Bed Capacity Research Articles

Emergency and postoperative access to critical and enhanced care: a multicentre prospective observational study.

The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%-< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care. This prospective, 7-day observational study was conducted across 19 acute hospital sites within the South West Critical Care Network. All adult inpatients having a procedure under the care of an anaesthetist (excluding cardiac and obstetric procedures) had a surgical outcome risk tool score calculated retrospectively, and their postoperative destination captured. Synchronously, all critical care referrals, admissions and refusal decisions were captured, along with critical care bed capacity. Of 2222 eligible patients, 1728 (78%) were captured. Retrospective surgical outcome risk tool score calculation revealed 1060 (61%) patients had a low, 418 (24%) a moderate and 250 (15%) a high risk of postoperative mortality. In patients with a moderate predicted risk of postoperative morbidity, 72/418 (17%) received enhanced or critical care and 64/249 (26%) patients with a high predicted risk received critical care. All critical care referral and admission activity was captured; in total, 263/680 (39%) of patients referred were admitted to critical care. Referrals to critical care exceeded the available level 3-equivalent beds on 79% of occasions. These data describe constraints in access to postoperative and emergency enhanced/critical care in the south-west of England. There is poor compliance with national guidance regarding the postoperative care location of patients with a moderate or high risk of postoperative mortality.

The realities of modern practice and prospects for the implementation of standards of secondary care for patients with acute stroke in the Left Bank of Kyiv Region according to the data of the hospital register (literature review and own research)

Background. The purpose of our work is to study the main indicators of the quality of care for patients with an acute stroke in individual hospitals of the Left Bank of the Kyiv Region of Ukraine. Materials and methods. The research was carried out at the Department of Nervous Diseases of the Shupyk National Healthcare University of Ukraine, on the basis of CNCE “Brovary Multidisciplinary Clinical Hospital”, angioneurological department with 85 beds (hereinafter — BMCH), and 4 secondary care centers with decentralized localization in the Kyiv Region (hereinafter — CDHKRLBU). The named departments are located 80–100 km, and BMCH is 15 km away from the regional center. They work according to an approved local protocol that meets industry standards for the management of patients with acute cerebral stroke and existing clinical guidelines. A total of 10,608 hospitalized patients with acute cerebral stroke were included in the prospective, cohort study (5,818 patients in BMCH and 4,790 patients in CDHKRLBU). For each case, the RES-Q (version 1.2) was filled out — a report form in an international program developed by the ESO-EAST initiative. Results. The study showed that the quality of care for stroke patients can be influenced by the material and technical base of the institution, as well as availability of diagnostic equipment, bed capacity and, of course, the logistical location, distance from the regional center. All quality indicators point to the leadership of BMCH compared to CDHKRLBU, and this has explanations. Conclusions. The study identified both positive and negative aspects of the therapeutic and diagnostic work in healthcare facilities, as well as factors influencing the success of treatment outcomes for patients with acute stroke. These findings have convincingly confirmed the relevance of studying quality care indicators and support the further implementation of the hospital registry method (based on RES-Q registry principles) in other areas of Kyiv Region and across Ukraine to evaluate and monitor the quality of medical care, including the analysis of the effectiveness of new technologies. During the study, BMCH purchased a new SCT, Philips Intera 1.5T MRI scanner (Netherlands), and Siemens angiograph in 2021, which improved the diagnosis of cerebral strokes and the use of treatment of thrombolytic therapy, thrombus extraction within the Left Bank of the Kyiv Region of Ukraine. Neighboring hospitals acquired SCT and expanded thrombolytic therapy for ischemic stroke. Of course, the research conducted is positive, because it becomes possible to identify certain shortcomings in the work and formulate recommendations for planning measures to improve medical care for stroke patients, as well as to compare the results of activities at the international and national levels.

Access to Pediatric Bed Capacity According to Social Determinants of Health: All Beds Are Not Created Equal

Access to Pediatric Bed Capacity According to Social Determinants of Health: All Beds Are Not Created Equal

Efficient in situ synthetic routes of the polymeric composite containing clinoptilolite using ultrasonic assistance for sorption of some lanthanides

The ultrasound assistance synthesis strategy of the polymeric composite is based on free radical polymerization of polyallylamine hydrochloride (PAH) cationic polyelectrolyte, with vinyl sulfonic acid (VSA) anionic monomer with microporous crystalline alumino silicate clinoptilolite clay. The P(AH-co-VSA)/clinoptilolite polymeric composite was fully characterized by fourier transform infrared spectroscopy, energy dispersive X-ray, thermogravimetric analysis, and scanning electron microscope. FTIR demonstrated the presence of PAH and VSA, confirming the composition of the prepared composite. It was also used to map the energy-dispersive X-ray to affirm the interdependence of the clinoptilolite into the polymeric matrix. Consequently, the physicochemical characteristics of this copolymer may be adjusted using VSA and PAH suitable combinations. Batch experiments were applied and maximal sorption capacities for studied ions Nd3+, Ce3+, Y3+, Gd3+, and Eu3+ were 36.6, 50.2, 55.9, 57.2, and 57.7 mg/g, respectively. Sorption kinetics and equilibrium isotherm were conducted. Experimental isotherms of studied ions were successfully fit to pseudo-second-order model, langmuir isotherm model. The Dubinin–Radushkevich (D–R) isotherm was found to be applicable and suggesting that, the sorption occurs via a ion exchange reaction. The breakthrough data were measured in a fixed bed column, and variable process factors were examined, including bed depth, flow velocity, and initial metal ion concentration. The experimental work was then focused, for continuous investigations, on Ce3+, Eu3+, and Y3+ to represent light, intermediate, and heavy lanthanides respectively. The overall bed capacity and total metal ion adsorption increased when the flow rate increased. They reduced with rising initial metal ion concentration and bed depth, and reached 22.8, 31.4, and 28.5 mg/g for Ce3+, Eu3+, and Y3+ metal ions, respectively.

THE STANDARD INPATIENT CLASS (KRIS) POLICY IN HOSPITALS AND ITS IMPACT ON THE DECLINE IN BED AVAILABILITY FOR BPJS

The Standard Inpatient Class (KRIS) policy introduced by BPJS Kesehatan aims to enhance equitable healthcare quality by standardizing hospital inpatient facilities in Indonesia. However, its implementation has raised concerns due to its significant impact on hospital bed availability, particularly in facilities with limited capacity, leading to challenges in service accessibility and quality. This study aims to examine the implications of the KRIS policy on bed capacity and healthcare service standards, as well as the obstacles faced by hospitals in maintaining service quality for BPJS participants. Employing a normative juridical method, the research systematically analyzes legal materials, including Presidential Regulation Number 59 of 2024, alongside relevant secondary literature. The findings reveal that the policy, while intended to improve service equity, has resulted in a notable decline in bed capacity, increased waiting times, and heightened workloads for medical personnel, particularly in resource-constrained hospitals. Hospitals in remote areas face additional challenges in meeting infrastructure requirements due to budget limitations. The study concludes that balancing the policy's quality standards with resource availability remains a critical issue, necessitating sustainable financial strategies, capacity-building programs, and innovative resource management solutions to ensure equitable healthcare access for all BPJS participants. Future research should focus on comparative assessments, patient satisfaction, and alternative strategies to optimize policy outcomes.

Threats and risks to health in emergency situations: biomedical, predictive analytical, and mathematical aspects

Introduction. The methodology for assessing health threats and risks is becoming increasingly in demand in the public management of the sanitary and epidemiological welfare of the population. New biomedical, predictive analytical, and mathematical approaches are being developed to assess and analyze health threats and risks in emergencies, including within biological risk monitoring. These issues require a scientifically based comprehensive consideration drawing on various scientific fields, including medicine, biology, management, prediction, sociology, and mathematics (probability theory, set theory, measure theory, etc.). To solve this problem, the authors adopted a convergent approach, paying special attention to the role of effective threat and risk management, which has a significant impact on the quality of life of people exposed to adverse factors in emergency situations.Objective. To improve the technology for analyzing and predicting threats and risks to human health in emergencies using a convergent multidisciplinary approach.Materials and methods. The authors searched electronic bibliographic databases in the Russian (eLibrary and CyberLeninka) and English (Web of Science, Scopus, PubMed, Google Scholar, and Cochrane Library) languages. The database “Regulatory Legal Acts on Radiation, Chemical, and Biological Monitoring” created at the Centre for Strategic Planning of the Federal Medical and Biological Agency served as the basis for analyzing regulatory documents. As the information platform in this study, the authors used the information system of the Federal Information and Analytical Center for Monitoring Biological Risks, which aggregates data on the monitoring of biological risks falling within the competence of the Federal Medical and Biological Agency, The predictive and analytical part of the study was scientifically justified using the database “Methods of Scientific Prediction” created at the Centre for Strategic Planning, which contains systematized methodological prognostic information. The theoretical methods used in the study include logical methods (analysis and synthesis of knowledge; analogy method), mathematical methods (modeling, probability theory, measure theory, graph theory, and set theory), and the method of theoretical generalization.Results. In the study, the existing approaches to assessing health threats and risks arising in emergency situations are summarized and systematized; their main characteristics and key parameters are considered. The phases of the process involving the emergence of threats and risks to health and the specifics of their management are analyzed. The scientific medical and biological point of view on the essence and general characteristics of health threats and risks is presented. The predictive analytical and mathematical aspects of the problem under consideration are outlined. An example algorithm for predictive and analytical calculation of indicators characterizing the resource capability and readiness of the healthcare system to adequately respond to a biological threat is described in detail. The required bed capacity of medical organizations is assessed, as well as the need for artificial lung ventilation devices in case of an epidemic; the final values are calculated. The analysis of the specified issues using a comprehensive convergent approach creates the prerequisites for effective management of health threats and risks in emergency situations.Conclusions. Predictive and analytical approaches are based on advanced ideas and mechanisms, including risk-based technologies, digital certification of territories and objects, active use of geoinformation developments, assessment procedures drawing on the combination of estimated and field data, situation modeling under changing or specified conditions, consideration of combined impact factors, etc. Characterizing the risk through a health hazard measure that combines the probability of health threats occurring in an emergency and the consequences of adverse effects for life and health, the authors define the value of risk as the mathematical expectation of the product of a function for assessing damage (consequences) to the health of an organism/population and the probability of combined impact of adverse factors in an emergency.

A Hybrid Mathematical-Simulation Approach to Hospital Beds Capacity Optimization for COVID-19 Pandemic Conditions

A Hybrid Mathematical-Simulation Approach to Hospital Beds Capacity Optimization for COVID-19 Pandemic Conditions

Air Purifiers and Acute Respiratory Infections in Residential Aged Care

The effectiveness of in-room air purification for the reduction of acute respiratory infections (ARIs) in residential aged-care facilities (RACFs) is unknown. To investigate the effectiveness of in-room air purifiers with high-efficiency particulate air (HEPA)-14 filters in reducing the incidence of ARIs among residents of RACFs. This randomized clinical trial used a multicenter, double-blind, 2-period, 2-treatment crossover design for 6 months from April 7 to October 26, 2023, in 3 RACFs with a bed capacity of 50 to 100 in New South Wales, Australia. The purposive sampling approach included permanent residents in private rooms in the enrolled RACFs. Data collection was performed every 2 weeks and required no additional follow-up beyond the final data collection on October 31, 2023. An air purifier containing a HEPA-14 filter was placed in rooms of participants in the intervention group, and an air purifier without a HEPA-14 filter was placed in rooms of the control participants. The groups crossed over after 3 months. The primary outcome was the incidence of ARIs, assessed with logistic mixed-model regression. Among 135 participants randomized (70 to the intervention-first group and 65 to the control-first group), 78 (57.8%) were female; mean (SD) age was 85.2 (8.6) years. In the intention-to-treat analysis, the use of air purifiers with HEPA-14 filters did not reduce ARIs compared with the control (OR, 0.57; 95% CI, 0.32-1.04; P = .07). Among the 104 participants who completed the entire study, the intervention reduced ARI incidence from 35.6% (37 participants) in the control group to 24.0% (25 participants) in the intervention group (OR, 0.53; 95% CI, 0.28-1.00; P = .048). In this clinical trial investigating use of air purifiers with HEPA-14 filters for reducing ARIs, no significant between-group difference was found in the intention-to-treat analysis. However, a significant reduction in ARIs was identified among participants who completed the entire study. These findings may help inform future large-scale studies of respiratory infectious diseases. ANZCTR identification: ACTRN12623000347662.

Biphenyl derived hyper-crosslinked polymer as a metal-free adsorbent for the removal of pharmaceuticals from water

The global concern of emergent aquatic pollutants, especially pharmaceutical contaminants, emphasizes the necessity for metal-free adsorbents to tackle water contamination issues. In this direction, a biphenyl-derived hyper-crosslinked polymer (poly-biph) was utilized as an adsorbent for the removal of ciprofloxacin (CPX) and doxycycline (DOX) from water. Micro-mesoporous hyper-crosslinked polymeric adsorbent (poly-biph) was synthesized by using biphenyl as precursor and formaldehyde dimethyl acetal (FDA) as crosslinker via microwave assisted method. It exhibits specific surface area (SABET) and pore volume of 1088 m2/g and 1.3 cm3/g, respectively. The spectral analysis confirmed the successful crosslinking of biphenyl with the linker FDA. The sorption efficiency of metal-free poly-biph for CPX and DOX was evaluated via batch and continuous flow modes under various operational parameters. poly-biph exhibited swift removal efficiency (>80 %) for CPX and DOX within a min. The batch mode sorption modeling revealed a chemisorption process and remarkable maximum sorption capacity of 470.8 and 425.1 mg/g for CPX and DOX, respectively. The continuous-flow studies of poly-biph revealed the better applicability of the Clark kinetic model with a maximum bed capacity of 313.5 and 372.4 mg/g for CPX and DOX, respectively. Synergistic mechanisms, including π-π interaction, electrostatic interaction, and pore-filling effect, were found to be the main driving forces for the sorptive removal of CPX and DOX onto poly-biph. The findings indicated that poly-biph possesses the ability to effectively eliminate DOX and CPX from the aquatic environment.

Australian community and inpatient general public sector mental health services between 2017-18 and 2021-22: Relative stasis in bed capacity, increasing outpatient demand, and stunted expenditure.

To descriptively analyse Australian public sector General Mental Health Services (GMHS) expenditure, ambulatory, and inpatient services, including key performance indicators (KPIs) in comparison with other subspeciality mental health services (MHS). We descriptively analysed data published by the Australian Institute of Health and Welfare (AIHW), including inpatient, ambulatory services, expenditure, and KPIs. From 2017-18 to 2021-22, per capita expenditure for Australian GMHS (18-64) rose by an average annual inflation-adjusted change of 2%. Overall bed numbers remained static, with non-acute beds declining, and commensurate expansion of acute beds. Community GMHS had high outpatient utilisation, with high rates of schizophrenia, schizoaffective disorder, and bipolar affective disorders as primary diagnoses in mid-life. From 2017-18 to 2021-22, GMHS inpatient and ambulatory episodes had decreasing rates of significant improvement and increasing rates of significant deterioration. Although GMHS has the highest overall population and service utilisation, there has been static bed availability and relatively small increases in expenditure which are occurring concurrently with worsening clinical outcomes. Evidence-based modelling of GMHS and outcomes is required to inform future service improvement.

Rehabilitation Therapists Have Better Job Satisfaction Than Nurses in a Tertiary Rehabilitation Healthcare Setting: A Cross-Sectional Study.

It is an established fact that job satisfaction of medical staff is a crucial factor that affects healthcare quality and plays a major role in the retention of qualified staff. This study aims to assess the occupational satisfaction of nurses and physiotherapists in a tertiary rehabilitation institution, holding a bed capacity of 511 beds, by utilizing the Job Satisfaction Survey (JSS) questionnaire. This cross-sectional survey was conducted at a tertiary rehabilitation hospital between August and November 2022. The study targeted full-time nurses and rehabilitation therapists working in the institution using an English questionnaire focusing on the Job Satisfaction Survey (JSS) that was sent electronically to all eligible staff. The JSS questionnaire assessed job satisfaction and consisted of 36 items in nine domains of job satisfaction, which included pay, promotion, supervision, benefits, rewards, operational procedures, coworkers, work itself, and communications. The response rate was 64.43% among nurses and 64.93% among therapists. The satisfaction rate was higher among therapists (34.41%) compared to nurses (26.25%). The overall job satisfaction mean score was significantly higher among therapists compared to nurses at 149.28±27.12 compared to 143.14±31.67, respectively.This was also observed in the pay domain (13.06±4.06 versus 12.36±4.29), fringe benefits domain (12.77±4.89 versus 11.90±4.82), and coworkers' domain (15.55±3.67 versus 14.71±4.17), while it was significantly higher among nurses compared to therapists when looking at the promotion domain at 14.27±3.52 versus 13.75±3.16, respectively. When doing regression analysis, the odds ratio (OR) was the highest among bachelor nurses and those with more than 40 years of age for therapists. Rehabilitation therapists are more satisfied than nurses with the main satisfaction domains being financial benefits in the form of pay, fringe benefits, and contingency rewards. Age, gender, and work duration did not show any significant value in this study, and overall, the dissatisfied group for both rehabilitation therapists and nurses did not manifest any difference in most of the job satisfaction factors.

Distinct impacts of microplastics on the carbon sequestration capacity of coastal blue carbon ecosystems: A case of seagrass beds

Seagrass beds, as an important coastal blue carbon ecosystem, are excellent at storing organic carbon and mitigating the impacts of global climate change. However, seagrass beds are under threat due to increased human activities and ubiquitous presence of microplastics (MPs) in marine environments. Bibliometric analysis shows that the distribution and accumulation of microplastics in seagrass beds has been widely documented worldwide, but their impacts on seagrass beds, particularly on carbon sequestration capacity, have not been given sufficient attention. This review aims to outline the potential impacts of MPs on the carbon sequestration capacity of seagrass ecosystems across five key aspects: (1) MPs act as sources of organic carbon, contributing to direct pollution in seagrass ecosystems; (2) Impacts of MPs on seagrasses and their epiphytic algae, affecting plant growth and net primary productivity; (3) Impacts of MPs on microorganisms, influencing production of recalcitrant dissolved organic carbon and greenhouse gas; (4) Impacts of MPs on seagrass sediments, altering the quality, structure, properties and decomposition processes of plant litters; (5) Other complex impacts on the seagrass ecosystems, depending on different behaviors of MPs. Latest progress in these fields are summarized and recommendations for future work are discussed. This review can provide valuable insights to facilitate future multidisciplinary investigations and encourage society-wide implementation of effective conservation measures to enhance the carbon sequestration capacity of seagrass beds.

The Influence of World Heritage Sites on Tourism Dynamics in the EU 27 Nations

Culture and tourism are crucial for economic growth and sustainable development, working together symbiotically. Culture boosts tourism by supporting heritage, production, and creativity, while cultural heritage, reflecting national identity and traditions, strengthens local economies. This study uses a panel data analysis to examine the impact of cultural factors on international tourist arrivals in 27 EU nations. The Driscoll–Kraay method reveals that UNESCO World Heritage Sites, government cultural expenditures, household recreation and cultural expenditures, real GDP per job, and bed capacity positively influence international tourist numbers. Regarding cultural factors, World Heritage Sites have the most significant influence, with each additional UNESCO site leading to a 0.22% rise in tourist numbers. The most crucial determinant of tourist arrivals is bed capacity, with a one percent increase leading to a 0.66% increase in tourist arrivals. Conversely, healthcare expenditures and political civil liberties have a negative impact on tourist arrivals. This study discusses managerial implications and offers recommendations for future research.

Exploring the risks of fragmentation in health care markets – An analysis of inpatient care in Georgia

Private providers play an important role in health systems in low-and middle-income countries. In many such contexts, markets are characterized by a high number of relatively small private facilities. The potential risks from highly concentrated healthcare markets are well-researched, and feature in the “Theories of Harm” investigated by competition regulators. However, there is limited evidence on markets that exhibit substantial harms as a result of very low concentration. This paper explores the risks associated with such market fragmentation, drawing on the example of Georgia, which has a largely privatized provider network.We used a mixed-method study design to analyze the inpatient market in Georgia. Market structure was described using administrative data on bed capacity and discharge numbers and geo-location data on travel time between facilities. The implications of the market structure were explored through in-depth interviews (n = 35) with policymakers, healthcare managers, and local experts and an anonymous online survey of similar groups (n = 97).Georgia's inpatient sector is characterized by a high number of small hospitals in terms of bed numbers and inpatient volumes, mitigated to a limited degree by the presence of provider networks. Travel time to the 3rd nearest competitor was extremely short, ranging from 3 to 5 min in big cities to 10 min in small towns and 33 min in remote locations. The fragmented nature of the market, together with inadequate regulatory and purchasing mechanisms, was argued to exacerbate challenges in the availability and competence of clinical staff, while the financial challenges caused by intense competition encouraged wasteful marketing, harmful cost-cutting measures, and demand inducement.We present “Theories of Harm” from market fragmentation, and argue that an effective policy response requires market-shaping activities using regulatory, financing, and purchasing mechanisms to encourage appropriate levels of market consolidation and so enhance quality, efficiency, and effective governance.

How can we reduce healthcare costs by using Enhanced Recovery After Surgery more effectively in different groups of gynaecological patients? A single-centre experience.

The objective of this study was to assess the impact of the Enhanced Recovery After Surgery (ERAS) programme implementation on treatment costs at a university-type centre, using the DRG scheme. Retrospective analysis of patients' data in a group of 604 individuals enroled in the study. We evaluated three groups of patients according to the ERAS clinical protocol (CP): (1) CP oncogynaecology, (2) CP simple hysterectomy, (3) CP laparoscopy. The study aimed to evaluate the impact on the length of stay (LOS), savings in bed-days, and the reduction in direct treatment costs. Three parameters-antibiotic consumption, blood derivative consumption and laboratory test costs-were chosen to compare direct treatment costs. The statistical significance of the difference in the observed parameters was tested by a two-sample unpaired t test with unequal variances at the 0.05 significance level. We analysed data from 604 patients. In all three groups, the length of stay (LOS) was significantly reduced. The most significant reduction was observed in the CP oncogynaecology group, where the LOS was reduced from 11.1 days to 6.8 days (2022) and 7.6 days (2023) compared to 2019 (p < 0.05). Furthermore, there was a notable reduction in inpatient bed-days, which resulted in the capacity being made available to admit additional patients. A statistically significant reduction in direct costs was observed in the group of CP hysterectomy (antibiotic use) and in the CP laparoscopy (laboratory test costs). The implementation of the ERAS principles resulted in a number of significant positive economic impacts-reduction in the LOS and a corresponding increase in bed capacity for new patients. Additionally, direct treatment costs, including those related to antibiotic use or laboratory testing were reduced. The Czech Republic's acute healthcare system, like the majority of European healthcare systems, is financed by the DRG system. This flat-rate payment per patient encourages hospital management to seek cost-reduction strategies. The results of our study indicate that fast-track protocols represent a potential viable approach to reducing the cost of treatment while simultaneously meeting the recommendations of evidence-based medicine.

The spatial-temporal variations and influencing factors of COVID-19 case fatality rate: a worldwide study in 30 countries from February 2021 to May 2022.

To evaluate the variations in COVID-19 case fatality rates (CFRs) across different regions and waves, and the impact of public health interventions, social and economic characteristics, and demographic factors on COVID-19 CFRs, we collected data from 30 countries with the highest incidence rate in three waves. We summarized the CFRs of different countries and continents in each wave through meta-analysis. Spearman's correlation and multiple linear regression were employed to estimate the correlation between influencing factors and reduction rates of CFRs. Significant differences in CFRs were observed among different regions during the three waves (P<0.001). An association was found between the changes in fully vaccinated rates (r s =0.41), population density (r s =0.43), the proportion of individuals over 65years old (r s =0.43), and the reduction rates of case fatality rate. Compared to Wave 1, the reduction rates in Wave 2 were associated with population density (β=0.19, 95%CI: 0.05-0.33) and smoking rates (β=-4.66, 95%CI: -8.98 - -0.33), while in Wave 3 it was associated with booster vaccine rates (β=0.60, 95%CI: 0.11-1.09) and hospital beds per thousand people (β=4.15, 95%CI: 1.41-6.89). These findings suggest that the COVID-19 CFRs varied across different countries and waves, and promoting booster vaccinations, increasing hospital bed capacity, and implementing tobacco control measures can help reduce CFRs.

Best clinical practice experience at University of Gondar Comprehensive specialized Hospital Emergency and critical care Medicine department, A Case Study Under a resource limited set up

Abstract Background The emergency department (ED) is unique unstable environment where someone faces unscheduled and undifferentiated diseased patients, stressed families, unsettled staffs and unequitable resources.UoGCSH is the oldest in the Ethiopia and the only referral hospital for more than 13 million people from the five-zone north-west Ethiopia with 950 beds capacity. During the 2020 G.C a proposal paper was submitted to the administration bodies of the college and the hospital. The proposal was suggesting short term, mid-term and long-term quality improvement segments implemented in institutionally convenient manner. Objective To describe the transformation of emergency and critical care medical services at University of Gondar Comprehensive specialized hospital from scratch to the current status. Method A descriptive case study design was applied to narrate critical care service transformation at UoG Comprehensive Specialized Hospital. Since this case study is a data review from gathered secondary data, desk reviews of the emergency department, quality directorate data review, and the annual audit report review, there was no need for IRB approval. Result and recommendation After a year of renovation, we were able to organize a newly refurbished emergency room having a triage area with adequate reception space, Red resuscitation area with 10 beds (considering patient overflow), Orange with 18 beds, Yellow with 10 beds and floater area, isolation room, decontamination room, ED laboratory, main store, disaster store and piped oxygen system to all beds. we have gone a long journey in bringing those promised practices into demonstrable practice and finally replicable prototypic best practice. Even though we paced extra miles in achieving this status. Standard emergency room work flow implementation enable us to control the day-to-day patient and attendant crowding that impedes the anticipated medical treatment outcome and result in a significant dissatisfaction.Despite this achievement the trauma center establishment and high-quality patient care is recommended.

Exploring antibiotic prescribing practices in multidisciplinary hospitals in the Republic of Moldova

Antimicrobial resistance (AMR) represents a major global challenge, amplified by the excessive and incorrect use of antibiotics. Th is study conducted in the Republic of Moldova investigated antibiotic prescribing practices in multidisciplinary hospitals to identify correlations between these practices and the increase in AMR. Th e study included a sample of 222 patients from four hospitals, selected based on the availability of a bacteriological laboratory and bed capacity. Data were collected using standardized questionnaires, which evaluated the type, duration, and changes in antibiotic therapy, as well as the results of bacteriological tests. Th e analysis revealed a high prevalence of antibiotic prescriptions, at 86.5%, with higher rates in urology (96%) and intensive care (92%) departments. Approximately 70% of patients hospitalized for 3-5 days received an antibiotic, while those hospitalized for more than 10 days were three times more likely to receive two or more antibiotics. The justification for these prescriptions was missing in most cases, signaling an urgent need for improvement in prescribing practices. Third-generation cephalosporins were the most frequently prescribed antibiotics (44.9%), followed by fluoroquinolones and aminoglycosides. Th e majority of the prescribed antibiotics were classified as „Watch” according to the WHO AWARe classification, indicating a need for intensive monitoring due to the risk of AMR. Th e results underscore the importance of implementing effective antimicrobial management programs and enhancing the monitoring of antibiotic use to combat the rise in AMR.

АНАЛИЗ РАБОТЫ ФТИЗИОХИРУРГИЧЕСКОЙ СЛУЖБЫ В СИБИРСКОМ И ДАЛЬНЕВОСТОЧНОМ ФЕДЕРАЛЬНЫХ ОКРУГАХ В ПЕРИОД С 2020 ПО 2022 ГОД

Introduction. In recent years, the Russian Federation has achieved some improvement in the epidemic situation regarding tuberculosis. However, in the Siberian and Far Eastern Federal Districts of Russia, epidemiological indicators remain above the Russian average. Surgical treatment of pulmonary tuberculosis contributes to the radical elimination of the main source of infection in the tissue and facilitates the therapy tasks. Aim of this study is to analyze the provision of phthisiosurgical care in the “Thoracic Surgery” profile to respiratory tuberculosis inpatients in the tuberculosis pulmonary-surgery departments of regional and local tuberculosis dispensaries of the Siberian and Far Eastern Federal Districts in 2020-2022. Materials and Methods. To assess the general characteristics of the phthisiosurgical service in the above districts, we analyzed the personnel composition, bed capacity, thoracic bed operation, surgical activities, average bed turnover, implementation of the bed-day plan, and the number of operations performed on respiratory tuberculosis patients. The study was basedon materials provided by the statistical departments of regional and local TB dispensaries. Results and Discussion. When comparing the indicators for the years of 2020 and 2022, a worsening personnel shortage was found: The number of surgeons decreased from 30 to 17 in the Far Eastern Federal District and from 35 to 29 in the Siberian Federal District. Over the past 3 years, there has been a significant decrease in the phthisiosurgical bed capacity in the Far East. In the Siberian Federal District and, especially, in the Far Eastern Federal District, beds in phthisiothoracic departments are often used for the purposes other than their intended one. In both the Siberian Federal District and the Far Eastern Federal District, surgical activity rates remain quite high or is recovering after the pandemic, except for Transbaikalia, the Republic of Buryatia, and the Amur Oblast. Conclusions. Analysis of the performance of phthisiosurgical departments in Siberia and the Far East in 2020-2022 shows that it is necessary to increase the number of specialized operations and improve the material and technical base of surgical departments in the above districts, although with the increase in multidrug resistance of Mycobacterium tuberculosis to anti-tuberculosis drugs, the role of surgical treatment methods increases. Today, only federal centers meet all the standards established for providing surgical care to tuberculosis patients

Seismic performance and recovery of medical infrastructure in Mexico City related to the September 19, 1985 and 2017 earthquakes

To date, the September 19, 1985 Michoacán (Ms = 8.1) and the September 19, 2017 Puebla-Morelos (Mw = 7.1) earthquakes have been the most devastating seismic events in Mexico City. During the 1985 earthquake, 13 important public hospital buildings collapsed or were demolished and 5800 hospital beds were lost. During the 2017 earthquake, 85 buildings of the medical sector were disturbed, two major public hospital were demolished and 1147 hospital beds were affected. In this paper, the author concentrates both in reviewing what occurred during the 1985 earthquake, and in reporting what it has been observed for the 2017 earthquake. From the structural viewpoint, the observed damage is discussed in relationships to: a) seismic codes, b) spectral demands, b) structural irregularities, c) soil settlements, d) tilting, e) structural pounding and, f) deterioration. The observed damaged inventory is also put into perspective with respect to the approximate number of medical facilities that are available in Mexico City. An instantaneous drop of seismic resilience for this sector is crudely assessed. Finally, the progress on the recovery process or adaptive resilience is discussed. Fortunately, most of the main hospitals in Mexico City were not severely damaged, and that it was why most of them and the hospital bed capacity in Mexico City previous to the 2017 earthquake was able to be recovered on time to attend the Covid-19 pandemic which affected Mexico since early 2020.