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Aims: Most type 2 diabetes (T2D) studies have predominantly enrolled White people aged <65 years. This retrospective study evaluated outcomes for iGlarLixi (fixed‐ratio combination [FRC] of insulin glargine 100 U/mL and lixisenatide) versus basal–bolus or premixed insulin in African American, Asian and Hispanic adults with T2D aged ≥65 years. Methods: Medicare claims data were assessed from beneficiaries receiving basal insulin who newly initiated iGlarLixi, basal–bolus insulin, or premixed insulin between 7/1/2019 and 12/30/2021. Groups were propensity score matched at baseline and followed for up to 12 months. Endpoints (primary: treatment persistence; secondary: treatment adherence, hypoglycaemia event rates, healthcare resource utilisation) were assessed using multivariable regression. Results: Treatment persistence was higher for iGlarLixi versus basal–bolus or premixed insulin in the overall population (26.9%, 7.6%, 18.9%; adjusted p < 0.0001) and numerically higher in all ethnic subgroups. Treatment adherence was numerically higher for iGlarLixi versus basal–bolus or premixed insulin in the overall population (28.0%, 8.0%, 19.0%) and in all subgroups. Hypoglycaemia event rates were numerically lower for iGlarLixi versus basal–bolus insulin or premixed insulin in the overall population (2.5, 3.8, 7.5/100 person‐years' follow‐up) and in all subgroups except Asians receiving basal–bolus insulin. All‐cause and diabetes‐related hospitalisation and emergency department visit event rates were lower with iGlarLixi versus basal–bolus insulin or premixed insulin in the overall population, and in all subgroups except for hospitalisations in Hispanics. Conclusion: FRC therapies such as iGlarLixi represent an appropriate treatment option when intensifying basal insulin therapy in ethnic minority older adults with T2D. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Healthcare systems need to address the high healthcare use of frail older adults. The Geriatric Services Hub (GSH) is a novel program in Singapore that delivers frailty screening, comprehensive geriatric assessment and coordinated care for community‐dwelling older persons with bio‐psycho‐social needs. We aimed to evaluate the effects of the GSH on healthcare use.We compared healthcare utilization of 634 GSH participants with 634 unique propensity score‐matched non‐GSH community‐dwelling older adults at 12 months before and after GSH enrolment. Baseline matching covariates included demographics, socioeconomic status, disease burden, calendar quarter of enrolment, and past healthcare utilization. We did exact matching on frailty categories (Clinical Frailty Score (CFS) score 4, 5, and 6–7). Difference‐in‐differences technique was used to derive effect estimates.After propensity score matching, baseline covariates were adequately balanced. Healthcare utilization declined in both groups after GSH enrolment. Relative to the comparators and after accounting for pre‐enrolment differences, participation in the GSH was associated with greater primary care (mean difference: 0.06, 95% CI−0.64 to 0.77) and specialist outpatient clinic visits (mean difference: 0.42, 95% CI −0.29 to 1.13), and fewer emergency department visits (mean difference: −0.18, 95% CI −0.69 to 0.34). However, these effects did not reach statistical significance. While number of hospitalizations did not differ between the groups, cumulative length of stay differed by 1.15 bed‐days and was not statistically significant. No statistically significant differences were observed within CFS groups.GSH was not associated with significant reductions in healthcare use in the first year of enrolment. Higher utilization of primary care and specialist outpatient clinic services could reflect the increased identification of care needs with the potential to reduce unnecessary healthcare use such as emergency department visits. Prospective studies with a longer follow‐up would ascertain if the GSH translates to reduced healthcare utilization as hypothesized. [ABSTRACT FROM AUTHOR]

Objective Study Setting and Design Data Sources and Analytic Sample Principal Findings Conclusions To compare healthcare services utilization across the healthcare system between frequent and non‐frequent emergency department (ED) users among Medicaid enrollees in South Carolina.We conducted a retrospective, longitudinal study of individuals with at least one ED visit in 2017 in South Carolina and identified their healthcare services visits over 730 days (2 years) after their first ED visit. We classified individuals based on intensity of ED use: superfrequent (≥9 ED visits/year), frequent (4–8 ED visits/year), and non‐frequent ED users (≤3 visits/year). We estimated differences between the three groups of ED users and non‐ED hospital and office‐based visits using multivariable two‐part regression models.We used statewide Medicaid claims from January 2017 to December 2019 for ED users aged 18–64 years with continuous Medicaid enrollment. We analyzed data on all frequent and superfrequent users and selected a 4:1 random sample among all non‐frequent users (~half of all non‐frequent users).The study included 52,845 ED users, of whom 42,764 were non‐frequent, 7677 frequent, and 2404 superfrequent users. Within 2 years from the date of their first ED visit, superfrequent ED users averaged 38.3 ED visits, frequent ED users 10.9 ED visits, and non‐frequent ED users 2.6 ED visits (p < 0.001). Compared with non‐frequent users, frequent and superfrequent ED users had more comorbidities and chronic conditions on average (1.6 vs. 3.5 vs. 6.4, p < 0.001). Both frequent and superfrequent users had more hospital visits beyond the ED overall (marginal effects: 0.23, 95% CI 0.18–0.27; 0.40, 95% CI 0.29–0.50), and more outpatient office visits overall (marginal effects: 4.39, 95% CI 2.52–6.27; 9.23, 95% CI 5.66–12.81), including primary care and most specialists' visits, compared with non‐frequent users.Frequent ED users utilized non‐ED hospital and outpatient office‐based healthcare services significantly more than non‐frequent ED users. These findings can guide tailored interventions using data across the healthcare system to efficiently coordinate care, contain costs, and improve health outcomes for these individuals. [ABSTRACT FROM AUTHOR]

The article "Myeloproliferative Neoplasms and Dementia Risk: A Population-Based Cohort Study" published in the European Journal of Haematology in 2025 explores the association between Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) and dementia risk. The study, conducted in Denmark, found that patients with MPNs had a 1.15-fold increased incidence of dementia compared to the general population, with a stronger association observed in men with MPNs. Chronic inflammation in MPNs was highlighted as a potential risk factor for dementia development. The study also used chronic lymphocytic leukemia (CLL) as a control disease, showing a decreased dementia incidence in CLL patients. Further research is needed to understand the gender-specific differences and potential preventive strategies for dementia in MPN patients. [Extracted from the article]

Aim: Safer Care Victoria updated a clinical guideline on extreme prematurity in 2020, reducing the threshold for offering resuscitation from 23 to 22 weeks gestation. The zone of parental discretion is the interval of shared decision‐making between parents and doctors regarding resuscitation decisions. It is especially relevant at this periviable gestation. Our study aimed to establish current practices in antenatal counselling and steroid administration at this cusp of viability, and examine the decisions made during the zone of parental discretion. Methods: Single centre retrospective cohort study. Sixteen thousand three hundred fifty‐four admissions and emergency department presentations between January 2021 and July 2023 were retrieved from Birthing Outcomes System (BOS) and patient details were imported and manually reviewed on Microsoft Excel, with particular note to the gestation at admission/emergency department presentation and duration of admission. Eighty‐seven patients were identified as present in the hospital between 21 + 0 and 22 + 6 weeks gestation. These 87 scanned records on Clinical Patient Folder (CPF) were then manually reviewed to identify if antenatal counselling occurred during this window. Thirty‐six patients were included who received antenatal counselling between 21 + 0 and 22 + 6 weeks gestation (the remaining patients did not receive antenatal counselling during this window), and relevant data was subsequently extracted from the scanned medical record and analysed using SPSS software (IBM SPSS Statistics 29). Results: Thirty‐six women received antenatal counselling between 21 + 0 and 22 + 6 weeks. 58% decided on full resuscitation and 39% opted for comfort care if their infant was to be born between 22 + 0 and 22 + 6 weeks. All but one baby born premature were exposed to steroids, with 83.3% receiving a full course. Twenty‐eight infants (62.2%) were fully steroid loaded at the time of delivery. In those fully steroid loaded, 31.1% of the time steroids were initiated prior to transfer, 50% of the time deferred until neonatal review and a decision regarding the resuscitation status of the baby, and on one occasion requested by the neonatologist before counselling. Conclusion: Patients at risk for premature birth who attended our hospital at the cusp of viability were generally counselled about the opportunity for resuscitation between 22 + 0 and 22 + 6 weeks gestational age, and offered steroids. Further studies are required to establish whether the content of antenatal counselling, and the timing of steroids, are consistent in this population. [ABSTRACT FROM AUTHOR]

This study presents findings from a cost and activity analysis of a citywide hospital‐based patient navigation program to engage women in timely breast cancer treatment post‐diagnosis. The information may be useful for payors in reimbursing navigation activities and health systems in planning for high quality navigation programs to ensure patient‐centered and timely treatment for women diagnosed with breast cancer. Background: Patient navigation is an evidence‐based intervention for reducing delays in cancer care for underserved populations. There are limited economic evaluations of patient navigation in the US health care system and few have considered costs at various phases along the implementation spectrum. Having economic data, including costs and cost savings, can support sustainability of patient navigation programs. This study presents findings from a cost and activity analysis of a citywide hospital‐based patient navigation program to engage women in timely breast cancer treatment post‐diagnosis. Methods: This study was conducted as part of Translating Research Into Practice (TRIP), a citywide patient navigation hybrid effectiveness‐implementation research study conducted at five cancer care hospitals in Boston, Massachusetts. The authors surveyed participating patient navigators and supervisors about their tasks and level of effort over consecutive 10‐day periods from 2019 to 2021. Patient navigators documented the time spent on activities in accordance with an 11‐step protocol across five sites. Cost data were collected from annual fiscal year end expenditure hospital administrative databases at concurrent time frames. Descriptive analyses were used to calculate average time on tasks, cost per activity and cost per outcome. Cost savings were estimated by calculating the additional persons engaged in timely entry to treatment compared to a matched control group with respect to hospitalization and emergency room costs averted. Results: Average time spent per day on TRIP‐specific navigation activities was approximately 3 hours (range, 0–8 hours) and the average time per patient per day was 25 minutes (n = 7 navigators). Total costs for clinical site interventions were $218,394 for startup and $392,407 for maintenance costs over the study period. A total of 223 patients were served during the intervention period with an average cost per patient of $979 for startup and $1759 for maintenance. Potential costs savings with the TRIP navigation program from averted hospitalization and emergency room visits for 63 additional patients who received timely treatment is estimated at $21,798–$30,429 and $2536–$5692 per patient, respectively, compared to treatment as usual. Conclusions: The economic evaluation in this study provides insight into startup and implementation costs for uptake and scalability of navigation programs across a citywide system. The information may be useful for payors in reimbursing navigation activities and health systems in planning for high quality navigation programs to ensure patient‐centered and timely treatment for women diagnosed with breast cancer. [ABSTRACT FROM AUTHOR]

Introduction: The shared risk profiles for cancer and heart disease suggest many individuals with cancer may have an implantable cardioverter defibrillator (ICD). ICDs can have dramatic cancer end‐of‐life care implications including painful and distressing shocks. ICD prevalence and association with aggressive end‐of‐life care among individuals with breast, colorectal, and pancreatic cancer was evaluated using the Surveillance, Epidemiology, and End Results‐Medicare dataset. Methods: A total of 37,306 Medicare beneficiaries aged ≥66 years with stage 3 or 4 cancer who died between 2005 and 2016 were identified. ICD prevalence, ICD‐related care utilization that might present opportunities to discuss end‐of‐life implications and association with aggressive end‐of‐life care (>1 emergency department visit, intensive care unit admission, >1 hospitalization, terminal hospitalization, chemotherapy, and invasive or life‐extending procedures) in the last month of life was assessed using multivariable logistic regression. Results: Among cancer decedents, 6% had an ICD. More individuals with an ICD (31%) died in the hospital than individuals without an ICD (25%; p <.001). Half (46%) of individuals with an ICD had device programming or interrogation visits that could be an opportunity for device discussion. In adjusted models, ICD presence was associated with higher odds of every indicator of aggressive end‐of‐life care other than chemotherapy. Conclusion: Many older cancer decedents in the United States had an ICD, and those with ICDs received more aggressive care at the end of life. Results suggest there are opportunities to discuss ICD and goals of care, raise awareness and encourage shared decision‐making for this population to ensure goal‐concordant care, and improve end‐of‐life care quality. Many cancer decedents in the United States had an implantable cardioverter defibrillator (ICD), and those with ICDs received more aggressive care at the end of life. Results suggest there are opportunities to discuss ICD and goals of care, raise awareness, and encourage shared decision‐making for this population to ensure goal‐concordant care and improve end‐of‐life care quality. [ABSTRACT FROM AUTHOR]

Background: The Veterans Affairs Nebraska Western Iowa Health Care System (VA‐NWIHCS) uses teleoncology and remote systemic cancer therapy services to expand care to veterans in rural Nebraska via remote sites in Lincoln and Grand Island. This study compares clinical outcomes in patients receiving care at these remote sites to those at the primary site in Omaha. Methods: Data were retrospectively reviewed for 151 patients who received first‐line systemic therapy at VA sites in Omaha, Lincoln, or Grand Island between January 1, 2018, and December 31, 2020. This included patient demographics, malignancy type and stage, survival, systemic therapy received, treatment intent and toxicities, missed or delayed cycles, and frequency of hospitalizations or emergency department visits. SAS version 9.4 was used for analysis. Results: The study population included 108 patients who received their systemic therapy in Omaha, whereas 43 received therapy at the remote sites. The demographic of both populations was predominantly male with a median age of 69 years and Eastern Cooperative Oncology Group Performance Status of 0 to 1. The two groups were comparable in terms of comorbidities. Both populations had a similar distribution of cancer types, proportion of patients with stage IV disease, and treatment with curative intent. There was no difference in 1‐ and 2‐year survival, systemic therapy‐related toxicity classification and prevalence, number of delayed/missed cycles, and hospitalization/emergency department visits. Conclusion: Evaluated outcomes in patients treated in Omaha versus remote sites via teleoncology under the same providers were similar. Effective oncology care, including systemic therapy, can be provided via teleoncology, and this model can help mitigate issues with access to care. Disparities in the delivery of high‐quality, cancer‐directed systemic therapy arise from a variety of factors including patient proximity to treatment centers. Use of teleoncology and remote systemic therapy administration can help to alleviate these barriers to cancer‐directed therapies. [ABSTRACT FROM AUTHOR]

The document provides abstracts of presentations and demonstrations from the 2024 MCBK North American chapter meeting, covering topics such as ontologization of OMOP data, interoperability standards for biomedical knowledge, and managing AI bias in healthcare. Demonstrations include ensemble reasoning, automated CBK deployment, and a knowledge object for computable biomedical knowledge. The text introduces Overture, an open-source modular software suite designed to streamline the gathering, organizing, and sharing of genomics data, aiming to make large-scale genomics data cost-effective and accessible for researchers worldwide. [Extracted from the article]

Objective: The objective of this study was to examine whether obesity without preexisting or gestational comorbidities is associated with postpartum hospital use (PHU). Methods: We studied 2016 to 2018 birth certificate and discharge data on 178,729 New York City births without International Classification of Diseases, Tenth Revision (ICD‐10) codes at delivery for diabetes; hypertension; placental disease; anemia; thyrotoxicosis; bariatric surgery; and pulmonary, cardiac, renal, bleeding, autoimmune, digestive, neuromuscular, mental, or substance‐use disorders. We defined PHU as ≥1 readmission or emergency department visit within 30 days of delivery discharge. We used ICD‐10 codes to specify postpartum hypertension, infection, or hemorrhage during PHU (i.e., "cause‐specific PHU") because these are leading mortality causes. We examined associations between prepregnancy BMI and PHU using multivariable logistic regression. Results: PHU incidence was 3.7% for those with normal weight, 5.1% for those with overweight, 6.3% for those with class 1 or 2 obesity, and 9.1% for those with class 3 obesity. A positive association persisted after adjustment. Obesity was associated with cause‐specific PHU of postpartum hypertension (adjusted odds ratio [aOR]: 2.2, 95% confidence limits [CL]: 1.8–2.7, normal weight referent) and wound infection (aOR: 1.5, 95% CL: 1.2–1.8), but not hemorrhage (aOR: 0.9, 95% CL: 0.7–1.3), mastitis, or genitourinary infection (aOR: 1.1, 95% CL: 0.9–1.3). Conclusions: Among individuals without other comorbidities, elevated BMI was associated with PHU. Findings can inform obstetric management to reduce morbidity during the critical fourth trimester. [ABSTRACT FROM AUTHOR]

In 2018, Idaho became the first state to grant broad prescriptive authority to pharmacists for select medications, such as rescue inhalers (a drug to prevent and treat asthmatic symptoms) and insulin pen needles (for people with diabetes). We analyze the impact of this reform on Medicare beneficiaries' access to these time‐sensitive treatments. Our findings reveal increased Medicare Part D claims, 30‐day fills, and 30‐day supplies of albuterol sulfate and insulin pen needles following expanded pharmacist authority. This translates to approximately three additional patients per pharmacist receiving timely care, potentially preventing costly alternatives such as emergency room visits. [ABSTRACT FROM AUTHOR]

Objective: Environmental hazards and heightened neighborhood social vulnerability coexist and disproportionately affect minoritized populations. We investigated associations between exposure to adverse environmental burden concentrated in areas with high social vulnerability and care fragmentation (missed appointments, emergency department visits, and hospitalizations) and social needs (eg, food and housing insecurity) among individuals with rheumatic conditions. Methods: We identified adults receiving care in a Massachusetts multihospital system with at least two rheumatic disease codes and complete street addresses. Geocoded addresses were linked to the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social–Environmental Ranking (SER), which combines census‐tract social vulnerability variables (eg, socioeconomic status) with environmental hazards (eg, air and water pollution). Social needs were obtained from self‐reported surveys. Multilevel, multinomial regression models estimated associations between SER quartiles and care fragmentation and social need burden, accounting for demographics and comorbidities. Results: Among 16,856 individuals with rheumatic conditions, 70% were female, 6% were Black, 82% were White, and 7% resided in the highest combined social vulnerability and environmental burden (SER quartile 4) areas. Among 7,083 with social needs data, 19% experienced more than one challenge. Individuals in SER quartile 4 areas (vs quartile 1) had 2.02 (95% confidence interval [CI] 1.67–2.46) times greater odds of at least four care fragmentation occurrences (vs 0) and 2.37 (95% CI 1.73–3.25) times greater odds of at least two social needs (vs 0). Conclusion: Residence in areas of high combined adverse environmental burden and social vulnerability was associated with significantly greater odds of care fragmentation and social needs. Addressing structural factors and emerging environmental threats contributing to these adverse exposures is essential to reduce rheumatic disease care inequities. [ABSTRACT FROM AUTHOR]

Background: The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale, the Community Assessment Risk Screen (CARS), and the Emergency Admission Risk Likelihood Index (EARLI) are scales that assess the risk of emergency department (ED) visits among home health care patients. This study validated these scales and explored factors that could improve their predictive accuracy among Japanese home health care patients. Methods: This was a single‐center retrospective cohort study. The primary outcome of unplanned ED visits was used to assess the validity of the DIVERT scale, CARS, and EARLI. Additionally, we examined whether the addition of patient age and receipt of advance care planning as variables on these assessments could enhance their precision. Results: Altogether, 40 (17.8%) had at least one ED visit during the 6 months study period. In these patients, the DIVERT scale, CARS, and EARLI of the patients with ≥1 ED visit was superior compared with no ED visit (both p < 0.05). The area under the curve (AUC) of the DIVERT scale, CARS, and EARLI were 0.62, 0.59, and 0.60, respectively. Adding patient age and receipt of advance care planning improved the AUC in all three scales. Conclusions: Our findings suggest that these assessment scales could be applicable to home health care patients in Japan. Furthermore, adding age and receipt of advance care planning as variables was found to enhance the predictive accuracy of the scales. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Heavy menstrual bleeding (HMB) is a significant health concern that may lead to critical medical care and impaired quality of life. The aim of the present study was to identify the clinical indicators of common causes of HMB in adolescents and evaluate the factors influencing the treatment preferences of clinicians.Between 2010 and 2022, the electronic medical records of adolescents between the ages of 10–18 with HMB were reviewed, and a final of 205 adolescents was included. Clinical, laboratory, and treatment data were retrospectively analyzed.Hypothalamic–pituitary‐ovarian (HPO) axis immaturity was diagnosed in 63.9%, bleeding disorders (BD) in 13.7%, and polycystic ovary syndrome (PCOS) in 12.2% of the patients. The presence of “heavy bleeding” and the bleeding length at presentation were not different between the groups. Patients with a BD presented with lower hemoglobin (Hb) levels (P = 0.019), and more frequently required inpatient admissions (P = 0.005). Of all patients, 34.6% were given only iron, 44.9% were given a low dose, and 15.6% were given a high‐dose hormone treatment. Factors influencing high‐dose hormone regimens were lower Hb levels (P < 0.001), the place of visit (ER rather than the clinic) (P < 0.001), and the presence of multiple ER visits (P < 0.001).Physicians base their decisions to start high‐dose hormonal therapy on objective parameters such as Hb levels and the need for hospitalization, while more precise guidelines are deemed necessary for initiating low‐dose hormonal therapy. Standardized protocols and their practical implementation at the clinical level are needed for the management of HMB in adolescence. [ABSTRACT FROM AUTHOR]

The article discusses the potential elimination of leukocyte reduction for low titer type O whole blood (LTOWB) and its implications for transfusion resuscitation in trauma patients. While the authors suggest that removing leukocyte reduction could streamline blood processing and increase supply, they emphasize the need for stronger evidence before making such a paradigm shift. The article highlights the importance of clinical benefits, logistical challenges, and the potential impact on patient outcomes, urging further research and consideration before implementing changes in blood processing practices. [Extracted from the article]

Aims Methods and results Conclusion No study has analyzed the impact of guideline‐directed medical therapy in preventing heart failure (HF) relapse in patients with arrhythmia‐induced cardiomyopathy (AiCM) following left ventricular ejection fraction (LVEF) improvement.We analyzed data from a single‐center cohort of 200 patients admitted for HF, LVEF <50% and cardiac arrhythmia considered by cardiologists to be the precipitating cause of the episode. The primary endpoint was time‐to‐HF relapse, defined as the composite of readmission for HF, Emergency Department (ED) visit for HF, or significant decline in LVEF. Changes in medication were recorded and a time‐varying multivariate Cox regression was performed. After a median follow‐up period of 6.14 years, diagnostic confirmation was achieved in 188 out of the initial 200 patients with suspected AiCM. A total of 89 patients (47.3%) met the primary endpoint. RAS inhibitors (adjusted hazard ratio (HR) 0.50 [0.31–0.81]; p = 0.005) and beta‐blockers (adjusted HR 0.48 [0.28–0.81]; p = 0.006) were associated with a lower incidence of relapse. Mineralocorticoid receptor antagonists were associated with a significantly lower incidence of ED visits for HF (adjusted HR 0.38 [0.15–0.95]; p = 0.038), but did not achieve statistical significance for the combined primary endpoint. Antiarrhythmic drugs did not show a significant impact on the primary endpoint.Maintaining RAS inhibitors and beta‐blockers was associated with a significantly lower incidence of relapse in the setting of AiCM with improved LVEF. [ABSTRACT FROM AUTHOR]

The article published in the British Journal of Haematology explores the use of exhaled breath analysis to identify volatile organic compounds that may serve as non-invasive biomarkers for predicting vaso-occlusive events (VOEs) in sickle cell disease (SCD). The study involved collecting breath samples from SCD patients during VOEs and steady states, analyzing them using gas chromatography-mass spectrometry, and identifying specific compounds associated with VOEs. The findings suggest that certain volatile organic compounds, indicative of oxidative stress-induced lipid peroxidation, were elevated during VOEs and may offer insights into the pathophysiology of SCD. Further research is needed to validate these compounds in a larger SCD cohort and explore their potential for predicting and understanding VOEs in SCD. [Extracted from the article]

The article "Exploring Occupational Asthmagen-Related Asthma Phenotypes: A Cluster Analysis and Machine Learning Study" investigates different phenotypes of work-related asthma (WRA) using cluster analysis and machine learning. The study identifies distinct phenotypes of WRA based on occupational exposure and asthma characteristics, linking phenotype understanding to practical applications. The research aims to enhance patient care for asthmatics by predicting severe asthma and understanding the impact of occupational exposure on asthma outcomes. [Extracted from the article]

The document titled "An Algorithm for the Diagnosis and Treatment of Food Protein-Induced Enterocolitis Syndrome (FPIES), 2024 Update" provides updated information on the diagnosis and management of FPIES, a non-IgE mediated food hypersensitivity with delayed gastrointestinal symptoms. The algorithm outlines the incidence, symptoms, diagnosis, and management of FPIES, including acute, chronic, atypical, and adult-onset phenotypes. It also discusses triggers, differential diagnosis, and treatment options based on severity and patient age, emphasizing the importance of avoiding trigger foods and seeking medical attention when necessary. The document highlights the need for a high index of suspicion to minimize misdiagnosis and provides guidance on oral food challenges and long-term management strategies. [Extracted from the article]

Background Methods Results Conclusion Care gaps in routine and preventive care are common among youth. To close care gaps, health systems should take a population health approach and create opportunities for partnership, collaboration, shared learning, and scale via learning networks (LNs).We describe the Pediatric Improvement Network for Quality (PINQ), a regional population health LN with the aim of closing well‐child and mental and behavioral health (MBH) care gaps. We initially launched PINQ with 2 primary care domains: well‐child care (WCC) and MBH and later added the third domain of PINQ focused on community MBH organizations. We defined measures for the primary care WCC (well‐child visits for infants 0–15 months; lead screening by 2 years of age, childhood immunization status 3 completion) and MBH domains (depression screening in youth 12–17 years, 30‐day follow‐up for positive depression screen, mental health emergency department utilization) and established system‐level key drivers.PINQ launched in September 2022 with 7 teams (5 in primary care WCC and 2 in primary care MBH domains, respectively). All teams participate in a monthly meeting that alternates between the Action Period call and Solutions Labs. We highlight two case studies that illustrate the impact of shared learning and quality improvement support on Improvement Team efforts.We foresee PINQ as a means of moving the needle toward high quality, comprehensive health care for Greater Cincinnati youth. The next steps include growing PINQ by adding Improvement Teams and expanding the network focus to include other primary care‐centric metrics and conditions. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Reducing length of stay has been proposed as a key component of policies that aim to meet demand and minimize costs associated with total joint arthroplasty. However, few studies explore shifting of healthcare utilization when length of stay is shortened.This retrospective cohort study examined patients undergoing primary, total hip and knee arthroplasty for osteoarthritis to simulate a policy‐level institutional reduction in acute hospital stay by 1 day. Costs, quality of life, and rates of complications, readmission and discharge to inpatient rehabilitation were compared in patients with a three‐ and four‐day length of acute stay. Balance was achieved using overlap‐propensity weighting.In total, 2023 patients were included. Earlier discharge from acute hospital was not associated with a change in odds of 90‐day complications (OR: 0.85 [95% CI, 0.58 to 1.27]; P = 0.447), readmissions (OR: 1.11 [95% CI, 0.67 to 1.82]; P = 0.691), and emergency department presentations (OR: 1.07 [95% CI, 0.66 to 1.73]; P = 0.774). Earlier discharge from acute hospital was associated with an increase in odds of discharge to inpatient rehabilitation (OR: 2.16 [95% CI, 1.45 to 3.20]; P < 0.001). No significant differences in costs and quality adjusted life years were observed at one‐year. Cost savings during index admission were shifted onto increased costs associated with inpatient rehabilitation.Earlier discharge was not associated with changes in 90‐day complications, readmission, or ED presentations. However, an increase in utilization of inpatient rehabilitation was observed, offsetting early cost savings. Patients who were discharged from acute care on day three had no difference in costs compared to those discharged on day four. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection Principal Findings Conclusions To understand relationships between healthcare use and food and housing insecurity in Medicaid expansion members, as well as whether these relationships differ by rurality or residential segregation.Database of Virginia Medicaid expansion members from the Department of Medical Assistance Services. Sample included individuals who enrolled January–June 2019, were aged 19–64 years, remained continuously enrolled for 12 months, and completed a Medicaid Member Health Screening (MMHS) conducted within the first 3 months of enrollment (n = 14,735).Retrospective cohort study. Outcomes included any primary care visits (PC) and any emergency department (ED) visits in the first 12 months of enrollment. The MMHS sample was weighted to represent all Medicaid expansion members (n = 234,296). Separate multivariable linear probability models regressed having any PC or ED visits on food and housing insecurity controlling for individual and neighborhood characteristics. Models were then stratified by rurality and racial residential segregation.None.Food insecurity was negatively associated with having any PC visit (−2.9 percentage points (PP); p‐value <0.01) and positively associated with having any ED visit (7.0 PP; p‐value <0.001). No significant relationships between PC or ED visits and housing insecurity were found. Suburban and urban individuals with food insecurity were significantly less likely to have any PC visit (p < 0.05 each). Medicaid expansion members living in disproportionately low‐income or mixed‐income neighborhoods experiencing food insecurity were also less likely to have any PC visits (p < 0.05), and the same was not true for those living in disproportionately high‐income neighborhoods.Food insecurity among Medicaid expansion members is associated with less primary care and more emergency department use, but these relationships differ by the neighborhoods in which members live. Medicaid agency efforts that coordinate medical and social service benefits and also consider local context may further increase access to necessary and appropriate care. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions Our primary aim was to identify a low‐risk subgroup of older adults (aged 65 and older) presenting to ED with minor head trauma which can be safely managed without a cranial CT (cCT).This was a single‐site, prospective, observational, cohort study conducted at a major‐referral ED. Alert, haemodynamically stable, older adults with suspected head trauma were eligible. This included both community dwellers and residential aged care facility (RACF) residents. Primary outcome was the proportion of patients who had a clinically important traumatic brain injury (ciTBI) within 42 days of index ED presentation. Secondary outcomes included proportion investigated with a cCT, and proportion needing neurosurgical intervention.Two hundred seventy‐six patients (mean age 80.5 years; 53.6% female) were enrolled. The most common mechanism of injury was ground‐level fall (93.8%). One in four patients was from RACFs, 30.1% had dementia and 52.2% were on blood thinners. 80.8% had a cCT during the index ED visit. Seven (2.5%) patients had ciTBI within 42 days of index ED presentation. Patients with ciTBI had either external signs of head injury or abnormal neurological exam. All patients with ciTBI were treated conservatively after shared decision‐making.Alert, haemodynamically stable, older ED adults with suspected head trauma had a low incidence of ciTBI in the present study. Abnormal physical examination findings were consistently present in patients with ciTBI. Shared decision‐making prior to cCT may be the pragmatic way ahead in the management of this patient cohort, especially among those from RACFs. [ABSTRACT FROM AUTHOR]

Renal infarcts are uncommon, difficult to diagnose, and can lead to long‐term kidney disease. Because they have numerous etiologies and patients may present with nonspecific symptoms, renal infarcts may be mistaken for other common conditions. A 50‐year‐old woman presented to the emergency department (ED) with flank pain, nausea, and vomiting. Computed tomography (CT) revealed multiple right kidney infarcts, transthoracic echocardiography revealed mitral valve stenosis with no evidence of atrial fibrillation, and hypercoagulability tests were negative. High‐intensity anticoagulation therapy resolved the infarcts and she was discharged on warfarin. Six years later, at the age of 56, the woman again presented to the ED with back pain, nausea, vomiting, and fever. She had undergone valvuloplasty to repair the mitral valve stenosis 1 month before this ED visit, and warfarin had been discontinued shortly after the procedure. CT imaging and ultrasonography showed no evidence of infarcts and electrocardiogram was normal. Although urinalysis was negative for infection, pyelonephritis was suspected per CT results. However, renal function and leukocytosis did not improve after 2 days of antibiotic therapy. Radioisotope renal scan then revealed infarcts in the left kidney. Anticoagulation therapy again led to recovery, and the patient was discharged back on warfarin. After the recurrent infarct, monitoring and cardiac care have led to adequate long‐term management, and no evidence of atrial fibrillation has ever been observed. This case illustrates the challenging diagnosis of an unusual presentation of recurrent renal infarct, where each infarct was suspected to have a unique and independent etiology: mitral valve stenosis in the first and hypercoagulability from withdrawal of warfarin in the second. Because no clear risk or symptom profiles exist for renal infarcts, this unusual condition should be considered when patients do not respond to treatment for other renal problems, especially those with cardiovascular disease. [ABSTRACT FROM AUTHOR]

Objectives Patients and Methods Results Conclusions To investigate the differences in perioperative characteristics and postoperative outcomes between inpatient and ambulatory percutaneous nephrolithotomy (PCNL) with a subgroup analysis of same‐day discharge (SDD) patients, summarise published ambulatory pathways and compare cost and satisfaction data.This study was completed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and registered a priori with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023438692). Ambulatory PCNL was defined as patients who were discharged after an overnight stay (≤23 h) and SDD was considered a subgroup discharged on postoperative Day 0.A total of 25 studies were included in the systematic review, of which 12 comparative studies were utilised for meta‐analysis. We had a pooled population of 2463 patients, of which 1956 (79%) ambulatory (747 [30%] SDD) and 507 (21%) inpatients. The ambulatory PCNL cohort had fewer overall complications (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.47–0.90; P = 0.010); however, there were no differences in major complications (i.e., Clavien–Dindo Grade ≥III; RR 0.46; 95% CI 0.17–1.21; P = 0.12), emergency department visits (RR 1.09, 95% CI 0.69–1.74; P = 0.71), 30‐day readmission (RR 1.09, 95% CI 0.54–2.21; P = 0.81) or readmission at any point (RR 1.00, 95% CI 0.53–1.88; P = 0.99). The ambulatory PCNL cohort was more likely to be stone‐free defined by imaging (RR 1.35, 95% CI 1.09–1.66; P = 0.005); however, when stone‐free was inclusive of any definition there was no difference in stone‐free rates (RR 1.10, 95% CI 0.98–1.23; P = 0.10). Subgroup analysis of SDD did not result in any significant differences. Cost savings ranged from $932.37 to a mean (standard deviation) $5327 (442) United States Dollars per case. No studies reported patient satisfaction data.Ambulatory PCNL seems to be a safe and efficacious model for select patients. Selection bias likely influenced ambulatory outcomes; however, this supports overall safety of current ambulatory inclusion criteria. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Generalized myasthenia gravis (gMG) is characterized by fluctuating muscle weakness. Exacerbation frequency, adverse events (AEs) related to immunosuppressant therapy and healthcare resource utilization (HCRU) are not well understood. Our study aimed to describe long‐term clinical outcomes, drug‐related AEs and estimated HCRU in gMG patients.This was a retrospective cohort analysis of clinical data from patients with gMG followed‐up over eight consecutive years in a Spanish referral unit. Myasthenia Gravis Foundation of America (MGFA) clinical classification, MGFA post‐interventional status (MGFA‐PIS), Myasthenia Gravis Activities of Daily Living (MG‐ADL) score, exacerbations, MG crises, therapies, AEs reported, specialist consultations and emergency room visits were studied biannually. An estimation of HRCU was made based on these data.Some 220 patients newly diagnosed with gMG were included. Ninety percent were seropositive (84.5% anti‐acetylcholine receptor [AChR], 5.9% anti‐muscle‐specific kinase [MuSK]). Baseline mean MG‐ADL score was 5.04 points (SD 3.17), improving to 0.7 points (SD 1.40) after 8 years. Exacerbations were more frequent in years 1–2 (30.1%) but still occurred in years 7–8 (20.2%). Myasthenic crisis frequency remained 1% in years 7–8. Eighty‐nine percent achieved MGFA‐PIS minimal manifestations or better at 8 years. Fifty‐one percent of patients reported at least one AE during the study period, leading to drug withdrawal in approximately 20% of cases. HCRU decreased between years 1–2 to years 7–8 with an estimated cost of MG from 8074.19 € per patient/year to 1679.46 €, respectively.There is a group of MG patients that suffers from persistent symptoms and exacerbations (11%–20%) or MG crises, and drug AEs, which may increase disease burden and impact on the healthcare system. [ABSTRACT FROM AUTHOR]

The article "Traumatic brain injury and hearing loss among older Medicare beneficiaries" explores the incidence of new hearing loss diagnoses following traumatic brain injury (TBI) among older adults. The study found that 11.2% of beneficiaries were newly diagnosed with hearing loss post-TBI, with an incidence rate of 14.1 per 100 person-years. Factors such as age, sex, race/ethnicity, and comorbidities were associated with the likelihood of receiving a hearing loss diagnosis. The study suggests that screening for and treating hearing loss post-TBI may be crucial in reducing the risk of Alzheimer's disease and related dementias among older adults. [Extracted from the article]

Objective: Evaluate the cost‐effectiveness of the Virtual Rural Generalist Service (VRGS) model of care. Design: A cost–consequence analysis of the VRGS model of care compared with usual care (treatment by local or locum [non‐VRGS] doctors) from the perspective of the health care funder in 2022 prices. Setting: Twenty‐nine rural and remote hospitals in the Western NSW Local Health District where the VRGS has been in operation (VRGS sites). Patients: Patients of any age who presented to an emergency department (ED) or were admitted to hospital at VRGS sites over the pre‐VRGS period (1 February 2019 to 31 January 2020) or the post‐VRGS period (1 July 2021 to 30 June 2022). Intervention: The VRGS model of care, which provides 24‐hour 7‐days‐a‐week rural generalist doctors, both virtually and in person, to small rural and remote hospitals, predominantly for lower acuity ED presentations, daily ward rounds for inpatients admitted by a VRGS medical officer, and ad hoc inpatient medical reviews when local doctors need support or are unavailable. Main outcomes measures: Incremental cost per incremental quality‐of‐care outcome, maintenance of health service activity levels, workforce sustainability (measured by changes in locum shifts), and service acceptability (as determined by thematic analysis of interviews). Results: The cost per standard unit of health care (national weighted activity unit) was lower for the VRGS ($1047) than for usual care ($1753). VRGS doctors dealt with ED presentations of similar complexity to non‐VRGS doctors, and admissions of significantly lower (40%) complexity. Health service activity remained stable from the pre‐VRGS period to the post‐VRGS period, only declining by 4% in the post‐VRGS period, which was during the coronavirus disease 2019 pandemic. Locum shifts decreased from 1456 days in the pre‐VRGS period to 609 days in the post‐VRGS period, improving the sustainability of the workforce. Local doctors and managers found the VRGS to be acceptable, but thought it could be enhanced with additional investment in nursing and technical staff. Conclusions: Our economic evaluation of the VRGS showed that it provided lower cost care and equivalent quality‐of‐care outcomes when compared with usual care for ED presentations of the same complexity, and supported local clinical staff to maintain activity levels despite a pandemic. With additional investment in data capture and in nursing and technical staff to support the service, the VRGS has promise as a flexible service that can help sustain access to quality medical care in rural and remote communities. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quantity and quality of medical care provided by the Western NSW Local Health District Virtual Rural Generalist Service (VRGS). Design: Retrospective cohort study; analysis of emergency department and administrative hospital data. Setting: Twenty‐nine rural or remote hospitals in the Western NSW Local Health District at which the VRGS was providing medical care in the emergency department (ED) and/or inpatient setting. The VRGS was providing predominantly virtual medical support when local doctors needed relief or were unavailable, typically for lower acuity ED presentations and scheduled inpatient ward rounds. Patients: All patients who presented or were admitted to a Western NSW Local Health District hospital serviced by the VRGS between 1 July 2021 and 30 June 2022. Main outcome measures: Treatment completions, transfers, ED departure within 4 hours, length of stay, and hospital mortality. Results: During 2021–22, 34% of ED presentations (13 660/39 701) and 40% of admissions (2531/6328) involved VRGS care. For ED presentations, after adjusting for socio‐demographic and clinical factors, patients attended by VRGS doctors had higher odds of not waiting (adjusted odds ratio [aOR], 3.69; 95% CI, 2.79–4.89), lower odds of transfer to another hospital (aOR, 0.66; 95% CI, 0.60–0.72) and slightly lower odds of ED departure within 4 hours (aOR, 0.92; 95% CI, 0.86–0.98) when compared with patients not attended by VRGS doctors (ie, those provided usual care). For admissions, after adjusting for socio‐demographic and clinical factors, inpatients attended exclusively by VRGS doctors had higher odds of discharging at their own risk (3.33; 95% CI, 1.98–5.61) and lower odds of being a long stay outlier (aOR, 0.51; 95% CI, 0.35–0.74) when compared with inpatients not attended by VRGS doctors. The odds of inpatient mortality were equivalent when comparing VRGS and non‐VRGS care (aOR, 0.78; 95% CI, 0.48–1.28) and when comparing combined (VRGS and non‐VRGS) and non‐VRGS care (aOR 1.21; 95% CI, 0.91–1.61). Conclusions: In the current environment of rural medical workforce shortages, the VRGS achieved similar outcomes on routinely collected measures of quality of care. It is demonstrably an option for complementing and enhancing the delivery of medical care in rural and remote communities with limited or no local medical services. [ABSTRACT FROM AUTHOR]

Objective: To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high‐income countries before and during the COVID‐19 pandemic. Data Sources and Study Setting: Administrative patient‐level data between 2017 and 2020 of eight high‐income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Study Design: Multi‐country retrospective observational study using a federated data approach that evaluated age‐sex standardized rates of hospitalizations and ED visits for mental health conditions. Principal Findings: There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre‐COVID‐19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID‐19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. Conclusion: The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID‐19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID‐19 preparedness, and community‐based care may contribute to these variations. What is known on this topic: Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies.Rates of mental health diagnoses vary across high‐income countries, with substantial differences in access to effective care.The COVID‐19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. What this study adds: This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high‐income countries.It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilitiesThe study identifies temporal and cross‐country differences in acute care management of mental health conditions coinciding with the onset of the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

The article "Bridging borders: Current trends and future directions in comparative health systems research" discusses the importance of cross-country comparison research in understanding and improving global health systems. It highlights the role of organizations like the World Health Organization and the OECD in measuring health outcomes, inputs, and expenditures. The article also addresses research gaps, such as the need for standardized data collection methods and longitudinal studies, and emphasizes the importance of incorporating social determinants of health into comparative analyses. The special section on international comparisons in Health Services Research provides valuable insights into health system resilience, disparities, and responses to global challenges, emphasizing the need for international collaboration and comprehensive research in health policy. [Extracted from the article]

Aim: Complex care programmes for children with medically complex cerebral palsy (CP) exist; however, evidence for their impact is limited. This study (i) explored the impact of The Royal Children's Hospital Complex Care Hub (CCH) on hospital service utilisation rates over a 3‐year period for children with medically complex CP compared with those eligible but received routine care, and (ii) compared health, disability and socio‐demographic characteristics of children and their families in both groups. Methods: Electronic medical record data from 78 children (mean age 9.43 years, females n = 37) with medically complex CP who accessed CCH services, and 92 (mean age 10.86 years, females, n = 39) who received routine care were included. Multivariable regression was used to analyse service utilisation: number of emergency department (ED) presentations, length/number of inpatient and intensive care unit admissions and number/type of hospital appointments. Critical health‐care needs, functioning/disability profile and child/family demographics for each group were compared. Results: More children in the CCH group had a mixed motor type (73.1% vs. 15.2%), were classified within Gross Motor Function Classification System level V (76.9% vs. 34.8%), had respiratory, nutrition and social support needs and epilepsy. Children receiving CCH services had higher service utilisation rates; ED presentations (rate ratio (RR) = 1.81, 95% confidence interval (CI): 1.09–3.01), inpatient admissions (RR = 2.77, 95% CI: 2.01–3.83), outpatient encounters (RR = 1.69, 95% CI: 1.31–2.18) and telephone encounters (RR = 6.05, 95% CI: 4.56–8.02). Conclusions: Children with medically complex CP accessing a complex care service have higher service utilisation rates yet have more complex clinical presentations and higher support needs. [ABSTRACT FROM AUTHOR]

The study "Gut permeability and its correlation with patient's traits and blood inflammatory markers in severe asthma: Real-world assessment from the Korean severe asthma registry-2 (KoSAR-2)" explores the relationship between gut permeability and severe asthma. The research found that patients with severe asthma exhibited increased gut permeability compared to non-asthma controls. Atopy was identified as the most significant patient trait influencing gut permeability in severe asthma, with elevated calprotectin levels associated with increased gut permeability in allergic severe asthma patients. The study suggests a potential bidirectional interaction between gut permeability and airway inflammation in severe asthma. [Extracted from the article]

Patients with breast cancer experience various types of adverse events (AEs) during their treatment journey. We aimed to evaluate the incidence, characteristics, and impact of serious AEs in breast cancer patients receiving antineoplastic treatment in the ambulatory setting. A 4‐month prospective observational study that included patients with breast cancer treated in the chemotherapy infusion clinics. Patients were assessed for serious AEs, defined as any AE that resulted in a visit to the emergency department (ED) with or without hospital admission, or required any clinical intervention, which were considered as the addition of supportive medications or modifications to the treatment protocol. Characteristics of the patients and antineoplastic regimens as well as the type of AEs were recorded. During the study period, 1168 patients received 2547 cycles. The mean age was 50 ± 11.6 (SD) years and patients had received a median (IQR) of 3 (1–5) treatment cycles prior to enrollment. Among the study cohort, 465 patients(40%) developed at least one serious AE. A total of 660 (26%) cycles were associated with 757 AEs, which required ED visits, addition of supportive medications, and modifications to the treatment protocol in 58%, 29%, and 17% of the cycles, respectively. Most common AEs were musculoskeletal (n = 132, 17%) and gastrointestinal (n = 125, 16.5%). Taxane‐based regimens were associated with the most AEs (n = 286, 38%). In a cohort of patients with breast cancer treated in the ambulatory setting, 4 out of 10 patients developed at least one serious AE during the study period. Future research should identify measures to reduce the incidence and severity of such complications. [ABSTRACT FROM AUTHOR]

Background: Novel systemic anticancer therapies (SACT) in the form of targeted and immunotherapies are increasingly replacing traditional chemotherapy. Little is known about the impact of novel SACT on healthcare resource utilization (HCRU) at the end of life. Methodology: A retrospective review of patients attending a tertiary cancer center in Toronto, Canada, with advanced solid or hematological malignancies who died in 2019. Demographic and cancer data, SACT use, HCRU (emergency room [ER] visits, acute/intensive care unit [ICU] admission, and place of death) were retrieved and compared between those who received SACT in their last 30 days of life and those who did not. Chi‐squared tests or Quasi‐Poisson regression calculated HCRU expressed as percentages or rate ratios (RR). Univariate and multivariable logistic regression identified factors independently associated with SACT use. Results: Of 443 patients included, 88 (20%) received SACT in the last 30 days of life, with 42 (48%) receiving targeted therapies and 10 (11%) immunotherapy. Factors associated with SACT use included younger age (p = 0.016), breast (p < 0.001), lung (p = 0.047), hematological malignancies (p = 0.002), fewer comorbidities (p = 0.039), and novel SACT (p = 0.006). Receipt of SACT was associated with a higher frequency of ER visits (55% vs. 36% who did not receive SACT, p = 0.001), acute hospitalizations (68% vs. 47%, p < 0.001), ICU admissions (18% vs. 7%, p = 0.003), and death in hospital (45% vs. 30%, p = 0.008). Conclusion: Novel SACT use at the end of life is high and is strongly associated with HCRU. Future studies should explore the impact of advance care planning and palliative care referrals on SACT use. [ABSTRACT FROM AUTHOR]

Objective: Falls are a leading cause for ED presentations among older adults. Existing secondary falls prevention interventions have not been shown to decrease fall‐related ED re‐presentation, indicating a need to better understand contributing factors. Our aim was to evaluate risk factors for fall re‐presentations among the older patient population presenting to the ED. Methods: This is a single‐centre case–control study. Cases were patients aged ≥65 years with two falls‐related ED presentations within 6 months. Age‐ and sex‐matched controls had a corresponding index, but no subsequent ED fall presentation. Data collected included falls risk factors and clinical features of the index presentation. Univariate and multivariate analyses were conducted to assess the relationship between potential exposures and fall re‐presentation. Results: A total of 300 patients (mean age 83.8 years) were studied. On univariate analysis, factors significantly associated with ED fall re‐presentation included increasing multimorbidity (P < 0.0001), increasing number of medications (P < 0.0001) and residing in residential aged care facility (RACF) (odds ratio [OR] 3.06, P < 0.001). No factors remained significant on multivariate analysis. Post‐hoc analyses for the RACF subgroup showed that psychotropic medication use (OR 1.65, P = 0.04) and prior fall within 12 months (OR 2.68, P < 0.001) were significantly associated with re‐presentation. Initial presentation with serious musculoskeletal injury was a significant protective factor (OR 0.21, P = 0.02). Conclusion: The present study failed to identify factors independently associated with ED fall re‐presentation, suggesting that the factors are complex and inter‐related. Two high‐risk populations were identified – those from RACF and those initially presenting with falls not resulting in serious injury. [ABSTRACT FROM AUTHOR]

Background: Strong relationships between trainees and physician supervisors can positively influence how trainees navigate workplace learning. How trainees act and learn in clinical workplaces characterized by rapidly developing and dissolving supervisory pairings is less well understood. This study uses the emergency department (ED) to examine the impact of transient supervisory relationships on how residents approach clinical learning opportunities. Methods: We retrospectively analyzed pediatric and emergency medicine resident rotations in an urban, tertiary, academic pediatric ED between July 2018 and June 2022. Using social network analysis (SNA), we identified resident–attending dyads and patients seen by each dyad. This informed semistructured interviews to understand how transience in supervisory relationships influences how residents approach and interpret clinical experiences. With self‐determination theory as an organizing framework, the investigators performed line‐by‐line coding with constant comparative analysis which supported subsequent theoretical coding. Results: During the study, 526 residents completed 1013 rotations with 87 attendings. A mean (±SD) of 25 (±7) attendings supervised a resident per rotation, with dyads caring for a mean (±SD) of 4 (±4) patients. Twelve residents were interviewed and described different paths to learning depending on the transience of their relationships with clinical supervisors. More sustained contact presented an opportunity to build competence by fostering autonomy and feedback, while briefer contact advanced residents' competence by exposing them to variable practice patterns. Conclusions: Combining SNA with qualitative analysis revealed that residents in the ED experience a spectrum of contact with attendings and perceive different paths to learning depending on the transience of this relationship. The results suggest different educational strategies may be necessary to maximize learning depending on the length or resident–attending interactions. [ABSTRACT FROM AUTHOR]

Background: During the fifth wave of COVID‐19, accident and emergency departments in Hong Kong experienced significant overcrowding yet there was limited evidence available regarding emergency services and patients' clinical outcomes. The aim of this study was to compare the 28‐day mortality, emergency department (ED) visits, and length of stay (LOS) between the peak period of COVID‐19 and a control period in 2019. Method: This was a retrospective case‐control study comparing the peak period of COVID‐19 (7 Feb 2022 to 23 Apr 2022) with a control period (7 Feb 2019 to 23 Apr 2019). Patients' characteristics, ED visits, diagnoses, mortality, and LOS were compared. Results: 35,429 patients were included. The 28‐day in‐hospital mortality was significantly higher in the peak period of COVID‐19 with a risk ratio of 3.91 (95% CI: 3.38–4.53). There was a 36% reduction in ED visits during the peak period of COVID‐19 while there was a 53.7% increase in critical cases at triage. The average LOS of emergency admissions increased from 3.8 days (Median = 2.0; IQR = 1.0–3.0) in the control period to 5.1 days (Median = 2.0; IQR = 1.0–6.0) in the peak period of COVID‐19 especially in the subgroups of chronic kidney disease, influenza and pneumonia, diabetes, and mental disorders. Conclusion: Increased risk of all‐cause 28‐day in‐hospital deaths was observed during the peak period of COVID‐19 along with a reduction in overall ED visits and lengthened LOS. [ABSTRACT FROM AUTHOR]

The CRISPR‐based gene editing therapy exagamglogene autotemcel (exa‐cel) recently received FDA approval for patients with severe sickle cell disease (SCD). The approval was based on a phase III trial (CLIMB SCD 121), which showed 97% efficacy of this treatment in eliminating vaso occlusive crises (VOCs) for 12 consecutive months. To help contextualize results from this trial, we aimed to investigate the proportion of patients with severe SCD who remain VOC‐free for a 1‐year period in routine clinical care. Using Medicaid claims data (2000–2018), we identified a cohort of patients, 12–35 years old with severe SCD, defined by ≥ 2 VOCs per year for 2 consecutive years, who met other exa‐cel trial inclusion criteria to mimic a trial‐like population. A VOC was identified using ICD diagnosis codes during hospitalization and ER visits. The primary outcome was the proportion of patients with no VOCs during a 1‐year follow‐up. A total of 7,425 patients with severe SCD [mean (SD) age: 20.5 (6.0) years, 54.6% females, 84% African Americans], had a mean of 5.2 VOCs, 5.1 ER visits and 3.5 hospitalizations per year during the baseline period. The proportion of patients with no VOCs during the 1‐year follow‐up was 7.7% (95% confidence interval: 7.1%–8.3%). In conclusion, less than one in 12 patients with severe SCD achieved VOC‐free status within 1 year in routine clinical care. These findings suggest that the high efficacy observed for exa‐cel in the trial, if replicated in routine clinical care, could translate into a significant public health impact. [ABSTRACT FROM AUTHOR]

Objective: Nonadherence to receiving hydroxychloroquine (HCQ) is associated with a three‐fold higher risk of lupus‐related hospitalization. Monitoring HCQ blood levels could improve adherence to receiving HCQ and efficacy. Yet, HCQ level monitoring is not routinely done partially due to cost and coverage concerns. To establish HCQ level monitoring cost‐effectiveness, we reported the following: (1) risk of acute care by HCQ blood levels, and (2) cost of HCQ monitoring versus acute care visits. Methods: HCQ blood levels were measured during routine lupus visits. HCQ levels were categorized as follows: (1) subtherapeutic (<750 ng/mL), (2) therapeutic (750–1,200 ng/mL), or (3) supratherapeutic (>1,200 ng/mL). All lupus‐related acute care visits (emergency room visits/hospitalizations) after the index clinic visit until next follow‐up were abstracted. In our primary analysis, we examined associations between HCQ levels and time to first acute care visit in all patients and subgroups with higher rates of acute care. Results: A total of 39 lupus‐related acute care visits were observed in 181 patients. Therapeutic HCQ blood levels were associated with 66% lower rates of acute care. In our cohort, two groups, Black or Hispanic patients and those with public insurance, faced three to four times higher rates of acute care. Levels within 750 to 1,200 ng/mL were associated with 95% lower rates of acute care use in subgroups with higher acute care use. Conclusion: HCQ blood levels within 750 to 1,200 ng/mL are associated with lower rates of acute care in all patients with lupus, including groups with higher rates of acute care. Future clinical trials should establish the causal association between HCQ level monitoring and acute care in patients with lupus. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) with reduced left ventricle ejection fraction (LVEF) is an entity with poor prognosis characterized by decompensations. Bioelectrical impedance analysis (BIA) is used to assess volume overload (VO) and may be useful to identify apparently stable HF outpatients at risk of decompensation. The aim of this study is to analyse whether VO assessed by BIA is associated with worsening heart failure (WHF) in stable outpatients with HF and reduced LVEF (HFrEF). Methods and results: This is a prospective single‐centre observational study. Consecutive stable HF outpatients with LVEF below 40% underwent BIA, transthoracic echocardiography, blood sampling, and physical examination and were followed up for 3 months. VO was defined as the difference between the measured weight and the dry weight assessed by BIA. Demographic, clinical, anthropometric, echocardiographic, and analytical parameters were recorded. The primary endpoint was WHF, defined by visits to the emergency department for HF or hospitalization for HF. A total of 100 patients were included. The median VO was 0.5 L (interquartile range 0–1.6 L). Eleven patients met the primary endpoint. Univariate binary logistic regression analysis showed that left ventricle filling pressures assessed by E/e′, N‐terminal pro B‐type natriuretic peptide, inferior vena cava dilatation (≥21 mm), signs of congestion, and VO were associated with the primary endpoint. Binary logistic regression multivariate analysis showed that VO was the only independent predictor for the primary endpoint (adjusted OR 2.7; 95% CI 1.30–5.63, P = 0.008). Multivariate Cox regression analysis also showed an adjusted hazard ratio (HR) for VO of 2.03; 95% CI 1.37–3.02, P < 0.001. Receiver‐operating characteristic curve analysis showed an area under the curve for VO of 0.88 (95% CI 0.79–0.97, P < 0.001) with an optimal cut‐off of 1.2 L. Conclusions: VO assessed by BIA is independently associated with WHF in stable outpatients with HFrEF at 3 months. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion For people diagnosed with ulcerative colitis (UC), racial disparities exist both in access to medications and clinical outcomes.We used the TriNetX database for two population‐based retrospective analyses with Black (n = 22,519) and Asian (n = 8,626) individuals with UC matched for age, sex, and ethnicity. Outcomes included mortality, medication prescriptions, and clinical encounters at 6 months and 10 years.At 6 months and 10 years after diagnosis, Black people had increased mortality (2.7% vs. 1.9% and 8.1% vs. 6.9%, p < 0.0001), were prescribed fewer UC‐specific therapies (21.3% vs. 26.4% and 30% vs. 36%, p < 0.0001), had higher rates of emergency department visits (22.3% vs. 13.6% and 41.2% vs. 31.5%, p < 0.0001), and higher hospitalisation rates (30.1% vs. 25.8% and 42.6% vs. 39.9%, p < 0.0001). At 6 months, they had more opioid prescriptions (18.5% vs. 15.7%, p < 0.0001). Asian people had lower mortality at 10 years (5.6% vs. 7.7%, p < 0.0001), higher rates of UC‐specific medications at 6 months (28.6% vs. 26.5%, p = 0.002), and more hospitalizations (38.8% vs. 27.7%, p < 0.0001 at 6 months and 50% vs. 42.2%, p < 0.0001 at 10 years).Black individuals with UC are prescribed fewer disease‐specific therapies compared to White individuals and have increased hospitalizations and mortality. Black individuals have higher rates of opioid prescriptions. Opioids have been associated with increased complication rates in inflammatory bowel disease. These trends are not seen in Asian individuals. This reveals critical disparities in the care of Black people with UC with opportunity for targeted interventions. [ABSTRACT FROM AUTHOR]

Summary Introduction Methods Results Discussion Evidence on patient experiences with pain in hospitals and its impact on post‐discharge outcomes is limited. This study investigated the prevalence of pain in hospitals, patient characteristics associated with pain management adequacy, and the link between pain experiences, care ratings, readmission and emergency department visits after discharge.We conducted a retrospective cross‐sectional analysis of the 2019 Adult Admitted Patient Survey, focusing on self‐reported pain experiences, including presence, severity and management adequacy. The outcomes included self‐reported overall care ratings; readmission; and emergency department visits within one month of discharge. Multivariable logistic regression adjusted for population weight was used to estimate adjusted odds ratios.Among 75 large public hospitals, 21,900 patients responded (35% response rate), with 51% of patients reporting pain (mean (SD) age 57 (8.8) y; 54.9% female), 38.3% of whom classified their pain as severe. Aboriginal and/or Torres Strait Islander people and patients who spoke a language other than English were less likely to report adequate pain management (aOR (95%CI) 0.74 (0.58–0.96) and 0.82 (0.70–0.96), respectively). Pain also correlated with poor to very poor care ratings (aOR (95%CI) 2.05 (1.42–2.95)). Those patients who experienced pain were twice as likely to be readmitted (aOR (95%CI) 1.92 (1.55–2.37)) or visit the emergency department after discharge (aOR (95%CI) 1.91 (1.58–2.32)). Conversely, adequate pain management was associated with a lower likelihood of readmission (aOR (95%CI) 0.69 (0.51–0.94)) and emergency department visits (aOR (95%CI) 0.62 (0.44–0.87)). Mediation analysis suggests adequate pain management significantly mediated the relationship between pain severity and hospital rating (50.8%), readmission (11.6%) and emergency department visits (5.9%), after adjusting for all available observed confounders.This study highlights the importance of adequate pain management in patients' perception of care and recovery outcomes, especially among culturally and linguistically diverse patients. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion To determine the frequency and clinical consequences of discrepancies in skeletal radiograph interpretation between emergency and radiology doctors in an Australian ED.We reviewed the records of adult and paediatric patients assessed with skeletal radiography in an ED in Victoria, Australia over 3 months (January to March 2022). Epidemiological data, the interpretation of the radiograph by ED and radiology doctors, and clinical management of the patient were recorded to determine interpretation discrepancies and the consequences of these.There were 2359 unique skeletal radiographs in 1576 patient presentations during the study period. Of these, 140 (6%) had a discrepancy. Where a discrepancy existed, 47% of the ED interpretation reported a fracture and/or dislocation which was not present in the radiology interpretation (false positive), whereas the remaining (53%) were attributed to a missed fracture and/or dislocation (false negative). Thirty‐five discrepancies (2%) required a change in patient management and were therefore clinically significant. The most commonly affected body region was the elbow, where 15% of radiographs were discrepant. Pathology was more often missed when multiple abnormalities were present on the same radiograph (odds ratio = 4.2, 95% confidence interval = 2.5–6.8).The rate of clinically significant discrepancies in the interpretation of skeletal radiographs by emergency medicine doctors is low. This data support using the ED interpretation of radiographs to guide initial management as safe practice. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Identify clinical and demographic characteristics of low‐acuity presentations (LAPs) to the ED and analyse correlations between population rates of LAPs to ED and rates of Medicare‐subsidised general practitioner (GP) services across statistical areas.Retrospective data linkage study using state‐wide ED data and publicly available data on GP services per population by statistical area. We performed multilevel logistic regression to determine predictors of LAP at an individual level after adjusting for remoteness categories and performed correlations between rates of LAP and GP services per population across statistical areas in New South Wales, Australia. The primary outcome was the rate of LAPs to ED, LAPs being defined as patients who self‐presented to ED, assigned an Australasian Triage Score of 4 or 5 and subsequently discharged from ED.There were 2.9 million ED presentations in 2021, of which 39.9% presentations were classified as LAP. LAPs were associated with younger age, routine care, eyes, ear, nose and throat and musculoskeletal presentations. The rate of LAPs was higher in non‐metropolitan areas. Additionally, 85% of LAPs were seen and discharged from ED within 4 h. There was an inverse correlation between the rate of Medicare‐subsidised GP services and the rate of total ED or LAPs in non‐metropolitan areas (ρ = −0.47, ρ = −056 and P = 0.012, P = 0.001, respectively). In metropolitan areas, correlations were either positive for all ED presentations (ρ = +0.41, P = 0.007) or not significant for LAPs (ρ = +0.18, P = 0.57).A relationship between LAPs to ED and Medicare‐subsidised GP episodes of care exists for non‐metropolitan but not metropolitan areas. [ABSTRACT FROM AUTHOR]

The article discusses the issue of polypharmacy, particularly central nervous system-active polypharmacy, in older adults with dementia. It highlights the risks associated with multiple medications, including cognitive decline, falls, and mortality. The study emphasizes the importance of communication among prescribers and the need for deprescribing efforts to reduce medication burden. It also suggests potential solutions, such as involving patients and caregivers in the deprescribing process and addressing barriers faced by primary care providers. The findings aim to inform future interventions to manage medication use in older adults with dementia. [Extracted from the article]

The article "Air Pollution and Its Impact in Electrophysiology" discusses the significant health threat posed by air pollution, particularly in relation to cardiovascular disease and arrhythmias. It highlights key air pollutants, such as PM2.5, ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide, and their impact on cardiovascular health. Studies have shown associations between air pollution and atrial fibrillation events, as well as increased mortality rates. The article also emphasizes the importance of awareness and measures to mitigate the acute and chronic effects of air pollution on patients, providing practical recommendations for clinicians and patients to manage risks related to air pollution and heat exposure. [Extracted from the article]

The article discusses the attrition of remote patient monitoring (RPM) use for hypertension management in Medicare fee-for-service beneficiaries from 2018 to 2021. The study found that around half of RPM initiators did not have an RPM claim 12 months after initiation, with a gradual decline in use over time. Female beneficiaries were less likely to have persistent RPM use, while Asian beneficiaries and rural residents had higher probabilities of persistent use. The study highlights the need for further research on sustained RPM use in older adults with chronic conditions to prevent complications. [Extracted from the article]

ABSTRACT Objective Method Results Discussion Our understanding of the impact of eating disorders (ED) treatment in Autistic people remains elusive. Research has begun to explore ED treatment outcomes and experiences in this population, however current understandings are poorly integrated. The current review therefore sought to explore the impact of ED treatment on Autistic people and those with higher Autistic traits.A convergent, segregated approach was used, independently evaluating quantitative then qualitative studies before integrating findings into a coherent narrative synthesis.Autistic people and people with higher Autistic traits report poorer experiences of treatment and may be at increased risk of inpatient admission and prolonged inpatient treatment, possibly explained by difficulties with treatment timeframes and a lack of autism‐informed support. Both groups reported similar improvements in ED symptoms and BMI. Higher rates of psychosocial difficulties pre‐and post‐treatment were reported in those with higher Autistic traits, and emotion‐focused interventions were felt to be particularly relevant to Autistic presentations of EDs. Concerns were reported as to how well aligned group‐based programs and cognitive‐based interventions are for Autistic individuals and those reporting higher Autistic traits.Future research in diagnosed autism samples is urgently needed to develop a more robust understanding of Autistic outcomes and experiences. Review findings demonstrate the need for increased understanding of ED presentations and the possible need for treatment adaptations, for Autistic people or those with higher Autistic traits. [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance This study was undertaken to determine whether admission to dedicated seizure monitoring units (SMUs) result in reduced health care use (HCU).This was a retrospective open cohort study covering the years 2010–2018 of patients residing in Alberta, Canada, who were referred to the Calgary Comprehensive Epilepsy Program and admitted to a level 4 SMU. Patients were required to have ≥3 years pre‐ and postadmission follow‐up. The outcome was the change in trajectory of composite HCU (primary care, specialist outpatient visits, emergency department visits, and hospitalizations) for the 3 years prior to and 3 years following SMU admission using the point of admission as the “index date.” Secondary outcomes were HCU limited to specific settings. We excluded the first 30 days following the point of admission to mitigate the confounding admission would have on the postadmission HCU trajectory. We used adjusted restricted maximum likelihood linear and nonlinear effects models to determine trajectories expressed as Canadian dollars.A total of 315 of 600 (53%) patients met eligibility criteria. Mean age was 40 years (SD = 17.4), 176 (56%) were female, 220 (70%) had focal epilepsy, and 60 (19%) had functional seizures or physiologic seizure mimics without epilepsy as adjudicated by the attending physician at the point of discharge. Mean per person health care costs increased by CAD$341.28 (95% confidence interval [CI] = −25.17 to 707.74) for each successive 6‐month interval prior to SMU admission (p = .07). Following admission, mean per person costs decreased by CAD$802.34 (95% CI = 699.62–905.06, p < .001) for each successive 6‐month interval up to 3 years postdischarge. Similar trends were noted for primary and specialist care, emergency department, admitted care, and when nonlinear models were applied.Admission to an SMU is associated with significant and enduring declines in HCU. Each 6‐months following discharge overall HCU declined by a mean of CAD$802.34 and acute inpatient, emergency department, and outpatient physician interactions declined by 25%, 26%, and 18% respectively. Comprehensive epilepsy care not only reduces morbidity and mortality but also reduces cost. [ABSTRACT FROM AUTHOR]