Clinical characteristics of COVID-19 in children: a large multicenter study from Iran.

Introduction: During the COVID-19 pandemic, pediatric cases typically exhibit milder symptoms and lower mortality rates. However, the delay in pediatric vaccination poses major risks for children. This multicenter study aimed to comprehensively analyze demographic characteristics, clinical features, disease severity, and risk factors for ICU admission in Iran. Materials and methods: This observational study enrolled children aged 0-21 years with confirmed or probable COVID-19 diagnoses, referred from selected hospitals across 17 counties in Mazandaran province, Iran, between February 19 and August 14, 2021. Patients were categorized into mild, moderate, severe, or critical cases based on clinical and radiographic criteria. Data were extracted from medical records and analyzed using statistical methods. Logistic regression analysis was performed to identify factors associated with ICU admission and disease severity. Results: Among the 1,031 children included in the study, 61 were diagnosed with MIS-C. The distribution of patients by severity was 156 mild, 671 moderate, and 204 severe/critical cases. Age distribution significantly differed across severity groups (P < 0.001), with 55.19% aged over 5 years and 54% being male. 11.44% had underlying diseases. Fever (71.97%) was the most common symptom, followed by cough (34.43%) and dyspnea (24.83%). Within the inpatient group, 19.77% required ICU admission, with 0.91% mortality, including 3 MIS-C cases. Children with underlying diseases, gastrointestinal symptoms, and obesity had 4.16, 3.10-, and 2.17-times higher likelihood of ICU admission, respectively. Conclusion: Our study emphasized the importance of recognizing pediatric COVID-19 severity and symptoms. While fever, cough, and dyspnea prevailed, mortality rates were relatively low. However, comorbidities, obesity, and gastrointestinal symptoms linked to ICU admission, stressing early intervention. BMI also impacted disease severity and admission rate. Vaccination and targeted interventions are essential for protecting vulnerable children and easing healthcare strain.

A theory of change evaluation of doctoral admission methods: A case study of a Chinese university.

In response to China's incentive for "connotative development" in doctoral education, universities are actively fostering creative and innovative PhD candidates with enhanced research productivity and superior educational quality. A Chinese university, aligning with this objective, has initiated significant reforms in its doctoral admission methods, introducing a new type of student and altering the proportion of existing ones. Recognizing the complexity and uncertainty inherent in the doctoral admission process, this theory-based study employs a Theory of Change framework to systematically evaluate the immediate, intermediate, and long-term outcomes of this university's interventions. It assesses the transformative impact of these changes by integrating secondary data with qualitative insights, including focus group discussions with twelve students and semi-structured interviews with three supervisors. The study reveals that while this university has made substantial progress in achieving short-term goals, these reforms have not uniformly benefited all student categories, presenting distinct challenges and opportunities for stakeholders. Consequently, it advocates for diversifying the student composition and emphasizes inclusive pedagogical strategies to facilitate high-quality doctoral education. Importantly, this research extends beyond this university, promoting a balanced mix of student profiles and a holistic approach to shaping effective policies and practices within doctoral admission, essential for navigating global competition.

Congenital Heart Defects and Concurrent Diagnoses in Influenza Hospitalization in the Pediatric Health Information System Study, 2004-2019.

Influenza is associated with adverse outcomes in children, although modification by additional medical conditions is not well-documented. We aimed to compare outcomes in children with versus without congenital heart defects (CHDs) who were hospitalized for influenza. We retrospectively evaluated patients 1-18y hospitalized for influenza in the Pediatric Health Information (PHIS) database from 2004 to 2019. Outcomes were compared by CHD presence and then by CHD severity (minor biventricular, major biventricular, and single ventricle disease) using log-binomial regression adjusted for propensity scores accounting for age at admission, sex, and history of asthma. Outcomes included inpatient mortality, intensive care unit (ICU) admission, mechanical ventilation, and length of stay (LOS) > 12 days. To evaluate for effect modification by genetic diagnoses, analyses were repeated stratified by CHD and genetic diagnosis. Among 55,161 children hospitalized for influenza, 2369 (4.3%) had CHDs, including 963 with minor biventricular, 938 with major biventricular, and 468 with single ventricle CHDs. Adjusting for propensity scores, children with CHDs had higher mortality (4.1% versus 0.9%) compared to those without CHDs (risk ratio [RR] 2.5, 95% confidence interval [CI] 1.9-3.4). Children with CHDs were at higher risk of mechanical ventilation (RR 1.6, 95% CI 1.6-1.7), ICU admission (RR 1.9, 95% CI 1.8-2.1), and LOS > 12 days (RR 2.2, 95% CI 2.0-2.3). Compared to those with neither CHD nor genetic condition, children with both had significantly higher risk of all outcomes, with the largest difference for LOS > 12 days (RR 2.3, 95% CI 2.0-2.7). Children with CHDs hospitalized for influenza are particularly susceptible to adverse outcomes compared to those without CHDs. Future studies are needed to corroborate findings in light of influenza vaccination.

Development and Validation of Machine Learning-Based Models for Prediction of Intensive Care Unit Admission and In-Hospital Mortality in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease.

Background: This present work focused on predicting prognostic outcome of inpatients developing acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and enhancing patient monitoring and treatment by using objective clinical indicators. Methods: The present retrospective study enrolled 322 AECOPD patients. Registry data downloaded based on COPD Pay-for-Performance Program database from January 2012 to December 2018 were used to check whether the enrolled patients were eligible. Our primary and secondary outcomes were ICU admission and in-hospital mortality, respectively. The best feature subset was chosen by recursive feature elimination. Moreover, seven machine learning (ML) models were trained for forecasting ICU admission among AECOPD patients, and the model with the most excellent performance was used. Results: According to our findings, random forest (RF) model showed superb discrimination performance, and the values of area under curve (AUC) were 0.973 and 0.828 in training and test cohorts, separately. Additionally, according to decision curve analysis, the net benefit of RF model was higher when differentiating patients with a high risk of ICU admission at a <0.55 threshold probability. Moreover, the ML-based prediction model was also constructed to predict in-hospital mortality, and it showed excellent calibration and discrimination capacities. Conclusion: The ML model was highly accurate in assessing the ICU admission and in-hospital mortality risk for AECOPD cases. Maintenance of model interpretability helped effectively provide accurate and lucid risk prediction of different individuals.

The geriatric trauma hospitalist service: An analysis of a management strategy for injured older adults.

BACKGROUND: Management of geriatric trauma patients requires balancing chronic comorbidities with acute injuries. We developed a care model in which patients are managed by hospitalists with trauma-centered education and hypothesized that clinical outcomes would be similar to outcomes in patients primarily managed by trauma surgeons. METHODS: This was a retrospective study of trauma patients aged ≥65 from January 2020 to December 2021. Groups were defined by admitting service: trauma surgery service (TSS) or geriatric trauma hospitalist service (GTHS). The primary outcome was in-hospital mortality. Regression analyses and inverse probability treatment weighted (IPTW) propensity score (PS) analyses were performed to determine the association between admitting service and outcomes. RESULTS: A total of 1004 patients were eligible for inclusion-580 GTHS and 424 TSS admissions. GTHS patients were older (82 vs. 74, p < 0.001), more likely to have suffered blunt trauma (99.5% vs. 95%, p < 0.001), more likely to have comorbidities (91.2% vs. 87%, p < 0.001), had higher Charlson Comorbidity Indexes (CCIs), and had lower median injury severity scores (9 vs. 13, p < 0.001). Rates of mortality, delirium, 30-day readmission, and overall complications were low and similar between groups. While TSS patients were likely to be discharged home, GTHS had more discharges to skilled nursing facilities and longer length of stay (LOS). On multivariable analysis adjusted for age, ISS, CCI, and sex, patients admitted to GTHS had lower odds of death with an odds ratio of 0.15 (95% confidence interval [CI] 0.02-0.75, p = 0.03) when compared to TSS. On IPTW PS analysis, patients admitted to GTHS had similar odds of death with an odds ratio of 0.3 (95% CI 0.06-1.6, p = 0.16). CONCLUSIONS: Protocolized admission criteria to a GTHS resulted in similar low mortality rates but longer LOS when compared to patients admitted to a TSS. This care model may inform other trauma centers in developing their strategies for managing the increasing volume of vulnerable injured older adults.

Hospital admissions and community health service contacts for mental illness following self-reported child maltreatment: Results from the Childhood Adversity and Lifetime Morbidity (CALM) study.

BACKGROUND: Child maltreatment (CM) includes neglect, and several types of abuse, including physical, emotional, and sexual. CM has been associated with a wide range of mental illnesses. Literature examining these illnesses in mid-life is scarce, and the impact of these illnesses on mental health service use is currently unknown. OBJECTIVE: To examine associations between self-reported CM and subsequent hospital admissions for mental illnesses, and/or community mental health service contacts. SETTING: Birth cohort study data linked to administrative health data, including hospital admissions and community mental health service contacts, up to the age of 40. METHODS: Associations between hospital admissions for mental health and community mental health contacts and CM subtypes (neglect, physical abuse, emotional abuse and sexual abuse) were examined using multivariate logistic regression. RESULTS: Adjusted analyses showed that all subtypes of CM were significantly (p < 0.05) associated with admissions to hospital for any type of mental illness (aOR range 1.87-3.61), non-psychotic mental disorders (aOR range 1.98-3.61), alcohol and/or substance use (aOR range 2.83-5.43), and community mental health service contacts (aOR range 2.44-3.13). Hospital admissions for psychotic mental disorders were significantly associated with physical abuse, emotional abuse, and sexual abuse (aOR range 2.14-3.93). CONCLUSIONS: The results of this study confirm the current knowledge around CM and subsequent mental health illnesses up to the age of 40, and extend this knowledge to hospital and mental health service use.

Ethnicity and outcomes for patients with gastrointestinal disorders attending an emergency department serving a multi-ethnic population.

BACKGROUND: Ethnic inequalities in acute health acute care are not well researched. We examined how attendee ethnicity influenced outcomes of emergency care in unselected patients presenting with a gastrointestinal (GI) disorder. METHODS: A descriptive, retrospective cohort analysis of anonymised patient level data for University Hospitals of Leicester emergency department attendees, from 1 January 2018 to 31 December 2021, receiving a diagnosis of a GI disorder was performed. The primary exposure of interest was self-reported ethnicity, and the two outcomes studied were admission to hospital and whether patients underwent clinical investigations. Confounding variables including sex and age, deprivation index and illness acuity were adjusted for in the analysis. Chi-squared and Kruskal-Wallis tests were used to examine ethnic differences across outcome measures and covariates. Multivariable logistic regression was used to examine associations between ethnicity and outcome measures. RESULTS: Of 34,337 individuals, median age 43 years, identified as attending the ED with a GI disorder, 68.6% were White. Minority ethnic patients were significantly younger than White patients. Multiple emergency department attendance rates were similar for all ethnicities (overall 18.3%). White patients had the highest median number of investigations (6, IQR 3-7), whereas those from mixed ethnic groups had the lowest (2, IQR 0-6). After adjustment for age, sex, year of attendance, index of multiple deprivation and illness acuity, all ethnic minority groups remained significantly less likely to be investigated for their presenting illness compared to White patients (Asian: aOR 0.80, 95% CI 0.74-0.87; Black: 0.67, 95% CI 0.58-0.79; mixed: 0.71, 95% CI 0.59-0.86; other: 0.79, 95% CI 0.67-0.93; p < 0.0001 for all). Similarly, after adjustment, minority ethnic attendees were also significantly less likely to be admitted to hospital (Asian: aOR 0.63, 95% CI 0.60-0.67; Black: 0.60, 95% CI 0.54-0.68; mixed: 0.60, 95% CI 0.51-0.71; other: 0.61, 95% CI 0.54-0.69; p < 0.0001 for all). CONCLUSIONS: Significant differences in usage patterns and disparities in acute care outcomes for patients of different ethnicities with GI disorders were observed in this study. These differences persisted after adjustment both for confounders and for measures of deprivation and illness acuity and indicate that minority ethnic individuals are less likely to be investigated or admitted to hospital than White patients.

Adults With Spina Bifida Fare Worse Than Young Adults: A Systemic Vulnerability in Urinary Tract Infection-Related Hospital Care.

PURPOSE: We aim to estimate the odds of UTI-related hospital care in spina bifida (SB) patients aged 18 to 25 years as compared with patients with SB in adolescence (11-17 years) or adulthood (26-35 years). We hypothesize that patients with SB in the typical transitional age, 18 to 25 years, will have higher odds of UTI-related hospital care as compared to adolescent SB patients or adult SB patients. MATERIALS AND METHODS: Using Cerner Real-World Data, we performed a retrospective cohort analysis comparing SB patients to age- and gender-matched controls. SB cases between 2015 and 2021 were identified and compared in 3 cohorts: 11 to 17 years (adolescents), 18 to 25 years (young adults [YA]), and 26 to 35 years (adults). Logistic regression analysis was used to characterize the odds of health care utilization. RESULTS: Of the 5497 patients with SB and 77,466 controls identified, 1839 SB patients (34%) and 3275 controls (4.2%) had at least 1 UTI encounter. UTI-related encounters as a proportion of all encounters significantly increased with age in SB patients (adolescents 8%, YA 12%, adult 15%; P < .0001). Adjusting for race, sex, insurance, and comorbidities, the odds of a UTI-related encounter in YA with SB were significantly higher than for adolescents with SB (adolescent odds ratio = 0.65, 95% CI: 0.57-0.75, P < .001). YA had lower odds of a UTI-related encounter as compared with adults with SB (adult odds ratio = 1.31, 95% CI: 1.16-1.49, P < .001). CONCLUSIONS: YA with SB have higher odds of UTI-related hospital care than adolescents, but lower odds of UTI-related hospital care when compared with adults.

Study protocol for an adaptive, multi-arm, multi-stage (MAMS) randomised controlled trial of brief remotely delivered psychosocial interventions for people with serious mental health problems who have experienced a recent suicidal crisis: Remote Approaches to Psychosocial Intervention Delivery (RAPID).

BACKGROUND: People with serious mental health problems (SMHP) are more likely to be admitted to psychiatric hospital following contact with crisis services. Admissions can have significant personal costs, be traumatic and are the most expensive form of mental health care. There is an urgent need for treatments to reduce suicidal thoughts and behaviours and reduce avoidable psychiatric admissions. METHODS: A multi-stage, multi-arm (MAMS) randomised controlled trial (RCT) with four arms conducted over two stages to determine the clinical and cost effectiveness of three psychosocial treatments, compared to treatment as usual (TAU), for people with SMHP who have had recent suicidal crisis. Primary outcome is any psychiatric hospital admissions over a 6-month period. We will assess the impact on suicidal thoughts and behaviour, hope, recovery, anxiety and depression. The remote treatments delivered over 3 months are structured peer support (PREVAIL); a safety planning approach (SAFETEL) delivered by assistant psychologists; and a CBT-based suicide prevention app accessed via a smartphone (BrighterSide). Recruitment is at five UK sites. Stage 1 includes an internal pilot with a priori progression criteria. In stage 1, the randomisation ratio was 1:1:1:2 in favour of TAU. This has been amended to 2:2:3 in favour of TAU following an unplanned change to remove the BrighterSide arm following the release of efficacy data from an independent RCT. Randomisation is via an independent remote web-based randomisation system using randomly permuted blocks, stratified by site. An interim analysis will be performed using data from the first 385 participants from PREVAIL, SAFETEL and TAU with outcome data at 6 months. If one arm is dropped for lack of benefit in stage 2, the allocation ratio of future participants will be 1:1. The expected total sample size is 1064 participants (1118 inclusive of BrighterSide participants). DISCUSSION: There is a need for evidence-based interventions to reduce psychiatric admissions, via reduction of suicidality. Our focus on remote delivery of established brief psychosocial interventions, utilisation of different modalities of delivery that can provide sustainable and scalable solutions, which are also suitable for a pandemic or national crisis context, will significantly advance treatment options. TRIAL REGISTRATION: ISRCTN33079589. Registered on June 20, 2022.

Impact of Pre-Admission Grade Point Averages on Anesthesiologist Assistant Student Performance at Emory University School of Medicine.

Purpose: The Anesthesiologist Assistant career is gaining significant popularity in the health professions in the United States. Given that this medical occupation is relatively young, there is limited information regarding student success in this demanding graduate-level program. Assessing if pre-admission metrics influence how students perform during the curriculum is essential to recruiting the appropriate candidates. Grade point averages have been shown to correlate with student success in medical education programs for both medical students and physician assistant students, but there is currently no information regarding anesthesiologist assistant students. Methods: Pre-matriculation science and cumulative grade point averages were accessed in a deidentified manner for Emory University Anesthesiologist Assistant Students, and 2-tailed Pearson coefficients were calculated to see if there was a correlation with performance during the science/didactic curriculum of our program and with the clinical curriculum of the program. Results: The 2-tailed Pearson coefficients showed a moderately strong positive correlation between pre-admission science and cumulative grade point averages and performance during the science curriculum of the Emory program (r=0.522). Data also suggested a moderate correlation with grade point averages at graduation from our program (r=0.484). Similar results were found with cumulative grade point averages as well. Conclusion: Given the limited information, we have regarding pre-admission metrics and performance in an Anesthesiologist Assistant program, our study shows that pre-admission science scores and grades in general in undergraduate studies does in fact mimic the information found from studies of other health profession students. Further studies are needed to elucidate how to choose the most appropriate candidates for admission to anesthesiologist assistant programs.

Predictive modeling of perioperative patient deterioration: combining unanticipated ICU admissions and mortality for improved risk prediction.

OBJECTIVE: This paper presents a comprehensive analysis of perioperative patient deterioration by developing predictive models that evaluate unanticipated ICU admissions and in-hospital mortality both as distinct and combined outcomes. MATERIALS AND METHODS: With less than 1% of cases resulting in at least one of these outcomes, we investigated 98 features to identify their role in predicting patient deterioration, using univariate analyses. Additionally, multivariate analyses were performed by employing logistic regression (LR) with LASSO regularization. We also assessed classification models, including non-linear classifiers like Support Vector Machines, Random Forest, and XGBoost. RESULTS: During evaluation, careful attention was paid to the data imbalance therefore multiple evaluation metrics were used, which are less sensitive to imbalance. These metrics included the area under the receiver operating characteristics, precision-recall and kappa curves, and the precision, sensitivity, kappa, and F1-score. Combining unanticipated ICU admissions and mortality into a single outcome improved predictive performance overall. However, this led to reduced accuracy in predicting individual forms of deterioration, with LR showing the best performance for the combined prediction. DISCUSSION: The study underscores the significance of specific perioperative features in predicting patient deterioration, especially revealed by univariate analysis. Importantly, interpretable models like logistic regression outperformed complex classifiers, suggesting their practicality. Especially, when combined in an ensemble model for predicting multiple forms of deterioration. These findings were mostly limited by the large imbalance in data as post-operative deterioration is a rare occurrence. Future research should therefore focus on capturing more deterioration events and possibly extending validation to multi-center studies. CONCLUSIONS: This work demonstrates the potential for accurate prediction of perioperative patient deterioration, highlighting the importance of several perioperative features and the practicality of interpretable models like logistic regression, and ensemble models for the prediction of several outcome types. In future clinical practice these data-driven prediction models might form the basis for post-operative risk stratification by providing an evidence-based assessment of risk.

Associated Factors of Patients' Survival in Out of Hospital Cardiac Arrest; a Cross-sectional Study.

Introduction: Chinese populations have an increasingly high prevalence of cardiac arrest. This study aimed to investigate the prehospital associated factors of survival to hospital admission and discharge among out-of-hospital cardiac arrest (OHCA) adult cases in Macao Special Administrative Region (SAR), China. Methods: Baseline characteristics as well as prehospital factors of OHCA patients were collected from publicly accessible medical records and Macao Fire Services Bureau, China. Demographic and other prehospital OHCA characteristics of patients who survived to hospital admission and discharge were analyzed using multivariate logistic regression analysis. Results: A total of 904 cases with a mean age of 74.2±17.3 (range: 18-106) years were included (78%>65 years, 62% male). Initial shockable cardiac rhythm was the strongest predictor for survival to both hospital admission (OR=3.57, 95% CI: 2.26-5.63; p<0.001) and discharge (OR=12.40, 95% CI: 5.70-26.96; p<0.001). Being male (OR=1.63, 95% CI:1.08-2.46; p =0.021) and the lower emergency medical service (EMS) response time (OR=1.62, 95% CI: 1.12-2.34; p =0.010) were also associated with a 2-fold association with survival to hospital admission. In addition, access to prehospital defibrillation (OR=4.25, 95% CI: 1.78-10.12; p <0.001) had a 4-fold association with survival to hospital discharge. None of these associations substantively increased with age. Conclusion: The major OHCA predictors of survival were initial shockable cardiac rhythm, being male, lower EMS response time, and access to prehospital defibrillation. These findings indicate a need for increased public awareness and more education.

High flow, low results: The limits of high flow nasal cannula in the treatment of bronchiolitis.

Bronchiolitis continues to be the most common cause of hospitalization in the first year of life. We continue to search for the remedy that will improve symptoms, shorten hospitalization and prevent worsening of disease. Although initially thought to be a promising therapy, large randomized controlled trials show us that high flow nasal cannula (HFNC) use is not that remedy. These trials show no major differences in duration of hospital stay, intensive care unit (ICU) admission rates, duration of stay in the ICU, duration of oxygen therapy, intubation rates, heart rate, respiratory rate or comfort scores. Additionally, practices regarding initiation, flow rates and weaning continue to vary from institution to institution and there are currently no agreed upon indications for its use. This reveals the need for evidence based guidelines on HFNC use in bronchiolitis.

Strategies to identify medical patients suitable for management through same-day emergency care services: A systematic review.

Same-day emergency care (SDEC) in unplanned and emergency care is an NHS England (NHSE) priority. Optimal use of these services requires rapid identification of suitable patients. NHSE suggests the use of one tool for this purpose. This systematic review compares studies that evaluate the performance of selection tools for SDEC pathways. Nine studies met the inclusion criteria. Three scores were evaluated: the Amb score (seven studies), Glasgow Admission Prediction Score (GAPS) (six studies) and Sydney Triage to Admission Risk Tool (START) (two studies). There was heterogeneity in the populations assessed, exclusion criteria used and definitions used for SDEC suitability, with proportions of patients deemed 'suitable' for SDEC ranging from 20 to 80%. Reported score sensitivity and specificity ranged between 18-99% and 10-89%. Score performance could not be compared due to heterogeneity between studies. No studies assessed clinical implementation. The current evidence to support the use of a specific tool for SDEC is limited and requires further evaluation.

A Novel Facet of In-Hospital Food Consumption Associated with Hospital Mortality in Patients with Scheduled Admission-Addition of a Study Protocol to Test the Existence of Effects of COVID-19 in the Same Study in the Post-COVID-19 Period.

BACKGROUND: Humankind has faced unexperienced pandemic events since 2020. Since the COVID-19 pandemic has calmed down, we felt the need to verify whether in-hospital mortality had worsened compared to pre-pandemic conditions due to the COVID-19 pandemic. OBJECTIVE: To test the hypothesis that daily food consumption is associated with in-hospital mortality during hospitalization and to provide baseline data to examine whether the effects of COVID-19 exist or not in post-pandemic period. METHODS: All hospitalized patients staying in a single institution on the third Thursday of May, August, November, and the following February were included. Compared data: (1) among four seasons, (2) between age < 75 vs. ≥75 years, (3) between <75% vs. ≥75% of in-hospital food, and (4) logistic regression analysis to identify factors associated with in-hospital mortality. RESULTS: In 365 inpatients, the following results were obtained: (1) no seasonality or age effect in in-hospital mortality, (2) the novel cutoff value of 75% of the hospital food requirement was used to identify poor in-hospital survivors, (3) logistic regression analysis showed low food consumption, with <75% of the hospital food requirement as the predictor of high in-hospital mortality. CONCLUSIONS: A small eater of in-hospital food < 75% during hospitalization was associated with significantly higher in-hospital mortality in patients with scheduled hospitalization in the pre-pandemic period. Then, a study protocol is proposed to test the existence of the effects of COVID-19 in the same study in the post-COVID-19 period. This study protocol is, to our knowledge, the first proposal to test the effects of food consumption in the post-COVID-19 period on in-hospital mortality in the clinical nutritional areas.

Morbidity of Rescued Wild Birds by Admission Causes in the Republic of Korea.

Insufficient reports are available on what clinical and pathological conditions are observed in rescued free-living wild birds. This study investigated recent diagnoses of admitted wild birds based on admission causes in a southwestern area of South Korea over the past 2 years. A retrospective study was conducted on 1464 birds rescued from 2019 to February 2021. Overall, 12 admission subcategories were classified, and the diagnoses identified for each cause were analyzed. The three most frequently observed categories, general, integumentary, and musculoskeletal, each accounted for 20% of the total diagnoses. Trauma accounted for 71.4% of all diagnoses, and 81.5% featured inflammatory conditions, primarily due to trauma or infection. The proportion of birds that presented inflammatory conditions was much greater than the proportion of birds that were admitted due to trauma-related causes. This was because inflammatory diseases were identified at a high frequency, even from nontraumatic admission causes, and inflammatory conditions were not easily revealed. Suspecting an inflammatory condition in most rescued birds is advisable.

Impact of corrupt admission on the mental health of Chinese adolescents.

Through preferential treatment by education officials or through bribery, some adolescents can obtain admission to a junior high school. However, it is unclear whether it affects the mental health of adolescents. This study used Propensity Score Matching to examine the effects of corruption on adolescent mental health. A total of 17,254 junior high school students sample (11-18 years old; 48.7% girls and 53.1% boys) were used from the China Education Panel Survey. 14.1% of adolescents attended a junior high school by corrupt means, corruption had a significantly negative effect on the mental health of these adolescents (ATT = -0.388, p < 0.01), the reasons grounded in the fact that they received more criticisms from teachers and wanted to leave their current school. In general, corruption in the admissions process can have detrimental effects on the mental health of adolescents. This study extends the previous articles on how to improve adolescent mental health and complements the application of cognitive dissonance theory. Findings from this study revealed that anti-corruption in the education sector is necessary, and the institutional design to ensure fair enrolment in basic education will contribute to the mental health of adolescents.

Development of an admission criterion framework for high-cost medical consumables in governmental hospitals: a systematic review.

BACKGROUND: High-cost medical consumables (HMCs) have emerged as significant economic and technological challenges for numerous national healthcare systems. Governmental hospitals play an indispensable role in many national health systems, closely linked to the evaluation of admissions and the management of procurement for HMCs. Nevertheless, many governmental hospitals face avoidable management risks due to the lack of a decision-making tool. In response, we conducted a systematic review to establishing a framework for the admission criteria of HMCs. This framework aims to enhance their effective utilization and maximize economic, clinical, and social benefits. METHODS: In accordance with a systematic review protocol developed for our study, we conducted comprehensive searches in the PubMed, Web of Science, and Embase databases to identify all correlation studies conducted prior to December 31, 2021. Subsequently, two independent reviewers performed a two-round screening process, resulting in the inclusion of 23 articles in our study. Finally, a third reviewer meticulously examined the selected indicators and contributed to the development of the final criterion framework. RESULTS: The criterion framework was established with 7 first-level indicators and 23 s-level indicators. Among the first-level indicators, "Clinical Benefit" held the highest significance, with a combined weight of 1.606, followed by "Economic Value" and "Organizational Impact" at 1.497 and 1.159, respectively. At the second level, "Safety" and "Efficacy" carried equal weight in the decision-making tool, with combined weights of approximately 1.300 each and a standard combined weight of 0.130. CONCLUSION: This admission criteria framework serves as a vital decision-making tool for managing admissions and highlights several crucial evaluation indicators. Economic considerations emerge as the principal determinant in HMCs procurement decisions. Consequently, healthcare managers and decision-makers are recommended to give precedence to value-based healthcare and evidence-based procurement practices. In the long term, governmental hospitals must grapple with the challenge of judiciously allocating limited resources to maximize both social and economic benefits.

The Prevalence and Pattern of Admission Mortality among Acute Stroke Patients Managed at a Tertiary Hospital in Abakaliki, Nigeria: A Retrospective Study.

BACKGROUND: Stroke ranks as the second leading cause of mortality worldwide, following ischemic heart disease, and is expected to maintain this position through 2030. This neurological ailment is profoundly impactful, imposing a significant burden on health and the economy. In 2019 alone, it was responsible for 6.6 million fatalities and the loss of 143 million disability-adjusted life years (DALYs) across the globe. OBJECTIVES: This study highlighted the prevalence and pattern of admission mortality among acute stroke patients managed over 9 years in a private tertiary hospital in Abakaliki, Nigeria. METHODOLOGY: This was a retrospective hospital-based study conducted at a tertiary hospital in Abakaliki, Nigeria from January 2014 to December 2022. Relevant data were extracted from the patients' case notes and the sociodemographic, clinical and laboratory parameters of acute stroke survivors were compared with those of their dead counterparts. RESULTS: Out of the 172 (males - 57%; females - 43%) patients that fulfilled the inclusion criteria, 53 (30.81%) had haemorrhagic stroke while 119 (69.19%) had ischaemic stroke. The overall admission mortality rate was 15.12%, and it was more common in patients with haemorrhagic stroke, advancing age, severe hypertension, severe stroke, impairment of consciousness, renal dysfunction, hypernatremia, neutrophilic leucocytosis, and short admission duration. CONCLUSIONS: High mortality rates are linked to acute stroke admissions, particularly in cases involving haemorrhagic stroke, increasing age, severe hypertension, substantial stroke severity, impaired consciousness, renal dysfunction, hypernatremia, neutrophilic leukocytosis, and brief admission duration.

CONTEXTE: L'accident vasculaire cérébral (AVC) est la deuxième cause de mortalité dans le monde, après la cardiopathie ischémique, et devrait conserver cette position jusqu'en 2030. Cette affection neurologique a un impact profond, imposant une charge significative sur la santé et l'économie. En 2019 seulement, elle a été responsable de 6,6 millions de décès et de la perte de 143 millions d'années de vie ajustées sur l'incapacité (DALYs) dans le monde. OBJECTIFS: Cette étude a mis en évidence la prévalence et le modèle de la mortalité à l'admission chez les patients victimes d'AVC aigu gérés pendant 9 ans dans un hôpital privé tertiaire à Abakaliki, Nigéria. MÉTHODOLOGIE: Il s'agissait d'une étude rétrospective en milieu hospitalier menée dans un hôpital tertiaire à Abakaliki, Nigéria, de janvier 2014 à décembre 2022. Les données pertinentes ont été extraites des dossiers des patients et les paramètres sociodémographiques, cliniques et de laboratoire des survivants d'un AVC aigu ont été comparés à ceux de leurs homologues décédés. RÉSULTATS: Parmi les 172 patients (hommes - 57 % ; femmes - 43 %) qui remplissaient les critères d'inclusion, 53 (30,81 %) avaient un AVC hémorragique tandis que 119 (69,19 %) avaient un AVC ischémique. Le taux global de mortalité à l'admission était de 15,12 % et était plus fréquent chez les patients ayant un AVC hémorragique, un âge avancé, une hypertension sévère, un AVC sévère, une altération de la conscience, une dysfoncti on rénal e, une hyper natrémie, une l eucocytose neutrophilique et une courte durée d'admission. CONCLUSIONS: Les taux de mortalité élevés sont liés aux admissions pour AVC aigu, en particulier dans les cas d'AVC hémorragique, d'âge avancé, d'hypertension sévère, de sévérité importante de l'AVC, d'altération de la conscience, de dysfonction rénale, d'hypernatrémie, de leucocytose neutrophilique et de courte durée d'admission. MOTS-CLÉS: Facteurs de risque, Mortalité à l'admission, AVC aigu, Étude rétrospective.

Evaluating the Impact of Emergency Department Length of Stay in a Military Training Hospital Following the Implementation of a Standardized Paging System.

Emergency department (ED) lengths of stay (LOS) may be unnecessarily extended by inefficient consulting processes. Delays in initiating consultations, returning calls, consultant evaluation of patients, and communication of recommendations can contribute to potentially avoidable increases in LOS. Prolonged ED LOS has been shown to increase patient morbidity and mortality and to decrease patient satisfaction. We created a standardized procedure for ED-initiated consultations, with the goal of reducing the time to initial consultant callback, time to admission, and total ED LOS. Following our intervention, time to consultant callback was decreased; however, there was no reduction in total ED LOS for admitted patients.