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1.
PLoS One ; 16(12): e0261064, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34932584

RESUMO

OBJECTIVES: To determine the prevalence and associated factors of unrecognized depression among patients who visit non-psychiatric outpatient departments in the University of Gondar specialized teaching hospital. North West Ethiopia. METHODS: An institution-based cross-sectional study was conducted among Medical outpatient departments in the University of Gondar specialized referral hospital from March to April 2019. We collected data through face-to-face interviews. We recruited 314 participants for face-to-face interviews using the systematic random sampling technique. The patient health questionnaire (PHQ-9) was used to measure depression. Coded variables were entered into Epi Info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics and multivariable logistic regression analysis were used. Adjusted odds ratios (AOR) with a 95% confidence interval were used to calculate significance. RESULTS: A total of 314 participants were interviewed with a response rate of 100%. The prevalence of depression was 15.9% with (95% CI (12.1-20.1)). In the multivariate logistic regression revealed that, able to read and write (AOR = 0.24, 95% CI (0.67-0.84)), secondary education (AOR = 0.34, 95% CI (0.12-0.91)), education in college and university level (AOR = 0.32, 95% CI (0.13-0.78)), poor social support (AOR = 7.78, 95% CI (2.74-22.09)), current cigarette smokers(AOR = 12.65, 95% CI (1.79-89.14)) were associated with depression. CONCLUSION: The prevalence of depression among outpatient attendees was high. We recommend an early depression screening be carried out by health professionals.


Assuntos
Depressão/epidemiologia , Escolaridade , Pacientes Ambulatoriais/psicologia , Pacientes Ambulatoriais/estatística & dados numéricos , Apoio Social , Adulto , Estudos Transversais , Depressão/diagnóstico , Etiópia/epidemiologia , Feminino , Departamentos Hospitalares , Humanos , Masculino , Prevalência
2.
BMJ Open Qual ; 10(4)2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34697037

RESUMO

Surgical departments commonly rely on third-party quality improvement registries. As electronic health data become increasingly integrated and accessible within an institution, alternatives to these platforms arise. We present the conceptualization and implementation of an in-house quality improvement platform that provides real-time reports, is less onerous on clinicians and is tailored to an institution's priorities of care.


Assuntos
Hospitais , Melhoria de Qualidade , Departamentos Hospitalares , Humanos
3.
Pan Afr Med J ; 39: 176, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34584602

RESUMO

Introduction: hematopoietic stem cell transplantation (HSCT) is part of the cellular immunotherapy arsenal. It is used in the treatment of several malignant and non-malignant hematological conditions as well as other extra-hematological diseases. HSCT has been described since 1950 and introduced in Morocco since the 2000s. GSCH is still little used in our context due to several legal, financial and organizational barriers. The purpose of this study is to report the experience of the Bone Marrow Transplant Department of the Marrakech's Mohammed VI University Hospital with hematopoietic stem cell transplantation, is one of the Hospital Departments in developing countries. Methods: we carried out a descriptive retrospective study over a period of 6 years. Results: during the study period, sixty-six HSCT were performed. Multiple myeloma was the main indication for HSCT in our case series (30 patients with autografts). In our case series, mortality rate was around 20%, relapse rate was 23% while complications rate was 38%. Despite the challenges, our results were encouraging during the long follow-up period. Conclusion: efforts still need to be made to improve therapy results.


Assuntos
Doenças Hematológicas/terapia , Neoplasias Hematológicas/terapia , Transplante de Células-Tronco Hematopoéticas/métodos , Adulto , Feminino , Seguimentos , Doenças Hematológicas/patologia , Neoplasias Hematológicas/patologia , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Departamentos Hospitalares , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Marrocos , Estudos Retrospectivos , Resultado do Tratamento
4.
Acta Otolaryngol ; 141(8): 791-795, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34340651

RESUMO

BACKGROUND: Health care workers (HCW) at otorhinolaryngological departments have an increased risk of contracting COVID-19, due to aerosol-inducing diagnostic and surgical procedures in the airways. The ongoing exposure to physical and psychological stressors could impact the mental health of HCW. AIM/OBJECTIVE: To investigate the impact on mental health in an otorhinolaryngological department during the COVID-19 pandemic. MATERIALS/METHOD: Cross-sectional questionnaire study, assessing symptoms of depression (PHQ-9) and anxiety (GAD-10). Physicians, nurses, and secretaries were included at a tertiary department of otorhinolaryngology in the Capital Region of Denmark during the COVID-19 lockdown in spring 2020. RESULTS: Positive screenings for stress reactions were found in 22% for depressive symptoms and 15.5% anxiety. 27% feared becoming infected, 47% feared infecting their families in relation to work. 27% felt others were distancing from them, and 38% isolated themselves from others because of their work. Women had an odds ratio of 9.18 (CI 1.49-179) for depressive stress reactions. CONCLUSION: HCW were primarily concerned with transmitting COVID-19 to their relatives. Secondarily, there was a concern about becoming infected despite feeling adequately protected by personal protective equipment. Women were at higher risk of more severe depressive symptoms when corrected for professions.


Assuntos
COVID-19/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Estresse Ocupacional/epidemiologia , Otolaringologia , Recursos Humanos em Hospital/psicologia , Adulto , COVID-19/prevenção & controle , COVID-19/psicologia , Estudos Transversais , Dinamarca , Feminino , Departamentos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Centros de Atenção Terciária
5.
Artigo em Inglês | MEDLINE | ID: mdl-34444145

RESUMO

Work-related mental health issues, accounting for high worker absenteeism in the world's developed economies, are increasing, with the main cause being workplace conditions. The health services sector is especially experiencing great problems with this, because of challenging psychosocial working conditions. The aim of this study was to explore employees' experiences of development work with a focus on the work environment within a hospital department with an outspoken special development assignment. The special assignment was decided by the highest management at the hospital and concerned work environment, caring processes, and ways of organizing the work. Eleven employees completed two individually semi-structured interviews, approximately 7 and 13 months after the start of the special assignment at the department. Interviews were analyzed using thematic analysis. The results reveal that both internal and external aspects influence the development work and highlight the importance of viewing the local development work in relation to how the rest of the organization functions. Important factors and conditions for a supportive and change-friendly work culture are discussed, as well as the need to plan for integration and change to create conditions for successful implementation of the results from organizational development and change initiatives.


Assuntos
Absenteísmo , Local de Trabalho , Atenção à Saúde , Departamentos Hospitalares , Organizações
6.
J Healthc Qual Res ; 36(5): 253-262, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34305039

RESUMO

INTRODUCTION: We designed and conducted a survey to analyze the impact of the COVID-19 pandemic on the operation and performance of the orthopedic departments of the National Health System and private entities. MATERIAL AND METHODS: Descriptive study of a survey is distributed to Spanish Ortohopedic surgeons via Internet. RESULTS: 401 valid responses were obtained, out of these 85.7% had to reduce their surgical activity between 50% and 100%. 46% of the sample were asked to collaborate in other units or services and another 43% felt that their work had been underused. 52% modified the treatment indications in various bone fractures, with variability between centers and communities. 30% reported being satisfied with the management from the state and 60% with that of their province and center. 70% showed little to no satisfaction with the training received on the use of masks and personal protective equipment. An additional of 80% were also unsatisfied with the training received with regard to sample-taking. 65% did not have protective equipment to carry out their work. 46% have been denied protective measures to treat patients with suspected or confirmed infection. CONCLUSION: The COVID-19 pandemic has placed the National Health System in an extremely serious situation. Through the analysis of the results, we can observe an inefficient use of available human resources, a widespread discontent, as well as an absence of means and measures, which has had a direct impact on the number of infected professionals.


Assuntos
COVID-19 , Departamentos Hospitalares/organização & administração , Ortopedia/organização & administração , Traumatologia/organização & administração , COVID-19/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Espanha/epidemiologia
7.
J Neurosurg Pediatr ; 28(4): 380-386, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34330092

RESUMO

OBJECTIVE: Transitional care in surgical neurooncology is poorly studied. However, this period is pivotal, since it allows the patient to be empowered in his or her disease management. Here, the authors describe the experience of the Necker-Enfants Malades and the Sainte-Anne Hospital collaboration. METHODS: The mixed transitional consultations started in September 2019 in a dedicated space for transitional care, named the "La Suite" department, located in the Necker-Enfants Malades Hospital, Paris, France. The authors organized planned consultations to schedule the clinical and radiological follow-up in the adult neurosurgical department but also emergency consultations to manage tumor recurrence in young adult patients. Transitional care was performed jointly by pediatric and adult neurosurgeons who have developed clinical and research skills in the field of surgical neurooncology. Neuropathological analysis was performed by a neuropathologist who is specialized in pediatric and adult neurooncology. RESULTS: Fourteen patients benefited from a mixed transitional consultation. All of them accepted to start their management in an adult neurosurgical environment. Eleven patients (78.6%) for whom the disease was controlled benefited from a planned consultation. Three patients (21.4%) required rapid neurosurgical management for a tumor recurrence (n = 2) or for a new primary CNS tumor (n = 1) and benefited from an emergency consultation. CONCLUSIONS: For adult patients harboring a brain tumor during childhood or adolescence, the authors suggest that neurosurgeons specialized in adult surgical neurooncology with a full knowledge in pediatric neurooncology will combine the required skills to optimize care management for these patients within a dedicated multidisciplinary organization framework.


Assuntos
Neoplasias Encefálicas/cirurgia , Neoplasias Encefálicas/terapia , Oncologia/métodos , Neurocirurgia/métodos , Cuidado Transicional , Adolescente , Feminino , França , Departamentos Hospitalares , Hospitais , Humanos , Masculino , Recidiva Local de Neoplasia/cirurgia , Neurocirurgiões , Equipe de Assistência ao Paciente , Encaminhamento e Consulta , Adulto Jovem
8.
World Neurosurg ; 153: e481-e487, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34242826

RESUMO

BACKGROUND: Social media has become ubiquitous in modern medicine. Academic neurosurgery has increased adoption to promote individual and departmental accomplishments, engage with patients, and foster collaboration. We sought to quantitatively evaluate the adoption of one of the most used social media platforms, Twitter, within academic neurosurgery. METHODS: A quantitative and qualitative analysis of Twitter use across 118 academic neurosurgery departments with residency programs in the United States was performed in March 2019 and March 2021. We collated Twitter handles, Doximity residency ranking (a peer-determined ranking system), geographic location, and Twitter demographics (tweets, followers, likes, and tweet content) from before and after the coronavirus disease 2019 (COVID-19) pandemic. Tweet content was characterized by reviewers over a predetermined 6-month period. Linear regression and parametric/nonparametric tests were used for analysis. RESULTS: Departmental accounts grew 3.7 accounts per year between 2009 and 2019 (R2 = 0.96), but 43 accounts (130%) were added between 2019 (n = 33) and 2021 (n = 76). This growth, coinciding with the COVID-19 pandemic, changed the model from linear to exponential growth (R2 = 0.97). The highest-ranking programs based on Doximity were significantly more likely to have an account (P < 0.001) and have more followers (P < 0.0001). Tweet content analysis revealed prioritization of faculty/resident activity (mean 49.9%) throughout the quartiles. CONCLUSIONS: We demonstrate rapid uptake in Twitter use among U.S. academic neurosurgical departments, accelerated by COVID-19. With the impact of COVID-19, it is clear that there will be continued rapid adoption of this platform within neurosurgery, and future studies should explore the outcomes of peer collaboration, patient engagement, and dissemination of medical information.


Assuntos
COVID-19/cirurgia , Neurocirurgia/estatística & dados numéricos , Procedimentos Neurocirúrgicos , Mídias Sociais , Departamentos Hospitalares/estatística & dados numéricos , Humanos , Disseminação de Informação/métodos , SARS-CoV-2/patogenicidade , Estados Unidos
10.
J Pak Med Assoc ; 71(5): 1515-1520, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34091651

RESUMO

OBJECTIVE: To identify the deficiencies in patient note record-taking with the aim of improving the quality to meet international standards. METHODS: This prospective clinical quality improvement audit study was conducted at the department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital Lahore from January 2019 to February 2020. The first audit cycle was carried out in July 2019, after data anonymisation, the notes from 1st January to 31st June were analysed in the first audit cycle against a hybrid proforma containing entries deemed essential in operative notes according to the guidelines of the Royal College of Surgeons of England. The guidelines were subsequently disseminated among postgraduate trainees using various methods. Post-intervention, randomly selected patientnotes from 1st August to 31st December 2019 were analysed in the second audit which was done in February 2020. The result of the two audits were compared to assess significance of association between the cycles for each categorical variable. RESULTS: Of the 100 patient-notes audited, 50(50%) were part of each of the two cycles. Significant improvements (p<0.05) were seen between the two cycles in time of operation, pre-op status, post-op care, monitoring instruction, mobilisation, feeding instructions, wound care and position. There was 100% improvement in entries including name, age and sex, date of operation, elective/emergency, name of the procedure and name of operating surgeon and assistant, and the name of anaesthetist. Overall, marked improvement was observed in all parameters except in 'use of antibiotic prophylaxes'. CONCLUSIONS: Regular audits are needed to monitor and improve patient care.


Assuntos
Documentação , Melhoria de Qualidade , Departamentos Hospitalares , Humanos , Paquistão , Estudos Prospectivos
11.
Medicine (Baltimore) ; 100(26): e26346, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190152

RESUMO

ABSTRACT: Aging of population is characterized by multiple chronic conditions in the same individual. Health-related quality of life (HR-QOL) reflects the multidimensional impact of chronic disease on population and it is increasingly analysed as outcomes.The aim of this study was the evaluation of the predictors of quality of life among elderly patients hospitalized in internal medicine ward, investigating the effect of comorbidities on health-related quality of life.Data collected in this cross-sectional study were analysed. Socio-demographic, clinical characteristics, disease distribution and quality of life by the 12-Item Short Form Health Survey (SF-12) were evaluated.Of 240 inpatients, subjects with Barthel Index (BI)≤40 were 23.7%, 55% had a Geriatric Depression Scale (GDS)≥2. After categorizing mental component score (MCS) and physical component score (PCS) in five classes, we found that diabetics and patients with cancer were more frequent in the first class of MCS while patients with NYHA III-IV are significantly more frequent in the first class of PCS. When we classified patients according to GDS≥2 or < 2, subjects with GDS≥2 had BI and MCS significantly lower. In the multivariate analysis GDS score ≥2 was independently associated with first MCS class [16.32 (3.77-70.68)] while NYHA III-IV class and claudicatio intermittents were strong predictors of the worst PCS class [9.54 (1.97-47.40), 2.53 (1.16-5.49), respectively]. Liver disease was independently associated with GDS≥2 [5.26 (1.13-24.39)].Our study highlighted the impact of chronic diseases on health-related quality of life in elderly subjects hospitalized in an internal medicine ward pointing out the importance of taking into account patient's needs and perception and the setting up of a personalised health-care. Patients with diabetes and liver disease along with persons affected by cancer need psychological support to improve their quality of life. A GDS score ≥ 2 is a strong predictor of poor quality of life and should trigger an in-depth assessment of mental health in this kind of patients.


Assuntos
Depressão/psicologia , Idoso Fragilizado/psicologia , Hospitalização , Múltiplas Afecções Crônicas/psicologia , Questionário de Saúde do Paciente , Qualidade de Vida , Idoso , Estudos Transversais , Diabetes Mellitus/psicologia , Feminino , Departamentos Hospitalares , Humanos , Medicina Interna , Hepatopatias/psicologia , Masculino , Neoplasias/psicologia , Apoio Social
13.
Wiad Lek ; 74(5): 1057-1060, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090263

RESUMO

OBJECTIVE: The aim: The aim of the study is to assess the quality of medical care and determine the relationship between treatment outcomes of patients and acute respiratory viral infectious disease caused by SARS-CoV-2,depending on patients` age, the time from onset of symptoms to hospitalization, and the presence of comorbidity. PATIENTS AND METHODS: Materials and methods: According to the specially designed form, a retrospective analysis of primary accounting documents was carried out (f. No. 103/o) in 158 patients with COVID-19. The research was carried out in specialized inpatient infectious diseases wards of health institutions of the Sumy region during the period from April to September 2020. The study used a systemic approach, bibliosemantic, comparative and statistical analyses, logical generalization methods. RESULTS: Results: Among the study group of patients, namely 158 people, a bigger number of women (56.33±3.95%) than men (43.67±3.95%) were recorded. Patients of working age (from 18 to 64 years old) took 70.89±3.61% of all patients, and people aged 65 years and older - 29.11±3.61%. The time from the beginning of symptoms to hospitalization in each second patient (49.37±3.98%) lasted 5-7 days. In most cases, the patient's stay in the hospital equaled 13-15 bed-days - 32.28±3.72%. The index of patients with severe and critical state was 20.89±3.23% (33 patients). In 8.23±2.19% (13 people) of treated cases of hospital stay ended in death. A large index of patients with a severe course of the disease, the treatment of which ended in discharge, were in hospital for more than 13 bed days - 12.03±2.59% (19 people). All of these patients were older, had CNCDs (chronic non-communicable diseases), half of them were hospitalized on day 7 and later from the onset of symptoms. CONCLUSION: Conclusions: In older people, the disease progresses faster and complications are developing more often. Also, the severity of the SARS-CoV-2 pattern and the length of staying in the hospital are affected by the time starting the onset of symptoms till hospitalization and the presence of CNCDs. The hereinafter data allows to increase knowledge about spreading of COVID-19, to improve the quality of organizational and preventive events in the provision of medical care, and reducing mortality.


Assuntos
COVID-19 , Pacientes Internados , Adolescente , Adulto , Idoso , Feminino , Departamentos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2 , Adulto Jovem
14.
Int J Qual Health Care ; 33(3)2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34166503

RESUMO

BACKGROUND: Patient complaints are increasingly recognized to provide a valuable insight into patients' experience of healthcare. Being local and subjective, they can bring to light previously under-appreciated causes of patient dissatisfaction. The focus of surgical care is usually an intervention, and the nature of complaints made about surgical care may vary substantially from that in non-surgical specialties. This may have specific implications for quality improvement in surgical departments. OBJECTIVE: To investigate the causes of patient dissatisfaction in surgical care. METHODS: We retrospectively examined the content and frequency of patient complaints received by surgical departments at a UK district general hospital in the calendar year 2017. Second-hand reports of complaints, documented by the members of the hospital's complaints department, were collated from a prospectively maintained database and categorized by content. RESULTS: Three hundred and ninety-nine complaints were received over the study period. These related to the care of 327 different patients. One complaint was generated for every 111 patient encounters. Ninety-one per cent of the complaints were made by the patient, and 8.8% were made by a family member. Complaints cited communication with hospital staff in 25% of cases, out-of-hospital delays in 24%, clinical issues in 22%, hospital administration in 16% and in-hospital delays in 10%. Post-operative symptoms and complications accounted for only 2% of the complaints. Twenty-six per cent of the complaints resulted in the rescheduling of an operation or a clinic appointment. Seventeen per cent of the complaints prompted internal actions within the surgical department to investigate and learn from the incident. CONCLUSION: The profile of complaints made about surgical departments is similar to that of non-surgical departments in other studies. Clinical issues represented only the third largest cause of complaints. More complaints implicated patient-staff communication, and around half implicated management-related issues. Improving staff communication training, clinical standards and hospital administration continues to represent opportunities to enhance the patients' overall experience of surgical care.


Assuntos
Hospitais Gerais , Satisfação do Paciente , Departamentos Hospitalares , Humanos , Estudos Retrospectivos , Reino Unido
15.
Nutr Hosp ; 38(4): 710-714, 2021 Jul 29.
Artigo em Espanhol | MEDLINE | ID: mdl-34024114

RESUMO

Introduction: Introduction: the pandemic caused by SARS-CoV-2 led to the declaration of the state of sanitary alarm between March and June 2020 in Spain. The activity of human milk banks was affected during that period, making it necessary to implement new measures in order to promote milk donation and diminish said impact. Method and objective: the aim of the study was to evaluate the impact of the state of alarm decreed from March 14 to June 22, 2020 on the breastmilk bank at Hospital Virgen de las Nieves, Granada, Spain, in comparison with the same period during the previous year. To that end, a retrospective descriptive study was undertaken in which the activity indicators of the breastmilk bank were collected and compared to data from the milk bank at Hospital Virgen de las Nieves and peripheral collaborating centers. Results: during the first state of alarm in 2020 a global reduction was seen in new donor registrations, number of donors who donated milk, donated mean volume per mother, and total volume of received and pasteurized milk. However, new registrations and number of donors who donated milk during this period increased in Granada's breastmilk bank. Discussion: the new measures adopted in the breastmilk bank in Granada, such as encouraging milk donation in mothers with admitted newborns in the Neonatal Unit, increasing information given to mothers, and home collection of donated milk, allowed to attenuate the impact of the pandemic while guaranteeing safety.


Assuntos
COVID-19 , Bancos de Leite/estatística & dados numéricos , Leite Humano , Pandemias , Feminino , Departamentos Hospitalares , Humanos , Recém-Nascido , Mães , Quarentena , Estudos Retrospectivos , Espanha , Doadores de Tecidos
16.
Anesthesiol Clin ; 39(2): 363-377, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34024437

RESUMO

In March 2020, the COVID-19 pandemic reached New York City, resulting in thousands of deaths over the following months. Because of the exponential spread of disease, the New York City hospital systems became rapidly overwhelmed. The Department of Anesthesiology at New York Presbyterian (NYP)-Columbia continued to offer anesthesia services for obstetrics and emergency surgery, while redirecting the rest of its staff to the expanded airway management role and the creation of the largest novel intensive care unit in the NYP system. Tremendous innovation and optimization were necessary in the face of material, physical, and staffing constraints.


Assuntos
Anestesia/estatística & dados numéricos , Anestesiologia/organização & administração , COVID-19 , Recursos em Saúde/organização & administração , Hospitais , Pandemias , Departamentos Hospitalares/organização & administração , Humanos , Cidade de Nova Iorque , Salas Cirúrgicas/organização & administração
17.
Transfusion ; 61(7): 2082-2089, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33955577

RESUMO

BACKGROUND: Massive transfusions are associated with a high mortality rate, but there is little evidence indicating when such efforts are futile. The purpose of this study was to identify clinical variables that could be used as futility indicators in massively transfused patients. METHODS: We retrospectively analyzed 138 adult surgical patients at our institution receiving a massive transfusion (2016-2019). Peak lactate and nadir pH within 24 h of massive transfusion initiation, along with other clinical variables, were assessed as predictors of the primary outcome, in-hospital mortality. RESULTS: The overall rate of in-hospital mortality among our patient population was 52.9% (n = 73). Increasing lactate and decreasing pH were associated with greater mortality among massively transfused patients. Mortality rates were ~2-fold higher for patients in the highest lactate category (≥10.0 mmol/L: 25 of 37; 67.6%) compared to the lowest category (0.0-4.9 mmol/L: 17 of 48; 35.4%) (p = .005), and ~2.5-fold higher for patients in the lowest pH category (<7.00: 8 of 9; 88.9%) compared to the highest category (≥7.40: 8 of 23; 34.7%) (p = .016). Increasing age was also associated with higher mortality (≥65 years: 24 of 33; 72.7%) when compared to younger patients (18-64 years: 49 of 105; 46.7%) (p = .010). CONCLUSIONS: Peak lactate ≥10.0 mmol/L, nadir pH <7.00, and age ≥65 years were significantly associated with higher rates of in-hospital mortality among massively transfused patients. Incorporating these clinical parameters into a futility index for massive transfusions will be useful in situations where blood products are scarce and/or mortality may be unavoidable.


Assuntos
Transfusão de Sangue , Mortalidade Hospitalar , Concentração de Íons de Hidrogênio , Lactatos/sangue , Futilidade Médica , Adulto , Fatores Etários , Idoso , Área Sob a Curva , Biomarcadores/sangue , Feminino , Departamentos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Prognóstico , Curva ROC , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios , Adulto Jovem
18.
Artigo em Inglês | MEDLINE | ID: mdl-33995713

RESUMO

The COVID pandemic has made telematic consultations a basic tool in daily practice. Aims: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients.The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. Methods: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. Results: Phone call to 5619 patients were made with a lack of response of 19%The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department.Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement.Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. Conclusions: The cases of 74% of the patients who answered the phone call were resolved virtually.Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests.Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.


Assuntos
COVID-19 , Departamentos Hospitalares , Ortopedia/métodos , Consulta Remota , Traumatologia/métodos , Humanos , Consulta Remota/organização & administração , Consulta Remota/estatística & dados numéricos
19.
J Laryngol Otol ; 135(8): 675-679, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34002682

RESUMO

BACKGROUND: Acute epistaxis can be a life-threatening airway emergency, requiring in-patient admission. The coronavirus disease 2019 pandemic placed significant strain on hospital resources, and management has shifted towards an out-patient-centred approach. METHODS: A five-month single-centre retrospective study was undertaken of all epistaxis patients managed by the ENT department. A pre-coronavirus disease 2019 pandemic group was managed with pre-existing guidelines, compared to new guidelines for the coronavirus disease 2019 pandemic group. A telephone survey was performed on out-patients with non-dissolvable packs to assess patient comfort and satisfaction. RESULTS: A total of 142 patients were seen. The coronavirus disease 2019 pandemic group had significantly more patients aged over 65 years (p = 0.004), an increased use of absorbable dressings and local haemostatic agents (Nasopore and Surgiflo), and fewer admissions (all p < 0.0005). Rates of re-presentation and morbidity, and length of hospital stay were similar. The telephone survey revealed out-patient management to be efficacious and feasible. CONCLUSION: The coronavirus disease 2019 pandemic has shifted epistaxis management towards local haemostatic agents and out-patient management; this approach is as safe and effective as previously well-established regimens.


Assuntos
COVID-19/epidemiologia , Epistaxe/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Previsões , Técnicas Hemostáticas , Departamentos Hospitalares , Humanos , Masculino , Pessoa de Meia-Idade , Otolaringologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Reino Unido/epidemiologia
20.
Rev Neurol ; 72(9): 307-312, 2021 05 01.
Artigo em Espanhol | MEDLINE | ID: mdl-33908617

RESUMO

INTRODUCTION AND AIM: COVID-19 pandemic has disturbed many hospital activities, including medical education. We describe the switch from in-person didactic sessions to videoconferencing in a Neurology department. We analyse the opinions and satisfaction of participants. MATERIAL AND METHODS: Narrative description of the adopted measures; Online survey among participants. RESULTS: One of the three weekly sessions was cancelled, and two switched to videoconferencing. There were more participants online than in the conference hall. 49 users answered the survey, 51% women, mean age 40.5 years (range 25-65). Satisfaction was higher for previous face-to-face meetings (8.68) than for videoconferencing (8.12) (p=0.006). There was a significant inverse correlation between age and satisfaction with virtual sessions (r=-0.37; p=0.01), that was not found for in-person attendance. Most users (75.5%) would prefer to continue with online sessions when the pandemic is over, and 87.8% support inter-hospital remote meetings, but the safety of web platforms is a concern (53.1%). CONCLUSIONS: The change from in-person to virtual sessions is an easy measure to implement in a neurology department, with a good degree of satisfaction among users. There are some unsolved problems with the use of commercial web platforms and inter-hospital connection. Most users recommend leadership and support from educational and health authorities.


Assuntos
COVID-19 , Comportamento do Consumidor , Educação Médica Continuada/métodos , Educação de Pós-Graduação em Medicina/métodos , Neurologia/educação , Pandemias , Comunicação por Videoconferência , Adulto , Idoso , Estudos Transversais , Feminino , Departamentos Hospitalares , Hospitais Universitários , Humanos , Internato e Residência , Masculino , Pessoa de Meia-Idade , Neurologistas/educação , Neurologistas/psicologia , Transferência da Responsabilidade pelo Paciente , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Comunicação por Videoconferência/instrumentação , Comunicação por Videoconferência/estatística & dados numéricos
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