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1.
Neth Heart J ; 30(12): 559-566, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-35670951

RESUMEN

OBJECTIVE: The risk of major adverse cardiovascular events (MACE) for older emergency department (ED) patients presenting with non-cardiac medical complaints is unknown. To apply preventive measures timely, early identification of high-risk patients is incredibly important. We aimed at investigating the incidence of MACE within one year after their ED visit and the predictive value of high-sensitivity cardiac troponin T (hs-cTnT) and N­terminal pro-B-type natriuretic peptide (NT-proBNP) for subsequent MACE. METHODS: This is a substudy of a Dutch prospective cohort study (RISE UP study) in older (≥ 65 years) medical ED patients who presented with non-cardiac complaints. Biomarkers were measured upon ED arrival. Cox-regression analysis was used to determine the predictive value of the biomarkers, when corrected for other possible predictors of MACE, and area under the curves (AUCs) were calculated. RESULTS: Of 431 patients with a median age of 79 years, 86 (20.0%) developed MACE within 1 year. Both hs-cTnT and NT-proBNP were predictive of MACE with an AUC of 0.74 (95% CI 0.68-0.80) for both, and a hazard ratio (HR) of 2.00 (95% CI 1.68-2.39) and 1.82 (95% CI 1.57-2.11) respectively. Multivariate analysis correcting for other possible predictors of MACE revealed NT-proBNP as an independent predictor of MACE. CONCLUSION: Older medical ED patients are at high risk of subsequent MACE within 1 year after their ED visit. While both hs-cTnT and NT-proBNP are predictive, only NT-proBNP is an independent predictor of MACE. It is likely that early identification of those at risk offers a window of opportunity for prevention.

2.
Acute Med ; 21(1): 5-11, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35342904

RESUMEN

BACKGROUND: Internal medicine residents are frequently interrupted by phone calls, which may compromise workflow, work quality and job satisfaction. AIM: This study investigates the number, nature and impact of calls on residents and their work during evening shifts in the emergency department and ward. METHODS: This prospective observational study compares measurements from direct observations with subjective data from questionnaires. RESULTS: Residents received 26 resp. 30 (median) calls per shift in the emergency department and ward, with duration of 50 resp. 80 seconds. Residents perceived high burden and impact on quality of work and job satisfaction. DISCUSSION & CONCLUSION: Frequent interruptions by phone calls were observed, which resulted in high burden. Our study raises the urgency for finding solutions and provides insights necessary for possible interventions.


Asunto(s)
Servicio de Urgencia en Hospital , Teléfono , Humanos , Estudios Prospectivos , Encuestas y Cuestionarios
3.
Acute Med ; 18(4): 232-238, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31912054

RESUMEN

BACKGROUND: Nonspecific complaints (NSC) at the Emergency Department (ED) are not well researched yet. OBJECTIVE: To investigate the number of patients who could be classified as having NSC early after arrival in the ED using an algorithm. METHOD: Retrospective cohort study was conducted among all hemodynamically stable non-trauma adult patients with MTS category orange/yellow visiting the ED. Patients who had no specific complaints/signs, predefined on a list, were categorized as NSC. RESULTS: In total, 2419 patients, of whom 102 (4.2%) presented with NSC. Hospitalization was more prevalent (85.3% vs. 69.0%, p<0.001) and in-hospital mortality was higher in the NSC-group (11.8% vs. 3.5%, adjusted OR 2.0, 95% CI 1.0-3.9, p=0.04). CONCLUSION: Using an algorithm it is possible to identify NSC patients who have (worse) outcomes than those classified as SC.


Asunto(s)
Servicio de Urgencia en Hospital , Mortalidad Hospitalaria , Hospitalización , Adulto , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Estudios Prospectivos , Estudios Retrospectivos
4.
Acute Med ; 17(2): 83-90, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29882558

RESUMEN

The aims of this retrospective cohort study were to retrieve characteristics and outcomes of older (65+) medical patients who are directly admitted to ICU from the ED and to compare these with those admitted to ICU from a ward. Of 1396 patients, 21 (1.5%) were directly admitted to ICU and 54 (3.9%) after a delay. Blood pressure was lower and respiratory rate higher in the direct than in the delayed group. The direct group had lower mortality (28-day: 19.0 vs. 38.9%, p=0.14; 1-year: 42.9 vs. 66.7%; p=0.06), shorter length-of-stay and returned more frequently to independent living than the delayed group. Only a fraction of older patients are admitted to ICU; directly admitted patients tend to have better outcomes.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Mortalidad Hospitalaria , Humanos , Evaluación de Resultado en la Atención de Salud/métodos , Estudios Retrospectivos
5.
Eur J Public Health ; 26(5): 743-748, 2016 10.
Artículo en Inglés | MEDLINE | ID: mdl-27001795

RESUMEN

BACKGROUND: Older individuals are particularly prone to suffer health-care-related adverse events (AEs); they often have more comorbidity and, thus, require more health-care. Since our society is ageing, insight into AEs leading to hospital admissions is necessary. We aimed to assess the incidence, predictive factors and consequences of AEs leading to admission in older individuals. METHODS: We performed a retrospective cohort study of all older patients (≥65 years) who were admitted through the emergency department (ED) to the department of internal medicine in the last week of every month in 2011. We retrieved the incidence and possible predictive factors for AEs leading to admission and mortality (both in-hospital and within 28 days after discharge). The control group consisted of older patients admitted because of other reasons. RESULTS: In the study period, there were 262 admissions, of which 106 (40.5%) were because of an AE. The most common AE was medication-related (55.7%). Predictive factors of admission because of an AE were the number of medications used [odds ratio (OR) 1.16 per medication, 95% confidence intervals (CI) 1.08-1.25] and dependency in instrumental activities of daily living (IADL) (OR 0.35, 95% CI 0.14-0.91). Both in-hospital mortality and mortality within 28 days after discharge were lower in the AE group (5.7% vs. 16.0%, P = 0.01, and 0 vs. 6.9%, P < 0.05, respectively). CONCLUSION: Admissions through the ED to the department of internal medicine of older patients are often because of AEs (40.5%), with medication use being the greatest culprit. Surprisingly, mortality was lower in the AE group. The number of medications used (positive) and IADL dependency (negative) were predictive factors for being admitted because of an AE.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Países Bajos , Oportunidad Relativa , Estudios Retrospectivos
6.
Emerg Med J ; 29(4): 295-300, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21511973

RESUMEN

BACKGROUND: The tendency of sepsis to progress rapidly and the benefit of an early start of treatment emphasise the importance of fast risk stratification in the emergency department (ED). The aim of the present work was to validate the Mortality in Emergency Department Sepsis (MEDS) score as a predictor of 28-day mortality in ED patients with sepsis in The Netherlands, and to compare its performance to C reactive protein (CRP) and lactate. METHODS: This was a historical cohort study in a secondary and tertiary care university hospital. Patients were included if they were seen by an internist in the ED, fulfilled the clinical criteria for sepsis and were admitted to the hospital. Primary outcome was all-cause in-hospital mortality within 28 days. RESULTS: In the 6-month study period, 331 patients were included, of whom 38 (11.5%) died. Mortality varied significantly per MEDS category: ≤4 points (very low risk: 3.1%), 5-7 points (low risk: 5.3%), 8-12 points (moderate risk 17.3%), 13-15 points (high risk: 40.0%), >15 points (very high risk: 77.8%). Receiver operating characteristic (ROC) analysis showed that the MEDS score predicted 28-day mortality better than CRP (area under the curve (AUC) values of 0.81 (95% CI 0.73 to 0.88) and 0.68 (95% CI 0.58 to 0.78), respectively). Lactate was not measured in enough patients (47) for a valid evaluation, but seemed to predict mortality at least fairly (AUC 0.75, 95% CI 0.60 to 0.90). CONCLUSIONS: The MEDS score is an adequate tool for predicting mortality in patients with sepsis in a Dutch internistic ED population. CRP is less useful in this context. Lactate appears to be at least a fair predictor of mortality, but needs to be investigated more systematically in a larger population.


Asunto(s)
Proteína C-Reactiva/análisis , Ácido Láctico/sangre , Sepsis/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Biomarcadores/sangre , Estudios de Cohortes , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Valor Predictivo de las Pruebas , Curva ROC , Sepsis/diagnóstico
7.
Ned Tijdschr Geneeskd ; 1642020 05 11.
Artículo en Holandés | MEDLINE | ID: mdl-32608930

RESUMEN

The flash mob method is a new way of conducting prospective research whereby relatively simple - but clinically relevant - questions can be answered in a short period of time. The design and intensity of the spirited action - the 'flash' - with which the research is initiated determines the size of the group - the 'mob' - of researchers who will collect research data, and therefore determine the size of the study population. The reach of a flash mob study differs from that of traditional studies and gives flash mob studies a special character. In this article we show how the flash mob method works, the opportunities that it presents, its limitations and the kinds of questions it is able to answer.


Asunto(s)
Investigación Biomédica , Proyectos de Investigación/tendencias , Investigación Biomédica/métodos , Investigación Biomédica/tendencias , Recolección de Datos , Humanos , Selección de Paciente , Estudios Prospectivos , Factores de Tiempo
8.
Artículo en Inglés | MEDLINE | ID: mdl-32621972

RESUMEN

OBJECTIVES: To determine the effect of a single dose of gentamicin on the incidence and persistence of acute kidney injury (AKI) in patients with sepsis in the emergency department (ED). METHODS: We retrospectively studied patients with sepsis in the ED in three hospitals. Local antibiotic guidelines recommended a single dose of gentamicin as part of empirical therapy in selected patients in one hospital, whereas the other two hospitals did not. Multivariate analysis was used to evaluate the effect of gentamicin and other potential risk factors on the incidence and persistence of AKI after admission. AKI was defined according to the KDIGO (Kidney Disease Improving Global Outcomes) criteria. RESULTS: Of 1573 patients, 571 (32.9%) received a single dose of gentamicin. At admission, 181 (31.7%) of 571 of the gentamicin-treated and 228 (22.8%) of 1002 of the non-gentamicin-treated patients had AKI (p < 0.001). After admission, AKI occurred in 64 (12.0%) of 571 patients who received gentamicin and in 82 (8.9%) of 1002 people in the control group (p 0.06). Multivariate analysis showed that shock (odds ratio (OR), 2.72; 95% CI, 1.31-5.67), diabetes mellitus (OR, 1.49; 95% CI, 1.001-2.23) and higher baseline (i.e. before admission) serum creatinine levels (OR, 1.007; 95% CI, 1.005-1.009) were associated with the development of AKI after admission, but not receipt of gentamicin (OR, 1.29; 95% CI, 0.89-1.86). Persistent AKI was rare in both the group that received gentamicin (16/260, 6.2%) and the group that did not (15/454, 3.3%, p 0.09). CONCLUSIONS: With regard to renal function, a single dose of gentamicin in patients with sepsis in the ED is safe. The development of AKI after admission was associated with shock, diabetes mellitus and higher baseline creatinine level.

9.
Rheumatology (Oxford) ; 47(4): 530-4, 2008 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18356178

RESUMEN

OBJECTIVES: In patients with ANCA-associated vasculitis (AAV), an increased incidence of venous thromboembolism (VTE), mainly during active disease, has been described. In a large cohort of AAV patients, we assessed the incidence of VTE and its relation with disease activity and classic risk factors for VTE. METHODS: Patients newly diagnosed with AAV between 1990 and 2005 and treated with cyclophosphamide and corticosteroids were included. Data were retrospectively retrieved from charts and by questionnaire. The incidence of VTE associated with and following a diagnosis of AAV was calculated (VTE/100 person-years) and related to periods with active disease. RESULTS: One hundred and ninety-eight patients with AAV were followed for 6.1 (0.2-17.6) yrs. In 23 patients (12%), 25 VTEs (17 deep venous thromboses, 3 pulmonary emboli, 5 both) occurred in association with AAV, of which 52% occurred during active disease, defined as 3 months before and after diagnosis or relapse of AAV. Overall, VTE incidence was 1.8/100 person-years, increasing to 6.7/100 during active disease. VTEs occurred significantly less frequently in patients with WG than in patients with microscopic polyangiitis and renal limited vasculitis. Classic risk factors were present in most patients at some moment during follow-up. There were no significant differences in classic risk factors between patients with and without AAV-associated VTE. CONCLUSIONS: Patients with AAV have an increased risk of developing VTEs, especially when AAV is active. This finding could not be explained by classic risk factors, but is probably related to endothelial changes and hypercoagulability induced by AAV and its therapy.


Asunto(s)
Anticuerpos Anticitoplasma de Neutrófilos/sangre , Enfermedades Autoinmunes/complicaciones , Vasculitis/complicaciones , Tromboembolia Venosa/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo
11.
Clin Exp Rheumatol ; 22(6 Suppl 36): S94-101, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15675143

RESUMEN

Current treatment based on the use of cyclophosphamide and corticosteroids has changed anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides from highly fatal into more chronic relapsing diseases. Relapses are a major problem in these diseases and cause increased morbidity and mortality. Current clinical research mainly focuses on achieving control of active disease while minimizing treatment-related toxicity. Risks for longterm relapse and their sequelae have been less thoroughly studied. It is noteworthy that, besides treatment, several other factors have been associated with the occurrence of relapses. Thus, compared to MPO-ANCA positive patients, patients with PR3-ANCA associated vasculitis run a significantly increased risk of experiencing relapses. ANCA-status during follow-up, levels of T cell activation, genetic background, and infectious and other exogenous factors have been linked to relapse as well. With a few exceptions, these associations are merely descriptive and not pathophysiologically proven. Furthermore, data on adapting treatment in accordance with risk factors for relapse are scarce. We review here the risk factors for relapse in ANCA-associated vasculitis, their potential pathogenic implications, and their possible role in preventive strategies and adaptations of current treatment policies.


Asunto(s)
Anticuerpos Anticitoplasma de Neutrófilos/sangre , Vasculitis/inmunología , Anticuerpos Anticitoplasma de Neutrófilos/inmunología , Supervivencia sin Enfermedad , Glomerulonefritis/inmunología , Glomerulonefritis/mortalidad , Glomerulonefritis/patología , Granulomatosis con Poliangitis/inmunología , Granulomatosis con Poliangitis/mortalidad , Granulomatosis con Poliangitis/patología , Humanos , Recurrencia , Factores de Riesgo , Tasa de Supervivencia , Vasculitis/mortalidad , Vasculitis/patología
12.
Ned Tijdschr Geneeskd ; 142(43): 2361-3, 1998 Oct 24.
Artículo en Holandés | MEDLINE | ID: mdl-9864514

RESUMEN

A 59-years-old man with oesophageal cancer (T3NXMo) presented with trismus, dysarthria and diaphoresis. Later, he developed opisthotonus and generalized spasms. Despite negative blood cultures and sufficiently high anti-tetanus-titres, tetanus was suspected, on clinical grounds. He was intubated and treated with tetanus toxoid, human antitetanus immunoglobulin, benzylpenicillin, propofol, benzodiazepines, vecuronium, and sufentanil, and recovered gradually. Tetanus is caused by Clostridium tetani, a Gram-positive rod capable of remaining present latently in the body for years. Absence of a visible external wound suggests that the oesophageal mucosal cancer lesion could have served as portal of entry or that endogenous reactivation of latent tetanus bacteria had taken place.


Asunto(s)
Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/diagnóstico , Tétanos/diagnóstico , Tétanos/etiología , Clostridium tetani/aislamiento & purificación , Quimioterapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Tétanos/tratamiento farmacológico , Antitoxina Tetánica/uso terapéutico , Resultado del Tratamiento , Trismo/diagnóstico
15.
Neth J Med ; 71(1): 44-9, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23412826

RESUMEN

BACKGROUND: To monitor and improve the quality of care we provide it is important to register complications. Complications occurring after discharge or after treatment at outpatient clinics are usually not registered and complications occurring in domains other than where they originated may be missed. The emergency department (ED) may offer an opportunity to register these complications. This study assesses the prevalence and nature of complications in patients at the moment of acute admission by internists. METHODS: A retrospective cohort study over a five-month period was performed in which we reviewed the charts of all patients who were admitted to our hospital via the ED by internists. We investigated the number, nature, preventability and severity of complications present at the moment of admission. RESULTS: In total, there were 1128 admissions. Of these, 284 patients were admitted 324 times (28.7%) due to a complication. The most common complication was medication-related (43.5%), in particular bleeding while using anticoagulants. The second most prevalent complication was chemotherapy-related (26.9%), while 17.3% were due to a procedure. Up to 27.8% of all complications were considered preventable. Eighteen (6.3%) patients died during their admission, seven (2.5%) did not recover completely. A total of 23.1% of all complications originated in specialities other than internal medicine. CONCLUSION: Complications are a major reason for hospitalisation. Registering complications present at admission gives broad insight into the complications following the care doctors provide. It is important to understand these complications better to prevent such admissions.


Asunto(s)
Complicaciones de la Diabetes/epidemiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Servicio de Urgencia en Hospital , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Recolección de Datos/métodos , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
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