Hospital Beds Research Articles

Current practices and challenges of outpatient parenteral antimicrobial therapy: a narrative review.

Extended hospitalization for infection management increases inpatient care costs and the risk of healthcare-associated adverse events, including infections. The growing global demand for healthcare, the diminishing availability of hospital beds and an increasing patient preference for care within their own home have been the primary drivers of the expansion of hospital-in-the-home programmes. Such programmes include the use of IV antimicrobials in outpatient settings, known as outpatient parenteral antimicrobial therapy (OPAT). However, OPAT practices vary globally. This review article aims to describe the current OPAT practices and challenges worldwide. OPAT practice begins with patient evaluation and selection using eligibility criteria, which requires collaboration between the interdisciplinary OPAT team, patients and caregivers. Depending on care requirements, eligible patients may be enrolled to various models of care, receiving medication by healthcare professionals at outpatient infusion centres, hospital clinics, home visits or through self-administration. OPAT can be used for the management of many infections where an effective oral treatment option is lacking. Various classes of parenteral antimicrobials, including β-lactams, aminoglycosides, glycopeptides, fluoroquinolones and antifungals such as echinocandins, are used globally in OPAT practice. Despite its benefits, OPAT has numerous challenges, including complications from medication administration devices, antimicrobial side effects, monitoring requirements, antimicrobial instability, patient non-adherence, patient OPAT rejection, and challenges related to OPAT team structure and administration, all of which impact its outcome. A negative outcome could include unplanned hospital readmission. Future research should focus on mitigating these challenges to enable optimization of the OPAT service and thereby maximize the documented benefits for the healthcare system, patients and healthcare providers.

Effective health systems facing pandemic crisis: lessons from COVID-19 in Europe for next emergencies

PurposeThe investigation goal is the analysis of the relation between healthcare expenditures and other resources, and COVID-19 fatality rates among European countries to design effective health policies for crisis management.Design/methodology/approachResearch methodology is based on descriptive statistics and various parametric methods, also including a linear model of regression to analyze basic relationships of variables under study.FindingsResults show that a lower COVID-19 fatality rate is associated with higher levels of health expenditure (% GDP), of healthcare expenditure per capita, health expenditure in preventive care (% GDP), hospitals per million inhabitants, physicians, nurses, hospital beds and curative acute care beds per 1,000 inhabitants. Regression analysis shows that a 1% increase in healthcare expenditures per capita of countries, it reduces the level of COVID-19 fatality rate by 0.74%. In fact, many countries in Eastern Europe with low healthcare expenditures per capita in 2019 (e.g., Bulgaria, Romania, Hungary, Poland, Latvia, Slovakia, Lithuania, etc.), they have experienced high COVID-19 fatality rates. Instead, a lot of countries in Western Europe, with high healthcare expenditures per capita, such as Germany, Denmark, Austria, and the Netherlands, they had resilient health systems to face pandemic crisis and lower COVID-19 fatality rates.Practical implicationsThese findings suggest strategies of systematic and continuous investments in healthcare, medical technologies, and ICT infrastructures to support effective health policy of crisis management in countries to face future pandemic crisis and other emergencies in society.Originality/valueThe explanation of critical role of high health expenditure (% GDP) and healthcare expenditure per capita to support robust health systems that bolster the resilience in nations to face health emergencies and worldwide crises.

Addressing Hospital Overwhelm During the COVID-19 Pandemic by Using a Primary Health Care-Based Integrated Health System: Modeling Study.

After strict COVID-19-related restrictions were lifted, health systems globally were overwhelmed. Much has been discussed about how health systems could better prepare for future pandemics; however, primary health care (PHC) has been largely ignored. We aimed to investigate what combined policies PHC could apply to strengthen the health care system via a bottom-up approach, so as to better respond to a public health emergency. We developed a system dynamics model to replicate Shanghai's response when COVID-19-related restrictions were lifted. We then simulated an alternative PHC-based integrated health system and tested the following three interventions: first contact in PHC with telemedicine services, recommendation to secondary care, and return to PHC for recovery. The simulation results showed that each selected intervention could alleviate hospital overwhelm. Increasing the rate of first contact in PHC with telemedicine increased hospital bed availability by 6% to 12% and reduced the cumulative number of deaths by 35%. More precise recommendations had a limited impact on hospital overwhelm (<1%), but the simulation results showed that underrecommendation (rate: 80%) would result in a 19% increase in cumulative deaths. Increasing the rate of return to PHC from 5% to 20% improved hospital bed availability by 6% to 16% and reduced the cumulative number of deaths by 46%. Moreover, combining all 3 interventions had a multiplier effect; bed availability increased by 683%, and the cumulative number of deaths dropped by 75%. Rather than focusing on the allocation of medical resources in secondary care, we determined that an optimal PHC-based integrated strategy would be to have a 60% rate of first contact in PHC, a 110% recommendation rate, and a 20% rate of return to PHC. This could increase health system resilience during public health emergencies.

The Impact of Outpatient Parenteral Antimicrobial Therapy (OPAT) in Al Hada Armed Forces Hospital, Taif, Saudi Arabia

Background In the realm of healthcare quality, outpatient parenteral antimicrobial therapy (OPAT) has emerged as the gold standard for managing patients who have transitioned from inpatient care but still require extended intravenous antimicrobial treatment. The adoption of OPAT at Al Hada Armed Forces Hospital in Taif, Saudi Arabia, not only bolsters patient satisfaction but also serves as a catalyst for reduced hospitalization durations, lower rates of emergency department readmissions, and an overall reduction in healthcare expenditures. The main objective of this study was to evaluate the effectiveness of OPAT in a tertiary center facility in Saudi Arabia. Methods In this retrospective investigation, we conducted a thorough review of patient records spanning from November 2020 to October 2021. Our study encompassed all patients who had intravenous antibiotics and were participants in the hospital’s OPAT program during this specific timeframe. Our primary goal was to achieve a 20% reduction in the total number of hospital bed days related to long-term antibiotic therapy. Results The incorporation of OPAT has yielded a multifaceted transformation within the hospital. Over the span of one year, from November 2020 to October 2021, there was a notable decrease in the proportion of patients requiring intravenous antibiotics. This percentage initially dropped from 23% to 12% with the implementation of the OPAT quality improvement project, and later, it reached an even lower 8%. This positive transformation not only had a positive impact on patient care but also led to significant cost savings, exceeding 2 million riyals. These savings were primarily driven by the reduction in hospitalization duration and the more efficient allocation of resources. Moreover, this improvement contributed to the avoidance of 673 patient days of hospitalization, thereby creating additional resources for more critical cases. Conclusion OPAT has emerged as a pivotal component of Al Hada Armed Forces Hospital’s commitment to elevating healthcare quality. This abstract offers a concise insight into the quality-driven impact of OPAT within a specific healthcare context, underlining its capacity to optimize patient care, enhance healthcare efficiency, and elevate resource allocation. Ongoing research and continuous evaluation will play a critical role in refining and expanding the OPAT program while preserving its quality-oriented perspective.

Does haze-related sentiment affect income inequality in China?

We investigate the effect of haze-related sentiment on urban–rural income inequality of prefecture-level cities in China. Income inequality is captured by the Theil index, the ratio and the difference between urban–rural income. We use GPT-3.5 models to conduct the sentiment analysis on the haze-related posts retrieved from the Weibo platform from 2018 to 2021. The generated emotion score and the number of posts are used to construct the haze-related sentiment measure. We find that haze-related unhappiness exacerbates urban–rural income inequality. The net population flow is investigated as the mechanism, indicating that negative sentiment reduces the net flows of both the floating population and resident population and consequently increases income inequality. The heterogeneity analysis finds that the effects of haze-related unhappiness on income inequality are smaller in cities with more hospital beds, doctors, and green spaces. Furthermore, the effects of the sentiment measure on income inequality vary significantly across cities in different geographic locations.

QAPI 146 - No Catheter, No CAUTI! Implementing Leadership Rounds to Decrease Device Utilization and CAUTI Rates in a 500-bed Acute Care Hospital

QAPI 146 - No Catheter, No CAUTI! Implementing Leadership Rounds to Decrease Device Utilization and CAUTI Rates in a 500-bed Acute Care Hospital

Impact of frailty on hospitalized patients with prostate cancer: A retrospective analysis.

e23054 Background: The impact of Hospital frailty risk score on outcomes in hospitalized patients with prostate cancer has not been previously studied. This research aimed to examine the association between frailty and prostate cancer outcomes. Methods: This retrospective study utilized hospitalization data from the National Inpatient Sample (NIS) between January 1, 2020, and December 31, 2020. Data of patients with a primary or secondary discharge diagnosis of prostate cancer (ICD10-CM codes C61.0, D07.5, and Z85.46) were obtained. The objective was to evaluate the correlation between frailty and prostate cancer. Multivariate analysis was performed, stratified by race, age, Charlson index, median annual income in the patient's zip code, hospital bed size, teaching status, and census division of the hospital. Results: A total of 51,980 hospitalizations for prostate cancer were identified, with 72.7% in the intermediate to high frailty score (IHFS) group and 27.3% in the low frailty score (LFS) group. The IHFS group had a higher unadjusted in-hospital mortality rate than the LFS group (5.85% vs. 1.2%). Patients with IHFS had increased odds of adjusted mortality compared to those with LFS (adjusted odds ratio [aOR] = 4.45, 95% Cl [3.80-5.22], P &lt; 0.01). Hispanic and Black race patients also had increased odds of adjusted mortality compared to Caucasian race patients (aOR = 1.42, 95%CI [1.19-1.70], P &lt; 0.01); aOR = 1.16, 95%CI [1.00-1.32], P = 0.037, respectively). Additionally, the IHFS group had longer lengths of stay (5.65 ± 0.038 vs. 3.26 ± 0.28 days) and higher adjusted total costs ($66,107 ± 850 vs. $64,308 ± 1066) compared to the LFS group. Conclusions: Patients with prostate cancer and a high hospital frailty risk score exhibited significantly higher mortality rates, longer lengths of stay, and increased total adjusted costs. Frailty assessment plays a crucial role in predicting outcomes in patients with prostate cancer. Physicians can use frailty assessment to stratify patients based on risk and improve their ability to anticipate consequences.

Association of characteristics of cancer, patient, and county with telemedicine services use: Impact of the waiver of reimbursement restrictions on telemedicine.

11058 Background: Telemedicine services have great potential to improve access to care of cancer patients who are vulnerable in health status and may experience financial hardship due to the cost of their care. However, very little is known about how the Centers for Medicare and Medicaid Services’ waiver of reimbursement restrictions on telemedicine and characteristics of cancer affected their use of telemedicine services. We examined the changes in frequency of telemedicine use before and after the waiver and, after the waiver, the determinants of telemedicine use across medical provider types. Methods: We used the 5% Surveillance, Epidemiology and End Results registry file linked to Medicare data among patients who had a newly diagnosed cancer in 2019 and were enrolled in Medicare Parts A and B during 2019-2020, and Area Health Resources File. Our outcomes were binary variables of telemedicine services use in outpatient (OP), office-based clinics (OB), and emergency department (ED), respectively, and for detailed provider types in OB. Primary independent variables included the ten most frequently observed cancer sites (reference: all other sites), sequence of cancer, stage of diagnosis, and quarter of diagnosis in 2019. Analysis was by a multilevel mixed effects logistic regression model, adjusting characteristics of cancer, patient and county. Results: Among eligible patients (n = 14,226), telemedicine services use for all provider types increased from 4.3% in pre-waiver period to 40.3% (5.2% in OP, 39.3% in OB, and 0.2% in ED) in post-waiver period. Telemedicine services use varied by primary cancer site, but was higher for those with a cancer recurrence (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.16-1.60) and advanced cancer stage (OR 1.24, 95% CI 1.03-1.48). For visits to oncologists, cancer characteristics such as recurrence (OR 1.67, 95% CI 1.34-2.08), advanced stage (OR 5.52, 95% CI 4.12-7.40) and diagnosis in the last quarter in 2019 (OR 1.39, 95% CI 1.20-1.61) were associated with greater use of telemedicine. Patients of older age and minority race/ethnicity and in non-Northeast regions were less likely to use telemedicine, while women, patients with dual eligibility for Medicaid, and those living in a county with high median household income and high availability of hospital beds were more likely to use telemedicine. Conclusions: Cancer patients used telemedicine services more frequently after the waiver and their cancer characteristics were most strongly associated with that use, implying their greater need for, and benefit from, telemedicine. Disparities in telemedicine use related to individual and county-level socio-demographics and medical supply suggest health policy changes to improve equitable access to telemedicine and efficient cancer care planning.

Is essential thrombocytosis associated with worse outcomes in patients with stroke? Results from 2016-2020 National Inpatient Sample study.

e23060 Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm. Thrombosis is a major cause of morbidity and mortality in ET. It is unknown whether the morbidity and mortality of ischemic stroke in ET is different from that in non-ET patients. Similarly, the quantitative data regarding the use of platelet pheresis in this population is also unknown. This National Inpatient Sample (NIS) database study aims to answer these questions. Methods: A retrospective analysis of the NIS database from 2016 to 2020 was conducted using ICD-10 codes to identify hospitalizations with ischemic stroke. STATA version SE18.0 was used for statistical analysis. We used multivariate regression analysis to calculate the effects of ET on mortality and length of stay along with various other variables including age, gender, primary payer, household income, Charlson Comorbidity index, hospital bed size, hospital region, diabetes mellitus, heart failure, hypertension, coronary artery disease, smoking, hyperlipidemia, carotid artery stenosis, and atrial fibrillation. Results: There were 2,635,595 hospitalizations with primary diagnosis of ischemic stroke. Among these, 9604 patients had secondary diagnosis of ET. The mean age of ET patients with stroke was 67 years. 60.5% of patients were females. 40 (0.41%), 335 (3.48%) and 720 (7.49%) patients underwent plateletpheresis, thrombectomy, and thrombolysis respectively. Multivariate logistic regression showed that ET was not associated with increased mortality, but was associated with significantly increased length of stay with odds ratio (OR) of 0.95 [95% confidence interval (CI) = 0.73 to 1.23, p-value = 0.7) and 2.58 (95% CI = 2.12 to 3.04, p-value = 0.00) respectively. The effect of other pertinent variables are summarized in Table 1. Conclusions: Our analysis shows that stoke in ET was not associated with increased mortality. ET was associated with increased length of stay in patients with stroke. 0.41% of ET patients with stroke received platelet pheresis. Limitations of this study include failure of the multivariate model to account for all the variables, coding errors, and increased risk of bias due to retrospective nature of the data. [Table: see text]

Effects of socioeconomic status (SES) and healthcare resource (HCR) availability on survival in Black patients (pts) versus (vs) White pts with multiple myeloma (MM): A SEER Medicare analysis.

e13678 Background: In MM, disparities exist for overall survival (OS) by race, and many factors may contribute to these differences. This study evaluates whether SES and HCR availability impacts OS in older pts with newly diagnosed MM (NDMM) based on race. Methods: This retrospective study used linked SEER-Medicare claims (diagnosis [Dx] 6/1/2013–12/31/2017) and Area Health Resource Files (AHRFs; from 2018) to identify non-Hispanic White and non-Hispanic Black pts aged ≥66 years with NDMM. AHRFs included county-level HCR availability data (e.g. number of long-term hospital beds, medical doctors [MDs]). Continuous Medicare A and B enrollment until 12/31/2019 or preceding death was required. Pts with other cancers, Dx from death data, missing county information and enrollment in health maintenance organizations or clinical trials were excluded. Kaplan-Meier was used for unadjusted median OS and Cox proportional hazards for OS risk by race. Age, sex, race, Charlson Comorbidity Index (CCI), poverty, education, and HCR availability were included in the adjusted mixed effects Cox model. Results: We identified 6,609 pts with NDMM; 15.6% were Black. For Black pts vs White pts, median age at Dx was 76 vs 77 years, 57.1% vs 46.0% were female, and mean CCI was 2.1 vs 1.4 (p&lt;.001 for all). Within census tracts, mean percentage of pts living under the poverty line and received &lt;12 years of education was 21.2% vs 11.3% (p&lt;.001) and 19.0% vs 11.3% (p&lt;.001) for Black pts vs White pts, respectively. Unadjusted median OS for Black pts vs White pts was 2.76 vs 3.01 years (hazard ratio [HR]: 1.08; p=.063). In the adjusted model, several SES and HCR availability factors were significant. OS HR by race reversed directionality when adjusted for demographics, SES and HCR availability, but this was not significant (HR: 0.92; p=.12; Table). Conclusions: We found that Black pts with NDMM in SEER-Medicare claims were younger, had higher CCI, completed less education, and were more likely to live in census tracts with higher poverty percentages vs White pts. Several factors relating to SES and HCR availability significantly influenced OS and may drive disparities in care. Further research on larger datasets is needed to better understand these disparities. [Table: see text]

Virtual Medicine Wards and Hospital-at-Home Programs

What Is the Issue? In 2021, the occupancy rate of acute care hospital beds in Canada was 86.7%. High occupancy rates without turnover to accommodate all hospitalization needs is an indicator of potential bed shortages and health system pressure. Patients have historically remained in hospital beds until their treatment or recovery is complete. Some patients may be well enough to continue their treatment or recovery at home sooner if provided with the right supports. What Are the Technologies? Virtual wards, also known as hospital-at-home programs, support the provision of inpatient-level acute medical care in a patient’s home. There are 2 main models of these programs: admission avoidance and supported early discharge. This report focuses on the latter type. Many of these programs are technology-enabled and incorporate remote monitoring devices to record the patient’s vital signs and tablets or web portals to facilitate data sharing. Video calls with the clinical team are also used in combination with in-person visits by health care providers. What Is the Potential Impact? Hospital beds can be freed up more quickly to provide space for newly admitted patients with more acute care needs. The safety and effectiveness of virtual ward programs have been examined in several systematic reviews in the existing clinical literature. Factors evaluated include mortality, length of stay, hospital readmissions, and costs as outcomes. Both admission avoidance and early supported discharge via hospital-at-home programs had lower or similar mortality and hospital admission outcomes as inpatient care after completion of care. Patients, caregivers, and health care providers appear to be generally satisfied with their participation in virtual ward programs. Comfort and satisfaction can be improved by allowing patients to receive treatment in a familiar and comfortable environment without compromising patient outcomes. However, increased caregiver burden, lack of sufficient training for participants and staff, and difficulties recruiting health care providers were identified as challenges associated with virtual ward programs. What Else Do We Need to Know? The level of technological support required by patients, caregivers, and staff participating in these programs should be considered when developing a program. Adequate training about how to use provided equipment and other tasks needed to manage care in the home (e.g., drug administration, symptom monitoring, communication with health care professionals) is required for patients and caregivers. There should also be provision of all necessary equipment with supports to overcome any barriers (e.g., visual impairment, physical limitations) to ensure comfort and proficiency. Care coordination and communication among the multidisciplinary care team, the patient, and their caregivers is important. Canadian cost data were not identified, but it is generally accepted that virtual ward programs are associated with reduced costs when compared with traditional in-hospital care. The inclusion of digital monitoring and record keeping technologies as part of virtual ward programs may disproportionately exclude people from some groups, including older people, people living in social housing or without housing, people with lower incomes, people who are unemployed, people living with disabilities, and people who live in rural areas without access to such programs. Key recommendations for development of virtual ward programs in Canada include using a single remote patient-monitoring platform that connects with the hospital’s electronic health record system, choosing a technology to connect patients and providers that best fits the needs of the virtual ward program, and ensuring data security, confidentiality, and data management protocols are in place.

The influence of health insurance on coverage of a country’s population with medical services

One of the effective ways to increase the level of population coverage with medical services is health insurance. The paper aims to determine what type of health insurance (compulsory, social, or voluntary) has the greatest impact on a country’s ability to provide large-scale and timely medical services to citizens, as measured by the number of unmet needs for medical examination, treatable and preventable mortality. The control variables included a country’s population size, the level of economic well-being, and the scale of the public health system (number of doctors and hospital beds) based on EUROSTAT data for all 27 EU countries in 2012–2021. Modelling (regression models of panel data with fixed and random effects in STATA 18, Wald test, Hausman test, Breusch and Pagan test) proved that only one of three researched types of insurance – voluntary health insurance – positively influences a country’s ability to provide large-scale and timely medical services to citizens: an increase in its volume by 1% leads to a decrease in unmet needs in medical examination on average across all EU countries by 0.26%, treatable mortality rate by 0.08%, preventive mortality rate by 0.27%. The influence of the other two types – compulsory and social – was not confirmed (received regression coefficients for these variables are not statistically significant). This emphasizes the importance of citizens’ conscious attitude to their health (due to the increase in voluntary health insurance) both in strengthening public health and in ensuring faster and better access to medical services.

ANALYSIS AND FORECAST OF THE EMPLOYEES IN THE PUBLIC AND PRIVATE HEALTH SYSTEMS IN ROMANIA

In this paper, a statistical analysis is made of the health personnel in Romania in the public and private systems using data from the period 1990-2022, provided by the National Institute of Statistics. Using the least squares method, analytical functions are found that model the trend and forecasts are made for the years 2023 and 2024. The confidence intervals for the predictions are also found, at a significance threshold of 5%, and the correlations between certain indicators are analysed. It was found that in the public sector there was a downward trend, in general, for all categories of medical personnel in the period 1990-2017, followed by an increasing evolution after 2018, due to salary increases in the system. However, there is still a shortage of physicians in the public sector, even if their number has steadily increased in the last years. There is no correlation between the number of physicians and the number of beds in public hospitals, although this should be positive and high. On the other hand, in the private sector the trend is obviously increasing throughout the studied period, the correlations are very strong between the analysed indicators, a situation explained by the fact that in this system the goal is to minimize expenses and increase profit and less access of all citizens to health services.

Study on Universal Health Coverage Scheme in India – The Stumper to Private Hospitals

Background Many governments have introduced health insurance schemes for the poor sections of society to save them from catastrophic health expenditure. Private hospitals play a key role in India, as they are in significant number in secondary and tertiary care services. Private hospitals have to fund their infrastructure, staff salaries from the revenue of previous year. In this study, we compared money received by a private medical college hospital bed through government insurance scheme patient and private paying patient. Methods Observational study, comparing money reimbursed for top ten procedures treated in private medical college hospitals by Ayushman Bharat (AB) fund and the price offered by a paying patient in similar bed. Results On average 600 patients received medical care through the AB scheme per month at our tertiary care super-specialty hospital. Highest numbers were seen in specialties like cardiovascular, and cancer treatments and infectious diseases under general medicine specialty. The costs considered were surgeon’s cost, medicines, devices, and hospitalization costs. The laparoscopic procedures were incurring a loss of 130%, knee replacements about 50%, coronary bypass grafting thankfully due to controlling of prices by central government is incurring a loss of 10%. The package amount offered accounts to 26–52% only of the costs incurred by the private hospitals. Conclusion The private academic hospitals need 25% to 50% more than current prices offered, across various procedures.

A retrospective analysis of the incidence and risk factors of perioperative urinary tract infections after total hysterectomy

IntroductionPerioperative urinary tract infections (PUTIs) are common in the United States and are a significant contributor to high healthcare costs. There is a lack of large studies on the risk factors for PUTIs after total hysterectomy (TH).MethodsWe conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively.ResultsPUTIs were found in 9087 patients overall, showing a 2.0% incidence. There were substantial differences in the incidence of PUTIs based on age group (P < 0.001). Between the two groups, there was consistently a significant difference in the type of insurance, hospital location, hospital bed size, and hospital type (P < 0.001). Patients with PUTIs exhibited a significantly higher number of comorbidities (P < 0.001). Unsurprisingly, patients with PUTIs had a longer median length of stay (5 days vs. 2 days; P < 0.001) and a higher in-hospital death rate (from 0.1 to 1.1%; P < 0.001). Thus, the overall hospitalization expenditures increased by $27,500 in the median ($60,426 vs. $32,926, P < 0.001) as PUTIs increased medical costs. Elective hospitalizations are less common in patients with PUTIs (66.8% vs. 87.6%; P < 0.001). According to multivariate logistic regression study, the following were risk variables for PUTIs following TH: over 45 years old; number of comorbidities (≥ 1); bed size of hospital (medium, large); teaching hospital; region of hospital(south, west); preoperative comorbidities (alcohol abuse, deficiency anemia, chronic blood loss anemia, congestive heart failure, diabetes, drug abuse, hypertension, hypothyroidism, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, paralysis, peripheral vascular disorders, psychoses, pulmonary circulation disorders, renal failure, solid tumor without metastasis, valvular disease, weight loss); and complications (sepsis, acute myocardial infarction, deep vein thrombosis, gastrointestinal hemorrhage, pneumonia, stroke, wound infection, wound rupture, hemorrhage, pulmonary embolism, blood transfusion, postoperative delirium).ConclusionsThe findings suggest that identifying these risk factors can lead to improved preventive strategies and management of PUTIs in TH patients. Counseling should be done prior to surgery to reduce the incidence of PUTIs.The manuscript adds to current knowledgeIn medical practice, the identification of risk factors can lead to improved patient prevention and treatment strategies. We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. PUTIs were found in 9087 patients overall, showing a 2.0% incidence. We found that noted increased length of hospital stay, medical cost, number of pre-existing comorbidities, size of the hospital, teaching hospitals, and region to also a play a role in the risk of UTI’s.Clinical topicsUrogynecology

Healthcare-seeking behavior and spatial variation of internal migrants with chronic diseases: a nationwide empirical study in China.

Individuals migrating with chronic diseases often face substantial health risks, and their patterns of healthcare-seeking behavior are commonly influenced by mobility. However, to our knowledge, no research has used spatial statistics to verify this phenomenon. Utilizing data from the China Migrant Dynamic Survey of 2017, we conducted a geostatistical analysis to identify clusters of chronic disease patients among China's internal migrants. Geographically weighted regressions were utilized to examine the driving factors behind the reasons why treatment was not sought by 711 individuals among a population sample of 9272 migrant people with chronic diseases. The results indicate that there is a spatial correlation in the clustering of internal migrants with chronic diseases in China. The prevalence is highly clustered in Zhejiang and Xinjiang in north-eastern China. Hotspots were found in the northeast (Jilin and Liaoning), the north (Hebei, Beijing, and Tianjin), and the east (Shandong) and also spread into surrounding provinces. The factors that affect the migrants with no treatment were found to be the number of hospital beds per thousand population, the per capita disposable income of medical care, and the number of participants receiving health education per 1000 Chinese population. To rectify this situation, the local government should "adapt measures to local conditions." Popularizing health education and coordinating the deployment of high-quality medical facilities and medical workers are effective measures to encourage migrants to seek reasonable medical treatment.

Utilizing disease transmission and response capacities to optimize covid-19 control in Malaysia

ObjectivesPublic Health Social Measures (PHSM) such as movement restriction movement needed to be adjusted accordingly during the COVID-19 pandemic to ensure low disease transmission alongside adequate health system capacities based on the COVID-19 situational matrix proposed by the World Health Organization (WHO). This paper aims to develop a mechanism to determine the COVID-19 situational matrix to adjust movement restriction intensity for the control of COVID-19 in Malaysia.MethodsSeveral epidemiological indicators were selected based on the WHO PHSM interim guidance report and validated individually and in several combinations to estimate the community transmission level (CT) and health system response capacity (RC) variables. Correlation analysis between CT and RC with COVID-19 cases was performed to determine the most appropriate CT and RC variables. Subsequently, the CT and RC variables were combined to form a composite COVID-19 situational matrix (SL). The SL matrix was validated using correlation analysis with COVID-19 case trends. Subsequently, an automated web-based system that generated daily CT, RC, and SL was developed.ResultsCT and RC variables were estimated using case incidence and hospitalization rate; Hospital bed capacity and COVID-19 ICU occupancy respectively. The estimated CT and RC were strongly correlated [ρ = 0.806 (95% CI 0.752, 0.848); and ρ = 0.814 (95% CI 0.778, 0.839), p < 0.001] with the COVID-19 cases. The estimated SL was strongly correlated with COVID-19 cases (ρ = 0.845, p < 0.001) and responded well to the various COVID-19 case trends during the pandemic. SL changes occurred earlier during the increase of cases but slower during the decrease, indicating a conservative response. The automated web-based system developed produced daily real-time CT, RC, and SL for the COVID-19 pandemic.ConclusionsThe indicators selected and combinations formed were able to generate validated daily CT and RC levels for Malaysia. Subsequently, the CT and RC levels were able to provide accurate and sensitive information for the estimation of SL which provided valuable evidence on the progression of the pandemic and movement restriction adjustment for the control of Malaysia.

Incidence and Risk Factors for Medical Device-Related Pressure Injury in Hemodynamically Unstable Intensive Care Unit Patients: A Prospective Cohort Study.

The purpose of this study was to determine the incidence and identify potential risk factors for medical device-related pressure injury (MDRPI) in critically ill and hemodynamically unstable adults (patients classified class III or IV on the Therapeutic Intervention Scoring System-28; TISS-28). Prospective cohort study. The target population was critically ill adults who were using one or more medical devices and categorized as class III or IV on the TISS-28. The study sample comprised 77 participants followed daily until discharge, death, transfer, or lesion development. Data were collected from January to March 2020. The study setting was an intensive care unit with 40 beds in a large hospital in a municipality in the state of Minas Gerais, Brazil. Sociodemographic and pertinent clinical data, pressure injury (PI) risk assessed using the Braden Scale for Pressure Sore Risk, and head-to-toe skin inspections were completed. The incidence rate of MDRPIs was calculated, and survival analyses were completed via the Kaplan-Meier method and Cox regression model. Forty-nine of 77 participants developed an MDRPI, reflecting an incidence rate of 63.6%. Collectively, 71 MDRPIs occurred in these 49 participants. Univariate analysis indicated significant associations between MDRPI occurrences and level of consciousness (P =<.001), use of tube holder for ventilation devices (P =.013), nasal cannula (P =.034), nasogastric cannula (P =.034), presence of edema (P =.001), infection (P =.007), higher TISS score (P =.047), and greater number of medical devices (P =.022). Survival analysis indicated that a high or very high-risk score on the Braden Scale for Pressure Sore Risk (P =.043) and edema (P =.030) are risk factors for MDRPI occurrences in this vulnerable population. The incidence rate of MDRPIs was 63.6%. The categories with the highest high or very high risk scores on the Braden Scale for Risk of Pressure Pain and Edema emerged as risk factors for MDRPI in this critically ill and vulnerable population.

Advanced practice nurse-coordinated same-day-discharge after atrial fibrillation ablation

Abstract Background Catheter ablation is an effective atrial fibrillation (AF) therapy, but a complex, resource-intensive procedure. Same-day discharge (SDD) reduces utilization of health care resources including personell and hospital beds, and may help to accommodate the increasing demand for AF ablation. However, besides structural adaptations, SDD requires more efficient logistics and coordination. Purpose Against this background, we established and validated a streamlined SDD program fully coordinated by an advanced practice nurse. Methods As dedicated SDD coordinator the advanced practice nurse was in charge of the full SDD protocol, including patient eligibility, patient flow, in-hospital logistics, patient education, discharge and short-term follow-up. For inclusion, basic home support and accessibility of the hospital within 60 minutes had to be warranted. Patients with LVEF &amp;lt;35% were excluded. Ablation was performed at the operator’s discretion. Ultrasound-guided femoral puncture was at the operator’s discretion for the first 150 SDD patients but became mandatory per protocol for all subsequent patients. Discharge by the SDD coordinator followed a standardized protocol including supervised ambulation, patient education, femoral inspection and echo. On post-ablation days 1 and 3, patients were called by the SDD coordinator to ensure well-being and good aspect of the femoral access site (smartphone foto control). In addition, patients could consult the SDD coordinator via mobile phone any time during working hours. In-person follow-up visits were scheduled at 2 weeks and 3, 6 and 12 months post-ablation. Results 420 consecutive patients were evaluated by the SDD coordinator of whom 331 were eligible for SDD. Reasons for exclusion were lack of home support (4.5%), living remotely (6.9%), or LVEF &amp;lt;35% (4.0%). 300 of the eligible patients (91%) were successfully discharged the same day (Fig. 1). Rates of unplanned medical attention (4.0%) and 30d-readmission (1.6%) were extremely low. Importantly, there was no major post-SDD complication. Unplanned medical attention and hospital readmissions were largely driven by minor femoral access site complications. Of note, those were significantly reduced upon introduction of mandatory ultrasound-guided puncture after the first 150 SDD patients (p=0.0145, Fig. 2). SDD coordination by the advanced practice nurse streamlined patient flow and in-hospital logistics and significantly reduced the total workload of nursing and medical staff. This resulted in great acceptance of the SDD program and satisfaction both among staff and patients. Conclusions Advanced practice nurse-coordinated SDD after AF ablation is safe and efficient. In fact, the position of a dedicated coordinator may be a key in the forthcoming transition of hospitals to SDD. Importantly, ultrasound-guided femoral puncture virtually eliminated relevant femoral access site complications and should be a prerequisite for SDD.Figure 1Figure 2

Ablation of anomalous mitral annular pathways via transradial access: early hospital discharge due to the covid-19 pandemic

Abstract Introduction Wolff-Parkinson-White (WPW) syndrome arises from the conduction through accessory pathways (AP) connecting the atria and ventricles, bypassing the atrioventricular node. Radiofrequency catheter ablation of AP is the recommended treatment, often performed via transradial access. This approach is widely utilized in percutaneous coronary intervention due to its safety, effectiveness, patient preference, cost-effectiveness, and simplicity. Our study aims to present the results of AP ablation in the mitral annulus through transradial access amid the Covid-19 pandemic, marked by hospital bed scarcity and the need for early discharge. Materials and Methods Between May 2020 and December 2021, eight cases of transradial AP ablation in the mitral annulus were conducted. The service had previously achieved success in 16 transradial ablation cases. Among the eight cases during the pandemic, 62.5% were male, aged 24 to 56 years, all experiencing tachycardic palpitations and pre-syncope with a history of hospitalization. In 25% of cases, syncope episodes occurred. Patients were on propafenone, with no structural heart disease. Covid-19 tests were negative. Radial and ulnar artery perfusion integrity was assessed using the Allen maneuver and arterial Doppler. The right radial artery was used in 100% of cases. Sixty-two point five percent of accessory pathways were in anterolateral positions, and 37.5% were left posteroseptal. The approach was through the right radial artery, under local anesthesia, with venous sedation, using a 7Fr introducer sheath and positioning of the explorer catheter. Mapping was conducted during sinus rhythm, and adenosine IV tests followed ablation. The catheter was removed, and a pneumatic local dressing was applied for 2 hours, followed by a conventional dressing change for 24 hours. Results Ablation was successful in all eight patients. The procedure time ranged from 40 to 80 minutes, with an average of 55 minutes. Two to four radiofrequency applications were applied for a total of 2 minutes, using 55 W energy and a temperature of 55 to 60°C. No complications occurred during or after the procedure. Patients were discharged three hours post-intervention. Follow-up included reviews every four months, ECGs without ventricular pre-excitation, asymptomatic patients without antiarrhythmic medication, and no complications at the puncture site one year post-procedure. Conclusion Although based on a small sample of eight cases, and acknowledging the need for a larger sample to establish the procedure as an alternative, considering possible operator experience influence, we conclude that radial access proved effective and safe in this patient group. Its usage was exceptional, specifically in the context of a pandemic with crowded hospitals. Selection criteria and comparisons with other alternatives should be adopted for analyzing its potential future use.Transradial approachAblation catheter in the mitral plane