Admission Procedures Research Articles

LEGAL BASIS FOR ADOPTION NEW SUBJECTS TO THE RUSSIAN FEDERATION PART 1. CONSTITUTIONAL CONDITIONS

The article is devoted to the definition of the constitutional conditions for the admission of new subjects to the Russian Federation. Special emphasis is placed on the formal legal approach to the disclosure of the subject of research. The author substantiates the independence of the procedures: “admission of a new subject to the Russian Federationˮ and “formation of a new subject within the Russian Federationˮ. Substantial analysis of proposals to amend the federal constitutional law “On the procedure for Admission to the Russian Federation and the formation of a new subject of the Russian Federation in its compositionˮ has been carried out.

Exploring the Perspectives of Students with Disabilities on the Reasonable Accommodations Provided in Higher Education Institutions

The purpose of this study was to explore the available treatment for students with disabilities (SWD) in post-secondary education. the main research question focuses on exploring the perspectives of SWD about the reasonable accommodation focuses they received at King Saud University (KSU), and Princess Nourah University (PNU). A qualitative research methodology was used, information was subsequently collected from 12 SWD via a semi-structured interview format and using Thematic analysis to write the result report. some significant results arose, such as that the majority of SWDs stated that CDSS helps assist with their schooling. Many, however, said that the faculty did not understand their demands and that they needed instruction in this area. They also expressed dissatisfaction with admissions procedures that bar them from enrolling in certain departments. Received: 16 May 2024 / Accepted: 16 September 2024 / Published: 05 November 2024

Reforming School Choice Systems to Reduce Segregation in Schools: A Comparative Political Economy Study of Education Reform in Belgium, Chile, and the Netherlands

ABSTRACT This study offers a comparative examination of desegregation policy reforms in Belgium, Chile, and the Netherlands, addressing equity reforms to universal school choice systems. Through an analysis of the reform trajectories, we explore the evolution of policies, the causal mechanisms of change, efforts to institutionalize policies, and the sources of resistance to reform. We then undertake a cross-national comparison to discern trends and confirm or disconfirm theorized causes. Policy strategies from each context included nondiscrimination policies, fiscal incentives, and eventually reform of admissions procedures. Causal mechanisms facilitating equity reforms included shifts in political context, grassroots mobilization, generated focusing events through scholarly work and reports of civil society and transnational actors, and effective framing. Oppositional forces from non-state school networks and middle-class/white parents emerged in each context, affecting reform design and the path to institutionalization, but were unable to block reforms. The resulting reforms in each context were the products of compromise that retreated from deeper structural changes, likely mitigating the effects of reforms on school-based segregation.

Investigating the support for equitable admissions policies in health professions education: the Formal Consensus method

Higher education institutions increasingly aim to implement equity in admissions. However, there is no one-size-fits-all solution to determine which equitable admissions procedures are suitable in a specific context, nor which groups should be its beneficiaries. Therefore, we applied the Formal Consensus Method (FCM) to investigate the support amongst experts and stakeholders for different equitable admissions policies and target groups within the context of Health Professions Education in The Netherlands. We found majority support (median of ratings ≥ 7 on a scale of 1 to 9) in both groups for the target groups ‘applicants with a low or average socio-economic status’ and ‘applicants with an underrepresented migration background’. The majority of participants was also in favor of Contextualized Admissions, especially when used to increase enrolment of applicants with a low or average socio-economic status, with an underrepresented migration background, and asylum status holders. Lastly, both groups supported lottery with extra tickets for applicants with an underrepresented migration background. However, as the range of ratings fell outside the FCM prescribed range of 5-9, no case in which there was majority support could be defined as a ‘consensus’. The expert group proposed the use of Bonded Medical Places for applicants from the Caribbean parts of the Dutch Kingdom. The policies and target groups for which broad support was found, could contribute to equitable admissions, improved student diversity, and enhanced quality of health education and future care. Our application of the FCM in the area of equitable admissions policies may be useful for researchers in other countries where equity principles are not (widely) used in admissions decisions.

Predictability of adult patient medical emergency condition from triage vital signs and comorbidities: a single-center, observational study

BackgroundVital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient’s status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED.MethodsThis prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered “medical emergency conditions”. The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression.ResultsA total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd’s Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities.ConclusionAmong the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.

Aspects of rational organization of labor of medical staff

The introduction of new technologies, new organizational forms in the treatment and diagnostic process, the formation of new views on disease prevention, structural reorganization in healthcare require the development of a modern regulatory framework for labor and its continuous improvement. Target. Definition of aspects of rational organization of labor of medical personnel and their application in the practice of nursing specialists. Results. The main types of activities of nurses of the therapeutic department are analyzed, the working time costs of the nursing staff are studied by means of photo timing and interviewing, a comparative analysis of the workload of nurses per shift and the quality of medical care is carried out. Conclusion. The labor costs of the nursing staff are influenced by many, so-called, standardforming factors, which include: qualification, professional level of a specialist; composition of patients by nosological forms of the disease, severity of the course, presence of complications, concomitant diseases; gender and age composition of patients; intensity of treatment and diagnostic measures, stage of medical care; the procedure for admission of patients to the hospital, etc. The effect of these factors on the relationship between themselves is quite complex, determining the possibility of taking them into account will allow adjusting the number of positions in each division of the healthcare institution based on local conditions, ongoing changes in the composition of those hospitalized, and determining specific workload standards for each employee.

Artificial Intelligence Plays Crucial Role in Education Sector of Assam

“AI is a mirror, reflection not only our intellect, but our values and fears” Artificial intelligence (AI) is shaping the future of technology and revolutionizing our education system. Due to evolution of artificial intelligence, we have seen the drastic change in our educational sector throughout the globe. It indicates a positive signal for present and future generations of our country and also throughout the globe. Artificial Intelligence (AI) can play a crucial role in the school functioning process, streamlining and optimizing the procedure for both institutions and applicants. Through AI-driven algorithms, schools can efficiently sift through a large pool of applicants, identifying the most suitable candidates based on predefined criteria such as student’s enrollment according to their academic performance, extracurricular activities, and personal attributes. One of the most remarkable advantages of employing AI in the admission process is its ability to eliminate human bias, ensuring fairness and equal opportunities for all applicants. AI systems are programmed to assess candidates solely based on their qualifications and merit, reducing the influence of subjective factor, viz., race, gender, or socioeconomic background. We have seen the drastic changes in case of new admission in our School and College for last 3 to 4 years in the state of Assam and country as well. Moreover, AI facilitates personalized and efficient communication with applicants, providing them with updates on their application status and guiding them through the admission process. Virtual assistants powered by AI can promptly address queries from applicants, offering them the support they need. Furthermore, AI enables predictive analysis, allowing schools to forecast future trends in admission and tailor their strategies accordingly. By analyzing past admission data and trends, AI systems can provide valuable insights into the preferences and behaviors of prospective students, helping schools make informed decisions and develop targeted recruitment strategies. AI is revolutionizing the school admission process by making it more efficient, transparent, and fair. By leveraging AI technologies, schools can streamline their admission procedures, improve the candidate experience, and ultimately ensure that the most qualified and deserving students are admitted. In Assam, the education department of Government of Assam has introduced Shiksha Setu App to enhance communication between students, parents, teachers, and educational institutions. It facilitates access to various educational resources, attendance tracking of both teachers and students, exam schedules, leave for teachers, and performance reports. Its significance lies in improving transparency, efficiency, and accessibility in the whole education system of Assam, and as result contributing to better student outcomes and parental involvement.

Beyond Neyman–Pearson: E-values enable hypothesis testing with a data-driven alpha

A standard practice in statistical hypothesis testing is to mention the P-value alongside the accept/reject decision. We show the advantages of mentioning an e-value instead. With P-values, it is not clear how to use an extreme observation (e.g. [Formula: see text]) for getting better frequentist decisions. With e-values it is straightforward, since they provide Type-I risk control in a generalized Neyman-Pearson setting with the decision task (a general loss function) determined post hoc, after observation of the data-thereby providing a handle on "roving [Formula: see text]'s." When Type-II risks are taken into consideration, the only admissible decision rules in the post hoc setting turn out to be e-value-based. Similarly, if the loss incurred when specifying a faulty confidence interval is not fixed in advance, standard confidence intervals and distributions may fail, whereas e-confidence sets and e-posteriors still provide valid risk guarantees. Sufficiently powerful e-values have by now been developed for a range of classical testing problems. We discuss the main challenges for wider development and deployment.

A Rule-Based System for Admission Recommendations in Nigerian Tertiary Institutions

This research presents a rule-based system to provide admission recommendations in Nigerian tertiary institutions. Unlike many existing studies that employ machine learning classifiers, this research aims to develop a transparent and deterministic system using predefined rules. The rule-based system recommends suitable courses based on candidates’ O’level results, Unified Tertiary Matriculation Examination (UTME) scores, computed post-UTME scores, and specific eligibility criteria. By focusing on a rule-based approach, the system mitigates the limitations and potential misclassifications associated with machine learning, thereby enhancing the efficiency and accuracy of the admissions process. The methodology follows predefined guidelines to ensure a transparent and understandable admissions procedure. This approach avoids the complexities and uncertainties of predictive models, providing an accurate and reliable method for course recommendations. The rule-based recommendation system ultimately aims to support educational institutions and admission offices in making informed decisions regarding candidate qualifications, eligibility, and course recommendations.

Amend the Mental Health Care Act 2017: A Survey of Indian Psychiatrists (Paper 1).

This paper highlights the difficulties and lacunae in the Mental Health Care Act 2017 that hinder its implementation and use for the care and treatment of persons with mental illness in India. An online nationwide survey, involving structured questions as well as open-ended questions, to elicit the level of implementation, experience in complying with the provisions of the Act, and level of satisfaction, of practicing psychiatrists was carried out. Responses were analyzed using appropriate statistics. 600 respondents answered the online questionnaire. A majority of psychiatrists were senior practitioners with over 10 years of experience. 92.5% respondents were dissatisfied with the MHCA, wherein 73.3% wanted it amended, and 19.2% asked for repeal. Procedural issues were deterrent for 66.5% from taking medically necessary or helpful decisions for patients. Non-implementation of the Act was a major finding. Major dissatisfaction was expressed regarding judicial over reach in admission and discharge procedures, inclusion of general hospital psychiatry units in the definition of mental health establishment, non-applicability of provisions like advance directive and nominated representative in Indian setting, and that all treatment should be covered under insurance. The Act in its present form defies the spirit of its own objectives and is unimplementable. It needs major revisions.

A challenging decision for emergency physicians: Routine repeat computed brain tomography of the brain in head trauma in infants and neonates.

Head trauma is a leading cause of death and disability. While standard treatment protocols exist for severe head trauma, no clear follow-up standards are available for mild head trauma with positive imaging findings in infants and newborns. Although routine follow-up brain computed tomography (CT) imaging is not recommended for children with moderate and mild head trauma, the necessity for follow-up imaging in infants and newborns remains uncertain. Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package. Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on follow-up CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay. Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings.

Perancangan Sistem Informasi Penerimaan Siswa Baru di SMK Harapan Bangsa Berbasis Web Menggunakan CodeIgniter 4

The admission of new students is a critical process in educational institutions, designed to select candidates based on specific criteria set by the school. This process typically involves multiple stages, including registration, selection through testing, and the announcement of results. However, at SMK Harapan Bangsa, this process has been managed manually using paper-based documentation and Microsoft Excel, which is inefficient and prone to errors. This study aims to develop a web-based information system for new student admissions using the CodeIgniter 4 framework and MySQL database to streamline and enhance the process. The software development methodology employed in this research is the Waterfall model, which consists of analysis, design, implementation, and system testing stages. The result of this research is an information system that simplifies the access to new student admission information for parents and students, enabling them to register online and monitor the selection results more efficiently. Additionally, the system supports the school in automatically archiving and organizing registration data. This web-based solution offers a more structured and error-free process, significantly improving the overall efficiency and accuracy of the admissions procedure.

Procedure for licensing medical activities at the present stage: problems and ways to overcome them

BACKGROUND: One of the tools for ensuring the quality of medical care and medical services is licensing procedures for admission to medical activities, which include licensing. Licensing is indicated as a mandatory condition for carrying out medical activities in the list of types of activities for which licenses are required (clause 46 of Article 12 of the Federal Law “On Licensing of Certain Types of Activities”). Since life and health are the most important universal human values and are legally enshrined at the level of the Constitution of the Russian Federation, the study of the healthcare sector, including from the point of view of legal support for procedures for admitting individuals and legal entities to medical activities, is of exceptional scientific and practical interest. It should be noted that the institution of licensing of medical activities is one of the legal institutions that is constantly undergoing legislative changes, which allows us to speak about the relevance and relevance of this issue. Issues of licensing medical activities quite often come to the attention of researchers, however, due to the dynamic changes in the current legislation on the issue under study and the presence of quite extensive judicial practice, they require additional research in order to resolve problematic issues that arise in practice. OBJECTIVE OF THE STUDY: based on an analysis of the regulatory framework for licensing medical activities, to identify problematic procedural issues and determine ways to improve the current legislation regulating the provision of medical care and medical services. MATERIALS AND METHODS: Using the method of expert assessments, an analysis was carried out of the regulatory framework of the Russian Federation regulating legal relations during the procedure for licensing medical activities by organizations of the public and private healthcare system. RESULTS: Licensing as an institution of law is complex in terms of the legal relations it generates, combining at its core the legal norms of two broad branches of law — administrative and civil. At the same time, licensing is a mandatory criterion for the functioning of a medical organization and includes a number of requirements for such organizations. Despite the extensive regulatory framework on the issue under study, licensing requirements contain a number of problematic aspects that create obstacles for licensees and license applicants and require legislative approval. In this regard, the authors have proposed ways to resolve existing contradictions by making specific proposals to change the current legislation. The proposed optimization of the licensing procedure for all participants in this process, as well as minimizing the risks arising from these legal relations, according to the authors, fully meets the objectives of ensuring the rights of citizens to high-quality and safe medical care.

OPTIMIZING PREOPERATIVE HAEMOGLOBIN MONITORING AND TRANSFUSION PRACTICES IN SHOULDER ARTHROPLASTY SURGERY: A COST-EFFECTIVE ANALYSIS OF PREOPERATIVE ADMISSIONS IN THE NATIONAL HEALTH SERVICE

Shoulder replacement surgery is a well-established orthopaedic procedure designed to significantly enhance patients’ quality of life. However, the prevailing preoperative admission practices within our tertiary shoulder surgery unit involve a two-stage group and save testing process, necessitating an admission on the evening before surgery. This protocol may unnecessarily prolong hospital stays without yielding substantial clinical benefits.The principal aim of our study is to assess the necessity of conducting two preoperative group and save blood tests and to evaluate the requirement for blood transfusions in shoulder arthroplasty surgeries. A secondary objective is to reduce hospital stay durations and the associated admission costs for patients undergoing shoulder arthroplasty. We conducted a retrospective observational study covering the period from 1st January 2023 to 31st August 2023, collecting data from shoulder arthroplasty procedures across three hospitals within the Aneurin Bevan University Health Board.Our analysis included 21 total shoulder replacement cases and 13 reverse shoulder replacement cases. Notably, none of the patients required postoperative blood transfusions. The mean haemoglobin drop observed was 14 g/L for total shoulder replacements and 15 g/L for reverse shoulder replacements. The mean elective admission duration was 2.4 nights for total shoulder replacements and 2 nights for reverse shoulder replacements. Our data indicated that hospital stays were extended by one night primarily due to the preoperative group and save blood tests.In light of these findings, we propose a more streamlined admission process for elective shoulder replacement surgery, eliminating the need for the evening-before-surgery group and save testing. Hospital admissions in these units incur a cost of approximately £500 per night, while the group and save blood tests cost around £30 each. This revised admission procedure is expected to optimise the use of healthcare resources and improve patient satisfaction without compromising clinical care.

Admission Test Scores and Colleges’ Retention Rates

Most higher education institutions eliminated standardized test requirements for applicants following the COVID-19 pandemic. The impact of college admission criteria on college student retention has been the subject of extensive research in higher education. This literature suggests that admission criteria play a significant role in influencing student retention rates. However, the impacts of test-optional admissions procedures have been relatively understudied. Using a dataset of admissions requirements, institutional profiles, measures of collegiate success, financial aid, and demographics of full-time, first-year students at public or not-for-profit private 4-year institutions for the 2021-2022 academic year, we find that, of the different criteria used in admission policies, required or recommended letters of recommendation and graduation rates combined have an impact on college retention rates. Required or recommended admission test scores positively increase retention rates, albeit not robustly.

Examining Nursing Students’ Interest and Performance in Chemistry in Nigeria Colleges of Nursing Sciences: Emerging Issues

Nurses require a good understanding of chemistry as a result of the interrelationship of many chemistry concepts with nursing both in the classroom and in applications hence, the indispensable nature of chemistry to nursing. However, most nursing students have consistently found chemistry as one of their major nightmares in the course of their studies. This is evident in their performances and interest. This paper aims to critically examine the causes of the increasing decline in nursing students’ interest in chemistry in Nigerian nursing colleges in relation to how they are negatively impacting in their chemistry performances. The paper relied on both primary and secondary sources and on careful analysis found out the major challenging issues as: foundational problems, unqualified candidates/ examination malpractice, faulty/fraudulent admission procedures, lack of laboratories/learning materials and the ease of cross border migration. While the problems obviously maybe more than as elucidated, in chatting a way forward, some strategies suggested as recommendations include proper result verification process, guiding the students through the use of problem-solving skills, the provision of well-equipped laboratories and the adoption and the implementation of digital mode of teaching and learning. Even though they may not be exhaustive, but they have been carefully chosen as highlighted and would go a long way to help if fully implemented.

Satisfaction of patients treated in a Physical Medicine and Rehabilitation department during the Covid-19 pandemic: a cross-sectional study

Background Patients treated in Physical Medicine and Rehabilitation (PM&R) departments benefit from global and multidisciplinary long-term care. The study of satisfaction represents an important element in the evaluation of the quality of the healthcare provided. The aim of this study is to assess the level of satisfaction of patients treated in the PM&R department of Sahloul university hospital of Sousse Tunisia as well as the associated factors during the year 2020. Methods We conducted a cross-sectional study, including patients treated in the hospitalization and the outpatient units of the PM&R department. Monnin and Perneger scale validated in Arabic was used to measure satisfaction in its different dimensions. Medical data were completed from patients’ records. Results A total of 240 patients were included in our study. The level of satisfaction was significantly higher with the admission procedures for inpatients compared to outpatients (87.9% vs. 60.0%, p<0.001). Regarding the global assessment, 82.1% of patients were satisfied. Multivariate analysis showed that for administrative procedures, consultation for outpatients was a factor of dissatisfaction (aOR=0.18, p<0.001). Patients’ physiotherapy treatment during the Covid-19 period was negatively associated with satisfaction for logistics (aOR= 0.44, p=0.011) and for the global assessment of health care provided in our department (aOR= 0.46, p=0.04). Conclusion Our study showed overall good levels of satisfaction in the department of PM&R of Sahloul. However, more studies should follow to determine other factors that can influence satisfaction.

Hospitalization risk in multiple myeloma episodes of care.

e23101 Background: The Enhancing Oncology Model (EOM) is a total cost of care (TCOC) program that was initiated in July 2023. Participating groups are expected to reduce expenditures while delivering high-quality care. Hospitalization (IP) is an important quality metric and cost driver in TCOC programs such as EOM. Understanding how cancer treatment may impact IP is essential for success. Multiple Myeloma (MM) treatment has transformed with multi-agent treatment as the standard of care (SOC), routinely incorporating 3 or more drugs used concurrently to maximize response. We examined the impact multi-drug treatment had on IP rates in MM patients. Methods: Using Parts A, B and D Medicare claims data from EOM baseline period (January 2019 - June 2022) for 12 participating practices, we extracted a unique count of chemotherapy drugs and IP admissions attributed to 6-month episodes of care. Dexamethasone (dex) was included even if claims were not found. Planned and cancer-surgery related IP were excluded using the Clinical Classifications Software Planned Admission Procedure Categories and per EOM specifications. IPs were dichotomized as Yes/No. A logistic regression model was developed to evaluate the association between the number of unique drugs and the unplanned IP, adjusting for variables: prior chemo, age at episode start, race, and HCC count. A 3-drug regimen was established as the reference (including dex) based on SOC. Results: 11,613 episodes had a primary diagnosis of MM, with at least one IP occurring in 2,382 episodes. The number of episodes (% IP) per drug count group are 1-2: 6636(16.3%); 3: 3772 (23.6%); 4: 863 (30.8%); 5+: 342 (40.9%). Detailed statistics are provided in Table 1. Compared to a 3-drug regimen, 4+ drugs increased the risk of IP, while episodes with 1-2 drugs had a lower risk of IP after adjusting for age, race, HCC count and prior treatment. Conclusions: Our findings can guide the design of care transforming interventions aimed at avoiding unnecessary IP while using guideline concordant SOC treatments for MM, driving TCOC reduction. Identifying patients with a higher likelihood of IP helps practices target patient monitoring programs. To understand why patients with prior treatment had lower IP identifying maintenance following initial treatment and patients receiving 3 or more drugs after failure of prior therapy, are worth exploring further. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. [Table: see text]

#741 Gender differences in vascular access for prevalent dialysis patients

Abstract Background Gender disparities of some aspects of vascular access (VA) for hemodialysis (HD) have been reported. Aim To analyze the VA profile of prevalent HD patients (pts) according to gender in Catalonia Method Data from the Catalan Renal Registry of end-stage kidney disease (ESKD) pts over 18 years of age treated by HD on 31 December were examined from 1997 to 2021. Results The total cumulative number of follow-ups registered for prevalent ESKD pts treated by HD was 95 575 out of 25 130 pts; we have VA information for most of the follow-ups (93.1%, 88 980/95 575). The number of prevalent HD pts increased from 3104 in 1997 to 4270 in 2021. The characteristics of prevalent HD pts in 2021 (n = 4270) were different for male (n = 2731) vs female (n = 1539) regarding mean age (69.1 ± 14.6 vs 70.9 ± 14.3 years), age bracket >74 years (42.4% vs 48.3%), median time on HD [24.0 (9.8−48.2) vs 27.6 (10.5−59.1) ], aetiology of ESKD as polycystic kidney disease (4.4% vs 7.2%), normal functional status (38.0% vs 28.4%), cardiovascular disease (76.3% vs 71.1%) and obesity rate (body mass index BMI>30 kg/m2: 17.4% vs 27.2%) (for all comparisons, p < 0.001). The distribution of the VA used for performing HD in 2021 was also different in men vs women: fistula AVF (58.1%, n = 1465 vs 45.6%, n = 657), graft (1.8%, n = 45 vs 3.5%, n = 51) and tunnelled catheter (35.8%, n = 903 vs 45.8%, n = 660) (for all comparisons, p < 0.001) ; there were no differences for non-tunnelled catheter (4.3%, n = 107 vs 5.0%, n = 72) (p = 0.15). In addition, the type of AVF was different in men vs women: radiocephalic AVF (53.9% vs 40.9%) and brachial artery-based AVF (46.1% vs 59.1%) (p < 0.001). The percentage of pts who required at least one hospital admission or outpatient procedure for any VA pathology in 2021 was similar when comparing men [7.3% (n = 180) and 19.6% (n = 456), respectively] and women [8.6% (n = 122) and 19.3% (260), respectively] (p = 0.34 and p = 0.38, respectively). Regarding the total cumulative number of VA used for HD, the percentage of pts who used only one VA was higher for men (50.4%, n = 1265) than women (47.1%, n = 663); however, this difference is reversed when the percentage of pts who used ≥4 VA was calculated: 11.5% (n = 289) vs 14.4% (n = 203) (for all comparisons, p = 0.001). The percentage of pts who have been dialyzed through AVF at some point over time was higher for men (69.2%, n = 1889) than women (62.6%, n = 964) (p < 0.001) The probability of performing HD through AVF in 2021was independently associated with male gender (odds ratio 1.58 [95% confidence interval: 1.36–1.82], p < 0.001) after adjusting for age, time on HD, primary kidney disease, cardiovascular disease, functional status and BMI (multivariate logistic regression analysis). The percentage of both men and women on HD through AVF decreased progressively from 1997 (89.1% and 81.3%, respectively) to 2021 (58.1% and 45.6%, respectively) (for both comparisons, p < 0.001). The percentage of prevalent men on HD with AVF was always higher over time than that of women from 1997 (89.1% vs 58.1%) to 2021 (81.3% vs 45.6%) (for both comparisons, p < 0.001). Conclusions 1) AVF was the main type of VA used for prevalent men on HD, but AVF and tunnelled catheter shared this ranking in women. 2) Male gender was an independent factor associated with a 58% greater probability of performing HD through AVF than female. 3) The percentage of prevalent HD pts dialyzed through AVF progressively decreased over time in both sexes but it was always higher in men than women. 4) The type of AVF mainly used was different depending on gender: radiocephalic AVF for men and brachial artery-based AVF for women.

Statewide Hospital Admissions for Adult Survivors of Infant Surgical Diseases Over a 10-Year Period

IntroductionThe number of patients with congenital disease living to adulthood continues to grow. Often undergoing surgical correction in infancy, they continue to require lifelong care. Their numbers are largely unknown. We sought to evaluate hospital admissions of adult patients with esophageal atresia with tracheoesophageal fistula (EA/TEF), congenital diaphragmatic hernia (CDH), and Hirschsprung disease (HD). MethodsThe Florida Agency for Healthcare Administration inpatient database was merged with the Distressed Communities Index and Centers for Medicare and Medicaid Services Hospital and Physician Compare datasets. The dataset was queried for adult patients (≥18 y, born after 1970) with EA/TEF, CDH, and HD in their problem list from 2010 to 2020. Patient demographics, hospitalization characteristics, and discharge information were obtained. ResultsIn total, 1140 admissions were identified (266 EA/TEF, 135 CDH, 739 HD). Patients were mostly female (53%), had a mean age of 31.6 y, and often admitted to an adult internist in a general hospital under emergency. Principal diagnoses and procedures (when performed) varied with diagnosis and age at admission. EA patients were admitted with dysphagia and foregut symptoms and often underwent upper endoscopy with dilation. CDH patients were often admitted for diaphragmatic hernias and underwent adult diaphragm repair. Hirschsprung patients were often admitted for intestinal obstructive issues and frequently underwent colonoscopy but trended toward operative intervention with increasing age. ConclusionsAdults with congenital disease continue to require hospital admission and invasive procedures. As age increases, diagnoses and performed procedures for each diagnoses evolve. These data could guide the formulation of multispecialty disease-specific follow-up programs for these patients.