Study Time Frame Research Articles

Are protected characteristics associated with mental health care inequalities in the adult UK general population? a cross-sectional study.

This study investigates the association between protected characteristics and inequalities in mental health care in the UK. Multinomial regression was used to model the association between protected characteristics and self-reported distress. Data was extracted from waves 6-10 (2014-2019) of the UK Household Longitudinal Study. Two risk categories were constructed: "undiagnosed distress" referred to a General Health Questionnaire-12 (GHQ-12) score above "caseness" along with no history of mental health diagnosis; "diagnosis without self-report symptoms" referred to a GHQ-12 score consistently below "caseness" within the study time frame but having received a mental health diagnosis. Compared to people without a disability, people with a disability are at considerably greater risk of both undiagnosed distress (Relative risk ratios (RRR) 2.76; Confidence Interval (CI): 2.55, 2.99) and diagnosis without self-reported symptoms (RRR 3.61; CI: 2.80, 4.66). Likewise, women were more likely than men to report undiagnosed distress (RRR = 1.49; CI: 1.38,1.61) or a diagnosis without self-reported symptoms (RRR = 1.38; CI: 1.08, 1.76. Lesbian, gay, and bisexual people are at greater risk of undiagnosed distress compared with heterosexual people (RRR 1.42; CI: 1.19, 1.70). Adults aged 16-24 years were at greatest risk compared to all other age groups. People from a minority ethnic background had a reduced risk of diagnosis without self-report symptoms compared with people from a White ethnic background (RRR 0.34; CI: 0.20, 0.61). Education, employment and income variables moderated some of these associations. This is the first study to examine diagnosis without self-report symptoms alongside undiagnosed distress. Findings suggest that addressing inequality in mental health care requires increased understanding of the needs and strengths within different groups and to provide appropriate forms of social, medical or psychosocial intervention rather than a singular focus on increasing detection, diagnosis and treatment. People with a disability appear to be at greatest disadvantage, requiring greater attention in policy and practice.

An experimental analysis and deep learning model to assess the cooling performance of green walls in humid climates

Introduction: Amidst escalating global temperatures, increasing climate change, and rapid urbanization, addressing urban heat islands and improving outdoor thermal comfort is paramount for sustainable urban development. Green walls offer a promising strategy by effectively lowering ambient air temperatures in urban environments. While previous studies have explored their impact in various climates, their effectiveness in humid climates remains underexplored.Methods: This research investigates the cooling effect of a green wall during summer in a humid climate, employing two approaches: Field Measurement-Based Analysis (SC 1: FMA) and Deep Learning Model (SC 2: DLM). In SC 1: FMA, experiments utilized data loggers at varying distances from the green wall to capture real-time conditions. SC 2: DLM utilized a deep learning model to predict the green wall’s performance over time.Results: Results indicate a significant reduction in air temperature, with a 1.5°C (6%) decrease compared to real-time conditions. Long-term analysis identified specific distances (A, B, C, and D) contributing to temperature reductions ranging from 1.5°C to 2.5°C, highlighting optimal distances for green wall efficacy.Discussion: This study contributes novel insights by determining effective distances for green wall systems to mitigate ambient temperatures, addressing a critical gap in current literature. The integration of a deep learning model enhances analytical precision and forecasts future outcomes. Despite limitations related to a single case study and limited timeframe, this research offers practical benefits in urban heat island mitigation, enhancing outdoor comfort, and fostering sustainable and climate-resilient urban environments.

Quality of Care in the Last Two Years of Life for Children With Complex Chronic Conditions

ContextLimited data exists about care received by children with complex chronic conditions (CCCs) in the final years of their disease and end-of-life (EOL). ObjectiveTo examine hospital performance on EOL quality measures and to describe healthcare services during the last two years of life for children with CCCs who died in-hospital. MethodsRetrospective automated electronic health record review of children with ≥1 CCC ICD-10 diagnosis code, who died inpatient between October 2020 and March 2023 at a single quaternary U.S. children's hospital. Quality was assessed based on performance on 15 measures across five domains: healthcare utilization, interprofessional supports, medical intensity, symptom management, and communication. Quality EOL care and healthcare services in the last two years of life were determined overall by age group and per patient. Descriptive statistics were used to evaluate demographic differences by age. Results266 children with CCCs died in the study timeframe; 45% were infants (n = 120), 52% (n = 137) were male, 42% (n = 113) were white, 64% (n = 170) were non-Hispanic, and 59% (n=156) had public insurance. Children had a median of three CCCs (IQR 2.4; range 1–8). On average, children met 69% (SD 13%) of EOL quality measures for which they were eligible. In the two years prior to death, 98% (n = 261) had an ICU admission, 75% (n = 200) had a procedure requiring sedation, and 29% (n = 79) had received cardiopulmonary resuscitation. 86% (n = 229) died in the ICU. ConclusionIn this study, children with CCCs met 69% of quality measures and received high-intensity healthcare in the last two years of life.

Analysis of Requirements within Neuroradiology Job Advertisements in a Specific Timeframe.

The neuroradiology job market is constantly changing along with the skill sets needed by fellowship graduates to participate successfully in the job market. This study aimed to establish a baseline of employer requirements in the neuroradiology job market within the study timeframe. The American Society of Neuroradiology and American College of Radiology job boards were queried for neuroradiology positions between August 12, 2022, and December 31, 2022. The positions and requirements were categorized into academic versus private practice, general diagnostic radiology, full-subspecialized neuroradiology, hybrid remote/onsite, outpatient, inpatient/emergency, general interventional radiology procedures, and neuroradiology procedures. Exclusion criteria included neurointerventional only, remote-only, pediatric-only, no preference for neuroradiology, and duplicate posts within and between the job boards. Of 1777 total job posts, 179 were neuroradiology-specific and the remainder were general. Of the 179 neuroradiology-specific jobs, 55 neuroradiology jobs were academic and 124 jobs were private practice. A higher proportion of private practice jobs required general diagnostic interpretations (83% versus 26%), a higher proportion of academic jobs required neuroradiology procedures (56% versus 31%), and a higher proportion of private practice jobs required general interventional radiology procedures (22% versus 0%). Thirty-nine percent of all neuroradiology-specific onsite jobs required neuroradiology procedures, and 15% required general interventional radiology procedures. Because there was a sizable difference between general radiology and procedure requirements between academic and private practice positions, tailoring fellowship training for career aspirations of neuroradiology fellows should be considered to adapt to the skills needed for the evolving job market. In the queried timeframe, 61% of neuroradiology-specific onsite jobs did not have a specific procedure skill requirement for job applicants. This article serves as a single snapshot of the job market and its requirements for neuroradiologists, to aid in planning training to meet the needs of employers.

Safety and Tolerability of Initiating Sacubitril-Valsartan With Spironolactone During Hospitalization for Acute Decompensated Heart Failure.

Background: Initiation of sacubitril-valsartan and mineralocorticoid receptor antagonists (MRA) during hospitalization for acute decompensated heart failure (ADHF) may be an ideal time to optimize guideline-directed medical therapy. However, there is limited research assessing the safety of combining these agents in the hospital. Methods: This was a multi-center, retrospective, propensity-score matched cohort study performed at 7 acute-care hospitals within a large health care system. All adult patients admitted with ADHF between January 1, 2019 to December 31, 2021 who received sacubitril-valsartan with MRA (MRA group) or without MRA (non-MRA group) and had a left ventricular ejection fraction (LVEF) < 40% were included in the study. Results: 220 patients were screened during the study time frame with 179 meeting inclusion criteria. Following propensity-score matching, 50 patients in the MRA group were matched to 50 patients in the non-MRA group. The overall incidence of adverse drug reactions (ADRs) was 24% in the non-MRA group compared to 20% in the MRA group (P = .629). There was a significantly greater incidence of hyperkalemia in the MRA group (0% vs 10%; P = .022). None of the patients in the non-MRA group were readmitted within 30 days due to an ADR compared to 6% in the MRA group (P = .079). Conclusion: The addition of spironolactone to sacubitril-valsartan in the hospital setting following stabilization of ADHF did not lead to a significantly greater incidence of overall ADRs, but patients were more likely to develop hyperkalemia and there was a numerically higher incidence of 30-day readmissions due to ADRs.

Endovascular Treatment for Complex Vascular Pathologies in the Pediatric Population: Experience from a Center with Dual-Trained Neurosurgeons

Endovascular treatment of complex vascular pathologies in the pediatric population is often performed by non-pediatric subspecialists with adaptation of equipment and techniques developed for adult patients. We aimed to report our center's experience with safety and outcomes of endovascular treatments for pediatric vascular pathologies. We performed a retrospective review of our endovascular database. All patients ≤18 years who underwent endovascular treatment between January 1, 2004 and December 1, 2022 were included. During the study time frame, 118 cerebral angiograms were performed for interventional purposes in 55 patients. Of these patients, 8(14.5%) had intracranial aneurysms, 21(38.2%) had intracranial arteriovenous malformations (AVMs), 6(10.9%) had tumors, 5(9.1%) had arterial occlusions (n=3) or dissections (n=2), 8(14.5%) had vein of Galen malformations, and 7(12.7%) had other cerebrovascular conditions. Of the total 118 procedures, access-site complications occurred in 2(1.7%), intraprocedural complications occurred in 3(2.5%), and transient neurological deficits were observed after 2(1.7%). Treatment-related mortality occurred in 1(1.8%) patient. Neurointervention in pediatric patients was safe and effective in our experience.

The Potential of Insulin Therapy in Improving Cardiovascular and Pulmonary Health for Diabetic Patients

Aims: This study aimed to investigate the effects of diabetes on cardiac contractile proteins and assess the potential reversibility of these effects through insulin therapy, with a specific focus on the interconnectedness of cardiovascular and pulmonary health. Methods: A prospective 9-month study involving 150 adults categorized into three groups, including diabetic individuals without insulin treatment, those with insulin treatment, and a control group. Comprehensive baseline assessments were conducted, and various measurements, including cardiac contractile proteins, glycemic control, heart function, and pulmonary health, were analyzed at regular intervals. Statistical analyses encompassed paired and independent t-tests, ANOVA, and regression analysis, utilizing SPSS software (version 23) with a significance threshold of p &lt; 0.05. Results: Both diabetic groups demonstrated improved glycemic control, with the Diabetic Insulin Group (DIG) experiencing a reduction in HbA1c levels from 8.3% to 7.9% and the Diabetic Group (DG) displaying a decrease in fasting blood glucose levels from 166.2 mg/dL to 158.4 mg/dL. DG showed enhanced ejection fraction, suggesting improved cardiac function, and a minor shortening of the QTc interval, indicating better electrical cardiac stability, potentially linked to enhanced pulmonary function. A noteworthy increase in actin levels was observed in DIG, signifying a potential reversal of cardiac protein changes with potential implications for pulmonary health. Conclusion: This study underscores the significance of effective glycemic control and the potential of insulin therapy in preserving or restoring heart function in individuals with diabetes, emphasizing the need for comprehensive diabetes management in addressing and preventing cardiac issues. Pulmonary function tests indicated minimal changes in pulmonary health within the study's timeframe, suggesting limited impact during this period.

Concealed Handgun License Laws and Concealed Handgun License Adoption, 2002–2019

IntroductionNational-level data suggest that gun owners in the United States carry concealed weapons in public at growing rates. This research investigates whether these trends are associated with state adoption of more permissive concealed carry licensing laws between 2002-2019. MethodsData was obtained from 31 U.S. states from 2002-2019. State-level rates of licenses issued, denied, and newly issued per 100,000 residents were calculated and compared across three state legal categories: 1) states that banned carrying concealed weapons and adopted a shall-issue law, 2) states with a may-issue law that adopted a shall-issue law and 3) states that made no changes to concealed carry licensing laws. Difference-in-differences methods were used to compare the rate of licenses newly issued and denied in ban to shall-issue states relative to states with no concealed carry licensing law change during the study timeframe. Data were analyzed in 2022-23. ResultsStates that transitioned from a ban on concealed weapons carrying to shall-issue laws were positively associated (2-6%, SE=.11-.13) with additional new licenses relative to states that did not enact concealed carry licensing law changes. Ban to shall-issue law changes were also associated with denial of substantially more licenses (75-85%, SE=.24-.23). Further, states that transitioned from may-issue to shall-issue laws awarded fewer licenses than those transitioning from a concealed weapons ban to shall-issue laws. ConclusionsState-level concealed carry licensing may inform public health and safety policies as large restrictive U.S. states transition to more permissive concealed carry licensing laws.

Assessing environmental injustice in Kansas City by linking paediatric asthma to local sources of pollution: a cross-sectional study

ObjectiveA grassroots environmental-justice organisation in Kansas City has been examining the disproportionate exposure to air pollution experienced by residents living fenceline to the largest classification railyard in the USA. Prior...

Post-Pandemic Growth in 9-1-1 Paramedic Calls and Emergency Department Transports Surpasses Pre-Pandemic Rates in the COVID-19 Era: Implications for Paramedic Resource Planning

Objectives The COVID-19 pandemic led to a decline in emergency department (ED) visits and a subsequent return to baseline pre-pandemic levels. It is unclear if this trend extended to paramedic services and if patient cohorts accessing paramedics changed. We examined trends and associations between paramedic utilization (9-1-1 calls and ED transports) and the COVID-19 timeframe. Methods We conducted a retrospective cross-sectional study using paramedic call data from the Hamilton Paramedic Services from January 2016 to December 2023. We included all 9-1-1 calls where paramedics responded to an incident, excluding paramedic interfacility transfers. We calculated lines of best fit for the pre-pandemic period (January 2016 to January 2020) and compared their predictions to the actual volumes in the post-pandemic period (May 2021 to December 2023). We used an interrupted time series regression model to determine the association between pandemic timeframes (pre-, during-, post-COVID-19) and paramedic utilization (9-1-1 calls and ED transports), while testing for annual seasonality. Results During the study timeframe, 577,278 calls for paramedics were received and 413,491 (71.6%) were transported to the ED. Post-pandemic, 9-1-1 calls exceeded predicted pre-pandemic levels by 1,298 per month, while ED transports exceeded by 543 per month. The pandemic significantly reduced monthly 9-1-1 calls (-588.2, 95% CI −928.8 to −247.5) and ED transports (-677.3, 95% CI −927.0 to −427.5). Post-pandemic, there was a significant and sustained resurgence in monthly 9-1-1 calls (1,208.0, 95% CI 822.1 to 1,593.9) and ED transports (868.8, 95% CI 585.8 to 1,151.7). Both models exhibited seasonal variations. Conclusions Post-pandemic, 9-1-1-initiated paramedic calls experienced a substantial increase, surpassing pre-pandemic growth rates. ED transports returned to pre-pandemic levels but with a steeper and continuous pattern of growth. The resurgence in paramedic 9-1-1 calls and ED transports post-COVID-19 emphasizes an urgent necessity to expedite development of new care models that address how paramedics respond to 9-1-1 calls and transport to overcrowded EDs.

DEI-01. CLINICAL AND SOCIOECONOMIC FACTORS ASSOCIATED WITH PARTICIPATION IN POST-MORTEM TISSUE DONATION IN PEDIATRIC BRAIN TUMORS: A RETROSPECTIVE CHART REVIEW

Abstract BACKGROUND The gift of post-mortem tissue donation is a critical resource in the discovery and interrogation of pathobiological mechanisms of pediatric brain tumors. Broad generalizability of research findings requires a representative population to participate in pre-clinical studies. As a “Center of Excellence” within the Gift from a Child initiative, our institution has a well-established post-mortem tissue donation program funded by the Swifty Foundation. Our primary objective was to determine if clinical and socioeconomic differences exist between patients that participated in and those that declined research-based autopsy. METHODS We performed a single-institution retrospective chart review of pediatric patients with central nervous system (CNS) malignancies who died from their disease between 1/1/2021 and 12/31/2022. Individual clinical, demographic, and socioeconomic data were assessed. Population-level data were estimated using Zip Code Tabulation Areas. Descriptive statistics were used to compare categorical data. RESULTS Among 26 patients who died secondary to disease in the study timeframe, 23 (88%) were approached and 8/23 (35%) consented to participation. In the consented group (C) vs. declined group (D), there was a higher percentage of White, Non-Hispanic/Latino patients by self-reported race (C: 88% vs. D: 55%) and no patients who identified as Asian or Hispanic/Latino (C: 0% &amp; 0% vs. D: 13% &amp; 27%). Of all patients approached, 2 required interpreters (9%) and both families declined participation. The rate of private insurance was higher in the consented group (C: 75% vs D: 47%) compared to Medicaid as primary insurance in the declined group (C: 13% vs D: 53%). CONCLUSIONS Patients from racial and ethnic minorities are underrepresented in tissue donation programs. Future research should aim to understand and improve identified disparities to ensure advancements benefit all children with CNS malignancies. One area we plan to address is improved communication with non-English speaking families by educating interpreter services prior to discussion.

Real-world PET PSMA imaging patterns in a Chicago safety-net hospital.

e17009 Background: Prostate-specific membrane antigen positron emission tomography (PSMA PET) imaging is an FDA-approved imaging modality with increased sensitivity for prostate cancer (PCa) detection. It thus can more accurately stage patients to determine optimal initial treatment. However, patients with indications for these scans can still experience significant delays in obtaining them, mainly due to insurance denials. Such delays often disproportionately affect those with healthcare disparities, representing a substantial population at University of Illinois Chicago (UIC), a safety-net hospital. We sought to identify patterns, barriers, &amp; areas for improvement in obtaining this guideline-directed imaging modality. Methods: PCa patients with a PSMA PET scan ordered between January 2021 and June 2023 were included for analysis. Key medical and demographic data such as age, race/ethnicity, and insurance status were obtained. We also determined the time between ordering and obtaining the PSMA PET, and whether the scan led to classifying the patient’s disease as clinically localized, regional, or metastatic. We also determined whether subsequent treatment was curative or palliative intent. The dates and types of other imaging modalities, if obtained, were also recorded. Results: We identified 76 patients with PSMA PET scans ordered during the study timeframe. The mean age was 68.6 years, with a standard deviation of 7.3 years. 60.0% identified as Black or African American, 24.0% as White, 4.0% as Asian, and 1.3% as American Indian or Alaska Native. 40.8% had Illinois Medicare as their primary insurance, 27.6% had Medicaid, and 31.6% had another medical insurance. Most individuals (77.6%) had a delay in obtaining their PSMA PET scan, with a median time to scan of 23.0 days (range 6-136). All insurance types, including Illinois Medicare, Medicaid, and private insurance, had delays (74.2%, 81.0% and 79.2% of all PSMA PETs, respectively). Many delayed individuals also received conventional imaging (46.0%) within 3 months of the PSMA PET scan order as part of their workup, with 40.0% of PSMA PETs revealing new findings compared to the other scans. Ultimately, most of the imaged patients (54.0%) were determined to have regional or metastatic PCa. Delays in obtaining and receiving the results of scans affected individuals who underwent both curative (40.8%) as well as palliative intent (46.1%) treatment. Conclusions: Between January 2021 and June 2023, PCa patients had a median delay of approximately three weeks in obtaining a PSMA PET scan that was ordered urgently for the determination of their PCa treatment. Such delays can significantly impact health outcomes and often result in redundant conventional imaging. This retrospective study represents the first step in a quality improvement project to reduce delays to PSMA PETs and enable the development of a timely treatment plan to improve patient outcomes in our diverse patient population.

Histopathological features of SMARCA4-deficient thoracic malignancies: Data from resource-limited setting.

e20045 Background: SMARCA4 deficient tumors are rare malignancies that develop due to inactivating mutation in switch/sucrose-nonfermenting chromatin remodeling complexes (SWI/SNF). This is an aggressive type of non-small cell lung cancer (NSCLC) with a poor prognosis and mediocre treatment response. The trials and observational research on SMARCA4 deficient thoracic malignancies are lacking, especially in limited resource settings. This study aims to analyze pathological and immunohistochemical (IHC) profiles of patients with SMARCA4 deficient thoracic malignancies in Armenia. Methods: The current research utilizes a retrospective cohort single-center study design. The study setting was the only pathology center in Armenia that runs an IHC panel for SMARCA4/BRG1 protein evaluation. For data collection purposes, a census sampling has been done and all the pathology reports of SMARCA4 deficient thoracic malignancies were reviewed. The study timeframe was from 24 February 2021 up to 11 December 2023. Descriptive statistics through portions were done to analyze the data. Results: In total, 19 patients with SMARCA4 deficient thoracic malignancies were diagnosed. The male-to-female ratio was 15:1 and the median age was 63 years (range: 50-73 years). Of those cases, 21% (n = 4) were excluded from the current analysis as histopathological examination of those tissue samples was not performed. The diagnosis was based on an IHC evaluation to obtain a second opinion. The tissue histopathological architecture was represented: 60% (n = 9) solid, 6.67% (n = 1) trabecular, and 6.67% (n = 1) papillary. Of those samples, 66.7% (n = 10) had hyperchromatic/polymorphic nuclei and 33.3% (n = 5) pleomorphic nuclei. Similarly, the evaluated sample cells have 53.3% (n = 8) eosinophilic, 13.3% (n = 2) clear, and 13.3% (n = 2) scant cytoplasm. All 19 cases were included in the descriptive analysis of the IHC profile as examinations were performed for all the subjects. The IHC profile of the cohort is presented in the table. Ki67 was checked in 47.4% (n = 9) of cases with 70-75% median expression. In general, the most frequently examined markers were TTF1, p40, Chromogranin, and AE1/3. Conclusions: In conclusion, the study shed light on SMARCA4 thoracic tumors spread in Armenia. Considering the rarity of the disease, further research is required to investigate the actual prevalence of SMARCA4 deficient thoracic tumors and treatment approaches in Armenia. [Table: see text]

Acute and one-year procedural effects with proactive esophageal cooling during radiofrequency ablation with proactive esophageal cooling - comparison of paroxysmal and persistent atrial fibrillation

Abstract Background/Introduction Proactive esophageal cooling is FDA cleared to reduce the likelihood of ablation-related esophageal injury from radiofrequency (RF) cardiac ablation, and is becoming more prevalent as an alternative to luminal esophageal temperature (LET) monitoring. Data also suggest shorter procedure times and improved freedom from arrhythmia with esophageal cooling due to the lower continuity index achieved with esophageal cooling. Purpose To determine acute and long-term procedural outcomes of PVI for paroxysmal and persistent atrial fibrillation (AF) using active esophageal cooling. Methods Procedure times and one-year follow-up rhythm status of all patients treated with PVI for paroxysmal and persistent AF by a single operator were reviewed. Patients were treated over the time span February 2020 through July 2022. Procedure times and freedom from atrial arrhythmia were then compared between paroxysmal and persistent AF. Results A total of 317 patients with paroxysmal or persistent atrial fibrillation were treated over the course of the study timeframe. Of these patients, 167 (52.7%) had paroxysmal atrial fibrillation, and 150 had persistent AF. Mean age was 70.6±11.0 years (paroxysmal AF: 68.2±10.4 years and 43% female, persistent AF: 73.4±11.0 years and 37% female), with 40% female overall. Mean procedure time was 68.8±28.1 minutes (61.4 minutes for paroxysmal, 77.3 minutes for persistent). Most patients (224, or 71%) received no fluoroscopy, while the remainder received 1.28±4.0 minutes of fluoroscopy use. The KM estimate for freedom from atrial arrhythmia at one-year for paroxysmal patients was 81.4±3.9%. For persistent patients, the KM estimate for freedom from atrial arrhythmia at one-year was 70.4±4.4% (Figure 1). Conclusions Proactive esophageal cooling is associated with a high rate of long-term freedom from arrhythmia for both paroxysmal and persistent AF patients, as well as short procedure times, and the ability to achieve low or zero fluoroscopy use.Figure 1

Natural radioactivity level in Yemen: A systematic review of radiological studies

This paper aimed to conduct a systematic review of 26 published articles from 13 different regions in the Republic of Yemen related to the study of natural radioactivity (NORM) and enhanced artificial radioactivity (TENORM). The study relied on the analysis of various sample types, including air, groundwater, surface water, hot spring water, soil, sand, rocks, building materials, and oil field samples. It also analyzed the study areas, the types of detectors employed, and the study's timeframe. The analytical results raised significant concerns regarding the high levels of radioactivity observed in many of the studied regions. Moreover, some regions indicated the absence of any prior radiological study, despite apparent effects on the population and the environment, which suggest the presence of potential radionuclide concentration. Based on this study, it is strongly recommended that researchers conduct further radiological studies in regions previously studied over extended periods and in areas where no prior radiological studies have been conducted to assess potential radionuclide concentration.

The Brain Injury Guidelines (BIG) and emergency department observation and admission rates: A retrospective cohort study

BackgroundEmergency Department (ED) Observation Units (OU) can provide safe, effective care for low risk patients with intracranial hemorrhages. We compared current ED OU use for patients with subdural hematomas (SDH) to the validated Brain Injury Guidelines (BIG) to evaluate the potential impact of implementing this risk stratification tool. MethodsRetrospective cohort of patients ≥18 years old with SDH of any cause from 2014 to 2020 to evaluate for potential missed OU cases. Missed OU cases were defined as patients with an initial Glasgow Coma Score (GCS) of 15 with hospital length of stays (LOS) <2 days, who did not meet the composite outcome and were not cared for in the OU or discharged from the ED. Composite outcome included in-hospital death or transition to hospice care, neurosurgical intervention, GCS decline, and worsening SDH size. Secondary outcomes were whether application of BIG would increase ED OU use or reduce CT use. Results264 patients met inclusion criteria over 5.3 year study timeframe. Mean age was 61 years (range 19–93) and 61.4% were male. SDH were traumatic in 76.9% and 60.2% of the cohort had additional injuries. The admission rate was 81.4% (n = 215). Fourteen (6.5%) missed OU cases were identified (2.6/year). Retrospective application of BIG resulted in 82.6% (n = 217) at BIG 3, 10.2% (n = 27) at BIG 2 and 7.6% (n = 20) at BIG 1. Application of BIG would not have decreased admission rates (82.6% BIG 3) and BIG 1 and 2 admissions were often for medical co-morbidities. The composite outcome was met in 50% of BIG 3, 22% of BIG 2, and no BIG 1 patients. ConclusionIn a level 1 trauma center with an established observation unit, current clinical care processes missed very few patients who could be discharged or placed in ED OU for SDH. Hospital admissions in BIG 1/2 were driven by co-morbidities and/or injuries, limiting applicability of BIG to this population.

Understanding provider use of a new clinical decision support tool aimed at reducing excess telemetry in an academic health system: A retrospective study.

Cardiac monitoring has often been identified as an area of overutilization and remains a limited resource in many hospitals. With the aim of reducing telemetry overuse, we added clinical decision support to our health system's telemetry order with guidance on appropriate indications for monitoring. The new order requires selection of an appropriate clinical indication. In this study, we aimed to understand provider engagement with this tool by assessing concordance between selected indications within the order and the clinical presence of those conditions as documented within the patient chart. We randomly selected 100 telemetry orders from July to October 2022 across four different hospitals at NYU Langone Health. Two independent, blinded reviewers used a structured protocol to identify documentation of actual indications for telemetry in each selected chart. We calculated the rate of concordance between indications selected in the order and indications that were determined to be clinically present on chart review. There were 30,839 telemetry orders placed during the study timeframe. Overall concordance between the selection within the order and the actual indication was 48% (95% confidence interval [CI], 38.21%-57.79%). We observed especially low concordance rates for vague indications, such as 'Other', and for 'Confirmed Stroke', which was the only indication allowing for indefinite telemetry. The overall low concordance suggests a disconnect between the support tool and clinical practice. Providers are more likely to select an indication that reduces downstream work regardless of a patient's true clinical indication.

P007 Successful use of patient initiated follow-up in a tertiary paediatric rheumatology service

Abstract Background/Aims Patient initiated follow-up (PIFU) is a national strategy enabling patients or carers to initiate contact with a service rather than a traditional model of routine scheduled appointments. PIFU enables patient empowerment and elective recovery after the Covid-19 pandemic. NHSE identified Paediatrics as appropriate for PIFU, but specific measures are needed to ensure safeguarding of paediatric patients is maintained. Methods With NHSE &amp; I support and extrapolating guidance implementing PIFU in adult rheumatology services, we developed a clinical pathway that included safeguarding/governance structures within Paediatric Rheumatology at Alder Hey Children’s Hospital. Two strategies were developed - PIFU culminating with either a timed return (PEND) or discharge (DISCHARGE) model. A PIFU feasibility study in paediatric rheumatology initially targeted three index conditions (arthritis, mechanical pain and primary Raynaud’s) in March 2022. This was extended within a Plan-Do-Study-Act model of Quality Improvement. Results We placed 536 patients within PIFU pathways (PEND = 297, DISCHARGE = 239). The monthly usage of PIFU increased from &amp;lt;10 patients per month in March 2022 to &amp;gt; 40 patients per month in August 2023 with expansion of PIFU conditions. Within this time frame the number of patients put through the DISCHARGE model increased steadily to 60% of the monthly proportion as clinician confidence in PIFU increased. We demonstrate an 11% (total Rheumatology patients) PIFU rate over the study time frame, with a 2.7% (15/536) reactivation rate. Where calculable, timescale for review following activation was &amp;lt;48 hours. In our experience, patients/families are comfortable with PIFU and feel reassured by the safety-net provided. Decision for PIFU PEND/DISCHARGE is made in partnership with patients/families. As well as increased use within Rheumatology, PIFU use has extended to 80% of clinical teams across Alder Hey. The Trust-wide PIFU rate of 10% in September 2023 is double the original NHS England guidance target of 5%. Conclusion We advocate safety of PIFU in the correct population and its ability to empower patients. Table 1 shows the significant impact that correct use of PIFU can have on increasing capacity for seeing new patients, decreasing time to review and matching the number of patient reviews to referrals. Disclosure W. Calvert: None. J. Spinty: None. L.J. McCann: None. G. Cleary: None.

Systematic Literature Review on the Incidence of Herpes Zoster in Populations at Increased Risk of Disease in the EU/EEA, Switzerland, and the UK.

Older adults and patients with underlying conditions such as immunocompromised (IC) populations (e.g., due to medical conditions or immunosuppressive medication) are at increased risk for herpes zoster (HZ). The first HZ recombinant vaccine for IC patients was approved in 2020. Limited evidence exists to inform decision-makers on HZ incidence in high-risk patients in Europe. This systematic literature review (SLR) assessed HZ incidence across 14 high-risk populations in the European Union/European Economic Area, Switzerland, and the United Kingdom. An SLR (Embase, Medline, 2002-2022, observational studies) was performed to identify HZ incidence (i.e., primary outcomes: rate or cumulative; secondary: relative incidence) in type 1 and 2 diabetes mellitus (DM); chronic obstructive pulmonary disease and asthma; depression; rheumatic disorders (RD); multiple sclerosis (MS); inflammatory bowel diseases (IBD); psoriasis; lupus; human immunodeficiency virus (HIV); solid organ transplantation (SOT); solid organ malignancy (SOM); hematologic malignancy (HM); and stem cell transplantation (SCT). Of 776 unique records screened, 59 studies were included (24 reported incidence rate per 1000 person-years; two, cumulative incidence per 1000 persons; and 33, relative incidence). The highest incidence rates were reported for SOT (12.1-78.8) and SCT (37.2-56.1); HM (2.9-32.0); RD (0.41-21.5); lupus (11.0-16.5); IC mixed population (11.3-15.5); HIV/AIDS (11.8-13.0); chronic respiratory diseases (4.7-11.4); SOM (8.8-11.0); IBD (7.0-10.8); DM (4.3-9.4); depression (7.2-7.6); MS (5.7-6.3); and psoriasis (5.3-6.1). In many high-risk populations, HZ incidence was higher for older age groups, women, and some treatments. The HZ incidence rate in Europe increased with age and varied across high-risk populations, with high rates for solid organ and stem cell transplants, cancer, and rheumatoid arthritis. Most studies were retrospective with methodological differences affecting generalizability and comparability. Future studies should stratify data by IC population, age, sex, severity, medication, and study timeframe.

Potential Benefits of Photon-Counting CT in Dental Imaging: A Narrative Review.

Background/Objectives: Advancements in oral imaging technology are continually shaping the landscape of dental diagnosis and treatment planning. Among these, photon-counting computed tomography (PCCT), introduced in 2021, has emerged as a promising, high-quality oral technology. Dental imaging typically requires a resolution beyond the standard CT systems achievable with the specialized cone-beam CT. PCCT can offer up to 100 µm resolution, improve soft-tissue contrast, and provide faster scanning times, which are crucial for detailed dental diagnosis and treatment planning. Using semiconductor detectors, PCCT produces sharper images and can potentially reduce the number of scans required, thereby decreasing patient radiation exposure. This review aimed to explore the potential benefits of PCCT in dental imaging. Methods: This review analyzed the literature on PCCT in dental imaging from January 2010 to February 2024, sourced from PubMed, Scopus, and Web of Science databases, focusing on high-resolution, patient safety, and diagnostic efficiency in dental structure assessment. We included English-language articles, case studies, letters, observational studies, and randomized controlled trials while excluding duplicates and studies unrelated to PCCT's application in dental imaging. Results: Studies have highlighted the superiority of PCCT in reducing artifacts, which are often problematic, compared to conventional CBCT and traditional CT scans, due to metallic dental implants, particularly when used with virtual monoenergetic imaging and iterative metal artifact reduction, thereby improving implant imaging. This review acknowledges limitations, such as the potential for overlooking other advanced imaging technologies, a narrow study timeframe, the lack of real-world clinical application data in this field, and costs. Conclusions: PCCT represents a promising advancement in dental imaging, offering high-resolution visuals, enhanced contrast, and rapid scanning with reduced radiation exposure.