Discharge Information Research Articles

Effect of integrated medicines management on quality of discharge medication information - a secondary endpoint in a randomized controlled trial.

High-quality discharge information is important to promote patient safety when patients are transferred from hospital to primary care. Patients with multiple long-term conditions are especially vulnerable to insufficient transfer of medication information, as they use many medications and have complex interactions with the healthcare services. The aim of this study was to investigate the effect of integrated medicines management provided to hospitalized multimorbid patients on the quality of the discharge medication information. Multimorbid patients ≥18 years, using a minimum of four regular medications from a minimum of two therapeutic medication classes were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomized controlled trial; the difference between the intervention and control group in the quality of discharge medication information. The analysis population comprised 384 patients. Integrated medicines management improved the discharge summary quality score of the medication information from 5.8 ± 1.5 to 8.6 ± 2.6 (mean difference 2.7, 95% CI 2.3-3.2, p < 0.001). In total 171 intervention patients (89%) received a patient discharge information letter, compared to 66 control patients (35%), p < 0.001. The quality score of the medication information in the patient discharge information letter was improved from 6.0 ± 1.8 in the control group to 10.0 ± 1.3 in the intervention group (mean difference 4.0, 95% CI 3.6-4.4, p < 0.001). Integrated medicines management delivered to multimorbid patients during a hospital stay improved the quality of the medication information in discharge summaries as well as patient discharge information letters and ensured that a discharge information letter in lay language was prepared for almost all patients who were involved in the management of their medications after discharge.

ExtendinG SUb-DAily River Discharge data over INdia (GUARDIAN).

River discharge information is crucial for various applications, but the measurement process often remains impeded by factors that hinder near real-time (NRT) data availability in India. However, leveraging telemetry-based water surface elevation (WSE) data across the country provides an opportunity to convert it into river discharge. This conversion is made possible by utilizing rating curves (RCs) derived from historical collocated measurements of WSE and discharge. In this study, NRT WSE from the Central Water Commission (CWC) flood portal is obtained via the web-scraping tool. Through the application of RCs, discharge data is extended across 210 gauging stations in India from the year 2020 to the present, encompassing sub-daily discharge during the non-monsoon and hourly discharge series during monsoon (June-September) across the Indian rivers. Annually, the study generated over 800,000 discharge data points for Indian rivers, accounting for more than 4000 discharge measurements per station annually. These comprehensive datasets provide valuable insights for water resource and flood management research, offering NRT access to WSE, and discharge, along with the local RCs.

Survival and clinical characteristics of patients with disorders of consciousness in a developing country between 2002 and 2018

ABSTRACT Objective Describe the survival, sociodemographic and clinical characteristics of subjects with disorders of consciousness in a reference rehabilitation center, in a developing country. Methods Patients with disorders of consciousness (DoC) caused by acquired neurological injuries, admitted between the years 2002–2018 in a neurorehabilitation center. Extracted data covered demographics, clinical details, survival time, and discharge information. Cox proportional hazard model and Kaplan-Meier analysis were used to reveal, associations with survival. Result Out of 5064 neurological cases, 159 patients were diagnosed with DoC. The demographic data showed a male dominance (65%), with an average injury age of 42 years. The most common causes were traumatic (41%), anoxic (36%), and vascular (10%), with traffic accidents accounting for 71% of traumatic injuries. The study found that 75% of patients remained in a vegetative state (VS), and 25% in a minimally conscious state (MCS), with an average survival of 2110 days. Conclusion There were no significant differences in survival days between patients in MCS and VS. Patients with traumatic injuries showed a higher survival rate than those with non-traumatic injuries. Age and etiology were identified as factors associated with a higher risk of death.

Introduction of a Novel Patient Safety Advisory: Evaluation of Perceived Information With a Modified QPP Questionnaire-A Case-Control Study.

Adverse events (AEs) may result in serious injuries or death. AEs occur in approximately 9.2% of hospitalizations, with a potential preventability of 43.5%. The aim of this study was to examine whether use of an illustrated patient safety advisory affected information transfer to inpatients regarding how they can participate in their own care to decrease the risk of AEs. All patients in the control (n = 129) and case/intervention (n = 511) groups received verbal information from healthcare personnel. The intervention group also received the illustrated patient safety advisory, "Your safety at the hospital." Before discharge, patients completed the Quality from the Patient's Perspective questionnaire. Mean patient age was 64.6/62.4 years in the intervention/control group, respectively, and 50% were men. Significant differences between groups were observed for most questions presented from the perceived reality of care perspective, in favor to the intervention group. Patients at surgical wards indicated higher scores on 9 of 12 Quality from the Patient's Perspective questions. Patients with hospital stays ≥4 days, at surgical wards, and living with someone else, placed higher subjective importance to questions concerning, e.g., protection/infection, nutrition, risk of falls and pressure ulcers, and discharge information. Using an illustrated patient safety advisory to complement oral information about patient safety risks resulted in positive responses and a significant difference was demonstrated in how information is perceived. The safety advisory could be used as a tool to decrease AEs. Patients who live alone may need more focused patient safety information to encourage involvement in their own care.

Medicaid Status is Independently Predictive of Increased Complications, Readmission, and Mortality Following Primary Total Shoulder Arthroplasty

In recent years, several studies have evaluated the effect of Medicaid insurance status on total shoulder arthroplasty (TSA) outcomes and have presented discordant findings. The purpose of this study is to determine if Medicaid status is an independent predictor of all-cause complications, readmission, revision, and mortality following elective primary TSA using a large, national administrative claims database. The Nationwide Readmissions Database (NRD) was queried to identify patients who underwent elective primary TSA from 2016 to 2020. Patients were propensity score matched in a 1:1 proportion based on age, sex, and discharge weight, yielding 15,374 Medicaid cases and 15,448 control cases. Patient demographic and discharge information, preoperative comorbidities, and postoperative outcomes were compared with bivariate analysis. Binary logistic regression was performed to account for the influence of variables other than Medicaid status on postoperative outcomes. Medicaid patients had higher rates of preoperative comorbidities, higher Charlson-Deyo Comorbidity Index scores, and lower household incomes than matched controls. Compared to controls, Medicaid patients undergoing TSA had higher odds of adverse clinical outcomes, including all-cause complications, readmission, and mortality within 180 days, along with other specific medical and implant-related complications including broken hardware, dislocation, prosthetic loosening, and surgical site infection. Medicaid status was independently predictive of increased rates of all-cause complications within 180 days, readmission within 180 days, dislocation, pneumonia, sepsis, and decreased rates of prosthetic loosening. Medicaid patients had an increased mean cost of $1,396 and increased mean length of stay of 0.4 days. Medicaid status was independently predictive of readmission, complications, and mortality within 180 days of primary TSA, as well as other specific medical and surgical complications. Medicaid patients experience higher admission costs and longer hospital stays compared to those with other insurance types. Medicaid status is a risk factor for adverse clinical outcomes, and orthopedic surgeons need to consider the multitude of disparities that Medicaid patients experience when determining surgical options, treatment plans, and hospital disposition.

FP6.13 - A Quality improvement project to reduce the number of readmissions to surgical assessment unit (SAU) in East Sussex hospitals (ESHT) following laparoscopic cholecystectomy

Abstract Aim This is a QI project aiming to reduce the number of readmissions following laparoscopic cholecystectomy in ESHT from the current rate of 8.1% to the UK national average rate of 5%. This proposal followed an audit I conducted previously. About two-thirds of those readmissions occurred on day one following discharge, half of them due to pain, and almost 90% of them discharged without any intervention needing only reassurance, pain control, and analgesia. Methods Problem identified, SMART objectives followed, which means our intervention is: specific, measurable, achievable, relevant, and time specified. Set up a process map showing areas where intervention is desirable/beneficial. These include time allowed for consent, preoperative assessment clinic, and postoperative discharge information. Then a driver diagram is drawn to indicate the primary and secondary drivers we need to tackle in order to achieve our goal. In summary, the proposed changes include allowing more time in clinic for patients to explain procedure and consent, junior doctors and nurses’ education, resources, and provision of leaflets and websites for information. Identification of stakeholders including managers, anaesthetists’ nurses, and patients, and dealing with them according to their influence and interest. PDSA (plan do study and act) cycle, TQM (total quality management), SPC (statistical process control), and lean methodology were implemented. Conclusion This project is aimed primarily at reducing readmissions numbers to SAU following laparoscopic cholecystectomy from 8.1% to 5% within a year. Areas in the process map were identified to achieve this objective, and since about 90% of patients were discharged without any intervention, we believe this should be achievable.

SP6.11 - What the Doctor Said: Evaluation of Discharge Information to Inpatient Colorectal Patients

Abstract Aims To establish clarity of post operative information for patients for elective colorectal patients. To establish comprehensiveness of discharge information for elective colorectal patients. Methods 100 consecutive discharge summaries were collected from a busy elective colorectal unit. These were evaluated against NHS England’s discharge standards as well as a defunct local “After Care Advice’ form. Anonymous data were collated on Google Sheets and analysed. Results Patients had a median age of 68, with 54% being female. Operations ranged from EUA to exenteration with the most common operations being reversal of ileostomy (9%), laparoscopic right hemicolectomy (8%) and laparoscopic anterior resection (8%). The mode of length of stay was 9 days. Two patients were given the incorrect name of procedure on their discharge paperwork. 61% were not given details of investigations performed during admission with only 12% given details and timescales of tests to be performed on discharge. Follow up details were relayed to 77% on their discharge summaries. Of those that has wounds closed, 77% were not given details on how, with 97% receiving no wound care advice. Patients did not receive advice on return to activity (99%), bleeding (96%), anaesthetic limitations (100%) or driving (99%). Only 8% received information regarding VTE prophylaxis while 94% were not given infection advice. Despite these being colorectal operations, 94% did not receive any advice regarding bowel function or use of laxatives. Conclusions These results indicate that patients are not receiving adequate information regarding their time in hospital, their procedures or what to expect afterwards. This must improve.

Human echinococcosis incidence in Canada: A retrospective descriptive study using administrative hospital and ambulatory visit data, 2000-2020.

Echinococcosis is a zoonotic disease caused by the ingestion of tapeworm eggs shed by canids. The potential recent establishment of a more virulent European-type strain may be impacting human echinococcosis in Canada, yet information is limited. Administrative hospital and ambulatory visit data were used to provide a baseline of human echinococcosis cases in Canada between 2000-2020. Canadian Institute of Health Information's Discharge Abstract Database, Hospital Morbidity Database and National Ambulatory Care Reporting System were combined to identify cases. Risk ratios (RR) by demographic factors and cumulative incidences (CIN) over place and time were calculated. A total of 806 echinococcosis cases were identified in Canada between 2000-2020, for a mean annual CIN of 1.3 cases per million population. Over the two decades, the mean annual CIN of cases increased nationally (1.3-1.4 cases per million), in the Northwest Territories (6.3-9.1 cases per million), in Alberta (1.5-2.4 cases per million) and in the Atlantic provinces (0.2-0.6 cases per million). Those from the Territories had the highest risk of echinococcosis (RR 17.1; 95% confidence interval: 8.7-33.7). Though explanations are multifactorial, the new European-type strain may have a role in the small absolute increase in echinococcosis CIN in Canada observed over the study period. The CIN is likely underestimated and the validity of administrative data for analyzing zoonoses warrants investigation. Though this study contributes important awareness and a baseline, improved data are needed to clarify the effects of the new strain and inform public health response.

Preparation and Characterization of Prednisolone Containing Nanoparticles for Treatment of Colon Disorder

The point of flow research work is planning and portrayal of prednisolone containing nanoparticles by spray drying process using regular, semi engineered and manufactured polymers for treatment of colon problem. The pre-arranged Nanoparticles were assessed for Surface morphology, Medication entanglement effectiveness, differential filtering colorimetry, molecule size, Fourier change infrared spectroscopy, in-vitro drug release and X-beam diffraction studies. The pre-arranged Nanoparticles are smooth in surface and showing circular shape. The normal molecule sizes of the nanoparticles were tracked down in the scope of 523 nm to 901 nm. The medication exemplification effectiveness (EE) of the steroid containing nanoparticles were tracked down in the scope of 82.21%to 89.30%. Here the medication encapsulation efficiency of arranged nanoparticles were expanded with expansion in the fixation of the polymer. The X-beam diffractogram of drug has shown trademark serious top between the 2ө of 19.67 and 30 because of its translucent nature. Where as in the event of medication free Nanoparticles, no extreme pinnacles connected with drug. In drug stacked Nanoparticles peaks were saw between 2ө of 29.67 and 49. The in-vitro drug discharge information of the multitude of definitions were viewed as zero request and shown supported discharge over a time of 24hour.The FTIR Spectra of Nanoparticles detailing are contrasted and the spectra of unadulterated medication, there is no much deviation in the spectra's and not noticed any medication and polymer communications. The brief time frame dependability investigation of streamlined plan has done and exposed to sedate epitome effectiveness and In-vitro drug release studies, where results shown that there is no huge change in the detailing. Keywords: Polymer, Steroids, FTIR, X-Ray, Prednisolone.

The influence of written medication reminder on patient experience among older adult patients: a repeat cross-sectional study

BackgroundOlder adult patients are particularly vulnerable to medication-related issues during the discharge process. To enhance medication discharge education and patient experience, a written medication reminder, incorporating crucial medication side effects and warning signs, was implemented in medicine wards. This study aimed to examine the influence of this reminder on patient experience and medication-taking behaviors among older adults in public healthcare settings.MethodsTwo separate rounds of cross-sectional surveys were conducted before and after the program implementation among different discharged patients in each round. The study enrolled older adult patients aged ≥ 65 or their caregivers discharged from the medical wards of four pilot public hospitals in Hong Kong. A structured questionnaire was administered via telephone within 14 days of the patient’s discharge. The survey assessed patients' experience with the provided medication information during discharge, including the clarity, adequacy, and usefulness of the information, as well as their overall experience with inpatient services. The self-reported medication-taken behaviors, including adherence and side-effect encounters, were also measured.ResultsA total of 1,265 responses were collected before the implementation of the medication reminder, and 1,426 responses were obtained after the implementation. Pre/post-implementation survey comparison showed significant improvement in patient experience regarding the clarity of the provided medication information (7.93 ± 1.84 vs. 8.18 ± 1.69, P = 0.002), adequacy (7.92 ± 1.93 vs. 8.15 ± 1.76, P = 0.014), and usefulness (8.06 ± 1.80 vs. 8.26 ± 1.70, P = 0.017), significantly positive experience on the overall discharge information (β coefficient, 0.43 [95%CI, 0.30 to 0.56]) and inpatient service (β coefficient, 0.47 [95%CI, 0.32 to 0.61]). In addition, the side effects encounters were significantly lower in the post-implementation survey group (11.6% vs. 9.0%, P = 0.04) and no statistical difference was found in self-reported medication adherence between the two groups.ConclusionsThe provision of written medication reminders on key medication risks effectively improved older adult patients’ experience and reduced side effects without any unintended negative consequences. The findings can serve as a reference for similar settings seeking to enhance post-discharge care among older adult patients. Future studies could investigate the influence in other specialties and age groups and include clinical outcomes to test the program’s effectiveness.

Patient experience with hospital care following the Maryland global budget revenue model: A difference-in-difference analysis.

As a result of the success of Maryland's full risk capitated payment model experiment (Global Budget Revenue) in constraining healthcare costs, there is momentum for expanding the reach of such models. However, as these models are implemented, studies analyzing their long-term effects suggest unintended spillover effects that may ultimately influence patient experiences. The aim of this study was to determine whether implementation of the GBR was associated with changes in patient experience. Cross-sectional study using a difference-in-difference analysis to examine changes in patient experiences according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) domains before and after implementation of the GBR model. Acute care hospitals from 2010-2016 with completed HCAHPS surveys were included. Hospitals identified for inclusion were then matched, based on county location, to area level characteristics using the Area Health Resource File. A total of 844 hospitals were included. Compared to hospitals in non-GBR states, hospitals in GBR states experienced significant declines in the following HCAHPS domains: "would definitely recommend the hospital to others" [Average treatment effect (ATT) = -1.19, 95% CI = -1.97, -0.41)] and 9-10 rating of the hospital (ATT = -0.93, 95% CI = -1.71, -0.15). Results also showed significant increases in the HCAHPS domains: "if patient's rooms and bathroom were always kept clean" (ATT = 1.10, 95% CI = 0.20, 2.00). There were no significant differences in changes for the other domains, including no improvements in: nursing communication, doctor communication, help from hospital staff, pain control, communication on medicines, discharge information, and quietness of the patient environment. These findings suggest there should be efforts made to ascertain and mitigate potential adverse effects of care transformation initiatives on patient experience. Patients are stakeholders and their inputs should be sought and incorporated in care transformation efforts to ensure that these models align with improved patient experiences.

Assessing uncertainties of a remote sensing-based discharge reflectance model for applications to large rivers of the Congo Basin

ABSTRACT Adequate monitoring of river discharge is crucial for effective water resource management. However, this objective remains difficult to achieve in the context of large and ungauged river basins. This study assesses the performance of remote sensing applications for discharge monitoring in the lower reach of the Congo River, where daily discharge information is required to support many water resource operations. The approach is based on the use of Moderate Resolution Imaging Spectroradiometer (MODIS) remote sensing imagery to produce a daily time series of a ratio of reflectance values (C/M) for discharge monitoring. The validation of the approach is performed based on three-year water level data collected at the outlet gauging site and limited in situ Acoustic Doppler Current Profiler (ADCP) cross-section measurements for high and low flow seasons. The simulated discharge closely matches the observed values and falls within acceptable ranges, with errors below 10% and Nash-Sutcliffe coefficients ranging from 0.65 to 0.76 for ADCP and gauging station, respectively.

Nonresponse Bias on Inpatient Rehabilitation Hospitals’ Experience of Care Quality Measure Scores

ObjectiveTo describe the magnitude of nonresponse bias on inpatient rehabilitation facility (IRF) experience of care survey data in patients with neurologic disorders. DesignCohort study of patients at 2 IRFs. Patients reported experience of care via an IRF-administered survey as part of routine operations approximately 2 weeks after discharge. A partially overlapping sample of research participants completed a similar survey approximately 2 weeks and 30 days after discharge. SettingTwo inpatient rehabilitation facilities. ParticipantsPatients aged ≥18 years with neurologic disorders who were discharged from 2 IRFs. InterventionsNone. Main Outcome MeasuresExperience of care data collected via an IRF Survey (self-report or proxy responses) and a Research Survey (self-report only). ResultsOf the 1055 patients admitted during the study period who met the age and diagnosis criteria, 490 (46.4%) completed one or both of the surveys. Of the 325 IRF Survey respondents, 202 were self-report, 99 were proxy respondents, and 24 were unknown respondents. Only patients completed the Research Survey (N=285). One hundred twenty patients completed both surveys, of which 7 were proxy IRF Survey respondents. IRF Survey respondents had higher cognitive function than nonrespondents; patients with spinal cord injuries were more likely to complete the IRF Survey than other patients. There were no differences in the proportions of patients answering favorably on the IRF Survey (all respondents) compared with the Research Survey, except for physician communication and discharge information. Mutual information analysis revealed agreement between the scores produced by the 2 data sources. ConclusionsThere were subtle, potentially important differences in quality measure results across surveys, reflecting the extent to which patients are encouraged to complete experience of care surveys. There was higher agreement on questions about global hospital perceptions than specific aspects of patients’ experience.

The problem of unconscious and unidentified patients in emergency department admissions; a 3-year retrospective study.

Unidentified patients present a medical information dilemma for all medical departments but can be a major problem in Emergency Departments (EDs). This study aimed to determine the clinical and socio-demographic profile of 'unidentified' patients admitted to the ED with altered consciousness and to define the outcomes of these patients. All ED presentations were analyzed retrospectively for the unidentified patients brought to the hospital by ambulance with altered consciousness. We assessed demographic data, clinical presentation, discharge information, and major clinical outcomes. In this study, 1324 unidentified patients were admitted with altered consciousness to the ED. Of these, 1048 (80.1%) were foreign nationals. In this patient group, the most common diagnoses were; traffic accidents, assault or sharp object injuries, drug addicts, or syncope-epilepsy. In addition, the number of patients who left the hospital without permission or escaped and therefore could not be diagnosed was higher in the foreign nationalities group and constituted approximately one-fifth of the patients (18.9% vs. 5.4%, p:0.001). Of the unidentified patients, 903 (68.2%) were discharged after treatment. 351 (26.5%) patients left the ED unattended. 32 (2.4%) patients were hospitalized. 38 (2.9%) patients died in ED. The majority of the unidentified patients admitted to the ED with altered consciousness were immigrant males. Unidentified patients are a high-need population, most commonly presenting with substance misuse or trauma. Although most of the patients were seeking urgent treatment, more than one-fourth of the patients left the hospital without appropriate treatment and most of these patients were also immigrants. We believe that economic, linguistic, and social disadvantages played an important role in this outcome.

Seasonal Variations in Stroke Occurrence.

Understanding seasonal variations in stroke can help stakeholders identify underlying causes in seasonal trends, and tailor resources appropriately to times of highest needs. We sought to evaluate the seasonal occurrence of stroke and its subtypes. We conducted a retrospective cohort study using administrative data from January 1st, 2003, to December 31st, 2017, in Ontario, Canada's most populous province. We evaluated seasonal variations in stroke occurrence by subtype, via age/sex standardized rates and adjusted rate ratios using Poisson regressions. In those with stroke, we evaluated 30-day case fatality risks by season, adjusted for age, sex, stroke type, and comorbid conditions, and then used Cox proportional hazard models to estimate the effect of season on the fatality. The administrative data used in this study were from the Canadian Institute for Health Information's Discharge Abstract Database, the National Ambulatory Care Reporting System Database, the Ontario Registered Persons Database, and the 2006 and 2011 Canada Census and linked administrative databases. During our study period, we observed 394,145 strokes or TIA events, with a decrease in monthly hospitalization/emergency department visits per 100,000 people between January 2003 and December 2017 from 24.22 to 17.43. Compared to the summer, overall stroke occurrence was similar in the spring but slightly lower in the fall (adjusted rate ratio [aRR] 0.97, 95% confidence interval [CI] 0.96-0.98) and winter (aRR 0.94, 95% CI: 0.94-0.95). There were minor variations by stroke subtype. Winter was associated with the highest risk of stroke case fatality compared to the summer (12.4% vs. 11.4%, adjusted hazard ratio 1.10, 95% CI: 1.07-1.13). We found seasonal variations in stroke occurrence and case fatality, although the absolute differences were small. Further work is needed to better understand how environmental or meteorological factors might affect stroke risk.

Patient Satisfaction in Rural Versus Non‐Rural US Hospitals

ABSTRACTIntroductionAssessing patient satisfaction is an effective way to provide an evaluation of the quality of healthcare services. As a result, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Patient Survey was established as the first standardized national survey to publicly report patient ratings on hospital care. There remains a lack of research that examines rural–urban distinctions in patient satisfaction. The objective of this study was to investigate if there is a difference in hospital determinants of patient satisfaction among hospitals based on rural status.MethodsThe study utilized two public datasets containing HCAHPS survey results from 4714 US hospitals and from eligible cancer hospitals that participate in the Prospective Payment System‐Exempt Cancer Hospital Quality Reporting. The data were collected from July 1, 2021 to June 30, 2022 and published by Centers for Medicare &amp; Medicaid Services. Rural status of each hospital was determined by matching zip codes with data provided by the Health Resources &amp; Services Administration.ResultsA total of 3248 hospitals were included in the analysis, with approximately 51.14% located in rural areas. There was a significant difference across every hospital determinant when comparing rural and non‐rural status. Rural hospitals had a higher score for every hospital determinant (Cleanliness, Nurse communication, Doctor communication, Staff responsiveness, Communication about medicines, Discharge information, Care transition, Overall hospital rating, Quietness, and Willingness to recommend the hospital), indicating better performance.ConclusionRural hospitals demonstrated better HCAHPS performance across every hospital determinant in comparison to urban hospitals, suggesting possible recent improvements. Future research is necessary to investigate this trend and its consistency, which can inform targeted interventions to better address the healthcare needs of diverse populations in the United States.

Machine learning for parameters diagnosis of spark discharge by electro-acoustic signal

Discharge plasma parameter measurement is a key focus in low-temperature plasma research. Traditional diagnostics often require costly equipment, whereas electro-acoustic signals provide a rich, non-invasive, and less complex source of discharge information. This study harnesses machine learning to decode these signals. It establishes links between electro-acoustic signals and gas discharge parameters, such as power and distance, thus streamlining the prediction process. By building a spark discharge platform to collect electro-acoustic signals and implementing a series of acoustic signal processing techniques, the Mel-Frequency Cepstral Coefficients (MFCCs) of the acoustic signals are extracted to construct the predictors. Three machine learning models (Linear Regression, k-Nearest Neighbors, and Random Forest) are introduced and applied to the predictors to achieve real-time rapid diagnostic measurement of typical spark discharge power and discharge distance. All models display impressive performance in prediction precision and fitting abilities. Among them, the k-Nearest Neighbors model shows the best performance on discharge power prediction with the lowest mean square error (MSE = 0.00571) and the highest -squared value ( ). The experimental results show that the relationship between the electro-acoustic signal and the gas discharge power and distance can be effectively constructed based on the machine learning algorithm, which provides a new idea and basis for the online monitoring and real-time diagnosis of plasma parameters.

A Survey Study on Discharge Process of Critically Ill Patients: for Residents at a Tertiary Hospital in Korea

Purpose: The number of severely ill patients requiring post-acute care has been increasing. Careful discharge planning minimizes unplanned emergency room visits and readmissions. This study aimed to survey the knowledge, experience, confidence, and obstacles faced by medical residents and fellows regarding the discharge process of severely ill patients.Methods: A survey consisting of 27 questions was sent electronically to residents and fellows who had experience in discharging severely ill patients from a tertiary hospital in Korea. The survey was conducted over a two-week period from September 29, 2022.Results: A total of 98 residents and fellows responded to the survey. Of these, 94% experienced difficulties related to the discharge process. The main obstacle was changes in the patient’s condition during discharge planning (92.3%). Although 95% of the respondents acknowledged the need for providing discharge information, only 53.1% of the residents and fellows practiced this. Only 42.9% of the respondents and 20.4% of residents and fellows explained local community healthcare and welfare resources to patients because of a lack of relevant knowledge (69.7%) and feeling no responsibility to explain (40.4%).Conclusion: This study revealed that residents and fellows experienced difficulties in devising discharge plans and providing post-acute care related information, despite recognizing the importance of these. These gaps result from the lack of a discharge planning curriculum regarding critically ill patients and appropriate training in the discharge process. This suggests that an integrated discharge planning curriculum should be developed and adopted in residents’ training programs for the differentiated treatment of critically ill patients.

A potential optical approach for diagnosis of the local magnetic field near the surface of the first wall/divertor tiles by Zeeman effect using polarization-resolved laser-induced breakdown spectroscopy

Magnetic field measurement is the basic diagnosis to obtain the physical engineering parameters of magnetic confinement fusion device and the macro information of plasma discharge. The real-time diagnosis of magnetic field distribution near the plasma-facing components (PFCs) surface provides the important information on the migration and transport model of key elements. In this work, a remote, in-situ approach for the magnetic field measurement near the surface of PFCs by the polarization-resolved laser-induced breakdown spectroscopy (LIBS) based on Zeeman effect is proposed and implemented. The Zeeman characteristics of the emission spectra of laser-induced W, Mo and C plasmas were verified in the laboratory by using different magnetic field configurations. According to the polarization characteristics of the Zeeman sublines of the LIBS spectrum, the intensity and direction of the external local magnetic field were successively identified by using a linear polarizer. Subsequently, a linear array fiber was utilized to determine the polarity of the external magnetic field. And finally, the magnetic field intensity near the lower edge surface of the tungsten baffle of the Experimental Advanced Superconducting Tokamak (EAST) upper divertor was measured when the field coils were demagnetized. This method can supplement the experimental data near the PFCs for the magnetic field configuration of the magnetic confinement fusion device and provide a reference for the wall element analysis model diagnosed by LIBS.

Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland

ObjectiveRecovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe...