas as speakers in this session. Co-chair Dr. Douglas Ruderfer, will introduce the session by presenting the opportunities, challenges and some initial successes of utilizing these resources. Next, Dr. Lea Davis will describe development of EMR-based algorithms for detection of neurodevelopmental disorders, results of an EMR-enabled biomarker discovery approach using Vanderbilt's 270,000 patient biobank (BioVU), and community-engaged efforts to develop a more complete understanding of genomic privacy concerns related to participation in biobanks. Dr. Gerome Breen will then discuss general applicability of using the 500k-individual UK Biobank, along with details of a study in anorexia nervosa. Dr. Beate St. Pourcain will describe new results from her work examining genetic factors that contribute to the developmental trajectory of behavioral traits using the Avon Longitudinal Study of Parents and Children (ALSPAC) data set, and highlight implications when assessing trait-disorder overlap. Finally, Dr. Zhengming Chen will describe results of ongoing PheWAS of functional variants to assess causal associations (e.g. alcohol) in the 500K-person Kadoorie Biobank. Following the speakers, Dr. Jordan Smoller will lead a discussion focused on efforts currently underway to combine biobank resources through the psychEMERGE consortium and future resources available from the NIH All of Us project. Topics for discussion include genome-informed machine learning approaches to prediction models, structural equation models using genetic relationship data in cohorts, challenges to algorithmic portability, and opportunities for immediate translation of genomic findings. Symposium attendees will become familiar with (a) potential resources that are available to them, (b) strategies for maximizing the utility of such resources, (c) challenges in utilizing these resources, and (d) ethical issues related to genomic privacy in the context of biobanks. Finally, attendees will learn about novel discoveries emerging from biobank and registry resources in the United States, United Kingdom, and China. [ABSTRACT FROM AUTHOR]

Background: The adoption rate of electronic health records (EHRs) in hospitals has become a main index to measure digitalization in medicine in each country., Objective: This study summarizes and shares the experiences with EHR adoption in China and in the United States., Methods: Using the 2007-2018 annual hospital survey data from the Chinese Health Information Management Association (CHIMA) and the 2008-2017 United States American Hospital Association Information Technology Supplement survey data, we compared the trends in EHR adoption rates in China and the United States. We then used the Bass model to fit these data and to analyze the modes of diffusion of EHRs in these 2 countries. Finally, using the 2007, 2010, and 2014 CHIMA and Healthcare Information and Management Systems Services survey data, we analyzed the major challenges faced by hospitals in China and the United States in developing health information technology., Results: From 2007 to 2018, the average adoption rates of the sampled hospitals in China increased from 18.6% to 85.3%, compared to the increase from 9.4% to 96% in US hospitals from 2008 to 2017. The annual average adoption rates in Chinese and US hospitals were 6.1% and 9.6%, respectively. However, the annual average number of hospitals adopting EHRs was 1500 in China and 534 in the US, indicating that the former might require more effort. Both countries faced similar major challenges for hospital digitalization., Conclusions: The adoption rates of hospital EHRs in China and the United States have both increased significantly in the past 10 years. The number of hospitals that adopted EHRs in China exceeded 16,000, which was 3.3 times that of the 4814 nonfederal US hospitals. This faster adoption outcome may have been a benefit of top-level design and government-led policies, particularly the inclusion of EHR adoption as an important indicator for performance evaluation and the appointment of public hospitals., (©Jun Liang, Ying Li, Zhongan Zhang, Dongxia Shen, Jie Xu, Xu Zheng, Tong Wang, Buzhou Tang, Jianbo Lei, Jiajie Zhang. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.02.2021.)

Background: The application of artificial intelligence techniques for processing electronic health records data plays increasingly significant role in advancing clinical decision support. This study conducts a quantitative comparison on the research of utilizing artificial intelligence on electronic health records between the USA and China to discovery their research similarities and differences.Methods: Publications from both Web of Science and PubMed are retrieved to explore the research status and academic performances of the two countries quantitatively. Bibliometrics, geographic visualization, collaboration degree calculation, social network analysis, latent dirichlet allocation, and affinity propagation clustering are applied to analyze research quantity, collaboration relations, and hot research topics.Results: There are 1031 publications from the USA and 173 publications from China during 2008-2017 period. The annual numbers of publications from the USA and China increase polynomially. JAMIA with 135 publications and JBI with 13 publications are the top prolific journals for the USA and China, respectively. Harvard University with 101 publications and Zhejiang University with 12 publications are the top prolific affiliations for the USA and China, respectively. Massachusetts is the most prolific region with 211 publications for the USA, while for China, Taiwan is the top 1 with 47 publications. China has relatively higher institutional and international collaborations. Nine main research areas for the USA are identified, differentiating 7 for China.Conclusions: There is a steadily growing presence and increasing visibility of utilizing artificial intelligence on electronic health records for the USA and China over the years. The results of the study demonstrate the research similarities and differences, as well as strengths and weaknesses of the two countries. [ABSTRACT FROM AUTHOR]

Background and Objective: Clinical prognosis prediction plays an important role in clinical research and practice. The construction of prediction models based on electronic health record data has recently become a research focus. Due to the lack of external validation, prediction models based on single-center, hospital-specific datasets may not perform well with datasets from other medical institutions. Therefore, research investigating prognosis prediction model construction based on a collaborative analysis of multi-center electronic health record data could increase the number and coverage of patients used for model training, enrich patient prognostic features and ultimately improve the accuracy and generalization of prognosis prediction., Materials and Methods: A web service for individual prognosis prediction based on multi-center clinical data collaboration without patient-level data sharing (POPCORN) was proposed. POPCORN focuses on solving key issues in multi-center collaborative research based on electronic health record systems; these issues include the standardization of clinical data expression, the preservation of patient privacy during model training and the effect of case mix variance on the prediction model construction and application. POPCORN is based on a multivariable meta-analysis and a Bayesian framework and can construct suitable prediction models for multiple clinical scenarios that can effectively adapt to complex clinical application environments., Results: POPCORN was validated using a joint, multi-center collaborative research network between China and the United States with patients diagnosed with colorectal cancer. The performance of the models based on POPCORN was comparable to that of the standard prognosis prediction model; however, POPCORN did not expose raw patient data. The prediction models had similar AUC, but the BMA model had the lowest ECI across all prediction models, indicating that this model had better calibration performance than the other models, especially for patients in Chinese hospitals., Conclusions: The POPCORN system can build prediction models that perform well in complex clinical application scenarios and can provide effective decision support for individual patient prognostic predictions., (Copyright © 2018 Elsevier Inc. All rights reserved.)