Hospital Emergency Research Articles

Multimorbidity and emergency hospitalisations during hot weather

BackgroundPeople with chronic diseases are a commonly listed heat-vulnerable group in heat-health action plans. While prior research identifies multiple health conditions that may increase vulnerability to ambient heat, there is minimal evidence regarding the implications of multimorbidity (two or more chronic diseases). MethodsFrom the statewide hospital registry of Queensland, Australia, we identified people aged ≥15 years who had emergency hospitalisation(s) between March 2004 and April 2016 and previously had 0, 1, 2, or ≥3 of five chronic diseases: cardiovascular disease, diabetes, mental disorders, asthma/COPD, and chronic kidney disease. We conducted time-stratified case-crossover analyses to estimate the odds ratio of hospitalisations associated with ambient heat exposure in people with different numbers, types, and combinations of chronic diseases. Ambient heat exposure was defined as a 5 °C increase in daily mean temperature above the median. FindingsThere were 2,263,427 emergency hospitalisations recorded (48.7% in males and 51.3% in females). When the mean temperature increased, hospitalisation odds increased with chronic disease number, particularly in older persons (≥65 years), males, and non-indigenous people. For instance, in older persons with 0, 1, 2, or ≥3 chronic diseases, the odds ratios associated with ambient heat exposure were 1.00 (95% confidence interval: 0.96, 1.04), 1.06 (1.02, 1.09), 1.08 (1.02, 1.14), and 1.13 (1.07, 1.19), respectively. Among the chronic diseases, chronic kidney disease, and asthma/COPD, either existing alone, together, or in combination with other diseases, were associated with the highest odds of hospitalisations under ambient heat exposure. InterpretationWhile individuals with multimorbidity are considered in heat-health action plans, this study suggests the need to consider specifically examining them as a distinct and vulnerable subgroup. FundingWellcome.

The burden of significant pain in the cirrhosis population: Risk factors, analgesic use, and impact on health care utilization and clinical outcomes.

We aimed to characterize pain and analgesic use in a large contemporary cohort of patients with cirrhosis and to associate pain with unplanned health care utilization and clinical outcomes in this population. We included all patients with cirrhosis seen in UCSF hepatology clinics from 2013 to 2020. Pain severity and location were determined using documented pain scores at the initial visit; "significant pain" was defined as moderate or severe using established cutoffs. Demographic, clinical, and medication data were abstracted from electronic medical records. Associations between significant pain and our primary outcome of 1-year unplanned health care utilization (ie, emergency department visit or hospitalization) and our secondary outcomes of mortality and liver transplantation were explored in multivariable models. Among 5333 patients with cirrhosis, 32% had a nonzero pain score at their initial visit and 25% had significant (ie moderate/severe) pain. Sixty percent of patients with significant pain used ≥1 analgesic; 34% used opioids. Patients with cirrhosis with significant pain had similar Model for End-Stage Liver Disease-Sodium scores (14 vs. 13), but higher rates of decompensation (65% vs. 55%). The most common pain location was the abdomen (44%). Patients with abdominal pain, compared to pain in other locations, were more likely to have decompensation (72% vs. 56%). Significant pain was independently associated with unplanned health care utilization (adjusted odds ratio: 1.3, 95% CI: 1.1-1.5) and mortality (adjusted hazard ratio: 1.4, 95% CI: 1.2-1.6). Pain among patients with cirrhosis is often not well-controlled despite analgesic use, and significant pain is associated with unplanned health care utilization and mortality in this population. Effectively identifying and treating pain are essential in reducing costs and improving quality of life and outcomes among patients with cirrhosis.

Identifying key health system components associated with improved outcomes to inform the re-configuration of services for adults with rare autoimmune rheumatic diseases: a mixed-methods study

Adults with rare autoimmune rheumatic diseases face unique challenges and struggles to navigate health-care systems designed to manage common conditions. Evidence to inform an optimal service framework for their care is scarce. Using systemic vasculitis as an exemplar, we aimed to identify and explain the key service components underpinning effective care for rare diseases. In this mixed-methods study, data were collected as part of a survey of vasculitis service providers across the UK and Ireland, interviews with patients, and from organisational case studies to identify key service components that enable good care. The association between these components and patient outcomes (eg, serious infections, mortality) and provider outcomes (eg, emergency hospital admissions) were examined in a population-based data linkage study using routine health-care data obtained from patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis from national health datasets in Scotland. We did univariable and multivariable analyses using Bayesian poisson and negative binomial regression to estimate incident rate ratios (IRRs), and Cox proportional hazards models to estimate hazard ratios (HRs). People with lived experiences were involved in the research and writing process. Good care was characterised by service components that supported timely access to services, integrated care, and expertise. In 1420 patients with ANCA-associated vasculitis identified from national health datasets, service-reported average waiting times for new patients of less than 1 week were associated with fewer serious infections (IRR 0·70 [95% credibility interval 0·55-0·88]) and fewer emergency hospital admissions (0·78 [0·68-0·92]). Nurse-led advice lines were associated with fewer serious infections (0·76 [0·58-0·93]) and fewer emergency hospital admissions (0·85 [0·74-0·96]). Average waiting times for new patients of less than 1 week were also associated with reduced mortality (HR 0·59 [95% credibility interval 0·37-0·93]). Cohorted clinics, nurse-led clinics, and specialist vasculitis multi-disciplinary team meetings were associated with fewer serious infections (IRR 0·75 [0·59-0·96] for cohorted clinics; 0·65 [0·39-0·84] for nurse-led clinics; 0·72 [0·57-0·90] for specialist vasculitis multi-disciplinary team meetings) and emergency hospital admissions (0·81 [0·71-0·91]; 0·75 [0·65-0·94]; 0·86 [0·75-0·96]). Key components were characterised by their ability to overcome professional tensions between specialties. Key service components associated with important health outcomes and underpinning factors were identified to inform initiatives to improve the design, delivery, and effectiveness of health-care models for rare autoimmune rheumatic diseases. Versus Arthritis.

Blood Link

Abstract: In the face of medical emergencies, the rapid and reliable delivery of blood to hospitals can be a matter of life and death. This project presents "BloodLink," a comprehensive solution that leverages modern web technologies and drone delivery systems to streamline the blood supply chain between blood banks and hospitals. The front-end of the system is developed using HTML, CSS, and JavaScript, ensuring a user-friendly interface for hospital staff to post blood group requirements. The backend is powered by the Flask framework of Python, facilitating robust and scalable server-side operations. Utilizing the Google Maps API, our platform dynamically identifies and displays the nearest blood banks in response to hospital requests, ensuring timely and accurate information. For critical situations requiring immediate action, we have integrated an innovative drone delivery system designed to expedite the transportation of blood to the requesting hospitals. The software development phase of the project is complete, and efforts are currently focused on the practical design and implementation of the drone system. This paper details the architecture, development process, and potential impact of "BloodLink" in revolutionizing emergency blood delivery and hospital blood bank coordination.

Clinical–Pathological Features of Thyroid Neoplasms in Young Patients Diagnosed in a Single Center

Background and objectives: The aim of this study was to evaluate the clinical–pathological profile in young patients with thyroid cancer. Materials and methods: We realized a retrospective study on patients with thyroid neoplasms who underwent surgery at the “Pius Brinzeu” County Clinical Emergency Hospital in Timisoara, Romania. A comparative analysis of some parameters between two groups, young patients (<45 years) versus patients ≥45 years, was performed. Results: A total of 211 patients met the study inclusion criteria, mostly females (86.26%) with a female/male ratio of 6.81:1. In patients <45 years old (25.64%), papillary thyroid carcinoma was identified in 51.85% of cases; in 53.85% of cases, the tumor was >1 cm; 13.46% had extrathyroidal extension (p = 0.0430); 21.15% capsule invasion (p = 0.1756); 23.08% lympho-vascular invasion (p = 0.0048); and 13.46% of cases locoregional nodal invasion (p = 0.0092). Conclusion: Thyroid cancer in young people was associated with chronic lymphocytic thyroiditis and tumor progression parameters, identifying more cases of extrathyroidal extension, locoregional nodal invasion, lympho-vascular invasion and perineural invasion in young patients compared to older ones. For a better understanding of this pathology and to improve diagnosis and therapeutic management, more studies are needed for these patients.

An Orthopedic Healthcare Facility Governance Assessed with a New Indicator System

Background and Objectives: A sustainability-oriented hospital governance has the potential to increase the efficiency of healthcare services and reduce the volume of expenses. The objective of this research is to develop a new complex tool for evaluating healthcare facility governance as a component of social responsibility, integrated into sustainability. Materials and Methods: We designed the research to develop the domains of a new reference framework for evaluating healthcare facility governance. The methodology for designing the indicators that make up the new reference framework consists of collecting and processing the most recent and relevant practices regarding the governance of healthcare facilities that have been reported by representative hospitals around the world. Results: We designed eight indicators that are brought together in the healthcare facility governance indicators matrix. They have descriptions and qualitative and quantitative rating scales with values from 0 to 5 that allow the degree of fulfillment to be quantified. The importance of the indicators is evaluated on a specific scale described qualitatively and quantitatively by values from 0 to 5. The values of the degree of achievement–importance couples of the indicators allow the development of improvement measures with priority according to the results revealed by the Eisenhower-type assessment diagram. Conclusions: Validation in practice of the system of indicators at an emergency hospital in an orthopedic profile highlighted the fact that they can be integrated into other national and international reference frameworks implemented in the hospital. The added value of the implementation consists of the facilitation of sustainable development and the orientation of health personnel, patients, and interested parties toward sustainability.

#1370 Frailty prevalence and short-term outcomes among younger end-stage renal disease patients on maintenance hemodialysis

Abstract Background and Aims Frailty is a medical condition of reduced function and health, or a state of heightened risk for catastrophic decline in vitality and function which is evident among end-stage renal disease (ESRD) patients. There has been only limited data regarding its occurrence in the younger age group since most of the published frailty studies involved the elderly as their study population. It is important to identify who among the younger hemodialysis patients are frail, since frailty is related to a higher risk of hospitalization and mortality. This study aims to estimate the prevalence of frailty among younger ESRD patients on maintenance hemodialysis using the Edmonton Frail Scale (EFS) and its association with short-term outcomes: hospital consultations, use of emergency room services, hospitalizations, and mortality. Method A prospective single-center cohort study was conducted. All ESRD patients aged 18-64 years old on maintenance hemodialysis on an outpatient basis were included. Data collection included the patients’ demographic data, underlying diseases, comorbid conditions, body mass index, and recent laboratory results. The EFS was administered during the first month of the study, and patients were then monitored for consultations, use of emergency room services, hospitalizations, and mortality in the succeeding months until the end of the study period. Results Out of 166 ESRD patients, 94 belong to the younger age group and 87 patients were included: 33 (37.9%) were frail, 21 (24.1%) were vulnerable, and 33 (37.9%) were fit. Chronic Glomerulonephritis was the leading cause of ESRD in the younger population, and Diabetic Nephropathy was the primary cause among those categorized as frail. Hypertension was the predominant comorbid condition across all categories. Frail patients had the greatest number of hospital consultations (54%) and had frequent utilization of emergency room services. They also exhibited the highest number of hospitalizations consisting 69% of the total admissions across all categories. All deaths in this study came from the patients categorized as frail. Conclusion Frailty is prevalent among younger ESRD patients on maintenance hemodialysis and is associated with increased risk for hospital consultation, use of emergency room services, hospitalization, and mortality.

#608 Effects of shared decision-making on the prognosis of peritoneal dialysis patients

Abstract Background and Aims Patients with chronic kidney disease (CKD) require shared decision-making (SDM) processes when choosing a dialysis method. Peritoneal dialysis (PD) guarantees patient autonomy; thus, SDM is even more important. Based on these findings, we aim to highlight the benefits of PD and increase the rate in which patients choose PD. In order to increase the rate of PD implementation, patients must actively participate in dialysis decisions, and SDM process is necessary between doctors and patients. So, we investigated the effect of SDM on the prognosis of patients with CKD. We focused on the effects of SDM on patient death, survival rates, hemodialysis conversion, emergency room visits, hospitalization days, and outpatient visits. The results of this study suggest that SDM has a positive impact on increasing the number of patients who choose PD and reduce unnecessary medical cost. Method Among patients with chronic kidney failure from eight hospitals in Korea who started dialysis, 256 who participated in a pilot project for home management of PD were included in the present study. A mixed-methods study was conducted using questionnaires and semi-structured interviews. Our study focused on the effects of SDM on patient death, survival rate, hemodialysis conversion, emergency room visits, hospitalization days, and outpatient visits. Results A significant difference was observed in the number of days of hospitalization per admission (p = 0.0044) between the SDM and non-SDM groups. However, no significant differences were observed in survival rate, rate of conversion to hemodialysis (HD), survival rate after conversion to HD, emergency room visit rate, number of hospitalizations per patient, outpatient visit rate, medical cost, hospitalization cost, outpatient cost, and phosphate-binding agent prescription rate. Conclusion The number of hospitalization days per admission decreased throughout the SDM process. Continued communication between patients and medical staff on how to manage PD in the long term after making the decision to undergo dialysis will be beneficial in promoting the home management of PD patients.

#3003 Increased focus on peritoneal dialysis gives patients improved quality of life and saves millions for the region

Abstract Background and Aims Is it possible to improve PD patients' quality of life and everyday life in combination with the challenge of mastering large geographical distances and at the same time a desire to make healthcare more patient safe and enable patients to be co-creators in their dialysis care? With an area of 48,935 km2, which corresponds to 12% of Sweden's area and larger than the whole of Denmark, Östersund Hospital is the only hospital in a region that takes care of 132,670 inhabitants. In 2018, 85% of patients were dialyzed with hemodialysis at Östersund Hospital. Several of the patients had to travel 200-300 km one way, three to four times a week to receive their dialysis treatment. In addition to high medical travel costs for the region, this also contributed to a low quality of life for the patients. Patients of working age found it difficult to maintain their jobs due to long journeys to the hospital. In a study by (Van Bulck et al, 2018), he shows that patients on dialysis have low participation in their care compared to other patient groups. Method A first step towards a change to provide an increased quality of life for the patients was to invest in self-care with peritoneal dialysis. Several studies describe peritoneal dialysis as a treatment with increased freedom that offers the patient independence with the opportunity to continue working if they are of working age (IIkka et al, AJKD 2012). In addition, several studies show several medical benefits, such as preserving the patient's residual function, which indirectly associates with better patient survival (Van de Luijtgaarden et al, NDT 2011). To continue its work, the dialysis clinic needed approval from the region to start using a night machine connected to a cloud service. After a long wait, the dialysis clinic received approval to use the new technology. Results Since the digital platform was introduced, remote dialysis treatment has increased in the Jämtland Härjedalen region. Digitalization gives healthcare professionals the opportunity to follow the patient's treatment results daily and optimize dialysis treatments without the patient needing to visit the hospital. Today, work is more proactive and provides the conditions to prevent problems before they arise. Five years ago, 85% of dialysis treatments were performed at the hospital. Today, as many as 60% of dialysis treatments with peritoneal dialysis take place in the patient's home. Already in the first year of increased self-care, the region saved SEK 6 million on reduced patient travel. Success factors for a successful result and our way of working today: Conclusion With a patient centric approach, a clear goal focuses and collaboration between several different professional categories. Östersund Hospital has managed to increase the proportion of patients with home treatment from 15% to 60%. Through the implementation of new technology in the form of a digital platform tied to a dialysis machine, the patient's treatment can be evaluated and adjusted remotely. From previously working reactively and solving problems when they arise, now working proactively and planning care for the patient. Emergency hospitalizations can be avoided. In addition to reducing the patient's suffering and providing a better quality of life with fewer hospital visits, it also promotes the hospital's finances. By having the courage to dare to try when others say impossible, learn from their mistakes instead of seeing it as a failure, the clinic's work has improved self-care and participation for this patient group.

Early Access to First-Seizure Clinics, Subsequent Outcomes, and Factors Associated With Attendance

First-seizure clinics (FSCs) aim to deliver prompt specialist care to patients with new-onset undifferentiated seizure events. To determine whether FSC attendance and time to FSC are associated with subsequent health care utilization and mortality and to investigate factors associated with FSC nonattendance. This was a record-linkage, retrospective, cohort study of patients who booked appointments at 2 FSCs between 2007 and 2018. Patients' records were linked to state-wide administrative databases between 2000 and 2021. The setting comprised the FSCs of 2 major metropolitan public hospitals in Melbourne, Australia, providing national inpatient and outpatient adult epilepsy services. Of patients who booked appointments at the FSCs, those who were successfully linked for analysis were included in the study. Patients who recorded only canceled appointments were excluded from analysis of outcomes. Study data were analyzed from January 2000 to December 2021. FSC attendance. Subsequent all-cause and seizure-related emergency department (ED) presentations and hospital admissions. Of 10 162 patients with appointments at FSCs, 9392 were linked for analysis, with mean (SD) follow-up time 6.9 (2.8) years after FSC referral. A total of 703 patients were excluded. Among 9392 linked patients, 5398 were male (57.5%; mean [SD] age, 59.7 [11.2] years). FSC attendance was associated with reduced subsequent all-cause emergency presentations (adjusted incidence rate ratio [aIRR], 0.72; 95% CI, 0.66-0.79) and all-cause hospitalization (aIRR, 0.81; 95% CI, 0.75-0.88). Those who attended at the first-scheduled appointment, compared with those who attended only a rescheduled, delayed appointment, had reduced subsequent all-cause emergency presentations (aIRR, 0.83; 95% CI, 0.76-0.91), all-cause hospitalization (aIRR, 0.71; 95% CI, 0.65-0.79), seizure-related presentations (aIRR, 0.40; 95% CI, 0.33-0.49), and mortality (hazard ratio, 0.82; 95% CI, 0.69-0.98). Male sex was associated with nonattendance (adjusted relative risk [aRR], 1.12; 95% CI, 1.03-1.22), as were injury at emergency presentation (aRR, 1.12; 95% CI, 1.01-1.24), psychiatric comorbidity (aRR, 1.68; 95% CI, 1.55-1.81), previous seizure-related presentations (aRR, 1.35; 95% CI, 1.22-1.49), and delays (>14 days) between FSC referral and appointment (aRR, 1.35; 95% CI, 1.18-1.54). Hospitalization at referral was associated with reduced nonattendance (aRR, 0.80; 95% CI, 0.72-0.90), as were non-English language preference (aRR, 0.81; 95% CI, 0.69-0.94), distance greater than 6 mi from home to clinic (aRR, 0.85; 95% CI, 0.76-0.95), and physical comorbidity (aRR, 0.80; 95% CI, 0.72-0.89). Results of this cohort study suggest that FSC attendance, particularly early attendance, was associated with reduced rates of subsequent hospital utilization. This knowledge may support adequately resourcing FSCs to improve equitable, timely access. Future study directions include assessing interventions that may support FSC attendance for at-risk groups.

Comparison of Financial Hardship and Healthcare Utilizations Associated with Cancer in the United States Medicare Programs during the COVID-19 Pandemic.

In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic. We utilized data from the 2020-2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM. Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM. While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape.

Development of a Multivariable Risk Prediction Tool to Predict Adverse Outcomes among Children with Type 1 Diabetes: A Pilot Study

Background. Children and adolescents with type 1 diabetes mellitus (T1DM) are frequently hospitalised for severe hypoglycaemia, hyperglycaemia, and diabetic ketoacidosis (DKA). While several risk factors have been recognised, clinically identifying these children at high risk of acute decompensation remains challenging. Objective. To develop a risk prediction model to accurately estimate the risk of acute healthcare utilisation due to severe hypoglycaemia, hyperglycaemia, and DKA in children and adolescents with T1DM. Materials and Methods. Using a retrospective dataset, baseline demographic and clinical data were collected from patients (<18 years) seen at a regional paediatric diabetes clinic from 1 January 2018 to 1 January 2020. The outcome was the number of emergency department presentations or hospital admissions for severe hypoglycaemia, hyperglycaemia, and DKA across the study period. Variables that were significant in univariate analysis were entered into a multivariable model. Receiver operator characteristic (ROC) curves assessed the model’s discrimination and generated cut-offs for risk group stratification (low, medium, and high). Kaplan–Meier survival analysis measured time to acute healthcare utilisation across the risk groups. Results. Our multivariable risk prediction model consisted of five predictors (continuous glucose monitoring device, previous acute healthcare utilisation, missed appointments, and child welfare services involvement and socioeconomic status). The model exhibited good discrimination (area under the ROC = 0.81), accurately stratified children into low-, medium-, and high-risk groups, and demonstrated significant differences between median time to healthcare utilisation. Conclusion. Our model identified patients at an increased risk of acute healthcare utilisation due to severe hypoglycaemia, hyperglycaemia, and DKA.

IMPLEMENTING ADVANCED X-RAY TECHNOLOGIES AT THE THIRD CHERKASY CITY EMERGENCY HOSPITAL

Introduction: In recent decades, the world has seen a transition from traditional to digital radiography. Ukraine has also joined this process, replacing outdated equipment with modern digital systems that have become especially important during the Covid-19 epidemic and the Russian-Ukrainian war. The Third Cherkasy City Emergency Hospital implements modern digital technologies of X-ray diagnostics in order to improve the provision of medical care and diagnostics. This study aims at investigating and evaluating the experience of implementing digital X-ray technologies in The Third Cherkasy City Emergency Hospital. Materials and methods: This study involved analyzing medical records from The Third Cherkasy City Emergency Hospital and conducting individual interviews with eight healthcare professionals, including radiologists, other physicians, and a nurse from the hospital. Results. Beginning in 2017, due to the decentralization policy and changes in the Cherkassy city administration, there has been a gradual transition of the medical sector, particularly The Third Cherkassy City Emergency Hospital, to modern digital equipment. This transition has significantly enhanced the quality of medical services and streamlined the process of diagnosing and treating patients. The integration of digital X-ray technologies into the hospital's medical practice has expedited the acquisition and processing of X-ray images, reducing labor and time previously spent on film installation and processing. This reduction in personnel and equipment needs has led to cost savings and process optimization. The implementation of modern X-ray technology has notably improved the efficiency and workflow of hospital staff, facilitating faster and more accurate processing and analysis of X-ray images. The absence of chemical reagents and the utilization of high-quality, clear images have reduced physical and emotional stress among medical personnel. Furthermore, the technology has enabled more effective detection of various diseases at early stages and streamlined emergency care for injured patients. Additionally, the impact of X-ray radiation on both patients and medical staff has decreased. However, the adoption of digital technologies has brought forth new challenges, such as organizing storage and access to digital archives. Addressing these challenges necessitates additional investments in server equipment and the development of specialized programs. Ensuring the reliability and security of medical information storage is crucial to prevent potential data loss or corruption.

Optimal emergency hospitals construction in an unexpected epidemic with considering the interactive effect

AbstractConstructing emergency hospitals is one of the most critical measures to defeat an unexpected epidemic. However, existing operations research (OR) studies rarely consider the interactive effect between the construction of emergency hospitals and the dynamics of epidemic transmission. Inspired by this gap, we propose a new modeling framework for decision‐making in emergency hospital construction. In our optimization model, we address the pandemic evolution functions as constraints. We also consider the heterogeneity among infected individuals, distinguishing between those with mild and severe symptoms, each requiring treatment in different types of emergency hospitals. We formulate the problem as a mixed integer nonlinear programming model. Our model can envision the current and future evolution of the epidemic and the impact of different decisions regarding emergency hospital construction on epidemic development. Simultaneously, it provides the optimal strategy to build hospitals and minimize the total number of untreated patients due to the disease. The proposed model is tested using the Covid‐19 outbreak case in Wuhan. The results can provide precise guidelines for emergency hospitals construction, including timing and capacity, and offer decision boundaries for policymakers considering the uncertainty of disease transmission. Furthermore, our decision‐making framework is general and can be adapted to study other epidemics.

Multifocal superficial thrombophlebitis of the extremities in HIV infection

Long-term observations indicate an increased risk of developing venous thromboembolic conditions in people with the human immunodeficiency virus, their tendency to relapse or a widespread nature. In addition, the incidence of thrombosis increases several times in HIV-infected people compared to the average rates characteristic of people of the same age. A clinical case of multiple bilateral lesions of the subcutaneous veins of the upper and lower extremities in a young patient with HIV infection is presented. Ineffective outpatient treatment and ascending superficial thrombophlebitis of the lower extremities required emergency hospitalization and surgical treatment of the patient to prevent thromboembolic complications. In the postoperative period, in order to prevent the progression of the thrombotic process, as well as to relieve the symptoms of an acute inflammatory reaction of the venous wall and paravasal tissues, a complex application of compression therapy, modern oral anticoagulant drugs, phlebotropic drugs with proven efficacy was carried out. The postoperative period proceeded without complications. In the next few days, the patient’s condition improved, there was a clear regression of thrombotic limb damage. Conclusion: In case of multiple thrombotic lesions of the subcutaneous veins of the upper and lower extremities on the background of HIV infection, the combination of timely surgical intervention with systemic anticoagulant therapy and phlebotropic agents of general and topical use has significant effectiveness in the medical rehabilitation of the patient.

Treatment of portal hypertension complicated by variceal bleeding

Background. Mortality in variceal bleeding (VB) on the background of portal hypertension (PH) is highest among patients with gastrointestinal bleeding. The treatment of PH complicated by VB is a complex problem that is far from being solved, especially in case of Child-Pugh class B and C decompensation. The aim of the study was to determine the causes of PH complicated by VB, features of conservative and interventional therapy, indications and nature of surgical procedures, treatment efficacy, as well as causes of complications and mortality. Materials and methods. We analyzed treatment outcomes of 923 inpatients with PH complicated by VB who were treated in the clinic of the Department of Surgery of the Faculty of Dentistry of Bogomolets National Medical University on the basis of the Kyiv City Clinical Emergency Hospital from 2012 to 2023. It was possible to talk about the cause of PH based on anamnestic data in 61 % of cases. In 711 (77 %) patients, the source of bleeding was detected endoscopically within 30–60 minutes from the moment of admission to the clinic. Conservative therapy included the administration of hemostatic and agents lowering pressure in the portal system, as well as vasoconstrictors that reduce portal blood flow. For the failure of conservative therapy, unstable hemostasis, and repeated previous bleedings, 59 (6.4 %) patients were operated. The methodology of the research analysis consisted in the fact that the arithmetic mean and standard error (M ± m) were determined as the characteristics of the groups for features with a distribution corresponding to the Gaussian law. This reference method of descriptive statistics was applied to evaluate surgical treatment in comparison with conservative therapy and interventional measures. Results. Endoscopic hemostasis by the ligature method was achieved in 97 (10.5 %) patients. Repeated endoscopy due to VB recurrence was done in 276 (29.9 %) participants. In cases of unsatisfactory endoscopic hemostasis, as well as recurrent VB, a Sengstaken-Blakemore probe was installed. In case of right-sided PH, the formation of varices in the esophagus is caused by the discharge of blood mainly through the coronary vein, which required its transection during еsophagogastric devascularization. In compliance with this rule, the patients underwent esophagogastric devascularization, circular transection of the esophagus, which provided portoazygous disconnection. The total mortality rate was 43.1 %, among operated people — 8.5 %, and among non-operated ones — 42.1 %. Conclusions. PH complicated by VB is evidence of decompensated processes in the liver parenchyma or obstruction in the portal system. Conservative therapy and interventional measures make it possible to stop bleeding and prepare the patient for elective surgery, if necessary. An operation that stops blood flow through dilated veins of the esophagus or stomach is an effective method of treating bleeding in portal hypertension.

Pharmacists in Trauma: a randomised controlled trial of emergency medicine pharmacists in trauma response teams

BackgroundAnalgesia is an important component for patient well-being, but commonly delayed during trauma resuscitation. The Pharmacists in Trauma trial assessed the effects of integrating pharmacists into trauma response teams to...

Causes and clinical symptoms of anaphylactic reactions in children: experience of the first «Pediatric Moscow Anaphylaxis Registry» in the Russian Federation

BACKGROUND: In Russian, there was a problem of the lack of registry of anaphylaxis, as the most important tool for monitoring this group of patients. Since 2022, the first "Pediatric Moscow Anaphylaxis Registry" has started working at the Morozov Children's Hospital. AIMS: Analysis of data from the Pediatric Moscow Anaphylaxis Registry to determine frequency, causes andclinical characteristics of anaphylaxis among children of the Moscow region. MATERIALS AND METHODS: Statistical analysis of the questionnaire data of 69 children aged 0-18, who were prospectively included in the Register during emergency hospitalization due to anaphylaxis, was carried out. RESULTS: The incidence of anaphylaxis among children hospitalized with acute allergic reactions from May 2022 to September 2023 was 5.8%. Higher percentage of anaphylaxis (38%) were observed among adolescents aged 13-18, three patients developed anaphylaxis in the first year of life (minimum age 1 month). Boys (70%) prevailed among patients under the age of 13, and girls (56%) prevailed among adolescents aged 13-18 (p=0.042). 75% anaphylaxis developed at home. Food anaphylaxis was dominant (75%-91%). Tree nuts were the most common trigger of food anaphylaxis – 35%, and confectionery products - 17%. 56% of children experienced symptoms from 4 or more organ systems, the most common symptoms were: skin/mucous (94%), respiratory (78%) and laryngeal symptoms (64%). Emergency care, diagnosed anaphylaxis in 22%, administration of epinephrine was 54%. The frequency of epinephrine use among children under 3 years was lower compared to adolescents aged 13-18 (25% vs 76%, p=0.003). CONCLUSIONS:Data from the "Pediatric Moscow Register of Anaphylaxis" showed a high incidence of anaphylaxis among patients with acute allergic reactions. More than 1/3 of anaphylaxis occurs in adolescents aged 13-18 years, anaphylaxis occurs in the first month of life. Most often, anaphylaxis occurs at home, which requires training patients to eliminate the trigger. The dominant cause of anaphylaxis in children in the Russian, regardless of age, are food allergens, tree nuts induce food anaphylaxis in more than 1/3 of cases. The emergency care diagnoses anaphylaxis in 22% of cases, epinephrine is administered in 54%, minimal use of epinephrine was among children under 3 years of age.

Impact of the Omicron Strain on Febrile Convulsions Requiring Hospitalization in Children: A Single-Center Observational Study.

The emergence of the Omicron strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the end of December 2021 has drastically increased the number of infected children in Japan, along with the number of children with febrile convulsions, but its clinical impact is unclear. We compared the frequency of SARS-CoV-2 infection in children hospitalized with febrile convulsions with the frequency of SARS-CoV-2 infection in children with fever and respiratory symptoms without convulsions. In 2021 and 2022, 49 and 58 children required emergency hospitalization for febrile convulsions (FC group) with status epilepticus or cluster spasms, in which 24 and 38 children underwent a Filmarray® respiratory panel test (FA test), respectively, and others received a quantitative antigen test for SARS-CoV-2. In 2022, only six patients tested positive for SARS-CoV-2 (10.3%, 6/58). As a reference group, 655 children aged <10 years who underwent the FA test for fever and respiratory symptoms during the same period were investigated, and 4 (1.8%, 4/223) and 42 (9.7%, 42/432) tested positive for SARS-CoV-2 in 2021 and 2022, respectively. Rhinovirus/enterovirus (RV/EV) was the most frequently detected virus (40.3%, 264/655), followed by respiratory syncytial virus (RSV) (18.9%, 124/655) and parainfluenza virus 3 (PIV3) (7.8%, 51/655). There was no significant difference in the trend of detected viruses between the two groups. The frequency and severity of febrile convulsions requiring hospitalization associated with SARS-CoV-2 infection of the Omicron strain may be similar to that of other respiratory viruses in children.

Socioeconomic deprivation, health and healthcare utilisation among millennials

This study estimates and decomposes components of different measures of inequality in health and healthcare use among millennial adolescents, a sizeable cohort of individuals at a critical stage of life. Administrative data from the UK Hospital Episode Statistics are linked to Next Steps, a survey collecting information about millennials born between 1989 and 1990, providing a uniquely comprehensive source of health and socioeconomic variables. Socioeconomic inequalities in psychological distress, long-term illness and the use of emergency and outpatient hospital care are measured using a corrected concentration index. Shapley-Shorrocks decomposition techniques are employed to measure the relative contributions of childhood socioeconomic circumstances to adolescents’ health and healthcare inequality of opportunity. Results show that income-related deprivation contributes to significant inequalities in mental and physical health among adolescents aged between 15 and 17 years old. There are also pro-rich inequalities in the use of specific outpatient hospital services (e.g., orthodontic and mental healthcare), while pro-poor disparities are found in the use of emergency care services. Regional and parental circumstances are leading factors in influencing inequality of opportunity in the use of hospital care among adolescents. These findings shed light on the main drivers of health inequalities during an important stage of human development and have potentially important implications on human capital formation across the life-cycle.