Heat exposure and hospitalizations for chronic kidney disease in China: a nationwide time series study in 261 major Chinese cities

Background:Climate change profoundly shapes the population health at the global scale.However,there was still insufficient and inconsistent evidence for the association between heat exposure and chronic kidney disease(CKD).Methods:In the present study,we studied the association of heat exposure with hospitalizations for cause-specific CKD using a national inpatient database in China during the study period of hot season from 2015 to 2018.Standard time-series regression models and random-effects Meta-analysis were developed to estimate the city-specific and national averaged associations at a 7 lag-day span,respectively.Results:A total of 768,129 hospitalizations for CKD was recorded during the study period.The results showed that higher temperature was associated with elevated risk of hospitalizations for CKD,especially in sub-tropical cities.With a 1℃ increase in daily mean temperature,the cumulative relative risks(RR)over lag 0-7 d were 1.008[95% confidence interval(CI)1.003-1.012]for nationwide.The attributable fraction of CKD hospitalizations due to high temperatures was 5.50%.Stronger associations were observed among younger patients and those with obstructive nephropathy.Our study also found that exposure to heatwaves was associated with added risk of hospitalizations for CKD compared to non-heatwave days(RR=1.116,95%CI 1.069-1.166)above the effect of daily mean temperature.Conclusions:Short-term heat exposure may increase the risk of hospitalization for CKD.Our findings provide insights into the health effects of climate change and suggest the necessity of guided protection strategies against the adverse effects of high temperatures.

Impact of metabolic dysfunction-associated steatotic liver disease on COVID-19 hospitalizations:A propensity-matched analysis of the United States

BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),formally known as nonalcoholic fatty liver disease,is the most common chronic liver disease in the United States.Patients with MASLD have been reported to be at a higher risk of developing severe coronavirus disease 2019(COVID-19)and death.However,most studies are single-center studies,and nationwide data in the AIM To study the influence of MASLD on COVID-19 hospitalizations during the initial phase of the pandemic.METHODS We retrospectively analyzed the 2020 National Inpatient Sample(NIS)database to identify primary COVID-19 hospitalizations based on an underlying diagnosis of MASLD.A matched comparison cohort of COVID-19 hospit-alizations without MASLD was identified from NIS after 1:N propensity score matching based on gender,race,and comorbidities,including hypertension,heart failure,diabetes,and cirrhosis.The primary outcomes included inpatient mortality,length of stay,and hospitalization costs.Secondary outcomes included the prevalence of systemic complications.RESULTS A total of 2210 hospitalizations with MASLD were matched to 2210 hospitalizations without MASLD,with a good comorbidity balance.Overall,there was a higher prevalence of severe disease with more intensive care unit admissions(9.5%vs 7.2%,P=0.007),mechanical ventilation(7.2%vs 5.7%,P=0.03),and septic shock(5.2%vs 2.7%,P<0.001)in the MASLD cohort than in the non-MASLD cohort.However,there was no difference in mortality(8.6%vs 10%,P=0.49),length of stay(5 d vs 5 d,P=0.25),and hospitalization costs(42081.5$vs 38614$,P=0.15)between the MASLD and non-MASLD cohorts.CONCLUSION The presence of MAFLD with or without liver cirrhosis was not associated with increased mortality in COVID-19 hospitalizations;however,there was an increased incidence of severe COVID-19 infection.This data(2020)predates the availability of COVID-19 vaccines,and many MASLD patients have since been vaccinated.It will be interesting to see if these trends are present in the subsequent years of the pandemic.

Racial and gender-based disparities and trends in common psychiatric conditions in liver cirrhosis hospitalizations:A ten-year United States study

BACKGROUND Chronic liver disease is associated with various neuropsychiatric conditions.There are currently no large studies assessing and comparing the prevalence of psy-chiatric illnesses based on patient profiles and the etiology of cirrhosis.AIM To examine the trends of hospitalizations among psychiatric conditions in cirrhosis.METHODS We used the National Inpatient Sample database 2016-2019 for the primary diagnosis of liver cirrhosis.The outcomes included the prevalence,trends,and associations of psychiatric diagnoses in these hospitalizations.Chi-square for categorical variables and the Wilcoxon rank test for continuous variables were utilized.RESULTS The prevalence of generalized anxiety disorder(GAD)in liver cirrhosis hospitalizations increased from 0.17%in 2009 to 0.92%in 2019(P<0.001).The prevalence of depression increased from 7%in 2009 to 12%in 2019(P<0.001).Attention deficit hyperactivity disorder(ADHD)prevalence increased from 0.06%to 0.24%.The prevalence of schizophrenia increased from 0.59%to 0.87%(P<0.001).Schizoaffective disorder prevalence increased from 0.10%to 0.35%(P<0.001).Posttraumatic stress disorder(PTSD)prevalence displayed increasing trends from 0.36%in 2009 to 0.93%in 2019(P<0.001).The prevalence of suicidal ideation increased from 0.23%to 0.56%in 2019.Cirrhosis related to alcoholic liver disease[adjusted odds ratios(aOR)1.18,95%CI 1.08-1.29,P<0.001]and non-alcoholic fatty liver disease(NAFLD)(aOR 1.14,95%CI 1.01-1.28,P=0.025)was associated with depression more than other causes.Alcohol-and NAFLD-associated cirrhosis had a stronger link to psychiatric disorders.Females had a higher association with GAD(aOR 2.56,95%CI 2.14-3.06,P<0.001),depression(aOR 1.78,95%CI 1.71-1.84,P<0.001),bipolar disorder(aOR 1.64,95%CI 1.52-1.77,P<0.001]and chronic fatigue(aOR 2.31,95%CI 1.31-4.07,P<0.001)when compared to males.Blacks,Hispanics,and Asian/Native Americans had a significantly lower association with GAD,depression,bipolar disorder,PTSD,and ADHD when compared to the white race.CONCLUSION The prevalence of psychiatric comorbidities in liver cirrhosis hospitalizations has increased over the last decade.Females had a higher association with psychiatric disorders compared to males.Blacks,Hispanics,and Asian/Native Americans had lower associations with psychiatric comorbidities compared to the white race.

Trends in gastrointestinal disease hospitalizations and outcomes during the first year of the coronavirus pandemic

BACKGROUND The impact of the coronavirus on hospitalizations for gastrointestinal(GI)disease,particularly at a population level is understudied.AIM To investigate trends in hospitalizations,inpatient endoscopy resource utilization,and outcomes during the first year of the coronavirus pandemic and subsequent lockdowns.METHODS Using the California State Inpatient Database for 2018-2020,we explored year-toyear and 2020 month-to-month trends in hospitalizations,length of stay,and inpatient mortality(all-cause&viral pneumonia-specific)for common inpatient GI diagnoses including acute pancreatitis,diverticulitis,cholelithiasis,noninfectious gastroenteritis,upper and lower GI bleeding(LGIB),Clostridium difficile,viral gastroenteritis,inflammatory bowel disease,and acute cholangitis.RESULTS Disease-specific hospitalizations decreased for all included conditions except nonvariceal upper GI bleeding(NVUGIB),LGIB,and ulcerative colitis(UC)(ptrend<0.0001).Allcause inpatient mortality was higher in 2020 vs 2019,for acute pancreatitis(P=0.029),diverticulitis(P=0.04),NVUGIB(P=0.003),and Crohn’s disease(P=0.004).In 2020,hospitalization rates were lowest in April,November,and December.There was no significant corresponding increase in inpatient mortality except in UC(ptrend=0.048).Viral pneumonia and viral pneumonia complicated by respiratory failure increased(P<0.001)among GI hospitalizations.Endoscopy utilization within 24 h of admission was unchanged for GI emergencies except NVUGIB(P<0.001).CONCLUSION Our findings suggest that hospitalization rates for common GI conditions significantly declined in California during the COVID pandemic,particularly in April,November and December 2020.Allcause mortality was significantly higher among acute pancreatitis,diverticulitis,NVUGIB,and Crohn’s disease hospitalizations.Emergency endoscopy rates were mostly comparable between 2020 and 2019.

Predictive Factors of Multiple Hospitalizations for Acute Exacerbations of COPD

Background: Multiple hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with considerable morbidity and mortality. Objectives: To identify predictive factors of multiples hospitalizations for AECOPD. Methods: This is a retrospective single center study of consecutive patients with COPD hospitalized at the Department of Respiratory Medicine between January 1990 and December 2015. We calculated for each patient the mean number of hospitalizations for AECOPD/year (H/y). We distinguished 2 groups (G) of patients. G1: <2 H/y and G2: ≥2 H/y. Predictors of multiple admissions identified by univariate analysis were included in the multivariate analysis. Results: The study included 1167 COPD patients (mean age 67 ± 10 years, 97% males). Three hundred six (26%) COPD patients had a mean number of hospitalizations per year ≥ 2. Multivariate logistic regression analysis demonstrated that an mMRC ≥ 2 (Odd ratio [OR] 1.8, 95% confidence interval [CI] 1.08 - 2.99, p = 0.022), a low PaO2 (PaO2 OR 0.97, 95% CI 0.95 - 0.99, p = 0.007) and frequent exacerbations (OR 2.95, 95% CI 2.56 - 3.39, p < 0.001) are independent factors associated with multiple admissions for AECOPD. Conclusions: An mMRC ≥ 2, a low PaO2 and frequent exacerbations are independently associated with multiple hospitalizations for AECOPD. The identification of these high risk COPD patients will be helpful in the decision of intervention strategies.

Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme

Summary:Throughout the duration of the New Cooperative Medical Scheme(NCMS),it was found that an increasing number of rural patients were seeking out-of^county medical treatment,which posed a great burden on the NCMS fund.Our study was conducted to examine the prevalence of out-of^county hospitalizations and its related factors,and to provide a scientific basis for follow?up health insurance policies.A total of 215 counties in central and western China from 2008 to 2016 were selected.The total out-of-county hospitalization rate in nine years was 16.95%,which increased from 12.37%in 2008 to 19.21%in 2016 with an average annual growth rate of 5.66%.Its related expenses and compensations were shown to increase each year,with those in the central region being higher than those in the western region.Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region(XI),rural population(X2),per capita per year net income(X3),per capita gross domestic product(GDP)(X4),per capita funding amount of NCMS(X5),compensation ratio of out-of^county hospitalization cost(X6),per time average in-county(X7)and out-of-county hospitalization cost(X8).According to Bayesian network(BN),the marginal probability of high out-of^county hospitalization rate was as high as 81.7%.Out-of^county hospitalizations were directly related to X8,X3,X4 and X6.The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors,economy factors,regional characteristics and NCMS policy factors was 95.7%,91.1%,93.0% and 88.8%,respectively.And how these factors affect out-of-county hospitalization and their interrelationships were found out.Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations,and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.

Influenza-Related Hospitalizations and Associated Comorbidities in Nebraska: 2007-2011

Objective: Influenza afflicts approximately 5% - 20% of the US population annually. Although prevalence statistics are useful, they are insufficient to understand completely influenza on a health care system. This study estimated Nebraska’s annual hospitalization and comorbidity rates due to influenza from 2007 to 2011. Methods: Influenza was defined according to ICD-9-CM primary codes beginning with 487 or 488 in hospital discharge records. The comorbidities of patients with influenza were defined according to ICD-9-CM secondary diagnosis codes. Results: The highest yearly age-adjusted hospitalization rates were 30.6 and 31.1 per 100,000 populations for 2008 and 2009, respectively. In 2008, the highest hospitalization rate was among those aged 65 yrs and older;in 2009, the highest rate was among those younger than 5 yrs. Asthma was the most frequent comorbidity overall and among those younger than 50 yrs. Conversely, hypertension and heart failure were the most frequent comorbidities among those aged 50 yrs and older. Conclusion: These findings provide a better understanding of the influenza burden and may contribute to developing more effective influenza prevention strategies.

Hospitalizations and in-hospital mortality for inflammatory bowel disease in Brazil

BACKGROUND Inflammatory bowel disease(IBD)is associated with complications,frequent hospitalizations,surgery and death.The introduction of biologic drugs into the therapeutic arsenal in the last two decades,combined with an expansion of immunosuppressant therapy,has changed IBD management and may have altered the profile of hospitalizations and in-hospital mortality(IHM)due to IBD.AIM To describe hospitalizations from 2008 to 2018 and to analyze IHM from 1998 to 2017 for IBD in Brazil.METHODS This observational,retrospective,ecological study used secondary data on hospitalizations for IBD in Brazil for 2008-2018 to describe hospitalizations and for 1998-2017 to analyze IHM.Hospitalization data were obtained from the Hospital Information System of the Brazilian Unified Health System and population data from demographic censuses.The following variables were analyzed:Number of deaths and hospitalizations,length of hospital stay,financial costs of hospitalization,sex,age,ethnicity and type of hospital admission.RESULTS There was a reduction in the number of IBD hospitalizations,from 6975 admissions in 1998 to 4113 in 2017(trend:y=-0.1682x+342.8;R^(2)=0.8197;P<0.0001).The hospitalization rate also decreased,from 3.60/100000 in 2000 to 2.17 in 2010.IHM rates varied during the 20-year period,between 2.06 in 2017 and 3.64 in 2007,and did not follow a linear trend(y=-0.0005049x+2.617;R^(2)=0,00006;P=0.9741).IHM rates also varied between regions,increasing in all but the southeast,which showed a decreasing trend(y=-0.1122x+4.427;R^(2)=0,728;P<0.0001).The Southeast region accounted for 44.29%of all hospitalizations.The Northeast region had the highest IHM rate(2.86 deaths/100 admissions),with an increasing trend(y=0.1105x+1.110;R^(2)=0.6265;P<0.0001),but the lowest hospitalization rate(1.15).The Midwest and South regions had the highest hospitalization rates(3.27 and 3.17,respectively).A higher IHM rate was observed for nonelective admissions(2.88),which accounted for 81%of IBD hospitalizations.The total cost of IBD hospitalizations in 2017 exhibited an increase of 37.5%compared to 2008.CONCLUSION There has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years.IHM rates varied and did not follow a linear trend.

Wastewater surveillance provides 10-days forecasting of COVID-19 hospitalizations superior to cases and test positivity:A prediction study

Background:The public health response to COVID-19 has shifted to reducing deaths and hospitalizations to prevent overwhelming health systems.The amount of SARS-CoV-2 RNA fragments in wastewater are known to correlate with clinical data including cases and hospital admissions for COVID-19.We developed and tested a predictive model for incident COVID-19 hospital admissions in New York State using wastewater data.Methods:Using county-level COVID-19 hospital admissions and wastewater surveillance covering 13.8 million people across 56 counties,we fit a generalized linear mixed model predicting new hospital admissions from wastewater concentrations of SARS-CoV-2 RNA from April 29,2020 to June 30,2022.We included covariates such as COVID-19 vaccine coverage in the county,comorbidities,demographic variables,and holiday gatherings.Findings:Wastewater concentrations of SARS-CoV-2 RNA correlated with new hospital admissions per 100,000 up to ten days prior to admission.Models that included wastewater had higher predictive power than models that included clinical cases only,increasing the accuracy of the model by 15%.Predicted hospital admissions correlated highly with observed admissions(r¼0.77)with an average difference of 0.013 hospitalizations per 100,000(95%CI¼[0.002,0.025])Interpretation:Using wastewater to predict future hospital admissions from COVID-19 is accurate and effective with superior results to using case data alone.The lead time of ten days could alert the public to take precautions and improve resource allocation for seasonal surges.

Ambient Nitrogen Dioxide and Hospitalizations of Full-Spectrum Respiratory Diseases:A National Case-Crossover Study

Few multicity studies have examined the acute effects of nitrogen dioxide(NO_(2))on respiratory disease(RD),especially its specific causes.This study aimed to investigate the associations between short-term exposure to NO_(2)and hospitalization of full-spectrum RDs in China.Hospitalization of 10 major categories and 40 cause-specific RDs were obtained from 20 provinces over the study period of 2013−2020.A time-stratified case-crossover study was conducted at the individual level to explore the associations between NO_(2)and RDs.NO_(2)was significantly associated with increased hospitalization of eight major RDs(acute upper respiratory infections,influenza and pneumonia,acute lower respiratory infections,upper respiratory tract diseases,chronic lower respiratory diseases,respiratory interstitium diseases,pleura diseases,and other respiratory diseases)and 18 specific causes of RDs,with the largest associations observed on lag 0−1 day.The effect estimates ranged from 0.75 to 4.09%per 10μg/m^(3)of NO_(2)exposure.The associations remained robust after controlling for copollutants.The concentration−response curves were mostly positive and linear.This nationwide study provides comprehensive information on the acute effects of NO_(2)on respiratory morbidity across the full spectrum,highlighting the need for caution with regard to this important traffic-related air pollutant in current pollution control programs.

Survey and clinical considerations of gender identity in lower primary school children

BACKGROUND Gender consciousness directly affects the development of gender identity,which is a continuous and lifelong process.Meanwhile,hospitalization is a part of many children's lives and has an impact on their gender development.AIM To investigate the current situation of gender identity in lower primary school children by conducting a survey of 202 hospitalized children in the lower grades and to provide a theoretical basis and foundation for the cultivation of gender identity and medical treatment of children based on the results.This study aims to inspire clinical medical staff to scientifically and reasonably arrange hospital wards for lower primary school children and pay attention to gender protection during the medical treatment process and to help children shape a unified and clear gender identity,which will enable them to better integrate into society and promote their personality development.METHODS The gender consciousness scale for elementary and middle school students was RESULTS Gender identity was already present in lower primary school children.The children's gender roles and gender equality consciousness were strong,exceeding the critical value,but their gender characteristics,gender identity,and gender ideal consciousness were weak.Children aged 6 had the weakest gender identity,and girls had significantly stronger gender identity than boys.CONCLUSION Gender identity is already present in lower primary school children,providing a basis and inspiration for the cultivation of gender identity and medical treatment of lower primary school children.Clinical medical staff should be aware of and understand these results and should scientifically and reasonably arrange hospital wards for lower primary school children.

Correlation of neutrophil to lymphocyte ratio to severity of coronary artery disease and in-hospital clinical outcomes in patients with acute coronary syndrome: A prospective observational study

Objective:To explore correlation of neutrophil-to-lymphocyte ratio(NLR)to severity of coronary artery disease(CAD)and in-hospital clinical outcomes in patients with acute coronary syndrome(ACS).Methods:In this prospective and observational study,we recruited 500 patients with ACS.For all the eligible patients,demographic details were collected,and laboratory parameters were evaluated.The CAD severity was evaluated in terms of the number of involved vessels.The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed.Results:77.2%of Patients was male,and 52%of the patients aged between 55-70 years.Based on the type of ACS,396 out of 500 patients had ST-elevation myocardial infarction.An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among classⅣpatients.The mean NLR value among the non-survivors were higher compared to the survivors(9.52±5.72 vs.4.76±2.36;P<0.01).Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0%and a specificity of 77.3%.Conclusions:The NLR can be used as an independent prognostic marker in ACS.An elevated NLR value serves as a reliable predictor for short-term complications,notably in-hospital mortality.

Bowel preparation protocol for hospitalized patients ages 50 years or older:A randomized controlled trial

BACKGROUND The incidence and mortality rate of colorectal cancer progressively increase with age and become particularly prominent after the age of 50 years.Therefore,the population that is≥50 years in age requires long-term and regular colonoscopies.Uncomfortable bowel preparation is the main reason preventing patients from undergoing regular colonoscopies.The standard bowel preparation regimen of 4-L polyethylene glycol(PEG)is effective but poorly tolerated.AIM To investigate an effective and comfortable bowel preparation regimen for hospitalized patients≥50 years in age.METHODS Patients were randomly assigned to group 1(2-L PEG+30-mL lactulose+a lowresidue diet)or group 2(4-L PEG).Adequate bowel preparation was defined as a Boston bowel preparation scale(BBPS)score of≥6,with a score of≥2 for each segment.Non-inferiority was prespecified with a margin of 10%.Additionally,the degree of comfort was assessed based on the comfort questionnaire.RESULTS The proportion of patients with a BBPS score of≥6 in group 1 was not significantly different from that in group 2,as demonstrated by intention-to-treat(91.2%vs 91.0%,P=0.953)and per-protocol(91.8%vs 91.0%,P=0.802)analyses.Furthermore,in patients≥75 years in age,the proportion of BBPS scores of≥6 in group 1 was not significantly different from that in group 2(90.9%vs 97.0%,P=0.716).Group 1 had higher comfort scores(8.85±1.162 vs 7.59±1.735,P<0.001),longer sleep duration(6.86±1.204 h vs 5.80±1.730 h,P<0.001),and fewer awakenings(1.42±1.183 vs 2.04±1.835,P=0.026)than group 2.CONCLUSION For hospitalized patients≥50 years in age,the bowel preparation regimen comprising 2-L PEG+30-mL lactulose+a low-residue diet produced a cleanse that was as effective as the 4-L PEG regimen and even provided better comfort.

Innovative pathways allow safe discharge of mild acute pancreatitis from the emergency room

Acute pancreatitis(AP)is a leading cause of gastrointestinal-related hospitalizations in the United States,resulting in 300000 admissions per year with an estimated cost of over$2.6 billion annually.The severity of AP is determined by the presence of pancreatic complications and end-organ damage.While moderate/severe pancreatitis can be associated with significant morbidity and mortality,the majority of patients have a mild presentation with an uncomplicated course and mortality rate of less than 2%.Despite favorable outcomes,the majority of mild AP patients are admitted,contributing to healthcare cost and burden.In this Editorial we review the performance of an emergency department(ED)pathway for patients with mild AP at a tertiary care center with the goal of reducing hospitalizations,resource utilization,and costs after several years of implementation of the pathway.We discuss the clinical course and outcomes of mild AP patients enrolled in the pathway who were successfully discharged from the ED compared to those who were admitted to the hospital,and identify predictors of successful ED discharge to select patients who can potentially be triaged to the pathway.We conclude that by implementing innovative clinical pathways which are established and reproducible,selected AP patients can be safely discharged from the ED,reducing hospitalizations and healthcare costs,without compromising clinical outcomes.We also identify a subset of patients most likely to succeed in this pathway.

Reform of Hospitality English Teaching Based on the Educational Concept of Outcome-Based Education(OBE)

The Outcome-Based Education(OBE)educational concept,proposed by renowned American educator Spady,aims to guide students in mastering learning laws and ultimately achieving expected learning outcomes.The application of OBE educational concept in Hospitality English curriculum not only can effectively enhance the learning effect but also promote the reform of the Hospitality English curriculum,thus improving students’learning enthusiasm.Therefore,taking the Hospitality English curriculum as an example,this paper points out the existing problems in the teaching of this course and suggests the reform measures based on the OBE teaching concept,hoping to provide guidelines for related educational work.

An artificial intelligence diabetes management architecture based on 5G

Along with the development of 5G network and Internet of Things technologies,there has been an explosion in personalized healthcare systems.When the 5G and Artificial Intelligence(Al)is introduced into diabetes management architecture,it can increase the efficiency of existing systems and complications of diabetes can be handled more effectively by taking advantage of 5G.In this article,we propose a 5G-based Artificial Intelligence Diabetes Management architecture(AIDM),which can help physicians and patients to manage both acute complications and chronic complications.The AIDM contains five layers:the sensing layer,the transmission layer,the storage layer,the computing layer,and the application layer.We build a test bed for the transmission and application layers.Specifically,we apply a delay-aware RA optimization based on a double-queue model to improve access efficiency in smart hospital wards in the transmission layer.In application layer,we build a prediction model using a deep forest algorithm.Results on real-world data show that our AIDM can enhance the efficiency of diabetes management and improve the screening rate of diabetes as well.

Geriatric nursing competence of clinical nursing staff at different hospital levels in Chongqing,China:A cross-sectional study

Objectives:This study aimed to survey the geriatric nursing competencies of clinical nursing staff in Chongqing City,China,and provide suggestions to enhance these competencies.Methods:This study was conducted in 204 hospitals in Southwest China from December 24,2022 to January 7,2023.The“Geriatric Nursing Competence of Clinical Nurse Investigation Tool”was used to explore factors that influence geriatric nurses’competencies via stratified sampling.The survey was conducted by distributing and collecting questionnaires through the online platform Wenjuanxing.Results:A total of 10,692 nurses answered the questionnaires.Of these questionnaires,9,442 were valid.The total geriatric nursing competence score of the clinical nursing staff was 2.29±0.81,the secondary hospital score was 2.23±0.78,and the tertiary hospital’s overall mean score was 2.33±0.83.The factors that influenced secondary hospitals included the department of medicine,age of nurses and total length of career(P<0.05).The factors that influenced tertiary hospitals included the department of medicine,age of nurses,nurses’professional title,and geriatric practical advanced nurses’certification(P<0.05).Conclusions:Geriatric nursing competence among clinical nursing staff is imbalanced at a lower-middle level and is influenced by various factors.Thefindings highlight the need for further clinical training in geriatric nursing.The training of geriatric nurses should focus on necessary clinical skills and on preparing them to adequately manage comprehensive geriatric syndromes.

Temporal patterns and clinical characteristics of healthcare-associated infections in surgery patients:A retrospective study in a major Chinese tertiary hospital

Background:Given the preventable nature of most healthcare-associated infections(HAIs),it is crucial to under-stand their characteristics and temporal patterns to reduce their occurrence.Methods:A retrospective analysis of medical record cover pages from a Chinese hospital information system was conducted for surgery inpatients from 2010 to 2019.Association rules mining(ARM)was employed to explore the association between disease,procedure,and HAIs.Joinpoint models were used to estimate the annual HAI trend.The time series of each type of HAI was decomposed to analyze the temporal patterns of HAIs.Results:The study included data from 623,290 surgery inpatients over 10 years,and a significant decline in the HAI rate was observed.Compared with patients without HAIs,those with HAIs had a longer length of stay(29 days vs.9 days),higher medical costs(96226.57 CNY vs.22351.98 CNY),and an increased risk of death(6.42%vs.0.18%).The most common diseases for each type of HAI differed,although bone marrow and spleen operations were the most frequent procedures for most HAI types.ARM detected that some uncommon diagnoses could strongly associate with HAIs.The time series pattern varied for each type of HAI,with the peak occurring in January for respiratory system infections,and in August and July for surgical site and bloodstream infections,respectively.Conclusions:Our findings demonstrate that HAIs impose a significant burden on surgery patients.The differing time series patterns for each type of HAI highlight the importance of tailored surveillance strategies for specific types of HAI.

Effects of integrated management on surgical outcomes and mental health of patients following endoscopic submucosal dissection

BACKGROUND Endoscopic submucosal dissection(ESD)is a less invasive local treatment for diseases throughout the gastrointestinal tract.AIM To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after ESD.METHODS The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated management.RESULTS The management group exhibited shortened fasting time and length of hospital stay compared to the control group(P<0.05).The management group exhibited a higher incidence rate of postoperative complications than the control group(3 cases vs 11 cases;P=0.043).The management group exhibited a lower uncertainty score for disease knowledge compared to the control group 12 h after surgery(P<0.05).The management group gave more scores on the domains of patient familiarity to the responsible nurses,professional skills of responsible nurses,and general evaluation compared to the control group.The management group had a higher total score of patient satisfaction towards the responsible nurses in term of health care than the control group(P<0.01).The management group exhibited lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores compared to the control group 12 h after surgery(P<0.01).CONCLUSION The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.