Hospital Division Research Articles

Symptomatic Uterine Rudiments in Adolescents and Adults with Mayer–Rokitansky–Küster–Hauser Syndrome (MRKHS): Management and Outcomes

Background: Women with an aplastic uterus (ESHRE/ESGE classification) or Müllerian agenesis (ASRM MAC 2021) might present with functional uterine remnants. Our study aimed to report the clinical course of symptomatic uterine rudiments in adolescents and adults with Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS). Methods: This study involved 20 patients with MRKHS who, between 2012 and 2023, underwent surgery for symptomatic uterine horns at the mean age of 25.2 years in the Division of Gynaecology, Gynaecological and Obstetric Clinical Hospital, Poznan University of Medical Sciences, Poland. The records of the patients were retrospectively analysed. Results: The volume of the uterine horns ranged from 0.8 to 58.3 cm3, and the volume of the endometrial cavity within the horns ranged from 0.03 to 12 cm3, with no significant difference between adolescents and adults (p = 0.36). In five patients (25%), MRKHS was identified during the diagnosis of recurrent pelvic pain at the age of 12.6–14.8 years. In 19 patients, uterine rudiments were removed: unilaterally in 3 patients (16%), bilaterally in 16 patients (84%), and laparoscopically in 89% of cases. In one patient, the horn was preserved (horno-neovaginal anastomosis). Histopathology confirmed the presence of the endometrium in uterine rudiments ipsilateral to the pain location in 75% of cases. Four patients (20%) were diagnosed with endometriosis. Conclusions: Recurrent pelvic pain in patients with MRKHS should prompt the diagnosis of functional uterine rudiments. The resection of symptomatic uterine horns can result in the complete resolution of pain. Patients with endometriosis are at risk of pain recurrence. In some patients strongly desirous of menstruation, horno-neovaginal anastomosis can be cautiously attempted.

Healthcare workers' perspectives on diabetic foot complications among type 2 diabetes mellitus patients in Fiji.

Diabetic Foot Complications (DFCs) are a growing cause of morbidity and mortality with less than one third of physicians able to discern the signs of diabetes related peripheral neuropathy. DFCs and resultant amputations account for a considerable proportion of surgeries in Fiji, with very limited literature available to verify the factors that influence these alarming figures. This study aimed to explore Health Care Workers' (HCWs) perspectives on diabetic foot complications and challenges of foot care management in Fiji. An exploratory descriptive qualitative design was used among HCWs at the Sigatoka Sub Divisional Hospital (SDH), Fiji in 2021. HCWs at the SDH were required to have a minimum work experience of at least six months in public health. All participants who met the inclusion criteria were selected through purposive sampling. Data was collected using a focus group discussion guide composed of semi-structured open-ended questions to guide the Focus Group Discussions (FGDs). Focus discussions were audio recorded and transcribed with thematic analysis applied to derive the themes and sub-themes outlined in the study. Twenty HCWs participated in four FGDs with four major themes identified. The first theme was HCWs' perceptions and practice of foot care which revealed that all participants had adequate diabetic foot care knowledge. The second theme was factors affecting foot care which was mainly focused on identified barriers such as inadequate patient foot care knowledge, the lack of resources such as manpower, and health system challenges like the COVID-19 pandemic. The third theme is creating awareness among patients and HCWs to improve foot care practices. The fourth theme is strengthening foot care practices at the different levels of health care that is aimed at optimizing diabetic foot outcomes. Various foot care barriers namely patient factors and the lack of resources is a concern depicted in this study. There is a need to address health system barriers and enforce diabetic foot education, screening and care for patients and the community.

Knowledge, Aptitude, and Practice Study Regarding Modifiable Factors Among Females Diagnosed With PCOS

Background: Polycystic Ovarian Syndrome (PCOS) is a lifelong endocrine disorder affecting reproductive, metabolic, and psychological health. Despite its prevalence, especially in South Asian populations, awareness of lifestyle modifications for managing PCOS remains inadequate.Objective: To assess the knowledge, attitudes, and practices regarding modifiable factors such as exercise among women diagnosed with PCOS in Pakistan.Methods: A cross-sectional study was conducted over four months at the Divisional Head Quarter Hospital in Gujranwala, Pakistan, involving 255 women aged 18-45 years diagnosed with PCOS. Data were collected using a self-designed Knowledge, Attitude, and Practice (KAP) questionnaire and analyzed with SPSS version 25. Descriptive statistics and Pearson’s correlation were used for analysis.Results: The mean knowledge, attitude, and practice scores were 18.16 (SD = 3.56), 8.45 (SD = 2.66), and 6.57 (SD = 1.74), respectively. 44.31% of participants had poor practice habits, and only 2.7% had been referred to physiotherapists. Emotional distress was common, with 35.3% reporting anxiety.Conclusion: Despite moderate knowledge and favorable attitudes, the adoption of lifestyle modifications for PCOS management is low. A multidisciplinary approach integrating physiotherapy and psychological support is needed to improve health outcomes for women with PCOS.

Clinical features most frequently present in patients with concomitant diabetic kidney disease and diabetic retinopathy.

To evaluate the profile of patients with diabetic kidney disease (DKD) with and without concomitant diabetic retinopathy (DR) to identify clinical predictors of the development of both complications together. Cross-sectional study including patients with type 1 and type 2 diabetes and DKD followed at the endocrinology division of a public hospital in Southern Brazil and referred for retinography assessment. The definition of DR was the occurrence of any diabetes-related damage identified in color fundus photographs under mydriasis. Urinary albumin excretion ≥ 14 mg/L and/or glomerular filtration rate < 60 mL/min/1.73 m2 (CKD-EPI equation) were used to define DKD. Factors evaluated included the clinical differences of the participants according to the presence or absence of DR. Multiple regression models were used to identify predictors of DR presence according to the clinical characteristics evaluated. The study included 517 patients with DKD, 433 (83.7%) of whom had type 2 diabetes (median age 64.7 years [interquartile range 59-73 years] years, 59.8% women, 83.4% white) and 84 (16.3%) had type 1 diabetes (median age 46.6 years [interquartile range 33.5-54.2 years], 46.4% women, 91.7% white). Patients with type 2 diabetes and DR (versus those without DR) were more often on insulin (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.89-7.00), had diabetes for longer (OR 1.04, 95% CI 1.02-1.07), and had higher systolic blood pressure (OR 1.01, 95% CI 1.00-1.02). No predictors of DR presence were identified in participants with type 1 diabetes. Among patients with DKD and type 2 diabetes, insulin use, longer diabetes duration, and higher systolic blood pressure level were associated with the presence of DR.

Multidisciplinary assessment and interventions for childhood auditory processing disorder (APD) and listening difficulties (LiD).

Auditory processing disorder (APD) has been studied in both research and clinic settings, but the relation between the two has not been addressed. In a longitudinal research study (SICLiD), we found that children with clinically normal audiometry who had caregiver-reported listening difficulties (LiD), with or without clinically assessed APD, performed poorly on both listening and cognitive tests. Specific questions asked here were, for the children with LiD, what other neurodevelopmental clinical conditions were identified, what interventions were used by different clinical providers, and how clinical practice was predicted by research results. Study setting was a large, research-led, tertiary pediatric hospital. Electronic medical records of 74 children aged 6-13 years, recruited into SICLiD and assigned to an LiD group based on a validated and reliable caregiver report (ECLiPS), were independently reviewed. Focus was on clinical assessments and interventions following appointments provided in the Hospital Divisions of Audiology, Occupational Therapy, Psychology (Developmental and Behavioral Pediatrics), and Speech-Language Pathology (SLP), prior to participation in SICLiD. Descriptive statistics on clinical encounters, identified conditions, and interventions were compared with quantitative, standardized performance on SICLiD assessments of listening and cognitive function. SICLiD z-scores were compared for participants with and without each clinical condition using univariate and logistic prediction analyses. Most (86%) of the children with LiD had been evaluated by at least one clinical service. Overall, 24 assessment categories related to LiD, including APD, were identified. Most common conditions were attention (32%), language (28%), hearing (18%), anxiety (16%), and autism spectrum (6%) disorders. Performance on SICLiD measures varied significantly between providers, conditions, and interventions. Significant relationships between SICLiD and clinical conditions were mostly caregiver-reported items from the ECLiPS or the Children's Communication Checklist (CCC-2). Other significant correlations were scarce, but included the SCAN composite score, which predicted clinical language and attention, but not other auditory abilities or APD. SICLiD data combined with caregiver reports provided reliable predictions of all clinical conditions except APD. The variety of disciplines, assessments, conditions and interventions revealed here supports previous studies showing that LiD and APD are multifaceted problems of neurodevelopment. Comparisons between clinical- and research-based assessments suggest a diagnostic path that prioritizes caregiver reports and selected psychometric tests for screening and diagnostic purposes.

Predictors of Mortality and the Development of a Risk Score for Gallbladder Adenocarcinoma: A Population-Based Analysis Using Healthcare Cost and Utilization Project National Inpatient Database (HCUP-NIS) Data.

Objective This study aims to identify factors predictive of mortality in patients with gallbladder adenocarcinoma and to develop a risk score to predict poor outcomes using data from the Using Healthcare Cost and Utilization Project National Inpatient Database (HCUP-NIS) database between 2016 and 2020. Methods We conducted a retrospective cohort study analyzing 8596 patients diagnosed with gallbladder adenocarcinoma. Data were extracted using the International Classification of Diseases (ICD) 10th Edition Clinical Modification(CM) code C23. Variables analyzed included age, gender, hospital division, race, income quartile, and APRDRG mortality risk. Logistic regression was utilized to determine the predictors of mortality and develop a risk-scoring system. Descriptive statistics and Chi-squared tests assessed the relationship between variables and mortality, with p-values indicating significance. Results The study population had a mean age of 68.3 years, with 66.6% female patients. The overall mortality rate was 7.2%. Key predictors of mortality included higher All Patients Refined Diagnosis Related Groups (APR DRG) risk of mortality (p<0.001), age (p=0.04), and female gender (p=0.033). Race and hospital division were significantly associated with mortality (p<0.001 and p=0.015, respectively). A logistic regression model incorporating these variables yielded an area under the receiver operating characteristics curve of 0.82, indicating good discriminative ability. The developed risk score categorized patients into low, medium, and high-risk groups, with corresponding mortality rates of 0.88%, 5.28%, and 17.78%. Conclusion This study identified critical predictors of mortality in gallbladder adenocarcinoma patients, with APR DRG risk of mortality and age being the most significant. The developed risk score effectively stratifies patients by risk, potentially guiding clinical decision-making and improving patient outcomes.

Adolescent athlete low back pain diagnoses, characteristics, and management: A retrospective chart review

ObjectivesThe aim of this study was to characterise the presentation, treatment, and management of adolescent athlete low back pain (LBP) as diagnosed in a clinical setting. The objectives were to 1) identify diagnoses associated with LBP in adolescent athletes; 2) categorise the differences in LBP diagnosis and presentation by sport, sex, BMI, and age; and 3) examine treatment and management methods of LBP in adolescent athletes. DesignRetrospective chart review. MethodsThis retrospective medical chart review was conducted in the Sports Medicine Division of Boston Children's Hospital (BCH), a tertiary paediatric academic hospital. Data were collected and analysed from 363 adolescent athletes who had experienced LBP between 2015 and 2020. Chi-squared tests for association were used to assess for associations between LBP diagnoses and age, sex, BMI, and sport. Statistical analysis was conducted using SAS software version 9.4 (SAS Institute, Cary NC). ResultsNon-specific LBP was the most common LBP diagnosis amongst 363 adolescent athletes with LBP (34 %). This was closely followed by spondylolysis (28 %). There was a higher proportion of female athletes amongst participants diagnosed with facet-joint related pain (90 %) and SI-joint related pain (89 %) compared to the proportion of female athletes amongst participants diagnosed with spondylolysis (50 %). There was a high rate of diagnostic MRI usage in this cohort. Commonly used management techniques in this cohort were diagnostic MRI, physical therapy, relative rest, and bracing. ConclusionsAn awareness of the sex-based differences in adolescent athlete LBP diagnoses may be useful for clinicians. It may be important to refine methods of diagnosis of LBP in this group, as there was a high rate of diagnostic MRI use. Future research should be directed towards the development of management guidelines specific to LBP in adolescent athletes to assist in the optimal management of this diagnosis.

An investigation of the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer: a randomized controlled trial

BackgroundBreast cancer is an extremely unpleasant and unbearable experience that can have a profound impact on a person’s life. Compared to other types of cancer, breast cancer has a more severe psychological impact on women.PurposeThis study aimed to investigate the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer.MethodA sample of 30 women with breast cancer were randomly divided into intervention and control groups. The research was conducted in the oncology division of Imam Reza Hospital in Kermanshah by the clinical trial method with a two-group pretest–posttest design and a 2 month follow-up. Participants in the intervention group received Mindfulness-integrated cognitive behavior therapy for eight sessions. The intervention was carried out individually in weekly 60 min sessions. While the control group received self-help treatment (through an educational book). A demographic questionnaire, Demoralization Scale (DS-II), Body Image Scale (BIS), and Female Sexual Function Index (FSFI) were used to collect data. For data analysis, means and standard deviations were calculated and repeated measures and the Bonferroni test was conducted using SPSS 26.ResultsThe results showed the effectiveness of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function (p < 0.05). Concerning demoralization in the intervention group, the pre-test mean was 16.73 ± 3.33, and it reduced to 11.93 ± 1.49 in the post-test. The body image mean score showed a decreasing trend in the intervention group, from 12.47 ± 1.88 in the pre-test to 8.80 ± 3.21 in the post-test. The mean score for sexual function showed an increasing trend, increasing from 18.06 ± 2.29 in the pre-test to 23.07 ± 0.91 in the post-test. There was no significant difference in the mean score of the post-test compared to the pre-test and follow-up in the control group (p < 0.05).ConclusionMICBT can be used in conjunction with pharmaceuticals and medical treatments to improve the psychological symptoms of women with breast cancer, according to this study’s results.Trial registration (IRCT20160103025817N6). 2022-04-06.

Nursing students led simulations to improve healthcare workers’ hand hygiene compliance

Background Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance. Objective This study aimed to assess the effect of simulation interventions led by nursing students on HCWs’ HHC. Method A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel. Results Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement. Conclusion Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.

Immuno-Diagnostic Interest in Monitoring CD16+CD56+ (Natural Killer) Cells and CD19+CD45+ (B Lymphocytes) in Individuals Newly Diagnosed with HIV in a Tertiary Care Center.

Monitoring multiple cellular markers of immune cells may provide a more accurate evaluation of the immune status of people living with human immunodeficiency virus (PLHIV). This study assessed the value of CD16+CD56+ cells (NK cells) and CD19+ lymphocytes (B cells) phenotyping in indicating viral load, AIDS status, and treatment efficacy. A retrospective, laboratory-based study was conducted at the Diagnostic immunology division of a referral tertiary hospital. It involved 82 newly diagnosed HIV patients treated between 2009-2016. We explored three objectives: (1) the paired change in CD16+CD56+ and CD19+CD45+ cells counts and percentages from baseline to 2-to-6 months after treatment; (2) the association of these phenotypes with 5 gradual categories of viral load; and (3) the accuracy of CD16+CD56+ and CD19+CD45+ cells counts in indicating AIDS stage defined as CD4+ < 200 cells/mm3. The second and third objectives were tested using a pooled analysis (N = 300-373). The median CD19+CD45+ and CD16+CD56+ counts increased by 1.9-fold and 1.3-fold after treatment respectively (p < 0.001). A negative correlation of viral load with both CD16+CD56+ (ρ = -0.29, p < 0.001) and CD19+CD45+ (ρ = -0.34, p < 0.001) counts was observed. CD16+CD56+ count < 73 cells/mm3 and CD19+CD45+ count < 166.5 were indicative for AIDS with 95.5% and 63.6% sensitivity respectively. Findings advocate for the usefulness of CD16+CD56+ and CD19+CD45+ phenotyping in characterizing the severity of HIV infection and its impact on both the humoral and cellular immunity, as well as monitoring the effectiveness of treatment.

Multidisciplinary atopic dermatitis program: A novel approach to managing difficult-to-control atopic dermatitis patients.

Disease improvement for difficult-to-control pediatric atopic dermatitis may be more challenging to achieve when directed by single specialties due to disjointed and conflicting dialogue with patients. The Multidisciplinary Atopic Dermatitis Program (MADP) was developed through collaborations with the Rady Children's Hospital and UC San Diego Health Divisions of Dermatology, Allergy & Immunology and Clinical Pharmacy, to create team-based evaluation and management of children and adolescents with atopic dermatitis (AD). The MADP allows concurrent, comprehensive evaluations by multiple specialists to develop treatment plans. The program includes extensive patient education to support shared decision making, incorporating patient and family's perspectives along with those of clinical experts into their care. Objective severity measures and patient reported outcome data were collected, along with assessment of patient and family satisfaction with the MADP. Data showed significant improvement in AD severity as assessed by providers, patients and families by the first follow-up visit. BSA mean percentage decreased by up to 56% by the 7th visit, and pruritus (NRS), CLDQI and POEM mean scores decreased by more than 4 points, 12 points, and over 11 points, respectively. After management was initiated in the MADP, 72.73% of patients achieved an EASI 50 and 47.73% achieved an EASI 75 from a baseline mean of 21.7. Patients who continued in clinic beyond the second visit showed further clinically significant decreases in disease measures. The multidisciplinary approach shows success in the treatment of difficult-to-control AD patients with improvements in clinician and patient reported outcome measures.

Intra‐tumoral tumor infiltrating Lymphocyte‐T CD8+ and chemotherapy response in colorectal cancer: A prospective observational study

Background: The immunotherapy approach to colorectal cancer is becoming one of the key approaches to colorectal cancer treatment. One of the components of immune responses is tumor‐infiltrating lymphocyte CD8+ cells (TILs CD8+). While chemotherapy is one of the main treatments for colorectal cancer, we need to consider immunotherapy for advanced colorectal cancer. Thus, this study is aimed at finding the association between TIL CD8+ expression and chemotherapy response. Methods: This is a prospective cohort study with colorectal cancer patients in the Digestive Surgery division of a tertiary general hospital in West Java, Indonesia. An immunohistochemistry examination was used to evaluate the expression of TIL CD8+. The response evaluation criteria in solid tumors (RECIST) were used for the evaluation of chemotherapy response. Results: There were 53 research subjects included. There were 20 (37.7%) subjects with high expression of TILs CD8+; there were 30 (56.6%) subjects in stage III, followed by stage IV (17.32%) and stage II (6.11%). There were 18 subjects (34%) who showed progressive disease, 17 subjects (32.1%) showed partial response, and 16 subjects (30.2%) with high expression of TILs CD8+ showed partial chemotherapy response. The TILs CD8+ expression showed no significant relationship with age, sex, subtype, grade, or tumor location, but showed a significant relationship with stage and chemotherapy response (P &lt; 0.05). Conclusion: High TILs CD8+ expression show a relationship with better chemotherapy response and a better prognosis based on disease stage in colorectal cancer patients.

Revie ⊕: Impact of a resource-based life review intervention on patients with advanced cancer: A waitlist controlled trial

PurposeLife review interventions aim to support individuals facing an incurable disease accompanied by existential concerns and health-related challenges. Based on encouraging feasibility results, this study assessed the effects of Revie ⊕ life review intervention on the self-esteem of patients with advanced cancer, and the effects on well-being, post-traumatic growth, life satisfaction, symptom burden and interaction with nurses. MethodThe study consisted of a two-arm parallel-group, waitlist-controlled trial (WCT) in the oncology division of a Swiss-French University Hospital. Revie ⊕ was composed of nurse-led meeting with the patient to address and document significant life events using a strengths-focused approach and targeting the life project. ResultsDue to Covid-19 pandemic, adjustments were made regarding study duration and participant's allocation: Fifty-eight patients received Revie ⊕, 39 completed all the measurements. Self-esteem was high at baseline and maintained stability over time. The social well-being decreased in the intervention group before-after Revie ⊕ (−1.7 (3.9), p = 0.044) while emotional and functional well-being showed stability. The intensity of symptoms decreased in the intervention group before-after Revie ⊕: 4.9 (9.4), p = 0.020. ConclusionsThis study suggests that patients living with an advanced cancer and who received Revie ⊕ intervention may have maintained their self-esteem high over time. Observed results are promising, particularly considering the influence of the pandemic. Nevertheless, these findings do not allow us to draw definitive conclusions regarding the efficacy of the intervention on self-esteem. WCT seems not to be the appropriate design to highlight the added value of Revie ⊕ for this particularly vulnerable population. Clinical trial registration numberNCT04254926.

Screening for diabetes complications and associated factors in primary care in Galle, Sri Lanka

Introduction: Diabetes (DM) and its complications show an increasing trend and pose a huge burden on the health system. Thus, early detection of complications is essential. Primary care institutions treat and follow up patients with diabetes in their territories. The aim of the study was to assess awareness, practices, and service-related factors associated with screening for diabetes complications among patients attending the medical clinics of primary care level hospitals in the Galle district.Methods: A descriptive cross-sectional study was conducted at three Divisional Hospitals in Galle District, among patients attending medical clinics. Data was collected through an interviewer-administered questionnaire designed to assess awareness and screening practices for diabetes complications, screening done for diabetes complications, and associated factors were analyzed.Results: Four hundred patients with diabetes participated in the study. The majority (more than 95%) were aware of common organs affected by DM and were aware of investigations and their availability at primary care institutions (more than 85.0%). Adherence to recommended screening tests and frequency was very low (ranging from 3% to 16%) and nearly half of the patients never had any form of screening. Older age was associated with better retinopathy screening {OR = 0.61 95% CI (0.41-0.91)} while having co-morbidities was associated with better screening for retinopathy {OR = 1.67 95% CI (1.02-2.71)} and ischemic heart disease.{OR = 2.03 95% CI (1.22-3.40)}. A better awareness was associated with better screening for DM complications.Conclusions: In conclusion, awareness about screening for diabetes complications was satisfactory among the study sample. However, the screening practices were sub-optimal as the recommended screening protocols have not been followed. Better screening was associated with better awareness, older age, having comorbidities, and being employed.

Correlates of Intentional and Unintentional Firearm-Related Injuries Among Pediatric Hospital Patients

ABSTRACT Gun violence has continued to be the leading cause of pediatric injuries in recent years (CDC, 2022). Given the sparse literature on this topic, the current study examined correlates of the types of firearm-related injuries (i.e. intentional and unintentional) among pediatric patients within the Trauma Services Division of a Level-1 pediatric hospital (N = 87). The results indicated that patients in later developmental stages, particularly adolescence, and those with higher ACE score were significantly more likely to experience an intentional firearm injury, whereas white patients were significantly less likely to experience an intentional firearm injury, highlighting the structural factors that increase the risk of firearm violence including poverty and systemic racism. We discuss the implications and need for expanded hospital- and school-based violence prevention programs.

Analysis of Hospitalization Outcomes in Bone Marrow Transplant Patients with Graft-Versus-Host Disease: A Nationwide Study

Background: Graft-versus-host disease (GVHD) is a well-known complication in patients with bone marrow transplantation. There is a need for additional data on the in-patient outcomes of GVHD in patients who have undergone bone marrow transplantation. Our analysis aims to evaluate the outcomes of GVHD in hospitalized patients with bone marrow transplantation. Method: In this retrospective study, we utilized data from the National Inpatient Sample (NIS) database from 2016 to 2019. Using ICD-10 codes, we identified hospitalizations involving bone marrow transplantation and categorized them into two groups: those with GVHD and those without GVHD. To account for potential confounding variables, we considered a comprehensive set of factors, including age, sex, race, zip code-based income quartile, hospital region, hospital teaching status, hospital division, hospital bed size, insurance status, and the Charlson comorbidity index score. We performed univariable logistic regression analysis to calculate unadjusted odds ratios. Subsequently, we conducted a multivariable logistic regression analysis to account for potential confounding effects and calculated adjusted odds ratios.(see Figure), where the model included only variables that were found to be associated with the outcome of interest in the univariable regression analysis at a significance level of P &amp;lt; 0.2. Proportions were compared using the Fisher exact test for categorical variables, and continuous variables were compared using the Student t-test. All P-values were two-sided, and the significance level was set at P &amp;lt; 0.05, indicating statistical significance. Results: From 2016 to 2019, data were collected from 13,999 hospitalizations involving bone marrow transplants. Among these cases, 836 hospitalizations were linked to GVHD patients. A comparison of patient characteristics showed that individuals with GVHD had a mean age of 51.61 years, while those without GVHD had a slightly higher mean age of 55.55 years. There were slight variations in gender and race distributions between the two groups, with a higher percentage of males and whites observed in the GVHD group compared to the group without GVHD. The analysis of outcomes between the two groups revealed significant differences. Patients with GVHD experienced notably longer mean lengths of stay (41.40 days vs. 21.31 days, P = 0.000) and incurred higher mean total hospital charges ($824,058 vs. $335,765, P = 0.000). Furthermore, after adjusting for confounding factors, GVHD posed a substantial risk to patients undergoing bone marrow transplantation. The adjusted odds ratio (aOR) for mortality in those with GVHD was 7.20 (95% CI: 5.54 to 9.36, P = 0.000) compared to those without GVHD, indicating a considerably higher risk of death. The coefficient for the length of stay was 19.36 days (95% CI: 17.29 to 21.42), and the coefficient for total hospital charges was $453,733 (95% CI: $396,577 to $510,889) in patients with GVHD compared to those without GVHD hospitalizations. Moreover, the presence of GVHD in patients was associated with elevated risks of various medical conditions. The adjusted odds ratios (aORs) for sepsis, pneumonia, acute respiratory failure, intubation and mechanical ventilation, Clostridium difficile infection, and acute kidney injury (AKI) in patients with GVHD were 2.79 (95% CI: 2.28 to 3.41, P = 0.000), 3.30 (95% CI: 2.57 to 4.24, P = 0.000), 5.10 (95% CI: 4.01 to 6.49, P = 0.000), 4.88 (95% CI: 3.75 to 6.34, P = 0.000), 1.45 (95% CI: 1.13 to 1.86, P = 0.003), and 3.57 (95% CI: 2.97 to 4.29, P = 0.000), respectively (see Figure). Conclusion: Patients with GVHD in patients with bone marrow transplantation experience higher mortality rates, extended hospital stays, and increased hospital charges. Additionally, they are at a significantly higher risk of developing severe medical conditions, including sepsis, pneumonia, acute respiratory failure, Clostridium difficile infection, and acute kidney injury (AKI). These findings highlight the importance of closely monitoring and effectively managing GVHD to enhance patient outcomes and alleviate the burden of complications associated with bone marrow transplantation. Nevertheless, further prospective studies are necessary to gain a deeper understanding and more comprehensive evaluation of the outcomes in these hospitalized patients.

A Nationwide Analysis of Risks and Outcomes in Hospitalized Patients with Immune Thrombocytopenia and COVID-19 Infection

Background: Insufficient data exists on COVID-19 risks and hospitalization outcomes in patients with immune thrombocytopenia (ITP). Our analysis aims to assess risks and outcomes associated with COVID-19 in ITP patients. Method: In this retrospective study, we obtained data from the National Inpatient Sample (NIS) database for the year 2020. Hospitalizations for ITP were identified using ICD-10 codes, further classified into those with and without COVID-19 infection (Table 1). To account for potential confounding factors, we considered variables such as age, sex, race, zip code-based income quartile, hospital region, hospital teaching status, hospital division, hospital bed size, and insurance status. Additionally, the Charlson index and relevant comorbid conditions such as smoking, alcohol use, illicit drug use, hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), atrial fibrillation (AF), liver disease, and chronic use of anticoagulants were included. Firstly, univariable logistic regression analysis calculated unadjusted odds ratios (ORs). Then, to adjust for potential confounders, a multivariable logistic regression analysis was performed to calculate adjusted odds ratios (aORs) (Table 2). The multivariable logistic regression model only included variables associated with the outcome of interest in univariable regression analysis at P &amp;lt; 0.1. Proportions were compared using the Fisher exact test, and continuous variables were compared using the Student t-test. All P-values were two-sided, with a significance threshold of .05. Results: Data from 10,831 hospitalizations for ITP in 2020 were gathered. Among those, 563 hospitalizations were of patients with COVID-19. Unadjusted data revealed minimal differences in the mean age between both groups, but there was a statistical difference between COVID-positive and COVID-negative males (48.2% vs. 42.9%) and females (51.8% vs. 57.0%). White race had the highest number of patients in both groups with a statistical difference of 62.5% vs. 68.5%, p=0.000 compared to other races. Moreover, COVID-positive patients with ITP had a significantly higher rate of comorbidities like hypertension (67.8% vs. 60.2%, p=0.000) and diabetes mellitus (38.5% vs. 28.9%, p=0.000). On the other hand, there was no statistical difference between groups with associated comorbidities like smoking, alcohol, illicit drugs, COPD, CHF, CAD, atrial fibrillation, liver disease, and chronic anticoagulation use. ITP patients with COVID-19 showed a significantly longer median length of stay (10.7 days vs. 6.3 days; p=0.000) and higher overall cost-of-hospitalization ($136,915 vs. $98,657; p=0.000). After adjusting for potential confounders using multivariate logistic regression, we found that ITP patients with COVID-19 had notably higher odds of mortality (adjusted odds ratio (aOR) = 5.42, 95% CI: 4.18 to 7.03, p=0.000), longer hospital stays (Coefficient: 4.31 days, 95% CI: 3.31 to 5.30, p=0.000), and increased total hospital charges (Coefficient: $37,243, 95% CI: $20,137 to $54,350, p=0.000). However, there were no statistically significant differences in the administration of PRBC transfusions, platelet transfusions, or immunoglobulin transfusions between the two groups. Additionally, no notable distinctions in the odds ratio of experiencing intracranial bleeding, gastrointestinal (GI) bleeding, myocardial infarction (MI), or acute cerebrovascular accident (CVA) were observed between ITP patients with and without COVID-19. Conclusion: In conclusion, this study highlights the higher risks and poorer hospitalization outcomes associated with COVID-19 in patients with immune thrombocytopenic purpura. The results of our study highlight the significance of taking COVID-19 infection into account when managing and evaluating outcomes in ITP patients, as it seems to be linked to more severe disease manifestations and higher utilization of healthcare resources. Further research and prospective studies are necessary to gain a deeper understanding and address the implications of COVID-19 in this particular patient population.

Effectiveness of Basic Quality Improvement Techniques in Reducing Patient Waiting Time for Outpatient Services at Primary Care Hospitals - An Interventional Study at Two Sri Lankan Divisional Hospitals

Effectiveness of Basic Quality Improvement Techniques in Reducing Patient Waiting Time for Outpatient Services at Primary Care Hospitals - An Interventional Study at Two Sri Lankan Divisional Hospitals

Improving Asthma Action Plan Completion Rates across Five Divisions in an Academic Children's Hospital.

Asthma is the most common chronic disease among children. Asthma Action Plans (AAPs) enable asthma self-management tailored to each patient and should be updated annually. At our institution, providers face challenges in creating reliable processes to consistently complete AAPs for patients with asthma. This project's aim was to increase the percentage of patients across five hospital divisions who have an up-to-date AAP from 80% in May 2021 to 85% by October 1, 2021. We launched a quality improvement (QI) project using the Model for Improvement, focusing on improving AAP completion rates across five hospital divisions providing ambulatory care for asthma patients. The divisions (Adolescent/Young Adult Medicine, Allergy, Pulmonary, and two Primary Care sites) participated in the QI process using tools to understand the problem context. They implemented a cross-divisional AAP completion competition from June to October 2021. Each month during Action Periods, divisions trialed their interventions using Plan-Do-Study-Act cycles. We held monthly Learning Sessions for divisions to collaborate on successful intervention strategies. Statistical process control chart analysis demonstrated that the overall AAP completion rate increased from a baseline of 80% to 87% with the initiation of the competition. All divisions showed improvement in AAP completion rates during the active intervention period, but sustainment varied. The cross-divisional competition motivated five divisions to improve processes to increase AAP completion rates. This approach effectively fostered engagement and idea sharing to boost performance, and may be considered for other QI projects.

Racial differences in healthcare expenditures for prevalent multimorbidity combinations in the USA: a cross-sectional study

BackgroundWe aimed to model total charges for the most prevalent multimorbidity combinations in the USA and assess model accuracy across Asian/Pacific Islander, African American, Biracial, Caucasian, Hispanic, and Native American populations.MethodsWe used Cerner HealthFacts data from 2016 to 2017 to model the cost of previously identified prevalent multimorbidity combinations among 38 major diagnostic categories for cohorts stratified by age (45–64 and 65 +). Examples of prevalent multimorbidity combinations include lipedema with hypertension or hypertension with diabetes. We applied generalized linear models (GLM) with gamma distribution and log link function to total charges for all cohorts and assessed model accuracy using residual analysis. In addition to 38 major diagnostic categories, our adjusted model incorporated demographic, BMI, hospital, and census division information.ResultsThe mean ages were 55 (45–64 cohort, N = 333,094) and 75 (65 + cohort, N = 327,260), respectively. We found actual total charges to be highest for African Americans (means $78,544 [45–64], $176,274 [65 +]) and lowest for Hispanics (means $29,597 [45–64], $66,911 [65 +]). African American race was strongly predictive of higher costs (p < 0.05 [45–64]; p < 0.05 [65 +]). Each total charge model had a good fit. With African American as the index race, only Asian/Pacific Islander and Biracial were non-significant in the 45–64 cohort and Biracial in the 65 + cohort. Mean residuals were lowest for Hispanics in both cohorts, highest in African Americans for the 45–64 cohort, and highest in Caucasians for the 65 + cohort. Model accuracy varied substantially by race when multimorbidity grouping was considered. For example, costs were markedly overestimated for 65 + Caucasians with multimorbidity combinations that included heart disease (e.g., hypertension + heart disease and lipidemia + hypertension + heart disease). Additionally, model residuals varied by age/obesity status. For instance, model estimates for Hispanic patients were highly underestimated for most multimorbidity combinations in the 65 + with obesity cohort compared with other age/obesity status groupings.ConclusionsOur finding demonstrates the need for more robust models to ensure the healthcare system can better serve all populations. Future cost modeling efforts will likely benefit from factoring in multimorbidity type stratified by race/ethnicity and age/obesity status.