Revisit Rates Research Articles

Anesthesia management experience for pediatric day-case PDA ligation under thoracoscopy assisted by a robot: a retrospective study

BackgroundTo summarize the anesthesia management experience for pediatric day-case patent ductus arteriosus (PDA) ligation under robot-assisted thoracoscopy and explore the key points of anesthesia management for this procedure.MethodsThe clinical data of 72 pediatric patients who underwent robot-assisted thoracoscopic day-case PDA ligation at the Children’s Hospital, Zhejiang University School of Medicine from April 2021 to February 2023 were retrospectively analyzed. 0.3% ropivacaine local infiltration combined with S-ketamine 0.2 mg/kg intravenous injection was used for postoperative analgesia The patient’s basic information and intraoperative conditions were analyzed, which included gender, age, weight, surgery time, anesthesia time, extubation time, intraoperative blood loss, MAP before pneumothorax, PaCO2 before pneumothorax, etc. Postoperative conditions were also monitored, such as PACU stay time, agitation during the recovery period, pain, and the incidence of nausea and vomiting. After discharge, the recovery status was assessed.ResultsA total of 70 pediatric patients who met the criteria for day-case PDA ligation were included in this study. Before the occurrence of pneumothorax, the mean arterial pressure (MAP) of these 70 patients was 69.58 ± 12.52 mmHg, and during controlled hypotension, the MAP was 54.96 ± 11.23 mmHg. Before the occurrence of pneumothorax, the partial pressure of carbon dioxide (PaCO2) was 38.69 ± 3.38 mmHg, and during controlled hypotension, the PaCO2 was 51.42 ± 4.05 mmHg. Three cases experienced agitation during the recovery period, and four cases had mild pain, but there was no moderate or severe pain, nausea, or vomiting. Only 1 case of postoperative respiratory tract infection and 1 case of postoperative pneumothorax occurred. Within 30 days after discharge, the unplanned revisit rate, unplanned readmission rate, and surgical wound infection rate were all 0. The residual shunt rate detected by echocardiography was 0 after 1 month.ConclusionsThe children under the robot-assisted thoracoscopic day case PDA surgeries in this study have limited trauma, little bleeding, and little postoperative pain, though still at a risk of respiratory infection and pneumothorax.

Safety and Feasibility of an Emergency Department-to-Outpatient Pathway for Patients With TIA and Nondisabling Stroke.

Evaluation of transient ischemic attack/nondisabling ischemic strokes (TIA/NDS) in the emergency department (ED) contributes to capacity issues and increasing health care expenditures, especially high-cost duplicative imaging. As an institutional quality improvement project, we developed a novel pathway to evaluate patients with TIA/NDS in the ED using a core set of laboratory tests and CT-based neuroimaging. Patients identified as 'low risk' through a safety checklist were discharged and scheduled for prompt outpatient tests and stroke clinic follow-up. In this prespecified analysis designed to assess feasibility and safety, we abstracted data from patients consecutively enrolled in the first 6 months. We compared data from 106 patients with TIA/NDS enrolled in the new pathway from April through September 2020 (age 67.9 years, 45% female), against 55 unmatched historical controls with TIA encountered from April 2016 through March 2017 (age 68.3 years, 47% female). Both groups had similar median NIHSS scores (pathway and control 0) and ABCD2 scores (pathway and control 3). Pathway-enrolled patients had a 44% decrease in mean ED length of stay (pathway 13.7 hours, control 24.4 hours, p < 0.001) and decreased utilization of ED MRI-based imaging (pathway 63%, control 91%, p < 0.001) and duplicative ED CT plus MRI-based brain and/or vascular imaging (pathway 35%, control 53%, p = 0.04). Among pathway-enrolled patients, 89% were evaluated in our stroke clinic within a median of 5 business days; only 5.5% were lost to follow-up. Both groups had similar 90-day rates of ED revisits (pathway 21%, control 18%, p = 0.84) and recurrent TIA/ischemic stroke (pathway 1%, control 2%, p = 1.0). Recurrent ischemic events among pathway-enrolled patients were attributed to errors in following the safety checklist before discharge. Our TIA/NDS pathway, implemented during the initial outbreak of COVID-19, seems feasible and safe, with significant positive impact on ED throughput and ED-based high-cost duplicative imaging. The safety checklist and option of virtual telehealth follow-up are novel features. Broader adoption of such pathways has important implications for value-based health care.

Automated remote sensing tools to counter illicit maritime activity: vessel detection, bathymetry and topography from WorldView imagery

ABSTRACT Illicit maritime activity, such as piracy and smuggling, is a global issue that often occurs in areas where interdiction authorities are sparse, ground-based monitoring technologies like radar lack range and coverage, and dark vessels abound. Our objective was to assess vessel congregation patterns, identify likely beaching areas based on terrain maps, and use them to narrow the search for potential smuggling transfer and overland routes in a specific region along the Puntland coast of Somalia. To accomplish this goal, we developed automated protocols applied to WorldView satellite imagery for (1) vessel detection and size classification, (2) shallow-water bathymetric characterization, and (3) coastal topography mapping. Utilizing a single sensor for vessel detection and topographic and bathymetric extraction at high spatial resolution and at a high re-visit rate provides a simplification to near-shore characterization for monitoring purposes. The extracted topography and bathymetry are then presented as a single, comprehensive perspective of a coastal region. The vessel-detection algorithm identified all vessels larger than approximately 15 metres in length (35 of 35), but misidentified six artefacts (i.e. false positives), resulting in an overall accuracy of 85%. The combined vessel and terrain maps facilitated the identification of a potential beaching and overland transportation route location.

Preliminary Evaluation of Geometric Positioning Accuracy of C-SAR Images Based on Automatic Corner Reflectors

C-SAR/01 and C-SAR/02 serve as successors to the GF-3 satellite. They are designed to operate in tandem with GF-3, collectively forming a C-band synthetic aperture radar (SAR) satellite constellation. This constellation aims to achieve 1 m resolution imaging with a revisit rate of one day. It can effectively cater to various applications such as marine disaster prevention, monitoring marine dynamic environments, and supporting marine scientific research, disaster mitigation, environmental protection, and agriculture. Geometric correction plays a pivotal role in acquiring highly precise geographic location data for ground targets. The geometric positioning accuracy without control points signifies the SAR satellite’s geometric performance. However, SAR images do not exhibit a straightforward image-point–object-point correspondence, unlike optical images. In this study, we introduce a novel approach employing high-precision automatic trihedral corner reflectors as ground control points (GCPs) to assess the geometric positioning accuracy of SAR images. A series of satellite-ground synchronization experiments was conducted at the Xilinhot SAR satellite calibration and validation site to evaluate the geometric positioning accuracy of different C-SAR image modes. Firstly, we calculated the azimuth and elevation angles of the corner reflectors based on satellite orbit parameters. During satellite transit, these corner reflectors were automatically adjusted to align with the radar-looking direction. We subsequently measured the exact longitude and latitude coordinates of the corner reflector vertex in situ using a high-precision real-time kinematics instrument. Next, we computed the theoretical image coordinates of the corner reflectors using the rational polynomial coefficients (RPC) model. After that, we determined the accurate position of the corner reflector in the Single Look Complex (SLC) SAR image using FFT interpolation and the sliding window method. Finally, we evaluated and validated the geometric positioning accuracy of C-SAR images by comparing the two coordinates. The preliminary results indicate that the positioning accuracy varies based on the satellite, imaging modes, and orbital directions. Nevertheless, for most sample points, the range positioning accuracy was better than 60 m, and the azimuth positioning accuracy was better than 80 m. These findings can serve as a valuable reference for subsequent applications of C-SAR satellites.

Leveraging multimission satellite data for spatiotemporally coherent cyanoHAB monitoring

Cyanobacteria harmful algal blooms (cyanoHABs) present a critical public health challenge for aquatic resource and public health managers. Satellite remote sensing is well-positioned to aid in the identification and mapping of cyanoHABs and their dynamics, giving freshwater resource managers a tool for both rapid and long-term protection of public health. Monitoring cyanoHABs in lakes and reservoirs with remote sensing requires robust processing techniques for generating accurate and consistent products across local and global scales at high revisit rates. We leveraged the high spatial and temporal resolution chlorophyll-a (Chla) and phycocyanin (PC) maps from two multispectral satellite sensors, the Sentinel-2 (S2) MultiSpectral Instrument (MSI) and the Sentinel-3 (S3) Ocean Land Colour Instrument (OLCI) respectively, to study bloom dynamics in Utah Lake, United States, for 2018. We used established Mixture Density Networks (MDNs) to map Chla from MSI and train new MDNs for PC retrieval from OLCI, using the same architecture and training dataset previously proven for PC retrieval from hyperspectral imagery. Our assessment suggests lower median uncertainties and biases (i.e., 42% and -4%, respectively) than that of existing top-performing PC algorithms. Additionally, we compared bloom trends in MDN-based PC and Chla products to those from a satellite-derived cyanobacteria cell density estimator, the cyanobacteria index (CI-cyano), to evaluate their utility in the context of public health risk management. Our comprehensive analyses indicate increased spatiotemporal coherence of bloom magnitude, frequency, occurrence, and extent of MDN-based maps compared to CI-cyano and potential for use in cyanoHAB monitoring for public health and aquatic resource managers.

Rates of 30-day revisit to the emergency department among older adults living with dementia: a systematic review and meta-analysis.

Older adults visit emergency departments (EDs) at higher rates than their younger counterparts. However, less is known about the rate at which older adults living with dementia visit and revisit EDs. We conducted a systematic review and meta-analysis to quantify the revisit rate to the ED among older adults living with a dementia diagnosis. We searched MEDLINE, Embase, and CINAHL, as well as gray literature, to identify observational studies reporting on older adults living with dementia that revisited an ED within 30days of a prior ED visit. We calculated pooled rates of 30-day revisit as percentages using random effects models, and conducted stratified analyses by study data source, study population, and study period. We assessed between-studies heterogeneity using the I2 statistic and considered [Formula: see text] > 50% to indicate substantial heterogeneity. All analyses were performed in R software. We identified six articles for inclusion. Percentages of 30-day ED revisit among older adults living with dementia ranged widely from 16.1% to 58.0%. The overall revisit rate of 28.6% showed significant heterogeneity. Between-studies heterogeneity across all stratified analyses was also high. By data source, 30-day revisit percentages were 52.3% (public hospitals) and 20.0% (administrative databases); by study population, revisit percentages were 33.5% (dementia as main population) and 19.8% (dementia as a subgroup). By study period, revisit percentages were 41.2% (5years or greater) and 18.9% (5years or less). Existing literature on ED revisits among older adults living with dementia highlights the medical complexities and challenges surrounding discharge and follow-up care that may cause these patients to seek ED care at an increased rate. ED personnel may play an important role in connecting patients and caregivers to more appropriate medical and social resources in order to deliver an efficient and more rounded approach to care.

The Effect of Spatial Production in Hair Salons on Customer’s Revisit Intention and Word-of-Mouth Intention

The purpose of this study is to provide more practical basic data for hair salon marketing strategies by examining the effect of spatial production in hair salons on customer’s revisit intention and word-of-mouth intention. As a result, it was found that only the cleanliness factor of spatial production had a significant positive effect on the customer's revisit intention, and the cleanliness and differentiation factor of spatial production had a significant positive effect on the customer's word-of-mouth intention. Specific improvements in cleanliness and differentiation are as follows in order to promote revisit and word-of-mouth of beauty salon customers. First, in order to secure regular customers, the priority should be to create a clean space, and in the case of already existing hair salons, the revisit rate of existing customers can be increased by cleanly managing the space where the customer directly exists. Second, in order to attract new customers, it is believed that the effect of creating new customers through word-of-mouth can be increased by focusing on cleanliness as previously mentioned, and by using the brand's representative color so that customers can experience the brand's unique sensibility in the salon space. This study is meaningful because previous research on beauty salon space was insignificant, and it suggests that more attention should be paid to the cleanliness and differentiation of beauty salon space to revisit customers and attract new customers. However, in this study, several items that hinder reliability in relation to functionality were deleted, and in future studies, it is considered necessary to further revise and supplement functionality-related items so that the constituent concepts of spatial performance can be evaluated more closely.

Leveraging Landsat-8/-9 underfly observations to evaluate consistency in reflectance products over aquatic environments

With an identical design and build, the Operational Land Imager-2 (OLI2) aboard Landsat-9 (L9) complements OLI observations by reducing the global revisit rate of Landsat to 8 days. This study takes advantage of near-coincident OLI2 and OLI observations obtained on 11–17 November 2021 to assess the relative quality of the standard United States Geological Survey (USGS) top-of-atmosphere (TOA) reflectance (ρt) and atmospherically corrected reflectance (aquatic reflectance; ρwAR) products over bodies of water. The TOA assessment was carried out for all the visible bands, including the panchromatic band, as well as the near-infrared (NIR) and shortwave infrared (SWIR) bands, whereas ρwAR products were analyzed in the 443, 482, 561, and 655 nm bands. The overlapping areas of OLI-OLI2 ρw product pairs were further analyzed for the rigor in corrections for the viewing geometry implemented in selected atmospheric correction (AC) processors, including SeaDAS, ACOLITE, and POLYMER, with products denoted as ρwAR, ρwac, and ρwpol, respectively. Overall, we found the OLI2-OLI ρt products to be consistent within 0.4% in the visible-near-infrared (VNIR) bands except in the green band (561 nm), where OLI2 records ∼0.8% larger values than OLI. The two SWIR bands (1610 and 2200 nm) were also found to agree within ∼2.2% and 2.1%, respectively, with OLI2 being lower in magnitude. The median differences in the standard ρw (ρwAR) were estimated to be ∼2.4%, 1.5%, 2.3%, and 2.5% in the 443, 482, 561, and 655 nm bands, respectively, which are well within the accepted differences in cross-mission data merging schemes. Further, we show that OLI2's signal-to-noise ratio (SNR) is 7–30% higher than that of OLI in all the bands, likely due to its 14-bit digitization rate, as compared to OLI's 12-bit digitization rate. Our self-consistency assessment of the AC processors for handling the differences in the view zenith angles (ΔVZA) and relative azimuth angles (ΔRAA) of OLI2 and OLI observations suggests that, overall, the processors account for the Sun-sensor geometry differently at different spectral bands. These differences (inconsistencies) amount to average median absolute percentage differences (MAPD) in ρw from 0.3 to 5.3% (e.g., ∆ρwAR443nmΔVZAΔRAA=ρwAR,OLI443+6.310−ρwAR,OLI2443+3.9−13<0.5%).More specifically, we found that SeaDAS provides the most optimal corrections for the angular variability as a function of VZA, ρwac are most consistent for different ranges of RAAs, and POLYMER performs best in the 443 nm band. We surmise that future (and other existing) AC methods should be tested with Landsat-8/-9 underfly imagery to quantify their performance for tackling the variability in imaging geometry and minimize associated uncertainties. With several missions planned for launch by the end of this decade, it is further emphasized that post-launch tandem maneuvers are essential to creating harmonized multi-mission data products and, therefore, similar operations should be considered and extended to ensure a broad range of environmental conditions are captured for comprehensive cross-mission analyses.

Bed Rest as a Protective Factor for Subdural Hematoma in Spontaneous Intracranial Hypotension: A Retrospective Study

BACKGROUND: Subdural hematoma (SDH) is a potentially life-threatening complication in patients with spontaneous intracranial hypotension (SIH). Though bed rest is the basis of conservative treatment, no clear evidence exists regarding the association between bed rest and the later complication of SDH in these patients. OBJECTIVES: This study aimed to evaluate the association between bed rest and SDH development in patients with SIH. STUDY DESIGN: A retrospective study was conducted from March 2013 through December 2019. Four hundred twenty adult patients diagnosed with SIH were enrolled. Clinical presentations and radiographic findings were recorded. The cumulative duration of bed rest in hours was used to measure the bed rest length. The clinical outcomes during follow-up were assessed. METHODS: Categorical data were compared using chi-square tests; continuous data were compared using the Mann-Whitney U test or Kruskal-Wallis test. A backwards stepwise Cox proportional hazard regression model adjusted with confounders which differed between SDH and non-SDH in univariate analysis was used to estimate the risk of cumulative duration of bed rest for SDH. A stratified Cox regression was performed to exclude the effect of the treatment algorithm. RESULTS: Of the 420 patients with SIH, 88 (21%) were in the SDH Group and 332 (79%) were in the non-SDH (NSDH) Group. The cumulative duration of bed rest in hours was a protective factor for SDH in SIH (Hazard Ratio [HR] = 0.997; P &lt; 0.001). A stratified Cox regression analysis showed that the cumulative duration of bed rest remained a protective factor for SDH both in patients who received conservative treatment before admission (HR = 0.997; P &lt; 0.001) and in those who did not (HR = 0.996; P = 0.061). Age (HR = 1.029, 95% CI, 1.009-1.050; P = 0.004) and orthostatic headache (HR = 4.770, 95% 95% CI, 2.177-10.450; P &lt; 0.001) were risk factors for SDH in SIH. The clinical outcomes, including length of hospital stay, epidural blood patch (EBP) therapy, and repeated EBP therapy, were higher in the SDH Group. The revisit rate was similar between the 2 groups. LIMITATIONS: Retrospective studies are susceptible to different radiological procedures and therapeutic strategies. A bed rest score based on a patient’s memory is susceptible to recognition and reporting bias. This is a single-center study and the sample size is not large. The validity of the bed rest scale has not been previously evaluated in any other study. CONCLUSIONS: Bed rest was a protective factor for SDH in patients with SIH. With more time and proper treatment, patients with SIH who have an SDH can achieve good prognosis in the long term. KEY WORDS: Spontaneous intracranial hypotension, complication, subdural hematoma, bed rest, protective factor, conservative treatment, epidural blood patch, prognosis

Critical Revisits Among Children After Emergency Department Discharge

Identifying higher risk groups could reveal ways to prevent critical emergency department (ED) revisits. The study objectives were to determine the rate of critical ED revisits among children discharged from the ED and to identify factors associated with critical revisits. We performed a retrospective study using the Healthcare Cost and Utilization Project State ED Databases (SEDD) and the State Inpatient Databases (SID). We included data from 6 states from 2014 through 2017. Critical ED revisit was defined as either ICU admission or death within 3 days of the initial ED discharge. We included all patients younger than 21 years. The main outcome was the rate of critical ED revisit. We also determined the relative risk (RR) of a critical ED revisit for the most common index ED visit diagnoses. We used negative binomial regression to calculate incidence rate ratios (IRR) of a critical ED visit by pediatric volume and complex chronic conditions. A total of 16.3 million children were discharged from an ED over the 4-year study period. There were 18,704 (0.1%) critical ED revisits, 180 (0.00001%) of whom died. Asthma (RR 2.24, 95% confidence interval [CI] [2.11 to 2.38) had the highest relative risk of a critical revisit among all ED diagnoses. Adjusting for hospital volume and patient age, patients with complex chronic conditions were also more likely to have a critical ED revisit (IRR 11.03, 95% CI, 7.76 to 15.67). Critical revisits after ED discharge were uncommon among children in our study sample, with revisits resulting in patient death within 3 days of an ED discharge being rare. Given the short time interval between ED discharges, however, future research should focus on understanding higher risk patients among those with asthma and a history of complex chronic conditions.

Patient-Physician Race Concordance, Physician Decisions, and Patient Outcomes

AbstractUsing administrative data from a large and diverse emergency department (ED), we examine the impact of race concordance between patients and physicians on physician decision-making and patient health outcomes. We find that patient-physician race concordance increases consultation time and decreases the probability of inpatient admission and diagnostic testing. Subsequently, race-concordant patients have lower revisit rates after ED discharge. The effect of race concordance is largely driven by patients who had less serious illnesses and whose diseases had nonspecific symptoms or less clear causes. The results are best explained by the informational and communication mechanism.

An Outcome Comparison Between Geriatric and Nongeriatric Emergency Departments

We sought to describe diagnosis rates and compare common process outcomes between geriatric emergency departments (EDs) and nongeriatric EDs participating in the American College of Emergency Physicians Clinical Emergency Data Registry (CEDR). We conducted an observational study of ED visits in calendar year 2021 within the CEDR by older adults. The analytic sample included 6,444,110 visits at 38 geriatric EDs and 152 matched nongeriatric EDs, with the geriatric ED status determined based on linkage to the American College of Emergency Physicians' Geriatric ED Accreditation program. Stratified by age, we assessed diagnosis rates (X/1000) for 4 common geriatric syndrome conditions and a set of common process outcomes including the ED length of stay, discharge rates, and 72-hour revisit rates. Across all age categories, geriatric EDs had higher diagnosis rates than nongeriatric EDs for 3 of the 4 following geriatric syndrome conditions of interest: urinary tract infection, dementia, and delirium/altered mental status. The median ED site-level length of stay for older adults was lower at geriatric EDs compared with that at nongeriatric EDs, whereas 72-hour revisit rates were similar across all age categories. Geriatric EDs exhibited a median discharge rate of 67.5% for adults aged 65 to 74 years, 60.8% for adults aged 75 to 84 years, and 55.6% for adults aged >85 years. Comparatively, the median discharge rate at nongeriatric ED sites was 69.0% for adults aged 65 to 74 years, 64.2% for adults aged 75 to 84 years, and 61.3% for adults aged >85 years. Geriatric EDs had higher geriatric syndrome diagnosis rates, lower ED lengths of stay, and similar discharge and 72-hour revisit rates when compared with nongeriatric EDs in the CEDR. These findings provide the first benchmarks for emergency care process outcomes in geriatric EDs compared with nongeriatric EDs.

Association of Chest Radiography With Outcomes in Pediatric Pneumonia: A Population-Based Study.

Chest radiograph (CXR) is often performed for the evaluation of community-acquired pneumonia (CAP) in the ED setting. We sought to evaluate the association of undergoing CXR with 7-day hospitalization after emergency department (ED) discharge among patients with CAP. This was a retrospective cohort study including children 3 months to 17 years discharged from any ED within 8 states from 2014 to 2019. We evaluated the association of CXR performance with 7-day hospitalization at both the patient and ED levels using mixed-effects logistic regression models accounting for markers of illness severity. Secondary outcomes included 7-day ED revisits and 7-day hospitalization with severe CAP. Among 206 694 children with CAP, rates of 7-day ED revisit, hospitalization, and severe CAP were 8.9%, 1.6%, and 0.4%, respectively. After adjusting for illness severity, CXR was associated with fewer 7-day hospitalizations (1.6% vs. 1.7%, adjusted odds ratio: [aOR] 0.82, 95% confidence interval [CI]: 0.73-0.92). CXR performance varied somewhat between EDs (median 91.5%, IQR: 85.3%-95.0%). EDs in the highest quartile had fewer 7-day hospitalizations (1.4% vs 1.9%, aOR: 0.78, 95% CI: 0.65-0.94), ED revisits (8.5% vs 9.4%, aOR: 0.88, 95% CI: 0.80-0.96) and hospitalizations for severe CAP (0.3% vs. 0.5%, aOR: 0.70, 95% CI: 0.51-0.97) as compared to EDs with the lowest quartile of CXR utilization. Among children discharged from the ED with CAP, performance of CXR was associated with a small but significant reduction in hospitalization within 7 days. CXR may be helpful in the prognostic evaluation of children with CAP discharged from the ED.

Factors Associated with Return Visits by Elders within 72 Hours of Discharge from the Emergency Department.

Elders have a higher rate of return visits to the emergency department (ED) than other patients. It is critical to understand the risk factors for return visits to the ED by elders. The aim of this study was to determine the factors associated with return visits to the ED by elders. This study retrospectively reviewed the hospital charts of elders who returned to the ED within 72 h after discharge from ED. The risk factors identified in the Triage Risk Screening Tool were applied in this study. Of the elders discharged from the ED, 8.64% made a return visit to the ED within 72 h. The highest revisit rate occurred within 24 h after discharge. Factors associated with return ED visits within 24 h by elders were difficulty walking and having discharge care needs. The factor associated with ED return visits within 24-48 h was polypharmacy. Difficulty walking, having discharge care needs, and hospitalization within the past 120 days were associated with return visits made within 48-72 h following discharge. Identifying the reasons for return visits to the ED and providing a continuous review of geriatric assessment and discharge planning could reduce unnecessary revisits.

(319) The Pandemic, Telemedicine, and Andrology: What Have We Learned?

Abstract Introduction Telemedicine has gained wide acceptance during the COVID-19 pandemic. It was critical for patient care when lockdowns were implemented worldwide. While there has been evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine. Objective To assess the perception of andrology patients to telemedicine during the COVID-19 pandemic Methods Three electronic databases: PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients “wishing for telemedicine consultation”, “preferring telemedicine over in person”, “accepting the current telemedicine arrangement”, “having needs addressed with teleconsultation”, or “willingness to do a teleconsultation”. Results Of the 1128 retrieved abstracts, 56 underwent full-text review and 11 were included in the final analysis, comprising a total cohort of 2195 cases. Video visits were used in 7 studies, 2 used only telephone encounters, and one used both methods. 3 studies showed andrology and sexual medicine are compatible with telemedicine with a few 30 and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of $149-252 per patient. All 8 studies that assessed the perception of andrology patients to telemedicine showed that most patients had a “positive perception”. Pooled analysis of the positive response to telemedicine was 73.7% (Figure 1) and that of patients who recommended telemedicine was 58.5%. While the percentage of patients (97%) recommending telemedicine is high among studies using videoconference, the percentage drops to 26.3% in studies using telephone visits only. In the latter group, up to 27.1% of patients preferred in-person visits, with security and privacy of either mode of telecommunication being a concern. Conclusions Most patients have a positive perception of telemedicine, particularly with videoconferencing, and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Clarus Therapeutics, Antares Pharma, Acerus, Hims &amp; Hers Health, Inc.

The pandemic, telemedicine, and andrology: what have we learned?

Telemedicine gained wide acceptance during the COVID-19 pandemic, as it was deemed critical for patient care when lockdowns were implemented worldwide. While there is evidence to suggest that urology patients were receptive to telemedicine, no systematic review has been done to date on andrology patients and their perception of telemedicine. Three electronic databases, PubMed, Scopus, and Web of Science, were searched from their inception until June 2022 for relevant articles. Two independent teams reviewed abstracts and extracted data from the selected manuscripts. A meta-analysis was completed in line with PRISMA 2020 and AMSTAR Guidelines. For our study, we limited telemedicine to communication through videoconferencing or telephone encounters between patients and medical professionals. Positive response to telemedicine was defined as patients "wishing for telemedicine consultation", "preferring telemedicine over in person", "accepting the current telemedicine arrangement", "having needs addressed with teleconsultation", or "willingness to do a teleconsultation". Of the 1128 retrieved abstracts, 56 underwent full-text review and 12 were included in the final analysis, comprising a total cohort of >4021 cases. Video visits were evaluated in 5 studies, telephone encounters were analyzed in 2 studies, and both methods were examined in 1 randomized control study. Three studies showed that andrology and sexual medicine are compatible with telemedicine, with few 30- and 90-day in-person revisit rates. Telemedicine was shown to save an average cost of US$149-$252 per patient, and 8 studies that directly assessed andrology patient perceptions of telemedicine showed that most patients had a "positive perception."Pooled analyses of the positive responses to telemedicine were 68.7% (95% CI, 49.4%-83.1%, P = 0.057), and those of patients who recommended telemedicine were 65.1% (95% CI, 18.4%-93.9%, P = 0.577). While the percentage of patients recommending telemedicine was high among studies using videoconferencing, the percentage dropped in studies using telephone visits only. The difference between recommending video and telephone practices was statistically significant, with 84.6% pooled proportion for recommending video practice compared to 38.9% pooled proportion for recommending telephone practice, P = 0.035. In the telephone-only encounters, up to 27.1% of patients preferred in-person visits, as security and privacy of any mode of telecommunication were of concern. Most patients have a positive perception of telemedicine, particularly with videoconferencing and less so with telephone visits. These results suggest that telemedicine will likely continue to play a pivotal role in andrology and sexual medicine practices.

The Safety of Performing Surgery at Ambulatory Surgery Centers Versus Hospital Outpatient Departments in Older Patients With or Without Multimorbidity.

Surgery for older Americans is increasingly being performed at ambulatory surgery centers (ASCs) rather than hospital outpatient departments (HOPDs), while rates of multimorbidity have increased. To determine whether there are differential outcomes in older patients undergoing surgical procedures at ASCs versus HOPDs. Matched cohort study. Of Medicare patients, 30,958 were treated in 2018 and 2019 at an ASC undergoing herniorrhaphy, cholecystectomy, or open breast procedures, matched to similar HOPD patients, and another 32,702 matched pairs undergoing higher-risk procedures. Seven and 30-day revisit and complication rates. For the same procedures, HOPD patients displayed a higher baseline predicted risk of 30-day revisits than ASC patients (13.09% vs 8.47%, P < 0.0001), suggesting the presence of considerable selection on the part of surgeons. In matched Medicare patients with or without multimorbidity, we observed worse outcomes in HOPD patients: 30-day revisit rates were 8.1% in HOPD patients versus 6.2% in ASC patients ( P < 0.0001), and complication rates were 41.3% versus 28.8%, P < 0.0001. Similar patterns were also found for 7-day outcomes and in higher-risk procedures examined in a secondary analysis. Similar patterns were also observed when analyzing patients with and without multimorbidity separately. The rates of revisits and complications for ASC patients were far lower than for closely matched HOPD patients. The observed initial baseline risk in HOPD patients was much higher than the baseline risk for the same procedures performed at the ASC, suggesting that surgeons are appropriately selecting their riskier patients to be treated at the HOPD rather than the ASC.

Monitoring Green Tide in the Yellow Sea Using High-Resolution Imagery and Deep Learning

Green tide beaching events have occurred frequently in the Yellow Sea since 2007, causing a series of ecological and economic problems. Satellite imagery has been widely applied to monitor green tide outbreaks in open water. Traditional satellite sensors, however, are limited by coarse resolution or a low revisit rate, making it difficult to provide timely distribution of information about green tides in the nearshore. In this study, both PlanetScope Super Dove images and unmanned aerial vehicle (UAV) images are used to monitor green tide beaching events on the southern side of Shandong Peninsula, China. A deep learning model (VGGUnet) is used to extract the green tide features and quantify the green tide coverage area or biomass density. Compared with the U-net model, the VGGUnet model has a higher accuracy on the Super Dove and UAV images, with F1-scores of 0.93 and 0.92, respectively. The VGGUnet model is then applied to monitor the distribution of green tide on the beach and in the nearshore water; the results suggest that the VGGUnet model can accurately extract green tide features while discarding other confusing features. By using the Super Dove and UAV images, green tide beaching events can be accurately monitored and are consistent with field investigations. From the perspective of near real-time green tide monitoring, high-resolution imagery combined with deep learning is an effective approach. The findings pave the way for monitoring and tracking green tides in coastal zones, as well as assisting in the prevention and control of green tide disasters.

Croup associated with COVID-19: A case series

BackgroundCroup encounters substantially decreased when the pandemic first began, specifically between March and September 2020, before croup cases dramatically spiked again with the Omicron variant. There is a dearth of information concerning children at risk for severe or refractory COVID-19-associated croup and their outcomes. ObjectiveThe objective of this case series was to describe the clinical characteristics and outcomes of croup associated with the Omicron variant in children, with a focus on cases refractory to treatment. MethodsThe case series includes children from birth to 18 years old who presented to a freestanding children's hospital emergency department in the Southeastern United States between December 1, 2021 and January 31, 2022 with a diagnosis of croup and a laboratory-confirmed diagnosis of COVID-19. We used descriptive statistics to summarize patient characteristics and outcomes. ResultsOf the total 81 patient encounters, 59 patients (72.8%) were discharged from the ED, with one patient requiring two revisits to the hospital. Nineteen patients (23.5%) were admitted to the hospital, and three of these patients represented to the hospital after discharge from the hospital. Three patients (3.7%) were admitted to the intensive care unit, none of whom represented after discharge. ConclusionsThis study reveals a wide age range of presentation as well as a relatively higher rate of admission and fewer coinfections compared to pre-pandemic croup. Reassuringly, the results also show a low postadmission intervention rate as well as a low revisit rate. We discuss four refractory cases to highlight nuances for management and disposition decisions.

Evaluation of a transitions clinic to bridge emergency department and primary care.

Suboptimal transitions from the emergency department (ED) to ambulatory settings contribute to poor clinical outcomes and unnecessary nonurgent ED utilization. Care transition clinics (CTCs) are a potential solution by providing ED follow-up and facilitating the bridge to longer-term primary care. The objective was to evaluate the implementation of an ED transitions clinic on 30-day ED revisits and hospital readmissions. Retrospective cross-sectional study. This study included adults 18 years and older discharged from the ED and reeferred to the CTC. Appointment attendance, follow-up time, and frequencies of care type provided were computed to assess clinic utilization. Rates of 30-day ED revisit and hospital admission were compared between completed and missed appointments using logistic regression. Between March 2021 and March 2022, 373 patients were referred to the CTC totaling 405 appointments. Half (53%) of appointments were completed with a median follow-up time of 4 days (IQR = [2, 7]). The most common care types provided were wound care (44%) and clinical problem management (33%), with wound care appointments more likely to be completed compared with clinical appointments (OR = 1.7, CI = [1.1, 2.8], p = .03). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment (OR = 0.51, CI = [0.27, 0.98], p < .05). No effect was seen for CTC appointment completion on hospital readmission. Transition clinics are a viable method to provide timely access to follow-up for patients discharged from the ED and may help reduce excess ED use for ambulatory care needs.