Improve Patient Care Research Articles

Perancangan Sistem Informasi Pengolahan Data Rekam Medis Elektronik Guna Menunjang Tata Kelola Pelaporan Rawat Jalan

Recording and reporting medical records is the main activity in health service institutions, and hospital information systems play an essential role in this process. Outpatient data processing at XYZ Hospital uses spreadsheets and Google Sheets even though it has yet to implement SIMRS fully. Because the data in the SIMRS must be changed for each spreadsheet report, there are several reporting problems. Therefore, the authors begin to develop a web-based outpatient reporting system after researching the need for more efficient applications. This study uses a qualitative approach to data collection through interviews and observations, focusing on developing a waterfall software. The results showed that searching and managing patient data and making outpatient recapitulation reports became easier for medical record officers. Implementing this system brings several concrete impacts, including reducing human errors in data recording, increasing the speed of access to medical information, and increasing time efficiency in making reports. This system also allows better data integration between hospital departments, improving patient care coordination and the overall quality of health services.

Post-Traumatic Trigeminal Neuropathic Pain: A Narrative Review of Understanding, Management, and Prognosis.

This study provides an updated overview of the clinical characteristics of post-traumatic trigeminal neuropathic pain (PTNP) resulting from dental procedures or facial trauma, addressing its etiology, prevalence, evaluation, management, and prognosis. PTNP arises from injury to the trigeminal nerve, which governs sensory and motor functions in the maxillofacial region. The prevalence and characteristics of PTNP vary considerably across studies, with a reported prevalence ranging from 1.55% to 13%. The predominant causative factors are dental procedures, particularly third molar removal and implant placement. While gender distribution varies, a trend towards higher incidence in females is observed, particularly within the 40-60-year age group. Anatomically, the mandibular nerve is frequently involved. PTNP presents with a spectrum of symptoms ranging from tingling sensations to severe pain. Diagnostic challenges arise due to the lack of standardized criteria and potential overlap with focal neuralgia, necessitating comprehensive evaluation. Misdiagnosis can lead to prolonged patient suffering and unnecessary interventions. Successful management hinges on prompt diagnosis and interdisciplinary collaboration, with early intervention crucial in mitigating progression to chronic pain. Although nerve recovery post-trauma is challenging, preventive measures through accurate evaluation and treatment are paramount. Management strategies for PTNP include non-invasive and surgical interventions, with non-invasive approaches encompassing systemic and local pharmacological management. This narrative review aims to enhance uniformity in PTNP evaluation and treatment approaches, ultimately improving patient care and outcomes.

WP7.3 - FAMiSH: FAsting prior to eMergency general Surgery in Hospital – Quality improvement project protocol

Abstract This study was conducted to evaluate adherence to preoperative fasting guidelines at the RD&E hospital, focusing on safety and reducing prolonged fasting complications particularly in patients with extremes of age, diabetic or co-morbid. Data were gathered anonymously over 2 cycles for 4 weeks through patient records and questionnaire to access patient given instructions for fasting. All patients with planned procedures were included, excluding emergency operations (NCEPOD) 1 or 2a/2b classification. Issues such as inadequate communication, excessive fasting, insufficient monitoring, and medication mismanagement were addressed. Cycle one revealed 25% of patients fasted for more than 6 hours, 56.25% did not consume liquids for more than 12 hours, and 25% abstained from drinking for more than 8 hours preoperatively. It was noted that guidelines were not thoroughly adhered to. Some patients have missed their medications, as well as diabetic patients with prolonged hours of fasting. We have provided a session for junior doctors and nurses aiming education on ASA guidelines and encouraging individualised fasting plans for patients. Information leaflets were created to be distributed to patients planned for surgery. In the second cycle only 20% and 24% of patients didn’t follow fasting guidelines for solids and liquids respectively as compared to 68.75% of the patients receiving inappropriate instructions in 1st cycle, showing significant improvement in patient care. In our study at the RD&E we have noted an improvement in departmental focus on adherence to fasting guidelines, which focus on abstaining from solid foods up to 6 hours and drinks up to 2 hours prior to surgery, aiding patient safety and improvement of quality of care.

ThP1.4 - Evidence-Based Perioperative Improvements in Microvascular Breast Free Flap Reconstruction: An Audit-Centric Evaluation & Retrospective Cohort Study

Abstract Aim This audit aimed to evaluate and improve the results of microvascular breast free flap reconstruction by implementing an enhanced perioperative care approach. Method All microvascular breast free flap reconstructions between June to August 2023 were included. Additionally, a three year retrospective review was conducted in adherence to ABS and the BAPRAS guidelines. Our team plans to introduce an evidenced-based modified Enhanced Recovery After Surgery (ERAS) protocol via MDT collaboration with a focus on pre-operative and post-operative care to improve postoperative outcomes. Results During June – August 2023, 22 flaps were performed with an average length of stay (LOS) of 5.47 days (target <3d). There were no unplanned readmissions, an 18% return to theatre (RTT) rate and a total complication rate of 18%. Over the past three years, out of 323 flaps, there was a 13% RTT rate with no unplanned readmissions. Suggested modifications to reduce length of stay include pre-surgical counselling and nutritional loading. Post-operatively, using a multi-modal opioid sparing analgesia (MOSA) regime, along with laxatives, early mobilisation and feeding has proven to enhance recovery. Pre-admission patient optimisation, VTE and perioperative antibiotic prophylaxis have been shown to reduce rates of flap failures and post-operative complications. Effective wound care, post-discharge support and physiotherapy are also crucial in accelerating recovery and preventing readmissions. Conclusion Implementing these ERAS modification to our current protocol is predicted to significantly improve post-operative recovery, thus improving surgical outcomes. This underscores the potential for continual improvement in patient care through an efficient evidence-based perioperative pathway.

WP2.6 - Improving theatre utilisation and reducing waiting list times – could ‘standby’ patients be the answer?

Abstract Aims With the NHS waiting list at a record high of over 7.3 million patients, it has never been more important to maximise theatre productivity. We piloted a ‘standby patient’ initiative for patients awaiting elective day-case procedures, with the aim of optimising theatre utilisation, reducing waiting lists, improving hospital revenue and ultimately patient care. Methods The principle of a ‘standby’ patient is to reduce the rate of ‘on the day’ cancellation and utilise theatre time. Suitable patients were offered the opportunity to be on ‘standby’ for selected day case lists. If list capacity allowed, the patient was called in. If postponed, they were offered a dedicated date. A patient questionnaire was also conducted to gain an understanding of the ‘standby’ patient experience. Results Between May and November 2023, 12 ‘standby' patients were identified, average waiting list time of 44 weeks. Cases included hernia repairs and laparoscopic cholecystectomies. 6/12 were operated on their standby slot, 1 patient cancelled, and 5/12 were postponed but had surgery within an average of 6 weeks. This earnt the trust approximately £15240 in additional tariff. 10/12 patients responded to the patient questionnaire with all reporting either good or excellent experience of the initiative. Positive comments included ‘good communication’ and ‘excellent standard of care’. Conclusion The standby patient initiative is well received by patients, and provides a cost-effective solution to optimise theatre utilisation, reduce waiting list times, and improve patient care. Following this successful pilot, we plan to introduce the standby patient across further surgical lists within the trust.

Development and implementation of an optimization model for the assignment of medical specialties in clinics: application of the Knapsack algorithm with a graphical interface in Python

This project presents the development and application of an optimization model designed to allocate medical specialties to clinics based on a predefined schedule. By employing the Knapsack algorithm in Python, the model aims to optimize resource utilization within a medical environment, ensuring that the distribution of services is both efficient and effective. The model incorporates critical constraints such as clinic capacity and patient service demand, which are essential for balancing resources across various specialties. Furthermore, the model addresses potential scheduling conflicts, ensuring that no overlaps occur among different specialty professionals assigned to the same clinic. The integration of these constraints ensures that the allocation process is not only optimal but also practical for real-world implementation. The results demonstrate the potential of this approach to enhance operational efficiency, minimize resource wastage, and improve patient care by strategically managing the availability of specialized medical services across clinics. This model serves as a robust framework for healthcare organizations aiming to improve their resource management strategies.

WP3.17 - Rationalising the use of Abdominal X Ray to ensure the best utilisation of clinical radiology services

Abstract Aim To rationalise indications for Abdominal Xray (ABXR). Method All patients undergoing ABXR from 1st September 2022 to 31st December 2022 were included timing the Xray, requesting department and grade of doctor noted We compared the indications of the request and whether patients proceeded to CT scan. Based on the iRefer recommendations Grade C as well as need of CT, inappropriate requests were identified and ones that could be avoided. Results 279 patients underwent ABXR 184 Xrays were done during in hours(IH) (0800-2000hrs) 175 requests originated from A&E, 103 from Wards and 1 from GP. 137/279 ABXR were requested for obstruction. 37/279 for Foreign Body. Other common IH requests included identifying retained capsule, post enteral tube placements as well as diagnostic/therapeutic gastrograffin result. IH request also included identification of renal stones following CT KUB. 134/279 concurred with Recommendation A/B and 145/279 Recommendation C of iRefer guidelines. 62/279 patients underwent post ABXR CT scan. 70% (43/62) were to rule out obstruction for which in the majority ABXR would not be indicated. Of these 49% (21/43) were normal and 51% (22/43) showed obstruction. 45/62 of the patients who underwent CT had an avoidable ABXR. In total 144 ABXRs could have been avoided. 1 request was from GP and hence could not be commented on. Conclusions Avoiding abdominal Xray will improve patient care, bypassing inadequate tests and moving straight to CT where clinically appropriate. Rationalising the use of ABXR will minimise overburdening clinical radiology services and decrease unnecessary exposure of radiation to patients.

Large language model triaging of simulated nephrology patient inbox messages.

Efficient triage of patient communications is crucial for timely medical attention and improved care. This study evaluates ChatGPT's accuracy in categorizing nephrology patient inbox messages, assessing its potential in outpatient settings. One hundred and fifty simulated patient inbox messages were created based on cases typically encountered in everyday practice at a nephrology outpatient clinic. These messages were triaged as non-urgent, urgent, and emergent by two nephrologists. The messages were then submitted to ChatGPT-4 for independent triage into the same categories. The inquiry process was performed twice with a two-week period in between. ChatGPT responses were graded as correct (agreement with physicians), overestimation (higher priority), or underestimation (lower priority). In the first trial, ChatGPT correctly triaged 140 (93%) messages, overestimated the priority of 4 messages (3%), and underestimated the priority of 6 messages (4%). In the second trial, it correctly triaged 140 (93%) messages, overestimated the priority of 9 (6%), and underestimated the priority of 1 (1%). The accuracy did not depend on the urgency level of the message (p = 0.19). The internal agreement of ChatGPT responses was 92% with an intra-rater Kappa score of 0.88. ChatGPT-4 demonstrated high accuracy in triaging nephrology patient messages, highlighting the potential for AI-driven triage systems to enhance operational efficiency and improve patient care in outpatient clinics.

FP5.12 - Write what you know: A retrospective documentation audit

Abstract Aims The Royal College of Physicians (RCP) stipulates that every patient entry in the notes should be; dated, timed and signed by the author (name and designation included). Additionally, the content should have a standardised structure and layout with a chronological order to reflect a continuum of patient care. This audit aimed to assess the percentage of patient documentations that were compliant with these standards. Methods We retrospectively evaluated inpatient documentations for general, colorectal and vascular surgery for one week within a district general hospital setting. The data was obtained from electronic documentations. We assessed inpatient documentation for all relevant criteria as per RCP guidelines. Inpatient documentation included; the admission notes, post take ward round, daily ward rounds and inter-speciality discussions. Results A total of 88 patient related entries were reviewed. Of these 89.8% were dated. 42.0% of the entries were timed, with inter-specialty discussion having the highest percentage of recorded times. 93.2% had a standardised structure. The structure of admission entries was the most consistent with standards. 6.8% and 3.4% had the authors designation and signature respectively. Conclusion Clear informative documentation is pivotal for safe and effective patient care. Failure of patient documentation to meet the stipulated standards was established in this audit. Factors including inadequate junior doctor training, pace of ward rounds and reliance on electronic noting systems are potential reasons for poor compliance. Capitalising on opportunities to educate junior doctors is paramount in improving patient care.

An Overview of Biotechnological Drug’s Various Techniques of Downstream Process, Guideline’s And Different Chromatographic Analysis

Abstract: Biotechnology, a field discovered in 1919, unites biology and engineering to harness living organisms for medical purposes. Fueled by using DNA's discovery in the 1950s, biotechnology has converted through genetic engineering, yielding impactful merchandise regulated by means of entities like the FDA. The manufacturing involves upstream and downstream processing including the various techniques involved in the downstream processing of biotechnological drugs, along with relevant guidelines and chromatographic analysis methods. The biotechnological industry, which integrates biological science with engineering, has significantly advanced since the discovery of DNA's structure, leading to the development of biopharmaceuticals. These drugs, including monoclonal antibodies, recombinant proteins, and gene therapies, are produced using living organisms and hold the potential for treating complex diseases. The downstream process, a crucial phase in biopharmaceutical production, involves the purification and formulation of drug products to meet stringent regulatory standards. Traditional techniques such as centrifugation, filtration, and chromatography are employed to extract and purify biopharmaceuticals. Chromatographic techniques, including ion exchange, affinity, and size exclusion chromatography, play a pivotal role in achieving the desired purity levels. However, these methods are often time-- consuming and expensive, necessitating continuous advancements in the field. The paper highlights the importance of regulatory guidelines, including cGMP, in ensuring the quality and safety of biopharmaceuticals. It also discusses the significant role of organizations such as the FDA and EMA in regulating biotechnological drug production. The evolution of downstream processing techniques and the development of novel methods promise greater efficiency, scalability, and cost-effectiveness in biopharmaceutical production. Understanding these advancements is essential for continued growth and innovation in the industry, ultimately contributing to improved patient care and pharmaceutical innovation.

WP8.3 - "Effectiveness of Malnutrition Screen and Interventions for Surgical Inpatients - A MUST Score Based Audit"

Abstract Malnutrition significantly impacts surgical inpatients, affecting outcomes like infection rates, hospital stays, and wound healing. This audit evaluates the effectiveness of the Malnutrition Universal Screening Tool (MUST) in identifying at-risk surgical inpatients and examines the subsequent interventions and nutrition assessments. Our prospective audit encompassed surgical inpatients admitted for elective procedures or via the emergency department. Data were collected through patient records and medical charts, focusing on MUST score completion, accuracy, and updates. The audit assessed staff training, consistency in scoring, and the quality of nutrition interventions documented by dietitians. Key findings revealed a high completion rate (83.3%) of MUST scores but identified significant inaccuracies due to insufficient consideration of BMI, weight loss, and acute disease effect. Only a minor percentage (15.6%) of patients had their MUST scores updated. Staff training inadequacies and inconsistent scoring practices were noted. Despite these limitations, clinical teams effectively identified at-risk patients using their judgment and promptly initiated interventions. A malnutrition awareness week was organised with the dieticians, and teaching sessions were conducted for the healthcare staff to enhance understanding and application of the MUST tool. This initiative aimed to raise awareness and improve the quality of malnutrition screening and management. The audit highlights the need for improved accuracy in MUST scoring, enhanced staff training, and ongoing professional development. Recommendations include comprehensive staff training, standardized documentation processes, interdisciplinary collaboration, and patient and family education. This audit underscores the importance of accurate malnutrition screening and effective interventions to improve patient care quality for surgical inpatients. It calls for action plans to address the identified gaps, thereby enhancing malnutrition management within healthcare settings.

Stacking Ensemble Artificial Intelligence Model for Heart Disease Diagnosis

Personalized treatment plans, predictive analytics, and artificial intelligence (AI)-driven diagnostics are becoming more and more popular as a way to improve decision-making, expedite operations, and improve patient care. But there are still a number of substantial barriers to overcome, which includes but not limited to issues with user adoption, trust, prejudice, and fairness brought on by resistance from healthcare providers and a lack of confidence in the system's recommendations. To overcome these challenges and realize the full potential of AI-driven solutions, the system's accuracy and safety through meticulous testing and validation of AI algorithms becomes indispensable. This research provides a hybrid AI model that blends three base models with a Meta model in order to diagnose heart disease effectively. The essence is to revalidate the existing AI diagnostic models for cardiac diseases diagnostics and to tackle the concerns impeding the full utilization of the available AI diagnostic system. The study makes use of each model's advantages by merging these various and complimentary algorithms into a stacking ensemble model to create a diagnostic system that is more potent. Using publicly available heart disease data, the model performs remarkably well; it achieves 89% accuracy, 85% recall (sensitivity), 92% specificity, and 89% precision. This hybrid model's performance and proven efficacy are expected to boost trust in the system's recommendations and encourage broader implementation in clinical practice.

Regulatory Compliance and Risk Management in Pharmaceuticals and Healthcare

Purpose: This study aims to examine the evolving regulatory landscape and its impact on compliance and risk management within the pharmaceutical and healthcare industries. It seeks to identify effective strategies for maintaining data integrity and traceability in accelerated pharmaceutical development (APD), and to understand how these strategies improve patient care and healthcare system responsiveness. Methodology: The research involves a comprehensive review of current regulations, emerging trends, and industry practices. It utilizes an analysis of regulatory updates, risk management frameworks, and case studies to illustrate successful compliance strategies and the challenges faced by organizations. Findings: The study highlights key regulatory requirements, identifies common risks and mitigation strategies, and provides insights into effective practices for ensuring data integrity and traceability. It demonstrates that robust compliance and risk management practices contribute to enhanced patient outcomes and improved healthcare system efficiency. Unique Contribution to Theory, Policy, and Practice: This research offers a detailed examination of the intersection between regulatory compliance and risk management, providing a valuable framework for understanding and addressing the complexities of the pharmaceutical and healthcare sectors. It contributes to theory by integrating recent regulatory changes with practical risk management approaches, informs policy by highlighting critical areas for regulatory focus, and offers actionable recommendations for industry practitioners to optimize compliance and data management processes.

Urine Sample Handling in Laboratory—Process Reengineering is the Need of the Hour

Background and Aims: Monitoring and a continual improvement of turnaround time (TAT) in urine examination and reporting is essential for improved management of laboratory quality as well as ensuring patient satisfaction. TAT can be impacted by multiple factors, some of which appear to be beyond the control of laboratory, especially the preanalytical phase of urine examination such as specimen collection, transportation and sample preparation. The aim of the study was to compare the preanalytical variables like TAT for transportation and incidences of spill between our current urinalysis workflow process and the new urinalysis workflow process using a pneumatic chute-compatible closed urine collection system. Materials and Methods: This observational prospective study was conducted on 4/9/23 from 9 am to 4 pm at the laboratory of Apollo Main Hospital, Chennai. Pneumatic chute compatible closed urine collection cup was given to the patients in Group-A and normal screw cap containers which we are currently using were given to the patients in Group-B. Once the urine samples were collected in the respective containers, they were transported to the laboratory using pneumatic chutes for Group-A samples and manual carry for Group-B samples. Analysis of transportation time using the new collection method (Group-A) when compared with the current method of practice (Group-B) was done. The incidence of spillage was also monitored. Results: A significant improvement was noticed in the transportation process and spill incidence with closed collection devices through the pneumatic chute. Conclusion: To conclude, the implementation of pneumatic chute compatible closed collection tubes for urine improves the transportation and processing time, eliminates the manual carry of urine samples, eliminates the incidences of leakage and spillage, reduces errors and reduces the exposure of urine to healthcare workers, thereby leading to significant improvement in patient care, patient experience and staff satisfaction.

Advances in Tissue Engineering and Its Future in Regenerative Medicine Compared to Traditional Reconstructive Techniques: A Comparative Analysis.

Tissue engineering represents a revolutionary approach in regenerative medicine, offering promising alternatives to traditional reconstructive techniques. This systematic review explores recent advances in tissue engineering, comparing their efficacy, postoperative outcomes, and patient satisfaction to conventional methods. A comprehensive literature search was conducted across PubMed, Cochrane Library, and Google Scholar, covering studies published from 2000 to 2024. Fourteen studies were selected for final analysis based on inclusion criteria focusing on outcomes such as scar quality, postoperative pain, and patient satisfaction. The review demonstrated that tissue engineering techniques consistently provided superior cosmetic outcomes with minimal scarring compared to traditional methods. Patients undergoing tissue-engineered procedures experienced mild-to-moderate postoperative pain with rapid resolution, whereas traditional techniques resulted in moderate to severe pain requiring extended management. Furthermore, patients treated with tissue engineering reported high satisfaction rates due to improved cosmetic and functional outcomes. Despite challenges such as ensuring adequate vascularization, controlling scaffold degradation, and overcoming regulatory and cost barriers, ongoing research and development are essential to fully realize the potential of these innovative therapies. Tissue engineering offers significant advantages over traditional reconstructive techniques and has the potential to profoundly improve patient care in regenerative medicine.

Assessment of long-term psychosocial outcomes in N-methyl-D-aspartate receptor encephalitis – the SAPIENCE study protocol

BackgroundN-methyl-D-aspartate-receptor (NMDAR) encephalitis is a rare neurological autoimmune disease with severe neuropsychiatric symptoms during the acute phase. Despite good functional neurological recovery, most patients continue to experience cognitive, psychiatric, psychological, and social impairments years after the acute phase. However, the precise nature and evolving patterns over time of these long-term consequences remain unclear, and their implications for the well-being and quality of life of predominantly young patients have yet to be thoroughly examined.MethodsSAPIENCE is a European multi-center (n = 3) prospective observational cohort study studying the long-term cognitive, psychiatric, psychological, and social outcome in patients with NMDAR encephalitis. The study consists of three interconnected levels. Level 1 comprises a qualitative interview and focus groups with patients and their caregivers. Level 2 consists of a condensed form of the interview, standardized questionnaires, and a detailed neuropsychological examination of patients. Level 3 involves an online survey that will be open to patients world-wide and explores patient-reported outcomes (PROMs), and patient-reported experiences (PREMs) in association with clinical and cognitive outcomes. Levels 1 to 3 will progressively contribute developing of structured interviews, survey questions, and treatment guidelines by informing one another.DiscussionSAPIENCE is an in-depth study of the long-term effects of NMDAR encephalitis and bridges the gap between standardized assessments and individual patient experiences, intending to improve patient care and to increase awareness of the psychosocial long-term consequences of the disease. Through collaboration of experts in clinical neurology and social and health psychology across Europe, SAPIENCE aims to create online assessment tools and formulate guidelines for patient-centered post-acute care that will help enhance the quality of life for patients and caregivers.

Advancements in Diagnosis and Management of Distal Radioulnar Joint Instability: A Comprehensive Review Including a New Classification for DRUJ Injuries.

Distal radioulnar joint (DRUJ) instability is a complex condition that can severely affect forearm function, causing pain, limited range of motion, and reduced strength. This review aims to consolidate current knowledge on the diagnosis and management of DRUJ instability, emphasizing a new classification system that we propose. The review synthesizes anatomical and biomechanical factors essential for DRUJ stability, focusing on the interrelationship between the bones and surrounding soft tissues. Our methodology involved a thorough examination of recent studies, incorporating clinical assessments and advanced imaging techniques such as MRI, ultrasound, and dynamic CT. This approach allowed us to develop a classification system that categorizes DRUJ injuries into three distinct grades. This system is intended to be practical for both clinical and radiological evaluations, offering clear guidance for treatment based on injury severity. The review discusses a range of treatment options, from conservative measures like splinting and physiotherapy to surgical procedures, including arthroscopy and DRUJ arthroplasty. The proposed classification system enhances the accuracy of diagnosis and supports more effective decision making in clinical practice. In summary, our findings suggest that the integration of advanced imaging techniques with minimally invasive surgical interventions can lead to better outcomes for patients. This review serves as a valuable resource for clinicians, providing a structured approach to managing DRUJ instability and improving patient care through the implementation of our new classification system.

Real-world performance of a single-use, analyser-free, molecular point-of-care test for COVID-19 used in the emergency department: Results of a prospective trial (ED-POC)

A novel single-use, analyser-free, molecular point-of-care test for SARS-CoV-2 (Veros COVID-19 test, Sherlock Biosciences) could reduce time to results and improve patient care and flow in the emergency department (ED), but its performance in this setting is unknown. Adults aged ≥18 years presenting to Southampton General Hospital (UK) with suspected COVID-19 were tested with the Veros COVID-19 test in addition to standard of care near-patient PCR. Measures of diagnostic accuracy were calculated for the Veros COVID-19 test stratified by Ct value. Discrepant results underwent viral culture. Between Jan 16 and May 2, 2023, 400 patients were enrolled with a median (IQR) age of 60 (34-77) and 141 (35·3%) were SARS-CoV-2 positive by PCR. The Veros test gave valid results on the first test in 384 (96·0%), and sensitivity and specificity were 127/141 (90·1%, 95%CI 83·9-94·5) and 258/259 (99·6%, 95%CI 97·9-100) overall. For those with high or moderate viral load (Ct ≤30), sensitivity was 125/129 (96·9%, 95%CI 92·3-99·2). One (7·1%) of 14 PCR positive/Veros test negative samples was culture positive. Median (IQR) time from sample collection to result was 19 (18-20) mins with the Veros test versus 73 (59-92) mins with PCR (p<0·0001). The Veros COVID-19 test generated results in near real-time, around 1h sooner than rapid, near-patient, analyser-based PCR, and accuracy was excellent for samples with moderate and high viral loads. The Veros test represents a step-change in molecular diagnostics for infection and could significantly reduce time to results and improve patient management in EDs and other settings.

Associated Factors and Mortality of Arrhythmia in Emergency Department: A Narrative Review.

Cardiac arrhythmias represent a major concern in the emergency department (ED), particularly given their association with significant morbidity and mortality. This narrative review examines the various factors influencing arrhythmias and their impact on patient outcomes in emergency settings. Managing complex supraventricular and ventricular arrhythmias (VAs) during acute myocardial infarction (AMI) and severe cardiovascular conditions remains challenging, despite advancements in diagnostic and therapeutic techniques. Ventricular arrhythmias frequently forecast worse outcomes during hospital stays and heighten the chances of sudden cardiac death and cardiac arrest, especially within the initial 30 days after a heart attack. The incidence of arrhythmias in ED is increasing due to demographic changes and higher rates of chronic illnesses such as diabetes, hypertension, and chronic kidney disease. These comorbidities, coupled with lifestyle factors such as smoking and alcohol consumption, complicate arrhythmia management, especially among older adults and males. Rapid and precise ECG interpretation in the ED is crucial for identifying specific arrhythmia types and initiating appropriate treatments. Atrial fibrillation (AF), the most prevalent form of rapid heart rhythm originating above the ventricles, notably impacts patient outcomes, particularly in cases of AMIand heart failure. In the ED, managing AFfocuses on preventing strokes with thromboprophylaxis and employing risk assessment tools such as CHA2DS2-VASc and HAS-BLED scores. The analysis highlights how risk factors like hypertension, obesity, obstructive sleep apnea (OSA), and diabetes intricately influence the development and worsening of AF. Optimizing AF treatment outcomes requires a multidisciplinary approach involving cardiologists, emergency physicians, and critical care specialists. Future research should prioritize evaluating the effectiveness of preventive and therapeutic interventions for AF, integrating new risk factors and genetic insights to enhance prediction and management strategies. Understanding the factors contributing to arrhythmias and mortality in the ED underscores the importance of timely and accurate diagnostic and therapeutic measures to improve patient care and outcomes.

Exploring the Prognostic Role of D-dimer Levels in Pancreatic Cancer: A Comprehensive Review of Clinicopathological Associations.

Pancreatic cancer is known for its dismal prognosis and high mortality rate, primarily due to late-stage diagnosis and aggressive disease progression. Finding reliable prognostic biomarkers is crucial in improving patient outcomes and guiding treatment strategies. D-dimer, a fibrin degradation product, has emerged as a potential biomarker of interest in various cancers due to its association with coagulation abnormalities. This comprehensive review investigates the prognostic role of D-dimer levels in pancreatic cancer by synthesizing current research and exploring its clinicopathological associations. Elevated D-dimer levels in pancreatic cancer patients have been linked to poorer clinical outcomes, including reduced overall survival and increased disease progression. The review examines how D-dimer levels correlate with tumor characteristics such as stage, grade, and metastatic spread, highlighting its potential utility as a prognostic marker. Additionally, the review addresses the methodological challenges in D-dimer measurement and the need for standardized protocols to enhance the reliability and applicability of results. Future research directions are identified, focusing on validating D-dimer's clinical utility and integrating it into routine practice for risk stratification and personalized treatment planning. By providing a comprehensive overview of D-dimer's prognostic value, this review aims to contribute to developing more effective management strategies for pancreatic cancer, ultimately improving patient care and outcomes.