Return Visit Research Articles

Impact of the Amount of Intravenous Glucose Administration on Hospitalization for Acute Gastroenteritis in a Pediatric Emergency Department.

In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established. The main objective of this study was to evaluate the association between the amount of intravenous glucose provided and hospitalization for children with acute gastroenteritis. Another objective was to evaluate practice variation regarding the amount of glucose provided for IV rehydration in a pediatric emergency department (ED). We conducted a retrospective cohort study from 2019 to 2022 in a Canadian pediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease, or diabetes were excluded. The IV glucose administered during the initial 4 hours of rehydration was quantified. The primary outcome was hospitalization, and return visit within the following week was a secondary outcome. Ten percent of the charts were evaluated in duplicate to assess interrater reliability. We examined glucose distribution at 1 and 4 hours and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions. Among 6939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent interrater reliability. Notable variations existed in glucose quantities provided, both at 1 hour (first quartile, 87 mg/kg; third quartile, 294 mg/kg) and 4 hours (first quartile, 681 mg/kg; third quartile, 1174 mg/kg) of rehydration. Multiple logistic regression showed a negative association between hospitalization and glucose administration during the initial hour (OR for each 100 mg/kg increment, 0.60; 95% CI, 0.42-0.84) and 4 hours (OR, 0.76; 95% CI, 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were less likely of having a return visit (OR for each 100 mg/kg increment: 0.52; 95% CI, 0.35-0.78), as well as during the first 4 hours (OR for each 100 mg/kg increment, 0.83; 95% CI, 0.73-0.94). There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.

Viral load suppression and retention in care among children and adolescents receiving multi-month anti-retroviral therapy refills: a program data review in Uganda

BackgroundIn July 2022, Uganda’s Ministry of Health extended the 2021 WHO guidelines that recommended 3–6 monthly dispensing of antiretroviral therapy (ART) to include all children and adolescents living with HIV (CALHIV). Treatment outcomes following this recommendation have not yet been documented. We compared viral load (VL) suppression and retention in HIV care rates among CALHIV receiving 1, 2–5, and > = 6 monthly ART dispensation in Uganda.MethodsA cross-sectional study of electronic medical records in 118 health facilities was conducted. Data for CALHIV 10–19 years captured at their most recent five clinic visits as of 15th May 2023 were analysed. Most recent two VL < 1000 copies/ml were used as measures for VL suppression and sustained VL suppression. A client was considered retained in care if they visited the clinic within 28 days from their expected return visit date. We used margins plots and a modified poisson model adjusting for facility level clustering to assess VL suppression and retention across multi-month ART categories.ResultsA total of 2864 CALHIV, 1609 (56.2%) being females and with a median age of 12 years (inter quartile range, iqr = 7) were included. Overall suppression and retention rates were 80.4% (2133/2654) and 87.8% (2514/2864) respectively. A significant number had been dispensed ART for ≥ 2 months (50%, 2–5 months and 43.5%, ≥ 6 months). Probability of having a suppressed VL was higher among CALHIV that had received ≥ 6 months and 2–5 months of ART compared to those of 1 month i.e., 83% vs 79% vs 41% respectively. Probability of being retained in care didn’t differ across multi-month ART categories. CALHIV who received ART for 2–5 months and ≥ 6 months compared to 1 month were more likely to have a suppressed VL; (adj.PR = 1.98; 95%CI:1.41, 2.80) and (adj.PR = 2.21; 95% CI:1.59, 3.05) respectively. CALHIV with a Tuberculosis diagnosis history were less likely to have a suppressed VL (adj.PR = 0.73; 95%CI:0.65,0.81), however this was not statistically significantly different between multi-month categories.ConclusionCALHIV receiving multi-month ART including 6 months dispensation had better VL suppression rates. Retention rates however didn’t differ by multi-month dispensing categories as observed among adults in the interval trial. We recommend multi-month ART dispensation including more than 6 months among CALHIV irrespective of their age, clinical stage, and history of prior co-morbidities.

Peritonsillar Abscess Outcomes with and Without Computed Tomography: A Retrospective Cohort Study.

Peritonsillar abscess (PTA) is a common deep space head and neck infection, which can be diagnosed with or without computed tomography (CT). CT poses a risk for false positives, leading to unnecessary abscess drainage attempts without benefit, whereas needle or open aspiration without imaging could potentially lead to missed abscess in need of treatment. This study considered the utility and impact of obtaining CT scans in patients with suspected PTA by comparing outcomes between CT and non-CT usage. Retrospective cohort analysis using TriNetX datasets compared the outcomes of two cohorts: PTA without CT and PTA with CT. Measured outcomes included incision and drainage; quinsy adenotonsillectomy; recurrent PTA; airway emergency/obstruction; repeat emergency department (ED) visits; and need for antibiotics, opiates, or steroids. Odds ratios (OR) were calculated using a cohort analysis. The CT usage group had increased odds of receiving antibiotics (OR 3.043, [2.043-4.531]), opiates (OR 1.614, [1.138-1.289]), and steroids (OR 1.373, [1.108-1.702]), as well as a higher likelihood of returning to the ED (OR 5.900, [3.534-9.849]) and developing a recurrent PTA (OR 1.943, [1.410-2.677]). No significant differences were observed in the incidence of incision and drainage, quinsy adenotonsillectomy, or airway emergency/obstruction. Our study indicated that CT scans for PTA diagnosis were associated with increased prescription of antibiotics, opioids, steroids, return ED visits, and recurrent PTA. Future prospective trials are needed to determine if the use of CT scans indicates higher patient acuity that explains the potential negative outcomes. 2 Laryngoscope, 134:4911-4917, 2024.

Hôtel La Fêlure: A work of fictocriticism

“Hôtel La Fêlure” is a work of fictocriticism in the form of a short story. In the piece’s auto-critical introduction, the author explains that, after a visit to Marrakech, Morocco, in early 2023, he conducted preliminary research on Moroccan male sexuality in advance of a return visit. Along the way, he viewed The Blue Caftan, a Morocco-set film directed by Maryam Touzani, and read L’amour Fait Loi (Love Lays Down the Law), a Morocco-based essay collection edited by Pierre Pascual. Rather than write a scholarly essay on the film, his first inclination, he created “Hôtel La Fêlure”. In the short story, Benjamin and a cast of Moroccan characters, who lodge in the eponymous hotel, watch and analyse The Blue Caftan through the lens of a fictional lecture on Moroccan male sexuality. Over the course of their conversation, the characters occasionally ventriloquize lines from L’amour Fait Loi.

Overnight Monitoring Criteria for Children with Obstructive Sleep-Disordered Breathing After Tonsillectomy: Revisited.

Previous studies indicate children who pass an Asleep Room Air Challenge (AsRAC) do not have significant postoperative adverse respiratory events after adenotonsillectomy (T&A). Subsequently, we revised our overnight monitoring (OM) criteria, allowing patients with an obstructive apnea/hypopnea index (OAHI) ≤20 or nonsevere obesity (Class I) to be considered for same-day surgery (SDS) if they passed an AsRAC. Our hypothesis is that our modified OM criteria would not increase the return visits or readmission rates for patients undergoing SDS within 48 h or 15 days of T&A. A retrospective review of all children aged ≥3 and <21 years who underwent T&A at a tertiary children's hospital and its satellite locations was performed from January 2017 to September 2022. Descriptive statistics and outcome measures were compared using a 3% margin noninferiority test before and after the new criteria implementation. Before intervention, 3,266 (58%) T&As were performed as SDS. Afterward, 74% of T&As were performed as SDS (p-value <0.05). There was no difference in the ED revisit rate for SDS within the 3% noninferiority margin. Following intervention, 29% more children with Class I obesity (62% vs. 33%) underwent SDS (p-value <0.001). Afterward, 19% more children with polysomnography underwent SDS (39% vs. 20%), p-value <0.001. After intervention, within 48 h of SDS, six (0.9%) children had revisits for bleeding and seven (1.2%) for vomiting. There were no perioperative respiratory events. Our revised monitoring criteria did not demonstrate an increase in ED visit or readmissions rates within 48 h or 15 days of T&A. Additionally, we found a 29% increase in Class I obese children undergoing SDS T&A. 3 Laryngoscope, 134:5223-5230, 2024.

Evaluating Dialogic Communication of Pesantren in East Java, Indonesia: Building Public Relationships via Instagram

Instagram posts by pesantren are very high but replies and reactions to followers' comments are still very low, as an indicator that communication between pesantren and their public is not a two-way dialogue. This study aims to evaluate dialogic communication of pesantren in East Java, Indonesia in building public relationships via Instagram. A quantitative approach with content analysis methods is used to measure dialogic communication of pesantren on Instagram with four principles, namely the information of interest to public, the generation of return visits, the conservation of visitors and the dialogic loop. The sample was determined using purposive sampling by identifying and verifying official Instagram accounts of pesantren that had a minimum of 15 posts on June and 15 posts on July 2023. Data analysis used frequency distribution to exmine the frequency of posts. Results indicated that most of pesantren have implemented dialogic communications in building public relationships on Instagram optimally. The principle of information of interest to publics and the principle of generation of return visits are most commonly used with a very high category. The principle of conservation of visitors is low category and the principle of dialogic loop is very low category implemented. The implication of this study can provide the theoretical contribution and strategic implication on implementation the dialogic communication to build public relationships through Instagram. With a lack of study done in this area, the novelty of this study is in extending understanding on the use of dialogic communication of pesantren, especially in East Java, in building public relationships on Instagram.

Pengaruh Social Media Marketing dan Accesbility Terhadap Minat Kunjung Kembali Wisatawan di Pantai Lon Malang

The purpose of this study is to examine how social media marketing and accessibility affect revisit interest. The method used in this research is quantitative method. Statistical Product and Service Solutions (SPSS) version 25 was used to process and analyze data collected from 105 respondents through questionnaires. Simultaneously, social media marketing and accesbility variables have a positive and significant influence on return visit interest, and partially both variables have a significant effect on return visit interest. Therefore, a highly visible social media marketing campaign and easy access will influence visitors' propensity to return.

Pengaruh Citra Destinasi dan Fasilitas Wisata Terhadap Kepuasan Wisatawan dan Loyalitas Wisatawan pada Pantai Lon Malang Kabupaten Sampang

This research aims to determine the influence of destination image and the quality of tourist facilities on the level of satisfaction and loyalty of visitors to Lon Malang Beach, Sampang Regency. The approach used in this research is a quantitative method involving 100 respondents selected through a purposive sampling technique. Data was obtained by distributing questionnaires, and data analysis was carried out using the Partial Least Squares (PLS) method supported by SmartPLS 4 software. The findings from this research show that destination image has a significant influence on visitor satisfaction, apart from that the quality of tourism facilities also makes a big contribution. to that satisfaction. In addition, destination image is proven to have a significant influence on tourist loyalty, while tourist facilities do not show a significant influence on visitor loyalty. The level of visitor satisfaction is also proven to have a big influence on their loyalty to return visits. Overall, destination image and tourist facilities play an important role in influencing tourist satisfaction and loyalty at Lon Malang Beach, Sampang Regency. Although the influence of each variable varies depending on the route being tested. However, the level of tourist satisfaction has the greatest influence on their loyalty

Virtual Home Care for Patients With Acute Illness

Recent evolutions in clinical care and remote monitoring suggest that some acute illnesses no longer require intravenous therapy and inpatient hospitalization. To describe outcomes of patients receiving care in a new, outpatient, virtual, home-based acute care model called Safer@Home. This retrospective cohort analysis, conducted from September 1, 2022, through August 31, 2023, included 2466 patients treated at a safety net hospital in Los Angeles County for 10 core illnesses and 24 other acute illnesses for which patients are commonly hospitalized. Outpatient, home-based, acute care with virtual monitoring and clinic visits in lieu of inpatient or in-home care. The primary measure was hospital length of stay. Secondary measures included all-cause mortality, 30-day readmission, return urgent care visit rates, and return emergency department (ED) visit rates. Safer@Home provided care to 876 patients (mean [SD] age, 54.0 [14.5] years; 541 men [61.8%]) during the study period, compared with a cohort of 1590 patients (mean [SD] age, 52.3 [19.6] years; 901 men [56.7%]) with matching diagnoses who received standard, hospital-based care. Safer@Home patients had significantly shorter mean (SD) lengths of inpatient stay than the comparison cohort (1.3 [2.0] vs 5.3 [10.4] days; P < .001), totaling 3505 bed-days avoided (mean [SD], 4.0 [10.6] bed-days saved per patient), with no significant difference in all-cause mortality at last follow-up (2.6% [23 of 876] vs 4.0% [64 of 1590]; P = .07). Safer@Home patients and control patients also had no significant difference in the proportion experiencing 30-day hospital readmission (19.9% [174 of 876] vs 16.7% [266 of 1590]; P = .06). As intended, more Safer@Home than control patients had at least one 30-day return urgent care visit (37.3% [327 of 876] vs 5.2% [82 of 1590]; P < .001). In contrast, the Safer@Home and control cohorts did not significantly differ in experiencing at least one 30-day return ED visit (15.2% [133 of 876] vs 12.5% [199 of 1590]; P = .06). Safer@Home patients had significantly fewer mean (SD) total 30-day return ED visits per patient than control patients (0.19 [0.50] vs 0.21 [0.85]; P < .001). In this cohort study, patients receiving acute, virtual, home care with remote monitoring and as-needed return urgent care visits had markedly shorter hospital stays than patients receiving standard inpatient hospital care, with no significant increase in mortality, ED revisits, or return hospitalizations. This new care model is promising for systems that cannot staff Medicare-compliant hospital-at-home visits.

The Influence Of Service Quality And Satisfaction Of Outpatients Of Hospital.X With The Intention To Visit Again

This study aims to identify the effect of service quality on outpatient satisfaction and the intensity of repeat visits at the K.R.M.T. Regional Hospital. Wongsonegoro Semarang (RSWN). Using quantitative methods and descriptive analysis, this study involved 107 outpatients selected based on inclusion and exclusion criteria. Data were collected through observation, interviews, questionnaires, and literature studies, and analyzed using validity, reliability, classical assumption tests, and T and F hypothesis tests. The results showed that service quality had a significant effect on patient satisfaction (p &lt; 0.05), with aspects of diagnostic accuracy, staff skills, and effective communication having a positive impact. Service quality also affects the intensity of repeat visits, with an increase in service quality positively associated with the frequency of return visits. Regression test results showed 8.4% of the variation in patient satisfaction was explained by service quality. The conclusion of this study is that improving service quality can increase satisfaction and encourage repeat visits. Hospitals are advised to improve service quality through staff training, improved facilities, and better communication systems.

Progression of Motor Speech Function in Speakers With Primary Progressive Apraxia of Speech.

Speakers with primary progressive apraxia of speech (PPAOS) have an insidious onset of motor speech planning/programming difficulties. As the disease progresses, the apraxia of speech (AOS) becomes more severe and a co-occurring dysarthria often emerges. Here, longitudinal data from speakers with phonetic- and prosodic-predominant PPAOS are used to characterize the progression of their motor speech impairment, including the development of dysarthria and mutism. Data are presented from 52 speakers who had PPAOS at enrollment (i.e., progressive AOS in the absence of aphasia, cognitive, or other neurologic symptoms). Twenty-one had predominantly phonetic features, whereas 31 had primarily prosodic features. All participants underwent a comprehensive motor speech evaluation at their enrollment visit and each annual return visit, with a median of three visits per participant. Almost 25% of the speakers with PPAOS presented with dysarthria at their enrollment visit (median disease duration of 3.65 years), whereas more than 70% of them had developed dysarthria by their last visit (median disease duration of 6.85 years). Neither the likelihood to develop dysarthria nor the disease duration at which it was detected differed significantly between the phonetic and prosodic groups. However, muteness emerged sooner for speakers with phonetic-predominant PPAOS; the median disease duration at which they became mute was 1.5 years shorter than for their prosodic counterparts. Clinically, these results facilitate more accurate prognostication of motor speech symptoms in speakers with PPAOS, allowing for timely introduction of alternative means of communication. The results also support the differentiation between progressive AOS and dysarthria as distinct motor speech disorders that often co-occur in these individuals.

Assessing the Experiential Service Quality, Perceived Image, Experiential Satisfaction, and Revisiting Intentions of Public Zoo Visitors

The role of zoos in wildlife management has been revolutionized from basic conservation sites into research institutions, public education, and recreational desti-nations for public visitors. Building upon this evolution, the present study delves into the intricate interrelationships between public zoo experiential service quality, the perceived image of these institutions, experiential satisfaction, and visitors' intentions to revisit. Questionnaires were administered to 330 visitors via purposive sampling at the Kuala Lumpur National Zoo. The study hypotheses were supported, highlighting the significant and positive interrelationship between interaction quality, physical environment quality, enjoyment quality, educational quality, zoo image, experiential satisfaction, and visitor’s revisit intention. The study provides practical managerial implications for the public zoo in delivering superior services, essential in improving visitor satisfaction. Excellent service quality ensures visitor satisfaction, enabling zoo management to meet visitor's expectations and encourage return visits, thus enhancing the zoo’s sustainability. The study results urge public zoo management in developing and implementing out of the box market-orientated service strategies by enhancing the interaction, enjoyment, educational quality, and physical environment perceived by future visitors.

Experimental Study on Video Discharge Instructions for Pediatric Fever in an Emergency Department.

Fever is a frequent cause of consultation in the pediatric emergency department (PED). Adequate discharge instructions are essential to guarantee good management at home and can reduce caregivers' anxiety and re-consultations. This study compares the improvement of caregivers' knowledge regarding fever between verbal discharge instructions and the addition of a video to verbal information. As a secondary outcome, we compared the rate of return visits. An experimental, prospective, single-center study was conducted in a tertiary hospital PED. Patients between 3months and 5years old with febrile syndrome were enrolled. Patients with comorbidities or SARS-COV2 infection were excluded. First, caregivers answered a written test concerning fever characteristics, management, and warning signs. Patients were assigned by simple randomization to a control group (standard verbal and written instructions) or to an intervention group (which additionally received video instructions). After discharge, investigators contacted caregivers by telephone. Caregivers were asked to answer the same questions as in the written test in addition to the need for subsequent visits (at the PED or any other healthcare facility) after discharge. Seventy-three patients were randomized to the intervention group and 77 to the control group (2 were lost during follow-up). There were no differences in the acquisition of caregiver's knowledge, with a median score improvement of 2 points in both groups (control group interquartile range (IQR) 1-2; intervention group IQR 1-3) (P =.389). In the intervention group, we observed a significant increase of correct answers in 4 out of 7 questions compared to 3 out of 7 questions in the control group. In the control group, 18.7% reconsulted compared to 10.9% in the intervention group (P =.188). Video instructions were not superior to verbal instructions at improving caregivers' knowledge of fever overall. However, more questions obtained a significant score increase in those that received video and verbal instructions. Our results suggest that the addition of video instructions could help reduce return visits.

The Influence of Tourist Attraction and Digital Marketing on Return Visit Interest with Tourist Satisfaction as a Mediating Variable in Tinalah Tourism Village, Kulonprogo Regency

The objectives of this study include: (1) To determine the effect of tourist attraction on tourist satisfaction at Tinalah tourist attraction, Kulonprogo Regency. (2) To determine the effect of digital marketing on tourist satisfaction at Tinalah Tourism Village, Kulonprogo Regency. (3) To determine the effect of tourist satisfaction on interest in visiting again at Tinalah Tourism Village, Kulonprogo Regency. (4) To determine the effect of tourist attraction on return visit interest in Tinalah Tourism Village, Kulonprogo Regency, which is mediated by tourist satisfaction. (5) To determine the effect of digital marketing on return visit interest in the Tourism Village, Kulonprogo Regency, which is mediated by tourist satisfaction. The research design used in this research was quantitative research design. The population used in this study were tourists visiting Tinalah Tourism Village, Tinalah, Kulonprogo Regency with a large and unknown number. The sampling technique used in this study is non probability sampling by purposive sampling. The respondents who met the criteria were tourists who had visited Tinalah Tourism Village with a maximum limit of the last three months. The research sample amounted to 150 people. The data collection procedure in this study is to use the questionnaire method. The analytical tool used is Patial Least Square (PLS), which is a variance-based SEM, with SmartPLS 2.0 software. Based on the results of the analysis discussed in the previous chapter, the following conclusions can be given: (1) Attractiveness of tourist objects has a positive effect on tourist satisfaction in Tinalah Tourism Village, Kulonprogo Regency. (2) Digital marketing has a positive effect on tourist satisfaction in Tinalah Tourism Village, Kulonprogo Regency. (3) Tourist satisfaction has a positive effect on interest in visiting again at Tinalah Tourism Village, Kulonprogo Regency. (4) Tourism attraction has a positive effect on interest in visiting again at Tinalah Tourism Village, Kulonprogo Regency, which is mediated by tourist satisfaction. (5) Digital marketing has a positive effect on interest in visiting again at Tinalah Tourism Village, Kulonprogo Regency, which is mediated by tourist satisfaction.

Epidemiological Trends and Characteristics of Dermatological Conditions Presenting to a Saudi Major Emergency Department.

Numerous dermatological conditions present in the emergency department (ED). Some have subtle presentations, yet most provoke patient suffering. Such conditions need to be identified and managed properly. This study aims to epidemiologically describe the patterns and characteristics of dermatological conditions presenting to a secondary teaching hospital's ED. This retrospective chart review study analyses data on dermatological conditions that have presented to the ED between January 2021 and May 2023. The data gathered included sociodemographic variables, date and shift of visit, triage level, dermatological complaint characteristics, management, and discharge status. Comparative analysis was performed, and the level of significance was set at 0.05. The total number of cases was 301. The median age was 12 years (IQR = 4-30 years), with similar distribution between males and females (50.17% and 49.83% respectively). Most cases had presented to the ED during the morning shift (49.83%). Triage levels IV and V made up 94.69%, and only 5.32% belonged to triage level III. Most presented during the winter season (32.89%). The median visit duration was 312minutes, and of all cases treated, only 10 required a return visit to the ED. Also, 41.53% were discharged and 58.47% required further management. Maculopapular rashes were the most common finding (35.55%). Bullae/blisters and erythroderma accounted for those that most often required further management. The two most prescribed medications were topical steroids and antihistamines, followed by emollients (32.09% and 15.81%, respectively). Viral infections were the most reported complaint (22.26%) and only two patients complained of erythema multiforme (0.66%). This study found that the majority of cases could have been managed by family physicians at a primary care setting. Also, epidemiological seasonal variations were observed where the majority of patients requiring further management had presented during the autumn season.

31 Impact of the amount of intravenous glucose administration on hospitalization for acute gastroenteritis in a paediatric emergency department

Abstract Background In case of failure of oral rehydration, children with acute gastroenteritis can be hydrated using intravenous (IV) solution. The choice of the intravenous solution itself (solutions containing dextrose versus crystalloids alone) and the glucose quantities to administer are not well established. Objectives The main objective of this study was to evaluate the impact of the amount of intravenous glucose provided to children treated for acute gastroenteritis on hospitalizations. Other objectives were to evaluate practice variation regarding the amount of glucose and liquid provided for IV rehydration in a paediatric emergency department (ED). Design/Methods We conducted a retrospective cohort study from 2019-2022 in a Canadian paediatric ED. We included children with acute gastroenteritis undergoing IV rehydration. Patient with hypoglycemia, metabolic disease or diabetes were excluded. The IV glucose administered during the initial four hours of rehydration was quantified. The primary outcome was hospitalization and return visit in the following seven days was a secondary outcome. 10% of the charts were evaluated in duplicate to assess inter-rater reliability. We examined glucose distribution at one and four hours, and utilized multiple logistic regression to relate glucose amounts with hospitalization and second visit, accounting for age, weight, bicarbonate levels, ondansetron use, and amount of liquid infused. It was estimated that the evaluation of 250 cases would have at least 50 admissions. Results Among 6,939 children evaluated for potential acute gastroenteritis, 250 met our inclusion/exclusion criteria. All variables included in the analysis had excellent inter-rater reliability. Notable variations existed in glucose quantities provided, both at one hour (first quartile: 87 mg/Kg; third quartile: 294 mg/Kg) and four hours (first quartile: 681 mg/Kg; third quartile: 1174 mg/kg) of rehydration. Multiple logistic regression showed a greater hospitalization risk with smaller amount of glucose administered during the initial hour (OR for each 100mg/kg increment: 0.60; 95%CI: 0.42-0.84) and four hours (OR: 0.76; 95%CI: 0.63-0.91) of rehydration. Moreover, children who received more dextrose during the first hour of rehydration were at lower risk of return visit (OR for each 100mg/kg increment: 0.52; 95%CI: 0.35-0.78), as well as during the first four hours (OR for each 100 mg/kg increment: 0.83; 95%CI: 0.73-0.94). Conclusion There was a wide practice variation in intravenous glucose provided to children with acute gastroenteritis. In this population, higher intravenous glucose amount was associated to a lower risk of hospitalization and lower risk of return visit.

53 Clinical characteristics and outcomes of children hospitalized with RSV-associated acute respiratory infections

Abstract Background Respiratory syncytial virus (RSV) is one of the most common acute respiratory infections (ARI) in infants and young children. After the relaxation of COVID-19 pandemic restrictions, children’s hospitals worldwide experienced unprecedented volumes and severity in presentation of children admitted with ARIs, such as RSV. It is unknown whether the increase in volumes was also associated with changes in the typical demographic, severity and outcomes of patients with RSV infections. Objectives To describe sociodemographic characteristics, clinical presentation, management including diagnosis and disposition and clinical outcomes of children under the age of 18 years admitted to tertiary care paediatric hospital with RSV-associated ARI. Design/Methods Observational cohort of children and adolescents aged 0-18 years admitted to two large Canadian children’s hospitals between July 1, 2022 - December 31, 2022, who had microbiological evidence of RSV infection. Detailed clinical and demographic information were extracted, including admission and discharge diagnoses, diagnostic tests, viral and bacterial testing, interventions, and respiratory settings. Clinical outcomes and complications were collected, including length of hospital admission, paediatric intensive care unit (PICU) admission, need for invasive mechanical ventilation, disposition, and death. Results There were 455 patients admitted with an RSV infection, of which a third (35.0%, n=146) were transfers from other hospitals. Cases were 41.0% male and the median age was 1.22 years (interquartile range [IQR] 0.19-3.06). Nearly two-thirds of patients (62.0%, n=284) were younger than 2 years of age, 8.6% had a history of prematurity. One third (31.0%, n=142) of patients had at least one documented comorbid condition, the most common diagnosis was asthma (6.6%). In addition to RSV, 3.5% (n=16) of patients had a simultaneous bacterial pathogen identified. Most patients (73%, n=330) were only RSV positive, while 24% (n=109) had two pathogens identified. One quarter (25.9%) were admitted to the PICU. The median length of hospital stay was 3 days (IQR 2.00-5.00) and for those admitted to the PICU, nearly two thirds of patients (63.0%, n=75) were admitted for less than 4 days. 0 patients died. The most common discharge diagnosis in 61.0% of patients (n=279) was bronchiolitis. There were 56 patients (12.3%) who had an unscheduled return visit to the ED within 30 days of discharge with 23.0% (n=13) requiring readmission to the hospital. Conclusion There continues to be a substantial volume of hospitalizations secondary to RSV infection, predominantly in those &amp;lt;2 years of age, with a prominent diagnosis of bronchiolitis. A quarter of patients had notable severity requiring PICU admission.

Using Technology to Support Measurement-Based Care: Design and Implementation of the Measurement-Assisted Care Program.

The authors aimed to increase measurement-based care in an outpatient academic psychiatry service. The Measurement-Assisted Care program (MAC) was implemented as a clinical quality-improvement effort that included 4,665 unique patients and 176 clinicians over 12 months. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), PTSD Checklist for DSM-5, and Brief Inventory of Thriving were automatically included in the patient electronic check-in process for new visits; the PHQ-9 and GAD-7 were included for return visits. Patient responses were automatically routed to clinicians' electronic health record inboxes and documentation templates. MAC was rolled out in two phases, and clinicians were surveyed about their use of MAC data 3-6 months after the start of the program. After implementation of MAC, PHQ-9 completion rates increased from 5% to 66% of visits for phase 1 and from 5% to 60% for phase 2. Post-MAC completion rates were higher for telehealth (70%) than for in-person (40%) visits. More than 90% of clinicians reported that MAC was useful with at least one of their three most recent patients, and 51% reported that it was useful with all three of their three most recent patients. Clinician adoption was high, with 78% reporting that they use MAC data to guide care. MAC increased the completion rate of patient-reported outcome measures, especially for telehealth visits. Clinicians reported that they frequently use and discuss MAC data with patients, implying that technology-supported workflows can help systems with high telehealth utilization capture and use patient-reported outcomes.

Pica in sickle cell disease: nutritional management and implications

Background: Individuals with sickle cell disease (SCD) frequently experience nutritional disturbances, including deficiencies in essential micronutrients. Iron and zinc deficiency anemia has been specifically associated with pica, an atypical eating behavior. Aims: This systematic review aimed to characterize pica among individuals with SCD, focusing on potential nutritional causes. Methods: A comprehensive literature search was conducted across the MEDLINE (PubMed), Latin American and Caribbean Center on Health Sciences Information (Bireme), and Google Scholar databases from July 2017 to January 2024. Eligible articles included original observational studies, interventions, and case reports involving individuals with SCD across all age groups. Literature reviews, doctoral or master's theses, unrelated studies, and duplicate publications were excluded. Results: Ten studies were selected that described the occurrence of pica episodes in the SCD population and explored potential associated nutritional causes. The most prevalent genotype was Hb SS, with ages ranging from 2 to 23 years. Males were more predominant than females in the included studies. Approximately 51.05% of the studied population exhibited pica behavior. Some studies observed that children with pica behavior had low weight and/or height and abnormal laboratory test results. The most commonly consumed objects were paper, foam, fabric, dust, soil, clay, and rubber, although the quantity and frequency of object consumption were not reported in most studies. The most reported symptoms associated with pica behavior included abdominal pain, vomiting, constipation, vaso-occlusive events, dizziness, and fatigue. Clinical interventions in the studies were pain medication, intestinal cleansing, intestinal resection, intravenous hydration, antibiotic therapy, gastric "bezoar" removal, and cognitive-behavioral therapy. The majority of the studied population was monitored by health centers, with frequent return visits. In all studies, physicians were responsible for clinical care. Conclusion: A significant association between SCD and pica was evident in the reviewed studies. Iron and zinc deficiencies emerged as potential contributing factors to this atypical eating behavior. Keywords: Pica, sickle cell disease, iron, zinc, eating disorders.

Association between initial antibiotic route and outcomes for children hospitalized with pneumonia.

Initial oral antibiotics may be as effective as intravenous (IV) antibiotics for children hospitalized with community-acquired pneumonia (CAP), but further data are needed. We evaluated for associations of initial antibiotic route (IV vs. oral) with length of stay (LOS) and secondary outcomes for children hospitalized with CAP. This multicenter, retrospective cohort study included children with CAP who were hospitalized for >48 h, had chest radiographs, and received antibiotics at four children's hospitals between 2014 and 2020. Data were obtained from the Pediatric Health Information System and manual chart review. The exposure was initial antibiotic route (i.e., first antibiotic given intravenously or orally). We performed multivariable regression modeling using inverse probability treatment weights from propensity scores. Outcomes included LOS, oxygen duration, cost, care escalation, and readmission or emergency department revisit. Of 1147 included children, 37% received initial oral antibiotics. Within the propensity balanced sample, LOS was 73.5 h (IQR 61.0, 99.5) and 78.7 (61.0, 118.0) for patients with initial oral and IV antibiotics, respectively. Children receiving initial oral antibiotics had an 8% reduction in LOS (OR 0.92 [95% CI: 0.87, 0.94]) and 14% reduction in cost (OR 0.86 [95% CI 0.79, 0.94]) versus those receiving initial IV antibiotics. There were no differences in other outcomes. Children with CAP receiving initial oral antibiotics had reduced LOS and hospital cost without differences in escalated care or return visits. Starting hospitalized children on oral antibiotics is likely a safe and effective alternative to IV treatment.