Visit Duration Research Articles

Urban park green space use analysis based on trajectory big data: Experience from a medium–sized city in China

Regular visits to park green space offer remarkable benefits for the physical and mental health of urban residents. Achieving a comprehensive understanding of the utilization across the entire city is a prerequisite for improving the overall utilization rate of park green spaces. Traditional social survey methods are limited by their sample size and time-consuming nature, while methods based on geographic location big data are gaining momentum. This study focuses on Xuchang, a medium-sized city in China, and systematically analyzes the current state and influencing factors of park green space utilization by mining GPS trajectory big data from April 3 to 12, 2022. Results indicate that residents' choices of park green spaces are highly diverse. Approximately 20% of visitors on holidays and weekends, and about 25% of visitors on weekdays, prefer the park green space closest to their homes. Notably, the distance threshold for park green space visits on weekdays, weekends, and holidays is 3633, 3824, and 4127 m, respectively. These distances are significantly higher than the several hundred meters specified in planning documents or commonly used in accessibility analyses. For individuals who frequently visit park green spaces, distance is the most critical influencing factor. Conversely, for those who occasionally visit, distance is not the primary consideration. For individuals who rarely or never visit park green spaces, personal attitudes play an essential role. In comparison to weekdays, the number of visitors on holidays and weekends is larger, the travel distance is longer, and they are more inclined to choose larger parks. Visits are concentrated in the afternoon and evening, and weather changes remarkably affect park green space utilization. Importantly, no compensatory effect is observed between the frequency and duration of park green space visits. These findings hold important implications for urban planning, management, and the promotion of park green space utilization.

Better Communication for Better Management of Persons with Hemophilia: Results from a Patients'-Clinicians' Project to Address the New Therapeutic Landscape.

Applying the Delphi method, this study aims at characterizing the perceptions and needs of physicians, individuals with hemophilia, and their caregivers in relation to the management of routine visits during regular follow-ups. A single structured questionnaire, prepared by an advisory board, was administered to 139 participants, comprising hemophilia treaters, patients and caregivers, during the period from May to June 2023. Agreement (defined following the Delphi method as developed by RAND Corporation) was reached on several topics. The Principal Component Analysis methods identified the four most relevant areas where consensus was reached among the interviewees, underscoring the necessity for in-depth discussions during routine visits: (1) medical aspects related to symptoms, life-limitations, pain, etc.; (2) non-medical related aspects (ambitions, lifestyle, network, etc.); (3) logistical-organizational aspects (home-hospital distance, alternative modalities of communication); and (4) visit duration and telemedicine integration. The results of both the Delphi and Principal Component Analysis underline that the care of individuals with hemophilia extends beyond merely prescribing drugs or treatment regimens. Instead, it necessitates consideration of numerous variables from both therapeutic and non-therapeutic domains, all of which are deemed important for the holistic management of the individuals. As a result, these aspects are routinely discussed and addressed during visits.

Recommendations on visit duration and sample number requirements for an automated head chamber system.

Automated head chamber systems (AHCS; GreenFeed, C-Lock Inc., Rapid City, SD) increasingly are being used for measuring the gas flux of unrestrained cattle. There are a wide range of recommendations for what constitutes a "good" visit (i.e., duration) to an AHCS and how many visits are required for the AHCS to quantify gas fluxes accurately and precisely. Accordingly, the purpose of this experiment was to investigate the effects of visit duration thresholds and the subsequent effects of these thresholds on the number of visits needed to provide adequate estimates of carbon dioxide (CO2) and methane (CH4) emissions, and oxygen (O2) consumption by beef cattle. This analysis utilized data from three previously published experiments with grazing beef steers and one experiment with finishing beef steers, with 103 steers total. When comparing all available visits, there was excellent agreement [Lin's concordance correlation coefficient (CCC) ≥ 0.96] between visits ≥ 3min in duration and those ≥ 2min for the three gases in all four experiments. When data from all four experiments were pooled, there was excellent agreement between visits ≥ 3min and those ≥ 2min and ≥ 1min for all gases (CCC ≥ 0.96). These results suggest that estimates from visits ≥ 2min are like those from visits ≥ 3min. Next, we investigated if including visits ≥ 2min or ≥ 1min would increase the minimal number of visits required to provide excellent agreement with the "gold-standard" (mean of all visits ≥ 3min). For this, we used only one of the experiments and randomly selected visits per animal ranging from n = 5 to 60, in increments of 5. The sole experiment was used because all animals had more than 60 visits. We then assessed the agreement between the "gold-standard" (mean of all visits ≥ 3min [144 ± 55.01 visits per steer]) estimates of CO2, O2, and CH4. The minimum number of visits required to achieve excellent agreement (CCC ≥ 0.90) to the "gold-standard" estimate for all gases was 30 visits ≥ 3min in duration, or 40 visits ≥ 2min in duration. Visits ≥ 1min in duration did not achieve excellent agreement, even when 60 were used. Based on these results, we recommend excluding visits < 3min in duration with 30 minimum visit records per animal. However, if researchers choose to implement a 2-min visit duration threshold then 40 visit records are needed per animal.

The Influence of Demographic Factors on Tourist Experiences at Sikkim Buddhist Monasteries

This paper provides an analysis of tourists’ experience based on their demography. Sikkim is known to be a Buddhist state has incorporated religious sites in tourism. The monasteries in the state have not only attracted domestic tourists but international tourists as well. Tourists who visit solely for the purpose of religion mostly follow the Vajrayana sect of Buddhism. This study focuses on the aspect of religious tourism in the State of Sikkim. It takes into account the demography of the tourists and their effect on experience in monasteries situated within Sikkim. The demographic variable of tourists was categorized into gender, age, marital status, monthly income, educational qualification, occupation, and Sikkim monasteries profile of the tourists were the type of tour, Motivation for visiting religious sites, participation in or performed rituals in religious ceremony, accommodation of stay, duration of visit, means of bookings, monasteries visited while in Sikkim, means of information and recommendation of the site to others. Data was collected through primary and secondary sources. Data were collected from respondents through interviews and questionnaires based on the nominal scale. A total of 200 samples were gathered from diverse tourists visiting six of the Buddhist monasteries in Sikkim (Rumtek, Tashiding, Sangachoeling, Chorten, Pemayangtse and Dubdi monastery) utilizing the convenience sampling method. The collected questionnaires were analyzed with the application of independent sample T-test and one-way ANOVA. This study concluded that the demography of the tourists is essential in segregating and assessing what tourists expect from their visits to these monasteries. The study provides an overview of tourists visiting Sikkim religious sites, revealing diverse demography and motivations for tourists to visit monasteries. Hence, identifying the demography of the tourists needs to be given equal importance to enhance the future tourist experience.

Propensity Score Matching Analysis of the Influence of Waiting Time Satisfaction on Community Resident's Satisfaction With Medical Institutions: An Extensive Survey of Outpatient Population in Shantou City of Southern China.

This study was designed to perform a nuanced analysis of the multifaceted association between community residents' satisfaction and their perceived satisfaction concerning the visit duration at medical facilities, that could be harnessed to enhance and streamline the process of hierarchical diagnosis and treatment, thereby augmenting healthcare outcomes and patient experiences. Respondents who had utilized services from medical institutions were invited to fill out questionnaires by scanning QR codes. Additionally, surveys also distributed questionnaires through WeChat groups of community residents in densely populated areas of the community, as well as WeChat groups for patients who had previously visited local hospitals. To balance differences between groups, propensity score matching was applied to analyze the contrast between residents satisfied and dissatisfied with their medical visits. After eliminating the interference of confounding factors, a comparative analysis was conducted on the relationship between resident satisfaction and medical institution experience.After eliminating the interference of confounding factors, a comparative analysis was conducted to delve deeply into the relationship between residents' satisfaction and their experiences at medical facilities. The study incorporated a large dataset encompassing 2356 community residents. Upon successful propensity score matching, logistic regression analysis elucidated several determinants of overall resident satisfaction. Notably, the grade of the medical institution (χ2 = 8.226, P < .05), satisfaction with the time invested in the registration process (χ2 = 11.04, P < .05), satisfaction with the waiting duration for consultation (χ2 = 15.759, P < .05), and satisfaction with the travel time to the hospital (χ2 = 45.157, P < .05) each exerted significant influence on the holistic satisfaction of residents with their medical experience. Factors such as the grade of the medical institution, satisfaction related to registration and waiting durations, and travel time to the hospital emerged as crucial determinants shaping community residents' holistic satisfaction with their medical encounters. These findings underscore the exigency for strategic allocation and optimization of medical resources, refinement of the classification system, and enhancement of public health education on the graded diagnosis and treatment schema. The study also demonstrates the value of employing advanced propensity score matching and predictive modelling techniques in health services research.

Health Coaching: America's Overlooked Personalized Health Solution

Chronic diseases are on the rise in the United States, particularly in rural and underserved areas, and they are often caused by preventable factors, accounting for a significant portion of healthcare costs. The short duration of routine medical visits does not give clinicians enough time to adequately address and support changes in patients' behavior that are required to improve health outcomes. Health coaching, which focuses on holistic behavior modification, shows potential in preventing and controlling chronic diseases through individualized assistance and accountability. Motivational interviewing and continual patient involvement are critical components of health coaching, and they have proven to be highly beneficial. Despite the established success of existing programs, a more comprehensive implementation tailored to individual requirements is required. Health coaching is an underutilized but intriguing method for healthcare providers to address patient health concerns proactively and directly at the cause. This strategy focuses on those who neglect their health owing to stated time restrictions, financial worries, or a lack of health education, resulting in delayed treatment and the onset of preventable chronic disease. The adaptable design, as well as a combination of medical experts and volunteers, offers exciting possibilities for urban, suburban, and rural locations alike, and may be the answer to a long-standing problem to personalized medicine in a highly diverse healthcare environment.

Clinical characteristics and healthcare utilisation associated with undiagnosed cognitive impairment in elderly patients with diabetes in a primary care setting: a population-based cohort study

ObjectivesThe objective of this study is to report the prevalence, clinical characteristics and healthcare utilisation of patients with type 2 diabetes (T2DM) and previously undiagnosed cognitive impairment who were identified...

Research of Ukraine’s Tourism Image – Based on Data Analysis of The Travel Notes of the Chinese TourismResearch of Ukraine’s Tourism Image – Based on Data Analysis of The Travel Notes of the Chinese Tourism Website Mafengwo

Since the implementation of the visa-on-arrival policy for Chinese citizens in 2016, the number of Chinese tourists visiting Ukraine has significantly increased. The main purpose of the article is to determine the main characteristics of Ukrainian tourist destinations based on the analysis of travel notes of tourists to Mafengwo from the period 1992 to 2023, as well as to find out the general views of Chinese tourists on food, accommodation, tourism and shopping in Ukraine, using the method of frequency analysis of words to summarize the specific ideas of Chinese tourists about Ukraine. The article employs a combination of literature review, text analysis, and word frequency analysis. The Word frequency analysis complements content analysis by quantifying the prevalence of specific terms in the travel notes of Chinese tourists visiting Ukraine, focusing on the tokenized analysis of these notes. The findings succinctly capture Chinese tourists' perceptions of Ukraine, revealing concerns for safety issues, as evidenced by the frequent mention of "war". The analysis shows a preference for traveling in groups, with an average expenditure of approximately $1,600 per person and a typical visit duration not exceeding 10 days. The overall sentiment towards travel experiences in Ukraine is positive, with words like "cheap" "delicious" and "like" frequently used, indicating an appreciation for the affordability and quality of food. Chinese tourists favor a mix of historical, cultural, and seaside destinations, reflecting diverse interests. However, communication barriers emerge as a complaint among these travelers.

An unintended consequence of COVID-19 immunity passports-quasi-experimental evidence of moral hazard observed after implementing the domestic Green Pass policy during the second wave of the COVID-19 pandemic in Italy.

Amidst the second wave of the COVID-19 pandemic, Italian policymakers mandated to exhibit evidence of vaccination or immunity (the Green Pass) as a condition to access retail premises and public offices. This study aims to offer evidence, in a quasi-experimental setting, suggesting that an unintended consequence of this policy was the emergence of moral hazard. Google visit duration data measured the time customers typically spend on retail premises or public offices. A pairwise comparison of median visit time per premise was performed at a six-week interval before and after the introduction of the Green Pass. This study is the first to provide evidence of "ex-post" moral hazard associated with introducing a domestic Green Pass policy. The median visiting time on premises that required digital immunity control significantly increased after introducing the domestic Green Pass policy, contrary to other public premises where access remained free of limitations. The increase in median visit time in premises with faster customer turnaround, such as coffee shops (+49%) and fast-food restaurants (+45%), was lower than the increase observed for fine-dining restaurants (+74%) and pizzerias (+163%). No significant increase in median visit time was observed in premises where the Green Pass was not required, such as food supermarkets, retail non-food shops, post offices, banks, pharmacies, and gas stations. The evidence of moral hazard highlights the critical issue of unintended consequences stemming from public health policies. This discovery is pivotal for policymakers, indicating that unforeseen behavioral adjustments could offset the intended benefits despite the intent to reduce risk through measures like the Green Pass.

THE GEOSTATISTICAL DIMENSION OF TOURIST FLOWS GENERATED BY FOREIGN TOURISTS IN ROMANIA

The article represents a comprehensive and insightful study aiming to unravel the intricate dynamics of foreign tourism within Romania. This research delves into various key aspects, employing a geostatistical approach to offer a nuanced understanding of the spatial and temporal dimensions of foreign tourist flows. One of the primary inquiries addressed by the study revolves around the quantitative assessment of foreign tourists visiting Romania. By meticulously analyzing arrival data, the research seeks to provide a comprehensive overview of the sheer number of foreign visitors the country attracts. This quantitative dimension is crucial for assessing the overall impact of tourism on the national economy and informing strategic decisions in the tourism sector. Moving beyond mere numbers, the study ventures into the temporal aspect of foreign tourism in Romania. By scrutinizing patterns over time, researchers aim to answer the question of when foreign tourists predominantly choose to visit the country. Understanding the temporal preferences of tourists is invaluable for both businesses and policymakers, enabling them to optimize resource allocation, marketing efforts, and infrastructure management during peak tourism seasons. Furthermore, the research explores the destinations chosen by foreign tourists within Romania. The geostatistical analysis differentiates arrivals based on specific tourist destinations and counties, shedding light on the preferences of international visitors. This information is pivotal for local authorities, businesses, and stakeholders, offering insights into which regions benefit the most from foreign tourism, thus facilitating targeted development strategies and resource allocation. In addition to destination preferences, the study investigates the accommodation choices made by foreign tourists. Through geostatistical analysis, the research categorizes accommodation preferences based on various criteria, including types of accommodation units and comfort categories. This information proves invaluable for the hospitality industry, guiding investments, and helping businesses tailor their offerings to meet the diverse needs of international visitors. The temporal aspect of foreign tourists' stays in Romania is another focal point of the study. By examining the duration of visits, researchers aim to provide a comprehensive understanding of how long foreign tourists typically stay in the country. This data is instrumental in shaping tourism policies, influencing marketing strategies, and optimizing services to enhance the overall tourist experience. Beyond the borders of Romania, the study investigates the means of transportation foreign tourists employ to reach the country. By understanding the modes of transportation preferred by international visitors, Romania can improve its infrastructure and connectivity, ensuring a seamless and positive experience for tourists from various origins. Lastly, the research explores the geographical origins of foreign tourists who visit Romania. This analysis not only provides insights into the diverse cultural backgrounds of visitors but also aids in crafting targeted marketing campaigns to attract specific international markets. The article goes beyond a mere exploration of tourist numbers. It offers a comprehensive and detailed analysis of the spatial and temporal dimensions of foreign tourism, providing valuable insights for policymakers, businesses, and stakeholders. This geostatistical approach not only enriches our understanding of the complex dynamics of foreign tourist flows but also lays the foundation for strategic and sustainable tourism development in Romania.

Exploring the Relationship Between Coffee Shop Visitors' Coping Strategies and Well-Being

This article investigates the relationship between coping strategies and the well-being of coffee shop visitors. Coffee shops serve as more than just places to get coffee; they provide individuals with a space to unwind, socialize, and cope with stress. Using a mixed-methods approach, including quantitative surveys and qualitative interviews, this study explores the experiences of visitors from different age groups in three coffee shops. The findings reveal that sensory engagement, visit duration, and the overall ambiance of coffee shops significantly contribute to emotional relaxation and well-being. Coffee shop owners can leverage these findings to create supportive environments that promote positive coping strategies and enhance the well-being of their customers. Further research is needed to validate these findings in different contexts and examine the long-term effects of coping strategies in coffee shop settings. Understanding the connection between coping strategies and well-being in coffee shop environments has implications for mental health promotion and the development of supportive spaces for individuals to cope with daily pressures.

Using free Wi-Fi to assess impact of COVID-19 pandemic on traditional wet markets in Hanoi

Traditional wet markets are the main source of fresh food and the largest source of daily nutrient intake for citizens of Hanoi. Nevertheless, due to the lack of traceability and sales registration systems, food flows within these markets remain largely invisible. This makes it challenging to assess the impact of shocks, such as pandemics, on these markets. In this paper, we characterize the impact of COVID-19 by analyzing data from 25 Wi-Fi access points installed in five formally established wet markets. The study timeframe covers a pre-pandemic period from July 2019 to the end of the initial stage of the pandemic in November 2020. While providing free Internet access, data were continuously collected about devices in close vicinity to the access points. Based on this information, we tested five hypotheses about the number, frequency, time, and duration of visits to the markets as well as changes in inter-market activities. The results show that during the shock (February to mid-April 2020) and aftershock (mid-April to July 2020) periods, market actors significantly decreased the total number of market visits (-26% P < 0.001) and the frequency of market visits (up to -47% for very frequent market users, P < 0.001). The number of inter-market visits dropped sharply during the shock period (66% ±\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\pm$$\\end{document} 17% of the baseline level, P < 0.001), and the peak time for market shopping shifted significantly by 90 min later in the day, P < 0.001. No change was observed in visit duration. Several factors identified in existing literature as affecting consumer behaviors provide possible explanations for the changes observed. We present a set of recommendations to limit the negative impact of the pandemic in terms of food security and livelihoods in Hanoi and to mitigate consumers’ negative perception of wet markets in terms of food safety.

Exploring the impact of cultural context on eye-tracking studies of architectural monuments in selected European cities: Sustainable heritage management

Sustainable management of architectural heritage requires conducting an inclusive diagnosis of users' opinions, considering both residents and tourists as the recipients of urban space. Given the cultural diversity within these groups, proposing the use of eye-trackers (ET) as an alternative to traditional public consultation prompts the need to assess the method's advantages and disadvantages. It remains uncertain whether individuals from different countries look at historical architecture and its transformations similarly. The uniqueness of this subject matter prevents drawing parallels from experiences in other domains. Moreover, prior research provides conflicting conclusions and may include methodological errors. This uncertainty impedes the adoption of ET as an administrative and legal tool. To address this gap, 320 volunteers, encompassing both Poles and foreigners, were invited. Qualification involved optometric tests and questionnaires. Subsequently, a portion of the participants underwent the experiment using ET while viewing visual stimuli on a monitor. The experiment featured twelve monuments, with six originating from Wrocław and six from another major European city (Paris, Rome, London, Berlin, Dresden, Dortmund). The study focused on the nature and pattern of fixations made on original photographs and their modified versions. Analyzing the collected ET data for 24 stimuli, two primary aspects were explored. First, whether both groups, irrespective of their familiarity with the object or the city of residence, looked at the original photographs in the same manner. Second, it was investigated whether participants cultural background significantly influenced observers' reactions to visual changes in the buildings. Only 8 out of 160 comparisons demonstrated statistically significant deviations. Other results, including visitor numbers, fixation counts, average fixation duration, total visit duration, and time to first fixation, exhibited similarity across the board.

A CHECKLIST-BASED INTERVENTION TO SUPPORT FAMILY CAREGIVERS IN PRIMARY CARE

Abstract Family caregivers commonly accompany older adults to their routine medical visits, but caregivers’ own needs and concerns are not systematically identified or addressed in clinical practice. Collaborative Healthcare Encounters with Caregivers (CHEC) is a checklist-based intervention that uses a prioritization approach to help caregivers efficiently identify and communicate their most salient concerns to primary care providers. This presentation will report findings from a pilot randomized controlled trial of N=37 patient-caregiver dyads who were randomized to CHEC (N=21) or usual care (n=16). The goals of the pilot trial were to evaluate CHEC’s impact on medical visit duration and communication (using time-stamped audio-recordings and a structured coding system) and caregivers’ perceptions of CHEC’s utility (using questionnaires and interviews). Total visit duration was comparable across treatment groups (CHEC: 29.3 minutes vs. UC: 32.8 minutes; p=0.55), but a greater proportion of the visit time was spent addressing caregivers’ concerns among CHEC group participants, as compared to usual care participants (25% vs. 6%; p&amp;lt;.001). In post-visit interviews, caregivers commented that CHEC was useful in helping them to prepare for the visit by thinking about their questions in advance and prompting providers to acknowledge their concerns. Findings from this study explicitly address the RAISE Act’s recommendation for integrating evidence-based caregiver assessment instruments into clinical care delivery (Outcome 2.2) and indicate CHEC’s potential as an efficient, clinically feasible intervention that can support greater inclusion of caregivers in primary care discussions.

The Effectiveness of Internet Advertising on Consumer Behavior: A Case Study Analysis of College Students in Changsha (Hunan)

Advertisement is an important tool of businessmen, producers and sellers, which is used in variety of ways to attract consumer’s attention towards the product. This study tries to explore the specific effect of on-line advertisement on consumer behaviour by making a case study of college students in Changsha (Hunan). The study applied mix method approach for collection of data and observations on consumer behaviour and advertisement. A total of 661 students were interviewed by using structured questionnaire and more than 14 students were taken for in-depth interviews, case studies and moreover two focus group studies were conducted in the university. The findings indicate that there's a strong positive association between on-line advertisement and consumer behaviour. The factors such as ads compositions, ad recall, duration of page visit and ad content were the primary determinants influencing consumer preference for on-line advertisement. The results of focus group discussions and case studies revealed that individuals were more inclined to those ads and products which include their favourite celebrity and an amazing story that impress the viewer and made his/her preference towards the advertisement. On the basis of results, the study suggested that ads should be short, conclusive and has a short amazing story and a celebrity to attract more consumers’ attention to the product.

Tourist Preferences for Revitalizing Wellness Products and Reversing Depopulation in Rural Destinations

Wellness tourism is a growing segment that destinations can rely on to increase tourism flows and revive underdeveloped rural areas. This study elicits tourists’ preferences for wellness tourism products and the redevelopment of a wellness destination in a depopulated rural area. The research included 595 participants in Central Greece using on-site, face-to-face surveys. The survey data were analyzed using a two-step process. First, conjoint analysis was applied to determine the combination of wellness tourism product attributes that maximize visitors’ utility. In the second step, we elicited visitors’ willingness to pay (WTP) for improvements in tourism product attributes using the contingent valuation method. The findings indicate that the combination of attributes that maximizes the preference structure of respondents includes time of visit from September to October, duration of visit from 1 to 7 days, wellness tourism as the primary purpose of the visit, and wellness activities that contain both physical activities and training as well as spiritual and emotional enhancement. Using binary logistic regression, the analysis indicates that respondents are willing to pay EUR 47.33 per visit on average further to develop wellness tourism products in the study area. Empirical results confirmed that sustainability issues, quality, and entrepreneurship factors positively impact visitors’ WTP for revitalizing wellness products. In contrast, a longer duration of stay in the area and respondents’ age negatively impact their WTP. These findings suggest that structuring a customer-driven tourism product will enhance the rural destination’s efforts to attract high-yield visitors and advance the rural economy. Furthermore, practical implications reveal that Destination Management Organizations will benefit from research results to foster targeted management plans.

Using “Appointment Tickets” to Track Visit Duration as a Quality Improvement Initiative After Incorporating Laser Epilation in a Pilonidal Care Clinic

BackgroundLaser epilation (LE) is effective in decreasing pilonidal disease (PD) recurrence, but laser use has not been a standard practice in pediatric surgery clinic. We hypothesized that “appointment tickets” can 1) track utilization and clinic visit delays, 2) inform patients of their clinic progress in real time. MethodsAn observation study was performed on LE patients treated at our PD clinic 3/2021-7/2022. Two exam rooms were utilized for manual shaving and one for LE. After gluteal cleft hair shaving, various anesthetic (topical lidocaine, ice, or cryotherapy) was applied prior/during LE. At each visit, patient received an “appointment ticket” on which providers recorded the visit start/end time, manual shaving duration, local anesthetic application/wait time, LE duration. Visits were scheduled for 20 min-slots. Clinic staff recorded any delays (>20 min). Results1317 visits were recorded. Mean number of visits per week was 18 ± 6. Mean total visit length was 60 ± 22 min, mean shaving time 15 ± 11 min, mean anesthetic application/wait time 16 ± 11 min, mean LE time 14 ± 9 min. Over the study period, average visit length has decreased, and average visits/clinic day has increased. Most delays occurred in months April, May, October–December. Delays due to patient late arrival occurred in May, July, and August of 2021, none in 2022. ConclusionsLE visits have multiple components that required close coordination to ensure no clinic delays. Clinic delays spiked prior to summer and winter holidays. “Appointment tickets” provided patients with real-time visit progress tracked clinic utilization to improve the quality of pilonidal care delivery. Level of evidenceLevel IV.

Evaluation of Medication Errors by Prescription Audit at a Tertiary Care Teaching Hospital

Objectives The prescription errors and prescribing fault analysis was assessed, the rationality of the prescriptions was checked, and the medication error was categorized according to the NCC MERP Index. Materials and Methods A cross-sectional, observational study was designed as per STROBE guidelines and conducted for 2 months in the pharmacy stores after approval of the Institutional Review Board. Patients’ written informed consent was taken before getting their prescriptions, and each of the prescriptions procured in this way was photographed for record. The completeness of 320 prescriptions of outpatients of all age groups regarding the details about the doctor and the patient and clinical diagnosis/indication was analyzed. The rationality of prescription was based on WHO core drug use indicators. Descriptive analysis was done by using Microsoft Excel. Results A total of 320 prescriptions were analyzed from eight departments. Information about patients and prescribers was mentioned in 100% of prescriptions. The diagnosis (40%), an indication was written in 195 prescriptions. Instructions for dispensing drugs (89%), instructions to patients (90%), duration of treatment (100%), follow-up visits (19%), and non-pharmacological instructions (13%) were mentioned. In total, 82% of prescriptions were legible. In a total of 1004 drugs, 92% of drugs were prescribed with a generic name, 100% from the essential drug list. The route and frequency of drug administration were mentioned for all drugs. According to NCCMERP, the category of medication errors falls under category B. Conclusion To reduce medication errors, we can implement an electronic system, involve clinical pharmacologists, utilize prescription charts, and organize nationwide workshops on rational prescription writing. We should encourage regular prescription audits and reporting to improve the healthcare system in the country.

Importance of early weight loss and other predictors of lower weight loss in a commercial program: A secondary data analysis.

There is substantial inter-individual variability in response to weight loss interventions and emerging evidence suggests that weight loss during the early weeks of an intervention may be predictive of longer-term weight loss. This secondary analysis of data from a commercial program therefore examined 1) the associations between early weight loss (i.e., week 4) with final visit weight loss and duration on the program, and 2) other predictors of lower weight loss at final visit. Client charts of adults with overweight or obesity (N=748) were analyzed. Clients were stratified into categories of weight loss at the week 4 (< and ≥2%, 3% and 4%) and final visits (< and ≥5% and 10%). Multivariate logistic regression was used to assess predictors of <5% and <10% final visit weight loss. The odds ratios for losing <5% or <10% of weight at the final visit were higher (49.0 (95% CI: 13.84, 173.63) and 20.1 (95% CI: 6.96, 58.06)) for clients who lost <2% or <3% compared to those who lost ≥2% or ≥3% at week 4. Other predictors of not losing a clinically relevant amount of weight included female sex, use of higher calorie meal plans and shorter time in the program, among others. Those who lost ≥2% at week 4 also had a significantly greater percent program completion (109.2±75.2% vs. 82.3±82.4, p<0.01) compared with those who did not meet the 2% threshold. Lower 4-week weight loss was identified as a strong predictor of not losing a clinically relevant amount of weight. These results may be useful for the early identification of individuals who can be targeted for additional counseling and support to aid in attaining weight loss goals.

Differing Definitions of Vaso-Occlusion in Clinical Studies of Sickle Cell Disease Can Result in Differing Outcomes

Background: Frequent episodes of vaso-occlusion are the hallmark of sickle cell disease (SCD), but the definition of what constitutes a vaso-occlusive episode is not consistently applied across clinical trials, creating challenges in evaluating and comparing efficacy results among different therapies. Here, we compare vaso-occlusion endpoint definitions from clinical trials for various therapies, including genetic therapies, and use clinical trial data to demonstrate the potential for outcomes differences based on differing definitions of vaso-occlusive episodes. Methods: We reviewed completed and ongoing clinical trials and published articles using endpoints assessing the reduction or elimination of vaso-occlusive crisis/events, including trials of (i) exagamglogene autotemcel (exa-cel, CRISPR/Cas-9 based genome editing treatment), (ii) lovotibeglogene autotemcel (lovo-cel, gene addition therapy), (iii) L-glutamine, (iv) voxelotor, (v) hydroxyurea (HU) and (vi) crizanlizumab. Outcomes related to vaso-occlusion were compared across variables including care setting, care duration, treatments, and complications. Data from the CLIMB SCD-121 trial of exa-cel in patients aged 12 to 35 years with severe SCD (data cut as of 10 Feb 2023) were evaluated using different published definitions of vaso-occlusion. Results: The most substantial differences in vaso-occlusion endpoint definitions were associated with frequency and duration of visits to medical facilities for acute pain and inclusion of specific SCD specific complications. Definitions of vaso-occlusions for acute pain related events differed across studies. The definitions of severe vaso-occlusive crises for exa-cel (severe VOC; exa-cel), sickle cell pain-related crises (SCPC; crizanlizumab and L-glutamine), and VOC (VOC; voxelotor) include events with medical facility visits of any duration (severe VOC and SCPC) or medical records of a patient being seen or contacting a physician within 1 business day of an event (VOC), whereas the definition of severe vaso-occlusive events (severe VOE; lovo-cel) requires a ≥ 24-hour hospital or emergency room (ER) observation unit visit or ≥2 visits to a day unit or ER over 72 hours. Vaso-occlusion definition for HU (painful crisis) required a facility visit of ≥4 hours duration. All endpoints include acute chest syndrome and priapism; however, the definition of severe VOE requires ≥4 visits to a medical facility for priapism to meet criterion, while others require only a single visit. The exa-cel phase 3 trial in SCD employs a broad and inclusive definition for severe VOC which counts each individual medical facility visit, regardless of frequency or duration of hospitalization. Based on this, 19 out of 20 patients (95%) met the primary endpoint of freedom from severe VOCs for at least 12 consecutive months (95% CI, 75.1%, 99.9%; P&amp;lt;0.0001). However, when the primary endpoint was analyzed using the severe VOE definition, all patients (20/20; 100.0%) were free from severe VOEs for at least 12 consecutive months (95% CI: 83.2%, 100.0%; P&amp;lt;0.0001). Conclusions: Requirements for health care facility visits in the definitions of severe VOC (exa-cel), VOC, and SCPC were more broadly inclusive and include events that would not be counted in the definitions of severe VOE (lovo-cel) or painful crisis. Clinically, support for this observation comes from our analysis of exa-cel SCD pivotal clinical trial data using these different definitions, which showed the number of patients free from vaso-occlusive episodes changed depending on the definition of vaso-occlusion employed. These results show differences in vaso-occlusion definitions have the potential to impact assessments of treatment efficacy across different SCD therapies.