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1.
Rev Bras Epidemiol ; 23: e200006, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32130395

RESUMEN

INTRODUCTION: Systemic arterial hypertension (SAH) has a high prevalence in Brazil and impacts on the use of health services. OBJECTIVE: This study verified the influence of the Family Health Strategy (FHS) on the use of health services by adults ≥ 18 years old who reported SAH in the National Health Survey (Pesquisa Nacional de Saúde - PNS) 2013. METHODS: The Propensity Score (PS) method was used to correct the lack of homogeneity between the groups with SAH under exposed or not to the FHS. PS was estimated using binary logistic regression, which reflected the conditional probability of receiving the household register in the FHS according to socioeconomic, demographic and health covariates of adults and their families. After estimating the PS, the stratification was used to group hypertensive adults into five mutually exclusive strata (pairing them). Prevalence and confidence intervals at 95% were estimated of medical consultations and hospitalizations. The effects of the complex NHS sampling were incorporated into all phases of the analysis. RESULTS: It was verified that hypertensive adults enrolled in FHS had worse socioeconomic, health and health conditions, but similar prevalence of medical consultations and hospitalizations to adults without a FHS registry and with better living and health conditions. The FHS has attenuated individual and contextual inequalities that impact the health of Brazilians by favoring the use of health services. CONCLUSION: The FHS can favor the care and control of SAH in Brazil. Thus, it must receive investments that guarantee its effectiveness.


Asunto(s)
Salud de la Familia , Servicios de Salud/estadística & datos numéricos , Hipertensión/epidemiología , Hipertensión/prevención & control , Programas Nacionales de Salud/estadística & datos numéricos , Anciano , Brasil/epidemiología , Composición Familiar , Femenino , Encuestas de Atención de la Salud , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Factores Socioeconómicos
3.
; Brasil.
Recurso de Internet en Portugués | LIS - Localizador de Información en Salud, LIS-bvsms | ID: lis-LISBR1.1-47008

RESUMEN

O fórum de dois dias foi realizado em linha com o Projeto de Pesquisa e Desenvolvimento da OMS – uma estratégia para desenvolver medicamentos e vacinas antes de as epidemias ocorrem, além de acelerar a pesquisa e o desenvolvimento enquanto elas ocorrem.


Asunto(s)
Prioridades en Salud , Coronavirus , Encuestas de Atención de la Salud/métodos
6.
Pneumologie ; 74(2): 103-111, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31935761

RESUMEN

In the EU, five biologics have been approved as add-on therapy for patients with severe asthma. Until recently, none of the biologics was approved for home use and had to be administered under medical supervision, a time-consuming schedule for both patients and physicians, accompanied by greater expenditure. However, over the last year, four out of the five biologics have been granted approval for patient self-administration at home. The objective of this multiple-choice survey was to understand how patients with severe asthma treated with omalizumab and their treating physicians view the potential home use of biologics exemplified by omalizumab. The questionnaires were answered by 120 physicians and 432 patients (response rate: 51.7 % and 20.6 %, respectively). Overall, 44.7 % of patients were in favour of self-administration at home while 30.6 % opposed this method of administration and 23.8 % of patients were neutral. Especially teenagers and young adults had a positive attitude towards self-administration. 76.7 % of the questioned physicians were in favour of home use for certain patients. Time saving was the main advantage for self-administration mentioned by patients (53.2 %) as well as by physicians (72.5 %). The main concern for patients was 'making a mistake while injecting' (43.8 %) while 'forgetting to inject omalizumab' (73.3 %) was the main concern for physicians. 44.4 % of patients expressed a wish for individual training and 70.8 % of physicians agreed with this statement. The latter group also considered a starter kit including several information materials (54.2 %) as well as an electronic reminder system (50.8 %) as useful. In conclusion, self-administration of biologics has the potential to be timesaving for both patients and physicians.


Asunto(s)
Antialérgicos/administración & dosificación , Antiasmáticos/administración & dosificación , Anticuerpos Monoclonales Humanizados/uso terapéutico , Asma/tratamiento farmacológico , Productos Biológicos/administración & dosificación , Omalizumab/administración & dosificación , Autoadministración , Adolescente , Adulto , Antialérgicos/uso terapéutico , Antiasmáticos/uso terapéutico , Anticuerpos Monoclonales Humanizados/administración & dosificación , Productos Biológicos/uso terapéutico , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Encuestas y Cuestionarios , Adulto Joven
7.
J Nurs Adm ; 50(2): 72-77, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31929345

RESUMEN

OBJECTIVE: To examine whether end-of-life care quality is superior in Magnet hospitals, a recognition designating nursing excellence. BACKGROUND: Considerable research shows better patient outcomes in hospitals with excellent nurse work environments, but end-of-life care quality has not been studied in Magnet hospitals. METHODS: An analysis of cross-sectional data was completed using surveys of nurses and hospitals. Multivariate logistic regression models were used to determine the association between Magnet hospitals and measures of end-of-life care quality. RESULTS: Overall, nurses report poor quality of end-of-life care in US hospitals. In Magnet hospitals, nurses were significantly less likely to give their hospital an unfavorable rating on end-of-life care. CONCLUSIONS: Hospital Magnet status may signal better quality in end-of-life care. Administrators looking to improve the quality of end-of-life care may consider improving aspects of nursing that distinguish Magnet hospitals.


Asunto(s)
Hospitales/estadística & datos numéricos , Personal de Enfermería en Hospital/psicología , Personal de Enfermería en Hospital/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Cuidado Terminal/psicología , Cuidado Terminal/normas , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Cultura Organizacional , Cuidado Terminal/estadística & datos numéricos , Estados Unidos
8.
High Blood Press Cardiovasc Prev ; 27(1): 43-49, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31916208

RESUMEN

INTRODUCTION: Albuminuria is an early marker of kidney disease and reduction of albuminuria translates into a decreased occurrence of cardiovascular and renal outcomes. AIMS: To evaluate the changes in the prevalence of albuminuria in diabetic hypertensive patients treated with several combinations of renin-angiotensin aldosterone system with calcium channel blockers. METHODS: We analysed data from 668 unselected patients from the PAIT survey (mean age 60.4 ± 10.2 years, prevalence of males 38%), with and without albuminuria, maintained for 6 months with the previous treatment with amlodipine-valsartan, amlodipine perindopril, lercanidipine-enalapril, verapamil-trandolapril, nitrendipine-enalapril and felodipine-ramipril Albuminuria was assessed, as urinary albumin-creatinine ratio, using a Multistic-Clinitek device analyzer. Microalbuminuria was defined as a loss of 3.4-33.9 mg albumin/mmol creatinine (30-300 mg/g) and macroalbuminuria as a loss of > 33.9 mg albumin/mmol creatinine (> 300 mg/g). Blood pressure was measured with a validated digital device. RESULTS: At baseline, albuminuria was present in 310 subjects (46.4%) (microalbuminuria in 263 (84.8%), macroalbuminuria in 15.2%), and normoalbuminuria in 53.6% 358. After 6 months, the prevalence of subjects with albuminuria was significantly lowered (p < 0.01) by 23.5% (microalbuminuria - 23.9%, p < 0.01 and macroalbuminuria - 21.3%). The prevalence of subjects with microalbuminuria was reduced with all treatments: amlodipine-valsartan - 15.6%, amlodipine-perindopril - 11.8%, lercanidipine-enalapril - 41.3% and verapamil-trandolapril - 19.2%. Data with nitrendipine-enalapril and felodipine-ramipril were not analyzed, due to the low number of patients. The frequency of patients with normoalbuminuria was significantly higher (p < 0.01) with lercanidipine-enalapril compared with any other treatment. Blood pressure was significantly (p < 0.01) reduced, with a similar effect between treatments. CONCLUSIONS: The treatments decrease the prevalence of subjects with albuminuria, showing a significant difference among the different drug combinations, favoring the use of new dihydropyridine calcium channel blockers, such as lercanidipine, combined with RAAS inhibitors, to control albuminuria in diabetic hypertensive patients.


Asunto(s)
Albuminuria/prevención & control , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/uso terapéutico , Diabetes Mellitus/epidemiología , Nefropatías Diabéticas/epidemiología , Hipertensión/tratamiento farmacológico , Insuficiencia Renal Crónica/epidemiología , Anciano , Albuminuria/diagnóstico , Albuminuria/epidemiología , Albuminuria/fisiopatología , Presión Sanguínea/efectos de los fármacos , Estudios Transversales , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatología , Nefropatías Diabéticas/diagnóstico , Nefropatías Diabéticas/fisiopatología , Quimioterapia Combinada , Europa (Continente)/epidemiología , Femenino , Encuestas de Atención de la Salud , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Prevalencia , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Sistema Renina-Angiotensina/efectos de los fármacos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
9.
Epidemiol Psychiatr Sci ; 29: e92, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31928567

RESUMEN

AIMS: Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India. METHODS: We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression. RESULTS: We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98-1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small. CONCLUSIONS: Geographic accessibility - as measured by travel distance - is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.


Asunto(s)
Depresión/terapia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Conducta de Búsqueda de Ayuda , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud , Población Rural/estadística & datos numéricos , Viaje/estadística & datos numéricos , Adulto , Estudios Transversales , Depresión/diagnóstico , Depresión/psicología , Femenino , Sistemas de Información Geográfica , Encuestas de Atención de la Salud , Investigación sobre Servicios de Salud , Humanos , India , Masculino , Vigilancia de la Población , Factores de Tiempo
10.
BMC Public Health ; 20(1): 4, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906905

RESUMEN

BACKGROUND: In China, addressing disparities in the HIV epidemic among men who have sex with men (MSM) requires targeted efforts to increase their engagement and retention in prevention. In an effort to advance MSM-friendly HIV services within China, and informed by community-based partnerships, we tested whether MSM who have ever versus never disclosed their same-sex behavior to healthcare providers (HCP) differ in sociodemographic and behavioral characteristics as well as the qualities of sexual health services each group would prefer to access. METHODS: We conducted a cross-sectional survey among HIV-negative MSM who went to MSM-focused voluntary counseling and testing clinics in four cities in China. The survey was anonymous and collected information on sociodemographic characteristics, testing behaviors, sexual-health related behavior, and sexual health service model preferences. RESULTS: Of 357 respondents, 68.1% participants had ever disclosed same-sex behavior to HCPs when seeking advice for sexual health. Younger age (aOR = 1.04; 95% CI: 1.01-1.08), and worry of HIV acquisition (aOR = 1.39; 95% CI: 1.05-1.84) were associated with higher odds of past disclosure. The availability of comprehensive sexual health services was one of the most valued characteristics of the ideal sexual health clinic. Those who ever disclosed and never disclosed differed significantly in their ranking of the importance of three out of ten dimensions: sexual health counseling services available (M = 3.99 vs. M = 3.65, p = .002), gay identity support available (M = 3.91 vs. M = 3.62, p = .016) and clinic collaborates with a gay CBO (M = 3.81 vs. M = 3.56, p = .036). CONCLUSIONS: Our hypothesis that MSM who had disclosed versus never disclosed same-sex behavior would differ in the value they placed on different dimensions of sexual health service was partially borne out. As health authorities in China decide on implementation models for pre-exposure prophylaxis (PrEP) delivery and specifically within which institutions to integrate PrEP services, the preferences of target populations should be considered to develop comprehensive, patient-centric and LGBT-friendly services.


Asunto(s)
Revelación/estadística & datos numéricos , Infecciones por VIH/prevención & control , Homosexualidad Masculina/psicología , Prioridad del Paciente/estadística & datos numéricos , Minorías Sexuales y de Género/psicología , Adulto , China , Ciudades , Estudios Transversales , Encuestas de Atención de la Salud , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Atención Dirigida al Paciente/organización & administración , Relaciones Médico-Paciente , Minorías Sexuales y de Género/estadística & datos numéricos
11.
BMC Public Health ; 20(1): 5, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31906964

RESUMEN

BACKGROUND: Studies from European and non-European countries have shown that migrants utilize cervical cancer screening less often than non-migrants. Findings from Germany are inconsistent. This can be explained by several limitations of existing investigations, comprising residual confounding and data which is restricted to only some regions of the country. Using data from a large-scale and nationwide population survey and applying the Andersen Model of Health Services Use as the theoretical framework, the aim of the present study was to examine the role that different predisposing, enabling and need factors have for the participation of migrant and non-migrant women in cervical cancer screening in Germany. METHODS: We used data from the 'German Health Update 2014/2015' survey on n = 12,064 women ≥20 years of age. The outcome of interest was the participation in cancer screening (at least once in lifetime vs. no participation). The outcome was compared between the three population groups of non-migrants, migrants from EU countries and migrants from non-EU countries. We employed multivariable logistic regression to examine the role of predisposing, enabling and need factors. RESULTS: Non-EU and EU migrant women reported a lower utilization of cervical cancer screening (50.1 and 52.7%, respectively) than non-migrant women (57.2%). The differences also remained evident after adjustment for predisposing, enabling and need factors. The respective adjusted odds ratios (OR) for non-EU and EU migrants were OR = 0.67 (95%-CI = 0.55-0.81) and OR = 0.80 (95%-CI = 0.66-0.97), respectively. Differences between migrants and non-migrants were particularly pronounced for younger age groups. Self-rated health was associated with participation in screening only in non-migrants, with a poorer health being indicative of a low participation in cancer screening. CONCLUSIONS: The disparities identified are in line with findings from studies conducted in other countries and are indicative of different obstacles this population group encounters in the health system. Implementing patient-oriented health care through diversity-sensitive health services is necessary to support informed decision-making.


Asunto(s)
Detección Precóz del Cáncer/estadística & datos numéricos , Migrantes/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Femenino , Alemania , Encuestas de Atención de la Salud , Humanos , Persona de Mediana Edad , Adulto Joven
12.
Medicine (Baltimore) ; 99(2): e18525, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914025

RESUMEN

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.


Asunto(s)
Epidemias/prevención & control , Infecciones por VIH/epidemiología , VIH/aislamiento & purificación , Tamizaje Masivo/métodos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Estudios Transversales , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Encuestas de Atención de la Salud/métodos , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Consultorios Médicos/estadística & datos numéricos , Pruebas Serológicas/métodos , Pruebas Serológicas/estadística & datos numéricos , Estados Unidos/epidemiología , Adulto Joven
13.
J Stroke Cerebrovasc Dis ; 29(1): 104464, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31699576

RESUMEN

INTRODUCTION: Emergency departments play a key role in the diagnosis and treatment of transient ischemic attacks, but limited data are available about the early management of such patients in emergency wards. Therefore, we aimed to evaluate emergency physicians' management of transient ischemic attack and analyze variations factors. METHODS: A multicenter survey among emergency physicians of the Grand Est region network (Est-RESCUE) was conducted from January 28th to March 28th, 2019. Medical and administrative data were collected by the same network and the national directory of medical resources. RESULTS: Among 542 emergency physicians recipients, 78 answered (14%) and 71 were finally included, practicing in 25 public hospitals homogeneously distributed across the territory, including 3 university hospitals. A cerebral magnetic resonance imaging was obtained for 75%-100% of patients by 4.3% of responders, 36.4% of which were performed within more than 24 hours. A cardiac monitoring was prescribed in 75%-100% of cases by 32.4% of responders. A neurologic consultation was routinely requested by 84.6% of responders practicing in a university hospital and 36.8% of responders practicing in a community hospital (P = .02). Patients were hospitalized in a neurovascular unit in 75%-100% of cases by 17.4% of responders, which happened more likely in university hospitals (P < .001). CONCLUSIONS: Transient ischemic attack suffers from management disparities across territories, due to limited access to technical facilities and neurologic consultations. Therefore, international recommendations are too often not followed. Implementation of territorial neurovascular tracks may help to standardize the management of these patients.


Asunto(s)
Servicio de Urgencia en Hospital/tendencias , Disparidades en Atención de Salud/tendencias , Hospitales/tendencias , Ataque Isquémico Transitorio/terapia , Pautas de la Práctica en Medicina/tendencias , Tiempo de Tratamiento/tendencias , Adulto , Femenino , Francia , Encuestas de Atención de la Salud , Hospitalización/tendencias , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Derivación y Consulta/tendencias , Factores de Tiempo , Resultado del Tratamiento
14.
Public Health ; 178: 82-89, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31644986

RESUMEN

OBJECTIVES: To our knowledge, there has been limited description of emergency department (ED) visits involving homeless patients over the last decade. Our study aims to analyze US national survey data to elucidate the differences between homeless and non-homeless patients' ED visits in terms of patient demographics, resource utilization, and diagnoses received. STUDY DESIGN: This was a retrospective study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005 until 2015. METHODS: Patient visits were classified as homeless or non-homeless based on survey data; appropriate statistical analyses were subsequently performed to compare these groups in terms of patient demographics, geography, payment method, resource utilization/diagnostic service use, as well as both psychiatric and non-psychiatric diagnoses received in the ED. RESULTS: NHAMCS data from 2005 to 2015 were aggregated. In total, 303,326 patient visits were included, which represent an estimated 1.30 billion ED visits over this period. Of these, 2750 encounters were by homeless people, representing 8,781,925 ED visits. Compared with non-homeless visits, homeless patients were disproportionately male, black, non-Hispanic, and seen in large metropolitan areas or the Western/Southern US. Homeless visits were more likely to be related to an injury (47.5% vs. 33.8%), related to an assault (4.2% vs. 1.3%), or self-inflicted (4.8% vs 0.84%). Homeless patients were also more likely to have been seen in the same ED within 72 h (7.3% vs. 3.9%) compared with non-homeless patients (3.9%, 95% confidence interval [CI]: 3.5-4.4) and were seen an average of 5.7 times (95% CI: 4.7-6.8) in the same ED over the preceding 12 months, with non-homeless patients seen an average of 3.2 times (95% CI: 3.1-3.4). Homeless patients were more likely to be admitted to the hospital (14.9% vs. 11.2%) and, when admitted, spent an average of 6.3 days in the hospital (95% CI: 5.6-7.1) compared with non-homeless patients at 5.2 (95% CI: 5.1-5.3). In total, 28.4% of homeless patients received a psychiatric diagnosis (95% CI: 25.8-31.2) compared with 5.4% for non-homeless patients (95% CI: 5.2-5.7, P < 0.001). In reference to non-homeless visits, homeless visits showed increased odds of alcohol-related diagnoses (odds ratio [OR]: 17.3, 95% CI: 10.1-29.8, P < 0.001) and substance abuse diagnoses (OR: 8.4, 95% CI: 7.2-9.8, P < 0.001). Homeless visits also exhibited greatly increased odds of diagnosis of schizophrenia (OR: 16.6, 95% CI: 12.6-22.5, P < 0.001) and personality disorders (OR: 15.4, 95% CI: 6.4-36.9, P < 0.001). CONCLUSIONS: Less than one in 100 US ED visits in 2005-2015 were made by homeless patients. Compared with the non-homeless, homeless patients had greatly increased rates of ED care for alcohol-related, substance abuse-related, and mental health-related problems, particularly schizophrenia and personality disorders. Homeless patients were also more likely to be seen in the ED within the past 72 h or the past 12 months. Homeless patients were more likely to be admitted to the hospital and, when admitted, exhibited longer stay times.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Personas sin Hogar/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos , Adulto Joven
15.
World Neurosurg ; 133: e428-e433, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31525483

RESUMEN

BACKGROUND: A paucity of randomized trials have compared prophylactic dose of unfractionated heparin (UFH) versus low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolic events in spinal surgery. Our objective was to determine the most prevalent chemoprophylactic techniques in spine surgery. METHODS: The Accreditation Council for Graduate Medical Education was queried for all neurosurgical residency programs, which were subsequently sent an electronic survey about prophylactic UFH versus LMWH in spine surgery for (1) degenerative/deformity, (2) traumatic, and (3) neoplastic pathologies. RESULTS: Of 69 unique responding residencies, the first dose of chemoprophylaxis for degenerative/deformity spinal disease started most commonly on postoperative day (POD) 1 in 75.3% of neurosurgery programs, followed by POD 2 in 10.1% of programs, POD 0 (same day of surgery) in 8.7% of programs, POD 3 in 1.4% of programs, and morning of surgery in 1.4% of programs. Choice of postoperative chemoprophylaxis did not differ statistically significantly between UFH versus LMWH: 56.5% versus 36.2% in degenerative/deformity pathologies (P = 0.080) and 50.7% versus 43.4% in traumatic pathologies (P = 0.535). Three programs (4.3%) in both the degenerative/deformity and trauma groups documented no chemoprophylaxis. Neoplastic pathologies saw a statistically significantly higher proportion of prophylactic UFH (60.8%) compared with prophylactic LMWH (36.2%) (P = 0.037). One program (1.4%) in the neoplastic group did not utilize chemoprophylaxis. Two institutions (2.8%) in the degenerative/deformity cohort and 1 institution (1.4%) in the trauma and cancer cohorts reported "other". CONCLUSIONS: Prophylactic UFH was statistically more common than LMWH in neoplastic spinal surgery, but not in the degenerative/deformity and trauma groups (cohorts). Further trials are warranted.


Asunto(s)
Anticoagulantes/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Heparina/uso terapéutico , Neurocirugia/educación , Procedimientos Neuroquirúrgicos , Complicaciones Posoperatorias/prevención & control , Enfermedades de la Columna Vertebral/cirugía , Tromboembolia Venosa/prevención & control , Anticoagulantes/administración & dosificación , Quimioprevención/métodos , Esquema de Medicación , Encuestas de Atención de la Salud , Heparina/administración & dosificación , Heparina de Bajo-Peso-Molecular/administración & dosificación , Humanos , Internado y Residencia , Neoplasias de la Columna Vertebral/cirugía , Estados Unidos
16.
Ann Otol Rhinol Laryngol ; 129(2): 142-148, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31559860

RESUMEN

BACKGROUND: The prevalence of opioid abuse has become epidemic in the United States. Microdirect laryngoscopy (MDL) is a common otolaryngological procedure, yet prescribing practices for opioids following this operation are not well characterized. OBJECTIVE: To characterize current opioid-prescribing patterns among otolaryngologists performing MDL. METHODS: A cross-sectional survey of otolaryngologists at a national laryngology meeting. RESULTS: Fifty-eight of 205 physician registrants (response rate 28%) completed the survey. Fifty-nine percent of respondents were fellowship-trained in laryngology. Respondents performed an average of 13.3 MDLs per month. Thirty-four percent of surgeons prescribe opioids for over two-thirds of their MDLs, while only 7% of surgeons never prescribe opioids. Eighty-eight percent of surgeons prescribed a combination opioid and acetaminophen compound, hydrocodone being the most common opioid component. Many surgeons prescribe non-opioid analgesics as well, with 70% and 84% of surgeons recommending acetaminophen and ibuprofen after MDL respectively. When opioids were prescribed, patient preference, difficult exposure and history of opioid use were the most influential patient factors. Concerns of opioid abuse, the physician role in the opioid crisis, and literature about postoperative non-opioid analgesia were also underlying themes in influencing opioid prescription patterns after MDL. CONCLUSIONS: In this study, over 90% of practicing physicians surveyed are prescribing opioids after MDL, though many are also prescribing non-opioid analgesia as well. Further studies should be completed to investigate the needs of patients following MDL in order to allow physicians to selectively and appropriately prescribe opioid analgesia postoperatively.


Asunto(s)
Analgésicos Opioides , Prescripciones de Medicamentos/estadística & datos numéricos , Laringoscopía , Otolaringología , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Analgésicos , Estudios Transversales , Encuestas de Atención de la Salud , Humanos , Laringoscopía/métodos
17.
Radiol Med ; 125(3): 329-335, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31832987

RESUMEN

INTRODUCTION: The management of patients bearing a cardiac implantable electronic device and needing a radiotherapy treatment is an important clinical scenario. The aim of this survey was to evaluate the level of awareness within the Italian Radiation Oncologist community on this topic. MATERIALS AND METHODS: A survey was promoted by the Young Group of Italian Association of Radiotherapy and Clinical Oncology (AIRO) with a questionnaire made up of 22 questions allowing for multiple answers, which was administered, both online and on paper version. It was addressed to Radiation Oncologists, AIRO members, participating in the National Congress held in 2015. RESULTS: A total of 113 questionnaires were collected back and analyzed (survey online: 50 respondents; paper version: 63). The answers showed a good level of awareness on the issue, but with a nonhomogeneous adherence to the different published guidelines (GL). There is a general low rate of referral for a preliminary cardiological evaluation in patients bearing PM/ICDs, in line with some published surveys; nevertheless, a focused attention to certain specific treatment factors and patient-centered point of view emerged. CONCLUSIONS: A generally good awareness of this topic was shown but homogeneous application of GL was not observed, possibly due to the multiplicity of available GL. A prospective data collection could help to better clarify the shadows on this topics.


Asunto(s)
Desfibriladores Implantables , Adhesión a Directriz , Marcapaso Artificial , Oncología por Radiación , Radioterapia , Adulto , Desfibriladores Implantables/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Encuestas de Atención de la Salud/estadística & datos numéricos , Humanos , Italia , Marcapaso Artificial/estadística & datos numéricos , Dosis de Radiación , Oncología por Radiación/estadística & datos numéricos , Sociedades Médicas
18.
Tumori ; 106(1): 25-32, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31456509

RESUMEN

BACKGROUND: Several approaches towards pain control for admitted cancer patients have been suggested by the literature without achieving satisfactory results. In this quality improvement project, we proposed a multicomponent intervention. MEASURES: A set of indicators was established for each component of the project. The feasibility of both the intervention and its evaluation system was measured. According to the literature review and the analysis of the local context, 5 active components were identified, piloted, and assessed: training of ward professionals, education of patients and nonprofessional caregivers, regular pain assessment, specialist-level pain consultation procedures, and involvement of hospital management. RESULTS: Multiprofessional training programs with daily discussions, daily pain assessment, and a readily available specialized palliative care service seem to be the active components of this complex intervention. The quality improvement project achieved 2 years sustainability. CONCLUSION: Consolidated educational and organizational methodologies support the feasibility of this complex intervention.


Asunto(s)
Dolor en Cáncer/epidemiología , Pacientes Internos , Manejo del Dolor , Dimensión del Dolor , Mejoramiento de la Calidad , Dolor en Cáncer/diagnóstico , Dolor en Cáncer/terapia , Cuidadores , Manejo de la Enfermedad , Femenino , Estudios de Seguimiento , Encuestas de Atención de la Salud , Humanos , Masculino , Modelos Teóricos , Manejo del Dolor/métodos , Manejo del Dolor/normas , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Educación del Paciente como Asunto , Derivación y Consulta
19.
Urology ; 136: 225-230, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31758980

RESUMEN

OBJECTIVE: To determine pediatric urologists' antibiotic prophylaxis prescribing practices for children with vesicoureteral reflux (VUR) and other congenital anomalies of the kidney and urinary tract (CAKUT). METHODS: Web-based survey of pediatric urologists about their practice of antibiotic prophylaxis in children with CAKUT. RESULTS: We had a response rate of 17.8% (n = 73). The majority of respondents always or often prescribe prophylactic antibiotics for grade IV or V VUR, while greater variability was seen for lower grades of VUR. 47.9% of respondents report that they often or always prescribe antibiotics for patients with grade 4 hydronephrosis, and most respondents report that they never or rarely prescribe antibiotics for grade 1 or 2 hydronephrosis. The majority of respondents never or rarely prescribe antibiotics for horseshoe or solitary kidney (88% and 86%, respectively), but frequently prescribed antibiotic for ureterocele. For ectopic ureter, almost half of respondents prescribe prophylactic antibiotics always or often, whereas only 18% prescribe antibiotics always or often for duplication anomalies. Only 11% reported prescribing antibiotics for prophylaxis always or often for children with myelomeningocele. CONCLUSION: We report notable variability in antibiotic prescribing patterns for children with CAKUT. Given the lack of guidelines around the use of prophylaxis in the majority of these conditions, standardization of care may be warranted to decrease this variability.


Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Prescripciones de Medicamentos/estadística & datos numéricos , Pediatría , Pautas de la Práctica en Medicina , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control , Anomalías Urogenitales/complicaciones , Urología , Reflujo Vesicoureteral/complicaciones , Niño , Encuestas de Atención de la Salud , Humanos
20.
Ann Vasc Surg ; 62: 114-118.e1, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31476423

RESUMEN

BACKGROUND: Opioid overdose is now the leading cause of injury-related death in the United States. Overprescription of opioids is one factor contributing to this epidemic. Previous studies demonstrated an overprescription of opioids compared with patient consumption after general surgery procedures. The objective of this study is to evaluate opioid consumption after carotid revascularization. METHODS: This is a retrospective review of the opioid-prescribing habits after discharge of carotid revascularization. Patients who were documented to receive an opioid prescription were included in the study. A phone survey was conducted to determine patient consumption of the prescribed pills. Surgical procedures include carotid endarterectomy (CEA) and transcarotid arterial revascularization (TCAR). The primary outcome is the difference between opioids prescribed and opioids consumed. RESULTS: There were 209 patients available for inclusion. The mean age was 68 years with white (98%) males (58%) making up most patients. CEA and TCAR accounted for 75% and 25% of cases, respectively. About 98 (47%) patients were prescribed opioids after discharge. Eight were excluded from analysis (3 for prior opioid use and 5 declined participation). About 71% of patients participated in the survey. A total of 1,623 pills were prescribed (25.4 ± 5.5 per patient), but only 336 pills were consumed (5.3 ± 1.1 per patient). About 1,287 (79% of total) pills were not consumed. CONCLUSIONS: These data are the first to compare opioid prescription with opioid consumption after carotid revascularization. We demonstrate that patients consume much less opioids than prescribed. These findings indicate that a reduction in opioid prescriptions may be possible after carotid revascularization.


Asunto(s)
Analgésicos Opioides/administración & dosificación , Enfermedades de las Arterias Carótidas/cirugía , Endarterectomía Carotidea/efectos adversos , Cumplimiento de la Medicación , Dolor Postoperatorio/tratamiento farmacológico , Pautas de la Práctica en Medicina , Anciano , Analgésicos Opioides/efectos adversos , Prescripciones de Medicamentos , Revisión de la Utilización de Medicamentos , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Alta del Paciente , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
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