Decline in emergency department visits during the COVID-19 quarantine

BACKGROUND

Emergency department (ED) visits can be divided into urgent and non-urgent. A delay in seeking medical help, especially in urgent cases, can lead to fatal consequences, along with a higher rate of complications and morbidity. Coronavirus disease 2019 (COVID-19) pandemic spread led to restrictions and eventually quarantines. We investigated the impact of the COVID-19 spread and quarantine on ED visits rates comparing to parallel periods in preceding years (2013-2019). In addition, we compared this decrease to holidays and weekends, times in which a decrease in ED visits is seen.

METHODS

This was a descriptive retrospective study. Causes of ED referrals were divided into urgent and non-urgent, then into different subcategories including infectious, cardiac, etc. RESULTS: For the spring COVID-192020 quarantine period, a 56.3% decrease of mean ED visits per day was seen, as compared to preceding years (55.7% and 98.9% respectively). This decrease was also statistically evident when comparing the urgent and non-urgent causes separately and for all sub-categories. This pattern of decrease also showed statistical evidence of fewer ED visits during holidays for most comparisons, in which lower ED visit rates are expected. Significantly lower rates of ED visits were demonstrated during the COVID-19 quarantine period, as compared to preceding years and main holidays and weekends, a decrease that was also demonstrated for urgent life-threatening causes.

CONCLUSION

Our findings can be used to inform a wide range of stakeholders, including regional planners, historians, sociologists, and international healthcare organizations. Healthcare providers should understand the reasons for this ED visit decline pattern, attempt to address patients' concerns, and increase awareness regarding alarming symptoms in urgent medical situations.

Antimicrobials in the Hospital are Unevenly Discontinued on Weekdays

Objective Amid the global spread of antimicrobial resistance, antimicrobial stewardship should be further promoted in the clinical setting. Our previous study suggested an intra-week disproportion of discontinuation of broad-spectrum antibiotics. We therefore explored the generalization of this prescription trend by investigating the use of all intravenous antibiotics. Methods A retrospective, observational study. Patients Between January 1, 2018, and December 31, 2020, we collected data on the initiation and discontinuation of intravenous antimicrobials on each day of the week and on days after holidays at Okayama University Hospital, Japan. We compared the monthly antimicrobial prescription initiation and discontinuation using the Kruskal-Wallis test and Mann-Whitney U-test with Bonferroni correction as a post-hoc procedure. Results Data from 15,293 hospitalized cases were analyzed. The initiation of antimicrobials differed slightly among days of the week, although this trend was clinically insignificant. Compared with the initiations, antimicrobial discontinuations were disproportionately biased among the weekdays, tending to occur on Mondays (p <0.001) about twice as often as on other days. Similarly, antimicrobials were unevenly discontinued on the day after holidays compared to other days (p <0.001), with an approximately 2-fold difference. The use of antimicrobials in the hospital was thus unequally terminated on weekdays. Conclusion To further promote antimicrobial stewardship, clinicians should be aware of the influence of behavioral, environmental, and social factors on antimicrobial prescription, which is seemingly beyond medical indications.

Outcomes of emergency appendectomies and cholecystectomies performed at weekends

PURPOSE

To determine the impact of hospital admissions and operations at weekends on two common emergency general surgeries (cholecystectomy and appendectomy) and their outcomes.

METHODS

A total of 539 patients were included in the study. Information on patient demographics, comorbidities, admission date, surgery date, complications, readmission, and follow-up details were collected from electronic medical records.

RESULTS

Most patients were admitted to hospital on weekdays (n = 391), and 444 surgeries were performed on weekdays, while 86 surgeries were performed at weekends. No significant difference was found between the type of surgery performed on weekday and weekend admissions (P = 0.384). Surgical procedures of patients admitted to hospital on a weekend tended to be delayed by a median of one day compared with weekday admissions, with a similar overall length of stay for both groups. Weekend admissions were associated with higher complication rates than weekday admissions (12.2 vs. 6.1%). Patients who were operated on at weekends were younger in age than those admitted on weekdays (32 vs. 30 years old, P = 0.019). More appendectomies were performed at weekends (77.9% vs. 45.9%), and fewer cholecystectomies were performed (22.1 vs. 54.1%, P = 0.000).

CONCLUSIONS

The surgical procedures of patients admitted to hospital on weekends tended to be delayed by 1 day and had a higher rate of complications. Appendectomy was the most common performed weekend surgery.

Clinical characteristics and outcomes of patients with venous thromboembolism according to diagnosis on weekends versus on weekdays

There are uncertainties on the influence of the days of diagnosis in a week (weekends versus weekdays) on clinical outcomes in patients with acute venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT). The COMMAND VTE registry is a multicenter cohort study enrolling 3027 consecutive patients with acute symptomatic VTE. The current study population consisted of 337 patients diagnosed on weekends and 2690 patients diagnosed on weekdays. We compared the clinical characteristics, management strategies and 30-day outcomes between the 2 groups. The patients diagnosed on weekends more often presented with PE (72% vs. 55%, P < 0.001), and with more severe hemodynamic condition for PE patients. The patients diagnosed on weekends more often received initial parenteral anticoagulation therapy and thrombolysis than those diagnosed on weekdays. The cumulative 30-day incidence of all-cause death was not significantly different between the two groups among PE patients (diagnosis on weekends: 6.2% vs. diagnosis on weekdays: 6.5%, P = 0.87), as well as among DVT patients (0.0% vs. 1.5%, P = 0.24). The most frequent cause of deaths was fatal PE in both groups among PE patients. The risks for recurrent VTE and major bleeding at 30-day were not significantly different between the 2 groups among PE patients, nor among DVT only patients. In conclusion, the VTE patients diagnosed on weekends presented more often with PE, and with more severe condition for PE patients. Nevertheless, the risk for 30-day mortality was not significantly different between patients diagnosed on weekends and on weekdays.

Does diet strictness level during weekends and holiday periods influence 1-year follow-up weight loss maintenance? Evidence from the Portuguese Weight Control Registry

There is not much evidence about how diet strictness during weekends and holidays influence long-term weight loss maintenance. Our aim was to examine how dieting more or less strictly during weekends and holidays (vs. weekdays and non-holiday periods) influence weight loss maintenance.Participants (n = 108) from the Portuguese Weight Control Registry indicated whether they had a more or less strict diet regimen during weekends compared to weekdays. A similar question about holiday and non-holiday period' diet regimen was answered. Weight and height were measured at baseline and 1y follow-up. A 3% maximum weight variation defined participants as "non-regainers".General level on dieting strictness on weekends vs. weekdays (r = - 0.28, p < 0.01) and holidays vs. non-holidays (r = - 0.33, p < 0.001) predicted 1y weight change.Participants who reported being less strict on weekends (OR = 0.34, 95% CI: 0.15-0.81) were more likely to be non-regainers when compared with the ones who reported being more strict on weekends. Non-significant results were found during holidays (OR = 0.47, 95% CI: 0.20-1.09).Adopting a less strict diet regimen during weekends, when compared to weekdays, was a behavioral strategy associated with long-term weight management in our sample.

Cannabis use motives on weekends versus weekdays: Direct and indirect relations with cannabis use and related problems

College cannabis users report using more cannabis during the weekend than on weekdays, yet little attention has been paid to the role of weekend and weekday-specific motives for use. The present investigation evaluated the impact of weekend and weekday-specific cannabis motives on cannabis use and related problems among current (past-3 month) cannabis using undergraduates (N = 276). Participants reported more cannabis use motives during the weekend than weekday. Enhancement and social motives were greater than coping, conformity, and expansion motives during weekends. Enhancement and conformity motives were indirectly related to problems via cannabis use frequency for both weekdays and weekends. Yet social, coping, and expansion motives were indirectly related to problems via cannabis use frequency for only weekdays. Findings support the differential impact of weekend and weekday-specific motives on cannabis use and related problems.

The influence of periodic increases of human activity on crepuscular and nocturnal mammals: Testing the weekend effect

Human recreation can negatively affect wildlife, particularly on weekends when human activity is highest (i.e., the weekend effect). Much of what we understand about the weekend effect is based on research conducted on diurnal species, which have greater temporal overlap with humans. Because nocturnal species generally avoid times when humans are active, they are likely less affected by anthropogenic activity on weekends. Our objective was to test the weekend effect in relation to the degree of nocturnality of mammals in a recreational area. We predicted that as nocturnality increased, the effect of human activity would decrease. To address our objective, we placed 50 remote cameras along the Diamond Fork River in Utah from January to June 2015. We found that three out of the four focal species supported our predictions. Mule deer (crepuscular) reduced activity throughout our entire study area during weekends and avoided campgrounds. Beavers and mountain lions (both nocturnal) did not negatively respond to increased human activity. Raccoons (nocturnal) reduced activity during weekends, but only within campground areas. Our findings indicate that as the temporal overlap increases between wildlife and humans, so does the influence that humans have on wildlife.

Is the timing of radiological intervention and treatment day associated with economic outcomes in DRG-financed health care systems: a case study

BACKGROUND

In 2012, Switzerland has introduced a diagnosis related group (DRG) system for hospital financing to increase the efficiency and transparency of hospital services and to reduce costs. However, little is known about the efficiency of specific processes within hospitals. The objective of this study is to describe the relationship between timing of radiological interventions, in particular scan and treatment day, and the length of stay (LOS) compliance in a hospital.

METHODS

This is a cross-sectional observational study based on administrative records of all DRG cases in a Swiss university hospital in 2013, enriched by data from the radiology information system and accounting details. The data are analysed using descriptive statistics and regression methods.

RESULTS

Radiology and related treatment on a weekend is associated with a higher LOS compliance of approximately 22.12% (p<0.01) compared to scans and treatments on weekdays, controlling for gender, age and insurance of the patient, as well as detailed medical and radiology-related factors. The higher LOS compliance is driven by emergency cases, which supports the hypothesis that for those cases on weekends more efficient scan and treatment processes are in place.

CONCLUSION

The study provides evidence on how days of radiological intervention are related to LOS compliance in a Swiss hospital under DRG and attempts to explain how this is linked to standardised operating procedures. Our results have implications regarding potential cost savings in hospital care through alignment of care processes, infrastructure planning and guidance of patient flows.

Curvilinear associations of sleep patterns during weekdays and weekends with glycemic control in type 2 diabetes: the Hong Kong Diabetes Registry

AIMS

We aimed to explore the associations of sleep patterns during weekdays and weekends with glycemic control in patients with type 2 diabetes.

METHODS

We examined the association between indices of glycemic control [glycated hemoglobin (HbA_1c) and fasting plasma glucose (FPG)] and sleep parameters (sleep duration, bedtime, and differences of sleep duration during weekdays and weekends) from adults with type 2 diabetes recruited in a prospective cohort enrolling from hospital medical clinics. Restricted cubic spline regression was used to examine the relationships between the glycemic indices and sleep parameters.

RESULTS

Excluding shift workers, a total of 3508 patients enrolled between July 2010 and July 2014 were included in this analysis. Mean age was 53.9 [standard deviation (SD) 8.7] years, and mean disease duration of diabetes was 8.3 (SD 7.1) years. Fifty-nine percentage were men. Mean sleep duration during weekdays and difference of sleep durations between weekdays and weekends were 7.7 (SD 1.3) hours and 0.6 (SD 1.2) hours, respectively. Mean HbA_1c and FPG were 7.6 (1.5) % and 7.6 (2.5) mmol/L, respectively. Using restricted cubic spline regressions with successive adjustments of potential confounders, sleep duration difference between weekdays and weekends remained significantly associated with both HbA_1c and FPG in a curvilinear manner. Sleep duration of about 1 h more during weekends when compared to weekdays was associated with beneficial effect in HbA_1c (-0.13 %, 95 % confidence interval -0.24 to -0.02).

CONCLUSIONS

In type 2 diabetes, regular sleeping habit with modest sleep compensation during weekends has positive impact on glycemic control.

Weekday-weekend patterns of physical activity and screen time in parents and their pre-schoolers

Background

This study focuses on the comparison of weekday/weekend parent-child behavioural patterns (step count (SC) and screen time (ST)) and answers the question of whether achieving the recommendations for daily SC (10,000) in parents also helps their preschool children achieve the recommended daily SC (11,500).

Methods

The participants (278 parents aged 30–45 and their 194 children aged 4–7) were randomly recruited from 10 Czech public kindergartens. The participants recorded SC (pedometer Yamax Digiwalker SW-200) and ST duration (proxy-report) for seven consecutive days (≥8 h/day) during September–October 2014 and April–May 2015. Differences between weekdays/weekends SC or ST were tested using a paired t-test. The odds of achieving the recommended daily SC for children were estimated using general logistic regression separately for weekdays and weekends.

Results

Only the mothers were found to have a significantly lower SC at weekends than on weekdays. All of the participants showed significantly more ST at weekends than on weekdays (daughters: 78.6 vs. 45.7 min/day, p < 0.001; sons: 78.8 vs. 55.8 min/day; mothers: 93.0 vs. 68.3 min/day; and fathers: 116.6 vs. 87.5 min/day). Daughters and sons were significantly more likely to achieve daily SC recommendation if a) the SC on weekdays during the daily routine in kindergarten exceeded the median of kindergarten SC or b) at weekends if their mother (OR: 9.67, 95 % CI: 3.57–26.23) exceeded 10,000 steps a day.

Conclusions

Especially at weekends, preschoolers have higher odds of meeting the recommended 11,500 steps per day when their mother reaches 10,000 steps per day and this is independent of the amount of parents’ ST. Moreover, physical activity in kindergarten helps preschool children meet the 11,500 recommended steps per day on weekdays. Therefore, interventions to promote physical activity in preschoolers should focus on kindergartens and encourage involvement of their families.

Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers

BACKGROUND AND PURPOSE

The outcome in acute stroke strongly depends on patient-related issues, as well as on the availability of human and diagnostic resources. Our aim was to evaluate safety and effectiveness of intravenous alteplase for stroke according to the time of admission to the hospital.

MATERIALS AND METHODS

We analyzed the data of all acute stroke patients treated with alteplase between October 2003 and December 2010, contributed to the Safe Implementation of Thrombolysis for Stroke registry from 27 Polish stroke centers. According to the time of admission we distinguished between: (1) non-working days (Friday 14:30-Monday 08:00 plus national holidays); (2) out-of-office hours (non-working days plus 14:30-08:00 during working days); and (3) night hours (time from 23:00 to 06:00). Patients admitted during regular working hours (Monday 08:00-Friday 14:30, excluding national holidays) were used as the reference.

RESULTS

Of 1330 patients, 448 (32.5%) were admitted on non-working days, 868 (65.3%) at out-of-office hours, and 105 (7.9%) during night hours. In multivariate logistic regression, none of the evaluated periods showed association with symptomatic intracranial hemorrhage, 7-day mortality, and neurological improvement ≥4 points in the National Institutes of Health Stroke Scale score at day 7. Patients admitted during night hours had lower odds (OR 0.53, 95% CI: 0.29-0.95, p=0.032) for achieving favorable outcome (modified Rankin Scale score 0-2).

CONCLUSIONS

There is no bad time for thrombolysis. Stroke centers should feel confident about the treatment outside regular working hours, irrespective of equipment and staff availability. However, it may be reasonable to pay additional attention during nighttime.