Length Of Admission Research Articles

Clinical Predictors of Subacute Myocardial Dysfunction in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19.

Multisystem Inflammatory Syndrome in Children (MIS-C) often involves a post-viral myocarditis and associated left ventricular dysfunction. We aimed to assess myocardial function by strain echocardiography after hospital discharge and to identify risk factors for subacute myocardial dysfunction. We conducted a retrospective single-center study of MIS-C patients admitted between 03/2020 and 03/2021. Global longitudinal strain (GLS), 4-chamber longitudinal strain (4C-LS), mid-ventricular circumferential strain (CS), and left atrial strain (LAS) were measured on echocardiograms performed 3–10 weeks after discharge and compared with controls. Among 60 MIS-C patients, hypotension (65%), ICU admission (57%), and vasopressor support (45%) were common, with no mortality. LVEF was abnormal (< 55%) in 29% during hospitalization but only 4% at follow-up. Follow-up strain abnormalities were prevalent (GLS abnormal in 13%, 4C-LS in 18%, CS in 16%, LAS in 5%). Hypotension, ICU admission, ICU and hospital length of stay, and any LVEF < 55% during hospitalization were factors associated with lower strain at follow-up. Higher peak C-reactive protein (CRP) was associated with hypotension, ICU admission, total ICU days, and with lower follow-up GLS (r = − 0.55; p = 0.01) and CS (r = 0.41; p = 0.02). Peak CRP < 18 mg/dL had negative predictive values of 100% and 88% for normal follow-up GLS and CS, respectively. A subset of MIS-C patients demonstrate subclinical systolic and diastolic function abnormalities at subacute follow-up. Peak CRP during hospitalization may be a useful marker for outpatient cardiac risk stratification. MIS-C patients with hypotension, ICU admission, any LVEF < 55% during hospitalization, or a peak CRP > 18 mg/dL may warrant closer monitoring than those without these risk factors.

Laparoscopic Cholecystectomy with Intraoperative Cholangiogram and Antegrade Biliary Stenting in Acute Gallstone Pancreatitis: A Pilot Study.

Aims: To demonstrate feasibility and efficacy of simultaneous intraoperative cholangiogram (IOC) and antegrade biliary stenting (ABS) with laparoscopic cholecystectomy (LC) compared with preoperative biliary investigation and delayed LC in acute gallstone pancreatitis (AGP). Methods: A retrospective case-control study was performed comparing patients who had a simultaneous IOC ± ABS with LC at index admission with those who had delayed LC in the treatment of AGP. 74 patients were included in this study from January 2016 to October 2018. All patients who underwent LC for AGP were included in a prospective database with 1 year follow-up. Results: 30 (40.5%) patients underwent simultaneous IOC ± ABS with LC, 11 of these required ABS insertion. 2 (6.7%) patients also underwent magnetic resonance cholangiopancreatography (MRCP). No patients underwent endoscopic retrograde cholangiopancreatography (ERCP). No patients were readmitted with AGP or symptomatic gallbladder. Mean length of total hospital admission was 10.1 days. 44 (59.5%) patients underwent delayed LC. Of this cohort, 7 (15.9%) patients underwent ERCP and 19 (43.2%) underwent MRCP. In total, there were 19 (43.2%) readmissions in this group with pancreatitis or symptomatic gallbladder. Mean length of total hospital admission was 13 days. Conclusions: In our pilot study we demonstrated that performing simultaneous IOC ± ABS with LC is a feasible option in the secondary care setting. Using this surgical technique, we have demonstrated a reduction in readmissions with AGP and symptomatic gallbladder while also reducing the number of CBD investigations required. Using simultaneous IOC ± ABS with LC reduced the mean total length of stay in hospital.

No evidence of delay in colorectal cancer diagnosis during the COVID-19 pandemic in Gwangju and Jeonnam, Korea

We evaluated whether the coronavirus disease 2019 (COVID-19) pandemic caused delays in the diagnosis and treatment of colorectal cancer (CRC) in Korea, where there have been no regional or hospital lockdowns during the pandemic period. Data on CRC patients (n=1,445) diagnosed in Gwangju Metropolitan City and Jeonnam Province between January 2019 and December 2021 were assessed. The stage at the time of CRC diagnosis, route to diagnosis, time to initial cancer treatment, and length of hospital admission were compared before and during the COVID-19 pandemic. Logistic regression was also performed to identify factors associated with the risk for diagnosis in an advanced stage. No negative effects indicating a higher CRC stage at diagnosis or delayed treatment during the pandemic were observed. Instead, the risk for an advanced stage at diagnosis (TNM stage III/IV) decreased in CRC patients diagnosed during the pandemic (odds ratio, 0.768; 95% confidence interval, 0.647 to 0.911). No significant differences in the interval from diagnosis to operation or chemotherapy were observed. No negative effects on CRC diagnosis and treatment were found until the end of 2021, which may be related to the small magnitude of the COVID-19 epidemic, the absence of a lockdown policy in Korea, and the rebound in the number of diagnostic colonoscopy procedures in 2021.

Improving Patient Flow in the Surgical Assessment Unit by Facilitating Access to Computer Tomography Scanning.

Introduction Patient flow is "the ability of healthcare systems to manage patients effectively and with minimal delays as they move through stages of care". National Health Service (NHS) England has highlighted the importance of improving patient flow, and the many benefits to both staff and patients, including: "improved clinical outcome and experience of patients"; "eliminating waits and delays"; "saving time and effort by avoiding duplication of work"; "saving money"; and "improving the reputation of the NHS". Limited access to computerised tomography (CT) imaging for surgical patients can disrupt patient flow through delayed diagnosis, management, and discharge.The aims of this quality improvement project were to assess the effect of a dedicated Surgical Assessment Unit (SAU) radiologist on access to CT scanning and its impact on patient flow. The measured outcomes were time from admission to CT scanning, and length of admission. Method In June 2020, a radiology registrar was allocated to the SAU to vet and report CT imaging. CT requests from the SAU were identified from Picture Archiving and Communication System (PACS) in the first two weeks of June 2019 and 2020 during normal working hours (Monday to Friday, between 0900 and 1700). We performed a retrospective audit and compared data from 2019 and 2020. The measured primary outcome was time from admission to imaging. The secondary outcome was the length of admission. Results In the two-week period in June 2019, 25 patients requiring a CT scan presented to SAU during normal working hours. In 2020, this number increased to 40 patients. In 2019, 5 patients had a CT scan performed within four hours of admission (20%). In 2020, following the allocation of a radiologist to the SAU, 33 patients (82.5%) had their CT performed within four hours of admission.In 2019, one patient (4%) was discharged within six hours of admission. A further 16% had a length of admission between six and 12 hours. The majority of patients (80%) remained in the hospital for more than 12 hours. In 2020, 45% of patients were discharged within four hours following a CT scan. More than half of the patients (57.5%) were discharged within 12 hours. Conclusion The allocation of a radiologist in the SAU led to both areduction in time to perform CT scans and an increased number of patients being discharged within 12 hours. These results suggest that early access to imaging improves patient flow. Further research will help to establish whether the allocation of a radiologist in the SAU is a beneficial and cost-effective method of improving patient flow, and whether this may help reduce the current pressure on NHS services.

Suboptimal coronary flow after PCI in STEMI patients: clinical implications and predictors

Abstract Background Even in experienced angioplasty centers, percutaneous coronary intervention (PCI) in the acute setting of ST-elevation myocardial infarctions (STEMI) is associated with a low, but still significant rate of suboptimal coronary flow. Identification of its clinical impact and potential modifiable risk factors is important. Purpose To evaluate the clinical impact of suboptimal coronary flow after PCI in STEMI patients and to access potential predictors of suboptimal coronary flow. Methods We retrospectively evaluated 103 hospitalized patients with acute STEMI who were admitted to our center between 2018 and 2019 and underwent PCI. Coronary flow was accessed using the Thrombolysis in myocardial infarction (TIMI) Flow Grading System. Patients were divided into suboptimal patency of the culprit-vessel, defined as TIMI flow ≤2 (group 1, n=8 (7,8%)) and optimal patency of the culprit-vessel defined as TIMI flow 3 (group 2, n=95 (92,2%)). Glomerular filtration rate (GFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Results Mean age 58,15±12,6 years and 85,4% were males. Seventy-eight patients (75,7%) had history of smoking, 45 (43,7%) dyslipidemia, 20 (19,4%) previous acute coronary syndrome, 18 (17,5%) diabetes, 17 (15,5%) were obese and 4 (3,9%) had chronic kidney disease. The revascularization strategy was primary PCI in 55 (54,4%) patients and fibrinolytic therapy with facilitated PCI in 48 (46,6%) patients. Infarct-related artery was the left anterior descending artery in 45 (45,5%) and multivessel disease was present in 38 (38,0%). Angiographic no-reflow after PCI was 3,0%. Intrahospital cardiovascular death occurred in 4 (3,9%) patients and was significantly associated with suboptimal flow (p=0,036) and there was no association with stent thrombosis. Predictors of suboptimal flow were higher blood urea nitrogen, creatinine and GFR at hospital admission (p=0,017 and p=0,012), peak creatinine (p=0,012) and stent length (p=0,038). Suboptimal flow was associated with higher Zwolle score (p=0,010) and ischemic Paris score (p=0,036). Conclusion Failure to achieve optimal culprit-vessel patency after PCI in STEMI patients, although infrequent, is associated with increased hospital cardiovascular death. Longer stents could be and important modified risk factor. Renal dysfunction is an important comorbidity that should be promptly identified and could be partially improved with medical treatment. Funding Acknowledgement Type of funding sources: None.

RIGHT VENTRICULAR PARAMETERS AND OUTCOMES IN PATIENTS WITH DVT AND PULMONARY EMBOLISM ADMITTED WITH COVID-19 INFECTION

RIGHT VENTRICULAR PARAMETERS AND OUTCOMES IN PATIENTS WITH DVT AND PULMONARY EMBOLISM ADMITTED WITH COVID-19 INFECTION

48.3 A Short-Term Partial Hospitalization Program for Youth with ASD and Developmental Disorders

This session describes both patient and staff outcomes following treatment on a short-term (M admission length = 12.5 days) partial hospitalization program (PHP) for youth diagnosed with ASD and/or other developmental disorders (DDs).

Disappearing Help Text: Implementing a Note-Based Tool for In-Line Clinical Decision Support and Note Bloat Reduction.

The authors describe a novel solution to the challenges of lengthy notes and poor note readability by creating an unobtrusive clinical decision support tool named "disappearing help text." We designed this tool in Pediatric Hospital Medicine (PHM) note templates to provide in-line decision support on best documentation practices, note bloat reduction, billing compliance, and provider workflow enhancement. After template changes that utilized disappearing help text, we reduced the percent of notes utilizing any laboratory SmartLink from 90.2 to 15.3% for admission notes (p <0.001), 92.6 to 17.8% for progress notes (p <0.001), and 14 to 7.2% for discharge summaries (p <0.001). In admission and progress notes, this correlated with a significant reduction in the median note length as a proxy of note bloat reduction, with a 18.7% character count reduction in progress notes (p <0.001) and a 6.4% reduction in admission notes (p <0.001). PHM coding queries decreased from an average of 42 per month to 36 per month, and there was no change in PHM attending billing compliance audit performance. Note template changes that utilized disappearing help text significantly reduced the length of both progress and admission notes, a proxy for note bloat reduction, without negatively impacting coding query frequency or internal billing audit performance. One factor that likely contributed to this reduction in note length is the reduced usage of laboratory SmartLinks prompted by disappearing help text. We present the use of in-line disappearing help text embedded into note templates as a clinical decision support tool to improve note readability, educate trainees on note documentation, and protect confidential teen information. Help text implementation correlated with a reduction in the automatic insertion of laboratories into notes and a decrease in note character count.

Effect of Racial, Ethnic and Linguistic Disparities on the Treatment of End-Stage Ankle Osteoarthritis

Category: Ankle Arthritis; Trauma Introduction/Purpose: Social and demographic determinants of health including gender, race, ethnicity and language, have been shown to impact treatment pathways across medical specialties. Very little such research, however, has focused explicitly on orthopaedic foot and ankle patients. Given the debilitating health implications of ankle arthritis, this study aimed to investigate the effect of demographic and social factors on the treatment pathways and outcomes of patients presenting to orthopaedic foot and ankle surgeons with end-stage ankle arthritis. Methods: In this retrospective, cross-sectional study, ICD 9/10 codes were used to identify 3,219 adult patients presenting to seven academic and community hospitals with ankle arthritis between 2011-2021. These patients were screened for end-stage ankle arthritis (Grade 3 or 4 on Kellgren-Lawrence Classification) and 509 patients were included in the final sample. For the primary variables of interest, patients were grouped by race (White/ Non-white), ethnicity (Hispanic/ Non-Hispanic), and primary spoken language (English/ non-English). Other demographic data included sex, age, body mass index, tobacco use, and insurance profile. The type of treatment (operative or nonoperative), length of postoperative admission, postoperative complication rates, and reoperation rates were compared between the groups using Chi square tests. Linear regression models were used to determine if the primary explanatory variables were among the factors affecting the time between initial consultation and surgical treatment, and duration of hospital stay. P&lt;0.05 was considered statistically significant where applicable. Results: Among the patients receiving treatment for end-stage ankle arthritis at our hospital system, 447 (87.82%) were White, 480 (94.3%) were non-Hispanic, and English was the most primary language among 482 (94.7%) patients. The difference in the proportion receiving nonoperative treatment between Whites and Non-whites (53.91% vs. 58.06%), Non-Hispanics and Hispanics (54.58% vs. 51.72%), and English and non-English speakers (54.56% vs. 51.85%) was not significant (p&gt;0.05). Linear regression revealed that, among the explanatory variables, Hispanic ethnicity (Unstandardised coefficient=18.017; p=0.021), and history of former or no tobacco use (Unstandardised coefficient=9.156; p=0.021) significantly predicted the time gap between the diagnosis of end-stage ankle arthritis and surgical treatment. Regression models also showed that primary language being non-English and septic arthitis as a predisposing cause of arthitis significantly predicted hospital stay duration (Unstandardised coefficient= 3.409, 13.228 respectively, p= 0.010, &lt;0.001 respectively). Race, ethnicity, and language had no significant association with post-operative complications and re-operation rates. Conclusion: This study demonstrated that race and ethnicity did not impact whether patients presenting with end-stage ankle arthritis were preferentially treated operatively or nonoperatively by orthopaedic foot and ankle surgeons at our institutions. However, non-English speaking patients were more likely to have lengthened hospital stays, and Hispanic patients had a longer time lapse between diagnostic consultation of end-stage osteoarthritis and operative treatment, underscoring that barriers to care still exist. Additional research is necessary to elucidate the manner in which demographics and social determinants of health impact the care of foot and ankle patients.

S1280 Comparing Outcomes of Decompensated Cirrhosis Management on a Primary Hepatologist-Managed Service versus a Hospitalist-Managed Service at an Urban Hospital

Introduction: While there are treatment guidelines for management of decompensated cirrhosis, limited data exist about adherence to specific quality measures and whether adherence differs based on specialty training (hospitalists versus hepatologists). We aimed to compare outcomes of quality-based practices of hepatology-led versus hospitalist-led services for admissions for management of decompensated cirrhosis. Methods: 2,009 admissions of patients presenting to our institution with a diagnosis of decompensated cirrhosis from 2016 to 2020 were retrospectively reviewed. 547 admissions of patients admitted for management of hepatic encephalopathy (HE), ascites, bleeding esophageal varices (EV), hepatorenal syndrome (HRS), or spontaneous bacterial peritonitis (SBP) were included. Patients were grouped based on service at the time of discharge: hepatology service (HH), hospitalist service (GM), or hospitalist service with hepatology consult (MH). Quality indicators assessed included admission length of stay, intensive care unit (ICU) admission, and death. Stat was used for statistical analysis. Results: Of the 547 admissions included, 168 admissions were on GM, 178 on MH, and 201on HH services. On average, GM patients were younger compared to their MH and HH counterparts (56.1, 59.2, 59.1 years respectively, p = 0.02). Additionally average MELD score at admission was higher on GM (23.1) compared to MH (17.6) and HH (20.3; p< 0.001) services. This was similarly reflected in the Child-Pugh Score at admission [GM (10.3), MH (8.9), and HH (9.6; p< 0.001)]. GM admissions had a longer hospital stay (9.1 days) compared to HH (6.2 days; p< 0.001) admissions, which remained significant when controlling for MELD score and age (p=0.001). GM admissions had a lower incidence of ICU transfers compared to MH and HH (27.2%, 34.8%, 38.0% respectively; p = 0.007). Patients on MH were less likely to expire prior to discharge compared to GM and HH (1% vs 8.4% and 14.9% respectively, p< 0.001). (Table) Conclusion: This study demonstrates differences in baseline characteristics and outcomes for decompensated patients admitted to GM, MH, and HH services for management of decompensations. Overall, this study speaks to shorter hospitalizations and decreased incidence of death for patients presenting with decompensated cirrhosis on HH versus GM services, however, further investigations would be needed to determine the rationale for differing patient outcomes, as this was not reflected in ICU transfers. Table 1. - Comparison of reason for admission between hospitalist led service without a hepatology consult (GM), hospitalist led service with a hepatology consult (MH), and a hepatologist led service (HH) Reason for Admission GM MH HH P value Bleeding esophageal varices (EV) 32.5% 29.8% 37.6% 0.054 Hepatic Encephalopathy (HE) 30.4% 36.2% 33.4% 0.054 Spontaneous Bacterial Peritonitis (SBP) 29.5% 33.7% 36.8% 0.058 Ascites 25.8% 35.0% 39.2% 0.036 Hepatorenal Syndrome (HRS) 28.8% 34.4% 36.7% 0.000

Chest CT Findings in Patients with HIV Presenting to the Emergency Department: A Single Institute Experience

The aim of this study was to analyze chest CT imaging findings and relevant clinical factors in patients with HIV presenting to the emergency department (ED). A retrospective review was performed to identify patients with HIV who received chest CT imaging evaluation in the acute ED setting. Analyzed patients included adults with a known diagnosis of HIV who presented to the ED at a single tertiary care center between 2004 and 2020 and received chest CT imaging. Chest CT findings were assessed by 2 radiologist readers, and relevant clinical data were gathered. Statistical analysis was performed to determine if imaging and clinical factors demonstrate significant associations with CD4 count, viral load, and antiretroviral therapy status. A total of 113 patients with HIV were identified who presented to the ED and underwent chest CT imaging evaluation (mean age 47 ± 11 years). Frequently detected chest CT findings included infectious pneumonia (24%), malignancy (11%), pleural effusion (17%), pericardial effusion (13%), and pulmonary embolism (4%). CD4 count, viral load, and active retroviral therapy demonstrated statistically significant associations with a number of key imaging and clinical factors, including presence of pneumonia, malignancy, average length of hospital admission, and survival. Patients with HIV present with a wide range of imaging findings when presenting in the acute ED setting. CD4 count, viral load, and active retroviral therapy status demonstrate statistically significant associations with multiple key imaging findings and clinical factors. Chest CT plays an integral role in the clinical management of this unique patient population.

Follow-up study of infants recruited to the randomised, placebo-controlled trial of azithromycin for the prevention of chronic lung disease of prematurity in preterm infants—study protocol for the AZTEC-FU study

BackgroundPreterm birth, especially at less than 30 weeks’ gestation, is significantly associated with respiratory, neurodevelopmental and growth abnormalities. The AZTEC study has recruited 799 infants born at < 30 weeks’ gestation to determine if a ten-day intravenous treatment with azithromycin improves survival without development of chronic lung disease of prematurity (CLD) at 36 weeks’ post menstrual age (PMA) when compared to placebo. The follow-up studies will compare respiratory, neurodevelopmental and growth outcomes up to 2 years of corrected age between infants who received azithromycin and those who received placebo in the early neonatal period.MethodsSurvivors at 36 weeks’ PMA from the main Azithromycin Therapy for Chronic Lung Disease of Prematurity (AZTEC) study with parental consent will continue to be followed up to discharge from the neonatal unit and to 2 years of corrected age. Length of stay, rates of home oxygen, length of supplemental oxygen requirement, hospital admissions, drug usage, respiratory illness, neurodevelopmental disability and death rates will be reported. Data is being collected via parentally completed respiratory and neurodevelopmental questionnaires at 1 and 2 years of corrected age respectively. Additional information is being obtained from various sources including hospital discharge and clinical letters from general practitioners and hospitals as well as from national databases including the National Neonatal Research Database and NHS Digital.DiscussionThe AZTEC-FU study will assess mortality and important neonatal morbidities including respiratory, neurodevelopmental and growth outcomes. Important safety data will also be collected, including the incidence of potential consequences of early macrolide use, primarily pyloric stenosis. This study may have implications on future neonatal care.Trial registrationThe study was retrospectively registered on ISRCTN (ISRCTN47442783).

P398 COVID-19-associated pulmonary aspergillosis: Species distribution and susceptibility profiles

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesThis study aimed to investigate the species distribution and susceptibility profiles of Aspergillus species isolated from patients admitted to the intensive care unit with severe COVID-19 in Isfahan, Iran, between April 2021 and March 2022.MethodsThis retrospective study included intubated patients with COVID-19 in three referral COVID-19 hospitals. Tracheal aspirate (TA) samples were taken from 267 patients to investigate pulmonary co-infections. COVID-19-associated aspergillosis (CAPA) was defined according to the 2020 European Confederation of Medical Mycology/International Society of Human and Animal Mycosis consensus criteria. Aspergillus species obtained from samples were characterized based on conventional and molecular assays. In vitro antifungal susceptibility testing was performed on the obtained isolates according to the guidelines from the Clinical and Laboratory Standards Institute.ResultsThe mean age of the patients was 61.73 ± 12.69 years. The mean length of hospitalization and admission in ICU were 18.77 ± 12.94 and 13.51 ± 9.83 days, respectively. A total of 61 (22.9%) patients presented with a single cavity lesion. Pulmonary artery pseudoaneurysm was seen in seven patients and post-COVID-19 changes were seen in all patients. Based on the conventional and molecular techniques, 72 isolates of Aspergillus species (26.9%), including A. flavus (10.1%%), A. fumigatus (8.6%%), A. niger (3.3%), A. tubingensis (2.9%), A. terreus (1.1%), A. luchuensis (0.37%) A. quadrillineatus, and (0.37%), were obtained from 267 patients. MIC results showed that all Aspergillus species were susceptible to all tested antifungal drugs.ConclusionAccess to priority clinical groups, improving the care of patients with simultaneous pulmonary aspergillosis with COVID-19, and identifying Aspergillus species are essential steps in the care cascade to manage those affected by them.

Neonatal outcomes following intrauterine transfusion for hemolytic disease of the fetus and newborn: a twenty-year service review

Objective The primary objective was to explore perinatal and neonatal outcomes amongst infants who received intrauterine transfusion (IUT) for the management of hemolytic disease of the fetus and newborn (HDFN). The secondary objective was to evaluate the role of key investigations in the fetus at risk of HDFN and assess the relationship with neonatal outcomes. We hypothesized that middle cerebral artery peak systolic velocity (MCA-PSV) and corresponding multiples of the median (MoM) would be predictive of neonatal course. Methods This was a retrospective observational study conducted at a tertiary center in the United Kingdom between January 2000 and August 2020. Trust approval was obtained to conduct this service review. Pregnancies requiring IUT for HDFN were identified using the fetal medicine department database. Inclusion criteria were infants who received IUT for HDFN. 67 pregnancies were eligible for inclusion in the study with 156 IUT events. Data were extracted using healthcare records. Statistical analysis was performed using SPSS version 28.0, data were assessed for normality and Spearman’s correlation analysis was performed with p values < .05 considered significant. Results 67 pregnancies were included in the study which led to the live birth of 68 infants (one twin pregnancy). There were no fetal deaths following IUT. There was one neonatal death due to extreme prematurity following spontaneous vaginal delivery at 23 + 4 weeks gestation, occurring three days following IUT. 97% of infants required admission to the neonatal intensive care unit and 88% required phototherapy. 25% of infants required readmission for red blood cell transfusion due to anemia. There was a significant correlation between maternal anti-D antibody levels and length of neonatal admission r = 0.477, p = .014. MCA-PSV and MoM measured prior to the last IUT had a significant positive correlation with the duration of phototherapy: r = 0.527 (p < .001) and r = 0.313 (p < .05) respectively. Linear regression analysis demonstrated a significant positive relationship between MCA-PSV and corresponding MoM recorded prior to the last IUT with r 2= 0.177 (p = .003) and r 2= 0.101 (p = .029). Conclusion HDFN is an important cause of fetal anemia associated with significant neonatal morbidity. MCA-PSV and MoM may be predictive of neonatal phototherapy requirements. The predictive value of MCA-PSV appears to be dependent on the timing of measurement during the antenatal period and more research is needed. Multicentre collaboration is required to generate a reliable large-scale database to further delineate the value of MCA-PSV and MoM and predict neonatal outcomes in cases of HDFN requiring IUT. This data would assist clinicians in antenatal planning and enable more informed counseling of parents in the antenatal period.

Exacerbation of Pre-existing Neurological Symptoms With COVID-19 in Patients With Chronic Neurological Diseases: An Updated Systematic Review.

The neurotropism of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can potentially explain the worsening of symptoms in patients with a history of neurological conditions such as stroke, Parkinson's disease, Alzheimer's, and epilepsy. Several studies have reported that these pre-existing conditions may worsen with a higher frequency of flare-ups, thus resulting in a more significant risk of patient mortality. In this review, we sought to provide an overview of the relationship between pre-existing neurological disorders and COVID-19, focusing on whether the initial infection directly influenced the severity of symptoms. We systematically searched the electronic database PubMed (MEDLINE) and used specific keywords related to our aims from January 2020 to July 2022. All articles published on COVID-19 with keywords pertaining to pre-existing neurological diseases were retrieved and subsequently analyzed. After independent review, the data from 107 articles were selected and evaluated. After analyzing the data from selected articles reviewing the effect of COVID-19 on neurological conditions, we have documented the relationship between said pre-existing neurological diseases, showing an increased risk of hospitalization, admission length, worsening of symptoms, and even mortality in COVID-19 patients.

Reflective Lullaby Writing with two mother--infant dyads who recently experienced an admission to a neonatal intensive care unit

ABSTRACT Introduction Having a premature baby is a complex experience for parents, especially where an admission to a Neonatal Intensive Care Unit (NICU) after birth is required. Regardless of length of admission, parents likely confront mixed emotions related to their concerns for their baby’s physical health and development, which are often still present in the months and years after their baby’s discharge. Supporting parents to emotionally process their experience presents unique challenges, and a deeper understanding of how to facilitate this process is needed. Method The purpose of this research project was to explore parents’ experiences of engaging in individualised parent--infant music therapy in their home setting after their baby’s discharge from a NICU setting. Interviews were conducted with two mothers and descriptive phenomenology guided the immersive process of data analysis and explicating the prominent themes. Results Four shared themes were identified. Songwriting was experienced as being distinctly therapeutic, and mothers described the value of intentionally creating lyrics which captured what they wanted to remember about their NICU and parenting journey. Both mothers valued reconnecting with aspects of their previous selves from before their NICU experience. Discussion The composition of a personal song using therapeutic techniques offered mothers the opportunity to reflect on, and to begin to process their parenting experiences. Reflective Lullaby Writing is articulated as a novel approach to support post-NICU families. The findings of this pilot study will inform future studies in this area of practice which has not yet been well-established in the current discourse.

The effect of the COVID-19 pandemic lockdown measures on plastic, reconstructive and hand surgery emergency presentations – A comparative retrospective study in a regional referral center in Germany

BackgroundThe global COVID-19 pandemic has led to social constraints and changes in injury patterns during the government-imposed restrictions. The aim of this study was to evaluate the effects of the lockdown period on the pattern of emergency presentations in a plastic, hand and reconstructive surgery department in a German referral center.MethodsA retrospective cohort study was conducted comparing patients presenting during the enforced lockdown period in 2020 and the same pre-pandemic period during the previous year 2019. All emergency presentations in the emergency unit requiring treatment by plastic, hand and reconstructive surgery were included. Patient demographics, reason for presentation, need for hospital admission, body region affected, location of injury and/or occurrence of first clinical symptoms and injuries of anatomical structures were considered.ResultsDemographics were comparable among both groups. A 42.7% reduction in emergency cases was observed during the lockdown period. A significant elevation of domestic injuries and symptoms in the pandemic group (51.54% vs. 66.15%, p = 0.007) was registered. Concurrently, a decrease in recreational injuries (27.31% vs. 15.38%, p = 0.009) and workplace injuries (10.57% vs. 7.69%, p = 0.37) was noted. Hospital admission rates and length of stay were comparable. Similarly, no statistically significant differences could be detected regarding injuries of functional anatomical structures. The same holds true for crush injuries, animal bites, fall injuries, finger amputations, disc saw injuries, and distortion injuries. Fractures of the phalanges, the metacarpus/carpus and the forearm exhibited an increase.ConclusionsIn spite of decreasing total emergency caseloads, there was an unchanged need for plastic, hand and reconstructive in-patient surgery and care during the lockdown period. Resource allocation has to be considered in future pandemic waves. Prevention strategies are warranted and should focus on finding measures to counteract domestic injuries.

Liver Fibrosis Indices Predict the Severity of SARS-CoV-2 Infection.

Discovering novel risk and prognostic factors for COVID-19 may help not only in reducing severity and mortality but also in creating targeted therapies considering patients’ individual features. Liver fibrosis is considered a complication in Non-alcoholic Fatty Liver Disease (NAFLD), it is a feature of steatohepatitis (NASH), and it has already been related to an increased risk for a wide range of diseases. Here, we aimed to define if any parameter assessing metabolic status has predictive power in identifying inpatients at risk for poorer prognosis and an increased mortality from COVID-19. This retrospective study was conducted at the Sub-Intensive Medicine Care Unit of the Presidio Maxi-Emergenze Fiera del Levante, Azienda Ospedaliero-Universitaria Policlinico di Bari, Italy. We evaluated 271 inpatients with moderate-to-severe SARS-CoV-2-related respiratory failure by comparing biochemical features and non-invasive liver fibrosis scores among discharged, transferred to Intensive Care Units (ICU) and non-survivor patients. Moreover, by performing ROC curves, we defined cut-off values to predict mortality and disease severity for each score. We found that non-invasive scores of liver fibrosis, obtained at day of admission, such as AAR (p < 0.001), FIB-4 and mFIB-4, FORNS, and AARPRI (p < 0.05) strongly predict not only in-hospital mortality but also the length of hospitalization and eventual admission to ICU. FIB-4 was the best score to identify non-survivor patients (sensitivity of 80% and specificity of 63%) and predict the need for ICU or mortality (71% of sensitivity and 65% of specificity), with a cut-off value of 1.94. Therefore, we present the predictive power and the cut-off values of several liver fibrosis scores here for disease severity and mortality in SARS-CoV-2 in-patients and we proposed the use of the present scores to identify ab initio the clinical therapeutic and diagnostic protocols for high-risk patients.

Does prophylactic low-dose amiodarone decrease the incidence of postoperative atrial fibrillation after coronary artery bypass graft surgery? A randomized controlled trial

BackgroundPostoperative atrial fibrillation (POAF) occurs within 1 to 5 days after coronary artery bypass grafting (CABG), with a peak occurrence on the second day. This research aimed to assess the role of dose-low amiodarone in the prevention of POAF after CABG.MethodsThis randomized controlled blind-single study was carried out on 150 patients undergoing elective CABG with sinus rhythm. Cases were randomized into two equal groups. The placebo group received matching placebo tablets. The amiodarone group received a prophylactic oral amiodarone 5 mg/kg/day for 6 days before and 6 days after surgery.ResultsThe incidence of POAF was significantly lower in the amiodarone group compared to the placebo group (16% vs 33.3%, P = 0.013) with a relative risk of 0.48 times (95% confidence interval: 0.26–0.88). The onset of POAF, percent of patients responded to medication, and time elapsed to respond to medication were insignificantly different between both groups. The mean (± SD) of ICU stay was 2.51 ± 1.11 days in the amiodarone group versus 3.31 ± 1.83 days in the placebo group, and the mean (± SD) of hospital stay duration was 10 ± 1.99 days in the amiodarone group versus 12.72 ± 2.23 days in the placebo group. The length of ICU admission and hospital stay was significantly lower in the amiodarone group than in the placebo group (P = 0.002 and < 0.001, respectively).ConclusionsLow-dose oral amiodarone was effective in POAF prevention after CABG with a lower length of ICU admission and hospital stay.Trial registrationPan African Clinical Trials Register PACTR202101651961317. Registered on 21 January 2021

Evaluating physical urban features in several mental illnesses using electronic health record data.

ObjectivesUnderstanding the potential impact of physical characteristics of the urban environment on clinical outcomes on several mental illnesses.Materials and MethodsPhysical features of the urban environment were examined as predictors for affective and non-affective several mental illnesses (SMI), the number and length of psychiatric hospital admissions, and the number of short and long-acting injectable antipsychotic prescriptions. In addition, the urban features with the greatest weight in the predicted model were determined. The data included 28 urban features and 6 clinical variables obtained from 30,210 people with SMI receiving care from the South London and Maudsley NHS Foundation Trust (SLaM) using the Clinical Record Interactive Search (CRIS) tool. Five machine learning regression models were evaluated for the highest prediction accuracy followed by the Self-Organising Map (SOM) to represent the results visually.ResultsThe prevalence of SMI, number and duration of psychiatric hospital admission, and antipsychotic prescribing were greater in urban areas. However, machine learning analysis was unable to accurately predict clinical outcomes using urban environmental data.DiscussionThe urban environment is associated with an increased prevalence of SMI. However, urban features alone cannot explain the variation observed in psychotic disorder prevalence or clinical outcomes measured through psychiatric hospitalisation or exposure to antipsychotic treatments.ConclusionUrban areas are associated with a greater prevalence of SMI but clinical outcomes are likely to depend on a combination of urban and individual patient-level factors. Future mental healthcare service planning should focus on providing appropriate resources to people with SMI in urban environments.