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.

Reducing Extended Hospital Lengths of Stay

In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.

The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(<4 h, 4–12 h,12–24 h, and >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality.RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(<4 h) and had higher level trauma team T1 activation(TTA-1), higher Injury Severity Score(ISS), higher shock index(SI), and more head injuries than the other groups(P=0.001). Patients with an EDLOS >24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). CONCLUSIONS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.

Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer

BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall prognosis.One potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021.Patients were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS 26.0.RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer perforation.The median HLOS was 10 d.There were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P<0.05).The SA level on postoperative day 2 was a protective factor for patients with HLOS>7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 d.CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU.The pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely manner.

Machine learning applications for the prediction of extended length of stay in geriatric hip fracture patients

BACKGROUND Geriatric hip fractures are one of the most common fractures in elderly individuals,and prolonged hospital stays increase the risk of death and complications.Machine learning(ML)has become prevalent in clinical data processing and predictive models.This study aims to develop ML models for predicting extended length of stay(eLOS)among geriatric patients with hip fractures and to identify the associated risk factors.AIM To develop ML models for predicting the eLOS among geriatric patients with hip fractures,identify associated risk factors,and compare the performance of each model.METHODS A retrospective study was conducted at a single orthopaedic trauma centre,enrolling all patients who underwent hip fracture surgery between January 2018 and December 2022.The study collected various patient characteristics,encompassing demographic data,general health status,injury-related data,laboratory examinations,surgery-related data,and length of stay.Features that exhibited significant differences in univariate analysis were integrated into the ML model establishment and subsequently cross-verified.The study compared the performance of the ML models and determined the risk factors for eLOS.RESULTS The study included 763 patients,with 380 experiencing eLOS.Among the models,the decision tree,random forest,and extreme Gradient Boosting models demonstrated the most robust performance.Notably,the artificial neural network model also exhibited impressive results.After cross-validation,the support vector machine and logistic regression models demonstrated superior performance.Predictors for eLOS included delayed surgery,D-dimer level,American Society of Anaesthesiologists(ASA)classification,type of surgery,and sex.CONCLUSION ML proved to be highly accurate in predicting the eLOS for geriatric patients with hip fractures.The identified key risk factors were delayed surgery,D-dimer level,ASA classification,type of surgery,and sex.This valuable information can aid clinicians in allocating resources more efficiently to meet patient demand effectively.

Concept Analysis: Emergency Department Crowding and Length of Stay before and after an Increase in Catchment Area

Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.

Comparison of Mortality, Length of Stay, and Hospitalization Costs of Hospitalized COVID-19 Patients with Cardiac and Non-Cardiac Disease

Background: The COVID-19 pandemic has presented unprecedented challenges to global healthcare systems. As the pandemic unfolded, it became evident that certain groups of individuals were at an elevated risk of experiencing severe disease outcomes. Among these high-risk groups, individuals with pre-existing cardiac conditions emerged as particularly vulnerable. Objective: This study aimed to investigate the relationship between the length of stay, mortality, and costs of COVID-19 patients with and without a history of cardiac disease. Design: This retrospective study was conducted in Jam Hospital in Tehran, Iran, from March 21, 2021, to March 21, 2022. All patients with laboratory-confirmed COVID-19 who were hospitalized during this period were included. Results: A total of 500 COVID-19 patients were hospitalized, with 31.6% having a history of cardiac disease and 68.4% without any cardiac disease. Patients with cardiac disease were significantly older (median [range] age, 69.35 [37 - 94] years) compared to non-cardiac patients (54.95 [13 - 97] years) (p Conclusion: Patients with cardiac disease who are hospitalized with COVID-19 have a higher mortality rate, longer hospital stays, greater disease severity, ICU admission, and higher costs. Therefore, improved prevention and management strategies are crucial for these patients.

旅游小城镇规划中的Long Stay要素分析

根据小城镇具有发展Long Stay的条件,在进行小城镇规划建设中考虑Long Stay要素的体现,并对旅游小城镇的效益进行了分析。结果表明:小城镇具有发展Long Stay的条件,在城镇的总体规划中体现出其作用,并能对城镇产生经济效益与社会效益。

“Long Stay”与分时度假的比较分析

"Long Stay"与分时度假是休闲旅游的两种特殊形式,"Long Stay"刚进入国人视野,前景看好,而分时度假在国内的发展陷入困境。通过对比两者的主体、客体以及在我国发展的适应性,发现两者具备一定的互补优势,协同发展可以实现产品价值最大化和企业利润最大化。

Effects of Water Stress on Stay Green of Sugarcane Innovative Materials Yunge F_2 Generation

[Objective] This study aimed to investigate the effect of water stress on stay green of Yunge F2 generation. [Method] Total 26 sugarcane innovative germplasm materials of Yunge F2 generation, along with their female parent, were selected as the experimental materials. Based on the observation on appearance of stray green and other five physiological and biochemical indexes, the drought resis- tance of the experimental materials was evaluated comprehensively by subordinate function method, grey relational analysis, and cluster analysis. [Result] The rank of drought resistance of the experimental materials was not exactly the same between subordinate function method and grey relational analysis. However, the drought .re- sistance evaluation results by isometric range-based cluster analysis were consistent with those by the two foregoing methods except Yunge F2 11-68 and Yunge F1 11- 254. At the Euclidean distance of 2.00, the tested materials were classified into four groups. The first group included 8 drought-strongly resistant materials, the third group included 6 drought-moderately resistant materials, the fourth group included 3 drought-poorly resistant materials, and the second group included drought-strongly resistant and drought-moderately resistant materials. The drought resistance coeffi- cients of green leaf numberLtotal leaf number and top four leaves chlorophyll content showed significantly positive correlation with drought resistance comprehensive eval- uation value, thus green leaf number/total leaf number and top four leaves chloro- phyll content could be used as the evaluation indexes of drought resistance in sug- arcane. [Conclusion] The excellent materials possess strong drought resistance and good green holding performance, such as Yunge F2 11-159, can be used as crucial parents and basic germplasm materials in drought resistance breeding of sugarcane. 7

Analysis of the Long Stay Elements in the Planning of Small Tourism Towns

According to the conditions to develop Long Stay in small tourism towns,the demonstration of Long Stay in the planning and construction of small towns was taken into consideration,and its benefits for tourism towns were analyzed.The results showed that small tourism towns were endowed with sound conditions to develop Long Stay,which played its role in the overall planning of towns and would benefit the economic development of these towns.

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.

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength,as well as a decline in functional ability,which is associated with malnutrition,hormonal changes,chronic inflammation,distur-bance of intestinal flora,and exercise quality.Pancreatoduodenectomy is a com-monly employed clinical intervention for conditions such as pancreatic head cancer,ampulla of Vater cancer,and cholangiocarcinoma,among others,with a notably high rate of postoperative complications.Sarcopenia is frequent in patients undergoing pancreatoduodenectomy.However,data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy(PD)are both limited and inconsistent.The PubMed,Cochrane Library,Web of Science,and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD.Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria.Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted.Forest and funnel plots were used,respectively,to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias.RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis.The patients in the sarcopenia group(n=833)had higher overall postoperative complication rates[odds ratio(OR)=3.42,95%confidence interval(CI):1.95-5.99,P<0.0001],higher Clavien-Dindo class≥Ⅲ major complication rates(OR=1.41,95%CI:1.04-1.90,P=0.03),higher bacteremia rates(OR=4.46,95%CI:1.42-13.98,P=0.01),higher pneumonia rates(OR=2.10,95%CI:1.34-3.27,P=0.001),higher pancreatic fistula rates(OR=1.42,95%CI:1.12-1.79,P=0.003),longer hospital stays(OR=2.86,95%CI:0.44-5.28,P=0.02),higher mortality rates(OR=3.17,95%CI:1.55-6.50,P=0.002),and worse overall survival(hazard ratio=2.81,95%CI:1.45-5.45,P=0.002)than those in the non-sarcopenia group(n=1548).However,no significant inter-group differences were observed regarding wound infections,urinary tract infections,biliary fistulas,or postoperative digestive bleeding.CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD.Patients with preoperative sarcopenia have increased rates of complications and mortality,in addition to a poorer overall survival rate and longer hospital stays after PD.

“play+stay”理念在营口理工学院网球课中的应用研究

2007年2月ITF正式发起了一项意在增加全球网球参与性的运动——play+stay。它的目标是使网球这项运动更容易、更有趣和更健康。并保证每一位初学者在第一堂课中都能够掌握发球、对打和得分的能力。"play+stay"的理念主要包括5部分:网球是简单的;网球是有趣的;网球比赛是有趣的;网球是健康的;网球适合所有人。营口理工学院于2012年开始设置了网球课程,并与2014—2015学年引入了"play+stay"理念并结合自身的特点和教学经验进行了教学实验,得出以下结论:(1)"play+stay"理念非常适合高校网球教学。(2)同学们的学习热情显著提高,网球技能水平达到了教学目标的要求。(3)"play+stay"理念应与高校自身的特点相结合才能发挥最大的优势。

The effect of intraoperative goal-directed fluid therapy in patients under anesthesia for gastrointestinal surgery

BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.

Readmission rate and early complications in patients undergoing total knee arthroplasty:A retrospective study

BACKGROUND Total knee arthroplasty(TKA)can improve pain,quality of life,and functional outcomes.Although uncommon,postoperative complications are extremely consequential and thus must be carefully tracked and communicated to patients to assist their decision-making before surgery.Identification of the risk factors for complications and readmissions after TKA,taking into account common causes,temporal trends,and risk variables that can be changed or left unmodified,will benefit this process.AIM To assess readmission rates,early complications and their causes after TKA at 30 days and 90 days post-surgery.METHODS This was a prospective and retrospective study of 633 patients who underwent TKA at our hospital between January 1,2017,and February 28,2022.Of the 633 patients,28 were not contactable,leaving 609 who met the inclusion criteria.Both inpatient and outpatient hospital records were retrieved,and observations were noted in the data collection forms.RESULTS Following TKA,the 30-day and 90-day readmission rates were determined to be 1.1%(n=7)and 1.8%(n=11),respectively.The unplanned visit rate at 30 days following TKA was 2.6%(n=16)and at 90 days was 4.6%(n=28).At 90 days,the unplanned readmission rate was 1.4%(n=9).Reasons for readmissions included medical(27.2%,n=3)and surgical(72.7%,n=8).Unplanned readmissions and visits within 90 days of follow-up did not substantially differ by age group(P=0.922),body mass index(BMI)(P=0.633),unilateral vs bilateral TKA(P=0.696),or patient comorbidity status(30-day P=0.171 and 90-day P=0.813).Reoperation rates after TKA were 0.66%(n=4)at 30 days and 1.15%(n=8)at 90 days.The average length of stay was 6.53 days.CONCLUSION In this study,there was a low readmission rate following TKA.There was no significant correlation between readmission rate and patient factors such as age,BMI,and co-morbidity status.

Machine learning insights on intensive care unit-acquired weakness

Intensive care unit-acquired weakness(ICU-AW)significantly hampers patient recovery and increases morbidity.With the absence of established preventive strategies,this study utilizes advanced machine learning methodologies to unearth key predictors of ICU-AW.Employing a sophisticated multilayer perceptron neural network,the research methodically assesses the predictive power for ICU-AW,pinpointing the length of ICU stay and duration of mechanical ventilation as pivotal risk factors.The findings advocate for minimizing these elements as a preventive approach,offering a novel perspective on combating ICU-AW.This research illuminates critical risk factors and lays the groundwork for future explorations into effective prevention and intervention strategies.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes:A retrospective cohort study

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

Study on the Development of "Farm Stay" Tourism in Yanan City of Shaanxi Province

'Farm stay' tourism is a kind of new tourism form in recent years,which can promote regional economic development.The study discusses the existing problems in the setting of tourism products,and puts forward some countermeasures for the development of 'farm stay' tourism in Yanan city.