Machine Learning and Clinical Predictors of Mortality in Cardiac Arrest Patients: A Comprehensive Analysis.

BACKGROUND Cardiac arrest (CA) is a global public health challenge. This study explored the predictors of mortality and their interactions utilizing machine learning algorithms and their related mortality odds among patients following CA. MATERIAL AND METHODS The study retrospectively investigated 161 medical records of CA patients admitted to the Intensive Care Unit (ICU). The random forest classifier algorithm was used to assess the parameters of mortality. The best classification trees were chosen from a set of 100 trees proposed by the algorithm. Conditional mortality odds were investigated with the use of logistic regression models featuring interactions between variables. RESULTS In the logistic regression model, male sex was associated with 5.68-fold higher mortality odds. The mortality odds among the asystole/pulseless electrical activity (PEA) patients were modulated by body mass index (BMI) and among ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) patients were by serum albumin concentration (decrease by 2.85-fold with 1 g/dl increase). Procalcitonin (PCT) concentration, age, high-sensitivity C-reactive protein (hsCRP), albumin, and potassium were the most influential parameters for mortality prediction with the use of the random forest classifier. Nutritional status-associated parameters (serum albumin concentration, BMI, and Nutritional Risk Score 2002 [NRS-2002]) may be useful in predicting mortality in patients with CA, especially in patients with PCT >0.17 ng/ml, as showed by the decision tree chosen from the random forest classifier based on goodness of fit (AUC score). CONCLUSIONS Mortality in patients following CA is modulated by many co-existing factors. The conclusions refer to sets of conditions rather than universal truths. For individual factors, the 5 most important classifiers of mortality (in descending order of importance) were PCT, age, hsCRP, albumin, and potassium.

The Impact of Rationing Nursing Care on Patient Safety: A Systematic Review.

BACKGROUND Rationing of nursing care (RONC) has been associated with poor patient outcomes and is a growing concern in healthcare. The aim of this systematic study was to investigate the connection between patient safety and the RONC. MATERIAL AND METHODS A thorough search of electronic databases was done to find research that examined the relationship between restricting nurse services and patient safety. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers (M.L. and A.P.) independently screened the titles and abstracts, and full-text articles were assessed for eligibility. Data were extracted, and a quality assessment was performed using appropriate techniques. RESULTS A total of 15 studies met the inclusion criteria. The studies included in the review demonstrated a correlation between rationing of nursing care and patient safety. The results of these studies revealed that there is an inverse relationship between rationing of nursing care and patient safety. The review found that when nursing care is rationed, there is a higher incidence of falls, medication errors, pressure ulcers, infections, and readmissions. In addition, the review identified that the work characteristics of nurses, such as workload, staffing levels, and experience, were associated with RONC. CONCLUSIONS RONC has a negative impact on patient safety outcomes. It is essential for healthcare organizations to implement effective strategies to prevent the RONC. Improving staffing levels, workload management, and communication amo0ng healthcare providers are some of the strategies that can support this.

Dairy product consumption, eating habits, sedentary behaviour and physical activity association with bone mineral density among adolescent boys: a cross-sectional observational study.

BACKGROUND: During childhood and adolescence, skeletal microarchitecture and bone mineral density (BMD) undergo significant changes. Peak bone mass is built and its level significantly affects the condition of bones in later years of life. Understanding the modifiable factors that improve bone parameters at an early age is necessary to early prevent osteoporosis. To identify these modifiable factors we analysed the relationship between dairy product consumption, eating habits, sedentary behaviour, and level of physical activity with BMD in 115 young boys (14-17 years). METHODS: Bone parameters were measured by dual energy x-ray absorptiometry using paediatric specific software to compile the data. Dairy product consumption and eating habits were assessed by means of a dietary interview. Sedentary behaviour and physical activity was assessed in a face-to-face interview conducted using the International Physical Activity Questionnaire. Data collection on total physical activity level was performed by collecting information on the number of days and the duration of vigorous and moderate intensity (MVPA) and average daily time spent in sitting (SIT time). RESULTS: The strongest relationships with BMD in distal part of forearm were found for moderate plus vigorous activity, sit time, and intake of dairy products, intake of calcium, protein, vitamin D, phosphorus from diet. Relationships between BMD, bone mineral content (BMC) in the distal and proximal part of the forearm and PA, sit time and eating parameters were evaluated using the multiple forward stepwise regression. The presented model explained 48-67% (adjusted R2 = 0.48-0.67; p < 0.001) of the variance in bone parameters. The predictor of interactions of three variables: protein intake (g/person/day), vitamin D intake (µg/day) and phosphorus intake (mg/day) was significant for BMD dis (adjusted R2 = 0.59; p < 0.001). The predictor of interactions of two variables: SIT time (h/day) and dairy products (n/day) was significant for BMD prox (adjusted R2 = 0.48; p < 0.001). Furthermore, the predictor of interactions dairy products (n/day), protein intake (g/person/day) and phosphorus intake (mg/day) was significant for BMC prox and dis (adjusted R2 = 0.63-0.67; p < 0.001). CONCLUSIONS: High physical activity and optimal eating habits especially adequate intake of important dietary components for bone health such as calcium, protein, vitamin D and phosphorus affect the mineralization of forearm bones.

Sex-related differences in the impact of nutritional status on in-hospital mortality in acute coronary syndrome: A retrospective cohort study.

BACKGROUND AND AIMS: In patients with some cardiovascular disease conditions the result of Nutritional Risk Screening 2002 (NRS-2002) and body mass index (BMI) is related to the in-hospital mortality. The aim of this study was to assess the prognostic impact of BMI and NRS 2002 on in-hospital mortality among patients with acute myocardial infarction (AMI) in relation to sex. METHODS AND RESULTS: The study was based on a retrospective analysis of 945 medical records of AMI patients admitted to the Cardiology Department between 2017 and 2019. Patients with a score NRS2002 ≥ 3 are considered to be nutritionally at risk. The WHO BMI criteria were used. The endpoint was in-hospital mortality. Logistic regression was used to analyse the impact of quantitative variables on dichotomous outcome. Odds ratios (OR) with 95% confidence intervals were reported. Female patients were significantly older than male patients (73.24 ± 11.81 vs 67 ± 11.81). In an unadjusted model, the risk of malnutrition was a significant predictor of the odds of in-hospital mortality only in female patients (OR = 7.51, p = 0.001). In a multivariate model adjusted by all variables, heart failure (HF) (OR = 8.408, p = 0.003) and the risk of malnutrition (OR = 6.555, p = 0.007) were independent predictors of the odds of in-hospital mortality in female patients. The only significant independent predictor of the odds of in-hospital mortality in male patients was HF (OR = 3.789 p = 0.006). CONCLUSIONS: Only in the case of female patients with AMI, the risk of malnutrition was independently associated with the odds of in-hospital mortality. There was no effect of BMI on in-hospital mortality in both sexes.

Orthorexia nervosa in gay men-the result of a spanish-polish eating disorders study.

BACKGROUND: The purpose of this exploratory study was to identifying demographic factors and unique predictors of ON e.g., the use of pre-exposure prophylaxis (PrEP), the use of social media and the Grindr ® dating application among a sample group of Spanish and Polish identifying gay men. METHODS: The study was conducted in Poland and Spain between March and June 2021 using questionary: ORTO-15. Data was collected using a three-section self-administered questionnaire. The first section contained demographic data, the second part was the Polish and Spanish version of the Orto-15, and the third part was the Polish and Spanish version of the EAT-26. RESULTS: Total enrollment was 394 gay men. In regression proportional hazards single model, significant predictors of ON were: age (OR = 0.964, 95% CI, 0.944-0.984), BMI (OR = 0.895, 95% CI, 0.848-0.944), staying in an informal relationship compared to being single (OR = 2.138, 95%CI, 1.225-3.732), occasional use of Pre-exposure Prophylaxis (OR = 4.667, 95%CI, 1.186-18.362) and use of the Grindr application (OR = 5.312, 95%CI, 3.373-8.365). Instagram users had lower risk of ON (OR = 0.479, 95%CI, 0.279-0.822). The multivariate analysis showed that Grindr usages (OR = 4.72; 95%CI, 2.89-7.72) correlated with higher risk of ON. Higher BMI (OR = 0.913, 95%CI, 0.861-0.98) and daily use of Pre-exposure Prophylaxis (OR = 0.142, 95%CI, 0.03-0.674) is associated with lower risk of ON. CONCLUSIONS: The most important predictors of orthorexia nervosa in gay men are: low BMI and the use of Grindr. The effect of daily usage of PrEP is associated with lower risk, and occasional use is associated with increased risk, of orthorexia nervosa.

The variables in the rationing of nursing care in cardiology departments.

BACKGROUND: The rationing of nursing care is a complex process that affects the quality of medical services. PURPOSE: An assessment of the impact of nursing care rationing on burnout and life satisfaction in cardiology departments. METHODS: The study included 217 nurses working in the cardiology department. The Perceived Implicit Rationing of Nursing Care, the Maslach Burnout Inventory, and the Satisfaction with Life Scale were used. RESULTS: A greater emotional exhaustion, the more frequently the rationing of nursing care (r = 0.309, p < 0.061) and the lower the job satisfaction (r=-0.128, p = 0.061). Higher life satisfaction was associated with less frequent rationing of nursing care (r=-0.177, p = 0.01), better quality of care provided (r = 0.285, p < 0.001), and higher job satisfaction (r = 0.348, p < 0.01). CONCLUSION: Higher levels of burnout contribute to more frequent rationing of nursing care, poorer evaluation of the quality of care provided, and lower job satisfaction. Life satisfaction is associated with less frequent rationing of care, better evaluation of the quality of care provided, and greater job satisfaction.

Rationing of nursing care in Internal Medicine Departments-a cross-sectional study.

BACKGROUND: Implicit rationing of nursing care refers to a situation in which necessary nursing care is not performed to meet all of the patients' needs. PURPOSE: To examine the factors influencing the rationing of nursing care, nurses' assessment of the quality of patient care, and their job satisfaction in Internal Medicine Departments. METHODS: A cross-sectional descriptive study was undertaken. The study included 1164 nurses working in the Internal Medicine Departments in 8 hospitals (Lower Silesia, Poland). The Perceived Implicit Rationing of Nursing Care instrument was used. RESULTS: Respondents rarely ration nursing care, with a mean score of 1.12 (SD = 0.68). The mean score for quality of patient care was 6.99 (SD = 1.92). In contrast, the mean job satisfaction score was 6.07 points (SD = 2.22). The most important predictors of high rates of rationing of nursing care were work experience of 16-20 years (regression parameter: 0.387) and a Bachelor's degree in nursing (regression parameter: 0.139). Nurses' assessment of the quality of patient care ratings were increased by having a Master's degree in nursing (regression parameter: 0.41), and significantly decreased by work experience of 16-20 years (regression parameter: -1.332). Independent predictors of job satisfaction ratings in both univariate and multivariate analysis were Master's degree and long-shift working patterns. CONCLUSION: The factors that influence an increased level of nursing care rationing on medical wards are nurse seniority, exceeding 16 years and female gender. Obtaining a Master's degree in nursing indicates improved nurses' assessment of the quality of patient care.

Psychological impact on care professionals due to the SARS-Cov-2 virus in Spain.

OBJECTIVE: To analyze the psychological impact of the SARS-Cov-2 pandemic on nurses in Spain in three different dimensions: exposure to stressors, perceived emotions, and stress coping. BACKGROUND: On March 11, 2019, the World Health Organization recognized a global pandemic caused by a SARS-Cov-2 virus, COVID-19, which rapidly spread across the planet, involving a community health emergency of international scope. INTRODUCTION: The pandemic situation in health centers has led to significant changes in the work environment, compromising care professionals' physical and psychological health and resulting in strong physical and mental exhaustion. METHODS: An observational, descriptive, cross-sectional study was carried out, between February and April 2021, in a large sample of 1360 participants. The researchers conducted the dissemination of a validated questionnaire to working nurses in Spain. RESULTS: The sex variable in relation to the study dimensions (stressors, perceived emotions, and coping strategies) showed a mean for stressors of 62.2 ± 10.5 in women and 59.8 ± 12.5 in men (p = 0.010), showing statistically significant differences. Age was a protective factor for all dimensions (p < 0.001). Time of experience showed statistically significant differences for stressors and coping strategies in professionals with more than 15 years of experience. DISCUSSION: Female nurses who are younger, have less work experience, have not built a family of their own, and live in smaller or indoor flats may be more vulnerable to the effects of the COVID-19 pandemic on their mental health. Other national and international studies, in this line, have shown an important psychological impact on these professionals. CONCLUSION: It is necessary to design and adopt effective strategies and measures for the protection of nurses' mental health, as well as for the prevention and early diagnosis of possible mental health problems.

Complication during transportation and 30 days mortality of patients with acute coronary syndrome.

BACKGROUND: Patients with acute coronary syndrome (ACS) who present to hospitals without interventional facilities frequently require transfer to another hospital equipped with a cardiac catheterization laboratory. This retrospective cohort study evaluates the association of the type of medical transport with patient outcomes. METHODS: A retrospective analysis of medical records of patients with ACS transported by basic (BT) and specialist transfer (ST) by emergency medical teams (EMTs). We analyzed age, gender, hemodynamic parameters, type of the emergency medical team, and complications during transport as well as patient survival to hospital admission, survival time and the 30-day mortality rate. RESULTS: Of 500 patients who underwent transfer, ST transported 368 (73.6%) and BT 132 (26.4%) patients (p < 0.001). Complications during transportation occurred in 3 (1%) in the ST group and 2 (1.5%) in and BT group. Cardiac arrest during transfer occurred in no (0%) patients in the ST group, and 2 (1.5%) in the BT group (p = 0.118). Survival to admission was recorded in all patients in the ST group and 131/132 (0.8%) patients in the BT group (p = 0.592). 40 (12%) of patients in the ST group and 13 (11%) patients in the BT group (p = 0.731) died within 30 days of transfer. CONCLUSIONS: Complications during medical transport of ACS patients from hospitals without a cardiac catheter lab to hospitals equipped with such a lab were rare and their incidence was not associated with the type of transporting EMT. The type of EMT was not associated with 30-day patient mortality.

Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). METHODS: The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. RESULTS: The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86-3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). CONCLUSIONS: The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR.

Association of Body Mass Index with Outcomes in Patients with Heart Failure with Reduced Ejection Fraction (HFrEF).

Heart failure (HF) is a major health issue, affecting up to 2% of the adult population worldwide. Given the increasing prevalence of obesity and its association with various cardiovascular diseases, understanding its role in HFrEF outcomes is crucial. This study aimed to investigate the impact of obesity on in-hospital mortality and prolonged hospital stay in patients with heart failure with reduced ejection fraction (HFrEF). We conducted a retrospective analysis of 425 patients admitted to the cardiology unit at the University Clinical Hospital in Wroclaw, Poland, between August 2018 and August 2020. Statistical analyses were performed to evaluate the interactions between BMI, sex, and comorbidities on in-hospital mortality. Significant interactions were found between sex and BMI as well as between BMI and post-stroke status, affecting in-hospital mortality. Specifically, increased BMI was associated with decreased odds of in-hospital mortality in males (OR = 0.72, 95% CI: 0.55-0.94, p < 0.05) but higher odds in females (OR = 1.18, 95% CI: 0.98-1.42, p = 0.08). For patients without a history of stroke, increased BMI reduced mortality odds (HR = 0.78, 95% CI: 0.64-0.95, p < 0.01), whereas the effect was less pronounced in those with a history of stroke (HR = 0.89, 95% CI: 0.76-1.04, p = 0.12). In conclusion, the odds of in-hospital mortality decreased significantly with each 10% increase in BMI for males, whereas for females, a higher BMI was associated with increased odds of death. Additionally, BMI reduced in-hospital mortality odds more in patients without a history of cerebral stroke (CS) compared to those with a history of CS. These findings should be interpreted with caution due to the low number of observed outcomes and potential interactions with BMI and sex.

Sex-related differences in the impact of nutritional status on in-hospital mortality in heart failure: a retrospective cohort study.

AIMS: A nutritional status is related to the length of hospitalization and in-hospital mortality of patients with heart failure (HF). The aim of this study is to assess the prognostic impact of nutritional status and body mass index (BMI) on in-hospital mortality among patients with HF relative to their sex. METHODS AND RESULTS: We conducted a retrospective study and analysis of 809 medical records of patients admitted to the Institute of Heart Disease of the University Clinical Hospital in Wroclaw (Poland). Women were statistically significantly older than men (74.67 ± 11.15 vs. 66.76 ± 17.78; P < 0.001). In unadjusted model, significant predictors of the odds of in-hospital mortality for men were underweight (OR = 14.81, P = 0.001) and the risk of malnutrition (OR = 8.979, P < 0.001). In the case of women, none of the traits analysed was significant. In age-adjusted model, significant independent predictors of the odds of in-hospital mortality in the case of men were BMI < 18.5 (OR = 15.423, P = 0.001) and risk of malnutrition (OR = 5.557, P = 0.002). In the case of women, none of the nutritional status traits analysed were significant. In multivariable-adjusted model in men, significant independent predictors of the odds of in-hospital mortality were BMI < 18.5 (OR = 15.978, P = 0.007) compared with having normal body weight and the risk of malnutrition (OR = 4.686, P = 0.015). In the case of women, none of the nutritional status traits analysed were significant. CONCLUSION: Both underweight and the risk of malnutrition are direct predictors of the odds of in-hospital mortality in men, but not in women. The study did not find a relationship between nutritional status and in-hospital mortality in women.

Psychometric Properties and Cultural Adaptation of the Polish Version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT- DOCSS-PL).

People from the LGBT+ community often face unique healthcare disparities, including barriers to accessing appropriate and respectful care. The purpose of this study was to test the psychometric properties of the Polish-language version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT- DOCSS-PL). Before testing its psychometric properties, the LGBT-DOCSS was translated and adapted from the original English version into Polish. Subsequently, we tested the instrument's psychometric properties on a sample of 415 participants. In addition, internal consistency of the questionnaire was checked with confirmatory factor analysis (CFA). Cronbach's alpha together with discriminative power index were uses as internal consistency measures. There were more female than male participants (58%). More than 57% of the participants were heterosexual and the average age of the respondents was approximately 30 years. The internal consistency of the Polish version and its domains was strong with an overall Cronbach's alpha of 0.789. The alpha ranges for each subscale domains were between 0.780-0.824. The McDonald's omega coefficient was 0.86. The Polish version of the LGBT-DOCSS-PL has good properties of factorial validity.

Psychometric properties and cultural adaptation of the Polish Version of the Gay Affirmative Practice Scale.

Introduction: The lesbian, gay, bisexual, and transgender (LGBT) people often face unique medical disparities, including obstacles to accessing adequate and respectful care. The purpose of this study was to test the psychometric properties(internal consistency, reliability, and factor structure) of the Polish-language version of the Gay Affirmative Practice Scale (GAP-PL). Material: The study was conducted over a 6-month period in 2023, from February to June, involving 329 medical students and professionals who evaluated the GAP-PL. Methods: Before testing the psychometric properties of the original Gay Affirmative Practice Scale (GAP), it was translated and adapted from the original English language version into the Polish language. Authors then tested the psychometric properties of the tool on a sample of 329 participants. The internal coherence of the questionnaire was tested with the analysis of verifying factors (Confirmatory Factor Analysis). Cronbach alpha and the discriminatory power index were used as internal consistency measures. Results: There were more female than male participants (55.32%). More than 53% of the participants were heterosexual, and the average age of the respondents was ~30 years. The internal consistency of the Polish-language version and its domains was strong with the overall Cronbach's alpha ranges for each subscale domains ranging between 0.936 and 0.949. The McDonald's omega coefficient was 0.963. Conclusion: The GAP-PL has excellent properties of factorial validity and can be used in research and clinical practice in Polish-speaking populations.

Descriptive study on substance uses and risk of sexually transmitted infections in the practice of Chemsex in Spain.

Background: In recent years, there has been an increasing use of sex-related substances (known as "Chemsex") to facilitate, intensify, and prolong the sexual experience of men who have sex with men. This phenomenon poses a public health problem, increasing the risk of sexually transmitted infections (STIs) and mental disorders. Objective: The primary aim of this study was to delve into the correlation between substance use and sexual health, specifically examining the association between different substances used and the risk of sexually transmitted infections (STIs) in the context of Chemsex in Spain. Methods: An observational, descriptive, cross-sectional study was conducted among 563 Spanish participants between January and April 2023. Non-probabilistic purposive sampling was used by the investigators. The researchers administered a questionnaire to men who have sex with men who use substances, especially in the sexual sphere, in all the autonomous communities of Spain. Results: 14.7% reported having practiced slamsex in the last year, and 17.94% were diagnosed with a Sexually Transmitted Infection in the previous 6 months. Of these, 21% were on PREP treatment, with the main STIs being gonorrhea (p < 0.001), chlamydia (p < 0.001), genital herpes (p = 0.020), and syphilis (p < 0.001). The 63.7% used methamphetamines as the main drug in the practice of chemsex. Discussion: Chemsex in Spain is linked to a high prevalence of STIs, especially gonorrhea and chlamydia, even among those on PrEP treatment. The use of various drugs during chemsex, such as amyl nitrite, GHB, ecstasy, and others, correlates with higher rates of STIs, highlighting the need for interventions to reduce risk and harm. The drugs most associated with slamsex include ketamine, mephedrone, and methamphetamine, underscoring the importance of addressing the risk behaviors associated with this activity. Conclusion: This study shows that chemsex appears to be associated with a high prevalence among men who have sex with men. Who use multiple substances in a sexual context, and are particularly exposed to sexually transmitted infections (STIs), indicating a particular need for STI prevention and care in this group.

Knowledge Level of ICU Nurses Regarding Nutritional Assessment of Critically Ill Patients: A Systematic Review.

BACKGROUND: Nutritional assessment on admission of critical patients is of vital importance to determine critical patients in whom there is a risk of malnutrition. Currently, it has been detected in most of the patients admitted to the Intensive Care Unit (ICU) that 60% of the daily calories are not achieved. Nurses play an essential role in the comprehensive assessment of the patient, including the nutritional area; however, significant deficits have been detected in some knowledge regarding Enteral Nutrition (EN). OBJECTIVE: We aim to determine the level of knowledge of nurses in the nutritional assessment of critically ill patients. METHODOLOGY: A systematic review of the scientific literature was conducted using the PRISMA statement. Between January 2017 and February 2023, articles were rescued from the electronic databases "Pubmed", "Scopus" and "The Cochrane Library", which analyzed the level of knowledge of ICU nurses regarding nutritional assessment. RESULTS: Most of the results found showed that nurses had deficient levels of knowledge in relation to nutritional assessment and practices. Interventions related to nutritional assessment were scarce, in contrast to those associated with the management of Nasogastric Tube (NGT) or patient positioning. CONCLUSIONS: The level of knowledge described was low or inadequate in relation to the care associated with the nutritional assessment of critically ill patients. The use of scales to assess the risk of malnutrition was not reported. This study was prospectively registered at PROSPERO on 25/10/2023 (insert date) with registration number CRD: 42023426924.

Rationing in healthcare-a scoping review.

Healthcare rationing has been the subject of numerous debates and concerns in the field of health economics in recent years. It is a concept which refers to the allocation of scarce healthcare resources and involves the use of different approaches to the delivery of health services and patient care. Regardless of the approach used, healthcare rationing fundamentally involves withholding potentially beneficial programs and/or treatments from certain people. As the demands placed on health services continue to rise and with that significant increases to the cost, healthcare rationing has become increasingly popular and is deemed necessary for the delivery of affordable, patient-care services. However, public discourse on this issue has largely been centered on ethical considerations with less focus on economic rationality. Establishing the economic rationality of healthcare rationing is essential in healthcare decision-making and consideration of its adoption by healthcare authorities and organizations. This scoping review of seven articles demonstrates that the economic rationality of healthcare rationing is the scarcity of healthcare resources amidst increased demand and costs. Therefore, supply, demand, and benefits are at the core of healthcare rationing practices and influence decisions on its suitability. Given the increased costs of care and resource scarcity, healthcare rationing is a suitable practice towards ensuring healthcare resources are allocated to people in a rational, equitable, and cost-effective manner. The rising costs and demands for care place significant pressure on healthcare authorities to identify suitable strategies for the allocation of healthcare resources. Healthcare rationing as a priority-setting strategy would support healthcare authorities identify mechanisms to allocate scarce resources in a cost-effective manner. When used in the context of a priority-setting approach, healthcare rationing helps healthcare organizations and practitioners to ensure that patient populations achieve maximum benefits at reasonable costs. It represents a fair allocation of healthcare resources to all populations, especially in low-income settings.

Sex-related differences in the impact of nutritional status on length of hospital stay in atrial fibrillation: a retrospective cohort study.

Background: Nutritional status is related to the length of hospitalization of patients with atrial fibrillation (AF). The aim of this study is to assess the prognostic impact of nutritional status and body mass index on length of hospital stay (LOHS) among patients with AF relative to their sex. Methods: A retrospective analysis of the medical records of 1,342 patients admitted urgently with a diagnosis of AF (ICD10: I48) to the Cardiology Department (University Hospital in Wroclaw, Poland) between January 2017 and June 2021. Results: In the study group, women were significantly older than men (72.94 ± 9.56 vs. 65.11 ± 12.68, p < 0.001). In an unadjusted linear regression model, malnutrition risk was a significant independent predictor of prolonged hospitalization in men (B = 1.95, p = 0.003) but not in women. In the age-adjusted linear regression model, malnutrition risk was a significant independent predictor of prolonged hospitalization in men (B = 1.843, p = 0.005) but not in women. In the model adjusted for age and comorbidities, malnutrition risk was a significant independent predictor of prolonged hospitalization in men only (B = 1.285, p = 0.043). In none of the models was BMI score a predictor of LOHS in either sex. Conclusion: The risk of malnutrition directly predicts the length of hospital stays in men but not women. The study did not find a relationship between body mass index and length of hospital stay in both women and men.

Comprehensive Cardiac Care: How Much Does It Cost?

The benefits of coordinating care between healthcare professionals and institutions are the main drivers behind reforms to the payment and delivery system for healthcare services. The purpose of this study was to analyse the costs incurred by the National Health Fund in Poland related to the comprehensive care model for patients after myocardial infarction (CCMI, in Polish: KOS-Zawal). METHODS: The analysis involved data from 1 October 2017 to 31 March 2020 for 263,619 patients who received treatment after a diagnosis of first or recurrent myocardial infarction as well as data for 26,457 patients treated during that period under the CCMI programme. RESULTS: The average costs of treating patients covered by the full scope of comprehensive care and cardiac rehabilitation under the programme (EUR 3113.74/person) were higher than the costs of treating patients outside of that programme (EUR 2238.08/person). At the same time, a survival analysis revealed a statistically significantly lower probability of death (p < 0.0001) in the group of patients covered by CCMI compared to the group not covered by the programme. CONCLUSIONS: The coordinated care programme introduced for patients after myocardial infarction is more expensive than the care for patients who do not participate in the programme. Patients covered by the programme were more often hospitalised, which might have been due to the good coordination between specialists and responses to sudden changes in patients' conditions.

Do Body Mass Index and Nutritional Risk Score 2002 Influence the In-Hospital Mortality of Patients Following Cardiac Arrest?

BACKGROUND: Contemporarily, cardiac arrest (CA) remains one of the leading causes of death. Poor nutritional status can increase the post-CA mortality risk. The aim of this study was to determine the relationship between body mass index (BMI) and Nutritional Risk Score 2002 (NRS 2002) results and in-hospital mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. METHODS: A retrospective study and analysis of medical records of 161 patients admitted to the ICU of the University Clinical Hospital in Wroclaw (Wroclaw, Poland) was conducted. RESULTS: No significant differences in body mass index (BMI) and nutritional risk score (NRS 2002) values were observed between non-survivors and survivors. Non-survivors had significantly lower albumin concentration (p = 0.017) and total cholesterol (TC) (p = 0.015). In multivariate analysis BMI and NRS 2002 scores were not, per se, associated with the in-hospital mortality defined as the odds of death (Model 1: p: 0.700, 0.430; Model 2: p: 0.576, 0.599). Univariate analysis revealed significant associations between the hazard ratio (HR) and TG (p ≈ 0.017, HR: 0.23) and hsCRP (p ≈ 0.018, HR: 0.34). In multivariate analysis, mortality risk over time was influenced by higher scores in parameters such as BMI (HR = 0.164; p = 0.048) and hsCRP (HR = 1.006, p = 0.002). CONCLUSIONS: BMI and NRS 2002, on their own (unconditionally - in the whole study group) did not alter the odds of mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. The risk of in-hospital mortality (expressed as hazard ratio - the risk over the time period of the study) increased with an increase in BMI but not with NRS 2002.