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Describe the demographic and clinical characteristics of children presenting to the emergency department (ED) for agitation and aggression from school versus other sites.We performed a retrospective cross-sectional study of children 5 to 18 years old who were evaluated in an urban tertiary care pediatric ED with a chief complaint of agitation or aggression. We examined demographics, disposition, and payments for children presenting from school versus other sites. We conducted multivariable logistic regression to identify predictors of referral site (school versus all other sites, school versus home) and discharge status (home versus higher level of psychiatric care).Of the 513 included children, 147 (29%) presented from school. Children were more likely to present from school versus other sites if they were Black (adjusted odds ratio [aOR] 2.26, 95% confidence interval [CI] 1.32, 3.88), Latinx (aOR 2.91, 95% CI 1.42, 5.97), or had special educational needs (aOR 2.55, 95% CI 1.64, 3.97). These associations persisted in the analysis of school versus home referrals. Children presenting from school versus all other sites were more likely to be discharged home (aOR 1.60, 95% CI 1.05, 2.44), although this difference did not persist when comparing school versus only home referral. A total of $154,269 (median $367 per encounter) was paid for school referrals to the ED.Children with agitation and aggression referred from school were more likely to be Black, Latinx, or have special educational needs. Future efforts should identify and address root causes of this disparity to decrease ED referrals, reduce healthcare spending, and address inequities.

Background: Syncope is a common presentation to the emergency department (ED), yet little is known regarding patient mode of arrival. Methods: We identified patients ≥20 years old who presented to the ED with a primary diagnosis of syncope in Alberta and Ontario, Canada, between 2010 and 2016. Outcomes included 30-day in-hospital mortality, ED revisits, and rehospitalizations according to mode of arrival and discharge status. The estimated cost for ambulance use was calculated based on the provincial rates (Alberta CAD$385 and Ontario $240). Results: A total of 271,601 syncope presentations to the ED were identified and 60.7% arrived by ambulance. A total of 76.3% (n = 125,793) of ambulance users and 87.0% of self-presenters (n = 92,845) were discharged from the ED. Regardless of mode of arrival, discharged patients were younger with fewer comorbidities. Compared with ambulance users admitted, those discharged had lower in-hospital mortality (0.2% vs 3.5%, P < 0.001), ED revisits (4.4% vs 10.4%, P < 0.001), and rehospitalizations (3.6% vs 10.7%, P < 0.001). Discharged self-presenters also had significantly lower outcomes (P < 0.001, for each outcome) compared with admitted self-presenters. The estimated cost for ambulance use among patients discharged from the ED was $33,137,735. Conclusion: A majority of syncope patients arrived to the ED by ambulance, and over 3 quarters were directly discharged home. Although discharged patients had a favourable short-term prognosis, they incurred high transportation costs. Strategies aimed at preventing unnecessary ambulance use are needed. Résumé: Contexte: La syncope est une manifestation courante chez les patients qui se présentent au service des urgences; pourtant, on en sait peu sur la façon dont ces patients arrivent à l’hôpital. Méthodologie: Nous avons examiné les dossiers de patients âgés de 20 ans ou plus qui se sont présentés au service des urgences d’hôpitaux de l’Alberta et de l’Ontario, au Canada, et qui ont reçu un diagnostic de syncope entre 2010 et 2016. Les issues évaluées comprenaient la mortalité hospitalière à 30 jours, les nouvelles visites au service des urgences et les réadmissions à l’hôpital en fonction du mode d’arrivée et du statut au moment de la sortie de l’hôpital. Le coût estimatif des services d’ambulance a été calculé à partir des tarifs provinciaux (385 $ en Alberta et 240 $ en Ontario). Résultats: En tout, 271 601 cas de syncope ont été recensés dans les services des urgences; dans 60,7 % des cas, le patient est arrivé en ambulance. Au total, 76,3 % (n = 125 793) des patients arrivés en ambulance et 87,0 % des patients qui se sont présentés d’eux-mêmes (n = 92 845) ont reçu leur congé du service des urgences. Quel que soit leur mode d’arrivée, les patients qui ont reçu leur congé étaient plus jeunes et présentaient moins d’affections concomitantes. Chez les patients arrivés en ambulance, ceux qui ont reçu leur congé ont affiché des résultats inférieurs à ceux qui ont été admis à l’hôpital quant à la mortalité hospitalière (0,2 % vs 3,5 %, p < 0,001), aux nouvelles visites au service des urgences (4,4 % vs 10,4 %, p < 0,001) et aux réadmissions à l’hôpital (3,6 % vs 10,7 %, p < 0,001). Dans le cas des patients qui se sont présentés d’eux-mêmes, l’incidence des issues évaluées était aussi plus faible chez ceux qui ont reçu leur congé (p < 0,001 pour chaque issue) que chez ceux qui ont été admis à l’hôpital. Le coût estimatif du recours aux services d’ambulance par les patients qui ont reçu leur congé du service des urgences se chiffrait à 33 137 735 $. Conclusion: La majorité des patients subissant une syncope sont arrivés au service des urgences en ambulance, et plus des trois quarts ont reçu directement leur congé à la maison. Bien que le pronostic à court terme des patients ayant reçu leur congé du service des urgences ait été favorable, ces patients ont dû payer des frais de transport élevés. Des stratégies visant à prévenir le recours inutile aux services d’ambulance s’imposent.

Introducción: Resaltar aspectos estratégicos del abordaje respiratorio radica en la prevención de factores de riesgo que eviten a gran escala secuelas crónicas ligadas a co-morbi mortalidad siendo este una problemática de Salud Pública en el Ecuador. Objetivos: Determinar los principales factores frecuente que inciden en el riesgo de las áreas de recuperación post quirúrgica. Métodos: La presente investigación de rasgo cuali-cuantitativo, no experimental, espectro transversal, y característica descriptiva, exploratoria con recolección de datos del historial clínico de hospital de referencia público nacional (MSP-HFIB), en instrumento diseñado y evaluado por expertos para posterior procesamiento estadístico, de población y muestra en 133 pacientes intervenidos. Resultados: el procesamiento con pruebas de Chi cuadrado de sus variables con identificación estadística de factores relevantes, como el predominio de casos del género masculino con 70 pacientes conformando el 52,6%, sobre 63 pacientes femeninos que constituye un 47,4%, otra notable relación fue: edad, días de ventilación mecánica/vía aérea artificial, observación al estado de alta médica. Identificó que, en menores edades con diagnóstico e intervención ejecutadas, con soportes y procedimientos críticos durante menor tiempo (Transquirúrgico - 16 horas o menos), aumentó la tendencia que aleja la predisposición de adquirir otras patologías. Conclusiones: Se observó beneficios y proporcionalidad de la aplicación de estrategias continuas y actualizadas en su abordaje, destacando conservar la protección del aspecto neurológico-respiratorio mitigando efectos colaterales modificables, que restringe la proyección de su autonomía y calidad de vida de los pacientes intervenidos. Palabras clave: estrategias, prevención, comorbilidades, respiratorias. AbstractIntroduction: Highlighting strategic aspects of the respiratory approach lies in the prevention of risk factors that avoid chronic sequelae linked to co-morbi mortality on a large scale, this being a Public Health problem in Ecuador. Objective: To determine the main frequent factors that affect the risk of post-surgical recovery areas. Methods: The present investigation is a qualitative-quantitative, non-experimental, transversal spectrum, and descriptive characteristic exploratory. With a data collection of the national public reference hospital (MSP-HFIB). An instrument designed and evaluated by experts for later Statistical, population and sample processing in 133 operated patients. Results: The processing with Chi-square tests of its variables with statistical identification of relevant factors, such as the prevalence of male cases with 70 patients, making up 52.6%, over 63 female patients, which constitutes 47.4%. Another Remarkable relationship was: age, days of mechanical ventilation / artificial airway, observation of medical discharge status, identifying that in younger ages with diagnosis and intervention performed, with supports and critical procedures for a shorter time (Transsurgical - 16 hours or less ), increased the tendency that moves away the predisposition to acquire morbid mortality. Conclusions: Benefits and proportionality of the application of continuous and updated strategies in its approach were observed, highlighting the protection of the neurological-respiratory aspect. Application and monitoring that mitigates modifiable side effects, which restricts the projection of their autonomy and quality of life of the operated patients. Keywords: strategies, prevention, comorbidities, respiratory.

Objective: The neutrophil to lymphocyte ratio (NLR) has been investigated as an indicator of mortality and/or morbidity in many clinical pathologies. However, these studies have mostly been conducted for specific diseases. We investigated whether there is a relationship between the NLR and hospitalization or discharge decisions in the emergency department (ED). Methods: We retrospectively reviewed the medical records of patients admitted to the ED. The NLR values of the patients were calculated, and their demographic characteristics (age and gender) and clinical outcomes were recorded. Results: Of the 1970 patients, 1400 (71.1%) were discharged from the ED, and 570 (28.9%) were hospitalized. The patients who were discharged were younger and had lower NLR values, and this group had a lower female gender ratio (p

BACKGROUND Women have worse stroke outcomes than men, and almost 17% of all stroke cases have symptom onset when admitted to the hospital for a separate condition. OBJECTIVE The aim of this study was to investigate the distinctive factors that impact the activation of an in-hospital stroke code and outcomes in women who have a stroke while admitted to the hospital for a separate condition. METHODS A retrospective observational propensity score study guided by the model for nursing effectiveness was used. RESULTS In-hospital stroke code was activated in 46 of 149 or 30.9% of women and 15 of 149 or 10.1% of women received thrombolytic therapy. Activation of an in-hospital stroke code was significant (P < .001) for women receiving thrombolytic therapy and significant to a home discharge status (P = .014). Age (P < .001), ethnicity (P < .001), common (P ≤ .001) and unique (P = .012) stroke symptoms, stroke risk factors (P < .001), comorbid conditions (P < .001), time last known well (P = .041), and diagnostic imaging (P < .001) were all significantly related to activation of an in-hospital stroke code. CONCLUSIONS Activation of an in-hospital stroke is a key indicator for women to receive thrombolytic therapy and be discharged to home. Younger married women from non-Caucasian ethnic groups and women with stroke risk factors and comorbid conditions are at a greater risk for delayed stroke symptom detection and not having an in-hospital stroke code activated. Awareness of these factors that hinder early stroke detection in women is crucial to improving stroke treatment and outcomes in women.

Aim: Taking out the patient profile that is used inMersin City Education and Research Hospital. Methods: 850 inpatient's file which in the palliative care unitbetween 15.03.2017 and 15.03.2018 were analysed retrospectively. Age, gender,duration of hospital stay, admission diagnosis, nutritional status anddischarge status are analysed. Results:450 of 850 patient attending the research is distributed as %52 female, %47male. The patient staying in the Palliative care unit age avarage is 69.3±17.6,duration of hospital stay 11.2±13.3 days. 242 patient (%28) stayed in thehospital because of malignancy and its complications. 162 of patients (%18)with those diagnosis also have nutrition deficiency and decubitis ulcer. 423 ofthose patient's (%50) nutrition was enteral and parenteral feeding.. 468 (%55)were transferred to another department, 282 (%33) were discharged, 100 (%11)died. Conclusions: Althoughpalliative care units are common all around the world, in Turkey they are newlyfounded. Rising in elderly population and chronic disiases all around the worlis rises palliative unit demands. Therefore patient profile should bedetermined and according to that palliative care units should have necessaryequipment and trained staff., Amaç: Mersin Şehir Eğitim ve Araştırma Hastanesi ErişkinPalyatif Biriminden faydalanan hasta profilini çıkarmak Yöntem: Hastanemiz Palyatif Bakım biriminde 15.03.2017/15.03.2018tarihleri arasında yatan 850 hastanın dosyaları HBYS üzerinden retrospektifolarak incelendi. Hastalara ait yaş, cinsiyet, hastanede kalış süresi, yatıştanısı, beslenme durumu ve taburculuk durumları değerlendirildi. Bulgular: Çalışmaya alınan 850 hastanın450’si %53’si kadın, 400’ü %47’si erkek hasta idi. Palyatif Bakım birimindeyatan hastaların yaş ortalaması 69.3±17.6 olup, hastanede ortalama kalışsüreleri 11.2±13.3 gün olarak belirlendi. Hastaların 242’si (%28) malignite vemaligniteye bağlı komplikasyonlar nedeni ile hastanede yatırıldı. 217 hasta(%25) serebrovasküler hastalıklar ve sekelleri nedeniyle yatırıldı. Butanılarla yatan hastaların 162’sine (%18) beslenme bozukluğu ve yatak yarasıtanıları eşlik etmekteydi. Bu hastaların 423’ünün (%50) beslenmesi enteral veparenteral yolla sağlandı. Hastaların 468’i (%55) başka bir branşa sevkedilirken, 282’si (%33) taburcu edildi, 100 (%11) hasta ex oldu. Sonuç: Dünyada Palyatif bakım birimleriyaygın olmakla birlikte ülkemizde birçok hastanede yeni açılmaktadır. Dünyanınher yerinde yaşlı nüfustaki ve kronik hastalıklardaki artış, palyatif bakımihtiyacını artırmaktadır. Bunun için hasta profilinin belirlenip ona görePalyatif Bakım Birimlerinin gerekli donamıma ve eğitimli personele sahip olmasıgerekmektedir.

Although several prognostic factors for traumatic brain injury (TBI) have been evaluated, a useful predictive scoring model for the outcomes has not been developed for patients with severe TBI who undergo decompressive craniectomy (DC). The aim of the present study was to determine independent predictors and develop a multivariate logistic regression equation to predict the early outcome and discharge status for patients with severe TBI who have undergone DC.A total of 13 different variables were evaluated. The data from all 278 patients with severe TBI who had undergone DC in the present study were retrospectively evaluated from July 2011 to June 2017. Using univariate, multiple logistic regression and prognostic regression scoring equations it was possible to draw receiver operating characteristic curves to predict the early outcomes and discharge status after TBI.We found that younger age (P = 0.012), no significant medical history (P = 0.044), diameter of both pupils4 mm (P = 0.032), higher admission Glasgow coma scale score (P = 0.004), no tracheotomy (P0.001), and DC for severe TBI were associated with a favorable early outcome and discharge status. Using receiver operating characteristic curves to predict the probability of a favorable outcome, the sensitivity was 80.0% and the specificity was 79.5%.Our preliminary findings have shown that 5 variables can be used as independent predictors in assessing the early outcome and discharge status for patients with severe TBI after DC.

To analyze our institutional experience transitioning from overnight observation (OBS) to same day surgery (SDS) for artificial urinary sphincter (AUS) procedures. Prior research has questioned the need for OBS following AUS surgery.We retrospectively reviewed AUS surgeries performed by a single surgeon at our tertiary academic medical center between 08/2013 and 01/2020. Patients were grouped based on discharge status: OBS vs SDS. Cost savings associated with SDS were estimated using room and bed charges from a contemporary group of AUS patients.We identified 525 AUS cases that met inclusion criteria. Men in the SDS group (n = 318) were more likely to have undergone a virgin AUS insertion and were slightly younger and healthier. Men in the OBS group (n = 207) were more likely to suffer an immediate postoperative complication (1% vs 0%, P.01) and to be readmitted within 90 days of surgery (15% vs 5%, P.01). The groups did not vary with respect to multiple other perioperative outcomes measures. Among patients who underwent AUS surgery between 09/2017 and 08/2020, those with OBS status (n = 39) had mean additional room and bed charges of $ 745 ± 302 vs none for SDS patients (n = 183).SDS for AUS insertion is safe, effective, and associated with significant cost savings. Routine overnight observation after AUS insertion appears to be unnecessary.

Background Court-mandated substance use disorder (SUD) treatment, compared to nonmandated treatment, has been associated with increased retention and completion. However, due to limitations of previous studies, whether child protective services (CPS) and criminal justice (CJ) mandated treatment improve treatment completion and retention among women in residential treatment remains unclear. Purpose This study investigated differences in treatment completion and progress based on three clinical discharge outcomes (i.e., completer, noncompleter with significant progress, and noncompleter without significant progress). We hypothesized that women mandated by (1) CJ will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to women who are CPS mandated; (2) CPS will have a better treatment discharge outcome (i.e., treatment completer and noncompleter with satisfactory progress) compared to nonmandated women. Methods Study staff conducted multinomial logistic regression analyses on data for a diverse sample of 161 women mandated or nonmandated (CJ: N = 71, CPS: N = 66, nonmandated: N = 24) into residential SUD treatment to determine each group's clinically defined treatment discharge outcomes while controlling for covariates. Results Multinomial logistic regression analyses revealed that being mandated by the CJ system predicted being a treatment completer compared to those who were CPS mandated (RR = 9.88, p = .009). The study found no differences in discharge status of completer without satisfactory progress between those who were CPS mandated and those who were CJ mandated or nonmandated. For women mandated by the CPS system compared to nonmandated women, the risk of being a treatment completer relative to noncompleters with satisfactory progress was not significant (RR = 1.08, p = .897). Analyses showed that being mandated by the CJ system predicted an improved clinically defined discharge outcome of treatment completer compared to women who were nonmandated to treatment (RR = 10.74, p = .016). In several of the models, drug and alcohol craving was associated with increased odds of being a noncompleter of treatment without satisfactory progress. Conclusions This study demonstrates that improved treatment completion and discharge status cannot be assumed based solely on being mandated by the CJ or CPS systems. As evidenced by variability in treatment discharge outcomes within and among referral groups, the paper suggests directions for future research.

Objective: Diagnosis-related groups (DRGs) are the main mechanism for assessing payments for medical treatment. This study aimed to analyze the determinants of costs for chronic-disease patient visits in a major public hospital.Material and Methods: Hospital cost data available from the hospital database relating to claims made to the Thailand Health Security Office were obtained from a major tertiary hospital for all such patients admitted and discharged in 2016. Linear regression models were created to predict the cost based on several determinants including age and gender, primary diagnosis, number of diagnoses, length of stay, number of procedures, and discharge status.Results: Only length of stay in hospital and number of procedures were significant predictors of the total hospital costs.Conclusion: It thus appears that just a combination of these two factors might be a better measure of the true hospital visit costs for patients with chronic disease than DRGs.

Giriş: Erken Palyatif bakım müdahaleleri ve yapılandırılmış ileri bakım planlaması, beyin tümörü hastalarında semptom kontrolünü ve yaşam kalitesini artırabilir. Bu çalışmada palyatif bakım merkezimizde (PBM) primer ve metastatik beyin tümörü tanısı alan hastaların semptomlarını, çıkış durumlarını ve yatış sürelerini araştırmayı amaçladık.Gereç ve Yöntem: Bu retrospektif çalışmada palyatif bakım servisinde primer ve metastatik beyin tümörü tanısı ile izlenen 91 hasta alındı. Çalışmaya alınan hastaların demografik özellikleri, glaskow koma skalası (GCS), Karnofsky Performans Skalası (KPS), çıkış durumu, hastanede yatış süresi ve semptomları karşılaştırıldı. Bulgular: Hastaların yaş ortalaması 60,67 yıldı, %59,3’ü erkekti ve yatış süreleri ortalama 29,26 gündü. Primer beyin tümörü olan hastalarda PEG, trakeostomi durumu ve nöbet, parezi semptomu oranları anlamlı derecede fazla idi. (p, Introduction: Early palliative care interventions and structured advance care planning can improve symptom control and quality of life in patients with a brain tumor. In this study, we aimed to investigate symptoms, hospital discharge conditions, and the length of stay of patients with primary and metastatic brain tumors in our palliative care center (PCC).Material and Method: Ninety-one patients; who had been followed-up in the PCC with the diagnosis of a primary or metastatic brain tumor were included in this retrospective study. Demographic characteristics, Glasgow Coma Scale (GCS) scores, Karnofsky Performance Scale (KPS) scores, hospital discharge status, and symptoms of the patients included in the study were compared. Results: The mean age of the patients was 60.67 years; 59.3% were male, and the mean length of hospital stay was 29.26 days. The rates of PEG, tracheostomy, seizures, and paresis symptoms were significantly higher in patients with a primary brain tumor (p

We aimed to clarify usefulness of the modified Frailty Index 11 (mFI-11) for assessing risk of postoperative complications (POCs) and effectiveness of perioperative management team (POMT) intervention for improving postoperative status of frail aged patients requiring colorectal cancer (CRC) surgery.We compared, retrospectively, surgical outcomes among 151 consecutive CRC surgery patients aged ≥80 years. Patients were grouped by mFI-11 scores and by POMT intervention (vs. no POMT intervention).POCs were more prevalent, postoperative stays were longer, and discharge status was poorer among high-risk (mFI-11 ≥ 3/11) patients without POMT intervention than among low-risk (mFI-11 ≤ 2/11) patients (p = 0.04, p = 0.02, p 0.01). Multiple POCs occurred less frequently and performance of activities of daily living was better for high-risk patients with (vs. those without) POMT intervention (p = 0.04, p = 0.03).POMT intervention appears beneficial for frail aged patients scheduled for CRC surgery.

Objective: Covid19 has emerged as a greatest threat of the decade worldwide. At present there is no certain treatment for treating coronavirus diseases, while some antiviral drugs (Remdesivir , Lopinavir and Ritonavir) are under investigation. Many countries including India have adopted the convalescent plasma therapy in the treatment of moderate to severely ill patients. Despite the treatment being given ,there are no such evidences on the utility and efficacy of convalescent plasma. Hence this study tries to find out the impact on the discharge status from hospital of the patients receiving the very therapy. Design: Systematic review and meta analysis. Setting: An extensive search was made, following PRISMA guidelines on online databases such as Pubmed, Google scholar and Science direct. Studies those fulfilled the inclusion and exclusion criteria ,were included and reviewed and analyzed for a common outcome(discharge status). Participants: A total of 6 eligible studies were analyzed qualitatively and quantitatively which included three case control, two case series and one case report. Results: The overall pooled discharge rate from the above studies was 75.7% after the CP therapy. When analyzed for relative risk , it showed CP therapy having a lower risk of staying in hospital (not getting discharged) when compared to Standard therapy ,overall RR (relative risk) being 0.946. Conclusion: Our study shows that there is always a higher rate of discharge and low risk of prolonged hospital stay in those patients who receive plasma therapy. CP therapy being a low cost and easy to administer therapy with very less adverse events, requires more focus on further research as it has a potential to become an ideal effective treatment option for COVID-19.

Highlights • Most elderly cancer patients (>75%) require healthcare facility support after skeletal-related event-related hospitalization, with substantial associated costs. • The largest proportion of bone metastases patients were discharged to skilled nursing facilities (SNF) (32.9%), then home health agency (HHA) (13.7%), hospice (13.5%), and long-term care (LTC) (11.3%). • The largest proportion of multiple myeloma (MM) patients were discharged to SNF (35.9%), then HHA (18.2%), hospice (7.2%), and LTC (1.5%). • Mean Medicare cost per patient per facility stay was < $10,000 for hospice, and from $15,517 for LTC nursing home to $49,729 for LTC hospital for MM patients., Background Previous studies have quantified direct inpatient costs of skeletal-related events (SREs); however, costs associated with subsequent post-SRE care have not been examined. Methods We identified two study cohorts using 2011–2015 Medicare 20% sample data: patients diagnosed with 1) bone metastases from solid tumors or 2) multiple myeloma (MM), both with SRE-related hospitalization discharge dates January 1, 2011-September 30, 2015. We assessed discharge status and costs from discharge to the earliest of death, end of Medicare enrollment, or December 31, 2015. Discharge status was defined as: skilled nursing facility (SNF), rehabilitation facility, hospice, home health agency (HHA), long-term care (LTC) nursing home, LTC hospital, or rehospitalization within or after 30 days. Percentage, stay duration, and Medicare costs were calculated for each setting. All analyses were descriptive. Results We identified 7988 bone metastases patients and 4277 MM patients discharged from index SRE-related hospitalizations; corresponding mean ages were 76.9 and 76.6 years. The largest proportion of bone metastases patients were discharged to SNF (32.9%), then HHA (13.7%), hospice (13.5%), and LTC (11.3%); the pattern was similar for MM patients (SNF, 35.9%; HHA, 18.2%; hospice, 7.2%; LTC, 1.5%). Almost 10% of patients in both cohorts were re-hospitalized within 30 days. Mean Medicare cost per patient per facility stay was < $10,000 for hospice, and from $15,517 for LTC nursing home to $49,729 for LTC hospital for MM patients. Conclusion Most elderly cancer patients (>75%) require healthcare facility support after SRE-related hospitalization, with substantial associated costs. Post-discharge management is clinically and economically important.

Frailty has been associated with poor postoperative outcomes. This study evaluated the 5-factor modified frailty index (mFI-5) to assess complications, mortality, discharge disposition, and readmission in patients undergoing lower extremity (LE) bypass for critical limb ischemia (CLI).The National Surgical Quality Improvement Program vascular module (2011-2017) was utilized to identify patients undergoing LE bypass for CLI. Adverse events included infectious complications, bleeding complications, prolonged ventilation, amputation, readmission, and death. Patients were divided into groups based on mFI-5 scores: mFI1 (0), mFI2 (0.2), mFI3 (0.4), and mFI4 (0.6-1). Data were analyzed using the Cochran-Mantel-Haenszel statistic for general association and multivariable logistic regression. About 11,530 patients undergoing bypass for CLI were identified (42% rest pain and 58% tissue loss; 23% mFI1, 31% mFI2, 27% mFI3, and 19% mFI4; 64% men and 36% women). An increase in mFI-5 was associated with higher 30-day mortality (mFI1 = 0.62%; mFI12 = 1.45%; mFI13 = 1.35%; and mFI14 = 3.09%; P .0001). After adjustment for age, mFI4 was associated with increased mortality compared with mFI1 (odds ratio, 3.80; 95% confidence interval, 1.69-8.54). Increased mFI-5 was associated with bleeding complications, wound infections, urinary tract infections, prolonged ventilation, sepsis, unplanned reoperations, and discharge to nonhome destination (all P .01). Compared with mFI1 (13.5%), mFI4 was associated with increased 30-day readmission (24.8%, P .0001). In patients undergoing LE bypass for CLI, higher mFI-5 was associated with increased postoperative complications, in-hospital and 30-day mortality, nonhome discharge, and 30-day readmission. The mFI-5 as an easily calculated tool can identify patients at high risk for inferior outcomes. It should be incorporated into discharge planning after LE bypass for CLI.

This study evaluated the impact of length of stay reduction by discharge status in the hospitals of Syracuse, New York. It focused on the two largest inpatient services, adult medicine and adult surgery, between 2008 and 2018. In the Syracuse hospitals, the adult medicine mean length of stay declined by 0.12 days, resulting in a savings of 14,154 patient days during the ten year period. The adult surgery mean stays declined by 0.91 days, resulting in a savings of 22,639 patient days. The reductions in stays were accompanied by differences in utilization by discharge status. For discharges to self care, the changes in mean stays increased the number of days saved for adult medicine from 5111 to 13,264 and the number of days saved for adult surgery from 4355 to 13,862. These changes were brought about through internal efficiencies within the hospitals. For discharges to nursing homes, the reductions in stays caused the number of excess days to decline from 13,631 to 8695 for adult medicine and from 9150 to 5075 for adult surgery. These changes were brought about through cooperative efforts with long term care providers in the community.

Patients who are discharged home following primary hip and knee arthroplasty have lower associated costs and better outcomes than patients who are discharged to skilled nursing facilities (SNFs). However, patients who live alone are more likely to be discharged to an SNF. We studied the factors that determine the discharge destination for patients who live alone after total joint arthroplasty (TJA) at an urban tertiary care academic hospital between April 2016 and April 2017. We identified 127 patients who lived alone: 79 (62.2%) were sent home, and 48 (37.8%) were sent to an SNF after surgery. Patients who went home versus to an SNF differed in age, employment status, exercise/active status, patient expectation of discharge to an SNF, ASA score, and the length of stay. After controlling for expectations of discharge to an SNF (OR: 28.98), patients who were younger (OR: 0.03) and employed (OR: 6.91) were more likely to be discharged home. In conclusion, the expectation of discharge location was the strongest predictor of discharge to an SNF even after controlling for age and employment. Future research should include a multi-hospital approach to strengthen the validity of our findings and investigate additional factors that impact discharge destination.

Aims: Post-surgical pain experienced by patients undergoing total knee arthroplasty (TKA) can be severe. Enhanced recovery after surgery programs incorporating multimodal analgesic regimens have ev...

Little is known about over 125,000 veterans who received non-honorable military discharges since 2001, even though these veterans face substantial barriers to obtaining services and are likely to be at high risk for negative mental and behavioral health outcomes including suicide. Seven-hundred twenty-two veterans living the in the San Francisco Bay Area participated in the study. The sample comprised honorably discharged (n = 508) and non-honorably discharged veterans (n = 214). T-tests were used to compare means on predictors of suicide risk including Posttraumatic Stress Disorder (PTSD), depression, alcohol use, somatic symptoms, and physical disability. A series of regression models tested relationships between predictors, discharge status, and suicide risk. Non-honorably discharged veterans demonstrated higher mean scores than honorably discharged veterans on all predictors. In regression models, somatic symptoms (β = 0.22, p

Electrical discharge machining (EDM) has been recommended as the most effective way to produce an integral shrouded blisk, whereas its low machining efficiency cannot meet the batch production requirements of this component. An electrode feeding method with perturbations in the EDM process of the integral shrouded blisk is proposed, in which extra perturbations are periodically added on the original feeding path. Those perturbations are perpendicular to the original feeding path and are determined by two parameters: separation distance and perturbation factor. The optimal perturbation parameters for blisk EDM machining are experimented to be a separation distance of 2.5 mm combined with a perturbation factor of 30%. Compared with the electrode feeding method without perturbations, that with perturbations had a better discharge status. A machining time reduction of 18.45% was achieved in the EDM process of a real integral shrouded blisk by using the electrode feeding method with perturbations.

Objectives The number of transsphenoidal adenohypophysectomies (TSAs) surgeries has grown significantly since 1993. While there has been an overall decreasing trend in length of stay (LOS), socioeconomic factors may impact hospitalization. This study explores the impact of socioeconomic factors on LOS and total charges in uncomplicated patients undergoing TSA. Design Retrospective cohort. Setting 2009 to 2013 Nationwide Inpatient Sample. Participants Patients undergoing TSA without medical complications. Main Outcomes Measures LOS and total charges. Results A total of 6,457 patients were identified, of which 17.2% had secreting tumors. Patients with secreting tumors stayed 2.95 days versus those with nonsecreting tumors stayed 3.26 days (p Conclusions These results demonstrate that, even without complications, patients can be delayed in their discharge. While several socioeconomic factors significantly predict LOS and charges, the discharge disposition ultimately has the greatest effect. This suggests that efforts should focus on improving organizational factors such as coordination with social work and outside facilities to decrease LOS and charges for this patient population.

Antibiotics are one of the most widely used drugs in curing various kinds of infectious diseases. The use ofantibiotics, especially in chronic renal failure, need to be considered because it can cause nephrotoxicityin kidneys. The purpose of this study was to evaluate the rational use of antibiotics in RSUP Dr. SoeradjiTirtonegoro in cases of chronic renal failure in 2014. The evaluation includes the right indication, theright drug, right patient, and proper dosage. This research is conducted in a manner that is based on aretrospective medical record belongs to chronic renal failure patients on inpatient RSUP Dr. TirtonegoroKlaten 2014. The search results obtained from medical records and evaluation results indicated the useof appropriate antibiotics as many as 20 cases (55.56%), patients with chronic renal failure who meet theappropriate criteria are 39 cases (97.7%), use of the right type of antibiotics drugs there were 13 cases(29,5%), and to use appropriate antibiotics doses were 21 cases (47.7%). Discharge status of patientswith a total of 36 cases (100%) with result of the patient’s health improved. From the result of arithmeticleukocytes figure, there are 33 cases ( 91.67 % ) with leukocytes count back to normal.