Pediatric Training Crisis of Emergency Medicine Residency during the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) is an emerging viral disease that has caused a global pandemic. Among emergency department (ED) patients, pediatric patient volume mostly and continuously decreased during the pandemic period. Decreased pediatric patient volume in a prolonged period could results in inadequate pediatric training of Emergency Medicine (EM) residents. We collected data regarding pediatric patients who were first seen by EM resident physicians between 1 February 2019, and 31 January 2021, which was divided into pre-epidemic and epidemic periods by 1 February 2020. A significant reduction in pediatric patients per hour (PPH) of EM residents was noted in the epidemic period (from 1.55 to 0.81, p < 0.001). The average patient number was reduced significantly in the classification of infection (from 9.50 to 4.00, p < 0.001), respiratory system (from 84.00 to 22.00, p < 0.001), gastrointestinal system (from 52.00 to 34.00, p = 0.007), otolaryngology (from 4.00 to 2.00, p = 0.022). Among the diagnoses of infectious disease, the most obvious drop was noted in the diagnosis of influenza and enterovirus infection. Reduced pediatric patient volume affected clinical exposure to pediatric EM training of EM residency. Changes in the proportion of pediatric diseases presented in the ED may induce inadequate experience with common and specific pediatric diseases.

Decreasing Energy and Nutrient Intake During Hospitalization In Muhammadiyah Lamongan Hospital

Inpatient Malnutrition rates are quite high and distributed in almost all hospitals for all types of diseases and socio-economic sufferers. This study aims to examine the nutritional status, total patient intake, and factors that influence the total intake of newly hospitalized patients at Muhammadiyah Lamongan Hospital. The study was conducted from November to December 2019 in the internal, surgical, and Obgyn departments of the Muhammadiyah Lamongan Hospital. A total of 80 patients were selected as samples using the accidental sampling technique. The results showed that 87.5% of patients were hospitalized due to non-communicable diseases such as diabetes mellitus, acute and chronic kidney failure, cirrhosis, acute myocardial infark, and others. Only 12.5% ​​are treated for infectious diseases such as tuberculosis, meningitis, diarrhea, and others. Calculation of BMI in patients shows that 10% of patients are obese, 30% are overweight, 50% are normal and 10% are malnourished. 24-hour recall results showed that 100% of patients could not meet energy and nutrient requirements (<80% of energy and nutrient demand figures). The average patient is only able to meet 24% of energy, 17% protein, 24% carbohydrates, and 18% fat. As many as 35% of patients complained of nausea and 22.5% of them were accompanied by vomiting. The number of patients said that decreased appetite because abdominal pain (35%), 25% patients experienced shortness of breath. Many patients complained that their bodies were weak / without strength (95%). Appetite also decreased due to difficulty chewing (17.5%) and difficulty swallowing (22.5%). Physical conditions like weakness accompanied by other eating disorders can be the cause of the patient's decreased food intake. This has led to a decrease in nutritional status in patients due to inadequate energy and nutrient need (especially those who have to go through a long period of hospitalization).

One month safety study of ExoFlo injection for the treatment of lumbar or cervical radiculopathy in the epidural space

This One month safety study addresses any potential risks behind the use of bone marrow-derived mesenchymal stem cell extracellular vesicle isolate product (ExoFlo Direct Biologics) as a treatment for cervical and lumbar radiculopathy. Ten healthy adults were treated with ExoFlo injections for cervical radiculopathy (n=5) and lumbar radiculopathy (n=5). Follow up occurred twenty-four hours, three days, one week, three weeks and one month post injection. By the one month follow-up, the average patient improved 55% in BPI, 55.2% in QD, 25.4% in UEFS, 19.75% in ODI and 26% in LEFS. There were no complications or adverse events by the end of the study and no patient exhibited worsening radiculopathy. Patients will continue to be followed for at least six months post injection.

Pengaruh Efisiensi Waktu Tunggu, Biaya Pelayanan, Kebersihan, serta Kenyamanan Ruangan terhadap Kepuasan Pasien (Studi Pada Pelayanan Instalasi Rawat Jalan Rumah Sakit Medika Lestari)

Seeing the importance of patient adherence in a patient's therapeutic journey and several factors related to patient adherence, we tried to assess patient satisfaction with the outpatient unit of Medika Lestari Hospital in 2021. Therefore, we conducted a cross-sectional study of patients aged 18–59 years to assess their satisfaction with the services of the Medika Lestari Hospital outpatient unit on 28 July 2021. We evaluated 4 main dimensions, namely: (1) Efficiency, (2) Convenience; (3) Cleanliness; and (4) Financing. The survey instrument was prepared based on the consensus of the research team and has good validity and reliability based on the Pearson and Cronbach–alpha tests. All statistical analyzes were performed with SmartPLS software version 3.3.3. A total of 206 patients were recruited, with a composition of 102 (49.51%) males and 104 (50.49%) females. There were 43 (20.87%), 103 (50%), 46 (22.33%), and 14 (6.80%) patients, respectively, in the age categories 18-25 years, 26–35 years, 36–45 years, and 46–59 years, respectively. We found that the average patient satisfaction with outpatient services at Medika Lestari Hospital was 4.23 (84.6%). The average patient satisfaction score for the outpatient service at the Medika Lestari Hospital is 4.23±0.363. In addition, we also found that service efficiency, cost, cleanliness of the service room, and comfort of the service room had a positive effect on patient satisfaction in the outpatient unit at Medika Lestari Hospital.

Age and sex trends of Gardnerella vaginalis infection in patients with sexually transmitted infections in Korea

Background and Objectives: Gardnerella vaginalis and Candida albicans are the most common causative agents of bac- terial vaginosis, and infections with these pathogens lead to inflammation, endometritis, and pruritus. The aim of this retro- spective study was to determine the trends of G. vaginalis infections based on real-time PCR data according to age and sex in patients with sexually transmitted diseases. Materials and Methods: A total of 59,381 specimens isolated at a clinical laboratory from September 2018 to December 2020 were subjected to real-time PCR for the detection of G. vaginalis DNA. Sample types included catheter, pus, tissue, swab, and urine samples. Results: Among 59,381 samples, 20,718 (34.8%) were positive for G. vaginalis. Of the positive samples, 13,186 (63.7%) were from male patients and 7,532 (36.3%) were from female patients. Average patient age was 39.1 years (the average age of male and female patients was 38.34 and 40.43 years, respectively). Female patients younger than 19 years exhibited the highest incidence of G. vaginalis, at 71.57%, followed by 68.46% incidence in those aged 20-29 years; the lowest incidence was in women aged 40-49 years. Further, among specimen types, the highest number of G. vaginalis-positive specimens was obtained by the swab sampling method. Conclusion: From 2018 to 2020 in Korea, the number of tests conducted for bacterial vaginosis has increased, while the incidence of G. vaginalis infections appears to have decreased. the finding that female adolescents have a high tendency to carry the pathogen is important. and for effective surveillance of BV, sampling by cotton swabs and detection by multiplex PCR might be a good approach.

Overview of Usual Food Leftovers in Inpatients at the Jailolo Regional General Hospital, West Halmahera Regency

Hospital nutrition services are part of a complete health service. Each hospital provides nutritional services, not only providing food for patients and staff, but the most important thing is the provision of food that meets the needs of human metabolism for recovery during treatment. Food waste is the amount of food that is not eaten or not consumed by the patient. The purpose of this study was to determine the type of food and the amount of leftover food that was not consumed by patients who received regular food at the Jailolo Hospital. The type of research used is descriptive with sampling using purposive sampling as many as 20 respondents. The results showed that of the 20 respondents using the Comstock method, the average patient leftover food left a lot (> 20%) in the staple food type 40%, animal side dishes 35%, vegetable side dishes 30%, vegetables 30% and fruit 40%. Based on the results of the study, it can be concluded that most of the respondents still left a lot of food and it is recommended for nutrition installations to improve the quality and taste of the food served so that there is no more food left.

Retrospective Analysis of COVID-19 Pandemic Impact on Breast Cancer Screening Rates in Northwest Indiana

Background: Few changes to healthcare delivery during the COVID-19 pandemic altered pre-pandemic diagnostic testing as much as those made to cancer screening. Several studies show that screening volumes decreased by as much as 80% across multiple modalities and cancer types in the spring of 2020. These studies examined large hospital systems in the American East and West, but communities with predominantly Black populations like Gary, Indiana, have been absent from this research. Methods: Our study captures how the COVID-19 pandemic affected access to diagnostic screening for cancerous and precancerous breast lesions through mammography using patient-level data. “Hospital A” provided data from 17,973 mammography encounters that occurred between March 2019 and June 2021. Screening volumes from the eight-week period from March 23rd and May 17th in 2020, the period elective procedures were suspended, was compared to three other distinct periods: the previous 8-week period, the next 8-week period, and the same 8-week period from 2019. Results: From the 17,973 encounters, the average patient age was 61.7 (SD 11.4) years, 61.0% of patients paid with Medicare or Medicaid, and 66.0% of patients identified as Black. Despite performing a weekly average of 190 (12.3) mammograms during the 2019 baseline period and 158 (16.1) mammograms in the eight weeks preceding the COVID-19 pandemic, the weekly average fell to 13 (22.4) mammograms during the study period with zero occurring in a four-week stretch. Fortunately, volume returned sharply to near pre-pandemic levels in the eight weeks following the study period with 139 (18.9) average weekly mammograms. Conclusion: Despite a 93% year-over-year decrease in mammography during the height of the pandemic, volume returned in the summer of 2020. Concerning, however, is that average monthly volume (582 (88.5) mammograms) in the first six months of 2021 remains 22.1% lower than 2019 numbers (747 (66.7) mammograms).

Who Is Next: Patient Prioritization Under Emergency Department Blocking

In “Who Is Next: Patient Prioritization Under Emergency Department Blocking,” Li, Sun, and Hong study how physicians and nurses choose the next patient for treatment in hospital emergency departments (EDs). Using data from a tertiary hospital in Alberta, Canada, they conduct an empirical investigation and find that both clinical factors and resource constraints are considered in patient-prioritization decisions. In particular, discharged patients are prioritized when ED beds are increasingly occupied by boarding patients so as to avoid further blocking the ED. A stylized model is developed to explain the rationale behind the prioritization behavior. Using a simulation study, they show such behavior can improve ED operations by reducing the average patient waiting time and length of stay without adding extra capacity, which results in significant cost savings for hospitals.

Disease and medication burden of medically complex adolescents seen in an interdisciplinary transitional care clinic

PURPOSE: Transitional care for adolescents with complex diseases, who are entering adulthood, is challenging. The purpose of this study is to quantify the disease and medication burden of this population, who are transitioning though an interdisciplinary specialty clinic. METHODS: This study is a retrospective observational study of all patients seen in a transitional care clinic between July 2012 and March 2015. The main outcomes assessed included disease state and medication burden. Descriptive statistics, along with the paired t-test and McNemar’s test, were used. RESULTS: The study cohort included 216 patients. The average patient age was 20.7 years, and the median number of clinic encounters was 6. Patients had at least 1 of 8 primary diagnoses. On average, patients took medications from 5 classes and used 3 dose forms. Among 163 patients who had medication reconciliation performed, the average number of medication classes increased by 0.44±1.51 (p = 0.003). There was an average increase of 3.70%(SD±36.31%; p = 0.27) in the number of required medication lab assessments ordered for patients who had medication reconciliation performed. CONCLUSION: There is a high disease and medication burden among adolescent patients with complex disease states who are to transition to adult care.

Nutrition in the Nursing Home: Expectation vs Reality

Background: Determine the nutritional value of the food provided to the average patient in the nursing home and compare to the guidelines for the age matched community dwelling individual. Methods: We obtained weekly meal plans. Nutritional value of each meal was calculated from the USDA food composition database with reference to the supply company. The 3 nursing homes ranged in ownership and in star rating and averaged 120 beds per facility. Food companies were comparable. Results: Patients received 1.58 cups of vegetables with a standard deviation (SD) of 0.31 daily. 1.26 cups of fruit (SD of 0.08) and 0.79 cups of dairy (SD 0.26) daily. Average of 5,308mg of sodium (SD 770.4) daily. 474.08 mg of added sugar (SD 137.88) daily. Saturated fats were 10.86% (SD 0.01) of the calories. Conclusions: Intake of fruits, dairy and vegetables was below recommended levels. Calories and sodium were above recommended values. Added sugar and saturated fats were within recommendations. Several changes can be made to improve nutrition in the nursing home to bring the nutrition closer to expectations in the average community dwelling adult values. We recommend further study concerning interventions.