Bed Days Research Articles

P1215 Hospital utilisation for ulcerative colitis in Australia, 1993–2022: a review of observational separation data

Abstract Background The prevalence of ulcerative colitis (UC) is compounding in Western nations, including in the Australasia region1. Mortality has fallen over the last 7 decades since the introduction of intravenous corticosteroids, but despite newer therapies, colectomy rates have not improved2, 3. UC is a chronic, relapsing and remitting condition, and flares lead to hospitalisations and significant costs4. In the era of advanced IBD therapies, understanding trends in admissions will guide cost management strategies. We aimed to assess hospital utilisation trends for UC in Australia between 1993-94 and 2021-22. Methods We obtained resident population figures from the Australian Bureau of Statistics and hospital data for the financial years 1993-94 and 2021-22 from the Australian Institute of Health and Welfare’s National Hospital Morbidity Database. We calculated the rate of hospital separations due to UC (ICD-10 code K51) per 100,000 residents, mean length of stay, and bed utilisation rate for UC admissions. The advent of biologics between 1993-94 and 2021-22 led to an increase in hospital separations and bed days, as each visit to an infusion unit is treated as a separate same-day hospital separation with a uniform length of stay of 1 day. Therefore, we also assessed the separation rate, mean length of stay, and bed utilisation rate for non-same-day separations (i.e., overnight or multi-day stays) to better reflect trends in acute UC flares requiring emergency treatment. Results Total hospital separations for UC grew by 841.1%, from 5,148 in 1993-94, to 48,447 in 2021-22; total patient days increased by 286.1%, from 18,396 to 71,034. Same-day admissions rose 1160.7%, from 3,499 to 44,111. Non-same-day hospitalisations grew by 163.0%, from 1,649 to 4,336, and total days in hospital for these multi-day stays grew by 80.7%, from 14,897 to 26,923. The rate of non-same-day hospitalisation increased by 80.0%, from 9.3 to 16.7 per 100,000 people. Mean length of stay for non-same-day admissions decreased by 31.2%, from 9.0 days to 6.2 days per stay. The bed utilisation rate for UC non-same-day admissions per 100,000 increased by 23.7% from 83.7 to 103.5 per 100,000 people. Conclusion Infusion unit visits for new biologics have driven a massive rise in same-day hospital separations with a primary diagnosis of UC. Despite treatment advances, the rate of non-same-day hospitalisations for UC has also grown, though more modestly, and although mean length of stay has shortened, overall bed utilisation rates due to non-same-day UC admissions have increased. These trends appear to reflect the increasing prevalence of UC in Australia, and healthcare cost modelling must factor this in going forward.

P0769 Impact of Nurse-Led Day Case Management of Acute Inflammatory Bowel Disease Flares on Admissions to Hospital

Abstract Background To assess the impact on admissions to hospital when patients are treated on a nurse led day case unit for inflammatory bowel disease flares over a 1-year period. Methods During the COVID 19 pandemic, patients were reluctant to be admitted to hospital and where possible wanted care as day case patients. This has continued due to the pressures of the acute gastroenterology hospital ward and demand for bed spaces. The Gastroenterology and Medical Ambulatory Care Unit allowed for rapid assessment, diagnosis, and treatment with appropriate safety netting for this group of patients. 63 patients where identified. Those who needed admission were advised to do so based on presenting symptoms and response to treatment. Data Collection and Results 63 patients presented to the Unit with a pre-existing diagnosis of IBD, 88% (n=55) where Ulcerative Colitis and 12% (n=8) Crohns Disease and had failed to suppress the flare with oral steroid and topical therapies. Symptoms varied from loose stools, urgency, bleeding, pain, lethargic and dehydration, common signs of an IBD flare, (Sturm and White 2019). Patients were offered admission, however all wanted to be treated as a day case on the proviso that if needed admission would be arranged. The aim was to give the same initial flare treatment as would be received on the ward. Hydrocortisone 200mg IV am followed by 500mls of IV fluids and a further Hydrocortisone 200mg IV in the pm. Patients were also supported by the team on the Unit during their flare allowing perspective to be placed on their disease and management as a whole. Open dialogue was held with the Unit and IBD nursing teams further enhancing patient care. Bloods and faecal calprotectin were checked as a baseline for our interventions. Results Of the 63 only 9.5% (n=6) did not respond and needed admission. Conclusion: Outcome and Recommendations Overall patients were happy with and responded to treatment in the day case unit. This saved at least 171 bed days in hospital based on a minimum of 3 days per patient treated. Being able to access support as well as treatment worked well. Day case assessment treatment and care has a clear future for this group of patients providing patients are selected appropriately. References Sturm A and White L (2019) Inflammatory Bowel Disease Nursing Manual. Springer

Carbapenemase-Producing Enterobacterales: An Increasing Threat to Australian Liver Transplant Recipients.

Carbapenemase-producing Enterobacterales (CPE) are associated with increased morbidity and mortality in liver transplant recipients (LTRs). There is a paucity of data regarding CPE colonization and infection in Australian LTRs. A single-center retrospective cohort study of CPE was performed in LTRs from 2015 to 2024. LTRs underwent targeted screening and a period of enhanced screening to evaluate the incidence of CPE colonization. CPE infections were identified via clinical samples. All CPE isolates underwent whole genome sequencing. CPE isolation rates in LTRs were compared to the general hospital population and trends over time were analyzed. There were 31 episodes of CPE isolation (5 community acquired, 26 healthcare associated) from 28 LTRs. Nine episodes of CPE infection were found: urinary tract (n = 3), bloodstream (n = 3), wound/abscess (n = 2), and Salmonella gastroenteritis (n = 1). The remaining 22 episodes represented new CPE colonization. CPE Klebsiella pneumoniae was the most common bacterial species (n = 12) with the New Delhi metallo-β-lactamase (n = 13), the most common CPE gene detected. CPE isolation rates in LTRs increased over the study period (p = 0.06). The overall rate of CPE infection was significantly higher in LTRs than the general hospital population (1.92vs. 0.30 per 10 000 occupied bed days, p = 0.04). Enhanced CPE screening identified an additional eight episodes of CPE colonization in 415 patients screened (1.9%). CPE is an emerging threat for Australian LTRs and there is an urgent need to optimize strategies to prevent CPE colonization and infection in LTRs.

Cost-effectiveness of anti-viral treatment for infants with RSV disease in the United Kingdom.

Respiratory Syncytial Virus (RSV) is a common cause of hospitalisation in infants worldwide, causing significant morbidity and mortality. Recently, the antiviral treatment, Ziresovir, has shown promising results in a Phase III trial conducted on infants hospitalised with RSV. Based on these topline results, this study aims to investigate the cost-effectiveness of Ziresovir in the United Kingdom (UK). The cost-effective analysis (CEA) uses a proportional outcomes model using data from topline reports by the AIRFLO trial and published data to explore the effect of Ziresovir administration on hospitalised infants aged <24months at admission. We estimated the reduction in ICU bed days and deaths and the maximum cost-effective price (MCEP) per treated individual, assuming a threshold of £20,000 per Quality-adjusted Life Year (QALY) gained. Administering Ziresovir to all hospitalised infants averts four deaths (range: 2.8-4.5), 216 ICU admissions (range:160-260) and 3169 ICU bed-days (range: 2348-3804) per annum, the MCEP for Ziresovir per hospitalised infant is £429.65 (95% CrI: £236-£771). If preterm infants are targeted, then the MCEP increases to £2108.38 (95% Crl: £870-£3540). The MCEP for exclusively treating Infants with Chronic Lung Disease (CLD) and Congenital Heart Disease (CHD) is £6557.24 (95% Crl: £1250 - £14,920) and £9459.44 (95% Crl £3350-£20,300) respectively. The model is highly sensitive to changes in the efficacy of Ziresovir and the risk of ICU admission and mortality. Ziresovir is a cost-effective intervention for all infants hospitalised with RSV if priced below £430 per dose and strategies that exclusively treat high-risk- with CLD and CHD infants justify a higher price of £6558 and £9460 respectively. The outcomes are highly sensitive to the efficacy of Ziresovir and can be improved when the full results of the AIRFLO trial are available.

АНАЛИЗ ОБЪЕМА ПОТРЕБЛЕНИЯ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ ПРИ ЛЕЧЕНИИ ЭПИЛЕПСИИ В СТАЦИОНАРЕ

The article presents the results of the study of the volume of consumption of medicinal drugs for the treatment of patients diagnosed with epilepsy. As a result of retrospective processing of case histories (continuous sampling for 2021-2023) obtained in the inpatient department of the Clinic of Nervous Diseases named after A.Y. Khlebnikov of Sechenov University, the dynamics of drugs consumption from 2021 to 2023 was analyzed. The range of antiepileptic drugs in the clinic in 2022-2023 compared to 2021 was supplemented with such names as: topiramate, oxcarbazepine. Increased consumption of levetiracetam in 2023 compared to 2021 by 4 times. Based on the data obtained, it is obvious that there are no 3rd generation antiepileptic drugs in the assortment. Among other pharmacotherapeutic groups the leading position is occupied by B vitamins, the volume of consumption of these drugs in 2023 amounted to 496.86 NDDD/100 bed days. In addition, a decrease in the consumption of myorelaxants should be noted. The results obtained can be the basis for the development of recommendations to optimize the use of drugs and improve the quality of drug care for patients with epilepsy at the inpatient level.

Hospital-Acquired Complications in Critically Ill Children and PICU Length of Stay, Duration of Respiratory Support, and Economics: Propensity Score Matching in a Single-Center Cohort, 2015-2020.

To identify the health and economic costs of hospital-acquired complications (HACs) in children who require PICU admission. Propensity score matched cohort study analyzing routinely collected medical and costing data collected by the health service over 6 years (2015-2020). Tertiary referral PICU in Queensland, Australia. All children admitted to the PICU were included. None. We assessed ventilator- and respiratory support-free days at 30 days post-PICU admission, length of PICU stay, prevalence of individual HACs, and attributable healthcare costs. A total of 8437 admissions, representing 6054 unique patients were included in the analysis. Median (interquartile range) for cohort age was 2.1 years (0.4-7.7 yr), 56% were male. Healthcare-associated infections contributed the largest proportion of HACs (incidence rate per 100 bed days, 46.5; 95% CI, 29.5-47.9). In the propensity score matched analyses (total 3852; 1306 HAC and 1371 no HAC), HAC events were associated with reduced ventilator- (adjusted subhazard ratio [aSHR], 0.88 [95% CI, 0.82-0.94]) and respiratory support-free days (aSHR, 0.74 [95% CI, 0.69-0.79]) and increased PICU length of stay (aSHR, 0.63 [95% CI, 0.58-0.68]). Healthcare costs for children who developed a HAC were higher compared with children with no HAC, with mean additional cost ranging from Australian dollar (A$) 77,825 (one HAC [95% CI, $57,501-98,150]) to $310,877 (≥ 4 HACs [95% CI, $214,572-407,181]; in 2022, the average conversion of A$ to U.S. dollar was 0.74). In our PICU (2015-2020), the burden of HAC for critically ill children was highest for healthcare-associated infections. Further high-quality evidence regarding HAC prevention and prospective risk assessment could lead to improved patient outcomes and reduced costs.

Modern Views on the Treatment of Hemorrhoid Disease Complicated by Post Hemorrhagic Anemia

Research purpose: to improve the surgical treatment results of patients with bleeding hemorrhoids complicated by posthemorrhagic anemia through the development of rational methods of surgical treatment. Patients and methods: A method of operation by first ligating blood vessels to the internal hemorrhoids without any instruments with simultaneous removal of external hemorrhoids has been developed. Research design: The study included 56 patients operated on for chronic bleeding hemorrhoids complicated with posthemorrhagic anemia from 2018 to 2022. All patients underwent a method to ligate blood vessels to internal hemorrhoids without any instruments along with simultaneous removal of external hemorrhoids. In the postoperative period in these patients, the pain syndrome was less pronounced, the patients behaved relatively actively, reflex urinary retention was not noted, postoperative bleeding and postoperative stricture of the anal canal were not observed, the patients were in the hospital for an average of 11.08 hospital days, and closed hemorrhoidectomy was 16.09 bed days. Findings: The operation is low-cost; there is no need for expensive high-tech equipment; it is effective for all stages of hemorrhoids; the surgical field is wide; visibility is unlimited; the operation is performed by all proctologists without special training. Low trauma; there is no open wound in the anal canal, i.e., “X”-shaped and interrupted sutures are applied for transanal hemorrhoidal ligation of blood vessels to internal hemorrhoids and mucopexy. Conclusion: short recovery period, low intensity of postoperative pain, absence of postoperative urinary retention, postoperative bleeding, and anal stricture.

LAPAROSCOPIC ROBOT-ASSISTED PROSTATECTOMY IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

ANNOTATION. The article presents a review of the literature over the past 15 years regarding the surgical treatment of patients with benign prostatic hyperplasia. It was established that during this period of time, new surgical methods of treating benign prostatic hyperplasia appeared in the arsenal of urologists, namely: laparoscopic and robot-assisted prostatectomy (including single-port). These minimally invasive operations dramatically reduced the percentage of open prostatectomies by reducing the number of intraand postoperative complications, reoperations, postoperative bed days, and wound pain. Laparoscopic robot-assisted prostatectomy, when compared with laparoscopic prostatectomy, allows for better visualization of the operative field, greater volume and accuracy of instrument movements in hard-to-reach areas, less intraoperative blood loss and postoperative bed-day. The authors presented the methods and results of laparoscopic robot-assisted prostatectomy according to the literature in patients with benign prostatic hyperplasia. The introduction of robot-assisted prostatectomy will improve the results of treatment of patients with benign prostatic hyperplasia in Ukraine.

Changes in emergency healthcare use following intervention by Navigator, an emergency department social support programme: a multi-centre retrospective before-and-after study.

Patients living with social deprivation, and those with experiences of violence, substance misuse, mental ill-health and homelessness are known to use emergency departments (EDs) more often. It is not known whether a programme of social support initiated during ED attendance may lead to a reduction in healthcare use. The objective of this study is to determine the change in emergency, inpatient and outpatient healthcare use following a social support programme, Navigator, initiated during an ED attendance. Retrospective before-and-after study. Adult patients ≥16 years, attending EDs in the West of Scotland from 14th September 2016 to 10th March 2023, with a Navigator programme encounter. The Navigator social support programme, delivered by trained support workers, initiated during ED attendance, and targeting patients affected by issues including violence, substance misuse, mental ill-health, domestic abuse and homelessness. Healthcare use rates in the 365 days following intervention, as change compared to those in the 365 days prior to the intervention. The primary outcome was the number of ED attendances in the year following intervention compared with the year prior to intervention. Secondary outcomes included inpatient admissions, inpatient bed days, outpatient appointments and outpatient appointments where the patient did not attend. Changes in use rates were analysed with negative binomial regression and reported as incidence rate ratios for interpretation as percentage change. Analysis was repeated for a subgroup of frequent attenders to the ED. Of 1421 Navigator programme encounters, 1056 were included for analysis. Median attendance in the year prior to intervention was 3 [interquartile range (IQR) 1-5], and in the year following intervention was 2 (IQR 0-4). Negative binomial regression demonstrated that in the year following Navigator intervention, there was a 29% (95% confidence interval: 24-33%) reduction in ED attendances. The Navigator programme was associated with reduced emergency and acute healthcare use in the year following intervention, with increased scheduled outpatient care. There is the potential for a social support programme, delivered from the ED, to change patterns of healthcare use, and future work should consider prospectively assessing the impact of such an intervention.

The potential for reducing greenhouse gas emissions through disease prevention: a secondary analysis of data from the CREDENCE trial.

The health-care sector is responsible for 5·2% of global emissions, however, little data exist regarding the environmental impact of disease management strategies. SGLT2 inhibitors are now widely used to reduce the risk of hospital admission and kidney failure in people with type 2 diabetes and chronic kidney disease. This study aimed to estimate the impact of SGLT2 inhibitors on greenhouse gas emissions using data from the CREDENCE trial. For this modelling analysis, we used data from the randomised, double-blind, placebo-controlled, CREDENCE trial, which compared the effect of canagliflozin versus placebo on kidney and cardiovascular outcomes in patients with type 2 diabetes and albuminuric chronic kidney disease. For this secondary analysis, we included all participants randomly assigned to canagliflozin or placebo at baseline in the CREDENCE trial. Data on greenhouse gas emissions resulting from hospital inpatient days, maintenance dialysis therapy, and SGLT2 inhibitor tablet production were derived from published reports and used to model greenhouse gas emissions from total number of hospital inpatient days, total number of days of maintenance dialysis therapy, and from SGLT2 inhibitor treatment over the course of the CREDENCE trial. We compared greenhouse gas emission estimates for participants in the canagliflozin group and placebo group of the CREDENCE trial. We used bootstrapping analyses to calculate uncertainty estimates and permutation tests to generate p values for the difference in number of days on dialysis and inpatient bed days between treatment groups. 4401 participants who were randomly assigned to the canagliflozin (n=2202) or placebo group (n=2199) were included in the secondary analyses. During a median follow-up of 2·62 years (IQR 0·02 to 4·53), SGLT2 inhibitor production for 2202 participants resulted in greenhouse gas emissions of 63 tonnes of CO2 equivalent (CO2e; 95% CI 62 to 64). The total number of inpatient bed days was 17 002 days in the placebo group versus 13 672 days in the canagliflozin group; the 3330 fewer inpatient days (95% CI 1037 to 5686; p=0·042) with SGLT2 inhibitor treatment equated to a reduction of approximately 126 tonnes of CO2e (95% CI 39 to 216). Participants in the placebo group required 24 877 days of maintenance dialysis compared with 16 605 days in the treatment group; 8272 fewer days of dialysis ( -168 to 16 755; p=0·16), equated to a reduction of 161 tonnes of CO2e (-3 to 327). Overall, mean greenhouse gas emissions per-participant-year were reduced from 196 kg of CO2e per-participant-year to 157 kg of CO2e per-participant-year. The addition of an SGLT2 inhibitor to routine therapy for people with type 2 diabetes and chronic kidney disease has the potential to reduce greenhouse gas emissions through the prevention of hospital admissions and need for dialysis. None.

Falls prevention in an older adult mental health ward through a quality improvement initiative

Falls in the inpatient units are the most frequently reported patient safety incidents and their consequences can be devastating. Risk factors for falls are broadly categorised into two factors—‘extrinsic and...

Pharmacoepidemiology of antibacterials use for nosocomial infections

Introduction. Antibacterial resistance of nosocomial infectious agents is a serious problem. It makes a choice of therapy complicated and worsens the prognosis of the disease significantly. Purpose of the study. The purpose of the study was the pharmacoepidemiological analysis of antibacterial use as a treatment for infections caused by multidrug-resistant pathogens. Material and methods. A retrospective study of medical records was conducted for hospitalized patients at the State Budgetary Institution “City Clinical Hospital named after S.S. Yudin DZM” in 2019–2021. Antibacterial therapy in hospital settings against pathogens of the ESKAPE group was analyzed and the resistance of the detected pathogens was determined. Results. 226 confirmed clinical cases of infection were analyzed. Results of 1422 microbiological studies were studied to determine the resistance of the detected pathogens. The structure of 562 prescriptions of drugs of the group J01 “Antibacterial drugs for systemic use” was studied. In 2020 the total volume of consumption of systemic antibacterials amounted for 85594 DDD. The DU-90% segment by the number of DDDs made up five drugs – meropenem, polymyxin B, tigecycline, amikacin and ampicillin/sulbactam. The intensity of drug consumption was also expressed in DDD/100 bed days. The most prescribed empirically systemic antibiotics for infections treatment have become the group of β-lactam drugs in combination with β-lactamase inhibitors and carbapenems. Tigecycline, polymyxin B and carbapenems are the main drugs for targeted treatment of nosocomial infections at the multidisciplinary hospital of the State Budgetary Institution “City Clinical Hospital named after S.S. Yudin DZM”.

Looking after patients with hip fracture in low- and middle-income countries.

In the UK, multidisciplinary teamwork for patients with hip fracture has been shown to reduce mortality and improves health-related quality of life for patients, while also reducing hospital bed days and associated healthcare costs. However, despite rapidly increasing numbers of fragility fractures, multidisciplinary shared care is rare in low- and middle-income countries around the world. The HIPCARE trial will test the introduction of multidisciplinary care pathways in five low- and middle-income countries in South and Southeast Asia, with the aim to improve patients' quality of life and reduce healthcare costs.

Rapid antibiotic susceptibility testing for urinary tract infections in secondary care in England: a cost-effectiveness analysis

ObjectivesTo perform a model-based cost-effectiveness evaluation of a rapid antimicrobial susceptibility test.DesignA Markov model of a cohort of hospital inpatients with urinary tract infection (with inpatient numbers based on national...

Are virtual wards for children safe and effective? A 3-year retrospective service evaluation of an urban Hospital at Home service for children and young people

ObjectiveService evaluation of an urban ‘Hospital at Home’ service which provides care in patients’ homes that would traditionally be delivered in the hospital setting.DesignRetrospective longitudinal review of routinely collected data...

Laparoscopic access is the modern standard for extended liver resection

Objective. To evaluate the safety and early results of laparoscopic extended liver resection in case of focal liver pathology by retrospective comparison with the relevant parameters of a similar open intervention. Materials and methods. The study involved 162 patients who were divided into two groups: Group 1 – 50 patients who underwent laparoscopic extended liver resection, and Group 2 – 112 patients who underwent open extended liver resection. The groups were compared by age structure, sex, body mass index, type of pathology (benign/malignant), as well as by characteristics of surgical intervention and postoperative period. Statistical analysis included a t–test for independent samples, Pearson's chi–square test, and other appropriate methods with the calculation of the confidence level p (parametric criterion). The difference in indicators was considered statistically significant at p &lt; 0.05. Results. Laparoscopic osshire for liver resection was longer (p = 0.0012), but was associated with a lower level of pain according to the visual analog scale (p = 0.02) and fewer bed days to discharge (p = 0.0007) than a similar open intervention. There was no statistically significant difference between the groups in terms of age structure, body mass index, number of liver tumors, blood loss, complication rate, and degree of ischemic liver damage. Conclusions. Laparoscopic extended liver resection is a less invasive method than open liver resection, and patients recover faster after it, although its duration is longer. At the same time, laparoscopic and open intervention had a similar incidence of complications, which indicates acceptable safety and high clinical efficacy of the laparoscopic approach in the treatment of patients with liver disease.

Clinical Benefits of Sustained Oral Nirmatrelvir/Ritonavir Use for the Outpatient Treatment of COVID-19: Findings from the Taiwanese Health Authority Perspective Using a Decision Tree Modeling Approach.

Despite the observed clinical benefits of nirmatrelvir/ritonavir (NMV/r), it is uncertain whether Taiwan will continue covering NMV/r for high-risk individuals with mild-to-moderate coronavirus disease 2019 (COVID-19). This analysis assessed the impact of sustained utilization of NMV/r on COVID-19-associated healthcare resource utilization (HCRU) and mortality from the Taiwanese health authority perspective (THAP). A decision tree model estimated the incremental number of clinical events associated with NMV/r utilization over a 30-day period. Model results compared (1) a base case using current rates of NMV/r from the THAP, and (2) a hypothetical scenario assuming the current supply of NMV/r is not extended in Taiwan. NMV/r utilization rates included 80% and 0% in the base case and hypothetical scenario, respectively. Outcomes included the number of hospitalizations involving a general ward (GW) stay, intensive care unit (ICU) stay, and mechanical ventilation (MV) use, as well as the number of bed days, symptom days, and hospitalization deaths. Based on epidemiologic data, 150,255 patients with COVID-19 were eligible for treatment from the THAP. In the hypothetical scenario, HCRU increased by 175% compared to the base case, including increases in hospitalizations involving GW, ICU, and MV use (differences: 2067; 623; 591, respectively), bed days (difference: 51,521), symptom days (difference: 51,714), and deaths (difference: 480). Findings indicate that sustained utilization of NMV/r from the THAP reduces the clinical burden of mild-to-moderate COVID-19 through the reduced incidence of COVID-19-related HCRU and deaths.

Cost-effectiveness of using granulocyte colony-stimulating factor in the treatment of uterine body leiomyosarcomas. A retrospective analysis

Background. The main approach in the treatment of patients with uterine leiomyosarcoma is surgery followed by chemotherapy, which is the basis of treatment. Febrile neutropenia (FN) is a life-threatening condition, so the use of granulocyte colony-stimulating factor (G-CSF) after each cycle of chemotherapy in this category of patients remains an integral part. Aim. To evaluate the pharmacoeconomic efficacy of the use of short and long-acting G-CSF forms in a round-the-clock inpatient facility (RIF). Materials and methods. A retrospective analysis of economic expenditures was performed at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in the RIF setting for the period from January 2018 to December 2023 for the treatment of 62 patients with high-grade uterine leiomyosarcomas of stage IB–IVA according to the classification of the International Federation of Gynecology and Obstetrics (2009). All patients underwent surgical treatment, complete hysterectomy with appendages, followed by antitumor drug therapy with a high risk of FN. In the economic cost analysis, the treatment regimens gemcitabine 900 mg/m2 on day 1 and day 8 + docetaxel 100 mg/m2 + empegfilgrastim (regimen code sh1207.1) and gemcitabine 900 mg/m2 on day 1 and day 8 + docetaxel 100 mg/m2 + filgrastim (regimen code sh1070) were compared. The costs of clinical blood tests and staying in RIF were also considered. Results. The stay in the RIF was 9 bed days with a long-acting G-CSF regimen and 15 days with a short-acting G-CSF regimen. When using a treatment regimen with filgrastim in 6 patients, the number of bed days increased to 18 due to persistent neutropenia. No FN events were reported. The calculations consisted of the cost of a bed day in the RIF (1,660 rubles) and purchasing of short- and long-acting G-CSF, without the cost of the main therapy. The costs of treating patients with short-acting G-CSF were comparable to those with long-acting G-CSF. Conclusion. The regimen with long-acting G-CSF is effective, easy to use, and cost-effective in RIF settings.

Improved use of antibiotics following implementation of antimicrobial stewardship in a neonatal intensive care unit.

Inappropriate antibiotic use in infants can have multiple adverse effects and contribute to the development of bacteria resistant to antimicrobials. Antimicrobial stewardship programs can reduce unnecessary antibiotic use in children. The aim of this study was to evaluate the effect of an antimicrobial stewardship program implemented in 2017 in the Neonatal Intensive Care Unit (NICU) at The Children's Hospital Iceland. The study included all infants who were admitted to the NICU during the study period (January 1st 2012-October 31st 2020). Data was collected from hospital records. Three periods were defined: preimplementation (2012-2014), peri-implementation (2015-2016) and postimplementation (2017-October 2020). Antibiotic use was quantified using days of therapy (DOT) per 1000 bed days (BD). For statistical analysis the pre- and postimplementation periods were compared. Antibiotics were administered in 38.6% (1372) of admissions to the NICU during the study period. Antimicrobial use per year decreased from 584.6 to 317.1 DOT/1000 BD per year (P < 0.001). Use of broad-spectrum antibiotics decreased significantly. The average number of BD per month decreased from 297.8 to 220.9 BD/month (P = 0.0096). There were no significant changes in the length of stay for each infant or the proportion of readmissions or retreatment. Increased awareness of appropriate use of antimicrobials in the NICU led to shorter treatments and less use of broad-spectrum antibiotics. No increase in adverse effects such as readmissions or retreatment was observed.

Effects of a Virtual Trauma Clinic on admissions and length of stay for minor to moderate trauma.

To investigate the feasibility of a Virtual Trauma Clinic (VTC) for patients with minor to moderate trauma, and evaluate patient satisfaction and outcomes. One hundred VTC patients were matched 1:1 with historical patients from the hospital trauma registry who received conventional care. Matching was based on age ± 5 years, sex, mechanism of injury, Injury Severity Score ± 2, trauma team activation and day of week of presentation. VTC patients were sent surveys on experience and outcome measures. VTC was associated with reduced average hospital length of stay for admitted patients by 1.81 days (95% CI = -2.82, -0.79; P = 0.001) and reduced hospital admissions (odds ratio 0.26; 95% CI = 0.14, 0.48; P < 0.001). There was an avoidance of 199 inpatient bed days in total, with no trauma-related readmissions within 30 days post-hospital discharge. 92% of respondents (n = 22) rated the care they received from VTC as excellent or good. Patient-reported outcome surveys showed overall improvement in functional domains but evidence of ongoing disability, with persistent issues of pain and psychological distress at 1 month post-injury. Patients with minor to moderate trauma have ongoing care needs with high rates of pain, psychological distress and disability remaining prevalent long after discharge. VTC provided an innovative strategy for hospital avoidance with high levels of patient satisfaction and no adverse effects on safety. The overall quality of care for these patients was enhanced through the provision of standardised, patient-centred and multidisciplinary follow-up.