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1.
BMC Med Res Methodol ; 21(1): 53, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726711

RESUMEN

BACKGROUND: Beginning in 2019, stepped-wedge designs (SWDs) were being used in the investigation of interventions to reduce opioid-related deaths in communities across the United States. However, these interventions are competing with external factors such as newly initiated public policies limiting opioid prescriptions, media awareness campaigns, and the COVID-19 pandemic. Furthermore, control communities may prematurely adopt components of the intervention as they become available. The presence of time-varying external factors that impact study outcomes is a well-known limitation of SWDs; common approaches to adjusting for them make use of a mixed effects modeling framework. However, these models have several shortcomings when external factors differentially impact intervention and control clusters. METHODS: We discuss limitations of commonly used mixed effects models in the context of proposed SWDs to investigate interventions intended to reduce opioid-related mortality, and propose extensions of these models to address these limitations. We conduct an extensive simulation study of anticipated data from SWD trials targeting the current opioid epidemic in order to examine the performance of these models in the presence of external factors. We consider confounding by time, premature adoption of intervention components, and time-varying effect modification- in which external factors differentially impact intervention and control clusters. RESULTS: In the presence of confounding by time, commonly used mixed effects models yield unbiased intervention effect estimates, but can have inflated Type 1 error and result in under coverage of confidence intervals. These models yield biased intervention effect estimates when premature intervention adoption or effect modification are present. In such scenarios, models incorporating fixed intervention-by-time interactions with an unstructured covariance for intervention-by-cluster-by-time random effects result in unbiased intervention effect estimates, reach nominal confidence interval coverage, and preserve Type 1 error. CONCLUSIONS: Mixed effects models can adjust for different combinations of external factors through correct specification of fixed and random time effects. Since model choice has considerable impact on validity of results and study power, careful consideration must be given to how these external factors impact study endpoints and what estimands are most appropriate in the presence of such factors.


Asunto(s)
Estudios Cruzados , Intervención Médica Temprana , Modelos Biológicos , Trastornos Relacionados con Opioides/mortalidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación , Simulación por Computador , Epidemias , Humanos , Trastornos Relacionados con Opioides/epidemiología , Evaluación de Procesos y Resultados en Atención de Salud , Distribución Aleatoria , Factores de Tiempo
2.
Medicine (Baltimore) ; 100(9): e24604, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655925

RESUMEN

ABSTRACT: Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.


Asunto(s)
Cuidados Críticos , Enfermedad Crítica , Evaluación de Síntomas , Tiempo de Tratamiento/estadística & datos numéricos , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , /diagnóstico , /fisiopatología , China/epidemiología , Cuidados Críticos/métodos , Cuidados Críticos/estadística & datos numéricos , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Enfermedades del Sistema Digestivo/diagnóstico , Enfermedades del Sistema Digestivo/etiología , Femenino , Neumonía Asociada a la Atención Médica/diagnóstico , Neumonía Asociada a la Atención Médica/mortalidad , Cardiopatías/diagnóstico , Humanos , Hiperamilasemia/diagnóstico , Hiperamilasemia/etiología , Hipernatremia/diagnóstico , Hipernatremia/etiología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Pronóstico , Análisis de Supervivencia , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
3.
Medicine (Baltimore) ; 100(12): e25323, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761735

RESUMEN

ABSTRACT: The optimal strategy for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation remains debatable. This study sought to compare the performance of rotational atherectomy (RA) and modified balloon (MB)-based strategy in patients with HCCL receiving current-generation DES.This retrospective study comprised 564 consecutive patients who underwent RA (n = 229) or MB (n = 335) for HCCL at our hospital and were treated with DES. Baseline clinical and angiographic data was obtained from our database. Patients were clinically monitored for the occurrence of any adverse events during the hospitalization. One-year follow-up was conducted by either telephone contact or outpatient visits. 1:1 propensity score matching (PSM) was performed to balance the baseline covariates. After PSM, the clinical outcomes between the 2 groups were compared.After PSM, except more target lesion in right coronary artery existing in the RA group (P = .008), no significant statistical differences were shown in regard of the other angiographic and procedural characteristics of the 2 groups. Strategy success rates were all 100% in both groups. In the unadjusted Cox proportional hazard analysis, participants with RA had a significantly lower risk of target lesion revascularization (TLR) (hazard ratio, HR 0.275, 95% confidence intervals, CI 0.119-0.635, P = .003) and major adverse cardiac event (MACE) (HR 0.488, 95% 0.277-0.859, P = .013). After adjusting for potential confounding variables, RA was significantly associated with TLR (HR 0.32, 95% 0.12-0.853, P = .023), but no longer significantly associated with MACE (HR 0.674, 95% 0.329-1.381, P = .282).In patients with HCCL, lesion preparation with RA was safe and could improve strategy success rate. There was lower rate of TLR with RA, however, no significant difference was found in the MACE rate at 1-year follow-up between RA and MB-based strategy.


Asunto(s)
Angioplastia Coronaria con Balón , Aterectomía Coronaria , Enfermedad de la Arteria Coronaria , Vasos Coronarios , Stents Liberadores de Fármacos , Calcificación Vascular , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/métodos , Aterectomía Coronaria/efectos adversos , Aterectomía Coronaria/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/etiología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Vasos Coronarios/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/métodos , Estudios Retrospectivos , Calcificación Vascular/diagnóstico , Calcificación Vascular/cirugía
4.
Comunidad (Barc., Internet) ; 22(3): 0-0, nov.-feb. 2021. tab, graf
Artículo en Español | IBECS | ID: ibc-195072

RESUMEN

INTRODUCCIÓN: La pandemia ocasionada por el SARS-CoV-2 ha supuesto una reestructuración sin precedentes de la asistencia sanitaria y también de los centros de salud. OBJETIVO: Conocer las percepciones del personal médico del Centro de Salud Albaycín sobre la respuesta del equipo de Atención Primaria ante la pandemia de la COVID-19 en los meses de marzo y abril de 2020. MÉTODOS: Estudio cualitativo, observacional de orientación fenomenológica mediante entrevistas individuales. El ámbito de estudio es el Centro de Salud Albaycín. La saturación teórica determinó el tamaño de la muestra (la totalidad de la plantilla médica). Se llevó a cabo un análisis narrativo del contenido. RESULTADOS: Los discursos muestran seis categorías de análisis: organización de la toma de decisiones, características de la respuesta dada, mantenimiento de los pilares de la Atención Primaria, cualidades del equipo potenciadas, rol de la docencia y nuevas dinámicas generadas. Los resultados describen una respuesta adecuada, coordinada con la comunidad y anticipada a las directrices institucionales. La toma de decisiones ha sido consensuada y horizontal, potenciándose las cualidades del equipo. A pesar de las limitaciones, se ha mantenido la accesibilidad y la longitudinalidad. Durante la pandemia se ha visto afectada la calidad asistencial y la actividad docente. DISCUSIÓN: Un liderazgo transformacional, que refuerza el vínculo entre profesionales y fomenta la participación activa también de los residentes, permite una respuesta satisfactoria ante una situación emergente. Contar con la participación de la comunidad puede generar confianza en la organización y mejorar los resultados en salud


INTRODUCTION: The SARS-CoV-2 pandemic has brought about an unprecedented restructuring of healthcare and health centers. OBJECTIVES: Learn the perceptions of medical staff from Albayzín Health Centre regarding the Primary Care team's response to the COVID-19 pandemic in March and April 2020. METHODS: Qualitative, observational study with a phenomenological approach conducted by means of individual interviews. The scope of the study is Albaycín Health Centre. The theoretical saturation determined sample size (the entire medical staff). Content was analysed in narrative terms. RESULTS: Conversations revealed six categories of analysis: organization of the decision-making process, characteristics of the response provided, maintaining the cornerstones of Primary Care, enhanced team qualities, role of teaching and new dynamics generated. The results report an adequate response, which was coordinated with the community and anticipated institutional guidelines. Decision-making was consensual and horizontal, which enhanced the team's qualities. Despite the limitations, accessibility and longitudinal configuration have been maintained. Both the quality of care and teaching have been affected during the pandemic. DISCUSSION: Transformational leadership, which strengthens the bond between professionals and encourages residents to participate actively, facilitates a satisfactory response to an emerging situation. Having the community participate can build trust in the organization and improve health outcomes


Asunto(s)
Humanos , Infecciones por Coronavirus/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Virus del SRAS/patogenicidad , Planificación de Instituciones de Salud/organización & administración , Personal de Salud/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Técnicas de Apoyo para la Decisión
5.
Medicine (Baltimore) ; 100(5): e23928, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592846

RESUMEN

ABSTRACT: Care maps (CMs), which are innovative, comprehensive, educational, and simple medical tools, were developed for 6 common diseases, including heart failure, stroke, hyperglycemia, urinary tract infection, dengue infection, and upper gastrointestinal bleeding, were implemented in a short-stay ambulatory ward. This study aimed to investigate the effectiveness of and level of clinician satisfaction with CMs in an ambulatory care setting.A retrospective chart review study comparing the quality of care between before and after CM implementation was conducted. The medical records of patients who were admitted to a short-stay ambulatory ward in a tertiary referral center were reviewed. Demographic data, severity of disease, quality of care, length of stay (LOS), admission cost, and CM user satisfaction were collected and recorded.The medical records of 1116 patients were evaluated. Of those, 589 and 527 patients were from before (non-CM group) and after CM (CM group) implementation, respectively. There were no significant differences between groups for age, gender, or disease-specific severity the median (interquartile range) total and essential quality scores were significantly higher in the CM group than in the non-CM group [total quality score 85.3 (75.0-92.9) vs 61.1 (50.0-75.0); P < .001, and essential quality scores 90.0 (75.0-100.0) vs 60.0 (40.6-80.0); P < .0001, respectively]. All aspects of quality of care were significantly improved between before and after CM implementation. Overall median LOS was significantly decreased from 3.8 (2.5-5.7) to 3.0 (2.0-4.9) days, but there was no significant decrease for admission cost. However, CMs were able to significantly reduce both LOS and admission cost in the infectious disease-related subgroup. Most CM users reported satisfaction with CMs.CMs were shown to be an effective tool for improving the quality of care in patients with ambulatory infectious diseases. In that patient subgroup, LOS and admission cost were both significantly reduced compared to pre-CM implementation.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Atención Ambulatoria/organización & administración , Enfermedades Transmisibles/terapia , Vías Clínicas/normas , Calidad de la Atención de Salud/organización & administración , Anciano , Atención Ambulatoria/normas , Instituciones de Atención Ambulatoria/normas , Femenino , Implementación de Plan de Salud , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos
7.
BMJ Open ; 11(1): e044526, 2021 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-33518528

RESUMEN

OBJECTIVES: To determine if obesity and diabetes are risk factors for severe outcomes in COVID-19 and to compare patient outcomes in those two conditions. DESIGN: Retrospective cohort study. SETTING: Urban tertiary care center in New York City. PARTICIPANTS: 302 patients admitted in an inpatient setting, ≥18 years old, with a laboratory-confirmed diagnosis of COVID-19 via nasal PCR swab were randomly selected. Patients were separated into two cohorts based on their body mass index and hemoglobin A1c. 150 patients were placed in the non-obese, non-diabetic cohort and 152 patients were placed in the corresponding cohort (obesity alone, obesity and diabetes, and diabetes alone). MEASUREMENTS: Primary outcomes were development of acute kidney injury, commencement of renal replacement therapy, aminotransferase elevation, troponin elevation, lactic acidosis, development of septic shock, use of vasopressors, presence of acute respiratory distress syndrome (ARDS) and intubation. The secondary outcomes were length of stay in days and mortality. RESULTS: Patients with obesity and/or diabetes were more likely to develop ARDS (79 patients vs 57 patients, p<0.0001) and to be intubated (71 patients vs 45 patients, p=0.0031). Patients with obesity and/or diabetes were more likely to require vasopressors (60 patients vs 41 patients, p=0.0284) and to develop lactic acidosis (median 3.15 mmol/L, IQR 1.8 to 5.2 mmol/L, p=0.0432). When comparing patients with diabetes with and without obesity against patients with obesity alone, they were more likely to develop ARDS (87.5%, p=0.0305). Despite these findings, there was no difference in mortality. CONCLUSIONS: In patients hospitalised with COVID-19, those with obesity and/or diabetes were more likely to suffer severe complications, but had negligible differences in mortality. This highlights the importance of close monitoring of patients with these conditions and additional areas of research needed to explain the mortality findings.


Asunto(s)
Diabetes Mellitus , Hemoglobina A Glucada/análisis , Obesidad , /aislamiento & purificación , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Índice de Masa Corporal , /complicaciones , /terapia , Comorbilidad , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Ciudad de Nueva York/epidemiología , Obesidad/diagnóstico , Obesidad/epidemiología , Evaluación de Procesos y Resultados en Atención de Salud , Distribución Aleatoria , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
9.
Medicine (Baltimore) ; 100(5): e24005, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592856

RESUMEN

ABSTRACT: Although transforaminal lumbar interbody fusion (TLIF) is a widely accepted procedure, major complications such as cage retropulsion (CR) can cause poor clinical outcomes. Endplate injury (EI) was recently identified as a risk factor for CR, present in most levels developing CR. However, most EIs occurred in non-CR levels, and the features of EIs in CR levels remain unknown.The aim of this study was to identify risk factors for CR following TLIF; in particular, to investigate the relationship between EIs and CR, and to explore the features of EIs in CR.Between October 2010 and December 2016, 1052 patients with various degenerative lumbar spinal diseases underwent bilateral instrumented TLIF. Their medical records, radiological factors, and surgical factors were reviewed and factors affecting the incidence of CR were analyzed.Twenty-one patients developed CR. Nine had back pain or leg pain, of which six required revision surgery. A pear-shaped disc, posterior cage positioning and EI were significantly correlated with CR (P < .001, P = .001, and P < .001, respectively). Computed tomography (CT) scans revealed the characteristics of EIs in levels with and without CR. The majority of CR levels with EIs exhibited apparent compression damage in the posterior part of cranial endplate on the decompressed side (17/18), accompanied by caudal EIs isolated in the central portion. However, in the control group, the cranial EIs involving the posterior part was only found in four of the total 148 levels (P < .001). Most of the injuries were confined to the central portion of the cranial or caudal endplate or both endplates (35 in 148 levels, 23.6%). Additionally, beyond cage breaching into the cortical endplate on lateral radiographs, a characteristic appearance of coronal cage misalignment was found on AP radiographs in CR levels with EIs.A pear-shaped disc, posterior cage positioning and EI were identified as risk factors for CR. EI involving the posterior epiphyseal rim had influence on the development of CR. Targeted protection of the posterior margin of adjacent endplates, careful evaluation of intraoperative radiographs, and timely remedial measures may help to reduce the risks of CR.


Asunto(s)
Fijadores Internos/efectos adversos , Vértebras Lumbares , Complicaciones Posoperatorias , Falla de Prótesis/efectos adversos , Fusión Vertebral , Espondilolistesis , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Radiografía/métodos , Reoperación/métodos , Reoperación/estadística & datos numéricos , Medición de Riesgo/métodos , Factores de Riesgo , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Espondilolistesis/diagnóstico por imagen , Espondilolistesis/cirugía
10.
Emerg Infect Dis ; 27(4): 1077-1086, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33539721

RESUMEN

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.


Asunto(s)
Aspergillus fumigatus/aislamiento & purificación , Unidades de Cuidados Intensivos/estadística & datos numéricos , Aspergilosis Pulmonar , Voriconazol/uso terapéutico , Anciano , Antifúngicos/uso terapéutico , /inmunología , /terapia , Femenino , Humanos , Factores Inmunológicos/administración & dosificación , Factores Inmunológicos/efectos adversos , Incidencia , Cooperación Internacional , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Aspergilosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/tratamiento farmacológico , Aspergilosis Pulmonar/mortalidad , Sistema de Registros , Respiración Artificial/métodos , Factores de Riesgo , /aislamiento & purificación
11.
BMC Neurol ; 21(1): 76, 2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33596841

RESUMEN

BACKGROUND: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. METHODS: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. RESULTS: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time < 1 month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value = 0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value = 0.009). CONCLUSION: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes.


Asunto(s)
Atención Ambulatoria/normas , Psicoterapia/normas , Rehabilitación de Accidente Cerebrovascular/normas , Accidente Cerebrovascular/terapia , Adulto , Anciano , Anciano de 80 o más Años , Consenso , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Neuropsicología , Evaluación de Procesos y Resultados en Atención de Salud , Proyectos Piloto , Indicadores de Calidad de la Atención de Salud , Reproducibilidad de los Resultados , Estudios Retrospectivos , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología
12.
Interv. psicosoc. (Internet) ; 30(1): 35-45, ene. 2021. tab, graf
Artículo en Inglés | IBECS | ID: ibc-197951

RESUMEN

Parental promotion of an adequate environment during early childhood results in healthy child development. This study evaluated the feasibility and effectiveness of the positive parenting programme, 'Gaining health and wellbeing from birth to three' (GH&W), as a universal prevention strategy. Participants were 87 parents with children < 36 months old attending 20 primary care centres. Centres were randomly assigned to three GH&W intervention levels: online course (level 1), online course plus group workshops (level 2), and online course plus group workshops plus individual support at medical check-ups (level 3), delivered by healthcare professionals. As for feasibility, participants in levels 2 and 3 reported higher utility and satisfaction with the online course than participants in level 1. Pretest-posttest comparisons and cluster analysis showed that participants in level 3 achieved the best results and were associated with a consolidated cluster characterised by improvements in health promotion activities, parental self-regulation, and satisfaction with the service, whereas participants in levels 1 and 2 showed fewer improvements and were associated with initial and transitional clusters. The GH&W programme improves the universal reach of web-based courses and efficiently activates the contribution of the primary care system to the support network for healthy child development and wellbeing


La promoción de entornos saludables en el contexto familiar durante la primera infancia es clave para el desarrollo infantil. Este estudio evaluó la viabilidad y la eficacia del programa de parentalidad positiva "Ganar salud y bienestar de 0 a 3 años" (GSB) como estrategia de prevención universal. Participaron 87 figuras parentales con hijos o hijas de menos de 36 meses usuarios de 20 centros de salud. Los centros fueron asignados aleatoriamente a tres niveles de intervención del GSB: curso online (nivel 1), curso online más talleres grupales (nivel 2) y curso online, más talleres grupales, más apoyo individual en revisiones médicas (nivel 3) implementado por los equipos de pediatría. Respecto a la viabilidad, los participantes de los niveles 2 y 3 consideraron más útil y satisfactorio el curso online que los participantes del nivel 1. En las comparaciones pretest-postest y el análisis de clúster el nivel 3 logró los mejores resultados y se asoció al clúster consolidado caracterizado por mejoras en rutinas saludables, autorregulación parental y satisfacción con el servicio, mientras que los niveles 1 y 2 mostraron menos mejoras y se asociaron al clúster inicial y de transición. El programa GSB amplía el alcance universal del curso online e implica eficazmente al sistema sanitario en la red de apoyo al desarrollo saludable y del bienestar infantil


Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Adulto , Estudios de Factibilidad , Resultado del Tratamiento , Evaluación de Procesos y Resultados en Atención de Salud , Desarrollo de Programa , Responsabilidad Parental/psicología , Desarrollo Infantil/fisiología , Bienestar del Niño/psicología , Promoción de la Salud/organización & administración , Intervención Médica Temprana , Psicología Infantil , Relaciones Padre-Hijo
13.
Rev. enferm. UFPE on line ; 15(1): [1-12], jan. 2021. ilus, tab
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1147309

RESUMEN

Objetivo: relatar um caso sobre a redução manual do prolapso em um estoma intestinal. Método: trata-se de um estudo descritivo, tipo relato de caso clínico, sobre a redução manual do prolapso em um estoma intestinal de um paciente. Relata-se que o cenário foi um centro de referência no atendimento ao estomizado. Avaliaram-se a efetividade das intervenções de Enfermagem com base na comparação dos resultados iniciais e finais do procedimento. Resultados: nota-se a presença de lesões e permeabilidade na presença de prolapso, realizando a manobra de redução digital, até a sua total regressão, facilitando a limpeza da pele e a colocação do equipamento coletor, observando as possíveis lesões periestomais e na mucosa. Conclusão: informa-se que os pacientes com prolapso em estoma intestinal têm um desconforto devido ao volume dentro do equipamento coletor e ao pouco espaço para conter as suas eliminações. Utiliza-se a técnica de redução manual para facilitar a troca do equipamento coletor, esta deverá ser realizada por enfermeiro estomaterapeuta ou enfermeiro capacitado. Salienta-se que os casos em que se afeta o desenvolvimento de atividades cotidianas merecem uma avaliação da equipe cirúrgica.(AU)


Objective: to report a case about manual reduction of prolapse in an intestinal stoma. Method: it is a descriptive, case report type study on the manual reduction of prolapse in a patient's intestinal stoma. It is reported that the scenario was a reference center in the care of the stoma. They evaluated the effectiveness of nursing interventions based on the comparison of the initial and final results of the procedure. Results: the presence of injuries and permeability in the presence of prolapse is noted, performing the digital reduction maneuver, until its total regression, facilitating the cleaning of the skin and the placement of the collector equipment, observing the possible periestomal and mucosal lesions. Conclusion: it is reported that patients with prolapse in the intestinal stoma have a discomfort due to the volume inside the collector equipment and the little space to contain their eliminations. The manual reduction technique is used to facilitate the exchange of the collector equipment, this should be performed by a stoma therapist or trained nurse. It is emphasized that the cases in which the development of daily activities is affected deserve an evaluation of the surgical team.(AU)


Objetivo: reportar un caso de reducción manual del prolapso en un estoma intestinal. Método: se trata de un estudio descriptivo, a modo de reporte de caso clínico, sobre la reducción manual del prolapso en el estoma intestinal de un paciente. Se informa que el escenario fue un centro de referencia en la atención de pacientes ostomizados. Evaluaron la efectividad de las intervenciones de Enfermería a partir de una comparación de los resultados iniciales y finales del procedimiento. Resultados: se observa la presencia de lesiones y permeabilidad en presencia de prolapso, realizando la maniobra de reducción digital, hasta su total regresión, facilitando la limpieza de la piel y la colocación del equipo colector, observando las posibles lesiones periestomales y mucosas. Conclusión: se informa que los pacientes con prolapso en estoma intestinal presentan molestias por el volumen dentro del equipo de recolección y el poco espacio para contener sus eliminaciones. La técnica de reducción manual se utiliza para facilitar el intercambio del equipo colector, esto debe ser realizado por un estomaterapeuta o enfermero capacitado. Cabe destacar que los casos en los que se ve afectado el desarrollo de las actividades diarias merecen una valoración por parte del equipo quirúrgico. (AU)


Asunto(s)
Humanos , Masculino , Anciano , Evaluación de Procesos y Resultados en Atención de Salud , Prolapso , Estomía , Estomas Quirúrgicos , Atención de Enfermería , Epidemiología Descriptiva , Terminología Normalizada de Enfermería
14.
Crit Care Med ; 49(3): 490-502, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33405409

RESUMEN

OBJECTIVES: Prone position ventilation is a potentially life-saving ancillary intervention but is not widely adopted for coronavirus disease 2019 or acute respiratory distress syndrome from other causes. Implementation of lung-protective ventilation including prone positioning for coronavirus disease 2019 acute respiratory distress syndrome is limited by isolation precautions and personal protective equipment scarcity. We sought to determine the safety and associated clinical outcomes for coronavirus disease 2019 acute respiratory distress syndrome treated with prolonged prone position ventilation without daily repositioning. DESIGN: Retrospective single-center study. SETTING: Community academic medical ICU. PATIENTS: Sequential mechanically ventilated patients with coronavirus disease 2019 acute respiratory distress syndrome. INTERVENTIONS: Lung-protective ventilation and prolonged protocolized prone position ventilation without daily supine repositioning. Supine repositioning was performed only when Fio2 less than 60% with positive end-expiratory pressure less than 10 cm H2O for greater than or equal to 4 hours. MEASUREMENTS AND MAIN RESULTS: Primary safety outcome: proportion with pressure wounds by Grades (0-4). Secondary outcomes: hospital survival, length of stay, rates of facial and limb edema, hospital-acquired infections, device displacement, and measures of lung mechanics and oxygenation. Eighty-seven coronavirus disease 2019 patients were mechanically ventilated. Sixty-one were treated with prone position ventilation, whereas 26 did not meet criteria. Forty-two survived (68.9%). Median (interquartile range) time from intubation to prone position ventilation was 0.28 d (0.11-0.80 d). Total prone position ventilation duration was 4.87 d (2.08-9.97 d). Prone position ventilation was applied for 30.3% (18.2-42.2%) of the first 28 days. Pao2:Fio2 diverged significantly by day 3 between survivors 147 (108-164) and nonsurvivors 107 (85-146), mean difference -9.632 (95% CI, -48.3 to 0.0; p = 0·05). Age, driving pressure, day 1, and day 3 Pao2:Fio2 were predictive of time to death. Thirty-eight (71.7%) developed ventral pressure wounds that were associated with prone position ventilation duration and day 3 Sequential Organ Failure Assessment. Limb weakness occurred in 58 (95.1%) with brachial plexus palsies in five (8.2%). Hospital-acquired infections other than central line-associated blood stream infections were infrequent. CONCLUSIONS: Prolonged prone position ventilation was feasible and relatively safe with implications for wider adoption in treating critically ill coronavirus disease 2019 patients and acute respiratory distress syndrome of other etiologies.


Asunto(s)
/complicaciones , Evaluación de Procesos y Resultados en Atención de Salud , Posicionamiento del Paciente , Respiración Artificial/métodos , Insuficiencia Respiratoria/terapia , Centros Médicos Académicos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Posición Prona , Insuficiencia Respiratoria/etiología , Estudios Retrospectivos , Estados Unidos/epidemiología
15.
Am J Public Health ; 111(3): 485-493, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33476240

RESUMEN

Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States.Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention's National Syndromic Surveillance Program data. We stratified the data by sex and age groups.Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years.Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV.


Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Servicio de Urgencia en Hospital/tendencias , Vigilancia de la Población/métodos , Delitos Sexuales/tendencias , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Examen Físico/tendencias , Violación/estadística & datos numéricos , Delitos Sexuales/estadística & datos numéricos , Estados Unidos
16.
Euro Surveill ; 26(1)2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33413742

RESUMEN

Elderly care facilities have become a major focus of coronavirus disease (COVID-19) control. Here, we describe an outbreak of COVID-19 in a nursing home in Germany from 8 March to 4 May 2020 (58 days), and the effect of an intervention of general screening and cohort isolation. COVID-19 cases among residents and staff were recorded on a daily basis from the first positive SARS-CoV-2 test from a resident on 8 March 2020, until 4 May 2020 when the last staff member was classified COVID-19 negative. Eighty of 160 residents (50%) and 37 of 135 staff members (27%) tested positive for SARS-CoV-2. Twenty-seven of the 80 residents were asymptomatic but tested positive during the first general screening. Cohort isolation of SARS-CoV-2 positive residents by reorganising the facility proved to be a major effort. After the intervention, four further asymptomatic residents tested positive in follow-up screenings within a period of 6 days, and were possibly infected prior to the intervention. Thereafter, no further infections were recorded among residents. The described outbreak was controlled by implementing general screening and rigorous cohort isolation, providing a blueprint for similar facilities.


Asunto(s)
/prevención & control , Brotes de Enfermedades/prevención & control , Hogares para Ancianos , Casas de Salud , Cuarentena , Anciano , Anciano de 80 o más Años , /epidemiología , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos
17.
Isr Med Assoc J ; 23(1): 12-16, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33443336

RESUMEN

BACKGROUND: Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES: To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS: We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS: Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS: Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.


Asunto(s)
Dietoterapia/métodos , Cálculos Renales , Nefrolitiasis , Cuidados Posteriores/métodos , Cuidados Posteriores/estadística & datos numéricos , Calcio/orina , Ácido Cítrico/orina , Femenino , Humanos , Israel/epidemiología , Cálculos Renales/complicaciones , Cálculos Renales/epidemiología , Cálculos Renales/fisiopatología , Masculino , Administración del Tratamiento Farmacológico/estadística & datos numéricos , Metaboloma/efectos de los fármacos , Metaboloma/fisiología , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Nefrolitiasis/diagnóstico , Nefrolitiasis/dietoterapia , Nefrolitiasis/tratamiento farmacológico , Nefrolitiasis/metabolismo , Evaluación de Procesos y Resultados en Atención de Salud , Cólico Renal/epidemiología , Cólico Renal/etiología , Prevención Secundaria/métodos , Prevención Secundaria/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Ácido Úrico/orina
18.
Isr Med Assoc J ; 23(1): 28-32, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33443339

RESUMEN

BACKGROUND: Patients with critical limb ischemia (CLI) involving the below-the-knee (BTK) arteries are at increased risk of limb loss. Despite improvement in endovascular modalities, it is still unclear whether an aggressive approach results in improved limb salvage. OBJECTIVES: To assess whether an aggressive approach to BTK arterial disease results in improved limb salvage. METHODS: A comparative study of two groups was conducted. Group 1 included patients treated between 2012 and 2014, primarily with transfemoral angioplasty of the tibial arteries. Group 2 included patients treated between 2015-2019 with a wide array of endovascular modalities (stents, multiple tibial artery and pedal angioplasty, retrograde access). Primary endpoint was freedom from amputation at 4 years. RESULTS: A total of 529 BTK interventions were performed. Mean age was 71 ± 10.6 years, 382 (79%) were male. Patients in group 1 were less likely to be taking clopidogrel (66% vs. 83%, P < 0.01) and statins (72 % vs. 87%, P < 0.01). Several therapeutic modalities were used more often in group 2 than in group 1, including pedal angioplasty (24 vs. 43 %, P = 0.01), tibial and pedal retrograde access (0 vs. 10%, P = 0.01), and tibial stenting (3% vs. 25%, P = 0.01). Revascularization of two or more tibial arteries was performed at a higher rate in group 2 (54% vs. 50%, P = 0.45). Estimated freedom from amputation at 40 months follow-up was higher in group 2 (53% vs. 63%, P = 0.05). CONCLUSIONS: An aggressive, multimodality approach in treating BTK arteries results in improved limb salvage.


Asunto(s)
Amputación , Angioplastia , Procedimientos Endovasculares , Isquemia , Pierna , Recuperación del Miembro , Enfermedad Arterial Periférica , Complicaciones Posoperatorias , Arterias Tibiales , Anciano , Amputación/métodos , Amputación/estadística & datos numéricos , Angioplastia/efectos adversos , Angioplastia/métodos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/métodos , Femenino , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/cirugía , Israel , Pierna/irrigación sanguínea , Pierna/cirugía , Recuperación del Miembro/instrumentación , Recuperación del Miembro/métodos , Recuperación del Miembro/estadística & datos numéricos , Masculino , Evaluación de Procesos y Resultados en Atención de Salud , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Stents , Arterias Tibiales/diagnóstico por imagen , Arterias Tibiales/fisiopatología , Arterias Tibiales/cirugía , Grado de Desobstrucción Vascular
19.
Medicina (Kaunas) ; 57(1)2021 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-33477852

RESUMEN

The COVID-19 pandemic has led to a reduction in hip and knee replacement surgery across healthcare systems. When regular operating returns, there will be a large volume of patients and an emphasis on a short hospital stay. Patients will be keen to return home, and capacity will need to maximised. Strategies to reduce the associated risks of surgery and to accelerate recovery will be needed, and so Enhanced Recovery after Surgery (ERAS) should be promoted as the model of care. ERAS protocols are proven to reduce hospital stay safely; however, ERAS pathways may require adaption to ensure both patient and staff safety. The risk of exposure to possible sources of COVID-19 should be limited, and so hospital visits should be minimised. The use of technology such as smartphone apps to provide pre-operative education, wearable activity trackers to assist with rehabilitation, and the use of telemedicine to complete outpatient appointments may be utilised. Also, units should be reminded that ERAS protocols are multi-modal, and every component is vital to minimise the surgical stress response. The focus should be on providing better and not just faster care. Units should learn from the past in order to expedite the implementation of or adaption of existing ERAS protocols. Strong leadership will be required, along with a supportive organisational culture, an inter-professional approach, and a recognised QI method should be used to contextualize improvement efforts.


Asunto(s)
Artroplastia de Reemplazo de Cadera/rehabilitación , Artroplastia de Reemplazo de Rodilla/rehabilitación , Recuperación Mejorada Después de la Cirugía/normas , Humanos , Tiempo de Internación/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud , Cuidados Posoperatorios/normas , Recuperación de la Función
20.
Emerg Med J ; 38(3): 229-231, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33472870

RESUMEN

COVID-19 has had a significant effect on healthcare resources worldwide, with our knowledge of the natural progression of the disease evolving for the individual patient. To allow for early detection of worsening clinical status, protect hospital capacity and provide extended access for vulnerable patients, our emergency department developed a remote patient monitoring programme for discharged patients with COVID-19. The programme uses a daily emailed secure link to a survey in which patients submit biometric and symptoms data for monitoring. Patients' meeting criteria are escalated to a physician for a phone or video visit. Here, we describe the development, implementation and preliminary analysis of utilisation of the programme.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Monitoreo Fisiológico , Evaluación de Procesos y Resultados en Atención de Salud , Alta del Paciente , Adulto , Femenino , Humanos , Masculino , Pandemias , Arabia Saudita
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