Hospital Status Research Articles

Association of a remote monitoring programme with all-cause mortality and hospitalizations in patients with heart failure: National-scale, real-world evidence from a 3-year propensity score analysis of the TELESAT-HF study.

To examine the association of a remote monitoring programme (RMP) with all-cause mortality and hospital admissions for heart failure (HF) within the French healthcare system. A national-scale, real-world, propensity-weighted cohort study was conducted using the SNDS French database from August 2018 to December 2022 (NCT06312501). Patients receiving standard of care (SoC) were compared with those receiving RMP (Satelia® Cardio, NP Medical). The Satelia® Cardio algorithm adjusted the monitoring frequency based on symptom and weight changes, and provided tailored web-based patient education. The RMP included a digital interface for proficient patients and phone monitoring by nurses for those uncomfortable with digital technology. Data were sourced from over 300 healthcare centres across France. A propensity-weighted Cox regression model was used, supplemented by sensitivity analyses across subgroups. In total, 5357 RMP patients and 13 525 SoC patients were included after weighting. Weighted/adjusted analyses showed lower all-cause mortality for RMP patients (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.59-0.70; p < 0.0001), persisting across hospitalization and/or long-term illness status subgroups (HR 0.52 to 0.75). RMP was neutrally associated with HF hospitalization rates (rate ratio [RR] 0.95; 95% CI 0.89-1.02) but linked to less time in hospital (-2.1%, p < 0.0001) and fewer emergency visits (RR 0.83; 95% CI 0.75-0.92; p = 0.001). In France, RMP with customized monitoring frequencies and educational strategies was associated with lower all-cause mortality, emergency visits, and time spent in hospital in patients with HF which may enhance nationwide HF management.

Optimal Timing and Approaches for First Tangential Excision in Patients with ≥70% TBSA Burns: Insights from a Retrospective Cohort of a Mass Casualty Incident.

We aim to determine the optimal timing and approaches for first tangential excision of severely burned patients ≥70% total body surface area (TBSA). Early tangential excision is the gold-standard surgical therapy for full-thickness burns. However, there are debates about its optimal timing and approaches for severely burned patients ≥70%TBSA. This study included 185 patients in the Kunshan factory explosion. We focused on surgical timing, surgical area, and main wound covering method for first tangential excision. We determined the optimal cut-off values for surgical timing and area using R language "surv_cutpoint" and "surv_categorize" functions, and utilized the Kaplan-Meier survival analysis to investigate their influences on patients' overall survival. Then, we utilized multi-variate Cox regression analysis to identify independent factors, and performed subgroup analyses to find confounding factors. Finally, we employed a 10-year single-center cohort of 144 patients with burn injury ≥70% TBSA for external validation. Performing first tangential excision in >3 days (hazard ratio=2.37, 95% confidence interval=1.05-5.40, P =0.039) and surgical area > 48% TBSA (hazard ratio=2.41, 95% confidence interval=1.46-4.00, P <0.001) were independent risk factors in the Kunshan cohort for overall survival of patients ≥70% TBSA, and were associated with higher rate of complications. Subgroup analysis revealed that the timing and TBSA of first tangential excision were influenced by several treatment and complications factors (hemodynamic status and types of hospitals). Main wound covering methods was a significant confounding factor. Patients with more autograft showed better overall survival than those with more extensive use of temporary skin substitutes in the Kaplan-Meier survival analysis ( P <0.001). However, main wound covering methods influenced by the severity of injury, availability of autologous skin source, as well as the medical resources. Additionally, external validation demonstrated consistent results and acceptable calibration. This study identified the optimal timing and approaches for first tangential excision, validating them as independent prognostic factors for patients with ≥70% TBSA. However, considering the various confounding factors, treatment for each patient should be tailored.

Impact of COVID-19 Diagnosis on Weight Trajectories of Children in the US National COVID Cohort Collaborative.

The COVID-19 pandemic has exacerbated the obesity epidemic, with both adults and children demonstrating rapid weight gain during the pandemic. However, the impact of having a COVID-19 diagnosis on this trend is not known. Using longitudinal data from January 2019 to June 2023 collected by the US National Institute for Health's National COVID Cohort Collaborative (N3C), children (age 2-18 years) with positive COVID-19 test results (n=11,474, 53% male, mean [SD] age 5.57 [±3.29] years, 54% white, mean [SD] 5.2 [±2.9] BMI observations per participants) were matched with COVID-19 negative children with identical demographic characteristics and similar observation window. We compared BMI percentile trajectories between the COVID-19 positive and COVID-19 negative cohorts, with further evaluation performed on COVID-19 positive patients stratified by hospitalization status. COVID-19 positive patients had a greater increase in %BMI p95 than COVID-19 negative patients (average increase of 2.34 (±7.73) compared to 1.46 (±6.09), p<0.0005). COVID-19 positive patients gained more weight after their diagnosis of COVID-19 than before. Non-hospitalized children gained more weight than hospitalized children (average increase in %BMI p95 of 2.38 (±7.65)) compared to 1.87 (±8.54)). Mixed effect regression analyses demonstrated that these associations remained even after adjusting for time, demographics, and baseline %BMI p95 . Having a COVID-19 diagnosis was associated with more rapid weight gain, especially after diagnosis and early in the pandemic. Future research should explore the reasons for this association and the implications for future health emergencies. M.M.M. drafted the initial manuscript and assisted with the data curation, formal analysis, methodology, and visualization. T.T.P. assisted with the study design, interpretation of results, funding acquisition, and manuscript drafting and editing. C.T.B. and C.G.C assisted with formal analysis and interpretation of results. L.A.P. assisted with the interpretation of results and manuscript editing. R.B. supervised the study with study design, resources, funding acquisition, and manuscript editing. All authors assisted in the conceptualization of the study and approved it for publication. The authors declare no conflicts of interest. This study investigating the weight trajectories of children during the COVID-19 pandemic shows that the pandemic has led to a significant increase in weight gain among US children aged 6-11, with boys gaining more weight than girls. Non-hospitalized COVID-19-positive children were found to be at greater risk of gaining weight. The analyses described in this publication were conducted with data or tools accessed through the NCATS N3C Data Enclave https://covid.cd2h.org and N3C Attribution & Publication Policy v 1.2-2020-08-25b supported by NCATS U24 TR002306, Axle Informatics Subcontract: NCATS-P00438-B, [DUR RP-0BDD0E] and was supported by NIH awards, P20GM103446 and U54-GM104941. This research was possible because of the patients whose information is included within the data and the organizations ( https://ncats.nih.gov/n3c/resources/data-contribution/data-transfer-agreement-signatories ) and scientists who have contributed to the ongoing development of this community resource [ https://doi.org/10.1093/jamia/ocaa196 ].

Impact of COVID-19 Diagnosis on Weight Trajectories of Children in the US National COVID Cohort Collaborative.

Background: The COVID-19 pandemic has exacerbated the obesity epidemic, with both adults and children demonstrating rapid weight gain during the pandemic. However, the impact of having a COVID-19 diagnosis on this trend is not known. Methods: Using longitudinal data from January 2019 to June 2023 collected by the US National Institute for Health's National COVID Cohort Collaborative (N3C), children (age 2-18 years) with positive COVID-19 test results {n = 11,474, 53% male, mean [standard deviation (SD)] age 5.57 [±3.29] years, 54% White, mean [SD] 5.2 [±2.9] BMI observations per participant} were matched with COVID-19-negative children with identical demographic characteristics and similar observation window. We compared BMI percentile trajectories between the COVID-19-positive and COVID-19-negative cohorts, with further evaluation performed on COVID-19-positive patients stratified by hospitalization status. Results: COVID-19-positive patients had a greater increase in than COVID-19-negative patients (average increase of 2.34 (±7.73) compared to 1.46 (±6.09), p < 0.0005). COVID-19-positive patients gained more weight after their diagnosis of COVID-19 than before. Nonhospitalized children gained more weight than hospitalized children [average increase in of 2.38 (±7.65) compared to 1.87 (±8.54)]. Mixed-effect regression analyses demonstrated that these associations remained even after adjusting for time, demographics, and baseline . Conclusions: Having a COVID-19 diagnosis was associated with more rapid weight gain, especially after diagnosis and early in the pandemic. Future research should explore the reasons for this association and the implications for future health emergencies.

Risk and Protective Factors of Anxiety in Nurses During the Covid-19 Pandemic: A Systematic Review

The COVID-19 pandemic has significantly impacted nurses, exposing them to challenges that have affected their overall well-being. Most nurses have experienced psychosocial problems, including anxiety. This study aims to identify the protective and risk factors associated with anxiety among nurses during the COVID-19 pandemic. A systematic review was used as a method in this study. Eight databases were used Science Direct, PubMed, CINAHL, Embase, ProQuest, Scopus, Taylor &amp; Francis, and JSTOR. The literature search was conducted using keywords derived from the Medical Subject Headings (MeSH) framework. The search terms included: Nurses OR "staff nurses" OR "healthcare professionals", AND "factors associated with anxiety" OR "risk factors" OR "protective factors", AND "COVID-19" OR "COVID-19 pandemic". The data were further analyzed by critically assessing the quality of the articles using the JBI and CASP checklists. The research articles included in the review were cross-sectional studies published between 2020 and 2022, written in English, available in full text, and specifically focused on protective and risk factors for anxiety. A risk of bias assessment was conducted using the Joanna Briggs Institute quality assessment checklist. A total of 33 articles were reviewed, revealing two primary themes of protective and risk factors: internal and external factors. Internal factors included variables such as age and gender, while external factors encompassed aspects such as hospital status. Based on the findings, it is recommended that hospitals implement mental health and psychosocial support interventions as promotive and preventive efforts to improve the nurses' psychological well-being.

Harmonising Hope: Impact of Music Therapy on Cancer Pain and Palliative Care

Objectives: Music therapy can be a harmonising hope for cancer patients under palliative care to overcome fear, anxiety, anger, depression, pain and the range of emotional responses. Music therapists contribute to a comprehensive approach to providing holistic, patient-centred care to mainstream medical treatment. Hence, the study aims to understand the clinical impact of music therapy in cancer pain and palliative care. Materials and Methods: After approval from the Institutional Review Committee and getting informed consent, a total of 102 individual music therapy sessions were conducted for 43 patients with cancer hospitalised under palliative care. Each patient received an average of 2–4 music therapy sessions by a certified music therapist. Music therapy sessions were based on clinician referrals, hospitalisation status and musicality profile. Pain scores, anxiety scores, mood scores and intrinsic and extrinsic motivation levels were evaluated using a visual analogue scale before and immediately after the sessions. Data were statistically analysed using the Statistical Package for the Social Sciences version 26. Results: The study indicates that cancer patients undergoing pain and palliative care experienced notable outcomes from music therapy sessions, including a significant decrease in anxiety and pain perception, along with enhancements in mood and motivation (P &lt; 0.01). Conclusion: To sum up, the ongoing study and understanding of the impact of music therapy underscore its meaningful and promising role in improving the overall quality of life for cancer patients within a holistic care approach.

Analysis of hospitalization status by major classification according to ICD-10 among public assistance recipients considering sex and age

Objectives We evaluated the number of hospitalizations among public assistance recipients for each major classification according to the International Classification of Diseases 10th Revision (ICD-10), adjusting for sex and age differences in the general Japanese population. This study aimed to provide a comprehensive assessment of hospitalization patterns among public assistance recipients by disease category.Methods We used indirect methods to adjust for sex and age, with public assistance recipients and the entire Japanese population as the observation and reference groups, respectively. We calculated the standardized hospitalization ratios (SHRs) for each major classification based on the ICD-10. We only used publicly available government statistics, including data from the 2020 Patient Survey, for hospitalization rates according to sex, age, and major classification. Additionally, we used data from the 2020 National Survey on Public Assistance Recipients conducted for the number of public assistance recipients by sex and age groups and data from the 2020 Survey on the Actual Status of Medical Assistance conducted for the number of hospitalizations by major classification.Results After adjusting for age, the overall SHR was 1.49. The major classifications with the high SHRs for men and women were "V. Mental and behavioural disorders" (SHR for men; 4.06, women; 3.45) and "IV. Endocrine, nutritional, and metabolic diseases" (SHR for men; 2.40, women; 1.47). Conversely, the major classifications with low SHRs were "XVI. Certain conditions originating in the perinatal period" (SHR; 0.43) and "VII. Diseases of the eye and adnexa" (SHR; 0.44) for men. For women, these were "XV. Pregnancy, childbirth, and the puerperium" (SHR; 0.17) and "VII. Diseases of the eye and adnexa" (SHR; 0.27).Conclusion After adjusting for age, hospitalization status among public assistance recipients was higher overall than in the general Japanese population. However, if divided based on major classifications, higher and lower rates were observed compared with the general population. In assessing the status of medical assistance for public assistance recipients, research should be conducted by disease classification, considering the significant differences in age composition between public assistance recipients and the general Japanese population.

Epidemiology of Dengue - Puerto Rico, 2010-2024.

Dengue is a mosquitoborne viral illness that can cause acute febrile illness, severe disease, or death. Worldwide, the number of dengue cases is increasing. During the last dengue outbreaks in Puerto Rico throughout 2010-2013, dengue virus (DENV) serotype 1 (DENV-1) predominated, and the largest proportion of cases occurred among adolescents and young adults aged 10-19 years. Dengue case data from January 1, 2010-November 4, 2024, were obtained from the Puerto Rico Department of Health. Bivariate analyses were conducted to evaluate the distribution of cases by patient age, DENV serotype, and hospitalization status during three periods: 2010-2019, 2020-2022, and 2023-2024. During 2023-2024, the median age of dengue cases increased to 26 years (95% CI=25-27 years) compared with that during 2020-2022 (17 years; 95% CI=17-18 years) and 2010-2019 (19 years; 95% CI=19-19 years). After >10 years of DENV-1 predominance, the proportions of DENV serotypes 2 (DENV-2) and 3 (DENV-3) increased significantly during 2023-2024, with DENV-3 replacing DENV-1 as the predominant serotype. In addition, the proportion of dengue patients who were hospitalized increased from 35.7% (2010-2019) to 53.5% (2023-2024). The current dengue outbreak in Puerto Rico marks a shift in serotype predominance to DENV-3 and increasing percentages of cases in older age groups (61.7% in adults aged ≥20 years), although a high proportion of cases still occur among adolescents aged 10-19 years (29.5%). The current dengue outbreak also has a higher rate of hospitalizations than those in previous years. Understanding the changing epidemiology of dengue is crucial to guiding public health strategies for dengue control, including clinical management, surveillance and health care system resilience, and public outreach and education.

Effects of factors influencing cesarean section rates between 2008 and 2018 in Taiwan: A population-based cross-sectional study.

Many factors can affect delivery mode decisions. Therefore, this study aimed to explore the effects of maternal age, physician's sex, region, income, and hospital type on cesarean section (C/S) delivery rates between 2008 and 2018 in Taiwan. In this population-based cross-sectional study, data were extracted from the Taiwan National Health Insurance Research Database (2 million individuals). The logistic regression method was used to analyze the aforementioned risk factors, and data are expressed as odds ratios (ORs) and 95% confidence intervals. In total, 9826 and 9714 deliveries in 2008 and 2018, respectively, were included in the analysis. The C/S ratio increased from 16.5% (n = 1607) in 2008 to 19.7% (n = 1916) in 2018. A higher C/S risk for women aged >34 years (ORs: 2.835 and 2.225 in 2008 and 2018, respectively) than for those aged ≤34 years was noted in both years. Female physicians had a lower risk of performing C/S than male physicians in 2008 (OR: .762, 95% confidence interval: .625-.928), but this was not apparent in 2018. Higher income levels (>new Taiwan dollar 45,081) and central Taiwan were associated with a lower C/S risk in both years. Private, not-for-profit hospitals had a lower C/S risk in 2008, which was not apparent in 2018. In conclusion, this study revealed a significant increase in C/S rates over the past decade, which was influenced by multiple factors. Maternal age, physician's sex, income status, location, and type of hospital may influence C/S rates. Analyzing these relationships can inform the development of strategies aimed at reducing future C/S rates, and targeted interventions may reduce the C/S rates.

Antibiotic Choice and Outcomes for Respiratory Infections in Children With Tracheostomies.

Respiratory infections are a major cause of hospitalization in children with tracheostomies, contributing significantly to hospital expenses. Limited data exist to describe optimal diagnostic strategies or management recommendations for these infections. This study aimed to explore factors associated with antibiotic therapy, including usage, administration route, duration, variables influencing the decision to prescribe antibiotics, and outcomes in children with tracheostomies experiencing episodes of respiratory infection other than pneumonia (tracheobronchitis and nonspecific respiratory episodes [NSRE]). We conducted a retrospective cohort study using the medical records of 83 children who underwent tracheostomy and received treatment at a tertiary hospital from 2010 to 2021. A total of 164 episodes of tracheobronchitis and 98 episodes of NSRE were analyzed. Children with tracheobronchitis were more frequently treated with antibiotics: 75% in nonhospitalized cases and 76% in hospitalized cases. In NSRE, antibiotic prescription dropped to 40% and 29%, respectively. Out of 51 tracheobronchitis and 15 NSRE initially treated with oral antibiotics, a switch to intravenous administration was deemed necessary in only 7 tracheobronchitis cases (14%). Fever was significantly associated with antibiotic prescription in tracheobronchitis and NSRE, regardless of hospitalization status. Two children died within the 28-day period following the onset of tracheobronchitis symptoms. Many cases identified as tracheobronchitis, along with a greater number of NSRE cases, resolved without requiring antibiotics. Although fever was associated with increased antibiotic prescription, it does not necessarily indicate severity. Therefore, careful consideration should be given before prescribing antibiotics, especially in febrile cases, to avoid unnecessary treatments.

Clinical characteristics of patients admitted to Samsun Training and Research Hospital from the Turkiye-Syria earthquake region

Aims: After the two major earthquakes that occurred in the Türkiye-Syria region on February 6th, 2023, earthquake casualties presented to hospitals in various centers across the country. This study aimed to analyze the characteristics of the presentations made to the emergency department and outpatient clinics of our tertiary hospital from the earthquake region after the earthquake. Methods: A total of 1534 earthquake casualties who were admitted to the Samsun Training and Research Hospital emergency department and outpatient clinics with the diagnosis code X-34 were included in the study. The data of the patients were scanned retrospectively through the online system and age, sex, presentation date, clinic and hospitalization status were recorded. Results: The mean age of the patients was 24.6±25.9 (range: 0-98) years. Six hundred eighty-six (44.7%) patients were male, 441 (28.7%) were age under 18 years, and 1199 (78.2%) were admitted or brought to the emergency room or intensive care units (ICUs). A total of 210 (13.7%) patients were hospitalized after being admitted or brought to the hospital. No fatalities were recorded among the earthquake casualties who presented. A total of 730 (47.6%) patients were admitted to our hospital within the first 30 days after the earthquake. The highest presentation peak period was between days 5 and 9. The mean age in women, inpatients, patients presnting to outpatient clinics, and patients from Adana, Hatay, Kahramanmaraş and Osmaniye provinces was significantly higher than the other groups (p&lt;0.001 for each). The rates of hospitalized patients were found to be significantly higher in women (p=0.002), patients presenting to outpatient clinics (p&lt;0.001), and patients presenting within the first 30 days after the earthquake compared to other groups (p&lt;0.001). The rates of patients presenting to emergency rooms or ICUs were significantly higher in men (p=0.011) and in those who presented within the first 7 days after the earthquake compared with the other groups (p=0.001). Conclusion: The findings obtained from our study indicated that the prognosis was good for earthquake casualties who presented to our hospital, which is far from the center of a major earthquake, that the highest number of presentations was between the 5th and 9th days, the period between the earthquake and the hospital admission was a determining factor in terms of the clinic presented and hospitalization, and the proximity to the center of the earthquake did not affect the prognosis in presentations. Our findings also show that the age group is an important factor in terms of the clinic of presentation, hospitalization, the period after the earthquake, and the province from which the presentation is made.

Comparing hospital leadership and front-line workers’ perceptions of patient safety culture: an unbalanced panel study

Background/aimThis article examines the relationships between workers’ hospital leadership status, hospital front-line status and patient safety culture in hospitals throughout the USA. By identifying possible disparities in perception, targeted interventions...

Trends and Disparities in Inpatient Palliative Care Use in Metastatic Renal Cell Carcinoma Patients Receiving Critical Care Therapy

PurposeTemporal trends in and predictors of inpatient palliative care use in patients with metastatic renal cell carcinoma (mRCC) undergoing critical care therapy are unknown. MethodsRelying on the Nationwide Inpatient Sample (2008-2019), we identified mRCC patients undergoing critical care therapy, namely invasive mechanical ventilation, percutaneous endoscopic gastrostomy tube insertion, dialysis for acute kidney failure, total parenteral nutrition or tracheostomy. Estimated annual percentage changes (EAPC) analyses and multivariable logistic regression models addressed inpatient palliative care use. ResultsOf 3802 mRCC patients undergoing critical care therapy, 817 (21.5%) received inpatient palliative care. Overall, inpatient palliative care use increased from 4.9% to 31.5% between 2008 and 2019 (EAPC +9.2%). In subgroup analyses, the highest increase in inpatient palliative care use was observed in the Midwest (EAPC: +11.9%), in the South (EAPC +10.4%), and in teaching hospitals (EAPC +9.0%; all P ≤ .004). In logistic regression models, teaching hospital status (odds ratio [OR] 1.41) and contemporary year interval (OR 2.12; all P < .001) independently predicted higher inpatient palliative care rates. Conversely, hospital admission in the Northeast (OR 0.53) or in the South (OR 0.79; all P ≤ .03) was associated with lower inpatient palliative care rates than in the West. ConclusionIn mRCC patients, inpatient palliative care rates have improved over time, with the highest increase in hospitals in the Midwest and in the South. Moreover, admission to teaching hospitals or in the West is associated with higher inpatient palliative care rates. In consequence, regional disparities, as well as differences according to teaching hospital status represent targets to achieve comprehensive inpatient palliative care coverage in mRCC patients receiving critical care therapy.

Working conditions, health status, and musculoskeletal disorders among hospital cleaning workers: a cross-sectional study in Turkey.

Cleaning workers face many workplace risk factors and may experience many health problems. In this context, this study aimed to evaluate the musculoskeletal disorders, the health status of hospital cleaning workers, and the working conditions and risk factors affecting the workplace environment. This cross-sectional study was conducted in a university hospital of Turkey. All the cleaning workers who have been working for ≥1 year were participants. The participants' socio-demographic and occupational characteristics, health complaints, workplace risk factors, occupational accidents, and ergonomic nonconformities were observed and questioned. Four hundred thirty-eight cleaning employees participated in the study. In the past year, 19.6% of participants had an occupational accident. Of those, 24.4% did not report it, and 30.2% were absent from work. No pre-employment examination was reported by 36.8% of the participants, and periodic medical examinations were never undergone by 98.4%. Low back pain was experienced by 42.0% of the participants, while 29.5% reported shoulder pain and 28.8% knee pain. While working, 83.1% of the participants bent frequently, 82.2% repeated the same movement, and 73.2% stood for a long time. Chemical substances were the most common workplace risk factors. There were significant differences according to age and gender in almost all musculoskeletal disorders. Gender differences were observed also in various health outcomes and occupational complaints. Repeated bending and prolonged standing were associated with hip/leg and foot/ankle pains; heavy lifting with low back, back, wrist/hand, and ankle/foot pains; and failure to the breaks with shoulder, knee and hip/leg pains. This research investigated the health issues and occupational safety challenges faced by hospital cleaning personnel. Specifically, it examined musculoskeletal disorders and work-related accidents, emphasizing gaps in regular health screenings for these workers. The findings underscore gender variations in these challenges and propose strategies to mitigate ergonomic risks encountered by cleaning staff. Med Pr Work Health Saf. 2024;75(5):397-413.

Impact of Tumor Response After Neoadjuvant Treatment on Overall Survival Among Patients With Pancreatic Ductal Adenocarcinoma: National Cancer Database Analysis.

Background Complete pathologic response following neoadjuvant therapy (NAT) forpancreatic ductal adenocarcinoma (PDAC) is rare; alternative markers associated with survival are needed. The aim of this study was to evaluate the impact of tumor response to NAT on overall survival (OS) in PDAC patients who received NAT and curative-intent surgery. Methods A retrospective study utilizing the 2006-2018 National Cancer Databaseidentified 6,960 adult patients with PDAC who received NAT. As a comparator group, 15,799 patients who underwent upfront surgical resection were separately analyzed. Primary outcome among patients who received NAT was OS according to changes in pathologic T and N staging compared to clinical T and N staging following NAT, defined as favorable response (downstaging) and non-favorable response (no change and upstaging). Results After NAT, 35.1%, 43.4%, and 21.5% of patients had T downstaging, no change, and upstaging, respectively. Comparatively, 3.5%, 53.4%, and 43.1% of patients who underwent upfront surgical resection were over-staged, accurately staged, and under-staged, respectively, in reference to the T stage. Adjusting for patient, hospital, treatment, tumor, and margin status covarities, a favorable response to NAT, or T downstaging, was significantly associated with higher OS (HR 0.80, 95% CI 0.75-0.86; median OS 34.4 months, 95% CI 32.6-36.5) compared with a non-favorable response to NAT as the reference group (median OS 27.9 months, 95% CI 26.9-28.8). Similarly, a favorable response to NAT in the N stage was associated with a higher OS (HR 0.87, 95% CI 0.79-0.95; median OS 33.7 months, 95% CI 31.4-36.5) compared with a non-favorable response (median OS 29.3 months, 95% CI 28.6-30.3). Conclusion A favorable response to NAT is associated with higher OS among PDAC patients who underwent curative intent surgery.

ASSESSMENT OF ANTIBIOTIC STEWARDSHIP IN TERTIARY HEALTH CARE TEACHING MEDICAL INSTITUTION IN CENTRAL INDIA

Objective: The objective of the study was to mitigate the impact of antimicrobial resistance and ensure continued access to effective treatments for bacterial infections. This study was undertaken to explore the hospital status of antibiotic prescription and evaluate the impact of antibiotic stewardship in clinical wards of tertiary health care settings. Methods: This is hospital-based observational prospective study carried out in a tertiary health care settings. All patients of either sex of any age who came in outpatient department and admitted in inpatient department of medicine, orthopedics, surgery, and pediatric departments and prescribed antibiotics were selected randomly in the study. Results: Study response rate was male predominance (57%). Empiric antimicrobials were mainly prescribed orally (47.3%), significantly higher than injectable route (22.8%) (p&lt;0.001), while the majority were not given an empiric antibiotic by a clinical expert. A significantly high number of patients were prescribed injectable 1st Antimicrobial after surgery/culture, namely, injectable piperacillin+tazobactum (35.5%), followed by injectable cephalosporin (34.0%), amikacin injection/4.5%, and injection carbapenem/1.8% (p&lt;0.001). Its frequency is significantly high with BD dose (66.8%) and the majority prescribed for period of 6–10 days (63.5%) followed by 1–6 days (19.5%) (p&lt;0.001). Conclusion: As all prescriptions got optimal dose and duration of therapy, the stay of patients in the hospital was following Indian Council of Medical Research (2019) guideline therefore, it can thus be said that the results of this study revealed precise prescribing pattern of antibiotics. However, emphasis on information technology staff and patient education is vital in incorporating stewardship protocols. Emphasizing the importance of conducting antibiotic time-outs within 48–72 h is crucial for reassessing the necessity and choice of antibiotics. Such stewardship studies are instrumental in monitoring patterns of antibiotic usage and aid in future policy-making steps.

Same day discharge after hepatectomy: Can it be done safely?

With the advent of minimally invasive techniques and enhanced recovery pathways, outpatient surgery is becoming increasingly common, but has not yet been extensively described in liver surgery. The aim of the present study was to analyze the incidence, characteristics, and outcomes of patients undergoing outpatient hepatectomy in the US. We utilized the National Surgical Quality Improvement Program (NSQIP) database for patients who underwent laparoscopic or robotic, elective hepatectomy from 2014 to 2021. Patients discharged on postoperative day 0 were assigned to the "same-day discharge" group, otherwise the patient was considered "admitted." Postoperative outcomes were compared with propensity-matched analysis. Multivariate analysis was performed to identify predictors of postoperative LOS (length of stay). We identified 7279 patients, of which 361 were in the same-day discharge cohort and 6918 were in the admitted cohort. For admitted patients, median postoperative length of stay was three days (SD = 6). Same-day discharge patients tended to be younger (age 59 vs. 62, p = .034) and more often ASA class ≤2 (49% vs. 29%, p < .001). Comorbidities such as hypertension (40% vs. 45%, p = .048) and diabetes (12% vs. 19%, p = .002) were less common in the same-day discharge cohort. On propensity-matched comparison, there was no significant difference in 30-day mortality (p > .9), 30-day readmission (p = .2), and overall postoperative complication rate (p = .2). Predictors of longer postoperative LOS included longer operative time, inpatient hospital status, preoperative transfusion, dependent functional status, and use of neoadjuvant chemotherapy. Our results indicate that for low-risk patients and uncomplicated cases, same-day discharge after minimally invasive, elective hepatectomy is feasible without compromising patient safety and outcomes.

Hospitalized Advanced HeartFailure With Preserved vs Reduced Left Ventricular Ejection Fraction: A Global Perspective.

Outcomes of hospitalized patients with heart failure (HF) and characteristics of advanced HF stage may vary across left ventricular ejection fraction (LVEF) and world regions. This study sought to analyze characteristics of hospitalized advanced HF patients across LVEF spectrum, world regions, and country income. Among 18,553 hospitalized patients with acute HF (7,902 new-onset HF and 10,651 decompensated chronic HF) enrolled in the global registry REPORT-HF (International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of HeartFailure), we analyzed characteristics and outcomes of patients with advanced HF, defined as previously diagnosed HF; severe symptoms before current admission (NYHA functional class III/IV); and≥1 HF-related hospitalization in the preceding 12months, excluding the current. Differences among hospitalized advanced HF subgroups stratified by LVEF, world region, and country income were examined. Among 6,999 patients with decompensated chronic HF and available previous NYHA functional class and HF hospitalization status, 3,397 (48.5%; 18.3% of the total population) had advanced HF. Of these, 44.5% had severely reduced (≤30%), 34.9% mildly/moderately reduced (31%-49%), and 20.7% preserved (≥50%) LVEF. Patients from Eastern Europe had the lowest 1-year mortality (23%), whereas those from Southeast Asia had the highest (37%). Patients from lower-middle-income countries were younger, with shorter HF duration and lower comorbidity prevalence, received fewer beta-blockers and HF-devices, and had higher 1-year mortality (34%) than upper-middle- (26%) or high-income countries (27%; P=0.018). Adjusted 1-year mortality risk did not differ among LVEF subgroups (all P > 0.05), nor did 1-year HF hospitalization rate (P=0.56). Hospitalized patients with advanced HF and preserved LVEF had similarly adverse outcomes as those with reduced LVEF. Patients from lower-middle-income countries had less implementation of HF therapies and higher 1-year mortality.

Risk of Sarcopenia, Hospitalization, and Mortality Among Malaysian Older Adults With Knee Pain: Five-Year Follow-up Study.

This study explores the longitudinal relationship between the presence of knee pain and knee osteoarthritis (OA) symptoms with risk of sarcopenia, hospitalization, and mortality. Data from Malaysian Elders Longitudinal Research (MELoR) study was utilized. The presence of knee pain and knee OA symptoms was determined at baseline between 2013 and 2015, whereas sarcopenia was determined in 2019 using SARC-F with telephone interviews. Hospitalization status was identified by asking participants "Have you been admitted to hospital since you enrolled into the MELoR study?" Death Registry data were obtained from the National Registry Department. Data from 577 individuals, mean age (SD) = 68.214 (7.095), range = 54 to 97 years, and 55.5% women at baseline, were included. Knee pain and knee OA symptoms were associated with increased risk of probable sarcopenia at follow-up, odds ratios (95% confidence interval) =2.71 [1.61, 4.58] and 2.73 [1.59, 4.71], respectively, after adjustment for confounders. Knee pain and knee OA symptoms were not associated with hospitalization and mortality. Knee pain and knee OA symptoms were associated with increased risk of probable sarcopenia at five-year follow-up in an urban older population in Kuala Lumpur. Future studies should seek to identify modifiable risk factors for the development of sarcopenia in individuals with knee OA.

Risk factors of 30-day mortality following cardiac surgery in adults with congenital heart disease: analysis from the Japanese registry

Abstract Background With advancements in pediatric therapies, the adult congenital heart disease (ACHD) population has grown consistently. ACHD patients often face complications necessitating cardiac surgery, and understanding surgical risk factors is essential. Purpose This study aims to assess ACHD surgical risk factors using big data, addressing evidence gaps in previous research limited to univariate analysis due to few perioperative adverse events. Methods We analyzed the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination (JROAD-DPC) database from April 2013 to March 2020. The JROAD-DPC database covers nearly all teaching hospitals with cardiovascular beds participation in JROAD. Our study included ACHD patients (&amp;gt;15 years) undergoing open-heart surgery. Our primary outcome was 30-day mortality. We assessed clinical backgrounds, admission status, treatment, and length of hospital stay. Results Out of 13,677 ACHD patients (mean age: 53 years, females 47%) undergoing cardiac surgery assessed for 30-day mortality, 13,516 (98.8%) patients were categorized into the survival group and 161 (1.2%) into the death group. Mortality rates varied by complexity of congenital heart disease (CHD): 0.8% for simple, 1.8% for moderate, and 0.9% for great. The figure shows that a significant increase in 30-day mortality rates with age was demonstrated in simple and moderate complexity (p&amp;lt;0.001 for trend analysis in both categories). In contrast, for cases of great complexity, the increase in 30-day mortality rates with aging was not statistically significant (p=0.443). The death group was significantly older and had higher rates of ambulance admissions, renal disease, and peripheral vascular disease. Intra-aortic balloon pumps (IABP), veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and dialysis during hospitalization were significantly higher among deceased patients. Length of ICU stay was significantly longer in the death group (median [IQR]; 3 [2-4] vs. 6 [3-11], p&amp;lt;0.001). Cox proportional-hazards model showed that age, moderate complexity, emergency admission, hospital bed counts, renal disease, and use of IABP and VA-ECMO were independently associated with 30-day mortality (Table). Conclusions The present study, which utilizes the nationwide administrative DPC database, demonstrates that surgical outcomes for patients with ACHD, as measured by 30-day mortality rates, are generally favorable. These outcomes significantly depend on factors such as age, complexity of CHD, emergency admissions, hospital capacity, renal disease, and use of mechanical circulatory support.