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• The VAP rates continue to be very high, especially in resource-limited regions. • VAPs are associated with extra hospital stays, costs, and mortality. • This document presents the main risk factors for VAP. • We updated the recommendations for VAP prevention including resource-limited regions. This review by a panel of experts convened by the International Society for Infectious Diseases aims to consolidate current recommendations for preventing ventilator-associated pneumonia (VAP). It provides insights into VAP rates, the attributable extra length of stay, costs, mortality, and risk factors in high-income and low- and middle-income countries (LMICs). A comprehensive review of existing recommendations and evidence-based strategies for preventing VAP was conducted. The expert panel analyzed data on VAP incidence, associated healthcare burdens, and risk factors across different economic settings to formulate applicable preventive measures. The review identifies significant differences in VAP rates, healthcare costs, extra length of hospital stay, and mortality between high-income and LMICs. Evidence-based strategies for preventing VAP were highlighted, demonstrating their effectiveness across different healthcare settings. The recommendations and insights provided in this position paper aim to guide healthcare professionals in effectively preventing VAP. The adoption of evidence-based preventive strategies can potentially reduce VAP rates, and associated costs, and improve patient outcomes in both high-income and LMICs. [ABSTRACT FROM AUTHOR]

Abstract: Background: Previous assessments linked transfusions in trauma to increased respiratory and infectious complications. However, these studies included patients with severe trauma, brisk hemorrhage, and shock. Thus, the potentially harmful impact of transfusion was difficult to determine. Methods: A retrospective review of all trauma patients with an injury severity score (ISS) of 9 to 14 admitted to a Level 1 Trauma Center over a 5-year period was performed. Patients were stratified by transfusion history and injury severity. Results: Records of 2,332 patients were reviewed; 208 (8.9%) received at least 1 packed red blood cell transfusion. The incidence of complications was significantly higher in patients receiving transfusions (42.3% vs 9.0%; P < .001), and transfusion was a significant independent predictor of the development of a complication (odds ratio, 5.85; P < .001). Further, the association of transfusion with complications was dose-dependent. Transfusion was associated with a significantly increased hospital length of stay (10.6 vs 3.9 days; P < .0001). Conclusions: Moderately injured trauma patients receiving transfusions suffered significantly more complications. Indications for transfusion in this population should be reassessed carefully. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the healthcare sector faced unprecedented challenges in effectively managing hospital resources. A crucial aspect of resource planning and allocation is the ability to predict the expected length of a patient's stay. Detecting whether a patient requires extended hospitalization or a shorter stay becomes vital for efficient hospital resource allocation and utilization. This paper aims to build a deep learning-based analytical model named LoSNet that predicts the length of stay for each patient at the time of admission to the Hospital. The early prediction of the length of stay requirement would aid healthcare professionals in optimizing the utility of hospital beds and other resources. In this direction, this paper compares the prediction ability of various machine-learning models including Random Forest, Decision Tree, Logistic Regression, and Naïve Bayes with a customized deep neural network model. The dataset used for this analysis includes ground truth on 3,18,438 patients' length of stay categorized into eleven classes such as 0-10 days being one class, 11-20 days being another class, and so on to more than 100 days. The methodology employed in this study involves data collection, data transformation, and training LoSNet, a deep neural network with no attention mechanisms. The results indicate impressive performance over other models and a random classifier, with a cross-entropy loss of 1.531 and an accuracy of 0.408 in predicting hospitalization durations in an 11-class classification setup, highlighting the framework's effectiveness in healthcare management. [ABSTRACT FROM AUTHOR]

The article presents abstracts on liver studies which include the association between chemotherapy within 30 days prior to liver resection and postoperative morbidity or mortality, safety and efficacy of adding bevacizumab to the adjuvant therapy following liver resection for colorectal cancer liver metastases and its impact on survival, and comparison of the perioperative course and hospital stay of patients managed with single dose intrathecal morphine with gabapentin and continuous epidural analgesia.

Stevens-Johnson's Syndrome (SJS) and Toxic Epidermal Necrolysis are rare, life-threatening dermatologic conditions with acute onset and not clearly established treatment protocol. A plethora of observational studies are present with lack of up-to-date consensus based on evaluation of objective endpoints, among others mortality. Thorough analysis of available databases (Pubmed, EMBASE, Cinahl, Web of Science, Clinical Trials) was conducted according to PRISMA guidelines. Authors initially identified 700 papers, with 82 of them potentially eligible according to adopted criteria. A total of 42 studies were included into pooled synthesis. For continuous outcomes we analyzed the pooled means for endpoint scores using observed cases data. Categorical outcomes were analyzed by calculating the pooled event rates. We conducted subgroup and exploratory maximum likelihood random effects meta-regression analyses regarding SCORTEN of all outcomes. Using random-effects model, the overall pooled Mortality Rate was 0.191 (95%CI, 0.132-0.269). The lowest mortality rate was found to be linked with Etanercept and highest in Total Plasma Exchange (TPE) and Intravenous Immunoglobulin (IVIG). Overall reepithelization was 13.278 days (95%CI, 8.773-17.784),The highest was found in cyclosporine treatment; 14.739 whilst the lowest for steroids. Length of hospital stay in overall analysis was 19.99 days (95%CI, 16.53-23.44),the highest was linked with TPE/TPE+IvIg treatment, the lowest with steroids. Risk of bias of assessed studies was estimated to be high (for observational studies mean STROBE score 12.44). High quality TEN and SJS studies are lacking. Almost all papers report observational data without randomization and double-blind control. Therefore, the pooled analysis cannot be presented with initial bias. In our meta-analysis the most successful regimen was Etanercept treatment. It was linked with the lowest mortality. The most negative treatment outcome was observed in studies reporting TPE and IVIG. Randomized trials of high quality are needed in SJS and TEN. [ABSTRACT FROM AUTHOR]

Planning and resource management are important aspects of a company's operational sustainability. With good management, companies can achieve their targets while minimizing operational costs. The same goes for hospitals. Various challenges related to resources are experienced by hospitals, such as scheduling nurses, patient surgeries, and patient appointments. Therefore, this paper aim at optimizing patient admission scheduling in order to improve hospital resource efficiency. To be more specific, patient admission scheduling, also known as the Patient Admission Scheduling Problem (PASP), is a scheduling problem that considers patient preferences and needs, bed availability, resource efficiency, and utilization. This problem is highly relevant, especially for large hospitals. The number of rooms, specialists, and facilities makes manual scheduling extremely difficult. It is due to the varied preferences, needs, and lengths of stay for patients in hospital. Various methods, both heuristic and exact, have been proposed, including the use of integer programming methods. However, for a large search space, this method requires a very long computational time. To address the PASP, this study applies the Variable Neighborhood Search (VNS) algorithm and random selection as optimization algorithms. The method was chosen because it has been proven effective to solve some combinatorial optimization problems in prior studies. Seven types of neighborhoods are implemented to find the best combinations in optimizing the PASP. The results show that the VNS algorithm outperforms the random selection algorithm, as it is able to generate 5 out of 7 solutions that are better, reducing penalties by 27.84% to 55.29%. The expected impact of this study is to increase the hospital patient satisfaction whereas in the same time minimize the operational cost. [ABSTRACT FROM AUTHOR]

Aim: To systematically review literature and to assess the status of the ERAS protocol in pediatric populations undergoing gastrointestinal surgery. Methods: Literature research was carried out for papers comparing ERAS and traditional protocol in children undergoing gastrointestinal surgery. Data on complications, hospital readmission, length of hospital stay, intraoperative fluid volume, post-operative opioid usage, time to defecation, regular diet, intravenous fluid stop, and costs were collected and analyzed. Analyses were performed using OR and CI 95%. A p value <0.05 was considered significant. Results: A total of 8 papers met the inclusion criteria, with 943 included patients. There was no significant difference in complication occurrence and 30-day readmission. Differently, length of stay, intraoperative fluid volume, post-operative opioid use, time to first defecation, time to regular diet, time to intravenous fluid stop, and costs were significantly lower in the ERAS groups. Conclusions: ERAS protocol is safe and feasible for children undergoing gastrointestinal surgery. Without any significant complications and hospital readmission, it decreases length of stay, ameliorates the recovery of gastrointestinal function, and reduces the needs of perioperative infusion, post-operative opioid administration, and costs. [ABSTRACT FROM AUTHOR]

Background: We examined whether a context and process-sensitive 'intelligent' checklist increases compliance with best practice compared with a paper checklist during intensive care ward rounds.Methods: We conducted a single-centre prospective before-and-after mixed-method trial in a 35 bed medical and surgical ICU. Daily ICU ward rounds were observed during two periods of 8 weeks. We compared paper checklists (control) with a dynamic (digital) clinical checklist (DCC, intervention). The primary outcome was compliance with best clinical practice, measured as the percentages of checked items and unchecked critical items. Secondary outcomes included ICU stay and the usability of digital checklists. Data are presented as median (interquartile range).Results: Clinical characteristics and severity of critical illness were similar during both control and intervention periods of study. A total of 36 clinicians visited 197 patients during 352 ward rounds using the paper checklist, compared with 211 patients during 366 ward rounds using the DCC. Per ICU round, a median of 100% of items (94.4-100.0) were completed by DCC, compared with 75.1% (66.7-86.4) by paper checklist (P=0.03). No critical items remained unchecked by the DCC, compared with 15.4% (8.3-27.3) by the paper checklist (P=0.01). The DCC was associated with reduced ICU stay (1 day [1-3]), compared with the paper checklist (2 days [1-4]; P=0.05). Usability of the DCC was judged by clinicians to require further improvement.Conclusions: A digital checklist improved compliance with best clinical practice, compared with a paper checklist, during ward rounds on a mixed ICU.Clinical Trial Registration: NCT03599856. [ABSTRACT FROM AUTHOR]

The relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak. We searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach. We identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department. Overall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings. Lower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest. [ABSTRACT FROM AUTHOR]

Emergency Departments around the world are under increasing pressure due to rising demand. In the United Kingdom ambulatory emergency care has been demonstrated to deliver safe and effective care for emergency patients and has now become an accepted treatment modality. This paper outlines a quality improvement project undertaken to evaluate an ambulatory emergency care centre implemented at a tertiary hospital in Perth, Western Australia, from February to August 2021. The findings demonstrated a 4% improvement in the Western Australian Emergency Access Target for a four week period, a 6.3% reduction in the number of patients admitted with a length of stay less than 24 h and that patient's attending the Ambulatory Emergency Care Centre were managed as safely as if they were seen in the Emergency Department. [ABSTRACT FROM AUTHOR]

Background: We performed a systematic review of mechanically ventilated patients with COVID-19, which analysed the effect of tracheostomy timing and technique (surgical vs percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS), decannulation from tracheostomy, duration of mechanical ventilation, and complications.Methods: Four databases were screened between January 1, 2020 and January 10, 2022 (PubMed, Embase, Scopus, and Cochrane). Papers were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Population or Problem, Intervention or exposure, Comparison, and Outcome (PICO) guidelines. Meta-analysis and meta-regression for main outcomes were performed.Results: The search yielded 9024 potentially relevant studies, of which 47 (n=5268 patients) were included. High levels of between-study heterogeneity were observed across study outcomes. The pooled mean tracheostomy timing was 16.5 days (95% confidence interval [CI]: 14.7-18.4; I2=99.6%). Pooled mortality was 22.1% (95% CI: 18.7-25.5; I2=89.0%). Meta-regression did not show significant associations between mortality and tracheostomy timing, mechanical ventilation duration, time to decannulation, and tracheostomy technique. Pooled mean estimates for ICU and hospital LOS were 29.6 (95% CI: 24.0-35.2; I2=98.6%) and 38.8 (95% CI: 32.1-45.6; I2=95.7%) days, both associated with mechanical ventilation duration (coefficient 0.8 [95% CI: 0.2-1.4], P=0.02 and 0.9 [95% CI: 0.4-1.4], P=0.01, respectively) but not tracheostomy timing. Data were insufficient to assess tracheostomy technique on LOS. Duration of mechanical ventilation was 23.4 days (95% CI: 19.2-27.7; I2=99.3%), not associated with tracheostomy timing. Data were insufficient to assess the effect of tracheostomy technique on mechanical ventilation duration. Time to decannulation was 23.8 days (95% CI: 19.7-27.8; I2=98.7%), not influenced by tracheostomy timing or technique. The most common complications were stoma infection, ulcers or necrosis, and bleeding.Conclusions: In patients with COVID-19 requiring tracheostomy, the timing and technique of tracheostomy did not clearly impact on patient outcomes.Systematic Review Protocol: PROSPERO CRD42021272220. [ABSTRACT FROM AUTHOR]

Background: Currently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences.Methods: A systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme.Results: Eighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols.Conclusion: Due to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: Amputations are a devastating consequence of severe burns. Amputations in a resource-limited setting are challenging as rehabilitation services available to these patients are inconsistent and often fragmented. Epileptic patients are a particularly vulnerable group when it comes to burn-injuries and often sustain deeper burns. The aim of this study is to analyse amputations secondary to burn injuries. We seek to identify vulnerable groups as a means for advocacy efforts to reduce the devastation of an amputation secondary to a burn injury. This paper highlights the burden of these injuries on the healthcare system and emphasizes the need for additional trained therapists for the rehabilitation of these patients.Methods: A retrospective database review was conducted. All burns admissions who underwent an amputation between 1 February 2016 and 31 January 2019 were considered.Results: A total of 1575 patients were admitted during the study period. Fifty-four percent of the admissions were paediatric patients. The amputation rate in the paediatric population was 1.5% (13/850) while in the adult population it was 4.8% (35/724) . Most paediatric amputations were as a result of electrical injuries. Flame burns were most likely to result in amputations in the adult group and convulsions were the leading circumstance leading to the injury. There was no significant difference in sepsis or length of stay between the groups. There were no mortalities in the paediatric group but there was an 11% mortality rate in the adult group.Conclusion: The incidence of amputations in burns is low, however, it remains a devastating morbidity. Epileptics are a vulnerable group and these patients account for the most amputations among adult burns patients. Education interventions are needed regarding their diagnosis, administration of their medication and the importance of compliance. Advocacy efforts to ensure constant supply of anti-epileptic drugs at the clinics and other district level health facilities is also essential. Electrical injuries in children are not as common as hot water scalds, however, they are more likely to result in amputation. Communities need to be informed of the risk associated with illegal electrical connections and initiatives need to drive the safe provision of affordable electricity to these under-privileged, vulnerable communities. [ABSTRACT FROM AUTHOR]

Obesity has been associated with increased perioperative complications following shoulder arthroplasty, though this finding has not been consistently reported. The purpose of this systematic review is to summarize the correlation between elevated body mass index (BMI) and the prevalence of perioperative complications and clinical outcomes following anatomic total shoulder arthroplasty (aTSA). An extensive literature search of PubMed, Embase, ScienceDirect, and Google Scholar was conducted up until October 2020. Clinical studies that specifically examined the association between BMI and/or various categories of obesity with perioperative complications and functional outcomes following aTSA were included. Public databases (NIS, ACS-NSQIP, PearlDiver, and statewide databases) were largely excluded from the analysis unless procedural codes allowed for differentiation between reverse total shoulder arthroplasty (rTSA) and aTSA. Eleven studies were included in this systematic review - 9 studies reported solely on perioperative complications, 1 study solely on functional outcomes, and 1 study on both complications and outcomes following aTSA. Seven papers had a MINORS (Methodological Index for Non-Randomized Studies) score of <16, indicating low methodological quality. There was no association found between elevated BMI and overall perioperative medical and surgical complications, surgical site infection (SSI), re-operation without revision, aseptic revision, periprosthetic fracture, intraoperative blood loss, need for blood transfusion, 90-day re-admission, absolute hospital LOS or short-term mortality. There is an increased risk for overall revision following aTSA and need for extended hospital LOS in patients with elevated BMI. Range of motion of the operative shoulder, pain, and patient reported outcome measures (PROMs) have generally demonstrated significant improvement following unconstrained arthroplasty. Increasing BMI was not found to be associated with an elevated risk for the majority of perioperative complications following aTSA. Range of motion and patient reported functional outcomes can be expected to improve, even amongst morbidly obese patients. Level IV; Review Article [ABSTRACT FROM AUTHOR]

The present paper offers a review of the phenomena of bullying and peer violence among children and adolescents living in residential care settings (RCS). The review was conducted on four databases (Scopus, Web of Science, PsycINFO and ERIC). Findings of the 31 full-text papers included in the present work showed that bullying and peer violence involve various forms of direct and indirect attacks. While bullying in RCS involves severe and repeated aggressive actions, peer violence seems to be characterized by distinct levels of severity; i.e., low-level attacks are infrequent and isolated, whereas high level attacks may be severe and frequent. Several individual factors, such as age, gender, and length of stay in RCS were found to be associated with both bullying and peer violence. Contextual risk factors such as activities, structure and facility size, along with a residential peer culture characterized by a high level of hierarchy and a poor emotional bond between children and staff, contributed to bullying and peer violence. Furthermore, findings of the studies included in the present review showed that both perpetrators and victims manifest a number of behavioral and psychological problems. Overall, the present study offers a picture of bullying and peer violence among institutionalized children. However, distinct operationalization of constructs among studies, together with the use of different methods and measures, made comparisons among studies difficult. Future research should overcome these limitations in order to promote validity and compatibility of research in this field of study. [ABSTRACT FROM AUTHOR]

According to the World Health Organization (WHO), patient Length of Stay (LOS) in hospitals is an important performance measurement and monitoring indicator. Prolonged LOS in the Intensive Care Unit (ICU) may lead to consuming hospital resources, manpower, and equipment. Therefore, accurate prediction of patient LOS may aid the healthcare specialists to take medical decisions and allocate medical team and resources. As well, the patient and insurance companies may use this prediction to manage their budget. In this paper, a framework for predicting patient LOS in the ICU using different machine learning (ML) techniques is proposed. Unlike most of the previous studies, this study relies on general medical features collected on patient admission regardless of the patient diagnosis. This provide a broad scope and cover all patients making this approach general and easy to use. The prediction accuracy of the proposed approach was recorded to be very high and different for each ML technique. For example, the best prediction accuracy was achieved by fuzzy with accuracy reach 92%, while classification tree managed to achieve a prediction accuracy of 90% coming in the second place. [ABSTRACT FROM AUTHOR]

• Higher CFS scores are associated with poorer outcomes in orthopaedic patients. • These include increased rates of mortality, length of hospital stay and risk of adverse events post-procedure. • CFS is a strong and often favourable prognostic tool when compared to other frailty scales. • As research accumulates on the CFS, postoperative functional status and mortality, it may refine the consent process due to personalised outcome measures. The Clinical Frailty Scale (CFS) is a 9-point scaling system used to categorise the frailty of patients. The CFS is well-established as a prognostic tool for decision-making within healthcare settings. However, the relationship between the CFS as a predictor for orthopaedic outcomes is limited. This review aims to provide an overview of the efficacy of the CFS as a prognostic tool for predicting orthopaedic outcomes. Systematic review using PRISMA checklist (PROSPERO registered: CRD42023456648). Ovid and PubMed databases were searched using defined search terms to identify English language papers between 2007 and June 2023 which fit the inclusion criteria. Abstract screening was carried out independently and included studies proceeded to full-text review. 10 studies were identified. Studies used a range of outcome measures to assess success, including gross outcomes like mortality rates, as well as more specific functional outcomes, such as joint functionality scores. Studies identified that higher CFS scores correlate to poorer outcomes within orthopaedic patients. These include higher rates of mortality (41.7 % at one-year post proximal femur fracture for CFS ≥ 7), longer length of hospital stay and increased risk of adverse events post-procedure (both increased linearly from CFS 1 to 4). Additionally, the CFS was shown to be a strong prognostic tool when compared to other frailty scales. The number of studies that evaluated the relationship between the CFS and joint functionality scores is limited. Higher CFS scores are associated with poorer orthopaedic outcomes. However, it is difficult to quantify the true impact due to the limited number of high-quality studies. Further work to characterise the relationship between both gross and functional outcomes associated with the utilisation of the CFS in orthopaedic settings is essential to ascertain the utility of this simple score to improve resource allocation and provide effective consent to patients. [ABSTRACT FROM AUTHOR]

Background: Early readmission to hospital after hip fracture is associated with increased mortality and significant costs to the healthcare system. There is growing interest in the use of 30-day readmission rates as a metric of hospital performance. Identifying patients at increased risk of readmission after hip fracture may enable pre-emptive action to mitigate this risk and the development of effective methods of risk-adjustment to allow readmission to be used as a reliable measure of hospital performance.Methods: We conducted a systematic review of bibliographic databases and reference lists up to July 2016 to identify primary research papers assessing the effect of patient- and hospital-related risk factors for 30-day readmission to hospital after hip fracture.Results: 495 papers were found through electronic and reference search. 65 full papers were assessed for eligibility. 22 met inclusion criteria and were included in the final review. Medical causes of readmission were significantly more common than surgical causes, with pneumonia consistently being cited as the most common readmission diagnosis. Age, pre-existing pulmonary disease and neurological disorders were strong independent predictors of readmission. ASA grade and functional status were more robust predictors of readmission than the Charlson score or individual co-morbidities. Hospital-related risk factors including initial length of stay, hospital size and volume, time to surgery and type of anaesthesia did not have a consistent effect on readmission risk. Discharge location and the strength of hospital-discharge facility linkage were important determinants of risk.Conclusions: Patient-related risk factors such as age, co-morbidities and functional status are stronger predictors of 30-day readmission risk after hip fracture than hospital-related factors. Rates of 30-day readmission may not be a valid reflection of hospital performance unless a clear distinction can be made between modifiable and non-modifiable risk factors. We identify a number of deficiencies in the existing literature and highlight key areas for future research. [ABSTRACT FROM AUTHOR]

We sought to compare the outcomes of single-position (SP) circumferential lumbar interbody fusion in lateral decubitus versus dual-position (DP) fusion. A systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in PubMed, Web of Science, and Scopus databases to identify comparative studies reporting the outcomes of SP lumbar interbody fusion versus DP. For risk of bias assessment, the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool was used. Four comparative studies were included from an initial search of 3780 papers. All 4 studies were retrospective cohort studies comparing outcomes of SP versus DP LLIF. A total of 349 patients were operated using SP versus 254 using DP. All studies involved reported operating time, estimated blood loss, length of stay, change in segmental lordosis, and complications. From a general perspective, baseline variables were similar in both groups in all the studies and all reported a significant decrease in operative time and length of stays with SP. Literature comparing SP versus lateral-then-prone lumbar fusion shows a tendency toward shorter operating time and hospital stays in SP lumbar fusion while maintaining similar perioperative outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Far posterior, or paraspinal rib fractures, defined as fractures that are medial to the medial border of the scapula (and may involve the costovertebral articulation), are often treated nonoperatively. However, in certain cases, including severe displacement, persistent pain, nonunion, or persistent respiratory distress, stabilization with open reduction and internal fixation (ORIF) may be warranted. There is a paucity of literature regarding the surgical approach and clinical outcomes following ORIF for far posterior rib fractures and fracture-dislocations. The purpose of this paper is to describe the surgical approach and to report the first collection of clinical outcomes for patients undergoing paraspinal rib ORIF.Patients and Methods: A retrospective case series was performed at a single urban level 1 trauma center. Patients 18 years of age or older who underwent ORIF of far posterior rib fractures were included in this study. Far posterior rib fractures were defined as fractures that occurred medial to the medial border of the scapula underneath the paraspinal musculature. Data collection including patient demographics, injury characteristics, operative variables, and postoperative outcomes were collected and analyzed.Results: Twenty-six patients, with a mean age of 50.7 years, who underwent paraspinal rib ORIF were included in this study. The mean follow-up was 12.1 months. 80.8% of patients had a flail chest injury. On average, 3.4 ribs were instrumented posteriorly with 22.8% of patients requiring fixation spanning the costotransverse articulation. No intraoperative complications occurred. Only one patient required a repeat procedure. Total hospital length of stay averaged 17.3 days with an intensive care unit stay averaging 6.2 days. Total ventilator time averaged 4 days. 7 patients were diagnosed with postoperative pneumonia and 6 patients required tracheostomy.Conclusion: Open reduction and internal fixation for far posterior, or paraspinal rib fractures and fracture-dislocations is a safe procedure with low complications rates and favorable postoperative outcomes including hospital length of stay, ICU length of stay, need for tracheostomy, postoperative pneumonia, and mechanical ventilation time. [ABSTRACT FROM AUTHOR]

Surgery is the definitive treatment option for symptomatic Chiari malformation I (CMI), but there is no clear consensus as to the preferred surgical method. This study aimed to quantitatively assess and compare the effect and safety of dura splitting decompression (DSD) and posterior fossa decompression with duraplasty (PFDD) in treating patients with CMI. A literature search of EMBASE, MEDLINE, PubMed, Cochrane Library, and Web of Science databases was conducted. References from January 1990 to September 2020 were retrieved. We only included papers containing original data, comparing the use of DSD and PFDD in CMI patients. Overall, 11 relevant studies were identified, wherein 443 patients treated for CMI by DSD were compared with 261 patients treated by PFDD. No difference was observed between PFDD and PFD in terms of clinical improvement (P = 0.69), syringomyelia improvement (P = 0.90), or reoperation (P = 0.22). DSD was associated with shorter operation durations (P = 0.0007), shorter length of stay (P = 0.0007), and shorter overall postoperative complications (P < 0.0001) (especially cerebrospinal fluid [CSF] leak P = 0.005], meningitis P = 0.002], and pseudomeningocele P = 0.002]), as compared with PFDD. This study confirmed that dura splitting decompression has clinical and syringomyelia improvement outcomes comparable to posterior fossa decompression with duraplasty. Compared with PFDD, DSD not only significantly shortened the operation time and length of stay, but also significantly reduced the overall complication rate, especially those related to incidence of CSF-related complications. More evidence from advanced multicenter studies are needed to require to validate the findings. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary exercise testing (CPX) can objectively measure fitness and oxygen uptake at anaerobic threshold. The relationship between fitness and postoperative outcomes after upper gastro-intestinal surgery is unclear. The aim of the present review is to assess the prognostic ability of CPX in predicting postoperative outcome associated with oesophagogastric surgery. Methods: Relevant studies were identified through a systematic search of EMBASE, Medline, CINAHL, Cochrane Library, and Web of Science to July 2019. The eligibility criteria for studies included prognostic studies of upper gastro-intestinal surgery among adult populations using a preoperative CPX and measurement of postoperative outcome (mortality or morbidity or length of stay). Risk of bias was assessed using the QUIPS Quality in Prognostic Studies validated tool. Results: Thirteen papers with a total of 1735 participants were included in data extraction. A total of 7 studies examined the association between CPX variables and postoperative mortality. Patients undergoing gastro-intestinal surgery with lower anaerobic threshold values were found to have an increased risk of postoperative mortality. Similarly, a lower rate of oxygen consumption was found to be associated with higher mortality. There was conflicting evidence regarding the association between CPX variables and postoperative morbidity. The evidence did not demonstrate any association between preoperative CPX variables and hospital length of stay. Conclusion: Studies report an association between CPX variables and postoperative mortality; however, there is conflicting evidence regarding the association between CPX variables and postoperative morbidity. [ABSTRACT FROM AUTHOR]

The Stanford classification of aortic dissection was described in 1970. The classification proposed that type A aortic dissection should be surgically repaired immediately, whereas type B aortic dissection can be treated medically. Since then, diagnostic tools and management of acute type A aortic dissection (ATAAD) have undergone substantial evolution. This paper evaluated historical changes of ATAAD repair at Stanford University since the establishment of the aortic dissection classification 50 years ago. The surgical approaches to the proximal and distal extent of the aorta, cerebral perfusion methods, and cannulation strategies were reviewed. Additional analyses using patients who underwent ATAAD repair at Stanford University from 1967 through December 2019 were performed to further illustrate the Stanford experience in the management of ATAAD. While technical complexity increased over time, post-operative survival continued to improve. Further investigation is warranted to delineate factors associated with the improved outcomes observed in this study. [ABSTRACT FROM AUTHOR]

The emergency department (ED) offers a critical and unique opportunity to assess and intervene on suicide risk. Despite its potential benefits, the ED setting presents several potential sources of stress. The present paper calls attention to how suicidal patients may be especially vulnerable to stressful ED experiences. This research synthesis cites the growing literature on ED-related stressors, as they have been shown to affect both psychiatric and nonpsychiatric patient populations. We identified specific interpersonal, physical, and temporal features of the ED that have been shown to affect multiple patient populations, including suicidal individuals. Beyond this, there appears to be broad underutilization of therapeutic care in ED settings. It is important to consider how the ED setting may be both helpful and harmful toward suicidal patients. We conclude with recommended domains of study and methodological considerations when pursuing these future directions. The proposed research agenda would help address this known high risk period around hospitalization and discharge, and ultimately optimize suicide prevention efforts. [ABSTRACT FROM AUTHOR]

The latest MIMC III (Medical Information Mart for Intensive Care III) database has rich information on over 58k patient's medical histories for over 11 years. Based on MIMC III database, this paper presents a study of those patient's primary disease risk prediction modeling, which focuses on assessing future disease risks for an individual who is ready for discharge. We explore a framework that combines regression modeling and deep learning techniques to substantially improve the performance of developed models. Firstly, a regression model will be applied to predicting the length of stay for a patient's future ICU visit. Secondly, deep learning approach will be adopted to assess individual's future visit in terms of time and the primary disease. If the modeling gets adopted in a hospital, the predicted results can be promisingly utilized as a reference for medical professionals and experts to offer effective health care guidance for patients. The proposed framework can also be utilized for developing an innovative tool that helps individuals create and maintain a better healthcare plan over time. [ABSTRACT FROM AUTHOR]

Length of stay has become a key variable for tourism management. However, estimation of tourists' length of stay implies the need to implement surveys of tourists. In addition to the significant costs associated to tourism surveys, their implementation over time is frequently interrupted, either due to budget issues or to methodological changes, and, consequently, monitoring average stay evolution is often difficult. In this paper, a new method for estimating tourists' length of stay from airport data is proposed and tested for the case of the Balearic Islands (Spain). Using regression analysis techniques, it is found how it is possible to replicate estimations for tourists' length of stay in the Balearic Islands obtained from surveys, for the different islands, different years, and also different nationalities; it is even possible to fill in the data where official statistics failed and obtain a homogenous estimation that targets multiple comparisons including the temporal one. • It is important to observe how the tourist length of stay changes over time. • Estimation of tourists' length of stay has implied the need to implement surveys. • Surveys are expensive to implement and often suffer methodological changes. • A new method for estimating tourists' length of stay from airport data is proposed. • It is possible to obtain the estimation of the tourist length of stay without surveys. [ABSTRACT FROM AUTHOR]

Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources. [ABSTRACT FROM AUTHOR]

• Gaining of competitive advantage in hotel industries. • The influence of revenue management performance on competitive advantage. • Non-pricing strategies are often ignored, but this paper gives due importance to it. • The critical pricing and non-pricing strategies are identified. • The strategic managers of hotels can be benefited by the suggestions. This research attempts to establish linkages between the dimensions of pricing and non-pricing strategies adopted in hotels in Qatar on the revenue management performance and the gaining of the competitive advantage in business. Nine of the prominently used pricing strategies and four of the non-pricing strategies commonly used in hotel industries have been considered. The research methodology uses interpretivist paradigm using SEM to test the 14 hypotheses with a sample size of 210 managers chosen from 20 five star hotels. Results indicated that hotels should closely monitor demand based pricing, optional product pricing, promotional pricing, and psychological pricing among pricing strategies and length of stay control in non-pricing strategies, as they have a significant relationship with revenue management performance which in turn can provide competitive advantage in business as revealed through the hypothesis testing. Implications have been drawn to benefit the strategic managers to enhance the revenue management performance. [ABSTRACT FROM AUTHOR]

Background: Enhanced Recovery After Surgery (ERAS) has been successfully adopted across a range of procedures. This study explores whether there is scope to improve length of stay (LOS) for total ankle replacement surgery (TAR) in the UK by implementing ERAS pathways.Methods: Hospital Episode Statistics (HES) data (April 2015/March 2016) on LOS for TAR were analysed. A literature search was then carried out to examine whether there were any publications on outpatient TAR and/or the use of ERAS protocols.Results: Mean observed LOS was 3.3days (range 0-17.3) days. Case mix-adjusted expected LOS range was 2.0-5.7 days. It is likely that the wide observed LOS range is due to differences in local processes and pathways. Two papers were found by the literature search.Conclusions: TAR should aim to be outpatient surgery as the literature, and data demonstrating scope for improvement in LOS, suggest this should be possible. [ABSTRACT FROM AUTHOR]

Purpose: We conducted a meta-analysis to evaluate and compare the short- and long-term results of laparoscopy-assisted and open rectal surgery for the treatment of patients with rectal cancer.Methods: We searched MEDLINE, EMBASE, Science Citation Index, and the Cochrane Controlled Trial Register for relevant papers published between January 1990 and April 2011 by using the search terms "laparoscopy," "laparoscopy assisted," "surgery," "rectal cancer," and "randomized controlled trials." We analyzed outcomes over short- and long-term periods.Results: We identified 12 papers reporting results from randomized controlled trials that compared laparoscopic surgery with open surgery for rectal cancer. Our meta-analysis included 2,095 patients with rectal cancer; 1,096 had undergone laparoscopic surgery, and 999 had undergone open surgery. In the short-term period, 13 outcome variables were examined. In the long-term period, eight oncologic variables, as well as late morbidity, urinary function, and sexual function were analyzed. Laparoscopic surgery for rectal cancer was associated with a reduction in intraoperative blood loss and the number of transfused patients, earlier resumption of oral intake, and a shorter duration of hospital stay over the short-term, but with similar short-term and long-term oncologic outcomes compared to conventional open surgery.Conclusions: Laparoscopic surgery may be an acceptable alternative treatment option to conventional open surgery for rectal cancer. [ABSTRACT FROM AUTHOR]

Abstract: Lacking any conventional definition, the phenomenon of so-called “bed-blockers” concerns the issue of long-stay inpatients in short-term units. Our paper explores this question in the context of French Emergency Rooms (ERs) and focuses not on “bed-blocking” as a patient phenomenon but rather on the social constructs developed around these patients by ER professionals. In this paper, we present a case study on one of these “bed-blockers” and venture some hypotheses regarding this phenomenon. On the one hand, it appears as a dysfunction in the healthcare system. Indeed, French ERs take on patients that specialized medical units are reluctant to admit, either because they do not fit into any one specific scientific or clinical category, or because they are not “profitable” when analyzed using care-management tools. On the other hand, bed-blockers play an important role in building a positive identity for the French emergency doctors and personnel performing the “dirty work” of treating them. [Copyright &y& Elsevier]

Home health care (HHC) is a fast-growing area of research that has received increasing attention in recent years due to the rise in life expectancy and the fall in birth rates. It is expected to reduce length of stay in hospital as well as to allow patients to receive care and assistance in their home. Several models and algorithms have been proposed to manage the various constraints and criteria. However, multi-objectives HHC routing and scheduling problems (HHCRSP) with practical and complicated constraints as well as Pareto dominance based approaches are still scarce in the literature. In this paper, we focus on modeling and solving the multi-objectives HHCRSP with lunch breaks, multiple time windows, duty length, skill requirement and a mix of soft and hard services. A mixed integer linear programming (MILP) model with three objectives is proposed, which aims to minimize tardiness of soft services and caregivers' waiting times and also to balance their workload. Two approaches, Pareto and decomposition based, with multi-objective evolutionary algorithms are proposed to solve the multi-objective HHCRSP. We developed a memetic algorithm (NSGA-LS), resulting from the hybridization of non-dominated sorting genetic algorithm II (NSGA-II) with multidirectional local search (MDLS), to trade-off between exploration and exploitation. Computational results and performance measures inferred that NSGA-LS has a better performance compared to other algorithms. According to the hyper-volume indicator, NSGA-LS obtained 93.75% better solutions for the tested instances in a pairwise comparison between algorithms while multiobjective evolutionary algorithm based on decomposition (MOEA/D) has a better complexity. Sensitivity analysis of the percentage of soft/flexible services and the maximum allowed tardiness showed that increasing them significantly improved the quality and trade-off of solutions. [ABSTRACT FROM AUTHOR]

Although operating an emergency department (ED) can influence general admission activity of hospitals, most articles that analyze hospital care ignore the potential spillover of emergency activity. In this paper, we examine the consequences of a French reform that encouraged the creation of EDs within private-for-profit (PFP) hospitals in order to decrease congestion in EDs. We use administrative panel data on 365 French PFP hospitals observed between 2002 and 2012. Specifications including hospital fixed-effects are estimated to examine the impact of an ED opening on private hospitals' admission activity, namely inpatient and day-care admissions (ED visits are excluded, but patients admitted following an ED visit are included). We control for shocks that can impact demand for care in hospitals, and we estimate yearly changes before and after the opening. We find that an ED opening is followed by an increase in the number and proportion of inpatient admissions, and by an increase in the length of inpatient stays. A transitory increase in the bed occupancy rate is also observed. In many countries, public and private hospitals compete to some extent. The former provide a public service, while the latter are profit-maximizers that are allowed to specialize in profitable activities. They generally focus on day-care admissions. We provide empirical evidence that private hospitals experience a significant change in the composition of their admissions when they start providing emergency care. Opening an ED creates a new non-selective entryway to private hospitals, resulting in admissions of inpatients with health problems that are more severe. Hence, involving PFP hospitals in the provision of emergency care is likely to make the structure of admissions of private hospitals closer to that of public hospitals. • Financial incentives encouraged the creation of EDs among French private hospitals. • Starting up emergency care spills over to private hospital admissions. • ED opening increases hospital's proportion and length of inpatient admissions. • Results suggest higher severity of patients' conditions after opening. • Structure of stays in private and public hospitals gets more similar after ED opening. [ABSTRACT FROM AUTHOR]

Most of the caregivers working in hospitals are highly skilled and educated work force. Even if they are supported by administrative staff, part of their time still consists of administrative procedures or trying to empirically fill or retrieve agendas on the basis of real-time constraints. Similarly, patients waste time waiting for adequate treatments so they occupy slots (beds) in hospitals while their hospitalization is not a necessity. This leads to huge wastes of resources for the hospital that has to hospitalize and prioritize patients in more effective need of care and monitoring. In order to ensure real-time patient support during its entire stay in the hospital (in terms of bed occupancy, appointments with doctors and/or for medico-technical exams) as well as to furnish a central solution open for future IT integration we propose, in this paper, to build a Multi-Agent System (MAS) based software solution. The latter has been built following a socio-technical approach; it maps, at runtime, the working processes of a Belgian hospital. Processes have been modeled in a patient-centric way in order to identify most relevant stages and bottlenecks in bed, cares and medico-technical exams management; real-time data transmission allows to update and re-optimize slots statuses as well as schedules. Also, data analysis (i.e., business intelligence) functions are supported by the MAS implementation for decision making/taking. Further than the proof of concept that shows the managerial support of the software solution, the MAS modules’ benefits to the overall hospital strategy is studied. The latter shows the relevance of the solution to the hospital’s governance. [ABSTRACT FROM AUTHOR]

Acute Medical Units (AMUs) are instigated in many hospitals across the world. An AMU admits acute patients, mainly arriving via the emergency department, for further assessment, care and treatment for a maximum designated period. Thereafter, patients who require additional care are transferred to regular wards that also admit elective patients. The literature reports several benefits (including reductions in in-patient mortality and in the length of stay), with these conclusions mostly based on empirical findings from studies focused on acute patient performance only. This paper sheds light on the potential hospital-wide impact of implementing a range of AMU designs in terms of length of the designated period, size and transfer policy. A simulation study is performed based on data from a large Dutch hospital. When establishing an AMU, hospitals usually transfer resources from existing wards to the new AMU. This seems logical since these wards receive fewer acute admissions once an AMU is in place. However, our research shows that this transfer of resources decreases the overall performance (of the AMU and the wards) for all the AMU designs investigated. We report on the scale of these negative effects and the required reduction in the length of acute patients' stays required to compensate for these effects. [ABSTRACT FROM AUTHOR]

Objective Dementia is a crucial challenge in acute care hospitals. Using a retrospective claims data cohort, this paper explores dementia patients' acute hospitalization rates, risk factors, and length of stay. Methods The study used claims data from AOK PLUS, the largest statutory health insurance service (SHI) in Saxony, a federal state of Germany. The analysis included 61,239 people with dementia and 183,477 control subjects, all 65 years and older. Control subjects were age, gender, and regionally matched in a 1:3 ratio. Negative binomial hurdle regression was used to compare differences in hospitalization for the year 2014. Results People with dementia had 1.49 times higher adjusted odds of being hospitalized at least once (95% confidence interval [CI], 1.46–1.52). Among those individuals hospitalized at least once, dementia increased the number of readmissions by 18% (95% CI, 1.15–1.20). Dementia patients also had a 1.74 times higher odds for at least one emergency admission compared to individuals without dementia (95% CI, 1.70–1.78). Dementia patients' admission risk factors included having care dependency, being recently diagnosed with dementia and living outside a metropolitan region. The increased length of stay for people with dementia per year was mainly attributable to higher admission rates. Conclusions Dementia patients are at higher risk for hospitalization, especially if they live outside the metropolitan region. Healthcare systems need to respond to the challenges resulting from the predicted demographic developments and increasing burden of dementia in the general population. [ABSTRACT FROM AUTHOR]

Objective Integrating primary care services into specialty mental health clinics has been proposed as a method for improving health care utilization for medical conditions by adults with serious mental illness. This paper examines the impact of a mental health based primary care program on emergency department (ED) visits and hospitalizations. Method The program was implemented in seven New York City outpatient mental health clinics in two waves. Medicaid claims were used to identify patients treated in intervention clinics and a control group of patients treated in otherwise similar clinics in New York City. Impacts of the program were estimated using propensity score adjusted difference-in-differences models on a longitudinally followed cohort. Results Hospital stays for medical conditions increased significantly in intervention clinics relative to control clinics in both waves (ORs = 1.21 (Wave 1) and 1.33 (Wave 2)). ED visits for behavioral health conditions decreased significantly relative to controls in Wave 1 (OR = 0.89), but not in Wave 2. No other significant differences in utilization trends between the intervention and control clinics were found. Conclusion Introducing primary care services into mental health clinics may increase utilization of inpatient services, perhaps due to newly identified unmet medical need in this population. [ABSTRACT FROM AUTHOR]

This paper seeks to explain variations in acute inpatient length of stay in the National Health Service in England. A model is proposed in which the length of stay is allowed to vary according to patient characteristics, the local supply of NHS care, the local pressure on NHS resources, other non-NHS health care supply factors, and local policy effects. Length of stay data are obtained from the 1991/1992 Hospital Episode Statistics. They are standardized for age, sex and broad specialty group, and are aggregated to the level of small areas with populations of about 10,000. Explanatory variables include socio-economic data from the 1991 Census of Population, health status data, waiting time data, measures of access to inpatient and GP services, and measures of local private health care provision. The paper finds that variability in length of stay is greatest in the over-65 age group. The most important determinants of variations in length of stay are access to NHS hospitals, access to private hospitals, waiting times for elective surgery, indicators of poverty, and indicators of the availability of informal care. [ABSTRACT FROM AUTHOR]

This paper focuses on predicting the length of stay for patients on the first day of admission and propose a predictive model named DGLoS. In order to capture the influence of various complex factors on the length of stay as well as the dependencies among various factors, DGLoS uses a deep neural network to model both the patient information and diagnostic information. Targeting at different attribution types, we utilize different coding methods to convert raw data to the input features. Besides, we find that similar patients have closer lengths of stay. Therefore, we further design a module based on graph representation learning to generate patients' similarity-aware representations, capturing the similarity between patients and therefore enhancing predictions. These similarity-aware representations are incorporated into the output of the deep neural network to jointly perform the prediction. We have conducted comprehensive experiments on a real-world hospitalization dataset. The performance comparison shows that our proposed DGLoS model improves predictive performance and the significance test demonstrates the improvement is significant. The ablation study verifies the effectiveness of each of the proposed components and the hyper-parameter investigation shows the robustness of the proposed model. [ABSTRACT FROM AUTHOR]

Various demographic and medical factors can be linked to severe deterioration of patients suffering from traumatic injuries. Accurate identification of the most relevant variables is essential for building more accurate prediction models and making more rapid life-saving medical decision. The intention of this paper is to select a number of features that can be used to accurately predict patients' outcomes through three feature selection methods: random forest, ReliefF and the evidential reasoning (ER) rule. The impact of an outcome's class imbalance on feature selection is discussed, and synthetic minority over-sampling technique (SMOTE) is performed to show the differences in the selected features. The results show that length of stay in hospital, length of stay in intensive care unit, age, and Glasgow Coma Scale (GCS) are the most selected features across different techniques. The prediction models based on the features selected by the ER rule show the highest prediction performance represented by the area under the receiver operating characteristic curve (AUC) values, which has a median of 0.895 for the model employed by the ten highest-weighted variables, while the median AUC values are 0.827 and 0.885 if the ten highest-weighted variables are selected by ReliefF and random forest respectively. The results also show that after the ten most important features, increasing the number of the less important features has only a slight increase in prediction accuracy. • The paper focuses on improving trauma outcome prediction accuracy through feature selection. • The impact of imbalanced classes in feature selection is measured. • The evidential reasoning rule method for trauma feature selection is proposed. • Models using the features selected by the evidential reasoning rule method has the highest prediction accuracy. • The results highlight the key predictors of patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The PARAMEDIC cluster randomised trial evaluated the LUCAS mechanical chest compression device, and did not find evidence that use of mechanical chest compression led to an improvement in survival at 30 days. This paper reports patient outcomes from admission to hospital to 12 months after randomisation.Methods: Information about hospital length of stay and intensive care management was obtained through linkage with Hospital Episode Statistics and the Intensive Care National Audit and Research Centre. Patients surviving to hospital discharge were approached to complete questionnaires (SF-12v2, EQ-5D, MMSE, HADS and PTSD-CL) at 90days and 12 months. The study is registered with Current Controlled Trials, number ISRCTN08233942.Results: 377 patients in the LUCAS arm and 658 patients in the manual chest compression were admitted to hospital. Hospital and intensive care length of stay were similar. Long term follow-up assessments were limited by poor response rates (53.7% at 3 months and 55.6% at 12 months). Follow-up rates were lower in those with worse neurological function. Among respondents, long term health related quality of life outcomes and emotional well-being was similar between groups. Cognitive function, measured by MMSE, was marginally lower in the LUCAS arm mean 26.9 (SD 3.7) compared to control mean 28.0 (SD 2.3), adjusted mean difference -1.5 (95% CI -2.6 to -0.4).Conclusion: There were no clinically important differences identified in outcomes at long term follow-up between those allocated to the mechanical chest compression compared to those receiving manual chest compression. [ABSTRACT FROM AUTHOR]

Patients with burns have to live with a variety of long-term physical and psychosocial consequences. Burns lead to prolonged hospital stay, disfiguring scars, disability, and even death. Since self-immolation is common in women of Iraqi Kurdistan, the present study sought to explore the experiences of women living with scars caused by self-immolation. This paper was part of a qualitative research study. A purposive sample of 18 female self-immolation survivors from Iraqi Kurdistan was selected, and 21 individual interviews were conducted and analyzed using conventional content analysis. Four categories emerged during the data analysis: (1) feelings of disbelief, regret, and anger caused by post-burn scars; (2) desperately seeking solutions; (3) grief due to disappointment and surrender to despair; and (4) rejection and isolation. In conclusion, individuals with scars and disfigurements sometimes adopted inappropriate measures to deal with the psychological problems caused by others' behaviors and wrong perceptions. Educational and support programs are hence indicated to promote awareness levels of self-immolation survivors, their families, and the whole society. [ABSTRACT FROM AUTHOR]

Introduction: The diffuse epidermal exfoliation seen in Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) is similar to skin loss in second degree burns, and many of these patients are referred for treatment at burn centers. Treatment can differ markedly from center to center, and mortality can range from 25% to 70%, including a considerable morbidity. However, our experience over a 15-year period from 2000 to 2015 with 40 patients found a mortality rate of only 10% (4/40). The purpose of this paper is to discuss our treatment algorithm as a model for other centers treating SJS/TENs patients.Methods: Records were reviewed for all patients admitted to the LAC+USC burn unit between 2000 and 2015 and 40 patients were identified with biopsy-proven SJS or TENS. These cases were reviewed for age, gender, initial and greatest TBSA, causative drug, pre-existing medical conditions, and morbidity and mortality. All data were entered into the SPSS statistical software package and all statistical analyses were performed using this program.Results: Our treatment algorithm focused on early referral to a specialty burn unit, immediate discontinuation of the offending drug, fluid resuscitation, nutritional supplementation, and meticulous wound care. Average time to transfer to a burn unit was 3.36 days. Silver-releasing antimicrobial dressings were applied to the affected skin surface and changed every 3 days. Mupirocin coated petroleum gauze was used for facial involvement. Steroids were tapered and discontinued if initiated at an outside facility (58% of patients), and starting after 2001, all patients received a course of IVIG. All patients received fluid resuscitation and the majority received supplemental tube feedings (69%). Average length of total stay was 17.1 days and length of ICU stay 15.9 days. While 44% were transferred to another facility for further rehabilitative care, 37% of patients discharge to home. In patients discharged home with complete resolution of skin lesions, time to healing was an average of 14 days.Discussion: With our 10% mortality rate in 40 patients, our study represents a relatively large study population while maintaining a relatively low mortality rate. The demographic data from our study largely aligns with the existing literature, and we therefore feel that our low mortality rate is due to our treatment algorithm, rather than to a less severe pathology in our patient population. This claim is supported by a standard mortality ratio of 1.68. This ratio proves a significantly improved mortality than would be expected based on disease severity on admission. [ABSTRACT FROM AUTHOR]

Objective: Sutures in laparoscopy have been extensively developed in recent years. In this study, we assessed differences between Polysorb™ braided absorbable suture (CL-914) and V-Loc™ barbed suture (V-Loc 180) used in vaginal cuff closure during laparoscopic hysterectomy from various aspects.Study Design: This paper presented a prospective cohort study of 490 consecutive women underwent total laparoscopic hysterectomy (TLH) performed between January 2013 and September 2015 applying identical procedure technique, with cuff closure approaches selected by surgeons. Data collected included operative time, estimated blood loss, postoperative changes in body temperature, perioperative routine blood parameters changes, total average hospital stay, and postoperative hospital stay. In addition, short-term (at least 6 months) outcomes of vaginal cuff granulomatous (VCG) between the two suture approaches were compared.Results: Between groups, statistical differences were detected in operative duration, estimated blood loss, total and postoperative hospital stay, WBC, neutrophil counts and Hb in postoperative routine blood parameters; while there were no significant differences in other data (all P>0.05). Postoperative routine blood parameters in each group: compared to preoperative baseline, in Group 1, WBC, N increased (P<0.05), while RBC, Hb decreased (P<0.05). In Group 2, same tendency in WBC, N and Hb was indicated, but RBC increased with no significant difference. In both groups, vaginal cuff healing was well, with no dehiscence. VCG occurred more often in women used CL-914 than women applied V-Loc 180.Conclusions: V-Loc barbed suture can be used for vaginal cuff closure during TLH due to advantages such as less operative duration and blood loss, shorter postoperative and total hospital stay, and reduced VCG formation six months after TLH. [ABSTRACT FROM AUTHOR]

Introduction: Since 2005, the Western Australian paediatric burn unit has provided a state-wide clinical consultancy and support service for the assessment and management of acute and rehabilitative burn patients via its telehealth service. Since then, the use of this telehealth service has steadily increased as it has become imbedded in the model of care for paediatric burn patients. Primarily, the service involves acute and long term patient reviews conducted by the metropolitan-located burn unit in contact with health practitioners, advising patients and their families who reside outside the metropolitan area thereby avoiding unnecessary transfers and inpatient bed days. A further benefit of the paediatric burn service using telehealth is more efficient use of tertiary level burn unit beds, with only those patients meeting clinical criteria for admission being transferred.Aim: To conduct a retrospective audit of avoided transfers and bed days in 2005/06-2012/13 as a result of the use of the paediatric Burns Telehealth Service and estimate their cost savings in 2012/13.Method: A retrospective chart audit identified activity, avoided unnecessary acute and scar review patient transfers, inpatient bed days and their associated avoided costs to the tertiary burn unit and patient travel funding.Results: Over the period 2005/06-2012/13 the audit identified 4,905 avoided inpatient bed days, 364 avoided acute patient transfers and 1,763 avoided follow up review transfers for a total of 1,312 paediatric burn patients as a result of this telehealth service. This paper presents the derivation of these outcomes and an estimation of their cost savings in 2012/13 of AUD 1.89million.Conclusion: This study demonstrates avoided patient transfers, inpatient bed days and associated costs as the result of an integrated burns telehealth service. [ABSTRACT FROM AUTHOR]

Objective This study aims to describe the association between pre- and post-discharge factors and early readmission to acute psychiatric wards in a well-integrated community-based psychiatric service. Methods The analysis consisted of all the hospital discharge records containing a psychiatric diagnosis in 2011 from four Italian acute inpatient wards. Socio-demographic, clinical, admission and aftercare variables were investigated as possible predictors of readmission at 7, 30 and 90 days after discharge and were analyzed, controlling for dependency among same-patient observations. Results Previous psychiatric history was the most important predictor of readmissions. The socio-demographic and clinical characteristics of patients did not clearly influence readmission. Length of stay (LoS) was significant for readmission at 7 days even after controlling for other predictors and for same-patient dependence, in particular, for patients with previous admissions. Results suggest a protective role of a LoS higher than 28 days. In general, having a contact in community services did not turn out as protective from early readmission. Conclusions This paper contributes to increase the knowledge about factors that may predict the risk of early readmission. Implications for quality assessment in psychiatry emerged: readmission seems actionable by LoS and not by community follow-up. [ABSTRACT FROM AUTHOR]

Objectives: This paper evaluates the safety and effectiveness of self-expanding metallic stents (SEMS) for the management of emergency malignant colorectal obstruction in patients otherwise requiring multi-stage surgery. No systematic review has been conducted comparing SEMS to only multi-stage surgery.Methods: Bibliographic databases, including Cochrane, PubMed, EMBASE, and CINAHL, were searched in September 2011 and repeated in November 2013. A pre-determined protocol outlined the study inclusion and appraisal.Results: Forty articles were included, seven compared SEMS to multi-stage surgery. Included studies were of low to moderate quality. Bowel perforation was the most severe stent-related complication, while tumor- and stent-related events occurred most frequently. No significant differences in rates of obstruction relief were reported between treatments, and results regarding relative quality of life were inconclusive. SEMS recipients progressed to elective surgery sooner and required shorter post-procedural hospital stays, but commonly required re-intervention. SEMS provided enduring palliative relief of obstruction, with comparable survival longevity between treatments. Conclusion: SEMS placement is a viable alternative to multi-stage surgery, providing patients with benefits as a bridge-to-surgery and relief of obstruction in a palliative context, with minimal differences in clinical success and safety compared to multi-stage surgery. [ABSTRACT FROM AUTHOR]

Background: Most strategies used to help improve the patient experience of care and ease emergency department (ED) crowding and diversion require additional space and personnel resources, major process improvement interventions, or a combination of both.Objectives: To compare the impact of ED expansion vs. patient flow improvement and the establishment of a rapid assessment unit (RAU) on the patient experience of care in a medium-size safety net ED.Methods: This paper describes a study of a single ED wherein the department first undertook a physical expansion (2006 Q2 to 2007 Q2) followed by a reorganization of patient flow and establishment of an RAU (2009 Q2) by the use of an interrupted time series analysis.Results: In the time period after ED expansion, significant negative trends were observed: decreasing Press Ganey percentiles (-4.1 percentile per quarter), increasing door-to-provider time (+4.9 minutes per quarter), increasing duration of stay (+13.2 minutes per quarter), and increasing percent of patients leaving without being seen (+0.11 per quarter). After the RAU was established, significant immediate impacts were observed for door-to-provider time (-25.8 minutes) and total duration of stay (-66.8 minutes). The trends for these indicators further suggested the improvements continued to be significant over time. Furthermore, the negative trends for the Press Ganey outcomes observed after ED expansion were significantly reversed and in the positive direction after the RAU.Conclusions: Our results demonstrate that the impact of process improvement and rapid assessment implementation is far greater than the impact of renovation and facility expansion. [ABSTRACT FROM AUTHOR]

Over the past decades, reductions of hospital beds and lengths of stay in general psychiatry are opposed to increases in detention cases and times in forensic psychiatric institutions. These developments raise the issue of trans-institutionalization of patient subgroups, whose particular needs of support are less accommodated by rationalized general psychiatry. While forensic psychiatric aftercare with a focus on risk assessment and assertive treatment has been largely established, preventive care of high-risk psychiatric patients to avert delinquency, compulsory hospitalization, or forensic courses has not yet been developed. Three outpatient studies addressing these issues have been conceptualized independently and were initiated in Germany and Switzerland. All three have similar study endpoints regarding incidence of violence, delinquency, compulsory hospitalization, and forensific sequelae. However, designs and methods differ with regard to inclusion criteria, assessment methods, foci of interventions, modes of delivering care, degrees of assertiveness, and times of follow-up. By the time of study completions, it can be expected that the joined information from all three studies will allow for a comprehensive appraisal of preventive treatment strategies and approaches in high-risk patients. In this paper, the study designs and methods of the three trials are outlined. [ABSTRACT FROM AUTHOR]

Objective: Premature mortality is a public health concern that can be quantified as years of potential life lost (YPLL). Studying premature mortality from in-hospital mortality can help guide hospital initiatives and resource allocation. This paper identified the diagnosis categories associated with in-hospital deaths that account for the highest YPLL and their trends over time. Study design: Retrospective review of the Nationwide Inpatient Sample (NIS), 1988-2010. Methods: Using the NIS, YPLL on patients hospitalized in the United States from 1988 to 2010 was calculated. Hospitalizations were categorized by related principal diagnoses using the Healthcare Cost and Utilization Project (HCUP) single-level Clinical Classification Software (CCS) definitions. Results: Between 1988 and 2010, total in-hospital estimated mortality of 20,154,186 people accounted for 198,417,257 YPLL (9.84 YPLL per in-hospital mortality; 8,626,837 estimated annual mean YPLL). The ten highest YPLL diagnosis categories accounted for 51% of the overall YPLL. The liveborn disease category (i.e., in-hospital live births) was the most common principal diagnosis and accounted for the highest YPLL at 1,070,053. The septicemia category accounted for the second highest YPLL at 548,922. The highest in-hospital mortality rate (20.8%) was associated with adult respiratory failure/insufficiency/arrest. The highest estimated in-hospital annual mean deaths occurred in patients with pneumonia at 69,134. For all in-hospital mortality, the inflation adjusted total in-hospital charges per YPLL was highest for acute myocardial infarction at $9292 per YPLL. Conclusions: Using YPLL, a framework has been provided to compare the impact of premature in-hospital mortality from dissimilar diseases. The methodology and results may be used to help guide further investigation of hospital quality initiatives and resource allocation. [ABSTRACT FROM AUTHOR]