Services Department Research Articles

Diagnostic agreement between emergency medical service and emergency department physicians, a prospective multicentre study

IntroductionEarly and adequate preliminary diagnosis reduce emergency department (ED) and hospital stay and may reduce mortality. Several studies demonstrated adequate preliminary diagnosis as stated by emergency medical services (EMS) ranging between 61 and 77%. Dutch EMS are highly trained, but performance of stating adequate preliminary diagnosis remains unknown.MethodsThis prospective observational study included 781 patients (> 18years), who arrived in the emergency department (ED) by ambulance in two academic hospitals. For each patient, the diagnosis as stated by EMS and the ED physician was obtained and compared. Diagnosis was categorized based on the International Classification of Diseases, 11th Revision.ResultsThe overall diagnostic agreement was 79% [95%-CI: 76–82%]. Agreement was high for traumatic injuries (94%), neurological emergencies (90%), infectious diseases (84%), cardiovascular (78%), moderate for mental and drug related (71%), gastrointestinal (70%), and low for endocrine and metabolic (50%), and acute internal emergencies (41%). There is no correlation between 28-day mortality, the need for ICU admission or the need for hospital admission with an adequate preliminary diagnosis.ConclusionIn the Netherlands, the extent of agreement between EMS diagnosis and ED discharge diagnosis varies between categories. Accuracy is high in diseases with specific observations, e.g., neurological failure, detectable injuries, and electrocardiographic abnormalities. Further studies should use these findings to improve patient outcome.

Quality of Complaint Services through the Lapor Website at Departement of Education the East Java Provincial

The development of an Electronic Based Government System is an embodiment of improving the quality of public services. The LAPOR website is a national electronic-based complaint management system that can be accessed by all Indonesian people. The existence of LAPOR mandates that the management of complaint services in every government agency in Indonesia must be integrated with LAPOR, At department of east java provincial education service. The LAPOR website is the most widely used media by the people of East Java in sending complaints to at Departement of Eduaction The East Java Provincial. However, in reality there are still some complaints from the public about the services provided through LAPOR website. The purpose of this research to determine the quality of complaint services through the LAPOR website at Departement of Education The East Java Provincial. This research uses a qualitative approach with data collection techniques through observation, interview, and documentation. The results showed that the quality of complaints service through the LAPOR Website using the four objectives of the Electronic Service Quality theory study was of high quality but not optimal, because there were still several complaints whose follow-up did not run optimally and there were several complaints that experienced delays in the follow-up of further complaints.

Enhancing Patient Experience through Digital Transformation: A Case Study of Outpatient Department Services in Hospitals

Enhancing Patient Experience through Digital Transformation: A Case Study of Outpatient Department Services in Hospitals

Care in the Community: A COVID-19 initiative to reduce hospital re-presentations among community-dwelling people.

The COVID-19 pandemic has had a substantial impact on the utilisation of hospital and emergency department (ED) services. We examined the effect of a rapid response service on hospital re-presentations among people discharged from the ED and short-stay wards at a tertiary referral hospital. This retrospective cohort study compared 112 patients who completed the Care in the Community program with 112 randomly selected controls. Both cases and controls were discharged from hospital between September 2020 and June 2021. Intervention patients were evaluated by a multidisciplinary team, who implemented a goal-directed program of up to 4-weeks duration. Logistic regression, negative binomial regression and Cox proportional hazards regression were used to evaluate outcomes at 28 days and at 6 months. The median time between referral and the first home visit was 3.9 days. In adjusted analyses, the intervention reduced hospital re-presentations at 28 days (odds ratio: .40, 95% confidence interval (CI): .17-.94) and lengthened the time to the first hospital re-presentation (hazard ratio: .59, 95% CI: .38-.92). Although the intervention did not reduce the total number of hospital re-presentations at 6 months (adjusted incidence rate ratio: .73, 95% CI: .49-1.08), it reduced total time spent in hospital by 303 days (582 vs. 885). This study is among the first to investigate the effect of a community-based intervention on hospital re-presentations during the COVID-19 pandemic. It provides evidence that a sustainable 4-week intervention is associated with reduced hospital re-presentations and time spent in hospital.

Understanding the Regulatory Pathways Used to Develop, Evaluate, Authorize, and Approve New Drugs and Vaccines in the United States.

The United States (U.S.) Food and Drug Administration (FDA) oversees the safety and quality of drugs and vaccines that are used in the U.S. Administration of the FDA falls under the jurisdiction of the U.S. Department of Health and Human Services (HHS). The regulatory oversight of the FDA is complex and comprehensive, requiring the various roles and responsibilities to be divided across six main centers. The activities of two of these centers, the Center for Drug Evaluation and Research (CDER) and the Center for Biologics Evaluation and Research (CBER) are the primary focus of this review.

Disparities in satisfaction among insured and uninsured adult outpatient department service users in Southern Ethiopia, 2022: a comparative cross-sectional study

BackgroundPatient satisfaction is a critical measure of the quality of healthcare services provided by healthcare facilities. However, very few studies, particularly in Ethiopia, which includes the study area, have specifically examined these discrepancies among people who use outpatient care. In this study, satisfaction levels and associated factors were compared between insured and uninsured patients receiving outpatient services at public health institutions in Hadiya Zone, southern Ethiopia.MethodsA facility-based comparative cross-sectional study design was employed on 630 patients using multistage and systematic random sampling. Data were collected using a pretested and structured interviewer-administered questionnaire. Results of the analysis were presented in text, tables, and graphs as appropriate. Multivariable logistic regression was used to predict associations between predictors and the outcome variable. Statistical significance was declared at p-value < 0.05.ResultsOverall, 344(55.48%) patients were satisfied with the service they received, of which 206(65.8%) out of 313 with a 95% CI [60.7–71.2%] were insured and 138(44.95%) out of 307 with a 95% CI [39.4–5.1%] were uninsured. Among insured patients, factors associated with higher satisfaction included having a family size less than five members [AOR = 3.3, 95% CI; 1.5, 7.4], perceived fair waiting time to be seen[AOR = 2.35, 95% CI; 1.02, 5.5], perceived short waiting time to be seen[AOR = 8.12, 95% CI; 1.6, 41.3], having all ordered laboratory tests available within the facility[AOR = 7.89, 95% CI; 3.5, 17.5], having some ordered laboratory tests within the facility[AOR = 2.97, 95% CI; 1.25, 7.01] having all prescribed medications available within the facility[AOR = 16.11, 95% CI; 6.25, 41.5], having some prescribed medications available within the facility[AOR = 13.11, 95% CI; 4.7, 36.4]. Among non-insured patients, factors associated with higher satisfaction included urban residency, a fair and short perceived time to be seen, having ordered laboratory tests within the facility, and having prescribed drugs within the facility.ConclusionThis study identified lower overall satisfaction, particularly among uninsured patients. Enrollment in the CBHI program significantly impacted satisfaction, with both groups reporting lower levels compared to enrollment periods. Access to essential services, wait times, and socio-demographic factors identified as associated factors with patient satisfaction regardless of insurance status.

The influence of self-efficacy on employee performance with job satisfaction as an intervening variable at PT Wahana Andika Mandiri IT Services department

The influence of self-efficacy on employee performance with job satisfaction as an intervening variable at PT Wahana Andika Mandiri IT Services department

The accuracy of predicting hospital admission by emergency medical service and emergency department personnel compared to the prehospital MEWS: a prospective multicenter study

IntroductionOvercrowding in the emergency department (ED) is a global problem. Early and accurate recognition of a patient’s disposition could limit time spend at the ED and thus improve throughput and quality of care provided. This study aims to compare the accuracy among healthcare providers and the prehospital Modified Early Warning Score (MEWS) in predicting the requirement for hospital admission.MethodsA prospective, observational, multi-centre study was performed including adult patients brought to the ED by ambulance. Involved Emergency Medical Service (EMS) personnel, ED nurses and physicians were asked to predict the need for hospital admission using a structured questionnaire. Primary endpoint was the comparison between the accuracy of healthcare providers and prehospital MEWS in predicting patients’ need for hospital admission.ResultsIn total 798 patients were included of whom 393 (49.2%) were admitted to the hospital. Sensitivity of predicting hospital admission varied from 80.0 to 91.9%, with physicians predicting hospital admission significantly more accurately than EMS and ED nurses (p < 0.001). Specificity ranged from 56.4 to 67.0%. All healthcare providers outperformed MEWS ≥ 3 score on predicting hospital admission (sensitivity 80.0-91.9% versus 44.0%; all p < 0.001). Predictions for ward admissions specifically were significantly more accurate than MEWS (specificity 94.7–95.9% versus 60.6%, all p < 0.001).ConclusionsHealthcare providers can accurately predict the need for hospital admission, and all providers outperformed the MEWS score.

Longitudinal associations between urinary biomarkers of phthalates and replacements with novel in vivo measures of placental health.

What is the longitudinal association between gestational phthalate exposure and in vivo placental outcomes? Phthalates were adversely associated with placental microvasculature, stiffness, and presence of calcification, with different metabolites associated with different outcomes. Phthalate exposure is ubiquitous and implicated as a contributor to adverse pregnancy outcomes, possibly through impacts on the placenta. A total of 303 women were recruited in early pregnancy and prospectively followed for up to eight visits across gestation in the Human Placenta and Phthalates study. At each visit, women provided urine samples and underwent placental ultrasounds. Urine was analyzed for 18 metabolites of phthalates and replacements. We took the geometric mean of repeated measurements to reflect pregnancy-averaged phthalate or replacement exposure for each participant (n = 303). Placental microvasculature, stiffness, and microcalcification presence were quantified from ultrasounds at each visit. Higher scores reflected worse placental function for all measures. Generalized linear mixed models were created to estimate the association between pregnancy-averaged exposure biomarker concentrations and repeated outcome measurements for microvasculature and stiffness. Gestational age at the time of calcification detection was modeled using Cox proportional hazards models. Monocarboxyisononyl phthalate and summed di(2-ethylhexyl) phthalate metabolites were associated with impaired microvasculature development, such that an interquartile range increase in concentration was associated with 0.11 standard deviation increase in the microvasculature ratio, indicating poorer vascularization (95% CI: 0.00, 0.22); 0.11 [95% CI: -0.01, 0.22], respectively. Monoethyl phthalate was associated with increased placental stiffness (0.09 [95% CI: -0.01, 0.19]) while summed di-iso-butyl phthalate metabolites and monobenzyl phthalate were associated with increased hazard of calcification detection (hazard ratios: 1.18 [95% CI: 0.98, 1.42]; 1.13 [95% CI: 0.96, 1.34]). Outcomes used in this study are novel and further investigation is needed to provide clinical context and relevance. We found evidence of associations between select phthalate biomarkers and various aspects of in vivo placental health, although we did not observe consistency across placental outcomes. These findings could illustrate heterogeneous effects of phthalate exposure on placental function. This research was supported in part by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences (ZIA ES103344), and NIEHS T32ES007018. The authors declare that they have no competing interests to disclose. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Use of trade names is for identification only and does not imply endorsement by the CDC, the Public Health Service, or the US Department of Health and Human Services. N/A.

Expired blood transfusion and mortality outcomes in combat trauma patients.

Expired blood can be transfused if clinically indicated but outcome data do not exist. We hypothesized that modestly outdated blood can effectively support a hemorrhaging patient until surgical control is achieved. This study assessed whether expired blood was associated with mortality in combat trauma patients. A retrospective analysis of Armed Services Blood Program and Department of Defense Trauma Registry databases evaluated combat casualty records (2001-2023). The intervention of interest was transfusion of at least one unit of whole blood (WB), red blood cells (RBC), or platelets within one week past expiration. The outcome of interest was mortality at discharge. A control cohort that only received in-date blood was matched to the treatment cohort for logistic regression analysis. One hundred patients received expired RBCs (86), WB (11), and platelets (3). Mortality at discharge was 11.6% for expired RBC recipients and 13.4% for the control cohort (p = .97). After adjustment for injury severity, expired RBCs were not associated with mortality (OR = 0.40 [95% CI, 0.14-1.16]; p = .09). Of 10 patients who received the most expired RBCs by volume or storage duration, two were deceased at discharge. All 14 expired WB and platelet recipients were alive at discharge, but sample sizes were underpowered for regression analysis. Transfusion of modestly outdated RBCs was not associated with mortality in combat trauma patients. Expired WB and platelet recipients did well, but sample sizes were too small to draw significant conclusions. Expired blood should be further investigated for possible use in extenuating circumstances.

Outcomes and Hospital Service Use Among Patients With COPD in a Nurse- and Allied Health–Led Clinic

Multidisciplinary disease management efforts enable the improvement in lung function among patients with chronic obstructive pulmonary disease (COPD), but there is little evidence of its association with risks of adverse health outcomes and health care service use. To examine the association between the use of a nurse- and allied health-led primary care clinic for respiratory patients, namely the Nurse and Allied Health Clinic-Respiratory Care (NAHC-Respiratory), and their risks of mortality and morbidity and health care service use. This territory-wide, population-based, propensity-matched, retrospective cohort study used data from the electronic health records of all patients who used public health care services in Hong Kong, China, from January 1, 2010, to December 31, 2019. All patients with COPD treated in public outpatient clinics between January 1, 2010, and December 31, 2014, were included. Patients who attended NAHC-Respiratory and usual care only were propensity score-matched at a 1:2 ratio. Data analyses were conducted between August 2023 and April 2024. Attendance at NAHC-Respiratory. All-cause and cause-specific mortality, incidence of COPD complications, and use of emergency department and inpatient services until the end of 2019 were compared between the NAHC-Respiratory and usual care participants using Cox proportional hazard regression, Poisson regression, and log-link gamma regression models after matching. This study included 9048 eligible patients after matching, including 3093 in the exposure group (2814 [91.0%] men; mean [SD] age, 69.8 [9.5] years) and 5955 in the reference group (5431 [91.2%] men; mean [SD] age, 69.5 [11.7] years). Compared with patients in the usual care-only group (reference), patients in the exposure group had lower risks of all-cause mortality (hazard ratio [HR], 0.84; 95% CI, 0.78-0.90) as well as pneumonia-caused (HR, 0.85; 95% CI, 0.74-0.97), respiratory-caused (HR, 0.86; 95% CI, 0.77-0.96), and cardiovascular-caused (HR, 0.74; 95% CI, 0.59-0.93) mortality. Exposure was associated with reduced rates of emergency department visits (incidence rate ratio [IRR], 0.92; 95% CI, 0.86-0.98) and hospitalization through emergency department (IRR, 0.89; 95% CI, 0.83-0.95). In this cohort study, the use of a nurse- and allied health-led clinic in primary care settings was associated with reduced risks of mortality and use of hospital services among patients with COPD. These findings emphasize the important role of health care workers other than physicians in disease management in the primary care setting. The NAHC-Respiratory model and service components can be used to help improve primary care programs to benefit more patients with COPD.

Resilience building interventions to manage climate induced livestock poverty and deaths in Southern Zimbabwe

Livestock production in Mwenezi District (MD) has become more susceptible to effects of climatic variability and change which undermines developmental gains from livestock value chain. Climate change impacts are increasing the intensity of livestock poverty and deaths across all forms of livestock. The study examined livestock production interventions implemented to reduce livestock poverty deaths in MD. Descriptive research design which utilizes both qualitative and quantitative paradigms was used to accurately and systematically describe the phenomenon. A household survey questionnaire was administered to sampled households in MD wards 4 and 10 while interviews were conducted with purposively selected key informants from the department Agriculture Technical and Extension Services (AGRITEX), Veterinary Services Department, Rural District Council, CARE and District Development Coordinator's Office. Various interventions including construction of improved livestock structures, availing of safe drinking water for livestock, livestock feed formulation have been initiated to reduce and contain livestock poverty deaths. The study recommends that development actors should initiate more interventions to boost livestock production sector since it is the most suitable intervention in relation to climate and weather conditions experienced in MD. The research offers insights to address the complex interplay between climate change, livestock farming, poverty and resilience building. Results inform future researchers while guiding policy makers working in similar contexts on how best to support vulnerable communities. Findings lessen the burden to achieve Sustainable Development Goals namely no poverty, zero hunger amongst others. The study enlightened farmers on how to implement drought mitigation and adaptation techniques during drought periods.

Shift in emergency department utilization by frequent attendees with sickle cell disease during the COVID-19 pandemic: Amulticentre cohort study.

While the coronavirus disease-2019 (COVID-19) might have increased acute episodes in people living with sickle cell disease (SCD), it may also have changed their reliance on emergency department (ED) services. We assessed the impact of the COVID-19 pandemic and lockdowns on ED visits in adult SCD people followed in five French reference centres, with a special focus on 'high users' (≥10 visits in 2019). We analysed the rate of ED visits from 1 January 2015 to 31 December 2021, using a self-controlled case series. Among 1530 people (17 829 ED visits), we observed a significant reduction in ED visits during and after lockdowns, but the effect vanished over time. Compared to pre-pandemic, incidence rate ratios for ED visits were 0.59 [95% CI 0.52-0.67] for the first lockdown, 0.66 [95% CI 0.58-0.75] for the second and 0.85 [95% CI 0.73-0.99] for the third. High users (4% of people but 33.7% of visits) mainly drove the reductions after the first lockdown. COVID-19 lockdowns were associated with reduced ED visits. While most people returned to their baseline utilization by April 2021, high users had a lasting decrease in ED visits. Understanding the factors driving the drop in ED utilization among high users might inform clinical practice and health policy.

Evaluation of the implementation of the rational use of laboratory tests in the clinical chemistry laboratory

Abstract Objectives The ‘Rational Laboratory Use Project’ (RLUP) was launched in 2018 by the Department of Examination and Diagnosis Services under the General Directorate of Health Services of the Republic of Turkey’s Ministry of Health. In this study, we aimed to determine the rate of implementation of RLUP in medical biochemistry laboratories, and to contribute to new regulations by collecting the information and opinions of the laboratory experts participating the survey. Methods Thirty questions were uploaded to an online survey tool (SurveyMonkey®, San Mateo, ABD). The first five were descriptive for laboratories. Among the remaining 25 questions, one is open-ended and addresses the various topics encompassed by the project’s scope. Results The questionnaire was completed by 202 medical biochemistry specialists, of whom 82.12 % reported that they did not implement autoverification. 55.65 % defined consultations in Hospital Management Information System (HIMS), but; 70.49 % were not using it actively. 57.69 % of the participants answered, “I agree” to the statement “I think RLUP is feasible”. It was observed that the specialists tried to implement rational laboratory practices partially depending on their laboratory capacity, hospital administration and Laboratory Information Management System (LIMS). Conclusions Increasing clinicians’ awareness could increase the success of this project, which might provide more effective diagnosis and treatment for the patient. In our view, actively involving stakeholders of the information management system, which is not under the direct control of laboratory professionals, in the RLUP will accelerate the development of the project.

Sialic Acid Receptor Specificity in Mammary Gland of Dairy Cattle Infected with Highly Pathogenic Avian Influenza A(H5N1) Virus.

In March 2024, the US Department of Agriculture's Animal and Plant Health Inspection Service reported detection of highly pathogenic avian influenza (HPAI) A(H5N1) virus in dairy cattle in the United States for the first time. One factor that determines susceptibility to HPAI H5N1 infection is the presence of specific virus receptors on host cells; however, little is known about the distribution of the sialic acid (SA) receptors in dairy cattle, particularly in mammary glands. We compared the distribution of SA receptors in the respiratory tract and mammary gland of dairy cattle naturally infected with HPAI H5N1. The respiratory and mammary glands of HPAI H5N1-infected dairy cattle are rich in SA, particularly avian influenza virus-specific SA α2,3-gal. Mammary gland tissues co-stained with sialic acids and influenza A virus nucleoprotein showed predominant co-localization with the virus and SA α2,3-gal. HPAI H5N1 exhibited epitheliotropism within the mammary gland, and we observed rare immunolabeling within macrophages.

Prevalence of Candida auris Among High-Risk Patients at a Comprehensive Cancer Center

Background: Candida auris (C. auris) is a multidrug-resistant fungus that is increasingly implicated in outbreaks in healthcare facilities worldwide. The Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services recommend healthcare facilities screen patients who are considered high-risk for C. auris, including patients with an overnight stay in a healthcare facility outside the United States (U.S.) in the previous year, or recently stayed in a rehabilitation (rehab) facility, long-term acute care (LTAC), or skilled nursing facility (SNF). Screening patients for C. auris colonization allows for early implementation of infection control measures, preventing transmission to healthcare workers and other patients. According to the CDC, most cases of C. auris result from local spread within and among healthcare facilities in the same city or state. In Texas, 160 clinical cases have been reported during the past 12 months. At present, the necessity of screening high-risk patients at our center for C. auris is not known. We aimed to determine the prevalence of C. auris colonization among our patient population. Method: During a 4-week period, we performed targeted screening of patients meeting the CDC’s high-risk definition for C. auris. Admitted patients were screened by an Infection Preventionist (IP) using the electronic health record to identify patients who were either international or admitted from a rehab or care facility. A composite swab of bilateral axilla and groin creases was collected using an eSwab™ (Becton Dickinson) and sent to a reference lab (Mayo Clinic Laboratories) for polymerase chain reaction (PCR)-based detection of C. auris. Additionally, we reviewed historic cases of C. auris diagnosed at our institution to better define our at-risk patients. Results: Between July 14 – August 8, 2023, we consecutively screened 25 high-risk patients, including 18 (72%) international and 7 (28%) patients from rehabs, LTAC, or SNF. None were positive for C. auris. Since 2019, we identified six patients with C. auris positive cultures, including five clinical cases and one colonization case. Five patients were international and one was local with no history of international travel or stay in a care facility. Interestingly, all six were known to be colonized with extended-spectrum beta-lactamase (ESBL) E. coli. Conclusion: We have a very low prevalence of C. auris among CDC-defined high-risk patients. A review of historic C. auris cases indicated an association with colonization by other multidrug-resistant organisms, specifically ESBL E. coli, which will inform future screening protocols at our institution.Disclosure: Roy Chemaly: Contracted Research paid for my institution: Merck, Karius, AiCuris, Ansun Pharmaceuticals, Takeda, Genentech, Oxford Immunotec, and Eurofins-Viracor; Honorarium/Ad Board/Consultant: ADMA Biologics, Janssen, Merck/MSD, Partner Therapeutics, Takeda, Shinogi, AiCuris, Roche/Genentech, Astellas, Tether, Oxford Immunotec, Karius, Moderna, and Ansun Pharmaceuticals; Stock Options: Xenex

An Evaluation of the Content Quality, Readability, and Reliability of Publicly Available Web-Based Information on Pneumothorax Surgery in Ireland.

Introduction The internet is increasingly the first port of call for patients introduced to new treatments. Unfortunately, many websites are of poor quality, thereby limiting patients' ability to make informed health decisions.Within thoracic surgery, the treatment options for pneumothoraces may be less intuitive for patients to understand compared to procedures such as lobectomies and wedge resections. Therefore, patients must receive high-quality information to make informed treatment decisions.No study to date has evaluated online information regarding pneumothorax surgery. Knowledge regarding the same may allow physicians to recommend appropriate websites to patients and supplement remaining knowledge gaps. Objective This study aims to evaluate the content, readability, and reliability of online information regarding pneumothorax surgery. Methods A total of 11 search terms including "pneumothorax surgery,""pleurectomy,"and "pleurodesis"were each entered into Google, Bing, and Yahoo. The top 20 websites found through each search were screened, yielding 660 websites. Only free websites designed for patient consumption that provided information on pneumothorax surgery were included. This criterion excluded 581 websites, leaving 79 websites to be evaluated. To evaluate website reliability, the Journal of American Medical Association (JAMA) and DISCERN benchmark criteria were applied.To evaluate the readability, 10 standardized tools were utilized including the Flesch-Kincaid Reading Ease Score. To evaluate website content, a novel,self-designed 10-part questionnaire was utilized to assess whether information deemed essential by the authors was included.It evaluated whether websites comprehensively described the surgery process for patients, including pre- and post-operative care.Website authorship and year of publication were also noted. Results The mean JAMA score was 1.69 ± 1.29out of 4, with only nine websites achieving all four reliability criteria.The median readability score was 13.42 (IQR: 11.48-16.23), which corresponded to a 13th-14thschool grade standard. Only four websites were written at a sixth-grade reading level.In the novel content questionnaire, 31.6% of websites (n = 25) did not mention any side effects of pneumothorax surgery. Similarly, 39.2% (n = 31) did not mention alternative treatment options.There was no correlation between the date of website update and JAMA (r = 0.158, p = 0.123), DISCERN (r = 0.098, p = 0.341), or readability (r = 0.053, p = 0.606) scores. Conclusion Most websites were written above the sixth-grade reading level, as recommended by the US Department of Health and Human Services. Furthermore, the exclusion of essential information regarding pneumothorax surgery from websites highlights the current gaps in online information.These findings emphasize the need to createand disseminatecomprehensive, reliable websites on pneumothorax surgery that enable patients to make informed health decisions.

Comparison between Palonosetron and Ondansetron in Prevention of Chemotherapy Induced Nausea Vomiting

Background: Chemotherapy induced nausea and vomiting (CINV) is the commonest and the most incapacitating experience of thepatient undergoing cancer chemotherapy. Poorly controlled CINV sometimes make patients to refuse further treatment. This study aimed to compare the efficacy and safety of Palonosetron and Ondansetron in preventing CINV during cancer chemotherapy. Methods:This randomized controlled trial was conducted in the Department of Pharmacology and Therapeutics of Sylhet MAG Osmani Medical College from January 2021 to December 2021. There were 190patients enrolled initially; 14 patients from both groups withdraw themselves. Finally, 91 patients of Palonosetron and 85 patients of Ondansetron treated were recruited. The Palonosetron group were treated with Palonosetron at 0.25 mg and the Ondansetron group were treated with Ondansetron 8.0 mg intravenously, 30min before chemotherapy. After that Palonosetron 0.5 mg single time and Ondansetron 8.0 mg orally three times a day were given and total follow-up period was seven days. Episode of nausea and vomiting graded according to the guideline “Common Terminology Criteria for Adverse Events (CTCAE)”, version 4.0, which was published by the US Department of Health and Human Services (National Institute of Health and National Cancer Institute). Result: The groups were matched for the age (p = 0.263), gender (p = 0.630), body weight (p = 0.846),site of malignancy (p = 0.375), and drugsused for chemotherapeutic (p = 0.301) in both study groups. Palonosetron treated patients experienced significant lower episode of nausea in day-1 (p = &lt;0.001) and day-2 (p = 0.025), and in case vomiting in day-1 (p = 0.026) compared to Ondansetron. Significantly higher number of patients of Palonosetron compared to Ondansetron treated group showed complete response in both acute phase (p = 0.026), delayed phase (p = 0.036) and finally in overall phase (p = 0.014). Only four patients experienced with treatment failure in Ondansetron treated group. Observed adverse effects were in low intensity and not caused to stop the treatment procedure. Conclusion: Palonosetron was found to be more efficacious and well tolerated in preventing acute, delayed and overall phase of chemotherapy induced nausea and vomiting in this study.

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department. In this prospective observational cohort study, we screened children aged 0-17 years presenting with known or suspected blunt trauma at 18 specialised children's emergency departments in hospitals in the USA affiliated with the Pediatric Emergency Care Applied Research Network (PECARN). Injured children were eligible for enrolment into derivation or validation cohorts by fulfilling one of the following criteria: transported from the scene of injury to the emergency department by emergency medical services; evaluated by a trauma team; and undergone neck imaging for concern for cervical spine injury either at or before arriving at the PECARN-affiliated emergency department. Children presenting with solely penetrating trauma were excluded. Before viewing an enrolled child's neck imaging results, the attending emergency department clinician completed a clinical examination and prospectively documented cervical spine injury risk factors in an electronic questionnaire. Cervical spine injuries were determined by imaging reports and telephone follow-up with guardians within 21-28 days of the emergency room encounter, and cervical spine injury was confirmed by a paediatric neurosurgeon. Factors associated with a high risk of cervical spine injury (>10%) were identified by bivariable Poisson regression with robust error estimates, and factors associated with non-negligible risk were identified by classification and regression tree (CART) analysis. Variables were combined in the cervical spine injury prediction rule. The primary outcome of interest was cervical spine injury within 28 days of initial trauma warranting inpatient observation or surgical intervention. Rule performance measures were calculated for both derivation and validation cohorts. A clinical care algorithm for determining which risk factors warrant radiographic screening for cervical spine injury after blunt trauma was applied to the study population to estimate the potential effect on reducing CT and x-ray use in the paediatric emergency department. This study is registered with ClinicalTrials.gov, NCT05049330. Nine emergency departments participated in the derivation cohort, and nine participated in the validation cohort. In total, 22 430 children presenting with known or suspected blunt trauma were enrolled (11 857 children in the derivation cohort; 10 573 in the validation cohort). 433 (1·9%) of the total population had confirmed cervical spine injuries. The following factors were associated with a high risk of cervical spine injury: altered mental status (Glasgow Coma Scale [GCS] score of 3-8 or unresponsive on the Alert, Verbal, Pain, Unresponsive scale [AVPU] of consciousness); abnormal airway, breathing, or circulation findings; and focal neurological deficits including paresthesia, numbness, or weakness. Of 928 in the derivation cohort presenting with at least one of these risk factors, 118 (12·7%) had cervical spine injury (risk ratio 8·9 [95% CI 7·1-11·2]). The following factors were associated with non-negligible risk of cervical spine injury by CART analysis: neck pain; altered mental status (GCS score of 9-14; verbal or pain on the AVPU; or other signs of altered mental status); substantial head injury; substantial torso injury; and midline neck tenderness. The high-risk and CART-derived factors combined and applied to the validation cohort performed with 94·3% (95% CI 90·7-97·9) sensitivity, 60·4% (59·4-61·3) specificity, and 99·9% (99·8-100·0) negative predictive value. Had the algorithm been applied to all participants to guide the use of imaging, we estimated the number of children having CT might have decreased from 3856 (17·2%) to 1549 (6·9%) of 22 430 children without increasing the number of children getting plain x-rays. Incorporated into a clinical algorithm, the cervical spine injury prediction rule showed strong potential for aiding clinicians in determining which children arriving in the emergency department after blunt trauma should undergo radiographic neck imaging for potential cervical spine injury. Implementation of the clinical algorithm could decrease use of unnecessary radiographic testing in the emergency department and eliminate high-risk radiation exposure. Future work should validate the prediction rule and care algorithm in more general settings such as community emergency departments. The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the US Department of Health and Human Services in the Maternal and Child Health Bureau under the Emergency Medical Services for Children programme.

1131 A Series of Three Consecutive Emergency Room Thoracotomies Performed Within a Period of One Month at the National Accident and Orthopaedics Services Department in Sri Lanka

1131 A Series of Three Consecutive Emergency Room Thoracotomies Performed Within a Period of One Month at the National Accident and Orthopaedics Services Department in Sri Lanka