Number Of Bed Days Research Articles

Cost analysis of critical patient care at a pediatric intensive care unit of a tertiary care public hospital in an urban metropolis of India

Background: The cost of critical care is widely recognized as being high. However, it remains a challenge to accurately assess the cost of intensive care due to a lack of standardized methodology. There is also considerable heterogeneity with regard to allocation of resources and distribution of critical care services.Methods: We conducted a prospective study to analyse diagnosis-based costs of paediatric patient care at a pediatric intensive care unit (PICU) in a public hospital in Mumbai on the basis of identified cost components; direct (fixed and variable) and indirect costs.Results: Out of 167 (102 boys, 61%) patients enrolled, 65 (39%) were aged 1-7 months. They spent an average of 4±1.46 bed days in the PICU. The cost of direct fixed components (salaries, capital equipment, disposables) was Rs. 64,48,200 for six months. The maximum cost of direct variable components spent by the hospital (physiotherapy intervention, expert opinion, investigations, medicines, blood products, piped gases) amounted to Rs. 548.63/patient/day for treatment of non-infectious diseases. Cost of indirect components (building maintenance) was Rs. 12,500/six months. Linear regression analysis showed 83-99.99% dependency of treatment cost to diagnosis and bed days. The average cost of treatment of infectious and non-infectious diagnoses/patient/day spent by the hospital was Rs. 260 and Rs. 548.63 respectively as compared to Rs. 169.96 and Rs. 356.21 spent by the patients.Conclusions: Our study showed that majority of the treatment costs depended on the diagnosis and number of bed days of the patients. Also being a tertiary care public hospital, 60% of the treatment costs were borne by the hospital. Thus, our study attempts to quantify, in financial terms, the expenditure involved in running a paediatric ICU in a tertiary care public hospital so as to assist doctors and healthcare decision makers in the allocation of resources.

Impact of community treatment orders on inpatient bed usage in assertive outreach team

AimsTo examine the impact of using Communty Treatment Orders (CTO) of the Mental Health Act on use of inpatient care in Assertive Outreach team.BackgroundCurrently there is little evidence of the efficacy of community treatment orders (CTOs), and in particular with patients who use the Assertive Outreach service. One large randomised controlled study found no impact on use of inpatient care while a naturalistc study found significant impact.MethodOur primary outcome was the number of admissions with and without a CTO comparing each patient with themselves before CTO and under CTO(“mirror-image”). Our secondary outcomes were the number of bed days, and the percentage of missed community visits post-discharge. We also looked at the potential cost savings of a reduction in inpatient bed usage.ResultAll the 63 patients studied over period of 6 years had a severe and enduring mental illness. The use of a CTO was linked to a significant reduction in the number of admissions (mean difference = 0.89, 95% CI = 0.53–1.25, P < 0.0001) and bed days (mean difference = 158.65, 95% CI = 102.21–215.09, P < 0.0001) There was no significant difference in the percentage of missed community visits post-discharge. Looking at the costs, an average cost for an inpatient Assertive Outreach bed per day in the local Trust was £250, and there were 8145 bed days saved in total, making a potential saving of just over £2million, during the study period.ConclusionThis study suggests that the implementation of CTOs using clinical judgment and knowledge of patients can significantly reduce the bed usage of Assertive Outreach patients. The financial implications of CTOs need to be reviewed further, but this study does suggest that the implementation of CTOs is a cost-effective intervention and is economically advantageous to the local Trust.

The development and validation of a revised version of the Medical Outcomes Study Sleep Scale (MOS Sleep-R)

BackgroundThe 12-item Medical Outcomes Study Sleep Scale (MOS Sleep Scale) has been used to capture patient-reported sleep problems in hundreds of studies. A revised version of the MOS Sleep Scale (MOS Sleep-R) was developed that uses simplified response sets, provides interpretable norm-based scoring, and has two recall versions (one-week or four-week). The objective of this study was to evaluate the psychometric properties (reliability and construct validity) of the MOS Sleep-R using data from a representative sample of U.S. adults.MethodsStandardization of raw scores into norm-based T-scores (mean = 50, standard deviation = 10) was based on data from a 2009 U.S. internet-based general population survey. The internal consistency reliability of multi-item subscales and global sleep problems indices for both one-week and four-week recall forms of the MOS Sleep-R were examined using Cronbach’s alphas and inter-item correlations. Construct validity was tested by comparing item-scale correlations between items within subscales with item-scale correlations across subscales. Scale-level convergent validity was tested using correlations with measures including generic health-related quality of life (i.e., SF-36v2) and other relevant outcomes (e.g., job performance, number of days in bed due to illness or injury, happiness/satisfaction with life, frequency of stress/pressure in daily life, the impact of stress/pressure on health, and overall health).ResultsThe one-week and four-week recall forms of the MOS Sleep-R were completed by 2045 and 2033 respondents, respectively. The psychometric properties of the one-week and four-week forms were similar. All multi-item subscales and global index scores showed adequate internal consistency reliability (all Cronbach’s alpha > 0.75). Patterns of inter-item and item-scale correlations support the scaling assumptions of the MOS Sleep-R. Patterns of correlations between MOS Sleep-R scores with criterion measures of health-related quality of life and other outcomes indicated adequate construct validity.ConclusionsThe MOS Sleep-R introduces a number of revisions to the original survey, including simplified response sets, the introduction of a one-week recall form, and norm-based scoring that enhances interpretability of scores. Both the one-week and four-week recall period forms of the MOS Sleep-R demonstrated good internal consistency reliability and construct validity in a U.S. general population sample.

Psychiatric hospital utilisation following lithium discontinuation in patients with bipolar I or II disorder: A mirror-image study based on the lisie retrospective cohort

IntroductionEvidence for lithium as a maintenance treatment for bipolar disorder type II remains limited since most treatment-prevention studies focus on bipolar disorder type I or do not distinguish between types of bipolar disorder.ObjectivesTo compare the impact of lithium discontinuation on hospital utilisation in patients with bipolar disorder type I or schizoaffective disorder and patients with bipolar disorder type II or other bipolar disorder.MethodsMirror-image study, examining hospital utilisation within two years before and after lithium discontinuation as part of LiSIE, a retrospective cohort study into effects and side-effects of lithium for the maintenance treatment of bipolar disorder as compared to other mood stabilisers.ResultsFor the whole sample, the number of admissions increased from 86 to 185 admissions after lithium discontinuation, with the mean number of admissions/patient/review period doubling from 0.44 to 0.95 (p < 0.001). The number of bed days increased from 2218 to 4240, with the mean number of bed days/patient/review period doubling from 11 to 22 (p = 0.025). This increase in admissions and bed days was exclusively attributable to patients with bipolar disorder type I or schizoaffective disorder.ConclusionsOur findings suggest that due to a higher relapse risk in patients with bipolar disorder type I or schizoaffective disorder there is a need to apply a higher threshold for discontinuing lithium than for patients with bipolar disorder type II or other bipolar disorder.DisclosureMichael Ott has been a scientific advisory board member of Astra Zeneca Sweden, Ursula Werneke has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme 2014–2018 and EAPM 2016, Luleå, Sweden): Astra

Initial impact of a national programme to contain the spread of carbapenemase-producing Enterobacterales in Ireland

Carbapenemase-producing Enterobacterales (CPE) are an emerging cause of healthcare-associated infection (HCAI). In October 2017, a National Public Health Emergency on CPE was declared in Ireland, leading to improved CPE surveillance, implementation of performance monitoring and reporting, and a CPE national expert advisory group. To evaluate the impact of measures taken to control CPE. From August 2017, all acute Health Service Executive (HSE) hospitals were required to report performance indicators related to CPE control (number of CPE tests and number of newly detected CPE). The number of screening samples increased due to this requirement. Monthly incidences were calculated using the overall number of bed-days used (BDU) per hospital. All newly detected CPE were submitted for further genetic identification. Data analysis and predictions were performed for two separate periods (first year and second year after measure implementation). Over the two-year period studied, the average incidence of CPE cases per 10,000 BDU increased from 1.3 (±0.5) for year 1 to 1.7 (±0.4) for year 2, while the incidence of CPE cases per 1000 screens fell from 3.2 (±0.7) in year 1 to 2.3 (±0.6) in year 2. The OXA-48 gene was most often detected (72%), followed by KPC (13%) and NDM (7%). The declaration of the National Public Health Emergency to enhance prevention and control measures for CPE in Ireland is a unique approach in the EU/EEA. Our preliminary results suggest a positive effect on controlling the incidence of CPE in the acute HSE hospital system in Ireland.

Assessment of nutritive status and its correction in oncological patients after operations in the hepatopancreatoduodenal zone

Surgical interventions in the hepatopancreatoduodenal zone in cancer patients are associated with high risk of nutritional deficiency in the postoperative period. This feature is due to both the volume of the operation itself (pancreatoduodenectomy), and the predominance of catabolic processes in the early postoperative period. In this regard, the monitoring of the main indicators of carbohydrate, protein and fat metabolism in the early postoperative period becomes fundamental for choosing the correct tactics of nutritional support for this patients. Aim. Improvement of the nutritional status of cancer patients after operations carried out in the hepatopancreatoduodenal zone in connection with malignant neoplasms by means of a comprehensive comparative analysis of the effectiveness of isolated enteral, isolated parenteral and mixed types of nutritional support in the early postoperative period. Material and methods. The examination included 40 patients with an average age of 44.5±6.8 years (15 men, 25 women). All patients for analysis were divided into two groups: the first, the main - patients receiving strictly enteral and/or probe nutrition (n=21), the second, control - isolated parenteral nutrition (n=19). The dynamic of the main predictors of nutritional status in the early postoperative period was assessed: the level of total blood protein, including albumin, lymphocyte count, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activity, their ratio - the de Ritis coefficient (as indirect criterion of cytolytic syndrome), total bilirubin. The analysis included the time interval of the enteral and parenteral nutrition in the early postoperative period, together with the number of bed-days required to correct the nutritional status in these patients in an intensive care unit. To objectify and clarify the dynamics of the nutritional status of patients in the pre- and postoperative period, we used the generally accepted scales for assessing nutritional status - Subjective Global Assessment (SGA) Nutritional Risk Index (NRI). Results. According to the SGA and NRI rating scales, the overwhelming majority of patients in the main and control groups (85.7% and 94.7%, respectively) had a normal nutritional status before the operation. In the postoperative period, 4 (21%) patients in the control group showed signs of moderate malnutrition by day 12, which regressed after the enteral nutritional support was connected. There were no statistically significant changes in nutritional status in patients of the main group. The basal metabolic rate in patients of both groups had no statistical differences before surgery (2296±279 kcal/day). On the 15th day of the postoperative period, its increase by 394 kcal/day was recorded in the main group, in the control group an increase in the basal metabolic rate was observed only with the addition of the enteral component of nutritional support, on average, by 321 kcal/day. There was no statistically significant decrease in the level of blood lymphocytes in patients of the main group (p=0.289) in comparison with the traced tendency to lymphopenia (p=0.019) in patients of the control group. The patients of the main group showed a slower regression of the ALT activity, and, accordingly, less increase in the de Ritis coefficient. Conclusion. In patients operated in the hepatopancreatoduodenal zone due to malignant neoplasms, in the early postoperative period, the enteral administration of nutritional mixtures may be preferable, both as an isolated method of nutritional support and as a supplement to parenteral nutrition, given its positive effect on the gastrointestinal tract passage, the level of basal metabolism, the state of the protein-synthetic function of the liver and, indirectly, the degree of cytolytic syndrome.

Effects of aripiprazole long-acting injectable antipsychotic on hospitalization in recent-onset schizophrenia.

Recent-onset schizophrenia (ROS) represents a critical period that can greatly influence the clinical course of schizophrenia. The use of long-acting injectable antipsychotics (LAIs) in this period is increasingly being considered as a first-line treatment option. Aripiprazole LAI (ALAI) is the newest of all LAI's available on the market, with limited data on its effects on hospitalization rates after first episode of schizophrenia. It was our goal to evaluate whether ALAI has an effect on hospitalization rates, number of bed days and clinical improvement in patients with ROS. This mirror-image study included 138 inpatients suffering from schizophrenia. We collected sociodemographic data on all individuals, number of hospitalization days, hospitalization rates as well as Clinical Global Impression Scale-severity of illness (CGI-S) and Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS) scores at the initiation of ALAI and at the end of a 1 year follow up. Mean number of hospitalizations and hospitalization days in the year after starting ALAI significantly decreased compared to the year before (p = 0.005 and p < 0.001). Mean scores on both CGI and CRDPSS also significantly decreased after initiating ALAI (p < 0.001). Results suggest that ALAI is an important therapeutic option in patients with ROS. It leads to reduced usage of hospital services, potentially reducing the socio-economic healthcare burden.

Role of surfactant protein SP-D in the diagnosis of pulmonary complications in patients with combined thoracic injury

The aim: to evaluate the informativeness of the content of SP-D in the blood of patients with combined thoracic trauma as a marker of the severity of traumatic illness and the impact of the proposed modifications of the intensive care algorithm on treatment outcomes.Material and methods. The basis of this study is a statistical analysis of the results of a comprehensive examination of 92 patients with thoracic trauma. Control points were 1st, 3rd, 7th and 12th day of treatment. The severity of the injury was determined according to the ISS scale, the condition of patients at the time of admission according to the ARASNE II scale, the level of SP-D in the blood, the degree of pulmonary hypertension, the number of bed-days in the intensive care unit (IC). 3 groups of patients were identified. Group I - standard IC protocol, group II - standard IC protocol with the addition of ceruloplasmin, group III - standard IC protocol with the addition of a solution of D-fructose-1,6-diphosphate sodium salt of hydrate. Parametric statistics methods were used to process the obtained data.Results. In patients of group I, the maximum numbers of SP-D in the blood were determined, which had a positive strong correlation during the entire observation period with the frequency of pulmonary complications and the duration of treatment in the IC department. In group II, the administration of ceruloplasmin neutralized the negative effect of oxidative stress on the surfactant, so the average SP-D in the blood only on the 3rd day exceeded the reference values by 20 %, which affected the lack of correlations between pulmonary parenchyma and duration of treatment. In group III, the addition of a solution of D-fructose-1,6-diphosphate sodium salt hydrate had a positive effect on the general condition of patients as a whole, but throughout the study period SP-D figures in the blood exceeded the starting and reference, which affected the presence of strong and medium positive correlation between them, the degree of pulmonary hypertension and the length of stay in the IC department.Conclusions. In patients with combined thoracic trauma, it is important when planning patient management tactics to diagnose the content of surfactant protein SP-D in the blood during the entire period of stay in the intensive care unit. The level of SP-D in the blood of patients with combined thoracic trauma is a highly informative diagnostic marker of the functional state of the lung parenchyma (surfactant). An increase in its numbers three times indicates the beginning of the development of acute lung injury syndrome (exudative phase). Reduction of its figures in the course of respiratory distress syndrome by half the values in the exudative phase indicates the beginning of the proliferative phase and improvement of patients. The leading mechanism for the development of acute lung injury syndrome in patients with combined thoracic trauma. There is oxidative stress, so the appointment of ceruloplasmin as an adjunct to the standard protocol of intensive care is pathogenetically justified

The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia.

Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.

Correlation between compensated patient claims and 30-day mortality.

To test if compensation claims from patients (reported to the Norwegian System of Patient Injury Compensation) are correlated with the existing quality indicator of 30-day mortality (based on data from Norwegian Patient Registry). This correlation has not been previously evaluated. The association between patient claims and 30-day mortality at hospital trust level was assessed by the Pearson correlation coefficient. The Norwegian System of Patient Injury Compensation is a governmental agency under the Ministry of Health and Care Services and deals with patient-reported complaints about incorrect treatment in the public and private healthcare services. Patient-reported claims may be an indicator of healthcare quality, as 30-day mortality. All 19 Norwegian hospital trusts. : None. Patient claims rates, 30-day mortality and Pearson correlation coefficient. Both number of deaths within 30 days and number of claims have declined over time. High correlation (0.77, P < 0.001) was found between number of deaths within 30 days and the total number of claims. In addition, an even stronger association was found with approved claims, with a correlation coefficient of 0.83 (P < 0.001). Moreover, adjusted 30-day mortality was significantly correlated with the patient-claim rate using number of bed-days as denominator, but not when using number of discharges. The results from the present study indicate an association between compensation claims from patients and 30-day mortality, suggesting that both parameters reflect the latent quality of care for the hospital trusts, but they may capture different aspects of care.

Progressive Early Rehabilitation Program Applied to Patients with Acute Cerebrovascular Accident

Abstract. Early rehabilitation (ER) of patients with acute cerebrovascular accident (ACA) is one of the priority tasks of the vascular centers; the issue of increasing the volume of rehabilitation measures in the resuscitation and intensive care units (ICU) is relevant. Objective. To evaluate the safety and effectiveness of the progressive ER program in patients with ACA. Material and research methods. The study included 129 patients with ACA in ICU. Each patient of the main group (MGr, n = 61) underwent progressive ER: at least 4–5 vertical adjustments per day, passive mode Kinesiotherapy 49 ± 9.3 minutes, a double load of physiotherapy exercises, preventive physiotherapy; the total time of classes reached 240 minutes per day. In the comparison group (СGr, n = 68), standard ER was performed no more than 120 minutes per day. The groups are comparable by sex, age, severity of the disease and comorbidity. The severity of ACA, the gravity gradient, patient mobility, functional status, degree of dependence, and the presence of complications were evaluated. Results. During a month of work with the MGr, 102 ICU bed-days, 94 days of the artificial lung ventilation use, p &lt; 0.05 were saved. Mortality in MGr decreased -— 8 patients (13.1%) versus 14 (20.6%) in CGr (p &lt; 0.05). In patients within CGr, pulmonary thromboembolism developed in 8.8%, in MGr – in 3.3%. The severity of the apoplectic attack decreased ( by 28% in MGr, and by 20% in CGr ), mobility increased. Comparing the modalities of post resuscitationsyndrome in MGr, it was noted that the score decreased by 2 times from 6 [5; 6] to 3 [2.3; 3.3], but it has not changed in the CGr. Patients in the MGr were 2-–3 days earlier adapted to the vertical adjustment. Conclusions. The progressive ER program in ICU is safe, effective, realisable, and allows reducing the number of bed-days in ICU, the number of days of the artificial lung ventilation use, complications, and mortality in comparison with standard medical care.

Palliative outpatient parenteral antibiotic therapy: a review of 5 years of patient data.

ObjectivesA review of patients requiring lifelong antibiotics to control, rather than cure, infection was performed [‘palliative outpatient parenteral antibiotic therapy (OPAT)’]. This was to evaluate emerging themes and complications. The aim was to aid in the management of such patients.MethodsA retrospective review of the OPAT database over 5 years (2013–17) was performed. Of the 1438 patients, 9 were deemed to have received palliative OPAT.ResultsThe palliative cohort represented 0.6% of the total number of patients on OPAT and 8.6% of the bed days saved. Patients fell into two main groups: those with multiple comorbidities that precluded surgical management and those with a terminal condition. Both groups received IV antibiotics with no clear endpoint. The themes to emerge were: patients often had multiple comorbidities with a high operative risk to control the source of infection; a trial of no or oral antibiotics led to resurgence of the infection; vascular patients appeared to tolerate long-term antibiotics well; and conversely, antibiotic side effects were a significant issue in others. Patients with incurable cancer and a coincident infection can be given additional quality of life with the judicious use of appropriate therapy.ConclusionsThere are significant issues surrounding antimicrobial stewardship in the palliative OPAT group that should be considered. Excellent communication is required to deal with these often very complicated patients. There are considerable gains to be made both for patients and the number of bed days saved. The small number of patients accounted for a disproportionate number of bed days saved.

Availability and need for population of the federal districts in hospital beds

Providing the population with the necessary bed stock is an important task of public health. In order to compare the level of security and the population's need for hospital beds in the territory of the Federal districts of Russia, the study used the following methods: analytical, logical and descriptive statistics. Data on the population and bed Fund were taken from the official reports of Rosstat and the Ministry of health of Russia for 2016-2018. The population's need for hospital beds was calculated as the ratio of the product of the number of bed days per 1000 inhabitants and the population to the average annual bed occupancy multiplied by 1000. In the course of the study, the dynamics of the reduction of the bed stock in various profiles was identified and the population's need for hospital beds was determined, taking into account various variants of the population forecast. It was found that the optimization of hospital beds, in addition to economic interests, should be considered opportunities for providing outpatient and inpatient care, improve efficiency and quality of hospital care, as well as the necessity of forming a reserve of hospital beds in case of mass sanitary losses or increase the level of hospitalization of citizens in a short period of time.

On the issue of standards of organization of hospital psychiatric care

In the conditions of reforming psychiatric service in the Russian Federation, the procedure of organizing psychiatric care of patients in hospital, the effectiveness of treatment of patients in psychiatric hospital during 2015-2017 were analyzed. The article presents the results of study of organization of psychiatric care of patients in specialized hospital on the basis of Psychiatric clinical hospital № 13. The analysis covered number of patients treated in hospital by nosological forms; number of patients by gender. The age categories of mental patients and the format of professional status of patients were considered. The main indicators of psychiatric hospital activity were investigated: average duration of stay of patient in hospital, annual bed using, bed turnover, number of bed days. The attention was paid to primary output of patients with disabilities, number of re-hospitalizations and compulsory hospitalization. The analysis of financing of inpatient psychiatric care of treated patients for the study period of time was implemented. The vector of providing psychiatric care to patients at the stage of out-patient and hospital-replacing cases.

32 Medicine for Older People Liaison Service to Acute Surgery Reduces Length of Stay of Older People Living with Frailty

Abstract Background Of people admitted to the acute surgical unit (ASU) only 23% of them are aged over 70. However the number of bed days they occupy are disproportionate to this; comprising 48% of the total bed days. The average number of bed days rises exponentially with age, with those aged under 70 averaging less than two days; those aged 80 averaging approximately 4.5 bed days and those aged over 90 approximately 7 bed days. This disparity was recognised and a Medicine for Older People (MOP) liaison team comprising consultant geriatrician and Advanced Clinical Practitioner in Frailty starting working with the acute surgical team in November 2018, initially providing support two days a week, increasing to 5 days in March 2019. Methods The MOP liaison team meets with the acute surgical team each morning identifying and discussing relevant patients; those identified as living with frailty with associated complexity and uncertainty. This group of patients is then reviewed by the MOP liaison team utilising the principles of the comprehensive geriatric assessment to formulate a person-centred plan. Plans are discussed and coordinated with the surgical, nursing and therapy teams utilising a multi-disciplinary/ multi-professional approach. Results Length of stay is the main outcome measure and readmissions are monitored. Data on admission length and readmissions was analysed from April 2018 and has continued following commencement of the liaison service. Primary results- Length of stay has reduced from 4.4 to 3.3 days on average for all over 70-year-olds admitted to the ASU team. Whilst admission rates have dropped across all age ranges the biggest reduction in readmissions is among the over 80-year-olds with an almost 50% reduction as opposed to a 33% reduction in the under 70 age group Conclusions Proactively managing the admissions and discharges of patients with frailty allows them to receive the right care at the right time in their period of crisis and shortens their admissions by approximately 25%.

Partial compliance with long-acting paliperidone palmitate and impact on hospitalization: a 6-year mirror-image study.

Background:Previous studies showed a linear correlation between partial compliance with an oral antipsychotic medication and hospitalisation risk among patients with schizophrenia. Long-acting injections (LAIs) may significantly improve adherence and reduce relapse in patients with psychosis. The aim of this study was to evaluate the relationship between the level of compliance with 1-monthly paliperidone palmitate (PP1M) and hospitalisation rates.Methods:This was a naturalistic, mirror-image study examining retention, compliance and hospitalisation rates 3 years pre- and 3 years post-PP1M initiation. Compliance was divided in three groups: full (no missed dose/year), good (6–11injections/year), poor (<6 injections/year).Results:A total of 173 patients suffering from a severe mental illness (70% with a diagnosis of schizophrenia and 30% with other diagnoses) were included; 77% of patients continued PP1M for 1 year, 66% for 2 years and 55% for 3 years. Of the 95 patients who remained on PP1 throughout the 3 years of follow up, 81% showed full, 13% good, and only 6% poor compliance. In the patients who were fully compliant, the mean number of hospital admissions decreased from 1.34 to 0.43, and the mean number of bed days from 82 to 19 days per patient 3 years before and 3 years after PP1M initiation (p < 0.001). It is noteworthy that the reductions in hospital stay were statistically significant for the group of patients with full compliance but not for the other two groups. In fact, patients with poor compliance demonstrated higher hospitalisation rates both before and after PPM1 initiation. These findings were similar in the subgroup of patients with schizophrenia who continued treatment for 3 years (n = 68).Conclusion:There was a direct association between partial compliance and re-hospitalisation; fully compliant patients maintained the best outcomes in terms of reduced bed use following PPM1 initiation.

A Prognostic Model of the Development of Postpartum Purulent-Inflammatory Diseases

Background: Currently, postpartum purulent-inflammatory diseases continue to be a prominent issue in medicine. As a result, numerous scientific publications were devoted to finding the solution to this issue. Primarily these solutions included the idea of optimisation of antibiotic-based disease prevention and therapies. However, the early diagnosis and prognosis of these pathologies were unfortunately overlooked. The Aim of the Study: To build a prognostic model of the development of postpartum purulent-inflammatory diseases. Material and Methods: The main focus of our research was establishment of methods of early diagnosis and prognosis of purulent-inflammatory diseases. The main cohort consisted of 170 women diagnosed with purulent-inflammatory diseases while the control cohort was made of 40 women with an uncomplicated course of pregnancy; patient’s blood serum was analysed using fluorescence spectroscopy. Additionally, we implied a variety of standardised algorithms used during clinical and laboratory examination of the patients with postpartum endometritis. Results: Fluorescence spectra were studied for 40 women of control group and 170 women of the main group. Based on the data obtained using fluorescence spectroscopy and data from clinical and laboratory examinations (extragenital pathology, gynecology-related diseases, risk of miscarriage, surgery, TORCH-infections, colpitis, labour duration > 12 hrs, labour anomalies, maximum blood serum fluorescence spectrum values, fluorescence spectrum ≤ 0.845, age, number of bed days, fetal distress), we have derived a prognostic model of the development of postpartum purulent-inflammatory diseases. Conclusion: As a result, we derived a prognostic model based on the main 13 factors, which contribute to development of postpartum purulent-inflammatory diseases. This model was determined correct with a probability of over 99% (р 2 = 174.74; df = 13).

The Impact of Paliperidone Palmitate on Hospitalization in Patients with Schizophrenia: A Retrospective Mirror-image Study.

ObjectiveWhether long-acting injectable antipsychotics (LAI) are superior to oral antipsychotics remains a controversial question, and results vary depending on the study design. Our study was performed to compare outcomes of oral anti-psychotics and paliperidone palmitate (PP) in clinical practice by investigating the numbers of admissions and bed days.MethodsWe performed a retrospective observational mirror-image study at a single medical center, reviewing medical charts to obtain the clinical data. Forty-six patients with a diagnosis of schizophrenia or schizoaffective disorder who had received at least two doses of PP were included in the analysis. The Wilcoxon signed-rank test was used to compare the numbers of bed days and admissions 1 year before starting PP with those numbers at 1 year after.ResultsThe mean number of admissions fell from 0.83 to 0.17 per patient (p < 0.0002), and the median fell from 1 to 0. The mean number of bed days decreased significantly, from 24.85 to 8.74 days (p < 0.006). The outcomes remained similar in sensitivity analyses set up with different mirror points.ConclusionOur results indicate that initiating PP reduced the mean numbers of hospital admissions and bed days compared with prior oral medication. LAIs may thus be cost effective in practice; its use bringing about cost reductions greater than its purchase cost.

Experience in using povidone-iodine to treat superficial and full-thickness burns

Thermal injuries are now ranked number one among injuries, and incidence of injury-related complications, especially infectious and purulent, does not decrease in surgical practice, despite the modern methods for treatment and prevention. Purulent complications depress the speed and quality of wound healing and increase the number of bed-days and treatment costs. Moreover, infection spreading complicates treatment and increases mortality and disability of patients with burn injuries. Choosing the most effective antiseptic agent for burn injuries is crutial both from the perspective of effective local treatment of wounds and wound complications and from the perspective of pharmacoeconomic aspects. At the current time, povidone iodine solution and ointment are one of the leading antiseptics used at all stages of care for burn patients. Its efficacy has been proven by clinical trials and many years’ experience of use by specialists and patients. We have also gained extensive positive experience in using this drug to treat 269 patients with burns of 5 to 35% total body surface area (TBSA) and various thickness without development of resistance and pain in patients and with a pronounced antiseptic effect during its use on the basis of City Clinical Hospital No. 2 of Stavropol, which once again proved high efficacy and feasibility of the widespread use of povidone-iodine in practice due to antimicrobial activity, high bioavailability, ease of use and economic benefits.

Long-term effects of paliperidone palmitate on hospital stay and treatment continuation.

There is a growing need for real world data on long-term clinical and health resource utilization outcomes. The main purpose of this study was to establish the effects of 1-monthly Paliperidone Palmitate (PP1M) on treatment continuation and hospital stay in routine clinical practice. This is a naturalistic, 6-year mirror-image study examining retention and hospitalization rates 3 years pre-PP1M and 3 years post-PP1M initiation. One hundred seventy-three patients were included; 120 (70%) had a primary diagnosis of schizophrenia and 53 (30%) other diagnosis. In total, 77% of patients continued PP1M for one year, 66% for two years and 55% for three years. For the patients who continued with PP1M for 3 years (n = 95), the mean number of hospital admissions decreased significantly from 1.44 to 0.53 and the mean number of bed days from 93 to 29 bed days 3 years before and 3 years after PP1M initiation (P < 0.001). The group of patients with schizophrenia who continued for 3 years (n = 79) demonstrated similar outcomes. The introduction of PP1M had a significant impact on long-term clinical outcomes. More than half of patients were still continuing on PP1M at 3 years after initiation and had no admission during 3 years follow-up.