Weekend Effect Research Articles

Prevalence and predictors of antibiotic use among children visiting the Emergency Department in a Tertiary Hospital in Malaysia.

Inappropriate use of antibiotics in human and animal is one of the causes of antimicrobial resistance. This study evaluates the prevalence and predictors of antibiotic use among pediatric patients visiting the Emergency Department (ED) in Malaysia. A retrospective cross-sectional study was conducted in the ED of a tertiary hospital. Data of children aged 2 to 11years who visited the ED from January-May 2015 were extracted from the patient's assessment forms. A total of 549 children were included in the analysis (median age 5years) of which 54.3% were boys. Upper respiratory tract infections (URTI) were the most common diagnosis. Antibiotic was prescribed in 43.5% of the children. Children who visited the ED during the weekend (OR, 1.65; 95% confidence interval (CI) 1.13-2.40, P = 0.009), those diagnosed with URTI (OR 3.81; 95% CI, 2.45-5.93, P < 0.001) and those with a longer duration of fever (OR, 1.31; 95% CI, 1.15-1.48, P < 0.001) were more likely to have an antibiotic prescription.Conclusions: Antibiotic was prescribed in more than one-third of children who visited the ED and antibiotic use was associated with visits during the weekend, URTI, and duration of fever. Antimicrobial stewardship program is recommended in the pediatric ED to improve appropriate use of antibiotics.What is Known:•Use of antibiotic among children increases the risk of antibiotic resistance and adverse drug reactions.•Patient-, clinical-, and prescriber-related factors are three important domain associated with antibiotic use in children.What is New:•Fever and upper respiratory tract infections account for majority of antibiotic prescriptions.•The "weekend effect" influences the use of antibiotics in the ED while upper respiratory tract infection is the strongest predictor of antibiotic use among children visiting the ED.

Does Weekend Hospital Admission Affect Upper Gastrointestinal Hemorrhage Outcomes?: A Systematic Review and Network Meta-Analysis.

Compared with weekday admissions, weekend admissions are consistently associated with worse patient outcomes, known as the "weekend effect." The weekend effect may have adverse health consequences, including death. To determine the potential impact of the weekend effect on primary (ie, mortality) and secondary outcomes of patients with upper gastrointestinal hemorrhage (UGIH). This was a network meta-analysis based on cohort studies. Databases were searched for studies published up to April 2018. The predefined primary outcome was mortality (30-d mortality and in-hospital mortality). The secondary efficacy outcomes were rebleeding rates, use of endoscopic therapy, need for surgery or angiography, mean length of hospital stay, and time to endoscopy. The study protocol was registered with PROSPERO (No. CRD42018094660). In total, 25 studies, including 28 analyses (N=1,203,202 patients), were eligible. The results revealed a tendency toward increased 30-day mortality and increased in-hospital mortality among weekend admissions. In a subgroup analysis, there were significance differences in mortality according to the study location (ie, Europe) and UGIH type (ie, variceal UGIH), with these subgroups having elevated mortality rates. Moreover, weekday admissions were associated with a significant decrease in rebleeding rates. In the network meta-analysis, the study location (in Europe or Asia) and type of UGIH (ie, variceal UGIH) were associated with an increased likelihood of high in-hospital mortality among weekend admissions. The evidence derived from this network meta-analysis supports the idea that weekend admissions are associated with an increased risk of death, especially among variceal UGIH patients in European hospitals.

The Impact of the "Weekend Effect" on Emergency Exploratory Laparotomy Surgeries Outcomes at an Urban Level 1 Trauma Center.

The Impact of the "Weekend Effect" on Emergency Exploratory Laparotomy Surgeries Outcomes at an Urban Level 1 Trauma Center.

Acute pancreatitis and the weekend effect: does weekend admission affect patient outcome?

IntroductionWhen a patient is admitted to a hospital for acute pancreatitis (AP), the day of the week on which the admission occurs may influence the outcome of care. The link between reduced weekend staffing practices and outcomes for patients hospitalised for AP, however, has been inadequately studied.AimTo evaluate the relationship between weekend admission and AP outcome.Material and methodsOne hundred and twenty-six patients were prospectively included, assessed according to the revised Atlanta criteria, and observed until discharge or death. Weekend and weekday admissions were compared in terms of severity, aetiology, length of hospital stay, and in-hospital mortality.ResultsPatients were divided into two groups according to the timing of admission (weekday, n = 99, 78.6%; or weekend, n = 27, 21.4%). AP was considered severe in 33 (26.2%) patients, moderately severe AP in 37 (29.4%) patients, and mild in 56 (44.4%) patients. No significant differences were found with regard to the distribution of AP severity between the two groups. The impact of weekend admission was not significant for aetiology or for the length of hospital stay (median of 9 vs. 10 days). In-hospital mortality rates were not significantly different for weekday and weekend admissions.ConclusionsPatients admitted for hospitalisation during a weekend received the same level and quality of care at the facility under study as AP patients admitted during the week. Additionally, the rate of favourable outcomes for patients admitted during the weekend was found to be similar to the outcomes of patients admitted on a weekday.

Assessment of the Characteristics and Influencing Factors of Ozone in Fuzhou, China, Using Wavelet Analysis

ABSTRACT In recent years, ozone (O3) air pollution has become a major problem—which is still increasing—in China. In this study, data on the O3 concentration as well as on two of its influencing factors, meteorological parameters and traffic conditions, were collected in Fuzhou and then analyzed via wavelet transforms to evaluate the variation in O3 concentration and its relationships with the factors. High concentrations appeared during spring and summer, and notable fluctuations occurred primarily from March till April, from June till July and during September. The level of O3 exhibited significant positive correlations with the temperature and sunshine duration but negative ones with the relative humidity, precipitation and air pressure; additionally, it increased when the wind speed was low and fluctuated when the wind speed was high. The concentration was also significantly negatively correlated with the concentrations of O3 precursors (NOx and CO) and hence closely related to the traffic conditions, as the reduced vehicle speed during rush hour due to increased vehicle flow and traffic density led to higher precursor emissions in the vehicular exhaust. A prominent “weekend effect” was observed with the precursor levels, which displayed greater fluctuations during the weekdays than the weekends; the vehicle flow and the O3 concentration.

Spatiotemporal Variations of Particulate and Gaseous Pollutants and Their Relations to Meteorological Parameters: The Case of Xiangyang, China.

High air pollution levels have become a nationwide problem in China, but limited attention has been paid to prefecture-level cities. Furthermore, different time resolutions between air pollutant level data and meteorological parameters used in many previous studies can lead to biased results. Supported by synchronous measurements of air pollutants and meteorological parameters, including PM2.5, PM10, total suspended particles (TSP), CO, NO2, O3, SO2, temperature, relative humidity, wind speed and direction, at 16 urban sites in Xiangyang, China, from 1 March 2018 to 28 February 2019, this paper: (1) analyzes the overall air quality using an air quality index (AQI); (2) captures spatial dynamics of air pollutants with pollution point source data; (3) characterizes pollution variations at seasonal, day-of-week and diurnal timescales; (4) detects weekend effects and holiday (Chinese New Year and National Day holidays) effects from a statistical point of view; (5) establishes relationships between air pollutants and meteorological parameters. The principal results are as follows: (1) PM2.5 and PM10 act as primary pollutants all year round and O3 loses its primary pollutant position after November; (2) automobile manufacture contributes to more particulate pollutants while chemical plants produce more gaseous pollutants. TSP concentration is related to on-going construction and road sprinkler operations help alleviate it; (3) an unclear weekend effect for all air pollutants is confirmed; (4) celebration activities for the Chinese New Year bring distinctly increased concentrations of SO2 and thereby enhance secondary particulate pollutants; (5) relative humidity and wind speed, respectively, have strong negative correlations with coarse particles and fine particles. Temperature positively correlates with O3.

Assessment of the “Weekend Effect” in Lower Extremity Vascular Trauma

Studies suggest that patients admitted on weekends may have worse outcomes as compared with those admitted on weekdays. Lower extremity vascular trauma (LEVT) often requires emergent surgical intervention and might be particularly sensitive to this "weekend effect." The objective of this study was to determine if a weekend effect exists for LEVT. The National and Nationwide Inpatient Sample Database (2005-2014) was queried to identify all adult patients who were admitted with an LEVT diagnosis. Patient and hospital characteristics were recorded or calculated and outcomes including in-hospital mortality, amputation, length of stay (LOS), and discharge disposition were assessed. Independent predictors of outcomes were identified using multivariable regression models. There were 9,282 patients admitted with LEVT (2,866 weekend admissions vs. 6,416 weekday admissions). Patients admitted on weekends were likely to be younger than 45years (68% weekend vs. 55% weekday, P<0.001), male (81% weekend vs. 75% weekday, P<0.001), and uninsured (22% weekend vs. 17% weekday, P<0.001) as compared with patients admitted on weekdays. There were no statistically significant differences in mortality (3.8% weekend vs. 3.3% weekday, P=0.209), amputation (7.2% weekend vs. 6.6% weekday, P=0.258), or discharge home (57.4% weekend vs. 56.1% weekday, P=0.271). There was no clinically significant difference in LOS (median 7days weekend vs. 7days weekday), P=0.009. On multivariable regression analyses, there were no statistically significant outcome differences between the groups. This study did not identify a weekend effect in LEVT patients in the United States. This suggests that factors other than the day of admission may be important in influencing outcomes after LEVT.

The Weekend Effect in Non-Elective Abdominal Aortic Aneurysm Repair

Introduction - The ‘weekend effect’, first described in 2001, is a hotly debated topic1. It describes the phenomenon where patient outcomes appear worse for those admitted at the weekend when compared to those treated during the week. It has been used recently to justify significant changes in health policy2. Recent evidence has suggested that the effect may be due to a combination of inadequate correction for confounding factors and inaccurate coding3. We investigated the effects of these factors in patients with acute abdominal aortic aneurysm (AAA). Methods - All patients undergoing non-elective AAA repair entered into the prospectively collected National Vascular Registry from January 2013 until December 2015 were included in the study, with patients divided in a case-control study according to whether they were treated during the week (between 8am Monday and 5pm Friday) or at the weekend (between 5pm Friday and 8am Monday). Coding issues were investigated by looking separately at patients treated for ruptured, symptomatic or asymptomatic AAA within the non-elective cohort. The primary outcome was in-hospital mortality. Secondary outcomes included length of inpatient stay and cardiac, respiratory and renal complications. Results - Mortality appeared to be higher at the weekend (odds ratio (OR) 1.65, 95% confidence interval (CI) (1.44–1.89), P<0.001), but this effect disappeared when confounding factors and coding issues were corrected for (corrected OR for ruptured AAA 1.09, 95% CI (0.92–1.29), P=0.33). Differences in outcomes were similar for prolonged length of stay (uncorrected OR 1.42, 95% CI (1.26–1.60), P<0.001; corrected OR for ruptured AAA 1.06, 95% CI (0.91–1.10), P=0.48) and morbidity outcomes. Conclusion - After appropriate correction for confounding factors and coding effects, there is no evidence of a significant ‘weekend effect’ in the treatment of non-elective AAA within this large cohort. Further work is warranted to determine whether previously reported ‘weekend effect’s in other areas are robust to more rigorous statistical analysis.

The Weekend Effect in African Stock Markets

This study investigates daily stock market anomalies in the African stock markets, using two most representative stock index ETFs, each over at least eleven-year time period spanning from pre-financial crisis era to ten years into the financial crisis. This research attempts to test the presence of the weekend effect on stock returns in the African stock exchanges during the financial crisis. The results indicate a significant negative effect on Mondays. Our results shed some light on the degree of market efficiency in one of the major emerging capital markets in the world.

Weekend Operation and Outcomes of Patients Admitted for Nonelective Coronary Artery Bypass Surgery

The "weekend effect" is a purported phenomenon whereby patients admitted for time-sensitive medical and surgical conditions on a weekend suffer worse outcomes than those admitted on a weekday. There are limited data on the weekend effect for nonelective coronary artery bypass grafting (CABG). We studied outcomes for weekend vs weekday operations for all adult patients in the 2013 to 2014 National Inpatient Sample (NIS) undergoing nonelective CABG. Of 101,510 patients undergoing nonelective CABG, 12,795 patients (12.6%) underwent CABG on the day of admission (n= 1230 for weekend and 11,565 for weekday admission, respectively). Patients undergoing surgical procedures on a weekend were more likely to have a diagnosis of ST-elevation acute coronary syndrome (47.2% vs 20.2%, P < .001), require intraaortic balloon pump support (46.3% vs 23.1%, P < .001), and undergo same-day coronary angiography (66.7% vs 41.8%; P < .001) or same-day percutaneous coronary intervention (11.8% vs 7.1%; P= .01). Weekend admission was associated with increased mortality in unadjusted analysis (6.1% vs 3.2%; odds ratio, 1.99; 95% confidence interval, 1.13-3.52; P= .02), but this effect was attenuated in the adjusted model (adjusted odds ratio, 1.22; 95% confidence interval, 0.63-2.33; P= .47). Patients undergoing CABG on a weekend had higher crude mortality but similar risk-adjusted mortality compared with their weekday counterparts. Some of the excess mortality observed for weekend operations is likely attributable to a sicker cohort of patients undergoing CABG on the weekend.

Analysis of weekend effect in severe acute liver injury: A nationwide database study.

Background and AimsSevere acute liver injury (ALI) can lead to poor outcomes without timely management. Comparatively worse outcomes in various severe, emergent conditions have been attributed to reduced hospital resources experienced by patient weekend admissions, a phenomenon termed “weekend effect.” To date, a weekend effect has not been studied in severe ALI, an emergency also necessitating timely management. We aimed to evaluate such an effect in this condition by analyzing a large national inpatient database in the United States.MethodsWe analyzed the Nationwide/National Inpatient Sample (NIS) 2000 to 2014, the largest inpatient, all‐payer database in the United States (US), containing sociodemographic, clinical, patient‐, and hospital‐level data. We identified severe ALI using International Classification of Disease, 9th Revision diagnosis codes for acute/subacute hepatic necrosis (570) with encephalopathy (572.2). Our primary outcome was in‐hospital mortality. Using a full‐model approach for covariate selection, we performed multiple logistic regression modeling to assess for weekend effect and identify predictors of in‐hospital mortality.ResultsWe identified 15 762 eligible hospitalizations, with 12 182 (77.3%) having complete covariate data. This sample comprised 53.3% males, 69.3% White race, and had an average (± SD) age of 55.0 ± 14.1 years. We utilized a full‐model approach for covariate inclusion but did not include patient transfer data due to limited availability. We observed no significant mortality differences in weekend admissions (OR = 1.06, 95% CI: 0.97‐1.15, P = 0.02). However, significantly higher mortality was associated with male sex, older age, Black or Hispanic race, Northeast US hospitalization, urban teaching status, and larger hospital size. Sensitivity analyses using multiple imputation datasets and transfer covariates did not change our results.ConclusionWe did not observe a weekend effect of in‐hospital mortality for weekend admissions for severe ALI, but our overall diagnosis ascertainment yield was low—indicating that lack of accurate documentation for the etiology of severe ALI may be masking an effect. Additionally, our findings suggest that racial differences and hospital‐level characteristics in the context of severe ALI may be associated with varying outcomes, regardless of admission day, which warrants further research.

A ‘weekend effect’ in operative emergency general surgery

BackgroundEvidence of a “weekend effect” is limited in emergency general surgery (EGS). We hypothesized that there are increased rates of complications, death, and failure-to-rescue (FTR) in patients undergoing weekend EGS operations. MethodsNational Inpatient Sample (NIS) data, January 2014–September 2015 were used. Operative EGS patients were identified by ICD-9 procedure code and timing to operation. Complications were defined by ICD-9 code. We performed survey-weighted multivariable regression analyses. ResultsOf 438,110 EGS patients, 103,450 underwent weekend operation. There was no association between weekend operation and FTR (OR 1.17; 95%CI 0.95–1.45) or complications (OR 1.04; 95%CI 0.97–1.13). There was a weekend effect on mortality (OR 1.22; 95%CI 1.02–1.46) and an interactive effect between weekend operation and teaching status on complications (teaching OR 1.22; 95%CI 1.15–1.29; interaction OR 1.13; 95%CI 1.03–1.25). ConclusionsThere is evidence for a “weekend effect” on mortality, but not complications or FTR, in this cohort.

Risky short positions and investor sentiment: Evidence from the weekend effect in futures markets

AbstractThis paper examines the weekend effect in futures markets and presents rational and behavioral reasons for its existence. Specifically, we document a weekend effect (Friday's return minus the following Monday's return) in futures markets. The weekend effect occurs partly because of asymmetric risk between long and short positions around weekends; the weekend effect increases when short positions are relatively more risky. In addition, we find that both lagged and contemporaneous changes in investor sentiment are related to the weekend effect. These results are consistent with the investor sentiment literature that finds that mood improves on Fridays but deteriorates on Mondays.

Local characteristics of and exposure to fine particulate matter (PM2.5) in four indian megacities

Public health in India is gravely threatened by severe PM2.5 exposure. This study presents an analysis of long-term PM2.5 exposure in four Indian megacities (Delhi, Chennai, Hyderabad and Mumbai) based on in-situ observations during 2015–2018, and quantifies the health risks of short-term exposure during Diwali Fest (usually lasting for ~5 days in October or November and celebrating with lots of fireworks) in Delhi for the first time. The population-weighted annual-mean PM2.5 across the four cities was 72 μg/m3, ~3.5 times the global level of 20 μg/m3 and 1.8 times the annual criterion defined in the Indian National Ambient Air Quality Standards (NAAQS). Delhi suffers the worst air quality among the four cities, with citizens exposed to ‘severely polluted’ air for 10% of the time and to unhealthy conditions for 70% of the time. Across the four cities, long-term PM2.5 exposure caused about 28,000 (95% confidence interval: 17,200–39,400) premature mortality and 670,000 (428,900–935,200) years of life lost each year. During Diwali Fest in Delhi, average PM2.5 increased by ~75% and hourly concentrations reached 1676 μg/m3. These high pollutant levels led to an additional 20 (13–25) daily premature mortality in Delhi, an increase of 56% compared to the average over October–November. Distinct seasonal and diurnal variations in PM2.5 were found in all cities. PM2.5 mass concentrations peak during the morning rush hour in all cities. This indicates local traffic could be an important source of PM2.5, the control of which would be essential to improve air quality. We report an interesting seasonal variation in the diurnal pattern of PM2.5 concentrations, which suggests a 1–2 h shift in the morning rush hour from 8 a.m. in pre-monsoon/summer to 9–10 a.m. in winter. The difference between PM2.5 concentrations on weekdays and weekend, namely weekend effect, is negligible in Delhi and Hyderabad, but noticeable in Mumbai and Chennai where ~10% higher PM2.5 concentrations were observed in morning rush hour on weekdays. These local characteristics provide essential information for air quality modelling studies and are critical for tailoring the design of effective mitigation strategies for each city.

What does it take to provide clinical interventions with temporal consistency? A qualitative study of London hyperacute stroke units

ObjectivesSeven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of day and...

Tuesday left main: Chronobiology of acute myocardial infarction due to left main disease

ObjectivesThe existence of a “weekend effect” for onset of acute myocardial infarction (AMI) has been suggested in the past, but the relation with the culprit vessel has not been investigated. MI due to left main coronary artery lesion represents a particularly serious life-threatening condition. Our study was aimed to assess the chronobiology of admission to the emergency department for AMI considered to be induced by a left main culprit lesion. MethodsWe retrospectively reviewed patients who experienced an AMI due to a left main culprit lesion between January 1, 2008 and January 1, 2018 stratifying them according to the day of admission, on the basis of the symptom onset time; the 30-day cardiovascular mortality was also analyzed on the basis of the time of symptom onset. ResultsOut of 1789 patients with AMI, 130 (7.2%, 104 males and 26 females, mean age 74.5 ± 8.1 years) had left main disease as the culprit lesion. Tuesday was significantly over-represented as the admission day (p < 0.001 for Tuesday vs. other days; p = 0.009 for Tuesday vs. Sunday, respectively). The 30-day cardiovascular survival was not different between patients admitted on Tuesday and those admitted on remaining days (Log-rank, Mantel Cox, p = 0.43; Chi-square = 0.611). A significant difference was noted in patients with AMI on Sunday versus remaining days (Log-rank, Mantel-Cox, p = 0.005; Chi-square = 7.96). The diameter of the left main artery was larger in patients admitted on Tuesdays than on Sundays (p < 0.01). ConclusionThe relation between AMI onset and the day of the week is confirmed by our study, which also suggests that in case of a left main lesion, some delay of the weekend effect might be expected.

Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services

ObjectiveTo investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units compared with the rest of England.DesignProspective cohort study...

Is seniority of emergency physician associated with the weekend mortality effect? An exploratory analysis of electronic health records in the UK

ObjectiveAdmission to hospital over a weekend is associated with increased mortality, but the underlying causes of the weekend effect are poorly understood. We explore to what extent differences in emergency...

Is there a weekend effect after hip fracture surgery? A study of 74,410 hip fractures reported to the Norwegian Hip Fracture Register

Background and purpose — The term “weekend effect” describes differences in outcomes between patients treated at weekends compared with weekdays. We investigated whether there is a weekend effect for the risk of reoperation and mortality after hip fracture surgery at Norwegian hospitals.Patients and methods — We included data from 76,410 hip fractures in patients 60 years and older reported to the Norwegian Hip Fracture Register (NHFR) between 2005 and 2017. Cox survival analyses with adjustments for age, sex, ASA class, type of fracture, operating method, and waiting time from fracture to surgery were used to calculate the risk of reoperation and death after surgeries performed at weekends compared with surgeries performed on weekdays.Results — The mean age for all patients was 82 years, and 71% were female. 73% of fractures occurred on weekdays (Monday to Friday) and 27% during weekends (Saturday and Sunday). 71% of fractures were operated on a weekday and 29% at a weekend. Slightly increased mortality was observed during the 2 first months after weekend admission with hip fracture (HR 1.08; 95% CI 1.03–1.14). This did not continue in subsequent months, but the initial effect of weekend presentation was still apparent at 1-year follow-up. Further, there was no difference in mortality between patients who were operated at a weekend and patients operated on a weekday. Neither were there any differences in the risk of reoperation between weekday and weekend when comparing day of fracture or day of surgery.Interpretation — Patients who suffered a hip fracture during a weekend had slightly increased mortality in the first 2 months postoperatively. Whether the surgery was done on weekdays or at weekends did not affect mortality or the risk of reoperation.

Is There a Negative Night or Weekend Effect on the Child's Postnatal State Among Migrant Women?

Is neonatal morbidity of women with a migration background (= a proxy variable for an increased risk of cultural/linguistic communication problems) increased in the sense of a "weekend effect"? Data was collected at 3 Berlin maternity hospitals directly in the delivery room based on standardized interviews (questions on sociodemographics, care aspects, migration) and supplemented by maternal and clinical perinatal data. Surrogate markers for the child's morbidity were the Apgar score and umbilical cord pH value or transfer to a children's hospital. Descriptive and logistic regression analyses were carried out. The data sets of 2,014 1st-generation migrants, 771 2nd-generation migrants, and 2,564 women without a migrant background were included, including 39.7% so-called day-births (Monday - Friday, 7 a.m.-6 p.m.). In 2 models, the influence of birth time and various other parameters was examined for the 2 proxy parameters of childhood morbidity. The chances of unfavorable Apgar or umbilical pH levels were increased in births in the evening, at night, on weekends and public holidays (OR 1.84, 95% CI 1.23-2.76, p=0.003), in operative vaginal births (OR 3.36, 95% CI 2.07-5.46, p<0.001) or a secondary cesarean section (OR 1.94; 95% CI 1.28-2.96, p=0.002). The migration status of the woman giving birth was irrelevant. Despite possible intercultural and linguistic communication problems, women with a migration background are treated as well as pregnant women without a migration background irrespective of the time of day or day of the week.