Improving the Safety of the Manchester Triage System for Children with Congenital Heart Disease

This study is a prospective evaluation of the validity of a Manchester Triage System (MTS) modification for detecting under-triaged pediatric patients with congenital heart disease (CHD). Children with CHD visiting the emergency unit of the Department of Pediatrics and Adolescent Medicine, Vienna General Hospital, in 2014 were included. The MTS modification updated the prioritization of patients with complex syndromic diseases, specific symptoms related to chronic diseases, decreased general condition (DGC), profound language impairment, unknown medical history, or special needs. A four-level outcome severity index based on diagnostic and therapeutic interventions, admission to hospital, and follow-up strategies, was defined as a reference standard for the correct clinical classification of the MTS urgency level. Of the 19,264 included children, 940 had CHD. Of this group, 266 fulfilled the inclusion criteria for the modified triage method. The MTS modification was significantly more often applied in under-triaged (65.9%) than correctly or over-triaged (25%) children with CHD (p-value χ²test <0.0001, OR 5.848 95% CI: 3.636-9.6).Conclusion: The MTS urgency level upgrade modification could reduce under-triage in children with CHD. Applying a safety strategy concept to the MTS could mitigate under-triage in such a high-risk patient group.

Identifying a Clinical Risk Triage Score for Adult Emergency Department

Emergency triage is crucial for the treatment and prognosis of emergency patients, but its validity needs further improvement. The purpose of this study was to identify a risk score for adult triage. We conducted a regression analysis of physiological and biochemical data from 1,522 adult patients. A 60-point triage scoring model included temperature, pulse, systolic blood pressure, oxygen saturation, consciousness, dyspnea, admission mode, syncope history, chest pain or chest tightness, complexion, hematochezia or hematemesis, hemoptysis, white blood count, creatinine, bicarbonate, platelets, and creatine kinase. The area under curve in predicting ICU admission was 0.929 (95% CI [0.913–0.944]) for the derivation cohort and 0.911 (95% CI [0.884–0.938]) for the validation cohort. Four categories: critical level (≥13 points), severe level (6–12 points), urgency level (1–5 points), and sub-acute level (0 points) were divided, which significantly distinguished the severity of emergency patients.

Urgensi Kebijakan Peraturan Daerah tentang Pengendalian Demam Berdarah Dengue di Kota Tasikmalaya Berdasarkan Pendekatan Analisis Stakeholder

Dengue Hemorrhagic Fever (DHF) is still a public health problem that is difficult to deal with inTasikmalaya City, West Java Province. In 2019, the region experienced very significant cases increase leadingto an Outbreak. Various attempts have been made without optimal results. DHF control program managersexpressed the urgent need for strong policies, but no empirical studies have been carried out. It is importantto analyze evidence as justification for urgency and impetus in the policy agenda. This policy research withnaturalistic qualitative research with Analysis for Policy approach aims to explore evidence on the urgency ofDHF control regional regulations at policy stakeholders’ aspect. The results of this study revealed the evidenceof DHF Control Regional Regulation’s establishment urgency. Those are increasing community endangeringsituation of DHF cases; the urgent need of policies for program managers; and the corroborating evidence, asthe results of stakeholder analysis, in the form of majority stakeholder are the main policy stakeholder whohave the power and strong interest in supporting the policies’ urgency. The urgency level of DHF controlRegional Regulation based on this research has reached an emergency level, so there should be efforts toestablish DHF control Regional Regulation in Tasikmalaya City.Keywords: Stakeholders, Policy Urgencies, Regional Regulations, DHF

Product Review Ranking in e-Commerce using Urgency Level Classification Approach

Review ranking is useful to give users a better experience. Review ranking studies commonly use upvote value, which does not represent urgency, and it causes problems in prediction. In contrast, manual labeling as wide as the upvote value range provides a high bias and inconsistency. The proposed solution is to use a classification approach to rank the review where the labels are ordinal urgency class. The experiment involved shallow learning models (Logistic Regression, Naïve Bayesian, Support Vector Machine, and Random Forest), and deep learning models (LSTM and CNN). In constructing a classification model, the problem is broken down into several binary classifications that predict tendencies of urgency depending on the separation of classes. The result shows that deep learning models outperform other models in classification dan ranking evaluation. In addition, the review data used tend to contain vocabulary of certain product domains, so further research is needed on data with more diverse vocabulary.

Non-COVID Diseases during the Pandemic: Where Have All Other Emergencies Gone?

Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February –31 March) in the last three years (2018–2019–2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality.

Preparing Society for Automated Vehicles: Perceptions of the Importance and Urgency of Emerging Issues of Governance, Regulations, and Wider Impacts

This study explores the overall picture of how people perceive the importance level and urgency level regarding issues associated with automated vehicles, by sorting out ten issues, developing a questionnaire with 66 measurement items, and investigating how Artificial Intelligence (AI) experts and Computer Science (CS)/Electrical Engineering (EE) majors assessed these issues. The findings suggest that AI experts in Taiwan believed that the top five issues for preparing a society for autonomous vehicles (AVs) should include (1) data privacy and cybersecurity, (2) regulation considerations, (3) infrastructure, (4) governance, and (5) public acceptance. On the other hand, for their student counterparts, the results (1) demonstrate a somewhat different order from the third to the fifth place, (2) show an attention-focused profile on the issue of cybersecurity and data privacy, and (3) indicate that gender and a few wider-impact variables (technology innovation, infrastructure) are significant predictors for the assessment on the importance level of AVs, while some wider-impact variables (technology innovation, governance, economic benefits, infrastructure), which are positively associated, as well as concerns variables (cybersecurity and data privacy, regulations), which are negatively associated, could be predictors for the urgency level of AVs. Suggestions for future research and policymakers are provided.

Performance of a new guideline for telephone triage in out-of-hours services in Belgium: A pilot study using simulated patients

Background Patients in Belgium needing out-of-hours care have two options: the emergency department or the general practitioner on call often organised in a general practitioner cooperative. Currently, there is no triage system in Belgium so patients do not know where to go. Methods Our primary objective was to examine the ability of a newly developed telephone guideline, called 1733, to adequately estimate the urgency of health problems presented by simulated patients. Ten clinical vignettes were presented to 12 operators in a simulated phone call. The operators had to assign a protocol, urgency level and resource to dispatch (ambulance, general practitioner house visit, etc.) to each case. Results A total of 120 phone calls were analysed. The operators chose the right protocol in 69% and the correct urgency level in 35% of the cases. The proportion of under- and over-triage was 26% and 39%, respectively. There was important variation in between the operators. The sensitivity for detecting highly urgent cases was 0.42, the specificity 0.92. Conclusion Using the new Belgian 1733 guideline for telephone triage, operators mostly chose the appropriate protocol but only chose the correct urgency in one out of three cases. In this phase of development, the studied telephone guideline is not ready for implementation.

Humans sacrifice decision-making for action execution when a demanding control of movement is required

ABSTRACTA growing body of evidence suggests that decision-making and action execution are governed by partly overlapping operating principles. Especially, previous work proposed that a shared decision urgency/movement vigor signal, possibly computed in the basal ganglia, coordinates both deliberation and movement durations in a way that maximizes the reward rate. Recent data support one aspect of this hypothesis, indicating that the urgency level at which a decision is made influences the vigor of the movement produced to express this choice. Here we investigated whether conversely, the motor context in which a movement is executed determines decision speed and accuracy. Twenty human subjects performed a probabilistic decision task in which perceptual choices were expressed by reaching movements toward targets whose size and distance from a starting position varied in distinct blocks of trials. We found strong evidence for an influence of the motor context on most of the subjects’ decision policy but contrary to the predictions of the “shared regulation” hypothesis, we observed that slow movements executed in the most demanding motor blocks in terms of accuracy were often preceded by faster and less accurate decisions compared to blocks of trials in which big targets allowed expression of choices with fast and inaccurate movements. These results suggest that decision-making and motor control are not regulated by one unique “invigoration” signal determining both decision urgency and action vigor, but more likely by independent, yet interacting, decision urgency and movement vigor signals.NEW & NOTEWORTHYRecent hypotheses propose that choices and movements share optimization principles derived from economy, possibly implemented by one unique context-dependent regulation signal determining both processes speed. In the present behavioral study conducted on human subjects, we demonstrate that action properties indeed influence perceptual decision-making, but that decision duration and action vigor are actually independently set depending on the difficulty of the movement executed to report a choice.

Prioritas Penentuan Peningkatan Kualitas Lingkungan Permukiman Kumuh yang Berkelanjutan

The enhancement of environmental quality for urban settlement in Palembang is expected to be sustainable due to the increase number of slum areas and the limited funding allocation for the infrastructure establishment. This study aimed to determine priority scale of activities and locations according to three pillars of sustainable development which can alleviate slum areas i.e. physical environment, social and economic aspects by involving all stakeholders. This research will provide information for the local government to determine priority activities and locations for settlement improvement by using Analytical Hierarchy Process (AHP). The study revealed that the main factor to improve the environmental quality for settlement in 29 Ilir sub-district was the infrastructure development with urgency level reaching 46.7%. Meanwhile, the urgency level of social activity factor was approximately 31.2% followed by the economic development factor which was the lowest level by 22.1%. However, the highest priority level from those activity factors was household waste management by 100%, while other priority activities that should be done consecutively were waste infrastructure (93.5%), community service activities (83,6%), environmental drainage (66.2%), sanitation (66.1%), business capital loans (63%), training and entrepreneurship (61%), and compensation for the poor (57,9 %). The aforementioned activities were conducted in priority locations in which environmental quality was relatively poor.

Use of ambulance dispatch calls for surveillance of severe acute respiratory infections?

ObjectiveWe aim to assess whether influenza circulation, as measured through influenza-like-illness (ILI) in primary care, is reflected in ambulance dispatch (AD) calls.IntroductionSurveillance of severe influenza infections is lacking in the Netherlands. Ambulance dispatch (AD) data may provide information about severity of the influenza epidemic and its burden on emergency services.The current gold standard, primary care-based surveillance of influenza-like-illness (ILI), mainly captures mild to moderate influenza cases, and does not provide adequate information on severe disease.Monitoring the severity of the annual epidemic, particularly among groups most at risk of complications, is of importance for the planning of health services and the public health response.MethodsWe analysed all calls from four ambulance dispatch centers serving 4.3 million people in the Netherlands, between January 2014 and December 2016. The main complaint and urgency level is recorded during triage; those possibly caused by respiratory infections were grouped as respiratory syndrome calls (RSC). We modelled the proportion of all RSC calls against the weekly ILI incidence (we allowed up to 4-week lags and leads), from sentinel primary-care surveillance. We used binomial regression with identity link to obtain differences in proportions. We built separate models by age group, urgency level and time of day. We tested heterogeneity of effects by season.ResultsWe included 289,307 calls; 6.7% were RSC. Overall, proportion of RSC increased by 0.114 percentage points for each increase of 1/10,000 population in ILI incidence. In our study population, this translated into 550 ambulance calls attributable to influenza (as measured by ILI) per year. Association was stronger in the models including only out-of-office hours, children (<15 years) and highest urgency level calls. In the latter two, the effect varied by season. RSC was best associated with ILI from the previous 1-3 weeks in all models, except in children where RSC preceded ILI by 1 week.ConclusionsOur results demonstrate the potential usefulness of ambulance dispatch data to complement existing influenza surveillance by providing information on the volume and timing of severe cases attributable to influenza within the yearly epidemics.