Gender diversity and healthcare performance: A quantitative analysis from the Italian health system.

Unlike many other industries, which are characterized by a more significant presence of men than women, the healthcare sector has a clear majority of women. However, even if at the non-executive level, the percentage of women is extremely higher than that of men, at the executive level, this percentage is completely overturned, generating the so-called glass ceiling effect. Despite extensive research on gender diversity and its impact on financial metrics, few studies have focused on clinical measures. To bridge this research gap, the article analyzes the relationship between gender diversity and healthcare metrics. We developed an econometric model for unbalanced panel data by performing a random effect and a quantile regression analysis, which test the relationship between gender diversity and the average length of stay (LOS), controlling for structural and clinical metrics. We find that, in general, a higher percentage of women in non-executive positions is related to an increase in LOS. Conversely, a higher rate of women in executive positions is related to a lower level of LOS. Empirical evidence supports the relevance of including human resources strategies to increase the number of women at executive managerial positions. However, the study highlights also the necessity to consider how to make the public health sector positions more appealing for men.

[Dermatoses of elderly inpatients in Casablanca: epidemiology and factors associated with length of stay]. / Dermatoses du sujet âgé en hospitalisation à Casablanca : épidémiologie et facteurs associés à la durée de séjour.

Geriatric in-patient dermatoses are diverse. Few data in Morocco describe the epidemiological profile and factors associated with average length of stay (LOS). Our aim was to identify these dermatoses and determine the factors associated with LOS.

Effects of early rehabilitation on enhanced recovery after caesarean section.

The objective of this study was to evaluate the impact of improved rehabilitation on the average length of stay after a scheduled caesarean section under neuraxial anaesthesia, it is a descriptive, monocentric study with prospective recruitment. Our protocol was based on neuraxial anaesthesia with intrathecal morphine, multimodal analgesia, with oral analgesics postoperatively, prevention of postoperative nausea and vomiting (PONV), rapid demedicalization, refeeding and mobilisation. We included 99 patients. The mean length of stay (LOS) for the current caesarean section was 1.97 days versus a LOS for previous caesareans of 4.14 days. On the day of discharge, the mean satisfaction with overall management was 8.97+/-1.35. At six weeks, 92.6% wanted to have the same protocol for a future caesarean. Early rehabilitation after caesarean section is quite applicable to the Algerian context. It offers a quick functional recovery with patient satisfaction, as well as a reduction of the length of stay.

L'objectif de ce travail est d'évaluer l'impact de la réhabilitation améliorée sur la durée moyenne de séjour après une césarienne programmée sous anesthésie neuraxiale. C'est une étude descriptive, monocentrique, avec recrutement prospectif. Notre protocole a reposé sur une anesthésie neuraxiale avec morphine intrathécale, une analgésie multimodale, avec des antalgiques par voie orale en postopératoire, une prévention des nausées vomissements postopératoires, une démédicalisation rapide, une réalimentation et une mobilisation rapide. Nous avons inclus 99 patientes. La durée moyenne de séjour (DMS) de la césarienne actuelle était de 1.97 jours vs une DMS des césariennes antérieures de 4.14 jours. Le jour de sortie de l'hôpital, la moyenne de satisfaction de la prise en charge globale était de 8.97+/-1.35. A six semaines, 92.6 % souhaitaient, avoir le même protocole lors d'une prochaine césarienne. La réhabilitation précoce après césarienne est tout à fait applicable au contexte Algérien, elle offre une récupération fonctionnelle rapide avec une satisfaction des patientes, ainsi qu'une réduction de la durée de séjour.

[The hospital substitution form of home medical care of population of Tte Russian Federation: the analysis of functioning].

The important direction of the National Project "Health Care" are improvement of primary health care system, including introduction of hospital-replacing technologies.The purpose of the study is to evaluate functioning of hospital-substituting form of home medical care (home hospitals) to population of the Russian Federation in 2006-2020.The normative legal documents regulating activities of stationary-substituting form of home medical care (home hospitals) for adults and children, reporting forms of sectoral statistical observation № 14ds for 2006-2018 were analyzed. In 2019-2020, unified data on functioning of day hospitals and home hospitals and composition of patients treated there of medical organizations providing medical care on out-patient basis was filled in form № 14ds. The in-depth analysis permitted to extract information about activities of home hospitals for adults and children and to study their functioning in dynamics for 15 years. The content analysis, statistical and analytical methods were applied.The examination of data for 2006-2020 established increasing of number of treated adult patients in home hospitals up to 27.9% and children up to 15.0%.The distribution of the number of treated adults and children in hospitals at home per 1000 of the corresponding population by subjects indicates their significant fluctuation.For 15 years, it has been established that in the structure of treated adult patients, the proportion of people with diseases of the circulatory system has decreased from 62.2 to 31.5%, the musculoskeletal system and connective tissue - from 11.7 to 7.4%; in children - with respiratory diseases from 81.9 to 63.4%, some infectious and parasitic diseases - from 7.7 to 3.0%, diseases of the digestive system - from 3.6 to 3.2%.In the country for 2019-2020 in hospitals at home, the number of treated adults significantly increased by 1.8 times, children - by 2.3 times, the composition of those treated has changed, which is associated with the treatment of patients with a new coronavirus infection COVID-19 in them under conditions re-profiling of the majority of medical organizations into infectious diseases hospitals.

Robot-assisted and conventional urology surgical procedures: comparison of average length of stay, economic status, operative time and patient's expenditure in a tertiary care hospital of North India.

Robot-assisted surgeries allows the surgeons to operate using remote-controlled robotic arms that are more effective in comparison to conventional (open/laparoscopic) surgeries. However, there is substantial lack of evidence on the effectiveness of robot-assisted surgeries in low to middle income countries (LMICs) like India. A study was conducted with an aim to evaluate the average length of stay (ALOS), Operative time, economic status (patient's) and cost borne by the patient (patient's expenditure) for undergoing robot-assisted surgeries and conventional surgeries. Grouping of the surgical procedures was done wherein patients who were treated with robot-assisted surgical procedures were placed in Group-01 whereas those treated with conventional surgical procedures were placed under Group-02. Comparative evaluation of the two surgical groups revealed that in robot-assisted surgical procedure, the ALOS was less (18.43 vs. 23.14 days, p = 0.06) whereas operative time (316.7 vs. 252.63 min, p = 0.05) and patient's expenditure were more (INR 70,654.29 vs. INR 41,314.73, p = 0.00). However, there was no significant difference between the economic statuses of patients in both groups. The study concluded that in this era of rapidly expanding health care scenario; targeted, regular, rigorous and repeated training programmes in future may shorten the learning curve thereby paving a way to reduce the cost as well as the operative time of robot-assisted surgeries in LMICs.

Determining Efficacy of Inpatient Care for Select Surgeries at a Large Tertiary Care Hospital With Average Length of Stay as a Measure.

The purpose of the study was to determine average length of stay (ALOS) for selected surgical procedures for CABG, TKR, THR and inguinal hernia and to compare the variation of ALOS among the group and its comparison with standard guidelines. Passive file auditing method was followed to collect the required information to calculate the pre-operative, post- operative and overall LOS for a period of two months. Additional data was collected from electronic health record system used by the hospital. The observed value for ALOS for CABG was 12.76 days, for TKR - 6.44 days, THR-7.6 days and for inguinal hernia, it came to 2.28 days. Further, the mean and standard deviation with respect to pre-operative and post-operative stay for the four surgical procedures revealed mean pre-operative stay for CABG was 3.96 days, TKR - 1.18 days, THR- 1.60 days and Inguinal hernia was 0.53 days. The post-operative mean stay for CABG, TKR, THR and inguinal hernia were 8.80 days, 4.98 days, 6 days and 1.77 days respectively. It was also observed that there was difference in terms of length of stay (LOS) when compared between male and female patients for different surgical procedures. The findings help in identifying the factors leading to increased LOS number of cases with pre-operative, post-operative or overall stay from entry to exit. It has given an insight on the gaps that needs to address to improve the efficiency of patient services offered by the tertiary care hospital.

[Analysis of rising treatment cost of elevated BMI in patients with proximal femoral fracture]. / Analyse steigender Behandlungskosten bei erhöhtem BMI von Patienten mit proximaler Femurfraktur.

Driven by the aging population, the proximal femoral fracture is a rising fracture entity, challenging trauma surgeons as well as the German healthcare system as a whole. The rising average age of the population is accompanied by a rising BMI in the German population, resulting in longer operation times, longer average length of stay (ALOS) as well as more postoperative complications.The aim of this study was to demonstrate the economic correlation between body mass index and hospital costs. The retrospective analysis of 950 patient cases suffering from a proximal femoral fracture resulted in the finding of rising treatment costs being positively associated with rising BMI due to longer operation times and longer length of hospitalization (10,452 €, 11,505 €, 12,085 € and 13,681 € for patients with BMI < 18.5 kg/m2, BMI = 18.5-24.9 kg/m2, BMI = 25.0-29.9 kg/m2 and BMI ≥ 30.0 kg/m2, respectively).

Prior Diagnosis of COVID Has No Increased Complications in Total Joint Arthroplasty.

Introduction Although a substantial portion of the United States population has been infected with and recovered from Coronavirus Disease-19 (COVID-19), many patients may have persistent symptoms and complications from disease-driven respiratory disease, arrhythmias, and venous thromboembolism (VTE). With institutions resuming elective total joint arthroplasties (TJA), it is unclear whether a prior resolved diagnosis of COVID has any implications on postoperative outcomes. Methods All elective TJA performed in 2021 at our institution were retrospectively reviewed and a history of prior COVID+ result recorded. Baseline demographics, days from prior COVID+ result to surgery date, preoperative methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, and laboratory markers were obtained to determine baseline characteristics. Postoperative estimated blood loss (EBL), length of stay (LOS), rate of revision surgery, and discharge destination were compared between groups. Perioperative and postoperative rates of VTE, urinary tract infection (UTI), pneumonia, postoperative oxygen supplementation, cardiac arrhythmia, renal disease, sepsis, and periprosthetic joint infections within six months of surgery were recorded. Results Of the 155 elective TJA performed in 2021, 24 patients had a prior COVID+ diagnosis with a mean of 253 days from positive result to surgery date. There were no significant differences in baseline demographics, comorbidities, and preoperative lab markers between groups. Surgeries on patients with a prior COVID+ had a significantly higher EBL (260 vs 175cc), but postoperative outcomes of VTE, UTI, pneumonia, oxygen supplementation requirement, nares MRSA+, cardiac disease, and infection rates between groups were similar. Bivariate logistic regression revealed increased days from COVID+ diagnosis (>6 months) to surgery date were associated with a shorter LOS. Conclusion Although a prior COVID+ diagnosis had increased intraoperative blood loss, there were no significant differences in respiratory, infectious, cardiac, and thromboembolic complications up to six months after elective TJA. This study suggests that asymptomatic C+ patients receiving elective TJA do not require more aggressive prophylactic anticoagulation or antibiotic regimens to prevent VTE or perioperative infections. As institutions around the nation resume pre-COVID rates of arthroplasty surgeries, a prior diagnosis of COVID appears to have no effects on postoperative complications.

Planning for Maternity Waiting Home Bed Capacity: Lessons from Rural Zambia.

Background: Maternity waiting homes (MWH) allow pregnant women to stay in a residential facility close to a health center while awaiting delivery. This approach can improve health outcomes for women and children. Health planners need to consider many factors in deciding the number of beds needed for an MWH. Objective: The objective of the study is to review experience in Zambia in planning and implementing MWHs, and consider lessons learned in determining optimal capacity. Methods: We conducted a study of 10 newly built MWH in Zambia over 12 months. For this case study analysis, data on beds, service volume, and catchment area population were examined, including women staying at the homes, bed occupancy, and average length of stay. We analyzed bed occupancy by location and health facility catchment area size, and categorized occupancy by month from very low to very high. Findings: Most study sites were rural, with 3 of the 10 study sites rural-remote. Four sites served small catchment areas (<9 000), 3 had medium (9 000-11 000), and 3 had large (>11 000) size populations. Annual occupancy was variable among the sites, ranging from 13% (a medium rural site) to 151% (a large rural-remote site). Occupancy higher than 100% was accommodated by repurposing the MWH postnatal beds and using extra mattresses. Most sites had between 26-69% annual occupancy, but monthly occupancy was highly variable for reasons that seem unrelated to catchment area size, rural or rural-remote location. Conclusion: Planning for MWH capacity is difficult due to high variability. Our analysis suggests planners should try to gather actual recent monthly birth data and estimate capacity using the highest expected utilization months, anticipating that facility-based deliveries may increase with introduction of a MWH. Further research is needed to document and share data on MWH operations, including utilization statistics like number of beds, mattresses, occupancy rates and average length of stay.

Increasing hospital admission rates for anorexia nervosa amongst young women in Australia from 1998 to 2018.

OBJECTIVE: This study aims to describe the trends in community incidence, community prevalence, mortality, overnight hospital admission rates and average overnight inpatient length of stay (ALOS) for anorexia nervosa (AN) amongst young females aged 15-29 in Australia, between 1998-2018. METHODS: Hospitalisation and ALOS data was obtained from the Australian Institute of Health and Welfare principal data cubes. Epidemiological data relating to community-level incidence, community-level prevalence, disability adjusted life years (DALY) and mortality were obtained from the Global Health Data Exchange. We analysed the community and hospital rates for AN in 3 female age groups, 15-19, 20-24 and 25-29. RESULTS: Overnight hospital female admission rates for AN have substantially increased over the past two decades, with a higher rate increase between 2008-2018 for 15-29 age groups. The largest absolute increases were seen in the 15-19 female age group. Community prevalence and DALYs increased slightly, whilst community incidence has remained relatively stable. During the study period, mortality rates and the average hospital inpatient length of stay for AN declined for females 15-29 years. CONCLUSION: Overnight hospitalisation rates for AN particularly increased amongst young females (15-29) in Australia over the past decade. Less substantial increases in community incidence, community prevalence and DALYs, and declining mortality were also observed.

Low Efficiency in a Five-Year Hospital Performance Assessment According to Pabon Lasso Model: State-Affiliated Hospitals of Abadan.

BACKGROUND: A hospital consumes a large amount of health resources, and investigating hospital performance can increase hospital efficiency. METHOD: This retrospective descriptive research analyzed data on performance of 6 hospitals in Abadan, Iran, during a five-year period (2015-2019), based on Graphical Model of Pabon Lasso. RESULTS: Findings suggested 16% of studied hospitals were in Zone 1, 50% were in Zone 3, and 33% were in Zone 4 of the Model. None of the hospitals were in Zone 2. CONCLUSION: As the hospitals in this study did not perform efficiently, concerns related to more efficiently use of available resources are crucial.

Study on the inpatient care use since China′s new healthcare reform / 中华医院管理杂志

Objective:To analyze the reform actions on raising the appropriateness of inpatient care use, as well as the current situation, so as to provide suggestions on improving the appropriateness.Methods:Policies and literatures on the appropriateness of inpatient care use released from 2009 to 2021 were collected from such official websites as the State Council and China National Health Commission as well as literature databases from home and abroad, for a text analysis. Based on the data of China Health Statistics Yearbook(2010-2021) and The Sixth National Health Service Survey Report (2018), descriptive methods were adopted to analyze the situation of inpatient care use in China. Results:Since the new healthcare reform, the Chinese government had standardized the hospitalization standards and procedures to minimize inappropriate use of inpatient care, increased financial subsidies for public hospitals to minimize their inappropriate patient attraction merely for economic interests, and reformed the medical insurance payment methods so as to regulate physicians′ behavior. Under the influence of the above policies, the average length of stay decreased from 10.5 days in 2009 to 9.1 days in 2019, with an average annual growth rate of -1.42%. The average waiting time in hospitals decreased from 3.6 days in 2008 to 1.5 days in 2018.From 2012 to 2019, the admission rate increased from 13.2% to 19.0%.Conclusions:Since the new healthcare reform, the average length of stay in China has decreased year by year, but the admission rate has increased year by year. Therefore, it is necessary to further reduce the inappropriate utilization of inpatient care use by speeding up the construction of the close-type medical alliances, improving the reform of payment methods, refining the performance appraisal standards for medical staff and strengthening supervision mechanism.

Heart Failure Patients and Implications of Obesity: A Single-Center Retrospective Study.

Background and objective The prevalence of heart failure (HF) is on the rise; currently, it affects around five million people in the United States (US) and the prevalence is expected to rise from 2.42% in 2012 to 2.97% in 2030. HF is a leading cause of hospitalizations and readmissions, accounting for a major economic burden to the US healthcare system. Obesity is a widely accepted risk factor of HF; however, data regarding its independent association with HF mortality and morbidity is heterogeneous. Globally, more than two-thirds of deaths attributable to high body mass index (BMI) are due to cardiovascular diseases (CVD). This study aimed to investigate the potential role of obesity (BMI >30 Kg/m2) in HF patients in terms of 30-day readmissions, in-hospital mortality, and the use of noninvasive positive pressure ventilation (NIPPV). Methods In this single-center, retrospective study, all adult (age: >18 years) patients who were hospitalized with a primary diagnosis of HF at the Abington Jefferson Hospital from January 2015 to January 2018 were included. Demographic characteristics were collected manually from electronic medical records. Outcomes were 30-day readmission due to HF, all-cause in-hospital mortality, and requirement for NIPPV. Multivariable logistic regression analysis was conducted to investigate the association of obesity with HF outcomes. Results A total of 1,000 patients were initially studied, of these 800 patients were included in the final analysis based on the inclusion criteria. Obese patients showed higher odds for 30-day readmissions and the use of NIPPV compared to non-obese patients. There was no significant difference in in-hospital mortality in obese vs. non-obese patients. Conclusions Based on our findings, BMI >30 Kg/m2 is an independent risk factor for HF readmissions. Additionally, our results highlight the importance of guidelines-directed medical therapy (GDMT) for HF exacerbation, a low threshold for use of NIPPV in obese patients, promotion of lifestyle modifications including weight loss, and early follow-up after discharge to prevent HF readmissions in the obese population.

Assessing the performance of hospitals before and after the implementation of Iran's Health Sector Evolution Plan (HSEP) using the Pabon Lasso model.

Background: The health sector evolution plan was implemented in 2014 in government hospitals across the country as a part of the universal health coverage achievement programs. This study assessed the performance of hospitals before and after the implementation of this plan, using the Pabon Lasso model. Methods: The population of this study consisted of the hospitals of the country in the 2013-2015 time frame; overall, 874 hospitals (94.5% of the population) were included in the study. In order to assess performance, we used the Pabon Lasso model and hospital performance indicators (Average Length of Stay, Bed Turnover, and Bed Occupancy Rate). The data were collected from the Hospital Information System and provincial deputies of curative affairs and were then analyzed using the descriptive indicators of mean, frequency, and median in SPSS 22. Also, Paired Student T-test and ANOVA were used to compare the performance of different groups of hospitals before and after the implementation of the health sector evolution plan. Results: The implementation of the health sector evolution plan has led to a significant improvement in the three performance indicators in the hospitals of the country. Before the implementation of the health sector evolution plan, the most inefficient, inefficient, fairly efficient, and most efficient zones included 31%, 18%, 17%, and 33% of the studied hospitals, respectively. However, the implementation of the health sector evolution plan changed the percentages to 29%, 21%, 20%, and 30%, respectively. Teaching hospitals, which are governmental and are mostly located in capital cities of the provinces, were overall more inefficient than non-teaching hospitals. Conclusion: The number of the most efficient and most inefficient hospitals has decreased, and the number of average performance hospitals has increased after the implementation of the health sector evolution plan. Therefore, the health sector evolution plan has not led to an overall increase or decrease in the performance of hospitals but has reduced the difference in the performance of hospitals. Equal support of government hospitals along with financial protection against health expenses, improves the performance indicators of hospitals and reduces performance differences among them.

[The hospital medical care support of individuals older than able-bodied age in The Russian Federation].

The growth of population older than working age with specific age characteristics and problems inevitably results in increasing number of their visits to physicians both in out-patient and in-patient organizations. The purpose of the study is to evaluate indices of hospital medical care of patients older than working age based on the beds profile in the Russian Federation during 2012-2019. The comprehensive study was organized to investigate dynamics of the main indices of inpatient medical care of people older than working age residing at specialized hospital beds (hospitalization rate, hospital mortality, average length of stay in bed). The forms of the Federal statistical observation form № 47 and 30 for the Russian Federation in 2012-2019 were used. The statistical and analytical research methods were applied. During these 8 years, the hospitalization rate of patients older than working age increased up to 4.5% (from 27.36 to 28.6 per 100 of population of corresponding age), the hospital mortality rate - from 3.42% to 3.95%The average length of bed stay of patients decreased from 13.4 to 10.85 days that may be associated with intensification of treatment and diagnostic process. The rates of hospitalization of patients older than working age as compared with adults of able-bodied age were higher by 1.5-8.9 times for certain types of specialized medical care (ophthalmology, palliative care, nursing, cardiology, cardiac surgery, radiology, neurology, vascular surgery, oncology).

Practical exploration of one-stop admission service in a general hospital / 中华医院管理杂志

The authors introduced the construction of one-stop admission service in a large general hospital.Measures were carried out by implementing the measures of one window handling of admission business, building one-stop pre-hospital preparation center, optimizing the operational pattern of pre-hospital examination, strictly controlling the hospitalization time of surgical patients, optimizing the information system according to admission criteria, providing personalized services for clinic and implementing quality monitoring.It effectively improved the pre-hospital examination rate, shortened the waiting time and the average length of stay of the patients undergoing elective surgery, and increased the satisfaction of pre-hospital patients.

Describing Serbian Hospital Activity Using Australian Refined Diagnosis Related Groups: A Case Study in Vojvodina Province.

INTRODUCTION: AR-DRG system for classification hospital episodes was implemented in Serbia to improve efficiency and transparency in the health system. METHODS: L3H3, IQR, and 10th-95th percentile methods were used to identify outlier episodes in the classification. Classification efficiency and within-group homogeneity were measured by an adjusted reduction in variance (R2) and a coefficient of variation (CV). RESULTS: There were 246,131 hospital episodes with a total 1,651,913 bed days from 14 hospitals. All episodes were classified into 652 groups of which 441 had CV lower than 100%. "Medical groups" accounted for 51% of groups and for 72% of episodes. Chemotherapy and vaginal delivery were the highest volume groups, with 5% and 4% of total episodes. Major diagnostic category 6 (MDC 6, Diseases of the digestive system) was the highest volume MDC, accounting for 11% of episodes. "Day-cases" and "prolonged hospitalisation" accounted for 21% and 3% of episodes, respectively. The average length of stay varied from 5.6 to 8.2 days. Adjusted R2 was 0.3 for untrimmed data. Trimming by L3H3, IQR, and 10th-95th percentile method improved the value of adjusted R2 to 0.61, 0.49, and 0.51, identifying 24%, 7%, and 7% of total cases as outliers, respectively. Mental diseases (MDC 19) remained the lowest adjusted R2 in untrimmed and trimmed datasets. CONCLUSION: A long length of stay and a small percentage of "day-cases" characterized hospital activity in Vojvodina. Trimming methods significantly improved DRG efficiency. Future studies should consider cost data.

Identifying the Characteristics of Patients With Cervical Degenerative Disease for Surgical Treatment From 17-Year Real-World Data: Retrospective Study.

BACKGROUND: Real-world data (RWD) play important roles in evaluating treatment effectiveness in clinical research. In recent decades, with the development of more accurate diagnoses and better treatment options, inpatient surgery for cervical degenerative disease (CDD) has become increasingly more common, yet little is known about the variations in patient demographic characteristics associated with surgical treatment. OBJECTIVE: This study aimed to identify the characteristics of surgical patients with CDD using RWD collected from electronic medical records. METHODS: This study included 20,288 inpatient surgeries registered from January 1, 2000, to December 31, 2016, among patients aged 18 years or older, and demographic data (eg, age, sex, admission time, surgery type, treatment, discharge diagnosis, and discharge time) were collected at baseline. Regression modeling and time series analysis were conducted to analyze the trend in each variable (total number of inpatient surgeries, mean age at surgery, sex, and average length of stay). A P value <.01 was considered statistically significant. The RWD in this study were collected from the Orthopedic Department at Peking University Third Hospital, and the study was approved by the institutional review board. RESULTS: Over the last 17 years, the number of inpatient surgeries increased annually by an average of 11.13%, with some fluctuations. In total, 76.4% (15,496/20,288) of the surgeries were performed in patients with CDD aged 41 to 65 years, and there was no significant change in the mean age at surgery. More male patients were observed, and the proportions of male and female patients who underwent surgery were 64.7% (13,126/20,288) and 35.3% (7162/20,288), respectively. However, interestingly, the proportion of surgeries performed among female patients showed an increasing trend (P<.001), leading to a narrowing sex gap. The average length of stay for surgical treatment decreased from 21 days to 6 days and showed a steady decline from 2012 onward. CONCLUSIONS: The RWD showed its capability in supporting clinical research. The mean age at surgery for CDD was consistent in the real-world population, the proportion of female patients increased, and the average length of stay decreased over time. These results may be valuable to guide resource allocation for the early prevention and diagnosis, as well as surgical treatment of CDD.

Assessment of a Hospital-Wide CIWA-Ar Protocol for Management of Alcohol Withdrawal Syndrome.

OBJECTIVE: To determine if a hospital-wide symptom-based alcohol withdrawal protocol may result in significant clinical improvements to patient outcomes, safety, and hospital efficiency. METHODS: Retrospective/prospective cohort study between January 1, 2016 and December 31, 2016 (pre-protocol), and between March 1, 2017 and August 7, July 2017 (post-protocol). Pre-protocol patients were identified retrospectively using International Classification of Diseases, 10th revision codes (F10.1, F10.2, and Z71.4). Post-protocol patients were identified by the use of a unique alcohol withdrawal order set in their electronic medical record. The primary endpoint was average length of stay. Secondary outcomes included death, escalation of care as defined as requiring intensive care unit (ICU) consultation or the rapid response team, average ICU length of stay, respiratory failure, average benzodiazepine usage, and incidence of seizures. RESULTS: The study included 276 patients in the pre-protocol group and 145 patients in the post-protocol group. There was a significant reduction found in the primary endpoint of average length of stay (7.15 ± 6.5 days vs 5.7 ± 5.6 days; P=.02). There was a significant reduction in the average benzodiazepine use, use of adjunctive medications, need for ICU consultation or rapid response team, respiratory failure, average ICU length of stay, use of neurologic imaging, and the need for lumbar puncture. CONCLUSION: Implementation of a Clinical Institute Withdrawal Assessment for Alcohol, Revised-based alcohol withdrawal protocol may significantly improve quality of care, patient safety, and treatment effectiveness in a large, mixed medical/surgical, urban community-based academic medical center.

[In-hospital morbidity of the population over the working age of Belgorod Region.]

In the article the authors presented the dynamics of the population over the working age (pension) in the Belgorod region, which for 8 years (2010-2017) increased by 17,1% and confirms the trend of aging of the region's population. An increase of 13,3% in the absolute number of patients over the working age treated in hospitals of medical organizations (MO) of the region was shown. There was a decrease of 1,2% in the rate of hospital (hospitalized) morbidity in this age group. The reasons of hospitalization of these patients in the round-the-clock hospitals of MO of the region (structure of hospital morbidity) among which the following classes of diseases prevailed: systems of blood circulation, neoplasm, diseases of digestive, respiratory, eye and its additional apparatus are analyzed. The average length of stay in hospitals on the bed of patients older than working age in the classes of diseases, which for 8 years decreased by 4,8% (from 12,4 to 11,8 days.) In order to reduce the level of hospital morbidity and mortality in the region, increase the active life of the population older than the working age, identified ways of development of gerontological and geriatric care in the region, which will also contribute to the implementation of pension reform.