Hospital Treatment Research Articles

Fatigue and cognitive dysfunction in previously hospitalized patients with COVID-19: A 1-year follow-up.

The aim was to longitudinally explore changes in fatigue- and cognition-related symptoms during the first year after hospital treatment for COVID-19. Patients hospitalized for COVID-19 in Gothenburg, Sweden, were consecutively included from 01-07-2020 to 28-02-2021. Patients were assessed at the hospital (acute) and at 3 and 12 months after hospital discharge. Cognition was assessed with the Montreal Cognitive Assessment (MoCA), the Trail Making Test B (TMTB), and the Cognitive Failure Questionnaire (CFQ). Fatigue was assessed using the Multidimensional Fatigue Inventory-20 (MFI-20) and the Mental Fatigue Scale (MFS). Data was analyzed with demographics and changes over time calculated with univariable mixed-effects models. In total, 122 participants were included. Analyzes of Z-scores for MoCA indicated improvement over the year, however the results were 1 SD below norm at all assessments. Alertness (TMTB scores) improved significantly from the acute assessment to the 12- month follow-up (p = <0.001, 95% CI 34.67-69.67). CFQ scores indicated cognitive impairment, and the sum scores for MFI reflected a relatively high degree of fatigue at follow-up. In the first year after hospitalization for COVID-19, most patients experienced fatigue and cognitive impairment. Alertness improved, but improvements in other domains were limited.

Do Danish ICU Survivors Remain Employed After ICU Discharge? A Register-Based Longitudinal Cohort Study

Objectives: Admission to ICU is associated with long-term consequences for the survivors. The study explores whether Danish ICU survivors remain employed after ICU discharge. Design: A longitudinal register study of 16,284 Danish ICU survivors 25–67 years old 1:1 sex- and age-matched with general population references. Weekly prevalence proportions (%) of employed, public benefits, and deceased individuals were calculated based on the Danish Register-Based Evaluation and Marginalization Database and the Danish Civil Registration System until December 31, 2019. Age- and multivariate-adjusted hazard ratios (HRs) with 95% CIs were determined by Cox and Fine-Gray models. Setting: Denmark has tax-funded healthcare and social security ensuring hospital treatment and social benefits free of charge for all Danish residents. SUBJECTS: The study included Danish residents acutely admitted to public ICU treatment for critical illness from 2010 to 2018. Interventions: None. Measurements and Main Results: The prevalences of employed ICU survivors increased from 30% at 2–8 weeks to 56% at 52 weeks after ICU discharge showing minor delay in women. The prevalences declined by age being 63%, 58%, 55%, and 52% in ages 25–42, 43–52, 53–58, and 59–63 years, respectively, 52 weeks after ICU discharge. The prevalences of employed ICU survivors declined by level of comorbidity being 64%, 53%, and 37% in ICU survivors of Charlson Comorbidity Index score 0, 1–2, or greater than or equal to 3, respectively, 52 weeks after ICU discharge. ICU survivors had higher risks of becoming retired (HR, 14.86; 95% CI, 8.69–25.41) or sickness absent (HR, 7.56; 95% CI, 7.16–7.98) when accounting for competing risks compared with the general population references. Conclusions: About half of ICU survivors remained employed 52 weeks after ICU discharge. Age and comorbidity were effect modifiers.

Sustainable Health and Well-Being: Guidelines for Integrating Therapeutic Gardens for Holistic Hospital Care

Therapeutic hospital gardens (THGs) need to be purposefully designed for hospital users and well-integrated into the clinical hospital treatment plan to be effective. Healthcare decision-makers are critically important in establishing therapeutic gardens in hospitals and healthcare facilities because they have the ultimate decision-making power to include such gardens for the holistic care of their patients, staff, and visitors. This study aims to establish how THGs can be successfully created by investigating the professional experiences of 12 global healthcare decision-makers in hospital administration, executive government, and senior consultancy to government on the role of THGs in creating a healthy and sustainable hospital environment. This article shows how these decision-makers, who have already worked with healthcare designers and clinical practitioners to design and establish THGs, have been selected and interviewed. The qualitative analysis of these semi-structured interviews uncovered why and how these healthcare decision-makers made THGs a reality in their hospitals. This analysis informed the development of the THG Healthcare Decision-maker Guidelines, which were designed to guide all hospital CEOs, government executives, and senior consultants to the government to both design and then establish THGs successfully. These guidelines include five systematic steps: 1. design for hospital cohorts; 2. purposefully design and integrate THGs well; 3. facilitate inclusive and defined stakeholder engagement; 4. evaluate the garden visitor experience; and 5. understand the benefits and values of THGs. These five systematic steps can be used immediately by healthcare decision-makers to work with healthcare designers and clinical experts to implement such gardens in hospitals successfully. When the three sectors, healthcare governance, healthcare design, and clinical health, work together, more THGs can be established in hospitals for better patient care, visitor well-being, and a healthy and sustainable hospital environment.

Long working hours and health in Denmark: a post hoc analysis of three cohort studies

BackgroundTo protect the safety and health of workers, national legislations often stipulate an upper limit to weekly working time. The purpose of the present study was to provide information that may facilitate the obtainment of evidence-based limits to weekly working time.ObjectiveTo estimate incidence rate ratios (RRs) of (i) hospital treatment or death due to accidental injuries, (ii) redeemed prescriptions for psychotropic drugs and (iii) redeemed prescriptions for antihypertensive drugs, respectively, as continuous functions of weekly working hours among employees in the general population of Denmark.MethodsBaseline data on working time arrangements were obtained from the Danish Labor Force Surveys of 1999–2013. Follow-ups with a mean duration of 1.8, 4.0 and 6.6 years for accidental injuries, psychotropic drugs and antihypertensive drugs, respectively, were accomplished through national registers. Adjusted RRs were obtained through Poisson regression in the interval 32–80 weekly working hours (wwh). The reference (standard working hours) was set at 37 wwh. RR estimates were interpreted in accordance with a modified version of Monson’s guide to strength of associations, in which a RR in the open interval 0.83 to 1.2 is classified as ‘no association’ (too weak to be detected by observational studies).ResultsThe estimated RRs as well as the upper and lower limits of their 95% confidence intervals lied within the no-association zone throughout the intervals 32–76, 32–64 and 32–69 wwh, for accidental injury, psychotropic drug use and antihypertensive drug use, respectively. The estimated RRs for psychotropic drug use decreased from 1.08 (95% CI: 1.03–1.13) at 32 wwh to 0.96 (0.93–0.99) at 45 wwh. They thereafter increased to 1.00 (0.95–1.06) at 55 wwh and 1.31 (1.08–1.63) at 80 wwh. The estimated RRs for accidental injury and antihypertensive drug use increased slowly from 1.00 at 37 wwh to 1.04 (0.88–1.24) and 1.11 (0.94–1.31), respectively, at 80 wwh.ConclusionThese results suggest that, from a societal perspective, the effect of wwh on the rates of these types of morbidity is negligible throughout the interval 32–64 wwh.

Survivors’ Narratives of the Oklahoma City Bombing Retold Seven Years Post-Disaster

Introduction: A large proportion of the existing voluminous disaster mental health research literature represents the quantitative study of psychopathology, especially posttraumatic stress disorder. Subjective disaster experience is relatively unexplored. Qualitative narratives of surviving a disaster may provide insight into individual experiences of it and efforts to derive meaning from it. Methods: From an initial random sample of 182 survivors of the Oklahoma City bombing, narrative descriptions of this experience were collected 7 years after the bomb blast from 116 of the original sample, for the purpose of examining persistent as well as newly evolving content through qualitative analysis. The narrative content was analyzed for the evolution of thematic content in narrative data also collected at 6 months post-disaster and 1 year later. Results: The thematic content of the bombing experience was structured in a chronological fashion from the bomb blast (sensory, cognitive, and emotional), its immediate aftermath (e.g., escaping danger), and later experiences, (e.g., leaving the bomb site and receiving hospital treatment). During the time between interviews, the focus and general content of the narratives changed minimally, despite considerable compression of detail. Conclusions: The consistency of the material in these narratives over 7 years may reflect the persistence and salience of disaster memories, with the potential for its continuation for the rest of their lives.

Impact of the COVID-19 pandemic on the clinical features of patients with chronic obstructive pulmonary disease: an observational cross-sectional study.

The presence of chronic obstructive pulmonary disease (COPD) and COVID-19 infection is a detrimental combination for patients and can cause negative clinical consequences. The investigation aimed to compare sociodemographic and clinical parameters of COPD individuals hospitalized for exacerbations before and at the end of the COVID-19 pandemic. An observational cross-sectional study including 222 patients with COPD was conducted in two stages: a survey and assessment of clinical and laboratory data of patients hospitalized from September 2022 to March 2023 (n=98) and processing of the medical histories of patients with COPD who received hospital treatment in 2017 and 2018 (n=124). A comparative analysis of patients who received inpatient treatment for COPD showed that the frequency of patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) I was half as high after the COVID-19 pandemic, whereas the individuals with GOLD IV were more frequent during the same period (p<0.05). Multiple regression analysis proved the effects of smoking status and previous COVID-19 infection on the health status of patients with COPD according to COPD Assessment Test data (p<0.05). There was an increase in the frequency of comorbid pathologies in the post-COVID period: hypertension, coronary heart disease, gastrointestinal diseases, anemia (p<0.05), and other diseases. This study highlights the significant influence of the COVID-19 infection on people with COPD, which manifested as impaired lung function and an increased incidence of comorbidities.

Severe hypoglycaemia and diabetic ketoacidosis in adults presenting to a hospital emergency department: Adverse prognostic markers for survival in type 2 diabetes and the role of SGLT2 inhibitors.

To determine the prognosis associated with severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) in adults presenting to a hospital emergency department (ED). Medical records of adults with type 1 (T1D) and type 2 (T2D) diabetes who attended the ED with SH and DKA between 1 January 2019 and 30 June 2023, were reviewed for comorbidities, long-term survival, mortality and causes of death. A total of 429 episodes of DKA occurred in 293 people and 643 episodes of SH in 515 people. DKA predominated in T1D (77.6%) and SH in T2D (54.3%). In T2D, 32.3% of DKA events were associated with sodium-glucose cotransporter-2 inhibitor (SGLT2-i) medication. In both SH and DKA, patients with T2D were older and had more comorbidities than T1D, particularly cardiorenal disease, heart failure, cognitive impairment and cancer (all p < 0.005). Compared with T1D, mortality was higher in T2D after SH (48.4% vs. 19.9%, p < 0.005) and after DKA (30.8% vs. 13.4%, p = 0.001) with shorter median times to fatal outcome (SH: 134 vs. 511 days; DKA: 43 vs. 266 days, both p < 0.005). Long-term survival was lower (p < 0.005) and mortality risk was higher in T2D after index presentation with SH (HR 3.43 [95% CI: 2.43-4.84], p < 0.005) and DKA (HR 3.00 [95% CI: 1.77-5.10], p < 0.005). Irrespective of diabetes type, most causes of death in SH and DKA were non-cardiovascular. SH and DKA events requiring hospital treatment herald a poor prognosis with greater mortality in T2D adults with multimorbidity. A significant number of DKA episodes in T2D occurred in people receiving SGLT2-i medication.

How ethical is the use of financial incentives to promote medication adherence among patients with serious mental illness? - a scoping review of the literature

Poor adherence to medication treatment in those with serious mental illness is common. Typical solutions and consequences in Western, formal psychiatric care settings often involve coercive measures such as involuntary hospital admissions and treatment, and out-patient commitments, with serious infringements on civil liberty. We examine the relatively unfamiliar, controversial and under-explored area of using financial incentive (FI) to enhance medication adherence in this population through a comprehensive scoping literature review, focusing on the ethical aspects of this practice. From nineteen qualified papers, we identified seven key themes of ethical “concerns,” and opposing arguments on whether FI is: (1) itself a form of coercion affecting autonomy; (2) leading to erosion of a proper consent process; (3) causing indirect and unintended harm; (4) worsening multiple levels of stigma related to mental illness; (5) associated with loss of intrinsic motivation of treatment; (6) associated with misuse of the fund itself; and (7) potentially leading to negative impact on therapeutic relationships. The ethics review shows a moderate receptivity to the use of FI in some specific and individualized circumstances; exceptions for those with poor insight and lacking treatment capacity are particularly relevant in order to avoid other forms of coercion. Additional highlights of the review include the optimal amount, duration, scope, and target population of the FI, and need for rigorous attention to psychoeducation, process, therapeutic relationships, stigma, and not lose sight of ultimately aiming to improve on patients’ insight, autonomy, quality of life and intrinsic motivation in this controversial approach.

Evaluation of the therapeutic relevance of architectural aspects in child and adolescent psychiatric institutions from the perspective of architects and senior physicians

ObjectiveThe concept of “Healing Architecture” addresses the relevance of design and architectural issues on the outcome of medical and therapeutic treatment in hospitals. The questionnaire ARCHI was developed to record data on the opinion of different groups of users on the architectural design of their therapeutic environment in departments of child and adolescent psychiatry.MethodA Questionnaire-based cross-sectional study was conducted in two phases between 2020 and 2022 using ARCHI to gather the perspectives of senior physicians and architects on the significance of architectural design in German child and adolescent psychiatric facilities.ResultsIn the survey of the senior physicians, 49 heads of child and adolescents psychiatric departments initiated the survey, and 73.5% (n = 36) of them completed the questionnaire in its entirety. During the survey for the architect-specific, 145 individuals commenced the survey, and 60.7% of them completed the questionnaire (n = 88). Significant differences between architects and senior physicians became visible for four of the 93 items, namely “environment of the hospital”, “structure of building”, “labelling of floors” and “visible cleanliness”.ConclusionsAlthough senior physicians and architects were characterized by the same opinions on the relevance of architectural design on therapeutic issues for the major part of issues, differences could be obtained for several aspects which are important for the architectural planning of new departments and hospitals. It remains open why both professional groups had different point of views on these four aspects of hospital design which should be clarified to improve the process of hospital development in the future.

Post-discharge tobacco abstinence in a Mumbai hospital after implementation of tobacco cessation counseling: A pragmatic evaluation of the LifeFirst program.

Hospitalization provides a key opportunity to address tobacco use. Few studies have examined cessation treatment in hospitals in low- and middle-income countries (LMIC). We aimed to measure tobacco abstinence among individuals discharged from a Mumbai hospital after the implementation of cessation counseling compared to abstinence among those discharged pre-implementation. Pre-post intervention study in the Prince Aly Khan Hospital, Mumbai pre- (11/2015-10/2016) and post-implementation (02/2018-02/2020) of LifeFirst counseling. LifeFirst is multi-session (up to six sessions) counseling extending from hospitalization up to six months post-discharge. Primary analyses compare self-reported 6-month continuous abstinence among hospitalized individuals post-implementation (intervention) with pre-implementation (comparator) using an intent-to-treat approach that includes all participants offered LifeFirst post-implementation in the intervention group. Secondary analyses compare those who received ≥ 1 LifeFirst session with the pre-implementation group. We enrolled n = 437 individuals pre-implementation (8.7% dual use, 57.7% smokeless tobacco, 33.6% smoking) and n = 561 post-implementation (8.6% dual use, 64.3% smokeless tobacco, 27.1% smoking). Post-implementation, 490 patients (87.3%) accepted ≥ 1 counseling session. Continuous abstinence 6-months post-discharge was higher post-implementation (post: 41.6% vs. pre: 20.0%; adjusted odds ratio [aOR]: 2.86, 95% confidence interval [CI] 1.94-4.21). Those who received LifeFirst had higher odds of continuous abstinence compared to pre-implementation (aOR: 2.95, 95% CI 1.98-4.40). Post-discharge abstinence was more common after implementation of a multi-session tobacco counseling program for hospitalized patients compared to abstinence among patients hospitalized before implementation. These findings represent observational evidence of a promising association between post-discharge abstinence and a hospital-based tobacco cessation program implemented within routine practice in an LMIC setting.

Current situation and capacity of cancer diagnosis and treatment in county hospitals in China: a multicenter cross-sectional survey

PurposeCounty-level hospitals in China constitute a vital component of the healthcare system, delivering essential medical services, emergency care, and specialized treatments, particularly in oncology. This study aimed to comprehensively evaluate the current status of cancer diagnosis and treatment in county hospitals and assess their overall capacity.MethodsA nationwide cross-sectional survey by the China Anti-cancer Association (CACA) from February to May 2023 assessed cancer diagnosis and treatment in mainland China's county hospitals. Using a multi-center approach, a fifty-five-question questionnaire was administered to oncology professionals and management staffs, focusing on hospital facilities, oncology specialists, cancer cases, treatment capabilities, and healthcare collaboration. Questionnaire reliability and validity were established in a 2022 national survey. Participants, aged 18 or older, were recruited through purposive sampling, receiving self-administered questionnaires for confidentiality. SAS 9.4 software facilitated statistical analysis.ResultsThe study encompassed 76 county-level medical institutions, with 82.9% of them featuring established oncology departments providing comprehensive cancer care, including early screening, diagnosis, treatment, and long-term follow-up. Notably, a total of 56.6% of the institutions surveyed implemented programs for cancer screening and early diagnosis. A significant proportion of advanced cancer patients received treatment and follow-up at the county level. Persistent disparities in medical insurance policies at the county level were identified as a continuing challenge. Furthermore, 82.9% of hospitals had cultivated collaborative relationships with higher-level institutions to enhance patient care quality and treatment capacity. The study revealed a 56.6% shortage of remote collaboration platforms in these hospitals. The need for a patient-centered approach in county hospitals was underscored.ConclusionWhile county-level hospitals face challenges, such as a shortage of specialized oncologists and advanced resources, they exhibit progress in standardizing cancer care to enhance diagnosis and treatment in rural areas.

Antimicrobial stewardship to reduce overtreatment of asymptomatic bacteriuria in critical access hospitals: measuring a quality improvement intervention.

Asymptomatic bacteriuria (ASB) treatment is a common form of antibiotic overuse and diagnostic error. Antibiotic stewardship using the inappropriate diagnosis of urinary tract infection (ID-UTI) measure has reduced ASB treatment in diverse hospitals. However, critical access hospitals (CAHs) have differing resources that could impede stewardship. We aimed to determine if stewardship including the ID-UTI measure could reduce ASB treatment in CAHs. From October 2022 to July 2023, ten CAHs participated in an Intensive Quality Improvement Cohort (IQIC) program including 3 interventions to reduce ASB treatment: 1) learning labs (ie, didactics with shared learning), 2) mentoring, and 3) data-driven performance reports including hospital peer comparison based on the ID-UTI measure. To assess effectiveness of the IQIC program, change in the ID-UTI measure (ie, percentage of patients treated for a UTI who had ASB) was compared to two non-equivalent control outcomes (antibiotic duration and unjustified fluoroquinolone use). Ten CAHs abstracted a total of 608 positive urine culture cases. Over the cohort period, the percentage of patients treated for a UTI who had ASB declined (aOR per month = 0.935, 95% CI: 0.873, 1.001, P = 0.055) from 28.4% (range across hospitals, 0%-63%) in the first to 18.6% (range, 0%-33%) in the final month. In contrast, antibiotic duration and unjustified fluoroquinolone use were unchanged (P = 0.768 and 0.567, respectively). The IQIC intervention, including learning labs, mentoring, and performance reports using the ID-UTI measure, was associated with a non-significant decrease in treatment of ASB, while control outcomes (duration and unjustified fluoroquinolone use) did not change.

Cariprazine in Hospital Treatment of Acute Psychotic Conditions Due to Comorbid Schizophrenia and Chemical Addictions

Background: endogenous psychoses complicated with different addictions have special psychopathological structure including delirious episodes, true hallucinations combined with typical positive symptoms of schizophrenia. These cases are difficult for treatment due to non-compliance of patients and their bad tolerance to drugs. The aim was to study the most effective psychopharmacological treatment using cariprazine for acute psychotic states in paranoid schizophrenia combined with chemical addictions. Patients and Methods: the study was conducted at psychiatric hospitals of Tomsk region, St. Petersburg, Nizhnevartovsk and Noyabrsk from 2018 to 2024. 208 men aged 18 to 45 years suffering from paranoid schizophrenia and dependent on psychoactive substances were examined. The main group made up 104 in-patients, who took cariprazine alone or in combination with haloperidol or chlorpromazine. The control group included 104 in-patients treated with other antipsychotics (aripiprazole, risperidone, olanzapine). Research methods: clinical and psychopathological, psychometric (PANSS, SANS, CGI, GAF), statistical (Python 3.11.0; R version 3.2.4; SPSS Statistics Base 22.0). Results: It was revealed that when comparing the control group with the main group, similar indicators were observed on the CGI and GAF scales on the 2nd week of the study, and on the 4th week of the study, compared with the control group, an improvement in indicators on the PANSS, SANS, CGI, GAF scales was observed. Conclusions: Cariprazine, compared with other atypical antipsychotics (risperidone, olanzapine, aripiprazole), showed a distinct antipsychotic effect in the treatment of acute psychotic states in patients with schizophrenia dependent on psychoactive substances. By the end of the 2nd week after hospitalization, when treating with cariprazine at an average dose of 3 to 6 mg/day in combination with typical neuroleptics (haloperidol, chlorpromazine) or a tranquilizer, the most pronounced antipsychotic effect is achieved. Subsequent isolated use of cariprazine at a therapeutic dose of 3–4.5 mg/day has an effect similar to that of leading atypical antipsychotics by the end of the 4th week of treatment. Unlike other atypical antipsychotics, cariprazine was more effective in the treatment of negative symptoms of schizophrenia, which made it possible to achieve an improvement in overall functioning, increase the duration of remission, and reduce the risk of rehospitalization and the development of hospitalism.

Somatic and neurological comorbidities in COVID-19 with fatal outcome

Introduction. Although the risk of emerging coronavirus infection may seem to have disappeared at first glance, SARS-COV-2 has complex and poorly understood effects on many organ systems, including the nervous system. Disease progression and unfavorable outcome COVID-19 are not only due to lung damage, elderly age, concomitant pathology: hypertension, diabetes mellitus, etc. have a significant impact.Aim. To study the structure of mortality in a new coronavirus infection COVID-19, caused by delta strain of coronavirus SARS- CoV-2, taking into account the nature of concomitant therapeutic and neurological pathology, the degree of comorbidity, fatal complications, and sex and age characteristics.Materials and methods. A postmortem analysis of pathological and anatomical conclusions of 209 patients with COVID-19 with comorbid somatic and neurological pathology who received inpatient treatment in covid hospitals of the Republic of Mordovia in 2021 was performed. The severity of the underlying disease, concomitant therapeutic and neurological pathology, and comorbidity were analysed. The coincidence of the final clinical and pathological diagnoses, fatal complications were assessed. The presented data allowed to identify the main factors of unfavourable outcome.Results and discussion. In unfavourable outcome of the disease, concomitant pathology is represented by hypertension, ischemic heart disease, chronic heart failure, chronic cerebral ischemia. In women, cases of diabetes mellitus and atherosclerosis were more frequent, in men - hypertension and chronic heart failure.Conclusions. New coronavirus COVID-19 infection associated with delta strain of SARS-COV-2 virus is characterised by severe and extremely severe course in elderly patients with comorbid somatic and neurological pathology.

Consideration and implementation of the elements of hospital mass casualty planning in the hospitals of the TraumaNetworks DGU® : An evaluation within the framework of the development process of the guidelines for clinical disaster medicine in Germany (LeiKliKatMeD) by the EKTC, NIS, AKUT, AUC

The protection and maintenance of hospital functionality and treatment capacity require preventative planning and preparation for amass casualty incident with respect to the scenarios, disasters or catastrophes to be expected. The hospital alarm and operations (KAEP) or stockpiling plan should include and organize the procedures and measures in the respective clinics and hospitals. The aim of the present study was to evaluate the hospitals of the Trauma Networks of the German Society for Trauma Surgery® (TNW DGU®) with respect to the established organizational structures and contents of the KAEP. In this study 622 hospitals from the TNW DGU® were surveyed to determine current treatment capacities depending on the principles and standards of care. This was done via the DGU Academy of Trauma Surgery (AUC) and an online-based survey with voluntary participation via aweb-based platform (SurveyMonkey Europe UC, Dublin, Ireland). The data presented here represent an excerpt of the overall data focused on the topic of this paper. Of the 622 certified clinics 252 (40%) took part in the survey in December 2022 and 250 data sets could be evaluated. LevelI,II,III trauma centers (LTZ, RTZ, ÜRTZ) took part in equal numbers. Of the participating clinics 90% have aKAEP that has been updated in the last 3 years. The manual of the Federal Office of Civil Protection and Disaster Assistance (BBK) was known in two thirds of the clinics surveyed. Only 30% of the clinics adapted their own KAEP after it was published and only 40% exercised it in the last 3 years. Elements for the care of those affected and injured (psychosocial network, end-of-life care, care of relatives) were included in 25-44% of hospitals. Regardless of the certification, it became obvious that around 80% of the hospitals rely exclusively on one alarm procedure and only 20% use aredundant system with 2 or more notification procedures. The survey showed that more than 75% of the hospitals already have the option of selective or partial alerting. Depending on the triage category, the LTZs were able to initially admit an average of 2SKI and 4SKII patients. These capacities were almost doubled by the RTZ and tripled by the ÜTZ. The DGU Trauma Networks represent an essential part for the care in disaster and major disaster situations. The KAEP has been implemented in the majority of hospitals. Updating the KAEPs to current content, practicing and digital, selective and redundant systems for alerting represent achallenge. In addition, the harmonization of terms and organizational elements but also the establishment of care for relatives and the care and psychosocial emergency treatment (PSNV) have not yet been fully implemented. Ultimately, aKAEP must be implemented to make hospitals and the healthcare system more resilient to disasters and major disasters. It is important to support the hospitals and ensure that costs for exercises and training course formats are covered.

Antipsychotic Prescribing Practices for In-patients with Schizophrenia

Results: consumption of antipsychotics in hospital for the period 2015–2022 characterized by a decrease in the proportion of typical antipsychotics (TA) to 12.8% due to an increase in the proportion of atypical antipsychotics (AA) to 61.0% and long-acting antipsychotics (LA) to 26.2%. The administration of antipsychotics by hospital treatment units was relatively uniform. Clozapine (26.9%), zuclopenthixol (20.0%), haloperidol (10.3%), olanzapine (10.3%), risperidone (9.3%), quetiapine (8.2%), paliperidone (4.1%) accounted for 89.1% of all antipsychotics consumed. The total proportion of cariprazine, pericyazine, aripiprazole, ziprasidone, levomepromazine, chlorprothixene, chlorpromazine, tiapride and trifluoperazine, sertindole, lurasidone, sulpiride, flupenthixol and brexpiprazole was 10.9%. Among the medications prescribed to patients with schizophrenia, the leading ones were risperidone (36.2%), haloperidol (17.1%), olanzapine (15.6%), and clozapine (10.8%). The frequency of prescription of other drugs was less than 10.0%. The share of TA was 26.3%, AA — 73.7%. In the vast majority of cases (98.1%), patients received monotherapy. Conclusion: the data obtained on the structure of antipsychotic prescriptions indicate that our approaches correspond to the global trend of the predominant use of second-generation antipsychotics in the in-patient treatment of schizophrenia.

Analysis of the effectiveness of primary treatment of stage IA–IIA ovarian cancer. Siberian Journal of Oncology

Aim: to determine the effectiveness of primary treatment of patients with ovarian cancer of stages IA–IIA.Material and Methods. The study included 336 (100 %) patients with histologically confrmed ovarian cancer of stages IA–IIA, who were treated at the Primorsky Regional Oncology Center from 2004 to 2021. The overall survival (s) and progression-free survival (PFS) were analyzed depending on clinical and morphological factors: histological type of cancer, BRCA1/2 mutation, profle of the clinic where surgical treatment was performed, surgical staging and chemotherapy option. The examination for a mutation in the BRCA1/2 gene was performed by a new generation sequencing method. The data were statistically processed using the IBM SPSS Statistics 26 program.Results. The average age of patients with stage IA–IIA ovarian cancer was 52.12 ± 12.13 years. Statistically signifcantly higher survival rates were in patients with histological tumor type low-grade serous carcinoma compared with high-grade serous carcinoma (S: p=0.010 and IBP: p=0.020), with surgical treatment in specialized hospitals compared with patients operated in gynecological hospitals (s: p=0.040 and IBP: p=0.020), during adequate surgical staging (OV: p=0.008 and IBP: p=0.010), during treatment with platinum and taxanes (OV: p=0.001 and IBP: p=0.001).Conclusion. It was shown that about 30 % of patients with stage IA–IIA ovarian cancer in Primorsky Krai received primary surgical treatment in non-specialized hospitals, which increased the risk of progression and death by 1.7 times. A low percentage of adequate surgical staging was noted (12.5 %). Adjuvant chemotherapy with platinum and non-oxane agents worsened the prognosis of the disease. Patients with low-grade serous carcinoma had a more favorable prognosis (by 60 %). There was no statistically signifcant effect of the presence of a mutation in the BRCA1/2 genes on survival rates.

Musculoskeletal Sepsis in the Pediatric Intensive Care Unit

Background: Childhood bone and joint infection (BJI) ranges in severity, with the most unwell children requiring pediatric intensive care unit (PICU) support. We describe demographic and prehospital features of BJI cases associated with PICU admission and report treatment outcomes and costs for these cases. Methods: This study includes a retrospective cohort of children ≤15 years of age hospitalized with acute hematogenous osteomyelitis or septic arthritis in Auckland between 2018 and 2023. Cases admitted to PICU were compared to non-PICU hospitalized BJI cases. Direct medical hospitalization costs, treatment type and outcomes were described up to 1 year following discharge. Results: Of 563 BJI cases, 43 (8%) were admitted to PICU. PICU cases had shorter prehospital symptom duration (3.78 vs. 5.73 days, P = 0.0002). Sensitive Staphylococcus aureus was equally likely to cause disease in PICU and non-PICU cases (P = 0.86). Average hospitalization was longer (35.78 vs. 8.71 days, P ≤ 0.0001) for those admitted to PICU. Readmission and complication rates were both higher within the first year. Average cost per admission was $378,120 NZ dollars (±$796,891.64) for PICU cases versus $32,219 (±$201,797.33), P = 0.01 for cases not requiring PICU admission. In regression analysis, Māori ethnicity, previous history of infections and congenital conditions were statistically associated with PICU admission. Conclusion: In this study, children admitted to PICU with severe BJIs were more likely to have a history of congenital conditions or previous infections. Those of Māori ethnicity are overrepresented. Children treated in PICU have longer hospitalizations and experience more adverse outcomes at 1 year following discharge.

Acute abdominal pain in general practice

Acute abdominal pain (AAP) represents the 9th most common complaint in general practice. The etiologies are multiple: a third are non-specific, but around 10% require hospital treatment. An accurate history enables a correct diagnosis in 76% of cases, and abdominal palpation can detect a possible surgical abdomen. This article summarizes the intra- and extra-abdominal causes of AAP, the diagnostic strategies, and the most appropriate complementary examinations. It lists the most common causes in general practice, as well as their management and reviews the warning signs not to be missed.

Identifying physicians' needs in community-based palliative care consultation for cancer patients in palliative care specialist-deficient settings: a qualitative study.

Consultation with palliative care specialists can be beneficial in addressing the numerous demands of patients with cancers and their families within communities. In settings lacking palliative care specialists, establishing a new community-based palliative care consultation system necessitates gathering evidence to support its development. This study aimed to identify the specific palliative care consultation needs and the consultation methods requested by Japanese physicians in settings without palliative care specialists. A qualitative descriptive study utilizing semi-structured virtual interviews. From August 2023 to October 2023, we conducted interviews with 11 physicians providing cancer treatment in hospitals or clinics in a prefecture within the Kanto region of Japan without palliative care specialists. Participants were asked about the specific palliative care consultation needs they have and the need for consultation methods. Of the 11 physicians, nine had completed the nationwide basic primary palliative care education program. The survey revealed three themes regarding their consultation needs: 'receiving specialized insight', 'inspiring confidence', and 'improving care capacity', Two themes emerged regarding the need for consultation methods: 'enhancing care collaboration' and 'improving accessibility'. Physicians require consultation systems to empower them and enhance the community care capacity, in addition to providing specialized knowledge. These systems would include collaboration with specialists through outreach consultations, utilization of information and communications technology, and the establishment of nurse-led consultation teams to improve access to palliative care teams.