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OBJECTIVE: This study harnesses the power of text mining to quantitatively investigate the causative factors of falls in adult inpatients, offering valuable references and guidance for fall prevention measures within hospitals. METHODS: Employing KH Coder 3.0, a cutting-edge text mining software, we performed co-occurrence network analysis and text clustering on fall incident reports of 2,772 adult patients from a nursing quality control platform in a particular city in Jiangsu Province, spanning January 2017 to December 2022. RESULTS: Among the 2,772 patients who fell, 80.23% were aged above 60, and 73.27% exhibited physical frailty. Text clustering yielded 16 distinct categories, with four clusters implicating patient factors, four linking falls to toileting processes, four highlighting dynamic interplays between patients, the environment, and objects, and another four clusters revealing the influence of patient-caregiver interactions in causing falls. CONCLUSION: This study highlights the complex, multifactorial nature of falls in adult inpatients. Effective prevention requires a collaborative effort among healthcare staff, patients, and caregivers, focusing on patient vulnerabilities, environmental factors, and improved care coordination. By strengthening these aspects, hospitals can significantly reduce fall risks and promote patient safety.

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Accidentes por Caídas , Minería de Datos , Humanos , Accidentes por Caídas/prevención & control , Accidentes por Caídas/estadística & datos numéricos , Minería de Datos/métodos , Persona de Mediana Edad , Masculino , Femenino , Anciano , Adulto , Hospitalización/estadística & datos numéricos , Anciano de 80 o más Años , Factores de Riesgo , Pacientes Internos/estadística & datos numéricos , Seguridad del Paciente

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INTRODUCTION: Spinal cord lesions (SCL) are usually followed by neurological and functional improvement. The neurological improvement is natural and improves the functional potential of the patients, while rehabilitation improves the realization of that potential. The functional change depends on the neurological change, and usually does not represent the contribution of rehabilitation alone to the functional improvement. AIMS: To evaluate the net contribution of inpatient rehabilitation in Israel to functioning after SCL, and the ability to predict this contribution, which reflects the success of rehabilitation. METHODS: Demographic and clinical data of SCL patients admitted to rehabilitation between 2011 and 2020 were collected retrospectively. The data were used to calculate Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) scores, isolating the effect of neurologic status on functioning, its change during rehabilitation, and factors affecting it. Data were analyzed using t-tests, Pearson correlations, ANOVA, and ANCOVA. RESULTS: A total of 1,433 patients were included in the study. Their age was 54±17 years, 32% were females, and 37.2% had traumatic injuries. American Spinal Injury Association Impairment Scale (AIS) grades were A in 11% of the patients, B in 4.8%, C in 17.3% and D in 65.9%. SCI-ARMI was 52±24 at admission to rehabilitation, and 73.5±19 at discharge (41% improvement, p<0.001). Likewise, the neurological motor status and function significantly improved. SCI-ARMI improvement increased with lower admission SCI-ARMI values (r=-0.654, p<0.001) and younger age (r=-0.122, p<0.001), and correlated with longer stay in rehabilitation (r=0.261, p<0.001). CONCLUSIONS: Inpatient rehabilitation in Israel made a substantial contribution to functional improvement. Lower realization of the functional potential at admission to rehabilitation predicted greater success in the process of SCL rehabilitation.

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Actividades Cotidianas , Pacientes Internos , Recuperación de la Función , Traumatismos de la Médula Espinal , Humanos , Israel , Femenino , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Pacientes Internos/estadística & datos numéricos , Anciano , Resultado del Tratamiento

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PURPOSE: Studies evaluating oncological inpatient rehabilitation rarely include follow-up intervals beyond 6 months and larger proportions of patients other than those with breast cancer. Therefore, this study investigated changes in health-related quality of life (HRQoL), depression, and fear of progression of patients with breast, colorectal, or prostate cancer from the beginning to the end of oncological rehabilitation and a 9-month follow-up. METHODS: Three hundred seventy-seven patients with breast, colorectal, or prostate cancer undergoing oncological inpatient rehabilitation (median age 61 years, 49% female) completed the EORTC QLQ-C30, the PHQ-9, and the FoP-Q-SF at each measurement point. Data analysis used 3 (tumor site) × 3 (time of measurement) repeated measures ANCOVAs with patient age and time since diagnosis as covariates. At each time point, we also compared our sample to the general population on the measures used. RESULTS: Having controlled for the covariates, we found significant effects of tumor site, which were small except for Diarrhea. Effects of time of measurement were often significant and in part at least medium in size indicating improvement of HRQoL and depression during rehabilitation. At follow-up, some HRQoL domains and depression deteriorated. Women with breast cancer, in particular, showed a greater decrease in emotional functioning then. Compared to the general population, the sample's HRQoL and depression were significantly worse on most occasions. CONCLUSION: Oncological inpatient rehabilitation may improve HRQoL. The subsequent and in part differential deterioration in some HRQoL domains suggests a need for further follow-up care within survivorship programs.

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Neoplasias de la Mama , Neoplasias Colorrectales , Depresión , Progresión de la Enfermedad , Miedo , Pacientes Internos , Neoplasias de la Próstata , Calidad de Vida , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Longitudinales , Anciano , Depresión/etiología , Neoplasias de la Mama/rehabilitación , Neoplasias de la Mama/psicología , Miedo/psicología , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Neoplasias de la Próstata/rehabilitación , Neoplasias de la Próstata/psicología , Neoplasias Colorrectales/rehabilitación , Neoplasias Colorrectales/psicología , Adulto , Neoplasias/psicología , Neoplasias/rehabilitación , Encuestas y Cuestionarios , Estudios de Seguimiento , Anciano de 80 o más Años

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Negro o Afroamericano , Bases de Datos Factuales , Hidradenitis Supurativa , Humanos , Hidradenitis Supurativa/epidemiología , Hidradenitis Supurativa/etnología , Niño , Femenino , Masculino , Adolescente , Negro o Afroamericano/estadística & datos numéricos , Estados Unidos/epidemiología , Bases de Datos Factuales/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Preescolar , Lactante

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AIMS: Healthcare staff use coercive measures to manage patients at acute risk of harm to self or others, but their effect on patients' mental health is underexplored. This nationwide Swiss study emulated a trial to investigate the effects of coercive measures on the mental health of psychiatric inpatients at discharge. METHODS: We analysed retrospective longitudinal data from all Swiss adult psychiatric hospitals that provided acute care (2019-2021). The primary exposure was any coercive measure during hospitalization; secondary exposures were seclusion, restraint and forced medication. Our primary outcome was Health of the Nations Outcome Scale (HoNOS) score at discharge. We used inverse probability of treatment weighting to emulate random assignment to the exposure. RESULTS: Of 178,369 hospitalizations, 9.2% (n = 18,800) included at least one coercive measure. In patients exposed to coercive measures, mental health worsened a small but statistically significant amount more than in non-exposed patients. Those who experienced at least one coercive measure during hospitalization had a significantly higher HoNOS score (1.91-point, p < .001, 95% confidence interval [CI]: 1.73; 2.09) than those who did not experience any coercive measure. Results were similar for seclusion (1.60-point higher score, p < .001, 95% CI: 1.40; 1.79) and forced medication (1.97-point higher score, p < .001, 95% CI: 1.65; 2.30). Restraint had the strongest effect (2.83-point higher score, p < .001, 95% CI: 2.38; 3.28). CONCLUSIONS: Our study presents robust empirical evidence highlighting the detrimental impact of coercive measures on the mental health of psychiatric inpatients. It underscores the importance of avoiding these measures in psychiatric hospitals and emphasized the urgent need for implementing alternatives in clinical practice.

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Coerción , Hospitales Psiquiátricos , Trastornos Mentales , Salud Mental , Restricción Física , Humanos , Trastornos Mentales/terapia , Trastornos Mentales/psicología , Trastornos Mentales/epidemiología , Adulto , Masculino , Femenino , Salud Mental/estadística & datos numéricos , Estudios Retrospectivos , Suiza , Persona de Mediana Edad , Restricción Física/estadística & datos numéricos , Restricción Física/psicología , Hospitalización/estadística & datos numéricos , Aislamiento de Pacientes/psicología , Aislamiento de Pacientes/estadística & datos numéricos , Estudios Longitudinales , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos

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OBJECTIVE: This study aimed to develop and validate a nomogram for assessing the risk of nosocomial infections among obstetric inpatients, providing a valuable reference for predicting and mitigating the risk of postpartum infections. METHODS: A retrospective observational study was performed on a cohort of 28,608 obstetric patients admitted for childbirth between 2017 and 2022. Data from the year 2022, comprising 4,153 inpatients, were utilized for model validation. Univariable and multivariable stepwise logistic regression analyses were employed to identify the factors influencing nosocomial infections among obstetric inpatients. A nomogram was subsequently developed based on the final predictive model. The receiver operating characteristic (ROC) curve was utilized to calculate the area under the curve (AUC) to evaluate the predictive accuracy of the nomogram in both the training and validation datasets. RESULTS: The gestational weeks > = 37, prenatal anemia, prenatal hypoproteinemia, premature rupture of membranes (PROM), cesarean sction, operative delivery, adverse birth outcomes, length of hospitalization (days) > 5, CVC use and catheterization of ureter were included in the ultimate prediction model. The AUC of the nomogram was 0.828 (0.823, 0.833) in the training dataset and 0.855 (0.844, 0.865) in the validation dataset. CONCLUSION: Through a large-scale retrospective study conducted in China, we developed and independently validated a nomogram to enable personalized postpartum infections risk estimates for obstetric inpatients. Its clinical application can facilitate early identification of high-risk groups, enabling timely infection prevention and control measures.

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Infección Hospitalaria , Nomogramas , Humanos , Femenino , Estudios Retrospectivos , Infección Hospitalaria/epidemiología , China/epidemiología , Embarazo , Adulto , Factores de Riesgo , Pacientes Internos/estadística & datos numéricos , Curva ROC , Medición de Riesgo , Adulto Joven

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BACKGROUND: The way the healthcare delivery system is reflected by patient satisfaction. Establishing a health system with better results depends on it. It has been assumed that higher patient satisfaction levels correlate with quality healthcare outcomes. There is little national data to support patient satisfaction with inpatient health services in Ethiopia. In order to estimate the pooled proportion of patient satisfaction and determine the associated factors with inpatient health services at public hospitals, a systematic review and meta-analysis were conducted. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed in the extraction of the data. To get the included studies, the following electronic databases were searched: Pub-Med, Google Scholar, Med-Line, Web of Science, Scopus and Repositories. Software called STATA version 17 was used to analyze statistical data using the random effects model. Forest plots were used to display the pooled results. RESULTS: Of the 1583 records resulted in electronic databases searching, 11 studies with 3,958 participants were included in this systematic review and meta-analysis. The estimated pooled proportion of patient satisfaction with inpatient health services was found to be 57.4% (95% CI: 50.88-64.59, I2 = 95.25%). Assuring privacy for patients (OR = 7.44, 95% CI: 3.63-15.25, I2 = 0.0%), availability of direction signs (2.96, 95% CI: 1.91-4.57, I2 = 0.0%), providing adequate information (OR = 3.27, 95% CI: 1.63-6,58, I2 = 65.60%), history of previous admission (OR = 0.29, 0.18-0.46, I2 = 86.36%) and providing on time treatment (OR = 1.63, 95% CI: 1.21-2.20, I2 = 86.36%) were statistically significant factors associated with patient satisfaction with inpatient health services. CONCLUSION: The estimated pooled level of patient satisfaction with inpatient health services is low in Ethiopia. A higher level of patient satisfaction with inpatient health treatments was predicted by factors such as privacy assurance, fast services, availability of direction signs, provision of services with adequate information transfer, and no history of previous admission. To improve patient satisfaction, the Ministry of Health and hospital administration must place a strong emphasis on ensuring the provision of high-quality, standard-based inpatient healthcare.

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Hospitales Públicos , Pacientes Internos , Satisfacción del Paciente , Etiopía , Humanos , Satisfacción del Paciente/estadística & datos numéricos , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Calidad de la Atención de Salud

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To investigate the prevalence of functional constipation (FC) in elderly hospitalized patients and analyze the influencing factors. This was a cross-sectional study in which 506 patients hospitalized in general surgery from February to June 2020 were selected. Information on patients' age, gender, ethnicity, body mass index, intake of vegetables, fruits, meat, and spicy foods, sleep, smoking, alcohol consumption, time of defecation, and mode of defecation was collected through questionnaires, and the factors affecting functional constipation were analyzed using binary logistic regression models; among 506 patients, 254 had FC, with a prevalence of 50.19%. Among the clinical symptoms of FC, the most common ones were straining to defecate (83.85%) and lumpy or hard stools (81.80%). Univariate analysis revealed statistically significant differences in family history of constipation (P = .033), sedentary (P = .004), self-care ability (P = .001), body mass index (P = .013), defecation time (P < .0001), spicy food intake in dietary preference (P = .001), age (P = .004), and education level (P = .016), and binary logistic regression analysis showed that defecation time and spicy food consumption were independent influencing factors of FC. For hospitalized elderly people, regular morning defecation and not eating spicy foods can more helpful to slow the occurrence of functional constipation.

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Estreñimiento , Humanos , Estreñimiento/epidemiología , Estreñimiento/etiología , Estudios Transversales , Masculino , Femenino , Anciano , Prevalencia , Anciano de 80 o más Años , Pacientes Internos/estadística & datos numéricos , Defecación/fisiología , Factores de Riesgo , Índice de Masa Corporal , Persona de Mediana Edad , Encuestas y Cuestionarios , Modelos Logísticos

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BACKGROUND: To mitigate hospital-acquired transmission of coronavirus disease 2019 (COVID-19), various prevention and control measures have been strictly implemented in medical institutions. These stringent measures can potentially reduce the incidence of hospital-acquired respiratory infections. This study aimed to assess if there were changes in the prevalence of hospital-acquired respiratory infections during a period of national attention focused on COVID-19 prevention. METHODS: A retrospective analysis of the clinical data from adult patients with hospital-acquired respiratory infections admitted between October and December 2019 and during the same period in 2020 was performed. All patients were referred from a general hospital in Beijing China and COVID-19 patients were not treated at the hospital. Hospital-acquired respiratory infections were diagnosed based on the criteria of the Centers for Disease Control and Prevention/National Healthcare Safety Network (CDC/NHSN). A comparison of the incidence and mortality rate of hospital-acquired respiratory infections between the two selected time periods was conducted. Additionally, multivariate logistics regression analysis was used to identify mortality-associated risk factors. RESULTS: This study included 2,211 patients from October to December 2019 (pre-COVID-19 pandemic) and 2,921 patients from October to December 2020 (during the COVID-19 pandemic). The incidence of hospital-acquired respiratory infections in 2019 and 2020 was 4.7% and 2.9%, respectively, with odds ratio (OR): 0.61, 95% confidence interval (CI): 0.46-0.81, and P = 0.001. In-hospital mortality of hospital-acquired respiratory infections in 2019 and 2020 was 30.5% and 38.4%, respectively, with OR: 1.42, 95%CI: 0.78-2.59, and P = 0.25. Multivariate logistics regression analysis revealed that a history of previous malignancy (OR: 2.50, 95%CI: 1.16-5.35, P = 0.02), was associated with in-hospital mortality. CONCLUSIONS: The incidence of hospital-acquired respiratory infections was significantly decreased following the implementation of various prevention and control measures during the COVID-19 pandemic. A history of previous malignancy was associated with higher in-hospital mortality in older inpatients with hospital-acquired respiratory infections.

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COVID-19 , Infección Hospitalaria , Hospitales Generales , Infecciones del Sistema Respiratorio , Humanos , COVID-19/epidemiología , COVID-19/mortalidad , Estudios Retrospectivos , Masculino , Femenino , Anciano , Hospitales Generales/estadística & datos numéricos , Persona de Mediana Edad , China/epidemiología , Incidencia , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Infecciones del Sistema Respiratorio/mortalidad , Infección Hospitalaria/epidemiología , Anciano de 80 o más Años , SARS-CoV-2 , Adulto , Factores de Riesgo , Pacientes Internos/estadística & datos numéricos , Mortalidad Hospitalaria

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BACKGROUND: Orthopedic injuries are serious and continue to be a concern for healthcare systems worldwide. Approximately 90% of the estimated traumatic injuries occur in low- and middle-income countries. In Kenya, there is a dearth of information on orthopedic injury patterns that could be used to prioritize injury prevention measures and to help hospital management teams allocate resources appropriately. The purpose of this study was to determine the epidemiology of orthopedic injuries admitted to Kenyatta National Hospital. METHODS: This was a retrospective cross-sectional study. Overall, 720 charts were reviewed. Data were analyzed using frequency distribution, pearson chi-square test and logistic regression. RESULTS: Overall, 85% were aged 15-64 years. Approximately 80% were male, married or single. Patients with primary or secondary education composed 72%. Road traffic accidents (59.4%) and falls (24.7%) were the most common mechanisms of injury. A total of 99.9% of the inpatients were Kenyans. Open injuries were 40.1%. Lower limb (67.4%) and upper limb (26.9%) injuries were the most common. Inpatients aged 15-24 years were 74% less likely to have upper limb injuries than those aged 0-14 years (p = 0.023). However, those aged 15-24 years were 19.250 times more likely to have spine injuries than those aged 0-14 years (p = 0.008). Males were 68.6% and 51.2% less likely to have pelvic injury and comorbidities, respectively, than females (p < 0.001). Patients with secondary and tertiary education were 2.016 (p = 0.003) and 2.3 (p < 0.001) times more likely to have upper limb injuries, respectively, than those with no or preschool education. Similarly, those with tertiary education were 2.079 times more likely to have comorbidities than those with no or preschool education (p = 0.017). CONCLUSION: Most of the inpatients with orthopedic injuries were young, male involved in Road traffic accidents and therefore Kenya National Transport and Safety Authority needs to enforce road safety measures to reduce road carnage. Those with higher education and children were more likely to have upper limb injuries. Females were more likely to have pelvic injuries and co-morbidities. Lower and upper limb injuries were the most common injuries and this should guide resource allocation in management of orthopedic injuries.

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Centros de Atención Terciaria , Humanos , Masculino , Estudios Transversales , Adolescente , Kenia/epidemiología , Estudios Retrospectivos , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Niño , Preescolar , Lactante , Centros de Atención Terciaria/estadística & datos numéricos , Hospitales de Enseñanza , Heridas y Lesiones/epidemiología , Accidentes de Tránsito/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Recién Nacido , Anciano , Sistema Musculoesquelético/lesiones

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BACKGROUND: The majority of palliative care patients express a preference for remaining at home for as long as possible. Despite progression of disease there is a strong desire to die at home. Nonetheless, there are transfers between care settings, demonstrating a discrepancy between desired and actual place of death. AIM: To map the prevalence of patients near death undergoing specialized palliative home care and being transferred to inpatient care in Sweden. METHODS: A national retrospective cross-sectional study based on data from the Swedish Register of Palliative Care. Patients ≥ 18 years of age enrolled in specialized palliative home care with dates of death between 1 November 2015 and 31 October 2022 were included (n = 39,698). Descriptive statistics were used. RESULTS: Seven thousand three hundred eighty-three patients (18.6%), approximately 1,000 per year, were transferred to inpatient care and died within seven days of arrival. A considerable proportion of these patients died within two days after admission. The majority (73.6%) were admitted to specialized palliative inpatient care units, 22.9% to non-specialized palliative inpatient care units and 3.5% to additional care units. Transferred patients had more frequent dyspnoea (30.9% vs. 23.2%, p < 0.001), anxiety (60.2% vs. 56.5%, p < 0.001) and presence of several simultaneous symptoms was significantly more common (27.0% vs. 24.8%, p 0.001). CONCLUSION: The results show that patients admitted to specialized palliative home care in Sweden are being transferred to inpatient care near death. A notable proportion of these patients dies within two days of admission. Common features, such as symptoms and symptom burden, can be observed in the patients transferred. The study highlights a phenomenon that may be experienced by patients, relatives and healthcare personnel as a significant event in a vulnerable situation. A deeper understanding of the underlying causes of these transfers is required to ascertain whether they are compatible with good palliative care and a dignified death.

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Servicios de Atención de Salud a Domicilio , Cuidados Paliativos , Transferencia de Pacientes , Sistema de Registros , Humanos , Suecia , Masculino , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Femenino , Anciano , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/normas , Sistema de Registros/estadística & datos numéricos , Estudios Transversales , Estudios Retrospectivos , Anciano de 80 o más Años , Persona de Mediana Edad , Transferencia de Pacientes/estadística & datos numéricos , Transferencia de Pacientes/métodos , Transferencia de Pacientes/normas , Adulto , Pacientes Internos/estadística & datos numéricos , Pacientes Internos/psicología , Hospitalización/estadística & datos numéricos

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BACKGROUND: Cognitive impairments are common in patients with AUD and worsen the prognosis of addiction management. There are no clear guidelines for screening cognitive impairments in hospitalized patients with AUD. METHODS: Fifty-seven patients with an AUD history who were admitted to an acute hospital and assessed by the addiction care team were included. Those patients were screened for cognitive impairments using the Montreal Cognitive Assessment (MoCA) test. We collected clinical information regarding addiction history, comorbidities, and current treatments. Chi-square tests, t-tests, and Mann-Whitney tests were performed to determine factors associated with a pathological MoCA score (<26). RESULTS: A pathological MoCA score was positively associated with spatial-temporal disorientation, difficulty in recalling addiction history, patient underreporting of AUD and a date of last alcohol consumption lower than 11 days ago, and negatively associated with a reason for hospitalization due to alcohol-related health issues. No medication was associated with cognitive impairments. CONCLUSIONS: Clinical elements from assessment by the addiction care team allow for relevant indication for screening cognitive impairments.

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Alcoholismo , Disfunción Cognitiva , Humanos , Masculino , Femenino , Disfunción Cognitiva/epidemiología , Persona de Mediana Edad , Alcoholismo/epidemiología , Alcoholismo/psicología , Adulto , Pacientes Internos/estadística & datos numéricos , Pruebas de Estado Mental y Demencia , Hospitalización/estadística & datos numéricos , Anciano

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BACKGROUND: High-cost patients account for most healthcare costs and are highly heterogeneous. This study aims to classify high-cost patients into clinically homogeneous subgroups, describe healthcare utilization patterns of subgroups, and identify subgroups with relatively high preventable inpatient cost (PIC) in rural China. METHODS: A population-based retrospective study was performed using claims data in Xi county, Henan province. 32 108 high-cost patients, representing the top 10% of individuals with the highest total spending, were identified. A density-based clustering algorithm combined with expert opinions were used to group high-cost patients. Healthcare utilization (including admissions, length of stay, and outpatient visits) and spending characteristics (including total spending, and the proportion of PIC, inpatient and out-of-pocket spending on total spending) were described among subgroups. PIC was calculated based on potentially preventable hospitalizations (PPHs) which were identified according to the Agency for Healthcare Research and Quality Prevention Quality Indicators algorithm. RESULTS: High-cost patients were more likely to be older (Mean=51.87, SD=22.28), male (49.03%) and from poverty-stricken families (37.67%) than non-high-cost patients, with 2.49 (SD=2.47) admissions and 3.25 (SD=4.52) outpatient visits annually. Fourteen subgroups of high-cost patients were identified: chronic disease, non-trauma diseases which need surgery, female disease, cancer, eye disease, respiratory infection/inflammation, skin disease, fracture, liver disease, vertigo syndrome and cerebral infarction, mental disease, arthritis, renal failure, and other neurological disorders. The annual admissions ranged from 1.83 (SD=1.23, fracture) to 12.21 (SD=9.26, renal failure), and the average length of stay ranged from 6.61 (SD=10.00, eye disease) to 32.11 (SD=28.78, mental disease) days among subgroups. The chronic disease subgroup showed the largest proportion of PIC on total spending (10.57%). CONCLUSION: High-cost patients were classified into 14 clinically distinct subgroups which had different healthcare utilization and spending characteristics. Different targeted strategies may be needed for subgroups to reduce preventable hospitalizations. Priority should be given to high-cost patients with chronic diseases.

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Gastos en Salud , Hospitalización , Población Rural , Humanos , Masculino , China , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Anciano , Pacientes Internos/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Adulto Joven , Aceptación de la Atención de Salud/estadística & datos numéricos

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Introduction: Extended-spectrum ß-lactamase (ESBL) production among Enterobacteriaceae, such as E. coli, has been increasing worldwide, which causes treatment failure for urinary tract infections. Therefore, this study aimed to determine the prevalence and risk factors for the production of ESBL in E. coli from patients with urinary tract infections (UTI) in Zanzibar. Methods: a prospective cross-sectional study was conducted from January 2018 to December 2021 in Zanzibar. Data were retrieved from a routine bacteriological laboratory culture report from urine samples of 4306 patients at the Lancet Laboratory. In addition, the patient's social demographics and clinical data were retrieved by examining the medical records in the respective hospitals. All inpatients older than fifteen years diagnosed with urinary tract infections (UTI) and requested urine culture and sensitivity were included. The Chi-square and Fischer's exact tests were used to compare antibiotic resistance. In addition, a binary logistic regression analysis was used to predict ESBL production risk factors. Results: the prevalence of E. coli-producing ESBL was 13.4% (578/4030). Infection of ESBL. E. coli was prevalent in females 52.6% (n=304) compared to male patients, 47.4% (n=274), and the majority 38.8% (n=224), were people of young age, between 16-30 years. The average age of patients was 31.5±10.2 years, with minimum age of 16 years and a maximum age of 72 years. In multivariate analysis, results shown that previously hospitalised patients aOR: 6.35, 95% Cl 3.37-11.92; p=0.001, long hospital stays aOR: 10.34, 95% Cl 3.03-22.29; p <0.001, prior use of penicillin aOR: 7.78, 95% Cl 2.99-29.11; p < 0.001, and prior use of cephalosporin drugs aOR: 4.64, 95% Cl 2.99-9.96; p=0.001, were strongly associated with the emergence of ESBL-producing E. coli in urinary tract infection patients. ESBL E. coli showed high resistance to amoxicillin 99.5% (n=575), ampicillin 97.8.% (n=570), cotrimazaxole 86.2% (n=344), ceftriaxone 73.7% (n=344), ciprofloxacin 73.2% (n=423), and ceftaxime 59.5% (n=426). There was a less resistance to ampicillin -cloxacillin 44.3% (n=256), gentamicin 22.5% (n=22.5), and norfloxacin 18.9% (n=109) respectively. Isolates were shown to be more susceptible to meropenem at 1.6% (n=9). Conclusion: the overall prevalence of ESBL-producing E. coli is 13.4%. The risk of emergence ESBL was higher in patients with previous history of hospitalisation, long hospital stay, prior use of penicillin and cephalosporin drugs. High level of antimicrobial resistance observed against most commonly used antibiotics in treatment of urinary tract infections. The clinicians should rely on microbiological diagnosis in treatment of UTIs to reduce risk of treatment failure. Further study should be carried out to assess the prevalence and resistance pattern of other uropathogens and other risk factors.

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Antibacterianos , Infecciones por Escherichia coli , Escherichia coli , Centros de Atención Terciaria , Infecciones Urinarias , beta-Lactamasas , Humanos , Infecciones Urinarias/microbiología , Infecciones Urinarias/epidemiología , Infecciones Urinarias/tratamiento farmacológico , Estudios Transversales , Femenino , Estudios Prospectivos , Masculino , Factores de Riesgo , beta-Lactamasas/metabolismo , Escherichia coli/aislamiento & purificación , Escherichia coli/efectos de los fármacos , Prevalencia , Adulto , Persona de Mediana Edad , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Antibacterianos/farmacología , Adulto Joven , Tanzanía/epidemiología , Anciano , Adolescente , Farmacorresistencia Bacteriana , Pacientes Internos/estadística & datos numéricos , Pruebas de Sensibilidad Microbiana

RESUMEN

INTRODUCTION: Emerging infectious diseases (EIDs) can disrupt the healthcare system, causing regulatory changes that affect the healthcare-seeking process and potentially increase patient-physician dissatisfaction. This study aimed to collect and analyze patients' and physicians' complaints during an EID outbreak to inform potential clues regarding medical quality and patient safety enhancement in future dealing with EIDs, employing text mining methodologies. METHODS: In this descriptive study, complaint records from January 2020 to February 2023 at West China Hospital, a national medical facility in China, were analyzed. Patient and physician complaints have been retrospectively retrieved from the record from the medical department, and then categorized into distinct groups based on reporting reasons, encompassing COVID-19-related policies, healthcare access, availability of medical resources, and financial concerns. RESULTS: During the COVID-19 pandemic, 541 COVID-19-related complaints were identified: 330 (61.00%) from patients and 211 (39.00%) from physicians. The monthly volume of complaints fluctuated, starting at 10 in 2020, peaking at 21 in 2022, and dropping to 14 in 2023. Most complaints from inpatients were expressed by older males aged 40 to 65 (38.82%, 210/541). The primary source of complaints was related to mandatory COVID-19 policies (79.30%, 429/541), followed by concerns regarding timely healthcare services (31.61%, 171/541). Few complaints were expressed regarding the insufficiency of medical resources (2.77%, 15/541) and the high costs (4.25%, 23/541). The frequency of complaints expressed by doctors and patients in the emergency department was higher compared with other departments (24.58%, 133/541). CONCLUSIONS: Increased complaints may serve as a primitive and timely resource for investigating the potential hazards and drawbacks associated with policies pertaining to EIDs. Prompt collection and systematical analysis of patient and physician feedback could help us accurately evaluate the efficacy and repercussions of these policies. Implementing complaints-based assessment might improve care standards in forthcoming healthcare environments grappling with EIDs.

Asunto(s)

COVID-19 , Pacientes Internos , Médicos , SARS-CoV-2 , Humanos , COVID-19/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Anciano , China/epidemiología , Estudios Retrospectivos , Pacientes Internos/estadística & datos numéricos , Enfermedades Transmisibles Emergentes/epidemiología , Satisfacción del Paciente/estadística & datos numéricos , Adulto Joven , Pandemias

RESUMEN

The use of integrative Korean medicine treatment (IKMT) for patients with knee osteoarthritis (OA) has been reported previously; however, to date, no studies have investigated the long-term prognosis of these patients following IKMT for primary knee OA. We aimed to examine the long-term effects of IKMT in patients diagnosed with primary knee OA and receiving IKMT during hospitalization. This retrospective observational study, complemented by a follow-up survey, included patients with primary knee OA who received IKMT during hospitalization across 7 Korean medicine hospitals. The primary outcome was the Numerical Rating Scale knee-pain score, whereas the secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5 dimension-5 level questionnaire (EQ-5D-5L), and Patient Global Impression of Change scores. Patients were evaluated at admission, discharge, and during follow-up. Of the 180 included patients, 81 responded to the survey. Compared with the corresponding values at admission, the Numerical Rating Scale score decreased by 2.44 (2.08-2.81) points at discharge and 1.89 (1.5-2.26) points at follow-up. Additionally, compared with their scores at admission, the WOMAC score decreased by 17.20 (13.68-20.71) points at discharge and 25.74 (22.22-29.26) points at follow-up, whereas the EuroQol-5 dimension-5 level questionnaire score improved by -0.15 (-0.18 to -0.12) points at discharge and -0.12 (-0.15 to -0.09) points at follow-up. The patients expressed high satisfaction with pharmacopuncture (65.4%), acupuncture (54.03%), physical therapy (35.8%), and herbal medicine (34.6%). Regarding Patient Global Impression of Change, 96.30% of the patients reported improvement. IKMT was effective in improving pain, functional disability, and quality of life in patients with primary knee OA. Its effects were maintained throughout the long-term follow-up period, and physical functions continuously improved.

Asunto(s)

Osteoartritis de la Rodilla , Humanos , Osteoartritis de la Rodilla/terapia , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , República de Corea , Medicina Tradicional Coreana , Resultado del Tratamiento , Medicina Integrativa/métodos , Dimensión del Dolor , Calidad de Vida , Pacientes Internos/estadística & datos numéricos

RESUMEN

BACKGROUND: Pelvic fractures can be life-threatening for elderly individuals with diminished bone strength. Frailty is associated with fracture outcomes, but its impact on pelvic fracture recovery remains unexplored. The aim of this study was to investigate the association between frailty and short-term outcomes in older adults hospitalized for low-energy pelvic fractures. METHODS: Data from the Nationwide Inpatient Sample (NIS) covering the years 2005 to 2018 were reviewed. Inclusion criteria were age ≥ 60 years admitted for a low-energy pelvic fracture. Patients were categorized into frail and non-frail groups using the 11-factor modified Frailty Index (mFI-11). Association between frailty and in-hospital outcomes were determined by univariate and multivariable regression analyses. RESULTS: A total of 24,688 patients with pelvic fractures were included. The mean patient age was 80.6 ± 0.1 years, and 35 % were classified as frail. After adjustments, frailty was significantly associated with unfavorable discharge (adjusted odds ratio [aOR] = 1.07, 95 % confidence interval [CI]: 1.00-1.15, p = 0.038), prolonged hospitalization (aOR = 1.51, 95 % CI: 1.41-1.62, p < 0.001), complications (aOR = 1.42, 95 % CI:1.34-1.50, p < 0.001), and acute kidney injury (aOR = 1.68, 95 % CI: 1.56-1.82, p < 0.001). Stratified analyses based on age and fracture type showed frailty was consistently associated with adverse outcomes. CONCLUSIONS: Persons ≥60 years old with mFI-11 assessed frailty and a low-energy pelvic fracture are at higher risk of adverse in-hospital outcomes than non-frail patients. Additional research is needed to disclose the prognostic impact of clinical frailty on long-term functional outcomes and quality of life after discharge.

Asunto(s)

Fracturas Óseas , Fragilidad , Pacientes Internos , Huesos Pélvicos , Humanos , Masculino , Femenino , Fracturas Óseas/epidemiología , Fragilidad/epidemiología , Anciano , Anciano de 80 o más Años , Huesos Pélvicos/lesiones , Pacientes Internos/estadística & datos numéricos , Resultado del Tratamiento , Persona de Mediana Edad , Hospitalización/estadística & datos numéricos , Anciano Frágil

RESUMEN

BACKGROUND: Workplace violence persists in health care with nurses reporting physical and verbal abuse from aggressive patients causing emotional stress and lost workdays. The Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) was developed to measure risk for aggression in patients with behavioral health conditions in psychiatric and emergency department settings. The DASA-IV has not been validated with adult patients admitted to medical-surgical units. OBJECTIVE: To determine whether DASA-IV scores are predictive of aggressive events in adults hospitalized on medical-surgical units. METHODS: This multisite study used a case-control design. DASA-IV scores and acts of aggression were extracted from the medical record retrospectively to validate the appraisal's predictability. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to correlate DASA-IV scores with aggressive events. RESULTS: DASA-IV assessments (N=156 999; mean [SD] 10.1 [10.7]/patient; range 1-220) were collected from 13 611 patients. Patients were primarily White (86.1%) and female (51.7%). Aggression (n = 509 patients; 3.7%) was significantly associated with older age, male sex, smoking, illicit drug use, and high DASA-IV scores. AUC of the ROC analysis for the DASA-IV showed a 97% probability (95% confidence interval [CI] 0.964-0.977) that an aggressive patient would have a higher score on the DASA-IV than a nonaggressive patient. Binary logistic regression predicted that for every point increase in the DASA-IV, there was a 3.51 (95% CI 3.38-3.63) times increased risk for aggression (B = 1.255, SE = 0.18, Wald = 4766.6, P < .001). CONCLUSIONS: This study is the first to validate use of the DASA-IV in medical-surgical populations, demonstrating predictive ability for aggressive incidents. The DASA-IV can be used successfully in medical-surgical populations for early identification of potential aggression.

Asunto(s)

Agresión , Humanos , Masculino , Femenino , Agresión/psicología , Persona de Mediana Edad , Estudios de Casos y Controles , Adulto , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Estudios Retrospectivos , Encuestas y Cuestionarios , Medición de Riesgo/métodos , Anciano , Valor Predictivo de las Pruebas

RESUMEN

BACKGROUND: Prompt diagnosis and treatment of vertebral artery dissection (VAD) is critical for preventing stroke. The use of emboli detection studies (EDS) using Doppler ultrasonography is an emerging method that has been proposed to predict stroke risk and guide subsequent treatment. Limited data exists on the predictive value of this emerging modality in the posterior circulation. This study aims to assess the predictive value of emboli detection studies (EDS) in forecasting inpatient stroke in VAD patients and identify associated risk factors. Patients were recruited between January 2009 and January 2018. METHODS: We performed a retrospective analysis of 104 consecutive patients with VAD who underwent EDS at our institution. Patients underwent transcranial ultrasonography for detection of microemboli and were followed clinically and radiographically thereafter for evidence of stroke. RESULTS: A total of 104 patients with spontaneous (58 %), traumatic (39 %) or iatrogenic (4 %) VAD were included in our analysis. Stroke occurred more frequently in patients with spontaneous VAD compared to traumatic VAD (p < 0.001). Microemboli were detected in 17 patients (16 %), including 18.3 % of spontaneous VAD, 12.5 % of traumatic VAD, and 25 % of iatrogenic VAD. 61 patients (59 %) suffered a posterior circulation stroke, however there was no significant association between detection of microemboli and stroke events (60 % of patients without microemboli vs. 53 % of patients with ≥ 1 HITS during EDS; p = 0.6). Similarly, no microemboli were detected in any of the patients who went on to develop a delayed stroke. CONCLUSIONS: In our single-institution retrospective analysis of patients with VAD, the detection of microemboli on EDS was not associated with stroke nor was it predictive of delayed stroke. Additionally, patients with spontaneous VAD may be at higher risk for stroke compared to traumatic VAD.

Asunto(s)

Ultrasonografía Doppler Transcraneal , Disección de la Arteria Vertebral , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Disección de la Arteria Vertebral/epidemiología , Disección de la Arteria Vertebral/diagnóstico por imagen , Disección de la Arteria Vertebral/complicaciones , Adulto , Ultrasonografía Doppler Transcraneal/métodos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/diagnóstico por imagen , Anciano , Factores de Riesgo , Pacientes Internos/estadística & datos numéricos , Embolia Intracraneal/epidemiología , Embolia Intracraneal/diagnóstico por imagen , Embolia Intracraneal/etiología

RESUMEN

OBJECTIVE: To assess antibiotics prescribing and use patterns for inpatients at Benjamin Mkapa Zonal Referral Hospital (BMH) using the WHO-Point Prevalence Survey (WHO-PPS). DESIGN: A cross-sectional survey. SETTING: The Benjamin Mkapa Zonal Referral Hospital, Dodoma, Tanzania. PARTICIPANTS: Inpatient prescriptions, regardless of whether antibiotics were prescribed (n=286) on the day of PPS. OUTCOME MEASURES: Our study analysed the prevalence of antibiotic use at BMH for inpatients, the type of antibiotics used, the indications for use and the proportion of oral and parenteral antibiotics. We also assessed prescription-prescribed antibiotics after a positive antimicrobial susceptibility testing (AST) result. RESULTS: A survey was conducted on 286 prescriptions, which revealed that 30.07% of them included antibiotics. On average, each prescription contained at least 1.6 antibiotics. All prescriptions that included antibiotics were written in generic names, and 77.91% (67/86) of them followed the Standard Treatment Guidelines. Of the prescriptions that included antibiotics, 58.14% (50/86) had a single antibiotic, 20.93% (18/86) had parenteral antibiotics and 79.07% (68/86) had oral antibiotics. Based on AWaRe's (Access, Watch and Reserve) categorisation of antibiotics, 50% (8/16) were in the Access group, 31.25% (5/16) were in the Watch group, 12.50% (2/16) were in the Reserve group and 6.25% (1/16) were not recommended antimicrobial combinations. Out of 86 prescriptions included antibiotics, only 4.65% showed positive culture growth. However, antibiotics were still prescribed in 29.07% of prescriptions where there was no growth of bacteria, and in 66.28% of prescriptions, antibiotics were prescribed empirically without any requesting of bacteria culture and AST. CONCLUSION: BMH has reduced inpatient Antibiotic Use by half compared with the 2019 WHO-PPS. Adherence to National Treatment Guidelines is suboptimal. Clinicians should use AST results to guide antibiotic prescribing.

Asunto(s)

Antibacterianos , Pautas de la Práctica en Medicina , Humanos , Tanzanía/epidemiología , Antibacterianos/uso terapéutico , Estudios Transversales , Pautas de la Práctica en Medicina/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Masculino , Prevalencia , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino