Improving triage for children with comorbidity using the ED-PEWS: an observational study

ObjectiveTo assess the value of the Emergency Department–Pediatric Early Warning Score (ED-PEWS) for triage of children with comorbidity.DesignSecondary analysis of a prospective cohort.Setting and patients53 829 consecutive ED visits of children <16 years in three European hospitals (Netherlands, UK and Austria) participating in the TrIAGE (Triage Improvements Across General Emergency departments) project in different periods (2012–2015).InterventionED-PEWS, a score consisting of age and six physiological parameters.Main outcome measureA three-category reference standard as proxy for true patient urgency. We assessed discrimination and calibration of the ED-PEWS for children with comorbidity (complex and non-complex) and without comorbidity. In addition, we evaluated the value of adding the ED-PEWS to the routinely used Manchester Triage System (MTS).Results5053 (9%) children had underlying non-complex morbidity and 5537 (10%) had complex comorbidity. The c-statistic for identification of high-urgency patients was 0.86 (95% prediction interval 0.84–0.88) for children without comorbidity, 0.87 (0.82–0.92) for non-complex and 0.86 (0.84–0.88) for complex comorbidity. For high and intermediate urgency, the c-statistic was 0.63 (0.62–0.63), 0.63 (0.61–0.65) and 0.63 (0.55–0.73) respectively. Sensitivity was slightly higher for children with comorbidity (0.73–0.75 vs 0.70) at the cost of a lower specificity (0.86–0.87 vs 0.92). Calibration was largely similar. Adding the ED-PEWS to the MTS for children with comorbidity improved performance, except in the setting with few high-urgency patients.ConclusionsThe ED-PEWS has a similar performance in children with and without comorbidity. Adding the ED-PEWS to the MTS for children with comorbidity improves triage, except in the setting with few high-urgency patients.

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Patient Markers of Successful Diabetes Management

10.2337/figshare.14057912 ◽

2021 ◽

Author(s):

Amy T. Cunningham ◽

Pouya Arefi ◽

Alexzandra T. Gentsch ◽

Geoffrey D. Mills ◽

Marianna D. LaNoue ◽

...

Keyword(s):

Blood Glucose ◽

Diabetes Management ◽

Demographic Data ◽

Secondary Analysis ◽

Self Report ◽

Structured Interviews ◽

Successful Management ◽

Patient Centered ◽

Care Plans ◽

Ed Visits

Purpose. For individuals with diabetes, diabetes health status may not align with A1C targets. Patients may use nonclinical targets when assessing their diabetes management success. Identifying these targets is important in developing patient-centered management plans. The purpose of this study was to identify patient markers of successful diabetes management among patients in an urban academic health system. Methods. A secondary analysis of semi-structured interviews was completed with 89 adults with type 1 or type 2 diabetes. Participants had a recent diabetes-related emergency department (ED) visits or hospitalization or were primary care patients with an A1C >7.5%. Interviews were conducted to saturation. Demographic data were collected via self-report and electronic medical records. Interviews were analyzed using conventional content analysis. This analysis focused on patient perceptions of successful management coded to “measuring management success.” Results. Although most participants cited A1C or blood glucose as a marker of successful diabetes management, they had varied understanding of these metrics. Most used a combination of targets from the following categories: 1) A1C, blood glucose, and numbers; 2) engagement in medical care; 3) taking medication and medication types; 4) symptoms; 5) diet, exercise, and weight; and 6) stress management and social support. Conclusion. Individuals not meeting glycemic goals and/or with recent diabetes-related ED visits or hospitalizations had varied understanding of A1C and blood glucose targets. They use multiple additional markers of successful management and had a desire for management discussions that incorporate these markers. These measures should be incorporated into their care plans along with clinical targets.

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Decision Support System For Determining Power Loss And Refurbishability Of Failed Automotive Petrol Engine Block And Crankshaft

10.21203/rs.3.rs-585333/v1 ◽

2021 ◽

Author(s):

BASIL OLUFEMI AKINNULI ◽

OLADELE AWOPETU ◽

OLUWASEUN OLUWAGBEMIGA OJO

Keyword(s):

Decision Support ◽

Power Loss ◽

Computer Software ◽

Engine Block ◽

Measuring Instruments ◽

Main Bearing ◽

Test Engine ◽

Cause Of Failure ◽

Improved Performance ◽

The Cost

Abstract The crankshaft and engine block of automobile wear or fail after certain years of usage. The cause of failure is a contributing factor to the power loss of the engine. Power loss reduces the performance of the vehicle. Due to the economic situation in Nigeria, the cost of buying new engines is usually high and some used engines have problems that are latent. Pre-test engine analysis was carried out and torque of each selected engine was measured with a dynamometer to know the speed of the worn engine. Disassembly of four (4) cylinder engines namely; Toyota, Nissan, Mitsubishi, and Mazda were carried out and the affected failed parts, namely; main bearing, crankpin journal, and bore cylinder diameter were determined and the level of their wear as well as power losses ascertained using measuring instruments. For easy computation and analysis, a computer software using C-sharp programming language was developed to determine the power loss and predicting machining level of refurbish-ability and tested for performance evaluation. The model and its developed software are decision support tools for any automotive industry where maintenance and management of engines for improved performance and efficiency of operation is the focus.

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A Straight-Bladed Variable-Pitch VAWT Concept for Improved Power Generation

ASME 2003 Wind Energy Symposium ◽

10.1115/wind2003-524 ◽

2003 ◽

Cited By ~ 7

Author(s):

Yann Staelens ◽

F. Saeed ◽

I. Paraschivoiu

Keyword(s):

Power Output ◽

Angle Of Attack ◽

Correction Function ◽

Wind Speeds ◽

Abrupt Changes ◽

Effective Angle ◽

Improved Performance ◽

Stall Angle ◽

The Cost ◽

Local Angle

The paper presents three modifications for an improved performance in terms of increased power output of a straight-bladed VAWT by varying its pitch. Modification I examines the performance of a VAWT when the local angle of attack is kept just below the stall value throughout its rotation cycle. Although this modification results in a very significant increase in the power output for higher wind speeds, it requires abrupt changes in the local angle of attack making it physically and mechanically impossible to realize. Modification II improves upon the first by replacing the local angle of attack by the blade static-stall angle only when the former exceeds the latter. This step eliminates the two jumps in the local effective angle of attack curve but at the cost of a slight decrease in the power output. Moreover, it requires a discontinuous angle of attack correction function which may still be practically difficult to implement and also result in an early fatigue. Modification III overcomes the limitation of the second by ensuring a continuous variation in the local angle of attack correction during the rotation cycle through the use of a sinusoidal function. Although the power output obtained by using this modification is less than the two preceding ones, it has the inherent advantage of being practically feasible.

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Frequent use of emergency departments for mental and substance use disorders

Emergency Medicine Journal ◽

10.1136/emermed-2015-205554 ◽

2018 ◽

Vol 35 (4) ◽

pp. 220-225 ◽

Cited By ~ 15

Author(s):

Karen Urbanoski ◽

Joyce Cheng ◽

Jürgen Rehm ◽

Paul Kurdyak

Keyword(s):

Substance Use ◽

Mental Disorders ◽

Substance Use Disorders ◽

Service Use ◽

Secondary Analysis ◽

Mental Healthcare ◽

Specialist Care ◽

Ed Visits ◽

Administrative Health Databases

ObjectivesWe described the population of people who frequently use ED for mental disorders, delineating differences by the number of visits for substance use disorders (SUDs), and predicted the receipt of follow-up services and 2-year mortality by the level of ED use for SUD.MethodsThis retrospective observational study included all Ontario residents 15 years and older who had five or more ED visits during any 12-month period from 2010 to 2012 (n=263 346). The study involved a secondary analysis of administrative health databases capturing emergency, hospital and ambulatory care. Frequent ED users for mental disorders (n=5416) were grouped into nested categories based on the number of ED visits for SUD. Logistic regression was used to examine group differences in the receipt of follow-up services and mortality, controlling for sociodemographics, comorbidities and past service use.ResultsThe majority of frequent ED users for mental disorders had at least one ED visit for SUD, most commonly involving alcohol. Relative to people with no visits for SUD, those with ED visits for SUD were older and more likely to be men (Ps <0.001). As the number of ED visits for SUD increased, the likelihood of receiving follow-up care, particularly specialist mental healthcare, declined while 2-year mortality steadily increased (Ps <0.001). These associations remained after controlling for comorbidities and past service use.ConclusionsFindings highlight disparities in the receipt of specialist care based on use of ED services for SUD, coupled with a greater mortality risk. There is a need for policies and procedures to help address unmet needs for care and to connect members of this vulnerable subgroup with services that are better able to support recovery and improve survival.

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Health Services Utilization Among Chinese American Older Adults: Moderation of Social Support With Functional Limitation

Journal of Applied Gerontology ◽

10.1177/0733464818787716 ◽

2018 ◽

Vol 39 (5) ◽

pp. 481-489 ◽

Cited By ~ 1

Author(s):

Jinjiao Wang ◽

Dexia Kong ◽

Benjamin C. Sun ◽

XinQi Dong

Keyword(s):

Social Support ◽

Functional Limitations ◽

Functional Limitation ◽

Secondary Analysis ◽

Chinese American ◽

The United States ◽

Lower Odds ◽

Ed Visits ◽

Older Chinese ◽

Relationship Of

In this study, we aimed to examine the relationship of social support with hospitalizations and emergency department (ED) visits among older Chinese adults in the United States and its possible mechanism. This was a secondary analysis of data from the Population Study of Chinese Elderly (July 2011-June 2013; N = 3,157). After adjusting for demographic, clinical, and functional covariates in logistic regression analyses, significant interaction between social support from spouse and the number of functional limitations in (instrumental) activities of daily living was related to lower odds of hospitalization (odds ratio [OR] = 0.97 [0.95-0.99]) and ED visits (OR = 0.98 [0.96-0.99]). This finding suggests that among older Chinese American adults with functional limitations, more spousal support was related to lower odds of hospitalizations and ED visits. Future studies should comprehensively measure social support (e.g., content, amount) from other sources and investigate how unnecessary acute health service utilization in this population may be reduced by social support interventions.

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Using the Alberta Continuity of Services Observer-Rated Scale to Measure Continuity of Care in a Psychiatric Population

Journal of Nursing Measurement ◽

10.1891/1061-3749.24.1.131 ◽

2016 ◽

Vol 24 (1) ◽

pp. 131-146 ◽

Cited By ~ 1

Author(s):

Amanda Digel Vandyk ◽

Elizabeth G. VanDenKerkhof ◽

Ian D. Graham ◽

Margaret B. Harrison

Keyword(s):

Mental Health ◽

Continuity Of Care ◽

Secondary Analysis ◽

Health Record ◽

Response Options ◽

Record Data ◽

Ed Visits ◽

Psychiatric Population ◽

Scoring Accuracy ◽

The Relationship

Background and Purpose: Continuity of care (CoC) is an important component in the delivery of quality mental health care. Yet, its measurement is inconsistent. We explored the use of the Alberta Continuity of Services Scale for Mental Health (ACSS-MH) observer-rated scale and compared CoC scores in 2 groups (N = 140) of individuals with mental health complaints (5+ and 1 emergency department [ED] visits/year). Methods: Secondary analysis of health record data. Results: The application of the ACSS-MH observer-rated scale in our population is discussed, as well as differences in CoC scores by group. Conclusions: The ACSS-MH observer-rated scale may be useful for obtaining CoC scores in several mental health populations. Minor modifications (e.g., to response options) are suggested that may improve scoring accuracy. Research is needed to further explore the relationship between CoC and ED use.

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Human Evaluation of Internet-Based Bilateral Teleoperation Using Wave Variables With Adaptive Predictor and Direct Drift Control

Dynamic Systems and Control, Parts A and B ◽

10.1115/imece2006-14721 ◽

2006 ◽

Cited By ~ 2

Author(s):

Ho Ching ◽

Wayne J. Book

Keyword(s):

Human Subjects ◽

Transmission Delay ◽

Bilateral Teleoperation ◽

Wave Variables ◽

Human Evaluation ◽

Maze Navigation ◽

Improved Performance ◽

Tracking Surface ◽

The Cost ◽

Drift Control

In a conventional bilateral teleoperation, transmission delay over the Internet can potentially cause instability. The wave variables algorithm can solve this problem at the cost of poor transient response. The wave variables algorithm with adaptive predictor and drift control based on our previous work [24] has been proposed to provide stability under time delay with improved performance. The effectiveness of this algorithm is fully evaluated using human subjects with no previous experience in haptics. Three algorithms are tested using Phantom haptic devices as master and slave: conventional bilateral teleoperation with no transmission delay as control, wave variables with 200-300 ms transmission delay one way, and wave variables with adaptive predictor and direct drift control (WAPD) also with 200-300 ms delay one way. For each algorithm the human subjects are asked to perform three simple tasks: free space trajectory tracking, surface contour identification, and maze navigation. The results show WAPD to be superior to regular wave variables algorithm with higher subject ratings.

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The association between hospitals’ risk-adjusted emergency department visits and survival and costs in kidney cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.609 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 609-609

Author(s):

Joel E Segel ◽

Eric W. Schaefer ◽

Jay D. Raman ◽

Christopher S. Hollenbeak

Keyword(s):

Emergency Department ◽

Cancer Patients ◽

Kidney Cancer ◽

Mortality Rates ◽

Emergency Department Visits ◽

Medicare Data ◽

Initial Surgery ◽

Oncology Care ◽

Ed Visits ◽

The Cost

609 Background: As payers turn to alternative payment models, including the CMS Oncology Care Model, risk-adjusted emergency department (ED) visits are being incorporated as a quality. Yet little is know about this metric compares to existing metrics such as risk-adjusted mortality rates and costs. Methods: Using 2007-2012 SEER-Medicare data, we used logistic regression to model occurrence of an ED visit within 30 and 365 days for all kidney cancer patients receiving initial surgery. Our model controlled for demographics, stage, histology, systemic targeted therapy, and comorbidities. Based on model predictions, we created a ratio of actual versus predicted ED visits for hospitals to identify hospitals with higher and lower than predicted ED visit rates. We estimated the association between the hospitals’ ED visit ratio and hospitals’ risk-adjusted 365-day mortality rates, and 6- and 12-month total costs and total costs (less ED visits). Results: In our sample of 6,078 patients, 15.5% had an ED visit within 30 days of surgery and 43.5% within 365 days. For hospitals with ≥10 patients, we found no statistically significant association between 30-day or 365-day risk-adjusted ED visit rate and their 365-day risk-adjusted mortality rate. While hospitals’ 30-day ED visit rates were significantly associated with 6- and 12-month costs, the association was largely driven by the cost of the ED visit itself. Conversely, hospitals’ 365-day ED visit rates were significantly associated with 12-month costs after excluding the cost of the ED visit. Conclusions: Our results suggest hospitals’ risk-adjusted ED visit rates capture a qualitatively different measure of quality than the more commonly reported mortality rates and is significantly associated with patient cost.

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Simulating the Contact of Golf Club to Ball for Improved Performance

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.846.294 ◽

2016 ◽

Vol 846 ◽

pp. 294-299

Author(s):

Grant P. Steven ◽

Jacob Celermajer

Keyword(s):

Golf Club ◽

Manufacturing Processes ◽

Resin Infusion ◽

Simulation Techniques ◽

Limited Success ◽

Design Variables ◽

Design Changes ◽

Fea Simulation ◽

Improved Performance ◽

The Cost

Long before FEA was developed, people were participating in sports and as competition intensified is became clear that for many sports, the equipment plays as important a part in performance as does the athlete. With the use of modern materials and manufacturing processes there is always scope for maximizing the performance of sporting equipment. Traditionally improvements were incremental, as athletes fed-back suggestions to manufacturers and new prototypes were built and tested. Given the cost of tooling for many of the current manufacturing methods, carbon fibre with resin infusion to mention one, it is clear that such build and test iterations are not as preferable given the potential of limited success and high cost.Modern simulation techniques are capable of examining a “day–in–the-life” of an object and from an examination of the envelope of response the most sensitive regions can be detected. Iteration on the design variables, provided they remain within any constraints, be they physical or otherwise, can be incorporated to investigate their effect on performance.In this paper non-linear transient dynamic (NLTD) FEA is undertaken on a 3 iron golf club impacting a golf ball. During the less than 0.5 millisecond impact the whole outcome of the shit is established. Design changes that can lead to improved performance are studied. From the FEA simulation information on ball top spin, side spin, take off velocity are investigated.

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Variations in the cost of formal and informal health care for patients with advanced chronic disease and refractory breathlessness: A cross-sectional secondary analysis

Palliative Medicine ◽

10.1177/0269216317690994 ◽

2017 ◽

Vol 31 (4) ◽

pp. 369-377 ◽

Cited By ~ 18

Author(s):

Mendwas D Dzingina ◽

Charles C Reilly ◽

Claudia Bausewein ◽

Caroline J Jolley ◽

John Moxham ◽

...

Keyword(s):

Palliative Care ◽

Chronic Disease ◽

Standard Deviation ◽

Advanced Disease ◽

Secondary Analysis ◽

Formal Care ◽

Cross Sectional ◽

Informal Carers ◽

The Cost ◽

Advanced Chronic Disease

Background: Refractory breathlessness in advanced chronic disease leads to high levels of disability, anxiety and social isolation. These result in high health-resource use, although this is not quantified. Aims: To measure the cost of care for patients with advanced disease and refractory breathlessness and to identify factors associated with high costs. Design: A cross-sectional secondary analysis of data from a randomised controlled trial. Setting/participants: Patients with advanced chronic disease and refractory breathlessness recruited from three National Health Service hospitals and via general practitioners in South London. Results: Of 105 patients recruited, the mean cost of formal care was £3253 (standard deviation £3652) for 3 months. The largest contributions to formal-care cost were hospital admissions (>60%), and palliative care contributed <1%. When informal care was included, the total cost increased by >250% to £11,507 (standard deviation £9911). Increased patient disability resulting from breathlessness was associated with high cost (£629 per unit increase in disability score; p = 0.006). Increased breathlessness on exertion and the presence of an informal carer were also significantly associated with high cost. Patients with chronic obstructive pulmonary disease tended to have higher healthcare costs than other patients. Conclusion: Informal carers contribute significantly to the care of patients with advanced disease and refractory breathlessness. Disability resulting from breathlessness is an important clinical cost driver. It is important for policy makers to support and acknowledge the contributions of informal carers. Further research is required to assess the clinical- and cost-effectiveness of palliative care interventions in reducing disability resulting from breathlessness in this patient group.

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