Admission Of Patients Research Articles

Association between D-dimer-to-albumin ratio and 28-days all-cause mortality in patients with sepsis.

We aimed to investigate the correlation between the serum D-dimer (D-D) to albumin (ALB) ratio (DAR) and 28-day all-cause mortality in patients with sepsis. Data from sepsis patients admitted to the intensive care unit (ICU) of Wuhan Fourth Hospital from October 2021 to January 2024 were collected. Univariate cox analysis was performed for mortality factors in sepsis patients, and multiple cox regression models were used to analyze independent mortality risk factors. The receiver operating characteristics (ROC) curve was used to analyze the value of DAR in predicting sepsis mortality, and the Kaplan-Meier method was used to plot the survival curve. A total of 833 patients with sepsis in the ICU of our hospital were selected and divided into alive group (n = 574) and death group (n = 171) according to their 28-day survival. In the death group, D-D and DAR levels were higher, while ALB levels was lower than in the alive group. Spearman analysis found that DAR level were positively correlated with APACHE II and SOFA scores. Multivariate cox regression analysis showed that DAR was an independent predictor of all-cause mortality within 28 days of admission for sepsis patients (HR = 17.956, 95% CI 3.435-93.851, p < 0.001). The ROC curve results showed that the cut-off value of DAR was 0.068, with a sensitivity of 78.4% and a Youden index of 0.375, predicting mortality in sepsis patients, with an area under curve (AUC) of 0.767 (95% CI 0.744-0.790, P < 0.001). Further analysis divided patients into low DAR (DAR < 0.068) and high DAR (DA ≥ 0.068) groups based on the optimal cut-off value. Kaplan-Meier analysis found higher mortality in the high DAR group. DAR is an independent predictor of all-cause mortality within 28 days of admission in sepsis patients. Combining these two indicators can improve clinical treatment guidance and reduce the risk of death.

Adrenal Crisis and Adrenal Insufficiency Admissions in Patients 30-59 Years: Contribution of Psychosocial Factors.

Adrenal crises (AC) occur in middle aged adults with adrenal insufficiency (AI). Psychosocial difficulties may impede effective self-management in some cases. This study aimed to investigate associations between psychosocial problems and hospital admissions for AI/AC in middle aged adults. Data on all hospitalisations among patients aged 30-59 years with a diagnosis of AI were extracted from a regional database for the years 2005-2020. Trends in hospitalisations and associations between admissions and comorbid psychosocial problems were assessed. Of the 3948 admissions for AI between 2005 and 2020, 63.4% were in women. Admissions increased by 91.4%, from 61.89 to 118.44/million (p < 0.0001), while AC admission rates increased by 176.5% (from 7.71 to 21.33/million, p=NS). Secondary AI (SAI) admissions rose by 133.0%, from 27.98/million to 65.20/million (p < 0.001). Admissions increased in women in each decade but only in males aged 50-59 years. Comorbid infection was identified in 28.1% of admissions and at least one comorbid contributory psychological problem was found in 25.6%. Males, patients with SAI and those not living in a domestic partnership had a higher combined psychosocial problem burden. Females admitted with at least one sign of an AC had significantly higher psychosocial problem scores than those with less severe presentations. These results suggest that psychosocial factors may play a role in some admissions for AI/AC in adults aged between 30 and 59 years, possibly contributing to the otherwise unexplained rise in hospitalisations for AI.

Sympathetic nerve activity and response to physiological stress in Takotsubo syndrome.

The prevailing hypothesis posits that Takotsubo syndrome (TTS) is caused by massive sympathetic activation, yet supporting evidence remains inconsistent. The objectives of the present study were to determine whether sympathetic activity and reactivity are enhanced in the recovery phase of TTS, and to evaluate the effect of selective β1-receptor blockade on sympathetic reactivity. We conducted a case-control study that included 18 female patients with TTS and 13 age- and sex-matched controls. Muscle sympathetic nerve activity was measured through microneurography of the peroneal nerve at rest and during the cold pressor test. In the TTS group, recordings were repeated after randomisation to intravenous metoprolol or placebo. In 10 TTS patients, cardiac sympathetic activity was assessed using iodine123-metaiodobenzylguanidine scintigraphy. Blood samples were collected during hospitalisation. Microneurography was performed a median of 27.5days after patient admission. There were no significant differences in burst incidence, burst frequency, burst height or burst area between the TTS patients and the controls at rest, during stress or after administration of intravenous metoprolol. Iodine123-metaiodobenzylguanidine scintigraphy was performed a median of 12.5days after admission, revealing decreased early 1.54 ± 0.13 and late 1.40 ± 0.13 heart-to-mediastinum ratios, and an increased washout rate of 41.8 ± 12.1%. Catecholamine metabolites were comparable between the study groups. General sympathetic hyperactivity or hyperreactivityunlikelycontributesto TTS, as catecholamine levels and muscle sympathetic nerve activity at rest and during stress were similar between the TTS patients and the controls.As scintigraphy showed increased cardiac sympathetic activity, a pathological cardiac adrenergic response and vulnerability to sympathetic activationmay be crucial for the development of the syndrome.

The long-term conditional mortality rate in older ICU patients compared to the general population.

Understanding how preexisting comorbidities may interact with a critical illness is important for the assessment of long-term survival probability of older patients admitted to the ICU. The mortality after a first ICU admission in patients ≥ 55years old registered in the Swedish Intensive Care Registry was compared to age- and sex-matched individuals from the general population with a landmark after 1 year. The comparison was adjusted for age, sex, and baseline comorbidity using Cox regression. The 7-year study period included 140 008 patients, of whom 23% were 80 years or older. Patients surviving the first year remained at an increased risk compared to the general population, but much of this difference was attenuated after adjustment for baseline comorbidity (HR, 1.03; 95% CI 1.02-1.04). Excluding cardio-thoracic ICU admissions, the increased risk remained slightly elevated (adjusted HR, 1.15; 95% CI 1.13-1.16). Also, the subgroup ≥ 75years old surviving the first year returned to a mortality rate comparable to the general population (HR, 0.98; 95% CI 0.96-0.99). Stratified by admission diagnosis an increased mortality rate remained beyond the first year for acute-on-chronic respiratory failure (adjusted HR, 1.47; 95% CI 1.36-1.58) but not for other respiratory causes (adjusted HR, 1.03; 95% CI 0.99-1.07) or admission for septic shock (adjusted HR, 1.04; 95% CI 0.95-1.13). No substantial increased mortality rate was notable beyond the first year for other admission diagnoses. Older ICU patients that survive the first year after an ICU admission return to a mortality rate close to that of the general population having similar baseline comorbidity, but variability is seen depending on the ICU admission diagnosis. Trial registration ClinicalTrials.gov ID: NCT06234709, date 02/01/2024.

Clinical Subtype Trajectories in Sepsis Patients Admitted to the ICU: A Secondary Analysis of an Observational Study

OBJECTIVES: Sepsis is an evolving process and proposed subtypes may change over time. We hypothesized that previously established sepsis subtypes are dynamic, prognostic of outcome, and trajectories are associated with host response alterations. DESIGN: A secondary analysis of two observational critically ill sepsis cohorts: the Molecular diAgnosis and Risk stratification of Sepsis (MARS) and the Medical Information Mart for Intensive Care-IV (MIMIC-IV). SETTING: ICUs in the Netherlands and United States between 2011–2014 and 2008–2019, respectively. PARTICIPANTS: Patient admission fulfilling the Sepsis-3 criteria upon ICU admission adjudicated to one of four previously identified subtypes, comprising 2,416 admissions in MARS and 10,745 in MIMIC-IV. MAIN OUTCOMES AND MEASURES: Subtype stability and the changes per subtype on days 2, 4 and 7 of ICU admission were assessed. Next, the associated between change in clinical subtype and outcome and host response alterations. RESULTS: In MARS, upon ICU admission, 6% (n = 150) of the patient admissions were α-type, 3% (n = 70) β-type, 55% (n = 1317) γ-type, and 36% (n = 879) δ-type; in MIMIC-IV, this was α = 22% (n = 2398), β = 22% (n = 2365), γ = 31% (n = 3296), and δ = 25% (2686). Overall, prevalence of subtypes was stable over days 2, 4, and 7. However, 28–56% (MARS/MIMIC-IV) changed from α on ICU admission to any of the other subtypes on day 2, 33–71% from β, 57–32% from γ, and 50–48% from δ. On day 4, overall subtype persistence was 33–36%. γ or δ admissions remaining in, or transitioning to, subtype γ on days 2, 4, and 7 exhibited lower mortality rates compared with those remaining in, or transitioning to, subtype δ. Longitudinal host response biomarkers reflecting inflammation, coagulation, and endothelial dysfunction were most altered in the δ-δ group, followed by the γ-δ group, independent of the day or biomarker domain. CONCLUSIONS AND RELEVANCE: In two large cohorts, subtype change to δ was associated with worse clinical outcome and more aberrant biomarkers reflecting inflammation, coagulation, and endothelial dysfunction. These findings underscore the importance of monitoring sepsis subtypes and their linked host responses for improved prognostication and personalized treatment strategies.

HPB SO48 - Evaluating the timeframe for the provision of laparoscopic cholecystectomy in acute cholecystitis patients at a regional hospital

Abstract Background Acute biliary disease comprised a substantial proportion of the general emergency surgical workload. AUGIS and NICE guidelines recommend early laparoscopic cholecystectomy (LC) in acute cholecystitis (AC) patients as it is associated with reduced readmission rates, healthcare costs and faster recovery without notable complication risks. According to the local trust policy, it advocates early LC to be performed within 72 hours of admission for AC patients. If this is not possible a delayed LC should be performed within 8 weeks of admission. Our aim is to examine variations in the provision of LC between current practice and local trust/ NICE guidelines. Method This is a retrospective audit looking at the total number of surgical patients diagnosed with AC between Jan and Dec 2023. The number of patients who had LC in 2023, unfit for surgery and did not consent for the procedure were also included. This data was obtained from electronic patient records (investigative reports, discharge letters, outpatient letters) and then collated on a Microsoft Excel sheet for analysis. Surgical patients who were not diagnosed with AC such as those with biliary pancreatitis, cholelithiasis or cholangitis but subsequently underwent LC were excluded. Results The number of AC patients who were fit and consented to surgical intervention in 2023 was 88. The total number of delayed procedures done was 75 (85.2%). The number of patients who had early LC within 1 week was 13 (14.8%). Of the 75 patients who had delayed LC, 19 (25.3%) patients had delayed LC within 8 weeks from the diagnosis date. The remaining 56 (74.7%) patients had delayed LC after 8 weeks. For patients who had delayed LC, the readmission rate within 6 months of their discharge while waiting for their operative dates was 29 (38.7%). Conclusion One-third of AC patients were readmitted while waiting for LC, some had complications of gallstone disease such as perforation/ gallstone ileus. Therefore, the early provision of LC is crucial in minimising the readmission and complication rates. This data was highlighted in a departmental meeting and teaching session for consultants and junior doctors. We plan to liaise with stakeholders and theatre managers in implementing further solutions to improve compliance where possible. One critical area is auditing the condition of surgical patients in order to be put on the hospital’s twice-weekly hot gallbladder list to consider prioritising AC patient surgical time.

BS SO12 - Long-term impacts of emergency presentations following bariatric health tourism on patients and health services: A UK perspective

Abstract Background Bariatric surgery is an effective treatment for obesity. Whilst short-term complication rates are low, little is known about the longer-term impacts on patients and health services. Even less is known about the true impact of the increasing trend of Health Tourism (HT) in this field. This study aimed to explore this topic further to quantify the impact of HT on UK healthcare services and to subsequently inform future service planning. Method This was a retrospective study of consecutive emergency inpatient episodes related to bariatric surgery (presenting to ED or transferred from other hospitals) at a regional bariatric centre. The study included patients between January 2018- April 2023. Data on index procedure (type, time to presentation, location), complications (and associated management), and subsequent readmissions, diagnostic investigations, and interventions (surgical, radiological, endoscopic) following first discharge from our centre was collected. Results 308 patients (489 episodes) were included (188 patients had surgery in the UK, 77 HT, 43 unknown origin). Gastric band (50%) and gastric sleeve (39%) were the commonest causes for admission in UK and HT patients, respectively. 86 surgical interventions post discharge were required. An average of 2.0 diagnostic investigations were undertaken following discharge per patient (UK 2.3 vs HT 1.9). Following discharge, similar average rates of further readmissions (UK 0.6 v HT 0.6), surgical (UK 0.3 v HT 0.4), radiological (UK 0.2 v HT 0.2) and endoscopic interventions (UK 0.6 v HT 0.6) were seen between cohorts. Conclusion Patients presenting with emergencies following bariatric surgery require significant ongoing investigation and management following discharge from hospital. This ongoing burden is often overlooked in health services research. In our study, this demand was significantly increased by bariatric health tourism. This highlights the critical need to recognise this additional burden, improve service planning to accommodate increased service demand, and address underlying factors contributing to health tourism.

HPB SO75 - Burden and Pattern of Gallstone-Related Acute Surgical Admissions

Abstract Background Gallstone disease accounts for nearly one-third of emergency general surgery admissions, with a considerable number resulting from recurrent episodes. Laparoscopic cholecystectomy (LC) is the only definitive treatment for gallstones. This study aimed to examine the burden and patterns of acute biliary admissions. Method This prospective cohort study was conducted over a continuous 12-week period in 2022 within a single surgical unit, focusing on all gallstone-related admissions. The total number of admissions for various surgical pathologies was documented, and the proportion due to biliary disease was determined. The analysis encompassed patient demographics, reasons for biliary admission, prior gallstone history, and any planned laparoscopic cholecystectomies (LC). Results There were 532 acute admissions, 98 (18.4%) were gallstones related. Median age was 62 years (IQR 47-72) and 58 (59.2%) were female. 40 (40.8%) had acute cholecystitis, 24 (24.5%) had gallstone pancreatitis, 16 (16.3%) had bile duct stones, 10 (10.2%) had biliary colic and 8 (8.2%) had ascending cholangitis. 43 (43.9%) patients were known to have gallstones and 26 (26.5%) patients had prior admission related to gallstones. 35.7% patients had outpatient LC, 23.5% had no documentation, 19.4% had inpatient LC, 18.4% were not fit candidates and 3.1% patients declined LC. Median total length of stay was 6 days (IQR 4-11). Conclusion In our study, the rate of biliary-related admissions was lower than previously reported in the literature. This reduction may be attributed to our semi-aggressive management approach for gallstone disease. To further improve patient outcomes, we suggest implementing more aggressive management strategies for gallstones during the initial admission for patients who are deemed fit for surgery. Such an approach could potentially reduce the recurrence of biliary admissions and enhance overall treatment efficacy.

BS SO18 - Small bowel intussusception after Roux-en-Y gastric bypass: A case report and review of literature

Abstract Background Small bowel obstruction after RYGB for obesity can occur due to various common causes like internal hernia and adhesions. One of the rare complications of RYGB is retrograde intussusception of jejunum at the common channel. Since it does not present with typical symptoms of small bowel obstruction, it is often challenging to consider it as differential diagnosis at initial presentation. Also, managing the intussusception at non bariatric centres could prove difficult due to location of it in the common channel, which will require understanding of orientation of alimentary and biliary limbs as well as reconstruction after resection of the intussusception. Method We collected the details of our patients admission episode from a different centre where she was admitted initially to understand the clinical behaviour of the condition. Also, we conducted a systematic search of literature databases like PubMed, Embase, CINAHL, ProQuest Dissertations &amp; Theses using MeSH terms and keywords Intussusception, Retrograde intussusception, J-J intussusception, Intestinal Obstruction, Small bowel obstruction, Bowel obstruction, Obesity, Morbid obesity, Gastric Bypass, Roux-en-Y gastric bypass, Jejunojejunostomy, Jejuno-jejunostomy, Gastric by-pass, RYGB, Roux-en-Y. Data were extracted on to Excel sheet for analysis. Results The search yielded 41 case reports. Patients were operated in most instances except in seven cases where they had multiple episodes. The average age of presentation was 38 mostly in females and few instances being during pregnancy including our patient. Intussusception happened between 5 to 360 months after the initial operation with the average time after the operation being 66 months. Pain was the principal mode of presentation without classical symptoms of bowel obstruction. There were few instances of coffee ground vomiting. CT was the diagnostic modality in almost all cases. Recurrence was invariable when not managed with resection. Conclusion Small bowel intussusception after RYGB occurs retrogradely and does not present with classical symptoms and signs of small bowel obstruction. It can be reliably diagnosed with CT abdomen. Of note, medical management and no-resectional surgical management results in recurrence of this condition.

BN SO45 - Reported criteria and safety for day case management of acute appendicitis

Abstract Background Acute appendicitis has an incidence of 7-8%. About 45,000 appendicectomies are performed in UK/year. Whilst day case surgery (DCS) is standard for cholecystectomies, hernia repair and even gastric bypass, reluctance exists in application of day care pathway for acute appendicitis. We aimed to review published literature on patient selection criteria, rates of day case discharge, readmission and re-intervention rates and patient satisfaction. Method A literature search was conducted in Embase, Pubmed and Medline for day case appendicectomy, Patient safety, selection criteria. A total of 116 papers were found. Once duplicates were removed, 75 studies underwent abstract screening from which 41 were full text screened. 29 publications were included in this review study. Data was collected on criteria for patient selection, length of stay, rate of DCS, rates of re-admission and re-intervention and patient/ relative satisfaction. Results Studies assessed DCS in children and/or adults. All authors included patients with uncomplicated appendicitis, well managed pain without opioid analgesia and adequate social support. Other authors additionally, only included patients under 65yrs old. The rates of DCS varied between 36.9% - 87%. Factors affecting DCS were time of admission and operation, female patients, symptom control and social factors. Rates of readmission ranged between 0-2.5% with no difference between DCS and admitted patients. Rates of re-intervention were low (0-2.5%) with a high patient satisfaction (87-91%). Late evening finishing of operation led to patient admission (77%) with no complications occurring within 48hrs. Conclusion Day case surgery for appendicectomy is reported to be safe provided adequate patient education and clear criteria for patient selection. No significant difference was found between the rates of re-intervention and re-admission between day case and admitted patients. We suggest standardising care pathways and provision of adequate education to both patients and staff as a method of safe day care discharge.

Abstract 4117414: Risk Factors Associated with Cardiac Hospital Admissions in Cancer Patients Treated with Immune Checkpoint Inhibitors

Background: Immune checkpoint inhibitors (ICIs) are highly effective anti-cancer treatments for several cancers. However, treatment with ICIs is associated with metabolic perturbations, accelerated atherosclerosis, and increased risks of adverse cardiovascular events. In this study, we aimed to determine risk factors associated with cardiac hospital admissions in patients treated with ICIs for their cancer. Methods: Retrospective data was collected for all patients treated with ICIs between 1 January 2010 and 1 January 2020 through the Hunter New England Local Health District (HNELHD), Australia. Patient medical history and demographics were collected through electronic medical records. Outcome data was obtained from the HNELHD Institutional Cardiac and Stroke Outcomes Unit database. Cardiac admission was defined as cardiac disease based on hospital administration ICD-10 codes. Binary logistic regression was used for multivariate analysis and performed through SPSS version 28. Results: A total of 1,080 patients were included in the final analysis. Mean age of patients was 66.9 ± 11.7 years, with the majority male sex ( n =685; 63.4%). Primary cancer diagnosis of patients treated with ICIs included melanoma ( n =417; 38.7%), and cancer of the lung ( n =327; 30.3%). Nivolumab monotherapy was the most used first-line ICI treatment ( n =475; 44.0%) followed by pembrolizumab monotherapy ( n =428; 39.6%). A total of 266 (24.6%) patients had at least one cardiac hospital admission. On univariate analysis, pre-existing cardiovascular disease (CVD) ( p &lt;0.001), diabetes mellitus ( p &lt;0.001), chronic kidney disease ( p &lt;0.001), and prior CVD medications ( p &lt;0.001) were associated with cardiac hospitalisation. On multivariate analysis, prior history of heart failure ( p &lt;0.001), hypertension ( p =0.003), ischaemia, and peripheral vascular disease ( p =0.049) were independently associated with an increased risk of cardiac hospital admission. Conclusions: In cancer patients treated with ICIs, pre-existing CVD risk factors increases the risk of cardiac-associated hospitalisations. Adequate CVD risk modification and monitoring during treatment with ICIs may be necessary to reduce cardiac hospitalisations.

Abstract 4137907: Elevated Plasma Neopterin Levels in Patients with Takotsubo Cardiomyopathy

Background: Takotsubo cardiomyopathy (TC) is characterized by left ventricular apical ballooning and intact coronary arteries. The pathogenesis of this disorder is likely to be catecholamine-mediated myocyte damage, microvascular dysfunction and subsequent oxidative stress; however, a number of possible alternative theories have been suggested. Neopterin is produced by activated macrophages following stimulation by interferon-g produced by T-lymphocytes and is capable of enhancing the oxidative potential of reactive oxygen species. The aim of this study was to compare plasma neopterin levels between TC patients and patients with coronary artery disease. Methods: Plasma neopterin levels were measured on admission in patients with TC (n=37), stable angina pectoris (SAP, n=66), unstable angina pectoris (UAP, n=72) and acute myocardial infarction (AMI, n=67) using HPLC. A frozen myocardium specimen was obtained by biopsy from a patient with TC and stained for neopterin, macrophages, and microvessels using immunohistochemistry. Results: Plasma neopterin levels were significantly higher in TC patients compared with SAP patients ( P &lt;0.0001) or UAP patients ( P &lt;0.05), although they were not significantly different from those in AMI patients. In TC patients, plasma neopterin levels correlated positively with neutrophil count (R=0.47, P&lt;0.05) and serum C-reactive protein levels (R=0.38, P&lt;0.05). Immunohistochemical staining showed abundant neopterin-positive macrophages in the myocardium specimen from the patient with TC. Conclusions: This study demonstrates, for the first time, that plasma neopterin levels are elevated in TC patients compared with those in SAP and UAP patients. These findings suggest that neopterin may play an important role in the pathophysiology of Takotsubo cardiomyopathy.

Abstract 4114276: Identification of the heterogeneity in the risk of heart failure in those with left bundle branch block pattern using artificial intelligence

Introduction: The association between left bundle branch block (LBBB) and heart failure is well-established. However, the lack of a practical risk assessment tool for patients with LBBB poses a clinical challenge to the management despite the heterogeneity of the LBBB population. Hypothesis: Artificial intelligence (AI) can extract features to stratify the risk of heart failure (HF) within the heterogeneity of LBBB. Methods: All 12-lead ECGs diagnosed with LBBB recorded from 1/1/2015 to 12/31/2019 were identified in our institution. ECG data were analyzed as 2D matrices with a shape of 12×2500. The Uniform Manifold Approximation and Projection (UMAP) was used to visualize the heterogeneity of LBBB ECG. Additionally, a 2-dimensional convolutional neural network model was trained to detect LBBB ECGs associated with past HF diagnosis. The model was then applied to ECGs from an external cohort of patients with LBBB but without a history of HF. Cumulative incidences of HF admission were compared by stratifying according to tertiles of the model output (low, intermediate and high AI score groups) Results: We identified 15,124 LBBB ECGs in our institution (training dataset) and 2,463 individuals with LBBB ECGs in the external cohort (external test dataset). The UMAP projection of the ECGs revealed distinct heterogeneity in the data ( Fig A ). This heterogeneity was not fully explained by patient demographics, ECG features, or institutions. When the external cohort was divided into 3 groups according to the tertile of AI prediction, patients with high AI scores had a higher risk of HF admission (high vs low AI score group: hazard ratio (HR), 2.10; 95% confidence interval (CI), 1.66-2.65; intermediate vs low AI score group: HR, 1.39; 95%CI, 1.08-1.78: log-rank p &lt;0.0001; Fig 1B ). This finding was unchanged after adjusting for multiple clinical characteristics and ECG parameters, including QRS duration. Conclusion: We observed significant heterogeneity in ECGs presenting LBBB, and the AI model excellently stratified the risk of heart failure admission in patients with LBBB from a single recording of 12-lead ECG, suggesting great potential for clinical utility in managing patients with LBBB.

A Comparative Analysis of Human Resource for Health at three Teaching Hospitals in Sri Lanka: Availability and Workload

Background: This study investigates the availability and workload of Human Resources for Health (HRH) at three major teaching hospitals in Sri Lanka: National Hospital Sri Lanka (NHSL), Colombo South Teaching Hospital (CSTH), and Colombo North Teaching Hospital (CNTH). Understanding these hospitals' operational capacities and efficiency is crucial for enhancing healthcare delivery.Methods: A descriptive cross-sectional study was conducted using secondary data sources. Data extraction sheets were distributed to relevant hospital administrative personnel. The study analyzed bed strength, staff numbers, patient admissions, outpatient visits, and surgical throughput. Comparisons were made to evaluate efficiency and resource utilization across the three hospitals.Results: NHSL has the highest bed strength (3,321 beds), followed by CNTH (1,836 beds) and CSTH (1,242 beds). Bed occupancy rate was highest at NHSL at 75.76%, whereas CSTH and CNTH recorded 75.51% and 61.68%, respectively. Bed turnover was highest at CSTH (10.83/month), while the average length of stay was found to be lowest at CSTH (2.09 days). NHSL employs 1,135 doctors and 3,554 nurses, CSTH employs 537 doctors and 529 nurses, and CNTH employs 418 doctors and 607 nurses. NHSL handled the highest number of admissions and clinic patients, while CNTH had the highest number of clinic patients per doctor, indicating a higher operational efficiency but more significant strain on healthcare providers.Conclusions: NHSL, CSTH, and CNTH exhibit significant differences in operational capacities and efficiencies. To balance workload and improve healthcare outcomes, strategic resource management, enhanced staffing, and improved operational systems are recommended. Future studies should explore patient satisfaction and outcomes to improve policy decisions further.

Abstract 4118777: Outcomes Of Patients With Hypertrophic Cardiomyopathy In Academic Versus Non-Academic Centers: Analysis from the National Inpatient Sample Database 2012-2020

Introduction: Hypertrophic Cardiomyopathy (HCM) is an uncommon heart condition associated with serious complications. Advances in medicine have improved its prognosis. Despite this, such potentially life-saving improvements concerning the implementation of best practices are not ubiquitous; guidelines recommend management at specialized centers. Unfortunately, not all hospitals have specialized HCM centers. However, given that a sizeable portion of these specialists are also in academic centers (ACs), we hypothesize that ACs may be better positioned than non-academic centers to provide the highest quality care for HCM patients. Purpose: Our study aimed to assess in-hospital outcomes and healthcare burdens among patient admissions with HCM diagnoses, comparing those treated at academic centers with those receiving care at non-academic centers. We examine all-cause in-hospital mortality, length of stay (LOS), hospital costs, and investigate ethnic differences in patients with HCM. Methods: The National Inpatient Sample database was utilized to obtain HCM patient hospitalizations from 2012 through 2020 in the United States. Patient hospitalizations for which adult patients had a primary diagnosis of HCM were identified. Outcomes included all-cause in-hospital death, LOS, and hospital costs. All-cause in-hospital mortality was evaluated using multivariable logistic regression analysis. Multivariable lognormal regression models were used to estimate LOS and inflation adjusted cost outcomes. Results: All-cause mortality unadjusted rates were 2.2% in non-teaching hospitals compared with 1.7% at teaching hospitals; however, this difference was not statistically significant ( p =.235). Both unadjusted and adjusted hospital LOS were 32% shorter for non-teaching hospitals ( p &lt;.001). Both unadjusted and adjusted hospital costs were 46% lower for non-teaching hospitals compared to teaching hospitals ( p &lt;.001; $37,829 vs $70,216). For both LOS and cost, the overall interaction between race and teaching status was statistically significant ( p &lt; .001.) Conclusion: Our study shows variations in hospital outcomes and costs between teaching and non-teaching hospitals. Non-teaching hospitals displayed shorter stays and lower costs. Additionally, the interaction of race and teaching status significantly impacted length of stay and costs. These results underscore the necessity of tailored interventions to address healthcare delivery and resource inequities, especially in teaching hospitals.

Abstract 4119426: Enhancing early detection of ICI myocarditis cases during hospitalization: A role for large language models

Background: Immune-checkpoint inhibitor (ICI)-induced myocarditis is the most fatal immune-related adverse event (irAE). Early recognition and treatment of ICI myocarditis is associated with improved outcomes. However, current approaches to the diagnosis of ICI myocarditis have limitations. Open-source large language models (LLMs) are an accessible and scalable method of answering queries from human-generated text, and therefore may assist in the real-time early detection of ICI myocarditis among at-risk patients. Research Question: Can a free, open-source LLM detect cases of ICI myocarditis early in admission? Aims: We investigated the ability of a LLM pipeline to screen for ICI myocarditis within one day of admission using hospital medical records. Methods: Hospital admissions of patients on ICI therapy from November 4th, 2021, to September 5th, 2023 were retrospectively reviewed by a multidisciplinary immunotoxicity team using established, published definitions for the presence of ICI myocarditis. Progress notes written the day before, day of, and day after admission were fed into an open-source LLM pipeline built using Mistral 7B OpenOrca with retrieval augmentation generation (RAG). Performance of the LLM was measured via sensitivity and specificity in comparison to the gold standard of manual adjudication. Results: Of the 1874 hospital admissions of patients on ICI therapy, there were 22 (1.2%) cases of myocarditis. The average time to initiation of treatment was 2.45 days. Using notes written within one day after admission, the LLM detected ICI myocarditis with 95.5±8.7% sensitivity and 95.4±1.0% specificity, spending 2.13 seconds per chart. Conclusion: LLMs serve as a useful tool to screen for ICI myocarditis, detecting 95.5% of cases within one day of admission with 95.4% specificity. Future studies will investigate if integrating this tool into the real-time management of irAEs could lead to earlier diagnosis, faster initiation of treatment, and improved patient outcomes.

Efficacy of high-flow nasal oxygen therapy in cancer patients with concurrent acute hypoxemic respiratory failure: a retrospective propensity score study.

Acute respiratory failure is the leading cause of intensive care unit (ICU) admission of cancer patients. Studies of the efficacy of high-flow nasal cannula (HFNC) therapy were rarely conducted in cancer populations. We here compared the clinical effects of HFNC therapy and conventional oxygen therapy (COT) in cancer patients with concurrent acute hypoxemic respiratory failure (AHRF). In this single-center retrospective study, cancer patients with concurrent acute hypoxic respiratory failure either received initial oxygen therapy via HFNC (HFNC group, 68 patients) or received initial oxygen therapy via a nasal cannula, simple mask, or mask with reservoir bag (COT group, 133 patients). Groups were propensity score matched. Differences in respiratory rate (RR), heart rate (HR), and PaO2/FiO2 ratio before and after treatment in the two groups were compared using a mixed-effects model. The 28-day mortality risk was explored using a Cox proportional hazards model. The 24-h and 48-h PaO2/FIO2 ratios were significantly higher in the HFNC than in the COT group (210.5mmHg vs. 178.5mmHg; P < 0.01; 217.1mm Hg vs. 181.6mm Hg; P < 0.01, respectively). Differences in RR and HR between the groups at each time point were nonsignificant. The 28-day mortality rate was 17.4% vs. 38.1% for the HFNC and COT groups, respectively (P < 0.01). Hazard ratio was significantly higher for COT group (HR 2.6, 95% confidence interval 1.3, 5.3). Compared with COT, HFNC use for initial oxygen therapy can improve PaO2/FIO2 ratio and survival rate in cancer patients with AHRF.

Evaluating Software-Based Methods for Replacing Manual Collection of Midnight Totals: A Study from Sri Lanka

The manual collection of midnight totals in hospitals has long been used to calculate key performance indicators such as bed occupancy rates. Despite technological advancements, many hospitals still rely on labour-intensive manual methods prone to inaccuracies at multiple stages. This study introduces and evaluates the Smart Hospital Metrics Calculator, a tool developed to automate the calculation of midnight totals and same-day discharges using patient admission and discharge dates from the electronic Indoor Morbidity and Mortality Return (eIMMR). Both manual and software-based methods exhibited inaccuracies, but errors in software-based calculations were primarily due to issues with entering dates, which can be mitigated by improving workflows and refining the eIMMR system. In contrast, improving manual methods requires addressing challenges across multiple levels. Data from three hospitals were analysed, and while the results do not yet demonstrate these outcomes, it is postulated that with enhanced date entry processes, software-based methods, such as the Smart Hospital Metrics Calculator, could achieve near-zero inaccuracies. These findings suggest that transitioning to this automated approach has the potential to streamline data collection, enable real-time monitoring, and improve hospital data management—without requiring additional workload or significant investment. If successfully implemented, this change could represent a seamless transformation, realizing benefits without disrupting current operations.

A quality improvement model to identify undiagnosed heart failure at chronic obstructive pulmonary disease annual reviews

Abstract Introduction Heart failure (HF) is a common comorbidity in people with chronic obstructive pulmonary disease (COPD). The estimated prevalence of HF comorbidity in patients with COPD is up to 40%1. COPD and HF have overlapping symptoms which could delay the diagnosis of HF. Studies have shown that in UK primary care, HF treatment for COPD patients is delayed by almost twelve months compared to patients without COPD2. Early diagnosis and management of HF for COPD patients in primary care could reduce risk of recurrent exacerbation and subsequent hospitalisation. HF screen is not currently emphasised in the primary care COPD annual reviews. NICE guidance for COPD diagnosis mentions the use of serum natriuretic peptides to aid differential diagnosis of HF3. Pharmacists in general practice are the patients’ first point of contact, they are able to take leading roles in the holistic management of long-term conditions such as HF and COPD. Aim Reduce HF related complication including exacerbations and subsequent hospital admissions for COPD patients through early HF identification programme at COPD annual review. Methods Electronic Emis search was conducted on the practice database to identify patients on the COPD register. Patients with existing diagnosis of HF or NT-ProBNP in the last 12 month were excluded. Patients were invited for COPD annual review and screened for HF symptoms (breathlessness, fluid retention, fatigue, lightheadness) as per NICE guidance for HF identification. NT-ProBNP test was added to routine annual blood test for patients experiencing any of the HF symptoms. Patients with elevated NT-ProBNP &amp;gt;400ng/L were referred for further assessment for suspected HF. The project was a small scale service improvement project, it did not require ethical approval, this was confirmed with the Broad Street Health Centre clinical lead. Results Twenty six patients were screened out of 48 (54 %). Six patients (23%) had NT-pro BNP results over 400ng/L and were referred for further investigation for suspected HF. Diagnosis was confirmed for three patients 11%. Two of the newly diagnosed patients had an MRC score of 3, while one had and MRC score of 2. No patients with MRC score 1, 4 or 5 where among the newly diagnosed group. Discussion Results analysis correlates with published data regarding the prevalence of HF in COPD patients. Screening for HF in primary care might be most beneficial for patients with MRC of 2 or 3. Patients with score of 1 might have milder symptoms however annual screening will allow early detection of future deterioration. There were no newly diagnosed patients from the MRC score of 4 and 5 groups as they might have already been diagnosed if their symptoms were related to underlying HF. The three patients diagnosed with HF were treated for HF as per NICE guidance. Patients’ spontaneous feedback was positive regarding the new management approach. Conclusion Pharmacists in general practice can play a dynamic role in early identification of existing co-morbidities while conducting annual long-term conditions reviews. This in return facilitates vital early interventions to improve prognosis and reduce further complications along the way.

Timing of coronary angiography in high-risk non-ST-elevation acute coronary syndrome: results from the Portuguese Registry for Acute Coronary Syndromes (ProACS).

Current guidelines recommend an early invasive coronary angiography (ICA) within 24 h of admission for high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). Nevertheless, meta-analyses failed to demonstrate a clear advantage of this strategy in reducing hard endpoints such as death or nonfatal myocardial infarction compared to a delayed approach. Thus, the optimal timing of ICA in high-risk NSTE-ACS remains undetermined. This study aimed to determine the optimal timing for ICA in high-risk NSTE-ACS, regarding 1-year all-cause mortality and cardiovascular rehospitalizations. We conducted a national multicenter retrospective study of high-risk NSTE-ACS patients included in the Portuguese Registry for Acute Coronary Syndromes. Patients were divided into three groups according to the time of ICA: within the first 24 h, between 24 and 48 h, and between 48 and 72 h. The incidence of in-hospital complications and mortality, 1-year mortality, and cardiovascular rehospitalizations were assessed. Of the 9949 patients included, 46.7% underwent early ICA. This was associated with a lower incidence of acute heart failure (8.5% vs. 11.1% vs. 11.5%, P < 0.001) and shorter length of stay (3 vs. 4 vs. 6 days, P = 0.012). It, however, did not reduce in-hospital complications or mortality (1.2 vs. 0.7 vs. 0.8%, P = 0.066). We also found no significant association with the composite endpoint of 1-year mortality or cardiovascular rehospitalization (15.1 vs. 15.9 vs. 15.7%, P = 0.887). Early ICA was associated with a lower incidence of acute heart failure and shorter length of stay, without a significant impact on 1-year mortality risk or cardiovascular rehospitalizations.