Urgent Care Unit Research Articles

Admission prioritization of heart failure patients with multiple comorbidities.

The primary objective of this study was to enhance the operational efficiency of the current healthcare system by proposing a quicker and more effective approach for healthcare providers to deliver services to individuals facing acute heart failure (HF) and concurrent medical conditions. The aim was to support healthcare staff in providing urgent services more efficiently by developing an automated decision-support Patient Prioritization (PP) Tool that utilizes a tailored machine learning (ML) model to prioritize HF patients with chronic heart conditions and concurrent comorbidities during Urgent Care Unit admission. The study applies key ML models to the PhysioNet dataset, encompassing hospital admissions and mortality records of heart failure patients at Zigong Fourth People's Hospital in Sichuan, China, between 2016 and 2019. In addition, the model outcomes for the PhysioNet dataset are compared with the Healthcare Cost and Utilization Project (HCUP) Maryland (MD) State Inpatient Data (SID) for 2014, a secondary dataset containing heart failure patients, to assess the generalizability of results across diverse healthcare settings and patient demographics. The ML models in this project demonstrate efficiencies surpassing 97.8% and specificities exceeding 95% in identifying HF patients at a higher risk and ranking them based on their mortality risk level. Utilizing this machine learning for the PP approach underscores risk assessment, supporting healthcare professionals in managing HF patients more effectively and allocating resources to those in immediate need, whether in hospital or telehealth settings.

Detection of Novel Influenza Viruses Through Community and Healthcare Testing: Implications for Surveillance Efforts in the United States.

Novel influenza viruses pose a potential pandemic risk, and rapid detection of infections in humans is critical to characterizing the virus and facilitating the implementation of public health response measures. We use a probabilistic framework to estimate the likelihood that novel influenza virus cases would be detected through testing in different community and healthcare settings (urgent care, emergency department, hospital, and intensive care unit [ICU]) while at low frequencies in the United States. Parameters were informed by data on seasonal influenza virus activity and existing testing practices. In a baseline scenario reflecting the presence of 100 novel virus infections with similar severity to seasonal influenza viruses, the median probability of detecting at least one infection per month was highest in urgent care settings (72%) and when community testing was conducted at random among the general population (77%). However, urgent care testing was over 15 times more efficient (estimated as the number of cases detected per 100,000 tests) due to the larger number of tests required for community testing. In scenarios that assumed increased clinical severity of novel virus infection, median detection probabilities increased across all healthcare settings, particularly in hospitals and ICUs (up to 100%) where testing also became more efficient. Our results suggest that novel influenza virus circulation is likely to be detected through existing healthcare surveillance, with the most efficient testing setting impacted by the disease severity profile. These analyses can help inform future testing strategies to maximize the likelihood of novel influenza detection.

Humanized care for critically ill patients in Urgent and Emergency care units

To show the importance of the role of health professionals in providing care and humanized assistance in Urgent and Emergency Care Units. The chosen methodology was bibliographical research, of the integrative literature review type, and the search for manuscripts was carried out on the electronic pages: SCIELO, VHL, LILACS and MEDLINE, limiting those published between the years 2018 to 2022. Studies have shown that humanized assistance is of great relevance in urgent and emergency services and should have as its main objective the promotion of the patient's well-being, taking into account not only their clinical status, but also their emotional and mental health. their family members. These results are part of a search that found 142 articles, of which 29 were excluded for not meeting the research objective, 18 were excluded for being in English or Spanish, 34 were incomplete, 46 did not meet the time frame from 2018 to 2022 , with only 15 remaining included in the final sample of this review. Of these, 15 (100%) were in Portuguese, 06 (40%) are from 2018, 05 (33.33%) are from 2019, 01 (6.67%) are from 2020 and 03 (20%) are from 2021. Through the studies analyzed, it is concluded that even in the face of all the difficulties encountered, humanization and assistance in care, especially in the urgency and emergency sectors, are of great importance for all work performed to take place satisfactorily offering a quality service, trust, dignity and respect for human beings.

ADHERENCE OF PHYSICIANS PRACTICE TONATIONAL MINISTRY OF HEALTH (MOH) URGENT CARE GUIDELINE IN EASTERN REGION,SAUDI ARABIA

Introduction: In the new era of the Ministry of health transformation, urgent care units (UCCs) were established in primary care. This research evaluated the current practice at the urgent care unit in comparison to the MOH Guideline of Extended Hour Services. Materials and Methods: This is an analytical cross-sectional study that included 293 physicians who worked in UCCs at Primary health care (PHC), Saudi Arabia (SA). The data were collected via a validated online questionnaire distributed to the physicians. Furthermore, UCCs were visited to assess the availability of suitable settings. Univariate and multivariate data analyses were done using the SPSS program. Results: Less than a quarter (23.6%) of UCC physicians were aware of the presence of the National MOH Guideline of extended-hour services. Overall adherence as per physicians perception of the guideline was 48 (24.7%). Increased adherence to Ministry of Health policy as per guidelines by UCC physicians was associated with attending all training courses (OR = 33.72, 95% CI: 2.116-4.920) and awareness of the MOH manual of extended hours services (OR = 2.45, 95% CI: 0.345-1.435). Participants agree on the absence of a clear referral policy to an emergency department and outpatient clinics, 32.3% and 52.3% respectively. Conclusion: UCC physicians training and practices at PHCs did not adequately adhere to the Ministry of Health guidelines. More effort is needed to achieve better outcomes.

Characteristics of the clinical pharmacist interventions at the National Center for Cancer Care and Research Hospital in Qatar.

Drug-related problems (DRPs) affect the health outcomes of patients during hospitalization. We sought to analyze the clinical pharmacist-documented interventions among hospitalized patients in the cancer hospital in Qatar. A retrospective analysis of electronically reported clinical pharmacist interventions of patients admitted to cancer units at Hamad Medical Corporation, Qatar was conducted. Extracted data was based on an overall 3-month follow-up period; March 1-31, 2018, July 15-August 15, 2018 and January 1-31, 2019. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation (SD). A total of 281 cancer patients with 1354 interventions were included. The average age of the study participants was 47 years (SD ± 17.36). The majority of the study population was females (n = 154, 54.80%). The prevailing pharmacist intervention was the addition of a drug therapy (n = 305, 22.53%), followed by medication discontinuation (n = 288, 21.27%) and the addition of a prophylactic agent (n = 174, 12.85%). This pattern was similar across all subgroups (i.e., gender, age, ward), except for the urgent care unit, where an increase in medication dose was the third highest frequently identified intervention (n = 3, 0.22%). The two medication groups associated with the majority of interventions were the anti-infective and fluid/electrolyte agents. Most of the interventions documented were in the oncology ward (73.19%), while the urgent care unit had the least documented interventions (1.62%). Our analysis showed that clinical pharmacists can effectively identify and prevent DRPs among hospitalized cancer patients.

Factors related to work ability among nursing professionals from urgent and emergency care units: A cross-sectional study.

Nursing professionals are on the front line of health systems in Brazil as well as worldwide. Studies on the work ability of nursing professionals are especially relevant as care demands increase and health care workforce shortages are expected. As the population of Brazil ages, the need for nursing care will increase. To identify levels and predictors of work ability among Brazilian nursing professionals. A cross-sectional study with 267 nursing professionals (72 nurses and 195 nursing technicians and nursing auxiliary) from public emergency and urgent care units was conducted. Measures included the following: Work Ability Index; Questionnaire of Socio-demographics, Lifestyle and Work and Health Aspects; and Violence at Work questionnaire. Generalized linear regression and Poisson models were used for data analysis. The mean work ability was 40.4 (range: 22 to 49). Almost 79.6% (n = 211) of participants reported good or excellent work ability, and 20.4% (n = 54) reported moderate or poor work ability. Better perceptions of health and job satisfaction, absence of health issues (past 15 days), lower stress levels, and having a partner were associated with better work ability. Victims of workplace violence were less likely to have good or excellent work ability than non-victims (prevalence ratio = 0.80; 95% CI 0.72 to 0.90). Professionals with cumulative experiences of workplace violence were less likely to report better work ability. The prevalence of good or excellent work ability was 79.6%. Our findings indicate that the following factors are predictors of work ability: self-reported perception of health, health issues in the last 15 days, workplace violence, job satisfaction, stress, and marital status.

COVID-19: Protocol and Checklist for Nursing Care Management at Urgent Care Units.

The 24 h urgent care units (24 h UCU) in Brazil are the main pre-admission hospital process of the public healthcare system and constitute an intermediate modality between primary care and hospital care. These units also provide care in cases of less severity that are not considered urgent. This study aimed to create and validate the content of a graphic protocol and checklist for the nursing care management of patients with a suspicion or confirmation of infection by COVID-19 at urgent care units. A methodological study was carried out in three phases: construct of items and dimensions of the checklist; evaluation of the checklist by specialists for content validation; and construct and content validation of the graphic protocol. The checklist was evaluated by nine specialists. Eight items received suggestions for changes. Items with a content validity index ≥0.83 were maintained. With regard to content validity, despite the satisfactory level of agreement, the specialists suggested some changes in the writing of eight items. The graphic protocol was evaluated by six specialists and had an overall content validity of 0.97. The checklist with 44 items and three dimensions (Management, Biosafety and Care) and the protocol achieved a satisfactory standard of content validity for use at 24 h urgent care units. This protocol can contribute to the standardization and guidance of nursing actions in suspected and confirmed cases of COVID-19 at urgent care units, ensuring safe care based on scientific evidence.

CT Imaging Findings in Patients with Ovarian Cancer and Acute Abdominal Symptoms: Experience at a Tertiary Cancer Center.

To evaluate computed tomography (CT) findings in patients with ovarian cancer presenting to a comprehensive cancer center's urgent care unit with acute abdominal symptoms. This retrospective study included consecutive patients with ovarian cancer who underwent abdominal CT at a comprehensive cancer center's urgent care unit between January 1, 2018, and January 14, 2020, due to acute abdominal symptoms. Two abdominal radiologists reviewed the abdominal CT reports, categorizing imaging findings as follows: (a) no new or acute finding, (b) new or increased bowel or gastric obstruction, (c) new or increased ascites, (d) new or increased peritoneal carcinomatosis, (e) new or increased nonperitoneal metastases, (f) new inflammatory or infectious changes, (g) new or increased hydronephrosis, (h) new or increased biliary dilatation, (i) new vascular complications, or (j) new bowel perforation. A total of 200 patients (mean age, 59years; range, 22-87) underwent a total of 259 abdominal CT scans, of which 217/259 (83.8%) scans were found to have new or increased findings. A total of 115/259 (44.4%) scans had only one finding while 102/259 (39.4%) scans had 2 or more findings. Altogether, 382 new or increased findings were detected: findings were most commonly related to bowel or gastric obstruction (92/382, 24.1%) with small bowel obstruction being the most common finding (80/382, 20.9%); ascites (78/382, 20.4%); peritoneal carcinomatosis (62/382, 16.2%); and nonperitoneal metastases (62/382, 16.2%). Inflammatory or infectious findings accounted for 30/382 (7.9%) findings. Most patients with ovarian cancer presenting with acute abdominal had relevant positive findings on abdominal CT, with small bowel obstruction being the most common finding.

Predictive Mathematical Models of the Short-Term and Long-Term Growth of the COVID-19 Pandemic.

The prediction of the dynamics of the COVID-19 outbreak and the corresponding needs of the health care system (COVID-19 patients' admissions, the number of critically ill patients, need for intensive care units, etc.) is based on the combination of a limited growth model (Verhulst model) and a short-term predictive model that allows predictions to be made for the following day. In both cases, the uncertainty analysis of the prediction is performed, i.e., the set of equivalent models that adjust the historical data with the same accuracy. This set of models provides the posterior distribution of the parameters of the predictive model that adjusts the historical series. It can be extrapolated to the same analyzed time series (e.g., the number of infected individuals per day) or to another time series of interest to which it is correlated and used, e.g., to predict the number of patients admitted to urgent care units, the number of critically ill patients, or the total number of admissions, which are directly related to health needs. These models can be regionalized, that is, the predictions can be made at the local level if data are disaggregated. We show that the Verhulst and the Gompertz models provide similar results and can be also used to monitor and predict new outbreaks. However, the Verhulst model seems to be easier to interpret and to use.

Impact of COVID-19 on Dental Care during a National Lockdown: A Retrospective Observational Study.

The coronavirus disease 19 (COVID-19) has challenged dental health professions. This study analyzes its impact on urgent dental care in the Department of Conservative Dentistry and Periodontology, University Hospital Munich and Bavaria, Germany. Patient numbers without and with positive/suspected COVID-19 infection, their reasons for attendance, and treatments were retrospectively recorded (February–July 2020) and linked to local COVID-19 infection numbers, control measures, and numbers/reasons for closures of private dental practices in Bavaria, Germany. Patient numbers decreased within the urgent care unit and the private dental practices followed by a complete recovery by the end of July. While non-emergency visits dropped to almost zero during the first lockdown, pain-related treatments were administered invariably also in patients with positive/suspected COVID-19 infections. Reasons for practice closures were lack of personal protective equipment (PPE), lack of employees, staff’s increased health risks, and infected staff, which accounted for 0.72% (3.6% closures in total). Pain-driven urgent dental care remains a constant necessity even in times of high infection risk, and measures established at the beginning of the pandemic seem to have provided a safe environment for patients as well as oral health care providers. PPE storage is important to ensure patients’ treatment under high-risk conditions, and its storage and provision by regulatory units might guarantee a stable and safe oral health care system in the future.

Management of headaches in children and adolescents

Pediatric headache impacts up to 80% of children, many recurrently, by the time they are 15 years old. Preventing the progression of episodic to chronic headache results in less truancy, staying current with schoolwork and improves children's quality of life. Lifestyle choices can play an important role in headache treatment. Early effective treatment of episodic headache can prevent transformation into a chronic form. While details of a child's headache are critical for making a proper diagnosis; patient education is critical and effective rescue and preventive treatment strategies enable patients to focus on enjoying activities of daily living. Recognizing "red flags" that may suggest a serious underlying etiology is critical in the early stages of diagnosing and preparing to treat children with headaches. Finally directing patients to manage their headaches at home and when to proceed to an emergency department, urgent care or infusion unit can lower the economic burden of acute headache management.

The importance of the partnership between the public and private healthcare institutions to improve interhospital patient transfers

Purpose The purpose of this study/paper is to identify the importance of the partnership between the public and private health-care institutions to improve interhospital patient transfers. Scientific research and statistical data show the increased number of interhospital transportation services; therefore, timely and qualified patient transportation between different health-care institutions must be considered, the activity that directly and significantly impacts the patient’s health status and overall quality of the health-care services. The successful patient transportation from the smaller hospitals to the health-care institutions with advanced intensive care or urgent care units can be enhanced through the partnership between private and public health-care institutions. Design/methodology/approach The methodology included quantitative method, statistical data analysis and theoretical data generalization. Both primary and secondary data were collected and analyzed during the research. Expert quantification was performed using the survey research method. The survey was conducted in Lithuania. The respondents were selected to be the general managers of the health-care and urgent care institutions, the chief doctors of the reanimation and intensive care department also the chief doctors of the emergency department. Findings Because of the centralization and regionalization of health-care services, the number of patients transferred between hospitals by the emergency medical services (EMS) and personal health-care institutions has increased. University hospitals are not sufficiently prepared to accept an increasing flow of patients in accordance with the Ministry of Health orders. Not all regional or district hospitals have the right to provide such assistance, which increases transportation time and costs as well as requires additional human resources. The five EMS categories could be used to improve the patient transfer between different levels of health-care institutions. To increase partnership between private and public health-care organizations, incentives should be provided for the development of private health-care organizations, as well as encouraging actions should be taken to increase the demand for private health-care services by Lithuanian patients. Practical implications Five EMS categories identified in this paper could be used to ensure a smooth mechanism for the patient transfer between different levels of the personal health-care institutions. The proposed categories should also be used in the pre-stationary emergency phase (for reducing the interhospital patient transportation amount). Social implications Properly organized secondary and tertiary interhospital patient transfers influence the availability and quality of the EMS and reduce inequalities in the provided services and social exclusion. Originality/value This paper presents the classification of the interhospital transfer issues, determines the main reasons for the patient interhospital transfer, creates the model for the EMS patient process flows and defines five EMS categories for the assessment of patient conditions. Therefore, the research conducted and the results obtained have both theoretical and social-practical value.

Costs to provide a tobacco cessation intervention with parents of pediatric emergency department patients.

INTRODUCTIONPediatric emergency department (PED) visits are opportune times in which to provide smoking cessation interventions for parents who smoke. This study reports on the costs of providing parental smokers who bring their children to the emergency setting, with a screening, brief intervention, and assisted referral to treatment (SBIRT) intervention, which includes counseling about tobacco cessation and nicotine replacement therapy.METHODSCost data were collected during a randomized controlled trial with 750 parental smokers whose child was presented to a PED or pediatric Urgent Care unit with a potential tobacco smoke exposure-related illness. Interventionist training, screening, and SBIRT costs are reported from the organizational perspective (i.e. that of the providing hospital). A spreadsheet tool was created to allow for organizations to estimate their own costs based on their settings, for each aspect of the intervention.RESULTSThe mean costs per parent included interventionist training, screening and enrollment, SBIRT delivery, distribution of take-home materials and nicotine replacement therapy, booster text messages, and follow-up phone contact. The total cost per parent was approximately $97. Varying the underlying cost assumptions led to total costs ranging from $85 to $124 per treated parent.CONCLUSIONSThe emergency setting is an important locus of tobacco control that could have a large public health benefit to parents and children. The costs reported in this report and the accompanying spreadsheet tool will permit emergency settings to estimate the costs and assist with planning, staffing and resource allocation necessary to implement an SBIRT smoking cessation intervention in research-based and clinically-based cessation interventions into adult or pediatric emergency visits.

ReMindCare App for Early Psychosis: Pragmatic Real World Intervention and Usability Study.

BackgroundeHealth interventions are widely used in clinical trials and increasingly in care settings as well; however, their efficacy in real-world contexts remains unknown. ReMindCare is a smartphone app that has been systematically implemented in a first episode of psychosis program (FEPP) for patients with early psychosis since 2018.ObjectiveThe objective of this study was to assess the efficacy of ReMindCare after 19 months of use in the clinic and varying use by individual patients.MethodsThe integration of the ReMindCare app into the FEPP started in October 2018. Patients with early psychosis self-selected to the app (ReMindCare group) or treatment as usual (TAU group). The outcome variables considered were adherence to the intervention and number of relapses, hospital admissions, and visits to urgent care units. Data from 90 patients with early psychosis were analyzed: 59 in the ReMindCare group and 31 in the TAU group. The mean age of the sample was 32.8 (SD 9.4) years, 73% (66/90) were males, 91% (83/90) were White, and 81% (74/90) were single.ResultsSignificant differences between the ReMindCare and TAU groups were found in the number of relapses, hospitalizations, and visits to urgent care units, with each showing benefits for the app. Only 20% (12/59) of patients from the ReMindCare group had a relapse, while 58% (18/31) of the TAU patients had one or more relapses (χ2=13.7, P=.001). Moreover, ReMindCare patients had fewer visits to urgent care units (χ2=7.4, P=.006) and fewer hospitalizations than TAU patients (χ2=4.6, P=.03). The mean of days using the app was 352.2 (SD 191.2; min/max: 18-594), and the mean of engagement was 84.5 (SD 16.04).ConclusionsTo our knowledge, this is the first eHealth intervention that has preliminarily proven its benefits in the real-world treatment of patients with early psychosis.International Registered Report Identifier (IRRID)RR2-10.1111/eip.12960

Opt-out Consent in Children’s Emergency Medicine Research

ABSTRACT There is global acceptance that individuals should be allowed to decide whether or not to take part in research studies, and to do so after being informed about the nature of the research and the risk that might attach to participation. The process of providing detailed information before seeking consent (formalized by signatures) in advance of undertaking research procedures may not be possible in some circumstances, and sometimes an amended approach may be adopted. The use of opt-out consent has been recognized as a valid and ethical means of recruiting participants to studies particularly with large samples and where the risk to participants is small. However, it is sometimes misunderstood and can be a problematic factor in being accepted by research ethics committees and governing authorities. This may be due partly to differing expectations of the amount of information and support offered, together with the nature of the process that is adopted to ensure that a decision has been made rather than consent simply being assumed. In accordance with ongoing discussions with young people, and following consultation with parents, an opt-out consent strategy including varied means of providing information was employed in a large study of 44,501 cases of children attending emergency or urgent care departments. The study was conducted over more than 12 months in dissimilar emergency departments and an urgent care unit, and was designed to support better decision-making in pediatric emergency departments about whether children need to be admitted to hospital or can be discharged home safely. Robust analysis of the factors that exerted the greatest impact on predicting the need to admit or the safety of discharging children led to a revised version of an existing tool. In this article, we review approaches to consent in research, the nature and impact of opt-out consent, the factors that made this an effective strategy for this study, but also more recent concerns which may make opt-out consent no longer acceptable.

Urgency and discontinuity of oral health care in children and adolescents.

The aim of the present study was to investigate the discontinuity of oral health care among children and adolescents who accessed emergency services at primary care units and urgent care units. Records were reviewed of patients aged 0 to 17 years treated in the public healthcare system in city of Curitiba, Brazil. Discontinuity was considered when elective treatment was not registered at the primary care unit within six months after urgent care. The sample was stratified based on the Municipal Human Development Index (MHDI) (≤0.799 or ≥0.800). The association between discontinuity and covariables was assessed using univariate and multivariate Poisson regression models with robust variance (α=0.05). The incidence of discontinuity was 42.2%. In the MHDI≤0.799 stratum, the risk of discontinuity was greater among children younger than five years of age and individuals who had not had a dental appointment in the previous year. In both MHDI strata, the risk of discontinuity was higher in patients who received urgent care at an urgent care unit than those treated at a primary care unit. The incidence of the discontinuity of oral health care was high and was strongly influenced by the characteristics of dental service utilization among individuals living in regions with a lower MHDI.

Clinician Practice Patterns That Result in the Diagnosis of Coccidioidomycosis Before or During Hospitalization.

Coccidioidomycosis (CM) is common and important within endemic regions, requiring specific testing for diagnosis. Long delays in diagnosis have been ascribed to ambulatory clinicians. However, how their testing practices have impacted patient care has not been systematically unexplored. We analyzed practice patterns for CM diagnoses over 3 years within a large Arizona healthcare system, including diagnosis location, patient characteristics, and care-seeking patterns associated with missed diagnosis. For 2043 CM diagnoses, 72.9% were made during hospital admission, 21.7% in ambulatory clinics, 3.2% in emergency units, and only 0.5% in urgent care units. A 40.6% subgroup of hospitalized patients required neither intensive care unit or hospital-requiring procedures, had a median length of stay of only 3 days, but still incurred both substantial costs ($27.0 million) and unnecessary antibiotic administrations. Prior to hospital diagnosis (median of 32 days), 45.1% of patients had 1 or more visits with symptoms consistent with CM. During those visits, 71.3% were not tested for CM. Diagnoses were delayed a median of 27 days. Lack of testing for CM in ambulatory care settings within a region endemic for CM resulted in a large number of hospital admissions, attendant costs, and unneeded antibacterial drug use, much of which would otherwise be unnecessary. Improving this practice is challenging since many clinicians did not train where CM is common, resulting in significant inertia to change. Determining the best way to retrain clinicians to diagnose CM earlier is an opportunity to explore which strategies might be the most effective.

S114. THE EFFICACY OF “URGENT CONSULTATION REQUEST”; PRELIMINARY ANALYSIS OF A REAL-WORLD APP (REMIDCARE) FOR EARLY PSYCHOSIS

BackgroundPatients are clamming for more personalized and closer clinical attention (Bonet et al. 2018). To this end, we developed RemindCare app. The app conducts daily and weekly assessments and this information is used to prevent relapses, to improve the therapeutic alliance and it is automatically included at the electronic clinical record of the hospital. Moreover, patients can contact clinicians by an “Urgent Consultation Request” (UCR), which is answered by a phone call in a period of 24-48h. This app was introduced in clinical practice in October 2018. Since then, 81 patients met criteria for inclusion and 57/81 (71%) started using the app. The aim of this study is to analyze the efficacy of this UCR to determine if this function can improve the real-world treatment of patients with early psychosis.MethodsRemindCare app, is offered as an extra-service to the usual psychiatric care of patients in an Early Psychosis Program (EPP) at the Clinic Hospital of Valencia, Spain (Bonet et al. 2019). No remuneration is offered to any patient or clinician to use the app. Data of 57 patients diagnosed with a psychotic disorder was analyzed: the 26.3% (15/57) used the UCR (UCR group) and the 73.7% (42/57) did not (Non-UCR group). Mean age of the sample was 31.5 (SD=9.3), 56.1% were male, 87.7% caucasian and 82.5% were single. Mean years of illness was 3.5 (SD=2.8), CGI mean 4.1 (SD=0.9), GAF mean 60.5 (SD=12.3) and PANSS mean 56.6 (SD=12.2).ResultsMean of months using the app was 8.4 (SD=4.5), 38.6% (22/57) of patients used the app for more than a year (12–13 months) and mean of engagement was 84.3 (SD=18.9). No significant differences were found between UCR and Non-UCR group in terms of demographic and clinical characteristics. However, there was a difference between groups in terms of engagement to the app (χ2= 6.3, p=0.04). The 93.3% of the UCR group had a percentage of engagement to the app between 81–100% compared to the 66.7% in the Non-UCR group and the number of visits to the Urgent Care Units (UCU) was also higher in the UCR group (χ2= 4.4, p=0.03). Additionally, only the 13.3% (2/15) of patients used the UCR for a psychotic symptom′s aggravation, the 33.3% (3/15) used it to inform of anxiety symptoms and another 33.3% (3/15) to change the clinical appointment. Moreover, the 66.7% (4/6) of patients who attended to UCU had previously made an UCR and they went to the UCU before that period of 24-48h of clinical response ended. Finally, there were no differences in terms of hospital admissions (χ2= 1.1, p=0.3) and psychotic relapses (χ2= 0.08, p=0.8) between groups. However, patients who stopped using the app had more relapses than patients who continued using it (χ2= 15.3, p<0.000).DiscussionTo our knowledge, this is the first e-Health intervention systematically introduced in clinical practice. Rates of acceptance and engagement are high (71%; 84.3%) and nearly 40% of the sample is using the app for more than a year. Mean of engagement with the app, was extremely high among patients who used the UCR (93.3%; engagement between 81–100%) and although this UCR service was the most required in our previous survey (Bonet et al. 2018), these preliminary results suggest ¡ that the use of this alarm is not related to psychotic relapse detection. However, patients who use RemindCare app had less relapses than the ones who discontinue its use, which highlights the efficacy of the app. This, along with the high engagement and the positive feedback received, suggests that an improvement in real-world treatment of patients with early psychosis may be found in upcoming analysis.

Understanding the relationship between healthcare processes and in-hospital weekend mortality using MIMIC III

Abstract Studies showed evidence that hospitals that offer services 24 h seven days a week have a higher rate of mortality on weekends. However, there is limited information related to the type of hospital admissions effected, and the factors responsible for this phenomenon. This study proposes a novel approach to understand the factors that influence hospital mortality rate in patients admitted under Elective, Emergency and Urgent Care units. First, we compare the in-hospital mortality rate of patients admitted to the intensive care unit on weekdays and weekends. Then we extract the features from the MIMIC III database that support the prediction. The extracted features were then used to train and test four machine learning models: logistic regression, decision tree, gradient boosted tree and random forest. These statistical models help to understand the significant factors that influence weekend mortality predictions. Model performance is demonstrated based on AUC, kappa, precision and recall values. The results from the analysis demonstrate that patients admitted to elective care on the weekend have a high risk of mortality compared to weekday admissions. Our analysis also indicates that the reduced availability of caregivers and the number of lab tests performed are significant contributors to this phenomenon.

Incidência da queixa de dor torácica como sintoma de infarto agudo do miocárdio em uma unidade de pronto-atendimento

BACKGROUND AND OBJECTIVES: Chest pain is one of the main reasons why individuals seek urgent and emergency services. It is a symptom that may suggest several pathologies, among which the acute coronary syndrome, which makes differential diagnosis difficult. The objective of this study was to identify the incidence of chest pain confirmed as acute myocardial infarction in an urgent care unit in the city of Joinville; and specifically to describe the epidemiological profile of patients with chest pain due to acute myocardial infarction, regarding gender, age, type of acute myocardial infarction and cardiac enzyme alterations; identify how individuals described the symptom; to recognize other factors causing chest pain and to know the incidence of chest pain related to non-cardiac causes. METHODS: Documentary study, descriptive and quantitative approach. RESULTS: The incidence of chest pain as a symptom of acute myocardial infarction corresponded to 1% of the sample, affecting males. Several other causes were pointed out stemmed from the international code of diseases to seek care for this complaint. CONCLUSION: The study evidenced the relevance of this complaint in emergency and urgent care units and the need to recognize the clinical manifestations and acute myocardial infarction screening for differential diagnosis.