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1.
Alerta (San Salvador) ; 5(1): 74-80, ene. 28, 2022.
Article in Spanish | LILACS, BISSAL | ID: biblio-1354469

ABSTRACT

La insuficiencia cardíaca congestiva es parte importante de la morbimortalidad mundial. Estos pacientes pierden calidad de vida de manera considerable, particularmente por su trayecto impredecible. Los cuidados paliativos representan una oportunidad para mejorar el control sintomático y prevenir reingresos hospitalarios, especialmente en las fases avanzadas de la enfermedad (New York Heart Association III-IV). El objetivo de esta revisión es determinar la influencia de los cuidados paliativos en la calidad de vida de los pacientes con insuficiencia cardíaca en enfermedad avanzada, puesto que se ha demostrado que sufren múltiples hospitalizaciones: 84% tendrá ≥1 en sus últimos 12 meses de vida, y el reingreso hospitalario a los 30 días posteriores al alta circunda 20-50 %. En general, reciben menos cuidados paliativos que los pacientes oncológicos, y al recibirlos lo hacen presentando una menor funcionalidad (p<0,001). Al implementar los cuidados paliativos aumenta la calidad de vida (p=0,03) y mejoran la depresión (p=0,02), la ansiedad (p=0,048) y la frecuencia de reingresos hospitalarios en comparación con el manejo usual, 33,63 % vs. 61 %, y visitas a emergencias, 35,0 % vs. 60,0 %. Múltiples evidencias señalan que la mortalidad no es influenciada (p>0,19, p>0,22). Según la bibliografía, se concluye que los cuidados paliativos deben ser implementados desde el diagnóstico de esta patología, puesto que ofrecen una mayor calidad de vida, especialmente en enfermedad avanzada


Congestive heart failure is an important part of global morbidity and mortality. These patients lose quality of life considerably, particularly due to their unpredictable path. Palliative care represents an opportunity to improve symptom control and prevent hospital readmissions, especially in the advanced stages of the disease (New York Heart Association III-IV). The objective of this review is to determine the influence of palliative care on the quality of life of patients with heart failure in advanced disease, since it has been shown that they suffer multiple hospitalizations: 84% will have ≥1 in their last 12 months of life, and hospital readmission 30 days after discharge is around 20-50%. In general, they receive less palliative care than cancer patients, and when they receive it they do so with less functionality (p<0.001). When implementing palliative care, quality of life increases (p=0.03) and depression (p=0.02), anxiety (p=0.048) and the frequency of hospital readmissions improve compared to usual management, 33 .63%vs. 61%, and ER visits, 35.0% vs. 60.0%. Multiple pieces of evidence indicate that mortality is not influenced (p>0.19, p>0.22). According to the bibliography, it is concluded that palliative care should be implemented from the diagnosis of this pathology, since it offers a better quality of life, especially in advanced disease


Subject(s)
Palliative Care , Quality of Life , Heart Failure , Patient Readmission , Patients , Disease , Heart
2.
Esc. Anna Nery Rev. Enferm ; 26: e20200435, 2022. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1346055

ABSTRACT

RESUMO Objetivo analisar o conceito Cuidados de Transição no contexto da gestão da alta hospitalar. Método reflexão analítica utilizando-se a análise conceitual de Walker e Avant: seleção do conceito; definição do objetivo, identificação do uso do conceito (busca na literatura e dicionários entre setembro-dezembro/2019 nas bases de dados: PubMed, Biblioteca Virtual em Saúde e SCOPUS. Consideraram-se 77 artigos que contemplaram conceito e outros termos que corroboraram o estudo; para fins metodológicos, 12 estudos possibilitaram a análise); definição dos atributos; descrição de caso modelo; descrição de casos adicionais; definição de antecedentes e consequentes; definição de indicadores empíricos. Resultados os antecedentes cuidados fragmentados e reinternação são comuns ao conceito. Identificaram-se atributos cuidado integrado, colaboração profissional, coordenação, planejamento da alta, comunicação, integração profissional e gerenciamento de casos. Conclusão e implicações para a prática foi oportuno analisar o conceito em conjunto com termos relacionados ao contexto da alta hospitalar. Cuidados de Transição são práticas coordenadas e eficazes para a Continuidade dos Cuidados na transferência do usuário na alta hospitalar; nesse contexto, as Enfermeiras de Ligação são potenciais protagonistas para estar à frente nesse processo de Integração. As especificidades do conceito poderão favorecer a sua compreensão e a construção de conhecimentos que repercutam no cuidado coordenado e contínuo.


RESUMEN Objetivo analizar el concepto de Atención Transicional en el contexto de la gestión del alta hospitalaria. Método reflexión analítica utilizando el análisis conceptual de Walker y Avant: selección de conceptos; definición del objetivo, identificación del uso del concepto (búsqueda en la literatura y diccionarios entre septiembre-diciembre / 2019 en las bases de datos: PubMed, Virtual Health Library y SCOPUS. Se consideraron 77 artículos que contemplaban el concepto y otros términos que corroboraban el estudio; a efectos metodológicos, 12 estudios permitieron el análisis); definición de atributos; descripción del caso modelo; descripción de casos adicionales; definición de antecedentes y consecuencias; definición de indicadores empíricos. Resultados la atención fragmentada y los antecedentes de readmisión son comunes al concepto. Se identificaron los atributos atención integral, colaboración profesional, coordinación, planificación del alta, comunicación, integración profesional y manejo de casos. Conclusión e implicaciones para la práctica fue apropiado analizar el concepto junto con términos relacionados con el contexto del alta hospitalaria. Transition Care son prácticas coordinadas y efectivas para la Continuidad de la Atención en el traslado del usuario al alta hospitalaria; en este contexto, las Enfermeras de Enlace son potenciales protagonistas para estar a la vanguardia de este proceso de integración. La especificidad del concepto puede favorecer su comprensión y la construcción de conocimientos que inciden en la atención coordinada y continuada.


ABSTRACT Objective to analyze the concept of Transitional Care in the context of hospital discharge management. Method analytical reflection using the Walker and Avant's conceptual analysis: concept selection; definition of the objective, identification of the use of the concept (literature search and dictionaries between September-December/2019 in the databases: PubMed, Virtual Health Library and SCOPUS. A total of 77 articles that contemplated the concept and other terms that corroborated the study were considered; for methodological purposes, 12 studies enabled the analysis); definition of attributes; description of model case; description of additional cases; definition of antecedents and consequents; definition of empirical indicators. Results the fragmented care and readmission antecedents are common to the concept. The attributes integrated care, professional collaboration, coordination, discharge planning, communication, professional integration, and case management were identified. Conclusion and Implications for practice it was opportune to analyze the concept together with terms related to the context of hospital discharge. Transitional Care is coordinated and effective practices for the Continuity of Care in the transference of the user at hospital discharge; in this context, Liaison Nurses are potential protagonists to be ahead in this Integration process. The specificities of the concept may favor its understanding and the construction of knowledge that has repercussions on coordinated and continuous care.


Subject(s)
Humans , Patient Discharge , Transitional Care , Patient Readmission , Intersectoral Collaboration , Continuity of Patient Care , Nurses
3.
rev. cuid. (Bucaramanga. 2010) ; 12(3): 1-10, 20210821.
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1343782

ABSTRACT

Objective: To evaluate the effectiveness of care transition strategies from hospital-to-community compared to usual care for patients with colorectal cancer to reduce hospital stay, 30-day readmissions, and emergency room visits up to 30 days. Methods: Systematic review and meta­analysis protocol that followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). The protocol was registered on PROSPERO (CRD42020162249). We will include studies available in the electronic databases PubMed/Medline, Embase, Cochrane CENTRAL and LILACS with care transition strategies/actions from hospital to community as the primary outcome. Eligible studies will be selected, and data will be combined and synthesized using Review Manager (RevMan 5.4) software. We will combine risk ratios or odds ratios for dichotomous data and mean differences for continuous data using a random effects model. Discussion: This review will contribute to the practice and development of effective and safe care transition strategies from hospital to community for colorectal cancer patients. There is an expectation that this review will provide much needed evidence that effective care transitions could reduce short term hospital readmission, and may thus provide added value in the care of colorectal cancer patients. Conclusion: The results of the review will be used to provide clear recommendations for hospital and primary care management to improve care transitions and, as a result, also improve integration in the healthcare system.


Objetivo: Evaluar la efectividad de estrategias de transición de cuidados del hospital a la comunidad en comparación con el cuidado usual en pacientes con cáncer colorrectal para reducir el tiempo de estancia hospitalaria, readmisiones a los 30 días y visitas al departamento de emergencias dentro de los 30 días. Métodos: Protocolo de revisión sistemática y metaanálisis que siguió las recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). El protocolo se registró en PROSPERO (CRD42020162249). Se incluirán estudios disponibles en las bases de datos electrónicas PubMed/Medline, Embase, Cochrane CENTRAL y LILACS con estrategias/acciones de transición del cuidado del hospital a la comunidad como desenlace principal. Se seleccionarán los estudios elegibles y los datos se combinarán y sintetizarán mediante el software Review Manager (RevMan 5.4). Serán combinados los riesgos relativos u odds ratios para los datos dicotómicos y las diferencias de medias para los datos continuos mediante un modelo de efectos aleatorios. Discusión: Esta revisión contribuirá a la práctica y el desarrollo de estrategias de transición de cuidado efectivas y seguras del hospital a la comunidad para los pacientes con cáncer colorrectal. Se espera que esta revisión proporcione evidencias muy necesarias de que las transiciones de cuidado efectivas podrían reducir la readmisión hospitalaria a corto plazo y, por lo tanto, pueden proporcionar un valor agregado en el cuidado de los pacientes con cáncer colorrectal. Conclusión: Los resultados de la revisión se utilizarán para proporcionar recomendaciones claras para la gestión hospitalaria y de cuidado primario para mejorar las transiciones de cuidado y, como resultado, también mejorar la integración en el sistema de salud.


Objetivo: Avaliar a efetividade de estratégias de transição do cuidado do hospital para a comunidade comparada aos cuidados habituais para pacientes com câncer colorretal para diminuir tempo de permanência hospitalar, readmissões aos 30 dias e visita ao setor de emergência até 30 dias. Métodos: Protocolo de revisão sistemática e meta-análise que seguiu as recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). O protocolo foi registrado no PROSPERO (CRD42020162249). Incluiremos estudos disponíveis nas bases de dados eletrônicas PubMed/Medline, Embase, Cochrane CENTRAL e LILACS tendo como desfecho primário as estratégias/ações de transição do cuidado do hospital para a comunidade. Os estudos elegíveis serão selecionados e os dados serão combinados e sintetizados usando o software Review Manager (RevMan 5.4). Serão combinados os riscos relativos ou odds ratios para dados dicotômicos e diferenças de médias para dados contínuos usando um modelo de efeitos aleatórios. Discussão: Esta revisão contribuirá para a prática e desenvolvimento de estratégias de transição de cuidados efetivas e seguras do hospital para a comunidade para pacientes com câncer colorretal. Espera-se que esta revisão forneça evidências muito necessárias de que as transições de cuidados efetivas podem reduzir a readmissão hospitalar de curto prazo e podem, assim, fornecer valor agregado no cuidado de pacientes com câncer colorretal. Conclusão: Os resultados da revisão serão usados ​​para fornecer recomendações claras para a gestão hospitalar e de cuidados primários para melhorar as transições de cuidados e, como resultado, também melhorar a integração no sistema de saúde.


Subject(s)
Humans , Male , Female , Patient Readmission , Colorectal Neoplasms , Patient Transfer , Meta-Analysis , Systematic Review
4.
Invest. educ. enferm ; 39(2): [e05], 15 junio 2021. figure 1, figure 2, figure 3, figure 4, figure 5, table 1, table 2
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1254613

ABSTRACT

Objective. To estimate the combined effect of educational interventions (EI) on decreased readmissions and time of hospital stay in adults with heart failure, compared with usual care. Methods. Systematic review (SR) and meta-analysis (MA) of randomized controlled trials that followed the recommendations of the PRISMA statement. The protocol was registered on PROSPERO (CRD42019139321). Searches were made from inception until July 2019 in the databases of PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science, and Scopus. The MA was conducted through the random effects model. The effect measure used for the dichotomous outcomes was relative risk (RR) and for continuous outcomes the mean difference (MD) was used, with 95% confidence intervals (CI). Heterogeneity was evaluated through the inconsistency statistic (I2). Results. Of 2369 studies identified, 45 were included in the SR and 43 in the MA. The MA of studies with follow-up at six months showed a decrease in readmissions of 30% (RR: 0.70; 95% CI: 0.58 to 0.84; I2: 0%) and the 12-month follow-up evidenced a reduction of 33% (RR: 0.67; 95% CI: 0.58 to 0.76; I2: 52%); both analyses in favor of the EI group. Regarding the time of hospital stay, a reduction was found of approximately two days in patients who received the EI (MD: -1.98; 95% CI: -3.27 to -0.69; I2: 7%). Conclusion. The findings support the benefits of EI to reduce readmissions and days of hospital stay in adult patients with heart failure.


Objetivo. Estimar el efecto combinado de las intervenciones educativas (IE) en la disminución de readmisiones y tiempo de estancia hospitalaria en adultos con falla cardiaca comparado con el cuidado usual. Métodos. Revisión Sistemática (RS) y meta-análisis (MA) de ensayos clínicos aleatorizados que siguieron las recomendaciones de la declaración PRISMA. El protocolo se registró en PROSPERO (CRD42019139321). Se realizaron búsquedas desde el inicio hasta julio de 2019, en las bases de datos PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science y Scopus. El MA se realizó mediante modelo de efectos aleatorios. La medida de efecto utilizada para los desenlaces dicotómicos fue el riesgo relativo (RR) y para desenlaces continuos se usó la diferencia de medias (DM), con sus intervalos de confianza (IC) del 95%. La heterogeneidad se evaluó mediante el estadístico de inconsistencia (I2). Resultados. De 2369 estudios identificados, 45 se incluyeron en la RS y 43 en el MA. El MA de estudios con seguimiento a seis meses mostró una disminución en las readmisiones de 30% (RR: 0.70; IC 95%: 0.58 a 0.84; I2: 0%) y el seguimiento a doce meses evidenció una reducción de 33% (RR: 0.67; IC 95%: 0.58 a 0.76; I2: 52%), ambos análisis a favor del grupo de IE. Referente al tiempo de estancia hospitalaria, se encontró una reducción de aproximadamente dos días en los pacientes que recibieron las IE (DM: -1.98; IC 95%: -3.27 a -0.69; I2: 7%). Conclusión. Los hallazgos soportan los beneficios de las IE para la disminución de readmisiones y días de estancia hospitalaria en pacientes adultos con falla cardiaca.


Objetivo. Estimar o efeito combinado de intervenções educacionais (IE) na redução de readmissões e tempo de internação em adultos com insuficiência cardíaca, em comparação com o cuidado usual. Métodos. Revisão sistemática (RS) e meta-análise (MA) de ensaios clínicos randomizados que seguiu as recomendações da declaração PRISMA. O protocolo foi registrado no PROSPERO (CRD42019139321). Foram realizadas buscas desde o início até julho de 2019, nas bases de dados PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science e Scopus. A MA foi realizada usando um modelo de efeitos aleatórios. A medida de efeito utilizada para desfechos dicotômicos foi o risco relativo (RR) e para desfechos contínuos foi usada a diferença de médias (DM), com seus intervalos de confiança (IC) de 95%. A heterogeneidade foi avaliada por meio da estatística de inconsistência (I2). Resultados. De 2369 estudos identificados, 45 foram incluídos na RS e 43 na MA. A MA dos estudos com seguimento de seis meses mostrou uma diminuição nas readmissões de 30% (RR: 0.70; IC 95%: 0.58 a 0.84; I2: 0%) e o seguimento de doze meses mostrou uma redução de 33 % (RR: 0.67; IC 95%: 0.58 a 0.76; I2: 52%), ambas as análises em favor do grupo de IE. Em relação ao tempo de internação, foi observada uma redução de aproximadamente dois dias nos pacientes que receberam as IE (DM: -1.98; IC 95%: -3.27 a -0.69; I2: 7%). Conclusão. Os achados evidenciam os benefícios das IE para a redução de readmissões e dias de internação em pacientes adultos com insuficiência cardíaca.


Subject(s)
Humans , Patient Readmission , Self Care , Patient Education as Topic , Systematic Review , Heart Failure
6.
Arch. argent. pediatr ; 119(5): e435-e440, oct. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1292120

ABSTRACT

Introducción. Los reingresos hospitalarios en pediatría representan un problema grave, potencialmente evitable, en los sistemas de salud. Existe poca información sobre el tema en nuestro medio. Objetivo. Estimar la tasa de reingreso, la proporción de reingresos potencialmente prevenibles y las características asociadas a estos. Material y métodos. Estudio transversal que incluyó reingresos hospitalarios de pacientes de 0 a 18 años, internados en un hospital pediátrico de tercer nivel entre el 1 de enero de 2018 y el 31 de diciembre de 2018. Se evaluó si los reingresos fueron potencialmente prevenibles según tuvieran o no relación con el ingreso previo. Resultados. Sobre 8228 ingresos hospitalarios contabilizados en el período de estudio, se observó una tasa de reingresos por cualquier causa de 10 % a 30 días y del 7,1 % a 15 días. La proporción de reingresos clasificados como potencialmente prevenibles fue de 47,9 % a los 30 días y de 47,5 % a 15 días. No se observaron diferencias estadísticamente significativas entre los reingresos a 30 y a 15 días respecto de la edad de los pacientes, la cobertura de salud, la presencia de una enfermedad crónica ni la causa del reingreso. Conclusión. La tasa de reingresos hospitalarios fue de 10 % a 30 días del egreso y de 7,1 % a 1 días; casi la mitad de ellos se consideraron potencialmente prevenibles


Introduction. Hospital readmissions in pediatrics are a severe, potentially avoidable problem of health systems. In our setting, there is little information about this topic. Objective. To estimate the rate of readmissions, the proportion of potentially preventable readmissions, and their associated characteristics. Material and methods. Cross-sectional study including hospital readmissions of patients aged 0-18 years, admitted to a tertiary care children's hospital between January 1st and December 31st, 2018. Readmissions were assessed as potentially preventable based on whether they were or not related to the previous admission. Results. Out of 8228 hospital admissions recorded in the study period, the rate of readmissions for any cause was 10 % at 30 days and 7.1 % at 15 days. The proportion of readmissions classified as potentially preventable was 47.9 % at 30 days and 47.5 % at 15 days. No statistically significant differences were observed between readmissions at 30 and 15 days in terms of patient age, health insurance, presence of chronic disease or cause of readmission. Conclusion. The rate of hospital readmissions was 10 % at 30 days and 7.1 % at 15 days of discharge; almost half of them were considered potentially preventable.


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Patient Discharge , Patient Readmission , Tertiary Healthcare , Prevalence , Cross-Sectional Studies , Retrospective Studies , Hospitals
7.
Rev. bras. ter. intensiva ; 33(1): 31-37, jan.-mar. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1289059

ABSTRACT

RESUMO Introdução: Os efeitos provocados pela COVID-19 em longo prazo são desconhecidos. O presente estudo tem como objetivo avaliar os fatores associados com a qualidade de vida relacionada à saúde e os desfechos em longo prazo em sobreviventes à hospitalização por COVID-19 no Brasil. Métodos: Este será um estudo multicêntrico de coorte prospectivo, aninhado em cinco ensaios clínicos randomizados desenhados para avaliar os efeitos dos tratamentos específicos para COVID-19 em mais de 50 centros no Brasil. Pacientes adultos sobreviventes à hospitalização por infecção por SARS-CoV-2 comprovada ou suspeita serão seguidos por um período de 1 ano, por meio de entrevistas telefônicas estruturadas. O desfecho primário é o escore de utilidade para qualidade de vida relacionada à saúde após 1 ano, avaliado segundo o questionário EuroQol-5D3L. Os desfechos secundários incluirão mortalidade por todas as causas, eventos cardiovasculares graves, reospitalizações, retorno ao trabalho ou estudo, condição funcional física avaliada pelo instrumento Lawton-Brody Instrumental Activities of Daily Living, dispneia avaliada segundo a escala de dispneia modificada do Medical Research Council, necessidade de suporte ventilatório em longo prazo, sintomas de ansiedade e depressão avaliados segundo a Hospital Anxiety and Depression Scale, sintomas de transtorno de estresse pós-traumático avaliados pela ferramenta Impact of Event Scale-Revised e autoavaliação da condição de saúde, conforme a Escala Visual Analógica do EuroQol-5D3L. Serão utilizadas equações de estimativas generalizada para testar a associação entre cinco conjuntos de variáveis (1 - características demográficas, 2 - condição de saúde pré-morbidade, 3 - características da doença aguda, 4 - terapias específicas para COVID-19 recebidas e 5 - variáveis pós-alta atualizadas) e desfechos. Ética e disseminação: O protocolo do estudo foi aprovado pelos Comitês de Ética em Pesquisa de todas as instituições participantes. Os resultados serão disseminados por meio de conferências e periódicos revisados por pares.


Abstract Introduction: The long-term effects caused by COVID-19 are unknown. The present study aims to assess factors associated with health-related quality of life and long-term outcomes among survivors of hospitalization for COVID-19 in Brazil. Methods: This is a multicenter prospective cohort study nested in five randomized clinical trials designed to assess the effects of specific COVID-19 treatments in over 50 centers in Brazil. Adult survivors of hospitalization due to proven or suspected SARS-CoV-2 infection will be followed-up for a period of 1 year by means of structured telephone interviews. The primary outcome is the 1-year utility score of health-related quality of life assessed by the EuroQol-5D3L. Secondary outcomes include all-cause mortality, major cardiovascular events, rehospitalizations, return to work or study, physical functional status assessed by the Lawton-Brody Instrumental Activities of Daily Living, dyspnea assessed by the modified Medical Research Council dyspnea scale, need for long-term ventilatory support, symptoms of anxiety and depression assessed by the Hospital Anxiety and Depression Scale, symptoms of posttraumatic stress disorder assessed by the Impact of Event Scale-Revised, and self-rated health assessed by the EuroQol-5D3L Visual Analog Scale. Generalized estimated equations will be performed to test the association between five sets of variables (1- demographic characteristics, 2- premorbid state of health, 3- characteristics of acute illness, 4- specific COVID-19 treatments received, and 5- time-updated postdischarge variables) and outcomes. Ethics and dissemination: The study protocol was approved by the Research Ethics Committee of all participant institutions. The results will be disseminated through conferences and peer-reviewed journals.


Subject(s)
Humans , Adult , Quality of Life , COVID-19/complications , Patient Readmission , Telephone , Brazil , Cardiovascular Diseases/etiology , Randomized Controlled Trials as Topic , Prospective Studies , Follow-Up Studies , Cause of Death , Survivors , Sample Size , Return to Work , Patient Reported Outcome Measures , COVID-19/mortality
8.
Article in English | WPRIM | ID: wpr-921071

ABSTRACT

INTRODUCTION@#Analysis of risk factors can pave the way for reducing unscheduled hospital readmissions and improve resource utilisation.@*METHODS@#This was a concurrent nested, mixed method study. Factors associated with patients readmitted within 30 days between 2011 and 2015 at the National University Hospital, Singapore (N=104,496) were examined. Fifty patients were sampled in 2016 to inform an embedded qualitative study. Narrative interviews explored the periods of readmissions and related experiences, contrasted against those of non-readmitted patients.@*RESULTS@#Neoplastic disease (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.70-2.15), number of discharged medications (5 to 10 medications OR 1.21, 95% CI 1.14-1.29; ≥11 medications OR 1.80, 95% CI 1.66-1.95) and length of stay >7 days (OR 1.46, 95% CI 1.36-1.58) were most significantly associated with readmissions. Other factors including number of surgical operations, subvention class, number of emergency department visits in the previous year, hospital bill size, gender, age, Charlson comorbidity index and ethnicity were also independently associated with hospital readmissions. Although readmitted and non-readmitted patients shared some common experiences, they reported different psychological reactions to their illnesses and viewed hospital care differently. Negative emotions, feeling of being left out by the healthcare team and perception of ineffective or inappropriate treatment were expressed by readmitted patients.@*CONCLUSION@#Patient, hospital and system-related factors were associated with readmissions, which may allow early identification of at-risk patients. Qualitative analysis suggested several areas of improvement in care including greater empowerment and involvement of patients in care and decision making.


Subject(s)
Hospitals , Humans , Length of Stay , Patient Readmission , Retrospective Studies , Risk Factors
9.
Clin. biomed. res ; 41(1): 75-83, 2021.
Article in Portuguese | LILACS | ID: biblio-1255309

ABSTRACT

A sepse é uma disfunção orgânica aguda secundária à infecção e suas taxas de mortalidade hospitalar vêm reduzindo em muitos países nos últimos anos. Esta redução da mortalidade resulta em um maior número de pacientes que recebem alta hospitalar, porém frequentemente os sobreviventes experimentam novas incapacidades (físicas, cognitivas e psicológicas) e piora das condições crônicas de saúde em longo-prazo. Além disso, sua evolução pós-alta hospitalar cursa com elevado risco de morte e frequentes reinternações nos primeiros meses pós-hospitalização, bem como elevado uso de recursos de saúde. Esta revisão tem como objetivo descrever a morbimortalidade em longo prazo dos pacientes sobreviventes de sepse, seus efeitos sobre o sistema de saúde e as possíveis ações voltadas a minimizar as sequelas desta síndrome que acomete aproximadamente 1/3 dos pacientes admitidos em unidades de tratamento intensivo. (AU)


Sepsis is an acute organ dysfunction secondary to infection and its hospital mortality rates have been decreasing in many countries in recent years. This reduction in mortality results in a greater number of patients being discharged from the hospital, but survivors often experience new disabilities (physical, cognitive and psychological) and worsening chronic long-term health conditions. In addition, the post-discharge evolution leads to a high risk of death and frequent readmissions in the first months after hospitalization, as well as a high use of health resources. This review aims to describe the long-term morbidity and mortality of survivors of sepsis, its effects on the health system and the possible actions aimed at minimizing the sequelae of this syndrome that affects approximately 1/3 of patients admitted to intensive care units. (AU)


Subject(s)
Patient Discharge , Sepsis/mortality , Intensive Care Units , Patient Readmission , Sepsis/complications
10.
Clin. biomed. res ; 41(1): 33-38, 2021.
Article in English | LILACS | ID: biblio-1254968

ABSTRACT

Introduction: The occurrence of mental disorders and chronic diseases is associated with low treatment compliance and an increased mortality. The main objective of this study was to analyze medication prescriptions at hospital discharge in order to verify the patients' access to the prescribed treatment. Methods: This is a descriptive and retrospective study performed between September 2013 and September 2018 with patients admitted in the psychiatric ward of a university hospital in the state of Rio Grande do Sul. The studied patients consisted of 274 adults over 18 years of age admitted to this hospital with at least one psychiatric comorbidity included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) who lived in the city of Porto Alegre used specially controlled drugs, and had been hospitalized for at least 7 days. Results: Out of the 274 patients, 68.5% were readmitted once, 17.5% were readmitted twice, 9.5% were readmitted 3 times, and 4.5% went through this process 4 times or more. A significant association (p = 0.014) was observed between the number of drugs not included in the Municipal Essential Medicines List upon first readmission and the number of readmissions. Among patients who were readmitted 3 times or more, 79% were prescribed drugs that were not on this list. Conclusions: The understanding of how therapeutic itineraries are established when searching for drugs contributes to setting effective lines of care where professionals may position themselves more proactively to reduce mental health complications. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Patient Readmission , Mental Disorders , Substance-Related Disorders , Hospitals, University
11.
Rev. bras. cir. cardiovasc ; 35(6): 884-890, Nov.-Dec. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143984

ABSTRACT

Abstract Introduction: In order to reduce readmission rates after coronary artery bypass grafting (CABG), its predictors should be known in different contexts. The objective of this study was to identify predictive factors of hospital readmission within 30 days after CABG in a Brazilian center. Methods: A secondary analysis of an electronic database of patients submitted to isolated CABG was performed. The relationship between readmission within 30 days and demographic, anthropometric, clinical, and surgery-related characteristics was investigated by univariate analyses. Predictors were identified by multiple logistic regression. Results: Data from 2,272 patients were included, with an incidence of readmission of 8.6%. The predictors of readmission were brown skin color (Beta=1.613; 95% confidence interval [CI] 1.047-2.458; P=0.030), African-American ethnicity (Beta=0.136; 95% CI 0.019-0.988; P=0.049), chronic kidney disease (Beta=2.214; 95% CI 1.269-3.865; P=0.005), postoperative use of blood products (Beta=1.515; 95% CI 1.101-2.086; P=0.011), chronic obstructive pulmonary disease (Beta=2.095; 95% CI 1.284-3.419; P=0.003), and use of acetylsalicylic acid (Beta=1.418; 95% CI 1.000-2.011; P=0.05). Preoperative antibiotic prophylaxis (Beta=0.742; 95% CI 0.5471.007; P=0.055) was marginally significant. Conclusion: The predictors identified may support a closer postoperative follow-up and individualized planning for a safe discharge.


Subject(s)
Humans , Male , Patient Readmission , Coronary Artery Bypass , Data Analysis , Postoperative Complications/epidemiology , United States , Brazil , Retrospective Studies , Risk Factors , Treatment Outcome
12.
Rev. Assoc. Med. Bras. (1992) ; 66(12): 1690-1695, Dec. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143671

ABSTRACT

SUMMARY PURPOSE: This study intends to investigate the reasons for re-hospitalization, complaints, and prognoses of COVID-19 patients after being discharged. METHODS: COVID-19 patients who were re-hospitalized at the Sakarya University Training and Research Hospital were examined. Reverse transcriptase-polymerase chain reaction (RT-PCR), tomography and laboratory results, demographic characteristics, and prognostic results were recorded retrospectively. RESULTS: A total of 60 patients, including 26 males (43.3%) and 34 females (56.7%), with repeated admissions to the hospital for COVID-19 symptoms, were included in the study with a mean age of 56.9 (± 22.5) (median value = 61, age range = 3-88). The number of days of the second hospitalization was statistically significantly higher (p < 0.05). Patient age and number of days of hospitalization were strongly positively correlated (p < 0.01). A total of 11 patients (18%) had negative results in their first RT-PCR and subsequently tested positive in their second hospitalization. In addition, 10 (17.5%) of the patients who underwent thoracic tomography had unilateral involvement, 34 (59.6%) had bilateral involvement, and 13 (22.8%) had no significant results. Note that 4 (6.6%) of the patients re-hospitalized died in the hospital, while 56 (93.4%) were discharged once more. All of the four patients that died were female with a mean age of 81.5 years. CONCLUSION: Particularly patients with advanced age and comorbidities should be examined more carefully when discharged; if their complaints are repeated, they should be advised to quickly contact the emergency service.


RESUMO OBJETIVO: Este estudo pretende investigar as causas para re-hospitalizações, as reclamações e os prognósticos de pacientes com COVID-19 após a alta hospitalar. MÉTODOS: Pacientes com COVID-19 internados que foram re-hospitalizados no Sakarya University Training and Research Hospital foram examinados. Os resultados da reação em cadeia de polimerase precedida de transcrição reversa (RT-PCR), tomografia e dos exames laboratoriais, as características demográficas e os resultados prognósticos foram registrados retrospectivamente. RESULTADOS: Um total de 60 pacientes, 26 do sexo masculino (43,3%) e 34 do sexo feminino (56,7%), com internações repetidas devido a sintomas de COVID-19 foram incluídos no estudo, com uma idade média de 56,9 (± 22,5) (mediana = 61, faixa etária = 3-88). O número de dias da segunda internação foi estatisticamente significativamente maior (p < 0,05). A idade do paciente e o número de dias de internação apresentaram uma forte correlação positiva (p < 0,01). Um total de 11 pacientes (18%) apresentaram resultados negativos no primeiro RT-PCR e posteriormente tiveram resultados positivos na segunda internação. Além disso, 10 (17,5%) dos pacientes submetidos a tomografia de tórax apresentaram envolvimento unilateral, 34 (59,6%) bilateral, e 13 (22,8%) não apresentaram resultados significativos. Nota-se que 4 (6,6%) dos pacientes re-hospitalizados morreram no hospital, enquanto 56 (93,4%) receberam alta mais uma vez. Todos os quatro pacientes que morreram eram do sexo feminino, com idade média de 81,5 anos. CONCLUSÃO: Principalmente pacientes com idade avançada e comorbidades devem ser examinados com mais cuidado no momento da alta hospitalar; caso suas queixas se repitam, eles devem ser aconselhados a contatar o serviço de emergência o quanto antes.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Patient Readmission , Coronavirus Infections/diagnosis , Turkey , Retrospective Studies , Hospitalization , Middle Aged
13.
Rev. méd. Maule ; 36(2): 28-33, dic. 2020. tab
Article in Spanish | LILACS | ID: biblio-1344611

ABSTRACT

OBJECTIVE: Evaluate initial results of a ambulatory major surgery program in Gynecology. MATERIAL AND METHODS: Retrospective, descriptive study of the period March 2018 to June 2019. The interventions included were: surgical sterilizations via vaginal, minilap and laparoscopic, diagnostic laparoscopy, laparoscopic cyst or anexectomy, hysteroscopy, TOT, vaginal plasty, biopsy curettage, polypectomy, extraction of IUD under anesthesia, labiaplasty, and removal of transobsturatrix tape. Quality indicators such as suspension, readmissions and systemic and surgical complications have been analyzed. RESULTS: 136 patients were operated by CMA of which 43 were laparoscopic (31.6%), 55 patients vaginally (40.4%), 34 histeroscopy (25%) and 4 patients by minilap (3%)There were 4 minor and late complications (2.9%) that corresponded to operative wound infection in vaginal plasty and nymphoplasty, a dysfunctional TOT tape that had to be removed in a mediated manner and a PIP post surgical sterilization via vaginal route. CONCLUSIONS: Gynecological ambulatory major surgery is feasible to perform in a hospital of medium complexity with a low percentage of minor complications in this study.


Subject(s)
Humans , Female , Laparoscopy/methods , Ambulatory Surgical Procedures/methods , Hysterectomy, Vaginal/methods , Outpatients , Patient Readmission , Postoperative Complications/etiology , Clinical Record , Epidemiology, Descriptive , Treatment Outcome , Hysterectomy/methods
14.
Rev. medica electron ; 42(6): 2633-2643, nov.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1150043

ABSTRACT

RESUMEN Introducción: la cirugía como ciencia médica tuvo grandes retos para llegar a tener una forma de tratamiento quirúrgico seguro y viable, entre estos uno de los mayores era como evitar los resultados adversos. Se realizó un análisis de los pacientes que reingresaron en el servicio de cirugía general por post operatorio complicado. Objetivo: determinar las causas de reingresos por postoperatorio complicado en el servicio de cirugía general. Material y métodos: se realizó un estudio prospectivo - descriptivo- observacional sobre el universo, que fueron todos los pacientes reingresados por postoperatorio complicados, por el servicio de Cirugía General. Se analizaron múltiples variables que pudieran estar en relación con los reingresos las cuales fueron obtenidas a través de una planilla de recolección de datos y procesadas por el programa computadorizado Microsoft Office 2009. Resultados: los pacientes que reingresaron, el mayor porcentaje son del sexo masculino, de la raza blanca y los mayores de 60 años. Los reingresos por complicaciones postquirúrgicas representan un bajo por ciento respecto al volumen de casos que son intervenidos y la principal causa de reingreso fue la infección del sitio quirúrgico, las variables analizadas las que más se relacionaron con los reingresos fueron las operaciones realizadas por vía convencional, atendidos en salas abiertas, con operaciones limpias contaminadas. Conclusiones: de los pacientes que reingresaron 6 de cada 10 son del sexo masculino de la raza blanca y su edad mayor de 60 años (AU).


SUMMARY Introduction: Surgery, as a medical science, faced big challenges to become a form of a safe, feasible surgical treatment; among them, one of the biggest was avoiding adverse outcomes. The authors carried out an analysis of the patients readmitted in the service of General Surgery of the University Hospital "Faustino Perez Hernandez" of Matanzas due to complicated post-surgery evolution in the period from January 2016 to December 2018. Objective: to determine the causes of readmissions due to complicated post-surgery evolution in the service of General Surgery of the University "Hospital Faustino Perez Hernandez". Materials and methods: a prospective, descriptive, observational study was carried out on a universe of all patients readmitted in the service of General Surgery due to complicated post-surgery evolution. The authors analyzed several variables that could be related to readmissions and were obtained from a data collection form and processed with the computer program Microsoft Office 2009. Results: the main results were that among readmitted patients, the highest percent were male, white and elder than 60 years old. Readmissions due to post-surgery complications represent a low percent with respect to the quantity of patients who underwent surgery, and the main cause of readmission was infection at the surgery site. From the analyzed variables the once related the most with readmissions were conventional surgeries, patients looked after in open wards, with contaminated clean operations. Conclusions: six from each ten patients were male, white, and aged more than 60 years (AU).


Subject(s)
Humans , Male , Female , Patient Readmission , Postoperative Complications/classification , Postoperative Period , Surgery Department, Hospital , Causality , Multivariate Analysis
15.
Rev. bras. cir. cardiovasc ; 35(5): 732-740, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137335

ABSTRACT

Abstract Objective: To evaluate the frequency, causes, and related predictive factors of intensive care unit (ICU) readmissions after coronary artery bypass grafting (CABG) surgery. Methods: A total of 4112 consecutive patients who underwent on-pump CABG between January 2007 and January 2017 were retrospectively evaluated. The patients were divided into two groups as patients with and without ICU readmission. Demographic and perioperative characteristics were compared between the two groups. Results: The ICU readmission rate was 3.5%. The most common reasons for ICU readmissions were respiratory (29%) and cardiac (23.4%) complications. The 90-day mortality risk was significantly higher in the readmitted patients than the non-readmitted patients (22.1% and 1.6%, respectively; P<0.001; OR=17.6; 95% CI=11.19-28.41). Severe left ventricular dysfunction, chronic obstructive pulmonary disease, end-stage renal disease, emergency CABG, EuroSCORE II > 5%, cross-clamp time > 35 minutes, postoperative respiratory complications, neurological complications, and cardiac complications showed a strong association with ICU readmissions. Conclusion: ICU readmission after CABG is associated with an increased mortality rate. Evaluation, not only of patients' comorbidities, but also of intraoperative conditions and postoperative complications, is important to identify patients at risk for ICU readmission.


Subject(s)
Humans , Male , Female , Patient Readmission , Coronary Artery Bypass , Intensive Care Units , Postoperative Complications , Retrospective Studies , Risk Factors
16.
Rev. bras. ter. intensiva ; 32(2): 301-307, Apr.-June 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1138479

ABSTRACT

RESUMO Objetivo: Avaliar a hipótese de que o Modified Early Warning Score (MEWS) por ocasião da alta da unidade de terapia intensiva associa-se com readmissão, e identificar o nível desse escore que prediz com maior confiabilidade a readmissão à unidade de terapia intensiva dentro de 48 horas após a alta. Métodos: Este foi um estudo observacional retrospectivo a respeito do MEWS de pacientes que receberam alta da unidade de terapia intensiva. Comparamos dados demográficos, escores de severidade, características da doença crítica e MEWS de pacientes readmitidos e não readmitidos. Identificamos os fatores associados com a readmissão em um modelo de regressão logística. Construímos uma curva Característica de Operação do Receptor para o MEWS na predição da probabilidade de readmissão. Por fim, apresentamos o critério ideal com maior sensibilidade e especificidade. Resultados: A taxa de readmissões foi de 2,6%, e o MEWS foi preditor significante de readmissão, juntamente do tempo de permanência na unidade de terapia intensiva acima de 10 dias e traqueostomia. A curva Característica de Operação do Receptor relativa ao MEWS para predizer a probabilidade de readmissão teve área sob a curva de 0,82, e MEWS acima de 6 teve sensibilidade de 0,78 (IC95% 0,66 - 0,9) e especificidade de 0,9 (IC95% 0,87 - 0,93). Conclusão: O MEWS associa-se com readmissão à unidade de terapia intensiva, e o escore acima de 6 teve excelente precisão como preditor prognóstico.


ABSTRACT Objective: To evaluate the hypothesis that the Modified Early Warning Score (MEWS) at the time of intensive care unit discharge is associated with readmission and to identify the MEWS that most reliably predicts intensive care unit readmission within 48 hours of discharge. Methods: This was a retrospective observational study of the MEWSs of discharged patients from the intensive care unit. We compared the demographics, severity scores, critical illness characteristics, and MEWSs of readmitted and non-readmitted patients, identified factors associated with readmission in a logistic regression model, constructed a Receiver Operating Characteristic (ROC) curve of the MEWS in predicting the probability of readmission, and presented the optimum criterion with the highest sensitivity and specificity. Results: The readmission rate was 2.6%, and the MEWS was a significant predictor of readmission, along with intensive care unit length of stay > 10 days and tracheostomy. The ROC curve of the MEWS in predicting the readmission probability had an AUC of 0.82, and a MEWS > 6 carried a sensitivity of 0.78 (95%CI 0.66 - 0.9) and specificity of 0.9 (95%CI 0.87 - 0.93). Conclusion: The MEWS is associated with intensive care unit readmission, and a score > 6 has excellent accuracy as a prognostic predictor.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Patient Readmission/statistics & numerical data , Critical Illness , Early Warning Score , Intensive Care Units/statistics & numerical data , Patient Discharge , Prognosis , Severity of Illness Index , Tracheostomy/statistics & numerical data , Retrospective Studies , ROC Curve , Sensitivity and Specificity , Length of Stay
17.
Medwave ; 20(2): e7853, 31-03-2020.
Article in English, Spanish | LILACS | ID: biblio-1095856

ABSTRACT

INTRODUCCIÓN: La Unidad de Corta Estadía Infanto-juvenil del Hospital Psiquiátrico del Salvador (Valparaíso, Chile) y sus pacientes poseen características clínicas y sociales diferentes a las reportadas por la escasa literatura nacional al respecto. OBJETIVOS: Describir el funcionamiento la unidad, las características sociofamiliares y clínicas de sus pacientes y analizar los factores asociados a su evolución clínica. MÉTODOS: Estudio transversal que describió el universo de pacientes hospitalizados durante tres años. Las variables se recogieron desde una base de datos anonimizada. Se evaluó la evolución clínica dentro del año posterior al egreso hospitalario. RESULTADOS: El modelo de atención de la unidad presenta los componentes biomédico, psicodinámico y ecológico. Se analizaron 98 pacientes, 70,4% hombres, con edad promedio de 11,5 ± 2,3 años. Un 82,6% perteneció al nivel socioeconómico bajo y 35,7% estaba desescolarizado; 98,9% presentó disfunción familiar y 91,8% de los padres portaba alguna psicopatología. Los motivos de ingreso más frecuente fueron riesgo de hetero y autoagresión. Los diagnósticos de egreso más frecuente fueron trastornos de conducta, depresivos y del desarrollo de la personalidad. El tiempo de estadía promedio fue de 41,8 ± 31,1 días. Los fármacos más utilizados fueron antipsicóticos y estabilizadores del ánimo. Un 47% tuvo una buena evolución clínica, 27% regular y 26% insatisfactoria. El único factor que se asoció a esta última fue haber tenido prescrito un antidepresivo durante la hospitalización. El factor que consistentemente se vinculó al reingreso a lo largo de un año, fue el haber presentado trastorno por consumo de sustancias. El abandono a tratamiento se relacionó con haber presentado un trastorno de conducta al egreso hospitalario y a tener padres con antecedente de suicidio o suicidio consumado. CONCLUSIONES: El perfil de pacientes de esta unidad corresponde a pacientes de nivel socioeconómico bajo, psicopatología severa, conducta desadaptativa, disfunción familiar y frecuente psicopatología parental. El trastorno por consumo de sustancias es un factor significativamente asociado al reingreso hospitalario.


INTRODUCTION: Patients of the Short-stay Child and Adolescent Unit of the Del Salvador Psychiatric Hospital (Valparaíso, Chile) exhibit different clinical and social characteristics compared to literature reports of other national centers, although published data are scarce. OBJECTIVES: To describe the operation of the Unit, the socio-familial and clinical characteristics of its patients and analyze factors associated with their clinical evolution. METHODS: We performed a cross-sectional study to describe the patients hospitalized over a three-year period. Variables were registered in an anonymized database. Clinical evolution was evaluated over the year following hospital discharge. RESULTS: The Unit's model of care can be described as involving biomedical, psychodynamic, and ecological components. We included 98 patients, of which 70.4% were male, and the average age was 11.5 ± 2.3 years. 82.6% were of low socioeconomic status, and 35.7% did not attend school; 98.9% presented family dysfunction, and 91.8% of parents had a history of psychopathology. The most frequent reason for admission was the risk of harm to self or others. The most frequent discharge diagnoses were behavioral, depressive, and personality development disorders. The average length of stay was 41.8 ± 31.1 days. The most commonly used pharmacological agents were antipsychotics and mood stabilizers. Regarding clinical evolution in the first year post-discharge, 47% were evaluated as positive, 27% regular, and 26% unsatisfactory. The factor associated with an unsatisfactory clinical course was having had in-patient antidepressants. Re-admission during the first year post-discharge was associated with comorbid substance use disorder. Treatment noncompliance was associated with a history of behavioral disorder at hospital discharge and having parents with a history of suicide or consummated suicide. CONCLUSIONS: The patient profile is one of low socioeconomic status, severe psychopathology, maladaptive behavior, family dysfunction, and parental psychopathology. Substance use disorder is also associated with readmission.


Subject(s)
Humans , Male , Female , Child , Adolescent , Substance-Related Disorders/complications , Hospitalization , Mental Disorders/complications , Mental Disorders/psychology , Mental Disorders/therapy , Patient Readmission , Suicide , Antipsychotic Agents , Family , Chile , Cross-Sectional Studies , Hospitals, Psychiatric
19.
Acta méd. colomb ; 45(1): 1-9, Jan.-Mar. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1124063

ABSTRACT

Abstract Objective: to describe the clinical and biochemical characteristics and treatment of patients with decompensated heart failure with reduced ejection fraction hospitalized during 2015 at the Hospital Militar Central in Bogotá. Methods: a descriptive study reviewing the clinical records of patients over the age of 18 who were hospitalized due to decompensated heart failure with reduced ejection fraction during 2015. Clinical, biochemical, echocardiographic and treatment variables were recorded. A univariate analysis was performed reporting percentages for qualitative variables, measures of central tendency for quantitative variables, and medians and first and third quartiles for variables with a non-normal distribution. Results: the medical records of 114 patients were analyzed (average age 74.8 years; 69.3% males). The etiology of the heart failure was hypertension in 66.7% and ischemia in 60.5%. Noncompliance was the main precipitating factor for decompensation. High adherence to management guidelines was seen on discharge, with medications at suboptimal doses and ambulatory titration in 32% of patients; 38% were readmitted at least once during the first 30 days. Altogether, 25.4% required ICU care, with a mortality rate of 18%; there was a 16% mortality rate for early readmissions and 3% for patients with late admissions. Conclusion: the clinical profile in this study is similar to what is reported in other research. Adherence to management guidelines is adequate, but at suboptimal doses. There is a high percentage of recorded readmissions and hospital mortality.(Acta Med Colomb 2020; 45. DOI: https://doi.org/10.36104/amc.2020.1233).


Resumen Objetivo: describir las características clínicas, bioquímicas y tratamiento de pacientes con falla cardiaca descompensada con fracción de eyección reducida hospitalizados en el año 2015 en el Hospital Militar Central de Bogotá. Metodología: estudio descriptivo en el que se revisaron registros clínicos de pacientes mayores de 18 años hospitalizados por falla cardiaca descompensada con fracción de eyección reducida en el año 2015. Se registraron variables clínicas, bioquímicas, ecocardiográficas y de tratamiento. Se realizó análisis univariado, reportando para variables cualitativas proporciones, para variables cuantitativas medidas de tendencia central y para variables que no siguen distribución normal, medianas y cuartiles 1 y 3. Resultados: se analizaron registros de 114 pacientes, con edad promedio de 74.8 años, 69.3% hombres. La etiología de la falla cardiaca fue hipertensiva 66.7% e isquémica 60.5%, la no adherencia al tratamiento fue el principal factor precipitante de descompensación, se encontró alta adherencia a guías de manejo al egreso con medicación en dosis subóptimas, y titulación ambulatoria en 32% de los pacientes, el 38% reingresaron al menos una vez dentro de los primeros 30 días. Un 25.4% requirió manejo en UCI con mortalidad de 18% y para reingresos tempranos de 16%, siendo de 3% para pacientes con ingresos tardíos. Conclusión: en este estudio el perfil clínico es semejante a los reportados en otras series. La adherencia a guías de manejo es adecuada pero en dosis subóptimas. Existe un alto porcentaje de reingreso registrados y de mortalidad intrahospitalaria.(Acta Med Colomb 2020; 45. DOI: https://doi.org/10.36104/amc.2020.1233).


Subject(s)
Humans , Adult , Heart Failure , Patient Readmission , Research , Stroke Volume , Medical Records , Mortality
20.
Article in Chinese | WPRIM | ID: wpr-828640

ABSTRACT

OBJECTIVE@#To investigate the current status of readmission of neonates with hyperbilirubinemia and risk factors for readmission.@*METHODS@#From January 2017 to December 2019, a total of 85 infants who were readmitted due to hyperbilirubinemia were enrolled as the study group. A total of 170 neonates with hyperbilirubinemia but without readmission during the same period of time were randomly selected as the control group. The medical data were compared between the two groups. Multivariate logistic regression was used to assess the risk factors for readmission due to hyperbilirubinemia.@*RESULTS@#The readmission rate was 2.30%, and the interval between readmission and initial admission was 5 days. Compared with the control group, the study group had significantly higher levels of total bilirubin and indirect bilirubin at discharge (P<0.05) and a significantly longer duration of phototherapy during the first hospitalization (P<0.05). The univariate analysis showed that compared with the control group, the study group had significantly lower birth weight, gestational age, and age on initial admission (P<0.05) and a significantly higher proportion of infants with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency or hemolytic disease (P<0.05). The multivariate analysis showed that low gestational age (OR=1.792, P<0.05), young age on initial admission (OR=1.415, P<0.05), and G-6-PD deficiency (OR=2.829, P<0.05) were independent risk factors for readmission of neonates with hyperbilirubinemia.@*CONCLUSIONS@#The infants with hyperbilirubinemia who have lower gestational age, younger age on initial admission, and G-6-PD deficiency have a higher risk of readmission due to hyperbilirubinemia. It is thus important to strengthen the management during hospitalization and after discharge for these infants to prevent the occurrence of readmission.


Subject(s)
Bilirubin , Glucosephosphate Dehydrogenase Deficiency , Humans , Hyperbilirubinemia, Neonatal , Infant, Newborn , Patient Readmission , Risk Factors
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