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1.
Medicine (Baltimore) ; 100(11): e25222, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33726019

RESUMEN

ABSTRACT: The reasons for readmission of children with Hirschsprung disease (HD) are multiple. The study aims to predict the relevant factors for the readmission of children with HD by collecting and analyzing the relevant data of the child's admission to the hospital at the time of surgery.A retrospective review was performed including all patients with surgical treatment of HD at our institution between the years of 2011 to 2020. Univariate and multivariate Logistic regression analysis were performed to obtain the independent risk factor for this study. The receiver operating characteristic curve (ROC) were used to assess the performance of derived models.A total of 162 patients were identified. The average presurgery weights were 6.93 ±â€Š1.78 kg in the readmission group and 8.38 ±â€Š3.17 kg in the non-readmission group. Six children were classified as a low-weight in the readmission group, and 11 children classified as low-weight in the non-readmission group. The length of the intestinal tube after resection was 25.25 ±â€Š15.21 cm in the readmission group, and 16.23 ±â€Š4.10 cm in the non-readmission group. The ROC for the prediction model of readmission after HD surgery (AUC = 0.811).In children undergoing the HD surgery, we showed preoperative low body weight and long intra-operative bowel resection significantly increase the probability of readmission due to complications.


Asunto(s)
Peso Corporal , Enfermedad de Hirschsprung/cirugía , Admisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Área Bajo la Curva , Femenino , Enfermedad de Hirschsprung/fisiopatología , Humanos , Lactante , Modelos Logísticos , Masculino , Tempo Operativo , Complicaciones Posoperatorias/etiología , Periodo Preoperatorio , Curva ROC , Estudios Retrospectivos , Factores de Riesgo
2.
N Z Med J ; 134(1530): 69-75, 2021 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-33651779

RESUMEN

Injury remains one of the leading causes of years of life lost worldwide. In 2015, the New Zealand Major Trauma Registry was developed to provide a comprehen-sive data registry within New Zealand for looking at the outcomes and determinants of major trauma. It has published yearly major trauma reports since its founding.


Asunto(s)
Grupo de Ascendencia Oceánica/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Heridas y Traumatismos/etnología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Hospitales , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Sistema de Registros , Estudios Retrospectivos , Heridas y Traumatismos/mortalidad , Adulto Joven
3.
Ulster Med J ; 90(1): 13-15, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33642628

RESUMEN

Introduction: Based in Belfast, the Royal Victoria Hospital is the only Major Trauma Centre in Northern Ireland. Due to the COVID-19 pandemic, on 23rd March 2020, Northern Ireland was placed into 'lockdown' with the majority of the population advised to "stay at home". The objective of this paper is to identify what effect the lockdown restrictions had on the workload of the Major Trauma Service at the Royal Victoria Hospital. Method: Patients were identified at the orthopaedic trauma meetings and from direct referral to the Major Trauma Service (MTS). Patients admitted and seen by the MTS from 23/03/20, the day lockdown was announced, to 29/05/20, when restrictions were partially lifted, were included in the analysis. Admissions data from this time period was then compared to admissions data from the same period in 2019 (23/03/19 - 29/05/19). Results: When comparing pre-lockdown and lockdown groups there was an overall decrease of 26% in admissions to the MTS (n=57 vs n=42). Road Traffic Accidents were reduced by 53% (n=31 vs n=15) and falls from >2m were reduced by 29% (n=21 vs n=15). Conclusion: Overall the number of admissions to the major trauma service was reduced during the lockdown period. A significant proportion of the reduction may be a result of social restrictions that reduced volume of traffic on Northern Irelands roads. Further study of future lockdowns and including admissions data of other MTCs in the UK would allow us to draw more robust conclusions.


Asunto(s)
/epidemiología , Pandemias , Admisión del Paciente/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Irlanda del Norte/epidemiología , Carga de Trabajo
4.
Lancet ; 397(10279): 1063-1074, 2021 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-33676597

RESUMEN

BACKGROUND: Azithromycin, an antibiotic with potential antiviral and anti-inflammatory properties, has been used to treat COVID-19, but evidence from community randomised trials is lacking. We aimed to assess the effectiveness of azithromycin to treat suspected COVID-19 among people in the community who had an increased risk of complications. METHODS: In this UK-based, primary care, open-label, multi-arm, adaptive platform randomised trial of interventions against COVID-19 in people at increased risk of an adverse clinical course (PRINCIPLE), we randomly assigned people aged 65 years and older, or 50 years and older with at least one comorbidity, who had been unwell for 14 days or less with suspected COVID-19, to usual care plus azithromycin 500 mg daily for three days, usual care plus other interventions, or usual care alone. The trial had two coprimary endpoints measured within 28 days from randomisation: time to first self-reported recovery, analysed using a Bayesian piecewise exponential, and hospital admission or death related to COVID-19, analysed using a Bayesian logistic regression model. Eligible participants with outcome data were included in the primary analysis, and those who received the allocated treatment were included in the safety analysis. The trial is registered with ISRCTN, ISRCTN86534580. FINDINGS: The first participant was recruited to PRINCIPLE on April 2, 2020. The azithromycin group enrolled participants between May 22 and Nov 30, 2020, by which time 2265 participants had been randomly assigned, 540 to azithromycin plus usual care, 875 to usual care alone, and 850 to other interventions. 2120 (94%) of 2265 participants provided follow-up data and were included in the Bayesian primary analysis, 500 participants in the azithromycin plus usual care group, 823 in the usual care alone group, and 797 in other intervention groups. 402 (80%) of 500 participants in the azithromycin plus usual care group and 631 (77%) of 823 participants in the usual care alone group reported feeling recovered within 28 days. We found little evidence of a meaningful benefit in the azithromycin plus usual care group in time to first reported recovery versus usual care alone (hazard ratio 1·08, 95% Bayesian credibility interval [BCI] 0·95 to 1·23), equating to an estimated benefit in median time to first recovery of 0·94 days (95% BCI -0·56 to 2·43). The probability that there was a clinically meaningful benefit of at least 1·5 days in time to recovery was 0·23. 16 (3%) of 500 participants in the azithromycin plus usual care group and 28 (3%) of 823 participants in the usual care alone group were hospitalised (absolute benefit in percentage 0·3%, 95% BCI -1·7 to 2·2). There were no deaths in either study group. Safety outcomes were similar in both groups. Two (1%) of 455 participants in the azothromycin plus usual care group and four (1%) of 668 participants in the usual care alone group reported admission to hospital during the trial, not related to COVID-19. INTERPRETATION: Our findings do not justify the routine use of azithromycin for reducing time to recovery or risk of hospitalisation for people with suspected COVID-19 in the community. These findings have important antibiotic stewardship implications during this pandemic, as inappropriate use of antibiotics leads to increased antimicrobial resistance, and there is evidence that azithromycin use increased during the pandemic in the UK. FUNDING: UK Research and Innovation and UK Department of Health and Social Care.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Azitromicina/uso terapéutico , Síndrome de Liberación de Citoquinas/prevención & control , Factores de Edad , Anciano , Anciano de 80 o más Años , Azitromicina/farmacología , /diagnóstico , Síndrome de Liberación de Citoquinas/inmunología , Síndrome de Liberación de Citoquinas/virología , Farmacorresistencia Bacteriana , Femenino , Humanos , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Factores de Riesgo , /aislamiento & purificación , Factores de Tiempo , Resultado del Tratamiento , Reino Unido
5.
Medicine (Baltimore) ; 100(10): e25010, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725881

RESUMEN

ABSTRACT: Chronic obstructive pulmonary disease (COPD) is still a constant threat to people's health. We aimed to identify the relationship between increased red cell distribution width (RDW) on admission and length of hospitalization in acute exacerbation of chronic obstructive pulmonary disease patients (AECOPD).Patients with AECOPD were recruited and divided into 3 groups based on RDW tertiles.Two hundred eighty six patients with AECOPD admitted to our department during January 1, 2017 and June 30, 2019 were enrolled in the study. According to the RDW tertiles (≤12.8%, 12.9% to 13.6%, >13.6%), the patients were divided into 3 groups. Length of stay was significantly related to RDW (P < .001) in AECOPD patients. Correlation analysis indicated that RDW was negatively associated with FEV1% predicted (r = -0.142, P = .016). However, RDW was positively associated with prolonged of stay (r = 0.298, P < .001) in AECOPD patients. Multivariate regression analysis discovered that RDW was independently associated with the length of hospitalization (P = .001). Receiver operating characteristic (ROC) curve showed that RDW was a good predictor of prolonged hospital stay in AECOPD patients, and the area under the curve (AUC) was 0.818 (95% CI: 0.769-0.868). The highest sensitivity to predict prolonged hospital stay was 83.8% and the specificity was 71.6% with the cut-off 13.35%.In conclusion, prolonged hospital stay in AECOPD patients was closely associated with increased RDW. Elevated RDW may be an independent predictor for prolonged hospitalization in AECOPD patients.


Asunto(s)
Índices de Eritrocitos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Brote de los Síntomas , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/sangre , Enfermedad Pulmonar Obstructiva Crónica/terapia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
6.
Medicine (Baltimore) ; 100(10): e25058, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725894

RESUMEN

ABSTRACT: Appropriate risk stratification and timely revascularization of acute myocardial infarction (AMI) are available in percutaneous coronary intervention (PCI) - capable hospitals (PCHs). This study evaluated whether direct admission vs inter-hospital transfer influences cardiac mortality in patients with AMI. This study was conducted in the PCH where the patients were able to arrive within an hour. The inclusion criteria were AMI with a symptom onset time within 24 hours and having undergone PCI within 24 hours after admission. The cumulative incidence of cardiac death after percutaneous coronary intervention was evaluated in the direct admission versus inter-hospital transfer groups. Among the 3178 patients, 2165 (68.1%) were admitted via inter-hospital transfer. Patients with ST-segment elevation myocardial infarction (STEMI) in the direct admission group had a reduced symptom onset-to-balloon time (121 minutes, P < .001). With a median period of 28.4 (interquartile range, 12.0-45.6) months, the cumulative incidence of 2-year cardiac death was lower in the direct admission group (NSTEMI, 9.0% vs 11.0%, P = .136; STEMI, 9.7% vs 13.7%, P = .040; AMI, 9.3% vs 12.3%, P = .014, respectively). After the adjustment for clinical variables, inter-hospital transfer was the determinant of cardiac death (hazard ratio, 1.59; 95% confidence interval, 1.08-2.33; P = .016). Direct PCH admission should be recommended for patients with suspected AMI and could be a target for reducing cardiac mortality.


Asunto(s)
Hospitales/estadística & datos numéricos , Infarto del Miocardio sin Elevación del ST/cirugía , Intervención Coronaria Percutánea/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/cirugía , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/mortalidad , Admisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/mortalidad , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricos , Resultado del Tratamiento
7.
Eur J Anaesthesiol ; 38(4): 335-343, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33534266

RESUMEN

BACKGROUND: Mortality among patients admitted to intensive care units (ICUs) with COVID-19 is unclear due to variable follow-up periods. Few nationwide data are available to compare risk factors, treatment and outcomes of COVID-19 patients after ICU admission. OBJECTIVE: To evaluate baseline characteristics, treatments and 30-day outcomes of patients admitted to Swedish ICUs with COVID-19. DESIGN: Registry-based cohort study with prospective data collection. SETTING: Admissions to Swedish ICUs from 6 March to 6 May 2020 with laboratory confirmed COVID-19 disease. PARTICIPANTS: Adult patients admitted to Swedish ICUs. EXPOSURES: Baseline characteristics, intensive care treatments and organ failures. MAIN OUTCOMES AND MEASURES: The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and death. RESULTS: We identified 1563 patients with complete 30-day follow-up. The 30-day all-cause mortality was 26.7%. Median age was 61 [52 to 69], Simplified Acute Physiology Score III (SAPS III) was 53 [46 to 59] and 62.5% had at least one comorbidity. Median PaO2/FiO2 on admission was 97.5 [75.0 to 140.6] mmHg, 74.7% suffered from moderate-to-severe acute respiratory failure. Age, male sex [adjusted odds ratio (aOR) 1.5 (1.1 to 2.2)], SAPS III score [aOR 1.3 (1.2 to 1.4)], severe respiratory failure [aOR 3.0 (2.0 to 4.7)], specific COVID-19 pharmacotherapy [aOR 1.4 (1.0 to 1.9)] and continuous renal replacement therapy [aOR 2.1 (1.5 to 3.0)] were associated with increased mortality. Except for chronic lung disease, the presence of comorbidities was not independently associated with mortality. CONCLUSIONS: Thirty-day mortality rate in COVID-19 patients admitted to Swedish ICUs is generally lower than previously reported despite a severe degree of hypoxaemia on admission. Mortality was driven by age, baseline disease severity, the presence and degree of organ failure, rather than pre-existing comorbidities. TRIAL REGISTRATION NO: NCT04462393.


Asunto(s)
/terapia , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , /aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , /mortalidad , Estudios de Cohortes , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Suecia/epidemiología
8.
Medicine (Baltimore) ; 100(4): e24360, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530230

RESUMEN

ABSTRACT: The relationship regarding time of percutaneous coronary intervention (PCI) and clinical outcomes in patients with acute myocardial infarction (AMI) treated within the left main coronary artery (LMCA) is less investigated compared to the overall group of patients with AMI.Therefore, we aimed to assess the relationship between time of PCI (day- vs night-time) and overall mortality rate in patients treated due to AMI within the LMCA.This cross-sectional study included 443,805 AMI patients hospitalized between 2006 and 2018 enrolled in the Polish Registry of Acute Coronary Syndromes. We extracted 5,404 patients treated within the LMCA. The number of patients were treated during daytime hours (7:00 am-10:59 pm) was 2809 while 473 patients underwent treatment during night-time hours (11:00 pm-6:59 am). Differences in cardiac mortality rates between night- and day-hours among patients treated with PCI during the follow-up period were assessed via the Kaplan-Meier method.The 30-day (20.3% vs 14.9%, P = .003) and 12-month (31.7% vs 26.2%, P = .001) overall mortality rates were significantly greater among patients treated during night-time, which was confirmed by comparison using Kaplan-Maier survival curves (P = .001). The time of PCI was not found among predictors of survival in multiple regression analysis (hazard ratio: 1.22; 95% confidence interval: 0.96-1.55, P = .099).Patients treated during night-time in comparison to the day-time are related to higher in-hospital, 30-day and 12-month mortality. This is probably largely a consequence that the night-time, in comparison to the day-time, of treatment of patients with AMI with PCI within the LMCA is and indicator of higher comorbidity and clinical acuity of patients undergoing therapy. Therefore, the night-time was not found to be an independent predictor of greater mortality rate during the 12-months follow-up period.


Asunto(s)
Vasos Coronarios/cirugía , Infarto del Miocardio/mortalidad , Admisión del Paciente/estadística & datos numéricos , Intervención Coronaria Percutánea/mortalidad , Factores de Tiempo , Atención Posterior/estadística & datos numéricos , Anciano , Estudios Transversales , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/cirugía , Intervención Coronaria Percutánea/métodos , Polonia , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Sistema de Registros , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento
11.
Int J Qual Health Care ; 33(1)2021 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-33620065

RESUMEN

BACKGROUND: The effects of an early and prolonged lockdown during the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular intensive care units (CICUs) are not well established. OBJECTIVES: This study analyses patterns of admission, mortality and performance indicators in a CICU before and during the Argentine lockdown in the COVID-19 pandemic. METHODS: This is a retrospective observational cross-sectional study of all consecutive patients aged 18 years or more admitted to the cardiac intensive care unit at a high-volume reference hospital in Buenos Aires, Argentina, comparing hospitalization rates, primary causes of admission, inpatient utilization indicators, pharmacy supplies' expenditures and in-hospital mortality between 5 March and 31 July 2020, with two corresponding control periods in 2019 and 2018. RESULTS: We included 722 female patients [mean age of 61.6 (SD 15.5) years; 237 (32.8%)]. Overall hospitalizations dropped 53.2% (95%CI: 45.3, 61.0%), from 295.5 patients/year over the periods 2018/2019 to 137 patients in 2020. Cardiovascular disease-related admissions dropped 59.9%, while admission for non-cardiac causes doubled its prevalence from 9.6% over the periods 2018/2019 to 22.6% in the study period (P < 0.001).In the period 2020, the bed occupancy rate fell from 82.2% to 77.4%, and the bed turnover rate dropped 50% from 7.88 to 3.91 monthly discharges/bed. The average length of stay doubled from 3.26 to 6.75 days, and the turnover interval increased from 3.8 to 8.39 days in 2020.Pharmacy supplies' expenditures per discharge increased 134% along with a rise in antibiotics usage from 6.5 to 11.4 vials/ampoules per discharge (P < 0.02).Overall mortality increased from 7% (n = 41) to 13.9% (n = 19) (P = 0.008) at the expense of non-cardiac-related admissions (3.6-19.4%, P = 0.01). CONCLUSIONS: This study found a significant reduction in overall and cardiovascular disease-related causes of admission to the cardiac intensive care unit, worse performance indicators and increased in-hospital mortality along the first 5 months of the early and long-lasting COVID-19 lockdown in Argentina. These results highlight the need to foster public awareness concerning the risks of avoiding hospital attendance. Moreover, health systems should follow strict screening protocols to prevent potential biases in the admission of patients with critical conditions unrelated to the COVID-19 pandemic.


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Unidades de Cuidados Intensivos/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Argentina/epidemiología , Ocupación de Camas/estadística & datos numéricos , Estudios Transversales , Femenino , Política de Salud , Mortalidad Hospitalaria/tendencias , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias , Servicio de Farmacia en Hospital/economía , Servicio de Farmacia en Hospital/estadística & datos numéricos , Estudios Retrospectivos
12.
Seizure ; 86: 16-18, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33515905

RESUMEN

OBJECTIVE: The aim of the current study was to investigate whether seizure is among the presenting manifestations of COVID-19. METHODS: All patients referred to emergency rooms anywhere in Iran between 12 and 25 April 2020 and who were sufficiently ill to require hospital admission with COVID-19, confirmed by a positive COVID-19 test, were studied. Data on the presenting manifestations were collected. RESULTS: Of 5872 people, who were admitted to hospitals in Iran with COVID-19 during the study period, 45 came to the emergency room with seizures. This makes seizure as the presenting manifestation of COVID-19 in 0.8 % of all patients with a severe illness. 93 % of the patients were 15 years of age and older. Four of the individuals presenting with seizures (9%) had a past history of epilepsy. Fifteen of these individuals (33 %) had other chronic medical conditions (e.g., cancer, diabetes mellitus, heart disease, etc.). CONCLUSION: This case series provides evidence that seizures are among the presenting manifestations of COVID-19 in 0.8 % of the patients who are admitted to hospital due to a severe illness.


Asunto(s)
/complicaciones , Convulsiones/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , /terapia , Niño , Preescolar , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Lactante , Irán/epidemiología , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Convulsiones/epidemiología , Convulsiones/terapia , Adulto Joven
13.
Am J Infect Control ; 49(3): 281-285, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33428982

RESUMEN

BACKGROUND: The proportion of positive patients admitted to acute-care hospitals for reasons other than coronavirus disease-19 (COVID-19) is unknown. These patients potentially put other patients and healthcare workers at risk of infection. OBJECTIVE: The objective of this study was to define the proportion of asymptomatic patients admitted with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Secondary objectives were to define the positivity rate, reasons for admission, and the geographic distribution in the region. METHODS: Universal surveillance testing for SARS-CoV-2 was performed on patients admitted to this hospital over a 12-week period from April 9, 2020 to July 1, 2020. Positive patients were categorized as either symptomatic or asymptomatic as defined by the 11 criteria per the Centers for Disease Control and Prevention. The positivity rate, proportion with and without symptoms, reasons for admission, and geographic distribution in the region were recorded. RESULTS: The positivity rate ranged from 0.8% to 6.2%. The proportion of asymptomatic patients with SARS-CoV-2 was 37%. Asymptomatic patients primarily presented to the hospital because of either trauma or labor. Some clusters in the region were identified of both symptomatic and asymptomatic patients. CONCLUSIONS: The proportion of asymptomatic patients admitted with SARS-CoV-2 was significant. Identifying and isolating asymptomatic patients likely prevented exposure and development of hospital-acquired COVID-19 cases among healthcare workers and other patients, supporting the universal surveillance of all admitted patients.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Admisión del Paciente/estadística & datos numéricos , Vigilancia de la Población/métodos , Adulto , Infección Hospitalaria/prevención & control , Infección Hospitalaria/virología , Femenino , Humanos , Control de Infecciones/métodos , Control de Infecciones/estadística & datos numéricos , Kentucky/epidemiología , Masculino , Persona de Mediana Edad
16.
PLoS One ; 16(1): e0240385, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33439890

RESUMEN

BACKGROUND: With the proposed pathophysiologic mechanism of neurologic injury by SARS CoV-2, the frequency of stroke and henceforth the related hospital admissions were expected to rise. This paper investigated this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic. METHODS: This is a retrospective analysis of stroke admissions in a 100-bed stroke unit at the National Institute of Neurosciences and Hospital (NINS&H) which is considerably a large stroke unit. All the admitted cases from 1 January to 30 June 2020 were considered. Poisson regression models were used to determine whether statistically significant changes in admission rates can be found before and after 25 March since when there is a surge in COVID-19 infections. RESULTS: A total of 1394 stroke patients took admission in the stroke unit during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger. The male to female ratio is 1.06:1. From January to March 2020, the mean rate of admission was 302.3 cases per month, which dropped to 162.3 cases per month from April to June, with an overall reduction of 46.3% in acute stroke admission per month. In those two periods, reductions in average admission per month for ischemic stroke (IST), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and venous stroke (VS) were 45.5%, 37.2%, 71.4% and 39.0%, respectively. Based on weekly data, results of Poisson regressions confirm that the average number of admissions per week dropped significantly during the last three months of the sample period. Further, in the first three months, a total of 22 cases of hyperacute stroke management were done, whereas, in the last three months, there was an 86.4% reduction in the number of hyperacute stroke patients getting reperfusion treatment. Only 38 patients (2.7%) were later found to be RT-PCR SARS Cov-2 positive based on nasal swab testing. CONCLUSION: This study revealed a more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. Whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement or stay-home measures remains unknown.


Asunto(s)
/epidemiología , Hospitales/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Accidente Cerebrovascular/terapia , Adulto , Bangladesh/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos
17.
Emerg Infect Dis ; 27(2): 404-410, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33395382

RESUMEN

Switzerland began a national lockdown on March 16, 2020, in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed the prevalence of SARS-CoV-2 infection among patients admitted to 4 hospitals in the canton of Zurich, Switzerland, in April 2020. These 4 acute care hospitals screened 2,807 patients, including 2,278 (81.2%) who did not have symptoms of coronavirus disease (COVID-19). Overall, 529 (18.8%) persons had >1 symptom of COVID-19, of whom 60 (11.3%) tested positive for SARS-CoV-2. Eight asymptomatic persons (0.4%) also tested positive for SARS-CoV-2. Our findings indicate that screening on the basis of COVID-19 symptoms, regardless of clinical suspicion, can identify most SARS-CoV-2-positive persons in a low-prevalence setting.


Asunto(s)
/estadística & datos numéricos , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Precauciones Universales/estadística & datos numéricos , Adulto , Anciano , /prevención & control , Pruebas Diagnósticas de Rutina/métodos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Suiza/epidemiología , Precauciones Universales/métodos
18.
Am J Nurs ; 121(2): 46-52, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33497127

RESUMEN

PURPOSE: The purpose of this project was to examine whether initiating a standardized pressure injury (PI) assessment and prevention protocol early in adult patients' ED stay reduces hospital-acquired PIs (HAPIs) in those patients admitted from the ED to acute care inpatient medical units. METHODS: A nurse-led evidence-based practice team studied the problem of increasing HAPIs on four acute care inpatient units and found that, among patients who had been admitted to inpatient care from the ED, longer ED boarding times correlated with a higher rate of HAPIs. ED staff and acute care unit nurses collaborated to develop new protocols to prevent HAPIs in the ED, including staff education and standardized assessments and prevention care for at-risk patients. Data collection was performed at three time periods over approximately two and a half years: baseline, intervention, and postintervention. RESULTS: The incidence rate for HAPIs decreased from 3.56 per 1,000 patient-days at baseline to 1.31 per 1,000 patient-days during the intervention period. This reduction was sustained over the next five months, during which the HAPI incidence rate was 1.53 per 1,000 patient-days. IMPLICATIONS: At a time when ED length of stay is difficult to manage and continues to increase, the use of evidence-based interventions and protocols can reduce the rate of PIs in high-risk patients waiting for hospital admission, leading to a reduction in PI rates and overall hospital costs.


Asunto(s)
Admisión del Paciente/normas , Úlcera por Presión/prevención & control , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , California , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Enfermedad Iatrogénica/prevención & control , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos
20.
Neurol Sci ; 42(2): 445-453, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33394194

RESUMEN

BACKGROUND: Some previous reports have shown a reduced number of admission in stroke cases during the coronavirus disease 2019 (COVID-19) pandemic period. The present study aimed to investigate this changing pattern and the potential causes behind it at an academic neurology and neurosurgery center in Iran. METHODS: Patients admitted to our center with the diagnosis of ischemic and hemorrhagic stroke, between March 1, 2019, Jun 1, 2019, and the similar 3-month period in 2020 (COVID-19 pandemic period), were compared in terms of clinical characteristics and outcome. Poisson regression was also conducted to assess the correlation between daily admissions and the COVID-19 pandemic period. RESULTS: A total of 210 patients with stroke (ischemic and hemorrhagic) in 2019 were compared with 106 patients in 2020. COVID-19 pandemic period was significantly associated with the decline in the number of daily admissions in ischemic stroke (IRR, 0.51 [95% CI, 0.4-0.64]). A significant reduction (P = 0.003) in time from onset to arrival at hospital from median 12 h [IQR, 5-32] in 2019 to median 6 h [IQR, 4-16] in 2020 was found in ischemic stroke cases. National Institute of Health Stroke Scale (NIHSS) was significantly increased (P < 0.001) from median 4 [IQR, 2-7] in 2019 to median 9 [IQR, 4-14] in 2020. Glasgow coma scale (GCS) was significantly decreased from 13.9 (SD, 2) in 2019 to 12.8 (SD, 2.9) in 2020 (P < 0.001). CONCLUSIONS: The present study provided new pieces of evidence regarding the changed pattern of hospital admission in stroke especially the possible reasons for its decline.


Asunto(s)
Centros Médicos Académicos/estadística & datos numéricos , /terapia , Admisión del Paciente/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Escala de Coma de Glasgow , Humanos , Irán/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
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