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Introduction: Fewer women than men are admitted to intensive care units (ICUs) worldwide. Objectives: To quantify the relative contribution of each major diagnostic category to the overall sex balance in ICU admissions in Australia and New Zealand, and to describe changes in the sex balance over time and with patient age. Methods: Retrospective cross-sectional study of Australian and New Zealand ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2005 and 2018. Multivariate logistic regression for the likelihood of female admission considered key explanatory variables: diagnostic category, patient age, admission year, geographic region, hospital type, and planned versus unplanned ICU admission. Results: Overall, 42.3% of 1 616 856 Australian and New Zealand ICU patients were women (99% CI, 42.2–42.4%). 247 988 more men than women were admitted to an ICU during the 14-year study period. There was a sex imbalance in most diagnostic categories: less than 48% women in 15 of 23 diagnostic categories, and greater than 52% women in four diagnostic categories (P < 0.001). Admissions following cardiovascular surgery accounted for over half of the total sex imbalance. The percentage of ICU patients who are women increased linearly from 40.8% in 2005 to 43.6% in 2018 (R2 = 93.1%; P < 0.001). Compared with admission in 2005, the adjusted odds ratio for female admission in 2018 was 1.03 (99% CI, 1.01–1.06). Conclusion: There is a significant sex imbalance in ICU admissions in Australia and New Zealand, widespread across the diagnostic categories. Cardiovascular admissions contribute most to the observed preponderance of men. The proportion of female ICU patients is steadily increasing.

OBJECTIVES: Most children in the United States receive treatment in community hospitals, but descriptions of clinical practice patterns in pediatric care in this setting are lacking. Our objectives were to compare clinical practice patterns primarily between community and university-affiliated hospitals and secondarily by number of pediatric beds before and during participation in a national practice standardization project. METHODS: We performed a retrospective secondary analysis on data from 126 hospitals that participated in the American Academy of Pediatrics’ Value in Inpatient Pediatrics Reducing Excessive Variability in the Infant Sepsis Evaluation project, a national quality improvement project conducted to improve care for well-appearing febrile infants aged 7 to 60 days. Four use measures were compared by hospital type and by number of non-ICU pediatric beds. RESULTS: There were no differences between community and university-affiliated hospitals in the odds of hospital admission, average length of stay, or odds of cerebrospinal fluid culture. The odds of chest radiograph at community hospitals were higher only during the baseline period. There were no differences by number of pediatric beds in odds of admission or average length of stay. For hospitals with ≤30 pediatric beds, the odds of chest radiograph were higher and the odds of cerebrospinal fluid culture were lower compared with hospitals >50 beds during both study periods. CONCLUSIONS: In many key aspects, care for febrile infants does not differ between community and university-affiliated hospitals. Clinical practice may differ more by number of pediatric beds.

Background: Few studies have shown that smokers are more likely than nonsmokers to contract COVID-19, while others report that smokers are underrepresented among those requiring hospital treatment for this illness. This study was designed and implemented for investigating the severity and outcome of COVID-19 based on underlying smoking status. Materials and Methods: This was a case–control study that was implemented in Tehran and Ahvaz with all COVID-19 patients from February to July 2020. Patients were divided into two groups of COVID-19 positive (1044 cases) and negative (1231 controls) randomly based on entrance number. Results: The frequency of smokers in the case group is significantly lower than the control group (15.4% vs. 28%). However, the number of days of hospitalization and the use of more than 3 medications in the group of smokers were significantly higher. A comparison between groups of case and control based on smoking indicates that the death rate was significantly higher in smokers with COVID-19. Conclusions: The results of this study showed that although the number of smokers in COVID-19 patients is significantly lower, smokers run an aggresive curse and have higher mortality.

Paramedics were only given the essentials to deal with influenza vaccination. On the other hand, 67.6 percent of them were actually vaccinated. To reduce the spread of the virus, healthcare providers should work hard to immunize the population around us at any given time. There has been a lot of study into flu, and the general consensus is that it is a type of acute respiratory illness. Influenza is a very contagious and transmissible viral disease that can cause very severe symptoms. This was designed to determine those parents who smoke, how aware they are about the flu symptoms, and how they deal with them. This survey is a part of a study that was conducted by us of healthy male paramedics. When they were given an online questionnaire that included eight questions, all the participants found the questions to be very straightforward. As a result of this survey, we will know exactly what the Saudi parents really know about disease prevention and treatments. The purpose of the study is to find out if the paramedics of Saudi Hospitals would like to be vaccinated against seasonal influenza. The paper uses the word "seriously" to talk about the importance of vaccination (which is an interesting word choice). This research was conducted on a sample of 222 healthy male paramedics assessed by the use of an online questionnaire, along with a personal rating of beliefs regarding influenza vaccination and the status of self-reported vaccination. The paper also identifies the reasons why the people in question are not being vaccinated and the outcomes. By conducting a percentage analysis by reviewing the questionnaire results, it was found that the paramedics were very unaware of the importance of and effectiveness of the Hepatitis B Vaccination. According to what the paramedics found, the vaccine wasn't available in the hospitals, so they couldn't administer it, either.

Changes in how we deal with serious coronavirus infections are helping more people survive. Carrie Arnold reports on what is now the gold-standard hospital treatment

Objective: The goal of this research was to examine how hospital type influences emergency department (ED) utilization within 30 days after benign gynecologic surgery. Materials and Methods: This w...

The aim of this study was to assess whether home phototherapy was feasible and safe in a cohort of otherwise healthy term-born neonates who fulfilled the criteria for in-hospital phototherapy. This was a randomized controlled trial in which term newborns with a total serum bilirubin of 18–24 mg/dL (300–400 μmol) were randomized to either home phototherapy or conventional in-hospital phototherapy. The primary outcome measurements were safety and efficacy, length of stay and the number of failed treatments. The secondary outcomes were the number of blood samples and weight gain during treatment. One hundred forty-seven patients were recruited, 69 patients randomized to conventional phototherapy and 78 to home phototherapy. The results showed that no patients needed blood exchange and only 4% of the patients allocated to home phototherapy were admitted to the hospital. The duration of phototherapy, length of stay, amount of blood tests and weight change showed no statically significant differences.Conclusion: Home phototherapy could be a safe alternative to inpatient phototherapy for otherwise healthy newborns with hyperbilirubinemia if daily checkups and 24/7 telephone support can be provided. The parents should be informed to contact the hospital immediately if they fail to perform the treatment at home.Trial registration:Clinicaltrials.govNCT03536078What is Known:• Phototherapy in the hospital is a safe and effective treatment without major side effects.• Fibre optic equipment has made the choice of home phototherapy possible.What is New:• This is the first randomized controlled trial comparing home phototherapy with hospital phototherapy.• Results indicate that home phototherapy could be considered as a safe and feasible alternative when performed according to instructions given, to hospital treatment for otherwise healthy term newborns.

Objectives To review the current evidence on the relationship between three proposed mediators (comorbidities, hospital type, and treatment delays) for the relationship between socioeconomic status (SES) and bladder cancer survival. Materials and methods Six different searches using OVID (Medline and Embase) were carried out to collate information available between the proposed mediators with both SES and survival in bladder cancer. This systematic review was conducted according to a pre‐defined protocol and in line with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results A total of 49 studies were included in the review across the six searches (one appeared in two searches). There was a wealth of studies investigating the relationship between each of the proposed mediators with survival in bladder cancer patients. In general, a higher SES, lower comorbidities, and a larger hospital volume were all found to be associated with a decreased risk of death in bladder cancer patients. There was, however, a paucity of studies investigating the associations between these mediators and SES in bladder cancer patients. Conclusions To gain a deeper understanding of the relationship between SES and survival identified in several observational studies, further investigations into the relationship between the proposed mediators and SES are warranted. Moreover, modifiable mediators, eg, treatment delay, highlight the importance of the standardization of clinical care across SES groups for all bladder cancer patients.

Introduction Nasal polyps are a multifactorial inflammatory condition of the upper airways. Nasal polyps typically affect middle-aged and elderly patients, average age at diagnosis is 40 to 60, and men are affected more commonly than women. Aim To analyse the reported prevalence of nasal polyps in the Polish population, including demographics and co-morbidities, and to estimate the costs of outpatient and hospital (inpatient) services financed by the National Health Fund. Material and methods Statistical analysis of data extracted from the National Health Fund (NHF) registers for 2008-2018. Results In 2018, the recorded prevalence of nasal polyps in Poland was 52.0/10,000 population (0.52%), amounting to 64.6/10,000 (0.65%) in men and 40.2/10,000 (0.40) in women. Nasal polyps were much more frequent in patients aged 55-59 (98.1/10000) and 75-79 years (98.7/10,000). Among men, the highest prevalence was found in the 75-79 age group (164.3/10,000 population), and among women in the 55-59 age group (75.1/10,000). In 2018, the Polish NHF spent PLN 17.2 million (equivalent to EUR 4.0 million/USD 4.7 million) on health services related to the diagnosis of nasal polyps. Hospital services accounted for 77.4% of the total cost. Conclusions Nasal polyps are more than one and a half times as prevalent in men than in women. The recorded prevalence of nasal polyps increases with age, with the rates peaking in those between 75 and 79 years old, and is more often in urban than rural areas.

Dengue Hemorrhagic Fever (DHF) patients in Indonesia reached 129,650 cases with a death toll of 1,071 people in 2015. DHF puts an economic burden on the community and government. This study aims to determine the difference in real cost tariffs and INA CBG's for DHF in a hospital in Sidoarjo, East Java. This cross-sectional study applied a descriptive design, conducted from January to December 2019. The data in this study consisted of characteristic data and differences in real hospital tariffs and INA CBG tariffs for DHF in the hospital treatment room. 625 hospitalized cases were included in this study. This hospital underwent a deficit (loss) of 30% from the difference between the total INA CBG's package tariffs and the total real hospital tariffs in 2019. There is a negative difference between the real hospital tariffs and the tariffs according to INA CBG's in the treatment of dengue fever in a hospital in Sidoarjo which produces losses for the hospital.

Summary. Objective. Improvement of results of treatment of patients with stomach cancer complicated with perforation. Materials and methods. It was shown the analysis of results of surgical treatment of 19 patients with stomach cancer complicated with perforation, which got the hospital treatment at GI «V. T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine» from 2011 till 2020, aged 18 till 85. All patients randomly divided on 2 groups: the group of control — 9 patients (got the hospital treatment from 2011 till 2015), and the basic group — 10 patients (from 2016 till 2020). Results. The common surgical tactics and operations were used at the group of control. The two-staged active-idividualized surgical tactic, that consist of closure by interrupted sutures at first stage and reconstructive operation at second, was used at the basic group. Radical surgery was performed in 10 (52,6 %) cases; in 9 (47,4 %) cases – palliative and symptomatic. Postoperative complications occurred in 5 patients (26.3 %) and postoperative mortality in 26.3 % (5 patients) cases. Conclusion. There is the rational of using the two-staged surgical tactic. Using of this tactic leads to increasing of quantity of radical operations from 4(21,0 %) at the group of control till 6(31,6 %) at the basic group and leads to decreasing post-operative deaths from 15,8 % till 10,5 % respectively.

Summary. Objective. Improvement of results of treatment of patients with stomach cancer complicated with acute gastric bleeding. Materials and methods. It was shown the analysis of results of surgical treatment of 252 patients with stomach cancer complicated with acute gastric bleeding, which got the hospital treatment at GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine “ from 2010 till 2019, aged 29 till 76. All patients randomly divided on 2 groups: the group of control - 129 patients (got the hospital treatment from 2010 till 2014), and the basic group - 123 patients (from 2015 till 2019). Results. The common surgical tactics and operations were used at the group of control. The two-staged active-idividualized surgical tactic was used at the basic group. Radical surgery was performed in 120 (47.6 %) cases; in 132 (52,4 %) cases – palliative and symptomatic (the 121(48,0 %) cases of it was major abdominal surgery). Postoperative complications occurred in 79 patients (31.1 %) and postoperative mortality in 7.9 % (20 patients) cases. Conclusion. There is the rational of using the two-staged surgical tactic with wide using of minimally invasive procedure for the treatment of patients with stomach cancer complicated with acute gastric bleeding. Using of this tactic leads to increasing of quantity of radical operations from 38(29,2 %) at the group of control till 82(72,8 %) at the basic group and leads to decreasing post-operative deaths from 8,5 % till 7,2 % respectively.

Introduction This study aims to disentangle heterogeneity in the survival of bladder cancer (BC) patients of different socioeconomic status (SES) by identifying potential mediators of the relationship. Methods The Bladder Cancer Database Sweden (BladderBaSe) was used to select patients diagnosed between 1997 and 2014 with Tis/Ta‐T4 disease. The education level was used as a proxy for SES. Accelerated failure time models were used to investigate the association between SES and survival. Mediation analysis was used to investigate potential mediators of the association also accounting for interaction. Results The study included 37 755 patients from the BladderBaSe. Patients diagnosed with both non‐muscle invasive bladder cancer (NMIBC) and muscle‐invasive bladder cancer (MIBC) who had high SES were found to have increased overall and BC‐specific survival, when compared to those with low SES. In the NMIBC patients, Charlson Comorbidity Index was found to mediate this relationship by 10% (percentage of the total effect explained by the mediator) and hospital type by 4%. The time from referral to TURBT was a considerable mediator (14%) in the MIBC patients only. Conclusions Mediation analysis suggests that the association between SES and BC survival can be explained by several factors. The mediators identified were not, however, able to fully explain the theoretical causal pathway between SES and survival, therefore, future studies should also include the investigation of other possible mediators to help explain this relationship further. These results highlight the importance of standardization of clinical care across SES groups., This is the first time a study has aimed to disentangle the heterogeneity in survival outcomes in bladder cancer by identifying any potential mediators of the relationship between SES and survival. These results highlight the importance of standardization of clinical care across SES groups.

DHS with side plate assembly is most commonly used device for fixation of intertrochanteric fractures. It is a non collapsible fixation device, which permits the proximal fragment to collapse or settle on the fixation device seeking its own position of stability. After the patient with intertrochanteric fracture was admitted to hospital all the necessary clinical details were recorded in proforma prepared for this study. After the completion of the hospital treatment patients were discharged and called for follow up at out patient level, at regular intervals for serial clinical and radiological evaluation. All patients were followed up at 2 weeks interval till fracture union, at 12 weeks and at 6 months post operatively. 5 patients failed to attend the first follow up and were lost for further follow up (3 cases of DHS and 2 PFN). At each follow up radiographs of upper femur and hip were taken to assess the fracture union, implant failure and screw cut out. In our series of 30 patients 5 cases were lost for follow up and 2 cases expired due to associated medical problems.

The surgery rooms have an important role in the hospital, so it must be managed properly. The surgery rooms consume 9% of the annual hospital budget. High operational costs caused by the large cost of human resources, medical materials, and other supporting facilities. This study was conducted in a private hospital type C with 181 beds and has four surgery rooms. The number of patients which was operated in X Hospital was very high, and the highest number in July 2019 reached 515 patients. There were a large supply of drugs and medical devices in the surgery rooms. The number of each drug reached hundreds ampoule, and medical devices reached tens and some in the hundreds. The management of pharmaceutical supplies in the surgery rooms was carried out by senior nurse head of surgery rooms. Monitoring logistic by pharmacy officer only done once a month. This made excessive of stock and become expired. The purpose of this study was to analyze the factors that cause the lack of pharmaceutical logistics monitoring in the surgery rooms. Determination the root of the problem was done by using a fishbone diagram through a Focus Group Discussion with the division heads and subdivision heads of X Hospital. Focus Group Discussion is done by asking the participants one by one to find the root of the problem based on five factors (man, material, method, machine, and environment). Obtained 8 root problems then analyzed with 5 why to get the main root problem. Furthermore, determine the biggest problem using the CARL (capability, accessibility, readiness, and leverage) method, with a weighting score between 1-5. The results found that the absence of pharmaceutical logistics monitoring SOP in the surgery rooms was the most contributing factor to the lack of pharmaceutical logistics monitoring in the surgery rooms.

One of the nursing processes is determining nursing diagnoses. The determination of nursing diagnoses is based on the theory used, one of which is Carpenito's theory, which is based on patient responses as a guide in determining nursing diagnoses. This theory is not in line with the current situation. So this theory cannot answer the needs of patients because patients who are hospitalized cannot always respond or complain. Based on these problems, the authors provide instructions for determining nursing diagnoses based on the Abdella Faya theory, which is based on body physiological disorders. The service targets are nurses in the Bangil Hospital treatment room. The problem is resolved in two stages of activity, namely preparation and implementation. Preparation is carried out by conducting research in 2017 to see conditions in the field regarding nurses' procedures for determining nursing diagnoses. Implementation is carried out by the lecture method, namely the technique of determining nursing diagnoses and case exercises as a form of nursing diagnosis determination workshop activities. The results of the training activities show the level of success with an indication of the suitability of the material with the needs of nurses in determining nursing diagnoses, a positive response from the participants and the majority (90% of participants have understood the concept and how to determine nursing diagnoses. Key words: determination, nursing diagnosis, Patient Centered, Bangil general Hospital

Objective:This study examined variability among U.S. hospitals in rates of seclusion and physical restraint, including the effects of hospital type and ownership, as reported on Hospital Compare. B...

Background. According to WHO statistics, injuries are among the main causes of contemporary health problems. Injury statistics have been showing a continuing upward trend over years. This is due to numerous factors, such as technological progress, increased life expectancy, change of lifestyle, growing popularity of sports and changes in working conditions. The structures affected by injuries within the knee joint include the ligaments, menisci, articular cartilage and patellar retinacula, with the most common injuries being those to the ligamentous apparatus and menisci. The main objective of this paper is to determine the number of patients hospitalised due to a primary knee injury. Material and methods. Determination of the number of patients hospitalised due to a primary knee injury was performed using the API Interface of National Health Fund (NFZ) Statistics-Benefits Version 1.0. The process of acquiring information on the number of patients consisted of four stages: preparation of a list of primary diagnoses according to ICD-10 classification, analysis of the ordinances of the President of NFZ concerning the conclusion and implementation of contracts on hospital treatment to select products that could be used to bill hospitalisation of patients with selected types of diagnosis, generating medical data using the API Interface of National Health Fund Statistics–Benefits and analysis of reporting data obtained. Results. According to data reported to NFZ, a total of 101,773 patients were hospitalised due to traumatic knee injuries over the period of three years (2016–2018), which gives an average of ca. 34,000 patients annually. Conclusions. 1. Knee injuries represent a very serious health problem in Poland. 2. Knee injuries most frequently affect the ligaments and menisci. 3. It seems necessary to develop a complete nation-wide database with up-to-date information on injuries in Poland that would enable providers to adapt medical services to the current needs of the patients.

Background: Burn injuries can contribute to physical and psychological problems affecting quality of life (QoL). The QoL is a parameter to assess medical results after treatment. In Indonesia, studies concerning burn patients’ QoL after treatment are still limited. Objective: This study aims to observe correlations between 8 dimensions of QoL after treatment and histories of burn severity, numbers of surgical procedures, and lengths of hospital stay Methods: A cross sectional study was conducted in December 2018. Subject criteria of this study were patients who have experienced burn injuries for the last 2 years and have been treated at dr. Soebandi Hospital Jember. Then all the patients were discharged from the hospital by following medical advice in recovered conditions. They were asked to complete SF-36 questionnaires that consist of 8 dimensions of QoL. Every dimension was correlated with histories of burn severity, numbers of surgical procedure, and lengths of hospital stay. Next, the obtained data were analysed by Pearson and Spearman. Results: 13 subjects or patients were analysed. Most of them (38.5%) were adults in a range of 41 – 50 years old and were male (69.2%). A bivariate analysis found a significant negative correlation between burn severity and QoL in physical functions, bodily pains, and mental health dimensions (p=0.030, p=0.012, p=0.044). A significant negative correlation was also reported between numbers of surgical procedures and QoL in physical role dimensions (p=0.047). Lengths of hospital stay had a significant negative correlation with physical functions and physical role dimensions (p=0.044, p=0.031). Conclusion: This study revealed significant correlations between burn severity, numbers of surgical procedures, length of hospital stay and the various dimensions of QoL. This study also provided data of QoL, so in the future burn centres can identify dimensions of QoL after burn injuries and can improve their burn management and patient care to improve their QoL.

Highlights • Severe COVID-19 illness from infection with SARS-CoV-2 is associated with a high incidence of thromboembolic events. • Major thromboembolic episodes following previous COVID-19 in ambulant patients without risk factors for thrombophilia are not described in the literature. • A unique case of acute cor pulmonale from a saddle pulmonary embolism following previous COVID-19, managed successfully by thrombolysis, is reported here. • The case highlights the importance of planning randomized controlled trials to determine whether prophylactic anticoagulation should be prolonged even in patients with moderately severe COVID-19., Severe coronavirus disease 2019 (COVID-19) is known to be associated with a heightened risk of thromboembolism. However, the risk associated with mild and moderate illness from COVID-19 is unknown, and there is no current recommendation for prophylaxis against thromboembolism in patients after hospital treatment, unless there are established thrombophilic risk factors. We report the case of a 52-year-old woman who presented with massive saddle pulmonary embolism 1 week after initial hospital discharge, which was treated successfully with thrombolysis. This case raises the question of whether extended prophylactic anticoagulation should be considered even in low-risk COVID-19 cases.

Саламаттыкты сактоо үчүн ресурстардын потенциалдуу булактарын издөө каржылоону жакшыртууну талап кылат. Республикалык бюджеттин каражаттары чыгашаларынын негизги булагы болуп калууда. Мамлекеттик кепилдиктер менен медициналык жардамды алуунун реалдуу экономикалык шарттарынын ортосунда ажырым бар. “Милдеттүү медициналык камсыздандыруу системасы”, камсыздандыруунун чыныгы үлгүсү болуп эсептелбейт, анткени ал салык органдары жана Социалдык фонд кызматкерлери тарабынан топтолуучу камсыздандыруу төгүмдөрүн кайра бөлүштүрүү функциясын гана аткарат. Камсыздандырылган бейтап ММК системасынын субъектилеринин мамилелер системасынан тышкары болот. Акылуу медициналык кызмат көрсөтүүлөр саламаттык сактоо бюджетиндеги үлүшү 6%дан ашпайт, төлөмдүн олуттуу бөлүгү «формалдуу эмес төлөмдөрдүн» формасына ээ болот. Стационарларда дарылоо үчүн кошумча төлөө көлөмүн белгилөө принциби негиздүү эмес экенин белгилеп коюу керек.

The purpose of our study was to obtain expert opinions with respect to the barriers, strengths, and strategies related to community-based services for children ages 0 to 3 years who were born with ...

Background: As an anesthesia induced during cesarean section, spinal anesthesia is preferred over general and epidural anesthesia. This study aimed to review the trend of anesthetic methods for cesarean section based on data obtained from the Korean Health Insurance Review and Assessment Service from 2013 to 2018.Methods: The anesthetic methods were analyzed in 753,285 parturients who underwent a cesarean section in Korea from 2013 to 2018. We determined the association between each anesthetic method and hospital type and maternal and fetal factors. We also evaluated whether the anesthetic method was associated with the parturients’ length of hospital stay.Results: General anesthesia, spinal anesthesia, and epidural anesthesia were induced in 28.8%, 47.7%, and 23.6% of parturients from 2013 to 2018, respectively. Trend analyses showed that spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018. The opposite trend applied to general anesthesia, decreasing from 37.1% in 2013 to 22.2% in 2018. The factors that were significantly associated with the anesthetic method were parturient’s parity, emergency condition, gestational age, and fetal weight. The type of hospital, parturient’s age, and multiple birth were also associated with the anesthetic methods. There was a strong association between general anesthesia and hospital stay longer than 7 days.Conclusions: Spinal anesthesia is currently the main anesthetic method used for cesarean delivery, and the rate of spinal anesthesia is gradually increasing in Korea.

Effective case management is central for malaria control, but not all of those affected by malaria have access to prompt, effective treatment. In Kenya, free malaria treatment has been implemented since 2006. However, questions remain regarding effective treatment. We conducted cross-sectional epidemiological and questionnaire surveys in four counties in western Kenya in 2004, 2010, and 2016, and antimalarial availability surveys in 2016. We found a significant decline in self-reported malaria cases and an improvement in knowledge of malaria prevention and treatment since 2004. Parasite prevalence declined significantly from 2004 to 2010; however, it has remained unchanged since then. Artemisinin-based combination therapies (ACTs) and sulfadoxine-pyrimethamine (SP) drugs were widely available everywhere. The proportion of ACT usage increased from none in 2004 to 48% and 69%, respectively, in 2010 and 2016, whereas SP drug usage declined from 88% in 2004 to 39% in 2010 and 27% in 2016. During the 2016 survey, non-intermittent preventive treatment in pregnancy use of SP was common (20.9% of all surveyed individual treatments). In 2004, 27.2% (168/617) of households sought hospital treatment alone, and this number increased to 50.6% in 2016. The key factors affecting treatment-seeking behavior were education level, wealth index, household size, and distance to hospitals. Our results indicated that gaps in malaria case management remain and out-of-policy treatment is still a concern.

Background Current estimates of operative time (OT) for total hip arthroplasty (THA) are reported as the mean OT across all procedures. This method does not reflect variability among surgeons and surgical settings and should not be used to infer individual surgeon work. We hypothesized that this method would underestimate the time it takes individual surgeons to perform THA. Therefore, we compared the mean OT for all THA cases (“overall OT”) with the mean OT for individual surgeons (“individual surgeon OT”) and examined which factors were associated with each. Methods Mean OT was calculated for 3972 primary THA cases (“overall OT”) by 41 surgeons from 2015 to 2018 in a single health system. The mean OT for each surgeon was determined (“individual surgeon OT”), averaged across surgeons, and compared with overall OT. Overall OT and individual surgeon OT were assessed for associations with surgeon-related (adult reconstruction fellowship training, THA volume, years’ experience), hospital-related (hospital type, trainee presence), and patient-related (age, body mass index category, American Society of Anesthesiologists physical status classification) factors (alpha = 0.05). Results Mean individual surgeon OT was significantly longer (106 ± 21 minutes) than overall OT (96 ± 28 minutes) (P = .03), with 73% of individual surgeon OTs being greater than overall OT. Although all surgeon-, hospital-, and patient-related factors were associated with significant differences in overall OT, only hospital type was associated with differences in individual surgeon OT. Conclusion Individual surgeon OT was longer than overall OT for most surgeons and provides a better estimate of surgeon work.

OBJECTIVE To describe uptake of hospital in the home (HIH) by major Australian hospitals and the characteristics of patients and their HIH admissions; to assess change in HIH admission numbers relative to total hospital activity. DESIGN Descriptive, retrospective study of HIH activity, analysing previously collected census data for all multi-day hospital inpatient admissions to included hospitals during the period 1 January 2011 - 31 December 2017. SETTING, PARTICIPANTS Nineteen principal referrer hospital members of the Health Roundtable in Australia. MAIN OUTCOME MEASURES HIH admissions by diagnosis-related group (DRG); patient and admission characteristics. RESULTS 80 167 of 2 185 421 admissions to the 19 hospitals included HIH care, or 3.7% (95% CI, 3.6-3.7%) of all admissions. Median length of stay for admissions including HIH (7.3 days; IQR, 3.1-14 days) was longer than that for those that did not (2.7 days; IQR, 1.6-5.1 days). For HIH admissions, the proportion of men was higher (54.4% v 45.9%), the proportion of patients who died in hospital was lower (0.3% v 1.4%), and re-admission within 28 days was less frequent (2.3% v 3.6%). The 50 DRGs with greatest HIH activity encompassed 65 811 HIH admissions (82.1%), or 8.4% (95% CI, 8.4-8.5%) of all admissions in these DRGs. HIH admission numbers grew more rapidly than non-HIH admissions, but the difference was not statistically significant. CONCLUSIONS HIH care is most frequently provided to patients requiring hospital treatment related to infections, venous thromboembolism, or post-surgical care. Its use could be expanded in clinical areas where it is currently used, and extended to others where it is not. HIH activity is growing. It should be systematically monitored and reported to allow better overview of its use and outcomes.

Burnout in physicians affects personal life, health, commitment to work, and finally patient care. Surgeons in training have been shown to be prone to burnout. The aim of the present study is to characterize the prevalence of burnout among Swiss and Australian surgery residents, as well as to identify individual and system-related predispositions for burnout. All Swiss and Australian surgery residents were contacted to complete an online questionnaire between April and December 2017. Personal and system-related issues were assessed, and the abbreviated version of the Maslach Burnout Inventory, the Brief Resilience Scale, and a shortened version of the Interpersonal Support Evaluation List were included. In Switzerland 237 of 700 (34%) and in Australia 175 of 428 (41%) general surgery residents completed the online questionnaire. Australian residents were older, more experienced, and rather had family. While documented training programs are fewer, regulated weekly work hours are more common in Switzerland. Factors mostly associated with risk of burnout were “barely” or no free time activities and increased working hours per week. Factors inversely correlated with burnout were having children, salary satisfaction, and regulated weekly working hours. Factors not associated with burnout were country, age, gender, work experience, relationship, religion, hospital type, and a documented training program. Reduced free time activities and augmented working hours increase the risk of burnout, whereas having children, salary satisfaction, and regulated weekly working hours decrease the risk of burnout.

The problem of choosing an effective etiotropic treatment for acute respiratory viral infections in young children is one of the urgent in pediatrics. Materials and methods. The article presents data on the mechanism of the combined antiviral and immunomodulating action of the drug recombinant interferon alpha-2b. The results of observation of 80 children aged 3 to 12 months with acute respiratory viral infections of various etiologies are presented. Results. Clinical and laboratory indicators of intoxication that occur during acute respiratory viral infections in children have been identified. It has been shown that the use of rectal suppositories of interferon alpha-2b in the treatment of young children with acute respiratory viral infections causes a rapid relief of the clinical symptoms of the disease and helps to reduce the duration of hospital treatment of patients.

Purpose – This paper investigates the inpatients’ and outpatients’ perception of healthcare quality and aims to reveal if their perceptions differ in terms of hospital type. Services before the treatment, physician services, personal needs-laboratory services and physical environment were used as sub-dimensions of healthcare services. Design/methodology/approach – The research was conducted in Mugla-Turkey, and the data were collected via questionnaires from inpatients and outpatients treated in state, private and university hospitals. Analysis of variance test and t-test were used to analyze the data. Findings – For all dimensions, outpatients’ service quality perceptions of private hospitals are higher than public hospitals and university hospitals except physician services for the latter. Inpatients’ service quality perceptions of private hospitals are higher than public and university hospitals for the sub-dimensions of services before the treatment and personal needs-laboratory services. Besides, inpatients’ service quality perceptions of private hospitals are higher than public hospitals for only dimension of physical environment. Discussion – Service quality perceptions of inpatients’ and outpatients’ are not significantly different for both university and private hospitals. However, for public hospitals, inpatients perceive a higher quality than outpatients for only the dimension of personal needs-laboratory services. In this context, except in spesific services, inpatients and outpatients cannot be seen as separate stakeholders in terms of service quality evaluations.

Minimally invasive surgery (MIS) for colorectal cancer (CRC) is increasingly common; however, uptake has differed by hospital type. It is unknown how these trends have evolved for laparoscopic or robotic approaches in different types of hospitals. This study assesses temporal trends for MIS utilization and examines differences in surgical outcomes by hospital type.The National Cancer Database was queried for patients who underwent CRC surgery between 2010 and 2015. Time-trend analysis of MIS utilization was performed for both approaches by hospital type (community, comprehensive community, integrated network, academic). Multivariate logistic regression models were used to examine MIS utilization, differences in case severity, and surgical outcomes by hospital type, after controlling for patient characteristics.Across all hospital types, community hospitals had the lowest rate of laparoscopic (36.8%) and robotic (3.3%) procedures for CRC (P 0.001). Community hospitals also exhibited a significant lag in adoption rate of robotic surgery (colon = 0.84% versus 1.41%/y; rectum = 2.14% versus 3.88 %/y). Community hospitals performing MIS had worse outcomes, including the most frequent conversions to open (colon = 15.2%; rectal = 17.1%) and highest 90-day mortality (colon = 6%; rectal = 3.2%) (P 0.001). Finally, compared with laparoscopic colon surgery at academic centers, community centers treated lower grade tumors (OR 0.938, P 0.05) with higher 30-day (OR 1.332, P 0.05) and 90-day mortality (OR 1.210, P 0.05).MIS for CRC lags at the community level and experiences worse postoperative outcomes. Future initiatives must focus on understanding and correcting this trend to ensure uniform access to high-quality surgical care.

BACKGROUND:High-cost hospitalizations (HCHs) account for a substantial proportion of pediatric health care expenditures. We aimed to (1) describe the distribution of pediatric HCHs across hospital types caring for children and (2) compare characteristics of pediatric HCHs by hospital type.METHODS:Cross-sectional analysis of all pediatric hospitalizations in the 2012 Kids’ Inpatient Database. HCHs were defined as costs >$40 000 (94th percentile). Hospitals were categorized as children’s, small general, and large general.RESULTS:Approximately 166 000 HCHs were responsible for 50.8% of aggregate hospital costs ($18.1 of $35.7 billion) and were mostly at children’s hospitals (65%). Children with an HCH were largely neonates (45%), had public insurance (50%), and had ≥1 chronic condition (74%). A total of 131 children’s hospitals cared for a median of 559 HCHs per hospital (interquartile range [IQR]: 355–1153) compared to 76 HCHs per hospital (IQR: 32–151) at 397 large general hospitals and 5 HCHs per hospital (IQR: 2–22) at 3581 small general hospitals. The median annual aggregate cost for HCHs was $60 million (IQR: $36–$135) per children’s hospital compared to $6.6 million (IQR: $2–$15) per large general hospital and $300 000 (IQR: $116 000–$1.5 million) per small general hospital. HCHs from children’s hospitals encompassed nearly 5 times as many unique clinical conditions as large general hospitals and >30 times as many as small general hospitals.CONCLUSIONS:Children’s hospitals cared for a disproportionate volume, cost, and diversity of HCHs compared to general hospitals. Future studies should characterize the factors driving cost, resources, and reimbursement practices for HCH to ensure the long-term financial viability of the pediatric health care system.

The experts of the Union of Pediatricians of Russia have developed up-to-date clinical guidelines on management of children with acute bronchiolitis. Around 150 million cases of bronchiolitis (11 cases per 100 infants) are registered annually, 7–13 % of all cases require hospital treatment and 1–3 % require management in intensive care unit. Almost all children of the age under 2 years old (90 %) undergone respiratory syncytial viral infection. In 20 % of them they have bronchiolitis due to various factors. This article covers the issues of epidemiology, pathogenesis, differential diagnostics, treatment based on the principles of evidence in detail.

U radu su, na temelju analize istraživanja koje je pod nazivom Europski zdravstveni potrošački indeks (Euro Health Consumer Index – EHCI) provela renomirana švedska tvrtka Health Consumer Powerhouse, uspoređeni mjerljivi pokazatelji kvalitete i učinkovitosti zdravstvene skrbi u Republici Hrvatskoj s ostalim zemljama Europe. Spomenuta tvrtka svake godine objavljuje novu ediciju EHCI-ja kojom prati kretanja pojedinih pokazatelja ili cjelina pokazatelja u svakoj zemlji. S obzirom na tekovinu Andrije Štampara i njegovih istomišljenika, Hrvatska je u europskim i svjetskim okvirima prepoznata kao pionir postojećega europskog modela primarne zdravstvene zaštite i preventivnih aktivnosti. Zbog nedovoljnih financijskih ulaganja te nesustavnoga pristupa edukaciji populacije, Hrvatska je u spomenutoj analizi najlošije pokazatelje zdravstvene zaštite ostvarila upravo u području preventive. Istaknuti su kao važni i farmakoekonomski učinci ulaganja u prevenciju i primarnu zdravstvenu zaštitu jer je općepoznato kako je jedna kuna uložena u preventivu ekvivalentna iznosu od deset kuna uloženih u kurativu., The key goal of this paper is to compare quality and efficiency indicators of the level of healthcare services in the Republic of Croatia to other EU countries using the ‘Euro Health Consumer Index (EHCI)’ analysis, published by the renowned Swedish company Health Powerhouse. The mentioned company publishes a new edition of the EHCI annually, comparing trends of certain indicators or groups of indicators for each country. Due to the great heritage of Prof. Andrija Štampar and his followers, the Republic of Croatia is well-known in Europe and beyond as a pioneer of today’s model of primary healthcare and preventive activities. Unfortunately, according to the EHCI, after years of insufficient funding and an unsupervised education model, the Croatia shows the worst scores precisely in the indicators related to prevention quality. It is also important to mention that the poor results of prevention-based activities have a strong pharmacoeconomic impact; it is widely known that one kuna invested in prevention and primary healthcare is equivalent to 10 kunas invested in hospital treatment.

Under 60 year olds represent a rapidly growing segment of the cancer population. They often face longer hospital stays, higher treatment intensity, and hospitalization costs. In this background, we aim to assess the impact of the 2009 reforms on the hospital expenses of younger cancer inpatients. Our study sample included 11 791 young and middle age stomach, lung, colorectal, esophageal, and breast cancer inpatients hospitalized during 2013 to 2017. Hospitalization treatment costs of under 60 cancer inpatients increased, but it fell in 2017 under the impact of the health reforms. However, out-of-pocket expenditures rose, which partly reflected the failure of the health insurance scheme to adequately cover cancer inpatient cost, potentially imposing financial hardships on cancer inpatients and their families. To continue to reduce the economic burden of cancer patients, early screening and diagnosis among younger populations and enhanced hospice care integrated with the ongoing primary health care reform are important.

Background Video-Assisted Thoracoscopic Surgery (VATS) has recently occupied a significant place in the surgical treatment of primary pleural empyema (PPE). Patients with anamnesis shorter than 4 weeks have a good chance of being cured only by VATS. As it is not easy to define precisely the beginning of the disease, it is difficult to say strictly to which period VATS method will be successful in PPE treatment. Objective The aim of this study was to determine the efficacy of the VATS method in the surgical treatment of primary pleural empyema. Methods The study included 50 patients with findings appropriate for PPE over a period of three years, in whom the VATS method was applied in the surgical treatment of pleural empyema. Results The established total length of treatment was 13.56 ± 7.98 days and the length of hospital treatment after surgery was 9.90 ± 3.315. The duration of thoracic drainage was 8.06 ± 3.005. Treatment was completed by the primary procedure without additional interventions in 94% of patients. Based on the final outcome, all patients from the clinic were discharged as cured. Conclusion The best time to indicate surgical treatment by using VATS method is history of disease in duration of four weeks Debridement or VATS decortication method is safe and efficient surgical procedure, especially in the first two stages. It is recommended to use this method as the first surgical option for patients in early stages of the disease.

Introduction The aging of modern societies increases the general healthcare burden due to the growing demand for inpatient services, which lack adequate financing. Material and methods Data concerning the costs of 312,250 hospitalizations at University Clinical Hospital in Wrocław, Poland in the years 2012–2015 were analyzed according to the age of the patients: below 65 years and 65 years and older, with subgroups (65–74, 75–84 and 85 years and older). Results The mean length of stay (LOS) differed significantly for patients below 65 years and for patients 65 years old or older (3.5 vs. 4.7 person-days); over the 4 years covered by our data, these increased by 0.4 person-days, mostly among patients 85 years and older (by 0.7 person-days). The mean direct cost of hospitalization differed significantly for patients below 65 years and those 65 years or older (PLN 4,907.12 vs. PLN 6,357.15). The mean cost of laboratory tests and radiologic diagnostics was significantly higher among those in the 65+ group, and the difference had a rising trend. The differences between age groups in cost-related hospitalization characteristics and direct hospitalization costs that have been suggested by the medical literature have also been confirmed in Poland. Conclusions The mean hospitalization costs of patients aged 65 years and older in Poland are higher than for younger patients due to longer LOS and more complex and expensive treatment, especially laboratory and radiologic diagnostics, which is increasingly common in the oldest age groups. This demands an urgent systemic solution, especially in terms of adjusted financing of elderly patients’ hospital treatment.

Background/Aim: Pulmonary embolism (PE) is a diagnostic challenge, particularly in prehospital care. The aim of this study was to determine to what extent the evaluation of D-dimer value helps physicians with differentiation of PE and whether D-dimer values are in correlation with the values of revised Geneva score. Methods: Data have been collected for the patients whose D-dimer has been evaluated at the Emergency Care Department of the City of Banja Luka in 2018. Gender, age, symptoms, working diagnosis and D-dimer value have all been recorded and also the fact whether the patient was referred to hospital treatment or not. For each patient the revised Geneva score was determined. Results: Sixty-eight tests were done in 2018. Out of 68 tests, 41 were negative (60.3 %). D-dimer results helped in making decisions about referring patients to the hospital or not (ch2 = 36.32, p < 0.001). Patients with elevated D-dimer levels, especially where the values were four times higher than the reference ones typically were referred to hospital treatment, whereas 67.5% patients with negative D-dimer results were sent home after giving a treatment and advice. In the elderly patients D-dimer was statistically more positive (F = 10.82, p < 0.001). Values of D-dimer were not significantly different regarding gender (ch2 = 2.19, p = 0.33). According to the results of the revised Geneva score, 5.1 % of patients had high risk of PTE, while moderate and low risk had 47.5 % each. Although it has been found that the values of D-dimer were slightly more elevated at higher values of the revised Geneva score and that the difference was not statistically significant (ch2 = 7.71, p = 0.10). Conclusion: Values of D-dimer considerably helped in differentiation of PE in the Emergency Care Department. D-dimer has a high negative predictive value and should be used to exclude PE diagnosis for patients with low clinical probability of PE.

The data of patients with severe acute pancreatitis (AP) who were treated for the period from 2014 to 2018 were analyzed. Patients who on the second day of intensive therapy experienced intestinal failure syndrome, which made it impossible to conduct early enteral nutrition, nutritional support began with a total parenteral nutrition (TPN). Depending on the type of mixture that was used as nutritional support, the patients were divided into subgroups: subgroup 1 (n = 22) - patients who received three-component mixtures in special TPN bags. Subgroup 2 (n = 20) - patients who received three-component mixtures with a high content of ω-3 fatty acids for TPN. Subgroup 3 (control) - patients (n = 25), in which the TPN consisted of separate modules of carbohydrates, amino acids and fats. It is shown that during severe AP accompanied by increased levels of cortisol in patients subgroups 1, 2 and 3 is 1.8, 1.7 and 1.9 times higher than normal, stress-induced hyperglycemia and hypoalbuminemia from the first day of the disease. Conducting modular TPN did not provide a protein-saving effect against the background of hypercatabolism caused by the course of severe acute pancreatitis. The addition of ω-3 FA in the composition of TPN by three-chamber bags contributed to a more rapid recovery of the level of total blood protein and albumin against the background of the course of severe AP. On the background of the nutritional support by TPN using the three-chambered bags of enriched ω-3 fatty acids, it has been registered normalization of neutrophil-leukocyte index at 7 days by reducing leukocytosis and a significant increase in blood levels of lymphocytes, a faster and more pronounced decrease in blood levels of CRP. It determined that in patients with severe AP 1 and 2 subgroups that received TPN using a three-chambered bags, the total period of hospital treatment (27,5 ± 2,7 days and 22.1 ± 0.8 days, respectively) was significantly less than in patients who underwent TPN using modular systems (35.5 ± 7.7 days) (p 1, 2 = 0.001, p1, 3

To evaluate perioperative outcomes for women with uterine cancer undergoing hysterectomy at rural and public hospitals in New York State.The New York Statewide Planning And Research Cooperative System database was used to identify women with uterine cancer who underwent hysterectomy from 2000 to 2015. Perioperative complications, inpatient mortality, and resource utilization were compared at rural, public and private hospitals. Multilevel mixed effect log-linear models were developed to evaluate the association between hospital type and outcomes of interest. Patient characteristics, hospital and surgeon clustering were accounted for within the model.Over the years studied, there were 193 hospitals that cared for 46,298 women with uterine cancer. Of these, 9.8% were public, 15.0% were rural, and 75.1% were private metropolitan. They cared for 11.0%, 2.2% and 86.8% of patients, respectively. The proportion of patients cared for at rural hospitals decreased significantly from 5.2% in 2000 to 0.6% in 2014 (P.001). There was no change in the volume of patients cared for at public hospitals (11.3 to 10.3%, P.05). In a multivariable model adjusting for patient risk, there were no significant differences in perioperative morbidity, transfusion and length of stay across the three hospital types (P.05). Compared with private hospitals, treatment at a rural hospital was associated with increased inpatient mortality (adjusted risk ratio 4.03, 95% CI 1.02-15.97).In New York State, operative uterine cancer care is shifting away from rural hospitals. Public hospitals have similar risk-adjusted outcomes compared with private metropolitan facilities.

Health-care systems currently face great challenges, including an increasing elderly population. To respond to this problem, a hospital emergency department, three municipalities, and self-employed general practitioners in Denmark decided to collaborate with the aim of reorganizing treatment of elderly acute ill patients. By establishing a small-scale collaborative community and through an action research process, we show, how to jointly explore and develop a new organization design for in-home hospital treatment that enables the health professionals to collaborate in new ways, and at the same time to investigate and improve this cocreation process and codesign of knowledge among multiple different stakeholders.