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1.
Medicine (Baltimore) ; 100(9): e24163, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655909

RESUMEN

ABSTRACT: No national epidemiological investigations have been conducted recently regarding facial lacerations. The study was performed using the data of 3,634,229 people during the 5-year period from 2014 to 2018 archived by the National Health Information Database (NHID) of the Health Insurance Review and Assessment Service. Preschool and children under 10 years old accounted for about one-third of patients. Facial lacerations were concentrated in the "T-shaped" area, which comprised forehead, nose, lips, and the perioral area. The male to female ratio for all study subjects was 2.16:1. Age and gender are significantly related with each other (P < .001). Mean hospital stays decreased, and numbers of outpatient department visits per patient were highest for hospitals and lowest for health agencies. Over the study period, hospital costs per patient in tertiary and general hospitals increased gradually. Preschool and school-aged children are vulnerable to trauma. Male patients outnumbered female patients by a factor of more than 2. The "T-shaped'" area around forehead is vulnerable to injury. Total cost of medical care benefits per patient in tertiary hospitals was about 7 times on average than in health agencies. Regarding functional, behavioral, and aesthetic outcomes, more attention should be paid to epidemiologic data and hospital costs for facial lacerations.


Asunto(s)
Traumatismos Faciales/epidemiología , Laceraciones/epidemiología , Adolescente , Adulto , Distribución por Edad , Atención Ambulatoria/estadística & datos numéricos , Niño , Preescolar , Bases de Datos Factuales , Traumatismos Faciales/economía , Femenino , Costos de Hospital/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Laceraciones/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Programas Nacionales de Salud/estadística & datos numéricos , República de Corea/epidemiología , Distribución por Sexo , Adulto Joven
2.
Medicine (Baltimore) ; 100(9): e24956, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655962

RESUMEN

INTRODUCTION: Due to the diversity of reports and on the rates of medications errors (MEs) in Saudi Arabia, we performed the first meta-analysis to determine the rate of medications errors in Saudi Arabia using meta-analysis in the hospital settings. METHODS: We conducted a systematic literature search through August 2019 using PubMed, EMBASE, CINAHL, PsycINFO, and Google Scholar to identify all observational studies conducted in hospital settings in Saudi Arabia that reported the rate of MEs. A random-effects models were used to calculate overall MEs, as well as prescribing, dispensing, and administration error rates. The I2 statistics were used to analyze heterogeneity. RESULTS: Sixteen articles were included in this search. The total incidence of MEs in Saudi Arabia hospitals was estimated at 44.4%. Prescribing errors, dispensing errors, and adminstration errors incidents represent 40.2%, 28.2%, and 34.5% out of the total number of reported MEs, respectively. However, between-study heterogeneity was also generally found to be >90% (I-squared statistic). CONCLUSIONS: This study demonstrates the MEs common in health facilities. Additional efforts in the field are needed to improve medication management systems in order to prevent patient harm incidents.


Asunto(s)
Hospitales/estadística & datos numéricos , Errores de Medicación/estadística & datos numéricos , Humanos , Incidencia , Arabia Saudita/epidemiología
3.
Nat Commun ; 12(1): 1904, 2021 03 26.
Artículo en Inglés | MEDLINE | ID: mdl-33771988

RESUMEN

The spread of Coronavirus disease 19 (COVID-19) has led to many healthcare systems being overwhelmed by the rapid emergence of new cases. Here, we study the ramifications of hospital load due to COVID-19 morbidity on in-hospital mortality of patients with COVID-19 by analyzing records of all 22,636 COVID-19 patients hospitalized in Israel from mid-July 2020 to mid-January 2021. We show that even under moderately heavy patient load (>500 countrywide hospitalized severely-ill patients; the Israeli Ministry of Health defined 800 severely-ill patients as the maximum capacity allowing adequate treatment), in-hospital mortality rate of patients with COVID-19 significantly increased compared to periods of lower patient load (250-500 severely-ill patients): 14-day mortality rates were 22.1% (Standard Error 3.1%) higher (mid-September to mid-October) and 27.2% (Standard Error 3.3%) higher (mid-December to mid-January). We further show this higher mortality rate cannot be attributed to changes in the patient population during periods of heavier load.


Asunto(s)
/prevención & control , Mortalidad Hospitalaria/tendencias , Hospitales/estadística & datos numéricos , /aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , /virología , Epidemias , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Israel/epidemiología , Masculino , Persona de Mediana Edad , Método de Montecarlo , /fisiología
4.
Medicine (Baltimore) ; 100(10): e25058, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725894

RESUMEN

ABSTRACT: Appropriate risk stratification and timely revascularization of acute myocardial infarction (AMI) are available in percutaneous coronary intervention (PCI) - capable hospitals (PCHs). This study evaluated whether direct admission vs inter-hospital transfer influences cardiac mortality in patients with AMI. This study was conducted in the PCH where the patients were able to arrive within an hour. The inclusion criteria were AMI with a symptom onset time within 24 hours and having undergone PCI within 24 hours after admission. The cumulative incidence of cardiac death after percutaneous coronary intervention was evaluated in the direct admission versus inter-hospital transfer groups. Among the 3178 patients, 2165 (68.1%) were admitted via inter-hospital transfer. Patients with ST-segment elevation myocardial infarction (STEMI) in the direct admission group had a reduced symptom onset-to-balloon time (121 minutes, P < .001). With a median period of 28.4 (interquartile range, 12.0-45.6) months, the cumulative incidence of 2-year cardiac death was lower in the direct admission group (NSTEMI, 9.0% vs 11.0%, P = .136; STEMI, 9.7% vs 13.7%, P = .040; AMI, 9.3% vs 12.3%, P = .014, respectively). After the adjustment for clinical variables, inter-hospital transfer was the determinant of cardiac death (hazard ratio, 1.59; 95% confidence interval, 1.08-2.33; P = .016). Direct PCH admission should be recommended for patients with suspected AMI and could be a target for reducing cardiac mortality.


Asunto(s)
Hospitales/estadística & datos numéricos , Infarto del Miocardio sin Elevación del ST/cirugía , Intervención Coronaria Percutánea/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/cirugía , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio sin Elevación del ST/mortalidad , Admisión del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/mortalidad , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricos , Resultado del Tratamiento
6.
Am J Prev Med ; 60(4): 471-477, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33745520

RESUMEN

INTRODUCTION: Several studies in developed and developing countries have analyzed the health risk factors associated with COVID-19 mortality. Comorbid diseases are a key explanatory factor behind COVID-19 mortality, but current studies treat comorbidities in isolation, at average-population values, and rarely assess how death risk varies for different health profiles across institutions. Estimating death risk variations for different interactions between comorbid diseases and across healthcare institutions is crucial to gaining a significant depth of understanding in relation to mortality during the pandemic. METHODS: This study relies on data from approximately half a million people in Mexico (of all recorded cases through August 15, 2020) and on Bayesian estimation to provide a more robust estimate of the combined effect of several comorbidities and institutional inequalities on COVID-19 mortality. RESULTS: The findings of the study illustrate the additive effects of several comorbid diseases, with the presence of obesity, diabetes, hypertension, and chronic kidney disease increasing the mortality risk of COVID-19. There are also variations in the risk of death across the heterogeneous Mexican health system. CONCLUSIONS: This study shows that COVID-19 mortality risk sharply increases in patients with 2 or more comorbid diseases (obesity, diabetes, hypertension, and cardiovascular diseases) in Mexico. However, death risk varied significantly across institutions for patients with the same comorbidity profile.


Asunto(s)
/mortalidad , Hospitales/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Teorema de Bayes , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Masculino , México , Persona de Mediana Edad , Modelos Estadísticos , Obesidad/epidemiología , Insuficiencia Renal Crónica/epidemiología , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo
7.
J Orthop Surg (Hong Kong) ; 29(1): 2309499021996072, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33641538

RESUMEN

AIM: Taiwan's response to the coronavirus disease 2019 (COVID-19) differed in that it successfully prevented the spread without having to shutdown or overburden medical services. Patients' fear regarding the pandemic would be the only reason to reduce surgeries, so Taiwan could be the most suitable place for research on the influence of psychological factors. This study aimed to assess the impact of patients' fear on orthopedic surgeries in Taiwan amid the peak period of the COVID-19 pandemic. PATIENTS AND METHODS: The investigation period included the COVID-19 pandemic (March 2020 to April 2020) and the corresponding period in the previous year. The following data on patients with orthopedic diseases were collected: outpatient visits, hospital admission, and surgical modalities. RESULTS: The COVID-19 pandemic led to a 22%-29% and 20%-26% reduction in outpatients, 22%-27% and 25%-37% reduction in admissions, and 26%-35% and 18%-34% reduction in surgeries, respectively, at both hospitals. The weekly mean number of patients was significantly smaller during the COVID-19 pandemic for all types of surgery and elective surgeries at the university hospital, and for all types of surgery, elective surgeries, and total knee arthroplasties at the community hospital. Further, patients visiting the community hospital during the pandemic were significantly younger, for all types of surgery, elective surgeries, and total knee arthroplasties. CONCLUSIONS: The reduction in orthopedic surgeries in Taiwan's hospitals during COVID-19 could be attributed to patients' fear. Even without restriction, the pandemic inevitably led to a reduction of about 20%-30% of the operation volume.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/psicología , Hospitales/estadística & datos numéricos , Pacientes Ambulatorios , Pandemias , Comorbilidad , Hospitalización/tendencias , Humanos , Masculino , Taiwán/epidemiología
8.
Medicine (Baltimore) ; 100(8): e24755, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663091

RESUMEN

ABSTRACT: Health information technology (IT) is often proposed as a solution to fragmentation of care, and has been hypothesized to reduce readmission risk through better information flow. However, there are numerous distinct health IT capabilities, and it is unclear which, if any, are associated with lower readmission risk.To identify the specific health IT capabilities adopted by hospitals that are associated with hospital-level risk-standardized readmission rates (RSRRs) through path analyses using structural equation modeling.This STROBE-compliant retrospective cross-sectional study included non-federal U.S. acute care hospitals, based on their adoption of specific types of health IT capabilities self-reported in a 2013 American Hospital Association IT survey as independent variables. The outcome measure included the 2014 RSRRs reported on Hospital Compare website.A 54-indicator 7-factor structure of hospital health IT capabilities was identified by exploratory factor analysis, and corroborated by confirmatory factor analysis. Subsequent path analysis using Structural equation modeling revealed that a one-point increase in the hospital adoption of patient engagement capability latent scores (median path coefficient ß = -0.086; 95% Confidence Interval, -0.162 to -0.008), including functionalities like direct access to the electronic health records, would generally lead to a decrease in RSRRs by 0.086%. However, computerized hospital discharge and information exchange capabilities with other inpatient and outpatient providers were not associated with readmission rates.These findings suggest that improving patient access to and use of their electronic health records may be helpful in improving hospital performance on readmission; however, computerized hospital discharge and information exchange among clinicians did not seem as beneficial - perhaps because of the quality or timeliness of information transmitted. Future research should use more recent data to study, not just adoption of health IT capabilities, but also whether their usage is associated with lower readmission risk. Understanding which capabilities impact readmission risk can help policymakers and clinical stakeholders better focus their scarce resources as they invest in health IT to improve care delivery.


Asunto(s)
Hospitales/estadística & datos numéricos , Informática Médica/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Estudios Transversales , Registros Electrónicos de Salud/estadística & datos numéricos , Capacidad de Camas en Hospitales , Humanos , Acceso de los Pacientes a los Registros/estadística & datos numéricos , Participación del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Características de la Residencia , Estudios Retrospectivos , Estados Unidos
9.
Medicine (Baltimore) ; 100(11): e24482, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33725935

RESUMEN

ABSTRACT: The purpose of this research is to analyze and introduce a new emergency medical service (EMS) transportation scenario, Emergency Medical Regulation Center (EMRC), which is a temporary premise for treating moderate and minor casualties, in the 2015 Formosa Fun Color Dust Party explosion in Taiwan. In this mass casualty incident (MCI), although all emergency medical responses and care can be considered as a golden model in such an MCI, some EMS plans and strategies should be estimated impartially to understand the truth of the successful outcome.Factors like on-scene triage, apparent prehospital time (appPHT), inhospital time (IHT), and diversion rate were evaluated for the appropriateness of the EMS transportation plan in such cases. The patient diversion risk of inadequate EMS transportation to the first-arrival hospital is detected by the odds ratios (ORs). In this case, the effectiveness of the EMRC scenario is estimated by a decrease in appPHT.The average appPHTs (in minutes) of mild, moderate, and severe patients are 223.65, 198.37, and 274.55, while the IHT (in minutes) is 18384.25, 63021.14, and 83345.68, respectively. The ORs are: 0.4016 (95% Cl = 0.1032-1.5631), 0.1608 (95% Cl = 0.0743-0.3483), and 4.1343 (95% Cl = 2.3265-7.3468; P < .001), respectively. The appPHT has a 47.61% reduction by employing an EMRC model.Due to the relatively high appPHT, diversion rate, and OR value in severe patients, the EMS transportation plan is distinct from a prevalent response and develops adaptive weaknesses of MCIs in current disaster management. Application of the EMRC scenario reduces the appPHT and alleviates the surge pressure upon emergency departments in an MCI.


Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Incidentes con Víctimas en Masa , Factores de Tiempo , Transporte de Pacientes/estadística & datos numéricos , Adolescente , Adulto , Polvo , Servicios Médicos de Urgencia/métodos , Explosiones , Femenino , Humanos , Masculino , Taiwán , Triaje/métodos , Triaje/estadística & datos numéricos , Adulto Joven
10.
Mayo Clin Proc ; 96(3): 690-698, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33673920

RESUMEN

In March 2020, our institution developed an interdisciplinary predictive analytics task force to provide coronavirus disease 2019 (COVID-19) hospital census forecasting to help clinical leaders understand the potential impacts on hospital operations. As the situation unfolded into a pandemic, our task force provided predictive insights through a structured set of visualizations and key messages that have helped the practice to anticipate and react to changing operational needs and opportunities. The framework shared here for the deployment of a COVID-19 predictive analytics task force could be adapted for effective implementation at other institutions to provide evidence-based messaging for operational decision-making. For hospitals without such a structure, immediate consideration may be warranted in light of the devastating COVID-19 third-wave which has arrived for winter 2020-2021.


Asunto(s)
/terapia , Toma de Decisiones , Manejo de la Enfermedad , Hospitales/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Pandemias , /epidemiología , Predicción , Humanos
12.
JAMA Netw Open ; 4(2): e2036297, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33533928

RESUMEN

Importance: Given that 40% of hand function is achieved with the thumb, replantation of traumatic thumb injuries is associated with substantial quality-of-life benefits. However, fewer replantations are being performed annually in the US, which has been associated with less surgical expertise and increased risk of future replantation failures. Thus, understanding how interfacility transfers and hospital characteristics are associated with outcomes warrants further investigation. Objective: To assess the association of interfacility transfer, patient characteristics, and hospital factors with thumb replantation attempts and success. Design, Setting, and Participants: This cross-sectional study used data from the US National Trauma Data Bank from 2009 to 2016 for adult patients with isolated traumatic thumb amputation injury who underwent revision amputation or replantation. Data analysis was performed from May 4, 2020, to July 20, 2020. Exposures: Interfacility transfer, defined as transfer of a patient from 1 hospital to another to obtain care for traumatic thumb amputation. Main Outcomes and Measures: Replantation attempt and replantation success, defined as having undergone a replantation without a subsequent revision amputation during the same hospitalization. Multilevel logistic regression models were used to assess the associations of interfacility transfer, patient characteristics, and hospital factors with replantation outcomes. Results: Of 3670 patients included in this analysis, 3307 (90.1%) were male and 2713 (73.9%) were White; the mean (SD) age was 45.8 (16.5) years. A total of 1881 patients (51.2%) were transferred to another hospital; most of these patients were male (1720 [91.4%]) and White (1420 [75.5%]). After controlling for patient and hospital characteristics, uninsured patients were less likely to have thumb replantation attempted (odds ratio [OR], 0.61; 95% CI, 0.47-0.78) or a successful replantation (OR, 0.64; 95% CI, 0.49-0.84). Interfacility transfer was associated with increased odds of replantation attempt (OR, 1.34; 95% CI, 1.13-1.59), with 13% of the variation at the hospital level. Interfacility transfer was also associated with increased replantation success (OR, 1.23; 95% CI, 1.03-1.47), with 14% of variation at the hospital level. Conclusions and Relevance: In this cross-sectional study, interfacility transfer and particularly hospital-level variation were associated with increased thumb replantation attempts and successes. These findings suggest a need for creating policies that incentivize hospitals with replantation expertise to provide treatment for traumatic thumb amputations, including promotion of centralization of replantation care.


Asunto(s)
Amputación Traumática/cirugía , Hospitales/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Reimplantación , Pulgar/lesiones , Adulto , Factores de Edad , Certificación , Estudios Transversales , Femenino , Traumatismos de los Dedos/cirugía , Capacidad de Camas en Hospitales/estadística & datos numéricos , Hospitales Comunitarios/estadística & datos numéricos , Hospitales de Enseñanza/estadística & datos numéricos , Hospitales Universitarios/estadística & datos numéricos , Humanos , Seguro de Salud , Modelos Logísticos , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Medicare , Persona de Mediana Edad , Análisis Multinivel , Oportunidad Relativa , Cirujanos Ortopédicos/provisión & distribución , Centros Traumatológicos/estadística & datos numéricos , Resultado del Tratamiento , Estados Unidos
13.
JAMA Netw Open ; 4(2): e2037885, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33616666

RESUMEN

Importance: Transcarotid artery revascularization (TCAR) may serve as a safer alternative to carotid endarterectomy (CEA) for certain patients with carotid artery stenosis. Objective: To determine the center-level association of TCAR adoption with overall perioperative outcomes for TCAR and CEA combined at centers performing both procedures. Design, Setting, and Participants: This comparative-effectiveness research was conducted with a difference-in-difference analysis using retrospective data from 2015 to 2019 from the Vascular Quality Initiative registry, a consortium of more than 400 centers in North America. Included patients underwent TCAR or CEA for carotid artery stenosis. Patients who underwent transfemoral carotid stenting were excluded. Data were analyzed from December 2019 through August 2020. Exposures: Center-level adoption of TCAR vs not. Main Outcomes and Measures: The rate of major adverse cardiovascular events (MACE), a composite of in-hospital stroke, myocardial infarction, or death at 30 days, was measured. Results: Among 86 027 patients who underwent revascularization for carotid artery stenosis, 7664 patients (8.9%) underwent TCAR (mean [SD] age, 73.1 [9.6] years; 2788 [36.4%] women; 6938 White patients [90.6%]; and 3741 patients with symptoms [48.8%]) and 78 363 patients (91.1%) underwent CEA (mean [SD] age, 70.6 [9.2] years; 30 928 [39.5%] women; 70 663 White patients [90.2%]; and 37 883 patients with symptoms [48.3%]). The number of centers performing both TCAR and CEA increased from 15 centers in 2015 to 247 centers in 2019, a more than 16-fold increase. The proportion of all carotid procedures that were TCARs increased from 90 of 12 276 (0.7%) in 2015 to 2718 of 15 956 (17.0%) in 2019, a 24-fold increase. Overall, the crude rate of MACE was similar for TCAR and CEA (178 patients [2.3%] after TCAR vs 1842 patients [2.4%] after CEA; P = .91). However, the rate of MACE over time decreased for CEA (406 of 16 404 patients [2.5%] in 2015 vs 189 of 10 097 patients [1.9%] in 2019; P for trend < .001). The rate of MACE over time decreased for TCAR as well, but the change was not statistically significant (4 of 128 patients [3.1%] in 2016 vs 59 of 2718 patients [2.2%] in 2019; P for trend = .07). Difference-in-difference analysis demonstrated that centers that adopted TCAR had a 10% decrease in the likelihood of MACE at 12 months after TCAR adoption vs if those centers had continued to perform CEA alone (odds ratio, 0.90; 95% CI, 0.81-0.99; P = .04). Conclusions and Relevance: This comparative-effectiveness study of a cohort of patients who underwent TCAR or CEA found that availability of TCAR at a hospital was associated with a decrease in the likelihood of perioperative MACE after carotid revascularization.


Asunto(s)
Estenosis Carotídea/cirugía , Procedimientos Endovasculares/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Mortalidad , Infarto del Miocardio/epidemiología , Complicaciones Posoperatorias/epidemiología , Accidente Cerebrovascular/epidemiología , Anciano , Anciano de 80 o más Años , Investigación sobre la Eficacia Comparativa , Endarterectomía Carotidea/métodos , Procedimientos Endovasculares/métodos , Femenino , Mortalidad Hospitalaria , Hospitales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Punciones , Stents , Resultado del Tratamiento
14.
Lancet Public Health ; 6(3): e155-e163, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33571459

RESUMEN

BACKGROUND: Many patients prefer to avoid hospital-based care towards the end of life, yet hospitalisation is common and more likely for people with low socioeconomic position. The reasons underlying this socioeconomic inequality are not well understood. This study investigated health, service access, and social support as potential mediating pathways between socioeconomic position and receipt of hospital-based care towards the end of life. METHODS: For this observational cohort study, we included deceased participants from the nationally representative English Longitudinal Study of Ageing of people aged 50 years or older in England. We used a multiple mediation model with age-adjusted and gender-adjusted probit regression to estimate the direct effect of socioeconomic position (measured by wealth and education) on death in hospital and three or more hospital admissions in the last 2 years of life, and the indirect effects of socioeconomic position via three mediators: health and function, access to health-care services, and social support. FINDINGS: 737 participants were included (314 [42·6%] female, 423 [57·4%] male), with a median age at death of 78 years (IQR 71-85). For death in hospital, higher wealth had a direct negative effect (probit coefficient -0·16, 95% CI -0·25 to -0·06), which was not mediated by any of the pathways tested. For frequent hospital admissions, health and function mediated the effect of wealth (-0·04, -0·08 to -0·01), accounting for 34·6% of the total negative effect of higher wealth (-0·13, -0·23 to -0·02). Higher wealth was associated with better health and function (0·25, 0·18 to 0·33). Education was associated with the outcomes only indirectly via wealth. INTERPRETATION: Our findings suggest that worse health and function could partly explain why people with lower wealth have more hospital admissions, highlighting the importance of socioeconomically driven health differences in explaining patterns of hospital use towards the end of life. The findings should raise awareness about the related risk factors of low wealth and worse health for patients approaching the end of life, and strengthen calls for resource allocation to be made on the basis of health need and socioeconomic profile. FUNDING: Dunhill Medical Trust Fellowship Grant (RTF74/0116).


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Clase Social , Anciano , Anciano de 80 o más Años , Inglaterra , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Socioeconómicos
15.
BMC Infect Dis ; 21(1): 212, 2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33632137

RESUMEN

BACKGROUND: Healthcare-associated infections (HAIs) are relevant in developing countries where frequencies can be at least 3 times higher than in developed countries. The purpose of this research was to describe the intervention implemented in intensive care units (ICUs) to reduce HAIs through collaborative project and analyze the variation over 18 months in the incidence density (ID) of the three main HAIs: ventilator associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs) and catheter-related urinary tract infections (CAUTIs) and also the length of stay and mortality in these ICUs. METHODS: A quasi-experimental study in five public adult clinical-surgical ICUs, to reduce HAIs, through interventions using the BTS-IHI "Improvement Model", during 18 months. In the project, promoted by the Ministry of Health, Brazilian philanthropic hospitals certified for excellence (HE), those mostly private, certified as excellence and exempt from security contributions, regularly trained and monitored public hospitals in diagnostics, data collection and in developing cycles to improve quality and to prevent HAIs (bundles). In the analysis regarding the length of stay, mortality, the IDs of VAP, CLABSIs and CAUTIs over time, a Generalized Estimating Equation (GEE) model was applied for continuous variables, using the constant correlation (exchangeable) between assessments over time. The model estimated the average difference (ß coefficient of the model) of the measures analyzed during two periods: a period in the year 2017 (prior to implementing the project) and in the years 2018 and 2019 (during the project). RESULT: A mean monthly reduction of 0.427 in VAP ID (p = 0.002) with 33.8% decrease at the end of the period and 0.351 in CAUTI ID (p = 0.009) with 45% final decrease. The mean monthly reduction of 0.252 for CLABSIs was not significant (p = 0.068). Length of stay and mortality rates had no significant variation. CONCLUSIONS: Given the success in reducing VAP and CAUTIs in a few months of interventions, the achievement of the collaborative project is evident. This partnership among public hospitals/HE may be applied to other ICUs including countries with fewer resources.


Asunto(s)
Infección Hospitalaria/prevención & control , Hospitales/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Asociación entre el Sector Público-Privado/estadística & datos numéricos , Adulto , Brasil/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/epidemiología , Hospitales/normas , Humanos , Incidencia , Unidades de Cuidados Intensivos/normas , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/prevención & control , Asociación entre el Sector Público-Privado/organización & administración , Asociación entre el Sector Público-Privado/normas
16.
Emerg Infect Dis ; 27(3): 823-834, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33622481

RESUMEN

Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17-August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%-5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%-3.5%) and nursing home personnel (13.1%, 95% CI 11.5%-14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%-27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.


Asunto(s)
/epidemiología , Personal de Salud/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Casas de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , /transmisión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional/estadística & datos numéricos , Oportunidad Relativa , Equipo de Protección Personal/estadística & datos numéricos , Rhode Island/epidemiología , /aislamiento & purificación , Estudios Seroepidemiológicos , Adulto Joven
17.
Clin Drug Investig ; 41(2): 183-191, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33559103

RESUMEN

BACKGROUND: Schizophrenia is one of the mental disorders with the highest economic and social costs, with an important burden on patients, caregivers, and society. OBJECTIVE: The objective of this study was to estimate the direct and social security costs of schizophrenia in Italy. As far as direct costs are concerned, those related to hospitalizations and pharmaceutical expenditure have been analyzed, while disability benefits (DBs) and incapacity pensions (IPs) have been considered for the social security costs. METHODS: In order to provide annual economic burden of schizophrenia using the real-world data, we analyzed the main regional and national databases related to hospitalizations and pharmaceuticals. Hospitalizations have been analyzed considering the Hospital Information System, which collects all the information regarding hospital discharges from all public and private hospitals (psychiatric wards or residential facilities have not been considered). Hospitalizations with a discharge date between 2009 and 2016, and with a primary or secondary diagnosis of schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 295.xx) were selected. Hospital costs have been estimated considering the national tariffs associated with each selected hospitalization. In addition, using the same inclusion criteria, the average DBs (for workers with reduced working capacity) and IPs (for workers without working capacity) provided each year have been analyzed from the social security benefit applications database. The estimate of pharmaceutical expenditure was prepared based on the OsMed 2018 Report (Italian Medicines Agency, latest issue 18 July 2019). A one-way deterministic sensitivity analysis was conducted to examine the robustness of the results. RESULTS: In Italy from 2009 to 2016, schizophrenia had an important economic impact from a social perspective. On average, 13,800 patients were hospitalized, with an average of 2.98 hospitalizations per patient. From a National Health Service (NHS) perspective and with specific reference to hospitalizations, the annual economic burden was €101.4 million, with an average cost per patient of €7338. On the other hand, pharmaceutical expenditure amounts to over €147 million each year, while residential, semi-residential, and specialist facilities amount to approximately €1 billion. Again, schizophrenia led to approximately 15,000 recipients of social security benefits (DBs and IPs) yearly from 2009 to 2015, with an average annual expenditure of €160.1 million (average cost per patient = €10,675). CONCLUSIONS: Our study estimates an economic burden of schizophrenia of €1250 million per year in direct costs, of which 20% is related to hospitalizations and pharmaceutical expenditure. With regard to social security benefits, an average annual expenditure of €160.1 million was calculated (average cost per patient = €10,675).


Asunto(s)
Costo de Enfermedad , Esquizofrenia/economía , Seguridad Social/economía , Costos de la Atención en Salud , Hospitalización/economía , Hospitales/estadística & datos numéricos , Humanos , Clasificación Internacional de Enfermedades , Italia , Alta del Paciente , Medicina Estatal/economía
18.
Sci Rep ; 11(1): 4200, 2021 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-33603086

RESUMEN

Since its emergence in late 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic with more than 55 million reported cases and 1.3 million estimated deaths worldwide. While epidemiological and clinical characteristics of COVID-19 have been reported, risk factors underlying the transition from mild to severe disease among patients remain poorly understood. In this retrospective study, we analysed data of 879 confirmed SARS-CoV-2 positive patients admitted to a two-site NHS Trust hospital in London, England, between January 1st and May 26th, 2020, with a majority of cases occurring in March and April. We extracted anonymised demographic data, physiological clinical variables and laboratory results from electronic healthcare records (EHR) and applied multivariate logistic regression, random forest and extreme gradient boosted trees. To evaluate the potential for early risk assessment, we used data available during patients' initial presentation at the emergency department (ED) to predict deterioration to one of three clinical endpoints in the remainder of the hospital stay: admission to intensive care, need for invasive mechanical ventilation and in-hospital mortality. Based on the trained models, we extracted the most informative clinical features in determining these patient trajectories. Considering our inclusion criteria, we have identified 129 of 879 (15%) patients that required intensive care, 62 of 878 (7%) patients needing mechanical ventilation, and 193 of 619 (31%) cases of in-hospital mortality. Our models learned successfully from early clinical data and predicted clinical endpoints with high accuracy, the best model achieving area under the receiver operating characteristic (AUC-ROC) scores of 0.76 to 0.87 (F1 scores of 0.42-0.60). Younger patient age was associated with an increased risk of receiving intensive care and ventilation, but lower risk of mortality. Clinical indicators of a patient's oxygen supply and selected laboratory results, such as blood lactate and creatinine levels, were most predictive of COVID-19 patient trajectories. Among COVID-19 patients machine learning can aid in the early identification of those with a poor prognosis, using EHR data collected during a patient's first presentation at ED. Patient age and measures of oxygenation status during ED stay are primary indicators of poor patient outcomes.


Asunto(s)
/mortalidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Aprendizaje Automático , Medición de Riesgo/métodos , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Mortalidad Hospitalaria/tendencias , Hospitalización/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Londres/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Curva ROC , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Reino Unido/epidemiología
19.
Khirurgiia (Mosk) ; (1): 27-33, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33395509

RESUMEN

OBJECTIVE: To study and to justify statistically the influence of the incidence of ulcerative gastroduodenal bleeding on the results of treatment. MATERIAL AND METHODS: The results of treatment of 56.233 patients with ulcerative gastroduodenal bleeding in the Central Federal district have been analyzed throughout a 5-year follow-up period. Statistical analysis was performed in Microsoft Excel 2007 and Review Manager 5.3. RESULTS: Overall in-hospital mortality (r=0.871) and surgical activity (r=0.725) depend on the number of patients with ulcerative bleeding. Active surgical approach was followed by overall in-hospital mortality 6.9%, moderate surgical approach - 5.3% (OR 1.3%, 95% CI 1.18-1.4, p<0.05). CONCLUSION: The correlations between the number of patients with ulcerative bleeding and surgical activity, overall in-hospital and postoperative mortality were identified in a large sample.


Asunto(s)
Hemostasis Endoscópica , Úlcera Péptica Hemorrágica , Estudios de Seguimiento , Mortalidad Hospitalaria , Hospitales/estadística & datos numéricos , Humanos , Incidencia , Úlcera Péptica Hemorrágica/epidemiología , Úlcera Péptica Hemorrágica/etiología , Úlcera Péptica Hemorrágica/cirugía , Vigilancia de la Población , Federación de Rusia/epidemiología
20.
PLoS One ; 16(1): e0240385, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33439890

RESUMEN

BACKGROUND: With the proposed pathophysiologic mechanism of neurologic injury by SARS CoV-2, the frequency of stroke and henceforth the related hospital admissions were expected to rise. This paper investigated this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic. METHODS: This is a retrospective analysis of stroke admissions in a 100-bed stroke unit at the National Institute of Neurosciences and Hospital (NINS&H) which is considerably a large stroke unit. All the admitted cases from 1 January to 30 June 2020 were considered. Poisson regression models were used to determine whether statistically significant changes in admission rates can be found before and after 25 March since when there is a surge in COVID-19 infections. RESULTS: A total of 1394 stroke patients took admission in the stroke unit during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger. The male to female ratio is 1.06:1. From January to March 2020, the mean rate of admission was 302.3 cases per month, which dropped to 162.3 cases per month from April to June, with an overall reduction of 46.3% in acute stroke admission per month. In those two periods, reductions in average admission per month for ischemic stroke (IST), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and venous stroke (VS) were 45.5%, 37.2%, 71.4% and 39.0%, respectively. Based on weekly data, results of Poisson regressions confirm that the average number of admissions per week dropped significantly during the last three months of the sample period. Further, in the first three months, a total of 22 cases of hyperacute stroke management were done, whereas, in the last three months, there was an 86.4% reduction in the number of hyperacute stroke patients getting reperfusion treatment. Only 38 patients (2.7%) were later found to be RT-PCR SARS Cov-2 positive based on nasal swab testing. CONCLUSION: This study revealed a more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. Whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement or stay-home measures remains unknown.


Asunto(s)
/epidemiología , Hospitales/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Accidente Cerebrovascular/terapia , Adulto , Bangladesh/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos
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