Related Admissions Research Articles

Postprocedural Complications Hospitalization Pattern Among Paediatric Patients at National Health Service Trusts: An Ecological Study in England and Wales.

To analyze the hospitalization patterns associated with postprocedural complications among the pediatric population in England and Wales over the past two decades. This was an ecological study using hospital admission data extracted from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales for the period between April 1999 and April 2020. Postprocedural complications related hospital admissions were identified using the 10th version of the International Statistical Classification of Diseases (ICD) system (D78, E89, H59, H95, J95, L76, M96, and N99). The rate of hospital admissions declined by 2.1% [from 8.32 (95% CI 7.75-8.88) per 100,000 persons in 1999 to 8.15 (95% CI 7.61-8.68) per 100,000 persons in 2020, p>0.05]. The primary reasons for hospital admissions associated with postprocedural complications were related to the respiratory system, genitourinary system, and ear and mastoid process, constituting 43.0%, 23.8%, and 23.0% of cases, respectively. The trend of postprocedural complications among the pediatric population has been stable in the past two decades. Continuous monitoring of the hospitalization pattern for this type of complication is important due to advancements in healthcare provision and to improve patient care and safety. Future studies are needed to examine gender-based differences related to postprocedural complications and identify important preventable risk factors.

Designed for a pandemic: Mitigating the risk of SARS-CoV-2 transmission through hospital design and infrastructure

BackgroundTo describe the new Royal Adelaide Hospital (RAH) design and infrastructure features that helped mitigate the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission within the hospital during the pre-vaccination and pre-antiviral period. MethodThe RAH infrastructure, design and initial pandemic response was assessed. A retrospective review of all confirmed or suspected coronavirus disease 2019 (COVID-19) patients admitted from 1 February 2020 to 30 May 2020 was also performed to assess risk of transmission. Outbreak response reports were reviewed to identify episodes of nosocomial COVID-19. ResultsKey infrastructure features include single-bed overnight rooms with dedicated bathrooms, creation of pandemic areas accessible only to pandemic staff, and sophisticated air-handling units with improved ventilation. A total of 264 COVID-19 related admission occurred, with 113 confirmed cases and 1579 total cumulative bed days. Despite a limited understanding of SARS-CoV-2 transmission, no vaccination or anti-viral therapy, global shortages of particulate filter respirators and restricted testing during this period, only one probable nosocomial COVID-19 case occurred in a healthcare worker, with no nosocomial cases involving patients. ConclusionsThe RAH design and pandemic features complimented existing infection control interventions and was important in limiting nosocomial spread of SARS-CoV-2.

FRI657 Case Series On GLP-1 Receptor Agonist Related Acute Pancreatitis

Abstract Disclosure: A.U. Kulkarni: None. V. Mehta: None. M. Renzu: None. K. Pereira: None. M.A. Rather: None. Introduction: Acute pancreatitis (AP) has now become one of the leading causes of GI related hospital admissions in the United States. With increasing use of GLP-1 Receptor Agonists (GLP-1 RA) in T2DM and obesity, they are now being identified as one such class of drugs which can cause AP. We present this case series to discuss these adverse effects. Case 1: A 50 yo AA male with a history of T2DM and hypertension presented with acute severe epigastric pain, nausea and vomiting for 5 days. Vitals were stable. On physical exam, tenderness in the RUQ was noted. Labs revealed lipase of 313 U/l (11-82 U/l), BG of 213 mg/dL, HbA1c 11.3, normal LFT and lipid panel. Blood EtOH was negative. He denied tobacco, alcohol, and illicit drug use. CT abdomen showed acute interstitial edematous pancreatitis without cholelithiasis or choledocholithiasis. Liver ultrasound showed hepatic steatosis. He noted recent initiation of Semaglutide 6 months ago which was stopped 3 weeks prior to this visit due to abdominal discomfort. Previous Dulaglutide therapy was also discontinued due to GI intolerance. Home medication for DM otherwise included metformin and basal insulin. Case 2: A 68 yo AA woman with a history of T2DM, hypothyroidism presented after a week of severe epigastric pain, radiating to her back, with nausea and vomiting. Labs showed lipase 593 U/l (11-82 U/l), BG of 427 mg/dl, HbA1c of 10. Social history was non-contributory. CT Abdomen showed AP and no gallstones or bile duct dilatation. LFTs and lipid panel were unremarkable. Chart review noted prior admission for AP a month ago. Her home medications were basal Insulin and Dulaglutide (4 yrs). Drug induced AP from Dulaglutide was suspected. Lack of clinical improvement after 3 days of management prompted RUQ ultrasound, which was prematurely terminated due to pain during the scan. Subsequent CCK-HIDA was negative for acute cholecystitis but noted low gallbladder EF. Thus dulaglutide was identified as a potential trigger along with gallbladder dysmotility as a possible etiology for her recurrent AP. Both patients were managed with IV fluids, NPO diet and morphine. They were instructed to stop GLP-1 RA and discharged with PCP follow-up. Discussion: GLP-1 RA are now being widely used due to low risk of hypoglycemia and weight loss. Clinical trials with GLP-1 RA have shown mild, asymptomatic increase in lipase, amylase levels as well as rare incidences of AP. This has been attributed to the stimulation of pancreatic beta cells and exocrine duct cells leading to acinar cell hypertrophy, proinflammatory cytokine induction, causing pancreatic injury. Though drug-induced AP is uncommon and is a diagnosis of exclusion, detailed history taking, medication review and investigating for all other causes is of utmost importance. A good understanding of the drugs associated with AP should alert the physician to identify these agents and promptly discontinue them to prevent further complications. Presentation: Friday, June 16, 2023

THU333 Race Was Not A Predictor Of Poor Outcomes From COVID-19 At University Of Chicago Medicine Hospital

Abstract Disclosure: A. Rashied: None. J. Cursio: None. E.C. Hanlon: None. S. Pannain: None. University of Chicago Medicine (UCM) is a large, 800 bed, urban hospital located on the south side of Chicago that cares for a substantial number of African-American (AA) patients. The COVID-19 pandemic has impacted health drastically, especially for minorities (including AAs) and those with comorbid conditions. We examined COVID outcomes in our UCM patient population, including patterns by race, other demographic information (age, sex), and comorbidities, and the relationship with deaths, intensive care unit (ICU), and mechanical ventilator use. From the period March 2020 to February 2021, 61.6% (11,071/17,945) patients tested for COVID-19 at UCM were positive, and 52.8% (5,850/11,071) of these were hospitalized for further care. Of these hospitalized patients 3,171 were AA and 2,679 were all other races. AA had a higher percentage of patients who were female (62% vs 54%, p<0.0001), were older (49 vs 43 years, p<0.0001), had longer hospital stays (13.5 vs 13.0 days, p<0.0001), were admitted to the ICU (9% vs 4%, p<0.0001), and died (5% vs 2%, p<0.0001) compared to non-AA patients. In addition, the rates of comorbid conditions were higher for AAs compared to non-AAs for hypertension (52% vs 32%, p<0.0001), heart disease (15% vs 9%, p<0.0001), diabetes (36% vs 22%, p<0.0001), kidney disease (21% vs 8%, p<0.0001), and obesity (53% vs 40%, p<0.0001). To explore the relationship of race and death among patients hospitalized with COVID-19, a predictive model for death was estimated including age, race, gender, hospital stay in days, ICU length of stay, and indicators for obesity, heart disease, kidney disease, hypertension, and diabetes. The model shows that AA adults have a higher odds ratio (OR=1.08, p=0.71) for death than non-AA adults, however the p-value was insignificant. Instead, significant predictors of death included age (OR=1.058, p<0.0001) and kidney disease (OR=2.108, p=0.0002). Neither diabetes nor obesity were significant predictors of death in our cohort. Race was also not a predictor of mechanical ventilation or ICU status. However, obesity, diabetes and kidney disease were all significant predictors of requiring ventilation (all p<0.05). Moreover, age (OR=1.013, p=0.001), female gender (OR=0.687, p=0.002), kidney disease (OR=2.431, p<0.0001), and diabetes (OR=2.224, p<0.0001) were significant predictors of ICU admission. The model for death, ventilator, and ICU status for patients with COVID-19 at UCM show increased risks for AA versus non-AAs, however the odds ratios were insignificant. Instead, comorbidities like kidney disease were a significant predicator of death, as were obesity and diabetes for COVID-19 related ventilation and ICU admission. Thus, in our patient population that includes a significant number of AA adults, race was not a predictor of poor COVID-19 outcomes, but kidney disease, obesity, and diabetes were – irrespective of race. Presentation: Thursday, June 15, 2023

SAT294 Effectiveness Of Electronic Consults For Immune Related Endocrine Toxicities In Reducing Appointment Access Time And Preventing Hospital Admissions

Abstract Disclosure: A.I. Shariff: Consulting Fee; Self; Bristol-Myers Squibb. Speaker; Self; Merck. Background: Endocrine irAEs are noted in 4% to 14.6% of ICI treated patients leading to 12.2% of irAE related admissions.1Delayed access, diagnosis and management are often causes of preventable hospital admissions in cancer patient.2 3 Herein, we describe a single-institution experience with an e- consult platform from oncology to endocrinology as a cost effective and high impact solution to this limitation. Methods: Between 5/1/2020 to 11/1/2021 patients who received ICI were included in a retrospective observational cohort study. Data collection included patient demographic, cancer, treatments, irAE and appointment specifics. Results: 102 e-consults were reviewed during the study period. Thyroiditis was noted as the most common irAE while NSCLC, and pembrolizumab use were most commonly noted in the cohort. 88 and 60 consults received diagnostic and treatment recommendations respectively. Reduction in median time to appointment was lowered from 60.5 days to 38.50 days. Among e-consulted patients, 2 (2.23%) required hospitalization for further evaluation and management. This is a reduction from previous data at the same institution (2007- 2017) where 11% endocrine toxicities were admitted. With an average length of stay approximated to 6.4 days at $3,142 per day, a total of $100,544 was saved as a result of the consult service.1 We also noted that these e-consults were poorly reimbursed by all payers, and current average reimbursement ranged from $15- $32/ consult.4Conclusion: This study underscores the impact and effectiveness of e consults as a tool for timely recommendations and improving access leading to reduction in health care utilization. To support e-consults, the effort-payment mismatch must be addressed by health systems and payers that can propel integration and scalability of these effective services across oncology and other subspecialty practices to enhance access and mitigate gaps in specialty care provided to cancer patients. Presentation Date: Saturday, June 17, 2023

A transient positive association between direct-acting antiviral therapy for hepatitis C infection and drug-related hospitalization among people who inject drugs: Self-controlled case-series analysis of national data.

Direct-acting antiviral (DAA) treatment has an established positive effect on liver outcomes in people with hepatitis C infection; however, there is insufficient evidence regarding its effects on the 'extra-hepatic' outcomes of drug-related hospitalization and mortality (DRM) among people who inject drugs (PWID). We investigated associations between these outcomes and DAA treatment by comparing post-treatment to baseline periods using a within-subjects design to minimize selection bias concerns with cohort or case-control designs. This was a self-controlled case-series study. Scotland, 1 January 2015-30 November 2020. The study population of non-cirrhotic, DAA-treated PWID was identified using a data set linking Scotland's hepatitis C diagnosis, HCV clinical databases, national inpatient/day-case hospital records and the national deaths register. Three principal outcomes (drug overdose admission, non-viral injecting related admission and drug-related mortality) were defined using ICD codes. Self-controlled case-series methodology was used to estimate the relative incidence (RI) of each outcome associated with time on treatment and up to six 90-day exposure risk periods thereafter. A total of 6050 PWID were treated with DAAs in the sampling time-frame. Compared with the baseline period, there was a significantly lowered risk of a drug overdose hospital admission in the second to fifth exposure risk periods only [relative incidence (RI) = 0.86, 95% confidence interval (CI) = 0.80-0.99; 0.89, 95% CI = 0.80-0.99; 0.86, 95% CI = 0.77-0.96; 0.88, 95% CI = 0.78-0.99, respectively]. For non-viral injecting-related admission, there was a reduced risk in the first, third and fourth exposure risk periods (RI = 0.76, 95% CI = 0.64-0.90; 0.75, 95% CI = 0.62-0.90; 0.79, 95% CI = 0.66-0.96, respectively). There was no evidence for reduced DRM risk in any period following treatment end. Among people who inject drugs in Scotland, direct-acting antiviral treatment appears to be associated with a small, non-durable reduction in the risk of drug-related hospital admission, but not drug-related mortality. Direct-acting antiviral therapy, despite high effectiveness against liver disease, does not appear to offer a panacea for reducing other drug-related health harms.

290 Documenting medication-related needs of older persons assessed by frailty at the front door teams

Abstract Background Older persons presenting with frailty syndromes, polypharmacy and significant comorbidities to Emergency Departments (ED) have a higher rate of adverse outcomes. The aim of this study was to describe medication related needs of persons over 65 years seen by a Frailty at the Front Door (FFD) team in ED. Methods CGAs were performed by an inter-disciplinary team (IDT) between January–December 2022, and included a pharmacy prioritisation toolkit, collecting data including excessive polypharmacy, use of high-risk medications, specific patient or carer medication concerns, fall or medication-related admission and kidney injury. Age, gender, CFS, pharmacy toolkit triggers and specialist Geriatrician review were entered onto Excel and analysed using descriptive statistics. Results 529 CGAs were included. 60 were excluded due to incomplete data (n = 57) or aged under 65 years (n = 3). Mean (SD) age 82.9 (7.9) years. Female:Male ratio 1.5:1. Mean (SD) CFS = 5.2 (1.1). 25% (n = 131) had a fall or medication-related admission. 20% (n = 109) had an acute kidney injury (AKI) or chronic kidney disease (CKD). 26% (n = 141) had excessive polypharmacy. 53% (n = 284) were on one or more high risk medications. 9% (n = 50) had a specific medication concern. 46% (n = 246) triggered for pharmacy review. 72% (n = 178) required specialist geriatrician review. Conclusion Use of high risk medications, excessive polypharmacy and medication or fall related admission are the most common reasons for pharmacy review. Specialist geriatrician review is needed in the majority of cases to assess medication-associated risk and effectively deprescribe. There is a need to develop pathways of care that allow for pharmacy and Geriatrician review of approximately half of older persons seen by an FFD.

WTP4.14 Major Trauma Amongst E-scooter and Bicycle Users: A Nationwide Cohort Study

Abstract Aims To determine the number of E-Scooter related admissions due to significant trauma in comparison to bicycle related trauma within England and Wales. To compare morbidity and mortality associated with each form of transport. Methods A retrospective cohort study based on data which has been prospectively collected and submitted to the UK Trauma Audit and Research Network (TARN) registry. Patients of any age who were admitted to major trauma centres or trauma units in England and Wales with injuries following E-Scooter or bicycle incidents between the dates 01/01/2021- 31/12/2021. All patients must have met TARN database inclusion criteria. Results There were 293 E-Scooter trauma incidents compared to 2538 bicycle incidents. E-Scooter users were more likely to be admitted to a major trauma centre (p=0.019) or an intensive care unit (p=<0.001). Amongst e-scooter users, serious head injury (Abbreviated Injury Scale >2) was almost twice as common (p=<0.001) and the rate of serious limb trauma was also higher in this group (p=<0.001). Rates of serious chest and pelvic trauma were greater in the bicycle cohort (p=<0.001 and p=0.003 respectively). Over a third of E-Scooter injuries were incurred outside the remit of current legislation by patients who were under the influence of alcohol and drugs (75/293) or under the age of 17 (41/293). Conclusions The relative incidence of moderate to severe injury amongst E-Scooter users is likely to outweigh bicycle users. These early results suggest an alternative pattern of injury amongst E-scooter users compared to bicycles.

Long term risk of death and readmission after hospital admission with covid-19 among older adults: retrospective cohort study

ObjectivesTo characterize the long term risk of death and hospital readmission after an index admission with covid-19 among Medicare fee-for-service beneficiaries, and to compare these outcomes with historical control patients...

The af virtual ward, right care, right time and right team

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Fibrillation (AF) is the most common cardiac arrhythmia. AF related hospital admissions are rising, with significant cost and capacity implications. Virtual wards are novel pathways designed to support patients remotely, whilst maintaining safe high quality patient care, changing the landscape of care provision. Purpose The standard pathway for patients presenting acutely with AF or Atrial flutter (AFL), is to remain in hospital between 2-5 days, attached to a heart monitor until achieving rate or rhythm control. We developed an AF Virtual ward run by a specialist multi-disciplinary team; to provide remote out-of-hospital care for patients with AF or AFL and rapid ventricular response whilst focusing on improving patients’ care pathway and experience. Methods Patients presenting acutely with AF or AFL who met the criteria for our virtual ward, were on-boarded from an acute hospital admission area or outpatient department. Patients were given access to electronic platform (Dignio) via their smartphone or tablet. They were provided with instruction on how to use a blood pressure machine, single lead ECG device (Kardia) and a pulse oximeter. Once discharged they submitted readings, at least twice a day. Patients who didn’t have access to smart phones were provided with electronic tablets to ensure digital inclusion. Patients’readings, current medication and co-morbidities were assessed by Advanced Clinical Practitioners, Cardiology Registrars and Consultants on "virtual ward rounds". They were supported via messaging through the platform, telephone or video consultations. Health education, lifestyle advice, medication adjustments, and clinical decisions were undertaken remotely by the clinical team. Results A retrospective analysis of the first 50 virtual ward admissions from January - August 2022 was undertaken. Initial hospital admissions were completely avoided in 24 patients due to on-boarding from the outpatient department. Medical interventions by the specialist team prevented 25 readmissions, saving a total of 49 hospitalisations and between 98 - 245 bed days. A rhythm control strategy was pursued in 82% and sinus rhythm was achieved in 36% on discharge. A total of 28% patients were referred for direct current cardioversion (DCCV) and 30% for catheter ablation. The prompt development of a treatment plan avoided attendance in a specialist Cardiology outpatient clinic whose waiting time for an appointment is approximately 6 months. The NHS friends & family test was completed by 90% of the patients with 100% positive responses. Feedback themes revolved around empowerment, feeling safe, actively participating in their care, and avoiding hospital stay. Conclusion The innovative changes to create the AF Virtual ward has facilitated bed efficiencies allowing "hospital-at-home" remote care through prompt care by a specialist multidisciplinary team, with 100% patient satisfaction.

Outpatient albumin infusions reduce hospitalizations and improve outcomes in decompensated cirrhosis: A real-world cohort study.

Long-term human albumin (HA) infusions improve survival in cirrhotic patients with diuretic resistant ascites. We aimed to determine whether there is a significant benefit in a more unwell real-world cohort. This is a single-center retrospective cohort study. Patients received outpatient HA between April 2017 and June 2021. Inclusion criteria were age ≥18 years, cirrhosis with ascites, and received at least 1 month of HA. Patients with significant comorbidities and ongoing alcohol use were not excluded. Outcomes assessed were transjugular intrahepatic portosystemic shunt (TIPS)/transplant-free survival (TTFS), and biochemical and prognostic outcomes. Twenty-four patients were included. Median age was 59.5 years. Seven were female (29.2%). Etiology included were alcohol (50%), non-alcoholic steatohepatitis (16.7%), and viral/alcohol (12.5%). Median model for end-stage liver disease-sodium (MELD-Na) was 18.5, with Child-Pugh scores (CPS) A (4.2%), B (50%), and C (45.8%). Improvements in serum sodium (P = 0.014), albumin (P = 0.003), and CPS (P = 0.017) were observed. Reduction in hospitalizations (P = 0.001), particularly portal hypertensive related admissions was observed (relative risk 0.39; 95% confidence interval [CI] 0.21-0.69, P = 0.003), needed to treat 2.09 (95% CI 1.25-3.67). There was a reduction in total paracentesis requirements (P = 0.005). On multivariate analysis, type 2 diabetes mellitus significantly increased risk of TIPS/transplant/death (hazard ratio 6.16; 95% CI 1.23-30.84, P = 0.027). Median TTFS improved in patients with a change in MELD-Na ≤1 at 1 month: 29.4 months versus 7.7 months (P = 0.011). Outpatient HA infusions decrease portal hypertensive related hospital admissions, improve serum sodium, albumin levels, and CPS. Type 2 diabetes mellitus and change in MELD-Na score help discriminate those likely to benefit most.

Comparative effectiveness of bivalent BA.4-5 and BA.1 mRNA booster vaccines among adults aged ≥50 years in Nordic countries: nationwide cohort study

ObjectiveTo estimate the effectiveness of the bivalent mRNA booster vaccines containing the original SARS-CoV-2 and omicron BA.4-5 or BA.1 subvariants as the fourth dose against severe covid-19.DesignNationwide cohort analyses, using...

Comparative effectiveness of heterologous third dose vaccine schedules against severe covid-19 during omicron predominance in Nordic countries: population based cohort analyses

ObjectiveTo investigate the comparative vaccine effectiveness of heterologous booster schedules (ie, three vaccine doses) compared with primary schedules (two vaccine doses) and with homologous mRNA vaccine booster schedules (three vaccine...

COVİD-19 Enfeksiyonunun İkinci Dalgasında Çocuklarda Ev Kazaları: Tek Merkez Deneyimi

Objective: The COVID-19 pandemic has affected the whole world in terms of health, social life, and economics. In this study, the frequency of pediatric home accidents in the second wave of the pandemic, where social isolation continues, was investigated. Material and Methods: This is a single center, retrospective study. We evaluated cases of patients under the age of 18 who were admitted to the hospital due to a home accident between November 1, 2020 and January 31, 2021 (the second wave of the pandemic). Results were compared with the patients who were admitted to the same emergency department within the same period of the previous year. Researchers examined home accidents in three groups: crash-fall-incision (1), intoxication-foreign body ingestion (2), and burns (3). The patients were divided into four age groups: 0-1 year, 2-5 years, 6-11 years, and 12-17 years. Results: The study was completed with 607 cases pre-Covid and 683 cases post-Covid. The median age was 44.4 month (17-57) from 2019-2020 and 49.1 month (18-64) from 2020-2021 (p=0.154). The outpatient and sequela-free discharges were more frequent in both periods (p=0.046). In the second wave of the pandemic, there was an increase in burns and fall related admissions compared to before the pandemic (p<0.001). All types of home accidents were frequently detected at the ages of five years and younger. Conclusion: In this study, analyzing the second wave of the pandemic compared to pre-pandemic times, Researchers noted a decrease in the number of emergency admissions and an increase in admissions related to home accidents.

Can multiple sclerosis nurses help reduce non-elective admissions? Revisiting the question 2 years on from an analysis of a service delivery audit

Background: The results of a 2019/20 audit exploring the reasons for emergency hospital admissions among people with MS, identified urinary tract infections (UTIs) as a major reason. Consequently, the authors implemented several interventions with the aim of reducing non-elective admissions coded to UTI. This article disseminates whether the interventions implemented by the authors resulted in a reduction in non-elective UTI associated hospital admissions. Methods: The authors conducted a 12-month audit of non-elective admissions across two NHS Trusts, comparing and contrasting the data from the 2019/20 audit and national and local Hospital Episode Statistics. Findings: A reduction in non-elective admissions coded to UTI has significantly reduced across both sites, which is thought to be a consequence of the authors' proposed recommendations from the 2019/20 audit. Local data now identifies the main reasons for MS non-elective hospital admissions as respiratory issues and falls. Conclusions: Having raised awareness of the need to focus on improved bladder management, data now reveals further reduction in MS bladder and UTI related admissions. Further recommendations have been made, as there needs to be an increased focus on addressing improvements in both respiratory management and falls prevention.

Who Is Responsible for Nurse Wellbeing in a Crisis? A Single Centre Perspective

Background: Leadership during the COVID-19 pandemic often manifested as a command-and-control style of leadership which had detrimental emotional impacts on staff, particularly the nursing workforce. Leadership can have detrimental effects on staff wellbeing, or it can greatly boost their ability to handle a crisis. We sought to explore the interrelationship between leadership and nurses’ wellbeing in an inner-city university hospital during the initial wave of the pandemic. Methods: We conducted secondary analyses of interview data collected during a hospital-wide evaluation of barriers and facilitators to changes implemented to support the surge of COVID-19 related admissions during wave one. Data were collected through semi-structured video interviews during May–July 2020. Interviews were analysed using Framework analysis. Results: Thirty-one nurses participated, including matrons (n = 7), sisters (n = 8), and specialist nursing roles (n = 16). Three overarching themes were identified: the impact on nurses, personal factors, and organisational factors. The impact on nurses manifested as distress and fatigue. Coping and help-seeking behaviours were found to be the two personal factors which underpinned nurses’ wellbeing. The organisational factors that impacted nurses’ wellbeing included decision-making, duty, and teamwork. Conclusions: The wellbeing of the workforce is pivotal to the health service, and it is mutually beneficial for patients, staff, and leaders. Addressing how beliefs and misconceptions around wellbeing are communicated and accessing psychological support are key priorities to supporting nurses during pandemics.

FELLOWSHIP-TRAINED ORTHOPAEDIC TRAUMATOLOGISTS ACHIEVE BETTER POSTOPERATIVE RADIOLOGICAL PARAMETERS AFTER CEPHALOMEDULLARY NAILING OF INTERTROCHANTERIC FRACTURES COMPARED WITH COMMUNITY SURGEONS

Intertrochanteric fractures are common, accounting for nearly 30% of all fracture related admissions. Some have suggested that these fractures should be treated in community hospitals so as not to tax the resources of Level One trauma centers. Since many factors predictive of fixation failure are related to technical aspects of the surgery, the purpose of this study was to compare radiographic parameters after fixation comparing trauma fellowship trained surgeons to non-fellowship trained community surgeons to see if these fractures can be treated successfully in either setting.Using our hospital system's trauma database, we identified 100 consecutive patients treated with cephalomedullary nails by traumatologists, and 100 consecutive patients treated by community surgeons. Quality of reduction, neck shaft angle (NSA), tip-to apex distance (TAD) were compared.The mean TAD for the trauma group was 10mm compared to 21mm for the community group (p<0.001). The mean postoperative NSA for the trauma group was 133 degrees compared to 127 degrees for the community group (p<0.001). The mean difference in the NSA of the fractured side compared to the normal hip was 2.5 degrees of valgus in the trauma group compared to 5 degrees of varus for the community group (p<0.001). There were 93 good reductions in the trauma group compared to 19 in the community group (p<0.001). There were no poor reductions in the trauma group and 49 poor reductions in the community group (p<0.001).Fellowship trained traumatologists achieved significantly more accurate reductions and implant placement during cephalomedullary nailing of intertrochanteric hip fractures.

Risk prediction of covid-19 related death or hospital admission in adults testing positive for SARS-CoV-2 infection during the omicron wave in England (QCOVID4): cohort study

ObjectivesTo derive and validate risk prediction algorithms (QCOVID4) to estimate the risk of covid-19 related death and hospital admission in people with a positive SARS-CoV-2 test result during the period...

Incidence and prevalence of psychotic disorders, a county population study of Tirana hospital admissions

Objective: To estimate incidence and prevalence of first admissions for mental health diagnoses in the Tirana county catchment area and related admissions from other Albania counties to Tirana University Hospital Center “Mother Teresa”. Method: We used the historic dataset of mental health diagnoses composed of electronic patient records discharges. Tirana county, was the focus of the age standardized mean annual incidence (first admissions) per 100,000 population per region for ICD-9 three-digit codes - 295 (Schizophrenic psychoses), 296 (Affective psychoses) and 295-299 (Other psychoses), 2007 – 2021. Taking in consideration internal migration and emigration trends of the Albanian population we subdivided the study period in three periods, PI (2007-2011), PII (2012-2016), PIII (2017-2021). Mean annual incidence (first admissions) per 100,000 population per region and period prevalence, Albania, 2005 – 2021 were calculated. Results: During the study period, 2005 – 2021, resulted 21,287 diagnoses discharged as Mental Disorders (290-319) - ICD, 9th edition, period 2005-2021. First admissions were 12,251 cases, which were responsible for 57.6% of total admissions, of which 6,525 (53.3%) were males. Mean age (median) first admissions was 37.0 ± 15.5 (36.3) years. Age standardized mean annual incidence (first admissions) per 100,000 population (95% CI), Tirana county, Schizophrenic psychoses, Affective psychoses and Other psychoses, were respectively PI (15.48 [12.68 - 18.29], 19.38 [16.21 - 22.54] and 48.92 [43.69 - 54.16]), PII (10.05 [7.90 - 12.20], 14.29 [11.73 - 16.85] and 32.82 [28.93 - 36.71]) and PIII (9.24 [7.30 - 11.18], 18.82 [15.89 - 21.75] and 34.25 [30.29 - 38.20]). Tirana county, 17-year prevalence, of first hospitalizations was respectively by code, 224.8, 323.2 and 666.7 per 100,000 population. Conclusion: This aproach, from a tertiary hospital first admissions viewpoint can serve as a posible aproximation towards holistic studies. The synchronic study produces suficient backgroud information for next prospective level longitudinal studies.

Trends in hospital admission related to poisoning by, narcotics and psychodysleptics and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales between April 1999 and April 2020: An ecological study

BackgroundThis study aimed to investigate the trend of hospital admissions related to poisoning by narcotics and psychodysleptics and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales between April 1999 and April 2020. MethodsAn observational ecological study were conducted using data from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. The rate of hospital admissions with 95% confidence intervals (CIs) was calculated by dividing the number of episodes of poisoning by narcotics and psychodysleptics related admission and poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs-related admission by the mid-year population from the Office for National Statistics. All analyses were conducted using SPSS version 27. ResultsThe total annual number of hospital admissions for narcotics and psychodysfunctionals poisonings increased by 1.40-fold [from 15.70 (95% CI 15.36–16.04) in 1999 to 37.64 (95% CI 37.15–38.13) in 2020 per 100,000 people, p < 0.01]. However, the overall annual number of poisonings by antiepileptic, sedative-hypnotic and antiparkinsonism drugs hospital admissions for various reasons decreased by 12.8% [from 33.55 (95% CI 33.05–34.04) in 1999 to 29.26 (95% CI 28.82–29.69) in 2020 per 100,000 persons, p < 0.05]. Poisoning by other opioids (53.2%), heroin (15.1%), and other synthetic narcotics (13.3%) were the most common reasons for narcotic and psychodysfunctional poisoning. While poisoning by benzodiazepines (54.2%) and poisoning: other antiepileptic and sedative-hypnotic drugs (30.7%) were the most common hospital admission reasons for poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism. ConclusionPoisoning by narcotics have increased in England and Wales over the study period, however, poisoning by antiepileptic, sedative-hypnotic, and antiparkinsonism drugs in England and Wales were relatively stable during the same period. Future initiatives and awareness programs to prevent harmful use and drug poisoning by narcotics, sedative-hypnotic and other medications are needed.