Regular Admission Research Articles

P1188 Real-world quality of life experience of subcutaneous infliximab use in children with Inflammatory Bowel Disease (IBD) at a tertiary paediatric centre

Abstract Background Subcutaneous infliximab (SC-IFX) use offers relative pharmacokinetic stability and efficacy and safety profiles comparable to intravenous-infliximab (IV-IFX) in adult patients with IBD (1-4). Regular hospital admissions for infusions have an impact Quality of Life (QoL), impacting work and school commitments as well as increasing financial burden. Aim to assess tolerability and QoL in patients switched from IV to SC infliximab collected 12 weeks after the switch. Methods A prospectively identified cohort of 33 children with IBD commenced 120mg fortnightly SC-IFX dosing between February to July 2024 in an Australian tertiary paediatric IBD service. QoL and medication tolerability questionnaires (SIAQ and Costs For Patient’s questionnaire) included assessment of tolerability, convenience, satisfaction along with data about travel time and costs were completed at week 12. Assessment of disease activity, inflammatory biomarkers and therapeutic drug monitoring occurred 4 weekly for the first 12 weeks. Results 31(94%) patients completed the 12-week study treatment period. 21 patients (68%) responded to the QOL questionnaires. Satisfaction with SC treatment was 20 (95%) across respondents, only 1 patient reporting ‘somewhat dissatisfied’ experience. 18 (85%) described ease of administration, with 3 (14%) finding injections "not easy". Respondents described financial impacts to be greatest, followed by time-commitment for attendance, loss of school and work time for attendance for infusions. Nearly 2/3 caregivers required formal leave from employment to facilitate infusion attendance, and 1/3 of patients required full day off school. 100% described a definite or probable willingness to continue SC injections beyond the 12-week period. Conclusion We describe the largest cohort of children with IBD prescribed SC-IFX with short-term follow-up. There was high treatment persistence with the drug. QOL data demonstrates high patient satisfaction, with positive impacts on patient quality-of-life with treatment described. Our real-world experience of paediatric SC-IFX use suggests this well tolerated and preferable alternative to IV-IFX dosing in children in with IBD. Further large-cohort and long-term paediatric data is required. References 1)Schreiber S, Ben-Horin S, Leszczyszyn J et al. Randomized Controlled Trial: Subcutaneous vs Intravenous Infliximab CT-P13 Maintenance in Inflammatory Bowel Disease. Gastroenterology 2021; 160: 2340-53. 2)Buisson A, Nachury M, Bazoge M et al. Long-term effectiveness and acceptability of switching from intravenous to subcutaneous infliximab in patients with inflammatory bowel disease treated with intensified doses: The REMSWITCH-LT study. Aliment Pharmacol Ther 2024; 59: 526-34. 3)Gianolio L, Armstrong K, Swann E et al. Effectiveness of Switching to Subcutaneous Infliximab in Pediatric Inflammatory Bowel Disease Patients on Intravenous Maintenance Therapy. J Pediatr Gastroenterol Nutr 2023; 77: 235-9. 4)Gianolio L, Armstrong K, Swann E et al. OC5 Effectiveness and safety of switching to subcutaneous infliximab in paediatric inflammatory bowel disease patients on established intravenous biosimilar infliximab maintenance therapy: real world data from a regional cohort. Frontline Gastroenterology 2024; 15: A4-A.

입학전형 유형에 따른 대학적응경로 다집단분석: D 대학을 중심으로

Objectives This study was conducted to investigate whether there are differences in academic adaptation trajectories among multiple groups based on admission criteria. Methods For analysis, we obtained cooperation from the CS Center on campus and collected data from 17,969 students enrolled in the 2022 academic year. Descriptive statistics and correlation analyses were performed to determine the data normality and the relationship among variables. In addition, the Mplus program was used to analyze a structural equation model that established the relationship among department satisfaction, student support infrastructure, academic commitment, and GPA, and a multigroup analysis was conducted to verify the difference in pathways between groups according to the admission criteria. Results The structural model, which posits that department satisfaction and student support infrastructure influence GPA through departmental immersion, was found to be appropriate. In the multi-group analysis results comparing four groups—comprehensive student record admission, outstanding academic record admission, regular admission, and transfer admission—statistically significant differences in path coefficients were observed when comparing the comprehensive student record admission group with both the regular admission group and the outstanding academic record admission group. Conclusions It was found that there are differences in the relative impact of satisfaction and support infrastructure on departmental immersion depending on the type of admission. This finding suggests that such information could serve as foundational data for shaping student support policies.

Patient Experiences of Patient-Initiated Brief Admission in Psychiatric Care: A Systematic Review.

Patient-initiated brief admission (PIBA) is an innovative psychiatric care intervention that gives patients the autonomy to initiate a short admission (approximately 1-3 days) to psychiatric inpatient care. This intervention is structured around a mutual agreement between the patient and their care provider that outlines the specific structure and content of their care. Unlike regular psychiatric admissions, healthcare professionals do not review the patient's decision for admission during PIBA. Similar interventions have been developed globally to reduce the need for long inpatient admissions and compulsory care by enhancing patient autonomy, promoting active participation in care, and empowering patients to recognise early signs of mental health deterioration. The objective of this systematic review was to explore the experiences of PIBA among individuals with mental health disorders. A systematic review was conducted using qualitative articles sourced from the PubMed, CINAHL, and PsycINFO databases. A total of thirteen original articles were included in the review, encompassing 186 patients. Research demonstrates that PIBA significantly impacts patients' care experiences in various ways. Access to PIBA gives patients the opportunity to take a break from daily stressors, which has proven significant in interrupting the cycle of worsening symptoms and negative thoughts. Furthermore, when the care environment is characterised by trust and respect, patients experience an increased sense of freedom, which contributes to a more effective recovery process. PIBA provides patients with a sense of safety and offers the possibility of a more functional daily life. Healthcare professionals'attitude and care provision also significantly influences patients' experiences. Central to a positive patient experience are a warm reception, attentiveness, and active listening. PIBA can not only change patients' perceptions of healthcare but, more importantly, fosters a transformative view of themselves as active participants in their own well-being. Knowledgeable healthcare professionals are crucial for the successful implementation of this intervention. By offering dignity and warmth alongside safety, PIBA addresses a critical gap in patient mental health care.

Estimating Students' Academic Success in the Preclinical Stage of Undergraduate Medical Education Using the Admission Test Approach.

Medical schools face substantial challenges in objectively selecting the best applicants, and the admission process can impact medical students' academic performance. This study aimed to estimate the students' academic success in the preclinical stage of undergraduate medical education using admission tests. This cross-sectional study was conducted on 1,193 students' records from the 2014 to 2019 cohorts. The students' admission data comprised the cohort, sex, admission track, psychological test, and academic tests. The academic success was based on the student's end-year academic evaluation. Data were analyzed using contingency and Kendall's tau b tests with IBM® SPSS® Statistics version 16.0 for Windows. Most of the 1,193 preclinical medical students' records included in the study were females (68.1%), from the regular admission track (78.5%), from the considered psychology test category (52.8%), and had an academic admission test of less than or equal to the median. (51.6%). Most students (89.7%) met all the academic requirements to pass the end-year evaluation. The bivariate analyses showed significant correlations between academic success and cohort (p<0.001), psychology test (p=0.005), and academic test (p<0.001). The analyses showed no significant correlation between academic success and sex (p=0.324), and admission track (p=0.128). This study indicated that cohort and psychology tests could estimate the student's academic success at the preclinical stage of undergraduate medical education. The admission criteria related to the academic tests during the admission process should be re-evaluated, so that the academic tests could select the best students among the applicants.

Comparison of academic achievement, graduation competency and academic sustainability of veterinary students based on college admission processes

A university’s admission policy is established to select applicants who can successfully complete the curriculum. Thus, it is important to develop optimal admissions processes for applicant selection. This study was conducted to infer the most suitable admission processes for veterinary school applicants by examining academic achievement, graduation competency and academic sustainability. It was conducted on students admitted from 2009 to 2018 at one of the veterinary colleges in Korea. The admission methods were divided into, first the regular admission (RA) process, primarily reflecting the results of the College Scholastic Ability Test, and second, the rolling admission processes. The rolling processes were further divided into admission officer-based (AO), high school grade point average-based (GA), essay test-based (ET), admission for the underprivileged (UP) and admission for overseas Koreans and foreigners (OKF). The final grade point average was observed to be higher in the order of the GA, AO and RA groups. The survey on the veterinary graduation competency did not reveal any difference between the regular and rolling admission processes. However, among the latter, AO-based admission showed a higher ratio of outstanding competency levels. In terms of academic sustainability, OKF admission demonstrated a higher rate of failure while RA showed a higher rate of expulsion and dropout. Summarizing the above results, the most successful veterinary applicants were selected through AO-based admission. These results are meaningful in providing the basic information required to establish admission policies for veterinary colleges in Korea.

Analysis of the current status of interview evaluations in Korean medical schools and professors' perceptions of the interview evaluations process.

This study aimed to investigate the overall operational status of medical school admission interview evaluations in South Korea and explore the operational experience of universities conducting interview evaluations. This study used a mixed-methods approach, combining quantitative and qualitative methods. Through a nationwide survey and data collection from 39 medical schools, the quantitative analysis explored interview evaluations procedures, the purpose of the interview evaluations, and the competencies expected of medical school freshmen. Concurrently, qualitative data were obtained through focus group discussions with 12 professors from 10 medical schools, providing in-depth insights into the operational experiences and challenges faced during interview evaluations. In the quantitative data, interview evaluations were most prevalent in the "comprehensive school records screening" for rolling admissions (85.5%), but less common in regular admissions (18.6%). Private schools (64.2%) showed a statistically significant higher proportion of interview admissions than public schools (11.1%) in the "high school grades focused admission" (p&lt;0.01). Metropolitan areas (50.0%) conducted interview evaluations more frequently than non-metropolitan areas (11.1%) in the "College Scholastic Ability Test-focused admissions" (p&lt;0.05). In the qualitative data, professors recognize the dominant role of "negative selection" in filtering out unsuitable candidates. Challenges in maintaining a consistent evaluator pool and team-based question development were acknowledged. Strategies, such as seeking student feedback for question improvement and conducting study meetings for interviewer preparation are essential. This study illuminates the operation of admissions interview evaluations in South Korea, revealing variations across regions and admissions types. These findings offer insights for enhancing medical school admission processes, guiding future research and policy.

COVID-19 이후 대학생의 스트레스, 건강증진행위가 진로준비행동에 미치는 영향

This study aimed to examine the effects of employment-related characteristics, stress, and health-promoting behaviors on career preparation behaviors among university students after COVID-19. The subjects were 120 university students, and the study was conducted from May 2 to May 10, 2024. The collected data were analyzed using multiple regression analysis with the SPSS 29.0 program. The results showed a positive correlation between stress and health-promoting behaviors, a positive correlation between health-promoting behaviors and career preparation behaviors, and no correlation between stress and career preparation behaviors. The multiple regression analysis indicated that regular admissions (β = .210, p &lt; .01), employment preparation experience (β = .187, p &lt; .05), higher stress levels (β = .163, p &lt; .05), and higher health-promoting behaviors (β = .461, p &lt; .001) were associated with higher career preparation behaviors. Therefore, based on the results of this study, career support programs that consider stress and health-promoting behaviors should be developed.

대학 입학전형 선택의 영향 요인 분석

Objectives The purpose of this study is to analyze the factors that affect the choice of admission types among college students, including personal background, self-efficacy, autonomy, learning motivation, and major selection motivation. Methods To achieve this goal, a survey was conducted on 1,099 students enrolled at A University in Seoul. Factors influencing admission type preferences were analyzed using chi-square tests, one-way ANOVA, and multinomial logistic regression. Results Differences in admission type preferences emerged based on students' backgrounds, including the region and type of their high school, and the highest educational attainment of their guardians. Among personal characteristics, significant disparities in admission-type preferences were observed based on self-efficacy and major selection motivation. In relation to the origin of the high school, as the region shifted to Seoul and the metropolitan area, and as the educational attainment of male guardians increased, along with stronger intrinsic motives for major selection, the likelihood of opting for the regular comprehensive evaluation process increased. Conversely, in cases where the originating high school was located in urban or smaller cities, and when female guardians possessed higher educational qualifications, along with stronger extrinsic motives for major selection, there was an elevated probability of preferring the regular admission method. Conclusions Given the variations in the backgrounds and attributes of students selecting university admission types, universities should take a keen interest not only in the selection process but also in academic and career support.

Perceptions of spirituality and predictors of competence in spiritual care among nursing students in five middle eastern countries: A cross-sectional survey

BackgroundSpiritual Care is integral to holistic nursing; however, it often remains underprovided due to a lack of education. ObjectiveThis study examined perceptions of spirituality and predictors of competence in spiritual care among nursing students in Middle Eastern countries. DesignA cross-sectional survey was used. Participant/settingNursing students (n = 785) from five universities in Middle Eastern countries were included. MethodsParticipants completed the Spiritual Care-Giving Scale-Arabic and Spiritual Care Competency Scale. Multiple linear regression analysis was used to identify the predictors of perceived competence in spiritual care. ResultsNursing students showed positive attitudes towards spirituality, with a mean score of 5.1 (SD = 0.60) on the Spiritual Care-Giving Scale-Arabic. However, their perceived competence in providing spiritual care was low to moderate with a mean score of 79.0 (SD = 32.0) on the Spiritual Care Competency Scale. The bivariate analysis indicated significant relationships between students' spiritual care competence and gender, previous exposure to spirituality education, willingness to undergo spirituality training, and total spirituality score. Finally, significant predictors of higher competence included regular admission status, prior spiritual education, willingness to undergo spiritual care training, and higher personal spirituality scores. ConclusionNursing students in the Middle East have positive attitudes towards spirituality, but low to moderate competence in providing spiritual care. The influence of personal spirituality on competence underscores the importance of fostering a supportive environment for students to reflect on their beliefs. Comprehensive curriculum revisions and training programs, along with the recognition of the impact of personal spirituality, are essential to prepare future nurses for holistic people's care.

Variations in Hospital Admissions of Non-Communicable Disease Patients Before and During The COVID-19 Pandemic (A Tertiary Care Setting, January 2018-June 2021).

This study aimed to analyze the variations (if any) in hospital admissions of patients with any of the five common non-communicable diseases (NCDs), based on secondary analysis of electronic health records of patients admitted to Hacettepe University Hospitals at least once, from January 1, 2018 through June 15, 2021. Data were recruited from hospital's electronic health records on patients with diagnoses of ischemic heart disease, hypertension, diabetes, cancer, and chronic obstructive pulmonary disease, using relevant ICD-10 codes. Compared to the corresponding time span in the pre-pandemic period, the number of hospital admissions of patients with selected five NCDs significantly decreased during the pandemic, with an official start in Turkey on March 11, 2020. Number of total-, out-patient-, and in-patient admissions of NCD patients were significantly lower in the pandemic period compared to the expected values in time series analysis, controlling for patient characteristics, and seasonality. Study findings suggest that there has been a prominent impediment in NCD patients' access to, and/or use of health care services over the pandemic, which might evolve to higher admission rates, severity and fatality of such patients in the upcoming years. Further studies are warranted for confirmation of our findings in other care settings, with individual-based data on care compensation through settings other than regular admission sites (if any), and/or the reasons for under-use of services.

The Influence of Western Medical Perspective on the Effectiveness of Chinese Medical Education: A Prospective Teaching Study

In contrast to traditional Chinese culture and medicine, Western medical education in China is a relatively recent development. This study aims to explore the role and significance of international exchanges in Western medical education while providing resources to enhance China's current medical education system. To conduct a comparative analysis, we examined the final exam results of two groups of fourth-year medical students. The objective was to inspire and enhance students' interest and understanding of surgery through academic exchanges and insights into the development of Western medicine in clinical education. The study evaluated the academic performance of 89 medical students across two groups. While both groups had similar regular grades and admission test scores, their performance diverged after exposure to different learning experiences. The research group, comprising 45 students, attended a seminar on clinical teaching in Western medicine and studied its historical context, achieving an average score of 76. In contrast, the control group of 44 students, who spent their free time independently exploring, scored an average of 70. The significant difference in exam results highlights the impact of exposure to Western medical education. Interviews with students revealed a strong interest in understanding Western medicine’s principles and its varying applications in China and Western nations. The findings suggest that students with direct exposure to Western medical education and its history perform better academically. To advance the development of Western medicine, Chinese medical schools should foster students' understanding and provide more opportunities for international exchange.

Impact of IV Contrast Exposure during Vaso-Occlusive Crisis on Sickle Cell Disease (SCD)

Background Sickle cell disease (SCD) affects more than 100.000 Americans, that can experience vaso-occlusive crisis (VOC). It can present with signs and symptoms that overlap with pulmonary embolism (PE), e.g. pleuritic chest pain, shortness of breath, hypoxia or sinus tachycardia. Hence, it is not uncommon that patients with SCD are exposed routinely to IV contrast (IV-cx) to rule out PE with every VOC recurrence. We hypothesized that exposure to IV-cx increases blood viscosity temporarily and therefore exacerbates RBC sickling with worsening oxidative stress and VOC. Methods This was a retrospective chart review study, where we analyzed all encounters for VOC at the ED of MedStar Washington Hospital Center in between 2021-2022. We excluded those not admitted to the inpatient service and discharged from the ED, those not exposed to IV-cx to rule out PE and those without 3 other VOC admission without IV-cx exposure to compare as control. Herein, will discuss 33 patients' results. A total of 132 admissions were analyzed for 33 patients (1 with IV-cx + 3 regular admissions without IV-cx exposure), each patient serving as their own controls, acknowledging the heterogeneity of SCD VOC. For control admissions we looked at the 3 closest in time from the admission with IV-cx exposure. Severity of each VOC (with or without IV-cx exposure) was determined by the composite of lab results, clinical and treatment data for each admission, creating our own scoring system “VOC Severity Index” (Table 1). Scores were given from 0-4, &amp;gt;3 representing end-organ damage. Maximum score was 39. Likewise, we collected data on new PE, new DVT, therapeutic anticoagulation, basic demographics and SCD genotype not recorded in the severity index score. Results were analyzed through Graphpad Prism software. This study received IRB approval from MedStar Health Research Institute. Results 54.5% (18/33) were female, mean age was 25 (18-45), 86% were HbSS, and 100% were Black. We compared the severity index of the admission with IV-cx exposure against the mean severity index score of the 3 other VOC admissions without IV-cx exposure. VOC severity index was higher for the admission related with IV-cx exposure in 90% (30/33) patients (p= 0.0004***) (Fig 1A). CT chest with PE protocol was negative in 100% (33/33). No DVT was reported in the totality of 132 encounters. AKI was noted in 15.0% (5/33) of patients when IV-cx was used, vs 7.0% (7/99) when no IV-cx was used. Length of stay was not significantly different (p=0.436) (mean IV-cx stay: 8 days vs. mean non-IV cx stay: 7.8 days) . RBCs exchange transfusion happened in 10% of total encounters analyzed (14/132), being 42% (6/14) of the situations when IV-cx was used. Acute chest syndrome (ACS) developed in 19 admissions of 10 patients (6 female/4 male). Interestingly, 42% (8/19) of ACS happened when IV contrast had been used, and only 7/19 were managed with RBC exchange transfusion. In 1 encounter with IV-cx exposure, patient developed acute chest syndrome and ARDS requiring ECMO, (end-organ damage not reflected in our severity index score). VOC Severity Index means were similar in female vs male patients. Likewise, gender was not related to higher frequency of AKI, exchange transfusion or length of stay. Conclusions IV-cx exposure is associated with worsening in the severity of the VOC, manifested as more severe pain, and need of escalation of treatments, albeit with no increase in the LOS. Iv-cx should be avoided in SCD patients in VOC, when possible. PE should remain low in the differential in the setting of VOC, despite overlapping symptoms. Our findings are limited in the nature of retrospective chart review and small number of patients. Further analysis with prospective larger cohorts are needed for a better understanding on the role of IV-cx exposure, sickle cell renal disease and VOC.

Biological ageing and the risk of decreased handgrip strength among community-dwelling older adult Indians: a cross-sectional study

BackgroundEvidence from the literature demonstrates that the risk of decreased handgrip strength is associated with various health issues, particularly in older persons. To make judgments regarding their general health condition that are well-informed for longevity, it is crucial to assess the risk level of decreased handgrip strength among community-dwelling older adult Indians. However, no study has examined the relationship between biological aging and the risk of decreased handgrip strength in Indian men and women aged 60 and older. The goal of the current study was to fill this gap in the literature.MethodsIn this cross-sectional study, we included 31,464 (15,098 men and 16,366 women) community-dwelling older adult Indians aged 60 years and older using data from the Longitudinal Aging Study in India (LASI). The LASI is the world’s most extensive and India’s first multidisciplinary, internationally harmonized, longitudinal aging study. It has enrolled 72,250 individuals aged 45 and above across all 28 states and 8 union territories of India. Secondary analysis of biological ageing was performed by stratifying for age groups (60–64, 65–69, 70–74, 75–79, 80–84, and 85 + years) for both genders. The dominant right and nondominant left handgrip strength was assessed using the portable Smedley’s Hand Dynamometer. All individuals had a dominant right hand. The adjusted logistic regression analysis assessed the association between biological ageing and the risk of decreased handgrip strength for both genders.ResultsCompared to those between the ages of 60–64, those at age 65 and those aged 85 and above had 1-fold and 12-fold odds of decreasing handgrip strength, respectively. Men 85 years or older had a 12-fold higher chance than women in the same age group of having decreased handgrip strength.ConclusionsThe results indicate that community-dwelling older adult Indians aged 65 years and older are significantly associated with a higher risk of decreased handgrip strength, especially among older men. The results of this study can help assess and implement handgrip strength measurement in medicine for older Indians as part of regular admission assessment, particularly for older men.

Efecto sobre el momento del ingreso en la unidad de cuidados intensivos de la puesta en marcha de un servicio extendido de medicina intensiva

IntroductionThe implementation of the Critical Care Outreach Teams can influence the time of admission of patients to the Intensive Care Unit (ICU). Material and methodsRetrospective, descriptive, quasi-experimental “before-after” cohort study. All patients admitted to the unit urgently from Monday to Friday for two periods (between February 1, 2022 and June 30 and between February 1, 2023 and June 30, 2023) are included. The patients were divided into regular shift admissions (08-15h) and on-call (15-08h). The secondary objective was to assess whether there were differences in mortality between the two periods. ResultsDuring the first period of the study, 239 patients were admitted. 29.29% entered the ordinary shift and 70.71% on duty shift. During the second period, 211 patients were included with 43.13% of admissions in the ordinary shift. The comparison between the two periods observed a significant increase in the percentage of admissions in the morning hours in the second period (P=.0031). Mortality in the first period was 13.80% and in the second period 9.95%. The comparison between the two periods did not reveal significant differences. ConclusionsThe start-up of the Critical Care Outreach Teams is associated with an increase in the proportion of ICU admissions in the morning period without any observed changes in mortality.

In-hospital Outcomes and the Impact of Transfer Status in Nonelective vs Elective Transcatheter Aortic Valve Replacement

BackgroundNonelective transcatheter aortic valve replacement (TAVR) requires additional research to be fully understood. MethodsUsing the National Inpatient Sample database (2016-2019), we conducted a retrospective cohort study comparing nonelective vs elective TAVR. The primary outcome of interest was the in-hospital mortality rate among patients undergoing nonelective TAVR, compared to that among patients undergoing elective TAVR. We matched patients in a greedy nearest-neighbor 1:1 model and multivariable logistic regression, which was adjusted for demographics, hospital factors, and comorbidities, and was used to compare mortality in our matched cohort. ResultsEach cohort had 4389 patients in each cohort. When adjusted for age, race, sex, and comorbidities, nonelective TAVR patients had 1.99 times higher odds of suffering in-hospital mortality compared to elective admissions (adjusted odds ratio 1.99, 95% confidence interval: 1.42-2.81; P < 0.001). When separated by transfer status, nonelective patients admitted as regular hospital admissions or transferred from other acute-care centres also had higher odds of suffering in-hospital mortality compared to elective admissions. ConclusionsOur findings illustrate that nonelective TAVR patients are a vulnerable population that require additional medical support in the acute-care setting. As the demand for TAVR increases, further discussions regarding access to healthcare in underserved regions, the national physician shortage, and the future of the TAVR industry are imperative.

NEW STUDENT CLUSTERIZATION BASED ON NEW STUDENT ADMISSION USING DATA MINING METHOD

The process of admitting new students to the Faculty of Information Technology (FTI) at Universitas Budi Luhur produces a large amount of student data in the form of student profile data and other data. This happens causing a buildup of new student data, thus affecting the search for information on that data. This study aims to classify regular undergraduate admissions data at the Faculty of Information Technology (FTI) Universitas Budi Luhur by utilizing the data mining process using the clustering technique. The algorithm used for clustering is the K-Means algorithm. K-Means is a non-hierarchical clustering data method that can group student data into several clusters based on the similarity of the data, so that student data with the same characteristics is grouped in one cluster and those with different characteristics are grouped in another cluster. An implementation using RapidMiner is used to help find accurate values. This research produced a description of what clusters were formed from data on regular undergraduate admissions at the Faculty of Information Technology (FTI) at Universitas Budi Luhur. This will help recommend decision-making to determine the marketing promotion strategy for each study program at Universitas Budi Luhur. Based on the results of the K-Means algorithm cluster, it can also be seen which majors or study programs are of interest in each school from which new students come.

Divided We Survive? Multilevel Governance during the COVID-19 Pandemic in Italy and Spain

Abstract We compare the intergovernmental health system responses to the first wave of the COVID-19 pandemic in Italy and Spain, two countries where healthcare is managed at the regional level and the impact of the first wave was highly localized. However, whereas in Italy the regional government allowed for a passively accepted central level of coordination without restricting autonomy (“descentralised coordinantion”), in Spain, the healthcare system was de facto centralized under a “single command” (“hierarchical centralization”). We argue that the latter strategy crowded out incentives for information sharing, experimentation and regional participation in decision-making. This article documents evidence of important differences in health outcomes (infected cases and deaths) and outputs (regular and emergency hospital admissions) between the two countries, both at the national and regional levels. We then discuss several potential mechanisms to account for these differences. We find that given the strong localized impact of the pandemic, allowing more autonomy in Italy (compared to centralized governance in Spain) can explain some cross-country differences in outcomes and outputs.

P870 What had the greatest impact on the quality of life of IBD patients on intravenous biological therapy in Montenegro during COVID-19?

Abstract Background COVID-19 has affected the quality of life (QoL) of patients with chronic diseases, including patients with IBD. The aim of this study is to evaluate the QoL of patients with IBD on intravenous biological therapy (IvBT), through the Short Inflammatory Bowel Disease Questionnaire (sIBDQ), and to correlate the results with sociodemographic data of the patients. Methods This study was comprised of patients older than 18 years of age, with a pathohistologically confirmed diagnosis of IBD (Ulcerative Colitis (UC), and Crohn’s Disease (CD)). The study was conducted on September and October 2020, during one of the highest incidences period of COVID-19 in our country. Patients completed the sIBDQ, and DASS-21 (Depression, Anxiety and Stress Score-21) questionnaire too, assessing their level of depression, anxiety and stress. For significant symptoms (DASS-21), we used at least moderate DASS-21 subscale score: DASS-21 Depression (≥ 14), DASS-21 Anxiety (≥ 10) and DASS-21 Stress (≥19). The Simple Clinical Colitis Activity Index was used to assess the disease activity of UC; for CD, the Harvey-Bradshaw Index was used. Patients who scored below 50 on the sIBDQ were those labeled with worse QoL. We also examined demographic data, data on IBD characteristics and COVID-19 data and their impact on quality of life. Results Of the total number of patients (94), there were 40 (42.5%) females, 42 (44.6%) with CD. All patients have been receiving IvBTh (anti TNFα: infliximab-originator and biosimilar (59 patients) and anti-integrins: vedolizumab (35 patients)) for at least 6 months prior. The results indicated worse QoL in 25 (27%) patients. Multivariate analysis showed that the greatest impact on poor QoL during the COVD-19 pandemic were: active disease (p= 0.002), significant symptoms on the DASS21 score (p= 0.013), patients who did not regularly go to work or were not employed (p=0.017), if they had a patient with COVID-19 in their immediate environment (p=0.024) and those who had a higher degree of health concerns about coming to regular admission to biological therapy at the IBD unit. (p=0.046). Conclusion 27% of IBD patients on IvBT had worse QoL during the COVID 19 pandemic. In addition to disease activity and significant psychological disturbances, other reasons for lower QoL were identified during the pandemic and are directly related to it.

Impact of transfer from non-acute care centers on clinical outcomes in patients with congestive heart failure

Study objectiveTo compare the clinical outcomes in patients with congestive heart failure who are transferred to an acute care hospital from non-acute care centers with patients who are admitted as regular hospital admissions. DesignThis was a retrospective cohort study. SettingWe utilized the National Inpatient Sample database from 2016 to 2018. ParticipantsOur cohort consisted of hospitalized patients who were at least 18 years old with a primary diagnosis of congestive heart failure. InterventionsThese patients were either transferred from non-acute centers or presented as regular hospital admissions. Main outcome measurementsWe matched patients in a greedy nearest neighbor 1:1 model with caliper set at 0.2. Multivariable logistic regression, adjusted for age, sex, race and comorbidities, was used to compare mortality in our matched cohort. ResultsThis study included 35,010 non-acute care transfers and 951,189 regularly admitted patients. Compared to patients who were not transferred, non-acute care transfers were older, predominantly female, White and less racially diverse. After matching, there were 6689 patients in each cohort. When adjusted for age, race, sex and comorbidities, non-acute care transfers with congestive heart failure had 2.20 times higher odds of suffering in-hospital mortality compared to regular, non-transferred admissions (aOR 2.20, 95 % CI: 1.85–2.61; p < 0.001). ConclusionOur findings illustrate that non-acute care transfers are a vulnerable population that require additional medical support in the acute care setting.

Abstract 11254: Impact of Transfer Status on Non-St Segment Elevation Myocardial Infarction Outcomes

Introduction: Patients who are transferred between acute care medical facilities are an overlooked population. In this study, we explore the in-hospital outcomes of patients with a non-ST segment elevation myocardial infarction (NSTEMI) who were transferred to an acute care hospital from another acute care center. Methods: We queried the National Inpatient Sample database (2016-2019) to identify patients admitted with a principal diagnosis of NSTEMI. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression was used to compare mortality. Results: 131,948 patients met our inclusion criteria. Patients with a NSTEMI who were transferred from an acute care center had 1.20 times higher odds of suffering in-hospital mortality compared to regular hospital admissions (aOR 1.20, 95% CI: 1.13-1.28; p &lt; 0.001). When separated by race, acute care transfers had a higher mortality rate amongst White patients (3.5% vs 3.1%, p &lt; 0.001), but a decreased mortality rate in Black patients (3.5% vs 3.6%, p = 0.008, Figure 1). Acute care transfers were more likely to undergo percutaneous coronary intervention (35.9% vs 34.0%, p &lt; 0.001) and have intraoperative cardiac arrest (0.04% vs 0.01%, p &lt; 0.001, Table 1). Conclusions: Patients who were transferred to acute care hospitals from other acute care centers with a NSTEMI had higher odds of suffering in-hospital mortality compared to regular hospital admissions. Acute care transfers with a NSTEMI require additional medical support in the inpatient setting. Further studies should explore potential interventions to address these differences in outcomes.