Hospital Providers Research Articles

Characteristics and outcomes of patients hospitalized for infection with Influenza A, SARS-CoV-2 or respiratory syncytial virus in the season 2023/2024 in a large German primary care centre

BackgroundIn addition to the persistence of SARS-CoV-2 infections, those with Influenza A/B and RSV have reappeared in 2022/23. To compare the development of prevalence, clinical outcomes and risk factors, we analysed data of the season 2023/24 from the same region/hospital as for 2022/23.MethodsPatients covering the whole age range with a positive polymerase chain reaction (PCR) test for SARS-CoV-2, Influenza A/B, RSV were included from the internal, neurological and paediatric units of the RoMed hospital Rosenheim, Germany/Bavaria, from August 1st 2023 to 29th February 2024.ResultsOf 932 patients included, 912 showed single infections with SARS-CoV-2, Influenza A or RSV (47.9% female, median age 68.0 years; 52.9% SARS-CoV-2, 23.2% Influenza A, 21.8% RSV). Co-infections (2.0%) and Influenza B (0.1%) were negligible. In patients of age ≥ 18 years (n = 628, 68.5% SARS-CoV-2, 26.0% Influenza A, 5.6% RSV), patients with Influenza A were younger compared to SARS-CoV-2 (p < 0.001), with RSV similar to SARS-CoV-2. Heart failure and asthma were the most prevalent comorbidities for RSV, immunosuppression for Influenza A. Admission to Intensive Care Unit (ICU) occurred in 111 patients (17.0% of SARS-CoV-2, 17.2% Influenza A, 28.6% RSV), and 59 patients died (8.8% SARS-CoV-2, 8.6% Influenza A, 20.0% RSV). Low-flow oxygen supplementation and non-invasive ventilation (NIV) were most frequent for RSV (68.6% and 20.0%, respectively), oxygen demand upon admission for Influenza A (39.3%), without differences in high-flow oxygen supply or length of hospital stay. Among patients aged < 18 years (n = 284, 21.4% SARS-CoV-2, 18.0% Influenza A, 57.1% RSV), 15 were admitted to ICU (4.8% SARS-CoV-2, 3.8% Influenza A, 6.0% RSV); none of them died. Oxygen supply via high-flow, low-flow or upon admission was highest for RSV (23.8%, 70.2%, 21.4%, respectively), as well as the length of hospital stay.ConclusionBetween 8/2023 to 2/2024, a large population of patients hospitalized due to respiratory tract infection, showed relative contributions of SARS-CoV-2, Influenza A or RSV similar to those in 2022/23. The findings underline that in both, adults and children, RSV posed a relatively higher clinical risk than Influenza A and SARS-CoV-2, though absolute numbers remained highest for SARS-CoV-2.

Characterizing hospitalists’ comfort and familiarity with LGBTQ clinical topics

ABSTRACT Objectives Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S. inpatient provider workforce, this paper’s objective was to understand hospitalists’ comfort with LGBTQ health. Methods A 58-question anonymous online survey was distributed in 2019 to practicing hospitalists through the Society of Hospital Medicine regarding their experiences in caring for hospitalized LGBTQ patients. Results Two hundred and eighteen hospitalist providers completed the entire survey. While hospitalists reported high levels of comfort in caring for these populations (LGBQ: 90.6%, Transgender: 77.8%), they acknowledged feeling less confident in their clinical competence (LGBQ: 71.6%, Transgender: 51.2%). Hospitalist providers who were themselves LGBQ reported more comfort with most aspects of LGBQ patient clinical care than heterosexual respondents (p < 0.05 for 4 of 6 comfort variables). Seventy-four percent of hospitalists wanted training to advance their knowledge and skills in working with LGBTQ patients. Conclusions Hospitalist clinicians are regularly exposed to LGBTQ patients yet their comfort and expertise in caring for this vulnerable population is highly variable. Educational interventions that include reflective practice may serve to optimize hospitalists’ ability to more confidently and competently serve LGBTQ patients.

Social sustainability in the hospitality and tourism supply chains: what can we learn from existing research and what remains unexplored?

PurposeThis research systematically reviews the literature on social sustainability within hospitality and tourism supply chains (H&amp;T SCs). The aim is to identify research approaches, emerging themes, geographic and sectoral scopes and current gaps in understanding social sustainability practices in this sector.Design/methodology/approachThe review has been carried out using the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines” (PRISMA). The authors analyzed 17 peer-reviewed journal papers from 2008 to the present.FindingsEarly research focused on qualitative methods and developed countries, while recent studies have shifted to quantitative approaches. There is a notable gap in using multi-criteria decision-making for social sustainability. The review identified eight categories of social practices, with the most attention given to “society and community development” and the least to “human rights.”Research limitations/implicationsTo enhance social sustainability, businesses and policymakers should focus on improving supply chain collaboration, standardizing social sustainability metrics, assessing stakeholder perceptions and supporting small enterprises in developing countries. This review is limited to English open-access journals and excludes studies in other languages. Additionally, by not including articles on sustainable tourism or development – which often emphasize environmental and economic aspects – important social dimensions may have been overlooked. Future research should broaden search parameters to achieve a more comprehensive understanding of social sustainability in H&amp;T SCs.Originality/valueThis study addresses a critical gap in the literature on social sustainability within H&amp;T SCs, particularly in databases like Web of Science and Scopus, offering new insights and directions for future research.

Quality of neonatal health care in comprehensive specialized hospitals, Amhara Region, Ethiopia: a retrospective study with neonatal death audit

BackgroundNeonatal health is one of the targets for the sustainable development goals (SDGs) that aim to reduce neonatal mortality to at least as low as 12 per 1 000 live births in 2030. However, the world is not on track to achieve this target. The problem has worsened in many low-income countries, including Ethiopia, due to a fragile health system, as well as health crises such as the COVID-19 pandemic, conflict, food insecurity and climate change. According to the Mini Ethiopian Demographic Health Survey, neonatal mortality is unacceptably high in Ethiopia in general, and in Amhara region in particular. Despite these facts, there is a paucity of information on the quality of neonatal health service provision in comprehensive specialized hospitals in Amhara region. Therefore, this study is aimed at assessing the quality of neonatal health services in terms of outcome (neonatal mortality) and its causes in comprehensive specialized hospitals in Amhara region.MethodsA multi-center retrospective study was conducted (from September 1–30/2022) on 315 neonates in four comprehensive hospitals with chart review. Data were collected through death audit with standardized neonatal death audit tool. Data were entered into Epi-data 3.1 and exported to SPSS 20 for analysis. Descriptive analysis was used to describe and summarize the data in an informative manner.ResultsFrom 315 neonatal deaths, about two-thirds, 205 (65.1%), were from rural areas. Nearly half, 151 (48%), of the mothers had complications and delivered outside a health facility. About 36 (11.4%), 45 (14.3%), and 21 (6.7%) neonates’ mothers had 1st, 2nd, and 3rd delays, respectively. About 59 (19%) of mothers had membrane rupture before the onset of labor and 23 (7.3%) had meconium-stained liquor. Almost three-fourths, 226 (71.7%), of the deaths were low birth weight (< 2500 gram). About 25 (8%) of neonates had congenital anomalies, 65% of them had fast breathing and 54.6% were preterm.ConclusionHigher proportions of neonatal deaths were observed among neonates with rural residence, low birth weight, mothers’ complications and neonates admitted for fast breathing. Histories of abortion, complications, congenital anomalies, and the 3 delays contributed to neonatal deaths.

Revisiting the effects of state anesthesia policy interventions: A comprehensive look at certified registered nurse anesthetist service provision in U.S. hospitals from 2010 to 2021.

Rural hospitals in the United States often rely on nonphysician providers such as advanced practice nurses to care for their patients. One important role that is served by advanced practice nurses is that of anesthesia provider (certified registered nurse anesthetist or CRNA). In 2001, Centers for Medicare & Medicaid Services (CMS) passed an opt-out law affording state governors the right to loosen physician supervision requirements on CRNAs in their respective states, thus potentially improving access in targeted areas. Since then, 24 states have adopted these opt-out provisions. We aim to understand the extent to which the CMS opt-out law has resulted in increased CRNA service provision in hospitals, especially in rural areas. The study used a longitudinal design. We compiled 2010-2021 American Hospital Association data, which includes 4,464 unique U.S. hospitals observed an average of 8 times annually (35,863 total hospital-year observations). We model CRNA services provision at the hospital level using longitudinal mixed effects generalized linear models that incorporate state, county, and hospital control variables. Using descriptive statistics and mixed effects generalized linear models, we discovered that adopting opt-out provisions does not universally result in increased CRNA service provision in U.S. hospitals. Notably, opt-out provisions do not improve access in rural counties. However, in supplemental analysis, we discover some of the conditions under which the likelihood of CRNA service provision is influenced. Hospitals often utilize CRNAs to staff their hospitals. However, many hospitals use both CRNAs and physician anesthesiologists; this can be a potential source of contention and confusion, given the lack of uniformity in thescope of practice policies. We offer some suggestions with regard to the effects of state interventions into the field, and how they might impact this dispute. Lastly, policymakers should consider additional measures to address rural access limitations, as the opt-out policy does not seem to be working as intended.

Integrating Forecasting &amp; Planning Management for Sustainable Hospital Supply Chains and Societal Advancement

Integrating Forecasting &amp; Planning Management for Sustainable Hospital Supply Chains and Societal Advancement

Factors Affecting Hospital Provision of Health-Promoting Services Transferred to Provincial Administration in Thailand.

Following the transfer of hospital services to provincial government oversight, it is essential to understand how such changes impact service quality and efficiency. This study, conducted from 1 March 2023 to 31 March 2024 at sub-district health-promoting hospitals in Thailand, aims to identify the factors affecting hospital service quality post-transfer and evaluate the role of professional nurses in maintaining service standards under new governance. Utilizing a mixed-methods design based on the Global Fund-HSS framework (2012), which categorizes factors into accessibility, processes, productivity, and outcomes, we collected data from 340 nurses and 400 patients through structured questionnaires. These questionnaires were divided into seven sections, capturing metrics such as the personal data of nurses, hospital service activities, and leadership qualities. We employed a Likert scale to gauge the perceptions and expectations of service quality and conducted paired t-tests to compare performance metrics before and after the administrative transfer. One-way ANOVA was used to assess variability among different service units, and binary logistic regression helped identify the key determinants of service quality. The analysis revealed a significant correlation between the attitudes and competencies of healthcare teams and the levels of service quality. Notably, service units transferred less than 50% exhibited minimal changes, indicating that the degree of transfer significantly impacts service outcomes. Despite these variations, the fundamental mission of promoting health remained consistent. The study emphasizes the critical role of nurses and recommends further research to identify additional factors that could improve service quality in transferred healthcare facilities, potentially contributing to enhanced healthcare delivery across restructured health systems.

Use of half red blood cell units in oncology patients during severe shortages to extend hospital supply.

The COVID-19 pandemic exerted an unprecedented impact on the blood supply from 2020 through 2022. As a result, throughout 2021 there were months our hospital had less than one-day supply of type O RBCs. To meet transfusion needs, whole RBC units were split into half units and issued to stable, non-bleeding patients. This single-institution, retrospective study examines time intervals to subsequent transfusion and total numbers of RBC units subsequently transfused after the first half or whole RBC unit. Patients who were transfused RBC between May 21, 2021 and November 1, 2021 were divided into in- and outpatient groups, then based on whether they received at least 1 half RBC unit or only whole RBC units during the study period. The time interval between this first half unit transfusion, or first whole unit transfusion in those who did not receive half units, and the subsequent RBC transfusion within 90 days was calculated and compared, as well as the total number of RBC units transfused 30 days after the first unit. In general, patients transfused with half units received a subsequent transfusion significantly earlier than those transfused with whole units. Additionally, receiving an index half unit was associated with more RBC transfusions in the following 30 days (p = .001). Transfusion of half RBC units during a severe RBC blood shortage can temporarily decrease RBC usage but will result in a shorter interval to the next transfusion and greater total number of RBC units transfused in subsequent days.

Supply chain resilience in the tourism and hospitality industry: A comprehensive examination of driving and restraining forces

Supply chain disruptions and a lack of resilient supply chains have adverse impact on the global economy. Particularly, complex nature of the tourism and hospitality industry makes it even more susceptible to failure when supply chain resiliency is rather low or does not exist. However, despite its significance, a comprehensive and systematic examination of building resilience in tourism and hospitality supply chains (THSCs) is lacking in the extant literature. The purpose of this study is to develop a comprehensive framework that outlines the driving and restraining forces for building resilient THSCs. The decision framework proposed in this study integrates rough interval valued neutrosophic (RIVN) force field theory of change with RIVN-ISM-MICMAC methodology. The results showed that the restraining forces, such as lack of effective regulations and incentives and effective organizational and supply chain policies are the primary factors that constrain improving resilience in THSCs. Theoretical and practical implications are discussed.

Antimicrobial bathing of the critically ill for the prevention of healthcare-associated infection at a hospital in California

Background: Patients in the intensive care unit (ICU) have invasive lines increasing their risk for healthcare-associated infections (HAIs). Our objective was to determine if antimicrobial bathing with 2% chlorhexidine gluconate (CHG) compared to the colloidal silver-based antimicrobial product would reduce the incidents of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: We performed a before-and-after study in four adult ICUs at a two-hospital facility in California. Prospective surveillance of CLABSI and CAUTI prevention bundles monitoring was established. The intervention consisted of daily bathing with CHG for all patients in the ICUs. A baseline period of one year was followed by an intervention period of one year. The incidence rates of CLABSIs and CAUTIs were compared between the baseline and intervention periods utilizing a t-test analysis. Results: A total of 10103 patients were included. At Facility A, a mean CLABSI rate of 2.43/1000 central line catheter days (CL) with 2149 patients days (Mean differences 95% CI -0.5–3.1; P&gt;0.0975), during the baseline period followed by 1.11/1000 CL days with 2193 patient days in the intervention period. At Facility B, the mean CLABSI rate of 1.82/1000 CL days with 2976 patient days (Mean differences 95% CI -0.6–2.31; P&gt;0.161) during the baseline period was followed by 1.01/1000 CL days with 2785 patient days in the intervention period. At Facility A, the mean CAUTI rate of 1.37/1000 indwelling catheter days (IUC) with 2149 ICU patient days (Mean difference 95% CI is 0.28–1.97; P 0.2160) was noted in the baseline period, followed by 0.45/1000 IUC days with 2785 in the intervention period. Conclusion: Daily bathing with CHG significantly reduced the incidence of CAUTI at Facility A. It is unclear why Facility A saw a statistically significant reduction in CAUTI, but Facility B did not. The difference in outcomes may be related to hospital size, service lines, supply constraints, and discrepancies in staffing. CHG bathing was not directly associated with a reduced risk of CLABSI at Facility A and B during our limited study, but it was encouraging enough that our organization will continue this intervention to obtain additional data to determine if bathing with CHG will reduce CLABSI and CAUTI.

Analysis of The Influence of Supplier and Government Partnerships on Hospital Supply Chain Performance

Analysis of The Influence of Supplier and Government Partnerships on Hospital Supply Chain Performance

STRATEGIC IMPERATIVES FOR DIGITISATION OF THE UKRAINIAN PHARMACEUTICAL INDUSTRY

The purpose of the paper is to identify the strategic imperatives of the pharmaceutical industry in the context of the development of the digital economy. Inclusion of the pharmaceutical industry in the list of priority sectors of the economy will help attract state investment support for production and increase the number of jobs. This will help to prevent a collapse in the supply of medicines and medical devices to the healthcare system and ensure their uninterrupted production and supply to the end consumer. The population of Ukraine will have access to quality medicines and medical products. Methodology. The article presents an analysis of the indicators of the pharmaceutical industry for the period 2019-2023. These include the volume of import and export of pharmaceutical products, the structure of the main marketing organisations in the pharmaceutical market, leading drugs in terms of sales volume on the Ukrainian market, the structure of sales of "pharmacy basket" products, and the volume of hospital supplies in terms of funding sources. This paper analyses the main trends of digitisation in the pharmaceutical industry at the global level and in Ukraine in particular. A SWOT analysis was conducted to assess the development of the pharmaceutical industry in Ukraine. The analysis focused on identifying the key factors that contribute to the successful development of e-commerce in the pharmaceutical industry. Results. The publication identifies the main positive and negative manifestations of digitalisation of the pharmaceutical industry in Ukraine and the factors that hinder its development. Practical implications. Thus, the introduction of digitalisation tools in the Ukrainian pharmaceutical industry is an important step towards improving its competitiveness. The deployment of smart manufacturing systems makes it possible to produce medicines faster and more accurately. Such technological solutions can help to optimise the supply chain, which is important for the pharmaceutical industry, where the accuracy and speed of supply of medicines is critical. The use of digital technologies improves control over the safety of pharmaceutical products and increases production efficiency. Automation of business processes through the use of AI, VR, AR, cloud computing, big data, etc. can help reduce production costs and improve product quality. However, the implementation of digitalisation technologies in the pharmaceutical industry also requires significant investments and qualified personnel, which may temporarily reduce competitiveness due to higher prices for finished products.

The impact of Chinese volume-based procurement on pharmaceutical market concentration.

Optimizing the pharmaceutical industrial structure is the key mission of China's healthcare reform. From the industrial structure perspective, this study empirically evaluated the impact of China's national volume-based procurement (NVBP) policy on market concentration in the hospital-end drug market. This study used drug procurement data of China's public medical institutions which obtained from the national database. A quasi-natural experiment was designed involving eleven pairs of matched treatment-control region combinations, with NVBP policy as the intervention measure. The market was defined by drug name (molecular boundary) and city/province (geographical boundary). Market changes were measured from three dimensions: the number of enterprises and products, market share, and Herfindahl-Hirschman index (HHI). Dual comparison approach and difference-in-difference (DID) method with fixed effect model were applied to quantify policy impacts. The number of enterprises and products decreased by 18 and 83 in pilot regions after NVBP policy, far more than the decreases in control regions (6 and 21). The accumulative market share of 15 bid-winning enterprises increased by 53.67% in volume and 18.79% in value, among which the increment of enterprises with low baseline market share was more prominent (66.64% and 36.40%). Among three enterprise types, the market share of generic consistency evaluation (GCE) certificated generics significantly increased, GCE uncertificated generics significantly decreased, and originators slightly decreased. DID models indicated significantly positive impact of NVBP policy on market concentration, with HHI-volume and HHI-value increasing by 49.33% (β = 0.401, p < 0.01) and 21.05% (β = 0.191, p < 0.01). The implementation of NVBP promoted the intensive drug circulation and supply of Chinese public hospitals, intensifying the exit of GCE uncertificated generics from the hospital-end market. NVBP combined with GCE standards significantly improved market concentration, which brought a positive signal of pharmaceutical industrial structure optimization in China. In the future context of normalized and institutionalized NVBP, the balance should be further sought between low drug prices and reliable hospital drug supply, sustainable industry development.

Educating and empowering health care teams who present to the hospital to recognize and intervene on cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) in patients on bispecific t-cell engager therapy (BiTEs): A quality improvement study.

e23212 Background: Treatment of oncologic disease with Bispecific T-Cell Engager antibodies (BiTEs) are an emerging novel immunotherapy with demonstrated efficacy in multiple hematologic malignancies. Notable side effects of BiTE therapy include cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS), which can be life-threatening and must be rapidly identified. We aim to fill knowledge gaps surrounding CRS and ICANS for medical providers, particularly considering increased use of BiTE therapy. We hope that educating providers will allow faster recognition and treatment and will improve patient outcomes. Methods: Our study focused on the impact of educational presentations on awareness and identification of CRS/ICANS. Our intervention targeted the residents and attendings in the emergency department and the nurses, advanced practice providers, and hospitalists in the bone marrow transplant (BMT) unit at Stony Brook University Hospital. Anonymous surveys consisting of 9 multiple choice questions were conducted to assess baseline foundational knowledge of CRS/ICANS. QI consisted of a 15-minute educational presentation for both groups. The same surveys were repeated following the presentations to assess improvement in overall knowledge of CRS/ICANS. A two tailed independent T test was used to calculate significance. Results: The average pre-survey score for the emergency department (N = 37) was 39%. The average presurvey score for the BMT department (N = 13) was 45%. Significant improvements in scores after intervention were shown in both the emergency department (39% vs 66%, p = 0.0001) and the BMT department (45% vs 68%, p = 0.0006). Conclusions: Education among emergency department and hospitalist providers is essential in improving management of CRS and ICANS in patients treated with BiTEs. This quality improvement initiative confirmed a knowledge gap in CRS and ICANS amongst our healthcare teams. By providing educational resources to both departments, there was a significant improvement in this gap. Future directions for continued improvement in the detection and management of CRS/ICANS include patient medication identification cards, a central repository of treatment protocols, algorithms, and toxicities associated with BiTEs, and expanding our educational curriculum which are all currently under development at Stony Brook University Hospital.

Assessing the Efficiency of Municipal Infrastructure - Case study in Vaaniyambadi Municipality, Tamilnadu, India

Abstract: This document discusses the evaluation of infrastructure facilities in Vaniyambadi, with the aim of improving the quality of life by addressing the issues and suggesting ways to enhance these facilities. The study focuses on physical infrastructure, including water supply, sewage and drainage, solid waste management, and electricity supply. It highlights the need for alternate water sources, additional pumping stations, and proper distribution of overhead water tanks to ensure equal access to water. It also emphasizes the importance of covering open drains, installing sewage treatment plants, and raising awareness about proper waste management to create a cleaner and healthier environment. Furthermore, the document addresses social infrastructure, particularly healthcare facilities and educational institutions. It suggests improvements such as increasing the number of beds and water supply in government hospitals, enhancing security systems in schools, and promoting collaboration between the community and municipal workers to maintain cleanliness. The document concludes by emphasizing the significance of infrastructure in driving economic and social development and the need for continuous improvement and modernization. Keywords: Municipal infrastructure, Physical infrastructure, Social infrastructure, Solid waste management , water supply

Implementing the Lean 5S process improvement to boost efficiency and cost savings in hospital supply rooms.

A strong link exists between adequate supply chain management and nurse efficiency and satisfaction. Implementing Lean methodology, specifically 5S process improvement, staff created a unit-based supply room that was clean, safe, and well organized which led to reduced waste, greater efficiency, and cost savings.

A smart inventory management system with medication demand dependencies in a hospital supply chain: A multi-agent reinforcement learning approach

In light of the intense need for quality health and well-being, the healthcare industry must improve its operations by strengthening its service delivery and reducing overall costs. A smart inventory management system for managing medicines in a hospital supply chain (HSC) is one of the best solutions as its advantages ensure availability of affordable medicines as well as inventory cost reduction. Significant effort is made on inventory management from literature; however, smart inventory systems for HSC considering the various complexities and uniqueness of healthcare systems are limited. This paper attempts to fill this gap by developing a stochastic semi-Markov decision process model which is solved by a multi-agent reinforcement learning method. Data collected from a multispecialty hospital in India’s eastern region serves to validate the proposed model. The results present the optimal order quantities and optimal inventory control policy for the HSC considering the uncertain medication demand at the hospital pharmacy and multiple point-of-care units, and demand dependencies among medicines prescribed to the patients admitted in the hospital. The study also has significant managerial implications for enhancing HSC’s inventory performance, improving the healthcare service delivery, reducing healthcare cost, thereby ensuring the affordable, accessible, and quality healthcare to the society.

Improving efficiency in nitrous oxide hospital supply systems to aim towards a carbon neutral NHS Wales

&#x0D; Background: Nitrous oxide (N20) is a greenhouse gas with a global warming potential of 280 times that of carbon dioxide. This project aims to identify potential nitrous leak and reduce the waste of N20 in Glangwili Hospital, a small district general hospital in South Wales. &#x0D; &#x0D; &#x0D; Methods: British Oxygen Company (BOC) supplied us with data on how much N20 was supplied to, and returned from, the hospital between 2021-2022. Data was collected from the anaesthetic machines over a period of three months, looking at the consumption of N20. A leak test of the piped nitrous system was performed during which no nitrous was used. Lastly, anaesthetists were surveyed on their practice with regards to N20. &#x0D; &#x0D; &#x0D; Results: On average, Glangwili purchased 54,000L of N20 per month and consumed 2109L, a usage of 3.9%. The leak test identified a leak of 1.3L/min. From the survey of local anaesthetists, 80% of respondents state they use N20 only four times a year or less. &#x0D; &#x0D; &#x0D; Conclusion: This project has identified that 96% of the N20 purchased does not reach the patient. These findings are consistent with results from Cardiff and Vale University Health board, where a similar project was performed, and other audits across the United Kingdom. These results should encourage other health boards, including smaller hospitals, to investigate the efficiency of their N20 supply, as significant gains could be made in our steps towards carbon neutrality. &#x0D;

A Single-Port, Multiple-Access, Custom-Made Device Used in Laparoscopically Assisted Cryptorchidectomy in Standing Horses-A Preliminary Study.

This study evaluates a new multiport device with single access to the abdominal cavity produced with routine hospital supplies that could be applied to laparoscopically assisted cryptorchidectomy in standing horses. Initially, the new device was evaluated on five cadavers of bovine fetuses (n = 5), placed assisted in a minilaparotomy performed in the flank region. Subsequently, the device was evaluated in four cryptorchid horses treated during the hospital routine. During the evaluation of the new device, the possibilities of exploring the abdominal cavity, inspection, and intra-abdominal manipulation with two Babcock forceps were verified. The possibilities were described, and surgical time data were recorded and analyzed using descriptive statistics. In the cadavers, a wide exploration of the abdominal cavity was possible, with a laparoscopic inspection through the right paralumbar fossa and manipulation of intra-abdominal structures with Babcock forceps inserted by the new device. In cryptorchid horses, laparoscopically assisted cryptorchidectomy with a new device was feasible in two patients, and in the others, it allowed the diagnosis of adhesions and ectopic locations in the inguinal region of testicles retained in the cavity. Therefore, the new device was efficient in exploring the inguinal region of cryptorchid horses in the standing position. The present study is preliminary and can support future studies that aim to improve the developed prototype.

Utilization of data and information flows for enhancing a chambermaid scheduling decision making in a smart hospitality supply chain

Utilization of data and information flows for enhancing a chambermaid scheduling decision making in a smart hospitality supply chain