The mystery of "missing" visits in an emergency cardiology department, in the era of COVID-19.; a time-series analysis in a tertiary Greek General Hospital.

BACKGROUND: In the era of the current COVID-19 health crisis, the aim of the present study was to explore population behavior as regards the visits in the Εmergency Cardiology department (ECD) of a tertiary General Hospital that does not hospitalize SARS-CoV-2 infected patients METHODS AND RESULTS: Daily number of visits at the EDC and admissions to Cardiology Wards and Intensive Care Unit of a tertiary General Hospital, in Athens, Greece, were retrieved from hospital's database (January 1st-April 30th 2018, 2019 and 2020). A highly significant reduction in the visits at ECD of the hospital during March and April 2020 was observed as compared with January and February of the same year (p for linear trend < ·001); in particular the number of visits was 41.1% lower in March 2020 and 32.7% lower in April 2020, as compared to January 2020. As the number of confirmed COVID-19 cases throughout the country increased (i.e., from February 26th to April 2nd) the number of visits at ECD decreased (p = 0.01), whereas, the opposite was observed in the period afterwards (p = 0.01).The number of acute Myocardial infarctions (MI) cases in March 2020 was the lowest compared to the entire three year period (p < 0·001); however, the number of acute MI cases in April 2020 was doubled as compared to March 2020, but still was lower than the preceding years (p < 0·001). CONCLUSIONS: It is hard to explain the mystery of the "missing" emergency hospital visits. However, if this decline in cardiovascular disease related hospital visits is "true", it is something that needs to be rigorously studied, to learn how to keep these rates down.

Antibiotic Prescription Practices of Pediatricians and Pediatric Residents in Hospital Care in Greece.

INTRODUCTION: The administration of antibiotics for the treatment of pediatric illnesses is common, reaching one third of pediatric patients. This paper aims to identify the antibiotic prescription practices of pediatricians and to explore the associations between prescribing practices and a series of socio-demographic and professional determinants in Greece. MATERIAL AND METHOD: A cross-sectional study was conducted in public hospitals providing secondary and tertiary pediatric care from January to July 2012. A self-administered questionnaire was developed and tested in a pilot study, focusing on respondents' characteristics, their practices and attitudes related to prescribing antibiotics in common childhood diseases, diagnostic uncertainty, and parental demand. Multivariate regression analysis was performed. RESULTS: In total, 275 physicians responded to the questionnaire (61% response rate). The majority of the physicians prescribed antibiotics empirically in possible group A streptococcus infections (56.9%) and implemented the "watchful waiting" approach in acute otitis media (65.5%); further, they did not feel diagnostic uncertainty (74%) and were not affected by parental demand (81%). Finally, when prescribing, they did not take into consideration the drug cost (64.4%). Gender, physicians' experience, and the type of hospital (specialized or general hospital) were identified as prognostic factors of prescribing practices. CONCLUSION: Our findings could provide decision-makers with insights into how to manage physicians' prescription practices in order to reduce the high rates of antibiotic consumption that Greece is facing nowadays.

Long-term effect of fee-for-service-based reimbursement cuts on processes and outcomes of care for stroke: interrupted time-series study from Taiwan.

BACKGROUND: As healthcare spending continues to increase, reimbursement cuts have become 1 type of healthcare reform to contain costs. Little is known about the long-term impact of cuts in reimbursement, especially under a global budget cap with fee-for-service (FFS) reimbursement, on processes and outcomes of care. The FFS-based reimbursement cuts have been implemented since July 2002 in Taiwan. We examined the long-term association of FFS-based reimbursement cuts with trends in processes and outcomes of care for stroke. METHODS AND RESULTS: We analyzed all 411,487 patients with stroke admitted to general acute care hospitals in Taiwan during the period 1997 to 2010 through Taiwan's National Health Insurance Research Database. We used a quasi-experimental design with quarterly measures of healthcare utilization and outcomes and used segmented autoregressive integrated moving average models for the analysis. After accounting for secular trends and other confounders, the implementation of the FFS-based reimbursement cuts was associated with trend changes in computed tomography/magnetic resonance imaging scanning (0.31% per quarter; P=0.013), antiplatelet/anticoagulant use (-0.20% per quarter; P<0.001), statin use (0.18% per quarter; P=0.027), physiotherapy/occupational therapy assessment (0.25% per quarter; P<0.001), and 30-day mortality (0.06% per quarter; P<0.001). CONCLUSIONS: There are improvement trends in processes and outcomes of care over time. However, the reimbursement cuts from the FFS-based global budget cap are associated with trend changes in processes and outcomes of care for stroke. The FFS-based reimbursement cuts may have long-term positive and negative associations with stroke care.

The Mental Health Care Act No 17 - South Africa. Trials and triumphs: 2002-2012.

The Mental Health Care Act 17 of 2002 (MHCA) was promulgated in 2004. It has been hailed as one of the most progressive pieces of mental health legislation. A true measure of its merit is the degree to which it has transformed mental health services and in particular improved the quality of care. This paper will describe the impact of the Act on mental health care service delivery in the country. Literature pertaining to the MHCA published from 2006-2012, a report compiled by the South African Society of Psychiatrists and the results of a national survey conducted among Heads of Departments of Psychiatry, Mental Health Review Boards and Provincial Directors of Mental Health was reviewed. The MHCA has been successful in shifting the emphasis of care from psychiatric institutions to general hospitals. However, the integration of services has been hampered by infrastructure constraints and shortages of mental health personnel. It has been less successful in integrating mental health care into primary health services where the focus remains largely on the pharmacological maintenance treatment of the chronically mentally ill. Little attention has been given to the health promotion, disease prevention and rehabilitation aspects of care. Mental health review boards contend with limited resources, administrative challenges and limited political support. Isolated pockets of success characterised the implementation of the MHCA across the country. Greater investment of resources is needed to ensure the comprehensive implementation of the Act.

Trends in intensive care in patients over 90 years of age.

BACKGROUND: Average life expectancy has increased over the past century, leading to a larger proportion of elderly in the population. Comorbidity and dependence increases with age, and recent data have shown that the number of elderly patients admitted to intensive care is increasing. This has implications for the availability of health care for these patients, as health care is a finite resource. OBJECTIVE: This study examines the demographics of patients aged over 90 years who were admitted into the medical intensive care unit, in order to verify the results of previous research. METHODS: From 2007 to 2011, a retrospective study was conducted in very elderly patients (over 90 years of age) and elderly patients (between 80 and 89 years of age) admitted into intensive care in Vinzentius Hospital, a medium-size, acute-care, general hospital in Landau, Germany. RESULTS: A total of 8554 intensive care treatments were carried out in the study period. The number of intensive care treatments performed on patients aged over 90 years and those aged 80 to 89 years was 212 (2.48%) and 1715 (20.05%), respectively. No increase in the number of medical intensive care treatments was observed in very elderly patients over this period. CONCLUSION: Compared to the results of previous studies, an increase in the number of medical treatments in the intensive care units of patients aged over 90 years over the study period could not be found.

Teledermatology via a social networking web site: a pilot study between a general hospital and a rural clinic.

Teledermatology via a free public social networking Web site is a practical tool to provide attention to patients who do not have access to dermatologic care. In this pilot study, a general practitioner sent consults to a dermatology department at a general hospital via Facebook(®). Forty-four patients were seen and treatment was installed. We identified both simple-to-treat, common skin diseases and rare congenital diseases that require genetic counseling and more complex treatment. The majority of patients (75%) benefited with the diagnoses and treatments offered, thus avoiding unnecessary expenses or transportation to urban areas.

Retrospective study of pressure ulcer prevalence in Dutch general hospitals since 2001.

OBJECTIVE: To investigate whether factors such as patient characteristics, pressure ulcer (PU) prevention strategies and the structural quality indicators used by institutions and wards can explain an apparent decline in PU prevalence from 2001 to 2008. METHOD: The Dutch National Prevalence Survey of Care Problems (known as LPZ) database from 2001 to 2008 was used to explore differences in patient characteristics, PU prevention strategies and structural quality indicators used by institutions and wards between two periods, 2001-2004 (PU as an internal health-care quality indicator) and 2005-2008 (PU as an external health-care quality indicator). RESULTS: Compared with 2001-2004, fewer participants with CVA /hemiparesis (OR 0.485), infectious diseases (OR 0.861), surgery lasting >2 hours (OR 0.637), at-risk Braden scale scores (OR 0.844), and more participants with diabetes mellitus (OR 1.693) were found in the 2005-2008 group. More special beds/mattresses (OR 2.216) and special cushions in wheelchairs (OR 2.277) were used in the 2005- 2008 period, as well as slightly more repositioning, dehydration/malnutrition prevention and PU prevention and treatment information. More institutions had information leaflets (OR 5.894), PU prevention guidelines (OR 4.625), a PU committee (OR 2.503), and a PU-wound care nurse at ward level (OR 2.434) in the 2005-2008 period. CONCLUSION: The decline in PU prevalence at Dutch general hospitals after 2004 may be partly explained by differences in patient characteristics, improved structural quality indicators and a slight improvement in PU prevention. Further research is needed to find evidence of which individual factors can explain the decline in PU prevalence after 2004 and whether any changes in health care policy have impacted on these prevalence rates.

[Some aspects of outpatient care in the modem world].

The problems of improvement of outpatient care are considered, methodology of more active implementation of hospitalization technologies, the use of day care, hospital at home is proposed. It is emphasized that the introduction of hospitalization technology makes it less than treatment in hospital costs to improve quality of life for huge numbers of patients.

Specialty hospital market proliferation: Strategic implications for general hospitals.

BACKGROUND: Since the early 1990s, specialty hospitals have been continuously increasing in number. A moratorium was passed in 2003 that prohibited physicians' referrals of Medicare patients to newly established specialty hospitals if the physician has ownership stakes in the hospital. Although this moratorium expired in effect in 2007, many are still demanding that the government pass new policies to discourage the proliferation of specialty hospitals. PURPOSE: This study aimed at examining the regulatory and environmental forces that influence specialty hospitals founding rate. Specifically, we use the resource partitioning theory to investigate the relationship between general hospitals closure rates and the market entry of specialty hospitals. This study will help managers of general hospitals in their strategic thinking and planning. METHODOLOGY: We rely on secondary data resources, which include the American Hospital Association, Area Resource file, census, and Center for Medicare and Medicaid Services data, to perform a longitudinal analysis of the founding rate of specialty hospital in the 48 states. Specifically, we use the negative binomial generalized estimating equation approach available through Stata 9.0 to study the effect of general hospitals closure rate and environmental variables on the proliferation of specialty hospitals. FINDINGS: Specialty hospitals founding rate seems to be significantly related to general hospitals closure rates. Moreover, results indicate that economic, supply, regulatory, and financial conditions determine the founding rate of specialty hospitals in different states. PRACTICE IMPLICATIONS: The results from this study indicate that the closure of general hospitals creates market conditions that encourage the market entry of specialized health care delivery forms such as specialty hospitals. Managers of surviving general hospitals have to view the closure of other general hospitals not just as an opportunity to increase market share but also as a threat of competition from new forms of health care organizations.

Time trends in health care needs of non-EU citizens from developing countries, admitted to a general hospital in northern Italy.

Hospitalizations of foreign patients from developing countries outside the European Union were examined for the period 1999-2004, focusing on infectious diseases and on pregnancy issues. Patients over 14 years old had 6,003 admissions, leading to 7,231 overall diagnoses. During the 6-year study period, female hospitalizations increased steadily, with a peak in 2002 (p .001). This trend was mainly due to the rise in women from Eastern Europe (p .001), which occurs at a younger mean age versus that of males (p .001). Admission of illegal immigrants, performed on an emergency basis, accounted for an average of 9.4%. This phenomenon was very frequent in 1999 (43% of admissions), but dropped sharply after 2002 (p .001), caused by changes in Italian law. The prevalent women diagnoses were ob/gyn ones: voluntary pregnancy interruption, spontaneous abortion or pregnancy complications in 30.6% of cases, and childbirths or controls of pregnancies with a favourable outcome in 18.2% of patients. These diagnoses covered nearly 50% of hospitalizations of migrant women: other admissions were due to organic, dysmetabolic, or functional disorders, while infectious diseases were less frequent (4.6%). Among men, dysmetabolic disorder and organic-degenerative diseases, or functional illnesses (36.2%), were prominent, and significantly more frequent versus women (p .001), as well as post-traumatic diseases (16.5%), and infectious illnesses (12.1%; p .001). Also generic-undefined diagnoses were proportionally numerous (6.6%): cultural-language deficiencies affected the physician-patient relationship. Among infectious diseases, the main causative organisms were Mycobacterium tuberculosis (14.9%), HIV (7.1%), HBV (3.3%), and HCV (2.6%). Upper-lower airways represented the most involved organ system (45% of discharges), followed by the gastroenteric tract (16.4%), and skin-soft tissues (7.4%), while systemic infectious diseases accounted for 14.9% of episodes. Such disorders predominated (up to 90% of cases) among non-regular migrants during 1999-2000, while after 2002 an increase in infectious disorders was observed among patients from Eastern Europe. From a health care-social perspective, although a reduced incidence of infectious diseases did not occur, the possibility of attributing them to individuals of ascertained identity and housing makes it possible to trace index patients, and ultimately strive towards well-planned and effective therapeutic-preventive interventions.

Consultation-liaison psychiatry: how far have we come?

This article takes stock of how far the field of consultation-liaison psychiatry has come since its inception in the 20th century. In order to do this, we review its past in terms of its knowledge base in psychosomatic medicine and in terms of its practice at the bedside in the general hospital setting. We also offer a contemporary account of the field and finish with a subjective view of the opportunities and pitfalls faced during the next phase of consultation-liaison psychiatry in the 21st century.