Stringent Admission Criteria Research Articles

Health-care organization for the management and surveillance of SARS-CoV-2 infection in children during pandemic in Campania region, Italy

BackgroundIn comparison with adults, severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection in children has a milder course. The management of children with suspected or confirmed coronavirus disease (COVID-19) needs to be appropriately targeted.MethodsWe designed a hub-and-spoke system to provide healthcare indications based on the use of telemedicine and stringent admission criteria, coordinate local stakeholders and disseminate information.ResultBetween March 24th and September 24th 2020, the Hub Centre managed a total of 208 children (52% males, median age, 5.2, IQR 2–9.6 years) with suspected or confirmed COVID-19. Among them, 174 were managed in cooperation with family pediatricians and 34 with hospital-based physicians. One hundred-four (50%) received a final diagnosis of SARS-CoV-2 infection. Application of stringent criteria for hospital admission based on clinical conditions, risk factors and respect of biocontainment measures, allowed to manage the majority of cases (74, 71.1%) through telemedicine. Thirty children (28%) were hospitalized (median length 10 days, IQR 5–19 days), mainly due to the presence of persistent fever, mild respiratory distress or co-infection occurring in infant or children with underlying conditions. However, the reasons for admission slightly changed over time.ConclusionAn hub-and-spoke system is effective in coordinate territorial health-care structures involved in management paediatric COVID-19 cases through telemedicine and the definition of stringent hospital admission criteria.The management of children with COVID-19 should be based on clinical conditions, assessed on a case-by-case critical evaluation, as well as on isolation measures, but may vary according to local epidemiological changes.

Searching for a Standard—A Survey of Hospice Operating Practices in Michigan (S773)

•Describe the variability in hospice operating practices throughout Michigan.•Identify potential research directions to understand the mechanisms underlying variation in hospice services. More Americans than ever are receiving hospice care, but access to that care may not be equal. Stringent admission criteria, limitations in services offered, and rigid payment schema may limit access to hospice or compromise the care patients receive. Describe variation in the operating practices of hospices in Michigan and identify practices that may restrict access to hospice services. We conducted an online survey of hospices in Michigan using questions developed through an iterative process involving multiple stakeholders. The survey was conducted in two parts, one for the medical director and one for the hospice administrator. Respondents answered benchmarking to FY2016 data. Responses were tabulated. We received data from 49 (49%) medical directors and 39 (44%) hospice administrators. We observed variation in access to some therapies, such as palliative chemotherapy (29% did not cover), blood products (50%), hormonal cancer treatment (45%), TPN (37%), and vaccines (60%). Importantly, 20% could not support patients using methadone (20%). The reasons for not offering these treatments included: cost, perceived futility, hospice philosophy, and lack of trained staff. Most hospices (60%) reported recommending temporary disenrollment for patients to access services hospice could not provide. Most hospices lacked the ability to provide charity care (60%) or offer sliding scale payment (52%) to indigent patients. Many hospices lacked services tailored toward racial or ethnic minorities (40%). There is variation in the kinds of services hospices in Michigan can offer. We discovered a significant proportion of hospices limit access to some palliative treatments and medications, and cannot offer support for impoverished patients or ethnic minorities.

MRSAspat1081, a Highly Transmissible Strain Endemic to Hong Kong, China, in the Netherlands

MRSA<i>spa</i>t1081, a Highly Transmissible Strain Endemic to Hong Kong, China, in the Netherlands

Hospital preparedness in community measles outbreaks-challenges and recommendations for low-resource settings.

We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities.

Pain-suppressed behaviors in the red-tailed hawk (Buteo jamaicensis)

Our ability to provide analgesia in wild and exotic patients is hampered by a lack of species-specific information on effective drugs and protocols. One contributing factor is the difficulty of applying data from traditional laboratory tests of nociception to clinical conditions frequently involving combinations of inflammatory, mechanical, and neuropathic pain. Pain-suppressed behaviors have become a valuable predictor of clinical utility in other species; in this study we extend this framework to red-tailed hawks in a wildlife hospital, in an attempt to develop a new, humane testing method for birds of prey. We scored six behaviors in hawks hospitalized either for orthopedic trauma or for non-painful conditions. These behaviors included: movement about the cage, grooming, head motions, foot shifts, beak clacks, and rouse. Movement, head motions, and beak clacks were all significantly reduced in hawks with recent orthopedic injury, but not in hawks with healed or minor injuries (P<0.05 for all behaviors). However, it should be noted that due to stringent admission criteria, and the difficulties inherent in studying naturally-occurring injury in wild patients, this study only included 19 subjects in four experimental groups, and this limited our ability to fully investigate confounds within our data. A follow-up experiment was conducted to determine potential effects of buprenorphine, a mu opioid agonist, on the behaviors listed above. Buprenorphine in the absence of pain caused minor, non-significant decreases in most behaviors, and had no effect on head movement frequency. This suggests that head movements in particular may be sensitive to pain but not to sedative side-effects of buprenorphine. Overall, red-tailed hawks with recent orthopedic trauma show consistent and marked reductions in several normal maintenance behaviors. Head movements, reported for the first time in this study as a potential marker of pain in birds, in particular seem to be insensitive to sedative side effects of buprenorphine, while being a sensitive measure of affective state in hawks with painful injuries. These behaviors can be scored humanely and with minimal expense, and should be considered for further research on pain and analgesia in avian species.

Intensivmedizinisches Management hämatologischer und onkologischer Patienten

Management of critically ill cancer patients warrants stringent admission criteria and clear concepts concerning duration and limits of intensive care. Recent developments in mechanical ventilation and sepsis therapy can easily be used to improve the outcome of critically ill cancer patients. The incidence and overall prognosis of cancer is constantly growing and, thus, the number of critically ill cancer patients is increasing. Furthermore, novel oncology drugs-in particular immune modulators-produce unexpected and substantial side effects. Therefore, the development of an interdisciplinary algorithm by oncologists and intensivists remains an important and dynamic challenge.

Organized Music Instruction as a Predictor of Nursing Student Success

Stringent admission criteria exist for nursing programs in the United States, but better predictors of success are needed to reduce student attrition. Research indicates that organized music experiences are associated with greater academic success. This exploratory study examined the association between early music experiences and undergraduate nursing student success. Findings suggest that students with a music background were more likely to graduate, have higher grade point averages, and pass the licensure examination. Previous music education might be considered as an additional predictor of nursing student success.

Admission Criteria as a Predictor of Academic Performance in a Management Programme

Most of the autonomous B-Schools in India prescribe very stringent admission criteria for entry into their programmes. However the typical criteria consist of three components of evaluation-Written Test, Group Discussion (GD) and Personal Interview (PI). Some of the schools even use Graduation Score, Psychometric tests, written analysis tests, Calligraphy tests along with the regular Written Test, GD & PI. There had been many studies particularly in the US to examine to what extent the components of admission criteria predict the academic success. GMAT and Under Graduate Grade point Average (UGPA) were the strongest predictors of the Graduate Grade Point Average. However the explanatory power of GMAT and UGPA were reasonably low. This study includes the student performance in GD, PI, Intermediate (Plus 2) and Matriculation (SSC) as the explanatory variables apart from the Written Test and Graduate level performance-most commonly used in the previous studies. The results of this study are consistent with that of other studies in terms of the predictive power of Written Test (GMAT) and Graduation Score (UGPA); it is interesting to observe that Written Test is not the best predictor as it was in the previous studies.

EPD in its twentieth year: towards complete promoter coverage of selected model organisms

The Eukaryotic Promoter Database (EPD) is an annotated non-redundant collection of eukaryotic POL II promoters, experimentally defined by a transcription start site (TSS). Access to promoter sequences is provided by pointers to positions in the corresponding genomes. Promoter evidence comes from conventional TSS mapping experiments for individual genes, or, starting from release 73, from mass genome annotation projects. Subsets of promoter sequences with customized 5′ and 3′ extensions can be downloaded from the EPD website. The focus of current development efforts is to reach complete promoter coverage for important model organisms as soon as possible. To speed up this process, a new class of preliminary promoter entries has been introduced as of release 83, which requires less stringent admission criteria. As part of a continuous integration process, new web-based interfaces have been developed, which allow joint analysis of promoter sequences with other bioinformatics resources developed by our group, in particular programs offered by the Signal Search Analysis Server, and gene expression data stored in the CleanEx database. EPD can be accessed at .

Accessing Drug-Abuse Treatment: Perceptions of Out-of-Treatment Injectors

The Presidential Commission on the Human Immunodeficiency Virus Epidemic (1988) developed a 10-year plan in 1987 that recommended: “Expanded drug abuse treatment programs sufficient to admit all IV drug users who desired services and, until that occurred, short-term detoxification and low-dose methadone for those on waiting lists.” This study presents data collected from a sample of 2,613 out-of-treatment and non-incarcerated injection drug users in 21 U.S. cities to examine their drug-treatment access during the past year. Analyses on injectors who tried but were unable to enter treatment revealed that program-based reasons (e.g., no room, too costly, or stringent admission criteria) are the most commonly given barriers to drug treatment (72%). However, a notable number of injectors (20%) also reported that individual-based reasons are important for not accessing drug treatment. Injectors giving program- and individual-based reasons for not entering treatment are profiled using logistic regression.