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Lee SY, Ro YS, Shin SD, Kim SJ, Jung E. Epidemiology of Non-Emergent Cancer-Related Emergency Department Visits in Korea between 2016 and 2020. Yonsei Med J 2024; 65:418-426. [PMID: 38910305 PMCID: PMC11199182 DOI: 10.3349/ymj.2023.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/06/2024] [Accepted: 01/30/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE As people living with cancer increase in the aging society, cancer-related emergency department (ED) visits are also increasing. This study aimed to investigate the epidemiologic characteristics of non-emergent cancer-related ED visits using a nationwide ED database. MATERIALS AND METHODS A cross-sectional study was conducted using the National Emergency Department Information System (NEDIS) database. All cancer-related ED visits between 2016 and 2020 were included. The study outcome was non-emergent ED visits, defined as patients triaged into non-emergent condition at both the time of arrival at ED and discharge from ED and were discharged without hospitalization. RESULTS Among 1185871 cancer-related ED visits over 5 years, 19.0% (n=225491) were classified as non-emergent visits. While abdominal pain and fever are the top chief complaints in both emergent and non-emergent visits, non-emergent visits had high proportions of abdomen distension (4.8%), ascite (2.4%), and pain in lower limb (2.0%) compared with emergent visits. The cancer types with a high proportion of non-emergent visits were thyroid (32.4%) and prostate cancer (30.4%). Adults compared with children or older adults, female, medical aid insurance, urban/rural ED, direct-in compared with transfer-in, and weekend visit were associated with high odds for non-emergent visits. CONCLUSION Approximately 20% of cancer-related ED visits may be potentially non-emergent. A significant number of non-emergent patients visited the ED due to cancer-related symptoms. To improve the quality of care for people living with cancer, the expansion of supportive care resources besides of ED, including active symptom control, is necessary.
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Affiliation(s)
- Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sun Ro
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
- National Emergency Medical Center, National Medical Center, Seoul, Korea.
| | - Sang Do Shin
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Seong Jung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Chosun University Hospital, Gwangju, Korea
| | - Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea
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Lee KS, Sung HK, Choi YY, Han C, Min HS. Impact of the Early COVID-19 Pandemic on Emergency Department Visits of Adult Cancer Patients With Fever or Respiratory Symptoms: A Korean Nationwide Population-Based Study, 2016-2020. J Korean Med Sci 2024; 39:e187. [PMID: 38887201 PMCID: PMC11182695 DOI: 10.3346/jkms.2024.39.e187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/15/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND We performed a nationwide analysis to evaluate the impact of the early coronavirus disease 2019 (COVID-19) pandemic on emergency department (ED) visits by adult cancer patients having COVID-like symptoms. METHODS We analyzed the National Emergency Department Information System (NEDIS) data on ED visits by adult cancer patients who presented with chief complaints of fever or respiratory symptoms (FRS) indicative of COVID-19, from 2016 to 2020. An interrupted time series analysis with a quasi-Poisson regression model was performed, adjusting for seasonality and time, to evaluate whether underlying trends for monthly ED visits and the in-hospital mortality rate (%) per month changed with the pandemic among these patients. We also estimated the adjusted odds ratio (aOR) of in-hospital deaths among cancer patients using multivariable logistic regression analysis. RESULTS ED visits by cancer patients with FRS decreased during the COVID-19 pandemic (relative risk [RR] with 95% confidence interval [CI]: slope change, 0.99 [0.98-1.00] and step change, 0.84 [0.76-0.92]). However, the in-hospital mortality rate (%) for these patients was increased (slope change, 1.14 [1.04-1.25] and step change, 0.99 [0.98-1.01]). Factors such as urgent triage status, ambulance use, and treatment in hospitals with fewer than 300 staffed beds significantly contributed to increased aOR of in-hospital deaths during the COVID-19 pandemic compared to the pre-pandemic period. CONCLUSION Further studies are needed to highlight the importance of ED service preparation in planning and managing resources for cancer patients during future pandemics.
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Affiliation(s)
- Kyung Shin Lee
- Public Health Research Institute, National Medical Center, Seoul, Korea.
| | - Ho Kyung Sung
- Public Health Research Institute, National Medical Center, Seoul, Korea
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Youn Young Choi
- Public Health Research Institute, National Medical Center, Seoul, Korea
- Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hye Sook Min
- Public Health Research Institute, National Medical Center, Seoul, Korea
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Fleshner L, Lagree A, Shiner A, Alera MA, Bielecki M, Grant R, Kiss A, Krzyzanowska MK, Cheng I, Tran WT, Gandhi S. Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review. Oncologist 2023; 28:1020-1033. [PMID: 37302801 PMCID: PMC10712716 DOI: 10.1093/oncolo/oyad161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/04/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Patients diagnosed with cancer are frequent users of the emergency department (ED). While many visits are unavoidable, a significant portion may be potentially preventable ED visits (PPEDs). Cancer treatments have greatly advanced, whereby patients may present with unique toxicities from targeted therapies and are often living longer with advanced disease. Prior work focused on patients undergoing cytotoxic chemotherapy, and often excluded those on supportive care alone. Other contributors to ED visits in oncology, such as patient-level variables, are less well-established. Finally, prior studies focused on ED diagnoses to describe trends and did not evaluate PPEDs. An updated systematic review was completed to focus on PPEDs, novel cancer therapies, and patient-level variables, including those on supportive care alone. METHODS Three online databases were used. Included publications were in English, from 2012-2022, with sample sizes of ≥50, and reported predictors of ED presentation or ED diagnoses in oncology. RESULTS 45 studies were included. Six studies highlighted PPEDs with variable definitions. Common reasons for ED visits included pain (66%) or chemotherapy toxicities (69.1%). PPEDs were most frequent amongst breast cancer patients (13.4%) or patients receiving cytotoxic chemotherapy (20%). Three manuscripts included immunotherapy agents, and only one focused on end-of-life patients. CONCLUSION This updated systematic review highlights variability in oncology ED visits during the last decade. There is limited work on the concept of PPEDs, patient-level variables and patients on supportive care alone. Overall, pain and chemotherapy toxicities remain key drivers of ED visits in cancer patients. Further work is needed in this realm.
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Affiliation(s)
- Lauren Fleshner
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Andrew Lagree
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
- Temerty Centre for AI Research and Education, University of Toronto, Toronto, Canada
| | - Audrey Shiner
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Marie Angeli Alera
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mateusz Bielecki
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robert Grant
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
- The Cancer Quality Lab, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Ivy Cheng
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Emergency Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Emergency Medicine, University of Toronto, Toronto, Canada
| | - William T Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Radiogenomics Laboratory, Sunnybrook Health Sciences Centre, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Temerty Centre for AI Research and Education, University of Toronto, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Sonal Gandhi
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
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Lee AR, Park H, Yoo A, Kim S, Sunwoo L, Yoo S. Risk Prediction of Emergency Department Visits in Patients With Lung Cancer Using Machine Learning: Retrospective Observational Study. JMIR Med Inform 2023; 11:e53058. [PMID: 38055320 PMCID: PMC10733827 DOI: 10.2196/53058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/31/2023] [Accepted: 11/24/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients with lung cancer are among the most frequent visitors to emergency departments due to cancer-related problems, and the prognosis for those who seek emergency care is dismal. Given that patients with lung cancer frequently visit health care facilities for treatment or follow-up, the ability to predict emergency department visits based on clinical information gleaned from their routine visits would enhance hospital resource utilization and patient outcomes. OBJECTIVE This study proposed a machine learning-based prediction model to identify risk factors for emergency department visits by patients with lung cancer. METHODS This was a retrospective observational study of patients with lung cancer diagnosed at Seoul National University Bundang Hospital, a tertiary general hospital in South Korea, between January 2010 and December 2017. The primary outcome was an emergency department visit within 30 days of an outpatient visit. This study developed a machine learning-based prediction model using a common data model. In addition, the importance of features that influenced the decision-making of the model output was analyzed to identify significant clinical factors. RESULTS The model with the best performance demonstrated an area under the receiver operating characteristic curve of 0.73 in its ability to predict the attendance of patients with lung cancer in emergency departments. The frequency of recent visits to the emergency department and several laboratory test results that are typically collected during cancer treatment follow-up visits were revealed as influencing factors for the model output. CONCLUSIONS This study developed a machine learning-based risk prediction model using a common data model and identified influencing factors for emergency department visits by patients with lung cancer. The predictive model contributes to the efficiency of resource utilization and health care service quality by facilitating the identification and early intervention of high-risk patients. This study demonstrated the possibility of collaborative research among different institutions using the common data model for precision medicine in lung cancer.
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Affiliation(s)
- Ah Ra Lee
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hojoon Park
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Aram Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Seok Kim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Leonard Sunwoo
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Yoo HH, Ro YS, Ko E, Lee JH, Han SH, Kim T, Shin TG, Kim S, Chang H. Epidemiologic trends of patients who visited nationwide emergency departments: a report from the National Emergency Department Information System (NEDIS) of Korea, 2018-2022. Clin Exp Emerg Med 2023; 10:S1-S12. [PMID: 37967858 PMCID: PMC10662522 DOI: 10.15441/ceem.23.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE : This study analyzed trends in emergency department (ED) visits in South Korea using the National Emergency Department Information System (NEDIS) data from 2018 to 2022. METHODS : This was a retrospective observational study using data from the NEDIS database from 2018 to 2022. Age- and sex-standardized ED visits per 100,000 population, as well as age- and sex-standardized rates for mortality, admission, and transfer, were calculated. RESULTS : The standardized ED visits per 100,000 population was approximately 20,000 from 2018 to 2019 and decreased to about 18,000 in 2022. The standardized mortality rate ranged from 1.4% to 1.7%. The admission rate (18.4%-19.4%) and the transfer rates (1.6%-1.8%) were similar during the study period. Approximately 5.5% of patients were triaged as Korean Triage and Acuity Scale score 1 or 2. About 91% of patients visited the ED directly and 21.7% of patients visited the ED with an ambulance. The ED length of stay was less than 6 hours in 90.3% of patients and the ED mortality rate was 0.6%. Acute gastroenteritis was the most common diagnosis. Respiratory virus symptoms, such as fever and sore throat, were also common chief complaints. CONCLUSION : ED visits decreased during the 5-year period, while admission, transfer, and death rates remained relatively stable.
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Affiliation(s)
- Hyun Ho Yoo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Sun Ro
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eunsil Ko
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Jin-Hee Lee
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - So-hyun Han
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seongjung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea
- Department of Emergency Medicine, Chosun University Hospital, Gwangju, Korea
| | - Hansol Chang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ko JI, Choi SJ, Yoo SH, Cho B, Kim MS, Kim KH, Lee SY. Epidemiology and characteristics of emergency department utilization by patients with amyotrophic lateral sclerosis in Korea from 2016 to 2020: A nationwide study. Muscle Nerve 2023; 68:451-459. [PMID: 37540049 DOI: 10.1002/mus.27952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION/AIMS Patients with amyotrophic lateral sclerosis (ALS) inevitably visit the emergency department (ED) due to their increased risk of respiratory failure and mobility limitations. However, nationwide data on ED visits by patients with ALS are limited. This study investigated the characteristics of patients with ALS-related ED visits. METHODS We conducted a cross-sectional study from 2016 to 2020, utilizing a nationwide ED database. The total number of patients with ALS who visited the ED and their primary reasons for visiting/diagnoses were analyzed. RESULTS In total, 6036 visits to the ED were made by patients with ALS. Of these, 41.8% arrived by ambulance and 27.7% spent >9 h in the ED. Following ED treatment, 57.4% were hospitalized, including 19.3% admitted to the intensive care unit (ICU) and 5.4% who died in the hospital. The primary reasons for ALS-related ED visits were dyspnea (35.2%), feeding tube problems (10.1%), fever (7.8%), and mental status changes (3.6%). The most common diagnoses were pneumonia (14.5%), respiratory failure (5.7%), dyspnea (5.5%), aspiration pneumonia (4.3%), and tracheostomy complications (3.4%). DISCUSSION Reasons for ED visits for patients with ALS include acute respiratory distress, as well as concerns related to tube feeding and tracheostomy. To reduce the risk of patients with ALS requiring ED visits, it is essential to ensure the provision of timely respiratory support and high-quality home-based medical care teams that can support and address patients before their condition deteriorates.
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Affiliation(s)
- Jung-In Ko
- Department of Emergency Medicine, National Medical Center, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Republic of Korea
| | - Belong Cho
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine & Hospital, Seoul, Republic of Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine & Hospital, Seoul, Republic of Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kim YM, Min A, Hong HC. The Effectiveness of Telenursing Interventions on Patient Outcomes for Colorectal Cancer Patients: A Systematic Review and Meta-Analysis. Semin Oncol Nurs 2023; 39:151406. [PMID: 36966061 DOI: 10.1016/j.soncn.2023.151406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/23/2022] [Accepted: 02/22/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To systematically review existing telenursing interventions for patients with colorectal cancer and determine the effects of such interventions on health-related quality of life and health care service utilization. DATA SOURCES We conducted a systematic review and meta-analysis after protocol registration. International databases, including PUBMED, EMBASE, CINAHL, Web of Science, SCOPUS, and CENTRAL and Korean databases, were searched. The last search was conducted on June 8, 2021. Two authors independently selected relevant studies, evaluated their methodological quality, and extracted data. A meta-analysis of randomized controlled trials was conducted using the statistical software STATA 16.0. Of the 223 articles retrieved, 7 were included for narrative synthesis and 3 were used for the meta-analysis. There were 857 patients in the telenursing group and 842 patients in the conventional group. Three studies applied theoretical frameworks for designing the intervention. CONCLUSION The effect of telenursing intervention was not different from that of usual care. However, both readmission rates and emergency department visits were lower in the telenursing group than in the usual care group, although these trends were not statistically significant. IMPLICATIONS FOR NURSING PRACTICE These findings indicate that telenursing intervention did not differ from usual care in terms of health-related quality of life while reducing readmission and emergency department visits in a nonstatistically significant manner. Therefore, telenursing interventions could serve as a partial alternative to current face-to-face interventions for patients with colorectal cancer.
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Affiliation(s)
- Young Man Kim
- Assistant Professor, College of Nursing·Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, South Korea
| | - Ari Min
- Associate Professor, Department of Nursing, Chung-Ang University, Seoul, South Korea
| | - Hye Chong Hong
- Associate Professor, Department of Nursing, Chung-Ang University, Seoul, South Korea.
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Pettit NR, Li X, Stewart L, Kline J. Worsened outcomes of newly diagnosed cancer in patients with recent emergency care visits: A retrospective cohort study of 3699 adults in a safety net health system. Cancer Med 2023; 12:4832-4841. [PMID: 36394210 PMCID: PMC9972123 DOI: 10.1002/cam4.5303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/11/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Many patients receive a suspected diagnosis of cancer through an emergency department (ED) visit. Time to treatment for a new diagnosis of cancer is directly associated with improved outcomes with little no describing the ED utilization prior to the diagnosis of cancer. We hypothesize that patients that have an ED visit in proximity to a diagnosis of cancer will have worse outcomes, including mortality. METHODS This study is a retrospective cohort study of all patients with cancer diagnosed at Eskenazi Health (Indiana) between 2016 and 2019. Individual health characteristics, ED utilization, cancer types, and mortality were studied. We compared those patients seen in the ED within 6 months prior to their diagnosis (cases) to patients not seen in the ED (controls). RESULTS A total of 3699 patients with cancer were included, with 1239 cases (33.50%). Patients of black race had higher frequencies in the cases vs. controls (46.57% vs. 40.68%). Lung cancer was the most frequently observed cancer among cases vs. controls (11.70% vs. 5.57%). For the cases, 232 patients were deceased (18.72%) compared with 247 patients among the controls (10.04%, p < 0.0001, OR 2.06 95% confidence interval [CI] 1.70-2.51). An ED visit in past 6 months (OR = 1.73, 95% CI 1.38-2.18) and Medicaid insurance type (versus commercial, OR = 4.16, 95% CI 2.45-7.07) were associated with of mortality. Female gender (OR = 0.76, 95% CI 0.67-0.88), tobacco use (OR = 1.62, 95% CI 138-1.90), and Medicaid insurance type (versus commercial, OR = 2.56, 95% CI 2.07-3.47) were associated with prior ED use. CONCLUSIONS Over one third of patients with cancer were seen in the ED within 6 months prior to their cancer diagnosis. Higher mortality rates were observed for those seen in the ED. Future studies are needed to investigate the association and impact that the ED has on eventual cancer diagnoses and outcomes.
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Affiliation(s)
- Nicholas R Pettit
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA.,Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Xin Li
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Lauren Stewart
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Jeffrey Kline
- Department of Emergency Medicine, Indiana University, Indianapolis, Indiana, USA.,Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
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Choi CW, Sung HK, Jeong JY, Lim DH, Choi J, Kwon HC, Nam S, Kim Y, Chin B. Changing Features of Liver Injury in COVID-19 Patients: Impact of Infection with the SARS-CoV-2 Delta (B.1.617.2) Variants. Infect Chemother 2022; 54:744-756. [PMID: 36596683 PMCID: PMC9840963 DOI: 10.3947/ic.2022.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is growing evidence that abnormal liver function tests (LFTs) are common in patients with coronavirus disease 2019 (COVID-19). However, it is not known whether viral involvement in the liver differs according to the strain. We investigated the impact on liver injury in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta (B.1.617.2) variants. MATERIALS AND METHODS We conducted a single-center, retrospective cohort study, including 372 patients admitted during the pre-Delta period (PDP: between February 1 and November 30, 2020) and 137 patients admitted during the Delta period (DP: between August 1 and August 31, 2021). Initial liver injury was defined as alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels ≥3 × the upper limit of normal (ULN) or alkaline phosphatase (ALP) or total bilirubin ≥2 × the ULN within 3 days from admission. RESULTS Of 509 patients with COVID-19 included in our study, 38 (7.5%) patients had initial liver injury. The DP group had a significantly higher rate of initial liver injury than the PDP group (PDP: 5.9% vs. DP: 11.7%, P = 0.028). The DP group (adjusted odds ratio [aOR]: 2.737, 95% confidence interval [CI]: 1.322 - 5.666) was independently associated with initial liver injury. During hospitalization, 160 (31.4%) patients had severe COVID-19. The DP group and initial liver injury had higher odds of progressing to severe COVID-19 (aOR: 2.664, 95% CI: 1.526 - 4.648, and aOR: 4.409, 95% CI: 1.816 - 10.707, respectively). The mediation analysis suggested that initial liver injury mediates the relationship between SARS-CoV-2 Delta variant infection and severe COVID-19 (unstandardized beta coefficient = 0.980, Standard error = 0.284, P = 0.001). CONCLUSION Initial liver injury is more common in COVID-19 patients with Delta variants. Also, Delta variants and initial liver injury are associated with poor clinical outcomes.
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Affiliation(s)
- Chang Wan Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Ho Kyung Sung
- National Emergency Medical Center, National Medical Center, Seoul, Korea.,Research Institute for Public Health, National Medical Center, Seoul, Korea
| | - Jae Yoon Jeong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Dae Hyun Lim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Jongkyoung Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Hyeok Choon Kwon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Seongwoo Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - BumSik Chin
- Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea
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Patient and hospital characteristics predict prolonged emergency department length of stay and in-hospital mortality: a nationwide analysis in Korea. BMC Emerg Med 2022; 22:183. [PMID: 36411433 PMCID: PMC9677700 DOI: 10.1186/s12873-022-00745-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prolonged emergency department length of stay (EDLOS) in critically ill patients leads to increased mortality. This nationwide study investigated patient and hospital characteristics associated with prolonged EDLOS and in-hospital mortality in adult patients admitted from the emergency department (ED) to the intensive care unit (ICU). METHODS We conducted a retrospective cohort study using data from the National Emergency Department Information System. Prolonged EDLOS was defined as an EDLOS of ≥ 6 h. We constructed multivariate logistic regression models of patient and hospital variables as predictors of prolonged EDLOS and in-hospital mortality. RESULTS Between 2016 and 2019, 657,622 adult patients were admitted to the ICU from the ED, representing 2.4% of all ED presentations. The median EDLOS of the overall study population was 3.3 h (interquartile range, 1.9-6.1 h) and 25.3% of patients had a prolonged EDLOS. Patient characteristics associated with prolonged EDLOS included night-time ED presentation and Charlson comorbidity index (CCI) score of 1 or higher. Hospital characteristics associated with prolonged EDLOS included a greater number of staffed beds and a higher ED level. Prolonged EDLOS was associated with in-hospital mortality after adjustment for selected confounders (adjusted odds ratio: 1.18, 95% confidence interval: 1.16-1.20). Patient characteristics associated with in-hospital mortality included age ≥ 65 years, transferred-in, artificially ventilated in the ED, assignment of initial triage to more urgency, and CCI score of 1 or higher. Hospital characteristics associated with in-hospital mortality included a lesser number of staffed beds and a lower ED level. CONCLUSIONS In this nationwide study, 25.3% of adult patients admitted to the ICU from the ED had a prolonged EDLOS, which in turn was significantly associated with an increased in-hospital mortality risk. Hospital characteristics, including the number of staffed beds and the ED level, were associated with prolonged EDLOS and in-hospital mortality.
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12
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Workina A, Habtamu A, Zewdie W. Reasons for Emergency Department Visit, Outcomes, and Associated Factors of Oncologic Patients at Emergency Department of Jimma University Medical Centre. Open Access Emerg Med 2022; 14:581-590. [PMID: 36330170 PMCID: PMC9624217 DOI: 10.2147/oaem.s381816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/19/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The number of oncologic patients visiting the emergency department (ED) is increasing and represent a challenge for the emergency team owing to they might have acute sign and symptoms of a still undiagnosed malignancy, management of treatment-related side effects, co-morbidities, and palliative care. Thus, this study was aimed to identify reasons for ED visits, management outcomes, and associated factors of oncologic patients. PATIENTS AND METHODS A prospective cross-sectional study was conducted from March 11, 2021 to August 25, 2021 at the ED of Jimma University Medical Center on a total of 338 oncologic patients. Data were collected from the patient and the patient's medical record using a questionnaire developed from up-to-date similar literatures. The questionnaire was started filled out upon diagnosis of cancer and completed during discharge from the ED. The outcomes of the patients were dichotomized into died and survived then, it was analyzed using frequency and bivariate logistic regression. RESULTS The most common reasons for oncologic patients ED visit were neutropenic fever 79 (23.4%) followed by vomiting 38 (11.2%) and electrolyte abnormality 37 (10.9%) respectively. Among oncologic patients visited ED, 137 (40.5%) of them were admitted to ward and 126 (37.3%) of them were discharged with improvement while 64 (18.9%) of them were died. Based on multivariate logistic regression, those patients who had distant metastasis cancer (AOR 1.85; 95% CI 1.03-7.21), comorbidity (AOR 2.56; 95% CI 1.20, 6.96), and ECOG >3 (AOR 2.40; 95% CI 1.25,13.43) were more likely to die than their counterparts. CONCLUSION Most of the oncologic patients visited ED due to neutropenic fever, nausea and or vomiting, and electrolyte disorder. Amongst oncologic patients who were visited ED, most of them were admitted to ward while around one-fifth of them were died. Having distant metastasis cancer, comorbidity and ECOG >3 were independent predictors of an oncologic patient's outcome at the ED.
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Affiliation(s)
- Abdata Workina
- Department of Nursing, Jimma University, Jimma, Oromia, Ethiopia,Correspondence: Abdata Workina, Department of Nursing, Jimma University, Jimma University, P.O. Box-378, Jimma, Oromia, Ethiopia, Tel +251923643857, Email
| | - Asaminew Habtamu
- Department of Nursing, Jimma University, Jimma, Oromia, Ethiopia
| | - Wondeson Zewdie
- Department of Emergency, Jimma University Medical Centre, Jimma, Oromia, Ethiopia
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de Santis RB, Wainstein AJA, Machado GCOG, Santos FAV, Melo MRP, Drummond‐Lage AP. Cancer patients admitted in the emergency department: A single‐centre observational study. Eur J Cancer Care (Engl) 2022; 31:e13758. [DOI: 10.1111/ecc.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
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Park HM, Won YJ, Kang MJ, Park SJ, Kim SW, Jung KW, Han SS. Trend Analysis and Prediction of Hepatobiliary Pancreatic Cancer Incidence and Mortality in Korea. J Korean Med Sci 2022; 37:e216. [PMID: 35851861 PMCID: PMC9294502 DOI: 10.3346/jkms.2022.37.e216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/13/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This study aimed to analyze the current trends and predict the epidemiologic features of hepatobiliary and pancreatic (HBP) cancers according to the Korea Central Cancer Registry to provide insights into health policy. METHODS Incidence data from 1999 to 2017 and mortality data from 2002 to 2018 were obtained from the Korea National Cancer Incidence Database and Statistics Korea, respectively. The future incidence rate from 2018 to 2040 and mortality rate from 2019 to 2040 of each HBP cancer were predicted using an age-period-cohort model. All analyses, including incidence and mortality, were stratified by sex. RESULTS From 1999 to 2017, the age-standardized incidence rate (ASIR) of HBP cancers per 100,000 population had changed (liver, 25.8 to 13.5; gallbladder [GB], 2.9 to 2.6; bile ducts, 5.1 to 5.9; ampulla of Vater [AoV], 0.9 to 0.9; and pancreatic, 5.6 to 7.3). The age-standardized mortality rate (ASMR) per 100,000 population from 2002 to 2018 of each cancer had declined, excluding pancreatic cancer (5.5 to 5.6). The predicted ASIR of pancreatic cancer per 100,000 population from 2018 to 2040 increased (7.5 to 8.2), but that of other cancers decreased. Furthermore, the predicted ASMR per 100,000 population from 2019 to 2040 decreased in all types of cancers: liver (6.5 to 3.2), GB (1.4 to 0.9), bile ducts (4.3 to 2.9), AoV (0.3 to 0.2), and pancreas (5.4 to 4.7). However, in terms of sex, the predicted ASMR of pancreatic cancer per 100,000 population in females increased (3.8 to 4.9). CONCLUSION The annual incidence and mortality cases of HBP cancers are generally predicted to increase. Especially, pancreatic cancer has an increasing incidence and will be the leading cause of cancer-related death among HBP cancers.
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Affiliation(s)
- Hyeong Min Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mee Joo Kang
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Sang-Jae Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
| | - Sun-Whe Kim
- Department of Surgery, Chung-Ang University Gwang-Myeong Hospital, Gwangmyeong, Korea
| | - Kyu-Won Jung
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
| | - Sung-Sik Han
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea.
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