Return Visit Research Articles

Agritourism: The Role of Farm-to-Table in Promoting Local Cuisine and Return Visits

This exploration probes into the captivating effect of agritourism, anchored in farm-to-table traditions, on the enrichment of local culinary adventures and the allure for patrons to return, employing Self-Determination Theory to scrutinize visitor interactions. The primary goal is to investigate the intricate dance between perceived autonomy, competence, and connectedness, and how they shape perceived authenticity and the tendency for return visits, highlighting the pivotal influence of perceived cost. Information was gathered via a survey involving 354 individuals, and the connections were explored through Partial Least Squares Structural Equation Modeling (PLS-SEM). Results reveal that the perception of competence exerts the most significant positive influence on the sense of authenticity and the likelihood of return visits. Nonetheless, the dynamic interaction between perceived financial burden and authenticity revealed a negative correlation with subsequent visits, indicating that increased expenditures may diminish the advantageous effects of genuine experiences. This research emphasizes the importance of aligning authentic experiences with economic viability in the realm of agritourism. Ventures, offering valuable perspectives for operators to elevate visitor engagement, thereby fostering satisfaction and loyalty. The implications of these findings extend into the realm of enhancing the design of agritourism experiences. Doi: 10.28991/HEF-2024-05-03-013 Full Text: PDF

Aspiring to clinical significance: Insights from developing and evaluating a machine learning model to predict emergency department return visit admissions.

Return visit admissions (RVA), which are instances where patients discharged from the emergency department (ED) rapidly return and require hospital admission, have been associated with quality issues and adverse outcomes. We developed and validated a machine learning model to predict 72-hour RVA using electronic health records (EHR) data. Study data were extracted from EHR data in 2019 from three urban EDs. The development and independent validation datasets included 62,154 patients from two EDs and 73,453 patients from one ED, respectively. Multiple machine learning algorithms were evaluated, including deep significance clustering (DICE), regularized logistic regression (LR), Gradient Boosting Decision Tree, and XGBoost. These machine learning models were also compared against an existing clinical risk score. To support clinical actionability, clinician investigators conducted manual chart reviews of the cases identified by the model. Chart reviews categorized predicted cases across index ED discharge diagnosis and RVA root cause classifications. The best-performing model achieved an AUC of 0.87 in the development site (test set) and 0.75 in the independent validation set. The model, which combined DICE and LR, boosted predictive performance while providing well-defined features. The model was relatively robust to sensitivity analyses regarding performance across age, race, and by varying predictor availability but less robust across diagnostic groups. Clinician examination demonstrated discrete model performance characteristics within clinical subtypes of RVA. This machine learning model demonstrated a strong predictive performance for 72- RVA. Despite the limited clinical actionability potentially due to model complexity, the rarity of the outcome, and variable relevance, the clinical examination offered guidance on further variable inclusion for enhanced predictive accuracy and actionability.

Telehealth for Reproductive Health Services for Economically Disadvantaged Youth

PurposeThere is a lack of studies describing reproductive health service use and outcomes with telehealth in publicly funded clinics in community settings for economically disadvantaged adolescents and young adults (AYA). This study sought to compare use of reproductive health services before and during the COVID-19 pandemic and analyze the types and quality of reproductive health-care services for patients who did and did not complete a telehealth visit. MethodsMedical records were reviewed for AYA who sought reproductive health services at 9 urban family planning and school-based clinics. Visit-type differences and associated factors by year of service and among those who did and did not complete telehealth visits were analyzed. ResultsTwenty-seven thousand nine hundred sixty-one unique patients were served between 2019 and 2021. As compared to 2019, in 2020 and 2021, there were significantly fewer visits by minors (<18 years old) versus young adults (18–24 years old) (p < .001), and by those with male versus female natal sex (p < .001). At least one telehealth visit was completed by 17.98% of patients. Telehealth visit completion was more likely in young adults, female, Black, non-Hispanic, and higher-income patients. Telehealth users were more likely to complete annual sexually transmitted infection testing, had a higher number of visits per year, and had higher odds of requiring a return visit within 2 weeks of the index visit (odds ratio 1.5, 95% confidence intervals 1.41–1.76). DiscussionOur findings illustrate disparities in telehealth use in this population of economically disadvantaged AYA and provides pragmatic targets for future interventions.

Perceptions of the attributes of new long-acting HIV pre-exposure prophylaxis formulations compared with a daily, oral dose among South African young women: a qualitative study

ABSTRACT Oral PrEP is highly effective against the acquisition of HIV but is underutilised by young women. New options, like the monthly dapivirine vaginal ring (DVR) and injectable long-acting cabotegravir (CAB-LA), are emerging. However, little is known about young women’s perceptions of these alternatives. This qualitative study explored perceptions of the attributes of PrEP technologies in South Africa. Young women accessing sexual health services were purposively selected to participate in 22 in-depth interviews, five focus group discussions and two workshops using the nominal group technique, between August 2022 and March 2023. A thematic approach guided by the diffusion of innovation attributes, including relative advantage, compatibility with the student's lives, complexity of the technology, and trialability, was used for data analysis. The DVR was the least preferred because of lower efficacy, the perceived complexity of inserting it in the vagina and some safety concerns. Oral PrEP, which some had tried and discontinued, was least compatible with students’ busy schedules. Integrating PrEP and contraceptives with similar return visit patterns could enhance service delivery. Intensive demand creation campaigns will be needed to increase PrEP utilisation and dispel myths about the vaginal ring.

Characteristics of Patients with Persistent COVID-19 Symptoms and Unscheduled Return Visits to a Centre for COVID-19 Evaluation.

Background: This retrospective study aimed to evaluate the characteristics of patients with long COVID syndrome. Methods: This study included 457 adults who had at least one persistent symptom after COVID-19 infection. Results: The median time interval between the last SARS-CoV-2 infection and emergency room presentation was 3 months. Older patients had comorbidities (61.7 vs. 44.9 years, p < 0.0001), moderate or severe forms of COVID-19 (61.2 vs. 50.9 years, p < 0.0001), and respiratory symptoms (56.1 vs. 52.0 years, p = 0.0027). Non-vaccinated patients were older than vaccinated patients (56.0 vs. 51.5 years, p = 0.0008) and had residual lung abnormalities following COVID-19 infection (51.5% vs. 36.8%, p < 0.003). The time interval between the last SARS-CoV-2 infection and the hospital evaluation was shorter for vaccinated patients (3.2 vs. 3.9 months, p < 0.0001) and those with mild forms (3.3 vs. 4.12 months, p = 0.0001) versus non-vaccinated individuals. After the last SARS-CoV-2 infection, 107 patients developed impaired fasting glucose, impaired glucose tolerance, or diabetes mellitus, being patients with already known chronic diseases (p = 0.0002), or hypertension (p = 0.001). Conclusions: Our study pointed out the heterogeneity of symptoms following COVID-19, and they are associated with age, vaccination status, or severity of SARS-CoV-2 infection.

Prevalence and Etiology of Early Return Visit (ERV) Within Three Days of Discharge in Emergency Department

Prevalence and Etiology of Early Return Visit (ERV) Within Three Days of Discharge in Emergency Department

Patients returning to the emergency department with symptoms of cauda equina syndrome: do the symptoms differ with radiological cauda equina compression?

Background The guidance for clinicians on who requires further investigation when suspecting cauda equina syndrome has become clearer in England following the publication of the national recommendations. This does not have specific advice for those patients who have had recent imaging with no compression, returning to a healthcare provider with a change in symptoms. These cases can cause difficulty for clinicians with limited access to imaging who can often be reassured by previous imaging. Method This study presents a retrospective review of the case notes of 45 patients presenting on two occasions to the same Emergency Department who underwent magnetic resonance imaging due to the clinical diagnosis of cauda equina syndrome. Those with compression of the cauda equina on the second visit were compared to those without a compressive cause for their symptoms. Results Patients presenting with an increased number of clinical symptoms associated with cauda equina syndrome on their return visit were more likely to have compression of the cauda equina on imaging. Conclusion The small numbers in this study would suggest caution, however, if patients present with an increasing number of symptoms further imaging should be considered, even with previous reassuring scans.

“Pengaruh Kualitas Layanan terhadap Minat Berkunjung Kembali pada Hotel X di Surabaya”

This study aims to determine the effect of service quality on return visit interest at hotel X in Surabaya both simultaneously and partially, and to determine the most dominant variable in influencing return visit interest. This study belongs to the type of causal research with a quantitative approach. The sample used was 96 respondents, the results of which will be tested for validity and multiple linear regression analysis, multiple determination coefficients, F test, t test, and dominant test. The study results show that service quality affects the interest in revisiting hotel X in Surabaya both simultaneously and partially. The service quality variable is the most dominant variable in influencing return visit interest at hotel X in Surabaya. Furthermore, the ability of the service quality variable to influence the revisit interest variable is 50.5%, while the remaining 49.5% is influenced by other variables not discussed in this study.

Pengaruh Motivasi Internal Dan External Terhadap Niat Berkunjung Kembali Dimediasi Oleh Kepuasan

This research aims to analyze the influence of internal motivation and external motivation on intention to revisit which is mediated by satisfaction with visiting Pualu Nusa Penida. This research uses a quantitative descriptive approach. Data was collected through observation, interviews and distributing questionnaires to tourists. The research sample was 100 tourists, while the sampling technique used purposive sampling. Data was collected from 100 respondents using a questionnaire and analyzed using SEM PLS. Evaluation of the PLS-based structural model, apart from looking at the R-square and Q-square values, can also be carried out by fulfilling several criteria such as the Chi-Square Test, GFI (Goodness of Fit Index), SRMR (Standardized Root Residual) and NFI (Normal Fit Index) . Based on the results of the analysis using statistical tests, the results of this research are, internal motivation has a significant positive effect on tourist satisfaction, external motivation has a significant positive effect on tourist satisfaction, tourist satisfaction also has a positive effect on tourists' intention to revisit, internal motivation has a significant positive effect on intention. Tourists' return visit and external motivation have a positive influence on tourists' intention to return.

Decreasing Invasive Urinary Tract Infection Screening in a Pediatric Emergency Department to Improve Quality of Care.

Obtaining urine samples in younger children undergoing urinary tract infection (UTI) screening can be challenging in busy emergency departments (EDs), and sterile techniques, like catheterization, are invasive, traumatizing, and time consuming to complete. Noninvasive techniques have been shown to reduce catheterization rates but are variably implemented. Our aim was to implement a standardized urine bag UTI screening approach in febrile children aged 6 to 24 months to decrease the number of unnecessary catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs). After forming an interprofessional study team and engaging key stakeholders, a multipronged intervention strategy was developed using the Model for Improvement. A urine bag screening pathway was created and implemented using Plan, Do, Study Act (PDSA) cycles for children aged 6 to 24 months being evaluated for UTIs. A urine bag sample with point-of-care (POC) urinalysis (UA) was integrated as a screening approach. The outcome measure was the rate of ED urine catheterizations, and balancing measures included ED LOS and RVs. Statistical process control methods were used for analysis. During the 3-year study period from January 2019 to June 2022, the ED catheterization rate successfully decreased from a baseline of 73.3% to 37.7% and was sustained for approximately 2 years. Unnecessary urine cultures requiring microbiology processing decreased from 79.8% to 40.7%. The ED LOS initially decreased; however, it increased by 17 minutes during the last 8 months of the study. There was no change in RVs. A urine bag screening pathway was successfully implemented to decrease unnecessary, invasive catheterizations for UTI screening in children with only a slight increase in ED LOS. In addition to the urine bag pathway, an ED nursing champion, strategic alignment, and broad provider engagement were all instrumental in the initiative's success.

Optimal timing of surgery for inguinal hernia in premature neonates

AbstractAimThe surgical repair of inguinal hernias represents a significant risk for premature infants. Despite ongoing discourse, the optimal approach to hernia management remains contentious. Our investigation aims to establish the most favourable timing for inguinal repair in premature neonates.Patients and MethodsOur investigation involved the analysis of medical records for 536 neonates, born prematurely, who underwent inguinal hernia repair from January 2018 to December 2023. We dichotomised the cohort into two groups: those who received early repair and those who underwent late repair. The timing of the surgery was primarily determined by the surgeon's decision, in conjunction with familial consent to the surgical intervention. The primary endpoints were the incidence of recurrence or incarceration within 1 year after surgery. The secondary endpoints encompassed length of neonatal intensive care unit stay, post‐operative ventilator dependency, and frequency of return visits, whether to the inpatient and emergency department or an outpatient clinical setting, for hernia‐related issues.ResultsThe analysis encompassed a total of 454 neonates born prematurely, of which 163 underwent early repair, while 291 received late repair for inguinal hernia. The demographic data between the two groups demonstrated no significant differences. The occurrences of hernia recurrence and post‐operative apnoea presented similar trends across both cohorts. Notably, the late repair group exhibited an increased incidence of preoperative incarceration and return visits due to hernia complications. In this group, testicular atrophy or ovarian necrosis was observed in five cases, despite the overall absence of significant differences.ConclusionsOur findings suggest that the surgical repair of inguinal hernia in preterm neonates, performed at the time of presentation to our clinics, is both safe and feasible. However, a delay in hernia repair appears to be associated with a heightened risk of severe complications, such as testicular atrophy or ovarian necrosis.

Patient Preferences and Priorities for the Design of an Acute Kidney Injury Prevention Trial: Findings from a Consensus Workshop.

High-quality clinical trials are needed to establish the efficacy and safety of novel therapies for acute kidney injury (AKI) prevention. In this consensus workshop, we identified patient and caregiver priorities for recruitment, intervention delivery, and outcomes of a clinical trial of cilastatin to prevent nephrotoxic AKI. We included adults with lived experience of AKI, chronic kidney disease, or risk factors for AKI (e.g., critical care hospitalization), and their caregivers. Using a modified nominal group technique approach, we conducted a series of hybrid in-person/virtual discussions covering 3 clinical trial topic areas: (1) consent and recruitment; (2) intervention delivery; and (3) trial outcomes. Participants voted on their top preferences in each topic area, and discussion transcripts were analyzed inductively using conventional content analysis. Thirteen individuals (11 patients, 2 caregivers) participated in the workshop. For consent and recruitment, participants prioritized technology enabled pre-screening and involvement of family members in the consent process. For intervention delivery, participants prioritized measures to facilitate ease of intervention administration and return visits. For trial outcomes, participants identified kidney-related and other clinical outcomes (e.g., AKI, chronic kidney disease, cardiovascular events) as top priorities. Analysis of transcripts provided insight into care team and family involvement in trial-related decisions, implications of allocation to a placebo arm, and impact of participants' experiences of AKI and critical illness. Findings from our workshop will directly inform development of a clinical trial protocol of cilastatin for nephrotoxic AKI prevention and can assist others in patient-centered approaches to AKI trial design.

2244 Effect of long-term care insurance in a pilot city of China: health benefits among 12,930 disabled older adults

Abstract Introduction The surge of disabled older people has brought enormous burdens to society. The aim of this study was to examine the impact of long-term care insurance (LTCI) implementation on mortality and changes in physical ability among disabled older adults. Methods This was a prospective observational study based on data from the government led LTCI program in a pilot city of China from 2017 to 2021. Administrative data included the application survey of activities of daily living (ADL), the baseline characteristics and all-cause mortality. Return visit surveys of ADL were conducted between August 2021 and December 2021. A regression discontinuity model was used to analyse the impact of LTCI on mortality. Results: A total of 12,930 individuals older than 65 years were included in this study, and 10,572 individuals were identified with severe disability and participated in the LTCI program. Results LTCI implementation significantly reduced mortality by 5.10% (95% CI, −9.30% to −0.90%) and extended the survival time by 33.74 days (95% CI, 13.501 to 53.970). The ADL scores of the LTCI group dropped by 2.5 points on average, while the ADL scores of those did not participate in LTCI dropped by 25.0 points. The heterogeneity analysis revealed that the impact of LTCI on mortality reduction was more significant among females, individuals of lower age, those who were married, cared for by family members, and who lived in districts with rich care resources. Conclusions LTCI implementation had a favourable impact on the mortality and physical ability of participants. This research marks the first comprehensive exploration of the potential health benefits associated with the implementation of LTCI, providing valuable perspectives that can inform policy making and enhance the development of robust long-term care systems in developing countries.

Work absence and productivity loss of patients undergoing a trial of spontaneous passage for ureteral stones.

Patients with ureteral stones are often managed with a spontaneous trial of passage. While cost effective, the current literature has not examined the effects of a trial of passage on patients' work productivity. In this study, we aim to characterize work absence and productivity losses in a cohort of patients undergoing a trial of passage for ureteral stones. Actively employed patients aged 18 to 64 and discharged from Duke emergency departments without surgical intervention for ureteral stones ≤ 10mm were contacted by phone four weeks after their presentation. Participants completed the Institute for Medical Technology Assessment Productivity Cost Questionnaire which assesses three domains: absenteeism - missed work; presenteeism -productivity when returning to work; and unpaid work - assistance with household work. Linear regression associated demographic and stone factors with productivity losses.109 patients completed the survey. In total, 67% of patients missed work, 46% had decreased productivity when returning to work, and 55% required assistance with unpaid work. 59% of patients with stones ≤ 5mm missed work versus 84% with stones > 5mm (p = 0.009). African American race (coefficient 23.68, 95% confidence interval 2.24-45.11, p = 0.031), first-time stone formers (coefficient 20.28, 95% confidence interval 2.50-38.07, p = 0.026), and patients with stones > 5mm (coefficient 25.34, 95% CI 5.25-45.44, p = 0.014) were associated with increased productivity losses. The majority of patients miss work while undergoing a trial of passage and many have decreased productivity when returning to work. This information may help counsel patients in emergency departments, especially first-time stone formers, and prevent return visits.

The erector spinae plane block vs. usual care for treatment of mechanical back pain in the emergency department: a pilot study.

The ultrasound-guided erector spinae plane block (ESPB), traditionally utilized for thoracic regional pain control, has been reported as an effective analgesic option for mechanical back pain, renal colic, and rib fractures in the emergency department (ED). This pilot study aims to compare the effectiveness of the ESPB to usual analgesic treatment for patients presenting to the ED with mechanical back pain. A prospective, single-blind randomized controlled trial was conducted at a Canadian community hospital from March 2020 to December 2022. Adult patients presenting to the ED with mechanical back pain of at least 7 out of 10 on the Numeric Pain Rating Scale (NPRS) were randomized to receive either the ESPB or usual care. The primary outcome was the difference in NPRS score reduction at ED discharge. Secondary outcomes included ED length of stay, ED opiate use, follow-up NPRS and Brief Pain Inventory (BPI) scores, back pain-related return ED visits, and ongoing opiate use. A total of 30 patients were enrolled, with 19 randomized to the ESPB cohort and 11 to the usual care cohort. The mean NPRS reduction at ED discharge was significantly higher in the ESPB group compared to the usual care group (5.4 vs. 2.2), with a difference of 3.2 (95% confidence interval 1.4-5.1). ED opiate use was lower in the ESPB group. The ESPB also resulted in a significant reduction in ED length of stay (160min vs. 235min). There were no reported adverse effects related to the research interventions. This pilot study suggests that the ESPB may be an effective opioid-sparing analgesic option for patients presenting to the ED with mechanical back pain. NCT05982483.

Beyond a lasting impression: Exploring the impact of brand image on revisit intention, unveiling place attachment as a mediating mechanism

A robust and positive brand image, intertwined with a strong sense of place attachment, creates a symbiotic cycle that fuels customer loyalty and ignites the desire for a return visit. By leveraging a quantitative research approach and employing rigorous statistical methods, three distinct studies were conducted. The first study, primarily exploratory, was aimed at scrutinizing the psychometric attributes of the data collection instrument (n = 304). The ensuing confirmatory study sought to validate the results extracted from the exploratory factor analysis (n = 305). The third study was designed to examine the mediating influence of place attachment in the relation between the city of Lisbon's brand image and the revisit intention (n = 355). The data analysis revealed that brand image directly propels the revisit intention; however, when place attachment is introduced into the model as a mediator, the impact of brand image on revisit intention diminishes. These findings imply that when revisit intentions are evaluated, the significance ascribed to place attachment supersedes that ascribed to brand image.

Research on Reform and Innovation of Teaching Models of Public Safety Education Programs in Higher Education

This paper combines the characteristics of higher education and the characteristics of the discipline of safety engineering to reform and innovate the teaching mode of public safety education courses. In the form of a teaching team, we jointly discuss and develop a set of innovative teaching mode including teaching plan, lecture form, after-school activities arrangement and other detailed steps, and formulate a detailed implementation plan including teaching experiment design, teaching practice selection, and effect return visit analysis.

The Role of Ultrasound in Pediatric Peritonsillar Infection: A Descriptive Analysis.

In this study, we describe the role of ultrasound in diagnosing pediatric peritonsillar abscesses (PTAs). A retrospective chart review was conducted on 54 children aged 4 to 17 years who had an ultrasound performed for suspected PTA. Based on ultrasound imaging, the patients were classified into 2 groups: PTA-positive (8, 14.8%) and PTA-negative (46, 85.2 %). Trismus was significantly associated with PTA (50% vs. 13%, P = .03). PTA-positive patients were more likely to be given steroids, be admitted, and have extended hospital stays (P = .04, .004, and .002, respectively). The 2 groups had no significant difference in computed tomography (CT) acquisition, surgical intervention, and return visits (P = .92, .17, and .97, respectively). Larger abscesses trended toward surgical treatment (P = .087). Ultrasound is an efficient diagnostic modality for suspected peritonsillar infections in children, with similar clinical outcomes for PTA-positive and PTA-negative groups.

Understanding the influencing factors of tourists’ revisit intention in traditional villages

The intention of tourists to revisit traditional villages plays a significant role in their sustainable development. This study utilizes a cross-sectional survey design and collects 373 valid responses from Chinese tourists via a questionnaire. The questionnaire, based on a Likert 5-point scale, encompasses key constructs such as space Atmosphere, place attachment, perceived interest, experiential marketing, recreation perception, environmental image perception, well-being, information richness, and revisit intention. To ensure the quality of data, reliability and validity assessments were performed, followed by the verification of research hypotheses using Structural Equation Modeling (SEM). The findings indicate that perceived interest and experiential marketing are pivotal variables influencing tourists' revisit intentions. well-being emerges as a crucial driver that enhancing the likelihood of tourists' return visits. Additionally, recreation perception and perceived interest significantly impact well-being, while information richness positively moderates the effects of space atmosphere, place attachment, perceived interest, and environmental image perception on well-being. These findings can be utilized to formulate strategies that influence tourists' intentions to revisit traditional villages.

Treatment of masseter muscle hypertrophy with botulinum toxin type A injection: A review of adverse events.

The popularity of noninvasive botulinum toxin type A (BTX-A) injections for masseter muscle hypertrophy is increasing among Asian individuals with a square-shaped lower face. This study aimed to analyze the adverse events (AEs) caused by BTX-A injections into the masseter muscle. This observational study retrospectively evaluated 46 250 patients who underwent BTX-A injections into the masseter muscle in 2022. The inclusion criteria were the diagnosis of an AE by the physician at the return visit and subsequent follow-up of progress (n = 223). The patients who were lost to follow-up (n = 40) were excluded from the study. Among the 223 patients with AEs, the most common AE was paradoxical bulging (88.3%, n = 197/223). The average period from treatment until confirmation of improvement was 159.6 ± 113.6 days (range 13-667 days) for all AEs, all of which were temporary. The period until improvement was 166.1 days in the intervention group (n = 122) and 151.9 days in the observation group (n = 101) (p = 0.24). As the period until improvement of AEs included the period until the patients visited the clinics and the improvements were confirmed by physicians, the actual period was likely to have been shorter. (1) All AEs were temporary. (2) All AEs improved within 22.2 months (within 5.3 ± 3.8 months on average). (3) There was no significant difference between the intervention and observation groups in the period until the improvement of AEs.