Urgent Requests Research Articles

Exploration of primary care models and timely access to care in New Brunswick (Canada)

BackgroundThis correlative study aimed to examine how the different primary care models (physicians in solo practice, physicians in collaborative practice, physicians and nurse practitioners in collaborative practice, after-hours clinics, community centers, or emergency rooms) were associated with their capability to offer timely access to their patients. The data collected from the primary care provider’s perspective was to complete the New Brunswick Health Council results on patients’ perspective.MethodsA convenience sample of 120 primary care providers (33 physicians in solo practice, 33 physicians in collaborative practice, 27 providers in collaborative practice with nurse practitioners, 2 providers working in after-hours clinics, and 10 providers in Emergency departments) responded to an online survey about their primary care models and accessibility. We used the Statistical Package for Social Sciences software to run correlations, independent t-tests and Fisher’s exact tests to compare timely access to care between variable groups.ResultsA positive correlation was observed between patient load (or the number of patients under a primary care provider’s practice), age and years of experience. However, the patient load did not translate to more timely access to care. However, a statistically significant difference (p = 0.032) was observed when primary care providers kept appointment slots available for daily urgent requests. When a primary care provider booked all available appointment slots, only 85% of them could offer timely appointments (in 5 days or less), compared to 97% who could deliver it when appointment slots were left open in their daily schedule. The primary care model (solo vs. collaboration), the use of health technologies and the type of provider did not significantly influence timely access to care. In contrast, the primary care providers who reported teleworking (or working remotely) were less likely to offer timely access to care.ConclusionTimely access to care is not always available to patients, even those with a primary care provider. Certain organizational practices may improve access to care and should be integrated into primary care in New Brunswick and elsewhere in Canada.

Utility-Driven End-to-End Network Slicing for Diverse IoT Users in MEC: A Multi-Agent Deep Reinforcement Learning Approach.

Mobile Edge Computing (MEC) is crucial for reducing latency by bringing computational resources closer to the network edge, thereby enhancing the quality of services (QoS). However, the broad deployment of cloudlets poses challenges in efficient network slicing, particularly when traffic distribution is uneven. Therefore, these challenges include managing diverse resource requirements across widely distributed cloudlets, minimizing resource conflicts and delays, and maintaining service quality amid fluctuating request rates. Addressing this requires intelligent strategies to predict request types (common or urgent), assess resource needs, and allocate resources efficiently. Emerging technologies like edge computing and 5G with network slicing can handle delay-sensitive IoT requests rapidly, but a robust mechanism for real-time resource and utility optimization remains necessary. To address these challenges, we designed an end-to-end network slicing approach that predicts common and urgent user requests through T distribution. We formulated our problem as a multi-agent Markov decision process (MDP) and introduced a multi-agent soft actor-critic (MAgSAC) algorithm. This algorithm prevents the wastage of scarce resources by intelligently activating and deactivating virtual network function (VNF) instances, thereby balancing the allocation process. Our approach aims to optimize overall utility, balancing trade-offs between revenue, energy consumption costs, and latency. We evaluated our method, MAgSAC, through simulations, comparing it with the following six benchmark schemes: MAA3C, SACT, DDPG, S2Vec, Random, and Greedy. The results demonstrate that our approach, MAgSAC, optimizes utility by 30%, minimizes energy consumption costs by 12.4%, and reduces execution time by 21.7% compared to the closest related multi-agent approach named MAA3C.

The Economic Impact of Community Paramedics Within Emergency Medical Services: A Systematic Review.

Globally, emergency medical services (EMSs) report that their demand is dominated by non-emergency (such as urgent and primary care) requests. Appropriately managing these is a major challenge for EMSs, with one mechanism employed being specialist community paramedics. This review guides policy by evaluating the economic impact of specialist community paramedic models from a healthcare system perspective. A multidisciplinary team (health economics, emergency care, paramedicine, nursing) was formed, and a protocol registered on PROSPERO (CRD42023397840) and published open access. Eligible studies included experimental and analytical observational study designs of economic evaluation outcomes of patients requesting EMSs via an emergency telephone line ('000', '111', '999', '911' or equivalent) responded to by specialist community paramedics, compared to patients attended by usual care (i.e. standard paramedics). A three-stage systematic search was performed, including Peer Review of Electronic Search Strategies (PRESS) and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Two independent reviewers extracted and verified 51 unique characteristics from 11 studies, costs were inflated and converted, and outcomes were synthesised with comparisons by model, population, education and reliability of findings. Eleven studies (n = 7136 intervention group) met thecriteria. These included one cost-utility analysis (measuring both costs and consequences), four costing studies (measuring cost only) and six cohort studies (measuring consequences only). Quality was measured using Joanna Briggs Institute tools, and was moderate for ten studies, and low for one. Models included autonomous paramedics (six studies, n = 4132 intervention), physician oversight (three studies, n = 932 intervention) and/or special populations (five studies, n = 3004 intervention). Twenty-one outcomes were reported. Models unanimously reduced emergency department (ED) transportation by 14-78% (higher quality studies reduced emergency department transportation by 50-54%, n = 2639 intervention, p < 0.001), and costs were reduced by AU$338-1227 per attendance in four studies (n = 2962). One study performed an economic evaluation (n = 1549), finding both that the costs were reduced by AU$454 per attendance (although not statistically significant), and consequently that the intervention dominated with a > 95% chance of the model being cost effective at the UK incremental cost-effectiveness ratio threshold. Community paramedic roles within EMSs reduced ED transportation by approximately half. However, the rate was highly variable owing to structural (such as local policies) and stochastic (such as the patient's medical condition) factors. As models unanimously reduced ED transportation-a major contributor to costs-they in turn lead to net healthcare system savings, provided there is sufficient demand to outweigh model costs and generate net savings. However, all models shift costs from EDs to EMSs, and therefore appropriate redistribution of benefits may be necessary to incentivise EMS investment. Policymakers for EMSs could consider negotiating with their health department, local ED or insurers to introduce a rebate for successful community paramedic non-ED-transportations. Following this, geographical areas with suitable non-emergency demand could be identified, and community paramedic models introduced and tested with a prospective economic evaluation or, where this is not feasible, with sufficient data collection to enable a post hoc analysis.

A novel integrated gas-cooled fast nuclear reactor and vanadium chloride thermochemical cycle for sustainable fuel production

The continuous growth of anthropogenic carbon emissions from the aviation industry has emphasized the urgent request to substitute traditional aviation fuels with Sustainable Aviation Fuels (SAFs) because SAFs can potentially reduce carbon emissions by around 50–90% as compared to traditional kerosene-based fuels. In this paper, a novel SAF production pathway is developed which is based on biomass processing, nuclear energy, and thermochemical reactions of the vanadium chloride cycle for SAF, clean power, and hydrogen production. The entire system is assessed thermodynamically in terms of energy and exergy performances. Various sensitivity analyses are computed to determine the reliable operating parameters. The study concludes that biomass-to-SAF energetic and exergetic performance is achieved to be 76.72% and 74.35%. The energetic and exergetic performance values, through efficiencies, of the V–Cl cycle are calculated to be 68.08% and 53.50%, respectively. For hydrogen production and storage, an energy penalty of around 16.83 kJ/kg H2 is calculated, which results in an efficiency penalty of 6.18%. The overall energetic and exergetic efficiencies of the proposed integrated system are found to be around 59.79% and 23.78%, respectively.

Adolescent Mental Health: A Focus on Psychiatric Counseling from the Emergency Room of an Italian University Hospital in the Five Years from 2019 to 2023.

Recent studies have revealed increasingly worse and more complex mental health conditions in young people, which is reflected in a growing trend in emergency room (ER) visits for acute psychopathological symptoms (APSs). This phenomenon has become exacerbated in recent decades, with a peak in the post-pandemic period. To better characterize the phenomenon, we investigated the change in the rate and type of ER counseling requests provided at the Child Neuropsychiatry Unit of the University Hospital of Bari, Italy over the period between 2019 and 2023 for subjects younger than 18 years old. For this purpose, we retrospectively analyzed a total number of 1073 urgent consultation reports retrieved through the reporting computerized operating system of our hospital. The distribution of the counseling requests provided for APSs and, among these, the distribution of the numbers of APSs and of the male: female ratio were significantly different over the years, with an increasing linear trend identified for APSs (p = 3.095 × 10-7), the average number of APSs (p = 3.598 × 10-7), and female gender prevalence (p = 0.03908), as well as for the patients with a history of psychotropic drug assumption (p = 0.0006319). A significant change in the number of urgent counseling requests received for eating disorders (p = 0.0007408), depression (p = 7.92 × 10-8), somatization (p = 4.03 × 10-6), self-harm (SA) (p = 1.358 × 10-6), and non-suicidal self-injury (NSSI) (p = 8.965 × 10-6) was found, with a significant increasing trend for anxiety (p = 0.0444), depression (p = 8.06 × 10-6), somatization (p = 0.004616), SA (p = 3.998 × 10-8), and NSSI (p = 5.074 × 10-7). The findings of our study support the hypothesis of an alarming progressive worsening of the mental health of children and adolescents, with an overlapping effect of the pandemic exacerbating the process.

Reconfigurable supply-based feedback control for enhanced energy flexibility of air-conditioning systems facilitating grid-interactive buildings

Air-conditioning systems have great potential to provide energy flexibility services to the power grids of high-renewable penetration, due to their high power consumption and inherent energy flexibilities. Direct load control by switching off some operating chillers is the simplest and effective means for air-conditioning systems in buildings to respond to urgent power reduction requests of power grids. However, the implementation of this approach in today's buildings, which widely adopt demand-based feedback controls, would result in serious problems including disordered cooling distribution and likely extra energy consumption. This study, therefore, proposes a reconfigurable control strategy to address these problems. This strategy consists of supply-based feedback control, incorporated with the conventional demand-based feedback control, a control loop reconfiguration scheme and a setpoint reset scheme, facilitating effective control under limited cooling supply and smooth transition between supply-based and demand-based feedback control modes. The proposed control strategy is deployed in a commonly-used digital controller to conduct hardware-in-the-loop control tests on an air-conditioning system involving six AHUs. Test results show that the reconfigurable control achieves commendable control performance. Proper chilled water distribution enables even thermal comfort control among the building zones during demand response and rebound periods. Temperature deviation of the building zones is controlled below 0.2 K most of the time. 11.6 % and 27 % of power demand reductions are achieved during demand response and rebound periods respectively, using the proposed reconfigurable control compared with that using conventional controls.

Exploration of Preliminary Objective Triage by Menopause Score and CA 125 Result Prior to Accelerating Fast-Track Booking for Suspected Ovarian Cancer-A Role for the Pathway Navigator?

The 28-days-to-diagnosis pathway is the current expected standard of care for women with symptoms of ovarian cancer in the UK. However, the anticipated conversion rate of symptoms to cancer is only 3%, and use of the pathway is increasing. A rapid triage at the moment of receipt of the referral might allow resources to be allocated more appropriately. In secondary care, multidisciplinary teams (MDTs) use the risk of malignancy index (RMI) score, (multiply menopausal status pre = 1 or post = 3 × ultrasound score = 0 - 3 × the CA 125 level), using a score of >200, to triage urgency and management in possible ovarian cancer cases. The most powerful determinant of the RMI score variables is CA 125 level, an objective number. Could a simple modification of the RMI score retain a high sensitivity for cancer whilst improving specificity and, consequently, decrease the morbidity of false-positive classification? To test this hypothesis, a retrospective evaluation of an ovarian two-week-wait telephone clinic of one consultant gynaecological oncologist was undertaken. Enquiry re menopause status was scored as one for pre- and three for postmenopausal or uncertain. CA 125 levels of >67 u/mL for premenopausal and >23 u/mL for postmenopausal women were used to precipitate urgent cross-sectional imaging requests and MDT opinions. These CA 125 cut thresholds were calculated using an assumption that the RMI imaging score, regardless of whether the result was available, could be three. We contemplate that women who did not exceed a provisional RMI score of >200 might be informed they are extremely unlikely to have cancer, removed from the malignancy tracker and appropriate follow-up arranged. One hundred and forty consecutive cases were analysed; 43% were deemed premenopausal and 57% postmenopausal. Twenty of the women had cancer, eighteen (90%) of whom had an RMI > 200. One hundred and twenty were benign, and only twenty-three (19%) classified as urgent cases in need of accelerated referral to imaging. In contrast, CA 125 > 35 u/mL, whilst retaining the sensitivity of 90%, misclassified 36 (30%) of the benign cases. It is possible that a telephone triage via a questionnaire determining menopausal status and the CA 125 result could offer a sensitivity for cancer of 90% and urgent expert review of under 20% of benign cases. This rapid initial telephone assessment could be presented by a trained pathway navigator, physician associate or nurse specialist. Substantial savings in NHS cancer services resources, anxieties all around and reduced patient morbidity may occur as a result.

Integrated Automatic Examination Assignment Reduces Radiologist Interruptions: A 2-Year Cohort Study of 232,022 Examinations

Radiology departments face challenges in delivering timely and accurate imaging reports, especially in high-volume, subspecialized settings. In this retrospective cohort study at a tertiary cancer center, we assessed the efficacy of an Automatic Assignment System (AAS) in improving radiology workflow efficiency by analyzing 232,022 CT examinations over a 12-month period post-implementation and compared it to a historical control period. The AAS was integrated with the hospital-wide scheduling system and set up to automatically prioritize and distribute unreported CT examinations to available radiologists based on upcoming patient appointments, coupled with an email notification system. Following this AAS implementation, despite a 9% rise in CT volume, coupled with a concurrent 8% increase in the number of available radiologists, the mean daily urgent radiology report requests (URR) significantly decreased by 60% (25 ± 12 to 10 ± 5, t = -17.6, p < 0.001), and URR during peak days (95th quantile) was reduced by 52.2% from 46 to 22 requests. Additionally, the mean turnaround time (TAT) for reporting was significantly reduced by 440 min for patients without immediate appointments and by 86 min for those with same-day appointments. Lastly, patient waiting time sampled in one of the outpatient clinics was not negatively affected. These results demonstrate that AAS can substantially decrease workflow interruptions and improve reporting efficiency.

Semantic Interaction Matching Network for Few-Shot Knowledge Graph Completion

The prosperity of knowledge graphs, as well as related downstream applications, has raised the urgent need for knowledge graph completion techniques that fully support knowledge graph reasoning tasks, especially under the circumstance of training data scarcity. Although large efforts have been made on solving this challenge via few-shot learning tools, they mainly focus on simply aggregating entity neighbors to represent few-shot references, whereas the enhancement from latent semantic correlation within neighbors has been largely ignored. To that end, in this article, we propose a novel few-shot learning solution named SIM, a S emantic I nteraction M atching network that applies a Transformer framework to enhance the entity representation with capturing semantic interaction between entity neighbors. Specifically, we first design an entity-relation fusion module to adaptively encode neighbors with incorporating relation representation. Along this line, Transformer layers are integrated to capture latent correlation within neighbors, as well as the semantic diversification of the support set. Finally, a similarity score is attentively estimated with the attention mechanism. Extensive experiments on two public benchmark datasets demonstrate that our model outperforms a variety of state-of-the-art methods by a significant margin.

Nutrition-obesity. New program about behavioural issues involved in weight loss through surgery

Bariatric surgery is an effective treatment to improve metabolic health as long as behavioural changes are made. Opting for this therapeutic choice represents a real commitment on the part of patients which is complementary to the informative bariatric surgery consultation. After all, what practitioner has not been confronted with an urgent request from patients suffering from obesity who are over-investing in this operation? Therapeutic Patient Education offers the opportunity to work with patients to develop their status as committed actors through a new outpatient educational program. Increased feelings of self-efficacy and socio-cognitive conflict are ingredients that allow patients to invest in long-term changes.

Stabilized Positive Electrode Material to Enable High Energy/Power Density Lithium-Ion Batteries

Recently, the large-scale deployment of electric vehicles (EVs) and stationary battery systems has putforward urgent requests for rechargeable batteries with higher energy/power density and longerlifespans. As such, next-generation Li-ion batteries (LiBs) are expected to meet these requirements. Thepossibility of using Ni-rich high-capacity cathode materials (NMC) can help to achieve that goal, however,they still suffer from significant capacity fade via several chemical and mechanical degradation modes.One is crack formation within secondary particles which leads to parasitic reactions that evolve oxygenand potentially initiate the formation of inactive crystal structures. LiBs mechanical and chemicaldegradation mechanisms can be extended by applying protective coatings to the cathode’s surface. Manystudies explore atomic layer deposition (ALD) for this purpose. However, the complementary molecularlayer deposition (MLD) technique might offer the benefit of depositing flexible hybrid coatings that canaccommodate potential volume changes of the electrode during the battery cycling. This study reportsthe deposition of novel organic-inorganic films via the ALD-MLD method. Characterization analysis suchas FTIR, XPS, SEM-EDS, and TEM confirmed the film deposition on the surface of the NMC electrode.Besides, the electrochemical results showed the enhancement of the coated electrode, as evidenced byproviding a longer life with a 93% capacity retention after 150 cycles (3.0-4.4 V vs. Li/Li+), while theuncoated one retained only 83% of its initial capacity. Moreover, in situ dilatometry showed irreversiblevolume change for uncoated NMC while it was mostly reversible for coated ones during the cycling. Itrevealed the dilation behavior of the electrode, resulting in crack formation, which is significantlysuppressed for the coated samples. Stable cycling of Ni-rich cathode materials in crucial conditions suchas high voltage windows and elevated temperatures is still extremely challenging. To evaluate this, in situdilatometry was performed at elevated temperatures (40 °C and 55 °C) and higher voltage ranges (3.0-4.6V). The results confirmed that in both conditions, the dilation behavior of the coated sample is still undercontrol while the capacity is comparable to the uncoated sample. This revealed that the coatings presentgood lithium-ion kinetics and reduce electrolyte decomposition. Overall, this work showed the liability ofthe ALD-MLD films deposited on NMC electrodes to mitigate the degradation mechanisms and providesinsight into a method that seems promising as a protective and elastic coating for future high-energylithium-ion battery cathodes. Figure 1

Practical and Rapid Motor Sizing Technique Using Existing Electrical Motor

Electrical motor design requires considerable work and resources. In the field, motor designers need to decide on competitive motor sizing quickly to compete with other motor suppliers. Generally, expensive FEM S/W is required to obtain accurate motor sizing results, but buying and maintaining many licenses is costly. Moreover, patience is required to obtain the results from FEM analysis. In this paper, a motor sizing technique using an existing production motor is presented to enable responding to urgent requests from customers without using FEM analysis. In order to enhance the fidelity of the results, magnetic flux losses due to magnet coatings and non-linear characteristics are considered during the motor sizing process. The proposed sizing method is verified via a comparison with FEM analysis and the test results and shows reasonable performance. Also, this method has the substantial advantage of outputting accurate results instantly. The method can help with the modification design of electrical motors without using expensive FEM S/W and does not require a certain level of skill or experience.

EGS P19 Do Waiting Times for Inpatient Magnetic Resonance Cholangiopancreatography Affect Total Length of Stay? – A Single Centre Experience

Abstract Background Magnetic resonance cholangiopancreatography (MRCP) is an important imaging modality in ruling out choledocholithiasis and thus guide management of patients. However, access to MRI remains limited, which may lead to delays in discharge. Our aim was to analyse the waiting time for inpatient MRCP and its impact on total length-of-stay (LOS). Methods A retrospective cohort study of all consecutive adult inpatients who underwent MRCP in a single surgical unit was conducted from September 2020 to September 2022. Patients being investigated for non-biliary indications including hepato-pancreato-biliary malignancies were excluded. Patient demographics, laboratory results, MRCP indications, results and timestamps from the hospital’s radiology information system were analysed. Peak liver function test (LFT) values before MRCP were used. P-values were calculated using Student T-test. This study was registered with Clinical Quality Project (LanQIP 14736). Results 677 patient has inpatient MRCPs; 22 were excluded. Median age was 66 years (IQR 51-76) and 401 (59.2%) were female. 281 (41.5%) MRCPs were urgent requests. 128 (18.9%) patients were clinically jaundiced and 115 (17.0%) had gallstone pancreatitis. 228 (33.7%) patients had choledocholithiasis on MRCP, of which 192 (84.2%) were known to have gallstones pre-MRCP. Median waiting time for urgent MRCPs from time of order was 1.0 days versus 1.3 for routine requests (p&amp;lt;0.001). Overall, median LOS was 6.7 days (IQR 4.1-10.9). This was 6.1 days (IQR 3.7-10.1) for urgent scans and 7.0 (IQR 4.5-11.5) for routine scans (p=0.106). Conclusions Inpatient MRCP does not significantly delay discharge in our centre. Patients screened for high-risk features of choledocholithiasis should have MRCPs marked as urgent to expedite clinical decision-making and mitigate complications from biliary obstruction. Therefore, it remains useful in determining the need for endoscopic retrograde cholangiopancreatography and/or intra-operative cholangiogram in patients with gallstone disease.

Coordinated logistics with trucks and drones for premium delivery

Last-mile delivery, the final stage of the delivery process before a package arrives at a customer's address, has emerged as an important business opportunity for inland transportation. As people's perception of last-mile delivery has changed, more customers are using premium delivery services to get the delivery at a specific time rather than just pursuing free shipping. In order to satisfy the new trend of logistics, we propose a delivery system in which several drones and trucks work together to provide service to customers within given time windows. In addition, pair constraints, which considered a truck and a drone as a pair, are relaxed to determine more flexible delivery plans. A three-stage savings-based heuristic procedure was also developed based on the concept of savings to determine the operations of trucks and drones in real-world settings. We found that the drone efficiently responds to urgent delivery requests from customers and that a delivery system that utilises both trucks and drones provides substantial benefits.

Reducing wait times for initiation of chemotherapy at the Bellevue Cancer Center.

461 Background: The Bellevue Hospital Cancer Center is the primary oncologic referral center for the NYC Health and Hospitals System. It experiences high demand for infusion therapies requiring the resources of an infusion center and the expertise of chemotherapy registered nurses (RNs). From November 2021 to December 2022, there was a shortage in the number of chemotherapy RNs and the number of infusion chairs. This resulted in prolonged wait times for treatment initiation and difficulty accommodating requests to start treatment within 7 days. Here, we evaluate the impact of capacity building interventions on the success rate of treatment initiation within 7 days. Methods: We examined requests for initiation of infusion treatment within 7 days for all malignancies from December 2021 to December 2022. Our primary process measure was the percentage of requests fulfilled each month. We collected key variables for each chemotherapy request including number of RNs, number of infusion chairs, and the number of days between subsequent infusions. Finally, a root cause analysis was conducted to determine the causes for decreased RN and infusion care capacity. Using all the data above, a Plan-Do-Study-Act process was created to address key capacity deficiencies. Results: Our findings revealed an increase in successful treatment initiation within 7 days from December 2021 to December 2022. From August 2022 to December 2022, 100% of all requests within 7 days were successfully scheduled. There was also an increase in the number of available infusion chairs in this time interval, from a minimum of 18 in December 2021 to 22 in December 2022. There was also an increase in the number of chemotherapy certified RNs. These findings are summarized in the table below. There were key interventions to address capacity shortages. Facilities in the Ambulatory Cancer Center and the inpatient hematology/oncology unit were repurposed into additional infusion spaces. There were also additional pay lines created for chemotherapy RNs, increased recruitment, and hiring of Nursing Agency RNs. Conclusions: We describe the capacity limitations surrounding infusion therapy at the Bellevue Cancer Center. Key interventions included strategic recruitment, financial approval of new chemotherapy RN pay lines, hiring agency RNs, and repurposing ambulatory and inpatient spaces. This resulted in increased capacity and 100% fulfillment of urgent treatment initiation requests. As the number of patients requiring infusion services at the Bellevue Cancer Center grows, long-term capacity building solutions will be essential.[Table: see text]

A Review of On-Board Carbon Capture and Storage Techniques: Solutions to the 2030 IMO Regulations

The maritime sector is among the most polluting industrial sectors in the world. To oppose this and following the global trend towards carbon neutrality, the International Maritime Organization (IMO) introduced the objective to reduce the CO2 emission of vessels by the year 2030 of 40% and at the same time the European Union will introduce the maritime sector into the ETS system. Therefore, there is a need to reduce the emissions of the working vessels, and this can be accomplished through the Carbon Capture and Storage (CCS). There are many possible CCS technologies that can be applied to vessels: the one that has already been studied the most is the ammine scrubbing of the exhaust gasses. In parallel, other technologies have been proposed to reduce volume and energy needs, which are the Molten Carbonate Fuel Cells (MCFCs), membrane technologies, fixed bed absorption processes and limestone. The review shows how, depending on the used vessel type, the technology to be used may vary, and proposes some preferential options for different applications. The obtained results can be of relevant importance in the present context of energy transition promoting immediate retrofitting to respond to the urgent request for intervention.

Telemedicine Consultations for Children With Musculoskeletal Injuries: Data from the Turner National Medical Research Center of Сhildren’s Orthopedics and Trauma Surgery

Background. Currently, the mortality rate of pediatric patients due to injuries surpasses mortality from other causes worldwide. The selection and timely transfer of the injured to specialized clinics are crucial elements of the healthcare system. Telemedicine consultations (TMC) are considered by several authors as an effective means to enhance the quality of trauma care and optimize patient routing processes.&#x0D; Aim of the study was to analyze the results of urgent and emergent telemedicine consultations and hospitalizations based on telemedicine consultations for children with musculoskeletal injuries.&#x0D; Methods. TMC requests from 2020 to 2022 were analyzed. When evaluating TMC requests, attention was given to the type of request (planned, urgent, emergent), the region from which the request originated, and the correspondence of the requests urgency category to the patients diagnosis. The study also involved an analysis of the injury structure, its severity according to the Injury Severity Score (ISS) at the time of trauma, and the timelines for requesting and transferring to the federal clinic from the moment of injury.&#x0D; Results. From 2020 to 2022, a total of 3745 requests for TMC were received. Among them, there were 572 urgent and emergent requests. A threefold increase in the number of TMC requests was observed over the span of three years. In the same period, 78 patients were transferred to the clinic. For 36 patients with combined and multiple injuries, the severity of trauma was assessed using the ISS scale. The average score was 31 (min 9; max 57). The average time for regional institutions to send a request from the moment of the patients hospitalization was 6.7 days. Hospitalization in the centers clinic from the moment of injury was 10.3 days (min 1; max 58).&#x0D; Conclusion. The study revealed the following issues that need to be addressed through further organizational steps: a high percentage of mismatch between the type of request and the actual clinical picture, delayed consultations, prolonged medical evacuation, and organizational aspects of medical evacuation.

Urgent drug requests at the pharmacy: are they always justified and how to optimize them?

Urgent drug requests at the pharmacy: are they always justified and how to optimize them?

932 Provision of a 7 Day Radiology Service for Emergency Laparotomy Patients: Are We Compliant with Current Standards?

Abstract Introduction According to “NHS services, Seven Days a week Forum”, a radiological scan should be reported within 1 hour for “critical” requests and within 12 hours for “urgent “ones. Requests are considered critical when the test will alter patient’s management at the time; and urgent if the test will alter management but not necessarily that day. Aim The aim was to audit whether the above standards were met for urgent and critical requests for patients undergoing emergency laparotomy. Method A single centre retrospective audit of adults undergoing emergency laparotomy between 01/02/2014 to 30/12/2021 was performed. Data was collected from the National Emergency Laparotomy Audit database. A total of 1748 patient records were analysed out of which 1309 were included. Patients who underwent pre-operative CT scan in the same admission were included. Patients who had CT prior to admission for laparotomy and those who had more than one operative intervention were excluded. CT time was calculated as time taken from CT examination to reporting. Results Standards were met for 27.5% of all investigations ordered. 0.16% of Critical, and 53% of urgent scans were reported within required times. There was no difference in standards met between weekends and weekdays. Conclusions Limitations include the retrospective nature of data collection and amendment time being recorded instead of original reporting time for some scans. Recommendations include allowing time frames for standards and retaining interim report times.

WTP3.12 Value of magnetic resonance cholangiopancreatography (MRCP) in acute gallstone pancreatitis

Abstract Aims Magnetic resonance cholangiopancreatography (MRCP) is commonly performed in acute pancreatitis to rule out bile duct stones (BDS). The aim of this study was to determine if MRCP is required to rule out BDS in patients admitted with gallstone pancreatitis (GS). Method A retrospective cohort study of all consecutive MRCPs in a single surgical unit from October 2021 to September 2022 was conducted. Patient demographics, laboratory results and MRCP result data was analysed. Patients with MRCP proven BDS were compared to those without. Results Sixty-one patients were identified, 39 (63.9%) were female. Median age was 62 years (IQR 45-75) and median Scottish Index of Multiple Deprivation was 4 (IQR 3-7). 55 (90.2%) MRCPs were inpatient and 30 (49.2%) were urgent requests. Median wait time for inpatient MRCP was 1 day (IQR 0.7-1.8) and 17.1 days (IQR 14.6-28.3) for outpatient requests. 14 (23%) patients had BDS proven on MRCP. Of these, 6 (42.8%) had evidence of dilated bile ducts on preceding imaging and 8 (57.1%) had hyperbilirubinaemia and raised alkaline phosphatase levels. Median wait time for MRCP for patients with BDS was 0.8 days (IQR 0.35-1.5) compared to 1.2 days (IQR 0.85-2.85) in MRCPs with no evidence of BDS. Conclusion We conclude that MRCP is not required for low-risk patients with acute gallstone pancreatitis. However, MRCP will be beneficial in patients with jaundice and preceding radiological evidence of ductal dilatation. Intraoperative cholangiography is recommended in patients who proceed to laparoscopic cholecystectomy where MRCP has not been performed.