Good practices in the management of medical gases in teaching hospitals in Brazil: situational diagnosis

Objective: To characterize compliance with good practices in medical gas management in federal teaching hospitals in Brazil. Methods: A cross-sectional survey-type study, designed to perform a situational diagnosis of the pharmacy services in 40 federal teaching hospitals in Brazil linked to the Brazilian Hospital Services Company, with respect to compliance with good practices in gas management, through the application of the ABPGasMed 1.0 instrument. This instrument consists of 54 compliance standards divided into two sections (structure and process). The characterization of research participants and hospitals, and the classification of hospitals in terms of performance categories were expressed as absolute and relative values. Chi-square tests of independence were performed to investigate the association between the hospital’s performance category and the hospital’s geographic region and size. Results: In total, 87.5% of the invited hospitals participated in the study, and only 27.59% of the hospitals had a pharmacist responsible for medicinal gases. Pharmacovigilance was performed by pharmacists in 20.59% of the hospitals. Analyzing the hospitals by region of the country and size, statistically significant associations were found between the general classification of hospitals and the geographic region (x2(8)=18.936, p= 0.015), as well as the classification of the hospital and structure and size (x2(9)= 20.373, p= 0.016). Analyses of the adjusted standardized residues returned an association between the southeastern region and the satisfactory performance category when analyzing the entire instrument, and between the excellent performance category in the structure section and size of a small hospital. Conclusion: In most of the hospitals studied, management of medicinal gases did not show the desired performance, which indicates the need to comply with current healthcare legislations and improve the provided services. It is believed that compliance rates may evolve training of healthcare team members, with an emphasis on the pharmacist.

Efficiency and Productivity of Public Hospitals in Serbia Using DEA-Malmquist Model and Tobit Regression Model, 2015–2019

Improving productivity within health systems using limited resources is a matter of great concern. The objectives of the paper were to evaluate the productivity, efficiency, and impact of environmental factors on efficiency in Serbian hospitals from 2015–2019. Data envelopment analysis, Malmquist index and Tobit regression were applied to hospital data from this period, and public hospitals in Serbia exhibited a great variation regarding their capacity and performance. Between five and eight hospitals ran efficiently from 2015 to 2019, and the productivity of public hospitals increased whereas technical efficiency decreased in the same period. Tobit regression indicated that the proportion of elderly patients and small hospital size (below 200 beds) had a negative correlation with technical efficiency, while large hospital size (between 400 and 600 beds), the ratio of outpatient episodes to inpatient days, bed turnover rate and the bed occupation rate had a positive correlation with technical efficiency. Serbian public hospitals have considerable space for technical efficiency improvement and public action must be taken to improve resource utilization.

Prescription pattern analysis for antibiotics in working-age workers diagnosed with common cold

Antimicrobial resistance is a major health concern. A primary cause is the inappropriate use of antimicrobials, particularly by patients with upper respiratory tract infection. However, baseline information for antibiotic use for common cold before being applied the National Action Plan on Antimicrobial Resistance in Japan is lacking. Here, we analyzed the inappropriate use of antibiotics in the working-age workers. We used large claims data from an annual health check-up for at least 5 consecutive years. Among 201,223 participants, we included 18,659 working-age workers who were diagnosed with common cold at a clinic/hospital. We calculated the proportion of patients with common cold who were prescribed antibiotics and analyzed predictive factors associated with antibiotics prescription. Antibiotics were prescribed to 49.2% (n = 9180) of patients diagnosed with common cold. In the logistic regression analysis, the group taking antibiotics was predominantly younger, male, without chronic diseases, and diagnosed at a small hospital/clinic (where the number of beds was 0–19). Cephems accounted for the highest proportion of prescribed antibiotics, with 40–45% of patients being prescribed antibiotics. Our data may be applied to prioritize resources such as medical staff-intervention or education of working-age people without chronic diseases who visit clinics for common cold to avoid the potential inappropriate use of antibiotics and prevent antimicrobial resistance acceleration.

Litigation in Anesthesia and Intensive Care Units: An Italian Retrospective Study

Anesthesiologists consider professional insurance and its medico-legal problems as a remarkable aspect of their job. “Associazione Anestesisti Rianimatori Ospedalieri Italiani—Emergenza ed Area Critica” (AAROI-EMAC) is the Italian professional association of anesthesiologists and intensivists that works to train its subscribers on safety measures. This is a retrospective observational study on an insurance complaints database for anesthetic accidents that result in injuries to patients. The analyzed period runs from 1 January 2014 to 31 December 2016. A total of 1309 complaints related to 873 insurance claims were analyzed. Criminal complaints comprised 805 (64.4%) of the total, and civil complaints were 445 (35.6%). The iatrogenic damage claimed included: death (58% of the cases); peripheral nerve damage (8%); spinal cord injuries (5%); unspecified injuries (7%); dental damage (4%); infections (3%); needing second surgical procedure (2%); and other injuries (13%). There is a statistical significance between the size of the hospital and the number of the claims: small hospital complaints comprised 40.1% of the cases, while complaints against medium-sized and large hospitals constituted 20.6% of the cases (χ2GL = 8 = 39.87, p = 0.00). In Italy, anesthesiologists and intensivists are often involved in litigation even when they are not directly responsible for iatrogenic injuries, and the most frequent claims in ICU are related post-operative complications.

Modelling the Impact of Robotics on Infectious Spread Among Healthcare Workers

The Coronavirus disease 2019 (Covid-19) pandemic has brought the world to a standstill. Healthcare systems are critical to maintain during pandemics, however, providing service to sick patients has posed a hazard to frontline healthcare workers (HCW) and particularly those caring for elderly patients. Various approaches are investigated to improve safety for HCW and patients. One promising avenue is the use of robots. Here, we model infectious spread based on real spatio-temporal precise personal interactions from a geriatric unit and test different scenarios of robotic integration. We find a significant mitigation of contamination rates when robots specifically replace a moderate fraction of high-risk healthcare workers, who have a high number of contacts with patients and other HCW. While the impact of robotic integration is significant across a range of reproductive number R0, the largest effect is seen when R0 is slightly above its critical value. Our analysis suggests that a moderate-sized robotic integration can represent an effective measure to significantly reduce the spread of pathogens with Covid-19 transmission characteristics in a small hospital unit.

Pediatric Intrathecal Baclofen Pumps: A Descriptive Analysis of Hospital Course and Associated Costs

<b><i>Introduction:</i></b> The purpose of this study was to identify predictors of increased cost and postoperative length-of-stay (LOS) following intrathecal baclofen pump (ITBP) placement. <b><i>Methods:</i></b> Patients were derived from the 2009/2012 kids’ inpatient database. Inclusion criteria were selected for patients with ICD-9 codes 343.X (infantile cerebral palsy), 86.06 (infusion pump insertion), 03.90 (spinal catheter insertion), and elective hospitalizations. Nonparametric univariate analysis and subsequent gamma log-link general linear modeling were used to identify significant predictors of cost/LOS (<i>p</i> &#x3c; 0.05). <b><i>Results:</i></b> 529 unweighted patients (787 with survey weights applied) met criteria. Median LOS was 3.00 days, and median cost was USD 23,284. Following multivariate modeling, predictors of increased LOS (in days) included increased hospital ITBP volume (<i>p</i> = 0.027), small hospital size (+0.55, <i>p</i> = 0.004), device complications (+0.95, <i>p</i> &#x3c; 0.001), procedural complications (+1.40, <i>p</i> &#x3c; 0.001), additional procedures (+0.86, <i>p</i> &#x3c; 0.001), electrolyte abnormalities (+3.74, <i>p</i> &#x3c; 0.001), and neurological comorbidities (+1.60, <i>p</i> &#x3c; 0.001). Factors associated with decreased LOS were paralysis (−0.53, <i>p</i> &#x3c; 0.001), Northeastern hospital region (−0.55, <i>p</i> = 0.018), and investor-owned hospital status (−0.75, <i>p</i> = 0.001). Similarly, predictors of increased cost included race of Hispanic (+USD 1,156, <i>p</i> = 0.033) or “other” (+USD 2,158, <i>p</i> = 0.001), Northeast hospital region (+USD 4,120, <i>p</i> &#x3c; 0.001), small (+USD 4,139, <i>p</i> &#x3c; 0.001) or medium (+USD 3,368, <i>p</i> &#x3c; 0.001) hospital sizes, additional procedures (+USD 1,649, <i>p</i> &#x3c; 0.001), neurological comorbidities (+USD 3,222, <i>p</i> = 0.003), and increased LOS (<i>p</i> &#x3c; 0.001). Factors associated with decreased cost included Western hospital region (–USD 1,594, <i>p</i> = 0.001), government hospitals (–USD 1,391, <i>p</i> = 0.019), and investor-owned hospitals (–USD 2,057, <i>p</i> = 0.021). <b><i>Conclusion:</i></b> This study found multiple variables associated with increased cost/LOS following ITBP placement. Broadly, this analysis demonstrates national trends associated with increased cost following ITBP placement.

Comparison of expandable hospital competitions in Turkey and USA and space programs

The reason behind this article is the idea that “Expandable Hospital Competitions” are significant architectural events due to their organization in two different countries. Additionally, the research topic becomes much important due to the differences in “Hospital Design Standards” arising from the lapse of time as almost half a century since such competitions are organized at different times. The first competition, called “Expandable Hospital,” is organized in Turkey in the year 1975, while the second competition is named “Small Hospital-Big Idea,” which was organized in the USA in the year 2011. Due to such a year gap, the research becomes more multi-dimensional, with significant differences in the competition space programs. At the same time, there have been some improvements socially, general health conditions due to the changes in welfare and communication conditions, etc., hospital organization, medical practices, pharmaceutical manufacturing, medical devices, and medical equipment. All of such factors have changed the space standards that affect the hospital organization in the long year gap. Based on such developments, this study aims to identify the differences between hospital competitions and space programs under the existing conditions through the performance of comparison