Department Patients Research Articles

Corporate marketing in modern hospitals and satisfaction level of corporate clients in Bangladesh

The study's abstract emphasizes the Marketing Department's dual responsibility in creating external awareness and disseminating internal information in modern hospitals. To improve service quality and management decision-making, the department keeps an eye on patient happiness and oversees communication, advertising, corporate agreements and feedback methods. Key research findings show that while corporate patients generally value the department's cutting-edge technology and the expertise of its staff, they do have reservations about the department's responsiveness and punctuality, particularly with regard to inpatient care. Patients in the Outpatient Department (OPD) expressed greater levels of satisfaction than those in the Inpatient Department (IPD), where patients expressed greater dissatisfaction with personalized care and error correction. To increase general patient happiness, recommendations include enhancing service speed, providing personnel training, and attending to particular patient requirements.

АНАЛИЗ ОБЪЕМА ПОТРЕБЛЕНИЯ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ ПРИ ЛЕЧЕНИИ ЭПИЛЕПСИИ В СТАЦИОНАРЕ

The article presents the results of the study of the volume of consumption of medicinal drugs for the treatment of patients diagnosed with epilepsy. As a result of retrospective processing of case histories (continuous sampling for 2021-2023) obtained in the inpatient department of the Clinic of Nervous Diseases named after A.Y. Kozhevnikov of Sechenov University, we identified medicines with the highest NDDD value (number of defined daily doses) for each of the 8 allocated clinical and statistical groups. Among all clinical and statistical groups, the G40.0 group had the highest consumption. In clinical and statistical groups G40.0, G40.8 and G40.9, valproic acid and levetiracetam were found to have the highest NDDD value. In addition, the consumption volume analysis showed that in clinical and statistical group G40.8, the neuroleptics quetiapine and teraligene are used relatively more frequently than in other diagnoses. In clinical and statistical groups G40.1, G40.2, and G40.4, the medicines valproic acid, levetiracetam, and lamotrigine were used, respectively. B vitamins accounted for the highest consumption among all clinical and statistical groups, except for G40.2. The results obtained may become the basis for the development of recommendations to optimize the use of medicines and improve the quality of drug care for patients with epilepsy at the inpatient stage.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 2: Complications, postrevascularization care, and quality improvement.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the later phases of inpatient care are reviewed. Published descriptions and validation of clinical pharmacist roles specific to the acute management of STEMI are limited. This high-risk period from presentation through revascularization, stabilization, and hospital discharge involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. A companion article reviewed STEMI pharmacotherapy from emergency department presentation through revascularization. Herein we complete the pharmacotherapy review for the STEMI patient across the inpatient phases of care, including the management of peri-infarction complications with vasoactive and antiarrhythmic agents, considerations for postrevascularization antithrombotics, and assessments of supportive therapies and secondary prevention. Key guideline recommendations and literature developments are summarized from the clinical pharmacist's perspective alongside suggested pharmacist roles and responsibilities. Considerations for successful hospital discharge after STEMI and pharmacist involvement in associated institutional quality improvement efforts are also provided. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population and call for further research delineating pharmacists' impact on patient and institutional STEMI outcomes.

Pharmacotherapy of acute ST-elevation myocardial infarction and the pharmacist's role, part 1: Patient presentation through revascularization.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the critical initial phases of care are reviewed. Despite established value in the emergency department (ED), cardiac care, and intensive care settings, there is currently little published literature describing or supporting clinical pharmacist roles in the acute management of STEMI. The high-risk period from hospital presentation through revascularization and stabilization involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. While rife with opportunities for pharmacists to optimize care, this timeframe appears inconsistently targeted by clinical pharmacy services, which may halt after ED evaluation and then resume upon postcatheterization cardiac unit admission. Herein we review the key pharmacotherapeutic modalities and considerations for the patient with STEMI across the critical initial phases of care. These include supportive therapies prior to revascularization, the host of antithrombotics involved in revascularization by percutaneous coronary intervention and/or fibrinolysis, and other periprocedural medications. Important practice guidelines and clinical resources are summarized from the clinical pharmacist perspective, and roles and responsibilities of the responding pharmacist are suggested. A companion article will extend the review to periprocedural adverse event management, key early decision-making regarding long-term risk reduction, and pharmacist involvement in institutional quality improvement efforts. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population, and we call for further research delineating pharmacist impact on patient and institutional STEMI outcomes. Patients presenting with STEMI rapidly traverse multiple phases of care and receive a host of antithrombotic and supportive medications during acute management, presenting many important pharmacotherapeutic decision points and roles for pharmacists.

High-cost users still came to hospitals during the COVID-19 pandemic during first wave data in Thailand: secondary data analysis

BackgroundThe phenomenon of high-cost users (HCUs) in health care occurs when a small proportion of patients account for a large proportion of health care expenditures. By understanding this phenomenon during the COVID-19 pandemic, tailored interventions can be provided to ensure that patients receive the care they need and reduce the burden on the health system.ObjectivesThis study aimed to determine (1) whether the HCUs phenomenon occurred during the pandemic in Thailand by exploring the pattern of inpatient health expenditures over time from 2016 to 2021; (2) the patient characteristics of HCUs; (3) the top 5 primary diagnoses of HCUs; and (4) the potential predictors associated with being an HCU.MethodsThe secondary data analysis was conducted via inpatient department (IPD) e-Claim data from the National Health Security Office for the Universal Coverage Scheme, which provides health care to ~ 80% of the Thai population. Health care expenditure over time was calculated, and the characteristics of the population were examined via descriptive analysis. Multinomial logistic regression was applied to explore the potential predictors associated with being an HCU.ResultsThe characteristics of HCUs remained relatively the same from 2016 to 2021. In terms of the proportion of male (55%) to female patients (45%), the age ranged from 55 to 57 years, with an estimated 8-day length of hospital stay and 7 admissions per year, and the average health care cost per patient was ≥ USD 2,860 (100,000 THB). The low-cost users (LCUs) group (the bottom 50% of the population), had more female patients (55%), a younger age ranging from 27 to 33 years, a 3-day length of stay, 1‒2 admissions per year, and a lower average health care cost per patient, which was less than USD 315 (≤ 11,000 THB).ConclusionThe HCUs phenomenon still existed even with limited health care accessibility or lockdown measures implemented during the COVID-19 pandemic. This finding could indicate the uniqueness of the need for health services by HCUs, which differ from those of other population groups. By understanding the trends of health care utilization and expenditure, along with potential predictors associated with being an HCU, policies can be introduced to ensure the appropriate allocation of health resources to the right people in need of the right care during future pandemics.

Bacterial Profile in Urine Culture and Amikacin Sensitivity and Emergence of Carbapenem-Resistant Pathogens in Tertiary Medical College Hospital, Bangladesh

Background: Urinary tract infection (UTI) is one of the most common encounters both in the outpatient department and inpatient department. It is important to know the bacteriological etiology according to urine culture and to know the antibiotic sensitivity. Objective: Our study was carried out to observe the urine culture and sensitivity pattern to commonly used injectable antibiotics such as amikacin and to look for the emergence of carbapenem-resistant uropathogens.Materials and methods: A total of 150 patients of UTI being culture-positive were isolated and identified by random selection. Samples were collected throughout January 2022 to March 2022. Standard microbiological techniques were used to identify the bacteria and test for susceptibility to various antibiotics. Data were entered into MS Office Excel 2016 for analysis and visualization.Results: The most common urine culture positive was E. coli, 108 (72%) followed by Pseudomonas sp., 16 (11%) and staphylococcus saprophyticus, 15 (10%). The rest of 7% urine culture was positive were other bacterial species. Around 90% of the total cultured E. coli was sensitive to amikacin. Staphylococcus saprophyticus 8 cases (53%), E. coli 15 cases (14%) and Pseudomonas sp. single cases (6%) were resistant to carbapenem. Resistance to vancomycin was common among most of the pathogens, with 88 cases (81%) of E. coli and 12 cases (75%) of Pseudomonas sp. being resistant. In contrast, Staphylococcus saprophyticus had a higher sensitivity to vancomycin, with only 3 cases (20%) being resistant and 12 cases (80%) being sensitive.Conclusion: The study focused on the commonest uropathogens causing UTI and antibiotic resistance in urine isolates may be useful guidelines for clinicians initiating empirical antibiotic therapy as well as help in the formulation of antibiotic therapy strategy. KYAMC Journal Volume: 15, No: 01, April 2024: 16-19.

Nationwide epidemiological study of epilepsy in Montenegro

The aim of this study was to estimate the incidence and prevalence of epilepsy in Montenegro over the period 2011–2022 using hospital case records. The main sources for this study were hospital case records in every outpatient and inpatient neurological department in Montenegro, including the Clinical Center of Montenegro in the capital, a primary referral national center for epilepsy. For every patient, aged 18 and above, two neurologists reviewed all data collected to verify the validity of the diagnosis and to establish the date of clinical onset of the disease. Information on age and sex, EEG, CT scan, and MRI were included. Prevalent cases were selected in 2022 population. Incident cases of epilepsy were identified in 2011 and the incidence trend was followed up for the next 12 years. Crude and standardized incidence and prevalence were calculated. Average crude incidence rate of epilepsy for study period was 56.0 per 100,000 individuals (men 58.1; women 54.2). The age-specific incidence was lowest in the 30 s, and early 40 s and highest after 65 years. Over the 12-year period, increasing trend of standardized epilepsy incidence rates was observed for the total population and for females (p = 0.024 and p = 0.020 respectively). The crude overall prevalence of epilepsy on December 31, 2022 was 13.0 per 1000 individuals (men 13.5; women 12.6). The highest prevalence was in patients in their early 20 s and in the seventh decade. In conclusion, the incidence of epilepsy in this study was similar to those of other industrialized countries, with increasing trend during study period. Prevalence was higher compared to European countries.

Study on Misoprostol in Case of Missed Abortion

Background: Misoprostol and manual vacuum aspiration (MVA) are both effective treatments for incomplete abortion. Misoprostol, a medication that induces uterine contractions, is often preferred for its non-invasive nature and ease of administration. MVA, a surgical method, involves removing retained products of conception using suction. Studies suggest that while MVA has a higher success rate and faster recovery, misoprostol is a cost-effective, accessible option with fewer complications, though it may require follow-up treatment in some cases. Objective: In this our main goal is to assess the efficiency of misoprostol versus manual vacuum aspiration for the treatment of incomplete abortion. Method: This hospital based randomized controlled trial study was conducted in in-patient patient Department of Obstetrics and Gynaecology, Chittagong Medical College and Hospital from October 2007 to September 2008. A total of 128 women between the age of 15 to 40 years with diagnosis of first trimester uncomplicated spontaneous incomplete abortion was included in this study. Among them 64 patients were randomized in group ‘A’ as case who were treated with Misoprostol and 64 patients were in group ‘B’ as control who were treated with Manual Vacuum Aspiration. Results: During the study, where the mean gestational size of uterus was 9.52 weeks at the time of initial examination. The mean size of uterus in misoprostol group was 9.07(SD ±1.93) and that of MVA group was 9.87 (SD± 1.35). More women in case group had no child of viable age on the other hand increased number of women in control group had at least one viable birth. 36 (60%) out of 60 women in misoprostol group 26 (41.93%) out of 62 reported pain and 36 (58.07%) out of 62 women in MVA and 24 (40%) patients in misoprostol arm said bleeding as the worst feature. Thirty six percent women in misoprostol group and 16% women in MVA group reported that the adverse effects were easily tolerable. Thirty percent women ...

Patient Satisfaction in In-Patient Department in Tertiary care Hospital in Odisha

Patient satisfaction is a crucial factor in determining the overall Quality of services proved in the Hospital setting. It includes a collaborative and scientific inspection of the various departments associated with the patient that are being admitted to the Hospital. It gives an insight to the areas that need to be improved and increase the overall patient experience.

Evaluating estimated health care resource utilization and costs in patients with myelofibrosis based on transfusion status and anemia severity: A retrospective analysis of the Medicare Fee-For-Service claims data.

Myelofibrosis (MF) is a rare but aggressive myeloproliferative neoplasm that commonly affects older patients, with a mean age of onset of older than 60 years. At least a third of patients with primary MF are anemic at diagnosis, and nearly all patients become anemic over time; approximately half require red blood cell transfusions within a year of diagnosis. Anemia and transfusion dependence are leading negative prognostic factors for overall survival and are associated with diminished quality of life and increased health care-related economic burden in patients with MF. To describe baseline characteristics, health care resource utilization (HCRU), and costs as a function of transfusion status and anemia severity in patients diagnosed with MF among the US Medicare Fee-For-Service (FFS) population. This retrospective cohort study included patients diagnosed with MF appearing in the 100% Medicare FFS database enrolled between January 1, 2012, and December 31, 2020. Patients were segmented into hemoglobin level cohorts (no, mild, moderate, and severe anemia) and transfusion status cohorts (transfusion independent [TI], transfusion requiring [TR], or transfusion dependent [TD]). Across cohorts, demographics and disease characteristics were assessed at baseline; per patient per month all-cause HCRU and medical and pharmacy costs were reported during follow-up. All results were summarized descriptively. The transfusion status cohort (N = 1,749) included TI (n = 980), TR (n = 559), and TD (n = 210) patients; the anemia severity cohort (N = 365) included patients with no (n = 100), mild (n = 128), moderate (n = 99), and severe (n = 38) anemia. On average, TR and TD patients or those with moderate or severe anemia had numerically higher Deyo-Charlson Comorbidity Index scores than those who were TI or had mild or no anemia. TR and TD cohorts reported numerically greater all-cause outpatient, inpatient, and emergency department utilization vs the TI cohort. All-cause costs were numerically higher in the TD and TR cohorts vs the TI cohort ($14,655 and $14,249 vs $8,191). Incremental increases in HCRU and costs were also observed with increasing anemia severity. All-cause medical and pharmacy costs for no, mild, moderate, and severe anemia cohorts were $4,689, $7,268, $10,439, and $13,590, respectively. This retrospective analysis of the US Medicare FFS database descriptively evaluated patients by transfusion status and anemia severity and showed that costs and HCRU were numerically lower for patients with transfusion independence compared with those with transfusion dependence. Similar trends were seen when comparing patients based on anemia status, with numerically lower HCRU and cost observed with decreasing anemia severity.

A-267 How Does Rapid HIV Antibody Testing Fit Into the Current Testing Algorithm?

Abstract Background Many emergency departments (ED) currently use rapid HIV antibody tests as screening tools, despite limited sensitivity for detecting acute HIV infections. We performed an analysis of standard of care rapid and in-lab fourth generation HIV testing, to 1) assess the performance of rapid HIV testing in our patient population and 2) identify key symptoms of acute HIV infections. Methods A four-year retrospective analysis from 1/1/2018-12/31/2021 was conducted at Barnes Jewish Hospital and St. Louis Children’s Hospital in St. Louis, Missouri. During the study period, both rapid HIV testing (SURE CHECK HIV 1/2, Chembio) and in-lab fourth generation HIV testing (ARCHITECT HIV Ag/Ab Combo Assay, Abbott) were available to providers. Comparative performance of rapid testing and in-lab fourth generation testing was assessed using complete Fourth Generation HIV algorithmic testing as the gold standard. Symptomatology was recorded for a subset of patients that presented to the ED to determine associations with different testing patterns. Results A total of 28,240 rapid HIV antibody tests were administered throughout inpatient, outpatient, and emergency departments at both hospitals, revealing an average yearly positivity rate of 0.6%. In a subset of 1192 patients who underwent both rapid HIV antibody and fourth generation in-lab testing, the rapid HIV antibody test exhibited a positive percent agreement of 92.5% (95% CI: 84.6-96.5) and negative percent agreement of 98.1% (95% CI: 97.1-98.8). Rapid testing demonstrated a negative predictive value (NPV) of 99.5% (95% CI: 98.8-99.8) and a positive predictive value of 77.9% (95% CI: 68.6-85.1). Notably, the rapid test failed to detect 3/3 (100%) acute HIV infections defined as rapid HIV antibody test negative, Ag/Ab assay and nucleic acid amplification assay positive. The rapid test demonstrated comparable performance in patients with known HIV infections, regardless of antiretroviral therapy (ART) status. The positivity rate was 23/24 (95.8%) in known HIV patients with ART compared to 25/27 (92.6%) in those without (P>0.9999). Among patients on ART, the mean ± SD log10 viral load was 3.15±1.52, whereas those without ART exhibited a viral load of 4.87±0.99 (P=0.0140). In the ED, symptoms such as fever, nausea/vomiting, malaise, headache, and photophobia were significantly correlated with acute HIV infection. Acute HIV patients were more likely to display fever in conjunction with three other symptoms (P<0.0001). Conclusions The rapid HIV antibody test demonstrated high sensitivity, specificity, and NPV in our study population, reaffirming its effectiveness as a valuable screening tool. ART did not seem to affect the rapid test performance. However, the low PPV and 100% failure in detecting acute HIV infections underscore the importance of confirmatory in-lab testing. Insights into symptomatology of patients with acute HIV inform ED providers when confirmatory testing is essential for a timely and accurate HIV diagnosis.

Clinical Characteristics and Survival Analysis of Single Center Adult Chronic Myeloid Leukemia in Chronic Phase

To investigate the clinical characteristics and prognosis of single center adult chronic myeloid leukemia in chronic phase (CML-CP). Clinical data of 41 adult CML-CP patients in Department of Hematology, Shanghai Fengxian District Central Hospital from January 2015 to May 2021 were retrospectively analyzed. The clinical characteristics and prognosis of patients between <60 years group and ≥60 years group were compared. The 41 patients included 27 (65.9%) males and 14 (34.1%) females. The median age of the patients was 56(19-84) years, with 22 cases (53.7%) <60 years and 19 cases (46.3%) ≥60 years. Univariate analysis indicated that the proportions of patients with comorbidities, intermediate/high-risk Sokal score, myelofibrosis, and lactate dehydrogenase ≥1 000 U/L were significantly increased in ≥60 years group compared with <60 years group at initial diagnosis (all P <0.05). There were no statistical differences in the distribution of sex, ELST score, white blood cell count, platelet count, peripheral blood basophil percentage, peripheral blood eosinophil percentage and bone marrow primitive cell percentage between the two groups (P >0.05). The proportion of patients taking reduced-dose imatinib in ≥60 years group significantly increased (P <0.001). Patients <60 years had a higher proportion of molecular biological remission after treatment of tyrosine kinase inhibitors (TKIs) than patients ≥60 years (P <0.001). The incidence of non-hematologic adverse reactions to TKI therapy significantly increased in patients ≥60 years (P <0.001). Multivariate analysis showed that no adverse factors affecting the efficacy and prognosis of TKI. Compared with adult CML-CP patients <60 years, patients ≥60 years gain fewer benefits from TKI treatment and increased adverse reactions.

Lower Limb Comprehensive Reconstructive Surgery: Experiences from an Orthopedic Teaching Unit

Abstract Introduction: The burden of open extremity fractures is well recognized in placing a burgeoning demand on an already exhausted medical facility in low- and middle-income countries. This study aims to evaluate the functional outcome following “orthoplastic management” by orthopedic surgeons trained in limb reconstruction surgery. Methodology: Adult patients with open lower limb injuries treated from January 1, 2022, to December 30, 2022, who underwent single or staged fixation and reconstruction procedures were identified. Patients with Gustilo–Anderson type IIIB fractures requiring skeletal stabilization with soft-tissue cover were included. Polytrauma patients requiring multidisciplinary surgical attention were excluded. A team of orthopedic surgeons trained in limb reconstruction was involved in the management. Inpatient and outpatient department follow-up by the treating team was done to document complications (infections, reoperations, and graft failures) and functional outcomes using the Lower Extremity Function Score. The duration of mean follow-up was 1 year since index surgery. Results: A total of 24 adult patients with open lower limb injuries with preoperative Ganga Hospital Score (GHS) were included. Decision toward fixation with primary closure or further reconstruction was made collectively. The gray zone (GHS score of 15–16) of patients was more aggressively managed with emphasis on salvage. Additional reconstructive procedures were carried out based on the assessment at consequent follow-up. Three patients had a suboptimal joint function (less than functional range of motion for the involved joint) due to the resultant loss of compartment(s) and joint contracture. Five patients were retaken to the theater for further supplementary or corrective procedures following the index, definitive surgical procedure (bone grafting, partial flap loss, and fixator readjustment). Conclusion: Good-to-excellent functional outcome was demonstrated with the “orthoplastic approach” where skeletal stabilization as well as soft-tissue reconstruction was performed by trained orthopedic surgeons. This study demonstrated that orthoplastic surgery is a safe and effective method of limb salvage.

Disability, cognitive impairment and depression in patients with Traumatic Brain Injury (TBI) &amp;ndash; A Prospective Study

Introduction: Traumatic brain injuries are most commonly caused due to RTA in India, which has become the biggest killer. Physical deficits are given importance in the early phase of recovery post-head injury but it is the cognitive impairments and behavioural issues that lead to disability and prevent patients from returning back to work, causing an emotional and financial burden to families.Aims and objective: Purpose of the study was to assess for disability and cognitive impairment associated with post TBI. Also to assess for the presence and severity of depression in patients suffering from TBI.Methodology: 110 patients of TBI from the neurosurgery in-patient department, recruited from January 2016 to June 2016 consenting to study from a tertiary care hospital are considered for assessment for a period of 6 months by follow up. Disability is assessed by using the WHO-DAS scale, cognitive impairment is assessed by the HMSE scale and severity of depression is assessed by the HAM-D scale.Results: In this study out of 110 TBI patients, 21.8% had moderate disability and 8.2% had severe disa-bility. In this study 52.6% suffered from depression and among these 25% had mild depression, 55%had moderate and 20% had severe depression.Conclusions: This is one of few studies done in south India specifically in Karnataka to assess for the disability associated with post TBI and also to assess for cognitive impairment that patients with TBI suffer post injury. TBI patients suffer from depression, cognitive impairment and significant disability, hence early assessment is required.

SUGAMMADEX SHOULD BE USED TO REVERSE ROCURONIUM IN EMERGENCY DEPARTMENT PATIENTS WITH NEUROLOGIC INJURIES

SUGAMMADEX SHOULD BE USED TO REVERSE ROCURONIUM IN EMERGENCY DEPARTMENT PATIENTS WITH NEUROLOGIC INJURIES

High Blood Ammonia Level Is a Predictor of Medium and Large Size Esophageal Varices In Cirrhotic Patients

Background: The development of esophageal varices (EV) and rupture of them are the most serious complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV but it is a costly and troublesome invasive procedure. To find a non-invasive method for detection of size of EV and to predict the bleeding risk is appealing and would decrease the indications cost and discomfort of upper GI endoscopy. The aim of the study is to evaluate high blood ammonia level is a predictor of medium and large size of esophageal varices in Cirrhotic patients. Methods: This was an observational Cross-sectional study conducted on 40 cirrhotic patients in Department of Gastroenterology, BSMMU using a pre-designed data collection sheet. Information about clinical profile, laboratory parameters- blood ammonia, serum bilirubin, serum albumin, prothrombin time, and ultrasonography of abdomen, endoscopy upper GIT was collected and recorded. The collected data was analyzed by computer with the help of SPSS version 22. Statistical analysis was done by using appropriate statistical tool like Chi-square test, Student’s t- test. P value &lt; 0.05 was considered as significant. Diagnostic efficacy of blood ammonia was calculated by using a value. Results: A total of 40 patients with cirrhosis. Mean age of cirrhotic patients were 47.47±12.98 years. Mean blood ammonia of small size EV of cirrhotic patients was 73.70±32.11 (μmol/L) and medium and large size EV was 118.3±38.37 (μmol/L) (P&lt; .001). At the level of 78.5 (μmol/L), sensitivity and specificity of blood ammonia was 95% and 65% respectively in detection of size of EV. Conclusion: Blood ammonia estimation could be a good tool for identifying individuals with medium and large size esophageal who will need to undergo endoscopy more frequently. Bangladesh J Medicine 2024; 35: 167-172

Study on medical dispute prediction model and its clinical-application effectiveness based on machine learning

BackgroundMedical dispute is a global public health issue, which has been garnering increasing attention. In this study, we used machine learning (ML) method to establish a dispute prediction model and explored the clinical-application efficiency of this model in effectively reducing the occurrence of medical disputes.MethodsRetrospective study of All disputes filed by Gansu Medical Mediation Committee from 2019 to 2021 and patients with the same hospital level as that of the dispute group and hospitalization year were randomly selected as the control group in 1:1 ratio. SPSS software was used for univariate feature selection of the 14 factors that may cause disputes, and factors with statistical differences were selected. The data were divided into training and test sets in a 7:3 ratio. Six ML models were selected, and Python was used to establish a dispute prediction model. The area under the curve (AUC) of the receiver operating characteristic curve (ROC), sensitivity, specificity, accuracy, precision, average precision (AP), and F1 score were used to characterize the fitting and accuracy of the models, while decision curve analysis (DCA) was used to evaluate their clinical utility.ResultsA total of 1189 patients in the dispute and control groups were extracted. Following 11 influencing factors were selected: the inpatient department, doctor title, patient age, patient gender, patient occupation, payment method, hospitalization days, hospitalization times, discharge method, blood transfusion volume, and hospitalization espenses. Compared to other models, the AUC (0.945, 95% CI 0.913–0.981), Sensitivity (0.887), Accuracy (0.887), AP (0.834), and F1 score (0.880) of the random forest model were higher than those of other models, while the DCA curve indicated its high clinical benefits.ConclusionsInpatient department, hospitalization expenses, and discharge type are the primary influencing factors of dispute. Random forest exhibited high dispute prediction and clinical-application value and is expected to be promoted for offline dispute prediction.

Exploring the factors influencing the health-related quality of life in patients experiencing adverse drug reactions: a cross-sectional study

BackgroundThis study aimed to assess the factors influencing health-related quality of life (HRQoL) in patients experiencing adverse drug reactions (ADRs) at a tertiary care public sector hospital. A cross-sectional study was conducted over a period of 18 months, and included both male and female patients aged 18 years and above. Patients who visited the outpatient and inpatient departments with complaints associated with ADRs were included in this study. HRQoL data were collected using the EuroQol—5 Dimension—5 Level (EQ-5D-5L) questionnaire to assess five dimensions of health on a five-level scale. Descriptive statistics, t-tests, and analysis of variance were used to analyze the data. Multivariate regression analysis was performed to identify the potential determinants of HRQoL.ResultsA total of 316 patients were included in the study among these participants, of which 54% were female, and 65% were from rural areas. The majority (68%) of the patients had moderately severe ADRs, and 63% of the participants had an income < 2.5 lakh Indian rupees (3009 USD). The mean EQ-5D-5L and EuroQoL Visual Analog Scale (EQ VAS) scores of the study participants were 0.714 and 69.73, respectively. The variables ADR severity, income, and age showed a significant difference (p < 0.05) in HRQoL.ConclusionThis study provides insights into HRQoL among patients with ADRs and identifies the determinants of HRQoL. The findings of this study will contribute to improving patient-centered care and optimizing patient outcomes.

Understanding the Scope of Acute Care Vascular Surgery at a Tertiary Academic Medical System

The restructuring of nonelective general surgery and nationwide implementation of the acute care surgery paradigm has improved patient outcomes and healthcare resource utilization. Although vascular surgery maintains one of the highest acuity rates among surgical specialties, the acute care vascular surgery (ACVS) practice model has not been widely accepted. In the present study, we investigate the scope and burden of ACVS at a tertiary academic medical system. All vascular surgical procedures performed at three hospitals comprising a large tertiary academic medical system were retrospectively queried through electronic medical records. Data were collected on procedure, acuity, timing of intervention, primary service, admission type, and total costs and charges. Patients were stratified by acuity of surgical intervention, with ACVS being defined as urgent or emergent operation. A total of 12,689 vascular surgeries were performed from 2018 to 2022. ACVS procedures comprised 22.1% of this total (n=2,803; 12.5% urgent, 9.6% emergent), with an annual burden ranging from 19.1% to 28.3%. Vascular surgeons served as primary surgeon in 91.3% of ACVS and cosurgeon in 8.7%. Fourteen separate surgical specialties requested acute vascular assistance, with the most frequently consulting specialties, including trauma or acute care surgery (ACS) (n=109, 3.9%) and cardiac surgery (n=74, 2.6%). ACVS cases were more frequently performed during after-hours (30.7% vs 11.6%) and on weekends (27.1% vs 2.0%) compared with elective vascular procedures (P<0.0001 each). The majority of ACVS cases originated from inpatient (n=2,353, 85.0%) and emergency department (n=379, 13.5%) consultations. Overall, ACVS generated $37.5 million in charges, accounting for 14% of total procedure-related charges over the study period. ACVS comprises a substantial portion of modern vascular practice and is associated with significant human and healthcare resource expenditure. These data support the development of practice models dedicated to acute vascular surgical care.

Current status of professional memory clinics, inpatient services, and health professionals in China.

This study aims to explore the current status of dementia-specific diagnosis and treatment in China. This national survey was conducted in mainland China from September 2022 to February 2023, with strong support from the Cognitive Disorders Group of the Chinese Society of Neurology, Chinese Medical Association. Among 2721 hospitals surveyed, 244 (8.97%) have dementia-specific clinics (DSCs) and 166 (6.10%) have dementia-specific inpatient departments (DSIDs). Almost all hospitals have brain structural imaging capabilities and basic hematological examinations, but dementia-specific medical staff (DSMS) equipped for DSCs or DSIDs are rare. The proportion of patients with cognitive impairment receiving care through a DSCs or DSIDs is low, and most patients present with advanced (moderate to severe) disease. The survey shows that the proportion of DSCs and DSIDs is low, and the regional distribution varies significantly. Trained DSMS and specialized facilities for the diagnosis and treatment of dementia are inadequate. This study was a multi-center national research to comprehensively investigate the distribution and features of dementia-specific clinics and inpatient departments in mainland China, given that the limited literature was available regarding the dementia-specific centers. The study points to significant regional differences in the distribution of cognitive-specific clinics and inpatient departments in mainland China. More centers in Eastern Regions compared to Western Regions, a greater presence in provincial capitals as opposed to other cities, and a predominance of tertiary hospitals over non-tertiary ones. The aim is to provide data support for advancements in medical research within this field. Domestic dementia patients have inadequate access to specialized medical resources and expert assistance, which significantly contrasts with the growing number of dementia cases in China.