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1.
J Forensic Leg Med ; 69: 101887, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32056804

RESUMEN

BACKGROUND: Few studies address the demographics/epidemiology of patients presenting to emergency departments (ED) for evaluation of sexual assault across an entire nation. It was the purpose of this study to analyze the demographics of sexual assault using a national data base. METHODS: This was a retrospective study of prospectively collected data from National Electronic Injury Surveillance System - All Injury Program for years 2005-2013. Patients presenting for sexual assault were analyzed. Descriptive and logistic regression statistical analyses were performed with SUDAAN 11.0.01™ software. A p < 0.05 was considered statistically significant. RESULTS: Sexual assault accounted for an estimated 657,719 ED visits (0.24% of all injuries, and 3.4% of injuries due to violence). When an assault victim presented to the ED, a sexual assault was most likely when the patient was 0-14 years old (OR = 19.48 [12.02, 31.57]), White (OR = 2.12 [1.30, 3.47]), the perpetrator being a stranger (OR = 10.51 [8.21, 13.46]), and occurring at home (OR = 10.05 [6.61, 15.27]). The average annual incidence of ED visits for sexual assault per 10,000 US population was 2.39; 0.47 for males and 4.92 for females. The average was 19.6 years; 90.3% were female. Assaults occurred in the home in 45.6%, and were more common in the summer. The perpetrator was unknown in 37.5%, a friend/acquaintance in 24.8%, other relative in 9.4%, multiple perpetrators in 9.3%, spouse/partner in 6.8%, with the remaining 12.7% from other groups. Racial composition was White in 60.9%, Black in 25.9%, Amerindian in 12.5%, and Asian in 0.5%. The perpetrator was a close relative nearly twice as frequently for male victims compared to female victims. Hospital admission overall was 2.7%: 7.1% when the assault occurred on the street, 1.8% when at school or sporting locations, 4.9% for males and 1.5% for females. Nearly all (98.2%) extremity injuries occurred in females. CONCLUSIONS: Sexual assaults account for 4.4% of ED visits for violence. There was a decrease in the number of sexual assaults occurring on the street and at school/sporting locations over time while the number of assaults by strangers increased. For males, 54.1% occurred in those <10 years of age. The differences between patients by demographic and event characteristics is important information for health care providers.


Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Vigilancia en Salud Pública , Estudios Retrospectivos , Distribución por Sexo , Estados Unidos/epidemiología , Heridas y Traumatismos/epidemiología , Adulto Joven
2.
West Afr J Med ; 37(1): 67-73, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030715

RESUMEN

OBJECTIVE: The purpose of this study was to examine trends in clinical characteristics and in-hospital mortality of HIV patients in a low resource setting in the period 2010 to 2016. METHODS: Data on socio-demographic and clinical characteristics of 313 hospitalized HIV positive patients at the University College Hospital, Ibadan, Nigeria were retrospectively extracted, described and examined for trends. Factors independently associated with mortality were identified using multiple logistic regression. RESULTS: The mean age was 39 years (SD = 9.8) and about two thirds were female. The proportion of females decreased significantly from 83.3% in 2010-2011 to 39.8% in 2016. There was a significant reduction in the diagnosis of disseminated tuberculosis and mortality from 19.4% and 42.9% in 2010-2011 to 4.8% and 27.9% in 2016 respectively. On multiple logistic regression, being male, having neurological features, meningitis, and shorter stay in hospital had significantly higher odds of mortality. CONCLUSION: There was a reduction in in-hospital mortality of HIV patients over the period from 2010 to 2016. Being male and presence of neurological features were associated with mortality. Larger prospective studies are needed to further investigate this observed reduction in mortality among hospitalised patients.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones por VIH/tratamiento farmacológico , Pacientes Internos/estadística & datos numéricos , Mortalidad/tendencias , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Adolescente , Adulto , Fármacos Anti-VIH/administración & dosificación , Femenino , Infecciones por VIH/mortalidad , Hospitales de Enseñanza , Hospitales Universitarios , Humanos , Tiempo de Internación , Masculino , Meningitis/complicaciones , Meningitis/mortalidad , Persona de Mediana Edad , Nigeria/epidemiología , Admisión del Paciente/estadística & datos numéricos , Admisión del Paciente/tendencias , Estudios Retrospectivos , Distribución por Sexo , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/mortalidad , Adulto Joven
3.
JAMA Netw Open ; 3(1): e1919954, 2020 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-31995214

RESUMEN

Importance: The number of patients presenting to emergency departments (EDs) for psychiatric care continues to increase. Psychiatrists often make a conservative recommendation to admit patients because robust outpatient services for close follow-up are lacking. Objective: To assess whether the availability of a 45-day behavioral health-virtual patient navigation program decreases hospitalization among patients presenting to the ED with a behavioral health crisis or need. Design, Setting, and Participants: This randomized clinical trial enrolled 637 patients who presented to 6 EDs spanning urban and suburban locations within a large integrated health care system in North Carolina from June 12, 2017, through February 14, 2018; patients were followed up for up to 45 days. Eligible patients were aged 18 years or older, with a behavioral health crisis and a completed telepsychiatric ED consultation. The availability of the behavioral health-virtual patient navigation intervention was randomly allocated to specific days (Monday through Friday from 7 am to 7 pm) so that, in a 2-week block, there were 5 intervention days and 5 usual care days; 323 patients presented on days when the program was offered, and 314 presented on usual care days. Data analysis was performed from March 7 through June 13, 2018, using an intention-to-treat approach. Interventions: The behavioral health-virtual patient navigation program included video contact with a patient while in the ED and telephonic outreach 24 to 72 hours after discharge and then at least weekly for up to 45 days. Main Outcomes and Measures: The primary outcome was the conversion of an ED encounter to hospital admission. Secondary outcomes included 45-day follow-up encounters with a self-harm diagnosis and postdischarge acute care use. Results: Among 637 participants, 358 (56.2%) were men, and the mean (SD) age was 39.7 (16.6) years. The conversion rates were 55.1% (178 of 323) in the intervention group vs 63.1% (198 of 314) in the usual care group (odds ratio, 0.74; 95% CI, 0.54-1.02; P = .06). The percentage of patient encounters with follow-up encounters having a self-harm diagnosis was significantly lower in the intervention group compared with the usual care group (36.8% [119 of 323] vs 45.5% [143 of 314]; P = .03). Conclusions and Relevance: Although the primary result did not reach statistical significance, there is a strong signal of potential positive benefit in an area that lacks evidence, suggesting that there should be additional investment and inquiry into virtual behavioral health programs. Trial Registration: ClinicalTrials.gov identifier: NCT03204643.


Asunto(s)
Terapia Conductista/métodos , Servicio de Urgencia en Hospital , Trastornos Mentales/terapia , Admisión del Paciente/estadística & datos numéricos , Telemedicina/organización & administración , Adulto , Medicina de la Conducta/métodos , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , North Carolina , Automanejo/educación , Resultado del Tratamiento , Adulto Joven
4.
Ann R Coll Surg Engl ; 102(1): 36-42, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31660752

RESUMEN

INTRODUCTION: The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS: We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS: There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS: Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.


Asunto(s)
Educación de Postgrado en Medicina/métodos , Cirugía General/educación , Admisión del Paciente/estadística & datos numéricos , Traumatología/educación , Heridas y Traumatismos/etiología , Adulto , Anciano , Anciano de 80 o más Años , Inglaterra , Femenino , Hospitales de Alto Volumen , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Admisión y Programación de Personal/organización & administración , Admisión y Programación de Personal/estadística & datos numéricos , Estudios Retrospectivos , Horario de Trabajo por Turnos/estadística & datos numéricos , Factores de Tiempo , Centros Traumatológicos/organización & administración , Centros Traumatológicos/estadística & datos numéricos , Gales , Lugar de Trabajo/organización & administración , Lugar de Trabajo/estadística & datos numéricos , Heridas y Traumatismos/cirugía
5.
J Surg Res ; 246: 153-159, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31586889

RESUMEN

BACKGROUND: Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS). MATERIALS AND METHODS: We performed a retrospective cohort study at two level I pediatric trauma centers. INCLUSION CRITERIA: <15 y old with blunt or penetrating injury. We used univariate and multivariate logistic regression analyses to determine associations between trauma activation, ED length of stay (LOS), and hospital LOS with demographic and clinical characteristics. RESULTS: We identified 1161 patients: 40.1% arrived by self-transport and 59.9% by EMS. Self-transport patients were less likely to have an abnormal Glasgow Coma Scale score < 15 (2.1% versus 22.0%, P < 0.001) and Injury Severity Score > 15 (2.4% versus 11.7%, P < 0.001). Trauma activation was initiated in 52.5% of patients, occurring less often in self-transport than EMS patients (2.4% versus 86.2%, P < 0.001). Trauma activation rate was negatively associated with arrival by self-transport (odds ratio [OR] 0.001, 95% CI 0.00-0.003), positively associated with Glasgow Coma Scale <15 (OR 25.9, 95% CI 6.6-101.2) and site (OR 15.4, 95% CI 6.3-37.5) but not with Injury Severity Score >15 (OR 2.8, 95% CI 0.8-9.2). Self-transport arrival was associated with longer ED LOS (estimated regression slope 0.47, 95% CI 0.13-0.82). CONCLUSIONS: Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.


Asunto(s)
Transporte de Pacientes/estadística & datos numéricos , Centros Traumatológicos/organización & administración , Triaje/organización & administración , Heridas no Penetrantes/diagnóstico , Heridas Penetrantes/diagnóstico , Niño , Preescolar , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Utilización de Instalaciones y Servicios/organización & administración , Utilización de Instalaciones y Servicios/normas , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/estadística & datos numéricos , Masculino , Admisión del Paciente/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Centros Traumatológicos/normas , Centros Traumatológicos/estadística & datos numéricos , Triaje/normas , Triaje/estadística & datos numéricos , Estados Unidos , Heridas no Penetrantes/terapia , Heridas Penetrantes/terapia
6.
Arch Dis Child Fetal Neonatal Ed ; 105(1): 50-55, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31123055

RESUMEN

OBJECTIVE: Higher rates of neonatal morbidity and mortality at term combined with earlier spontaneous delivery have led to the hypothesis that babies born to South Asian born (SA-born) women may mature earlier and/or their placental function decreases earlier than babies born to Australian and New Zealand born (Aus/NZ-born) women. Whether babies born to SA-born women do better in the preterm period, however, has yet to be evaluated. In this study we investigated respiratory outcomes, indicative of functional maturity, of preterm babies born to SA-born women compared with those of Aus/NZ-born women to explore this hypothesis further. STUDY DESIGN AND SETTING: This retrospective cohort study was conducted at Monash Health. PATIENTS: Data were collected from neonatal and birth records of moderate-late preterm (32-36 weeks) infants born between 2012 and 2015 to SA-born and Aus/NZ-born women. OUTCOME MEASURES: Rates of nursery admissions and neonatal respiratory outcomes were compared. RESULTS: Babies born to Aus/NZ-born women were more likely to be admitted to a nursery (80%) compared with SA-born babies (72%, p=0.004). Babies born to SA-born mothers experienced significantly less hyaline membrane disease (7.8%), required less resuscitation at birth (28.6%) and were less likely to require ventilation (20%) than babies born to Aus/NZ-born mothers (18%, 42.2%, 34.6%; p<0.001). There was no difference in the duration of ventilation or length of stay in hospital. CONCLUSIONS: Moderate-late preterm babies born to SA-born women appear to have earlier functional maturity, as indicated by respiratory outcomes, than Aus/NZ-born babies. Our findings support the hypothesis of earlier fetal maturation in SA-born women.


Asunto(s)
Grupo de Ascendencia Continental Asiática , Grupo de Ascendencia Continental Europea , Enfermedad de la Membrana Hialina/epidemiología , Nacimiento Prematuro , Resucitación/estadística & datos numéricos , Adulto , Asia Sudoriental/etnología , Australia , Peso al Nacer , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Glucocorticoides/uso terapéutico , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Madres , Nueva Zelanda , Admisión del Paciente/estadística & datos numéricos , Atención Prenatal , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos
7.
J Surg Res ; 245: 13-21, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31394403

RESUMEN

BACKGROUND: Geriatric trauma patients who require an unplanned ICU admission (UIA) may experience worse outcomes. As such, the American College of Surgeons initiated the Trauma Quality Improvement Program which tracks UIA as a quality benchmark. We sought to determine the overall rate and impact of UIA in our geriatric trauma population and to identify predictive risk factors. METHODS: All geriatric trauma patients (≥65) admitted to an urban, level I trauma center from January 2012 to June 2018 were identified. A retrospectively collected administrative database was queried for demographics, comorbidities, injury characteristics, and outcomes. UIA were identified and medical records were queried. Univariate analysis followed by binary logistic regression analysis were performed (P < 0.05 = significant). RESULTS: Of the 2923 geriatric patients identified, 95 (3.3%) patients experienced UIA, most commonly secondary to respiratory (34.7%) and cardiac (22.1%) events. Patients with UIA were older (81 versus 78, P = 0.04), and had higher injury severity score (10 versus 9, P < 0.01) and Charlson comorbidity indices (5 versus 4, P = 0.02). On logistic regression, age (OR 1.027, P = 0.04) and injury severity score (OR 1.032, P < 0.01) were predictive of unplanned ICU admission. Of the UIA, 69.4% were readmissions, or "bounce backs". Patients initially admitted to the ICU had 2.5 increased odds of requiring UIA. Patients with UIA experienced longer hospital stays (15 versus 5, P < 0.01), more days in the ICU (6 versus 1, P < 0.01), and higher rates of mortality (11.6% versus 5.0%, P = 0.02). CONCLUSIONS: Despite relatively low injury severity, geriatric trauma patients requiring UIA have a significant increase in morbidity and mortality. Those initially admitted to the ICU are at especially high risk for UIA, suggesting the benefit of strategies to provide an extra layer of care post-ICU.


Asunto(s)
Unidades de Cuidados Intensivos/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Heridas y Traumatismos/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/estadística & datos numéricos , Masculino , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Centros Traumatológicos/estadística & datos numéricos , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/epidemiología
8.
Support Care Cancer ; 28(1): 341-349, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31044309

RESUMEN

PURPOSE: This study analysed nutritional parameters (baseline body mass index (BMI), weight changes and enteral nutrition (EN) use, and their association with hospital admissions during radiotherapy in patients with head and neck cancer (HNC)). METHODS: A retrospective review of patients diagnosed with HNC and treated with radiotherapy between October 2012 and April 2014 was conducted. Data on each subject's diagnosis, age, sex, chemotherapy, previous surgery, EN use, weight changes, and BMI were examined for their association with hospital admissions during treatment. RESULTS: Eighty-three patients were included, mean age (±standard deviation) = 61 (± 11 years). Thirty-four percent had self-reported weight loss at diagnosis, and mean BMI was 26.2 ± 5.3 kg/m2. Mean weight change during treatment was - 5.1 ± 6.2%. Ten patients used EN, with mean weight stabilisation during EN use (0.3 ± 5.1%). Higher presenting BMI, younger age, and definitive radiotherapy ± chemotherapy predicted greater weight loss (p < 0.05). Critical weight loss ≥ 5% was associated with a higher number of hospital admissions for nutrition reasons (n = 10) (p = 0.011) compared with those without critical weight loss (n = 2). EN use was associated with a higher number of nutrition-related admissions; however, it did not predict length of stay among those admitted. CONCLUSION: Critical weight loss during radiotherapy was associated with unplanned nutrition-related hospital admissions. Higher BMI was associated with greater weight loss during radiotherapy, whilst EN use assisted in weight preservation. Further research around patient selection for nutritional interventions aimed at preventing critical weight loss and unplanned hospital admissions is needed.


Asunto(s)
Nutrición Enteral/estadística & datos numéricos , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/terapia , Estado Nutricional/fisiología , Admisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Australia/epidemiología , Índice de Masa Corporal , Caquexia/epidemiología , Caquexia/etiología , Caquexia/terapia , Nutrición Enteral/efectos adversos , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Radioterapia/efectos adversos , Radioterapia/métodos , Radioterapia/estadística & datos numéricos , Estudios Retrospectivos , Pérdida de Peso/fisiología
9.
J Surg Res ; 245: 492-499, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31446191

RESUMEN

BACKGROUND: Older adults with isolated rib fractures are often admitted to an intensive care unit (ICU) because of presumedly increased morbidity and mortality. However, evidence-based guidelines are limited. We sought to identify characteristics of these patients that predict the need for ICU care. MATERIALS AND METHODS: We analyzed patients ≥50 y old at our center during 2013-2017 whose only indication for ICU admission, if any, was isolated rib fractures. The primary outcome was any critical care intervention (e.g., intubation) or adverse event (e.g., hypoxemia) (CCIE) based on accepted critical care guidelines. We used stepwise logistic regression to identify characteristics that predict CCIEs. RESULTS: Among 401 patients, 251 (63%) were admitted to an ICU. Eighty-three patients (33%) admitted to an ICU and 7 (5%) admitted to the ward experienced a CCIE. The most common CCIEs were hypotension (10%), frequent respiratory therapy (9%), and oxygen desaturation (8%). Predictors of CCIEs included incentive spirometry <1 L (OR 4.72, 95% CI 2.14-10.45); use of a walker (OR 2.86, 95% CI 1.29-6.34); increased chest Abbreviated Injury Scale score (AIS 3 OR 5.83, 95% CI 2.34-14.50); age ≥72 y (OR 2.68, 95% CI 1.48-4.86); and active smoking (OR 2.11, 95% CI 1.06-4.20). CONCLUSIONS: Routine ICU admission is not necessary for most older adults with isolated rib fractures. The predictors we identified warrant prospective evaluation for development of a clinical decision rule to preclude unnecessary ICU admissions.


Asunto(s)
Hipotensión/epidemiología , Unidades de Cuidados Intensivos/normas , Admisión del Paciente/normas , Fracturas de las Costillas/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Cuidados Críticos/normas , Cuidados Críticos/estadística & datos numéricos , Femenino , Humanos , Hipotensión/etiología , Hipotensión/terapia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Admisión del Paciente/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Fracturas de las Costillas/complicaciones , Medición de Riesgo , Centros Traumatológicos/normas , Centros Traumatológicos/estadística & datos numéricos
10.
Rev Med Chil ; 147(8): 997-1004, 2019 Aug.
Artículo en Español | MEDLINE | ID: mdl-31859964

RESUMEN

BACKGROUND: Pain prevalence during hospital admission is variable, with estimates ranging from 32 to 77%. AIM: To determine pain prevalence during admission to a clinical hospital. MATERIAL AND METHODS: Patients admitted to medical and surgical wards were interrogated about the presence of pain within 48 to 72 hours after admission. Subjective pain was analyzed using a scale ranging from 0 to 10. Data was analyzed separately for medical, surgical, and obstetrical patients. RESULTS: A total of 736 patients aged 18 to 94 years (416 women) were recruited. Pain prevalence at 48 hours after admission was 56% (95% confidence intervals (CI (52.7 to 60.1). Pain prevalence in medical, surgical and obstetric patients was 37% (95% CI 31.4 to 42.1), 70% (95% CI 64.5 to 75.5) and 77% (95% CI 68.6 to 84), respectively. The median pain intensities in medical, surgical, and obstetrical patients were 7 (interquartile range (IQR) 6-8), 7 (IQR 5-8) y 7 (IQR 5-8), respectively. CONCLUSIONS: The prevalence of pain among patients admitted to the hospital is high, especially in obstetric and surgical units.


Asunto(s)
Dolor/epidemiología , Admisión del Paciente/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina/epidemiología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Prevalencia , Índice de Severidad de la Enfermedad , Estadísticas no Paramétricas , Adulto Joven
11.
S Afr Med J ; 109(9): 645-651, 2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-31635588

RESUMEN

BACKGROUND: When critically ill patients with life-threatening conditions need urgent, expensive, life-sustaining care, admission and triage decision-making may be extremely challenging as critical care practitioners strive to balance these high-stakes, high-stress, time-sensitive decisions against a limited resource. The factors affecting the decision to admit or refuse a patient entry to an intensive care unit (ICU) have not been described in the South African (SA) context. OBJECTIVES: To identify and describe the factors that influence ICU triage decision-making for patients referred to a regional/tertiary facility for intensive care. METHODS: A retrospective review of recorded data from January 2014 to December 2017 was conducted for all referrals to the 12-bed, intensivist-led, closed general ICU at King Edward VIII Hospital, an 800-bed tertiary public facility in KwaZulu-Natal Province, SA. Data were extracted to identify factors associated with the decision to admit or refuse patients referred to the unit. Significant factors on univariate analysis were then included in a multivariable analysis using binary logistic regression to identify significant independent factors. RESULTS: A total of 4 469 referrals were received over the 48-month period studied. Of these, 507 (11.3%) were withdrawn before a final decision of acceptance or refusal and 94 (2.1%) had an unknown outcome, leaving 3 868 referrals where an acceptance/refusal decision was made as our study cohort. Of these, 38.7% were refused admission. The commonest reason for refusal (57.0%) was assessment of the patient as 'too sick' by the admitting specialist. Multivariable analysis identified age, referring discipline as medicine, poor or unknown premorbid functioning, and comorbidities of HIV, malignancy and cardiac failure as significant factors for refusal of admission to the ICU. Referrals were significantly more likely to be accepted from private institutions, and if the comorbidity was asthma or psychiatric disease. CONCLUSIONS: A better understanding of factors affecting ICU admission/refusal decisions will allow for a more effective and appropriate referral process and more rational utilisation of scarce ICU resources. Further prospective studies are necessary to elucidate fully the impact of various other factors.


Asunto(s)
Cuidados Críticos/estadística & datos numéricos , Enfermedad Crítica/terapia , Unidades de Cuidados Intensivos/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Triaje/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Toma de Decisiones , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Sudáfrica , Centros de Atención Terciaria , Adulto Joven
13.
Afr Health Sci ; 19(2): 1910-1923, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31656474

RESUMEN

Background: There is a high prevalence of paediatric emergency cases in less developed countries. However, prolonged hospital stay at emergency units may further overstretch the facilities. Objective: To assess the patterns of presentations, services offered and predictors of a prolonged stay at the Children Emergency Room of a tertiary hospital in Southern Nigeria. Methods: This prospective cross-sectional, study was conducted at the University of Calabar Teaching Hospital, Nigeria from 1st January-31st December 2014. Socio-demographic and clinical characteristics of consecutively recruited children (n=633) were recorded in a proforma. Binary logistic regression was conducted to determine predictors of prolonged stay (>72 hours). Result: The median age of participants was 2 (1 - 4.6) years. Three-fifths of children were admitted at off-hours and the commonest symptom was fever (73.9%). About 16.4% (95%CI:13.6% - 19.4%, n= 103/633) of the children had prolonged stay while those with sepsis had the longest mean stay (65.5±72.1 hours). Children admitted on account of Sickle cell disease (OR:11.2, 95%CI:1.3-95.1, P-value = 0.03), Malaria (OR:10.7, 95%CI:1.4-82.5, P-value = 0.02) or sepsis (OR:10.5, 95%CI:1.3 - 82.7, P-value = 0.03) had higher odds of prolonged hospital stay. There was no significant difference in hospital stay among children admitted by the consultant as compared to other health personnel (P-value = 0.08). Conclusion: Prevention and proper management of Sickle cell disease and malaria reduces paediatric hospital stay in our environment. Paediatric emergency medicine should be re-organized to cater for high volume of off-hour admissions.


Asunto(s)
Urgencias Médicas/epidemiología , Hospitales de Enseñanza/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Anemia de Células Falciformes/epidemiología , Niño , Preescolar , Estudios Transversales , Servicio de Urgencia en Hospital , Femenino , Fiebre/epidemiología , Mortalidad Hospitalaria , Humanos , Lactante , Malaria/epidemiología , Masculino , Nigeria/epidemiología , Estudios Prospectivos , Sepsis/epidemiología , Factores Socioeconómicos , Factores de Tiempo
14.
Acta Gastroenterol Belg ; 82(3): 397-400, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31566327

RESUMEN

BACKGROUND AND AIMS: Early prediction of severe acute pancreatitis (SAP)would be helpful for triaging patients to the appropriate level of care and intervention. The aim of this study is to compare the performance of the Change in Amylase And Body mass index (CAB) score and BISAP score for predicting SAP. PATIENTS AND METHODS: A total of 406 with AP were enrolled. The age, gender, body mass index(BMI), blood urea nitrogen determined at the time of admission and serum amylase determined on day 1 and day 2 after hospitalization were collected and analyzed statistically. RESULTS: Multivariable analysis confirmed that blood urea nitrogen (OR 1.06; 95%CI 1.03-1.09) and percentage change in amylase day 2 (OR 0.75; 95%CI 0.65-0.87) were independently associated with development of SAP. No statistically significant association was observed between BMI (OR 1.04; 95%CI 0.951.13) and severity of acute pancreatitis. The area under the receiver operating characteristic curve for Body mass index (BMI), percentage change in amylase day 2, BISAP score and CAB score were 0.57±0.05, 0.68±0.04, 0.84±0.03 and0.53±0.05, respectively. CONCLUSION: BISAP is more accurate for predicting the severity of acute pancreatitis than the CAB score.


Asunto(s)
Amilasas/sangre , Nitrógeno de la Urea Sanguínea , Índice de Masa Corporal , Pancreatitis/diagnóstico , Índice de Severidad de la Enfermedad , Enfermedad Aguda , Biomarcadores/sangre , Humanos , Pancreatitis/clasificación , Pancreatitis/patología , Admisión del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Estudios Retrospectivos
15.
J Prev Med Public Health ; 52(5): 316-322, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31588701

RESUMEN

OBJECTIVES: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. METHODS: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. RESULTS: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. CONCLUSIONS: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.


Asunto(s)
Hospitales Públicos/estadística & datos numéricos , Cuerpo Médico de Hospitales , Admisión del Paciente/estadística & datos numéricos , Hospitalización , Humanos , Registros Médicos , Reproducibilidad de los Resultados , República de Corea
16.
Medicine (Baltimore) ; 98(41): e17479, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31593111

RESUMEN

BACKGROUND: Community-acquired pneumonia (CAP) is a potentially life-threatening condition. The aim of this study is to investigate the stratified and prognostic value of admission lactate and severity scores (confusion, urea >7 mmol/L, respiratory rate ≥30/min, blood pressure <90 mm Hg systolic and/or ≤60 mm Hg diastolic, and age ≥65 years [CURB65], pneumonia severity index [PSI], sequential organ failure assessment [SOFA], qSOFA) in patients with CAP in emergency department. METHODS: Adult patients diagnosed with CAP admitted between January 2017 and January 2019 were enrolled and divided into severe CAP (SCAP) group and nonSCAP (NSCAP) group according to international guidelines, death group, and survival group according to 28-day prognosis. Predicting performance of parameters above was compared using receiver operating characteristic curves and logistic regression model. Cox proportional hazard regression model was used to identify variables independently associated with 28-day mortality. RESULTS: A total of 350 patients with CAP were enrolled. About 196 patients were classified as SCAP and 74 patients died after a 28-day follow-up. The levels of CURB65, PSI, SOFA, qSOFA, and admission lactate were higher in the SCAP group and death group. SOFA showed advantage in predicting SCAP, while qSOFA is superior in predicting 28-day mortality. The combination of SOFA and admission lactate outperformed other combinations in predicting SCAP, and the combination of qSOFA and lactate showed highest superiority over other combinations in predicting 28-day mortality. CONCLUSION: The SOFA is a valuable predictor for SCAP and qSOFA is superior in predicting 28-day mortality. Combination of qSOFA and admission lactate can improve the predicting performance of single qSOFA.


Asunto(s)
Infecciones Comunitarias Adquiridas/mortalidad , Ácido Láctico/sangre , Puntuaciones en la Disfunción de Órganos , Admisión del Paciente/estadística & datos numéricos , Neumonía/mortalidad , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas/sangre , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Neumonía/sangre , Pronóstico , Curva ROC , Estudios Retrospectivos
17.
Z Gerontol Geriatr ; 52(Suppl 4): 222-228, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31620876

RESUMEN

BACKGROUND: Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. OBJECTIVE: To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). METHOD: This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. RESULTS: The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46-0.63) but at 3 months (AUC 0.61, 95% CI 0.54-0.68), 6 months (AUC 0.63, 95% CI 0.56-0.70) and 12 months (AUC 0.63, 95% CI 0.56-0.70) after initial contact. CONCLUSION: For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Evaluación Geriátrica , Tamizaje Masivo/métodos , Admisión del Paciente/estadística & datos numéricos , Medición de Riesgo/métodos , Anciano , Cuidados Críticos , Femenino , Servicios de Salud para Ancianos , Hospitalización , Humanos , Masculino , Alta del Paciente/estadística & datos numéricos , Estudios Prospectivos , Medición de Riesgo/normas
18.
Isr Med Assoc J ; 21(10): 686-691, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31599512

RESUMEN

BACKGROUND: C-reactive protein (CRP) blood level is associated with clinical outcomes of several diseases. However, the independent predictive role of CRP in the heterogeneous population of patients admitted to internal medicine wards is not known. OBJECTIVES: To determine whether single CRP levels at admission independently predicts clinical outcome and flow of patients in general medicine wards. METHODS: This study comprised 275 patients (50.5% female) with a mean age of 68.25 ± 17.0 years, hospitalized with acute disease in a general internal medicine ward. The association between admission CRP levels and clinical outcomes including mortality, the need for mechanical ventilation, duration of hospitalization, and re-admission within 6 months was determined. RESULTS: A significant association was found between CRP increments of 80 mg/L and risk for the major clinical outcomes measured. The mortality odds ratio (OR) was 1.89 (95% confidence interval (95%CI, 1.37-2.61, P < 0.001), mechanical ventilation OR 1.67 (95%CI, 1.10-2.34, P = 0.006), re-admission within 6 months OR 2.29 (95%CI, 1.66-3.15 P < 0.001), and prolonged hospitalization >7 days OR 2.09 (95%CI, 1.59-2.74, P < 0.001). Lower increments of10 mg/L in CRP levels were associated with these outcomes although with lower ORs. Using a stepwise regression model for admission CRP levels resulted in area under the receiver operating characteristics curves between 0.70 and 0.76 for these outcomes. CONCLUSIONS: A single admission CRP blood level is independently associated with major parameters of clinical outcomes in acute care patients hospitalized in internal medicine wards.


Asunto(s)
Proteína C-Reactiva/análisis , Hospitalización/estadística & datos numéricos , Medicina Interna/métodos , Evaluación del Resultado de la Atención al Paciente , Enfermedad Aguda , Adulto , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Admisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Valor Predictivo de las Pruebas , Pronóstico , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
19.
Am J Health Syst Pharm ; 76(1): 44-49, 2019 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31603983

RESUMEN

PURPOSE: Results of a study to identify medication history technician (MHT) programs within the Veterans Health Administration (VHA) and to evaluate the personnel, structure, and scope of such programs are reported. METHODS: Specially trained pharmacy technicians can take accurate patient medication histories and contribute to the medication reconciliation process. An environmental scan of MHT programs within VHA was conducted via an email query of pharmacy personnel. Semistructured interviews of personnel at each responding site (an MHT, a pharmacist, or both) were conducted. RESULTS: Ten VHA sites had existing MHT programs; the earliest was initiated in 2010. Sites employed from 1 to 4 MHTs, who most commonly worked in the inpatient setting (7 sites). At most sites (9), MHTs obtained a "best possible medication history" through systematic collection of medication information using 2 reliable sources, such as patients, caregivers, and medical records. Survey respondents at all sites reported benefits of MHT programs, including dedicated time to obtain medication histories, allowing for more effective use of pharmacists' time. Six sites were eager to increase the reach of their programs. MHT training, oversight, and quality assurance varied across the sites. The survey results indicated that there are opportunities nationally-within and outside VHA-to develop standardized training, competency assessments, and quality assurance measures for MHT programs. CONCLUSION: Ten VHA sites with MHT programs were identified. MHTs most commonly worked in inpatient settings as part of admission medication reconciliation processes.


Asunto(s)
Conciliación de Medicamentos/organización & administración , Seguridad del Paciente , Técnicos de Farmacia/organización & administración , United States Department of Veterans Affairs/organización & administración , Estudios Transversales , Humanos , Conciliación de Medicamentos/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/organización & administración , Transferencia de Pacientes/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios/estadística & datos numéricos , Estados Unidos , United States Department of Veterans Affairs/estadística & datos numéricos
20.
BMC Res Notes ; 12(1): 590, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533796

RESUMEN

OBJECTIVE: Despite the access and availability of modern health care, Traditional Bone Setting (TBS) has a big place as alternative health care. Hence, this study was aimed to assess the preference of Traditional Bone Setting and associated factors among patients with a fracture. RESULTS: A total of 224 patients known to have fractured at Black Lion Hospital, Addis Ababa was included in the study. This study revealed that 29.9% of the study participants had a preference for the Traditional Bone Setting. Hospital admission (AOR = 8.158, 95% CI 1.179, 56.439), Traditional Bone Setting center as first port of call after injury (AOR = 0.004, 95% CI 0.001, 0.090), knowledge (AOR = 9.448, 95% CI 1.481, 60.251) and perception (AOR = 0.026, 95% CI 0.003, 0.215) were statistically significant. The preference for the Traditional Bone Setting is high. Hospital admission, Traditional Bone Setting center as a first port of call after injury, knowledge, and perception were significantly associated with the preference of Traditional Bone Setting. In addition to deployment of trained in trauma professionals, working more on awareness creation and training are recommended.


Asunto(s)
Fracturas Óseas/terapia , Hospitales , Admisión del Paciente/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Heridas y Traumatismos/terapia , Adolescente , Adulto , Estudios Transversales , Etiopía , Femenino , Fracturas Óseas/diagnóstico , Personal de Salud/normas , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Encuestas y Cuestionarios , Heridas y Traumatismos/diagnóstico , Adulto Joven
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