Triage Approach Research Articles

Treating wartime injuries amidst attack: insights from a medical facility on the edge of combat

BackgroundProviding emergency care during conflict poses unique challenges for frontline hospitals. Barzilai Medical Center (BUMCA) in Ashkelon, Israel is a Level I trauma center located close to the Gaza border. During the November 2023 escalation of conflict, BUMCA experienced surging numbers of civilian and military trauma patients while also coming under rocket fire.MethodsWe conducted a retrospective review of BUMCA operational records and 827 de-identified patient records from October 7–14, 2023. Records provided data on daily patient volumes, injury patterns, resource constraints, and impacts of rocket attacks on hospital function. Basic demographic data was obtained including age, gender, injury severity scores, and disposition.ResultsOf the 827 patients brought to BUMCA, most (n = 812, 98.2%) presented through the emergency department. Tragically, 99 individuals were pronounced dead on arrival. Injury severity assessments found nearly half (47%) had minor injuries such as lacerations, contusions and sprains, while 25% exhibited moderate injuries like deep lacerations and fractures. 15% sustained severe or critical injuries including severe head injuries. The largest age group consisted of adults aged 19–60 years. No pediatric patients were admitted despite proximity to residential neighborhoods. The majority of cases (61%) involved complex polytrauma affecting multiple body regions. BUMCA served as both the primary treatment facility and a triage hub, coordinating secondary transports to other trauma centers as needed. Patient volumes fluctuated unpredictably from 30 to an overwhelming 125 daily, straining emergency services. Resources faced shortages of beds, medical staff, supplies and disruptions to power from nearby missile impacts further challenging care delivery.ConclusionDespite facing surging demand, unpredictable conditions and external threats, BUMCA demonstrated resilience in maintaining emergency trauma services through an adaptive triage approach and rapid surges in capacity. Their experience provides insights for improving frontline hospital preparedness and continuity of care during conflict through advance contingency planning and surge protocols. Analysis of patient outcomes found a mortality rate of 15% given the complex, multi-region injuries sustained by many patients. This study highlights the challenges faced and strengths exhibited by medical professionals operating under hazardous conditions in minimizing loss of life.Patient and public involvement in researchGiven that the study analyzed patient data from a hospital treating casualties of an ongoing armed conflict, directly engaging patients or the public during the sensitive research process could have posed risks. The volatile security situation and restrictions and protections in place amidst the crisis made it not feasible or appropriate to involve them in the study’s design, methods, reporting of results, or dissemination plans. Our aim was to conduct this retrospective analysis in a way that did not endanger those affected or compromise the hospital’s emergency response operations.

Personalised exercise rehabilitation in cancer survivorship: the percs triage and referral system study protocol

BackgroundTo effectively embed exercise rehabilitation in cancer survivorship care, a co-ordinated system of acute and community exercise rehabilitation services, forming a stepped model of care, is recommended. Patients can be directed to the exercise rehabilitation service which best meets their needs through a system of assessment, triage and referral. Triage and referral systems are not yet widely applied in cancer survivorship practice and need to be evaluated in real-world contexts. The PERCS (Personalised Exercise Rehabilitation in Cancer Survivorship) study aims to evaluate the real-world application of an exercise rehabilitation triage and referral system in cancer survivors treated during the COVID-19 pandemic. Secondary aims are to evaluate change in physical and psychosocial outcomes, and to qualitatively evaluate the impact of the system and patient experiences, at three months after application of the triage and referral system.MethodsThis study will assess the implementation of an exercise rehabilitation triage and referral system within the context of a physiotherapy-led cancer rehabilitation clinic for cancer survivors who received cancer treatment during the COVID-19 pandemic. The PERCS triage and referral system supports decision making in exercise rehabilitation referral by recommending one of three pathways: independent exercise; fitness professional referral; or health professional referral. Up to 100 adult cancer survivors treated during the COVID-19 pandemic who have completed treatment and have no signs of active disease will be recruited. We will assess participants’ physical and psychosocial wellbeing and evaluate whether medical clearance for exercise is needed. Participants will then be triaged to a referral pathway and an exercise recommendation will be collaboratively decided. Reassessment will be after 12 weeks. Primary outcomes are implementation-related, guided by the RE-AIM framework. Secondary outcomes include physical function, psychosocial wellbeing and exercise levels. Qualitative analysis of semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) will provide insights on implementation and system impact.DiscussionThe PERCS study will investigate the real-world application of a cancer rehabilitation triage and referral system. This will provide proof of concept evidence for this triage approach and important insights on the implementation of a triage system in a specialist cancer centre.Trial registrationThis study is registered on ClinicalTrials.gov, registration number: NCT05615285, date registered: 21st October 2022.

A Proposed Approach to Allegations of Sexual Boundary Violation in Health Care.

Sexual boundary violations in the health care setting cause harm for victims, threaten an organization's culture, and create extraordinary organizational risk. The inherent complexities of health care organizations present unique challenges for the initial triage and response to reports of alleged violations. A group of experts with experience in law, leadership, human resources, medicine, and health care operations identified processes for organizations to triage and implement an early response to allegations of sexual boundary violations. The group reviewed a series of 100 reports of alleged violations described by patients and coworkers from a 200-hospital professional accountability collaborative to identify the elements of an ideal initial triage and management approach. The group identified three domains to guide early triage and response to reports of boundary violations: (1) severity and acuity of the alleged violation; (2) roles and relationship(s) of the complainant, respondent, and other affected individuals; and (3) contextual information such as prior activity or other mitigating factors. The group identified leadership engagement; coordinated responses; clear articulation of values, policies, and procedures; aligned data reporting; thoughtful reviews; and securing appropriate resources as essential elements of an organization's response. A structured systematic approach to classify and respond to allegations of sexual boundary violation is described. The initial response should be guided by assessment of the severity and timing of the reported behavior, followed by assessment of roles and responsibilities with involvement of all relevant stakeholders. Contextual issues and special circumstances of relevance should be identified and incorporated into the response. Systems to identify, store, and retrieve behavior of concern should be improved and integrated.

An acoustic-based method for locating maternity colonies of rare woodland bats.

Locating colonies of rare bats can be a time consuming process, as it is often difficult to know where to focus survey effort. However, identifying peaks of bat activity via acoustic monitoring may provide insights into whether a colony is locally present, and help screen out sites with low potential. Using a triage approach, we developed a survey methodology for locating colonies of the woodland-specialist barbastelle bat (Barbastella barbastellus). We investigated whether woodland occupancy by a colony could be predicted by acoustic data, and assessed the influence of survey effort (number of acoustic detectors deployed) on detectability. The methodology was then trialled in citizen science surveys of 77 woodlands, with follow-up radio-tracking surveys by specialists being used to confirm presence or absence. Using Receiver Operating Characteristic (ROC) curve analysis, we found that a threshold of four barbastelle passes recorded by at least one detector within one hour of sunset optimised the balance between the true- and false-positive rates. Subsequently, we found that a minimum survey effort of one detector per 6.25 hectares of woodland was needed to ensure a colony would be detected using this threshold, based on a survey sensitivity of 90%. Radio-tracking surveys in a subset of the woodlands, identified as having a high probability of being occupied by a colony based on acoustic monitoring, confirmed the presence of five previously unknown barbastelle maternity colonies. These results demonstrate that a triage system, in which high probability woodland sites are identified based on acoustic survey data, can be used to prioritise sites for future specialist surveys and conservation action.

Redesign of a Primary Care–Based Housing Intervention to Address Upstream Housing Needs

Summary The stark inequity in safe, affordable housing due to unfair policies and practices (e.g., redlining) underpins inequities across multiple social determinants of health (SDOH) and health outcomes. Suboptimal housing is associated with poorer health, less effective health care engagement, and higher health care costs. In response, some health care systems address patients’ housing needs. Since 2018, Brigham Health’s social care team (SCT) has been supporting 15 primary care practices to address patients’ SDOH. Rather than focus only on unhoused patients, Brigham’s housing program also supports patients who are at risk of eviction or living in unsafe or unhealthy housing conditions (i.e., upstream factors) to prevent illness by addressing housing needs before they become a housing and health crisis. Most patients reporting housing needs are at risk of eviction or housed in unsafe or unhealthy conditions; however, intervening with this group is complicated by the number of identified needs of varying acuity and the scarcity of affordable housing. Here, the authors describe the efforts of Brigham Health’s SCT to redesign housing intervention by triaging cases to identify patients whose housing needs acutely affect their health and for which there are potential remedies and to accompany and support patients to pursue those remedies. Via a team-based process improvement project, the SCT refined its housing intervention to better direct its housing advocates’ deep expertise toward patients who could benefit most from their support. Data revealed inefficiencies in the original intervention design. Using Plan–Do–Study–Act cycles, they designed a triage protocol guided by well-defined housing case types. This team-based triage approach preserved housing advocates’ effort and expertise for complex housing situations — enabling upstream intervention, which many health care–based interventions do not focus on. The authors describe their learning process and offer recommendations for systems expanding SDOH screening with limited resources for addressing housing needs. They did achieve some positive outcomes: 14.1% of 262 cases obtained a housing accommodation, and 16% were permanently housed (8% accepted a new housing placement offer; 8% avoided eviction and maintained stable housing). However, at the conclusion of this study, they had unclear outcomes for many patients: 13.3% were lost during follow-up procedures, and another 53.4% were on housing waitlists. New efforts, supported by additional funding, will include a mixed methods evaluation that provides a difference-in-differences analysis of associations between housing program participation, health care utilization, and health outcomes, as well as interviews to better understand patients’ experiences.

Assessing artificial intelligence enabled liquid-based cytology for triaging HPV-positive women: a population-based cross-sectional study.

Cytology-based triaging is commonly used to manage the care of women with positive human papillomavirus (HPV) results, but it suffers from subjectivity and a lack of sensitivity and reproducibility. The diagnostic performance of an artificial intelligence-enabled liquid-based cytology (AI-LBC) triage approach remains unclear. Here, we compared the clinical performance of AI-LBC, human cytologists and HPV16/18 genotyping at triaging HPV-positive women. HPV-positive women were triaged using AI-LBC, human cytologists and HPV16/18 genotyping. Histologically confirmed cervical intraepithelial neoplasia grade 2/3 or higher (CIN2+/CIN3+) were accepted as thresholds for clinical performance assessments. Of the 3514 women included, 13.9% (n = 489) were HPV-positive. The sensitivity of AI-LBC was comparable to that of cytologists (86.49% vs 83.78%, P = 0.744) but substantially higher than HPV16/18 typing at detecting CIN2+ (86.49% vs 54.05%, P = 0.002). While the specificity of AI-LBC was significantly lower than HPV16/18 typing (51.33% vs 87.17%, P < 0.001), it was significantly higher than cytologists at detecting CIN2+ (51.33% vs 40.93%, P < 0.001). AI-LBC reduced referrals to colposcopy by approximately 10%, compared with cytologists (51.53% vs 60.94%, P = 0.003). Similar patterns were also observed for CIN3+. AI-LBC has equivalent sensitivity and higher specificity compared with cytologists, with more efficient colposcopy referrals for HPV-positive women. AI-LBC could be particularly useful in regions where experienced cytologists are few in number. Further investigations are needed to determine triaging performance through prospective designs.

DART-HRMS triage approach part 2 – Application to the detection of cannabinoids and terpenes in recreational Cannabis products

The ambient ionization technique termed “direct analysis in real time – high-resolution mass spectrometry” (DART-HRMS) has been previously utilized to investigate the presence of cannabinoids in complex matrices such as personal-care products, edibles prepared in-house, certified reference materials, and hemp plant material (the non-psychoactive variety of Cannabis sativa). In the study presented here, this proof-of-concept was applied to commercially available retail Cannabis-derived products from a recreational Cannabis dispensary. Among the commercial products analyzed by DART-HRMS were edibles, concentrates, tinctures, topicals, vaporizers, marijuana flower, and pre-rolls comprised of marijuana plant material. Regardless of the type and complexity of the matrix, direct analysis of these materials in their native form readily revealed, as a function in either positive- or negative-ion mode, a range of cannabinoid acids, neutral cannabinoids, and terpenes, including CBGA (nominal m/z 361 and 359), THC/CBD (nominal m/z 315 and 313), CBN (nominal m/z 311 and 309), and eucalyptol (nominal m/z 155 and 153), respectively. This was accomplished without any sample preparation steps and permitted avoidance of some of the difficulties typically encountered when utilizing traditional chromatographic approaches for the analysis of cannabinoids in complex matrices. The rapidly obtained chemical information furnished by this approach facilitates assessment of whether further confirmatory testing should be performed, and if so, of what type, thereby avoiding indiscriminate performance of time-consuming and resource-intensive confirmatory testing on all samples.

A Molecular Biomarker-Based Triage Approach for Targeted Treatment of Post-COVID-19 Syndrome Patients with Persistent Neurological orNeuropsychiatric Symptoms.

Approximately 30% of COVID-19 cases may experience chronic symptoms, known as post-COVID-19 syndrome (PCS). Common PCS symptoms can include fatigue, cognitive impairment, and persistent physical, neurological, and neuropsychiatric complaints. To improve healthcare and management of the current and future pandemics, we highlight the need for establishing interdisciplinary post-viral outpatient clinics comprised of specialists in fields such as psychiatry, psychotherapy, neurology, cardiology, pneumology, and immunology. In this way, PCS patients with a high health burden can receive modern diagnostics and targeted therapeutic recommendations. A key objective is to distinguish the "sick recovered" from the "healthy recovered." Our hypothesis is that there is a PCS subgroup with autoimmune-mediated systemic and brain-vascular dysregulation, which may lead to circulatory disorders, fatigue, cognitive impairment, depression, and anxiety. This can be clarified using a combination of specific antibody diagnostics and precise clinical, psychological, and apparative testing.

Reverse triage in COVID surge planning: a case study of an allied health supported clinical care pathway in an acute hospital setting.

ObjectiveThis case study describes the development and outcomes of a new integrated and multidisciplinary care pathway. Spearheaded by allied health, the 'COVID community navigator team', applied established principles of reverse triage to create additional surge capacity.MethodsA retrospective cohort study examined workflow patterns using electronic medical records of patients who received navigator input at the Royal Melbourne Hospital between 20 September 2021 and 20 December 2021.ResultsThere were 437 eligible patient encounters identified. On average patients stayed 4.15 h in the emergency departments (ED) (s.d. = 4.31) and 9.5 h (s.d. = 10.9) in the short stay unit. Most patients were discharged into a 'low risk pathway' with community general practitioner follow up. Of discharged patients, only 38 re-presented to the ED with symptoms related to their initial COVID-19 diagnosis (34.9% of total re-admissions). Of these re-admissions, more than half did not require admission to a ward.ConclusionThe findings presented here provide support for the clinical utility of a multidisciplinary reverse triage approach in surge planning for anticipated presentation peaks.

Preparing for the Worst-Case Scenario in a Pandemic: Intensivists Simulate Prioritization and Triage of Scarce ICU Resources.

Simulation and evaluation of a prioritization protocol at a German university hospital using a convergent parallel mixed methods design. Prospective single-center cohort study with a quantitative analysis of ICU patients and qualitative content analysis of two focus groups with intensivists. Five ICUs of internal medicine and anesthesiology at a German university hospital. Adult critically ill ICU patients ( n = 53). After training the attending senior ICU physicians ( n = 13) in rationing, an impending ICU congestion was simulated. All ICU patients were rated according to their likelihood to survive their acute illness (good-moderate-unfavorable). From each ICU, the two patients with the most unfavorable prognosis ( n = 10) were evaluated by five prioritization teams for triage. Patients nominated for prioritization visit ( n = 10) had higher Sequential Organ Failure Assessment scores and already a longer stay at the hospital and on the ICU compared with the other patients. The order within this worst prognosis group was not congruent between the five teams. However, an in-hospital mortality of 80% confirmed the reasonable match with the lowest predicted probability of survival. Qualitative data highlighted the tremendous burden of triage and the need for a team-based consensus-oriented decision-making approach to ensure best possible care and to support professionals. Transparent communication within the teams, the hospital, and to the public was seen as essential for prioritization implementation. To mitigate potential bias and to reduce the emotional burden of triage, a consensus-oriented, interdisciplinary, and collaborative approach should be implemented. Prognostic comparative assessment by intensivists is feasible. The combination of long-term ICU stay and consistently high Sequential Organ Failure Assessment scores resulted in a greater risk for triage in patients. It remains challenging to reliably differentiate between patients with very low chances to survive and requires further conceptual and empirical research.

Decreases in emergency department and hospitalization visits over 5 years of the Oncology Care Model.

64 Background: In the last five years of the Oncology Care Model (OCM) our community oncology practice developed standardized processes throughout the practice to impact hospital and emergency department (ED) utilization. OCM feedback reports were evaluated and compared to practice baseline data to assess the effectiveness of these interventions in improving patient care. Within the practice continuous tracking allowed for timely reviews and process improvement. Methods: A multimodal triage approach was created, including development of individual patient treatment plans and weekly clinical team huddles where new treatment patients or high-risk patients were discussed. The “Call Us First” campaign was initiated through wallet cards. These cards were provided to patients outlining regimen details and indications for patients seeking urgent or emergent medical care. An improved triage program with Navigating Cancer (NC) reduced call back times to patients regarding patient symptoms and care needs, increased faster symptom management and decreased ED visits. Additionally, nursing check in calls were made to patients after initial chemotherapy treatments and hospital admissions. These statewide programs were rolled out through a systematic process over the first year of the OCM. Results: Admissions for the practice’s OCM patients were 22% in 2015 and decreased to 17% in 2021. For the practice’s OCM population in 2015, the baseline ED visits were 16% and decreased to 14% in late Fall 2021. Home health utilization increased from 17.9% at baseline to 22.3% after five years. Long term care days decreased from 10.7 days to 4.5 days. Skilled nursing facility days decreased from 67.6 days in 2015 to 36.80 days in 2021. By comparison, overall national OCM practices had similar declines in ED visits and hospital admissions. Conclusions: Through OCM participation there were systematic changes reducing ED visits and hospital admissions over five years. We believe that early intervention projects enable patients to avoid ED/hospital visits. Home health care visits may have contributed to less admissions. Patient outcomes were favorably impacted by the practice wide processes guided by the feedback reports. Future iterations of value-based care are undecided, and practices will build on these enhancements.

Determining the Reliability of A Seismically Assessed Building Conclusion Using A Modified FEMA P-154 Procedure

The quality of seismic risk management decisions depends on professional judgements. Such require an assessment of the reliability of the thought process and information used to give them credibility. The goal is to develop a process that assesses the reliability of a traditional P-154 assessment to determine whether it is sufficiently reliable to warrant action. P-154 is a triage approach meant to determine whether a detailed engineering assessment is required or not. Modifications to the P-154 procedures are proposed to warrant such actions without additional engineering assessment. This involves requiring highly experienced evaluators, specification of building document review, and technically independent supervision. Based on the nature of the conclusions, whether using the modifications or not, the reliability of the assessment can be evaluated, and a decision made whether it warrants action. It was validated by application to 56 likely hazardous buildings on three CSU campuses. The result of application of P-154 was that 52 of the 54 buildings need further engineering evaluation to reach a decision: two needed immediate attention, 12 requiring work overtime, where the reliability of all the evaluations indicated a good reliability for the conclusions, when the companion paper’s procedures for portfolio management were implemented. The application of the recommended approach was about $2,500 per building, including assessor time, travel, and expenses, more than the conventional P-154 cost but far less than the engineering P-154 assessment. A companion paper, Setting the Priority for Seismic Retrofit of Buildings Using a Modified FEMA P-154 [1] Procedure develops the seismic management program using this reliability determination as a key ingredient. The principal impact of the Modified P-154 process is that the retrofit decisions it recommended had acceptable reliability to CSU management and their advisors.

Impact of telephone triage on access to primary care for people living with multiple long-term health conditions: rapid evaluation

Background Telephone triage is a service innovation in which every patient asking to see a general practitioner or other primary care professional calls the general practice and usually speaks to a receptionist first, who records a few details. The patient is then telephoned back by the general practitioner/primary care professional. At the end of this return telephone call with the general practitioner/primary care professional, either the issue is resolved or a face-to-face appointment is arranged. Before the COVID-19 pandemic, telephone triage was designed and used in the UK as a tool for managing demand and to help general practitioners organise their workload. During the first quarter of 2020, much of general practice moved to a remote (largely telephone) triage approach to reduce practice footfall and minimise the risk of COVID-19 contact for patients and staff. Ensuring equitable care for people living with multiple long-term health conditions (‘multimorbidity’) is a health policy priority. Objective We aimed to evaluate whether or not the increased use of telephone triage would affect access to primary care differently for people living with multimorbidity than for other patients. Methods We used data from the English GP Patient Survey to explore the inequalities impact of introducing telephone triage in 154 general practices in England between 2011 and 2017. We looked particularly at the time taken to see or speak to a general practitioner for people with multiple long-term health conditions compared with other patients before the COVID-19 pandemic. We also used data from Understanding Society, a nationally representative survey of households from the UK, to explore inequalities in access to primary care during the COVID-19 pandemic (between April and November 2020). Results Using data from before the COVID-19 pandemic, we found no evidence (p = 0.26) that the impact of a general practice moving to a telephone triage approach on the time taken to see or speak to a general practitioner was different for people with multimorbidity and for people without. During the COVID-19 pandemic, we found that people with multimorbidity were more likely than people with no long-term health conditions to have a problem for which they needed access to primary care. Among people who had a problem for which they would normally try to contact their general practitioner, there was no evidence of variation based on the number of conditions as to whether or not someone did try to contact their general practitioner; whether or not they were able to make an appointment; or whether they were offered a face-to-face, an online or an in-person appointment. Limitations Survey non-response, limitations of the specific survey measures of primary care access that were used, and being unable to fully explore the quality of the telephone triage and consultations were all limitations. Conclusions These results highlight that, although people with multimorbidity have a greater need for primary care than people without multimorbidity, the overall impact for patients of changing to a telephone triage approach is larger than the inequalities in primary care access that exist between groups of patients. Future work Future evaluations of service innovations and the ongoing changes in primary care access should consider the inequalities impact of their introduction, including for people with multimorbidity. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 18. See the NIHR Journals Library website for further project information.

Automated Time Based Multi-Criteria Bug Triage Approach: Developer Working Efficiency and Social Network Based Developer Recommendation

Automated Time Based Multi-Criteria Bug Triage Approach: Developer Working Efficiency and Social Network Based Developer Recommendation

Reduced Emergency Department Length of Stay and Proportion of Patients Who Left Without Being Seen Following Implementation of an Interprofessional Vertical Flow Track With Pivot Triage: A Retrospective Pre-/Postintervention Evaluation.

Our objective was to assess change in length of stay and patients who left without being seen following implementation of a pivot triage and interprofessional vertical flow track process at a midwestern academic medical center emergency department. The intervention leveraged an existing interprofessional staffing model including a registered nurse and a paramedic to staff a vertical flow track daily from 1100 to 2300. Pre- and postintervention data were retrospectively abstracted from the electronic charting software. Outcomes included emergency department length of stay and percentage of patients leaving without being seen. Visits for patients during the postintervention period (May 10, 2019, to August 31, 2019) were compared with a corresponding preintervention time period 1 year prior (May 10, 2018, to August 31, 2018). The percentage of patients routed to the vertical flow track increased from 5% to 22% following the process intervention. Median emergency department length of stay decreased from 199 (interquartile range [IQR]: 129-282) to 159 (IQR: 98-232) min. The percentage of patients leaving without being seen decreased from 2.9% to 0.5%; between 1100 and 2300, these changes were more pronounced. Odds of a patient experiencing emergency department length of stay under 180 min increased nearly twofold (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.79-2.08) and odds that a patient stayed to be seen by a medical professional increased sixfold (OR: 5.94, 95% CI: 4.08-8.63). Overall, more than 20% of patients were routed through the vertical flow track following the process change. Implementation of an emergency department pivot triage approach with a dedicated interprofessional vertical flow track was associated with significantly shorter emergency department length of stay and reduced patients leaving without being seen.

\u201cWhat do you mean I can\u2019t have a doctor? this is Canada!\u201d \u2013 a qualitative study of the myriad consequences for unattached patients awaiting primary care attachment

BackgroundPatient access to primary healthcare (PHC) is the foundation of a strong healthcare system and healthy populations. Attachment to a regular PHC provider, a key to healthcare access, has seen a decline in some jurisdictions. This study explored the consequences of unattachment from a patient perspective, an under-studied phenomenon to date.MethodsA realist-informed qualitative study was conducted with unattached patients in Nova Scotia, Canada. Semi-structured interviews with nine participants were conducted and transcribed for analysis. The framework method was used to carry out analysis, which was guided by Donabedian’s model of assessing healthcare access and quality.ResultsFive key findings were noted in this study: 1) Participants experienced a range of consequences from not having a regular PHC provider. Participants used creative strategies to 2) attempt to gain attachment to a regular PHC provider, and, to 3) address their health needs in the absence of a regular PHC provider. 4) Participants experienced negative feelings about themselves and the healthcare system, and 5) stress related to the consequences and added work of being unattached and lost care.ConclusionsUnattached patients experienced a burden of care related to lost care and managing their own health and related information, due to the download of medical record management and system navigation to them. These findings may underestimate the consequences for further at-risk populations who would not have been included in our recruitment. This may result in poorer health outcomes, which could be mitigated by interventions at the structural level, such as enhanced centralized waitlists to promote attachment. Such waitlists may benefit from a triage approach to appropriately attach patients based on need.

Detection of Host Cell Gene/HPV DNA Methylation Markers: A Promising Triage Approach for Cervical Cancer

Cervical cancer is the most prevalent gynecologic malignancy, especially in women of low- and middle-income countries (LMICs). With a better understanding of the etiology and pathogenesis of cervical cancer, it has been well accepted that this type of cancer can be prevented and treated via early screening. Due to its higher sensitivity than cytology to identify precursor lesions of cervical cancer, detection of high-risk human papillomavirus (HR-HPV) DNA has been implemented as the primary screening approach. However, a high referral rate for colposcopy after HR-HPV DNA detection due to its low specificity in HR-HPV screening often leads to overtreatment and thus increases the healthcare burden. Emerging evidence has demonstrated that detection of host cell gene and/or HPV DNA methylation represents a promising approach for the early triage of cervical cancer in HR-HPV-positive women owing to its convenience and comparable performance to cytology, particularly in LMICs with limited healthcare resources. While numerous potential markers involving DNA methylation of host cell genes and the HPV genome have been identified thus far, it is crucial to define which genes or panels involving host and/or HPV are feasible and appropriate for large-scale screening and triage. An ideal approach for screening and triage of CIN/ICC requires high sensitivity and adequate specificity and is suitable for self-sampling and inexpensive to allow population-based screening, particularly in LMICs. In this review, we summarize the markers of host cell gene/HR-HPV DNA methylation and discuss their triage performance and feasibility for high-grade precancerous cervical intraepithelial neoplasia or worse (CIN2+ and CIN3+) in HR-HPV-positive women.

Efficacy and safety of an orally administered DGAT2 inhibitor alone or coadministered with a liver-targeted ACC inhibitor in adults with non-alcoholic steatohepatitis (NASH): rationale and design of the phase II, dose-ranging, dose-finding, randomised, placebo-controlled MIRNA (Metabolic Interventions to Resolve NASH with fibrosis) study

IntroductionSmall molecule inhibitors of the terminal step in intrahepatic triglyceride synthesis (diacylglycerol acyltransferase 2 inhibitor (DGAT2i, PF-06865571, ervogastat)) and upstream blockade of de novo lipogenesis via acetyl-coenzyme A carboxylase inhibitor...

Monitoring COVID-19 on Social Media: Development of an End-to-End Natural Language Processing Pipeline Using a Novel Triage and Diagnosis Approach.

BackgroundThe COVID-19 pandemic has created a pressing need for integrating information from disparate sources in order to assist decision makers. Social media is important in this respect; however, to make sense of the textual information it provides and be able to automate the processing of large amounts of data, natural language processing methods are needed. Social media posts are often noisy, yet they may provide valuable insights regarding the severity and prevalence of the disease in the population. Here, we adopt a triage and diagnosis approach to analyzing social media posts using machine learning techniques for the purpose of disease detection and surveillance. We thus obtain useful prevalence and incidence statistics to identify disease symptoms and their severities, motivated by public health concerns.ObjectiveThis study aims to develop an end-to-end natural language processing pipeline for triage and diagnosis of COVID-19 from patient-authored social media posts in order to provide researchers and public health practitioners with additional information on the symptoms, severity, and prevalence of the disease rather than to provide an actionable decision at the individual level.MethodsThe text processing pipeline first extracted COVID-19 symptoms and related concepts, such as severity, duration, negations, and body parts, from patients’ posts using conditional random fields. An unsupervised rule-based algorithm was then applied to establish relations between concepts in the next step of the pipeline. The extracted concepts and relations were subsequently used to construct 2 different vector representations of each post. These vectors were separately applied to build support vector machine learning models to triage patients into 3 categories and diagnose them for COVID-19.ResultsWe reported macro- and microaveraged F1 scores in the range of 71%-96% and 61%-87%, respectively, for the triage and diagnosis of COVID-19 when the models were trained on human-labeled data. Our experimental results indicated that similar performance can be achieved when the models are trained using predicted labels from concept extraction and rule-based classifiers, thus yielding end-to-end machine learning. In addition, we highlighted important features uncovered by our diagnostic machine learning models and compared them with the most frequent symptoms revealed in another COVID-19 data set. In particular, we found that the most important features are not always the most frequent ones.ConclusionsOur preliminary results show that it is possible to automatically triage and diagnose patients for COVID-19 from social media natural language narratives, using a machine learning pipeline in order to provide information on the severity and prevalence of the disease for use within health surveillance systems.

Finding Our Voice: Highly Flexible ED for the HyFlex World

The COVID-19 pandemic brought about unprecedented changes in our approach to delivering educational development (ED) programming. In this article we discuss how our dual ED centers pivoted during the sudden switch to online learning, highlighting how we overcame challenges such as a small staff, tight timelines, and faculty anxieties. Particularly, we explore how we adapted to the university’s investment in technologically advanced Hybrid-Flexible (HyFlex) classroom spaces and utilized a multi-pronged team approach to provide effective and timely ED to faculty. By identifying key faculty leaders, identifying multiple sources of data, and using multiple modalities, we supported the faculty in their mission to effectively serve their students during this difficult and stressful time. In pivoting from a triage approach to more tactically focused development, the two ED centers discovered that they could more effectively serve faculty (and by extension students) by shattering the structural silos that had previously defined them and instead working as a unified entity.