Hospital-acquired, laboratory-confirmed bloodstream infection: increased hospital stay and direct costs.

OBJECTIVES: To determine increased hospital stay and direct costs attributable to hospital-acquired, laboratory-confirmed bloodstream infection (BSI), and to evaluate the matching variable length of stay (LOS). DESIGN: Retrospective (historical) cohort study with 1:2 matching in intensive care units and surgical wards. SETTING: A 2,000-bed university hospital in Rome, Italy. PATIENTS: All patients admitted between January 1994 and June 1995 who had hospital-acquired, laboratory-confirmed BSI were considered cases; all others were eligible as controls. METHODS: Two controls (A and B) were selected per case in a stepwise fashion. Controls in group A were selected according to the following six criteria: ward, gender, age, diagnosis, central venous catheter, and LOS equal to the interval from admission to infection in a matched case +/- 20% (LOS +/- 20%). Controls in group B were selected according to the first five criteria, but excluded LOS +/- 20%. RESULTS: One hundred five of 108 patients were each matched with two controls. The matching appropriateness score was greater than 90%. With the use of controls in groups A and B, the case-fatality rates attributable to hospital-acquired, laboratory-confirmed BSI were 35.2% and 40.9%, respectively; the estimated risk ratios for death were 2.60 and 3.52 (P = .0001), respectively. The increased hospital stay per case attributable to hospital-acquired, laboratory-confirmed BSI was 19.1 (mean) and 13.0 (median) days for matched pairs in control group A and 19.9 (mean) and 15.0 (median) days for matched pairs in control group B. With controls in group A, the cost of increased hospital stay per patient attributable to hospital-acquired, laboratory-confirmed BSI was Euro 15,413. The additional cost per patient due to treatment was Euro 943, making the overall direct cost Euro 16,356 per case. CONCLUSIONS: This study should make it possible to estimate the cost of hospital-acquired, laboratory-confirmed BSI in most hospitals after adjusting for incidence rate. It also confirmed the use of LOS +/- 20% as a matching variable to limit overestimation of increased hospital stay. To our knowledge, this is among the first such studies in Europe

The Use of Clear Aligners in Multi-Segmental Maxillary Surgery: A Case–Control Study in Cleft Lip and Palate and Skeletal Class III Patients

Background: Maxillary hypoplasia and mandibular asymmetry may be corrected with orthognathic surgery after growth completion. For most stable results, some cases may require segmental Le Fort I osteotomies. Unfortunately, Invisalign’s software (6.0 version) still has some inherent limitations in predicting outcomes for complex surgeries. This study explores the potential of aligners, particularly in multiple-piece maxillary osteotomies in both cleft and non-cleft patients. Method: Thirteen patients who underwent pre-surgical treatment with Invisalign were retrospectively matched in terms of diagnosis, surgical procedure, and orthodontic complexity with thirteen patients treated using fixed appliances. Virtual curves following the lower arch were employed to guide the correct pre-surgical positions of the upper teeth with a simple superimposition technique. The amount of impressions required in both groups to achieve satisfactory pre-surgical alignment of the segmented arches was compared. Results: one or no refinement phases were needed in the Invisalign group to reach an acceptable pre-surgical occlusion, while the amount of pre-surgical impressions needed to reach adequate coordination with fixed appliance treatment was slightly higher (p > 0.05). Conclusions: it appears that clear aligner could serve as an effective treatment for individuals necessitating segmental Le Fort I osteotomies when aided by the suggested simple superimposition approach

Probing the nature of the χc1(3872)\chi_{c1}(3872) state using radiative decays

International audienceThe radiative decays $\chi_{c1}(3872)\rightarrow\psi(2S)\gamma$ and $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ are used to probe the~nature of the~$\chi_{c1}(3872)$ state using proton-proton collision data collected with the LHCb detector, corresponding to an~integrated luminosity of~9fb$^{-1}$. Using the~$B^+\rightarrow \chi_{c1}(3872)K^+$decay, the $\chi_{c1}(3872)\rightarrow \psi(2S)\gamma$ process is observed for the first time and the ratio of its partial width to that of the $\chi_{c1}(3872)\rightarrow J/\psi\gamma$ decay is measured to be $$\frac{\Gamma_{\chi_{c1}(3872)\rightarrow \psi(2S)\gamma}} {\Gamma_{\chi_{c1}(3872)\rightarrow J/\psi\gamma}} = 1.67 \pm 0.21 \pm 0.12 \pm0.04 ,$$ where the first uncertainty is statistical, the second systematic and the third is due to the uncertainties on the branching fractions of the $\psi(2S)$ and $J/\psi$ mesons. The measured ratio makes the interpretation of the $\chi_{c1}(3872)$ state as a~pure $D^0\bar{D}^{*0}+\bar{D}^0D^{*0}$ molecule questionable and strongly indicates a sizeable compact charmonium or tetraquark component within the $\chi_{c1}(3872)$ state