Long Term Implications of Home Healthcare Management on Mortality in Older Adults with Functional Difficulties in the Saudi Community

Background: This study aims to investigate whether certain demographic factors of patients receiving home healthcare (HHC) interventions have any positive impact on mortality. Methods: the study included all patients who were enrolled in the HHC program in a referred medical complex, Jeddah, Saudi Arabia between the years 2017 and 2020 (593 patients). Results: A total of 6,548 HHC visits were received during the study period. From the total number of visits, 3592 (54.9%) HHC visits were scheduled in the year 2020 compared to 157 (2.4%) scheduled HHC visits in 2017 (p < 0.001). The most successful HHC visits were provided in 2020 compared with the year 2017 (2193 vs. 132; p < 0.001). The cancelled HHC visits were observed to be the lowest (194) in 2019. Three explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] made a statistically significant contribution to the logistic regression model after controlling for other variables. Suffering from cerebrovascular diseases and/or bedridden were the strongest predictor of death in patients receiving HHC. Conclusions: During the 2020 pandemic, there was a sharp increase in HHC compared to previous years. Three significant explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] were reported.

Evaluation of Patient No-Shows in a Tertiary Hospital: Focusing on Modes of Appointment-Making and Type of Appointment

No-show appointments waste resources and decrease the sustainability of care. This study is an attempt to evaluate patient no-shows based on modes of appointment-making and types of appointments. We collected hospital information system data and appointment data including characteristics of patients, service providers, and clinical visits over a three-month period (1 September 2018 to 30 November 2018), at a large tertiary hospital in Seoul, Korea. We used multivariate logistic regression analyses to identify the factors associated with no-shows (Model 1). We further assessed no-shows by including the interaction term (“modes of appointment-making” X “type of appointment”) (Model 2). Among 1,252,127 appointments, the no-show rate was 6.12%. Among the modes of appointment-making, follow-up and online/telephone appointment were associated with higher odds of no-show compared to walk-in. Appointments for treatment and surgery had higher odds ratios of no-show compared to consultations. Tests for the interaction between the modes of appointment-making and type of appointment showed that follow-up for examination and online/telephone appointments for treatment and surgery had much higher odds ratios of no-shows. Other significant factors of no-shows include age, type of insurance, time of visit, lead time (time between scheduling and the appointment), type of visits, doctor’s position, and major diagnosis. Our results suggest that future approaches for predicting and addressing no-show should also consider and analyze the impact of modes of appointment-making and type of appointment on the model of prediction.

Intentional fallers with complex pelvic and acetabular fractures do not have worse radiological and functional outcomes than accidental fallers

Individuals who fell from heights of > 6 m can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers. We retrospectively reviewed forty-nine fallers who fell from heights of > 6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments between 2014 and 2017. The fallers were divided into the intentional and accidental fallers. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. Psychiatric counselling was performed for each intentional fallers during their follow ups. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (Merle d'Aubigné and Majeed hip scores at 6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. We found that the intentional fallers with pelvic and acetabular fractures might be accompanied by more severe combined injuries compared to accidental fallers. Under a standardized perioperative protocol and individualized physical and mental rehabilitation program, the functional and radiological outcomes of the intentional fallers could be comparable to those of the accidental fallers.

A comprehensive study of diagnosis faults techniques occurring in photovoltaic generators

Recently, many focuses have been done in the field of renewable energies, especially in solar photovoltaic energy. Photovoltaic generator, considered as the heart of any photovoltaic installation, exhibits sometimes malfunctions which involve degradations on the overall photovoltaic plant. Therefore, diagnosis techniques are required to ensure failures detection. They avoid dangerous risks, prevent damages, allow protection, and extend their healthy life. For these purposes, many recent studies have given focuses on this field. This paper summarizes a large number of such interesting works. It presents a survey of photovoltaic generator degradations kinds, several types of faults, and their major diagnosis techniques. Comparative studies and some critical analyses are given. Other trending diagnosis solutions are also discussed. A proposed neural networks-based technique is developed to clarify the main process of diagnosis techniques, using artificial intelligence. This method shows good results for modelling and diagnosing the healthy and faulty (shaded) photovoltaic array.

Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not have Worse Radiological and Functional Outcomes than Accidental Fallers

Background: Individuals who fell from heights of >6 m accidentally or intentionally can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods: Between 2014 and 2017, individuals who fell from heights of >6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments were enrolled. The fallers were divided into the intentional and accidental fallers, and their clinical parameters were statistically evaluated and compared.Results: Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. Conclusions: The intentional fallers with pelvic and acetabular fractures might be accompanied by more severe injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers.

Intentional Fallers with Complex Pelvic and Acetabular Fractures Do Not have Worse Radiological and Functional Outcomes than Accidental Fallers

Background: Individuals who fell from heights of >6 m accidentally or intentionally can suffer from complex pelvic and acetabular fractures. The extent to which an intentional fall correlates with prognosis and outcome after osteosynthesis is unclear. We aimed to investigate the clinical outcomes of fallers with pelvic and acetabular fractures after osteosynthesis and to compare the radiological and functional outcomes between intentional and accidental fallers.Methods: Between 2014 and 2017, individuals who fell from heights of >6 m, developed pelvic and acetabular fractures, survived after resuscitation, and completed surgical treatments were enrolled. The fallers were divided into the intentional and accidental fallers, and their clinical parameters were statistically evaluated and compared.Results: Forty-nine fallers who underwent osteosynthesis for pelvic and acetabular fractures were included. Sixteen patients were intentional fallers, whereas the rest of the patients fell accidentally. All patients who fell intentionally had pre-existing mental disorders, and the major diagnosis was adjustment disorder. The group with intentional fallers had female sex predominance, higher injury and new injury severity scores, and longer hospital stay. However, the early loss of fixation (less than three month) and functional outcomes (6- and 12-month follow-up) did not significantly differ between the intentional and accidental fallers. Conclusions: The intentional fallers with pelvic and acetabular fractures might be accompanied by more severe injuries compared to accidental fallers. However, the radiological and functional outcomes of the intentional fallers after osteosynthesis were not inferior to those of the accidental fallers.

Observational study on the current status of thalassaemia in Malaysia: a report from the Malaysian Thalassaemia Registry

ObjectiveThalassaemia is the most common inherited blood disorder in Malaysia. This study aims to report the current status of thalassaemia in Malaysia and provide a comprehensive understanding of the disease through data obtained from the Malaysian Thalassaemia Registry.DesignData were extracted from the Malaysian Thalassaemia Registry, a web-based system accessible to enrolled users through www.mytalasemia.net.my.SettingThe Malaysian Thalassaemia Registry data was recorded from reports obtained from 110 participating government and university hospitals in Malaysia.ParticipantsThe patients were those attending the 110 participating hospitals for thalassaemia treatment.InterventionData were collected from the Malaysian Thalassaemia Registry from 2007 until the fourth quarter of 2018.Primary outcome measure7984 out of 8681 patients with thalassaemia registered in the Malaysian Thalassaemia Registry were reported alive.ResultsMajority of the patients were reported in the state of Sabah (22.72%); the largest age group affected was 5.0–24.9 years old (64.45%); the largest ethnic group involved was Malay (63.95%); and the major diagnosis was haemoglobin E/β-thalassaemia (34.37%). From the 7984 patients, 56.73% were on regular blood transfusions and 61.72% were on chelation therapy. A small fraction (14.23%) has undergone splenectomy, while the percentage of patients with severe iron overload (serum ferritin ≥5000 µg/L) reduced over time. However, cardiac complications are still the main cause of death in patients with thalassaemia.ConclusionData gathered into the registry can be used to understand the progression of the disorder, to monitor iron overload management and to improve the outcomes of treatment, to enhance preventive strategies, reduce healthcare burden and improve the quality of life. Sustainability of the Malaysian Thalassaemia Registry is important for surveillance of thalassaemia management in the country and help the national health authorities to develop more effective policies.

Occurrence of neurocysticercosis in patients presenting with seizure and its serological evaluation

Background: Aims and objectives was to diagnose neurocysticercosis among the patient admitted with seizure in Pediatric Department of TMMRC and to correlate the serological and radiological findings.Methods: A total of 100 patients presenting with recent onset seizures were recruited from Pediatric department of a local major tertiary care teaching hospital during the period 2016-2017. Brain imaging was performed in all the above cases. Serological assessment was done using ELISA kit. Diagnosis of neurrocysticercois was done using Del Brutto’s criteria.Results: The recruited patients presented with generalized, simple partial, and focal seizures (68%, 21% and 11% respectively). NCC was diagnosed in 37 of 100 (37.0%) seizure cases based on imaging characteristics. There were 13% cases in whom, MRI showed calcified NCC/granuloma suggestive of NCC. In 24% cases, scolex suggestive of NCC was seen. A total of 15 (15%) cases were seropositive for Taenia. Using Del Brutto criteria, a total of 23% cases were diagnosed as probable NCC and 15% as definite neurocysticercosis. A total of 62% cases were confirmed as not having neurocysticercosis.Conclusions: The findings of present study showed that neurocysticercosis still is a major diagnosis among children presenting with seizure from this endemic area. Neuroimaging was a useful tool in diagnosis and characterisation of NCC than serological tool. The study highlighted the need to create awareness regarding maintenance of hygiene and cleanliness.