Red Code Research Articles

Predictive Modeling for Frailty Conditions in Elderly People: Machine Learning Approaches

BackgroundFrailty is one of the most critical age-related conditions in older adults. It is often recognized as a syndrome of physiological decline in late life, characterized by a marked vulnerability to adverse health outcomes. A clear operational definition of frailty, however, has not been agreed so far. There is a wide range of studies on the detection of frailty and their association with mortality. Several of these studies have focused on the possible risk factors associated with frailty in the elderly population while predicting who will be at increased risk of frailty is still overlooked in clinical settings.ObjectiveThe objective of our study was to develop predictive models for frailty conditions in older people using different machine learning methods based on a database of clinical characteristics and socioeconomic factors.MethodsAn administrative health database containing 1,095,612 elderly people aged 65 or older with 58 input variables and 6 output variables was used. We first identify and define six problems/outputs as surrogates of frailty. We then resolve the imbalanced nature of the data through resampling process and a comparative study between the different machine learning (ML) algorithms – Artificial neural network (ANN), Genetic programming (GP), Support vector machines (SVM), Random Forest (RF), Logistic regression (LR) and Decision tree (DT) – was carried out. The performance of each model was evaluated using a separate unseen dataset.ResultsPredicting mortality outcome has shown higher performance with ANN (TPR 0.81, TNR 0.76, accuracy 0.78, F1-score 0.79) and SVM (TPR 0.77, TNR 0.80, accuracy 0.79, F1-score 0.78) than predicting the other outcomes. On average, over the six problems, the DT classifier has shown the lowest accuracy, while other models (GP, LR, RF, ANN, and SVM) performed better. All models have shown lower accuracy in predicting an event of an emergency admission with red code than predicting fracture and disability. In predicting urgent hospitalization, only SVM achieved better performance (TPR 0.75, TNR 0.77, accuracy 0.73, F1-score 0.76) with the 10-fold cross validation compared with other models in all evaluation metrics.ConclusionsWe developed machine learning models for predicting frailty conditions (mortality, urgent hospitalization, disability, fracture, and emergency admission). The results show that the prediction performance of machine learning models significantly varies from problem to problem in terms of different evaluation metrics. Through further improvement, the model that performs better can be used as a base for developing decision-support tools to improve early identification and prediction of frail older adults.

Analysing South Sumatra red rice polymorphism using random amplified polymorphic DNA (RAPD) markers

this research aims to determine genetic variation based on polymorphism bands and the relationship between red rice in south sumatra based on PCR- RAPD (Polymerase Chain Reaction- Random Amplified Polymorphic DNA) tecnique using the mathematical modeling application NTSys 2.1. Collecting data using observation methods where samples are collected genetic variation and presented in quantitative form. Research instruments include tools and laboratory materials that facilitate the research process such as electrophoresis, thermal cycle machines, gel documentation and others. DNA bands obtained electrophoresized PCR sample is converted into binary data which is stated by the presence or absence of DNA bands, if there is a DNA band then marked with (1), whereas if the DNA band does not appear then marked with (0). Data were analysed using the NTSys version program. 2.1. Dendrogram created using unweighted pair-group with arithmetic average with genetic similarity coefficient using Jaccard Coefficient of Similarity and presented in the form of dendrogram. Based on the DNA band profile of RAPD results which 43 DNA bands show polymorphism (93.47%). Based on the analysis using the NTSys 2.1 program, a dendogram was obtained where red rice in South Sumatra was divided into two main clusters at a genetic similarity coefficient level of 0.19, namely cluster A consisting of red rice with CT code (Cahya Tani) and cluster B consisting of red rice SJ code (Sumber Jaya), SP (Sp Padang), and K (Kelirejo). The four red rice individuals taken from different places have a low genetic similarity coefficient of 0.15-0.37, meaning that the fourth genetic variation of red rice is very high.

Optimization model for the installation of SAMU bases: application in Natal-RN

A Medical Emergency Service is responsible for providing pre-hospital acute care and has the key role of providing good services to people, especially in urban areas. In Brazil, the Emergency Medical Assistance Service (SAMU) operates in several cities and aims to reach the victim early after an injury to his health has occurred, by sending vehicles manned by trained personnel. The objective of this study was the application of a mathematical model aiming to designate neighborhoods for the installation of new SAMU bases that minimize the distance traveled by the ambulances in the city of Natal / RN. After data collection, it was found that the average service response time of the SAMU was over 40 minutes for calls classified as red code. The average number of calls in 2015 was 1,930 per month, in this city with a population of 800,000. The application of the model allowed for the simulation of scenarios with the installation of 3 to 8 fixed bases. There was a significant reduction in the distance traveled by the ambulances which reached 48%, after the installation of eight bases. In other words, there was a reduction of 6,560 kilometers traveled per month by ambulances. The new SAMU bases are being installed in containers to minimize installation costs and easy relocation in the near future.

A red code triggers an unintended approach motivation toward sweet ultra-processed foods: Possible implications for front-of-pack labels

Front-of-package labels (FOPL) are recommended to reduce consumer intake of ultra-processed food products (UPP). The multiple traffic-light label is one example of FOPL that indicates the content of target nutrients in products by displaying red (high), amber (medium), and/or green (low) color-coding. The red code may implicitly enhance sweetness perception and approach dispositions toward sweet UPP via cross-modal visual-taste interactions. We conducted two experiments to examine the possibility of contradictory influence of explicitly learned and implicit cross-modal associations on the emotional responses evoked by UPP pictures. In both experiments, we first explicitly associated the color codes with health-related meanings. In Experiment I (n = 78), a psychometric tool estimated the emotional responses (pleasantness and arousal ratings) evoked by UPP pictures when preceded by red, amber, or green color-codes. In Experiment II (n = 24), we recorded participants’ electrocortical brain activity to assess the early posterior negativity (EPN) component as an index of the emotional responses to UPP. The reported pleasantness (Experiment I) and the EPN amplitude (Experiment II) were greater for sweet UPP relative to salty UPP when primed with red codes but not when primed with green or amber. A red code increased positive emotions toward sweet UPP despite its explicit association with increased health-risks. Thus, the use of multiple traffic-lights might lead to an unintended implicit approach behavior toward sweet UPP. Designers, researchers, and policy makers may consider color-taste cross-modal associations when designing, testing, and applying FOPL.

Presenting symptoms of older emergency department patients: a single-center experience of 10,692 patients in Turkey

ABSTRACT Objective: In this study, we aimed: (1) to evaluate the presenting symptoms of older emergency department (ED) patients within a 12-month period, (2) to compare the differences in presenting symptoms between three age groups, and (3) to evaluate the seasonal variations in the presenting symptoms. Methods: This retrospective single-centered observational study was conducted at the ED of a university hospital in older ED patients with yellow and red triage code. Consecutive patients aged 65 and older admitted to ED in the study period were included in the study. Results: In our study, 14.0% of all ED admissions were patients aged 65 and older. The mean age of 10,692 patients was 75.3 ± 7.3 years, and 49.2% of them were male. The most common presenting symptoms to ED were dyspnea (18.5%), abdominal pain (12.4%), and chest pain (8.3%). Whereas 6,352 (59.4%) patients had been discharged from the ED (to home), 4,305 (40.3%) were hospitalized. Falls became the third rank presenting symptom in patients aged 85 and older. The hospital admission rate increased from 35% to 53% by age, and the in-hospital mortality rate of patients aged 85 and older was higher than that of the other age groups (p < 0.001). Conclusion: ED physicians should be aware of the common medical problems and life-threatening conditions of older patients. Morbidity and mortality rates increase by age and those patients may need different management strategies and an increased number of resources.

Extreme Variabilities of Rainfall and Runoff Regime within Vulnerable Hydrographic River Basins. Case Study: Elan River Basin, 2016 (Romania)

Abstract The present paper analyzes the extreme variabilities of rainfall and runoff regime within vulnerable hydrographic river basins, focused on a case study: Elan river basin, year 2016. This year, due to excess rainfall, the Elan River basin was affected by torrential rainfall, warned against by orange and red code hydrological forecasts. For this reason, this study makes an analysis of the spatial and temporal variability of the surface runoff also considering the main flood events occurring in this river basin. The impact of liquid precipitation on the surface runoff will be highlighted by a statistical analysis of the relationship between monthly average flows and the sum of monthly precipitation in the river basin. The monthly flows series from the Murgeni and Poșta Elan hydrometric stations were capitalized through appropriate statistical analyses. Maximum flows were reported to the thresholds values corresponding to the Defense Levels.

Republication de : Le peau à peau du nouveau-né en cours de césarienne : une étude d’évaluation des pratiques professionnelles

BackgroundConsidering its benefits, immediate skin-to-skin should be applied irrespective of the way of delivery. While it is increasingly applied in case of vaginal delivery, it remains difficult to implement in case of caesarean section. ObjectiveTo estimate the degree of implementation of skin-to-skin in case of caesarean section. MethodsSurvey in immediate postpartum with a continuous series of patients having given birth by caesarean - whether scheduled or not - in a level 3 hospital systematically realizing skin-to-skin in case of vaginal delivery. The patients were included if the caesarean section had been realized between 16/11/17 and 28/11/17. ResultsThirty-five women gave birth by caesarean section during the period of study, among which 26 were planned (74%). The emergency levels were varied: 18 had a green code (51%), 12 an orange code (34%) and 5 a red code (14%). Forty-six percent of the newborn children were placed skin-to-skin. The frequency of skin-to-skin was closely linked to the planned character of the caesarean section (89 vs. 31%, P=0.005), as well as its color code (green 72%, orange 25%, red 0%). In case of impossibility to realize skin-to-skin in the course of the caesarean, the reasons were mainly related to the maternal state (63%) (malaise, bleeding, pain). In this situation, skin-to-skin was proposed to the spouse in 83% of cases and realized in recovery room with the mother in 82% of the cases. ConclusionSkin-to-skin is feasible during caesarean section, regardless of the color code of the procedure.

ASSESSMENT OF THE ROMANIAN AMBULANCE PUBLIC SERVICES

Public ambulance services in Romania are public health units of strategic importance, with legal personality, coordinated by the specialized department of the Ministry of Health, functioning under the direct subordination of the Ministry of Health, which provides the necessary funds for its operation, according to the provisions of art. 100 of Law 95/2006. The present analysis aimed in providing evidence of the activity of ambulance services, as well as future directions for action and recommendations to support the decision making in the Romanian health sector. In this respect, it was planned to carry out a descriptive, transversal study, based on activity data and resources used at the level of public ambulance services in Romania. In 2017 the public ambulance services in Romania carried out a total of 2,942,988 interventions, structured as follows: 352,286 Major Emergencies with the Life Threat (Red Code) 1,701,182 potentially life-threatening emergencies (yellow code) 523,582 non-acute problems - consultations at home (Green Code) 365,938 non-assisted medical transport that does not require medical assistance and vital functions monitoring, the carriage being carried out with A1 / A2 ambulance type with only the driver. If the county based analysis showed great differences in the volume of activity performed by each public ambulance service, an analysis of the served population grouped on the eight development regions results in a balanced and homogeneous situation, without significant differences, a situation that would justify a new approach to the organization / reorganization of public ambulance services. • The biggest problem is that when the number of requests increases significantly due to different code situations, can not be reached the shortest time at all requests due to staff shortages • The ambulance services face a large staff shortage at national level, compared to the norm approved by MoHOrder 1788/2006, based on the number of population statistically declared. • Staff policy dysfunctions are reflected both in the shortage of physicians and staff as well as in the health of those employees exposed to high levels of fatigue and stress. Keywords: public ambulance services, human resources, financing Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:8.0pt; mso-para-margin-left:0cm; line-height:107%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi;}

Sensitivity and specificity of trauma team activation protocol criteria in an Italian trauma center: A retrospective observational study

BackgroundThe trauma team (TT) model could reduce mortality, morbidity, and duration of hospital stay, costs, and complications. To avoid over- or undertriage for trauma team activation, robust criteria have to be chosen. ObjectiveThis study aimed to evaluate the sensitivity and specificity of a TT activation protocol for major trauma patients to predict the need for emergency treatment. MethodsA retrospective observational study was carried out in the Emergency Department (ED) of a major Italian trauma center. Patients with trauma or burns who accessed the ED in 2015 with a triage red or yellow priority treatment code were included, while pediatric patients were excluded. Sensitivity, specificity and positive predictive values were calculated for each TT activation criteria and the aggregated criteria. ResultsData from 240 patients were collected: 40.42% of patients had a congruent triage while 50% were overtriaged and 9.58% undertriaged. A correct triage led to a lower hospital stay (p < 0.01), while undertriage was not associated with patients’ death (p = 0.16). All criteria had a specificity higher than 95%, a total sensitivity of 80.83% and a total positive predictive value of 43.49%. ConclusionThis study highlighted that the TT activation criteria had high specificity and sensitivity, while the positive predictive value of the criteria was lower. Mechanisms of injury criteria were less specific and sensitive in detecting the TT activation correctly. As nurses play a pivotal role in the triage of traumatized patients and the TT, reduction of under- and overtriage is essential to improve the patients’ health outcome.

Le peau à peau du nouveau-né en cours de césarienne : une étude d’évaluation des pratiques professionnelles

BackgroundConsidering its benefits, immediate skin-to-skin should be applied irrespective of the way of delivery. While it is increasingly applied in case of vaginal delivery, it remains difficult to implement in case of caesarean section. ObjectiveTo estimate the degree of implementation of skin-to-skin in case of caesarean section. MethodsSurvey in immediate postpartum with a continuous series of patients having given birth by caesarean – whether scheduled or not – in a level 3 hospital systematically realizing skin-to-skin in case of vaginal delivery. The patients were included if the caesarean section had been realized between 16/11/17 and 28/11/17. ResultsThirty-five women gave birth by caesarean section during the period of study, among which 26 were planned (74%). The emergency levels were varied: 18 had a green code (51%), 12 an orange code (34%) and 5 a red code (14%). Forty-six percent of the newborn children were placed skin-to-skin. The frequency of skin-to-skin was closely linked to the planned character of the caesarean section (89 vs. 31%, P=0.005), as well as its color code (green 72%, orange 25%, red 0%). In case of impossibility to realize skin-to-skin in the course of the caesarean, the reasons were mainly related to the maternal state (63%) (malaise, bleeding, pain). In this situation, skin-to-skin was proposed to the spouse in 83% of cases and realized in recovery room with the mother in 82% of the cases. ConclusionSkin-to-skin is feasible during caesarean section, regardless of the color code of the procedure.

Trends and determinants of Emergency Room admissions for asthma: A retrospective evaluation in Northeast Italy

BackgroundAsthma still represents a cause of death and hospital admissions worldwide. Our study aimed at analyzing the trend of Emergency Room (ER) asthma admissions in Northeast Italy in order to investigate the relevance of specific patient-related determinants and environmental triggers (pollens, mold spores, and pollutants). MethodsRetrospective data from admissions for asthma exacerbations registered between the years 2013 and 2015 in two main ERs in Northeast Italy were collected. Data about patients' age, sex and nationality were recorded. Classification of disease severity followed the current Italian ER triage scoring system (white: no need for emergency treatment; green: need for fast treatment; yellow: severe condition; red: life-threatening condition). Data on pollen/mold spore counts and pollutants were analyzed. ResultsOverall, 1745 ​ER admissions for asthma were registered, with a persistent and significant increase year by year. A slight prevalence of females and patients over 50 years old was observed. Immigrants accounted for 32%, 36% and 26% of admissions respectively in 2013, 2014 and 2015. The prevalence of immigrants' admissions was significantly higher when comparing the relative ratio of immigrant populations/Italian nationals (p ​< ​0.05). The admissions were coded as follows: white, 6.30%; green, 35.36%; yellow, 39.37%; red, 18.97%. People aged ≥50 years were more frequently admitted with a red code, but the trend was not statistically significant (p ​= ​0,0815). By contrast, amongst immigrants there was a higher prevalence of white and green codes observed in comparison with Italian nationals. Grass pollen peak and PM10 high levels represented environmental determinants of ER admissions increase. ConclusionsThe increasing rate of asthma-related ER admissions highlights the need for implementing asthma control strategies. Investigating the traits of patients referring to ER for asthma exacerbations, as well as environmental-related determinants, may help in identifying at-risk individuals and in orienting preventive strategies accordingly. Immigrants represent the most vulnerable sub-population, and their potential difficulties in accessing treatments and health services should be specifically addressed. Overall, implementing patient education in order to improve treatment adherence, as well as providing an asthma action plan to every asthmatic patient, continue to be the most urgent needs.

Impact of establishment of a color code in emergency caesareans in secondary health care maternity

In 2008, a tertiary health care maternity set up a colour code organization for emergency caesarean to reduce the delay between decision and birth to thirty minutes.The aim of this study is to determine the feasibility of the implementation in secondary health care maternity. Materials and methodsThis retrospective study was conducted in secondary health care maternity and it was divided in two phases: phase I corresponding to the period before the implementation of colour code and phase II, to the period after the implementation of colour code. All patients who had an emergency caesarean were included. Then, we compared the decision to birth delay between the two phases and the neonatal state. ResultsTwo hundred and twenty patients were included (one hundred and thirteen for the first phase and one hundred and seven for the second). The rate of caesarean sections realized within thirty minutes was no different between two groups. Decision to birth delay is variable and tends to decrease between two phases (-7 min for orange code, p = 0.91; and -15 min for red code, p = 0.0769).The medium pH is the same in both groups (7.30, p = 0.22) and the rate of transfer in neonatology is 29% for the first group and 13% in the second (p = 0.004) ConclusionThis protocol has resulted in better care for patients who had an emergency caesarean section. Two elements are to be noticed as follows: a reduction of decision to birth delay for extremely emergency caesarean (p = 0.0769) and less transfer in neonatology (p = 0.004).

A 12-year retrospective analysis of differences between elderly and oldest old patients referred to the emergency department of a large tertiary hospital

ObjectivesGlobally, the average age of the population is increasing. Patients aged >65 years attending hospital emergency departments (EDs) differ from younger patients; in particular, they often present with multiple comorbidities. Our retrospective study evaluates the number of attendances at our ED by elderly patients in the 12 years from January 2005 to December 2017. Our first aim was to evaluate differences presented by elderly patients regarding symptoms, clinical features, color code (i.e. priority assigned to the case, where red is highest and yellow is medium), waiting time and outcome. Patients and methodsWe analyzed data from 201,580 patients aged >65, divided into two groups: 65–84 years and >85 years.Clinical and demographic data were collected from the computerized clinical record (GIPSE®). Results201,580 patients fulfilled the inclusion criteria, of whom 93,262 (46.3%) were male. There were 162,373 patients aged 65–84, and 39,207 aged >85.Patients aged >85 presented more complex cases, and were admitted more frequently with a red color code and were more frequently hospitalized. Larger proportions of this group had dementia, and attended the ED for trauma or gastrointestinal bleeding. The group aged 65–84 were admitted more frequently with a yellow color code and then discharged. They typically attended the ED for chest and abdominal pain. ConclusionThere is an increase in the request for health care especially in an emergency setting. The hospitalization of elderly patients is associated with a deterioration in motor skills and quality of life.Being able to reduce hospitalization in the elderly means avoiding disruption to the home care of people with dementia, and reducing both the risk of falls and hospital infections. In Italy, a program (as already experimented with in the USA) dedicated to the elderly who attend hospital EDs is desirable.

Republication de : Évaluation du respect du protocole des codes couleurs selon l’indication de césarienne et le délai décision-naissance

ObjectiveEvaluation of the compliance of the color codes protocol according to the indication of ceasarean section and on the decision-to-delivery interval according to the color code, the operator and the period. MethodsThis is a retrospective monocentric study including women who had to undergo an emergency cesarean section after 37 weeks of amenorrhea in the Jeanne-de-Flandre hospital between 2015 and 2017. Three groups were created: cesarean section with green code, orange code and red code. We compared population characteristics and obstetrical data, then drew up a reassessed color code and analyzed the correspondence between the initial color code and the reassessed one. Finally, we considered the respect of decision-to-delivery interval according to color code, operator level and period. ResultsEight hundred and eighty-one patients were included, amongst which 303 (34%) fell into the green c-section, 353 (40%) into the orange c-section and 225 (26%) into the red c-section. In the three groups, there was a significant consistency between the initial color code and the reassessed one, with a kappa agreement test of 95% 0.95 (0.93-0.97). The average decision-to-delivery interval was 37±20min for the green c-section, 20±6min for the orange c-section and 12±3min for the red c-section with a significant respect of the decision-to-delivery interval according to color code P<0.001. The decision-to-delivery interval was similar considering the operator level and the period. ConclusionIn our study, we observed the compliance with color code regarding the indication of ceasarean section and the respect of the decision-to-delivery interval whatever the time of occurrence and the operator.

Évaluation du respect du protocole des codes couleurs selon l’indication de césarienne et le délai décision-naissance

ObjectiveEvaluation of the compliance of the color codes protocol according to the indication of ceasarean section and on the decision-to-delivery interval according to the color code, the operator and the period. MethodsThis is a retrospective monocentric study including women who had to undergo an emergency cesarean section after 37 weeks of amenorrhea in the Jeanne-de-Flandre hospital between 2015 and 2017. Three groups were created: cesarean section with green code, orange code and red code. We compared population characteristics and obstetrical data, then drew up a reassessed color code and analyzed the correspondence between the initial color code and the reassessed one. Finally, we considered the respect of decision-to-delivery interval according to color code, operator level and period. ResultsEight hundred and eighty-one patients were included, amongst which 303 (34%) fell into the green c-section, 353 (40%) into the orange c-section and 225 (26%) into the red c-section. In the three groups, there was a significant consistency between the initial color code and the reassessed one, with a kappa agreement test of 95% 0.95 (0.93–0.97). The average decision-to-delivery interval was 37±20min for the green c-section, 20±6min for the orange c-section and 12±3min for the red c-section with a significant respect of the decision-to-delivery interval according to color code P<0.001. The decision-to-delivery interval was similar considering the operator level and the period. ConclusionIn our study, we observed the compliance with color code regarding the indication of ceasarean section and the respect of the decision-to-delivery interval whatever the time of occurrence and the operator.

Emergency Department Access in Diabetic Patients

Introduction: Access of diabetic patients to Emergency Departments (ED) is an indicator of the filtering capabilities of territorial services. Aims: To analyze the access to ED of the Trento province (540.000 inhabitants-north-east Italy) by diabetic patients in the period 2012-2016. Methods: Accesses of diabetics patients (ICDIXCM 250-251), were analyzed from the Database of ED considering year, gender, age class, month and week day, citizenship, way of arrival, triage score, area (urban/rural) of the residents cases, the proportion of hypoglycemia accesses, hospitalization. Results: A total of 2839 diabetic patients accessed to the ED in the study period (567/year), 70% were type 2. The time trend is slightly decreasing. Males are 54%; the age group 0-14:6%, 15-29 5%, 30+years 89%. Males median age is 61 y, Females median age 66 y. Foreigners represent 10% of the cases. Most subjects arrived by ambulance/helicopter (44%); 2,7% were in red code. There were no differences in relation to the month or day of the week; 52.7% are hospitalized. The ED access rate is 7.7/10.000/year for urban and 10/10.000/year for rural area residents (p&amp;lt;0,01). Hypoglycemia occur in 28% of total access of diabetics without any change over time; 60% were in type 1. There were no differences in relation to gender and age-class, compared to general cases and no change in relation to the month or day of the week or geographical area for resident cases as well. Patients with hypoglycemia at access are more serious considering that 76% accessed by ambulance or helicopter and 4.2% were in red code (p&amp;lt;0,001). The proportion of hospitalized cases is 30,2%, lower than the general case series. Conclusions: The access of diabetic patients to the ED of the province of Trento does not change over time. The proportion of patients with hypoglycemia is considerable, with a higher prevalence in case of type 1 diabetes. It does not change over time and requires substantial costs for the transfer to health structures. Disclosure S. Piffer: None.

Patient-reported outcomes in daily clinical practise in HIV outpatient care

IntroductionThe use of patient-reported outcomes (PROs) in outpatient care holds promise as a tool to enhance the quality of care. The management of chronic HIV infection is multidimensional, and clinical assessment includes broad screening to identify complications. With growing constraints on time and resources, the use of PROs may provide a much-needed tool to ensure optimal HIV care. The aim of this study was to evaluate the clinical implementation and use of a Web-based tool to collect PROs in a cohort of HIV-infected individuals. MethodsIn December 2015, the PRO system AmbuFlex, a Web-based tool for self-reporting of clinical symptoms, was implemented in HIV outpatient care at Aarhus University Hospital. The HIV-specific questionnaire was designed to cover items in the European AIDS Clinical Society guidelines. Patients responded through a Web-based system from home. Based on an HIV-specific algorithm, responses were automatically assigned a green, yellow, or red colour code reflecting the severity of the symptom. HIV-related data from the electronic hospital management system were used to compare respondents and non-respondents. For cognitive and red symptoms, patient records were accessed to address whether PRO provided new information. Furthermore, it was sought to determine whether implementing PROs in clinical care can help focus the consultation on current needs. This was done by checking if a flagged symptom was assessed clinically at the following consultation. ResultsFive hundred and five HIV patients were invited to participate and 277 (55%) accepted the invitation. Compared to respondents, non-respondents were significantly younger and more often female, born outside Denmark, newly diagnosed, and with a plasma viral load >50 copies/ml. Among the 262 correctly received PRO questionnaires, 104 (39%) had solely green colour-coded responses, whereas 59 (23%) had one or more red colour-coded responses. Of 69 red symptoms, 28 (41%) led to a specific clinical assessment. In many cases, PROs appeared to provide new information on cognitive (76%) and red-coded symptoms (42%). ConclusionsThe use of PROs identified several cases where physical or cognitive symptoms appeared to have been unnoticed. A substantial proportion of patients reported no symptoms requiring medical attention, suggesting a potential to individualize outpatient care and redistribute resource utilization.

A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments.

BackgroundNekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication.ObjectiveThe goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years.MethodsPatients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge.ResultsA total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units.ConclusionsOur study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. The potential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes.

Molecular, biochemical, and pathological impacts of energy drinks on renin-angiotensin-aldosterone pathway in Wistar rats

Background: Energy drinks (EDs) are widespreaded among young adolescents and adults to enhance physical and mental performance with numerous public health hazards. Aims and Objective: This study was conducted deeply to explore the mechanism by which EDs affect blood pressure (BP) and health status of the kidney. Materials and Methods: To examine impacts of EDs on rats, 60 male Wistar rats were divided into four groups. Control group was given water only; the remaining rats were administered orally red bull, code red, and power horse at a dose of 10 mg/kg once daily. After 60 days, rats were sacrificed and blood samples collected. Kidney tissues for all groups were harvested. Serum was collected for examining biochemical parameters related to kidney functions. Reverse transcription polymerase chain reaction was carried to examine the molecular changes in genes implicated in BP regulation and renin–angiotensin–aldosterone system (RAAS) pathway. Finally, histopathological examination for the kidney was investigated. Results: At biochemical level, consumption of EDs showed a significant (P < 0.05) increase in serum levels of glucose, urea, creatinine, uric acid, and phosphorus as compared with control group. Significant increases (P < 0.05) in expression of renin, angiotensin-converting enzyme (ACE), angiotensin II (Ang II), angiotensin type 1 receptors, desmin, erythropoietin (EPO), nitric oxide synthase-1, transforming growth factor β1, and kidney injury molecule-1 in rats administered EDs for 2 months as compared with control group. However, ACE2, angiotensin type 2 receptors, MAS receptor, and beta-2 macroglobulin (B2m) were not changed in ED-administered groups compared with control rats. Conclusion: Marketed EDs have initial hazardous effects on renal function and certainly increase BP through high caffeine content with the concern of the amount of sugar added in these drinks.

Incidencia de hemorragia posparto con base en el uso terapéutico de uterotónicos. Resultados maternos en un hospital de mediana complejidad de Bogotá, Colombia

Objetivo: describir la incidencia de hemorragia obstétrica posparto (HPP) severa por el uso de medicamentos uterotónicos, como también las intervenciones realizadas y los desenlaces maternos en las primeras 24 horas.Materiales y métodos: serie de casos de gestantes que presentaron HPP luego de parto vaginal o cesárea entre el 1 de febrero y el 31 de octubre de 2016, según el uso terapéutico de uterotónicos, en una institución pública de mediana complejidad en Bogotá. Muestreo consecutivo. Se midieron las características sociodemográficas, clínicas y los factores de riesgo para HPP. Como desenlace se determinó la causa de la hemorragia, grado de choque, sangrado posparto estimado, activación del código rojo obstétrico, intervenciones realizadas, ingreso a unidad de cuidado intensivo, necesidad de transfusión sanguínea y mortalidad. Se realizó análisis descriptivo.Resultados: de 1.633 nacimientos (1.080 partos y 553 cesáreas) se presentaron 35 (2,1 %) casos de HPP por uso de oxitócicos (26 y 9 respectivamente), y se activó el código rojo obstétrico en 11 casos (0,67 %). No hubo mortalidad materna. La principal causa de HPP fue hipotonía uterina 29/35 (82 %), y en el 82,8 % de los casos se resolvió con manejo médico; 4/35 (11,4 %) requirió taponamiento uterino adicional para control del sangrado; 2/35 (5,6 %) de las mujeres requirió manejo quirúrgico: sutura hemostática 1/35 (2,8 %) e histerectomía 1/35 (2,8 %).