Inpatient Treatment Research Articles

Prevalence and Patterns of Electrolyte Imbalance in Children Diagnosed with Acute Severe Malnutrition at a Nutritional Stabilization Center

Malnutrition accounts for around 35% of all fatalities in Pakistan among children under five, making it the primary cause of childhood mortality in that country. The most severe type of malnutrition, known as severe acute malnutrition (SAM), was frequently linked to electrolyte abnormalities. The purpose of this study was to ascertain how frequently electrolyte imbalance occurred in children with SAM who were admitted to a tertiary care facility. Objective: To Determine the Prevalence and Patterns of Electrolyte Imbalance in Children Diagnosed with Acute Severe Malnutrition at a Nutritional Stabilization Center”. Methods: A cross-sectional study was carried out in Nawabshah at the Department of Pediatrics, Peoples University of Medical and Health Sciences, from May 16 to August 15, 2024. This study comprised 92 patients with severe acute malnutrition, ranging in age from 2 to 60 months. Non purposive sampling technique was used for data collection. Children with secondary causes of wasting were excluded, including those with congenital heart disease, chronic renal or liver illness, TB, cancer, and hemolytic anaemia. Weight-for-height was calculated using measurements of weight, length, and height. When the weight-for-height ratio fell below the -3 standard deviation (SD), children were diagnosed with SAM. The lab received blood samples that were taken for serum electrolytes. The chi-square test was used for stratification, and descriptive statistics were computed. Results: Participants' average ages ranged from 23.63± 12.71 months. A total of 85 (93.4%) of the 92 SAM patients had an electrolyte imbalance. The prevalence of hypokalemia (70.08%), hypocalcemia (56.52%), hyponatremia (32.60%), and hypomagnesemia (28.26%), respectively. Conclusions: Children with SAM experience dyselectrolytemia both with and without problems. In all cases of SAM, serum electrolyte levels may need to be assessed in order to identify hyponatremia and hypokalemia in the absence of symptoms. This will facilitate the inpatient treatment triage process for patients with asymptomatic hyponatremia and hypokalemia.

Analysis of Echocardiography Indicators Depending on the Type of Surgical Correction of the Mitral Valve in Patients with Ischemic Heart Disease

The aim. To study the influence of echocardiography indicators on the choice of surgical intervention on the mitral valve in patients with mitral insufficiency and coronary heart disease. Materials and methods. The study included patients with mitral insufficiency who underwent myocardial revascularization and mitral valve reconstruction (plasty or replacement). The mean age of the study participants was 65.9 ± 4.0 years. The material for analysis was data from the primary medical records: medical history, clinical and instrumental examination data and protocols of operations. The division into study groups was performed retrospectively, according to the mitral valve operation performed: plasty (experimental group) or replacement (control group). Results. We identified the features of the main echocardiographic data that guide the cardiologist when choosing the tactics of surgical correction of the mitral valve. It was established that in patients of the research group, the following was reliably significant: moderate degree of mitral insufficiency (p = 0.02; χ2 = 9.38), decrease in the systolic function of the left ventricle (p = 0.001; χ2 = 10.75); it was found that calcium deposits on the fibrous ring of the mitral valve were insignificant. When analyzing the morphological changes in patients of the experimental group, we found a significantly lower frequency of anterior leaflet prolapse (p = 0.04; χ2 = 4.21) and in general the frequency of all prolapses of any type, while in the control group the frequency of all prolapses was significantly higher (p = 0.04; χ2 = 4.0). In patients of the control group, a significantly higher frequency of akinesis (p = 0.04; χ2 = 4.21) and hypokinesis zones of the posterior-inferior-lateral wall (p = 0.001; χ2 = 19.76) was established, which is an additional sign of involvement of the chordal-muscular apparatus of the mitral valve in pathological process. Conclusions. As a result of the study, echocardiographic differences in the structure of the mitral valve were established, which influenced the selection of the intervention volume. It was found that in patients of the experimental group, the early postoperative mortality and the duration of inpatient treatment were significantly higher than in patients of the control group, which indicates the imperfection of the criteria used by cardiac surgeons when choosing the tactics of surgical correction of the mitral valve in an attempt to perform organ-preserving surgery.

Psychometric properties of the German version of the brief resilience scale in persons with mental disorders

The Brief Resilience Scale (BRS) was developed to assess individual differences in the ability to recover from stress despite adversity and has been translated into several languages. This study aimed to examine the psychometric properties (i.e., item characteristics, reliability, factor structure, measurement invariance, and validity) of the German version of the BRS in persons with mental disorders. A total of N = 5,986 persons admitted to inpatient treatment completed the German version of the BRS and other questionnaires. The discriminating power of the items, the difficulty of the items, and the internal consistency were all sufficient. Moreover, confirmatory factor analysis supported the two–factor structure of the BRS, consistent with the findings of the German validation study in a non–clinical sample. The BRS also had strict measurement invariance across diagnostic groups for mental disorders according to ICD–10. Validity was examined using a network analysis, in which the BRS demonstrated positive correlations with life satisfaction, self–efficacy and optimism and negative correlations with somatic symptoms, anxiety, insomnia, and depression. The BRS can serve as a reliable and valid tool for assessing resilience in clinical settings, facilitating the identification of persons with potentially lower psychosocial resources.

Trajectories of daily antipsychotic use and weight gain in people hospitalized for the first episode of psychosis.

We need to better understand the risk factors and predictors of medication-related weight gain to improve metabolic health of individuals with schizophrenia. This study explores how trajectories of antipsychotic medication (AP) use impact body weight early in the course of schizophrenia. We recruited 92 participants with first-episode psychosis (FEP, n=92) during their first psychiatric hospitalization. We prospectively collected weight, body mass index (BMI), metabolic markers, and exact daily medication exposure during 6-week hospitalization. We quantified the trajectory of AP medication changes and AP polypharmacy using a novel approach based on meta-analytical ranking of medications and tested it as a predictor of weight gain together with traditional risk factors. Most people started treatment with risperidone (n=57), followed by olanzapine (n=29). Then, 48% of individuals remained on their first prescribed medication, while 33% of people remained on monotherapy. Almost half of the individuals (39/92) experienced escalation of medications, mostly switch to AP polypharmacy (90%). Only baseline BMI was a predictor of BMI change. Individuals in the top tercile of weight gain, compared to those in the bottom tercile, showed lower follow-up symptoms, a trend for longer prehospitalization antipsychotic treatment, and greater exposure to metabolically problematic medications. Early in the course of illness, during inpatient treatment, baseline BMI is the strongest and earliest predictor of weight gain on APs and is a better predictor than type of medication, polypharmacy, or medication switches. Baseline BMI predicted weight change over a period of weeks, when other traditional predictors demonstrated a much smaller effect.

A clinical case of extremely severe COVID-19 with a favourable outcome

COVID-19 is an infectious disease that can progress from carrier and mild symptoms of acute respiratory infections to bilateral pneumonia, severe respiratory failure, acute respiratory distress syndrome (ARDS), multiorgan failure, sepsis and shock. One of the predictors of severe course of infection is advanced age and comorbidities. In this work we considered a clinical case of COVID-19 patient S., 86 years old, who was admitted to the hospital, to the intensive care unit on the 10th day of the disease, in an extremely severe condition. A diagnosis of bilateral polisegmental pneumonia with 70% lung involvement caused by SARS-CoV-2 virus was made. In addition to antiviral therapy with remdesivir and symptomatic therapy, pathogenetic therapy with tocilizumab was applied. On admission, the patient had leukopenia, thrombocytopenia, elevated values of COE, urea, significant elevation of inflammatory markers CRP and D-dimer, as well as pCo2. During inpatient treatment, positive dynamics of the condition and laboratory parameters were observed. The patient was discharged in satisfactory condition, all laboratory parameters were normalised, except for a slight increase in CRP and pCO2 levels. Despite the age of the patient and the severity of COVID-19 course, the combined use of drugs with multidirectional action, including tocilizumab, may improve the outcome of the disease.

Clinical and epidemiological aspects of primary immunodeficiencies in the Republic of Karakalpakstan

Studying the prevalence of primary immunodeficiency disorders (PID) is an important aspect of epidemiological research, as it allows for assessing the frequency of these diseases occurring in different regions. The distribution of PID may vary depending on ethnic background and geographical location. Information on the prevalence of PID at regional, national, and international levels enables a more accurate determination of the scale of the problem and the development of effective prevention and treatment strategies. Studying the epidemiological and clinical profile of congenital immune disorders (PID) in the Republic of Karakalpakstan is crucial for understanding the prevalence, age and gender structure, as well as the spectrum of nosological forms of these rare diseases. The aim of this study was to investigate the epidemiological and clinical characteristics of congenital immune disorders, primary immunodeficiencies in the Republic of Karakalpakstan. The study material consisted of data on patients receiving inpatient treatment at a multidisciplinary children’s hospital in the Republic of Karakalpakstan and those under the care of an allergist-immunologist in the outpatient clinic at district medical centers in the Republic of Karakalpakstan. The average delay in diagnosis from the onset of clinical manifestation of PID in the region was 2.7 years. It was found that the mortality rate was 2.8%. Screening tests for verifying PID in the diagnostic search stage included clinical and biochemical blood analyses, and determination of serum immunoglobulins. At the time of diagnosis, patients exhibited a significant decrease in IgG and IgA immunoglobulin levels. In addition to the disorder in the humoral branch of adaptive immunity, children with this disease showed a decrease in the absolute number of T lymphocytes. The data obtained from the study indicate insufficient diagnosis of primary immunodeficiencies in the Republic of Karakalpakstan, which may serve as a basis for the development of educational programs aimed at increasing awareness of primary immunodeficiencies. Further research and systematization of information on patients with primary immunodeficiencies are necessary for the development of regional programs for the implementation of screening diagnostics.

Antiseizure Medication Use and Outcomes After Suspected or Confirmed Acute Symptomatic Seizures

Antiseizure medications (ASMs) are frequently prescribed for acute symptomatic seizures and epileptiform abnormalities (EAs; eg, periodic or rhythmic patterns). There are limited data on factors associated with ASM use and their association with outcomes. To determine factors associated with ASM use in patients with confirmed or suspected acute symptomatic seizures undergoing continuous electroencephalography, and to explore the association of ASMs with outcomes. This multicenter cohort study was performed between July 1 and September 30, 2021, at 5 US centers of the Post Acute Symptomatic Seizure Investigation and Outcomes Network. After screening 1717 patients, the study included 1172 hospitalized adults without epilepsy who underwent continuous electroencephalography after witnessed or suspected acute symptomatic seizures. Data analysis was performed from November 14, 2023, to February 2, 2024. ASM treatment (inpatient ASM continuation ≥48 hours). Factors associated with (1) ASM treatment, (2) discharge ASM prescription, and (3) discharge and 3-month Glasgow Outcome Scale score of 4 or 5 were ascertained. A total of 1172 patients (median [IQR] age, 64 [52-75] years; 528 [45%] female) were included. Among them, 285 (24%) had clinical acute symptomatic seizures, 107 (9%) had electrographic seizures, and 364 (31%) had EAs; 532 (45%) received ASM treatment. Among 922 patients alive at discharge, 288 (31%) were prescribed ASMs. The respective frequencies of inpatient ASM treatment and discharge prescription were 82% (233 of 285) and 69% (169 of 246) for patients with clinical acute symptomatic seizures, 96% (103 of 107) and 95% (61 of 64) for electrographic seizures, and 64% (233 of 364) and 48% (128 of 267) for EAs. On multivariable analysis, acute and progressive brain injuries were independently associated with increased odds of inpatient ASM treatment (odds ratio [OR], 3.86 [95% CI, 2.06-7.32] and 8.37 [95% CI, 3.48-20.80], respectively) and discharge prescription (OR, 2.26 [95% CI, 1.04-4.98] and 10.10 [95% CI, 3.94-27.00], respectively). Admission to the neurology or neurosurgery service (OR, 2.56 [95% CI, 1.08-6.18]) or to the neurological intensive care unit (OR, 7.98 [95% CI, 3.49-19.00]) was associated with increased odds of treatment. Acute symptomatic seizures and EAs were significantly associated with increased odds of ASM treatment (OR, 14.30 [95% CI, 8.52-24.90] and 2.30 [95% CI, 1.47-3.61], respectively) and discharge prescription (OR, 12.60 [95% CI, 7.37-22.00] and 1.72 [95% CI, 1.00-2.97], respectively). ASM treatment was not associated with outcomes at discharge (OR, 0.96 [95% CI, 0.61-1.52]) or at 3 months after initial presentation (OR, 1.26 [95% CI, 0.78-2.04]). Among 623 patients alive and with complete data at 3 months after discharge, 30 (5%) had postdischarge seizures, 187 (30%) were receiving ASMs, and 202 (32%) had all-cause readmissions. This study suggests that etiology and electrographic findings are associated with ASM treatment for acute symptomatic seizures and EAs; ASM treatment was not associated with functional outcomes. Comparative effectiveness studies are indicated to identify which patients may benefit from ASMs and to determine the optimal treatment duration.

The interplay of personality pathology and treatment outcome in psychosomatic psychotherapy: A longitudinal analysis using latent change score modelling

IntroductionWhile ample data demonstrate the effectiveness of inpatient psychosomatic treatment, clinical observation and empirical evidence demonstrate that not all patients benefit equally from established therapeutic methods. Especially patients with a comorbid personality disorder often show reduced therapeutic success compared to other patient groups. Due to the heterogeneous and categorical personality assessment, previous studies indicated no uniform direction of this influence. This complicates the derivation of therapeutic recommendations for mental disorders with comorbid personality pathology. MethodsAnalyzing n = 2094 patients from German university hospitals enrolled in the prospective “MEPP” study, we tested the dynamic interaction between dimensionally assessed personality functioning and psychopathology of anxiety and depression. ResultsLongitudinal structural equation modelling replicated the finding that the severity of symptoms at admission predicts symptom improvement within the same symptom domain. In addition, we here report a significant coupling parameter between the baseline level of personality function and the change in general psychopathology - and vice versa. Discussion and conclusionThese results imply that personality pathology at admission hinders the therapeutic improvement in anxiety and depression, and that improvement of personality pathology is hindered by general psychopathology. Furthermore, the covariance between both domains supports the assumption that personality functioning and general psychopathology cannot be clearly distinguished and adversely influence each other. A dimensional assessment of the personality pathology is therefore recommendable for psychotherapy research and targeted therapeutic treatment.

Dynamics of Splenic Transient Elastography in Patients With Alcohol Use Disorder.

Splenic stiffness (SS) measurement (SSM) is an evolving noninvasive assessment to evaluate portal hypertension. Studies with respect to SSM in patients with alcohol use disorder are limited. We studied patients seeking treatment for alcohol use disorder in an inpatient treatment protocol at the National Institutes of Health and parsed SSM into 3 groups based on degree of change. The improved SS group had statistically higher initial SSM and a nonstatistically increased liver stiffness measurement compared with others. SS is dynamic in a subset of patients immediately after alcohol cessation, and improved SS is associated with a normalization of platelet count.

A study on the introduction of mixed payment compensation system through top-down cost information analysis in Korea

This study aims to identify the problems of the Korean health insurance fee system and to suggest a reasonable insurance fee construction alternative using the cost analysis data of hospitals. To this end, the characteristics of the medical fee payment system and hospital cost analysis were examined, and the cost data of one national public general hospital were used for the analysis. The cost allocation criteria were divided into labor costs, material costs, pharmaceutical costs, equipment costs, and overhead costs, and a top-down cost analysis was conducted. The analysis results showed that the cost was greater than the income in the case of outpatient and inpatient treatment performance, and the analysis results on the amount of physician workload showed that the relative value of physician workload calculated based on the cost was analyzed to require an increase of 1.52 times for hospitalization fees and 1.72 times for examination fees. The main factor affecting the cost compensation rate was that when the proportion of examination fees was high, the cost compensation level increased, while on the other hand, the cost compensation rate decreased as the proportion of physician labor costs increased or the length of stay increased. In order to resolve the ongoing complaints of medical service providers under the current fee-for-service system and secure the appropriateness of health insurance compensation rates, compensation for physician fees should be induced to realize the level of cost compensation through cost-based, per-service fee calculations, and the rationality of the payment compensation system can be secured by securing autonomy of providers through bundled fees for hospital costs and changing the payment method.

Explanation of the problem of pulmonary embolism in relation to the optimization of modern algorithms for the actions of the family doctor

The purpose of the work is to ensure the improvement of the quality of education and educational services at a level that meets the expectations and needs of the family doctor, contributes to the optimization of the educational process on the problem of pulmonary embolism. Determination of clinical probability is an important component of management of patients with suspected PE. In clinical practice, the Canadian (P.S. Wells) and Geneva scales are most often used for this. For a patient with a high clinical probability of PE, multispiral computer tomography (MSCT) is of primary importance. With suspected high-risk PE, evidenced by shock or hypotension, CT angiography or bedside transthoracic echocardiography should be performed for diagnostic purposes. Today, magnetic resonance imaging is not recommended for the diagnosis of PE. Outpatient treatment should be carried out with PESI class I-II. Inpatient treatment - with PESI III-V class. Anticoagulant therapy (ACT), which should be started as early as possible at the stage of diagnosis, is the basis of VE treatment. Thrombolytic therapy should be carried out in the clinic of shock or in the presence of hemodynamic instability. As a basis for planning the educational process, it is desirable to take the constructive alignment model, which consists of the following three logically interconnected components. First of all, these are learning outcomes that must be aligned with the goals of the curriculum. Secondly, educational activities should be related to expected learning outcomes. An important component is assessment and feedback. The professional training of a general practitioner - a family doctor is aimed at acquiring new knowledge, deepening professional competences and improving practical skills to maintain an appropriate level of training for today's urgent problem - pulmonary embolism, taking into account the realities of wartime and the threat of repeated outbreaks of covid infection (CI)

Effects of intermittent theta burst stimulation add-on to dialectical behavioral therapy in borderline personality disorder: results of a randomized, sham-controlled pilot trial

AbstractDialectical behavioral therapy (DBT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in borderline personality disorder (BPD). We hypothesized that intermittent theta burst stimulation (iTBS), a modified rTMS protocol that provides unilateral stimulation to the left dorsolateral prefrontal cortex, would enhance the effects of DBT and reduce BPD-specific symptoms more than sham stimulation. We performed a single-blind, randomized, sham-controlled pilot study to evaluate iTBS as an add-on to 8-week DBT for BPD in routine inpatient treatment. A total of 53 BPD patients were randomly assigned to either iTBS (n = 25) or sham stimulation (n = 28) in weeks 4–8 of DBT; 40 patients were eligible for inclusion in the analyses according to pre-specified criteria (≥ 16 of 20 iTBS sessions). The primary endpoint was change on the 23-item Borderline Symptom List; secondary endpoints were changes in depressive symptoms and general level of functioning. A mixed model repeated measures analysis with a 2 × 2 factorial between-subjects design showed no significant effect of add-on iTBS treatment, but a distinct trend was observed in favor of iTBS (Cohen’s d = 0.23 for group difference). We found a main effect of DBT with and without iTBS over time, indicating efficacy of 8 weeks’ DBT (d = 0.89–1.12). iTBS may be beneficial as an add-on to DBT in the long term and warrants further evaluation in larger studies. Trial registration Registered at drks.de (no. DRKS00020413) on January 13, 2020.

Regional comparison of specialized outpatient and (partial) inpatient pain medicine care in Germany

Chronic pain requires graduated and staged levels of care. The aim of this study is to provide aregional overview regarding the accessibility of specialized outpatient and (partial) inpatient pain medicine care from the patient's perspective in Germany. For 1000 model patients randomly generated from German postal code location combinations, the travelling time by car (individual transport, IT)and available public transport connections (PTC) to the nearest specialized outpatient and inpatient pain medicine clinics and units were assessed using aroute planner. Outpatient facilities (in apractice setting) were mostly realistically accessible depending on the proportion of pain treatment and the networking structure. University pain outpatient clinics were at a critically reachable distance with IT for 70% of the patients (80% with PTC) and had unrealistic accessibility for 49% of the patients with IT (68% with PTC). Interdisciplinary multimodal pain programs in day clinics were at a critically reachable distance for 68% of patients with IT (83% with PTC) and in 49% (75% PTC) at an unrealistic travelling time distance considering the more intense treatment requiring frequent travel. Full inpatient interdisciplinary multimodal treatment was more realistically reachable (IT 39% critical, 14% unrealistic, PTC 61% critical, 48% unrealistic). The results show relevant nationwide differences in the accessibility of facilities for specialized pain treatment depending on the place of residence. Considering the treatment of achronic condition with long-term therapeutic goals and the need for graduated care (outpatient and inpatient treatment), the results reveal apartly critical situation from the patient's perspective.

Effects of amultimodal inpatient treatment for patients with fibromyalgia syndrome at the Rhineland-Palatinate Acute Rheumatology Center

Fibromyalgia syndrome (FMS) is acomplex condition that is often refractory to therapy and is associated with impaired quality of life. In some studies, multimodal rheumatological treatment has been shown to be an effective therapy option for patients with systemic-inflammatory and degenerative rheumatic diseases. However, the effects of this therapeutic approach have not been sufficiently investigated in patients with FMS. Therefore, the aim of this study was to examine the effect of aconcise 9‑ to 10-day inpatient multimodal fibromyalgia treatment (MFT) using patient-reported outcomes in aGerman cohort. The effects of MFT were assessed using visual analog scales (VAS) for pain(P) and subjective disease activity (DA), questionnaires measuring everyday functional capacity (Health Assessment Questionnaire [HAQ], Funktions-Fragebogen-Hannover [FFbH, Hannover Functional Ability Questionnaire]), and pharmacotherapy at three time points (Visit1: beginning of multimodal therapy, Visit2: end of MFT, and Visit3: 3months after Visit2). Sixty-one patients were enrolled in the study at the Rhineland-Palatinate Acute Rheumatology Center. Under MFT, asignificant improvement in VAS (P) and VAS (DA) was observed between the start and end of treatment (Visit2 versus Visit1: median decrease from 7to 5, p < 0.001, for both VAS [P] and VAS [DA]). Additionally, comparison of the other two assessment points showed achange in VAS (P) (Visit3 versus Visit1: median decrease from 7to 6, p = 0.041, and Visit3 versus Visit2: median increase from 5to 6, p = 0.004). However, there were no significant differences in FFbH and HAQ parameters among the three visits. Examination of the subgroup of patients whose medication therapy was not intensified during hospitalization also showed significant improvements in VAS (P) and VAS (DA) between the start and end of MFB (Visit2 versus Visit1: median decrease from 7to 4, p < 0.001, for VAS[P] and median decrease from 6.25 to 4, p = 0.002, for VAS [DA]). These findings indicate ademonstrable benefit to patients of MFT regarding both pain and subjective disease activity. Furthermore, pain relief was even observed 3months after the end of therapy. This shows the high value of this therapeutic approach to treating patients with FMS.

The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review

This scoping review examined quantitative research comparing involuntary inpatient groups with voluntary inpatients or other comparator group. Ten themes were identified: patient knowledge of legal status, experienced or perceived coercion, effects on medication use, clinical effects measured on outcome scales, effects on psychiatric readmission, use of restraints and seclusion, effects on suicide and deaths, patient satisfaction, length of stay and carer experiences. The review found that involuntary inpatient admission was associated with harms including increased subjective and objective coercion, increased cost and decreased patient satisfaction. In addition, it found that there may be significant confusion among both voluntary and involuntary patients regarding their legal rights. However, patients admitted on an involuntary basis experienced greater improvements in symptoms and function, possibly due to greater symptom burden prior to admission. Involuntary treatment carries the potential for both benefit and harms that should be acknowledged and mitigated by service providers.

Teleradiology-Based Referrals for Patients with Gastroenterological Diseases Between Tertiary and Regional Hospitals: A Hospital-to-Hospital Approach.

Teleradiology is recognized for fostering collaboration between regional and tertiary hospitals. However, its application in gastroenterological diseases remains underexplored. This study aimed to assess the effectiveness of teleradiology in improving gastroenterological care. This retrospective study analyzed patients with gastroenterological diseases in a tertiary hospital who were referred from a regional hospital using a cloud-based radiology image-sharing system between July 2020 and June 2023. Our primary focus was to conduct a descriptive statistical analysis to evaluate patient characteristics and the referral process and analyze the timeframes from referral to transfer and from the start of treatment to discharge and the outcomes. We analyzed 56 patients, with 45 (80.4%) presenting hepatobiliary pancreatic disease. The most frequent condition was common bile duct stones (17 cases). Forty-nine cases were transferred for inpatient treatments, four underwent endoscopic examinations as outpatients, and two had imaging consultation without subsequent hospital visits. On referral day, 16 patients were transferred, and the remaining 33 (67.3%) were placed on a waiting list starting from the subsequent day. The median time from referral to admission was 1day (range: 0-14days), and the median time from referral to treatment was 2days (range: 0-14days). Remote image-sharing systems ensure accurate imaging at referral, preventing care delays. In collaboration with regional and tertiary hospitals, teleradiology may also be useful for gastroenterological diseases.

Factors influencing hospital readmission rates in alcohol use disorder

According to data from the Federal Statistical Office, the diagnosis of alcohol use disorder (AUD) (F10) is the second most common main diagnosis for hospital treatment. Those affected by this disorder are often repeatedly hospitalized at short intervals due to relapses; however, little is known about the factors that influence readmission rates after initial treatment. The aim of this retrospective analysis is to analyze the effects of treatment type (qualified withdrawal treatment(QE) versus physical detoxification) and discharge mode on the probability of readmission in alcohol-dependent patients after inpatient treatment. Data from 981 male and female alcohol-dependent patients who completed either qualified withdrawal treatment (QE) (68% men; mean age47.6 years) or inpatient detoxification (74% men; mean age48.0 years) were analyzed. Predictors of regular discharge were determined separately for both types of treatment using stepwise logistic regression. Patients who had completed aqualified withdrawal treatment were significantly more likely to be regularly discharged. Regular completion of the qualified withdrawal treatment (QE) led to arelative reduction in the readmission rate of 25.64% within 1 year compared to aphysical detoxification. In order to prevent readmission and chronic courses of alcohol use disorder (AUD), qualified withdrawal treatment should always be recommended to affected patients instead of physical detoxification. Aktuelle Daten des Statistischen Bundesamtes für das Jahr 2022 zeigen, dass die Diagnose "Psychische und Verhaltensstörungen durch Alkohol (F10.X)" die zweithäufigste Hauptdiagnose bei Krankenhausbehandlungen darstellt [13]. Im Gesundheitssystem entstehen durch dieses Erkrankungsbild und seine somatischen und psychischen Folgeerkrankungen jährlich ca.10 Mrd. € direkte Kosten [13]. Dieser Sachverhalt wird dadurch kontrastiert, dass die Krankenkassen die qualifizierte Entzugsbehandlung (QE) als leitliniengerechte Goldstandardtherapie [4] wiederholt infrage stellen [10].

The composition of the stent microbiome is associated with morbidity and adverse events during endoscopic drainage therapy of pancreatic necroses and pseudocysts.

Development of pancreatic necroses or pseudocysts are typical complications of pancreatitis and may require endoscopic drainage therapy using metal or plastic stents. Microbial infection of these lesions poses a major challenge. So far, the composition and significance of the microbial colonization on drainage stents are largely unknown although it may impact outcomes during endoscopic drainage therapy. A total of 26 stents used for drainage of pancreatic lesions were retrieved and the stent microbiome was determined by 16S rRNA gene sequencing. Additional analysis included comparison of the stent microbiome to the intracavitary necrosis microbiome as well as scanning electron microscopy (SEM) and micro-computed tomography (μCT) imaging of selected metal or plastic stents. The stent microbiome comprises a large proportion of opportunistic enteric pathogens such as Enterococcus (14.4%) or Escherichia (6.1%) as well as oral bacteria like Streptococcus (13.1%). Increased levels of opportunistic enteric pathogens were associated with a prolonged hospital stay (r = 0.77, p = 3e-06) and the occurrence of adverse events during drainage therapy (p = 0.011). Higher levels of oral bacteria were associated (r = -0.62, p = 8e-04) with shorter durations of inpatient treatment. SEM and μCT investigations revealed complex biofilm networks on the stent surface. The composition of the stent microbiome is associated with prolonged hospital stays and adverse events during endoscopic drainage therapy, highlighting the need for effective infection control to improve patient outcomes. In addition to systemic antibiotic therapy, antimicrobial stent coatings could be a conceivable option to influence the stent microbiome and possibly enhance control of the necrotic microflora.

Outpatient treatment for hernia surgery in Germany

Outpatient surgery in the treatment of hernia is currently a major challenge for patients and treating physicians in Germany due to the new legal regulations (key term hybrid diagnosis-related groups, DRG). Despite large economic challenges and empty funds, the principle of medical treatment is still the patient-oriented scientifically founded medicine. Although outpatient treatment would be very desirable, clear medical knowledge should the basis for the justification of surgical strategies: outpatient short hospitalization (24h) or fully inpatient hospitalization (>24h). A completely outpatient treatment of hernias is not meaningful and the demarcation of outpatient, short inpatient and inpatient treatment should be demonstrated in a risk-adjusted manner. A classification is essential, particularly against the background of an intersectoral hybrid DRG.

Feasibility and structural prerequisites for conversion to outpatient treatment in proctology

Despite the introduction of the diagnosis-related groups (DRG) system, costs in the German healthcare system have risen continuously for years. In order to reduce costs the federal government is aiming to shift inpatient services to the outpatient sector. Outpatient services affect many areas of medicine, including proctological operations as these are common and can often be carried out on an outpatient basis. The aim of the present work is to discuss which areas of proctology are suitable for outpatient treatment and which structural requirements are necessary. The present article is intended to provide anarrative overview with reference to the literature on the topic of outpatient care in proctology. Aliterature search was carried out using the following keywords: outpatient care, selective sector-level remuneration, day care, proctological operations, AOP catalog and hybrid DRG. In proctology, outpatient surgical care is implementable in many cases; however, not every patient is suitable for this. In addition to previous illnesses, patient compliance and the possibility of postoperative care from relatives must also be taken into account. In addition, emergency treatment must be guaranteed. Contraindications include severe heart and circulatory diseases as well as severe coagulation or organ dysfunction. Extensive abscesses, complex fistulas or sphincter reconstructions should be surgically treated in an inpatient setting. The prerequisite for successful outpatient care is to make the sector boundaries between outpatient and inpatient patient care more permeable and to adequately remunerate the interventions. In addition to the surgical indications, the prerequisites for successful proctological operations are the correct assessment of the operational capability and compliance. From an organizational and economic perspective, better networking between outpatient and inpatient treatment and equal remuneration across the sector boundaries are crucial.