Reduce Hospital Costs Research Articles

Application of Rapid Rehabilitation Nursing in Perioperative Period of Laparoscopic Radical Prostatectomy for Prostate Cancer Patients

The purpose of the study is to explore the application of rapid rehabilitation nursing strategy in the perioperative period of laparoscopic radical prostatectomy for patients with prostate cancer. A total of 120 patients with prostate cancer undergoing laparoscopic radical prostatectomy were randomly divided into two groups, with 60 cases per group. The control group was given routine nursing care, and the experimental group received rapid rehabilitation nursing strategies. The stress hormone (cortisol and norepinephrine) levels, patient satisfaction, length of hospitalization, hospitalization costs, and postoperative complication were compared between the two groups before and after nursing. The serum cortisol and norepinephrine levels in the control group before nursing were similar to those in the experimental group ( P > 0.05 ). The stress hormone levels in the experimental group were lower than those in the control group ( P < 0.05 ). It was found that the experimental group had reduced operation time, less intraoperative blood loss, shortened exhaust time, and hospitalization stay and was earlier to eat and to get out of bed than the control group ( P < 0.05 ). The time for the patients in the experimental group to pull out the drainage tube was significantly shorter than that of the control group ( P < 0.05 ), and the hospitalization costs were fewer than the control group ( P < 0.05 ). The rates of postoperative complications including nausea, vomiting, bleeding, and fever in the experimental group were significantly lower than those in the control group ( P < 0.05 ). In conclusion, the study suggests that rapid rehabilitation nursing strategies can reduce the stress hormone levels, shorten the length of hospitalization, reduce hospitalization costs, reduce postoperative complication rates, and improve patient satisfaction for prostate cancer patients undergoing laparoscopic radical prostatectomy, in support of clinical application.

Psychosocial characteristics influence the duration of hospitalization in patients with psychotic disorders

IntroductionSchizophrenia spectrum disorders are related with prolonged stay in hospital and high cost for treating them. As a consequence, the determination of the factors that affect the duration of hospitalization is essential.ObjectivesThe purpose of the study is the determination of the psychosocial characteristics of inpatients in a public psychiatric hospital and their association with the duration of hospitalization.MethodsA total of 103 patients with a diagnosis of Schizophrenia (according to ICD-10) participated in the study. The socio demographic characteristics were recorded and the following psychometric tools were used: NEO- Five Factor Inventory, Connor-Davidson Resilience Scale (CD-RISC25), Multidimensional Scale of Perceived Social Support, Multidimensional Scale of Perceived Social Support (MSPSS), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning scale (GAF).All instruments were adapted to greek population. All statistical analysis was performed using SPSS v.25.ResultsThe median length of hospital stay was 40,7 days. The number of previous admissions (p=0,010), the type of admission (compulsory or voluntary) (p=0,017), the physical restrain (p=0,043), the duration of restrain (p=0,002) as well as the existence of social support networks and in particular social support from friends (p=0,018), seem to affect the duration of hospitalization.ConclusionsThe present study underlines the signification of the psychosocial factors that could contribute to the prediction of longer hospitals stays, the planning of appropriate interventions and as a result the reduction of hospital costs.

Insuficiência Cardíaca Crónica em Hospitalização Domiciliária

INTRODUÇÃO: A insuficiência cardíaca crónica é considerada, a nível mundial, a principal causa de internamento em doentes com idade superior a 65 anos. A Unidade de Hospitalização Domiciliária (UHD) foi criada com o objetivo de minimizar as complicações hospitalares, proporcionar maior qualidade de vida e atingir melhores resultados funcionais.MATERIAL E MÉTODOS: Estudo retrospetivo de um ano de hospitalização domiciliária da Unidade Local de Saúde de Castelo Branco, destacando apenas doentes internados por descompensação da insuficiência cardíaca crónica.RESULTADOS: Neste período foram internados 99 doentes, 23,3% por descompensação da insuficiência cardíaca crónica. Eram do sexo masculino, 52,1%. A idade média foi de 79,8 anos (±10,6). O tempo médio de internamento foi de 6,7 dias (±3). As principais causas da insuficiência cardíaca foram: hipertensão arterial (43,4%) e arritmias (30,4%). O principal fator de descompensação foi infeções (69,5%). Estiveram sob perfusão inicial de furosemida, 56,5%. Evoluíram favoravelmente 95,6% (n=22) dos doentes e 4,3% (n=1) foi transferido para o internamento convencional. Segundo a escala de NEWS, 7,9%-12,7% dos doentes tinham risco de serem admitidos em unidade de cuidados intermédios/intensivos ou morrer entre 60 dias. O índice de comorbilidades de Charlson foi de 3-10 pontos e a sobrevivência num período de 10 anos estimava-se em 0%-77%. Noventa dias após a alta, 69,5% não regressaram à urgência nem foram reinternados.CONCLUSÃO: A hospitalização domiciliária em doentes com insuficiência cardíaca é vantajosa por proporcionar maior conforto ao doente e reduzir as complicações. Estudos demonstraram que a hospitalização domiciliária aumentou o tempo entre as readmissões, melhorou a qualidade de vida dos doentes e reduziu os custos das hospitalizações.

Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

AbstractObjectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients.Design Present one is a prospective, observational study.Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital.Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery.Interventions ET versus LT was measured in the study.Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089).Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

Hospital-Based Nursing Research: Clinical and Economic Outcomes.

We surveyed 181 nursing research leaders from Magnet® hospitals, using mixed methods with the online Hospital-Based Nursing Research Clinical and Economic Outcomes survey, to describe the clinical and economic outcomes of nursing research conducted in hospital settings. We used descriptive statistics to analyze the quantitative findings and a qualitative descriptive approach to study the open-ended responses. Most respondents reported that findings from their hospital-based studies were implemented on their units (88.2%), improved health care processes (88.2%), and reduced hospital costs (79%). Over 50% reported positive impacts on core quality measures, including improving patient/family satisfaction (76.8%), nurse satisfaction (65%), length of stay (59.1%), and infection rates (56.5%). Four themes were identified: study evaluation, improvements in care delivery/clinical outcomes, economic impact, and intrinsic and extrinsic rewards. Much of the research reported by respondents focused on quality measures with findings that resulted in improved clinical and economic outcomes.

Deep Learning Identifikasi Tanaman Obat Menggunakan Konsep Siamese Neural Network

One of the roles of humans in community empowerment activities is in the health sector. Community empowerment in this field can be carried out through efforts to improve community health by utilizing family medicinal plants. The purpose of using family medicinal plants is so that the community can preserve these plants, reduce hospital costs, and serve as access to first aid for health if health services are difficult to reach. Based on this explanation, to increase public knowledge and understanding of the types of Toga and its benefits as a medicinal ingredient, it can be done several ways. One of them is through an in-depth learning approach. The deep learning approach with Siamese Neural Network is by comparing two patterns and producing an appropriate output based on the similarity of the two patterns. The application of Siamese Neural Network with an Android Smartphone is the right choice because it can facilitate the community in terms of usage. Based on these problems, the writer wants to build an application that can identify plants based on Android-based leaf images by applying the Siamese Neural Network approach. In this study, the results achieved were that the Siamese Neural Network could be implemented on Android-based smartphones. The application was able to identify family medicinal plants based on leaves.

Pressure Injury Prevention in Patients with Prolonged ED Stays Prior to Admission.

The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.

Endoscopic ultrasound-guided gastroenterostomy versus open surgical gastrojejunostomy: clinical outcomes and cost effectiveness analysis.

Early data suggests that endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a safe and efficacious option for gastric outlet obstruction (GOO). However, there is a scarcity of data comparing outcomes with open gastrojejunostomy (OGJ). Single-center retrospective cohort study of adult patients hospitalized with GOO who underwent EUS-GE or OGJ between January 1, 2014 and February 28, 2020. Primary outcomes were technical and clinical success. Sixty-six patients were included of which 40 (60.0%) underwent EUS-GE and 26 (40.0%) underwent OGJ. Baseline characteristics were similar with respect to age (70.5 vs 69.7, p = 0.81), sex (42.5% vs 42.3% female, p = 0.99), median length of follow-up (98.0 vs 166.5days, p = 0.8), prior failed intervention for GOO (22.5% vs 26.9%, p = 0.68), and the presence of altered anatomy (12.5% vs 30.8%, p = 0.07) between EUS-GE and OGJ, respectively. Technical success was achieved in 37 (92.5%) of EUS-GE and 26 (100%) of OGJ patients (p = 0.15). EUS-GE was associated with faster resumption of oral intake (1.3 vs 4.7days, p < 0.001) and shorter length of stay (5 vs 14.5days, p < 0.001). There were no significant differences in symptom recurrence (17.5% vs 19.2%, HR 1.85, CI 0.52-6.65, p = 0.34), reintervention (20% vs 11.5%, HR 0.82, CI 0.22-3.15, p = 0.78), death within 30days (12.5% vs 3.8%, HR 0.80, CI 0.09-6.85, p = 0.84), or 30-day readmission (17.5% vs 24.1%, HR 1.69, CI 0.53-5.41, p = 0.37) between EUS-GE and OGJ, respectively. EUS-GE patients initiated chemotherapy sooner (17.7 vs 31.3days, p = 0.033) and had lower overall costs as compared to OGJ ($49,387 vs $124,192, p < 0.001). There were no significant differences in technical or clinical success, symptom recurrence, reintervention, 30-day readmission, or 30-day mortality between EUS-GE and OGJ. EUS-GE patients experienced shorter delays to resumption of oral intake and chemotherapy, had shorter lengths of stay, and reduced hospital costs. Further prospective comparative studies are warranted to verify our results.

Impact of Enhanced Recovery After Bariatric Surgery (ERABS) Protocol in Reducing Length of Stay and Hospitalization Costs: the Experience of a Philanthropic Hospital in Brazil.

The global prevalence of obesity and increase in bariatric surgeries are burdening the healthcare system. Enhanced recovery postoperative protocols are associated with a reduction in hospitalization costs and length of stay (LOS) and may be an alternative to reduce public health expenses. To assess the impact of implementing a customized Enhanced Recovery After Bariatric Surgery (ERABS) protocol on hospitalization costs (HC), LOS, and complication rates. Santa Marcelina Hospital, São Paulo, Brazil. A retrospective electronic health record analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy and who were cared for within a clinical pathway (CP) protocol (Jan. 2016-Aug. 2018) or after implementation of an ERABS protocol (Aug. 2018-Jun. 2019). The LOS, HC, and complication, readmission, and reoperation rates were compared between the two groups. Eighty-two patients were included in the study (CP, 56, 87.5% women; ERABS, 26, 92.3% women). Hospital LOS and total HC decreased significantly by 32.5% and 15.2%, respectively (both, p < 0.05), after implementation of ERABS. There were no significant differences in 30-day readmission, complication, or reoperation rates. The implementation of a standardized enhanced recovery program resulted in reduced LOS and HC without an increase in perioperative morbidity. The ERABS protocol is cost-effective and can help ease the healthcare burden.

Hydrodynamic Considerations VI: Temporary Shunting for Intraventricular Hemorrhage: Observational Study of Two Treatment Variants

Abstract Introduction Patients who have external ventricular drainage (EVD) inserted are prone to many risks and complications. Intraventricular hemorrhage (IVH) is a frequent and life-threatening complication for spontaneous intracerebral hemorrhage (ICH) and results in an increased morbidity and mortality for those patients. An EVD insertion is a frequent surgical procedure for those with IVH. However, it is also known that IVH patients have a much higher rate of ventricular catheter occlusion. We hypothesize that blood clots have a predominant participation as a pathophysiological mechanism for EVD occlusion, and that a different and more appropriate catheter design might decrease the occlusion rate occurring during the utilization of EVDs on patients with IVH and, therefore, reduce implantation time. Methods The electronic data sheets of 30 patients with spontaneous IVH from March 2014 until April 2015 were evaluated. Two concepts in catheter design were evaluated: A group of 15 patients with a conventional type of catheter inserted was identified as Group C (conventional). A group of 15 patients with a new design of catheter inserted was identified as Group H (hemorrhagic). Both groups were compared regarding survival end parameters, outcomes, days spent in intensive care units (ICUs) and time spent with EVDs implanted. Results Hospitalization at the ICU was statistically significantly reduced for Group H compared with Group C. There was no significant difference among the hospitalization days between both groups. There was no statistical difference either for acute hydrocephalus or death rate. External ventricular drainage implantation days were significantly reduced for Group H related to Group C. Conclusion The results of the present study points to the fact that, although apparently the new catheter design did not change some secondary complications such as hydrocephalus and hospitalization rate, it seems that a better or specifically designed catheter for IVH purposes might lead to less ICU hospitalization days and EVD implantation days, two factors that have economic impact on healthcare due to the reduction of hospitalization costs and reduced incidence of related complications. The information obtained by this preliminary study should be grounded by a larger, more detailed and prospective evaluation; if these preliminary data are maintained, the new design should be considered for IVH associated EVDs insertions.

Does EMR Adoption by Nursing Homes Decrease Hospitalization Costs?

Electronic Medical Records (EMR) have the potential to decrease medical expenditures by increasing communication between healthcare providers and reducing the incidence of unnecessary tests and medical errors. Using a three-year panel of out-of-home Medicaid spending for long-term care patients in nursing homes, we analyze the effect of nursing home EMR adoption on out-of-home healthcare expenditures for their residents. First, we find evidence that EMR adoption by nursing homes reduces out-of-home healthcare costs for residents by 3.5%-14%. Second, beyond this direct effect, we find a further reduction of hospitalization costs for residents when hospitals and nursing homes both adopt EMR, which is an average savings of 13% of Medicaid expenditure and as much as 35% for hospitals that are part of a system. Given the interdependent nature of healthcare delivery for long-term care patients or patients with chronic conditions, our findings underscore the importance of looking outside the adopting institution when accounting for health IT (HIT) value.

USE OF GLUTAMINE AS AN ADJUVING THERAPY FOR THE NUTRITIONAL AND PHYSIOLOGICAL RESTORATION OF THE BIG BURNED PATIENT

Objective: To analyze the applicability of glutamine in the recovery of the nutritional and physiological status of burn patients. Methods: Study based on a literary review taken from reliable sources such as: The Scientific Electronic Library Online (Scielo), Pubmed, Bireme, Latin American and Caribbean Literature in Health Sciences (Lilacs), Virtual Health Library, the descriptors used were: glutamine ; nutritional therapy; burned; nutrition therapy; burned patients; glutamine, published in the last eleven years (2009-2020). Results: The research was carried out in a literary review format 30 full documents were read, 23 scientific articles were used, 3 bases of the Ministry of Health, 7 were postponed, the arguments used in the composition of the article, were the answer to the problem about applicability about the nutrient with immunomodulatory function glutamine for the recovery of the nutritional and physiological state of burn patients. Conclusion: The research argued about the use of glutamine in the treatment of large burn patients, through data obtained by literary analysis. The results obtained will contribute to the guidelines on the use of immunonutrients to improve the immune response, modulate the inflammatory response, reduce the rates of infectious complications, bringing a possible reduction in hospitalization costs. However, there is a need for further studies focused on this topic, in order to make the benefits of these immunonutrients appreciable for the scientific community, especially in terms of nutritional support more appropriate to supplementation and the recommendation of these nutrients.

Improving the Security and Confidentiality in the Internet of Medical Things Based on Edge Computing Using Clustering.

Families, physicians, and hospital environments use remote patient monitoring (RPM) technologies to remotely monitor a patient's vital signs, reduce visit time, reduce hospital costs, and improve the quality of care. The Internet of Medical Things (IoMT) is provided by applications that provide remote access to patient's physiological data. The Internet of Medical Things (IoMT) tools basically have a user interface, biosensor, and Internet connectivity. Accordingly, it is possible to record, transfer, store, and process medical data in a short time by integrating IoMT with the data communication infrastructure in edge computing. (Edge computing is a distributed computing paradigm that brings computation and data storage closer to the sources of data. This is expected to improve response times and save bandwidth. A common misconception is that edge and IoT are synonymous.) But, this approach faces problems with security and intrusion into users' medical data that are confidential. Accordingly, this study presents a secure solution in order to be used in the IoT infrastructure in edge computing. In the proposed method, first the clustering process is performed effectively using information about the characteristics and interests of users. Then, the people in each cluster evaluated by using edge computing and people with higher scores are considered as influential people in their cluster, and since users with high user interaction can publish information on a large scale, it can be concluded that, by increasing user interaction, information can be disseminated on a larger scale without any intrusion and thus in a safe way in the network. In the proposed method, the average of user interactions and user scores are used as a criterion for identifying influential people in each cluster. If there is a desired number of people who are considered to start disseminating information, it is possible to select people in each cluster with a higher degree of influence to start disseminating information. According to the research results, the accuracy has increased by 0.2 and more information is published in the proposed method than the previous methods.

Evaluating Diagnostic Accuracy of a New Artificial-Intelligence Driven Diagnostic Support Tool

Background: Diagnostic decision support systems (DDSS) are computer programs aimed to improve healthcare by supporting the clinician in the process of diagnostic decision making. Previous studies demonstrated their ability to enhance clinicians’ diagnostic skills, prevent diagnostic errors, and reduce hospitalization costs. Despite their potential benefits, their utilization in clinical practice is limited, emphasizing the need for new and improved products. Therefore, in this study we aimed to conduct a primary evaluation of diagnostic performance for “Kahun”, a new artificial intelligence driven diagnostic tool. Methods: Diagnostic performance was evaluated based on the program ability to “solve” clinical cases from the USMLE®-step-2-clinical-skills board-exams simulations. Cases were entered to Kahun by three blinded physicians, unexperienced with the platform. The generated differential-diagnoses (DDX) were recorded and compared to the expected one. The cases were drawn from the case-banks of three leading preparation companies: UWorld, Amboss and FirstAid. Each case included 3“correct” differential-diagnoses. Diagnostic performance was measured in two ways. First, as sensitivity, calculated as the total number of expected DDX appropriately suggested by Kahun divided by the total number of expected diagnoses in all cases. Second, as case specific success rates, calculated as the number of cases with 1/3,2/3 and 3/3 of expected DDX appropriately suggested by Kahun divided by the total number of cases. Findings: 91 clinical cases were included in the study with 78 different chief complaints, and 174 different DDX. Kahun correctly suggested 231 diagnoses, resulting in an overall sensitivity rate of 84.9%which was stable across different disciplines. In 63.8%of the cases Kahun correctly suggested 3/3 of expected DDX within the topmost likely diagnoses, in 89%at least 2/3, and in 97.8%at least 1/3. Interpretation: Kahun demonstrates an acceptable diagnostic accuracy and comprehensiveness. Funding: None to declare. Declaration of Interest: NBS, AS and TW were employed by Kahun Medical Ltd as medical advisors. All other authors have nothing to declare.

Antibiotics Therapy in the Multi-Resistant Patient.

Antibiotic resistance is not only a European or American problem: it is a global crisis. The emergence of resistance to multiple antimicrobial agents has become a major threat to public health. The main objective of the institution's antimicrobial policy is to adapt the effective treatment to each patient, with a minimum of complications, avoid adverse reactions, control the development and spread of strains of resistant microorganisms as well as reduce hospital costs whenever possible. World Health Organization published a global list of priority pathogens of antibiotic-resistant bacteria to help prioritize research and development of new and effective antibiotic treatments. We must take into account the risk factors related to multiresistance, as well as factors that favor horizontal and vertical transmission. The need to prioritize implementation of these global strategies is complex and involves a lot of effort and valuable time; this point favors the rapid development resistance.

A surgical hospitalist system in Korea: a preliminary study of the effects on hospital costs and postoperative outcomes.

PurposeThe aim of this study is to investigate the effect of the surgical hospitalist system on postoperative outcomes and hospital costs for surgical patients.MethodsWe reviewed the medical records of 522 patients who were admitted to the divisions of colorectal and gastrointestinal surgery for operation from September to December 2017 at Severance Hospital, Yonsei University College of Medicine in Seoul, Korea. All patients were divided into 2 groups; one that was managed by surgical hospitalists group (HG) and another that was managed by non-hospitalist residents group (NHG) after elective surgery. Postoperative outcomes and hospital costs were analyzed for each group.ResultsTwo hundred ninety-eight patients were managed by HG and 189 patients were managed by NHG after surgery. The length of hospital stay in the first group was shorter (9.6 ± 5.8 days vs. 12.2 ± 7.9 days, P < 0.001), the incidence of complications was lower (44.6% vs. 55.6%, P = 0.019), and the readmission rate was lower (3.0% vs. 6.9%, P = 0.046) in the HG than in the NHG. The difference in total hospital costs was not significant between the HG and the NHG (₩8,381,304 vs. ₩9,242,493, P = 0.559), but surgery-independent hospital costs were lower in the HG than in the NHG (₩3,020,873 vs. ₩3,923,308, P = 0.001).ConclusionThe surgical hospitalist system reduced the length of hospital stay, the incidence of postoperative complications, and the readmission rates of surgical patients. This led to the effect of a reduction in total hospital costs.

IoT-based e-Health Framework for COVID-19 Patients Monitoring

The COVID-19 pandemic, produced by the SARS-CoV-2 virus, has caused global public health emergency, with the rapid evolution and tragic consequences. The fight against this disease, whose epidemiological, clinical, and prognostic characteristics are still being studied in recent works which is forcing a change in the form of care, to include transforming some face-to-face consultations into non-face-to-face. Recently, various initiatives have emerged to incorporate the Internet of Things (IoT) in different sectors specially the health sector generally and in e-Health systems specifically. Millions of devices are connected and generating massive amounts of data. In this sense, based on the experience in the health sector in the management of the pandemic caused by COVID-19, it has been determined that monitoring potential patients of COVID-19 is still a great challenge for the latest technologies. In this paper, an IoT-based monitoring framework is proposed to help the health caregivers to obtain useful information during the current pandemic of COVID-19, thus bringing direct benefits of monitoring patient's health and speed of hospital care and cost reduction. An analysis of the proposed framework was carried out and a prototype system was developed and evaluated. Moreover, we evaluated the efficacy of the proposed framework to detect potentially serious cases of COVID-19 among patients treated in home isolation.

Initial emergency laparotomy outcomes following a transdisciplinary perioperative care pathway in Singapore.

AimEmergency laparotomy (EL) is a common surgery associated with high morbidity and mortality. An enhanced care pathway incorporates evidence‐based care bundles with the aim of providing standardized perioperative care. Prior to 2019, EL management in our institution was not standardized. This study aims to assess whether implementation of a transdisciplinary perioperative Emergency Laparotomy (ELAP) pathway improves clinical and efficiency outcomes of EL.MethodsA prospective single‐center audit was undertaken between 1 January and 31 December, 2019 following the implementation of the ELAP pathway. Comparisons were made with retrospective data from the preimplementation period between 1 January and 31 December, 2017. Demographics and clinical and efficiency outcomes were compared for patients (age > 16 years old) requiring EL for acute abdominal conditions.ResultsThere were 152 and 162 patients from preimplementation and postimplementation periods, respectively. There was a nonsignificant reduction of 30‐day mortality in the intervention group receiving perioperative pathway care compared with the preintervention group (3.1% versus 5.3%, respectively; P = 0.40). There was a decrease in postoperative complications in the intervention group, in particular for Clavien–Dindo IV complications (11.2% versus 3.1%, p < 0.01). Efficiency outcomes improved postimplementation with increased consultant surgeon and anesthetist presence in operating theater and postoperative geriatric assessment for elderly patients. There was an overall reduction in cost of hospital stay from S$32,128 to $27,947 (p = 0.24).ConclusionImplementation of a transdisciplinary perioperative care pathway was associated with significant reduction in postoperative complications, improvement in 30‐day mortality and efficiency outcomes at reduced hospital costs for patients following EL in our institution.

Healthcare resource utilization and costs of rivaroxaban versus warfarin among non-valvular atrial fibrillation (NVAF) patients with obesity in a US population

Aim To assess the real-world healthcare resource utilization (HRU) and costs of patients with non-valvular atrial fibrillation (NVAF) and obesity newly initiated on rivaroxaban or warfarin in the US. Methods This retrospective study used IQVIA PharMetrics Plus data (01/2010–09/2019) to evaluate patients (≥18 years) with NVAF and obesity (body mass index ≥30 kg/m2) initiated on rivaroxaban or warfarin (on or after 01/2013). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding between cohorts. HRU and costs were assessed post-treatment initiation. Weighted cohorts were compared using Poisson regression models and cost differences, with 95% confidence intervals (CIs) and p values generated using non-parametric bootstrap procedures. Results After IPTW, 10,555 and 5,080 patients were initiated on rivaroxaban and warfarin, respectively (mean age: 59 years). At 12 months follow-up, the rivaroxaban cohort had lower all-cause HRU, including fewer hospitalizations (rate ratio [RR]: 0.80, 95% CI: 0.74, 0.87), emergency room visits (RR: 0.89, 95% CI: 0.83, 0.97), and outpatient visits (RR: 0.72, 95% CI: 0.69, 0.77; all p < .05). Medical costs were also reduced in the rivaroxaban cohort (mean difference: −$6,759, 95% CI: −$9,814, −$3,311) due to reduced hospitalization costs (mean difference: −$5,967, 95% CI: −$8,721, −$3,327), resulting in lower total all-cause healthcare costs compared to the warfarin cohort (mean difference: −$4,579, 95% CI: −$7,609, −$1,052; all p < .05). The rivaroxaban cohort also had lower NVAF-related HRU and medical costs driven by lower hospitalization at 12 months post-treatment initiation. HRU and cost reductions associated with rivaroxaban persisted up to 36 months of follow-up. Limitations Claims data may have contained inaccuracies and obesity was classified based on ICD diagnosis codes given that patient BMI values were not available. Conclusions Rivaroxaban was associated with reduced HRU and costs compared to warfarin among NVAF patients with obesity in a real-world US setting.

SIMULTANEOUS LAPAROSCOPIC INGUINAL HERNIA REPAIR AND CHOLECYSTECTOMY: DOES IT CAUSE MESH INFECTION?

ABSTRACT Background: Repair of inguinal hernia concomitant with cholecystectomy was rarely performed until more recently when laparoscopic herniorrhaphy gained more adepts. Although it is generally an attractive option for patients, simultaneous performance of both procedures has been questioned by the potential risk of complications related to mesh, mainly infection. Aim:To evaluate a series of patients who underwent simultaneous laparoscopic inguinal hernia repair and cholecystectomy, with emphasis on the risk of complications related to the mesh, especially infection. Methods: Fifty patients underwent simultaneous inguinal repair and cholecystectomy, both by laparoscopy, of which 46 met the inclusion criteria of this study. Results: In all, hernia repair was the first procedure performed. Forty-five (97,9%) were discharged within 24 h after surgery. Total mean cost of the two procedures performed separately ($2,562.45) was 43% higher than the mean cost of both operations done simultaneously ($1,785.11). Up to 30-day postoperative follow-up, seven (15.2%) presented minor complications. No patient required hospital re-admission, percutaneous drainage, antibiotic therapy or presented any other signs of mesh infection after three months. In long-term follow-up, mean of 47,1 months, 38 patients (82,6%) were revaluated. Three (7,8%) reported complications: hernia recurrence; chronic discomfort; reoperation due a non-reabsorbed seroma, one in each. However, none showed any mesh-related complication. Satisfaction questionnaire revealed that 36 (94,7%) were satisfied with the results of surgery. All of them stated that they would opt for simultaneous surgery again if necessary. Conclusion: Combined laparoscopic inguinal hernia repair and cholecystectomy is a safe procedure, with no increase in mesh infection. In addition, it has important advantage of reducing hospital costs and increase patient’ satisfaction.