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1.
Esc. Anna Nery Rev. Enferm ; 26: e20200435, 2022. tab, graf
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1346055

RESUMEN

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


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


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


Asunto(s)
Humanos , Alta del Paciente , Cuidado de Transición , Readmisión del Paciente , Colaboración Intersectorial , Continuidad de la Atención al Paciente , Enfermeras y Enfermeros
2.
Emerg Med Clin North Am ; 40(1): 33-37, 2022 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34782089

RESUMEN

After treating the acute anaphylactic reaction, the clinician's next task is to prevent a recurrence. The patient should be observed in the ED. How long this observation period should last depends on their clinical course, risk factors, and social support. All patients should be discharged with a prescription for 2 epinephrine autoinjectors and counseled on appropriate use. The patient should also receive education on the signs and symptoms of anaphylaxis and avoiding triggers. The patient should follow-up with an allergy specialist who can confirm triggers and provide immunotherapy as indicated.


Asunto(s)
Anafilaxia/terapia , Alta del Paciente , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/tendencias , Epinefrina/administración & dosificación , Epinefrina/uso terapéutico , Humanos , Factores de Riesgo
3.
J Intensive Care Med ; 37(1): 134-143, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33626957

RESUMEN

BACKGROUND: There is conflicting evidence on the association between afterhours discharge from the intensive care unit (ICU) and hospital mortality. We examined the effects of afterhours discharge, including the potential effect of residual organ dysfunction, on hospital mortality in a large integrated health region. METHODS: We performed a multi-center retrospective cohort study of 10,463 adults discharged from 9 mixed medical/surgical ICUs in Alberta from June 2012 to December 2014. We applied a 2-stage modeling strategy to investigate the association between afterhours discharge (19:00h to 07:59h) and post-ICU hospital mortality. We applied mixed-effect multi-variable linear regression to assess the relationship between discharge organ dysfunction and afterhours discharge. We then applied mixed-effect multi-variable logistic regression to evaluate the direct, indirect and integrated associations of afterhours discharge on hospital mortality and hospitalization duration. RESULTS: Of 10,463 patients, 23.7% (n = 2,480) were discharged afterhours, of which 27.4% occurred on a holiday or weekend. This varied significantly by ICU size, type, and site. Patients discharged afterhours were more likely medical admissions, had greater multi-morbidity and illness acuity. A greater average SOFA score in the 72 hours prior to ICU discharge was not associated with afterhours discharge. However, a greater average SOFA score was associated with hospital mortality (adjusted-odds ratio [OR], 1.23; 95% CI, 1.18-1.28). Afterhours discharge was associated with higher hospital mortality (adjusted-OR, 1.19; 95% CI, 1.01-1.39), increased hospital stay (adjusted-risk ratio [RR], 1.10; 95% CI, 1.09-1.11) and increased post-ICU stay (adjusted-RR, 1.16; 95% CI, 1.14-1.17) when compared with workhours discharge. CONCLUSIONS: Afterhours discharge is common, occurring in 1 in 4 discharges, and is widely variable across ICUs. Patients discharged afterhours have greater risk of hospital mortality and prolonged hospitalization.


Asunto(s)
Unidades de Cuidados Intensivos , Alta del Paciente , Estudios de Cohortes , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Estudios Retrospectivos
4.
Clin Podiatr Med Surg ; 39(1): 57-71, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34809795

RESUMEN

Musculoskeletal injuries of the lower limb are frequent in pediatric patients and represent the most common cause of emergency department admissions. Acute sports-related injuries commonly involve the lower extremity, as the knee and ankle are the most frequently injured parts. Physeal fractures are common injuries in children and adolescents participating in contact sports, which may lead to growth disturbances and cause limb length discrepancy. It is imperative for pediatric trauma centers to implement evidence-based multispecialty protocols for the perimanagement of the injured child, especially through the postdischarge and rehabilitation phases, in order for the child to resume active daily living.


Asunto(s)
Traumatismos en Atletas , Fracturas Óseas , Adolescente , Cuidados Posteriores , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Niño , Fracturas Óseas/cirugía , Humanos , Extremidad Inferior , Alta del Paciente , Estudios Retrospectivos
5.
J Nurs Care Qual ; 37(1): 54-60, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-33734187

RESUMEN

BACKGROUND: In an inpatient setting, aspects of discharge planning are often left to the provider's memory, leading to errors, inefficiencies, and avoidable costs. METHODS: A multidisciplinary team of oncology practitioners used process improvement methodologies to redesign the discharge planning process. INTERVENTIONS: The primary intervention was an evidence-based discharge planning tool, called the discharge navigator, used from admission through discharge. RESULTS: Thirty-day unplanned readmission rates decreased by 29.0% from preimplementation (March 2017 through August 2017) to postimplementation (September 2017 through March 2020). The percentage of patients discharged before noon increased 76.2%. A comparable service not utilizing the intervention saw lesser or no improvement in these measures. CONCLUSION: The tool provided a systematic approach to discharge planning. Key design elements included a centralized location within the electronic health record and an electronic shortcut to populate the tool. Although developed for a specialized population, most elements are applicable to any hospitalized patient.


Asunto(s)
Alta del Paciente , Readmisión del Paciente , Humanos , Pacientes Internos
6.
Trials ; 22(1): 767, 2021 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-34732233

RESUMEN

BACKGROUND: While it is well established that perioperative use of oral nutrition supplement (ONS) improves nutrition status among severely malnourished surgical cancer patients, the evidence requires further substantiation for non-severely malnourished patients with cancer. This protocol paper presents the rationale and design of a randomised controlled trial to evaluate the effectiveness of preoperative as well as an extended 90-day postoperative use of ONS on nutritional and clinical outcomes among patients undergoing elective surgery for breast and colorectal cancer. METHODS: Patients with primary breast and colorectal cancer undergoing elective surgery are recruited from two tertiary hospitals. Eligible patients are assigned into one of the three intervention arms: (i) Group SS will receive ONS in addition to their normal diet up to 14 days preoperatively and postoperatively up to discharge; (ii) Group SS-E will receive ONS in addition to their normal diet up to 14 days preoperatively, postoperatively up to discharge and for an extended 90 days after discharge; and (iii) Group DS will receive ONS in addition to their normal diet postoperatively up to discharge from the hospital. The ONS is a standard formula fortified with lactium to aid in sleep for recovery. The primary endpoints include changes in weight, body mass index (BMI), serum albumin and prealbumin levels, while secondary endpoints are body composition (muscle and fat mass), muscle strength (handgrip strength), energy and protein intake, sleep quality, haemoglobin, inflammatory markers (transferrin, high sensitivity C-reactive protein, interleukin-6), stress marker (saliva cortisol), length of hospital stay and postoperative complication rate. DISCUSSION: This trial is expected to provide evidence on whether perioperative supplementation in breast and colorectal cancer patients presenting with high BMI and not severely malnourished but undergoing the stress of surgery would be beneficial in terms of nutritional and clinical outcomes. TRIAL REGISTRATION: ClinicalTrial.gov NCT04400552. Registered on 22 May 2020, retrospectively registered.


Asunto(s)
Neoplasias Colorrectales , Desnutrición , Neoplasias Colorrectales/cirugía , Suplementos Dietéticos , Fuerza de la Mano , Humanos , Desnutrición/diagnóstico , Desnutrición/etiología , Desnutrición/prevención & control , Estado Nutricional , Alta del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto
7.
BMC Health Serv Res ; 21(1): 1234, 2021 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-34775968

RESUMEN

BACKGROUND: Undernourished children in low- and middle-income countries remain at elevated risk of death following hospital discharge, even when treated during hospitalisation using World Health Organisation recommended guidelines. The role of community health workers (CHWs) in supporting post-discharge recovery to improve outcomes has not been adequately explored. METHODS: This paper draws on qualitative research conducted as part of the Childhood Acute Illnesses and Nutrition (CHAIN) Network in Bangladesh and Kenya. We interviewed family members of 64 acutely ill children admitted across four hospitals (a rural and urban hospital in each country). 27 children had severe wasting or kwashiorkor on admission. Family members were interviewed in their homes soon after discharge, and up to three further times over the following six to fourteen months. These data were supplemented by observations in facilities and homes, key informant interviews with CHWs and policy makers, and a review of relevant guidelines. RESULTS: Guidelines suggest that CHWs could play a role in supporting recovery of undernourished children post-discharge, but the mechanisms to link CHWs into post-discharge support processes are not specified. Few families we interviewed reported any interactions with CHWs post-discharge, especially in Kenya, despite our data suggesting that opportunities for CHWs to assist families post-discharge include providing context sensitive information and education, identification of danger signs, and supporting linkages with community-based services and interventions. Although CHWs are generally present in communities, challenges they face in conducting their roles include unmanageable workloads, few incentives, lack of equipment and supplies and inadequate support from supervisors and some community members. CONCLUSION: A multi-pronged approach before or on discharge is needed to strengthen linkages between CHWs and children vulnerable to poor outcomes, supported by clear guidance. To encourage scale-ability and cost-effectiveness of interventions, the most vulnerable, high-risk children, should be targeted, including undernourished children. Intervention designs must also take into account existing health worker shortages and training levels, including for CHWs, and how any new tasks or personnel are incorporated into hospital and broader health system hierarchies and systems. Any such interventions will need to be evaluated in carefully designed studies, including tracking for unintended consequences.


Asunto(s)
Agentes Comunitarios de Salud , Alta del Paciente , Cuidados Posteriores , Bangladesh , Niño , Hospitales , Humanos , Kenia , Investigación Cualitativa
11.
J Med Syst ; 46(1): 2, 2021 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-34786607

RESUMEN

Discharge planning is a vital tool in managing hospital capacity, which is essential for maintaining hospital throughput for surgical postoperative admissions. Early discharge planning has been effective in reducing length of stay and hospital readmissions. Between 2014 and 2017, Vanderbilt University Medical Center (VUMC) implemented a tool in the electronic health record (EHR) requiring providers to input the patient's estimated discharge date on each hospital day. We hypothesized discharge estimates would be more accurate, on average, for surgical patients compared to non-surgical patients because treatment plans are known in advance of surgical admissions. We also analyzed the data to identify factors associated with more accurate discharge estimates. In this retrospective observational study, via an analysis of covariance (ANCOVA) approach, we identified factors associated with more accurate discharge estimates for admitted adult patients at VUMC. The primary outcome was the difference between estimated and actual discharge date, and the primary exposure of interest was whether the patient underwent surgery while admitted to the hospital. A total of 304,802 date of discharge estimate entries from 68,587 inpatient encounters met inclusion criteria. After controlling for measured confounding, we found the discharge estimates were more precise as the difference between estimated and actual discharge date narrowed; for each additional day closer to discharge, prediction accuracy improved by .67 days (95% confidence interval [CI], 0.66 to 0.67; p < 0.001), on average. No difference was observed on the primary outcome in patients undergoing surgery compared with non-surgical treatment (0.02 days; 95% CI, 0.00 to 0.03; p = 0.111). Faculty members were found to perform best among all clinicians in predicting estimated discharge date with a 0.24-day better accuracy (95% CI, 0.20 to 0.27; p < 0.001), on average, than other staff. Weekend and holiday, specific clinical teams, staff types, and discharge dispositions were associated with the variability in estimated versus actual discharge date (p < 0.001). Given the widespread variation in current efforts to improve discharge planning and the recommended approach of assigning a discharge date early in the hospital stay, understanding provider estimated discharge dates is an important tool in hospital capacity management. While we did not determine a difference in discharge estimates among surgical and non-surgical patients, we found estimates were more accurate as discharge came nearer and identified notable trends in provider inputs and patient factors. Assessing factors that impact variability in discharge accuracy can allow hospitals to design targeted interventions to improve discharge planning and reduce unnecessary hospital days.


Asunto(s)
Alta del Paciente , Readmisión del Paciente , Adulto , Hospitalización , Humanos , Tiempo de Internación , Estudios Retrospectivos
12.
Anal Chem ; 93(45): 14923-14928, 2021 11 16.
Artículo en Inglés | MEDLINE | ID: mdl-34726372

RESUMEN

Due to the large size and high energy consumption of instruments, field elemental speciation analysis is still challenging so far. In this work, a portable and compact system device (230 mm length × 38 mm width × 84 mm height) was fabricated by using three-dimensional (3D) printing technology for the field speciation analyses of mercury and inorganic selenium. The device comprises a cold vapor generator, photochemical vapor generator, and miniaturized point discharge optical emission spectrometer (µPD-OES). For mercury, inorganic mercury (IHg) was selectively reduced to Hg0 by cold vapor generation, whereas the reductions of both IHg and methylmercury (MeHg) were obtained by photochemical vapor generation (PVG) in the presence of formic acid. For selenium, Se(IV) and total inorganic selenium were converted to their volatile species by PVG in the presence and the absence of nano-TiO2, respectively. The generated volatile species were consequently detected by µPD-OES. Limits of detection of MeHg, IHg, Se(IV), and Se(VI) were 0.1, 0.1, 5.2, and 3.5 µg L-1, respectively. Precision expressed as the relative standard deviations (n = 11) were better than 4.5%. The accuracy and practicality of the proposed method were evaluated by the analyses of Certified Reference Materials (DORM-4, DOLT-5, and GBW(E)080395) and several environmental water samples with satisfactory recoveries (95-103%). This work confirms that 3D printing has great potential to fabricate a simple, miniaturized, easy-to-operate, and low gas and power consuming atomic spectrometer for field elemental speciation analysis.


Asunto(s)
Mercurio , Compuestos de Metilmercurio , Selenio , Gases , Humanos , Alta del Paciente
13.
Artículo en Inglés | MEDLINE | ID: mdl-34769569

RESUMEN

Intensive care unit discharge is an important transition that impacts a patient's wellbeing. Nurses can play an essential role in this scenario, potentiating patient empowerment. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement. Embase), PubMed/MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), CUIDEN Plus, and LILACS databases; these were evaluated in May 2021. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. Quality of the studies included was assessed using the Cochrane risk-of-bias tool. Of the 274 articles initially identified, eight randomized controlled trials that reported on nursing interventions had mainly focused on patients' ICU discharge preparation through information and education. The creation of ICU nurse-led teams and nurses' involvement in critical care multidisciplinary teams also aimed to support patients during ICU discharge. This systematic review provides an update on the clinical practice aimed at improving the patient experience during ICU discharge. The main nursing interventions were based on information and education, as well as the development of new nursing roles. Understanding transitional needs and patient empowerment are key to making the transition easier.


Asunto(s)
Unidades de Cuidados Intensivos , Participación del Paciente , Cuidados Críticos , Humanos , Alta del Paciente
14.
West J Emerg Med ; 22(6): 1257-1261, 2021 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-34787548

RESUMEN

INTRODUCTION: Patients diagnosed with coronavirus disease 2019 (COVID-19) require significant healthcare resources. While published research has shown clinical characteristics associated with severe illness from COVID-19, there is limited data focused on the emergency department (ED) discharge population. METHODS: We performed a retrospective chart review of all ED-discharged patients from Wake Forest Baptist Health and Wake Forest Baptist Health Davie Medical Center between April 25-August 9, 2020, who tested positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from a nasopharyngeal swab using real-time reverse transcription polymerase chain reaction (rRT-PCR) tests. We compared the clinical characteristics of patients who were discharged and had return visits within 30 days to those patients who did not return to the ED within 30 days. RESULTS: Our study included 235 adult patients who had an ED-performed SARS-CoV-2 rRT-PCR positive test and were subsequently discharged on their first ED visit. Of these patients, 57 (24.3%) had return visits to the ED within 30 days for symptoms related to COVID-19. Of these 57 patients, on return ED visits 27 were admitted to the hospital and 30 were not admitted. Of the 235 adult patients who were discharged, 11.5% (27) eventually required admission for COVID-19-related symptoms. With 24.3% patients having a return ED visit after a positive SARS-CoV-2 test and 11.5% requiring eventual admission, it is important to understand clinical characteristics associated with return ED visits. We performed multivariate logistic regression analysis of the clinical characteristics with independent association resulting in a return ED visit, which demonstrated the following: diabetes (odds ratio [OR] 2.990, 95% confidence interval [CI, 1.21-7.40, P = 0.0179); transaminitis (OR 8.973, 95% CI, 2.65-30.33, P = 0.004); increased pulse at triage (OR 1.04, 95% CI, 1.02-1.07, P = 0.0002); and myalgia (OR 4.43, 95% CI, 2.03-9.66, P = 0.0002). CONCLUSION: As EDs across the country continue to treat COVID-19 patients, it is important to understand the clinical factors associated with ED return visits related to SARS-CoV-2 infection. We identified key clinical characteristics associated with return ED visits for patients initially diagnosed with SARS-CoV-2 infection: diabetes mellitus; increased pulse at triage; transaminitis; and complaint of myalgias.


Asunto(s)
COVID-19/diagnóstico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Alta del Paciente , Readmisión del Paciente , SARS-CoV-2/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Prueba de Ácido Nucleico para COVID-19 , Prueba de COVID-19 , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , SARS-CoV-2/genética
15.
Zhonghua Xin Xue Guan Bing Za Zhi ; 49(11): 1094-1101, 2021 Nov 24.
Artículo en Chino | MEDLINE | ID: mdl-34775719

RESUMEN

Objective: To investigate the efficacy and safety of percutaneous closure of ventricular septal rupture (VSR) after acute myocardial infarction (AMI) and the risk factors of all-cause mortality at 30 days after operation. Methods: This is a retrospective case series study. A total of 69 patients with post-AMI VSR, underwent percutaneous closure of VSR from October 2013 to May 2020 in Department of Cardiology of Henan Provincial People's Hospital and Department of Cardiology of Central China Fuwai Hospital, were included. Patients were divided into survival group (53 cases) and non-survival group (16 cases) according to the status at 30 days after operation. Clinical data were collected and analyzed during hospitalization. Telephone follow-up was performed 30 days after operation. The primary safety endpoint was occlusion failure and all-cause mortality at 30 days post operation. The secondary safety endpoint was the operation related or non-operation related complications. Efficacy endpoint included NYHA classification of cardiac function, index measured by right heart catheterization and echocardiography. Multivariate logistic regression was performed to analyze the risk factors of all-cause mortality at 30 days after operation. Results: A total of 69 patients, aged 67 (64, 71) years, including 42 women (60.9%), were enrolled in this study. All-cause death occurred in 16 patients (23.2%), including 13 in-hospital death and 3 death during follow-up. There were 4 cases of closure failure (5.8%). Among the 65 patients with successful closure, 12 (18.5%) experienced operation-related complications, among which 8 (12.3%) experienced valve injury. The mortality was significantly higher in patients with operation-related complications than that in patients without operation-related complications (41.7% (5/12) vs. 13.2% (7/53), P = 0.022). One case received percutaneous closure of VSR and PCI, this patient experienced new-onset AMI immediately post procedure and died thereafter (1.5%). One case (1.5%) developed multiple organ failure and 2 cases (3.1%) developed gastrointestinal bleeding post operation. All of the 65 patients with successful occlusion completed postoperative echocardiography, 56 patients completed cardiac function assessment at discharge, and 53 patients who survived up to 30 days post discharge completed clinical follow up by telephone. The NYHA cardiac function at discharge and 30 days after operation were significantly improved as compared to that before operation (P<0.001), the ratio of NYHA Ⅰ and Ⅱ patients was significantly higher post operation at these two time points as compared to baseline level (76.8% (43/56) vs. 23.1% (15/65), P<0.001, 77.4% (41/53) vs. 23.1% (15/65), P<0.001). The pulmonary circulation/systemic circulation blood flow ratio (Qp/Qs), pulmonary artery systolic pressure (PASP) and left ventricular end-diastolic diameter (LVDd) were decreased, aortic systolic pressure (ASP) and left ventricular ejection fraction (LVEF) were increased post operation (P<0.05). Multivariate logistic regression analysis showed that WBC>9.8×109/L (OR=20.94, 95%CI 1.21-362.93, P=0.037) and NT-ProBNP>6 000 ng/L (OR=869.11, 95%CI 2.93-258 058.34, P=0.020) were the independent risk factors of mortality at 30 days. Conclusions: Percutaneous closure in VSR after AMI is safe and effective. The increase of WBC and NT-ProBNP are the independent risk factors of all-cause mortality at 30 days after operation.


Asunto(s)
Infarto del Miocardio , Intervención Coronaria Percutánea , Rotura Septal Ventricular , Cuidados Posteriores , Femenino , Mortalidad Hospitalaria , Humanos , Alta del Paciente , Estudios Retrospectivos , Volumen Sistólico , Función Ventricular Izquierda , Rotura Septal Ventricular/etiología , Rotura Septal Ventricular/cirugía
17.
Health Technol Assess ; 25(67): 1-76, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34816795

RESUMEN

BACKGROUND: Acute otitis media is a painful infection of the middle ear that is commonly seen in children. In some children, the eardrum spontaneously bursts, discharging visible pus (otorrhoea) into the outer ear. OBJECTIVE: To compare the clinical effectiveness of immediate topical antibiotics or delayed oral antibiotics with the clinical effectiveness of immediate oral antibiotics in reducing symptom duration in children presenting to primary care with acute otitis media with discharge and the economic impact of the alternative strategies. DESIGN: This was a pragmatic, three-arm, individually randomised (stratified by age < 2 vs. ≥ 2 years), non-inferiority, open-label trial, with economic and qualitative evaluations, supported by a health-record-integrated electronic trial platform [TRANSFoRm (Translational Research and Patient Safety in Europe)] with an internal pilot. SETTING: A total of 44 English general practices. PARTICIPANTS: Children aged ≥ 12 months and < 16 years whose parents (or carers) were seeking medical care for unilateral otorrhoea (ear discharge) following recent-onset (≤ 7 days) acute otitis media. INTERVENTIONS: (1) Immediate ciprofloxacin (0.3%) solution, four drops given three times daily for 7 days, or (2) delayed 'dose-by-age' amoxicillin suspension given three times daily (clarithromycin twice daily if the child was penicillin allergic) for 7 days, with structured delaying advice. All parents were given standardised information regarding symptom management (paracetamol/ibuprofen/fluids) and advice to complete the course. COMPARATOR: Immediate 'dose-by-age' oral amoxicillin given three times daily (or clarithromycin given twice daily) for 7 days. Parents received standardised symptom management advice along with advice to complete the course. MAIN OUTCOME MEASURE: Time from randomisation to the first day on which all symptoms (pain, fever, being unwell, sleep disturbance, otorrhoea and episodes of distress/crying) were rated 'no' or 'very slight' problem (without need for analgesia). METHODS: Participants were recruited from routine primary care appointments. The planned sample size was 399 children. Follow-up used parent-completed validated symptom diaries. RESULTS: Delays in software deployment and configuration led to small recruitment numbers and trial closure at the end of the internal pilot. Twenty-two children (median age 5 years; 62% boys) were randomised: five, seven and 10 to immediate oral, delayed oral and immediate topical antibiotics, respectively. All children received prescriptions as randomised. Seven (32%) children fully adhered to the treatment as allocated. Symptom duration data were available for 17 (77%) children. The median (interquartile range) number of days until symptom resolution in the immediate oral, delayed oral and immediate topical antibiotic arms was 6 (4-9), 4 (3-7) and 4 (3-6), respectively. Comparative analyses were not conducted because of small numbers. There were no serious adverse events and six reports of new or worsening symptoms. Qualitative clinician interviews showed that the trial question was important. When the platform functioned as intended, it was liked. However, staff reported malfunctioning software for long periods, resulting in missed recruitment opportunities. Troubleshooting the software placed significant burdens on staff. LIMITATIONS: The over-riding weakness was the failure to recruit enough children. CONCLUSIONS: We were unable to answer the main research question because of a failure to reach the required sample size. Our experience of running an electronic platform-supported trial in primary care has highlighted challenges from which we have drawn recommendations for the National Institute for Health Research (NIHR) and the research community. These should be considered before such a platform is used again. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12873692 and EudraCT 2017-003635-10. FUNDING: This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 67. See the NIHR Journals Library website for further project information.


Asunto(s)
Antibacterianos , Otitis Media , Antibacterianos/uso terapéutico , Niño , Preescolar , Análisis Costo-Beneficio , Electrónica , Femenino , Humanos , Masculino , Otitis Media/tratamiento farmacológico , Alta del Paciente , Evaluación de la Tecnología Biomédica
18.
Sensors (Basel) ; 21(22)2021 Nov 12.
Artículo en Inglés | MEDLINE | ID: mdl-34833586

RESUMEN

Hospital readmissions impose an extreme burden on both health systems and patients. Timely management of the postoperative complications that result in readmissions is necessary to mitigate the effects of these events. However, accurately predicting readmissions is very challenging, and current approaches demonstrated a limited ability to forecast which patients are likely to be readmitted. Our research addresses the challenge of daily readmission risk prediction after the hospital discharge via leveraging the abilities of mobile data streams collected from patients devices in a probabilistic deep learning framework. Through extensive experiments on a real-world dataset that includes smartphone and Fitbit device data from 49 patients collected for 60 days after discharge, we demonstrate our framework's ability to closely simulate the readmission risk trajectories for cancer patients.


Asunto(s)
Alta del Paciente , Readmisión del Paciente , Predicción , Humanos , Complicaciones Posoperatorias , Factores de Riesgo
19.
BMJ ; 375: e066534, 2021 11 10.
Artículo en Inglés | MEDLINE | ID: mdl-34759038

RESUMEN

OBJECTIVE: To determine the use of epinephrine (adrenaline) before defibrillation for treatment of in-hospital cardiac arrest due to a ventricular arrhythmia and examine its association with patient survival. DESIGN: Propensity matched analysis. SETTING: 2000-18 data from 497 hospitals participating in the American Heart Association's Get With The Guidelines-Resuscitation registry. PARTICIPANTS: Adults aged 18 and older with an index in-hospital cardiac arrest due to an initial shockable rhythm treated with defibrillation. INTERVENTIONS: Administration of epinephrine before first defibrillation. MAIN OUTCOME MEASURES: Survival to discharge; favorable neurological survival, defined as survival to discharge with none, mild, or moderate neurological disability measured using cerebral performance category scores; and survival after acute resuscitation (that is, return of spontaneous circulation for >20 minutes). A time dependent, propensity matched analysis was performed to adjust for confounding due to indication and evaluate the independent association of epinephrine before defibrillation with study outcomes. RESULTS: Among 34 820 patients with an initial shockable rhythm, 9630 (27.6%) were treated with epinephrine before defibrillation, contrary to current guidelines. In comparison with participants treated with defibrillation first, participants receiving epinephrine first were less likely to have a history of myocardial infarction or heart failure, but more likely to have renal failure, sepsis, pneumonia, and receive mechanical ventilation before in-hospital cardiac arrest (P<0.0001 for all). Treatment with epinephrine before defibrillation was strongly associated with delayed defibrillation (median 3 minutes v 0 minutes). In propensity matched analysis (9011 matched pairs), epinephrine before defibrillation was associated with lower odds of survival to discharge (25.2% v 29.9%; adjusted odds ratio 0.81, 95% confidence interval 0.74 to 0.88; P<0.001), favorable neurological survival (18.6% v 21.4%; 0.85, 0.76 to 0.92; P<0.001), and survival after acute resuscitation (64.4% v 69.4%; 0.76, 0.70 to 0.83; P<0.001). The above findings were consistent in a range of sensitivity analyses, including matching according to defibrillation time. CONCLUSIONS: Contrary to current guidelines that prioritize immediate defibrillation for in-hospital cardiac arrest due to a shockable rhythm, more than one in four patients are treated with epinephrine before defibrillation, which is associated with worse survival.


Asunto(s)
Cardioversión Eléctrica/mortalidad , Epinefrina/administración & dosificación , Paro Cardíaco/terapia , Adulto , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/mortalidad , Cardioversión Eléctrica/métodos , Femenino , Paro Cardíaco/etiología , Paro Cardíaco/mortalidad , Humanos , Masculino , Alta del Paciente/estadística & datos numéricos , Puntaje de Propensión , Sistema de Registros , Factores de Tiempo , Resultado del Tratamiento
20.
Ann Palliat Med ; 10(10): 11083-11105, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34763470

RESUMEN

BACKGROUND: The aim of this study was to identify risk factors for 30-day readmission in ischemic stroke survivors, with an attempt to improve post-discharge care and lower the 30-day readmission rate. METHODS: Seven databases were searched from inception to April 30, 2021. Retrospective or prospective observational studies and interventional studies focusing on 30-day readmission risk factors in patients with ischemic stroke were included. Two authors independently screened the literature and evaluated the quality of the studies using the Newcastle-Ottawa scale (NOS). The pooled effect size was estimated using the odds ratio (OR), and the corresponding 95% confidence interval (CI) was calculated. The Cochrane Q (χ2) and I2 tests were used to assess heterogeneity among studies, and each risk factor was tested for its robustness using fixed- or random-effects models. RESULTS: A total of 17 retrospective observational studies from the United States (n=10), China (n=2), Republic of Korea (n=2), Norway (n=2), and Australia (n=1), comprising a total of 1,829,964 patients, were included. The 30-day readmission rates of ischemic stroke survivors ranged from 1.41% to 27.64%, with a mean value of 10.66%±6.87%. We finally identified 6 risk factors: history of stroke (OR, 1.33; 95% CI: 1.08-1.64; P=0.007), diabetes mellitus (OR, 1.15; 95% CI: 1.13-1.17; P<0.001), hypertension (OR, 1.10; 95% CI: 1.07-1.13; P<0.001), atrial fibrillation (OR, 1.26; 95% CI: 1.23-1.29; P<0.001), heart failure (OR, 1.59; 95% CI: 1.56-1.63; P<0.001), and age, among which age was determined by descriptive analysis. Four risk factors were ruled out: hyperlipidemia (OR, 1.01; 95% CI: 0.87-1.17; P=0.91), coronary artery disease (OR, 0.83; 95% CI: 0.73-0.96; P=0.009), smoking (OR, 0.97; 95% CI: 0.83-1.14; P=0.71), and gender (female, OR, 0.97; 95% CI: 0.96-0.98; P<0.001). DISCUSSION: The 30-day readmission rates of ischemic stroke survivors ranged from 1.41% to 27.64% and remained challenging. We found that stroke history, diabetes mellitus, hypertension, atrial fibrillation, heart failure, and advanced age were risk factors for 30-day readmission, whereas hyperlipidemia, coronary artery disease, smoking, and gender were not. All the studies included in this analysis were case-control studies, and thus causality cannot be inferred. Furthermore, recall bias may be present.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Cuidados Posteriores , Femenino , Humanos , Estudios Observacionales como Asunto , Alta del Paciente , Readmisión del Paciente , Estudios Retrospectivos , Factores de Riesgo
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