BACKGROUND: Improving transition to the operating room (OR) can enhance healthcare efficiency. Our aim was to determine whether adopting a communication board (CB) for first case surgical patients reduced delays to OR.
METHODS: A retrospective observational study was conducted from April to October 2021. We calculated differences in surgical daycare (SDC) departure time before and after implementation of the CB, differences in departure whether the CB was used or not, delay in variability between surgical specialties, and overall adoption of the CB.
RESULTS: After CB adoption, 13% of first cases left SDC by predefined target times. The mean delay in transfer was 18:51 minutes. When the CB was used, cases were on average 10:43 late, compared with 26:00 when it was not used. Otolaryngology had the shortest delays while plastic surgery had the longest. Reasons for delays included staffing delays, holds, and pending laboratory results.
CONCLUSIONS: Introducing a CB significantly reduced delays in transferring first case surgical patients from SDC to the OR.

OBJECTIVE: Contribution to the authorship, including that for case reports, should be appropriately evaluated. I have noticed a scarcity of case reports with clinic doctors listed as coauthors, prompting this investigation. I sought to offer suggestions on the possible reasons for this trend.
METHODS: I checked case reports published in the Journal of Obstetrics and Gynaecology Research, the Journal of Medical Case Reports, and the BMJ Case Reports. I identified case reports listing a clinic doctor as a coauthor. I consulted eight professors at Jichi Medical University to ascertain whether case reports from their departments included clinic doctors as coauthors and, if not, the reasons.
RESULTS: Among 65 case reports from Japanese institutes published in the Journal of Obstetrics and Gynaecology Research, only one paper lists a clinic doctor as a coauthor. Of 100 and 50 papers published in the Journal of Medical Case Reports and BMJ Case Reports, respectively, none listed a clinic doctor as a coauthor. Six out of eight professors admitted to never considering the idea of including clinic doctors as coauthors.
CONCLUSIONS: The scarcity of case reports with clinic doctors as coauthors extends beyond Japanese obstetrics and gynecology, encompassing various specialties worldwide. Center doctors do not think of the idea that a clinic doctor should be a coauthor. A clinic doctor who transferred the patient should be considered as a candidate coauthor depending on his/her scientific contribution. Such an approach could foster an environment encouraging doctors to contribute to academic writing, regardless of their workplace.

The principal task of national healthcare systems is to provide health services that are safe, accessible, high-quality and people-oriented. To ensure the continuity of healthcare, support activities related to patient transfer and logistics are necessary. Effective implementation of transport processes is a factor affecting the possibility of medical intervention, in terms of both planned and life-saving care. The reliability of the healthcare supply chain is a key factor in patient health. In our research, we have used the method of a single case study of a public regional hospital in Poland providing comprehensive medical services. The aim of the research is to identify the factors that affect the reliability of the healthcare supply chain in relation to the interhospital air transport of patients. Our qualitative research using process mapping reveals what factors affect the reliability of interhospital medical air transport. The analysis of 100 interhospital medical air transport cases has allowed us to create a general procedure related to the movement of patients between the facilities of the healthcare system in Poland. Our research shows that the key factor of reliability is the coherent and integrated cooperation of institutions involved in transport processes.

OBJECTIVE: Mental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts.
METHODS: A comparative multiple case study design was used to characterize transition practices within the literature examining children\'s, non-VA adult, and VA adult service contexts. Andersen\'s (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems.
RESULTS: Several key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity.
CONCLUSIONS: Synthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.

BACKGROUND: In the context of a shortage of medical specialists, a medical referral app, designed for use on smartphones, was launched in 2014 for use by doctors in the public health service in South Africa.
OBJECTIVE: As this is a novel intervention, with potential to have an impact on the use of scarce resources, and because not much was known about the use of the app, a descriptive study was undertaken to assess its adoption in Western Cape Government Health (WCGH) facilities.
METHODS: Usage data of the app in WCGH facilities, in terms of referral and user numbers, were obtained from the date of its introduction in 2014. In addition, all the referrals to WCGH facilities for July 2019, stripped of any identifying data of patients or doctors, were analysed for origin, destination, outcome and response times. Descriptive statistics were used to analyse the data.
RESULTS: Use of the app grew rapidly from 40 referrals per quarter to 16 437 per quarter after 5 years in use, with a cumulative total of 95 381 referrals. In July 2019, active users of the system included 913 sending doctors and 298 receiving doctors, representing 20 medical specialties. The senders and receivers were representative of every level in the healthcare system, from clinic to tertiary hospital. In July 2019, a total of 5 941 referrals were sent by means of the app to public facilities in Western Cape Province. Of the referrals, 80% were classified as acute and 20% as non-urgent. The referral outcomes included 51% accepted for transfer, 19% accepted for a specialist appointment, and 13% concluded with advice alone without the need for a specialist appointment or patient transfer - this category accounted for 28% of non-urgent referrals and 9% of acute referrals. In 50% of referrals, advice was given to the referring doctor, either as an additional or the only outcome. The median response times were 9 minutes for acute referrals and 19 minutes for non-urgent referrals.
CONCLUSIONS: This study documents the scale-up of a mobile phone consultation and referral app from pilot phase to significant growth in use across a resource-constrained healthcare system. In a large proportion of cases, advice was given to the referring doctor by means of the app, frequently obviating the need for a specialist appointment or patient transfer. This finding demonstrates that a mobile app has the potential to reduce the need for face-to-face specialist visits, thereby improving the use of scarce medical resources.

Safe and effective care transitions require interprofessional collaboration, but there is limited literature on interprofessional strategies to teach care transitions. The objective was to evaluate student pharmacist and nurse readiness for change towards interprofessional collaborative practice during care transitions.
Interprofessional teams were instructed to collaborate and provide care for their patient throughout multiple healthcare transitions. Students were asked to complete the Interprofessional Socialization and Valuing Scale (ISVS) 9A/9B, the nine-item set version, prior to implementation of the case conference series and after the activity debrief.
There was an increase across six items from the ISVS scale for pharmacy students and eight of nine for nursing students. There were significant changes in two of nine items for the pharmacy groups and three of nine in the nursing group.
An interprofessional case conference series demonstrated a significant increase in student pharmacist and student nurse awareness of the importance of working within a team during care transitions, as well as an appreciation towards their role within the interprofessional team.

Effective patient care transitions require consideration of social and clinical context, yet how these factors and relational processes in care coordination relate remains poorly described. This case report aims to describe provider networks and the clinical care and social context involved during longitudinal care transitions across settings.
We examined the utilization and provider networks of an oldest old woman with heart failure (HF) before and after her first hospitalization for HF. She used primary care for care management and had insurance, strong caregiver support, and comprehensive discharge planning; however, after the hospitalization, Mrs. A\'s ambulatory provider networks were more diverse yet sparser and less strongly connected.
Turbulence in care transition can result from sources other than transitioning between settings. The data-driven case report approach using electronic health records uncovered relational processes important for care coordination and may inform patient-centered approaches to improve care for patients with HF.

Background: Interfacility transport of laboring mothers is an infrequent endeavor associated with additional risk in the best of circumstances. Case Presentation: We report on a case where two laboring mothers were transported at night via fireboat, resulting in the delivery of one child while underway and delivery of another soon after arrival at the receiving facility. Conclusions: The objective of this case report is to describe the decision-making process and medical care for these two mothers during a nontraditional EMS transport.

The World Health Summit 2011 confirmed the epidemic-like occurrence of diabetes mellitus and obesity. In Germany, 62.7 % and 21.9 % of the population have a BMI of more than 25 kg/m² and more than 30 kg/m2, respectively. Currently, 10.5 obese people per 100 000 German inhabitants undergo bariatric surgery, while 86 and 114.8 per 100 000 in France and in Sweden, respectively, favor bariatric surgical interventions.
OBJECTIVE: By means of a scientific case report, the instructive case of a young patient with morbid obesity is illustrated based on 1) selective references from the medical literature and 2) insights from the daily clinical practice in the case-specific medical and perioperative management after successful surgery for malformation in his childhood and, thus, the limited therapeutic options of metabolic surgery.
UNASSIGNED: 35-year-old patient with morbid obesity. Medical history: Status after surgical intervention for gastroschisis as a newborn (surgery report not available). Clinical findings: Super obesity characterized by 234 kg and 174 cm (→ BMI: 77.3 kg/m²), hypogonadotrophic hypogonadism. Approach & course: · Initial treatment with gastric balloon followed by a weight reduction of 46 kg within the first 6 months; however, despite weight reduction, development of an insulin-dependent diabetes with insulin resistance from a diet-based diabetes;. · Repeat gastric balloon therapy for \"bridging\" but with no further weight reduction despite additional administration of GLP-1 analogues.. · Surgical intervention: Removal of the balloon - termination because of excessive adhesions to the liver and spleen as well as filiforme hepatic lesions (histopathology: liver hamartoma). Open surgery: extensive adhesiolysis because of previous pediatric surgery for gastroschisis, including associated non-rotation of the intestine with complete right-sided position of the intestine (left side: colon; right flexure: at infralienal position) prompting single-anastomosis duodeno-ileostomy (SADI)-procedure, leaving the stomach in situ with simultaneous cholecystectomy and herniotomy in sublay technique.. Outcome (early postoperative and mid- to long-term): The patient tolerated the intervention well. Postoperative course was uneventful with regard to mobilization, beginning of oral nutrition, and wound healing; there was a subsequent weight reduction due to a \"common channel\" of 250 cm.
CONCLUSIONS: While the increase of obesity prevalence in adults has currently stopped, incidence in children and teenagers is rapidly rising. The consequence might be that children and young adults who have undergone bariatric surgery in childhood and adolescence can develop complications from these former interventions as adults. Therefore, it is reasonable to recommend follow-up investigations within specialized centers according to well-established standards. On the other hand, the increasing prevalence of obesity in childhood leads to the possibility that adults who underwent pediatric surgery because of embryonal malformations may require an appointment with a bariatric surgeon at some point. For these patients (as a representative example of the transition of care phenomenon), the risk of metabolic surgical intervention is increased; such operations require the appropriate knowledge and expertise of the bariatric surgeon on embryonal malformations and their approach by pediatric surgery.
Auf dem World Health Summit 2011 wurde die epidemieartige Verbreitung von Diabetes mellitus und Adipositas bestätigt. In Deutschland weisen derzeit 62,7 % der Bevölkerung einen BMI über 25 kg/m2 und 21,9 % einen BMI über 30 kg/m2 auf.Derzeit erhalten 10,5 Betroffene pro 100 000 Einwohner einen adipositaschirurgischen Eingriff, währenddessen in Frankreich 86,0 Betroffene und in Schweden sogar 114,8 Betroffene pro 100 000 Einwohner operiert werden. ZIEL:  Mittels wissenschaftlichem Fallbericht soll, basierend auf · selektiven Referenzen der medizinisch-wissenschaftlichen Literatur (und). · Erkenntnissen aus dem klinischen Alltag im fallspezifischen medizinischen und perioperativen Management. der instruktive Fall eines jungen Patienten mit morbider Adipositas nach erfolgreicher Fehlbildungschirurgie im Kindesalter und den eingeschränkten Therapiemöglichkeiten der metabolischen Chirurgie illustriert werden. KASUISTIK:  (fall-, diagnostik- und therapiespezifische Aspekte): · 35-jähriger Patient mit morbider Adipositas. · Anamnese: Zustand nach Gastroschisis-Op im Säuglingsalter (Op-Bericht nicht verfügbar).. · Klinischer Befund: Super-Obesitas mit 234 kg bei 174 cm (BMI: 77,3 kg/m2), hypogonadotropher Hypogonadismus. · Vorgehen & Verlauf: Initiale Magenballontherapie mit zunächst Abnahme von 46 kg in den ersten 6 Monaten, jedoch trotz Gewichtsreduktion Entwicklung eines insulinpflichtigen aus einem diätetisch geführten Diabetes mellitus mit Insulinresistenz; nochmalige Ballontherapie zum „Bridging“, allerdings ohne weitere Gewichtsreduktion trotz additiver Gabe von GLP-1-Analoga. Op: Ballonentfernung – Beendigung wegen exzessiver Adhäsionen zu Leber und Milz und multiplen filiformen Leberherden (Histopathologie: Leberhamartome). Offen-chirurgisch: Ausgedehnte Adhäsiolyse bei mit vorheriger Gastroschisis assoziierte Non-Rotation des Intestinums mit kompletter rechtsseitiger Lokalisation des Dünndarmes (links: Kolon, rechte Flexur infralienal)  SADI-Operation („single-anastomosis duodeno-ileostomy“) unter Belassen des Magens mit simultaner Cholecystektomie & Herniotomie in Sublaytechnik.. Outcome (früh-postoperativ & mittel- bis langfristig): Der Patient tolerierte den Eingriff gut. Der postoperative Verlauf gestaltete sich hinsichtlich Mobilisation, Kostaufbau und Wundheilung komplikationslos – sukzessive Gewichtsreduktion bei einem „common channel“ von 250 cm. SCHLUSSFOLGERUNG:  Während der Anstieg der Adipositasprävalenz im Erwachsenenalter derzeit stagniert, nimmt die Inzidenz im Kindes- und Jugendalter rapide zu. Dies hat zur Folge, dass Kinder- und Jugendliche nach adipositaschirurgischen Eingriffen im Erwachsenenalter Komplikationen der Eingriffe ausbilden und in entsprechenden Zentren standardisiert nachgesorgt werden müssen. Die Zunahme der Prävalenz der Adipositas im Kindesalter führt andererseits auch dazu, dass in seltenen Fällen Erwachsene, die im Kindesalter kinderchirurgisch wegen embryonaler Fehlbildungen therapiert wurden, dem Adipositaschirurgen vorgestellt werden.Für diese Patienten ist das Risiko der metabolisch-chirurgischen Operation erhöht und erfordert Kenntnisse des Adipositaschirurgen hinsichtlich der embryonalen Missbildungen und der kinderchirurgischen Therapie.

Since December 2019, the novel SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) became an emerging infectious disease pathogen that led to a global pandemic with over 43 million cases reported worldwide and more than 1.1 million global deaths (as of 26 Oct 2020, from https://coronavirus.jhu.edu/map.html). Commonly known as coronavirus disease 2019 (COVID-19), this pathogen presents with a broad spectrum of disease progression and manifestations (no symptoms to acute respiratory distress syndrome leading to severe complications and death).1,2 Multiple publications have reported risk of disease and co-morbidities to include select underlying medical conditions and risks: older age (≥65 years), hypertension (HTN), cardiovascular disease, smoking, chronic respiratory disease, cancer, diabetes (DM), obesity (BMI ≥ 30 kg/m2), and male sex.2,3,4,5,6,7,8 In one study, researchers found severe obesity (BMI ≥ 35 kg/m2) associated with intensive care unit (ICU) admission alone.8 Nonetheless, risk factors for severity of the disease are determined by the pathogen, host, and environment.9.