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Dental care for hospitalized patients can improve nutritional status and feeding function while reducing complications. However, such care in Japan is not uniformly provided. This investigation examined the presence and characteristics of hospitals where dentists work and the collaboration between medical and dental teams. This cross-sectional study involves 7205 hospitals using the administrative reports on the Hospital Bed Function of 2018. Indicators described were the proportion of hospitals employing dentists, those providing perioperative oral care, and those with a nutrition support team (NST) that included dentists. A two-level logistic regression model was performed using hospital-based and secondary medical area-based factors to identify factors associated with hospitals employing dentists and dental care services. Some hospitals had poor medical and dental collaboration, even those with dentists, and no-dentist hospitals had rare medical and dental collaboration. Factors positively associated with hospitals that employed dentists were diagnosis-procedure-combination-hospital types, the Japanese government-established hospitals compared with hospitals established by public organizations, among others. In conclusion, the present study found poor medical and dental collaboration was observed in some hospitals and that hospital type, region, and hospital founders were associated with the performance of collaborative medical and dental care.

Aim To evaluate the impact of a proactive action of a specialized diabetes team (SDT) on different health outcomes in patients hospitalized in high complexity surgery units, including solid organ transplant surgical units, of a tertiary hospital. Methods Nested case control study matched (1:1) by age and gender. The control group consisted of patients ( n  = 120) who were under the standard of care diabetes management admitted three months’ prior the cases. The cases were admitted in the same surgical units ( n  = 120) and were treated in the setting of the so called “Smart Diabetes Hospital” (SDH) consisting in a SDT that prioritized their actions through a digital map showing blood glucose levels obtained during the previous 24 h. Results SDH implementation resulted in a significant reduction in both blood glucose levels (mean 162.1 ± SD 44.4 vs. mean 145.5 ± SD 48.0; p  = 0.008) and hypoglycaemic episodes (19.7% vs. 8.4%: p  = 0.002). Furthermore, a reduction of 3 days in the length of stay (LOS) was observed (15.6 ± 10.3 vs. 12.4 ± 6.0), which represents a significant cost-saving. Moreover, more new cases of diabetes were detected during the SDT period (2.5% vs. 6.7%, p  = 0.04). Conclusion SDH is effective in diabetes management and reduce LOS in complex surgical units.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and is a leading cause of disability in China. Acute exacerbations of COPD (AECOPD) are a leading cause of hospitalizations, and account for a substantial proportion of medical expenditure. Corticosteroids are commonly used to manage AECOPD in hospitalized patients, so our objective was to analyze the total medical expenditure associated with nebulized budesonide (nBUD) vs. systemic corticosteroids (SCS) in this population. A post-hoc analysis was carried out in 1,577 and 973 patients diagnosed with COPD who had received \"any\" nBUD or SCS regimen for AECOPD during hospitalization, respectively. Regimens included monotherapy, sequential therapy, and sequential-combination therapy. Comparative total medical expenditure was analyzed using a generalized linear model controlling for age, gender, comorbidities, smoking history, and respiratory failure or pneumonia on admission. The total medical expenditure per capita with any nBUD or SCS regimen was CN¥11,814 (US$1,922) and CN¥12,153 (US$1,977), respectively. Any nBUD regimen was associated with a significant saving of 5.1% in expenditure compared with any SCS regimen ( =0.0341). Comorbidities, Type II respiratory failure, or pneumonia were patient factors associated with higher total medical expenditure ( <0.0001). In a subgroup analysis of the patients who received monotherapy, total medical expenditure was CN¥10,900 (US$1,773) for nBUD and CN¥11,581 (US$1,884) for SCS; nBUD was associated with a significant saving of 8.7% in expenditure compared with SCS ( =0.0013). Similarly, in patients with respiratory failure, treatment with any nBUD regimen was associated with a 10.6% saving in expenditure over any SCS regimen ( =0.0239); however, the same comparison was not significant in patients without respiratory failure (3.4%; =0.2299). AECOPD is a leading cause of hospitalization in China, which places substantial burden on the healthcare system. This post-hoc analysis suggests that nBUD regimens are associated with lower medical expenditure than SCS regimens in hospitalized patients with AECOPD, and may reduce the financial burden of COPD. However, prospective studies evaluating the effectiveness of nBUD therapies are warranted.

Parenteral nutrition (PN) is a life-saving intervention for patients where oral or enteral nutrition (EN) cannot be achieved or is not acceptable. The essential components of PN are carbohydrates, lipids, amino acids, vitamins, trace elements, electrolytes and water. PN should be provided via a central line because of its hypertonicity. However, peripheral PN (with lower nutrient content and larger volume) can be administered via an appropriate non-central line. There are alternatives for the compounding process also, including hospital pharmacy compounded bags and commercial multichamber bags. PN is a costly therapy and has been associated with complications. Metabolic complications related to macro and micronutrient disturbances, such as hyperglycemia, hypertriglyceridemia, and electrolyte imbalance, may occur at any time during PN therapy, as well as infectious complications, mostly related to venous access. Long-term complications, such as hepatobiliary and bone disease are associated with longer PN therapy and home-PN. To prevent and mitigate potential complications, the optimal monitoring and early management of imbalances is required. PN should be prescribed for malnourished patients or high-risk patients with malnutrition where the feasibility of full EN is in question. Several factors should be considered when providing PN, including timing of initiation, clinical status, and risk of complications.

Background: Physical injuries can have prominent consequences, affecting not only physical health but also psychological well-being, potentially leading to Post-Traumatic Stress Disorder (PTSD). Moreover, gender plays an important role in the development and manifestation of PTSD symptoms in hospitalized patients. Objective: To observe the development of PTSD in hospitalized patients for physical injuries lasting more than a month in Pakistan Institute of Medical Sciences (PIMS) Islamabad Pakistan. Methods: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences, Islamabad, during September 2022 to March 2023, and included 261 participants. PTSD symptoms were assessed using the Urdu-translated version of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), which aligns with the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Results: The current study revealed that 100% of both male and female hospitalized patients exhibited substantial PTSD symptoms. There were 64.3% male patients categorized as severe while 53.8% females had severe PTSD symptoms and revealed a statistically significant association (p <0.05) of severity of PTSD symptoms and the extent of physical injuries in male patients. The prevalence of severe PTSD symptoms were highest among those with orthopedic trauma (76.0%), while 59.1% female patients of same category showed severe PTSD symptoms. Conclusion: The study concluded that both male and female hospitalized patients with physical injuries show significant PTSD symptoms, with male showing a higher severity.

Background: Physical injuries can have prominent consequences, affecting not only physical health but also psychological well-being, potentially leading to Post-Traumatic Stress Disorder (PTSD). Moreover, gender plays an important role in the development and manifestation of PTSD symptoms in hospitalized patients. Objective: To observe the development of PTSD in hospitalized patients for physical injuries lasting more than a month in Pakistan Institute of Medical Sciences (PIMS) Islamabad Pakistan. Methods: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences, Islamabad, during September 2022 to March 2023, and included 261 participants. PTSD symptoms were assessed using the Urdu-translated version of the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), which aligns with the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Results: The current study revealed that 100% of both male and female hospitalized patients exhibited substantial PTSD symptoms. There were 64.3% male patients categorized as severe while 53.8% females had severe PTSD symptoms and revealed a statistically significant association (p <0.05) of severity of PTSD symptoms and the extent of physical injuries in male patients. The prevalence of severe PTSD symptoms were highest among those with orthopedic trauma (76.0%), while 59.1% female patients of same category showed severe PTSD symptoms. Conclusion: The study concluded that both male and female hospitalized patients with physical injuries show significant PTSD symptoms, with male showing a higher severity.

BackgroundAlcohol and drug use results in substantial morbidity, mortality, and cost. Individuals with alcohol and drug use disorders are overrepresented in general medical settings. Hospital-based interventions offer an opportunity to engage with a vulnerable population that may not otherwise seek treatment.ObjectiveTo determine whether inpatient addiction consultation improves substance use outcomes 1 month after discharge.DesignProspective quasi-experimental evaluation comparing 30-day post-discharge outcomes between participants who were and were not seen by an addiction consult team during hospitalization at an urban academic hospital.ParticipantsThree hundred ninety-nine hospitalized adults who screened as high risk for having an alcohol or drug use disorder or who were clinically identified by the primary nurse as having a substance use disorder.InterventionAddiction consultation from a multidisciplinary specialty team offering pharmacotherapy initiation, motivational counseling, treatment planning, and direct linkage to ongoing addiction treatment.Main MeasuresAddiction Severity Index (ASI) composite score for alcohol and drug use and self-reported abstinence at 30 days post-discharge. Secondary outcomes included 90-day substance use measures and self-reported hospital and ED utilization.Key ResultsAmong 265 participants with 30-day follow-up, a greater reduction in the ASI composite score for drug or alcohol use was seen in the intervention group than in the control group (mean ASI-alcohol decreased by 0.24 vs. 0.08, p < 0.001; mean ASI-drug decreased by 0.05 vs. 0.02, p = 0.003.) There was also a greater increase in the number of days of abstinence in the intervention group versus the control group (+12.7 days vs. +5.6, p < 0.001). The differences in ASI-alcohol, ASI-drug, and days abstinent all remained statistically significant after controlling for age, gender, employment status, smoking status, and baseline addiction severity (p = 0.018, 0.018, and 0.02, respectively). In a sensitivity analysis, assuming that patients who were lost to follow-up had no change from baseline severity, the differences remained statistically significant.ConclusionsIn a non-randomized cohort of medical inpatients, addiction consultation reduced addiction severity for alcohol and drug use and increased the number of days of abstinence in the first month after hospital discharge.

Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI (p < 0.001) and concentrations of albumin (p < 0.001), hemoglobin (p < 0.001), total cholesterol (p < 0.001), prealbumin (p < 0.001) and total protein (p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition.

Among 11 patients in Thailand infected with severe acute respiratory syndrome coronavirus 2, we detected viral RNA in upper respiratory specimens a median of 14 days after illness onset and 9 days after fever resolution. We identified viral co-infections and an asymptomatic person with detectable virus RNA in serial tests. We describe implications for surveillance.

Nontuberculous mycobacteria (NTM) cause pulmonary and extrapulmonary infections in susceptible persons. To characterize the epidemiology of skin and soft tissue (SST) and disseminated extrapulmonary infections caused by NTM in the United States, we used a large electronic health record database to examine clinical, demographic, and laboratory data for hospitalized patients with NTM isolated from extrapulmonary sources during 2009-2014. Using all unique inpatients as the denominator, we estimated prevalence and summarized cases by key characteristics. Of 9,196,147 inpatients, 831 had confirmed extrapulmonary NTM. The 6-year prevalence was 11 cases/100,000 inpatients; source-specific prevalence was 4.4 SST infections/100,000 inpatients and 3.7 disseminated infections/100,000 inpatients. NTM species varied across geographic region; rapidly growing NTM were most prevalent in southern states. Infection with Mycobacterium avium complex was more common among patients with concurrent HIV and fungal infection, a relevant finding because treatment is more effective for M. avium complex than for other NTM infections.