Attention-based Clinical Note Summarization

In recent years, the trend of deploying digital systems in numerous industries has hiked. The health sector has observed an extensive adoption of digital systems and services that generate significant medical records. Electronic health records contain valuable information for prospective and retrospective analysis that is often not entirely exploited because of the complicated dense information storage. The crude purpose of condensing health records is to select the information that holds most characteristics of the original documents based on a reported disease. These summaries may boost diagnosis and save a doctor's time during a saturated workload situation like the COVID-19 pandemic. In this paper, we are applying a multi-head attention-based mechanism to perform extractive summarization of meaningful phrases on clinical notes. Our method finds major sentences for a summary by correlating tokens, segments, and positional embeddings of sentences in a clinical note. The model outputs attention scores that are statistically transformed to extract critical phrases for visualization on the heat-mapping tool and for human use.

Characterization of asthmatic patients hospitalized in a tertiary hospital during Covid-19 pandemic

Background: Covid-19 pandemic had an important impact on health care, in particular on the approach to respiratory diseases. Aim(s): To characterize asthmatics patients hospitalized in a tertiary hospital during Covid-19 pandemic. Method(s): Retrospective analysis of the clinical data of the patients hospitalized in our Hospital for asthma exacerbation during the first 12 months of Covid-19 pandemic (from March 2020 to February 2021) compared with the corresponding period before pandemic (from March 2019 to February 2020). In order to identify admitted patients for asthma, we used ICD9 and IC10 asthma diagnostic codes attributed to the main diagnosis. Result(s): A total of 56 hospitalizations were identified, corresponding to 53 patients, 81.1% females and 18.9% males, with a mean age of 47.3 years [ +/- 20.8 years;8-93 years]. Ten cases were excluded (missing information, in three, and other reason for admission, in seven). We identified 17 hospitalizations in the considered pandemic period and 39 in the pre-pandemic period, representing a significant reduction in asthma hospitalization during covid-19 pandemic (30.4% vs 69.6%, p < 0.001). When comparing the main characteristics between the two groups (pandemic vs pre-pandemic), namely age (47.1 vs 47.3 years, p = 0.972), gender (82.4% vs 79.5% female, p = 1.0), atopy (50.0% vs 64.5%, p = 0.366), hospitalization length (5.8 days vs 5.7 days, p = 0.9), previous therapy (37.5% vs 30.8% only SABA/LABA, p = 0.754), therapy after discharge (p = 0.842) or exacerbation trigger, no statistical differences were found. In both groups, viral respiratory tract infection was the main trigger for asthma exacerbation. In neither case SARS-CoV- 2 infection was identified. Conclusion(s): There was a significant decrease in asthma hospitalizations in the first 12 months of the Covid-19 pandemic, compared to the same period pre-pandemic. However no statistically significant differences were found between the characteristics of hospitalized patients in the two periods.

Assessing Changes in Blood Pressure Capture in Primary Care Emr Systems during the Covid-19 Pandemic

Background Primary care electronic medical records (EMRs) data can be used to inform health services, disease surveillance, and interventions. However, its utility is reliant on how well variables are captured. The COVID-19 pandemic shifted primary care delivery to virtual care resulting in fewer patients having their blood pressure (BP) checked in office. As such, BP may not be well documented in the structured fields of the EMR. In the EMR, BP's are used to identify patients who have hypertension, assess rates of hypertension screening, and evaluate hypertension management. The purpose of this study was to determine the change in BP documentation during the COVID-19 pandemic. Methods Data for this study were from the University of Toronto Practice-Based Research Network (UTOPIAN) Data Safe Haven, a EMR database which contains clinical records from family medicine clinics in Ontario, Canada. Hypertension visits (ICD-9 billing code 401) were assessed pre-pandemic (Jan 2017-Dec 2019) and during the pandemic (Jan 2020-Dec 2021) for structured BP. A sample of 12% of hypertension visits during the pandemic without structured BP measures were reviewed to determine if BP was recorded in an unstructured format. Two abstractors reviewed progress notes of patient charts to identify if BP was recorded. Results were analyzed using descriptive statistics. Results Pre-pandemic, 67% of hypertension visits had a BP recorded in structured fields (OR=4.14, 95% CI: 4.04-4.23), however this significantly decreased during the pandemic with only 33% of cases having a recorded BP (OR=0.24, 95% CI: 0.23-0.24). In the pandemic, 55% of hypertension visits were virtual. In the pandemic, 10% of virtual visits (OR=0.01, 95% CI: 0.01-0.01), versus 59% of in-person visits did have a structured BP (OR=2.48, CI: 2.37-2.60). Abstractors reviewed 3200 hypertension visits without structured BP. 55% of hypertension visits had a BP recorded in the unstructured progress notes. Conclusion There are clear gaps in pandemic BP recordings most likely due to high rates of virtual visits. Given that virtual visits will continue, future research should develop strategies for capturing BP from progress notes in EMR databases.Copyright © 2023 American College of Cardiology Foundation

Direct Versus Indirect Query Performance of ICD-9/-10 Coding to Identify Anaphylaxis.

BACKGROUND: Anaphylaxis is an often under =diagnosed, severe allergic event for which epidemiological data are sporadic. Researchers have leveraged administrative and claims data algorithms to study large databases of anaphylactic events; however, little longitudinal data analysis is available after transition to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). OBJECTIVE: Study longitudinal trends in anaphylaxis incidence using direct and indirect query methods. METHODS: Emergency department (ED) and inpatient data were analyzed from a large state health care administration database from 2011 to 2020. Incidence was calculated using direct queries of anaphylaxis ICD-9-CM and ICD-10-CM codes and indirect queries using a symptom-based ICD-9-CM algorithm and forward mapped ICD-10-CM version to identify undiagnosed anaphylaxis episodes and to assess algorithm performance at the population level. RESULTS: An average of 2.4 million inpatient and 7.5 million ED observations/y were analyzed. Using the direct query method, annual ED anaphylaxis cases increased steadily from 1,454 (2011) to 4,029 (2019) then declined to 3,341 in 2020 during the coronavirus disease 2019 (COVID-19) pandemic. In contrast, inpatient cases remained relatively steady, with a slight decline after 2015 during the ICD version transition, until a significant drop occurred in 2020. Using the indirect queries, anaphylaxis cases increased markedly after the ICD transition year, especially involving drug-related anaphylaxis. CONCLUSIONS: Nontypical drug associations with anaphylaxis episodes using the ICD-10-CM version of the algorithm suggest poor performance with drug-related codes. Further, the increased granularity of ICD-10-CM identified potential limitations of a previously validated symptom-based ICD-9-CM algorithm used to detect undiagnosed cases.

Incidence of COVID-19 hospitalization in patients with psoriasis taking systemic immunomodulators

Background: Current research on COVID-19-related outcomes in patients with psoriasis, particularly regarding influence of treatments, are subject to lack of comparator group, selection bias, and insufficient statistical power.1 Accordingly, it remains uncertain whether immunomodulatory treatments for psoriasis enhance or decrease the risk of severe COVID-19-related outcomes, including hospitalization. Objective(s): To compare the risk of COVID-19-related hospitalization according to immunomodulator treatment type in patients with psoriasis Methods: Retrospective cohort study of the Explorys database in the United States between March 1st, 2020 and December 31st, 2020. Psoriasis diagnosis was defined by at least 2 ICD-9 or ICD-10 diagnosis codes prior to March 1st, 2020. Drug exposure was classified as biologic or traditional immunosuppressive (methotrexate, cyclosporine, apremilast) treatment based on prescription order in the 3 months preceding March 1st, 2020. Biologic treatments included TNFalpha, IL-12/IL-23, IL-17A, IL-23 and JAK inhibitors. The primary outcome was defined as hospital admission with diagnosis of COVID-19 or positive lab test occurring between admission and discharge date. Propensity score weighting was used to compare COVID-19-related hospitalization between treatment groups, adjusting for comorbidities and demographic characteristics. Result(s): A total of 51,606 psoriasis patients aged 18-88 were included. Crude cumulative incidence of COVID-19 hospitalization per 1,000 psoriasis patients was 3.4 in the biologic group (9/2,669), 9.5 in the traditional immunosuppressive group (15/1,585), and 3.9 in those receiving neither drug class (184/47,352). Incidence was 4.7 (6/1,282) and 14 (13/898) per 1,000 patients among those receiving TNF-alpha inhibitors and methotrexate, respectively. After propensity-score weighting, risk of COVID-19-related hospitalization for patients receiving any biologic was lower than that of patients receiving traditional immunosuppressives (RR 0.39, 95% CI 0.16, 0.92), and those receiving neither drug class (RR 0.66, 95% CI 0.32, 1.34). TNF-alpha inhibitor use was associated with lower risk of hospitalization relative to methotrexate use (adjusted RR 0.39, 95% CI 0.14, 1.06). Adjusted relative risk of hospitalization for methotrexate users relative to those receiving neither drug class was 2.78 (95% CI 1.47, 5.26). Conclusion(s): During the first wave of the pandemic in 2020, psoriasis patients using biologics were at lower risk of COVID-19-related hospitalization compared to those using traditional immunosuppressives, particularly methotrexate. Methotrexate use was associated with a substantial increase in risk of hospitalization relative to those who did not receive systemic treatments.

Increased Rates of Hospitalized Children with Type 1 and Type 2 Diabetes Mellitus in NYC Hospital During COVID19 Pandemic

Objectives There have been reports of increased new onset diabetes and severity of DKA for children with diabetes following COVID19 infection and during the pandemic worldwide. Our objective is to study whether there is a change in admission rates and severity of presentation for type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in our center from 2018 to 2020. Methods This is an IRB approved retrospective chart review of children admitted to our two hospitals from 1/1/18 to 12/31/20. We included ICD9 and ICD10 codes for diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome (HHS) and hyperglycemia for those with diabetes. SAS 9.4 was used for ANOVA, T-test, Poisson regression. Results We included 132 patients with 214 hospitalizations: 158 T1DM, 40 T2DM and 16 other (14 steroid induced, 2 MODY). Overall admissions increased from 3.4% in 2018, to 4.6% in 2019, and 6.4% in 2020 (p = 0.05). Overall T1DM admissions were similar across all 3 years, however T2DM rates increased from 0.4% to 0.8% to 2% (p=0.0064). Newly diagnosed T1DM rates increased from 0.4% to 0.3% to 1.7% (p=0.002), and new-onset T2DM rates also increased from 0.2% to 0.7% to 1.1% (p=0.0026). DKA increased from 2.5% to 3.5% to 4% (p=0.028). HHS increased from 0.1% to 0.2% to 0.6% (p=0.047). There was no difference in average A1c. Severity of DKA in newly diagnosed diabetes was unaffected (p=0.833). Only 3 patients tested positive for COVID 19 while everyone else was negative by COVID 19 PCR. Conclusions Our urban academic medical center is located in central Brooklyn and serves a majority who are Black (87%). As far as we know, this is the first study investigating pediatric diabetes cases admitted in central Brooklyn during the height of the pandemic. Overall, hospitalization rates in children with T2DM and in new onset T1DM and T2DM increased, despite overall admissions declining in 2020. Whether the shutdown affected patient's perception of their symptoms or another reason leading to delayed care, or change in access to care remains to be seen. Active COVID19 infection did not appear to affect patients who had been admitted for diabetes. More studies are needed to elucidate the reason for this observed increase hospitalization rates.

Pre-Covid, Covid, and Post-Covid Trends of Rsv and Influenza across Geographic Regions in the USA

INTRODUCTION: Admissions to Pediatric Intensive Care Units (PICUs) for respiratory illnesses, particularly RSV and Influenza (INF), have decreased during the COVID-19 pandemic. The differences in trends for RSV and INF admissions to PICUs across different regions in the U.S. are unknown. Changes in these trends before (2014-19), during (2019-20), and towards the end of the pandemic (2021- 22), and utilization patterns across regions have not been evaluated. This analysis aimed at addressing these questions. METHOD(S): 874,066 USA PICU cases from the Virtual Pediatric Systems database (myvps.org), from Q1-2014 to Q2-2022, were used to study RSV and INF in patients < 18 years. The geographic regions according to U.S. Census definition included Mid-West (MW), Northeast (NE), South (S), and West (W). RSV and INF were defined by ICD-9 and ICD-10 codes. After removing low-risk patients (PRISM III POD < 0.004) the cohort size was 492,642. Segmented regression analysis (Muggeo 2016) was used to fit the trends in yearly rates for RSV and INF. Least-squares linear fits were applied to data segments before and after breakpoints (change in slope) to determine the correlation coefficients of each segment. Fisher's Z-transform was used to investigate significant differences between segments before and after their respective breakpoints. Utilization amongst regions was done by ANCOVA analysis, and Bonferroni corrected p-values for the most prevalent procedures in the cohorts. RESULT(S): All regions showed an increase in RSV and INF between 2014-19, but decreasing during 2020-21. In 2021- 22 all regions showed an increase trend in INF, but RSV increased only in MW and S compared to NE and W. Further analysis using RSV segmented regression revealed: MW, NE, and W breakpoints (positive to negative) in: 2018, 2019, and 2019, respectively. For INF, breakpoints for MW, NE, S, and W were detected in: 2019, 2020, 2019, and 2019, respectively. CPAP use in W was greater than S (p< 0.02). All other procedure comparisons had p-values>0.05. CONCLUSION(S): RSV and INF increased in all regions during pre-COVID. RSV and INF decreased in all regions during COVID. INF increased in all the regions towards the end of pandemic. RSV increased in MW and S near the end of the pandemic. Differences in use of CPAP for RSV were found between W and S.

Increase in kawasaki disease incidence observed in 30-year population-based study in scandinavia

Background and Aim: World-wide, Kawasaki disease (KD) is known to affect predominantly children under the age of 5, mostly boys. An increasing incidence has been reported from select countries, as well as seasonal differences, although with great variation among reports. Sweden has unique population-based health registers which can be linked to population registers via a personal number. In this study we therefore utilized population-based data over a period of more than 30 years to investigate demographics and epi-demiology of Kawasaki disease in a Scandinavian country. Method(s): Individuals receiving a diagnosis of Kawasaki disease in Sweden from 1987-2018 (before the occurrence of MIS-C) were identified by ICD9 and ICD10 discharge diagnoses in the Patient register at the National Board of Health and Welfare, and basic demographic information obtained by cross-linking with popula-tion registers at Statistics Sweden. Age-stratified population statis-tics were also retrieved during the corresponding time-period. Result(s): A total of 1,785 individuals with a KD diagnosis during the study period were identified, confirming a relatively low incidence in the Scandinavian population. Less than 5% of the cases were born in another country. The majority of cases (78%) occurred before 5 years of age, and there was a male dominance (61%). Sweden has a temperate climate of the northern hemisphere, and analysis of case distribution over the yearly cycle revealed peak incidence during the winter months. Notably, the incidence rose from around 6/100,000 lt;5-year-olds to 15/100,000 lt;5-year-olds during the 30-year study period. Two years with prominently higher incidence than prior and following years were observed. A large part of the rise in incidence seems to be associated with immigration and occurred before the occurrence of Multisystem Inflammatory Syndrome in Children related to SARS-CoV-2. Conclusion(s): Demographic parameters for Kawasaki disease in Sweden regarding age and sex distribution are similar to previous reports from other countries. Our data from a 30-year study period of population-based observations confirm peak incidence during the cold period, and a rising incidence during recent years, even before the occurrence of MIS-C. Our data also indicate outbursts during two years and immigration-associated patterns in rise in incidence.

SHOULD LACTATE BE INCLUDED IN ASSESSING RISK FOR ACUTE PE? A SINGLE-CENTER RETROSPECTIVE ANALYSIS

SESSION TITLE: Late Breaking Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Pulmonary embolism (PE) is a common form of thromboembolism which has a variable and non-specific presentation that can often be fatal. The Simplified Pulmonary Embolism Severity Index (sPESI) which includes hemodynamic parameters of perfusion has been shown to correlate with 30-day mortality in patients with acute PE. The purpose of this quality improvement project was to compare how lactate and sPESI perform in predicting clinical outcomes at our institution with the hopes of developing institutional guidelines for management of patients admitted with an acute PE. METHODS: We conducted a single center retrospective analysis on patients admitted to the intensive care unit with a new diagnosis of PE between the years 2016-2021. Patients were identified using ICD-9 CM codes. Exclusion criteria included current or prior positive testing for SARS-CoV-2 (COVID-19). We performed univariate, multivariate, and ROC (Receiver Operating Characteristic) analysis to assess correlations between all cause mortality, lactate, and sPESI. Both lactate and sPESI were included as continuous variables. Our covariates included age, sex, Body Mass Index, prior or current history emphysema/COPD, smoking, CKD, diabetes, cancer, atrial fibrillation, and CHF. All analysis was carried out using software R version 3.6.3. RESULTS: Of the 161 patients who were included in the study, the mean age was 60 years (SD 17 years) and 38% (61/161) were females. 31 patients (19.3%) were deceased. Mean BMI of study participants was 29.9 kg/m2. Comorbidities included 9.9% (16/161) with emphysema/COPD, 44% (71/161) with active or prior history of smoking, 6% (10/161) with CKD, 12% (20/161) with diabetes, 15% (24/161) with diagnosis of cancer, 15% (24/161) with atrial fibrillation, 15% (24/161) with history of CHF. We found that in univariate analysis, both sPESI (p=3.4*10

Mortality in patients with pemphigus: A retrospective US claims database study

Objective: We evaluated mortality in patients with pemphigus compared with non-pemphigus individuals matched on age and gender, in the United States (US). Methods: This retrospective cohort study used data from the US Optum Clinformatics claims database between May 1, 2000 and December 31, 2020. Mortality was assessed during a follow-up of up to 4 years after the index date (first pemphigus diagnosis). A sensitivity analysis was conducted (end of study period, March 31, 2020) to exclude the potential impact of COVID-19 on mortality analysis. Multivariable models (comorbidities as adjustment variables) were used to assess hazard ratios (HRs). Propensity score matched (PSM) model was used to minimize comorbidities difference at baseline. Results: Overall, 1391 patients with pemphigus (ICD-9 and ICD-10 codes) were identified (mean [SD] age: 63.7 [17.9] years;females: 57.0%). During follow-up, 227 patients (16.3%) died in the pemphigus cohort, compared with 172 patients (12.4%) in the non-pemphigus cohort. Pemphigus patients had higher death rate than the non-pemphigus cohort (adjusted HR [95% CI]: 1.69 [1.37–2.09];unadjusted HR [95% CI]: 1.33 [1.09–1.63];PSM HR [95% CI]: 1.49 [1.19–1.86];P <.01 for all). Similar results were observed in the sensitivity analysis (adjusted HR [95% CI]: 1.77 [1.41–2.23];P <.01);PSM HR [95% CI]: 1.52 [1.20–1.93];P <.01]). Infections, hypertension, diabetes, hematologic abnormalities, and cardiovascular comorbidities were strongly associated with mortality in pemphigus patients. Conclusions: These results suggest that pemphigus is associated with increased mortality observed over 4 years, highlighting the need for better treatment options for these patients.

Mortality in patients with pemphigus: a retrospective US claims database study

Objective: We evaluated mortality in patients with pemphigus compared with nonpemphigus individuals matched on age and gender, in the United States (US). Methods: This retrospective cohort study used data from the US Optum Clinformatics claims database between May 1, 2000 and December 31, 2020. Mortality was assessed during a follow-up of up to 4 years after the index date (first pemphigus diagnosis). A sensitivity analysis was conducted (end of study period, March 31, 2020) to exclude the potential impact of COVID-19 on mortality analysis. Multivariable models (comorbidities as adjustment variables) were used to assess hazard ratios (HRs). Propensity score matched (PSM) model was used to minimize comorbidities difference at baseline. Results: Overall, 1391 patients with pemphigus (ICD-9 and ICD-10 codes) were identified (mean [SD] age: 63.7 [17.9] years;females: 57.0%). During follow-up, 227 patients (16.3%) died in the pemphigus cohort, compared with 172 patients (12.4%) in the nonpemphigus cohort. Pemphigus patients had higher death rate than the nonpemphigus cohort (adjusted HR [95% CI]: 1.69 [1.37–2.09];unadjusted HR [95% CI]: 1.33 [1.09–1.63];PSM HR [95% CI]: 1.49 [1.19–1.86];P <.01 for all). Similar results were observed in the sensitivity analysis (adjusted HR [95% CI]: 1.77 [1.41–2.23];P <.01);PSM HR [95% CI]: 1.52 [1.20–1.93];P <.01]). Infections, hypertension, diabetes, hematologic abnormalities, and cardiovascular comorbidities were strongly associated with mortality in pemphigus patients. Conclusions: These results suggest that pemphigus is associated with increased mortality observed over 4 years, highlighting the need for better treatment options for these patients.

THE USE of ORAL AMINO-BISPHOSPHONATES and CORONAVIRUS DISEASE 2019 (COVID-19) OUTCOMES

Background: The determinants of the susceptibility to SARS-CoV-2 infection and severe Coronavirus Disease 19 (COVID-19) manifestations are yet not fully understood. Amino-bisphosphonates (N-BPs) have anti-infammatory properties and have been shown to reduce the incidence of lower respiratory infections, cardiovascular events and cancer. Objectives: We conducted a population-based retrospective observational case control study with the primary objective of determining if oral N-BPs treatment can play a role in thesusceptibility to the development of severe COVID-19. Methods: Administrative ICD-9-CM and AT C data, representative of Italian population (9% sample of the overallpopulation), were analyzed. Oral N-BPs (mainly alendronate and risedronate) were included in the analysis. Patients treated with bisphosphonates (cases) were randomly matched (1:1 ratio) for age, sex and for other clinically relevant variables (presence of treatments other than bisphosphonates and hospitalizations) with all the health-assisted population without this treatment (controls). Results: Incidence of Covid-19 hospitalization was 12.32 [95%CI 9.61-15.04] and 11.55 [95%CI 8.91-14.20], of ICU utilization due to COVID-19 was 1.25 [95%CI 0.38-2.11] and 1.42 [95%CI 0.49-2.36] and of all-cause death was4.06 [95%CI 2.50-5.61] and 3.96 [95%CI 2.41-5.51] for oral N-BPs users and non-users, respectively (Figure 1A). Figure 1B Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated subjects with anti-osteoporotic drugs and without corticos-teroids. C. Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated without previous vertebral or hip fragility fractures. D. Incidence of COVID-19related events in bisphosphonates treated and untreated patients without previous vertebral or hip fracture without corticosteroid prescriptions. Conclusion: In conclusion, we found that the incidence of COVID-19 hospi-talization, intensive care unit (ICU) utilization and COVID-19 potentially related mortality were similar in N-BPs treated and non-treated subjects. Similar results were found in N-BPs versus other anti-osteoporotic drugs. We provided real-life data on the safety of oral N-BPs in terms of severe COVID-19 risk on a population-based cohort. Our results strongly support national and international guidelines that advocate against the discontinuation of oral bisphosphonates only for the fear of COVID-19.

STRESS-ASSOCIATED INCREASES in RHEUMATOID ARTHRITIS DISEASE ACTIVITY and FLARES during the COVID-19 PANDEMIC

Background: The novel coronavirus disease 2019 (COVID-19) pandemic has spurred global action. Beginning in March of 2020, the Southern California COVID-19 pandemic response to limit virus transmission was characterized by mandated lockdowns and quarantines, resulting in signifcant stressors for rheumatology patients and potentially threatening their disease. Objectives: To examine factors associated with changes in rheumatoid arthritis (RA) disease activity and fares in the COVID-19 pandemic. Methods: RA patients identifed by ICD-9/10 codes and active email addresses within a University of California, Los Angeles (UCLA) Rheumatology database were sent surveys via email in July and November of 2020. The survey was UCLA Institutional Review Board approved and included electronic consent and questions related to: perceptions of disease activity/remission via Routine Assessment of Patient Index Data 3 (RAPID3), fare frequency, RA fare questionnaire (RA-FQ), Perceived Stress Scale (PSS-4), and pandemic impact on stress (I.e. emotional state, apprehension, panic, helplessness, work, home, fnancial, and social distancing stress). Demographics were extracted from electronic medical records. Results were examined via descriptive analyses, Pearson correlations, and chi-square test for comparisons plus linear stepwise regressions where appropriate to evaluate the relationship between stress measures, RA disease activity, and fare frequency and severity. Results: Among 5037 patients surveyed, 361 in July and 4676 in Novem-ber,1128 (22.4%) responded. The study population demographics were: mean age of 57.5 ± 15.1 years, 79.4% female, racially diverse (69.6% Caucasian, 13.7 % LatinX, 9.5 % Asian, and 4.9% Black), and 62% seropositive (CCP and/or RF). Perceived disease activity and remission remained stable in most patients with 719 reporting no fares, and 409 in current fares at the time of the survey (Table 1). A minority reported perceived increases in disease activity which were associated with multiple aspects of perceived stress. At survey completion, 346 had not experienced fares, 290 had experienced one fare, and 492 had experienced multiple fares. Use of DMARDs was associated with lack of fare versus current fare (77.8% versus 71.6%, p = 0.02). The use of conventional synthetic, biologic, or targeted synthetic DMARDs were not associated with fare while current corticosteroid use was associated with fare (9.3% without fare and 20.8% with fare, p < 0.0001). Current fare was associated with increased PSS-4 scores (odds ratio (OR): 1.17 (95% confdence interval: 1.12-1.22, p < 0.0001). Figure 1 describes the odds ratio of experiencing aspects of stress with the presence of RA fare. Conclusion: In a large survey population of RA patients during the COVID-19 pandemic, multiple aspects of stress were found to correlate with RA disease activity and fare.

FIRST, SECOND AND THIRD COVID-19 PANDEMIC WAVES AND THEIR DIFFERENT IMPACTS ON STROKE CARE: EVIDENCES FROM THE TUSCANY STROKE NETWORK

Background and aims: We aim at describing the impact of the first, second and third waves of the COVID-19 pandemic on stroke services in Tuscany. We measured the global impact of the COVID-19 pandemic on the volumes of both intracranial hemmorhage (ICH) and acute ischemic stroke (AIS) hospitalizations, as well as of reperfusion treatments throughout the pandemic years 2020-21 (January1, 2020 -June 30, 2021) compared with the year 2019 control period. Methods: Retrospective, observational, multicenter study, across 3 huband- spoke stroke systems, and 22 stroke hospitals. The diagnoses were identified by their ICD-9 CM codes and/or classifications in stroke databases at participating centers. Results: In comparison with the same periods of 2019, the hospitalization volumes for ICHs and for AIS declined by 26% and 30.1% respectively during the fist pandemic wave, by 11% and 24.6% during the second wave, and by 2.5% and 4% during the third wave. Reperfusion treatments decreased by 15% during the first wave, and by 11.4% and 0.3% during the second and third waves respectively. Treated patients' functional outcome at 90days did not vary throughout the pandemic waves. Casefatality at 30days increased from 10.3% to 10.8% for AIS, and from 26.5% to 27.6% for ICH before and after the COVID-19 outbreak. Conclusions: The COVID-19 pandemic waves were associated with a decreasing decline in the volume of stroke hospitalizations, nevertheless fewer and probably the most severe patients were able to reach the hospital within the therapeutic windows. We observed different pattern of variations across the three hub-and-spoke systems.

Should Lactate Be Included in Assessing Risk for Acute Pulmonary Embolism - A Single Center Retrospective Analysis

Introduction: Pulmonary embolism (PE) is a common form of thromboembolism which has a variable and non-specific presentation that can often be fatal. The Simplified Pulmonary Embolism Severity Index (sPESI) which includes hemodynamic parameters of perfusion has been shown to correlate with 30-day mortality in patients with acute PE. The purpose of this quality improvement project was to compare how lactate and sPESI perform in predicting clinical outcomes at our institution with the hopes of developing institutional guidelines for management of patients admitted with an acute PE. Methods: We conducted a single center retrospective analysis on patients admitted to the intensive care unit with a new diagnosis of PE between the years 2016-2021. Patients were identified using ICD-9 CM codes. Exclusion criteria included current or prior positive testing for SARS-CoV-2 (COVID-19). We performed univariant, multivariant, and ROC (Receiver Operating Characteristic) analysis to assess correlations between all cause mortality, lactate elevation, and sPESI. Our covariants included age, sex, Body Mass Index, prior or current history emphysema/COPD, smoking, CKD, diabetes, cancer, atrial fibrillation, and CHF. All analysis was carried out using software R version 3.6.3. Results: Of the 161 patients who were included in the study, the mean age was 60 years (SD 17 years) and 38% (61/161) were females. 31 patients (19.3%) were deceased. Mean BMI of study participants was 29.9 kg/m2. Comorbidities included 9.9% (16/161) with emphysema/COPD, 44% (71/161) with active or prior history of smoking, 6% (10/161) with CKD, 12% (20/161) with diabetes, 15% (24/161) with diagnosis of cancer, 15% (24/161) with atrial fibrillation, 15% (24/161) with history of CHF. We found that in univariant analysis, both sPESI (p=3.4∗10∧-6, AUC = 0.74) and lactate (p=1.1∗10∧-7, AUC = 0.71) correlate with mortality. When included in the same multivariant model, both lactate (p=1.3∗10∧-5) and sPESI (p=3.2∗10∧-4) retained their statistical significance with mortality. Conclusion: As in previous studies, our analysis confirms these results (lactate p=1.1∗10∧-7;AUC = 0.71, sPESI p=3.4∗10∧-6, AUC = 0.74). However, we also demonstrate that both lactate and sPESI retain statistical significance when both are included in the same multivariant model (p-value for lactate = 1.3∗10∧-5, p-value for sPESI = 3.2∗10∧-4). Thus, both lactate and sPESI each demonstrate independent statistical significance, contributing to prediction of mortality. This finding makes a compelling case for inclusion of lactate in risk stratification models used by Pulmonary Embolism Response Teams (PERT) across institutions for triaging the management of acute pulmonary embolism in the hospital.

Trends in Patients at Risk for Prolonged Mechanical Ventilation, 2011-2019

Rationale Patients receiving what has been termed “prolonged acute mechanical ventilation” (PAMV, i.e. mechanical ventilation [MV] >96 hours) consume a disproportionate share of hospital and post-acute resources, and a third progress to prolonged mechanical ventilation (MV>14-21 days). Prior estimates (based on 2000-2008 annual growth rates) projected that the incidence of PAMV in 2020 could overwhelm healthcare systems. However, actual trends in incidence and outcomes of PAMV in the last decade, especially just preceding the COVID-19 pandemic, are unclear. Methods Using Medicare Provider Analysis and Review and Master Beneficiary Summary Files from the Center for Medicare and Medicaid Services, we conducted a retrospective cohort study of Medicare fee-for-service beneficiaries >65 years hospitalized between January 1, 2011- December 31, 2019 with admission to an intensive care unit (ICU) who received PAMV (MV>96 hours [ICD-9 96.72 or ICD-10 5A1955Z procedure codes]). We determined annual rates of PAMV out of total MV (ICD-9 96.7, 96.71, 96.72;ICD10 5A1935Z, 5A1945Z, 5A1955Z) and used US Census Bureau population estimates of adults >65 years to derive annual populationstandardized rates of PAMV. Among patients receiving PAMV, we determined annual rates of tracheostomies, median hospital and ICU length of stay, discharge destination, and 90-day and 1-year mortality. We tested for significant trends with Cochrane- Armitage (binary), Cochran-Mantel-Haenszel (categorical) and Jonckheere-Terpstra (continuous outcomes) tests. Results From 2011-2019, a total of 646,677 patients met inclusion criteria. Population-standardized incidence of PAMV decreased from 189 per 100,000 adults >65 years to 112 per 100,000 adults (78,504 to 60,625 individuals, p<0.001), concurrent with a decrease in the total MV population (210,791 to 189,414) and decrease in proportion of PAMV/MV (37% to 32%) (Figure 1). Tracheostomy rates among patients receiving PAMV declined from 21% to 17.5% (p<0.001). Median ICU and hospital length of stay declined from 13 to 12 days (p<0.001) and 16 to 15 days (p<0.001), respectively. Discharge to long-term acute care hospitals was stable at ∼17%;discharge to skilled nursing facilities decreased from 22% to 20% and discharge to hospice increased from 7% to 10% (p<0.001). 90-day mortality increased slightly (61.2% to 62.3% [p=0.01]);1-year mortality remained stable (∼72% [p=0.19]). Conclusions Contrary to prior estimates, the incidence of PAMV declined from 2011-2019. Furthermore, tracheostomy placement and skilled nursing facility use declined with a concurrent increase in hospice use, trends that may reflect improved alignment with patient goals of care. The impact of COVID-19 on incidence of PAMV is unclear. (Figure Presented).

Guillain-Barré Syndrome During the COVID-19 Pandemic

Objective: We are investigating whether COVID-19 infection increases the propensity of developing Guillain-Barré Syndrome (GBS) or affects the clinical outcome of GBS. Background: During the pandemic, there have been many case reports and case series of GBS following COVID-19 infection. The causality of COVID-19 in these cases is not clear. There are conflicting reports regarding the incidence of GBS during the pandemic. In prior literature, clinical and electrophysiologic characteristics of GBS in COVID-19 associated cases did not differ from the previously described natural history. Design/Methods: Longitudinal electronic health record database for Optum, which included more than 4.4 million patients who underwent testing for COVID-19, was queried in May 2021 for ICD-9 and ICD-10 codes for GBS. Clinical information based on billing codes was acquired. GBS cases within 60 days of the first positive PCR test for COVID-19 were further analyzed. We also evaluated the presence of GBS in patients who tested negative for COVID 19 during the same time frame. Results: There were 725,347 patients in the database with COVID-19 diagnosis. We analyzed 844 patients with GBS, 86 of which occurred within 60 days of COVID-19 diagnosis. The incidence of GBS was not increased among the patients with recent COVID 19 diagnosis, compared to the GBS cases without COVID 19 in the same time frame. In our preliminary analysis, COVID-19 associated cases had higher mortality, intubation rates, and need for posthospital rehabilitation at a facility. Conclusions: Our preliminary analysis of this large database did not show any evidence that COVID-19 increases the propensity for developing GBS. However, when associated with COVID-19 infection, the outcomes for GBS seem to be worse. Further ongoing analyses considering covariates of age, comorbidities, and month of COVID-19 diagnosis is planned.

Attention-based clinical note summarization

In recent years, the trend of deploying digital systems in numerous industries has hiked. The health sector has observed an extensive adoption of digital systems and services that generate significant medical records. Electronic health records contain valuable information for prospective and retrospective analysis that is often not entirely exploited because of the complicated dense information storage. The crude purpose of condensing health records is to select the information that holds most characteristics of the original documents based on a reported disease. These summaries may boost diagnosis and save a doctor's time during a saturated workload situation like the COVID-19 pandemic. In this paper, we are applying a multi-head attention-based mechanism to perform extractive summarization of meaningful phrases on clinical notes. Our method finds major sentences for a summary by correlating tokens, segments, and positional embeddings of sentences in a clinical note. The model outputs attention scores that are statistically transformed to extract critical phrases for visualization on the heat-mapping tool and for human use. © 2022 ACM.

Low-dose ionizing radiation as a factor increasing cardiovascular mortality: Is there a risk from multiple computed tomographies in the context of COVID-19 pandemic?

The review aim was to familiarize biomedical professionals with the latest evidence-based data on the effect of sparsely ionizing radiation (X-ray, γ- and β-radiation) on cardiovascular mortality (ICD-9: 390-459;ICD-10: I00-I99), which is especially important during the coronavirus disease 2019 (COVID-19) pandemic due to the increased use of computed tomography (CT) and X-ray procedures. Information is presented on the officially accepted range of radiation doses (very low doses — 0-0,01 Gy, low doses — 0,01-0,1 Gy, moderate doses — 0,11,0 Gy, high doses — over 1 Gy). The evolution of ideas about the effects of radiation on the prevalence of cardiovascular diseases is discussed: From high and very high doses to the declaration in recent years of the possible effect of low doses. The statements from the documents of authoritative radiation organizations (UNSCEAR, ICRP, NCRP, EPA, etc.) are given, according to which the threshold for increasing cardiovascular mortality is 0,5 Gy (range of moderate doses), and there are no epidemiological justifications for the effects of low doses. According to a data for six countries, the maximum cumulative doses from multiple CT scans for COVID-19 diagnosis are one order less than the threshold dose, and the average cumulative doses are two orders less. Data on the absence or low risk of cancer after CT for this reason are also presented.

Environmental factors linked to hospital admissions in young children due to acute viral lower respiratory infections: A bidirectional case-crossover study.

OBJECTIVE: This study evaluated the association of the short-term exposure to environmental factors (relative humidity, temperature, NO2, SO2, O3, PM10, and CO) with hospital admissions due to acute viral lower respiratory infections (ALRI) in children under two years before the COVID-19 era. METHODS: We performed a bidirectional case-crossover study in 30,445 children with ALRI under two years of age in the Spanish Minimum Basic Data Set (MBDS) from 2013 to 2015. Environmental data were obtained from Spain's State Meteorological Agency (AEMET). The association was assessed by conditional logistic regression. RESULTS: Lower temperature one week before the day of the event (hospital admission) (q-value = 0.012) and higher relative humidity one week (q-value = 0.003) and two weeks (q-value<0.001) before the day of the event were related to a higher odds of hospital admissions. Higher NO2 levels two weeks before the event were associated with hospital admissions (q-value<0.001). Moreover, higher concentrations on the day of the event for SO2 (compared to lag time of 1-week (q-value = 0.026) and 2-weeks (q-value<0.001)), O3 (compared to lag time of 3-days (q-value<0.001), 1-week (q-value<0.001), and 2-weeks (q-value<0.001)), and PM10 (compared to lag time of 2-weeks (q-value<0.001)) were related to an increased odds of hospital admissions for viral ALRI. CONCLUSION: Short-term exposure to environmental factors (climatic conditions and ambient air contaminants) was linked to a higher likelihood of hospital admissions due to ALRI. Our findings emphasize the importance of monitoring environmental factors to assess the odds of ALRI hospital admissions and plan public health resources.