Predictors Of Representation Research Articles

P15 Admission avoidance in acute epistaxis: a prospective national audit during the initial peak of the COVID-19 pandemic

IntroductionIn March 2020, UK epistaxis guidelines were issued incorporating major shifts in standard practice, namely the recommended use of dissolvable products and discharge of patients with non-dissolvable packs.The aim of this audit was to assess patient outcomes following epistaxis care during the initial COVID-19 peak, exploring factors relating to unscheduled re-presentations.MethodsA UK-wide prospective multicentre national audit was performed over 12-weeks from 6th April 2020 at ENT departments treating adults with epistaxis. The primary outcome was re-presentation within 10-days. Univariable binary logistic regression analysis was used to identify significant determinants of the primary outcome measure.Results83 centres from all four UK nations submitted 2,631 cases, the majority of which were Emergency Department (ED) referrals (89.7%). ENT clinicians used a dissolvable intranasal product in 34.7% of patients overall (n = 816/2,351), and in 61.1% of those receiving an intranasal product (n = 816/1,336). 54.6% were discharged from the ED following ENT review. The overall re-presentation rate was 19.5% for ED discharges (n = 245/1,259) and 9.9% for ED admissions (n = 104/1,046). 6.8% of ED discharges and 5.7% of ED admissions were admitted following their re-presentations (n = 86 and 60 respectively). Not being packed by ED clinicians, antiplatelet medications, failed cautery and recent epistaxis treatment were predictors of re-presentation within 10-days.DiscussionRe-presentation data were similar to the 2016 UK Epistaxis Audit, however, there was a notable shift towards alternative packing techniques and reduced admission. This highlights that many patients who would previously have necessitated admission may be safely discharged from ED.

Breathlessness in the emergency care setting.

Breathlessness is one of the most common reasons for presentation at the emergency department (ED). The present review summarizes work published from 2017, which focuses on the symptom of breathlessness in its own right rather than as a signpost to diagnosis in relation to presentation to the ED. Seven relevant papers are included in the present review. Five describe the epidemiology of breathlessness presentation showing: a prevalence of approximately 5% all ED presentations, a high likelihood of hospital admission especially for those with heart failure, breathlessness as a predictor of re-presentation. A sixth study described self-management strategies for breathlessness crises used by expert patients in successfully avoiding presentations to the ED. The seventh study reported the validation of the shorter dyspnea severity scale for use in the ED using a mixture of symptom report and clinical observation measures. Breathlessness is a common presenting feature in the ED and carries clinical outcome significance irrespective of the causative disease. Routine enquiry is needed to identify, assess, and manage breathlessness alongside interventions to stabilize underlying reversible pathologies. Presentation to the ED because of breathlessness should trigger community-based, supported self-management for future episodes of breathlessness crises.

Atrial Fibrillation: Predictors of Re-Presentation to the Emergency Department

Atrial Fibrillation: Predictors of Re-Presentation to the Emergency Department

Predictors of African American Representation in Municipal Government

This article presents the results of a path analysis that investigates the explanatory power of five new predictors of African American representation in city government against eight traditional predictors of representation in municipal government. The findings generally indicate that the percentage of African Americans in the city population and African American personnel directors are the most consistent predictors of African American representation in municipal civil service. African American actors in the internal environment of the personnel game—personnel directors, administrators, mayors, and council members—are also generally more predictive of African American representation in city government than variables in the external environments of municipalities.