Length Of Hospital Days Research Articles

The Accuracy of using Antibiotics with the Gyssens Method on MDRO Events and its Impact on Cost Effectiveness Analysis (CEA) and Length of stay at RSUD dr. Iskak Tulungagung

Evaluation of antibiotics in terms of the quality of antibiotic use was carried out using the Gyssens method to evaluate the accuracy of the use of MDRO incidence antibiotics. The purpose of the study was to analyze the effect of the accuracy of antibiotic use on the incidence of MDRO and its impact on cost effectiveness analysis (CEA) and length of stay at Dr. Iskak Hospital Tulungagung. Research design in the form of quantitative research with case control analytical observational research methods with a retrospective approach. The research samples were some employees at RSUD dr. Iskak Tulunggung Regency as many as 50 case groups and 50 control groups with sampling techniques using the simple random sampling method. Data analysis using Path Analysis. The results showed that the punctuality variable of antibiotic administration had an indirect influence on the variable length of hospitalization days of -0.065, indicating that the timeliness of antibiotic administration would affect the length of hospitalization days must pass the MDRO incidence of -0.194. The variable accuracy of antibiotic administration has a direct effect on the length of days of treatment by -0.522. The variables of timeliness of antibiotic administration and the accuracy of the duration of antibiotic administration have a direct influence on the cost effective analysis of -0.191 and -0.426 without passing the MDRO event. Revise antibiogram guidelines, Increase monitoring activities for the use of antibiotics regularly, Increase teamwork of health professionals in an effort to improve the quality of antibiotic use and prevention of MDRO.

Health Care–Associated Infection in Elderly Patients With Cerebrovascular Disease in Intensive Care Units: A Retrospective Cohort Study in Taizhou, China

Cerebrovascular diseases are associated with high incidence of health care-associated infections (HAIs) and poor prognosis in elderly patients. This study aimed to investigate the incidence and clinical characteristics of HAIs in elderly patients with cerebrovascular disease in the intensive care unit (ICU). Patients admitted with cerebrovascular disease, aged≥65 years, were included. The clinical data of the patients were retrospectively analyzed to determine the risk factors, infection type, distribution, and pathogenic characteristics of HAIs in the context of cerebrovascular diseases. Out of 381 ICU inpatients monitored, 79 (20.73%) developed HAIs. Risk analysis revealed number of ventilator days as significant risk factors for HAIs in elderly patients with cerebrovascular diseases in the comprehensive ICU. In the HAI group, 56 patients (70.89%) had respiratory tract infection (RTI). Sixty-five patients (82.28%) were infected with Gram-negative bacteria (GNB), and 42 (53.16%) with multi-drug-resistant organism (MDRO). The length of hospitalization days, ventilator days, and overall hospitalization costs were higher in the HAI group than in the non-HAI group (P < 0.05), but there was no significant difference between groups in the treatment outcome of patients. Patients with MDRO infection had longer duration and higher cost of hospitalization than those infected with non-MDRO (P < 0.05), but there was no significant difference between the groups in the treatment outcome of patients. HAIs occurred mostly due to RTI and GNB infection. The hospitalization cost and duration, as well as the length of ventilator days, were higher for cerebrovascular patients with HAIs than for non-HAIs patients.

P-756 Change of anti-Müllerian hormone (AMH) value for ovarian reserve after minimal invasive benign ovarian cystectomy: Da Vinci robotic system (Xi and SP) and laparoscopic system.

Abstract Study question To investigate impact on ovarian reserve after minimal invasive ovarian cystectomy using two platforms; Da Vinci robotic system (Xi and SP) and laparoscopic system. Summary answer Benign ovarian cystectomy using Da Vinci robotic system takes a long time, but it is an effective minimally invasive method to preserve ovarian function. What is known already With the development of minimally invasive surgical methods such as laparoscopic and robotic system, patient satisfaction has increased not only in terms of pain relief but also cosmetic aspects such as smaller scars. Protection of ovarian function during surgery is important in terms of fertility preservation, and this should be considered first in minimally invasive surgery. Serum anti-Müllerian hormone (AMH) is a widely used index to evaluate ovarian reserve. Study design, size, duration This study included patients who underwent laparoscopic or Da Vinci robotic (Xi or SP) ovarian cystectomy for benign ovarian cysts between January 1, 2018 and September 30, 2022 at a single institution. A retrospective study was conducted through electronic medical chart review. Participants/materials, setting, methods A total of 128 patients were enrolled. Among them, 71 patients underwent laparoscopic surgery and 58 patients underwent robotic surgery. The preoperative AMH value was determined as the value within 4 weeks before surgery, and the postoperative AMH value was determined as the value from 1 month after surgery to within 1 year after surgery. The AMH change value (ΔAMH) was expressed as a percentage value; (postAMH – preAMH) x 100 / preAMH Main results and the role of chance There was no significant difference in preoperative age, BMI, parity, cyst size, and cyst position ratio. Estimated blood loss during operation, Hb drop, length of hospital day, adhesion detachment rate, and cyst rupture rate also showed no difference. However, the operation time was significantly shorter in the laparoscopic group. (68.51±30.99 minutes vs. 105.17±38.87 minutes, p &amp;lt; 0.01) The mean preoperative AMH was significantly higher in Da Vinci robotic system than laparoscopic system. (5.89±4.81 ng/mL vs. 4.02±3.61 ng/mL, p = 0.02) The mean postoperative AMH was also higher in Da Vinci robotic system. (4.31±3.34 ng/mL vs. 3.02±2.64 ng/mL, p = 0.02) But, the mean ΔAMH was not significantly different between two groups. (-19.55±40.67 % in laparoscopic system vs. -19.95±38.79 % in robotic system, p = 0.96) When the robot groups were divided into Xi system (N = 21) and SP system (N = 37) and compared, but ΔAMH did not show significant differences among the three groups. (-19.55±40.67 % in laparoscopic system vs. -14.63±47.80 % in Xi system vs. -22.97±32.97 % in SP system, p = 0.75) Even in the patient group with preoperative AMH below 2, ΔAMH was -9.50±57.58 % in the laparoscopic system (N = 20) and -11.72±60.92 % in the robotic system (N = 11), showing no significant difference between the two groups. (p = 0.92) Limitations, reasons for caution A limitation of this study is that the measurement period of AMH was set within a wide range within 1 year after surgery. In addition, the small sample size when divided into two systems, SP and Xi, is also a limitation. Wider implications of the findings Compared to the existing laparoscopic system, the robotic system does not show a significant difference in protection of the ovarian reserve, so it will be widely selected as an option for minimally invasive surgery. Trial registration number Not applicable

Early Exposure vs Delayed Exposure of Postoperative Wounds in Elective Inguinal Hernia Surgery: A Longitudinal Study

Introduction: Wounds and their management are fundamental aspects of the practice of surgery. A closed wound that heals in a timely fashion is considered to be a good indicator of surgical intervention. Many experimental studies have shown that precisely sutured incision with good haemostasis gets sealed with fibrin within 6 to 24 hours and the wound becomes adequately protected from outside moisture. Hence, early exposure to clean surgical wounds would be a cost-effective measure, especially in a resource-poor country like ours by avoiding unnecessary dressings for a long period of time. Aim: To assess the effectiveness of early exposure (24 hours) and delayed exposure (72 hours) in wound management after elective inguinal hernia surgery. Materials and Methods: A longitudinal study was conducted in the Department of General Surgery of Government Medical College, Kottayam, Kerala, India from September 2020 to August 2021. All elective cases (n=200) posted for inguinal hernia of age more than 18 years were consecutively allocated to two groups, group A early exposure of surgical wound site and group B delayed exposure. The wound site examination, on the third day along with white blood cell count was assessed. Wound site examination on 7th day and 30th postoperative day and length of hospital day were recorded. Southampton wound grading system was used for recording healing parameters. All data was described using means for continuous variables and percentages for categorical variables Chi-square test was used for categorical variables with significance level at p&lt;0.05. Results: Out of the 200 patients studied, 92 (92%) were males in group A and 94 (94%) of them were males in group B. The wound contamination in those patients where postoperative dressing was removed after 24 hours (group A) and 72 hours (group B), it was found that majority of patients had wound Grade-0 irrespective of dressing i.e., 96% and 97%, respectively (p-value=0.395) with reference to wound condition on postoperative day 7. In group A patients had (96 cases in 0-10 days) compared to group B (97 cases in 0-10 days) although statistically, it was not significant (p-value &gt;0.05). Conclusion: There is not much difference in wound healing and incidence of surgical site infection in patients, whose wounds were kept open 24 hours after surgery when compared to those, whose wounds were dressed daily for the next two days consecutively.

1105: PHENOBARBITAL VERSUS LORAZEPAM FOR THE MANAGEMENT OF ALCOHOL WITHDRAWAL IN HOSPITALIZED PATIENTS

Introduction: Alcohol withdrawal syndrome (AWS) is a potentially life-threatening medical condition and even though benzodiazepines (BZDs) are the standard of care in the treatment of AWS, therapy-associated complications like respiratory depression requiring ventilatory support and the use of adjunctive pharmacotherapy persist. Studies have shown promising results with phenobarbital (PB), but have been limited to use in the emergency department or as an agent of choice for refractory AWS in the intensive care unit (ICU). Our study aims to compare the ICU admissions rate between lorazepam versus PB in treating AWS in hospitalized patients. Methods: We conducted a retrospective cohort study on patients hospitalized for AWS from 2019 to 2022. Patients were categorized into those who received lorazepam using the revised Clinical Institute Withdrawal Assessment of alcohol scale (CIWA-Ar) and those who received PB based on the Richmond Agitation- Sedation scale (RASS). The primary outcome was the rate of admission to the ICU. Secondary outcomes included total length of hospital and ICU stay, mechanical ventilation rate, use of adjunctive medications and mortality. Results: 300 patients met the inclusion criteria, of whom 148 received lorazepam and 152 received PB. The mean patient age was 56 years and 51 years in the PB and lorazepam groups, respectively (p=0.001). There were significant differences between lorazepam and PB in terms of ICU admission (13.5% vs 5.3%, p=0.014), mechanical ventilation rate (9.5% vs 0.7%, p=0.0004), need for adjunctive dexmedetomidine (9.5% vs 1.3%, p=0.0016) and mean length of hospital days (6.16 vs 4.89 days, p value =0.004), and ICU days (1.07 vs 0.21 days, respectively, p value=0.003). Conclusions: AWS patients treated with PB per protocol were found to have a significantly decreased rate of ICU admission, need for invasive ventilation and adjunctive dexmedetomidine treatment, along with reduced ICU and total length of hospital stay as compared to those treated with lorazepam. We conclude that our results support the growing evidence of efficacy of PB over lorazepam as the primary treatment for AWS patients, due to its mechanism of action that better targets AWS pathophysiology. Prospective, randomized controlled studies that compare PB vs BDZs for AWS are needed.

Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011-2018.

With rapid economic growth and aging, hospital inpatient and emergency services utilization has grown rapidly, and has emphasized an urgent requirement to adjust and optimize the structure of health service utilization. Studies have shown that primary care is an effective way to reduce inpatient and emergency room (ER) service utilization. This study aims to examine whether middle-aged and elderly individuals who selected primary care outpatient services in the last month had less ER and hospital inpatient service utilization than those who selected hospitals outpatient services via the self-referral system. Data were obtained from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS). We pooled respondents who had outpatient visits and were aged 45 years and above. We used logistic regressions to explore the association between types of outpatient and ER visits or hospitalization, and then used zero-truncated negative binomial regression to examine the impact of outpatient visit types on the number of hospitalizations and the length of hospitalization days. A trend test was used to explore the trend of outpatient visit types and the ER or hospital inpatient services utilization with the increase in outpatient visits. Among the 7544 respondents in CHARLS, those with primary care outpatient visits were less likely to have ER visits (adjusted OR = 0.141, 95% CI: 0.101–0.194), hospitalization (adjusted OR = 0.623, 95% CI: 0.546–0.711), and had fewer hospitalization days (adjusted IRR = 0.886, 95% CI: 0.81–0.969). The trend test showed that an increase in the number of total outpatient visits was associated with a lower hospitalizations (p = 0.006), but a higher odds of ER visits (p = 0.023). Our findings suggest that policy makers need to adopt systematic policies that focus on restructuring and balancing the structure of resources and service utilization in the three-tier healthcare system.

Hospital readmissions in the group of users on the Flexible Assertive Community Treatment – experiences from RECOVER E Montenegro samples

IntroductionAs a part of Horizon 2020 program, RECOVER-E project activities were initiated in Montenegro in 2018. The initial step involved a thorough situation analysis of the setting and circumstances of treatment of users with severe mental health illnesses, followed by the establishment of the community mental health team (CMHT) within the Special Psychiatric Hospital Kotor. The CMHT became responsible for the treatment of a group of clients with severe mental health illnesses, based on the principles of „Flexible Assertive Community Treatment (FACT – A Dutch model).ObjectivesThe main objective of this research was to establish whether there were substantial differences regarding the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro.MethodsWithin the RECOVER-E project, a sample of 202 patients, users of mental health services, were recruited in Montenegro. Patients were randomized into two similar-sized groups - intervention group, whose treatment was managed by the multidisciplinary CMHT, and control group where treatment as usual was continued. To estimate and follow-up the frequency of hospital readmissions, medical documentation was used.ResultsPatients in the intervention group had less hospital days during the 18 months follow-up period. However, the differences between two groups regarding number of readmissions, and total length of hospital days were not statistically significant measured by independent T test.ConclusionsThis study showed that CMHT care could reduce the total length of hospital days during the treatment of psychotic disorders even dough during the COVID 19 pandemic and lock down measuresDisclosureNo significant relationships.

Effect of preoperative CT angiography examination on the clinical outcome of patients with BMI ≥ 25.0 kg/m2 undergoing laparoscopic gastrectomy: study protocol for a multicentre randomized controlled trial

BackgroundGastric cancer, which is the fifth most common malignancy and the third most common cause of cancer-related death, is particularly predominant in East Asian countries, such as China, Japan and Korea. It is a serious global health issue that causes a heavy financial burden for the government and family. To our knowledge, there are few reports of multicentre randomized controlled trials on the utilization of CT angiography (CTA) for patients who are histologically diagnosed with gastric cancer before surgery. Therefore, we planned this RCT to verify whether the utilization of CTA can change the short- and long-term clinical outcomes.MethodThe GISSG 20–01 study is a multicentre, prospective, open-label clinical study that emphasises the application of CTA for patients who will undergo laparoscopic gastrectomy to prove its clinical findings. A total of 382 patients who meet the inclusion criteria will be recruited for the study and randomly divided into two groups in a 1:1 ratio: the CTA group (n = 191) and the non-CTA group (n = 191). Both groups will undergo upper abdomen enhanced CT, and the CTA group will also receive CT angiography. The primary endpoint of this trial is the volume of blood loss. The second primary endpoints are the number of retrieved lymph nodes, postoperative recovery course, hospitalization costs, length of hospitalization days, postoperative complications, 3-year OS and 3-year DFS.DiscussionIt is anticipated that the results of this trial will provide high-level evidence and have clinical value for the application of CTA in laparoscopic gastrectomy.Trial registrationClinicalTrials.gov, NCT04636099. Registered November 19, 2020

Pharmacist involved education program in a multidisciplinary team for oral mucositis: Its impact in head-and-neck cancer patients.

This retrospective study examined how a pharmacist-involved education program in a multidisciplinary team (PEMT) for oral mucositis (OM) affected head-and-neck cancer (HNC) patients receiving concurrent chemoradiotherapy (CCRT). Total samples data of 53 patients during the stipulated timeframe were retrospectively collected from electronic medical records from February 2017 to January 2019. We compared the presence/absence of OM (OM: yes/no) between patients with and without PEMT (PEMT: yes/no) as the primary endpoint and OM severity as the secondary endpoint. The following information was surveyed: age, gender, weight loss, steroid or immunosuppressant use, hematological values (albumin, white blood cell count, blood platelets, and neutrophils), cancer grade, primary cancer site, type and use of mouthwash and moisturizer, opioid use (yes/no, days until the start of opioid use, and dose, switch to tape), and length of hospital day (LOD). The two groups were compared using Fisher's exact test for qualitative data and the Mann-Whitney U test for quantitative data, and a significance level of p<0.05 was set. The group managed by PEMT had significantly lower weight loss and a significantly lower incidence of local anesthetic and opioid use and switch to tape compared with the group not managed by PEMT (p<0.05). The two groups showed no significant difference in OM (yes/no) or OM severity. The PEMT group had significantly shorter LOD at 57 (53-64) days compared with the non-PEMT group at 63.5 (57-68) days (p<0.05). Our results showed that PEMT did not improve OM (yes/no) or OM severity in HNC patients undergoing CCRT. However, the PEMT group had a lower incidence of grades 3 and 4 OM than the non-PEMT group, although not significantly. In addition, PEMT contributed to oral pain relief and the lowering of the risk for OM by reduction in weight loss.

Full title: The prevalence of and predictors for perioperative hypothermia in postanaesthesia care unit.

Hypothermia is a common clinical issue during the perioperative period. The patients with perioperative inadvertent hypothermia are associated with higher risk of postoperative complications and higher hospitalisation costs. The aim of this study is to explore the prevalence of and predictors for hypothermia in patients entering postanaesthesia care unit. Retrospective cohort study. A rigorous retrospective cohort study was conducted according to the STROBE reporting checklist. A total of 7216 patients were enrolled in this study. The perioperative variables potentially related to hypothermia were collected. Univariate analysis and multivariate logistic regression analysis were performed to investigate the contributing factors. The overall prevalence of inadvertent hypothermia in postanaesthesia care unit was 21.3% (n=1505). The multivariate logistic regression analysis showed that age >65 (OR=1.561, 95% CI 1.371-1.778, p<.001), non-supine position [lateral decubitus position (OR=1.341, 95% CI 1.133-1.586, p=.001), lithotomy position (OR=1.639, 95% CI 1.295-2.075, p<.001)], non-superficial surgery (OR=2.195, 95% CI 1.566-3.077, p<.001), non-open surgery [laparoscopic surgery (OR=1.205, 95% CI 1.020-1.423, p=.029), endoscopic surgery (OR=1.430, 95%CI 1.084-1.887, p=.011)], the volume of intravenous infusion fluid >1000ml (OR=1.814, 95% CI 1.500-2.194, p<.001), blood transfusion (OR=1.552, 95% CI 1.159-2.078, p=.003), operation performed in the summer or fall (OR=1.874, 95%CI 1.656-2.122, p<.001) and use of dexmedetomidine (OR=1.147, 95%CI 1.015-1.296, p=.028) were associated with increased risk of hypothermia. In contrast, our finding showed that body mass index ≥25kg/m2 (OR=0.556, 95%CI 0.491-0.630, p<.001), higher baseline body temperature (OR=0.641, 95%CI 0.541-0.761, p<.001) and duration of fasting ≥18h (OR=0.487, 95%CI 0.345-0.689, p<.001) were associated with decreased risk of hypothermia. Compared with non-hypothermic patients, patients with hypothermia were associated with prolonged length of hospital days (5 vs. 4days, p<.001). For patients admitted to postanaesthesia care unit after elective procedures, old age, non-supine position, non-open surgery, non-superficial surgery, large volume of intravenous infusion fluid, dexmedetomidine, blood transfusion and Summer or Fall operative season were associated with increased risk of hypothermia, whereas high body mass index, high baseline body temperature and long fasting duration were associated with decreased risk of hypothermia. The outcomes of this study will raise the concerns of perioperative care team on hypothermia in surgical patients. Measures should be taken to improve perioperative hypothermia and clinical outcome.

Clinical efficacy of adductor canal blockade combined with transcutaneous electrical acupoint stimulation for total knee arthroplasty

To evaluate the efficacy of adductor canal block (ACB) combined with transcutaneous electrical acupoint stimulation (TEAS)for postoperative analgesia and early functional exercise after total knee arthroplasty (TKA). A total of 84 patients underwent primary unilateral TKA from January 2019 to August 2020 were selected, including 45 males and 39 females, aged 66-77 (72.8±8.9) years;body mass index (BMI) was for 19-25 (23.6±3.5) kg /m2. They were divided into adductor canal block combined with transcutaneous electrical acupoint stimulation group (TEAS+ACB group)and simple adductor canal block group (ACB group) according to random number table method, 42 cases in each group. ACB was performed in ACB group during the operation. And TEAS was performed in TEAS+ACB group on bilateral lower limbs in 1-7 days postoperative on the basis of ACB. VAS scores at 6, 12, 24, 48, 72 h after surgery, knee function at 1, 2, 3, 7 days after surgery, knee motion at 7 days after surgery and length of hospitalization days were recorded and compared between the two groups. There were no significant differences in VAS of rest pain and activity pain in postoperative 6, 12 h between two groups (P>0.05), but the VAS of TEAS+ACB group was lower at 24, 48, 72 h after surgery(P<0.05). There was no significant difference in at 1 day postoperatively between two groups(P>0.05) , but the knee function of TEAS+ACB group was better than that of the ACB group in 2, 3, 7 days postoperatively (P<0.05). The length of hospitalization days in were less than in ACB group. On the 7th day after operation, the knee motion of TEAS+ACB group was greater than that of the ACB group (P<0.05). TEAS combined with ACB has a better postoperative analgesic efficacy than simple ACB, and can promote early functional exercise of patients. It is safe and effective for postoperative analgesia after TKA.

Staged surgery of Sanders type Ⅳ calcaneal fractures with soft tissue three-degree swelling

To compare the clinical efficacy of staged surgery on Sanders Ⅳ calcaneal fractures with soft tissue Ⅲ swelling. The clinical data of 76 patients with Sanders type Ⅳ closed calcaneal fracture with soft tissue three-degree swelling treated from June 2017 to May 2020 was retrospectively analyzed, including 54 males and 22 females, aged from 25 to 50 (38.16±10.24) years. The patients were divided into observation group and control group according to different treatment methods. Twenty-four patients in the observation group were treated by staged surgery stageⅠclosed prying traction reduction and Kirschner wire fixation, stageⅡopen reduction and internal fixation with titanium plate, including 17 males and 7 females, aged from 25 to 50 (36.12±9.56) years. There were 52 patients in the control group, including 37 males and 15 females, aged from 25 to 50 (38.32±10.67) years, these patients were treated with open reduction and internal fixation with titanium plate after the dermatoglyphic signs appeared. The swelling subsidence time, the length of hospitalization days, and the incidence of postoperative incision complications were compared between two groups. The Bhler angle, Gissane angle, and calcaneal varus angle were measured by X-ray before and 6 months after operation. American Orthopedic Foot and Ankle Society (AOFAS) about the ankle hindfoot score was used to evaluate the clinical efficacy. All 76 patients were followed up for 8 to 12 (9.52±2.01) months. The swelling subsidence time and hospitalization days in observation group were (12.12± 3.24) d and (24.53±6.44) d, respectively, which in control group were (15.16±4.16) d and (29.46±9.61) d, with statistical difference between two groups (P<0.05). Postoperative 6 months, Bhler angle, Gissane angle and calcaneal varus angle were (31.33±10.15)°, (145.34±8.04) ° and (10.31±3.23) ° in observation group, while those in control group were (20.24±8.23) °, (165.28±10.29) °and (21.24±5.27) °, with statistical difference between two groups (P<0.05). And there was significant difference in all patients between before and 6 months after operation (P<0.05). The AOFAS score of the observation group and control group were 71.76±9.84 and 57.23±10.76 at 6 months after operation, with significant different between two groups (P< 0.05). The excellent rate of observation group was significantly higher than that of control group (P<0.05). Compared with open reduction and internal fixation with titanium plate after the appearance of dermatoglyphic signs, staged surgery for Sanders type Ⅳ calcaneal fractures with soft tissue three-swelling does not increase the risk of soft tissue complications, and can significantly shorten the patient's swelling subsidence time and hospitalization days, improve the quality of fracture reduction and short term function, and relieve pain.

Factors Related to Delirium of Intensive Care Unit Patients in Korea: A Systematic Review.

Background:The delirium in Intensive Care Units (ICU) patients is a major cause of unplanned extubation, increased length of hospital day. This study aimed to review systematically risk factors associated with the occurrence of delirium among ICU patients in South Korea.Methods:Data collection was done with domestic literature search databases including KMbase, KoreaMed, KISS, and KisTi and also with hand searching, from February 17 to May 19, 2019. Two researchers independently selected research literatures, and three researchers summarized and identified related variables based on data extraction methods.Results:Overall, 140 articles were identified, 18 articles met the inclusion criteria for review. According to the results of the methodological quality, one article was found to have a high level of quality, while the remaining 17 articles belonged to the medium level. Those factors were highly associated with delirium by more than 9 out of the 18 selected studies were listed as follows; age, the application of ventilator, APACHE II score, comorbidity, the application of restraint, and educational level. In addition, catheter insertion and the application of artificial airway had significant relevance with the occurrence of delirium.Conclusion:For management of delirium among ICU patients, it is necessary to eliminate and prevent delirium-associated risk factors, and also to detect and treat the delirium early through regular monitoring using an appropriate screening tool for delirium.

Factors Affecting the Length of Hospital Days After Laparoscopic Gastrectomy for Elderly Patients with Gastric Cancer.

To clarify the factors affecting the length of hospitalization after laparoscopic gastrectomy based on the physical function, body composition, and postoperative course of the patients. Of the patients with gastric cancer who underwent laparoscopic resection at the Ageo Central General Hospital, Japan, during 2018-2019, 51 underwent physical therapy. Data regarding the objective variables, such as length of postoperative hospital stay, and baseline attributes, such as age, body weight, body mass index (BMI), and corrected limb muscle mass, postoperative course (operation time, the estimated blood loss, the day before walking independently), preoperative physical function (grip strength, 6-min walking distance), and preoperative respiratory function (vital capacity [VC]%, one-second rate) were collected retrospectively from the medical records and analyzed using multiple regression plots. The most suitable hospital day model after surgery is one that incorporates the total postoperative course, respiratory function, physical function (R2=0.45, p<0001), and operation time (β=0.12, p<0.06). The information of the day before independent walking (β=0.68, p<0.001) and % VC (β=-0.19, p<0.04) was extracted as factors. We concluded that the operation time, walking independence days, and % VC influence the postoperative length of hospital days.

Lipid profiles and differential lipids in serum related to severity of community-acquired pneumonia: A pilot study.

This study aimed to characterize the lipidomic responses to community-acquired pneumonia (CAP) and provide new insight into the underlying mechanisms of pathogenesis and potential avenues for diagnostic and therapeutic treatments. This study was performed from January 2017 to October 2018. Lipidomic profiles were generated using ultra high-performance liquid chromatography with tandem mass spectrometry (UHPLC-MS/MS) platform. Spearman’s rank correlation test and multiple linear regression analysis were applied to explore the correlation between changes in the relative abundance of lipids and clinical parameters. Kaplan–Meier methods were used to build 30-day survival curves. From the UHPLC-MS/MS results, a total of 509 and 195 lipid species were detected in the positive and negative ionization mode respectively. Positive ionization covered six lipid classes (glycerol-phospholipids, glycerolipids, sphingolipids, sterol-lipids, prenol-lipids, and fatty acid), whilst negative ionization covered three (glycerol-phospholipids, sphingolipids, fatty acid). Four lipids were selected as targets: PC (16:0_18:1), PC (18:2_20:4), PC (36:4), and PC (38:6). The relative increase of the areas under the curves for all four lipids were superior to the pneumonia severity index and CURB-65 (confusion, urea, respiratory rate, blood pressure, and age ≥65 years old) for discriminating severe CAP from CAP. Decreasing relative levels of PC (18:2_20:4), PC (38:6), and PC (36:4) were negatively related to fraction of inspiration O2; Changes in the relative abundance of PC (16:0_18:1) and PC (18:2_20:4) had significantly linear relationship with procalcitonin. Patients with an elevated level of PC (16:0_18:1) had significantly longer duration of hospital stays. As the relative abundance of PC (18:2_20:4), PC (36:4), and PC (38:6) decreased, the length of hospitalization days and 30-day mortality rate increased significantly (all log-rank p<0.05). Therefore, using the UHPLC-MS/MS platform’s serum lipidomic approach can help reveal changes in lipid abundance during CAP and establish lipid profiles related to disease severity.

Aging and direct medical costs of osteoporotic fractures.

This study estimated the direct medical costs of osteoporotic fractures from a large claims database in Korea. We compared the medical costs of hip, vertebral, and wrist fractures between two age groups (50-64years vs 65years and older). We used a generalized linear model to investigate the drivers of osteoporotic fracture medical costs. Hip fractures had the highest costs, regardless of age, followed by vertebral and wrist. The cost of hip fracture was USD 7285 for those aged 65years and over and USD 6589 for those aged 50-64years. The length of hospital days was higher in hip fracture patients, regardless of age, followed by vertebral and wrist. As the number of hospitalizations increased, the medical cost increased by 33.0% (p < 0.0001). Patients older than 65years who were hospitalized for a fracture had a longer total length of hospital stay, compared to patients aged 50-64, regardlessness of the site of the fracture. The cost of treating fractures among those 65years and older increased by 31.8% compared to those 50-64years old (p < 0.0001). The direct medical costs increased by 8.6% as the number of fractures increased (p = 0.041). We identified that osteoporotic fracture-related medical costs and hospitalization days increased with age. Interventions are effective in reducing fracture risk the potential to yield substantial cost savings.

Respiratory acute discharge service: a hospital in the home programme for chronic obstructive pulmonary disease exacerbations (RADS study).

Respiratory Acute Discharge Service (RADS) is a novel early discharge service with nurse-led community based recovery in selected patients with acute exacerbations of chronic obstructive pulmonary disease. This pilot study aimed to determine the efficacy and safety of the programme in an Australian tertiary hospital. All patients who were recruited to RADS at Sunshine Coast University Hospital over a 6 months period from June to November 2018 were included. The co-primary outcomes were length of hospital days saved and rate of readmission within 30 days from discharge. A total of 166 patients (median age 74 years (interquartile range 70-80 years)) was recruited to the programme over the study period. The mean forced expiratory volume in one second (FEV1%) of the patients was 42% (standard deviation 19). The median length-of-stay prior to discharge on the RADS programme was 1 day (range 0-5), compared to a previous average of 5.8 days in our health service. Patients were on the programme for a median of 4 days (range 1-6). A total of 613 hospital bed days was saved over the study period, with significant cost savings. Forty-one (24.7%) patients represented to hospital within 30 days, the majority (64%) were due to recurrent symptoms. The rate of 30-day all-cause mortality for the study population was 1 (0.6%). Early supported discharge care model with nurse-led community based recovery after an acute exacerbation of chronic obstructive pulmonary disease in selected patients is safe, and has the potential to provide greater flow through the hospital systems with cost effective care.

Impact of antibiotic choice on readmission in adults experiencing an acute COPD exacerbation.

The impact of antibiotic therapy in managing acute chronic obstructive pulmonary disease (COPD) exacerbations requiring hospitalization remains unclear. We conducted a study to assess the impact of antibiotic therapy on the rate of 30-day readmission after discharge from a hospital stay for an acute COPD exacerbation. Additional study outcomes analyzed included the effects of antibiotic therapy on hospital length of stay, in-hospital mortality, 90-day and 12-month readmission rates, and time to next COPD exacerbation. The study was an institutional review board-approved, retrospective, observational review of adult patients at a tertiary academic medical center. The medical records of patients 18 years of age or older who were hospitalized for an acute COPD exacerbation between January 2008 and December 2014 were evaluated. Included patients were stratified by receipt of guideline-appropriate, guideline-inappropriate, or no antibiotic therapy. Nonparametric data were analyzed using the Kruskal-Wallis test (nonparametric) and categorical data via χ 2 test, respectively. Three hundred twenty-five subjects were included; there were no significant differences in baseline characteristics in the 3 study groups. Sixty-eight percent of patients (n = 223) received antibiotics. The percentage of patients readmitted within 30 days did not differ between cohorts: 11.9% (appropriate therapy) vs 13.2% (nonappropriate therapy) vs 12.2% (no antibiotics) (P = 0.95 for all comparisons). Additionally, no detectable differences in 90-day or 12-month readmission rate, length of hospital day, or in-hospital mortality were found. However, a trend toward increased time to next COPD exacerbation was noted in those receiving antibiotics vs no antibiotics (352 days vs 192 days, P = 0.07). Treatment of COPD exacerbations with antibiotics did not impact readmission rates, length of hospital stay, in-hospital mortality, or time to next exacerbation. More investigation is warranted to assess the effect of antibiotics on time to next exacerbation, as well as comparative effectiveness between antibiotic classes.

Evaluation of Hospital Food Waste—A Case Study in Portugal

Food waste (FW) has been linked with nutrient intake, menu performance, food acceptability, costs and environmental impacts. This study aims to evaluate the FW in the wards of a Portuguese public hospital. The evaluation of the FW of lunch meals was performed during 21 days, to all new hospitalized patients (n = 105) admitted in four hospital wards (Medicine (Med), Paediatrics (Ped), Oncology (Onc) and Orthopaedics (Ort)). For each patient, the type of diet and FW were evaluated during the length of hospital stay (covering 321 meals). The FW of the dish was calculated by the physical method by weighing and the soup by the method of visual estimation, evaluating before and after distribution. The patients have a mean 3.1 ± 2.2 day length of hospital stay. In relation to the FW of the dish per ward, that in the Ped ward it was 72.6%, Med 47.5%, Onc 46.9% and Ort 58.4% (ρ = 0.027). The FW for Ped soup was 67.1%, Med 30.9%, Onc 29.4% and Ort 35.2% (ρ = 0.018). The FW values are high, especially in the paediatric ward. The institutions are unaware of the FW produced and given the magnitude of the problem it is necessary to implement effective measures.

Clinical efficacy of convalescent plasma for treatment of COVID-19 infections: Results of a multicenter clinical study

Since Dec. 2019 the new coronavirus (SARS-CoV-2) has infected millions and claimed life of several hundred thousand worldwide. However, so far no approved vaccine or drug therapy is available for treatment of virus infection. Convalescent plasma has been considered a potential modality for COVID-19 infection. One hundred eighty-nine COVID-19 positive patients including 115 patients in plasma therapy group and 74 patients in control group, registered in the hospitals with confirmed COVID-19 infection, entered this multi-center clinical study. Comparison of outcomes including all-cause mortality, total hospitalization days and patients’ need for intubation between the two patient groups shows that total of 98 (98.2 %) of patients who received convalescent plasma were discharged from hospital which is substantially higher compared to 56 (78.7 %) patients in control group. Length of hospitalization days was significantly lower (9.54 days) in convalescent plasma group compared with that of control group (12.88 days). Only 8 patients (7%) in convalescent plasma group required intubation while that was 20 % in control group. This clinical study provides strong evidence to support the efficacy of convalescent plasma therapy in COVID-19 patients and recommends this treatment for management of these patients. Clinical efficacy, immediate availability and potential cost effectiveness could be considered as main advantages of convalescent plasma therapy.