Hospital Days Research Articles

Randomized Trial to Evaluate Effects of Peer- and Clinician-Led Interventions for Caregivers of Individuals With Acquired Brain Injury

ObjectiveTo evaluate the effectiveness of 2 interventions for caregivers of patients with acquired brain injury (ABI) transitioning home after inpatient rehabilitation, to prepare them for the role of caregiving and reduce stress and depression. DesignControlled trial with participants randomly assigned to (1) usual care (UC), (2) clinician-delivered Problem-Solving Training (PST), or (3) peer-led Building Better Caregivers (BBC) training; both experimental interventions initiated during the inpatient rehabilitation stay, delivered virtually, of similar intensity (six 60-minute sessions), and focused on managing stress and building skills related to caregiving. SettingNonprofit rehabilitation hospital specializing in care of persons with acquired brain and spinal cord injuries. ParticipantsCaregivers (n=169) of patients with ABI (54 stroke; 115 other ABI) admitted for rehabilitation whose discharge location was home with care provided by family members (caregivers: 83% women, 62% White, age [mean ± SD]: 51±11.5 y). Participants were recruited from February 2021 to November 2022, when COVID-19 restrictions were in place. InterventionsNoted above. Main Outcome MeasuresCaregiver-reported stress, depressive symptoms, and caregiving self-efficacy; patient unplanned hospital readmissions and emergency department visits 30 days post discharge. ResultsOnly 61% of participants in the 2 intervention groups completed 3 or more of 6 intervention sessions and only 53% completed all data collection surveys. Statistically significant improvements between UC and PST groups were noted for caregiver stress (p=.039). Positive differences in caregiver self-efficacy found between UC and the BBC intervention groups approached significance at 30 days after discharge (p=.054). Patient unplanned hospital readmissions and days hospitalized were also higher, albeit not statistically significant, for UC participants than both intervention groups. ConclusionsAlthough positive findings were noted, results were negatively affected by study limitations including low enrollment and limited engagement (intervention completion and follow-up outcomes assessment). These limitations resulted, in part, from restrictions put into place during the COVID-19 pandemic, which limited contact with study participants and required alterations to the BBC intervention likely influencing its effectiveness. Despite limitations noted, the encouraging findings suggest the need for further research.

Reducing Tracheostomy-Related Acquired Pressure Injury by Flipping the Ventilator Circuit Position Study.

Tracheostomy-related acquired pressure injuries (TRPIs) are one of the hospital-acquired conditions. We hypothesize that an uneven ventilator circuit load, leading to non-neutral tracheostomy tube positioning in the immediate post-tracheostomy period, leads to an increased incidence of TRPIs. Does switching the ventilator circuit load daily, in addition to standard post-tracheostomy care, lead to a decreased incidence of TRPIs? This is a prospective quality improvement study. Study was conducted at two academic hospital sites within tertiary care hospitals at Emory University in different ICUs. Consecutive patients undergoing bedside percutaneous tracheostomy by the interventional pulmonary service were included. The flip the ventilator circuit (FLIC) protocol was designed and implemented in selected ICUs, with other ICUs as controls. Incidence of TRPI in intervention and control group were recorded at post-tracheostomy day 5. A total of 99 patients were included from October 22, 2019, to May 22, 2020. Overall, the total incidence of any TRPI was 23% at post-tracheostomy day 5. Incidence of stage I, stage II, and stages III-IV TRPIs at postoperative day 5 was 11%, 12%, and 0%, respectively. There was a decrease in the rate of skin breakdown in patients following the FLIC protocol when compared with standard of care (13% vs. 36%; p = 0.01). In a multivariable analysis, interventional group had decreased odds of developing TRPI (odds ratio, 0.32; 95% CI, 0.11-0.92; p = 0.03) after adjusting for age, albumin, body mass index, diabetes mellitus, and days in hospital before tracheostomy. The incidence of TRPIs within the first week following percutaneous tracheostomy is high. Switching the side of the ventilator circuit to evenly distribute load, in addition to standard bundled tracheostomy care, may decrease the overall incidence of TRPIs.

Screening indicators to evaluate the clinical significance of drug-drug interactions in polypharmacy among older adults with psychiatric disorders: a delphi study

BackgroundPolypharmacy is common in older adults with psychiatric disorders, but no consensus has reached about the reliable indicators evaluating the benefits and risks of drug-drug interactions (DDIs) in polypharmacy. We aimed to identify indicators suitable for evaluating the clinical significance of DDIs in polypharmacy in older adults with psychiatric disorders.MethodsThe online tools were used to distribute and collect the questionnaires. The Delphi method was applied to analyze experts’ opinions. The degree of authority and coordination of experts were analyzed using the coefficient of variation, coefficient of coordination, expert’s judgment factor, familiarity with the study content factor, and Kendall coordination coefficient. Statistical analysis was conducted using the IBM SPSS® Statistics Package version 26.0.ResultsAfter three rounds of expert consultation, five primary and eleven secondary indicators were identified. The primary “pharmacodynamic indicator” included “severity of adverse drug reactions”, “duration of adverse drug reaction”, “symptom relief”, “time to onset of symptomatic relief”, “number of days in hospital”, and “duration of medication”. The secondary “pharmacokinetic indicator” contained “dosage administered” and “dosing intervals”. The primary “patient tolerance indicator” contained one secondary indicator of “patient tolerability”. The primary indicator “patient adherence” contained one secondary indicator of “patient adherence to medication”. The primary indicator “cost of drug combination” contained one secondary indicator of “readmission”. These indicators were used to determine the clinical significance of DDIs during polypharmacy.ConclusionsThe clinical significance of drug combinations should be taken into account when polypharmacy is used in the elderly. The five primary indicators and eleven secondary indicators might be preferred to evaluate their risks and benefits. Medication management in this population requires a multidisciplinary team, in which nurses play a key role. Future research should focus on how to establish efficient multidisciplinary team workflows and use functional factors to assess DDIs in polypharmacy for psychiatric disorders.

Calcinosis cutis associated with leptospirosis in a 4‐month‐old dog

AbstractCanine leptospirosis is a multisystemic disease that can affect dogs of all ages and lifestyles. This report describes a 4‐month‐old dog diagnosed with acute leptospirosis and treated with dialysis and antibiotic therapy as well as intensive supportive care for 11 days of hospitalisation. About 10 days after discharge, the dog developed cutaneous lesions that were consistent with calcinosis cutis on histopathology. The lesions resolved within 1 month without specific intervention. This report discusses a potential association between calcinosis cutis and leptospirosis infection and highlights a need for early vaccination to protect young dogs.

Analysis of risk factors for weaning failure from mechanical ventilation in critically ill older patients with coronavirus disease 2019

ObjectiveThis study aimed to investigate the factors influencing weaning failure from invasive mechanical ventilation (IMV) in critically ill older patients with coronavirus disease 2019 (COVID-19). MethodsWe enrolled critically ill older patients with COVID-19 who were admitted to the medical intensive care unit (ICU) and received IMV between December 2022 and June 2023. ResultsWe included 68 critically ill older patients with COVID-19 (52 male [76.5 %] and 16 female individuals [23.5 %]). The patients’ median age (interquartile range) was 75.5 (70.3–82.8) years. The median length of ICU stay was 11.5 (7.0–17.8) days; 34 cases (50.0 %) were successfully weaned from IMV. The successfully weaned group had a higher proportion of underlying chronic obstructive pulmonary disease [6 (17.6 %) vs. 0, P = 0.033] and fewer cases of diabetes [7 (20.6 %) vs. 16 (47.1 %), P = 0.021] compared with the weaning failure group. Serum lactate levels [1.5 (1.2–2.3) vs. 2.6 (1.9–3.1) mmol/L, P < 0.001], blood urea nitrogen [8.2 (6.3–14.4) vs. 11.4 (8.0–21.3) mmol/L, P = 0.033], Acute Physiology and Chronic Health Evaluation (APACHE) II score [19.0 (12.0–23.3) vs. 22.5 (16.0–29.3), P = 0.014], and hospitalization days before endotracheal intubation [1.0 (0.0–5.0) vs. 3.0 (0.0–11.0), P = 0.023] were significantly decreased in the successfully weaned group, whereas PaO2/FiO2 [148.3 (94.6–200.3) vs. 101.1 (67.0–165.1), P = 0.038] and blood lymphocyte levels [0.6 (0.4–1.0) vs. 0.5 (0.2–0.6) 109/L, P = 0.048] were significantly increased, compared with the weaning failure group. Multivariate logistic regression analysis showed that diabetes (OR= 3.413, 95 %CI 1.029−11.326), P = 0.045), APACHE II Score (OR = 1.089, 95 % CI 1.008−1.175), P = 0.030), and hospitalization days before endotracheal intubation (OR = 1.137, 95 % CI 1.023−1.264), P = 0.017) were independent risk factors for weaning failure. ConclusionIn critically ill older patients with COVID-19 with diabetes, higher APACHE II Score, and longer hospitalization days before endotracheal intubation, weaning from IMV was more challenging. The study could help develop strategies for improving COVID-19 treatment.

Ambulatory teclistamab administration in patients with relapsed/refractory multiple myeloma.

11146 Background: Teclistamab (Tec) is the first B-Cell Maturation antigen (BCMA)xCD3 bispecific antibody FDA approved for the treatment of relapsed or refractory multiple myeloma (RRMM) in patients who have received ≥4 prior lines of therapy. The phase 1-2 MajesTec-1 study raised concerns for cytokine release syndrome (CRS)/immune effector cell-associated neurotoxicity syndrome (ICANS). 48-hour inpatient observation is recommended for step-up dosing, which imposes financial and logistical burdens. We report our institutional experience with ambulatory Tec administration. Methods: Our inpatient/outpatient (IPOP) hybrid nursing unit is staffed with specialized nurses, advanced practice providers, and attending physicians. Our patients treated in IPOP must live within 1 hour of the hospital and have a 24-hour caregiver. Patients were treated with the recommended step-up dosing schedule. CRS grading and ICE scoring were performed daily. Both CRS and ICANS were graded according to the ASTCT grading systems. We collected toxicities until the second full treatment dose, at which point hospitalization is no longer recommended. Results: In total, 25 patients were treated with Tec between January 2023 to December 2023. The median age was 70 years old (range 59-89), with a median of 6 prior lines of therapy. One patient was dialysis dependent prior to starting Tec. All patients were triple class refractory. Thirteen patients (52%) received prior bone marrow transplant. One (4%) patient received prior anti-BCMA CAR-T therapy. Seventeen patients (68%) required admission during the Tec ramp-up period. CRS was observed in 15 (60 %) patients, all of which were grade I/II events. Fourteen of these patients were hospitalized for CRS. They were admitted for median number of 2 hospital days (range 1-6). Tocilizumab was administered for Grade 2 CRS in 3 patients (12%). ICANS was reported in 4 (16%) patients. Two of those patients developed Grade 2 ICANS which completely resolved with dexamethasone. The median number of admitted hospital days for these patients was 3 days (range 2-49). Neutropenia with ANC &lt; 500 was seen in only 1 (4%) patient. Grade 3/4 infections were seen in 3 (12%) patients during the ramp-up period. Conclusions: Tec administration through an inpatient/outpatient hybrid model is safe and feasible. CRS was common but low grade and short lived. ICANS was observed, but remained low grade and may be attributable to our older patient population. As our center gained experience with the Tec management, we noticed lower rates of admission for low grade CRS. Lower incidences of infections and neutropenia demonstrate that these complications emerge in the months after starting therapy. Future studies will help identify patients who are higher risk for CRS and ICANS during ramp-up treatment and may pave the way for prophylactic interventions and outpatient administration.

Preferences among patients with triple-class exposed (TCE) relapsed/refractory multiple myeloma (RRMM) in the era of B-cell maturation antigen (BCMA)-directed T-cell–engaging therapies.

e23309 Background: BCMA-directed T-cell–engaging therapies have been introduced into clinical practice for the treatment of TCE RRMM. While efficacious, such treatments are associated with safety considerations such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and serious infections. These treatments also vary in reported efficacy, administration processes, and hospitalization requirements. The aim of this study is to quantify patient preferences and tradeoffs regarding these attributes. Methods: A discrete choice experiment (DCE) was designed to elicit preference weights corresponding to seven attributes related to efficacy (objective response rate [ORR], overall survival [OS]), safety (all-grade CRS, all-grade ICANS, serious infections) and treatment procedures (treatment administration, hospitalization requirements). Attribute levels were based on plausible ranges of potential values. Patients in the United States (US) with a physician-confirmed diagnosis of TCE RRMM were recruited. Pre-test interviews with patients were conducted and the final survey deployed online in 2023. A random-parameters logit model was used to estimate preference weights. Conditional relative importance (CRI) was calculated to rank the relative importance of each attribute. The minimum acceptable benefit (MAB) and maximum acceptable risk (MAR) were calculated to estimate the tradeoffs between efficacy and safety attributes. Results: The sample included 200 respondents (mean [standard deviation] age: 61 [6.4] years; 43% female; 46% White; 10% African American). A total of 197 participants reported having responded to prior treatment, of whom 195 had relapsed or become refractory. In the DCE, a 24-month increase in OS was found to be the most important attribute, with a CRI of 32.0%. Next most important were avoiding a 60% risk of serious infection (CRI 17.3%), avoiding 14-day hospitalization requirements (CRI 15.0%), and a 38% increase in ORR (CRI 13.7%). A treatment that could be started immediately and administered weekly or up to every 4 weeks was preferred over a CAR T-like procedure with a waiting period. Fewer initial hospitalization days was significantly preferred over more hospitalization days. The MABs for OS when the risk of serious infection was increased from 20% to 60%, CRS from 40% to 95%, and ICANS from 3% to 20% were 24.2, 17.1, and 18.0 months, respectively. When OS was increased from 12 to 36 months, the estimated MARs for serious infections, CRS, and ICANS were &gt; 60%, &gt; 95%, and &gt; 20%, respectively. Conclusions: This study highlights US patient preferences regarding treatment attributes for TCE RRMM. Treatment benefits and risks and the mutual tradeoffs considered by patients should be evaluated when developing and selecting therapeutic approaches.

FOREIGN BODY ASPIRATION IN CHILDREN: CLINICAL, RADIOLOGICAL AND BRONCHOSCOPY FINDINGS

Background: Foreign body aspiration (FBA) is a serious problem that leads to partial or complete airway obstruction. Respiratory distress and pneumonia are the most common complications. The assortment of foreign bodies is very wide. The most common include candy, fish bones, peanuts and nuts, toys, food and batteries. Aim of this study was to determine how accurate the presenting symptoms and signs of foreign body aspiration are and to assess the radiologic findings, the types and sites of the foreign bodies removed. Patients and Methods: a retrospective study included101 patient from age of one month to 15 years with suspected foreign body aspiration based on history, clinical examination, Chest Xray. Rigid bronchoscopy was done for patients under general anaesthesia with muscle relaxation using neuromuscular blocking agents. For every patient gender, age, residence, interval between event and symptom onset, symptoms at admission, signs of respiratory insufficiency, pulmonary auscultation findings, Chest X-ray findings, interval between admission and bronchoscopy, the location of foreign body, type of foreign body, hospitalization days were studied and statistically analysed. A p-value of &lt; 0.05 was considered statistically significant. Results: Seventy six (75.24%) were proved to have foreign body aspiration that was removed by rigid bronchoscopy. toddler was the common age group 43(42.6%). Male were affected more than females 1.2:1. A significantly higher percentage of patients who had a foreign body were witnessed by a family member than those who did not have a foreign body 61.8% vs 0% (p=0.001). Stridor and cough with breathlessness were the most common signs and symptoms while unilateral wheezes, crepitations and diminished air entry were less frequent while each of crepitations, unilateral wheezes and cough with breathlessness were significantly associated with foreign body aspiration (p=0.001, 0.001, 0.02 respectively). Abnormal chest X ray finding was significantly associated with FBA (p=0.02) with hyperinflation being the most frequent finding. The types of foreign bodies removed were sunflower seeds (27.6%), food particles (18.4%) and nuts (17.1%). The most common site of foreign body was the right main bronchus (52.6%) followed by left main bronchus (34.2%). There is a significant association between foreign body aspiration and the time interval between admission and bronchoscopy but no significant relation with age, interval between the event and onset of symptoms and hospitalization days. Conclusion: The history of being witnessed by a family member, the presence of stridor and cough and finding of unilateral wheezes and crepitations on examination as well as hyperinflation on chest X ray are significantly associated with FBA. The sunflower seeds and food particles are the most common types and the right main bronchus is the main site of foreign bodies removed by bronchoscopy.

Investigating the link between antipsychotic use and post-stroke infections in older people: multi-centre propensity score analysis.

The risk of stroke increases with age, and although previous reports have suggested that infection risk may increase with antipsychotic use, relevant studies after stroke are scarce. We aimed to investigate whether antipsychotics increase post-stroke infection risk in the acute stroke period. This propensity score matching study included adults diagnosed with first-ever stroke between 2011 and 2020 at five university hospitals. In-hospital antipsychotic exposure was defined as any administration during hospitalisation for stroke. The primary outcome was post-stroke infection after the first 2 days of hospitalisation, and the secondary outcome was the presence of pneumonia, bacteraemia and/or bacteriuria. Among 23,885 first-ever stroke patients, 2,773 antipsychotic users (age 71.6 ± 12.4, male 54.6%) and 2,773 non-users (age 71.2 ± 13.2, male 54.6%) were selected as matched cohorts. After adjusting for propensity score, antipsychotics were not associated with an increased risk of post-stroke infection (odds ratio 0.99, 95% confidence interval 0.87-1.14). While our study did not find conclusive evidence linking antipsychotic medication to an increased risk of post-stroke infection, prescribing these medications should still be approached with prudence. Until further research can provide more definitive insights, clinicians should carefully weigh the potential infection risks when considering antipsychotic treatment during the acute stroke care period.

Comparison of the Efficacy of Indwelling Gastric Tubes in Preoperative and Postoperative Patients With Oral and Maxillofacial Malignancies

PurposeTo explore the optimal plan for the timing of indwelling gastric tube placement in oral and maxillofacial malignant tumor patients. DesignA prospective randomized controlled trial. Methods80 patients with oral and maxillofacial tumor were selected, and 40 patients were Pre-operative group. The remaining 40 patients were the control group, called Postoperative group. The body weight and hospital stay of the two groups were observed before and after surgery. Blood samples were taken before surgery and 1, 3 and 7 days after surgery to detect hemoglobin and plasma albumin. FindingsThe number of postoperative hospitalization days in the pre-operative group was significantly lower than that in the post-operative group; postoperative hemoglobin and plasma albumins were lower in both groups compared with the preoperative level. ConclusionsPreoperative nasogastric tube ensured early postoperative administration of gastrointestinal nutrition, promoted postoperative plasma albumin recovery, and shortened the days of hospitalization.

Chemotherapy Care Companion: Enhancing cancer care through digital remote monitoring.

1636 Background: Oncology patients often encounter preventable acute issues prompting the need for proactive monitoring and management. To manage disease and therapy complications, Ochsner Health developed Chemotherapy Care Companion (CCC) for remote monitoring of treatment patients. This abstract highlights the feasibility of digital remote monitoring (DRM) in managing oncologic patient care, while increasing patient satisfaction and reducing patient events and healthcare costs. Methods: Starting in January 2021, patients initiating an oral or intravenous cancer treatment with an active Ochsner portal account and smartphone became eligible. Providers can manually enroll patients via an order set and receive enrollment reminders within the Epic electronic medical record (EMR). Patients receive a digital WiFi-enabled monitoring scale, blood pressure cuff, and ear thermometer, at no cost. Patients are reminded via phone alerts to take vitals at 9am and 3pm, along with a daily questionnaire. The data is transmitted wirelessly to the EMR, where abnormal vital signs or questionnaire responses trigger escalations sent to an Epic in-basket pool. During clinic hours, advanced practice providers (APPs) review and intervene, utilizing embedded urgent care slots for same-day access. In August 2022, a patient satisfaction survey comprising of nine questions was distributed to all enrolled patients. Results: A retrospective analysis was conducted from September 2022 to August 2023 including 722 participants, 7,360 escalations and 668 interventions. Patient compliance reached 62%, defined as submitting at least 50% of daily vitals. The most common interventions were related to hypertension, hypotension, weight changes, and questionnaire responses. Regarding questionnaire responses, diarrhea, pain, fever, and dizziness were the mostly frequently triaged. Data analytics revealed that CCC led to a 5.9% decrease in emergency room visits, a 41.7% decrease in the rate of inpatient hospital admissions, and a 32.3% improvement in the inpatient length of stay compared to non-enrolled patients. Extrapolating this data across 5,500 oncology patients within our hospital system, CCC could prevent 172 ER visits, 914 inpatient hospital admissions and 2,006 hospital days. The survey (131 responses) revealed high satisfaction with CCC: over 80% felt a sense of security, 90% were overall satisfied, and more than 90% would recommend CCC. Conclusions: Findings highlight the value of integrating DRM in cancer care, showcasing its ability to reduce healthcare costs and optimize resource utilization while enhancing patient care and satisfaction. Moreover, the study underscores the high patient satisfaction and engagement with DRM, bolstering its feasibility and acceptance in oncology care. Further investigation is warranted to explore the financial benefits for hospitals, insurance companies, and pharmaceutical companies.

Correlation Analysis between Urinary Catheter Indwelling Time and Nosocomial Urinary Tract Infection.

Indwelling urinary catheter is closely associated with the occurrence of urinary tract infection (UTI). Herein, we further explored the correlation of urinary catheter indwelling time and UTI. Retrospectively, the medical data of nosocomial patients (n = 681) were collected during two quarters of April 2023 to June 2023 (the second quarter, 23.4-23.6, n = 330) and July 2023 to September 2023 (the third quarter, 23.7-23.9, n = 351). The baseline data and incidence of catheter-related UTI were analysed. The total hospitalisation days and indwelling urinary catheter days of patients in five departments were assessed, namely, coronary care unit (CCU), respiratory intensive care unit (RICU), surgical intensive care unit (SICU), neurology intensive care unit (NICU) and cardiac surgical intensive care unit (CSICU) departments. The correlation between hospitalisation days/indwelling urinary catheter days and the occurrence of UTI was evaluated by Spearman correlation analysis. In the CCU, RICU, SICU, NICU and CSICU departments, the number of patients was 463, 83, 29, 91 and 15, respectively. During 23.4-23.6, the incidence of catheter-associated UTI (CAUTI) was 0, 2.85, 6.12, 0 and 12.99 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. During 23.7-23.9, the incidence of CAUTI was 2.98, 6.13, 8.66, 0 and 0 per 1000 urinary catheter days in CCU, RICU, SICU, NICU and CSICU, respectively. Notably, hospitalisation days/indwelling urinary catheter days were positively correlated with the occurrence of CAUTI in each quarter (p < 0.05). There was a positive correlation between urinary catheter indwelling time and the occurrence of UTI.

Acute care and overall survival results of a randomized trial of a virtual health intervention during routine cancer treatment.

1503 Background: Despite rapid development of virtual health interventions, little is known of their impact on acute healthcare utilization and survival outcomes. This study aimed to evaluate the effectiveness of Integrative Medicine at Home (IM@Home), a virtual mind-body fitness program, on unplanned hospital admission and overall survival among patients undergoing systemic cancer treatment. Methods: We conducted a randomized clinical trial of IM@Home (choice of 23 weekly virtual live mind-body and fitness classes) compared with an enhanced usual care (EUC) control intervention consisting of asynchronous recordings (standard of care plus access to 17 pre-recorded online meditation resources) for patients with melanoma, thoracic, gynecological, or head/neck cancers on systemic treatment who reported moderate or greater fatigue. The study intervention lasted up to 12 weeks, and patients were followed thereafter for clinical events. Admission to a hospital over the study period was collected from patient-reported-outcomes and the electronic medical records and compared between arms. Overall survival was estimated using the Kaplan-Meier method. Results: Between October 2021 and March 2023,128 patients were randomized: (mean age 64 years) 109 (85.2%) were female, 106 (82.8 %) white, 10 (7.8%) Black, 7 (5.5%) Asian, and 118 (92.2%) non-Hispanic. 49 (38.3%) patients had thoracic, 44 (34.4%) gynecological, 25 (19.5%) head/neck, and 10 (7.8%) melanoma cancer. 58 (45.3%) were receiving chemotherapy, 45 (35.2%) immunotherapies, and 29 (22.7%) targeted therapies. Compared to EUC, patients in the IM@Home group were less likely to be hospitalized (4/64 [6.3%] vs. 12/63 [19.1%], p=0.038) and spent fewer days in the hospital (4.3 vs. 10.5 mean days per patient, p&lt;0.001) during the 12-week study period. Overall survival results were assessed in Feb 2024 after a median follow up of 20.3 months. Median overall survival was 24.3 months in the EUC arm and was not reached in the IM@Home intervention arm (p=0.06). Conclusions: Participation in the virtual IM@Home program reduced unplanned hospitalizations and number of hospitalization days among patients with cancer receiving systemic treatment. Larger studies with longer follow-up are needed to confirm the effect of virtual supportive care on improving overall survival and reducing acute healthcare utilization. Clinical trial information: NCT05053230 .

Application of 3D Printing Positioning Technology in Parasagittal Meningioma Surgery: A Single-center Retrospective Study

To assess the utility of 3D printing positioning technology for resection of parasagittal meningioma. Information related to clinical history, application of 3D printing positioning technology, neuroimaging, surgical-related information, and postoperative hospital days of consecutive patients with parasagittal meningioma treated between January 2020 and December 2022 were retrospectively collected. Patients were divided into 2 groups based on whether the 3D printing positioning technology was applied. The values between groups were statistically compared. A total of 41 patients were enrolled. In cases using 3D printing positioning technology (14 patients), the location of craniotomy was much better and the postoperative hospital stay was much shorter. The application of 3D printing positioning technology in parasagittal meningioma surgery could improve the location of craniotomy, and reduce the postoperative hospital stay. It is a low-cost positioning technology, and has the potential to be applied to other superficial intracranial tumors.

Cost effective utilization of apheresis for stem cell transplantation in multiple myeloma.

e19528 Background: Salvage autologous stem cell transplantation (ASCT) is an effective and feasible treatment option for patients with relapsed multiple myeloma (MM). It is standard practice to collect stem cells adequate for two transplants for ASCT eligible patients with newly diagnosed MM (NDMM). Stem cell collection is an expensive procedure due to the cost of granulocyte-colony stimulating factor, plerixafor, apheresis, chemotherapy in select cases and finally cryopreservation. However, the rate of utilization of second ASCT is not known. Methods: We conducted a single institution, retrospective study of 511 consecutive patients with NDMM who underwent ASCT to identify the proportion of patients receiving second ASCT. Patients received ASCT as front-line therapy between 1/1/2015-2/13/2019. Demographic and disease characteristics were summarized using median and range for continuous variables, and frequency and percentages were calculated for categorical variables. The cumulative incidence of second ASCT was estimated using the Fine and Gray method, and competing risk regression models were used to estimate the hazard ratios for risk of second ASCT. All statistical tests were two-sided with a type 1 error of &lt; 0.05 indicating statistical significance. All estimates were reported with 95% confidence intervals (95% CI). Results: At a median follow-up of 4.7 years, 25 out of 511 patients received a second ASCT. The cumulative incidence rate at 5 years was 2.6% (95% CI 1.4-4.4%).Age at diagnosis, age at first ASCT and Charlson comorbidity index (CMI) were significantly associated with the risk of second ASCT in univariable analysis (UVA). In multivariable analysis (MVA) age at first ASCT was the only factor that was predictive of a second ASCT. We devised a predictive score for utilization of second ASCT using hazard ratios for each of the three significant factors noted in the UVA. Scoring was done as follows: age &lt; 65 years – 1 point, &gt; 65 years – 7 points; 1 point for CMI 0-1, 2 points for CMI 2 or higher; serum creatinine ≤1.2 – 1 point, &gt; 1.2 – 3 points. Based on the total score, patients are grouped into low ( &lt; = 3), medium (4-6) and high (7+) likelihood categories, with cumulative incidence rates of receiving second ASCT at 4.0% (95% CI: 1.3-9.1%), 3.4% (95% CI 1.4-7.0%) and 0.6% (95% CI 0.1-3.1%) respectively. Patients older than 65 years were 87% less likely to receive a second ASCT compared with those younger than 65 years (HR = 0.13, 95% CI 0.02-0.98). Conclusions: Using this predictive score, goal of stem cell collection for patients with MM could be determined more efficiently. This could avoid extra days of apheresis, chemo mobilization, hospitalizations and need for cryopreservation at least for patients with a low likelihood of second ASCT, translating into cost effective utilization of resources. We plan to validate this score prospectively in a larger group of patients with NDMM undergoing ASCT in the future.

Bilateral simultaneous hip and knee replacement: an epidemiological nationwide study from 2001 to 2016

BackgroundSeveral studies have compared the pros and cons of simultaneous bilateral versus staged bilateral hip and knee replacement but the outcomes of these two surgical options remains a matter of controversy. This study aimed to evaluate demographic features, incidence and hospitalization rates of bilateral one stage total hip and knee arthroplasty in Italy.MethodsThe Italian Ministry of Health’s National Hospital Discharge Reports (SDO) were used to gather data. This study referred to the adult population (+ 20 years of age) from 2001 to 2015 for hip arthroplasty and from 2001 to 2016 for knee arthroplasty.ResultsOverall, 1,544 bilateral simultaneous hip replacement were carried out. The incidence rate was 0.21 cases per 100,000 adult Italian residents. Male/female ratio was 1.1. The average days of hospital stay was 11.7 ± 11.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, pelvic region and thigh (ICD code: 715.15). 2,851 bilateral simultaneous knee replacement were carried out. The incidence rate was 0.37 cases per 100,000 adult Italian residents. Male/female ratio was 0.6. The average days of hospital stay was 7.7 ± 5.8 days. The main primary codified diagnosis was: osteoarthrosis, localized, primary, lower leg (ICD code: 715.16).ConclusionsThe burden of hip and knee osteoarthrosis as a leading cause of bilateral joint replacement is significant in Italy. The national registers’ longitudinal analysis may provide data for establishing international guidelines regarding the appropriate indications for one stage bilateral simultaneous hip or knee replacement versus two stage.

Gender disparities in lost productivity resulting from non-communicable diseases in Mexico, 2005-2021.

Non-communicable diseases (NCDs) cause long-term impacts on health and can substantially affect people's ability to work. Little is known about how such impacts vary by gender, particularly in low- and middle-income countries (LMICs), where productivity losses may affect economic development. This study assessed the long-term productivity loss caused by major NCDs among adult women and men (20-76 years) in Mexico because of premature death and hospitalisations, between 2005 and 2021. We conducted an economic valuation based on the Human Capital Approach. We obtained population-based data from the National Employment Survey from 2005 to 2021 to estimate the expected productivity according to age and gender using a two-part model. We utilised expected productivity based on wage rates to calculate the productivity loss, employing Mexican official mortality registries and hospital discharge microdata for the same period. To assess the variability in our estimations, we performed sensitivity analyses under two different scenarios. Premature mortality by cancers, diabetes, chronic cardiovascular diseases (CVD), chronic respiratory diseases (CRD) and chronic kidney disease (CKD) caused a productivity loss of 102.6 billion international US dollars (Intl. USD) from 2.8 million premature deaths. Seventy-three percent of this productivity loss was observed among men. Cancers caused 38.3% of the productivity loss (mainly among women), diabetes 38.1, CVD 15.1, CRD 3.2, and CKD 5.3%. Regarding hospitalisations, the estimated productivity loss was 729.7 million Intl. USD from 54.2 million days of hospitalisation. Men faced 65.4 and women 34.6% of these costs. Cancers caused 41.3% of the productivity loss mainly by women, followed by diabetes (22.1%), CKD (20.4%), CVD (13.6%) and CRD (2.6%). Major NCDs impose substantial costs from lost productivity in Mexico and these tend to be higher amongst men, while for some diseases the economic burden is higher for women. This should be considered to inform policymakers to design effective gender-sensitive health and social protection interventions to tackle the burden of NCDs.

Medicare Advantage enrollment and outcomes of post-acute nursing home care among patients with dementia.

Enrollment in Medicare Advantage (MA) has been rapidly growing. We examined whether MA enrollment affects the outcomes of post-acute nursing home care among patients with Alzheimer's disease and related dementias (ADRD). We exploited year-to-year changes in MA penetration rates within counties from 2012 through 2019. After adjusting for patient-level characteristics and county fixed effects, we found that MA enrollment was not associated with days spent at home, nursing home days, likelihood of becoming a long-stay resident, hospital days, hospital readmission, or 1-year mortality. There was a modest increase in successful discharge to the community by 0.73 percentage points (relative increase of 2.4%) associated with a 10-percentage-point increase in MA enrollment. The results are consistent among racial/ethnic subgroups and dual-eligible patients. These findings suggest an imperative need to monitor and improve quality of managed care among enrollees with ADRD.

A Case Report of a Patient with Insomnia Related To Fibromyalgia Treated with Korean Medicine, including Bunshimgi-eum

In this case report, we describe the effects of Korean Medicine therapies, including Bunshimgi-eum, on a patient hospitalized with insomnia due to fibromyalgia in a Korean Medicine Hospital. We treated the patient with Bunshimgi-eum for 21 of 27 hospital days. Post-treatment, we used the Insomnia Severity Index (ISI) to measure the severity of insomnia. To determine the severity of multiple pain, including neck, low back, Lt. shoulder, Lt. elbow, Rt. knee, and hand, we used the Numerical Rating Scale (NRS). For evaluation of generic health status, we used the European Quality of Life-5 Dimensions (EQ-5D) scale. After the treatment, the patient’s clinical symptoms improved, according to the ISI, NRS, and EQ-5D. The results of this case study suggest that Korean Medicine therapies, including Bunshimgi-eum, may have positive effects as a treatment for insomnia related to fibromyalgia.

조현병 환자에서 장기 지속형 항정신병 주사제와 경구항정신병 약물제제의 폭력적인 행동 조절에 대한 효과 비교 연구

Objectives: The purpose of this study is to compare the changes in the severity of violent and psychotic symptoms before and after antipsychotics long-acting injections in patients with schizophrenia. Methods: From April, 2017 to April, 2022, a retrospective study through medical records review was conducted. Paliperidone or aripiprazole long-acting injections were prescribed among schizophrenic patients who received outpatient and inpatient treatment at the Department of Psychiatry at Chuncheon National Hospital. The demographic and clinical characteristics were investigated, and the hospitalization days before and after treatment, the number of hospitalizations, CGI-S, hostility of PANSS, and hostility/suspicion of BPRS were compared. Results: Both long-acting injections showed a significant decrease in CGI-S.(Paliperidone: t=14.407, p=0.000 / Aripiprazole: t=14.135, p=0.000). Additionally, it was confirmed that the hostility of PANSS in both groups decreased significantly,(Paliperidone: t=21.507, p=0.000 / Aripiprazole: t=11.403, p=0.000); furthermore, it was significantly decreased in Hostility/Suspicion of BPRS.(Paliperiodone: t=18.123, p=0.000 / Aripiprazole: t=14.480, p=0.000). There was no significant difference in the evaluation score before and after treatment for each longacting injection, indicating that there was no difference in the treatment effect between the two groups. Conclusion: In this study, it was expected that the two long-acting injectable antipsychotics would decrease socio-economic burdens, since they reduced the violence of schizophrenic patients, the number of days, and the number of hospitalizations. In the future, antipsychotics long-acting injections should be considered to aid patients and society. Since there are various limitations in this study, further follow-up studies are needed.