Bed Days Research Articles

Implication of COVID-19 pandemic on the incidence of Clostridioides difficile infection in a Greek tertiary hospital.

Introduction. C. difficile infection (CDI) represents an important global threat. In the COVID-19 era, the multifactorial nature of CDI has emerged.Hypothesis - Aim. The aim was to assess the impact of COVID-19 pandemic on the incidence of CDI in a Greek hospital.Methodology. A retrospective study was performed throughout a 51 month period (January 2018 to March 2022), divided into two periods: pre-pandemic (January 2018 to February 2020) and COVID-19 pandemic (March 2020 to March 2022). The effects of the pandemic compared to the pre-pandemic period on the incidence of CDI [expressed as infections per 10 000 bed days (IBD)] were studied using interrupted time-series analysis.Results. Throughout the study, there was an increase in the monthly CDI incidence from 0.00 to 11.77 IBD (P<0.001). Interrupted time-series disclosed an increase in CDI incidence during the pre-pandemic period from 0.00 to 3.36 IBD (P<0.001). During the COVID-19 pandemic period the linear trend for monthly CDI rose from 2.65 to 13.93 IBD (P<0.001). The increase rate was higher during the COVID-19 pandemic period (r2 = +0.47) compared to the pre-pandemic period (r1 = +0.16).Conclusion. A significant increase of CDI incidence was observed, with the rate of the rise being more intense during the COVID-19 pandemic.

Cost-benefit analysis of Intensive Care Unit with Activity-Based Costing approach in the era COVID-19 pandemic: A case study from Iran.

Providing intensive care to acute patients is a vital part of health systems. However, the high cost of Intensive Care Units (ICU) has limited their development, especially in low-income countries. Due to the increasing need for intensive care and limited resources, ICU cost management is important. This study aimed to analyze the cost-benefit of ICU during COVID-19 in Tehran, Iran. This cross-sectional study is an economic evaluation of health interventions. The study was conducted in the COVID-19 dedicated ICU, from the provider's point of view and within one-year horizon. Costs were calculated using a top-down approach and the Activity-Based Costing technique. Benefits were extracted from the hospital's HIS system. Benefit Cost ratio (BCR) and Net Present Value (NPV) indexes were used for cost-benefit analysis (CBA). A sensitivity analysis was performed to evaluate the dependence of the CBA results on the uncertainties in the cost data. Analysis was performed with Excel and STATA software. The studied ICU had 43 personnel, 14 active beds, a 77% bed occupancy rate, and 3959 occupied bed days. The total costs were $2,372,125.46 USD, of which 70.3% were direct costs. The highest direct cost was related to human resources. The total net income was $1,213,314.13 USD. NPV and BCR were obtained as $-1,158,811.32 USD and 0.511 respectively. Despite operating with a relatively high capacity, ICU has had high losses during the COVID-19. Proper management and re-planning in the structure of human resources is recommended due to its importance in the hospital economy, provision of resources based on needs assessment, improvement of drugs management, reduction of insurance deductions in order to reduce costs and improve ICU productivity.

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Cognitive enhancement interventions are effective for schizophrenia: why not provide them early?

Vaccine-Preventable Hospitalisations from Seasonal Respiratory Diseases: What Is Their True Value?

Hospitals in England experience extremely high levels of bed occupancy in the winter. In these circumstances, vaccine-preventable hospitalisations due to seasonal respiratory infections have a high cost because of the missed opportunity to treat other patients on the waiting list. This paper estimates the number of hospitalisations that current vaccines against influenza, pneumococcal disease (PD), COVID-19, and a hypothetical Respiratory Syncytial Virus (RSV) vaccine, could prevent in the winter among older adults in England. Their costs were quantified using a conventional reference costing method and a novel opportunity costing approach considering the net monetary benefit (NMB) obtained from alternative uses of the hospital beds freed-up by vaccines. The influenza, PD and RSV vaccines could collectively prevent 72,813 bed days and save over £45 million in hospitalisation costs. The COVID-19 vaccine could prevent over 2 million bed days and save £1.3 billion. However, the value of hospital beds freed up by vaccination is likely to be 1.1-2 times larger (£48-93 million for flu, PD and RSV; £1.4-2.8 billion for COVID-19) when quantified in opportunity cost terms. Considering opportunity costs is key to ensuring maximum value is obtained from preventative budgets, as reference costing may significantly underestimate the true value of vaccines.

Complications from the formation of preventive stomas in the surgical treatment of rectal cancer

Background. Anastomotic leakage is one of the most severe complications of colorectal cancer surgery. The formation of a preventive stoma can avoid the consequences of this complication. Given the increase in the rate of sphincter-preserving surgeries, the number of surgeries with the formation of preventive stoma has also increased significantly. There are several techniques and each of them has its advantages and disadvantages.The aim of the study was to compare the effectiveness of surgical treatment and techniques of preventive stoma formation.Material and Methods. The retrospective study included 353 patients with stage II–IV rectal cancer who underwent surgery with the formation of preventive stoma (110 with ileostomy formation, 243 with transversostomy) from 2016 to 2020. Both intraoperative parameters (operation time, blood loss, intraoperative complications) and postoperative parameters (postoperative bed-day, complications) were evaluated. Immediate complications within 30 days after surgery using the Clavien–Dindo complication scale and infectious complications mainly related to the stoma formation (prolapse, stoma retraction, presence of peristomal dermatitis, reoperation) were assessed.Conclusion. The choice in the formation of a preventive ileo- or transversostomy during rectal resection has no effect on the frequency of anastomosis failure; however, there is a tendency that patients with colostomy spend fewer bed days in a hospital. Stoma-related complications in the postoperative period are mild and can be treated conservatively in the vast majority of cases. In compliance with the standardized surgical procedures and the protocol of perioperative management of patients, the number of severe complications is minimal. It is necessary to evaluate the second step of management of patients with preventive stomas – their elimination.

Level of Care Appropriateness in VA Inpatient Surgery Cases.

Within the Veterans Health Administration, utilization management (UM) focuses on reducing unnecessary or inappropriate hospitalizations by applying evidence-based criteria to evaluate whether the patient is placed in the right level of care. This study examined inpatient surgery cases to classify reasons for not meeting criteria and to identify the appropriate level of care for admissions and subsequent bed days of care. There were 129 VA Medical Centers in which inpatient UM reviews were performed during that time, of which 109 facilities had UM reviews conducted in Surgery Service. All admissions to surgery service during fiscal year 2019 (October 1, 2018 to September 30, 2019) that had a UM review entered in the national database were extracted, including current level of care, recommended level of care, and reasons for not meeting criteria. The following demographic and diagnostic fields were supplemented from a national data warehouse: age, gender, marital status, race, ethnicity, and service connection status. Data were analyzed with descriptive statistics. Characteristics of patient demographics were compared using the χ2 test for categorical variables and the Student's t test. A total of 363,963 reviews met conditions to be included in the study: 87,755 surgical admission reviews and 276,208 continued stay reviews. There were 71,274 admission reviews (81.22%) and 198,521 (71.87%) continued stay reviews that met the InterQual criteria. The primary reason for not meeting admission criteria was clinical variance (27.70%), followed by inappropriate level of care (26.85%). The leading reason for not meeting continued stay criteria was inappropriate level of care (27.81%), followed by clinical instability (25.67%). Of the admission reviews not meeting admission criteria, 64.89% were in the wrong level of care and 64.05% of continued stay reviews were also in the wrong level of care. Half of the admission reviews not meeting criteria had a recommended level of care as home/outpatient (43.51%), whereas nearly one-third (28.81%) continued stay reviews showed a recommended level of care of custodial care or skilled nursing. This study identified system inefficiencies through admission and continued stay reviews of surgical inpatients. Patients admitted for ambulatory surgery or for preoperative testing prior to day of surgery resulted in avoidable bed days of care that may have contributed to patient flow issues and limited the available hospital beds for other patients. Through early collaboration with case management and care coordination professionals, alternatives can be explored that safely address the patient needs, such as temporary lodging options. There may be conditions or complications that can be anticipated on the basis of patient history. Proactive efforts to address these conditions may help avoid unnecessary bed days and extended lengths of stay.

Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis of hospital-wide and general (internal) medicine cohorts.

Guidelines recommend routine frailty screening for all hospitalised older adults to inform care decisions, based mainly on studies in elective or speciality-specific settings. However, most hospital bed days are accounted for by acute non-elective admissions, in which the prevalence and prognostic value of frailty might differ, and uptake of screening is limited. We therefore did a systematic review and meta-analysis of frailty prevalence and outcomes in unplanned hospital admissions. We searched MEDLINE, EMBASE and CINAHL up to 31/01/2023 and included observational studies using validated frailty measures in adult hospital-wide or general medicine admissions. Summary data on the prevalence of frailty and associated outcomes, measurement tools, study setting (hospital-wide vs general medicine), and design (prospective vs retrospective) were extracted and risk of bias assessed (modified Joanna Briggs Institute checklists). Unadjusted relative risks (RR; moderate/severe frailty vs no/mild) for mortality (within one year), length of stay (LOS), discharge destination and readmission were calculated and pooled, where appropriate, using random-effects models. PROSPERO CRD42021235663. Among 45 cohorts (median/SD age=80/5 years; n=39,041,266 admissions, n=22 measurement tools) moderate/severe frailty ranged from 14.3% to 79.6% overall (and in the 26 cohorts with low-moderate risk of bias) with considerable heterogeneity between studies (phet < 0.001) preventing pooling of results but with rates <25% in only 3 cohorts. Moderate/severe vs no/mild frailty was associated with increased mortality (n=19 cohorts; RR range=1.08-3.70), more consistently among cohorts using clinically administered tools (n=11; RR range=1.63-3.70; phet=0.08; pooled RR=2.53, 95% CI=2.15-2.97) vs cohorts using (retrospective) administrative coding data (n=8; RR range=1.08-3.02; phet < 0.001). Clinically administered tools also predicted increasing mortality across the full range of frailty severity in each of the six cohorts that allowed ordinal analysis (all p<0.05). Moderate/severe vs no/mild frailty was also associated with a LOS >8 days (RR range=2.14-3.04; n=6) and discharge to a location other than home (RR range=1.97-2.82; n=4) but was inconsistently related to 30-day readmission (RR range=0.83-1.94; n=12). Associations remained clinically significant after adjustment for age, sex and comorbidity where reported. Frailty is common in older patients with acute, non-elective hospital admission and remains predictive of mortality, LOS and discharge home with more severe frailty associated with greater risk, justifying more widespread implementation of screening using clinically administered tools. None.

Prevalence and Incidence of Pediatric Acute Respiratory Distress Syndrome in a Tertiary Academic PICU in South Africa.

To determine the prevalence and incidence of pediatric acute respiratory distress syndrome (pARDS) among infants and children admitted to the PICU. A single-center descriptive point prevalence study with twice weekly data collection over a 6 months (August 2020 to February 12, 2021). Red Cross War Memorial Children's Hospital, Cape Town, South Africa. All infants and children admitted to the PICU on study days were included. Data were captured electronically on a standardized case record form using a Research Electronic Data Capture electronic database. The Pediatric Acute Lung Injury Consensus Conference criteria were used to define pARDS cases. Prevalence was calculated as the total number of pARDS cases/1,000 PICU bed days. The study included 354 patients (median [interquartile range]) 10.1 months old (1.5-61.3 mo old), with 204 males (57.6%), who occupied 879 bed days. Of these 879 bed days, 266 (30.3%; 95% CI, 27.2-33.3%) were occupied by pARDS cases, with a calculated prevalence and incidence of 302.6 of 1,000 bed days (30.3%) and 29.7% (95% CI, 26.7-32.7%), respectively. Three cases from the cohort were defined using the oxygen saturation index calculation. In cases receiving invasive ventilation ( n = 494; 56.2%), pARDS severity was classified as mild ( n = 143; 16.3%), moderate ( n = 44; 5.0%), and severe ( n = 29, 3.3%). A further 205 beds (23.3%) were occupied by patients classified as being at risk of pARDS. The prevalence and incidence of pARDS in a South African PICU appears substantially higher than findings described in international reports. Further investigation of risk factors and outcomes is warranted.

Comparison of antibiotic use and antibiotic resistance between a community hospital and tertiary care hospital for evaluation of the antimicrobial stewardship program in Japan.

Assessment of risk-adjusted antibiotic use (AU) is recommended to evaluate antimicrobial stewardship programs (ASPs). We aimed to compare the amount and diversity of AU and antimicrobial susceptibility of nosocomial isolates between a 266-bed community hospital (CH) and a 963-bed tertiary care hospital (TCH) in Japan. The days of therapy/100 bed days (DOT) was measured for four classes of broad-spectrum antibiotics predominantly used for hospital-onset infections. The diversity of AU was evaluated using the modified antibiotic heterogeneity index (AHI). With 10% relative DOT for fluoroquinolones and 30% for each of the remaining three classes, the modified AHI equals 1. Multidrug resistance (MDR) was defined as resistance to ≥ 3 anti-Pseudomonas antibiotic classes. The DOT was significantly higher in the TCH than in the CH (10.85 ± 1.32 vs. 3.89 ± 0.93, p < 0.001). For risk-adjusted AU, the DOT was 6.90 ± 1.50 for acute-phase medical wards in the CH, and 8.35 ± 1.05 in the TCH excluding the hematology department. In contrast, the DOT of antibiotics for community-acquired infections was higher in the CH than that in the TCH. As quality assessment of AU, higher modified AHI was observed in the TCH than in the CH (0.832 ± 0.044 vs. 0.721 ± 0.106, p = 0.003), indicating more diverse use in the TCH. The MDR rate in gram-negative rods was 5.1% in the TCH and 3.4% in the CH (p = 0.453). No significant difference was demonstrated in the MDR rate for Pseudomonas aeruginosa and Enterobacteriaceae species between hospitals. Broad-spectrum antibiotics were used differently in the TCH and CH. However, an increased antibiotic burden in the TCH did not cause poor susceptibility, possibly because of diversified AU. Considering the different patient populations, benchmarking AU according to the facility type is promising for inter-hospital comparisons of ASPs.

Measuring broad-spectrum antibiotic use in hospitals with established versus new indicators.

The target of a 30% reduction in the use of broad-spectrum antibiotics in hospitals from 2012 to 2020 was not achieved, measured using the standard indicator of defined daily doses (DDD) per 100 bed days. We wished to investigate the reliability of the standard indicator and of selected alternative indicators for antibiotic use, and to determine the actual reduction in use. We included ten DDD-based indicators with adjustment for combinations of activity marker, admission category (inpatient vs. all admissions), and case mix, and evaluated these according to how each indicator correlated with antibiotic resistance in a self-developed model. We then calculated use of broad-spectrum antibiotics in hospitals for the period 2012-20 with indicators deemed valid, and compared these indicators with regard to change in use and ranking of hospitals according to use. We used consumption rate (DDD per 1000 inhabitants per day) as an activity-neutral reference indicator (national and regional). All the indicators for antibiotic use showed a strong correlation with resistance. For five indicators the correlation was statistically significant. Of these, the indicator that combined adjustment for the total number of admitted patients and case mix accorded best with the consumption rate (35.6%). The same indicator also showed the largest reduction in use (29.3%) and gave the most hospitals that achieved a reduction of at least 30% (13 of 22). Combined adjustment for number of admitted patients and case mix represents a new, robust indicator for antibiotic use that is suitable for hospitals at all levels. The indicator can be used in parallel with the consumption rate, and consideration should be given to introducing the latter as the new standard indicator at national and regional level.

Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors.

Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting and the related clinical-economic benefit at discharge. PPI prescriptive trends were compared between three quarters of 2019 (9 months) and the same period of 2018 by a chi-square test with a Yate's correction. The proportions of treated patients in the two years (1120 discharged patients in 2018 and 1107 in 2019) were compared by the Cochran-Armitage trend test. DDDs (defined daily doses) were compared between 2018 and 2019 by the non-parametric Mann-Whitney test and normalizing DDD/DOT (days of therapy) and DDD/100 bd (bed days) for each patient. Multivariate logistic regression was performed on PPI prescriptions at discharge. The distribution of patients with PPIs at discharge was significantly different in the two years (p = 0.0121). There was a downward trend in the number of PPI prescriptions (29.9%) in the third trimester of 2019 compared to the others of the same year (first trimester: 34.1%, second trimester: 36.0%) and by contrast with the same periods of 2018 (29.4, 36.0, and 34.7%) (p = 0.0124). DDDs/patient did not differ between 2018 and 2019 nor across the three trimesters. However, both DDD/DOT and DDD/100 bd showed a decrease in the third trimester of 2019, with a marked difference for DDD/DOT (p = 0.0107). The reduction in consumption detected in the last phase of 2019 in terms of DDD/DOT was 0.09 with a consequent containment of pharmaceutical spending. The development and implementation of multidisciplinary prescribing/deprescribing protocols in both hospital and community settings could lead to a reduction in the misuse of PPIs, with significant savings in healthcare resources.

Use of anti-viral therapies in hospitalised COVID-19 patients in the United Arab Emirates: a cost-effectiveness and health-care resource use analysis

BackgroundThis study attempts to estimate the cost-effectiveness of the antiviral remdesivir, as recommended in the 2021 COVID treatment guidelines for the United Arab Emirates, compared to standard of care (SOC), but also favipiravir (FAVI), which was also recommended for the treatment of hospitalized COVID patients.MethodsA cost-effectiveness model was built using published efficacy data for RDV, FAVI and SOC as well as local epidemiology data. The outcomes measured included hospital bed days averted, mortality, costs and cost per outcome over one year. One-way, probabilistic and scenario analyses were undertaken to reflect uncertainty in the estimates.ResultsWhen modelled over one year, the results indicated that treatment of adults in need of supplemental oxygen with RDV + SOC could result in 11,338 fewer general ward bed days, 7,003 fewer ICU days and 5,451 fewer ICU + MIV bed days compared to SOC alone and similar results when compared with FAVI + SOC. The model results also showed that there were 374 fewer deaths associated with the use of RDV + SOC compared to SOC alone. The model also estimates substantial potential cost-savings associated with RDV + SOC treatment compared with SOC alone (USD 3,454 per patient). The results of the one-way sensitivity analysis showed that the model was sensitive to estimates of length of stay and the cost of hospitalization. Despite this, the model predicted cost-savings in all scenarios versus all comparators.ConclusionsThe model estimated that using RDV + SOC could result in substantial reductions in HCRU and cost savings regardless of the comparator. However, it should be noted that reliable clinical information on FAVI was limited therefore it is challenging to interpret these results. All the potential benefits modelled here for RDV + SOC can have implications not only for the health of the UAE population but for improving hospital capacity to deal with other conditions.

Comparative analysis of the activities of emergency hospitals in the «covid» period

INTRODUCTION: The pandemic of a new coronavirus infection has become a serious test of our country’s health care system. OBJECTIVE OF THE STUDY: Analysis of the dynamics of the performance of emergency hospitals during the pandemic of a new coronavirus infection. MATERIALS AND METHODS: The material was the data of federal state statistics (sources - FSN No. 14 and 30, 2019- 2021) of 2 multidisciplinary hospitals operating in ambulance hospitals (24/7/365), which have fundamental structural and functional features related to the availability of beds for patients with COVID-19. Regulatory, statistical (analysis of averages using parametric T-test and one-way-ANOVA analysis of variance, Spearman correlation analysis) and analytical methods (analysis, synthesis, comparison) were used. RESULTS: For a hospital with deployed beds for patients with COVID-19, there was a characteristic decrease in volumetric performance indicators: the number of patients in the admission department (by 61.7 %), non-hospitalized patients (by 82.2 %) and patient refusals from hospitalization (by 83.6 %), the number of outpatients (by 77.7 %), the number of discharged patients (by 17.7 %), carried out by patients bed-days (2.9 %), patient re-hospitalizations (96.1 %). For a hospital that was not re-profiled for COVID-19, there was a slight increase in visits (+ 1.4 %) with a decrease in the number of discharged patients (-22.8 %) and spent bed days (-12.4 %), an increase in the number of non-hospitalized patients (by 34.2 %) and the volume of care on an outpatient basis (+ 22.7 %), the number of re-hospitalized patients increased (+ 55.5 %). In hospitals, there was an increase in the number of patients who died (by 154.8 % and 29.2 %, respectively), including those with respiratory diseases (by 433.3 % and 145.5 %, respectively). DISCUSSION: Two multidisciplinary emergency hospitals had significant differences in the organization of their work in the period 2019-2021, due to the re-profiling of beds for receiving infectious patients (for patients with COVID-19) and the assignment of additional volumes of specialized non-infectious medical care to the non-redesigned multidisciplinary hospital. CONCLUSION: Currently, multidisciplinary emergency hospitals require the development of new models and principles for organizing the medical and diagnostic process, providing for the deployment of inpatient emergency departments, mobile bed capacity, infectious beds, development of algorithms for admission and triage of patients, reduction of unreasonable and non-core hospitalization, increasing the availability, efficiency and quality of medical care, which will increase the readiness to work in emergency situations of such a pandemic with a new coronavirus infection (COVID-19).

Results of laparoscopic choledocholithoextraction and choledochoscopy for difficult choledocholithiasis: a single centre experience

The management of difficult choledocholithiasis, which accounts for 10—15% of all cases of bile duct stones, has not yet been definitively defined. One of the treatment options for difficult choledocholithiasis is laparoscopic choledocholithoextraction combined with choledochoscopy.&#x0D; Objective — to evaluate the experience of a single centre in the treatment of difficult choledocholithiasis using laparoscopic choledocholithoextraction and choledochoscopy.&#x0D; Materials and methods. A total of 47 patients, including 16 (34%) men and 31 (66%) women with difficult choledocholithiasis, were enrolled in the study and received treatment at our centre. All patients were operated on using laparoscopic choledocholithoextraction combined with choledochoscopy. Thereafter, the results of treatment were analysed for the cohort of patients. In the study, we identified the causes of difficult choledocholithiasis and evaluated the achievement of complete bile duct clearance, the surgery duration, total and postoperative bed days, complications, and mortality.&#x0D; Results. All patients underwent laparoscopic choledocholithoextraction combined with choledochoscopy. The causes of difficult choledocholithiasis were as follows: characteristics of bile duct stones — 27 (57.4%), altered anatomy of the organs of the hepatopancreatobiliary zone — 11 (23.6%), specific location of bile duct stones — 9 (19.1%). After laparoscopic choledocholitoextraction combined with choledochoscopy, complete bile duct clearance was achieved in 95.7% of cases. The average duration of the operation was 130.0±14.7 min. The length of hospital stay after surgery was, on average, 14.3±1.7 days. 4 (8.5%) patients had complications corresponding to classes II (2 (4.2%)) and III (2 (4.2%)) according to the standardized Clavien‑Dindo classification (2009).&#x0D; Conclusions. Laparoscopic choledocholithoextraction combined with choledochoscopy can be used as one of the technologies for the treatment of difficult choledocholithiasis.&#x0D;

Personalized dosing protocol for extended-release tacrolimus in kidney transplant recipients in the early postoperative period

Objective: to develop a personalized algorithm for extended-release tacrolimus in kidney recipients and to analyze its early outcomes in comparison with a retrospective control group.Materials and methods. The first (I) control group «Standard Protocol» included 228 patients operated on at Botkin City Clinical Hospital from June 2018 to November 2021; tacrolimus was administered postoperatively in a starting standard dosage of 0.2 mg/kg. The second group (II) consisted of 75 patients operated from December 2021 to November 2022, whose postoperative treatment involved a personalized extended-release tacrolimus dosing protocol. Induction immunosuppression was similar in both groups. The target tacrolimus level in the early postoperative period was considered to be 10-12 ng/ml for all patients. The comparison criteria included incidence of Over-immunosuppression (tacrolimus C0 &gt;15 ng/ml), incidence of acute rejection and infectious complications in the first month after surgery, incidence and duration of delayed graft function (DGF), and length of stay at the hospital.Results. Over-immunosuppression was statistically significantly lower in the personalized protocol group, with 36.7% in group I and 87.5% in group II (p &lt; 0.001). There was also a lower incidence of early infectious complications in group II: 5.4% vs. 13.2%, however, without reaching a level of statistical significance (p = 0.088). DGF incidence in group I and group II were 25.4% (58/228) and 22.7% (17/75), respectively. The length of stay at the hospital in group II was also statistically significantly lower: 13 versus 19 bed days (p = 0.033). In both subgroups, no patient developed acute rejection in the first month after surgery (p = 1).Conclusion. The personalized dosing protocol that was developed for extended-release tacrolimus in kidney recipients achieves the target levels of the drug recommended for the early postoperative period with low risk of under-immunosuppression and associated acute graft rejection, with a significantly lower incidence of over-immunosuppression.

The comparison of femoral neck system and cancellous screws internal fixation for femoral neck fracture

ABSTRACT Background The clinical efficacy of cancellous screws (CS) and femoral neck system (FNS) internal fixation in the treatment of femoral neck fracture (FNF) was compared in this research. Methods Ninety-six patients with FNF were enrolled in this study. There were 47 cases in FNS group and 49 cases in CS group. The data of operation time, intraoperative bleeding, bed days and complication were recorded. Patients’ joint function was evaluated by Harris score. At the last follow-up, the cost-effectiveness analysis of the two methods was analyzed according to the total cost of patients and hip function. Results The intraoperative blood loss of the patients in FNS group was significantly higher than that in the CS group, but the length of hospitalization was significantly lower. There was no significant difference in the incidence of complications between FNS and CS. The joint function of FNS group was significantly better than that of CS group at 3 months after operation. There was no significant difference in Harris score between the two groups at the last follow-up. The overall medical cost of FNS group in 1 year is high. Cost-effectiveness analysis showed that compared with CS group, FNS group needs to pay 5761.1 yuan more for each additional Harris score. Conclusion FNS and CS internal fixation can achieve satisfactory clinical results in the treatment of FNF. FNS treatment is helpful to the early functional recovery of patients, but the overall medical cost is high.

Rapid Decrease in Fluoroquinolones Consumption following Implementation of a Simple Antimicrobial Stewardship Bundled Intervention in a University Hospital during the COVID-19 Pandemic.

Fluoroquinolones (FQs) represent an class of antibiotics of medical importance, but their use has been restricted due to their ecologic impact and associated side effects. The reduction of FQs use is an important goal of antimicrobial stewardship programs (ASP). This work describes an ASP focused on overall antibiotics and FQs consumption reduction. From January 2021, an ASP was implemented in a 700-bed teaching hospital. The ASP was based on: (i) antibiotics consumption monitoring system (DDD/100 bed days); (ii) mandatory antibiotic prescription-motivation (using a dedicated informatic format) with the goal of >75% of motivated prescriptions; and (iii) data feedback and training on FQs use indications. We evaluated the impact of the intervention on overall systemic antibiotics and FQs consumption according to the objectives posed by Italian PNCAR (National Action Plan on Antimicrobial Resistance). A decrease of 6.6% in antibiotic use was observed (2019 vs. 2021). Notably, the FQs consumption fell by 48.3% from 7.1 DDD/100 bd in 2019 to 3.7 DDD/100 bd in 2021 (p < 0.001). After six months of mandatory antibiotic prescription-indication, all units achieved the target set. The study suggests that a simple, bundled ASP intervention can be rapidly effective obtaining the objectives of PNCAR on the reduction of overall antibiotics and FQs consumption.

5613396 DIFFERENCE IN HOSPITALIZATIONS AND ANNUAL BED DAYS FOR PATIENTS WITH SICKLE CELL DISEASE BY VARYING LEVELS OF ANEMIA: A RETROSPECTIVE ANALYSIS OF LINKED PRIMARY AND SECONDARY CARE DATABASES IN ENGLAND

Background: Sickle cell disease (SCD) is a life-threatening autosomal-recessive disorder in which the sickle variant of hemoglobin (Hb) polymerizes under deoxygenation, causing red blood cell sickling and hemolytic anemia. Anemia in SCD is associated with an increased risk of complications such as leg ulcers and end-organ damage (EOD), which often require hospitalization, a key driver of healthcare costs. Aims: To quantify differences in all-cause hospitalizations and annual bed days in patients with SCD and differing levels of anemia. Methods: We identified 6018 patients with SCD aged ≥12 years with ≥1 recorded Hb level between January 1, 2007, and March 31, 2019, from the Clinical Practice Research Datalink (Aurum version), an English longitudinal primary care electronic medical record, and linked these with Hospital Episode Statistics, a secondary care reimbursement data set. We obtained Hb levels from primary care records, when disease is expected to be relatively stable, as opposed to during hospitalization. We used Hb measurements separated by <30 days to calculate mean Hb for a time interval at a specific Hb level. Patients were grouped into Hb categories based on having ≥1 Hb record of <6 g/dL (severe anemia), 6 to <8 g/dL, 8 to 10.5 g/dL, or >10.5 g/dL; patient Hb category may have changed over the course of the study. Patient Hb intervals began with Hb in a category and ended on the day before a blood transfusion, with a Hb reading in a new category, or on the last activity date. We compared the significance of the categorical data distribution for hospitalizations using the Kruskal–Wallis test across Hb categories, extended with pairwise Wilcoxon rank sum testing. We repeated the above for hospitalizations due to any EOD and annual bed days. Results: Of 6018 patients with recorded Hb, 72% had a history of Hb >10.5 g/dL, 44% had 8 to 10.5 g/dL, 15% had 6 to 8 g/dL, and 3% had <6 g/dL. The annual rate of all-cause hospitalizations decreased as Hb increased: 5.84 in patients with Hb <6 g/dL, 4.13 for 6 to 8 g/dL, 3.3 for 8 to 10.5 g/dL, and 1.7 for >10.5 g/dL. Hospitalizations were significantly lower for patients with a history of Hb >10.5 g/dL than for those with Hb <6 g/dL (P<0.001); across Hb categories, the distribution of all-cause hospitalization was significant (P<0.001). Annual all-cause bed days decreased across increasing Hb categories, with a mean of 8.8 days in patients with a history of Hb <6 g/dL, 7.7 days with 6 to 8 g/dL, 5.8 days with 8 to 10.5 g/dL, and 3.2 days with >10.5 g/dL. A significant decrease in annual bed days was observed in patients with a history of Hb >10.5 g/dL compared with Hb <6 g/dL (P<0.001). Across Hb categories, the distribution of the difference in bed days was significant (P<0.001) (Figure).A total of 385 patients (6.4%) had ≥1 hospitalization for any EOD. Significantly fewer hospitalizations were attributable to any EOD in patients with a history of Hb >10.5 g/dL compared with those with a history of Hb <6 g/dL (0.36 and 2.4 hospitalizations per patient interval per year, respectively; P<0.001). Summary/Conclusion: All-cause hospitalizations and annual bed days were progressively reduced in patients with a history of higher Hb levels whereas patients with severe anemia did not experience the same benefit. Due to this tendency, appropriate measures should be taken to maximize Hb in patients with SCD. Reference 1. Kato GJ, Piel FB, Reid CD, et al. Sickle cell disease. Nat Rev Dis Primers. 2018;4:18010.

A single centre experience of prosthetic joint infection outcomes with outpatient parenteral antimicrobial therapy

ObjectivesProsthetic joint infection (PJI) is a serious complication following arthroplasties. This study assessed the clinical outcomes, readmission rates and financial impact of PJIs treated with outpatient parenteral antimicrobial therapy (OPAT). MethodsThe study used prospectively collected data from the OPAT patient database at a tertiary care Irish hospital for PJI cases managed between 2015 and 2020. Data was analyzed using IBM-SPSS. ResultsForty-one patients with PJIs were managed via OPAT over five years, with median age of 71.6 years. Median duration of OPAT was 32 days. Hospital readmission occurred in 34% of cases. Reasons for readmission included progression of infection in 64.3%, unplanned reoperation in 21.4% and planned admission for joint revision in 14.3%. Type 2 Diabetes Mellitus (T2DM) was found to have a statistically significant association with unplanned readmission (OR 8.5, CI 95% 1.1–67.6; p < 0.01). OPAT saved a mean of 27.49 hospital-bed days per patient. 1,127 bed days were saved in total, estimating a total savings of 963,585 euros and median savings of 26,505 euros. ConclusionsThe readmission rate observed was comparable to international data. Most readmissions were related to primary infections rather than due to OPAT-specific complications. Our main findings were that patients with PJIs can be safely managed via OPAT, and the finding of association between T2DM and increased risk of readmission.

Paediatric harmful adverse drug events (PHADE).

It is well established that adverse drug events are frequent in paediatric hospital practice. The objective of this study is to systematically quantify and report the incidence of harmful adverse drug events across our institution and to identify predominant medications and error types. We prospectively compiled a validated medication safety database for paediatric inpatients within our institution over a three-and-a-half-year period. All incidences of apparent patient harm relating to medication error were investigated and analyzed to determine veracity, severity of harm, phase of medication process, error type, causative medication, and contributory factors enabling each event. We identified 59 harmful adverse drug events, with an overall rate of 15.5 per 105 patient bed days. Most events occurred during administration (n = 27) and prescribing (n = 26) phases. Almost half of all harm (49%) was associated with opioids; a broad range of medication classes accounted for other harm. Harmful events occurred in 7.3 per 105 administrations of morphine and 13.3 per 105 administrations of hydromorphone. Wrong dose was the most frequently encountered error type. This is the first study to quantify harmful adverse drug events in paediatric hospital practice. Our prospective analysis and compilation of harmful medication errors in paediatric hospital practice, reported with denominators of opioid administrations, and patient bed days, is a new standard for comparison in the long-discussed problem of paediatric harmful adverse drug events. By focusing on identified problematic drugs, error types, and contributory factors, we identify opportunities for interventions, error prevention and harm reduction.