Inappropriate Resource Research Articles

Research-Driven Solutions for Enhancing Leadership in Competence-Based Curriculum Implementation in Kenyan Secondary Schools

Abstract: The study adopted a systematic review to analyze AI solutions in enhancing leadership in the implementation of CBC in junior secondary schools in Kenya. The study focuses on challenges relating to inadequate training of teachers, inappropriate resource allocation, and stakeholder engagement. We adopted Technology Acceptance Model (TAM) and Distributed Leadership Theory. The findings reveal that AI may enhance educational leadership by the implementation of real-time monitoring, preparation of teaching resources, and managing the institution more effectively. Moreover, the impeding factors for AI penetration in educational institutions are physical infrastructure, lack of digital literacy, and local conditions. In this regard, the study recommends partnerships between educational institutions and companies manufacturing technology equipment and digital training programs. Further research will focus on the development of specific AI applications to fit the Kenyan educational setup for serving all stakeholders: students, teachers, and school administrators.

NIMG-07. GLIOBLASTOMA AS A MIMIC OF ACUTE ISCHEMIC STROKE: AN UNDERRECOGNIZED PHENOMENON AND THE IMPACT ON PATIENT OUTCOMES

Abstract BACKGROUND Glioblastoma may present similarly to acute ischemic stroke. This study aims to determine characteristics and outcomes of patients with glioblastoma presenting with stroke-like symptoms. Our objective is to characterize patients with glioblastoma who present as mimics of acute ischemic stroke and identify differences in outcomes when compared to those diagnosed with glioblastoma only. METHODS The 2016-2019 National Inpatient Sample (NIS) database was queried for all patients who had a new diagnosis of glioblastoma. Patients with new glioblastoma who carried an admission diagnosis of acute ischemic stroke, but did not undergo thrombectomy, chemical thrombolysis, or hemicraniectomy were categorized as “GBM-Stroke Mimic”. The characteristics and comorbidities between GBM-Stroke Mimic and new glioblastoma patients were compared. Primary outcomes analyzed were discharge disposition and mortality. RESULTS Of 61,755 patients newly diagnosed with glioblastoma, 1,000 (1.6%) were GBM-Stroke Mimics. GBM-Stroke Mimic patients more commonly presented with aphasia (P < 0.001) and hemiplegia (P < 0.001). Age greater than 65, atrial fibrillation, diabetes mellitus, hypertension, hyperlipidemia, and long-term anticoagulation/antiplatelet therapy were more commonly associated with GBM-Stroke Mimic patients (all P < 0.001). GBM-Stroke Mimic patients were more likely to be discharged to skilled nursing facility, (p < 0.001), and a diagnosis of GBM-Stroke Mimic was an independent risk factor for inpatient death (P < 0.001). CONCLUSION To our knowledge, this is the first study formally investigating the clinical outcomes of glioblastoma when initially diagnosed as stroke. When this misdiagnosis is made, we found an association with increased inpatient mortality, delays of care, and inappropriate resource allocation.

Burden of Non-Protocolized Patient Transport Outside of Response Area on a Rural Emergency Medical Services System

Objectives Transport destination decisions by prehospital personnel depend on a combination of protocols, judgment, patient acuity, and patient preference. Non-protocolized transport outside the service area may result in unnecessary time out of service and inappropriate resource utilization. Scant research exists regarding clinician rationale for destination decisions. Methods We retrospectively reviewed one year of scene transports by a single rural, hospital-based emergency medical services (EMS) system. We collected dispatch, patient demographic, primary impression, and transport data from prehospital records and matched them to emergency department (ED) data. We characterized rationale for transport decisions and compared rates of hospital admission and specialist consultation in the ED as surrogates for decision appropriateness. Results We reviewed 2,223 patient transports, 281 of which were transported out of the service area. The most common reasons for out-of-area transport were patient preference NOT related to prior medical care (40%) and clinician judgment (24%). Admit rates were highest for per protocol (85%) and patient preference related to prior medical care (67%) groups and lowest for no explanation (41%) and clinician judgment (47%) groups. Rates of in person specialist consultation in the ED were highest in per protocol (69%) and clinician judgment (47%) groups and lowest in no explanation (23%) and patient preference NOT related to prior medical care (30%) groups. Clinician judgment was less predictive of admission and specialist consultation for non-trauma and pediatric patients than for all patients. Median time out of service was more than twice as long for out-of-area transports (140 min) compared to patients transported to the nearest facility (62 min). For out-of-area transports discharged from the ED without specialty consultation (n = 104), ambulances traveled an additional 52 miles/patient compared to theoretical transport to nearest facility. Conclusions Unit out of service time more than doubled for non-protocolized transports outside of the service area and rationale for destination decisions variably predicted admission and specialist consultation rates. Patient preference NOT related to prior medical care and, in pediatric and non-trauma populations, clinician judgment, were less predictive of admission and specialist consultation. Transport guidelines should balance rationale for transport destination and patient characteristics with resource preservation, especially in low-resource systems.

Maladaptive behaviors in disasters: case study evaluation of Hurricane Hugo, Hurricane Katrina and the Haiti Earthquake.

Maladaptive behaviors during a disaster refer to actions that do not benefit the individual or society. Quarantelli highlights several maladaptive behaviors myths associated with disasters: widespread antisocial behavior, passivity, role conflict or abandonment, and sudden widespread mental health breakdowns (1). Despite early work reporting these myths, the common perception is that maladaptive behaviors such as rioting, looting, panic, and criminal conduct are prevalent in the wake of disasters. This is despite research by de Ville de Goyet and Arnold which has called on public officials and the media to stop propagating false disaster myths (2, 3). The classic academic response has been that this is a misconception and that, in fact, such behaviors are a very small part of the overall disaster and are mostly non-existent. Misconceptions about the prevalence of maladaptive behaviors can lead to inappropriate resource allocation, such as allocating extra police officers to prevent looting when the overall crime rate for the most part, decreases during disasters (4). Furthermore, while there are several persistent maladaptive behaviors myths, this is confounded by the presence of actual negative behaviors post disaster: false damage claims, insurance fraud, illegally obtaining relief supplies, failure to provide contracted repair services, hoarding of essential items, psychological trauma (which can lead to intergenerational transmission of the disaster memory) and medications and price gouging (5).When reading lay-press articles about recent disasters, it appears that these behaviors are on the rise. This raises the question: Has there been a change in the basic human reaction to disasters and are maladaptive behaviors on the rise? This review article focuses on case studies from three natural disasters: Hurricanes Hugo and Katrina, and the Haiti Earthquake. The goal of this review article is to evaluate these three natural disasters for evidence of maladaptive behaviors.

Professional perceptions of right-first-time and quality management in construction projects through open-ended feedback

PurposeThe construction industry has struggled to deliver schemes on time to budget and right-first-time (RFT). There have been many studies into nonconformance and rework through quantitative research over the years to understand why the industry continues to see similar issues of failure. Some scholars have reported rework figures as high as 12.6% of total contract value, highlighting major concerns of the sustainability of construction projects. Separately, however, there have been few studies that explore and detail the views of industry professions who are caught in the middle of quality issues, to understand their perceptions of where the industry is failing. As such, this paper interrogates qualitative data (open-ended questions) on the topic of nonconformance and rework in construction to understand what industry professionals believe are the causes and suggested improvement areas.Design/methodology/approachA qualitative approach is adopted for this research. An industry survey consisting of seven open-ended questions is presented to two professional working groups within a Tier 1 contractor, and outputs are analysed using statistic software (NVivo 12) to identify prominent themes for discussion. Inductive analysis is undertaken to gain further insight into responses to yield recurrent areas for continuous improvement.FindingsQualitative analysis of the survey reveals a persistent prioritisation of cost and programme over quality management in construction project. Furthermore, feedback from construction professionals present a number of improvement areas that must be addressed to improve quality. These include increased training and competency investment, overhauling quality behaviours, providing greater quality leadership direction and reshaping the way clients govern schemes.Research limitations/implicationsThere are limitations to this paper that require noting. Firstly, the survey was conducted within one principal contractor with varying levels of knowledge across multiple sectors. Secondly, the case study was from one major highways scheme; therefore, the generalisability of the findings is limited. It is suggested that a similar exercise is undertaken in other sectors to uncover similar improvement avenues.Practical implicationsThe implications of this study calls for quality to be re-evaluated at project, company, sector and government levels to overhaul how quality is delivered. Furthermore, the paper identifies critical learning outcomes for the construction sector to take forward, including the need to reassess projects to ensure they are appropriately equip with competent personnel under a vetted, progressive training programme, share collaborative behaviours that value quality delivery on an equal standing to safety, programme and cost and tackle the inappropriate resource dilemmas projects finding themselves in through clear tendering and accurate planning. In addition, before making erratic decisions, projects must assess the risk profiling of proceed without approved design details and include the client in the decision-making process. Moreover, the findings call for a greater collaborative environment between the construction team and quality management department, rather than being seen as obstructive (i.e. compliance based policing). All of these must be driven by leadership to overhaul the way quality is managed on schemes. The findings demonstrate the importance and impact from open-ended survey response data studies to enhance quantitative outcomes and help provide strengthened proposals of improvement.Originality/valueThis paper addresses the highly sensitive area of quality failure outcomes and interrogates them via an industry survey within a major UK contractor for feedback. Unique insights are gained into how industry professionals perceive quality in construction. From previous research, this has been largely missing and offers a valuable addition in understanding the “quality status quo” from those delivering schemes.

Spectrum fragmentation-aware dynamic network slicing deployment in computing power networks based on elastic optical networks

Abstract The widespread application of AI with high computing requirements has driven the rapid development of the computing field. Computing Power Networks (CPNs) have been recognized as solutions to providing on-demand computing services, and its service provisioning can be modeled as a network slicing deployment problem. Elastic Optical Networks (EONs) offer the flexibility to allocate spectrum resources, making them well-suited for network slicing technology. Consequently, EON-based CPNs have attracted considerable attention. However, the unbalanced distribution of computing resources leads to inefficient computing resource utilization. Meanwhile, spectrum resources may be isolated and difficult for other services. This phenomenon is known as spectrum fragmentation, leading to inefficient spectrum resource utilization. To achieve balanced and efficient resource utilization, this paper first analyzes the main reasons for load unbalance and spectrum fragmentation in CPNs: mismatched slicing deployment and inappropriate resource scheduling. Therefore, a dynamic network slicing scheme based on traffic prediction (DNS-TP) is designed. Its core highlight is cooperative optimization slicing deployment and resource scheduling based on spectrum fragmentation awareness. Simulation results show that the proposed scheme enhances the network slicing acceptance ratio, computing and spectrum resource utilization while exhibiting strong performance in resource balancing.

Unnecessary interventions for the management of hip osteoarthritis: a population-based cohort study.

Patients aged 40-60 years who require total hip arthroplasty (THA) often first receive unindicated hip arthroscopy or magnetic resonance imaging (MRI). Our objective was to identify potentially inappropriate resource utilization before THA, specifically reporting on the proportion of patients aged 40-60 years who underwent hip arthroscopy or MRI in the year before THA. We conducted a retrospective, population-based study at the provincial level. We retrieved data from the Canadian Institute for Health Information (CIHI). We included all Ontario residents who underwent an elective, primary THA for osteoarthritis between Apr. 1, 2004, and Mar. 31, 2016. We identified the rates and timing of patients who underwent an MRI or hip arthroscopy before their index THA. The percentage of patients who underwent an MRI before THA increased significantly over the study period, from 8.7% in 2004 to 23.8% in 2015. There was also a significant but variable trend in the percentage of patients who underwent a hip arthroscopy before THA. Our results demonstrate a high, gradually increasing proportion of patients who received a hip MRI and a low but increasing proportion of patients who received hip arthroscopy in close proximity to THA. Multidisciplinary collaboration may improve knowledge translation and help reduce the rate of clinically unnecessary diagnostic and therapeutic interventions in this population of patients who require THA.

Value Leakage in Product–Service System Provision: A Business Model Alignment Perspective

To stay competitive, manufacturing companies offer product–service systems (PSS) to avoid commoditization of their products. The potential to create value through PSS offerings lies in a company's ability to successfully implement the PSS business model. However, many companies are unable to realize the benefits because PSS represents significant changes to all the business model elements, which comprise value creation, value delivery, and value capture. This leads to misalignment among the business model elements, which is a topic of interest within PSS and business model literatures. This article aims to provide empirical insights into the business-model-element alignment problems and conceptualize their consequences, which manufacturing companies face during PSS implementation. This article utilizes an abductive multicase study of three Swedish manufacturing companies with long-term experience of PSS provision to provide novel insights by identifying six alignment problems that companies face as a consequence of the interaction among the three business model elements. Furthermore, we contribute to both the PSS and business model literature by conceptualizing the consequences of business model element alignment problems, explaining the three value leakages that occur as a result of inappropriate resource and capability utilization, unattractive offer configurations, and inefficient service network processes in PSS provision.

A Coordinated Allocation Method for Right-Turn Strategy at Signalized Intersections with Optimal Pedestrian and Vehicle Delays

With strict enforcement of pedestrian right of way at all intersections, the inappropriate right-turn resource allocation from a spatial and temporal perspective will lead to a reduction in the operational efficiency of the intersection. In this paper, three spatiotemporal resource allocation schemes for right-turning vehicles are proposed, considering the vehicle and pedestrian traffic efficiency in all directions of the intersection. To minimize vehicle and pedestrian delay at the intersection individually, an optimization model is established with the effective green time of each phase and three schemes as decision variables. A right-turn vehicle and pedestrian conflict delay model is developed based on the pedestrian-vehicle interaction behavior as the constraints of the optimization model. The NSGA-II algorithm is used to solve the model, and the quantitative criteria for the exclusive right-turn lane and phase are obtained by sensitivity analysis. The results of this paper can be used as a guide for traffic design and for planning and controlling the operation of right-turning vehicles at intersections.

Pre-screening for non-diagnostic coronary computed tomography angiography.

Indiscriminate coronary computed tomography angiography (CCTA) referrals for suspected coronary artery disease could result in a higher rate of equivocal and non-diagnostic studies, leading to inappropriate downstream resource utilization or delayed time to diagnosis. We sought to develop a simple clinical tool for predicting the likelihood of a non-diagnostic CCTA to help identify patients who might be better served with a different test. We developed a clinical scoring system from a cohort of 21 492 consecutive patients who underwent CCTA between February 2006 and May 2021. Coronary computed tomography angiography study results were categorized as normal, abnormal, or non-diagnostic. Multivariable logistic regression analysis was conducted to produce a model that predicted the likelihood of a non-diagnostic test. Machine learning (ML) models were utilized to validate the predictor selection and prediction performance. Both logistic regression and ML models achieved fair discriminate ability with an area under the curve of 0.630 [95% confidence interval (CI) 0.618-0.641] and 0.634 (95% CI 0.612-0.656), respectively. The presence of a cardiac implant and weight >100 kg were among the most influential predictors of a non-diagnostic study. We developed a model that could be implemented at the 'point-of-scheduling' to identify patients who would be best served by another non-invasive diagnostic test.

Reinforcement Learning for Reducing the Interruptions and Increasing Fault Tolerance in the Cloud Environment

Cloud computing delivers robust computational services by processing tasks on its virtual machines (VMs) using resource-scheduling algorithms. The cloud’s existing algorithms provide limited results due to inappropriate resource scheduling. Additionally, these algorithms cannot process tasks generating faults while being computed. The primary reason for this is that these existing algorithms need an intelligence mechanism to enhance their abilities. To provide an intelligence mechanism to improve the resource-scheduling process and provision the fault-tolerance mechanism, an algorithm named reinforcement learning-shortest job first (RL-SJF) has been implemented by integrating the RL technique with the existing SJF algorithm. An experiment was conducted in a simulation platform to compare the working of RL-SJF with SJF, and challenging tasks were computed in multiple scenarios. The experimental results convey that the RL-SJF algorithm enhances the resource-scheduling process by improving the aggregate cost by 14.88% compared to the SJF algorithm. Additionally, the RL-SJF algorithm provided a fault-tolerance mechanism by computing 55.52% of the total tasks compared to 11.11% of the SJF algorithm. Thus, the RL-SJF algorithm improves the overall cloud performance and provides the ideal quality of service (QoS).

Examining predictors for 6-month mortality and healthcare utilization for patients admitted for heart failure in the acute care setting

BackgroundAcute heart failure (AHF) is a leading cause of mortality and hospitalization. Past studies reported increased healthcare spending in the last year of life in high-income countries, and this has been characterized as inappropriate healthcare resource utilization. The study aimed to examine potentially (in)appropriate healthcare utilization by comparing healthcare utilization patterns across predicted and observed 6-month mortality among patients admitted for HF. MethodsWe conducted a retrospective cohort study among patients presenting at the emergency department (ED) of a tertiary hospital with HF as primary diagnosis and admitted after their ED discharge. We used LASSO Cox proportional hazards models to predict 6-month mortality, and estimated healthcare utilization patterns of predicted and observed mortality across inpatient healthcare services. Results3946 patients were admitted into the emergency department with a primary diagnosis of HF. From 57 candidate variables, 17 were retained in the final 6- month mortality model (C-statistic 0.66). Patients who died within 6-months of ED admission had longer length of stay (LOS) and less inpatient surgeries than those who survived. Patients with a greater predicted mortality risk were admitted to the ICU more often and had a longer LOS than those with a lower predicted mortality risk. ConclusionsThere were significant differences in healthcare resource utilization in patients admitted for AHF across predicted versus actual mortality. Lack of information on patients' preferences prevents the estimation of (in)appropriateness. Future studies should account for these considerations to estimate inappropriate healthcare utilization among these patients.

Challenges Against Implementation of Social Studies Curriculum for Moral Development in Nigerian Junior Secondary Schools: Ilorin as Case Study

This study explores the challenges against the implementation of Junior Secondary School Social Studies curriculum for moral development in Ilorin, Kwara State, Nigeria. The study is a qualitative one that employed a case study research approach. The qualitative tools of interview and observation were used to gather data to address the research questions. A total of 12 teachers with a variety of years of experience were selected to participate in the study. Purposive sampling procedures were used to select the sample for the study. For data analysis, teacher perspectives were gathered and examined for emerging themes and trends among teachers in their perspectives. The result showed that the junior secondary school Social Studies curriculum has content and teaching approaches that are suitable for students’ moral development. Equally, the study revealed that class congestion, inadequate and inappropriate resource materials, wide syllabus and examination pressure were among the factors hindering effective implementation of the curriculum for moral inculcation. Some recommendations were also offered for the improvement of the Social Studies curriculum.

Roles of Public Financing to Address Urban Faecal Sludge Management (FSM) Services in Bangladesh: a Study of Dhaka And Faridpur Cities

Prior to adopting Sustainable Development Goals (SDGs), Bangladesh achieved 100% access to sanitation by 2015 mostly by on-site sanitation systems (OSSs). The major drawbacks of the OSSs are the deposition of the Faecal Sludge (FS) underground and environmental pollution due to the indiscriminate disposal of FS. As an overpopulated country, 40% out of 162 million people live in urban areas. However, the national planning process; the Five-Year Planning (FY 2016-20) did not put emphasis on the Faecal Sludge Management (FSM). Major policies also did not address FSM though there are various policies relevant to promote safe sanitation. Against this backdrop, it is difficult to manage the second-generation sanitation challenge like FSM services for the enormously growing urban population. However, to achieve the target of sustainable sanitation (SDG 6.2), the country needs much attention to address the FSM services with a huge public investment to build necessary infrastructures and initiate service delivery by involving stakeholders. This study investigated the role of public finance in addressing urban FSM services in two urban centers: Dhaka and Faridpur. The current public financing addressed FSM service for 39% of inhabitants in Faridpur; while in Dhaka, FSM service is very negligible and Dhaka Water Supply and Sewerage Authority (DWASA) is facilitating only the emptying service by engaging the private enterprises and NGOs shows a resource gap for FSM financing. Lack of institutional coordination, role clarity on service delivery, service provisioning, capacity, leadership, and inappropriate resource sharing among the utilities are the key challenges. The study has drawn a set of public financing mechanisms to achieve urban FSM service.

Erroneous electrocardiographic interpretations and its clinical implications.

The advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient's management. We performed a retrospective descriptive analysis of misinterpreted ECGs and its clinical impact from May 28, 2020 to May 9, 2021. An electrophysiologist screened ECGs with confirmed diagnosis of atrial fibrillation (AF), sinus tachycardia (ST), sinus bradycardia (SB), intraventricular conduction delay (IVCD), and premature atrial contraction (PAC) that were performed in the emergency department. We then classified the misinterpreted ECGs as wrongly diagnosed AF, ST, SB, IVCD, or PAC into the correct diagnosis and reviewed the misinterpreted ECGs and medical records to evaluate inappropriate use of antiarrhythmic drugs (AAD), beta-blockers (BB), calcium channel blockers (CCB), anticoagulation, or resource utilization of cardiology and/or electrophysiology (EP) consultation. A total of 4969 ECGs were screened with diagnoses of AF (2282), IVCD (296), PAC (972), SB (895), and ST (638). Among these, 101 ECGs (2.0%) were misinterpreted. Wrongly diagnosed AF (58.4%) was the most common followed by wrongly diagnosed PAC (14.9%), wrongly diagnosed ST (12.9%), wrongly diagnosed IVCD (7.9%), and wrongly diagnosed SB (6.0%). Patients with misinterpreted ECGs were aged 76.6 ± 11.6 yearswith male (52.5%) predominance and hypertension being the most prevalent (83.2%) comorbid condition. The misinterpretation of ECGs led to the inappropriate use of BB (19.8%), CCB (5.0%), AAD therapy (7.9%), anticoagulation (6.9%) in patients with wrongly diagnosed AF, as well as inappropriate resource utilization including cardiology (41.6%) and EP (8.9%) consultations. Misinterpretation of ECGs may lead to inappropriate medical therapies and increased resource utilization. Therefore, it is essential to encourage physicians to carefully examine AI interpreted ECG's, especially those interpreted as having AF.

Trans-diagnostic determinants of psychotherapeutic treatment response: The pressing need and new opportunities for a more systematic way of selecting psychotherapeutic treatment in the age of virtual service delivery.

Numerous forms of psychotherapy have demonstrated effectiveness for individuals with specific mental disorders. It is, therefore, the task of the clinician to choose the most appropriate therapeutic approach for any given client to maximize effectiveness. This can prove to be a difficult task due to at least three considerations: (1) there is no treatment approach, method or model that works well on all patients, even within a particular diagnostic class; (2) several treatments are equally efficacious (i.e., more likely to be effective than no treatment at all) when considered only in terms of the patient's diagnosis; and (3) effectiveness in the real-world therapeutic setting is determined by a host of non-diagnostic factors. Typically, consideration of these latter, trans-diagnostic factors is unmethodical or altogether excluded from treatment planning - often resulting in suboptimal patient care, inappropriate clinic resource utilization, patient dissatisfaction with care, patient demoralization/hopelessness, and treatment failure. In this perspective article, we argue that a more systematic research on and clinical consideration of trans-diagnostic factors determining psychotherapeutic treatment outcome (i.e., treatment moderators) would be beneficial and - with the seismic shift toward online service delivery - is more feasible than it used to be. Such a transition toward more client-centered care - systematically considering variables such as sociodemographic characteristics, patient motivation for change, self-efficacy, illness acuity, character pathology, trauma history when making treatment choices - would result in not only decreased symptom burden and improved quality of life but also better resource utilization in mental health care and improved staff morale reducing staff burnout and turnover.

Organisational forgetting in organisations: identifying the causes and contexts using thematic analysis method

Organisational forgetting is the main issue in organisations that have been considered by researchers in recent years. This study was conducted to examine the causes and themes of organisational forgetting in organisations based on the thematic analysis. This paper's case study comprised 40 Iranian and foreign studies on organisational forgetting over the past ten years. The results indicated that the main causes and themes creating organisational forgetting depend on two individual and organisational factors. In the case of individual factors, some components such as a sense of incapability and meaningless and organisational factors include organisational culture, inappropriate human resource management, lack of a strategic plan in the organisation, non-productive interactions in or out of the organisation, and lack of suitable maintenance and retrieval systems lead to such problem. According to the obtained results, it was recommended that researchers focus on designing an organisational culture model to cope with organisational forgetting by considering the mediating role of succession.

In-Hospital Mortality Following Traumatic Injury in South Africa.

The in-hospital trauma mortality rate in South Africa remains unknown, and it is unclear whether deficits in hospital care are contributing to the high level of trauma-related mortality. All patients hospitalized because of trauma at the Department of Surgery at Grey's Hospital, Pietermaritzburg Metropolitan Trauma Service, were prospectively entered in an electronic database starting in 2013 and the data were retrospectively analyzed. The trauma service adheres to Advanced Trauma Life Support and the doctors have attended basic and advanced courses in trauma care. The primary outcome was in-hospital mortality. Of 9795 trauma admissions, 412 (4.2%) patients died during hospital care between January 2013 and January 2019. Forty-six percent died after road traffic accidents, 19% after gunshot wounds, 13% after stab wounds, and 10% after assaults. Sixteen percent were classified as avoidable deaths due to inappropriate care and resource limitations. Fifty percent died because of traumatic brain injury and 80% of them were unavoidable. In conclusion, the in-hospital trauma mortality rate at a South African trauma center using systematic trauma care is lower than that reported from other trauma centers in the world during the past 20 years. Nevertheless, 16% of death cases were assessed as avoidable if there had been better access to intensive care, dialysis, advanced respiratory care, blood for transfusion, and improvements in surgery and medical care.

Abstract 9873: Erroneous Electrocardiographic Interpretations and Its Clinical Implications

Introduction: Advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient's management Methods: We performed a retrospective descriptive analysis of misinterpreted ECGs and its clinical impact from May 28, 2020 to May 9, 2021. An electrophysiologist screened ECGs with confirmed diagnosis of atrial fibrillation (AF), sinus tachycardia (ST), sinus bradycardia (SB), intraventricular conduction delay (IVCD), and premature atrial contraction (PAC) that were performed in the emergency department. We then classified the misinterpreted ECGs as pseudo-AF, ST, SB, IVCD, or PAC into the correct diagnosis, and reviewed the misinterpreted ECGs and medical records to evaluate inappropriate use of antiarrhythmic drugs (AAD), beta-blockers (BB), calcium channel blockers (CCB), anticoagulation, or resource utilization of cardiology and/or electrophysiology (EP) consultation. Results: A total of 4,969 ECGs were screened with diagnoses of AF (2,282), IVCD (296), PAC (972), SB (895), and ST (638). Among these, 101 ECGs (2.02%) were misinterpreted. Pseudo-AF (58%) was the most common followed by pseudo-PAC (15%), pseudo-ST (13%), pseudo-IVCD (8%) and pseudo-SB (6%). Patients with misinterpreted ECGs were aged 76.6±11.6yr with male (52.5%) predominance and hypertension being the most prevalent (83.2%) comorbid condition. The misinterpretation of ECGs led to the inappropriate use of BB (19.8%), CCB (5.0%), AAD therapy (7.9%), anticoagulation (30.7%) in patients with pseudo-AF, as well as inappropriate resource utilization including cardiology (41.6%) and EP (8.9%) consultations. Conclusions: Misinterpretation of ECGs may lead to inappropriate medical therapies and increased resource utilization. Therefore, it is essential to encourage physicians to carefully examine AI interpreted ECG’s, especially those interpreted as having AF.

Prehospital stroke mimics in the Stockholm Stroke Triage System.

IntroductionIn 2017, Stockholm implemented a new prehospital stroke triage system (SSTS) directing patients with a likely indication for thrombectomy to the regional comprehensive stroke center (CSC) based on symptom severity and teleconsultation with a physician. In Stockholm, 44% of patients with prehospital code stroke have stroke mimics. Inadvertent triage of stroke mimics to the CSC could lead to inappropriate resource utilization.AimsTo compare the characteristics between (1) triage-positive stroke mimics and stroke (TP mimics and TP stroke) and (2) triage-negative stroke mimics and stroke (TN mimics and TN stroke) and to (3) compare the distribution of stroke mimic diagnoses between triage-positive and triage-negative cases.MethodsThis prospective observational study collected data from October 2017 to October 2018, including 2,905 patients with suspected stroke who were transported by code-stroke ambulance to a Stockholm regional hospital. Patients directed to the CSC were defined as triage-positive. Those directed to the nearest stroke center were defined as triage-negative.ResultsCompared to individuals with TP stroke (n = 268), those with TP mimics (n = 55, median 64 vs. 75 years, P < 0.001) were younger and had lower NIHSS score (median 7 vs. 15, P < 0.001). Similarly, those with TN mimics (n = 1,221) were younger than those with TN stroke (n = 1,361, median 73 vs. 78 years, P < 0.001) and had lower NIHSS scores (median 2 vs. 4, P < 0.001). Functional paresis was more common in those with TP mimics than in those with TN mimics, 18/55 (32.7%) vs. 82/1,221 (6.7%), P < 0.001. Systemic infection was less common in those with TP mimics than in those with TN mimics, 1/55 (1.8%) vs. 160/1,221 (13.1%), P < 0.011. There was a trend toward “syncope, hypotension, or other cardiovascular diagnosis” being less common in those with TP mimics than in those with TN mimics, 1/55 (1.8%) vs. 118/1,221 (9.7%), P < 0.055.ConclusionsIn the SSTS, those with triage-positive and triage-negative stroke mimics were younger and had less severe symptoms than patients with stroke. All patients with TP mimics who had hemiparesis but overall exhibited less severe symptoms against true stroke but more severe symptoms than those with TN mimics were triaged to the nearest hospital. Over-triage of functional paresis to the CSC was relatively common. Meanwhile, a large majority of cases with minor symptoms caused by stroke mimics was triaged correctly by the SSTS to the nearest stroke center.