Branch Hospital Research Articles

A Descriptive Analysis of the Use of Various Therapeutics in a Cohort of COVID-19 Patients and the Influence of Media Coverage

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacted the healthcare system immensely throughout 2020-2022. Treatment practices varied in Texas, as guidelines were in flux. As a result, a variety of therapeutics were used. Many verified medications with scientific basis were trialed, while others were implemented despite a lack of scientific consensus. This study aimed to identify how practice patterns to treat and manage COVID-19 changed over time in a cohort of patients in the University of Texas Medical Branch hospital system. Methods: Ninety participants with a COVID-19 diagnosis were included in the analysis for this study. Data was collected by a retrospective chart review, and included medications administered before and during current admission. Medications were categorized as: antiviral, antibiotic, steroid, supplement, antibody, hydroxychloroquine, and others. Results: Differences in therapeutic use were identified based on hospitalization status (outpatient or inpatient) and month admitted. The largest difference in the antiviral remdesivir (78%), requiring intravenous administration for up to ten days. In the outpatient setting, antibiotics, primarily azithromycin, were quite common. Additionally, month-to-month variation in steroid use and antibiotic use was observed. Conclusion: This study shows that adapting medical guidelines and strong media coverage played a role in the clinical management of COVID-19 patients. At times, some ineffective medications were prescribed such as hydroxychloroquine. Medical leaders and news coverage should collaborate closely in future public health emergencies to prevent the prescription of ultimately ineffective and potentially hazardous treatments.

Validating ICD-10 Diagnosis Codes for Guillain-Barré Syndrome in Taiwan's National Health Insurance Claims Database.

To validate the International Classification of Diseases, 10th Revision (ICD-10) codes for Guillain-Barré syndrome (GBS) in Taiwan's insurance claims database. We identified adult patients hospitalized at any Chang Gung Memorial Foundation branch hospital between January 1st, 2017, and December 31st, 2022, with ICD-10 code G61.0 in any of the five discharge diagnosis positions, indicating possible Guillain-Barré syndrome. We then validated the possible GBS diagnosis using data from electronic medical records of the identified patients, based on the diagnostic criteria established by the National Institute of Neurological Disorders and Stroke. We determined the positive predictive values (PPV) of various operational definitions, including the position (primary or other) where the code was recorded in the discharge diagnosis, nerve conduction study (NCS) claims, and / or specific GBS treatments. The final validation cohort of 484 patients with ICD-10 code for GBS in the discharge diagnosis was found to include 368 true GBS patients. Identifying inpatients using only the ICD-10 code for GBS in any of the five positions for discharge diagnosis yielded a PPV of 76.0%. With more restrictive definitions (primary diagnosis only, or requiring additional claims for NCS and/or treatments), the PPV tended to increase, but with fewer true GBS patients identified. Using ICD-10 GBS code in the primary diagnosis plus NCS and treatment claims yielded the highest PPV (98.3%); however, 140 (38.0%) of the true GBS patients were missed using this definition. In contrast, using the ICD-10 GBS code in any position, plus claims for NCS, achieved a relatively good PPV (85.8%) with minimal loss of true GBS patients (13, ie, 3.5%). In Taiwan's NHI claims data, identifying true GBS patients using only the ICD-10 code yielded a PPV of 76.0%; however, adding claims for diagnostic procedure and GBS treatment increased the PPV to 98.3%.

Malnutrition Risk Factors and Clinical Outcomes in Gynecology and Obstetric Patients

Aim: Nutrition was a prerequisite for a healthy life, a basic human need, and a fundamental human right. The aim of this descriptive study is to examine the risk factors for malnutrition in obstetrics and gynecology patients and the relationship between malnutrition and clinical outcomes. Subjects and Method: The research was carried out in a Gynecology and Obstetrics Branch Hospital between 30.10.2018 and 01.06.2022. The research sample consisted of patients who were assessed for malnutrition risk using the Nutritional Risk Screening-2002 (NRS-2002) form during the specified dates and had severe risk of malnutrition in all of the patients (risk score of ≥3, case group, n=82). An equal number of patients with mild/moderate malnutrition risk (score=1 and 2) and patients without risk were randomly selected using a computerized randomization process. General health, obstetric, admission characteristics, and laboratory findings were compared between the groups. A statistical significance level of p<0.05 was accepted. Results: According to NRS-2002, the mean malnutrition risk score scores were 0.64±0.8 in the mild/moderate malnutrition risk group and 3.71±0.90 in the severe malnutrition risk group. The median age and body mass index of the group with a severe risk were higher and lower, respectively (p<0.05). The median length of hospital stay, weight loss, occurrence of surgical procedures, presence of infection, and presence of an oncological diagnosis were significantly higher in the group with a severe risk of malnutrition group compared to the other groups (p<0.05). Conclusion: When evaluating women for malnutrition, care should be taken in case of age, length of hospital stay, weight loss, surgical procedure, presence of infection and oncological diagnosis. In case of impaired laboratory findings and normal body mass index value, it is important not to ignore the evaluation and to perform a comprehensive evaluation.

Disparate outcomes in Hispanic patients with metabolic dysfunction-associated steatotic liver disease/steatohepatitis and type 2 diabetes: Large cohort study.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are a growing health burden across a significant portion of the global patient population. However, these conditions seem to have disparate rates and outcomes between different ethnic populations. The combination of MASLD/MASH and type 2 diabetes increases the risk of hepatocellular carcinoma (HCC), and Hispanic patients experience the greatest burden, particularly those in South Texas. To compare outcomes between Hispanic and non-Hispanic patients in the United States, while further focusing on the Hispanic population within Southeast Texas to determine whether the documented disparity in outcomes is a function of geographical circumstance or if there is a more widespread reason that all clinicians must account for in prognostic consideration. This cohort analysis was conducted with data obtained from TriNetX, LLC ("TriNetX"), a global federated health research network that provides access to deidentified medical records from healthcare organizations worldwide. Two cohort networks were used: University of Texas Medical Branch (UTMB) hospital and the United States national database collective to determine whether disparities were related to geographic regions, like Southeast Texas. This study findings revealed Hispanics/Latinos have a statistically significant higher occurrence of HCC, type 2 diabetes mellitus, and liver fibrosis/cirrhosis in both the United States and the UTMB Hispanic/Latino groups. All-cause mortality in Hispanics/Latinos was lower within the United States group and not statistically elevated in the UTMB cohort. This would appear to support that Hispanic patients in Southeast Texas are not uniquely affected compared to the national Hispanic population.

Laboratory Risk Analysis in a Branch Hospital: The L-type Matrix

Introduction: Laboratory workers are often exposed to various risk factors, which can be classified as biological, physical, chemical, psychosocial, and ergonomic. This study aims to conduct a risk analysis in the workers of microbiology and biochemistry laboratories of a branch hospital in Istanbul, Türkiye to identify occupational health and safety risks and provide recommendations for measures to be taken. Methods: The investigators conducted the risk analysis with a five-person team including occupational health and safety experts, a laboratory manager, and technicians. Risk assessments were performed using the L-type matrix 5x5 diagram. The level of risk was determined with the product of probability and severity. Results: Risk analysis in the microbiology laboratory showed ten risk factors. Three of them had moderate level scores as following "working with xylene", “continuous standing work” and "insufficient free space". The remaining risks have low-risk scores, including "working in a noisy environment, "microscope light and ambient light", "working with blood", "working with feces", "non-ergonomic chairs", "insufficient airflow in the environment" and "continuous presence in a closed space". In the biochemistry laboratory, four were classified as moderate risk, including working in constant standing, exposure to bodily fluids, blood tests for bacteria and viruses and non-ergonomic furniture. Conclusion: The priority should be to minimize the risks associated with contact with blood and body fluids. This could involve the implementation of strict safety measures and protocols, as well as providing appropriate personal protective equipment to all personnel who may encounter these fluids.

Investigation of Stress Levels of Nurses Working in a Private Branch Hospital According to Some Variables

Bu araştırma özel bir dal hastanesinde çalışan hemşirelerin stres düzeylerini bazı değişkenlere göre incelemek amacıyla yapılmıştır. Tanımlayıcı-kesitsel türde olan araştırma, İstanbul ilinde bir göğüs kalp ve damar hastanesinde Haziran-Eylül 2022 tarihleri arasında 205 hemşire ile yapılmıştır. Araştırmada araştırmacılar tarafından geliştirilen “Bireysel ve Mesleki Özellikler Formları” ve “Algılanan Stres Ölçeği” kullanılmıştır. Bireysel Özellikler formunda sosyodemografik özellikleri belirleyen 6 soru; Mesleki Özellikler formunda ise çalışma yaşamına yönelik 10 soru yer almaktadır. Beşli likert yapıda olan Algılanan Stres Ölçeği 14 maddeden oluşmaktadır. Ölçeğin puan aralığı 0-56 olup, kesme noktası yoktur. Verilerin değerlendirilmesinde Pearson Chi-Square, Independent Sample t Test, One-Way ANOVA ve Pearson Corelation testleri kullanılmıştır. Hemşirelerin %69,8’i kadın, %77,1’i 20-30 yaş aralığında, %67,8’i lisans mezunudur. Hemşirelerin Algılanan Stres Ölçeği puan ortalaması 31,20±7,88 olarak bulunmuş olup, %45,4’ünün ortalamanın üstünde stres düzeyine sahip olduğu belirlenmiştir. Kadınlar, çocuğu olmayanlar, lise/ön lisans mezunu olanlar, gelir durumunu yetersiz algılayanlar ve mesleği istemeyerek seçenlerin algılanan stres puanları diğer gruplardan yüksek bulunmuştur. Kalp damar cerrahisi öncesi ve kardiyoloji servislerinde çalışan hemşirelerin stres puanı en yüksek bulunurken, acil servis ve ameliyathanede çalışanların daha düşük bulunmuştur. Ayrıca bulunduğu servise atanma kararına katılmayanlar ile ekipten memnun olmayanların stres puanları daha yüksek bulunmuştur (p<0,001). Hemşirelerin yarıya yakınının stres düzeyleri ortalamanın üstündedir. Mesleği isteyerek seçmeyenlerin, kadınların, lise/ön lisans mezunu olanların, gelir durumunu yetersiz görenlerin, kardiyoloji servisinde çalışanların, serviste isteyerek çalışmayanların ve ekipten memnun olmayanların oryantasyon ve hizmet içi eğitim programları ile etkili baş etme becerileri kazandırılması; hemşirelerin strese dayanma güçlerinin artırılması ve ara ara stres yönünden değerlendirilmeleri önerilmektedir.

Development and validation of a new model for the early diagnosis of tuberculous meningitis in adults based on simple clinical and laboratory parameters

BackgroundThe differential diagnosis between tuberculous meningitis (TBM) and viral meningitis (VM) or bacterial meningitis (BM) remains challenging in clinical practice, particularly in resource-limited settings. This study aimed to establish a diagnostic model that can accurately and early distinguish TBM from both VM and BM in adults based on simple clinical and laboratory parameters.MethodsPatients diagnosed with TBM or non-TBM (VM or BM) between January 2012 and October 2021 were retrospectively enrolled from the General Hospital (derivation cohort) and Branch Hospital (validation cohort) of Ningxia Medical University. Demographic characteristics, clinical symptoms, concomitant diseases, and cerebrospinal fluid (CSF) parameters were collated. Univariable logistic analysis was performed in the derivation cohort to identify significant variables (P < 0.05). A multivariable logistic regression model was constructed using these variables. We verified the performance including discrimination, calibration, and applicability of the model in both derivation and validation cohorts.ResultsA total of 222 patients (70 TBM and 152 non-TBM [75 BM and 77 VM]) and 100 patients (32 TBM and 68 non-TBM [31 BM and 37 VM]) were enrolled as derivation and validation cohorts, respectively. The multivariable logistic regression model showed that disturbance of consciousness for > 5 days, weight loss > 5% of the original weight within 6 months, CSF lymphocyte ratio > 50%, CSF glucose concentration < 2.2 mmol/L, and secondary cerebral infarction were independently correlated with the diagnosis of TBM (P < 0.05). The nomogram model showed excellent discrimination (area under the curve 0.959 vs. 0.962) and great calibration (P-value in the Hosmer–Lemeshow test 0.128 vs. 0.863) in both derivation and validation cohorts. Clinical decision curve analysis showed that the model had good applicability in clinical practice and may benefit the entire population.ConclusionsThis multivariable diagnostic model may help clinicians in the early discrimination of TBM from VM and BM in adults based on simple clinical and laboratory parameters.

Clinical Features and Surgical Outcomes of 15 Cases of Intracranial Alveolar Echinococcosis

To investigate the surgical treatment strategy of intracranial alveolar echinococcosis (AE) and the clinical outcomes. The clinical and follow-up data of 15 intracranial AE patients who underwent surgical treatment in the Departments of Neurosurgery of Sichuan Provincial People's Hospital (SPPH) and People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture (a branch hospital of SPPH) between March 2017 and January 2021 were retrospectively analyzed. Full follow-up data were available for each of the 15 cases. The clinical and imaging characteristics, general surgical information, and surgical outcomes were analyzed. In the 15 patients, there were a total of 50 intracranial lesions, with an average of (3.3±3.1)/case. Four cases had solitary intracranial lesions, while 11 cases had multiple lesions, with the number of intracranial lesions per case ranging from 2 to 13. All patients with solitary intracranial lesions received total resection. In 6 patients with multiple intracranial lesions, only the largest lesion was surgically removed, and in 5 patients, 2 to 3 adjacent lesions were surgically removed. All but one patient had extracranial lesions in their liver, lungs, kidneys, adrenal glands, and thoracic vertebrae. The patients were followed up for 12 to 58 months after surgery, with the mean follow-up time being (28.1±13.4) months. Among the 15 cases, 13 showed stable intracranial condition during postoperative follow-up. Intracranial lesions recurred in 2 patients who had deep lesions accompanied by dissemination to the subarachnoid space. Two patients died during follow-up. Microsurgical treatment of intracranial AE is effective, but total surgical resection is difficult to accomplish when patients have echinococcosis lesions located at a depth, especially when the lesions are spreading to the subarachnoid space. The prognosis of patients is closely associated with the extent of lesion invasion and the control of systemic hydatid lesions, especially those in the liver.

Clinical significance of elevated soluble T-cell immunoglobulin and mucin domain 1 and soluble P-selectin in individuals with obstructive sleep apnea-hypopnea syndrome.

To assess the serum concentrations of soluble T-cell immunoglobulin and mucin domain 1 (sTIM-1) and soluble P-selectin (sP-selectin) in individuals who had obstructive sleep apnea-hypopnea syndrome (OSAHS). Between December 2020 and November 2022, 134 participants from the Sleep Monitoring Center of the Branch Hospital of Huai'an First People's Hospital, Jiangsu, China, engaged in this cross-sectional study. Participants were categorized as mild OSAHS (n=19), moderate OSAHS (n=22), severe OSAHS (n=57), and non-OSAHS (n=36) groups. Serum levels of sTIM-1, sP-selectin, and interleukin (IL)-6, as well as baseline clinical characteristics and polysomnography outcomes were assessed in each participant. Compared to the non-OSAHS group, sTIM-1 and sP-selectin levels were considerably elevated in people who had moderate or severe OSAHS (all p<0.05), but there were no notable changes between those who had mild OSAHS and non-OSAHS participants (p>0.05). The sTIM-1 and sP-selectin levels showed positive associations with the apnea-hypopnea index, body mass index (BMI), and IL-6 levels (all p<0.001). While elevated sTIM-1 was independently related to OSAHS (odds ratio [OR]=1.134, p=0.001), sP-selectin was not associated with OSAHS after adjusting for BMI (OR=1.013, p=0.467). People with moderate or severe OSAHS had higher serum sTIM-1 and sP-selectin levels, and elevated sTIM-1 is an independently related factor for OSAHS.

Myth or coverage: experience and expectation of policyholders from health insurance during COVID-19 in the NCR region of India

This study intends to determine whether and to what extent policyholders admitted to the hospital for COVID-19 treatment receive financial support from their health insurance. The researcher interviewed 67 health insurance claimants in the NCR region's several cities—some in Uttar Pradesh, Delhi, Haryana, and Rajasthan. They also interviewed various insurance system participants, including branch managers, agents, and hospital staff, to obtain an overview of policyholder experiences and insurer challenges. For analysis, qualitative research techniques have been used. This research is helpful in various situations when people are hospitalised for planned and unanticipated reasons by recommending what insurance companies should do to protect the interests of their customers. For the Indian insurance industry and regulator/supervisory authorities, the COVID-19 pandemic incidents can be a lesson about their strengths and weaknesses. According to this research, service-level agreement violations, procedural bottlenecks, and lack of clarity and awareness are the problems policyholders face when pursuing claims. The challenges insurers confront in serving their client's needs are maintaining operations in the face of financial stress and changing regulatory compliances, on the one hand, and helping policyholders by resolving their claims and raising awareness, on the other.

Analysis of Environmental Graphic Design in the Interior of the Pondok Indah Hospital Pediatric Clinic

Environmental Graphic Design (EGD) is one of the graphic design objects in an area. Its purpose is to provide information about the placement and identity of a place. EGD is usually used as a complement to interiors and architects. But that does not mean that EGD is underestimated, one of which is in the hospital area. Pondok Indah Group Hospital (RSPI) is a private hospital that manages three hospitals in Indonesia, one of which is RSPI-Puri. The main problem is the different EGDs of each branch. This makes the difference in the identity of the EGD from each RSPI, each hospital branch is unique and different in processing the EGD and one of the references for other branch hospitals is RSPI - Puri which is quite good, especially in the EGD of the pediatric clinic area. Therefore, research was conducted at RSPI - Puri on the interior area of the pediatric clinic. This research uses a descriptive method to be able to describe and classify the EGD and images that exist in the pediatric clinic area (Pediatric) RSPI-Puri. The purpose of this research is to describe the EGD and mural images that exist in the pediatric clinic at RSPI-Puri in terms of visual elements and functions. The benefit of this research is to add to the scientific treasure of EGD in hospitals. The result of the research is that there is a theme of wildlife and forest in the signage mural and sign system visualized in a continuous children's clinic.&#x0D; Keywords: EGD, Child Drawing, Mural, Hospital

The occupational distribution of foundling apprentices during the English Industrial Revolution

ABSTRACT This article presents a new analysis of the distribution of apprenticeships brokered by the London Foundling Hospital, England’s pre-eminent charitable foundation in the eighteenth century for orphaned and abandoned children. It explores the similarities and differences between charity apprenticeship and parish apprenticeship systems in supplying pauper children’s labour during the critical first phase of the English Industrial Revolution, within a wider European context. The results of this analysis illustrate that foundling children were set to work in agriculture, mainly in northern England, and in a variety of small manufacturing and retailing industries in the London area. For a short time, foundling girls were sent in batches to work in textile factories in the North and Midlands, but this practice was soon ended over concerns for children’s welfare. The extensive patronage networks of Foundling Hospital Governors and inspectors, the location of provincial branch hospitals set up to cope with the high volume of so-called ‘General Reception’ children, and gendered expectations of the life courses of the labouring poor were the most significant factors in determining where foundling children were sent as apprentices, and how they were employed.

Analysis of Environmental Graphic Design: A Study Case from Hospital in Indonesia

Environmental Graphic Design (EGD) is one of the roles of graphic design objects in an area. The goal is to provide information about the placement and identity of a place. EGD should had the standardization which had in several areas as corporate identity, one of them is a hospital. Pondok Indah Group Hospital (RSPI) is a private hospital that manages three hospitals in Indonesia, one of is RSPI-Bintaro. The main problem is the differences in EGD from each branch. This makes the difference in an EGD identity from each RSPI, one of them is the EGD at RSPI-Bintaro. The research was conducted at RSPI – Bintaro in an outdoor area (Signage exterior). This study uses a descriptive method to be able to describe and classify EGD at RSPI-Bintaro. This research goal is conducted to describe the EGD, especially the signage for the RSPI-Bintaro area in terms of visual elements and functions. The benefits of this research add to the scientific body of EGD in Hospitals. Besides, the exterior signage of the RSPI-Bintaro area is quite good and informative have compared to other branch hospitals.

Analysis of Environmental Graphic Design: A Study Case from Hospital in Indonesia

Environmental Graphic Design (EGD) is one of the roles of graphic design objects in an area. The goal is to provide information about the placement and identity of a place. EGD should had the standardization which had in several areas as corporate identity, one of them is a hospital. Pondok Indah Group Hospital (RSPI) is a private hospital that manages three hospitals in Indonesia, one of is RSPI-Bintaro. The main problem is the differences in EGD from each branch. This makes the difference in an EGD identity from each RSPI, one of them is the EGD at RSPI-Bintaro. The research was conducted at RSPI – Bintaro in an outdoor area (Signage exterior). This study uses a descriptive method to be able to describe and classify EGD at RSPI-Bintaro. This research goal is conducted to describe the EGD, especially the signage for the RSPI-Bintaro area in terms of visual elements and functions. The benefits of this research add to the scientific body of EGD in Hospitals. Besides, the exterior signage of the RSPI-Bintaro area is quite good and informative have comparedto other branch hospitals.

Characteristics of University Hospitals Implementing the Postgraduate Clinical Training "Tasukigake Method" and Their Correlation with Program Popularity: A Cross-Sectional Study.

In 2004, the postgraduate clinical training system in Japan was radically revised by introducing a super-rotation matching system. Although postgraduate clinical training became a mandatory 2 years of training, the program and operation were left to each facility's discretion, leading to training-program popularity differences. The Japanese Tasukigake method provides clinical training in which "hospitals where junior residents work" and "external hospitals/clinics that provide clinical training" conduct clinical training alternately on a 1-year basis. The study aimed to identify the characteristics of university hospitals that implement the Tasukigake method to help educators and medical institutions create more attractive and effective programs. All 81 university main hospitals were included in this cross-sectional study. The information regarding Tasukigake method implementation was collected from the facilities' websites. The training program's matching rate (popularity) was calculated from the Japan Residency Matching Program's interim report data (academic 2020). We used multiple linear regression analysis to evaluate the association between Tasukigake method implementation, program popularity, and university hospital characteristics. The Tasukigake method was implemented by 55 (67.9%) university hospitals, significantly more by public university hospitals (44/55, 80%) than by private (11/55, 20%) (P < 0.01) and by hospitals without branches (38/55, 69.1%) than with branches (17/55, 30.9%) (P < 0.001). The maximum hiring capacity of junior residents (P = 0.015) and number of branches (P < 0.001) were negatively correlated, and the population of the hospital's city (P = 0.003) and salary/month (P = 0.011) were positively correlated with the Tasukigake method implementation. Multiple linear regression analysis results showed no significant association between the matching rate (popularity) and Tasukigake method implementation. The results show no association between Tasukigake method and program popularity; also, highly specialized university hospitals in cities with fewer branch hospitals were more likely to implement the Tasukigake method.

Fetal death: analysis of angiogenic factors during pregnancy

Background: Fetal mortality is still insufficiently studied. Objectives: Analyze angiogenic factors (PlGF) in maternal-fetal interface and associate then with fetal mortality. Methods: This is part of a case control study from 15 public branch hospitals of Sao Paulo City were we selected fetal death and live births. Inclusion criteria: Single pregnancy; fetus and live births: &amp;#x2265; than 22 and &amp;#x2264; than 45 weeks of gestation and/or birth weight &amp;#x2265; 500g. Exclusion criteria: Absence of judicial termination of pregnancy and of maternal death on birth room Results: We analized 23 patients case and 23 controls. Birth weight averaged was 2290 grams for case group and 3177 grams for control (p &amp;#x3c; 0.001) (Mann-Whitney). Gestational age ranged from 27 to 39 weeks in case group and from 32 to 42 weeks in control (p &amp;#x3c; 0.001) (Qui Square) Maternal PlGF of case group had a mean of 433.9 and of the control had 132.6 (p = 0.005). Umbilical cord PlGF of case group had a mean of 358.2 and the control had 10.41 pg/mL (p &amp;#x3c; 0.001). Median PlGF of umbilical cord of pregnant women who had preterm birth was 358.7 and of those who had delivered at term was 15.1 (p &amp;#x3c; 0.001) (Mann-Whitney). Comparing PlGF of the control group and the fetal death group (intrapartum or antepartum) we found difference between live births and mothers who had intrapartum fetal death. By Dunn&amp;#x27;s post hoc test, the difference for maternal PLGF is between live birth vs intrapartum (p=0.012), similarly for cord PLGF (p&amp;#x3c;0.001) Conclusions: We found differences between the PlGF of the blood of the mother and the umbilical cord of the case and control. We intend to analyze the sFlt and relate them with the occurrence of fetal death and other obstetric parameters. Keywords: Fetal mortality, angiogenic factors and pregnancy

“So They May be Usefull to Themselves”: Work and Apprenticeship in the Ackworth Branch Foundling Hospital, 1757–1773

During the period 1756–1760, the Foundling Hospital accepted more children for admission than could be housed at its London premises. Branch Hospitals were opened across the country, including at Ackworth, Yorkshire. Ackworth Branch Hospital operated a manufactory, staffed by many of the children it received. The manufactory provided the children with experience prior to their undertaking apprenticeships and raised revenue for the Hospital. Children at Ackworth were apprenticed to a range of trades and, whilst most apprenticeships were successful, some were not. This article examines the training and apprenticeships provided to the Ackworth foundlings. It demonstrates that the Foundling Hospital took its role as in loco parentis seriously when apprenticeships went wrong. The hospital re-received children whose apprenticeships failed and provided them with further opportunities to become useful members of society.

Relationship Between the Level of Anatomical Risk of Hepatic Alveolar Echinococcosis and Complications after Radical Resection

To analyze the impact of high or low levels of anatomical risk of hepatic alveolar echinococcosis (HAE) on complications after radical resection. The baseline, surgical, and complication data were retrospectively collected from hepatic alveolar echinococcosis patients who underwent radical resection at the Ganzi Branch Hospital, West China Hospital, Sichuan University from 2015 to 2022. The patients were divided into anatomical low-risk (ALR) and anatomical high-risk (AHR) groups based on the PNM staging system designed by the World Health Organization (WHO-PNM). Complications were analyzed according to the Clavien-Dindo classification. Univariate and multivariate logistic regression analyses were performed to assess the effect of high and low risks of lesion anatomy on complications. Radical surgery was performed in 216 HAE patients and 102 of whom were in the AHR group. The median operative time was 230 (175, 300) min, the median intraoperative blood loss was 600 mL, and 129 (59.7%) patients developed complications. The complication rate was 73.5% (75/102) in the AHR group and 47.4% (54/114) in the ALR group, demonstrating statistically significant difference ( P<0.05). The incidence of serious complications was 36.3% (37/102) in the AHR group and 13.2% (15/114) in the ALR group, demonstrating statistically significant difference ( P<0.05). There was significant difference in the proportions of patients having postoperative complications of bile leak, anemia, fever, pleural effusion and ascites between the AHR group and the ALR group ( P<0.05). Multivariate logistic regression analysis suggested that AHR was the only independent risk factor for complications, including bile leak, anemia, fever, and pleural effusion, and severe complications. The anatomical risk of hepatic alveolar echinococcosis is independently associated with the development of multiple postoperative complications, and physicians should choose surgical procedures cautiously according to the actual situation when dealing with patients defined as AHR according to WHO-PNM.

Design and Implementation of a Comprehensive AI Dashboard for Real-Time Prediction of Adverse Prognosis of ED Patients.

The emergency department (ED) is at the forefront of medical care, and the medical team needs to make outright judgments and treatment decisions under time constraints. Thus, knowing how to make personalized and precise predictions is a very challenging task. With the advancement of artificial intelligence (AI) technology, Chi Mei Medical Center (CMMC) adopted AI, the Internet of Things (IoT), and interaction technologies to establish diverse prognosis prediction models for eight diseases based on the ED electronic medical records of three branch hospitals. CMMC integrated these predictive models to form a digital AI dashboard, showing the risk status of all ED patients diagnosed with any of these eight diseases. This study first explored the methodology of CMMC’s AI development and proposed a four-tier AI dashboard architecture for ED implementation. The AI dashboard’s ease of use, usefulness, and acceptance was also strongly affirmed by the ED medical staff. The ED AI dashboard is an effective tool in the implementation of real-time risk monitoring of patients in the ED and could improve the quality of care as a part of best practice. Based on the results of this study, it is suggested that healthcare institutions thoughtfully consider tailoring their ED dashboard designs to adapt to their unique workflows and environments.

Implementation of a machine learning application in preoperative risk assessment for hip repair surgery

BackgroundThis study aims to develop a machine learning-based application in a real-world medical domain to assist anesthesiologists in assessing the risk of complications in patients after a hip surgery.MethodsData from adult patients who underwent hip repair surgery at Chi-Mei Medical Center and its 2 branch hospitals from January 1, 2013, to March 31, 2020, were analyzed. Patients with incomplete data were excluded. A total of 22 features were included in the algorithms, including demographics, comorbidities, and major preoperative laboratory data from the database. The primary outcome was a composite of adverse events (in-hospital mortality, acute myocardial infarction, stroke, respiratory, hepatic and renal failure, and sepsis). Secondary outcomes were intensive care unit (ICU) admission and prolonged length of stay (PLOS). The data obtained were imported into 7 machine learning algorithms to predict the risk of adverse outcomes. Seventy percent of the data were randomly selected for training, leaving 30% for testing. The performances of the models were evaluated by the area under the receiver operating characteristic curve (AUROC). The optimal algorithm with the highest AUROC was used to build a web-based application, then integrated into the hospital information system (HIS) for clinical use.ResultsData from 4,448 patients were analyzed; 102 (2.3%), 160 (3.6%), and 401 (9.0%) patients had primary composite adverse outcomes, ICU admission, and PLOS, respectively. Our optimal model had a superior performance (AUROC by DeLong test) than that of ASA-PS in predicting the primary composite outcomes (0.810 vs. 0.629, p < 0.01), ICU admission (0.835 vs. 0.692, p < 0.01), and PLOS (0.832 vs. 0.618, p < 0.01).ConclusionsThe hospital-specific machine learning model outperformed the ASA-PS in risk assessment. This web-based application gained high satisfaction from anesthesiologists after online use.