Programming a LOGMAR calculator into a REDCap database.

We monitored a large-scale implementation of the Simple Amplification-Based Assay semi-quantitative viral load test for HIV-1 version I (SAMBA I Viral Load=SAMBA I VL) within Médecins Sans Frontières' HIV programmes in Malawi and Uganda, to assess its performance and operational feasibility. Descriptive analysis of routine programme data between August 2013 and December 2016. The dataset included samples collected for VL monitoring and tested using SAMBA I VL in five HIV clinics in Malawi (four peripheral health centres and one district hospital), and one HIV clinic in a regional referral hospital in Uganda. SAMBA I VL was used for VL testing in patients who had been receiving ART for between 6months and ten years, to determine whether plasma VL was above or below 1000 copies/mL of HIV-1, reflecting ART failure or efficacy. Randomly selected samples were quantified with commercial VL assays. SAMBA I instruments and test performance, site throughput, and delays in communicating results to clinicians and patients were monitored. Between August 2013 and December 2016 a total of 60889 patient samples were analysed with SAMBA I VL. Overall, 0.23% of initial SAMBA I VL results were invalid; this was reduced to 0.04% after repeating the test once. Global test failure, including instrument failure, was 1.34%. Concordance with reference quantitative testing of VL was 2620/2727, 96.0% (1338/1382, 96.8% in Malawi; 1282/1345, 95.3% in Uganda). For Chiradzulu peripheral health centres and Arua Hospital HIV clinic, where testing was performed on-site, same-day results were communicated to clinicians for between 91% and 97% of samples. Same-day clinical review was obtained for 84.7% across the whole set of samples tested. SAMBA I VL testing is feasible for monitoring cohorts of 1000 to 5000 ART-experienced patients. Same-day results can be used to inform rapid clinical decision-making at rural and remote health facilities, potentially reducing time available for development of resistance and conceivably helping to reduce morbidity and mortality.

Validation of diffusion-weighted images obtained on 0.35T MR imaging in Malawi has facilitated meaningful review of previously unreported findings in cerebral malaria. Malawian children with acute cerebral malaria demonstrated restricted diffusion on brain MR imaging, including an unusual pattern of restriction isolated to the subcortical white matter. We describe the patterns of diffusion restriction in cerebral malaria and further evaluate risk factors for and outcomes associated with an isolated subcortical white matter diffusion restriction. Between 2009 and 2014, comatose Malawian children admitted to the hospital with cerebral malaria underwent admission brain MR imaging. Imaging data were compiled via NeuroInterp, a RedCap data base. Clinical information obtained included coma score, serum studies, and coma duration. Electroencephalograms were obtained between 2009 and 2011. Outcomes captured included death, neurologic sequelae, or full recovery. One hundred ninety-four/269 (72.1%) children with cerebral malaria demonstrated at least 1 area of diffusion restriction. The most common pattern was bilateral subcortical white matter involvement (41.6%), followed by corpus callosum (37.5%), deep gray matter (36.8%), cortical gray matter (17.8%), and posterior fossa (8.9%) involvement. Sixty-one (22.7%) demonstrated isolated subcortical white matter diffusion restriction. These children had lower whole-blood lactate levels (OR, 0.9; 95% CI, 0.85-0.98), were less likely to require anticonvulsants (OR, 0.6; 95% CI, 0.30-0.98), had higher average electroencephalogram voltage (OR, 1.01; 95% CI, 1.00-1.02), were less likely to die (OR, 0.09; 95% CI, 0.01-0.67), and were more likely to recover without neurologic sequelae (OR, 3.7; 95% CI, 1.5-9.1). Restricted diffusion is common in pediatric cerebral malaria. Isolated subcortical white matter diffusion restriction is a unique imaging pattern associated with less severe disease and a good prognosis for full recovery. The underlying pathophysiology may be related to selective white matter vulnerability.

Background:We aimed to examine the attitudes of Pennsylvania rural residents toward data sharing in the setting of the COVID-19 pandemic. Specifically, we were interested in better understanding their willingness to provide personal information for contact tracing to public health staff investigating COVID-19 cases, as well as their concerns. We used a validated scale to describe the influence of distrust of healthcare organizations on their attitudes.Methods:We mailed 4000 surveys to rural residents identified from the electronic medical record of a healthcare system in central Pennsylvania. Data were entered into a REDCap database and analyzed using descriptive summaries, and both binomial and multivariable logistic regression.Results:Binomial logistic regression showed that both distrust in healthcare organizations and political values influence respondents’ willingness to share information with contact tracers as well as their concerns about sharing personal data. When our multivariable model was applied, political values remained and were consistently associated with willingness to share and concerns about sharing their data.Conclusion:This study is a first step in eliciting rural residents’ willingness to share personal data for contact tracing by public health officials. Understanding and addressing rural residents’ willingness to share personal data and their concerns about sharing those data will help public health officials identify effective strategies for managing COVID-19 and future pandemics in rural communities. By involving community members at the ground level, public health staff can ensure residents’ buy-in for the need to collect their personal data, thereby helping to mitigate the public health crises.

With the increasing complexity of haemophilia care and the advent of numerous therapeutic innovations, there is an unmet need for documentation and data collection tools tailored to people with haemophilia (PwH). To date, no fully integrated haemophilia-specific electronic health record (EHR) has been described in the literature. To evaluate the feasibility of integrating a haemophilia-specific navigator into the Epic EHR. Based on clinical experience and registry datasets, we identified key variables describing both PwH and carriers of haemophilia. These were then incorporated into a REDCap database, which served as a starting point for the development of a comprehensive haemophilia flowsheet. We built a dedicated haemophilia navigator within Epic that includes a flowsheet featuring up to 212 variables, as well as customised note templates and patient lists integrating data from the haemophilia flowsheet. It was feasible to develop a haemophilia navigator within Epic over the course of 12 months. The navigator's flowsheet enables systematic and comprehensive clinical assessment of PwH and carriers, while customised patient lists provide a quick summary of each patient's profile to the haemophilia treatment centre staff and highlight issues that require an intervention. In our clinical practice, patients actively participated in the new documentation process and responded positively to the navigator. Adapting EHRs to the needs of PwH and carriers promotes holistic care for this population and provides an opportunity for patient empowerment. Such haemophilia-specific EHRs are expected to promote standardisation of care and facilitate the collection of registry data on a national and international level.

BackgroundCoronavirus infection (COVID) presents with flu-like symptoms and can cause serious complications. Here, we discuss the presentation and outcomes of COVID in an ambulatory setting along with distribution of positive cases amongst healthcare workers (HCWs).MethodPatients who visited the COVID clinic between 03/11/2020 and 06/14/2020 were tested based on the CDC guidelines at the time using PCR-detection methods. Medical records were reviewed and captured on a RedCap database. Statistical analysis was performed using both univariate and bivariate analysis using Fischer’s exact test with 2-sided P values.ResultsOf the 2471 evaluated patients, 846 (34.2%) tested positive for COVID. Mean age of positivity was 43.4 years (SD ± 15.4), 60.1% were female and 49% were Black. 58.7% of people tested had a known exposure, and amongst those with exposure, 57.3% tested positive. Ninety-four patients were hospitalized (11.1%), of which 22 patients (23.4%) required ICU admission and 10 patients died. The overall death rate of patients presenting to clinic was 0.4%, or 1.2% amongst positive patients. Median length of hospital stay was 6 days (range 1-51). Symptoms significantly associated with COVID included: anosmia, fever, change in taste, anorexia, myalgias, cough, chills, and fatigue. Increased risk of COVID occurred with diabetes, whereas individuals with lung disease or malignancy were not associated with increased risk of COVID. Amongst COVID positive HCWs, the majority were registered nurses (23.4%), most working in general medicine (39.8%) followed by critical care units (14.3%).Discussion/ConclusionBlacks and females had the highest infection rates. There was a broad range in presentation from those who are very ill and require hospitalization and those who remain ambulatory. The above data could assist health care professionals perform a targeted review of systems and co-morbidities, allowing for appropriate patient triage.

Introduction Structural disease has been postulated as a possible etiology for the pathophysiology of idiopathic intracranial hypertension (IIH). There is growing evidence that venous sinus stenosis plays a role in propagating IIH through the obstruction of cerebrospinal fluid (CSF) clearance. Venous sinus stenting (VSS) is becoming a common treatment modality for medically refractory IIH with promising results. Although a trans‐stenotic venous pressure gradient (VPG) of ≥8mmHg was initially used to select optimal candidates, VPG thresholds for VSS remain undefined. Our study explores the efficacy of VSS between low and high pressure gradient groups. Methods A retrospective analysis was performed on patients treated with cerebral VSS for IIH at two tertiary hospitals from 2012 to 2024 through a grant‐funded multicenter registry. Demographic information, clinical characteristics, changes in associated signs and symptoms, changes in venous stenosis pressure gradients pre‐ and post‐stenting, and re‐stenting rates were collected for up to 12 months after treatment using a RedCap database. Information was collected through electronic medical record review. Symptom outcome measures were subjective from clinic follow up notes. Patients were dichotomized into VPG groups: low (0‐7mmHg) and high VPG (≥8mmHg). Results Our cohort includes 373 patients, of which 285 (76.4%) were female. Demographics and clinical characteristics information are noted int Table 1. Overall, patients in the low VPG group were older, had lower body mass index (BMI) and lumbar puncture (LP) opening pressures, and were less likely to present with papilledema, headache, or visual disturbances compared to those with higher VPG. Additionally, the low VPG was also more likely to report tinnitus and less likely to be on acetazolamide or topiramate. Venous sinus stenosis detection via non‐invasive imaging, laterality of stenosis, and re‐stenting rates were similar across groups. Additionally, outcome measures were similar across groups: VPG resolution (0‐3mmHg) (81.3% in the <8 mmHg group vs. 87.4% in the ≥8 mmHg group, p=0.19), papilledema improvement (71.4% vs. 71.2%, p=0.98), tinnitus improvement (69.8% vs. 73.2%, p=0.62), and headache improvement (80.7% vs. 77.4%, p=0.58). Conclusion While our cohort demonstrated differences between the two VPG groups, there appears to be similar beneficial results in lowering the venous pressure gradient across stenosis alongside symptomatic improvement with VSS. Future prospective confirmatory studies further liberating these restrictive criteria is warranted. image

Increasing volume and the role of gynecologic oncologists in peripartum hysterectomies – A single center study of 109 cases over 7 years (008)

Critically ill pediatric patients admitted to the pediatric intensive care unit (PICU) are highly vulnerable to infections, including invasive fungal diseases and antifungal agents are frequently prescribed. Little is known about antifungal usage in PICUs across Europe. A multinational 3-month weekly point-prevalence study for measuring antifungal drug use was organized. Eigtheen PICUs (16 hospitals) in 10 countries in the European region participated. All patients hospitalized in the participating PICUs and receiving systemic antifungals were included. Information about ward demographics was collected once; weekly ward and patient data were collected prospectively for the 12-week study period and entered in REDCap database. Among 18 PICUs, 8 (44%) followed prophylactic practices for targeted group of patients, 7/18 (39%) had an antifungal stewardship program and the majority (16/18, 89%) had the capacity of biomarker utilization (16/16 galactomannan, 13/16 beta-D-glucan, and 9/16 pan-fungal PCR). One hundred one courses in equal number of patients were recorded; 14 for patients aged <3month, 87 for patients ≥3month. Malignancy was the most common underlying condition among patients aged ≥3month (29%) followed by surgery/trauma (25%), whereas all patients <3month had undergone a recent surgery. Indication for antifungal prescribing was prophylaxis in 38% and treatment in 62% [empirical (57%), preemptive (13%), and targeted (30%)]. Fluconazole was the most common agent both for prophylaxis and treatment, whereas liposomal amphotericin B was the most frequent agent for targeted treatment. The majority (63%) of patients on prophylaxis were oncology or transplant patients. Common reasons for empirical and targeted treatment were persistent fever/other signs of infections in high-risk patients (61%) and Candida infections (100%), respectively. For targeted treatment, the most frequent pathogens were Candida albicans (37%) and Candida parapsilosis (32%). Most antifungal prescriptions across European PICUs were for treatment. Fluconazole was the most frequently prescribed antifungal. These surveillance data can guide antifungal stewardship strategies in PICUs.

Specific brace-fitting complications in idiopathic congenital talipes equinovarus (CTEV) have been rarely described in published series, and usually focus on non-compliance. We noted a moderate number of patients in our clubfoot population in a large hospital who had pressure sores with brace wear, particularly after an institutional change from Markell to Mitchell Boots. Our primary aim was to compare the rate of persistent pressure sores in patients fitted with Markell boots and Mitchell boots. Our additional aims were to describe the frequency of other brace fitting complications and identify age trends in these complications. Retrospective analysis of medical files from 247 idiopathic clubfoot patients (374 clubfeet) was performed after identification tthrough the electronic medical record and institutional database. Inclusion criteria included patient date of birth between January 1, 2010 and January 1, 2021, a primary diagnosis of idiopathic clubfoot in infancy as well as an assessment by one of our clinicians in our paediatric clubfoot team prior to fitting the patient for boots and bar orthosis. Clinical audit met criteria for ethics exemption through our institutional review board. RedCap database was created for this study. Chart reviews were performed between October 2021 and April 2022. Patients were excluded if they had orthotics management elsewhere. Primary achilles tenotomy was performed in 92% of patients; five percent of those patients required a revision achilles tenotomy in infancy. Pressure sores of sufficient severity for clinician to recommend time out of brace occurred in 23% of Mitchell boot and 13% of Markell boot patients (X2 = 6.9, p=0.009). Mean age pressure sores of sufficient severity for clinician to recommend time out brace was 8.1 months (SD 8.6 months). The overall rate of bracing complications was 51%. Thirty-three percent of parents admitted to bracing non-compliance and 31% of patients required re-casting during the bracing period for relapse. Thirteen percent of patients had behavioural intolerance which led to admitted parental early abandonment of bracing. For patients with a minimum follow-up to age 6 years, 44% required tibialis anterior tendon transfer. Parents admitting to non-compliance with brace wear or recommended bracing hours were significantly more likely to have a child who required tibialis anterior tendon transfer (X2 = 5.7, p=0.017). Overall rate of capsular release (posteromedial release or posterior release) was two percent. Globally, few publications describe specific bracing complications in clubfoot, despite this being a notable challenge for clinicians and families. Recurrent pressure sores is a persistent complication with the Mitchell boots for patients in our centre. In our population of CTEV patients, tibialis anterior tendon transfer for relapse is common, consistent with the upper limit of tibialis anterior tendon transfer rates reported globally.

8. MENTORSHIP IN RESIDENCY: IS IT PROTECTIVE AGAINST BURNOUT?

Background The COVID-19 pandemic exposed significant vulnerabilities of traditional in-person recruitment methodology in the context of limited access to clinical facilities. Remote recruitment is a potential solution, but its yield and efficiency are unknown. Objective This study aimed to determine remote recruitment and enrollment rates for a pilot feasibility trial of an electronic monitoring device (EMD) for asthma in the pediatric population. Methods Children aged 4-18 years with persistent asthma receiving inhaler medications compatible with an EMD were screened for enrollment in a feasibility and acceptability trial. The emergency department (ED) and inpatient wards were identified as initial in-person recruitment locations prior to the pandemic. Owing to the COVID-19 pandemic, recruitment sites transitioned from exclusive ED or inpatient enrollment to outpatient primary care or pulmonary clinics in an attempt to increase enrollment rates. Study staff called families to determine their interest in the study. Patient age, race and ethnicity, insurance, contact attempts, and reasons for enrollment or refusal were recorded. e-Consent was obtained through the REDCap database, and baseline surveys were administered by telephone. Results Since November 2019, the study staff reached 147 out of 278 (52.3%) eligible families by telephone. In total, 37 (13%) families contacted were enrolled in the study. It took the study staff a mean of 2 attempts to reach individuals for initial enrollment but a mean of 4 additional attempts to complete consent forms. Of the families approached, 47% were Hispanic or Latino, 26.5% were Black or African American, 24.5% were White, and 2% were Asian. Among patients approached, 20% Asian, 16% White, 14.5% Hispanic or Latino, and 12% Black patients were enrolled in the study. Conclusions Telephone recruitment had a low yield across all racial and ethnic groups, averaging approximately 1 successful enrollment per 8 candidates approached. A substantial number of contacts was required to obtain e-consent forms and complete survey questionnaires after participants agreement to enroll. The study findings suggest that when there are barriers to in-person recruitment, remote recruitment is a feasible alternative, but the yield is relatively low, and enrollment requires persistent, repeated follow-up contact. Conflicts of Interest None declared.

Real-World Outcomes in Adolescents and Young Adults with Acute Lymphoblastic Leukemia without Access to Allogeneic Stem Cell Transplant

Introduction: The promise of achieving cancer control both nationally and globally rest on rigorous data collection, data harmonization and data sharing to catalyze scientific knowledge and understanding to more quickly advance our progress to addressing cancer disparities. In response, the LIFE Project aimed to establish a cancer-focused robust, functional platform for data harmonization and sharing across national and international studies with a focus on low-resourced settings and LMIC. Methods: Established in 2022, the integrated database platform hosts data collected from the ongoing Jamaican LIFE and US CAP3 projects. Both studies focus on investigating biologic and socioecologic risk factors for non-communicable chronic diseases (NCDs) and cancers. Participants self-reported data via REDCap. A one-to one mapping of the variables from both questionnaires was conducted and stored in the integrated REDCap file. An automated REDCap Application Programming Interface (API) script weekly imports the new entries into the integrated database. To ensure data accuracy, on a weekly schedule, data importation and data integration are monitored and assessed by random sampling of original source data entries and the corresponding entries in the integrated database. Any additional errors in data integration are resolved via consultations with the programming team. Results: As of June 2023, 3,369 participants were enrolled - 2,561 enrolled from the LIFE study and 808 from the CAP3 study. Overall, the combined participants were 89% Afro-Caribbean or African American, and comprised 40% males with a median age of 54 years and 60% females with median age being 51 years. For the LIFE study, median age is 50 years, and for the CAP3 the median age is 55. The prevalence of self-reported health conditions are as follows: diabetes - 13% LIFE, 13% CAP3; hypertension - 37% LIFE, 19% CAP3; dyslipidemia - 15% LIFE, 21% CAP3. Conclusion: With the continuing need for precision public health, there is a dire need to address disparities through innovative ways that promote comprehensive data linkage and analyses. This platform can be used in mapping individual cohort data with demonstrated success for the LIFE and CAP3 studies. Our web-based query tool to interface that interfaces with our REDCap database also allows us to query the available variables in both the separate and combined cohort databases and will facilitate hypothesis development. The impact of our study goes beyond the data harmonization, and robust data integration platform that links the LIFE and CAP3 studies. This allows for US comparative studies. Novel. We will also have the ability to harmonize with large US cohort studies, as well as interrogate research questions examining commonalities and differences among African Americans, Afro-Caribbean Americans and Afro-Caribbeans in the Caribbean. These comparative studies will help to elucidate the causes increased health risks, and accelerate the science to remedy the global Black NCD and cancer disparities. Citation Format: Camille C. R. Ragin, Janeil Williams, Olga Tchuvatkina, Joette Mckenzie, Kimlin Ashing, Marshall Tulloch-Reid. Harmonization and integration of regional based prospective cohorts: A preliminary report of the African Caribbean Cancer Consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB141.

Category:Post-operative DrivingIntroduction/Purpose:For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study is to describe the driving habits of patients after right-sided foot surgery and assess the safety of left foot driving using a driving simulator.Methods:Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 patients to compare characteristics of left versus right foot driving.Results:Thirty six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left foot driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more (p<0.001) and hit other vehicles more (p<0.026) when driving with the right foot than the left. Time to fully brake and fully release the throttle in response to vehicular hazards were significantly prolonged in left foot driving compared to right (p = 0.019 and p = 0.034, respectively).Conclusion:A significant proportion of right foot and ankle surgery patients engaged in left foot driving during postoperative recovery. Driving with the left foot may prolong brake and throttle release times, and is therefore not recommended.

IntroductionManaging burn fluid resuscitation for large burns is challenging and relies heavily on accurate nursing documentation. The Burn Navigator (BN) is a clinical decision-support system designed to guide clinicians in burn fluid resuscitation. However, data entered into the BN do not auto-populate into the electronic medical record (EMR), thus requiring nurses to document in two systems. We sought to compare differences in nursing documentation of data entries between the EMR and the BN on burn patients with ≥ 20% total body surface area (TBSA) undergoing intravenous (IV) fluid resuscitation.MethodsInstitutional Review Board approval was obtained for a multi-center observational study of burn patients undergoing fluid resuscitation using the BN. Data were collected and analyzed between the EMR and BN entries entered into the REDCap database from 5 American Burn Association (ABA)-verified burn centers. The following variables were analyzed: time of burn injury, weight, TBSA burned, urine output (UOP), and hourly IV crystalloid fluid volume.ResultsAnalysis included 296 subjects (of 300 enrolled). Results show no significant difference between burn centers for mean weight (BN 87.02 ± 22.9 kg vs. EMR 87.1 ± 23.3 kg), TBSA (BN 40.71 ± 19.24% vs. EMR 40.97 ± 19.29%), or time of burn injury (< 1 hour). The time of injury recorded in the BN versus EMR was later in 44.6% (n=132) of patients and earlier in 46.4%, (n=138) and the same in 8.8% (n=26) of records. Additionally, in 293 records, there was no significant difference between centers in patient UOP (BN 0.91 ± 0.52 ml/kg/hr vs. EMR 0.91 ± 0.63 ml/kg/hr). One site had a significant difference in hourly fluid rates (Figure) due to a lack of inclusion of pre-hospital fluids.ConclusionsWhen comparing the data between the EMR to BN, it was observed that pre-hospital fluids tended not to be documented in the EMR, causing a statistically significant difference in total fluids administered in one burn center. Overall, the nursing documentation variability was minimal across all sites even though the nurses had to document the data in two different systems, while simultaneously caring for critically ill patients with large burn injuries. Close monitoring of the nursing documentation during burn fluid resuscitation should always be a priority.