15 research outputs found
Economic impact of kidney patients with sepsis in hospital setting
No full textIntroduction: Over the last decades, sepsis has become a real medical emergency, with a high mortality rate and often requiring admission to an intensive care unit. An increasing number of CKD patients contracts sepsis due to several clinical risk factors (use of catheters, immunosuppressive therapy, comorbidity, etc.) and is treated in Nephrology wards, generating additional costs that are not covered by hospital Diagnosis Related Groups (DRG) reimbursement. The aim of the study is to evaluate the costs of sepsis in one Nephrology Unit and to detect the mortality rate of CKD patients with sepsis. Methods: We conducted a retrospective study on a cohort of CKD patients admitted into one Nephrology Unit in 2017. CKD inpatients were divided in two groups: patients with sepsis (SP) and without (control group). Socio-demographic, clinical and therapeutic data, as well as routine biochemistry, were collected through a "sepsis form". SP were identified thanks to hospital discharge records (HDR). The hospital-related costs of a SP were obtained by summing up: (1) the average cost of an inpatient day of care for the average length of stay in the Nephrology Unit; (2) the average cost of the antimicrobial therapy, as recorded on the clinical folder. Results: Among the 408 CKD inpatients, 61 were septic. The overall average cost of a SP was 23.087,57 €; the average cost of the hospital stay and of the antimicrobial therapy was 19.364,98 € and 3.722,60 € respectively. The average length of stay in the Nephrology Unit was 16.7 days. The in-hospital mortality rate was 41.7%, with a 312% additional mortality rate. Conclusions: SP had an overall average cost three times higher than CKD inpatients without sepsis (9.290,79 €). This additional cost was due to a longer hospital stay (8.7 days more on average) and a higher cost of antimicrobial therapy per case (€ 221,24). A national multi-centre study is needed to confirm our data and to promote an adjustment of reimbursement tariff for DRG-sepsis, which is now applicable only to an ICU setting
Impatto economico correlato alla gestione di pazienti nefropatici con diagnosi di sepsi in ambiente ospedaliero
No full textIntroduzione: La sepsi è diventata negli ultimi decenni una vera emergenza medica, associata ad una mortalità elevata; necessita spesso di ricovero in ambito ospedaliero intensivistico, determinando elevati costi di gestione dei pazienti. A causa di una serie di fattori clinici (utilizzo di cateteri, terapie immunosoppressive, comorbilità, etc.) un numero sempre maggiore di pazienti nefropatici contraggono una sepsi e vengono trattati all’interno di degenze nefrologiche e ciò compromette la capacità del meccanismo di rimborso da tariffario nazionale dei Diagnosis Related Groups (DRG) di remunerare gli inevitabili costi aggiuntivi. Lo scopo principale di questo studio è quello di valutare i costi della sepsi nel caso di una singola Unità Operativa di Nefrologia e, secondariamente, rilevare il tasso di mortalità dei pazienti settici in ambito nefrologico. Metodi: È stato condotto uno studio retrospettivo con riferimento alla coorte dei pazienti ricoverati in una degenza nefrologica nel 2017. I pazienti sono stati divisi in due gruppi: quelli che hanno contratto la sepsi e quelli che invece non l’hanno contratta, questi ultimi considerati come gruppo controllo. Sono stati raccolti dati anagrafici, ematochimici, clinici e terapeutici del campione mediante la scheda aziendale “Sepsi”. I pazienti settici sono stati rilevati utilizzando le Schede di Dimissione Ospedaliera (SDO). Il costo relativo ad un ricovero per sepsi è stato ottenuto dalla somma di: (1) il costo medio di una giornata di degenza moltiplicato per il numero complessivo di giornate di degenza consumate; (2) il costo specifico del trattamento antibiotico eseguito in corso di degenza, rilevato direttamente dalla documentazione clinica. Risultati: Su 408 pazienti arruolati, 61 sono risultati con sepsi. Il costo medio complessivo pro-capite del ricovero di un paziente con sepsi in Nefrologia ammontava a 23.087,57 €; esso era costituito dal costo medio totale del ricovero per questa tipologia di paziente (19.364,98 €) e dal costo medio totale ponderato pro-capite della antibiotico terapia (3.722,60 €). Il tasso di mortalità è risultato pari al 41,7%, con una mortalità addizionale del 312%. Conclusioni: Un paziente nefropatico con sepsi aveva un costo totale di 23.087,57 €, pari quasi al triplo di un analogo paziente senza sepsi (9.290,79 €) ricoverato in Nefrologia. Le cause principali di questo discostamento erano dovute alla degenza media più lunga di 8,7 giorni e ai costi medi giornalieri pro-capite elevati della terapia antibiotica (221,24 €). Sono necessari ulteriori studi multicentrici nazionali per un’analisi più ampia dei costi aggiuntivi e per favorire l’adeguamento del corrispettivo tariffario di rimborso DRG della sepsi, attualmente applicabile principalmente in ambito intensivistico.Introduction: Over the last decades, sepsis has become a real medical emergency, with a high mortality rate and often requiring admission to an intensive care unit. An increasing number of CKD patients contracts sepsis due to several clinical risk factors (use of catheters, immunosuppressive therapy, comorbidity, etc.) and is treated in Nephrology wards, generating additional costs that are not covered by hospital Diagnosis Related Groups (DRG) reimbursement. The aim of the study is to evaluate the costs of sepsis in one Nephrology Unit and to detect the mortality rate of CKD patients with sepsis. Methods: We conducted a retrospective study on a cohort of CKD patients admitted into one Nephrology Unit in 2017. CKD inpatients were divided in two groups: patients with sepsis (SP) and without (control group). Socio-demographic, clinical and therapeutic data, as well as routine biochemistry, were collected through a "sepsis form". SP were identified thanks to hospital discharge records (HDR). The hospital-related costs of a SP were obtained by summing up: (1) the average cost of an inpatient day of care for the average length of stay in the Nephrology Unit; (2) the average cost of the antimicrobial therapy, as recorded on the clinical folder. Results: Among the 408 CKD inpatients, 61 were septic. The overall average cost of a SP was 23.087,57 €; the average cost of the hospital stay and of the antimicrobial therapy was 19.364,98 € and 3.722,60 € respectively. The average length of stay in the Nephrology Unit was 16.7 days. The in-hospital mortality rate was 41.7%, with a 312% additional mortality rate. Conclusions: SP had an overall average cost three times higher than CKD inpatients without sepsis (9.290,79 €). This additional cost was due to a longer hospital stay (8.7 days more on average) and a higher cost of antimicrobial therapy per case (€ 221,24). A national multi-centre study is needed to confirm our data and to promote an adjustment of reimbursement tariff for DRG-sepsis, which is now applicable only to an ICU setting
Unlocking Patient and Professional Value Through Patient Experience: Preliminary Development and Validation of the Patient Experience Assessment of In-Center Hemodialysis (PEACHD) Survey
No full textPatient experience is a crucial measure of healthcare quality with the potential to increase value for several health stakeholders. However, various barriers often hinder its impact on quality improvement. Therefore, valid and reliable instruments developed through structured and collaborative processes are needed to establish methodological and organizational practices and ensure consensus and credibility among all stakeholders. This study presents the development and validation of the Patient Experience Assessment of in-Center Hemodialysis (PEACHD) survey. An expert panel, cognitive interviews, and a pilot test were conducted, involving both people receiving hemodialysis care and professionals from four Italian hospitals. The questionnaire evaluates key aspects of the in-center hemodialysis experience, including the provision of medical information, involvement in treatment decision-making, and communication with professionals. The PEACHD survey demonstrated strong content and face validity, acceptable construct validity, and good internal consistency reliability. Pilot data highlighted that the professional delivering care (i.e. nephrologist or dialysis nurse) significantly influenced patient experience and emphasized the need for a holistic and person-centered approach. The PEACHD survey enables effective patient experience evaluation, enhancing value for both service users and professionals
MENINGKATKAN MOTIVASI BELAJAR IPS TENTANG PAHLAWAN MELALUI METODE DISKUSI PADA SISWA KELAS V SDN GUNTUR 03 PAGI SETIABUDI JAKARTA SELATAN
No full textPenelitian ini bertujuan untuk mengimplemtasikan melalui metode
diskusi dalam kegiatan pembelajaran IPS untuk dapat meningkatkan
motivasi belajar. Untuk mencapai tujuan tersebut penulis melakukan
penelitian di Sekolah Dasar Negeri 03 Pagi Setiabudi Jakarta Selatan.
Penelitian dilakukan pada bulan Januari sampai April 2010 dengan
subyek penelitian berjumlah 32 siswa yang duduk di kelas V.
Penelitian menggunakan penelitian Tindakan Kelas Menurut
Kemmis menggunakan siklus, setiap siklus melalui lima tahapan kegiatan
yaitu Perencanaan,Pelaksanaan, Tindakan,Pengamatan,refleksi.
Hasil penelitian menunjukkan bahwa terjadi peningkatan motivasi
belajar, setelah di lakukan tindakan pada siklus kesatumencapai 72,87%,
siklus kedua mencapai 88,90%. Adapun observasi tindakan guru dalam
pembelajaran diskusi pada siklus pertama 75%, pada siklus kedua
mencapai 88%.
Dengan demikian secara statistik terjadi peningkatan yang
signifikan pada prosentase motivasi belajar melalui metode diskusi siswa
belum dilakukan tindakan dengan sesudah dilakukan tindakan baik pada
siklus pertama dan kedua.
Dari hasil penelitian ini dapat disimpulkan bahwa pembelajaran
diskusi dapat meningkatkan motivasi belajar IPS sebesar 20,30% di
Sekolah Dasar Negeri Guntur 03 Pagi Setiabudi Jakarta Selatan.
*****
This study aimed to mengimplemtasikan through the method of
discussion in social studies learning activities to increase motivation to
learn. To achieve these objectives the author conducted research in 03
public elementary school in South Jakarta Setiabudi morning.
The study was conducted from January to April 2010 with research
subjects numbered 32 students who sat in class V.
Research using action research Classes by Kemmis use cycles,
each cycle through the five stages of the Planning, Execution, Action,
Observation, reflection.
The results showed that an increase in motivation to learn, after
doing the action in the cycle kesatumencapai 72.87%, 88.90% reached
the second cycle. The observation of teachers in action learning cycle of
discussion at the first 75%, at the second cycle reaches 88%.
Thus, a statistically significant increase in the percentage of
learning motivation through student discussion method has not been done
with the action after the action at both first and second cycle.
From this research we can conclude that the discussion of learning
can improve learning motivation IPS for 20.30% of public elementary
school in Guntur 03 Morning, South Jakarta Setiabudi
Detoxification of bilirubin and bile acids with intermittent coupled plasmafiltration and adsorption in liver failure (HERCOLE study)
No full textCPFA is an extracorporeal treatment used in severe sepsis to remove circulating proinflammatory cytokines. Limited evidence exists on the effectiveness of bilirubin adsorption by the hydrophobic styrenic resin, the distinctive part of CPFA. The aim of this study is to validate CPFA effectiveness in liver detoxification
Ultrasonography of Quadriceps Femoris Muscle and Subcutaneous Fat Tissue and Body Composition by BIVA in Chronic Dialysis Patients
No full textProtein Energy Wasting (PEW) in hemodialysis (HD) patients is a multifactorial condition due to specific pathology-related pathogenetic mechanisms, leading to loss of skeletal muscle mass in HD patients. Computed Tomography and Magnetic Resonance Imaging still represent the gold standard techniques for body composition assessment. However, their widespread application in clinical practice is difficult and body composition evaluation in HD patients is mainly based on conventional anthropometric nutritional indexes and bioelectrical impedance vector analysis (BIVA). Little data is currently available on ultrasound (US)-based measurements of muscle mass and fat tissue in this clinical setting. The purpose of our study is to ascertain: (1) if there are differences between quadriceps rectus femoris muscle (QRFM) thickness and abdominal/thigh subcutaneous fat tissue (SFT) measured by US between HD patients and healthy subjects; (2) if there is any correlation between QRFM and abdominal/thigh SFT thickness by US, and BIVA/conventional nutritional indexes in HD patients. We enrolled 65 consecutive HD patients and 33 healthy subjects. Demographic and laboratory were collected. The malnutrition inflammation score (MIS) was calculated. Using B-mode US system, the QRFM and SFT thicknesses were measured at the level of three landmarks in both thighs (superior anterior iliac spine, upper pole of the patella, the midpoint of the tract included between the previous points). SFT was also measured at the level of the periumbilical point. The mono frequency (50 KHz) BIVA was conducted using bioelectrical measurements (Rz, resistance; Xc, reactance; adjusted for height, Rz/H and Xc/H; PA, phase angle). 58.5% were men and the mean age was 69 (SD 13.7) years. QRFM and thigh SFT thicknesses were reduced in HD patients as compared to healthy subjects (p < 0.01). Similarly, also BIVA parameters, expression of lean body mass, were lower (p < 0.001), except for Rz and Rz/H in HD patients. The average QRFM thickness of both thighs at top, mid, lower landmarks were positively correlated with PA and body cell mass (BCM) by BIVA, while negatively correlated with Rz/H (p < 0.05). Abdominal SFT was positively correlated with PA, BCM and basal metabolic rate (BMR) (p < 0.05). Our study shows that ultrasound QRFM and thigh SFT thicknesses were reduced in HD patients and that muscle ultrasound measurements were significantly correlated with BIVA parameters
Circulating CXCL9, monocyte percentage, albumin, and C-reactive protein as a potential, non-invasive, molecular signature of carotid artery disease in 65+ patients with multimorbidity: a pilot study in Age.It
No full textBackground: Carotid endarterectomy (CEA) for the prevention of upcoming vascular and cerebral events is necessary in patients with high-grade stenosis (≥70%). In the framework of the Italian National project Age.It, a pilot study was proposed aiming at the discovery of a molecular signature with predictive potential of carotid stenosis comparing 65+ asymptomatic and symptomatic inpatients. Methods: A total of 42 inpatients have been enrolled, including 26 men and 16 women, with a mean age of 74 ± 6 years. Sixteen symptomatic and 26 asymptomatic inpatients with ≥70% carotid stenosis underwent CEA, according to the recommendations of the European Society for Vascular Surgery and the Society for Vascular Surgeons. Plaque biopsies and peripheral blood samples from the same individuals were obtained. Hematobiochemical analyses were conducted on all inpatients, and plasma cytokines/molecules, such as microRNAs (miRs), IL-6, sIL-6Ralpha, sgp130, myostatin (GDF8), follistatin, activin A, CXCL9, FGF21, and fibronectin, were measured using the ELISA standard technique. MiR profiles were obtained in the discovery phase including four symptomatic and four asymptomatic inpatients (both plasma and plaque samples), testing 734 miRs. MiRs emerging from the profiling comparison were validated through RT-qPCR analysis in the total cohort. Results and conclusion: The two groups of inpatients differ in the expression levels of blood c-miRs-126-5p and -1271-5p (but not in their plaques), which are more expressed in symptomatic subjects. Three cytokines were significant between the two groups: IL-6, GDF8, and CXCL9. Using receiver operating characteristic (ROC) analysis with a machine learning-based approach, the most significant blood molecular signature encompasses albumin, C-reactive protein (CRP), the percentage of monocytes, and CXCL9, allowing for the distinction of the two groups (AUC = 0.83, 95% c.i. [0.85, 0.81], p = 0.0028). The potential of the molecular signature will be tested in a second cohort of monitored patients, allowing the application of a predictive model and the final evaluation of cost/benefit for an assessable screening test
The stakeholders' relationships and the formation of environmental inequalities in the Valdivia plant, Los Rios region, Chile: a case study of environmental inequality
No full textMuch of the literature on Environmental Justice documents if a community suffering from an environmental hazard is non-white or low-income, ignoring the community’s context and relationships between them. These relationships reflect the formation of environmental inequality as the continuous shaping and shifting alliances between multiple stakeholders. By following Pellow’s model of Environmental Inequality Formation (2000), this thesis investigates the role that different stakeholders play in the formation of Environmental Inequalities by looking at the events that conforms the Valdivia Plant’s Cruces River pollution, in the Valdivia province, Los Rios region, southern Chile. This thesis was conducted using a qualitative method and case study approach to review the case literature and to gather, code, and interpret secondary sources of information, including archival records and historical documents in the written form of news and texts. The information about the Valdivia plant case was gathered between 1994 and 2007. The results from this thesis show that the stakeholders involved in the case study participated actively and influenced the formation and avoidance of Environmental Inequality, stepping away from traditional assumptions of a “perpetrator-victim” scenario where vulnerable communities are passively bearing the pollution. Accordingly, this thesis also examines the different outcomes that stakeholders can achieve, by comparing the Maiquillahue Bay and the Cruces River stories of success and failure regarding the pollution and environmental inequality coming from the Valdivia Cellulose Plant. Moreover, the purpose of this thesis is to identify the broader causes of Environmental Inequality, moving beyond the common race/class explanations, and looking for structural and local forces that may explain the Environmental Inequality phenomenon. Future research directions in EJ studies should aim to incorporate the multi-stakeholder perspective when looking for the causes of environmental inequality, and to further research locals’ active resistance to environmentally unequal situations.M.S.Includes bibliographical referencesby Gabriela E. Ullo
From Graphs to Qubits: A Critical Review of Quantum Graph Neural Networks
No full textQuantum Graph Neural Networks (QGNNs) represent a novel fusion of quantum computing and Graph Neural Networks (GNNs), aimed at overcoming the computational and scalability challenges inherent in classical GNNs that are powerful tools for analyzing data with complex relational structures but suffer from limitations such as high computational complexity and over-smoothing in large-scale applications. Quantum computing, leveraging principles like superposition and entanglement, offers a pathway to enhanced computational capabilities. This paper critically reviews the state-of-the-art in QGNNs, exploring various architectures. We discuss their applications across diverse fields such as high-energy physics, molecular chemistry, finance and earth sciences, highlighting the potential for quantum advantage. Additionally, we address the significant challenges faced by QGNNs, including noise, decoherence, and scalability issues, proposing potential strategies to mitigate these problems. This comprehensive review aims to provide a foundational understanding of QGNNs, fostering further research and development in this promising interdisciplinary field.21 pages, 9 figures, 2 tables. arXiv admin note: text overlap with arXiv:1909.12264 by other author
