Investigating Barriers and Facilitators to Congruence in Place of Care Among Unhoused Palliative Care Patients

An important quality marker for end-of-life services is congruence with patient’s preferred place of care, but this congruence in place of care is less likely for those facing structural inequalities (Grunier et al., 2007). As homelessness among older adults in the United States grows (Culhane et al., 2013), the urgency in understanding place of care in palliative care with unhoused patients grows. This presentation illustrates results from an organizational case study (Yin, 2014) of a novel homeless palliative care team and focuses on a qualitative content analysis of charts of patients over 50 receiving care both before and during the COVID-19 pandemic (n=27). Findings highlight (1) the interplay between environmental factors, psychosocial resources and constraints, and medical acuity in determining where care can take place, (2) facilitators for care in marginal settings such as emergency shelters and encampments, and (3) where opportunities for more equitable age-friendly healthcare system interventions exist.

Exploring the Mystery of the Sweetness of Baijiu by Sensory Evaluation, Compositional Analysis and Multivariate Data Analysis

Sweetness is an important Baijiu quality marker, but there is limited research on it. In this study, the main contributors to Baijiu sweetness were identified by “sensomics” combined with “flavoromics”. A total of 43 volatile compounds (mostly esters) were found that appeared to contribute to Baijiu sweetness, through sensory-guided fractionation and compositional analysis. Correlation analysis between the volatile composition and perceived sweetness of 18 Baijiu samples with different sweet intensities identified 14 potential contributors. Additional testing verified that combining the 14 compounds reproduced Baijiu sweetness exactly, and omission testing identified ethyl hexanoate, hexyl hexanoate and ethyl 3-methylbutanoate as the major contributors to Baijiu sweetness. These findings not only broadened our understanding of Baijiu sweetness, but also highlighted the major contribution of volatile compounds to sweetness perception, knowledge which may facilitate future flavor modification of a wide variety of foods and beverages.

Q-marker Prediction Analysis of Rhubarb in Fengyin Decoction Based on Fingerprint and Network Pharmacology

Fengyin Decoction (FYD) is a traditional Chinese medicine for the treatment of epilepsy and wind paralysis. However, the potential antiepileptic active component in rhubarb (which is the most effective Chinese medicine in FYD) has not been defined. In this study, we analyzed and predicted the potential quality marker (Q-marker) of rhubarb in FYD based on fingerprint and network pharmacology. The fingerprints of FYD and rhubarb were established to analyze the transmission law of active components. Ultra-high performance liquid chromatography (UPLC) was used to study quantitatively the active components obtained by different extraction methods of FYD. Combined with network pharmacological analysis, a “components-targets-pathways” network was constructed to predict the potential Q-marker. Eight peaks were identified by FYD fingerprint: aloe-emodin, rhein, emodin, chrysophanol, physcion, cinnamaldehyde, 6-gingerol, and glycyrrhizic acid ammonium salt. The determination of the 8 active components in FYD with different extraction methods suggested that rhubarb anthraquinone may be a potential antiepileptic active component. Twelve core components, 19 targets, and 21 pathways of rhubarb were screened by network pharmacology, which further demonstrated that rhubarb played a role mainly through these components, targets, and pathways. We preliminarily predicted that compounds such as rhubarb anthraquinones were a potential Q-marker. The UPLC fingerprint and the content determination method of the 8 components established in this study were effective and feasible. The findings in this study may provide a reference for further study of quality control of FYD and lay a theoretical foundation for the study of its action mechanism. In addition, our study may provide a novel idea for the study of the Q-marker of other classical compound traditional Chinese medicines.

Characteristics of oxygen concentration and the role of correction factor in real-time GI breath test

ObjectiveA high quality end-expiratory breath sample is required for a reliable gastrointestinal breath test result. Oxygen (O2) concentration in the breath sample can be used as a quality marker. This study investigated the characteristics of O2 concentration in the breath sample and the impact of using a correction factor in real-time breath measurement.DesignThis study includes two separate groups of patient data. Part 1 of the study analysed the patient’s ability to deliver end-expiratory breath samples over a 2-year period (n=564). Part 2 of the study analysed a separate group of patients (n=47) with additional data to investigate the O2 characteristics and the role of correction factor in breath test.ResultsThe results indicated 95.4% of 564 patients were able to achieve an O2 concentration below 14% in their end-expiratory breath. Part 2 of the study revealed that the distribution of O2 concentration was between 9.5% and 16.2%. Applying a correction factor to predict the end-expiratory H2 and CH4 values led to an average measurement error of −36.4% and −12.8%, respectively.ConclusionThe majority of patients are able to deliver a high quality end-expiratory breath sample, regardless of age or gender. The correction factor algorithm is unreliable when predicting the end-expiratory result at 15% O2 and it would have resulted in false negative result for 50% of the positive cases in this study. It has also indicated that the continuous O2 measurement is essential to ensure breath sample quality by preventing secondary breathing during real-time breath collection.

Quality Evaluation of Artemisia capillaris Thunb. Based on Qualitative Analysis of the HPLC Fingerprint and UFLC-Q-TOF-MS/MS Combined with Quantitative Analysis of Multicomponents

In this study, a new method was developed for the comprehensive quality evaluation (QE) of Artemisia capillaris Thunb. (A. capillaris, named Yinchenhao in Chinese), which is one of the most commonly used herbal medicines (HMs). First, fingerprints of 31 batch samples of A. capillaris were determined by HPLC, the reference fingerprint was established, and the common peaks were assigned. Second, the components of common peaks in the HPLC fingerprints were identified by ultrafast liquid chromatography- (UFLC-) Q-TOF-MS/MS. Finally, the contents of the components unambiguously confirmed by reference substances were determined, and the correlation between the contents of chlorogenic acid and the contents of others was analyzed. The results showed that there were 20 common peaks in the HPLC fingerprints of 31 batch samples. The components of these 20 common peaks were identified as ten organic acids, eight flavonoids, and two others. Among nine organic acids such as 1-caffeoylquinic acid, neochlorogenic acid, chlorogenic acid, caffeic acid, cryptochlorogenic acid, 1,3-dicaffeoylquinic acid, 3,4-dicaffeoylquinic acid, 3,5-dicaffeoylquinic acid, and 4,5-dicaffeoylquinic acid, three flavonoids such as rutin, hyperoside, and isoquercetin, and one other p-hydroxyacetophenone, a total of 13 ones were unambiguously identified by comparison with reference substances; one caffeoylquinic acid glucoside and one flavone di-C-glucoside were detected in A. capillaris for the first time. There were some differences in the contents of 13 components in different samples; chlorogenic acid could be regarded as the quality marker of A. capillaris. The current established method in this study can be used for the comprehensive QE of A. capillaris and can also provide reference for the QE of the other HMs.

Improving the patient's experience in the emergency department during COVID-19 pandemic: a community-based analysis from Western Saudi Arabia.

Background Patient satisfaction is an important measure of the health care encounter. It is challenging to achieve a perfect patient experience during the current COVID-19 pandemic, especially from an emergency department visit. Aim This study aimed to assess the factors that improve patient experience during an emergency department (ED) visit in the western region of Saudi Arabia. Methods This is a cross-sectional study, conducted over a month from January to February 2021. Via an electronic survey tool, we used the de en (EQS-H) to measure patients’ satisfaction with their ED encounter. Results The total level of satisfaction was high in 43.66% (n=224) of participants, moderate in 37.04% (n=190), and 19.29% (n=99) were unsatisfied. We noted significant predictors of dissatisfaction, including increasing age, higher educational level, and the existence of chronic diseases. A clear treatment plan and discharge instructions were important determinants for improving patient satisfaction. Conclusion The determinants of patient satisfaction during an ED visit are an important quality marker of the emergency department encounter. Such findings should be used as a benchmark for future programs aiming to improve patients’ experience during ED visits.

Az akut pancreatitist követő kórházi visszavételi arány mint minőségi mutató

Összefoglaló. Bevezetés: Az akut pancreatitis az egyik leggyakoribb kórházi felvételt igénylő gastrointestinalis kórkép. A korai visszavételi arány egyrészt az ellátást jellemző minőségi mutató, másrészt az akut pancreatitis 1 éves mortalitásának legerősebb prognosztikai faktora. Célkitűzés: A korai visszavétel arányának, illetve okainak vizsgálata klinikánkon akut pancreatitis diagnózisával kezelt betegek körében. Módszerek: Retrospektív vizsgálatunkat azon 18 év feletti betegek körében végeztük, akiket a 2010. január és 2018. december közötti időszakban akut pancreatitis diagnózisával kezeltünk klinikánkon, és az első emissziótól számítva 30 napon belül újból felvételre kerültek. A betegek adatait az Akut Pancreatitis Regiszter és a betegnyilvántartó rendszer (MedSol ) segítségével gyűjtöttük össze. A biliaris, illetve nem biliaris akut pancreatitises eseteket hasonlítottuk össze az epidemiológiai adatok, a visszavétel oka, a visszavételig eltelt átlagos időtartam, és a visszavétel időtartama, valamint kimenetele vonatkozásában. Eredmények: Akut pancreatitis diagnózisával 647 beteg került felvételre. Közülük 28 beteg került újrafelvételre. A leggyakoribb okok között 1) peripancreaticus szövődmények, 2) epés panaszok és 3) az akut pancreatitis kiújulása szerepel. A biliaris és a nem biliaris pancreatitises eseteket összehasonlítva, a visszavétel oka epés panasz volt az előbbi csoport 65,5%-ában és az utóbbi 15%-ában. A középsúlyos pancreatitises esetek száma szignifikánsan magasabbnak adódott a nem biliaris csoportban. Következtetés: A középsúlyos/súlyos pancreatitises esetek aránya magasabb volt a nem biliaris pancreatitises csoportban. Biliaris pancreatitis esetén javasolt index-cholecystectomia végzése. Orv Hetil. 2021; 162(11): 413–418. Summary. Introduction: Acute pancreatitis is the leading cause of hospitalization among gastrointestinal diseases. The early readmission rate is a quality marker and the strongest prognostical factor of 1-year mortality of acute pancreatitis. Objective: To investigate the rate and cause of early readmission among patients treated with acute pancreatitis at our clinic. Methods: Our retrospective study was conducted among patients (>18 years) treated with acute pancreatitis between January 2010 and December 2018 at our clinic, by whom unplanned readmission happened <30 days from emission. Personal data were collected from the Hungarian Pancreas Registry. Data of biliary and non-biliary acute pancreatitis cases were compared concerning epidemiological data, cause of readmission, mean time elapsed until readmission, its duration and outcome. Results: 647 patients were diagnosed with acute pancreatitis. Of them, 28 patients had early readmission. The most common causes were 1) local pancreatic complications, 2) biliary and 3) recurrence of acute pancreatitis. By investigating the biliary and non-biliary pancreatitis cases separately, the cause of readmission was biliary in 65.5% and 15%, respectively. The number of moderately severe pancreatitis cases was significantly higher in the non-biliary group. Conclusion: The proportion of moderate/severe diseases was higher in the non-biliary pancreatitis group. In the case of biliary pancreatitis, it is suggested to perform index cholecystectomy. Orv Hetil. 2021; 162(11): 413–418.