Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 768
Filtrar
1.
PLoS One ; 14(10): e0224355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31661506

RESUMO

BACKGROUND: Intensive care is care for critically ill patients with potentially reversible conditions. Patient selection for intensive care should be based on potential benefit but since demand exceeds availability, rationing is needed. In Tanzania, the availability of Intensive Care Units (ICUs) is very limited and the practices for selecting patients for intensive care are not known. The aim of this study was to explore doctors' experiences and perceptions of ICU referral and admission processes in a university hospital in Tanzania. METHODS: We performed a qualitative study using semi-structured interviews with fifteen doctors involved in the recent care of critically ill patients in university hospital in Tanzania. Inductive conventional content analysis was applied for the analysis of interview notes to derive categories and sub-categories. RESULTS: Two main categories were identified, (i) difficulties with the identification of critically ill patients in the wards and (ii) a lack of structured triaging to the ICU. A lack of critical care knowledge and communication barriers were described as preventing identification of critically ill patients. Triaging to the ICU was affected by a lack of guidelines for admission, diverging ideas about ICU indications and contraindications, the lack of bed capacity in the ICU and non-medical factors such as a fear of repercussions. CONCLUSION: Critically ill patients may not be identified in general wards in a Tanzanian university hospital and the triaging process for the admission of patients to intensive care is convoluted and not explicit. The findings indicate a potential for improved patient selection that could optimize the use of scarce ICU resources, leading to better patient outcomes.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/métodos , Unidades de Terapia Intensiva/tendências , Encaminhamento e Consulta/normas , Adulto , Atitude do Pessoal de Saúde , Cuidados Críticos , Estado Terminal , Feminino , Recursos em Saúde , Hospitalização/tendências , Humanos , Unidades de Terapia Intensiva/normas , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Masculino , Seleção de Pacientes/ética , Médicos , Tanzânia , Triagem/métodos , Triagem/normas
2.
Radiol Med ; 124(12): 1199-1211, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31407223

RESUMO

BACKGROUND: There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. AIM: To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. MATERIALS AND METHODS: We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. RESULTS: WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). CONCLUSION: The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.


Assuntos
Serviço Hospitalar de Admissão de Pacientes , Doenças Assintomáticas , Achados Incidentais , Tomografia Computadorizada Multidetectores/métodos , Abdome/diagnóstico por imagem , Adulto , Distribuição por Idade , Idoso , Doenças Assintomáticas/epidemiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Neoplasias/diagnóstico por imagem , Neoplasias/epidemiologia , Doses de Radiação , Estudos Retrospectivos , Distribuição por Sexo , Coluna Vertebral/diagnóstico por imagem , Doenças Torácicas/diagnóstico por imagem , Tomografia Computadorizada Espiral
3.
Aust J Rural Health ; 27(1): 49-56, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30693995

RESUMO

OBJECTIVE: To identify the extent to which rurality influences the admission and mortality rates for acute circulatory complications among people with type 2 diabetes mellitus. DESIGN: Retrospective study. SETTING: All Victorian hospitals. PARTICIPANTS: State-wide hospital admissions from 1 July 2010 to 30 June 2015 using the Victorian Admitted Episodes Dataset. Data included patients with type 2 diabetes mellitus and diagnosis of acute cardiovascular events, acute cerebrovascular haemorrhage or infarction, acute peripheral vascular events or hypertensive diseases. MAIN OUTCOME MEASURE: Rates of admission and mortality were calculated for local government areas and Department of Health regions. Regression analysis identified the influence between admission rates and various predictor variables. RESULTS: In total, 5785 emergency hospital admissions occurred during the study period, with the highest and lowest mortality and admission rates occurring in rural areas. Moderately high admission rates were identified in urban areas. Cardiovascular events far outnumbered other acute circulatory admissions. Regression analysis identified a number of significant socioeconomic variables, primarily for metropolitan residents. Socioeconomic disadvantage was the only significant factor in rural areas. CONCLUSION: Victorian admission and mortality rates for acute circulatory complications are greatest in rural areas; yet, there is considerable heterogeneity in the admission rates within both rural and metropolitan areas. Furthermore, socioeconomic status is more influential than remoteness in determining emergency admissions. Further research needs to investigate the particular variables that lead to poorer outcomes rurally, investigate socioeconomic disadvantage in rural areas and have greater emphasis on peripheral vascular disease prevention.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Serviços de Saúde Rural/estatística & dados numéricos , Choque/etiologia , Choque/terapia , Serviços Urbanos de Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque/mortalidade , Classe Social , Vitória , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-30519461

RESUMO

Background: Nosocomial infections are among the most common complications in hospitals. A major part is caused by multidrug-resistant organisms (MDRO). MRSA is still the most prominent and frequent MDRO. The early detection of carriers of multidrug-resistant bacteria is an effective measure to reduce nosocomial infections caused by MDRO. For patients who are planning to go to the hospital, an outpatient screening for MDRO and pre-hospital decolonization is recommended. However, the effectiveness of such pre-admission MDRO management in preparation for a planned hospital stay has not yet been sufficiently scientifically examined from an economic perspective. Methods: A decision tree will be used to develop scenarios for MDRO screening and treatment in the context of the outpatient and inpatient sectors using MRSA-positive patients as an example. Subsequently, the expected costs for the respective strategy are presented. Results: The decision tree analysis shows that the expected costs of outpatient MRSA management are €8.24 and that of inpatient MRSA management are €672.51. Conclusion: The forward displacement of the MRSA screening to the ambulatory sector and any subsequent outpatient decolonization for patients with a planned hospitalization is the most cost-effective strategy and should become a standard benefit. Excluding opportunity costs, the expected costs of inpatient MRSA management are €54.94.


Assuntos
Análise Custo-Benefício , Custos e Análise de Custo , Pacientes Internados/educação , Programas de Rastreamento , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Pacientes Ambulatoriais/educação , Infecções Estafilocócicas/economia , Serviço Hospitalar de Admissão de Pacientes , Antibacterianos/uso terapêutico , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Árvores de Decisões , Farmacorresistência Bacteriana Múltipla , Hospitalização/economia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/economia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia
6.
Clin Biochem ; 61: 28-33, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30153433

RESUMO

INTRODUCTION: Low-density lipoprotein cholesterol (LDL) is an important risk factor for cardiovascular disease (CVD) and generally measured after 8-12 h fasting. However, some recent studies have pointed that non-fasting lipoproteins, especially LDL concentrations, are better indicators for demonstrating CVD risk and atherosclerosis. They asserted that nutrition is a negligible factor on changes in lipoprotein concentrations and claimed this difference as a result of hemodilution effect, caused from fluid intake and can be eliminated by applying some adjustments. We aimed to compare the fasting and non-fasting LDL values of the same individuals and discuss whether non-fasting and fasting LDL results can be used in place of each other, directly or after applying hemodilution correction models. MATERIAL AND METHODS: Fasting and non-fasting blood samples of 248 apparently healthy participants were collected. Lipid panel tests, albumin and hemoglobin levels were studied in each sample. Results were evaluated in seven different models which were recommended to correct the hemodilution effect on fasting and non-fasting lipid concentrations of the same individual. Concordance of fasting and non-fasting risk group of the individual were calculated according to the National Cholesterol Education Program classification. RESULTS: Fasting and non-fasting LDL and non-high density lipoprotein cholesterol (non-HDL) concentrations were significantly different in every model (p < 0.001). Concordance results of fasting and non-fasting LDL and non-HDL risk groups were 63.8% and 77.9% respectively. CONCLUSIONS: Our results demonstrated that fasting and non-fasting LDL and non-HDL concentrations could not be used in place of each other even when the results were adjusted for elimination of the hemodilution effect.


Assuntos
Doenças Assintomáticas , Doenças Cardiovasculares/sangue , Hemodiluição , Lipoproteínas LDL/sangue , Lipoproteínas/sangue , Programas de Rastreamento/métodos , Modelos Cardiovasculares , Serviço Hospitalar de Admissão de Pacientes , Adulto , Idoso , Doenças Assintomáticas/epidemiologia , Biomarcadores/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Jejum/sangue , Feminino , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Turquia/epidemiologia
7.
J Healthc Manag ; 63(3): e20-e30, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29734287

RESUMO

EXECUTIVE SUMMARY: While many aspects of patient care have transitioned to digital technology, the patient registration process often is still paper based. Several studies have examined the effects of changes in clinic workflows and appointment scheduling on patient satisfaction, but few have investigated changes from a paper-based to a paperless registration process. The authors measured patient and staff satisfaction before and after implementation of a new, tablet-based registration process at NYU Langone Health's Center for Women's Health in New York City. Mean preimplementation patient satisfaction scores on the six questions related to the registration process (1-5 scale, with 5 being the highest score) ranged from 4.0 to 4.5. Postimplementation satisfaction scores on the nine questions (six premeasure questions and three additional questions related to the tablet-based process) ranged from 4.4 to 4.6, with four of the six premeasures showing statistically significant improvement in patient satisfaction. Staff satisfaction was generally lower (2.8-3.6 preimplementation and 2.8-4 postimplementation), with no statistically significant difference between time frames. Patient satisfaction was relatively high under the paper registration process, and it improved significantly in some respects under the paperless process, while staff satisfaction did not change. The convenience and ease of use of a paperless registration system can help maintain or increase patient and staff satisfaction while introducing new workflows and improving the efficiency of the outpatient registration process. In adopting technology that can lead to changing workflows, organizations should train staff members and support them during the process.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/normas , Eficiência Organizacional , Registros Eletrônicos de Saúde/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Serviços de Saúde da Mulher/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Cidade de Nova Iorque , Satisfação do Paciente/legislação & jurisprudência , Adulto Jovem
8.
Public Health Res Pract ; 28(1)2018 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-29582041

RESUMO

OBJECTIVE: To analyse routinely collected data from a hospital database of drug health consultation-liaison (CL) assessments. We aimed to investigate changes in psychostimulant-related health service demand in an inner-city hospital to inform the development of locally appropriate models of care. METHODS: We used de-identified drug health CL service data from 2012 to 2015. Psychostimulant-related consultations and admissions were compared with opioid-related consultations and admissions over time, by sex and by ward type (medical units, mental health units or emergency department). RESULTS: The CL service collected information on 8800 consultations and 4405 hospital admissions from 2012 to 2015. Psychostimulant use was responsible for 684 (7.8%) consultations and 372 (8.4%) admissions. Opioids were related to 1914 (21.8%) consultations and 864 (19.6%) admissions. Psychostimulants were the subject of three times more consultations in 2015 than in 2012, and more than twice as many admissions. Time trend analysis showed a significant time effect for consultations and admissions relating to psychostimulants. Conversely, no significant changes were observed in consultations and admissions relating to opioids. CONCLUSION: This study identified a rapid rise in the demand for psychostimulant-related inpatient assessments, suggesting the use of these drugs has increased locally. Because of the impact on the public health system, there is a need to invest in and implement new treatment strategies and services for psychostimulant users.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Transtornos Mentais/tratamento farmacológico , Entorpecentes/uso terapêutico , Pacientes/estatística & dados numéricos , Adulto , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Curr Med Res Opin ; 34(7): 1201-1207, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-28918667

RESUMO

BACKGROUND AND OBJECTIVE: Global Influenza Hospital Surveillance Network is a worldwide initiative that aims to document the burden of influenza infections among acute admissions and vaccine effectiveness in particular countries. As a partner of this platform, we aimed to determine the frequency of influenza infections among acute admissions with influenza-like illness and the outcomes of enrolled patients during the 2015-2016 influenza season in selected hospitals in Turkey. PATIENTS AND METHODS: The investigators screened the hospital admission registries, chart review or available records, and screened all patients hospitalized in the previous 24-48 hours or overnight in the predefined wards or emergency room. A total of 1351 patients were screened for enrollment in five tertiary care referral hospitals in Ankara and 774 patients (57.3% of the initial screened population) were eligible for swabbing. All of the eligible patients who consented were swabbed and tested for influenza with real-time polymerase chain reaction (PCR) based methods. RESULTS: Overall, influenza positivity was detected in 142 patients (18.4%). The predominant influenza strain was A H1N1pdm09. Outcomes were worse among elderly patients, regardless of the presence of the influenza virus. Half of the patients over 65 years of age were admitted to the intensive care unit, while one third required any mode of mechanical ventilation and one fourth died in the hospital in that particular episode. CONCLUSION: These findings can guide hospitals to plan and prepare for the influenza season. Effective influenza vaccination strategies, particularly aimed at the elderly and adults with chronic diseases, can provide an opportunity for prevention of deaths due to influenza-like illness.


Assuntos
Serviço Hospitalar de Admissão de Pacientes , Doença Crônica , Hospitalização/estatística & dados numéricos , Influenza Humana , Serviço Hospitalar de Admissão de Pacientes/métodos , Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Idoso , Doença Crônica/epidemiologia , Doença Crônica/terapia , Feminino , Mortalidade Hospitalar , Humanos , Vacinas contra Influenza/uso terapêutico , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Vigilância da População , Sistema de Registros , Estações do Ano , Turquia/epidemiologia , Vacinação/métodos , Vacinação/estatística & dados numéricos
10.
J Spec Pediatr Nurs ; 22(3)2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28497613

RESUMO

PURPOSE: The aim of this study was to assess the effectiveness of a family-centered care (FCC) intervention provided by an advanced practice nurse (APN) for parents of children with profound disabilities undergoing surgery. DESIGN AND METHODS: In a quasi-experimental design, we used the MPOC-20 to assess satisfaction with FCC and interviews to identify potential mechanisms for improving satisfaction. RESULTS: There was a positive effect on the MPOC-20 domain "general information," albeit with a small effect size (Cohen's d = 0.35). The interviewed parents expected additional support. PRACTICE IMPLICATIONS: Emphasis should be placed on providing comprehensive care coordination by an experienced APN. Shared care management is crucial in improving FCC.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/métodos , Prática Avançada de Enfermagem/métodos , Artroplastia de Quadril/psicologia , Crianças com Deficiência/psicologia , Enfermagem Familiar/métodos , Pais/educação , Pais/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Comportamento do Consumidor , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Projetos Piloto , Relações Profissional-Família , Inquéritos e Questionários
11.
Br J Nurs ; 26(1): 60-61, 2017 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-28079414

RESUMO

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses how the law surrounding deprivation of liberty safeguards relates to a person who is the subject of a guardianship order.


Assuntos
Liberdade , Serviço Hospitalar de Admissão de Pacientes , Humanos , Tutores Legais , Transtornos Mentais
13.
Ig Sanita Pubbl ; 72(1): 27-37, 2016.
Artigo em Italiano | MEDLINE | ID: mdl-27077558

RESUMO

Natural disasters, such as the earthquake that occurred in the province of L'Aquila in central Italy, in 2009, generally increase the demand for healthcare. A survey was conducted to assess perception of health status an d use of health services in a sample of L'Aquila's resident population, five years after the event, and in a comparison population consisting of a sample of the resident population of Avezzano, a town in the same region, not affected by the earthquake. No differences were found in perception of health status between the two populations. Both groups reported difficulties in accessing specialized healthcare and rehabilitation services.


Assuntos
Depressão/epidemiologia , Desastres , Terremotos , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Adulto , Idoso , Antipsicóticos/uso terapêutico , Assistência à Saúde/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Reabilitação/estatística & dados numéricos , Inquéritos e Questionários
14.
Artigo em Inglês | MEDLINE | ID: mdl-27007384

RESUMO

A study on the relationships between ambient air pollutants (PM2.5, SO2 and NO2) and hospital emergency room visits (ERVs) for respiratory diseases from 2013 to 2014 was performed in both urban and suburban areas of Jinan, a heavily air-polluted city in Eastern China. This research was analyzed using generalized additive models (GAM) with Poisson regression, which controls for long-time trends, the "day of the week" effect and meteorological parameters. An increase of 10 µg/m³ in PM2.5, SO2 and NO2 corresponded to a 1.4% (95% confidence interval (CI): 0.7%, 2.1%), 1.2% (95% CI: 0.5%, 1.9%), and 2.5% (95%: 0.8%, 4.2%) growth in ERVs for the urban population, respectively, and a 1.5% (95%: 0.4%, 2.6%), 0.8% (95%: -0.7%, 2.3%), and 3.1% (95%: 0.5%, 5.7%) rise in ERVs for the suburban population, respectively. It was found that females were more susceptible than males to air pollution in the urban area when the analysis was stratified by gender, and the reverse result was seen in the suburban area. Our results suggest that the increase in ERVs for respiratory illnesses is linked to the levels of air pollutants in Jinan, and there may be some urban-suburban discrepancies in health outcomes from air pollutant exposure.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Insuficiência Respiratória/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Fatores Sexuais , Fatores Socioeconômicos , População Suburbana/estatística & dados numéricos , Fatores de Tempo , População Urbana/estatística & dados numéricos , Adulto Jovem
16.
J Orthop Trauma ; 30(2): 95-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26371621

RESUMO

OBJECTIVES: The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient. DESIGN: Retrospective. SETTING: Urban level 1 trauma center. PATIENTS/PARTICIPANTS: Six hundred fourteen geriatric hip fracture patients from 2000 to 2009. INTERVENTIONS: Orthopaedic surgery for geriatric hip fracture. MAIN OUTCOME MEASUREMENTS: Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service. RESULTS: Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients. CONCLUSIONS: This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient's expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient's expected LOS. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Tempo de Internação/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Serviços de Saúde para Idosos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Tennessee/epidemiologia
17.
Clin Nutr ESPEN ; 15: 114-121, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28531775

RESUMO

BACKGROUND AND AIMS: Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). METHODS: A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. RESULTS: In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. CONCLUSION: Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures.


Assuntos
Redução de Custos , Custos Hospitalares , Apoio Nutricional , Nutrição Parenteral Total/economia , Nutrição Parenteral Total/normas , Serviço Hospitalar de Admissão de Pacientes/economia , Dietoterapia , Fidelidade a Diretrizes , Hospitalização/economia , Hospitais , Humanos , Desnutrição/dietoterapia , Política Nutricional , Estado Nutricional , Equipe de Assistência ao Paciente
18.
Clin Med (Lond) ; 15(5): 486-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26430192

RESUMO

Alcohol-related hospital attendances and admissions continue to escalate despite a fall in alcohol consumption levels in the UK population overall. People with alcohol-related problems pose a significant and often disproportionate burden on acute medical services as their management is often complex and challenging. This article focuses on the management of alcohol intoxication, with particular emphasis on aggressive and possibly violent behaviour; alcohol withdrawal; fitting; and the prevention and treatment of Wernicke's encephalopathy.


Assuntos
Delirium por Abstinência Alcoólica/terapia , Intoxicação Alcoólica/terapia , Serviço Hospitalar de Admissão de Pacientes , Delirium por Abstinência Alcoólica/fisiopatologia , Serviço Hospitalar de Emergência , Humanos , Encefalopatia de Wernicke/terapia
19.
J Adv Nurs ; 71(12): 2799-810, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26315153

RESUMO

AIM: This study analysed historical healthcare records to investigate how women diagnosed with mania or psychosis and admitted to two mental health facilities in Australia following childbirth, were described in the late Victorian (1885-1895) and inter-war period (1925-1935). BACKGROUND: Although historians have examined the history of mental health systems in Australia, there is no published scholarship that considers the healthcare records of these women. This was a unique opportunity to explore these documents. DESIGN: An historical study examining healthcare records. The data collection occurred in 2012. METHODS: Women admitted to mental health facilities with a diagnosis of psychosis or mania were identified in the admission registers found in the State Record Office of New South Wales and, if available, their healthcare record was transcribed verbatim. The records were imported into NVivo 10 for content analysis to determine the range and scope of information. A further textual analysis was conducted to see if the woman's diagnosis was congruent with the outcome of her admission. RESULTS/FINDINGS: 155 cases were identified across the two periods. Although, demographic data and the description of the women on admission were remarkably similar, 17% of women were physically, rather than mentally, ill and died soon after admission. The findings demonstrate the importance of current practices such as taking a comprehensive healthcare assessment and the use of antibiotics and sanitary measures during labour and in the postnatal period. CONCLUSION: Historical investigations of healthcare records provide legitimacy for current healthcare practices.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/história , Transtorno Bipolar/história , Hospitais Psiquiátricos/história , Registros Médicos , Serviços de Saúde Mental/história , Parto/psicologia , Transtornos Psicóticos/história , Adulto , Feminino , História do Século XIX , História do Século XX , Humanos , New South Wales , Gravidez , Adulto Jovem
20.
Intern Med J ; 45(9): 916-24, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26109328

RESUMO

BACKGROUND: Hyperglycaemia has been associated with adverse outcomes in several different hospital populations. AIM: The aim of this study was to investigate the relationship between admission blood glucose level (BGL) and outcomes in all patients admitted through the emergency department. METHODS: This study was a retrospective observational cohort study from an Australian tertiary referral hospital. Patients admitted in the first week of each month from April to October 2012 had demographic data, co-morbidities, BGL, intensive care unit admission, length of stay and dates of death recorded. Factors associated with outcomes were assessed by multi-level mixed-effects linear regression. RESULTS: Admission BGL was recorded for 601 admissions with no diagnosis of diabetes and for 219 admissions diagnosed with type 2 diabetes (T2DM). In patients with no diagnosis of diabetes, admission BGL was associated with in-hospital and 90-day mortality (P < 0.001). After multivariate analysis, BGL greater than 11.5 mmol/L was significantly associated with increased mortality at 90 days (P < 0.05). In patients with T2DM increased BGL on admission was not associated with in-hospital or 90-day mortality but was associated with length of hospital stay (ß: 0.22 days/mmol/L; 95% confidence interval 0.09-0.35; P < 0.001), although this association was lost on multivariable analysis. In patients with T2DM, increased coefficient of variation of BGL was also positively associated with length of hospital stay in an almost dose-dependent fashion (P < 0.001). CONCLUSION: Admission BGL was independently associated with increased mortality in patients with no diagnosis of diabetes. Glycaemic variability was associated with increased length of hospital stay in patients with T2DM.


Assuntos
Serviço Hospitalar de Admissão de Pacientes/estatística & dados numéricos , Glicemia/metabolismo , Serviço Hospitalar de Emergência , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Hiperglicemia/mortalidade , Tempo de Internação/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperglicemia/sangue , Hiperglicemia/diagnóstico , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Tasmânia/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA