Number Of Bed Days Research Articles

Costs and Budget Impact of Collagen-Based Vascular Closure Device Versus Manual Compression Following Peripheral Endovascular Procedures

To evaluate the annual costs and budget impact of using a vascular closure device to achieve haemostasis following femoral access endovascular procedures in England, compared with manual compression. A budget impact model was developed in Microsoft® Excel, based on the estimated number of peripheral endovascular procedures eligible for day-case management performed annually by the National Health Service in England. The clinical effectiveness of vascular closure devices was captured based on the requirement for inpatient stays and the incidence of complications. Data for endovascular procedures, time to haemostasis, length of hospital stay, and complications were collected from public sources and the published literature. There were no patients involved in this study. Model outcomes are reported as estimated number of bed days and annual costs to the National Health Service for all peripheral endovascular procedures in England, and the average cost per procedure. The robustness of the model was tested in a sensitivity analysis. The model estimated savings for the National Health Service of up to £4.5 million annually if vascular closure devices were used in every procedure instead of manual compression. The model estimated an average cost saving of £176 per procedure for vascular closure devices over manual compression, primarily due to fewer inpatient stays. The sensitivity analysis demonstrated that the proportion of day-case procedures for vascular closure devices and manual compression was a key driver of costs and savings. The use of vascular closure devices for achieving haemostasis after peripheral endovascular procedures may be associated with lower resource use and cost burden, compared with manual compression, based on shorter time to haemostasis and ambulation and an increased likelihood of a day-case procedure.

CLINICAL EFFICACY OF THE USE OF ENRICHED AUTOPLASMA IN PATIENTS WITH HEMORRHOIDECTOMY

bstract Purpose. Our research explores the effect of the use of PRP therapy in accelerated recovery and wound healing after hemorrhoidectomy. Material and methods. A study based on the results of the treatment of patients with chronic hemorrhoids who were treated from January 2021 to January 2022 was conducted based on the surgical department of the RDC and MIPO Clinics LLP. The study included 100 patients aged 21 to 72 years with chronic hemorrhoids of stage II and III, in the treatment of which the method of hemorrhoidectomy with PRP therapy (main group) and open hemorrhoidectomy (control group) was used. In the analysis of clinical efficacy, the severity and duration of pain syndrome, manifestations of complications in the early postoperative period, cytomorphological analysis of fingerprint smears, the number of bed days spent, and the period of recovery were used. An analysis of the assessment of the quality of life of patients after surgery in the long-term period was also carried out. Results. The intensity of pain severity was estimated at an average of 3±0.2 points in the main group and 6.1±0.3 points in the control comparison group. The duration of pain continuation after surgery averaged 3.1±0.2 days in the main group and 4.4± 0.2 days in the control comparison group. The development of early postoperative complications in the main group – in 6 (12%), in the control group were diagnosed in 14 (28%) cases. When assessing the dynamics ofthe wound process according to the cytological picture, it was noted that the neutrophil reaction was more pronounced in the control group. In the main group, epithelization elements appeared faster (from the 10th day - in 35%). The average epithelialization time was 31.1±2.2 days in the control group compared to 20.3±3.9 days in the main group. In the main group, by day 15, 31 (62%) patients and by day 25, 50 (100.0%) all patients returned to work. In the control group, 32 (64%) patients started working by day 30 and 100% by day 40. Conclusion. Taking into account the results of the study, the use of an integrated approach with the use of PRP therapy in the treatment of chronic hemorrhoids is recommended. It is shown that the use of the proposed patented treatment regimen leads to a decrease in postoperative pain syndrome, accelerated wound healing, and a decrease in the number of complications.

Managing the cost of systemic autoimmune rheumatic diseases treatment: cluster analyse

To determine the feasibility of using cluster analysis to manage treatment costs of systemic autoimmune rheumatic diseases (SARDs). MATERIALS AND METHODS. The object of the study was the case histories of patients hospitalized in 2020. A total of 954 case histories of patients with SARDs were analyzed, among them systemic scleroderma – 411 patients (43.1%), systemic lupus erythematosus – 263 (27.5%), rheumatoid arthritis seropositive and seronegative – 103 (10.8%), systemic vasculitis associated with anti-neutrophil cytoplasmic antibodies – 98 (10.3%), idiopathic inflam- matory myopathies (polymyositis, dermatomyositis) – 57 (6%), Sjögren’s disease – 22 (2.3%). Hierarchical cluster analysis by weighted pairwise mean using Euclidean distance and Chebyshev distance, and non-hierarchical clus- tering by k-means were performed for the sample of case histories in the STA- TISTICA 13.3. Multiple regression model with a dependent factor of treatment costs was built in MS Excel. RESULTS. Hierarchical clustering resulted in 2 dendrograms, which yielded the same number of clusters – 4. The cluster analysis identified 4 clusters with significant differences (p<0.05) in treatment costs with formative indicators: gender, age of patients, duration of disease, number of bed-days, number of hospitalizations, disease activity level, number of comorbidities and compli- cations, previous use of biologic agents, total number of medications pre- scribed, use of Acellbia, Benlista, other biologic agents, and immunoglobulins during hospitalization. General multiple regression model for all patients with SARDs and separate multiple regression models for each cluster were con- structed using statistically significant factors. CONCLUSIONS. Factors affecting the treatment costs for patients with SARDs include the number of days of hospitalization, the degree of disease activity, the number of medications prescribed, and the use of biologic agents and immunoglobulins during hospitalization.

The results of personificated ovarian cancer patients with peritoneal carcinomatosis treatment

The objective: to analyse of the experience of cytoreductive surgery using and hypenermic intraperitoneal chemperfusion (HIPEC) in patients with ovarian cancer IIIC stage, as well as overall and relapse-free survival in such patients. Materials and methods. 119 patients with ovarian cancer of the IIIC stage were involved into the study from 2013 to 2020 and they were treated at the University Clinic of Odessa National Medical University. Patients were divided into two groups: the clinical control group (n=53) included persons after suboptimal cytoreduction; the patients of the main group (n=66) had optimal or complete cytoreduction, and in some cases with subsequent intraoperative hyperthermic intraperitoneal chemotherapy. During the initial analysis of these groups, time (preoperative period, duration of surgery, number of postoperative bed-days), as well as the presence of complications in the postoperative period were determined. Results. In the main group there was an increase operation time due to large surgery volumes and the implementation of the HIPEC procedure with primary cytoreduction (p=0.001). In the postoperative period, an increase in the number of bed-days in the hospital in patients of the main group in relation to the control group was established, especially in those who had HIPEC (p=0.001). There was an increase in the number of surgical complications of class III-IV according to the Clavien-Dindo classification (from 5 % to 22.2 %) in patients after HIPEC. An increase in relapse-free survival from 10 months in the control group to 13-19 months in the main group was revealed. The recurrence median in the postoperative period in the control group was 10±1.3 months, and after interval cytoreduction and primary cytoreduction with HIPEC – 13±1.5 and 19±6.3 months, respectively. The index of relapse-free survival in the first 6 months in the control group was 63.2 %, in patients after optimal or complete cytoreduction – 88.0 %, in patients after optimal or complete cytoreduction and HIPEC – 90.4 %. One-year recurrence-free survival rate was 37.5 %, 63.2 % and 60.1 %, respectively, the average values of overall survival – 27.7±4.1 months versus 24.5±1.8 and 24.1±2.2 months, respectively. Conclusions. Cytoreductive surgery and methods of intraoperative hyperthermic intraperitoneal chemotherapy are perspective options of treatment of patients with peritoneal carcinomatosis by ovarian cancer regarding recurrence of the disease and survival, although they are accompanied by more postoperative complications and number of bed-days in hospital.

Second-Generation Antipsychotic Long-Acting Injection Reduced the Time of Restrictive Interventions in Patients With Schizophrenia: Retrospective, A 4-Year Mirror-Image Study.

Whether second-generation antipsychotic long-acting injection (SGA-LAI) reduces psychotic symptoms at relapse compared with oral antipsychotics remains unclear. The present study investigated the effects of SGA-LAI on the time (in hours) of restrictive interventions in hospitalization by conducting a retrospective observational 4-year mirror-image study at a single medical center in Japan. We performed a retrospective observational mirror-image study conducted between November 2013 and January 2018. Data were initially retrieved from 101 patients. The 38 patients with schizophrenia who met the inclusion criteria were enrolled in the analysis. The primary outcome was the time of restrictive interventions and the secondary outcomes included the number of hospitalizations (total, voluntary, and involuntary) and bed days compared 2 years before and after initiating SGA-LAI. The restrictive interventions were defined as seclusion and physical restraints. The mean time of restrictive interventions significantly decreased from 43.7 to 3.03 ( P = 0.021). The number of admissions and the total number of bed days in post-SGA-LAI fell from 1.03 to 0.61 ( P = 0.011) and 130 to 39.3 ( P = 0.003), respectively, compared with pre-SGA-LAI. In particular, the number of involuntary admissions was significantly reduced (0.50-0.26, P = 0.039). The findings indicate that SGA-LAI reduced the time of restrictive interventions and the number of involuntary admissions. Moreover, SGA-LAI may contribute to mild psychiatric symptoms during relapse.

Effect of Cholecalciferol Supplementation on the Clinical Features and Inflammatory Markers in Hospitalized COVID-19 Patients: A Randomized, Open-Label, Single-Center Study.

Recent studies showed that a low 25-hydroxyvitamin D (25(OH)D) level was associated with a higher risk of morbidity and severe course of COVID-19. Our study aimed to evaluate the effects of cholecalciferol supplementation on the clinical features and inflammatory markers in patients with COVID-19. A serum 25(OH)D level was determined in 311 COVID-19 patients. Among them, 129 patients were then randomized into two groups with similar concomitant medication. Group I (n = 56) received a bolus of cholecalciferol at a dose of 50,000 IU on the first and the eighth days of hospitalization. Patients from Group II (n = 54) did not receive the supplementation. We found significant differences between groups with the preferential increase in serum 25(OH)D level and Δ 25(OH)D in Group I on the ninth day of hospitalization (p < 0.001). The serum 25(OH)D level on the ninth day was negatively associated with the number of bed days (r = −0.23, p = 0.006); we did not observe other clinical benefits in patients receiving an oral bolus of cholecalciferol. Moreover, in Group I, neutrophil and lymphocyte counts were significantly higher (p = 0.04; p = 0.02), while the C-reactive protein level was significantly lower on the ninth day of hospitalization (p = 0.02). Patients with supplementation of 100,000 IU of cholecalciferol, compared to those without supplementation, showed a decrease in the frequencies of CD38++CD27 transitional and CD27−CD38+ mature naive B cells (p = 0.006 and p = 0.02) and an increase in the level of CD27−CD38− DN B cells (p = 0.02). Thus, the rise in serum 25(OH)D level caused by vitamin D supplementation in vitamin D insufficient and deficient patients may positively affect immune status and hence the course of COVID-19.

Urological stone disease: a 5-year update of stone management using Hospital Episode Statistics.

To reassess the trends in upper urinary tract (UUT) stone disease burden and management in the UK during the last 5 years. The present paper is our third quinquennial analysis of trends in the management of renal stones in England. Data were collected using the Hospital Episode Statistics database for the years 2015-2020 inclusive. These were then analysed, summarized and presented. The number of UUT stone episodes increased by 2.2% from 86 742 in 2014-2015 to 88 632 in 2019-2020 but annual prevalence remained static at 0.14%. The number of UUT stone episodes in those of working age has remained static but increased by 9% for patients aged > 60 years (from 27 329 to 29 842). The number of shockwave lithotripsy (SWL) treatments decreased by 6.8%. There was a further increase in the use of ureteroscopy (URS) between 2015 and 2020 of 18.9%. Within this subgroup, flexible URS had the most rapid increase in use, with a rise of 20.4% from 7108 to 8558 recorded cases. Over the 20-year period from 2000 to 2020 there was a remarkable 257% increase in URS cases. There was a further decline in open surgery for UUT stone disease by 40%. Stone surgery day-case numbers have increased by 14.7% (from 31 014 to 35 566), with a corresponding decline in the number of bed days of 14.3%. Emergency cases increased by 40%, while elective cases saw a slight increase of 1.9%. The present study shows a plateauing in the prevalence of UUT stone disease in England in the last 5 years, with a move towards day-case procedures and an increase in the proportion of emergency work. For the first time in England, URS has overtaken SWL as the most common procedure for treating UUT stone disease, which might reflect patients' or physicians' preference for a more effective definitive treatment.

Evaluation of hospital-level antibiotic use in Kyrgyzstan between 2016 and 2019 based on the World Health Organization AWaRe classification

Introduction and Aim: One of the main goals of the World Health Organization (WHO) global action plan to combat Antimicrobial Resistance is to study the tendency of antimicrobial consumption for systemic use to improve how antimicrobial medications are prescribed and utilized. The objective of the study was to evaluate antibiotic use based on the WHO Access, Watch, Reserve (AWaRe) classification and analyse antimicrobial consumption using Defined Daily Doses in a multidisciplinary hospital in Bishkek, Kyrgyzstan, between 2016 and 2019. Materials and Methods: A retrospective longitudinal analysis of antimicrobial consumption data from a multidisciplinary hospital in Bishkek, Kyrgyzstan, was completed between 2016 and 2019. Information on the structure and volume of antimicrobial consumption, and the number of bed days, was obtained from the internal database and official annual reports of the multidisciplinary hospital. Results: The consumption of levofloxacin increased by 3.935 Defined Daily Doses per 100 Bed-Days (DDD/100BD) (5.6 times) and that of moxifloxacin by 450 DDD/100BD (10.1 times), compared to that in 2016. Notably, the analysis of data on DDD/100BD consumption based on antimicrobial groups identified the most frequently used medications as stationary data points and identified the top-assigned antimicrobials from different groups, which increased in consumption over time. Conclusion: The rapid growth in the use of antibiotics from the Watch class, particularly in low- and middle-income countries, reflects the challenges associated with the rational use of antibiotics. The AWaRe system is an important indicator of efforts to combat Antimicrobial Resistance and ensure equal access to effective antibiotics worldwide.

The impact of an immuno-oncology service at a regional cancer centre based in the north west of the UK.

This article discusses the implementation and development of a centralised immuno-oncology service. As the indications and licensing of oncological immune checkpoint inhibitors (ICIs) expanded rapidly, they brought with them increasing challenges. The article evaluates the impact of an immuno-oncology service, focusing on the following areas: admission rates due to immune-related adverse events (irAEs), number of bed days occupied due to immunotherapy toxicity and the incidence of Grade 3 and 4 (severe and life-threatening) irAEs. The article will also give an overview of patients requiring acute and subsequent management of toxicity as a percentage of the overall patients commenced on immunotherapy. The ultimate aim of the article is to highlight the importance of toxicity management and the overall benefits of a immuno-oncology service. The article will also discuss the impact of COVID-19 on the immuno-oncology service, highlighting the ways in which the team has adapted to the current environment to ensure high standards of patient care have been maintained.

Comparison of endoscopic and open methods of surgical treatment for lumbosacral spinal canal stenosis: a systematic literature review

Objective. To analyze clinical outcomes and complication rates of transforaminal and interlaminar endoscopic decompression and open microsurgical operations performed for lumbosacral spinal canal stenosis.Material and Methods. The data of 60 literature sources selected in accordance with the inclusion and exclusion criteria in the PubMed, Science Direct, Google Scholar and Cochrane Library databases were systematized by evaluating diagnostic methods, clinical pictures and surgical treatment of the lumbar spinal canal stenosis. Original studies, case series and reviews containing information on surgical methods for the treatment of spinal stenosis at the lumbar level were analyzed.Results. The complication rate after transforaminal endoscopic decompression (relapses, infectious complications, damage to the dural membrane and spinal roots) does not exceed 2.7 %, which is significantly lower than that in open microsurgical operation (4.8–8.8 %). Endoscopic decompression and reconstruction of the spinal canal demonstrate good clinical outcomes, lower number of bed-days, readmissions, and good economic benefits. When stenosis is combined with instability of the spinal motion segment, performing only a decompressive operation in any volume does not give a significant clinical result, and stabilization surgery is required.Conclusion. The introduction of endoscopic reconstructive surgery for spinal canal stenosis in the lumbosacral spine is associated not only with technical progress and improvement of endoscopic optics, but also with the search for the causes of unsatisfactory results of open operations. Endoscopic interventions showed good clinical outcomes and a decrease in the complication rate. However, the evidence base needs to be expanded due to the lack of randomized trials to compare open decompression and stabilization, and endoscopic reconstructive surgeries in patients with various manifestations of spinal stenosis.

Respiratory Syncytial Virus-Associated Hospital Admissions and Bed Days in Children

Respiratory syncytial virus (RSV) is a leading cause of respiratory tract infections (RTIs) in young children. High-quality country-specific estimates of bed days and length of stay (LOS) show the population burden of RSV-RTI on secondary care services and the burden among patients, and can be used to inform RSV immunization implementation decisions. We estimated the hospital burden of RSV-associated RTI (RSV-RTI) in children under 5 years in 7 European countries (Finland, Denmark, Norway, Scotland, England, the Netherlands, and Italy) using routinely collected hospital databases during 2001-2018. We described RSV-RTI admission rates during the first year of life by birth month and assessed their correlation with RSV seasonality in 5 of the countries (except for England and Italy). We estimated average annual numbers and rates of bed days for RSV-RTI and other-pathogen RTI, as well as the hospital LOS. We found that infants born 2 months before the peak month of RSV epidemics more frequently had the highest RSV-RTI hospital admission rate. RSV-RTI hospital episodes accounted for 9.9-21.2 bed days per 1000 children aged <5 years annually, with the median (interquartile range) LOS ranging from 2 days (0.5-4 days) to 4 days (2-6 days) between countries. Between 70% and 89% of these bed days were in infants aged <1 year, representing 40.3 (95% confidence interval [CI], 40.1-40.4) to 91.2 (95% CI, 90.6-91.8) bed days per 1000 infants annually. The number of bed days for RSV-RTI was higher than that for RTIs associated with other pathogens in infants aged <1 year, especially in those <6 months. RSV disease prevention therapies (monoclonal antibodies and maternal vaccines) for infants could help prevent a substantial number of bed days due to RSV-RTI. "High-risk" birth months should be considered when developing RSV immunization schedules. Variation in LOS between countries might reflect differences in hospital care practices.

POSB57 Budget Impact Analysis of XprESS to Treat Sinus and Eustachian Tube Dysfunction in Spain: Positive Impact on the Care Pathway with Reduced Costs and Increased Hospital Capacity

With increasing surgical waiting lists due to COVID-19, there is a need to consider alternative healthcare delivery models to enhance efficiency, improve outcomes and increase hospital capacity. This analysis aims to estimate the budget impact of using XprESS to treat sinus and eustachian tube dysfunction in Spain in different care settings. Additionally, the impact of using XprESS on hospital capacity (i.e., number of bed days and operating room (OR) hours required) was assessed.

The medical rehabilitation: planning work load and number of positions

The article presents the results of analysis of normative legal documents and their changes related to planning of volume of medical care in "medical rehabilitation" profile. The calculation of planned normative number of beds of this profile from 2014 to 2021 is presented according to the number of bed-days and planned beds turnover. The number of arithmetic errors in planned indices of specialized medical care in hospital conditions for medical rehabilitation is demonstrated in the letters of the Minzdrav of Russia related to formation and economic validation of territorial program of state guarantees. So, significant decrease (by 44%) in recommended volumes in 2021 contradicts data presented in the Decree of the Government the Russian Federation. The violations of nomenclatures of positions of medical workers, double standard of the number of positions for day-and-night work are defects of vast majority of Orders about Procedures of provision of medical care that may testify severe problems in actual health planning. At the same time, such changes in Orders on Procedures of organizing medical rehabilitation as division into adults and children, alterations of set of units, staging in provision of medical care and corresponding staff standards, increasing of standard number of positions should result in improvement of quality of medical rehabilitation, including its implementation at early stages and expanding possibilities of rehabilitation without hospitalization related to organization of day hospital.

Analysis of lethal cases of pneumonia caused by SARS-CoV-2 virus according to the data of pathology department of Kharkiv Regional Clinical Hospital for the first half of 2021

Background. Given the great medical, social and economic significance of clinical research, pathogenesis and epidemiology of coronavirus infection, it is important to study the epidemiological and pathomorphological features of this infection in Ukraine, especially in fatal cases of this disease. Objective: to analyze the lethal cases of pneumonia caused by SARS-CoV-2 in comparison with lethal cases of pneumonia of other etiologies according to the pathology department of Kharkiv Regional Clinical Hospital for the first half of 2021. Methods. The material of this study was the observation of an autopsy from the archival material the pathology department of Kharkiv Regional Clinical Hospital. The study of autopsy protocols took into account the seasonality of the disease, sex and age of the deceased, the number of bed-days, data of clinical diagnosis and coincidences of pathological diagnosis, as well as the ICD code. 256 protocols of pathological examinations for the first half of 2021 were studied. Results. Of the 256 deaths from pneumonia of various etiologies, 201 (78.52%) were caused by SARS-CoV-2 infection. The highest number of deaths from pneumonia was registered in March, April and May 2021. The number of deaths of patients aged 18-44 years was 4.3% of the total, 45-59 years – 13.28%, 60-74 years – 47.27%, 75-90 years – 35.16%. The study sample among patients died of pneumonia caused by SARS-CoV-2 was dominated by women (57.42%, 147 cases), the number of men was 42.58% (109 cases). The direct causes of death were pulmonary-heart failure, multiple organ failure, acute pulmonary insufficiency, chronic pulmonary insufficiency, and pulmonary embolism. Conclusion. The obtained data can be useful for the analysis of regional features of epidemiology and pathogenesis of coronavirus disease in eastern Ukraine.

Hospital in the Home Delivery of Supportive Care for Autologous Stem Cell Transplantation: A Novel Single Centre Patient Focused Approach

Hospital in the Home Delivery of Supportive Care for Autologous Stem Cell Transplantation: A Novel Single Centre Patient Focused Approach

Evaluation of the effectiveness and acceptability of the long-acting oral antipsychotic penfluridol: Illustrative case series.

In this study, we sought to determine clinical outcomes at 1 year for patients prescribed penfluridol in an inner London National Health Service Trust. Using noninterventional data, we describe the use, effectiveness and safety of this treatment modality. We retrospectively followed up 17 patients prescribed penfluridol as part of routine clinical practice. All patients took penfluridol once weekly. Of these patients, 12 (70.6%) were considered treatment resistant. The average duration of illness for this cohort was 10 years (SD = 6.7). At 1 year, nine (53%) patients remained on treatment. Median survival time was not reached at 1-year follow-up; mean time on penfluridol was 251 days (95% confidence interval (CI), 184-318). The mean number of admissions to hospital in the year following penfluridol initiation was 0.6 compared with 0.8, 1 year before initiation (p = 0.465). The median number of bed days 1 year before penfluridol initiation was 24, whereas in the year following penfluridol initiation, it was 0 (p = 0.514). Although penfluridol is unlicensed in the United Kingdom, limited data suggest that this long-acting oral therapy has the potential to be used safely and effectively for the treatment of psychotic disorders. However, more data are required to establish the place of penfluridol and other potential long-acting oral antipsychotic formulations in the treatment of psychotic disorders.

Acute coronary syndrome outside and during the COVID-19 pandemic

Abstract Objective To analyze the register of patients with acute coronary syndrome (ACS) at the clinical cardiological dispensary from september to november 2018–2019 and 2020 during COVID-19. Materials and methods A retrospective study was conducted, the registry included 952 patients with ACS in 2018 and 1033 patients in 2019, as well as 964 patients in 2020 during the COVID-19 pandemic. Statistical analysis of the material was performed using the Statistica 11.0 software. Results When analyzing the provision of specialized care to patients with ACS in 2018, the average age of patients was 67 years, the mortality rate was 3.94%. The structure of ACS in 2018 was dominated by patients with ST-segment elevation myocardial infarction (STEMI) - 47%, myocardial infarction without ST-segment elevation (STEMI) occurred in 23%. The proportion of patients with unstable angina pectoris (NS) was 30%. Only 43.6% were registered with coronary heart disease (CHD) before ACS. 12.5% had a history of diabetes mellitus (DM), 31.2% had arterial hypertension (AH). This cardiovascular event recurred in 4% of patients. Average bed-days 9.73. In 2019, the average age of patients was 68 years, the mortality rate was 4.35%. In the structure of ACS in 2019, patients with STEMI were more common 47.5% than with STEMI 28%. The proportion of patients with HC was 24.5%. 52.1% of patients were registered at the dispensary before ACS with a diagnosis of coronary artery disease. A history of diabetes mellitus was in 13.0%, AH in 39.6% of patients. For 3.8% of patients, myocardial infarction in 2019 became recurrent. The average bed-days was 9.92. In 2020, the average age of patients was 66 years, the mortality rate was 6.25%. The structure of patients was dominated by patients with STEMI - 50.5%, STEMI was less common - in 17.5%. The proportion of patients with unstable angina pectoris was 32%. It was revealed that 54.4% were registered in the dispensary before ACS with coronary artery disease. 28.5% had a history of diabetes mellitus, 40.8% - AH. This event was repeated for 4.7% of patients. Average rate, bed-days rate is 8.85. Conclusions Initial analysis reveals that the group of patients with ACS in 2020 was younger than the group of patients in 2019–2020. ACS in combination with diabetes during the pandemic occurred 2 times more often than in the same period of 2018–2019. The proportion of patients registered with the dispensary increased over the period 2018–2019–2020, however, the mortality rate in the 2020 group had a clear upward trend, which may be due to various reasons, incl. the COVID-19 pandemic. The average number of bed-days also objectively decreased when comparing the 2020 and 2019–2018 patient cohorts, which may be due to the burden on the healthcare system during the pandemic. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Clinical Cardiology Dispensary

Duration of Hospital Stay and Influence on the Period between Hospitalizations of Patients

The purpose of the study. The article presents and substantiates the possibilities of reducing the risk of rehospitalization on the basis of a specially developed econometric model of behavior of the hospital doctor in conditions of different workload of patients using the schedule according to Slutsky. Materials and methods. The effects of the model showed that the growth of the competitive environment leads to: a) a decrease in the number of services provided by the hospital doctor; b) switching to perform functions that help improve the quality of the treatment process; c) an increase in the average duration of treatment. Modern tendencies are shown: a) reduction of the number of doctors of inpatient departments; b) increasing the workload of the hospital doctor with patients and bed-days; c) reducing the average length of stay in the hospital. Results and discussion. The economic mechanisms of reducing the risk of re-hospitalizations are substantiated, namely: a) compensation of the turn of the profit curve through compensatory mechanisms of payment for the quality of work of the hospital doctor; b) increasing the price elasticity of consumer demand for stationary services. That is, we chose the length of the period between regular hospitalizations of patients as a criterion for the quality of inpatient treatment. This criterion is essentially equivalent to the risk of re-hospitalization, in which hospitalization in a department of the same profile, which confirms the failure of the previous treatment. Thus, a link is expected between a longer stay of the patient in the hospital and a lower risk of re-hospitalization, provided that a longer stay will provide additional quality of treatment. Therefore, the discovery of such a connection is a confirmation of the hypothesis, which is based on the theoretical econometric model of physician behavior and relates to the reorientation to the additional quality of inpatient care in a competitive environment. That is, due to the increased load, the doctor reduces the length of the patient's stay in the hospital and therefore the quality of care deteriorates. Due to the fact that the discharge of the patient involves achieving a stable condition, doctors are sometimes forced to give an objective assessment of the condition at the time of discharge. The timeliness of evaluating effectiveness is the possibility of temporary relief when in fact the case of treatment is not over. It should be noted that in countries with a private health care system, reimbursement of hospital care costs is related to the number of bed-days spent by the patient in the hospital, where "day" is defined as the period from one midnight to the next, medical staff can manipulate the time of hospital discharge, as patients who are kept until midnight will have an additional day to reimburse. Conclusion. It follows from the research results that a reduction in the length of hospital stay in the existing situation significantly worsens the prognosis, increasing the risks of an uncontrolled course of the disease and, accordingly, subsequent hospitalizations

Hospital in the Home Delivery of Conditioning Therapy for Allogeneic Haematopoietic Stem Cell Transplantation: A Novel Single Centre Patient Focused Approach

Introduction: High dose therapy with Allogeneic Haematopoietic Stem Cell Transplantation (AlloHSCT) has traditionally been performed as an inpatient procedure. However, with improvements in supportive care and patient selection it is possible to safely deliver conditioning chemotherapy in an outpatient setting (Subirà M et al., 2003). While deemed an “outpatient procedure” this method is currently delivered on large day units which requires the patient to attend daily, often only spending the night at home.To reduce these daily visits The Royal Melbourne Hospital (RMH) Bone Marrow Transplant department in collaboration with the Hospital in the Home (HIH) department developed an innovative program to safely deliver Fludarabine chemotherapy as part of conditioning for AlloHSCT in the patient's home. This process involved a daily patient review by a HIH Doctor as well as twice daily visits by a HIH nurse to administer chemotherapy and supportive care in the comfort of the patient's home. Here we report on the safety outcomes of HIH AlloHSCT vs inpatient (IP) care, specifically complications and outcomes.Methods: A retrospective case note audit identified 395 consecutive AlloHSCT patients who received Fludarabine based conditioning between 2011 and 2017 at the RMH. Of these 130 received Fludarabine as part of the HIH Program and 265 as a traditional IP.Results: Of those treated as HIH patients, median age was 51 years (range 18-69). 59% patients were male (n=77) and 41% Female (n=53). Underlying disease groups included Leukaemia (n=53; 40%), Lymphoma (n=35; 27%), Myelodysplatic/Myeloproliferative (n=28; 21%), Myeloma (n=11; 9%) and Non-malignant (n=3; 3%). 2% of patients had myeloablative conditioning (n=2) and 98% received Reduced Intensity Conditioning (n=128). 57% (n=73) received stem cells from a sibling (Sib), 41% (n=54) from Voluntary Unrelated Donors (VUD) and 2% (n=3) from Umbilical Cord Donors.Median total Length of Stay (LOS) for HIH patients was 27 days (Range 10-97) with a median of 5 days (range 2-8) at home as part of this. The LOS for those receiving fludarabine as an IP was not significantly different at 26 days (range 5-174; p=0.209). Total number of IP Bed days saved through the HIH program was 682. There was no significant difference in median time to neutrophil engraftment (HIH 20 vs IP 17 days; p =0.95) or platelet engraftment (HIH 23 vs IP 20 days; p=0.99). Having chemotherapy as a HIH patient had no effect on outcome (HR 1.01). There is no difference in Overall Survival (OS) between the two groups (HIH 17 vs IP 16 months - see Figure 1) while Median OS was not reached.Of the 130 patients who were treated in the HIH Program only 11 had an unplanned admission before Day 0 of their AlloHSCT. Reasons for readmission included suspected infection (n=8; only one culture positive), vasovagal (n=1) and anxiety (n=2). Of note, four of these admissions arose in the first three months of the program with the other seven readmissions occurring over the following six years, with a readmission rate of approximately 5% (7/126 patients).Conclusion: The HIH delivery of chemotherapy and supportive care as part of conditioning for AlloHSCT in the patient's home is both safe and effective. It resulted in a median of five bed days saved per patient (Total number of bed days saved = 682), allowing the department to increase bed capacity without the costs associated with building a new ward. Additionally, the risk of complications was low (approximately 5%) and those that did occur were safely managed.Figure 1 - Comparison of Survival Between HIH and IP AlloHSCT Patients [Display omitted] DisclosuresRoutledge:Celgene: Honoraria; Gilead: Honoraria; Bristol-Myers Squibb: Honoraria. Ritchie:Amgen Inc.: Honoraria.

A clinical trial of the efficacy of a combination of antiseptic and antimicrobial agent in the treatment of inflammatory processes of the skin and soft tissue

Purpose of the study. To conduct a clinical trial of the local treatment efficacy of skin and soft tissue inflammatory processes combination with sodium carboxymethylcellulose, immobilized miramistin and metronidazole.Patients and methods. The study involved patients with purulent-inflammatory skin processes, divided into two groups – control and experimental – 30 in each. The most common nosological form were abscesses of various localization. In the control group, local treatment was carried out with dioxomethyltetrahydropyrimidine ointment with chloramphenicol, and in the experimental group – with a combination of sodium carboxymethylcellulose with miramistin and metronidazole. We studied the local temperature, wound pH, wound planimetry, the appearance of wounds, the species composition of infectious agents in the discharge from the wound, a general blood test (with the determination of leukocyte indices), blood biochemical parameters, and the number of bed-days in the hospital. The data obtained were processed statistically.Results. The percentage of reduction in the area and volume of wounds in the experimental group was significantly higher than in the control. The maximum rate of wound healing in the experimental group was noted on days 1-3 and amounted to 9.7 (6.3; 15.5) % / day, and in the control group – 5.6 (2.9; 7.7). Starting from the 5th day of treatment, the local temperature indices in the experimental group were significantly lower than in the control group, and the pH values of the wounds in the experimental group tended to neutral values from the 5th day of treatment, and in the control group there was an increase in pH. Most often, S. epidermidis and S. aureus were inoculated from the wound discharge (in total, more than 50 % of observations); in the control group, pathogenic microorganisms were inoculated 1.6 times more often than in the experimental group.Conclusion. Patients in the experimental group were hospitalized for 2.5 days less than patients in the control group. It is possible to recommend further study and application of the combination of miramistin and metronidazole immobilized on the sodium salt of carboxymethylcellulose in the treatment of wounds.