Biomedical Sciences and Clinical Medicine

Predicting Hospital Admission of Patients at Triage in the Emergency Department at Lampang Hospital

Wed, 18 Dec 2024 00:00:00 +0700

Objective This study aims to develop a model that can help predict the likelihood of hospital admission for patients at the triage point in Lampang Hospital’s Emergency Department.

Methods The study was designed around Clinical Prediction Rules and was conducted as a retrospective cohort study using data from July 2021 to January 2022 input through the Smart ER program. Patients were categorized into two groups: admit and discharge. Statistical
analysis involved both univariable and multivariable logistic regression analyses, presenting discrimination values with area under the receiver operating characteristic (AUROC), testing precision with a calibration plot, analyzing internal validation using the Bootstrapping method, and creating a risk curve to find the balanced cutoff point. The study then divided the predictions into one of three groups: Admit, Consult, and Discharge. Decision curve analysis (DCA) was performed and an application was developed and integrated into the Smart ER program for real- time analysis.

Results Out of 37,474 patients screened, 18,056 were excluded leaving 19,418 patients eligible for complete case analysis. Predictors of hospital admission included age, emergency level, vital signs, mode of hospital arrival, and prominent symptoms according to criteria-based dispatch (CBD) (criteria-based dispatch). The Admission Model showed an AUROC of 0.8934 (95% CI, 0.8890-0.8980); the calibration plot demonstrated that predicted values closely matched actual observed values; internal validation using the Bootstrapping method yielded a C-statistic of 0.8920 (95% CI, 0.888-0.895); and the balanced risk curve indicated over admission at 3.8% and over discharge at 3.7%.

Conclusions The Admission Model provides high AUROC and precision values. The model’s three-group division is likely to be beneficial in practical application.

Feasibility of Large Multi-Leaf Collimator in Stereotactic Radiosurgery/Stereotactic Radiotherapy: A Single Center Experience

Mon, 16 Dec 2024 00:00:00 +0700

Objective This study investigated the feasibility of using a large multi- leaf collimator (MLC) in a C-arm based linear accelerator for stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT).

Methods Patient Specific Quality Assurance was conducted on 69 patients treated with a single lesion SRS/SRT measuring dose distribution using patient-specific plans with SRS MapCHECK^®. Statistics were used to analyze the significance of correlation among dosimetric parameters, included Conformity Index (CI), Gradient Index (GI), plan complexity, and Gamma passing rate (GPR) in an absolute dose (AD) and relative dose (RD). confidence limit (CL) was also calculated to evaluate the performance of a large multileaf collimator (MLC) in SRS/SRT.

Results Planning target volumes (PTVs) ranged between 0.34 cm³ and 30.42 cm³. The study found a value of CI_ICRU, CIPaddick, and GI of 1.29 ± 0.17, 0.77±0.10 and 5.24±2.18 (mean±SD), respectively, significant correlations were found between PTV sizes and dosimetric parameters. Values of GPR₂_%/_2mm were 92.42±3.74 (AD), 96.38±3.24 (RD), whereas GPR₂_%/_1mmwere 82.03±6.69 (AD), 89.64±7.26 (RD). No significant correlation was found between plan complexity and GPR. CL values were 85.09% (AD), 90.03% (RD) for GPR₂_%/_2mm and 68.92% (AD), 75.41% (RD) for GPR2_%/_1mm_.

Conclusions This study assessed the feasibility of using a large MLC for a single lesion SRS/SRT across various PTV sizes. The values of CI and GI decreased for a small lesion. While the large MLC performed adequately across different PTV sizes, the CL value of RD GPR at 2%/1 mm fell below 90%. This indicates that the contribution of PTV margin might be consi-dered for a large MLC in SRS/SRT

The Relationship between Hyperuricemia and Anemia in Postmenopausal Korean Women

Mon, 16 Dec 2024 00:00:00 +0700

Objective The present study was conducted to assess the association of hyperuricemia and anemia in premenopausal and postmenopausal Korean women.

Methods Data from 9,239 adults (aged ≥ 20 years) in the Korean National Health and Nutrition Examination Survey VII (2016–2018) were analyzed.

Results After adjustment for related variables (including age), the odds ratio (OR) of hyperuricemia (uric acid [UA] < 6.0 mg/dL), using the normal group (hemoglobin [Hb] ≥ 12.0 g/dL) as a reference, was statistically significantly positively associated with the anemia group (Hb < 12.0 g/dL) in postmenopausal women (OR, 1.615; 95% CI, 1.187–2.198). In premenopausal women, after adjustment for the related variables (except age), the OR of hyperuricemia, with a normal group as a reference, was significantly inversely associated with the anemia group (OR, 0.583; 95% CI, 0.348–0.975). However, with further adjustment for age, hyperuricemia was no longer associated with anemia (OR, 0.679; 95% CI, 0.402–1.148).

Conclusions Hyperuricemia is positively associated with anemia in postmenopausal women but not in premenopausal women.