Bed Capacity Research Articles

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.

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.

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.

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.

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.

Investigation of E-Complaints of Hotel Guests Towards 4 and 5-Star Kayseri City Hotels

In recent decades Kayseri has emerged as a prominent destination for winter, nature, and cultural tourism, attracting visitors to its natural and cultural resources, and gastronomic offerings. The increase in tourist numbers has also led to a corresponding expansion in the accommodation sector, accompanied by a significant rise in hotel room numbers and available bed capacity. Despite this increase, academic studies examining the quality of accommodation services in the province or addressing customer perceptions of these services are relatively limited. This exploratory study aims to analyze e-complaints regarding 4 and 5-star city hotels in Kayseri, identify the most prevalent issues articulated by guests in these complaints, and categorize and assess them. For this purpose, the researchers first identified 497 negative reviews for seven different city hotels in Kayseri on the TripAdvisor website between August and December 2023. Then these reviews were subjected to content analysis. The content analysis findings revealed that guests were mostly unhappy with "rooms and housekeeping department services", “staff attitudes and performance", "food and beverage department services" and “physical characteristics and atmosphere” of hotels.

Production and Characterization of Electrospun Chitosan, Nanochitosan and Hyaluronic Acid Membranes for Skin Wound Healing.

The development of new wound dressings made from biomaterials, which offer a better cost-benefit ratio and accelerate the healing process, is increasing nowadays. Various biopolymers can be electrospun to form functional membranes for wound healing. Therefore, in this study, chitosan and nanochitosan membranes with or without hyaluronic acid were prepared using the electrospinning technique, characterized and evaluated in the healing of skin wounds in rats. Chitosan and nanochitosan solutions, with or without hyaluronic acid, were prepared at concentrations of 1%-4% using PEO (polyethylene oxide) and subjected to the electrospinning process to obtain membranes characterized by scanning electron microscopy (SEM), mechanical tests, and antimicrobial activity. The healing effect of the membranes was evaluated by monitoring the area of the lesions, contraction of the wounds, histologic analysis, and induction of pro-inflammatory cytokine (IL-1 α and TNF-α) production in rats. The nanochitosan and nanochitosan membranes with hyaluronic acid achieved greater fiber diameter and uniformity, resistance, elasticity, and thermal stability, in addition to good adhesion to the wound bed and permeation capacity. Despite not presenting antimicrobial activity in vitro, they contributed to the production of pro-inflammatory interleukins in the animals tested, provided physical protection, reduced the wound area more markedly until the seventh day of the evaluation, with an acceleration of the healing process and especially when functionalized with hyaluronic acid. These results indicate that the membranes may be promising for accelerating the healing process of chronic wounds in humans.

Need estimates of psychiatric beds: a systematic review and meta-analysis.

This study aimed to review and synthesize the need estimates for psychiatric beds, explore how they changed over time and compare them against the prevalence of actually existing beds. We searched PubMed, Embase classic and Embase, PsycINFO and PsycIndex, Open Grey, Google Scholar, Global Health EBSCO and Proquest Dissertations, from inception to September 13, 2022. Publications providing estimates for the required number of psychiatric inpatient beds were included. Need estimates, length of stay, and year of the estimate were extracted. Need estimates were synthesized using medians and interquartile ranges (IQRs). We also computed prevalence ratios of the need estimates and the existing bed capacities at the same time and place. Sixty-five publications with 98 estimates were identified. Estimates for bed needs were trending lower until 2000, after which they stabilized. The twenty-six most recent estimates after 2000 were submitted to data synthesis (n = 15 for beds with unspecified length of stay, n = 7 for short-stay, and n = 4 for long-stay beds). Median estimates per 100 000 population were 47 (IQR: 39 to 50) beds with unspecified length of stay, 28 (IQR: 23 to 31) beds for short-stay, and 10 (IQR: 8 to 11) for long-stay beds. The median prevalence ratio of need estimates and the actual bed prevalence was 1.8 (IQR: 1.3 to 2.3) from 2000 onwards. Historically, the need estimates for psychiatric beds have decreased until about 2000. In the past two decades, they were stable over time and consistently higher than the actual bed numbers provided.

Epidemiology of COVID-19 in Berlin-Neukölln nursing homes

BackgroundThe COVID-19 pandemic has affected various urban population groups in different ways. Earlier studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disproportionally impacts nursing home residents by increasing morbidity and mortality following viral exposure. However, little is known about the epidemiology of this disease in detail. Therefore, the objective of this study is to analyze the development of the COVID-19 pandemic in 14 nursing homes across Berlin-Neukölln, Germany, during pandemic waves 1 to 5 (Feb 2020 - May 2022). MethodsReporting data to the Neukölln Department of Public Health on COVID-19 cases in connection with nursing homes were extracted from the SORMAS database. The case fatality rates (CFRs) and odds ratios (ORs) of demographic parameters, prevalent variants of concern (VOCs) and vaccine availability were calculated. In addition, the temporal course in waves 1–5 in Neukölln and the relevant government measures were examined. ResultsData collected from nursing homes providing age-dependent physical care revealed that 1.9 % of the total 108,600 cases registered in Berlin-Neukölln during the study period were related one of the 14 facilities. Compared to the general population in Neukölln, nursing homes exhibited a 20-fold increase in the CFR. Notably, nursing homes with higher bed capacities displayed a greater CFR than did smaller nursing homes. Similarly, elderly residents living in nursing homes faced a much greater mortality rate than did their counterparts living outside of medical settings (OR = 3.5). The original wild-type SARS-CoV-2 strain had the most severe direct impact, with a CFR of 16.7 %, compared to the alpha (CFR = 6.9 %), delta (CFR = 10.2 %) and omicron (CFR = 2.8 %) variants in nursing homes. Interestingly, the number of infections increased following vaccination campaigns, but this trend was accompanied by a decrease in the number of deaths from 2.6 to 1.1 per week. As a result, the CFR significantly decreased from 18.4 to 5.5, while still exceeding the mean CFR compared to that of the general population of Neukölln. ConclusionsOur findings reveal the changing patterns of outbreak frequency and severity across the five pandemic waves. They highlight the crucial role of rapid vaccination programs for residents, staff, visitors, and third-party services in safeguarding nursing homes. Additionally, improvements in containment and cluster strategies are essential in prevaccination scenarios to prevent future infection traps for elderly individuals in long-term care facilities. The presented data highlight the importance of tailored protection measures for one of the most vulnerable populations in our society.

Caregivers’ experiences on preterm infants’ management in a tertiary care facility in Ghana: a qualitative exploratory study

BackgroundPreterm birth is a process that fundamentally alters parental or caregiver roles, particularly in the early weeks of childbirth. Caregiver experiences can be distressing due to struggles with an unfamiliar and potentially threatening environment of the Neonatal Intensive Care Unit (NICU). These experiences can affect the development of parenting or caregiving roles to a greater extent. Supporting caregivers of preterm infants through education and information sharing can significantly improve neonatal outcomes. This study sought to explore the experiences of caregivers with hospitalized preterm infants regarding the education and information they received from healthcare workers on the care of preterm infants.MethodAn exploratory descriptive qualitative study that explored caregivers’ experiences with the management of preterm infants hospitalized at the Level III Neonatal Intensive Care Unit (NICU) of a tertiary level facility with an annual delivery of almost 7500 and a bed capacity of 26. The study utilized a deductive approach and a purposive sampling technique to recruit 16 caregivers who participated in an in-depth interview using a piloted semi-structured interview guide. The interviews were audio-recorded, transcribed, and analyzed using thematic analysis.FindingsThe study identified three major themes, which were (1) preterm infant feeding and keeping infants warm, (2) routine procedures and activities at the NICU, and (3) preparation towards homecare after discharge. Seven (7) sub-themes were generated. Caregivers were satisfied with the education and information they received on infant feeding and keeping the infant ward. They also had adequate education that prepared them for home care of the preterm infant. Caregivers did not receive timely information and education on the health status of their infants and the care processes of the NICU. They felt they were left out as they were not involved in decision-making. Regarding the care of the preterm infant. The inadequate flow of information and use of medical terminologies were a great source of worry and frustration for participants. The study showed that although the NICU staff were willing to offer health education to caregivers, information giving and education were not structured and hence did not address all the needs of the caregivers.ConclusionHealthcare providers caring for preterm infants include caregiver education in their routine NICU activities and procedures. These processes start from the period of admission till discharge. Their education sessions primarily focus on breastfeeding, keeping the infant warm and adequate preparation of caregivers for preterm infant home care. This notwithstanding there are gaps in caregiver education and information on routine procedures in the NICU as well as information on the health needs of the infant. Participants are not fully involved in the decision-making processes and the use of medical terminologies compound caregivers’ frustrations and anxieties. It is important to develop structured educational programs tailored to address the information needs faced by caregivers to ensure optimal health outcomes for their preterm infants.

Comparative Studies of Diclofenac Sodium (NSAID) Adsorption on Wheat (Triticum aestivum) Bran and Groundnut (Arachis hypogaea) Shell Powder using Vertical and Sequential Bed Column

Wheat bran and groundnut shell powder have been used to study the mechanism of diclofenac sodium adsorption from aqueous solution using batch as well as column modes and maximum uptake is 84.3% for wheat bran and 82.4% for groundnut shell powder at pH 6, drug concentration 1 mg/L at 298 K for 30min. Isotherm and error analysis reveals that Freundlich and Langmuir isotherms fitted well. Kinetic studies show that the adsorption process follows second-order kinetics and thermodynamic study shows endothermic adsorption process. Column adsorption study is important for industrial scale adsorption and column studies have been carried out using vertical bed and sequential bed adsorption columns at pH 6 which is the optimum pH for maximum adsorption for batch experiments. Vertical and sequential bed columns setup is simple and economical which provides flow under gravity. The effect of varying inlet feed concentration and flow rate on the breakthrough and exhaustion time of columns has been studied to determine the bed capacities of both columns. Thomas model and Yoon-Nelson models fitted well with experimental data for continuous flow column studies.

Re-discovering macerating Posidonia oceanica bottoms: Characterization of meiofaunal community inhabiting a peculiar Mediterranean habitat

The highly efficient carbon storage capacity of beds formed by Posidonia oceanica, an endemic Mediterranean seagrass species, has been widely recognized. Recently, the supra-littoral deposits of leaf litter (i.e., banquettes) have been investigated in terms of their nutrients, biomass and associated community. Nevertheless, an overlooked fraction of the P. oceanica detritus never reaches the shore and sinks far away to deeper seafloor. Additionally, part of the supra-littoral deposit goes back to the sea during winter swells. This deep detrital compartment, mainly composed of sediment mixed with dead leaves and rhizomes coming from P. oceanica beds, has only been described once by Pères in 1953, who focused on the macrofaunal component. Here, we investigated for the first time the meiofaunal community inhabiting sediments characterized by P. oceanica detritus in a deposit located at 65−80 m depth off the Ischia Island (Gulf of Naples, Italy, Tyrrhenian Sea). Our results show that the meiofaunal community appears highly diversified and strongly dominated by nematodes (from 85% to 93%). Differences in meiobenthic assemblage structures were significant only when rare taxa were considered (i.e. taxa found in low abundances and characterized by a sporadic distribution in the study area). The nematode community revealed a very high biodiversity (number of families and genera: 31 and 104, respectively), with a clear prevalence of selective and non-selective deposit feeders that suggest the key role of this habitat in the benthic detrital food web. The richness of meiofauna and the taxonomic and functional diversity of the nematode assemblages account for a “good” to “moderate” ecological quality status. These findings support the high ecological value of the macerating seagrass bottoms, an overlooked component of the blue carbon cycle that deserves to be further investigated.

Organization of abdominal emergency surgical care across healthcare services in Senegal: a cross-sectional nationwide survey

IntroductionStudying surgical services and the workforce in sub-Saharan Africa is crucial for enhancing access to quality surgical care in the region. Despite many recommendations to produce evidence based on reliable data on this subject to guide policymakers, there is still a knowledge gap on this topic. The aim of this nationwide survey was to describe the organization of abdominal emergency surgical care across healthcare services in Senegal.MethodologyThis was a cross-sectional nationwide survey. The study period was between October 1st, 2023, and January 20th, 2024. The target population included all registered healthcare facilities in Senegal offering emergency surgical services. A structured questionnaire was designed to gather infrastructure-related data, surgical activities, and human resources.ResultsAll 33 identified healthcare facilities responded to the survey (100%). Emergency abdominal surgery services were available for 96.7% of the surveyed structures. The teams were mainly composed of surgeons and residents (45.2%) or surgeons and medical trainees (48.8%). The average bed capacity of the services was 21.9, with a standard deviation of 13.9. The absence of a dedicated hospitalization section for patients requiring special monitoring was found in 69.6% of the facilities. Operating rooms dedicated to emergency abdominal digestive surgery were present in 54.6% of the services. On average, the services performed 17.6 scheduled surgical interventions with a standard deviation of 11.5 and 29.7 emergency surgical interventions with a standard deviation of 16.8 per month. Morbidity and mortality conferences were not routinely held in the majority of departments (only 27.3%). Professional development programmes were present only in 24.2% of departments. Most of the departments did not have adequate human resources (69.6%). A total of 70 surgeons were identified, resulting in a national ratio of 0.39 general surgeons per 100,000 inhabitants. The strategies employed to address staff shortages included additional working hour by staff (54.5%), temporary workers (30.3%) or the use of trainee doctors or nurses (12.1%).ConclusionThis research shows that significant deficiencies are present in the essential physical and human resources needed to conduct fundamental life-saving surgical procedures. These findings suggest potential areas for improvement in the delivery of emergency surgical care in the region.

Impact of hospital volume and facility characteristics on postoperative outcomes after hepatectomy: A mediation analysis

BackgroundThe impact of hospital procedural volume on outcomes after hepatectomy relative to other facility-related factors remains unclear. We sought to define the comparative impact of hospital volume compared with other facility-related factors on postoperative outcomes among Medicare beneficiaries undergoing hepatectomy. MethodsData on patients who underwent hepatectomy between 2013 and 2021 were collected from the Medicare Standard Analytic Files and linked with facility-level data from the American Hospital Association Survey databases. Hospital volume was stratified into high- (top 10%) and low-volume centers. Propensity score matching was used to account for variable imbalances in patient characteristics among high-compared with low-volume centers. Mediation analysis was employed to delineate facility-related factors responsible for the impact of hospital volume on outcomes with a specific focus on incidence of complications, in-hospital mortality, and failure to rescue. ResultsThe analytic cohort included 22,969 patients from 340 institutions. After propensity score matching, receipt of surgery at a high-volume center was associated with a lower likelihood of postoperative complications (39.9% vs 41.7%, P = .01), in-hospital mortality (2.2% vs 2.8%, P = .02), and failure to rescue (5.4% vs 6.5%, P = .04) versus low-volume centers. Mediation analysis revealed that hospital capacity (bed capacity and nurse-to-bed ratio) contributed the most to the variations in risk of complications and in-hospital mortality, whereas liver transplant program status had the largest impact on failure to rescue. ConclusionsHospital volume is a significant determinant of postoperative outcomes after hepatectomy, with hospital capacity and liver transplant program status being important mediators of this effect. Centralization and optimal resource distribution are important to achieve favorable outcomes following liver resection.