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Purpose This study aimed to determine the psychology of pregnant women in a crisis that resulted in emergency admission to the maternal fetal intensive care unit (MFICU) under restricted family visitation owing to the spread of the coronavirus disease-2019 (COVID-19) pandemic. Methods This qualitative descriptive study included four pregnant women who were hospitalized within one month of being transferred to a general obstetric ward from the MFICU under restricted family visitation. Data were collected through semi-constructive interviews. Results The psychology of pregnant women was analyzed per Aguilera's problem-solving crisis model and can be summarized into eight categories. Pregnant women felt happy to be pregnant despite the COVID-19 pandemic. However, they were in a state of imbalance and feeling seriously ill due to emergency MFICU admission, which they associated with ICU. Furthermore, they felt an urgent need to restore their equilibrium by meeting their families and share their child's growth. However, they gradually came to a realistic perception that hospitalization was necessary to protect children. Further, they maintained the same family relationships they had before their hospitalization even under visitation restrictions. In addition, these women reported that nonfamily interactions were encouraging during their hospitalization. Moreover, they had an appropriate coping mechanism to reconcile their desire to visit their families. Hence, they reached a state of equilibrium recovery in which they flexibly adapted to the special care environment. Conclusion Pregnant women who were urgently admitted to the MFICU under restricted family visitation due to the COVID-19 pandemic always desired to share their child's growth with their families. However, they gradually responded positively to the fact that hospitalization was necessary to protect their children. Moreover, the pregnant women used information and communication technology to promptly share the progress of their pregnancies and growth of their children with their families. Finally, they came to terms with their feelings and flexibly adapted to the special medical care environment during their hospitalization. [ABSTRACT FROM AUTHOR]

Background: Many hospitalized patients decline in functional status after discharge, but functional decline in emergency admissions with hypoxemia is unknown. The primary aim of this study was to study functional outcomes as a clinical endpoint in a cohort of patients with acute hypoxemia. Methods: A multicenter prospective observational study was conducted in patients with new-onset hypoxemia emergently admitted to two respiratory departments at a university hospital and an academic teaching hospital. Using the WHO scale, the patients’ functional status 4 weeks before admission and at hospital discharge was assessed. The type and duration of oxygen therapy, hospital length of stay and survival and risk of hypercapnic failure were recorded. Results: A total of 151 patients with a median age of 74 were included. Two-thirds declined in functional status by at least one grade at discharge. A good functional status (OR 4.849 (95% CI 2.209–10.647)) and progressive cancer (OR 6.079 (1.197–30.881)) were more associated with functional decline. Most patients were treated with conventional oxygen therapy (n = 95, 62%). The rates of in-hospital mortality and need for intubation were both 8%. Conclusions: Patients with acute hypoxemia in the emergency room have a poorer functional status after hospital discharge. This decline may be of multifactorial origin.

Abstract Background Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. Method This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. Discussion We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. Conclusion This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.

Abstract Background The Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions. Methods We conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call. Results The study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission. Conclusion This study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress. Trial registration Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46).

Dealing with a mass casualty incident presents many challenges in the clinical and preclinical situation. There are various systems and structures to address this problem. In the present work, the management of the train accident near Garmisch-Partenkirchen on 3 June 2022 is evaluated with the aid of the recommendations of the Federal Office for Civil Protection and Disaster Relief for hospital alarm and deployment planning as well as the recommendations from the terror and disaster surgical care training of the German Academy of Trauma Surgery and the findings are presented from the perspective of a regional trauma center. It also discusses which key factors in the present case have proved to be successful and in which areas there is still a need for improvement. [ABSTRACT FROM AUTHOR]

Background Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. Method This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. Discussion We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. Conclusion This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts. [ABSTRACT FROM AUTHOR]

Background: Emergency departments (EDs) and ED observation units provide care for a wide range of medical emergencies, serving patients of all ages and conditions. This includes palliative care for patients who are rapidly deteriorating. However, there is limited knowledge about the incidence, reasons for ED visits, modes of arrival, symptoms, leading diagnoses, and the emergency care provided to these patients until the time of death. Method: This retrospective, exploratory study was conducted at the 754-bed Kliniken Maria Hilf academic teaching hospital in Moenchengladbach, Germany. It included patients who died in the ED resuscitation rooms or ED observation unit between 1st of July 2018 and 30th of June 2023. We utilized routine data to analyze the reasons for ED visits, modes of arrival, symptoms, diagnoses and the medical care provided. We also examined differences between oncologic and non-oncologic patients as well as between those requiring cardiopulmonary resuscitation (CPR) and those who did not. The study was approved by an ethics committee and categorical data were analyzed using the χ2-test with Yates correction. P-values < 0.05 were considered significant due to the exploratory nature of the study. Results: During the study period 168,328 patients were treated in the ED, with 43% admitted to the hospital. Of these, 262 died in the ED or ED observation unit. The primary mode of arrival was emergency medical services for 234 patients (89%). The most common symptoms were impaired consciousness (n = 198; 76%) and dyspnea (n = 83; 32%), among a range of others. Comparing non-oncologic (n = 214) and oncologic patients (n = 48), the former showed significantly higher rates of impaired consciousness (174/214 vs. 24/48; p = 0.0001), while dyspnea was more prevalent in oncologic patients (57/214 vs. 26/48; p = 0.0002). Among patients who underwent CPR (n = 147) and those who did not (n = 115), no statistical differences were found in levels of consciousness but a significant difference in dyspnea (prior to cardiac arrest) was noted (31/147 vs. 52/115; p = 0.0001). Palliative status was documented in 88 cases (34%), with palliative care initiated in only 58 (21%). Only three patients (1%) were receiving specialized outpatient palliative care (SAPV). The most common medical interventions were invasive ventilation (n = 160; 61%), opioid administration (n = 145; 55%), CPR (n = 143; 55%), and crystalloid administration (n = 90; 34%). Structured communication with relatives occurred in 188 cases (72%). Conclusion: The incidence of death in a large German ED was approximately one patient per week. These patients typically presented with symptoms common in critically ill non-trauma cases. The low incidence of SAPV patients (1%) suggests its potential to reduce ED admissions. Oncologic patients were a minority, possibly due to effective outpatient care and lower mortality within the first 24 h after ED admission. Emergency palliative care in the ED could alleviate the burden on intensive care units. Training ED staff in acute palliative care and establishing procedural standards for such care are essential to maintain high-quality treatment, given the frequency of palliative cases in the ED. [ABSTRACT FROM AUTHOR]

Introduction: Thermoregulation is a complex process in the human body with the ability to maintain a constant optimal body temperature. Biochemical processes of the organism, as well as metabolic processes, are closely correlated with body temperature. Human temperature is determined by several laws, in particular metabolic production and heat flow between the organism and the environment. For the proper functioning of the organs in the human body, it is essential to maintain a constant optimum body temperature. This can be disturbed by inadequate internal and external factors and thermal discomfort can affect the patient's overall outcome. Aim: The aim of this study is to evaluate the development of body temperature in critically ill patients in the emergency department and its effect on overall patient outcome. Design: Quasi-experiment. Methods: Direct observation was performed, including measurement and analysis of body temperature in patients with serious condition in emergency admission. Data were collected in the emergency department of a teaching hospital with a trauma center status between March and December 2021. Statistical tests were evaluated at the level of statistical significance a=0.05. Results: The study population consisted of 274 (100%) patients. Most negative readings were recorded at the time of patient admission. During the course of treatment, there was a gradual adjustment of body temperature to the physiological limit. The resulting body temperature values were within the desired or expected parameters. In terms of a more detailed description, the most significant values were identified in patients with cardiac problems. Conclusions: Knowing the direction of body temperature skew can be considered beneficial. Early correction of pathological values can have a major effect on the overall outcome of the patient. [ABSTRACT FROM AUTHOR]

Background: The Emergency unit of the hospital (Department) (ED) is the fastest and most common way for most French general practitioners (GPs) to respond to the complexity of managing older adults patients with multiple chronic diseases. In 2013, French regional health authorities proposed to set up telephone hotlines to promote interactions between GP clinics and hospitals. The main objective of our study was to analyze whether the hotlines and solutions proposed by the responding geriatrician reduced the number of hospital admissions, and more specifically the number of emergency room admissions. Methods: We conducted a multicenter observational study from April 2018 to April 2020 at seven French investigative sites. A questionnaire was completed by all hotline physicians after each call. Results: The study population consisted of 4,137 individuals who met the inclusion and exclusion criteria. Of the 4,137 phone calls received by the participants, 64.2% (n = 2 657) were requests for advice, and 35.8% (n = 1,480) were requests for emergency hospitalization. Of the 1,480 phone calls for emergency hospitalization, 285 calls resulted in hospital admission in the emergency room (19.3%), and 658 calls in the geriatric short stay (44.5%). Of the 2,657 calls for advice/consultation/delayed hospitalization, 9.7% were also duplicated by emergency hospital admission. Conclusion: This study revealed the value of hotlines in guiding the care of older adults. The results showed the potential effectiveness of hotlines in preventing unnecessary hospital admissions or in identifying cases requiring hospital admission in the emergency room. Hotlines can help improve the care pathway for older adults and pave the way for future progress. Trial registration: Registered under Clinical Trial Number NCT03959475. This study was approved and peer-reviewed by the Ethics Committee for the Protection of Persons of Sud Est V of Grenoble University Hospital Center (registered under 18-CETA-01 No.ID RCB 2018-A00609-46). [ABSTRACT FROM AUTHOR]

Objective: Obesity is defined as abnormal or excessive fat accumulation in the body to the extent that it impairs health in humans. It is a common health problem that is increasing in severity. Laparoscopic sleeve gastrectomy (LSG) is a preferred method because of satisfactory weight loss, resolution of comorbidities and performance safety. The increase in surgery has brought along the postoperative problems. New conditions related to bariatric surgery can be observed in all areas of life. Methods: After obtaining the necessary permission from the local clinical research ethics committee, patients who had bariatric surgery in our hospital between January 2018 and December 2021 were asked to respond by sending a mini-questionnaire about their application to the emergency department after surgery. Eighty patients who agreed to answer the questions were included in the study. Questions were asked and the results were evaluated. In addition, none of the patients who applied to the hospital were admitted to the hospital. Results: 53. 38% of the patients who applied to the hospital came with stomach spasm and vomiting. Among the 80 patients, 18.8% were admitted to the hospital again after surgery. After the operation, 53.3% of the patients applied to the hospital within the first three months, 26.6% within the 4th and 6th months, and 20.1% after the 10th month. Conclusion: General practitioners and emergency specialists should master the management algorithm of these patients. If there is the slightest doubt, obese patients should be consulted, if possible, from a surgeon experienced in bariatrics or a general surgeon. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal bleeding is a frequent medical emergency with a steady 10% mortality rate for 20 years. Upper gastrointestinal bleeding is an increasing global health issue requiring quick evaluation, resuscitation, coagulation correction, and interventions. Objectives: The study aimed to evaluate if a comprehensive approach involving quick evaluation, resuscitation, coagulation correction, and timely diagnostic or therapeutic intervention can improve outcomes of upper gastrointestinal bleeding patients. Patients and Methods: The retrospective analysis examined hospital records of 224 patients with upper gastrointestinal bleeding proximal to the Treitz ligament admitted to Al-Jalla Hospital from January to December 2021. The study collected clinical presentation, investigation, and outcome data through a specialized form. Results: The study analyzed 224 patients with upper gastrointestinal bleeding, with 65% male preponderance and almost half being over 60 years old. The majority (79.5%) were admitted to general surgical wards, and melena was the most common symptom (72%). Endoscopic findings revealed duodenal ulcer, gastric ulcer, and erosive gastritis in 21% of cases each, and erosive esophagitis in 9%. The mortality rate was 16%, with higher rates observed in patients over 60 years. Conclusion: The study found a mortality rate of 16% in the patient population, indicating a need for more resources and a more comprehensive approach to patient management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Healthwatch England estimated emergency readmissions have risen by 22.8% between 2012–13 and 2016–17. Some emergency readmissions could be avoided by providing patients with urgent out of hospital medical care or support. Sovereign Health Network (SHN) comprises of three GP practices, with a combined population of 38,000. OBJECTIVE: We will decrease the number of SHN patients readmitted within 30 days of discharge from Portsmouth Hospitals Trust following a non-elective admission (excluding Emergency Department attendance) by 40–60% by July 2020. METHODS: Four Plan, Do, Study, Act (PDSA) cycles were used to test the administrative and clinical processes. Our Advanced Nurse Practitioner reviewed all discharge summaries, added alerts to records, and proactively contacted patients either by text, telephone or home visit. RESULTS: 92 patients aged 23 days to 97 years were admitted onto the recent discharge scheme. Half of discharge summaries were received on the day of discharge, whilst 29% of discharge summaries were received more than 24 hours post-discharge, and one was received 11 days post-discharge. Following our interventions, there were 55% less than expected readmissions during the same time period. CONCLUSION: To allow proactive interventions to be instigated in a timely manner, discharge summaries need to be received promptly. The average readmission length of stay following a non-elective admission is seven days. Our proactive interventions saved approximately 102.9 bed days, with potential savings of 1,775 bed days over a year. We feel the results from our model are promising and could be replicated by other Primary Care Networks to result in larger savings in bed days. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to determine to what extent an aging population and shift to chronic illness has contributed to emergency admissions at a tertiary care hospital over ten years. Methods This was a retrospective observational study performed using a database of all emergency admissions from the Emergency Department (ED) at a single tertiary hospital in Singapore during a ten-year period (January 1st, 2008 to December 31st, 2017). Emergency admissions were defined as ED visits with inpatient admission as the disposition. This study analyzed the trends of demographics, pre-existing comorbidities, chronic conditions or ambulatory care sensitive conditions (ACSC) of all patients who underwent emergency admissions in Singapore General Hospital. Results A total of 446,484 emergency records were included. For elderly patients, the proportions of them had pre-existing multimorbidity at the time of undergoing emergency admissions were found to be lower at the end the 10-year study period relative to the beginning of the study period. The proportions of emergency admissions whose ED primary diagnoses were categorized as chronic conditions and certain chronic ACSC including chronic obstructive pulmonary disease, congestive heart failure, diabetes complications, and epilepsy also decreased for elderly patients over the 10-year study period. Conclusions In Singapore, despite a rapidly aging population, there have been surprisingly lower proportions of chronic conditions, pre-existing comorbidities, and chronic ACSC among the elderly emergency admissions. This is possibly consistent with an overall improved management of the chronic conditions among the elderly population. Future studies should include similar studies at the national level and comparison with other healthcare settings in different countries.

Abstract Background Appropriate treatment of stroke immediately after its onset contributes to the improved chances, while delay in hospitalisation affects stroke severity and fatality. This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency hospitalisation of patients with stroke in Japan. Methods This was an observational study that used nationwide administrative data of hospitalised patients diagnosed with stroke. We cross-sectionally observed patients’ background factors during April and May 2020, when the COVID-19 pandemic-related state of emergency was declared; we also observed these factors in the same period in 2019. We also modelled monthly trends in emergency stroke admissions, stroke admissions at each level of the Japan Coma Scale (JCS), fatalities within 24 h, stroke care unit use, intravenous thrombolysis administration, and mechanical thrombectomy implementation using interrupted time series (ITS) regression. Results There was no difference in patients’ pre-hospital baseline characteristics between the pre-pandemic and pandemic periods. However, ITS regression revealed a significant change in the number of emergency stroke admissions after the beginning of the pandemic (slope: risk ratio [RR] = 0.97, 95% confidence interval [CI]: 0.95–0.99, P = 0.027). There was a significant difference in the JCS score for impaired consciousness in emergency stroke, which was more severe during the pandemic than the pre-pandemic (JCS3 in level: RR = 1.75, 95% CI: 1.29–2.33, P

Abstract Background The novel coronavirus SARS-19 produces ‘COVID-19’ in patients with symptoms. COVID-19 patients admitted to the hospital require early assessment and care including isolation. The National Early Warning Score (NEWS) and its updated version NEWS2 is a simple physiological scoring system used in hospitals, which may be useful in the early identification of COVID-19 patients. We investigate the performance of multiple enhanced NEWS2 models in predicting the risk of COVID-19. Methods Our cohort included unplanned adult medical admissions discharged over 3 months (11 March 2020 to 13 June 2020 ) from two hospitals (YH for model development; SH for external model validation). We used logistic regression to build multiple prediction models for the risk of COVID-19 using the first electronically recorded NEWS2 within ± 24 hours of admission. Model M0’ included NEWS2; model M1’ included NEWS2 + age + sex, and model M2’ extends model M1’ with subcomponents of NEWS2 (including diastolic blood pressure + oxygen flow rate + oxygen scale). Model performance was evaluated according to discrimination (c statistic), calibration (graphically), and clinical usefulness at NEWS2 ≥ 5. Results The prevalence of COVID-19 was higher in SH (11.0 %=277/2520) than YH (8.7 %=343/3924) with a higher first NEWS2 scores ( SH 3.2 vs YH 2.8) but similar in-hospital mortality (SH 8.4 % vs YH 8.2 %). The c-statistics for predicting the risk of COVID-19 for models M0’,M1’,M2’ in the development dataset were: M0’: 0.71 (95 %CI 0.68–0.74); M1’: 0.67 (95 %CI 0.64–0.70) and M2’: 0.78 (95 %CI 0.75–0.80)). For the validation datasets the c-statistics were: M0’ 0.65 (95 %CI 0.61–0.68); M1’: 0.67 (95 %CI 0.64–0.70) and M2’: 0.72 (95 %CI 0.69–0.75) ). The calibration slope was similar across all models but Model M2’ had the highest sensitivity (M0’ 44 % (95 %CI 38-50 %); M1’ 53 % (95 %CI 47-59 %) and M2’: 57 % (95 %CI 51-63 %)) and specificity (M0’ 75 % (95 %CI 73-77 %); M1’ 72 % (95 %CI 70-74 %) and M2’: 76 % (95 %CI 74-78 %)) for the validation dataset at NEWS2 ≥ 5. Conclusions Model M2’ appears to be reasonably accurate for predicting the risk of COVID-19. It may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions.

National financial incentive schemes for improving the quality of primary care have come under criticism in the United Kingdom, leading to calls for localized alternatives. This study investigated whether a local general practice incentive-based quality improvement scheme launched in 2011 in a city in the North West of England was associated with a reduction in all-cause emergency hospital admissions. Difference-in-differences analysis was used to compare the change in emergency admission rates in the intervention city, to the change in a matched comparison population. Emergency admissions rates fell by 19 per 1,000 people in the years following the intervention (95% confidence interval [17, 21]) in the intervention city, relative to the comparison population. This effect was greater among more disadvantaged populations, narrowing socioeconomic inequalities in emergency admissions. The findings suggest that similar approaches could be an effective component of strategies to reduce unplanned hospital admissions elsewhere. [ABSTRACT FROM AUTHOR]

Aims This research aimed to determine the correlation between survival, symptoms, and unscheduled admission in oncologic patients. Furthermore, this study aimed to develop a prognostic model that helps clinicians establish the indication of intervention by palliative care teams. Methodology A retrospective study of patients' digital clinical history registry was conducted to meet the two core objectives. The study population was patients with solid tumors undergoing unscheduled admissions to the oncology ward between January 1, 2018, and May 31, 2018. Demographic and clinical variables of those patients were analyzed. Specifically, the statistical analysis involved descriptive analysis, Kaplan-Meier curves, Log-Rank, and Chi-Squared Automatic Interaction Detection decision tree modeling. Results The results were obtained from 100 admissions of patients with an average age of 64. Of the patient cases examined, 67% (n = 67) were male. In 72% (n = 72) of the cases, patients presented with Stage IV tumors, and the most frequent primary tumor location among the admissions was lung, at 29% (n = 29). Intervention by the palliative care team occurred for 38% (n = 38) of patients. Mortality at 30, 90, 180, and 365 days was 34% (n = 34), 56% (n = 56), 71% (n = 71), and 78% (n = 78), respectively. Hepatic metastasis was the main predictor of mortality at 30 days (65%, n = 13) and at 90 days (90%, n = 18). In the absence of hepatic metastasis, the presence of more than one symptom predicted a mortality rate of 70% at 30 days. The main factor associated with mortality at 180 and 365 days was the tumor stage, with stage IV tumors having the highest mortality rate (84.7%, n = 61, and 90.3%, n = 65, respectively). Among the Stage IV population, the primary site shows a significant impact on survival, with colorectal/reproductive tumors being associated with decreased mortality. Conclusion Unscheduled admission is a negative prognostic factor in oncologic patients. An unscheduled admission can be expected to result in low survival in an oncologic patient, especially in those presenting with stage IV; involving non-colorectal/reproductive primaries; or presenting with pain, dyspnea, cachexia, or delirium., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Ethics Committee, Hospital Universitario Arnau de Vilanova, Lleida issued approval CEIC-2354, dated October 29, 2020. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Argerich et al.)

We aimed to comprehensively investigate the associations of air pollutants with hospital admissions for critical illness in ED. Patients with critical illness including level 1 and level 2 of the Emergency Severity Index admitted in ED of Changsha Central Hospital from January 2016 to December 2020 were enrolled. Meteorological and air pollutants data source were collected from the National Meteorological Science Data Center. A Poisson generalized linear regression combined with a polynomial distributed lag model (PDLM) was utilized to explore the effect of air pollution on hospital admissions for critical illness in ED. Benchmarks as references (25th) were conducted for comparisons with high levels of pollutant concentrations (75th). At first, lagged effects of all different air pollutants were analyzed. Then, based on the most significant factor, analyses in subgroups were performed by gender (male and female), age (< 45, 45–65, and > 65), disorders (cardiovascular, neurological, respiratory), and seasons (spring, summer, autumn, and winter). A total of 47,290 patients with critical illness admitted in ED were included. The effects of air pollutants (PM2.5, PM10, SO2, NO2, O3 and CO) on critical illness ED visits were statistically significant. Strong collinearity between PM2.5 and PM10 (r = 0.862) was found. Both single-day lag and cumulative-day lag day models showed that PM2.5 had the strongest effects (lag 0, RR = 1.025, 95% CI 1.008–1.043, and lag 0–14, RR = 1.067, 95% CI 1.017–1.120, respectively). In both PM2.5 and PM10, the risks of critical illness in male, > 65 ages, respiratory diseases, and winter increased the most significant. Air pollutants, especially PM2.5 and PM10 exposure, could increase the risk of critical illness admission. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has been associated with excess mortality and reduced emergency department attendance. However, the effect of varying wave periods of COVID‐19 on in‐hospital mortality and length of stay (LOS) for non‐COVID disease for non‐COVID diseases remains unexplored. Methods: We examined a territory‐wide observational cohort of 563,680 emergency admissions between January 1 and November 30, 2020, and 709,583 emergency admissions during the same 2019 period in Hong Kong, China. Differences in 28‐day in‐hospital mortality risk and LOS due to COVID‐19 were evaluated. Results: The cumulative incidence of 28‐day in‐hospital mortality increased overall from 2.9% in 2019 to 3.6% in 2020 (adjusted hazard ratio [aHR] = 1.22, 95% CI 1.20 to 1.25). The aHR was higher among patients with lower respiratory tract infection (aHR: 1.30 95% CI 1.26 to 1.34), airway disease (aHR: 1.35 95% CI 1.22 to 1.49), and mental disorders (aHR: 1.26 95% CI 1.15 to 1.37). Mortality risk in the first‐ and third‐wave periods was significantly greater than that in the inter‐wave period (p‐interaction < 0.001). The overall average LOS in the pandemic year was significantly shorter than that in 2019 (Mean difference = −0.40 days; 95% CI −0.43 to −0.36). Patients with mental disorders and cerebrovascular disease in 2020 had a 3.91‐day and 2.78‐day shorter LOS than those in 2019, respectively. Conclusions: Increased risk of in‐hospital deaths was observed overall and by all major subgroups of disease during the pandemic period. Together with significantly reduced LOS for patients with mental disorders and cerebrovascular disease, this study shows the spillover effect of the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: It is well known that loneliness can worsen physical and mental health outcomes, but there is a dearth of research on the impact of loneliness in populations receiving mental healthcare. This study aimed to investigate cross-sectional correlates of loneliness among such patients and longitudinal risk for acute general hospitalisations. Method: A retrospective observational study was conducted on the data from patients aged 18 + receiving assessment/care at a large mental healthcare provider in South London. Recorded loneliness status was ascertained among active patients on the index date, 30th Jun 2012. Acute general hospitalisation (emergency/elective) outcomes were obtained until 31st Mar 2018. Length of stay was modelled using Poisson regression models and time-to hospitalisation and time-to mortality were modelled using Cox proportional hazards regression models. Results: The data from 26,745 patients were analysed. The prevalence of patients with recorded loneliness was 16.4% at the index date. In the fully adjusted model, patients with recorded loneliness had higher hazards of emergency (HR 1.15, 95% CI 1.09–1.22) and elective (1.05, 1.01–1.12) hospitalisation than patients who were not recorded as lonely, and a longer duration of both emergency (IRR 1.06, 95% CI 1.05–1.07) and elective (1.02, 1.01–1.03) general hospitalisations. There was no association between loneliness and mortality. Correlates of loneliness included having an eating disorder (OR 1.67, 95% CI 1.29–2.25) and serious mental illnesses (OR 1.44, 1.29–1.62). Conclusion: Loneliness in patients receiving mental healthcare is associated with higher use of general hospital services. Increased attention to the physical healthcare of this patient group is therefore warranted. [ABSTRACT FROM AUTHOR]

This study explores the views of advance care planning in caregivers of older hospitalised patients following an emergency admission. Semi-structured interviews were conducted with eight carers, mostly with a personal relationship to the older patient. Thematic analysis generated three themes: (1) working with uncertainty – it all sounds very fine... what is the reality?, (2) supporting the older person – you have to look at it on an individual basis and (3) enabling the process – when you do it properly. The belief that advance care planning can support older individuals and scepticism whether advance care planning can be enabled among social and healthcare challenges are discussed. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine to what extent an aging population and shift to chronic illness has contributed to emergency admissions at a tertiary care hospital over ten years. Methods: This was a retrospective observational study performed using a database of all emergency admissions from the Emergency Department (ED) at a single tertiary hospital in Singapore during a ten-year period (January 1st, 2008 to December 31st, 2017). Emergency admissions were defined as ED visits with inpatient admission as the disposition. This study analyzed the trends of demographics, pre-existing comorbidities, chronic conditions or ambulatory care sensitive conditions (ACSC) of all patients who underwent emergency admissions in Singapore General Hospital. Results: A total of 446,484 emergency records were included. For elderly patients, the proportions of them had pre-existing multimorbidity at the time of undergoing emergency admissions were found to be lower at the end the 10-year study period relative to the beginning of the study period. The proportions of emergency admissions whose ED primary diagnoses were categorized as chronic conditions and certain chronic ACSC including chronic obstructive pulmonary disease, congestive heart failure, diabetes complications, and epilepsy also decreased for elderly patients over the 10-year study period. Conclusions: In Singapore, despite a rapidly aging population, there have been surprisingly lower proportions of chronic conditions, pre-existing comorbidities, and chronic ACSC among the elderly emergency admissions. This is possibly consistent with an overall improved management of the chronic conditions among the elderly population. Future studies should include similar studies at the national level and comparison with other healthcare settings in different countries. [ABSTRACT FROM AUTHOR]

Ameena Alyazeedi,1 Ahmed Fouad Algendy,2 Mohamed Sharabash,3 Ahmed Karawia4 1Pharmacy Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar; 2Clinical Pharmacy, Geriatric Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar; 3Clinical Pharmacy, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar; 4Pharmacy Informatics and Inventory, Rumailah Hospital, Hamad Medical Corporation, Doha, QatarCorrespondence: Ahmed Fouad AlgendyPharmacy Department, Rumailah Hospital, Hamad Medical Corporation, PO 3050, Doha, QatarTel +97470094424Fax +97444397600Email amohamed89@hamad.qaPurpose: To assess the prevalence and associated risk of potentially inappropriate prescribing (PIP) in older adults.Methods: This was a national 3-year retrospective study of outpatient older adults exposed to potentially inappropriate medication (PIM) or polypharmacy. We used the Beers Criteria 2019 list to identify PIM to be avoided in older adults. We define moderate polypharmacy (MoP) and major polypharmacy (MaP) as using 6–10 or >10 chronic medications, respectively. Determinants of PIP included patients’ demographics, lab results, medications, comorbidities, and home healthcare services. We used Chi-square (for categorical variables), Unpaired t-test and ANOVA (for continuous variables as applicable) to assess the association of these determinants with PIP. Univariate followed by multivariate logistic regression models were used to get the crude and adjusted odds ratios of exposure to PIM or polypharmacy within patients who had emergency department (ED) admissions, bone fractures, falls, or constipation, compared to those who had not.Results: 3537 patients were included. 62.6%, 40.4%, and 27.2% were exposed to PIM, MoP and MaP, respectively. Determinants of PIP included age, gender, ethnicity, weight, kidney function, sodium levels, hypertension, diabetes, heart failure, CAD, and home healthcare services (all with p-value < 0.05). PIM was associated with risk of ED admission, bone fracture and constipation with adjusted OR (p-values) of 1.27 (0.002), 1.33 (0.005), and 1.40 (

AIMS OF THE STUDY An increasing number of patients are using telehealth before contacting the healthcare system. If we are to optimise future telehealth strategies and adequately respond to patient needs, we need to know more about the frequency and characteristics of telehealth use. Our objectives were (i) to investigate whether patients use telehealth before consulting the emergency department (ED), (ii) to compare patients with and without use of telehealth, and (iii) to investigate adherence, confidence and satisfaction. MATERIALS AND METHODS A survey was conducted among ED walk-in patients at a tertiary university hospital in Switzerland. Eligible patients were questioned about their use of telehealth before current presentation, during 30 shifts from 23 October to 15 December 2019. RESULTS A total of 183 (43.9%) of 417 surveyed patients used telehealth, with the telephone being the most commonly used modality, especially among elderly patients. Patients using telehealth were more likely to be male (53.5%, p = 0.001) and were similar in age to non-users. Telehealth users tended to be better educated. Telehealth was predominantly used for semi-urgent non-traumatic diseases that did not lead to hospitalisation. All age groups expressed satisfaction with telehealth, trusted the recommendations and adhered to them. The main reason for "non-use" of telehealth was lack of knowledge. CONCLUSIONS Lack of knowledge about telehealth opportunities and barriers in specific patient groups should be addressed to include all patients, and thus to exploit telehealth’s many advantages.

Background: The novel coronavirus SARS-19 produces 'COVID-19' in patients with symptoms. COVID-19 patients admitted to the hospital require early assessment and care including isolation. The National Early Warning Score (NEWS) and its updated version NEWS2 is a simple physiological scoring system used in hospitals, which may be useful in the early identification of COVID-19 patients. We investigate the performance of multiple enhanced NEWS2 models in predicting the risk of COVID-19.Methods: Our cohort included unplanned adult medical admissions discharged over 3 months (11 March 2020 to 13 June 2020 ) from two hospitals (YH for model development; SH for external model validation). We used logistic regression to build multiple prediction models for the risk of COVID-19 using the first electronically recorded NEWS2 within ± 24 hours of admission. Model M0' included NEWS2; model M1' included NEWS2 + age + sex, and model M2' extends model M1' with subcomponents of NEWS2 (including diastolic blood pressure + oxygen flow rate + oxygen scale). Model performance was evaluated according to discrimination (c statistic), calibration (graphically), and clinical usefulness at NEWS2 ≥ 5.Results: The prevalence of COVID-19 was higher in SH (11.0 %=277/2520) than YH (8.7 %=343/3924) with a higher first NEWS2 scores ( SH 3.2 vs YH 2.8) but similar in-hospital mortality (SH 8.4 % vs YH 8.2 %). The c-statistics for predicting the risk of COVID-19 for models M0',M1',M2' in the development dataset were: M0': 0.71 (95 %CI 0.68-0.74); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.78 (95 %CI 0.75-0.80)). For the validation datasets the c-statistics were: M0' 0.65 (95 %CI 0.61-0.68); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.72 (95 %CI 0.69-0.75) ). The calibration slope was similar across all models but Model M2' had the highest sensitivity (M0' 44 % (95 %CI 38-50 %); M1' 53 % (95 %CI 47-59 %) and M2': 57 % (95 %CI 51-63 %)) and specificity (M0' 75 % (95 %CI 73-77 %); M1' 72 % (95 %CI 70-74 %) and M2': 76 % (95 %CI 74-78 %)) for the validation dataset at NEWS2 ≥ 5.Conclusions: Model M2' appears to be reasonably accurate for predicting the risk of COVID-19. It may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions. [ABSTRACT FROM AUTHOR]

Purpose: Psychiatric emergency hospital admissions for distinct psychiatric disorders and length of inpatient stay in the hospital during the Coronavirus disease 2019 (COVID-19) outbreak have not been thoroughly assessed. Methods: A retrospective study was performed analyzing claims data from a large German Hospital network during the COVID-19 outbreak (study period: March 13–May 21, 2020) as compared to periods directly before the outbreak (same year control: January 1–March 12, 2020) and one year earlier (previous year control: March 13–May 21, 2019). Results: A total of 13,151 emergency hospital admissions for psychiatric diagnoses were included in the analysis. For all psychiatric diagnoses combined, emergency admissions significantly decreased during the study period with mean (interquartile range) incidence rate ratios (IRRs) of 0.68 (0.65, 0.71) and 0.70 (0.67, 0.73) as compared to the same and previous year controls, respectively (both p < 0.00001). IRR ranged from 0.56 for mood affective disorders (F30-F39) to 0.75 for mental disorders due to psychoactive substance use (F10-F19; all p < 0.00001). Mean (standard deviation) length of hospital stay for all psychiatric diagnoses was significantly shorter during the study period [9.8 (11.6) days] as compared to same [14.7 (18.7) days] and previous [16.4 (23.9) days] year controls (both p < 0.00001). Conclusion: Both emergency hospital admissions and length of hospital stay significantly decreased for psychiatric disorders during the COVID-19 outbreak. It needs to be assessed in further studies whether healthcare systems will face increased demand for the provision of mental health care in the nearer future. [ABSTRACT FROM AUTHOR]

Background: Patient participation is increasingly recognized as a key component in the redesign of health care processes and is advocated as a means to improve patient safety. We explored the usage of participatory engagement in patient-created and co-designed medical records for emergency admission to hospital.Methods: Design: Prospective iterative development and feasibility testing of personal health records.Setting: An Acute Medical Unit in a University affiliated hospital.Participants: Patients admitted to hospital for medical emergencies.Interventions: We used a design-led development of personal health record prototypes and feasibility testing of records completed by patients during the process of emergency admission. 'Express-check-in' records contained items of social history, screening questions for sepsis and acute kidney injury, in addition to the patients' ideas, concerns and expectations.Main outcomes measures: The outcome metrics focused on feasibility and a selection of quality-domains: Effectiveness of recording relevant history, time-efficiency of documentation process, patient centredness of resulting records, staff and patient feedback. The incidence of sepsis and acute kidney injury were used as surrogate measures for assessing the safety impact.Results: The medical record prototypes were developed in an iterative fashion and tested with 100 patients in which 39 patients were 70 or older, and 25 patients were classified as clinically frail. 96% of the data items were completed by patients with no or minimal help from healthcare professionals. The completeness of these patient records was superior to that of the corresponding medical records in that they contained deeply held beliefs and fears, whereas concerns and expectations recorded by patients were only mirrored in a small proportion of the formal clinical records. The sepsis self-screening tool identified 68% of patients requiring treatment with antibiotics. The intervention was feasible independent of the level of formal education and effective in frail and elderly patients with support from family and staff. The prototyped records were well received and felt to be practical by patients and staff. The staff indicated that reading the patients' documentation led to significant changes in their clinical management.Conclusions: Medical record accessibility to patients during hospital care contributes to the co-management of personal health care and might add critical information over and above the records compiled by healthcare professionals. [ABSTRACT FROM AUTHOR]

As hospital beds are scarce, and emergency admissions to a psychiatric ward are major life-events for children and adolescents, it is essential to have insight into the decision-making process that leads to them. To identify potentially modifiable factors, we, therefore, studied the contextual and clinical characteristics associated with the voluntary and compulsory emergency admission of minors. We used registry data (2008–2017) on 1194 outpatient emergencies involving children aged 6–18 who had been referred to the mobile psychiatric emergency service in two city areas in The Netherlands. Demographic and contextual factors were collected, as well as clinical characteristics including diagnoses, psychiatric history, Global Assessment of Functioning (GAF), and the Severity of Psychiatric Illness (SPI) scale. Logistic regression analyses were used to identify factors that predict voluntary or compulsory admission. Of 1194 consultations, 227 (19.0%) resulted in an admission, with 137 patients (11.5%) being admitted voluntarily and 90 (7.5%) compulsorily. Independently of legal status, the following characteristics were associated with admission: severity of psychiatric symptoms, consultation outside the patient's home, and high levels of family disruption. Relative to voluntary admission, compulsory admission was associated with more severe psychiatric problems, higher suicide risk, and prior emergency compulsory admission. Two potentially modifiable factors were associated with psychiatric emergency admission: the place where patients were seen for consultation, and the presence of family problems. Psychiatric emergency admissions may be reduced if, whenever possible, minors are seen in their homes and if a system-oriented approach is used. [ABSTRACT FROM AUTHOR]

The doctrine of consent (or informed consent, as it is called in North America) is built upon presumptions of mental capacity. Those presumptions must be tested according to legal rules that may be difficult to apply to COVID-19 patients during emergency presentations. We examine the principles of mental capacity and make recommendations on how to assess the capacity of COVID-19 patients to consent to emergency medical treatment. We term this the CARD approach (Comprehend, Appreciate, Reason, and Decide). [ABSTRACT FROM AUTHOR]

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Objective: This study aimed to investigate the knowledge, attitudes and practices of parents presenting to a hospital emergency department with a complaint of fever in a child. Methods: A total of 504 pediatric admissions for fever were included in this study. A 21-item questionnaire form was applied to caregivers via face-to-face interview method. Results: Overall, 37.1% of the mothers were primary school graduates and 81.5% were housewives. Only 11.7% of parents reported that they use a thermometer in measuring fever, 41.3% reported that they check fever with less than 30-min intervals and 85.7% stated the risk of seizure as the most fearful condition related to high fever. Mothers with higher vs. lower educational level were more likely to use thermometer in fever measurement (p = 0.046), use a 30-min interval between subsequent fever measurements (p = 0.041), and use antipyretic drugs (p = 0.045) rather than warm shower (p = 0.027) for the management of fever. Fathers with higher vs. lower educational level were more likely to accompany their wife in hospital admission (p = 0.008), to use thermometer in fever measurement (p = 0.045), use a 30-min interval between subsequent fever measurements (p = 0.002) and use antipyretic drugs (p < 0.001) rather than warm shower (p = 0.003) or emergency admission (p = 0.003) in the management of fever. Conclusion: In conclusion, our findings indicate a need for improved practice among caregivers regarding the approach to febrile child in terms of objective measurement and better management of high fever. Given the direct association of educational attainment with caregivers' approach to febrile child, healthcare professionals should be able to carry out more effective training activities to improve the approach of parents to a febrile child to prevent inappropriate practices by reducing the unnecessary fear and to ensure better practice regarding identification, interpretation and management of fever in a child. [ABSTRACT FROM AUTHOR]

Copyright of Florence (1801-464X) is the property of Care Comm s.r.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The number of older patients admitted to emergency departments (ED) increases continuously. The Identification of Seniors at Risk (ISAR) score is currently recommended to screen patients in German ED, but its appropriateness is being criticized. ISAR scores and clinical characteristics from 98 emergency admissions (EA), 80 from acute geriatrics (AG) and 89 from a geriatric rehabilitation (GR) unit were compared retrospectively. No significant differences were found between groups, being the ISAR score positive in 87.7% of EA, 94.9% of AG and 94.4% of GR cases. None of positively identified geriatric patients in the EA was transferred to the geriatric ward of competence. EA patients showed significantly higher number of functional impairments (p = 0.001) and higher BI score (p < 0.0001) compared to AG and GR groups. A higher ISAR score threshold and additional functional information might be needed to better select patients in need of prompt treatment by a geriatric team. [ABSTRACT FROM AUTHOR]

Dans notre établissement, le service d'accueil et des urgences (SU) adulte, accueille chaque année plus de 100,000 patients. Afin de fluidifier le parcours d'hospitalisation non programmée à partir des urgences, ont été mises en place fin 2017 une unité d'hospitalisation d'attente de 20 lits et une gestion centralisée des lits (gestionnaire de lits, logiciel de gestion des lits, lits dédiés). Le bilan d'une première année de fonctionnement fait l'objet de ce travail. Le nombre de passages au SU adulte continue à progresser (+ 3,5 % entre 2017 et 2018), avec un taux d'hospitalisation directe à partir du SU vers les secteurs d'hospitalisation conventionnelle d'environ 20 %, deux tiers en médecine et un tiers en chirurgie. En 2018, 3450 patients dont 54,6 % de plus de 75 ans ont été admis dans cette unité d'attente, avec une durée moyenne de séjour de 1,3 ± 1,4 jours, 35,4 % restant moins de 24 heures, 29,3 % sortant à moins de 48 heures et 34,8 % plus de 48 heures, dont 5,2 % restés plus de 4 jours. Cent trente-deux patients (3,8 %) sont décédés, 805 (23,3 %) sont retournés à domicile, 220 (6,4 %) ont été transférés dans un autre établissement et 2287 (66,3 %) ont été secondairement hospitalisés dans un autre service de l'hôpital, plus de 9 fois sur 10 dans un service de médecine (médecine interne 30 %, gériatrie 27,9 %, pneumologie 12,2 %). La filière d'hospitalisation non programmée à partir du SU mise en place, permet une hospitalisation quotidienne en lits de court séjour de près de 50 patients, avec le week-end une diminution nette du nombre de lits disponibles pour cette filière. Les principales pathologies sont les infections respiratoires (14,2 %), les cardiopathies (9,7 %), les troubles métaboliques (3,9 %) et les infections de l'appareil urinaire (3,6 %). Cette unité d'hospitalisation d'attente associée à une gestion centralisée donne satisfaction dans l'amélioration de la filière du non programmée notamment pour la filière médicale venant du service des urgences. La problématique du manque de lits d'aval le week-end et la gestion des périodes épidémiques restent un défi à relever. The adult emergency department at Rouen University hospital (CHU) welcomes over 100.000 patients per year. In order to streamline unscheduled hospital admissions from the emergency room (ER), a 20-bed pre-hospitalization unit and a centralized bed management system (bed manager, bed manager software, dedicated beds) have been put into place. Emergency admissions have increased by (+ 3.5% between 2017 and 2018) with 20% direct hospitalization from the ER to other conventional units (2/3 in medicine, 1/3 in surgery). In 2018, 3450 patients, of which 54% aged over 75 years have been admitted in the pre-hospitalization unit with an average length of stay of 1.3 ± 1.4 days: 35.4% stayed less than 24 hours and 34.8% more than 48 hours of which 5.2% stated more than 4 days, 132 patients (3.8%) died, 805 patients (23.3%) were discharged at home, 220 (6.4%) transferred to another facility, and 2287 (66.3%) were secondarily hospitalized in another hospital unit: more than 9 times out of 10 in a medicine unit (internal medicine 30%, geriatrics 27.9%, respiratory medicine 12.2%). This unscheduled emergency hospitalization allowed a daily hospitalization of 50 short stay inpatients beds. It has to be noted that the number of available inpatient beds clearly decreases during the week-ends. The main pathologies were respiratory infections (14.2%), heart diseases (9.7%), metabolic disorders (3.9%), and urinary tract infections (13.6%). This pre-hospitalization unit associated with a centralized bed management system has clearly improved the unscheduled hospital admissions, in particular concerning the emergency medical sector. The lack of inpatient beds at the week-end and the management of epidemic periods still remain a challenge that has to be taken up. [ABSTRACT FROM AUTHOR]

Air pollution affects the pathophysiology of gastrointestinal tract and has been linked to several gastrointestinal diseases in recent years. However, little is known about the association of air pollution with peptic ulcer bleeding (PUB). We aimed to conduct a time-series study to examine the association between short-term exposure to fine particulate matter (PM 2.5) and emergency admissions for PUB in Beijing, China. Data on emergency admissions for PUB between January 1, 2010, and June 30, 2012 were obtained from the Beijing Medical Claim Data for Employees. Measurements of PM 2.5 concentration were obtained from the United States Embassy air-monitoring station. A generalized additive Poisson model was applied to explore the association between PM 2.5 concentrations and emergency admissions for PUB, with stratification by gender and age. A total of 5123 emergency admissions for PUB were identified. Short-term exposure to outdoor PM 2.5 was significantly associated with increased emergency admissions for PUB at lag0 day. A 10 μg/m3 increase in PM 2.5 concentration at lag0 day corresponded to a 0.56% (95% confidence interval (CI) 0.04%–1.08%; P = 0.035) increase in emergency admissions for PUB. There was a clear concentration-response association between PM 2.5 concentrations and emergency admissions for PUB. The PM 2.5 effect estimates were greater in elderly people (≥65 years old) with the difference approaching statistical significance (percentage change 0.78, 95% CI 0.03%–1.54% in patients ≥65 years old; percentage change 0.32, 95% CI -0.38%–1.03% in patients <65 years old; P = 0.073), but the difference between men and women was not significant (percentage change 0.75, 95% CI 0.08%–1.43% in man; percentage change 0.27, 95% CI -0.51%–1.07% in woman; P = 0.368). Short-term elevation in outdoor PM 2.5 concentrations was associated with increased emergency admissions for PUB, particularly in elderly people. Future studies are warranted to confirm the findings and elucidate the mechanisms underlying the association. • Air pollution may contribute to the onset of peptic ulcer bleeding (PUB). • Significant associations were found between PM 2.5 and emergency admissions for PUB. • There was a clear concentration-response association between PM 2.5 and PUB risk. • The PM 2.5 effect estimates were greater in elderly people. [ABSTRACT FROM AUTHOR]

The increasing demand for emergency care may cause prolonged Emergency Department length of stay that has an impact on quality of care. In Indonesia, factors influencing Emergency Department length of stay are difficult to determine. The purpose of the study was to identify factors that contributed to length of stay at tertiary hospital Yogyakarta, Indonesia. A descriptive study was conducted with a cross-sectional, retrospective design. Participants (n = 139) were patients aged 18 years or over who presented to Emergency Department at tertiary hospital, over seven consecutive days. Data were gathered by reviewing patients' notes using modified data collection tool and by measuring the average time in each stage of Emergency Department patient journey. Mann–Whitney and Kruskal–Wallis tests were utilised to analyse data. The median Emergency Department length of stay was 330 min. The acuity level, specialist consultation and need for admission were associated with increased Emergency Department length of stay (p < 0.05). Laboratory turn around time (median 58 min) and waiting for bed availability (median 167 min) contributed to prolonged length of stay, for discharged and admitted patients, respectively. This study assists in understanding factors that most significantly influence Emergency Department length of stay in an Indonesian hospital and will inform policy makers in development of strategic plans to improve Emergency Department patient flow. [ABSTRACT FROM AUTHOR]

Comorbidity in patients, along with attendant operations and complications, is associated with reduced long-term survival probability and an increased need for healthcare facilities. This study proposes a user-friendly toolkit to design an adjusted case-mix model of the risk of comorbidity for use by the public for its incremental development. The proposed model, Temporal Comorbidity-Adjusted Risk of Emergency Readmission (T-CARER), introduces a generic method for generating a pool of features from re-categorised and temporal features to create a customised comorbidity risk index. Research on emergency admission has shown that demographics, temporal dimensions, length of stay, and time between admissions can noticeably improve statistical measures related to comorbidities. The model proposed in this study, T-CARER, incorporates temporal aspects, medical procedures, demographics, admission details, and diagnoses. And, it tries to address four weakness areas in popular comorbidity risk indices: robustness, temporal adjustment, population stratification, and inclusion of major associated factors. Three approaches to modelling, a logistic regression, a random forest, and a wide and deep neural network, are designed to predict the comorbidity risk index associated with 30- and 365-day emergency readmissions. The models were trained and tested using England's Hospital Episode Statistics inpatient database for two time-frames: 1999–2004 and 2004–2009, and various risk cut-offs. Also, models are compared against implementations of Charlson and Elixhauser's comorbidity indices from multiple aspects. Tests using k − f o l d cross-validation yielded stable and consistent results, with negative mean-squared error variance of -0.7 to -2.9. In terms of c-statistics, the wide and deep neural network and the random forest models outperformed Charlson's and Elixhauser's comorbidity indices. For the 30- and 365-day emergency readmission models, the c-statistics ranged from 0.772 to 0.804 across the timeframes. The wide and deep neural network model generated predictions with high precision, and the random forest model performed better than the regression model, in terms of the micro-average of the F1-score. Our best models yielded precision values in the range of 0.582–0.639, and an average F1-score of 0.730–0.790. The proposed temporal case-mix risk model T-CARER outperforms prevalent models, including Charlson's and Elixhauser's comorbidity indices, with superior precision, F1-score, and c-statistics. The proposed risk index can help monitor the temporal comorbidities of patients and reduce the cost of emergency admissions. • Using a set of generic administrative features to predict comorbidity risk. • Using comorbidity, operations, admission methods and demographics in models. • Comparing logistic regression, random forest and deep neural network models. • Implementing a framework to collect a pool of temporal features. [ABSTRACT FROM AUTHOR]

Aim: to determine the predictive factors on the length of stay of neurosurgical patients in the ICU setting. Methods: all patients admitted to the neurosurgical ICU between February 1 and July 31, 2011 were recruited. Patient demographics and clinical data for each variable were collected within 30 minutes of admission. The ICU length of stay was recorded and analyzed by linear regression model with statistical significance at p-value

Background: Air pollution is one of the most important factors threatening the health of citizens. It increases the prevalence of cardiovascular and respiratory diseases as well as emergency admissions to hospitals in the polluted metropolitan cities. The present study was conducted using Air Quality (AirQ) model and aimed to investigate the effects of air pollution on the number of emergency cardiovascular and respiratory patients admissions in Tehran hospitals during 2005-2014. Materials and Methods: This was cross-sectional study. First, the needed hourly information was received from the Bureau of Air Quality Control, and the Environmental Protection Agency of Tehran City. Then, the information was validated according to WHO criteria, and the statistical indicators and the stages required to quantify the harmful effects of air pollutants were calculated by using appropriate application. Results: According to the results, the number of cases admitted to the emergency ward of hospitals due to heart diseases (by exposure to particulate matter) during the years 2005 to 2014 were respectively 1797, 1280, 1766, 1980, 2132, 2703, 2389, 2594, 2158, and 2291 cases, totaling 20990 persons, and for respiratory diseases (due to exposure to particulate matter) during the same years were respectively 4643, 3301, 4650, 5117, 5511, 6999, 6180, 6452, 5577, and 5922 cases, totaling 54352 people. Also, the number of cases admitted to the emergency wards of hospitals due to chronic obstructive pulmonary disease caused by exposure to emissions of pollutants such as sulfur dioxide, nitrogen dioxide, and ozone were respectively, 1806, 2454, and 2941 cases. Conclusion: Air pollution in Tehran increases the load of emergency visits to hospitals and increases the risk of respiratory and heart diseases. Therefore, measures to reduce and control air pollution and to prepare, equip, and mobilize hospitals, particularly emergency wards, are among important priorities that should be pursued seriously by the authorities.

Palliative care model can be carried out at home, in the community, or in long-term home care. Home visits in palliative care have an important role in providing continuity of care and psychosocial support to both the patient and their parents/caretakers. This study is aimed to determine the impact of home visit program to the frequency of emergency room (ER) admissions in children with cancer., Methods: Randomized controlled trial of 60 pediatric patients with malignancies who were given palliative care (a 3-months home visit) and those who were not was conducted. Patients were children with cancer aged 2-18 years old. Emergency room admissions from the last three months were recorded before patients were enrolled. A two-way communication between a trained health worker and patients with or without their parents were conducted as the intervention. Interventions were given in six sessions (1 session every 2 weeks). During study period, ER admissions were recorded further. Data was analyzed using bivariate analysis, OR calculations were performed., Results: In the intervention group, 11 children (36.7%) had fewer ER admissions, while 4 (13.3%) had more and 15 children (50%) had constant ER admissions, respectively. Meanwhile, only 2 children (7.7%) were found to have fewer ER admissions in the control group. Others in this group have varying results, 11 children (42.3%) were found to have more admissions to the ER and 13 children (50%) had constant ER admissions. In the intervention group, ER admissions were reduced by 10 visits, while in the control group, the admissions were increased by 16 visits (OR 4.77, 95% CI 1.29-17.65; p = 0.018)., Conclusion: Palliative home visit provides care matched to patient and family needs, trained parents to be skillful in managing child, and enabling avoidance of unnecessary hospitalizations (4.7 times)., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: Avoiding unnecessary emergency admissions and managing those that are admitted more effectively is a major concern for both patients and health services. To generate evidence useful for improving services for direct patient benefit, this study explores service users' views and experiences of emergency admissions and subsequent inpatient care.Methods: Participants were recruited during a cancer-related emergency admission from a tertiary cancer centre with an emergency oncology service and emergency department. Semi-structured interviews were conducted with 15 patients and 12 carers post hospital discharge. Interview transcripts were analyzed using framework analysis.Results: Twenty patients experienced 43 emergency admissions over 6 months. Most admissions (35/43) followed patients presenting acutely or as emergencies with cancer treatment side effects. Most admissions (35/43) were directly to an oncology ward following specialist advice, review and triage, and thus unavoidable. Participants experienced outstanding inpatient care because of the following: prompt and effective symptom control and stabilization of acute conditions; continuity of cancer care and coordination between acute and long-term treatment; satisfactory professional-patient communication and information sharing; responsive, motivated and competent staff; and less restrictive visiting times. Gaps in care were identified.Conclusions: Many emergency admissions are necessary for people with cancer. Future work should focus on improving easy access to specialist advice and triage, and the process of admission; providing rapid palliation of symptoms and prompt stabilization of acute conditions, and satisfactory inpatient care; closing the circle of care for patients by actively involving primary care and palliative/end-of-life care services to address the complex needs of patients and carers. [ABSTRACT FROM AUTHOR]