Find research datasets worth reusing

opencc-by-4.0Apr 2020View details →

Corresponding spreadsheet to the Paper 'Hospital intensive care unit bed management in Italy'

The dataset reports the data collected in the Italian Ministry of Health website regarding the availability of hospital beds as well as the number of discharges and inpatient days. Data are distributed by hospital structure, year (2010 and 2017) and discipline. Additional sheets are included to report the hospital bed management indicators computed to assess the efficiency in the ordinary hospital bed management in Italy before the COVID-19 outbreak.  Last available raw data published by the Ministry of Health are available here: <a href="http://www.salute.gov.it/portale/documentazione/p6_2_8_1_1.jsp?lingua=italiano&id=6">http://www.salute.gov.it/portale/documentazione/p6_2_8_1_1.jsp?lingua=italiano&id=6</a>

opencc-zeroMay 2020View details →

Delays in emergency obstetrics referrals in Addis Ababa hospitals, Ethiopia: a facility-based, cross-sectional study

Objectives: To assess where the delays occur in the referral chain at most and maternal health outcomes based on the three delay model in Addis Ababa, Ethiopia. Design: The study was a facility-based cross-sectional study Setting: Two public and tertiary hospitals in Addis Ababa Participants: All pregnant women who were referred for only labor and delivery services after 28 weeks of gestation between December 2018 and February 2019 in Zewditu and Gandhi Memorial hospitals. Primary and secondary outcome measures: The primary outcome was the type of delays from the three-delay model which met operationally defined time. Maternal health outcomes based on the three-delay model as a secondary outcome. Results: A total of 403 pregnant women referred for delivery to the study hospitals were included in the study. Three-fourth (301, 74.7%) of referred pregnant women had the third delay (delayed receiving appropriate care); (211, 52.4%) had a first delay (delay in making a decision to seek care). Overall 366(90.8%) pregnant women had experienced at least one of the three delays and 71(17.6%) had all the three delays. Twenty-nine (7.2%) referred women had severe maternal outcomes (SMO). The most leading causes/diagnosis of SMO were blood transfusion 17 (58.6%) followed by postpartum hemorrhage 15 (52%) then eclampsia 9 (31%). In addition, women who experienced severe maternal outcomes were 2.9 times more likely to have at least one of the three delays. Conclusion & recommendation: This study highlights the persistence of delays at all levels and especially delay three and its contribution to severe maternal outcomes. Strengthening health referral systems and addressing specific health system bottlenecks during labor and birth in order to ensure no mother will be endangered. We also recommend a qualitative method of study (focus group discussion and in-depth interview) and observing the tertiary hospitals set-up and readiness to manage obstetrics emergencies.

opencc-by-4.0Feb 2018View details →

DBC Clinic started at Mayo Hospital Lahore

Dedicated Deep Brain Stimulation clinic started at Mayo Hospital Lahore. The clinic shall provide the following services: <ol> <li>Consult for Deep Brain Stimulation </li> <li>Consult for Spinal Cord Stimulation </li> <li>Consult for other stereotactic and functional neurosurgery procedures. </li> <li>Programming of IPGs</li> <li>Booking for DBS & SCS procedures.</li> </ol> Out Patient Days: Tue / Thu / Sat, Room 5 & 7, Mayo Hospital Lahore. for consult: kemuneurosurgery@gmail.com

opencc-zeroJul 2020View details →

Discordant Clostridioides difficile diagnostic assay and treatment practice: a cross-sectional study in a tertiary care hospital, Geneva, Switzerland

Objectives: To determine the proportion of patients who received a treatment for Clostridioides difficile infection (CDI) among those presenting a discordant Clostridioides difficile diagnostic assay and to identify patient characteristics associated with the decision to treat CDI. Design: Cross-sectional study. Setting: Monocentric study in a tertiary care hospital, Geneva, Switzerland Participants: Among 4562 adult patients tested for C. difficile between March 2017 and March 2019, 208 patients with discordant tests' results (positive nucleic acid amplification test [NAAT+]/negative enzyme immunoassay [EIA-]) were included. Main outcome measures: Treatment for CDI. Results: CDI treatment was administered in 147 (71%) cases. In multivariate analysis, an abdominal computed tomography scan with signs of colitis (OR 14.7; 95% CI 1.96-110.8) was the only factor associated with CDI treatment. Conclusions: The proportion of NAAT+/EIA- patients who received treatment questions the contribution of the EIA for the detection of toxin A/B after NAAT to limit overtreatment. Additional studies are needed to investigate if other factors are associated with the decision to treat.

opencc-by-4.0Oct 2020View details →

First COVID-19 Genomic Patient Cluster was at PLA Hospital in Wuhan, China

A paper published on Zenodo (DOI 10.5281/zenodo.4119263) by Dr. Steven Quay, M.D., PhD., head of two COVID-19 therapeutic programs at Atossa Therapeutics, Inc. (NASDAQ: ATOS), illuminates new scientific observations and conclusions documenting that the SARS-CoV-2 pandemic began at the General Hospital of Central Theater Command of People’s Liberation Army (PLA Hospital) in Wuhan, China, located at 627 Wulon Road, Wuchang District, Wuhan. International biospecimen data repositories indicate as early as December 10, 2019 COVID patient records were being created by PLA personnel, weeks before the Chinese government informed the WHO of the pandemic.   This is a short presentation by the author explaining his research.

opencc-zeroFeb 2020View details →

Data from: Brief in-hospital cognitive screening detects dementia and anticipates complex admissions

Objective: With the goal of improving community health by screening for dementia, we tested the utility of integrating the Six-Item Screener (SIS) into our emergency room neurology consultations. Methods: In this cross-sectional observational study, we measured SIS performance within 24 hours of hospital arrival in one hundred consecutive English-speaking patients aged ≥ 45 years. Performance was compared to patient age, previously-charted cognitive impairment, and proxies for in-hospital complexity: whether or not a patient was admitted to the hospital and the number of medical studies ordered. Results: Those with poor SIS performance were older (p = 0.02), more likely to have previously-charted cognitive impairment (p < 0.01; sensitivity 86%, specificity 77%). Poor performers were more likely to be admitted to the hospital (p = 0.04; odds ratio = 3.6) and were subjected to more tests once admitted (p < 0.01). These findings persisted after accounting for age and history of cognitive impairment. Conclusions: Poor performance on the SIS was associated with previously charted cognitive impairment, justifying future study of its ability to detect unrecognized dementia cases. Until then, its ability to inexpensively anticipate medically complex hospital admissions motivates broader emergency department use of the SIS.

opencc-zeroNov 2020View details →

Comparison of different thyroid surgical procedures and their outcomes/complications for benign disease in relation to expertise of the surgeon in a public hospital of a developing country over 2 decades

Objective: To compare the frequency of postoperative complications with thyroid surgical procedures and the expertise of the surgeon. Design: Retrospective cross-sectional study from 1999 to 2018. Setting: A public sector tertiary care teaching hospital. Participants and methods: Patients undergoing thyroid surgery (lobectomy with isthmusectomy, subtotal thyroidectomy (STT), near total thyroidectomy (NTT), or total thyroidectomy (TT)) were included. Expertise level 1, 2 and 3 (L1, L2, L3) of the surgeon was based on years of experience or number of thyroid surgeries to their credit. Primary and Secondary Outcome Measures: Postoperative complications (hypocalcemia, recurrent laryngeal nerve (RLN) damage, airway obstruction, hemorrhage and mortality) were measured against type of thyroid surgery and expertise of surgeon. Results: 833 thyroid surgeries were performed on 695 (83.43%) females and 138 (16.57%) males. 502 (60.26%) STT, 228 (27.37%) TT, 61 (7.32%) NTT, 42 (5.04%) lobectomies with isthmusectomies were performed, with LI, 2, and 3 surgeons performing 21.25%, 45.74% and 33.01%, respectively. L1, 2 and 3 surgeons caused 49.47%, 33.45% and 17.08% of adverse events respectively. The permanent hypocalcemia, RLN damage and mortality were significantly (p<0.05) more common in surgeries performed by L1 compared with L2 and L3. Transient and permanent hypocalcemia, transient and permanent RLN damage and mortality were significantly (p<0.01) more common for total thyroidectomy compared to subtotal thyroidectomy. Conclusion: Minimizing the occurrence of complications like permanent hypocalcemia, RLN damage and mortality, expertise of the surgeon and anticipated difficulty of the procedure needs to be taken into account while selecting a thyroid procedure. Keywords: Thyroid surgery, Total thyroidectomy, Subtotal thyroidectomy, near total thyroidectomy, Lobectomy with isthmusectomy, hypoparathyroidism, hypocalcemia, recurrent laryngeal nerve, postoperative complications

opencc-by-4.0Nov 2020View details →

Blood test dynamics in hospitalized COVID-19 patients: potential utility of D-dimer for pulmonary embolism diagnosis

SPSS dataset with metadata of the published article in PlosOne and MedRxIv

opencc-zeroDec 2016View details →

Data from: Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study

Objectives: Homeless people lack a secure, stable place to live, and experience higher rates of serious illness than the housed population. Studies, mainly from the US, have reported increased use of unscheduled health care by homeless individuals. We compared the use of unscheduled ED and inpatient care between housed and homeless hospital patients in a high-income European setting. Setting: A large university teaching hospital serving the south inner city in Dublin, Ireland. Patient data is collected on an electronic patient record within the hospital. Participants: We carried out an observational cross-sectional study using data on all ED visits (n=47,174) and all unscheduled admissions under the general medical take (n=7,031) in 2015. Primary and Secondary Outcome Measures: The address field of the hospital's electronic patient record was used to identify patients living in emergency accommodation or rough sleeping (hereafter referred to as homeless). Data on demographic details, length of stay and diagnoses was extracted. Results: In comparison to housed individuals in the hospital catchment area, homeless individuals had higher rates of ED attendance (0.16 attendances per person/annum vs 3.0 attendances per person/annum respectively) and inpatient bed days (0.3 bed days per person/annum vs 4.4 bed days per person/annum. The rate of leaving ED before assessment was higher in homeless individuals (40% of ED attendances vs 15% of ED attendances in housed individuals). The mean age of homeless medical inpatients was 44.19 (95% CI 42.98-45.40), whereas that of housed patients was 61.20 (95% CI 60.72-61.68). Homeless patients were more likely to terminate an inpatient admission against medical advice (15% of admissions vs 2% of admissions in homeless individuals). Conclusion: Homeless patients represent a significant proportion of ED attendees and medical inpatients. In contrast to housed patients, the bulk of usage of unscheduled care by homeless people occurs in individuals younger than 65.

opencc-zeroDec 2015View details →

Data from: Requirements and access needs of patients with chronic disease to their hospital electronic health record: results of a cross-sectional questionnaire survey

Objectives: To identify patient's views on the functionality required for personalised access to the secondary care EHR and their priorities for development. Design: Quantitative analysis of a cross-sectional self-complete survey of patient views on required EHR functionality from a secondary care EHR, including a patient ranking of functionality. Setting: Secondary care patients attending a regional cystic fibrosis unit in the north of England Participants: 201 adults [106 (52.7%) male], median age 29 years (range 17-58 years) entered and completed the study. Inclusion criteria; a confirmed diagnosis of CF, aged 16 years and over, at a time of clinical stability Outcome measures: Quantitative responses within 4 themes; 1) value placed on aspects of the EHR; 2) access requirements to functions of the EHR; 3) views on information sent to the EHR 4) patient feedback entered into the EHR. A ranked score for 15 functions of the EHR was obtained Results: Highest ratings (% reporting item as very important/important) were reported for access to clinical measures [lung function (94%), CRP (84%), sputum microbiology (81%) and blood results (80%)], medication changes (82%) and lists (83%) and sending repeat prescription (83%) and treatment requests (80%), whilst sending symptom diaries was less so (62%). Email contact with clinicians was the most valuable communication element of the EHR (84% very important/important). Of 15 features of the EHR [1=most desirable to 15=least desirable) patients identified 'clinical measures' [2.62 (CI 2.07-3.06)], and 'access to medication lists' [4.91 (CI 4.47-5.44)], as highest priority for development and the ability to comment on errors/ommissions [11.0 (CI 10.6-11.5)] or experience of care [11.8 (CI 11.4-12.2)] as lowest. Conclusions: Patients want extensive personal access to their hospital EHR, placing high importance on the viewing of practical clinical measures and medication management. These influence routine day to day care and are priorities for development

Data from: Validation of the hospital frailty risk score in a tertiary care hospital in Switzerland: results of a prospective, observational study

Objectives: Recently, the Hospital Frailty Risk Score based on a derivation and validation study in the United Kingdom has been proposed as a low-cost, systematic screening tool to identify older, frail patients who are at greater risk of adverse outcomes and for whom a frailty-attuned approach might be useful. We aimed to validate this Score in an independent cohort in Switzerland. Design: Secondary analysis of a prospective, observational study (TRIAGE study). Setting: One 600-bed tertiary care hospital in Aarau, Switzerland Participants: Consecutive medical inpatients aged 75 years or older that presented to the emergency department or were electively admitted between October 2015 and April 2018. Primary and secondary outcome measures: The primary endpoint was all-cause 30-day mortality. Secondary endpoints were length of hospital stay, hospital readmission, functional impairment, and quality of life measures. We used multivariate regression analyses. Results: Of 4957 included patients, 3150 (63.5%) were classified as low risk, 1663 (33.5%) intermediate risk, and 144 (2.9%) high risk for frailty. Compared to the low-risk group, patients in the moderate risk and high-risk groups had increased risk for 30-day mortality (odds ratio [OR] 2.53, 95%CI 2.09 to 3.06, P<0.001 and OR 4.40, 95%CI 2.94 to 6.57, P<0.001) with overall moderate discrimination (area under the ROC curve 0.66). The results remained robust after adjustment for important confounders. Similarly, we found longer length of hospital stay, more severe functional impairment and a lower quality of life in higher risk group patients. Conclusion: Our data confirms the prognostic value of the Hospital Frailty Risk Score to identify older, frail people at risk for mortality and adverse outcomes in an independent patient population. Trial registration number: ClinicalTrials.gov; Identifier: NCT01768494

Data from: Use of influenza antivirals in patients hospitalized in Hong Kong, 2000-2015

Objectives: We aimed to describe patterns in the usage of antivirals to treat influenza virus infection in hospitals in Hong Kong from 2000 through 2015. Methods: We analyzed centralized electronic health records that included dispensation information and diagnosis codes. Information collected on admissions included patient age, sex, admission year and month, and medications dispensed, and were matched with the first 15 discharge diagnosis codes. We divided monthly admission episodes by relevant population denominators to obtain admission rates, and stratified analyses by drug type, age group, and diagnosis codes. Results: Amantadine was used for influenza treatment in the early 2000s but changed with recommendations to avoid its use in 2006, and is now mainly used to treat Parkinson's disease. Oseltamivir usage increased substantially in 2009 and is now commonly used, with almost 40,000 hospitalizations treated with oseltamivir in the years 2012 through 2015, 66% of which was in persons ≥65 years of age. During the entire study period, of the 98,253 admission episodes in which oseltamivir was dispensed, 40,698 (41%) included a diagnosis code for influenza, and 80,283 (82%) included any diagnosis code for respiratory illness. Conclusions: The amount of oseltamivir used from 2012-15 was comparable to a separate ecological estimate of around 13,000 influenza-associated hospitalizations per year on average. We did not have access to individual patient laboratory testing data.

opencc-zeroDec 2016View details →

Data from: Quality control processes in allografting: a twenty-year retrospective review of a hospital-based bone bank in Taiwan

Musculoskeletal allografts are now commonly used. To decrease the potential risks of transmission of pathogenic bacteria, fungi, or viruses to the transplant recipients, certain issues regarding the management of patients who receive contaminated allografts need to be addressed. We aimed to clarify the incidence and extent of disease transmission from allografts by analyzing the allografting procedures performed in the bone bank of our hospital over the past 20 years. We retrospectively reviewed the data from our allograft registry center on 3979 allografts that were implanted in 3193 recipients throughout a period of two decades, from July 1991 to June 2011. The source of the allografts, results of all screening tests, dates of harvesting and implantation, and recipients of all allografts were checked. With the help of the Center for Infection Control of our hospital, a strict prospective, hospital-wide, on-site surveillance was conducted, and every patient with healthcare-associated infection was identified. Fisher's exact test was used to compare the infection rate between recipients with sterile allografts and those with contaminated allografts. The overall discard and infection rates were, respectively, 23% and 1.3% in the first decade (1991–2001); and 18.4% and 1.25% in the second decade (2001–2011). The infection rate of contaminated allograft recipients was significantly higher than that of sterile allograft recipients (10% vs. 1.15%, P < 0.01) in the second decade. Both infection and discard rates of our bone bank are comparable with those of international bone banks. Strict allograft processing and adequate prophylactic use of antibiotics are critical to prevent infection and disease transmission in such cases.

opencc-zeroDec 2015View details →

Data from: Economic evaluation of a general hospital unit for older people with delirium and dementia (TEAM randomised controlled trial)

Background: One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU) was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months. Objective: To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care. Methods: Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY) gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309). Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%). Results: The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4)). The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008). The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded. Conclusions: The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation.

Data from: Out-of-hospital endotracheal intubation experience, confidence, and confidence-associated factors among Northern Japanese emergency life-saving technicians: a population-based cross-sectional study

Objective: Clinical procedural experience and confidence are both important when performing complex medical procedures. Because out-of-hospital endotracheal intubation (ETI) is a complex intervention, we sought to clarify clinical ETI experience among prehospital rescuers as well as their confidence in performing ETI and confidence-associated factors. Design: Population-based cross-sectional study conducted from January to September 2017. Setting: Northern Japan, including eight prefectures. Participants: Emergency life-saving technicians (ELSTs) authorized to perform ETI. Outcome measures: Annual ETI exposure and confidence in performing ETI, according to a 5-point Likert scale. To determine factors associated with ETI confidence, differences between confident ELSTs (those scoring 4 or 5 on the Likert scale) and non-confident ELSTs were evaluated. Results: Questionnaires were sent to 149 fire departments; 140 agreed to participate. Among the 2821 ELSTs working at responding fire departments, 2620 returned the questionnaire (response rate, 92.9%); complete data sets were available for 2567 ELSTs (complete response rate, 91.0%). Of those 2567 respondents, 95.7% performed two or fewer ETI annually; 46.6% reported lack of confidence in performing ETI. Multivariable logistic regression analysis showed that years of clinical experience (adjusted odds ratio [AOR], 1.09; 95% confidence interval [CI], 1.05–1.13), annual ETI exposure (AOR, 1.79; 95% CI, 1.59–2.03), and the availability of ETI skill retention programs including regular simulation training (AOR, 1.31; 95% CI, 1.02–1.68) and operating room training (AOR, 1.44; 95% CI, 1.14–1.83) were independently associated with confidence in performing ETI. Conclusions: ETI is an uncommon event for most ELSTs and nearly half of respondents did not have confidence in performing this procedure. Because confidence in ETI was independently associated with availability of regular simulation and operating room training, standardization of ETI reeducation that incorporates such methods may be useful for prehospital rescuers.

opencc-zeroDec 2011View details →

Data from: Experiences with Global Trigger Tool reviews in five Danish hospitals – an implementation study

Objectives: To describe experiences with the implementation of global trigger tool (GTT) reviews in five Danish hospitals and to suggest ways to improve the performance of GTT review teams. Design: Retrospective observational study. Setting: The measurement and monitoring of harms are crucial to campaigns to improve the safety of patients. Increasingly, teams use the GTT to review patient records and measure harms in English and non-English-speaking countries. Meanwhile, it is not clear as to how the method performs in such diverse settings. Participants: Review teams from five Danish pilot hospitals of the national Danish Safer Hospital Programme. Primary and secondary outcome measures: We collected harm rates, background and anecdotal information and reported patient safety incidents (PSIs) from five pilot hospitals currently participating in the Danish Safer Hospital Programme. Experienced reviewers categorised harms by type. We plotted harm rates as run-charts and applied rules for the detection of patterns of non-random variation. Results: The hospitals differed in size but had similar patient populations and activity. PSIs varied between 3 and 12 per 1000 patient-days. The average harm rate for all hospitals was 60 per 1000 patient-days ranging from 34 to 84. The percentage of harmed patients was 25 and ranged from 18 to 33. Overall, 96% of harms were temporary. Infections, pressure ulcers procedure-related and gastrointestinal problems were common. Teams reported differences in training and review procedures such as the role of the secondary reviewer. Conclusions: We found substantial variation in harm rates. Differences in training, review procedures and documentation in patient records probably contributed to these variations. Training reviewers as teams, specifying the roles of the different reviewers, training records and a database for findings of reviews may improve the application of the GTT.

opencc-zeroDec 2012View details →

Data from: Long-term benefit of hepatitis C therapy in a safety net hospital system: a cross-sectional study with median 5-year follow-up

Objectives: To demonstrate the effectiveness of hepatitis C virus (HCV) therapy and survival benefit from sustained virologic remission (SVR) in a safety net hospital population with limited resources. Design and setting: We conducted a retrospective cross-sectional study at an urban safety-net hospital in the U.S. Participants and intervention: 242 patients receiving standard HCV therapy between 2001 and 2006. Primary and secondary outcome measures: Response rates, including sustained virologic response (SVR), were recorded for each patient. Univariate and multivariate analyses were performed to identify predictors of SVR and 5 year survival. Results: A total of 242 eligible patients were treated. Treatment was completed in 197 (81%) patients, with 43 patients discontinuing therapy early – 32 due to adverse events and 11 due to non-compliance. Complications on treatment were frequent, including 3 deaths. SVR was achieved in 83 patients (34%). On multivariate analysis, independent predictors of a decreased likelihood of achieving SVR included African American race (OR 0.20, 95% CI 0.07 – 0.54), genotype 1 HCV infection (OR 0.25, 95% CI 0.13 – 0.50) and the presence of cirrhosis (OR 0.26, 95% CI 0.12 – 0.58). Survival was 98% in those achieving SVR (median follow-up 72 months) and 71% in non-responders and those discontinuing therapy (n = 91, median known follow-up 65 and 36 months respectively). On multivariate analysis, the only independent predictor of improved survival was SVR (HR 0.12, 95% CI 0.03 – 0.52). Both cirrhosis and hypoalbuminemia were independent predictors of increased mortality. Conclusions: HCV therapy can be effective despite limited resources. Survival is improved in those achieving SVR. Treatment before histologic cirrhosis develops, in combination with careful selection, may improve long-term outcomes without compromising other health care endeavors in safety net hospitals and areas with financial limitations.

Data from: Missed opportunities for HIV testing among patients newly presenting for HIV care at a Swiss university hospital: a retrospective analysis

Objectives: To determine the frequency of missed opportunities (MOs) among patients newly-diagnosed with HIV, risk factors for presenting MOs, and the association between MOs and late presentation to care. Design: Retrospective analysis Setting: HIV outpatient clinic at a Swiss tertiary hospital Participants: Patients aged ≥18 years old newly presenting for HIV care between 2010 and 2015 Measures: Number of medical visits, up to five years preceding HIV diagnosis, at which HIV testing had been indicated, according to Swiss HIV testing recommendations. A visit at which testing was indicated but not performed was considered a MO for HIV testing. Results: Complete records were available for all 201 new patients of whom 51% were male and 33% from sub-Saharan Africa. Thirty patients (15%) presented with acute HIV infection while 119 patients (59%) were late presenters (LPs) (CD4 counts <350 cells/mm3 at diagnosis). Ninety-four patients (47%) had presented at least one MO, of whom 44 (47%) had multiple MOs. MOs were more frequent among individuals from sub-Saharan Africa, men who have sex with men, and patients under follow-up for chronic disease. MOs were less frequent in LPs than non-LPs (42.5% versus 57.5%, P = 0.03). Conclusions: At our centre, 47% of patients presented at least one MO. Whilst our late presentation rate is higher than the national figure of 49.8%, LPs were less likely to experience MOs, suggesting that these patients were diagnosed late through presenting late, rather than through being failed by our hospital. We conclude that, in addition to optimising physician-initiated testing, access to testing must be improved among patients unaware they are at HIV risk and who do not seek health care.

opencc-zeroDec 2018View details →

Data from: Airflow analysis of Pyeongtaek St. Mary's Hospital during hospitalization of the First Middle East respiratory syndrome patient in Korea

Middle East Respiratory Syndrome (MERS) is known to be transmitted through close contact. However, epidemiological surveys of MERS in Korea indicated that some secondary patients were infected without close contact. Therefore, the possibility of other transmission routes must be identified. In this study, the possibility of MERS spreading through airflow was investigated on the 8th floor of Pyeongtaek St. Mary's Hospital. Computational fluid dynamics was used to analyze the indoor airflow and passive tracer diffusion during the index patient's stay. Six cases were simulated for different outdoor wind directions and indoor mechanical ventilation operations. When a passive tracer was released in ward 8104, where the index patient was hospitalized, the passive tracer spread through the indoor airflow, which was created by the outdoor airflow. Ward 8109, which had the largest number of infected cases and was far distant from ward 8104, showed passive tracer concentration in all cases. This result indicates that MERS may have spread through airflow. The study results do not imply that the infection pathway of MERS is airborne. However, the results show the possibility of MERS spreading through airflow in specific environments such as poor ventilation environments.