Skilled Facility Research Articles

Potential risks of nonoperative management of appendicitis in high-risk patients

IntroductionThe popularity of nonoperative management for acute appendicitis is based on the untested assumption that it offers a lower risk alternative to surgery in patients who are at high risk for morbidity and mortality with appendectomy. We hypothesized that patients who were at a high risk with appendectomy would also be at a high risk for complications following nonoperative management. MethodsThis is a retrospective cohort study of patients with acute, uncomplicated appendicitis in the 2004–2017 National Inpatient Sample. We used a logistic regression model to predict the risk of morbidity or mortality following appendectomy and applied this model to predict the risk of patients managed nonoperatively. High risk was defined as ≥2 standard deviations above the mean predicted risk of morbidity or mortality. We used inverse probability weighting of the propensity score to compare outcomes of nonoperative versus operative management for high-risk patients. ResultsThe sample included 21,242 high-risk patients with a median age of 68 years (interquartile range 57–78), and 31% were managed nonoperatively. Compared to surgery, nonoperative management was associated with a 9% decrease in complications (95% confidence interval [CI] 7%–10%), 2% increase in mortality (95% CI 2%–3%), $10,202 increase in hospital costs (95% CI $9,065–$11,339), 3-day increase in length of stay (95% CI 2–3), and 9% greater likelihood of discharge to skilled nursing facilities (95% CI 8%–10%). ConclusionNonoperative management of acute appendicitis in high-risk patients may reduce morbidity but increase mortality, duration of hospitalization, discharge to skilled facility, and costs. Surgeons should exercise caution when considering nonoperative management in these vulnerable patients.

Impact of inpatient geriatrics consultation on hospital outcomes in older adults with trauma.

Older adults presenting with trauma have worse outcomes than younger adults. Starting in 2016, we provided geriatrics consultation (GC) to older adults admitted to the trauma service. We aimed to analyze the impact of GC on patient outcomes. We performed a retrospective pre-post study and year-matched cohort study. We identified patients from the trauma registry at our level 1 trauma center. In the pre-post study, we compared patients who received GC (2016-2022) with controls (2011-2015). In the cohort study (2016-2022), we compared patients who received GC with controls. We matched for age, race, sex, and injury severity score (ISS) in both studies, as well as admission year in the cohort study. Outcome variables included mortality (in-hospital, 30-day, 90-day), length of stay (LOS), discharge disposition, and hospital readmission rates (30-day, 90-day). We analyzed 1968 patients in the pre-post study and 2544 patients in the cohort study. Patients were similar in age, race, and sex. GC patients had a slightly higher ISS score and a higher rate of ICU stay. Delirium occurrence was lower among GC patients. GC patients had lower in-hospital mortality compared to controls (pre-post OR 0.27, p < 0.001; cohort OR 0.31, p < 0.001) and increased LOS (6 days vs 4 days, p < 0.001; both studies). GC patients in the cohort study also had lower 30- and 90-day mortality (OR 0.52 and 0.65, p < 0.01) and were less likely to return home (OR 0.81, p < 0.01); similar trends, though not statistically significant, were noted in the pre-post study. Lower readmission rates (statistically non-significant) were noted in the GC group across both studies. GC in older adults with trauma has proven benefit with reduced mortality and a trend toward lower readmission rates but was associated with increased LOS and higher rates of discharge to skilled facility.

Decreasing Skilled Facility Utilization in Geriatric Surgical Oncology

Decreasing Skilled Facility Utilization in Geriatric Surgical Oncology

The risks of failed nonoperative management of appendicitis in older adults

BackgroundThe consequences of failed nonoperative management of appendicitis in older patients have not been described. MethodsWe used the 2004–2017 National Inpatient Sample to identify acute appendicitis patients managed nonoperatively (<65 years old: 32,469; ≥65 years old: 11,265). Outcomes included morbidity, length of stay (LOS), inpatient costs, and discharge to skilled facilities. Differences were estimated using propensity scores. ResultsFor patients <65, nonoperative failure was associated with increased morbidity (7 ​% [95 ​% CI 6.9 ​%–8.1 ​%]), LOS (3 day [95 ​% CI 3–4]), costs ($9015 [95 ​% CI $8216- $9446]), and discharges to skilled facilities (1 ​% [95 ​% CI 0.9 ​%–1.6 ​%]) compared to successful nonoperative treatment. Patients ≥65 had differences in morbidity (14 ​% [95 ​% CI 13.6 ​%–16.2 ​%]), LOS (6 days [95 ​% CI 5–6]), costs ($15,964 [95 ​% CI $15,181- $17,708]), and discharges to skilled facilities (12 ​% [95 ​% CI: 10.0 ​%-13.3]) compared to nonoperative success. ConclusionsNonoperative management of appendicitis should be approached cautiously for older adults.

Voices from PE Professionals in Mindanao: Expectations Underlying Quality Physical Education Development

The Republic of the Philippines has been striving for quality physical education (PE). The country’s 2016 PE curriculum framework sought to optimise the promotion of active lifestyles, habitual behaviour in physical activities, and competency in physical development. This study explored the gap between PE professionals’ expectations and the reality of quality physical education (QPE) in Mindanao. The ‘Global Index of Quality Physical Education (GIQPE)’ survey was adopted to explore the practice of PE in schools from the perspectives of local PE teachers and professionals for PE curriculum development. Discussing whether their understanding of QPE is consistent with policies may help identify the barriers to local PE development. This research involved 558 participants from six cities of Mindanao to assess the eight dimensions of QPE development: skill development and bodily awareness, facilities and norms in PE, quality teaching of PE, social norms and cultural practice, governmental input for PE, cognitive skill development, and habituated behavior in physical activities. There was no statistically significant difference in QPE perceptions among the sexes, work experience, and positions. Differences appeared in all dimensions between the cities, with Marawi City achieving the lowest score. Sustainable peace against conflicts, sufficient national and local educational budget allocation, and efficient governance of local governments seem crucial to advancing QPE in Mindanao. A thorough investigation of PE in the country and a comparison of its development across the three major islands of the Philippines is recommended to help establish a culturally nuanced approach to QPE development.

The Basic and Clinical Science of Wounds in the Austere Environment

Surgery in developing countries is challenging on many levels. U.S. organizations sponsor approximately 200,000 surgeries performed abroad every year (Miclau et al. 2021a). These altruistic surgeons and physicians– despite their good intentions—may not be equipped with the specific surgical and communication skills necessary for a successful surgery in an austere environment. Surgical skill set, nutrition, facilities, and sociology all play a role in successful surgical outcomes. A thorough understanding of the basic science and clinical science of wounds in the austere environment is imperative for physicians and surgeons providing care in developing nations. Basic science research, in regards to nutrition, parasites; skin, dermal, and bone physiology; as well as microbiome interaction with these structures, can help optimize surgical outcome and reduce adverse events such as infection. Clinical science research and the development of algorithms for surgery in the austere environment can also help improve surgical outcomes and mitigate these adverse events.

Association of Language Barriers With Perioperative and Surgical Outcomes

English language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of language barriers with perioperative care and surgical outcomes to inform efforts aimed at reducing health care disparities. To examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes. A systematic review was conducted in MEDLINE, Embase, Web of Science, Sociological Abstracts, and CINAHL of all English-language publications from database inception to December 7, 2022. Searches included Medical Subject Headings terms related to language barriers, perioperative or surgical care, and perioperative outcomes. Studies that investigated adults in perioperative settings and involved quantitative data comparing cohorts with limited English proficiency and English proficiency were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Because of heterogeneity in analysis and reported outcomes, data were not pooled for quantitative analysis. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. Of 2230 unique records identified, 29 were eligible for inclusion (281 266 total patients; mean [SD] age, 57.2 [10.0] years; 121 772 [43.3%] male and 159 240 [56.6%] female). Included studies were observational cohort studies, except for a single cross-sectional study. Median cohort size was 1763 (IQR, 266-7402), with a median limited English proficiency cohort size of 179 (IQR, 51-671). Six studies explored access to surgery, 4 assessed delays in surgical care, 14 assessed surgical admission length of stay, 4 assessed discharge disposition, 10 assessed mortality, 5 assessed postoperative complications, 9 assessed unplanned readmissions, 2 assessed pain management, and 3 assessed functional outcomes. Surgical patients with limited English proficiency were more likely to experience reduced access in 4 of 6 studies, delays in obtaining care in 3 of 4 studies, longer surgical admission length of stay in 6 of 14 studies, and more likely discharge to a skilled facility than patients with English proficiency in 3 of 4 studies. Some additional differences in associations were found between patients with limited English proficiency who spoke Spanish vs other languages. Mortality, postoperative complications, and unplanned readmissions had fewer significant associations with English proficiency status. In this systematic review, most of the included studies found associations between English proficiency and multiple perioperative process-of-care outcomes, but fewer associations were seen between English proficiency and clinical outcomes. Because of limitations of the existing research, including study heterogeneity and residual confounding, mediators of the observed associations remain unclear. Standardized reporting and higher-quality studies are needed to understand the impact of language barriers on perioperative health disparities and identify opportunities to reduce related perioperative health care disparities.

A comprehensive medical Spanish curriculum model: the Vida Medical Spanish Curriculum

IntroductionRacial and language disparities in the United States healthcare system have long undermined the quality of care provided to minority patients. With the projected growth of the Hispanic population, there is an urgent need for medical schools to integrate high-quality medical Spanish and cultural competency content. We propose a comprehensive medical Spanish curriculum aligned with the preclinical curriculum as a solution to these issues. The primary goal of this study is to demonstrate the effectiveness of a clinically focused, culturally competent medical Spanish program and advocate for its widespread adoption in medical institutions nationwide.MethodsThe study utilized the Kirkpatrick Model to evaluate the success of the medical Spanish curriculum. A total of 111 medical students voluntarily enrolled in the medical Spanish course. Out of these students, 47 completed the final evaluation, which included a Spanish Objective Structured Clinical Examination and a 40-question Multiple-Choice Exam assessing the integration of Spanish language skills and cultural competency. Both assessment methods took place in clinical skills facilities. Descriptive statistics summarized exam results, and two-tailed t-tests compared mean exam scores between students of different proficiency levels.Results and discussionStudents achieved a mean score of over 80% on all components of the Spanish Objective Structured Clinical Examination and the Multiple-Choice Exam. Survey data suggest that students felt able to communicate in Spanish with patients after completing the course series. The study also provides a model for a medical Spanish curriculum that applies expert-recommended best practices to meet the needs of Hispanic patient populations.Limitations and conclusionsStudents who sat for the OSCE and MCE were self-selected. Baseline data on student perceptions and Spanish competency are not sufficient for making comparisons.

A-48 | Thirty-Day Readmission Rates, Predicators, and Causes of Readmission of Acute Coronary Syndrome Patients With Co-Diagnosis of Chronic Kidney Disease who Underwent Left Heart Catheterization During Index Admission: National Readmission Database of 2018

Left heart catheterization (LHC) for acute coronary syndrome (ACS) is a widely performed procedure. This is challenging to some extent in patients with chronic kidney disease (CKD) especially after receiving intravenous (IV) contrast. We aimed to analyze the rates, predictors and causes of readmission after LHC in ACS patients with co-morbid CKD. The National Readmission Database for 2018 was queried to identify hospitalized adults with ACS and co-diagnosis of CKD who received IV contrast during LHC with exclusion of elective and traumatic admissions. Multivariate logistic and linear regression analysis were used to adjust for possible confounders. A total of 78,168 hospitalizations with ACS and CKD who underwent LHC with 73,603 discharged alive. Within 30-days from discharge, 12,632 (17.2%) were readmitted. Congestive heart failure (CHF) with CKD stage 1-4 (15.5%), non-ST segment elevation myocardial infarction (7.7%), and Sepsis (4.6%) were most common causes of readmissions. Independent predictors of readmission included female sex (aOR 1.16, 95% CI: 1.09 - 1.24, P<0.001), discharge against medical advice (aOR 1.70, 95% CI: 1.23-2.35, P<0.001), CHF (aOR 1.45, 95% CI: 1.35-1.56, P<0.001). Figure 1 shows the Forrest plot of multivariate analysis of independent factors associated with readmissions. Predictors of readmission after LHC included female sex, discharge to skilled facility or against medical advice, anemia, hemodialysis, diabetes mellitus, CHF, acute kidney injury, and COPD. Modifiable factors need to be addressed to prevent such a high rate of readmissions.

Case Series of Nitrous Oxide Related Subacute Combined Degeneration from 2016 to 2022 (P9-4.002)

<h3>Objective:</h3> To report laboratory, radiologic, and clinical findings in a case series of patients hospitalized with subacute combined degeneration (SCD) caused by nitrous oxide (NO) abuse. <h3>Background:</h3> NO is legal and widely available as a food additive, making it an easily accessible recreational drug. NO inhibits methionine synthase and inactivates vitamin B12. Prolonged use can lead to B12 deficiency and SCD. <h3>Design/Methods:</h3> We reviewed hospital records from March 2016 until August 2022 and found three cases of SCD associated with NO abuse. <h3>Results:</h3> One 43-year-old male and two females, 27 and 44 years old, had SCD in the setting of NO abuse. All had numbness, weakness, and ataxia. Cognitive and behavioral changes with loss of vibratory sensation and proprioception were not universal. MRI of the cervical cord in all patients demonstrated T2 hyperintensity of the posterior columns in the classic “inverted V” shape consistent with SCD. B12 levels in two patients were 0.54 and 0.73X lower limit of normal (LLN), while in the third patient it was 2.3X the LLN. Methylmalonic acid (MMA) and homocysteine levels were elevated in all patients up to 34X the upper limit of normal. All patients were treated with high-dose B12 repletion, physical therapy, and counseled on nitrous oxide cessation. Two patients were discharged home, while one was discharged to a skilled facility for further rehabilitation. <h3>Conclusions:</h3> NO abuse can induce SCD. Patients may have a normal B12 level but still be functionally B12 deficient because NO inactivates the B12 molecule. Elevated MMA and homocysteine levels are consistent with B12 inactivation as well as deficiency, illustrating the utility of these additional diagnostic tests when B12 deficiency is suspected. Profound neurological deficits can persist at the time of hospital discharge in NO-related SCD. <b>Disclosure:</b> Dr. Warren has nothing to disclose. Dr. Taylor has nothing to disclose. Dr. Savage has nothing to disclose.

Impact of frailty on outcomes in acute ST-elevated myocardial infarctions undergoing percutaneous coronary intervention.

We analyzed the impact of frailty on readmission rates for ST-elevated myocardial infarctions(STEMIs) and the utilization of percutaneous coronary intervention(PCI) in STEMI admissions. The 2016-2019 Nationwide Readmission Database was analyzed for patients admitted with an acute STEMI. Patients were categorized by frailty risk and analyzed for 30-day readmission risk after acute STEMIs, PCI utilizationand outcomes, and healthcare resource utilization. Qualifying index admissions were found in 584,918 visits. Low risk frailty was noted in 78.20%, intermediate risk in 20.67%, and high risk in 1.14% of admissions. Thirty-day readmissions occurred in 7.74% of index admissions, increasing with frailty (p < 0.001). Readmission risk increased with frailty, 1.37 times with intermediate and 1.21 times with high-risk frailty. PCI was performed in 86.40% of low-risk, 66.03% of intermediate-risk, and 58.90% of high-risk patients (p < 0.001). Intermediate patients were 55.02% less likely and high-risk patients were 61.26% less likely to undergo PCI (p < 0.001). Length of stay means for index admissions were 2.96, 7.83, and 16.32 days for low, intermediate, and high-risk groups. Intermediate and high-risk frailty had longer length of stay, higher total cost, and were more likely to be discharged to a skilled facility (p < 0.001). Among adult, all-payer inpatient visits, frailty discerned by the hospital frailty risk scorewas associated with increased readmissions, increased healthcare resource utilization, and lower PCIadministration.

Investigating proficiency using a lift-type transfer support device for effective care: comparison of skilled and unskilled nursing homes

Purpose The purpose of the study was to investigate whether the sustained use of the "Hug," a "hugging" type robotic transfer support device, could increase the level of quality of care. Methods The effect of proficiency on using the device was examined in terms of time spent for transfer, ratio of transfers using the device, and range of targets. The results were compared between skilled care facilities that had used the device for >24 months and unskilled facilities. Results The time spent for transfer at the unskilled facility was 4.6 min (2nd week after introduction), was reduced to 3.0 min (5th week), and 1.5 min at the skilled facility. The usage ratio at the unskilled facility was 13% and 30% (2nd and 5th week, respectively), while it was 97% in the skilled facility. Further, we identified wider in the range of target care recipients in the skilled facility. Conclusion It takes time to master the use of Hug; however, its use was associated with many positive aspects, especially from the perspective of care recipients, e.g., better care, use of their own legs, and reduced time for transfers. These findings suggest that the widespread use of Hug would improve the quality of care. IMPLICATIONS FOR REHABILITATION Less physically burdened on the caregivers using Hug, they can afford to talk to the care recipients. Using recipient’s own legs during transfers, it prevents leg muscle disuse. As reduced time for transfers, recipients will have more opportunities to get out of bed.

Skin Specimen as an Alternative to Brain Tissue for Post Mortem Rabies Diagnosis in Animals to Scale up Animal Rabies Surveillance

Background: Detection of the virus or some of its specific components using WHO and OIE recommended standard laboratory tests is the only way to get a reliable diagnosis of rabies. Brain tissue is the preferred specimen for post-mortem diagnosis of rabies in both humans and animals. Higher biosecurity requirements, skill and transportation facilities required for collection and transport of brain or whole carcass to the laboratory is one of the reasons for the poor rabies surveillance in animals. Point of care testing with simple, reliable and easy to operate devices would be an ideal approach for providing rapid results. Methods: The study evaluated diagnostic performance of two reference tests, DFAT and RTPCR on skin specimen, to assess its suitability as an alternative of brain tissue for post mortem rabies diagnosis in animals. Brain tissue and skin sample belonging to different species of animals (n=90) collected at necropsy were compared using Fluorescent Antibody Test and RT PCR, internationally approved methods for rabies diagnosis. Results: Validation of RT-PCR on skin and DFAT on skin in comparison with DFAT on brain as gold standard gave a sensitivity of 98% (95% CI:94.1-100) and 80% (95%CI:71.8-88.2) respectively. Specificity was 100% in both tests. Conclusion: The findings highlight the potential of skin specimen for improving rabies surveillance in animals especially in resource poor countries.

Evaluating the Impact of Preoperative Geriatric-Specific Variables and Modified Frailty Index on Postoperative Outcomes After Elective Pancreatic Surgery.

Pursuing pancreatic resection in elderly patients is often complex and limited by concern for functional status and postoperative risk. This study examines the associations between two different preoperative functional status metrics with postoperative outcomes in the geriatric population. Patients who participated in the ACS NSQIP Geriatric Surgery Research File pilot program (2014-2018) undergoing elective pancreatic operations were included. Two clinically meaningful functional status scores were calculated: the presence of one or more geriatric-specific variable (GSV) and a 5-factor modified frailty index (mFI-5). Multivariable logistic regression adjusting for ACS NSQIP-estimated risk was performed to evaluate associations between preoperative GSV, mFI-5 and 30-day outcome measures. A total of 1266 patients were included: 808 (64%) age 65-74, 302 (24%) age 75-80, and 156 (12%) age ≥ 81; 843 (67%) patients underwent pancreatoduodenectomy. Operations were performed for pancreatic adenocarcinoma in 712 (56%) patients. Older patients had greater likelihood of postoperative morbidity (35% vs 31% vs 47%, by age group, p = 0.004) and discharge to a facility (12% vs 23% vs 48%, by age group, p &lt; 0.001). Adjusting for ACS NSQIP predicted risk, patients with a preoperative GSV were more likely to require reoperation and discharge to a facility (OR 1.81 [95% CI 1.03-3.16] and 3.95 [95% CI 2.91-5.38], respectively). The mFI-5 was not associated with postoperative outcomes (all p ≥ 0.18). The presence of a preoperative GSV is associated with reoperation and discharge to a skilled facility following elective pancreatic resection. Geriatric-specific variables should be considered in joint preoperative decision making to optimize care.

30-Day Readmission Reduction in a Skilled Facility Population Through Pharmacist-Driven Medication Reconciliation.

Transitions of care can be difficult to manage and if not performed properly, can lead to increased readmissions and poor outcomes. Transitions are more complex when patients are discharged to skilled nursing facilities. We assessed the impact of pharmacist-led initiatives, including medication reconciliation, on readmission rates between an academic medical center and a local skilled nursing facility (SNF). We conducted a two-phase quality improvement project focusing on pharmacist-led medication reconciliation at different points in the transition process. All-cause 30-day readmission rates, medication reconciliation completion rates, and total pharmacist interventions were compared between the 2 groups. The combined intervention and baseline cohorts resulted in a 29.8% relative reduction (14.5% vs. 20.6%) in readmission rates. Medication reconciliation was completed on 93.8% of SNF admitted patients in the first phase and 97.7% of patients in the second phase. Pharmacist interventions per reconciliation were 2.39 in the first phase compared with 1.82 in the second phase. Pharmacist-led medication reconciliation can contribute to reduction of hospital readmissions from SNFs and is an essential part of the SNF transition process.

Gender Justice in Islamic Education (A review of the book Al-Adala al-Ijtima'iyya fi'l-Islam by Sayyid Qutub)

The problem of gender justice in Islamic education starts from history and is still visible on the outside in our Islamic educational institutions. It was only in the 20th century that women obtained equal rights in education, although this equality had not been fully marked by the leaders of educational institutions in general, which were men. This research is a descriptive qualitative research with library-based data collection. The results of this study indicate that there is a need for gender equality reformulation in the leadership of Islamic educational institutions so that they can be more advanced and have high competitiveness, namely by utilizing a leadership model that includes women as part of the leadership board, namely 1) forming a board of directors. leaders of educational institutions by paying attention to gender participation, 2) increasing the facilitation of Islamic educational institutions for women, including sports and skills facilities.

Collaboration in Animal-Assisted Activities and Animal-Assisted Therapy

Animal Assisted Intervention is a valuable tool in inpatient and outpatient rehabilitation. Conducting goal-directed, therapeutic Animal-Assisted Interventions requires certification, training and collaboration. It is important that Animal Assisted Therapy teams comprised of specially trained dogs and handlers are co-certified to ensure the safety of patients, therapeutic interactions, and beneficial outcomes aligned with rehab goals. Some examples of speech therapy goals and outcomes in AAT are included below. It is preferred to conduct co-treatment sessions with AAT therapists and a second clinician to increase the opportunity for a variety of treatment modalities, to develop collaborative ideas for treatment sessions and to improve socialization opportunities. To collaborate for a successful AAT session, a co-treating therapist must first understand the AAT program and services available specific to the trained animal-handler team. This article outlines the process involved in obtaining and maintaining a skilled facility dog and an Animal Assisted Therapy program in an inpatient rehabilitation hospital. Animal Assisted Therapy has great potential to excite, distract, engage, encourage, and motivate patients. It is a new field, with generalized criteria for practice and limited standard protocols. It is underutilized and often mischaracterized. With more widespread education and advocacy and development of clinical standards and guidelines, AAT could improve the lives of so many people hoping to return to life as they knew it.

Anterior lumbar interbody fusion: single institutional review of complications and associated variables

As more patients undergo anterior lumbar interbody fusion (ALIF) procedures and more devices are created for that purpose, it is important to understand the complications that can arise and the variables that mitigate risk for major and minor complications. To assess complication rates after ALIF with or without posterior instrumentation and variables associated with increased likelihood of postoperative complications. We aim to provide this data as benchmarking to improve patient safety and surgical care. A single-center retrospective cohort study. All adult patients who underwent ALIF between 2017 and 2019 was performed OUTCOME MEASURES: Post-operative major and minor complications were evaluated. Complications were recorded and presented as percentages. Patient demographics, perioperative, and postoperative data were also collected and analyzed between patients who had no complications and those that had any complication. Subgroup analysis of surgical complications were performed by nonparametric Chi-square tests. Continuous variables were compared using Mann-Whitney U tests. Ninty-five of three hundred sixty-two (26.2%) of patients experienced a minor or major complication. Among the most common complications found were surgical site infections (5.8%), neurological complications (4.1%), vascular complications (3.6%), and urinary tract infections (3.3%). Patients undergoing ALIF alone with post-operative complications had higher mean age, higher BMI, higher ASA status, and experienced higher estimated blood loss. Patients undergoing ALIF and posterior instrumentation with post-operative complications were more likely to have diabetes and had a higher ASA status. Patients with any complications from both groups had longer length of stay, discharge to a non-home setting and were more likely to be readmitted or return to the operating room. Our study reveals variables associated with complications at our institution, including age of the patient, BMI, and ASA status leading to higher complications and greater LOS, higher readmission rates, and disposition to skilled facilities.

The barriers to using modern contraceptive methods among rural young married women in Moshi Rural District, the Kilimanjaro region, Tanzania.

The relationship between the rate of modern contraception and unintended pregnancy is complicated in Tanzania. Although the contraception rate has been slightly increased; the unintended pregnancy rate has remained at 22~24% since 1999. In addition, married women in rural areas use less modern contraceptive methods than those in urban areas. Young women are at a higher risk of mistimed and unintended pregnancy compared to older females. Various barriers to using contraceptive methods have been reported, including fear of side effects, lack of knowledge, misconception, accessibility of the methods, and limited health workers' skills. This study was aimed to invest the barriers to using modern contraceptive methods among rural young married. A qualitative study was carried out in Moshi rural district in northeast Tanzania between June 2019 and July 2019. 22 in-depth interviews (9 key informants and 13 young married women aged 19-34) were conducted. Thematic analysis was used and data transcripts were coded. As a result, all participants were familiar with modern contraceptive methods and experienced at least one of them. Fear of side effects and prefer inappropriate birth control methods especially superstitious methods were major barriers to use. Also, rumours and misleading concerns have arisen from peers and village members. Condoms were not used among them, and males and the elderly still perceived family planning negatively. Additionally, although long-term modern contraceptive methods have been increased and preferred, IUCD is inaccessible due to the lack of skilled workers and facilities. In conclusion, community-based reproductive education is required to increase awareness of safe and reliable modern contraceptive methods. And frequent outreach services of the field are essential to provide more contraception's benefits to the village members so that barriers to using contraception and unwanted pregnancy could be reduced in rural Tanzania. In order to do that, more interventions, such as NGOs and strengthened government systems of reproductive health, should be enhanced.

Psychiatric Comorbidities Affect the Hospitalization Course of Parkinson's Disease Patients: A Cross-Sectional Inpatient Study.

ObjectivesWe aim to delineate the differences in demographic characteristics and hospitalization outcomes including the severity of illness, hospitalization length of stay (LOS) and cost, utilization of deep brain stimulation (DBS), and disposition in Parkinson’s disease (PD) inpatients with psychiatric comorbidities versus without psychiatric comorbidities.MethodsWe conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS), included 56,844 PD inpatients (age ≥40 years), and subdivided them by inpatients into those without psychiatric comorbidities (N = 38,629) and with psychiatric comorbidities (N = 18,471). We compared the distributions of demographic characteristics and hospitalization outcomes (severity of illness, utilization ofDBS, and disposition) by performing Pearson’s chi-square test, and we measured the differences in continuous variables (i.e., age, LOS, and cost) by using the independent samples t-test. ResultsA significantly higher proportion of PD inpatients with psychiatric comorbidities were female (44.4%) and white (83%) and had a moderate loss of functioning (48.8%) compared to those without psychiatric comorbidities. PD inpatients with psychiatric comorbidities had an increased mean LOS (4.7 days vs. 3.7 days, P <0.001) but a lower mean cost ($37,445 vs. $ 41,957, P <0.001). Also, there was a significantly lower utilization of DBS in PD inpatients with psychiatric comorbidities (19.2% vs. 26.9%, P <0.001) compared to those without psychiatric comorbidities, and an adverse disposition of transfer to a skilled nursing facility/intermediate care facility (47.1% vs. 39.6%, P <0.001) compared to PD inpatients without psychiatric comorbidities.ConclusionAlthough PD patients with psychiatric comorbidities had a moderate loss of functioning, there was significant underutilization of DBS. Meanwhile, psychiatric comorbidities among PD patients led to increased LOS and transfer to skilled facilities.