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1.
Vasc Endovascular Surg ; 54(1): 58-64, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31500542

RESUMEN

A retrospective review from July 2016 to April 2018 was performed of 23 patients with submassive pulmonary embolism (PE) who received catheter-directed thrombolysis (CDT). Five (22%) of the 23 patients were discharged the same day from the intensive care unit (ICU) following thrombolysis completion. Their presentation, hospital courses, complications, and follow-up are reviewed. All 5 patients were diagnosed using chest computed tomography (CT) demonstrating a clot in the pulmonary vasculature and right ventricle dysfunction based on abnormal right ventricle to left ventricle (RV/LV) ratio. Patients with severe right heart dysfunction (RV/LV ratio ≥1.4) were protocolized to receive CDT via EkoSonic catheters (EKOS Corporation). Postoperatively, patients were admitted to the ICU with continuous alteplase at 1 mg/h. Echocardiography was then performed after 24 hours of therapy to assess right ventricle function and removal of EkoSonic catheters. Patients with reversal of right heart dysfunction and symptomatic improvement received bedside removal of catheters. The mean patient age was 50.6 years and body mass index was 33.6. Mean RV/LV ratio on admission via CT imaging was 1.56, with a mean troponin of 0.44. Interval mean RV/LV ratio on echocardiography after thrombolysis therapy was 0.91. There was a 0% incidence of periprocedural complications. One (20%) patient out of 5 had an emergency department visit 10 days postdischarge for acute shortness of breath, with workup revealing no evidence of recurrent PE. No patient required hospital readmission within 30 days. At the 6-week follow-up, all patients had continued normal right ventricular function noted on echocardiography. This case series demonstrates that for a select population of patients with severe submassive PE, the use of CDT and echocardiography monitoring can facilitate same-day discharge from the ICU.


Asunto(s)
Fibrinolíticos/administración & dosificación , Unidades de Cuidados Intensivos , Tiempo de Internación , Alta del Paciente , Embolia Pulmonar/tratamiento farmacológico , Terapia Trombolítica/métodos , Adulto , Ecocardiografía , Femenino , Fibrinolíticos/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/diagnóstico por imagen , Sistema de Registros , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Terapia Trombolítica/efectos adversos , Terapia Trombolítica/instrumentación , Factores de Tiempo , Resultado del Tratamiento , Dispositivos de Acceso Vascular
3.
J Opioid Manag ; 15(5): 357-361, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31849026

RESUMEN

OBJECTIVE: To evaluate current practices in naloxone prescribing upon hospital discharge. DESIGN: Electronic cross-sectional survey. SETTING: Academic medical center. PARTICIPANTS: Inpatient physicians and advanced practice providers. MAIN OUTCOME MEASURES: Respondents completed survey items including current naloxone prescribing practices, barriers to naloxone prescribing, and methods to improve naloxone prescribing. RESULTS: The survey response rate was 51.6 percent. Greater than 90 percent of respondents agreed that naloxone should be prescribed for patients with an active opioid use disorder, history of overdose, and use of greater than 50 morphine milligram equivalents per day. Lack of patient education on proper use of naloxone was the most identified barrier to prescribing. CONCLUSIONS: Providers agree with the Centers for Disease Control and Prevention recommendations to prescribe naloxone to high-risk patients. Certain barriers affect the rate of naloxone prescribing at discharge, including lack of time, patient education, provider training, and concern for increasing riskier behaviors.


Asunto(s)
Sobredosis de Droga , Naloxona , Alta del Paciente , Pautas de la Práctica en Medicina , Analgésicos Opioides/uso terapéutico , Estudios Transversales , Sobredosis de Droga/prevención & control , Humanos , Antagonistas de Narcóticos
4.
Medicine (Baltimore) ; 98(44): e17752, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689831

RESUMEN

Dispatcher assisted cardiopulmonary resuscitation (DACPR) by Emergency medical services has been shown to improve rates of early out of hospital cardiac arrest (OHCA) recognition and early cardiopulmonary resuscitation (CPR) for OHCA. This study measures the impact of introducing DACPR on OHCA recognition, CPR rates and on patient outcomes in a pilot region in Kuwait.EMS treated OHCA data over 10 months period (February 21-December 31, 2017) before and after the intervention was prospectively collected and analyzed.Comprehensive DACPR in the form of: a standardized dispatch protocol, 1-day training package and quality assurance and improvement measures were applied to Kuwait EMS central Dispatch unit only for pilot region. Primary outcomes: OHCA recognition rate, CPR instruction rate, and Bystander CPR rate. Secondary outcome: survival to hospital discharge.A total of 332 OHCA cases from the EMS archived data were extracted and after exclusion 176 total OHCA cases remain. After DACPR implementation OHCA recognition rate increased from 2% to 12.9% (P = .037), CPR instruction rate increased from 0% to 10.4% (P = .022); however, no significant change was noted for bystander CPR rates or prehospital return of spontaneous circulation. Also, survival to hospital discharge rate did not change significantly (0% before, and 0.8% after, P = .53)In summary, DACPR implementation had positive impacts on Kuwait EMS system operational outcomes; early OHCA recognition and CPR instruction rates in a pilot region of Kuwait. Expanding this initiative to other regions in Kuwait and coupling it with other OHCA system of care interventions are needed to improve OHCA survival rates.


Asunto(s)
Reanimación Cardiopulmonar/educación , Operador de Emergencias Médicas/educación , Servicios Médicos de Urgencia/métodos , Paro Cardíaco Extrahospitalario/terapia , Anciano , Reanimación Cardiopulmonar/métodos , Femenino , Implementación de Plan de Salud , Humanos , Kuwait , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Resultado del Tratamiento
5.
Medicine (Baltimore) ; 98(45): e17502, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702610

RESUMEN

AIM: Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest. BACKGROUND: Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test. RESULT: In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001). CONCLUSION: In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.


Asunto(s)
Epinefrina/uso terapéutico , Paro Cardíaco Extrahospitalario/tratamiento farmacológico , Anciano , Epinefrina/efectos adversos , Hospitalización , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Alta del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
6.
J Surg Oncol ; 120(8): 1456-1461, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31680250

RESUMEN

BACKGROUND AND OBJECTIVES: Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy. METHODS: Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage. RESULTS: Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high-dose period and 15 MMEs in the low-dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P = .006). Total non-remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long-acting narcotics. CONCLUSIONS: Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer-acting narcotics from intraoperative to postoperatively is also supported.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Utilización de Medicamentos/estadística & datos numéricos , Dolor Postoperatorio/tratamiento farmacológico , Remifentanilo/administración & dosificación , Tiroidectomía , Adulto , Procedimientos Quirúrgicos Ambulatorios , Femenino , Humanos , Infusiones Intravenosas , Cuidados Intraoperatorios , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Alta del Paciente , Periodo Posoperatorio , Estudios Retrospectivos
7.
Lakartidningen ; 1162019 Oct 07.
Artículo en Sueco | MEDLINE | ID: mdl-31593289

RESUMEN

The medical and nursing care of preterm infants has improved over the last decades, including the involvement of parents in the daily care. Previously parents could only visit a few scheduled hours per day but today most neonatal units in Sweden strive to let the parents be the primary caregivers, with the right to stay at the unit during the entire hospitalization period. Despite this development, there is still need for a number of improvements, not only in the neonatal care but also during the complicated pregnancy.


Asunto(s)
Cuidado Intensivo Neonatal/organización & administración , Responsabilidad Parental , Nacimiento Prematuro , Rol , Lactancia Materna , Continuidad de la Atención al Paciente , Padre , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Servicios de Salud Materna/organización & administración , Madres , Alta del Paciente , Educación del Paciente como Asunto , Embarazo , Apoyo Social , Suecia
8.
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
9.
Gan To Kagaku Ryoho ; 46(10): 1587-1590, 2019 Oct.
Artículo en Japonés | MEDLINE | ID: mdl-31631145

RESUMEN

A 74-year-old man with aspiration pneumonia was admitted in the internal medicine department. CT revealed progressive carcinoma of RS-Ra, which became the focus of intervention after the pneumonia was treated. After having been allowed temporary discharge, the patient was rehospitalized for surgical operation and rehabilitation. During the perioperative period of cancer patients, we use body distribution data for teaching and environment setting, which is a useful tool in rehabilitation. Rectal cancer was observed after hospitalization for pneumonia, presenting an interesting case. Therefore, care needs to be taken as body pressure distribution may be modified by comorbidity.


Asunto(s)
Neumonía por Aspiración , Neoplasias del Recto , Anciano , Hospitalización , Humanos , Masculino , Alta del Paciente , Neumonía por Aspiración/complicaciones , Neoplasias del Recto/complicaciones
14.
Einstein (Sao Paulo) ; 18: eAO4871, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31664324

RESUMEN

OBJECTIVE: To analyze, from the pharmacotherapy perspective, the factors associated to visits of older adults to the emergency department within 30 days after discharge. METHODS: A cross-sectional study carried out in a general public hospital with older adults. Emergency department visit was defined as the stay of the older adult in this service for up to 24 hours. The complexity of drug therapy was determined using the Medication Regimen Complexity Index. Potentially inappropriate drugs for use in older adults were classified according to the American Geriatric Society/Beers criteria of 2015. The outcome investigated was the frequency of visits to the emergency department within 30 days of discharge. Multivariate logistic regression was performed to identify the factors associated with the emergency department visit. RESULTS: A total of 255 elderly in the study, and 67 (26.3%) visited emergency department within 30 days of discharge. Polypharmacy and potentially inappropriate medications for older adults did not present a statistically significant association. The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with emergency department visits (OR=2.3; 95%CI: 1.04-4.94; p=0.048; and OR=2.1; 95%CI: 1.11-4.02; p=0.011), respectively. Furthermore, the diagnosis of diabetes mellitus and chronic kidney disease were protection factors for the outcome (OR=0.4; 95%CI: 0.20-0.73; p=0.004; and OR=0.3; 95%CI: 0.13-0.86; p=0.023). CONCLUSION: The diagnosis of heart failure and Medication Regimen Complexity Index >16.5 were positively associated with the occurrence of an emergency department visit within 30 days of discharge.


Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Quimioterapia/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Polifarmacia , Factores de Tiempo
15.
Einstein (Sao Paulo) ; 18: eAO4877, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31664332

RESUMEN

OBJECTIVE: To analyze the frequency of use of potentially inappropriate medication prescribed to elderly at hospital discharge from a public hospital, considering the Brazilian Consensus on Potentially Inappropriate Medication for Elderly, and to identify the associated factors. METHODS: Patients aged ≥60 years, admitted in clinical and geriatric units of a public hospital were invited to participate in the study. The information about the use of medicines was collected from the patient's electronic record and through telephone contact. The Brazilian Consensus on Potentially Inappropriate Medication for Elderly was used to classify the medication, regardless of the clinical condition. RESULTS: A total of 255 elders were included in this study. The frequency of use of potentially inappropriate medication by elderly was 58.4%. The potentially inappropriate medication use in elderly was positively associated with the presence of depression (odds ratio of 2.208) and polypharmacy (odds ratio of 2.495). The hospitalization in a geriatric unit showed an inverse association with the potentially inappropriate medication use in elderly (odds ratio of 0.513). CONCLUSION: The frequency of potentially inappropriate medication prescription to elderly upon hospital discharge was high. The presence of depression and polypharmacy were directly associated with use of potentially inappropriate medication in the elderly. Admission to the geriatric clinic has become a protection factor for the use of potentially inappropriate medication in elderly. Strategies to improve the elderly pharmacotherapy should implemented aiming at healthcare quality and safety in the transition of care.


Asunto(s)
Servicios de Salud para Ancianos/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Lista de Medicamentos Potencialmente Inapropiados , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polifarmacia
16.
Rev Lat Am Enfermagem ; 27: e3197, 2019 Oct 14.
Artículo en Portugués, Inglés, Español | MEDLINE | ID: mdl-31618390

RESUMEN

OBJECTIVE: to analyze the in-hospital complications of prolonged hospital stay in patients with ischemic stroke or transient ischemic attack, admitted to the stroke unit of a tertiary hospital. METHOD: this is an evaluative correlational study. All first-ever ischemic stroke or transient ischemic attack patients admitted were retrospectively analyzed. During hospital stay, the predictors of long-term hospitalization considered were: 1) clinical complications (pneumonia, urinary tract infection, pressure damage and deep vein thrombosis), and 2) neurological complications (malignant ischemic stroke and symptomatic hemorrhagic transformation). RESULTS: 353 patients were discharged in the study period. Mean age was 64.1±13.7 years old and 186 (52.6%) were men. The mean time of hospital stay was 13.7±14.3 days. Pneumonia (25.3±28.8 days, p<0.001), urinary tract infection (32.9±45.2 days, p<0.001) and malignant stroke (29.1±21.4 days, p<0.001) increased significantly the length of hospital stay compared to patients without any complications (11.2±7.1 days). CONCLUSION: this study showed that three complications delayed hospital discharge in patients admitted in a stroke unit, two preventable ones: pneumonia and urinary tract infection. More intense measures to avoid them should be included in the performance indicators to reduce the length of hospital stay in stroke units.


Asunto(s)
Hospitalización/estadística & datos numéricos , Ataque Isquémico Transitorio/prevención & control , Tiempo de Internación/estadística & datos numéricos , Accidente Cerebrovascular/prevención & control , Factores de Edad , Anciano , Correlación de Datos , Complicaciones de la Diabetes/complicaciones , Femenino , Humanos , Hipertensión/complicaciones , Ataque Isquémico Transitorio/complicaciones , Masculino , Persona de Mediana Edad , Alta del Paciente/estadística & datos numéricos , Neumonía/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Rehabilitación de Accidente Cerebrovascular/estadística & datos numéricos , Centros de Atención Terciaria/estadística & datos numéricos , Infecciones Urinarias/complicaciones
17.
Enferm. clín. (Ed. impr.) ; 29(5): 302-307, sept.-oct. 2019. tab
Artículo en Español | IBECS | ID: ibc-184155

RESUMEN

Introducción: Los informes de alta de hospitalización presentan gran cantidad de abreviaturas y su significado puede ser desconocido por médicos y enfermeras, pudiendo comprometer la seguridad del paciente. Objetivo: Evaluar el conocimiento de médicos y enfermeras de las abreviaturas clínicas presentes en el informe de alta. Métodos: Estudio observacional-transversal mediante un cuestionario elaborado ad hoc dirigido a médicos y enfermeras del Hospital Universitario de Fuenlabrada. Para la validación del cuestionario se realizó la evaluación del contenido y de la validez lógica. La cumplimentación fue anónima y voluntaria y se difundió online a través de los correos corporativos de los profesionales. El cuestionario incluía variables sociodemográficas y 14 abreviaturas presentes en los informes de alta. Los datos se obtuvieron de la historia clínica electrónica. Resultados: De 756 profesionales, el cuestionario fue respondido por 68 médicos y 86 enfermeras (n = 154). La edad media de los profesionales fue de 40,58 años (DE ±7,54), y la media de años de experiencia profesional fue de 17,10 años (DE ±7,37). Los profesionales presentan un porcentaje medio de aciertos del 35,84% de todas las abreviaturas evaluadas. El personal médico presentó un 55,94% de contestaciones correctas, y el personal de enfermería un 23,17%. Las abreviaturas en las que se produjeron más errores fueron: SNG, NPIM, EEA y RCP, con un porcentaje de aciertos del 5,19, 6,49, 6,49 y 7,79%, respectivamente. Conclusiones: La identificación de las abreviaturas en los informes de alta por parte de los médicos es superior a la del personal de enfermería. A nivel global, el conocimiento de las abreviaturas en ambos profesionales es bajo


Introduction: Medical Records have a large number of abbreviations and doctors and nurses may not be aware of their meaning, which could compromise patient safety. Objective: To evaluate the knowledge of doctors and nurses of the clinical abbreviations in medical discharge reports. Methods: Observational-cross sectional study through a questionnaire developed ad hoc for doctors and nurses from Hospital Universitario de Fuenlabrada. The content and logical validity of the questionnaire was assessed. The questionnaire was completed anonymously and voluntarily. The questionnaire was also distributed online to the professionals' corporate emails. The questionnaire included sociodemographic variables and 14 abbreviations present in medical discharge reports. The data were obtained from the Electronic Clinical Record. Results: Out of a total of 756 professionals, the questionnaire was answered by 68 doctors and 86 nurses (n = 154).The mean age of the professionals was 40.58 years (SD ±7.54), and the mean number of years of professional experience was 17.10s (SD ±7.37). The professionals gave an average percentage of correct answers of 35.84%. Doctors gave 55.94% of the correct answers, and nurses 23.17%. The abbreviations for which the most errors occurred were SNG, NPIM, EEA, RCP, with a success rate of 5.19%, 6.49%, 6.49% and 7.79%, respectively. Conclusions: The identification of the abbreviations in medical discharge reports by doctors is superior to that of nursing staff. Overall the knowledge of abbreviations in both professionals is low


Asunto(s)
Humanos , Conocimiento , Competencia Clínica , Abreviaturas como Asunto , Resumen del Alta del Paciente , Registros Médicos/normas , Epidemiología Descriptiva , Alta del Paciente/normas , Encuestas y Cuestionarios , Estudios Transversales
18.
J Urol ; 202(6): 1149, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31483712
19.
J Urol ; 202(6): 1143-1149, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31483713

RESUMEN

PURPOSE: Skeletal muscle and fat mass indexes have emerged as easily obtained, objective and useful tools to assess susceptibility to unfavorable postoperative outcomes. We examined the association between skeletal muscle and fat mass indexes, and the discharge disposition after radical cystectomy. MATERIALS AND METHODS: In a retrospectively collected, single institution cohort we studied patients who underwent radical cystectomy with pelvic lymphadenectomy of primary, nonmetastatic muscle invasive bladder cancer between 2009 and 2015. Included patients had undergone adequate axial computerized tomography at the L3 level within 90 days prior to surgery. Skeletal muscle and fat mass indexes were measured on preoperative computerized tomography and relationships to the outcomes of interest were analyzed. Multivariable logistic regression analysis was performed to assess the effect of the skeletal muscle and fat mass indexes on the discharge disposition while controlling for age, comorbidities, complications and previous neoadjuvant chemotherapy. RESULTS: A total of 136 patients met study inclusion criteria. The median skeletal muscle index among women and men in our study cohort was 36.4 and 47.6 cm2/m2, respectively. On multivariable logistic regression analysis a decreased skeletal muscle index (OR 0.94, 95% CI 0.90-0.98) and an increased fat mass index (OR 1.24, 95% CI 1.04-1.48) were associated with greater odds of discharge to a facility. Higher skeletal muscle to fat mass index ratios were also associated with greater odds of discharge to a facility (OR 1.69, 95% CI 1.22-2.44). Study limitations include the retrospective design and unknown confounders. CONCLUSIONS: Low skeletal muscle and high fat compositions are independent predictors of discharge to a facility after radical cystectomy of nonmetastatic muscle invasive bladder cancer.


Asunto(s)
Tejido Adiposo/diagnóstico por imagen , Cistectomía , Músculo Esquelético/diagnóstico por imagen , Alta del Paciente/estadística & datos numéricos , Tomografía Computarizada por Rayos X , Neoplasias de la Vejiga Urinaria/cirugía , Anciano , Comorbilidad , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/patología
20.
BMC Neurol ; 19(1): 213, 2019 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-31470811

RESUMEN

BACKGROUND: The global burden of stroke epidemiology is changing rapidly. Over the 1990-2013 periods, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of stroke varies in Ethiopia between regions and over time. Hence, this study was aimed to assess the burden, clinical outcomes and predictors of time to in hospital mortality among stroke patients. METHODS: A prospective cohort study was carried at stroke unit of Jimma University Medical Center (JUMC) from March 10-July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictor variable with P < 0.05 was considered statistically significant. RESULTS: A total of 116 eligible stroke patients were followed over 4 months. The mean age of patients was 55.1 + 14.0 years and males comprised of 73 (62.9%). Stroke accounted for 16.5% of total medical admissions. Among the 116 patients with stroke, 91 (78.4%) were discharged alive making in hospital mortality rate of 25 (21.6%). The median time of in hospital mortality and length of hospital stay after admission of the patients were 4.38 days and 9.21 days, respectively. The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure in 17 (68.0%) followed by respiratory failure secondary to aspiration pneumonia in 11 (44.0%) patients. Brain edema (AHR: 6.27, 95% CI: 2.50-15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48-8.17), National Institute of Health Stroke Scale (NIHSS) > 13 during hospital arrival (AHR: 22.58, 95% CI: 2.95-172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96-12.54) were the independent predictors of time to in hospital mortality. CONCLUSIONS: The mortality rate of stroke in this setup was comparable with other low- and middle-income countries (LMICs). There is an urgent need to establish well equipped and staffed stroke units in the country in addition to strengthening the already existing one's. Furthermore, future work must be designed to identify the barriers to improve stroke outcomes and recovery.


Asunto(s)
Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Accidente Cerebrovascular/mortalidad , Centros Médicos Académicos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Etiopía/epidemiología , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Alta del Paciente , Estudios Prospectivos , Adulto Joven
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