Daily Visits Research Articles

Patterns and characteristics of visits to psychiatric emergency departments: a three-year data study in China.

The composition and characteristics of emergency patients in the Affiliated Brain Hospital, Guangzhou Medical University during 2020-2022 were retrospectively analyzed to provide data support for the optimization of the process of psychiatric emergency and the elastic allocation of emergency medical staff. This study collected data from patients who sought medical attention at the emergency department of the Affiliated Brain Hospital, Guangzhou Medical University between January 1, 2020, and December 31, 2022. The fundamental information of these patients was statistically analyzed using descriptive analytic methods. In addition, a comprehensive statistical analysis was performed on the data of patient visits, which included precise triage time points, months, and seasons, in order to evaluate the temporal distribution of patient visits. The patient population had an average age of 36.4 years and was slightly more female (54.08%). The mean age of the male and female patients was 36.4 ± 18.91 and 36.4 ± 16.80 years, respectively. There was no statistically significant age difference between the male and female patients (p > 0.05). The top five diseases were mental disorder (6,483 cases), bipolar disorder (3,017 cases), depressive episode (2522 cases), schizophrenia (1778 cases) and anxiety state (1097 cases), accounting for 35.63%, 16.58%, 13.86%, 9.77% and 6.03% of the total, respectively. Additionally, a notable record of psychiatric drug intoxication was noted. Significant comorbidity with physical disorders, such as hypertension (9.36%), hypokalemia (3.41%), diabetes (2.83%), and cerebral infarction (2.79%), was also seen. The results of seasonal and monthly analysis indicated that emergency attendance patterns fluctuated, peaking in the spring and fall. The patterns of daily visits also revealed two peak times. The first peak occurs from 8:00 to 10:00, and the second peak occurs from 14:00 to 16:00. This study emphasizes the increasing occurrence of mental problems in psychiatric crises, particularly among younger populations, underscoring the necessity for comprehensive care methods. Specialized treatment methods and collaborative networks are required to address the substantial prevalence of psychiatric medication poisoning. Efficient allocation of resources and heightened security protocols are vital in emergency departments, particularly during periods of high demand and in handling instances of patient hostility.

Potential biosecurity breaches in poultry farms: Presence of free-ranging mammals near laying-hen houses assessed through a camera-trap study

Diligent application and implementation of biosecurity measures stand as the most effective measures to prevent disease transmission through direct or indirect interactions between poultry and free-ranging animals. Among these, free-ranging mammals can be hosts or disseminators of several pathogens relevant to poultry and of public health concern. Moreover, evidence of susceptibility to avian influenza virus infection in non-human mammals has raised questions about their potential role in the virus' epidemiology at the domestic animal-wildlife interface. Given this background, this study aimed to identify mammal species occurring near laying-hen houses and characterize the spatiotemporal patterns of these visits. Seven camera traps were deployed for a year-long period in three commercial poultry farms in a densely populated poultry area in Northern Italy. Various methods, including time series analysis and generalized linear models, were employed to analyze daily mammal visits. A total of 1,867 camera trap nights yielded 567 videos of seven species of wild mammals, and 1,866 videos showed domestic pet species (cats and dogs). Coypus (Myocastor coypus) and cats were the two mammals more frequently observed near poultry houses. For wild mammals, visits significantly increased at night, and slightly decreased during the spring season. Overall, the data hereby provided lay the groundwork for designing novel surveillance and intervention strategies to prevent cross-species disease transmission. Moreover, the utilization of visual evidence depicting free-ranging animals approaching poultry houses could assist health authorities in educating and raising awareness among stakeholders about potential risks of pathogen spillover.

Unravelling key environmental factors influencing urban park visits: Thermal comfort and air quality

Urban parks play a vital role in shaping physical and mental health. Walking and cycling to local urban parks have become increasingly popular since the COVID-19 pandemic, whereas the climate change and air pollution continue to spur health risks for outdoor activities. Existing literature have focused on measuring the impact of temperature on park attendance, mainly using incomplete or short-term park visit data from field investigations. However, there is a lack of research on how thermal comfort factors (e.g., heat and humidity) and air quality indices – individually and synergistically – enhance or reduce visits to urban parks, particularly with quality official daily park visit data spanning an entire year. In response to the research gap, this study conducted a comparative case study of two urban parks in Shanghai, covering descriptive, correlation, and regression analyses of how weather and air quality mediate daily park attendance from April 1, 2020 to March 31, 2021. This study identifies that temperature, humidity, and the ‘Heat Index’ combining heat and humidity are strong parameters influencing the number of park visits, while the impacts of air quality indices are mostly trivial. Urban humid heat, a weather condition becoming more frequent with the rise of extreme heat events in Shanghai's recent summers, received much less attention than the sheer degree of temperature, threatening healthy outdoor activities in parks. These findings provide timely and important implications for better urban park planning, design, and management for promoting outdoor activities while reducing health risks.

Reaction to at-home air purifiers installed to reduce traffic-related air pollution in near-highway residences

Background and aimTraffic-related ultrafine particle pollution near highways is associated with adverse health. Reducing exposure by use of portable air purifiers in homes is one approach to reducing this risk. However, the reaction of residents to having air purifiers in homes is not well studied.MethodsWithin the framework of our randomized crossover trial of air purifiers in homes near a major highway, we collected data about participants’ use and reactions to air purifiers using questionnaires at their 30-day and 90-day home visits, recorded electricity consumption using HOBO monitors, and conducted structured interviews with participants.ResultsNearly all 150 participants reported running the air purifiers virtually 24 h every day in both their living room and their bedroom in the prior month. The units’ HOBO electricity use, from a subset of 45 participants, supported the participants’ responses from the questionnaire. Approximately 80% of participants reported setting their air purifier on the medium setting. Tolerance to air purifier noise increased significantly between the 30-day and 90-day home visits, with approximately two thirds reporting not being bothered at all by the noise. The qualitative interviews in a subset of 26 participants yielded consistent responses to those from the questionnaires. Size of unit, airflow, and energy consumption were additional concerns that emerged during the interviews.ConclusionsResults from the questionnaires, HOBO data, and structured interviews all suggest participants had positive reactions towards the presence of in-home APs, and therefore may be receptive to using air purifiers in their homes on a regular basis.Trial registrationClinicalTrials.gov, NCT04279249. Registered 09 October 2019.

Validation of the Peak Pruritus-Numerical Rating Scale in patients with chronic plaque psoriasis: results from a phase 2 study.

Pruritus is a common, bothersome symptom for patients with mild-to-moderate plaque psoriasis (PsO), yet no validated scale assesses it in this patient population. We aimed to validate the Peak Pruritus-Numerical Rating Scale (PP-NRS) using data from a Phase 2b study investigating the efficacy of brepocitinib in patients with mild-to-moderate chronic PsO. Patients completed the PP-NRS daily from baseline for the first 2 weeks after the dose administration and subsequently only on visit days. Test-retest reliability (intraclass correlation coefficient [ICC]), construct validity (known group validity and convergent validity), ability to detect change, and meaningful within-patient change (MWPC) were evaluated using correlation and regression analyses. The PP-NRS demonstrated acceptable test-retest reliability (ICC: 0.86-0.89). Known-group evidence demonstrated that PP-NRS scores could discriminate between different degrees of disease severity. Convergent validity was supported by significant correlation coefficients between the PP-NRS and Patient Global Assessment (PtGA), Dermatology Life Quality Index, and Psoriasis Symptom Inventory, which generally exceeded 0.50. The ability to detect change was evidenced by an approximately linear relationship between changes in PP-NRS and Physician Global Assessment or PtGA of psoriasis scores. The value of 2.8 was determined as the MWPC for the PP-NRS. PP-NRS is a reliable, practical test for assessing pruritus in mild-to-moderate PsO clinical trials. NCT03850483.

A Study of the Influence of Meteorological and Environmental Factors on Otitis Media with Effusion in Lanzhou.

In observational studies, a possible correlation between atmospheric environmental factors and the number of daily outpatient visits by Otitis media with effusion(OME) patients has been observed. However, the causal relationship is not clear.To study the relationship between the incidence of OME and meteorological factors and air pollutants in the main urban areas of Lanzhou, it is helpful to further understand the health effects of meteorological and environmental factors on OME and to prevent and treat the disease, it is of great academic and practical significance to the prevention, treatment and prognosis of diseases. The levels of AQI、PM2.5、PM10、NO2、O3、SO2、CO、AP、RH、W and T were obtained from local monitor stations. Data of patients with OME were collected from two Grade A Level hospitals in Lanzhou from January 1, 2014 to December 31, 2016. Descriptive analysis of data was carried out for the study subjects. Spearman correlation coefficients between atmospheric environmental factors and daily visits of patients with OME were calculated by SPSS statistical software. Lag effects, relative risks(RR) and exposure-response curves were calculated by generalized additive model (GAM) with R software. (1) The incidence of OME in winter and spring was more than that in summer and autumn, which was consistent with the seasonal variation of meteorological environmental factors of Lanzhou. That was, the meteorological conditions and air quality in winter and spring were poor, while in summer and autumn they were relatively good. (2) The number of male outpatients were 1.05, 1.08 and 1.09 times of female outpatients during the period 2014-2016, respectively. And aged 0-10 years old outpatients accounted for 31% of the total OME outpatients. (3) Exposure-response curve showed that PM2.5, PM10, NO2 and SO2 were positively correlated with OME, T was negatively correlated with OME. When concentration < 1mg/m3, CO was positively correlated with OME. When concentration>1mg/m3, CO was negatively correlated with OME. When concentration<30 ug/m3, O3 was positively correlated with OME. When concentration>30ug/m3, O3 was negatively correlated with OME. (4) The factors we studied could significantly affect the number of OME outpatients within 2-3 days of single lag effects, and 3-4 days of cumulative lag effects.(5) The influential factors on OME were as follows: PM2.5、NO2、SO2、O3、 CO and T. The daily average number of OME patients in different seasons was different in major region of Lanzhou city, with more in winter、spring and fewer in summer、autumn. Age and sex were the important factors affecting the daily average number of OME patients. Males were more susceptible to OME than females and children awere moresusceptible to OME than adults. The change of OME patients was related to air quality, air pressure and temperature. The worse the air quality, the higher the air pressure, the lower the temperature, the more the average daily number of OME patients. Meteorological environmental factors affected the visits of OME, and the lagging effect time of different factors were different. Most of the research factors within 3-4 days had a significant impact on the number of patients of OME. 1.The number of OME visits in the Lanzhou was more seasonal in winter and spring than in summer and fall. 2.Age and sex were the most important factors affecting the number of patients with OME. According to the prevalence of OME in Lanzhou, children were more likely to have OME than adults and men were more likely to have OME than women. 3.The number of OME patients was related to air quality, air pressure and temperature. 4.The meteorological factors have a delayed effect on the onset of OME, and the time of delayed effect is different for different factors. The single delayed effect of 2-3 days and the cumulative delayed effect of 3-4 days have a significant effect on the change of the number of patients with OME. To study the relationship between the incidence of OME and meteorological factors and air pollutants in the main urban areas of Lanzhou, it is helpful to further understand the health effects of meteorological and environmental factors on OME and to prevent and treat the disease, it is of great academic and practical significance to the prevention, treatment and prognosis of diseases.

Evaluating the tolerability and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among health workers in Sierra Leone: a longitudinal hospital-based intervention study

BackgroundAlcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers.MethodsA longitudinal hospital-based intervention study was conducted in accordance with the WHO’s standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3–5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures.ResultsObjective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants’ self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product’s drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml).ConclusionThe WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.

Functional integration of services during the antenatal period can potentially improve childhood growth parameters beyond infancy: findings from a post-interventional follow-up study in West Bengal, India

BackgroundDespite progress, the prevalence of childhood undernutrition in India remains amongst the highest globally.ObjectiveWe aimed to evaluate the impact of a functional integration interventional package during the antenatal period on childhood growth parameters.MethodsThis is a post-interventional follow-up study of a maternal nutrition interventional study conducted between 2018 and 2019 among women in their first trimester of pregnancy from three districts in West Bengal, India. Pregnant women received a package of augmented interventions from study staff which supplemented those provided to them under the state-run programmes, that included body-mass-index measurement at pregnancy registration, monthly weight monitoring, targeted dietary counselling, supervised supplementary nutrition intake and iron-folic acid supplementation during daily anganwadi center visits. In the current follow-up study conducted in 2021, age-matched pregnant women from the same areas who were pregnant during the same period as in the original study and had received standard-of-care under the state-run programmes were recruited into a comparison group. Study staff collected data regarding maternal height and serial weights that were recorded at antenatal visits in 2018-19, and birth and infant characteristics. Child height and weight were measured during the follow-up visit in 2021, which were used to calculate the relative risks of stunting, wasting and underweight using generalized linear models, to understand the sustained impact of the intervention beyond infancy. Eight-hundred-nine mother-child dyads (406 intervention; 403 comparison) were followed.ResultsMedian age of women in the intervention and comparison group was 23 (IQR 20–25) and 25 (IQR 24–27) years respectively. Median gestational-weight-gain was higher amongst intervention group women (9 vs. 8 kg, p = 0.04). Low-birth-weight prevalence was 29.3% (119/406) and 32.0% (129/403) in the intervention and comparison group. At 12–35 months of age, children born to women in the intervention group had significantly reduced risk of stunting (RR = 0.65, 95% CI 0.44–0.94), wasting (RR = 0.57, 95% CI 0.33–0.97) and underweight (RR = 0.61, 95% CI 0.42–0.88).ConclusionsThese results indicate that functional integration and strengthening of routine antenatal care services including targeted nutritional counselling to expectant mothers can have distal beneficial effects on childhood undernutrition beyond the immediate post-natal period.

Rhegmatogenous Retinal Detachment with Giant Retinal Tear: Case Series and Literature Review.

Background/Objectives: This paper reviews three cases of rhegmatogenous retinal detachment (RRD) with giant retinal tear (GRT), focusing on surgical management and outcomes, and synthesizes the current literature on the subject. Methods: We retrospectively analyzed three cases of male patients diagnosed with RRD with GRT at our hospital from April 2022 to November 2023. The patients, aged 57, 66, and 60, underwent surgical interventions, with postoperative follow-up extending up to six months. All patients underwent pars plana vitrectomy (PPV), endolaser photocoagulation, fluid-air exchange, and intravitreal gas injection (perfluoropropane (C3F8) 14%) in each case. Surgeries were performed within four days of the patients' initial visits. Outcome measures included visual acuity improvement, intraocular pressure stabilization, and retinal reattachment rates. Complications in the patients were also evaluated. Results: The patient who had not previously undergone cataract surgery (Case 1) had it concurrently with the retinal surgery. Four months after the initial surgery, Case 3 developed a secondary epiretinal membrane (ERM) and subsequently underwent ERM removal surgery. Postoperative care involved the tailored use of anti-inflammatory medications and frequent monitoring to mitigate complications such as proliferative vitreoretinopathy, epiretinal membrane formation, and redetachment. Conclusions: While limited by the small sample size, this report underscores the potential benefits of prompt surgical intervention, meticulous postoperative care, and proactive management of complications in RRD with GRT. Insights from these cases, supported by multiple literature reviews, may inform treatment strategies and highlight areas for further research in larger, more diverse patient populations.

Physician Follow-Up of Pediatric and Young Adult Emergency Department Visits for Substance Use in Ontario, Canada

PurposeTo study the proportion and predictors of outpatient physician follow-up within 60 days of substance-related emergency department (ED) visits for Ontario youth. MethodsWe examined administrative data on substance-related ED visits before and during the COVID-19 pandemic among youths aged 10–24 years in Ontario, Canada. Substance-related visits were identified using International Classification of Diseases-10-CA codes. We described demographic characteristics, receipt of mental health services in the year before the ED visit, disposition from the ED, and follow-up services within 60 days of the ED visit. ResultsBetween April 1, 2017, and May 31, 2021, 64,236 youth had at least one ED visit for substance use. Visits for alcohol were the most common (49%), followed by cannabis (32.3%). ED visits for all substances were more prevalent during the pandemic than prepandemic, except visits for alcohol. The receipt of follow-up physician care for substance use was low (33.2% prepandemic) but increased during the pandemic (41.7%; adjusted odds ratio 1.34, 95% CI 1.28, 1.39) and varied between substances. Mental health service history in the year before the substance-related ED visit had the strongest association with receipt of follow-up physician care within 60 days (adjusted odds ratio 6.86, 95% CI 6.57, 7.17). DiscussionYouth frequently do not receive physician follow-ups within two months of the substance-related ED visit, although higher follow-up proportions were seen during the pandemic after the implementation of virtual care. Further research is required to understand why follow-up is low and to examine interventions that can increase connection to care.

Long-term prevention of hereditary angioedema attacks with lanadelumab in adolescents

BackgroundLanadelumab was well tolerated and effective in preventing hereditary angioedema (HAE) attacks in the phase 3, double-blind, placebo-controlled Hereditary angioEdema Long-term Prophylaxis (HELP) study and subsequent HELP open-label extension (OLE) study (NCT02741596). ObjectiveTo evaluate outcomes from HELP OLE for adolescent patients aged 12 to 17 years. MethodsThe HELP OLE study comprised patients who completed the HELP study (rollovers) and new eligible (lanadelumab-naive) patients. Rollovers received a single dose of lanadelumab 300 mg at the last HELP study visit (day 0). Treatment was then paused until patients experienced their first investigator-confirmed HAE attack, after which lanadelumab 300 mg was administered every 2 weeks for up to 33 months (4 wk/mo). Lanadelumab-naive patients received lanadelumab 300 mg every 2 weeks from day 0. Patient-reported outcomes included Angioedema Quality of Life Questionnaire. Safety was monitored throughout the study. ResultsThe subgroup analysis included 21 patients (8 rollovers and 13 lanadelumab-naive patients); 95.2% completed at least 30 months in the study. The mean (SD) monthly attack rate decreased from 1.58 (1.0) at baseline to 0.11 (0.2) during treatment (mean, 94.7% reduction). A total of 8 (38.1%) patients were attack-free during treatment and, on average, 99.1% of days were attack-free (mean, 27.7 d/mo). Patients reported a mean (SD) Angioedema Quality of Life Questionnaire total score of 27.5 (17.5) at baseline vs 7.5 (13.2) at the end of the study. There were 12 (57.1%) patients who reported treatment-related treatment-emergent adverse events; however, there were no treatment-related serious adverse events. ConclusionLanadelumab provided long-term efficacy in preventing HAE attacks, was associated with clinically meaningful improvements in health-related quality of life and high levels of treatment satisfaction, and was well tolerated in adolescent patients. Trial RegistrationClinicalTrials.gov Identifier: NCT02741596.

Bioequivalence and Safety of Bilastine 20 mg Orodispersible Tablets and Conventional Tablets: A Randomized, Single-Dose, Two-Period Crossover Study in Healthy Volunteers Under Fasting Conditions.

Orodispersible tablets (ODT) rapidly dissolve in the oral cavity and can improve patient's convenience. This pharmacokinetic study assessed the bioequivalence of a novel 20 mg ODT formulation of bilastine compared with bilastine 20 mg tablets in healthy volunteers under fasting conditions. A phase I, single-center, open-label, two-period, two-sequence crossover randomized clinical trial was conducted. The study comprised two periods, in which participants were administered a single oral dose of bilastine 20 mg in the form of ODT as the test product, or conventional tablets as the reference product, and a washout of 7 days between each period. Blood samples were collected for up to 72 h. Bioequivalence was established if the 90% confidence intervals of the Cmax and AUC0-t were within the acceptance range (80-125%). Safety was evaluated at the follow-up visit (days 4-7 after the second dose) and throughout the study. A total of 42 healthy volunteers were randomized, and 41 completed the study. Pharmacokinetic parameters were comparable for both formulations after a single dose of 20 mg. Bilastine ODT and conventional tablets were bioequivalent as the 90% confidence intervals of the test over reference ratios were within the predefined range (80-125%). Both formulations were well tolerated and showed a similar safety profile. Bilastine ODT was bioequivalent to the reference treatment formulated as conventional tablets when administered as a single oral dose of 20 mg under fasting conditions. Both formulations showed a similar tolerability and safety profile, with no serious adverse events or significant analytical alterations reported. 2019-004071-39. Date of authorization: 10 December 2019.

Assessing how frailty and healthcare delays mediate the association between sexual and gender minority status and healthcare utilization in the All of Us Research Program.

To understand how frailty and healthcare delays differentially mediate the association between sexual and gender minority older adults (OSGM) status and healthcare utilization. Data from the All of Us Research Program participants ≥50 years old were analyzed using marginal structural modelling to assess if frailty or healthcare delays mediated OSGM status and healthcare utilization. OSGM status, healthcare delays, and frailty were assessed using survey data. Electronic health record (EHR) data was used to measure the number of medical visits or mental health (MH) visit days, following 12 months from the calculated All of Us Frailty Index. Analyses adjusted for age, race and ethnicity, income, HIV, marital status ± general MH (only MH analyses). Compared to non-OSGM, OSGM adults have higher rates of medical visits (adjusted rate ratio [aRR]: 1.14; 95% CI: 1.03, 1.24) and MH visits (aRR: 1.85; 95% CI: 1.07, 2.91). Frailty mediated the association between OSGM status medical visits (Controlled direct effect [Rcde] aRR: 1.03, 95% CI [0.87, 1.22]), but not MH visits (Rcde aRR: 0.37 [95% CI: 0.06, 1.47]). Delays mediated the association between OSGM status and MH visit days (Rcde aRR: 2.27, 95% CI [1.15, 3.76]), but not medical visits (Rcde aRR: 1.06 [95% CI: 0.97, 1.17]). Frailty represents a need for medical care among OSGM adults, highlighting the importance of addressing it to improve health and healthcare utilization disparities. In contrast, healthcare delays are a barrier to MH care, underscoring the necessity of targeted strategies to ensure timely MH care for OSGM adults.

Electronic Health Record–Based Nudge Intervention and Axillary Surgery in Older Women With Breast Cancer

Choosing Wisely recommendations advocate against routine use of axillary staging in older women with early-stage, clinically node-negative (cN0), hormone receptor-positive (HR+), and HER2-negative breast cancer. However, rates of sentinel lymph node biopsy (SLNB) in this population remain persistently high. To evaluate whether an electronic health record (EHR)-based nudge intervention targeting surgeons in their first outpatient visit with patients meeting Choosing Wisely criteria decreases rates of SLNB. This nonrandomized controlled trial was a hybrid type 1 effectiveness-implementation study with subsequent postintervention semistructured interviews and lasted from October 2021 to October 2023. Data came from EHRs at 8 outpatient clinics within an integrated health care system; participants included 7 breast surgical oncologists. Data were collected for female patients meeting Choosing Wisely criteria for omission of SLNB (aged ≥70 years with cT1 and cT2, cN0, HR+/HER2- breast cancer). The study included a 12-month preintervention control period; baseline surveys assessing perceived acceptability, appropriateness, and feasibility of the designed intervention; and a 12-month intervention period. A column nudge was embedded into the surgeon's schedule in the EHR identifying patients meeting Choosing Wisely criteria for potential SLNB omission. The primary outcome was rate of SLNB following nudge deployment into the EHR. Similar baseline demographic and tumor characteristics were observed before (control period, n = 194) and after (intervention period, n = 193) nudge deployment. Patients in both the control and intervention period had a median (IQR) age of 75 (72-79) years. Compared with the control period, unadjusted rates of SLNB decreased by 23.1 percentage points (46.9% SLNB rate prenudge to 23.8% after; 95% CI, -32.9 to -13.8) in the intervention period. An interrupted time series model showed a reduction in the rate of SLNB following nudge deployment (adjusted odds ratio, 0.26; 95% CI, 0.07 to 0.90; P = .03). The participating surgeons scored the intervention highly on acceptability, appropriateness, and feasibility. Dominant themes from semistructured interviews indicated that the intervention helped remind the surgeons of potential Choosing Wisely applicability without the need for additional clicks or actions on the day of the patient visit, which facilitated use. This study showed that a nudge intervention in the EHR significantly decreased low-value axillary surgery in older women with early-stage, cN0, HR+/HER2- breast cancer. This user-friendly and easily implementable EHR-based intervention could be a beneficial approach for decreasing low-value care in other practice settings or patient populations. ClinicalTrials.gov Identifier: NCT06006910.

Summer scour syndrome in weaned dairy calves: case series

BackgroundSummer scour syndrome (SSS) is a recently identified pathological condition affecting weaned dairy and dairy-beef calves during their first grazing season in Ireland. The syndrome is characterised by diarrhoea, weight loss, weakness, and can ultimately lead to death in some calves. Oral and oesophageal ulcerations are present in some cases. This study aimed to characterise a series of SSS cases in weaned dairy-bred calves on Irish commercial farms.ResultsFive farms with calves having unexplained diarrhoea at grass were referred by private veterinary practitioners (PVP) following preliminary testing to exclude coccidiosis and parasitic gastroenteritis. Farms were visited within 2 to 5 days following PVP’s referrals, or 2 days to 3 weeks relative to the onset of clinical signs. Farm management data, grass and concentrate samples, and biological samples from 46 calves (8 to 10 calves/farm) displaying clinical signs were collected. Two farms were subsequently found positive for coccidiosis and/or had chronic pneumonia problems after a thorough herd investigation and were designated as non-case farms (NCF). The remaining three farms were deemed typical SSS outbreaks (case farms; CF). Mean rumen fluid pH per farm ranged from 6.67 to 7.09 on CF, and 6.43–6.88 on NCF. Mean rumen fluid ammonia concentrations ranged from 17.6 to 29.6 mg/L and 17.2–45.0 mg/L on CF and NCF, respectively. Corresponding blood ammonia concentrations ranged from 129 to 223 µmol/L and 22–25 µmol/L. Mean blood copper and molybdenum concentrations were within normal range on all farms. Grass crude protein concentrations on the paddocks where the calves had grazed, and were currently grazing on the day of visit ranged from 137 to 148 g/kg DM and 106–177 g/kg DM, respectively on CF, and 160–200 g/kg DM and 151–186 g/kg DM, respectively on NCF. On CF, inorganic nitrogen fertiliser was applied 1 to 3 weeks pre-grazing, whereas on the two NCF, inorganic nitrogen fertiliser was applied 2 to 3 weeks pre-grazing on one farm and no fertiliser was applied on the other.ConclusionThese findings suggest that copper or molybdenum toxicity, and ruminal acidosis are not the primary causes of SSS. High blood ammonia concentrations and the timing and level of inorganic nitrogen fertiliser application to paddocks pre-grazing, warrant further investigation.

Association between summertime emergency department visits and maximum daily heat index in rural and non-rural areas of Virginia (2015–2022)

There is growing evidence that high ambient temperatures are associated with a range of adverse health outcomes. Further evidence suggests differences in rural versus non-rural populations' vulnerability to heat-related adverse health outcomes. The current project aims to 1) refine estimated associations between maximum daily heat index (HI) and emergency department (ED) visits in regions of Virginia, and 2) compare associations between maximum daily HI and ED visits in rural versus non-rural areas of Virginia and within those areas, for persons 65 years of age and older versus those younger than 65 years. Our study utilized 16,873,213 healthcare visits from Virginia facilities reporting to the Virginia Department of Health syndromic surveillance system between May and September 2015–2022. Federal Office of Rural Health Policy defined rural areas were assigned to patient home ZIP code. The estimated daily maximum HI at which ED visits begin to rise varies between 25 °C and 33 °C across climate zones and regions of Virginia. Across all regions, estimated ED visits attributable to days with maximum HI above 25.7 °C were higher in rural areas (3.7%, 95% CI: 3.5%, 3.9%) versus in non-rural areas (3.1%, 95% CIs: 3.0%, 3.2%). Patients aged 0–64 years had a higher estimated heat attributable fraction of ED visits (4.2%, 95% CI: 4.0%, 4.3%) than patients 65 years and older (3.1%, 95% CI: 2.9%, 3.4%). Rural patients older than 65 have a higher estimated fraction of heat attributable ED visits (2.7%, 95% CI: 2.2%, 3.1%) compared to non-rural patients 65 years and older (1.5%, 95% CI: 1.3%, 1.8%). State-level syndromic surveillance data can be used to optimize heat warning messaging based on expected changes in healthcare visits given a set of meteorological variables, and can be further refined based on climate, rurality and age.

High Demand for Psychological Support in Patients Who Have Periprosthetic Hip and Knee Joint Infections: An Analysis of 13,976 Patients

BackgroundThere is only sparse knowledge on the psychological burden of patients who have periprosthetic joint infections. The aim of our study was to assess the need for psychological support following total joint arthroplasty of the hip and knee. A special focus was set on patients who had aseptic and septic complications. MethodsA total of 13,976 patients who underwent total hip (n = 6,926) or total knee arthroplasty (n = 7,050) between January 1, 2012 and December 31, 2019 at a single institution were retrospectively evaluated for the postoperative need for a psychological consultation. Data were collected on age, sex, type of surgery, and indications for revision procedures. The need for a psychological consultation was assessed during the daily postoperative visits, which were further coordinated by 2 institutional psychologists. ResultsThe average age was 68 years (range, 12 to 100), and there were 63.5% women. The overall rate of psychological consultations was 1.7%. Patients who had a septic indication for revision surgery had an 18.7-fold higher rate of postoperative psychological consultations compared to patients following primary surgery and a 5.4-fold higher rate compared to patients who had an aseptic indication. In detail, this rate was 1.0% in the primary subgroup, compared to 7.7% following revision arthroplasty (P < .001). In the revision subgroup, the rate was 17.9% for septic and 3.3% for aseptic revision arthroplasty cases (P < .001). Postoperative psychological consultations were twice as frequent in women (2.1%) compared to men (1.0%), P < .001. ConclusionsThe present study raises awareness of the markedly high psychological burden in revision arthroplasty cases, in the view of the high estimated number of unknown cases. There is a significant correlation between periprosthetic joint infectionsand the postoperative need for a psychological consultation, with women being at an even higher risk. Health care providers should aim at offering psychological support for patients who have a septic complication, with affected patients being at risk for psychological stress. Level of EvidenceIV.

Limitations of Patient-Controlled Epidural Analgesia Following Abdominoplasty.

Effective postoperative pain management is essential for patient satisfaction and an uneventful postoperative course, particularly in body contouring procedures. Systemic analgesic regimens can be supported by regional procedures, such as the transverse abdominis plane (TAP) block, but these have a limited duration of action. In contrast, thoracic epidural analgesia offers the possibility of a longer-lasting, individualized regional anesthesia administered by a patient-controlled analgesia pump. The aim of this study was to investigate the effects of a patient-controlled epidural analgesia to better classify the clinical value of this procedure in abdominoplasties. This work reviewed the digital medical charts of patients who underwent selective abdominoplasty without combined surgical procedures between September 2018 and August 2022. Evaluated data comprise the postoperative analgesia regimen, including on-demand medication, mobilization time, inpatient length of stay, and clinical outcome. The patients were grouped by the presence of a thoracic epidural catheter. This catheter was placed before anesthetic induction and a saturation dose was preoperatively applied. Postoperative PCEA patients received a basal rate and could independently administer boluses. Basal rate was individually adjusted during daily additional pain visits. The study cohort included 112 patients. Significant differences in the demand for supportive nonepidural opiate medication were shown between the patient-controlled epidural analgesia (PCEA) group (n = 57) and the non-PCEA group (n = 55), depending on the time after surgery. PCEA patients demanded less medication during the early postoperative days (POD 0: PCEA 0.13 (±0.99) mg vs non-PCEA 2.59 (±4.55) mg, P = 0.001; POD 1: PCEA 0.79 mg (±3.06) vs non-PCEA 2.73 (±3.98) mg, P = 0.005), but they required more during the later postoperative phase (POD 3: PCEA 2.76 (±5.60) mg vs non-PCEA 0.61 (±2.01) mg, P = 0.008; POD 4: PCEA 1.64 (±3.82) mg vs non-PCEA 0.07 (±2.01) mg, P = 0.003). In addition, PCEA patients achieved full mobilization later (PCEA 2.67 (±0.82) days vs non-PCEA 1.78 (±1.09) days, P = 0.001) and were discharged later (PCEA 4.84 (±1.23) days vs non-PCEA 4.31 (±1.37) days, P = 0.005). Because the postoperative benefits of PCEA are limited to potent analgesia immediately after abdominoplasty, less cumbersome, time-limited regional anesthesia procedures (such as TAP block) appear not only adequate but also more effective.

O-318 Decline of βhCG concentrations following pregnancy loss: exploring contributing factors

Abstract Study question Which factors impact βhCG decline after a pregnancy loss, thereby inhibiting return of menstrual cycle? Summary answer In pregnancy loss, decline in βhCG levels are influenced by gestational age, BMI, previous losses, and treatment method, impacting menstrual cycle resumption. What is known already Despite one in four pregnancies ending as a pregnancy loss, there is limited knowledge about when to expect reproductive recovery including the decline in βhCG. The placentally produced hormone βhCG binds to luteinizing hormone/hCG-receptors, which, through negative feedback in the pituitary, decreases release of gonadotropins. This limits chances of ovulation, thus inhibiting the onset of menstrual bleeding, however with great individual variability. Therefore, there is an unmet need for a more individualized understanding of the impact of maternal factors on the decline in βhCG concentrations and the relationship between βhCG and reproductive recovery after a pregnancy loss. Study design, size, duration The Copenhagen Pregnancy Loss study (COPL) is a prospective cohort focusing on pregnancy loss. Participants/materials, setting, methods Inclusion criteria required diagnosis of missed, spontaneous or anembryonic miscarriage and hCG results from both day of inclusion and follow-up visit 4-8 weeks later. Primary objective end points were serum-hCG on day of the diagnosis of pregnancy loss and at follow-up. Secondary end points from the follow-up visit included information on return of menstruation. Per laboratory protocol, βhCG &amp;gt; = 5 IU/L is indicative of pregnancy. Analysis was done using a multivariable Bayesian ordinal regression model. Main results and the role of chance Preliminary results, to be updated for presentation at ESHRE 2024: 1,306 women were included in this study between November 2020 - January 2024. Follow-up visits were conducted 6 weeks after pregnancy loss (IQR: 5.6-7.0 weeks). At follow-up, 199 (18.0%) women still had elevated concentrations of βhCG. At the time of pregnancy loss, gestational age (OR: 0.97, 95% CI 0.96-0.98), BMI (OR: 0.98, 95% CI 0.96-0.99), and number of prior pregnancy losses (OR: 1.09, 95% CI 1.01-1.18) were associated with βhCG. βhCG concentration, measured at the follow-up, was strongly influenced by the choice of treatment method, including surgical (OR: 2.74, 95% CI 1.76-4.26) and medical (OR: 1.69, 95% CI 1.11-2.56), compared to spontaneous. Furthermore, Age (OR: 1.02, 95% CI 1.00-1.04) and gestational age (OR: 1.01, 95% CI 1.00-1.01) also affected the decline. βhCG levels at follow-up were correlated with return of menstrual bleeding OR: 0.98, 95% CI 0.96-0.99). Of the women with βhCG levels exceeding 5 IU/L, 145 out of 199 (72.9%) reported the resumption of their menstrual cycle. Among those with βhCG levels above 25 IU/L, 17 out of 33 (52%) reported menstrual cycle return. Limitations, reasons for caution Analysis depicted total-hCG concentrations (intact hCG + free ß-subunit) without distinguishing between the various hCG isoforms. The cohort was gathered at a hospital, reflecting that setting. Wider implications of the findings Our findings are the first step towards a more personalised approach for patients facing pregnancy loss, aiding with counselling and planning of reproductive prospects, including IVF. The evident ßhCG-induced negative feedback, coupled with menstrual bleeding in women with elevated ßhCG, highlights system complexity and hints at additional unidentified factors. Trial registration number not applicable

Association between short-term ozone exposure and allergic conjunctivitis in China: A multi-city case-crossover study

Short-term exposure to ozone has been linked to multiple allergic diseases, but the relationship between ozone exposure and allergic conjunctivitis (AC) remains unclear. This study aimed to investigate the association between short-term exposure to ozone and the risk of AC. We conducted a time-stratified case-crossover study across five Chinese cities from 2014 to 2022. Daily outpatient visit records for AC were identified in five hospitals using either the diagnosis name or ICD-10 code H10.1. Data on air pollution and meteorological conditions were also collected. We first examined the city-specific association between short-term ozone exposure and AC using conditional logistic regression. A random-effects meta-analysis was then conducted to obtain overall estimates. During the study period, 130,093 outpatient visits for AC occurred, with 58.8% (76,482) being male and 41.2% (53,611) female. A one-standard-deviation (SD) increase in ozone was associated with an 8.3% increase (95% CI: 3.8%, 13.0%) in AC outpatient visits. Similar positive associations were observed when adjusting for other pollutants (PM2.5, CO, SO2 and NO2) in two-pollutant and multi-pollutant models. Furthermore, the positive association remained consistent when using mixed-effects regression models or further adjusting for meteorological conditions. In addition, no effect modification of the AC-ozone association by sex, age and season was apparent. This study provides evidence supporting a positive association between short-term ozone exposure and AC risk in China. This highlights the potential value of mitigating ozone pollution to reduce the risk of ocular surface disorders.