Impact of a learning health system on acute care and medical complications after intracerebral hemorrhage

Introduction: Patients with stroke often experience pneumonia during the acute stage after stroke onset. Oral care may be effective in reducing the risk of stroke‐associated pneumonia (SAP). We aimed to determine the changes in oral care, as well as the incidence of SAP, in patients with intracerebral hemorrhage, following implementation of a learning health system in our hospital. Methods: We retrospectively analyzed the data of 1716 patients with intracerebral hemorrhage who were hospitalized at a single stroke center in Japan between January 2012 and December 2018. Data were stratified on the basis of three periods of evolving oral care: period A, during which conventional, empirically driven oral care was provided (n = 725); period B, during which standardized oral care was introduced, with SAP prophylaxis based on known risk factors (n = 469); and period C, during which oral care was risk‐appropriate based on learning health system data (n = 522). Logistic regression analysis was performed to evaluate associations between each of the three treatment approaches and the risk of SAP. Results: Among the included patients, the mean age was 71.3 ± 13.6 years; 52.6% of patients were men. During the course of each period, the frequency of oral care within 24 hours of admission increased (P < .001), as did the adherence rate to oral care ≥3 times per day (P < .001). After adjustment for confounding factors, a change in the risk of SAP was not observed in period B; however, the risk significantly decreased in period C (odds ratio 0.61; 95% confidence interval 0.43‐0.87) compared with period A. These associations were maintained for SAP diagnosed using strict clinical criteria or after exclusion of 174 patients who underwent neurosurgical treatment. Conclusions: Risk‐appropriate care informed by the use of learning health system data could improve care and potentially reduce the risk of SAP in patients with intracerebral hemorrhage in the acute stage

Predictors towards entrepreneurial intention: a Malaysian case study

The bumiputra population in Malaysia seems unable to match the nonbumiputras especially the Chinese in terms of their entrepreneurial character. The small number of small business startup by the bumiputras in Malaysia evidently shows this. One reason suggested by many academics is the risktaking propensity by the bumiputras. This research intends to investigate the relationship between risk taking propensity and entrepreneurial intention among the bumiputras and Chinese in Malaysia. The respondents for this study were 746 students studying in Universiti Malaysia Sabah. Questionnaires were used in the data collection process. The results revealed that the Chinese respondents had significantly higher risk taking scores than the bumiputras. The Chinese were also found to be more intent to become entrepreneurs upon graduation from the university. This clearly explains why the Chinese are predominantly involved in business in Malaysia as compared to the bumiputras. Significant differences were also found between genders whereby male respondents were found to have higher risk taking scores and more intent to become entrepreneurs than the females. The degree programs in which the students are enrolled in also showed significant differences with the Science students having the highest risk taking scores followed by the Business and the Arts students. The regression result examining the relationship between risk taking propensity and intention to become an entrepreneur was found to be significant. However, the ability of risk taking propensity to explain the variance in entrepreneurial intention is very small. Suggestions were given to overcome the problems of low risk taking propensity among the bumiputras

Retrospective study on the outcomes and risk factors of right paramedian abomasopexy for right abomasal disorders in 47 dairy cows

Very few epidemiologic studies have verified the utility of the right paramedian abomasopexy (RPA) technique in cows with right abomasal disorders. This study aimed to investigate the outcomes and risk factors for non-survival in the herd within 30 days of surgery in cows with right abomasal disorders who underwent the RPA technique. Forty-seven Holstein cows with right abomasal disorders (25 with right abomasal displacement [RDA] and 22 with right abomasal volvulus [RAV]) were included. Twenty-two cows with RDA (22/25, 88.0%) and 10 cows with RAV (10/22, 45.5%) survived at 30 days post-surgery. Multivariate logistic regression analysis indicated that hyponatremia, hypokalemia, and the presence of abomasal volvulus were the major risk factors associated with non-survival

Relationship between bronchoalveolar lavage fluid and plasma endotoxin activity in calves with bronchopneumonia

The aim of this study was to investigate the relationship between the endotoxin activity in plasma and that in bronchoalveolar lavage fluid (BALF) in bronchopneumonia. Thirty-three calves were included in this study (17 healthy calves and 16 calves with respiratory disease). In the calves with bronchopneumonia, the median endotoxin activity in plasma (0.437 EU/ml, P<0.001) and BALF (29.45 EU/ml, P<0.001) was significantly higher than in the control calves. Plasma endotoxin activity was significantly and positively correlated with that in BALF (r2=0.900, P<0.001). Based on the receiver operating characteristics curves, we propose a diagnostic cutoff point for plasma endotoxin activity (0.104 EU/ml, AUC=0.914, P<0.001, Se 81.3% and Sp 82.4%) for identification of bronchopneumonia in calves which could die within a week