جستجوی مقالات مرتبط با کلیدواژه "hospital stay" در نشریات گروه "پزشکی"

Pleurectomy/decortication (P/D), a surgical procedure for malignant pleural mesothelioma (MPM), is a highly invasive surgery requiring prolonged hospitalization. Previous studies have reported that postoperative analgesia using regional anesthesia contributes to shorter hospital stays after surgery under general anesthesia by reducing acute postoperative pain. However, the association between postoperative analgesia and the length of hospital stay (LOHS) following P/D has not been evaluated.

To evaluate the association between postoperative analgesia and postoperative LOHS after P/D.

This single-institution observational study enrolled consecutive adult patients undergoing P/D under general anesthesia, who postoperatively received either intertransverse process block (ITPB) or continuous intravenous (IV) fentanyl infusion as postoperative analgesia between March 2022 and February 2023.

Among all enrolled patients with ASA physical status II or III (n = 60), postoperative analgesia was administered using either continuous ITPB (n = 19) or continuous IV fentanyl infusion (n = 41). Multivariable logistic regression analysis revealed that postoperative analgesia with continuous ITPB (P = 0.007), a lower incidence of major complications after surgery (P = 0.034), and female sex (P = 0.033) were significantly associated with a shorter postoperative LOHS. In subgroup analysis, patients who received continuous ITPB had significantly lower postoperative LOHS, lower postoperative serum C-reactive protein levels on postoperative day (POD) 3, and reduced acute postoperative pain on POD3 compared to those who received continuous IV fentanyl infusion.

Postoperative analgesia using continuous ITPB appears to be associated with a reduction in LOHS following P/D for MPM under general anesthesia.

The rising prevalence of chronic respiratory failure in pediatric patients necessitates a detailed evaluation of home mechanical ventilation (HMV).

This study assesses the advantages of HMV devices, focusing on cases from Imam Hussein Children's Hospital.

This research involved 20 children who required long-term ventilation and were admitted to both general and intensive care units at Imam Hussein Children's Hospital in Isfahan. Before discharge, a team of HMV experts trained the parents on the proper use of the ventilation devices. Post-discharge, the educational needs of the parents were assessed continuously, with regular home visits conducted by a nurse and a representative from the ventilator supplier.

Approximately 73% of the children demonstrated therapeutic effectiveness following HMV implementation. About 35% of parents observed no adverse effects in their children. The average cost savings from reduced ICU rehospitalizations was significant at 347.59%, and there was a 65.09% reduction in the costs associated with general ward hospitalizations.

The adoption of HMV has led to improved health outcomes, substantial reductions in medical expenses, and shorter hospital stays. It is advisable to plan for broader implementation of HMV in children who require long-term ventilation.

Bronchiolitis is a lower respiratory tract infection and one of the major health concerns and hospitalization factors in infants.

This study aimed to address inconsistencies in treating this disease.

This study is a double-blind clinical trial investigating the effect of salbutamol, epinephrine, and 5% inhaled hypertonic saline on treating infants with bronchiolitis referred to the Taleghani Pediatrics Hospital in Gorgan, Iran, during 2019 - 2020. The clinical results of the treatments and hospitalization stay were also evaluated.

In this study, the study sample encompassed 18 girls and 39 boys. There was no significant difference between the three groups regarding age, gender, parental literacy level, and history of allergies. Salbutamol and epinephrine, in comparison to hypertonic saline, were effective in shortening patients' hospital stay (P = 0.004). Moreover, there was a significant difference between the oxygen saturation of in the patients 48 h after treatment in the salbutamol and epinephrine groups compared to the saline group (P = 0.001).

In comparison to hypertonic saline, salbutamol and epinephrine can be selected to treat children with acute bronchiolitis since they can shorten hospital stay improve O2 saturation, and decrease treatment costs imposed on the health care system and families.

This was a randomized, double-blind clinical trial to compare the efficacy and safety of Atazanavir/Ritonavir (ATZ/RTV) with Lopinavir/Ritonavir (LPV/RTV) in moderate Coronavirus disease 2019 (COVID-19). Participants were randomly assigned to receive a single dose of hydroxychloroquine (HCQ) plus ATZ/RTV or LPV/RTV for a minimum of 5 to a maximum of 10 days. The primary outcomes were the reduced length of hospital stay and clinical recovery within 10 days from starting the intervention. The rate of intensive care unit (ICU) admission, intubation, and mortality, the lengths of ICU stay and being intubated, recovery within 14 days, and the frequency of adverse reactions was considered as secondary outcomes. Among 132 enrolled patients, 62 cases in each arm were analyzed at the end of the intervention. Fifty-one (82.3%) cases in the ATZ/RTV arm versus 41 (66.1%) in the LPV/RTV arm were discharged within 10 days (P = 0.06). The median number of the intervention days was 6 (IQR: 5-8) in ATZ/RTV arm versus 7 (IQR: 6-9) in LPV/RTV arm (P = 0.01). The rate and length of ICU admission and intubation (P ≥ 0.99), rate of mortality (P = 0.49), and recovery within 14 days (P = 0.09) were not statistically different between groups. The most reported adverse reactions were nausea and vomiting that all cases were in the LPV/RTV arm (P = 0.006). ATZ/RTV is better tolerated in comparison with LPV/RTV; however, it did not show more efficacies than LPV/RTV in clinical outcomes of COVID-19 in this study.

To evaluate the stone-free rates, quality of life, complications, use of fluoroscopy, analgesic requirements, a hospital stay following the management of lower calyceal with two different techniques (Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery) in a prospective manner.

50 patients with a diagnosis lower pole 1-2 cm stone were included into the study and were randomized into two groups.(Mini PCNL n: 25) ( RIRS n: 25). Safety and efficacy of both methods along with some other certain related factors were comparatively evaluated in both groups.

There was no significant difference between preoperative stone size, stone to skin distance, hemogram and creatinine values, need for analgesic drug, patients' replies to visual analog scale (VAS). The duration of both the hospital stay and the exposure to fluoroscopy, hematocrit decrease due to hemorrhage, complication rates were significantly higher in cases undergoing mini PCNL when compared to RIRS. Additionally, any significant difference was not observed with respect to the stone-free rates. Despite an increase in quality of life following the both type operations was noted; there was no significant difference in the quality of life between the patients in both groups.

Our findings demonstrated that both surgical techniques are the feasible alternatives in the minimal invasive treatment of lower pole stones. Although there was no meaningful difference in stone-free rates between two groups; complications, use of fluoroscopy, bleeding and duration of hospital stay were noted to be significantly higher in cases treated with mini PCNL.

COVID-19 is a new disease for which a definitive treatment has not yet been proposed. Therefore, the present study aimed to investigate the effect of combination therapy on the treatment of COVID-19 due to the importance of finding an appropriate treatment for this epidemic disease.

This two-center cohort study included 175 confirmed COVID-19 inpatients at two medical centers designated for the treatment of COVID-19 patients in Qom and Qazvin, Iran. In this study, four different groups of drug regimens were studied which included G1 (azithromycin, prednisolone, and naproxen), G2 (lopinavir/ritonavir, azithromycin, naproxen, and prednisolone), G3 (hydroxychloroquine, azithromycin, naproxen, and prednisolone), and G4 (levofloxacin, vancomycin, hydroxychloroquine, and oseltamivir). It should be noted that G1, G2, G3, and G4 treatment regimens were used on 48, 39,30, and 77 patients, respectively.

The study participants included 175 confirmed COVID-19 patients with mean±SD age of 58.9 ±15.1 years, out of whom 80 (46%) patients were male and the rest were females. The results indicated that the hospital stay period was significantly shorter in the G1 compared to other groups (G1:5.9±2.4, G2:8.1±4.2, G3: 6.3±1.7, and G4: 6.4±2.9; [P-value=0.008]). It should be noted that pulse rate, oxygen saturation, hemoglobin, and platelet count (PLT) changed significantly during the study in four treatment groups; however, a significant change in temperature, creatinine, and white blood cell (WBC) was observed only in G3, G4, and G1 groups, respectively. The number of ICU admissions and deaths were not statistically significant among the patients who received the four treatment regimens (P=0.785). Based on the results, the history of ischemic heart disease, baseline oxygen saturation, WBC, neutrophil, lymphocyte count, and C-reactive protein (CRP) are the risk factors for the prolonged hospital stay in COVID-19 patients.

The obtained results in this study indicated that the combination of azithromycin, prednisolone, and naproxen is the most effective regimen for the treatment of COVID-19, compared to three other combination treatment regimens.

The trauma is a major reason for various disabilities and even death around the world. Prompt actions and appropriate management are needed to minimize the level of injuries and mortality. An effective tool is needed to assess the prognosis of the patient in trauma. The objective of the study was to compare the evaluation of RTS and injury severity score (ISS) as a prognosis predictor among trauma patients.

A cross‑sectional clinical observational study was conducted in the emergency department. A total of 88 samples were selected by random sampling technique. The data collection was done using demographic and clinical tools, Glasgow Coma Scale, Revised Trauma Score (RTS), and ISS. Data analysis was performed using SPSS 18.

In the present study, the majority of the participants (79.54%) were male. The most common mode of injury among the patients was road traffic accidents (54.54%) with blunt trauma. The findings revealed a negative correlation (‒0.368) between RTS and ISS scores with significant P = 0.0004. RTS (<10) and ISS (≥20) have significant association with mortality and hospital stay. The sensitivities of ISS and RTS with mortality were 84.2% and 89.4%, respectively.

RTS is a comparatively better predictor of prognosis than ISS among trauma patients. Lower RTS and higher ISS are significantly associated with mortality and long hospital stay. Early evaluation of the injury level can be effective in patient management.

 Lumbar spine operations can be safely performed under general or neuroaxial anesthesia, but there are controversies as to the clinical outcomes and cost benefits of each method. The goal of this systematic review and meta-analysis was to determine the advantages of each technique (i.e., regional or general anesthesia) for lumbar spine surgery with regards to cost, duration of surgery, duration of post anesthesia care unit, and duration of hospital stay.
Data Sources: We conducted a systematic search for articles comparing regional anesthesia (RA) versus general anesthesia (GA) for lumbar spine surgery using three major databases (i.e., PubMed, EMBASE, and Google Scholar), without limitation for date and language of publication. We also manually double checked the references of all the related articles to detect missed articles by electronic searching. The last search was performed before September 2018; the quality of the included articles was assessed by different checklists according to the type of the article. STATA software (V. 10) was used for performing meta-analysis.

Twenty-eight articles were included in this meta-analysis. Cost data were presented in seven studies and reported a significant decrease in the cost of treatment in RA patients compared with GA patients. The standard mean difference (SMD) (95% CI) for cost was 1.64 (1.53 to 1.75); z = 29.17; P < 0.001; I2 = 98.9. Surgical time data were presented in 25 studies, which reported significant reduction in the surgery time in RA patients compared with GA patients, the SMD (95% CI) for surgery time was 0.77 (0.71 to -0.84); z = 23.9; P < 0.001; I2 = 97.9. Post anesthesia care unit (PACU) stay data were presented in 16 studies and reported significant increase in PACU stay in RA patients compared with GA patients. The SMD (95% CI) for PACU stay time was -0.4 (-0.49 to -0.31); z = 8.65; P < 0.001; I2 = 99.2. Hospital stay data were presented in 18 studies and reported significant decrease in hospital stay time in RA patients compared with GA patients. The SMD (95% CI) for hospital stay time was 0.76 (0.68 to 0.84); z = 18.81.; P < 0.001; I2 = 98.3. Egger and Begg’s tests showed no significant publication bias.

This comprehensive systematic review showed that RA has several advantages over GA with respect to cost, surgery time, and duration of hospital stay in patients undergoing lumbar spine surgery, while increase in PACU stay time was observed in RA patients.

A prolonged hospital stay causes bed occupancy rates and increases hospital costs. This study aimed to determine the factors affecting the ICU length of stay after coronary artery bypass graft surgery (CABG).

In this descriptive cross-sectional study, 346 patients undergoing CABG between March 2015 and September 2016 were ed through convenience sampling. Based on their ICU length of stay, the patients were divided into 2 groups: ICU length of stay ≤ 72 hours (3 d) (Group A) and ICU length of stay > 72 hours (Group B).

Among the 346 patients studied, 93 (27%) patients had an ICU length of stay ≥ 72 hours and 253 (73%) patients had an ICU length of stay < 72 hours. There was no statistically significant difference in the ICU length of stay between the women and men (P = 0.536). The subjects with a history of diabetes and hypertension were more likely to stay in the ICU for a longer period. For the patients with an ICU stay > 72 hours, the number of blood products received; the use of inotropes; the duration of cardiopulmonary bypass; the duration of intubation; cardiac, pulmonary, neural, and renal complications; infection, receiving inotropes in the ICU; postoperative bleeding; return to the operating room; receiving blood; and a history of bleeding were among the influential factors during the patients’ stay in the ICU.

The results of this study showed that the factors increasing the ICU length of stay after CABG were old age, a reduced left ventricular ejection fraction, a prolonged cardiopulmonary bypass time, receiving inotropes, prolonged intubation, the use of the intra-aortic balloon pump, receiving blood products, and postoperative bleeding. 

Acute gastroenteritis is one of the major causes of pediatric hospitalization and mortality worldwide. Vitamin D can improve the immune system, and its deficiency may exacerbate the severe symptoms of any infectious disease. Thus, the aim of this study was to investigate the effect of vitamin D on children admitted to a hospital due to acute gastroenteritis. In this double-blind randomized placebo-controlled trial, 100 children aged 3 months to 14 years old hospitalized due to acute gastroenteritis in Bandar Abbas pediatric hospital, Iran, were enrolled. The participants were divided into two groups of case and placebo (n = 50 per group). Patients were excluded from the study if they met the exclusion criteria. After obtaining parental (or guardian) consent, in addition to the conventional treatment of gastroenteritis, the placebo group received 2 cc of olive oil (as placebo) and the cases received 100000 IU of vitamin D (ZAHRAVI Vit D3). Discharge criteria included reduction of fever and defecation and improvement of the patient’s general condition. The required data including age, sex, baseline serum vitamin D level, level of dehydration, axillary temperature, and length of hospital stay were recorded in a checklist by a physician. Descriptive statistics, chi-square test, and Student’s t-test were used to compare the recorded data in SPSS, version 24. The mean lengths of hospital stay were 3.46 and 2.54 days in the placebo and case groups, respectively, indicating a significant difference between the two groups in this regard (P < 0.001). However, there were no significant age and sex differences between the two groups regarding hospital stay (P = 0.09 and P = 0.14). Furthermore, there was no significant relationship between length of hospital stay and the level of dehydration in either group (P = 0.15). We found that axillary temperature at discharge was significantly lower in the vitamin D group than the placebo group (P = 0.017). In general, length of hospital stay was shorter in the vitamin D group, and there was no difference between patients with baseline vitamin D level of < 30 ng/mL and those with vitamin D level of ≥ 30 ng/mL in the vitamin D group regarding length of hospital stay (P = 0.057). On the contrary, in placebo group, hospital stay was significantly longer in those with vitamin D level of < 30 ng/mL (P = 0.039). This prospective study demonstrated that vitamin D supplementation is significantly related to the reduction of hospital stay in pediatric acute gastroenteritis patients aged 3 months to 14 years old. This finding was achieved after unification of the confounding variables such as socioeconomic status. We also noted that the effect of vitamin D on hospital stay was not associated with age, sex, and level of dehydration.

Hospital beds are among valuable resources for care delivery. Therefore, optimum use of them is crucial for increasing the efficiency of health-care services and controlling health-care costs.
This study intended to evaluate inappropriate patient stay (IPS) in hospital settings and its reasons based on the appropriateness evaluation protocol.
This cross-sectional study was conducted on 335 patients hospitalized in a tertiary care university hospital. Data were gathered prospectively by 13 hospital nurses during a 6-month period. IPS rate was evaluated using a checklist, the 27 criteria of which were related to medical services, nursing/life support services, and patient's conditions. Moreover, a 12-item checklist was used to determine physician-, hospital-, and patient/family-related factors behind inappropriate hospital stay.
In total, 121 of 1925 (6.3%) hospitalization days of 335 patients were determined to be inappropriate. Neurosurgery and gynecology wards had the highest and the lowest inappropriate hospital stay rates (22.5% vs. 0%), respectively. The main reasons behind inappropriate hospital stay were hospital-related factors (33.1%), physician-related factors (29.1%), and patient-related factors (21.3%).
A wide variety of physician-, hospital-, and patient/family-related factors contribute to IPS. Given the multifactorial causes of IPS, reducing its rate necessitates multidisciplinary approaches.

To compare results of studies on supine and prone percutaneous nephrolithotomy (PCNL) techniques to find the best position for treating kidney stones.
A systematic literature review was done in April 2016 using PubMed, Scopus, and Web of Science databases to identify the relevant studies. Article selection was based on the preferred reporting elements of systematic reviews and meta-analysis criteria. A subgroup analysis was done comparing standard prone and supine PCNLs separately.
Twenty studies were selected for the analysis including 7733 PCNL cases: 2110 cases were (27.3%) in supine and 5623 cases were (72.7%) in prone position. Supine and prone PCNL had a similar stone-free rate (OR: 0.95; 95% CI: 070-1.27; P = 0.73), operation time (difference in means = -0.01, 95% CI: -0.07 to 0.03; P = .53), hospital stay (differencein means = 0.01, 95% CI: -0.07 to 0.03; P = .52), complication rate (OR: 0.88; 95% CI: 0.76-1.02; P = .09) and urinary leakage (OR: 1.14; 95% CI: 0.50-2.59; P = .75). However, patients received less blood transfusion (OR: 0.72; 95% CI: 0.55-0.94; P = .01) and had less fever rates (OR: 0.65; 95% CI: 0.52-0.80; P Supine PCNL has similar stone-free rate, operation time, and hospital stay relative to prone PCNL. However, the supine position has the advantage of less fever and need for blood transfusion. Although both prone and supine PCNLs are suggested for treatment, supine PCNL may have advantages especially in patients with comorbidity.

To determine the hospital required beds using stochastic simulation approach in cardiac surgery departments.
This study was performed from Mar 2011 to Jul 2012 in three phases: First, collection data from 649 patients in cardiac surgery departments of two large teaching hospitals (in Tehran, Iran). Second, statistical analysis and formulate a multivariate linier regression model to determine factors that affect patient's length of stay. Third, develop a stochastic simulation system (from admission to discharge) based on key parameters to estimate required bed capacity.
Current cardiac surgery department with 33 beds can only admit patients in 90.7% of days. (4535 d) and will be required to over the 33 beds only in 9.3% of days (efficient cut off point). According to simulation method, studied cardiac surgery department will requires 41-52 beds for admission of all patients in the 12 next years. Finally, one-day reduction of length of stay lead to decrease need for two hospital beds annually.
Variation of length of stay and its affecting factors can affect required beds. Statistic and stochastic simulation model are applied and useful methods to estimate and manage hospital beds based on key hospital parameters.

The readiness of mothers to take care for infants at discharge is a critical issue. Poor readiness of mothers in taking care of premature infants at the time of discharge is associated with potential adverse consequences. This study examined the effect of implementing mothers’ empowerment program on the weight gain and duration of hospitalization in premature infants.
This study was a quasi-experimental before–after study with a control group, in which 80 mothers with premature infants who were hospitalized in NICU Level II of two hospitals were recruited in the study. Mothers’ empowerment program was implemented as a three-stage training program for the intervention group. Mothers’ readiness questionnaire was
completed by the mothers before the intervention and at the discharge time. The changes in mean of mothers’ readiness scores were compared in both the groups.
The mean of daily weight gain in infants of the intervention group (3.95 g) was significantly higher than that of the infants in the control group (−0.9 g) (P = 0.003). The average duration of hospitalization for infants in the intervention and control groups was 15.45 days and 20.95 days, respectively, showing a statistically significant difference (P = 0.003).
Providing training to the mothers regarding how to care for premature infants can be a useful and effective method in the process of weight gain of premature and low-birth newborns, and may shorten the duration of infants’ hospitalization.

In recent decades, the increasing crowdedness of the emergency departments has posed various problems for patients and healthcare systems worldwide. These problems include prolonged hospital stay, patient dissatisfaction and nurse burnout or job dissatisfaction.

The aim of this study was to investigate the effect of emergency department (ED) nurses’ job specialization on their job satisfaction and the length of patient stay in the ED.

This before-after quasi-experimental study was conducted from April to May 2014 at the Baqiyatallah Hospital, Tehran, Iran. Initially, 35 patients were recruited as controls and the length of their stay in the ED was measured in minutes via a chronometer; Moreover, nurses’ job satisfaction was evaluated using the Mohrman-Cooke-Mohrman job satisfaction scale. Then, a job specialization intervention was developed based on the stabilization model. After that, 35 new patients were recruited to the treatment group and received specialized care services. Accordingly, the length of their stay in the ED was measured. Moreover, the same nurses’ job satisfaction was re-evaluated after the study. The study intervention lasted one month. Data were analyzed using the SPSS software version 20 and statistical tests such as the Kolmogrov-Smirnov, the paired and the independent t, and chi-square tests.

There was a significant difference between the two groups of patients concerning the length of their stay in the ED (P < 0.001). Moreover, compared with the pretest readings, nurses had greater job satisfaction after the study (P < 0.001).

The job specialization intervention can improve nurses’ satisfaction and relieve the crowdedness of the EDs.

To predict hospital stay by using various clinical parameters at admission.Patients and This prospective observational study was conducted over a period of one year (Jan – Dec 2010) in a tertiary level teaching hospital in North India. Out of 344 neonates admitted, 41 left against medical advice and were excluded. At time of admission, initial vital signs were noted along with basic information. All neonates were assessed on the basis of clinical parameters and followed up to the discharge/death. Final outcome was noted in terms of total duration of hospital stay in survived and non survived neonates. In the statistical analysis, Odds ratio along with 95% confidence intervals was calculated for each parameter and significant associations (p value ≤ 0.05) were studied. Of 30 clinical variables, 18 were found to be significantly associated with prolonged hospitalization viz more than 7days in survived neonates. These include abnormal heart rate (>160/min or <100/min), abnormal respiratory rate (>60/min or <30/min), abnormal SpO2 (<90%), prolonged capillary filling time (≥3seconds), moderate hypothermia or hyperthermia, decreased consciousness level, abnormal quality of cry, reduced or no activity, presence of pallor, icterus involving soles, central cyanosis, dehydration, chest recessions, respiratory distress, abdominal distension, hypotonia and incomplete or absent Moro’s reflex in term neonates and absent or sluggish deep tendon reflexes. Similarly, three parameters were found to be significantly associated with death of non survived neonates within 7 days of hospital stay- abnormal respiratory rate (>60/min or <30/min), abnormal SpO2 (<90%), prolonged capillary filling time (≥3seconds). Hospital stay of the neonate can be predicted at time of admission using these simple, easily assessed, promptly at bedside clinical parameters.