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Objectives: To investigate hospital admissions in England and Wales due to infections and diseases of the skin and subcutaneous tissue. Methods: Data from the Patient Episode Database for Wales (PEDW) and the Hospital Episode Statistics (HES) database in England for the years between April 1999 and April 2020 were used in this study. Using all the relevant diagnosis codes (L00–L99), hospital admissions related to various skin infections and diseases of the subcutaneous tissue were identified. Results: Hospital admissions for all causes increased overall by 78.8%, from 276,464 in 1999 to 494,433 in 2020, representing an increase in hospital admission rate of 56.1% (from 530.23 (95% CI 528.26–532.20) in 1999 to 827.92 (95% CI 825.62–830.22) per 100,000 people in 2020, p ≤ 0.05). The most prevalent diagnoses were disorders of the skin's appendages, infections of the skin and subcutaneous tissue, and other disorders of the skin and subcutaneous tissue. Nearly half of all hospital admissions were for males and for patients between the ages of 15 and 59. In 2020, the hospital admission rate for males increased by 60.2%, from 540.16 (95% CI 537.32–543.01) per 100,000 people in 1999 to 865.10 (95% CI 861.76–868.44) in 2020. From 520.75 (95% CI 518.02–523.48) in 1999 to 791.03 (95% CI 787.86–794.19) in 2020, the hospital admission rate for females grew by 51.9%. Conclusion: Hospital admission due to infections and disorders of the skin and subcutaneous tissue increased during the past two decades in England and Wales. Further studies are needed to explore the risk factors associated with infections and disorders of the skin and subcutaneous tissue complications, and its associated admissions. [ABSTRACT FROM AUTHOR]

Background: Seasonal variations have been observed in heart failure (HF) hospitalization. Numerous explanatory mechanisms have been proposed, but no prior studies have examined potential contributors directly. Our objective was to identify specific factors that could contribute to seasonal variability using a large longitudinal dataset of HF hospitalizations., Methods: Hospital discharge data were obtained for all hospitals in the state of New York from 1994 to 2007. Records with a primary diagnosis of HF by the International Classification of Diseases-9 Clinical Modification (ICD-9-CM) code (428.xx and 425.xx) were included. Year and month of admission were used as predictors to evaluate outcomes of in-hospital mortality, population-adjusted daily rate of hospital admissions and length of stay (LOS) using univariable regression including a sinusoidal model to assess the seasonality of HF outcomes. Observations were then adjusted for multiple medical covariables as well as the average local monthly temperature and humidity at each hospital using data from the Global Historical Climate Network to identify potential modifiers of seasonal variability., Results: Among 949 907 records, the median age was 76 [inter-quartile range (IQR) 65-84 years old], and the cohort was 54% female (510 945 records). The population-adjusted rate of HF admissions per day increased by 1.1 admissions/day/year between 1994 and 2007, whereas in-hospital mortality and LOS decreased by -0.3%/year and -0.3 days/year, respectively (P < 0.001 for all). Seasonal trends were identified for daily HF admissions (February peak, P < 0.0001), mortality (January peak, P < 0.001) and LOS (January peak, P < 0.01). Cosinor analysis revealed significant periodicity for HF admission rate (amplitude = ±0.9 admissions/day/100 000 people, P < 0.001), in-hospital mortality (amplitude = ±0.47%, P < 0.001) and LOS (amplitude = ±0.23 days, P < 0.01). No other patient characteristics were significant modifiers of seasonality. Odds of mortality were highest in July rather than January when adjusted for average local temperature but not humidity., Conclusions: Adverse outcomes in patients hospitalized with HF were significantly worse in the winter months even when adjusted for patient characteristics and concurrent acute diagnoses such as pneumonia. Local ambient temperature was the strongest modifier of the observed seasonality. Given the increasing frequency of extreme weather events, additional work to determine the mechanisms of this and other environmental risk factors is urgently needed., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

This study aimed to identify qualitative aspects of small animal veterinary internship applications that are associated with relative intern performance. This study took place with data collected on small animal interns from the 2015-2016, 2016-2017, and 2017-2018 intern classes from four different institutions. Applicants were divided into top-performers and bottom-performers by sorting the calculated overall scores from highest to lowest, labeling the top half of interns as "top-performers," and the lower half of interns as "bottom-performers." Thematic analysis of the intern applications was conducted. Relationship skills and knowledge application were identified as themes in the top-performing interns but not in the bottom-performing interns. Veterinary experience, presentations, community service, research, and teaching were all seen more frequently in the top-performing interns. More top performers had characteristics of greatest strength of technical skills, professionalism, relationship skills, and teamwork. More bottom performers had characteristics of greatest strength of stress management, communication, and patient care. More top performers had characteristics that would benefit from targeted mentoring of leadership. More bottom-performers had characteristics that would benefit from targeted mentoring of technical skills, general knowledge, and self-awareness. In narrative comments, adaptability, and self-awareness were more commonly noted in the bottom-performers. Lack of confidence was noted as a theme in the bottom-performers, but not in the top-performers. Certain qualities of intern applications may be used to predict top- or bottom-performing interns.

Abstract Background Identifying trends of hospital admissions for respiratory diseases is crucial for public health and research to guide future clinical improvements for better outcomes. This study aims to define the trends of respiratory disease-related hospital admissions (RRHA) in England and Wales between 1999 and 2019. Methods An ecological study was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data for respiratory diseases were extracted for the period between April 1999 and March 2019. The trend in hospital admissions was assessed using a Poisson model. Results Hospital admission rate increased by 104.7% [from 1535.05 (95% CI 1531.71–1538.38) in 1999 to 3142.83 (95% CI 3138.39–3147.26) in 2019 per 100,000 persons, trend test, p

Students from lower socio-economic backgrounds who were educated in state funded schools are underrepresented in medicine in the UK. Widening access to medical students from these backgrounds has become a key political and research priority. It is known that medical schools vary in the number of applicants attracted and accepted from non-traditional backgrounds but the reasons for this are poorly understood. This study aims to explore what applicants value when choosing medical schools to apply to and how this relates to their socioeconomic background. We conducted a multicentre qualitative interview study, purposively sampling applicants and recent entrants based on socioeconomic background, stage of application and medical school of application. We recruited participants from eight UK medical schools. Participants attended semi-structured interviews. We performed a framework analysis, identifying codes inductively from the data. Sixty-six individuals participated: 35 applicants and 31 first year medical students. Seven main themes were identified; course style, proximity to home, prestige, medical school culture, geographical area, university resources, and fitting in. These were prioritised differently depending on participants’ background. Participants from lower socioeconomic backgrounds described proximity to home as a higher priority. This was typically as they intended to be living at home for at least part of the course. Those from higher socioeconomic backgrounds were more concerned with the perceived prestige of medical schools. Since medicine is a highly selective course, only offered at a minority of UK higher education institutions, these differences in priorities may help explain observed differential patterns of medical school applications and success rates by applicant social background.

In the BJPsych Open Wong et al examined the influence of lockdown stringency during early stages of the COVID-19 pandemic on psychiatric emergency presentations among children and adolescents from ten countries. Data from March and April 2019 were compared with the same time frame in 2020, with particular focus on self-harm admissions. In this editorial, the publication is summarised and potential implications for the field and future studies are discussed.

Summary: Background: Robust evidence on the relationship between primary care and emergency admissions is lacking in low- and middle-income countries. This study evaluates how the phased roll out of the family health strategy (FHS) to the urban poor in Rio de Janeiro Brazil affected emergency hospital admissions and readmissions from ambulatory-care sensitives conditions (ACSCs). Methods: A cohort of 1.2 million adults in Rio de Janeiro city were followed for five years (Jan 2012 to Dec 2016). The association between FHS use and the likelihood of emergency hospital admissions and 30-day readmissions were evaluated using multi-level Poisson regression models with inverse probability treatment weighting and regression adjustment (IPTW-RA) for socioeconomic and household characteristics. Inequalities in associations were examined across groups of causes and by key socioeconomic groups. Results: Records from 2,551,934 primary care consultations and 15,627 admissions were analysed. In IPTW-RA analyses, each additional FHS consultation was associated with a 3% lower rate of ACSC admission (RR: 0.97; 95%CI: 0.95, 0.98), a 63% lower rate of 30-day readmissions from any non-birth cause (RR: 0.37; 95%CI: 0.30, 0.46), and an 57% lower rate of 30-day readmissions from ACSCs (RR: 0.43; 95%CI: 0.33, 0.55). Individuals who were older, had the lowest educational attainment, were unemployed, and had higher incomes had larger reductions in ACSC admissions associated with FHS use. Interpretation: Investment in primary care is important for reducing emergency hospital admissions and their associated costs in LMICs. Funding: DFID/MRC/Wellcome Trust/ESRC.

Introduction: Patients undergoing elective laparoscopic cholecystectomy (ELLC) represent a heterogeneous group making it challenging to stratify risk. The aim of this paper is to identify pre-operative factors associated with adverse peri- and post-operative outcomes in patients undergoing ELLC. This knowledge will help stratify risk, guide surgical decision making and better inform the consent process.Methods: All patients who underwent ELLC between January 2015 and December 2019 were included in the study. Pre-operative data and both peri- and post-operative outcomes were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were divided into groups based on clinical indication (i.e. biliary colic versus cholecystitis) and adverse outcomes were compared. Multivariate regression models were generated for each adverse outcome using pre-operative independent variables.Results: Two-thousand one hundred and sixty-six ELLC were identified. Rates of peri- and post-operative adverse outcomes were significantly higher in the cholecystitis versus biliary colic group and increased with number of admissions of cholecystitis (p < 0.05). Rates of subtotal (29.5%), intra-operative complication (9.8%), post-operative complications (19.6%), prolonged post-operative stay (45.9%) and re-admission (16.4%) were significant in the group of patients with ≥ 2 admissions with cholecystitis.Conclusion: Our data demonstrate that patients with repeated biliary admission (particularly cholecystitis) ultimately face an increased risk of a difficult ELLC with associated complications, prolonged post-operative stay and readmissions. These data provide robust evidence that individualised risk assessment and consent are necessary before ELLC. Strategies to minimise recurrent biliary admissions prior to LC should be implemented. [ABSTRACT FROM AUTHOR]

BACKGROUND: Trauma performance improvement programs are required by the American College of Surgeons to review all nonsurgical admissions if the annual rate exceeds 10%. These reviews can have varying consistency between reviewers, are time consuming, and the consequent aggregate data are difficult to evaluate for trends. OBJECTIVE: This study set forth to standardize nonsurgical admission review through validation of the Nelson tool, which is a published objective scoring tool to determine the appropriateness of nonsurgical admissions. We hypothesized that implementation of this tool would facilitate earlier identification of events resulting in meaningful intervention and a reduction of inappropriate nonsurgical admissions. METHODS: The Nelson tool and scoring was integrated into the nonsurgical admission review process. A customized audit filter and report were built in the trauma registry. Data were reviewed with respect to scores and admitting service. Statistical analysis included using analysis of variance and t tests to examine differences between admitting services, χ2 test of independence or Fisher's exact to test the association of categorical variables, and ordinal logistic regression to test the ability of the total Nelson tool to predict appropriateness of admission. RESULTS: Using the Nelson tool, scores resulted in appropriate admission service in over 90% of cases. Implementation of the tool resulted in a decreased performance improvement workload with a 78% reduction in nonsurgical admission cases required to go to secondary level of review. CONCLUSIONS: Utilization of a validated scoring tool decreases performance improvement workload without compromising patient safety. [ABSTRACT FROM AUTHOR]

Many selective colleges consider the backgrounds of applicants to improve equity in admissions. However, this information is usually not available for all applicants. We examine whether the chances of admission and enrollment changed after 43 colleges gained access to a new tool that standardizes information on educational disadvantage for all applicants. Applicants from the most challenging school and neighborhood backgrounds experienced a 5-percentage point increase in the probability of admission in the year of adoption relative to similar applicants in the previous year. The tool did not alter the probability of enrollment as a function of applicant challenge level in the full sample, but positive changes are concentrated among applicants to institutions that used the tool to allocate financial aid. [ABSTRACT FROM AUTHOR]

Background: For patients with substance use disorder (SUD), a peer recovery coach (PRC) intervention increases engagement in recovery services; effective support services interventions have occasionally demonstrated cost savings through decreased acute care utilization. Objective: Examine effect of PRCs on acute care utilization. Design: Combined results of 2 parallel 1:1 randomized controlled trials. Participants: Inpatient adults with substance use disorder Interventions: Inpatient PRC linkage and follow-up contact for 6 months vs usual care (providing contact information for SUD resources and PRCs) Main Measures: Acute care encounters (emergency and inpatient) 6 months before and after enrollment; encounter type by primary diagnosis code category (mental/behavioral vs medical); 30-day readmissions with Lace+ readmission risk scores. Key Results: A total of 193 patients were randomized: 95 PRC; 98 control. In the PRC intervention, 66 patients had a pre-enrollment acute care encounter and 56 had an encounter post-enrollment, compared to the control group with 59 pre- and 62 post-enrollment (odds ratio [OR] = −0.79, P = 0.11); there was no significant effect for sub-groups by encounter location (emergency vs inpatient). There was a significant decrease in mental/behavioral ED visits (PRC: pre-enrollment 17 vs post-enrollment 10; control: pre-enrollment 13 vs post-enrollment 16 (OR = −2.62, P = 0.02)) but not mental/behavioral inpatient encounters or medical emergency or inpatient encounters. There was no significant difference in 30-day readmissions corrected for Lace+ scores (15.8% PRC vs 17.3% control, OR = 0.19, P = 0.65). Conclusions: PRCs did not decrease overall acute care utilization but may decrease emergency encounters related to substance use. Trial Registration: ClinicalTrials.gov (NCT04098601, NCT04098614) [ABSTRACT FROM AUTHOR]

Access to healthcare services for underrepresented minority populations can be improved by having a diverse profession that reflects the diversity of the patient population being served. The criteria used for pharmacy school admissions may inhibit or strengthen the opportunities that URM students have to be accepted into the University of Arizona R. Ken Coit College of Pharmacy (COP) program. It is currently unclear how personal characteristics are associated with pharmacy school admissions at the COP. This study evaluates whether Hispanic ethnicity was associated with pharmacy school admission status, and secondarily, determines other characteristics associated with admissions. This retrospective database study used admissions data from 2005 to 2018. Completed applications were included in the analysis. The outcome variable was admitted versus not admitted to the pharmacy program. A multivariable logistic regression model was used to identify variables associated with admission status using an a priori alpha level of 0.05. A total of 2096 applicants were included in the analysis (mean age 25.1 ± 5.2 years, 59.9% female, 13.0% Hispanic). Hispanic ethnicity was not associated with admission status. Characteristics significantly associated with admission to pharmacy school were age, gender, high school attended, previous application to the college, and Pharmacy College Admission Test (PCAT) biology and chemistry scores. Although bias was not seen in the admissions process, this study highlights the need for intervention to ensure future cohorts better reflect the diversity of the region. [ABSTRACT FROM AUTHOR]

Purpose: Hurricane Maria is the most devastating natural phenomenon in the recent history of Puerto Rico. Due to its destructive path through the island, the Puerto Rico Trauma Center (PRTC) remained the only hospital managing orthopaedic trauma in the immediate post-disaster period. We investigated the impact of this hurricane on the orthopaedic trauma epidemiology in the PRTC.Methods: We evaluated the admissions by the orthopaedic surgery service in terms of demographics, mechanisms of injury, and orthopaedic diagnoses for two months after the impact of Hurricane Maria (HM) on September 20, 2017. We compared our study group with the same two month period for two years prior (2015 and 2016) and after (2018 and 2019) as control periods. A p value of < 0.05 was considered statistically significant.Results: We included 384 admissions from September 20 to November 20, 2017. The majority were males (63%) and had an average age of 54 years. The most-reported mechanism of injury was fall from standing height (FFSH), showing a significant increment compared with the control periods. Contrarily, motor vehicle accidents (MVA) showed a significant reduction. Among the orthopaedic diagnoses, the hip + pelvis category showed a significant decline within the study group.Conclusions: This study highlighted the impact of HM on the orthopaedic trauma epidemiology at the PRTC. Our findings provide valuable evidence to healthcare institutions to better prepare to manage the potential changes in the orthopaedic trauma epidemiology after a major atmospheric event. [ABSTRACT FROM AUTHOR]

Global warming is projected to have major implications on global health. It is however not yet clear how this will translate to impacts on the healthcare system. By linking changes in temperature with changes in required bed days at a hospital level, through the use of a simple bed model, we quantify the projected impacts UK hospitals will need to adapt to. We show that there is already a local peak of bed days required in the main summer months due to hot temperatures. The results further show that there will be a significant increase during the main summer in both the mean and maximum number of beds needed, but a non‐significant decrease during the peak winter months. These changes lead to a more constant need of care of the year and shift the seasonal cycle of lowest hospital needs. [ABSTRACT FROM AUTHOR]

Background and Objectives: During the COVID-19 pandemic, hospitals were overwhelmed and non-COVID admissions were restricted due to national guidelines and decreased references. The aim of this study was to evaluate the collateral effect of the pandemic on general surgery admissions, operations, and patient outcomes. Patients and Methods: After the ethics committee approval for this retrospective descriptive study, all general surgery patients from February 23 to May 21, 2020, were compared with a similar timeframe in 2019. Time from symptom onset to admission, final diagnosis, and type of surgery was documented. Morbidity and mortality rate, intensive care unit (ICU) admission time, and total admission time were compared. Results: During the first COVID-19 surge, a 64% decrease in admissions was observed. The mean time from symptom onset to admission showed a significant delay of 1.2 days. Fewer patients were admitted to the ICU, but ICU admission time was longer. Total admission time and postoperative surgical and nonsurgical complications showed no significant difference. The rate of complicated appendicitis increased from 2.8% to 12.3% of total surgeries. A decrease in total trauma admissions was observed, but trauma operations remained unchanged, and penetrating trauma admissions had doubled. Conclusion: Although morbidity and mortality were not increased during the pandemic, increased time to admission, under triage of trauma patients, shortage of ICU beds, and a higher rate of complicated appendicitis portray the collateral effects of the pandemic on general surgery patient care. The increased number of penetrating injuries demands psychological support during home confinement. Efforts should be made to maintain maximal surgical care during pandemics. [ABSTRACT FROM AUTHOR]

Background: Underrepresented minorities in medicine (URMM) may face financial and social limitations when applying to medical schools. The computer-based assessment for sampling personal characteristics (CASPER) test is used by many medical schools to assess the nonacademic competencies of applicants. Performance on CASPER can be enhanced by coaching and mentorship, which URMMs often lack, for affordability reasons, when applying to medical schools. Methods: The CASPER Preparation Program (CPP) is a free, online, 4-week program to help URMM prepare for the CASPER test. CPP features free medical ethics resources, homework and practice tests, and feedback from tutors. Two of CPPs major objectives include relieving URMM of financial burdens and increasing their accessibility to mentorship during the COVID-19 pandemic. A program evaluation was conducted using anonymous, voluntary postprogram questionnaires to assess CPPs efficacy in achieving the aforementioned objectives. Results: Sixty URMMs completed the survey. The majority of the respondents strongly agreed or agreed that CPP relieves students of financial burden (97%), is beneficial for applicants with low-socioeconomic statuses (98%), provides students with resources they could not afford (n = 55; 92%), and enables access to mentors during the pandemic (90%). Discussion: Pathway coaching programs, such as the CASPER Preparation Program, have the potential to offer URMMs mentorship and financial relief, and increase their confidence and familiarity with standardized admission tests to help them matriculate into medical schools. [ABSTRACT FROM AUTHOR]

BackgroundAlthough heart failure (HF) is a common cause of hospital admissions, few data describe temporal trends in HF hospitalization. We present data on number of HF admissions, length of stay (LOS), and inpatient mortality in the United States, 1996-2009.HypothesisTo assess HF hospitalizations in a national sample of United States population.MethodsData were obtained from the National Hospital Discharge Survey (NHDS), a national probability sample survey of discharges conducted annually by the National Center for Health Statistics. Sampling weights are applied to raw NHDS data to produce national estimates. Hospitalizations with a primary diagnosis of HF were identified using ICD-9-CM codes. We excluded hospitalizations where HF was a secondary diagnosis. Weighted least squares regression was used to test for linear trends in HF hospitalizations.ResultsApproximately 15.5 million weighted primary HF hospitalizations were included. The number of total primary HF hospitalizations increased from 1 000 766 in 1996 to about 1 173 832 in 2009 (β = 7371 hospitalizations per year; 95% confidence interval (CI): 552 to 14 190, P = 0.036). Mean LOS per hospitalization decreased from 6.07 days in 1996 to about 5.26 days in 2009 (β = -0.059 days per year; 95% CI: -0.079 to -0.039, P < 0.001). Inpatient mortality rates declined from 4.92% in 1996 to 3.41% in 2009 (β = -0.17% per year; 95% CI: -0.23 to -0.10, P < 0.001).ConclusionsIn a nationally representative sample of HF hospitalizations, mean LOS and inpatient mortality rates declined over the past 2 decades. HF management cost is most likely to be reduced by decreasing the number of HF admissions.

Abstract Global warming is projected to have major implications on global health. It is however not yet clear how this will translate to impacts on the healthcare system. By linking changes in temperature with changes in required bed days at a hospital level, through the use of a simple bed model, we quantify the projected impacts UK hospitals will need to adapt to. We show that there is already a local peak of bed days required in the main summer months due to hot temperatures. The results further show that there will be a significant increase during the main summer in both the mean and maximum number of beds needed, but a non‐significant decrease during the peak winter months. These changes lead to a more constant need of care of the year and shift the seasonal cycle of lowest hospital needs.

A current challenge for higher education is the declining trend of men attending college. Because of this downward trend, universities are working hard to attract male students. Club sports are a potential strategy to help recruit and retain male students. The purpose of this study was to explore the perceptions of higher education administrators concerning the role club sports play in recruiting and retaining male students. Using a case study approach, administrators at four North Carolina schools were interviewed. In addition, campus tours and club sports facilities were observed, and document analysis was conducted on admissions, campus recreation, and club sports brochures, pamphlets and webpages. Results indicated that club sports are used at each institution to recruit and retain male students at varying levels. Although challenges exist, administrators acknowledged the possibility for success with a specific male market interested in club sport. [ABSTRACT FROM AUTHOR]

Abstract Background The Emergency Repartment (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia. Methods This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome. Results The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57–5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85–89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65–51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70–133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23–0.38). Conclusions A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.

Abstract Background Hospital admissions for Ambulatory Care Sensitive Conditions (ACSCs) are potentially avoidable. Dementia is one of the leading chronic conditions in terms of variability in ACSC admissions by general practice, as well as accounting for around a third of UK emergency admissions. Methods Using Bayesian multilevel linear regression models, we examined the ecological association of organizational characteristics of general practices (ACSC n=7076, non-ACSC n=7046 units) and Clinical Commissioning Groups (CCG n=212 units) in relation to ACSC and non-ACSC admissions for people with dementia in England. Results The rate of hospital admissions are variable between GP practices, with deprivation and being admitted from home as risk factors for admission for ACSC and non-ACSC admissions. The budget allocated by the CCG to mental health shows diverging effects for ACSC versus non-ACSC admissions, so it is likely there is some geographic variation. Conclusions A variety of factors that could explain avoidable admissions for PWD at the practice level were examined; most were equally predictive for avoidable and non-avoidable admissions. However, a high amount of variation found at the practice level, in conjunction with the diverging effects of the CCG mental health budget, implies that guidance may be applied inconsistently, or local services may have differences in referral criteria. This indicates there is potential scope for improvement.

Background: A review of admissions to nursing in Northern Ireland was prompted by the growing number of applications and a desire to ensure that the applicants had the right values for a career in nursing. Concerns regarding authorship, plagiarism and reliability of personal statements used to select applicants to interview was the focus of this research. This study evaluates the psychometric properties of a Personal Statement (PS) as a method for admission to a nursing programme and a values-based psychological screening tool, Nurse Match (NM). Methods: A self-selecting, purposive sample (n = 228; 9.7%) was drawn from applicants to Schools of Nursing in the United Kingdom (n = 2350). Participants all of whom had completed a Personal Statement were asked to complete a psychological tool and the scoring outcomes and psychometric properties of both tests were investigated. Statistical analysis was conducted using Minitab 17. Results: Applicants from 18 schools and five colleges responded. The majority (72.4%) were aged 18–19. Findings provide practical, theoretical, statistical, and qualitative reasons for concluding that the Personal Statement has substantial limitations as a measure of suitability. It does not compare well with international test standards for psychometric tests. In contrast, NM is a valid and reliable measure with good discriminatory power, standardised administration and consistent marking. Conclusion: NM is a viable alternative to the PS for shortlisting applicants for nursing interviews. [ABSTRACT FROM AUTHOR]

Sustaining the attractiveness of the teaching profession to recruit committed students to teacher education is a global policy issue. However, in many parts of the world, the teaching profession has become less attractive. Also in Finland, where teacher education has traditionally been highly attractive, several programmes have recently suffered from a substantial decrease in the number of applicants. The current paper addresses the phenomenon by investigating student teachers' pre-admission demotives. A total of 146 freshly admitted student teachers in primary teacher education in two universities wrote texts concerning the reasons for turning down primary teacher education and the profession during the application period. Thematic qualitative analysis revealed that demotives were connected to 1) arduous admissions, 2) deterministic training and 3) a precarious profession. The majority (54%) of participants expressed demotives connected to the above themes: concerns about the profession were the most frequent followed by doubts concerning admissions. By focusing on demotives the study fills the current gap in existing literature. The results can be implemented when outlining the measures to increase the attractiveness of the teaching profession, developing recruitment strategies and admission procedures, and designing more effective and meaningful teaching and learning in teacher education. [ABSTRACT FROM AUTHOR]

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Rich learning environments that celebrate differences and prepare students for today's global society are cultivated when a diverse student population is actively sought. By evaluating students on factors beyond grades and standardized tests using holistic admission processes, institutions can admit a more diverse student body and enhance students' experiences. This paper explores the academic literature on holistic admission, the intricacies of the approach, and the impact these alternative evaluation practices have on campus diversity. This review gives a snapshot of the history of holistic admission, outlines the approach, and provides examples of the impact holistic admission practices have on student diversity. [ABSTRACT FROM AUTHOR]

Using data from a large public research university in the United States, we examine the relationship between the characteristics of undergraduate college students' regional origins and students' interest in entrepreneurship. We find that several entrepreneurial indicators of students' regional origins predict students' entrepreneurial intent and ideation. One possible explanation for our results is that the extent of entrepreneurial activity in a region may imprint attitudes towards entrepreneurial careers on people growing up in those regions. Our findings suggest the composition of admitted students' geographical origins may impact the entrepreneurial focus of universities' student bodies. [ABSTRACT FROM AUTHOR]

Among adolescents, acute intoxications caused by drugs as well as intoxications caused by toxic substances make up an important chapter of emergency pediatric pathology. We conducted a retrospective study carried out for a period of 1 year, 2021–2022, which included a number of 37 patients, admitted in the Pediatric Clinic of the County Clinical Hospital "Sfântul Apostol Andrei" Constanța. Out of the total of admissions during a 12 months period, 0,5% consisted in acute intoxications in adolescents. There is a higher tendency for substance intoxication in females (65,5% of total cases). There is a higher tendency for adolescents with suicide ideation to use substances in order to end their life because of multiple risk factors, mental health disorders putting them at a higher risk to attempt suicide. Alcohol is widely used. [ABSTRACT FROM AUTHOR]

Background: Although dermatology is mostly an outpatient specialty, some patients with severe skin disease need hospital admission for management. There is a paucity of data regarding the profile of these dermatology in-patient admissions.Aims: We studied the profile of patients admitted to the dermatology ward of our tertiary care government hospital in North India.Methods: This was a retrospective analysis of discharge sheets of patients admitted in the dermatology ward from January 1, 2014 to December 31, 2017.Results: Discharge sheets of 2032 admissions for 1664 patients were analyzed. The most common diagnoses in the admitted patients were immunobullous disorders (576, 28%), connective tissue diseases (409, 20%), infections, including leprosy and sexually transmitted infections (179, 8.8%), psoriasis (153, 7.5%) and reactive arthritis (92, 4.5%). The mean duration of admission was 13.95±11.67 days (range 1-118 days). Two hundred and fifty-six patients (15.38%) were re-admitted, accounting for 368 (18.11%) re-admissions. Patients with immunobullous disorders (OR 1.72, 95% CI 1.29-2.28) and psoriasis (OR 1.62, 95% CI 1.02-2.55) were more likely to be re-admitted. Adult patients, those who were admitted for more than four weeks, those who had comorbidities, and those who developed a complication during the hospital stay also had a greater likelihood of being re-admitted.Limitations: The retrospective design of the study, and the non-availability of data regarding transfers to other specialties or intensive care units and deaths were the main limitations of this study.Conclusion: This study describes the profile of patients admitted in a dermatology ward of a tertiary care centre center in North India. The patient profile and admission characteristics associated with a higher probability of re-admission were identified. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of the COVID‐19 pandemic on acute admissions and inpatient activity at a tertiary referral centre. Design: Retrospective review of coding‐based inpatient electronic records. Setting: An otolaryngology and head and neck surgery department at a major UK trauma and tertiary referral centre. Participants: Otolaryngology patients admitted as an emergency over a period of 10 months pre‐COVID19 (01/04/2019‐23/01/2020) and 10 months post‐COVID19 (01/04/2020‐23/01/2021). Main outcome measures: Baseline characteristics, admission rates, length of stay (LoS), overall mortality and 30‐day mortality. Results: A total of 1620 records were reviewed; (1066 pre‐COVID19, 554 post‐COVID19). Admissions across all age groups were reduced, with an increase in mean age from 39.88 to 47.4 years (p =.018). LoS remained unchanged (3.85 vs 3.82 days, p =.160). Infection remained the most common presentation, followed secondly by epistaxis which entailed an increased LoS compared to the pre‐COVID19 cohort. GP referrals reduced from 18.3% to 4.2% (n = 195 vs n = 23, p <.001) and ED referrals proportionally increased from 71.9% to 85.9% (n = 766 vs n = 476, p <.001). Critical care admissions were higher in the post‐COVID19 cohort (OR 1.78 (1.07–2.98) [95% CI], p =.027). There was no significant difference in overall mortality between groups (n = 60, 5.6% vs. n = 33, 6.0%; p =.844). Thirty‐day mortality increased from 0.9% (n = 12) pre‐COVID19 to 2.3% (n = 13) post‐COVID19 (p =.039). Conclusions: This study demonstrates significant changes and a reduction in acute otolaryngology presentations. Our findings may suggest that sicker, frailer patients were admitted during the pandemic. This study reports the observational effect that the pandemic has had on acute otolaryngology admissions, which may be relevant in addressing unmet care needs in the post‐pandemic period. [ABSTRACT FROM AUTHOR]

Background  The coronavirus disease 2019 (COVID-19) pandemic is associated with fewer deliveries and premature births; however, the impact of this pandemic on the well-baby nursery (WBN) is unknown. Objective  The aim of the study is to evaluate the impact of the COVID-19 pandemic on infants admitted to the WBN by comparing pandemic and pre-pandemic cohorts. Study Design  We performed a retrospective study of infants admitted to a WBN during the pandemic period (March 18, 2020 to March 17, 2021) and compared them to those during the pre-pandemic period (March 18, 2019 to March 17, 2020). Maternal (age, parity, gestation, method of delivery, and COVID-19 status) and neonatal (sex, weight, Apgar score, feeding pattern, urine toxicology, and neonatal intensive care unit [NICU] admission) data were collected and compared between the two periods. The results were statistically analyzed, and significance was set at p <0.05. Results  There were 824 and 859 WBN admissions during the pandemic and pre-pandemic periods, respectively, a 4% decrease in WBN admissions during the pandemic period. During the pandemic period, the number of deliveries among nulliparous women increased (From 40.3% to 45.1% p  = 0.01), and deliveries among multiparous women decreased (From 59.2% to 53.1% p  = 0.01). The number of infants exposed to marijuana in utero increased (From 8.2% to 16.1% p  = 0.035), and transfers from WBN to NICU decreased (From 9% to 6.3% p  = 0.044) during the pandemic period. Conclusion  Compared with the pre-pandemic period, the number of WBN admissions, multiparous deliveries, and NICU admissions decreased, while the number of nulliparous deliveries and infants exposed to marijuana in-utero increased during the pandemic period. Key Points COVID-19 Pandemic is associated with decreased number of deliveries, preterm births, and NICU admissions. We observed decreased admissions to WBN, deliveries by multiparous women, and transfers from WBN. More nulliparous women delivered, and more infants were exposed to marijuana in-utero during the Pandemic. [ABSTRACT FROM AUTHOR]

Objective: To assess the change in inpatient radiotherapy related to COVID-19 lockdown measures during the first wave of the pandemic in 2020. Methods: We included cases hospitalized between January 1 and August 31, 2018–2020, with a primary ICD-10 diagnosis of C00–C13, C32 (head and neck cancer, HNC) and C53 (cervical cancer, CC). Data collection was conducted within the Medical Informatics Initiative. Outcomes were fractions and admissions. Controlling for decreasing hospital admissions during holidays, calendar weeks of 2018/2019 were aligned to Easter 2020. A lockdown period (LP; 16/03/2020–02/08/2020) and a return-to-normal period (RNP; 04/05/2020–02/08/2020) were defined. The study sample comprised a control (admission 2018/19) and study cohort (admission 2020). We computed weekly incidence and IR ratios from generalized linear mixed models. Results: We included 9365 (CC: 2040, HNC: 7325) inpatient hospital admissions from 14 German university hospitals. For CC, fractions decreased by 19.97% in 2020 compared to 2018/19 in the LP. In the RNP the reduction was 28.57% (p < 0.001 for both periods). LP fractions for HNC increased by 10.38% (RNP: 9.27%; p < 0.001 for both periods). Admissions for CC decreased in both periods (LP: 10.2%, RNP: 22.14%), whereas for HNC, admissions increased (LP: 2.25%, RNP: 1.96%) in 2020. Within LP, for CC, radiotherapy admissions without brachytherapy were reduced by 23.92%, whereas surgery-related admissions increased by 20.48%. For HNC, admissions with radiotherapy increased by 13.84%, while surgery-related admissions decreased by 11.28% in the same period. Conclusion: Related to the COVID-19 lockdown in an inpatient setting, radiotherapy for HNC treatment became a more frequently applied modality, while admissions of CC cases decreased. [ABSTRACT FROM AUTHOR]

Graduation from a genetic counseling graduate program accredited by the Accreditation Council of Genetic Counseling and certification obtained by passing the American Board of Genetic Counseling (ABGC) certification examination are increasingly required to practice as a genetic counselor in the USA. Despite the ABGC certification examination serving as a gateway to the genetic counseling career, there have been no research studies to date that have examined what variables are associated with examination performance. Therefore, the Association of Genetic Counseling Program Directors established a Task Force to assess whether trainee demographics, Grade point average (GPA) and Graduate Record Exam (GRE®) percentile scores are associated with passing the ABGC certification examination on the first attempt. We surveyed accredited genetic counseling graduate programs in North America and gathered demographic data, admissions variables, and certification examination outcome data for 1,494 trainees from 24 training programs, representing approximately 60.5% of matriculants between 2007 and 2016. Univariable analysis was performed to assess associations between admissions variables and categorical outcome (pass vs. fail) on the certification examination using Wilcoxon rank‐sum or Fisher's exact test. Variables significantly associated with the categorical board outcome were then entered in a stepwise model selection procedure. In stepwise logistic regression, trainees with higher GPA (OR = 3.41; 95% CI = 1.99, 5.83), higher verbal (OR = 1.02; 95% CI = 1.01, 1.03) and quantitative (OR = 1.02; 95% CI = 1.01, 1.03) GRE® scores, female trainees (OR = 2.95; 95% CI = 1.70, 5.12), and White trainees (OR 3.37; 95% CI = 2.14, 5.30) had higher odds of passing the certification examination on the first attempt. As programs move to a holistic approach to graduate admissions in order to improve access to the genetic counseling profession, our results may influence programs to provide additional preparation for the certification examination for all trainees. In addition, genetic counseling professional organizations should continue to work together to assess and eliminate outcome disparities in admissions, training, and certification processes. [ABSTRACT FROM AUTHOR]

Abstract Background Videoconferencing has been proposed as a way of improving access to healthcare for older adults in care homes. Despite this, effective uptake of videoconferencing remains varied. This study evaluates a videoconferencing service for care home staff seeking support from healthcare professionals for the care of residents. The aim was to explore factors affecting the uptake and sustainability of videoconferencing in care homes, to establish what works for whom, in which circumstances and respects. The findings informed recommendations for commissioners and strategic managers on how best to implement videoconferencing for remote healthcare provision in care homes for older adults. Methods Realist evaluation was used to develop, refine and test theories around the uptake and maintenance of videoconferencing in three care homes across Yorkshire and the Humber, England. The care homes were selected using maximum variation sampling regarding the extent to which they used videoconferencing. A developmental inquiry framework and realist interviews were used to identify Context, Mechanism and Outcome Configurations (CMOCs) regarding uptake and sustainability of the service. Participants included care home residents (aged > 65) and staff, relatives and strategic managers of care home chains. The interviews were an iterative process conducted alongside data analysis. Transcripts of audio recordings were entered into NVIVO 12, initially coded into themes, then hypotheses developed, refined and tested. Results Outcomes were generated in relation to two main contextual factors, these were: (1) communication culture in the home and (2) the prior knowledge and experience that staff have of videoconferencing. The key facilitators identified were aspects of leadership, social links within the home and psychological safety which promoted shared learning and confidence in using the technology. Conclusions Videoconferencing is a valuable tool, but successful implementation and sustainability are dependent on care home culture and staff training to promote confidence through positive and supported experiences.

Introduction The COVID-19 pandemic has affected mental health globally, but the impact on referrals and admissions to mental health services remains understudied. Objectives To assess patterns in psychiatric admissions, referrals, and suicidal behavior before and during the COVID-19 pandemic in Denmark. Methods Utilizing hospital and Emergency Medical Services (EMS) health records covering 46% of the Danish population, we compared psychiatric in-patients, referrals to mental health services and suicidal behavior in years prior to the COVID-19 pandemic to levels during the first lockdown (March 11 – May 17, 2020), inter-lockdown period (May 18 – December 15, 2020), and second lockdown (December 16, 2020 – February 28, 2021) using negative binomial models. Results The rate of psychiatric in-patients declined compared to pre-pandemic levels (RR = 0.95, 95% CI = 0.94 – 0.96, p < 0.01). Referrals were not significantly different (RR = 1.01, 95% CI = 0.92 – 1.10, p = 0.91) during the pandemic; neither was suicidal behavior among hospital contacts (RR = 1.04, 95% CI = 0.94 – 1.14, p = 0.48) nor EMS contacts (RR = 1.08, 95% CI = 1.00 – 1.18, p = 0.06). In the age group

This paper examines the practical experience and research background of one private training provider with over 10 years’ experience reskilling and upskilling mid-career workers with academic qualifications for employment in a growing technical and highly regulated pharmaceutical manufacturing industry. This paper offers insights into how to maximise the efficiency and effectiveness of the admissions, enrollment, induction and orientation process for adult learners looking to commence studies on university accredited continuous professional development (CPD) courses. This process is based on and analysed through the lens of Behavioural Science, while also building upon the work of Dirksen, Colvin Clark, Stolovitch, and Keeps. The data set has been gathered during 2020 and 2021, from 425 adult learner applicants, coming from a variety of educational and employment backgrounds, with 5 to 25 years of work experience.

Background: Assertive community treatment (ACT) is an intervention implemented to manage the effects of deinstitutionalisation. South African studies have reported decreased admissions at 12 and 36 months when a modified ACT intervention is compared with standard care. However, costs associated with the intervention have raised the question of its feasibility in developing countries. Aim: This study aimed to describe the long-term demographic and clinical outcomes of a group of psychiatric high-frequency users (HFUs) included in the first South African ACT study. Setting: Stikland Psychiatric Hospital, Cape Town, South Africa. Methods: Data from 55 HFUs participating in the first South African ACT trial, including both the intervention and control groups, were retrospectively reviewed 10 years after the patients’ inclusion. Results: Of the 55 HFUs initially included, nine remained in the formal ACT programme whilst 16 received standard care over the full 10 years. Five patients died and two were admitted to long-term wards. The mean number of admissions was 3.73 and the mean number of admission days was 261.11 over the 10 years. Twelve patients were never re-admitted; of these, nine came from the original study intervention group. Conclusions: This was the first study looking at the long-term outcomes of a group of psychiatric HFUs in an under-resourced setting receiving either a modified ACT intervention or standard outpatient care. Reflecting broadly on the group, there were a larger number of patients in the original ACT group who had no re-admissions and a comparatively higher utilisation of available services during the 10-year follow-up period.

Background: The COVID 19 pandemic has had a crucial effect on the patterns of disease and treatment in the healthcare system. This study examines the effect of the COVID-19 pandemic on respiratory ED visits and admissions broken down by age group and respiratory diagnostic category.Methods: Data on non-COVID related ED visits and hospitalizations from the ED were obtained in a retrospective analysis for 29 acute care hospitals, covering 98% of ED beds in Israel, and analyzed by 5 age groups: under one-year-old, 1-17, 18-44, 45-74 and 75 and over. Diagnoses were classified into three categories: Upper respiratory tract infections (URTI), pneumonia, and COPD or asthma. Data were collected for the whole of 2020, and compared for each month to the average number of cases in the three pre-COVID years (2017-2019).Results: In 2020 compared to 2017-2019, there was a decrease of 34% in non-COVID ED visits due to URTI, 40% for pneumonia and a 35% decrease for COPD and asthma. Reductions occurred in most age groups, but were most marked among infants under a year, during and following lockdowns, with an 80% reduction. Patients over 75 years old displayed a marked drop in URTI visits. Pediatric asthma visits fell during lockdowns, but spiked when restrictions were lifted, accompanied by a higher proportion admitted. The percent of admissions from the ED visits remained mostly stable for pneumonia; the percent of young adults admitted with URTI decreased significantly from March to October.Conclusions: Changing patterns of ED use were probably due to a combination of a reduced rate of viral diseases, availability of additional virtual services, and avoidance of exposure to the ED environment. Improved hygiene measures during peaks of respiratory infections could be implemented in future to reduce respiratory morbidity; and continued provision of remote health services may reduce overuse of ED services for mild cases. [ABSTRACT FROM AUTHOR]

Congenital cytomegalovirus (cCMV) infection can result in considerable morbidity and mortality. However, the impact of cCMV on health system utilisation beyond infancy is poorly defined. Here we sought to describe the burden of cCMV health service use and mortality using linked population-based datasets. The design was a matched cohort study using record-linked administrative datasets. Participants included all children aged 0–15 years identified through the New South Wales (NSW), Australia, Admitted Patient Data Collection who were hospitalised with an admission code for cCMV infection between 2001 and 2011. Participants were then matched by age, sex and birth postcode quintile using Socio-Economic Indexes for Area, to children randomly selected from the NSW Perinatal Data Collection, excluding those with central nervous system infections or cerebral palsy. We calculated rate ratios (RR) for hospital admissions adjusted for preterm birth, the median length of stay, cost weights of admission and odds ratio (OR) for deaths. There were 130 children with cCMV matched to 2672 children. Neonates (aged <1 month) with cCMV had twice the rate of admissions (RR 2.4 95%CI 2.0, 2.8) and children aged ≥ 5yr to < 15yrs with cCMV almost eight times the rate of admissions (RR 7.8 95%CI 5.1, 11.5). Children with cCMV had significantly higher cost weights of admissions and an increased risk of mortality (OR 18.4 95%CI 7.8, 43.6). Throughout childhood, children with cCMV had higher rates of hospital admissions, higher admission cost weights and an increased risk of mortality compared with matched peers without cCMV. • Children with congenital cytomegalovirus have higher rates of admission and more costly hospital stays. • The neurodevelopmental sequelae of congenital cytomegalovirus have an on-going impact on hospital utilisation throughout childhood. • Congenital cytomegalovirus increases the risk of mortality amongst children <5 years of age. [ABSTRACT FROM AUTHOR]

Minorities are underrepresented in the health professions, and the educational pathway is an opportunity to identify early barriers. This study evaluates the relationship between social determinants and admission to an undergraduate clinical healthcare program that largely relies on grade point average (GPA). Applicants to nursing, radiography, and dental hygiene programs served as the nonprobability population sample for this quantitative correlational study. Admitting students based on GPA favored those who have better social experiences and excluded traditionally marginalized populations who experience social disadvantages. More balanced admissions criteria would help to address the inequities in diversity and inclusion that hamper the health professions. [ABSTRACT FROM AUTHOR]

As of 2020, 75 accredited institutions with the Association of American Medical Colleges (AAMC) are described as "DACA-friendly" and welcome undocumented students to apply under the Deferred Action for Childhood Arrivals (DACA) program. However, there is wide variation in their DACA policies, complicating an already demanding application process. Herein, we discuss this process and the common challenges for DACA-recipients. From September 2018 to July 2019, a three-item survey was emailed to admissions representatives at DACA-accepting institutions. While all participating universities were familiar with DACA, only 58% of representatives were aware of their institutional policies. Further, less than 10% of schools reserved funds for DACA-recipients; some required proof of payment for all 4 years prior to matriculation. The number of "DACA-friendly" institutions having enrolled DACA students is limited. Open promotion of institutional DACA policies may increase the number of recipients that successfully complete US medical training. [ABSTRACT FROM AUTHOR]

We ask whether a scandal in a university's athletics department affects the quality of the incoming student body. To do so, we evaluate the child sex abuse scandal at Penn State University in 2011. The violations involved a former employee with the crimes occurring a decade prior. The plausibly-exogenous shock allows us to make a causal identification of the scandal's effect on the university. We use synthetic control methods establishing economically meaningful impacts. We find that the average high school GPA is 0.12 points less and the proportion of students with high SAT Math scores is down 4.8 percentage points. [ABSTRACT FROM AUTHOR]