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Background: Self-medication refers to usage of drugs by population to cure self-diagnosed medical illnesses or symptoms without seeking medical advice. AI has become the prevailing technology in recent times, experiencing significant growth. Following the COVID-19 pandemic, there has been a surge in AI adoption, driven by concerns about visiting hospitals. Despite awareness of its potential drawbacks, relying on AI and online resources for medical and therapeutic purposes has become widespread. Objectives: This study determines the use of AI and Internet in self-medication as well as perceives the knowledge, attitudes, and self-medication practices among south Indian Pharmacy students. Methods: This is a cross-sectional study that included pharmacy students to evaluate the trends and practices of self-medication. A self-designed questionnaire was adopted that contained four sections including Consent, demographic details, AI in medications, Knowledge-Attitude-Practice sections. The data was collected both manually and via e-links. Results: The study included a total of 527 participants, among which 278 (52.8%) were females. 472 (89.56%) used internet and AI for diagnosing their condition, whereas 396 (75.14%) used to self-medicate. 315 (59.8%) had good knowledge and 521 (98.9%) exhibited positive attitude towards self-medication. The practice of selfmedication was high - 217 (41.2%) practiced self-medication within one month, 149 (28.3%) within two or three months, 101 (19.2%) within 6 months and 60 (11.4%) practiced a year ago. Conclusion: The study participants used more internet and AI for self-diagnosing as well as self-medicating than consulting the medical professionals. Majority had good knowledge and positive attitude with high prevalence of self-medication practices. Self-medication awareness and public health education has to be carried out in order to avoid unexpected reactions by self-medications. [ABSTRACT FROM AUTHOR]

OBJECTIVE: During the SARS-CoV-2 pandemic, hospital visitation restrictions hindered patients' access to vital social support. This study explores the impact and feasibility of a student-led program facilitating audiovisual communication between inpatient rehabilitation patients and their caregivers. METHODS: The study design employed a prospective observational approach, and convenience sampling enrolled 99 participants, including 33 patients, 33 caregivers, and 33 medical students. From September 2021 to March 2022, eligible patients admitted to an inpatient rehabilitation hospital identified a caregiver and participated in a 30-minute audiovisual call organized by a medical student. Post-visit surveys via RedCap were completed by all participants and covered limitations in video calls, program benefits, comfort levels in video conferencing, and overall program ratings. The study adopted a quantitative research paradigm for data analysis. Statistical analysis utilized pairwise McNemar's and Wilcoxon's test for inter-group comparison. RESULTS: Patients, caregivers, and medical students all reported positive outcomes in program offerings including providing social support, decreasing feelings of isolation, and providing a feeling of connection. Patients rated the program 4.82 ± 0.47 on a Likert scale, with 97% recommending it to others, even beyond visitation restrictions. The most common diagnosis among patients was stroke (30%), highlighting the program's potential applicability across diverse patient populations. Caregivers rated the program 4.59 ± 0.87 and expressed a desire for its continuation post-restrictions (80%). Medical students (81%) recommended the program, citing benefits in reducing social isolation and gaining clinical experience. No statistical differences were observed between groups in emotional and humanistic domains. CONCLUSION: This study highlights the potential for programs to utilize technology to address social isolation in the healthcare setting. When public health restrictions occur, medical educators should consider opportunities to support and foster innovation for student-led programs. Further research should explore broader impacts on healthcare outcomes and medical education. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic started in Alberta in March 2020 and significantly increased telehealth service use and provision reducing the risk of virus transmission. We examined the change in the number and proportion of virtual visits by physician specialty and condition (chronic obstructive pulmonary diseases [COPD], heart failure [HF], colorectal and lung cancers), as well as associated changes in physician compensation. Methods: A population-based design was used to analyze all processed physician claims comparing the number and proportion of virtual visits and associated physician billings relative to in-person between pre- (2019/2020) and intra-pandemic (2020/2021). Physician compensations were the claim amounts paid by the health insurance. Results: Pre-pandemic (intra-), there were 8,981 (8,897) lung cancer, 9,245 (9,029) colorectal, 37,558 (36,292) HF, and 68,270 (52,308) COPD patients. Each patient had totally 2.3–4.7 (of which 0.4–0.6% were virtual) general practitioner (GP) visits and 0.9–2.3 (0.2–0.7% were virtual) specialist visits per year pre-pandemic. The average number and proportion of per-patient virtual visits to GPs and specialists grew significantly pre- to intra-pandemic by 2,138–4,567%, and 2,201–7,104%, respectively. Given the lower fees of virtual compared with in-person visits, the reduction in physician compensation associated with the increased use of virtual care was estimated at $3.85 million, with $2.44 million attributed to specialist and $1.41 million to GP. Discussion: Utilization of telehealth increased significantly, while the physician billings per patient and physician compensation declined early in the pandemic in Alberta for the four chronic diseases considered. This study forms the basis for future study in understanding the impact of virtual care, now part of the fabric of health care delivery, on quality of care and patient safety, overall health service utilization (such as diagnostic imaging and other investigations), as well as economic impacts to patients, health care systems, and society. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is a risk factor for many chronic conditions. This retrospective cohort study examined associations between physical activity (PA) with health care utilization (HU). Methods: A PA vital sign was recorded in clinics from January 2018 to December 2020. Patients were categorized as inactive, insufficiently active, or sufficiently active by US PA aerobic guidelines. Associations between PA vital sign and visits (inpatient admissions, emergency department, urgent care, and primary care) were estimated using population average regression by visit type. Results: 23,721 patients had at least one PA vital sign recorded, with a mean age of 47.3 years and mean body mass index (BMI) of 28; 52% were female and 63% were White. Sufficiently active patients were younger, male, White, and had lower BMI than insufficiently active patients. Achieving 150 minutes per week of moderate to vigorous PA per 1000 patient years was associated with 34 fewer emergency department visits (P <.001), 19 fewer inpatient admissions (P <.001), and 38 fewer primary care visits (P <.001) compared with inactive patients. Stronger associations between lower PA and higher HU were present among those who were older or had a higher comorbidity. BMI, sex, ethnicity, and race did not modify the association between PA and HU. Conclusions: Meeting aerobic guidelines was associated with reduced HU for inpatient, primary care, and emergency department visits. [ABSTRACT FROM AUTHOR]

Purpose: To examine factors of influence in diabetes management and their association with self-reported health outcomes in patients with type 2 diabetes treated at Federally Qualified Health Centers (FQHCs). Methods: This cross-sectional study examined data from the 2014 Health Center Patient Survey (HCPS). Predictor variables were categorized across three levels of the National Institute on Minority Health and Health Disparities research framework. Outcome variables retrieved from HCPS included self-reports of blood glucose levels, and diabetes-related emergency department (ED)/hospital visits during past year. Results: A total of 936 patients with diabetes were included. Most (65%) participants received a diabetes self-management plan. During the previous year, 72% received > = 2 A1C checks, 52% reported high blood glucose levels, and 12% visited an ED/hospital. Multivariable results showed that insulin use and receiving a self-management plan were associated with high blood glucose levels and ED/hospital visits. Community factors of being unable to get medications and receiving a specialist foot exam were respectively associated with high blood glucose levels and ED/hospital visits. Conclusion: Different factors were associated with health outcomes in patients with diabetes treated at FQHCs. Identifying these factors can help with targeted screening and follow-up and assessing potential interventions to improve health outcomes. [ABSTRACT FROM AUTHOR]

Background: The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area. Aims: To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes. Method: A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes. Results: Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication. Discussion: LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing. [ABSTRACT FROM AUTHOR]

The effects of meteorological conditions on asthma in Haikou, a tropical city in China, are still unclear. This study aimed to determine the relationships between meteorological factors and the number of asthma hospital visits in Haikou. A Poisson generalized additive model combined with a distributed lag nonlinear model is used to model the nonlinear exposure–response relationship between the daily mean temperature and asthma hospital visits. The daily mean pressure and air quality are used as covariates and simultaneously control the mixed effects of holiday effects, weekend effects, and long-term trends. The results indicate that there is a significant statistical relationship between the daily mean temperature and asthma hospital visits, which shows an inverted J-shaped relationship. When the daily mean temperature is below the reference value (29.3 °C), the number of asthma patients increases considerably, and there is a marked lag in the prevalence of asthma. The longest lag is 9 days, and the most pronounced impact of the daily mean temperature on the number of asthma hospital visits can be found when the lag time is 1–4 days. When the daily mean temperature is 10 °C, the cumulative effect of the relative risk of asthma is 2.204, an increase of 120.4% (95% CI 1.294–3.755). If the daily mean temperature is below the 2.5th percentile value (14.8 °C), the relative risk significantly increases by more than 5.3% (95% CI 1.000–1.110), and the longest lasting impact time is 5 days. This indicates that increases in asthma hospital visits in Haikou, China, are significantly correlated with low-temperature weather. We suggest that preventive measures for asthma should take low-temperature weather into account. Additionally, we also found that extremely high temperatures have a certain impact on the increase in asthma hospital visits, but that the correlation is not significant. [ABSTRACT FROM AUTHOR]

Restrictive visitation policies produce inequities in healthcare that have meaningful consequences for patients' health and well-being. There is a surplus of existing literature exploring the consequences of reduced visitation in the setting of pediatric patients lacking decision-making capacity, but relatively little scholarship addressing visitation restriction for less vulnerable adults possessing capacity. Here, we present the case of a patient who suffered serious complications of childbirth, during the delivery of her healthy newborn, leading to prolonged hospitalization. During her treatment course, she was subsequently denied visitation with her newborn, who had been discharged from the hospital, and this had detrimental effects on her recovery. Hospital policies restricting visitation during the COVID-19 pandemic were intended to reduce the risk of disease exposure for both patients and staff, despite conflicting evidence demonstrating this benefit. In contrast, they often have negative effects on patient stress, mood, and physical recovery. The sequelae of this US-based case study argue the need for more holistic hospital visitation policies, placing a specific lens on adult patients receiving a visitation from their newborn children. [ABSTRACT FROM AUTHOR]

Individuals involved with the criminal legal system have higher rates of mental illness, addiction, and health care utilization. The authors examined whether substance use disorders and mental illness alone or in combination drive health care utilization among those with recent criminal legal involvement. This cross-sectional analysis used nationally representative data from U.S. adults with past-year criminal legal involvement (N=9,039) recorded in the National Survey on Drug Use and Health (2015–2019). Using adjusted negative binomial regression models, the authors estimated relative risks for health care utilization. Primary independent variable categories included neither substance use disorder nor mental illness, substance use disorder only, mental illness only, and both conditions. Health care utilization included emergency department (ED) visits and nights spent in inpatient care. Relative to neither mental illness nor substance use disorder, mental illness alone was associated with significantly increased acute health care services use: for ED visits, incidence risk ratio (IRR)=1.43 (95% CI=1.18–1.75) and for inpatient stays, IRR=2.14 (95% CI=1.47–3.11). Having both conditions was associated with increased ED visits (IRR=1.62, 95% CI=1.38–1.91) and inpatient stays (IRR=4.16, 95% CI=2.98–5.82). Substance use disorder alone was associated only with higher risk for ED visits compared with neither condition (IRR=1.23, 95% CI=1.01–1.50). Mental illness with or without co-occurring substance use disorder is a strong driver of acute health care utilization after interaction with the criminal legal system. Interventions tailored to the unique needs of individuals with mental illness or substance use disorder are needed for those with recent criminal legal involvement. [ABSTRACT FROM AUTHOR]

Aim: Lifelong monitoring is essential to detect aorta-related complications. Yet, patient non-compliance with surveillance programs poses a significant obstacle. We explored reasons for adherence by engaging in clear, patient-centred communication and analyzed factors contributing to non-compliance. Material and Methods: In 2019, our clinic conducted elective EVAR procedures on 50 patients. They were informed of annual surveillance, including hospital visits, starting with a first-month appointment post-discharge. Patients with no or only one follow-up were deemed non-compliant, while two to three follow-ups indicated moderate compliance, and four to seven follow-ups qualified as high compliance. We recorded each patient's age, education level and demographics. We retrospectively assessed the factors on their compliance level as our first outcome. The second was to explore whether the survey could enlighten any reasons from the patient's perspective. Results: The average age of our cohort was 68.8±8.45 years, with only three females. Non-attendance at follow-ups was observed in 8 patients (16%). Seventy percent (35 patients) complied with at least two appointments. Residing in the same city markedly increased compliance by 20 times (p<0.001). Older age appeared to influence compliance positively, on the borderline significantly (p=0.057). The primary motivation for attendance was adherence to doctor recommendations (n=14), while the predominant reason for non-attendance was patients' feeling well (n=29). Notably, patients with lower compliance than predicted more frequently cited COVID-19 as a deterrent (p=0.02). Conclusion: Residence within the same city positively influences follow-up compliance. The national databases might be helpful tools for enhancing the surveillance anywhere the patients live. The existing hypotheses by healthcare professionals about patient follow-up compliance are only partially corroborated. Incorporating the patient's perspective into these models may be helpful in comprehensively understanding the underlying factors. [ABSTRACT FROM AUTHOR]

Background Previous studies have suggested that people with dementia (PwD) are more likely to be admitted to hospital, have prolonged hospital stay, or visit an emergency department (ED), compared to people without dementia. Aim This study assessed the rates of hospital admissions and ED visits in PwD and investigated the causes and factors predicting this healthcare use. Further, this study assessed survival following hospital admissions and ED visits. Design This was a retrospective study with data from 26 875 PwD and 23 961 controls. Methods Data from national datasets were extracted for demographic characteristics, transitions to care homes, hospital and ED use and were linked through the Honest Broker Service. PwD were identified through dementia medication and through causes for hospital admissions and death. Results Dementia was associated with increased risk of hospital admissions and ED visits, and with lower odds of hospital readmission. Significant predictors for hospital admissions and readmissions in PwD were transitioning to a care home, living in urban areas and being widowed, while female gender and living in less deprived areas reduced the odds of admissions. Older age and living in less deprived areas were associated with lower odds of an ED visit for PwD. In contrast to predictions, mortality rates were lower for PwD following a hospital admission or ED visit. Conclusions These findings result in a better understanding of hospital and ED use for PwD. Surprisingly, survival for PwD was prolonged following hospital admissions and ED visits and thus, policies and services enabling these visits are necessary, especially for people who live alone or in rural areas; however, increased primary care and other methods, such as eHealth, could provide equally effective care in order to avoid distress and costs for hospital admissions and ED visits. [ABSTRACT FROM AUTHOR]

Background: Although physicians are highly regarded members of society, patients are not always satisfied with their care, suggesting a mismatch between the public's expectations and reality. Thus, the aim of this study was to determine the public's expectations regarding roles and responsibilities of a physician, to assess patient experiences, and to evaluate factors associated with the two outcomes. Methods: A cross-sectional study was conducted via face-to-face structured interviews from July 14th to August 2nd, 2023, in Karachi, Pakistan. The study sample comprised 424 consenting adults enrolled by visiting public spaces (malls, parks, hospitals, and residential areas). A modified version of 'Exceptionally Good Doctor Likert scale', and 'Patient Picker-15' (PPE-15) questionnaires was used. The Likert and PPE-15 sections were scored through pre-decided criteria for expectations and experience, respectively, and categorized using a median cut-off into high and low expectations and negative and positive experiences, respectively for simple and multivariable logistic regression. Results: A median score of 30.5/ 34 (IQR = 3.3) was found for expectations and 4/ 14 (IQR = 4) for experiences. Significant factors associated with expectations were older age groups (OR = 4.54 [1.18–17.50]) and higher monthly household incomes (0.40 [0.20–0.79]), while the odds of negative experiences were lower after visits to emergency departments (0.38 [0.18–0.84]) and private health care centers (0.31 [0.13–0.70]). Conclusion: These results suggest that the public has high expectations from physicians, however their experiences are not always positive. Initiatives to develop a patient-centric ethos are needed for which we outline recommendations to both the public and physicians, respectively. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to clarify factors associated with polypharmacy among patients with systemic lupus erythematosus. Methods: This single-centre cross-sectional study was conducted by reviewing the medical records and questionnaire data of 261 systemic lupus erythematosus patients at a teaching hospital in Japan from 1 September to 30 November 2020. Polypharmacy was defined as the regular administration of five or more oral medications; excessive polypharmacy consisted of the regular use of 10 or more oral medications. This study investigated (1) the prevalence of polypharmacy and excessive polypharmacy, (2) the distribution of medication types, and (3) the factors associated with polypharmacy and excessive polypharmacy. Results: The proportions of patients who exhibited polypharmacy and excessive polypharmacy were 70% and 19%, respectively. Polypharmacy was associated with older age, long duration of systemic lupus erythematosus, high disease activity, and administration of glucocorticoids or immunosuppressive agents. Excessive polypharmacy was associated with a higher updated Charlson comorbidity index, history of visits to multiple internal medicine clinics, and presence of public assistance. Conclusions: Polypharmacy and excessive polypharmacy in patients with systemic lupus erythematosus are related to medical aspects such as disease severity and comorbidities in addition to social aspects such as hospital visitation patterns and economic status. [ABSTRACT FROM AUTHOR]

Background Individuals with chronic diseases are less often presented to hospitals due to the restrictions enforced during the pandemic period and the fear of contracting the disease. The purpose of the present study was to investigate the effects of the anxiety level associated with novel coronavirus on daily life, treatment compliance, and metabolic conditions in elderly diabetes mellitus (DM) patients. Methods This study included 263 patients diagnosed with type 2 DM aged >65 years. The researchers collected the study data through the face-to-face interview method. The Patient Information Form, Coronavirus Anxiety Scale (CAS), Morisky Medication Adherence Scale, Insomnia Severity Index, and the Depression Anxiety Stress Scales (DASS-21) were used for data collection. Results The mean CAS score was 4.25±3.76. Mean CAS scores were higher in the participants who reported a decrease in the frequency of shopping, grocery/market visits, public transport use, hospital visits, and attending routine checks, during the pandemic (p<0.05). Furthermore, a significant positive correlation was found between the mean CAS score and the DASS-21 score (p<0.05). There was a significant negative correlation between the mean CAS score and the treatment compliance score (p<0.05). Conclusion The pandemic and coronavirus anxiety have had an adverse effect on daily life, treatment compliance, and metabolic conditions in elderly DM patients. [ABSTRACT FROM AUTHOR]

Clinician moral distress has been documented over the past several decades as occurring within numerous healthcare disciplines, often in relation to clinicians' involvement in patients' end-of-life decision-making. The resulting harms impact clinician well-being, patient well-being, and healthcare system functioning. Given Covid-19's catastrophic death toll and associated demands on end-of-life decision-making processes, the pandemic represents a particularly important context within which to understand clinician moral distress. Thus, we conducted a convergent mixed methods study to examine its prevalence, associations with clinicians' demographic and professional characteristics, and contributing circumstances among Veterans Health Administration (VA) clinicians. The study, conducted in April 2021, consisted of a cross-sectional on-line survey of VA clinicians at 20 VA Medical Centers with professional jurisdiction to place life-sustaining treatment orders working who were from a number of select specialties. The survey collected quantitative data on respondents' demographics, clinical practice characteristics, attitudes and behaviors related to goals of care conversations, intensity of moral distress during "peak-Covid," and qualitative data via an open-ended item asking for respondents to describe contributing circumstances if they had indicated any moral distress. To understand factors associated with heightened moral distress, we analyzed quantitative data using bivariate and multivariable regression analyses and qualitative data using a hybrid deductive/inductive thematic approach. Mixed methods analysis followed, whereby we compared the quantitative and qualitative datasets and integrated findings at the analytic level. Out of 3,396 eligible VA clinicians, 323 responded to the survey (9.5% adjusted response rate). Most respondents (81%) reported at least some moral distress during peak-Covid. In a multivariable logistic regression, female gender (OR 3.35; 95% CI 1.53–7.37) was associated with greater odds of moral distress, and practicing in geriatrics/palliative care (OR 0.40; 95% CI 0.18–0.87) and internal medicine/family medicine/primary care (OR 0.46; 95% CI 0.22–0.98) were associated with reduced odds of moral distress compared to medical subspecialties. From the 191 respondents who completed the open-ended item, five qualitative themes emerged as moral distress contributors: 1) patient visitation restrictions, 2) anticipatory actions, 3) clinical uncertainty related to Covid, 4) resource shortages, and 5) personal risk of contracting Covid. Mixed methods analysis found that quantitative results were consistent with these last two qualitative themes. In sum, clinician moral distress was prevalent early in the pandemic. This moral distress was associated with individual-, system-, and situation-level contributors. These identified contributors represent leverage points for future intervention to mitigate clinician moral distress and its negative outcomes during future healthcare crises and even during everyday clinical care. [ABSTRACT FROM AUTHOR]

Objectives: 1) To compare the average cost of an emergency department (ED) visit for various minor musculoskeletal disorders between two models of care (physiotherapist and ED physician or ED physician alone); 2) To evaluate the incremental cost-effectiveness ratio (ICER) of these two models of care over a 3-month period post-initial visit; and 3) To estimate the ICER of three ED models of care (physiotherapist and ED physician, ED physician alone, physiotherapist alone) over a two-year period. Methods: Obj.1: The costs incurred by participants in the two groups during their ED visit will be calculated using the Time-Driven Activity-Based Costing (TDABC) method. These costs will be compared using generalized linear models. Obj. 2: The ICER of the two models will be evaluated over three months via a cost-utility analysis that will combine costs and effectiveness data (quality-adjusted life years) using both Health system and Societal perspectives (patient + health system costs). Obj. 3: The 2-year ICER of the three above-mentioned models will be estimated using a mathematical model including a decision tree (0–3 months post-visit) and a Markov model (3–24 months post-visit), also using both Health system and Societal perspectives. Data to answer the three objectives will come from data collected during a randomized clinical trial (n = 78, CHU de Québec)which will be supplemented with data obtained via some of the CHU de Québec administrative databases (nominative data; SIURGE (ED management software), Cristal-Net (patient electronic record), and the ED's pharmacy transactions directory; administrative data: drug costs repository), the literature, and public cost repositories. Conclusion: This study will help to determine which model of care is most efficient for the management of individuals who come to the ED with minor musculoskeletal disorders. The increased involvement of various health professionals in the management of patients in the ED paves the way for the development of new avenues of practice and more efficient organization of services. [ABSTRACT FROM AUTHOR]

Background and rationale: As general health care is publicly funded in Canada and oral health care is not, many people seek care from hospitals for their dental problems. This study assessed if the unprecedented times of Coronavirus disease (COVID-19) affected the hospital visits for dental emergencies, making disadvantaged populations further vulnerable for attendance of their dental problems. Methods: Data from IntelliHealth Ontario for emergency department (ED) visits, day surgery visits, and hospitalizations associated with non-traumatic dental conditions (NTDCs) were retrieved for years 2016 to 2020 to assess trends before COVID-19 and changes, if any, for the year 2020. Trends by month, for the years 2019 and 2020, to make straight comparisons and understand the effects of lockdown in Ontario, was also analyzed. Results: In the year 2020, there was a reduction of 40% in day surgeries, 21% in ED visits and 8% in hospitalizations compared to 2019. Stratified by month, largest reductions were observed in April 2020: 96% in day surgeries; 50% in ED visits; and 38% reductions in hospitalizations when compared to the same month of 2019. In May 2020, day surgeries and ED visits though remained reduced, hospitalization rates increased by 31%. Conclusion: Hospital EDs are inefficient avenues for handling dental emergencies. Nevertheless, they do remain a care setting that is sought by many for dental problems, and if the need for hospitalization and day surgery is there, this care setting is an important avenue for dentally related medical care. Perhaps unsurprisingly, COVID-19 has lessened the opportunity and capacity for such care. Practical implications: Administrators and policy makers can utilize this information to strategize on augmenting community infrastructure for building more effective, and cost-efficient avenues of care for timely management of dental problems. [ABSTRACT FROM AUTHOR]

Introduction:The COVID-19 pandemic created an unprecedented surge toward telemedicine. This project investigated oncology clinic telemedicine utilization across the Vanderbilt University Medical Center (VUMC) from January to October 2020. Poorer prognosis and care of oncology patients is expected to be associated with increased emergency department (ED) visits. Methods:January to October 2020 clinic visits were identified from the VUMC's Electronic Data Warehouse (EDW). Oncology patients were identified by ICD-10 code and their EDW ED visit data were extracted. Joinpoint piecewise linear regression evaluated trends in tele-oncology visits. VUMC ED visits were compared for patients who did versus did not use telemedicine for oncology clinic visits. A Welch's two-tailed t-test investigated differences in ED visits/patient between these cohorts (α < 0.05). Results:A sharp increase in tele-oncology clinic visits from January to April 2020 (Monthly Percent Change = 396.26%) was followed by a steady decrease from April to October 2020 (Monthly Percent Change = −20.93%). The difference between these two trends was significant (p < 0.002). Of 18 cancer sites, breast cancers had the highest proportion (29.04%) of tele-oncology visits. There was no significant difference in January to October 2020 ED usage for oncology patients who did (0.40 ED visits/patient) versus did not (0.38 ED visits/patient) utilize telemedicine (p = 0.69). A total of 9.64% of oncology clinic visits from January to October 2020 were telemedicine visits, just below the 13.0% institutional average. Discussion:At the VUMC, tele-oncology spiked in March and April 2020 before decreasing from April to October 2020. Breast cancer clinics were most likely to use tele-oncology. Telemedicine use was not associated with increased ED visits for oncology patients, suggesting telemedicine as an alternative for routine oncology clinics. Oncology clinic telemedicine usage was 18th-highest among 33 specialties at our institutions, and among the lowest of nonsurgical specialties. [ABSTRACT FROM AUTHOR]

Introduction. The aim of the study is to determine the prevalence of negative outcomes associated with medication (NOMs) and adverse drug reactions (ADRs) occurring in the emergency department (ED) of a health centre. Method. An exploratory observational, cross-sectional study of patients with NOMs consulting in an ED. According to the variables of interest, the information was collected with an instrument designed and evaluated for this purpose. A multivariate logistic regression model was applied to the NOMs and found the most important variables predisposing to the appearance of NOM. In addition, the avoid ability of NOM (Baena et al. criteria), the severity of NOM (Schneider classification) and the causality of ADR (Naranjo algorithm) were shown. Results. A total of 158 patients were included in the study. The prevalence of visits to the ED due to NOM was 35.0 % (55 patients) and ADR was 5.1 % (8 patients). Overall, 88.0 % of the ADRs were considered avoidable and 74.0 % were of mild severity. On the other hand, 37.5 % (n=3) of suspected ADR were classified as avoidable and 50.0 % as probable. The multivariate logistic model indicates a possible association between NOMs with lower levels of schooling, the use of medicinal plants and the number of diseases. Conclusions. The visit of 1 in 3 patients to the emergency department is associated with a NOM, while 1 in 20 is associated with an ADR. Further studies are needed. [ABSTRACT FROM AUTHOR]

Facilitating parent‐child interactions is a key component of evidence‐based early childhood home visiting programs. Several observational measures have been created to effectively capture home visiting activities from an operationalized perspective. While the field has a reasonable understanding of what home visitors can do to facilitate developmentally supportive interactions, and why, the how remains elusive for many home visitors. This qualitative study used a modified grounded theory approach to examine the facilitation of caregiver‐child interactions during home visits. Home visit video recordings previously coded using the Home Visit Rating Scale (HOVRS) A+ were selected based on facilitation quality. Sixteen home visits (8 lower‐ and 8 higher‐quality facilitation scores) were examined for differences in home visitor behaviors that support parent‐child interactions during visits. We identified contextual and specific behaviors that home visitors used to actively engage caregivers and children together in developmentally supportive interactions. Results revealed 11 home visitor behaviors that discriminated higher quality facilitation. These behaviors were categorized into four domains: environmental conditions, executing the activity, strengths‐based focus, and caregiver responses. This qualitative study highlights specific behaviors and professional development areas to support more effective home visiting services for a diverse population of families with young children. [ABSTRACT FROM AUTHOR]

The use of cyproheptadine as an appetite stimulant is off label in Thailand which depends on professional discretion. This study aimed to determine the potential of weight gain effect of cyproheptadine in Thai patients. A retrospective study was conducted in adult patients receiving cyproheptadine as an off-labelled use for appetite stimulant, having body weight records at 2 times consecutively during 12-month period at the medical outpatient department, the Police General Hospital, Thailand. Of 125 participants, 69.6% were females and the mean age was 78.38 (SD ± 11.68) years. Hypertension, dyslipidemia and diabetes mellitus were the most common underlying conditions. The mean body mass index (BMI) at 1st visit was 21.16 (SD ± 3.64) kg/m². The mean body weight at 1st and 2nd visit were 52.46 (SD ± 11.11) kg, and 52.61 (SD ± 10.98) kg, respectively. Overall, there was no significant change in body weight between two visits. In underweight patients (BMI < 18.5 kg/m²), the mean BMI decreased significantly in the 2nd visit compared to 1st visit (p = 0.044). At the 2nd visit, older age and highdensity lipoprotein cholesterol levels were negatively associated with body weight (p < 0.05). The polypharmacy (odds ratio (OR), 0.778; 95% confidence interval (CI), 0.616 - 0.982), the presence of hypertension (OR, 0.022; 95%. CI, 0.001 - 0.390) and low-density lipoprotein cholesterol levels (OR, 0.969; 95% CI, 0.942 - 0.996) were also negatively associated with abnormal BMI. In conclusion, cyproheptadine might not improve body weight at 4 mg per day. The factors associated with lower body weight in this study may be helpful in further research. [ABSTRACT FROM AUTHOR]

Background: Frequent Emergency Department (ED) visitors are identified by the policymakers to reduce avoidable ED visits and lessen the financial and operational burden. This study aimed to identify the factors related to the frequent use of ED services. Methods: This nationwide, cross-sectional observational study was conducted using information obtained from the 2019 National Emergency Department Information System (NEDIS) database. Frequent ED users were defined as patients with four or more ED visits a year. We performed multiple logistic regression analyses to verify the relationship among sociodemographic characteristics, residential characteristics, clinical characteristics, and frequency of ED visits. Results: Among 4,063,640 selected patients, 137,608 patients visited the ED four or more times a year (total number of visits = 735,502 times), which accounted for 3.4% and 12.8% of the total number of ED users and ED visits, respectively. A high ED visit frequency was associated with male sex, age < 9 or ≥ 70 years, Medical Aid (based on the insurance type), lower number of medical institutions and beds compared with that of the national average, and conditions, such as cancer, diabetes, renal failure, and mental illness. A low ED-visit frequency was associated with residence in regions vulnerable to emergency medical care and regions with high income. The possibility of frequent ED visits was high for patients with level 5 severity (non-emergent) and those with an increased need for medical treatment, including older patients and patients with cancer or mental illness. The possibility of frequent ED visits was low for patients aged > 19 years with level 1 severity (resuscitation). Conclusions: Health service accessibility factors, including low income and medical resource imbalance, were associated with frequent ED visits. Future large-scale prospective cohort studies are warranted to establish an efficient emergency medical system. [ABSTRACT FROM AUTHOR]

Introduction: Hospitals are a major source of care for underserved populations in the United States. However, little is known about how hospital-based health information technology (HIT) can improve the efficiency of care and reduce disparities. Objective: We examined the variation of preventable emergency department (ED) visits and associated racial disparities by hospital adoption of HIT patient engagement (HIT-PE) functionalities. Methods: This was an observational study of 6,543,514 non-Hispanic Black (Black) and non-Hispanic White (White) adult patients using 2019 datasets of seven states (Arizona, Florida, Kentucky, Maryland, North Carolina, Vermont, Wisconsin) from the State Emergency Department Databases, American Hospital Association Annual Survey & Information Technology Supplement, and Area Health Resources File. Results: High HIT-PE adoption was associated with lower rates of preventable ED (odds ratio [OR] = 0.992, p < 0.001). Specific HIT-PE functions such as importing medical records from other organizations into the patient portal (OR = 0.977, p < 0.001), electronically sending medical information to a third party (OR = 0.970, p < 0.001), and scheduling appointments online (OR = 0.987, p < 0.001) were also associated with reduced preventable ED rates. Black patients had higher rates of preventable ED compared with Whites (OR = 1.386, p < 0.001); however, the interaction of Black patients and high HIT-PE adoption was associated with lower rates of preventable ED (OR = 0.977, p < 0.001). Our results also showed that higher HIT-PE adoption was associated with a reduction in preventable ED visits among Black patients with comorbidities and Black patients living in low-income areas. Conclusions: The results of our study suggest that there is potential to reduce preventable ED rates and racial disparities through hospital-based HIT-PE functionalities. [ABSTRACT FROM AUTHOR]

Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms. [ABSTRACT FROM AUTHOR]

Medical facilities, such as hospitals, clinics, and locations where diagnosis and treatment are administered, create dangerous waste that predisposes individuals to deadly infections. Medical waste management aims to improve health and prevent public health and environmental threats. Questionnaires, interviews, site visitations, and observations were utilized to determine the management strategies implemented in the three hospitals and evaluate the efficacy of waste management. The hospitals under review are Afe Babalola University Multi-system Hospital (AMSH), Ekiti State University Teaching Hospital (EKSUTH), and Federal Teaching Hospital Ido-Ekiti (FETHI). Statistical Package for the Social Sciences (SPSS) was utilized for the statistical analysis of the questionnaires, and the mean assessment was utilized to compute the waste per bed each day. The results revealed that the three hospitals' sharp, infectious, and pharmaceutical waste is the most sorted. All hospitals burn their medical waste in incinerators but dispose of the ashes in dumpsites. The mean evaluation of all hospitals' medical waste was weighed to establish the overall amount generated. The total amount of medical waste created at AMSH, EKSUTH, and FETHI is 31.5 kg, 53.6 kg, and 135.1 kg, respectively. The medical waste generated per bed per day in AMSH, EKSUTH, and FETHI is 0.61 kg, 0.74 kg, and 0.73 kg, respectively. It was determined that the proper management and disposal of waste is a critical obligation of healthcare facilities. There should be a provision for educating personnel about the consequences of inappropriately disposing of medical waste. [ABSTRACT FROM AUTHOR]

Objective: Guidelines recommend outpatient follow-up after emergency department visits for asthma, but factors related to rates of follow-up among the adult population are understudied. We sought to describe patient and community-level predictors of outpatient follow-up after an index ED visit for asthma and evaluate the association between outpatient follow-up visits and subsequent ED revisits.Methods: We conducted a retrospective observational cohort study of adult patients with emergency departments visits for asthma. The primary predictor was time to outpatient follow-up visit within 30 days of the index ED visit. The primary outcome was all-cause ED revisit within 30 days of the index ED visit. Cox proportional hazards regression was utilized to test the association between time to outpatient follow-up and hazard of ED revisit within 30 days.Results: Time to outpatient follow-up visit within 30 days was not significantly associated with hazard of 30-day ED revisit for asthma (HR 1.05; 95% CI 0.69–1.61). However, male patients (HR 1.45; 95% C 1.11–1.89) and smokers (HR 1.67; 95% CI 1.22–2.29) were significantly more likely to have an ED revisit.Conclusion: Younger, Black patients with Medicaid were less likely to receive follow-up care relative to older patients insured by Medicare. While follow-up visits were not associated with 30-day revisit rates, differences by age, race, and insurance status suggest disproportionate barriers to accessing care. Future research may target these subgroups to improve transitions of care after an ED visit for asthma. [ABSTRACT FROM AUTHOR]

In this paper, we explore the acceptance of parents into children's wards in Tel-Hashomer Hospital, an important foundation of Israel's health system. In 1953, Tel-Hashomer was the first hospital in Israel to conduct an experimental programme of minimum separation between children and their parents, influenced by the theory of British psychoanalyst and psychiatrist John Bowlby. Tel-Hashomer medical staff encouraged parents to stay long hours near the bedsides of their daughters and sons, which led to a notable change in the ward's daily routine. Eventually, parents became an inseparable part of the ward. This tendency to embrace and welcome parents into the wards was especially surprising when one considers that many of these parents were of Mizrahi origin and suffered an orientalist, racialised stigma of unfit parenting. [ABSTRACT FROM AUTHOR]

Ferritin is an acute-phase reactant that is elevated in autoimmune disorders, including systemic lupus erythematosus (SLE). However, their correlation with disease activity scores has not been confirmed. Pandemic Covid-19 makes children visitation to hospital to get the treatment of SLE were delayed. This study aimed to evaluate correlation between serum ferritin and disease activity and its role in screening for flare in pediatric SLE (pSLE) patients during pandemic Covid-19. This is a cross-sectional study conducted in Saiful Anwar General Hospital Malang. Sampling was carried out sequentially on pediatric patients who met the criteria for Systemic Lupus International Collaborating Clinics (SLICC) and were recorded between July 2021-May 2022. All patients were interviewed and assessed for disease activity using SLE Disease Activity Index 2000 (SLEDAI-2k). A score <4 was categorized as inactive disease. Biochemical, serological tests including markers of disease activity and ferritin level were measured by standard laboratory procedure. Comparison, correlation and ROC curve analyses were performed with SPSS software. There were 38 females pSLE participated in this study. The mean age of the patients were 12.6 ± 3.02 years. Serum ferritin significantly higher in active disease compared to inactive disease 84.50 ng/mL (68.00-151.75 ng/mL) ng/mL and 815.00 ng/mL (451.25-1570.00 ng/mL), a value of p<0.05 was determined to be statistically significant. A significant correlation was found between serum ferritin with SLEDAI 2K (r = 0.890, p = 0.000). Correlation was also found between serum ferritin and IgM anti-double stranded- DNA (r = 0.325, p = 0.046), but not with other laboratory and serological parameters. In ROC curve analysis, we found that Area Under The Curve (AUC) 0.989, 95%CI 0.964-1.014, p value 0,000, with cut off value 297.50 with sensitivity 85% and specificity 94.4%. Ferritin was increased in active disease as compared to inactive disease and correlated with SLEDAI score and IgM-dsDNA. Thus, ferritin may be potential as an affordable and available marker of disease activity in pSLE during pandemic Covid-19. [ABSTRACT FROM AUTHOR]

Introduction The common target audience of the current guidelines for the prevention of healthcare-associated infections is represented by healthcare workers. Behavioral protocols for visitors and caregivers that aim to prevent healthcare-associated infections are still not available. The aim of this study was to determine the behavior of the visitors and to determine possible behavior that would contribute to the transmission of pathogenic microorganisms, in order to provide suggestions for visitors in the post-pandemic period. Methods A survey about visitor behavior was administered to 621 visitors. The survey consisted of questions regarding the demographic features and the behavior of the patient visitors. Results Seventy-seven visitors (12.4%) had at least one infection-related symptoms. Overall, 426 (68.6%) visitors stated that they would cancel their visit if they had any infection-related symptoms. The location of the hand washbasin to wash or sanitize the hands at the patient’s unit was not known by 142 (22.9%) visitors. The number of visitors performing all hand hygiene steps was 351 (56.5%). Compliance with hand hygiene was not affected by age, gender, living in the same house as the visited patient, or visiting an adult or pediatric patient. Conclusions The visitors should be queried about symptoms of infectious disease at the entrance of the hospital. The knowledge level of the visitors about hand hygiene is not sufficient. Clear recommendations about when and how often visitors should practice hand hygiene and providing information at the entrance of the hospital will improve the hand hygiene compliance of the visitors. [ABSTRACT FROM AUTHOR]

Navigation in large hospitals remains a challenge, especially for patients, visitors and, in some cases, for staff, but in particular it is notable in the case of tracking ambulatory equipment. Current techniques generally seek to reproduce what outdoor navigation systems provide, i.e., "good" accuracy. In many cases, especially in hospitals, reliability is much more important than accuracy. We show that it is possible to realize a simple, reliable system with a low accuracy, but which perfectly fulfills the task assigned in the particular case of tracking stretchers. Optimizing the use of hospital equipment requires the knowledge of its movement. The possibility to access equipment location in real time as well as on the knowledge of the time necessary to move it between two locations allows to predict or to estimate the load and possibly to scale the necessary number of stretchers, and thus the availability of the stretcher bearers. In this paper, an approach of the real-time location of these devices is proposed, and it is called "symbolic". The principle is described, as well as the practical implementation and the data that can be retrieved. In the second part, an analysis of the results obtained is provided in two directions: the location of stretchers and the determination of travel times. The methodology followed is described, and it is shown that a correct positioning rate of 90% is reached, which is slightly lower than expected, explained by the chosen practical implementation. Moreover, the average error on the determination of travel times is approximately ten seconds on 2 to 7 min trips. The "reliability" (the terminology of which is discussed at the end of the paper) of the results is related to the simplicity of the approach. [ABSTRACT FROM AUTHOR]

Objective: This study examined the impact of Japan's state of emergency on trends in diabetes care during the coronavirus disease 2019 (COVID-19) pandemic. Design: A descriptive and retrospective study. Setting: Showa University Hospital, Japan. Participants: Patients with diabetes who received medical treatment from 2018 to 2020. Determinants of interest: Number of patients with diabetes visiting the hospital per week. To examine the impact of the Japan's state of emergency, the number of hospital visitations by patients with diabetes was summarized from 28 weeks of data for each year, from calendar week 8 to calender week 35. Results: Compared with the mean of 2018 and 2019, no significant difference was found between the three periods (before, during, and after the state of emergency). However, the numbers of patients from both inside and outside Tokyo increased at 7 weeks after the state of emergency was lifted. Conclusions: A significant increase in the numbers of patients with diabetes was seen compared with the same period in 2018 and 2019, suggesting that the state of emergency may have hindered diabetes care. Therefore, patients with diabetes should receive continuous follow-up regarding their diabetes care, keeping a close eye on relvent measurements. [ABSTRACT FROM AUTHOR]

Prison visitation transportation services perform an important yet understudied role in the process of prison visitation for many people with incarcerated loved ones. This article draws on the findings of an ethnographic study of the experiences of loved ones of incarcerated people using a small, Black-owned prison visitation transportation service. Prison visitation transportation services help to mitigate the carceral state's inherent function to separate people from their incarcerated loved ones, but in turn these services are also subjected to intensive forms of carceral control themselves. As a result, prison visitation transportation services and their staff experience a form of tertiary prisonization. This ultimately results in the drivers of these services experiencing a heightened and enduring state of layered liminality, which becomes attached to them as individuals. [ABSTRACT FROM AUTHOR]

Palliative care services (PCS) have improved quality of life for patients across various cancer subtypes. Minimal data exists regarding PCSfor metastatic hepatopancreaticobiliary (HPB) and gastrointestinal (GI) cancers. We assessed the impact of PCS on emergency department visits, hospital admissions, and survival among these patients. Patients with metastatic HPB and GI cancer referred to outpatient PCS between 2014 and 2018 at a single institution were included. We compared the demographics, outcomes, and end-of-life indicators between those who did and did not receive PCS. The study included 183 patients, with 118 (64.5%) having received PCS. There were no significant differences in age, gender, race, marital status, or insurance. Those receiving PCS were more likely to have colorectal cancer (p = 0.0082) and receive chemotherapy (p = 0.0098). On multivariate analysis, PCS was associated with fewer ED visits (p = 0.0319), hospital admissions (p = 0.0002), and total inpatient hospital days (p < 0.0001) per 30 days of life. Overall survival was greater among patients receiving PCS (HR: 0.65 (0.46–0.92)). Outpatient PCS for patients with metastatic HPB and GI cancer is associated with fewer emergency department visits, hospital admissions, and inpatient hospital days, and improved overall survival. [ABSTRACT FROM AUTHOR]

The article "Exemption from professional confidentiality in favor of relatives" in the Journal of Medical and Health Law addresses the problem that doctors and other healthcare professionals often violate their duty of confidentiality when disclosing information to relatives, risking legal consequences. One solution could be a prior declaration of exemption by the patients. It is pointed out that the duty of confidentiality continues to exist even after the patient's death and that relatives have no right to information about the patient's health condition without the patient's consent. Various relevant laws and norms are mentioned. The article discusses the question of exemption from professional confidentiality in favor of relatives. It is stated that the presumed will of the patient should only be considered as a last resort and that there is no legal presumption that non-communicative patients desire the disclosure of information. It is emphasized that in emergencies, information regarding the treatment of the patient can be disclosed and that the patient's interest in information should take precedence over data protection. However, the justification for disclosing information to relatives is more limited and requires a balancing of the interests of the patient and the relatives. It is recommended to proceed restrictively and to make the balancing on a case-by-case basis. It is also noted that the presumed will of the patient should be determined and that even in cases where there is no actual interest in confidentiality, the duty of confidentiality and data protection must be upheld. The patient's right to visitation is also mentioned. The article addresses various aspects of data protection in relation to patient rights and patient safety. It is pointed out that a patient's right to visitation in hospitals does not automatically imply consent to the disclosure of information to third parties. The disclosure of information to relatives or trusted individuals usually occurs on a voluntary basis and requires the patient's consent. Minors also have the right to data protection and informational self-determination, with their decision-making capacity being assessed based on their age and cognitive abilities. In certain cases, parents can be informed about important medical facts, especially if the child is at risk of suicide. In Germany, the obligation of doctors to provide information to parents regarding incapacitated minors is attributed to the state's duty of care. The article discusses confidentiality in healthcare and the possibility of exempting certain individuals from this obligation. In Austria, in addition to the state's duty of care, family autonomy also plays an important role. Adult individuals can have a legal representative who can also decide on the disclosure of health information to relatives. It is recommended to provide a written declaration to exempt doctors, nursing staff, and institutions from the duty of confidentiality. This exemption can only be made when the person is capable of making decisions and should be handed to the authorized person. [Extracted from the article]

Introduction The common target audience of the current guidelines for the prevention of healthcare-associated infections is represented by healthcare workers. Behavioral protocols for visitors and caregivers that aim to prevent healthcare-associated infections are still not available. The aim of this study was to determine the behavior of the visitors and to determine possible behavior that would contribute to the transmission of pathogenic microorganisms, in order to provide suggestions for visitors in the post-pandemic period. Methods A survey about visitor behavior was administered to 621 visitors. The survey consisted of questions regarding the demographic features and the behavior of the patient visitors. Results Seventy-seven visitors (12.4%) had at least one infection-related symptoms. Overall, 426 (68.6%) visitors stated that they would cancel their visit if they had any infection-related symptoms. The location of the hand washbasin to wash or sanitize the hands at the patient's unit was not known by 142 (22.9%) visitors. The number of visitors performing all hand hygiene steps was 351 (56.5%). Compliance with hand hygiene was not affected by age, gender, living in the same house as the visited patient, or visiting an adult or pediatric patient. Conclusions The visitors should be queried about symptoms of infectious disease at the entrance of the hospital. The knowledge level of the visitors about hand hygiene is not sufficient. Clear recommendations about when and how often visitors should practice hand hygiene and providing information at the entrance of the hospital will improve the hand hygiene compliance of the visitors. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic drove rapid adoption of telehealth across oncologic specialties. This revealed barriers to telehealth access and telehealth-related disparities. We explored disparities in telehealth access in patients with cancer accessing oncologic care. Materials/Methods: Data for all unique patient visits at a large academic medical center were acquired pre- and intra-pandemic (7/1/2019-12/31/2020), including visit type (in-person, video, audio only), age, race, ethnicity, rural/urban (per zip code by Federal Office of Rural Health Policy), distance from medical facility, insurance, and Digital Divide Index (DDI; incorporates technology/internet access, age, disability, and educational attainment metrics by geographic area). Pandemic phases were identified based on visit dynamics. Multivariable logistic regression models were used to examine associations of these variables with successful video visit completion. Results: Data were available for 2,398,633 visits for 516,428 patients across all specialties. Among these, there were 253,880 visits from 62,172 patients seen in any oncology clinic. Dramatic increases in telehealth usage were seen during the pandemic (after 3/16/2020). In multivariable analyses, patient age [OR: 0.964, (95% CI 0.961, 0.966) P<0.0001], rural zip code [OR: 0.814 (95% CI 0.733, 0.904) P = 0.0001], Medicaid enrollment [OR: 0.464 (95% CI 0.410, 0.525) P<0.0001], Medicare enrollment [OR: 0.822 (95% CI 0.761, 0.888) P = 0.0053], higher DDI [OR: 0.903 (95% CI 0.877, 0.930) P<0.0001], distance from the facility [OR: 1.028 (95% CI 1.021, 1.035) P<0.0001], black race [OR: 0.663 (95% CI 0.584, 0.753) P<0.0001], and Asian race [OR: 1.229 (95% CI 1.022, 1.479) P<0.0001] were associated with video visit completion early in the pandemic. Factors related to video visit completion later in the pandemic and within sub-specialties of oncology were also explored. Conclusions: Patients from older age groups, those with minority backgrounds, and individuals from areas with less access to technology (high DDI) as well as those with Medicare or Medicaid insurance were less likely to use video visits. With greater experience through the pandemic, disparities were not mitigated. Further efforts are required to optimize telehealth to benefit all patients and avoid increasing disparities in care delivery. [ABSTRACT FROM AUTHOR]

We investigated asthma quality measures to understand patient characteristics associated with non-attainment of quality care and measure the association with asthma-related emergency department (ED) visits or inpatient hospitalizations (IPs). Using administrative data from ALL Kids, Alabama's Children's Health Insurance Program, from 2013 to 2019 we calculated non-attainment of the Medication Management for Asthma (MMA) and Asthma Medication Ratio (AMR) quality measures. Patient characteristics and asthma-related ED visits and IPs associated with non-attainment of the MMA and AMR measures were assessed using logit regression models and Marginal effects at the mean. Among 2528 children with asthma, 53.2% failed to attain the MMA measure and 8.5% the AMR measure. Prior asthma-related ED visits or IP stays increased likelihood of non-attainment by 14.8 percentage points (95% CI 8.6–20.9) for MMA and 7.3 percentage points (95% CI 2.8–11.8) for AMR. Among 868 children (34.3%) with three years of continuous enrollment, AMR non-attainment was associated with a 6.1 percentage point increase in ED or IP utilization (95% CI 1.3–10.9), however MMA non-attainment was not associated with either outcome. Prior ED visit/IP stay was associated with a 17.2 percentage point (95% CI 8.3–26.1) increase in the likelihood of a subsequent ED visit/IP stay among those with non-attainment MMA and a 15.5 percentage point increase (95% CI 6.9–24.2) for non-attainment AMR. Patient characteristics associated with non-attainment of asthma quality measures presents actionable evidence to guide improvement efforts as non-attainment AMR increases the risk of subsequent ED visits and IP stays. [ABSTRACT FROM AUTHOR]

This article aimed to identify the prevalence of not receiving a home visit by a community health agent (CHA) and the factors associated with it. This was a cross-sectional study, conducted with 38,865 health teams and 140,444 users in the entire country, who participated in the external evaluation of the Program of Access and Quality Improvement in Primary Health (PMAQ-AB, in Portuguese) in 2017/2018. The association between not receiving a home visit by a CHA and the characteristics of the towns, teams, and individuals were estimated by the prevalence ratio (PR) with 95% confidence intervals. The prevalence of not receiving a home visit by a CHA was 18.6% and the main causes were: CHA did not visit the home, lack of knowledge of the existence of CHAs in the neighborhood or unit, and no one present at the home when the CHA visited. The probability of receiving a home visit was higher in poorer regions like the Northeast Region of the country; in towns with a smaller population; among older age users with a lower income, users with chronic health conditions, or users who have someone with a physical disability at home. The results showed that there is a need to increase the coverage of CHA visits in the country, considering that their home visits improve equity in health care. [ABSTRACT FROM AUTHOR]

Introduction: Infection prevention and control (IPC) in healthcare settings is imperative for the safety of patients as well as healthcare providers. To measure current IPC activities, resources, and gaps at the facility level, WHO has developed the Infection Prevention and Control Assessment Framework (IPCAF). This study aimed to assess the existing IPC level of selected tertiary care hospitals in Bangladesh during the COVID-19 pandemic using IPCAF to explore their strengths and deficits. Methods: Between September and December 2020, we assessed 11 tertiary-care hospitals across Bangladesh. We collected the information from IPC focal person and/or hospital administrator from each hospital using the IPCAF assessment tool.. The score was calculated based on eight core components and was used to categorize the hospitals into four distinct IPC levels– Inadequate, Basic, Intermediate, and Advanced. Key performance metrics were summarized within and between hospitals. Results: The overall median IPCAF score was 355.0 (IQR: 252.5–397.5) out of 800. The majority (73%) of hospitals scored as 'Basic' IPC level, while only 18% of hospitals were categorized as 'Intermediate'. Most hospitals had IPC guidelines as well as environments, materials and equipments. Although 64% of hospitals had IPC orientation and training program for new employees, only 30% of hospitals had regular IPC training program for the staff. None of the hospitals had an IPC surveillance system with standard surveillance case definitions to track HAIs. Around 90% of hospitals did not have an active IPC monitoring and audit system. Half of the hospitals had inadequate staffing considering the workload. Bed occupancy of one patient per bed in all units was found in 55% of hospitals. About 73% of hospitals had functional hand hygiene stations, but sufficient toilets were available in only 37% of hospitals. Conclusion: The majority of sampled tertiary care hospitals demonstrate inadequate IPC level to ensure the safety of healthcare workers, patients, and visitors. Quality improvement programs and feedback mechanisms should be implemented to strengthen all IPC core components, particularly IPC surveillance, monitoring, education, and training, to improve healthcare safety and resilience. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess the number of RCT done in the maxillary anteriors among patients with Class III caries. The study includes patients visiting the OP of Saveetha Dental College diagnosed with class III caries on the maxillary anteriors and to find the number of RCTs done among those patients. The results were statistically analysed using SPSS software. Descriptive statistics and chi-square tests were done for gender and diagnosis of the tooth. Among a total of 345 patients diagnosed with class III caries on the maxillary anteriors, 21.74% have undergone RCT while 78.26% of the patients did not undergo RCT. The incidence of RCT done in patients with Class III caries was found to be low. This might be due to the aesthetic consideration of the patients and hence early treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) is a severe adverse event that negatively affects a patient's quality of life (QOL). The reasons for CINV and hospitalization after chemotherapy include poor adherence to guidelines and not prescribing the appropriate outpatient antiemetic drugs. At Tampa General Hospital, a pharmacist-led service model was created at the outpatient infusion center to contact patients receiving moderately or highly emetogenic chemotherapy to assess the incidence of CINV and to provide appropriate therapy recommendations. OBJECTIVES: To evaluate the impact of a pharmacist follow-up on the incidence of emergency department visits, hospital admissions, or infusion center appointments for CINV, with or without dehydration, within 30 days of receiving moderately or highly emetogenic chemotherapy, as well as the impact of CINV on patients' QOL. METHODS: In this single-center, retrospective study we compared patients who received an antiemetic drug regimen at our institution. Patients were divided into 2 groups: the intervention group included patients who had telephone follow-up by a pharmacist within 48 hours of initiating moderately or highly emetogenic chemotherapy between January and July 2020 and a historical control group of patients who received treatment between January and July 2019 and did not have follow-up with a pharmacist. During the follow-up calls, the pharmacist assessed the patient's adherence to an antiemetic drug regimen, the incidence of CINV, the patient's QOL, and the need for intervention. RESULTS: The study involved a total of 111 patients, including 68 patients in the intervention group and 43 patients in the historical control cohort. The incidence of the primary composite end point of emergency department visits, hospital admissions, or infusion center appointments for CINV, with or without dehydration, within 30 days of receiving moderately or highly emetogenic chemotherapy was 1.5% in the intervention group compared with 7% in the control group (P = .129). Significantly more patients in the control group were not prescribed outpatient antiemetic drugs than those in the intervention group (27.9% vs 1.5%, respectively; P <.000024). In the overall study population, 40% of all administered antiemetic drug regimens adhered to the current National Comprehensive Cancer Network guideline recommendations. CONCLUSION: The pharmacist-led service model did not significantly affect emergency department or clinic visits for CINV, but it did result in a significant increase in prophylactic prescribing of antiemetic drugs. Nevertheless, this finding suggests that a follow-up call by a pharmacist for patients who are administered highly or moderately emetogenic chemotherapy may have a positive impact on the patients' QOL. [ABSTRACT FROM AUTHOR]

1. Utilizing a case-based approach, participants will be able to advocate for the specific values and preferences of end-of-life care in Amish patients. 2. Utilizing a case-based approach, participants will develop an approach to advocate for culturally-sensitive care at the systems level for all patients. For example, they will be able to re-evaluate hospital visitation polices in the post-COVID-19 pandemic era. Despite the known low risk of transmission of COVID-19 between visitors and patients who take appropriate precautions, hospital visitation restrictions have continued. This has significantly impacted the Amish population who value community support at end-of-life. Therefore, culturally-sensitive, modified hospital visitation policies in the post-COVID-19 era are warranted for them and all patients. WD is an adolescent Amish male with a history of Congenital Heart Disease who underwent heart transplantation at age 8. Our inter-disciplinary Pediatric Advanced Care Team (PACT) provided palliative care to WD and his family from an early age. He suffered several post-transplantation complications, most notably protein-losing enteropathy which resulted in progressive heart failure requiring frequent admissions for paracentesis and medical management. He presented to the Pediatric CICU for the twelfth time in one year with worsening fatigue and shortness of breath. His hospitalization was complicated by poly-microbial septic shock and Multiple Organ Dysfunction Syndrome. WD's parents stated to PACT that Amish community support meant a great deal to him, aided in boosting his morale, and improved his comfort. Past pandemic visitor restrictions caused great distress for WD and his parents. PACT advocated to the CICU regarding the importance of family and community in his life. They wrote a letter to the Head of Security to allow unlimited visitors at bedside which was approved. Unfortunately, WD's clinical condition continued to decline. His parents made the loving decision to pursue comfort measures at the hospital as they wanted him to continue to have a good quality of life with his visitors. Activities he enjoyed would not be able to be done at home given his fragile state. This was in contrast to the Amish community's general preferences for end-of-life (EOL) care at home. He died peacefully surrounded by a room, hallway, and waiting area full of family and community members. This case highlights the four core values of the Amish community: faith, family, community, and simplicity. They rely heavily on other Amish community members for social, emotional, and spiritual support - especially at EOL. Modifying hospital visitation policies in a culturally-sensitive way can be safely accomplished to meet family EOL goals. Existential / Humanities / Spirituality / Religion; Interdisciplinary Teamwork / Professionalism [ABSTRACT FROM AUTHOR]

1. Using a case-based approach, participants will be able to discuss the vulnerability of patient and provider amid the ethical duty to provide care and describe the challenges in providing compassionate and ethical care in the setting of a violent threat. 2. Using a case-based approach, participants will recognize the imperative of finding creative solutions to balance duty to a patient and safety of the provider. There are ethical dilemmas that impact the ability to provide compassionate care at end-of-life in circumstances where a patient or family threaten violence. As violence against healthcare workers has increased, discussion of the need to balance staff safety with the duty to provide care is paramount. Healthcare workers have ethical challenges providing care in situations where there is risk of harm. Risks must be mitigated for staff safety considering vulnerability of the patient. Violent behavior of a patient or family presents obstacles to providing compassionate care and developing a therapeutic relationship. We juxtapose 2 cases: (A) 72-year-old woman with advanced Interstitial Lung Disease status-post tracheostomy/gastrostomy-tube admitted for acute-on-chronic respiratory failure. (B) 63-year-old man with Non-Small Cell Lung Cancer and brain metastasis with history of craniotomy for mass resection admitted with altered mental status, agitation secondary to progression of disease. Palliative Care was consulted for assistance with psychosocial support and goals-of-care discussions as both cases resulted in prolonged and complicated hospitalizations in which next-of-kin were responsible for decision-making. In Case A, as the patient clinically deteriorated, the routinely hostile healthcare agent threatened physical violence against staff in conversation and through a letter. Police became involved and this agent was barred from visitation. Routine communication regarding plan-of-care continued. Accommodations were made through support of hospital administration and security for family meetings and visitation at end-of-life. In Case B, the patient himself made homicidal threats against his neurosurgeon. His violent non-adherence to treatment and intervention caused harm to staff. Delirium could not be managed through multiple modalities with the family then requesting comfort-focused care. Patient ultimately received palliative sedation and transitioned to inpatient hospice. The bioethics principles of beneficence and nonmaleficence can come at odds with the need to protect healthcare workers from a violent patient or family. The directive for compassionate care is strongly reflected in a practitioner's feeling of duty in treating vulnerable patients despite reasonable risk of harm. This presentation reviews unique examples of the need to balance ethical care of dying patients with ensuring safety of vulnerable hospital staff. Ethical / Legal Aspects of CareManaging Suffering and Distress [ABSTRACT FROM AUTHOR]

The tourism plays a significant role in economics and development of any country through revenue generation from multiple sources. Spain has been tourist place and host million foreign tourist. The tourism is highly depended on climate and thermal comfortness of the visiting place. This present research aimed to analyze the outdoor thermal comfort conditions in microclimates of the urban ancient plazas of the two important cities of Spain, namely Sevilla and Madrid on a hot humid stress day of the year. The microclimatic measurement, questionnaire survey, and simulation results were examined to evaluate the thermal comfort condition of six different urban plazas in Sevilla and Madrid to distinguish the supreme time to visit each ancient site. The results have suggested that the outdoor thermal comfort range for the tourist in the historical plazas of Sevilla and Madrid varies from 28.42 to 30.87 °C and 24.5 to 29.82 °C in the hot summer. Despite the high heat stress condition, the result of questionnaires survey shows that about 38.11% and 28.09% of tourists in Sevilla and Madrid, respectively, were satisfied with the thermal conditions. As witnessed from the result of the Envi-met simulation, Plaza de Santa Ana of Madrid and Plaza Nueva of Sevilla is the best place for visitors in the early morning hours. Additionally, during the peak hours, the thermal comfort of Alameda de Hercules of Sevilla and Plaza de Santa Ana of Madrid is the most suitable historical places for visitors, whereas in the evening hours, Plaza Nueva of Sevilla and Plaza de Mayor of Madrid with wider semi-open spaces and relatively suitable vegetation bring more favorable conditions for visitors. The comparison of the simulation result with the questionnaire reveals that the urban plazas with relatively high thermal stresses have a higher rate of thermal dissatisfaction. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, adults with chronic conditions delayed or avoided seeking preventative and general medical care, leading to adverse consequences for morbidity and mortality. In order to bring patients back into care, we, in this qualitative study, sought to understand the foremost health-related needs of our multi-morbid ambulatory patients to inform future outreach interventions. Via a telephone-based survey of our high-risk patients, defined using a validated EPIC risk model for hospitalization and ED visits, we surveyed 214 participants an open-ended question, "What is your top health concern that you would like to speak with a doctor or nurse about". We found 4 major themes: 1) primary care matters, 2) disruptions in health care, 3) COVID-19ʹs impact on physical and mental health, and 4) amplified social vulnerabilities. Our results suggest that interventions that reduce barriers to preventative services and disruptions to healthcare delivery are needed. [ABSTRACT FROM AUTHOR]

Simple Summary: Negative mental health outcomes have affected healthcare workers, patients, and community members following pandemics: most recently, the SARS-CoV-2 (COVID-19) outbreak. Although therapy dog visitation programs are associated with reduced stress, most hospital-based programs were placed on hiatus during the COVID-19 pandemic. This study examined human–animal interactions during the reactivation of a hospital-based therapy dog program during the pandemic. Characteristics of the interactions and the participants involved were recorded and analyzed. Findings indicated that most visit recipients were healthcare workers, while the longest interaction times occurred with adult and pediatric patients. High levels of adherence to human and animal safety protocols indicate that human–dog therapy teams can safely return to hospital visitation work. This study examined human–animal interactions during the reactivation of a hospital-based therapy dog program during the COVID-19 pandemic. Data were collected from human–dog interactions at an academic medical center in Virginia. Interaction length, participant role, age group (pediatric or adult), and observed gender were recorded. Handler adherence to human and animal safety protocols (donning personal protective equipment (PPE), using hand sanitizer, and limiting visit length) was measured. Observations from 1016 interactions were collected. t-tests and analysis of variance were conducted. Most visit recipients were healthcare workers (71.69%). Patients received longer visits than other participants (F(4880) = 72.90, p = <0.001); post hoc Bonferroni analyses (p = 0.05/4) showed that patients, both adult (M = 2.58 min, SD = 2.24) (95% C.I = 0.35–1.68) and pediatric (M = 5.81, SD = 4.38) (95% C.I. 3.56–4.97), had longer interaction times than healthcare workers (M = 1.56, SD = 1.92) but not visitors (p = 1.00). Gender differences were not statistically significant (t(552) = −0.736), p = 0.462). Hand sanitizer protocols were followed for 80% of interactions. PPE guidelines were followed for 100% of visits. Most interactions occurred with healthcare workers, suggesting that therapy dog visits are needed for this population. High adherence to COVID-19 safety protocols supports the decision to reactivate therapy animal visitation programs in hospitals. Challenges to safety protocol adherence included ultra-brief interactions and crowds of people surrounding the dog/handler teams. Program staff developed a "buddy system" mitigation strategy to minimize departures from safety protocols and reduce canine stress. [ABSTRACT FROM AUTHOR]

Background: Despite their broad commitment to family-centred care, children's hospitals and associated pediatric intensive care units (PICUs) restricted family presence during the COVID-19 pandemic. This study aimed to describe family presence policies and practices in Canadian PICUs from March to May 2020, and their evolution by August to December 2020. Methods: We conducted an environmental scan of family presence policies and restrictions in all 19 Canadian PICUs using 2 methods. We conducted a literature review of public-facing visitation policy documents in June 2020 using a standardized data extraction form. We also administered a cross-sectional survey of PICU leadership (managers and physician chiefs) between August and December 2020 by telephone or videoconferencing. We used inductive content analysis to code qualitative data, generating summative count data. We analyzed quantitative data descriptively. Results: As part of the literature search, we collected 2 (12%) PICU-specific, 14 (82%) pediatric-specific and 1 (6%) hospital-wide visitation policy documents from the early pandemic. One policy document provided guidance on all of the policy elements sought; the number of enabled caregivers was not included in the documents for 7 of 19 units (37%). All 19 Canadian PICUs were represented among the 24 survey respondents (15 physician chiefs and 9 operations or clinical managers). Before the COVID-19 pandemic, all units allowed the presence of 2 or more family members. Early in the pandemic, reported practices limited the number of adult caregivers for patients without SARS-CoV-2 infection to 1 (n = 21/24, 88%) or 2 (n = 3/24, 12%); all units prohibited siblings. Some centres restricted caregivers from switching bedside presence with one another (patients without SARS-CoV-2 infection: n = 16/23, 70%; patients with confirmed or suspected SARS-CoV-2 infection: n = 20/23, 87%); leaving their child's PICU room (patients without SARS-CoV-2 infection: n = 1/24, 4%; patients with confirmed or suspected SARS-CoV-2 infection: n = 16/24, 67%); and joining in-person rounds (patients without SARS-CoV-2 infection: n = 9/22, 41%; patients with confirmed or suspected SARS-CoV-2 infection: n = 17/22, 77%). All respondents endorsed policy exceptions during end-of-life care. Some reported policies and practices were adapted over the study period. Interpretation: Early COVID-19-related family presence policies in Canadian PICUs varied among centres. Although some centres adapted policies and practices, this study revealed ongoing potential threats to family centred care at the mid-pandemic stage. [ABSTRACT FROM AUTHOR]

Purpose The current study aimed to identify the overall characteristics of cancer-related emergency department (ED) visits by adult in Korea, including analyses of factors associated with ED stay time and outcomes nationwide. Materials and Methods We collected data on cancer-related ED visits from the National Emergency Department Information System (NEDIS) database between 2017 and 2019. Results ED visits by cancer patients comprised 5.5% (667,935 visits) of total ED visits from 2017 to 2019, which was slightly higher than in other counties. Patients with cancer who visited the ED were over 50 years old, the majority being males, and patients with cancer visited EDs in certified tertiary hospitals more frequently than patients without cancer. In multivariate analyses, the adjusted odds ratio for a length of stay more than 8 hours in the ED of certified tertiary hospitals was 126.34 (95% confidence interval, 1.422 to 1.460) when compared to hospitals. Nevertheless, the longer the patients stayed in the ED, the more likely they were to be admitted. Conclusion The longer ED stay and higher proportion of cancer patient hospitalizations suggest that cancer patients visit ED to be admitted as well as to receive acute care. The frequency of ED visits and admission may be adjusted to some extent depending on outpatient education, such as self-management of symptoms and situations. Improving cancer care in local communities should be met though provisions such as linking treatment between hospitals or supplying appropriate medical personnel, even for the efficient use of ED resources in hospitals. [ABSTRACT FROM AUTHOR]