Longer Delay Research Articles

Interaction of Ethnicity and Arrival Method on Thrombectomy Delay: The Society of Vascular and Interventional Neurology Collaboration

Background Compared with non‐Hispanic White patients, non‐Hispanic Black (NHB) and Hispanic populations are less likely to receive acute treatment for ischemic stroke, and when they do, it can be delayed. We evaluated the interaction between arrival method and race or ethnicity on door‐to‐arterial puncture (DTAP) time in thrombectomy. Methods We conducted a retrospective observational cohort study of consecutive adults who underwent endovascular thrombectomy from 14 US Comprehensive Stroke Centers (January 1, 2019–July 31, 2020). DTAP was assessed in a linear mixed model including an interaction term for race or ethnicity and arrival method. Results Of the 1908 included patients, 356 of whom were Hispanic, Hispanic and NHB patients experienced significant delays in DTAP compared with non‐Hispanic White patients (adjusted β Hisp =0.32, 95% CI, 0.08–0.55; β NHB =0.23; 95% CI, 0.04–0.41). More severe deficits were associated with shorter DTAP (β NIHSS per point −0.03; 95% CI −0.04 to −0.03), and arrival via emergency medical services or private vehicle versus transfer were associated with longer delays (β EMS =0.57; 95% CI, 0.41–0.74; β PV =1.27; 95% CI, 0.85–1.70). There was a significant interaction between Hispanic ethnicity and emergency medical services ( P =0.03) or private vehicle arrival ( P =0.04) in a direction favoring shorter treatment delays. Sites that treated a minority population of Hispanic patients (<50% being Hispanic) experienced a significant delay in DTAP among Hispanic and NHB versus non‐Hispanic White (median 72 minutes [interquartile range (IQR), 49–104] versus 83 minutes [IQR, 50–119] versus 58 minutes [IQR, 27–95], P <0.01), whereas sites treating a Hispanic majority showed no difference in DTAP ( P =0.39). Conclusions Endovascular therapy is delayed in Hispanic and NHB patients when compared with non‐Hispanic White patients. Although arrival by emergency medical services or private vehicle also contributed to treatment delays, Hispanic ethnicity modified this effect such that there was less delay in DTAP. This may be related to communication barriers between caregivers and health care providers when a Hispanic patient is suddenly disabled from stroke.

Is There a Weekend Effect in the Management of Maxillofacial Trauma Patients?

Many previous studies have shown that patients admitted to the hospital at weekends have a longer delay than those on weekdays. It has been proposed that the equality of specialist services throughout the week could mitigate the 'weekend effect.' This study aimed to determine whether or not a weekend effect is observed in Oral and Maxillofacial surgery patients at a medical college and teaching hospital. Our primary predictor variable was the day of admission. Our primary outcome of interest was the length of hospital stay from admission to operation. Descriptive analysis, correlation analysis, One way ANOVA, and post hoc comparison were performed for statistical analysis. Out of 1185, 1005 (84.8%) were male and 180 (15.2%) female, with a mean age of 30.3 (SD=14.1) years. There was a significantly higher admission on weekends, Friday, and Saturday, and the weekend admissions were associated with a longer delay from admission to operation. The night shift was also associated with a longer delay from admission to operation. The diagnosis based procedure had the most significant effect on delay from admission to operation. The patient's age and gender had no association with the primary outcome. There is a delay in the definitive treatment of maxillofacial surgery patients admitted on weekends. These findings have implications for adequate staffing and resource allocation on the weekends based on admission volume.

Multidisciplinary Management of Suspected Lyme Borreliosis: Clinical Features of 569 Patients, and Factors Associated with Recovery at 3 and 12 Months, a Prospective Cohort Study.

Introduction. Because patients with a suspicion of Lyme borreliosis (LB) may have experienced difficult care paths, the Tick-Borne Diseases Reference Center (TBD-RC) was started in 2017. The aim of our study was to compare the clinical features of patients according to their final diagnoses, and to determine the factors associated with recovery in the context of multidisciplinary management for suspected LB. Methods. We included all adult patients who were seen at the TBD-RC (2017–2020). Four groups were defined: (i) confirmed LB, (ii) possible LB, (iii) Post-Treatment Lyme Disease Syndrome (PTLDS) or sequelae, and (iv) other diagnoses. Their clinical evolution at 3, 6, and 9–12 months after care was compared. Factors associated with recovery at 3 and at 9–12 months were identified using logistic regression models. Results. Among the 569 patients who consulted, 72 (12.6%) had confirmed LB, 43 (7.6%) possible LB, 58 (10.2%) PTLDS/sequelae, and 396 (69.2%) another diagnosis. A favorable evolution was observed in 389/569 (68.4%) at three months and in 459/569 (80.7%) at 12 months, independent of the final diagnosis. A longer delay between the first symptoms and the first consultation at the TBD-RC (p = 0.001), the multiplicity of the diagnoses (p = 0.004), and the inappropriate prescription of long-term antibiotic therapy (p = 0.023) were negatively associated with recovery, reflecting serial misdiagnoses. Conclusions. A multidisciplinary team dedicated to suspicion of LB may achieve a more precise diagnosis and better patient-centered medical support in the adapted clinical sector with a shorter delay, enabling clinical improvement and avoiding inappropriate antimicrobial prescription.

Determinants of satisfaction with the detection process of autism in Europe: Results from the ASDEU study.

Professional guidance and support in response to first concerns appears to be an important predictor of the level of satisfaction with the detection process of autism in young children. In this study, we analyzed the views of 1342 family members, including 1278 parents, who completed an online survey form collecting information about their experience and satisfaction with the early detection of autism in their child. Specifically, we were interested in how specific experiences with the detection process relate to the satisfaction with it and whether we could identify important predictors of satisfaction. The detection process is an emotionally charged period for parents, often described as painful, chaotic, and lengthy. A better understanding of their experiences is important to take appropriate action to improve the detection process. In our sample, the level of satisfaction with the detection process varied greatly from one respondent to another. Among the different experiences we considered, whether or not respondents received professional guidance and support in response to first concerns explained most of this variation. We also found that difficulty finding information about detection services, lack of professional guidance and support in response to first concerns, having to find a diagnostic service on one's own, and longer delays between confirmation of concerns and first appointment with a specialist were experiences associated with a greater likelihood of being unsatisfied. The findings of this study highlight the importance of the parent-professional relationship in the detection process and have important practical implications for health administrations to improve the detection process.

Spatial and Temporal Global Patterns of Drought Propagation

Drought is the most expensive natural hazard and one of the deadliest. While drought propagation through standardised indices has been extensively studied at the regional scale, global scale drought propagation, and particularly quantifying the space and time variability, is still a challenging task. Quantifying the space time variability is crucial to understand how droughts have changed globally in order to cope with their impacts. In particular, better understanding of the propagation of drought through the climate, vegetation and hydrological subsystems can improve decision making and preparedness. This study maps spatial temporal drought propagation through different subsystems at the global scale over the last decades. The standardised precipitation index (SPI) based on the gamma distribution, the standardised precipitation evapotranspiration index (SPEI) based on the log-logistic distribution, the standardised vegetation index (SVI) based on z-scores, and the standardised runoff index (SRI) based on empirical runoff probabilities were quantified. Additionally, drought characteristics, including duration, severity and intensity were estimated. Propagation combined the delay in response in the subsystems using drought characteristics, and trends in time were analysed. All these were calculated at 0.05 to 0.25 arc degree pixels. In general, drought propagates rapidly to the response in runoff and streamflow, and a with longer delay in the vegetation. However, this response varies spatially across the globe and depending on the observation scale, and amplifies progressively in duration and severity across large regions from the meteorological to the agricultural/ecological and hydrologic subsystems, while attenuating in intensity. Significant differences exist between major Köppen climate groups in drought characteristics and propagation. Patterns show intensification of drought severity and propagation affecting vegetation and hydrology in regions of southern South America, Australia, and South West Africa.

28 Review of Operative and Non-Operative Time-Use During General Anaesthetic Cases in a Busy Surgical Oncology Service

Abstract Aim To review theatre running times of all general anaesthetic cases performed in a single theatre during a set six-week period. We intend to assess the division of theatre time between operative and non-operative tasks and review areas of improvement in our department. Method The data was collected concurrently by a member of the surgical team (AB) at the time of surgery. Date, surgical procedure, and time elapsed from knife-to-skin (KTS) to skin closure were monitored between the hours 08:30–17:00. Results were reviewed and presented graphically using Microsoft Excel. Instances of theatre over-running were identified, and these outliers were reviewed in more detail. Results We identified two main time management issues in our department. The first occurs prior to the first procedure which highlighted significant delays with only one instance of KTS at 08:30 during the period of data collection. The second notable issue is the pattern of delays. There was a trend toward longer delays between cases as the day proceeds. Conclusions Upon review of our data, we were able to identify possible areas of improvement in the time management of our theatre group. These improvements will allow for accurate theatre planning which should be a priority for all stakeholders given the significant waiting lists created by the COVID19 pandemic. There are many peer-reviewed methods of improving the efficiency of departments such as ours. Further work is required to discuss targets for improvement with relevant stakeholders and to implement PDSA cycles to assess the impact of implemented changes in our theatre.

Tunable x-ray free electron laser multi-pulses with nanosecond separation

X-ray Free Electron Lasers provide femtosecond x-ray pulses with narrow bandwidth and unprecedented peak brightness. Special modes of operation have been developed to deliver double pulses for x-ray pump, x-ray probe experiments. However, the longest delay between the two pulses achieved with existing single bucket methods is less than 1 picosecond, thus preventing the exploration of longer time-scale dynamics. We present a novel two-bucket scheme covering delays from 350 picoseconds to hundreds of nanoseconds in discrete steps of 350 picoseconds. Performance for each pulse can be similar to the one in a single pulse operation. The method has been experimentally tested with the Linac Coherent Light Source (LCLS-I) and the copper linac with LCLS-II hard x-ray undulators.

Design of a Hybrid Split-Delay Line for Hard X-ray Free-Electron Lasers

High repetition-rate X-ray free-electron lasers (XFELs) enable the study of fast dynamics on microsecond time scales. Split-delay lines (SDLs) further bring the time scale down to femtoseconds by splitting and delaying the XFEL pulses. Crystals and multilayers are two common types of optical elements in SDLs, offering either long delay ranges or high temporal accuracy. In this work, we introduce the design of a hybrid SDL for the coherent diffraction endstation of Shanghai High Repetition Rate XFEL and Extreme Light Facility (SHINE). It uses crystals for the first branch and multilayers for the second one, thus simultaneously offering a relatively long delay range and high temporal accuracy. Moreover, a third branch can be installed to switch the SDL to the all-crystal configuration for longer delay ranges.

Retracted publications in pharmacy systematic reviews.

Objective:Systematic reviews and other evidence syntheses, the pinnacle of the evidence pyramid, embody comprehensiveness and rigor; however, retracted data are being incorporated into these publications. This study examines the use of retracted publications in the field of pharmacy, describes characteristics of retracted publications cited by systematic reviews, and discusses factors associated with citation likelihood.Methods:Using data from Retraction Watch, we identified retracted publications in the pharmacy field. We identified all articles citing these retracted publications in Web of Science and Scopus and limited results to systematic reviews. We classified the retraction reason, determined whether the citation occurred before or after retraction, and analyzed factors associated with the likelihood of systematic reviews citing a retracted publication.Results:Of 1,396 retracted publications, 283 were cited 1,096 times in systematic reviews. Most (65.0%) (712/1096) citations occurred before retraction. Citations were most often to items retracted due to data falsification or manipulation (39.2%), followed by items retracted due to ethical misconduct including plagiarism (30.4%), or concerns about or errors in data or methods (26.2%). Compared to those not cited in systematic reviews, cited items were significantly more likely to be retracted due to data falsification and manipulation, were published in high impact factor journals, and had longer delays between publication and retraction.Conclusions:Further analysis of systematic reviews citing retracted publications is needed to determine the impact of flawed data. Librarians understand the nuances involved and can advocate for greater transparency around the retraction process and increase awareness of challenges posed by retractions.

New-onset non-lesional aphasic status epilepticus. Clinical description, diagnostic clues, and treatment algorithm.

De novo aphasic status epilepticus (ASE) in patients without a previous history of epilepsy and without cerebral lesions (aphasic NOSE) is rare. The aim of the study is to describe its clinical characteristics, etiologies, and outcome. Single-center study including consecutive patients presenting to the emergency department between 2011 and 2019 with acute aphasia, which was finally diagnosed as aphasic NOSE. Subsequent episodes of aphasia (>5min) were recorded and divided into confirmed ASE and postictal aphasic episodes (non-ASE). Clinical characteristics of the two types of episodes were compared. Nineteen patients were included, suffering fifty episodes of epileptic aphasia, episodes per patient 2.6 (range 1-7). Fifteen patients (71.4%) were women, mean age at ASE onset was 66.05years old (SD 6.3). Nine (47%) patients died, 6 of them (66.7%) during the aphasic episode. Ictal EEG was available in 37 episodes, confirming the diagnosis of ASE in 12 episodes; in 8 episodes, the EEG fulfilled the criteria of possible ASE. The most frequent etiologies were inflammatory and vascular. Comparing ASE with non-ASE episodes, ASE was longer than non-ASE (225 vs 65h, p .024) and was treated more frequently with BZD (76 vs 24%, p .001) but with a longer delay (22.2 vs 1.5h, p .06). ASE is a treatable, highly relapsing emergency, with the subsequent relapses ASE or postictal aphasia. EEG is diagnostic in half of the patients, while in others imaging techniques are also useful. Benzodiazepines should be administered. Persistent aphasia, of more than 65hours' duration, is highly suggestive of ASE.

Abstract TP93: Interaction Of Ethnicity And Arrival Method On Thrombectomy Delay: The Society Of Vascular And Interventional Neurology Multicenter Collaboration

Introduction: Compared to White patients, non-White minority populations are less likely to receive acute treatment for ischemic stroke, and when they do, it can be delayed. Hypothesis: To evaluate the interaction between arrival method (transfer vs. emergency medical services [EMS] vs. private vehicle) and race/ethnicity (non-Hispanic Black [NHB] vs. non-Hispanic White [NHW] vs. Hispanic) on door-to-arterial puncture (DTAP) time in thrombectomy. Methods: Multicenter retrospective cohort study of consecutive patients (≥18 years) treated with endovascular thrombectomy at 14 US Comprehensive Stroke Centers (1/1/2019-07/31/2020). Door (arrival) to arterial puncture (DTAP) was evaluated using a linear mixed model to estimate the effect of race/ethnicity and arrival mode on treatment time. Results: Of the 1,908 included patients, 356 (19%) of whom were Hispanic, stroke severity was similar between race/ethnicity groups, however Hispanic and NHB patients experienced significant delays in DTAP compared to NHWs (adjusted β Hisp = 0.32, 95%CI 0.08-0.55; β NHB = 0.23, 95%CI 0.04-0.41). In the final linear mixed model, more severe neurologic deficits were associated with shorter DTAP (β NIHSS per point -0.03, 95%CI -0.04- -0.03), and arrival via EMS or private vehicle versus transfer were associated with longer delays (β EMS = 0.57, 95%CI 0.41-0.74; β PV = 1.27, 95%CI 0.85-1.70). There was a significant interaction between Hispanic ethnicity and arrival by EMS (p=0.03) or private vehicle (p=0.04) in a direction favoring shorter treatment delays. Conclusions: Endovascular therapy is delayed in Hispanic and NHBs when compared to NHWs. While arrival by EMS or private vehicle (vs. inter-hospital transfer) also contributed to treatment delays, Hispanic ethnicity modified this effect such that there was less delay in DTAP. This may be related to communication barriers between caregivers and healthcare providers when a patient is suddenly disabled from stroke.

Predictors of Delay in Diagnosis and Treatment for Tuberculosis in North India: A Cross Sectional Analytical Study

Introduction: Tuberculosis (TB) has been a continuous major public health problem.The treatment delay affects an individual, the community, a country’s health and economy. In general, it is very difficult to quantify the crisis in country’s health and economy, especially in the era of MDR-TB, from suffering and death of economically productive individuals from such preventable and treatable disease because of delayed initiation of treatment.Understanding the causes behind delay in diagnosis and treatment is essential for all partners involved in tuberculosis control. Material and Methods: The cross-sectional study was conducted among the patients of tuberculosis diagnosed at I.G.M.C. Shimla from 1st August 2018 through 31st July 2019.A structured, validated and pretested questionnaire was adapted from the WHO multi country tuberculosis treatment delay survey. Questionnaire consists of basic demographic profile of patients, type of tuberculosis and associated co-morbidities, TB knowledge, attitude toward TB and regarding potential delays. Data was collected from patients at the time of their registration for treatment at DOTS centre. Results: The most common levels of delays identified in study participants were patient delay and health care provider delay.The mean delay at patient level was 66 days and delay at health care provider was 83 days. Total delay among participants was 130 days.Among all study participants, 31.03% thought that their symptoms would go at their own. The economic constraint was found in 22.41 %.Reason of delay among 41.42 % participants was Late diagnosis at level of health care provider. Out of total, 18.5% who visited private practitioner, were not diagnosed. Conclusion: There was a delay of 66 days for seeking treatment and 84 days for diagnosis of tuberculosis at health care provider level. A longer delay was revealed in smoker, residents of rural area and patients from low income group for seeking treatment.The delay at the level of health care provider was significantly associated in participants who travelled less than five kilometers to reach first health facility for seeking treatment.

Variation in Seeking Care for Cardiovascular Disease and Ambulance Utilization among Migrants in Australia: Time, Ethnicity, and Delay (TED) Study III.

Insight into differences in seeking medical care for chest pain among migrant populations is limited. This study aimed to determine ethnic differences in seeking care behaviors and using ambulances among migrants compared to an Australian-born group. A total of 607 patients presenting with chest pain to a tertiary hospital between 1 July 2012 and 30 June 2014 were randomly selected. Data from the emergency department dataset and medical record reviews were collected and linked for analysis. The migrant group was stratified into nine ethnic groups for analysis based on the Australian Standard Classification of Cultural and Ethnic Groups. The overall median prehospital delay time was 3.7 (1.5, 10.7) h, which ranged from 2.5 (1.0, 10.7) (Southern and Eastern European group) to 6.0 (2.3, 20.6) (Sub-Saharan African group). The median decision time was 2.0 (0.8, 7.9) h, which ranged from 1.5 (Australian-born group) to 4.5 h (Sub-Saharan African group). Five ethnic groups had significantly longer decision times compared to the Australian-born group. Decision time accounted for 58.4% of pre-hospital delay time. Migrant patients were 60% less likely to seek care for chest pain within one hour (odds ratio 0.40, (0.23–0.68), p = 0.001). There was no significant difference in ambulance utilization between migrant and Australian-born groups. In conclusion, ethnic differences in seeking care for chest pain do exist, and ethnicity plays a vital role in a longer delay in seeking care. To reduce the delays and improve patient outcomes, appropriate health campaigns focusing on ethnic differences among migrant populations and normalizing cultural competency into practice are recommended.

Stimulus-driven visual attention in mice.

In primates, stimulus-driven changes in visual attention can facilitate or hinder perceptual performance, depending on the location and timing of the stimulus event. Mice have emerged as a powerful model for studying visual circuits and behavior; however, it is unclear whether mice show similar interactions between stimulus events and visual attention during perceptual decisions. To investigate this, we trained head-fixed mice to detect a near-threshold change in visual orientation and tested how performance was altered by task-irrelevant stimuli that occurred at different times and locations with respect to the orientation change. We found that task-irrelevant stimuli strongly affected mouse performance. Specifically, stimulus-driven attention in mice followed a similar time course as that in other species: The decreases in reaction times fully emerged between 250 and 400 ms after the stimulus event, and detection accuracy was not affected. However, the effects of stimulus-driven attention on behavior in mice were insensitive to stimulus-event location, an aspect different from what is known in primates. In contrast, reaction times in mice were reduced at longer delays after the task-irrelevant stimulus event regardless of its spatial congruence to the target. These results highlight the strengths and limitations of using mice as a model for studying higher-order visual functions.

The impact of the COVID pandemic on primary care diabetes services in the UK: A cross-sectional national survey of views of health professionals delivering diabetes care

BackgroundHealthcare systems worldwide have been adversely affected by the Coronavirus disease 2019 (COVID-19) pandemic. There has been a substantial decrease in admissions for acute medical conditions with longer delays between the onset of the symptoms and hospital treatment compared to the pre-pandemic period. The impact of the COVID pandemic on primary care services is uncertain. AimUsing an online survey, we examined the impact of the COVID pandemic on primary care diabetes services in the UK. MethodsAn online survey was developed by the Primary Care Diabetes Society research group and administered to healthcare and allied health professionals delivering diabetes care in the UK from January to May 2021. Descriptive statistics and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. ResultsOf the 1070 professionals surveyed, 975 (91.1%) completed the questionnaire. Most respondents were nurses or nurse practitioners (59.7%) and doctors (32.9%). The mean age of respondents was 52 years and 79% were female. The majority of respondents felt overloaded with work (71.2%) or emotionally drained at the end of a working day (79.1%) compared with the pre-pandemic period. Being a doctor and worried about infecting a family member with the Coronavirus were each associated with an increased odds of being substantially overworked or emotionally drained: (OR = 2.52; 95% CI, 1.25−5.07) and (OR = 2.05; 95% CI, 1.24–3.39), respectively. The most common consultation method used to provide diabetes care during the pandemic was telephone consultation (92.0%). Overall 79.1% of respondents felt the COVID-19 pandemic had had moderate to significant impact on their practice's ability to provide routine diabetes care; 70.6% of respondents felt the COVID-19 pandemic had had moderate to significant impact on their practice's ability to provide routine health checks or screening for type 2 diabetes and approximately half of respondents (48.3%) reported encountering mental health concerns in people with diabetes. ConclusionsCOVID-19 pandemic has had significant impact on the ability of healthcare professionals and their practices to deliver routine diabetes care. Failure to restore primary care provision urgently and safely to at least pre-pandemic levels in a sustainable manner may lead to emotionally drained and overworked workforce in primary care, place additional burden on the already overburdened healthcare system and worse outcomes for patients.

An Assessment, with NICE Guidelines as a Benchmark, of Delay to Care in a Cohort of Colorectal Cancer Patients Seen in the Witwatersrand University Academic Complex

Background: Colorectal cancer (CRC) in South Africa (S.A) is the second most common in women and the third in men. Worldwide it is the second most deadly cancer. As a subset, colon cancer is the fifth most deadly with an estimated 551,000 deaths in 2018. CRC makes up 5.8% of all cancer-related deaths globally. Despite this, there are no screening programmes in S.A, with a diagnosis being largely dependent on symptomatology. Additionally, there is no clear understanding of the significance of the outcome imposed by delay in referral and treatment. Unlike countries in Europe, South Africa has no guidelines defining cut-offs for acceptable delays in this context. Methods: A retrospective study was done on the delay in referral, diagnosis, and treatment of CRC patients. A cohort of patients in which surgery was the primary treatment that was presented to Witwatersrand Academic Hospitals was studied. Delays were benchmarked against fourteen days from primary contact to consultation with a specialist and consultation to treatment delay of more than 31 days. Definitive treatment delay was defined as the time from referral to the treatment centre and tumour resection of more than 62 days. Outcomes were evaluated by defining the 90-day mortality. Results: The median referral delay was 78 days, for treatment delay was 54 days and for definitive treatment delay was 175 days. Of the 587 patients analysed, 341 had therapeutic surgery, 17 demised within 90 days post-surgery. Longer delays and higher mortality rates were seen in the public sector and a lower socio-economic group of patients. Conclusion: The time parameters set out by the NHS and Europe were not met. There were greater delays seen in patients with lower socio-economic backgrounds and in those attending the public sector. The effect of delays on 90-day mortality is doubtful. Delays to care both outside of hospitals and in hospitals may be a point of investigation in future studies.

Consortium Shared Identity Over an Enterprise Blockchain

The current onboarding and offboarding processes for production crews involve a set of often inconsistent and manual activities, which are repetitive and inefficient, leading to various issues such as longer delays in bringing people on to a production project, inconsistent permission enforcement when a project is over, and higher overall cost.

Early Alzheimer's disease-like reductions in gray matter and cognitive function with aging in nonhuman primates.

IntroductionAge‐related neuropathology associated with sporadic Alzheimer's disease (AD) often develops well before the onset of symptoms. Given AD's long preclinical period, translational models are needed to identify early signatures of pathological decline.MethodsUsing structural magnetic resonance imaging and cognitive assessments, we examined the relationships among age, cognitive performance, and neuroanatomy in 48 vervet monkeys (Chlorocebus aethiops sabaeus) ranging from young adults to very old.ResultsWe found negative associations of age with cortical gray matter volume (P = .003) and the temporal‐parietal cortical thickness meta‐region of interest (P = .001). Additionally, cortical gray matter volumes predicted working memory at approximately 1‐year follow‐up (correct trials at the 20s delay [P = .008]; correct responses after longer delays [P = .004]).DiscussionCortical gray matter diminishes with age in vervets in regions relevant to AD, which may increase risk of cognitive impairment. This study lays the groundwork for future investigations to test therapeutics to delay or slow pathological decline.

An Assessment, with NICE Guidelines as a Benchmark, of Delay to Care in a Cohort of Colorectal Cancer Patients Seen in the Witwatersrand University Academic Complex

Background: Colorectal cancer (CRC) in South Africa (S.A) is the second most common in women and the third in men. Worldwide it is the second most deadly cancer. As a subset, colon cancer is the fifth most deadly with an estimated 551,000 deaths in 2018. CRC makes up 5.8% of all cancer-related deaths globally. Despite this, there are no screening programmes in S.A, with a diagnosis being largely dependent on symptomatology. Additionally, there is no clear understanding of the significance of the outcome imposed by delay in referral and treatment. Unlike countries in Europe, South Africa has no guidelines defining cut-offs for acceptable delays in this context. Methods: A retrospective study was done on the delay in referral, diagnosis, and treatment of CRC patients. A cohort of patients in which surgery was the primary treatment that was presented to Witwatersrand Academic Hospitals was studied. Delays were benchmarked against fourteen days from primary contact to consultation with a specialist and consultation to treatment delay of more than 31 days. Definitive treatment delay was defined as the time from referral to the treatment centre and tumour resection of more than 62 days. Outcomes were evaluated by defining the 90-day mortality. Results: The median referral delay was 78 days, for treatment delay was 54 days and for definitive treatment delay was 175 days. Of the 587 patients analysed, 341 had therapeutic surgery, 17 demised within 90 days post-surgery. Longer delays and higher mortality rates were seen in the public sector and a lower socio-economic group of patients. Conclusion: The time parameters set out by the NHS and Europe were not met. There were greater delays seen in patients with lower socio-economic backgrounds and in those attending the public sector. The effect of delays on 90-day mortality is doubtful. Delays to care both outside of hospitals and in hospitals may be a point of investigation in future studies.

The role of process mining tools in STEMI networks: where should we build a new primary PCI centre?

Abstract Background In ST-segment elevation myocardial infarction (STEMI), time delay between symptom onset and treatment is critical to improve outcome. The expected transport delay between patient location and percutaneous coronary intervention (PCI) centre is paramount for choosing the adequate reperfusion therapy. The “Centre” region of Portugal has heterogeneity in PCI assess due to geographical reasons. Purpose We aimed to explore time delays between regions using process mining (PM) tools. Methods We retrospectively assessed the Portuguese Registry of Acute Coronary Syndromes for patients with STEMI from October 2010 to September 2019, collecting information on geographical area of symptom onset, reperfusion option, and in-hospital mortality. We used a PM toolkit (PM4H – PMApp Version) to build two models (one national and one regional) that represent the flow of patients in a healthcare system, enhancing time differences between groups. One-way analysis of variance was employed for the global comparison of study variables between groups and post hoc analysis with Bonferroni correction was used for multiple comparisons. Results Overall, 8956 patients (75% male, 48% from 51 to 70 years) were included in the national model (Fig. 1A), in which primary PCI was the treatment of choice (73%), with the median time between admission and primary PCI <120 minutes in every region; “Lisboa” and “Centro” had the longest delays, (orange arrows). Fibrinolysis was performed in 4.5%, with a median time delay <1 hour in every region. In-hospital mortality was 5%, significantly higher for those without reperfusion therapy compared to PCI and fibrinolysis (10% vs. 4% vs. 4%, P<0.001). In the regional model (Fig. 1B) corresponding to the “Centre” region of Portugal divided by districts (n=773, 74% male, 47% from 51 to 70 years), only 61% had primary PCI, with “Guarda” (05:04) and “Castelo Branco” (06:50) showing significant longer delays between diagnosis and reperfusion treatment (orange and red arrows, respectively) than “Coimbra” (01:19) (green arrow); only 15% of patients from “Castelo Branco” had primary PCI. Fibrinolysis was chosen in 10% of patients, mostly in “Castelo Branco” (53%), followed by “Guarda” (30%), with a median time delay of 39 and 48 minutes, respectively. Regarding mortality, PCI and fibrinolysis groups had similar death rates while those patients without reperfusion had higher mortality (5% vs. 3% vs. 13%, P=0.001). Conclusion Process mining tools help to understand referencing networks visually, easily highlighting inefficiencies and potential needs for improvement. The “Centre” region of Portugal has lower rates and longer delay to primary PCI partially due to the geographical reasons, with worse outcomes in remote regions. The implementation of a new PCI centre in one of these districts, is critical to offer timely first-line treatment to their population. Funding Acknowledgement Type of funding sources: None. Figure 1