One-year Study Period Research Articles

Applicability of the WHO maternal near-miss tool: A nationwide surveillance study in Suriname.

BackgroundMaternal near-miss (MNM) is an important maternal health quality-of-care indicator. To facilitate comparison between countries, the World Health Organization (WHO) developed the “MNM-tool”. However, several low- and middle-income countries have proposed adaptations to prevent underreporting, ie, Namibian and Sub-Sahara African (SSA)-criteria. This study aims to assess MNM and associated factors in middle-income country Suriname by applying the three different MNM tools.MethodsA nationwide prospective population-based cohort study was conducted using the Suriname Obstetric Surveillance System (SurOSS). We included women with MNM-criteria defined by WHO-, Namibian- and SSA-tools during one year (March 2017-February 2018) and used hospital births (86% of total) as a reference group.ResultsThere were 9114 hospital live births in Suriname in the one-year study period. SurOSS identified 71 women with WHO-MNM (8/1000 live births, mortality-index 12%), 118 with Namibian-MNM (13/1000 live births, mortality-index 8%), and 242 with SSA-MNM (27/1000 live births, mortality-index 4%). Namibian- and SSA-tools identified all women with WHO-criteria. Blood transfusion thresholds and eclampsia explained the majority of differences in MNM prevalence. Eclampsia was not considered a WHO-MNM in 80% (n = 35/44) of cases. Nevertheless, mortality-index for MNM with hypertensive disorders was 17% and the most frequent underlying cause of maternal deaths (n = 4/10, 40%) and MNM (n = 24/71, 34%). Women of advanced age and maroon ethnicity had twice the odds of WHO-MNM (respectively adjusted odds ratio (aOR) = 2.6, 95% confidence interval (CI) = 1.4-4.8 and aOR = 2.0, 95% CI = 1.2-3.6). The stillbirths rate among women with WHO-MNM was 193/1000births, with six times higher odds than women without MNM (aOR = 6.8, 95%CI = 3.0-15.8). While the prevalence and mortality-index differ between the three MNM tools, the underlying causes of and factors associated with MNM were comparable.ConclusionsThe MNM ratio in Suriname is comparable to other countries in the region. The WHO-tool underestimates the prevalence of MNM (high mortality-index), while the adapted tools may overestimate MNM and compromise global comparability. Contextualized MNM-criteria per obstetric transition stage may improve comparability and reduce underreporting. While MNM studies facilitate international comparison, audit will remain necessary to identify shortfalls in quality-of-care and improve maternal outcomes.

High-sensitivity Troponin T in hemodialysis patients: a randomized placebo-controlled sub-study investigating angiotensin-II-blockade, variation over time and associations with clinical outcome

BackgroundTroponin T (TnT) is a well-known risk factor for negative outcome in hemodialysis (HD) patients, but little is known about variation over time, and the impact of clinical and dialysis specific factors. This study investigated the effect of angiotensin II receptor blockade (ARB), short and long-term variation in TnT and associations with clinical parameters.MethodsIn this analysis based on the SAFIR-cohort (Clinical Trials ID: NCT00791830) 81 HD patients were randomized double-blind for placebo (n = 40) or angiotensin II receptor blocker (ARB) treatment (n = 41) with irbesartan (150–300 mg) and followed for 12 months with six serial measurements of TnT using a high-sensitivity assay.ResultsFifty-four patients (67%) completed follow-up. Baseline TnT-medians (min-max) were (placebo/ARB): 45(14–295)/46(10–343) ng/L. ARB-treatment did not significantly affect mean TnT-levels over the 12-month study period. Median week-to-week and one-year TnT-variation (5th–95th-percentile range) using all samples regardless of intervention were: 0(− 14–10) ng/L (week-to-week) and 3(− 40–71) ng/L (12 months). Median TnT-amplitude, capturing the change from the lowest to the highest TnT-value observed during the one-year study period was 38% or 20.5 ng/L. Median ratios with 95% limits of agreement were: 1.00(0.73–1.37); P = 0.92 (1 week/baseline; n = 77) and 1.07(0.52–2.25); P = 0.19 (12 months/baseline; n = 54). Baseline TnT was positively correlated with diabetes, ultrafiltration volume, arterial stiffness, change in intradialytic total peripheral resistance and N-terminal pro b-type natriuretic peptide (NT-proBNP) and negatively correlated with hematocrit, residual renal function and change in intradialytic cardiac output. High baseline TnT was associated with a higher risk of admission and cardiovascular (CV) events during follow-up. Increase in TnT over time (ΔTnT = 12-months-baseline) was significantly associated with increase in left ventricular (LV) mass and NT-proBNP and decrease in LV ejection fraction and late intradialytic stroke volume. ΔTnT was not significantly associated with admissions, CV or intradialytic hypotensive events during follow-up. Admissions were significantly more likely with a high (TnT-amplitude> 20.5 ng/L) than a low TnT-amplitude. Peaks in TnT were less frequent in aspirin-treated patients.ConclusionARB-treatment had no significant effect on TnT-levels. Week-to-week variation was generally low, yet over 12 months individual patients had considerable TnT fluctuations. Rise in TnT over time was significantly correlated with markers of cardiac deterioration.Trial registrationClinicalTrials.gov Identifier: NCT00791830. Date of registration: November 17, 2008. EudraCT no: 2008–001267-11.

Evaluation of the Long-Term Storage Stability of the Cyanide Antidote: Dimethyl Trisulfide and Degradation Product Identification.

This study reports the long-term storage stability of a formulation of the cyanide (CN) antidote dimethyl trisulfide (DMTS). The F3-formulated DMTS was stored in glass ampules at 4, 22, and 37 °C. Over a period of one year, nine ampules (n = 3 at each temperature) were analyzed by high-performance liquid chromatography (HPLC)–UV/vis at daily time intervals in the first week, weekly time intervals in the first month, and monthly thereafter for a period of one year to determine the DMTS content. No measurable loss of DMTS was found at 4 and 22 °C, and good stability was noted up to five months for samples stored at 37 °C. At 37 °C, a 10% (M/M) decrease of DMTS was discovered at the sixth month and only 30% (M/M) of DMTS remained by the end of the study; discoloration of the formulation and the growth of new peaks in the HPLC chromatogram were also observed. To identify the unknown peaks at 37 °C, controlled oxidation studies were performed on DMTS using two strong oxidizing agents: meta-chloroperoxybenzoic acid (mCPBA) and hydrogen peroxide (H2O2). Dimethyl tetrasulfide and dimethyl pentasulfide were observed as products using both of the oxidizing agents. Dimethyl disulfide was also observed as a product of degradation, which was further oxidized to S-methyl methanethiosulfonate only when mCPBA was used. HPLC–UV/vis and gas chromatography–mass spectrometry/solid phase microextraction analysis revealed good agreement between the degradation products of the stability study at 37 °C and those of disproportionation reactions. Furthermore, at 4 and 22 °C, chromatograms were remarkably stable over the one-year study period, indicating that the F3-formulated DMTS shows excellent long-term storage stability at T ≤ 22 °C.

Audit on in-hospital mortality of trauma patients: EMS Management and Mismanagement

Background: The investigation of trauma-related mortality is one of the key components in trauma studies and it is used as a performance index and measure of health care quality. Objective: The present study aimed to evaluate the performance of pre-hospital interventions and identify possible mismanagements in dealing with trauma patients transferred by emergency medical services (EMS) to the hospital and died. Methods: This study was conducted in 2019, in Tehran, Iran. All trauma patients who were transferred to the emergency department (ED) of three main referral hospitals, by Tehran EMS and died at the hospital within 24 hours of admission, were studied retrospectively. The required information was collected from the EMS and the hospital records. A panel of experts was asked to identify possible errors based on standards for each patient. Results: During the one-year study period, almost 14000 trauma patients were transported by Tehran EMS to the studied hospitals. Of them, a total of 197 deaths were recorded. The most and least provided services were breathing management (87.3%) and intravenous (IV) fluid therapy (12.2%), respectively. Needle thoracostomy, IV fluids therapy, life supports (basic and advanced cardiac), and airway management had the highest percentage of mismanagement among provided services. Bleeding control and resuscitation were consistent with the recommended standard. Conclusion: In the current study, bleeding control and immobilization was performed appropriately. Needle tracheostomy was not performed at all. Airway management and life supports of the victims were not performed properly.

The Effect of Pharmacy Students’ Attendance on Examination Performance in Two Sequential Active-Learning Pharmacotherapy Courses

Objective. To examine the relationship between class attendance by Doctor of Pharmacy students and their performance on pharmacotherapy examinations within an active-learning classroom model. Methods. Second-year pharmacy students enrolled in a pharmacotherapy course series were included in the study (N=160). Class attendance was taken manually by members of the study team over a one-year study period (fall 2017 and spring 2018 semesters). Course attendance was not required and had no direct impact on student grades. Scores from the six competency-based examinations and overall course grades for each semester course, respectively, were then linked to class attendance records. Two additional examination attempts (retake and extended learning experience) were administered to students who did not receive a score of at least 80% on the initial exam or retake exam, respectively. Results. Class attendance was documented during 48 class sessions. Of the six examinations given each semester, students required an average of 1 retake of the examination during the fall semester and 1.5 retakes in the spring semester. A significant negative correlation was found in both courses between students missing more classes and receiving a lower final course grade. For each missed class session, there was a reduction in overall course grade of 0.18% and 0.14% in the fall and spring courses, respectively. Conclusion. Regular class attendance by pharmacy students enrolled in an active-learning pharmacotherapy curriculum was associated with higher scores on examinations. The results of this study illustrate the importance of attending active-learning sessions to attain higher examination scores. Further research is needed to determine whether class attendance is associated with students' improved ability to apply pharmacotherapy concepts.

Measuring Student Interprofessional Skills in the Roles/Responsibilities Competency.

To assess students' perceptions and knowledge of interprofessional collaborative practice related to the Interprofessional Education Collaborative (IPEC) Roles/Responsibilities (RRs) competency after engagement in interprofessional education experiences. Thirty physician assistant students were surveyed 3 times during the clinical year to assess the level of collaborative engagement with 5 professions. The level of engagement was assessed utilizing a 5-point Likert scale, and an open-ended question measured student knowledge of other professionals' roles. Student responses indicated that the level of engagement was greatest during the first clinical semester overall for all 3 levels of engagement. An increase in the level of engagement was noted for 2 professions over the one-year study period. Students also provided examples of opportunities where they relied on the expertise of another profession during the clinical rotation year. Study results confirm student acquisition of 2 IPEC RR subcompetencies during clinical rotations. However, there remains a gap in correlating interprofessional education with interprofessional collaborative practice.

Effects of advanced carbohydrate counting on glucose control and quality of life in children with type 1 diabetes.

The effect of advanced carbohydrate counting (ACC) on metabolic and quality of life (QOL) outcomes is uncertain in children with type 1 diabetes. Our aim was to determine whether ACC would improve HbA1c and QOL scores as compared with standard nutrition in this population. We randomized 87 patients using pump and rapid-acting analogs in a 1 year randomized multicenter study (age 9.6 ± 3.5 years, diabetes duration 4.6 ± 2.7 years, HbA1c 7.8 ± 0.5% [62 ± 5 mmol/mol]). The ACC group received CC education and the control group received traditional dietary education. HbA1c was measured every 3 months. At 0 and 1 year, general, diabetes-specific, and diet-related QOL were respectively assessed by the KIDSCREEN and WHO-5 questionnaires, the diabetes-specific module of the DISABKIDS, and the diet restriction items of the DSQOLS. Mean HbA1c was lower in the ACC than the control group at 3 months (P < .05) and tended to be lower at 6 months (P = .10), 9 months (P = .10), but not at 12 months. The mean of individual average HbA1c during the one-year study period (from M3 to M12) was 7.63 ± 0.43 in the ACC vs 7.85 ± 0.47% in the control group (60 ± 5 vs 62 ± 5 mmol/mol)(P < .05). ACC was associated with significantly higher scores at 1 year on the KIDSCREEN children's psychological scale and the KIDSCREEN parents' physical scale, the DISABKIDS children's treatment scale, and the children's and parents' dietary restriction scales of the DSQOLS (indicating better QOL or lower perceived diet restriction). ACC may be associated with small improvements in metabolic control and QOL scores in children.

Prediction of the Abundance of Artemia parthenogenetica in a Hypersaline Wetland Using Decision Tree Model

The hypersaline wetland of Meighan located in western Iran is an important habitat for Artemia parthenogenetica. The habitat condition of this native zooplankton is facing with various problems in the wetland, so its abundance has been reduced in the wetland in the recent years. The study aimed to optimize decision tree model with an optimizer (greedy stepwise) to predict the species abundance in 10 different sampling sites over one-year study period (2017–2018). The model output was the species abundance categorized into 4 classes (poor: 5–20; fair: 21–50; good: 51–100; very good:101–255 individuals) and measured with abiotic variables. The optimizer method improved the model performance leading to easy interpretation of the model. According to the model’s prediction, high abundance of species in the wetland is associated with high concentration of specific conductivity, dissolved oxygen and total dissolved solids. In contrast, increased concentration of chloride, total suspended solids, nitrate and precipitation might decrease the abundance of zooplankton. Chi-square test showed a significant difference between the species abundance and spatio-temporal patterns in the wetland (x2 = 160.2, p = 0.001) so that warm seasons (spring and summer) had more contribution to the zooplankton sampling than cold seasons (autumn and winter).

The Impact of Telepharmacy Services on the Identification of Medication Discrepancies, High-Alert Medications, and Cost Avoidance at Rural Healthcare Institutions

Telepharmacy, remote reviewing and profiling of medication orders by an offsite pharmacist, has been shown to be an effective method for reducing medication order inaccuracy rates, but there is a lack in studies examining harm reduction and potential cost avoidance by such services. Methods: Retrospective data, collected over a one-year period, were examined for medication order deficiencies; a deficiency was defined as the telepharmacist being required to advocate for clinical action. Based on published rates of adverse drug reactions and expenses related to their treatment, a potential cost avoidance was calculated. Results: Over the course of the one-year study period over 218,000 orders were reviewed by a telepharmacist with 2,292 orders flagged as deficient which included 16,224 individual medication deficiencies. The most common deficiencies included patient allergy to medication, or class of medications, (31.2% of deficiencies) and medication dose adjustment via renal and/or hepatic guidelines (24.1% of deficiencies). There were also a number of deficiencies for specific medications found on the Institute for Safe Medication Practices’ high-alert medication list for ambulatory/community healthcare settings such as insulins and heparinoids. Based on adverse drug reaction incidence rates and treatment expenses, potential cost avoidance was calculated to be as high as over $1.4 million US dollars. Telepharmacists aided in enhancement of pharmacy services by continuing to review medication orders and provide clinical interventions even when an onsite pharmacist was unavailable. Conclusions: Use of the telepharmacist service provided a large cost avoidance by the prevention of potential adverse drug reactions.

FATAL ROAD TRAFFIC ACCIDENTS IN MYSORE CITY USING GEOGRAPHICAL INFORMATION SYSTEM

A deep study of road traffic deaths during 2013 was conducted in Mysore city, Karnataka, India. Victims in RTAs sustain varieties of injuries, which are fatal or dangerous to life. The current paper has attempted to mapping the fatal road traffic accidents within Mysore City in the year of 2013. This is a descriptive secondary data analysis of police records of reported RTA of the year January–December 2013 collected from Krishnaraja, Devaraja, and Narasimaraja Traffic police stations within the administrative region of Mysore city. During the one-year study period of Mysore city in 2013 occurs 902 cases of road traffic accidents. within Mysore city there are 141 death road traffic accident has plotted using Arc Gis 10.3 software. Mainly the result shows that in the city center, North-West of the city and state Highway 88 have more death road traffic accidents. In adding, an effort also made to know the percentage of cause of death. Keywords: Fatal accidents; Road traffic accidents; GIS

PRN Medication Events in a Forensic Psychiatric Hospital: A Document Analysis of the Prevalence and Reasons

The aim of this study was to describe and explain the prevalence and reasons for as needed medication (pro re nata, PRN) in a forensic psychiatric hospital. We reviewed the documents of 67 long-term inpatients (87% male) over the one-year study period and identified 8626 PRN events. Virtually all of the patients received PRN for physical reasons, just over half for psychiatric reasons, and just over one-third for insomnia. The number of PRN events per patient was unevenly distributed. The prevalence of PRN events for both psychiatric reasons (26%) and insomnia (14%) were associated with the female gender, more severe psychiatric symptoms, and lower daily functioning. Half of the patients did not receive PRN for psychiatric reasons. It is likely that the use of such medication was successfully mitigated with scheduled medication and psychosocial approaches. The high number of PRN events for physical reasons (60%) was not explained by the patient characteristics and urgent research is needed on this aspect. Protracted PRN use should be recognized in clinical practice, and consider more structured solutions to develop PRN protocols and evidence-based care. Future research should examine how PRN is integrated with patients’ regular treatment and non-pharmacological methods.

Early Extended Neonatal Screening for Congenital Cytomegalovirus Infection: A Quality Improvement Initiative

Identification of congenital cytomegalovirus (cCMV) infection in neonates is important for early diagnosis of sensorineural hearing loss. Therefore, a quality improvement project was designed with an aim to improve newborn CMV screening by 25% from a baseline rate of 22%. This project was conducted across two hospital sites at one medical center with two tertiary care newborn nurseries and neonatal intensive care units. Symptomatic neonates with suggestive findings of cCMV, who had failed the newborn hearing screen, who had not had a hearing screen performed by 10 days of age, or who were infants of HIV-positive mothers were screened for cCMV. Serial interventions (formalized teaching sessions using an algorithm and involving a nurse educator, creation of electronic medical record order sets, huddle board reminders, and regular audits) were conducted, and statistical process control p-charts were used to identify any signals and to determine if there was any special cause variation. Of 5,817 infants born in 2018, 903 were eligible for screening. Small for gestational age (46%) was the most common indication for screening. After multiple interventions, the median screening rate increased from a baseline of 22% in 2016 to 74% during the one-year study period. Four infants had positive CMV screen and received appropriate treatment as a result of these interventions. Multidisciplinary quality improvement initiatives can improve newborn screening for cCMV infection in a tertiary care environment.

GENDER BASED ASSESSMENT OF ROAD TRAFFIC ACCIDENTS IN MYSORE CITY

Road Traffic Accidents (RTA) are growing is an alarming rate throughout the world. The present paper has tried to mapping and analysis the road traffic accidents male and female occupants within Mysore City in the year 2013. The secondary data were collected relating to accidents registered with Krishnaraja, Devaraja and Narasimaraja Traffic Police stations in Mysore city. During one-year study period of Mysore city 2013 occurs 902 cases of road traffic accidents. There are 768 Male occupants and 205 Female occupants road traffic accident has plotted within Mysore city used Arc Gis 10.3 software. In adding, a determination also made to know the percentage of cause of male and female occupants road traffic accidents. Keywords: occupants; road traffic accidents; GIS

MO078HEMODIAFILTRATION MAINTAINS A SUSTAINED IMPROVEMENT IN BP COMPARED TO CONVENTIONAL HEMODIALYSIS IN CHILDREN - THE HDF, HEART AND HEIGHT (3H) STUDY

Abstract Background and Aims Hypertension is prevalent in children on dialysis and associated with left ventricular hypertrophy, cardiovascular disease and mortality. We studied the effect of different dialysis modalities (conventional hemodialysis [HD] vs hemodiafiltration [HDF]) on BP and risk factors affecting the evolution of BP over a one-year follow-up. Method This is a post-hoc analysis of the “3H - HDF-Hearts-Height” dataset, a multicenter, non-randomized, parallel-arm intervention study. The time–averaged 24-h mean arterial pressure (MAP) was used for the analyses and hypertension defined as 24-h MAP standard deviation score exceeding the 95th percentile. Results All 133 children who completed 12 months follow-up in the 3H study were included in this post - hoc analysis. 78 (74%) were on HD and 55 (77%) on HDF. At baseline MAP-SDS was &amp;gt; 95th percentile in 64 (82%) of children on HD and 23 (41.8%) patients on HDF, but these data are skewed by a high percentage of prevalent dialysis patients in the study. 43 (55%) of HD patients and 23 (42%) of HDF patients were on antihypertensive medications, and uncontrolled hypertension (BP&amp;gt;95th centile on medications) was present in 38 (88%) of HD patients and 6 (25%) of HDF patients. In the stepwise logistic regression at baseline, independent risk factors for hypertension were gender (OR 2.29; 95%CI 1.06–4.96; p=0.04) and inter-dialytic weight gain at baseline (OR 1.3; 95%CI 1.1–1.55; p=0.004). Over the one-year study period, MAP-SDS increased by 39% in HD patients and 12% in HDF patients (p&amp;lt; 0.001) (Figure). Significant risk factors for hypertension over time were dialysis modality (OR for HD compared to HDF 7.65; 95% CI 3.23 – 18.12; p&amp;lt; 0.001), inter-dialytic weight gain (OR 1.21; 95% CI 1.05 – 1.39; p=0.007), and dialysate sodium (for 1 mmol/L increase in dialysate sodium MAP-SDS increased by 1.1mmHg ; 95% CI 1.01 – 1.21; p=0.04). Conclusion Children on HD compared to HDF had a 7.6-fold higher 24-hr MAP-SDS and a sustained increase in BP over the one-year study period. Higher inter-dialytic weight gain and higher dialysate sodium levels were associated with a higher MAP-SDS in both groups.

Leaf-litter decomposition and nutrient dynamics of five selected tropical tree species

Leaf-litter decomposition in terrestrial ecosystems has a major role in recycling the nutrients to the soil. Nutrient dynamics is the way nutrients cycle in an ecosystem. The present study was conducted for five selected tropical tree species viz. Shorea robusta, Ficus hookeri, Mallotus philippensis, Artocarpus lakoocha and Dillenia pentagyna at Hetauda, Makawanpur. This paper aims to determine the litter decomposition rate-constant and nutrient mineralization pattern of the selected species. The litter-bag method was used to assess the decomposition and nutrient dynamics for one year. Both decomposition rate-constant and weight loss were highest for M. philippensis (% weight loss = 73.49; k = 0.33) and lowest for S. robusta (% weight loss = 54.01; k = 0.18). In general, weight remaining showed a strong negative correlation with N and P concentration but a slightly negative with K. However, the remaining weight of litter showed a strong positive correlation with C : N ratio, thus indicating a good predictor of mass loss and mineralization. The study showed that there was no net release of nitrogen during the one-year study period; however, the net P release was found to be highest for S. robusta followed by D. pentagyna and the net K release was highest in F. hookeri followed by A. lakoocha.

Patchy resources and multiple threats: How do koalas navigate an urban landscape?

Urbanisation is increasing throughout the range of the koala (Phascolarctos cinereus) and has contributed to the decline of koala populations in many areas. In urban landscapes where koalas may need to travel considerable distances to access resources, they face increased risks of predation by domestic dogs and vehicular collision. Understanding how koalas navigate this risky landscape is key to developing effective conservation strategies. We used GPS data collected from 20 koalas to examine koala habitat use and movements in an urbanised area of the Mornington Peninsula, Victoria, Australia. Koala home ranges were large (males = 9.1 ha, females = 4.3 ha) and covered up to 153 properties. Analysis of GPS tracks showed that koalas moved frequently (median number of different locations per week: 14 [males], 8 [females]), usually over short distances (median distance: 69 m [males], 50 m [females]), and often crossed roads (average crossings per week: 9.4 [males], 2.7 [females]). Despite this movement behaviour placing koalas at risk of vehicular collision and predation by dogs, we recorded only three deaths during the one-year study period; two were due to old age and one of unknown cause. Our low mortality rate may be due to movements occurring at night when risks may be lower, and high awareness in the community about koalas that mitigates threats. Our results suggest that effective conservation of urban populations of koalas requires a landscape-scale approach with participation by the community and public land managers to maintain and establish koala habitat and connectivity, and to encourage koala-friendly driving behaviour.

Use of health and support services by people living with dementia in the community setting.

To determine the access to and use of health-care services by people with dementia in the community. A retrospective cross-sectional analysis of the Australian Government Department of Veterans' Affairs (DVA) administrative claims data was conducted. Veterans and their spouses with one or more dementia claims between 1 January 2000 and 30 June 2016, who were aged ≥45years at the time of the claim and who were still alive and living in the community on 30 June 2017, were included. We assessed the proportions of people with dementia who received medical, pharmacy and medicines, allied health services, and home care supports from 1 July 2016 to 30 June 2017. A total of 10171 people with dementia were included. They had a median age of 89years, 60% were female, and 63% lived in a major city. Over the one-year study period, 98% visited the GP and 99% had medicines dispensed at a pharmacy. Eighty-two per cent saw a specialist, and 19% saw a geriatrician. Thirty-one per cent received a DVA-funded dose administration aid to support medication administration, and 19% received a home medicines review. Less than half had claims for occupational therapist services (48%), community nursing (48%), physiotherapists (41%) or dentist visits (33%). Fifty-eight per cent received home care supports, for example domestic assistance. Many people living with dementia in the community do not access all of the health-care or support services available to them. Ensuring that people with dementia and their carers are supported to access the services available to assist them live in the community setting for as long as possible is important.

MON-136 Reducing Unnecessary Inpatient Adrenocorticotropin Stimulation Tests

Background:Outpatient adrenocorticotropin (ACTH) stimulation tests can be challenging to interpret due to heterogeneously reported cut-offs. Inpatient stimulation tests present additional challenges due to the presence of acute illness and unreliable coordination of dynamic function testing on a busy inpatient service. This study aims to characterize the use of ACTH stimulation tests in hospitalized patients to determine necessity of testing.Methods:We conducted an inpatient audit of ACTH simulation tests done to rule out adrenal insufficiency between April 2018 to March 2019 at our institution. Normal post-ACTH response was defined as peak cortisol ≥500 nmol/L. Testing was considered inappropriate in patients with normal post-ACTH response who had a serum cortisol ≥250 nmol/L drawn during the same admission prior to stimulation testing. Cut-offs were based on previous analysis of 195 outpatient stimulation tests.Results:During the one-year study period there were 40 inpatients who had an ACTH stimulation test. Nineteen (48%) were considered unnecessary because patients either had a pre-ACTH serum cortisol ≥250 nmol/L and/or a 0-minute cortisol value just prior to the ACTH stimulation test ≥250 nmol/L. Except for a single instance where the patient was inappropriately on prednisone when basal cortisol was tested, all patients with any pre-ACTH cortisol ≥250 nmol/L had a normal post-ACTH responseConclusion:Institutions may avoid unnecessary inpatient ACTH stimulation tests by implementing protocols which ensure that basal cortisol levels are drawn and below locally determined cut-offs before proceeding to dynamic testing. To characterize further, a three-year analysis of inpatient ACTH stimulation tests is underway.

Atmospheric correction for satellite-derived bathymetry in the Caribbean waters: from a single image to multi-temporal approaches using Sentinel-2A/B.

Different atmospheric correction (AC) procedures for Sentinel-2 satellites are evaluated for their effectiveness in retrieving consistent satellite-derived bathymetry (SDB) over two islands in the Caribbean (Buck and Culebra). The log-ratio method for SDB, which allows use of minimal calibration information from lidar surveys (25 points in this study), is applied to several Sentinel-2A/B scenes at 10 m spatial resolution. The overall performance during a one-year study period depends on the image quality and AC. Three AC processors were evaluated: ACOLITE Exponential model (EXP), ACOLITE Dark Spectrum Fitting model (DSF), and C2RCC model. ACOLITE EXP and ACOLITE DSF produce greater consistency and repeatability with accurate results in a scene-by-scene analysis (mean errors ∼1.1 m) for depths up to 23 m (limit of lidar surveys). In contrast, C2RCC produces lower accuracy and noisier results with generally higher (>50%) errors (mean errors ∼2.2 m), but it is able to retrieve depth for scenes in Buck Island that have moderately severe sunglint. Furthermore, we demonstrate that a multi-temporal compositing model for SDB mapping, using ACOLITE for the input scenes, could achieve overall median errors <1 m for depths ranging 0-23 m. The simple and effective compositing model can considerably enhance coastal SDB estimates with high reliability and no missing data, outperforming the traditional single image approaches and thus eliminating the need to evaluate individual scenes. The consistency in the output from the AC correction indicates the potential for automated application of the multi-scene compositing technique, which can apply the open and free Sentinel-2 data set for the benefit of operational and scientific investigations.

Intubation in the Intensive Care Unit: C-MAC video laryngoscope versus Macintosh laryngoscope

PurposeVarious modifications of the Macintosh blade and direct laryngoscopy have been incorporated into practice to improve the intubation success rate and avoid complications while ensuring patient safety. This study evaluates the usefulness of two different direct laryngoscopy methods used by operators with various level of experience in the Intensive Care Unit. Material and methodsIn a single centre prospective study, C-MAC and Macintosh laryngoscopes were compared in terms of laryngoscopy and intubation outcomes such as glottic visualization, number of intubation attempts, intubation success and satisfaction score. ResultsDuring the one-year study period, 263 patients were evaluated and data of 218 patients were analyzed. The rate of successful first attempt intubation was higher in the video laryngoscope group (VL) (84% vs 57%; P<0.001). A significantly greater number of patients in the Macintosh laryngoscopy group had difficult visualization of the glottis in terms of the modified Cormack and Lehane classification and Percentage of Glottic Opening scale. ConclusionThe use of video laryngoscope for intubation in ICU settings results in better visualization of the glottis and a higher incidence of successful intubation attempts.