scholarly journals Ban Bedcentricity: a Multifaceted Innovation to Reduce Sedentary Behavior of Patients During the Hospital Stay

2021 ◽  
Author(s):  
Niek Koenders ◽  
Sandra Potkamp-Kloppers ◽  
Yvonne Geurts ◽  
Reinier Akkermans ◽  
Maria W G Nijhuis-van der Sanden ◽  
...  

Abstract Objective The purpose of this study was to explore differences in sedentary behavior, length of hospital stay, and discharge destination of patients before and after the Ban Bedcentricity implementation at ward-level. Methods The Ban Bedcentricity innovation and implementation procedure were implemented at the cardiothoracic surgery, cardiology, and orthopedics-traumatology wards. Sedentary behavior data were collected 2 weeks before and after the implementation using behavioral observations and analyzed with Pearson’s chi-square. Length of hospital stay and discharge destination data were collected from all admitted patients and analyzed with multiple and logistic regression analyses. Results Behavioral observations showed that in 52% of the observations patients were lying in bed before implementation and 40% after implementation at the cardiothoracic surgery, 64% and 46% at the cardiology, and 53% and 57% at the orthopedics-traumatology wards. The mean length of hospital stay after implementation (compared to before implementation) was 5.1 days at the cardiothoracic surgery (n = 1923; mean + +0.13 days; 95%CI = −0.32 to +0.60), 2.6 days at the cardiology (n = 2646; mean = −0.22 days; 95%CI = −0.29 to −0.14), and 2.4 days at the Orthopedics-Traumatology wards (n = 1598; mean = +0.28 days = 95%CI = +0.06 to +0.50). After the implementation, more patients were discharged home from the cardiothoracic surgery (odds ratio [OR = 1.23]; 95%CI = 1.07 to 1.37) and cardiology wards (OR = 1.37; 95%CI = 1.22 to 1.49), and no statistically significant difference was found at the orthopedics-traumatology ward (OR = 1.09; 95%CI = 0.88 to 1.27). Conclusions The outcomes indicate beneficial outcomes after the implementation with less sedentary behavior and proportionately more patients being discharged home, compared to before the implementation. However, little information is available about the adoption and fidelity of Ban Bedcentricity, therefore, outcomes should be interpreted with caution. Impact This multifaceted innovation to reduce sedentary behavior of patients during the hospital stay seems to be promising, with outcomes indicating less sedentary behavior in patients and more patients being discharged home after the implementation.

2021 ◽  
Vol 55 (9) ◽  
Author(s):  
Jannie Lyne C. Notarte-Palisbo ◽  
Cindy D. Canceko-Llego

Objective. To compare outcomes of low-birth-weight neonates delivered before and after implementation of intermittent kangaroo mother care (KMC) in terms of duration of hospital stay, mortality rate, and clinical outcome. Methods. This is a retrospective analytical study that included all neonates delivered in a tertiary government hospital with birth weight of less than 2000 grams before and after intermittent KMC implementation from January 2015 to December 2016. Chart review was done for demographics, mortality profile, and length of hospital stay. Chi-square test and Student’s t-test were used to compare mortality rate and length of hospital stay, and odds ratio was used for mortality outcome. Results. A total of 677 low birth weight newborns were reviewed and of these, 276 (79.8%) neonates in group 1 (Pre-intermittent KMC implementation), and 263 (79.4%) neonates in group 2 (Post-intermittent KMC implementation) fulfilled the inclusion criteria. The duration of hospital stay of neonates enrolled in KMC was significantly shorter (p ≤ 0.05). In Groups 1 and 2, 93–94% of neonates were discharged improved with a 5–6% mortality of almost equal distribution. There was no significant difference in mortality between groups 1 and 2 (OR 1.19, 95% CI 0.59, 2.42). Conclusion. There was no significant difference in mortality rate and cause of death pre- and post-intermittent KMC implementation. However, the length of hospital stay among the LBW neonates discharged improved was significantly shortened.


2016 ◽  
Vol 102 (6) ◽  
pp. 516-521 ◽  
Author(s):  
Daniel Cromb ◽  
Chris Carter ◽  
Claire Lemer ◽  
C Ronny Cheung

ObjectivesThis study aims to review whether implementation of increased duration of consultant presence is associated with reduction in length of hospital stay (LoS) in children with an unplanned admission to hospital.Method (design/setting/participants/interventions/outcome measures)An observational before-and-after study of all unplanned general paediatric admissions to a UK hospital between 1 September 2012 and 31 August 2015, comparing LoS and readmission rates before and after implementation of a policy mandating consultant review within 12 hours of unplanned hospital admission.Results5367 inpatient admissions were analysed: 3386 prior to implementation of the policy and 1981 afterwards. There was no significant difference in median LoS between the two groups or in readmission rates at 24 hours, 48 hours or 7 days. However, among children who stayed in hospital for under 24 hours, and those who were discharged with a diagnosis of acute gastroenteritis, consultant review within 12 hours of admission was associated with a shorter LoS—respectively, 16 hours 23 min versus 15 hours 45 min (p=0.01) and 28 hours 46 min versus 19 hours 41 m (p<0.01).ConclusionsIncreased duration of consultant presence was not associated with significant impact on LoS, other than in admissions of brief duration and in gastroenteritis, where diagnosis is based on clinical judgement in the absence of objective diagnostic thresholds. Future studies should focus on whether these results are generalisable across other settings, and other measures of cost-effectiveness of early consultant review, given the major implications on resource and workforce planning of such policies.


Author(s):  
Dr.Randa Mohammed AboBaker

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.


2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.


Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Hüsnü Kamil Limandal ◽  
Mehmet Ali Kayğın ◽  
Servet Ergün ◽  
Taha Özkara ◽  
Mevriye Serpil Diler ◽  
...  

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.


2020 ◽  
Author(s):  
YuJin Chung ◽  
JinHo Beom ◽  
JiEun Lee ◽  
Incheol Park ◽  
Junho Cho

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.


Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4997
Author(s):  
Madelon Dijkstra ◽  
Sanne Nieuwenhuizen ◽  
Robbert S. Puijk ◽  
Florentine E. F. Timmer ◽  
Bart Geboers ◽  
...  

This cohort study aimed to evaluate efficacy, safety, and survival outcomes of neoadjuvant chemotherapy (NAC) followed by repeat local treatment compared to upfront repeat local treatment of recurrent colorectal liver metastases (CRLM). A total of 152 patients with 267 tumors from the prospective Amsterdam Colorectal Liver Met Registry (AmCORE) met the inclusion criteria. Two cohorts of patients with recurrent CRLM were compared: patients who received chemotherapy prior to repeat local treatment (32 patients) versus upfront repeat local treatment (120 patients). Data from May 2002 to December 2020 were collected. Results on the primary endpoint overall survival (OS) and secondary endpoints local tumor progression-free survival (LTPFS) and distant progression-free survival (DPFS) were reviewed using the Kaplan–Meier method. Subsequently, uni- and multivariable Cox proportional hazard regression models, accounting for potential confounders, were estimated. Additionally, subgroup analyses, according to patient, initial and repeat local treatment characteristics, were conducted. Procedure-related complications and length of hospital stay were compared using chi-square test and Fisher’s exact test. The 1-, 3-, and 5-year OS from date of diagnosis of recurrent disease was 98.6%, 72.5%, and 47.7% for both cohorts combined. The crude survival analysis did not reveal a significant difference in OS between the two cohorts (p = 0.834), with 1-, 3-, and 5-year OS of 100.0%, 73.2%, and 57.5% for the NAC group and 98.2%, 72.3%, and 45.3% for the upfront repeat local treatment group, respectively. After adjusting for two confounders, comorbidities (p = 0.010) and primary tumor location (p = 0.023), the corrected HR in multivariable analysis was 0.839 (95% CI, 0.416–1.691; p = 0.624). No differences between the two cohorts were found with regards to LTPFS (HR = 0.662; 95% CI, 0.249–1.756; p = 0.407) and DPFS (HR = 0.798; 95% CI, 0.483–1.318; p = 0.378). No heterogeneous treatment effects were detected in subgroup analyses according to patient, disease, and treatment characteristics. No significant difference was found in periprocedural complications (p = 0.843) and median length of hospital stay (p = 0.600) between the two cohorts. Chemotherapy-related toxicity was reported in 46.7% of patients. Adding NAC prior to repeat local treatment did not improve OS, LTPFS, or DPFS, nor did it affect periprocedural morbidity or length of hospital stay. The results of this comparative assessment do not substantiate the routine use of NAC prior to repeat local treatment of CRLM. Because the exact role of NAC (in different subgroups) remains inconclusive, we are currently designing a phase III randomized controlled trial (RCT), COLLISION RELAPSE trial, directly comparing upfront repeat local treatment (control) to neoadjuvant systemic therapy followed by repeat local treatment (intervention).


2021 ◽  
Vol 5 (11) ◽  
pp. 1030-1036
Author(s):  
Galih Aktama ◽  
Henky Agung Nugroho ◽  
Muhammad David Perdana Putra

The pandemic that began in late 2019, COVID-19, affects all patients, including cancer patients. Patients with cancer that continues to spread and  there is no other effective alternative treatment must undergo surgery so that cancer does not get worse. Given this problem, many health care centers have developed a protocol system in the form of a COVID-19-free surgical route. This study is a retrospective cohort study comparing the incidence of pulmonary complications in patients undergoing elective cancer surgery at dr. Moewardi Surakarta before and during the COVID-19 pandemic. The study sample was adult patients  aged ≥ 18 years which underwent elective surgical procedures with the aim of curative cancer starting before COVID-19 (March 2019-February 2020) until the time the COVID-19 pandemic emerged (March 2020 - February 2021). The data obtained were 768 patients. Of these patients, 384 were classified as having a COVID19-free operation route during the pandemic, and 384 others underwent elective surgery in the pre-pandemic period. Based on the Chi-Square test, a p-value of 0.850 was obtained (P>0.05) which shows that there is significant difference between cases of pulmonary complications in surgical patients before and after the pandemic who were carried out through the COVID-19-free protocol route. In conclusion, there is no significant change in effect of the covid-19 free operation path protocol on the incidence of lung complications in postoperative elective patients at dr. Moewardi Hospital Surakarta, although this patented and mandatory protocol can reduce cancer patients’ morbidity and mortality who undergoing elective surgery during a pandemic.


2021 ◽  
Vol 8 (1) ◽  
pp. 37-42
Author(s):  
Hasan Ghandhari ◽  
◽  
Ebrahim Ameri ◽  
Mohsen Motalebi ◽  
Mohamad-Mahdi Azizi ◽  
...  

Background: Various studies have shown the effects of morbid obesity on the adverse consequences of various surgeries, especially postoperative infections. However, some studies have shown that the complications of spinal surgery in obese and non-obese patients are not significantly different. Objectives: This study investigated and compared the duration of surgery, length of hospital stay, and complications after common spinal surgeries by orthopedic spine fellowship in obese and non-obese patients in a specialized spine center in Iran. Methods: All patients who underwent decompression with or without lumbar fusion were included in this retrospective study. These patients were classified into two groups: non-obese (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2). The data related to type and levels of surgery, 30-day hospital complications, length of hospital stay, rate of postoperative wound infection, blood loss, and need for transfusion were all extracted and compared between the two groups. Results: A total of 148 patients (74%) were in the non-obese group and 52 patients (26%) in the obese group. The number of patients that need packed cells was significantly higher in the obese group (51.8% vs 32.6%) (P=0.01). Otherwise, there were not a significant difference between type of treatment (fusion or only decompression) (P=0.78), interbody fusion (P=0.26), osteotomy (P=0.56), duration of surgery (P=0.25), length of hospital stay (P=0.72), mean amount of blood loss (P=0.09), and postoperative complications (P=0.68) between the two groups. Conclusion: Our results suggest that duration of surgery, length of hospital stay, and postoperative complications are not associated with the BMI of the patients.


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