Hospital Days Research Articles

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

Pneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed. To evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non-critically ill patients admitted with pneumonia. Cluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n = 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non-critically ill adults (≥18 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020. CPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (<10%) of MDRO pneumonia, coupled with feedback and education. The primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy and safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes compared differences between baseline and intervention periods across strategies. Among 59 hospitals with 96 451 (51 671 in the baseline period and 44 780 in the intervention period) adult patients admitted with pneumonia, the mean (SD) age of patients was 68.1 (17.0) years, 48.1% were men, and the median (IQR) Elixhauser comorbidity count was 4 (2-6). Compared with routine stewardship, the group using CPOE prompts had a 28.4% reduction in empiric extended-spectrum days of therapy (rate ratio, 0.72 [95% CI, 0.66-0.78]; P < .001). Safety outcomes of mean days to ICU transfer (6.5 vs 7.1 days) and hospital length of stay (6.8 vs 7.1 days) did not differ significantly between the routine and CPOE intervention groups. Empiric extended-spectrum antibiotic use was significantly lower among adults admitted with pneumonia to non-ICU settings in hospitals using education, feedback, and CPOE prompts recommending standard-spectrum antibiotics for patients at low risk of MDRO infection, compared with routine stewardship practices. Hospital length of stay and days to ICU transfer were unchanged. ClinicalTrials.gov Identifier: NCT03697070.

Impact of preoperative anemia on patients undergoing total joint replacement of lower extremity: a systematic review and meta-analysis

sPurposePreoperative anemia increases postoperative morbidity, mortality, and the risk of allogeneic transfusion. However, the incidence of preoperative anemia in patients undergoing total hip arthroplasty and total knee arthroplasty (TKA) and its relationship to postoperative outcomes has not been previously reported.MethodsWe conducted a comprehensive literature search through PubMed, Cochrane Library, Web of Sincien, and Embase from inception to July 2023 to investigate the prevalence of preoperative anemia in patients undergoing Total Joint Arthroplasty, comorbidities between anemic and non-anemicpatients before surgery, and postoperative outcomes. postoperative outcomes were analyzed. Overall prevalence was calculated using a random-effects model, and heterogeneity between studies was examined by Cochran's Q test and quantified by the I2 statistic. Subgroup analyses and meta-regression analyses were performed to identify sources of heterogeneity. Publication bias was assessed by funnel plots and validated by Egger's test.ResultsA total of 21 studies with 369,101 samples were included, all of which were retrospective cohort studies. 3 studies were of high quality and 18 studies were of moderate quality. The results showed that the prevalence of preoperative anemia was 22% in patients awaiting arthroplasty; subgroup analyses revealed that the prevalence of preoperative anemia was highest in patients awaiting revision of total knee arthroplasty; the highest prevalence of preoperative anemia was found in the Americas; preoperative anemia was more prevalent in the female than in the male population; and preoperative anemia with a history of preoperative anemia was more common in the female than in the male population. patients with a history of preoperative anemia; patients with joint replacement who had a history of preoperative anemia had an increased risk of infection, postoperative blood transfusion rate, postoperative blood transfusion, Deep vein thrombosis of the lower limbs, days in hospital, readmission within three months, and mortality compared with patients who did not have preoperative anemia.ConclusionThe prevalence of preoperative anemia in patients awaiting total joint arthroplasty is 22%, and is higher in TKA and female patients undergoing revision, while preoperative anemia is detrimental to the patient's postoperative recovery and will increase the risk of postoperative complications, transfusion rates, days in the hospital, readmission rates, and mortality.

Role of second look endoscopy in endoscopic submucosal dissection and peptic ulcer bleeding: Meta-analysis of randomized controlled trials.

Second-look endoscopy (SLE) to prevent recurrent bleeding in patients with peptic ulcer disease (PUD) and those undergoing endoscopic submucosal dissection (ESD) is routinely being performed. Conflicting evidence exists regarding efficacy, risk, benefit, and cost-effectiveness. To identify the role and effectiveness of SLE in ESD and PUD, associated rebleeding and PUD-related outcomes like mortality, hospital length of stay, need for endoscopic or surgical intervention and blood transfusions. A systematic review of literature databases PubMed, Cochrane, and Embase was conducted from inception to January 5, 2023. Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included. The study was conducted per PRISMA guidelines, and the protocol was registered in PROSPERO (ID CRD42023427555:). RevMan was used to perform meta-analysis, and Mantel-Haenszel Odds ratio (OR) were generated using random effect models. A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis, of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding. In ESD, the rates of rebleeding were 7% in the SLE group compared to 4.4% in the non-SLE group with OR 1.65, 95% confidence intervals (CI) of 0.96 to 2.85; P = 0.07, whereas it was 11% in the SLE group compared to 13% in the non-SLE group with OR 0.8 95%CI: 0.50 to 1.29; P = 0.36. The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01, 95%CI: -0.22 to 0.25; P = 0.91. In SLE vs non-SLE groups with PUD, the OR for Endoscopic intervention was 0.29, 95%CI: 0.08 to 1.00; P = 0.05 while it was OR 2.03, 95%CI: 0.95 to 4.33; P = 0.07, for surgical intervention. The mean difference in the hospital length of stay was -3.57 d between the SLE and no SLE groups in PUD with 95%CI: -7.84 to 0.69; P = 0.10, denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE. For mortality between SLE and non-SLE groups in PUD, the OR was 0.88, 95%CI: 0.45 to 1.72; P = 0.70. SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding. SLE also does not provide any significant improvement in mortality, need for interventions, or blood transfusions in PUD patients. SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.

Safety and efficacy of endoscope-assisted versus microscopic microvascular decompression surgery for hemifacial spasm: a prospective cohort study.

Microscopic microvascular decompression (M-MVD) is a classical treatment for relieving long-term hemifacial spasms (HFS). An endoscopy technique has recently been introduced to improve M-MVD; however, this application remains debatable. This study compared the safety and effectiveness of endoscope-assisted microvascular decompression (EA-MVD) and M-MVD for HFS. From February 2021 to September 2022, we enrolled 49 patients with HFS assigned to the EA-MVD (n = 26) and M-MVD (n = 23) groups. The patients were assessed with Park YS grades, operative time, hospital days, and complications. Evaluations were performed in the early postoperative period, at one month, 3months, 6months, and at least 12months. Twenty-three (23/26, 88.5%) patients in the EA-MVD group and 20 (20/23, 87.0%) patients in the M-MVD group achieved spasm-free relief, ranging over "excellent" and "good" Park YS grades. The operative time in the EA-MVD and M-MVD groups were 143 ± 28min and 145 ± 22min (p = 0.002). The duration of hospital stay was 6.8 ± 0.8days and 7.2 ± 1.3days in the EA-MVD and M-MVD groups (p = 0.002), respectively. All surgeries for HFS were successful, with no death, stroke, hearing loss, facial numbness, or other extreme complications. In conclusion, EA-MVD, compared with M-MVD, demonstrated equally effective outcomes with decreased operative time and hospital stays, providing bright intraoperative illumination and flexible surgical vision.

Robust Analysis of the Influencing Factors for Hospitalization Costs of Senile Cataracts Patients in Chengdu Considering Different Types of Insurance

Chengdu is one of the earliest pilot cities for urban-rural basic medical insurance integration in China. This study aimed to analyze the influencing factors of hospitalization costs of senile cataract in a tertiary hospital in Chengdu by robust method, especially considering the influence of medical insurance type. A total of 1310 discharged patients from a tertiary hospital from January 2020 to June 2021 who were mainly diagnosed with senile cataracts were selected as the research subjects. Kruskal-Wallis H test and Spearman correlation analysis are used to conduct univariate statistical analysis. The robust multivariate linear regression model and a semi-parametric multivariate regression model are established to obtain the influencing factors for their hospitalization costs. The robust multivariate regression model results show that reimbursement ratio, number of surgeries, type of medical insurance, hospitalization days, number of additional diagnoses and material proportion have significant correlations with the response variable, i.e. total hospitalization costs of the senile cataract patients. In the robust multivariate regression analysis, the type of insurance is significantly associated with the hospitalization costs. Fixing other variables, the hospitalization costs of patients with UEBMI insurance were 7.6% higher than those with URRBMI insurance. Generalized additive model (GAM) can express the nonlinear relationship between explanatory variables and response variable. Because of the nonlinear part of the GAM, the interpretation and description of the model can provide more knowledge than the linear models. In the GAM model, the type of insurance is also significantly related to the total costs. According to the regression effects of reimbursement ratio, number of surgeries, type of medical insurance, hospitalization days, number of additional diagnoses and material proportion on total costs, the paper aims to provide some references for promoting the reform of the local medical system and improving the eye health status and quality of life of middle-aged and elderly groups.

Australasian Malignant PLeural Effusion (AMPLE)-4 trial: study protocol for a multi-centre randomised trial of topical antibiotics prophylaxis for infections of indwelling pleural catheters

BackgroundMalignant pleural effusion (MPE) is a debilitating condition as it commonly causes disabling breathlessness and impairs quality of life (QoL). Indwelling pleural catheter (IPC) offers an effective alternative for the management of MPE. However, IPC-related infections remain a significant concern and there are currently no long-term strategies for their prevention. The Australasian Malignant PLeural Effusion (AMPLE)-4 trial is a multicentre randomised trial that evaluates the use of topical mupirocin prophylaxis (vs no mupirocin) to reduce catheter-related infections in patients with MPE treated with an IPC.MethodsA pragmatic, multi-centre, open-labelled, randomised trial. Eligible patients with MPE and an IPC will be randomised 1:1 to either regular topical mupirocin prophylaxis or no mupirocin (standard care). For the interventional arm, topical mupirocin will be applied around the IPC exit-site after each drainage, at least twice weekly. Weekly follow-up via phone calls or in person will be conducted for up to 6 months. The primary outcome is the percentage of patients who develop an IPC-related (pleural, skin, or tract) infection between the time of catheter insertion and end of follow-up period. Secondary outcomes include analyses of infection (types and episodes), hospitalisation days, health economics, adverse events, and survival. Subject to interim analyses, the trial will recruit up to 418 participants.DiscussionResults from this trial will determine the efficacy of mupirocin prophylaxis in patients who require IPC for MPE. It will provide data on infection rates, microbiology, and potentially infection pathways associated with IPC-related infections.Ethics and disseminationSir Charles Gairdner and Osborne Park Health Care Group Human Research Ethics Committee has approved the study (RGS0000005920). Results will be published in peer-reviewed journals and presented at scientific conferences.Trial registrationAustralia New Zealand Clinical Trial Registry ACTRN12623000253606. Registered on 9 March 2023.

Impact on Hospital Resource Utilization of Endoluminal Bypass Using the Viabahn Endoprosthesis with Heparin Bioactive Surface Compared With Surgical Femoropopliteal Bypass.

To assess the impact of heparin-bonded endoprosthesis compared with femoropopliteal bypass on key hospital resources and revenues up to 1-year follow-up. A 2-arm scenario resource consumption data analysis was modeled based on a multicentre prospective randomized controlled trial. Six centers in the Netherlands. A total of 100 patients were assigned to 2 arms (50 each arm). The first arm evaluated endovascular treatment using the heparin-bonded Viabahn endoprosthesis and the second the femoropopliteal bypass. Resource consumption rates were compared between arms. Resource consumption rates, including hospital stay for bypass procedure, operating room time, type of anesthesia, number of used (endo)grafts, use of different types of bed locations (vascular ward, medium or intensive care), readmission for wound infections, and reinterventions over a period of 12 months. Endovascular repair used fewer hospital resources, with an overall difference of €149.983. Hospital stay was 118 days less (261 vs 379), including 21 fewer days in medium/intensive care (5 vs 26) and 50 fewer operating room hours (100 vs 150). Fewer patients required general anesthesia (31 vs 39), and there were less surgical site infections (3 vs 12). In the surgical bypass group, there were 18 fewer days of hospital stay related to reinterventions (80 vs 62), and the cost of the devices was €309.996, cheaper. The total monetary difference was € 160.013, in favor of the femoropopliteal bypass (€3.200, per patient). Endovascular repair of the superficial femoral artery reduces the use of valuable hospital resources. Its major limitation is the cost of the devices, which should be balanced against the reduction in peri-procedural morbidity and faster recovery. In the context of shortage of hospital beds, it offers capacity benefits, allowing for the treatment of more patients overall. These benefits may outweigh the fewer reinterventions in the surgical bypass group. The SuperB Trial was registered in clinicaltrials.gov; NCT-ID: NCT01220245. Modeling is a useful technique to predict the impact of treatment modalities on hospital resources and revenue. This study uses real-world data from the SuperB Trial to compare two treatment strategies of superficial femoral artery disease, reflecting actual clinical practice and patient outcomes. The analysis focused on direct costs associated with hospital resources and device usage without considering indirect costs or long-term cost-effectiveness. The analysis showed that endovascular repair reduces the use of valuable hospital resources. Its major limitation is device costs, which should be balanced against the reduction in peri-procedural morbidity and faster recovery. In the context of shortage of hospital beds, it offers capacity benefits, allowing for the treatment of more patients overall.

Efficacy and Safety of Endoscopic Surgery Versus Craniotomy for Hypertensive Putamen Hemorrhage.

This study aimed to evaluate the efficacy and safety of neuroendoscopy for treating hypertensive putamen hemorrhage (HPH), compared with traditional craniotomy. We retrospectively analyzed 81 consecutive patients with HPH treated with neuroendoscopy (n=36) or craniotomy (n=45) in the Department of Neurosurgery at the Anhui Provincial Hospital Affiliated to Anhui Medical University between January 2015 and December 2017. We compared the clinical and radiographic outcomes, excluded 14 patients who did not meet the inclusion criteria. Patient characteristics in emergency room were recorded. In addition, hospitalization days, total cost during hospitalization, operative time, blood loss, evacuation rate, rebreeding, intracranial infection, pulmonary infection, epilepsy, hemorrhage of digestive tract, venous thrombus, hypoproteinemia, aphasia, oculomotor paralysis, mortality, Modified Rankin Scale score 6 months after surgery, and Glasgow Outcome Scale score 6 months after surgery were compared between the 2 groups. Comparative analysis of preoperative patient data revealed no notable disparities. Neuroendoscopic surgery afford distinct benefits including reduced operative time, minimal patient blood loss, and enhanced efficacy in hematoma evacuation. However, the incidence of postoperative complications such as rebleeding, intracranial infections, pulmonary infections, postoperative epilepsy, hemorrhage of digestive tract, venous thrombus, hypoproteinemia, aphasia, and oculomotor paralysis did not significantly differ. In contrast, endoscopic techniques, relative to conventional craniotomy for hematoma evacuation, are characterized by less invasive incisions, a marked decrease in the duration of hospitalization, and a substantial reduction in associated healthcare costs. Furthermore, endoscopic techniques contribute to superior long-term recuperative outcomes in patients, without altering mortality rates. In comparison to the conventional method of craniotomy, the utilization of neuroendoscopy in the treatment of hypertensive putamen hemorrhage (HPH) may offer a more efficacious, minimally invasive, and cost-effective approach. This alternative approach has the potential to decrease the length of hospital stays and improve long-term neurologic outcomes, without altering mortality rates.

Rising Cardiovascular Mortality Despite Increased Resource Utilization: Insights From the Nationwide Inpatient Sample Database.

Introduction The global burden of cardiovascular disease (CVD) has risen over the past decade, potentially escalating resource utilization, morbidity, and mortality. We analyzed trends in hospitalization for CVDs, outcomes of hospitalizations, and the impact of the COVID-19 pandemic on CVDhospitalizations between 2016 and 2020. Methods Adult CVD hospitalizations recorded in the2016-2020 nationwide inpatient sample (NIS) were identified using major diagnostic categories (MDC- class 5). The NIS is the largest all-payer repository of all hospitalizations in the USA within a calendar year. We compared sociodemographic factors andoutcomes (mortality, length of stay, and hospital charges) of CVD hospitalization before and during the pandemic using Pearson's χ2 tests.We used Stata ranking commands and ICD-10 (10th revision of the International Statistical Classification of Diseases and Related Health Problems) codes to identify the most recurring diagnoses associated with CVD mortality during the study period.Trends in mortality and resource use were assessed using theJonckheere-Terpstra trend test. Hospital charges wereadjusted for inflationusing the Medical Expenditure Panel Survey index. We used stepwise multivariate logistic regression analyses(P ≤ 0.05 for entry; P > 0.10 for removal) to identify covariates associated with cardiovascular mortality during the study period. Results Hospitalizations for CVDs rose from 4,283,502 in 2016 to 4,635,246 in 2019 (Ptrend< 0.001) and declined to 3,865,399 in 2020. 452,930 mortalities were recorded during the study period. In-hospital mortality rose from 111,090 (2.6%) in 2016 to 118,825 (2.8%) in 2020 (Ptrend< 0.001). Compared with the prepandemic years, mortality rates were higher during the pandemic (108,231 [2.8%] vs. 445,373 [2.5%]; P<0.001), and increased in hospitalizations for hypertensive heart disease with chronic kidney disease (CKD) (15,585[14.4%] vs. 45,873 [10.3%]; P<0.001), hypertensive heart disease with heart failure (7,468 [6.9%] vs. 21,378 [4.8%]), ventricular tachycardia (2,056 [1.9%] vs. 7,571 [1.7%]; P=0.022), and peripheral angiopathy with gangrene (1,191 [1.1%] vs. 3,118 [0.7%]; P<0.001). CVD hospitalizations totaled 80.3 million hospital days and 39.7 million hospital procedures during the period. The mean number of procedures (3 vs. 2) and mean length of hospital stay (5.6 vs. 4.5 days) increased during the pandemic (P<0.001). The mean hospital cost for CVD increased from US$ 69,394 in 2016 to US$ 89,728 in 2020 (Ptrend< 0.001). Conclusion CVD mortality increased despite increased resource use over the study period. Hospitalizations during the pandemic had poorer mortality and resource use outcomes than those in the preceding years.

Therapeutic and Clinical Traits of Ludwig’s Angina: A 10-year retrospective study of 24 patients

Introduction: Ludwig's angina is a life-threatening infection that affects the floor of mouth and originates from odontogenic infections in more than 90% of cases.&#x0D; Aim: This study aimed to recognize the clinical and therapeutic traits of Ludwig's angina.&#x0D; Method &amp; Materials: In this retrospective study, medical records of hospitalized patients in the Oral and Maxillofacial Department, Tehran Taleghani Hospital between 2006-2016 with deep neck infections and Ludwig's angina diagnosis were checked. Then patients were compared in terms of demographic, anatomical, risk factors, clinical course and treatment characteristics. Data were analyzed with SPSS software version 18.&#x0D; Results: The results showed that of 325 studied patients, 24 patients (7.38%) had Ludwig's angina which of these, 3 patients (12.5%) died ultimately. There was a statistically significant relationship between the occurrence of dyspnea, involved anatomical areas and days of hospitalization in ICU and death; however, there was no significant relationship between gender, age, socioeconomic status, fever, maximum and minimum blood pressure, heart rate, white blood cells count, Odynophagia, origin of infection, received antibiotics, hospitalized days and systemic diseases with death.&#x0D; Conclusion: Ludwig's angina is a fatal infection and requires immediate intervention and results showed involved about 8% of Deep Infections of Head and Neck Area, and the mortality rate of these patients is approximately 12.5%. Therefore, diagnosis and treatment of this disease is important in emergencies.

Therapeutic Effect of Synbiotics (Lactobacillus reuteri, Lactobacillus rhamnosus, Bifidobacterium infantis, and Fructooligosaccharides (FOS)) on Acute Non-bloody Diarrheal Episodes in Hospitalized Children Aged Between 6 - 24 Months: Randomized Double-Blind Placebo-Controlled Trial

Background: Regarding the appropriate effect of probiotics in treating acute diarrhea and the high prevalence of non-bacterial acute diarrhea among children in the population. Objectives: The present study evaluates the effect of synbiotic drops in children with acute diarrhea, including the number of hospitalization days, daily excreted diarrhea volume, duration of diarrhea, and reduction in the number of excretions between the case and control groups. Methods: This was a prospective double-blinded and randomized-controlled clinical trial on children aged 6 - 24 months with non-bloody acute diarrhea were included. The reason for hospitalization was diarrhea. In the case group, the patients consume PediLact (Zisttakhmir, Tehran, Iran) drop (Lactobacillus rhamnosus, Lactobacillus reuteri, and bifidobacterium infantis) 109 CFU and fructooligosaccharides. PediLact drop was used with milk or lukewarm food for five days along with other routine hospital cares. The number of hospitalization days, the daily excreted diarrhea, diarrhea duration, and decreasing numbers of excretion in patients were compared. Results: In the current study, 114 children were included. The duration of hospitalization was 3.87 ± 0.9 days in the synbiotic group and 4.26 ± 0.12 days in the placebo group (P-value = 0.001). The time between the onset of diarrhea and recovery was significantly higher in the placebo group than in the synbiotic group (P = 0.032). The number of evacuations was 1.89 ± 0.13 in the synbiotic group and 2.52 ± 0.18 in the placebo group (P = 0.014).

Association between mental health social worker staffing in psychiatric emergency wards and readmission outcomes: A nationwide survey in Japan.

The mental healthcare system in Japan is transitioning from institution-based to community-based treatment. To prevent prolonged hospitalization and community integration of psychiatric patients, mental health social workers (MHSWs) are pivotal in coordinating post-discharge arrangements for psychiatric inpatients. This study aimed to propose a care model to improve clinical outcomes in psychiatric emergency wards in Japan. We conducted a mail-in questionnaire survey targeting medical facilities with psychiatric emergency wards. We collected data of the psychiatric care system, including facility profiles, staffing conditions and caseloads, and the provided psychiatric services and treatment options. Using multiple regression analyses, we explored associations between these data and clinical outcomes, focusing on the average number of days for hospitalization and the integration of patients into a community. Data were collected from 82 facilities (response rate, 45.8%). The average number of days for hospitalization and community integration were 64.7 and 327.9 days, respectively. The caseloads for MHSWs were significantly associated with longer hospitalization (β = 0.31, p = 0.009) and shorter duration of community living (β = -0.28, p = 0.027). The clinical performance in psychiatric emergency wards surpassed the Japanese government's targets regarding these outcomes. We found that heavy caseloads on MHSWs were associated with worse clinical outcomes for patients in psychiatric emergency wards. These findings suggest that reducing MHSW caseloads (≤20 cases) may be a potential interventional strategy to prevent prolonged hospitalization and promote successful community integration of patients.

874 Comparative Study on the Efficacy of Optic Nerve Decompression Through Pterional and Supraorbital Approaches in the Treatment of Progressive Completely Blind Traumatic Optic Neuropathy

INTRODUCTION: Traumatic optic neuropathy (TON) is a serious complication of craniomaxillofacial trauma that directly or indirectly damages the optic nerve and cause different degrees of visual impairment. The role of optic nerve decompression (OND) in treating TON remained inconclusive. METHODS: Patients with progressive completely blind TON treated with OND through pterional and supraorbital approach in our institute by one surgeon from September 2019 to June 2022 were retrospective reviewed in this study. Demographic information, trauma factors, interval between trauma and complete blind, interval between trauma and surgery, and preoperative CT findings were recorded. Hospitalization days and the postoperative visual acuity of patients in two groups were compared. RESULTS: There are 54 patients included in this study, 21 patients underwent OND through pterional approach, and the others underwent supraorbital approaches. Male patients are more common than female in both groups. Respectively, in groups of pterional and supraorbital approaches, the average hospitalization days were 9.8 ± 2.4 and 10.7 ± 2.9, the mean durations of follow-up are 20.1 ± 4.2 and 21.4 ± 3.1 months, respectively. The number of patients underwent pterional approach who improved their visual acuity to light perception and digit counting, respectively, is nine (42.9%) and three (14.3%). In group of supraorbital approach, the number is 9 (27.3%) and 6 (18.2%), respectively. The overall improvement rates of pterional and supraorbital approaches is 57.1% and 45.5%, and no significant difference was noted (P=0.40). CONCLUSIONS: Patients with progressive completely blind traumatic TON can benefit from OND. No significant difference was noted regarding to the improvement rates of OND through pterional and supraorbital approaches in the treatment of progressive completely blind TON in this study.

Carbamazepine-induced toxidermia: Case report and a literature review

IntroductionCarbamazepine is effectively used in treatment of bipolar disorder for its thymoregulatory virtues, but it can induce numerous side effects, including skin eruptions that can be severe sometimes.ObjectivesTo study the relationship between toxidermia and treatment with carbamazepine.MethodsWe report the case of a patient who developed a toxidermia following the intake of carbamazepine.ResultsMr. AD, 19 years old, with medical history of diabetes, has been diagnosed with bipolar disorder since the age of 17. He was initially treated with risperidone with an irregular follow-up.He was hospitalized in our department for a manic episode with psychotic features with agitation and refusal of treatment.The patient was put on injectable treatment 15 mg/day of Haloperidol and 20 mg/day of diazepam.After 5 days in hospital, we switched to the oral route, gradually increasing haloperidol doses to 30mg, reducing diazepam doses and introducing carbamazepine for thymoregulatory purposes.Carbamazepine was progressively increased up to a dose of 800mg per day.Fourteen days after the introduction of carbamazepine, the patient presented a generalized rash requiring the discontinuation of this medication. He was treated with an anti-histamine and local corticosteroids, on the advice of dermatologists.In the days following discontinuation of carbamazepine, skin lesions regress and then disappear.Biologically, we observed a rise in eosinophilic polynuclear cells to 580, followed by a gradual decrease after stopping the treatment.A pharmacovigilance opinion was sought, concluding that carbamazepine was responsible for the toxidermia, given the delay in onset and the favorable evolution after discontinuation of the incriminating treatment. Moreover, this undesirable effect is well described in the literature.Hence the contraindication to further use of carbamazepine in Mr. AD.In addition, the patient was put on sodium valproate with good tolerance.ConclusionsEach prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon. The attitude can be modulated on a case-by-case basis, after specialist advice, depending on the severity of the rash and the disease to be treated.Disclosure of InterestNone Declared

Tigecycline as Salvage Therapy in a Neonate with Multidrug-resistant Klebsiella pneumoniae Meningitis and Ventriculitis – Case Report and Literature Review

Multi drug resistant (MDR) infections especially in paediatric population, with already limited treatment options, often leave clinicians at loss for an effective antimicrobial treatment making us as helpless as in pre-antibiotic era. Tigecycline is an ‘immature’ antibiotic for children. According to FDA, tigecycline is only indicated in patients 18 years of age and older for the treatment of complicated MDR infection. According to the published literature, the youngest patient on whom Tigecycline treatment has been attempted was 73 day old baby born at 27 weeks gestation with a birth weight of 1028 grams having Acinetobacter baumanii ventriculitis . Here, we discuss use of Tigecycline in a neonate with MDR Klebsiella Pneumoniae meningitis and ventriculitis who presented to us on day 12 of life. Child was born preterm at 34 weeks and 3 days by Lower Segment Caesarean Section in view of foetal distress, maternal preeclampsia and gestational hypothyroidism in a private hospital. On 12thday of life the baby presented to our hospital after being referred with complaints of abnormal body movements, lethargy, difficulty in taking feeds and difficulty in breathing. The complaints had been documented to be present since birth but were increasing over time. Aerobic culture of CSF led to isolation of multi-drug resistant (MDR) Klebsiella pneumoniae resistant to most empirical antibiotics, with intermediate susceptibility to Amikacin susceptibility to Colistin and Tigecycline. We found our isolate produced both NDM and OXA-48 contributing to the increased virulence and resistance of the strain. Considering the paucity of knowledge of Tigecycline’s efficacy and safety in children less than 8 years, lack of FDA approval and the fact that CSF bioavailability is considered low, Tigecycline therapy was deferred and infant was continued on injection Meropenem and injection Amikacin. Condition of child did not improve and marginal weight gain was documented over next 10 days. CSF culture from repeat LP again grew Klebsiella pneumoniae with same susceptibility pattern. On day 23 due adverse affects, and injection Tigecycline was added. A total of 42 days of Meropenem and 21 days of Tigecycline were completed and child was discharged after 42 days of hospital stay. Child was gaining weight, taking feeds orally and no abnormal body movements were present. The child is being followed up for long term sequelae of HIE 2 and meningitis on OPD basis

New ways in delivering services for people with dual diagnosis

IntroductionPeople with severe mental health disorders and concurrent addiction problems are one of the most challenges patients to treat within mental health and addiction. They often find themselves fallen between different chairs within mental health and addiction services and between spescialist and primary care. There is a need for new ways of delivering services for this group.ObjectivesThe objective of this presentation is to present how Flexible assertive outreach teams (FACT) are delivered in a densly populated country and the results on changes in use of spescialist services and detension. We will also present the results of changes in quality of life before and after entering FACT and which factors that might be associated with life quality.MethodsThe establising of FACT in Norway has been extecively evaluated both in the form of official reports to the health authorities and academic research papers. We will do a scoping review of the Norwegian research on the effect of FACT teams with a spesific attention to the results obtained in densly populated areas. The review will cover the years fra 2018 up til to day.ResultsThe results so far indicate that it is possible to deliver FACT services in densly populated areas and that there is an increase in qualty of life before and after entering a FACT team. The use of hospitalization days are reduced with about 50 % and the same applies for days in detention.ConclusionsFACT teams seems to be a viable way of delivering mental health care services to one of the most vulnerable groups in our society.Disclosure of InterestNone Declared

Epidemiology of Spondylolisthesis: A Nationwide Study From 2001 to 2016 in the Italian Population.

Epidemiological study. This study aimed to evaluate the annual incidence of spondylolisthesis requiring surgery in Italy and the epidemiological characteristics of the patients. The health care system continues to incur considerable costs as a result of low-back pain. Segmental instability of the lumbar spine has attracted significant interest from researchers as a potential mechanism leading to mechanical low back pain. The Italian Ministry of Health's National Hospital Discharge Reports database in the 2001-2016 period was considered. A total of 55,804 hospital admissions for spondylolisthesis were performed in Italy. The cumulative incidence was 6.8 interventions for every 100,000 Italian adult residents. The highest amount of procedures was recorded in the 65-69 years of age group. The overall patient's age was 56.8 ± 15.1 years. The 62.2% of patients were females. The average hospital stay length was 8.1 ± 7.3 days. On average, older patients require more days of hospital stay. Over the study period, it was observed a decreasing trend in the average number of days of hospital stay. The main primary diagnoses included were "acquired spondylolisthesis" [International Classification of Diseases (ICD) code: 738.4; 57.8%] and "spondylolisthesis" (ICD code: 756.12; 42.2%). By far, the main primary procedure performed was "lumbar and lumbosacral fusion of the anterior column, posterior technique" (ICD code: 81.08; 60.3%). Spondylolisthesis is a problem in Italy and a leading cause requiring spine surgery. Females were the majority of patients requiring surgery for spondylolisthesis. However, for younger age groups, males showed superior or equal need for spine surgery. The socioeconomic impact of spondylolisthesis in Italy is relevant, affecting patients still in the working population. The increasing trend of spine surgery for spondylolisthesis in Italy may be attributable to the widespread diffusion of modern diagnostic and surgical technologies. Level II.

Real-world effectiveness of disease-modifying therapies in older adults with multiple sclerosis

BackgroundDisease-modifying therapies (DMTs) can alter multiple sclerosis (MS) disease course.Peak prevalence age for people with MS (pwMS) has increased, but little is known about MS clinical course or DMT response in older pwMS.The objective of this retrospective analysis of a US administrative claims database to was to evaluate MS disease course, DMT use, healthcare utilisation, and time to relapse during follow-up, in pwMS ≥50 years with active disease. MethodsInclusion criteria were ≥3 years’ continuous enrolment, ≥1 MS relapse (index event), and age ≥50 years. Baseline period was 1 year prior to index event. Follow-up was 2 years.Two patient categories were considered: (i) not under DMT treatment at index date (untreated group) and (ii) under DMT treatment at index date (treated group). ResultsFollowing propensity score matching there were 3,869 patients in the treated and 3,869 patients in the untreated groups.The untreated group numerically spent more days in hospital than the treated group (9.4 vs 7.8 days) and had more emergency room (ER)/urgent care visits (1.3 vs 1.0 visits).There were no observed differences in time to relapse between groups.At index relapse, pwMS were treated with glatiramer acetate (29%), interferons (27%), oral DMTs (29%), or intravenous DMTs (15%). During follow-up, 32% of the untreated group were treated with a DMT, mostly intravenous and oral DMTs. DMT treatment remained largely unchanged in the treated group. ConclusionDMTs may provide shorter hospital stays and less frequent ER visits in older pwMS with active MS. Treatment inertia after relapse was high.

Escalated complement activation during hospitalization is associated with higher risk of 60-day mortality in SARS-CoV-2-infected patients.

The complement system, an upstream recognition system of innate immunity, is activated upon SARS-CoV-2 infection. To gain a deeper understanding of the extent and duration of this activation, we investigated complement activation profiles during the acute phase of COVID-19, its persistence post-recovery and dynamic changes in relation to disease severity. Serial blood samples were obtained from two cohorts of hospitalized COVID-19 patients (n=457). Systemic complement activation products reflecting classical/lectin (C4d), alternative (C3bBbP), common (C3bc) and terminal pathway (TCC and C5a) were measured during hospitalization (admission, days 3-5 and days 7-10), at 3 months and after 1 year. Levels of activation and temporal profiles during hospitalization were related to disease severity defined as respiratory failure (PO2/FiO2 ratio <26.6kPa) and/or admission to intensive care unit, 60-day total mortality and pulmonary pathology after 3 months. During hospitalization, TCC, C4d, C3bc, C3bBbP and C5a were significantly elevated compared to healthy controls. Severely ill patients had significantly higher levels of TCC and C4d (p<0.001), compared to patients with moderate COVID-19. Escalated levels of TCC and C4d during hospitalization were associated with a higher risk of 60-day mortality (p<0.001), and C4d levels were additionally associated with chest CT changes at 3 months (p<0.001). At 3 months and 1 year, we observed consistently elevated levels of most complement activation products compared to controls. Hospitalized COVID-19 patients display prominent and long-lasting systemic complement activation. Optimal targeting of the system may be achieved through enhanced risk stratification and closer monitoring of in-hospital changes of complement activation products.

Candida auris in Greek healthcare facilities: Active surveillance results on first cases and outbreaks from eleven hospitals within Attica region

BackgroundCandida auris was sporadically detected in Greece until 2019. Thereupon, there has been an increase in isolations among inpatients of healthcare facilities. AimWe aim to report active surveillance data on MALDI-TOF confirmed Candida auris cases and outbreaks, from November 2019 to September 2021. MethodsA retrospective study on hospital-based Candida auris data, over a 23-month period was conducted, involving 11 hospitals within Attica region. Antifungal susceptibility testing and genotyping were conducted. Case mortality and fatality rates were calculated and p-values less than 0.05 were considered statistically significant. Infection control measures were enforced and enhanced. ResultsTwenty cases with invasive infection and 25 colonized were identified (median age: 72 years), all admitted to hospitals for reasons other than fungal infections. Median hospitalisation time until diagnosis was 26 days. Common risk factors among cases were the presence of indwelling devices (91.1 %), concurrent bacterial infections during hospitalisation (60.0 %), multiple antimicrobial drug treatment courses prior to hospitalisation (57.8 %), and admission in the ICU (44.4 %). Overall mortality rate was 53 %, after a median of 41.5 hospitalisation days. Resistance to fluconazole and amphotericin B was identified in 100 % and 3 % of tested clinical isolates, respectively. All isolates belonged to South Asian clade I. Outbreaks were identified in six hospitals, while remaining hospitals detected sporadic C. auris cases. ConclusionCandida auris has proven its ability to rapidly spread and persist among inpatients and environment of healthcare facilities. Surveillance focused on the presence of risk factors and local epidemiology, and implementation of strict infection control measures remain the most useful interventions.