Number Of New Patients Research Articles

Incidence of Thrombotic Microangiopathies in Quebec: An 8-Year Overview from a Laboratory Centralizing Adamts-13 Testing

Primary and secondary thrombotic microangiopathies (TMA) constitute a group of life-threatening diseases of different aetiologies characterized by similar symptoms. The comprehensive compilation of data related to TMA is challenging due to their rare occurrence. The objective of this study was to provide an overview of the incidence of thrombotic thrombocytopenia (TTP) and non-TTP TMAs in the Province of Quebec (PQ) (8.485 Million inhabitants in 2019) by taking advantage of the centralized ADAMTS-13 activity and antibody testing for PQ since 2013 at the CHU Sainte-Justine (CHUSJ)All ADAMTS-13 activity and antibody titration were performed locally at CHUSJ. ADAMTS-13 results and patient demographic characteristics from April 2012 to December 2019 were extracted from the Laboratory Information System of CHUSJ and used in an anonymized database. Information on previous TMA episodes was obtained from a standardized clinical assessment form accompanying each plasma sample. Statistical analyses were performed with IBM SPSS version 26.0. The annual incidence rates were calculated based on the number of patients with a first-time recorded diagnosis of TMA using the Quebec mid-year (yr) estimated population of the years at stake. Patients with suspected TMA were further divided into two categories: individuals with TTP, defined by either an ADAMTS-13 activity ≤10% or a positive anti-ADAMTS-13 antibody titration, and patients with a suspected TMA other than TTP (non-TTP TMA) with a result of ADAMTS-13 activity >10%. The study was approved by the Research Ethics Committee of CHUSJ.A progressive increase in the annual requests for ADAMTS13 activity was observed over the study period. The number of new patients increased from 2012 to 2016 but plateaued after 2016 at an average number of 170 new patients per year. The number of confirmed TTP cases in Quebec was higher from 2014 to 2018 compared to in 2012, 2013 and 2019 (Figure 1). A total of 2081 requests for ADAMTS13 activity testing were received during the study period, representing 846 subjects with a suspected TMA. 147 subjects (17%) had a confirmed TTP and 699 (83%) had a suspected non-TTP TMA.TMAs were suspected more often in females (59%), both in confirmed TTP (62%) and non-TTP TMA (58%).The mean annual incidence rate (MAIR) of TTP was 1.91 case/million/yr (95%CI: 1.46-2.35). This was higher in females (2.36 cases/million/yr; 95%CI: 1.34-3.37) compared to males (1.42 case/million/yr; 95%CI: 0.57-1.44; p=0.001). The MAIR of non-TTP TMA was 9.97 cases/million/yr (95%CI:5.85-14.09), 11.52 for females (95%CI:6.71-16.33) versus 8.41 for males (95% CI: 4.81-12.02; p=0.001).In non-TPP TMA, the MAIR for males ranged from 3.9 to 7.2 cases per million prior to 60 year of age and increased after up to 24.5 at ages 80-89. For females, a first peak MAIR above 10 cases per million was observed during their thirties and a second peak was observed during their seventies (Figure 2).In TPP, peaks incidences in females were observed from ages 20 to 49. It dipped from ages 50 to 69 and then increased again. In males, a highest MAIR was observed between ages 40 to 79.In conclusion, the provincial centralization of ADAMTS-13 testing has enabled us to depict comprehensive picture of TTP and other suspected non-TPP TMA, thereby providing valuable information for caregivers and health authorities into these rare diseases. Sex and age related incidences observed in this study are comparable to those obtained through other registries and aggregated studies. Further analyses on clinical presentation of TMAs and patient follow up are now possible using the identification of this large cohort. [Display omitted] DisclosuresLapeyraque: Alexion Pharmaceuticals Inc: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding. Rivard: Bayer Inc: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer Inc: Membership on an entity's Board of Directors or advisory committees, Research Funding; Octapharma Inc: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk Inc: Membership on an entity's Board of Directors or advisory committees; CSL Behring Inc.: Membership on an entity's Board of Directors or advisory committees, Research Funding. Bonnefoy: Sanofi Genzyme Inc: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; CSL Behring Inc: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Alexion Pharmaceuticals Inc: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

A practical implementation of machine learning in predicting breast cancer

Cancer is the leading disease in the world by the increasing number of new patients and deaths every year. Hence, it is the most feared disease of our time. It is believed that lung cancer and breast cancer are most common types of cancer and they both are subtypes of the same group of cancer – carcinoma. With this type of cancer early detection is of great importance for patient survival. As it is the disease that has unfortunately been around for many years, today we have datasets with all necessary information for diagnosing and predicting cancer. Predicting cancer means deciding if the cancer is malignant or benign. The key to this answer lays in different values of parameters that have been stored when the disease was discovered. Machine learning plays the crucial role in predicting cancer, given the fact that algorithms such as Support Vector Machine (SVM), Decision Tree (DT), Random Forest (RF) and etc. are designed to find the pattern that occurs in large sets of data and based on that make a decision. In this paper, author's goal is to see how machine learning and its practical implementation on public datasets can help with early breast cancer diagnosis and hopefully help save more lives.

Mutated cuckoo search algorithm for dynamic vehicle routing problem and synchronization occurs within the time slots in home healthcare

The advancement and development of technologies promote more interest in exploring Dynamic Vehicle Routing Problems (DVRP), especially in Home Healthcare. Home healthcare (HHC) has gained more attention from researchers in recent years due to its increasing demand. There are certain cases where some patients may require one or more care services concurrently. In such a situation, synchronization of vehicles within specific time slots is necessary. The inclusion of dynamic patients and synchronization of vehicles without disregarding the time window will transform into a formidable task for HHC organizations. Hence, the investigation of the Dynamic Vehicle Routing problem where Synchronization occurs within the Time Slots (DVRPSTS) becomes a remarkable model in the context of HHC. This paper proposed one such complex endeavour considering multi-objectives such as (i) minimize the total travel time and the number of vehicles utilized (ii) maximize the number of new patients visits in HHC. The accuracy and efficiency of the proposed algorithm Mutated Cuckoo Search Algorithm (MCSA) are validated by comparing its results with existing methods in the literature. Thus, this algorithm outperforms most of the randomly generated test instances. To the best of our knowledge, the proposed MCSA has not yet been modelled for the DVRPSTS in HHC.

A New Virtual Reality: Benefits and Barriers to Providing Pediatric Gender-Affirming Health Care Through Telehealth.

Access to early, multidisciplinary, gender-affirming health care significantly improves the psychosocial well-being of transgender and gender diverse youth. The Doernbecher Gender Clinic (DGC) is an interdisciplinary pediatric gender clinic consisting of endocrinology, psychology, and social work. Following the initiation of modified operations in March 2020 due to the COVID-19 pandemic, the DGC converted all interdisciplinary new patient appointments to telehealth. The purpose of this article is to (1) describe the model of care implemented during modified operations, (2) compare the number of new patients seen before and after modified operations, and (3) to contextualize this information with data from a patient satisfaction survey. Retrospective chart review was used to determine how many interdisciplinary new patient appointments occurred before and during modified operations. Additional variables included age, gender, visit modality (phone or video), geographic location, and number of caregivers who participated. In addition, patients and families who attended appointments since modified operations were invited to complete a prospective survey regarding their experience and satisfaction with these appointments, and the narrative responses to questions about advantages and disadvantages were analyzed thematically. Chart review revealed a similar number and make up of new patient appointments before and after the initiation of modified operations. The percentage of patients residing in other urban areas outside of the Portland metro increased over the course of the three time periods, but not to a significant degree. Survey results suggest that both telehealth and in-person visits have advantages and disadvantages with regard to (1) access and (2) comfort. Families appear to differ with regard to their priorities in each area. Telehealth has the potential to provide quality pediatric gender-affirming health care without sacrificing the benefits of an interdisciplinary team-based approach.

The increasing trend and the seasonal variation in attendance of diffuse parenchymal lung disease patients presenting to a pulmonary clinic in Eastern India.

Background:Diffuse parenchymal lung disease (DPLD) is not an uncommon problem in clinical practice. Although the exact prevalence of DPLD in India is not known, the relative etiological distribution in DPLD in India has been reported. There has been no information as regards the seasonality of the disease.Patients and Methods:The archive of the Institute of Pulmocare and Research, Kolkata, was searched for the number of new patients registered at the outpatient department to a single consultant (practicing in the same style on appointment only) over years from 2009 to 2019. The attendance (absolute and relative) was arranged year wise and then month wise to look for the annual and seasonal trends, if any.Results:A total of 2226 patients were registered from 2009 to 2019. There has been a steady increase in both the absolute number (104 in 2009 to 204 in 2019) and the relative percentage of attendance (4.36% in 2009 to 6.9% in 2019) of new registration of DPLD patients over the years. Regarding seasonal variation, two consistent peaks in attendance have been observed as December–January and April–May over the years with dips in February and September; the first being more consistent then the latter.Conclusions:The increase in relative attendance in the DPLD patients over the years needs further investigation to establish a rising trends in incidence and prevalence of DPLD. The unequivocal trend in seasonal variation needs attention and further research.

Impact of COVID-19 on presentation, staging, and treatment of head and neck mucosal squamous cell carcinoma

ObjectivesDuring the COVID-19 pandemic, maintenance of safe and timely oncologic care has been challenging. The goal of this study is to compare presenting symptoms, staging, and treatment of head and neck mucosal squamous cell carcinoma during the pandemic with an analogous timeframe one year prior. Materials and methodsRetrospective cohort study at a single tertiary academic center of new adult patients evaluated in a head and neck surgical oncology clinic from March -July 2019 (pre-pandemic control) and March - July 2020 (COVID-19 pandemic). ResultsDuring the pandemic, the proportion of patients with newly diagnosed malignancies increased by 5%, while the overall number of new patients decreased (n = 575) compared to the control year (n = 776). For patients with mucosal squamous cell carcinoma (SCC), median time from referral to initial clinic visit decreased from 11 days (2019) to 8 days (2020) (p = 0.0031). There was no significant difference in total number (p = 0.914) or duration (p = 0.872) of symptoms. During the pandemic, patients were more likely to present with regional nodal metastases (adjusted odds ratio (OR) 2.846, 95% CI 1.072-3.219, p = 0.028) and more advanced clinical nodal (N) staging (p = 0.011). No significant difference was seen for clinical tumor (T) (p = 0.502) or metastasis (M) staging (p = 0.278). No significant difference in pathologic T (p = 0.665), or N staging (p = 0.907) was found between the two periods. ConclusionHead and neck mucosal SCC patients presented with more advanced clinical nodal disease during the early months of the COVID-19 pandemic despite no change in presenting symptoms.

Association Between Characteristics of Danish Chiropractors and Number of Referred Patients From General Practitioners: A Cross-sectional Study

ObjectiveThe purposes of this study were to quantify the number of patients referred weekly from primary health care general practitioners (GPs) to chiropractors and to identify chiropractor characteristics associated with the number of referrals. MethodsAn online, cross-sectional survey was sent to the 600 active members of the Danish Chiropractic Association. Of those, 364 completed the survey and 286 met our inclusion criteria. We used bivariable analyses and negative binomial multivariable regression to evaluate the association between predetermined characteristics and the weekly number of patients referred by GPs. ResultsOn average, chiropractors reported that they received 2.5 (standard deviation, 2.2) referrals from GPs per week, representing 31% of all new patients received by chiropractors. Clinics with more than 1 chiropractor and access to diagnostic ultrasound received more GP referrals. Chiropractors reporting expertise in geriatrics and a higher number of new patients per week reported more referrals. Chiropractors who reported referring more patients to GPs also reported receiving more referrals from them. ConclusionVariables related to access to chiropractic care, the type of care provided, and interprofessional communication were positively associated with the number of GP referrals that chiropractors self-reported. This is the first study to report on factors associated with GP referrals to Danish chiropractors.

The magnitude and management of functional constipation at pediatric gastroenterology clinics: A survey study of various countries.

There have been no large-scale epidemiological study of functional constipation of pediatric gastroenterology services. This survey was undertaken to investigate the prevalence of functional constipation and magnitude of related problems in hospital settings of various countries as well as the practice of pediatric gastroenterologists in management of these conditions. The survey was conducted by sending questionnaires to members of Societies for Pediatric Gastroenterology Hepatology and Nutrition of various continents. A total of 274 pediatric gastroenterologists from 41 countries participated in this study. Functional constipation accounted for overall 30% of patients attending pediatric gastroenterology outpatient clinics. In comparison with non-western countries, respondents from western countries reported significantly higher median annual numbers of new patients with intractable functional constipation (10 [4,25] vs 5 [2,10], P < 0.001), dyssynergic defecation (3 [0,15] vs 1 [0,4], P < 0.001), and colonic inertia (2 [0,5] vs 0 [0,1], P < 0.001). The use of high dose polyethylene glycol for fecal disimpaction was significantly more commonly among respondents from western countries, whereas rectal enema was significantly more favored in non-western countries. Respondents from different continents reported significant discrepancies in choices of investigations and management of patients with dyssynergic defecation and colonic inertia. Functional constipation is a major problem for pediatric gastroenterology outpatient services worldwide. There were significant variations in the investigations of choice and therapeutic management of functional constipation, intractable functional constipation, and related problems among pediatric gastroenterologists of different geographic regions.

Patterns of leprosy at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, and review of current clinical practice

Background. The World Health Organization announced a strategy to eliminate childhood leprosy infections, visible deformities and discriminatory legislation against leprosy patients by 2020. However, challenges in achieving a leprosy-free world and preventing neurological sequelae still exist. HIV infection is a challenge in South Africa (SA). HIV-leprosy co-infection may result in an increase in the frequency of leprosy reactions without affecting the spectrum of leprosy. From 1921 to 1997, the prevalence of leprosy remained <1 patient per 10 000 population. Current SA literature has very scanty information regarding leprosy infections. Objectives. To describe the trend of new leprosy patients at Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, from 1999 to 2015, including demographics, clinical spectrum and treatment outcomes. Methods. A retrospective review of patients’ clinical records was undertaken. Data on demographics, clinical spectrum including the leprosy classification, reactions, neurological involvement, association with HIV infection and treatment outcomes were extracted. Data analysis was performed using descriptive and inferential statistics and a time series analysis. Results. An upward trend from 1999 to 2001 was followed by a decline in the number of new patients. Eighty patients were registered over a period of 17 years, with a male-to-female ratio of 3:1. Thirty-six patients were immigrants, and 5 were children aged <15 years. Multibacillary leprosy was the most common type ( n =71 patients). Thirty-six patients had the lepromatous leprosy subtype, 22 were borderline lepromatous, 13 were borderline tuberculoid, 6 were borderline borderline, and 3 had tuberculoid leprosy. Thirty-one patients presented with reactions, type 1 in 9 patients and type 2 in 21 patients, with both types in 1 patient. Grade 2 neurological deformities were diagnosed in 37 patients, of whom 2 were children. Eight patients were found to have HIV-leprosy co-infection. Of 52 patients who completed treatment, 26 were cured and 26 were lost to follow-up. Twenty-one patients defaulted from treatment, while 3 patients relapsed. Conclusions. This study highlights the current status of leprosy in a low-endemic centre with declining numbers of new patients. Multibacillary forms with grade 2 disabilities (G2Ds) are common. The constant emergence of leprosy in our population highlights shortfalls in our control campaigns. Furthermore, a high rate of G2Ds necessitates scrutiny of education directed at early patient detection and follow-up strategies.

Prevent Skin Cancer in the Society, An Integrated Personalised Care Approach

IntroductionIn the Netherlands, skin cancer is the most common type of cancer (KWF, 2016). More than 51.000 new cases of skin cancer are diagnosed every year and over 900 fatalities are reported (RIVM, 2017). Skin cancer incidence rates increase dramatically: since 1990 the number of new patients with skin cancer quadrupled (RIVM, 2017). This increase is much higher than in other types of cancer (IKNL, 2016). It is expected that incidence rates of skin cancer will increase even further, probably with a factor 2 to 5 (RIVM, 2017).Direct costs for medical treatment of skin cancer are estimated at 325 million each year (250-400 million) (RIVM, 2017). On top of that, sick leave and premature mortality are also important indirect costs in melanoma (Brochez et al., 1999). Increasing use of more costly treatment, such as Mohs surgery and photodynamic therapy, is contributing to rising treatment costs (Hollestein et al, 2017). In addition to the costs, this growing group of patients with skin cancer will represent an important burden on the limited specialized dermatological care in the Netherlands.Subsequent early assessment of skin cancer risk is necessary for timely preventive measures in the general population.Theory/Methods1) A systematic review of the literature on patient characteristics with a prognostic predictive value for future basal cell carcinoma, squamous cell carcinoma or melanoma (such as age, gender, presages, signs and risk behaviour).2) A Current practice analysis on care concerning risk behaviour, presages and signs of skin cancer.3) Prognostic modelling using existing data of over 5000 cases from the Netherlands Comprehensive Cancer Organisation (IKNL).4) Developing risk profiles and implement these through internet and social media.ResultsIt will provide insight in early risk behaviours in the general population. It also provide knowledge of serious presages or signs enabling these patients to be seen by their GP timely.ConclusionBasal cell carcinoma (BCC, approx. 70%), squamous cell carcinoma (SCC, approx. 20%) and melanoma (approx. 10%) are the three most common types of skin cancer. Melanoma is the most lethal type, accounting for 90% of all skin cancer fatalities. The incidence of melanoma in the Netherlands is among the highest in Europe (RIVM, 2017). Despite the fact that most non-melanoma skin cancers (BCC and SCC) can be cured, the treated lesions can be disfiguring or even lethal if not treated timely.Lessons learnedRisk profiles will enable healthcare professionals and citizens both with knowledge which persons are at high risk and should be screened and insight in risk behaviour.LimitationsRisk screening is costly, time consuming and it is to be expected that the adherence will be moderate.Suggestions for future researchBehaviour change intervention target groups in the society as implementation research.

Review of referrals reveal the impact of referral content on the triage and management of ophthalmology wait lists

ObjectivesMany chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a...

Asking a Chatbot for COVID-19 Food and Nutrition

Coronavirus 19 (COVID-19) is a disease caused by a new coronavirus called severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2; previously known as 2019-nCoV). On March 11, 2020, WHO declared COVID-19 a global pandemic, the first pandemic since H1N1 influenza was declared a pandemic in 2009. The disease has hit almost every country in the world and so far, no medicine nor antiviral was found. In some countries where the death rate is high, the number of patients continues to increase. On May 20, 2020, the number of patients exceeded 4.8 million and the toll is 318,000 (6.6 percent). Although the number of new patients in many countries declined after the access rights lockdown (lockdown), the second attack returned to the area where the first attack occurred. The COVID-19 case in Indonesia still shows an increasing trend even though various efforts have been made by the state and society. This research is intended to discuss us regarding the use of chatbots to provide guidance on food and nutrition during the COVID-19 pandemic. The results showed that a review of maintaining a healthy lifestyle by adhering to health protocol during the pandemic of COVID-19, shows that the higher the rating, the more effective it is to reduce the transmission of the corona virus in the future.

Review of the adaptations in opioid agonist treatment during the COVID-19 pandemic: Focus on buprenorphine-based treatment.

Availability and access to opioid agonist treatment (OAT) are limited despite its evidence of effectiveness in treating opioid use disorders (OUDs). COVID-19 pandemic has inadvertently exacerbated the problems of restricted access to OAT and, at the same time, has increased odds of harm due to opioid use. We examined (a) adaptations conceived or implemented in the buprenorphine (BPN)-based OAT service delivery at the national, regional, or local level during the COVID-19 pandemic and (b) the impact of such transformations on the quantitative and qualitative aspects of service delivery. We focused exclusively on BPN-based OAT. We carried out a systematic electronic database search in PubMed and Google Scholar. We included all types of articles. Additionally, we looked up relevant websites of international and national government agencies working in the field of drug abuse. We included 21 articles from 10 countries in the review and summarized the results in a narrative format. The majority of literature was from developed countries. We observed changes in the BPN initiation, dosing, and dispensing protocols, and particular emphasis on telemedicine. There was limited literature on service provisions for the vulnerable population. The changing modes of service delivery have possibly increased the number of new patients and reduced the risk of exposure owing to limited in-person contact. Newer adaptations to meet with the challenges of COVID-19 pandemic in the BPN-based OAT delivery tend to be innovative, flexible, and patient centered. Although it is too early to comment on these newer adaptations' impact, the outcome's directions appear to be positive.

Abstract 27: Trends of Cancer Patients Seeking Care in Makueni County Referral Hospital during the COVID19 Lockdown in Kenya

Abstract Purpose: Kenya has few qualified health care workers and facilities that are dedicated to cancer treatment most of which are located in the urban centers. Patients living in rural areas are expected to travel to urban areas for treatment. However, this is obstructed by poor roads, high levels of poverty, packed cancer wards, and lack of a place to stay in the city depriving the patients of timely and appropriate medical treatment. We outline the number of patients seeking cancer treatment care from a rural County Referral Hospital in Makueni County in Kenya during the COVID19 lockdown season that prohibited the movement of people in and out of Nairobi and Mombasa. Methods: International Cancer Institute, a non-governmental organization working in sub-Saharan Africa and based in Eldoret Kenya established partnerships with Makueni County, to offer cancer care to patients at the County Referral Hospital. Patients attending the clinic were registered every month and their treatment history taken every time they sought treatment at the clinic for their first visit and subsequent visits. The trend of the number of patients over the lockdown season was plotted using a line graph. Results: The observed number of new patients visiting the clinic in the year 2020 increased from Jan; 8, Feb; 11, Mar; 19, Apr; 15, May; 22, Jun; 19, July; 31, Aug; 16, Sept; 12, Oct; 17, Nov; 7, Dec; 4 patients respectively. The subsequent patient visits rose from Jan; 10, Feb; 20, Mar; 37, Apr; 41, May; 45, Jun; 43, July; 90, Aug; 40, Sept; 30, Oct; 61, Nov; 32, Dec; 19 patients respectively. Conclusion: The travel ban influenced the number of patients seen at the Makueni County Referral hospital; more patients sought treatment at the oncology during the lockdown period than any other period of the clinic in the year 2020. Citation Format: Stephen Karuru Maina, Edwin Odoyo, Stephen Mwatha, Raphael Musyoki, Gavin Orangi, Emmah Achieng, Chite Asirwa. Trends of Cancer Patients Seeking Care in Makueni County Referral Hospital during the COVID19 Lockdown in Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 27.

Traumatic Knee Injuries in 2016-2019 - an Analysis of Newly Diagnosed Patients Based on NHF Data Reporting.

Traumatic musculoskeletal injuries are more and more frequently regarded as an important health, social and economic problem. According to WHO statistics, injuries are a major present-day health problem. The main aim of the study is to identify the number of new patients who sustained knee structure injuries during a year and to classify them based on data on services provided under National Health Fund agreements. Information on the number of patients with a knee injury was obtained in a three stage process. First an inventory of relevant diagnoses was determined. Then, the National Health Fund data from 2016-2019 was queried in accordance with the adopted methodology and assumptions. The analysis was based on the report submitted by the NHF in response to the query. According to the NHF reporting data, knee injuries affect approx. 244,000 people per year. There are slightly more men (approx. 52%) than women (48%). People aged 11-20 years constitute the most numerous group of patients with knee injuries, with approx. 41,342 cases per year. The most frequently reported diagnoses in both groups were S80.0 Contusion of knee (approx. 30%), S83.6 Sprain and tear of other and unspecified parts of knee (approx. 21%) and M23.8 Other internal derangements of knee (approx. 9%). According to available data, the overall rate of knee injuries in 2019 was 6.4 per 1000 population. 1. Knee injuries pose a major health problem. In Poland, according to the reporting data, approx. 244,000 knee injuries occur every year. 2. Knee injuries are more common among men than women, and people aged 11-20 years constitute the most numerous group of patients. 3. The National Health Fund reporting data is a very valuable source of information on the magnitude of the problem of injuries.

How Do Breast Cancer Patients Present Following COVID-19 Early Peak in a Breast Cancer Center in Turkey?

Coronavirus disease 2019 (COVID-19) has placed an unprecedented burden on healthcare systems and restricted resources for non-COVID patients worldwide. Treatment approaches and follow-up plans have been modified to prevent the risk of infection for patients and healthcare workers. Patients prefer to delay or cancel their treatments during the peak period of infection. We retrospectively reviewed the characteristics of patients with breast cancer who were consulted at our outpatient clinic right after early COVID-19 peak in May and June 2020 and compared them with the same period in 2017 to 2019. The number of patients who consulted at our outpatient medical oncology clinic declined in May and June 2020. This decline was regardless of stage and was larger in May than in June 2020. In general, the distribution of tumor subtypes [luminal, human epidermal growth factor receptor 2 (HER-2) positive, and triple negative] was not different from 2017 to 2020. Less than half of the patients received adjuvant chemotherapy following early COVID-19 peak in May and June 2020. Few patients received chemotherapy for metastatic disease, whereas many metastatic patients received endocrine therapy. None of the consulted new patients had a non-invasive disease. More patients received endocrine therapy than chemotherapy. The presentation patterns of patients with breast cancer after early COVID-19 peak differed from those during the same period in the last 3 years. The pandemic affected the number of new patients consulted and the way medical oncologists treat their patients.

Do Patients Respond to Posted Emergency Department Wait Times: Time-Series Evidence From the Implementation of a Wait Time Publication System in Hamilton, Canada

One proposed solution to prolonged emergency department (ED) wait times is a publicly available website that displays estimated ED wait times. This could provide information to patients so that they may choose sites with low wait times, which has the potential to smooth the overall wait times in EDs across a health system. We describe the effect of a novel city-wide ED wait time website on patient volume distributions throughout the city of Hamilton, Ontario, Canada. We compared the number of new patients arriving every 15 minutes during 2 separate time periods-before and after a publicly viewable wait time website was made available. For each ED site, the effect of the posted wait time was measured by assessing its association with the total number of patient arrivals in the subsequent hour at the same site and at all other sites in Hamilton. Linear models showed clinically modest changes in patient volumes when wait times changed. However, nonlinear models showed that a 60-minute increase in wait time at a site was associated with 10% fewer patients presenting over the next hour. Larger negative associations were observed at community hospitals and urgent care centers. Increases in wait times at a given site were also associated with increased patient volumes at other sites in the system. After the implementation of a public wait time website, elevated wait times led to fewer patients at the same site but more patient visits at other sites. This may be consistent with the wait time tracker inducing patients to avoid sites with high wait times and instead visit alternate sites in Hamilton, but only when wait times were very high.

Advanced Applications of Fuel Cells during the COVID-19 Pandemic

COVID-19 was identified all over the world as a pandemic in December 2019. This novel coronavirus affects the lower respiratory area, which causes pneumonia in the human body and transfers from human to human. Every day, the number of new patients and the number of deaths are increasing immensely, while specific drugs for this virus are still being developed. Hospitals are struggling to accommodate patients, resulting in a large number of temporary hospitals. These makeshift hospitals need an uninterrupted power supply to continuously maintain all the electrical facilities. Fuel cells, especially solid oxide fuel cells, play an essential role in meeting the additional energy needs of humankind during this critical moment. SOFCs are able to supply power to those makeshift hospitals from the main hospital building, as well as supplying electricity to locked-down residential areas to ease the strain on the electrical grid during this pandemic situation. As a result of their extensive applicability and numerous uses, SOFCs can be used to address electrical needs challenges in various sectors.

Effects of the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant accident on behavioural and psychological symptoms of dementia among patients.

BackgroundThe Great East Japan Earthquake triggered accidents at the Fukushima Daiichi Nuclear Power Plant, becoming the first complex disaster that included both a natural and a nuclear power disaster. This study examines how complex disasters affect patients with dementia.MethodsParticipants included the 331 people diagnosed with dementia out of the 2482 new patients (between January 2008 and December 2015) at a psychiatric hospital located in the indoor sheltering zones nearby mandatory evacuation zones. Medical records were retrospectively examined to identify the number of new patients with dementia, the severity, their chief complaints, and the behavioural and psychological symptoms of dementia (BPSD) types. BPSD were classified into the hyperactive BPSD group and the hypoactive BPSD group. The hyperactive BPSD group was further subdivided into the hyperactivity‐impulsivity‐irritability‐disinhibition‐aggression‐agitation group, which exhibited agitation, disinhibition, and irritability, and the psychosis group, which exhibited delusions and hallucinations. The hypoactive BPSD group included depression, inactivity, apathy, and anxiety. Results were divided into the period before the complex disaster (2008–2010) and after (2012–2015) and were compared. In addition, the post‐complex‐disaster period was subdivided into the early phase (2012–2013) and the late phase (2014–2015).ResultsThe proportion of new patients with dementia increased significantly after the disaster. Although there was no change in patients' age and the disease's severity, the proportion of patients whose chief complaint was BPSD increased significantly after the disaster. Furthermore, there was a significant increase in the hyperactivity‐impulsivity‐irritability‐disinhibition‐aggression‐agitation group in the early post‐complex‐disaster phase and a significant increase in the psychosis group in the late post‐complex‐disaster phase.ConclusionThis complex disaster caused increased consultations from patients with dementia and increased BPSD. Additionally, it increased participants' symptoms of agitation and irritability in the early post‐complex‐disaster phase and the proportion of hallucinations and delusions in the late post‐complex‐disaster phase.

The impact of air pollution alert services on respiratory diseases: generalized additive modeling study in South Korea

To reduce human exposure to particulate matter (PM), governments have enacted various preventive measures, to which a warning system is central. To the best of our knowledge, we are the first to assess the effectiveness of mobile-based warning systems on respiratory health outcomes, examining two types of (particles less than in diameter) alerts via text messaging systems: Wireless Emergency Alert (WEA) and Air Quality Information Text (AIT) as employed in South Korea from January 2015 to October 2019. We used a generalized additive model to control the non-linear relationship between the level and the number of hospital visits and admissions for four respiratory sicknesses—chronic obstructive pulmonary disease, respiratory tract infection, asthma, and pneumonia—while deciphering how such visits and admissions are reduced by the warning systems. Our results found that both systems reduced the number of new patients with the four sicknesses at a 5% statistical significance level. Of the two, WEA was found to be more effective than AIT. The former reduced the number of new patients by 16.4%, while the latter did so by 2.8%. WEA is for everyone with a cell phone connection. By sending simple and direct alerts to a broader range of people, WEA would help people to reduce the chance of short-term exposure to PM in general. The findings provide evidence with policy implications regarding air pollution adaptation.