Information System Development for Web Based Routine Reporting of Pneumonia in Acute Respiratory Infection Control Program at Semarang District Health Office

Evaluation activities for a program of Acute Respiratory Tract Infection Disease Control at SemarangDistrict Health Office were not optimal because required information from a routine report couldnot be used to support evaluation activities. Some problems existing on current information systemof pneumonia routine reporting were as follows: an officer had a difficulty to change or re-access pneumonia information, resulted information was incomplete and unclear, and submission of areport was not timely. This research aimed to develop information system of Pneumonia routinereporting based on web on the program of Acute Respiratory Tract Infection Disease Control atSemarang District Health Office.Design of this research was pre-experiment with one group pretest-posttest approach. In addition,development of the system used the methods of Framework for the Application of System Techniques(FAST). Subjects consisted of a system user at District Health Office and four pilot health centers.Data were collected using methods of observation, indepth interview, and a closed-endedquestionnaire. Furthermore, data were analyzed using content analysis and Wilcoxon test.This research resulted information system of Pneumonia routine reporting based on web on theprogram of Acute Respiratory Tract Infection Disease Control to solve problems happened in theold system. The result of Wilcoxon test revealed that there were any quality differences of informationin terms of the aspect of easiness (p=0.0001), the aspect of completeness (p=0.0001), the aspect ofclarity (p=0.0001), and the aspect of timeliness (p=0.0001) before and after developing theinformation system.As a suggestion, Semarang District Health Office needs to have commitment to optimally operatethe new system. Additionally, data reported from health centers to District Health Office must beaccurate in accordance with reality in the fields

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Feasibility of the duration of actigraphy data to illustrate circadian rhythm among cognitively intact older people in nursing home: cosinor analysis

Assessment of sleep is an important determinant of health. Moreover, sleep assessment is quite difficult in elderly people; getting consent for participation in the study, spending more time due to cognitive and communicative disruptions, having difficulties in accessing to individuals, and higher withdrawal rate of elderly people than adults occur as additional difficulties. The objective of the study was to determine whether 1-day measurement could be enough to determine the circadian rhythm of cognitively intact older adults in nursing home. A sample of the study consisted of individuals living in three nursing homes with similar environmental conditions and who were independent in daily living activities. The exclusion criteria were severe health problems, severe neurological and mental diseases, and severe hearing loss and cognitive impairment. Continuous actigraphy monitoring was performed in 52 older adults who met the sampling criteria over a 4-day period. Cycle mesor, amplitude, acrophase, and R-2, calculated using 1 to 4 days of data and each day of data, were compared. For amplitude, acrophase and R-2 parameters, there was no statistically significant difference between 4-day measurement and 1-day measurement (p > 0.05). However, for mesor parameter, there was no significant difference between 1-day, 2-day, and 3-day measurements, and differentiation was observed in 4-day measurements. A daily measurement could be used to determine the circadian rhythm of actigraphy in cognitively intact older adults in nursing home. However, further studies are required to better understand and support our findings

Feasibility of the duration of actigraphy data to illustrate circadian rhythm among cognitively intact older people in nursing home: cosinor analysis

Assessment of sleep is an important determinant of health. Moreover, sleep assessment is quite difficult in elderly people; getting consent for participation in the study, spending more time due to cognitive and communicative disruptions, having difficulties in accessing to individuals, and higher withdrawal rate of elderly people than adults occur as additional difficulties. The objective of the study was to determine whether 1-day measurement could be enough to determine the circadian rhythm of cognitively intact older adults in nursing home. A sample of the study consisted of individuals living in three nursing homes with similar environmental conditions and who were independent in daily living activities. The exclusion criteria were severe health problems, severe neurological and mental diseases, and severe hearing loss and cognitive impairment. Continuous actigraphy monitoring was performed in 52 older adults who met the sampling criteria over a 4-day period. Cycle mesor, amplitude, acrophase, and R-2, calculated using 1 to 4 days of data and each day of data, were compared. For amplitude, acrophase and R-2 parameters, there was no statistically significant difference between 4-day measurement and 1-day measurement (p > 0.05). However, for mesor parameter, there was no significant difference between 1-day, 2-day, and 3-day measurements, and differentiation was observed in 4-day measurements. A daily measurement could be used to determine the circadian rhythm of actigraphy in cognitively intact older adults in nursing home. However, further studies are required to better understand and support our findings