Costs of post-stroke dysphagia during acute hospitalization from a health-insurance perspective.

Purpose: Oropharyngeal dysphagia is a common and complication-prone symptom after stroke and is assumed to increase medical expenses. The purpose of this study was therefore to examine acute hospitalization costs associated with post-stroke dysphagia. Method: This retrospective study included patients with acute stroke who had been examined by Flexible Endoscopic Evaluation of Swallowing (FEES). Health insurance expenditures were determined for the patient cases according to the 2021 revenue criteria. Multiple linear regression was used to examine predictors of health insurance spending including age, sex, stroke severity, stroke characteristics, comorbidity, therapeutic interventions, duration of artificial ventilation, length of hospital stay, and severity of dysphagia, as assessed by the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), ranging from 1 (best) to 6 (worst). Findings: Six hundred seventy four patients (men/women: 367/307; mean age: 71.1 ± 12.8 years; mean National Institute of Health Stroke Scale: 11.2 ± 6.2; FEDSS 1/2/3/4/5/6: 113/73/144/119/124/101; mean health-insurance costs 11,521.5 ± 12,950.5€) were included in the analysis. Advanced age (p = 0.007; B = 57.6), catheter interventions (p < 0.001; B = 4105.6), tracheotomy (p = 0.006; B = 5195.2), duration of artificial ventilation (p < 0.001; B = 388.6), length of hospital stay (p < 0.001; B = 441.9), and severe dysphagia with an FEDSS of 6 (p = 0.004, B = 2554.3) were independent predictors of increased health insurance expenditures (p < 0.001, R-squared = adjusted-R-squared = 0.83). Discussion and conclusion: The results of this study show an association between severe dysphagia and health care costs for acute hospitalization from a health-insurance perspective. Therefore, therapies that target severe dysphagia with impaired secretion management may have the potential to reduce costs.

Prospective surveillance of colonization and disease by methicillin-resistant Staphylococcus aureus (MRSA) at a European pediatric cancer center.

PURPOSE: Children and adolescents undergoing treatment for cancer or allogeneic hematopoietic cell transplantation are at increased risk for methicillin-resistant Staphylococcus aureus (MRSA). We therefore examined the occurrence and outcome of MRSA colonization and infection in patients of a large European pediatric cancer center. METHODS: In a prospective observational cohort study conducted between 2007 and 2018, nasopharyngeal swabs for culture of MRSA were obtained from all admitted patients. The primary endpoint of the study was the colonization rate over time. Secondary endpoints included genetic relatedness of isolates, time burden of isolation measures, and results of decolonization efforts. RESULTS: During the study period, MRSA screening identified 34 colonized patients (median age: 10 years; range: 0-21) without trends over time. MRSA colonization was associated with the presence of classical risk factors. There was no molecular evidence of patient-to-patient transmission. A standard MRSA eradication regimen led to a lasting eradication of the organism in 26 of 34 patients. MRSA infection occurred in two patients with no associated fatalities. CONCLUSION: Prospective monitoring revealed low rates of MRSA colonization and infection at our center. These low rates and the absence of patient-to-patient transmission support the effectiveness of the management bundle of MRSA identification, isolation, and decolonization.

[Scabies-clinical resistance to permethrin therapy : Case reports and a critical discussion of current treatment recommendations]. / Skabies ­ klinische Therapieresistenz auf Permethrin : Fallbeschreibungen und eine kritische Auseinandersetzung mit den aktuellen Therapieempfehlungen.

Scabies is a contagious disease with increasing frequency. This is confirmed by data from insurance companies as well as increased search queries on Google. There is a controversial discussion in the scientific literature whether the mite has become resistant to standard therapy with permethrin. One case report and a group of cases (N = 12) from a mother-child facility are described in the following demonstrating decreased effectiveness of permethrin therapy. Dermatoscopy can be helpful in diagnosis and in assessing effectiveness of therapy. Dermatoscopic criteria are shown and therapeutic concepts are critically discussed.

Treatment of Children With Cancer and/or Hematopoietic Stem Cell Transplantation in the Intensive Care Unit: Experience at a Large European Pediatric Cancer Center.

Pediatric cancer treatment and hematopoietic stem cell transplantation (HSCT) carry considerable risks of morbidity. We conducted a single-center retrospective analysis of intensive care unit (ICU) admissions in unselected children and adolescents treated for cancer or undergoing HSCT. In a 10-year time period, 140 patients had 188 ICU admissions for a life-threatening condition. Main reasons for ICU admission were respiratory or cardiovascular insufficiency and sepsis. Mortality in the ICU was 19.1% and related to organ failure or acute complications in 77.8% and progress of the underlying malignancy in 22.2%. Mortality rates at 30, 100, and 365 days after discharge from the ICU were 24.5%, 30.9%, and 39.9%. Kaplan-Meier survival probabilities at 5 and 10 years were 46.4% and 39.8%, respectively. Multivariable analysis revealed the number of failed organ systems, the number of prior ICU stays, and days spent in the ICU as parameters independently associated with death. Taken together, the outcome of pediatric cancer and/or HSCT patients admitted to the ICU for life-threatening conditions was not as dismal as reported elsewhere. Most patients benefitted from ICU care, and survival was predominantly compromised by the evolution of complications.

Therapeutic advances in cutaneous T-cell lymphoma (CTCL): from retinoids to rexinoids.

Retinoids comprise a family of polyisoprenoid lipids that include vitamin A (retinol) and its various natural and synthetic analogues. Retinoids are compounds with multiple actions. They are involved in the control of cell proliferation, cell differentiation, and embryonic development. Each retinoid has its own profile of pharmacologic properties that determines its usefulness in clinical dermatology or oncology. Although numerous synthetic retinoids have been synthesized, their biological activities are usually associated with clinical disadvantages such as toxicity and teratogenicity. Retinoids that bind to both the retinoic acid receptor and retinoid X receptor subtypes have shown clinical activity in hematologic malignancies and can mediate genes associated with both growth and differentiation. Retinoid X receptor-specific rexinoids have also shown efficacy in the treatment of cutaneous T-cell lymphomas, but their exact mechanism of action is unclear. This article summarizes the clinical relevance of both groups of compounds in this important patient population.