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1.
Braz. j. biol ; 84: e253065, 2024. tab
Artículo en Inglés | MEDLINE, LILACS, VETINDEX | ID: biblio-1350311

RESUMEN

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.


Resumo A cultura sanguínea de rotina é usada para a detecção de infecções na corrente sanguínea por bactérias aeróbias e anaeróbias e por leveduras patogênicas comuns. Estudo retrospectivo realizado em hospital público de Maceió-AL, por meio da coleta de dados de todos os prontuários com culturas sanguíneas positivas. Das 2.107 culturas sanguíneas realizadas, 17% foram positivas com Staphylococcus coagulase negativo (51,14%), seguido por Staphylococcus aureus (11,21%) e Klebsiella pneumoniae (6,32%). As bactérias Gram-positiva predominaram entre as culturas de sangue positivas, destacando-se o grupo das Staphylococcus coagulase-negativo. Enquanto as bactérias Gram-negativas apresentaram um número maior de espécies entre as culturas de sangue positivas.


Asunto(s)
Humanos , Sepsis , Bacterias Gramnegativas , Brasil , Estudios Retrospectivos , Hospitales
2.
Health Aff (Millwood) ; 41(2): 237-246, 2022 02.
Artículo en Inglés | MEDLINE | ID: mdl-35130071

RESUMEN

Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being farther from most services. These patterns likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need. The findings also illustrate the difficulty of using a single metric-distance-to investigate access to care on a national scale.


Asunto(s)
Accesibilidad a los Servicios de Salud , Femenino , Geografía , Hospitales , Humanos , Embarazo , Estados Unidos
3.
Trop Med Int Health ; 27(4): 454-462, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35189005

RESUMEN

OBJECTIVES: We investigated the characteristics of prophylactic antimicrobial use in clean and clean-contaminated surgical procedures and assessed the efficacy of a prophylactic antimicrobial stewardship intervention at Thong Nhat Hospital, Ho Chi Minh City, Vietnam. METHODS: A cross-sectional study was conducted on 354 patients who underwent either clean or clean-contaminated surgical procedures at Thong Nhat Hospital. Eligible patients were classified with respect to three periods of intervention from 2017 to 2020. Data collection included surgical procedures, patient characteristics, and prophylactic antimicrobial usage. We determined the efficacy of antimicrobial stewardship intervention based on comparisons among the primary outcome (the appropriateness of prophylactic antimicrobials) and secondary outcomes (postoperative antimicrobial prophylaxis (AP) prolongation, length of postoperative hospital stay, and cost of antimicrobials). RESULTS: The mean age of patients in periods 1, 2, and 3 was 54.5 ± 16.6, 50.2 ± 16.5, and 52.8 ± 17.3 years, respectively, with an overall male/female ratio of 1.1/1. No significant differences were detected in basic patient characteristics during the three periods. Majority of the surgical procedures were clean (56%-59%) and scheduled (85%-86%). Prophylactic antimicrobial stewardship intervention enhanced AP appropriateness (by 12.7%, 12.7%, and 39.0% in periods 1, 2, and 3, respectively, p < 0.001), decreased postoperative prophylactic antimicrobial duration [3.0 (0-6), 1.5 (0-5), and 0.0 (0-1) days, respectively, p < 0.001], and reduced average antimicrobial expenses (p < 0.001). CONCLUSIONS: The prophylactic antimicrobial stewardship interventions introduced at Thong Nhat Hospital had several positive impacts on the appropriateness of prophylactic antimicrobial use and treatment costs.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Programas de Optimización del Uso de los Antimicrobianos/métodos , Estudios Transversales , Femenino , Hospitales , Humanos , Masculino , Vietnam
4.
J Health Popul Nutr ; 41(1): 16, 2022 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-35505386

RESUMEN

BACKGROUND: The purpose of the project was to improve newborn health in neonatal care units in a low resource area with high neonatal mortality, predominantly by better nutrition and educational exchange of health care workers. METHOD: A fourfold program to make human milk production and distribution feasible and desirable. 1 Education to enlighten health care workers and parents to the excellence of human milk. 2 Lactation counselling to address the various challenges of breastfeeding. 3 Improving infants´ general condition. 4 Infrastructure alterations in the hospital. A collaboration between hospitals in India and Norway. RESULTS: The number of infants receiving human milk increased pronouncedly. Systematic, professional lactation counselling, the establishment of a milk bank, and empowerment of nurses was perceived as the most important factors. CONCLUSIONS: It is possible to greatly improve nutrition and the quality of newborn care in low/middle income settings by optimising human resources. Viable improvements can be obtained by long-term health partnership, by involving all hierarchal levels and applying locally developed customized methods.


Asunto(s)
Lactancia Materna , Salud del Lactante , Femenino , Hospitales , Humanos , Renta , Lactante , Recién Nacido , Pobreza
5.
JAMA ; 327(18): 1827, 2022 05 10.
Artículo en Inglés | MEDLINE | ID: mdl-35536273
6.
Inquiry ; 59: 469580221100166, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35514066

RESUMEN

While nurse staffing shortage is generally true, it is not universal, and it remains unclear the degree to which variation in local staffing markets might influence the relationship between nurse staffing and care quality. This study seeks to determine the effect of nurse staffing markets on the quality of hospital care delivered in U.S. hospitals by examining the relationship between the proximal density of nurse staffing resources to hospitals and patient-reported care quality outcomes. This examination analyzes hospital performance on (Hospital Consumer Assessment of Healthcare Providers and Systems) HCAHPS based on the proximal density of nursing schools. The analysis combines data from Centers for Medicare and Medicaid Services (CMS) Hospital Compare (N1 = 2959) and U.S. nursing school locations from the American Association of Colleges of Nursing (N2 = 811) via a series of binary logistic regressions to determine whether local nurse staffing availability is related to hospital's attainment of either low or high star quality ratings. A sensitivity analysis is also offered to determine the association with 1, 3, and 5-star ratings. The findings suggest that the odds of receiving both a low-star rating and a high-star rating of HCAHPS performance increase as proximal density increases while the odds of receiving a 3-star rating decrease. Hospitals are able to achieve the highest levels of performance as high performing hospitals in high-density markets seem to be taking advantage of resource availability to establish close, strong ties with nurse staffing resources as opposed to viewing nurses as an easily replaceable resource.


Asunto(s)
Personal de Enfermería en Hospital , Facultades de Enfermería , Anciano , Hospitales , Humanos , Medicare , Admisión y Programación de Personal , Calidad de la Atención de Salud , Estados Unidos
7.
BMC Health Serv Res ; 22(1): 626, 2022 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-35538575

RESUMEN

BACKGROUND: Nursing home residents are at increased risk for hospital transfers resulting in emergency department visits, observation stays, and hospital admissions; transfers that can also result in adverse resident outcomes. Many nursing home to hospital transfers are potentially avoidable. Residents who experience repeat transfers are particularly vulnerable to adverse outcomes, yet characteristics of nursing home residents who experience repeat transfers are poorly understood. Understanding these characteristics more fully will help identify appropriate intervention efforts needed to reduce repeat transfers. METHODS: This is a mixed-methods study using hospital transfer data, collected between 2017 and 2019, from long-stay nursing home residents residing in 16 Midwestern nursing homes who transferred four or more times within a 12-month timeframe. Data were obtained from an acute care transfer tool used in the Missouri Quality Initiative containing closed- and open-ended questions regarding hospital transfers. The Missouri Quality Initiative was a Centers for Medicare and Medicaid demonstration project focused on reducing avoidable hospital transfers for long stay nursing home residents. The purpose of the analysis presented here is to describe characteristics of residents from that project who experienced repeat transfers including resident age, race, and code status. Clinical, resident/family, and organizational factors that influenced transfers were also described. RESULTS: Findings indicate that younger residents (less than 65 years of age), those who were full-code status, and those who were Black were statistically more likely to experience repeat transfers. Clinical complexity, resident/family requests to transfer, and lack of nursing home resources to manage complex clinical conditions underlie repeat transfers, many of which were considered potentially avoidable. CONCLUSIONS: Improved nursing home resources are needed to manage complex conditions in the NH and to help residents and families set realistic goals of care and plan for end of life thus reducing potentially avoidable transfers.


Asunto(s)
Medicare , Casas de Salud , Anciano , Servicio de Urgencia en Hospital , Hospitalización , Hospitales , Humanos , Transferencia de Pacientes , Estados Unidos
8.
Value Health ; 25(5): 844-854, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35500953

RESUMEN

OBJECTIVES: Underuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. To achieve value-based care, guidelines and recommendations should target both underuse and overuse and be supported by evidence from economic evaluations. We aimed to conduct a systematic review of the economic value of in-hospital clinical practices in acute injury care to advance knowledge on value-based care in this patient population. METHODS: Pairs of independent reviewers systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central Register for full economic evaluations of in-hospital clinical practices in acute trauma care published from 2009 to 2019 (last updated on June 17, 2020). Results were converted into incremental net monetary benefit and were summarized with forest plots. The protocol was registered with PROSPERO (CRD42020164494). RESULTS: Of 33 910 unique citations, 75 studies met our inclusion criteria. We identified 62 cost-utility, 8 cost-effectiveness, and 5 cost-minimization studies. Values of incremental net monetary benefit ranged from international dollars -467 000 to international dollars 194 000. Of 114 clinical interventions evaluated (vs comparators), 56 were cost-effective. We identified 15 cost-effective interventions in emergency medicine, 6 in critical care medicine, and 35 in orthopedic medicine. A total of 58 studies were classified as high quality and 17 as moderate quality. From studies with a high level of evidence (randomized controlled trials), 4 interventions were clearly dominant and 8 were dominated. CONCLUSIONS: This research advances knowledge on value-based care for injury admissions. Results suggest that almost half of clinical interventions in acute injury care that have been studied may not be cost-effective.


Asunto(s)
Cuidados Críticos , Hospitales , Análisis Costo-Beneficio , Atención a la Salud , Humanos
9.
J Med Syst ; 46(6): 32, 2022 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-35501418

RESUMEN

Pharmacy robots and automated dispensing cabinets are commonly used to distribute medications to inpatient units efficiently and safely. Decisions regarding the use of these technologies are often made without full knowledge regarding system effects. This paper determines a cost effective and safe way to distribute medications to patients across a hospital system by minimizing the distribution cost and missing dose rate. A mathematical model is formulated which captures key aspects of the pharmacy distribution process to determine a primary pathway to distribute each medication and dose type to each unit. The model focuses on three primary distribution pathways: cart fill via pharmacy robot, cart fill via pharmacy technician, and automated dispensing cabinets. The problem is solved using a complete year of data from the Geisinger Medical Center. The model results demonstrate the trade-off between pharmacy technician and nurse workload and missing dose rates that occur as hospitals move from a centralized pharmacy to automated dispensing cabinets. These results demonstrate the importance of evaluating the labor effort and missing dose rates when determining the best method to distribute medication.


Asunto(s)
Sistemas de Medicación en Hospital , Servicio de Farmacia en Hospital , Hospitales , Humanos , Pacientes Internos , Carga de Trabajo
10.
Eur Rev Med Pharmacol Sci ; 26(8): 2669-2675, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35503611

RESUMEN

OBJECTIVE: Clinical audits enable a more responsible and patient-centric healthcare paradigm by comparing patient care processes to self-defined standard norms. The current study is a descriptive prospective observational analysis performed on data extracted from in-patient active audit files from a multispecialty hospital based in Delhi NCR, India. The files were reviewed to find out if the current documentation technique adhered to the accreditation board's audit guidelines. MATERIALS AND METHODS: A random sample of 325 files among all inpatient medical records from the selected wards of the hospital was analyzed in accordance with standard protocols. The information gathered was primary in nature with 15-20 files being audited from different wards daily based on fulfillment of National Accreditation Board of Hospitals (NABH) criterion. RESULTS: Active audit data collection was lacking in many criteria like desired outcomes (25.2%) and others. Educating clinical staff about the necessity of accurate form recording and hospital-wide consistency of medical record keeping, providing summary of admission and discharge is vital. Utmost care should have been taken to ensure that hospital medical records are maintained in a systemic and scientific manner. CONCLUSIONS: There is an acute need for proper documentation to improve the quality. Active audits of this nature should be made regular to improve the standard of care over time.


Asunto(s)
Auditoría Clínica , Países en Desarrollo , Atención a la Salud , Hospitales , Humanos , Registros Médicos
11.
BMJ Open ; 12(5): e059371, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35501076

RESUMEN

OBJECTIVES: To derive two household context factors - living alone and living in a two-person household with a person who is frail - from routine administrative health data and to assess their association with emergency hospital use in people aged 65 or over. DESIGN: Retrospective cohort study using national pseudonymised hospital data and pseudonymised address data derived from a minimised version of the Master Patient Index, a central database of all patient registrations in England. SETTING: England-wide. PARTICIPANTS: 4 876 285 people aged 65 years or older registered at GP practices in England on 16 December 2018 who were living alone or in a household of up to six people, and with at least one hospital admission in the last 3 years. OUTCOMES: Rates of accident and emergency (A&E) attendance and inpatient emergency admissions over a 1-year follow-up period. RESULTS: Older people living alone had higher rates of A&E attendances (adjusted rate ratio 1.09, 95% CI 1.09 to 1.10) and emergency admissions (1.14, 95% CI 1.14 to 1.15) than older people living in households of 2-6 people. Older people living with someone with frailty in a two-person household had higher rates of A&E attendance (adjusted rate ratio 1.09, 95% CI 1.08 to 1.10) and emergency admissions (1.10, 95% CI 1.09 to 1.11) than other older people living in a two-person household. CONCLUSIONS: We show that household context factors can be derived from linked routine administrative health data and that these are strongly associated with higher emergency hospital use in older people. Using household context factors can improve analyses, as well as support in the understanding of local population needs and in population health management.


Asunto(s)
Fragilidad , Anciano , Atención a la Salud , Inglaterra/epidemiología , Fragilidad/epidemiología , Hospitales , Humanos , Estudios Retrospectivos
12.
BMJ Open ; 12(5): e058237, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35501104

RESUMEN

OBJECTIVE: Medication management guidance for carers of people with dementia at hospital discharge is important to prevent medication-related harm during transitions of care. This study aimed to develop a tool to evaluate medication management guidance provided to carers of people with dementia at hospital discharge. DESIGN: The tool was developed using mixed methods involving two stages. Stage 1 involved item generation and content validation. Items were based on a previous qualitative study and systematic review. Content validation involved experts and consumers with knowledge or experience of medication management guidance in the acute care setting, and rating each item on importance and relevance. Stage 2 involved conducting cognitive interviews with carers of people with dementia to pretest the tool. SETTING: For stage 1, experts and consumers from Australia, USA and New Zealand were included. For stage 2, carers of people with dementia were recruited across Australia. PARTICIPANTS: 18 experts and consumers participated in round 1 of content validation, and 13 experts and consumers completed round 2. Five carers of people with dementia participated in cognitive interviews. RESULTS: The final tool contained 30 items capturing information across five domains: (1) provision of medication management guidance at hospital discharge; (2) carer understanding of medication management guidance provided at discharge; (3) carer engagement in discussing the safe use of medications at discharge; (4) carer preparedness to conduct medication management activities after discharge; and (5) co-ordination of medication management guidance after discharge. CONCLUSIONS: We developed the first tool to assess medication management guidance provided for carers of people with dementia at hospital discharge. The tool may be useful to inform future research strategies to improve the delivery of medication management guidance at discharge.


Asunto(s)
Cuidadores , Demencia , Cuidadores/psicología , Demencia/tratamiento farmacológico , Demencia/psicología , Hospitales , Humanos , Administración del Tratamiento Farmacológico , Alta del Paciente
13.
Indian J Ophthalmol ; 70(5): 1539-1545, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35502020

RESUMEN

Purpose: To assess the role of noninvasive ocular surface analyzer (OSA) in workup of meibomian gland dysfunction (MGD) and to estimate hospital-based prevalence of MGD using this objective device. Methods: The study recruited 113 consecutive participants attending the ophthalmology outpatient department of a tertiary care hospital. All participants were administered a symptom questionnaire. Participants underwent a comprehensive ocular examination, including slit-lamp biomicroscopy and meibomian gland expression. Lipid layer thickness (LLT), noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), and meibomian gland loss (MGL) were assessed using OSA. The presence of either or both reduced/absent meibum secretion and cloudy to toothpaste-like secretion was diagnosed as MGD. Results: Prevalence of total MGD was 57.52% (95% confidence interval [95% CI]: 48.3%-66.8%) and that of symptomatic MGD was 42.5% (95% CI: 33.2%-51.7%). Prevalence of total and symptomatic MGD was highest in those aged ≥50 years (P < 0.001 and P = 0.004, respectively). Computer vision syndrome increased the odds of symptomatic MGD (odds ratio [OR]: 4.3). NIBUT and MGL significantly differed in MGD and non-MGD groups (P = 0.023 and P < 0.001, respectively). LLT significantly differed between asymptomatic and symptomatic cases (P = 0.033). MGL >25% increased the odds of having MGD (OR: 19.1). Significant negative correlations were observed between MGL and NIBUT (P = 0.04) and between MGL and LLT (P = 0.02). MGL demonstrated the highest diagnostic accuracy for MGD (AUC = 0.827, sensitivity = 75.4%, specificity = 85.4%, cut-off value: ≥26%). Conclusion: MGD is a common disorder in adults attending the ophthalmology outpatient services of a tertiary eye care hospital. Incorporating noninvasive OSA in clinical practice can aid in rapid and reliable measurements of MGD-related parameters.


Asunto(s)
Disfunción de la Glándula de Meibomio , Apnea Obstructiva del Sueño , Adulto , Hospitales , Humanos , Disfunción de la Glándula de Meibomio/diagnóstico , Disfunción de la Glándula de Meibomio/epidemiología , Glándulas Tarsales/metabolismo , Prevalencia , Apnea Obstructiva del Sueño/metabolismo
14.
Indian J Ophthalmol ; 70(5): 1869, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35502117

RESUMEN

Background: Bevacizumab vials that are commercially available are fractionated into smaller quantities into the form of pre-filled syringes in a sterile and aseptic laboratory setting. Purpose: To share the long term experience of aliquoting of bevacizumab injections in a tertiary eye care center in India. Synopsis: Compounding of bevacizumab was found to be a cost-effective and sustainable practice that has benefited more patients with an affordable cost, while maintaining high levels of quality. Highlights: Compounding of bevacizumab, when done with aseptic precautions can be a safe and cost-effective practice, the benefits of which can be passed on to needful patients. Video Link: https://youtu.be/C5XOpKHFkew.


Asunto(s)
Inhibidores de la Angiogénesis , Factor A de Crecimiento Endotelial Vascular , Bevacizumab , Hospitales , Humanos , Inyecciones Intravítreas
15.
BMC Pediatr ; 22(1): 252, 2022 05 05.
Artículo en Inglés | MEDLINE | ID: mdl-35513880

RESUMEN

BACKGROUND: Pain is a common symptom in children receiving hospital care. Adequate pain management in paediatric patients is of the utmost importance. Few studies have investigated children's own experiences of pain during hospitalization. AIM: To describe the prevalence of pain, self-reported pain intensity at rest and during movement, pain management and compliance with pain treatment guidelines in children and adolescents receiving hospital care. Furthermore, to examine self-reported statements about pain relief and how often staff asked about pain. METHODS: A quantitative, cross-sectional study with descriptive statistics as the data analysis method was conducted at a county hospital in western Sweden. Sixty-nine children/adolescents aged 6-18 years who had experienced pain during their hospital stay were included. A structured, verbally administered questionnaire was used to obtain pain reports. The participants were also asked what they considered alleviated pain and how often they told staff about pain. Patient demographics, prescribed analgesics and documentation of pain rating were obtained from medical records. RESULTS: Fifty children/adolescents (72%) experienced moderate to severe pain in the previous 24 hours. At the time of the interview 36% reported moderate to severe pain at rest and 58% during movement. Seven participants (10%) reported severe pain both at rest and during movement. About one-third were on a regular multimodal analgesic regimen and 28% had used a validated pain rating scale. Thirty children/adolescents (43%) reported that they had experienced procedural pain in addition to their underlying pain condition. Most of the children/adolescents (74%) reported that analgesics provided pain relief. Forty (58%) stated that various non-pharmacological methods were helpful. CONCLUSIONS: Despite evidence-based guidelines, half of the children/adolescents experienced moderate to severe pain, highlighting the need for improvement. Pain levels should be assessed both at rest and during movement. Response to treatment should be evaluated to prevent undertreatment of pain. Compliance with guidelines and professional communication are of the utmost importance for pain management in children/adolescents. Non-pharmacological methods are a valuable part of a pain management strategy. This study shows that it is important to evaluate and improve pain care also outside specialised tertiary clinics.


Asunto(s)
Manejo del Dolor , Dolor , Adolescente , Analgésicos/uso terapéutico , Niño , Estudios Transversales , Hospitales , Humanos , Dolor/epidemiología , Dolor/etiología , Manejo del Dolor/métodos , Suecia/epidemiología
16.
Rev Soc Bras Med Trop ; 55: e05292021, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35522809

RESUMEN

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a growing threat to public health. METHODS: A 3-year retrospective study was conducted to evaluate the prevalence and lethality of multidrug-resistant (MDR) A. baumannii isolated from Brazilian patients. RESULTS: In this study, 219 Acinetobacter baumannii isolates were identified, of which 70.8% (155/219) were isolated from patients hospitalized in intensive care units. Of these, 57.4% (n = 89/155) were assessed, of which 92.1% (82/89) were carbapenem-resistant, and 49 were classified as infected. The lethality rate was 79.6% (39/49). CONCLUSIONS: We highlight the need of an effective epidemiological surveillance measure to contain the dissemination of CRAB in the hospital environment.


Asunto(s)
Infecciones por Acinetobacter , Acinetobacter baumannii , Infección Hospitalaria , Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/epidemiología , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Brasil/epidemiología , Carbapenémicos/farmacología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana Múltiple , Monitoreo Epidemiológico , Hospitales , Humanos , Unidades de Cuidados Intensivos , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , beta-Lactamasas
17.
Sci Rep ; 12(1): 7606, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534648

RESUMEN

Infectious and inflammatory stimuli elicit the generation of chitinase-3-like protein-1 (CHI3L1), involved in tissue damage, repair and remodeling. We evaluated whether plasma CHI3L1 at disease onset predicts clinical outcome of patients with Coronavirus 2019 (COVID-19) disease. Blood from 191 prospectively followed COVID-19 patients were collected at hospital admission between March 18th and May 5th, 2020. Plasma from 80 survivors was collected one month post-discharge. Forty age- and sex-matched healthy volunteers served as controls. Primary outcome was transfer to intensive care unit (ICU) or death. CHI3L1 was higher in COVID-19 patients than controls (p < 0.0001). Patients with unfavorable outcome (41 patients admitted to ICU, 47 died) had significantly higher CHI3L1 levels than non-ICU survivors (p < 0.0001). CHI3L1 levels abated in survivors one month post-discharge, regardless of initial disease severity (p < 0.0001), although remaining higher than controls (p < 0.05). Cox regression analysis revealed that CHI3L1 levels predict primary outcome independently of age, sex, comorbidities, degree of respiratory insufficiency and systemic inflammation or time from symptom onset to sampling (p < 0.0001). Kaplan-Meier curve analysis confirmed that patients with CHI3L1 levels above the median (361 ng/mL) had a poorer prognosis (log rank test, p < 0.0001). Plasma CHI3L1 is increased in COVID-19 patients and predicts adverse outcome.


Asunto(s)
COVID-19 , Quitinasas , Cuidados Posteriores , Proteína 1 Similar a Quitinasa-3 , Hospitales , Humanos , Alta del Paciente , Estudios Prospectivos
18.
Sci Rep ; 12(1): 7562, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534657

RESUMEN

Accreditation is a widespread culture internationally and nationally. The effectiveness of compliance with accreditation standards was positively correlated with health care settings' performance in multiple aspects: leadership, professional performance, patient safety and organizational culture. There is limited knowledge of the national compliance rate with accreditation standards. Therefore, it is important to assess the hospital compliance with accreditation rate in the Kingdom Saudi Arabia (KSA) and its related factors. This paper presents a quantitative cross-sectional study. Data were extracted from the annual Essential Safety Requirement (ESR) survey database from the Central Board for Accreditation of Health care Institutions (CBAHI) research center during the period 2016 to 2018. Hospitals that started their operation after the first ESR survey round in 2016 or shut down during the study period were excluded. The hospital scoring was on a scale of 0 to 100 and classified as follows: score 2 if the hospital satisfactory compliance (Fully Met) was ≥ 80% and score 1 if particular compliance (Partially Met) was ≥ 50% to < 80%. Then, a score of 0 indicated insufficient compliance (Not Met) when < 50% and a score of not applicable (NA) if the standard does not apply to the hospital. A total of 437 hospitals were surveyed in 20 regions in the KSA and had an overall compliance rate on average that was higher among private hospitals than among public hospitals (77% vs. 66%). Overall, private hospitals had a significantly better compliance rate than public hospitals (mean rate = 84% vs. 68%, respectively, P = 0.019). Large hospitals had more compliance with some standards than smaller hospitals. After adjusting for the year of the survey report, the private hospital type was more compliant than the public hospital. This study supports mandatory accreditation programs for both public and private health sectors, with increased monitoring by the concerned parties (i.e., CBAHI and the Ministry of Health). The authors encourage the application of accreditation for specialized and independent health services.


Asunto(s)
Acreditación , Hospitales , Estudios Transversales , Humanos , Cultura Organizacional , Arabia Saudita
19.
Crit Care ; 26(1): 130, 2022 05 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534867

RESUMEN

BACKGROUND: The detection of coinfections is important to initiate appropriate antimicrobial therapy. Molecular diagnostic testing identifies pathogens at a greater rate than conventional microbiology. We assessed both bacterial coinfections identified via culture or the BioFire® FilmArray® Pneumonia Panel (FA-PNEU) in patients infected with SARS-CoV-2 in the ICU and the concordance between these techniques. METHODS: This was a prospective study of patients with SARS-CoV-2 who were hospitalized for no more than 48 h and on mechanical ventilation for no longer than 24 h in 8 ICUs in Medellín, Colombia. We studied mini-bronchoalveolar lavage or endotracheal aspirate samples processed via conventional culture and the FA-PNEU. Coinfection was defined as the identification of a respiratory pathogen using the FA-PNEU or cultures. Serum samples of leukocytes, C-reactive protein, and procalcitonin were taken on the first day of intubation. We analyzed the empirical antibiotics and the changes in antibiotic management according to the results of the FA-PNEUM and cultures. RESULTS: Of 110 patients whose samples underwent both methods, FA-PNEU- and culture-positive samples comprised 24.54% versus 17.27%, respectively. Eighteen samples were positive in both techniques, 82 were negative, 1 was culture-positive with a negative FA-PNEU result, and 9 were FA-PNEU-positive with negative culture. The two bacteria most frequently detected by the FA-PNEU were Staphylococcus aureus (37.5%) and Streptococcus agalactiae (20%), and those detected by culture were Staphylococcus aureus (34.78%) and Klebsiella pneumoniae (26.08%). The overall concordance was 90.1%, and when stratified by microorganism, it was between 92.7 and 100%. The positive predictive value (PPV) was between 50 and 100% and were lower for Enterobacter cloacae and Staphylococcus aureus. The negative predictive value (NPV) was high (between 99.1 and 100%); MecA/C/MREJ had a specificity of 94.55% and an NPV of 100%. The inflammatory response tests showed no significant differences between patients whose samples were positive and negative for both techniques. Sixty-one patients (55.45%) received at least one dose of empirical antibiotics. CONCLUSIONS: The overall concordance was 90.1%, and it was between 92.7% and 100% when stratified by microorganisms. The positive predictive value was between 50 and 100%, with a very high NPV.


Asunto(s)
COVID-19 , Coinfección , Neumonía , Antibacterianos/uso terapéutico , Bacterias , COVID-19/diagnóstico , Colombia , Hospitales , Humanos , Unidades de Cuidados Intensivos , Reacción en Cadena de la Polimerasa Multiplex/métodos , Neumonía/tratamiento farmacológico , Estudios Prospectivos , SARS-CoV-2
20.
Sci Rep ; 12(1): 7665, 2022 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-35538186

RESUMEN

Smoking influences the risks of inflammatory bowel disease (IBD). A hospital-based cohort was conducted to evaluate the effect of smoking on the development and outcomes of IBD, with age, sex and comorbidities matched non-IBD controls from the National Health Interview Survey database of Taiwan. 700 IBD patients (360 ulcerative colitis (UC), 340 Crohn's disease (CD)) were analyzed for outcomes; and 575 patients (297 UC, 278 CD) were analyzed for prevalence. Smoking prevalence was significantly lower in UC patients than controls (20.9% vs. 30.4%, p < 0.01), but no difference between CD patients and controls (19.8% vs. 22.1%, p = 0.60). UC smokers had fewer admissions (1.6 vs. 2.5, p < 0.05) but higher rates of new cancer development (16% vs. 6.7%, p < 0.05) and mortality (16% vs. 4.9%, p < 0.01) than nonsmokers. CD smokers tended to have higher rates of stricturing and penetrating diseases (p < 0.05), and higher surgery risk (60.3% vs. 38.3%, p < 0.01) than nonsmokers. Smoking prevents UC occurrence and is associated with fewer hospitalization but increases risks of cancer and mortality. By contrast, smoking does not affect CD occurrence but is related to more aggressive behavior which results in a higher surgical rate.


Asunto(s)
Colitis Ulcerosa , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Neoplasias , Enfermedad Crónica , Estudios de Cohortes , Colitis Ulcerosa/epidemiología , Colitis Ulcerosa/etiología , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/etiología , Hospitales , Humanos , Enfermedades Inflamatorias del Intestino/epidemiología , Enfermedades Inflamatorias del Intestino/etiología , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Taiwán/epidemiología
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