Indicators for an extended length of stay in the emergency service unit of a Thai community hospital: A multi-level analysis

Background: Extended length of stay affects the efficiency of patient care and results in undesirable patient outcomes. This study explores potential indicators for a prolonged length of stay in the emergency unit in a community hospital setting. Methods: A retrospective cohort study was conducted. Patients who visited the emergency unit during the first half of September 2018 were included. A multivariable multi-level risk regression was used to explore for potential indicators of an extended length of stay in the emergency unit. Results: A total of 1,160 emergency visits nested within 16 days study period were included for analysis. 126 (10.9%) visits with an extended length of stay (≥4 hours) and 1,034 visits with a length of stay less than 4 hours were identified. Different patient characteristics and characteristics related to emergency unit between groups were explored. Male gender (RR=1.52, 95% CI; 1.05-2.20, p=0.025), elderly patients (RR=1.82, 95% CI; 1.08-3.04, p=0.016), Burmese citizenship (RR=1.72, 95% CI; 1.15-2.59, p=0.009), non traumatic mode of presentation (RR=2.50, 95% CI; 1.28-4.92, p=0.008), hospital admission as disposition status (RR=2.38, 95% CI; 1.50-3.77, p<0.001), visit on weekends (RR=2.42, 95% CI; 1.12-5.23, p=0.025), and visit during day shifts (RR=5.75, 95% CI; 1.38-23.92, p=0.016) were identified as significant indicators for extended length of stay in the emergency unit. Conclusion: Indicators for an extended length of stay in the emergency unit of a Thai community hospital were male patients, elderly patients, Burmese citizenship, non-traumatic mode of presentation, hospital admission as disposition status, visit on weekends, and visit during day shifts

Predictive factors of extubation failure in pediatric cardiac intensive care unit: A single-center retrospective study from Thailand

Introduction/objectiveExtubation failure increases morbidity and mortality in pediatric cardiac patients, a unique population including those with congenital heart disease or acquired heart disease. This study aimed to evaluate the predictive factors of extubation failure in pediatric cardiac patients and to determine the association between extubation failure and clinical outcomes.MethodsWe conducted a retrospective study in the pediatric cardiac intensive care unit (PCICU) of the Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, from July 2016 to June 2021. Extubation failure was defined as the re-insertion of the endotracheal tube within 48 hours after extubation. Multivariable log-binomial regression with generalized estimating equations (GEE) was performed to explore the predictive factors associated with extubation failure.ResultsWe collected 318 extubation events from 246 patients. Of these, 35 (11%) events were extubation failures. In physiologic cyanosis, the extubation failure group had significantly higher SpO2 than the extubation success group (P < 0.001). The predictive factors associated with extubation failure included a history of pneumonia before extubation (RR 3.09, 95% CI 1.54–6.23, P = 0.002), stridor after extubation (RR 2.57, 95% CI 1.44–4.56, P = 0.001), history of re-intubation (RR 2.24, 95% CI 1.21–4.12, P = 0.009), and palliative surgery (RR 1.87, 95% CI 1.02–3.43, P = 0.043).ConclusionExtubation failure was identified in 11% of extubation attempts in pediatric cardiac patients. The extubation failure was associated with a longer duration of PCICU stay but not with mortality. Patients with a history of pneumonia before extubation, history of re-intubation, post-operative palliative surgery, and post-extubation stridor should receive careful consideration before extubation and close monitoring afterward. Additionally, patients with physiologic cyanosis may require balanced circulation via regulated SpO2

Dextrose Administration and Resuscitation Outcomes in Patients with Blood Sugar Less Than 150 mg/dL during Cardiopulmonary Resuscitation: An Observational Data Analysis

Low blood sugar is commonly found during cardiopulmonary resuscitation (CPR). However, current guidelines do not mention the importance of glucose testing and acute management for hypoglycemia during CPR. We intended to investigate the association between dextrose administration and resuscitation outcomes in patients with blood sugar less than 150 mg/dL during cardiac arrest in the emergency department (ED). We conducted a retrospective cohort study at a tertiary hospital between 2017 and 2020, including patients with intra-arrest blood glucose <150 mg/dL. Logistic regression with inverse probability treatment weighting (IPTW) was used. The primary outcome was the return of spontaneous circulation (ROSC). Secondary outcomes included survival to hospital admission and hospital discharge and favorable neurological outcomes at discharge. A total of 865 patients received CPR at the ED during the study period. Of these, 229 with low blood sugar were included (60 in the treatment group and 169 in the non-treatment group). The mean age was 59.5 ± 21.4 years. After IPTW, dextrose administration during CPR was not associated with ROSC (adjusted OR [aOR] 1.44, 95% CI 0.30–0.69), survival to hospital admission (aOR 1.27, 95% CI 0.54–3.00), survival to hospital discharge (aOR 0.68, 95% CI 0.20–2.29), and favorable neurological status (aOR 2.21, 95% CI 0.23–21.42). Our findings suggested that dextrose administration during CPR at the ED might not lead to better or worse resuscitation outcomes. Owing to the design limitations and residual confounding factors, strong recommendations for dextrose administration could not be formulated. Further evidence is needed from prospective trials to confirm the efficacy of dextrose during CPR

Impacts of Solar Electricity Generation on the Thai Electricity Industry

This paper analyses the impacts of electricity generation from solar energy on the Thai electricity industry. In this paper, three scenarios (REF, Solar2015 and Solar2018) are developed to represent an increased levels of electricity produced from solar energy. A Low Emissions Analysis Platform (LEAP) model is employed, in this paper, to assess the impacts for the period 2019–2037. This paper assesses and analyses the scenario impacts in terms of diversification of electricity generation, fossil fuel requirement and emissions of CO2 and SO2. The analysis reveals that increased electricity generation from solar energy would help diversify energy supply for electricity generation, reduce fossil fuel imports, and therefore help improve energy security of the country. Furthermore, it would help mitigating CO2 and SO2 emissions – an issue of environmental significance. Despite several benefits, there are a number of emerging barriers for promoting electricity generation from solar energy in Thailand. These include the intermittency of solar energy, high-capital cost, unsupportable grid infrastructure and unfavourable regulatory framework. This paper, therefore, suggests that the implementation of energy storage system, provision of financial incentives to potential investors, improvement of grid flexibility and the revision of the regulations to support solar energy business could be effective strategies in order to address the barriers facing the Thai electricity industry

Association between Intra-Arrest Blood Glucose Level and Outcomes of Resuscitation at the Emergency Department: A Retrospective Study

Since current cardiac arrest guidelines do not address the benefit of blood glucose measurement, the ideal ranges and target of blood glucose (BG) levels during cardiac arrest to achieve a better result are warranted. We intended to investigate the associations between intra-arrest BG levels and outcomes of cardiac arrest resuscitation at the emergency department (ED). We conducted a retrospective observational study at a single university hospital. Cardiac arrest patients at the ED between 2017 and 2020 were included. Multivariable logistic regression analysis was performed to examine the associations between intra-arrest BG levels and clinical outcomes. We categorized intra-arrest BG into five groups: &lt;70 mg/dL, 70&ndash;99 mg/dL, 100&ndash;180 mg/dL, 181&ndash;250 mg/dL, and &gt;250 mg/dL. Eight hundred and nineteen patients experienced ED cardiac arrest during the study period. Of all, 385 intra-arrest BG measurements were included in the data analysis. The mean age was 60.4 years. The mean intra-arrest BG level was 171.1 mg/dL, with 64 (16.6%) patients who had intra-arrest BG level below 70 mg/dL and 73 (19.0%) patients who had intra-arrest BG level more than 250 mg/dL. Markedly low (&lt;70 mg/dL) and low (70&ndash;99 mg/dL) intra-arrest BG levels were significantly associated with a lower chance of return of spontaneous circulation (ROSC, OR 0.36, 95% CI 0.14&ndash;0.99, p = 0.05 and OR 0.33, 95% CI 0.12&ndash;0.93, p = 0.04, respectively). For patients who experienced cardiac arrest at the ED, an intra-arrest BG level of less than 100 was inversely correlated with sustained ROSC. Although we could not draw a causal relationship between variables concerning this study design, normalizing intra-arrest BG was shown to result in good clinical outcomes

Comparative effectiveness among available treatments in difficult-to-treat port-wine stains (PWS): a Network Meta-Analysis of observational evidence

Background Although pulsed dye laser (PDL) is the treatment of choice for port-wine stains (PWS), clinical resistance to PDL has been observed in 20–30% of cases. Several alternative treatment modalities have been introduced; however, there is still a lack of definite recommendations regarding the optimal treatment for difficult-to-treat PWS. Objective We aimed to systematically review and analyze the comparative effectiveness among treatments for problematic PWS. Methods & Materials We systematically searched for comparative studies assessing treatments for patients with difficult-to-treat PWS through relevant biomedical databases until August 2022. A Network Meta-Analysis (NMA) was conducted to estimate the odds ratio (OR) for all pairwise comparisons. The primary outcome is the improvement of lesions of more than 25%. Results Of the 2498 studies identified, six treatments from five studies were available for NMA. Compared with 585 nm short-pulsed dye laser (SPDL), intense pulsed light (IPL) was the most effective in clearing lesions (OR 11.81, 95% CI 2.15 to 64.89, very low confidence rating), followed by 585 nm long-pulsed dye laser (LPDL) (OR 9.95, 95% CI 1.75 to 56.62, very low confidence rating). The 1064 nm NdYAG, 532 nm NdYAG, and LPDL >585 nm exhibited potential superiority over SPDL 585 nm, although statistical significance was not observed. Conclusions IPL and 585 nm LPDL are likely to be more effective than 585 nm SPDL for treating difficult-to-treat PWS. Well-designed clinical trials are warranted to confirm our findings

Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight &gt; 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population

Emulation of a Target Trial to Evaluate the Causal Effect of Palliative Care Consultation on the Survival Time of Patients with Hepatocellular Carcinoma

Palliative care has the potential to improve the quality of life of patients with incurable diseases or cancer, such as hepatocellular carcinoma (HCC). A common misconception of palliative care with respect to the patient’s survival remains a significant barrier to the discipline. This study aimed to provide causal evidence for the effect of palliative care consultation on the survival time after diagnosis among HCC patients. An emulation of a target trial was conducted on a retrospective cohort of HCC patients from January 2017 to August 2019. The primary endpoint was the restricted mean survival time (RMST) at 12 months after HCC diagnosis. We used the clone–censor–weight approach to account for potential immortal time bias. In this study, 86 patients with palliative care consultation and 71 patients without palliative care consultation were included. The adjusted RMST difference was −29.7 (95% confidence interval (CI): −81.7, 22.3; p-value = 0.263) days in favor of no palliative care consultation. However, palliative care consultation was associated with an increase in the prescription of symptom control medications, as well as a reduction in life-sustaining interventions and healthcare costs. Our findings suggest that palliative care consultation was associated with neither additional survival benefit nor harm in HCC patients. The misconception that it significantly accelerates the dying process should be disregarded