Hospital Treatment Research Articles

A Cross-Sectional Study of Acute Poisoning Cases Admitted in a Tertiary Care Hospital in Mangaluru, Karnataka, India

Abstract Introduction: A poison is a substance that causes serious illness and endangers the life of a person when ingested in a relatively small quantity. Poisoning is one of the most common problems encountered in day-to-day clinical practice. Poisoning causes morbidity and mortality which can be prevented and managed if clinicians are sensitized with adequate knowledge of common poisons. Therefore, this study was conducted to know the profile of acute poisoning cases admitted in a tertiary care hospital in Mangaluru. Materials and Methods: 100 patients admitted in the intensive care units and wards of the General Medicine department, Kasturba Medical College, Mangaluru, and Government Wenlock District Hospital, Mangaluru with various poisoning were evaluated for various factors like the distribution of poisoning cases according to age, gender, intention of poisoning, nature of poisons consumed and the nature of treatment received at another hospital before getting admitted. Results: Most of the cases of poisoning occurred in the age group between 21-30 years of age (38%). The majority of the patients in the study were males (60%) and females formed 40% of the study population. The majority of patients in this study (99%) consumed poison with suicidal intention. 77% of patients received first-aid treatment in a peripheral hospital before getting admitted to our hospital. Conclusion: This study shows that the peak incidence of acute poisoning cases was seen in the age group of 21 to 30 years with male predominance. The pattern of poisoning was suicidal in the majority of the patients.

Opinions of Patients with Sepsis Concerning Selected Elements of Holistic Patient Nursing Care During Hospitalization

Objectives: In this study, we examined the opinions of patients with severe sepsis concerning selected elements of patient nursing care during hospital treatment. Methods: We studied 105 adult patients with severe sepsis who received hospital treatment in Poland. Patients' opinions were examined concerning the engagement of nurses in the nursing process in the bio-psycho-social sphere and health education from the aspect of self-care after discharge from hospital. Results: Patients with sepsis received the highest level of support from nurses regarding making contacts with the family. Approximately one-third of respondents reported deficits in nursing care in the area of meeting the need for security, observation of vital signs, and assistance with feeding. A portion of respondents did not receive information about the possibility of social support after discharge from hospital. Conclusions: It is necessary to improve nursing care of patients with sepsis in the bio-psycho-social sphere, regarding the observation of vital signs and health education, because approximately one-third of patients reported deficits in these areas.

Outpatient parenteral antibiotic therapy in non-cystic fibrosis lung transplant recipients: characteristics, efficacy and safety.

Bacterial isolation is associated with worse outcomes after lung transplantation (LTx), and successful bacterial eradication is shown to improve long-term survival and pulmonary function. Outpatient Parenteral Antibiotic Therapy (OPAT) may be an effective therapeutic modality for bacterial eradication post-LTx. A single-center, retrospective analysis of OPAT characteristics, efficacy, safety, and costs in non-cystic fibrosis LTx recipients. A total of 156 OPAT courses (from June 2019 to December 2022) were evaluated in 108 distinct LTx recipients. OPAT mainly consisted of dual antibiotic therapy (69%) for pulmonary bacterial isolation (97%), mostly Pseudomonas aeruginosa (66%). Successful eradication at 3 months post-OPAT was achieved in 71%. Eradication rate was significantly higher in patients treated after the first post-operative year (79%), compared to patients within the first year (61%) (p = 0.017). Eradication rate was similar for multidrug resistance (eradication rate 61%) versus no multidrug resistance (74%) (p = 0.116). Spirometry remained stable at 90 days post-OPAT. A statistically significant, but clinically negligible, increase in serum creatinine at 90 days post-OPAT was observed (1.33mg/dL vs. 1.39mg/dL, p < 0.001), yet unrelated to the antibiotic regimen used. OPAT-related hospital admissions occurred in 13% and line-related adverse events in 6%. Median number of hospitalization days saved per OPAT-course was 10 days (range 2-92), accounting for a total of 1841 avoided admission days and an estimated net cost reduction of 47% per treatment course. OPAT is an effective and safe therapeutic modality for bacterial eradication post-LTx, associated with a significant reduction in hospitalization days and treatment costs.

Managing the patient portfolio using mathematical programming: decision support guidelines using a real-world use case at a university hospital

AbstractMany hospitals in Germany are facing escalating economic pressures. After several years of stagnation, the number of inpatient hospital treatments dropped by $$\:13\%$$ in 2020 compared to the previous year. This negative tendency can also be seen in operating theaters (OTs). Strategic management of the case mix in hospital OTs now necessitates a solid data foundation. The case mix and the case mix index have become central economic indicators in contemporary hospital operations. In this work, we develop a mathematical model for case mix optimization at Augsburg University Hospital in Germany, which is based on an extensive data analysis with descriptive methods. The optimization model is subject to rigorous testing and evaluation through an extensive series of scenario analyses. The primary objective is to calculate a revenue-maximizing patient mix while respecting the available scarce personnel resources in the OT and intensive care unit. This research marks a pioneering effort in delineating the practical integration of case mix planning into a hospital’s routine operations using mathematical optimization. The analyses reveal a strong correlation between an upsurge in revenue and an increased number of cases. Furthermore, the results demonstrate that strategic planning of the patient mix has the potential to enhance revenue with existing resources. Even though the optimal patient mix may not be directly implementable in practice, the findings yield valuable insights for managerial decision-making. A critical examination of these results also fosters a nuanced discourse on the utilization of optimization models as decision support tools within hospital management.

Effect of Animal-Assisted Activities on Symptoms and Emotions of Children with Neoplastic Disease: A Systematic Review with Meta-Analysis

BACKGROUND: Animal-assisted activities (AAAs) have long been present in pediatric oncology as a nonpharmacological intervention aimed at helping children cope with symptoms and negative emotions during hospitalization and antineoplastic treatment. Among the systematic reviews in the literature, there is a lack of one with meta-analysis that includes only RCTs centered on the effect of the intervention on symptoms and emotions in children with neoplastic disease. OBJECTIVE: To synthesize the effect of AAAs on symptoms and emotions of children with neoplastic disease. METHODS: Studies were searched from biomedical databases Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus, AMED, sciELO, LILACS, CNKI, J-GLOBAL, J-STAGE, main trial registries and major sources of grey literature. Searching for useful documents took place from the inception of each resource until April 18, 2024. The risk of bias of included studies was assessed with RoB 2, and the overall effect size of the intervention was calculated by creating random-effects meta-analyses graphically represented by forest plots. The summary of findings was illustrated with a table in accordance with the GRADE method. RESULTS: Three parallel-group randomized controlled trials with low risk of bias were included (N = 151, mean age: 8.5-11.2 years). AAAs are promising for anxiety reduction (N = 134; SMD = -0.07 [95% CI: -0.40, 0.27], p &gt; 0.05) and quality of life improvement (N = 84; SMD = -0.11 [95% CI: -0.53, 0.31], p &gt; 0.05) in children and for anxiety reduction (N = 154; SMD = -0.50 [95% CI: -1.52, 0.52], p &gt; 0.05) in parents/caregivers. The certainty/quality of evidence is low to very low. CONCLUSIONS: The effect of animal-assisted activities to reduce anxiety and improve the quality of life of children with neoplastic disease and to reduce parent/caregiver anxiety is small to moderate; however, the quality/certainty of evidence is very low to low. Therefore, further studies on the topic that overcome the current limitations need to be conducted in order to collect more robust data in favor of implementing the intervention in pediatric oncology.

Body image discontentment among head and neck cancer patients in Visakhapatnam district: An empirical study

Head and neck cancers, which comprise tumours of the oral cavity, throat, nasal cavity, and thyroid, pose substantial physical and psychological issues. These tumours frequently require harsh therapies such as surgery, radiation therapy, and chemotherapy, which can result in apparent changes in appearance and physical function. As a result, patients are frequently subjected to body image distress, low self-esteem, and overall unhealthy psychological well-being. This study aims to investigate head and neck cancer patients' self-perceptions and body image problems, with an emphasis on feelings of self-consciousness, physical attractiveness, and general body dissatisfaction amongst head and neck cancer out patients undergoing treatment in HCG cancer hospital in Visakhapatnam. This study was conducted on 50 head and neck cancer outpatients undergoing treatment at an oncology centre Healthcare Global Enterprises ltd (HCG) hospital Visakhapatnam during the period of (May 2023 to June 2023) who were willing to participate in the study and were 20 years of age and above. An interview schedule was prepared by the researcher and administered to the patients comprising section A (questions pertaining to the demographic and clinical details of the patient), section B (modified 6 item Body Image Scale). Majority of the patients were male (62%) while female constituted 38% with the majority aged between 20- 39 years (61%) and the most common cancer being that of oral cavity (58%). The findings reveal a sizable proportion of respondents reporting feeling self-conscious and less physically attractive as a result of their sickness or treatment. Many individuals are dissatisfied with their appearance and overall body image, with a significant percentage reporting that these issues interfere with their social relationships and sense of wholeness. These findings highlight the need of addressing psychological and emotional support in the treatment and care of head and neck cancer patients. Integrating mental health and body image counselling into cancer treatment programmes has the potential to greatly improve patients' overall well-being and quality of life.

Improved survival of patients with stage III small-cell lung cancer with primary resection: A SEER-based analysis

Introduction: Small cell lung cancer (SCLC) is mostly diagnosed in stage III-IV patients and associated with poor prognosis. To date, surgery is no gold-standard treatment for any SCLC stage and evidence is lacking whether it is beneficial. Here we investigate the impact of surgery, with special attention to stage III SCLC patients, sub-stages and treatment combinations. Methods: The overall survival (OS) and cancer-specific survival (CSS) of 33,198 SCLC patients (SEER database) were analyzed retrospectively, using various statistical analyses, including propensity score matching (PSM), recursive partitioning, and sequential landmark analyses. Results: Independent of stage, the OS of patients with surgery-including treatments was almost always better than without surgery. This holds true for stage I-II patients, even after PMS analysis (p < 0.017). The same was found for stage IV patients that underwent surgery plus chemotherapy vs. chemotherapy alone (p = 0.013 after PSM). Stage III patients showed a robust improvement in OS and CSS after surgery (OS: 18 vs.13 months) or surgery plus chemotherapy (OS: 20 vs.15 months) as confirmed by well-balanced PSM and sequential landmark analyses of long-term survivors. More detailed analyses using two independent approaches showed prolonged OS in T3–4/N0–1 and T1–2/N2 stage III patients after surgery or surgery plus chemotherapy. Importantly, primary site surgery had a major survival advantage over surgery at regional sites (p < 0.003). Conclusion: Our study demonstrates that selected patients of all stages, including stage III T3–4/N0–1 and T1–2/N2, can benefit greatly from surgery-including treatments. Thus, surgery should be included into hospital treatment recommendations for specifically selected SCLC patients.Condensed abstractPrimary resection in patients with stage III SCLC needs re-evaluation. Selected patients with stage III SCLC benefit significantly from surgery. Patients with T3–4/N0–1 and T1–2/N2 stage III SCLC should be considered for surgery.

A Novel Dhillonvirus Phage against Escherichia coli Bearing a Unique Gene of Intergeneric Origin.

Antibiotics resistance is expanding amongst pathogenic bacteria. Phage therapy is a revived concept for targeting bacteria with multiple antibiotics resistances. In the present study, we isolated and characterized a novel phage from hospital treatment plant input, using Escherichia coli (E. coli) as host bacterium. Phage lytic activity was detected by using soft agar assay. Whole-genome sequencing of the phage was performed by using Next-Generation Sequencing (NGS). Host range was determined using other species of bacteria and representative genogroups of E. coli. Whole-genome sequencing of the phage revealed that Escherichia phage Ioannina is a novel phage within the Dhillonvirus genus, but significantly diverged from other Dhillonviruses. Its genome is a 45,270 bp linear double-stranded DNA molecule that encodes 61 coding sequences (CDSs). The coding sequence of CDS28, a putative tail fiber protein, presented higher similarity to representatives of other phage families, signifying a possible recombination event. Escherichia phage Ioannina lytic activity was broad amongst the E. coli genogroups of clinical and environmental origin with multiple resistances. This phage may present in the future an important therapeutic tool against bacterial strains with multiple antibiotic resistances.

Māori experiences and perspectives of hospital treatment in the context of acute care.

Through exploring Māori experiences when presenting acutely to hospital, we aimed to identify specific aspects of culturally safe care that we could incorporate into healthcare professionals' training and hospital processes. Using Kaupapa Māori approaches, we undertook semi-structured interviews and thematic analysis to collect and analyse data from diverse groups of Māori participants. We interviewed 17 participants, with 16 follow-up interviews. We found a lack of trust, and perceptions of unequal treatment for Māori. Our participants highlighted the following key needs: the importance of whanaungatanga in building trusting relationships with patients and whānau; creating safe spaces for patients and whānau; improved staff cultural safety; exploring individual patient and whānau needs, avoiding assumptions about cultural requirements or stereotypical characteristics; upholding the mana of all patients with respectful interactions; and empowering Māori as partners in their care. By sharing their personal experiences, participants have highlighted specific aspects of their interactions with hospital staff and the healthcare system that could and should be improved. These insights can guide our efforts to enhance cultural safety for Māori patients and whānau through targeted staff training and structural changes.

Hospital Accreditation Status and Treatment Differences Among Black Patients With Colon Cancer

Hospital-level factors, such as hospital type or volume, have been demonstrated to play a role in treatment disparities for Black patients with cancer. However, data evaluating the association of hospital accreditation status with differences in treatment among Black patients with cancer are lacking. To evaluate the association of Commission on Cancer (CoC) hospital accreditation status with receipt of guideline-concordant care and mortality among non-Hispanic Black patients with colon cancer. This population-based cohort study used the National Program of Cancer Registries, which is a multicenter database with data from all 50 states and the District of Columbia, and covers 97% of the cancer population in the US. The participants included non-Hispanic Black patients aged 18 years or older diagnosed with colon cancer between January 1, 2018, and December 31, 2020. Race and ethnicity were abstracted from medical records as recorded by health care facilities and practitioners. The data were analyzed from December 7, 2023, to January 17, 2024. CoC hospital accreditation. Guideline-concordant care was defined as adequate lymphadenectomy during surgery for patients with stages I to III disease or chemotherapy administration for patients with stage III disease. Multivariable logistic regression models investigated associations with receipt of guideline-concordant care and Cox proportional hazards regression models assessed associations with 3-year cancer-specific mortality. Of 17 249 non-Hispanic Black patients with colon cancer (mean [SD] age, 64.8 [12.8] years; 8724 females [50.6%]), 12 756 (74.0%; mean [SD] age, 64.7 [12.8] years) were treated at a CoC-accredited hospital and 4493 (26.0%; mean [SD] age, 65.1 [12.5] years) at a non-CoC-accredited hospital. Patients treated at CoC-accredited hospitals compared with those treated at non-CoC-accredited hospitals had higher odds of receiving guideline-concordant lymphadenectomy (adjusted odds ratio [AOR], 1.89; 95% CI, 1.69-2.11) and chemotherapy (AOR, 2.31; 95% CI, 1.97-2.72). Treatment at CoC-accredited hospitals was associated with lower cancer-specific mortality for patients with stages I to III disease who received surgery (adjusted hazard ratio [AHR], 0.87; 95% CI, 0.76-0.98) and for patients with stage III disease eligible for chemotherapy (AHR, 0.75; 95% CI, 0.59-0.96). In this cohort study of non-Hispanic Black patients with colon cancer, patients treated at CoC-accredited hospitals compared with those treated at non-CoC-accredited hospitals were more likely to receive guideline-concordant care and have lower mortality risk. These findings suggest that increasing access to high-quality guideline-concordant care at CoC-accredited hospitals may reduce variations in cancer treatment and outcomes for underserved populations.

Short-term effectiveness of music therapy songwriting for mental health outcomes of at-risk parents in the NICU: a study protocol of an international multicenter mixed-methods trial.

Preterm birth contributes to adverse mental health outcomes of parents dealing with a premature neonate. The main objective of this study is to determine whether music therapy (MT) songwriting during the infants' stay in the neonatal intensive care unit (NICU) is superior to standard care in reducing the risk of postpartum depression in high-risk parents of preterm children throughout the hospital treatment. The secondary objectives include assessment of effectiveness of MT in other aspects of mental health (anxiety level, perceived stress, mental wellbeing, coping, resilience). Furthermore, this trial will evaluate the medical and social factors that may be associated with the effects of MT songwriting. The study design is a sequential mixed method study with a dominant status QUAN to qual. The quantitative trial was designed as a parallel, multicenter, pragmatic, randomized controlled trial. The qualitative study is a descriptive phenomenological study that seeks to understand the lived experiences of participants exposed to songwriting. Participants are parents of premature infants hospitalized in NICU (106 families) in 5 hospitals, in Colombia and Poland. Intervention: 3 MT songwriting sessions per week across 3 weeks. Primary outcome: the risk of postnatal depression; secondary outcomes: anxiety level, mental wellbeing, resilience, stress, coping. The results will be analyzed quantitatively and qualitatively. This study will provide a report on the effectiveness of MT songwriting on mental health in at-risk parents of preterm infants.

Effect of Animal-Assisted Activities on Symptoms and Emotions of Children with Neoplastic Disease: A Systematic Review with Meta-Analysis

BACKGROUND: Animal-assisted activities (AAAs) have long been present in pediatric oncology as a nonpharmacological intervention aimed at helping children cope with symptoms and negative emotions during hospitalization and antineoplastic treatment. Among the systematic reviews in the literature, there is a lack of one with meta-analysis that includes only RCTs centered on the effect of the intervention on symptoms and emotions in children with neoplastic disease. OBJECTIVE: To synthesize the effect of AAAs on symptoms and emotions of children with neoplastic disease. METHODS: Studies were searched from biomedical databases, trial registries, and web resources. The risk of bias of included studies was assessed with RoB 2, and the overall effect size of the intervention was calculated by creating random-effects meta-analyses graphically represented by forest plots. The summary of findings was illustrated with a table in accordance with the GRADE method. RESULTS: Three parallel-group randomized controlled trials with low risk of bias were included (N = 151, mean age: 8.5-11.2 years). AAAs are promising for anxiety reduction (N = 134; SMD = -0.07 [95% CI: -0.40, 0.27], p &gt; 0.05) and quality of life improvement (N = 84; SMD = -0.11 [95% CI: -0.53, 0.31], p &gt; 0.05) in children and for anxiety reduction (N = 154; SMD = -0.50 [95% CI: -1.52, 0.52], p &gt; 0.05) in parents/caregivers. The certainty/quality of evidence is low to very low. CONCLUSIONS: The effect of animal-assisted activities to reduce anxiety and improve the quality of life of children with neoplastic disease and to reduce the anxiety of parents/caregivers is promising. However, more studies need to be conducted on the topic that overcome the important methodological limitations manifested by current research in order to collect more data in favor of implementing the intervention in pediatric oncology.

Reform proposal "Occasional surgical oncology" : Medical strategic analysis and ramifications of the draft bill within the framework of the Hospital Treatment Improvement Act (KHVVG) from the perspective of a university hospital

Cancer remains the second most common cause of death in Germany. Performance management and specialization concepts in medicine have the potential to positively influence the care and chances of survival of patients. From the perspective of the University Hospital Freiburg (UKF), the legislative initiative within the framework of the Hospital Treatment Improvement Act (KHVVG) results in anumber of medical strategic implications. This article explains and discusses the background, objectives and contents of the reform project "Occasional surgical oncology" and provides perspectives on strategic fields of action. Analysis and interpretation of the draft of the Act for improvement of the treatment quality in hospitals and on the reform of the remuneration structures (Federal Government draft act). From the point of view of the UKF hospitals should engage in cooperative discussions with neighboring hospitals at the earliest opportunity to shape regional healthcare with the goals of mapping the local allocation of oncology patients for optimal treatment, mitigating the loss of patients at affected locations and preparing for patient growth at facilities that will continue to provide treatment in surgical oncology. The ongoing legislative process and the fact that areliable analysis of relevant treatment areas will be possible for hospitals in the first half of 2025, presents particular challenges for hospitals and the strategic planning of activities. The gaps in the bill presented in this article should be urgently addressed to avoid undermining the project's goals and to support the hospitals remaining in the healthcare system in their preparations.

Nutritional Management of Patients with Fatty Acid Oxidation Disorders.

Treatment of fatty acid oxidation disorders is based on dietary, pharmacological and metabolic decompensation measures. It is essential to provide the patient with sufficient glucose to prevent lipolysis and to avoid the use of fatty acids as fuel as far as possible. Dietary management consists of preventing periods of fasting and restricting fat intake by increasing carbohydrate intake, while maintaining an adequate and uninterrupted caloric intake. In long-chain deficits, long-chain triglyceride restriction should be 10% of total energy, with linoleic acid and linolenic acid intake of 3-4% and 0.5-1% (5/1-10/1 ratio), with medium-chain triglyceride supplementation at 10-25% of total energy (total MCT+LCT ratio = 20-35%). Trihepatnoin is a new therapeutic option with a good safety and efficacy profile. Patients at risk of rhabdomyolysis should ingest MCT or carbohydrates or a combination of both 20 min before exercise. In medium- and short-chain deficits, dietary modifications are not advised (except during exacerbations), with MCT contraindicated and slow sugars recommended 20 min before any significant physical exertion. Parents should be alerted to the need to increase the amount and frequency of carbohydrate intake in stressful situations. The main measure in emergency hospital treatment is the administration of IV glucose. The use of carnitine remains controversial and new therapeutic options are under investigation.

The Diagnostic Value of Ultrasound Combined with Serum VEGF and TSGF Levels Detection for Differentiated Thyroid Cancer

Objective: To explore the diagnostic value of ultrasound combined with serum VEGF (vascular endothelial growth factor) and TSGF (tumor specific growth factor test) levels in differentiated thyroid cancer, and analyze clinical and pathological characteristics. Methods: Multiple patients with differentiated thyroid cancer who received diagnosis and treatment in a certain hospital in China from February 2021 to February 2023 were selected for the experiment. 50 patients were randomly selected as the experimental group. Based on the type of adenocarcinoma, these 50 patients were further divided into the thyroid follicular carcinoma group and the thyroid papillary carcinoma group. Fifty patients with thyroid sarcoidosis were selected as the control group during the same period. Compare the ultrasound examination results and serum levels of VEGF and TSGF between two experimental groups to explore their relationship with the clinical and pathological characteristics of differentiated thyroid cancer. Results: Through experimental observation, it can be concluded that the sensitivity of ultrasound combined with serum VEGF and TSGF levels in the diagnosis of differentiated thyroid cancer is relatively high, and it will significantly exceed the diagnostic sensitivity of ultrasound alone, with P&lt;0.05. And the combination of ultrasound and serum VEGF, TSGF level detection will exceed the specificity and positive predictive value of ultrasound detection in both positive predictive value and specificity. Conclusion: Ultrasound combined with serum VEGF and TSGF levels detection has a relatively high diagnostic value for differentiated thyroid cancer, and can determine the correlation between tumor invasion and metastasis in patients with differentiated thyroid cancer and their serum VEGF and TSGF levels.

Weight Regain following Bariatric Surgery and in vitro Fertilization Outcomes

Introduction: The aim of this study was to estimate the time to pregnancy and live birth and evaluate the effect of weight regain in women with a history of bariatric surgery (BS) who underwent in vitro fertilization (IVF) treatments. Methods: This is a retrospective cohort study. All patients with previous BS who underwent IVF treatment in a tertiary university-affiliated hospital between 2013 and 2022 were included. Time to pregnancy and live birth were compared between patients who regained less than or greater than three points of body mass index (BMI) from the nadir weight after BS. Kaplan-Meier curves and log-rank tests were used to compare groups. Results: A total of 78 patients were included in this study. The positive β-hCG, clinical pregnancy, and live birth rates following BS were 89.4%, 78.9%, and 50.8%, respectively. The median time from the beginning of IVF treatments to a positive β-hCG test was 2.97 months (95% CI: 1.04–4.89 months), to a clinical pregnancy was 7.1 months (95% CI: 3.56–10.91), and to a live birth was 20.2 months. Women who maintained their nadir BMI following BS had nearly twice the chance of achieving a clinical pregnancy (HR 1.967, 95% CI: 1.026–3.771, p = 0.042) and were approximately three times more likely to achieve a live birth (2.864, 95% CI: 1.196–6.859, p = 0.018) than those who regained at least three points of BMI. Conclusion: Weight regain after BS is associated with a lower rate of live births and prolonged time to achieve clinical pregnancy and live birth.

The effectiveness of neurorehabilitation in inpatient department

The objective of the study is to evaluate the effectiveness of rehabilitation treatment in patients with neurological pathology in inpatient department.Materials and methods. The study included 101 patients undergoing hospital treatment due to an existing neurological disease. The mean age was 52.41 ± 13.49 years. The condition of each patient upon admission and after the course of inpatient treatment was assessed using special tools – scales, tests, indices and questionnaires, such as the Rehabilitation Routing Scale and the modified Rankin scale, and according to the clinical specifics and needs of rehabilitation treatment – the Ashworth scale, Caprini Scale, Muscle Strength Grading Scale, National Institutes of Health Stroke Scale, HAS-BLED Scale, Berg Scale, Functional Independence Measure, Waterlow Score, Numeric Pain Rating Scale, Frenchay Arm Test, Rivermead Mobility Index, Hauser Index, EQ-5D, Barthel Index. The dynamics of recovery were calculated by comparing scores obtained using special instruments upon admission to rehabilitation treatment and after it.Results. By analyzing the results of the study, a positive dynamic of recovery was established, confirming the effectiveness of an inpatient course of neurorehabilitation, which is expressed in an improvement in the condition of patients when assessed using the designated tools for its objectification.Conclusions. The study confirms the effectiveness of an inpatient course of medical rehabilitation in restoring neurological deficits, increasing the activity of daily living, reducing the degree of social maladjustment and improving the rehabilitation prognosis.

Reported snakebite mortality and state compensation payments in Madhya Pradesh, India, from 2020 to 2022.

India experiences the highest snakebite burden globally, with 58 000 predicted deaths annually. The central Indian state of Madhya Pradesh is thought to have a substantial snakebite burden and provides compensation to families who can demonstrate by postmortem and hospital treatment reports that their relatives have died due to snakebite. This study represents the first report on the frequency of distribution of compensation for snakebite deaths in Madhya Pradesh. Statewide snakebite death compensation data from 2020-2021 and 2021-2022, provided by the Madhya Pradesh health authorities, were analysed alongside interviews with 15 families that described the events that ultimately led to their compensation claims. Compensation was paid to a total of 5728 families, with a total value equating to 22 912 Lakhs (approximately US${\$}$27.94 million). Families described commonly recognised snakebite risk factors and behaviours in the events that resulted in their relatives' deaths. The snakebite burden in Madhya Pradesh is significant, both in terms of mortality and economic expenditure of the state. Sustained investment in preventative interventions, as well as monitoring of the rate of compensation payouts due to snakebite death as a measure of intervention effectiveness, should be considered to substantially reduce snakebite incidence and mortality.

Assessing post-abortion care using the WHO quality of care framework for maternal and newborn health: a cross-sectional study in two African hospitals in humanitarian settings

BackgroundAbortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR).MethodsWe mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals’ PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively.ResultsAmong the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time.ConclusionOur comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.

Health-economic evaluation of orthogeriatric co-management for patients with pelvic or vertebral fragility fractures

BackgroundOrthogeriatric co-management (OGCM) addresses the special needs of geriatric fracture patients. Most of the research on OGCM focused on hip fractures while results concerning other severe fractures are rare. We conducted a health-economic evaluation of OGCM for pelvic and vertebral fractures.MethodsIn this retrospective cohort study, we used German health and long-term care insurance claims data and included cases of geriatric patients aged 80 years or older treated in an OGCM (OGCM group) or a non-OGCM hospital (non-OGCM group) due to pelvic or vertebral fractures in 2014–2018. We analyzed life years gained, fracture-free life years gained, healthcare costs, and cost-effectiveness within 1 year. We applied entropy balancing, weighted gamma and two-part models. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.ResultsWe included 21,036 cases with pelvic (71.2% in the OGCM, 28.8% in the non-OGCM group) and 33,827 with vertebral fractures (72.8% OGCM, 27.2% non-OGCM group). 4.5–5.9% of the pelvic and 31.8–33.8% of the vertebral fracture cases were treated surgically. Total healthcare costs were significantly higher after treatment in OGCM compared to non-OGCM hospitals for both fracture cohorts. For both fracture cohorts, a 95% probability of cost-effectiveness was not exceeded for a willingness-to-pay of up to €150,000 per life year or €150,000 per fracture-free life year gained.ConclusionWe did not obtain distinct benefits of treatment in an OGCM hospital. Assigning cases to OGCM or non-OGCM group on hospital level might have underestimated the effect of OGCM as not all patients in the OGCM group have received OGCM.