Conventional Hospital Research Articles

Hollow Microneedle‐based Plasmonic Sensor for on Patch Detection of Molecules in Dermal Interstitial Fluid

AbstractInterstitial fluid (ISF) extraction and analysis are challenges that can be tackled by Hollow MicroNeedles (HMNs) technology, overcoming most of the difficulties associated with in situ detection. Herein, a plasmonic transducer, composed of gold nanoparticles embedded in poly(ethylene glycol) diacrylate (PEGDA) hydrogels, is integrated in the inner cavity of HMNs to detect biomarkers from the ISF‐based point‐of‐care. The wearable HMN‐based patch is used for minimally invasive pierce of the skin. The large swelling capability of the plasmonic transducer allows the uptake of ISF by capillarity. Biotin, as a small model molecule, is efficiently collected in the inner cavity of HMN and its high specificity with the streptavidin is exploited as a validation of the plasmonic nanocomposite functionality embedded within. The recognition of biotin is achieved in dual‐optical mode: the localized surface plasmon resonance (label‐free) and the metal‐enhanced fluorescence (label‐based). Overall, the proposed HMN‐based patch for target sensing in ISF can represent a novel point‐of‐use device for the detection of biomarkers as an alternative to conventional hospital or lab settings to help faster medical decision‐making.

High levels of exfoliated fragments following glycocalyx destruction in hemorrhagic fever with the renal syndrome are associated with mortality risk.

The glycocalyx is a gel-like structure that covers the luminal side of vascular endothelial cells. It plays an important role in maintaining the integrity of the vascular endothelial barrier structure. However, the presence or absence of glycocalyx destruction in hemorrhagic fever with renal syndrome (HFRS) and its specific mechanism and role is still unclear. In this study, we detected the levels of exfoliated glycocalyx fragments, namely, heparan sulfate (HS), hyaluronic acid (HA), and chondroitin sulfate (CS), in HFRS patients and investigated their clinical application value on the evaluation of disease severity and prognosis prediction. The expression of exfoliated glycocalyx fragments in plasma was significantly increased during the acute stage of HFRS. The levels of HS, HA, and CS in HFRS patients during the acute stage were significantly higher than in healthy controls and convalescent stages of the same type. HS and CS during the acute stage gradually increased with the aggravation of HFRS, and both fragments showed a significant association with disease severity. In addition, exfoliated glycocalyx fragments (especially HS and CS) showed a significant correlation with conventional laboratory parameters and hospitalization days. High levels of HS and CS during the acute phase were significantly associated with patient mortality and demonstrated an obvious predictive value for the mortality risk of HFRS. Glycocalyx destruction and shedding may be closely associated with endothelial hyperpermeability and microvascular leakage in HFRS. The dynamic detection of the exfoliated glycocalyx fragments may be beneficial for the evaluation of disease severity and prognosis prediction in HFRS.

Spatio-Temporal Clustering of Multi-Location Time Series to Model Seasonal Influenza Spread.

Although seasonal influenza disease spread is a spatio-temporal phenomenon, public surveillance systems aggregate data only spatially, and are rarely predictive. We develop a hierarchical clustering-based machine learning tool to anticipate flu spread patterns based on historical spatio-temporal flu activity, where we use historical influenza-related emergency department records as a proxy for flu prevalence. This analysis replaces conventional geographical hospital clustering with clusters based on both spatial and temporal distance between hospital flu peaks to generate a network illustrating whether flu spreads between pairs of clusters (direction) and how long that spread takes (magnitude). To overcome data sparsity, we take a model-free approach, treating hospital clusters as a fully-connected network, where arcs indicate flu transmission. We perform predictive analysis on the clusters' time series of flu ED visits to determine direction and magnitude of flu travel. Detection of recurrent spatio-temporal patterns may help policymakers and hospitals better prepare for outbreaks. We apply this tool to Ontario, Canada using a five-year historical dataset of daily flu-related ED visits, and find that in addition to expected flu spread between major cities/airport regions, we were able to illuminate previously unsuspected patterns of flu spread between non-major cities, providing new insights for public health officials. We showed that while a spatial clustering outperforms a temporal clustering in terms of the direction of the spread (81% spatial v. 71% temporal), the opposite is true in terms of the magnitude of the time lag (20% spatial v. 70% temporal).

Adaptive Changes in the Working Environment of Community Pharmacists during the Covid-19 Pandemic in the Kano Metropolis, North-Western Nigeria.

Background: Rapid spread of COVID-19 and the resultant strict access to conventional hospitals forced the public to turn to community pharmacies being the most accessible points of primary healthcare, thus overloading the pharmacy services. This study aims to assess the coping strategies and adaptive changes in the work environment of community pharmacists in Kano Metropolis, NorthWestern Nigeria during the lockdown periods due to the COVID-19 pandemic Methods: A questionnaire-based cross-sectional study was carried out across selected community pharmacies within Kano Metropolis, North-Western Nigeria. A non-probability (convenience) sampling was used in this study. Convenience sampling also known as availability sampling, here units are selected for inclusion in the sample because they are easiest for the researcher to access. The survey retrieved relevant data from the participants, including socio-demographic data and changes in the work environment during the COVID-19 pandemic lockdown periods. Data were analysed using IBM SPSS version 23.0. Results: A total of 97 licensed pharmacists responded to the survey. Majority of the pharmacists (73.2%) reported increased workload, caused mostly by more prescriptions, and higher demand for safety equipment, antiseptics, and disinfectants. Moreso, 79.4%, reported higher stress levels during the pandemic as compared to the pre-pandemic era. About 89.9% of participants reported adjusting their working conditions to include the use of facemasks as protective equipment which is available in sufficient quantities as reported by 61.9% of pharmacists. The pandemic and subsequent lockdowns aroused concerns in the majority of participants (90.7%) for their health and that of their families. This prompted majority of the community pharmacists (92.7%) to suggest that pharmacists should be authorized to independently renew prescriptions of patients with stable chronic conditions during the COVID-19 pandemic. Likewise, 91.8% supported the idea that pharmacists should be authorized to participate in the COVID-19 immunization process to widen coverage. Conclusions: The COVID-19 pandemic resulted in an increased workload and altered working conditions of community pharmacists in Kano metropolis of North-Western Nigeria. This prompted pharmacists to professionally re-strategize to accommodate such an increased workload despite being frontline healthcare providers in the healthcare system.

Organization of patient transfer from conventional hospital to hospitalization at home

The organization of patient transfer from conventional hospital to hospitalization at home (HAH) is not well known. Our study aims to describe this organization by identifying the key professionals of the pathways and the incentives and obstacles to the continuity of care. Patient transfer from conventional hospital to HAH is a period of strong tension between all health care professionals and the organization of discharge is not sufficiently anticipated by hospital prescribers. The description of the patient clinical state is not always shared between the conventional hospital and the HAH professionals mainly when they do not work together. An HAH physician can be of support. Finally, the HAH nurse has a main role at the interface of the hospital department, the patient, and the home care professionals with an important activity of coordination of interventions. Patient transfer from conventional hospital to HAH should be anticipated by hospital professionals upon entrance and common needs assessment tools would allow a better security of the pathways.

Patient-Initiated Follow-Up in Ovarian Cancer

This study aimed to assess the feasibility of patient-initiated follow-up (PIFU) in combination with regular tumour marker monitoring as an alternative to conventional hospital follow-up for ovarian cancer survivors. Women who had recently completed treatment for ovarian cancer and had a raised pre-treatment tumour marker were recruited. Participants were allocated to PIFU (intervention group) or conventional hospital follow-up (control group) according to their own preference. Both groups had regular tumour marker monitoring. The change in fear of cancer recurrence (FCR) score as measured by the FCR inventory, and the supportive care need (SCN) scores as measured by the SCN survey at baseline and at 6 months between PIFU and hospital follow-up were compared. Out of 64 participants, 37 (58%) opted for hospital follow-up and 27 (42%) opted for PIFU. During the 6-month study period, there was no significant difference in the change of FCR between the two groups (p = 0.35). There was a significant decrease in the sexuality unmet needs score in the intervention group from baseline to 6-month FU (mean difference -8.7, 95% confidence interval -16.1 to -1.4, p = 0.02). PIFU with tumour marker monitoring is a feasible follow-up approach in ovarian cancer survivorship care. FCR and SCN were comparable between PIFU and conventional hospital follow-up.

VNOTES Hysterectomy: What about Obese Patients?

To compare the surgical outcomes of hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) for patients with body mass index (BMI) <30 and BMI ≥30. A retrospective cohort study. A French teaching hospital. All patients who underwent a vNOTES hysterectomy from February 2020 to January 2022 were included (N=200). The vNOTES approach was chosen for all patients requiring a hysterectomy, unless the procedure was for endometriosis or cancer (except grade 1 endometrioid adenocarcinoma). Patients were categorized into 2 groups based on their BMI (<30 or ≥30 kg/m2). The population characteristics, surgical outcomes, and hospitalization outcomes were compared. The main outcome was the intraoperative conversion rate. Secondary end points were blood loss, operative time, perioperative and postoperative complications, and same-day surgery management. A total of 146 patients were included in the BMI <30 group, and 54 patients in the BMI ≥30 group. There was no statistical difference between obese and nonobese patients concerning intraoperative conversion (p=.150), with 4 cases occurring in the BMI <30 group (2.74%) and 4 occurring in the BMI ≥30 group (7.41%). Operative times were longer in obese patients (115.93 min [±55.28] vs 79.78 min [±40.38], p <.001). There was no significant difference in blood loss (p=.337) or perioperative and postoperative complications (p=.346 and p=.612, respectively). The ability to complete the surgery as a same-day procedure was no different between obese and nonobese patients (p=.150). The results concerning intraoperative conversion and perioperative and postoperative complications show that vNOTES hysterectomies seem to be feasible for obese patients. When same-day surgery was decided before surgery, no more obese than nonobese patients were converted to conventional hospitalization. Further studies are needed to confirm these observations.

Medicinal plants and their uses by a folk medicinal practitioner of Matlab Upazila in Chandpur district, Bangladesh

Background: Bangladesh is a small developing country with the majority population still residing in villages; most villages lack many modern amenities like proper drinking water facilities, sanitation, and conventional (allopathic) doctors and hospitals. On the other hand, although it is getting lost with possibly every passing day, villagers have a long history of traditional medicinal practitioners, who are also known as folk medicinal practitioners or Kavirajes (in Bengali). Kavirajes for the most part use medicinal plants, which are locally available for treatment and thus saves the villagers from costly conventional treatment, the medicines of which are neither readily available nor affordable. Once common, Kavirajes are fast disappearing along with loss of their folk medicinal knowledge. This loss is irreparable because plants and their phytochemicals still form the basis for discovery of modern drugs. For more than a decade, we had been conducting ethnomedicinal surveys among folk and tribal medicinal practitioners of Bangladesh.Methods and Findings: Interviews were conducted of the only folk medicinal practitioner (FMP) in Matlab Upazila. Prior permission was obtained from the FMP. Interviews were conducted with the help of a semi-structured questionnaire, extensive discussions, and field trips to areas frequented by the FMP to collect medicinal plants. Information was noted carefully. Plants were pictured, and plant samples identified by a trained botanist following collection, drying and mounting onto herbarium sheets. We could obtain information on only ten formulations, which were used for treatment of respiratory disorders, gastrointestinal tract disorders, pain, dengue, diabetes, acne, fever, eye problems, jaundice, gonorrhea, sexual problems, and debility.Conclusions: The richness of folk medicinal practice can be glimpsed from the diversity of illnesses treated with just twelve medicinal plant species. Some of these plants urgently need scientific attention before plants and FMPs disappear altogether. The phytochemicals present in the plants can be sources of potential drugs, lead compounds, or scaffolds for better drugs.

Positive and Negative Syndrome Scale (PANSS) predictors of hospitalization during home treatment on 1045 patients with schizophrenia in acute crisis

IntroductionSeveral factors related to the risk of requiring psychiatric hospitalization have been described in patients diagnosed with schizophrenia treated with methods other than home treatment. With regard to the symptoms, high global illness severity and positive symptoms of schizophrenia have been most frequently related to the risk of hospitalization in patients with schizophrenia. However, there are no studies describing which clinical factors increase the likelihood of being hospitalized while undergoing home follow-up.ObjectivesTo determine which of the clinical factors assessed in the PANSS predict the risk of hospitalization in patients diagnosed with schizophrenia following a home treatment program.MethodsAll patients with schizophrenia who were visited by a home treatment team in Barcelona between January 2017 and December 2021 were included in the study. A comparative, bivariate analysis of each item of the PANSS and of the global results of each category was conducted on those who were hospitalized and those who were not hospitalized. Finally, a logistic regression of each category of the PANSS was done on both groups, controlling for other socio-demographic and clinical factors.ResultsA total of 1045 patients with schizophrenia were evaluated in this study. PANSS positive symptom subscale (PANSS-S), PANSS General Psychopathology, PANSS Excited Component and PANSS Global Score scored higher in patients who were finally hospitalized in a conventional acute treatment unit. Regarding the PANSS negative symptom subscale, no significant differences were found between the two groups.In patients who required hospitalization, the scores of all the PANSS positive symptom subscale (PANSS-P) items and all items on the PANSS excited component (excitement, tension, hostility, uncooperativeness and poor impulse control) were significantly higher. Some items regarding general psychopathology (Somatic concern, anxiety, guilt feelings, tension, and mannerisms) were also significantly higher in the hospitalization group. Only 3 items—blunted affect, guilt feelings and motor retardation—scored significantly higher in patients who did not require hospitalization. In the logistic regression, only the global score of the PANSS-P reached statistical significance (P = 0.001).ConclusionsPositive symptoms scored in the PANSS seem to be the most predictive factors of hospitalization regarding clinical symptoms in patients with Schizophrenia following home treatment. Other items regarding exciting symptoms and general psychopathology also showed as relevant regarding the risk of conventional hospitalization in those patients.Disclosure of InterestNone Declared

Mental Health Home Intensive Care during Spanish national lockdown due to COVID-19 Pandemic

IntroductionThe SARS-CoV-2 pandemic situation forced the Spanish Government to declare a home confinement that was prolonged for three months. The Health System had to focus almost entirely on the treatment of patients with Covid-19 infection and vulnerable populations such as people with severe mental illness were overlooked. In this context, mental health home care as an alternative to hospitalization became a first-line approachment for patients with an acute mental health disorder.ObjectivesThe aim of this study is to describe the professional practice and the patients characteristics attended by a mental health team in Catalonia during the home confinement due to the SARS-CoV-2 pandemic.MethodsThis study includes the period between March 15, 2020 and June 21, 2020. Sociodemographic, clinical and team functioning variables were described. The patient data was obtained from medical history whereas the rest of information was collected through the creation of a database by the members of the assistencial team.ResultsTeam’s structure was changed with the creation of two mirror teams. Psychological attention was expanded and the weekend coverage was reorganized.During that period 40 patients were treated with a mean age of 47 years. There were no differences regarding the gender (50% were men and 50% were women). 87% of the patients lived with their family. 75% of referrals were made by the hospital and 90% were referred to community services upon discharge. Regarding diagnoses, 57.5% of the patients were diagnosed with a psychotic disorder (10% being reactive to Covid-19). A total of 482 visits were made, of which 51% were conducted in a telematic form. The mean time between the referral and the admission was 37.98h. The team accepted 97% of the referred patients with an occupancy rate of 112.4%.ConclusionsThe re-organisation of a home treatment team during the domiciliary lockdown allowed to increase the occupancy rate and offered a rapid response to patients, avoiding the need of conventional hospitalization and providing a proper care plan.Disclosure of InterestNone Declared

Emergency department direct discharge compared to short-stay unit admission for selected patients with acute heart failure: analysis of short-term outcomes

Short stay unit (SSU) is an alternative to conventional hospitalization in patients with acute heart failure (AHF), but the prognosis is not known compared to direct discharge from the emergency department (ED). To determine whether direct discharge from the ED of patients diagnosed with AHF is associated with early adverse outcomes versus hospitalization in SSU. Endpoints, defined as 30-day all-cause mortality or post-discharge adverse events, were evaluated in patients diagnosed with AHF in 17 Spanish EDs with an SSU, and compared by ED discharge vs. SSU hospitalization. Endpoint risk was adjusted for baseline and AHF episode characteristics and in patients matched by propensity score (PS) for SSU hospitalization. Overall, 2358 patients were discharged home and 2003 were hospitalized in SSUs. Discharged patients were younger, more frequently men, with fewer comorbidities, had better baseline status, less infection, rapid atrial fibrillation and hypertensive emergency as the AHF trigger, and had a lower severity of AHF episode. While their 30-day mortality rate was lower than in patients hospitalized in SSU (4.4% vs. 8.1%, p < 0.001), 30-day post-discharge adverse events were similar (27.2% vs. 28.4%, p = 0.599). After adjustment, there were no differences in the 30-day risk of mortality of discharged patients (adjusted HR 0.846, 95% CI 0.637–1.107) or adverse events (1.035, 0.914–1.173). In 337 pairs of PS-matched patients, there were no differences in mortality or risk of adverse event between patients directly discharged or admitted to an SSU (0.753, 0.409–1.397; and 0.858, 0.645–1.142; respectively). Direct ED discharge of patients diagnosed with AHF provides similar outcomes compared to patients with similar characteristics and hospitalized in a SSU.

Abstract WP15: Short-Term Functional Outcomes Of Patients With Large Vessel Occlusions Transported By Mobile Stroke Unit Compared To Conventional Transport.

Background: A major limiting factor of favorable outcomes among patients with emergent large vessel occlusions (ELVO) is delay in transfer to a comprehensive stroke center (CSC). Stony Brook University Hospital (SBUH) is one of two CSCs in Suffolk County, serving approximately 1.5 million patients over 912 square miles. In 2019, SBUH implemented 2 mobile stroke units in strategic locations within Suffolk County to facilitate rapid delivery of acute stroke treatments. With the capability of performing computed tomography angiography (CTA) in addition to non-contrasted head CT, SBUH MSU offers an opportunity to rapidly triage patients to necessary CSCs. We sought to compare functional outcomes of patients receiving thrombectomies following transport by MSU versus conventional EMS and hospital transfers. Methods: A retrospective study was conducted that included patients eligible to receive mechanical thrombectomy from 2017 to 2020. Patients who had pre-morbid modified Rankin scale (mRs) greater than 0, transient ischemic events, subarachnoid hemorrhage, intraparenchymal hemorrhage, or strokes post-hospital arrival were excluded. A total of 77 patients were included, 37 of whom received care by MSU and 40 by EMS or transfers. Time interval from Door-to-Needle time was measured. T-test for independent samples was used to measure differences in time among both groups. Functional outcomes were measured using mRS at discharge. Patients were trichotomized into three outcome groups, mRS 0-1, 2-4, and 5-6. Chi square was used to analyze differences among the outcome groups Results: MSU patients had a significantly shorter Door-to-Needle time than the EMS patients: (69± 64 min vs. 115 ± 65 min respectively, t=3.319, 78.155df, P&lt;0.001). At discharge in MSU group, 37.8% (14) had favorable mRS 0-1 compared to the control group 26.4% (14). The MSU group had 56.8% (21) moderate mRS 2-4 compared to the control group 47.2% (25) with mRS of 2-4. The MSU group had 5.4% (2) severe mRS 5-6 compared to the control group 26.4% (14). X 2 =7.716, 2df, p&lt;.01 Conclusions: CTA can be performed on MSUs to detect ELVOs in the field and achieve prompt triage of these patients to CSCs, thereby reducing time to thrombectomy and improving short-term functional outcomes.

Abstract 155: NORAHOME. A Virtual Multimodal Stroke Remote Monitoring Hospitalization Program

Background and Aims: The rising pressure on medical services, highlighted throughout the pandemic, has revealed a need for alternative methods of hospital care. Our objective is to evaluate a home hospitalization virtual multimodal monitoring program (NORAHOME) for patients who have had a previous transient ischemic attack (TIA) or minor stroke, as an efficient strategy compared to Routine Clinical Practice (RCP). Methods: A prospective cohort study of consecutive patients with a suspected TIA or minor stroke evaluated at the emergency room of a tertiary hospital by a neurologist between 1st December 2020 and 1st June 2022, had completed NORAHOME and was compared with a historic control group of patients with a suspected TIA or minor stroke who had completed a conventional hospitalization (RCP) between 1st June and 30th November 2020. Results: 430 patient cases were analyzed, 215 patients in the prospective group were compared with a retrospective cohort of the same number of patients. Mean age 75.21 ± 12.6 years; 54.9% women. In the NORAHOME group we observed a recurrence rate of 2.3% (5 patients) and mortality of 2.8% (6 patients) during the follow up. In the RCP group 6.5% (14 patients) presented recurrence and 7% (15 patients) died. No significant differences were found in the risk of early recurrence, emergency room readmission or functional outcome between the groups. Conclusions: In our series of TIA and minor stroke patients, NORAHOME is a safe strategy compared to RCP. The development and implementation of digital home-hospitalization programs may reduce direct hospital costs by shortening length of stay and reducing hospital readmission. Moreover, the program improves self-assessed health outcomes reported by patients and their experience with the healthcare system compared to the RCP.

Conventional Hospitalization versus Sequential Outpatient Parenteral Antibiotic Therapy for Staphylococcus aureus Bacteremia: Post-Hoc Analysis of a Multicenter Observational Cohort.

It is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performed in two prospective Spanish cohorts of patients with S. aureus bacteremia. The PROBAC cohort is a national, multicenter, prospective observational cohort of patients diagnosed in 22 Spanish hospitals between October 2016 and March 2017. The DOMUS OPAT cohort is a prospective observational cohort including patients from two university hospitals in Seville, Spain from 2012 to 2021. Multivariate regression was performed, including a propensity score (PS) for receiving OPAT, stratified analysis according to PS quartiles, and matched pair analyses based on PS. Four hundred and thirteen patients were included in the analysis: 150 in sequential OPAT and 263 in the full hospitalization therapy group. In multivariate analysis, including PS and center effect as covariates, 60-day treatment failure was lower in the OPAT group than in the full hospitalization group (p &lt; 0.001; OR 0.275, 95%CI 0.129-0.584). In the PS-based matched analyses, sequential treatment under OPAT was not associated with higher 60-day treatment failure (p = 0.253; adjusted OR 0.660; % CI 0.324-1.345). OPAT is a safe and effective alternative to conventional in-patient therapy for completion of treatment in well-selected patients with SAB, mainly those associated with a low-risk source and without end-stage kidney disease.

Clinical Characteristics and Follow-up Assessment in Patients Diagnosed With Alzheimer's Dementia Through Regional Dementia Centers and Conventional Hospital System.

The rapidly increasing socioeconomic strain caused by dementia represents a significant public health concern. Regional dementia centers (RDCs) have been established nationwide, and they aim to provide timely screening and diagnosis of dementia. This study investigated the clinical characteristics and progression of patients diagnosed with Alzheimer's dementia (AD), who underwent treatment in RDCs or conventional community-based hospital systems. This retrospective single-center cohort study included patients who were diagnosed with AD between January 2019 and March 2022. This study compared two groups of patients: the hospital group, consisting of patients who presented directly to the hospital, and the RDC group, those who were referred to the hospital from the RDCs in Pohang city. The clinical courses of the patients were monitored for a year after AD diagnosis. A total of 1,209 participants were assigned to the hospital (n = 579) or RDC group (n = 630). The RDC group had a mean age of 80.1 years ± 6.6 years, which was significantly higher than that of the hospital group (P < 0.001). The RDC group had a higher proportion of females (38.3% vs. 31.9%; P = 0.022), higher risk for alcohol consumption (12.4% vs. 3.3%; P < 0.001), and greater number of patients who discontinued treatment 1 year after diagnosis (48.3% vs. 39.0%; P = 0.001). In the linear regression model, the RDC group was independently associated with the clinical dementia rating sum of boxes increment (β = 22.360, R²\n = 0.048, and P < 0.001). Patients in the RDC group were older, had more advanced stages of conditions, and exhibited a more rapid rate of cognitive decline than patients diagnosed through the conventional hospital system. Our results suggested that RDC contributed to the screening of AD in a local region, and further nationwide study with the RDC database of various areas of Korea is needed.

Discrete GWO Optimized Data Aggregation for Reducing Transmission Rate in IoT

The conventional hospital environment is transformed into digital transformation that focuses on patient centric remote approach through advanced technologies. Early diagnosis of many diseases will improve the patient life. The cost of health care systems is reduced due to the use of advanced technologies such as Internet of Things (IoT), Wireless Sensor Networks (WSN), Embedded systems, Deep learning approaches and Optimization and aggregation methods. The data generated through these technologies will demand the bandwidth, data rate, latency of the network. In this proposed work, efficient discrete grey wolf optimization (DGWO) based data aggregation scheme using Elliptic curve Elgamal with Message Authentication code (ECEMAC) has been used to aggregate the parameters generated from the wearable sensor devices of the patient. The nodes that are far away from edge node will forward the data to its neighbor cluster head using DGWO. Aggregation scheme will reduce the number of transmissions over the network. The aggregated data are preprocessed at edge node to remove the noise for better diagnosis. Edge node will reduce the overhead of cloud server. The aggregated data are forward to cloud server for central storage and diagnosis. This proposed smart diagnosis will reduce the transmission cost through aggregation scheme which will reduce the energy of the system. Energy cost for proposed system for 300 nodes is 0.34μJ. Various energy cost of existing approaches such as secure privacy preserving data aggregation scheme (SPPDA), concealed data aggregation scheme for multiple application (CDAMA) and secure aggregation scheme (ASAS) are 1.3 μJ, 0.81 μJ and 0.51 μJ respectively. The optimization approaches and encryption method will ensure the data privacy.

Perspectives on the Home Monitoring of Macular Disease.

Recent advancements in imaging technology have led to increasing interest in home monitoring of macular disease. The prevalence of macular disease is projected to rise considerably over time, leading to a significant burden on hospital services for age-related macular degeneration and diabetic macular edema. Home monitoring has the potential to augment conventional hospital assessment and so enable improved access to clinical care for low- and moderate-risk patients, while also allowing sensitive detection of early signs of disease that may require prompt intervention. Despite this, there are significant considerations before large-scale implementation could be possible. These are related to both the current availability of home monitoring technology and the logistical barriers to its widespread introduction. Access to home monitoring is also likely to be more challenging in lower-income communities and countries, with subsequent implications for health inequality that will need to be considered and addressed appropriately.

Hospital at home treatment with remdesivir for patients with COVID-19: real-life experience

ObjectivesAccess and appropriateness of therapeutics for COVID-19 vary because of access or regulatory barriers, the severity of the disease, and for some therapies, the stage of the pandemic and circulating variants. Remdesivir has shown benefits in clinical recovery and is the treatment of choice for selected patients, both hospitalized and nonhospitalized, in main international guidelines. The use of remdesivir in alternatives to conventional hospitalization such as hospital at home (HaH) units remains incompletely explored. In this study, we aim to describe the real-life experience of outpatient remdesivir infusion for COVID-19 in a HaH unit. MethodsWe selected all the consecutive patients receiving remdesivir from a prospective cohort of 507 COVID-19 patients admitted at a HaH unit. Admission criteria included COVID-19 with a fraction of inspired oxygen requirement under 0.35 and respiratory rate under 22 rpm. Patients were daily assessed in person by a nurse and a physician. ResultsA total of 236 patients admitted at the HaH unit received remdesivir, 172 of whom were treated at home. Only 2% presented any adverse event related to the infusion, all of them mild. HaH saved 1416 day-beds, with only 5% of the patients requiring transfer back to the hospital. ConclusionRemdesivir infusion in HaH units seems to be a safe and efficient alternative to conventional hospitalization for treating patients with nonsevere COVID-19.

50 SERVICE EVALUATION COMPARING ACUTE CARE AT HOME FOR OLDER SEOPLE SERVICE AND CONVENTIONAL ACUTE HOSPITAL CARE OF THE ELDERLY WARD

Abstract Background Globally, there has been an increased demand for healthcare services caused by population growth and a rise in chronic conditions and an ageing population. Acute Care at Home services offer acute, hospital-level care in a person's own home. Five services have been commissioned across Northern Ireland since 2014 with limited research investigating their feasibility and effectiveness. This study evaluated the impact of a consultant-led Acute Care at Home service in comparison with conventional hospital admission to a care of elderly ward. Methods Quantitative design, using service evaluation methodology. A 1-year retrospective chart review was undertaken exploring admission demographics and post-discharge clinical outcomes of patients admitted to a Northern Ireland, Care of the Elderly ward (n = 191) and a consultant-led Acute Care at Home Service (n = 314) between April 2018–March 2019. Data were analysed using descriptive and inferential data analysis methods including frequencies, independent t tests and chi-square analysis. Outcome measurements included length of stay, 30-day, 3-and 6-month readmission and mortality rates, functional ability and residence on discharge. STROBE checklist was used in reporting this study. Results Acute Care at Home services are associated with higher readmission and mortality rates at 30 days, 3 and 6 months. Patients admitted to the Acute Care at Home services experience a reduced length of stay and decreased escalation in domiciliary care packages and are less likely to require subacute rehabilitation on discharge. There is no difference in gender, age and early warnings score between the two cohorts. Conclusion The Acute Care at Home service is a viable alternative to hospital for older patients. It prevents functional decline and the need for domiciliary care or nursing home placement. Acute Care at Home service has higher mortality and readmissions rates due to treating a higher proportion of dependent, frail older adults.

Unidades de Cuidados Respiratorios Intermedios: preguntas y respuestas

The intermediate respiratory care units (UCRI) are areas of monitoring and specialized care of patients with acute or chronic-exacerbated respiratory failure, whose severity does not require admission to an intensive care unit, but which due to their complexity cannot be treated in conventional hospitalization. Although the COVID-19 pandemic has proven its usefulness in the management of critical respiratory patients, the historical trajectory of the UCRI comes from many years ago, in which its cost-effectiveness has been demonstrated by far. This document presents a series of questions and answers on the history of the UCRI, in addition to the criteria for admission, infrastructure, human and technical resources, and the types of existing Units. Within the UCRI year 2021-2022 designated by the Spanish Society of Pneumology and Thoracic Surgery, any scientific dissemination linked to the in-depth knowledge of these units is timely, where multidisciplinarity and the work of professionals related to the care of critical respiratory patients converge.