Lymphedema as a Meteoropathic Disease Based on a Retrospective Study in a Single Institute: a Preliminary Report

Since cellulitis is one of the most important factors for the prognosis of lymphedema, the prevention and prediction of cellulitis are considered to be critical in controlling lymphedema. We hypothesized that patients with lymphedema might show meteoropathy, as abdominal aortic aneurysm ruptures are considered to be influenced by climatic conditions, and the lymphatic system is one of the circulation systems. Thus, we aimed to determine if the onset of cellulitis in limbs affected by lymphedema is related to climatic conditions. We reviewed the clinical records of patients with lymphedema admitted for cellulitis at our institute between January 2007 and December 2017. We identified 40 patients, 25 of whom lived in the same area. We examined the association between the number of patient admissions according to season and meteorological data obtained from the Japan Meteorological Agency database. Thirteen of 25 patients were admitted in summer, whereas only one patient was admitted in winter. Both higher temperature and lower atmospheric pressure around the day of admission were associated with the occurrence of cellulitis. Lymphedema may be regarded as a meteoropathic disease, as climatic conditions were shown to be associated with cellulitis in limbs affected by lymphedema.

Suicidal ideations and suicide attempts prior to admission to a psychiatric hospital in the first six months of the COVID-19 pandemic: interrupted time-series analysis to estimate the impact of the lockdown and comparison of 2020 with 2019

Background There is a substantial burden on global mental health as a result of the Coronavirus disease 2019 (COVID-19) pandemic that has become putting pressure on healthcare systems. There is increasing concern about rising suicidality consequential to the COVID-19 pandemic and the measures taken. Existing research about the impact of earlier epidemics and economic crises as well as current studies about the effects of the pandemic on public mental health and populations at risk indicate rising suicidality, especially in the middle and longer term. Aims This study investigated the early impact of the COVID-19 pandemic on suicidality by comparing weekly in-patient admissions for individuals who were suicidal or who attempted suicide just before admission, for the first 6 months after the pandemic's onset in Switzerland with corresponding 2019 control data. Method Data was collected at the Psychiatric University Hospital of Zurich. An interrupted time-series design was used to analyse the number of patients who were suicidal. Results Instead of a suggested higher rate of suicidality, fewer admissions of patients with suicidal thoughts were found during the first 6-months after the COVID-19 outbreak. However, the proportion of involuntary admissions was found to be higher and more patients have been admitted after a first suicide attempt than in the corresponding control period from 2019. Conclusions Although admissions relating to suicidality decreased during the pandemic, the rising number of patients admitted with a first suicide attempt may be an early indicator for an upcoming extra burden on public mental health (and care). Being a multifactorial process, suicidality is influenced in several ways; low in-patient admissions of patients who are suicidal could also reflect fear of contagion and related uncertainty about seeking mental healthcare.

Exploring factors influencing patient mortality and loss to follow-up in two paediatric hospital wards in Zamfara, North-West Nigeria, 2016–2018

Introduction Child mortality has been linked to infectious diseases, malnutrition and lack of access to essential health services. We investigated possible predictors for death and patients lost to follow up (LTFU) for paediatric patients at the inpatient department (IPD) and inpatient therapeutic feeding centre (ITFC) of the Anka General Hospital (AGH), Zamfara State, Nigeria, to inform best practices at the hospital. Methods We conducted a retrospective cohort review study using routinely collected data of all patient admissions to the IPD and ITFC with known hospital exit status between 2016 and 2018. Unadjusted and adjusted rate ratios (aRR) and respective 95% confidence intervals (95% CI) were calculated using Poisson regression to estimate the association between the exposure variables and mortality as well as LTFU. Results The mortality rate in IPD was 22% lower in 2018 compared to 2016 (aRR 0.78; 95% CI 0.66–0.93) and 70% lower for patients coming from lead-affected villages compared to patients from other villages (aRR 0.30; 95% CI 0.19–0.48). The mortality rate for ITFC patients was 41% higher during rainy season (aRR 1.41; 95% CI 1.2–1.6). LTFU rates in ITFC increased in 2017 and 2018 when compared to 2016 (aRR 1.6; 95% CI 1.2–2.0 and aRR 1.4; 95% CI 1.1–1.8) and patients in ITFC had 2.5 times higher LTFU rates when coming from a lead-affected village. Conclusions Our data contributes clearer understanding of the situation in the paediatric wards in AGH in Nigeria, but identifying specific predictors for the multifaceted nature of mortality and LTFU is challenging. Mortality in paediatric patients in IPD of AGH improved during the study period, which is likely linked to better awareness of the hospital, but still remains high. Access to healthcare due to seasonal restrictions contributes to mortalities due to late presentation. Increased awareness of and easier access to healthcare, such as for patients living in lead-affected villages, which are still benefiting from an MSF lead poisoning intervention, decreases mortalities, but increases LTFU. We recommend targeted case audits and qualitative studies to better understand the role of health-seeking behaviour, and social and traditional factors in the use of formal healthcare in this part of Nigeria and potentially similar settings in other countries.

E-contact tracing of hospital infections – validation of SIRSZ automatic risk assessment

Aim. Contact networks play a crucial role in infectious disease propagation and position in the network mediate risk of acquiring or sending infections. We studied the spread of hospital-associated infections through computer simulations and validated our ‘computer assisted’ risk assessment with ‘human’ risk assessment in a prospective study.Concept. We collected time-varying structure of contacts and covariates reconstructed from Polish Hospitals:1. The organisational structure is mapped by a set of questionnaires, CAD maps integration, functional paths annotation and local vision. It is done mostly by surveys within medical staff through an interactive web application.2. The Cohabitation layer processes data from the registry of patient admissions and discharges from each hospital unit (wards, clinics, etc.) and medical shift register. With simulated infection paths, we were able to compute network centrality measures for patients. We obtained the risk of getting infected, based on the patient’s incoming connections, and the risk of spreading infections resulting from outgoing connections. We compare various standard centrality measures – position of patients and staff in contact networks (‘computer assisted’ risk assessment) of both contacts and paths networks, with a predictor of ‘human’ risk perception (based on 190 patients).Results. We showed that the best predictor of HAI risk is Adjusted Rage Rank on paths (r= 0.42, p < 0.01). However, surprisingly good predictive power in risk assessment was found in the betweenness centrality of the underlying network of contacts (r = 0.30, p < 0.01).Conclusion: We conclude that epidemiology of a given pathogen in a given place and time could be explained only with the contact network only to a large extent. However, further possibility of the collection, processing and storage of the data on individual persons, translated to mathematical modelling could lead in future to satisfactory improvement in risk assessment.

Innovations in clinical documentation integrity practice: Continual adaptation in a data-intensive healthcare organisation

Background Numbers of clinical documentation integrity specialists (CDIS) and CDI programs have increased rapidly. CDIS review patient records concurrently with patient admissions and visits to ensure that information is accurate, complete and non-ambiguous, and query clinicians when they see opportunities for improving data. The occupation was initially focused on improving data for reimbursement, but rapid changes to clinical coding requirements, technologies and payment systems led to a quickly evolving role for CDI programs and changes in CDIS practice. Objective This case study seeks to uncover the ongoing innovation and adaptation occurring in a CDI program by tracing the evolution of a single CDI program over time. Method We present a case study of the CDI program at the HonorHealth hospital system in Arizona. Results The HonorHealth CDI program holds a unique hybrid expertise and role within the healthcare organisation that allows it to rapidly adapt to support emergent demands both internal and external to the organisation, such as supporting accurate data collection for the COVID-19 pandemic. Conclusion CDIS are a vital component in present data-intensive resourcing efforts. The hybrid expertise of CDIS and capacity for adaption and relationship building has enabled the HonorHealth CDI program to adapt rapidly to meet a growing array of clinical documentation integrity needs, including emergent needs during the COVID-19 pandemic. Implications The HonorHealth case study can guide other CDI programs in adaptation of the CDI role and practices in response to changing organisational needs.

The hidden danger of lithium battery powered electric bicycles and scooters: A case series of the Israeli National Burn Center experience

Electric powered bicycles and scooters that use rechargeable lithium batteries are an urban transportation alternative and have become increasingly popular. However, in recent years, there has been an increase in patient admissions to the Israeli National Burn Center with burns associated with their use. In this case series of all patients (n=9) referred to the Emergency Department (February 2016 - October 2020) with lithium related battery burns from electric powered bicycles and scooters, we present burn depth, size, treatment, inhalation injuries and hospitalization. All patients were admitted to in the Israeli National Burn Center for treatment. The average total burn surface area was 27.5% (range 3-57%). All but one patient had a combination of partial to full-thickness burns affecting the upper and lower limbs. Three patients sustained inhalation injuries and a total of four patients required intubation. Seven patients required surgery that included debridement and, in most cases, skin grafting. The availability and increase in the use of battery powered bicycles and scooters may lead to an increase in injuries and death if consumers are not aware of the potential dangers related to the safe use of lithium batteries.

Fast, Reliable, and Simple Point-of-Care-like Adaptation of RT-qPCR for the Detection of SARS-CoV-2 for Use in Hospital Emergency Departments

During COVID-19 pandemics, the availability of testing has often been a limiting factor during patient admissions into the hospital. To circumvent this problem, we adapted an existing diagnostic assay, Seegene Allplex SARS-CoV-2, into a point-of-care-style direct qPCR (POC dqPCR) assay and implemented it in the Emergency Department of Clinical Hospital Center Rijeka, Croatia. In a 4-month analysis, we tested over 10,000 patients and demonstrated that POC-dqPCR is robust and reliable and can be successfully implemented in emergency departments and similar near-patient settings and can be performed by medical personnel with little prior experience in qPCR.

An Analysis of Admissions to a Refugee Child Mental Health Unit in the Context of the COVID-19 Pandemic

Background To examine the admissions to a refugee child outpatient mental health unit in the COVID-19 pandemic and to compare them with the pre-pandemic period. Methods This retrospective observational study, planned through the hospital information system and patient files, included the 1-year number of outpatient unit admissions, sociodemographic, and clinical data. Results Before the COVID-19 pandemic (March 2019–February 2020), a total of 2322 patients (local and refugee) applied to the same unit, and 236 (10.1%) of these patients were refugees. Since the commencement of the COVID-19 pandemic in Turkey (March 2020–February 2021), 1209 patients applied, and 10.4% ( n = 126) of them were refugees. While 19.66 ± 6.31 refugees applied per month in the pre-pandemic period, this number decreased to 10.50 ± 5.31 during the pandemic period ( p = 0.01). During the pandemic period, there was a significant decrease in the number of female refugee patient admissions. In addition, while admissions for external disorders increased significantly during the pandemic period ( x 2 = 13.99, p = 0.001), admissions for internal disorders decreased significantly ( x 2 = 4.54, p = 0.03). Conclusions The decrease in the mental health unit demands with the pandemic may lead to negative consequences in the long term. To determine mental health and psychological needs of patients during the outbreak will greatly contribute to the pandemic management process.

The Analysis of the Main Working Parameters of the Head Regional Vascular Center of N.V. Sklifosovsky Research Institute for Emergency Medicine

Introduction. The regional vascular centers (RVC) network was created throughout Russia to manage cardiovascular diseases. On the basis of N.V. Sklifosovsky Research Institute for Emergency Medicine in Moscow, a center was created, which received the status of the head RVC. A comprehensive analysis of its work has not yet been carried out.Aim of study. To assess the main performance indicators and development directions of the head RVC based on the analysis of data for 2012–2019.Results. Analysis of the data obtained showed that by 2019 the flow of patient admissions increased 2.3-fold. At the same time, the use of the hospital bed fund does not exceed 100%, and the use of the intensive care bed fund has increased to 123%. A significant proportion of patients come with not field-specific diagnosis. The mortality, which is the main indicator of the quality of treatment in patients treated at the RVC, remained within 2.33–3%, which turned out to be 3 times lower in similar patients treated in other departments of the Institute.Discussion. Against the background of a constant increase in the number of hospitalizations, resusci-tation provision turned out to be insufficient when the number of hospital beds corre-sponded to the flow of admissions. The general lack of intensive care beds in the center and the lack of specialized intensive care for the department of vascular surgery forces the use of other intensive care units of the Institute. The admission of patients with other (not specific for RVC) diagnosis to the vascular center reduces the volume of highly specialized care for specialized patients.Conclusion. The analysis of the performance indicators of the head regional vascular center on the basis of N.V. Sklifosovsky Research Institute for Emergency Medicine, identified the need to expand the resuscitation bed fund in the existing departments of the center and organize specialized resuscitation for patients of the vascular surgery department. Also, the lack of intensive care beds is aggravated by a large flow of non-core admissions. Their reduction with the existing structure will provide significant savings in resources and will increase the number of treated profile patients and improve the quality of highly specialized care.

Linkage of National Congenital Heart Disease Audit data to hospital, critical care and mortality national datasets to enable research focused on quality improvement

Objectives To link five national datasets (three registries, two administrative) and create longitudinal health care trajectories for patients with congenital heart disease (CHD), describing the quality and the summary statistics of the linked dataset. Design Bespoke linkage of record-level patient identifiers across five national datasets. Generation of spells of care defined as periods of time-overlapping events across the datasets. Setting National congenital heart disease audit (NCHDA) procedures in public (NHS) hospitals in England and Wales, paediatric and adult intensive care datasets (PICANet and ICNARC-CMP), administrative hospital episodes (HES inpatient, outpatient, A&E), and mortality registry data. Participants Patients with any CHD procedure recorded in NCHDA between April 2000 and March 2017 from public hospitals. Primary and secondary outcome measures Primary outcomes: Number of linked records, number of unique patients and number of generated spells of care (e.g. inpatient stays, outpatient appointments). Secondary outcomes: Quality and completeness of linkage. Results There were 143,862 records in NCHDA relating to 96,041 unique patients. We identified 65,797 linked PICANet patient admissions, 4,664 linked ICNARC-CMP admissions, and over 6 million linked HES episodes of health care (1.1M Inpatient, 4.7M Outpatient). The 96,041 unique patients had 4,908,153 spells of care comprising 6,481,600 records after quality checks. Considering only years where datasets overlapped, 95.6% surgical procedure records were linked to a corresponding HES record, 93.9% paediatric (cardiac) surgery procedure records were linked to a corresponding PICANet admission, and 76.8% adult surgery procedure records were linked to a corresponding ICNARC-CMP record. Conclusions We successfully linked four national datasets to the core dataset of all CHD procedures performed between 2000 and 2017. This will enable a much richer analysis of longitudinal patient journeys and outcomes. We hope that our detailed description of the linkage process will be useful to others looking to link national datasets to address important research priorities.