Patient Treatment Time Research Articles

Impact of RapidAI mobile application on treatment times in patients with large vessel occlusion

BackgroundCurrent efforts to reduce door to groin puncture time (DGPT) aim to optimize clinical outcomes in stroke patients with large vessel occlusions (LVOs). The RapidAI mobile application (Rapid Mobile App)...

Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy.

BackgroundRadiotherapy for head and neck cancer may cause various oral sequelae, such as radiation-induced mucositis. To protect healthy tissue from irradiation, intraoral devices can be used. Current tissue retraction devices (TRDs) have to be either individually manufactured at considerable cost and time expenditure or they are limited in their variability. In this context, a 3D-printed, tooth-borne TRD might further facilitate clinical use.MethodsA novel approach for the manufacturing of TRDs is described and its clinical application is analysed retrospectively. The devices were virtually designed for fabrication by 3D-printing technology, enabling—in only a single printing design—caudal or bi-lateral tongue displacement, as well as stabilization of a tongue-out position. For a total of 10 patients undergoing radiotherapy of head and neck tumors, the devices were individually adapted after pre-fabrication. Technical and clinical feasibility was assessed along with patient adherence. Tissue spacing was calculated by volumetric analysis of tongue retraction. In one exemplary case, radiotherapy treatment plans before and after tissue displacement were generated and compared. The reproducibility of maxillomandibular relation at device re-positioning was quantified by repeated intraoral optical scanning in a voluntary participant.Results3D-printing was useful for the simplification of TRD manufacture, resulting in a total patient treatment time of less than 30 min. The devices were tolerated well by all tested patients over the entire radiation treatment period. No technical complications occurred with the devices. The TRDs caused an effective spacing of the healthy adjacent tissue, e.g., the tongue. Position changes of maxillomandibular relation were limited to a mean value of 98.1 µm ± 29.4 µm root mean square deviation between initial reference and follow-up positions.ConclusionsThe presented method allows a resource-efficient fabrication of individualized, tooth-bourne TRDs. A high reproducibility of maxillomandibular relation was found and the first clinical experiences underline the high potential of such devices for radiotherapy in the head and neck area.

Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study

BackgroundThe aim of our present study was to investigate the clinical characteristics, treatment status and complications in women with endometriosis (EM) and tube ovarian abscess (TOA) to determine the possible association between TOA and EM.MethodsMedical records were used to analyze the clinical characteristics, treatment and complications. Twenty women who were diagnosed with TOA with EM were compared with 93 women diagnosed as having TOA without EM between January, 2008 and December, 2018.ResultsIn this study, TOA patients with EM were significantly more likely to have a lower age range (20–39 years) than the non-EM group [11/20 (55.0%) vs 27/93 (29.0%)]. In addition, TOA patients with EM were associated with a significantly lower rate of parity [11/20 (55.0%) vs 75/93 (80.6%)], higher rates of infertility [8/20(40%) vs 0/93(0%)] and a significantly lower incidence of elevated blood platelet counts [5/20 (25%) vs 43/93 (46.2%)]. Furthermore, women with EM had greater blood loss (347 ± 445.77 vs 204.67 ± 289.46) and an increased complication rate [3/20(15%) vs 0/93(0%)]. Among the 3 patients who had complications in the EM group, 2 patients had septic shock and 1 patient had intestinal obstruction. And 1 case who had septic shock followed by IVF treatment. There was no significance difference on other factors.ConclusionsThe present study indicated that EM did not increase the difficulty and time of treatment in patients with TOA, but increased bleeding during surgery and serious complications. It is suggested that doctors should pay more attention to postoperative treatment and nursing in women with TOA and EM, especially those who have a history of recent infertility treatment and related procedures.

Assessment of an Artificial Intelligence Algorithm for Detection of Intracranial Hemorrhage

Immediate and accurate detection of intracranial hemorrhages (ICHs) is essential to provide a good clinical outcome for patients with ICH. Artificial intelligence has the potential to provide this, but the assessment of these methods needs to be investigated in depth. This study aimed to assess the ability of Canon's AUTOStroke Solution ICH detection algorithm to accurately identify patients both with and without ICHs present. Data from 200 ICH and 102 non-ICH patients who presented with stroke-like symptoms between August 2016 and December 2019 were collected retrospectively. Patients with ICH had at least one of the following hemorrhage types: intraparenchymal (n= 181), intraventricular (n= 45), subdural (n= 13), or subarachnoid (n= 19). Noncontrast computed tomography scans were analyzed for each patient using Canon's AUTOStroke Solution ICH algorithm to determine which slices contained hemorrhage. The algorithm's ability to detect ICHs was assessed using sensitivity, specificity, positive predictive value, and negative predictive value. Percentages of cases correctly identified as ICH positive and negative were additionally calculated. Automated analysis demonstrated the following metrics for identifying hemorrhage slices within all 200 patients with ICH (95% confidence intervals): sensitivity= 0.93 ± 0.03, specificity= 0.93 ± 0.01, positive predictive value= 0.85 ± 0.02, and negative predictive value= 0.98 ± 0.01. A total of 95% (245 of 258) of ICH volumes were correctly triaged, whereas 88.2% (90 of 102) of non-ICH cases were correctly classified as ICH negative. Canon's AUTOStroke Solution ICH detection algorithm was able to accurately detect intraparenchymal, intraventricular, subdural, and subarachnoid hemorrhages in addition to accurately determine when an ICH was not present. Having this automated ICH detection method could drastically improve treatment times for patients with ICH.

Abstract P285: Thrombectomy Treatment Times Pre-Post Early Activation of Interventional Radiology Team

Background: Reducing treatment time for ischemic stroke is crucial. In 2017, an urban Comprehensive Stroke Center (CSC) in the Pacific Northwest (PNW) initiated early activation of the interventional radiology team (Early-IR) based on first responder LAMS’ score of 4 or 5 to improve thrombectomy treatment times (door-to-arterial access times [DTAA]) for acute ischemic stroke patients. Policy efficacy has not been evaluated. Objectives: 1) Compare DTAA times and clinical outcomes pre vs post Early-IR initiation using a multi-state stroke registry. 2) Compare DTAA times and clinical outcomes between the PNW and other CSCs in the same multi-state stroke registry. Methods: Included ischemic stroke patients arrived via emergency medical services from 01/01/2015 to 03/30/2020 at PNW CSC and from 05/15/2017 to 03/31/2020 at five other CSCs. Mann-Whitney U test and multiple linear regression were used to compare DTAA among patients arriving Pre-Early IR vs Post-Early IR at PNW and then to compare PNW vs other CSCs during the Post-Early IR phase. Discharge disposition and ambulation were compared using Pearson’s chi-squared tests. Models were adjusted for admission NIHSS, age, gender, race, IV tPA treatment, comorbidities and medications at admission. Results: A total of 156 PNW patients were included in the primary analysis, 32.1 % (n=50) in the Pre- and 67.9% (n=106) in the Post-Early IR groups. Bivariate analyses showed DTAA was faster Post-Early IR (131 minutes vs 92 minutes, p<.001) and remained faster after adjusting for covariates (B=-.500, p <.001). Early IR did not significantly impact discharge disposition ( p =.620) or ambulation ( p =.995) (Table 1). Comparing the PNW to five other CSCs during the Post-Early IR period showed no significant difference in DTAA or secondary outcomes (Table 1). Conclusion: Early IR decreased thrombectomy treatment initiation times for ischemic stroke patients at the PNW CSC.

Abstract P153: SARS-CoV-2 (COVID-19) Protection Efforts on Acute Stroke Treatment

Introduction: It is unclear how the interventions designed to restrict community and in-hospital exposure to the SARS-CoV-2 virus affected the care for stroke patients seeking acute treatment. The objective of the following study was to determine the impact COVID-19 has had on the treatment times for patients evaluated as acute stroke alerts at Baptist Hospital of Miami (BHM). A co-primary objective of the study was to assess the risk of contracting SARS-CoV-2 within 2 weeks from hospital discharge. Methods: This retrospective, two phase study was conducted between December 2019 and April 2020. In phase one, we assessed time from symptom onset to hospital arrival, number of strokes with witnessed onset, and in-hospital treatment times pre & post implementation of Covid-19 preventive exposure measures. In phase two of the study, a telephone survey was conducted on the post implementation group to assess the risk of patients developing symptoms or testing positive for SARS-CoV-2 from hospital admission up to two weeks post discharge. Results: Phase I demonstrated there was a 40% decline in stroke volume, but no significant delay to seek medical attention post implementation of the SARS prevention strategies. On average individuals in the pre-group (n=155) waited approximately 260 minutes (SE=24) to seek medical attention vs. 203 minutes (SE=27) minutes for the post-group (n=87). However, there was nearly a six-fold increase in the percentage of cases with unknown symptom onset post implementation of COVID-19 safety precautions. There was significant delay in administering IV alteplase, increasing from 24 mins (n=16) to 33 mins (n=21) post implementation; delays observed for endovascular treatment were not significant (pre, n=13 mean= 73 mins, post n=12 mean= 82 mins). The volume of patients treated with either IV alteplase and/or endovascular treatment remained similar. Phase II of the study is on-going, results will be available for the ISC. Discussion: The COVID-19 crisis in our community was associated with a six-fold increase in the percentage of cases with unknown stroke onset time. Besides a marked decrease in stroke volume, we did not evidence significant delays to either seek or provide acute stroke care outside a modest increase in door to needle time.

Timing of corticosteroids impacts mortality in hospitalized COVID-19 patients.

The optimal timing of initiating corticosteroid treatment in hospitalized patients is unknown. We aimed to assess the relationship between timing of initial corticosteroid treatment and in-hospital mortality in COVID-19 patients. In this observational study through medical record analysis, we quantified the mortality benefit of corticosteroids in two equally matched groups of hospitalized COVID-19 patients. We subsequently evaluated the timing of initiating corticosteroids and its effect on mortality in all patients receiving corticosteroids. Demographic, clinical, and laboratory variables were collected and employed for multivariable regression analyses. 1461 hospitalized patients with confirmed COVID-19 were analyzed. Of these, 760 were also matched into two equal groups based on having received corticosteroid therapy. Patients receiving corticosteroids had a lower risk of death than those who did not (HR 0.67, 95% CI 0.67–0.90; p = 0.01). Timing of corticosteroids was assessed for all 615 patients receiving corticosteroids during admission. Patients receiving first dose of corticosteroids > 72 h into hospitalization had a lower risk of death compared to patients with first dose at earlier time intervals (HR 0.56, 95% CI 0.38–0.82; p = 0.003). There was a mortality benefit in patients with > 7 days of symptom onset to initiation of corticosteroids (HR 0.56, 95% CI 0.33–0.95; p = 0.03). In patients receiving oxygen therapy, corticosteroids reduced risk of death in mechanically ventilated patients (HR 0.38, 95% CI 0.24–0.60; p < 0.001) but not in patients on high-flow or other oxygen therapy (HR 0.46, 95% CI 0.20–1.07; p = 0.07) and (HR 0.84, 95% CI 0.35–2.00; p = 0.69), respectively. Timing of corticosteroids initiation was related to in-hospital mortality for COVID-19 patients. Time from symptom onset > 7 days should trigger initiation of corticosteroids. In the absence of invasive mechanical ventilation, corticosteroids should be initiated if the patient remains hospitalized at 72 h. Hypoxia requiring supplemental oxygen therapy should not be a trigger for initiation of corticosteroids unless the timing is appropriate.

The Evaluation Characteristics of Type B Aortic Intramural Hematoma and Ten Years Treatment Outcomes

Background: Type B aortic intramural hematoma (IMH-B) is recognized as a subset of aortic dissection. The evolution of uncomplicated IMH-B is very difficult to predict. How and when to deal with this disease is unclear. The present study constructed two models to explore this problem. One is the morphology evolution model, which explored the risk factors and predictors for the IMH-B patients. Another is the predictive model confirmed the predictors and the time for invasive treatment of uncomplicated IMH-B patients. Objective: To explore the evolution predictors and detect the time for invasive treatment of uncomplicated IMH-B patients. Methods: Themorphology evolution model demonstrated that all 81 patients were diagnosis with CTA images. The initial and follow-up data were retrospectively studied. The evolution data were collection and measurement from initial and follow-up CTA images data. The predictive model showed that predictors of progression were detected with cox regression analysis. Results: All 81IMH-B patients were followed-up ranged from 1.2 to 36 months (median, 22 months). 26 patients accepted invasive treatment (24 underwent TEVAR and 2 underwent Surgery). 55 patients received medical treatment. Invasive treatment (IT) group overall events are 1/26 (3.8%); medical treatment (MT) group overall events are 33/55 (60.0%); IT group vs. MT group: p . Moreover, we found that most events related aorta occurred within 30 days. Multivariate Cox regression analysis MDAD (hazard ratio, 3.58; 95% CI, 1.25- 5.78; p - 7.84; p - 5.63; p Conclusions: MDAD > 45 mm, MDAHT > 10 mm, and IMH with PAU may be the important predictors for uncomplicated IMH-B patients. Most adverse aorta related events occurred within 30 days. It would be careful follow-up, closely observe for these patients within 30 days, and take necessary treatment strategies in time.

How to Choose a Survival Period? The Impact of Antibiotic Use on OS or PFS in NSCLC Patients Treated With Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis.

Background:The development of immunotherapy has dramatically changed the treatment of non-small-cell lung cancer. The negative association of antibiotics on the clinical activity of immune checkpoint inhibitors in patients with NSCLC is well known.Methods:PubMed, Embase, and Medline databases were searched until January 11, 2020. We included retrospective studies of ICIs (e.g., PD-1, PD-L1, and CTLA-4). The clinical outcomes were progression-free survival (PFS) and overall survival (OS). Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated, and subgroup and sensitivity analyses were performed.Results:Our results indicated that the use of antibiotics reduced the survival of NSCLC patients treated with ICIs. The pooled HRs of PFS and OS were HR = 1.41 (95% CI = 1.23-1.61; P < 0.001) and HR = 2.16 (95% CI = 1.79-2.60; P < 0.001). We divided the studies into 5 subgroups according to antibiotic exposure time. Subgroup analysis showed that the patients that were administered antibiotics [−60 days; 0 days] or [−30 days; 0 days] before the initiation of ICIs treatment had a poorer OS rate, whereas those patients that were administered antibiotics [0 days; 30 days] after the initiation of ICIs treatment had a poorer PFS rate. In summary, ATB treatment in patients [−60 days; +30 days] near the initiation of ICIs treatment significantly reduced the survival in NSCLC patients.Conclusion:Our results indicated that ATB use is negatively associated with survival in NSCLC patients treated with ICIs immunotherapy. Similar studies involving a larger sample of cases are still being published. This meta-analysis identified that the timing of ATB treatment in NSCLC patients receiving ICIs immunotherapy has different effects on the OS and PFS of these patients. ATB treatment prior to the initiation of ICIs treatment affects OS, whereas ATB treatment after the initiation of ICIs treatment affects PFS.

Solving the Emergency Care Patient Pathway by a New Integrated Simulation-Optimisation Approach

One of the most critical objectives in the healthcare system is maximising patient flows in the emergency care patient pathway. Patient emergency flow analysis indicates that the timetabling of a patient’s movement from one activity to another through the Emergency Department (ED) is critical for treating patients. The ED deals with the patient’s arrival, triage, physician assessment, imaging and laboratory studies, treatment planning, nursing procedures, and decisions to admit or discharge the patient. Any delayed activities in patient flow reduce the service level of healthcare. To address these challenges, this paper develops a stochastic ED Simulation-Optimisation approach by considering stochastic variables, such as patient interarrival times and treatment times, using statistical distributions. This type of distribution depends on two main elements: day shifts and patient categories. A hybrid evolutionary algorithm is integrated with the simulation to find a satisfactory solution for this stochastic optimisation problem in real time. Computational experiments show that the proposed approach can serve more patients in specific time windows or provide the same quality of the service with the use of fewer medical resources.

Keratoconus: cross-linking the window of the eye.

Review of current treatments using cross-linking to halt the progress of keratoconus Keratoconus is a disease in which the curved cornea, the transparent window at the front of the eye, weakens, bulges forward into a cone-shape and becomes thinner. This change of curvature means that light is not focussed onto the retina correctly and vision is progressively impaired. Traditionally, the effects of early keratoconus were alleviated by using glasses, specialist contact lenses, rings inserted into the cornea and in severe cases, by performing a corneal transplant. However, it was discovered that by inducing chemical bonds called cross-links within the cornea, the tissue could be strengthened and further thinning and shape changes prevented. The standard cross-linking procedure takes over an hour to perform and involves the removal of the cells at the front of the cornea, followed by the application of Vitamin B2 eye drops and low energy ultraviolet light (UVA) to create new cross-links within the tissue. Clinical trials have shown this standard procedure to be safe and effective at halting keratoconus progression. However, there are many treatment modifications currently under investigation that aim to reduce patient treatment time and increase comfort, such as accelerated cross-linking procedures and protocols that do not require removal of the surface cells. This review describes the different techniques being developed to carry out corneal cross-linking efficiently and painlessly, to halt keratoconus progression and avoid the need for expensive surgery.

The importance of general practitioners in emergency and pre-hospital first aid

The purpose of this study is to determine the critical role and managerial impact of general practitioners in pre-hospital first aid and emergency work. The study subjects were 100 emergency patients treated in a hospital between May 2020 and November 2021. They were randomly assigned to an observation group and a control group, each having 50 cases. The control group followed a standard management protocol, but the observation group included emergency care. Management, compare the management effectiveness of the two patient groups. The observation group's arrival and rescue times were much shorter than those in the control group. Patient satisfaction was much greater in the observation group than in the control group. Conclusion: General practitioners have a broader range of medical expertise and are better equipped to give complete medical care to their patients. Emergency management can enhance general practitioners' productivity, further reduce emergency response time, prioritize patient treatment time, and raise the success rate of rescue. Additionally, patient satisfaction.

Evaluation of upper labial frenectomy: A randomized, controlled comparative study of conventional scalpel technique and Er:YAG laser technique.

ObjectivesAbnormalities in the maxillary frenum may lead to esthetic or functional limitations and need to be corrected with a surgical intervention called frenectomy. The aim of the study was to compare frenectomies performed using Er:YAG laser technology with those using a conventional scalpel technique. Comparisons were of patients' experiences, treatment times, bleeding during treatment and wound healing.Material and methodsThe trial was performed as a prospective, randomized and controlled, single‐blind investigation. A total of 40 patients requiring frenectomy were randomly assigned to groups which underwent either conventional or Er:YAG laser treatment. Patients' experiences, treatment time, bleeding and wound healing were evaluated immediately after surgery and 5 days, 12 days and 3 months after surgery.ResultsSignificant increase in time spent in surgery and bleeding was seen with conventional scalpel surgery. Directly after surgery the wound area was significantly larger in the laser group but at the 5‐day evaluation no difference could be observed between the groups. Finally, patients were satisfied with both methods, giving them the same assessments.ConclusionIn the frenectomy procedure, laser surgery is faster and causes less bleeding and may be advantageous in frenectomies.

Evaluation of relationship between chronological age cervical vertebrae maturation index method and canine calcification stages for the assessment of optimal treatment timing in orthodontic patients

Introduction: The study was undertaken to evaluate the reliability of cervical vertebrae as skeletal age maturation in response to chronological age and evaluate the relationship between DEMIRIJAN system of mandibular canine calcification and cervical vertebral maturation as a clinical method for skeletal maturation indicator. Materials and Methods: 120 children (60 females and 60 males) were randomly selected in the age range of 8-14 years. Results: 23.3% of males showed E stage of (canine calcification stage) CCS and stage II of cervical vertebral maturation (CVM), 16.6% showed F stage of CCS and stage III of CVM, 13.3% showed stage G of CCS and Stage III of CVM 8.3% showed stage G of CCS and stage IV of CVM. 13.3% of females showed E stage of CCS and stage II of CVM, 13.3% showed F stage of CCS and stage III of CVM, 16.67% showed stage G of CCS and Stage III of CVM, 15% shows stage G of CCS and stage IV of CVM,. Conclusions: The correlation values between the Chronological age, dental calcification stages and cervical vertebrae maturation method were high. Attaining of maturity in canine calcification and cervical vertebrae maturational stages was ahead in females when compared to males. Keywords: Cervical vertebrae, Cephalometrics, Canine calcification.

Doctor reported outcomes: Real-world data from a tertiary eye cancer center.

Purpose:To provide real-world data on the world-wide-web for patient and doctor awareness.Methods:From December 2017 to January 2020, consecutive patients with choroidal melanoma (CM), iris ciliary body melanoma (ICM), and ocular surface squamous carcinoma (OSSC) had specific outcomes recorded at each return visit. Each result was anonymized, entered in an online portal, and sent to a unique software program where it was used to create real-world data of number of patients, mean vision, local tumor control, eye salvage, systemic metastases, and length of follow-up for our eye cancer center.Results:A HIPAA compliant, internet-based software program was developed and linked to public access web page to collect and analyze near-real-time data pertaining to the treatment, vision, life, and follow-up time of patients. During this period, CM radiation plaque tumor control was 99.7%, median vision 20/25 (mean 20/50) and eye salvage 95.8%. ICM tumor control was 99.1% and the median vision 20/20 (mean 20/20). OSSC tumor control was 100% and the most common vision was 20/20 (mean 20/25). Rates of primary enucleation as treatment were 4.2% for CM, 2.8% for ICM, and 0% for OSSC. All patient results were updated by the ophthalmic oncology fellow at each patient visit as to reflect near-real-time outcomes at our center.Conclusion:Prospective data collection of returning patients was found to be a simple method to reflect patient care outcomes. This method of reporting doctor outcomes offers a measure of transparency for patients and an opportunity to compare results with other clinical practices.

CRISPR-Based Approaches for Efficient and Accurate Detection of SARS-CoV-2.

An outbreak of COVID-19, caused by infection with SARS-CoV-2 in Wuhan, China in December 2019, spread throughout the country and around the world, quickly. The primary detection technique for SARS-CoV-2, the reverse-transcription polymerase chain reaction (RT-PCR)–based approach, requires expensive reagents and equipment and skilled personnel. In addition, for SARS-CoV-2 detection, specimens are usually shipped to a designated laboratory for testing, which may extend the diagnosis and treatment time of patients with COVID-19. The latest research shows that clustered regularly interspaced short palindromic repeats (CRISPR)–based approaches can quickly provide visual, rapid, ultrasensitive, and specific detection of SARS-CoV-2 at isothermal conditions. Therefore, CRISPR-based approaches are expected to be developed as attractive alternatives to conventional RT-PCR methods for the efficient and accurate detection of SARS-CoV-2. Recent advances in the field of CRISPR-based biosensing technologies for SARS-CoV-2 detection and insights into their potential use in many applications are reviewed in this article.

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

PurposeIntracranial lateral dural arteriovenous fistula (LDAVF) represents a specific subtype of cerebrovascular fistulae, harboring a potentially life-threatening risk of brain hemorrhage. Fluoroscopically guided endovascular embolization is the therapeutic gold standard. We provide detailed dosimetry data to suggest novel diagnostic reference levels (DRL).MethodsRetrospective single-center study of LDAVFs treated between January 2014 and December 2019. Regarding dosimetry, the dose area product (DAP) and fluoroscopy time were analyzed for the following variables: Cognard scale grade, endovascular technique, angiographic outcome, and digital subtraction angiography (DSA) protocol.ResultsA total of 70 patients (19 female, median age 65 years) were included. Total median values for DAP and fluoroscopy time were 325 Gy cm2 (25%/75% percentile: 245/414 Gy cm2) and 110 min (68/142min), respectively. Neither median DAP nor fluoroscopy time were significantly different when comparing low-grade with high-grade LDAVF (Cognard I + IIa versus IIb–V; p > 0.05, each). Transvenous coil embolization yielded the lowest dosimetry values, with significantly lower median values when compared to a combined transarterial/transvenous technique (DAP 290 Gy cm2 versus 388 Gy cm2, p = 0.031; fluoroscopy time 85 min versus 170 min, p = 0.016). A significant positive correlation was found between number of arterial feeders treated by liquid embolization and both DAP (rs = 0.367; p = 0.010) and fluoroscopy time (rs = 0.295; p = 0.040). Complete LDAVF occlusion was associated with transvenous coiling (p = 0.001). A low-dose DSA protocol yielded a 20% reduction of DAP (p = 0.021).ConclusionThis LDAVF study suggests several local DRLs which varied substantially dependent on the endovascular technique and DSA protocol.

Does crowding influence emergency department treatment time and disposition?

ObjectiveThe objective of this study was to determine whether crowding influences treatment times and disposition decisions for emergency department (ED) patients.MethodsWe conducted a retrospective cohort study at 2 hospitals from January 1, 2014, to July 1, 2014. Adult ED visits with dispositions of discharge, admission, or transfer were included. Treatment times were modeled by linear regression with log‐transformation; disposition decisions (admission or transfer vs discharge) were modeled by logistic regression. Both models adjusted for chief complaint, Emergency Severity Index (ESI), and 4 crowding metrics in quartiles: waiting count, treatment count, boarding count, and National Emergency Department Overcrowding Scale.ResultsWe included 21,382 visits at site A (12.9% excluded) and 29,193 at site B (15.0% excluded). Respective quartiles of treatment count increased treatment times by 7.1%, 10.5%, and 13.3% at site A (P < 0.001) and by 4.0%, 6.5%, and 10.2% at site B (P < 0.001). The fourth quartile of treatment count increased estimates of treatment time for patients with chest pain and ESI level 2 from 2.5 to 2.9 hours at site A (20 minutes) and from 3.0 to 3.3 hours at site B (18 minutes). Treatment times decreased with quartiles of waiting count by 5.6%, 7.2%, and 7.3% at site B (P < 0.001). Odds of admission or transfer increased with quartiles of waiting count by 8.7%, 9.6%, and 20.3% at site A (P = 0.011) and for the third (11.7%) and fourth quartiles (27.3%) at site B (P < 0.001).ConclusionsLocal crowding influenced ED treatment times and disposition decisions at 2 hospitals after adjusting for chief complaint and ESI.

The factor VIII treatment history of non‐severe hemophilia A

BackgroundIn patients with non‐severe hemophilia A, we lack detailed knowledge on the timing of treatment with factor VIII (FVIII) concentrates. This knowledge could provide information about the expected treatment timing in patients with severe hemophilia A treated with non‐replacement therapies. ObjectiveTo assess the FVIII treatment history in patients with non‐severe hemophilia A. MethodsPatients with non‐severe hemophilia (baseline FVIII activity [FVIII:C] 2‐40 IU/dL) were included from the INSIGHT study. The primary outcome was median age at first FVIII exposure (ED1). In a subgroup of patients for whom more detailed information was available, we analyzed the secondary outcomes: median age at first 20 EDs, annualized bleeding rate for all bleeds (ABR), joint bleeds (AJBR), and major spontaneous bleeds (ASmBR). ResultsIn the total cohort (n = 1013), median baseline FVIII activity was 8 IU/dL (interquartile range [IQR] 4‐15) and the median age at ED1 was 3.7 years (IQR 1.4‐7.7). Median age at ED1 rose from 2.5 years (IQR 1.2‐5.7) in patients with FVIII:C 2‐5 IU/dL to 9.7 years (IQR 4.8‐16.0) in patients with FVIII:C 25‐40 IU/dL. In the subgroup (n = 104), median age at ED1, ED5, ED10, and ED20 was 4.0 years (IQR 1.4‐7.6), 5.6 years (IQR 2.9‐9.3), 7.5 years (IQR 4.4‐11.3), and 10.2 years (IQR 6.5‐14.2), respectively. Median ABR, AJBR, and ASmBR were 1.1 (IQR 0.5‐2.6), 0.3 (IQR 0.1‐0.7), and 0 (IQR 0‐0), respectively. ConclusionThis study demonstrates that in non‐severe hemophilia A, the age at first FVIII exposure increases with baseline FVIII:C and that major spontaneous bleeds rarely occur.

Improving Nutrition Services to Reduce Plate Waste in Patients Hospitalized Based on Theory of Constraint

Background: Highly plate waste in hospitalized patients has become a problem in Hospitals’ nutrition service department, this causes adding treatment time for patient’s recovery and making the hospital service inefficient.Objectives: This research strives to develop a set of recommendations to improve the nutrition department service quality by reducing plate wastes in hospitals. Methods: This research uses a cross-sectional approach. The constraint causing analysis is done by observing dominant waste in each menu’s component and conducting FGD with the management team, nutrition department, and other related departments. The research population is 3000 plates.Results: One of the success indicators in the hospital’s nutrition services is less than 20% of plate waste. It was found that 26,65% or 327 of 1230 observed plates have more than 20% plate waste. The constraint was set with low scale value, food’s aroma, with 2,7 which make food’s aroma as a first priority problem to solve.Conclusions: The solution recommendation about constraint causes was sent to the nutrition department and hospital directors to review the hospital’s policies and SOP. The improvement can be focused on the hospital’s internal policies, Standard Operating procedures, employee competencies, obedience to set procedures, and also chefs and cooks skill