Patients Research Articles

EP109 Assesment of factors contributing to delay of emergency laparotomies and potential solutions to optimize patient flow at a high volume centre. A Quality Improvement Project

Abstract Aim To identify factors resulting in delay of emergency laparotomies and offer potential solutions. Methods This was a retrospective study spanning 7 months including all laparotomies and major laparoscopic procedures excluding appendicectomies and cholecystectomeis. Data from the trust IT system was used to populate the various times of each procedure. Results 265 patients were studied in total including 76 category 1 laparotomies. Transport time defined as the duration between completion of the briefing to patient arrival at the operating theatre was found to be inaccurately documented in 66 cases. Median time was 20 min with 15 patients needing more than 45 min for transport. Median anaesthetic time defined as time from patient arrival to initiation of surgery was 50 min. Median procedure duration was 113 min. Median post operative time defined as the duration between surgery completion and exiting the operating theatre was 17 min. Median post op recovery time was 137 min with 15 patients requiring more than 12 hours in recovery. Post changes of informal education the median transport time reduced to 17 min. Conclusions Factors that can be optimized to reduce delays are ensuring ward prepardeness before transferring to theatres, appropriate documentation of transport times so staff are aware they maybe audited and satisfactory communication between teams (including site/bed managers) to ensure adequate prepardeness and a smooth flow of patients to the ward and prevent a hold up in recovery.

How are the Spiritual Resources and Needs of Mental Health Consumers Identified and Documented by Staff upon Admission to an Australian Mental Health Service? A Mixed Methods Study.

This study investigated how the spiritual resources and needs of Australian mental health consumers are identified by staff during admission at an inner-city acute care hospital. A mixed-methods study was conducted incorporating an audit of medical records (n = 205), and a staff focus group (n = 6). The results revealed that information collected during admission is often limited to factors such as medical and social history. Although participants could identify benefits of asking about spirituality, reasons for not asking were also articulated. Staff training and better care planning were identified as two ways to improve awareness of patients' spiritual needs.

Progress and Outcomes of Intraoperative Nerve Monitoring During Thyroidectomy

Intraoperative nerve monitoring (IONM) is not considered standard of care during thyroidectomy, and guidelines are vague about its use in the absence of strong evidence of superiority over visualization of the recurrent laryngeal nerve (RLN) alone. To characterize patterns of IONM use during thyroidectomy in the US and evaluate the association of IONM with postoperative outcomes. This cohort study used the National Surgical Quality Improvement Program (NSQIP) thyroidectomy data from January 1, 2016, to December 31, 2022. A nationally representative sample included adult patients without poorly differentiated thyroid cancer who underwent thyroidectomy at multiple centers. Data were collected from the time of surgery until 30 postoperative days through January 31, 2023. IONM during thyroidectomy. Prevalence of IONM during thyroidectomy and postoperative outcomes including RLN injury, hypocalcemia, and neck hematoma. A total of 44 265 patients undergoing thyroidectomy were included (77.2% female; mean [SD] age, 51.8 [15.2] years), with 30 633 (69.2%) using IONM. Common indications for surgery in the cohort were goiter (35.3%) and a single nodule or neoplasm (39.2%). The prevalence of IONM increased from 62.5% in 2016 to 75.9% in 2022. RLN injury occurred in 6.0% of cases. On propensity score-matched analyses, IONM was associated with decreased odds of RLN injury overall (adjusted odds ratio [AOR], 0.98; 95% CI, 0.97-0.99) and decreased odds among patients with differentiated thyroid cancer (AOR, 0.96; 95% CI, 0.94-0.99). IONM was not associated with postoperative hypocalcemia (AOR, 0.99; 95% CI, 0.99-1.00) or neck hematoma (AOR, 1.00; 95% CI, 0.99-1.00). This cohort study found that IONM during thyroidectomy has become routine, and use has increased over the last 7 years. IONM was associated with a slightly decreased odds of RLN injury, but no difference in hypocalcemia or neck hematoma. Although IONM use is widespread, further research is needed to identify patients who would benefit the most from this technology.

What Do Women (With Serious Knee Injury) Want to Know about Knee Health? Identifying Research Priorities With a Consumer Advisory Group

OBJECTIVES: To (1) establish a women’s knee health Consumer Advisory Group (CAG) via an evidence-informed process and (2) identify the CAG’s research priorities to inform future projects. DESIGN: Mixed-methods priority-setting study METHODS: The CAG was established, grounded in a participatory action research approach and using the Patient Engagement in Research Framework, to inform a 4-phase process: (1) understand; (2) plan; (3) undertake; and (4) evaluate. We identified the CAG’s priorities for knee health research via a mixed-methods approach using the nominal group technique (NGT). We adopted a constructivist epistemology, using reflexive thematic analysis to construct codes and themes inductively. RESULTS: Six women (mean age 35 years) joined the CAG, generating, reviewing, and discussing 70 ideas during NGT phases 1-3. We constructed 14 codes, grouped into 3 key themes: (1) Best practice management and support for serious knee injury and rehabilitation; (2) Social and gendered factors; and (3) Physical, psychological, and personal factors. Voting and ranking (NGT phases 3-6) revealed the CAG’s highest priority for future research was: “Knowledge of, and access to specialised knee rehabilitation and practitioners”. CONCLUSION: Establishing a CAG was an achievable and novel approach to identifying consumer priorities to enhance women’s knee health outcomes. Women wanted improved access to information and best-practice care via genuine therapeutic relationships with practitioners who understand the gendered-social rehabilitation environment.

The Relationship Between Muscle Metabolic Index (Cr/CysC) Levels and Short-Term Prognosis with Acute Ischemic Stroke: Findings from a Cohort Study.

Sarcopenia significantly impacts prognosis in patients with acute ischemic stroke (AIS). This study investigates the relationship between serum creatinine/serum cystatin C (Cr/CysC) levels and short-term prognosis in AIS patients, aiming to inform post-treatment strategies. We analyzed AIS patients at the First Affiliated Hospital of the University of Science and Technology of China from January 2022 to January 2024. Baseline data were collected through interviews and medical records, with a 3-month follow-up for prognosis assessment. 265 were included in the final analysis. Cr/CysC levels were categorized into quartiles (Q1-Q4). Logistic regression and restricted cubic spline analysis were employed to evaluate the association between Cr/CysC and prognosis. Among the 265 patients, the average age was 66.18 ± 12.41years, and 129 (48.68%) had poor short-term prognosis. Multivariate logistic regression showed that patients in the lowest quartile of Cr/CysC (Q1) had a significantly lower risk of poor prognosis compared to those in the highest quartile (Q4) (odds ratio= 0.287, 95% confidence interval: 0.090-0.917, P= 0.035). A linear relationship was identified between Cr/CysC and prognosis (P overall<0.001, P nonlinear= 0.571). This study establishes a significant linear correlation between Cr/CysC levels and poor short-term prognosis in AIS patients. Encouraging muscle function exercises may enhance patient outcomes.

Transforming Non-Digital, Clinical Workflows to Detect and Track Vision-Threatening Diabetic Retinopathy via a Digital Platform Integrating Artificial Intelligence: Implementation Research.

Screening diabetic retinopathy (DR) for timely management can reduce global blindness. Many existing DR screening programs worldwide are non-digital, standalone, and deployed with grading retinal photographs by trained personnel. To integrate the screening programs, with or without artificial intelligence (AI), into hospital information systems to improve their effectiveness, the non-digital workflow must be transformed into digital. We developed a cloud-based digital platform and implemented it in an existing DR screening program. We conducted the following processes in the platform for prospective DR screening at a community hospital: capturing patients' retinal photographs, uploading them for grading by AI or trained personnel on alternate weeks for 32weeks, and referring vision-threatening DR to a referral center. At this center, the platform was applied for the assessment of potential missed referrals via remote over-reading by a retinal specialist and tracking referrals. Implementational outcomes, such as detecting positive cases, agreement between AI and over-reading, and referral adherence were assessed. Of 645 patients screened by AI, 201 (31.2%) were referrals, 129 (64.2%) of which were true positives agreeable by over-reading; 115 of these true positives (89.1%) had referral adherence. False negatives judged by over-reading were 1.1% (5/444). Of 730 patients in manual screening, 175 (24.0%) were potential referrals, 11 (6.3%) of which were referred at the point-of-screening; eight of these (72.7%) adhered to referral. The remaining 164 cases were appointed for later examination by a visiting general ophthalmologist; 11 of these 116 examined (9.5%) were referred for non-DR-related eye conditions with 81.8% (9/11) referral adherence. No system failure or interruption was found. The digital platform can be practically integrated into the existing non-digital DR screening programs to implement AI and monitor previously unknown but important indicators, such as referral adherence, to improve the effectiveness of the programs. ClinicalTrials.gov. (registration number: NCT05166122).

Do low-risk patients really need follow-up after a pulmonary embolism?

The British Thoracic Society recommend that pulmonary embolism (PE) patients with low-risk Pulmonary Embolism Severity Index (PESI) scores are considered for outpatient (OP) management, in settings where robust pathways for follow-up and monitoring exist. Retrospective cohort study. We reviewed the electronic records of 109 consecutive PE patients considered appropriate for OP management. Primary outcomes were the incidence of recurrent venous thromboembolism, major bleeding, mortality at 1 year and evidence of chronic thromboembolic pulmonary hypertension (CTEPH). Low-risk PESI scores (I-II) were recorded in 78 (72%) patients, with higher scores a consequence of age and comorbidity rather than haemodynamic instability. There was a low rate of adverse outcomes despite a lack of formal follow up for most patients. There was no evidence of CTEPH in 34 patients who underwent echocardiography. Our analysis challenges the need for robust follow-up pathways for all patients with pulmonary embolism.

Changes in Emergency Department and Inpatient Encounters for Falls after the Onset of the COVID-19 Pandemic.

This study investigates changes in clinical encounters due to falls before and after the onset of the COVID-19 pandemic. De-identified health record data from a large mid-western health system was used to examine the frequency of emergency department (ED) and inpatient (IP) encounters for falls by month among adults age 50+ (N = 485, 886 patients) using joinpoint regression analysis. Also, overall rates before and during the pandemic were compared using log-binomial models. Fall rates increased following the onset of the COVID-19 pandemic for IP encounters but not for ED encounters. There were no differences by age, gender, race, or nSES. Monthly IP fall rates increased by 0.68% per month both before and after the onset of the COVID-19 pandemic. Pandemics may occur in the future, and interventions are needed to prevent falls in older adults during the next public health emergency.

Prevalence of acute kidney injury and outcome in cats treated as inpatients versus outpatients following lily exposure.

To investigate the prevalence of acute kidney injury (AKI) and outcome in cats treated for lily exposure as inpatients (IPs) or outpatients (OPs). Medical records of cats with lily exposure were retrospectively evaluated; 112 cats were included. Signalment, type of exposure, time from exposure to presentation, decontamination procedures, treatment group (IPs vs OPs), creatinine and International Renal Interest Society AKI grade at specific time points (initial presentation, 0 to 24 hours, 24 to 48 hours, and 48 hours to 2 weeks), whether an AKI developed at any point, whether AKI grade was static or improved when comparing baseline to last documented AKI grade, and outcome (alive or dead/euthanized) were recorded. There were no significant differences in prevalence of AKI between the IP cats (45 of 96 [46.9%]) and OP cats (7 of 16 [43.8%]). Of the AKI cats, 27 IP cats (60%) and 4 OP cats (57.1%) had a static or improved AKI grade. Inpatient cats had a significantly higher survival compared to OP cats (100% vs 86.5%). Cats exposed to lilies in both groups had a higher prevalence of AKI than previously reported; however, many cats with AKIs had a static or improved AKI grade by the last documented AKI grade. Although the survival was lower in OP cats compared to IP cats, overall survival was excellent. Results of our study suggested that IP cats have a superior outcome than OP cats; however, cats treated as OPs may still have favorable outcomes.

Multi-center study on the application potential of Siaα-2,6Gal in early and differential diagnosis of lung cancer.

This study aimed to investigate the application potential of the abnormal glycan structure Siaα-2,6Gal in the early and differential diagnosis of lung cancer. Clinical data and serum samples from 730 patients and 120 healthy individuals participating in clinical trials on Siaα-2,6Gal were collected at three medical centers between January 2022 and June 2023. The levels of Siaα-2,6Gal, carcinoembryonic antigen (CEA), cytokeratin 19 fragment antigen (CYFRA21-1), squamous cell carcinoma antigen (SCC), neuron-specific enolase (NSE), and pro-gastrin-releasing peptide (ProGRP) in serum were measured. The application potentials of these markers in the early and differential diagnosis, classification, and staging of lung cancer were explored. (1) Serum Siaα-2,6Gal levels in the lung cancer group were 2,606 (1,970-3,458) U/mL, significantly higher than those in the benign lung disease, miscellaneous malignant tumor, miscellaneous benign disease, and healthy individual groups at 1,359 (950-1,528), 1,252 (903-1,532), 1,196 (850-1,490), and 1,210 (1,100-1,287) U/mL (P < 0.0001). (2) Serum Siaα-2,6Gal levels in the early-stage lung cancer (stages 0-II) group were 2,576 (1,929-3,338) U/mL, significantly higher than those in the benign pulmonary nodule group at 1,419 (1,105-1,820) U/mL (P < 0.0001). (3) Receiver operating characteristic curves showed that Siaα-2,6Gal had a high diagnostic efficiency for lung cancer (area under the curve (AUC)=0.9217), significantly superior to CEA, CYFRA21-1, SCC, NSE, and ProGRP (AUCs of 0.6618, 0.6605, 0.5783, 0.5985, and 0.6381). Siaα-2,6Gal is a promising biomarker for lung cancer diagnosis and may offer superior differential diagnosis of early-stage lung cancer from benign pulmonary nodules compared to traditional tumor markers.

Stakeholder experiences collaborating with My Place: a service supporting pregnant and young parents in the child welfare system in metropolitan Adelaide

ABSTRACT My Place is a therapeutic and health service for high-risk, vulnerable children and youth (12–25 years), connected with the child protection system, who are pregnant or parents whose infants are at risk of removal. Qualitative interpretive phenomenology guided the focus group interviews with staff, stakeholders and health consumers (n = 30). My Place was reported to be trauma-responsive, culturally-sensitive model of care and was viewed as responsible for the development of trust, empowerment, and self-determination among young people due to therapeutic interventions, case management, health information and support with service system navigation. Contributing to practice-based evidence, stakeholders considered the programme delivered kind, gentle, and healing care to young people and developed collegial, trusting, and collaborative relationships with workers across service systems. Stakeholders reported that My Place improved their own trauma-responsive practices. My Place is an early intervention for young, at-risk cohorts, providing a foundation for trauma-informed child welfare systems across metropolitan Adelaide.

Prevalence of Complications Due to Transphyseal Hematogenous Osteomyelitis.

Transphyseal hematogenous osteomyelitis (THO) is a common infectious condition, being present in 25% of patients with hematogenous osteomyelitis. A large proportion of pediatric hematogenous osteomyelitis infections can spread through the growth cartilage and therefore may be potentially responsible for growth disorders, leading to limb-length discrepancy or angular deformities. The purpose of the present study was to identify both the prevalence of complications caused by transphyseal osteomyelitis and factors influencing their occurrence. The records for all patients who had been treated for THO over a 17-year period at the University Hospitals of Geneva and the Gesù Bambino Hospital in Rome were retrospectively analyzed. Clinical, biological, and bacteriological data were analyzed. Magnetic resonance imaging (MRI) scans were reviewed for all patients to assess the cross-sectional area of growth plate involvement. Restart of growth of the affected physeal cartilage was subsequently monitored by means of iterative radiographic examination. From a cohort of 594 patients with hematogenous osteomyelitis, 89 patients (15.0%) were found to have THO. The median age was 84 months (range, 1 to 167 months), with a bimodal distribution and peaks at 30 and 150 months; 59.6% (53) of the 89 patients were male. The lower limbs were most often affected, with the distal tibia and fibula accounting for 47.2% of all cases. Methicillin-sensitive Staphylococcus aureus and Kingella kingae were the most frequently identified pathogens, accounting for 61.8% of the cases. Virulence factors, such as Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and accessory gene regulator (Agr), were recorded in 12.4% of MSSA strains. Transphyseal lesions affected a median of 7.6% (range, 0.79% to 58.2%) of the physeal surface. Complications affecting further growth were noted in 13% of patients with THO. Thrombocytopenia, leukocytosis, and the presence of virulence factors significantly influenced the occurrence of complications. THO affects all age categories of the pediatric population. In the present study, growth disturbance occurred in 13% of cases. The presence of deep thrombocytopenia, leukocytosis, and virulence factors, such as Agr, TSST, and PVL, seems to strongly influence the occurrence of such complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Private-Sector Readmissions for Inpatient Surgery in Veterans Health Administration Hospitals

The Veterans Health Administration (VHA) reports multiple indicators of hospital surgical performance, including hospital risk-standardized 30-day readmission rates (RSRRs). Currently, most routinely reported measures do not include readmissions that occur outside VHA hospitals. The impact of readmissions outside the VHA on hospital RSRR is not known. To measure the impact of including non-VHA readmissions on VHA hospital performance rankings for 30-day readmission. This retrospective cohort study included patients aged at least 65 years from 2013 to 2019 from the Veterans Affairs Surgical Quality Improvement Program linked to patient-level data from the VHA and Medicare. Data were limited to patients with VHA and Medicare enrollment during the year prior to surgery. Data were analyzed from November 2023 through July 2024. The main outcome was readmissions to acute care VHA or non-VHA hospitals within 30 days of discharge. VHA hospital-level RSRRs were estimated using separate generalized linear mixed-effects risk adjustment models that alternatively included VHA-only or VHA plus non-VHA readmissions. VHA hospitals were then stratified into quintiles based on RSRRs derived using VHA-only or VHA plus non-VHA readmissions. Changes in hospital performance quintiles with the addition of non-VHA readmissions were calculated, and characteristics of VHA hospitals most impacted by including non-VHA readmissions were evaluated. The eligible cohort included 108 265 patients (mean [SD] age, 72.2 [6.5] years; 105 661 [97.6%] male) who underwent surgery in 104 VHA hospitals. The combined readmission rate was 14.0%. The proportion of readmissions occurring outside the VHA ranged from 0% to 55.3% across the 104 VHA hospitals (median, 20.9%). Using VHA and non-VHA readmissions, 24 VHA hospitals (23.1%) improved performance and 23 hospitals (22.1%) worsened performance, defined as a decrease or increase, respectively, of 1 or more RSRR quintiles. Improvements in hospital performance rank were associated with larger surgical volume (-7.48; 95% CI, -11.33 to 03.64; P < .001), urban location, greater surgical complexity (-9.86; 95% CI, -16.61 to -3.11; P = .005), and lower proportion of readmissions outside the VHA (-8.15; 95% CI, -12.75 to -3.55; P < .001). In this cohort study, VHA hospitals whose readmission performance metric improved by including non-VHA readmissions had higher patient volume, higher complexity, and lower proportion of care outside the VHA. Thus, improving continuity of care may have a paradoxical effect of worsening VHA performance metrics.

Quality of life of elderly cardiac patients with multimorbidity and burnout among their caregivers

Abstract Background Changes in cardiovascular anatomy, physiology, and biology associated with aging increase vulnerability to cardiovascular diseases (CVD), and more people are living into old age with chronic CVD. As a result, a significant number of elderly people have CVD, whereas CVD is more likely to emerge as part of a cluster of chronic conditions in younger patients that have an impact on their QOL (quality of life). Burnout syndrome (BO) is an increasingly serious problem among caregivers. Results A hospital-based cross-sectional study was conducted to evaluate the quality of life of elderly cardiac patients with multimorbidity and BO syndrome among their caregivers on 265 patients and their caregivers; data was collected using sociodemographic, World Health Organization Quality of Life-Brief (WHOQOL-BREF), and Maslach Burnout Inventory (MBI) questionnaires. We found that 46.8% of elderly cardiac patients with multimorbidity showed poor overall QOL and health, and 16.6% of caregivers showed a high degree of total burnout score. According to age-adjusted Charlson Comorbidity Index, the 10-year survival of our patients was 21%, 2%, and 0% in 56.2%, 26.4% and 17.4% of patients respectively. Conclusion Our study concluded that physical, psychological, and environmental QOL domains are poor among elderly cardiac patients with multimorbidity, and more than half of their care caregivers showed a low degree of personal accomplishment. Therefore, it is critical to carry out additional clinical trials aimed at developing novel rehabilitation programs and therapy avenues that will improve the QOL for elderly cardiac patients and their caregivers.

Medicare Advantage Population in the United States: Outcomes of Patients with Asthma Treated with ICS/LABA Before and After Initiation with Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI).

The clinical benefits of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) have been demonstrated in clinical trials. There is limited evidence regarding the effectiveness and economic outcomes associated with FF/UMEC/VI use in US clinical practice. This real-world study assessed asthma-related exacerbations, healthcare resource utilization (HRU), and healthcare costs among a Medicare Advantage-insured population before and after initiation of FF/UMEC/VI in patients with asthma previously treated with an inhaled corticosteroid/long-acting β2-agonist (ICS/LABA). De-identified data were obtained from the Komodo Health database (01/01/2016-12/31/2023) for adults with asthma who received prior ICS/LABA treatment and had ≥ 12months of continuous Medicare Advantage coverage both pre- and post-FF/UMEC/VI initiation (index date). Rates of asthma-related exacerbations and HRU were compared using rate ratios (RR) from Poisson regressions. Healthcare costs were calculated per patient per year (PPPY) and compared using mean cost differences from generalized linear models. In total, 2598 Medicare Advantage-insured patients who initiated FF/UMEC/VI for asthma were included. The mean ± SD age was 67.9 ± 12.3years; 75.5% were female. The rate of overall asthma-related exacerbations was 31% lower in the post- versus pre-initiation period (RR 0.69; 95%CI 0.65, 0.73; p < 0.001) and included a 24% lower rate of inpatient/emergency department (IP/ED)-defined exacerbations (RR 0.76; 95%CI 0.68, 0.85; p < 0.001) and a 34% lower rate of systemic corticosteroid (SCS)-defined exacerbations (RR 0.66; 95%CI 0.61, 0.71; p < 0.001). Asthma-related ED visits (RR 0.69; 95%CI 0.60, 0.80; p < 0.001) and asthma-related outpatient (OP) visits (RR 0.77; 95%CI 0.71, 0.84; p < 0.001) were both lower, and the mean reduction in cost was $411 PPPY (95%CI $575, $248; p < 0.001), after FF/UMEC/VI initiation. Initiation of FF/UMEC/VI after ICS/LABA treatment among Medicare Advantage-insured patients with asthma was associated with reduced rates of asthma-related exacerbations, ED and OP visits, and healthcare costs, highlighting the benefits of therapy escalation among this patient population.

Early Albumin Administration in Veno-Arterial Extracorporeal Membrane Oxygenation.

The clinical outcome and fluid balance of patients with veno-arterial extracorporeal membrane oxygenation (VA ECMO) or after extracorporeal cardiopulmonary resuscitation (eCPR) may be improved by addressing the high fluid demand with an early albumin administration. In this prospective observational study, patients supported with VA ECMO or eCPR received early albumin administration (25 g/L) to prime the VA ECMO system. These patients were compared to patients who received a regimen based solely on balanced crystalloids (crystalloid group) or a regimen based on a 1:4 volume mixture of albumin (10 g/L) and balanced crystalloids (albumin group). 660 VA ECMO patients (66.4% eCPR) treated between January 2017 and June 2021 were analyzed, whereby 265 patients received crystalloid fluid therapy, 269 patients received albumin therapy, and 126 patients received early albumin therapy. When compared to the albumin and crystalloid groups, patients in the early albumin treatment group had significantly lower cumulative fluid balances (p < 0.05). However, this effect was only observed in the group of eCPR patients and not in patients with cardiogenic shock. Logistic regression revealed albumin administration as an independent predictor of increased survival (Odds ratio 1.66 (1.11-2.47) [95%-CI], p = 0.013). Yet, only eCPR patients showed a survival benefit from albumin administration compared to the crystalloid group (survival of 29.4% vs. 18.8%, p = 0.024). Early albumin administration in eCPR patients was linked to a significant decline in fluid balance. Moreover, volume therapy with albumin application was an independent predictor for improved survival in eCPR patients.

Financial Health Management of Otolaryngology by Telemedicine: Opportunities and challenges

The COVID-19 pandemic has impacted the world and medical branches are affected too, this article shows otolaryngology (Otlogy) management like patient care in the outpatient (OP) remotely by the implementation of business strategy of telemedicine (TME). The research explains how the applications of management strategies in TME for Otlogy can reduce the medical expenses and also offer profits to the medical practitioners. This article suggests the advantages of TME for (Otlogy) related health risks and advises health centers to implement the business strategy of TME which can provide services using remote Information Communications Technology (ICT) to evade exposure risks to HCR providers, patients, and the general community. The realization of TME, or virtual services, can help the Otolaryngologists to provide needed care to patients amid COVID pandemic. This research illustrates the challenges in the application of TME and benefits to the patients as well as for the medical professionals.

Resolution of MASH with no worsening of fibrosis after bariatric surgery improves 15-year survival: a prospective cohort study.

Investigate the consequences of the histological progression of metabolically associated steatohepatitis (MASH) and fibrosis on long-term survival after bariatric surgery. From 1994 to 2021, 3028 patients at the University Hospital of Lille were prospectively included. Baseline liver biopsies were systematically performed with proposed follow-up biopsies 1 year after surgery, mainly in MASH patients. We evaluated the association of the baseline and 1-year histological progression of MASH and fibrosis status and long-term survival using Cox regression models. At baseline, 2641 patients had a biopsy (89%), including 232 with MASH (8.7%) and 266 (10.8%) with significant fibrosis (grade F2-F4). The median follow-up was 10.1 years. At 1 year, 594 patients had qualitative paired biopsies. Survival was shorter at the 15-year follow-up in patients with baseline MASH, than in those without (hazard ratio (HR), 2.21; 95% confidence interval (CI), 1.38 to 3.53) and in F2-F4 than in F0-F1 (HR, 3.38; (95%CI, 2.24 to 5.10). At the 1-year landmark analysis, compared to patients without baseline MASH, mortality increased in those with persistent MASH and/or if fibrosis worsened (adjusted HR, 2.54 (95% CI, 1.06 to 6.10), but not if MASH resolved without the worsening of fibrosis (adjusted HR, 0.73 (95% CI, 0.28 to 1.87). Similarly, compared to patients without significant fibrosis at baseline, patients with persistent significant fibrosis had increased mortality (adjusted HR, 4.03 [95% CI, 1.86 to 8.72]) but not if fibrosis improved from F2-F4 to F0-F1 (adjusted HR; 1.49; 95%CI, 0.52 to 4.24). Histological remission of MASH or significant fibrosis improves survival after bariatric surgery.

Racial and Ethnic Disparities in Child Abuse Identification and Inpatient Treatment

Child abuse is a leading cause of morbidity in early childhood. Accurate detection remains challenging. To describe racial and ethnic disproportionalities in suspicion for child abuse (SCA) in pediatric patients admitted after traumatic injury. This retrospective, multicenter cross-sectional study performed between 2022 and 2024 examined a representative national sample of children and adolescents (aged <18 years) admitted for pediatric trauma indications from 2006 to 2019. Data were from the Kids' Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database. Patient demographics, injury severity, and hospitalization characteristics were classified by race and ethnicity and compared using univariate and multivariate regression. Statistical analysis was performed between March 2022 and October 2024. The SCA subgroup was identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes corresponding to child and adolescent maltreatment. The primary outcome was the racial and ethnic composition of pediatric patients admitted after traumatic injury with SCA vs those without SCA. Among the weighted total of 634 309 pediatric patients with complete data included in the study, 13 579 patients had injuries attributable to SCA (SCA subgroup; mean [SD] age, 1.70 [0.04] years; 7650 male [56.3%]; 2868 Black [21.1%], 2293, Hispanic [16.9%], and 5675 White [41.8%]) and 620 730 patients did not (non-SCA subgroup; mean [SD] age, 9.70 [0.01] years; 395 158 male [63.7%]; 86 376 Black [13.9%], 108 406 Hispanic [17.5%], and 298 748 White [48.1%]). The racial and ethnic distribution of the non-SCA subgroup was similar to that of the 2010 US Census. In the SCA subgroup, Black patients (odds ratio [OR], 1.75; 95% CI, 1.65-1.85; P < .001) and Hispanic patients were overrepresented (OR, 1.11; 95% CI, 1.05-1.18; P < .001) and White patients were underrepresented compared with the Census. After controlling for socioeconomic factors and hospital characteristics among 504 365 (weighted) observations in White, Black, and Hispanic patients (493 530 patients without and 10 835 patients with SCA), Black race remained an independent risk factor associated with SCA (OR, 1.10; 95% CI, 1.03-1.17; P = .004), whereas Hispanic race was found to be a protective factor associated with decreased odds of SCA (OR, 0.71; 95% CI, 0.67-0.76; P < .001). Compared with White patients in the SCA subgroup, Black patients had a 26.5% (95% CI, 11.0%-44.3%) longer length of stay (P < .001) for mild to moderate injuries and a 40.1% (95% CI, 16.4%-68.5%) longer length of stay (P < .001) for serious injury. In this study, Black children and adolescents were suspected to have experienced child abuse at higher rates than children and adolescents of other racial and ethnic backgrounds. More research is necessary to understand the origins of these disparities to reduce them in child abuse identification.

Comorbidity in incident rheumatoid arthritis—a nationwide case-control study with bidirectional follow-up

Abstract Objectives To investigate the association between risk of different co-morbidities and diagnosis of rheumatoid arthritis (RA) using a temporal approach. Methods Retrospective, case-control study. Data were extracted from all healthcare claims for Poland between 2011-2021. Prevalent RA(n = 262 265) patients were examined to evaluate morbidity patterns. Incident RA(n = 15 879) and age-, sex- and region-matched controls were sampled 1:10 from the general population (GP). Exposure was new-onset RA identified by interspaced, repeat claims and prescription. Follow-up was performed in a bidirectional, five-year timeframe from RA diagnosis(Dx). Results RA is associated with enhanced risk of multiple organ system disorders both pre- and post-Dx, especially hematologic (IRR 1.80, 95% CI 1.58, 2.05), pulmonary (IRR 1.57, 95% CI 1.53, 1.62), gastrointestinal (IRR 1.53, 95% CI 1.46, 1.60), and cardiovascular (IRR 1.25, 95% CI 1.22, 1.27) conditions. RA appears strongly associated with interstitial lung disease (pre-Dx IRR 2.97, 95% CI 2.20, 4.02; post-Dx IRR 4.66, 95% CI 3.91, 5.56) and inflammatory bowel disease (pre-Dx IRR 1.61, 95% CI 1.25, 2.07; post-Dx IRR 2.12, 95% CI 1.70, 2.63). Enhanced post-Dx risk of thyroid cancer (IRR 1.29, 95% CI 1.00, 1.66) and lymphoma (IRR 1.50, 95% CI 1.20, 1.88) was observed, in contrast to reduced risk of colon cancer (IRR 0.77, 95% CI 0.62, 0.94). Conclusion Enhanced risk of multiple comorbidities was observed both pre- and post-RA Dx, with varying patterns across different organ systems. These data highlight the multisystem nature of RA and warrant research into causal, bidirectional relationships.