Treatment Urgency Research Articles

Telemedicine and Access to Elective Cholecystectomy for Socially Vulnerable Adults

Socially vulnerable patients with symptomatic cholelithiasis are more likely to face barriers to accessing surgical care. This barrier to access can lead to delays in treatment, the need for emergent cholecystectomy, and worse outcomes. To determine the effectiveness of telemedicine vs in-person surgical consultation on access to elective cholecystectomy in socially vulnerable populations and to evaluate the association of scheduling navigation with access to elective cholecystectomy in these populations. This pilot randomized clinical trial conducted in a single academic center enrolled 60 adults from February 1, 2023, to February 21, 2024, with 3-month follow-up of clinical outcomes. Data were also collected retrospectively on a comparison group of 32 patients referred from June 30 to December 29, 2022. Adults with social vulnerability, such as being non-White or Hispanic or having nonprivate insurance or low income, with a diagnosis of symptomatic cholelithiasis and referral for outpatient surgical consultation were included. All trial participants were randomized to the telemedicine or in-person surgical consultation group, and received professional scheduling navigation. The latter intervention was compared with a historical cohort without navigation assistance. The primary outcome was completion of outpatient surgical consultation. Secondary outcomes included receipt of treatment and operative urgency. The trial enrolled 60 participants (30 per arm). Their mean (SD) age was 48.2 (18.2) years, 50 (83.3%) were female, 2 (3.3%) were Asian, 39 (65.0%) were Black, 8 (13.3%) were Hispanic, 11 (18.3%) were White, and 41 (68.3%) had no private insurance. The historical patient cohort included 32 participants (mean [SD] age, 45.9 [3.2] years; 27 [84.4%] female; 3 [9.4%] Asian, 15 [46.9%] Black, 10 [31.3%] Hispanic, and 6 [18.8%] White; and 18 [56.3%] without private insurance). In total, 18 trial participants assigned to telemedicine (60.0%) completed surgical consultations compared with 23 trial participants assigned to in-person visits (76.7%; P = .17). For telemedicine participants who underwent cholecystectomy, 3 of 7 (42.9%) underwent emergent cholecystectomy compared with 0 of 14 (0%) participants with in-person consultations (P = .03). Of 30 trial participants who received scheduling navigation, 23 (76.7%) completed surgical consultations compared with 15 of 32 patients in the historical cohort who did not receive scheduling navigation (46.9%; P = .02). Of 14 trial participants who received scheduling navigation and cholecystectomy, no participants underwent emergent cholecystectomy compared with 4 of 16 (25.0%) participants in the historical cohort without scheduling navigation (P = .04). In this pilot randomized clinical trial of socially vulnerable adults with symptomatic cholelithiasis, telemedicine consultation compared with in-person visits did not improve access to elective outpatient surgical care. However, scheduling navigation services may improve access to elective outpatient surgical care. Future large-scale studies are needed to identify possible barriers to virtual health care and mechanisms to address inequities. ClincialTrials.gov Identifier: NCT05745077.

Decision-making conflicts regarding hematopoietic stem cell transplantation in patients with hematological neoplasms: A descriptive qualitative study

PurposeTo explore and understand the conflict in decision-making of hematopoietic stem cell transplantation in patients with hematological neoplasms. MethodsA descriptive qualitative study of 16 patients with hematologic neoplasms in the hematology department was conducted between February 2022 and May 2022. Purposive sampling was used to select participants. Face-to-face in-depth personal interviews were performed. Interviews were recorded, transcribed, and coded. This descriptive qualitative study adhered to the COREQ checklist. ResultsAll patients indicated difficulties in making decisions regarding hematopoietic stem cell transplantation. Five themes were identified: (1) weighing the pros and cons of HSCT, (2) financial burden versus desire for rebirth, (3) treatment urgency versus being unprepared, (4) saving oneself versus damaging loved ones, and (5) family companionship versus emotional isolation. These themes reflect the contradictions, entanglements, and realistic conflicts in decision-making regarding hematopoietic stem cell transplantation for patients with hematological neoplasms. ConclusionsThis study identified multiple conflicts of decision-making in patients with hematologic neoplasms regarding decisions on hematopoietic stem cell transplantations. Healthcare workers should provide patients with disease knowledge, doctor-patient and intra-family communication, and access to financial support in order to resolve their conflicts and ultimately help them make the decision that is most optimum for them.

Patient Management System Using Fuzzy Multiple Attribute Decision Making Method with SAW at Noura Aesthetic Clinic

This study presents the development and implementation of a Patient Management System (PMS) at Noura Aesthetic Clinic using the Fuzzy Multiple Attribute Decision Making (FMADM) method with Simple Additive Weighting (SAW). The aim is to enhance the decision-making process for patient treatment prioritization and management. The PMS integrates various patient attributes, including medical history, treatment urgency, and resource availability, into a comprehensive decision-making framework. By employing the FMADM method, the system addresses the inherent uncertainties and subjectivities in patient data, ensuring more accurate and reliable prioritization. The SAW technique further refines this process by assigning weighted scores to each attribute, facilitating a straightforward and effective comparison. This combination allows for a balanced assessment of multiple factors, promoting optimal resource allocation and improving overall patient care. The implementation at Noura Aesthetic Clinic demonstrated significant improvements in operational efficiency and patient satisfaction. The system's adaptability to diverse clinical settings and its user-friendly interface make it a valuable tool for healthcare providers. This study underscores the potential of advanced decision-making methodologies in transforming patient management practices, paving the way for more informed and equitable healthcare delivery.

How I treat: Coronavirus disease 2019 in leukemic patients and hematopoietic cell transplant recipients.

Among immunocompromised hosts, leukemia patients, and hematopoietic cell transplant recipients are particularly vulnerable, facing challenges in balancing coronavirus disease 2019 (COVID-19) management with their underlying conditions. In this How I Treat article, we discuss how we approach severe acute respiratory syndrome coronavirus 2 infections in daily clinical practice, considering the existing body of literature and for topics where the available data are not sufficient to provide adequate guidance, we provide our opinion based on our clinical expertise and experience. Diagnostic approaches include nasopharyngeal swabs for polymerase chain reaction testing and chest computed tomography scans for symptomatic patients at risk of disease progression. Preventive measures involve strict infection control protocols and prioritizing vaccination for both patients and their families. Decisions regarding chemotherapy or hematopoietic cell transplantation in leukemia patients with COVID-19 require careful consideration of factors such as COVID-19 severity and treatment urgency. Treatment protocols include early initiation of antiviral therapy, with nirmatrelvir/ritonavir or remdesivir. For cases of prolonged viral shedding, distinguishing between viable and non-viable viruses remains challenging but is crucial for determining contagiousness and guiding management decisions. Overall, individualized approaches considering immune status, clinical presentation, and viral kinetics are essential for effectively managing COVID-19 in leukemia patients.

Perceived treatment urgency of common mental disorders in the German population

Perceived treatment urgency of mental disorders are important as they determine utilization of health care. The aim was to analyze variations in perceived treatment urgency in cases of psychosis (adolescents), alcoholism (adults), and depression (older adults) with two levels of severity each by characteristics of the case and the respondents. A telephone survey (N = 1200) with vignettes describing cases of psychosis, alcoholism, and depression was conducted in Hamburg, Germany. Vignettes varied by symptom severity and sex. Perceived treatment urgency was assessed by three items. A sum scale was calculated. Linear regression models were computed to analyze differences in perceived urgency by characteristics of the case (severity, sex) and the respondents (sex, age, education, migration background, illness recognition, personal affliction). Perceived treatment urgency was significantly higher in severe cases and varied by education. Additionally, regarding psychosis, estimated urgency varied significantly by correct illness recognition. With regard to depression, perceived urgency differed significantly by age and correct illness recognition. Interaction effects between case severity and sociodemographic characteristics of the respondents, personal affliction, and correct recognition of the disorder were found. The identified differences should be considered in the development of interventions on mental health literacy with regard to adequate urgency assessment.

A pilot study on the efficacy of GPT-4 in providing orthopedic treatment recommendations from MRI reports

Large language models (LLMs) have shown potential in various applications, including clinical practice. However, their accuracy and utility in providing treatment recommendations for orthopedic conditions remain to be investigated. Thus, this pilot study aims to evaluate the validity of treatment recommendations generated by GPT-4 for common knee and shoulder orthopedic conditions using anonymized clinical MRI reports. A retrospective analysis was conducted using 20 anonymized clinical MRI reports, with varying severity and complexity. Treatment recommendations were elicited from GPT-4 and evaluated by two board-certified specialty-trained senior orthopedic surgeons. Their evaluation focused on semiquantitative gradings of accuracy and clinical utility and potential limitations of the LLM-generated recommendations. GPT-4 provided treatment recommendations for 20 patients (mean age, 50 years ± 19 [standard deviation]; 12 men) with acute and chronic knee and shoulder conditions. The LLM produced largely accurate and clinically useful recommendations. However, limited awareness of a patient’s overall situation, a tendency to incorrectly appreciate treatment urgency, and largely schematic and unspecific treatment recommendations were observed and may reduce its clinical usefulness. In conclusion, LLM-based treatment recommendations are largely adequate and not prone to ‘hallucinations’, yet inadequate in particular situations. Critical guidance by healthcare professionals is obligatory, and independent use by patients is discouraged, given the dependency on precise data input.

Rural Zambian Oral Health Transition: A Long-Term Retrospective Examination of an Outreach Program's Progress and Impact.

This study aimed to (a) describe an annual prevention-focused, community-based oral health outreach program in rural Zambia, (b) assess its oral health outcomes using demographic and oral health variables, and c) identify milestones resulting from program activities. A retrospective analysis of demographic and oral health data from a single site between 2007-2014 and 2018-2019 was conducted. Demographic variables included sex and age, while clinical outcomes encompassed pain, untreated caries, and treatment urgency. Bivariate and multivariable analyses were performed, adjusting for sex and age categories. Information on community development was obtained from the Ministry of Health and local community representatives. Data from 5,791 subjects were analyzed. The prevalence of pain, untreated caries, and highest treatment urgency category decreased consistently across year categories. Both bivariate and multivariable analyses showed statistically significant differences in clinical outcomes between year categories (p < 0.001). In addition, the percentage of male participants and younger age categories increased during the study period. Key program milestones included the installation of two boreholes for clean water, the development of a local community oral health volunteer program, the establishment of an educational pipeline by the Dental Training School for residents, and the construction of a maternal/oral health center with district and ministry oversight. The observed decrease in treatment urgency scores, presence of pain, and untreated caries are consistent with the prevention-seeking behavior of program participants. The increasing participation and changing demographic patterns over time suggest a growing demand for oral health services among males and younger individuals. The positive oral health outcomes and development of a maternal child/oral health facility exemplify a program design aligned with community needs and appropriate care delivery.

Pediatric emergency patients in the emergency departments of aGerman metropolitan region : Aretrospective cross-sectional study over aone-year period

To date, no detailed analysis of pediatric emergencies treated in emergency departments (ED) exists. However, in the context of capacity planning and upcoming emergency care reform in Germany, these data are urgently needed. Retrospective, multicenter cross-sectional study for the period 01July2013 to 01June2014 of pediatric cases in emergency departments in Munich. Atotal of 103,830 cases were analyzed (age: 6.9 ± 5.4years, boys/girls 55%/45%). A total of 85.9% of cases were treated as outpatients, 12.4% (9.6per 100,000 children) were admitted to normal and 1.7% (1.0 per 100,000 children) to intensive care. However, the real bed requirements exceeded these guideline numbers, with an absolute requirement of 4.9ICU beds and 35.1normal ward beds per day. Load peaks were seen on Wednesday and Friday afternoons and on weekends. Every 8thpatient who presented to an ED as aself-referral was treated as an inpatient. Capacity planning for inpatient emergency care of pediatric patients requires planning for more beds than can be expected on apopulation basis. The availability of panel physician care influences patient volume in the EDs. Initial medical assessment tools for treatment need and urgency are needed to distribute patients. The pediatric emergency centers planned as part of the current reform of emergency care must be adequately staffed and financed in order to be able to handle-in close cooperation with statutory health insurance-accredited medical care-the expected demand for care.

Knowledge, attitude, and practice of stroke among Saudi population in Balqarn Governorate, Kingdom of Saudi Arabia, 2023

Background: Stroke is a global top cause of death and disability, with a rising impact in countries like Saudi Arabia. Awareness of stroke signs, treatment urgency, and disparities tied to factors such as age and education contribute to its severity. This study aimed at assessing stroke knowledge, attitude, and practice among adults in the Balqarn community in Saudi Arabia. Methods: A cross-sectional survey was conducted among 745 adults in a community in Balqarn Governorate, Saudi Arabia, during the year 2023. Data were collected using a structured questionnaire that assessed knowledge, attitude, and practice related to stroke, as well as sociodemographic factors. Results: The studied participants had a mean age of 42.1 ± 12.8 years old, with most being males (74.4%) and married (77%). The majority had a university level of education or above (63.4%). The most known causes and risk factors of stroke were identified as unhealthy lifestyle, stress, obesity, hypercholesterolemia, hypertension, and Diabetes Miletus (DM). Social media and open channel internet were the most reported sources of information. Positive preventive behaviors were reported among participants, and the majority reported they would go directly to the hospital if they experienced stroke symptoms. Female gender and university level of education were significantly associated with a good overall knowledge level regarding stroke. Conclusion: The present study conducted at Balqarn Governorate, Saudi Arabia, underscores the necessity for improved stroke awareness and education. Social media and the internet stand out as key information sources, suggesting the potential for focused educational efforts. Encouragingly, participants showed readiness for healthy lifestyles. Women and university-educated individuals exhibited better stroke knowledge, highlighting targeted education&amp;apos;s importance. These insights can shape effective stroke prevention and management strategies.

Refining triage practices by predicting the need for emergent care following major trauma: the experience of a level 1 adult trauma center.

We examined the predictability of selected parameters for establishing the need for urgent care following multi-trauma as a means to warrant the highest level of trauma activation and potentially improve over- and under-triage rates. In this retrospective cohort study of multi-trauma patients aged ≥ 16years performed at a level 1 trauma center, trauma activation criteria and additional characteristics were examined with respect to treatment urgency, defined as: a direct disposition to the operating room or intensive care unit, initiating acute intervention in the trauma room, and in-hospital death within 7days of admission. We enrolled 1373 patients (median age 36.0years). The following parameter were inserted into the final multivariable model: age > 75years, male sex, Charlson comorbidity index, trauma circumstances and mechanism, signs of respiratory distress, systolic BP ≤ 110 and GCS ≤ 13. Adjusted independent predictors of acute care requirement were as follows: GCS ≤ 13 (aOR 5.27 [95% CI 3.45-8.05], p < 0.001), systolic BP ≤ 110mmHg (aOR 2.15 [95% CI 1.45-3.21], p < 0 .001), respiratory distress (aOR 2.05 [95% CI 1.53-2.77], p < 0.001), and age ≥ 75years (aOR 1.90 [95% CI 1.18-3.08], p = 0.008). A GCS ≤ 13, systolic BP < 110mmHg, signs of respiratory distress, and age > 75years best predicted the need for acute care following multisystem trauma. Prospective studies are warranted to confirm the predictability of these criteria and to assess the extent to which their implementation will refine over- and under-triage rates.

Prevalence of oral mucosal and periodontal disease amongst patients receiving dialysis

End-stage renal disease (ESRD) requires renal replacement therapy (RRT), namely a renal transplant or renal dialysis or both. Dialysis corrects the electrolyte imbalance and reduces circulating urea and creatinine levels. ESRD patients may present with oral complications and disease due to impaired renal functions, associated comorbidities, or the pharmacological management thereof.To determine the prevalence of periodontal- and oral mucosal disease in ESRD patients undergoing dialysis. Recommendations will be made regarding dental treatment needs and dental management. Cross-sectional study. Fifty-three ESRD patients were evaluated for mucosal lesions and periodontal disease. Patient's age, race, gender, comorbidities, dialysis duration and medicationwere recorded. Treatment urgency was determined, and patients referred accordingly for appropriate dental treatment. Mean age of patients was 42,9 ±10,4 years with a median time on dialysis of 30 months. Majority of patients were hypertensive (94.34%). No oral mucosal lesions was found. PSR score of 3 was mostly found (36.58%). Sixty-two percent of patients had a moderate treatment urgency.A relationship between chronic kidney disease and periodontitis exists. ESRD patients should thus be enrolled into a periodontal screening and treatment program and all dental treatmen

Gesundheitskompetenz und Hausarztbindung nicht dringlicher Patientinnen und Patienten in Notaufnahmen: Ergebnisse der PiNo-Studie in Hamburg und Schleswig-Holstein

IntroductionHigh utilization of emergency departments by low-acuity patients remains a major challenge for the health care system. Surveys of treatment urgency show that a considerable part of the emergency department population could also be cared for in the outpatient sector. Little is known about the contributing circumstances of non-utilization of outpatient care (despite indication). The expression of health literacy is often called to explain non-urgent use of emergency departments. The extent to which a distinguished commitment to primary care might have a moderating effect is currently not known. MethodsThe data for this secondary evaluation of a non-urgent emergency department population were taken from the cross-sectional observational study PiNo Nord (“Patients in the emergency departments of hospitals in Northern Germany”) (Scherer et al. 2017).In five hospitals in Hamburg and the federal state of Schleswig-Holstein, health literacy and ‘intensity of the commitment to a general practitioner’ were measured by self-assessment questionnaires (HLS-EU-Q16, F-HaBi). In addition to descriptive data analysis, linear regression was used to estimate the ‘intensity of the commitment to a general practitioner’ and other somatic, psychological, and sociodemographic characteristics of the population on health literacy. Results548 non-urgent adult patients (mean age 41.5 years, 54.4% men) were included in the evaluation: 55.5% had sufficient, 31.4% problematic and 13.1% inadequate health literacy. 88.3% of the population had a general practitioner. A higher ‘intensity of the commitment to a general practitioner’, female gender, a higher subjective urgency for treatment, better self-efficacy and better social support were associated with higher health literacy. No associations were found with regard to age, household income, education and migration background, current pain or the degree of physical complaints. DiscussionThe extent of health literacy of a non-urgent sample of the PiNo North study population, responding to the HLS-EU-Q16, was comparable to the health literacy of the general population. Health literacy and intensity of commitment to a general practitioner were positively associated. However, the intensity of GP commitment was rather low. The fact that younger respondents were more likely to provide information about their health literacy and the availability of specialists in urban areas could explain these findings. ConclusionImproving commitment to primary care physicians could include providing individualized information on how to navigate the health care system. This could make it easier for patients to choose an adequate level of care – and thus have a steering effect on emergency department utilization.

Patients treated by general practitioners in auniversity emergency department before and after implementation of atriage system

In auniversity emergency department (ED), patients with low treatment urgency and general medical complaints are assigned to general practitioners within the ED. The Emergency Severity Index (ESI) was implemented to determine the urgency of treatment. To investigate the impact of the ESI implementation on the patient population treated by general practitioners and to show the distribution of ESI categories among these patients. Comparison of emergency patients treated by general practitioners over 6months before (t0) and after (t1) ESI implementation using routine data and an evaluation form to be completed by the general practitioner. The analysis was carried out descriptively and using the Χ2test and t‑test. At t0, 615 treatment cases and at t1 751cases were analyzed. There were no significant differences in age, gender, the proportion of patients being referred to ED, or hospital admissions. The ESI classification was predominantly in the low urgency categories ESI5 (37%) and ESI4 (46%), with 8% of patients in ESI3 or2. The predicted resource needs matched for 76% of patients in ESI5, for 36% in ESI4, and for 44% of patients in ESI3. Hospital admission was required for 3% of ESI 5patients and 7% of ESI 4patients. Even for patients with low treatment urgency, hospital admission may be indicated. In addition, differences from the predicted resource requirements indicate triaging problems in the patient population studied. Thus, the ESI assessment does not seem suitable to redirect patients to non-ED-based outpatient care.

Factors Affecting the Perception of Strabismus Among Pediatric Ophthalmologists.

To define potential factors that influence the perceived urgency of strabismus surgery with a specific focus on the contributions of gender, degree of strabismus, and direction of strabismus. An electronic survey was sent to members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Respondents provided demographic information and ranked eight photographs of adults digitally altered to create varying degrees of strabismus according to perceived urgency for surgery. Pediatric ophthalmologists ranked deviations of increasing size with increasing treatment urgency. Men were perceived with higher urgency for treatment compared to women in the smaller angles of strabismus. No consistent preference for type of deviation was found. The gender of the patient and the amount of misalignment may influence the urgency of surgical management among strabismus surgeons. [J Pediatr Ophthalmol Strabismus. 2023;60(4):257-262.].

Extended Scope Physiotherapists are Effective and Safe in the Emergency Department: A Systematic Review and Meta-Analysis

Purpose: Extended scope physiotherapists (ESPs) are an innovative approach to service delivery that have emerged in response to increasing pressures on emergency departments (EDs). While previous systematic reviews have suggested that ESPs have a positive impact on ED outcomes, clinical practice recommendations based on limited evidence highlight a pressing need for evaluation studies to truly determine their effectiveness and safety in this setting. Therefore, the objective of this systematic review and meta-analysis was to evaluate the clinical effectiveness and safety of ESPs when delivering services in EDs. Method: Systematic literature searches were conducted using the online databases: Medline (Ovid), CINAHL (EBSCOhost), Scopus, PEDro, Cochrane Library and Informit in October, 2019. Randomised controlled trials (RCTs) or cohort studies investigating the clinical effectiveness and safety of ESPs in EDs in comparison with usual ED medical care providers were eligible for inclusion. Data extraction was completed using a form specifically developed for the study. The quality of each study was assessed using the Crowe Critical Appraisal Tool (CCAT) as well as a subjective assessment of bias, and the level of evidence was graded using the National Health and Medical Research Council (NHMRC) evidence hierarchy. Random-effects model meta-analyses were conducted using Stata (version 16.1). Results: Eleven studies met the inclusion criteria for the systematic review. These studies provided III-1 to III-3 evidence, with quality scores ranging from 50% to 93%. Consistent positive results were found regarding ESP clinical effectiveness and safety with meta-analyses demonstrating significant reductions in wait time (Cohen’s d effect size: -0.54; 95% confidence interval [CI]: -0.64 to -0.45) and length of stay (Cohen’s d effect size: -0.79; 95% CI: -0.86 to -0.72) for patients managed by ESPs. Although, confounding of results by treatment urgency made it difficult to establish a clear causal link between ESP services and outcomes. Conclusion: Although it was not able to be suggested that ESPs are an appropriate substitute for usual ED medical care due to the presence of bias and confounding, the results highlighted that ESPs, as an additional staff member in EDs, improve throughput and access to care for patients in lower urgency triage categories.

Frontline treatment of follicular lymphoma with atezolizumab and obinutuzumab, with and without radiotherapy (The FLUORO study).

TPS7587 Background: Follicular lymphoma (FL) is the commonest indolent lymphoma, comprising 20% of non-Hodgkin Lymphoma, with approximately 80% of patients (pts) requiring therapy. At present, advanced stage is incurable; most pts require &gt;1 treatment. Overall response rates (ORR) to standard chemoimmunotherapy (bendamustine or CHOP with rituximab or obinutuzumab) approximate 85% with considerable toxicity (grade 3-5 in 69-75%) (Hiddemann 2018). With the FL population predominantly &gt;65 years, 10-year median survival and need for further therapy, efficacious treatments with low toxicity are desirable. PD1/PDL1 axis inhibitors are active in FL. A phase I study of obinutuzumab (O) + atezolizumab (A) induced 57% ORR in pts with rituximab-refractory FL (Palomba 2017). Our phase II ‘1st FLOR’ study, combining nivolumab + rituximab in treatment naïve FL yielded 92% ORR, (54% Complete Response, CR). Toxicity profiles compared favourably with conventional chemotherapy: 41% grade 3-5 events (Hawkes 2021). FL is sensitive to low dose radiotherapy (RT), with abscopal effects reported, and potential to improve treatment efficacy with minimal additional toxicity when combined with PD1/PDL1 inhibitors (Sharabi 2015). This investigator initiated, multicentre single-arm phase II PET-adapted trial aims to assess the response of O + A +/- RT for treatment-naïve FL, reducing treatment-related toxicity using a chemotherapy-free, multi-modality, synergistic regimen. Methods: Eligible pts are &gt;18 years, ECOG 0-2 with untreated, biopsy proven, grade 1-3A stage II-IV FL. Exclusions are significant compressive symptoms, autoimmune disease, pneumonitis and treatment urgency. All pts receive 6 cycles (q21 days) of O 1000mg + A 1200mg (plus O given on days 8 &amp; 15 of cycle 1). Interim PET-CT is performed post cycle 2. Pts with less than CR will undergo RT (4Gy) to residual disease after cycle 3. At end of induction, responding patients will receive maintenance O (up to 12 cycles, 1000mg Q8W). Pts with significant progression will be taken off study. Total follow-up is 2 years post treatment. Primary endpoint is CR rate following 6 x O&amp;A +/- RT. Secondary endpoints include ORR, PFS, OS and adverse events. PET centres are ARTnet accredited with central analysis. An extensive exploratory biomarker substudy is planned. Sample size is 46 according to a Simon’s 2-stage design. If ≥5 positive responses (CR +/- PR) without prohibitive toxicity are seen in the first 15 pts, 31 further pts will be recruited.The trial has currently enrolled 7 pts from 4 Australian sites. Clinical trial information: NCT04962126.

Influence of Weekday and Seasonal Trends on Urgency and In-hospital Mortality of Emergency Department Patients.

BackgroundGiven the scarcity of resources, the increasing use of emergency departments (ED) represents a major challenge for the care of emergency patients. Current health policy interventions focus on restructuring emergency care with the help of patient re-direction into outpatient treatment structures. A precise analysis of ED utilization, taking into account treatment urgency, is essential for demand-oriented adjustments of emergency care structures.MethodsTemporal and seasonal trends in the use of EDs were investigated, considering treatment urgency and hospital mortality. Secondary data of 287,119 ED visits between 2015 and 2017 of the two EDs of Charité Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow Klinikum were analyzed.ResultEDs were used significantly more frequently on weekends than on weekdays (Mdn = 290 vs. 245 visits/day; p < 0.001). The proportion of less urgent, outpatient emergency visits on weekends was above average. Holiday periods were characterized by at least 6, and at most 176 additional ED visits. In a comparison of different holidays, most ED visits were observed at New Year (+68% above average). In addition, a significant increase in in-hospital mortality on holidays was evident among inpatients admitted to hospital via the ED (3.0 vs. 3.2%; p < 0.001), with New Year's Day being particularly striking (5.4%).ConclusionThese results suggest that, in particular, the resource planning of outpatient emergency treatment capacities on weekends and holidays should be adapted to the increased volume of non-urgent visits in EDs. Nevertheless, treatment capacities for the care of urgent, inpatient emergencies should not be disregarded and further research projects are necessary to investigate the causes of increased mortality during holiday periods.

Trends in dental insurance claims in the United States before and during the SARS-CoV-2 pandemic in 2020.

The SARS-CoV-2 pandemic disrupted health care services. Previous reports estimated reductions in demand and supply of dental care services, but actual changes have not been reported. The present report depicts a perspective of trends in claims from private dental practice in the United States during 2019 and 2020. Private dental insurance paid claims data from a data warehouse (encompassing 66+ carriers in the United States) were obtained for children and adults (treatments identified by their American Dental Association Code of Dental Procedures and Nomenclature [CDT]), encompassing a 5% random sample of all records between January 2019 and December 2020. A market-based treatment classification placed CDT codes into one of four categories based on the likelihood of being associated with urgent/emergency care. Claims for 3.8 million patients constituted the 5% random sample for analyses. Substantial drops in the provision of treatment items were quantified for a large segment of private dental insurance plans at a national level, showing differential impacts in dental care categories. Week-by-week, detailed descriptions of demand/availability changes in dental care throughout the first year of the 2020 SARS-CoV-2 pandemic were obtained through contrasting perspectives in 2019. Provision of dental care and associated impacts fluctuated over time subject to treatment urgency, but also modified as the weeks/months of dental office lockdowns ebbed in and out of the dental market.

Barriers to Optimal Acute Management of Stroke: Perspective of a Stroke Center in Mexico City.

Background: Stroke is a leading cause of death and disability worldwide, particularly in low- and middle-income countries. We aimed to identify the main barriers to optimal acute management of stroke in a referral center.Methods: Demographic data was collected from patients assessed with acute stroke in the emergency department of the Instituto Nacional de Neurología y Neurocirugía (INNN) from January to June 2019. Additionally, a telephone interview was conducted with patients/primary caregiver to know which they considered the main reason for the delay in arrival at INNN since the onset of stroke.Results: 116 patients were assessed [age 65 ± 15 years, 67 (57.8%) men]. Patients consulted other facilities prior to arrival at INNN in 59 (50.9%) cases (range of hospitals visited 1–4), 83 (71.6%) arrived in a private car, with prenotification in only 4 (3.4%) of the total sample. The mean onset-to-door time was 17 h (45 min−10 days). Telephone interviews were done in 61 patients/primary caregivers, stating that they consider the multiple evaluations in other facilities [n = 26/61 (42.6%)] as the main reason for delay in arrival at the ED, followed by ignorance of stroke symptoms and treatment urgency [n = 21/61 (34.4%)].Conclusion: In this small, retrospective, single center study, the main prehospital barrier to optimal acute management of stroke in a developing country is multiple medical evaluations prior to the patient's transport to a specialized stroke hospital, who mostly arrived in a private car and without prenotification. These barriers can be overcome by strengthening public education and improving patient transfer networks and telemedicine.

Is subjectively perceived treatment urgency of patients in emergency departments associated with self-reported health literacy and the willingness to use the GP as coordinator of treatment? Results from the multicentre, cross-sectional, observational study PiNo Bund

ObjectivesAim of this study was to analyse if subjectively perceived treatment urgency of patients in emergency departments is associated with self-reported health literacy and the willingness to use the general...