Ordinary Bed Research Articles

The economic burden of bipolar disorder: a case study in Southern Iran

BackgroundBipolar Disorder (BD) imposes considerable economic and social burdens on the community. Therefore, the present study aimed to determine the economic burden of bipolar disorder in patients referred to single-specialty psychiatric hospitals at the secondary and tertiary care level in 2022.MethodsThis partial economic evaluation was conducted as a cross-sectional study in the south of Iran in 2022, and 916 patients were selected through the census method. The prevalence-based and bottom-up approaches were used to collect cost information and calculate the costs, respectively. The data on Direct Medical Costs (DMC), Direct Non-Medical Costs (DNMC), and Indirect costs (IC) were obtained using the information from the patients’ medical records and bills as well as the self-reports by the patients or their companions. The human capital approach was also used to calculate IC.Findings: The results showed that in 2022, the annual cost of bipolar disorder was $4,227 per patient. The largest share of the costs was that of DMC (77.66%), with hoteling and ordinary beds accounting for the highest expenses (55.40%). The shares of DNMC and IC were 6.37% and 15.97%, respectively, and the economic burden of the disease in the country was estimated at $2,799,787,266 as well.ConclusionIn general, the costs of bipolar disorder treatment could impose a heavy economic burden on the community, the health system, the insurance system, and the patients themselves. Considering the high costs of hoteling and ordinary beds, it is suggested that hospitalization of BD patients be reduced by managing treatment solutions along with prevention methods to reduce the economic burden of this disease. Furthermore, in order to reduce the costs, proper and fair distribution of psychiatrists and psychiatric beds as well as expansion of home care services and use of the Internet and virtual technologies to follow up the treatment of these patients are recommended.

Transforming a public university hospital and its area of influence into a comprehensive resource in response to the COVID-19 pandemic

Introduction and objectivesThe outbreak of COVID-19 has overwhelmed healthcare systems all over the world. The aim of this article is to describe the process of transforming the Vall d’Hebron University Hospital, the second largest hospital in Spain, into a COVID-19 centre coordinating response to the pandemic in its reference area. Materials and methodsThe study draws on the experience of the authors in transforming the hospital into a comprehensive resource in response to the COVID-19 pandemic. The strategy is based on four central strategies: early planning, coordination of all healthcare agents in its reference area, definition of clear leadership roles, and the organisation of care based on multidisciplinary teams with minimal recruitment of new staff. ResultsThe transformation strategy enabled the hospital to cope with the surge in patients without exceeding its capacity. During the response phases, which amounted to a period of 57 days, 3106 patients consulted the ER and 2054 were admitted, 346 of whom were treated at the ICU. To accommodate the number of adult COVID-19 patients, adult ICU availability was progressive increased by 371%, and ordinary beds increased by 240. A total of 671 staff members went on sick leave after testing positive for COVID-19. ConclusionThe transformation experience of the hospital provides insight into how effectively adapt the structures and functioning of large hospitals. The relevance of territorial coordination during the pandemic is stressed as an effective strategy that contributed coping the pandemic.

Cope with the COVID-19 pandemic: Dynamic bed allocation and patient subsidization in a public healthcare system

In many countries and territories, public hospitals play a major role in coping with the COVID-19 pandemic. For public hospital managers, on the one hand, they must best utilize their hospital beds to serve the COVID-19 patients immediately. On the other hand, they need to consider the need of bed resources from non-COVID-19 patients, including emergency and elective patients. In this work, we consider two control mechanisms for public hospital managers to maximize the overall utility of patients. One is the dynamic allocation of bed resources according to the evolution process of the COVID-19 pandemic. The other is the usage of a subsidy scheme to move elective patients from the public to private hospitals. We develop a dynamic programming model to study the allocation of isolation and ordinary beds and the effect of the subsidy policy in serving three types of patients, COVID-19, emergency, and elective-care. We first show that the dynamic allocation between isolation and ordinary beds can provide a better utilization of bed resources, by cutting down at least 33.5% of the total cost compared with the static policy (i.e., keeping a fixed number of isolation beds) when facing a medium pandemic alert. Our results further show that subsidizing elective patients and referring them to private hospitals is an efficient way to ease the overcrowded situation in public hospitals. Our results demonstrate that, by dynamically conducting bed allocation and subsidy scheme in different phases of the COVID-19 pandemic, patient overall utility can be greatly improved.

Cope with the COVID-19 Pandemic: Dynamic Bed Allocation and Patient Subsidization in a Public Healthcare System

In many countries and territories, public hospitals play a major role in coping with the COVID-19 pandemic. For public hospital managers, on the one hand, they must best utilize their hospital beds to serve the COVID-19 patients immediately. On the other hand, they need to consider the need of bed resources from non-COVID-19 patients, including emergency and elective patients. In this work, we consider two control mechanisms for public hospital managers to maximize the overall utility of patients. One is the dynamic allocation of bed resources according to the evolution process of the COVID-19 pandemic. The other is the usage of a subsidy scheme to move elective patients from the public to private hospitals. We develop a dynamic programming model to study the allocation of isolation and ordinary beds and the effect of the subsidy policy in serving three types of patients, COVID-19, emergency, and elective-care. We first show that the dynamic allocation between isolation and ordinary beds can provide a better utilization of bed resources, by cutting down at least 33.5\% of the total cost compared with the static policy (i.e., keeping a fixed number of isolation beds) when facing a medium pandemic alert. Our results further show that subsidizing elective patients and referring them to private hospitals is an efficient way to ease the overcrowded situation in public hospitals. Our results demonstrate that, by dynamically conducting bed allocation and subsidy scheme in different phases of the COVID-19 pandemic, patient overall utility can be greatly improved.

Oil shale upgrading by gas-solid high density separation fluidized bed under secondary accumulation distribution

In the separation of oil shale using gas–solid separation fluidized beds, the waste rocks fall on the distribution plate after separation and the scraper fails to discharge them in time, causing the airflow entering the bed to be redistributed. Due to its unique secondary layout effect on airflow, the existence of stacking beds is an important factor affecting the stability of the fluidized bed, and indirectly affects the separation performance of gas–solid fluidized beds. Therefore, it is necessary to carry out further research on the stacking bed to provide a strong basis for optimizing the practical operation and sorting performance of the gas–solid fluidized bed. Here, the effects of stacked beds on energy consumption, density uniformity, and bed stability were systematically analyzed experimentally. The results showed that the secondary accumulation bed has a synergistic effect on the fluidization stability of the bed and can improve the fluidization quality of the ordinary bed. Oil shale was sorted under optimized test operating conditions (accumulation height HS = 35 mm, accumulation particle diameter D = 6 mm, fluidization number N = 1.3), and the refined mineral yield was 29.85%, oil yield was 9.42%, tail mineral yield was 70.15%, and oil yield was 1.54%. The possible deviation, E, was 0.085.

Environmental and sociodemographic factors associated with household malaria burden in the Congo

BackgroundMalaria is one of the most severe public health issues that result in massive morbidity and mortality in most countries of the sub-Saharan Africa (SSA). This study aimed to determine the scope of household, accessibility to malaria care and factors associated with household malaria in the Democratic Republic of Congo (DRC).MethodsThis was a community-based cross-sectional study conducted in an urban and a rural sites in which 152 households participated, including 82 urban and 70 rural households (1029 members in total). The ‘malaria indicator questionnaire’ (MIQ) was anonymously answered by household heads (respondents), reporting on malaria status of household members in the last 12 months.ResultsThere were 67.8% of households using insecticide-treated bed nets (ITN) only, 14.0% used indoor residual spraying (IRS) only, 7.3% used ordinary bed nets (without insecticide treatment), 1.4% used mosquito repelling cream, 2.2% combined ITN and IRS, whereas 7.3% of households did not employ any preventive measure; p < 0.01). In addition, 96.7% of households were affected by malaria (at least one malaria case), and malaria frequency per household was relatively high (mean: 4.5 ± 3.1 cases reported) in the last 12 months. The mean individual malaria care expenditure was relatively high (101.6 ± 10.6 USD) in the previous 12 months; however, the majority of households (74.5%) earned less than 50 USD monthly. In addition, of the responders who suffered from malaria, 24.1% did not have access to malaria care at a health setting. Furthermore, a multivariate analysis with adjustment for age, education level and occupation showed that household size (OR = 1.43 ± 0.13; 95% CI 1.18–1.73; p < 0.001), inappropriate water source (OR = 2.41 ± 0.18; 95% CI 1.17–2.96; p < 0.05) absence of periodic water, sanitation and hygiene (WASH) intervention in residential area (OR = 1.63 ± 1.15; 95% CI 1.10–2.54; p < 0.05), and rural residence (OR = 4.52 ± 2.47; 95% CI 1.54–13.21; p < 0.01) were associated with household malaria.ConclusionThis study showed that household size, income, WASH status and rural site were malaria-associated factors. Scaling up malaria prevention through improving WASH status in the residential environment may contribute to reducing the disease burden.

Effect of air mattress bed on the quality of hands-only chest compression

Objective To observe the effect of air mattress bed on the quality of chest compression during cardiopulmonary resuscitation (CPR). Methods This was a self-controlled study and included twenty formally CPR-trained doctors. According to the 2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, chest compression was randomly tested on a manikin for two minutes in A, B, C group. Group A was tested in ordinary bed, group B was compress in air mattress and hard backboard, and group C was tested in air mattress bed. There was a ten minutes rest between each compression. All compression data, including compression rate, depth, incomplete recoil and shallow number, were collected via real-time feedback device. Statistical analysis was performed using SPSS 22.0. Multiple groups were compared with One-way ANOVA and within groups were compared with t test. The enumeration data was analyzed by chi-square test. Results There was no statistically significant difference between groups in mean chest compression rates (107.9±5.1 vs. 107.7±4.56 vs. 109.7±4.86, P=0.6). Mean compression depth was significantly better in group A and B than in group C [(53.45±2.04) mm and (52.65±2.13) mm vs. (48.45±1.36) mm, all P<0.05)]. The number of shallow compression in group C was significantly higher than those in group A and B [(97.3±23.4) vs. (23.6±19.3) and (35.3±33.9), all P<0.05)]. The retention rates in group A was better than those in group B and C [(58.43±4.17%) vs. (62.51±4.37)% and (62.63±4.22)%, all P<0.05]. The compression depth of group C in the second minute was significantly less than that in the first minute (46.45±1.43 mm vs. 50.05±1.64 mm, P<0.05), and the number of shallow compression was more than the first minute (62.1±16.4 vs. 35.3±8.5, P<0.05). Significant difference in accuracy was observed among the three groups (33.64% vs. 28.66% vs. 19.24%, P<0.05). Conclusions The use of air mattress bed in CPR has a significant impact on the quality of manual chest compression. Eliminating the elasticity of air mattress bed would effectively improve the quality of chest compressions. Key words: Hands-only chest compression; Air mattress bed; Cardiopulmonary resuscitation; Quality of chest compressions

Vector control using LLIN/ITN: reduction of malaria morbidity in Bangladesh

Malaria is one of the major public health concerns due to re-emergence of the disease in Bangladesh in the 1990s. Currently it is endemic in 13 out of 64 administrative districts bordering India and Myanmar. Three hill tract districts (Khagrachhari, Rangmati, Bandarban) in the south-eastern part of the country report the highest incidences. The overall prevalence rate is 3.1% in the 13 endemic districts and 11% in 3 hill districts. BRAC initiated a pilot malaria control project in one of these hill districts in 1998. By 2004, the program expanded to all three hill tract districts covering 1.4 million population with the support from National Malaria Control Programme and with technical support from WHO. Later in 2007, BRAC led consortium of 20 partner NGOs started comprehensive implementation of the programme in all endemic districts with a population of 11 million in collaboration with the government and with financial support from the Global Fund to fight AIDS, TB and Malaria (GFATM). The aim was to control the vector, to prevent disease transmission, and to provide early diagnosis and prompt effective treatment services to reduce morbidity and mortality. Currently Long Lasting Insecticidal Nets (LLIN) are being distributed and ordinary bed nets are being treated with insecticide (Insecticide Treated Net- ITN) to the endemic districts. BRAC has selected female Community Health Workers from their own community and involved them to reach the poor and people living in areas with limited access to treatment services supplementing the government’s health care system. They provide home-based care of malaria diagnosis and treatment. They also provide malaria related information especially on malaria transmission, bed net usage, malaria symptoms and available treatment services at community level. Different sensitization meetings are conducted with opinion and religious leaders, local government and civil society representatives to increase awareness on malaria prevention and management. A recent survey showed that net utilization rate among children under five is 90% and among pregnant women is 85% in malaria endemic region. The national disease specific report shows a substantial decline in malaria cases from the baseline year 2008 (84,690 cases) to 2013 (26,891 cases), a 68% reduction of cases. Increased use rate of LLIN/ITN along with early seeking of home based malaria management is the key to success in malaria control.

Investigation of Vorticity Effects on Local Scouring

This paper describes a numerical model developed to simulate flow and bed deformation around hydraulic structures. The model uses an improved formula for the bed shear stress by applying vorticity effect and solves the full three-dimensional Reynolds-averaged Navier–Stokes equations to calculate the flow field. The capability for numerical models to predict local scour is severely restricted by the sediment transport formula. Up to now, the scour computations were developed based on general sedimentation formula through a straight unobstructed flow path. The new sedimentation formula introduced in this paper can take into account vortices that affect the local scour process. To verify the model, a bridge pier and a groyne, which are considered as typical river-engineering structures, were simulated in different hydraulic conditions by applying both the ordinary bed shear stress equation and the new one. Comparisons show that the new equation could predict the scour more accurately than the ordinary one.

Development of a PVDF Piezopolymer Sensor for Unconstrained In-Sleep Cardiorespiratory Monitoring

This paper reports the development of an unconstrained sensing technique for monitoring the respiration and heartbeats during sleep using a polyvinylidene fluoride (PVDF) piezopolymer film sensor with the aim that the sensor can be used on the ordinary bed together with the condition that the use of the sensor does not interfere the daily sleep of the patient under measurement. A PVDF film is used as the sensory material in the sensor system. The film is placed under the sheet at the location of the thorax to pick up the fluctuation of the pressure on the bed caused by the respiratory movement and heartbeats. Wavelet multiresolution decomposition analysis is used for the detection of respiration and heartbeat from the sensor output. It is shown that the respiration and heartbeats can simultaneously be detected by the sensor with the use of the wavelet multiresolution decomposition analysis.

A PVDF piezopolymer sensor for unconstrained cardiorespiratory monitoring during sleep

This paper presents an unconstrained sensing technique for the detection of the respiration and heartbeats during sleep using a piezopolymer PVDF film sensor with the aim that the sensor can be used on the ordinary bed together with the condition that the use of the sensor does not interfere the daily sleep of the patient under detection. A polyvinylidene fluoride (PVDF) film is used as the sensory material in the sensor system. The film is placed under the sheet at the location of the thorax to pick up the fluctuation of the pressure on the bed caused by the respiratory movement and heartbeats. Fundamental principle and the functional verification of the sensor system are described in details in the paper. It is shown that the respiration and heartbeats can simultaneously be detected by the sensor with the use of the wavelet decomposition analysis.

Physiological effects of acute and ordinary bed rest conditions on endurance trained volunteers

The aim of this study was to carry out a comparative study of water balance and water protein composition of the blood during exposure to acute (abrupt restriction of motor activity) and ordinary rigorous bed rest of 7 days. The studies were performed on 30 long distance runners aged 22–25 years old who had a VO 2 max of 66 ml kg −1·min −1 on the average. The volunteers were divided into three equal groups: the volunteers in the 1st group were under a normal ambulatory life conditions (control subjects), the volunteers of the 2nd group subjected to an acute bed rest (abrupt restriction of motor activity) regime (acute bed rested subjects) and the volunteers of the 3rd group were submitted to ordinary and rigorous bed rest (rigorous bed rested subjects). All volunteers were on an average of 13.8 km/day before taking part in this investigation. The 2nd and 3rd groups of volunteers were kept under a rigorous bed rest regime for 7 days. During the prebed rest period and actual bed rest period plasma volume (PV), total protein and protein fractions (albumins and globulins) and hematocrit were measured. Exposure to acute bed rest conditions induced a significant increase in hematocrit, hemoglobin concentration, protein fractions and marked decrease in (PV) and water balance which were significantly more pronounced than during exposure to ordinary rigorous bed rest. It was concluded that exposure to acute bed rest conditions induces significantly greater changes in water balance and water-protein concentration of the blood of endurance trained volunteers than exposure to ordinary rigorous bed rest conditions.

Etude de la formation d'un lit torrentiel Dune à forte pente et pavage

Stream beds exhibit chaotic features which are hardly understandable whereas they reflect the stream behaviour. We carried out some small-scale experiments in the aim of understanding their formation. As a first step a very small-scale model allowed us to quantify locally bed load and particle grading. Two distinct phenomena appeared : The hyperconcentrated bed load transport for which bed load is governed by hydraulic conditions. ln this case, the stream bed is relatively fine-grained and regular, the flow is rapid and the solid concentration is high. The particle grading - less important - increases the motion of big boulders. The ordinary bed load transport - close to the incipient motion threshold - for which the solid transport is quite variable and the Froude number varies around unity. Fine grains are easily moved which induces an armouring process. As a second step, using a wide open channel, we showed that the bed load intensity decreases when the bed width is able to increase. Additionally, the different morphological structures tend to stop fine and coarse grain motions while intermediate grains are moved downstream. The irreversibility of the bifurcation between hyperconcentrated and ordinary bed load transport leads to a strong spatial heterogeneity between these two phenomena. This diversity can be seen by the appearance of large scale morphological structures : steep slopes dunes.

Intensive care for the elderly.

In 1852 Florence Nightingale wrote, “It is valuable to have one place in the hospital where postoperative and other patients needing close attention can be watched”. Almost 100 years later, an American “anesthesia study commission” concluded that one-third of postoperative deaths in the first 24 hours could have been prevented by better nursing care. Yet it is only in the last 25 years that designated intensive care units have become a feature of acute hospitals in developed countries. In the United States, intensive care beds now comprise 15% of acute beds, and they cost at least two to three times more than ordinary ward beds. Over half the difference between “activity and treatment” in hospitals in the United States and in the United Kingdom is attributed to the much lower provision of intensive care in Britain (1), where such units comprise only 1% of acute hospital beds. Selection for intensive care is therefore more stringent than in the United States, as it is for other high technology procedures (e.g., coronary artery surgery and renal dialysis). However, even in the United States there is now reluctant recognition not only that health care as a whole has to be rationed, but also that unlimited access to high technology medicine is not always in the best interests of patients and their families. In particular the cost-benefit ratio of intensive care for certain types of patients has recently come under scrutiny at an NIH Consensus Development Conference (2) and at the Massachusetts General Hospital (3).

The Intermediate Coronary Care Unit-Reply

In Reply. —The comments by Frieden and Cooper show that they have missed the point of the article. The cost comparison should, indeed, be with ordinary rooms and not with the CCU. The thesis of the article is that there are too many intermediate care beds being used for patients who do not need monitoring and who should be in ordinary hospital beds—not in the CCU. I am not arguing that postmyocardial infarction patients should be denied step-down or intermediate monitoring. If intermediate unit monitoring was limited to postmyocardial infarction patients, the vast proliferation of monitored beds throughout the United States would not have occurred. The arithmetic that I quoted is correct. Most institutions charge a $2 to $3/hr monitoring fee plus an additional nursing charge of $5/hr. This means a minimum of $7/hr. This multiplied by 24 equals $168, which, multiplied by ten would be $1,680 additional fees over

Postural Rest in Pulmonary Tuberculosis

From our short experience of this form of treatment, and despite the relatively few patients who give their complete co-operation it has been the impression throughout the hospital that the response to postural rest far outweighs that of ordinary bed rest and appears to deserve more wholehearted approval and aclaim than any other single method of treatment. We are indebted to Mrs. Barton-Hoare for doing the photographic work connected with this article.

CARDIOVASCULAR AND PERIPHERAL VASCULAR DISEASES

It has long been known that improvement in peripheral blood circulation and cardiac efficiency can be obtained by certain postural changes, utilizing the effects of gravity to facilitate improved blood flow and tissue fluid exchange. This has been accomplished by elevation of the extremities, changing the position of the trunk and the application of elastic pressure over the more distant portions of the circulatory tree. The means adopted to accomplish these ends have included attachments to the ordinary hospital bed, specially designed chairs or mechanical arrangements in which centrifugal force can be used and, in addition, certain negative and positive air pressure machines. My interest in the problems of peripheral edema dates back several years. I observed that elderly patients with fractures of the lower extremities necessitating immobilization for several months developed edema that persisted for unduly long periods of time. Following the institution of postural changes in these cases, wherein

The Inefficiency of the Ordinary Bed Rest; Its Correction with a Thigh Support

The Inefficiency of the Ordinary Bed Rest; Its Correction with a Thigh Support

On the Structure of the Strata between the London Clay and the Chalk in the London and Hampshire Tertiary Systems

The preceding descriptions I believe embrace, with two or three exceptions, all the principal sections exhibiting the superposition of the basement bed of the London clay. Although, considering the extent of the line of outcrop, they are not very numerous, the intervals between them are sufficiently short to trace this deposit from place to place with considerable certainty. The details of each may vary in a few points, but they all present a general resemblance. This may not however be considered sufficient for our object—such thin and ordinary beds might be subordinate to some other portion of the Eocene series, and not peculiar to this part of them, and therefore some other proofs of their position may be thought necessary. In the first place, all the sections in the tertiary district show, by evidence of the clearest kind, that the London clay forms a nearly homogeneous mass, several hundred feet thick, of tough clay of a predominating brown colour—that throughout its whole body it nowhere presents any subordinate beds of a mineral character essentially different from that of its ordinary argillaceous type—and that its organic remains are very irregularly dispersed, abounding.in some parts and being entirely wanting in others. This clay occupies an area which is very well defined. Now wherever, without a single exception that I am aware of, the lower beds of this clay outcrop, there is found underlying them a basement bed of a conglomerate character and with or without organic remains—and these, if present, invariably belong