Total Attendance Research Articles

Right-Siting Care and Decongesting Specialist Outpatient Clinics - A Singapore Case Study

Abstract Issue Globally, Specialist Outpatient Clinics (SOCs) face a growing burden due to rising chronic diseases. This strain on resources leads to long appointment wait times (LAWTs), delaying diagnoses and treatments. This is particularly of concern in countries with rapidly ageing populations such as Singapore. Description The Right-Site Care Program is a healthcare transformation initiative implemented by individual healthcare clusters within Singapore to improve access to timely SOC care by directing patients to the most appropriate care level (right-siting). This transitions stable chronic disease patients to primary care providers (PCPs) for ongoing management. A standardised approach utilises evidence-based guidelines for patient selection, followed by identification and transfer of suitable patients to PCPs. This multi-center program offers a real-world example of healthcare system optimisation for chronic disease management. Results A multi-source data analysis, including program reports and peer-reviewed studies from participating healthcare clusters, was conducted to evaluate program impact. The analysis focused on LAWTs, patient outcomes and implementation challenges. Right-siting yielded mixed results across various conditions. Right-sited patients had better survival rates, likely due to closer monitoring and management of chronic conditions with higher total outpatient attendance frequencies. (1) Improvements were particularly significant for diabetes mellitus patients who successfully transitioned to PCPs. (2) However, challenges such as patient scepticism about PCP competence and a preference for specialist care have been identified. (3) Lessons learned Right-siting care can improve patient outcomes for certain chronic diseases. The program’s impact varied across different chronic diseases, highlighting the need for tailored strategies. Educational interventions addressing patient concerns can facilitate smoother patient transitions and program success. Key messages • Right-siting care shows promise, with improved patient outcomes for conditions like diabetes mellitus. • Patient education is crucial to overcome patient scepticism and preference for specialists.

Excess Cardiopulmonary Arrest and Mortality after COVID-19 Vaccination in King County, Washington

Introduction: Since the onset of widespread COVID-19 vaccination campaigns, there have been concerns about serious cardiovascular adverse events as a result of mass vaccination. This study aimed to estimate excess cardiopulmonary arrest mortality in King County, WA, and investigate any association with COVID-19 vaccination rates. Methods: An exploratory data analysis was performed. Comparative analyses were performed to evaluate the changes in total EMS attendances over time. Excess deaths were calculated using the 2015-2020 cardiopulmonary arrest mortality trend line. The relationship between excess cardiopulmonary arrest mortality and vaccination rates was analyzed using polynomial regression analysis. Results: Approximately 98% of the King County population received at least one dose of a COVID-19 vaccine by 2023. As of August 2nd, 2024, there have been approximately 589,247 confirmed COVID-19 cases in King County. In 2021- 2022, Total EMS attendances in King County sharply increased by 35.34% from 2020 and by 11% from pre-pandemic years. Cases of 'obvious death' upon EMS arrival increased by 19.89% in 2020, 36.57% in 2021, and 53.80% in 2022 compared to the 2017-2019 average. We found a 25.7% increase in total cardiopulmonary arrests and a 25.4% increase in cardiopulmonary arrest mortality from 2020 to 2023 in King County, WA. Excess fatal cardiopulmonary arrests were estimated to have increased by 1,236% from 2020 to 2023, rising from 11 excess deaths (95% CI: -12, 34) in 2020 to 147 excess deaths (95% CI: 123, 170) in 2023. A quadratic increase in excess cardiopulmonary arrest mortality was observed with higher COVID-19 vaccination rates. The general population of King County sharply declined by 0.94% (21,300) in 2021, deviating from the expected population size. Applying our model from these data to the entire United States yielded 49,240 excess fatal cardiopulmonary arrests from 2021-2023. Conclusions: We identified a significant ecological and temporal association between excess fatal cardiopulmonary arrests and the COVID-19 vaccination campaign. The increase in excess cardiopulmonary arrest deaths may also be attributed to COVID-19 infection and disruptions in emergency care during the pandemic. Urgent further research is needed to confirm our observations with attention to risk mitigation for incident events and improved survival with resuscitation.

Analisis Kualitas Layanan Aplikasi Prestige Di Kabupaten Gresik Menggunakan Metode ServQual

The Prestige application is an online attendance for Gresik Regency ASN. What is the assessment of the feasibility of the functionality of the Prestige Application, and what factors influence employees dissatisfaction with the Prestige Application. In previous research on attendance applications, only regarding the impact of the application on employee performance. This research tests the application functionality, so that it meets what is required. Researchers as instruments and data collectors provide assessments of the Prestige application, finding problems that result in a decrease in the quality of the Prestige application. The ServQual method or what is called the service quality concept is a method used to test the nature of service quality, and involves 90 questionnaire respondents. In this research, it was found that there is no forget password feature, and importantly there is a feature to display the total number of attendance points. The Reliability dimension gets the largest value, and the Empathy dimension gets the smallest value. As input, BKPSDM needs to add a forget password feature and information regarding total employee attendance points.

Motivation to Run in One-Day Cricket

This paper presents a novel approach to identify an optimal coefficient for evaluating a player’s batting average, strike rate, and bowling average, aimed at achieving an optimal team score through dynamic modeling using a path integral method. Additionally, it introduces a new model for run dynamics, represented as a stochastic differential equation, which factors in the average weather conditions at the cricket ground, the specific weather conditions on the match day (including abrupt changes that may halt the game), total attendance, and home field advantage. An analysis of real data is been performed to validate the theoretical results.

Profile and healthcare utilisation patterns of adolescent frequent attenders in Singapore primary care: a retrospective study

ObjectivesFrequent attenders (FAs) visit healthcare settings at higher rates compared with the general population and use disproportionate amounts of healthcare resources. Frequent attendance (FA) has also been associated with greater...

Exploring Apulia’s Regional Tourism Attractiveness through the Lens of Sustainability: A Machine Learning Approach and Counterfactual Explainability Process

Visitor attraction dynamics lead tourism industry paths. A complex artificial neural network model was built to predict the incoming tourism flow in the Apulia region of Southern Italy as a function of the heterogeneity of the tourism supply available in this area. Open data from the Regional Tourism Observatory were targeted. Information on the distribution of facilities and activities that attract regional tourist flows was collected and grouped by municipality. An artificial neural network model was built with total tourist attendance as the dependent variable and tourist attractions as regressors. The Root Mean Square Error (RMSE) was used to select the optimal model using the lowest value. The final model was run with a hidden layer consisting of three neurons and a decay value of 0.01. A Multi-Objective Counterfactual model (MOC) was then constructed using a randomly selected row of normalized data frame to validate a useful tool in increasing total tourist attendance by 20% over that of the randomly selected municipality. A Garson’s variables importance plot indicated natural landscapes such as beaches, sea caves, and natural parks have a primary role expressed in terms of variable importance in the AI algorithm when used as an innovative methodology for evaluating tourism flows in the Apulia region. A further MOC model built using a randomly selected row of normalized data frame showed convents, libraries, historical buildings, public gardens, and museums as the top five features most modified to improve total attendance in a randomly selected municipality. Use of AI modeling revealed that the implementation of nature-based solutions may speed up the flow of tourism in the Apulia region while also promoting sustainable social development.

Proportions and incidence rates of corneal lesions

Many corneal lesions end in corneal blindness by opacity. Eye Bank, which is not yet available in Yemen, is the source of substituted corneal grafts to retain eye vision. This study compared percentages and incidence rates of corneal lesions in two samples of total 2600 patients in 1993 and 1440 patients in 2004 who attended the same clinic. From the total new eye patients, these with corneal lesions either isolated or combined underwent the same determinants to show demography, etiology, and laterality through documenting their basic data, full history, and examinations. Results: Respectively among the tow samples, a total of (141) 5.42% and (135) 9.38% (belonging to (130) 5.0% and (118) 8.19% patients) had corneal lesions distributed among all age groups, with the age group of 19- 50 years constituted (66) 50.77% and (65) 55.08%. The demography in (number) percentage and incidence rates were as follows: samples were comparable higher among males in (80) 61.54%, 3.08%, and (84) 71.19%, 5.48%, monocular (130) 92.2%, 5.00%, and (118) 87.41%, 8.19%, and AGMH received (79) 66.94%, 5.49%, and (118) 87.0%, 8.00% of the total attendance from outside Sana'a city. Right eye was in (48) 34.04%, 1.85%, and (75) 55.5%, 5.21%. Among etiologies, the incidences were: trauma (69) 2.65%, (61) 4.24%, inflammation (36) 1.38%, 3.08%, and (18) 1.25%; both are controllable and constituted 66.7% and 51% of the total corneal lesions. Then degenerative lesions (12) 0.423%, (9) 0.625%, keratoconus (8) 0.307%, (12) 0.833%, edema (5) 0.231%, (12) 0.833%, dryness (5) 0.192%, (7) 0.278%, dystrophy (4) 0.154%, (8) 0.416%, congenital (2) 0.076%, (6) 0.416%, and tumors were only in 2004 as (2) 0.138%. Conclusion: The incidence rates of corneal lesions were 5.0 and 8.0%, and the proportions of the controllable trauma and inflammations were 66.67% and 51.1%, reflecting the need for wide distribution of eye health centers among the country.

The impact of SARS-CoV-2 on emergency health care demand: inverse relationship between COVID-like illnesses and ED accesses in Genoa, Italy.

SARS-CoV-2 has changed the demand for in-person health care. The aim of this study was to retrospectively analyzed data on access to San Martino Hospital Emergency Department (ED), Genoa, Italy, during the COVID-19 pandemic. Descriptive statistics for 180,117 records of patients accessing the ED between 2019 and 2021 were reported. A linear regression model was built to evaluate the relationship between the weekly number of COVID-like illness cases and ED attendances. In comparison to pre-pandemic levels, the median number of ED visits declined by 41.6% in 2020 and by 27.4% in 2021. The period of maximum drop in access (-61.9%) was the 2020 12-16th calendar weeks and coincided with the highest rates of COVID-like illness cases (+360%; 22.8% of total ED attendances). About 20% of the variation of the weekly number of ED attendances was explained by the number of COVID-like illness cases. In 2020 and 2021 non-urgent ED codes decreased (-6.7%; -7.3%) and both urgent and emergency ED codes increased (+4.8% and +3.9% the first; +1.9% and +3.5% the second). However, the absolute number of ED access fell drastically for all codes. In particular, the highest increase was registered in 2020 for acute respiratory infections (ARI), including COVID-19 (+3.28%), while traumas and eye diseases saw the highest decrease (-1.02%; -3.80%). While the reduction in non-urgent visits suggests avoidable pre-pandemic access levels, the decline in non-COVID-19 urgent accesses potentially points to an increase in delayed and missed care.

Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data.

The COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown. Multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3). During the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed. The first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.

Association between emergency department attendances, sociodemographic factors and long-term health conditions in the population of Norfolk and Waveney, England: Cross sectional study.

Demand for urgent and emergency health care in England has grown over the last decade, for reasons that are not clear. Changes in population demographics may be a cause. This study investigated associations between individuals' characteristics (including socioeconomic deprivation and long term health conditions (LTC)) and the frequency of emergency department (ED) attendances, in the Norfolk and Waveney subregion of the East of England. The study population was people who were registered with 91 of 106 Norfolk and Waveney general practices during one year from 1 April 2022 to 31 March 2023. Linked primary and secondary care and geographical data included each individual's sociodemographic characteristics, and number of ED attendances during the same year and, for some individuals, LTCs and number of general practice (GP) appointments. Associations between these factors and ED attendances were estimated using Poisson regression models. 1,027,422 individuals were included of whom 57.4% had GP data on the presence or absence of LTC, and 43.1% had both LTC and general practitioner appointment data. In the total population ED attendances were more frequent in individuals aged under five years, (adjusted Incidence Rate Ratio (IRR) 1.25, 95% confidence interval 1.23 to 1.28) compared to 15-35 years); living in more socioeconomically deprived areas (IRR 0.61 (0.60 to 0.63)) for least deprived compared to most deprived,and living closer to the nearest ED. Among individuals with LTC data, each additional LTC was also associated with increased ED attendances (IRR 1.16 (1.15 to 1.16)). Among individuals with LTC and GP appointment data, each additional GP appointment was also associated with increased ED attendances (IRR 1.03 (1.026 to 1.027)). In the Norfolk and Waveney population, ED attendance rates were higher for young children and individuals living in more deprived areas and closer to EDs. In individuals with LTC and GP appointment data, both factors were also associated with higher ED attendance.

Emergency Department Presentations to the Mental Health Services at Sligo University Hospital during the COVID pandemic

IntroductionIn March 2020, the WHO declared the outbreak of SARS-CoV-2 a pandemic and Ireland went into its first lockdown. The Mental Health Liaison team at Sligo University Hospital operate 8 am to 8 pm, 7 days a week, with out of hours covered by the on-call Psychiatry junior doctors. The service has seen an increase in referrals, many of whom are known to community mental health teams.ObjectivesWe reviewed the numbers and trends of mental health presentations to the Emergency Department at Sligo University Hospital throughout the pandemic, including the patterns of presentations around the implementation of lockdowns.MethodsThe Liaison Mental Health Service at Sligo University Hospital gathers data relating to numbers and types of presentation to the service. Data was taken from a pre-existing database of psychiatric presentations to the emergency department at Sligo University Hospital including patient demographics, nature of presenting complaint, time period in which they presented and whether they were previously linked in with a community mental health team in the preceding six months. We also looked at the pattern of ED mental health presentations from March 2019 to August 2021. In order to compare psychiatric presentations pre and during covid, data was broken down into two groups: the twelve months preceding March 2020 and the twelve months from March 2020. Categorical data were analysed using the Chi squared test for homogeneity in SPSS.ResultsOverall, there was a 14% increase in mental health presentations during the pandemic. There was a significantly greater proportion of presentations of psychosis during the pandemic period (p&lt;.014) and for medication review (p=.03) and significantly less presenting with addiction (p &lt;0.001). Of those patients seen in the Emergency Department in 2021, 54.3% were known to the CMHT in the previous 6 months. in 2019, mental health presentations made up 1.36% of total ED attendances. This increased to 1.47% in 2020. From January to August 2021, 2.62% of ED attendances were mental health presentations.Image:ConclusionsThe Covid-19 pandemic led to increased mental health presentations to Sligo University Hospital emergency department, with a significantly greater proportion presenting with psychosis and for medication review. These findings have implications around patient care and service provision. These results show that the prevalence of mental health has increased during the pandemic, particularly severe and enduring mental illnesses. New strategies must be implemented to accommodate to this increase in presentations.Disclosure of InterestNone Declared

Impact of water exhaled out by visitors in show caves: a case study from the Moravian Karst (Czech Republic)

The anthropogenic impact of the water and CO2 exhaled by visitors was studied in the show caves of the Moravian Karst (Czech Republic), especially in the Balcarka and Výpustek Caves. Two alternative models based on (1) the known/presumed composition of the breathed air and physical activity of visitors and (2) the detailed monitoring microclimatic data were proposed. The CO2 fluxes of 2.4 × 10−4 and (2.0–3.9) × 10−4 mol person−1 s−1 and the water vapor fluxes of (3.2–8.9) × 10−3 and (0.6–1.2) × 10−2 g person−1 s−1 were found for a slightly increased physical load. The total attendance and cave tour duration were the main driving factors. For the available data on attendance and accessibility periods, the total mass of water vapor exhaled by visitors in all show caves in the Moravian Karst was estimated between 9.6 × 106 and 4.3 × 108 g with significant seasonality. According to the geochemical model, this mass of water is capable of dissolving 1280 to 59,038 g of calcite, assuming a mean winter and summer CO2 concentration in the cave air of 1000 and 3000 ppmv. The larger extent of water condensation can lead to the so-called condensation corrosion, whereas the lower extent of condensation probably causes a recrystallization of calcite on the surface of speleothems and rocks.

Connectedness, feeling At home, and joyful Play (CAP): A place-based wellness model for cognitive health promotion in the community by the community

ABSTRACT As populations age, leveraging community resources to reduce dementia risk is increasingly vital for brain health. Using community-based participatory research methods, we co-developed and tested a pilot program with older adults in Metro Vancouver, Canada, to better understand and address brain health needs in community settings. Over 12 focus groups, older adults provided input which led to a place-based wellness model ‘Connectedness, feeling At home, and joyful Play’ (CAP). The CAP model was incorporated into an 8-week feasibility study, testing various components of a multi-domain realist controlled trial (n = 78). Older adults were recommended various existing activities in the community based on their CAP profiles. A ‘Finding Meaning in Aging’ mindful discussion program was added in response to older adults’ feedback on current gaps. Path analysis of preliminary data suggests that total attendance (β = .196, p = .070) improved brain health at week 8 by increasing a sense of playfulness at week 4 (β = .284, p = .002). Mindfulness (β = .215, p = .046) improved brain health by increasing a sense of at-homeness (β = .227, p = .025). Both pre- and post-implementation feedback from older adults centred the importance of friendship in late life, specifically to address late-life losses. The community-generated CAP model shows promise for place-based cognitive health promotion.

Evaluating the Impact of Annual Resident Retreats on Radiology Resident Wellbeing

To investigate the effect of resident-run wellness retreats on measures of stress, resilience, and cohesion amongst radiology residents. All diagnostic and interventional radiology residents in a single academic medical center were invited to participate in a wellness-focused off-campus retreat. Three retreats were held on an annual basis from 2018 to 2022 and included physical exercises, nutritional wellness, and team-building activities. Participants were surveyed pre- and post- retreat attendance focusing on the following domains: Perceived Stress Scale, higher scores indicating higher levels of perceived stress; Brief Resilience Scale, higher scores indicating greater resilience; Cohesion Scale, higher scores indicating greater cohesion. Paired t-tests and linear regression models were used to compare mean Perceived Stress, Brief Resilience, and Cohesion Scales pre- and post-retreat across covariates. Of 78 total retreat attendances, 75 residents (96%) completed pre- and/or post-surveys. Study population was 51% female and 49% male, with mean age 29±2.8 years. Comparing post- with pre-surveys, retreat attendance was associated with a significant reduction in mean Perceived Stress (12.7 vs 16.3; 95% CI 2.1-5.3) and significant increase in Brief Resilience (3.9 vs 3.7; 95% CI 0.05-0.34) and Cohesion (33 vs 27; 95% CI 4.3-6.7). First year residents experienced the greatest increase in Cohesion compared to fourth year residents (p<0.001). Pre-retreat cohesion was significantly lower in 2022 than in 2018-2019 (26.6 vs 28.7 vs 28.6; p=0.04), with stress and resilience not significantly different by year. An annual resident retreat decreased stress, while increasing resilience and cohesion within a radiology residency, supporting retreats as a potentially viable intervention to promote physician well-being.

Sosialisasi Pembukuan Digital Syariah pada Kelompok Usaha Bersama (Pengolah Krupuk, Telur Asin dan Amplang) di Desa Batakan

The Community Engagement Activity in Batakan Village is focused on the socialization of Sharia digital accounting within the Collective Business Group, attended by 49 participants. The Method of Discussion Approach with a participatory Focused Group Discussion is employed to facilitate the exchange of ideas and perspectives. Participants demonstrate high enthusiasm with a total attendance rate of 100% and active participation, including asking questions throughout the event. Socialization emphasizes using information technology and digitalizing financial accounting by introducing the Finansialku application (Finansialku.com). Evaluation indicates a significant improvement in participants' understanding after the socialization, with the category of 'good' reaching 51.02% and 'sufficient' at 36.73%. The Community Engagement Activity is highly regarded by participants in terms of speakers (87.76% good) and materials (81.63% good) based on the evaluation results. The importance of this activity is evidenced through statistical testing, with a significant value of 0.000 &lt; p (0.05), indicating a significant difference in the participants' cognitive assessment after the socialization. Thus, the delivery of socialization material has proven effective in educating participants about Sharia digital accounting within the collective business group in Batakan Village.

Development and piloting of One Health curriculum in Jordan.

In Jordan, several steps have been done to implement One Health (OH) approach. To increase the awareness for OH concept and approach among health professionals, there was an apparent need to develop an OH curriculum or package to orientate human, animal, and environmental health officials and professionals. The aim of this study was to describe the development and piloting of a OH curriculum for human, animal, and environmental officials and professionals in Jordan. OH curriculum was developed and consisted of four chapters/sections, each of which contained series of power point presentations that covered subject thoroughly and met the learning objectives for each section. Four day workshops on OH curriculum were done for four cohorts of participants from different OH partners. Each section started and ended with a quick knowledge assessment consisting of multiple choice questions (MCQs) (pre- and post-chapter). Comparison of the pre- and post-chapter knowledge assessment scores/results were used to assess gain of knowledge after each section of OH curriculum was completed. The scores of correct answers were compared within the different cohorts using Pearson's chi-square test with p-values ≤0.05 considered significant. Of the total attendance, pre- and post- training quizzes were scored for 102 participants (816 quizzes). Pre-training scores for the different cohorts ranged from 29% to 36%, while post-training scores for the different cohorts ranged from 80% to 87%. Post-training correct answers scores were significantly higher than those were for pre-training scores for the different cohorts (p < 0.05). Percentage of knowledge gain ranged from 41% to 62% for the first section, 34% to 47% for the second section, 41% to 55% for the second section, and 48% to 60% for the fourth section. Average percentage of knowledge gain for the first, second, third, and fourth cohorts were 51%, 53%, 47%, and 47%, respectively, and was 50% for all cohorts. The developed OH curriculum improved different OH partners and officials understanding of the OH concept and approach.

Dementia Caregiving 101: The effect of a pilot virtual dementia caregiving course on caregiver role preparedness and self‐efficacy

AbstractBackgroundDementia affects approximately 6.5 million people over the age of 65 in the US, most of whom are cared for at home by family members. Dementia caregivers (CGs) have reported inadequate perceived role preparedness and self‐efficacy, in addition to burden, depression, and anxiety that is disproportionate to CGs of those without dementia. We created a virtual Dementia Caregiving 101 course offering psychoeducation and skills training through an immersive structured program. The virtual platform was designed to improve access to dementia caregiving education for the rural CGs we serve. Goals of this course were to increase CG role preparedness and self‐efficacy by providing information about dementia and an overview of the caregiving experience.MethodPrior to the first class, CGs were administered questionnaires to assess role preparedness and self‐efficacy. Two intervention groups were then conducted simultaneously for ten weeks. Post‐intervention data regarding role preparedness, self‐efficacy, and course feedback were collected.ResultFifteen CGs enrolled in the course. Four CGs were lost to follow up by the time of post‐group data collection, and one CG’s data was excluded whose scores were significantly discrepant from the overall pattern (this person joined by phone instead of by video). CGs included spouses/significant others (n = 5), former spouses (n = 1), siblings (n = 2), and adult children (n = 2). CGs ranged in age from 58‐76 (age M = 69.2; SD = 6.4). Diagnoses of CG’s loved ones included vascular dementia (n = 4), Alzheimer’s disease (n = 2), and unspecified dementia/no diagnosis given (n = 4). Total session attendance was high (M = 7.8; SD = 1.9; range = 5‐10). Following course completion, CGs reported an overall increase in role preparedness (Pre‐course score = 175; Post‐course score = 198) and self‐efficacy (Pre‐course score = 417; Post‐course score = 482). Qualitative analysis of CG feedback revealed high satisfaction with the course overall, with particular emphasis on usefulness of the manual, convenience of the virtual platform, and the opportunity to learn from other CGs.ConclusionThe Dementia Caregiving 101 virtual course appears to be an accessible and effective program for improving CG role preparedness and self‐efficacy, which are important factors in reducing negative CG outcomes. Our preliminary results are encouraging and underscore the benefits of virtual skills‐based interventions for dementia CGs.

Prevalence and pattern of medico-legal cases in emergency department of a tertiary care Centre in Kathmandu, Nepal

Medico-legal cases are essential component of medical practice and comprise important cases in emergencies.The objectives of this study was to assess the frequency and pattern of medico-legal cases and to identify the vulnerable gender, age group, outcome and the duration of stay in the Emergency Department of Nepal Medical College Teaching Hospital in Kathmandu. Medico-legal cases visiting emergencies from 1st March 2020 to 28th February 2021 were recorded using a proforma. During this period, a total of 1,176 medico-legal cases were registered (10.5% of the total emergency attendance; n=11,212) with 68.0% males and 32.0% females. Maximum number of cases belonged to the age group of 21 - 30 years (n=378; 32.1%) followed by 31 - 40 years (n=271; 23.0%). Most common medico-legal diagnosis was physical assault (n=389; 33.1%) followed by road traffic accidents (n=379; 32.2%). Majority of cases were accidental in nature (47.5%). Most of cases (56.1%) were discharged, 13.8% cases were admitted in different specialties for further management, 8.3% cases were referred to other centers and 21.7% cases left against medical advice. The length of stay was 15 minutes to 24 hours (mean 2.58 hours, SD 1.61). Most of the cases needed surgical consultation.

WORKSHOP IMPLEMENTASI KURIKULUM MARDEKA PENYUSUNAN PERANGKAT PEMBELAJARAN &amp; PROYEK PENGUATAN PROFIL PELAJAR PANCASILA (P5) UNTUK GURU GURU SMKS &amp; SMAS YPK MEDAN

The Mardeka curriculum is motivated by the results of the Program for International Student Assessment (PISA) which shows that 70% of students aged 15 years are below the minimum competence in understanding simple reading or applying basic mathematical concepts. This PISA score has not experienced a significant increase in the last 10-15 years. In addition, there are large disparities between regions and between socio-economic groups in terms of the quality of learning which has been exacerbated by the COVID-19 pandemic. Educators and education practitioners around the world are starting to realize that learning things outside the classroom can help students develop better. Studying things in everyday life can increase students' sensitivity and concern for the surrounding environment. However, in practice this has not been done optimally in the current education system. The Mardeka Curriculum Implementation Workshop for the Preparation of Learning Devices the Project to Strengthen Pancasila Student Profiles (P5) for SMKS and SMAS YPK Medan teachers was held for 4 days. During the workshop, there were 107 participants who attended. As a percentage, the total attendance of participants was 95%.

Assessing Strategies to Reduce the Carbon Footprint of the Annual Meeting of the American Academy of Ophthalmology

Greenhouse gas emissions associated with medical conferences have been associated with climate change, and the effects of climate change have been associated with an increased incidence of ophthalmic diseases. Identifying practical strategies associated with reducing these emissions may be warranted. To assess greenhouse gas emissions associated with in-person and virtual meetings of the American Academy of Ophthalmology (AAO) and to conduct mitigation analyses to suggest strategies to reduce future emissions. Quality improvement study in which attendee and conference data were used to estimate emissions from in-person (October 12 to October 15, 2019, San Francisco, California) and virtual (November 13 to November 15, 2020) AAO annual meetings for 35 104 attendees. The data were also used to perform mitigation analyses to assess whether meeting format alterations could be used to reduce future emissions. Data were analyzed from December 21, 2021, to April 18, 2022. Attendance at a selected meeting. Total attendance was 23 190 participants in 2019 and 11 914 participants in 2020. Greenhouse gas emissions produced by the in-person meeting were estimated by calculating the equivalent metric tons of carbon dioxide (CO2) associated with attendee transportation, attendee accommodations, and the conference venue. Emissions produced by the virtual meeting were estimated by calculating the equivalent metric tons of CO2 associated with attendees' computer use, network data transfer, and video-conferencing server use. Mitigation analyses simulated the association of changing the meeting location and format with reductions in emissions. In this analysis, the 2019 in-person meeting produced 39 910 metric tons of CO2 (1.73 metric tons of CO2 per capita), and the 2020 virtual meeting produced 38.6 metric tons of CO2 (0.003 metric tons of CO2 per capita). Mitigation analyses showed that holding a single in-person meeting in Chicago, Illinois, rather than San Francisco, California, could be associated with transportation-related emissions reductions of 19% (emissions for the San Francisco meeting, 38 993 metric tons of CO2; for the Chicago meeting, 31 616 metric tons of CO2). Holding multiple in-person meetings in separate regions could be associated with transportation-related emissions reductions of as much as 38% (emissions for the San Francisco meeting, 38 993 metric tons of CO2; for multiple meeting scenario 2, 24 165 metric tons of CO2). This study found that the AAO's 2019 in-person meeting was associated with substantially higher greenhouse gas emissions compared with the 2020 virtual meeting, primarily due to transportation-related emissions. Increasing the proportion of virtual participants, holding the meeting in locations chosen to minimize transportation-related emissions, or offering multiple regional meeting locations may reduce the carbon footprint of future meetings.