Clinical decision support system in emergency telephone triage: A scoping review of technical design, implementation and evaluation.

OBJECTIVES: Emergency department overcrowding could be improved by upstream telephone triage. Emergency telephone triage aims at managing and orientating adequately patients as early as possible and distributing limited supply of staff and materials. This complex task could be improved with the use of Clinical decision support systems (CDSS). The aim of this scoping review was to identify literature gaps for the future development and evaluation of CDSS for Emergency telephone triage. MATERIALS AND METHODS: We present here a scoping review of CDSS designed for emergency telephone triage, and compared them in terms of functional characteristics, technical design, health care implementation and methodologies used for evaluation, following the PRISMA-ScR guidelines. RESULTS: Regarding design, 19 CDSS were retrieved: 12 were knowledge based CDSS (decisional algorithms built according to guidelines or clinical expertise) and 7 were data driven (statistical, machine learning, or deep learning models). Most of them aimed at assisting nurses or non-medical staff by providing patient orientation and/or severity/priority assessment. Eleven were implemented in real life, and only three were connected to the Electronic Health Record. Regarding evaluation, CDSS were assessed through various aspects: intrinsic characteristics, impact on clinical practice or user apprehension. Only one pragmatic trial and one randomized controlled trial were conducted. CONCLUSION: This review highlights the potential of a hybrid system, user tailored, flexible, connected to the electronic health record, which could work with oral, video and digital data; and the need to evaluate CDSS on intrinsic characteristics and impact on clinical practice, iteratively at each distinct stage of the IT lifecycle.

Clinical features of 1487 COVID-19 patients with outpatient management in the Greater Paris: the COVID-call study.

Clinical features of COVID-19 have been mostly described in hospitalized patients with and without ICU admission. Yet, up to 80% of patients are managed in an outpatient setting. This population is poorly documented. In France, health authorities recommend outpatient management of patients presenting mild-to-moderate COVID-19 symptoms. The aim of this study was to describe their clinical characteristics. The study took place in an emergency medical dispatching center located in the Greater Paris region. Patients included in this survey met confirmed COVID-19 infection criteria according to the WHO definition. We investigated clinical features and classified symptoms as general, digestive, ear-nose-throat, thoracic symptoms, and eye disease. Patients were included between March 24 and April 6 2020. 1487 patients included: 700 (47%) males and 752 (51%) females, with a median age of 44 (32-57) years. In addition to dry cough and fever reported in more than 90% of cases, the most common symptoms were general symptoms: body aches/myalgia (N = 845; 57%), headache (N = 824; 55%), and asthenia (N = 886; 60%); shortness of breath (N = 479; 32%) and ear-nose-throat symptoms such as anosmia (N = 415; 28%) and ageusia (N = 422; 28%). Chest pain was reported in 320 (21%) cases and hemoptysis in 41 (3%) cases. The main difference between male and female patients was an increased prevalence of ear-nose-throat symptoms as well as diarrhea, chest pains, and headaches in female patients. General symptoms and ear-nose-throat symptoms were predominant in COVID-19 patients presenting mild-to-moderate symptoms. Shortness of breath and chest pain were remarkably frequent.

How Vine Shoots as Fillers Impact the Biodegradation of PHBV-Based Composites.

Vine shoots are lignocellulosic agricultural residues. In addition to being an interesting source of polyphenols, they can be used as fillers in a poly(3-hydroxybutyrate-3-hydroxyvalerate) (PHBV) matrix to decrease the overall cost and to propose an alternative to non-biodegradable fossil-based materials. The objective of the present work was to investigate how the incorporation of vine shoots fillers and a preliminary polyphenol extraction step could impact the biodegradability of biocomposites. Biocomposites (20 wt %) were produced by microcompounding. The biodegradation of materials was assessed by respirometric tests in soil. The negative impact of polyphenols on the biodegradability of vine shoots was confirmed. This was supported by crystallinity measurements and scanning electron microscopy (SEM) observations, which showed no difference in structure nor morphology between virgin and exhausted vine shoots particles. The incorporation of vine shoots fillers in PHBV slightly accelerated the overall biodegradation kinetics. All the biocomposites produced were considered fully biodegradable according to the French and European standard NF EN 17033, allowing the conclusion that up-cycling vine shoots for the production of lignocellulosic fillers is a promising strategy to provide biodegradable materials in natural conditions. Moreover, in a biorefinery context, polyphenol extraction from vine shoots has the advantage of improving their biodegradability.

Compliance with fluoride supplements provided by a dental hygienist in homes of low-income parents of preschool children in Quebec.

OBJECTIVE: This study aimed to assess the compliance with fluoride supplements provided at home by a dental hygienist to mothers of at-risk preschool children. METHODS: Participants were recruited during pregnancy of low-income women. On the first visit, the mothers of 60 infants aged 6 to 9 months were handed free fluoride supplements. A questionnaire was administered at that time and after 6 and 12 months to assess compliance during the preceding week. RESULTS: At the beginning of the study, none of the mothers reported having given fluoride supplements, in comparison with 73 percent of mothers of 44 infants who received all three visits at the end of follow-up; 48 percent reported fluoride supplement use on a daily basis. CONCLUSIONS: Removal of financial and physical barriers and personal professional involvement are good strategies to achieve compliance with fluoride supplements. Further assessment regarding the possible application of this intervention to other professional or cultural contexts is warranted.