Increased Health Care Costs Research Articles

Implementation of a Standardized Process of Coude Catheter Insertion Decreases Traumatic Catheterizations

ObjectiveTo address the issue of traumatic foley catheterization we developed and implemented a coude catheter education program for operating room nurses as well as standardize the usage of a coude catheter for male patients. Traumatic catheterization leads to patient morbidity and increased healthcare costs. MethodsA retrospective review was conducted to identify all traumatic catherizations over a 6-month period for several surgical services at our institution. A nursing education program was implemented that included basic urological anatomy, coude urethral catheter insertion techniques, and catheter safety. We conducted our trial over a period of 2-months with all catheterizations tracked. Following the trial, the process and outcomes were reviewed and then implemented for all male patients >18 years old requiring indwelling catheter placement in the operating room. ResultsOn retrospective review there were 18 traumatic foley catheterizations of patients on the three surgical services out of a total 601 catheter placements (3% traumatic placement rate). The total cost of these traumatic catherizations was $27,793 when accounting for additional procedures, supplies, and additional OR time required for each traumatic catheterization. The average cost per patient was $1,544. After full implementation of the process across all operating room services in June 2021 there have been 2038 catheterizations performed using a coude catheter kit with 4 traumatic foley placements through May 2022 (0.2% traumatic catheterization rate). ConclusionImplementation of the nursing education program and utilization of the coude catheter for all male catheterizations reduces costs, decreases iatrogenic urethral injury, and improves patient safety.

Current issues in osteoarthritis treatment

Background: Osteoarthritis (OA) is the most prevalent chronic joint disorder that leads to pain, disability, and functional impairment. The OA prevalence among those aged ≥65 years in Korea was 30.2% between 2017 and 2021. Owing to a rapidly aging population, OA is becoming a significant public health and socioeconomic concern.Current Concepts: The onset of OA is characterized by cartilage injury, which affects the surrounding tissues and progresses to joint destruction. The pathophysiology varies across joints; hand OA is associated with genetic factors, whereas knee and hip OA are associated with mechanical stress. Nonsteroidal anti-inflammatory drugs are the primary treatment; however, considering their adverse effects and limited efficacy in halting disease progression, further research is warranted for more effective therapies. Natural medicines have been investigated; however, their clinical efficacy is inadequate.Discussion and Conclusion: Currently, no disease-modifying treatments are validated for OA. Animal models fail to reflect the slow progression and complexity of human OA; therefore, drug development remains challenging. In view of increasing healthcare costs and rapid population aging, further research and broader socioeconomic strategies are essential to manage the growing burden of OA.

The Impact of Social Media on Public Perception and Litigation in Hernia Surgery Complications: A Narrative Review

Title: The Impact of Social Media on Public Perception and Litigation in Hernia Surgery Complications. Introduction: Social media significantly impacts public perception of healthcare, leading to increased litigation for complications after hernia surgery. Our research focused on terms like ‘inguinal hernia repair,’ ‘medico-legal,’ ‘informed consent,’ ‘litigation,’ ‘malpractice,’ ‘social media’, ‘mesh’, ‘Leistenbruch’, and OLG in Pubmed, Google Scholar, and Google. Results showed chronic postoperative pain as a common cause of malpractice claims, with ultrasound being a valuable diagnostic tool. Urological injuries account for a significant portion of complications after surgery. Mesh infection leads to hospital readmission, increased healthcare costs, and lawsuits. The quality of the consent process is crucial, and patient perceptions of mesh use influence their decision-making. Healthcare professionals must understand the impact of social media on public perception and provide comprehensive patient information for informed consent and satisfaction.

Pharmacological Prevention of Postoperative Delirium in Adults: A Review of Recent Literature.

Postoperative delirium (POD) is a common complication that has important implications for surgical patients, often leading to both short- and long-term cognitive deficits, worse outcomes, and increased healthcare costs. Given these implications, there may be a benefit in reducing the incidence of POD. Pharmacologic interventions may have the potential to reduce the risk of a patient developing POD. Recently studied therapies include dexmedetomidine, propofol, haloperidol, ketamine, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, acetaminophen, melatonin/ramelteon, corticosteroids, midazolam, physostigmine, and neostigmine. In addition, the implementation of regional anesthesia and reduction of overall anesthetic depth have been examined. Of these therapies, dexmedetomidine has been studied the most and has the most supporting evidence for prevention of POD, but current studies lack clarity on optimal dosing and timing of dexmedetomidine administration. Acetaminophen, corticosteroids, and melatonin/ramelteon are other plausible medications that have potential for reducing POD incidence, but they all require further investigation. Reduction of anesthetic depth and regional anesthetics are options for anesthetic management that show promise but still lack enough supporting evidence in recent literature to receive a strong recommendation. Future research should focus on identifying optimal strategies for the implementation of the pharmacological options listed, including doses and timing of administration. Attention should be given to dexmedetomidine given its promise demonstrated by recent literature.

Can flow cytometry be an alternative method for the detection of antimicrobial resistance?

Background: The inappropriate use of antibiotics may cause antibiotic resistance, cause side effects, and eventually cause an increase in healthcare costs. This study aimed to determine a flow cytometry-based test to detect ESBL E. coli and MDR p. aeruginosa in a short time. Methods: The study included 25 E.coli isolates and 25 P.aeruginosa isolates identified by Phoenix TM 100 automated system [Becton Dickinson, USA]. In the flow cytometric method, the percentages of death cells exposed to cephalosporin including ceftazidime [CAZ] or cefotaxime [CTX] and clavulanic acid [CLA] combination, were compared with death cells exposed only to a cephalosporin [CAZ or CTX]. CLA index values [CAZ-CLA and CTX-CLA indices] were obtained for CTX and CAZ. Index values that were higher than 1.5 just for one cephalosporin were accepted as positive. Results: Cell viability was performed after 1-hour exposure to the drugs. When PI staining was applied to ESBL-treated and MDR-treated bacteria, 65% and 85% had nonviable membranes, indicating the method efficiently identified only cells with damaged membranes. Conclusion: Flow cytometry is a rapid and reliable method for the detection of ESBL and MDR in clinical microbiology laboratories Keywords: Antibiotic resistance; ESBL; flow cytometry; MDR.

12273 Do The First 48 Hours Of Hospitalization Require More Vigilance In Geriatric Patients At Risk Of Hypoglycemia?

Abstract Disclosure: S. Ravi: None. H. Afsana: None. Hypoglycemia (HG; blood glucose <70 mg/dL) is a commonly encountered problem in hospitalized patients and is associated with significant morbidity and mortality as well as increased healthcare costs. Elderly patients are particularly vulnerable to HG as they are more likely to have autonomic dysfunction, resulting in fewer discernible symptoms as well as an impaired counterregulatory response, making it more likely that events go undetected and uncompensated. A survey of the literature identifies a number of risk factors for developing HG, including nephropathy, liver disease, infection, cognitive dysfunction, as well as sulfonylurea and long-term insulin use. Given the significant risks posed by HG, we pose the question: how can we do better to identify geriatric patients at high risk of HG events? In this retrospective chart review, data was collected from charts of patients aged 65-99 years with HG, who presented to the ED and were hospitalized for various reasons at a community hospital. Patients were included if a diagnosis of HG was documented in the EMR during hospitalization regardless of diagnosis of Diabetes Mellitus (DM). In 219 total individuals, potential associated variables were analyzed using descriptive statistics, chi-square tests, and Fisher’s exact tests. When data was not complete for any individual variables, the incomplete data was excluded during respective analysis. Among 219 patients, 128 (58.45%) presented at the time of admission, 33 (15.07%) presented within 24 hours after, 15 (6.85%) presented between 24 - 47 hours after, and 43 (19.63%) presented ≥48 hours after admission. Overall, 80.37% of HG events occurred within the first 48 hours of hospitalization. Interestingly there was no significant relationship identified between severity of HG events and HbA1c. The percent distribution identified delayed or missed meals (33%), insulin use (26%), and infection (8%), as the most common potential causes. These findings suggest that it is beneficial to extend the suspicion of HG events to all geriatric patients, regardless of diagnosis of DM. While validated tools have been proposed to identify diabetic patients at risk for HG, fewer studies have been done to identify potential markers of HG risk in all geriatric patients. It may be that the first 48 hours pose a critical period to identifying and better managing these patients’ blood sugars. While use of continuous glucose monitoring in the inpatient setting has been proposed as a potential solution, other cost-effective methods include ensuring timely delivery of meals and food intake, as well as closer finger stick glucose monitoring in the first 48 hours. Higher powered studies across a wider variety of clinical settings are required to further investigate hypoglycemic events in geriatric patients and to synthesize validated assessment tools. Presentation: 6/2/2024

Prevalence and impact of multidrug-resistant bacteria in solid cancer patients with bloodstream infection: a 25-year trend analysis.

Multidrug-resistant (MDR) bacteria pose a global public health threat as they are more challenging to treat, and they are on the rise. Solid cancer patients are often immunocompromised due to their disease and cancer treatments, making them more susceptible to infections. Understanding the changes and trends in bloodstream infections in solid cancer patients is crucial, to help physicians make informed decisions about appropriate antibiotic therapies, manage infections in this vulnerable population, and prevent infection. Solid cancer patients often require intensive and prolonged treatments, including surgery, chemotherapy, and radiation therapy. Infections can complicate these treatments, leading to treatment delays, increased healthcare costs, and poorer patient outcomes. Investigating new strategies to combat MDR infections and researching novel antibiotics in these patients is of paramount importance to avoid these negative impacts.

Association of polypharmacy with clinical outcomes and healthcare utilization in older adults with cardiometabolic diseases: a retrospective cohort study.

Limited knowledge exists on the association between polypharmacy among older patients diagnosed with cardiometabolic diseases and the risk of clinical outcomes and healthcare utilization. This study aimed to estimate the impact of polypharmacy on clinical outcomes and healthcare utilization in older adults with cardiometabolic diseases. A retrospective cohort analysis was performed using data from the Beijing Municipal Medical Insurance Database. The study focused on polypharmacy prescribing patterns in community-dwelling adults 65years and older with cardiometabolic diseases. Polypharmacy was defined as the use of five or more medications on the index date. The primary outcome included clinical outcomes, including hospitalizations and emergency department visits. The secondary outcome focuses on hospital utilization, specifically medication costs and length of stay. The study included a cohort of 405,608 patients. Among these, the most frequently used drug classes in the polypharmacy and non-polypharmacy groups were HMG-CoA reductase inhibitors and dihydropyridines, respectively. After adjustment for covariates, polypharmacy was not associated with an increased risk of hospitalization (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.95-1.26, p = 0.23) or ED visits (OR 1.28, 95% CI 0.97-1.68, p = 0.08). Similarly, no significant association was found with an increase in inpatient medication costs ($2,620.5, 95% CI $2387.3-$2894.3, p = 0.97) or length of stay (3.98days, 95% CI 3.68-4.30days, p = 0.79). However, polypharmacy was associated with higher medication costs in outpatient settings ($73.07, 95% CI $72-$74, p < 0.05) and ED visits ($51.2, 95% CI $44.5-$59.1, p < 0.05). Although polypharmacy is associated with increased healthcare costs in outpatient settings and ED visits, it does not significantly increase the risk of hospitalization or ED visits when properly managed.

Effect of recombinant irisin on recombinant human bone morphogenetic protein-2 induced osteogenesis and osteoblast differentiation

Osteoporotic fragility fractures substantially impact aging societies, necessitating long-term care and increasing healthcare costs. Myokine irisin, secreted by skeletal muscle, influences bone metabolism; however, a comprehensive understanding of the mechanisms by which irisin affects bone metabolism is still lacking. Therefore, this study aimed to explore the effects of irisin on osteogenesis and osteoblast differentiation triggered by bone morphogenetic protein-2 (BMP-2). We used 4-week-old male ICR mice and implanted polyethylene glycol pellets containing recombinant human BMP-2 (rh-BMP-2) into the left dorsal muscle pouch. Mice received weekly intraperitoneal injections of either phosphate-buffered saline or recombinant irisin (re-irisin). Ectopic bone formation was evaluated 3 weeks post-surgery using micro-computed tomography (μ-CT) and histological analysis. In vitro experiments, C2C12 cells were treated with or without rh-BMP-2 and re-irisin, and we assessed osteoblast differentiation markers, e.g., runt-related transcription factor 2, alkaline phosphatase, osteocalcin, and osteopontin, using real-time reverse transcription-polymerase chain reaction. The μ-CT analyses showed that re-irisin significantly increased bone mineral content and bone volume of ectopic bones newly formed by rh-BMP-2. The gene expressions of the osteoblast markers were significantly increased by rh-BMP-2 and further upregulated by re-irisin. The treatment of cyclic AMP response element-binding protein (CREB) small interfering RNA attenuated these effects, suggesting that CREB signaling pathway was involved in rh-BMP-2/re-irisin-induced osteoblastic differentiation. This study demonstrates the potential of irisin to enhance osteogenesis through BMP signaling, offering insights for osteoporosis treatment and highlighting irisin as a promising therapeutic target for improving bone health and extending a healthy lifespan.

Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews.

Acute respiratory infections are a common reason for consultation with primary and emergency healthcare services. Identifying individuals with a bacterial infection is crucial to ensure appropriate treatment. However, it is also important to avoid overprescription of antibiotics, to prevent unnecessary side effects and antimicrobial resistance. We conducted a systematic review to summarise evidence on the diagnostic accuracy of symptoms, signs and point-of-care tests to diagnose bacterial respiratory tract infection in adults, and to diagnose two common respiratory viruses, influenza and respiratory syncytial virus. The primary approach was an overview of existing systematic reviews. We conducted literature searches (22 May 2023) to identify systematic reviews of the diagnostic accuracy of point-of-care tests. Where multiple reviews were identified, we selected the most recent and comprehensive review, with the greatest overlap in scope with our review question. Methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Summary estimates of diagnostic accuracy (sensitivity, specificity or area under the curve) were extracted. Where no systematic review was identified, we searched for primary studies. We extracted sufficient data to construct a 2 × 2 table of diagnostic accuracy, to calculate sensitivity and specificity. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Where possible, meta-analyses were conducted. We used GRADE to assess the certainty of the evidence from existing reviews and new analyses. We identified 23 reviews which addressed our review question; 6 were selected as the most comprehensive and similar in scope to our review protocol. These systematic reviews considered the following tests for bacterial respiratory infection: individual symptoms and signs; combinations of symptoms and signs (in clinical prediction models); clinical prediction models incorporating C-reactive protein; and biological markers related to infection (including C-reactive protein, procalcitonin and others). We also identified systematic reviews that reported the accuracy of specific tests for influenza and respiratory syncytial virus. No reviews were found that assessed the diagnostic accuracy of white cell count for bacterial respiratory infection, or multiplex tests for influenza and respiratory syncytial virus. We therefore conducted searches for primary studies, and carried out meta-analyses for these index tests. Overall, we found that symptoms and signs have poor diagnostic accuracy for bacterial respiratory infection (sensitivity ranging from 9.6% to 89.1%; specificity ranging from 13.4% to 95%). Accuracy of biomarkers was slightly better, particularly when combinations of biomarkers were used (sensitivity 80-90%, specificity 82-93%). The sensitivity and specificity for influenza or respiratory syncytial virus varied considerably across the different types of tests. Tests involving nucleic acid amplification techniques (either single pathogen or multiplex tests) had the highest diagnostic accuracy for influenza (sensitivity 91-99.8%, specificity 96.8-99.4%). Most of the evidence was considered low or very low certainty when assessed with GRADE, due to imprecision in effect estimates, the potential for bias and the inclusion of participants outside the scope of this review (children, or people in hospital). Currently evidence is insufficient to support routine use of point-of-care tests in primary and emergency care. Further work must establish whether the introduction of point-of-care tests adds value, or simply increases healthcare costs. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159948.

Development and Novel Therapeutics in Diabetic Retinopathy.

Diabetic retinopathy (DR) is a complication of diabetes mellitus which causes retinal damage which when left untreated will cause visual problems. As the prevalence of DR increases over the years, there is a need to optimise the currently available treatments as well as developing novel drugs to improve the therapy provided for the patients in the clinical practice. Several pharmacological therapies like, anti-vascular endothelial growth factor and anti-inflammatory therapies which include intravitreal, and implant of corticosteroids are significant in the management to decrease the risk of DR-related vision impairment. Clinical trials for novel drug therapies are still ongoing till this day to enhance the efficacy of DR treatment. Even though there are also modern treatments such as laser therapy for the patients, prevention should be done to lower the number of individuals affected by DR. Due to the complexity of DR, there are numerous obstacles to develop new medications for DR which include the increasing healthcare cost of DR treatment. New insights such as utilisation of artificial intelligence will be implemented into the management of DR as it has proved its potential in aiding the screening process. In parallel with the increase in DR prevalence and the number of treatments developed, extensive understanding of the mechanism of action of DR should be further improved to prevent more complications in the future. This review summarises the epidemiological trend, prevention strategies, challenges in treatment, current novel therapeutics (including drugs under clinical trials), future therapeutic trends and possibilities for implementing AI in the early diagnosis and management of DR.

Trends in health care expenditures and incremental health care cost in adults with atrial fibrillation in the United States

BackgroundAtrial fibrillation (AF) is associated with increased healthcare costs; however, comprehensive data on the financial burden of AF remain limited. ObjectivesTo delineate healthcare expenditures among patients with AF. MethodsWe used the longitudinal panels from the Medical Expenditure Panel Survey (MEPS) covering 2016-2019 to estimate healthcare expenditures associated with AF. We identified individuals aged ≥18 with AF in the first year of each panel (2016-2018) using the ICD-10 code. Covariates included sociodemographic characteristics and comorbidities. Healthcare expenditures were derived from the second year of each panel (2017-2019) to reflect the cost of having the condition for an entire year. Adjusted mean annual costs were calculated, including total healthcare expenditure, hospital inpatient, emergency room visits, office based, outpatient visits, home health visits, prescribed medicines, and other expenses. Adjusted models were used to estimate the mean annual incremental total healthcare cost associated with AF. ResultsThe weighted study population included 3,080,055 adults with AF (382 respondents, mean age 71.5, 89.9% White). The adjusted annual total healthcare cost among adults with AF totaled $14,083 (95% CI, $10,887 – 17,279) compared to $8,771 (95% CI, $ 8,106 – 9,436) for those without AF. Primary drivers of cost over time were hospital inpatient care, office based visits, and prescribed medications. The annual incremental total healthcare cost associated with AF was $5,312 per adult (in 2019 US dollars). ConclusionAdults with AF in the US face a higher financial burden across various healthcare services compared to those without the condition, with consistently increasing expenses in inpatient care and prescribed medicines. Further research is needed to identify the independent contribution of AF to these costs.

Is Magnetic Resonance Imaging Overused Among Patients Undergoing Total Knee Arthroplasty?

With increasing healthcare costs, it is important to quantify the number of total knee arthroplasty (TKA) patients who have MRIs that are not considered clinically necessary. The purpose of this study was to determine the number of unnecessary preconsultation MRIs done among TKA patients at our institution. Eight hundred and sixty-nine patients who underwent a primary TKA were identified. Review of medical records and imaging results was conducted to determine which patients had received preconsult MRIs and whether they were necessary or unnecessary. Of the 869 TKA, 177 (20.4%) presented with a preconsultation MRI, of which, 112 met the study inclusion criteria. Of the 112 MRIs, 18 (20.7%) were done without radiographic imaging, and 69 (79.3%) were completed after radiographically evident moderate-to-severe arthritis. Overall, 87 MRIs (10.0%) were deemed clinically unnecessary. Referring physicians are overusing MRIs before consultation with an orthopaedic surgeon. The 87 patients who had unnecessary MRIs at our institution over a one-year period represented a cost of $20,706. Extrapolating that number to the scale of patients affected by arthritis each year is potentially a staggering amount of money. Evidence-based guidelines should be put into place to optimize healthcare utilization.

Machine learning model predicting factors for incisional infection following right hemicolectomy for colon cancer

Background and aimColorectal cancer is a prevalent malignancy worldwide, and right hemicolectomy is a common surgical procedure for its treatment. However, postoperative incisional infections remain a significant complication, leading to prolonged hospital stays, increased healthcare costs, and patient discomfort. Therefore, this study aims to utilize machine learning models, including random forest, support vector machine, deep learning models, and traditional logistic regression, to predict factors associated with incisional infection following right hemicolectomy for colon cancer.MethodsClinical data were collected from 322 patients undergoing right hemicolectomy for colon cancer, including demographic information, preoperative chemotherapy status, body mass index (BMI), operative time, and other relevant variables. These data are divided into training and testing sets in a ratio of 7:3. Machine learning models, including random forest, support vector machine, and deep learning, were trained using the training set and evaluated using the testing set.ResultsThe deep learning model exhibited the highest performance in predicting incisional infection, followed by random forest and logistic regression models. Specifically, the deep learning model demonstrated higher area under the receiver operating characteristic curve (ROC-AUC) and F1 score compared to other models. These findings suggest the efficacy of machine learning models in predicting risk factors for incisional infection following right hemicolectomy for colon cancer.ConclusionsMachine learning models, particularly deep learning models, offer a promising approach for predicting the risk of incisional infection following right hemicolectomy for colon cancer. These models can provide valuable decision support for clinicians, facilitating personalized treatment strategies and improving patient outcomes.

Expectation and Needs of Medical Students Towards the Implementation of Virtual Simulation in Learning Rational Use of Medicine.

The irrational use of medicines remains prevalent globally despite education efforts, leading to decreased treatment quality and increased healthcare costs. With the rise of online learning during the COVID-19 pandemic, virtual simulation offers a promising solution to enhance the teaching of rational medicine use among medical students. This study aimed to investigate medical students' perspectives and needs regarding the implementation of virtual simulation in learning the rational use of medicines. This study, conducted at Universitas Indonesia from August 2022 to September 2023, used a mixed-method approach to assess the needs for developing virtual simulation in education of rational medicine use. A validated questionnaire with 14 closed-ended and 14 open-ended questions was completed by 281 medical students. The quantitative data were analysed descriptively, using SPSS v16, while thematic analysis was applied to open-ended responses. Students perceived virtual simulations to be the most effective tool for distance learning and suggested features like case scenarios, realistic representation, a good user interface, and user-friendly navigation. The majority preferred a 10-20-minute duration for virtual simulations. Additionally, 52.3% had no prior knowledge of the rational use of medicines, but acknowledged its importance. Virtual simulations could be used to explain the concept, management, and implementation of the rational use of medicines. Virtual simulation should be implemented in distance learning on rational medicine use to increase students' motivation, understanding, retention, interactivity, and focus. The findings might be utilized by medical educators to tailor virtual simulation design to meet medical students' needs and expectations.

Emerging strategies for treating medical device and wound-associated biofilm infections.

Bacterial infections represent a significant global threat to human health, leading to considerable economic losses through increased healthcare costs and reduced productivity. One major challenge in treating these infections is the presence of biofilms - structured bacterial communities that form protective barriers, making traditional treatments less effective. Additionally, the rise of antibiotic-resistant bacteria has exacerbated treatment difficulties. To address these challenges, researchers are developing and exploring innovative approaches to combat biofilm-related infections. This mini-review highlights recent advancements in the following key areas: surface anti-adhesion technologies, electricity, photo/acoustic-active materials, endogenous mimicking agents, and innovative drug delivery systems. These strategies aim to prevent biofilm formation, disrupt existing biofilms, and enhance the efficacy of antimicrobial treatments. Currently, these approaches show great potential for applications in medical fields such as medical device and wound - associated biofilm infections. By summarizing these developments, this mini-review provides a comprehensive resource for researchers seeking to advance the management and treatment of biofilm-associated infections.

A Study of Knowledge and Recognition on Postoperative Delirium Among Postanesthesia Care Unit (PACU) Nurses

PurposePostoperative delirium (POD) is a syndrome that often occurs after surgery. Nursing staff are the first-line personnel who have the most time and close contact with postoperative patients. If delirium is not recognized immediately, it will affect the patient's prognosis and increase clinical care requirements and health care costs. This study explores postanesthesia care unit (PACU) nursing staff’s knowledge and ability to recognize POD in patients. DesignA cross-sectional study was conducted with purposive sampling to recruit nurses from hospital PACUs in central and southern Taiwan. Data were collected from April to December 2019 using a questionnaire survey on knowledge of POD and videos to test delirium recognition abilities. MethodsA total of 178 nurses from 9 hospitals met the inclusion criteria for participation; 2 participants were unable to attend because of taking leave, resulting in 176 valid questionnaires. FindingsThe percentage of correct answers for POD knowledge was 63.84%, and for recognizing POD was 59.1%, both at a moderate level. Nurses’ advanced skills significantly influenced their POD knowledge and recognition abilities. There was a positive correlation between PACU nurses’ POD knowledge and recognition abilities (r = 0.23, P < .01). ConclusionsPACU nurses demonstrated a moderate level of knowledge and ability to recognize POD in patients. Those with higher-level nursing skills showed better POD knowledge and recognition abilities. Nurses with better POD knowledge exhibited higher recognition abilities.

Association Between Blood-Brain Barrier Disruption and Stroke-Associated Pneumonia in Acute Ischemic Stroke Patients After Endovascular Therapy: A Retrospective Cohort Study.

Stroke, particularly due to large vessel occlusion (LVO), is a major cause of mortality and disability globally. Endovascular therapy (ET) significantly improves outcomes for acute ischemic stroke (AIS) patients, but complications such as stroke-associated pneumonia (SAP) increase mortality and healthcare costs. This study investigates the association between blood-brain barrier (BBB) disruption and the increased risk of SAP and explores the relationship between BBB disruption and medium-term functional outcomes. The retrospective cohort study was performed on AIS patients enrolled between January 2019 to February 2023 who underwent ET. Patients were divided into two groups: BBB disruption and without BBB disruption. Multiple logistic regression model was conducted to measure the association between BBB disruption and SAP. Mediation analysis was used to estimate the potential mediation effects on the associations of BBB disruption with SAP. A restricted cubic spline (RCS) regression model was used to further outline the connection between the highest CT value of hyperattenuated lesions areas and the risk of SAP. The study included 254 patients who underwent endovascular therapy, with 155 patients in the BBB disruption group (exposure) and 99 patients in the without BBB disruption group (control). Multiple logistic regression analysis revealed a significantly increased risk of SAP in patients with BBB disruption (OR = 2.337, 95% CI: 1.118-4.990, p = 0.025). Furthermore, mediation analysis suggested that this association may be partly due to malignant cerebral oedema and haemorrhagic transformation. The study found an inverse L-shaped dose-response relationship between the maximum CT values of BBB disruption areas and the incidence of SAP. SAP partially mediated the association between BBB disruption and 3-month poor functional outcome. BBB disruption are a potential risk factor for SAP. BBB disruption may affect short- and medium-term prognosis of patients after ET in part through SAP.

Relationship between hospital surgical volume and the perioperative esophagectomy costs for esophageal cancer: a nationwide administrative claims database study.

Numerous studies have described positive relationships between hospital volume (HV) and clinical outcomes in highly complex procedures, including esophagectomies. Although the centralization of surgery has been considered a possible solution for improving clinical outcomes, the HV impact on perioperative healthcare costs is unknown. This study aimed to determine the relationship between HV and perioperative healthcare costs for patients undergoing esophagectomy for esophageal cancer. This retrospective, nationwide cohort study used Japanese Administrative Claims Database data. Data on esophagectomies performed nationwide in 2015 were extracted. The outcome measure was perioperative healthcare costs per person from the perspective of the insurer. The healthcare costs in outpatient or inpatient settings of any hospital and clinic where patients received treatment were summed up from the month the surgery was performed to 3months after. Linear regression analyses were conducted to assess the risk-adjusted effects of the HV category (1-4/5-9/10-14/15-) on perioperative costs. A total of 5232 patients underwent an esophagectomy at 584 hospitals. The overall perioperative cost was 20.834 billion Japanese yen (JPY). The median perioperative costs per person for each HV category (1-4/5-9/10-14/15-) were 3.728 (709 patients), 3.740 (658 patients), 3.760 (512 patients), and 3.760 (3253 patients) million JPY, respectively (P = 0.676). Multivariate analyses revealed that each HV category had no significant impact on perioperative costs. There were no significant differences in the perioperative costs between high- and low-volume centers. Esophageal cancer surgery centralization may be achievable without increasing healthcare costs.

Multi-Modal Approach to Mitigating Hamstring Injuries in Division I College Football Athletes

Hamstring injuries (HSIs) are prevalent in sports that involve changes in direction, kicking, and sprinting. These injuries are a major cause of time lost from competition, practice, and training, as well as increased healthcare costs. In a Division I collegiate football program, the authors implemented a multifactorial approach that included repeated performance assessments, detailed data analysis, and a flexible strength and conditioning regimen. Over a three-year period, this resulted in no game time loss due to HSI. This model can be adapted and implemented across sports settings.