Healthcare Patients Research Articles

Clinical practice perception in relation with DEPTh model among dental practitioners in Madurai city -A cross sectional study

Introduction : Clinical epidemiology is a science of making predictions, which aims at promoting the quality of clinical and patient oriented health care, in order to make good decision in care of patients. The study aimed to assess the perception of clinical practice in relation with Diagnosis, Etiology, Prognosis, Therapy (DEPTh) Model among dental practitioners in Madurai City. Materials and Methods : The Questionnaire based cross sectional study was conducted among Dentist in Madurai city for a period of 1 month and the sample size was about 181. The self-structured questionnaire consisted of 13 closed ended questions which was formulated based on their perception towards practice either as Diagnostic, Etiology, Prognosis or Therapy (DEPTh) Model. Results : The present study was conducted among 183 dental practitioners practicing in Madurai city. The result of the study was based on the questionnaire, which revealed that 32.92% of dental practitioners prefer to give importance to diagnosis of disease, 27.15 % of dental practitioners prefer to give importance to the etiology of disease, 19.14 % of dental practitioners preferred to give importance to prognosis of disease and 31.44 % of dental practitioners preferred to give importance to therapy overall. Conclusion : The result of the present study highlights the importance of clinical practice decision making, as dental practitioners there a need to investigate the condition in holistic way and not merely the therapy and diagnostic aspect alone. This study attempted to attune their own practice for inculcating effective contribution to overall care and patient well-being

Prospective application of theoretical implementation frameworks to improve health care in hospitals — a systematic review

BackgroundHealth Service implementation projects are often guided by theoretical implementation frameworks. Little is known about the effectiveness of these frameworks to facilitate change in processes of care and patient outcomes within the inpatient setting. The aim of this review was to assess the effectiveness of the application of theoretical implementation frameworks in inpatient healthcare settings to change processes of care and associated patient outcomes.MethodWe conducted a search in CINAHL, MEDLINE, EMBASE, PsycINFO, EMCARE and Cochrane Library databases from 1st January 1995 to 15th June 2021. Two reviewers independently applied inclusion and exclusion criteria to potentially eligible studies. Eligible studies: implemented evidence-based care into an in-patient setting using a theoretical implementation framework applied prospectively; used a prospective study design; presented process of care or patient outcomes; and were published in English. We extracted theoretical implementation frameworks and study design against the Workgroup for Intervention Development and Evaluation Research (WIDER) Checklist and implementation strategies mapped to the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy. We summarised all interventions using the Template for Intervention Description and Replication (TIDieR) checklist. We appraised study quality using the Item bank on risk of bias and precision of observational studies and the revised Cochrane risk of bias tool for cluster randomised trials. We extracted process of care and patient outcomes and described descriptively. We conducted meta-analysis for process of care and patient outcomes with reference to framework category.ResultsTwenty-five studies met the inclusion criteria. Twenty-one used a pre-post (no comparison), two a pre-post with a comparison, and two a cluster randomised trial design. Eleven theoretical implementation frameworks were prospectively applied: six process models; five determinant frameworks; and one classic theory. Four studies used two theoretical implementation frameworks. No authors reported their justification for selecting a particular framework and implementation strategies were generally poorly described. No consensus was reached for a preferred framework or subset of frameworks based on meta-analysis results.ConclusionsRather than the ongoing development of new implementation frameworks, a more consistent approach to framework selection and strengthening of existing approaches is recommended to further develop the implementation evidence base.Trial registrationCRD42019119429.

Art and other group therapies with adolescents in inpatient mental health care

ABSTRACT Background: Group programmes are a common component of treatment in inpatient child and adolescent mental health service (CAMHS) units. There is evidence for specific group interventions, however, comparison across a multidisciplinary group programme is under-explored. Aims: This research examines young people's experiences of, and satisfaction with, a multidisciplinary group programme on an acute inpatient CAMHS unit. Methods: Weekly surveys were distributed to young people, and 37 responses were gathered across four months in 2018. Rates of attendance, enjoyment and perceived helpfulness of groups were calculated. Content analysis was used to explore key themes in qualitative responses. Results: Young people rated a creative activities and games group (54.05%) and the art therapy group (48.95%) as the two most enjoyable groups. Art therapy was reported to be the most helpful group overall (45.65%). Young people also expressed their dislike for verbal psychotherapy groups (43.24%), finding these confronting relative to other modalities in the programme. Conclusions: Art therapy and arts-based groups received the highest positive feedback relative to predominantly verbal psychotherapy groups. A multidisciplinary group programme which integrates art therapy and other creative modalities has the potential to enhance engagement in acute inpatient settings which may result in improved mental health outcomes for young people. Implications for future research and practice: Future research should aim to foreground young people's perspectives and experiences of therapeutic programmes, and provide opportunities for clinicians to redevelop programmes responsively to service user feedback. Survey findings support advocacy for consistent art therapy roles and services within inpatient CAMHS units.

The Cost We Bear: Financial Implications for Hip Fracture Care Amidst the COVID-19 Pandemic.

The purpose of this study was to assess the impact of COVID-19 on the cost of hip fracture care in the geriatric/middle-aged cohort, hypothesizing the cost of care increased during the pandemic, especially in COVID+ patients. Between October 2014 and January 2022, 2,526 hip fracture patients older than 55 years were analyzed for demographics, injury details, COVID status on admission, hospital quality measures, and inpatient healthcare costs from the inpatient admission. Comparative analyses were conducted between: (1) All comers and high-risk patients in the prepandemic (October 2014 to January 2020) and pandemic (February 2020 to January 2022) cohorts and (2) COVID+ and COVID- patients during the pandemic. Subanalysis assessed the difference in cost breakdown for patients in the overall cohorts, the high-risk quartiles, and between the prevaccine and postvaccine pandemic cohorts. Although the total costs of admission for all patients, and specifically high-risk patients, were not notably higher during the pandemic, further breakdown showed higher costs for the emergency department, laboratory/pathology, radiology, and allied health services during the pandemic, which was offset by lower procedural costs. High-risk COVID+ patients had higher total costs than high-risk COVID- patients ( P < 0.001), most notably in room-and-board ( P = 0.032) and allied health ( P = 0.023) costs. Once the pandemic started, subgroup analysis demonstrated no change in the total cost in the prevaccine and postvaccine cohort. The overall inpatient cost of hip fracture care did not increase during the pandemic. Although individual subdivisions of cost signified increased resource utilization during the pandemic, this was offset by lower procedural costs. COVID+ patients, however, had notably higher total costs compared with COVID- patients driven primarily by increased room-and-board costs. The overall cost of care for high-risk patients did not decrease after the widespread administration of the COVID-19 vaccine. III.

Racial disparities in utilization of palliative care among inpatients admitted for lung cancer.

e24166 Background: Multiple national database-based studies have shown that Black and Hispanic patients are less likely to receive palliative care options at end-of-life (EOL) inpatient care leading to higher costs and poorer quality of life. To the best of our knowledge, there is no reported data specifically considering lung and pleural malignancies. Methods: We analyzed hospitalizations across the United States in 2019 from the National Inpatient Sample dataset, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. We identified adult non-emergent hospitalizations with ‘malignant neoplasm of the lung and bronchus’ (including mesothelioma) listed as the principal reason for hospitalization using the International Classification of Diseases, 10th revision, clinical modification codes C34.0, C34.1, C34.2, C34.3, C34.8, C34.9, and their sub-branches. StataCorp Stata software was used to extract data and compute mortality and palliative care consult utilization among various demographic factors such as sex, age, race, and payer status. Results: Of 67,425 total hospitalizations, 9.4% resulted in mortality. Of these 6338 patients that died, 73.1% were White, 13% Black, 5.8% Hispanic, 3.9% Asians/Pacific Islanders, 0.6% Native Americans, and 3.3% were other races. Palliative care was consulted in 63% of the patients whose admission resulted in death. 64.9% of the White patients, 58.6% of the Black patients, 62.6% of Hispanic patients, 67.7% of Asians/Pacific Islanders, 60% Native Americans, and 59.6% of other races were offered palliative care prior to their death. The average age among the admissions which resulted in death was 69.03 years. Conclusions: While most admissions resulting in mortality were among the White population, there was still a clear discrepancy in the number of Black patients on whom palliative care was consulted. Possible reasons include poor healthcare literacy, physician mistrust, and cultural preferences. Clinicians should consider and suggest early palliative care consultation in the care of Black patients and other minority racial groups to improve the quality of EOL care.

EE250 Evaluation of Inpatient Healthcare Resource Utilization and Costs Pre- and Post- Nusinersen for the Treatment of Spinal Muscular Atrophy (SMA) Using US Claims

EE250 Evaluation of Inpatient Healthcare Resource Utilization and Costs Pre- and Post- Nusinersen for the Treatment of Spinal Muscular Atrophy (SMA) Using US Claims

The Impact of COVID-19 on Mental Healthcare Utilization in Switzerland Was Strongest Among Young Females-Retrospective Study in 2018-2020.

Objectives: To provide a thorough assessment of the impact of the COVID-19 pandemic on the utilization of inpatient and outpatient mental healthcare in Switzerland. Methods: Retrospective cohort study using nationwide hospital data (n > 8 million) and claims data from a large Swiss health insurer (n > 1 million) in 2018-2020. Incidence proportions of different types of psychiatric inpatient admissions, psychiatric consultations, and psychotropic medication claims were analyzed using interrupted time series models for the general population and for the vulnerable subgroup of young people. Results: Inpatient psychiatric admissions in the general population decreased by 16.2% (95% confidence interval: -19.2% to -13.2%) during the first and by 3.9% (-6.7% to -0.2%) during the second pandemic shutdown, whereas outpatient mental healthcare utilization was not substantially affected. We observed distinct patterns for young people, most strikingly, an increase in mental healthcare utilization among females aged <20years. Conclusion: Mental healthcare provision for the majority of the population was largely maintained, but special attention should be paid to young people. Our findings highlight the importance of monitoring mental healthcare utilization among different populations.

A scoping review of institutional policies and recommendations for trans inpatient mental health care.

INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.

78 Improvement of Cell Viability in Temporary Storage of Split Thickness Skin Grafts

Abstract Introduction Autologous split thickness skin grafts (STSGs) are the preferred donor tissue for restoration of large tissue deficits. Although grafting should be done at the time of donor harvest, various factors necessitate tissue storage, traditionally in saline solution (SS) at 4oC. However, STSGs often expire before grafting in these conditions. Patients then require further excision procedures or die due to inadequate skin coverage. For patients’ wellbeing, establishing a new storage protocol is imperative. This study sought to determine an effective storage media for prolongation of graft viability for subsequent incorporation into excision and grafting practice. Methods Following patient consent, excess tissue &amp;gt;1cm2 was collected after grafting procedures. Tissue was stored at 4oC in RPMI, DMEM, and SS with penicillin/streptomycin. Samples were evaluated at 2, 5, 7, and 14 days. Cell viability was measured by Trypan blue dye exclusion test in an automated cell counter yielding percentage of viable keratinocytes (PVK). An unbiased pathologist assessed tissue integrity by epidermal-dermal junction, perinuclear keratinocyte halos, and collagen organization with higher scores denoting deterioration. Data were evaluated by ANOVA and Effect size. Results A total of 155 sets of two specimens each were collected from 13 patients. Mean PVK values at day 2, 5, 7, and 14: SS (57.38, 36.96, 38.38, 27.50), RPMI (69.46, 69.92, 70.33, 62.67), DMEM (63.17, 53.50, 54.83, 37.92). By pairwise comparison, RPMI preserved PVK better than SS at days 5, 7, and 14 (p = 0.001 for each day). DMEM preserved PVK better than SS when comparing all days (p = 0.011) but failed to produce a statistically significant difference at any specific day. RPMI preserved PVK greater than DMEM each day. However, statistically significant differences were only revealed at day 14 (p = 0.017) and when comparing all days (p &amp;lt; 0.001). Effect size was large for overall group differences of PVK at day 5, 7, and 14 (Cohen’s f = 0.72, 0.73, and 0.75). Tissue integrity scores at day 2, 5, 7, and 14: SS (0.69, 1.0, 1.38, 2.0), RPMI (0.54, 0.92, 0.85, 1.54), DMEM (0.77, 0.92, 0.77, 1.15). Although culture media preserved tissue integrity greater than SS, no statistically significant differences were found. Conclusions RPMI preserved cell viability better than DMEM and SS. This suggests that STSGs stored in RPMI may prolong the time of which tissue could be stored and successfully amalgamated with skin. Applicability of Research to Practice Storing tissue in RPMI could benefit burn patients by decreasing tissue disposal therefore reducing future donor site area or eliminating repetitious excision procedures entirely. These effects decrease inpatient days and healthcare costs. Most importantly, successful tissue storage will save patients’ lives, especially those of large surface area burns who lack sufficient donor sites.

Does energy poverty increase health care expenditures in China?

ABSTRACT Using the 2012–2018 waves of the China Family Panel Studies, we investigate the impact of energy poverty (EP) on health care expenditures among Chinese adults aged 18+. Employing a methodology combining a random effects two-part model and instrumental variable estimations, we show that EP leads to higher levels of total (305 yuan/year), out-of-pocket (199 yuan/year), inpatient (230 yuan/year) and other (113 yuan/year) health care expenditures, with more pronounced impacts among females and those living in urban areas and Eastern China. These results are robust not only to alternative EP and health care expenditure measures but also to a series of estimation approaches that control for endogeneity. An additional structural equation modelling analysis of the underlying pathways further reveals that this EP-health care expenditure relationship is mediated by individual self-reported health as well as expenditures on food and other daily necessities. Combating EP is an effective way to improve people’s health and reduce the burden on health care expenditures. Policymakers should also pay more attention to vulnerable groups such as women.

Review of: "[Perspective] The study of Safety of Inpatient Health Care needs to include adverse event rates from venous and urinary catheters"

Review of: "[Perspective] The study of Safety of Inpatient Health Care needs to include adverse event rates from venous and urinary catheters"

Exploring The Transgender Individual's Experience With Healthcare Interactions: A Phenomenological Study.

The purpose of the study was to provide a transgender narrative on healthcare interactions to increase visibility and awareness of transgender-identified issues in accessing care. This study aimed to: (a) examine how transgender individuals perceive and experience interactions with trained healthcare professionals, such as nurses, physicians, and mental health professionals, (b) identify common issues related to transgender individuals' barriers to care, and (c) identify how these barriers affect a transgender individual's ability to access health care. A phenomenological approach was used. The nine transgender-identified participants received a demographic questionnaire followed by a virtual semi-structured interview. Thematic analysis was used to analyze the interview data. The themes that emerged from the data were (a) challenges with accessing health care, (b) inconsistent healthcare information, and (c) disenfranchised versus empowered experiences. The results of this study not only provided an opportunity for the transgender participants to share their experiences, but also provides educational information for healthcare providers to improve their future interactions with transgender patients. Identifying the transgender patient with the correct name and pronoun, providing a welcoming and open healthcare environment, and knowing where to locate transgender health resources will improve the transgender patient's healthcare experience.

Inpatient epidemiology, healthcare utilization, and association with comorbidities of Turner syndrome: A National Inpatient Sample study.

We aimed to investigate the prevalence, resource utilization, and comorbidities of patients with Turner syndrome (TS) hospitalized in the United States. We identified patients within the Nationwide Inpatient Sample database from the year 2017 to 2019. A propensity-matched cohort of non-TS patients from the same database was constructed to serve as comparators. There were 9845 TS patients, corresponding to inpatient prevalence of 10.4 per 100,000 admissions. The most common admission diagnosis was sepsis (27.9%). TS patients had higher inpatient mortality (adjusted odds ratio 2.16, 95% confidence interval 1.57-2.96) and morbidity, including shock, ICU admission, acute kidney injury, systemic inflammatory response syndrome, acute respiratory distress syndrome, and multi-organ failure. Increased risk of comorbidities, such as stroke, myocardial infarction, autoimmune diseases, and non-variceal gastrointestinal bleeding, was observed. TS patients had longer length of stay (LOS; 5.1 days vs. 4.5 days, p < 0.01) and displayed a mean additional $5382 (p < 0.01) in total hospital costs and a mean additional $20,083 (p < 0.01) in total hospitalization charges. In conclusion, hospitalization of patients with TS was associated with a significantly higher inpatient morbidity, mortality, expenditures, and longer LOS compared to non-TS patients. Patients with TS had a higher risk of cardiovascular complications, autoimmune diseases, and gastrointestinal bleeding.

Therapeutic leave and direct inpatient healthcare costs in inpatients with mental illness

AimsBalancing the economic costs related to mental illness is a pressing matter globally. Scarce monetary and staff resources impose an ongoing challenge. Therapeutic leaves (TL) are an established clinical tool in psychiatry possibly improving therapy outcome and potentially lowering direct mental healthcare costs in the long term. We thus examined the association between TL and direct inpatient healthcare costs. MethodsWe analyzed the association between the number of TL and direct inpatient healthcare costs in a sample of 3151 inpatients, using a tweedie multiple regression model, including eleven confounders. Using multiple linear (bootstrap) and logistic regression models we assessed the robustness of our results. ResultsThe tweedie model showed that the number of TL was associated with lower costs following the initial inpatient stay (B = –.141, CI 95% = [–0.225, –.057], p < 0.001). Results of the multiple linear and the logistic regression models matched those of the tweedie model. ConclusionOur findings suggest a link between TL and direct inpatient healthcare costs. TL might lower direct inpatient healthcare costs. In the future RCTs might examine whether an increased utilization of TL leads to a reduction of outpatient treatment costs and evaluate the association of TL with outpatient treatment costs and indirect costs. The systematic use of TL during inpatient treatment could reduce healthcare costs following the initial inpatient stay which is highly relevant due to global rise of mental illness and the associated financial pressure on healthcare systems.

PO-01-193 SMOKING CESSATION REDUCES THE RISK OF INCIDENT ATRIAL FIBRILLATION

Active smoking is now an established risk factor atrial fibrillation (AF). However, whether smoking cessation reduces the risk of AF remains unknown. To determine whether those who quit smoking experience a lower risk of AF compared to those who continue to smoke. We utilized the UK Biobank, a prospective cohort study with serial assessments of lifestyle and medical diagnoses. The analyses were constrained to those who smoked at baseline, did not have prevalent AF, and that completed at least one follow-up smoking survey. Smoking cessation was identified from follow-up smoking surveys. Incident AF was ascertained using inpatient and outpatient healthcare coding diagnoses. Multivariable Cox proportional hazards models were used to assess the association between smoking cessation and incident AF. Among 3718 subjects meeting inclusion and exclusion criteria, the median follow-up time was 1059 days (IQR 457-2504 days). Median age was 54 years old (IQR 47-60 years), 1587 (43%) were female, and 145 (4%) were non-white. During follow-up, 1889 (51%) quit smoking. Among the 32 (0.86%) of those that experienced new AF after their follow up visit, 9 (28%) occurred in those that quit smoking and 23 (72%) among ongoing smokers (Figure). After adjusting for age, sex, ethnicity, body mass index, hypertension, hyperlipidemia, diabetes, coronary artery disease, valvular heart disease, congestive heart failure, chronic kidney disease, peripheral artery disease, cancer, alcohol use, smoking cessation was associated with a 55% lower risk of incident AF (HR 0.45, 95% CI 0.21 to 0.98, p = 0.044). Among smokers, those who quit experienced a substantially lower risk of developing AF. These results suggest that the heightened risk of AF among smokers is not immutable, but rather that smoking cessation may be a useful strategy to prevent AF.

Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis

ObjectivesAssess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes.DesignSystematic review and narrative synthesis.Data sourcesMedline, Embase, Google Scholar and the National Institute for Health and...

The Effectiveness of Celengan Rindu in Monitoring Fetal Movement in Third-Trimester Mothers

Aims: Neonatal mortality ranks fifth among the top ten causes of death in the world, including neonatal conditions. Early detection measures, such as assessing the well-being of the fetus during the womb through monitoring Fetal Movements (FM), can help to reduce the incidence of IUFD. Monitoring FM aims to determine fetus well-being. Celengan Rindu application was created with the goal of making it easier for mothers to monitor FM daily. This study to determine the efficacy of Celengan Rindu in monitoring FM in third-trimester mothers at the Sidomulyo Inpatient Health Center. Methods: This study was carried out quantitatively on Celengan Rindu using a quasi-experimental design and FM monitoring. This study's sample included up to 30 pregnant women in their third trimester. The sampling technique used was accidental sampling with a questionnaire designed by the researcher himself regarding monitoring FM. The Wilcoxon test was used to analyze the data in this study. Results: Most of the pregnant women 66.7%, were in their early adulthood and had gravida status, with the majority being primigravida, 63.3%. Only 16.7% of respondents monitored FM according to the results of the pretest before using the Celengan Rindu. The post-test showed that 25 people monitoring fetal movements out of 30 respondents. The P-value was 0.001, it means Celengan Rindu was effective to monitor FM. Conclusions: Celengan Rindu can be used to prevent IUFD and provide the results of a successful pregnancy, allowing the mother to proceed with the expected delivery process.

Adaptation of Serious Illness Care Program to be delivered via telehealth for older patients with hematologic malignancy.

Older patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) experience intense inpatient health care at the end-of-life stage. Early advance care planning may improve care at the end of life for patients with AML or MDS. The Serious Illness Care Program (SICP) is a multicomponent, communication intervention developed to improve conversations about values for patients with serious illnesses. The SICP has been shown to improve the quality and frequency of advance care planning discussions. We adapted the SICP for delivery via telehealth to older patients with AML or MDS. We conducted a single-center qualitative study of 45 participants (25 clinicians, 15 older patients with AML or MDS, and 5 caregivers). Participants, whether clinicians, patients, or caregivers, agreed that the SICP would help older patients with AML or MDS to share their personal values with their care team. Four qualitative themes emerged from our data: (1)serious illness conversations can be conducted via telehealth, (2) older patients have limited experience using technology but are willing and able to learn, (3) patients feel that serious illness conversations will help them understand their AML or MDS diagnosis and prognosis better, and (4) serious illness conversations should be common and routine, not extraordinary. The adapted SICP may provide older patients with AML or MDS an opportunity to share what matters most to them with their care team and may assist oncologists in aligning patient care with patient values. The adapted SICP is the subject of an ongoing single-arm pilot study at the Wilmot Cancer Institute (clinicaltrials.govidentifier:NCT04745676).

A 7-year perspective on femoral neck fracture management in New York State—Do Level 1 trauma centers provide better care?

IntroductionPatients with femoral neck fractures are at a substantial risk for medical complications and all-cause mortality. Given this trend, our study aims to evaluate postoperative outcomes and the economic profile associated with femoral neck fractures managed at level-1 (L1TC) and non-level-1-trauma centers (nL1TC). MethodsThe SPARCS database was queried for all geriatric patients sustaining atraumatic femoral neck fractures within New York State between 2011 and 2017. Patients were then divided into two cohorts depending on the treating facility's trauma center designation: L1TC versus nL1TC. Patient samples were evaluated for trends and relationships using descriptive analysis, Student's t-tests, and Chi-squared. Multivariable linear-regressions were utilized to assess the effect of trauma center designation and potential confounders on patient mortality and inpatient healthcare expenses. ResultsIn total, 44,085 femoral neck fractures operatively managed at 161 medical centers throughout New York during a 7-year period. 4,974 fractures were managed at L1TC while 39,111 were treated at nL1TC. Following multivariate regression analysis, management at L1TC was the most significant cost driver, resulting in an average increased cost of $6,330.74 per fracture. ConclusionOur results suggest that femoral neck fractures treated at L1TC have more comorbidities, higher in-hospital mortality, longer LOS, and greater hospital costs.

Achieving Elimination of Perinatal HIV in the United States.

In 2012, the Centers for Disease Control and Prevention published a Framework for Elimination of Perinatal Transmission of HIV in the United States in Pediatrics, setting the goals of an incidence of <1 case of perinatal HIV per 100 000 live births, and a perinatal transmission rate of <1%. We used National HIV Surveillance System data to monitor the numbers of perinatally acquired HIV cases among US-born persons and perinatal HIV diagnosis rates per 100 000 live births to approximate incidence. Perinatal HIV transmission rates from 2010 to 2019 were calculated by using estimates of live births to women with an HIV diagnosis from the National Inpatient Sample, Healthcare Cost and Utilization Project. The annual estimated number of live births to women with diagnosed HIV decreased from 4587 in 2010 to 3525 in 2019, and the number of US-born infants with perinatally acquired HIV decreased from 74 in 2010 to 32 in 2019. Annual perinatal HIV diagnosis rates declined from 1.9 to 0.9 per 100 000 live births, and perinatal HIV transmission rates declined from 1.6% to 0.9%. Racial and ethnic disparities in HIV diagnosis rates persisted but declined substantially over the 10-year period. Both diagnosis and transmission rate elimination goals were first achieved in 2019. To maintain the elimination of perinatal HIV, and to eliminate racial disparities, the continued coordinated effort of health care and public health is required. The approach to perinatal HIV elimination is a public health model that can be replicated or expanded to areas beyond HIV.