Admission Variables Research Articles

SP8.4 National variation in the management of pancreatitis and the effect on patient outcome

Abstract Aim Pancreatitis is one of the most common general surgical presentations, but there is variation in how patients are managed. Our aim was to assess the degree of variation across the United Kingdom (UK) and how it affects patient outcomes. Method A multicentre, observational cohort study was carried out across the UK between March-April 2021. Admission variables including whether the unit was a district general or specialist unit were recorded. Imaging and operative details were collected with 30-day outcomes. Results Data from 113 hospitals were recorded, including 2580 patients. 24(21%) of these hospitals were specialist units. Imaging rates varied between sites, with ultrasound performed within 24 hours of admission on between 14 and 100% of patients and CT between 22 and 100% of patients. Between 0% and 100% of patients received a laparoscopic cholecystectomy within 30 days. Median length of stay was 5 days, but increased to 6 days in low volume centres (p=0.01). Variation in access to ultrasound and to surgery were related to hospital volume, but not whether they were a tertiary unit. Mortality and readmission rates were not correlated to hospital volume but unplanned readmission was higher in non-specialist centres (18.1%v14.4%, p=0.024). Conclusions There is significant inequity in accessing best practise pancreatitis care in the UK, based on admitting hospital. Case volume at a hospital was more significantly associated with access to imaging and surgery, than being a specialist centre, however specialist centres achieved lower rates of unplanned readmission.

Identifying the most important data for research in the field of infectious diseases: thinking on the basis of artificial intelligence.

Clinical data on which artificial intelligence (AI) algorithms are trained and tested provide the basis to improve diagnosis or treatment of infectious diseases (ID). We aimed to identify important data for ID research to prioritise efforts being undertaken in AI programmes. We searched for 1,000 articlesfrom high-impact ID journals on PubMed, selecting 288 of the latest articles from 10 top journals. We classified them into structured or unstructured data. Variables were homogenised and grouped into the following categories: epidemiology, admission, demographics, comorbidities, clinical manifestations, laboratory, microbiology, other diagnoses, treatment, outcomes and other non-categorizable variables. 4,488 individual variables were collected, from the 288 articles. 3,670 (81.8%) variables were classified as structured data whilst 818 (18.2%) as unstructured data. From the structured data, 2,319 (63.2%) variables were classified as direct-retrievable from electronic health records-whilst 1,351 (36.8%) were indirect. The most frequent unstructured data were related to clinical manifestations and were repeated across articles. Data on demographics, comorbidities and microbiology constituted the most frequent group of variables. This article identified that structured variables have comprised the most important data in research to generate knowledge in the field of ID. Extracting these data should be a priority when a medical centre intends to start an AI programme for ID. We also documented that the most important unstructured data in this field are those related to clinical manifestations. Such data could easily undergo some structuring with the use of semi-structured medical records focusing on a few symptoms.

Use of multiple admission variables better predicts intestinal strangulation in horses with colic than peritoneal or the ratio of peritoneal:blood l-lactate concentration.

Early identification of strangulating obstruction (SO) in horses with colic improves outcomes, yet early diagnosis of horses requiring surgery for SO often remains challenging. To compare blood and peritoneal fluid l-lactate concentrations, peritoneal:blood l-lactate ratio, peritoneal minus blood (peritoneal-blood) l-lactate concentration and other clinical variables for predicting SO and SO in horses with small intestinal lesions (SO-SI) and then to develop a multivariable model to predict SO and SO-SI. Retrospective cohort. A total of 197 equids admitted to a referral institution for colic between 2016 and 2019 that had peritoneal fluid analysis performed at admission were included. Twenty-three admission variables were evaluated individually for the prediction of a SO or SO-SI and then using multivariable logistic regression. Odds ratios (ORs) with 95% confidence intervals (CI) and area under the curve of the receiver operator characteristic (AUC ROC) were calculated. All variables performed better in the model than individually. The final multivariable model for predicting SO included marked abdominal pain (OR 5.31, CI 1.40-20.18), rectal temperature (OR 0.30, CI 0.14-0.64), serosanguineous peritoneal fluid (OR 35.34, CI 10.10-122.94), peritoneal-blood l-lactate (OR 1.77, CI 1.25-2.51), and peritoneal:blood l-lactate ratio (OR 0.36, CI 0.18-0.72). The AUC ROC was 0.91. The final multivariable model for predicting SO-SI included reflux volume (OR 0.69, CI 0.56-0.86), blood l-lactate concentration (OR 0.43, CI 0.22-0.87), serosanguineous peritoneal fluid (OR 4.99, CI 1.26-19.74), and peritoneal l-lactate concentration (OR 3.77, CI 1.82-7.81). Retrospective, single-hospital study design. Blood and peritoneal fluid l-lactate concentrations should be interpreted in conjunction with other clinical variables. The relationship between peritoneal and blood l-lactate concentration for predicting SO or SO-SI was complex when included in a multivariable model. Models to predict SO probably vary based on lesion location.

Early Intraventricular Antibiotic Therapy Improved In-Hospital-Mortality in Neurocritical Patients with Multidrug-Resistant Bacterial Nosocomial Meningitis and Ventriculitis.

Hospital-acquired multidrug-resistant (MDR) bacterial meningitis and/or ventriculitis (MEN) is a severe condition associated with high mortality. The risk factors related to in-hospital mortality of patients with MDR bacterial MEN are unknown. We aimed to examine factors related to in-hospital mortality and evaluate their prognostic value in patients with MDR bacterial MEN treated in the neurointensive care unit. This was a single-center retrospective cohort study of critically ill neurosurgical patients with MDR bacterial MEN admitted to our hospital between January 2003 and March 2021. Data on demographics, admission variables, treatment, time to start of intraventricular (IVT) therapy, and in-hospital mortality were analyzed. Both univariate and multivariable analyses were performed to identify determinants of in-hospital mortality. All 142 included patients received systemic antibiotic therapy, and 102 of them received concomitant IVT treatment. The median time to start of IVT treatment was 2days (interquartile range 1-5days). The time to start of IVT treatment had an effect on in-hospital mortality (hazard ratio 1.17; 95% confidence interval 1.02-1.34; adjusted p = 0.030). The cutoff time to initiate IVT treatment was identified at 3days: patients treated within 3days had a higher cerebrospinal fluid (CSF) sterilization rate (81.5%) and a shorter median time to CSF sterilization (7days) compared with patients who received delayed IVT treatment (> 3days) (48.6% and 11.5days, respectively) and those who received intravenous antibiotics alone (42.5% and 10days, respectively). Early IVT antibiotics were associated with superior outcomes in terms of the in-hospital mortality rate, time to CSF sterilization, and CSF sterilization rate compared with delayed IVT antibiotics and intravenous antibiotics alone.

Contraindications to use of neuraxial anesthesia for lower limb revascularization surgery in adults: a cross-sectional study.

Nonrandomized and some randomized data suggest neuraxial anesthesia may improve outcomes after lower limb revascularization surgery. Nevertheless, the prevalence of contraindications to neuraxial anesthesia in vascular surgery patients is unknown. We aimed to identify the prevalence of patients with contraindications to neuraxial anesthesia, and to derive and validate a case ascertainment algorithm identifying individuals likely to have contraindications. We conducted a historical cross-sectional study of open lower limb revascularization surgeries performed between 2019 and 2021 at The Ottawa Hospital. Medical records were reviewed for demographic data, admission, procedural characteristics, and presence of contraindications to neuraxial anesthesia. Case ascertainment algorithms to predict the presence of absolute contraindications to neuraxial anesthesia were derived and internally validated. We identified 340 cases. General anesthesia was used in 219 (64.4%) cases, isolated neuraxial (spinal and/or epidural) in 106 (31.2%) cases, and general plus neuraxial in 15 (4.4%) cases. Seventy-eight (22.9%; 95% confidence interval [CI], 18.8 to 27.7) patients had absolute contraindications to neuraxial anesthesia, primarily because of anticoagulation or antiplatelet medication (89.4%); 21 (6.2%; 95% CI, 4.1 to 9.3) had relative contraindications, primarily long anticipated duration of surgery (16/21, 76.2%). We derived and validated three nested case-ascertainment algorithms. Using admission and procedure variables, discrimination was moderate with moderately explained variance, and calibration was inadequatefor reliable use. Patient comorbidity and laboratory data did not improve algorithm performance. Most patients undergoing lower limb revascularization surgery did not have absolute contraindications to neuraxial anesthesia. When present, contraindications typically related to anticoagulation. Admission, procedure, comorbidity, and laboratory data did not provide adequate accuracy to ascertain contraindication status.

Analysis of Means Based on Exponentiated Inverted Weibull Distribution

The probability model of a quality characteristic is assumed to follow the exponentiated inverted weibull distribution. The technique of analysis of means for a skewed population is applied with respect to exponentiated inverted weibull distribution. The subgroup means are used to develop control charts to assess whether the population from which these subgroups are drawn is operating with admissible quality variations. The results are illustrated by examples on live data.

Injury outcomes across Canadian trauma systems: a historical cohort study.

Most North American trauma systems have designated trauma centres (TCs) including level I (ultraspecialized high-volume metropolitan centres), level II (specialized medium-volume urban centres), and/or level III (semirural or rural centres). Trauma system configuration varies across provinces and it is unclear how these differences influence patient distributions and outcomes. We aimed to compare patient case mix, case volumes, and risk-adjusted outcomes of adults with major trauma admitted to designated level I, II, and III TCs across Canadian trauma systems. In a national historical cohort study, we extracted data from Canadian provincial trauma registries on major trauma patients treated between 2013 and 2018 in all designated level I, II, or III TCs in British Columbia, Alberta, Quebec, and Nova Scotia; level I and II TCs in New Brunswick; and four TCs in Ontario. We used multilevel generalized linear models to compare mortality and intensive care unit (ICU) admission and competitive risk models for hospital and ICU length of stay (LOS). Ontario could not be included in outcome comparisons because there were no population-based data from this province. The study sample comprised 50,959 patients. Patient distributions in level I and II TCs were similar across provinces but we observed significant differences in case mix and volumes for level III TCs. There was low variation in risk-adjusted mortality and LOS across provinces and TCs but interprovincial and intercentre variation in risk-adjusted ICU admission was high. Our results suggest that differences in the functional role of TCs according to their designation level across provinces leads to significant variations in the distribution of patients, case volumes, resource use, and clinical outcomes. These results highlight opportunities to improve Canadian trauma care and underline the need for standardized population-based injury data to support national quality improvement efforts.

Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care Organizations: Implications for Quality Measurement.

Background Accountable care organizations (ACOs) aim to improve health care quality and reduce costs, including among patients with heart failure (HF). However, variation across ACOs in admission rates for patients with HF and associated factors are not well described. Methods and Results We identified Medicare fee-for-service beneficiaries with HF who were assigned to a Medicare Shared Savings Program ACO in 2017 and survived ≥30 days into 2018. We calculated risk-standardized acute admission rates across ACOs, assigned ACOs to 1 of 3 performance categories, and examined associations between ACO characteristics and performance categories. Among 1 232 222 beneficiaries with HF, 283 795 (mean age, 81 years; 54% women; 86% White; 78% urban) were assigned to 1 of 467 Medicare Shared Savings Program ACOs. Across ACOs, the median risk-standardized acute admission rate was 87 admissions per 100 people, ranging from 61 (minimum) to 109 (maximum) admissions per 100 beneficiaries. Compared to the overall average, 13% of ACOs performed better on risk-standardized acute admission rates, 72% were no different, and 14% performed worse. Most ACOs with better performance had fewer Black beneficiaries and were not hospital affiliated. Most ACOs that performed worse than average were large, located in the Northeast, had a hospital affiliation, and had a lower proportion of primary care providers. Conclusions Admissions are common among beneficiaries with HF in ACOs, and there is variation in risk-standardized acute admission rates across ACOs. ACO performance was associated with certain ACO characteristics. Future studies should attempt to elucidate the relationship between ACO structure and characteristics and admission risk.

Predicting First-Time National Physical Therapy Examination Performance for Graduates of an Entry-Level Physical Therapist Education Program.

The National Physical Therapy Examination (NPTE) is a standardized examination designed to assess competence after graduation from an entry-level physical therapist education program. Previous studies have identified applicant and student variables that are related to NPTE performance, with applicant variables reflecting performance before admission and student variables reflecting performance after admission. However, there are very few articles describing how these variables can be combined to predict NPTE performance. The purpose of this study was to develop, evaluate, and describe models to predict first-time NPTE scores and NPTE outcomes (pass vs fail), based on various applicant and student variables related to academic performance. Pre- and postadmission data and NPTE scores were recorded for 185 individuals who graduated from an entry-level physical therapist education program. Multiple linear regression was used to develop a model to predict NPTE scores, and binary logistic regression was used to develop a model to predict NPTE outcomes (pass vs fail). A model including undergraduate prerequisite grade point average, grade point average in basic science courses taken during the program, and comprehensive examination scores combined to explain 30.9% of the variance in NPTE scores and accurately predicted NPTE outcomes (pass vs fail) 81.1% of the time. In general, our findings support the notion that prediction of NPTE performance should be based on a combination of applicant and student variables. The models described in this article could be used to identify students who may be likely to struggle on the NPTE, making it possible to provide additional support to these students. Various applicant and student variables related to academic performance can be combined to predict NPTE performance. The results of this study provide a framework for programs interested in applying models to predict NPTE performance.

Opioid and stimulant attributed treatment admissions and fatal overdoses: Using national surveillance data to examine the intersection of race, sex, and polysubstance use, 1992–2020

BackgroundWe use national surveillance data to evaluate race/ethnicity by sex/gender differences and trends in substance use treatment admissions and overdose deaths involving opioid and stimulant use. MethodsWe used data (1992–2019) from the Treatment Episode Dataset-Admissions to identify treatment admissions and the Center for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (1999–2020) to identify overdose deaths. We assessed treatment admissions and related drug overdose deaths per 100,000 adults by sex and race/ethnicity for opioid and stimulant groups: cocaine, opioid, methamphetamines, cocaine and opioid use, cocaine and methamphetamines, and opioid and methamphetamines. ResultsWe found significant variations in treatment admissions and deaths by race/ethnicity and sex/gender. Cocaine-related treatment admissions and deaths were most prevalent among Non-Hispanic Black individuals over the study years, yet lower rates were evident among individuals from other racial/ethnic groups. Notably, Non-Hispanic Black men experienced larger increases in cocaine-only admissions than men of other racial/ethnic groups between 1992 and 2019. Men had higher opioid and stimulant treatment admissions and overdose deaths than women. We observed skyrocketing methamphetamine deaths among American Indian/Native Alaskan men and women from 1992 to 2019. DiscussionSteep increases in overdose deaths fueled by methamphetamines among Non-Hispanic Native Americans and cocaine among Non-Hispanic Black individuals suggest a need for more effective interventions to curb stimulant use. Variations by race/ethnicity and sex/gender also suggest interventions should be developed through an intersectionality lens.

Identifying temporal variations in burn admissions.

Variations in admission patterns have been previously identified in non-elective surgical services, but minimal data on the subject exists with respect to burn admissions. Improved understanding of the temporal pattern of burn admissions could inform resource utilization and clinical staffing. We hypothesize that burn admissions have a predictable temporal distribution with regard to the time of day, day of week, and season of year in which they present. A retrospective, cohort observational study of a single burn center from 7/1/2016 to 3/31/2021 was performed on all admissions to the burn surgery service. Demographics, burn characteristics, and temporal data of burn admissions were collected. Bivariate absolute and relative frequency data was captured and plotted for all patients who met inclusion criteria. Heat-maps were created to visually represent the relative admission frequency by time of day and day of week. Frequency analysis grouped by total body surface area against time of day and relative encounters against day of year was performed. 2213 burn patient encounters were analyzed, averaging 1.28 burns per day. The nadir of burn admissions was from 07:00 and 08:00, with progressive increase in the rate of admissions over the day. Admissions peaked in the 15:00 hour and then plateaued until midnight (p<0.001). There was no association between day of week in the burn admission distribution (p>0.05), though weekend admissions skewed slightly later (p = 0.025). No annual, cyclical trend in burn admissions was identified, suggesting that there is no predictable seasonality to burn admissions, though individual holidays were not assessed. Temporal variations in burn admissions exist, including a peak admission window late in the day. Furthermore, we did not find a predictable annual pattern to use in guiding staffing and resource allocation. This differs from findings in trauma, which identified admission peaks on the weekends and an annual cycle that peaks in spring and summer.

Symptom burden and end of life care in patients with acute myeloid leukemia undergoing intensive induction chemotherapy in a rural setting.

e24117 Background: Patients with acute myeloid leukemia (AML) who receive intensive induction chemotherapy (IC) face a prolonged hospitalization and a life-threatening illness. As a result, patients experience a high physical, psychological, and emotional symptom burden which can significantly affect their quality of life (QOL).1 There is also a high mortality rate associated with IC, with one study showing 12.3% chance of in-hospital death and 3.7% discharge to hospice.2 Early integration of palliative care (IPC) has shown improvements in QOL, decrease in psychological stress and improved end-of-life care.3 The aim of this study was to examine the historic use of IPC during IC and assess the symptom burden in a rural healthcare setting and to provide a rationale for early incorporation of palliative care into IC. Methods: We performed an IRB approved retrospective study of all patients with AML who were admitted to Gundersen Health System for IC from January 2013 to September 2021. Data collection included basic demographics, disease and treatment specific variables, and admission variables. Symptom burden was also assessed by reviewing daily progress notes. Statistical analysis included descriptive statistics, Wilcoxon signed-rank test, and Fisher’s exact test and was performed in SAS version 9.4 at a significance level of 0.05. Results: Our study included 33 patients with an average age of 62 years. Our sample was 100% white, 58% male, 82% married and 58% former smokers. Average length of stay was 29 days and 5 (15%) patients died during this time. Individuals experienced an average of 9.8 (range 4-17) of the 20 recorded symptoms, most commonly pain (97%), fevers (88%), edema (73%), anorexia (67%), rash (61%), and diarrhea (61%). Only 6 patients (18%) received a palliative care consultation during IC. For patients without a palliative care consultation during IC, advanced care planning (ACP) documents were found in only 37% during or before IC. However, when palliative care was consulted, ACP documentation increased to 83% demonstrating a trend towards significance (p = 0.07). There was a significant difference between the number of symptoms observed in those who received a palliative care consultation (median = 13 symptoms) and those who did not (median = 9 symptoms, p = 0.007). Conclusions: Despite our patients experiencing a high symptom burden and a significant chance of death, there was a low rate of early integration of palliative care. This retrospective study was unable to determine if IPC improved symptom burden, but we did find that IPC increased the rate of ACP documentation from 37% to 83%. The presence of ACP documentation has been shown to significantly reduce ICU utilization and improve the quality of care at the end of life.4 Given these findings; we plan to move forward with routine integration of palliative care into the management of patients undergoing IC for AML.

Definability of mixed period maps

We equip integral graded-polarized mixed period spaces with a natural \mathbb{R}_{\mathrm{alg}} -definable analytic structure, and prove that any period map associated to an admissible variation of integral graded-polarized mixed Hodge structures is definable in \mathbb{R}_{\mathrm{an,exp}} with respect to this structure. As a consequence we re-prove that the zero loci of admissible normal functions are algebraic.

An Exploration of the Relationship Between Pharmacy School Admission Variables and PGY1 Pharmacy Residency Program Match

ObjectiveTo explore the relationship between pharmacy school admission variables and matching to a postgraduate year 1 (PGY1) pharmacy residency program. MethodsDemographic data, academic indicators, and application review scores were collected for the 2017–2020 Doctor of Pharmacy (PharmD) graduating classes. Multiple mini-interview (MMI) scores were collected for the 2018–2020 PharmD graduating classes. Postgraduate year 1 matching data were collected for all students. Bivariate analyses were performed comparing students who matched to a PGY1 residency versus those who did not match versus those who did not pursue a residency. Logistic regression modeling was performed to explore predictors of matching to a PGY1 residency program. ResultsA total of 616 students were included. Bivariate analyses revealed that students who matched to a PGY1 had a higher undergraduate grade point average, higher pharmacy college admissions test composite score, were younger in age, and were more likely to identify as female. Students who matched also scored higher on MMI stations with constructs related to integrity, adaptability, critical thinking, and why pursuing our school. Logistic regression modeling found that an increase in age was associated with lower odds of matching to a PGY1 (0.88 [0.78–0.99]) and an increase in composite MMI station score was associated with higher odds of matching (1.8 [1.31–2.47]). ConclusionSeveral pharmacy school admission variables were found to be associated with successful matching to a PGY1 residency. These findings have the potential for impact at a programmatic level when evaluating the weight of certain criteria for admission decisions and at the individual student level when providing career services support.

Left atrial strain–a memory of the severity of atrial myocardial stress in atrial fibrillation

Left atrial (LA) strain is a simple marker of LA function and could be useful in evaluating the determinants of atrial cardiomyopathy. We sought to evaluate LA strain as an imaging biomarker of atrial cardiomyopathy. We prospectively evaluated clinical, biological, metabolomic, echocardiographic parameters for 85 consecutive patients hospitalized for atrial fibrillation (AF) with restoration of sinus rhythm at 6 months. Eighty-one patients with an analysable LA strain at 6 months were divided into groups according to median reservoir strain: < 23.3% (n = 40) vs. ≥ 23.3% (n = 41). Compared to patients with the highest LA strain, patients with lowest LA strain had multiple differences at admission: clinical (older age; more frequent history of AF; more patterns of persistent AF); biological (higher fasting blood glucose levels, glycated hemoglobin, high-sensitivity C-reactive protein, and urea; lower glomerular filtration rate); metabolomic (higher levels of kynurenine, kynurenine/tryptophan, and urea/creatinine; lower levels of arginine and methionine/methionine sulfoxide); and echocardiographic (higher two-dimensional end-systolic LA volume [LAV] indexes; higher three-dimensional end-systolic and end-diastolic LAV and right atrial [RA] volume indexes; lower LA and RA emptying fractions and three-dimensional right ventricular ejection fraction) (all P < 0.05). Area under the receiver operating characteristic curve (AUC) to predict LA strain alteration at 6 months was highest for a combined score including clinical, biological, metabolomic, and echocardiographic variables at admission (AUC 0.871; P < 0.0001) (Fig. 1). LA strain reservoir could be a memory of initial atrial myocardial stress in AF. It can be predicted using a combination of clinical, biological, metabolomic, and echocardiographic admission variables.

The Ax–Schanuel conjecture for variations of mixed Hodge structures

We prove in this paper, the Ax–Schanuel conjecture for all admissible variations of mixed Hodge structures.

Efecto de la pandemia de COVID-19 en pacientes no COVID-19 que ingresan por Guardia en el Servicio de Cirugía, durante la fase estricta de la pandemia en Buenos Aires. Un estudio de cohorte.

Background: Emergency general surgery conditions require immediate evaluation and timely resolution, even during quarantine. Objective: to analyze variations in admissions, surgical outcomes and severity of the disease in nonCOVID-19 emergency admissions during the first months of the pandemic. Secondary objectives, to performed a sub-analysis of common surgical conditions, as appendicitis, biliary tract disease, diverticulitis and complicated tumors. Material and methods: An observational, ambispective study was carried out on a prospective cohort of patients who consulted with on-call surgical pathology and required hospitalization from March 20th, 2020 until July 31, 2020 referred to as Pandemic Group (PG), analyzed and compared with the same period of 2019, Control Group (CG). Results: We experienced an increase in the number of patients admitted at the ED during the pandemic PG vs CG (346 versus 305, p 0.157). Patients in the PG were found to be significantly more ill (58.1% versus 48,8%, p 0.018). A significant delay was found globally in both, time from onset of symptoms presentation to consultation (48 hours versus 24 hours, p &lt; 0.001), and time from diagnosis to surgery (23 hours versus 7 hours, p &lt; 0.001) in the PG, and an increase in the mean operative time (75 versus 60 minutes, p= 0,001). There was no significant difference in postoperative complications. Conclusion: During the pandemic we observed an increase in urgent surgical procedures due to biliary pathology and gastrointestinal tumors. The patients consulted with more advanced stages of disease, but this had no impact on postoperative morbidity or mortality, demonstrating that it was possible to maintain surgical outcomes despite delayed consultation.

Seasonal variations in acute diverticular disease hospitalisations in New Zealand

PurposeSeasonal variation of acute diverticular disease is variably reported in observational studies. This study aimed to describe seasonal variation of acute diverticular disease hospital admissions in New Zealand.MethodsA time series analysis of national diverticular disease hospitalisations from 2000 to 2015 was conducted among adults aged 30 years or over. Monthly counts of acute hospitalisations’ primary diagnosis of diverticular disease were decomposed using Census X-11 times series methods. A combined test for the presence of identifiable seasonality was used to determine if overall seasonality was present; thereafter, annual seasonal amplitude was calculated. The mean seasonal amplitude of demographic groups was compared by analysis of variance.ResultsOver the 16-year period, 35,582 hospital admissions with acute diverticular disease were included. Seasonality in monthly acute diverticular disease admissions was identified. The mean monthly seasonal component of acute diverticular disease admissions peaked in early-autumn (March) and troughed in early-spring (September). The mean annual seasonal amplitude was 23%, suggesting on average 23% higher acute diverticular disease hospitalisations during early-autumn (March) than in early-spring (September). The results were similar in sensitivity analyses that employed different definitions of diverticular disease. Seasonal variation was less pronounced in patients aged over 80 (p = 0.002). Seasonal variation was significantly greater among Māori than Europeans (p < 0.001) and in more southern regions (p < 0.001). However, seasonal variations were not significantly different by gender.ConclusionsAcute diverticular disease admissions in New Zealand exhibit seasonal variation with a peak in Autumn (March) and a trough in Spring (September). Significant seasonal variations are associated with ethnicity, age, and region, but not with gender.

Clinical outcomes and prognostic factors of traumatic basal ganglia hematomas: A 4-year single-center study.

Traumatic basal ganglia hematomas (TBGH) are rare entities. They are situated in the deep cerebral parenchyma and have also been termed as intermediate coup contusions. Available literature is sparse with regards to the characteristics and prognosis of TBGH. We aim to share our experience in the management, outcomes, and prognostic factors of TBGH. A 4-year retrospective study which included all cases of TBGH, except dot contusions (<2 mL) and those with coagulopathies. Admission variables were correlated with Glasgow Outcome Scale score at discharge and 12 months. Thirty-two patients were analyzed. The mean age was 39.2 years. Two-thirds were due to road traffic accidents. Around 60% were severe head injuries. The mean Glasgow coma scale (GCS) score at presentation was 8.5. Twenty patients had moderate-to-severe hemiparesis. The mean hematoma volume was 18.1 mL. Associated traumatic intracranial lesions were seen in 28 cases. Only 7 patients (22%) underwent surgery. The mean follow-up was 17.4 months (range 14-34 months). The mortality rate was 12.5% (n = 4). Among the survivors, only 39% (n = 11) had good outcomes at discharge which showed modest improvement to 54% (n = 15) at 12 months. Our study noted that poor admission GCS scores, poor motor response, presence of significant hemiparesis, and larger hematoma volumes (>20 mL) correlated with poor outcomes at 12 months. The overall outcomes have been mostly unfavorable as observed in majority of studies due to deeper location of these hematomas, high proportion of severe head injuries, and high proportion of residual weakness in survivors.

Dependence of clinical outcomes on time of hospital admission in patients with ST-segment elevation myocardial infarction.

There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference. Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission. Retrospective SETTING: Tertiary percutaneous coronary intervention center. Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals. Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women. Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (P=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (P=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (P=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (P=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality. While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes. More "real world" results might have been obtained if the study had replicated more typical referral conditions for PCI. None.