Regional Care Center Research Articles

Risk factors of male and female Alzheimer's disease patients with neuropsychiatric symptoms

BackgroundThis study investigates risk factors in the population of Alzheimer disease (AD) patients with NPS (ADNPS). MethodBaseline risk factors associated with male and female ADNPS were examined using data from a regional AD care center. Univariate analysis was used to determine factors in male and female patients, while logistic regression models were developed to generate odds ratios (OR) to predict risk factors that are associated with male or female ADNPS. ResultsIn the adjusted analysis, dyslipidemia (OR = 0.630, 95 % CI, 0.431–0.992, P = 0.017), thyroid dysfunction (OR = 0.549, 95 % CI, 0.377–0.798, P = 0.002), and cerebral infarction (OR = 0.684, 95 % CI, 0.472–0.991, P = 0.0085) were associated with male ADNPS patients, whereas chronic heart failure (OR = 1.408, 95 % CI, 0.953–2.079, P = 0.0085) was associated with female ADNPS patients. ConclusionsOur results reveal that female ADNPS patients were associated with heart failure, whereas male patients were associated with dyslipidemia and cerebral infarction.

Study of Comparison of Magnetic Resonance Imaging with Surgical and Pathological features in Carcinoma Rectum Patients.

Colorectal cancer is the second-most common cancer in the females and third-most common cancer in males worldwide and it is the second-most common cause of mortality. In India, colorectal cancer is the fifth-most common cancer overall, constituting 6.3%. With the advent of high-resolution magnetic resonance imaging (MRI), it has become the investigation of choice for local staging of rectal cancers as well as in predicting the response to neoadjuvant treatment and streamlining the management. The aims and objectives of this study were to compare the results of MRI with surgicopathological findings in carcinoma (Ca) rectum patients in Indian patients from a tertiary regional Cancer care centre. An observational retrospective study was carried out in the Department of Surgical Oncology Acharya Harihar Regional Cancer Centre, Cuttack, from January 2021 to June 2022. All the patients who were admitted and planned for the definitive surgery for Ca Rectum and Recto sigmoid Ca were included in the study. A total of 68 patients were included, including both upfront and post-neoadjuvant treatment cases. All the patients who received neoadjuvant treatment underwent an MRI for local staging. The findings of MRI were compared with surgical and histopathology results. Results were compared in terms of T staging, N staging and response to neoadjuvant therapy among MRI and surgical and pathological findings. Overall, there was good agreement between MRI and operative findings and histopathological findings.

Family Caregivers of Children With Medical Complexity: Changes in Health-Related Quality of Life and Experiences of Care Coordination

ObjectiveExamine the longitudinal association between family experiences of care coordination (FECC) and health-related quality of life (HR-QOL) for family caregivers of children with medical complexity (CMC). MethodsA longitudinal survey of family caregivers of CMC was completed between July 2018 and June 2020. Baseline data were collected at initial contact with a regional complex care center; follow-up data were collected 12 to 16 months later. Assessed receipt of care coordination and caregiver HR-QOL via FECC questionnaire and Center for Disease Control’s HR-QOL-14 measure, respectively. Baseline and follow-up results were compared via McNemar’s and Wilcoxon signed-rank tests. Relationships between changes in FECC and changes in HR-QOL were examined using multivariable logistic regression. ResultsOf 185 eligible, 136 caregivers enrolled and completed baseline surveys (74%) and 103 (76% initial sample) follow-up surveys. Caregivers reported significant improvements in 8 of 9 FECC measures after 1 year of care within a complex care center (all P < .05). In contrast, caregiver HR-QOL (general health status, unhealthy days, symptom days) remained stable over the study period (all P > .05) except for monthly days of poor sleep (baseline vs follow-up median; 16 vs 15 [P = .05]). At both timepoints, >20% participants rated their general health status as fair-to-poor, and >50% reported frequent poor sleep and fatigue. No significant associations were observed between changes in FECC and changes in HR-QOL. ConclusionsAfter receiving 1 year of care through a complex care center, CMC family caregivers report improvement in care coordination but not in HR-QOL. Caregivers’ continued mentally unhealthy days and negative mental symptom days highlight the need for a directed intervention.

A hub-and-spoke model for cardiac ablations: utilising satellite units to tackle the challenges from the pandemic and beyond

Abstract Background Since setting up the cardiac electrophysiology (EP) service at our tertiary centre (UH) in 2010, there has been a significant increase in referrals for EP procedures. We currently serve a large catchment area (&amp;gt;1.6 million people) and the increasing demand coupled with limited resources in a publicly funded health system has led to a huge supply-demand mismatch in our EP waiting list. This mismatch was compounded by the COVID-19 pandemic. Aim To share our experience of how we set up a hub-and-spoke model to mitigate the EP waiting list pressures before and during the pandemic by utilising satellite EP laboratory units. Methods Single shot cryoballoon pulmonary vein isolation (PVI) became the initial ablation strategy for all paroxysmal and persistent atrial fibrillation (AF) patients undergoing catheter ablation (due to shorter procedure times/standardised workflow). Almost all EP cases were performed under local anaesthesia. We transitioned from overnight-stay to same-day EP cases (all standard ablation and some complex ablation procedures) and demonstrated its safety and cost-effectiveness. We increased our EP laboratory capacity by developing a hub-and-spoke model in collaboration with 2 regional secondary care centres (WH &amp; StX). During the pandemic, 3 national lockdowns were declared (Figure 1) and national healthcare services were restructured. Urgent inpatient cardiac EP cases were still performed at UH but elective EP procedures across all three sites (UH, WH &amp; StX) were cancelled during the first lockdown. One of the steps taken to mitigate the impact of the pandemic on our EP waiting list was to collaborate with the private sector (MH) which functioned as a ‘clean’ site for elective EP procedures. Cryoballoon PVI and other EP cases resumed at our centre within 2 months of the first lockdown. Data from every EP case performed were routinely entered into an electronic database. Data was extracted from the 01/01/2018 (pre-pandemic) to 31/12/2022 (post-pandemic). UH was labelled as ‘tertiary unit’ while WH, StX and MH were pooled together (labelled as ‘satellite units’). Graphpad Prism was used for analysis (Chi-squared test for categorical variables and t-test for continuous variables). Results 3695 EP cases were performed over 5 years. Satellite units performed predominantly standard ablation and cryoballoon PVI cases (Table 1). The implementation of three national lockdowns led to a transient decrease in the number of EP procedures (Figure 1). However, the ‘clean’ patient pathway that we rapidly established at our satellite unit (MH) facilitated the sustained delivery of our cardiac EP service throughout the pandemic from 2020 to 2021. The higher complication rates in the tertiary unit likely reflected the higher proportion of complex ablation cases. Conclusion Our hub-and-spoke model is a safe and novel system in tackling the EP waiting list even throughout the pandemic.Figure 1Table 1

Development of provider ordered genetic testing pathway and electronic medical record best practice advisory (BPA) to aid in germline genetic testing for patients with metastatic breast cancer.

443 Background: Genetic testing for BRCA 1/2 in breast cancer patients can have important impacts on patients’ systemic therapy options. NCCN recommendations for genetic testing include all patients with metastatic breast cancer or triple negative breast cancer to determine qualification of PARP inhibitor therapy. New guidelines recommend testing high risk, her2-negative breast cancer patients who would qualify for olaparib adjuvant therapy. It is vital that these breast cancer patients be offered genetic testing early in their cancer diagnosis journey so appropriate therapies can be provided. Due to the limited access to genetic counselors, provider ordered testing can help provide genetic testing in an expedited manner. Methods: A retrospective review of metastatic breast cancer patients who were seen at our institution between 01/01/2021 and 12/31/2021 was performed to determine if they met with genetic counselors at our institution. Based on this data, a new protocol was established guiding providers on ordering genetic testing for patients by their primary team. Additionally, a best practice advisory was designed and input into the electronic medical record to alert providers to patients who should be tested. Results: A review of patients with metastatic breast cancer seen at our institution in 2021 showed that only 29.6% of them had met with genetic counselors at our institution. Based on this finding, we created a provider initiated genetic testing process, where providers order genetic testing at the initial appointment to expedite genetic testing results. Due to an initial low uptake of this process (less than 10 tests ordered in the first three months), we also implemented a best practice advisory (BPA) within our electronic medical records (EMR). This BPA flags patients with stage IV breast cancer, that have not seen genetic counselors at our institution, and guides providers to either order genetic testing, place a referral for genetic counseling, or dismiss the BPA due to reasons. Conclusions: With the expansion of genetic testing recommendations for patients with metastatic breast cancer our institution is moving to oncologist ordered testing to increase the access to genetic testing. We hope to expand this best practice alert to other subgroups of breast cancer who would qualify for adjuvant PARP therapy. Additionally, expanding provider-initiated testing to other providers such as breast surgeons, or oncologists in our regional care centers can help increase the overall yield.

A Review of Disparities and Unmet Newborn Screening Needs over 33 Years in a Cohort of Mexican Patients with Inborn Errors of Intermediary Metabolism.

Advances in an early diagnosis by expanded newborn screening (NBS) have been achieved mainly in developed countries, while populations of middle- and low-income countries have poor access, leading to disparities. Expanded NBS in Mexico is not mandatory. Herein, we present an overview of the differences and unmet NBS needs of a group of Mexican patients with inborn errors of intermediary metabolism (IEiM), emphasizing the odyssey experienced to reach a diagnosis. We conducted a retrospective observational study of a historical cohort of patients with IEiM from a national reference center. A total of 924 patients with IEiM were included. Although 72.5% of the diseases identified are detectable by expanded NBS, only 35.4% of the patients were screened. The mortality in the unscreened group was almost two-fold higher than that in the screened group. Patients experienced a median diagnostic delay of 4 months, which is unacceptably long considering that to prevent disability and death, these disorders must be treated in the first days of life. Patients had to travel long distances to our reference center, contributing to their unacceptable diagnostic odyssey. This study highlights the urgent need to have an updated, expanded NBS program with adequate follow up in Mexico and promote the creation of regional medical care centers. We also provide compelling evidence that could prove valuable to decision makers overseeing public health initiatives for individuals impacted by IEiM from middle- and low-income countries.

Działalność opiekuńcza i edukacyjno-wychowawcza Fundacji Podkarpackie Hospicjum dla Dzieci w latach 2006-2021. Wybrane przykłady

Introduction: The first hospice was established in 1967 by Cicely Saunders. Another important event was the establishment of a day centre for terminally ill patients in Sheffield at St Luke’s Hospice. In Poland, hospice care was developed on the initiative of Hanna Chrzanowska. A special type of this institution are children’s hospices. One of them is the Podkarpackie Hospice for Children Foundation, established in 2006. Research Aim: The aim of the research was to present the history of the establishment and development of the Podkarpackie Hospice for Children Foundation, as well as analyse examples of patient care and educational activities undertaken by the management, employees and teachers cooperating with the Foundation in the period 2006–2021. The methodology used involved a critical analysis of documents and source materials and a review of the literature on hospice care. Evidence-based Facts: Two periods can be identified in the history of the Podkarpackie Hospice for Children Foundation between 2006 and 2021. From 2006 to 2011, patient care was provided under the at-home hospice care system. Simultaneously, efforts were undertaken to organise a separate location to expand the assistance provided, which resulted in the establishment of an in-patient hospice in 2011, which implements a broader range of tasks of the Foundation, including Perinatal Hospice, which was created in response to public demand. Summary: Patient care and educational activity of the Foundation is carried out through its individual units, including the at-home, in-patient and perinatal hospice, as well as the regional care and therapy centre “Tęczowy Domek”, which implement the goals and tasks of the Foundation. In addition, the educational activity of the Volunteer Centre helps to breaking down stereotypes related to hospices.

Structure and dynamics of the course of chronic non-infectious somatic diseases in patients during war events on the territory of Ukraine

BackgroundThe work studied and compared the dynamics of changes in the course of hypertension, type 2 diabetes, and somatized disorders in Ukrainian population, in the 1st period before war (October 2021 – February 2022) and 2nd period during the war (March -July 2022). The choice of the study of the above-mentioned nosology is due, first of all, to the increase in cases of referrals to outpatient doctors regarding hypertensive crises, the increase in the frequency of patients’ complaints about the lability of glycemic indicators during routine monitoring of glucose levels with ambulatory glucometers, the appearance of chronic pain syndrome of unspecified pathology with the beginning of war events.Methods272 people were examined in Mykolaiv Region (Ukraine). The patients were divided into three clinical groups: 1st group − 90 people patients with arterial hypertension; 2nd group – 92 people with type 2 diabetes; the 3rd group – 90 people with somatiform disorders.ResultsIn the patients of the 1st group during the 2nd period, amount of people with hypertension of the 1st stage increased in 1.8 times (p = 0.0412), with 2nd stage hypertension increased in 2 times (p = 0.0491) and 3rd stage hypertension increased in 2.5 times (p = 0.0391); somatized disorders in 3rd group also increased in 4.1 times (p = 0.001 < 0.05); in 2nd group recorded an increase in HbA1c by 0.99 ± 0.57 mmol/l (p = 1.795e-07 < 0.05), in comparison with the indicators for the 1st observation period.ConclusionsThe war events in Ukraine not only changed the life of every Ukrainian, but also had a significant impact on the dynamics and structure of chronic somatic diseases, in particular due to an increase in patient referrals for hypertensive crises, exacerbations of type 2 diabetes, somatized disorders, and chronic pain syndrome of unknown etiology. Considering these results, it is important to increase the equipment of regional primary care centers with antihypertensive, hypoglycemic and sedative drugs.

Geriatric Oncology in the Instagram Era: Feasibility and Acceptability Randomised Controlled Trial on Adopting PhotoVoice to Enable Empowerment, Patient-Centred Care, and Shared Decision Making-Study Protocol.

Geriatric assessment (GA) is fundamental to optimising cancer care in older adults, yet implementing comprehensive GA tools in real-world clinical settings remains a challenge. This study aims to assess the feasibility and acceptability of integrating information from patient-derived photographs (PhotoVoice) into enhanced supportive care (ESC) for older adults with cancer. A feasibility randomised controlled trial will be conducted at a regional cancer care centre in Australia. Participants aged 70 and above will be randomised into two groups: PhotoVoice plus ESC or usual care (ESC) alone. In the PhotoVoice group, participants will provide four photographs for deduction of representations of different aspects of their lives using photo-elicitation techniques. ESC will be conducted for both groups, incorporating PhotoVoice analysis in the intervention group. PhotoVoice may improve patient-centred care outcomes, including enhanced communication, shared decision making, and identification of patient priorities and barriers. Findings will provide insights into implementing PhotoVoice in geriatric assessment and guide future trials in cancer among older adults.

Placenta Accreta Spectrum Disorders: A National Survey

ObjectivesDescribe the current practice of Canadian obstetricians-gynaecologists in managing placenta accreta spectrum (PAS) disorders from suspicion of diagnosis to delivery planning and explore the impact of the latest national practice guidelines on this topic. MethodsWe distributed a cross-sectional bilingual electronic survey to Canadian obstetricians-gynaecologists in March–April 2021. Demographic data and information on screening, diagnosis, and management were collected using a 39-item questionnaire. The survey was validated and pretested among a sample population. Descriptive statistics were used to present the results. ResultsWe received 142 responses. Almost 60% of respondents said they had read the latest Society of Obstetricians and Gynaecologists of Canada clinical practice guideline on PAS disorders, published in July 2019. Nearly 1 in 3 respondents changed their practice following this guideline. Respondents highlighted the importance of 4 key points: (1) limiting travel to thereby remain close to a regional care centre, (2) preoperative anemia optimization, (3) performance of cesarean-hysterectomy leaving the placenta in situ (83%), (4) access via midline laparotomy (65%). Most respondents recognized the importance of perioperative blood loss reduction strategies such as tranexamic acid and perioperative thromboprophylaxis via sequential compression devices and low-molecular-weight heparin until full mobilization. ConclusionsThis study demonstrates the impact of the Society of Obstetricians and Gynaecologists of Canada's PAS clinical practice guideline on management choices made by Canadian clinicians. Our study highlights the value of a multidisciplinary approach to reducing maternal morbidity in individuals facing surgery for a PAS disorder and the importance of regionalized care that is resourced to provide maternal-fetal medicine and surgical expertise, transfusion medicine, and critical care support.

Retrospective cohort study on treatment modalities and survival time after oesophageal fistula in patients with oesophageal cancer in a regional cancer care centre in China

BackgroundOesophageal fistula (perforation) is a devastating complication in patients with oesophageal cancer . The optimal treatment remains uncertain.ObjectiveWe sought to present real-world evidence on treatment modalities and survival postfistula in...

Neonatal retrievals from a regional centre: Outcomes, missed opportunities and barriers to back transfer.

High-risk neonates are retrieved from regional centres to tertiary neonatal units when the required care of the baby exceeds the clinical capabilities of the birthing facility. However, there is limited research on the outcomes of neonatal retrievals from regional special care centres and the barriers to back transfer of neonates from a tertiary centre are not well established. This study aimed to review the outcome of neonatal retrievals >32 weeks gestation from a regional referral centre. The study also aimed to determine missed opportunities for providing care at the regional centre and evaluate patient back transfer delays. All neonates transferred to a tertiary neonatal intensive care unit in North Queensland over the 5-year period January 2016 to December 2020 from a regional neonatal centre were retrospectively reviewed from the electronic medical records. Fifty neonates transferred to a tertiary neonatal intensive care unit over the study period were identified. Between 2016 and 2020, the number of neonatal retrievals increased (P = 0.021). Out of the 50 neonatal retrievals, 86% were for medical reasons. Overall, eight neonates were identified as missed opportunities whose care could have been maintained at the regional centre with support from the tertiary neonatal intensive care unit. In total, 16 neonates were affected by a delay in back transfer. This study shows a significant increase in retrievals to tertiary neonatal intensive care unit over the study period. Increasing bed capacity, utilising telehealth and recruiting regional special care nursery staff could improve outcomes and reduce strain on tertiary neonatal resources.

Kocuria kristinae - An unusual opportunistic pathogen in head and neck malignancy: Case series from central India's regional cancer care centre.

Kocuria kristinae is a commensal organism, sometimes considered as a lab contaminant, but its repeated isolation from clinical samples in immunocompromised patients should raise red flags. We confirmed the infection with re-isolation of the organism from the same site before starting treatment. For the identification of Kocuria kristinae we used IDGP cards on VITEK 2 compact system. Antibiotic susceptibility test was done manually following CLSI guidelines 2018 for Coagulase-negative staphylococci. A total of 510 major head neck oncosurgeries were performed during the period of two years. Out of which 120 patients had skin and soft tissue infections. Out of these infected patients, 90 were culture positive and of these Kocuria kristinae were isolated in 12 patients. Resistance to penicillin and oxacillin is seen in all isolates. Kocuria kristinae should not be ignored as a commensal flora or lab contaminant in immunocompromised hosts. Its Increase in resistance pattern is a matter of concern. It is an ignored opportunistic pathogen whose detailed sensitivity test should be developed to treat patients timely and effectively.

KNOWLEDGE, ATTITUDE, AND PRACTICES OF SAUDI ASTHMATIC PATIENTS ABOUT ASTHMA: A CROSS-SECTIONAL STUDY IN PHC FACILITIES, QASSIM, SAUDI ARABIA

Background: According to the evidence, accurate asthma knowledge and perceptions have a good link with medication adherence and frequent medical follow-up. Community knowledge, attitude, and perception (KAP) assessments are necessary for developing public health interventions. There is a dearth of community-based KAP research on asthma in KSA, since the majority of available information comes from hospital-based studies conducted in an urban context. Methods:A descriptive, cross-sectional study. to evaluate knowledge, attitude and practice about asthma at a single point of measurement, this is the most suitable design. This design enables the researcher to collect reliable data within short period. This study was conducted at primary health care centers in Qassim region, Saudi Arabia from 23-10-2022 until 31-12-2022. Results: The median age of asthmatic patientswas 29 years, with a range between 12 and 65 years. Almost more than half of them (n= 80, 55.6%) had completed university degrees. Some of thestudy participants reported having A comorbid disease besides asthma. Diabetes mellitus was the most frequent (n= 26, 18.1%) and hypertension comes in the second place among (n= 10, 6.9%). The duration of asthma diagnosis ranged from 3 months to 40 years with A median duration of diagnosis of 7 years. Participants knowledge, attitude and practice assessment was good among most of them (75%). Having observed asthma patients was associated with KAP on symptoms and triggers, whereas a younger age and having an asthmatic relative were independently associated with KAP on treatment. Participants with asthmatic relatives were three times more likely to have good KAP than their counterparts [(OR 3.04 95% (1.5–6.1)]. Conclusion: In Saudi Arabia, asthma knowledge and perceptions are limited. Appropriate investments in public awareness are urgently required.

Consideration on the role of the regional oral care center for persons with disabilities and the appropriate role of specialized dental hygienists

Consideration on the role of the regional oral care center for persons with disabilities and the appropriate role of specialized dental hygienists

Impact of Cancer Care Regionalization on Patient Volume.

Cancer centers are regionalizing care to expand patient access, but the effects on patient volume are unknown. This study aimed to compare patient volumes before and after the establishment of head and neck regional care centers (HNRCCs). This study analyzed 35,394 unique new patient visits at MD Anderson Cancer Center (MDACC) before and after the creation of HNRCCs. Univariate regression estimated the rate of increase in new patient appointments. Geospatial analysis evaluated patient origin and distribution. The mean new patients per year in 2006-2011 versus 2012-2017 was 2735 ± 156 patients versus 3155 ± 207 patients, including 464 ± 78 patients at HNRCCs, reflecting a 38.4 % increase in overall patient volumes. The rate of increase in new patient appointments did not differ significantly before and after HNRCCs (121.9 vs 95.8 patients/year; P = 0.519). The patients from counties near HNRCCs, showed a 210.8 % increase in appointments overall, 33.8 % of which were at an HNRCC. At the main campus exclusively, the shift in regional patients to HNRCCs coincided with a lower rate of increase in patients from the MDACC service area (33.7 vs. 11.0 patients/year; P = 0.035), but the trend was toward a greater increase in out-of-state patients (25.7 vs. 40.3 patients/year; P = 0.299). The creation of HNRCCs coincided with stable increases in new patient volume, and a sizeable minority of patients sought care at regional centers. Regional patients shifted to the HNRCCs, and out-of-state patient volume increased at the main campus, optimizing access for both local and out-of-state patients.

Valacyclovir-associated acute kidney injury and encephalopathy in an elderly woman with normal kidney function: a case report

A 72-year-old Japanese woman was treated by 3000 mg/day of valacyclovir for the herpes zoster in her left back. She had been treated as hypertension with no renal insufficiency. In two days, she visited an emergency room of a regional stroke care center with dysarthria, dexterity disorder and gait disturbance. Neither head CT nor MRI found intracranial lesions, then, laboratory tests revealed that her serum creatinine level was 4.63 mg/dL. She was transferred and admitted to our hospital on the following day and received hemodialysis under the diagnosis of AKI due to acyclovir accompanied with encephalopathy. Afterward, her serum concentration of acyclovir revealed as 44 μg/mL, which is extremely high. Her neurological symptom disappeared in parallel with the decrease of serum concentration of acyclovir. She received 3 sessions of hemodialysis and discharged on the 8th day of admission with almost normal renal function and no neurological sequela.

Understanding workforce needs of allied health staff in regional cancer care centres: Informing recruitment and succession planning.

To describe: (1) the type and frequency of interventions undertaken by regional cancer specialist Allied Health Professionals (AHPs); and (2) regional generalist AHPs' exposure and confidence in undertaking these interventions. Multiphase, observational study including a prospective study and a cross-sectional survey. Two regional Queensland Hospitals. Cancer specialist AHPs (n=13 in a prospective study; n=7 in a cross-sectional survey) and generalist AHPs (n=36 in a cross-sectional survey), across six disciplines from two regional hospitals and cancer services. Phase 1: Frequency of cancer care AHP occasions of service and interventions. Phase 2: Current practice in cancer care AHP interventions; confidence; access to training, professional development and mentorship; barriers to working in cancer care, among cancer care and generalist AHPs. Over 10-months, cancer care AHPs collectively delivered 12 393 interventions across 8850 occasions of service. Only four cancer care interventions were exclusively or predominantly carried out by cancer care AHPs-laryngectomy pre-operative counselling, laryngectomy rehabilitation and tracheostomy management (speech pathology) and lymphoedema management (physiotherapy). Generalist AHPs reported slightly lower confidence across all tasks if asked to carry out known interventions in a cancer setting compared with familiar settings. The primary perceived barrier to working in cancer care was lack of skills/experience/training reported by most CC AHPs, generalist Physiotherapists and Speech Pathologists, but not other generalist AHPs. There was a significant overlap in interventions undertaken in the cancer care and generalist setting for AHPs. Appropriate on-boarding to contextualise interventions to cancer care is recommended to overcome reported lower confidence.

Preparedness of Primary Care Centers for COVID-19 epidemic in Aseer region, KSA.

The objective of this study is to assesses the preparedness of primary care centers (PHCs) in Aseer region, KSA, for the coronavirus disease 2019 (COVID-19) pandemic. This survey was conducted during April 2020 in PHCs. The questionnaire was developed by the investigators and sent via e-mail to health care providers of primary health care centers (PHCCs). The questionnaire consisted of five parts to assesses readiness of PHCs, knowledge, attitude, and practice of health care providers (HCPs) concerning the COVID-19 pandemic. Data entry and analysis were managed by SPSS version 20. Three hundred and seventy-one HCPs participated in this study. Most of them were males (58%), doctors or nurses (81%). Almost all PHCCs have adequate infection control resources, with some shortage in sterilization rooms. Most of participants received on-job training (85%) and had good knowledge about COVID-19. Attitudes of participants showed variation toward COVID-19; 74% were afraid to be infected, 54% were afraid to care for infected patients, 58% were ready for vaccination, and 80% thought that COVID-19 has a huge negative impact on the health care system. Compliance with preventive measures ranged from 66% for keeping social distance to 90% for using personal protective equipment. Most of the participants had positive contributions regarding health education of individuals and communities using different methods including the new social media (80%). This study revealed that PHCCs in Aseer region were well equipped and HCPs were well prepared to deal with the COVID-19 pandemic. There are some shortage in a few items of infection control at PHCCs and gaps in knowledge and practice among HCPs which need continuous assessment and monitoring to overcome such barriers.

Misdiagnosis of Thoracic Aortic Emergencies Occurs Frequently Among Transfers to Aortic Referral Centers: An Analysis of Over 3700 Patients.

BackgroundAcute aortic syndromes may be prone to misdiagnosis by nonreferral aortic centers with less diagnostic experience. We evaluated regional variability in these misdiagnosis trends among patients transferred to different regional quaternary care centers with presumed acute aortic syndromes.Methods and ResultsTwo institutional aortic center databases were retrospectively reviewed for emergency transfers in patients diagnosed with acute aortic dissection, intramural hematoma, penetrating aortic ulcer, thoracic aortic aneurysm, or aortic pseudoaneurysm between 2008 and 2020. Transferring diagnoses versus actual diagnoses were reviewed using physician notes and radiology reports. Misdiagnoses were confirmed by a board‐certified cardiothoracic surgeon. A total of 3772 inpatient transfers were identified, of which 1762 patients were classified as emergency transfers. The mean age was 64 years (58% male). Patients were transferred from 203 medical centers by ground (51%) or air (49%). Differences in transfer diagnosis and actual diagnosis were identified in 188 (10.7%) patients. Of those, incorrect classification of Type A versus B dissections was identified among 23%, and 30% of patients with a referring diagnosis of an acute aortic dissection did not have one. In addition, 14% transferred for contained/impending rupture did not have signs of rupture. All misdiagnoses were secondary to misinterpretation of imaging, with motion artifacts (n=32, 17%) and postsurgical changes (n=44, 23%) being common sources of diagnostic error.ConclusionsMisdiagnosis of acute aortic syndromes commonly occurred in patients transferred to 2 separate large aortic referral centers. Although diagnostic accuracy may be improving, there are opportunities for improved physician awareness through standardized web‐based imaging education.