Mean Number Of Incidents Research Articles

Evaluation of operating room inefficiencies and their impact on operating room duration using a surgical app

BackgroundEfficient utilization of the operating room (OR) is essential. Inefficiencies are thought to cause preventable delays. Our goal was to identify OR incidents causing delays and estimate their impact on the duration of various general surgery procedures. MaterialsThree trained observers prospectively collected intraoperative data using the ExplORer Surgical app, a tool that helped capture incidents causing delays. The impact of each incident on case duration was assessed using multivariable analysis. Results151 general surgery procedures were observed. The mean number of incidents was 2.7 per each case that averaged 109min. On average, each incident caused a 2.8 ​min delay (p ​< ​0.001), however, some incidents were associated with longer delays. The procedural step of each procedure most susceptible to incidents was also defined. ConclusionThe identification of the type of incidents and the procedural step during which they occur may allow targeted interventions to optimize OR efficiency and decrease operative time.

Violence against women during the pandemic from the viewpoint of a tertiary forensic medicine clinic

COVID-19 pandemic and measures to combat the pandemic caused an increase in the risk of violence against women. In this study, it was aimed to examine the change in violence crimes against women evaluated in a tertiary forensic medicine clinic over a two-year period by focusing on periods of lockdown and domestic violence. Victims of violence against women who admitted to our center between 01/01/2020 and 12/31/2021 were included in the study. Patient files and forensic reports were used to acquire information regarding the age, date of the incident, relationship of the offender, type of incident, usage of weapons, injuries sustained, and if the incident was domestic violence. The ages of 121 cases evaluated ranged from 10 to 88 years, and the mean age was 36.1 (SD=17.6) years. When the mean number of incidents per day was examined, it was shown that cases of domestic violence were most common during the lockdown period. When all cases were considered together, it was shown that the highest mean number of cases occurred in the first days following the restrictions. Violence against women increased during the periods of the pandemic. In cases of domestic violence, as expected, the most significant rise occurred during lockdown periods. The 24-hour period following the lockdown application has been identified as the most intensive time of violence against women during the pandemic.

Service Evaluation of COVID and Non-COVID Admission Trends to an East Midlands General Adolescent Psychiatric Inpatient Unit

AimsTo explore the differences in admissions between the first COVID-19 lockdown cohort and a pre-COVID-19 cohort.Methods23 young people who were admitted to an East Midlands General Adolescent Inpatient Unit during the first COVID-19 lockdown from March 2020 to September 2020 were compared with the 48 young people who were admitted in the same period in 2019. Demographic details, admission duration and reasons, mental health act (MHA) status, diagnoses, functional status, and incidents were obtained retrospectively from the trust's online records.ResultsThe unit received more female admissions prior to lockdown (60.4% Vs 47.8%). Approximately 30% of adolescents in the pre-COVID-19 group were not in education whereas those admitted during COVID-19 were all receiving education. More of the pre-COVID-19 group attended school than college and more of the COVID-19 group were employed, consistent with a lower mean age of admission in the former group. Most of the COVID-19 admissions were local and none were out of area. Young people were also more likely to be looked after by their parents during COVID-19 (82.6%) and none were taken care of by their relatives.Pre-COVID019 admissions were discharged sooner than their counterparts, which had 13% of admissions between 6–9 months. Both cohorts had mainly informal admissions due to risk to self. Most of the COVID-19 admissions were due to anxiety, followed by self-harm while the majority of pre-COVID-19 admissions were due to depression and PTSD. 43% of the COVID-19 admissions had at least one comorbid diagnosis, notably depression. More adolescents in the COVID-19 cohort were not started on any psychiatric medication during and after admission.The mean number of incidents were two times higher in the COVID-19 group; self-harm was the most common reason. There was more violence towards staff during lockdown. However, absconsion, possession of contraband items, and staff error were higher in the pre-COVID-19 group.ConclusionThe introduction of COVID-19 restrictions was associated with a change in both the frequency and nature of inpatient admissions to this ward. Less young people were admitted during COVID-19, more frequently with anxiety as the primary reason and stayed for longer. Although the pre-COVID-19 group received more psychiatric medication, it is unclear if this contributed to a better functional status overall. This service evaluation also demonstrated the impact of COVID-19 on young people's mental health and life circumstances. An exploration of these trends in other units across the country would increase the generalisability of results.

Person-centred care provided by a multidisciplinary primary care team to improve therapeutic adequacy in polymedicated elderly patients (PCMR): randomised controlled trial protocol

IntroductionThe increase in elderly population has led to an associated increase in multiple pathologies, frailty, polypharmacy, healthcare costs, decreased quality of life and mortality. We designed an intervention based on...

Healthcare Resource Utilization and Costs Associated with Different Treatment Modalities of Relapsed/Refractory Multiple Myeloma Patients in the US: Findings from Preamble

Introduction: Proteasome inhibitors (PIs), immunomodulatory drugs (IMiDs), and treatments involving both a PI and an IMiD (PI+IMiD) are the principal therapies for treating relapsed/refractory multiple myeloma (RRMM). The immuno-oncology (I-O) agents elotuzumab (elo) and daratumumab (dara) may bring new and promising solutions to patients (pts). The adoption of these treatments may come with high healthcare resource utilization (HCRU) and costs. It is important to further understand HCRU by different treatment modalities in real-world practice settings. Here we evaluate HCRU and costs in pts receiving different treatment modalities for RRMM.Methods: PREAMBLE is an ongoing, prospective, multinational, noninterventional observational study (NCT01838512). Pts ≥18 y of age with RRMM, ≥1 prior therapy, and who initiated treatment (index therapy) with a PI (including carfilzomib [carf], bortezomib [bort], and ixazomib), an IMiD (including lenalidomide [len], pomalidomide [pom], and thalidomide), an IMiD+PI combination, or I-O agents within 90 d before or 30 d after study consent were identified. Pt data were collected at each healthcare provider (HCP) visit, over 3 y or until the end of pt follow-up, including clinic/physician office visits, emergency room (ER) visits, hospital outpatient visits, hospitalizations, and home healthcare/other visits. Demographic and baseline characteristics were analyzed using descriptive statistics. The median duration of treatment (mDoT) was estimated using Kaplan-Meier (K-M) methods. HCRU was estimated using the mean number of incidents, per-1000-patients-per-month (1000 PPM) metric in a period up to 12 mo from start of index therapy (index date).Results: 341 pts (median age 67 y; 59% male) were enrolled in the US. At the time of data cut-off (May 27, 2017), 187 (55%) had withdrawn from the study; 117 (63%) of the withdrawn pts had died. Median (range) follow-up was 11.8 mo (<0.1, 41.2). At study entry, 30 pts were receiving I-O agent-based index therapy (dara, n=26; elo, n=4). Pts were divided into 4 cohorts based on index therapy: dara (26/337, 8%), PI (n=174, 52%; carf 92/174; bort 80/174), IMiD (n=75, 22%; pom 31/75), and IMiD+PI (n=62, 18%; bort+len 35/62). The 4 treatment cohorts were similar in sex, race, disease status, International Staging System stage, and comorbidities, although pts on dara received significantly more prior therapies than those on other treatments (Table). Of the 26 pts on dara, 31% (n=8) were still on treatment at the time of data cut-off, and of those who discontinued index therapy (n=18, 69%), 61% (n=11) were due to disease progression, which was higher than for other treatments (p=0.0468). The K-M estimate of mDoT for pts on dara was 4.2 mo, similar to that for PI (4.1 mo) but shorter than for other treatments (p=0.0305). In the PI cohort, carf had a shorter mDoT than bort (3.4 vs 5.2 mo). Of 3093 HCP visits overall, the most common type was clinic/physician office visits (n=2649, 86%), followed by ER visits/hospitalizations (n=233, 8%), and hospital outpatients (n=164, 5%). Per 1000 pts treated, pts receiving PI+IMiD had the most HCRU visits in a 1-mo period, vs least for dara (mean 1000 PPM: 1619 vs 1013 visits). This was also true for clinic/physician office visits and hospital outpatients (Table). Notably, mean 1000 PPM ER visits/hospitalizations were higher for pts receiving dara than for any other treatment (n=181, 18%). Among pts receiving a PI, those on carf had higher mean 1000 PPM total visits (n=1001) than those on bort (n=710); this remained true for each of the healthcare resource categories investigated in this study.Conclusions: Routine management of RRMM and treatment-related events drive HCRU, which may differ by treatment. This preliminary analysis suggests that pts on dara appear to have shorter mDoT and fewer outpatient visits, but more ER visits and hospitalizations, compared with pts on other treatments. Receiving carf appears to be associated with more HCRU visits overall, and for each of the healthcare resource categories compared with bort. The study is ongoing and further analysis will be necessary to better understand HCRU patterns observed with these new treatment modalities in clinical practice settings.Study support: Bristol-Myers Squibb. [Display omitted] DisclosuresKuter:Fujifilm: Consultancy; Dova: Consultancy, Membership on an entity's Board of Directors or advisory committees; ONO: Consultancy; 3SBIO: Consultancy; Protalex: Consultancy, Research Funding; Incyte: Consultancy, Research Funding; Rigel: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Merck: Consultancy; Syntimmune: Consultancy, Research Funding; Pfizer: Consultancy; Novartis: Consultancy; Zafgen: Consultancy; Genzyme: Consultancy; Shire: Consultancy, Research Funding; Amgen: Consultancy; Alexion: Consultancy, Research Funding; Argenx: Consultancy. Chen:Bristol-Myers Squibb: Employment. Popov:Parexel: Employment. Davis:Bristol-Myers Squibb: Employment. Vij:Takeda, Onyx: Research Funding; Celgene, Onyx, Takeda, Novartis, BMS, Sanofi, Janssen, Merck: Consultancy.

A retrospective study on clinical profile of patients with firecracker-related injury presenting to the emergency department of a tertiary care center in South India

Background: Firecracker injuries are very common in India. They are mostly used during the various festivals celebrated in India. This study analyses the profile and outcome of firecracker injuries in the emergency department (ED). Materials and Methods: This was a retrospective observational study of all firecracker-related injury patients presenting to our ED. Details of the incident, injuries, management, and outcome were noted. Data were extracted from the ED triage software and hospital electronic database. Results: We received a total number of 13,604 trauma patients to our ED, among which 92 (0.7%) had firecracker burst-related injury. The mean age of the patient was 27 (standard deviation 11.6) years. Male (97.8%) predominance was noted. Majority of them were triaged to Priority II, i.e., 64 (70%) patients and 6 (6%) in Priority I. The mean number of incidents per month during the festive season of Diwali was 3.25 compared to 3.95 during the rest of the year. The majority of the injuries had sustained lacerations (78.5%), followed by abrasions (12.9%). Among all patients, only 4.3% (4) suffered second- and third-degree burns each. It was noted that the upper limbs (79.6%) were most commonly involved as expected, followed by the face (16.1%). The new injury severity score was more than 5 in (6.4%) of patients. Most patients were taken up for emergency procedures such as wound wash, debridement, suturing, or nailing of the fractures in the ED. Majority (81.5%) required hospital admission and had to undergo major surgical intervention. The rest were either discharged stable or discharged against medical advice after primary care. Conclusions: This study has expressed the pattern of firecracker injuries. An alarmingly high number of young adolescents with significant upper limb injuries were noted. Public awareness and education along with increase legislative enforcement are needed for the betterment and well-being of the mass during the festival season to prevent the catastrophe since these injuries are prevalent in the productive age groups.

Human–crocodile conflict in the Indian Sundarban: an analysis of spatio-temporal incidences in relation to people's livelihood

AbstractThe incidence of human–crocodile conflict is increasing, and fear of injury and loss of life is affecting public and political support for crocodile conservation. We studied conflicts between people and estuarine crocodiles Crocodylus porosus across socio-economic dimensions, using a spatio-temporal database. We collected data on 127 crocodile attacks that occurred during 2000–2013, through questionnaires including open- and close-ended questions, administered in 30 villages of five blocks of the Indian Sundarban. Most of the attacks (42%) occurred during winter (December–February), followed by the early monsoon (May–July; 27%). Almost 80% of victims were prawn seed collectors and were 11–50 years old, and 61.16% of victims died as a result of the attacks. Female victims accounted for a higher percentage of deaths (55.12%) than male victims (44.88%). Crocodile attacks were more common in the daytime than at night, with 76.35% of the killings occurring during 08.00–17.00. Most of the cases were recorded from Gosaba (34%), followed by Patharpratima (25.24%) and Namkhana (18.45%) blocks. The mean number of incidents per year was 9.07, with vulnerability and mortality rates of 0.07 and 0.04, respectively, per 10,000 persons. Existing management practices are insufficient to eliminate the risk of crocodile attacks and ensure the conservation of the Sundarban ecosystem. A comprehensive management plan for reducing dependency on forest resources is needed to minimize human–crocodile conflict.

Clozapine use in women with borderline personality disorder and co‐morbid learning disability

PurposeThe aim of this study is to test the hypothesis that Clozapine reduces rates of self injury and the use of restraint in a medium secure setting in female patients who have a diagnosis of borderline personality disorder (BPD) and mild learning disability.Design/methodology/approachA retrospective method of data collection was used with a requirement of six months baseline data on rates of self injury and the use of restraint. Patients were required to remain on Clozapine for a minimum of six months.FindingsThe mean number of incidents of self injury in the six months prior to Clozapine was 20.75 (SD 8.8) and 13.5 (SD 4.51) in the six months following Clozapine, a reduction of 35 per cent. The mean number of incidents of restraint in the six months prior to Clozapine was 17.75 (SD 6.86) compared with 9.25 (SD 4.96) in the six months following commencement of Clozapine therapy, a reduction of 48 per cent. The results were analysed using the paired t‐test and the difference between the means (self injury and use of restraint) was not statistically significant. This study demonstrates a reduction in the rates of self injury and use of restraint in women with a diagnosis of BPD when treated with Clozapine which was clinically significant although not statistically significant.Originality/valueThe authors are not aware of any published articles on the use of Clozapine in women with BPD and co‐morbid learning disability.

PROVOCATION, HOSTILITY, AGGRESSION, AND VICTIMIZATION: FIREFIGHTERS AND INCARCERATED FELONS

This study examined self-reported histories of victimization among prosocial and antisocial men. The Lifespan Violence Survey Schedule (LVSS), the Novaco Provocation Inventory, and the Buss-Durkee Hostility and Aggression Inventories were administered to a prosocial group (29 firefighters) and an antisocial group (30 incarcerated felons). The LVSS is a measure of perceived victimization across five types of abuse (physical, sexual, coercive, verbal, and neglect). Prisoners reported a higher mean number of incidents of abuse of all types except verbal than did firefighters. Fourteen of the fifteen possible behavioral-abuse correlations were significant when prisoners and firefighters were considered collectively. However, the two groups differed significantly in the pattern of behavioral-abuse correlations.

Roots of urban violence

Alcohol consumption and dependence, employment status, social and family history and history of previous violence in 49 patients injured in city-centre violence were compared with that in 49 paired, age and sex matched control individuals in a major accident and emergency department. All control individuals had been in the same locations as the patients at the time of injury. Alcohol consumption was recorded in units and dependence was assessed by means of the CAGE questionnaire. Patients had consumed significantly more alcohol in the 6 h before injury (mean consumption: 9 units/controls 7.1 units) and had been involved in more previous violence (mean number of incidents in previous 5 years: 4.3/controls: 1.5 incidents). In comparison with controls, male patients tended to be single rather than married ( P = 0.051), to have lost a parent ( P = 0.058) and to feel guilty about their alcohol consumption ( P = 0.068). These results indicate that in relation to young adults, injury in urban violence was associated with excessive binge-alcohol consumption, but not with alcohol dependence, unemployment at the time of violence or socio-economic group.