Admission Route Research Articles

Hospitalization of patients with Down syndrome in acute care hospitals in Japan

AbstractBackgroundDown syndrome is the most common genetic disorder, and the life expectancy of patients with Down syndrome has increased over the decades. However, the diseases and social problems experienced by patients with Down syndrome remain unknown in Japan. Therefore, we aimed to investigate the disease status of such patients admitted to acute care hospitals in Japan.MethodsThis observational study was conducted using the Diagnosis Procedure Combination data from 2016 to 2021 to evaluate routes of admission, principal diagnoses, comorbidity of dementia, orthopedic surgeries for limb fractures, and discharge destinations of patients with Down syndrome (International Classification of Diseases, Tenth Revision code: Q90).ResultsOverall, 26,195 individuals with Down syndrome were included, of whom 5195 were ≥20 years of age. As the age increased, the number of admissions from home decreased and that from nursing homes increased. Pneumonia was the most common principal diagnosis, with the incidence of aspiration pneumonia increasing in patients >40 years of age. We observed an increase in the incidence of dementia and surgery for limb fractures after 40 years of age. The number of discharges to home decreased with increasing age, whereas that to nursing homes increased with increasing age.ConclusionsThese results suggest that patients with Down syndrome are often hospitalized because of pneumonia and that the incidence of aspiration pneumonia, dementia, and limb fractures increases after 40 years of age. Therefore, a system to prevent pneumonia, especially aspiration pneumonia, and limb fractures in patients with Down syndrome is needed.

Comparison of direct and indirect admission to a cardiac arrest centre for intubated out-of-hospital cardiac arrest patients in the Northwest England: an audit

Abstract Background Despite concerted global efforts to enhance cardio-pulmonary resuscitation (CPR) and post-resuscitation care, out-of-hospital cardiac arrest (OHCA) remains a significant cause of mortality. Current guidelines promote the concept of Cardiac Arrest Center (CAC), offering advanced post-resuscitation management with the aim of improving survival rates. However, it remains uncertain whether directly transporting OHCA patients from the scene to these centers would enhance their prognosis. Purpose This study aimed to assess whether direct transport of intubated OHCA patients to a higher-level cardiac arrest center in the Northwest of England yielded better outcomes compared to initial resuscitation in smaller local emergency departments followed by transfer. Methods Conducted as a retrospective analysis, the audit examined OHCA patients presenting at a single cardiac arrest center between October 2018 and April 2022. Only intubated patients were included. The study compared two groups based on the route of admission: direct admission to the cardiac arrest center from the field by emergency medical service providers versus indirect admission via inter-hospital transfer to the center. The primary outcomes assessed were inpatient survival and 30-day survival. Statistical analysis employed Student's T-test and Chi-square test for clinical significance. Results The audit included 214 patients, with 112 (52.34%) in the direct group and 102 (47.66%) in the indirect group. Baseline characteristics between the groups were similar, including age, gender, downtime, bystander CPR, haemodynamic status, initial presenting rhythm (VT/VF), post-arrest ECG (STEMI), comorbidities, and procedural outcomes (Table 1). However, the direct group exhibited significantly shorter average arrival times at the cardiac arrest center (72 minutes vs. 190 minutes, p=0.017), along with improved in-hospital survival (52.68% vs. 41.18%, p=0.009) and 30-day survival rates (52.68% vs. 37.25%, p=0.002). Conclusion The direct admission of intubated OHCA patients to a cardiac arrest center, as observed in this audit, was associated with improved outcomes attributed to expedited admission times. The study’s design limitations, including its non-randomized nature and single-center approach, underscore the need for further research.

Predictores del éxito académico en estudiantes de pregrado de la carrera de Nutrición y Dietética de la Pontificia Universidad Católica de Chile

IntroductionIdentifying the factors that determine academic success can help design strategies focused on increasing academic success. We aimed to identify predictors associated with academic success in undergraduate students of the Nutrition and Dietetics Program of the Pontificia Universidad Católica de Chile (PUC). MethodsRetrospective study using the institutional database. Academic success was the main outcome, including two indexes: i) final grade point average (GPA-f) and; ii) timely graduation, defined as graduating in ≤10 semesters. Candidate predictors were: age, sex, region of origin, school attended, score at the university selection test (PSU-score), admission route, and preference for the program. Stepwise linear regression was used to identify predictors of GPA-f. Binary logistic regression was used to identify variables associated with timely graduation. ResultsPSU-score was the only predictor of GPA, explaining 24% of its variance. The odds (OR [95%CI]) for a timely graduation were influenced by PSU-score (1.017 [1.003–1.031]) and admission route (PSU 1.00 [Reference], Inclusive 0.30 [0.10–0.96], Special 0.46 [0.13–1.57]). Conclusions and implicationsPSU-score partially predicts the academic success of Nutrition and Dietetics students. In addition, students who accessed the program by the equity admission had lower odds of a timely graduation. As educational inequalities may affect academic success, the teaching and learning process needs to be addressed with specific strategies for these students to ensure academic success.

Observational study of in-hospital mortality risk from bladder cancer: Five years of experience at a tertiary referral hospital in Indonesia.

Bladder cancer (BC) is a neoplasm arising from the bladder. It requires appropriate management and its prognosis depends on many factors. This study aimed to analyze the factors that influence outcomes in BC management. This was a retrospective study. Data were collected at one of Indonesia's largest tertiary referral hospitals. All patients diagnosed with BC from January 2019 to December 2023 were included. The outcome measured was survival or death. Statistical analysis was conducted using SPSS version 26.0 software. The study included 219 patients with a median age of 57.97 years, of which 99 (45.2 %) patients died. In a bivariate analysis, sex, active smoking status, Karnofsky score, metastasis status, chronic kidney disease, type 2 diabetes mellitus, chemotherapy, radiotherapy, and alternative medicine were found to affect mortality status. Based on multivariate analysis, the route of admission (odds ratio [OR] 0.19), irregular visit (OR 6.21), metastasis (OR 3.58), radiotherapy (OR 21.12), and traditional medicine (OR 0.21) were independent factors of in-hospital mortality. The mortality rate for BC was considerably high. Irregular visits, metastasis, type 2 diabetes, and radiotherapy were independent risk factors for mortality.

Composition and influencing factors of hospitalization expenses for epilepsy patients based on path analysis

ObjectiveThis study aimed to understand the composition and influencing factors of epilepsy patients’ hospitalization expenses, thus providing a reference for reducing the disease burden of epilepsy patients in low- and middle-income developing countries.MethodsA total of 4206 hospitalized cases of epilepsy from 2018 to 2020 were collected. Descriptive statistics were used to understand the patient cost composition, path analysis was used to understand the direct and indirect factors of hospitalization expenses.ResultsFrom 2018 to 2020, the average hospitalization expenses for epilepsy patients was 4,299.93 RMB yuan, and the average length of stay was 2.47 days. The highest proportion of hospitalization expenses was diagnosis costs (> 50%), followed by comprehensive medical service costs and drug costs. In terms of the total effect coefficient, the major factors affecting the hospitalization expenses were length of stay (0.880), emergency admission(0.463), and the comorbidities and complications(> 0.250). Hospital length of stay, discharge mode(death) and number of hospitalizations(2 times) affect hospitalization expenses through direct effect. Long-term hospitalization (> 30 days), admission routes(emergency), the comorbidities and complications, presence of drug allergy, and age also affect hospitalization expenses through indirect effects.ConclusionDiagnosis costs and length of stay are important factors affecting the medical expenses of epilepsy inpatients. In general, the quality control of the hospital is good, but it still needs to standardize the diagnosis and treatment behavior of medical staff through the clinical path.

Psychological Impact of Bladder Cancer: Insights from 219 Patients and Caregivers in Indonesia Using DASS-21 (2019-2023).

BACKGROUND Bladder cancer (BC) is a common disease worldwide. Low survival rates and high recurrence lead to the risk of mental disorders. This study analyzed 219 patients with bladder cancer using the Indonesian Version of the 21-item Depression, Anxiety, and Stress Scale (DASS-21) and related factors. MATERIAL AND METHODS This cross-sectional study included 219 patients diagnosed with bladder cancer during 2019-2023 in a referral hospital in Indonesia. Data were collected using a questionnaire that assessed the characteristics of the patients and a DASS-21 questionnaire. RESULTS Some patients and caregivers experienced depression, stress, and anxiety. The percentage of caregivers who experienced anxiety was higher than for patients (47.9% vs 45.7%). Statistical analysis showed that age, income, and marital status were associated with the incidence of depression (p=0.000, p=0.001, and p=0.000, respectively), anxiety (p=0.000, p=0.012, and p=0.001, respectively), and stress (p=0.000, p=0.007, and p=0.000, respectively). Routes of patient admission (p=0.043, respectively) and employment status (p=0.005, respectively) were associated with the incidence of depression in patients (p=0.043, respectively). Employment status was also associated with stress in patients (p=0.038, respectively). Statistical analysis of caregivers found that routes of patient admission and marital status were related to the incidence of depression among caregivers (p=0.036 and p=0.007, respectively). CONCLUSIONS Monitoring and providing support for patients and caregivers are needed to prevent poor prognosis due to psychological problems, including paying attention to sociodemographic factors.

Factors influencing the achievement of early surgery in proximal femoral fractures under a Japanese incentive policy

BackgroundProximal femoral fractures in geriatric patients are a major challenge in orthopedics, often leading to major functional impairment. Early surgical intervention is crucial for improving patient recovery and overall health outcomes. Thus, Japan’s Ministry of Health, Labour and Welfare initiated a reimbursement policy in April 2022 to encourage early surgery for these fractures in patients aged ≥ 75 years. This study investigated the impact of this policy on early surgery rates in Japan and identified factors influencing the timing of surgical interventions. MethodsWe retrospectively analyzed the data of patients who underwent surgery for proximal femoral fractures at our institution between April 2022 and March 2023. Patients were categorized into two groups based on the timing of surgery relative to the injury: ≤48 h and >48 h. Demographic and clinical data, including age, sex, fracture type, and various health- and admission-related factors, were assessed. ResultsOf the 192 patients, 152 were included in the study. Among them, 38% underwent early surgery (≤48 hours), and 15% of the patients arrived more than 48 h post-injury. Significant differences were found in admission routes and residence types between the groups. The ≤48 h group had shorter intervals from injury to admission and surgery than the >48 h group. Factors such as the admission process, day of the week, and C-reactive protein levels significantly influenced the timing of surgery. ConclusionsAfter introducing incentives for early surgery in Japan, 38% of patients with proximal femoral fractures underwent surgery within 48 h of injury. Factors contributing to patients not receiving early surgery included transport from another hospital, weekend hospitalization, and elevated CRP levels. These findings suggest that achieving surgery within 48 h of injury is challenging through hospital efforts alone, and the time criteria might be more appropriate if changed to “admission to surgery.”

Finnish open university education and students’ transitions into and within higher education

There is a growing number of higher education (HE) students who do not follow the conventional sequential progression from the beginning to the end of their studies. Instead, they may use alternative admission routes, take gap years, delay their studies and transfer from one discipline or institution to another. In particular, students from under-represented social groups tend to follow less linear trajectories. In this article, we are interested in the institutional policies and practices that enable multiple ways for students to navigate into and within HE. As a theoretical lens, we apply Gale and Parker’s typology of student transition and the conceptualisation of transition as ‘becoming,’ which entails rejecting the notion of linearity and normativity. Our empirical case is Finnish open university education (OUE). Using student interviews (N=16) and reflexive thematic analysis, we identified three institutional characteristics: openness of access, flexible mode of studies, and alternative access route to degree studies. These characterisics enabled highly individualised learning trajectories and opportunity to enter, withdraw and return to OUE throughout life. However, the OUE gateway was selective, which limited its potential to reduce social inequality in student transitions. The study advances the policy discussion and development of inclusive universities.

Sosialisasi Mahasiswa Baru Universitas PGRI Palembang di Kabupaten Ogan Komering Ilir Palembang

Socialization is a general concept which is defined as a process in which we learn to interact with other people, how to act, think and feel, all of which are important in producing effective social participation. This socialization was carried out as a form of the university's efforts to provide information regarding the acceptance of new students. The method used in this community service activity is providing socialization and promotion of all admission routes and study programs at PGRI Palembang University. In this socialization program, information is also provided regarding the new rules for accepting new students through the report card and written selectionroute. in 2024. With this activity, it is hoped that it will be useful for high school students in South Sumatra to be able to choose a major that suits their talents and interests. Apart from socialization activities, introducing the PGRI Palembang University Campus to high school and vocational school students in Ogan Regency Komering Ilir Palembang in this activity also socialized all majors, both undergraduate and postgraduate, for teachers who taught at the high school. As one university, PGRI Palembang University also holds socialization for new student admissions every year.

Pattern of Disease Admissions and Their Outcome of Neonates Admitted In Neonatal Intensive Care Unit of A Tertiary Care Hospital in Quetta

Objective: to determine the admission pattern and outcomes of neonatal admissions to a neonatal intensive care unit (NICU) in a tertiary care hospital of Quetta Pakistan. Study Design: Prospective longitudinal study. Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital (CMH), Quetta Pakistan, from Jan to Dec 2020. Methodology: All neonates admitted to the NICU Indoor or Outdoor Department during study duration were included. The disease pattern of the admission was noted, along with information regarding gender, gestational age, birth weight, diagnosis, duration of NICU stay, and outcome. Results: Of 424 neonates, respiratory-related disorders were predominantly higher (185,43.6%) followed by infection/sepsis-related disorders (105,24.8%), care of prematurity (81,19.1%), whereas 53(12.5%) had miscellaneous disorders. The overall mortality rate was observed in 34(8.0%) babies. A significant mean difference in gestational age (p: <0.001), birth weight (p: <0.001), and duration of stay (p: 0.003) was observed for reasons for admissions. Furthermore, a significant association of reasons for admission was observed with gender (p: 0.013), route of admission (p: <0.001), and respiratory support (p: <0.001). Conclusion: The pattern of the disease admission showed that respiratory-related disorders were predominantly higher, followed by infection/sepsis-related disorders and care of prematurity. Though the mortality rate was low, however, low birth weight, prematurity, and caesarean delivery are common risk factors.

Clinical and Epidemiological Characteristics of a Contingent of Elderly Patients Treated in the Somatopsychiatric Department of a Multi-Field Hospital

Background: comorbidity of somatic and mental pathology is the most common reason that complicates the provision of medical care to the elderly even under the conditions of a specialized somatopsychiatric department (SPD) of a multi-field hospital, which dictates the need for further study of the clinical and epidemiological features of these patients population.The aim of the study was to investigate the clinical and epidemiological characteristics of a contingent of elderly patients treated over a year in SPD of a multi-field hospital in comparison with similar data from a psychiatric hospital. The objectives of the study were to analyze the demographic structure of this contingent, the distribution of various types (categories) of somatic and mental pathology, routes of admission, time and outcomes of treatment in SPD of a multidisciplinary hospital.Materials and methods: the research material was the medical documentation of a sample of patients treated during 2019 in the SPD of the City Clinical Hospital № 1 named after. N.I. Pirogov of the Moscow Department of Health Protection (the total number of patients treated was 3379 people, of which 1456 were aged 65 and older). To conduct a comparative analysis, we used data from an epidemiological study in a psychiatric hospital (City Psychiatric Hospital № 13 of the Moscow Department of Health Protection), conducted in the same 2019 year.Results: it was established that in the SPD of a multi-field hospital, care is provided to a heterogeneous (demographic and clinical-diagnostic) group of patients, predominantly of late age (65 years and older). The most common diagnosis is dementia of various origins, complicated by severe somatic pathology (acute or associated with decompensation of a chronic somatic disease).Conclusion: elderly and senile patients make up more than half of the contingent of patients treated in the SPD of a multidisciplinary hospital. Significant differences were revealed in the SPD diagnostic distribution of young-middle-aged and elderly patients. Special features of the gender and age distribution of patients in the indicated age groups were established. Data were obtained on a higher mortality rate for those aged 65 years and older. The presence of problems in providing care to patients of older age groups in SPD determines the need for its improvement. For this purpose, it is advisable to consider the issue of creating a model of SPD of geriatric profile in a multi-field hospital to provide emergency psychiatric and somatic care to elderly patients.

Factors affecting treatment outcomes of hospital injury patients in Korea.

To analyze the characteristics of hospital injured patients and the factors that affect treatment results. We used the data from the Korea National Hospital Discharge In-depth Injury Survey from 2019 to 2021 of the Korea Disease Control and Prevention Agency (KDCA), 18,037 people who experienced hospital injury accidents were analyzed. In a retrospective cross-sectional study, general characteristics and injury-related characteristics of patients with hospital-acquired injuries were collected. The data were analyzed using chi-square test and logistic regression analysis of complex sampling design. The significance of all statistical analyses was verified at the p-value (<0.05) level. Variables that significantly affected the death of patients with hospital injuries were gender, age, route of admission, type of hospital injury, principal diagnosis, and length of stay (p < 0.05). The risk of death was 3.174 times (95% confidence interval: 2.376-4.238) higher when neoplasm was the principal diagnosis compared to cases with principal diagnosis of other systems. It is necessary to do patient safety education to help medical personnel be more aware of groups of patients who had a high risk of death from hospital damage, such as male and elderly patients, patients who admitted through the emergency room, and patients whose principal diagnosis was neoplasm, circulatory system, or respiratory system disease.

Mortality and Discharge Outcome in Acute Myocardial Infarction Patients: A Study Based on Korean National Hospital Discharge In-Depth Injury Survey Data.

The aim of this study was to analyze hospital-discharged acute myocardial infarction (AMI) patients in Korea (2006-2020) to understand how pre-existing conditions affect mortality rates. This study utilized the 2006-2020 Korean National Hospital Discharge In-depth Injury Survey data. A weighted frequency analysis estimated discharged AMI patients and calculated age-standardized discharge and mortality rates, Charlson Comorbidity Index (CCI) score distribution, and general patient characteristics. Weighted logistic regression analysis examined influencing mortality factors. There were 486,464 AMI patients (143,751 female), with AMI-related mortality rates at 7.5% (36,312): 5.7% for males (19,190) and 11.8% for females (17,122). The highest mortality rate was among individuals aged 70-79 years (25%). Factors influencing mortality included sex, insurance type, admission route, hospital bed count, region, operation status, and CCI score. Mortality risk at discharge was 1.151 times higher in females than males (95% CI: 1.002-1.322), 0.787 times lower among those with national health insurance than Medicaid recipients (95% CI 0.64-0.967), 2.182 times higher among those admitted via the emergency department than the outpatient department (95% CI 1.747-2.725), and 3.402 times higher in patients with a CCI score of 3 points than those with 0 points (95% CI 1.263-9.162). The number of discharged AMI patients and related mortality rates increased, underscoring the need for proactive management of chronic diseases, particularly for those with higher CCI scores.

Regresi Logistik Ordinal untuk Memodelkan Predikat Lulusan Perguruan Tingggi

Logistic regression is an alternative model that can model the relationship between a categorical response variable and one or more categorical, continuous predictor variables, or a combination of categorical and continuous predictor variables. Based on the number of categories in the response variable, the logistic regression model consists of a dichotomous logistic regression model and a polychotomous regression model. The dichotomous logistic regression model is a logistic regression model that has two categories in the response variable and has a Bernoulli distribution. In comparison, the polychotomous logistic regression model is a logistic regression model that has three or more categories and a multinomial distribution. The polychotomous logistic regression model is divided into two models, namely the multinomial logistic regression model and ordinal logistic regression. This research aims to examine ordinal logistic regression modeling and its application to the predicate of graduates of the undergraduate program at the Faculty of Mathematics and Natural Sciences, Mulawarman University (FMIPA UNMUL) for the 2020 graduation period. The results of the research show that the factors that have a significant influence on the predicate of graduates of the FMIPA UNMUL undergraduate program are gender and admission route. Female graduates of the FMIPA UNMUL undergraduate program have a greater chance of achieving satisfactory and very satisfactory predicates compared to achieving a cum laude predicate. Graduates of the FMIPA UNMUL undergraduate program who are accepted through the SMMPTN admission route have a lower chance of achieving satisfactory and very satisfactory predicates compared to achieving a cum laude predicate.

Evaluation of clinical, laboratory, and molecular genetic features of patients with biotinidase deficiency.

Biotinidase deficiency (BD) is an autosomal recessive inherited metabolic disorder which results from the inability of biotin-dependent carboxylase enzymes to function due to the release and absorption of biotin, leading to neurological and cutaneous findings. In the present study, evaluation of demographic characteristics, clinical findings, laboratory results, molecular genetic characteristics, and genotype-phenotype correlations of cases with BD. Two hundred forty-seven cases were included in the study who were admitted to the Department of Pediatric Metabolism of Ankara Bilkent City Hospital after being identified with potential BD through the Newborn Screening Program (NBS), during family screening or based on suspicious clinical findings, or following the detection of a pathogenic variant in a BTD genetic analysis during the period of October 2020 and February 2022. The medical files of the cases were reviewed retrospectively. An analysis of the admission routes of all cases to our clinic revealed 89.5% NBS, 5.7% family screening, and 4.9% suspicious clinical findings suggestive of BD. Complete enzyme deficiency was identified in 19.8%, partial enzyme deficiency in 55.1%, and heterogenous enzyme deficiency in 9.7%. The most common pathogenic variants were c.1270G > C (p.Asp424His), c.410G > A (p.Arg137His), and c.38_44delGCGCTGinsTCC (p.Cys13Phefs*36) in BTD gene. The c.1270G > C variant was most common in patients with cutaneous symptoms. The c.410G > A and c.38_44delGCGCTGinsTCC variants were more common in the patients with neurological symptoms. The mean activity level in patients with the c.1270G > C homozygous variant was statistically significantly higher than the mean activity level in the c.1270G > C compound heterozygous patients and the activity level of patients without the c.1270G > C variant. The mean activity level in c.410G > A homozygous patients was statistically significantly lower than the mean activity level of the c.410G > A compound heterozygous patients and the activity level of patients without the c.410G > A variant. In the course of our study, four new pathogenic variants were detected, namely: c.190G > A (p.Glu64Lys), c.249 + 5G > T, c.228delA (p.Val77*), and c.682A > G (p.Ile228Val). Conclusions: The present study has determined the clinical and genetic spectrum of a large group of patients with BD in a single center. The frequent mutations in our study were similar to those reported in literature, and four novel variants were also described. What is Known: • Biotinidase deficiency is an autosomal recessive, treatable inborn error of metabolism. Two hundred ninety-four pathogenic variants in the BTD gene have been identified and the c.1270G > C variant is the most frequent BTD gene mutation in both Turkey and around the world. What is New: • Four new pathogenic variants (c.190G > A, p.Glu64Lys; c.249 + 5G > T; c.228delA, p.Val77*; and c.682A > G, p.Ile228Val) have been identified. It is believed that the c.38_44delGCGGCTGinsTCC variant is more commonly seen in individuals with ocular issues; however, further genotype-phenotype correlations are needed.

STUDY STYLE OF BEST GRADUATES (Case Study of Best Graduates of UIN Antasari Banjarmasin)

One key to a student's success in achieving the title of the best graduate is their learning style. This study aims to explain that learning style greatly influences the outcomes of students' struggles throughout their education at the university. This paper is based on interviews conducted with 7 top graduates from UIN Antasari Banjarmasin, selected through purposive sampling using the homogeneous sampling technique. The theory used in this research is Rita Dunn and Dunn Kanneth's. The research design employed is qualitative case study in descriptive form. The results of this study indicate that the majority of the top graduates entered the university through the test-based admission route, specifically the UM-Mandiri route. The most common reason cited by the top graduates for studying is the demand, which includes task requirements and scholarships. The most effective learning environment is a quiet room away from crowds, and music is effective in enhancing focus or concentration and providing a sense of calm while studying. Studying alone is more effective than studying in groups. The senses used are primarily visual combined with auditory perception. The most effective study time is midnight, and the strategy for dealing with difficulties in understanding lessons or completing tasks is to ask someone who has a better understanding of the material or the assigned task. This study is limited to relatively small data, which allows for further research with a larger data scope.

Development and Validation of a Risk-Prediction Nomogram for Preoperative Blood Type and Antibody Testing in Spinal Fusion Surgery.

With advancements in minimally invasive techniques, the use of spinal fusion surgery is rapidly increasing and transfusion rates are decreasing. Routine preoperative ABO/Rh blood type and antibody screening (T&S) laboratory tests may not be appropriate for all spinal fusion patients. Herein, we constructed a nomogram to assess patient transfusion risk based on various risk factors in patients undergoing spinal fusion surgery, so that preoperative T&S testing can be selectively scheduled in appropriate patients to reduce healthcare and patient costs. Patients who underwent spinal fusion surgery between 01/2020 and 03/2023 were retrospectively examined and classified into the training (n = 3533, 70%) and validation (n = 1515, 30%) datasets. LASSO and multivariable logistic regression were used to analyze risk factors for blood transfusion. Nomogram predictive model was built according to the independent predictors and mode predictive power was validated using consistency index (C-index), Hosmer-Lemeshow (HL) test, calibration curve analysis and area under the curve (AUC) for receiver operating characteristic (ROC) curve. Bootstrap resampling was used for internal validation. Decision curve analysis (DCA) was applied to evaluate the model's performance in the clinic. Being female, age, BMI, admission route, critical patient, operative time, heart failure, end-stage renal disease or chronic kidney disease (ESRD or CKD), anemia, and coagulation defect were predictors of blood transfusion for spinal fusion. A prediction nomogram was developed according to a multivariate model with good discriminatory power (C-index = 0.887); Bootstrap resampling internal validation C-index was 0.883. Calibration curves showed strong matching between the predicted and actual probabilities of the training and validation sets. HL tests for the training and validation sets had p-values of 0.327 and 0.179, respectively, indicating good calibration. When applied to the training set, the following parameters were found: AUC: 0.895, 95% CI: 0.871-0.919, sensitivity 78.2%, specificity 86.7%, positive predictive value 29.4% and negative predictive value 98.2%. If the model were applied in the training set, 2911 T&S tests (82.4%) would be eliminated, equaling a RMB349,320 cost reduction. The AUC in the internal validation was: 0.879, 95% CI: 0.839-0.927, sensitivity 75.2%, specificity 88.8%, positive predictive value 34.3%, negative predictive value 97.9%, would eliminate 1276 T&S tests (84.2%), saving RMB 153,120. The DCA curve indicated good clinical application value. The nomogram based on 10 independent factors can help healthcare professionals predict the risk of transfusion for patients undergoing spinal fusion surgery to target preoperative T&S testing to appropriate patients and reduce healthcare costs.

Considerations on the implementation of the Clinical Microbiology and Parasitology training program in Spanish hospitals: A national survey

IntroductionThe specialty of Microbiology and Parasitology is a four-year multidisciplinary training with a central role in the diagnosis and epidemiological surveillance of infectious diseases.The aim of this study is to analyze the degree of implementation of the official program and the degree of satisfaction of residents with their training. MethodsWe conducted an online survey distributed in eight sections to which active residents of the Specialty of Clinical Microbiology and Parasitology had access. ResultsA total of 69 responses were received, with a predominance of residents from the regions of Madrid (43.5%) and of FIR admission route (55%).The areas in which the residents feel best prepared correspond to systematic bacteriology, antimicrobials and clinical aspects of microbiology. The areas with the worst preparation, on the other hand, are mycology, parasitology and microbiological emergencies.There are significant differences between the clinical rotation time for residents with MIR access pathway with respect to residents with other degrees.Respondents perceive a high degree of responsibility and a medium agreement with the quality of teaching. Attendance at clinical sessions and external rotations is frequent.Research activity is perceived as complicated, both at the level of doctoral studies and with respect to entering research lines and the publication of scientific results. ConclusionSome points of improvement of the training itinerary have been identified that need to be reinforced. Likewise, it would be interesting to seek a better balance between care, teaching and research activities.

The Usefulness of Present-on-Admission Data as an Indicator of Healthcare Quality Evaluation Using the Korean National Hospital Discharge in-Depth Injury Survey Data from 2006 to 2019.

Comorbidities of a principal diagnosis have varying impacts on disease and require different management depending on the onset timing. This study investigated the usefulness of present-on-admission (POA), specifically focusing on decubitus ulcers, delirium, and hypokalemia, as an indicator of healthcare quality. We analyzed patient discharge data for 14 years from 2006 to 2019 using Korean National Hospital Discharge In-Depth Injury Survey (KNHDIS). Out of 3,231,731 discharged patients, 19,871 had secondary diagnosis codes for decubitus ulcers (n=10,390, 52.3%), delirium (n=6103, 30.7%), or hypokalemia (n=3378, 17.0%). Analysis of patients with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia revealed notable differences in demographics, including gender distribution, mean age, admission route, insurance type, surgical intervention rates, mortality rates, and length of stay (LOS). Among patients with one of the top 20 principal diagnoses, those with secondary diagnoses of decubitus ulcers, delirium, or hypokalemia exhibited higher odds of surgery, increased mortality risks, and longer LOS compared to those without these secondary diagnoses. All three of these diseases commonly occur postoperatively or during treatment and thus should be designated as potentially preventable complications that require special attention, and should also be considered as quality-of-care indicators.

Evaluation of Dermatological Disorders Among Patients Admitted to the Intensive Care Units of a Tertiary Care Hospital in India

: Background: The management of critically-ill individuals in intensive care units (ICU) is complex. Immobility, pharmacological treatments, and reduced perfusion lead to compromised skin integrity, predisposing to complications like infections and allergies. The presence of dermatological disorders (DDs) may influence management strategies, the patient’s quality of life, duration of ventilation, length of hospitalization, and rate of mortality. Hence, it is critical to analyze the predictors of DDs among ICU inpatients. Objectives To determine the prevalence of DDs in ICUs, classify them, and analyze their associated parameters. Methods: Patients admitted to Medicine/Neonatal/Paediatric ICUs were enrolled in this hospital-based cross-sectional study conducted over two months at a tertiary care hospital. Patients with pre-existing DDs not leading to admission were excluded. The screening was initiated within 48 hours of admission, continued daily throughout the ICU stay, and terminated on discharge from the ICU, in the case of patient death or at the end of the data collection period. Requisite information was recorded using a predesigned proforma. Results: Out of 688 patients screened, 129 were found to have 136 skin lesions, with an overall prevalence of 18.9%; MICU had the highest prevalence (22.7%), followed by NICU (17.3%) and PICU (12%). Skin lesions were classified into seven major categories. A significant association was found between the type of dermatological disorder and age, the presence of comorbidity, and the route of admission (P-value &lt; 0.05). Conclusions: This study identified modifiable predictors associated with DDs among ICU inpatients. Infectious disorders constituted the foremost category in children, and iatrogenic disorders were predominant in adults. More comprehensive prospective studies are needed to fully understand the impact of DDs on the prognosis and outcome of ICU patients.