Time trends in case-mix and risk of revision following hip and knee arthroplasty in public and private hospitals: a cross-sectional analysis based on 476,312 procedures from the Dutch Arthroplasty Register.

BACKGROUND AND PURPOSE: This study aims to assess time trends in case-mix and to evaluate the risk of revision and causes following primary THA, TKA, and UKA in private and public hospitals in the Netherlands. METHODS: We retrospectively analyzed 476,312 primary arthroplasties (public: n = 413,560 and private n = 62,752) implanted between 2014 and 2023 using Dutch Arthroplasty Register data. We explored patient demographics, procedure details, trends over time, and revisions per hospital type. Adjusted revision risk was calculated for comparable subgroups (ASA I/II, age ≤ 75, BMI ≤ 30, osteoarthritis diagnosis, and moderate-high socioeconomic status (SES). RESULTS: The volume of THAs and TKAs in private hospitals increased from 4% and 9% in 2014, to 18% and 21% in 2022. Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES compared with public hospital patients. In private hospitals, age and ASA II proportion increased over time. Multivariable Cox regression demonstrated a lower revision risk for primary THA (HR 0.7, CI 0.7-0.8), TKA (HR 0.8, CI 0.7-0.9), and UKA (HR 0.8, CI 0.7-0.9) in private hospitals. After initial arthroplasty in private hospitals, 49% of THA and 37% of TKA revisions were performed in public hospitals. CONCLUSION: Patients in private hospitals were younger, had lower ASA classification, lower BMI, and higher SES com-pared with public hospital patients. The number of arthroplasties increased in private hospitals, with a lower revision risk compared with public hospitals.

Patient safety culture in private hospitals in China: a cross-sectional study using the revised Hospital Survey on Patient Safety Culture.

Background: This study aimed to translate the revised Hospital Survey on Patient Safety Culture (HSOPSC 2.0) to Mandarin, evaluate its psychometric properties, and apply it to a group of private hospitals in China to identify the determinants associated with patient safety culture. Methods: A two-phase study was conducted to translate and evaluate the HSOPSC 2.0. A cross-cultural adaptation of the HSOPSC 2.0 was performed in Mandarin and applied in a cross-sectional study in China. This study was conducted among 3,062 respondents from nine private hospitals and 11 clinics across six cities in China. The HSOPSC 2.0 was used to assess patient safety culture. Primary outcomes were measured by the overall patient safety grade and patient safety events reported. Results: Confirmatory factor analysis results and internal consistency reliability were acceptable for the translated HOSPSC 2.0. The dimension with the highest positive response was "Organizational learning - Continuous improvement" (89%), and the lowest was "Reporting patient safety event" (51%). Nurses and long working time in the hospital were associated with lower assessments of overall patient safety grades. Respondents who had direct contact with patients, had long working times in the hospital, and had long working hours per week reported more patient safety events. A higher level of patient safety culture implies an increased probability of a high overall patient safety grade and the number of patient safety events reported. Conclusion: The Chinese version of HSOPSC 2.0 is a reliable instrument for measuring patient safety culture in private hospitals in China. Organizational culture is the foundation of patient safety and can promote the development of a positive safety culture in private hospitals in China.

Medical and psychiatric comorbidities, somatic and cognitive symptoms, injuries and medical procedure history in patients with functional seizures from a public and a private hospital.

PURPOSE: Patients with functional seizures (FS), otherwise known as psychogenic non-epileptic seizures (PNES), from different socioeconomic backgrounds may differ, however, this remains a gap in current literature. Comorbidities can play both a precipitating and a perpetuating role in FS and are important in the planning of individual treatment for this condition. With this study, we aimed to describe and compare the reported medical and psychiatric comorbidities, injuries, somatic and cognitive symptoms, and medical procedures among patients with FS from a private and a public epilepsy monitoring unit (EMU) in Cape Town, South Africa. METHODS: This is a retrospective case-control study. We collected data on the comorbidity and medical procedure histories, as well as symptoms and clinical signs reported by patients with video-electroencephalographically (video-EEG) confirmed FS without comorbid epilepsy. We used digital patient records starting with the earliest available digital record for each hospital until the year 2022. RESULTS: A total of 305 patients from a private hospital and 67 patients from a public hospital were included in the study (N = 372). Public hospital patients had higher odds of reporting intellectual disability (aOR=15.58, 95% CI [1.80, 134.95]), circulatory system disease (aOR=2.63, 95% CI [1.02, 6.78]) and gait disturbance (aOR=8.52, 95% CI [1.96, 37.08]) compared to patients with FS attending the private hospital. They did, however, have fewer odds of reporting a history of an infectious or parasitic disease (aOR=0.31, 95% CI [0.11, 0.87]), respiratory system disease (aOR=0.23, 95% CI [0.06, 0.82]), or medical procedures in the past (aOR=0.32, 95% CI [0.16, 0.63]). CONCLUSION: The study presents prevalence and comparative data on the medical profiles of patients with FS from different socioeconomic backgrounds which may inform future considerations in FS diagnosis and treatment.

Partial-Cost Analysis and Economic Impact of Ambulatory Coronary Angioplasty in a Private Hospital in the Caribbean: Análisis Parcial de Costos e Impacto Económico de la Angioplastia Coronaria Ambulatoria en un Hospital Privado del Caribe.

OBJECTIVES: This study aimed to assess direct costs of percutaneous coronary intervention (PCI) without hospital admission versus PCI with hospital admission longer than 24 hours in a private hospital-institutional perspective in the Dominican Republic in 2022. METHODS: This study has a comparative approach based on a prospective cross-sectional partial-cost analysis. We evaluated the direct costs of 10 patients from PCI without hospital admission approach and 10 patients from a hospital admission longer than 24 hours as a control group. We used a "first-come-first-served" approach from December 2021 to March 2022. The analysis used the electronic invoice generated for each patient. RESULTS: PCI without hospital admission approach represents $472.56 in patient savings, equivalent to a cost reduction of 12.5%. The subcosts analysis showed the pharmacy section as the main driver of the overall cost difference. CONCLUSIONS: PCI without hospital admission was economically cost-saving compared with the control approach in direct costs in the Dominican perspective. The economic benefit is substantial and compliments the ease of use. This analysis may lead to improvements in institutional management of resources and can potentially be adapted to other health systems in the region.

Association between hospital ownership and patient selection, management, and outcomes after carotid endarterectomy or carotid artery stenting : - Secondary data analysis of the Bavarian statutory quality assurance database.

BACKGROUND: This study analyses the association between hospital ownership and patient selection, treatment, and outcome of carotid endarterectomy (CEA) or carotid artery stenting (CAS). METHODS: The analysis is based on the Bavarian subset of the nationwide German statutory quality assurance database. All patients receiving CEA or CAS for carotid artery stenosis between 2014 and 2018 were included. Hospitals were subdivided into four groups: university hospitals, public hospitals, hospitals owned by charitable organizations, and private hospitals. The primary outcome was any stroke or death until discharge from hospital. Research was funded by Germany's Federal Joint Committee Innovation Fund (01VSF19016 ISAR-IQ). RESULTS: In total, 22,446 patients were included. The majority of patients were treated in public hospitals (62%), followed by private hospitals (17%), university hospitals (16%), and hospitals under charitable ownership (6%). Two thirds of patients were male (68%), and the median age was 72 years. CAS was most often applied in university hospitals (25%) and most rarely used in private hospitals (9%). Compared to university hospitals, patients in private hospitals were more likely asymptomatic (65% vs. 49%). In asymptomatic patients, the risk of stroke or death was 1.3% in university hospitals, 1.5% in public hospitals, 1.0% in hospitals of charitable owners, and 1.2% in private hospitals. In symptomatic patients, these figures were 3.0%, 2.5%, 3.4%, and 1.2% respectively. Univariate analysis revealed no statistically significant differences between hospital groups. In the multivariable analysis, compared to university hospitals, the odds ratio of stroke or death in asymptomatic patients treated by CEA was significantly lower in charitable hospitals (OR 0.19 [95%-CI 0.07-0.56, p = 0.002]) and private hospitals (OR 0.47 [95%-CI 0.23-0.98, p = 0.043]). In symptomatic patients (elective treatment, CEA), patients treated in private or public hospitals showed a significantly lower odds ratio compared to university hospitals (0.36 [95%-CI 0.17-0.72, p = 0.004] and 0.65 [95%-CI 0.42-1.00, p = 0.048], respectively). CONCLUSIONS: Hospital ownership was related to patient selection and treatment, but not generally to outcomes. The lower risk of stroke or death in the subgroup of electively treated patients in private hospitals might be due to the right timing, the choice of treatment modality or actually to better structural and process quality.

Assessment of health care workers preparedness to epidemics: A case of Ebola virus disease preparedness in private hospitals in Kampala, Uganda.

INTRODUCTION: Unrecognized Ebola Virus Disease (EVD) can lead to multiple chains of transmissions if the first caretakers are not trained and prepared. This study aimed to assess healthcare workers (HCWs) preparedness in private hospitals located in Kampala, to detect, respond and prevent EVD. METHODOLOGY: A descriptive cross-sectional study was carried out among HCWs in direct clinical care provision in four private hospitals, and in one Ebola Treatment Unit (ETU) using a self-administered questionnaire from March to June 2020. RESULTS: 222 HCWs agreed to participate aged from 19 to 64 years and with 6 months to 38 years of practice where most were nurses (44%). 3/5 hospitals did not have written protocols on EVD case management, and only one (ETU) had an exclusive emergency team. 59% were not sure whether contact tracing was taking place. Private hospitals were not included in EVD trainings organized by the Ministry of Health (MoH). In addition, HCWs in private hospitals were not empowered by the MoH to take part in EVD case management. Despite these shortcomings, only 66% of HCWs showed an interest to be immunized. Knowledge about potential Ebola vaccines was generally poor. CONCLUSIONS: In Kampala, Uganda, establishment of a more comprehensive preparedness and response strategy for EVD outbreaks is imperative for HCWs in private facilities, including a wide vaccination educational program on Ebola vaccination. The findings from this study if addressed will likely improve the preparedness and management of future Ebola outbreaks in Uganda.

Evaluating private hospital performance before and during COVID-19 in China.

The coronavirus disease 2019 (COVID-19) pandemic had a tremendous impact on the global medical system. The development of private hospitals is an important measure to deepen the reform of China's medical and health system, and an important driving force to improve the effective supply of medical services. This study aims to compare the performance of China's private hospitals before and during COVID-19 and determine the factors that affect hospital profitability between the 2 periods. Data are collected from 10 private listed hospitals from 2017 to 2022, and ratio analysis is used to measure hospital performance in 5 aspects, namely profitability, liquidity, leverage, activity (efficiency), and cost coverage. Multiple regression analysis is used to determine the influencing factors of hospital profitability. The results show a negative impact of COVID-19 on private hospital performance. Specifically, regardless of region, hospital profitability, liquidity, and cost coverage were reduced due to COVID-19, while hospital leverage was increased. COVID-19 had also an impact on hospital efficiency. In addition, before COVID-19, current ratio and cost coverage ratio were the determinants of hospital profitability, while only cost coverage ratio affected hospital profitability during the COVID-19 outbreak. We provide evidence that COVID-19 had an impact on China private hospitals, and the findings will aid private hospitals in improving their performance in the post-COVID-19 era.

Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China.

BACKGROUND: China initiated the Medical Alliances (MAs) reform to enhance resource allocation efficiency and ensure equitable healthcare. In response to challenges posed by the predominance of public hospitals, the reform explores public-private partnerships within the MAs. Notably, private hospitals can now participate as either leading or member institutions. This study aims to evaluate the dynamic shifts in market share between public and private hospitals across diverse MAs models. METHODS: Data spanning April 2017 to March 2019 for Dangyang County's MA and January 2018 to December 2019 for Qianjiang County's MA were analyzed. Interrupted periods occurred in April 2018 and January 2019. Using independent sample t-tests, chi-square tests, and interrupted time series analysis (ITSA), we compared the proportion of hospital revenue, the proportion of visits for treatment, and the average hospitalization days of discharged patients between leading public hospitals and leading private hospitals, as well as between member public hospitals and member private hospitals before and after the reform. RESULTS: After the MAs reform, the revenue proportion decreased for leading public and private hospitals, while member hospitals saw an increase. However, ITSA revealed a notable rise trend in revenue proportion for leading private hospitals (p < 0.001), with a slope of 0.279% per month. Member public and private hospitals experienced decreasing revenue proportions, with outpatient visits proportions declining in member public hospitals by 0.089% per month (p < 0.05) and inpatient admissions proportions dropping in member private hospitals by 0.752% per month (p < 0.001). The average length of stay in member private hospitals increased by 0.321 days per month after the reform (p < 0.01). CONCLUSIONS: This study underscores the imperative to reinforce oversight and constraints on leading hospitals, especially private leading hospitals, to curb the trend of diverting patients from member hospitals. At the same time, for private hospitals that are at a disadvantage in competition and may lead to unreasonable prolongation of hospital stay, this kind of behavior can be avoided by strengthening supervision or granting leadership.

An implementation analysis of a quality improvement project to reduce cesarean section in Brazilian private hospitals.

BACKGROUND: Brazil has one of the highest prevalence of cesarean sections in the world. The private health system is responsible for carrying out most of these surgical procedures. A quality improvement project called Adequate Childbirth Project ("Projeto Parto Adequado"- PPA) was developed to identify models of care for labor and childbirth, which place value on vaginal birth and reduce the frequency of cesarean sections without a clinical indication. This research aims to evaluate the implementation of PPA in private hospitals in Brazil. METHOD: Evaluative hospital-based survey, carried out in 2017, in 12 private hospitals, including 4,322 women. We used a Bayesian network strategy to develop a theoretical model for implementation analysis. We estimated and compared the degree of implementation of two major driving components of PPA-"Participation of women" and "Reorganization of care" - among the 12 hospitals and according to type of hospital (belonging to a health insurance company or not). To assess whether the degree of implementation was correlated with the rate of vaginal birth data we used the Bayesian Network and compared the difference between the group "Exposed to the PPA model of care" and the group "Standard of care model". RESULTS: PPA had a low degree of implementation in both components "Reorganization of Care" (0.17 - 0.32) and "Participation of Women" (0.21 - 0.34). The combined implementation score was 0.39-0.64 and was higher in hospitals that belonged to a health insurance company. The vaginal birth rate was higher in hospitals with a higher degree of implementation of PPA. CONCLUSION: The degree of implementation of PPA was low, which reflects the difficulties in changing childbirth care practices. Nevertheless, PPA increased vaginal birth rates in private hospitals with higher implementation scores. PPA is an ongoing quality improvement project and these results demonstrate the need for changes in the involvement of women and the care offered by the provider.

Medication use in patients with functional seizures from a public and a private hospital.

PURPOSE: Currently, we have limited knowledge of any potential differences among patients with functional seizures (FS), otherwise known as psychogenic non-epileptic seizures (PNES), from different socioeconomic backgrounds. Investigating medication use among these patients may provide insight into the quality and intensity of medical care they receive. Thus, we aimed to assess and compare the frequency and quantity of antiseizure medications (ASMs), and psychiatric and other medications used among patients with FS from a private and public epilepsy monitoring units (EMUs) in Cape Town, South Africa. METHODS: Only video-electroencephalographically (video-EEG) confirmed patients with FS with no comorbid epilepsy were eligible for the study. For this retrospective case-control study we collected data on patients' medication-taking histories using digital patient records, starting with the earliest available digital patient record for each hospital. RESULTS: A total of 305 patients from a private hospital and 67 patients from a public hospital were included in the study (N = 372). Patients with FS attending the public hospital had lower odds of taking any ASMs at presentation (aOR=0.39, 95% CI [0.20, 0.75]) and ever taking psychiatric medications (aOR=0.41, 95% CI [0.22, 0.78]) compared to FS patients from the private hospital. They did, however, have higher odds of being discharged with an ASM (aOR=6.60, 95% CI [3.27, 13.35]) and ever taking cardiovascular medication (aOR=2.69, 95% CI [1.22, 5.90]) when compared to the private hospital patients. With every additional presenting ASM (aOR=0.63, 95% CI [0.45, 0.89]) and psychiatric medication (aOR=0.58, 95% CI [0.40, 0.84]) the odds of being from the public hospital decreased. However, they increased with every additional discharge ASM (aOR=3.63, 95% CI [2.30, 5.72]) and cardiovascular medication (aOR=1.26, 95% CI [1.02, 1.55]). CONCLUSION: Standard approaches to pharmacological treatment for patients with FS differed between the public and private hospitals and may indicate a gap in quality of care.

Outcomes of Women Undergoing Noncardiac Surgery in Veterans Affairs Compared With Non-Veterans Affairs Care Settings.

Importance: Recent legislation facilitates veterans' ability to receive non-Veterans Affairs (VA) surgical care. Although veterans are predominantly male, the number of women receiving care within the VA has nearly doubled to 10% over the past decade and recent data comparing the surgical care of women in VA and non-VA care settings are lacking. Objective: To compare postoperative outcomes among women treated in VA hospitals vs private-sector hospitals. Design, Setting, and Participants: This coarsened exact-matched cohort study across 9 noncardiac specialties in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) and American College of Surgeons National Surgical Quality Improvement Program (NSQIP) took place from January 1, 2016, to December 31, 2019. Multivariable Poisson models with robust standard errors were used to evaluate the association between VA vs private-sector care settings and 30-day mortality. Hospitals participating in American College of Surgeons NSQIP and VASQIP were included. Data analysis was performed in January 2023. Participants included female patients 18 years old or older. Exposures: Surgical care in VA or private-sector hospitals. Main Outcomes and Measures: Postoperative 30-day mortality and failure to rescue (FTR). Results: Among 1 913 033 procedures analyzed, patients in VASQIP were younger (VASQIP: mean age, 49.8 [SD, 13.0] years; NSQIP: mean age, 55.9 [SD, 16.9] years; P < .001) and although most patients in both groups identified as White, there were significantly more Black women in VASQIP compared with NSQIP (29.6% vs 12.7%; P < .001). The mean risk analysis index score was lower in VASQIP (13.9 [SD, 6.4]) compared with NSQIP (16.3 [SD, 7.8]) (P < .001 for both). Patients in the VA were more likely to have a preoperative acute serious condition (2.4% vs 1.8%: P < .001), but cases in NSQIP were more frequently emergent (6.9% vs 2.6%; P < .001). The 30-day mortality, complications, and FTR were 0.2%, 3.2%, and 0.1% in VASQIP (n = 36 762 procedures) as compared with 0.8%, 5.0%, and 0.5% in NSQIP (n = 1 876 271 procedures), respectively (all P < .001). Among 1 763 540 matched women (n = 36 478 procedures in VASQIP; n = 1 727 062 procedures in NSQIP), these rates were 0.3%, 3.7%, and 0.2% in NSQIP and 0.1%, 3.4%, and 0.1% in VASQIP (all P < .01). Relative to private-sector care, VA surgical care was associated with a lower risk of death (adjusted risk ratio [aRR], 0.41; 95% CI, 0.23-0.76). This finding was robust among women undergoing gynecologic surgery, inpatient surgery, and low-physiologic stress procedures. VA surgical care was also associated with lower risk of FTR (aRR, 0.41; 95% CI, 0.18-0.92) for frail or Black women and inpatient and low-physiologic stress procedures. Conclusions and Relevance: Although women comprise the minority of veterans receiving care within the VA, in this study, VA surgical care for women was associated with half the risk of postoperative death and FTR. The VA appears better equipped to meet the unique surgical needs and risk profiles of veterans, regardless of sex and health policy decisions, including funding, should reflect these important outcome differences.

Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition.

Importance: The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown. Objective: To examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals. Design, Setting, and Participants: Data from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity-acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes. Main Outcomes and Measures: Hospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare & Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions). Results: Hospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line-associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge. Conclusions and Relevance: Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.

Knowledge, Attitude and Practices of Frontline Health Care Workers to Disaster Risk Management in Private General Hospitals in Addis Ababa, Ethiopia: Multicenter Cross-Sectional Study.

Background: Disaster is an acute dysfunction of the existing environment that requires external assistance. Although disaster has had a significant impact in Ethiopia, little is known about KAP of frontline HCW on disaster management in private hospitals. Therefore, this study will be a background for future researches and disaster management plan in private health sectors. The study was conducted to assess the knowledge, attitudes, practices and their influencing factors among frontline healthcare workers on disaster risk management in private general hospitals in Addis Ababa. Methods: The study design was multicenter cross-sectional survey that used structured closed- and open-ended questions. Multi-stage sampling technique was used. The sample size was 270 with a response rate of 98.9%. The study was conducted in frontline HCW of six private general hospitals from July 20-September 30, 2022. Epi-info version 7.0 and SPSS-25 were used for data clearing and statistical analysis. Level of KAP was calculated from the participants' scores of the questions. Associations were done by using bivariate and multivariate logistic regression. Results: Of the participants, 64% had poor level of knowledge, and 89.10% had poor level of practice while 93.6% had positive attitude. Lack of previous training, inadequate level of practice, and health experience below one year were negatively associated with good level of knowledge. Poor level of knowledge was negatively associated with good practice. Conclusion: Although the majority of the participants had positive attitude, the mean level of knowledge and practice were poor to properly handle disastrous events.

Boletim epidemiológico: perfil epidemiológico de mortalidade do Hospital Santa Casa de Misericódia de Goiânia / Epidemiological bulletin: epidemiological profile of mortality at Hospital Santa Casa de Misericódia de Goiânia from April to June 2023

Trata-se de um estudo descritivo, realizado com dados da Santa Casa de Misericórdia de Goiânia. Para a coleta dos dados foi feita a extração de dados da planilha de registro de óbitos com informações provenientes das declarações de óbitos e prontuário eletrônico do paciente

This is a descriptive study, carried out with data from Santa Casa de Misericórdia de Goiânia. To collect data, data was extracted from the death registration spreadsheet with information from death certificates and the patient's electronic medical record

Impact of cytokine storm on severity of COVID-19 disease in a private hospital in West Jakarta prior to vaccination.

BACKGROUND AND AIM: Coronavirus Disease 2019 (COVID-19) has become a worldwide pandemic and is a threat to global health. Patients who experienced cytokine storms tend to have a high mortality rate. However, to date, no study has investigated the impact of cytokine storms. MATERIALS AND METHODS: This retrospective cohort study included only COVID-19 positive patients hospitalized in a Private Hospital in West Jakarta between March and September 2020. All patients were not vaccinated during this period and treatment was based on the guidelines by the Ministry of Health Indonesia. A convenience sampling method was used and all patients who met the inclusion criteria were enrolled. RESULTS: The clinical outcome of COVID-19 patients following medical therapy was either cured (85.7%) or died (14.3%), with 14.3% patients reported to have cytokine storm, from which 23.1% led to fatalities. A plasma immunoglobulin (Gammaraas®) and/or tocilizumab (interleukin-6 receptor antagonist; Actemra®) injection was utilised to treat the cytokine storm while remdesivir and oseltamivir were administered to ameliorate COVID-19. Most (61.5%) patients who experienced the cytokine storm were male; mean age 60 years. Interestingly, all patients who experienced the cytokine storm had hypertension or/ and diabetes complication (100%). Fever, cough and shortness of breath were also the common symptoms (100.0%). Almost all (92.3%) patients with cytokine storm had to be treated in the intensive care unit (ICU). Most (76.9%) patients who had cytokine storm received hydroxychloroquine and all had antibiotics [1) azithromycin + levofloxacin or 2) meropenam for critically ill patients] and vitamins such as vitamins C and B-complex as well as mineral. Unfortunately, from this group, 23.1% patients died while the remaining 70% of patients recovered. A significant (p<0.05) correlation was established between cytokine storms and age, the presence of comorbidity, diabetes, hypertension, fever, shortness of breath, having oxygen saturation (SPO2) less than 93%, cold, fatigue, ward of admission, the severity of COVID-19 disease, duration of treatment as well as the use of remdesivir, Actemra® and Gammaraas®. Most patients recovered after receiving a combination treatment (oseltamivir + remdesivir + Antibiotics + Vitamin/Mineral) for approximately 11 days with a 90% survival rate. On the contrary, patients who received oseltamivir + hydroxychloroquine + Gammaraas® + antibiotics +Vitamin/Mineral, had a 83% survival rate after being admitted to the hospital for about ten days. CONCLUSION: Factors influencing the development of a cytokine storm include age, duration of treatment, comorbidity, symptoms, type of admission ward and severity of infection. Most patients (76.92%) with cytokine storm who received Gammaraas®/Actemra®, survived although they were in the severe and critical levels (87.17%). Overall, based on the treatment duration and survival rate, the most effective therapy was a combination of oseltamivir + favipiravir + hydroxychloroquine + antibiotics + vitamins/minerals.

Charges, length of stay, and complication associations with trauma center ownership in adult patients with mild to moderate trauma.

BACKGROUND: For-profit (FP) trauma centers (TCs) charge more for trauma care than not-for-profit (NFP) centers. We sought to determine charges, length of stay (LOS), and complications associations with TC ownership status (FP, NFP, and government) for three diagnoses among patients with overall low injury severity. METHODS: Adult patients treated at TCs with an International Classification of Diseases-based injury severity score (ICISS) survival probability ≥ 0.85 were identified. Only those who with a principal diagnosis of femur, tibial or rib fractures were included. RESULTS: Total charges were significantly higher at FP centers than NFP and lower at government centers (89.6% and -12.8%, respectively). FP TCs had a 12.5% longer LOS and government TCs had a 20.4% longer LOS than NFP TCs. CONCLUSION: Patients presenting to FP TCs with mild/moderate femur, tibial, or rib fractures experienced higher charges and increased LOS compared with government or NFP centers. There was no difference in overall complication rates.

Blood product utilisation for coronary artery bypass graft surgery at a public and a private hospital in Western Cape Province, South Africa.

BACKGROUND: Numerous studies have documented variation in transfusion practice for coronary artery bypass graft (CABG) surgery, despite the widespread availability of clinical guidelines. Blood management systems seek to streamline utilisation, with key indicators being patient care and outcome as well as reduction of waste and cost. OBJECTIVES: To facilitate this view, this study sought to audit blood product utilisation for CABG surgery at a private and a public sector hospital in Western Cape Province, South Africa. METHODS: A retrospective audit of 100 consecutive patients undergoing CABG surgery at a private and a public hospital during 2017 was performed. Blood product use was compared between the two hospitals, and the influence of confounding factors such as gender, weight, age, pre- and intraoperative medications, type and complexity of the procedure, and patient comorbidities was analysed. RESULTS: The proportion of patients receiving red cell concentrates (RCCs) at the public hospital was significantly higher than at the private hospital (92% v. 56%; p<0.001), which resulted in significantly higher postoperative haemoglobin concentrations (p<0.001). Although the increased proportion of RCC transfusion observed at the public hospital may have been influenced by decreased body mass (p<0.001), the patient population at the private hospital was older (p<0.05) and had higher rates of ischaemia (p<0.001), increased numbers of grafts (p<0.001) and higher preoperative use of aspirin (p<0.05). CONCLUSIONS: This study demonstrated increased use of blood products at the public hospital, despite performing fewer grafts. Although this study had limitations, which included low patient numbers and the inclusion of only two hospitals, we concluded that there is a significant variation in the use of blood products despite the risks associated with blood transfusion. These findings could be used to employ systems that will lead to improved blood usage practices.

Assessment of knowledge and implementation practices of the ventilator acquired pneumonia (VAP) bundle in the intensive care unit of a private hospital.

Studies have shown that a ventilator associated pneumonia (VAP) bundle significantly decreases VAP rates. In this study, we evaluated existing knowledge, practices, and adherence of nurses and infection control preventionists (ICP) to the VAP bundles of care in the intensive care unit (ICU) by using qualitative and quantitative tools. Of 60 participants (56 nurses and 4 ICPs), mean knowledge score regarding specific evidence-based VAP guidelines was 5 (range 3-8) out of 10 points. Self-reported adherence to the VAP bundle ranged from 38.5 to 100%, with perfect compliance to head of bed elevation, and poorest compliance with readiness to extubate. Overall VAP median bundle compliance was 84.6%. Knowledge regarding specific components of VAP prevention is lacking. Formal training and interactive educational sessions should be performed regularly to assess the competency of key personnel regarding the VAP bundle, especially in the context of rapid nurse turnover. Incentives for retention of nurses should also be considered, so that knowledge of hospital specific initiatives such as the VAP bundles of care can be cultivated over time.

Job Satisfaction and Associated Factors among Health Professionals Working at Public and Private Hospitals in Bahir Dar City, Northwest Ethiopia: A Comparative Cross-Sectional Study.

INTRODUCTION: Job satisfaction is a pleasurable or positive emotional state resulting from evaluating one's job or job experiences. However, knowledge of workplace factors that either satisfy employees to keep working or dissatisfy them making them leave their jobs or working places is essential for decision-making. Thus, this study is aimed at assessing job satisfaction and associated factors among healthcare professionals working at public and private hospitals in Bahir Dar city, northwest Ethiopia. METHODS: An institution-based comparative cross-sectional study design was conducted from 10 February 2020 to 29 May 2020. A total of 520 health professionals were selected from public and private health facilities using stratified systematic random sampling techniques. Data were collected using structured pretested self-administered questionnaires. A binary logistic regression model with Huber-White robust standard error was fitted to identify job satisfaction and associated factors among healthcare professionals working at public and private hospitals. A less than 0.05 p value and an Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were considered to have a statistically significant association with the outcome variable. RESULTS: The overall magnitude of job satisfaction was 55.2% (95% CI: 51.0, 59.4%). At public and private hospitals, the provider's satisfaction was 29.0% (95% CI: 23.2, 35.1%) and 81.23% (95% CI: 76.6, 85.8%), respectively. Working at private hospital (AOR: 8.89; 95% CI: 5.14, 15.35), pleasant nature of work (AOR: 1.82; 95% CI: 1.05, 3.15), autonomy (AOR: 2.37; 95% CI: 1.29, 4.33), adequate supportive supervision (AOR: 2.42; 95% CI: 1.33, 4.40), good reward and recognition (AOR: 3.04; 95% CI: 1.37, 6.75), and high normative commitment (AOR: 2.57; 95% CI: 1.48, 4.43) were factors affecting the overall job satisfaction of health professionals. CONCLUSIONS: The magnitude of job satisfaction was relatively low in private and public hospital health professionals and severe among health professionals working in public hospitals. Healthcare policy-makers and hospital managers need to develop and institutionalize evidence-based satisfaction strategies considering the predictors of health professional's job satisfaction.