Average Number Of Hospital Days Research Articles

Clinical and socioeconomic predictors of hospital use and emergency department visits among children with medical complexity: A machine learning approach using administrative data

Objectives The primary objective of this study was to identify clinical and socioeconomic predictors of hospital and ED use among children with medical complexity within 1 and 5 years of an initial discharge between 2010 and 2013. A secondary objective was to estimate marginal associations between important predictors and resource use. Methods This retrospective, population-cohort study of children with medical complexity in Alberta linked administrative health data with Canadian census data and used tree-based, gradient-boosted regression models to identify clinical and socioeconomic predictors of resource use. Separate analyses of cumulative numbers of hospital days and ED visits modeled the probability of any resource use and, when present, the amount of resource use. We used relative importance in each analysis to identify important predictors. Results The analytic sample included 11 105 children with medical complexity. The best short- and long-term predictors of having a hospital stay and number of hospital days were initial length of stay and clinical classification. Initial length of stay, residence rurality, and other socioeconomic factors were top predictors of short-term ED use. The top predictors of ED use in the long term were almost exclusively socioeconomic, with rurality a top predictor of number of ED visits. Estimates of marginal associations between initial length of stay and resource use showed that average number of hospital days increases as initial length of stay increases up to approximately 90 days. Children with medical complexity living in rural areas had more ED visits on average than those living in urban or metropolitan areas. Conclusions Clinical factors are generally better predictors of hospital use whereas socioeconomic factors are more predictive of ED use among children with medical complexity in Alberta. The results confirm existing literature on the importance of socioeconomic factors with respect to health care use by children with medical complexity.

Vitamin D deficiency and its impact on outcomes in myocardial infarction patients: a prospective observational study

Objectives: Vitamin D deficiency has been linked to cardiovascular diseases, but its impact on outcomes in myocardial infarction (MI) patients remains unclear. This study investigated the relationship between serum vitamin D levels and short-term and medium-term outcomes in patients with myocardial infarction. Ischemic heart diseases (IHD) are the most common cause of death in the world. Identifying risk factors and predictors can play a critical role in identifying high-risk people in screenings, identifying high-risk patients during admission to the hospital, and adjusting these risk factors in patients to improve prognosis. Methods: This prospective observational study was conducted on 212 patients diagnosed with myocardial infarction at Seyed al-Shohada Hospital in Urmia, Iran. Having been admitted, the patients had their serum vitamin D levels measured using the same blood sample for routine tests. Levels of vitamin D were categorized as normal (>30 ng/ml), insufficient (21-29 ng/ml), or deficient (<20 ng/ml). The patient's files provided the demographic, clinical, and biomedical information, echocardiography, and angiography data. The patients were followed for at least six months post-MI, with a maximum follow-up of 11 months. Follow-up occurred through monthly phone calls and outpatient clinic visits as needed. Primary outcomes included in-hospital complications (such as death, significant bleeding, acute pulmonary edema, cardiogenic shock, and arrhythmias), cardiac readmissions, and mortality. Logistic regression and Cox regression analyses were used to examine the connection between outcome variables and vitamin D levels, adjusting for potential confounders including age, gender, blood pressure, diabetes, blood lipids, creatinine, disease severity (SYNTAX score*), and left ventricular ejection fraction. The mean serum level of vitamin D in patients on admission was 33. 62 ng/dL. The average number of hospitalization days was 4.8 days, and the rate of re-hospitalization was 26.6% in the six-month follow-up and 30.3% in the 9-month follow-up. The hospital mortality rate was equal to 1.4%, and the mortality rate at the end of the follow-up period was equal to 8.3%. The most common complication during hospitalization among the patients was ventricular tachycardia. However, in follow-up, re-hospitalization due to previous issues was the most common complication. Results: The mean serum vitamin D level was 33. 62 ng/ml,with 52.8% of patients having insufficient or deficient levels. The most common in-hospital complication was ventricular tachycardia (11.5%). Vitamin D deficiency was not significantly associated with in-hospital complications. However, during the follow-up period, vitamin D deficiency was significantly related to increased risk of readmission to hospital (HR: 6.984, 95% CI: 3.500-13.936, p<0.001). The 6-month readmission rate was 26.6%, increasing to 30.3% at 9 months. Vitamin D deficiency was also associated with increased cardiac mortality (HR: 12.936, 95% CI: 1.494- 112.016, p=0.020) during follow-up. The 9-month mortality rate was 8.3%. Other factors contributing to cardiac mortality included disease severity (SYNTAX score) and female gender. Conclusions: While vitamin D deficiency did not impact short-term complications, it was associated with increased risk of hospitalreadmission and mortality in MI patients during medium-term follow-up. These findings suggest that vitamin D status can significantly impact long-term outcomes for MI patients

Patterns of psychiatric hospitalizations of Arab and Jewish adults with chronic psychotic disorders, before and after national mental health reforms, Israel, 1991–2016

BackgroundMembers of the Arab minority in Israel are at increased risk of developing mental illness, although less likely to seek care and have accessible treatment. This study compares trends in psychiatric hospitalizations between Arabs and Jews with chronic psychotic disorders, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000, and governmental recognition of the need to allocate resources for patients with co-occurring substance use disorder and mental illness in 2010.MethodsThe National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorder, hospitalized in 1991–2016 (at least once in 2010–2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of population-group (Arabs and Jews), time-period (Period1: 1991–2000, Period2: 2001–2009, Period3: 2010–2016) and sex, on average length of stay (LOS), annual number of hospitalizations and hospitalization days.ResultsThe proportion of Arab patients hospitalized with a diagnosis of chronic psychotic disorder (14.4%) was significantly lower than their proportion in the general population (21%), and their average age at first hospitalization (28.4 years) was older than that of Jewish inpatients (27.0 years). The average number of hospitalization days and LOS of Jewish patients were double that of Arab patients in Period1. Following implementation of the Rehabilitation Law, hospitalization days increased among Arab patients and decreased slightly among Jewish patients, such that by Period3 the average number of hospitalization days was similar among Jewish (41) and Arab (37) patients. The increase in hospitalization days among Arab patients was limited to men with no change noted among women. The number of hospitalization days among Arab women was about half that of Jewish women (p < 0.0001).ConclusionsThe findings reveal a narrowing of disparities in psychiatric hospitalizations between Arab and Jewish patients in Israel over time. However, among Arab women the number of hospitalization days remains considerably lower than that of Jewish women, raising concerns that Arab women may be receiving insufficient care. Further study is needed to fully understand the underpinnings of these disparities, although increasing the number of Arabic-language mental health services and providing psycho-education, will help further close the gap.

Exploring the factors influencing the use of health services by people with diabetes in Northwest China: an example from Gansu Province

BackgroundDiabetes is associated with high morbidity, mortality and quality-of-life impairment in patients. In China, the number of people suffering from diabetes ranks first in the world. Gansu Province is located in northwest China and is an economically underdeveloped region of China. By analyzing the level of health service utilization of people with diabetes in Gansu Province, the degree of equity in health service utilization and its influencing factors were studied to provide scientific data to support the promotion of health equity for people with diabetes and the introduction of relevant policies by relevant authorities.MethodsA sample of 282 people with diabetes who were 15 years old and above was chosen by multi-stage stratified sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Random forest and logistic regression analysis were used to demonstrate the effects of the explanatory variables on health seeking behaviors from predisposing, enabling and need variables. The concentration index was used to indicate the equity of health service utilization across households of different economic levels.ResultsThe outpatient rate for the diabetic population surveyed was 92.91%, with 99.87% of urban patients, higher than the 90.39% of rural patients. The average number of hospital days per person was 3.18 days, with 5.03 days per person in urban areas, which was higher than the 2.51 days per person in rural areas. The study showed that the factors most likely to influence patients to seek outpatient services were frequency of taking diabetic medication, whether or not they were contracted to a household doctor, and living environment; the top three factors most likely to influence patients with diabetes to seek inpatient services were number of non-communicable chronic disease, self-assessment of health status, medical insurance. The concentration index for outpatient service utilization and inpatient service utilization were − 0.241 and 0.107, respectively, indicating that outpatient services were concentrated on patients at lower income levels and patients at higher income levels tended to favor inpatient services.ConclusionThis study found that the low level of health care resources available to people with diabetes, whose health status is suboptimal, makes it difficult to meet their health needs. Patients' health conditions, comorbidities of people with diabetes, and the level of protection were still important factors that hindered the use of health services. It is necessary to promote the rational use of health services by diabetic patients and further improve the corresponding policies to achieve the goal of chronic disease prevention and control in “Health China 2030”.

P139 Inflammatory bowel disease and impairment of working life

Abstract Background Inflammatory bowel disease(IBD) is a lifelong illness that mainly affects patients of working age with a significant impact on their professional life. In fact, the maintenance and promotion of employees is one of the important social goals and can be considered as a determinants of health for IBD patients. The aim of the study was to analyze the impact of disease on the working life among IBD patients and to characterize the breadth of challenges they experience in their workplace. Methods We conducted a cross-sectional study including working patients followed for IBD, over a 9-months period. We collected sociodemographic, clinico-biological and evolutionary data. We performed a survey among these patients using a self-report questionnairy on employment status, IBD-related difficulties at work and sick leave. Results We included 45 patients: 80% Crohn disease and 20% ulcerative colitis. The mean age was 44 years [20-72], the sex-ratio M/F was 0.7 and the average of follow-up was 9 years [1-18]. Civil servants represented 33% of the total population, those in the private sector 47%, and those in the liberal profession 20%. The most important socio-professional category was manual workers with 51%. Thirty-seven patients(82%) developed their disease after being employed with a mean delay of 142 months[2-648]. The average number of working hours per week was 38.84 [9-60]. The majority of the employees worked full time(84%), only seven subjects worked part-time, two of them because of their IBD. One in three patients claimed to have been exposed to at least one harmful agent during their professional career. The main complaint reported by the patients during the daily work was about physical fatigue (69%). The digestive symptoms were mainly abdominal pain(53%) evaluated according to VAS with a mean intensity of 2.8 [0 - 10], subocclusive syndrome(40%), presence of diarrhea(38%), incontinence and fecal impaction(22%) which was worsened by the absence of accessible restrooms(33%). Psychological repercussions such as anxiety and depression were mentioned in 27% of cases. The average absenteeism during the last twelve months was 49.6 days [0-240] and the average number of hospitalization days was 30.7 [0-150]. Twenty patients(44%) claimed that they were subject to a salary restriction because of their illness. Only five people had alreadỳ benefited from a contact with the occupational medicine and health service. Conclusion IBD has a negative impact on the working life of patients, due to uncomfortable symptoms, days of absenteeism, and unadapted workplaces, which can affect career plans, professional achievement, and income. Appropriate supports and accommodations to the workplace are needed in order to improve their working experience.

P148 Work Ability Index (WAI) as a suitable instrument to assess work ability among IBD patients

Abstract Background Inflammatory bowel disease(IBD) is a chronic disease usually diagnosed in early adulthood and characterized by unpredictable flare-ups and debilitating symptoms that can interfere with the patient's ability to work and perform daily activities. In fact, since work disability is difficult to quantify, several scores have been developed for this purpose. The Work Ability Index(WAI) is a validated practical tool to measure the work capacity of patients. The objective of this study was to assess work performance in patients followed for IBD using the WAI psychometric tool, and to identify predictive factors of work disability. Methods We conducted a cross-sectional study including working patients followed for IBD, over a 9-months period. We collected sociodemographic, clinico-biological and evolutionary data. Quality of life was assessed by the IBDQ questionnairy. Work capacity was assessed using the WAI, a short 7-item questionnairy, which classified work performance into four categories: poor (score between 7-27), moderate(28-36), good(37-43) and excellent(44-49). Results We included 45 patients: 80% Crohn disease and 20% ulcerative colitis. The mean age was 44 years[20-72], the sex-ratio M/F was 0.7, and the mean of follow-up time was 9 years[1-18]. The average number of working hours per week was 38.84 [9-60]. The mean absenteeism during the last twelve months was 49.6 days [0-240] and the average number of hospitalization days was 30.7 [0-150]. The mean WAI value was 32.58, which corresponds to a moderate work performance. Assessment of work performance according to the WAI questionnaire showed that 38% of patients (N=17) had poor work ability, 24% (N=11) moderate work ability, 33% (N=15) good work ability and only two patients had an excellent work ability. In univariate and multivariate study, predictive factors of disability at work in IBD patients were: Furthermore, the assessment of health-related quality of life by the IBDQ questionnairy showed a mean IBDQ value of 160.78 which corresponds to a moderate score relating a quality of life; 224 being the maximum score obtainable reflecting an optimal quality of life. In the analytical study and using Spearman's test, a statistically significant correlation was found between the WAI and IBDQ with a p-value &amp;lt;0.0001 and a correlation coefficient r=0.7, reflecting the impact of work life on quality of life. Conclusion In our study, one third of patients had poor work capacity. Risk factors for poor performance were disease severity, presence of osteoarticular extraintestinal manifestation, and patients with children. The only protective factor identified was a high level of education. Thus, the Work Ability Index can be used as a screening tool to identify the need for rehabilitation.

Comparison of the Effects of Special Care Enhanced Recovery and Conventional Recovery Methods after Mini Omega Gastric Bypass.

Bariatric surgery is a surgical procedure for patients with extreme obesity. Enhanced Recovery after Surgery (ERAS) is a method that provides special peri- and post-operation care. Here, we aimed to compare the effects of ERAS and standard recovery cares. This is a randomized clinical trial that was performed in 2020-2021 in Isfahan on 108 candidates for mini gastric bypass. Patients were then randomly divided into two equal groups receiving ERAS and standard recovery protocols. Patients were examined and visited after one month regarding the average number of hospitalization days, the average days required to return to normal activity or work, occurrence of pulmonary thromboemboli (PTE) and the rate of readmission. Patients that received ERAS had significantly lower frequencies of nausea and vomiting (P = 0.032). Patients that received ERAS had significantly lower hospitalization duration (P < 0.001) compared to controls. No other significant differences were observed between two groups regarding surgery complication, re-admission rate and occurrence of PTE (P > 0.99 for all). Patients that received ERAS protocol after gastric bypass had significantly lower hospitalization duration and lower incidence of nausea and vomiting. They also had similar post-operative outcomes compared to the standard protocol.

Peristomal skin complications in ileostomy and colostomy patients: a systematic literature review

Abstract Background Peristomal skin complications (PSCs) are one of the main post-operative complications of ostomy surgery. They have a considerable impact on patients’ quality of life and represent a challenge for healthcare professionals involved in their management. The majority of PSCs is preventable and costly. Knowing their burden could guide decision makers on the ostomy patients’ management who are predominantly cancer and chronic bowel disease patients. Thus, the aim of this study was to summarize existing literature regarding the clinical-epidemiological burden of PSCs in ostomy patients. Methods A systematic literature review was performed querying three database (PubMed, Scopus, Web of Science) from January 2012 to February 2022. It included studies in English language and focused on the clinical and epidemiological burden of PSCs in the adult patients with ileostomy and colostomy. Results Overall, 35 studies were considered. Epidemiological data on PSCs were not systematically collected in the available literature. The principal underlying disease requiring the ostomy surgery were rectal, colon and gynaecological cancers, inflammatory bowel diseases, diverticulitis, occlusion and intestinal perforation. It was described a range of PSCs from 11% to 45%. The PSCs were most commonly erythema, papules, erosion, ulceration and vesciculation. Skin complications increased the average number of hospitalization days and of hospital readmission within 120-day following surgery. Conclusions The data on PSCs are still limited. Estimating the PSCs burden could support healthcare professionals and decision makers called upon to identify the most appropriate responses to patients’ health needs. The management of these complications plays a vital role to improve patient’s quality of life and a multidisciplinary approach with the active involvement of stomatherapist, surgeon and dermatologist is critical. Furthermore, a better patient education and empowerment is needed. Key messages • Developing a multidisciplinary approach to managing PSCs is essential in order to provide the best treatment possible and the best outcomes for patients. • Further studies should be conducted in order to better define the clinical-epidemiological burden of ileo- and colostomies and to support better health planning.

Effective Evaluation of Nursing Intervention Based on Pediatric Early Warning Score for Pediatric Patients in the Respiratory Department.

Objective This study evaluated the impact of nursing intervention based on the Pediatric Early Warning Score (PEWS) on pediatric patients. Methods A retrospective analysis was performed on 120 children admitted to the pediatric respiratory unit of Anhui Children's Hospital, and they were randomly and equally assigned to the observation group (PEWS-based nursing intervention) and the control group (usual care). The following parameters were compared: incidence of unplanned admissions to the pediatric intensive care unit (PICU), disease progression, average hospitalization days, hospital costs, time required for nursing assessment and management, nursing record error rate, and medical satisfaction. Results The incidence of unplanned admissions to PICU and disease exacerbations, mean hospital days and hospital costs were significantly lower in the observation group than in the control group (P < 0.05). Compared with the control group, the observation group had lower nursing care time, time to assess the disease, and an error rate in writing the entire nursing record. In addition, the accuracy rate of nurse assessment and the satisfaction rate of doctors and nurses in the observation group were significantly higher than those in the control group (P < 0.05). Conclusion The PEWS-based nursing intervention not only reduced the unplanned admission rate, the incidence of disease worsening, and the average number of hospital days and hospital costs in the PICU but also accelerated the recovery process of pediatric patients in the respiratory unit. Meanwhile, PEWS-based nursing interventions can effectively improve nursing efficiency and medical care satisfaction.

Analiza świadczeń psychiatrycznych dla pacjentów z rozpoznaniem schizofrenii sprawozdanych do Narodowego Funduszu Zdrowia w latach 2009–2018

Analysis of psychiatric services for patients diagnosed with schizophrenia, reported to the National Health Fund in the years 2009-2018. Schizophrenia is analyzed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In the study, the unitary data of the National Health Fund (NFZ) was used, reported in the years 2009-2018. Patients were identified by the Personal Identity Number (PESEL). The services for adults were analyzed, i.e., people who were at least 18 years old in the year when the services were discontinued, for whom the main disease was schizophrenia classified by ICD-10 codes: F20 to F20.9. Provided services were analyzed according to those specified in the ordinance of the President of the National Health Fund of June 28, 2019 - organizational units and billing product codes. Between 2009 and 2018, the number of patients diagnosed with schizophrenia treated in the public sector increased by 5%. In the analyzed years, the number of in-patients decreased by 9%, while the number of people using out-patient services and community treatment increased by 6%. In forensic psychiatry departments, a very high increase (by 212%) in the number of hospitalized patients was observed. In 2018, the average number of hospitalization days in a general psychiatric ward was 43, in the forensic ward 279. A very low percentage of patients (less than 3%) used day therapy. In out-patient treatment, the mainstay of therapy was a medical consultation; less than 10% of patients used other types of services. In 2018, an average of four visits/consultations per patient was reported. There has been a very high decrease in the number of patients (by 77%) using group therapy, family therapy and support. In 2009-2018, most patients diagnosed with schizophrenia in the public sector were treated using the traditional model of care: medical consultation and psychiatric hospitalization. It is advisable to reorganize the system - implementation and development of comprehensive care coordinated within the community care model. Extending the study with information from the non-public sector would give a full picture of system functioning and facilitate service needs estimation for this group of patients.

Cost-effectiveness of tunneled peritoneal catheters versus repeat paracenteses for recurrent ascites in gynecologic malignancies

ObjectiveTo compare the cost-effectiveness of tunneled peritoneal catheter (TPC) versus repeated large-volume paracentesis (LVP) for patients with recurrent ascites secondary to gynecological malignancy. MethodsA retrospective cohort study was performed at a single institution from 2016 through 2019 of patients with recurrent ascites from gynecologic malignancies that underwent either TPC or LVP. Data on procedural complications and hospital admissions were extracted.A cost-effectiveness analysis with Markov modeling was performed comparing TPC and LVP. Statistical analyses include base case calculation, Monte Carlo simulations and deterministic sensitivity analyses. ResultsThere were no significant differences between the cohorts in the average number of hospital days (p = 0.21) or emergency department visits (p = 0.69) related to ascites. Palliative care was more often involved in the care of patients who had a TPC.The base case calculation showed TPC to be the more cost-effective strategy with a slightly lower health benefit (0.22980 versus 0.22982 QALY) and lower cost ($3043 versus $3868) relative to LVP (ICER of LVP compared to TPC: $44,863,103/QALY). Probabilistic sensitivity analysis showed TPC was the more cost-effective strategy in 8028/10,000 simulations. Deterministic sensitivity analysis showed TPC to be more cost-effective if its complication risk was >0.81% per 22 days or its procedural cost of TPC insertion was >$1997. When varying the cost of complications, TPC was more cost-effective if the cost of its complication was less than $49,202. ConclusionsTPC is the more cost-effective strategy when compared to LVP in patients with recurrent ascites from gynecological malignancy.

Our Experiences in the Treatment of Anterior Chest Wall Infections (2015 - 2021).

Background:Sternotomy is a classical surgical procedure for approaching the heart and mediastinum. Sternotomy wound infections can be superficial or deep.Objective:The aim of this study is to retrospectively evaluate the results of two treatments for deep sternal wound infection (DSWI), closed treatment (debridement, refixation and retrosternal irrigation) and open treatment (debridement, VAC therapy and then pectoral flap).Methods:Retrospective analysis of two methods of treatment of DSWI in the period of six years. The first group (G1): surgical debridement, sternum fixation with, if necessary, retrosternal irrigation. The second group (G2): surgical debridement, open sternum with VAC therapy and subsequent pectoral flap with sternum refixation if necessary. Sternotomy wound infection will be classified according to the depth of the affected areas and the time of infection. Risk factors, outcome, local findings, number of revisions, number of hospital treatment days, types of isolates, etiology of sternotomy, time from onset of sternal instability to first surgical treatment will be observed.:Results:The number of patients with DSWI was 16, which represents 1% of all sternotomy in the observed period. Mortality in the DSWI group was 35%. Surgical myocardial revascularization was initially performed in 73% of patients with DSWI. Two risk factors for DSWI were in 32% of patients and 25% had diabetes mellitus. The average time for DSWI development in G1 was 10 days (min 0, max 30) and in G2 was 20 days (min 12, max 30). Number of revisions in G1 (min 1, max 2), G2 (min 1, max 3). Average number of hospital days were in G1 23.50 days (SD 13.15), and in G2 38.17 days (SD 28.65). The sternum was osteomyelitic and fragmented in 20% of patients. More than one revision occurred in 40% of patients. The main initial isolate was Enterococcus faecalis in 27% of all DSWI (dominantly in G1 2/3 of all): Conclusion:We found that there is no statistically significant difference in observed treatments, and that each treatment has its own indications. We suggested that studies with a larger sample are needed for a definite opinion on this issue.

THE ROLE OF HYPERBARIC OXYGEN THERAPY IN FOURNIER’S GANGRENE: LITERATURE REVIEW

Introduction: Fournier’s Gangrene is a severe necrotising infection that can be fatal if not recognised and treated immediately. Treatment consists of a combination of conventional therapy with a multidisciplinary approach (early diagnosis, surgical debridement, antibiotic therapy, intensive care and reconstructive surgery) and adjuvant therapy with hyperbaric oxygen therapy sessions. Objective: To identify the role and evaluate the efficacy of hyperbaric oxygen therapy in Fournier’s gangrene. Method: To conduct the following narrative review a research question was outlined using the PIO methodology. Subsequently, a literature review was conducted using the PubMed, Scopus and CINAHL Complete databases from December 2020 to February 2021. Results: Eight studies emerged from the literature review showing that the use of adjuvant Hyperbaric oxygen therapy (HBOT) in combination with classical treatment has beneficial effects and enhances the efficacy of hyperbaric oxygen therapy, resulting in lower mortality rates, in contrast to the average number of hospital days spent in intensive care, which do not undergo any significant change. But in contrast to mortality, the average number of days spent in intensive care differed significantly in favour of the standard treatment group. Conclusion: The combined effect of hyperbaric oxygen therapy with conventional therapy offers a significant advantage in the management of FG; furthermore, HBOT is associated with a significant survival advantage.

The Effect of Cognitive-Behavioral Therapy (CBT) on Anxiety Reduction in Critical Care Unit (CCU) Patients During Hospitalization

Patients admitted to Critical Care Units (CCU) face multiple stressors, and these stressors cause anxiety in patients. Anxiety increases heart function in heart patients. High levels of anxiety in cardiac patients increase in association with hospital complications. The purpose of this study was to determine the effect of Cognitive-Behavioral Therapy (CBT) on reducing the anxiety of patients in CCU during their hospitalization. The study design was quasi-experimental (pre-test and post-test). This study was performed on patients in CCU of Shahid Mostafa Khomeini hospital in 2019; for this purpose, 30 patients in CCU were randomly divided into intervention (n=15) and control (n=15) groups. Before the intervention, the demographic variables questionnaire and DASS-21 anxiety questionnaire were completed by both groups. Then, the intervention group received CBT for eight sessions according to the average number of hospital days (eight days) by the therapist (researcher). The control group did not receive any intervention. After the intervention, the demographic variables questionnaire and DASS-21 questionnaire were completed by the intervention and control groups again. Data analysis was done by SPSS-21 software and descriptive tests, ANOVA, and independent and pairwise t-test. There was no significant difference between the two groups in the mean score of anxiety before treatment, but the mean score of anxiety significantly decreased after treatment in the intervention group (9.63±2.773) compared to the control group (13.23±2.115; p&lt;0.001). CBT can reduce the level of anxiety in patients admitted to CCU, and this method can be used as a simple and low-cost complementary non-pharmacological practice in these patients.

Reducing hospitalizations: Implementation of CADD pumps in infusion clinic at a Los Angeles safety net hospital.

e18648 Background: Computerized ambulatory drug delivery (CADD) pumps introduced in the 1980s made it possible to move infusion delivery from the hospital to the home. At Harbor-UCLA Medical Center, hundreds of scheduled chemotherapy admissions occur annually. The procurement and implementation of CADD pumps was a collaborative effort with members of pharmacy, nursing, physicians and administration. The implementation of CADD pumps for home chemotherapy demonstrated a cost-savings by decreasing the number of inpatient hospital days required for scheduled chemotherapy admissions. Methods: The first outpatient chemotherapy infusion by CADD pump began on 12/5/2017. Records from 12/5/2017 through 12/4/2018 (365 days) were reviewed to assess the benefit of CADD pumps, defined by inpatient hospital days avoided. Eight chemotherapy regimens were administered through outpatient CADD pumps; the equivalent number of inpatient hospital days were estimated based on inpatient hospital records between 2015 and 2017. The average number of hospital days that would have occurred inpatient per chemotherapy regimen was multiplied by the number of outpatient CADD pump chemotherapy infusions to estimate the number of inpatient hospital days avoided. Based on information provided by our hospital’s finance department, including reimbursement for inpatient and similar outpatient care, each hospital day avoided was estimated to provide $1,695 in cost-savings. On average, a typical hospitalization for infusional 5-FU chemotherapy was three days in length. Results: Over one year, 35 patients received a total of 178 outpatient CADD infusions. The average number of CADD infusions per patient was five. We estimated that 642 hospital bed days were saved over a 1-year period following the implementation of outpatient CADD pumps. With the estimate that each hospital bed day saved was valued at $1,695, we concluded a savings of $1.1 million dollars at our hospital through the implementation of CADD pumps within the first year. Conclusions: The implementation of CADD pumps for home chemotherapy demonstrated cost-savings by decreasing the number of inpatient hospital days required for scheduled chemotherapy admissions. This shift provides a superior value for the patient with equivalent treatment outpatient, spending less time in the healthcare setting, and reduced health care costs. [Table: see text]

Healthcare resource utilization and associated cost of patients with bone metastases from solid tumors who are na\xefve to bone-targeting agents: a comparative analysis of patients with and without skeletal-related events

BackgroundThis study analyzes the impact of skeletal-related events (SRE) on healthcare resource utilization (HCRU) and costs incurred by patients with bone metastases (BM) from solid tumors (ST), who are therapy-naïve to bone targeting agents (BTAs).MethodsGerman claims data from 01/01/2010 to 30/06/2018 were used to conduct a retrospective comparative cohort analysis of BTA-naive patients with a BM diagnosis and preceding ST diagnosis. HCRU and treatment-related costs were compared in two matched cohorts of patients with and without a history of SREs, defined as pathological fracture, spinal cord compression, surgery to bone and radiation to bone. The first SRE was defined as the patient-individual index date. Conversely, for the non-SRE patients, index dates were assigned randomly.ResultsIn total, 45.20% of 9,832 patients reported experiencing at least one SRE (n = 4444) while 54.80% experienced none (n = 5388); 2,434 pairs of SRE and non-SRE patients were finally matched (mean age: 70.87/71.07 years; females: 39.07%/38.58%). Between SRE and non-SRE cohorts, significant differences in the average number of hospitalization days per patient-year (35.80/30.80) and associated inpatient-care costs (14,199.27€/10,787.31€) were observed. The total cost ratio was 1.16 (p < 0.001) with an average cost breakdown of 23,689.54€ and 20,403.27€ per patient-year in SRE and non-SRE patients.ConclusionThe underutilization of BTAs within a clinical setting poses an ongoing challenge in the real-world treatment of BM patients throughout Germany. Ultimately, the economic burden of treating SREs in patients with BM from ST was found to be considerable, resulting in higher direct healthcare costs and increased utilization of inpatient care facilities.

The effect of application of a Soton ureteroscope on infection after flexible ureteroscopy lithotripsy.

IntroductionPostoperative infection is still one of the most common complications following flexible ureteroscopy lithotripsy (FURL). However, whether a combination of negative pressure ureteroscopy (and Soton ureteroscopy) is superior to FURL in lithotripsy with regard to intraoperative pressure and possibly the incidence of postoperative infection remains to be validated.AimTo explore the effect of a Soton ureteroscope on infection following flexible ureteroscope lithotripsy.Material and methodsSixty patients with kidney stones were randomly divided equally into study and control groups. The operation duration, stone-free rate, postoperative blood routine, procalcitonin, C-reactive protein, and other data between the two groups were then analysed and compared.ResultsThere were no statistically significant differences between the study group and the control group regarding the average operation time and the average number of hospitalization days. The mean stone-free rate 1 week after surgery and mean VAS pain score 1 day after surgery for the study group and the control group were 91.3% and 0.27 vs. 76.9% and 0.61, respectively. Notably, the average body temperature after the first day of the operation was 36.4°C in the study group and 36.7°C in the control group. More importantly, concerning postoperative infection index, white blood cells (WBCs), percentage of neutrophils, C-reactive protein, and procalcitonin were all lower in the study group than in the control group.ConclusionsCompared with flexible ureteroscopy alone, combined use of Soton ureteroscopy is associated with fewer substantially infection following lithotripsy.

Quality of life post-reconstruction of the bile tract

Presenter: Norberto Portillo Lopez MD | Universidad de la Frontera Background: Bile duct reconstruction secondary to bile duct injury associated to cholecystectomy is a complex surgery and an important aspect is quality of life before the procedure. Methods: Quality of life study conducted in a concurrent cohort for convenience. The cohort is composed of 32 patients undergoing bile duct reconstruction for bile duct injury associated to cholecystectomy. To have a comparison group, a cohort of patients undergoing cholecystectomy without incident was chosen. These cohorts were matched 1: 1 by age (± 1 year), gender and type of surgery. The SF-36 questionnaire was applied with the score proposed by the RAND group personally or by telephone. Results: Results: The bile duct reconstruction patient cohort consists of 32 patients, with an average age of 47 ± 17.68 years; predominantly female gender (78%). The average number of hospi-talization days was 20 ± 11.85. The average follow-up was 7 ± 5 years. The average score obtained by patients undergoing bile duct reconstruction vs cholecystectomy without com-plications was: Physical Function: 77,5 ± 21.81 vs 78,91 ± 25,42; Physical Role: 60,94 ± 37,53 vs 65,63 ± 36,89; Body pain: 47,86 ± 21,95 vs 43,2 ± 23,49; General Health: 57,84 ± 10,45 vs 56,13 ± 17,26; Vitality: 42,97 ± 11,56 vs 47,34 ± 16,26; Social Function: 52,73 ± 20,84 vs 49,61 ± 16,03; Emotional Role: 66,41 ± 31,8 vs 71,72 ± 36,01; Mental Health: 42,38 ± 10,94 vs 44 ± 6,82; finding no statistically significant difference between the 2 cohorts. Conclusion: The present study found no significant difference in quality of life between patients with bile duct injury associated to cholecystectomy and bile duct reconstruction in comparison with cholecystectomized patients without complications

Factors Associated with the Utilization of Comprehensive Nursing Services in Hospitals among Elderly Inpatients after Surgery

Purpose The aims of this study were to compare patient characteristics and healthcare utilization of the comprehensive nursing service (CNS) and general ward groups among elderly patients after surgery and to identify the factors associated with CNS use. Methods This secondary data analysis was conducted using the 2016 inpatient claims data of the Health Insurance Review and Assessment Service-National Inpatients Sample (HIRA-NIS). Elderly CNS patients were defined as those with at least one hospitalization record based on a CNS code. Independent t-tests, chi-squared tests, and hierarchical logistic regression analyses were performed by employing the Anderson behavioral model. Results A total of 81,840 elderly patients with a history of surgery (6,374 in the CNS group vs. 75,466 in the general ward group) were identified using the 2016 HIRA-NIS data. The average number of hospital days was greater (14.25 vs. 13.07) and the average cost per hospitalization was higher (Korean won 4,567,915 vs. 3,374,410) for the CNS group. Factors associated with the utilization of CNS included age, gender, department type, major diagnosis, admission route, intensive care unit entrance, medical assistance type, and healthcare institution type, location, and the number of doctors and nurses per 50 beds (all p<.001). Conclusion Based on our study findings, it is necessary to meet patients’ needs by focusing on dominant users and consider institutional characteristics that reflect the target group to apply the CNS policy more effectively. 주요어: ë ¸ì¸, ìˆ˜ìˆ , 간호서비스, 환자건강관리수용 Key Words: Aged, General surgery, Nursing services, Patient acceptance of health care

The Evaluation of Relation between Age, Sex and Length of Hospitalization with Recurrent Stroke

Introduction: Stroke is sixth leading cause of death in the world. Economically taking care of stroke patients and rehabilitating costs more than those with acute and complicated diseases. Today, recurrent stroke is one of the leading causes of death in those survived stroke previously. Diagnosing the causes of early recurrence would help us promoting secondary prevention and accurately selecting the high risk patients in stroke recurrence. Methodology: In this article, as a cross-sectional descriptive one, is tried to study, extract the demographic data and length of hospitalization of about 600 stroke patients hospitalized in Tabriz Imam Reza Hospital during 2016. Eventually, abstracted data analyzed by spss15.0.0. Result: In this study 617 stroke patients, 403 men and 214 women, were examined. The age average was 62.63 and the average number of hospital days was 19.10. Among 617 patients studied, 22(19men and 3 women) had recurrent stroke. Average age of these patients was 61 and the average of hospital days was 14. Conclusion: Generally, It is worth mentioning that because of data distortion in patients with recurrent stroke, it was impossible to compare those patients with the primitive society.