Hospital practice (1995)最新文献

{"title":"Assessing the effectiveness of a rural distribution program in reducing time to prothrombin complex concentrate administration in patients taking warfarin.","authors":"Abigail Polzin, Joel Stroman, Riley Schaap, Rebecca Baird, David Sturdevant, Aarabhi Gurumoorthy","doi":"10.1080/21548331.2025.2455930","DOIUrl":"10.1080/21548331.2025.2455930","url":null,"abstract":"<p><strong>Study objectives: </strong>Reversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods, such as fresh frozen plasma (FFP). In many rural facilities, the availability of both FFP and PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal.</p><p><strong>Methods: </strong>This was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) and time to PCC4 administration from outside hospital admission. Active warfarin prescription, transfer to a tertiary facility, and administration of anticoagulation reversal between January 2013 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Linear regressions were performed to determine the effect of the variable and INR reversal methods on the time to INR reversal as well as the time to PCC4 administration. Time-to-event analysis was used to analyze the primary outcome between comparison groups. <i>p</i> values of less than 0.05 were considered significant.</p><p><strong>Results: </strong>Chart review identified 189 patients: 56 within the pre-implementation group and 133 within the post-implementation group. Statistics were compared between these two groups. The post-implementation group had a shorter time to INR reversal (median 9.97 h) compared with the pre-implementation group (median 14.58 h, <i>p</i> = 0.00004). Time to PCC4 administration was also significantly decreased (<i>p</i> = 0.023). No statistically significant differences were found for hospital survival or 30-day mortality.</p><p><strong>Conclusion: </strong>In rural hospitals, increasing availability of PCC4 using air medical transport along with a medication exchange program significantly reduces time to PCC4 administration in warfarin anticoagulated patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2455930"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescribing patterns of SGLT-2 inhibitors and their association with heart failure readmissions: a single-center cross-sectional study from a low- and middle-income country.","authors":"Abrar Ali Chhachhar, Saadia Sattar, Farhala Baloch, Umair Javed, Maria Wajid, Salva Shariq, Muhammad Qamar Masood","doi":"10.1080/21548331.2025.2463879","DOIUrl":"10.1080/21548331.2025.2463879","url":null,"abstract":"<p><strong>Objectives: </strong>Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce cardiovascular death and heart failure (HF) hospitalizations in patients with reduced and mildly reduced or preserved ejection fraction. This study assesses the effectiveness of SGLT2 inhibitors in reducing HF readmission rates and examines prescription patterns in hospitalized patients.</p><p><strong>Methods: </strong>This single-center retrospective cross-sectional study evaluated the impact of SGLT2 inhibitors on HF readmission rates when initiated during index hospitalization or within 14 days of discharge. Patients were divided into an SGLT2 group and a non-SGLT2 group, with 6-month readmission rates compared to the groups.</p><p><strong>Results: </strong>Of the 234 patients, 85 (36.3%) were prescribed SGLT2 inhibitors, while 149 (63.7%) were not. SGLT2 inhibitors were prescribed less frequently to patients with chronic kidney disease (CKD) and patients admitted under cardiology services were more likely to receive SGLT2 inhibitors. Among those prescribed SGLT2 inhibitors, the median ejection fraction was significantly lower compared to those not prescribed, while the median estimated glomerular filtration rate was higher. There were 107 total readmissions (45.7%), with most (55%) occurring within 30 days of the index hospitalization. Total readmissions and 30-day readmissions were significantly lower in the SGLT2 inhibitor group (31.8% vs 53.7%, <i>p</i> = 0.001) and (33.33% vs 62.50%, <i>p</i> = 0.029), respectively. Heart failure readmissions were also lower in the SGLT2 group (29.6% vs 21.3%, <i>p</i> = 0.37).</p><p><strong>Conclusion: </strong>Our study demonstrated a significant reduction in heart failure readmission rates among patients prescribed with SGLT2 inhibitors. However, we also observed a gap in the prescription of SGLT2 inhibitors.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2463879"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct costs of severe hypoglycemia events in individuals with diabetes mellitus: a perspective from the Colombian health system - a single-center study.","authors":"Natalia A Rojas-Henao, Michael Garcia-Rivera, Ana C Hernandez-Herrera, Juliana Díaz-Giraldo, Carlos E Builes-Montaño","doi":"10.1080/21548331.2024.2439775","DOIUrl":"10.1080/21548331.2024.2439775","url":null,"abstract":"<p><strong>Background and aims: </strong>Diabetes mellitus is one of the more prevalent chronic diseases globally, and healthcare expenditures for diabetes care are on the rise. Intensive diabetes treatment has been associated with reducing the risk of chronic complications. However, hypoglycemia, the most common adverse effect, poses a significant risk to individuals' lives and is linked to high costs for healthcare systems.</p><p><strong>Methods: </strong>We conducted a retrospective cross-sectional study to determine direct costs by identifying emergency room visits due to hypoglycemia events using diagnostic codes during January 2017 to June 2019. Direct costs were calculated using billed data from the payer and information on outpatient treatment regimens. Differences in median costs were estimated based on length of stay and type of outpatient treatment.</p><p><strong>Results: </strong>Data from 101 patients and the same number of events were included. Women represented (62.4%) of the patients, the median age was 70 (IQR 59.5-80). Blood glucose levels at admission ranged from 12 mg/dL to 67 mg/dL. Most patients were on insulin for outpatient treatment. The median cost of care per hypoglycemia episode was US $345.35 (IQR US $202-727.8), and the cost per episode was higher in patients treated with regimens that included sulfonylureas.</p><p><strong>Conclusions: </strong>The management of patients admitted to the emergency department with a diagnosis of hypoglycemia places a significant burden on the Colombian healthcare system, primarily due to the associated hospitalization costs. Patients treated with regimens that included sulfonylureas incurred higher costs per episode. Prevention, patient education, and individualized treatment approaches could help alleviate the burden of hypoglycemia on both patients and the healthcare system.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2439775"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global strategies to reduce elective surgery waiting times for sustainable health outcomes: a systematic review.","authors":"Dimuthu Rathnayake, Mike Clarke, Viraj Jayasinghe","doi":"10.1080/21548331.2024.2435802","DOIUrl":"10.1080/21548331.2024.2435802","url":null,"abstract":"<p><strong>Objective: </strong>Long waiting times for elective surgery reflect not just backlog issues but systemic inefficiencies that disrupt the smooth flow of patients through the surgical care pathway. This systematic review adopts a holistic approach to summarize global policies, strategies, and interventions aimed at reducing elective surgery wait times.</p><p><strong>Method: </strong>A comprehensive electronic search was performed in PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane Library from December 2019 to January 2020 and updated in April 2022. Eligible studies, published after 2013, focused on waiting lists for major elective surgeries in adults, excluding cancer-related surgeries. Both randomized and non-randomized studies and systematic reviews were included. Study quality was assessed using ROBINS-I, AMSTAR 2, and CASP tools, as appropriate. The review was registered in PROSPERO (CRD42019158455) and reported using a PRISMA flow diagram.</p><p><strong>Results: </strong>From 7543 records, 92 articles met the inclusion criteria. Evidence was categorized into seven strategic areas: referral management, patient prioritization, preventing scheduled surgery cancellations, perioperative time management, quality improvement methods for surgical care pathways, and waiting time targets for hospitals. Strategies such as referral management, patient prioritization, and preventing cancellations had the most significant impact on reducing waiting times, while perioperative time management and waiting time targets proved less effective.</p><p><strong>Conclusion: </strong>The review highlights that targeted interventions at different stages of the surgical care pathway yield variable impacts on overall waiting times. While individual measures had limited effects, combining multiple short-term strategies may be more beneficial, particularly for health systems recovering from the COVID-19 pandemic.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2435802"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of patient demographics and outcomes in teaching and non-teaching hospitals in Iran.","authors":"Niusha Shahidi Sadeghi, Mohammadreza Maleki, Hassan Abolghasem Gorji, Soudabeh Vatankhah, Bahram Mohaghegh, Ali Behmanesh","doi":"10.1080/21548331.2025.2455931","DOIUrl":"10.1080/21548331.2025.2455931","url":null,"abstract":"<p><strong>Aims: </strong>This study investigates the differences in patient demographics and outcomes between teaching and non-teaching hospitals in Iran. By analyzing these differences, it aims to provide useful information for policymakers to optimize resource allocation, improve patient care, and balance educational and service delivery goals in teaching hospitals.</p><p><strong>Materials and methods: </strong>In this cross-sectional investigation, both teaching and non-teaching general hospitals were examined. A comprehensive analysis was carried out on 13 non-teaching and 25 teaching hospitals with homogeneity, utilizing Health Information System (HIS) data comprising 10,611,647 records through census sampling in 2019. Before employing the logistic regression models to clarify the relationship between a binary dependent variable (distinguishing teaching or non-teaching hospitals) and independent variables, we utilize the Recursive Feature Elimination (RFE) technique to select the most crucial predictor variables.</p><p><strong>Findings: </strong>the optimal logistic regression model revealed that the teaching status of hospitals played a crucial role as an indirect predictor for variables including referral patients, length of stay (<24 hours), patients with partial improvement, and those who received less than 3 services. It also emerged as a direct predictor for variables such as length of stay (>30 days), patients receiving more than the mean services, death rate, and patients with complete improvement. Moreover, the teaching status had an indirect impact on variables like outpatient cases, length of stay (>30 days), and paraclinical services, while directly predicting variables such as patients with supplementary insurance and vulnerable groups insurance type, rehabilitation services, clinic wards, and length of stay (between 4-30 days).</p><p><strong>Conclusion: </strong>In Iranian teaching hospitals, we observed an increase in patient numbers, extended length of stay, a rise in both the quantity and complexity of services, and more intricate patient admissions. It appears that small teaching hospitals in Iran have transitioned from being referral centers to functioning as outpatient centers with active clinics.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2455931"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of type 2 diabetes mellitus on mortality and recurrence of clostridioides difficile infection.","authors":"Cristina Martínez Cuevas, María Del Carmen Rebollo Nájera, Jessica Abadía Otero, Miriam Gabella Martín, Mónica de Frutos Serna, José María Eiros Bouza, Luis Corral Gudino, José Pablo Miramontes González","doi":"10.1080/21548331.2024.2440305","DOIUrl":"10.1080/21548331.2024.2440305","url":null,"abstract":"<p><strong>Background: </strong>Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea. The infection is associated with a high mortality rate and risk of recurrence. We assessed risk factors for death or recurrent CDI (CDI) in patients with diabetes mellitus (DM).</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a single institution from 2019 to 2020. CDI was defined as a positive toxin assay for C. difficile. CDI was defined as a repeat positive toxin assay within ≤ 60 days of stopping CDI treatment. Logistic regression models were used to identify risk factors for CDI-related mortality, recurrence, and the combined outcome of mortality and recurrence.</p><p><strong>Results: </strong>Of the 252 enrolled patients with CDI, 19% had DM. Only 49% of patients with DM fully recovered after the first CDI occurrence, whereas 69% of patients without diabetes fully recovered (<i>p</i> = 0.021); 23% of patients with DM vs. 17% of patients without DM had recurrences (<i>p</i> = 0.200); and 23% of patients with DM vs. 15% of patients without DM died (<i>p</i> = 0.169). DM was associated with mortality (OR 2.75, 95% CI 0.94-8.06) and the combined outcome (OR 2.10, 95% CI 1.05-4.18). Nosocomial transmission, immunosuppression, CKD, and age were associated with mortality.</p><p><strong>Conclusions: </strong>Diabetes is associated with a worse prognosis in patients with CDI. Prevention efforts should be optimized in patients with diabetes by reducing CDI transmission and avoiding nonessential medications, such as PPIs or antibiotics when they are not necessary. [Figure: see text].</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"2440305"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucocorticoids treatment and adverse infectious events in rheumatic diseases.","authors":"Valeria Rella, Cinzia Rotondo, Raffaele Barile, Francesca Erroi, Francesco Paolo Cantatore, Addolorata Corrado","doi":"10.1080/21548331.2024.2423598","DOIUrl":"10.1080/21548331.2024.2423598","url":null,"abstract":"<p><p>It is well known that rheumatic diseases are characterized by an increased infection risk, due to several factors, such as an intrinsically dysfunctional immune system, disease activity, and the use of immunosuppressive drugs. Glucocorticoids are widely used therapeutic agents for treating several chronic inflammatory and immune diseases, due to their anti-inflammatory and immunosuppressive effects. Their use is burdened by well-known side effects in dose- and duration of use-dependent manner. Physicians need to be aware of the mechanism of action of glucocorticoids, their side effects, particularly infectious side effects, and the significance of cumulative dose and duration of glucocorticoid treatment. Additionally, physicians shoultdleveld have knowledge of each patient and their comorbidities. They could use appropriate tools for assessing glucocorticoid-related toxicity and morbidity, particularly in the context of chronic glucocorticoid administration. This comprehensive understanding is crucial for ensuring the proper and safe use of these drugs, particularly in terms of minimizing infectious risks. The aim of this review is to focus on available data concerning the infectious risk associated to glucocorticoid treatment in rheumatic diseases, highlighting the role of the correct drug management in clinical practice and the role of the disease itself in the occurrence of this worthy side effect. We conducted a review of randomized controlled trials and observational studies about glucocorticoid use in autoimmune/rheumatic diseases, analyzing the infectious risk during glucocorticoid therapy, and its relationship with the used dose and duration of treatment.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing hospitalists' comfort and familiarity with LGBTQ clinical topics.","authors":"Keshav Khanijow, Nicole Rosendale, Scott Wright, Rita S Lee, Scott Nass, Angela Keniston, Monika Dalal, Leah R Jager, Tyler Anstett","doi":"10.1080/21548331.2024.2414734","DOIUrl":"10.1080/21548331.2024.2414734","url":null,"abstract":"<p><strong>Objectives: </strong>Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S. inpatient provider workforce, this paper's objective was to understand hospitalists' comfort with LGBTQ health.</p><p><strong>Methods: </strong>A 58-question anonymous online survey was distributed in 2019 to practicing hospitalists through the Society of Hospital Medicine regarding their experiences in caring for hospitalized LGBTQ patients.</p><p><strong>Results: </strong>Two hundred and eighteen hospitalist providers completed the entire survey. While hospitalists reported high levels of comfort in caring for these populations (LGBQ: 90.6%, Transgender: 77.8%), they acknowledged feeling less confident in their clinical competence (LGBQ: 71.6%, Transgender: 51.2%). Hospitalist providers who were themselves LGBQ reported more comfort with most aspects of LGBQ patient clinical care than heterosexual respondents (<i>p</i> < 0.05 for 4 of 6 comfort variables). Seventy-four percent of hospitalists wanted training to advance their knowledge and skills in working with LGBTQ patients.</p><p><strong>Conclusions: </strong>Hospitalist clinicians are regularly exposed to LGBTQ patients yet their comfort and expertise in caring for this vulnerable population is highly variable. Educational interventions that include reflective practice may serve to optimize hospitalists' ability to more confidently and competently serve LGBTQ patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142476526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An insight into the updated pharmacotherapy of metabolic-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatohepatitis (MASH) in lean individuals: a review.","authors":"Sanjay Bandyopadhyay, Shambo Samrat Samajdar, Sirshendu Chaudhuri, Saibal Das","doi":"10.1080/21548331.2024.2412513","DOIUrl":"10.1080/21548331.2024.2412513","url":null,"abstract":"<p><p>Metabolic-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatohepatitis (MASH) in lean individuals represents a distinctive subset of MASH. Current pharmacotherapies, for MASH as demonstrated in clinical trials, predominantly target obese patients with limited consideration for lean MASH. We aimed to systematically review the literature on the pharmacotherapy of lean MASH. We searched standard medical databases, such as PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov to identify eligible studies published in English up to 31 December 2023 regarding the effect of pharmacological interventions in individuals with lean MASH. We have summarized the role of various drug classes including peroxisome proliferator-activated receptor agonists, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, vitamin E, farnesoid X receptor agonists, selective thyroid hormone receptor-β agonists, and selective cholesterol absorption inhibitors. Consequently, lifestyle interventions, encompassing dietary modifications, exercise, and weight loss particularly directed at visceral obesity or achieving a reduction in body weight are recommended for all non-obese individuals with MASH. A highlight on the only available treatment recommendation for lean MASH is also presented. The available evidence regarding the efficacy of various drugs for the treatment of lean MASH is limited. Conclusive evidence is warranted from clinical trials exclusively involving lean individuals with MASH.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest tube size selection for pleural effusion: from the perspective of thoracic surgeons and pulmonologists.","authors":"Rayyan M Almusally, Hatem Elbawab, Hasan Alswiket, Ryad Alamry, Hawra Aldar, Maram Alismail, Zahra Albahrani, Zeead Alghamdi, Farouk AlReshaid, Mohammed Sabri","doi":"10.1080/21548331.2024.2401315","DOIUrl":"https://doi.org/10.1080/21548331.2024.2401315","url":null,"abstract":"<p><strong>Background: </strong>The current discourse within the thoracic surgical and pulmonological communities pertains to a contentious debate over the optimal selection criteria for thoracostomy tube diameters utilized in the management of pleural effusions. A comprehensive examination of the variables that inform the clinical decision-making paradigm for the determination of appropriate chest tube calibers is imperative to enhance patient management and elevate the prognostic results.</p><p><strong>Objectives: </strong>The objective of this inquiry is to elucidate the determinants that influence thoracic surgeons and pulmonologists in their selection of chest tube size for the management of pleural effusions.</p><p><strong>Methods: </strong>This cross-sectional study was based on an electronic questionnaire that was sent to the targeted populations through e-mail or a professional WhatsApp. The survey assessed the considerations of chest tube size selection as well as the respective advantages, disadvantages, and potential complications related to each size.</p><p><strong>Results: </strong>The conducted study encompassed participants, with a nearly even distribution between thoracic surgeons (49.1%) and pulmonologists (50.9%). Most of these practitioners are within tertiary-level medical institutions (82.1%). A preference for small-bore chest tubes (SBCT), defined as < 14 French (Fr), was indicated by 54.8% of participants. The drawbacks associated with SBCT, such as kinking (60%) and blockage (70%), influenced the decision-making process negatively, while pain was a significant factor in the selection against LBCT (64%). Ultrasound guidance was a positive influence for the selection of SBCT (55%). Complications associated with LBCT included visceral and vascular injuries (55.7%), wound infection (45.3%), re-expansion pulmonary edema (43.3%), and subcutaneous emphysema (57.5%). In contrast, malposition was a complication more commonly associated with SBCT (49.1%).</p><p><strong>Conclusion: </strong>The decision regarding chest tube size was influenced by several critical factors which included the nature of pleural effusion, the volume of pleural fluid, and potential complications specific to the size of the chest tube used.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}