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Aim Methods Results Conclusions Maternal health and gestational control are crucial to improving the newborn's prognosis. This study analyses demographic and obstetric factors at the beginning of pregnancy related to neonatal health, assessing their impact on the risk of hospital admission and prematurity.Observational retrospective study conducted in Northeast Spain with data of 9560 newborns between February 2017 and February 2022. The following have been evaluated as risk factors for hospital admission: nulliparity, multiple gestation, fertilisation techniques, foreign maternal origin, maternal age, smoking and residential location, dividing the sample according to gestational age. Hypothesis testing and logistic regression were performed.Nulliparity, fertilisation techniques and multiple gestation represent a risk factor for neonatal admission (OR 22.48, 4.04 and 3.34, respectively), especially in premature newborns <32 weeks of GA (OR: 30.71, 10.71 and 22.76, respectively). Foreign maternal origin also adds risk of admission, both in term newborns (OR 1.26; CI: 1.10–1.43) and in premature babies <32 weeks of GA (OR 1.61; CI: 1.09–2.38). Tobacco does not present a significant risk of neonatal admission. The multivariate analysis model confirms the influence of the following factors in all the studied groups: nulliparity, multiple gestation and foreign maternal origin.Nulliparity and multiple pregnancies are both main risk factors for neonatal admission and premature delivery. The use of fertilisation techniques and the foreign origin of the mother significantly associate increased risk of admission and neonatal prematurity. These findings underscore the need for a comprehensive approach to prenatal care to improve neonatal prognosis and promote long‐term health in risk populations. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the potential changes in substance use disorder (SUD) admission rates before and after the lockdown in a major addiction center in Saudi Arabia. Method: This retrospective cohort study extracted data from Al-Amal Hospital Electronic Health Record in the city of Dammam, Eastern region of Saudi Arabia. A total of 2,426 cases included in the analysis for patients who received services from the SUD treatment programs from 1/1/2015 to 31/12/2021. Results: Before the pandemic, there was a consistent increase in the admission rates for patients with substance use disorder. The highest proportion of increase were among unemployed, young, newly admitted patients. During lockdown, there was nearly a 70% reduction in SUDs-related admission rate. The age group 18–25 was seven-times more likely to be admitted for SUD after the lockdown. Amphetamine-related admissions were two times more likely to be admitted after the lockdown (Odds ratio (OR) 2.04; confidence interval (CI) 95%[1.64, 2.54]). Conclusions: There was nearly 70% reduction in SUDs admission rates during the lockdown. After the lockdown, a significant proportional increase in amphetamine use disorder admissions was observed mostly among the patients age group 18–24 with a history of a previous admissions. Determining populations at risk for high health care utilization is crucial in building a comprehensive and effective prevention strategy. Therefore, the need to adopt coordinated strategies and innovative, comprehensive approaches to benefit individuals with SUD is imperative to face the increased rate of SUD related admissions. [ABSTRACT FROM AUTHOR]

Our research examines the potential gender identity discrimination within higher education in the U.S. An audit study was conducted by sending emails to admission counselors, where the messages varied in the inclusion of gender pronouns in the signature line. The results indicate a higher response rate for emails which included preferred pronouns, with a response rate increase of approximately four percentage points, regardless of the type of pronoun used. We engage in text analysis and show that responses to inquiries with pronouns received more friendly responses receiving heightened use of exclamation marks, emojis/emoticons, and from a topic modeling algorithm were less likely to be strictly replies explaining the admission process. Finally, we apply machine learning to identify key institution attributes that are useful in predicting heterogeneous responses, and to identify the attributes of institutions where negative discrimination is likely to occur. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) and asthma can be treated with inhaled corticosteroids (ICS) delivered by low climate impact inhalers (dry powder inhalers) or high climate impact inhalers (pressurized metered-dose inhalers containing potent greenhouse gasses). ICS delivered with greenhouse gasses is prescribed ubiquitously and frequent despite limited evidence of superior effect. Our aim was to examine the beneficial and harmful events of ICS delivered by low and high climate impact inhalers in patients with asthma and COPD. Methods: Nationwide retrospective cohort study of Danish outpatients with asthma and COPD treated with ICS delivered by low and high climate impact inhalers. Patients were propensity score matched by the following variables; age, gender, tobacco exposure, exacerbations, dyspnoea, body mass index, pulmonary function, ICS dose and entry year. The primary outcome was a composite of hospitalisation with exacerbations and all-cause mortality analysed by Cox proportional hazards regression. Results: Of the 10,947 patients with asthma and COPD who collected ICS by low or high climate impact inhalers, 2,535 + 2,535 patients were propensity score matched to form the population for the primary analysis. We found no association between high climate impact inhalers and risk of exacerbations requiring hospitalization and all-cause mortality (HR 1.02, CI 0.92–1.12, p = 0.77), nor on pneumonia, exacerbations requiring hospitalization, all-cause mortality, or all-cause admissions. Delivery with high climate impact inhalers was associated with a slightly increased risk of exacerbations not requiring hospitalization (HR 1.10, CI 1.01–1.21, p = 0.03). Even with low lung function there was no sign of a superior effect of high climate impact inhalers. Conclusion: Low climate impact inhalers were not inferior to high climate impact inhalers for any risk analysed in patients with asthma and COPD. [ABSTRACT FROM AUTHOR]

Legal education scholars have argued that law schools strategically use Students of Color for enrollment management purposes; they can admit more to meet admission targets, but they should not enroll so many that they need to open new course sections. As law school applications decline, we analyze enrollment panel data reported to the American Bar Association. We find that examining the intersection of race and gender matters for understanding the ways that law schools are strategic about diversity in enrollment management. For each group (e.g., Black women, White men), law schools balance higher enrollment in one year with lower incoming enrollment of that same group in the subsequent year, thereby working against the racial diversification of legal education and the legal profession. In some instances, higher enrollment in one group (e.g., Hispanic women) also leads to higher enrollment in the subsequent year among incoming students with the same race but different gender (e.g., Hispanic men). This analytical approach—informed by intersectionality—reveals that differential race x gender patterns would be overlooked in analyses that solely focused on race while not considering gender. Moreover, the results are generally robust across models examining both the number and percentage representation of incoming students. Finally, we find evidence that these balancing dynamics are sometimes more pronounced at law schools with higher median LSAT scores, which are typically most selective. We discuss implications for equity in legal education and future research directions for graduate and professional education. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the waiving of GRE/GMAT for admission to master's degree programs in a state university in Florida, USA. Standardized tests, such as GRE/GMAT, were required for admission to the master's degree programs in 2019/2020, waived in 2020/2021, and removed or modified in 2021/2022. We analyzed the application, enrollment, and performance data to assess the impact of these changes. The data show that the number of applicants and enrolled students exhibit an upward trend from 2019 to 2021. The undergraduate GPA of new applicants who did not submit the GRE in 2021 tends to be statistically significantly higher than for those who did submit the GRE in 2019 (p < 0.001). The new students' first-semester graduate GPA in 2021 (no GRE requirement) tends also to be statistically significantly higher than the new students' first-semester graduate GPA in 2019 (GRE requirement) (p < 0.01). The study employed random forest feature importance using the Gini index to analyze the predictive power of GRE and undergraduate GPA for forecasting first-semester graduate GPA. The results show that undergraduate GPA is a more significant factor than GRE. Overall, the study's statistical evidence indicates that waiving GRE/GMAT requirements for master's degree programs did not affect applicants' performance, as measured by their undergraduate GPA, nor did it lead to a decline in student performance, as measured by first-semester graduate GPA. [ABSTRACT FROM AUTHOR]

Background: Previous studies have consistently reported a decrease in hospital admissions for respiratory diseases during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on idiopathic pulmonary fibrosis (IPF) admissions remains unknown. Methods: This study used data from the Korean National Health Insurance Service database. IPF was defined based on the International Classification of Diseases 10th Revision (ICD-10) and rare intractable disease (RID) codes. The rate of IPF admissions was calculated by dividing the number of IPF admissions by the prevalence of IPF. The rate of IPF admissions during the COVID-19 pandemic (2020–2021) was compared with the mean rate of admissions during the prepandemic period (2017–2019) and presented as the rate ratio (RR). A sensitivity analysis was conducted on patients treated with systemic corticosteroids during IPF admission. Results: In patients with IPF defined based on the ICD-10 (analysis 1), the RRs significantly decreased from March in 2020 to December 2021, except for June and September in 2020. Similarly, in patients with IPF defined based on the ICD-10 and RID (analysis 2), the RRs significantly decreased from March 2020 to December 2021, except for June and September 2020. In the sensitivity analysis of analysis 1, the RR significantly decreased in 2020 (0.93; 95%CI: 0.88–0.99; P = 0.029), whereas the RR in 2021 was not significantly different. The RRs in the sensitivity analysis of analysis 2 significantly decreased to 0.85 (0.79–0.92; P < 0.001) in 2020 and 0.82 (0.76–0.88; P < 0.001) in 2021. In the subgroup analysis, the rates of IPF admissions significantly decreased in 2020 and 2021 across both sexes, patients aged ≥ 60 years, and all household income groups. Conclusions: The rate of IPF admissions significantly decreased during the COVID-19 pandemic. This result indicates that preventive measures against COVID-19 may effectively mitigate IPF exacerbation. Therefore, it is assumed that there is a close relationship between respiratory viral infections and IPF exacerbations. [ABSTRACT FROM AUTHOR]

Introduction: The length of stay (LOS) in psychiatric hospitals is regularly used as an indicator of inpatient care efficiency and quality indicator. Psychiatric hospitalizations have been linked to a variety of clinical and patient-related factors. The objectives of this study were to assess the duration of stay in psychiatric hospital in Lebanon and to evaluate the LOS associated factors. Methods: A five years retrospective study was conducted at the Psychiatric hospital of the Cross between January 2018 and December 2022. Data on hospital admissions was obtained from medical files and the LOS was defined as the time in days elapsed between the admission and discharge date as noted in the medical file. Results: The mean duration of the global length of the stay was 28.35 ± 26.57 days, with a range between 2 and 300 and a median of 21.00 days. Being diagnosed with schizophrenia (Beta = 10.25), having a public insurance (Beta = 4.09) and having an intermediate social status (Beta = 3.45) were significantly associated with higher length of stay. Being a female (Beta = − 5.15), married (Beta = − 3.94) and older age (Beta = − 0.17) were significantly associated with lower length of stay. Conclusion: The importance of social factors should be highlighted, as they are necessary components of patients' wellbeing and may facilitate the decision of discharge. Being single, male gender and a diagnosis of schizophrenia were associated with a longer stay at the psychiatric hospital. Further studies are needed to explore the clinical implication of the factors related to LOS in order to identify patients with a higher probability for prolonged hospitalization, to plan necessary interventions for these specific situations. [ABSTRACT FROM AUTHOR]

Introduction: Applicant perceptions of selection impact motivation and performance during selection, and student diversity. However, in-depth insight into which values underly these perceptions is lacking, creating challenges for aligning selection procedures with applicant perceptions. This qualitative interview study aimed to identify values applicants believe should underlie selection, and how, according to applicants, these values should be used to make specific improvements to selection procedures in undergraduate health professions education (HPE). Methods: Thirty-one applicants to five undergraduate HPE programs in the Netherlands participated in semi-structured interviews using Appreciative Inquiry, an approach that focuses on what goes well to create vision for improvement, to guide the interviews. Transcriptions were analyzed using thematic analysis, adopting a constructivist approach. Results: Applicants' values related to the aims of selection, the content of selection, and the treatment of applicants. Applicants believed that selection procedures should aim to identify students who best fit the training and profession, and generate diverse student populations to fulfill societal needs. According to applicants, the content of selection should be relevant for the curriculum and profession, assess a comprehensive set of attributes, be of high quality, allow applicants to show who they are, and be adapted to applicants' current developmental state. Regarding treatment, applicants believed that selection should be a two-way process that fosters reflection on study choice, be transparent about what applicants can expect, safeguard applicants' well-being, treat all applicants equally, and employ an equitable approach by taking personal circumstances into account. Applicants mentioned specific improvements regarding each value. Discussion: Applicants' values offer novel insights into what they consider important preconditions for the design of selection procedures. Their suggested improvements can support selection committees in better meeting applicants' needs. [ABSTRACT FROM AUTHOR]

Current cutting-edge solutions to the spectrum shortage problem are unable to meet the growing demand for a limited spectrum. A key dimension beyond state-of-the-art solutions is to exploit the free spectrum more effectively. Although various schemes have been proposed for trading spectrum, few studies have focused on optimal admission of spectrum requests for maximizing service providers' (SP's) profit. Thus, this timely study presents a novel intelligent admission scheme for spectrum requests from the perspective of a non-cooperative game, in which the information of all participants (customers and providers) is incomplete to others, and each player wishes to maximize its benefit. The proposed control admission policy may evict clients in-service to release spectrum for serving certain, e.g., wealthy clients. Evicted clients are compensated using a dynamic strategy that adopts greedy game theory to capture the conflict of interest between SP and evicted users. Simulation experiment results validate and demonstrate the feasibility and efficiency of the proposed scheme, compared to a benchmark reinforcement learning approach and another widely used scheme for admission and eviction control of cognitive radio users. [ABSTRACT FROM AUTHOR]

Background and Objectives A better understanding of factors associated with assisted living admission and discharge practices can help identify communities that are more likely to allow residents to age in place. This study examined how state regulations and assisted living organizational characteristics related to community admission and discharge practices for bathing, getting out of bed, and feeding. Research Design and Methods Using data from a representative sample of 250 assisted living communities in seven states and a database of assisted living state regulations, we employed multilevel logistic regression models to examine regulatory and organizational correlates of assisted living community admission and discharge practices for 3 activities of daily living (bathing, getting out of bed, and feeding). Results States' regulations were not associated with assisted living community admission and discharge practices. However, assisted living communities above the median in the number of personal care staff members per resident were 17% (95% confidence interval [CI]: 6.5%, 27.1%) more likely to admit residents who needed assistance with feeding and 25.4% (95% CI: −37.7, −13.2) less likely to discharge these residents. For-profit communities were more likely to admit residents with bathing and feeding limitations. Discussion and Implications Organizational characteristics (e.g. for-profit affiliation, staffing levels) may, in part, drive admission and discharge practices, especially related to different care needs. The ability to house residents with advanced care needs may be influenced more by the organizational resources available to care for these residents than by states' admission and discharge regulations. [ABSTRACT FROM AUTHOR]

Introduction: Following the emergence of COVID‐19, multiple preventative measures were implemented to limit the spread of the disease. This study aims to elucidate the impact of COVID‐19 restrictions on hospital admissions of otolaryngology‐related infections. Materials and Methods: A retrospective chart review was conducted to capture all admissions for otolaryngology‐related infections in the 2 years pre‐ and post‐COVID‐19 at the Health Sciences Centre in Winnipeg, Manitoba. These infections included croup, tracheitis, neck abscess, peritonsillar abscess, otitis media, mastoiditis, sinus infection, orbital infection, pharyngotonsillitis, retro/parapharyngeal abscess, and acute epiglottitis. Demographic information and admission details were collected and analyzed to compare pre‐ and post‐COVID‐19 admissions. Further analysis was conducted to compare hospital admissions of patients from rural/remote regions. Results: Between March 2018 and March 2022, 253 pediatric patients and 197 adults were admitted for otolaryngology‐related infections. Total pediatric admissions decreased post‐COVID‐19 (154 pre‐COVID‐19, 99 post‐COVID‐19; p < 0.001) whereas adult admissions remained stable (107 pre‐COVID‐19, 90 post‐COVID‐19; p = 0.25). No significant difference in mean patient age, admission duration, surgical rates or in the proportion of admissions from patients from rural/remote regions was observed in the pediatric or adult cohort when comparing pre‐COVID‐19 data to post‐COVID‐19 data. Diagnosis‐specific changes in admissions were observed in pediatric croup (40 pre‐COVID‐19, 15 post‐COVID‐19; p < 0.001) and in adult orbital infections (30 pre‐COVID‐19, six post‐COVID‐19; p < 0.001). Conclusion: Following the implementation of COVID‐19 restrictions, there was a decrease in admissions due to pediatric croup and adult orbital infections with an overall decrease in pediatric Otolaryngology‐infection related admissions. Level of Evidence: 3 Laryngoscope, 134:3542–3547, 2024 [ABSTRACT FROM AUTHOR]

Abstract Background Chronic obstructive pulmonary disease (COPD) and asthma can be treated with inhaled corticosteroids (ICS) delivered by low climate impact inhalers (dry powder inhalers) or high climate impact inhalers (pressurized metered-dose inhalers containing potent greenhouse gasses). ICS delivered with greenhouse gasses is prescribed ubiquitously and frequent despite limited evidence of superior effect. Our aim was to examine the beneficial and harmful events of ICS delivered by low and high climate impact inhalers in patients with asthma and COPD. Methods Nationwide retrospective cohort study of Danish outpatients with asthma and COPD treated with ICS delivered by low and high climate impact inhalers. Patients were propensity score matched by the following variables; age, gender, tobacco exposure, exacerbations, dyspnoea, body mass index, pulmonary function, ICS dose and entry year. The primary outcome was a composite of hospitalisation with exacerbations and all-cause mortality analysed by Cox proportional hazards regression. Results Of the 10,947 patients with asthma and COPD who collected ICS by low or high climate impact inhalers, 2,535 + 2,535 patients were propensity score matched to form the population for the primary analysis. We found no association between high climate impact inhalers and risk of exacerbations requiring hospitalization and all-cause mortality (HR 1.02, CI 0.92–1.12, p = 0.77), nor on pneumonia, exacerbations requiring hospitalization, all-cause mortality, or all-cause admissions. Delivery with high climate impact inhalers was associated with a slightly increased risk of exacerbations not requiring hospitalization (HR 1.10, CI 1.01–1.21, p = 0.03). Even with low lung function there was no sign of a superior effect of high climate impact inhalers. Conclusion Low climate impact inhalers were not inferior to high climate impact inhalers for any risk analysed in patients with asthma and COPD.

Abstract Background Previous studies have consistently reported a decrease in hospital admissions for respiratory diseases during the coronavirus disease 2019 (COVID-19) pandemic. However, the impact of the pandemic on idiopathic pulmonary fibrosis (IPF) admissions remains unknown. Methods This study used data from the Korean National Health Insurance Service database. IPF was defined based on the International Classification of Diseases 10th Revision (ICD-10) and rare intractable disease (RID) codes. The rate of IPF admissions was calculated by dividing the number of IPF admissions by the prevalence of IPF. The rate of IPF admissions during the COVID-19 pandemic (2020–2021) was compared with the mean rate of admissions during the prepandemic period (2017–2019) and presented as the rate ratio (RR). A sensitivity analysis was conducted on patients treated with systemic corticosteroids during IPF admission. Results In patients with IPF defined based on the ICD-10 (analysis 1), the RRs significantly decreased from March in 2020 to December 2021, except for June and September in 2020. Similarly, in patients with IPF defined based on the ICD-10 and RID (analysis 2), the RRs significantly decreased from March 2020 to December 2021, except for June and September 2020. In the sensitivity analysis of analysis 1, the RR significantly decreased in 2020 (0.93; 95%CI: 0.88–0.99; P = 0.029), whereas the RR in 2021 was not significantly different. The RRs in the sensitivity analysis of analysis 2 significantly decreased to 0.85 (0.79–0.92; P

Abstract Introduction Applicant perceptions of selection impact motivation and performance during selection, and student diversity. However, in-depth insight into which values underly these perceptions is lacking, creating challenges for aligning selection procedures with applicant perceptions. This qualitative interview study aimed to identify values applicants believe should underlie selection, and how, according to applicants, these values should be used to make specific improvements to selection procedures in undergraduate health professions education (HPE). Methods Thirty-one applicants to five undergraduate HPE programs in the Netherlands participated in semi-structured interviews using Appreciative Inquiry, an approach that focuses on what goes well to create vision for improvement, to guide the interviews. Transcriptions were analyzed using thematic analysis, adopting a constructivist approach. Results Applicants’ values related to the aims of selection, the content of selection, and the treatment of applicants. Applicants believed that selection procedures should aim to identify students who best fit the training and profession, and generate diverse student populations to fulfill societal needs. According to applicants, the content of selection should be relevant for the curriculum and profession, assess a comprehensive set of attributes, be of high quality, allow applicants to show who they are, and be adapted to applicants’ current developmental state. Regarding treatment, applicants believed that selection should be a two-way process that fosters reflection on study choice, be transparent about what applicants can expect, safeguard applicants’ well-being, treat all applicants equally, and employ an equitable approach by taking personal circumstances into account. Applicants mentioned specific improvements regarding each value. Discussion Applicants’ values offer novel insights into what they consider important preconditions for the design of selection procedures. Their suggested improvements can support selection committees in better meeting applicants’ needs.

Introduction: Leaving hospital care prematurely could threaten the healthy survival of and expose children to a risk of harmful alternatives. It is also a concern and a challenge to healthcare providers and the health system. A better understanding of itscharacteristic could help mitigate the impact on children. Objective: To determine the prevalence, types of, and reasons for premature hospital discharge amongst children. Methods: We carried out a threeyear retrospective review of case notes of children who were taken away from hospital admission by their parents/caregivers before they were due for discharge. Socio-demographic, clinical and discharge information were collected and data was entered into Microsoft® Excel® for Mac 2011 (Version 14.1.0), cleaned and analysed. Results were presented as percentages, statistical means and standard deviations, tables and charts. Results: There were 56 cases of premature discharge out of 2858 admissions, giving a prevalence of 2.0%. Under-five children constituted 65.4%, with a male: female ratio of 2.3:1. Thirty-one (55.3%) children were absconded with while 25 (44.7%) were taken away by caregivers against medical advice. The commonest diagnoses were protein-energy malnutritionand pneumonia and majority were from poor socio-economic family background. The commonest reasons for discharge AMA were unaffordable costs and perception of improvement of child’s medical condition. Conclusion: Socio-economic factors were significant determinants of utilization of in-patient hospital services for the children studied. There is a need for provision of affordable health care as well as efficient discharge policy to protect children from potential risksassociated with premature hospital discharge.

Abstract Through preferential treatment by education officials or through bribery, some adolescents can obtain admission to a junior high school. However, it is unclear whether it affects the mental health of adolescents. This study used Propensity Score Matching to examine the effects of corruption on adolescent mental health. A total of 17,254 junior high school students sample (11–18 years old; 48.7% girls and 53.1% boys) were used from the China Education Panel Survey. 14.1% of adolescents attended a junior high school by corrupt means, corruption had a significantly negative effect on the mental health of these adolescents (ATT = −0.388, p

Saron Naji Gebremariam, Faisel Dula Sema, Abdisa Gemedi Jara, Gizework Alemnew Mekonnen Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Saron Naji Gebremariam, Email saronnaji@gmail.comBackground: Medication-related hospital admission (MRHA) is hospitalization due to drug-related problems. MRHAs have been reported to be on the rise in recent decades.Objective: This study was aimed at determining the prevalence, patterns, and predictors of MRHA among patients visiting the emergency ward of the University of Gondar comprehensive specialized hospital, Ethiopia.Methods: A cross-sectional study was conducted from June 1, 2022, to August 30, 2022 G.C. in the emergency ward at the University of Gondar Comprehensive Specialized Hospital. The AT-HARM 10 tool was used to collect data from participants who fulfilled the inclusion criteria. Data was entered into EpiData Manager 4.6.0.0 and was exported to Statistical Package for Social Sciences (SPSS) version 24 for analysis. Descriptive statistics were presented using frequency and percentage. Binary logistic regression was applied to identify factors associated with MRHAs with a 95% confidence level, and significance was declared at a p-value < 0.05.Results: The prevalence of MRHAs was 30.5% (95% CI = 27.7– 36.4%). More than half (64.52%) of MRHAs were definitely preventable. The majority of MRHAs (48.39%) were severe. Non-compliance (41.12%), followed by untreated indication (26.61%) and adverse drug reaction (12.09%) were the most frequent causes of MRHAs. Renal impairment (AOR = 2.703, 95% CI: 1.29 to 5.663), chronic disease (AOR = 10.95, 95% CI: 4.691 to 25.559), history of traditional medication use (AOR = 2.089, 95% CI: 1.162 to 3.755), and history of hospitalization (AOR = 4.001, 95% CI: 1.98 to 8.089) were significantly associated with MRHAs.Conclusion: MRHAs were substantially prevalent. Most of the MRHAs were definitely preventable. Renal impairment, chronic disease, history of traditional medication use, and history of hospitalization were predictors of MRHAs. At the university hospital, health care providers should strive to prevent and manage MRHAs appropriately.Keywords: medication, admission, Gondar

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

In this paper, we investigate the waiving of GRE/GMAT for admission to master’s degree programs in a state university in Florida, USA. Standardized tests, such as GRE/GMAT, were required for admission to the master’s degree programs in 2019/2020, waived in 2020/2021, and removed or modified in 2021/2022. We analyzed the application, enrollment, and performance data to assess the impact of these changes. The data show that the number of applicants and enrolled students exhibit an upward trend from 2019 to 2021. The undergraduate GPA of new applicants who did not submit the GRE in 2021 tends to be statistically significantly higher than for those who did submit the GRE in 2019 (p < 0.001). The new students’ first-semester graduate GPA in 2021 (no GRE requirement) tends also to be statistically significantly higher than the new students’ first-semester graduate GPA in 2019 (GRE requirement) (p < 0.01). The study employed random forest feature importance using the Gini index to analyze the predictive power of GRE and undergraduate GPA for forecasting first-semester graduate GPA. The results show that undergraduate GPA is a more significant factor than GRE. Overall, the study’s statistical evidence indicates that waiving GRE/GMAT requirements for master’s degree programs did not affect applicants’ performance, as measured by their undergraduate GPA, nor did it lead to a decline in student performance, as measured by first-semester graduate GPA.

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

Simple Summary: Wild birds are at risk of death owing to human activities, including indirect human threats, such as environmental pollution, habitat destruction, and climate change. This study was conducted to analyze the records of birds rescued by the Jeonbuk Wildlife Center in the Republic of Korea to identify the problems and trends in terms of injury and disease that most affect free-living wild birds. From January 2019 to February 2021, medical records, including species, date, and location of rescue, cause of hospitalization, diagnosis, and treatment records, were obtained for all admitted birds. The analysis included 1464 birds belonging to 106 species. The main admitted causes were being orphaned, window collisions, and trauma from unknown reasons. Inflammatory conditions were predominant in diagnoses mainly caused by trauma and infection. The most frequent diagnoses were dehydration, integumentary injuries, and neurological injuries. The inflammation-related diagnosis accounted for 82% of all diagnoses. Insufficient reports are available on what clinical and pathological conditions are observed in rescued free-living wild birds. This study investigated recent diagnoses of admitted wild birds based on admission causes in a southwestern area of South Korea over the past 2 years. A retrospective study was conducted on 1464 birds rescued from 2019 to February 2021. Overall, 12 admission subcategories were classified, and the diagnoses identified for each cause were analyzed. The three most frequently observed categories, general, integumentary, and musculoskeletal, each accounted for 20% of the total diagnoses. Trauma accounted for 71.4% of all diagnoses, and 81.5% featured inflammatory conditions, primarily due to trauma or infection. The proportion of birds that presented inflammatory conditions was much greater than the proportion of birds that were admitted due to trauma-related causes. This was because inflammatory diseases were identified at a high frequency, even from nontraumatic admission causes, and inflammatory conditions were not easily revealed. Suspecting an inflammatory condition in most rescued birds is advisable. [ABSTRACT FROM AUTHOR]

Widening participation outcomes in admissions to UK medical schools have not changed 2007–2018, partly due to inequity in selection. This study models the effects of changing selection, using a novel method of contextualising applicants, on widening participation. We studied 1084 English school leaver applicants to a single medical school over two years, using data from their public exams taken 2 years pre-application (GCSE) and recent admissions test (UCAT). Widening participation was defined by postcode. We modelled two shortlists for a pre-determined number of 500; one ranked on UCAT total score, and the other on a metric that contextualised applicants' GCSE grades against their schools' average GCSE performance. There was a significant difference in the postcode-defined widening participation characteristics of the two shortlists; 46% by contextualisation and 32.2% by UCAT (Chisquare p < 0.00001). As widening participation covers 42% of postcodes, the "contextualise everyone" method achieves equity. Conventionally, contextual admissions identify individuals belonging to under-represented groups and gives them preferential treatment. Changing the rules for everyone, by using a relative attainment instead of simple absolute attainment metric, benefits from treating applicants equally; and could promote equity through widening participation. [ABSTRACT FROM AUTHOR]

Objectives: During the coronavirus disease (COVID‐19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on dementia) were profoundly affected by an abrupt transformation in healthcare systems. Here, we evaluated quality‐care outcomes, including length of stay (LOS), in‐hospital mortality, early readmission and mortality after hospital discharge, in older adults admitted for AMS during the pandemic and compared them to patients admitted prior to the pandemic. Methods: Chi‐squared and Fisher's exact tests were used to examine changes to admissions for AMS before and during the pandemic, and their outcomes. Logistic regression analyses, with reference to pre‐pandemic data, were conducted to examine the impact of the pandemic on outcomes. Design: Prospective data of 21,192 non‐COVID admissions to an acute general medical department in a Surrey (UK) hospital were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021). Results: There were 10,173 (47.7% men) from the pre‐pandemic and 11,019 (47.5% men) from the pandemic periods; overall mean age = 68.3yr. During the pandemic AMS patients had significantly higher admission rates (1.1% vs 0.6%, P < 0.001). However, median LOS in hospital was shorter (9.0 days [IQR = 5.3–16.2] vs 15.5 days [IQR = 6.2–25.7], P < 0.001) and thus were less likely to stay in hospital >3 weeks: adjusted OR = 0.26 (95%CI = 0.12–0.57). In‐hospital mortality and readmission within 28 days of discharge did not change during the pandemic, but were less likely to die within 30 days of discharge: adjusted OR = 0.32 (95%CI = 0.11–0.96). Conclusions: This combination of higher admission rate, shorter LOS, and an unchanging early readmission suggests a higher admission‐discharge turnover of different patients with AMS and provides important insights into the potential impact of the COVID‐19 pandemic on healthcare delivery to individuals with AMS. Key points: During the coronavirus disease (COVID‐19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on delirium) were profoundly affected by an abrupt transformation in healthcare systems.Patients admitted with AMS during the pandemic had higher admission rates but shorter length of stay (LOS) in hospital, whilst mortality in hospital and readmission within 28 days of discharge did not change during the pandemicThese observations suggest a higher admission‐discharge turnover of different patients with AMS and provide important insights into the potentially impact of the COVID‐19 pandemic on healthcare delivery to individuals with AMS. [ABSTRACT FROM AUTHOR]

The fiction of non-entry is a legal fiction usually employed by States at their borders. Such a fiction is based on the distinction between the physical presence of a person on the national territory and her legal entitlement to cross the border and reside herewith. More precisely, the fiction of non-entry revolves around the concept of admission and on the premise that unadmitted migrants (i.e. migrants not fulfilling the entry conditions and, therefore, refused entry, or migrants awaiting admission) at the borders, despite being physically present on the territory, are not to be considered so for legal purposes. By this mean, States are able to deny the application of the ordinary legal regime, institutionalizing a detrimental legal framework for unadmitted migrants at the borders as opposed to the one applicable to regular or even irregular migrants within the national territory. The purpose of this article is to explore the role of such a fiction in European migration law, namely in the context of EU law and the ECtHR jurisprudence, with a focus on the issues of admission on national territory, detention and expulsion. Moreover, this contribution aims at showing how this legal construct is to become increasingly central to European migration law. Indeed, the fiction of non-entry is currently at the core of the new "integrated border procedure" proposed within the 2020 new pact on migration and asylum. Therefore, the contribution will analyse the consequences of such an institutionalization on the rights of migrants at the EU external borders. [ABSTRACT FROM AUTHOR]

The significant rise in the number of forcibly displaced people crossing international borders, i.e., refugees, necessitates a thorough examination of the policies implemented by receiving states to manage the arrival of these vulnerable populations. This article reviews the literature on the factors that influence refugee policies, focusing on two dimensions of host state responses: admission and integration. We argue that there may be an inherent tension between refugee admissions and refugee integration policies, as countries attempt to restrict benefits when admission numbers increase. Further, we highlight how refugee policies are influenced by international and domestic constraints and priorities that can at times be conflicting or complementary. The article ultimately advocates for a systematic analysis of the endogenous relationship between refugee policies, public perception of refugees, and migration patterns. [ABSTRACT FROM AUTHOR]

Universal screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on admission is reportedly beneficial in preventing nosocomial infections. However, some issues remain, including low positivity rate, cost, and time required for testing. We describe SARS-CoV-2 reverse transcription polymerase chain reaction (PCR) for universal screening in asymptomatic patients on planned admissions. In total, 14,574 patients were included between October 12, 2020, and June 23, 2022. The PCR-positive rate for the period was 0.44 % (64/14,574). The PCR positivity for the epidemic period by strain was 0.28 % (95 % confidence interval [CI] 0.12–0.56 %), 0.16 % (95 % CI 0.05–0.37 %), 0.21 % (95 % CI 0.09–0.41 %), and 0.9 % (95 % CI 0.65–1.2 %) for the wild-type strain, Alpha, Delta, and Omicron variants, respectively. The proportion of Ct values < 30 was higher in the first half of the epidemic (first vs. second, 29.4 % [95 % CI 16.9–44.8 %] vs. 16.7 % [95 % CI 6.0–28.5 %]), whereas that of Ct values ≥ 35 increased significantly in the second half (first vs. second, 32.4 % [95 % CI 19.3–47.8 %] vs. 70.0 % [95 % CI 53.5–83.4 %]). Of all positives, 50 % (32/64) had a coronavirus disease (COVID-19) history before PCR screening, with a median of 28 days (10–105) from COVID-19 onset or positive to PCR screening. PCR screening may help detect positives with high viral loads early in the epidemic for each mutant strain, with an increasing proportion of positives with low viral loads later in the epidemic. PCR testing may be unnecessary for recently diagnosed cases and patients in whom reinfection is unlikely. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of standard care (SoC) combined with supervised in-bed cycling (Bed-Cycle) or booklet exercises (Book-Exe) versus SoC in community-acquired pneumonia (CAP). Methods In this randomized controlled trial, 186 patients with CAP were assigned to SoC (n = 62), Bed-Cycle (n = 61), or Book-Exe (n = 63). Primary outcome length of stay (LOS) was analyzed with analysis of covariance. Secondary outcomes, 90-day readmission, and 180-day mortality were analyzed with Cox proportional hazard regression and readmission days with negative-binominal regression. Results LOS was −2% (95% CI: −24 to 25) and −1% (95% CI: −22 to 27) for Bed-Cycle and Book-Exe, compared with SoC. Ninety-day readmission was 35.6% for SoC, 27.6% for Bed-Cycle, and 21.3% for Book-Exe. Adjusted hazard ratio (aHR) for 90-day readmission was 0.63 (95% CI:.33–1.21) and 0.54 (95% CI:.27–1.08) for Bed-Cycle and Book-Exe compared with SoC. aHR for 90-day readmission for combined exercise was 0.59 (95% CI:.33–1.03) compared with SoC. aHR for 180-day mortality was 0.84 (95% CI:.27–2.60) and 0.82 (95% CI:.26–2.55) for Bed-Cycle and Book-Exe compared with SoC. Number of readmission days was 226 for SoC, 161 for Bed-Cycle, and 179 for Book-Exe. Incidence rate ratio for readmission days was 0.73 (95% CI:.48–1.10) and 0.77 (95% CI:.51–1.15) for Bed-Cycle and Book-Exe compared with SoC. Conclusions Although supervised exercise training during admission with CAP did not reduce LOS or mortality, this trial suggests its potential to reduce readmission risk and number of readmission days. Clinical Trials Registration NCT04094636. [ABSTRACT FROM AUTHOR]

An estimated 39 million individuals globally were living with human immunodeficiency virus (HIV) at the end of 2022 with approximately 1.3 million individuals newly infected during 2022. Similarly, the number of people living with HIV (PWH) has consistently increased in Korea and the number of PWH seeking emergency care is expected to increase. This study aimed to elucidate utilization patterns of emergency department (ED) of PWH and identify key indicators that predict admission and poor prognosis. This was a single-center retrospective study of HIV-positive adult patients who visited the ED between 01 January 2013 and 31 December 2022. Data was collected at the visit level and analyzed using the generalized estimating equation method. Visits were categorized into direct hospital admissions from the ED or discharges to home to evaluate admission-associated factors. Additionally, visits in the poor prognosis group were compared with the remainder to elucidate prognostic indicators. The poor prognosis group was defined as admitted visits with intensive care unit placement, visits with inhospital mortality, or both. Annually, an average of 8.9 per 10,000 ED visits were made by PWH, with an admission rate of 49.8%. A total of 369 ED visits corresponding to 183 PWH were included in the analysis, and 93% of them were on highly active antiretroviral therapy. Underlying chronic renal failure, presenting with fever or general weakness, supplemental oxygen administration, or ancillary department consultation in the ED increased admission odds. Ambulance use, high triage level and use of oxygen in the ED were associated with poor prognosis. Most notably, higher levels of blood urea nitrogen (BUN) or lactic acid were independent factors of poor prognosis. We hope these analytic insights from 10 years of institutional data will assist emergency physicians in providing timely informed care to HIV-infected individuals visiting the ED, ultimately leading to improved patient outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Situational Judgement Tests (SJT) are a cost-efficient method for the assessment of personal characteristics (e.g., empathy, professionalism, ethical thinking) in medical school admission. Recently, complex open-ended response format SJTs have become more feasible to conduct. However, research on their applicability to a German context is missing. This pilot study tests the acceptability, reliability, subgroup differences, and validity of an online SJT with open-ended response format developed in Canada ("Casper"). Methods: German medical school applicants and students from Hamburg were invited to take Casper in 2020 and 2021. The test consisted of 12 video- and text-based scenarios, each followed by three open-ended questions. Participants subsequently evaluated their test experience in an online survey. Data on sociodemographic characteristics, other admission criteria (Abitur, TMS, HAM-Nat, HAM-SJT) and study success (OSCE) was available in a central research database (stav). Results: The full sample consisted of 582 participants. Test-takers' global perception of Casper was positive. Internal consistency was satisfactory in both years (α=0.73; 0.82) while interrater agreement was moderate (ICC(1,2)=0.54). Participants who were female (d=0.37) or did not have a migration background (d=0.40) received higher scores. Casper scores correlated with HAM-SJT (r=.18) but not with OSCE communication stations performance. The test was also related to Abitur grades (r=-.15), the TMS (r=.18), and HAM-Nat logical reasoning scores (r=.23). Conclusion: This study provides positive evidence for the acceptability, internal consistency, and convergent validity of Casper. The selection and training of raters as well as the scenario content require further observation and adjustments to a German context to improve interrater reliability and predictive validity. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the associations between environmental temperature and schizophrenia admissions in Liuzhou, China. A Poisson generalized linear model combined with a distributed lag nonlinear model was used to analyze the effects of daily mean temperature on schizophrenia admissions from 2013 to 2020 in Liuzhou. Additionally, subgroup analyses were conducted to investigate possible modifications stratified by gender, marital status, and age. In this study, 10,420 schizophrenia admissions were included. The relative risks of schizophrenia admissions increased as the temperature rose, and the lag effects of high temperature on schizophrenia admissions were observed when the daily mean temperature reached 21.65°C. The largest single effect was observed at lag0, while the largest cumulative effect was observed at lag6. The single effects of high temperatures on schizophrenia admissions were statistically significant in both males and females, but the cumulative effects were statistically significant only in males, with the greatest effect at lag0–7. The single effect of high temperatures on admissions for unmarried schizophrenics was greatest at lag5, while the maximum cumulative effect for unmarried schizophrenia was observed at lag0–7. The single effects of high temperatures on schizophrenia admissions were observed in those aged 0–20, 21–40, and 41–60. The cumulative effects for schizophrenics aged 21–40 were observed from lag0–3 to lag0–7, with the maximum effect at lag0–7. In conclusion, the risk of schizophrenia admissions increased as the environmental temperature increased. The schizophrenics who were unmarried appeared to be more vulnerable to the single and cumulative effects of high temperature. [ABSTRACT FROM AUTHOR]

Objective: To investigate the hypothesis that day-case cochlear implantation is associated with equal quality of life, hearing benefits and complications rates, compared to inpatient cochlear implantation. Study design: A single-center, non-blinded, randomized controlled, equivalence trial in a tertiary referral center. Methods: Thirty adult patients with post-lingual bilateral sensorineural hearing loss eligible for unilateral cochlear implantation surgery were randomly assigned to either the day-case or inpatient treatment group. The effect on general quality of life, patient satisfaction, (subjective) hearing improvement, postoperative complications and causes of crossover and/or readmission were assessed using questionnaires, auditory evaluations and patients' charts over a follow-up period of 1 year. Results: Overall quality of life measured by the HUI3 was equal between the day-case (n = 14) and inpatient group (n = 14). The overall patients' satisfaction showed a slight favor towards an inpatient approach. There was no significant difference in the subjective and objective hearing improvement between both treatment groups. During the 1-year follow-up period no major complications occurred. Minor complications occurred intraoperatively in three day-case patients resulting in three out of nine admissions of day-case patients. Other causes of admission of day-case patients were nausea and vomiting (n = 1), drowsiness (n = 1), late scheduled surgery (n = 2), social reasons (n = 1), or due to an unclear reason (n = 1). No patients required readmission. Conclusion: We found equal outcomes of QoL, patient satisfaction, objective, and subjective hearing outcomes between day-case and inpatient unilateral cochlear implantation. Nine out of 14 day-case patients were admitted for at least one night postoperatively (crossover). No major complications occurred in both groups. A day-case approach seems feasible when using specific patient selection, surgical planning and the preoperative provision of patient information into account. Besides this, the familiarity with a day-case approach of both patient and the surgical team can increase the feasibility of day-case surgery. Level of evidence: 1. [ABSTRACT FROM AUTHOR]

While most friction burns are adequately managed in an outpatient setting, many may require hospital admission, operative excision, and extended care. To this day, there is a wide variance in friction burn management. Our goal is to review the etiology, management, and outcomes of such burns warranting hospitalization. We conducted a retrospective review of all friction burns admitted to a single, American Burn Association-verified burn center from January 1, 2016 to December 31, 2020. A total of 28 (34%) patients required surgery for their friction burns and 15 (18%) ultimately required a split-thickness skin graft. The mean number of operations was 2.4 (95% CI 1.6-3.1). Overall, the operative group was younger (29.9 vs 38.3 years, P =.026), more likely to have a concomitant traumatic brain injury (25% vs 7%, P =.027), and had a longer hospital length of stay (17.5 vs 3.9 days, P <.001). Both groups had a similar overall TBSA (8.5% vs 10.0%, P =.35), but the operative group had a larger surface area comprised of third-degree burns (3.05% vs 0.2%, P <.001). Overall, friction burns resulting in hospital admission are associated with high-energy traumatic mechanisms and concomitant injuries. Patients who need operative intervention for their burns typically require multiple procedures often culminating in a split-thickness skin graft. While non-operative management of friction burns with topical agents has been found to be successful, patients with higher injury severity scores should be monitored very closely as they may require surgical excision. [ABSTRACT FROM AUTHOR]

Introduction: Most developing regions of the world are undergoing gradual epidemiological transition resulting in high burden of both communicable and noncommunicable diseases. Morbidity and mortality pattern is a reflection of disease burden. Detailed assessment of these parameters tends to aid in formulating pivotal aspects of in-hospital policies, standards of care and so consequently promoting efficient work systems. The aim of this study is to identify the pattern of mortalities in medical wards in a tertiary care hospital. Methods: This retrospective descriptive cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital focusing on all patients admitted to the medical wards (General Medical, Hepatology, Nephrology, Neurology, Endocrinology, Pulmonology, Cardiology and Gastrology) between January 1 to December 31, 2023 after obtaining ethical approval from Institutional Review Committee (Reference Number: 390/2080/81). Total population sampling was done. Data were analyzed using Microsoft Excel and SPSS. Results: Among 10124 admitted patients in medical wards, mortality was reported in 732 (7.22%). The number of deaths seen in general medical ward was 389 (53.14%) and in liver ward was 85 (11.61%). Systemic cause of death due to respiratory diseases was 157 (21.5%) and liver disease was 143 (19.6%). Conclusions: The respiratory disease is responsible for a higher proportion of deaths among admitted patients. However, the deaths due to liver disease are increasing because of the rise in cirrhosis of the liver in the younger age group.

Background: Guidelines recommend high-sensitivity cardiac troponin (hs-cTn) for diagnosis of myocardial infarction. Use of hs-cTn is increasing across the U.S., but questions remain regarding clinical and operational impact. Prior studies have had methodologic limitations and yielded conflicting results. Objective: To evaluate the impact of transitioning from conventional cardiac troponin (cTn) to hs-cTn on test and resource utilization, operational efficiency, and patient safety. Design: Retrospective cohort study in two New York City hospitals during the months before and after transition from conventional cTn to hs-cTn at Hospital 1. Hospital 2 served as a control. Participants: Consecutive emergency department (ED) patients with at least one cTn test resulted. Intervention: Multifaceted hs-cTn intervention bundle, including a 0/2-h diagnostic algorithm for non-ST-elevation myocardial infarction, an educational bundle, enhancements to the electronic medical record, and nursing interventions to facilitate timed sample collection. Main Measures: Primary outcomes included serial cTn test utilization, probability of hospital admission, ED length of stay (LOS), and among discharged patients, probability of ED revisit within 72 h resulting in hospital admission. Multivariable regression models adjusted for age, sex, temporal trends, and interhospital differences. Key Results: The intervention was associated with increased use of serial cTn testing (adjusted risk difference: 48 percentage points, 95% CI: 45–50, P < 0.001) and ED LOS (adjusted geometric mean difference: 50 min, 95% CI: 50–51, P < 0.001). There was no significant association between the intervention and probability of admission (adjusted relative risk [aRR]: 0.99, 95% CI: 0.89–1.1, P = 0.81) or probability of ED revisit within 72 h resulting in admission (aRR: 1.1, 95% CI: 0.44–2.9, P = 0.81). Conclusions: Implementation of a hs-cTn intervention bundle was associated with an improvement in serial cTn testing, a neutral effect on probability of hospital admission, and a modest increase in ED LOS. [ABSTRACT FROM AUTHOR]

Our retrospective database study investigates sex-stratified predictors of prolonged operative time (POT) and hospital admission following parathyroidectomy for primary hyperparathyroidism (PHPT). The 2016 to 2018 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for patients with PHPT undergoing parathyroidectomy. Cases analyzed were all outpatient status, arrived from home, coded as non-emergent, and elective. POT was defined by the 75th percentile. Hospital admission was defined as LOS ≥ 1 day. Univariate and multivariable binary logistic regressions were utilized. Of 7442 cases satisfying inclusion criteria, the majority were female (78.0%) and White (78.5%). Median OT (IQR) for females and males was 77 (58–108) and 81 (61–109) minutes, respectively (P = 0.003). 1965 (33.9%) females and 529 (32.3%) males required hospital admission. Independent predictors of POT included ASA class III/IV (aOR 1.342, 95% CI 1.007–1.788) and obesity (aOR 1.427, 95% CI 1.095–1.860) for males (P < 0.05). Independent predictors of hospital admission included age (aOR 1.008, 95% CI 1.002–1.014), ASA class III/IV (aOR 1.490, 95% CI 1.301–1.706), obesity (aOR 1.309, 95% CI 1.151–1.489), dyspnea (aOR 1.394, 95% CI 1.041–1.865), chronic steroid use (aOR 1.674, 95% CI 1.193–2.351), and COPD (aOR 1.534, 95% CI 1.048–2.245) for females (P < 0.05); and ASA class III/IV (aOR 1.931, 95% CI 1.483–2.516) and bleeding disorder (aOR 2.752, 95% CI 1.443–5.247) for males (P < 0.005). In conclusion, predictors of POT and hospital admission following parathyroidectomy for PHPT differed by patient sex. Identifying patients at risk for POT and hospital admission may optimize healthcare resource utilization. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Archive document scanning refers to the procedure of converting physical paper records into digital formats, such as images or text files, and establishing a systematic workflow to preserve and access these archived files electronically over an extended period [1]. With the growing acceptance of mobility and digitalization worldwide, institutions such as libraries, government offices, museums, and universities are increasingly adopting document scanning as means to safeguard and preserve historical documents and records. This approach is particularly valuable in preventing the natural degradation and aging of physical documents, as highlighted by Scan2Archive [2]. The purpose of the Admission and Registrar Office (ARO) Mobile Document Scanner with Archiving System is to support the registrar's office in managing student requests and admissions as well as handling the documents that are presented during the enrollment. The office of the registrar will experience a transformation in document handling with the development of a document archiving system, which will promote operational excellence, security, and transparency. With the help of this system, the office's procedures for managing vital records--such as student transcripts, enrollment requirements, and other important paperwork--will be completely transformed. The basis for the development of the system is transforming paper-based records into a digitally accessible format. In evaluating the effectiveness of the application and the system's operation it specified the performance requirements for the software evaluation. The star topology was used as part of the communication interfaces. The thirty (30) respondents tabulated the data in each of the different features of the system are accuracy, user-friendliness, reliability, operability, learning reinforcement, interactivity, compatibility, and the cross-platform environment was rated as "excellent". The application was made to help the whole process become much more convenient to the admin and staff of the university. [ABSTRACT FROM AUTHOR]

Background: Heart failure with reduced ejection fraction (HFrEF) poses significant health risks. Midodrine for maintaining blood pressure in HFrEF, requires further safety investigation. This study explores midodrine’s safety in HFrEF through extensive matched analysis. Methods: Patients with HFrEF (LVEF <50%) without malignancy, non-dialysis dependence, or non-orthostatic hypotension, were enrolled between 28 August 2013, and 27 August 2023. Propensity score matching (PSM) created 1:1 matched groups. Outcomes included mortality, stage 4 and 5 chronic kidney disease (CKD), emergency room (ER) visits, intensive care unit (ICU) admissions, hospitalizations, and respiratory failure. Hazard ratios (HR) with 95% confidence intervals (95% CI) were calculated for each outcome, and Kaplan-Meier survival analysis was performed. Subgroup analyses were conducted based on gender, age (20-<65 vs. ≥65), medication refill frequency, and baseline LVEF. Results: After 1:1 PSM, 5813 cases were included in each group. The midodrine group had higher risks of respiratory failure (HR: 1.16, 95% CI: 1.08–1.25), ICU admissions (HR: 1.14, 95% CI: 1.06–1.23), hospitalizations (HR: 1.21, 95% CI: 1.12–1.31), and mortality (HR: 1.090, 95% CI: 1.01–1.17). Interestingly, midodrine use reduced ER visits (HR: 0.77, 95% CI: 0.71–0.83). Similar patterns of lower ER visit risk and higher risks for ICU admissions, respiratory failure, and overall hospitalizations were observed in most subgroups. Conclusion: In this large-scale study, midodrine use was associated with reduced ER visits but increased risks of respiratory failure, prolonged ICU stays, higher hospitalizations, and elevated mortality in HFrEF patients. Further research is needed to clarify midodrine’s role in hemodynamic support and strengthen existing evidence. [ABSTRACT FROM AUTHOR]

Introduction and Background: The COVID-19 pandemic of 2020 has greatly impacted healthcare service and disruption in functioning of hospitals worldwide. The applied restrictive preventive measures affected patients’ decision to visit emergency departments (ED) hospitals seeking surgical consultation and other medical care. However, there are numbers of problems that contribute to the noticeable decrease of ED visits in the pandemic period. With the upsurge of confirmed cases of covid-19 patients, people are getting anxious of ED visits in fear of hospital acquired infection. The kingdom of Saudi Arabia, one of the best countries successfully applied the highly restrictive health measures to prevent and spread of with COVID-19 was on March 2nd, 2020. Aim: This study aims to assess and compare the impact of COVID-19 pandemic on emergency department admissions volume of emergency surgical patients in King Faisal General Hospital, Makkah, Saudi Arabia. Methods: A retrospective cohort study was conducted including All patients who visited King Faisal Hospital ED, and required general surgery consultation from 2019 and 2021,six months before and similar period during the pandemic covid-19. Data were collected from medical records of patient who visited ED and required surgical consultation, in pre and during pandemic period. Data were analyzed and compared to a corresponding nonpandemic period covering the same time interval in 2019 and 2021. A pre-structured data collection sheet for each period that consists of four primary sections was used to avoid data extraction errors. Results: A total of 872 patients were included in this study, during 2019, 256 (29.4%) during 2020, and 616 (70.7%) during 2021. Exact of 67% of those who attended at 2019-2021 were regular patients versus to 70.7% of others who attended at 2020. As for level of triage, it was CAT 2 among 48.1% of cases admitted during 2019- 2021 versus 46.9% of cases admitted during 2020. Considering length of hospital stay, 33.6% of cases admitted during 2019-2021 were for 1 day versus 27.3% of those admitted during 2020 while admission for 2-4 days was reported among 42.2% and 36.7%, respectively (P=.004). Conclusion: In conclusion, the current study showed that there was a significant drop at the number of patients attended to ED and reduced the length of hospital stay during the peak of covid-19 pandemic. The indirect impact of Covid-19 on the healthcare system can help improve treatment strategies in future outbreaks. [ABSTRACT FROM AUTHOR]

Rising length of stay and inpatient boarding in emergency departments have directly affected patient satisfaction and nearly all provider-to-patient care metrics. Prior studies suggest that ED observation has significant clinical and financial benefits including decreasing hospitalization and length of stay. ED observation is one method long employed to shorten ED length of stay and to free up inpatient beds, yet many patients continue to be admitted to the hospital with an average hospital length of stay of only one day. The objectives of this study were to evaluate whether vigorous tracking and provider reviews of one day hospital admits affected the utilization of ED observation and whether this correlated with significant change in rates of admission from observation status. Between September 2020 and May 2021, in a tertiary care hospital with an annual ED volume of 55,0000, chart reviews of 24-h inpatient discharges were initiated by two senior EM faculty to determine perceived suitability for ED observation. Non-punitive email reviews were then initiated with ED attending providers in order to encourage evaluation of whether these patients would have benefitted from being placed into observation. We then analyzed ED observation patient volumes and subsequent admission rates to the hospital from ED observation and compared these numbers to baseline ED observation volume and admission rates between September 2018 and May 2019. A total of 1448 reviews were conducted on 24-h discharges which correlated with an increase in utilization of ED observation from 11.77% (95% CI [11.62, 12.31]) of total ED volume in our control period to 14.21% (95% CI [13.84, 14.58]) during the study period. We found that the overall admission rate from ED observation increased from 20.12% (95% CI [18.97, 21.26]) baseline to 23.80% (95% CI [22.60, 25.00]) during the same time periods. Our data suggest that increasing the total number of patients placed into observation by 21% correlated with a relative increase in admission rates from ED observation by 18%. This would suggest that our efforts to potentially include more patients into our observation program led to a significant increase in subsequent admission rates. There is likely a balance that must be struck between under- and over-utilization of ED observation, and expanding ED observation may be an effective solution to hospital boarding and ED overcrowding. [ABSTRACT FROM AUTHOR]

Patients present to emergency departments (EDs) from a variety of backgrounds, which may help inform decision making. This study investigated the clinical characteristics and outcomes of outpatient department (OPD)-referred patients and self-referred patients in the ED. We selected nontrauma ED adult patients from a tertiary teaching hospital in Taiwan between August 1, 2020, and October 31, 2020. The acuity levels were determined by dichotomizing the triage classification scores. After propensity score matching, we compared the hospitalization, mortality, and length of ED stay of OPD-referred and self-referred patients. We categorized the patients into "emergency" or "urgent" subgroups according to their triage information and then analyzed the effects of different severity levels. Statistical significance was set at p < 0.05. A total of 564 OPD-referred and 11,959 self-referred patients were included. After propensity score matching, the OPD-referred patients (n = 564), compared with self-referred patients (n = 564), had a higher admission rate (49.8% vs. 28.9%; p < 0.001; odds ratio [OR] 2.44). Among the emergency subgroup patients, there was no significant difference between OPD-referred patients (n = 131) and self-referred patients (n = 138) regarding the admission rate (p = 0.257) or the mortality rate (p = 0.253). Among the urgent subgroup patients, OPD-referred patients (n = 433), compared with self-referred patients (n = 426), had a significantly higher admission rate (46.0% vs. 20.2%; p < 0.001; OR 3.36), but not mortality rate (2.1% vs. 0.5%; p = 0.064). Regarding the length of ED stay, OPD-referred and self-referred patients had a significant difference only in the "urgent and discharged" subgroup (5.8 vs. 2.3 h; p < 0.001). OPD-referred ED patients might have more severe and complex conditions and need comprehensive care management. [ABSTRACT FROM AUTHOR]

Objective: Admissions to hospitals for people with anorexia nervosa (AN) often last over 2 months, during which significant time is often spent with other patients, but there is little qualitative research on the impact on recovery of the inter‐patient relationships. Our aim was to conduct qualitative interviews with people with a history of inpatient treatment for AN, focusing on the impact of interactions and relationships between patients during hospital admission on recovery, including short‐term and long‐term effects. Method: We conducted nine semi‐structured, one‐to‐one interviews, specifically exploring the helpful and unhelpful aspects of inter‐patient relationships during inpatient treatment for AN. No type of relationship was either included or excluded. Participants were recruited as volunteers in response to an online advertisement; all who met the eligibility criteria were selected. Interviews were transcribed and analyzed using thematic analysis. Results: Thematic analysis identified five themes: (1) comparison and justification, (2) learnt unhelpful behaviors, (3) dealing with distress, (4) compassion, and (5) role‐modeling. All participants expressed conflicting feelings about their relationships with other patients, but generally described developing more resilience to negative effects as they got closer to recovery. Positive effects, such as compassion, appeared to hold significance long term in participants' recovered lives. Discussion: The detailed exploration of themes in this study provides a deeper understanding of inter‐patient relationships during inpatient treatment for AN. This could aid clinical decision‐making when choosing appropriate treatment settings for individual patients as well as informing clinical practice in hospital. Public Significance: This study closely examines the effect on recovery of relationships with other patients during hospital treatment for AN, a severe eating disorder. Findings might help hospital staff to understand the feelings of those they look after and develop ways to protect patients from the negative effects of peer relationships and enhance the positive ones, to support recovery in hospital. [ABSTRACT FROM AUTHOR]

• Perinatal mortality is similar in inpatient and outpatient vasa praevia patients. • Outpatient vasa praevia patients are associated with prolonged gestation. • Outpatient vasa praevia patients have higher emergency caesarean rates. • Outpatient management of asymptomatic vasa praevia patients should be considered. Vasa praevia is a serious pregnancy complication that is potentially life-threatening for the fetus. The possible benefits of prophylactic hospital admission of asymptomatic women diagnosed with vasa praevia antenatally remain unclear. This study aims to compare the pregnancy outcomes of inpatient versus outpatient management in women with a prenatal diagnosis of vasa praevia. A systematic search of four electronic databases was conducted and two reviewers independently screened studies for eligibility. The inclusion criteria incorporated studies with prenatally diagnosed vasa praevia, a distinction on whether women were managed as inpatients and/or outpatients and where perinatal mortality was recorded as an outcome. The primary outcome of the study was perinatal mortality with additional outcomes of perinatal morbidity, need for emergency caesarean and antenatal steroid administration. Reporting of the results followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search produced 2,300 studies with ten of these studies included in the qualitative synthesis and four included in the quantitative analysis. There was no significant difference in perinatal mortality (OR 1.12, 95 % CI 0.10–12.07, p = 0.93, I2 = 0 %) or morbidity between women managed as inpatients or outpatients. The prophylactic inpatient group had higher rates of earlier gestational delivery and antenatal corticosteroid administration (OR 10.78, 95 % CI 1.07–108.74, p = 0.04, I2 = 82 %), but lower rates of emergency caesareans (OR 0.35, 95 % CI 0.17–0.72, p = 0.004, I2 = 0 %). There were no significant differences in perinatal mortality or morbidity rates observed between inpatient and outpatient management of asymptomatic women with antenatally diagnosed vasa praevia. However, outpatient management is associated with prolonged gestation, a decrease in antenatal corticosteroid administration, and higher odds of emergency caesarean. Outpatient management of prenatally diagnosed vasa praevia seems appropriate for carefully selected asymptomatic women. [ABSTRACT FROM AUTHOR]

High sensitivity cardiac troponins (hs-cTn) allow earlier identification and exclusion of acute myocardial infarction. We determined if transitioning from contemporary to high sensitivity troponin T (hs-cTnT) would reduce ED length of stay in chest pain (CP) patients. We conducted a pragmatic, prospective, before and after study of implementing a hs-cTnT by reviewing the electronic health records in all adult ED patients presenting to a large, suburban academic medical center during the 3 months before and after transitioning from a 4th generation troponin to a 5th generation hs-cTnT (Elecsys® Troponin T -high sensitive, Roche Diagnostics, Indianapolis, IN). There were 1431 and 1437 CP patients before and after the intervention. Mean (SD) age was 51.5 (18) yrs. and 54.3% were female. The median (IQR) ED LOS for chest pain patients directly discharged to home was 6.2 (4.7–8.4) and 5.3 (4.0–7.2) hours before and after introducing hs-cTn respectively; difference 47 min (95%CI, 35–59); P < 0.001. The median (IQR) ED LOS for chest pain patients admitted to the hospital was 9.5 (6.6–13.8) and 8.1 (5.7–11.2) hours before and after introducing hs-cTn respectively; difference 77 min (95%CI, 35–121); P < 0.001. Overall admission rates (22 vs 21% both before and after) did not change during the study. The rates of computed tomography coronary angiography before and after the intervention were 21 and 20.4% respectively. The rates of invasive coronary angiography before and after the intervention were 5.8 and 5.6% respectively. Transitioning to a hs-cTnT is associated with a clinically relevant and statistically significant reduction in ED LOS for both discharged and admitted patients with and without CP with no increase in admission or coronary angiography rates. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with bacterial meningitis can be severely ill necessitating intensive care unit (ICU) treatment. Here, we describe clinical features and prognostic factors of adults with bacterial meningitis admitted to the ICU in a nationwide prospective cohort study. Methods We prospectively assessed clinical features and outcome of adults (age > 16 years) with community-acquired bacterial meningitis included in the MeninGene study between March 1, 2006 and July 1, 2022, that were initially admitted to the ICU. We identified independent predictors for initial ICU admission and for unfavourable outcome (Glasgow Outcome Scale score between 1–4) by multivariable logistic regression. Results A total of 2709 episodes of bacterial meningitis were included, of which 1369 (51%) were initially admitted to the ICU. We observed a decrease in proportion of patients being admitted to the ICU during the Covid-19 pandemic in 2020 (decreased to 39%, p = 0.004). Median age of the 1369 patients initially admitted to the ICU was 61 years (IQR 49–69), and the rates of unfavourable outcome (47%) and mortality (22%) were high. During the Covid-19 pandemic, we observed a trend towards an increase in unfavourable outcome. Prognostic factors predictive for initial ICU admission were younger age, immunocompromised state, male sex, factors associated with pneumococcal meningitis, and those indicative of systemic compromise. Independent predictors for unfavourable outcome in the initial ICU cohort were advanced age, admittance to an academic hospital, cranial nerve palsies or seizures on admission, low leukocyte count in blood, high C-reactive protein in blood, low CSF: blood glucose ratio, listerial meningitis, need for mechanical ventilation, circulatory shock and persistent fever. 204 of 1340 episodes (15%) that were initially not admitted to the ICU were secondarily transferred to the ICU. The rates of unfavourable outcome (66%) and mortality (30%) in this group were high. Conclusions The majority of patients with community-acquired bacterial meningitis are admitted to the ICU, and the unfavourable outcome and mortality rates of these patients remain high. Patients that are initially admitted to non-ICU wards but secondarily transferred to the ICU also had very high rates of unfavourable outcome.

Abdallah Y Naser,1 Hassan Al-shehri2 1Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan; 2Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi ArabiaCorrespondence: Abdallah Y Naser, Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan, Tel +962795285555, Email abdallah.naser@iu.edu.joPurpose: To analyze the hospitalization patterns associated with postprocedural complications among the pediatric population in England and Wales over the past two decades.Patients and Methods: This was an ecological study using hospital admission data extracted from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales for the period between April 1999 and April 2020. Postprocedural complications related hospital admissions were identified using the 10th version of the International Statistical Classification of Diseases (ICD) system (D78, E89, H59, H95, J95, L76, M96, and N99).Results: The rate of hospital admissions declined by 2.1% [from 8.32 (95% CI 7.75– 8.88) per 100,000 persons in 1999 to 8.15 (95% CI 7.61– 8.68) per 100,000 persons in 2020, p> 0.05]. The primary reasons for hospital admissions associated with postprocedural complications were related to the respiratory system, genitourinary system, and ear and mastoid process, constituting 43.0%, 23.8%, and 23.0% of cases, respectively.Conclusion: The trend of postprocedural complications among the pediatric population has been stable in the past two decades. Continuous monitoring of the hospitalization pattern for this type of complication is important due to advancements in healthcare provision and to improve patient care and safety. Future studies are needed to examine gender-based differences related to postprocedural complications and identify important preventable risk factors.Keywords: admission, England, hospital, postprocedural, Wales

Mohammad R Naqeeb,1 Abdallah Y Naser2 1College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 2Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, JordanCorrespondence: Mohammad R Naqeeb, College of Medicine, Umm Al-Qura University, Makkah, 21421, Saudi Arabia, Tel +966555505011, Email mrnaqeeb@uqu.edu.saPurpose: The aim of this study was to examine hospitalisation profiles related to postprocedural disorders of eye and adnexa in England and Wales.Patients and Methods: This was an ecological study using publicly available data extracted from the “Hospital Episode Statistics (HES) database” in England and the “Patient Episode Database for Wales (PEDW)” for the period between April 1999 and April 2020. Diagnostic code for postprocedural disorders of eye and adnexa (H59) was used to identify hospital admission. We used the chi-squared test to assess the difference between the hospital admission rates between 1999 and 2020.Results: Hospital admission rate decreased by 6.3% [from 4.98 (95% CI 4.79– 5.17) in 1999 to 4.67 (95% CI 4.50– 4.84) in 2020 per 100,000 persons, trend test, p< 0.05]. The most common hospital admissions causes were other postprocedural disorders of eye and adnexa “Chorioretinal scars after surgery for detachment.” The age group 75 years and above accounted for 44.3% of the total number of admissions. Hospital admission rate among females decreased by 30.2% [from 5.90 (95% CI 5.61– 6.19) in 1999 to 4.12 (95% CI 3.89– 4.35) in 2020 per 100,000 persons]. Hospital admission rate among males increased by 30.2% [from 4.02 (95% CI 3.77– 4.26) in 1999 to 5.23 (95% CI 4.97– 5.49) in 2020 per 100,000 persons].Conclusion: This study revealed that hospital admission rates for postprocedural disorders of the eye and adnexa decreased over the course of the study period. Eye and adnexa disorders accounted for the preponderance of hospital admissions among the elderly. Further research is required to identify risk factors that can be avoided.Keywords: admission, adnexa, eye, disorders, postprocedural

Background: Traumatic brain injury (TBI) is a common cause of death and disability, the incidence of which in northern Sweden is not fully investigated. This study classifies and characterize epidemiological and demographic features of TBIs in a defined population in Umeå county, Sweden. Specifically, to evaluate frequencies of (1) intracranial lesions detected with computed tomography (CT), (2) need for emergency intervention, and (3) hospital admission, in minimal, mild, moderate, and severe TBI, respectively. Methods: The data were gathered from 4057 TBI patients visiting our emergency room (ER) during a two-year period (2015–2016), of whom 56% were men and approximately 95% had minimal TBIs (Glasgow Coma Scale (GCS), score 15). Results: Of all injuries, 97.8% were mild (GCS 14–15), 1.7% were moderate (GCS 9–13), and 0.5% were severe (GCS < 9). CT scans were performed on 46% of the patients, with 28% being hospitalized. A high annual TBI incidence of 1350 cases per 100,000 citizens was found. The mortality rate was 0.5% with the majority as expected in the elderly group (>80 years). Conclusions: Minimal TBIs were not as mild as previously reported, with a relatively high frequency of abnormal CT findings and a high mortality rate. No emergency intervention was required in patients in the GCS 13–15 group with normal CT scans. These findings have implications for clinical practice in the ER with the suggestion to include biomarkers to reduce unnecessary CT scans. [ABSTRACT FROM AUTHOR]