1564 Not all roads lead to Rome! – A Retrospective Insight into a Young Adult Hip Pain Referral Pathway

Introduction Young adult hip pain is increasingly recognized as an early warning sign for development of debilitating arthritis later in life. Two common causes for young adult hip pain are femoroacetabular impingement (FAI) and dysplasia. Yet, no universal referral pathway exists in the UK for young patients experiencing hip pain. Our aim was to investigate the timeline and journey of patients seen in a specialist young adult hip clinic at a tertiary orthopaedic centre. Method We conducted a case series using a two-part open question questionnaire given to 40 patients at a young adult hip clinic at a tertiary orthopaedic centre between March and November 2019. Results Average time from onset of symptoms to appointment in specialist clinic was 2.9 (± 3.9) years, with range between 1 month and 23 years. Average time between first GP appointment and appointment at a tertiary centre was 2.1 (±2.4) years. A total of 33 (83%) patients were seen in secondary care prior to referral to a specialist clinic at a tertiary centre. Imaging modalities prior to attendance were as follows: 23 (58%) patients had a hip X-ray, 15 (38%) a CT scan, 30 (75%) an MRI scan and 6 (15%) an ultrasound scan of their hip. A total of 23 (58%) patients had corticosteroid injections prior to referral to a specialist clinic. Conclusions Large variation seen in our results highlights an opportunity for service improvement and development of a universal referral pathway to improve patient care and reduce burden on other services.

Intracranial pulse pressure waveform analysis using the higher harmonics centroid

Background The pulse waveform of intracranial pressure (ICP) is its distinctive feature almost always present in the clinical recordings. In most cases, it changes proportionally to rising ICP, and observation of these changes may be clinically useful. We introduce the higher harmonics centroid (HHC) which can be defined as the center of mass of harmonics of the ICP pulse waveform from the 2nd to 10th, where mass corresponds to amplitudes of these harmonics. We investigate the changes in HHC during ICP monitoring, including isolated episodes of ICP plateau waves. Material and methods Recordings from 325 patients treated between 2002 and 2010 were reviewed. Twenty-six patients with ICP plateau waves were identified. In the first step, the correlation between HHC and ICP was examined for the entire monitoring period. In the second step, the above relation was calculated separately for periods of elevated ICP during plateau wave and the baseline. Results For the values averaged over the whole monitoring period, ICP (22.3 ± 6.9 mm Hg) correlates significantly (R = 0.45, p = 0.022) with HHC (3.64 ± 0.46). During the ICP plateau waves (ICP increased from 20.9 ± 6.0 to 53.7 ± 9.7 mm Hg, p < 10−16), we found a significant decrease in HHC (from 3.65 ± 0.48 to 3.21 ± 0.33, p = 10−5). Conclusions The good correlation between HHC and ICP supports the clinical application of pressure waveform analysis in addition to the recording of ICP number only. Mean ICP may be distorted by a zero drift, but HHC remains immune to this error. Further research is required to test whether a decline in HHC with elevated ICP can be an early warning sign of intracranial hypertension, whether individual breakpoints of correlation between ICP and its centroid are of clinical importance.

Changes in Motor Behavior Predict Falls and Identify Acute Events

This study aimed to examine how changes in motor behavior are associated with falls, delirium, and urinary tract infections (UTIs). Twenty-three (128 observations) skilled nursing residents were examined for up to 18 months. In multilevel models, motor behaviors (e.g., time and distance traveled, gait speed), measured by a real-time locating system, were used to predict falls, UTIs, and delirium. Falls were associated with decreased gait speed ( OR = 0.01; p ≤ 0.001) and path distance ( OR = 0.99; p ≤ 0.05); delirium was associated with increased distance traveled ( OR = 1.01; p ≤ 0.001), path distance ( OR = 1.02; p ≤ 0.001), and decreased time traveled ( OR = 0.99; p ≤ 0.001) and path time ( OR = 0.99; p ≤ 0.001); UTIs were associated with increased distance traveled ( OR = 1.01; p ≤ 0.001), decreased time traveled ( OR = 0.99; p ≤ 0.001), and the number of paths ( OR = 0.91; p ≤ 0.01). Subtle changes in motor behavior may be an early warning sign of falls and acute events. Continuous monitoring may enable clinical staff to prevent, identify early, and/or delay these poor health outcomes.

Association between internet addiction and suicidal ideation in university students

Objective: to investigate the evidence in the literature on the association between internet addiction and suicidal ideation in university students. Method: an integrative review of publications on the CINAHL, EMBASE, LILACS, MEDLINE, PubMed, PsycInfo, SciELO, SCOPUS, Web of Science and Biblioteca Virtual em Saúde databases was carried out, without restrictions regarding language or publication date. The final sample comprised 5 articles, which were organized and characterized according to author, year, method, sample, country, instruments and results. Results: the prevalence of internet addiction among university students ranged from 7.7% to 27.3%, and suicidal ideation from 7.4% to 36.1%. The results of simple logistic regression analyses showed a significant association between internet addiction and suicidal ideation, although on multiple logistic regression this association was not statistically significant for 2 out of the 5 studies reviewed. Subjects at risk of or with addiction to the internet had a significantly higher rate of suicidal ideation compared with controls. Conclusion: although the presence of association does not indicate causality, these findings serve as an early warning sign to parents, educators and health professionals, indicating the need for longitudinal studies to further elucidate this relationship.

Mortality in hemodialysis: Synchrony of biomarker variability indicates a critical transition

Critical transition theory suggests that complex systems should experience increased temporal variability just before abrupt change, such as increases in clinical biomarker variability before mortality. We tested this in the context of hemodialysis using 11 clinical biomarkers measured every two weeks in 763 patients over 2496 patient-years. We show that variability – measured by coefficients of variation – is more strongly predictive of mortality than biomarker levels. Further, variability is highly synchronized across all biomarkers, even those from unrelated systems: the first axis of a principal component analysis explains 49% of the variance. This axis then generates powerful predictions of all-cause mortality (HR95=9.7, p<0.0001, where HR95 is a scale-invariant metric of hazard ratio across the predictor range; AUC up to 0.82) and starts to increase markedly ~3 months prior to death. Such an indicator could provide an early warning sign of physiological collapse and serve to either trigger intervention or initiate discussions around palliative care.

Neutrophil-to-Lymphocyte Ratio and Covid-19 Symptom-based Severity at Admission

Background: Increased Neutrophil-to-Lymphocyte Ratio (NLR) is an independent risk factor for mortality in Covid-19 patients and is considered as an early warning sign of Covid-19 severity. This study aimed to observe the differences in NLR at admission between patients with mild, moderate, and severe symptoms of Covid-19 treated in a referral hospital in Banda Aceh, Indonesia.Methods: A total of 114 patients with Covid-19 admitted to a referral hospital in Banda Aceh, Indonesia, during March–September 2020 were included in this study. Demographic information and baseline laboratory data, including the NLR, were collected. Descriptive and inferential statistics were used to analyze the data. Results: The median NLR at admission was higher among patients with moderate to severe symptoms than those with mild symptoms [6.54 (2.80–97.00, IQR 4.81–9.44) vs 2.27 (0.79–5.07, IQR 1.43-2.98), p <0.001]. Covid-19 patients who died had a higher NLR than those who survived [10.88 (4.17–47.50, IQR 7.00–15.17) vs 6.15 (2.80–97.00, IQR 4.63–8.50), p 0.02]. Patients with moderate-severe symptoms had an initial NLR of 4.63–8.50 and decreased to 2.75–5.43 at the end of the treatment had a greater chance of survival. There was an increased probability of death in patients with moderate-severe symptoms whose initial NLR was 7.00–15.17, which was then elevated to 14.33–23.25.Conclusion: Different NLR at admission is seen among Covid-19 patients with mild and moderate-severe symptoms, leading to significantly different outcomes. The NLR can be used as a simple parameter to determine the severity of the disease and predict the outcome of Covid-19 patients.