Differences in the length of postoperative care of endoscopic endonasal surgery in simple and complex surgical procedure groups.

Background: The rapid development of endoscopic endonasal surgery has made the procedure widely used in nasal and sinus surgery. Endoscopic endonasal surgery is a minimally invasive procedure, but the possibility of postoperative damage to the sinonasal mucosa cannot be ruled out. The aim of this study was to analyze the difference in the length of postoperative care between complex and simple endoscopic endonasal surgeries which can be used as a reference in planning postoperative care.   Methods: This was a retrospective cross-sectional observational study. The participants were divided into two groups, i.e., simple, and complex surgical procedures groups. The simple procedure group consisted of middle meatal anstrostomy, uncinectomy, endoscopic septoplasty, and endoscopic turbinoplasty. The complex procedure group included frontal sinusotomy, sphenoidectomy, as well as anterior and posterior ethmoidectomy. The length of postoperative care between the two groups were measured and analyzed using the Chi-square test.   Results: The median length of care in the complex procedure group was significantly longer than that in the simple procedure group (p = 0.028), 12 weeks and 9 weeks, respectively. The number of postoperative outpatient visits was significantly less in the simple procedure group compared with the complex procedure group (Median 4 vs. 5; p=0.015). There was a significant correlation between length of care and the endonasal endoscopic surgical procedure group (p = 0.023).   Conclusions: The complex endoscopic endonasal surgery group required a longer length of care and more postoperative outpatient visit than the simple procedure group.

WHODAS 2.0: Associations of functional disability with sex, age, and length of care in outpatients with schizophrenia-spectrum disorders.

Schizophrenia is a disabling mental disorder that is associated with impairments in both social and occupational functioning. Few studies, however, have explored functional domains of disability and its associations with age, sex, and length of care. As part of a hospital quality improvement initiative, data were collected on outpatients' age, sex, length of care, and levels of disability (using the WHODAS 2.0; N=180; M=45.72; 68% male). Mean disability summary and domain scores were compared with population norms from international samples and two published studies in schizophrenia. A series of three-way ANOVAs and post-hoc tests evaluated differences in levels of disability based on age, sex, and length of care categories. Sample mean summary scores were comparable to published studies in schizophrenia (M=24.81; SD=17.37; 85th percentile). Statistically significant main effects of sex and age on summary and domain-specific scores were found, whereas length of care was not significant. A statistically significant three-way interaction of sex x length of care x age was found for summary and mobility scores. Findings provide support for the reliability and validity of the WHODAS 2.0 in outpatients with schizophrenia. Although causal inferences cannot be made, findings show that age and sex are important factors to consider in addressing disability.

Identifying the Main Predictors of Length of Care in Social Care in Portugal.

In this paper, we aim to identify the main predictors at admission and estimate patients' length of care (LOC), within the framework of the Portuguese National Network for Long-Term Integrated Care, considering two care settings: (1) home and community-based services (HCBS) and (2) nursing home (NH) units comprising Short, Medium, or Long Stay Care. This study relied on a database of 20,984 Portuguese individuals who were admitted to the official long-term care (LTC) system and discharged during 2015. A generalised linear model (GLM) with gamma distribution was adjusted to HCBS and NH populations. Two sets of explanatory variables were used to model the random variable, LOC, namely, patient characteristics (age, gender, family/neighbour support, dependency levels at admission for locomotion, cognitive status, and activities of daily living [ADL]) and external factors (referral entity, number of beds/treatment places per 1,000 inhabitants ≥65 years of age), maturity and occupancy rate of the institution, and care setting. The features found to most influence the reduction of LOC are: male gender, having family/neighbour support, being referred by hospitals to NH (or by primary care to HCBS), and being admitted to units with a lower occupancy rate and with fewer months in operation. Regarding the dependency levels, as the number of ADL considered "dependent" increases, LOC also increases. As for the cognitive status, despite the opposite trend, it was only statistically significant for NH. Furthermore, two additional models were applied by including "death," although this feature is not observable upon admission. By creating a model that allows for an estimate of the expected LOC for a new individual entering the Portuguese LTC system, policy-makers are able to estimate future costs and optimise resources.

Neste artigo, pretendemos identificar os principais preditores na admissão e estimar a duração de cuidados dos doentes (LOC) na Rede Nacional de Cuidados Continuados Integrados, considerando duas tipologias de cuidados: Cuidados Domiciliários (HCBS) e três Tipologias de Internamento (NH), nomeadamente Cuidados de Curta, Média e Longa duração. Este estudo assenta numa base de dados de 20.984 indivíduos com admissão e alta durante o ano de 2015, na Rede Nacional de Cuidados Continuados. Um modelo linear generalizado (GLM) com distribuição Gama foi ajustado para as populações HCBS e NH. Dois conjuntos de variáveis explicativas foram utilizados para modelar a variável aleatória LOC, nomeadamente, características do doente (idade, género, apoio familiar / vizinhos, níveis de dependência na admissão para locomoção, cognitivo e atividades da vida diária) e fatores externos (entidade referenciadora, número de camas / locais de tratamento por 1.000 habitantes com 65 ou mais anos), maturidade e taxa de ocupação da instituição, assim como a tipologia de cuidados. As características que mais influenciam a redução da LOC são o género masculino, ter apoio familiar / vizinhos, ser encaminhado por hospitais das NH (pelos cuidados primários nas HCBS), receber cuidados em unidades com menor taxa de ocupação e com menos meses de funcionamento. Em relação aos níveis de dependência, à medida que aumenta o número de atividades diárias consideradas "dependentes," aumenta igualmente a LOC. Quanto ao estado cognitivo, apesar da tendência oposta, apenas se verificou estatisticamente significativo nas NH. Além do mais, dois modelos adicionais foram realizados incluindo a "morte," embora esse recurso não seja observável na admissão. Ao criar um modelo que permite estimar a LOC esperada para um novo indivíduo que entra no sistema LTC português, os decisores políticos serão capazes de estimar os custos futuros e otimizar recursos.

Trends in length of hospice care from 1996 to 2007 and the factors associated with length of hospice care in 2007: findings from the National Home and Hospice Care Surveys.

Using the National Home and Hospice Care Surveys, we examined trends in length of hospice care from 1996 to 2007 and the factors associated with length of care in 2007. Results suggest that the increasing average lengths of care over time reflect the increase in the longest duration of care. For-profit ownership is associated with hospice care received for over a year.

Enteral glutamine supplementation reducing infectious morbidity in burns patients: a randomised controlled trial.

PURPOSE: Enteral glutamine supplements have been shown to reduce infectious morbidity in trauma patients, but their effect on patients with burns is not completely studied. The objective of this study was to measure the impact of enteral glutamine supplementation on infectious morbidity and in turn, the hospital-stay in patients with burns. METHODS: Thirty patients with burns were randomly divided into two groups with 15 patients in each, the study (glutamine supplemented) and control group. Patients were randomised to receive either isonitrogenous mixture without glutamine or isonitrogenous mixture with glutamine until complete healing of the burn wound occurred. Incidence of positive blood culture, wound culture, total leucocyte count, hospital-stay and mortality was recorded. RESULTS: The results showed that the incidence of positive blood culture was considerably reduced in the study group (0.20±0.41) vs. control (0.73±0.96; p = 0.065). The incidence of positive wound culture was significantly reduced in the study group (1.00 ± 1.25) vs. control (3.53 ± 2.47; p = 0.001). In addition, the wound healing was better and hospital-stay days were reduced in the study group (22.73 ± 9.13 days) vs. (39.73 ± 18.27 days; p = 0.003). CONCLUSIONS: These results indicate that enteral glutamine supplementation in adult burn patients could abate the degree of infectious morbidity and reduce hospital-stay.