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1.
Rev. Odontol. Araçatuba (Impr.) ; 43(3): 33-39, set.-dez. 2022. tab
Article in Portuguese | LILACS, BBO | ID: biblio-1381093

ABSTRACT

O presente estudo aborda os protocolos odontológicos instituídos na Unidade de Terapia Intensiva COVID de um Hospital do Extremo Sul Catarinense. A cavidade oral, considerada uma abertura para a entrada de microrganismos, possui características favoráveis ao seu crescimento, com temperatura e umidade ideais para sua sobrevivência em longo prazo. A odontologia, por manipular diretamente mucosa oral, fica exposta e vulnerável ao contágio do COVID-19, assim como a equipe multiprofissional que manipula o paciente nas diversas áreas de atenção à saúde, no ambiente hospitalar. A COVID-19 é uma infecção respiratória aguda causada pelo coronavírus SARS-CoV-2, potencialmente grave, de elevada transmissibilidade e de distribuição global. A maioria das pessoas (cerca de 80%) se recupera da doença sem precisar de tratamento hospitalar. Uma em cada seis pessoas infectadas por COVID-19 fica gravemente doente e desenvolve dificuldade de respirar. As pessoas idosas e as que têm outras condições de saúde, como pressão alta, problemas cardíacos e do pulmão, diabetes ou câncer, têm maior risco de ficarem gravemente doentes. No entanto, qualquer pessoa pode pegar a COVID-19 e ficar gravemente doente. Constatou-se que a aplicação de protocolos odontológicos na Unidade de Terapia Intensiva apresenta uma série de vantagens em relação à prevenção da contaminação dos profissionais de saúde, à manutenção da saúde bucal do paciente, aos benefícios gerais para a saúde, à prevenção e ao tratamento de infecções oportunistas, que podem reduzir o tempo de internação do paciente, pois infecção generalizada e pneumonia são doenças nosocomiais também causadas por distúrbios na microbiota oral. Os resultados mostraram que não há cirurgiões dentistas atuando na Unidade de Terapia Intensiva, os protocolos não são específicos para área de odontologia e os equipamentos de proteção individuais são utilizados, porém, não em todos atendimentos(AU)


The present study addresses the dental protocols established in the COVID Intensive Care Unit of a Hospital in Extremo Sul Santa Catarina. The oral cavity, considered an opening for the entry of microorganisms, has characteristics favorable to its growth, with ideal temperature and humidity for its long-term survival. Dentistry, by directly manipulating the oral mucosa, is exposed and vulnerable to COVID-19 contagion, as well as the multidisciplinary team that handles the patient in the different areas of health care, in the hospital environment. COVID-19 is a potentially serious acute respiratory infection caused by the SARS-CoV-2 coronavirus, with high transmissibility and global distribution. Most people (about 80%) recover from the disease without needing hospital treatment. One in six people infected with COVID-19 becomes seriously ill and develops difficulty breathing. Elderly people and those with other health conditions, such as high blood pressure, heart and lung problems, diabetes or cancer, are at increased risk of becoming seriously ill. However, anyone can take COVID-19 and become seriously ill. It was found that the application of dental protocols in the Intensive Care Unit has a number of advantages in relation to the prevention of contamination of health professionals, the maintenance of the patient's oral health, the general benefits for health, prevention and treatment of opportunistic infections, which can reduce the patient's hospital stay, as generalized infection and pneumonia are nosocomial diseases also caused by disorders in the oral microbiota. The results showed that there are no dentists working in the Intensive Care Unit, the protocols are not specific to the field of dentistry and individual protective equipment is used, however, not in all cases(AU)


Subject(s)
Dentists , COVID-19 , Intensive Care Units , Patient Care Team , Oral Health , Disease Transmission, Infectious , Length of Stay , Mouth Mucosa
2.
Arq. ciências saúde UNIPAR ; 26(3): 862-877, set-dez. 2022.
Article in Portuguese | LILACS | ID: biblio-1399484

ABSTRACT

O acesso limitado do atendimento ao trauma aumenta proporcionalmente à ruralidade, refletindo em uma maior mortalidade e invalidez a longo prazo. A pesquisa objetivou identificar os desfechos de pacientes internados por trauma em Unidades de Terapia Intensiva, acometidos em ambientes rurais. Trata-se de um estudo transversal observacional realizado em uma UTI geral de um hospital da região central do Estado do Paraná entre 2013 a 2019, através da análise de prontuários de 230 pacientes traumatizados em ambiente rural. Os dados foram analisados por meio de testes de Qui-quadrado de Pearson, exato de Fisher ou t de Student. Dentre os desfechos identificados, observou-se associação do sexo feminino com as comorbidades (p=0,024), das regiões mais afetadas de cabeça, pescoço e tórax com a gravidade do trauma (p=0,001), além de variáveis do primeiro atendimento, como suporte respiratório básico, PAS <90mmHg e Glasgow associados à pacientes cirúgicos e pupilas alteradas em pacientes clínicos. Para o desfecho, observou-se que as médias do tempo de permanência hospitalar foi significativamente menor para aqueles que foram a óbito. As características apresentadas assemelham-se às informações mencionadas na literatura, em que as lesões graves com a necessidade de intervenção cirúrgica e maior tempo de permanência hospitalar estão associados ao óbito em traumas rurais. Contudo, o trauma no ambiente rural, apesar de não refletir nem sempre em maior gravidade, apresenta desfechos impactantes para o paciente.


Limited access to trauma care increases proportionally to rurality, reflecting higher mortality and long-term disability. The research aimed to identify the outcomes of patients hospitalized for trauma in Intensive Care Units, affected in rural environments. This is an observational cross-sectional study carried out in a general ICU of a hospital in the central region of the State of Paraná between 2013 and 2019, through the analysis of medical records of 230 trauma patients in a rural environment. Data were analyzed using Pearson's chi-square, Fisher's exact or Student's t tests. Among the outcomes identified, there was an association between female sex and comorbidities (p=0.024), the most affected regions of the head, neck and chest with the severity of the trauma (p=0.001), in addition to variables of the first care, such as basic respiratory support, SBP <90mmHg and Glasgow associated with surgical patients and altered pupils in medical patients. For the outcome, it was observed that the average length of hospital stay was significantly lower for those who died. The characteristics presented are similar to the information mentioned in the literature, in which serious injuries requiring surgical intervention and longer hospital stays are associated with death in rural traumas. However, trauma in the rural environment, although not always reflecting greater severity, has impacting outcomes for the patient.


El acceso limitado a la atención traumatológica aumenta proporcionalmente a la ruralidad, lo que se refleja en una mayor mortalidad y discapacidad a largo plazo. La investigación tenía como objetivo identificar los resultados de los pacientes ingresados por traumatismos en las Unidades de Cuidados Intensivos, afectados en entornos rurales. Se trata de un estudio observacional transversal realizado en una UCI general de un hospital de la región central del Estado de Paraná entre 2013 y 2019, a través del análisis de las historias clínicas de 230 pacientes lesionados en el medio rural. Los datos se analizaron mediante las pruebas de chi-cuadrado de Pearson, exacta de Fisher o t de Student. Entre los resultados identificados, el sexo femenino se asoció con las comorbilidades (p=0,024), las regiones más afectadas de la cabeza, el cuello y el tórax con la gravedad del traumatismo (p=0,001), además de las variables de los primeros cuidados, como la asistencia respiratoria básica, la PAS <90mmHg y el Glasgow asociado a los pacientes quirúrgicos y las pupilas alteradas en los pacientes clínicos. En cuanto al resultado, se observó que la duración media de la estancia hospitalaria fue significativamente menor para los que murieron. Las características presentadas son similares a la información mencionada en la literatura, en la que las lesiones graves con necesidad de intervención quirúrgica y mayor estancia hospitalaria se asocian a la muerte en el trauma rural. Sin embargo, el traumatismo en el medio rural, a pesar de no reflejar siempre una mayor gravedad, presenta resultados impactantes para el paciente.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Wounds and Injuries/diagnosis , Rural Areas , Inpatients/statistics & numerical data , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Surgical Procedures, Operative/statistics & numerical data , Medical Records/statistics & numerical data , Cross-Sectional Studies/methods , Hospitals/statistics & numerical data
3.
Säo Paulo med. j ; 140(3): 463-473, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377389

ABSTRACT

ABSTRACT BACKGROUND: For critically ill patients, physicians tend to administer sufficient or even excessive oxygen to maintain oxygen saturation at a high level. However, the credibility of the evidence for this practice is unclear. OBJECTIVE: To determine the effects of different oxygen therapy strategies on the outcomes of mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING: Systematic review of the literature and meta-analysis conducted at Jiangxi Provincial People's Hospital, Affiliated to Nanchang University, Nanchang, China. METHODS: We systematically searched electronic databases such as PubMed and Embase for relevant articles and performed meta-analyses on the effects of different oxygen therapy strategies on the outcomes of mechanically ventilated ICU patients. RESULTS: A total of 1802 patients from five studies were included. There were equal numbers of patients in the conservative and liberal groups (n = 910 in each group). There was no significant difference between the conservative and liberal groups with regard to 28-day mortality (risk ratio, RR = 0.88; 95% confidence interval, CI = 0.59-1.32; P = 0.55; I2 = 63%). Ninety-day mortality, infection rates, ICU length of stay, mechanical ventilation-free days up to day 28 and vasopressor-free days up to day 28 were comparable between the two strategies. CONCLUSIONS: It is not necessary to use liberal oxygen therapy strategies to pursue a higher level of peripheral oxygen saturation for mechanically ventilated ICU patients. Conservative oxygen therapy was not associated with any statistically significant reduction in mortality.


Subject(s)
Humans , Oxygen , Respiration, Artificial , Oxygen Inhalation Therapy , Prognosis , Critical Illness/therapy , Intensive Care Units , Length of Stay
4.
Rev. Ciênc. Méd. Biol. (Impr.) ; 21(1): 123-129, maio 05,2022. ilus, tab, fig
Article in Portuguese | LILACS | ID: biblio-1370805

ABSTRACT

Introdução: a deficiência no sistema por obstrução crônica aos fluxos aéreos é uma doença caracterizada por inflamação, associada a alterações anatômicas e fisiológicas, podendo ocasionar exacerbações respiratórias. A oxigenoterapia tem sido uma alternativa usada em pacientes que possuem insuficiência respiratória decorrente da obstrução crônica, como tentativa de diminuir os sintomas e as complicações geradas. Objetivo: avaliar os efeitos da oxigenoterapia em pacientes com deficiência do sistema respiratório por obstrução crônica, com e sem hipercapnia, quanto aos desfechos pressão parcial de oxigênio, frequência respiratória, tempo de internamento e qualidade de vida.Metodologia: revisão de ensaios clínicos controlados e randomizados (ECR) nas bases de dados PubMed, Cochrane e PEDro. Incluídos estudos originais que utilizaram a oxigenoterapia como intervenção em pacientes com deficiência do sistema respiratório por obstrução crônica aos fluxos aéreos ou que outras síndromes. Resultados: na busca realizada nas bases de dados foram identificados um total de 387 estudos, reduzindo para 87 quando aplicado o descritor "ensaio clínico" e 7 estudos foram incluídos publicados entre os anos de 2004 e 2019. Conclusão: A oxigenoterapia mostrou-se incremento da pressão parcial de oxigênio, frequência respiratória e redução do tempo de internamento com impactos na melhora da qualidade de vida.


Introduction: system deficiency due to chronic airflow obstruction is a disease characterized by inflammation, associated with anatomical and physiological changes, which can cause respiratory exacerbations. Oxygen therapy has been an alternative used in patients who have respiratory failure due to obstruction of the obstruction as an attempt to reduce symptoms and as complications generated. Objective: to evaluate the effects of oxygen therapy in patients with respiratory system deficiency due to chronic obstruction, with and without hypercapnia, in terms of partial oxygen pressure, respiratory rate, length of stay and quality of life. Methodology: review of controlled clinical trials and (RCT) in the PubMed, Cochrane and PEDro databases. Included original studies that used oxygen therapy as an intervention in patients with respiratory system deficiency due to obstruction to flow flows or other syndromes. Results: in the search carried out in the databases, a total of 387 studies were identified, for 87 when the descriptor "clinical trial" was projected and 7 studies were included between the years 2004 and 2019. Conclusion: oxygen therapy showed an increase in pressure partial oxygen, respiratory rate and reduction in hospital stay with impacts on improving the quality due.


Subject(s)
Humans , Oxygen Inhalation Therapy , Respiratory Insufficiency/therapy , Pulmonary Disease, Chronic Obstructive/therapy , Hypercapnia/therapy , Quality of Life , Randomized Controlled Trials as Topic , Length of Stay
5.
Rev. bras. ortop ; 57(2): 295-300, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1387981

ABSTRACT

Abstract Objective To analyze the radiological, clinical, and functional outcomes of clavicle fractures treated with the minimally-invasive plate osteosynthesis (MIPO) technique. Methods From June 2018 to July 2019, 17 cases of clavicular fractures were managed using the MIPO technique under C-arm fluoroscopy. The functional outcomes were assessed using the Constant-Murley score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical results of union, the complications, the operative time, the hospital stay, as well as infection, were analyzed. Results The mean follow-up time was of 10.41 1.75 months (range: 8 to 14 months). There were 11 male and 6 female patients, with a mean age of 39.05 10.76 years (range: 22 to 57 years). All fractures united on the mean time of 15.35 3.08 weeks (range: 12 to 20 weeks). The mean operative time was of 98.11 13.83 minutes (range: 70 to 130 minutes), and the mean length of the hospital stay was of 4.7 1.12 days (range: 3 to 7 days). The mean Constant-Murley score was of 74.82 6.36 in 4th postoperstive month, and of 92.35 5.48 in the 8th postoperative month, which was statistically significant. The mean DASH score was of 9.94 1.55 in the 4th postoperative month, and of 5.29 1.85 in the 8th postoperative month, which was also statistically significant. One patient had superficial skin infection at the site of the incision. Conclusions The MIPO technique is an alternative method for the fixation of clavicle fractures, but it is technically more demanding, and requires well-equipped operating room facilities.


Resumo Objetivo Analisar o resultado radiológico, clínico e funcional das fraturas da clavícula, tratadas pela técnica de osteossíntese com placa minimamente invasiva (MIPO). Métodos De junho de 2018 a julho de 2019, um total de 17 casos de fraturas claviculares foram tratadas com a técnica de osteossíntese com placa minimamente invasiva (MIPO), sob fluoroscopia com o braço em C. Os resultados funcionais foram avaliados por meio do escore de Constant-Murley e pelo escore de incapacidade do braço, ombro e mão (DASH). Foram analisados os resultados clínicos de consolidação, complicações, tempo cirúrgico, permanência hospitalar e infecção. Resultados O tempo médio de acompanhamento neste estudo foi de 10,41 1,75 meses (variação, 8 a 14 meses). Havia 11 pacientes do sexo masculino e seis do feminino, com média de idade de 39,05 10,76 anos (variação de 22 a 57 anos). Todas as fraturas se consolidaram no tempo médio de 15,35 3,08 semanas (variação, 12 a 20 semanas). O tempo cirúrgico médio foi de 98,11 13,83 minutos (variação, 70 a 130), sendo a permanência hospitalar média de 4,7 1,12 dias (variação de 3 a 7). O escore de Constant-Murley médio foi de 74,82 6,36 no 4° mês e 92,35 5,48 no 8° mês do pós-operatório, o que foi estatisticamente significativo. O escore DASH médio foi de 9,94 1,55 no 4° mês e 5,29 1,85 na 8ª semana do pós-operatório, também sendo estatisticamente significativo. Um paciente apresentou infecção cutânea superficial no local da incisão. Conclusões A técnica MIPO é um método alternativo para a fixação de fraturas da clavícula, porém é tecnicamente mais desafiador, já que necessita de instalações cirúrgicas mais bem equipadas.


Subject(s)
Humans , Male , Female , Clavicle/surgery , Clavicle/injuries , Minimally Invasive Surgical Procedures , Fracture Fixation, Internal , Length of Stay
7.
REME rev. min. enferm ; 26: e1427, abr.2022. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1387070

ABSTRACT

RESUMO Objetivo: verificar a associação entre peso ao nascer, idade gestacional e diagnósticos médicos secundários no tempo de permanência hospitalar de recém-nascidos prematuros. Métodos: estudo transversal, com 1.329 prontuários de recém-nascidos no período de julho de 2012 a setembro de 2015, em dois hospitais de Belo Horizonte, que utilizam o sistema Diagnosis Related Groups Brasil. Para determinar um ponto de corte para o peso ao nascer e a idade gestacional no nascimento que melhor determinasse o tempo de internação, foi utilizada a curva Receive Operator Characteristic. Posteriormente, utilizou-se o teste de análise de variância e teste de Duncan para a comparação entre a média de tempo de permanência hospitalar. Resultados: a prematuridade sem problemas maiores (DRG 792) foi a categoria mais prevalente (43,12%). O maior tempo médio de internação foi de 34,9 dias, identificado entre os recém-nascidos prematuros ou com síndrome da angústia respiratória (DRG 790). A combinação de menor peso ao nascer e menor IG ao nascimento apresentou o maior risco de permanência hospitalar, aumentada quando comparados aos demais perfis formados para esse DRG. Conclusão: os achados poderão direcionar a assistência em relação à mobilização de recursos físicos, humanos e de bens de consumo, além da análise crítica de condições que influenciam os desfechos clínicos. A possibilidade da otimização do uso desses recursos hospitalares aliada à melhoria da qualidade dos atendimentos e da segurança dos pacientes está associada à minimização do tempo de permanência hospitalar e da carga de morbidade e mortalidade neonatal.


RESUMEN Objetivo: verificar la asociación entre el peso al nacer, la edad gestacional y los diagnósticos médicos secundarios en la duración de la estancia hospitalaria de los recién nacidos prematuros. Métodos: estudio transversal, con 1.329 registros de recién nacidos de julio de 2012 a septiembre de 2015, en dos hospitales de Belo Horizonte, que utilizan el sistema Diagnosis Related Groups Brasil. Para determinar un punto de corte para el peso al nacer y la edad gestacional al nacer que mejor determina la duración de la estadía, se utilizó la curva Receive Operator Characteristic. Posteriormente, se utilizó la prueba de análisis de varianza y la prueba de Duncan para comparar la duración media de la estancia hospitalaria. Resultados: la prematuridad sin mayores problemas (DRG 792) fue la categoría más prevalente (43,12%). La estancia media más larga fue de 34,9 días, identificada entre los recién nacidos prematuros o aquellos con síndrome de dificultad respiratoria (DRG 790). La combinación de menor peso al nacer y menor IG al nacer presentó el mayor riesgo de estancia hospitalaria, que se incrementó en comparación con los otros perfiles formados para este DRG. Conclusión: los hallazgos pueden orientar la atención en relación con la movilización de recursos físicos, humanos y de bienes de consumo, además del análisis crítico de las condiciones que influyen en los resultados clínicos. La posibilidad de optimizar el uso de estos recursos hospitalarios, aliada a mejorar la calidad de la atención y la seguridad del paciente, está asociada a minimizar la duración de la estancia hospitalaria y la carga de morbilidad y mortalidad neonatal.


ABSTRACT Objective: to verify the association between birth weight, gestational age, and secondary medical diagnoses in the length of hospital stay of premature newborns. Methods: cross-sectional study, with 1,329 medical records of newborns from July 2012 to September 2015, in two hospitals in Belo Horizonte, which use the Diagnosis Related Groups Brasil system. To determine a cutoff point for birth weight and gestational age at birth that best determined the length of hospital stay, the Receive Operator Characteristic curve was used. Subsequently, the analysis of variance test and Duncan's test were used to compare the mean length of hospital stay. Results: prematurity without major problems (DRG792) was the most prevalent category (43.12%). The longest mean length of hospital stay was 34.9 days, identified among preterm infants or infants with respiratory distress syndrome (DRG 790). The combination of lower birth weight and lower GA at birth presented the highest risk of hospital stay, increased when compared to the other profiles formed for this DRG. Conclusion: the findings may direct assistance in relation to the mobilization of physical, human and consumer goods resources, in addition to the critical analysis of conditions that influence clinical outcomes. The possibility of optimizing the use of these hospital resources, allied to improving the quality of care and patient safety, is associated with minimizing the length of hospital stay and the burden of neonatal morbidity and mortality.


Subject(s)
Humans , Infant, Newborn , Infant, Low Birth Weight , Infant, Premature , Gestational Age , Length of Stay/statistics & numerical data , Respiratory Distress Syndrome, Newborn , Medical Records , Cross-Sectional Studies , Diagnosis-Related Groups
8.
Hematol., Transfus. Cell Ther. (Impr.) ; 44(1): 7-12, Jan.-Mar. 2022. tab
Article in English | LILACS | ID: biblio-1364882

ABSTRACT

Abstract Introduction Coronavirus Disease 2019 (COVID-19) is a novel viral disease with person-to-person transmission that has spread to many countries since the end of 2019. Although many unknowns were resolved within a year and the vaccine is available, it is still a major global health problem. Objective COVID-19 infection may present with a considerably wide spectrum of severity and host factors play a significant role in determining the course of the disease. One of these factors is blood groups. Based on previous experience, it is believed that the ABO blood group type affects prognosis, treatment response and length of stay in the hospital. In this study, our aim was to evaluate whether the blood group had an effect on the length of the hospital stay. To the best of our knowledge, no previous studies have assessed the effect of ABO blood groups, as well as age, on the length of the hospital stay in these settings. Methods In this retrospective cohort study, 969 patients admitted to our hospital between March 15, 2020 and May 15, 2020 were evaluated. The patients were divided into 4 groups according to ABO blood groups. The effect of the ABO blood group by age on the course of the disease, need for intensive care, duration of hospitalization and mortality in patients with COVID-19 infection, especially in geriatric patients, was evaluated. Results Of all the patients, 9.1% required admission to the intensive care unit (ICU), of whom 83% died. The average length of ICU stay was 11 days (0 - 59). The observed mortality rates in blood groups A, B, AB and 0 were 86.4%, 93.3%, 80.0% and 70.8%, respectively, indicating similar death rates in all ABO blood types. When the Rh phenotype was taken into consideration, no significant changes in results were seen. Conclusion As a result, we could not observe a significant relationship between blood groups and clinical outcomes in this study, which included a sample of Turkish patients with COVID-19.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , ABO Blood-Group System , COVID-19 , Coronavirus , Length of Stay
9.
Acta Paul. Enferm. (Online) ; 35: eAPE01456, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1393723

ABSTRACT

Resumo Objetivo Avaliar o impacto do programa de comanejo multidisciplinar nos desfechos de pacientes com fratura de quadril hospitalizados. Métodos Estudo observacional, do tipo antes e depois, retrospectivo. Foram coletados dados dos pacientes hospitalizados por fratura de quadril entre 2015 e 2019, em hospital universitário com serviço referência para ortopedia. A intervenção analisada foi o programa de comanejo multidisciplinar, que iniciou em 2017. Resultados O número de lesões por pressão adquiridas na internação diminuiu significativamente (p<0,005) após a implementação do comanejo. Da mesma forma, o tempo de internação até a cirurgia reduziu (p<0,046), sendo cumpridas as diretrizes nacionais e internacionais de correção da fratura em até 48 horas. Infecções, reinternações e óbitos não tiveram seu impacto confirmado. Conclusão O comanejo multidisciplinar teve impacto positivo nos desfechos dos pacientes hospitalizados por fratura de quadril, resultando em redução do número de lesões por pressão e do tempo de espera para realizar a cirurgia. Através deste estudo, foram identificadas evidências preliminares que suportam a implementação desse tipo de programa.


Resumen Objetivo Evaluar el impacto del programa de manejo conjunto multidisciplinario en los desenlaces de pacientes con fractura de cadera hospitalizados. Métodos Estudio observacional, tipo antes y después, retrospectivo. Se recopilaron datos de pacientes hospitalizados por fractura de cadera entre 2015 y 2019, en un hospital universitario con servicio de ortopedia de referencia. La intervención analizada fue el programa de manejo conjunto multidisciplinario, que comenzó en 2017. Resultados El número de úlceras por presión adquiridas en la internación se redujo significativamente (p<0,005) luego de la implementación del manejo conjunto. De la misma forma, el tiempo de internación hasta la cirugía se redujo (p<0,046), cumpliendo las directrices nacionales e internacionales de corrección de la fractura en 48 horas como máximo. No se confirmó el impacto de infecciones, reinternaciones y fallecimientos. Conclusión El manejo conjunto multidisciplinario tuvo un impacto positivo en los desenlaces de los pacientes hospitalizados por fractura de cadera, lo que redujo el número de úlceras por presión y el tiempo de espera para realizar la cirugía. A través de este estudio, se identificaron evidencias preliminares que respaldan la implementación de este tipo de programa.


Abstract Objective To assess the impact of the multidisciplinary co-management program on the outcomes of hospitalized patients with hip fractures. Methods This is an observational, before-and-after, retrospective study. Data were collected from patients hospitalized for hip fracture between 2015 and 2019, at a university hospital with a referral service for orthopedics. The intervention analyzed was the multidisciplinary co-management program, which started in 2017. Results The number of pressure injuries acquired during hospitalization decreased significantly (p<0.005) after the implementation of co-management. Likewise, the length of hospital stay until surgery was reduced (p<0.046), and national and international guidelines for fracture correction within 48 hours were complied with. Infections, readmissions and deaths have not had their impact confirmed. Conclusion The multidisciplinary co-management had a positive impact on the outcomes of patients hospitalized for hip fracture, resulting in a reduction in the number of pressure injuries and in the waiting time for surgery. Through this study, preliminary evidence was identified to support the implementation of this type of program.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Patient Care Team , Orthopedic Nursing , Electronic Health Records , Hip Fractures , Hospitalization , Retrospective Studies , Observational Studies as Topic , Length of Stay
10.
J. vasc. bras ; 21: e20220016, 2022. tab, graf
Article in Portuguese | LILACS | ID: biblio-1386125

ABSTRACT

RESUMO Contexto A doença arterial obstrutiva periférica apresenta alta prevalência, sendo associada a elevado risco de eventos cardiovasculares. A intervenção cirúrgica ou endovascular faz-se necessária na isquemia crítica do membro. Objetivos Avaliar a distribuição de realização de revascularizações abertas e endovasculares nas diferentes regiões do Brasil, analisando os custos para o sistema de saúde e a mortalidade relacionada a esses procedimentos. Métodos Foi realizado um estudo epidemiológico observacional transversal descritivo para avaliar as cirurgias abertas e endovasculares realizadas no sistema público de saúde do Brasil entre 2010 e 2020. Os dados foram coletados através do Departamento de Informática do SUS (Datasus). Resultados No período analisado, foram registradas 83.218 internações para realização de cirurgias abertas e endovasculares, com um custo total de R$ 333.989.523,17. Houve predominância das internações para os procedimentos percutâneos (56.132) em relação aos cirúrgicos convencionais (27.086). As Regiões Sudeste e Sul concentraram a maior parte do total de procedimentos realizados no país (83%), enquanto a Região Norte foi a que apresentou a menor taxa de internação. Observou-se uma tendência decrescente para os procedimentos abertos, e uma tendência crescente para os endovasculares. A média de permanência hospitalar foi menor nos procedimentos endovasculares (5,3 dias) em relação aos abertos (10,2 dias). Além disso, notou-se uma maior taxa de mortalidade hospitalar relacionada à revascularização aberta em relação à endovascular (5,24% versus 1,56%). Conclusões As técnicas endovasculares consistiram em uma abordagem dominante no tratamento cirúrgico da isquemia crítica, apresentando menor taxa de mortalidade hospitalar e menor tempo de internação quando comparada às cirurgias abertas.


ABSTRACT Background Peripheral artery disease (PAD) has high prevalence and is associated with high risk of cardiovascular events. Surgical or endovascular intervention is necessary in chronic limb-threatening ischemia. Objectives To evaluate the distribution of open and endovascular revascularizations in different regions of Brazil, analyzing the health system costs and mortality related to these procedures. Methods A descriptive, cross-sectional, observational, epidemiological study was carried out to evaluate open and endovascular surgeries performed on the SUS public healthcare system in Brazil, from 2010 to 2020. Data were collected from the SUS Department of Informatics (Datasus). Results Over the period analyzed, 83,218 admissions for open and endovascular surgeries were registered, with a total cost of R$ 333,989,523.17. There were more hospital admissions for percutaneous procedures (56,132) than for conventional surgery (27,086). Most of the procedures (83%) were performed in the country's Southeast and South regions, while the North region had the lowest number of procedures. Over the period evaluated, there was a decreasing trend for open procedures and an increasing trend for endovascular procedures. The average hospital stay was shorter for endovascular procedures (5.3 days) than for open surgery (10.2 days). The analysis of mortality related to these procedures revealed a higher rate of in-hospital mortality associated with open revascularization than with endovascular (5.24% vs. 1.56%). Conclusions Endovascular techniques constituted the primary approach for revascularization treatment in critical limb-threatening ischemia, with a lower in-hospital mortality rate and shorter hospital stay when compared to open surgeries.


Subject(s)
Humans , Peripheral Arterial Disease/surgery , Endovascular Procedures/mortality , Brazil/epidemiology , Comparative Study , Epidemiology, Descriptive , Cross-Sectional Studies , Hospital Costs , Limb Salvage , Peripheral Arterial Disease/mortality , Length of Stay
11.
Article in Portuguese | LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1367503

ABSTRACT

Em pacientes críticos o risco nutricional e a hiperglicemia associam-se ao aumento da incidência de desfechos desfavoráveis. Objetivo: Avaliar a relação do risco nutricional pelo Nutrition Risk in Critically III, versão modificada (mNUTRIC) e perfil glicêmico nos desfechos de alta, óbito e tempo de internação de pacientes críticos e verificar o impacto das ferramentas Acute Physiology and Chronic Health Disease Classification System II (APACHE II) e do Sepsis-Related Organ Failure Assessment (SOFA) nesses desfechos. Método: Estudo longitudinal prospectivo desenvolvido em Unidade de Terapia Intensiva (UTI). Foram incluídos adultos, com tempo ≥ 48 horas de internação e com registro mínimo de duas aferições glicêmicas. Excluíram-se pacientes em cuidados paliativos, readmitidos nas UTI e gestantes. O teste Exato de Fisher e Shapiro Wilk foram utilizados para avaliar as variáveis categóricas e contínuas, respectivamente. Posteriormente, utilizou-se o teste de Mann-Whitney ou t-Student não pareado. Realizou-se análise de regressão logística e linear. O nível de significância adotado foi de 5%. Resultados: Ao avaliar 35 pacientes, 45,7% apresentaram alto risco nutricional. Foi observado associação do risco nutricional com os desfechos de alta e óbito; o SOFA associou-se ao óbito e tempo de internação. O incremento de 1 ponto no escore do SOFA aumentou a chance de óbito em 83% e tempo maior de internação em 0,49 dias. O perfil glicêmico e APACHE II não se associou aos desfechos. Conclusão: o escore SOFA foi o instrumento que apresentou associações significativas com o desfecho do óbito e maior tempo de internação de pacientes críticos


In critically ill patients, nutritional risk and hyperglycemia are associated with an increased incidence of unfavorable outcomes. Objective: To evaluate the relationship of nutritional risk by the Nutrition Risk in Critically III, modified version (mNUTRIC) and glycemic profile in the outcomes of discharge, death and length of stay in critically ill patients and to verify the impact of the Acute Physiology and Chronic Health Disease Classification System II (APACHE II) and the Sepsis-Related Organ Failure Assessment (SOFA) tools on these outcomes. Method: Prospective longitudinal study developed in an Intensive Care Unit (ICU). Adults were included, with ≥ 48 hours of hospitalization and with a minimum record of two blood glucose measurements. Patients in palliative care, readmitted to ICU and pregnant women were excluded. Fisher's Exact test and Shapiro Wilk test were used to evaluate categorical and continuous variables, respectively. Subsequently, the Mann-Whitney or unpaired t-Student test was used. Logistic and linear regression analysis was performed. The significance level adopted was 5%. Results: When evaluating 35 patients, 45.7% were at high nutritional risk. An association was observed between nutritional risk and discharge and death outcomes; SOFA was associated with death and length of hospital stay. The increment of 1 point in the SOFA score increased the chance of death by 83% and a longer hospital stay by 0.49 days. Glycemic profile and APACHE II were not associated with outcomes. Conclusion: the SOFA score was the instrument that showed significant associations with the outcome of death and longer hospital stay in critically ill patients


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Blood Glucose , Malnutrition/mortality , Patient Acuity , Patient Discharge , Nutrition Surveys/methods , Longitudinal Studies , APACHE , Organ Dysfunction Scores , Intensive Care Units , Length of Stay
12.
Article in Chinese | WPRIM | ID: wpr-943047

ABSTRACT

Enhanced recovery after surgery (ERAS) and minimally invasive surgery are two important development directions of modern surgery in the 21st century. They provide new clinical treatment methods and theoretical basis for the rapid recovery of surgical patients and more rational utilization of medical resources. They are two hot topics in clinical research and academic exchange of surgery-related subjects, and promote the rapid development and clinical application of surgery. ERAS covers a range of preoperative, intraoperative, and postoperative optimization measures, of which minimally invasive surgery is an important part of intraoperative optimization. The quality of surgery, especially minimally invasive surgery, plays a key role in postoperative recovery, which is the most important one of all ERAS measures. With good surgical quality and no postoperative complications, patients will recover quickly. Therefore, minimally invasive surgery plays a central role in the ERAS concept. The combination of ERAS with minimally invasive surgery is not only safe and feasible, but is also better than these two clinical therapies alone for postoperative recovery, and improves short-term and long-term outcome and accelerates the recovery of patients. For surgical diseases treated with minimally invasive surgery as far as possible, using the ERAS management for patients will result in reduced traumatic stress, better surgical tolerance, less postoperative pain, smaller incision, earlier ambulation, better organ function, and less morbidity of complications. In short, ERAS and minimally invasive surgery complement and promote each other. As two outstanding achievements of modern medicine, they are clinical treatments that provide sufficient theoretical basis for rapid recovery of patients and open a new chapter for the development of modern surgery.


Subject(s)
Enhanced Recovery After Surgery , Humans , Length of Stay , Minimally Invasive Surgical Procedures/methods , Postoperative Complications/etiology , Postoperative Period
13.
Article in Chinese | WPRIM | ID: wpr-943039

ABSTRACT

Objective: To investigate the experience of patients in the implementation of enhanced recovery after surgery (ERAS) strategy after radical gastrectomy and the factors affecting the treatment experience. Methods: A prospective cohort study was carried out. Patients who were diagnosed with gastric cancer by pathology and underwent radical gastrectomy at the Xijing Digestive Disease Hospital from December 2019 to December 2020 were consecutively enrolled. Those who received emergency surgery, residual gastric cancer surgery, preoperative neoadjuvant chemotherapy, non-curative tumor resection, intraperitoneal metastasis, or other malignant tumors were excluded. Patients' expectation and experience during implementation were investigated by questionnaires. The questionnaire included three main parts: patients' expectation for ERAS, patients' experience during the ERAS implementation, and patients' outcomes within 30 days after discharge. The items on the expectation and experience were ranked from 0 to 10 by patients, which indicated to be unsatisfied/unimportant and satisfied/important respectively. According to their attitudes towards the ERAS strategy, patients were divided into the support group and the reject group. Patients' expectation and experience of hospital stay, and the clinical outcomes within 30 days after discharge were compared between the two groups. Categorical data were reported as number with percentage and the quantitative data were reported as mean with standard deviation, or where appropriate, as the median with interquartile range (Q1, Q3). Categorical data were compared using the Chi-squared test or Fisher's exact test, where appropriate. For continuous data, Student's t test or Mann-Whitney U test were used. Complication was classified according to Clavien-Dindo classification. Results: Of the included 112 patients (88 males and 24 females), aged (57.8±10.0) years, 35 patients (31.3%) were in the support group and 77 (68.7%) in the reject group. Anxiety was detected in 56.2% (63/112) of the patients with score >8. The admission education during the ERAS implementation improved the patients' cognitions of the ERAS strategy [M(Q1, Q3) score: 8 (4, 10) vs. 2 (0, 5), Z=-7.130, P<0.001]. The expected hospital stay of patients was longer than the actual stay [7 (7, 10) days vs. 6 (6, 7) days, Z=-4.800, P<0.001]. During the ERAS implementation, patients had low score in early mobilization [3 (1, 6)] and early oral intake [5 (2.25, 8)]. Fifty-eight (51.8%) patients planned the ERAS implementation at home after discharge, while 32.1% (36/112) preferred to stay in hospital until they felt totally recovered. Compared with the reject group, the support group had shorter expected hospital stay [7 (6, 10) days vs. 10 (7, 15) days, Z=-2.607, P=0.009], and higher expected recovery-efficiency score [9 (8, 10) vs. 7(5, 9), Z=-3.078, P=0.002], lower expected less-pain score [8 (6, 10) vs. 6 (5, 9) days, Z=-1.996, P=0.046], expected faster recovery of physical strength score [8 (6, 10) vs. 6 (4, 9), Z=-2.200, P=0.028] and expected less drainage tube score [8 (8, 10) vs. 8 (5, 10), Z=-2.075, P=0.038]. Worrying about complications (49.1%) and self-recognition of not recovery (46.4%) were the major concerns when assessing the experience toward ERAS. During the follow-up, 105 patients received follow-up calls. There were 57.1% (60/105) of patients who experienced a variety of discomforts after discharge, including pain (28.6%), bloating (20.0%), nausea (12.4%), fatigue (7.6%), and fever (2.9%). Within 30 days after discharge, 6.7% (7/105) of patients developed Clavien-Dindo level I and II operation-associated complications, including poor wound healing, intestinal obstruction, intraperitoneal bleeding, and wound infection, all of which were cured by conservative treatment. There were no complications of level III or above in the whole group after surgery. Compared with the support group, more patients in the reject group reported that they had not yet achieved self-expected recovery when discharged [57.1% (44/77) vs. 22.9% (8/35), χ2=11.372, P<0.001], and expected to return to their daily lives [39.0% (30/77) vs. 8.6% (3/35), χ2=10.693, P<0.001], with statistically significant differences (all P<0.05). Only 52.4% (55/105) of patients returned home to continue rehabilitation, and the remaining patients chose to go to other hospitals to continue their hospitalization after discharge, with a median length of stay of 7 (7, 9) days. Compared with the reject group, the support group had a higher proportion of home rehabilitation [59.7% (12/33) vs. 36.4% (43/72), χ2=4.950, P=0.026], and shorter time of self-perceived postoperative full recovery [14 (10, 20) days vs. 15 (14, 20) days, Z=2.100, P=0.036], with statistically significant differences (all P<0.05). Conclusions: Although ERAS has promoted postoperative rehabilitation while ensuring surgical safety, it has not been unanimously recognized by patients. Adequate rehabilitation education, good analgesia, good physical recovery, and early removal of drainage tubes may improve the patient's experience of ERAS.


Subject(s)
Enhanced Recovery After Surgery , Female , Gastrectomy , Humans , Length of Stay , Male , Pain , Patient Outcome Assessment , Postoperative Complications/surgery , Prospective Studies , Retrospective Studies , Stomach Neoplasms/surgery , Treatment Outcome
14.
Article in Chinese | WPRIM | ID: wpr-943038

ABSTRACT

Perioperative traumatic stress is a systemic nonspecific response caused by stimuli such as anesthesia, surgery, pain and anxiety, which lasts throughout the perioperative period.The continuous excessive stress response is not conducive to the postoperative rehabilitation of patients. Enhanced recovery after surgery (ERAS), a research hotspot of modern surgery, can significantly reduce perioperative pain and stress, thus promoting the rehabilitation of patients. With the progress of artificial intelligence and information technology, wearable, non-invasive, real-time heart rate variability (HRV) dynamic monitoring can effectively realize the digitalization of stress monitoring with low price, which is worthy of clinical application. Therefore, the use of HRV for digital monitoring of perioperative stress has a significant research value. Moreover, the combination of HRV and ERAS has shown its advantages and the prospect of clinical application is worthy of anticipating.


Subject(s)
Artificial Intelligence , Enhanced Recovery After Surgery , Humans , Length of Stay , Pain , Perioperative Period , Postoperative Complications
15.
Article in Chinese | WPRIM | ID: wpr-943037

ABSTRACT

Enhanced recovery after surgery (ERAS) is a multimodal perioperative care program to decrease the risk of delayed hospitalization, medical complications, readmission and to improve patient short- and long-term outcomes with minimized level of surgical stress responses through multidisciplinary cooperation. Despite its huge success, the program has challenges for further optimization with a primary focus on modification according to the specific pathophysiology and perioperative management characteristics of patients with gastrointestinal tumors to improve the compliance and implementation rate of items. Patient education, prehabilitation, multimodal analgesia, precision surgery, early mobilization, early oral feeding and oral nutrition supplement (ONS) should be regarded as core terms suitable for all the patients. During the application of ERAS pathway management, it is necessary to fully understand the perioperative changes of organ function and pathophysiology, and to strictly implement the ERAS program and items based on evidence-based medicine. Moreover, the close collaboration of multidisciplinary teams is needed to improve the compliance and increase the adherence rate of ERAS protocol for patients, which emphasizes the dynamic, gap-free and whole course management that covers pre-hospital, pre-operative, intra-operative, post-operative and post-hospital periods. Concurrently, we encourage our patients and their families to participate in the whole healthcare activities. Even more concerning, it is indispensable to adjust ERAS program for special time and special patients. At present, several consensus and guidelines on the ERAS management of gastrointestinal tumor surgery have come out for clinical practice in China, which, however, still lacks a high-level evidence from more high-quality clinical trials conducted by Chinese researchers. It is urgent to carry out a series of large-scale randomized controlled studies in accordance with international standards to obtain high-level evidence-based medical evidence for clinical practice, which is problem-oriented and integrated with features of metabolism and perioperative management of gastrointestinal tumor surgery.


Subject(s)
Enhanced Recovery After Surgery , Gastrointestinal Neoplasms/surgery , Humans , Length of Stay , Perioperative Care/methods , Postoperative Complications
16.
Article in Chinese | WPRIM | ID: wpr-943036

ABSTRACT

The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care pathway, which is to reduce the perioperative stress and metabolic variation, with the ultimate goal of improving patient recovery and outcomes. This article reviews some hot issues in the clinical practice of ERAS in China. Currently, the concept and pathways of ERAS are very consistent with China's medical reform, and the basic principle of "safety first, efficiency second" should be adhered to. In specific clinical practice, multidisciplinary cooperation, the improvement of surgical quality and the implementation of prehabilitation pathway should be advocated. In addition, the ERAS approaches should be implemented individually to avoid mechanical understanding and dogmatic implementation. The implementation of ERAS and its clinical outcome should be audited to accumulate experience, and a feedback mechanism should be established to improve the outcome continuously. In clinical practice, "fast recovery" should not be the sole purpose. For patients, the decrease in the risk of readmission rate is more important as compared to discharge rate. Additionally, the disparities between the development of ERAS clinical research in China and that in the world are also analyzed in this review. A national ERAS database should be established on the basic platform of academic groups to ensure the development of high-quality clinical research in China.


Subject(s)
Critical Pathways , Enhanced Recovery After Surgery , Humans , Length of Stay , Perioperative Care/methods , Postoperative Complications
17.
Article in Chinese | WPRIM | ID: wpr-941001

ABSTRACT

OBJECTIVE@#To investigate the relationship between early lymphocyte responses and the prognosis in severely injured patients.@*METHODS@#Consecutive patients with severe trauma who were treated in Peking University People's Hospital Trauma Medical Center between June 2017 and June 2020 were enrolled in this restropective chart-review study. According to the responses of lymphocyte after severe injury, the patients were divided into three groups, group 1: lymphopenia-returned to normal; group 2: persistent lymphopenia; group 3: never lymphopenic, and the outcome of 28 d were recorded. Clinical data such as gender, age, base excess, mechanism of injury, Glasgow coma scale (GCS), injury severity score (ISS) and massive blood transfusion were collected. Perform statistical analysis on the collected clinical data to understand the trend of lymphocyte changes in early trauma and the relationship with prognosis. In order to eliminate the interference of age, stratification was carried out according to whether the age was ≥ 65 years old, in different age groups, they were grouped according to whether the length of stay was ≥ 28 d, and the relationship between lymphocyte trend and length of stay was discussed.@*RESULTS@#A total of 83 patients were included, 66 males and 17 females. The main injury mechanisms were traffic accident injuries and high-altitude fall injuries. The average ISS was (30±11) points. 65 patients had lymphopenia on the day of injury, 32 of them returned to normal on the 5th day, and the rest did not recover; the other 18 patients had normal lymphocyte levels after injury. Patients which are failure to normalize lymphopenia within the first 5 days following admission was related with the long hospitalization time and higher 28 d mortality rate. After further stratification by age, failure to normalize lymphopenia within the first 5 days following admission in the elderly group (age ≥65 years) was a risk factor for prolonged hospital stay (≥28 d), P=0.04. While in younger group, a high level of neutrophils within the first 5 d following admission was a risk factor for bad outcome.@*CONCLUSION@#A failure to normalize lymphopenia in severely injured patients is associated with significantly higher mortality and longer hospital stay. This study reveals lymphocytes can be used as a reliable indicator for the prognostic evaluation.


Subject(s)
Aged , Female , Humans , Injury Severity Score , Length of Stay , Lymphopenia/etiology , Male , Prognosis , Retrospective Studies
18.
Article in English | WPRIM | ID: wpr-939557

ABSTRACT

INTRODUCTION@#Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes.@*METHODS@#We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021. Suitable patients, who otherwise required hospitalisation, were admitted to the programme. They were from inpatient wards, emergency department and community nursing teams in the western part of Singapore, where a multidisciplinary team provided hospital-level care at home. Electronic health record data were extracted from all patients admitted to the programme. Patient satisfaction surveys were conducted post-discharge.@*RESULTS@#A total of 108 patients enrolled. Mean age was 67.9 (standard deviation 16.7) years, and 46% were male. The main diagnoses were skin and soft tissue infections (35%), urinary tract infections (29%) and fluid overload (18%). Median length of stay was 4 (interquartile range 3-7) days. Seven patients were escalated back to the hospital, of whom 2 died after escalation. One patient died at home. There was 1 case of adverse drug reaction and 1 fall at home, and no cases of hospital-acquired infections. Patient satisfaction rates were high and 94% of contactable patients would choose to participate again.@*CONCLUSION@#Hospital-at-home programmes appear to be safe and feasible alternatives to inpatient care in Singapore. Further studies are warranted to compare clinical outcomes and cost to conventional inpatient care.


Subject(s)
Aftercare , Aged , Female , Hospitalization , Humans , Length of Stay , Male , Patient Discharge , Retrospective Studies , Singapore
19.
Chinese Journal of Burns ; (6): 156-164, 2022.
Article in Chinese | WPRIM | ID: wpr-935990

ABSTRACT

Objective: To explore the epidemiological characteristics and treatment outcomes of patients with hydrofluoric acid burns in hands. Methods: A retrospective observational study was conducted. The medical records of 229 patients with hydrofluoric acid burns in hands who were admitted to Zhejiang Quhua Hospital from January 2008 to December 2020 and met the inclusion criteria were collected. The following statistical data of patients were collected, including gender, age, type of affiliated enterprise, hydrofluoric acid mass fraction, injury site, total burn area, prehospital time, length of hospital stay, length of wound healing, whether hypocalcemia and hypomagnesemia occurred or not on admission, whether surgery intervention was performed or not, and whether scar sequelae occurred or not. Single factor and multivariate logistic regression analysis were used to screen out the risk factors impacting surgery intervention and scar sequelae of all the patients and patients whose hydrofluoric acid mass fraction was known. Single factor and multivariate linear regression analysis were used to screen out the risk factors impacting the length of wound healing of all the patients and patients whose hydrofluoric acid mass fraction was known. Results: The 229 patients included 206 males and 23 females, with the majority aged 30 to 50 years (139 patients). The type of affiliated enterprise of majority patients was non-fluorine chemical enterprise. The hydrofluoric acid mass fraction was known in only 91 patients, mainly medium. The majority injury site was in the middle and end of finger. The total burn area was below or equal to 1% total body surface area. The prehospital time was 19 (9, 29) h. The length of hospital stay was 2 (1, 7) d. The length of wound healing was 12 (8, 18) d. The proportions of hypocalcemia and hypomagnesemia were 0.9% (2/229) and 1.3% (3/229) on admission, respectively. Thirty-six patients had surgeries and 83 patients had scar sequelae. In 229 patients, single factor logistic regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting surgery intervention (with odds ratio values of 7.86 and 51.35, respectively, 95% confidence intervals of 1.83-33.76 and 11.89-221.78, respectively, P<0.01) and scar sequelae of patients (with odds ratio values of 3.62 and 27.40, respectively, 95% confidence intervals of 1.76-7.43 and 13.25-56.68, respectively, P<0.01); multivariate logistic regression analysis showed that prehospital time was the independent risks factor impacting surgery intervention and scar sequelae of patients (with odds ratio values of 43.00 and 24.55, respectively, 95% confidence intervals of 9.89-187.03 and 11.78-51.16, respectively, P<0.01); single factor linear regression analysis showed that both type of affiliated enterprise and prehospital time were the factors impacting the length of wound healing of patients (with β values of 6.16 and 12.83, respectively, 95% confidence intervals of 3.38-8.93 and 10.72-14.93, respectively, P<0.01); multivariate linear regression analysis showed that both type of affiliated enterprise and prehospital time were the independent risk factors impacting the length of wound healing of patients (with β values of 2.81 and 12.16, respectively, 95% confidence intervals of 0.50-5.13 and 10.00-14.31, respectively, P<0.05 or P<0.01). In 91 patients whose hydrofluoric acid mass fraction was known, single factor logistic regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting surgery intervention of patients (with odds ratio values of 9.10, 11.25, 10.69, and 0.04, respectively, 95% confidence intervals of 1.15-72.25, 1.39-90.93, 1.32-86.59, and 0.01-0.19, respectively, P<0.05 or P<0.01), type of affiliated enterprise, hydrofluoric acid mass fraction, and prehospital time were all the factors impacting scar sequelae of patients (with odds ratio values of 0.32, 0.21, and 36.80, respectively, 95% confidence intervals of 0.11-0.92, 0.06-0.73, and 11.03-122.79, respectively, P<0.05 or P<0.01); multivariate logistic regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting surgery intervention of patients (with odds ratio values of 11.51 and 0.04, respectively, 95% confidence intervals of 1.22-108.26 and 0.01-0.25, respectively, P<0.05 or P<0.01), prehospital time was the independent risk factor impacting scar sequelae of patients (odds ratio=37.71, with 95% confidence interval of 9.97-142.69, P<0.01); single factor linear regression analysis showed that type of affiliated enterprise, hydrofluoric acid mass fraction (low and high), and prehospital time were all the factors impacting the length of wound healing of patients (with β values of 7.12, -5.63, -9.74, and 13.50, respectively, 95% confidence intervals of 2.43-11.81, -10.59--0.68, -14.78--4.70, and 10.14-16.86, respectively, P<0.05 or P<0.01); multivariate linear regression analysis showed that both hydrofluoric acid mass fraction and prehospital time were the independent risk factors impacting the length of wound healing of patients (with β values of -5.84 and 0.09, respectively, 95% confidence intervals of -10.59--1.08 and 0.05-0.12, respectively, P<0.05 or P<0.01). Conclusions: The majority of patients with hydrofluoric acid burns in hands are young and middle-aged males. Type of affiliated enterprise, hydrofluoric acid mass fraction and prehospital time are the risk factors that affect the treatment outcomes of patients with hydrofluoric acid burns in hands.


Subject(s)
Adult , Body Surface Area , Burns , Female , Humans , Hydrofluoric Acid/adverse effects , Length of Stay , Male , Middle Aged , Retrospective Studies , Treatment Outcome
20.
Chinese Journal of Pediatrics ; (12): 41-45, 2022.
Article in Chinese | WPRIM | ID: wpr-935637

ABSTRACT

Objective: To explore the etiologies and clinical characteristics of fever of unknown origin (FUO) and to provide clues for early diagnosis of FUO. Methods: The data about etiology, age, sex, clinical course, length of hospital stays and the expression levels of inflammatory factors in fever phase of 357 pediatric inpatients who were diagnosed with FUO in Children's Hospital of Fudan University from 1 January 2016 to 31 December 2020 were collected and retrospectively analyzed. Participants were grouped into infectious disease, inflammatory disease, malignancy and others and according to the classification of diseases and also grouped into those aged<1 year, 1-<3 years,3-<6 years, 6-<12 years and 12-<18 years. Comparisons between groups were performed using the Mann-Whitney U test, Kruskal-Wallis H test and χ² test. Results: Among the 357 patients (217 males and 140 females). The age of onset was 3.9 (1.3, 9.2) years and visiting age was 5.1 (2.0, 9.3) years. The time-consuming of diagnosis was 94 (66, 213) days. The hospital stay was 8 (6, 14) days. The most frequently identified cause of FUO was infectious diseases (163 cases, 45.7%), followed by non-infectious inflammatory diseases (133 cases, 37.2%), malignancy (21 cases, 5.9%) and others (40 cases, 11.2%). The patients at younger age were more likely to be attacked by malignancy, oncologic diagnoses, and others, nevertheless patients at older age were more likely to be attacked by non-infectious inflammatory diseases oppositely (9.8 (3.6, 11.5) vs. 3.0 (1.2, 7.0), 2.3 (1.0, 5.2), 0.9 (0.5, 1.8) years, U=41.30, 15.94, 37.08, all P<0.01);106 (65%) patients were male, and 57 (35%) patients were female. This result indicated that boys were more susceptible to infectious diseases (χ²=14.73, P<0.01). Analysis of inflammatory factors in serum among 103 patients, interleukin (IL)-6 level in 40 infectious diseases patients (9 (2, 38) ng/L) was significantly lower than those of 6 tumor patients (89 (64, 599) ng/L) and 57 non-infectious inflammatory diseases patients (25 (8, 78) ng/L, U=51.05, 15.70, both P<0.05), no significant difference was observed in IL-2, IL-4, IL-10, tumor necrosis factor α and interferon among the groups (all P>0.05). The patients grouped into those aged 1-<3 years and 3-<6 years were more likely to be attacked by infectious diseases (51.3% (59/115) and 57.1% (40/70)), while patients grouped into those aged 6-<12 years and 12-<18 years were more likely to be attacked by non-infectious inflammatory diseases (55.6% (65/117) and 72.4% (21/29)). Conclusions: Infectious disease is still the main cause of FUO in children and the boys are more susceptible to infectious diseases. However, the morbidity of non-infectious inflammatory diseases increases to number 1 in FUO of children over 6 years of age.


Subject(s)
Aged , Child , Communicable Diseases/complications , Female , Fever of Unknown Origin/etiology , Humans , Length of Stay , Male , Neoplasms/complications , Retrospective Studies
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