Total Days Research Articles

Time toxicity for patients receiving oral versus parenteral hypomethylating agents for myelodysplastic syndromes/neoplasms (MDS).

6568 Background: Patients spend substantial time receiving cancer care. Patients with higher-risk MDS treated with hypomethylating agents (HMAs) are generally older and have a median life expectancy of 11–17 months. Patients receiving parenteral treatment for MDS spend significant time in clinics receiving HMA treatment; as such, information on the time burden of treatments (“time toxicity”) is needed to help clinicians guide patients and caregivers with alternative routes of administration. The development of oral HMA therapies offers a strategy that mitigates the time toxicity associated with MDS treatment by increasing the number of “home days” for patients. This study details the time burden among patients with MDS receiving oral HMA therapy versus those receiving intravenous and subcutaneous (IV/SC) HMAs. Methods: This was a retrospective analysis of adult patients with MDS initiating HMA therapy (oral or IV/SC HMA), using the US Cerner Enviza claims database (08/2020–08/2022). Propensity score matching (1:1) was performed on the treatment groups to balance confounding factors; matched cohorts were analyzed (N=158 each). The total direct healthcare encounter days for oral and IV/SC HMA administered patients were evaluated based on the number of healthcare encounter days spent on parenteral HMA administration (0 days for oral HMAs), outpatient, inpatient, and emergency room (ER) visits, and infusion days. Only distinct encounter days were included in the total count; multiple visits in a day were de-duplicated. Mean (SD) healthcare days for oral versus IV/SC HMA groups were calculated for each type of healthcare encounter and summarized. Results: Patients receiving oral HMA incurred a mean total of 15.2 healthcare encounter days compared with 32.8 days for those receiving IV/SC HMAs (Table). Most encounter days for the oral HMA cohort were in the outpatient setting (34.9%) while most encounters for the IV/SC HMA cohort were attributed to receiving parenteral HMA administration (55.5%), followed by inpatient (16.2%) and outpatient visits (14.9%). Conclusions: This study, which is the first report to date of time toxicity in MDS among patients treated with HMA therapy, revealed that patients receiving oral HMA incurred half the time burden of those receiving IV/SC HMAs. Further research is warranted to validate these results in a larger patient cohort and compare these findings with other cancer therapies. [Table: see text]

Comparison of Task-Layered Clinical Orientation to Traditional Orientation in a RN Residency Program.

The purpose of this study was to compare outcomes of using a task-layered clinical orientation when compared with the original patient-layering approach. Use of task-layering to orient new graduate nurses to the clinical world of nursing has been theorized to provide a decrease in cognitive load and allow for more streamlined clinical orientation. The method of this study was a nonrandomized, comparative design to measure the outcomes of length of orientation, new graduate perceptions about level of confidence/comfort with professional nurse responsibilities/skills, stress, satisfaction, and perceptions about orientation. Analysis revealed no statistical significance between the 2 groups. However, the task-layered clinical orientation group completed orientation earlier than the traditional patient-layered group. The task-layered approach to clinical orientation provided as good of outcomes as traditional orientation strategy and may result in cost savings due to decrease in total clinical orientation days.

Correlation Analysis between Urinary Catheter Indwelling Time and Nosocomial Urinary Tract Infection.

Indwelling urinary catheter is closely associated with the occurrence of urinary tract infection (UTI). Herein, we further explored the correlation of urinary catheter indwelling time and UTI. Retrospectively, the medical data of nosocomial patients (n = 681) were collected during two quarters of April 2023 to June 2023 (the second quarter, 23.4-23.6, n = 330) and July 2023 to September 2023 (the third quarter, 23.7-23.9, n = 351). The baseline data and incidence of catheter-related UTI were analysed. The total hospitalisation days and indwelling urinary catheter days of patients in five departments were assessed, namely, coronary care unit (CCU), respiratory intensive care unit (RICU), surgical intensive care unit (SICU), neurology intensive care unit (NICU) and cardiac surgical intensive care unit (CSICU) departments. The correlation between hospitalisation days/indwelling urinary catheter days and the occurrence of UTI was evaluated by Spearman correlation analysis. In the CCU, RICU, SICU, NICU and CSICU departments, the number of patients was 463, 83, 29, 91 and 15, respectively. During 23.4-23.6, the incidence of catheter-associated UTI (CAUTI) was 0, 2.85, 6.12, 0 and 12.99 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. During 23.7-23.9, the incidence of CAUTI was 2.98, 6.13, 8.66, 0 and 0 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. Notably, hospitalisation days/indwelling urinary catheter days were positively correlated with the occurrence of CAUTI in each quarter (p < 0.05). There was a positive correlation between urinary catheter indwelling time and the occurrence of UTI.

Digital health program for patients with cancer to support self-management: A retrospective real-world analysis.

1570 Background: Sidekick Health’s 13-week digital health program was built to support cancer self-management. It was available free of charge to US-based cancer patients through commercial health insurance. The program includes disease education, mindfulness, medication adherence support, and asynchronous messaging with a care manager. We hypothesized that highly engaged users had reduced symptom frequency and severity, and improved quality of life (QoL) outcomes. Methods: In-app data were analyzed for registrations Aug 2021-Jan 2024: n(registered)=1286; n(retained ≥7 days)=795; n(QoL/symptoms)=284. QoL was defined as self-reported sleep quality, energy and stress (10-point scale, ≤4x/week). Symptoms were also self-reported (10-point scale, ≤7x/week). Generalized linear mixed models for repeated measures were used to investigate QoL, symptom frequency and severity changes over the program. Subgroup analysis: weekly iterative k-means clustering into highly- and less-engaged (based on total active days) to mitigate survival bias. Results: Diverse patients from 37 states engaged: mean age 58.0 years (SD=10.5), 71% female; 49% diagnosed &lt;6 months ago, 36% ≥12 months ago; 23% early-stage disease, 26% stable disease, 6% in remission and 2% terminal; 60% received chemotherapy, 24% radiation therapy, and 21% immunotherapy. Most (61%) registered users were active after 7 days and 29% after 90 days. Less-engaged users reported higher mean baseline weight (85.3kg (SD=26.7)) vs highly engaged (76.9kg (SD=18.3); p=0.010) but were otherwise similar (age, gender, height, time since diagnosis and treatment: p&gt;0.05). For QoL, highly engaged users had improved energy (p=0.013) and sleep (p=0.002), but not stress (p=0.164) vs less engaged. A significant time-group interaction for sleep (p&lt;0.001) showed highly engaged users had better sleep, and larger improvements over time vs less-engaged. Overall, users reported fewer symptoms over the program (IRR (95% CI)=0.965 (0.953, 0.978), p&lt;0.001). Symptom frequency decreased significantly for stress (p=0.034) and nausea (p=0.003), but not numbness (p=0.320) or fatigue (p=0.530). Highly engaged users’ symptom severity had a downward trajectory, compared with less-engaged, for fatigue (p=0.044) and nausea (p=0.001), but not stress (p=0.234) or numbness (p=0.680). Conclusions: Theprogram was accessed by a broad patient group and retention was high. Highly engaged users reported improved QoL (energy, sleep) and reduced symptom severity (fatigue, nausea). Total symptom frequency was reduced over the program, as well as for stress and nausea specifically. These findings indicate digital self-management is not only achievable for patients with cancer, but that higher engagement may improve patient-reported outcomes.

Quantifying the Regulation Capacity of the Three Gorges Reservoir on Extreme Hydrological Events and Its Impact on Flow Regime in a Changing Climate

AbstractThe Three Gorges Reservoir (TGR) is one of the world's largest hydropower projects and plays an important role in water resources management in the Yangtze River. For the sake of disaster prevention and catchment management, it is crucial to understand the regulation capacity of the TGR on extreme hydrological events and its impact on flow regime in a changing climate. This study obtains historical inflows of the TGR from 1961 to 2019 and uses a distributed hydrological model to simulate the future inflows from 2021 to 2070. These data are adopted to drive a machine learning‐based TGR operation model to obtain the simulated outflow with TGR operation, which are then compared with the natural flow without TGR operation to assess the impact of TGR. The results indicate that the average flood peaks and total flooding days in the historical period could have been reduced by 29.2% and 53.4% with the operation of TGR. The relative declines in drought indicators including duration and intensity were generally less than 10%. Faced with more severe extreme hydrological events in the future, the TGR is still expected to alleviate floods and droughts, but cannot bring them down to historical levels. The impact of TGR operation on flow regime will also evolve in a changing climate, potentially altering the habitats of river ecosystems. This study proposes feasible methods for simulating the operation of large reservoirs and quantifying the impact on flow regime, and provides insights for integrated watershed management in the upper Yangtze River basin.

Changes in Inhaled Nitric Oxide Use Across ICUs After Implementation of a Standard Pathway.

Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator. It is expensive, frequently used, and not without risk. There is limited evidence supporting a standard approach to initiation and weaning. Our objective was to optimize the use of iNO in the cardiac ICU (CICU), PICU, and neonatal ICU (NICU) by establishing a standard approach to iNO utilization. A quality improvement study using a prospective cohort design with historical controls. Four hundred seven-bed free standing quaternary care academic children's hospital. All patients on iNO in the CICU, PICU, and NICU from January 1, 2017 to December 31, 2022. Unit-specific standard approaches to iNO initiation and weaning. Sixteen thousand eighty-seven patients were admitted to the CICU, PICU, and NICU with 9343 in the pre-iNO pathway era (January 1, 2017 to June 30, 2020) and 6744 in the postpathway era (July 1, 2020 to December 31, 2022). We found a decrease in the percentage of CICU patients initiated on iNO from 17.8% to 11.8% after implementation of the iNO utilization pathway. We did not observe a change in iNO utilization between the pre- and post-iNO pathway eras in either the PICU or NICU. Based on these data, we estimate 564 total days of iNO (-24%) were saved over 24 months in association with the standard pathway in the CICU, with associated cost savings. Implementation of a standard pathway for iNO use was associated with a statistically discernible reduction in total iNO usage in the CICU, but no change in iNO use in the NICU and PICU. These differential results likely occurred because of multiple contextual factors in each care setting.

Smile, You’re on Camera: Investigating the Relationship between Selfie Smiles and Distress

Background: This study examined the relationship between (1) participant smiling in daily “selfie” videos and (2) self-reported distress. Given the extensive use of digital devices for sharing expressions of non-verbal behavior, and some speculation that these expressions may reveal psychological states—including emotional distress—we wanted to understand whether facial expression in these TikTok-like videos were correlated with standardized measures of psychological distress. Based on the work of Paul Ekman and others, which posits that facial expressions are universal reflections of people’s inner states, we predicted that smiling would be inversely related to psychological distress. Method: Twenty-four undergraduate students, aged 18+ years (M = 18.35, SD = 2.75), were prompted to record a two-minute selfie video each evening during two weeks of data collection (i.e., 14 total days). They were instructed to describe various aspects of their day. They also completed self-report questionnaires at the end of each assessment week, including the Depression Anxiety Stress Scale (DASS), Perceived Stress Scale (PSS), and the Pittsburgh Sleep Quality Index (PSQI). Results: A counterintuitive effect was observed whereby smiling intensity during selfie videos was positively correlated with individual differences in anxiety, depression, and stress. Discussion: This study challenges the common view that facial expressions necessarily reflect our inner emotions. It provides preliminary evidence that a mobile sensing app that captures selfies—along with other naturalistic data—may help elucidate the relationship between facial expressions and emotions.

Trend analysis of extreme rainfall indices from CHIRPS precipitation estimates over the Lake Tana sub-basin, Abbay Basin of Ethiopia.

Ethiopia is among the African nations most susceptible to climate change because of its frequent droughts and heavy rainfall. Therefore, hydrological and water management problems require an investigation of regional variability and extreme rainfall patterns. This study analyzed the spatiotemporal trends of extreme rainfall in the Lake Tana sub-basin (LTSB) of Ethiopia's upper Blue Nile basin (UBNB) between 1981 and 2019. The trend and geographic patterns of ten extreme rainfall indices are evaluated using high-resolution data from Climate Hazards Group InfraRed Precipitation Stations (CHIRPS). The researcher used RClimDex, an R software tool, to analyze the ten severe rainfall indices. The variability of the extreme rain indices was also assessed by applying the standard anomaly index (SAI). The trend analysis shows that the majority of rainfall indices decreased in the majority of station locations. Among the rainfall locations, the decreasing trend was only significant in 40% consecutive wet days (CWD), 13.33% (R95p and R99p), and 6.66% highest rainfall amount in a 1-day period (RX1day). In contrast, significant positive patterns were revealed in the incidence of rainfall events of number of heavy precipitation days (R10mm), annual total wet day rainfall (PRCPTOT), and consecutive dry days (CDD), with significant positive trends of 26.66% (R10mm) and 40% (PRCPTOT). Furthermore, a spatial distribution result of extreme rainfall trends reveals considerable variations between stations location. Thus, these findings point to the necessity of creating adaptation and mitigation plans for climate change variability within the sub-basin.

#2499 Multicenter observational study on the impact of continuous monitoring of vascular access on the survival and quality of life of patients on dialysis

Abstract Background and Aims AVE is a multicenter observational study aimed at evaluating the improvements in dialysis efficiency, AVF longevity and mortality that can be achieved by implementing both monitoring by a multidisciplinary team. The universal goal of AV monitoring is to identify early events such as stenosis and intervene before thrombosis, thus maximizing the longevity of access and minimizing morbidity. Method This study takes advantage of the opportunity to use data from 19 hemodialysis centers and approximately 1000 patients and to correlate and examine variables that are commonly reported with each treatment, trends in AV use, trends in patient characteristics, and the practice associated with VA. The data were collected by nurses in a specific section of the management database at each treatment for 5 years. Results Trends at the beginning and at the end of the study were evaluated, and Kaplan Maier curves were performed regarding the survival of the VA and the survival of the patients. The average age of 1000 patients enrolled was 73.5 years. Native AVF was used by 79%, AVG by 2% and CVC by 19%. With increasing age, the use of CVC goes from 6% (15-39 years) to 50.5% in patients over 85 years old. The most frequent complications were: Thrombosis 16.5%, Infections 5.5%. VA-related hospitalization days are 28.7% of total days. The average dialysis goals achieved were: QB 290 ml/Min; purified blood 69.7 L; KT/V:1.35. The AVE study, the survival curves evaluated in aggregate were not different between men and women during the observation period (year 2018: p = 0.327; year 2019: p = 0.174; year 2020: p = 0.343). This finding was also confirmed when the survival data were analyzed according to gender and chronological age. No difference was observed between genders while the significant difference (p = 0.000) between chronological age levels was confirmed as shown in the Figure Conclusion By interpreting data collection for specific performance measures using accurate reports, healthcare professionals can highlight AV performance/inefficiencies and provide correct information to clinical staff to support them in their daily clinical practice and decision making.

#1664 Assessing vascular access thrombectomy service adherence to GIRFT recommendations: single centre experience

Abstract Background and Aims Studies showed that early thrombectomy of dialysis vascular access (VA) is associated with better outcomes [1], especially for native VA [2]. Timely treatment of VA thrombosis within 24-48 hours is recommended by GIRFT to minimize access loss and requirement for dialysis line insertion [3]. Our centre has approximately 430 HD patients but has no on-site vascular surgery or vascular access interventional radiology (IR) service. Wait time for elective VA surgery or fistuloplasty is &amp;gt;8 weeks and VA surveillance is based on routine clinical monitoring. VA prevalence is 62% AV fistula (AVF), 2% AV graft (AVG), 36% central venous catheter (CVC). Fistula thrombectomy is provided at another centre, with increasing waiting times over recent years due to shortage of interventional radiologists. This study evaluates adherence to GIRFT recommendations for patients at our centre requiring thrombectomy and will identify potential local strategies to reduce fistula thrombosis and CVC use. Method In a 24-months’ retrospective cohort analysis of maintenance HD patients with permanent VA, we obtained data on: Results 44 patients with permanent VA developed VA thrombosis. The median waiting time for thrombectomy was 8 days (Fig. 1). Post-intervention primary patency rate was 71% at 3-months and 60% at 6-months (Fig. 2). 61% of patients required hospital admission with a 12-day median length of stay, with total inpatient admission days of 403 days over 2 years (2022-2023), and total cost of £246,065 (Figs. 3 and 4). The median CFD-extended was 356 days, i.e. 9 days/patient/year with VA-related complications (Fig. 5). Conclusion This study shows that our centre's VA thrombectomy service falls far outside the GIRFT recommendation of intervention within 24-48 hours. The high associated rates of CVC use, inpatient bed days and avoidable costs place a heavy burden on patient outcomes and NHS resources. The ideal solution of an on-site thrombectomy service is difficult to achieve due to lack of vascular IR support. In response to this study, we now aim to reduce thrombosis rates by training additional interventional nephrologists in elective fistuloplasty, implementing a robust VA surveillance to improve early detection of malfunctioning VA suitable for elective intervention and improving staff education on fistula care.

Effects of a medical admission unit on in-hospital patient flow and clinical outcomes

Backgroundthe burden of acute complex patients, increasingly older and poli-pathological, accessing to Emergency Departments (ED) leads up hospital overcrowding and the outlying phenomenon. These issues highlight the need for new adequate patients’ management strategies.The aim of this study is to analyse the effects on in-hospital patient flow and clinical outcomes of a high-technology and time-limited Medical Admission Unit (MAU) run by internists. Methodsall consecutive patients admitted to MAU from Dec-2017 to Nov-2019 were included in the study. The admissions number from ED and hospitalization rate, the overall in-hospital mortality rate in medical department, the total days of hospitalization and the overall outliers bed days were compared to those from the previous two years. Results2162 patients were admitted in MAU, 2085(95.6%) from ED, 476(22.0%) were directly discharged, 88(4.1%) died and 1598(73.9%) were transferred to other wards, with a median in-MAU time of stay of 64.5 [0.2–344.2] hours. Comparing the 24 months before, despite the increase in admissions/year from ED in medical department (3842 ± 106 in Dec2015–Nov2017 vs 4062 ± 100 in Dec2017-Nov2019, p<0.001), the number of the outlier bed days has been reduced, especially in surgical department (11.46 ± 6.25% in Dec2015–Nov2017 vs 6.39 ± 3.08% in Dec2017-Nov2019, p=0.001), and mortality in medical area has dropped from 8.74 ± 0.37% to 7.29 ± 0.57%, p<0.001. Conclusionsover two years, a patient-centred and problem-oriented approach in a medical admission buffer unit run by internists has ensured a constant flow of acute patients with positive effects on clinical risk and quality of care reducing medical outliers and in-hospital mortality.

Spatiotemporal Variations in Snow Cover on the Tibetan Plateau from 2003 to 2020

The variations in snow cover on the Tibetan Plateau play a pivotal role in comprehending climate change patterns and governing hydrological processes within the region. This study leverages daily snow cover data and the NASA Digital Elevation Model (DEM) from 2003 to 2020 to analyze spatiotemporal snow cover days and assess their responsiveness to climatic shifts by integrating meteorological data. The results reveal significant spatial heterogeneity in snow cover across the Plateau, with a slight decreasing trend in annual average snow cover duration. Snow cover is predominantly observed during the spring and winter seasons, constituting approximately 32% of the total snow cover days annually. The onset and cessation of snow cover occur within a range of 120–220 days. Additionally, an increasing trend in snow cover duration below 5000 m altitude was observed, in addition to a decreasing trend above 5000 m altitude. Sub-basin analysis delineates the Tarim River Basin as exhibiting the lengthiest average annual snow cover duration of 83 days, while the Yellow River Basin records the shortest duration of 31 days. The decreasing trend in snow cover duration closely aligns with climate warming trends, characterized by a warming rate of 0.17 ± 0.54 °C per decade, coupled with a concurrent increase in precipitation at a rate of 3.09 ± 3.81 mm per year. Temperature exerts a more pronounced influence on annual snow cover duration variation compared to precipitation, as evidenced by a strong negative correlation (CC = −0.67). This study significantly augments the comprehension of hydrological cycle dynamics on the Tibetan Plateau, furnishing essential insights for informed decision-making in water resource management and ecological conservation efforts.

Impact of removing ESBL status labelling from culture reports on the use of carbapenems for non-bacteraemic patients diagnosed with ESBL-positive urinary tract infections.

To evaluate carbapenem prescribing rates for initial definitive treatment of urinary tract infections and clinical outcomes before and after removing ESBL status labels on antibiotic susceptibility reports. This was a retrospective cohort study of adult patients treated for at least 48 h for an ESBL-producing/ceftriaxone-resistant Enterobacterales urinary tract infection. ESBL status reporting ceased in September 2022 for a network of seven community hospitals within the USA. The primary endpoint was the rate of carbapenem prescribing for initial definitive treatment of urinary tract infections. Secondary endpoints included total days of therapy for initial definitive treatment with carbapenems, clinical cure rates, time to transition to oral antibiotic therapy for initial definitive treatment, rate of guideline-compliant therapy, rate of relapsed infection within 30 days, 30 day readmission rate, and 30 day all-cause in-hospital mortality. Of 3055 patients screened, 199 were included in the pre group and 153 were included in the post group. The rate of carbapenem prescribing for initial definitive treatment was 156 patients (78%) in the pre group, compared with 93 patients (61%) in the post group (P = <0.01). Days of therapy for initial definitive therapy with carbapenem was 620 in the pre group compared with 372 in the post group (P < 0.01). There was no difference between other secondary outcomes. Removing ESBL status labels from laboratory reports reduced carbapenem use for initial definitive treatment of urinary tract infections from 78% to 61% (P < 0.01) without impacting clinical outcomes.

Comparison of the pregnancy outcomes of progestin-primed vs. antagonist ovarian stimulation in patients with poor ovarian response: a retrospective study

Objectives Progestin-primed ovarian stimulation (PPOS) is an efficient controlled ovarian stimulation (COS) method. The study explored the pregnancy outcomes between PPOS and antagonist ovarian stimulation protocol (GnRH-ant) in infertile patients with poor ovarian response (POR). Methods This retrospective study included patients with POR who underwent COS at the Reproductive Medical Center of Shanxi Maternal and Child Health Hospital from January 2021 to April 2022. The cycles were grouped as the GnRH-ant group and the PPOS group. The primary outcome was the clinical pregnancy rate; the secondary outcomes included the biochemical pregnancy abortion rate and live birth rate. Results Frozen embryo transfer was used in all cycles in this study. The cycles were divided into the GnRH-ant (n = 236 cycles) and PPOS (n = 273 cycles) groups. Age, BMI, type of infertility, infertility duration, FSH, LH, PRL, E2, T, P, and the number of cycles in the hospital were similar between the two groups (all p > 0.05). No statistically significant differences were observed in the clinical pregnancy rate (primary outcome, 32.71% vs. 43.90%, p = 0.082), total Gn dose, total Gn days, ART mode (IVF or ICSI), AFC, MII follicles, 2PN embryos, fertility, cycle cancelation rate, biochemical pregnancy rate, abortion rate, or live birth rate between the two groups (all p > 0.05). The PPOS group exhibited a higher rate of high-quality embryos than the GnRH-ant group (50.12% vs. 42.90%, p = 0.045). Conclusions The PPOS protocol was comparable to the GnRH-ant protocol regarding induction parameters and cycle cancelation, biochemical pregnancy, clinical pregnancy, and abortion rates but might be associated with a higher proportion of high-quality embryos.

Pediatric Health and System Impacts of Mass Incarceration, 2009–2020: A Matched Cohort Study

ObjectiveThe US has the highest incarceration rate in the world; incarceration’s direct and indirect toll on the health and health care use of youth is rarely investigated. We sought to compare the health of youth with known personal or family justice involvement and a matched cohort of youth without known personal/family justice involvement. MethodsA cross-sectional matched parallel cohort study was conducted. We queried electronic health records on youth (<21 years) with a visit in a large Midwestern pediatric hospital-based institution from January 2009 to December 2020. Youth were located by searching for justice-related (eg, prison, jail) keywords within all clinician notes. Health diagnostic profiles were measured using ICD 9/10 codes. Health care use included total admissions, inpatient days, emergent and urgent visits, and outpatient visits. ResultsAcross all youth at one institution over an 11-year period, 2.2% (N = 38,263) were identified as having probable personal or family justice-involvement. Youth with personal or familial justice involvement had 1.5–16.2 times the prevalence of mental health and physical health diagnoses across all domain groupings compared to a matched sample and the total population sample. From 2009–2020, approximately two-thirds of behavioral health care and nearly a quarter of all hospital inpatient days were attributed to the 2.2% of youth with probable personal or familial justice system involvement. ConclusionThe study illuminates the vast disparities between youth with indirect or direct contact with the criminal legal system and matched youth with no documented contact. Better investment in monitoring and prevention efforts are needed.

Mental illness comorbidity significantly impacts surgical outcomes for emergency surgical patients.

Whilst both mental illness comorbidity and the delivery of emergency surgery are commonplace in Australia, there is little evidence investigating any link between them. As such, this study examines the emergency surgical outcomes for patients with mental illness compared to other surgical patients within the Australian public surgical system. Retrospective cohort study involving adult emergency and elective surgical patients treated at three public hospitals in Sydney, Australia between 2018 and 2019. Patients were identified using ICD-10 diagnosis codes, and grouped by those with decompensated mental illness, chronic depression, or those without mental illness. Outcome measures included those within the emergency department (ED), along with in-hospital mortality and surgical outcomes. Of 48 338 total patients, 31 890 (66.0%) had elective and 16 448 (34.0%) had emergency surgery. For patients with decompensated mental illness, only 228 (0.7%) had elective whilst 425 (2.6%) had emergency surgery. Their outcomes for this surgery type included being triaged significantly higher (Cat 1 or 2, 34% vs. 15%) and longer ED stays (8.3 vs. 6.6 h). They also had significantly more post-operative complications (26% vs. 8%) and total days in hospital (33.8 vs. 8.5 days). There was no significant difference for in-hospital mortality. Patients with mental illness are significantly more likely to have emergency surgery including presenting to the ED with more acute physical illness and to experience worse surgical outcomes compared to other surgical patients for every measure analyzed except mortality. There is considerable opportunity to further investigate how these differences might be improved.

Multimodal approach utilising a weight management programme prior to bariatric surgery in patients with BMI ≥50 kg/m2: A propensity score matching retrospective cohort study.

We evaluated preoperative weight loss and days from initial consult to surgery in patients with BMI ≥50 kg/m2 who were and were not enrolled in medical weight management (MWM) prior to laparoscopic sleeve gastrectomy. We retrospectively identified patients with BMI ≥50 kg/m2 who had primary sleeve gastrectomy between 2014 and 2019 at two bariatric surgery centres in our healthcare system. Patients presenting after 2017 that received preoperative MWM (n = 28) were compared to a historical cohort of non-MWM patients (n = 118) presenting prior to programme initiation in 2017 on preoperative percent total body weight loss (%TBWL) and days from initial consult to surgery. A total of 151 patients (MWM, 33; non-MWM, 118) met inclusion criteria. BMI was significantly greater in MWM versus non-MWM (p = .018). After propensity score matching, median BMI at initial consult in non-MWM versus MWM no longer differed (p = .922) neither were differences observed on the basis of weight, age, sex, race or ethnicity. After PSM, MWM had significantly lower BMI at surgery (p = .018), lost significantly more weight from consult to surgery (p < .001) and achieved significantly greater median %TBWL from consult to surgery (p < .001). We noted no difference between groups on 6-month weight loss (p = .533). Days from initial consult to surgery did not differ between groups (p < .863). A preoperative MWM programme integrated into multimodal treatment for obesity in patients with a BMI ≥50 kg/m2 resulted in clinically significant weight loss without prolonging time to surgery.

Surgical recovery from the COVID-19 pandemic in English adult neurosurgical centres

Objectives The COVID-19 pandemic required a change in resource priority from Neurosurgical care in order to treat medically unwell patients suffering from the complications of COVID-19 infections. We demonstrate the impact of COVID-19 on total bed days in 24 Neurosurgical centres in England offering adult Neurosurgery as well as the total spells (single inpatient episodes) for operative Neurosurgical patients between 2020 and 2022 when compared with 2019. Methods We used Capse Healthcare Knowledge System software iCompare in order to show the change in total spells for patients undergoing a primary or secondary Neurosurgical procedure as defined using the National Neurosurgical Audit Programme (NNAP) OPCS-4 coding framework between 2019 and 2022. Results The overall mortality rate of COVID-19 patients was 12.3% and the percentage of total bed days taken up by COVID-19 patients in hospitals at large was on average 7.7%. The total number of spells for all procedures over the 24 centres in 2022 was 39,019 compared with 45,742 in 2019. There was a cumulative deficit of 24,904 spells. The loss of spells was not equally distributed across regions and hospital Trusts. The average number of referral to treatment pathways completed within 18 weeks has declined from 76% to 57% over the study period and the referral to treatment clearance time has risen from 17 to 24 weeks. Conclusions The mean elective cranial output in 2022 compared with 2019 is at 88% with spinal output lagging at 69%. If the rate of change year on year were to remain at current levels then we would reach pre-pandemic levels of output by 2026.

Experiencing beauty in everyday life

Beauty surrounds us in many ways every day. In three experience sampling (ESM) studies we investigated frequency, category of eliciting stimuli (natural vs human-made) and, the potential moderating role of several individual difference measures on such everyday experiences of beauty in an ecologically valid manner. Further, we explored the impact of such experiences on valence & arousal. Study 1 re-analysed data from a previous study, in line with the current aims. In Studies 2 and 3, we asked participants to report daily experiences of beauty using a mixed random and event-contingent sampling schedule. Mobile notifications (random sampling) prompted participants to take a photo and rate the beauty of their surroundings. Further, current valence and arousal were assessed. Notification frequency and total days of participation differed between these two studies. Participants were able to report additional experiences outside of the notification windows (event-contingent sampling). Our results indicate that we frequently encounter beauty in everyday life and that we find it in nature, in particular. Our results further suggest a mood-boosting effect of encounters with beauty. Lastly, our results indicate influences of individual differences however, these were inconclusive and require further attention.

Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA).

Respiratory tract infections (RTIs) are the leading cause of antibiotic prescriptions, primarily due to the risk for secondary bacterial infections. In this study, we examined whether Echinacea could reduce the need for antibiotics by preventing RTIs and their complications, and subsequently investigated its safety profile. A comprehensive search of EMBASE, PubMed, Google Scholar, Cochrane DARE and clinicaltrials.gov identified 30 clinical trials (39 comparisons) studying Echinacea for the prevention or treatment of RTIs in 5652 subjects. Echinacea significantly reduced the monthly RTI occurrence, risk ratio (RR) 0.68 (95% CI 0.61-0.77) and number of patients with ≥1 RTI, RR = 0.75 [95% CI 0.69-0.81] corresponding to an odds ratio 0.53 [95% CI 0.42-0.67]. Echinacea reduced the risk of recurrent infections (RR = 0.60; 95% CI 0.46-0.80), RTI complications (RR = 0.44; 95% CI 0.36-0.54) and the need for antibiotic therapy (RR = 0.60; 95% CI 0.39-0.93), with total antibiotic therapy days reduced by 70% (IRR = 0.29; 95% CI 0.11-0.74). Alcoholic extracts from freshly harvested Echinacea purpurea were the strongest, with an 80% reduction of antibiotic treatment days, IRR 0.21 [95% CI 0.15-0.28]. An equal number of adverse events occurred with Echinacea and control treatment. Echinacea can safely prevent RTIs and associated complications, thereby decreasing the demand for antibiotics. Relevant differences exist between Echinacea preparations.