Impact of heat on emergency hospital admissions related to kidney diseases in Texas: Uncovering racial disparities.

BACKGROUND AND OBJECTIVE: While impact of heat exposure on human health is well-documented, limited research exists on its effect on kidney disease hospital admissions especially in Texas, a state with diverse demographics and a high heat-related death rate. We aimed to explore the link between high temperatures and emergency kidney disease hospital admissions across 12 Texas Metropolitan Statistical Areas (MSAs) from 2004 to 2013, considering causes, age groups, and ethnic populations. METHODS: To investigate the correlation between high temperatures and emergency hospital admissions, we utilized MSA-level hospital admission and weather data. We employed a Generalized Additive Model to calculate the association specific to each MSA, and then performed a random effects meta-analysis to estimate the overall correlation. Analyses were stratified by age groups, admission causes, and racial/ethnic disparities. Sensitivity analysis involved lag modifications and ozone inclusion in the model. RESULTS: Our analysis found that each 1 °C increase in temperature was associated with a 1.73 % (95 % CI [1.43, 2.03]) increase in hospital admissions related to all types of kidney diseases. Besides, the effect estimates varied across different age groups and specific types of kidney diseases. We observed statistically significant associations between high temperatures and emergency hospital admissions for Acute Kidney Injury (AKI) (3.34 % (95 % CI [2.86, 3.82])), Kidney Stone (1.76 % (95 % CI [0.94, 2.60])), and Urinary Tract Infections (UTI) (1.06 % (95 % CI [0.61, 1.51])). Our research findings indicate disparities in certain Metropolitan Statistical Areas (MSAs). In Austin, Houston, San Antonio, and Dallas metropolitan areas, the estimated effects are more pronounced for African Americans when compared to the White population. Additionally, in Dallas, Houston, El Paso, and San Antonio, the estimated effects are greater for the Hispanic group compared to the Non-Hispanic group. CONCLUSIONS: This study finds a strong link between higher temperatures and kidney disease-related hospital admissions in Texas, especially for AKI. Public health actions are necessary to address these temperature-related health risks, including targeted kidney health initiatives. More research is needed to understand the mechanisms and address health disparities among racial/ethnic groups.

Impact of heat on emergency hospital admission in Texas: geographic and racial/ethnic disparities.

BACKGROUND: Studies exploring the racial/ethnicity disparity of the impact of heat on hospital admission are notably limited, especially in Texas, a state with a diverse population and consistently ranking among the top ten U.S. states for heat-related deaths per capita from 2018 to 2020. OBJECTIVE: Our objective is to determine the correlation between elevated temperatures and emergency hospital admissions for various causes and age groups across 12 Metropolitan Statistical Areas(MSAs) in Texas. Additionally, we aim to investigate health inequalities in the five largest MSAs in Texas between 2004 and 2013. METHODS: We used MSA-level hospital admission and weather data to estimate the relationship between heat and emergency hospital admissions. We applied a Generalized Additive Model and random effects meta-analysis to calculate MSA-specific associations and overall correlation, repeating the analysis for age groups and specific causes of admission. We also investigated health disparities across racial and ethnic groups and performed a sensitivity analysis. RESULTS: The results showed that a 1 °C increase in temperature was associated with a 0.50% (95% CI [0.38%, 0.63%]) increase in all-cause emergency hospital admissions. Heat's impact on hospital admissions varied among age groups and causes, with children under 6 years showing the highest effect estimate (0.64% (95% CI [0.32%,0.96%])). Statistically significant associations were found for Cardiovascular Diseases (0.27% (95% CI [0.07%,0.47%])), Ischemic Heart Diseases (0.53% (95% CI [0.15%,0.92%])), Pneumonia (0.70% (95% CI [0.25%,1.16%])), and Respiratory Diseases (0.67% (95% CI [0.18%,1.17%])). Health disparities were found among racial and ethnic groups in the five largest MSAs. IMPACT STATEMENT: Studies exploring the impact of heat on hospital admission in Texas are notably limited. Our research provided a comprehensive examination of the connection between heat and emergency hospital admissions throughout Texas. Furthermore, we are the first to examine racial/ethnic disparities, identifying African American and Hispanic groups as disproportionately affected. These insights provide valuable insights for policymakers to allocate resources and implement strategies to mitigate the negative consequences of rising temperatures.

Impact of Geriatric Admissions on Workload in the Emergency Department.

Background: Due to the increase in life expectancy, both the general population and the population of patients of emergency departments (ED) are getting older. An understanding of differences, workload and resource requirements may be helpful in improving patient care. The main goal of this study was to evaluate the reasons for geriatric admissions in the ED, identify typical medical problems and assess the number of resources in order to provide more effective management. Methods: We examined 35,720 elderly patients' ED visits over the course of 3 years. The data collected included age, sex, timing and length of stay (LOS), use of various resources, endpoint (admission, discharge or death) and ICD-10 diagnoses. Results: The median age was 73 years [66-81], with more females (54.86%). There were 57.66% elderly (G1), 36.44% senile (G2) and 5.89% long-liver (G3) patients. There were more females in the older groups. The total admission rate was 37.89% (34.19% for G1, 42.21% for G2 and 47.33% for G3). The average length of the patient's stay was 150 min [81-245] (G3 180 min [108-277], G2 (162 min [92-261]) and G1 139 min [71-230]). Heart failure, atrial fibrillation and hip fracture were the most common diagnoses. Nonspecific diagnoses were common in all groups. Conclusion: The vast majority of geriatric patients required considerable resources. With increasing ages, the number of women, LOS and number of admissions increased.

Uma análise documental do atendimento psicológico das vítimas de violência sexual infantil no pronto socorro / A documental analysis of the psychological care for victims of child sexual abuse in the emergency room / Un análisis documental de la atención psicológica a víctimas de violencia sexual en urgencias

INTRODUÇÃO: O Hospital Odilon Behrens é um dos hospitais de referência que atende Vítimas de Violência Sexual (VVS) em Belo Horizonte nas primeiras 72 horas após a ocorrência da violência. OBJETIVO: Identificar os sinais e sintomas desenvolvidos após a violência sexual assim como os diversos fatores contextuais que devem ser considerados para compreender o impacto da violência sofrida no sujeito no atendimento no pronto socorro de um hospital de referência. MÉTODOS: Foi realizada uma análise de dados qualitativos coletados a partir de 187 relatórios realizados de todos os pacientes que foram atendidos pela equipe de psicologia no Pronto Socorro e que foram consequentemente encaminhados ao Conselho Tutelar, considerando os pacientes de sexo masculino e feminino com idade inferior a 18 anos que foram atendidos no período de janeiro a dezembro do ano 2021. RESULTADOS: 79,8% dos casos eram do sexo feminino, 38,4% entre os 6 a 12 anos, o tipo de revelação sexual mais incidente foi a detecção acidental, os sinais de violência sexual mais frequentes foram os sinais físicos seguido de sinais emocionais. DISCUSSÃO: Foi percebido que a incidência de violência sexual é subnotificada e que há um grande desconhecimento do fluxo de atendimento dos diversos dispositivos da rede. CONCLUSÃO: Não foi possível um único quadro psicopatológico ou sintomatologia característica para todos os casos de violência sexual, sublinhando a relevância da análise da subjetividade do sujeito e dos fatores contextuais no atendimento à vítima de violência sexual.

INTRODUCTION: Hospital Odilon Behrens is one of the reference hospitals that assist Victims of Sexual Abuse in Belo Horizonte in the first 72 hours after the occurrence of the abuse. OBJECTIVE: To identify the signs and symptoms developed after sexual violence as well as the various contextual factors that must be considered to understand the impact of the violence suffered on the subject when treated in the emergency room of a reference hospital. METHODOLOGY: An analysis of qualitative data collected from 187 reports made of all patients who were assisted by the psychology team at the Emergency Room and who were consequently referred to the Tutelary Council, considering male and female patients under the age of 18 years old who were assisted from January to December of 2021 was carried out. RESULTS: 79.8% of the cases were female, 38.4% were between 6 and 12 years old, the most common type of sexual disclosure was accidental detection, and the most common signs of sexual abuse were physical signs followed by emotional signs. DISCUSSION: It was noticed that the incidence of sexual abuse is underreported and that there is a great lack of knowledge about the service flow of the various devices in the network. CONCLUSION: It was not possible to find a single psychopathological profile or characteristic symptomatology for all cases of sexual abuse, underlining the relevance of analyzing the subject's subjectivity and contextual factors in caring for victims of sexual abuse.

INTRODUCCIÓN: El Hospital Odilon Behrens es uno de los hospitales de referencia que asiste a Víctimas de Violencia Sexual en Belo Horizonte en las primeras 72 horas después de la ocurrencia de la violencia. OBJETIVO: Identificar los signos y síntomas desarrollados después de la violencia sexual, así como los diversos factores contextuales que deben ser considerados para comprender el impacto de la violencia sufrida en el sujeto cuando es atendido en la sala de emergencia de un hospital de referencia. MÉTODO: Se realizó un análisis de los datos cualitativos recolectados de 187 informes realizados de todos los pacientes que fueron consultados por el equipo de psicología en el Servicio de Urgencias y que fueron derivados al Consejo Tutelar, considerando pacientes a los hombres y mujeres menores de 18 años, quienes fueron consultados de enero a diciembre de 2021. RESULTADOS: El 79,8% de los casos fueron mujeres, el 38,4% entre 6 y 12 años, el tipo de revelación sexual más frecuente fue la detección accidental, las señales de violencia sexual fueron las físicas seguidas de las emocionales. DISCUSIÓN: Se notó que la incidencia de violencia sexual es sub-reportada y que existe un gran desconocimiento sobre el flujo de servicio de los diversos dispositivos en la red. CONCLUSIÓN: No fue posible encontrar un cuadro psicopatológico único o sintomatología característica para todos los casos de violencia sexual, lo que subraya la relevancia de analizar la subjetividad del sujeto y los factores contextuales en el cuidado de las víctimas de violencia sexual.

Simple approaches to characterising multiple long-term conditions (multimorbidity) and rates of emergency hospital admission: Findings from 495,465 UK Biobank participants.

BACKGROUND: Numerous approaches are used to characterise multiple long-term conditions (MLTC), including counts and indices. Few studies have compared approaches within the same dataset. We aimed to characterise MLTC using simple approaches, and compare their prevalence estimates of MLTC and associations with emergency hospital admission in the UK Biobank. METHODS: We used baseline data from 495,465 participants (age 38-73 years) to characterise MLTC using four approaches: Charlson index (CI), Byles index (BI), count of 43 conditions (CC) and count of body systems affected (BC). We defined MLTC as more than two conditions using CI, BI and CC, and more than two body systems using BC. We categorised scores (incorporating weightings for the indices) from each approach as 0, 1, 2 and 3+. We used linked hospital episode statistics and performed survival analyses to test associations with an endpoint of emergency hospital admission or death over 5 years. RESULTS: The prevalence of MLTC was 44% (BC), 33% (CC), 6% (BI) and 2% (CI). Higher scores using all approaches were associated with greater outcome rates independent of sex and age group. For example, using CC, compared with score 0, score 2 had 1.95 (95% CI: 1.91, 1.99) and a score of 3+ had 3.12 (95% CI: 3.06, 3.18) times greater outcome rates. The discriminant value of all approaches was modest (C-statistics 0.60-0.63). CONCLUSIONS: The counts classified a greater proportion as having MLTC than the indices, highlighting that prevalence estimates of MLTC vary depending on the approach. All approaches had strong statistical associations with emergency hospital admission but a modest ability to identify individuals at risk.

Conhecimento de enfemeiras sobre a criança com doença falciforme / Conocimiento de enfemeiras sobre el niño con enfermedad falciforme / Knowledge of nurses about children with sickle cell disease

Objetivo: conhecer a percepção das enfermeiras sobre a criança com doença falciforme. Método: pesquisa qualitativa Convergente-Assistencial, ocorrida em hospital público pediátrico, da qual participaram 12 enfermeiras da emergência no período de julho de 2020 a abril de 2021, após submissão ao Comitê de Ética. As técnicas de coleta de dados foram: sondagem do conhecimento por entrevista semiestruturada, grupos de convergência e observação participante. Os dados foram analisados conforme referencial da Pesquisa Convergente-Assistencial e suas fases, sendo elas concepção, instrumentalização, teorização, transferência e análise. Resultados: as enfermeiras reconheceram a doença pela principal manifestação clínica, a crise álgica, a qual foi citada como característica marcante da criança com doença falciforme. Considerações finais: as enfermeiras atuantes na emergência pediátrica conhecem alguns aspectos da doença falciforme e revelaram conhecimento incipiente sobre a fisiopatologia da doença.

Objetivo: conocer la percepción de las enfermeras sobre el niño con enfermedad falciforme. Método: Investigación cualitativa Convergente-Asistencial, ocurrida en hospital público pediátrico, de la cual participaron 12 enfermeras de la emergencia en el período de julio de 2020 a abril de 2021, tras sumisión al Comité de Ética. Las técnicas de recolección de datos fueron: sondeo del conocimiento por entrevista semiestructurada, grupos de convergencia y observación participante. Los datos fueron analizados conforme referencial de la Investigación Convergente-Asistencial y sus fases, siendo ellas concepción, instrumentalización, teorización, transferencia y análisis. Resultados: las enfermeras reconocieron la enfermedad por la principal manifestación clínica, la crisis álgica, la cual fue citada como característica distintiva del niño con enfermedad falciforme. Consideraciones finales: las enfermeras que actúan en la emergencia pediátrica conocen algunos aspectos de la enfermedad falciforme y revelaron conocimiento incipiente sobre la fisiopatología de la enfermedad.

Objective: to know the perception of nurses about the child with sickle cell disease. Method: qualitative Convergent-Care research, occurred in a public pediatric hospital, in which 12 emergency nurses participated from July 2020 to April 2021, after submission to the Ethics Committee. The data collection techniques were: survey of knowledge by semi-structured interview, convergence groups and participant observation. The data were analyzed according to the referential of the Convergent-Care Research and its phases, being them conception, instrumentalization, theorization, transfer and analysis. Results: the nurses recognized the disease by the main clinical manifestation, the pain crisis, which was cited as a striking characteristic of the child with sickle cell disease. Final considerations: the nurses working in the pediatric emergency know some aspects of sickle cell disease and revealed incipient knowledge about the pathophysiology of the disease.

Dignity in the care of people with advanced illness in emergency services from the perspective of family members: A qualitative study.

BACKGROUND AND AIM: Patients with advanced illness frequently attend emergency services, accompanied by their relatives. The objective of this study was to explore and describe the experiences of relatives, related to loss and preservation of dignity in end-of-life care in the emergency department. MATERIALS AND METHODS: Descriptive qualitative study. Eighteen in-depth interviews were conducted in the period between January 2020 and June 2020. The Atlas.Ti ® version 9 programme was used as support in the analysis of the speeches. RESULTS: 3 themes emerged: 1) "the urgency of dignity" which includes aspects related to going to the emergency room and moments when dignity can be threatened; 2) "dignity in the hands of health professionals" which deals with attitudes and gaps in communication skills of professionals: 3) "care from the perspective of dignity in emergencies" which includes conditions that can help preserve dignity and those aspects of the health system that interfere in the maintenance of dignity. CONCLUSION: The care of these patients and their families requires specific protocols that include a humane and dignified approach, as well as intervention programmes aimed at health professionals.

Pediatric triage modifications based on vital signs: a nationwide study.

OBJECTIVE: To analyze the clinical significance of a heart rate (HR) or respiratory rate (RR) higher or lower than the normal in pediatric triage. METHODS: A retrospective observational study was conducted with data from the Korean National Emergency Department Information System. The subjects were children <15 years of age in 2016. Reported HRs and RRs were divided into seven groups: grade -3 (3 or more standard deviations [SDs]normal), grade 2 (2 SDs>normal), and grade 3 (3 or more SDs>normal). The main outcomes were hospitalization and intensive care unit (ICU) admission rates. Logistic regression analysis was used to analyze the relationship of the outcomes according to grade in each group. RESULTS: Data for 981,297 patients were analyzed. Hospitalization and ICU admission rates increased significantly in the higher HR group (grades 1 to 3; odds ratio [OR], 1.353; P<0.001; OR, 1.747; P<0.001; respectively) and in the higher RR group (OR, 1.144; P<0.001; OR, 1.396; P<0.001; respectively), compared with grade 0 group. In the lower HR group (grades -1 to -3), the hospitalization rate decreased (OR, 0.928; P<0.001), whereas the ICU admission rate increased (OR, 1.207; P=0.001). Although the hospitalization rate increased. In the lower RR group (OR, 1.016; P=0.008), the ICU admission rate did not increase (OR, 0.973; P=0.338). CONCLUSION: Deviations in HR and RR above normal are related to increased risks of hospitalization and ICU admission. However, this association may not apply to deviations below normal.

Leveraging Advanced Data Analytics to Predict the Risk of All-Cause Seven-Day Emergency Readmissions.

Introduction Emergency readmissions have been a long-time, multifaceted, unsolved problem. Developing a predictive model calibrated with hospital-specific Electronic Health Record (EHR) data could give higher prediction accuracy and insights into high-risk patients for readmission. Thus, we need to proactively introduce the necessary interventions. This study aims to investigate the relationship between features that consider significant predictors of at-risk patients for seven-day readmission through logistic regression in addition to developing several machine learning models to test the predictability of those attributes using EHR data in a Saudi Arabia-specific ED context. Methods Univariate and multivariate logistic regression has been used to identify the most statistically significant features that contributed to classifying readmitted and not readmitted patients. Seven different machine learning models were trained and tested, and a comparison between the best-performing model was conducted in terms of five performance metrics. To construct the prediction model and internally validate it, the processed dataset was split into two sets: 70% for the training set and 30% for the test set or validation set. Results XGBoost achieved the highest accuracy (64%) in predicting early seven-day readmissions. Catboost was the second-best predictive model at 61%. XGBoost achieved the highest specificity at 70%, and all the models had a sensitivity of 57% except for XGBoost and Catboost at 32% and 38%, respectively. All predictive attributes, patient age, length of stay (LOS) in minutes, visit time (AM), marital status (married), number of medications, and number of abnormal lab results were significant predictors of early seven-day readmissions while marital status and number of vital-sign instabilities at discharge were not statistically significant predictors of seven-day readmission. Conclusion Although XGBoost and Catboost showed good accuracy, none of the models achieved good discriminative ability in terms of sensitivity and specificity. Thus, none can be clinically used for predicting early seven-day readmission. More predictive variables need to be fed into the model, specifically predictors approximate to the day of discharge, in order to optimize the model's performance.

Palliative chemotherapy for breast cancer: A population-based cohort study of emergency hospital admissions and place of death.

OBJECTIVE: Patients with incurable breast cancer may be treated with chemotherapy to improve cancer-related symptoms, quality of life and survival. We examined the association between use of palliative chemotherapy towards the end of life in breast cancer patients and outcomes including unplanned hospital admission and place of death. METHODS: A total of 10,966 women, treated with palliative chemotherapy for breast cancer (diagnosed 1995-2017 in England) within the 2 years prior to death (death between 2014 and 2017), were analysed. Logistic regression (outcome = emergency hospital admission in last 90 days of life yes/no; outcome = place of death hospital/other) was performed, adjusting for line of palliative chemotherapy in the last 90 days of life and patient demographics. RESULTS: The odds of hospital admission reduced with increasing line of chemotherapy received (1st line odds ratio [OR] = 2.7, 2nd line OR = 2.1, 3rd line OR = 1.9, 4th+ line OR = 1.7; baseline chemotherapy) in last 90 days of life. A similar relationship was observed for hospital death (1st line OR = 2.4, 2nd line OR = 2.1, 3rd line OR = 1.7, 4th+ line OR = 1.5). CONCLUSION: This study finds palliative chemotherapy towards the end of life to be associated with increased odds of unplanned hospital admissions and hospital death. These findings can be used to inform discussions between patients and healthcare professionals towards the end of life.

Developing and validating a predictive model for future emergency hospital admissions.

Although many emergency hospital admissions may be unavoidable, a proportion of these admissions represent a failure of the care system. The adverse consequences of avoidable emergency hospital admissions affect patients, carers, care systems and substantially increase care costs. The aim of this study was to develop and validate a risk prediction model to estimate the individual probability of emergency admission in the next 12 months within a regional population. We deterministically linked routinely collected data from secondary care with population level data, resulting in a comprehensive research dataset of 190,466 individuals. The resulting risk prediction tool is based on a logistic regression model with five independent variables. The model indicated a discrimination of area under the receiver operating characteristic curve of 0.9384 (95% CI 0.9325-0.9443). We also experimented with different probability cut-off points for identifying high risk patients and found the model's overall prediction accuracy to be over 95% throughout. In summary, the internally validated model we developed can predict with high accuracy the individual risk of emergency admission to hospital within the next year. Its relative simplicity makes it easily implementable within a decision support tool to assist with the management of individual patients in the community.

Perfil de pacientes com infarto agudo do miocárdio em um pronto socorro do distrito federal / Perfil de los pacientes con infarto agudo de miocardio en una urgencias del distrito federal / Profile of patients with acute myocardial infarction in an emergency room of the federal district

Objetivo: identificar o perfil sociodemográfico, epidemiológico, clínico e os desfechos dos pacientes com infarto agudo do miocárdio em um pronto socorro. Método: estudo descritivo, transversal, quantitativo, realizado através de dados secundários de pacientes infartados. Resultados: a idade predominante foi entre 50-59 anos, sendo em sua maioria homens, pardos, casados. Foram acometidos com infarto com Supradesnivelamento de ST, apresentando precordialgia, sendo hipertensos, diabéticos, com sobrepeso/obesidade além de histórico de tabagismo. Os infartados apresentaram quadro hipertensivo na admissão, e durante a internação necessitaram de drogas vasoativas e suporte de oxigênio. O principal tratamento utilizado foi uso de fibrinolíticos, tendo como desfecho a transferência para hospitais cardiológicos. Conclusão: Há necessidade de aprimorar e intensificar a prevenção de fatores de riscos, elaborar protocolos e dispor de recursos capazes de proporcionar um atendimento adequado(AU)

Objective: to identify the sociodemographic, epidemiological, clinical profile and outcomes of patients with acute myocardial infarction in an emergency department. Method: descriptive, cross-sectional, quantitative study carried out using secondary data from infarcted patients. Results: the predominant age was between 50-59 years, being mostly men, brown, married. They were affected with infarction with ST elevation, presenting chest pain, being hypertensive, diabetic, overweight/ obese, in addition to a history of smoking. The infarcted patients presented with hypertension on admission, and during hospitalization they required vasoactive drugs and oxygen support. The main treatment used was the use of fibrinolytics, with the outcome being transfer to cardiology hospitals. Conclusion: There is a need to improve and intensify the prevention of risk factors, develop protocols and have resources capable of providing adequate care.(AU)

Objetivo: identificar el perfil sociodemográfico, epidemiológico, clínico y evolución de los pacientes con infarto agudo de miocardio en un servicio de urgencias. Método: estudio descriptivo, transversal, cuantitativo, realizado con datos secundarios de pacientes infartados. Resultados: la edad predominante fue entre 50-59 años, siendo en su mayoría hombres, morenos, casados. Se encontraban afectados de infarto con elevación del segmento ST, presentaban dolor torácico, eran hipertensos, diabéticos, con sobrepeso/obesidad, además de antecedentes de tabaquismo. Los pacientes infartados presentaban hipertensión arterial al ingreso y durante la hospitalización requirieron fármacos vasoactivos y soporte de oxígeno. El principal tratamiento utilizado fue el uso de fibrinolíticos, con resultado de traslado a hospitales de cardiología. Conclusión: Existe la necesidad de mejorar e intensificar la prevención de los factores de riesgo, desarrollar protocolos y contar con recursos capaces de brindar una atención adecuada(AU)

Assessment of serum CK-MM level as a bioindicator for work-related musculoskeletal injuries among Emergency hospital workers.

Musculoskeletal disorders (MSDs) are considered a growing problem among healthcare personnel, especially service workers. The emergency room (ER) service workers are highly exposed to work-related risk factors which predispose them to MSDs. A cross-sectional study was performed on 78 ER workers. Full medical and occupational histories were taken. The Standardized Nordic Questionnaire (SNQ) was used for the assessment of musculoskeletal symptoms. Clinical examination was done with special emphasis on the locomotors system, and serum levels of muscle enzymes, including creatine kinase (CK) and creatine kinase isoenzyme (CK-MM), were measured. The study aims to detect the prevalence of occupational musculoskeletal disorders (MSDs) among ER workers at University hospitals, and assessment of CK-MM as a biomarker used in the early detection of MSDs. We found that 71.8% of the participants were complaining of musculoskeletal disorder in the last 7 days before the study, while only 34.6% were complaining of musculoskeletal disorder in the last 12 months before the study. The knee joint was the most commonly affected site in the past 7 days, by 39.7%. On the other hand, the highest prevalent disorder in the last 12 months was for the ankle joint (17.9%) with significantly high levels of serum CK-MM. In conclusion, musculoskeletal injuries are a common complaint among healthcare occupations, especially among ER service workers that need regular health education and ergonomic training programs. Monitoring of serum CK-MM level with cut-off value 90 ng\ml could be used as a novel approach for the early detection of work-related musculoskeletal disorders.

Drastic Reduction Inpatient Visits to the Emergency Department in a Hospital in Israel During the COVID-19 Outbreak, Compared to the H1N1 2009.

BACKGROUND: On February 26, 2020, the first case of coronavirus disease 2019 (COVID-19) was detected in Israel. The Ministry of Health (MoH) instructed people to take isolation measures and restrict their movement. Similarly, there was a gradual decrease in the number of visits to our emergency department (ED). OBJECTIVES: To describe the decline in the referrals to the ED and in-hospital beds occupancy during the COVID-19 pandemic and to compare it to the H1N1 2009 pandemic. METHODS: Employing a cross-sectional epidemiologic study, the pattern of visits to the ED during the COVID-19 was compared with the pattern of visits during the 2009 H1N1 pandemic, as well as a year without a pandemic. The data was adjusted to consider changes in population size. The Welch t test for unpaired, unequal samples was used to analyze the data. RESULTS: Within 2 months of the COVID-19 outbreak, the average number of visits to the ED dropped by 30.2% and the hospital occupancy by 29.2% (a minimum of 57%), compared to the same period, the year before. In comparison to the same period during the H1N1 outbreak, we witnessed a significant decline in the number of visits to the ED during the COVID-19 outbreak. CONCLUSION: The behavior of people during the COVID-19 pandemic was different from their behavior during the H1N1 pandemic. People seemed to avoid visiting the ED. The boundary between precaution and panic in the generation of the media could be very thin. Decision-makers must take this into account.

Epidemiological Study of Violence against Children and Its Increase during the COVID-19 Pandemic.

The aim of this study was to identify the epidemiological profiles of violence against children, victims, and their aggressors, and their correlations between socioeconomic and demographic factors analyzed before and during the COVID-19 pandemic. This was a cross-sectional, retrospective observational study based on a review of Individual Notification Forms from the Information System for Notifiable Diseases, including child victims of violence, under 18 years, assisted by a pediatric emergency service in Brazil, from 2016-2020. Data were stratified, then statistical analysis was performed using the two-proportion equality test and the Chi-square test, with p < 0.05 and a 95% confidence interval. A total of 609 notifications were analyzed and a prevalence of sexual violence (63.2%) was reported. The prevalent profile of victim was female (76.7%), aged between 2-9 years (38.1%) and 14-18 years (35.6%). The violence occurs in the victim's home (58.9%). The prevalent profile of perpetrator was male (82.4%), young adolescent (59.2%), living as family (64%), mainly the parents (18.4%). No correlation was found between the classified socioeconomic and demographic variables and violence. There was an increase in notifications during the COVID-19 pandemic, compared to the same period in the previous year; self-harm was reported in 59.7% of physical violence in 2020. Prevalence of sexual violence was higher for females, aged between 2-9 and 14-18 years, victimized in their homes, by male offenders, living as family, mainly by their parents. No association was found between child violence and the socioeconomic and demographic.

VALIDITY OF THE INSTRUMENT interRAI EMERGENCY SCREENER FOR PSYCHIATRY FOR THE BRAZILIAN CONTEXT

Objective: The aim of this study was to carry out the translation and present the evidence of validity of the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP). Method: this is a cross-sectional study conducted in a municipal hospital in the metropolitan region of Porto Alegre, Rio Grande do Sul. A total of 161 patients were evaluated in the first 24 hours of emergency arrival using ESP. Exploratory factor analyses of the sections of the instrument and reliability analyses were conducted using Cronbach's alpha and McDonald's Omega. Results: the analyses suggested an appropriate structure to the purpose of the instrument, two sections containing two factors instead of the expected one-dimensional structure. However, sections with two factors have interpretability and theoretical consistency. The factors presented internal consistency. Conclusion: the Brazilian version of the interRAI Emergency Screener for Psychiatry (ESP) demonstrates adequate psychometric properties through the internal structure of the instrument. Future studies should investigate the relationship of the scores produced by the instrument with clinical diagnosis and with covariates relevant to mental health outcomes.

Objetivo: El objetivo de este estudio era realizar la traducción y presentar la evidencia de validez del examinador de emergencia interRAI para psiquiatría (ESP). Método: se trata de una encuesta transversal realizada en un hospital municipal de la región metropolitana de Porto Alegre, Rio Grande do Sul. Un total de 161 pacientes fueron evaluados en las primeras 24 horas de llegada de emergencia utilizando ESP. Los análisis exploratorios de factores de las secciones del instrumento y los análisis de fiabilidad se llevaron a cabo utilizando Cronbach's alpha y McDonald's Omega. Resultados: los análisis sugirieron una estructura adecuada a los propósitos del instrumento, dos secciones que contienen dos factores en lugar de la estructura unidimensional esperada. Sin embargo, las secciones con dos factores tienen interpretabilidad y consistencia teórica. Los factores presentaron consistencia interna. Conclusión: la versión brasileña del Examinador de Emergencia InterRAI para Psiquiatría (ESP) demuestra propiedades psicométricas adecuadas a través de la estructura interna del instrumento. Los estudios futuros deben investigar la relación de las puntuaciones producidas por el instrumento con el diagnóstico clínico y con covariables relevantes para los resultados de salud mental.

Objetivo: O objetivo do estudo foi realizar a tradução e apresentar as evidências de validade do interRAI Emergency Screener for Psychiatry (ESP). Método: trata-se de uma pesquisa transversal realizada em um hospital municipal da região metropolitana de Porto Alegre, Rio Grande do Sul. Foram avaliados 161 pacientes nas primeiras 24 hs da chegada a emergência utilizando o ESP. Foram conduzidas análises fatoriais exploratórias das seções do instrumento e análises de fidedignidade por meio do alfa de Cronbach e Ômega de McDonald. Resultados: as análises sugeriram uma estrutura adequada ao propósito do instrumento, sendo duas seções contendo dois fatores ao invés da estrutura unidimensional esperada. Contudo, as seções com dois fatores possuem interpretabilidade e consistência teórica. Os fatores apresentaram consistência interna. Conclusão: a versão brasileira do interRAI Emergency Screener for Psychiatry (ESP) demonstra adequadas propriedades psicométricas por meio da estrutura interna do instrumento. Estudos futuros deverão investigar a relação dos escores produzidos pelo instrumento com diagnóstico clínico e com covariáveis relevantes para os desfechos de saúde mental.

Expedited and Comprehensive Management of Low-Risk TIA Patients in the Emergency Department is Safe and Less Costly.

OBJECTIVES: Transient ischemic attack (TIA) can be a warning sign of an impending stroke. The objective of our study is to assess the feasibility, safety, and cost savings of a comprehensive TIA protocol in the emergency room for low-risk TIA patients. MATERIALS AND METHODS: This is a retrospective, single-center cohort study performed at an academic comprehensive stroke center. We implemented an emergency department-based TIA protocol pathway for low-risk TIA patients (defined as ABCD2 score < 4 and without significant vessel stenosis) who were able to undergo vascular imaging and a brain MRI in the emergency room. Patients were set up with rapid outpatient follow-up in our stroke clinic and scheduled for an outpatient echocardiogram, if indicated. We compared this cohort to TIA patients admitted prior to the implementation of the TIA protocol who would have qualified. Outcomes of interest included length of stay, hospital cost, radiographic and echocardiogram findings, recurrent neurovascular events within 30 days, and final diagnosis. RESULTS: A total of 138 patients were assessed (65 patients in the pre-pathway cohort, 73 in the expedited, post-TIA pathway implementation cohort). Average time from MRI order to MRI end was 6.4 h compared to 2.3 h in the pre- and post-pathway cohorts, respectively (p < 0.0001). The average length of stay for the pre-pathway group was 28.8 h in the pre-pathway cohort compared to 7.7 h in the post-pathway cohort (p < 0.0001). There were no differences in neuroimaging or echocardiographic findings. There were no differences in the 30 days re-presentation for stroke or TIA or mortality between the two groups. The direct cost per TIA admission was $2,944.50 compared to $1,610.50 for TIA patients triaged through the pathway at our institution. CONCLUSIONS: This study demonstrates the feasibility, safety, and cost-savings of a comprehensive, emergency department-based TIA protocol. Further study is needed to confirm overall benefit of an expedited approach to TIA patient management and guide clinical practice recommendations.

Associations between attainment of incentivised primary care indicators and emergency hospital admissions among type 2 diabetes patients: a population-based historical cohort study.

OBJECTIVES: England has invested considerably in diabetes care over recent years through programmes such as the Quality and Outcomes Framework and National Diabetes Audit. However, associations between specific programme indicators and key clinical endpoints, such as emergency hospital admissions, remain unclear. We aimed to examine whether attainment of Quality and Outcomes Framework and National Diabetes Audit primary care diabetes indicators is associated with diabetes-related, cardiovascular, and all-cause emergency hospital admissions. DESIGN: Historical cohort study. SETTING: A total of 330 English primary care practices, 2010-2017, using UK Clinical Practice Research Datalink. PARTICIPANTS: A total of 84,441 adults with type 2 diabetes. MAIN OUTCOME MEASURES: The primary outcome was emergency hospital admission for any cause. Secondary outcomes were (1) diabetes-related and (2) cardiovascular-related emergency admission. RESULTS: There were 130,709 all-cause emergency admissions, 115,425 diabetes-related admissions and 105,191 cardiovascular admissions, corresponding to unplanned admission rates of 402, 355 and 323 per 1000 patient-years, respectively. All-cause hospital admission rates were lower among those who met HbA1c and cholesterol indicators (incidence rate ratio = 0.91; 95% CI 0.89-0.92; p < 0.001 and 0.87; 95% CI 0.86-0.89; p < 0.001), respectively), with similar findings for diabetes and cardiovascular admissions. Patients who achieved the Quality and Outcomes Framework blood pressure target had lower cardiovascular admission rates (incidence rate ratio = 0.98; 95% CI 0.96-0.99; p = 0.001). Strong associations were found between completing 7-9 (vs. either 4-6 or 0-3) National Diabetes Audit processes and lower rates of all admission outcomes (p-values < 0.001), and meeting all nine National Diabetes Audit processes had significant associations with reductions in all types of emergency admissions by 22% to 26%. Meeting the HbA1c or cholesterol Quality and Outcomes Framework indicators, or completing 7-9 National Diabetes Audit processes, was also associated with longer time-to-unplanned all-cause, diabetes and cardiovascular admissions. CONCLUSIONS: Attaining Quality and Outcomes Framework-defined diabetes intermediate outcome thresholds, and comprehensive completion of care processes, may translate into considerable reductions in emergency hospital admissions. Out-of-hospital diabetes care optimisation is needed to improve implementation of core interventions and reduce unplanned admissions.

Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response: Retrospective Study and Comparison with the United States.

BACKGROUND: Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. OBJECTIVE: The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. METHODS: Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. RESULTS: German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. CONCLUSIONS: Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.

Factors associated with potentially missed acute deterioration in primary care: cohort study of UK general practices.

BACKGROUND: In the UK, while most primary care contacts are uncomplicated, safety incidents do occur and result in patient harm, for example, failure to recognise a patient's deterioration in health. AIM: To determine the patient and healthcare factors associated with potentially missed acute deterioration in health. DESIGN AND SETTING: Cohort of patients registered with English Clinical Practice Research Datalink general practices between 1 April 2014 and 31 December 2017 with linked hospital data. METHOD: A potentially missed acute deterioration was defined as a patient having a self-referred admission to hospital having been seen in primary care by a GP in the 3 days beforehand. All diagnoses and subsets of commonly-reported missed conditions were analysed.. RESULTS: A total of 116 097 patients contacted a GP 3 days before an emergency admission. Patients with sepsis (adjusted odds ratio [aOR] 1.09, 95% confidence interval [CI] = 1.01 to 1.18) or urinary tract infections (aOR 1.09, 95% CI = 1.04 to 1.14) were more likely to self-refer. The duration of GP appointments was associated with self-referral. On average, a 5-minute increase in appointment time resulted in a 10% decrease in the odds of self-referred admissions (aOR 0.90, 95% CI = 0.89 to 0.91). Patients having a telephone consultation (compared with face-to-face consultation) (aOR 1.14, 95% CI = 1.11 to 1.18) previous health service use, and presence of comorbidities were also associated with self-referred admission. CONCLUSION: Differentiating acute deterioration from self-limiting conditions can be difficult for clinicians, particularly in patients with sepsis, urinary tract infections, or long-term conditions. The findings of this study support the call for longer GP consultations and caution against reliance on telephone consultations in primary care; however, more research is needed to understand the underlying mechanisms.