Economics of implementing an early deterioration detection solution for general care patients at a US hospital

Aim: This study estimates the costs and outcomes pre- versus post-implementation of an early deterioration detection solution (EDDS), which assists in identifying patients at risk of clinical decline. Materials & methods: A retrospective database analysis was conducted to assess average costs per discharge, length of stay (LOS), complications, in-hospital mortality and 30-day all-cause re-admissions pre- versus post-implementation of an EDDS. Results: Average costs per discharge were significantly reduced by 18% (US$16,201 vs $13,304; p = 0.007). Average LOS was also significantly reduced (6 vs 5 days; p = 0.033), driven by a reduction in general care LOS of 1 day (p = 0.042). Complications, in-hospital mortality and 30-day all-cause re-admissions were similar. Conclusion: Costs and LOS were lower after implementation of an EDDS for general care patients.

Spatiotemporal control of femtosecond laser filament-triggered discharge and its application in diagnosing gas flow fields

Precise control of the discharge in space and time is of great significance for better applications of discharge plasma. Here, we used a femtosecond laser filament to trigger and guide a high-voltage DC pulse discharge to achieve spatiotemporal control of the discharge plasma. In space, the discharge plasma is distributed strictly along the channel generated by the femtosecond laser filament. The breakdown voltage threshold is reduced, and the discharge length is extended. In time, the electrical parameters such as the electrode voltage and the electrode gap affect discharge delay time and jitter. By optimizing the parameters, we can achieve sub-nanosecond jitter of the discharge. Based on the spatiotemporal control of the discharge, we applied filament-triggered discharge for one-dimensional composition measurements of the gas flow field. Besides, the technique shows great potential in studying the spatiotemporal evolution of discharge plasma.

Review Article on Evalution of Endometriosis Disorder

Endometriosis may be a unwellness of adolescents and reproductive-aged ladies characterised by the presence of mucosa tissue outside the cavity and normally related to chronic girdle pain and physiological condition. Recent Findings Early age at start, shorter discharge length, and taller height ar related to the next risk of adenomyosis whereas parity, higher body mass index (BMI), and smoking ar related to reduced risk. adenomyosis usually presents as physiological condition or continuing girdle pain despite treatment with analgesics and cyclic oral contraceptive pill pills. pathology is characterised by the presence of mucous membrane tissues outside the female internal reproductive organ. It affects females in their procreative years, and will be associate degree estrogen-dependent condition. The calculable prevalence of adenomyosis within the general population is as high as increased , and is accumulated in females with subfertility. The diagnosing of pathology is typically suspected clinically and confirmed by transvaginal ultrasound or resonance imaging of the pelvis. The gold normal of diagnosing is surgical visual examination of the girdle organs by associate degree experienced physician throughout laparotomy. A positive microscopic anatomy can make sure the diagnosis; but, a negative microscopic anatomy doesn't exclude it. liquid body substance cancer antigen-125 levels is also accumulated in ladies with adenomyosis, however, it's a poor diagnostic tool compared to laparotomy. The management of adenomyosis depends on whether or not the first drawback is pain or subfertility. Keywords: Introduction of Endometriosis, Pathology, Pain Infertility, Diagnosis, Management, Sign, symptoms, Treatment .

Admission Hydration Status and Ischemic Stroke Outcome—Experience from a National Registry of Hospitalized Stroke Patients

Reduced intravascular volume upon ischemic stroke (IS) admission has been associated with in-hospital complications, disability, and reduced survival. We aimed to evaluate the association of the urea-to-creatinine ratio (UCR) with disability or death at discharge, length of stay, in-hospital complications, and mortality during the first year. Using a national registry, we identified hospitalized IS patients without renal failure. Disability or death at discharge, length of stay, in-hospital complications, and mortality during the first year were studied by UCR, and associations between UCR levels and each outcome were assessed adjusting for age, sex, stroke severity, comorbidities, use of statins, and use of diuretics. In total, 2212 patients were included. Levels (median (25–75%)) for the main study variables were: urea 5.16 (3.66–6.83) mmol/L; creatinine 80 (64–92) µmol/L; and UCR 65 (58–74). Levels of UCR were significantly higher in patients with disability or death at discharge (p < 0.0001), those with complications during hospitalization (p = 0.03), those with infection during hospitalization (p = 0.0003), and those dead at 1 year (p < 0.0001). Analysis by UCR quartile showed that rates of disability or death at discharge, infections, complications overall, and death at 1 year in patients with UCR in the 4th quartile were significantly higher than in others. Risk-factor-adjusted analysis by UCR quartiles demonstrated an inconsistent independent association between UCR and disability or death after ischemic stroke. A high 1-year mortality rate was observed in IS patients with elevated UCR, yet this finding was not statistically significant after controlling for risk factors. Our study shows inconsistent associations between hydration status and poor functional status at discharge, and no association with length of stay, in-hospital complications (infectious and overall), and 1-year mortality.

Comparison of outcomes of neurosurgical operations performed before and during the COVID-19 pandemic: a matched cohort study

ObjectiveTo determine how the first wave of the COVID-19 pandemic affected outcomes for all operatively managed neurosurgical patients, not only those positive for SARS-CoV-2.DesignMatched cohort (pairwise method).SettingA single tertiary neurosurgical referral centre at a large UK Major Trauma Centre.ParticipantsDuring the first COVID-19 wave, 231 neurosurgical cases were performed. These cases were matched to cases from 2019. Cases were matched for age (±10 years), primary pathology and surgical procedure. Cases were excluded from analysis if either the age could not be matched to within 10 years, or the primary pathology or procedure was too unique. After exclusions, 191 cases were included in final analysis.Outcome measuresPrimary outcomes were 30-day mortality and postoperative pulmonary complications. Secondary outcomes included Glasgow Outcome Score (GOS) on discharge, length of stay (LoS), operative and anaesthetic times and grade of primary surgeon. An exploratory outcome was the SARS-CoV-2 status of patients.ResultsThere was no significant difference between the pandemic and matched cohorts in 30-day mortality, pulmonary complications, discharge GOS, LoS, operative or anaesthetic times. There was a significant difference in the variation of grade of primary surgeon. Only 2.2% (n=5) of patients had a SARS-CoV-2 positive swab.ConclusionDuring the first UK wave of the COVID-19 pandemic, the mortality, morbidity and functional outcomes of operatively managed neurosurgical patients at University Hospitals Birmingham were not significantly affected compared with normal practice. The grade of primary surgeon was significantly more senior and adds to the growing body of evidence that demonstrates how the pandemic has negatively impacted UK surgical training. Mixing COVID-19 positive, unknown and negative cases did not significantly impact on outcomes and indicates that further research is required to support the implementation of evidence-based surgical pathways, such as COVID-light sites, throughout the next stage of the pandemic.

A study on the effectivness of Guggulu based Karaveera Ksharasutra in comparison with Apamarga Ksharasutra in the management of Shalyaja Nadivrana w.s.r. to Pilonidal Sinus

Shalyaja Nadivrana is of Agantuja Vranabedha. Nidana Panchaka is described in Sushruta Samhita Nidhana and Chikitsa Sthana. Presence of “Shalya” is hindering factor for healing. Management of Nadivrana includes Ksharasutra ligation. Pilonidal sinus is acquired sinus occurring in young hirsute men’s commonly seen at intergluteal cleft caused by hair penetrating the skin resulting in Pilonidal abscess which gradually forms into sinus with presence of “Hair” leading to wound discharge. It is one of the troublesome diseases which doesn’t respond to medical management till hair is evacuated. The current surgical procedures adopted have surgical risk and recurrence as well. Guggulu and Karaveera is abundantly available and can be preserved easily for long time. Hence can be used as substitute to the standard Ksharasutra. The present study “A study on the effectiveness of Guggulu based Karaveera Ksharasutra in comparison with Apamarga Ksharasutra in the management of Shalyaja Nadivrana w.s.r. to Pilonidal Sinus”was conducted in SJIIM hospital Bengaluru with 40 patients randomly allotted into 2 groups namely - Group A and Group B. Assessment was done based on subjective parameters like (pain, discharge) and objective parameters like (length of tract, tenderness). Observation was done before treatment and on every 7th day till tract is completely cut and healed. Assessment of Pain, discharge, length of tract and tenderness in Group-A showed 100%, 100%, 100% and 100% improvement and in Group-B showed 97.92%, 100%, 100% and 100% respectively. UCT in Group-A is 6.58% and Group-B is 9.15%. Overall results of group A and B is 100% and 99.5% respectively. Statistical analysis revealed that the effectiveness of Guggulu based Karaveera Ksharasutra in Shalyaja Nadivrana is as effective as Apamarga Ksharasutra w.s.r. to pilonidal sinus.

Rapid referral for headache management from Emergency Department to Headache Centre: four years data

Background Headache is one of the most common reason for medical consultation to emergency department (ED). Inappropriate use of ED for non-urgent conditions is a problem in terms of crowding emergency facilities, unnecessary testing and treatment, increased medical bills, burden on medical service providers and weaker patient-primary care provider relationships. The aim of this study was to analyzed the different steps of the ED management of patients with headache to detect those deficiencies that can be overcome by a prompt referral to a headache clinic.Methods The study is a retrospective analysis of the electronic medical records (EMRs) of patients discharged from an academic ED between 1 January 2015 and 31 December 2018 and referred to the tertiary level headache centre of the same hospital. We analyzed all the aspects related to the permanence in ED and we also assessed if there was a concordance between ED diagnosis and ours.Results Among our sample of 244 patients, 76.2% were admitted as green tag, 75% underwent a head computed tomography, 19.3% received neurological consultation, 43% did not receive any pharmacological treatment and 62.7% still had headache at discharge. Length in ED stay was associated with the complaint of the first aura ever (p = 0.014) and if patients received consultations (p < 0.001). Concordance analysis shown a significant moderate agreement only for the diagnosis of migraine and only between triage and headache centre.Conclusions The majority of patients who went to the ED complaining of headache received the same therapy regardless of their diagnosis and in many cases the headache had not yet resolved at the time of discharge. Given the several shortcomings of ED management of headaches, a rapid referral to the headache centre is of primary importance to help the patient obtain a definite diagnosis and adequate treatment.

A NEW METHOD OF EPISTAXIS MANAGEMENT USING NASAL GEL: A SINGLE CENTER, RANDOMIZED CLINICAL TRIAL

Objective: Epistaxis is one of the common causes of patients’ referral to the emergency departments. In the majority of cases, epistaxis is managed by traditional methods. We investigated the efficacy of nasal gel (NG) in comparison to anterior nasal packing (ANP) to stop mild-to-moderate anterior nasal bleeding.Methods: In this prospective, randomized clinical trial, patients were divided into two groups of ANP (n=60) and NG (n=40). We determined and compared the efficacy of treatment (bleeding stop time and recurrence), patients’ satisfaction at discharge (length of stay in the hospital, pain during the procedure, and procedural time), and safety (less side effects) in both groups.Results: The procedural time ≤2 min was observed in 90% and 58.33 % of NG group and ANP group, respectively (p<0.001). Pain score during procedure ≤4 and patients’ satisfaction ≥7 were, respectively, seen in 87.5% and 65% of NG group, but it was 43.33% and 41.7% in ANP group, respectively (p<0.001, p=0.02). The side effects in ANP group were 35%; however, no side effects were observed in NG group.Conclusion: In the management of mild-to-moderate anterior nasal bleeding although NG efficacy is equivalent to ANP, using NG may be more convenient and satisfactory for patients. In addition, the use of this gel may result in more safety and fewer side effects.