Pub Date : 2024-09-12DOI: 10.1101/2024.09.11.24313201
Steve Goodacre, Laura Sutton, Gordon Fuller, Ashleigh Trimble, Richard Pilbery
Background Initial emergency department (ED) assessment can use early warning scores to identify and prioritise patients who need time-critical treatment. We aimed to determine the accuracy of the National Early Warning Score version 2 (NEWS2) for predicting the need for time-critical treatment. Methods We undertook a single centre retrospective observational cohort study. We randomly selected 4000 adults who attended a tertiary hospital ED in 2022 and had NEWS2 routinely recorded on electronic patient records. The first NEWS2 score and vital signs were extracted from electronic records. Research nurses selected cases that received a potentially time-critical treatment. Two independent clinical experts then determined whether time-critical treatment was or should have been received, using an expert consensus derived list of interventions. We used receiver operating characteristic (ROC) analysis and calculated sensitivity and specified at pre-defined thresholds to evaluate the accuracy of NEWS2 for predicting need for time-critical intervention. Results After excluding ten patients who received their intervention before NEWS2 recording, 164/3990 (4.1%) needed time-critical treatment and 71/3990 (1.8%) died within seven days. NEWS2 predicted need for time-critical treatment with a c-statistic of 0.807 (95% confidence interval 0.765 to 0.849) and death within seven days with a c-statistic of 0.865 (0.813, 0.917). NEWS2>4 predicted need for time-critical treatment with sensitivity of 0.518 (0.442, 0.593) and positive predictive value of 0.258 (0.213, 0.307). Patients needing emergency surgery, antibiotics for open fractures, insulin infusion, or manipulation of limb-threatening injuries frequently had NEWS2≤4. Patients with NEWS2>4 who did not need time-critical treatment frequently scored three points on NEWS2 for their respiratory rate, conscious level, or receiving supplemental oxygen. Conclusion NEWS2 has limited accuracy for predicting need for time-critical treatment. We have identified time-critical interventions that frequently have low NEWS2 scores and NEWS2 parameters than may overestimate need for time-critical intervention.
{"title":"Accuracy of the National Early Warning Score version 2 (NEWS2) in predicting need for time-critical treatment: Retrospective observational cohort study","authors":"Steve Goodacre, Laura Sutton, Gordon Fuller, Ashleigh Trimble, Richard Pilbery","doi":"10.1101/2024.09.11.24313201","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313201","url":null,"abstract":"Background\u0000Initial emergency department (ED) assessment can use early warning scores to identify and prioritise patients who need time-critical treatment. We aimed to determine the accuracy of the National Early Warning Score version 2 (NEWS2) for predicting the need for time-critical treatment. Methods\u0000We undertook a single centre retrospective observational cohort study. We randomly selected 4000 adults who attended a tertiary hospital ED in 2022 and had NEWS2 routinely recorded on electronic patient records. The first NEWS2 score and vital signs were extracted from electronic records. Research nurses selected cases that received a potentially time-critical treatment. Two independent clinical experts then determined whether time-critical treatment was or should have been received, using an expert consensus derived list of interventions. We used receiver operating characteristic (ROC) analysis and calculated sensitivity and specified at pre-defined thresholds to evaluate the accuracy of NEWS2 for predicting need for time-critical intervention. Results\u0000After excluding ten patients who received their intervention before NEWS2 recording, 164/3990 (4.1%) needed time-critical treatment and 71/3990 (1.8%) died within seven days. NEWS2 predicted need for time-critical treatment with a c-statistic of 0.807 (95% confidence interval 0.765 to 0.849) and death within seven days with a c-statistic of 0.865 (0.813, 0.917). NEWS2>4 predicted need for time-critical treatment with sensitivity of 0.518 (0.442, 0.593) and positive predictive value of 0.258 (0.213, 0.307). Patients needing emergency surgery, antibiotics for open fractures, insulin infusion, or manipulation of limb-threatening injuries frequently had NEWS2≤4. Patients with NEWS2>4 who did not need time-critical treatment frequently scored three points on NEWS2 for their respiratory rate, conscious level, or receiving supplemental oxygen. Conclusion\u0000NEWS2 has limited accuracy for predicting need for time-critical treatment. We have identified time-critical interventions that frequently have low NEWS2 scores and NEWS2 parameters than may overestimate need for time-critical intervention.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and importance: A quarter of patients presenting to the emergency department (ED) have anemia. Although red blood cell (RBC) transfusion is routinely used in symptomatic anemia, there is no evidence on the benefit of blood transfusion in hemodynamically stable patients in the ED for patients requiring hospitalization. Objective: The study aimed to compare in-hospital length of stay (LOS) of patients with anemia between 70 and 90 g.L-1 transfused or not in ED. Design : Retrospective single-center study Settings and participants: All adult patients admitted to the ED of our university hospital with an initial hemoglobin level between 70 and 90 g.L-1, without hemorrhagic shock, who were hospitalized after ED admission. Outcome measures and analysis: A propensity score, comprising hemoglobin level, Charlsons comorbidity index, clinical signs of anemia, the chronicity of anemia and hospitalization department was used to compare the LOS of patients transfused versus non-transfused in the ED. Intervention: RBC transfusion in the ED Main results: From January 1st to December 31st, 2022, 1 169 patients were screened of whom 569 (49%) were excluded, mostly due to discharge without hospitalization. The remaining 564 (48%) patients had a median age of 77 [68; 85] and 240 (43%) were women. Finally, 127 (23%) patients were transfused in ED. Transfused patients received more units of RBC during the whole hospitalization period (4 [3; 5] versus 2 [1; 3] than non-transfused patients (p< 0.01)). After propensity score matching, median LOS was 9 [5; 19] days for ED transfused patients and 8 [5; 15] days for non-ED transfused patients (median difference= -1 95% CI [-3; 2]; p= 0.45). Conclusion: In patients with non-life-threatening anemia, RBC transfusion in the ED does not appear to reduce in-hospital LOS compared with transfusion in inpatient departments. Further studies are needed to identify patients requiring transfusion in ED.
{"title":"In-hospital stay of anemic patients (70-90 g.L-1) in the ED with/without transfusion: a single-center propensity-matched study.","authors":"Fabien Coisy, Clemence Anselme, Radjiv Goulabchand, Laura Grau-Mercier, Thibaut Markarian, Xavier Bobbia, Romain Genre-Grandpierre","doi":"10.1101/2024.09.11.24313465","DOIUrl":"https://doi.org/10.1101/2024.09.11.24313465","url":null,"abstract":"Background and importance: A quarter of patients presenting to the emergency department (ED) have anemia. Although red blood cell (RBC) transfusion is routinely used in symptomatic anemia, there is no evidence on the benefit of blood transfusion in hemodynamically stable patients in the ED for patients requiring hospitalization. Objective: The study aimed to compare in-hospital length of stay (LOS) of patients with anemia between 70 and 90 g.L-1 transfused or not in ED.\u0000Design : Retrospective single-center study Settings and participants: All adult patients admitted to the ED of our university hospital with an initial hemoglobin level between 70 and 90 g.L-1, without hemorrhagic shock, who were hospitalized after ED admission. Outcome measures and analysis: A propensity score, comprising hemoglobin level, Charlsons comorbidity index, clinical signs of anemia, the chronicity of anemia and hospitalization department was used to compare the LOS of patients transfused versus non-transfused in the ED.\u0000Intervention: RBC transfusion in the ED\u0000Main results: From January 1st to December 31st, 2022, 1 169 patients were screened of whom 569 (49%) were excluded, mostly due to discharge without hospitalization. The remaining 564 (48%) patients had a median age of 77 [68; 85] and 240 (43%) were women. Finally, 127 (23%) patients were transfused in ED. Transfused patients received more units of RBC during the whole hospitalization period (4 [3; 5] versus 2 [1; 3] than non-transfused patients (p< 0.01)). After propensity score matching, median LOS was 9 [5; 19] days for ED transfused patients and 8 [5; 15] days for non-ED transfused patients (median difference= -1 95% CI [-3; 2]; p= 0.45). Conclusion: In patients with non-life-threatening anemia, RBC transfusion in the ED does not appear to reduce in-hospital LOS compared with transfusion in inpatient departments. Further studies are needed to identify patients requiring transfusion in ED.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1101/2024.09.10.24313268
Samuel Evans, Catherine Atkin, Austin Hunt, Georgina Ball, Charlotte Cassidy, Alexander Costley-White, Rebecca Wilding, Elizabeth Sapey
Background: Pressures on hospital emergency care services have led to increasing interest in new models of acute care provision. One such model is a medical emergency department where medical patients are triaged directly to acute internal medicine, without assessment by emergency medicine. The evidence for this model of care is unclear. Design: Systematic review. Methods: Studies included direct referral pathways to acute internal medicine. The protocol was registered prospectively (Prospero: CRD42023495786). Databases searched included MEDLINE (Ovid), The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE in process, Web of Science, CINAHL, and Embase. Studies had no time or language restrictions. Studies were selected based on inclusion and exclusion criteria, assessed by at least two independent researchers. ROBINS I risk of bias assessment was applied to the selected studies and a narrative synthesis was performed. Results: From 4405 abstracts, 89 full text articles were screened and 4 were selected for data extraction. Two studies assessed tools to predict the need for a medical admission and two studies assessed the impact of direct referral pathways to medicine. Risk of bias was mixed, and studies were heterogeneous. However, the studies reported a good ability to appropriately select patients for direct referral to medicine and a reduced length of time to medical assessment. There were no differences in other outcomes such as mortality or overall length of stay. Discussion: The current evidence to support direct admission to medicine, effectively a medical ED, is limited with studies being heterogeneous and of varying quality. Models for patient selection varied, but there was evidence to support accurate, early identification of medical patients and of reduced delays in medical assessment and care. Conclusion: Given these positive early signs of benefit, more studies are needed to design and evaluate care models such as medical EDs. Registration: Prospero Registration Number: CRD42023495786.
背景：由于医院急诊服务所面临的压力，人们对提供急诊服务的新模式越来越感兴趣。其中一种模式是设立内科急诊室，将内科病人直接分流到急诊内科，而无需急诊医学科进行评估。这种医疗模式的证据尚不明确。设计：系统回顾。方法：研究包括直接转诊至急诊内科的途径。研究方案进行了前瞻性注册（Prospero：CRD42023495786）。检索的数据库包括 MEDLINE (Ovid)、Cochrane 对照试验中央注册中心 (CENTRAL)、MEDLINE in process、Web of Science、CINAHL 和 Embase。研究没有时间或语言限制。研究根据纳入和排除标准进行筛选，并由至少两名独立研究人员进行评估。对所选研究进行 ROBINS I 偏倚风险评估，并进行叙述性综合。结果：从 4405 篇摘要中筛选出 89 篇全文，并选择了 4 篇进行数据提取。两项研究评估了预测入院医疗需求的工具，两项研究评估了直接转诊途径对医疗的影响。偏倚风险参差不齐，研究内容也不尽相同。不过，这些研究报告称，适当选择患者直接转诊至医疗机构的能力很强，而且医疗评估的时间也缩短了。死亡率或总住院时间等其他结果没有差异。讨论：目前支持直接转诊至内科（实际上是内科急诊室）的证据有限，研究内容不尽相同，质量也参差不齐。选择病人的模式各不相同，但有证据支持准确、早期识别内科病人，并减少医疗评估和护理的延误。结论：鉴于这些积极的早期获益迹象，需要更多的研究来设计和评估医疗 ED 等护理模式。注册：Prospero 注册号：CRD42023495786。
{"title":"What strategies are used to select patients for direct admission under acute medicine services? A systematic review of the literature.","authors":"Samuel Evans, Catherine Atkin, Austin Hunt, Georgina Ball, Charlotte Cassidy, Alexander Costley-White, Rebecca Wilding, Elizabeth Sapey","doi":"10.1101/2024.09.10.24313268","DOIUrl":"https://doi.org/10.1101/2024.09.10.24313268","url":null,"abstract":"Background: Pressures on hospital emergency care services have led to increasing interest in new models of acute care provision. One such model is a medical emergency department where medical patients are triaged directly to acute internal medicine, without assessment by emergency medicine. The evidence for this model of care is unclear. Design: Systematic review. Methods: Studies included direct referral pathways to acute internal medicine. The protocol was registered prospectively (Prospero: CRD42023495786). Databases searched included MEDLINE (Ovid), The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE in process, Web of Science, CINAHL, and Embase. Studies had no time or language restrictions. Studies were selected based on inclusion and exclusion criteria, assessed by at least two independent researchers. ROBINS I risk of bias assessment was applied to the selected studies and a narrative synthesis was performed. Results: From 4405 abstracts, 89 full text articles were screened and 4 were selected for data extraction. Two studies assessed tools to predict the need for a medical admission and two studies assessed the impact of direct referral pathways to medicine. Risk of bias was mixed, and studies were heterogeneous. However, the studies reported a good ability to appropriately select patients for direct referral to medicine and a reduced length of time to medical assessment. There were no differences in other outcomes such as mortality or overall length of stay. Discussion: The current evidence to support direct admission to medicine, effectively a medical ED, is limited with studies being heterogeneous and of varying quality. Models for patient selection varied, but there was evidence to support accurate, early identification of medical patients and of reduced delays in medical assessment and care. Conclusion: Given these positive early signs of benefit, more studies are needed to design and evaluate care models such as medical EDs. Registration: Prospero Registration Number: CRD42023495786.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-09DOI: 10.1101/2024.09.04.24312893
Aleeza Nasir, Rida Nasir, Daisy Puca, Kevin Charles, Sandhya LoGalbo, Jayme Schwartz, Ishveer Kaur, Temesgen Tsige, Tran Tu Huynh, Lisa Iyeke, Lindsay Jordan, Mark Richman
Medical school admissions are highly competitive, leading to high attrition rates, particularly among underserved minority (URM) students. Mentorship and clinical exposure are critical for the success of URM students, but limited access to these experiences can be due to factors such as time constraints and transportation barriers. Augmented reality (AR) has the potential to revolutionize medical education for pre-medical students by providing engaging and accessible clinical shadowing opportunities. This study aims to investigate the feasibility and impact of integrating OpticSurg's Vision Beyond AR platform into the educational experience of students shadowing the Emergency Department (ED). The study will focus on students' experience using the Vision Beyond platform and the potential strengths and weaknesses associated with the overall use of the device. The study included Hofstra pre-medical undergraduate and post-baccalaureate students of good academic standing and character all cleared to shadow in the Long Island Jewish Medical Center Emergency Department (ED), aged 18 or older. This pilot study explored the use of Vision Beyond AR glasses, for remote pre-medical education. Students who were not present in the ED accessed medical teaching materials using de-identified resources available on the internet, such as CT scans, EKGs, lab results, physical examination findings, ultrasounds, and X-rays. No patients were involved in the study. The educator used the Vision Beyond goggles to start a session and invited the students to participate through the Vision Beyond website. Students utilized the interactive feature to indicate areas where they desired greater detail or explanation. After each session, students completed a survey to assess their experience, including demographics, system usability, ease of use for specific topics, overall impression, and the strengths and weaknesses of the platform. Fifteen pre-medical and post-baccalaureate students participated in the study. Students rated the device on a 1-to-5 scale (1 = Strongly disagree, 5 = Strongly agree) for ease of use and learnability. On average, the ratings for these categories were 4 or above. The incidence of motion sickness and nausea received an average rating of 1.8 out of 5. The pilot program using OpticSurg's Vision Beyond platform showed promise, with students reporting a positive experience and finding the device easy to use. However, challenges such as internet connectivity issues and limitations of the AR goggles were noted. Future research should explore how this technology can enhance diversity in the medical field.
{"title":"Feasibility of mixed-reality telecollaboration to enhance pre-medical student shadowing education","authors":"Aleeza Nasir, Rida Nasir, Daisy Puca, Kevin Charles, Sandhya LoGalbo, Jayme Schwartz, Ishveer Kaur, Temesgen Tsige, Tran Tu Huynh, Lisa Iyeke, Lindsay Jordan, Mark Richman","doi":"10.1101/2024.09.04.24312893","DOIUrl":"https://doi.org/10.1101/2024.09.04.24312893","url":null,"abstract":"Medical school admissions are highly competitive, leading to high attrition rates, particularly among underserved minority (URM) students. Mentorship and clinical exposure are critical for the success of URM students, but limited access to these experiences can be due to factors such as time constraints and transportation barriers. Augmented reality (AR) has the potential to revolutionize medical education for pre-medical students by providing engaging and accessible clinical shadowing opportunities. This study aims to investigate the feasibility and impact of integrating OpticSurg's Vision Beyond AR platform into the educational experience of students shadowing the Emergency Department (ED). The study will focus on students' experience using the Vision Beyond platform and the potential strengths and weaknesses associated with the overall use of the device. The study included Hofstra pre-medical undergraduate and post-baccalaureate students of good academic standing and character all cleared to shadow in the Long Island Jewish Medical Center Emergency Department (ED), aged 18 or older. This pilot study explored the use of Vision Beyond AR glasses, for remote pre-medical education. Students who were not present in the ED accessed medical teaching materials using de-identified resources available on the internet, such as CT scans, EKGs, lab results, physical examination findings, ultrasounds, and X-rays. No patients were involved in the study. The educator used the Vision Beyond goggles to start a session and invited the students to participate through the Vision Beyond website. Students utilized the interactive feature to indicate areas where they desired greater detail or explanation. After each session, students completed a survey to assess their experience, including demographics, system usability, ease of use for specific topics, overall impression, and the strengths and weaknesses of the platform. Fifteen pre-medical and post-baccalaureate students participated in the study. Students rated the device on a 1-to-5 scale (1 = Strongly disagree, 5 = Strongly agree) for ease of use and learnability. On average, the ratings for these categories were 4 or above. The incidence of motion sickness and nausea received an average rating of 1.8 out of 5. The pilot program using OpticSurg's Vision Beyond platform showed promise, with students reporting a positive experience and finding the device easy to use. However, challenges such as internet connectivity issues and limitations of the AR goggles were noted. Future research should explore how this technology can enhance diversity in the medical field.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142225764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1101/2024.09.03.24312252
Alex Garner, Quin Ashcroft, Dale Kirkwood, Vishnu Chandrabalan, Hedley Emsley, Suzanne M Mason, Nancy Preston, Jo Knight
Background Since December 2022, the NHS has experienced large-scale strikes over pay by staff. Strikes heavily impact elective care delivery. The NHS cancels approximately 12 million elective care appointments each year. One million appointments have been cancelled due to strikes between 2022 and 2024. During this time emergency care is prioritised, and in a recent opinion piece, the president of the Royal College of Emergency medicine claimed the Emergency Department ran ‘better than usual’. The aim of this paper was to investigate changes in patient flow into hospitals through the ED during the strike periods.
{"title":"Evaluating the Impact of NHS Strikes on Patient Flow through Emergency Departments","authors":"Alex Garner, Quin Ashcroft, Dale Kirkwood, Vishnu Chandrabalan, Hedley Emsley, Suzanne M Mason, Nancy Preston, Jo Knight","doi":"10.1101/2024.09.03.24312252","DOIUrl":"https://doi.org/10.1101/2024.09.03.24312252","url":null,"abstract":"<strong>Background</strong> Since December 2022, the NHS has experienced large-scale strikes over pay by staff. Strikes heavily impact elective care delivery. The NHS cancels approximately 12 million elective care appointments each year. One million appointments have been cancelled due to strikes between 2022 and 2024. During this time emergency care is prioritised, and in a recent opinion piece, the president of the Royal College of Emergency medicine claimed the Emergency Department ran ‘better than usual’. The aim of this paper was to investigate changes in patient flow into hospitals through the ED during the strike periods.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1101/2024.08.22.24312125
Kirstin West, Alena Pauley, Mia Buono, Miriana Mikindo, Yvonne Sawe, Joseph Kilasara, Francis Sakita, Sharla Rent, Bariki Mchome, Blandina T. Mmbaga, Catherine A. Staton
Background Rates of prenatal alcohol use in Sub-Saharan Africa (SSA) are increasing, despite regulatory bodies urging pregnant women to abstain from alcohol. Tanzania has minimal policies, interventions, and young female education addressing alcohol consumption during pregnancy (ACDP), leading to a considerable number of pregnancies being exposed to alcohol and consequent health consequences like fetal alcohol spectrum disorder (FASD). Research investigating the prevalence of ACDP in SSA —specifically in Tanzania— is abundant. In Tanzania, there is a limited understanding of alcohol use practices among pregnant women who consume alcohol (PWCA), as well as community knowledge, attitudes, and cultural beliefs related to ACDP.
{"title":"The Burden of Generational Harm due to Alcohol use in Tanzania: a mixed method study of pregnant women","authors":"Kirstin West, Alena Pauley, Mia Buono, Miriana Mikindo, Yvonne Sawe, Joseph Kilasara, Francis Sakita, Sharla Rent, Bariki Mchome, Blandina T. Mmbaga, Catherine A. Staton","doi":"10.1101/2024.08.22.24312125","DOIUrl":"https://doi.org/10.1101/2024.08.22.24312125","url":null,"abstract":"<strong>Background</strong> Rates of prenatal alcohol use in Sub-Saharan Africa (SSA) are increasing, despite regulatory bodies urging pregnant women to abstain from alcohol. Tanzania has minimal policies, interventions, and young female education addressing alcohol consumption during pregnancy (ACDP), leading to a considerable number of pregnancies being exposed to alcohol and consequent health consequences like fetal alcohol spectrum disorder (FASD). Research investigating the prevalence of ACDP in SSA —specifically in Tanzania— is abundant. In Tanzania, there is a limited understanding of alcohol use practices among pregnant women who consume alcohol (PWCA), as well as community knowledge, attitudes, and cultural beliefs related to ACDP.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: To understand the utilization and burden of emergency medical conditions (EMCs), we assessed EM Department (EMD) data from the Health Management and Information System (HMIS) of India and EMC from the Global Burden of Diseases (GBD). Methods: This was a retrospective cross-sectional analysis of HMIS and GBD data for 2019. We extracted EMD registrations, admissions, and deaths from HMIS and incidence, deaths, and DALYs from GBD for 31 EMCs at the national and state levels. We analyzed HMIS and GBD data for proportions and rates of registrations, deaths, and incident cases relative to population counts and hospital admission numbers. Results: In 2019, 119,103,358 patients (8,935.66 per 100,000 people) were registered at EMDs. The national EMD registration rate was 6,744.21 per 100,000 hospital admissions and the EMD death rate was 43,939.49 per 100,000 inpatient deaths. Only 12.14% of all HMIS registrations had cause-specific data. GBD estimated 2,047,175,737 EMC incident cases nationally, accounting for 27.22% of all-cause incidence, 51.71% of all-cause mortality, and 42.30% of all-cause DALYs. Trauma-related registrations were 9.27% in HMIS while injuries in GBD accounted for 7% of EMCs. Overall, HMIS EMD registrations were lower than GBD EMC incidence numbers, with regional variations. Conclusions: The study reveals gaps in the EMD utilization as per HMIS data compared to the EMC burden estimates from GBD. Improved data integration and reporting can address regional disparities.
{"title":"Emergency Care in India: A Retrospective Cross-sectional Analysis of Health Management and Information System and Global Burden of Disease","authors":"Gaurav Urs, Siddhesh Zadey, Padmavathy Krishna Kumar, Tejali Gangane, Pushkar Nimkar, Catherine Staton, Joao Ricardo Nickenig Vissoci","doi":"10.1101/2024.08.16.24312130","DOIUrl":"https://doi.org/10.1101/2024.08.16.24312130","url":null,"abstract":"Background: To understand the utilization and burden of emergency medical conditions (EMCs), we assessed EM Department (EMD) data from the Health Management and Information System (HMIS) of India and EMC from the Global Burden of Diseases (GBD). Methods: This was a retrospective cross-sectional analysis of HMIS and GBD data for 2019. We extracted EMD registrations, admissions, and deaths from HMIS and incidence, deaths, and DALYs from GBD for 31 EMCs at the national and state levels. We analyzed HMIS and GBD data for proportions and rates of registrations, deaths, and incident cases relative to population counts and hospital admission numbers. Results: In 2019, 119,103,358 patients (8,935.66 per 100,000 people) were registered at EMDs. The national EMD registration rate was 6,744.21 per 100,000 hospital admissions and the EMD death rate was 43,939.49 per 100,000 inpatient deaths. Only 12.14% of all HMIS registrations had cause-specific data. GBD estimated 2,047,175,737 EMC incident cases nationally, accounting for 27.22% of all-cause incidence, 51.71% of all-cause mortality, and 42.30% of all-cause DALYs. Trauma-related registrations were 9.27% in HMIS while injuries in GBD accounted for 7% of EMCs. Overall, HMIS EMD registrations were lower than GBD EMC incidence numbers, with regional variations. Conclusions: The study reveals gaps in the EMD utilization as per HMIS data compared to the EMC burden estimates from GBD. Improved data integration and reporting can address regional disparities.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1101/2024.08.14.24311987
Mike Wells, Lara Nicole Goldstein, Terran Wells, Niloufar Ghazi, Abhijit Pandya, Borifoje Furht, Gabriella Engstrom, Muhammad Tanveer Jan, Richard Shih
Background Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often not possible. Inaccurate estimations may lead to inaccurate drug dosing, which may cause patient harm. High-tech 3D camera systems driven by artificial intelligence might be the solution to this problem. The aim of this review was to describe and evaluate the published literature on 3D camera weight estimation methods. Methods A systematic literature search was performed for articles that studied the use of 3D camera systems for weight estimation in adults. Data on the study characteristics, the quality of the studies, the 3D camera methods evaluated, and the accuracy of the systems were extracted and evaluated. Results A total of 14 studies were included, published from 2012 to 2024. Most studies used Microsoft Kinect cameras, with various analytical approaches to weight estimation. The 3D camera systems often achieved a P10 of 90% (90% of estimates within 10% of actual weight), with all systems exceeding a P10 of 78%. The studies highlighted a significant potential for 3D camera systems to be suitable for use in emergency care. Conclusion The 3D camera systems offer a promising method for weight estimation in emergency settings, potentially improving drug dosing accuracy and patient safety. Weight estimates were extremely accurate. Importantly, 3D camera systems possess characteristics that could make them very appropriate for use during emergency care. Future research should focus on developing and validating this methodology in larger studies with true external and clinical validation.
{"title":"Total body weight estimation by 3D camera systems: potential high-tech solutions for emergency medicine applications? A scoping review","authors":"Mike Wells, Lara Nicole Goldstein, Terran Wells, Niloufar Ghazi, Abhijit Pandya, Borifoje Furht, Gabriella Engstrom, Muhammad Tanveer Jan, Richard Shih","doi":"10.1101/2024.08.14.24311987","DOIUrl":"https://doi.org/10.1101/2024.08.14.24311987","url":null,"abstract":"Background\u0000Weight estimation is required in adult patients when weight-based medication must be administered during emergency care, as measuring weight is often not possible. Inaccurate estimations may lead to inaccurate drug dosing, which may cause patient harm. High-tech 3D camera systems driven by artificial intelligence might be the solution to this problem. The aim of this review was to describe and evaluate the published literature on 3D camera weight estimation methods.\u0000Methods\u0000A systematic literature search was performed for articles that studied the use of 3D camera systems for weight estimation in adults. Data on the study characteristics, the quality of the studies, the 3D camera methods evaluated, and the accuracy of the systems were extracted and evaluated. Results\u0000A total of 14 studies were included, published from 2012 to 2024. Most studies used Microsoft Kinect cameras, with various analytical approaches to weight estimation. The 3D camera systems often achieved a P10 of 90% (90% of estimates within 10% of actual weight), with all systems exceeding a P10 of 78%. The studies highlighted a significant potential for 3D camera systems to be suitable for use in emergency care.\u0000Conclusion\u0000The 3D camera systems offer a promising method for weight estimation in emergency settings, potentially improving drug dosing accuracy and patient safety. Weight estimates were extremely accurate. Importantly, 3D camera systems possess characteristics that could make them very appropriate for use during emergency care. Future research should focus on developing and validating this methodology in larger studies with true external and clinical validation.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-17DOI: 10.1101/2024.08.14.24311988
Rose Gagnon, Kadija Perreault, Jason Robert Guertin, Luc J. Hebert, Simon Berthelot
Objectives: Compare the average cost of an emergency department (ED) visit between three ED care models, namely management by an emergency physician (EP) alone (usual care), management by a primary contact physiotherapist (PT) and an EP (intervention), and management by a PT alone (sensitivity analysis). Methods: Cost study (Canadian Public Payer perspective) based on data collected during a pragmatic randomized clinical trial (2018-2019) conducted in an urban Canadian academic ED (CHUL, Quebec City, Canada; n=78, 18-80 years old). Costs incurred for the management of persons presenting to the ED for a minor musculoskeletal disorder (MSKD) were calculated using Time-Driven Activity-Based Costing, in which time invested with a patient determines care costs. The main outcome measure was the average cost of an ED visit. Generalized linear models with Gamma distributions and log links were used to assess whether there were significant differences in average costs between the care models. Results: Mean ED visit cost was $278.47 (2019 $CAD, 95%CI: $223.70, $357.42) for PT and EP management, compared with $254.68 for EP management ($178.48, $346.68), resulting in a non-significant absolute difference of 23.79 CAD/patient ($-87.04, $135.74) between models (p=.58). Sensitivity analyses showed that the average cost of ED management by a PT was $194.40 ($160.86, $235.14), representing a non-significant average saving of 60.28 CAD/patient ($-168.19, $31.46) compared to EP management. Conclusion: This study is a first step towards a better understanding of the costs incurred by the Canadian Public Payer for the management of persons presenting with MSKDs in the ED. Primary contact physiotherapists have the potential to complement care of MSKD ED patients without increasing healthcare costs.
{"title":"Assessing innovative care models for musculoskeletal disorders' management in the emergency department using Time-Driven Activity-Based Costing","authors":"Rose Gagnon, Kadija Perreault, Jason Robert Guertin, Luc J. Hebert, Simon Berthelot","doi":"10.1101/2024.08.14.24311988","DOIUrl":"https://doi.org/10.1101/2024.08.14.24311988","url":null,"abstract":"<strong>Objectives:</strong> Compare the average cost of an emergency department (ED) visit between three ED care models, namely management by an emergency physician (EP) alone (usual care), management by a primary contact physiotherapist (PT) and an EP (intervention), and management by a PT alone (sensitivity analysis). <strong>Methods:</strong> Cost study (Canadian Public Payer perspective) based on data collected during a pragmatic randomized clinical trial (2018-2019) conducted in an urban Canadian academic ED (CHUL, Quebec City, Canada; n=78, 18-80 years old). Costs incurred for the management of persons presenting to the ED for a minor musculoskeletal disorder (MSKD) were calculated using Time-Driven Activity-Based Costing, in which time invested with a patient determines care costs. The main outcome measure was the average cost of an ED visit. Generalized linear models with Gamma distributions and log links were used to assess whether there were significant differences in average costs between the care models. <strong>Results:</strong> Mean ED visit cost was $278.47 (2019 $CAD, 95%CI: $223.70, $357.42) for PT and EP management, compared with $254.68 for EP management ($178.48, $346.68), resulting in a non-significant absolute difference of 23.79 CAD/patient ($-87.04, $135.74) between models (p=.58). Sensitivity analyses showed that the average cost of ED management by a PT was $194.40 ($160.86, $235.14), representing a non-significant average saving of 60.28 CAD/patient ($-168.19, $31.46) compared to EP management. <strong>Conclusion:</strong> This study is a first step towards a better understanding of the costs incurred by the Canadian Public Payer for the management of persons presenting with MSKDs in the ED. Primary contact physiotherapists have the potential to complement care of MSKD ED patients without increasing healthcare costs.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1101/2024.08.13.24311780
Anna Mattioni, Claudia Carsetti, Krenare Bruqi, Valerio Caputo, Valentina Cianfanelli, Maria Giulia Bacalini, Mariella Casa, Carlo Gabelli, Emiliano Giardina, Gianluca Cestra, Flavie Strappazzon
Selective elimination of early pathological TAU species may be a promising therapeutic strategy to reduce TAU accumulation that contributes to neurodegeneration and hallmarks Alzheimer disease (AD). By performing a genetic analysis of a cohort of 435 patients with (AD), we defined the NDP52GE variant (rs550510) of the autophagic receptor NDP52 (also known as CALCOCO2) as a protective factor for AD. We provide evidence that in in vitro systems and in a Drosophila melanogaster model of TAU-induced AD, NDP52 reduces the accumulation of pathological forms of TAU through the autophagic process and rescues typical neurodegenerative phenotypes induced by hTAU-toxicity. More importantly, we showed that the NDP52GE variant is much more effective in this respect than NDP52WT. Mechanistically, we showed that NDP52 directly binds pathological phospho-TAU, and that NDP52WT and NDP52GE bind them with comparable efficiency. On the contrary, we showed that NDP52GE binds the autophagic machinery (LC3C and LC3B) more efficiently than NDP52WT. We also showed for the first time that NDP52 is a direct target of protein phosphatase 2A (PP2A) in vitro, opening the way to the possibility that this phosphatase may fine-tune the autophagic function of NDP52 in AD. Finally, we found a positive correlation between the worldwide distribution of the allele encoding NDP52GE and the incidence or prevalence of AD. Overall, our work highlights the variant NDP52GE as a resilience factor in AD that shows a robust effectiveness to drive pathological TAU degradation.
选择性消除早期病理 TAU 物种可能是一种很有前景的治疗策略，可减少导致神经变性和阿尔茨海默病（AD）特征的 TAU 积累。通过对 435 名阿尔茨海默病患者进行基因分析，我们发现自噬受体 NDP52（又称 CALCOCO2）的 NDP52GE 变体（rs550510）是阿尔茨海默病的保护因子。我们提供的证据表明，在TAU诱发AD的体外系统和黑腹果蝇模型中，NDP52通过自噬过程减少了病理形式TAU的积累，并挽救了hTAU毒性诱发的典型神经退行性表型。更重要的是，我们发现 NDP52GE 变体在这方面比 NDP52WT 更有效。从机理上讲，我们发现 NDP52 可直接结合病态磷酸-TAU，而且 NDP52WT 和 NDP52GE 与之结合的效率相当。相反，我们发现 NDP52GE 与自噬机制（LC3C 和 LC3B）的结合效率高于 NDP52WT。我们还首次发现 NDP52 在体外是蛋白磷酸酶 2A (PP2A) 的直接靶标，这为该磷酸酶可能微调 NDP52 在 AD 中的自噬功能提供了可能。最后，我们发现编码 NDP52GE 的等位基因在全球的分布与 AD 的发病率或流行率呈正相关。总之，我们的工作强调了变异体 NDP52GE 是 AD 中的一个恢复因子，它显示了驱动病理 TAU 降解的强大功效。
{"title":"A variant of the autophagic receptor NDP52 counteracts phospho-TAU accumulation and emerges as a protective factor for Alzheimer Disease.","authors":"Anna Mattioni, Claudia Carsetti, Krenare Bruqi, Valerio Caputo, Valentina Cianfanelli, Maria Giulia Bacalini, Mariella Casa, Carlo Gabelli, Emiliano Giardina, Gianluca Cestra, Flavie Strappazzon","doi":"10.1101/2024.08.13.24311780","DOIUrl":"https://doi.org/10.1101/2024.08.13.24311780","url":null,"abstract":"Selective elimination of early pathological TAU species may be a promising therapeutic strategy to reduce TAU accumulation that contributes to neurodegeneration and hallmarks Alzheimer disease (AD). By performing a genetic analysis of a cohort of 435 patients with (AD), we defined the NDP52GE variant (rs550510) of the autophagic receptor NDP52 (also known as CALCOCO2) as a protective factor for AD. We provide evidence that in in vitro systems and in a Drosophila melanogaster model of TAU-induced AD, NDP52 reduces the accumulation of pathological forms of TAU through the autophagic process and rescues typical neurodegenerative phenotypes induced by hTAU-toxicity. More importantly, we showed that the NDP52GE variant is much more effective in this respect than NDP52WT. Mechanistically, we showed that NDP52 directly binds pathological phospho-TAU, and that NDP52WT and NDP52GE bind them with comparable efficiency. On the contrary, we showed that NDP52GE binds the autophagic machinery (LC3C and LC3B) more efficiently than NDP52WT. We also showed for the first time that NDP52 is a direct target of protein phosphatase 2A (PP2A) in vitro, opening the way to the possibility that this phosphatase may fine-tune the autophagic function of NDP52 in AD. Finally, we found a positive correlation between the worldwide distribution of the allele encoding NDP52GE and the incidence or prevalence of AD. Overall, our work highlights the variant NDP52GE as a resilience factor in AD that shows a robust effectiveness to drive pathological TAU degradation.","PeriodicalId":501290,"journal":{"name":"medRxiv - Emergency Medicine","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142200843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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