Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 106.055
Filtrar
1.
Fortschr Neurol Psychiatr ; 87(12): 711-713, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31847033

RESUMEN

Evaluations of cases of a neurological early rehabilitation clinic carried out by the medical services of health insurances (2018) are described and analyzed. More than a quarter of the 1098 cases were evaluated. Examinations focused on hours of ventilation, unnecessary hospitalization, intensity of nursing and features of the definition of early neurological rehabilitation. Strategies to minimize are errors described.


Asunto(s)
Seguro de Salud , Rehabilitación Neurológica , Alemania , Hospitalización , Humanos , Rehabilitación Neurológica/economía
2.
J Clin Ethics ; 30(4): 356-359, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31851627

RESUMEN

Intravenous drug abusers may incur bloodstream infections, in particular those involving the heart valves, that often require extended courses of antibiotics, commonly on the order of six weeks. Conventional wisdom has dictated that even when patients are sufficiently well to not need ongoing hospitalization, it is unsafe to complete their antibiotic course in any setting other than in a closely supervised facility, even if this is contrary to their wishes. The assumption has been that such patients would be at risk of using their indwelling intravenous catheter for illicit purposes. Recent advances in the care of patients who suffer from addiction disorders suggest that when patients receive state-of-the-art addiction treatment, many may be able to continue their intravenous antibiotic course unsupervised, at home. This represents a departure from the parentalistic model of care of impaired patients who are prone to self-harm, moving towards a model that respects autonomy and trusts patients who are in recovery to continue their care in a manner that is self-beneficial.


Asunto(s)
Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Inyecciones Intravenosas/ética , Trastornos Relacionados con Opioides/complicaciones , Hospitalización , Humanos
3.
JAMA ; 322(23): 2292-2302, 2019 12 17.
Artículo en Inglés | MEDLINE | ID: mdl-31846016

RESUMEN

Importance: Short-term infusions of single vasodilators, usually given in a fixed dose, have not improved outcomes in patients with acute heart failure (AHF). Objective: To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation using individualized up-titrated doses of established vasodilators in patients with AHF. Design, Setting, and Participants: Randomized, open-label blinded-end-point trial enrolling 788 patients hospitalized for AHF with dyspnea, increased plasma concentrations of natriuretic peptides, systolic blood pressure of at least 100 mm Hg, and plan for treatment in a general ward in 10 tertiary and secondary hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Enrollment began in December 2007 and follow-up was completed in February 2019. Interventions: Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization (n = 386) or usual care (n = 402). Early intensive and sustained vasodilation was a comprehensive pragmatic approach of maximal and sustained vasodilation combining individualized doses of sublingual and transdermal nitrates, low-dose oral hydralazine for 48 hours, and rapid up-titration of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or sacubitril-valsartan. Main Outcomes and Measures: The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days. Results: Among 788 patients randomized, 781 (99.1%; median age, 78 years; 36.9% women) completed the trial and were eligible for primary end point analysis. Follow-up at 180 days was completed for 779 patients (99.7%). The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 117 patients (30.6%) in the intervention group (including 55 deaths [14.4%]) and in 111 patients (27.8%) in the usual care group (including 61 deaths [15.3%]) (absolute difference for the primary end point, 2.8% [95% CI, -3.7% to 9.3%]; adjusted hazard ratio, 1.07 [95% CI, 0.83-1.39]; P = .59). The most common clinically significant adverse events with early intensive and sustained vasodilation vs usual care were hypokalemia (23% vs 25%), worsening renal function (21% vs 20%), headache (26% vs 10%), dizziness (15% vs 10%), and hypotension (8% vs 2%). Conclusions and Relevance: Among patients with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, did not significantly improve a composite outcome of all-cause mortality and AHF rehospitalization at 180 days. Trial Registration: ClinicalTrials.gov Identifier: NCT00512759.


Asunto(s)
Insuficiencia Cardíaca/tratamiento farmacológico , Vasodilatadores/administración & dosificación , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Causas de Muerte , Comorbilidad , Esquema de Medicación , Femenino , Insuficiencia Cardíaca/mortalidad , Hospitalización , Humanos , Masculino , Readmisión del Paciente/estadística & datos numéricos , Vasodilatadores/efectos adversos
4.
Nephrol Nurs J ; 46(6): 629-640, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31872993

RESUMEN

Reducing the growing burden of acute kidney injury (AKI) is a real challenge. This article explores admissions and emergency visits of patients with AKI in California between 2005 and 2015. Data were drawn from California's Office of Statewide Health Planning and Development (OSHPD) hospital dataset. Trend analyses, including comorbidities and spatiotemporal analysis, were conducted. AKI hospital episodes almost doubled between 2005 and 2015 (25,495 vs. 48,845, respectively); the growing trend was largely attributable to an increasing number of patients with co-existing CKD and diabetes or hypertension (2,511 vs. 25,098 in 2005 and 2015, respectively). We also found an increasingly positive spatiotemporal correlation between diabetes prevalence and AKI hospitalization rate over time. Based on results of this study, we identified modifiable targets to reduce the growing number of AKI episodes and the potential escalating health care costs.


Asunto(s)
Lesión Renal Aguda , Complicaciones de la Diabetes , Diabetes Mellitus , Hospitalización , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/epidemiología , California/epidemiología , Complicaciones de la Diabetes/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Estudios Retrospectivos , Factores de Riesgo
6.
Soins ; 64(841): 22-25, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31864507

RESUMEN

Modern day treatment of blood cancers is characterised by the introduction of targeted therapies. Alone or in combination with more traditional treatments, administered in a hospital or an outpatient setting, these new medicines possess specific mechanisms of action and particular side effects in addition to or instead of those of traditional treatments. To understand the changes to the care management of patients taking these new treatments, it is necessary to describe their mechanism of action and their side effects.


Asunto(s)
Neoplasias Hematológicas/terapia , Servicios de Atención de Salud a Domicilio , Hospitalización , Historia del Siglo XXI , Humanos
7.
Georgian Med News ; (294): 165-171, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31687971

RESUMEN

The article explores the issue of human rights protection in the field of health care by the Constitutional Court of Ukraine. The decisions of the Constitutional Court of Ukraine in the case of K. G. Ustimenko (1997), the case of paid medical services (1998), the case of free medical care (2002), the case of judicial control over the hospitalization of incapacitated persons into psychiatric institute are analyzed (2016), as well as the new legislation of Ukraine in the light of radical reform in the healthcare sector. Attention is drawn to the principle of friendly attitude to international law, constitutional complaint, legal positions of the Constitutional Court of Ukraine in the above-mentioned cases and the prospect of their application into the development of new legislation of Ukraine in the context of radical reform of the health care system of Ukraine. It is emphasized that the legal positions of the Constitutional Court of Ukraine, with regard of peculiarities of the national legislature, can serve as a source of inspiration for the courts of other countries. The purpose of the article is to specify the role and place of the Constitutional Court of Ukraine in the system of judicial protection of human and citizen rights, to determine the prospects of applying the legal positions of the Constitutional Court of Ukraine within the development of new legislation of Ukraine in the light of radical reform of the health care system. The object of the study is the social relations that arise during protection of human rights in the field of health care by the Constitutional Court of Ukraine. The methodological basis of the research are general and special methods of scientific knowledge (formal-logical method, comparative-legal, structural-logical). As a result of the conducted research, the role and place of the Constitutional Court of Ukraine in the system of judicial protection of human and citizen rights, the role of the decisions of the Constitutional Court of Ukraine in the case of K. G. Ustimenko, the case of paid medical services, the case of free medical care, the case of judicial control over hospitalization of incapacitated persons into psychiatric institution in the formation and development of domestic constitutional proceedings are defined. It is emphasized that the introduction of the constitutional complaint concept (institution) contributed to the improvement of the national mechanism of human rights protection in the field of health care. Conflicts of constitutional regulation of the human right to free medical care have been identified, and proposals have been worked out regarding possible ways and methods to eliminate them.


Asunto(s)
Prestación de Atención de Salud/legislación & jurisprudencia , Derechos Humanos , Derechos del Paciente , Instituciones de Salud , Hospitalización , Humanos , Ucrania
8.
Pan Afr Med J ; 33: 189, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692788

RESUMEN

Introduction: Burn injuries are a major cause of hospitalization and are associated with significant morbidity and mortality, particularly in children aged four years or below. In Cameroon, the mortality rate of pediatric severe burns was estimated at 41.2%. There is need to determine the predictors of such mortality in order to guide appropriate management. Methods: This study is aimed at assessing the predictors of mortality of pediatric patients who sustained a burn injury over a period of 11 years (between 1st of January 2006 and 31st of December 2016) in Douala General Hospital (DGH). The data for this study was entered in an electronic questionnaire and analyzed using Epi info version 7. All variables thought to be associated with mortality were entered in a multiple binary logistic regression model. The magnitude or risk was measured by odds ratio, and the 95% confidence interval was estimated. Results: A total of 125 cases of pediatric burns were recorded over the study period. A total of 69 (55.65%) were males, giving a male to female ratio of 1.25:1. The median age was 4 years. Most pediatric burns resulted from accidents. Most patient 78 (69%) came before 8 hours following injury. Scalding was the predominant mechanism of injury in 56 (45.5%) of patients. Most patients had partial thickness burn and most burns involved 1-9.9% body surface areas (BSA). The mean length of hospital stay in this study was 7 days, more than half of the patients had no complications during admission. Among those that developed complications, 19 (35%) developed sepsis. Conclusion: Mortality rate of pediatric burns obtained in this study was 29%, mostly due to cardiac arrest. Flame burns (p=0.03) and BSA >25% (p=0.001) were statistically significant predictors of mortality.


Asunto(s)
Accidentes/estadística & datos numéricos , Quemaduras/epidemiología , Paro Cardíaco/epidemiología , Hospitalización/estadística & datos numéricos , Adolescente , Quemaduras/complicaciones , Quemaduras/mortalidad , Camerún , Niño , Preescolar , Estudios Transversales , Femenino , Paro Cardíaco/etiología , Paro Cardíaco/mortalidad , Hospitales Generales , Humanos , Lactante , Recién Nacido , Tiempo de Internación , Masculino , Estudios Retrospectivos , Encuestas y Cuestionarios
9.
Pan Afr Med J ; 33: 263, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31692806

RESUMEN

The time between clinical symptoms onset and the diagnosis of bronchial cancer should be as short as possible so that it can be managed early and effectively. In Madagascar, this diagnostic delay is unknown. Therefore this study aims to evaluated the diagnostic delay of bronchopulmonary cancers at the the USFR Befelatanana Pneumology, Antananarivo, Madagascar. We conducted a retrospective descriptive study of patients with bronchopulmonary cancers diagnosed at the USFR Befelatanana Pneumology over the period 1st January 2011 to 31st December 2015 (5 years). All patients hospitalized during the study period and receiving anatomopathologically-confirmed diagnosis of bronchopulmonary cancer were included in the study. During the study period we collected data from 43 medical records of patients with bronchopulmonary cancer confirmed histologically, reflecting a rate of 0.64% of hospitalized patients. Pre-hospital delay, hospital delay and total delay were 171.74 days, 13.97 days and 185.71 days respectively. The time between symptom onset and consultation with a doctor was less than three months in 30 cases (69.76%), between 3 and 6 months in 8 cases (18.60%). Pre-hospital delay was very long according to the international recommendation for delayed diagnosis of bronchopulmonary cancers. An effort should be made to improve the diagnostic delay.


Asunto(s)
Neoplasias de los Bronquios/diagnóstico , Hospitalización , Neoplasias Pulmonares/diagnóstico , Diagnóstico Tardío , Humanos , Madagascar , Estudios Retrospectivos , Factores de Tiempo
10.
Rev Med Suisse ; 15(670): 2046-2051, 2019 Nov 06.
Artículo en Francés | MEDLINE | ID: mdl-31696680

RESUMEN

Stroke is the most common acute neurological disease in the world. Approximately 16 000 strokes occur each year in Switzerland. In the older population, the stroke outcomes are related to high risk of malnutrition due to neurological deficits impacting oral feeding. Therefore, systematic screening of malnutrition is required upon admission to hospital. Then, assessment of the nutritional status by a specialist should be initiated before deciding on individualised nutritional strategy. Rehabilitation is complex and must be done in multidisciplinary team to provide optimal care to the patients.


Asunto(s)
Desnutrición/etiología , Desnutrición/terapia , Evaluación Nutricional , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Anciano , Hospitalización , Humanos , Desnutrición/diagnóstico , Estado Nutricional , Accidente Cerebrovascular/epidemiología , Suiza/epidemiología
11.
Medicine (Baltimore) ; 98(45): e17502, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31702610

RESUMEN

AIM: Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest. BACKGROUND: Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test. RESULT: In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001). CONCLUSION: In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.


Asunto(s)
Epinefrina/uso terapéutico , Paro Cardíaco Extrahospitalario/tratamiento farmacológico , Anciano , Epinefrina/efectos adversos , Hospitalización , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Alta del Paciente , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
12.
Pneumologie ; 73(11): 670-676, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31715635

RESUMEN

BACKGROUND: Home mechanical ventilation is dramatically evolving in Germany. Patients with non-invasive and invasive ventilation are increasingly treated at home. In-hospital treatment of these patients is also necessary either for control visits or the management of acute medical problems. However, the development of in-hospital patient care, morbidity and mortality of these patients is unknown. METHODS: All patients with long-term dependence on mechanical ventilation for more than three months requiring hospitalisation between 2006 and 2016 were analysed (data obtained from the Federal Statistical Office of Germany). RESULTS: There was an exponential increase in the number of in-patients with long-term dependence of mechanical ventilation. While 24 845 patients were treated in-hospital in 2006, 86 117 patients were treated in 2016. Correspondingly, mortality decreased from 13.2 % (2006) to 5.7 % (2016). In addition, in 2016 47 % of all patients were treated on the intensive care or high dependency care unit. Overall, patients had been severely ill, as there were plenty of medical and neurological co-morbidities. The most common diagnosis was COPD with 58 % of all cases, followed by several cardiology diagnosis. A high number of patients had an impairment of renal function (24 %), in part requiring dialysis. CONCLUSIONS: The rapid development of home mechanical ventilation substantially impacts on the development of the hospital landscape in Germany. The exponential increase of these care-intensive patients is challenging for the health care system and requires a discussion about its limits.


Asunto(s)
Cuidados Críticos , Servicios de Atención de Salud a Domicilio , Atención al Paciente/tendencias , Respiración Artificial , Cuidados Críticos/métodos , Cuidados Críticos/tendencias , Alemania , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/tendencias , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Respiración Artificial/métodos , Respiración Artificial/estadística & datos numéricos
13.
N C Med J ; 80(6): 348-351, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31685569

RESUMEN

Many incarcerated patients will require in-hospital care outside prison facilities. Often, this care is provided by clinicians unfamiliar with the correctional context. In this article, we reflect on our experiences caring for incarcerated inpatients in non-carceral settings in North Carolina and highlight sources of misunderstanding and potential conflicts that arise in the care of these patients.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Hospitalización , Prisioneros , Prisiones/organización & administración , Comunicación , Humanos , Relaciones Interprofesionales , North Carolina
14.
MMWR Morb Mortal Wkly Rep ; 68(46): 1076-1080, 2019 Nov 22.
Artículo en Inglés | MEDLINE | ID: mdl-31751326

RESUMEN

CDC, the Food and Drug Administration (FDA), state and local health departments, and public health and clinical stakeholders are investigating a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) (1). As of November 13, 2019, 49 states, the District of Columbia, and two U.S. territories (Puerto Rico and U.S. Virgin Islands) have reported 2,172 EVALI cases to CDC, including 42 (1.9%) EVALI-associated deaths. To inform EVALI surveillance, including during the 2019-20 influenza season, case report information supplied by states for hospitalized and nonhospitalized patients with EVALI were analyzed using data collected as of November 5, 2019. Among 2,016 EVALI patients with available data on hospitalization status, 1,906 (95%) were hospitalized, and 110 (5%) were not hospitalized. Demographic characteristics of hospitalized and nonhospitalized patients were similar; most were male (68% of hospitalized versus 65% of nonhospitalized patients), and most were aged <35 years (78% of hospitalized versus 74% of nonhospitalized patients). These patients also reported similar use of tetrahydrocannabinol (THC)-containing products (83% of hospitalized versus 84% of nonhospitalized patients). Given the similarity between hospitalized and nonhospitalized EVALI patients, the potential for large numbers of respiratory infections during the emerging 2019-20 influenza season, and the potential difficulty in distinguishing EVALI from respiratory infections, CDC will no longer collect national data on nonhospitalized EVALI patients. Further collection of data on nonhospitalized patients will be at the discretion of individual state, local, and territorial health departments. Candidates for outpatient management of EVALI should have normal oxygen saturation (≥95% while breathing room air), no respiratory distress, no comorbidities that might compromise pulmonary reserve, reliable access to care, strong social support systems, and should be able to ensure follow-up within 24-48 hours of initial evaluation and to seek medical care promptly if respiratory symptoms worsen. Health care providers should emphasize the importance of annual influenza vaccination for all persons aged ≥6 months, including persons who use e-cigarette, or vaping, products (2,3).


Asunto(s)
Brotes de Enfermedades , Hospitalización/estadística & datos numéricos , Lesión Pulmonar/epidemiología , Vapeo/efectos adversos , Adolescente , Adulto , Anciano , Femenino , Humanos , Lesión Pulmonar/terapia , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
15.
Zhonghua Yi Xue Za Zhi ; 99(43): 3432-3436, 2019 Nov 19.
Artículo en Chino | MEDLINE | ID: mdl-31752474

RESUMEN

Objective: To explore the differences in epidemiology and clinical features of Guillain- Barré syndrome (GBS) between rural and urban areas of southern China. Methods: The clinical data of 759 hospitalized GBS patients from 31 hospitals of 13 provinces/cities in southern China, between January 1st, 2013 and September 30th, 2016, were collected and analyzed retrospectively. Results: The risk of GBS was higher for males than females in rural and urban areas and the median age was 49 and 48 years, respectively. Seasonal clustering in winter and spring was noted in both rural and urban areas, and the seasonal trend was more markedly in rural areas, but the differences showed no statistical significance. There were 70.37% of patients in rural areas and 73.69% in urban areas who had antecedent respiratory infection. The median time from onset to nadir was 7 days, and Hughes Disability Scale at admission, nadir and discharge were (2.95±1.10 vs 2.84±1.15), (3.25±1.11 vs 3.14±1.21), (2.02±1.24 vs 2.00±1.31) in rural and urban areas respectively. Albuminocytologic dissociation was present in 84.34% of patients in rural areas and 84.62% of cases in urban areas. There were 8.65% and 10.94% of cases in rural and urban areas who required mechanical ventilation during hospitalization, respectively. Demyelinating GBS accounted for 53.29% and 48.77%, respectively, in patients with findings of nerve conduction studies available in rural and urban areas. Conclusions: GBS in rural areas of southern China showed male predominance and a peak of spring and winter occurrence, with respiratory infection as the predominated preceding events and demyelinating GBS being main clinical subtype. Winter and spring showed a higher incidence of GBS in rural and urban areas. There were no significant differences of sex, age, preceding events, season trend, progression of disease, clinical subtypes and cerebrospinal fluid investigations in GBS patients between rural and urban areas.


Asunto(s)
Síndrome de Guillain-Barré , China , Femenino , Hospitalización , Humanos , Incidencia , Masculino , Estudios Retrospectivos
16.
Rev Med Liege ; 74(11): 566-571, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31729844

RESUMEN

Following a solicitation of INAMI in 2016, a team of the CHU Liège pneumology department has proposed a telemonitoring pilot project in severe chronic obstructive pulmonary disease (COPD) patients. The main objective of the study was to reduce the number of hospitalizations for COPD exacerbation. The patients included in the study had been at least hospitalized once in 12 months before the beginning of the telemonitoring. A close collaboration with the general practitioner was required. Patients were educated in the manipulation of the application and connected objects. The numerous technical difficulties encountered limited the number of patients studied within the short time allowed by INAMI. However, some interesting observations could be made and a first experience in the field acquired. A project on a large scale seems necessary.


Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Telemedicina , Hospitalización , Humanos , Proyectos Piloto , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico
17.
Artículo en Inglés | MEDLINE | ID: mdl-31738866

RESUMEN

The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology of hospitalisations with laboratory-confirmed influenza during the 2018 influenza season. In this observational surveillance system, cases were defined as patients admitted to any of the 17 sentinel hospitals with influenza confirmed by nucleic acid detection. Data were also collected on a frequency-matched control group of influenza-negative patients admitted with acute respiratory infection. During the period 3 April to 31 October 2018 (the 2018 influenza season), 769 patients were admitted with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 30% were elderly (≥65 years), 28% were children (<16 years), 6.4% were Aboriginal and Torres Strait Islander peoples, 2.2% were pregnant and 66% had chronic comorbidities. A small proportion of FluCAN admissions were due to influenza B (13%). Estimated vaccine coverage was 77% in the elderly (≥65 years), 45% in non-elderly adults with medical comorbidities and 26% in children (<16 years) with medical comorbidities. The estimated vaccine effectiveness (VE) in the target population was 52% (95% CI: 37%, 63%). There were a smaller number of hospital admissions detected with confirmed influenza in this national observational surveillance system in 2018 than in 2017, with the demographic profile reflecting the change in circulating subtype from A/H3N2 to A/H1N1.


Asunto(s)
Subtipo H1N1 del Virus de la Influenza A/inmunología , Subtipo H3N2 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/epidemiología , Cobertura de Vacunación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Informes Anuales como Asunto , Australia/epidemiología , Estudios de Casos y Controles , Femenino , Hospitalización , Hospitales , Humanos , Gripe Humana/prevención & control , Gripe Humana/virología , Masculino , Persona de Mediana Edad , Embarazo , Vigilancia de Guardia , Adulto Joven
18.
Medicine (Baltimore) ; 98(41): e17371, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31593087

RESUMEN

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease associated with increased prevalence of type 2 diabetes mellitus (T2DM). Here, we investigated the effect of the combination of cyclooxygenase (COX)-2 inhibitors and metformin on the rate of admission in patients with RA and T2DM and compared it with that of only COX-2 inhibitors.In total, 1268 subjects with RA and T2DM under COX-2 inhibitor and metformin therapy were selected from the National Health Insurance Research Database of Taiwan, along with 2536 patients as 1:2 sex-, age-, and index year-matched controls without metformin therapy. Cox proportional hazard analysis was used to compare the rate of admission during the 10 years of follow-up.At the end of the follow-up, 72 enrolled subjects (1.89%) had admission, including 9 from the combination group (0.71%) and 63 from the COX-2 inhibitor group (2.48%). The combination group was associated with a lower rate of admission at the end of follow-up (P < .001). Cox proportional hazard regression analysis revealed the lower rate of admission for subjects under combination therapy (adjusted hazard ratio of 0.275; 95% confidence interval = 0.136-0.557, P < .001).Patients with RA and T2DM receiving the combination of COX-2 inhibitors and metformin were associated with lower admission rate than those on COX-2 inhibitors alone, and this effect may be attributed to the decrease in the levels of proinflammatory factors.


Asunto(s)
Artritis Reumatoide/tratamiento farmacológico , Inhibidores de la Ciclooxigenasa 2/administración & dosificación , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hospitalización/estadística & datos numéricos , Hipoglucemiantes/administración & dosificación , Metformina/administración & dosificación , Anciano , Artritis Reumatoide/complicaciones , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/complicaciones , Quimioterapia Combinada , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Taiwán/epidemiología
19.
JAMA ; 322(14): 1371-1380, 2019 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-31593271

RESUMEN

Importance: Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations have high rehospitalization rates and reduced quality of life. Objective: To evaluate whether a hospital-initiated program that combined transition and long-term self-management support for patients hospitalized due to COPD and their family caregivers can improve outcomes. Design, Setting, and Participants: Single-site randomized clinical trial conducted in Baltimore, Maryland, with 240 participants. Participants were patients hospitalized due to COPD, randomized to intervention or usual care, and followed up for 6 months after hospital discharge. Enrollment occurred from March 2015 to May 2016; follow-up ended in December 2016. Interventions: The intervention (n = 120) involved a comprehensive 3-month program to help patients and their family caregivers with long-term self-management of COPD. It was delivered by nurses with special training on supporting patients with COPD using standardized tools. Usual care (n = 120) included transition support for 30 days after discharge to ensure adherence to discharge plan and connection to outpatient care. Main Outcomes and Measures: The primary outcome was number of COPD-related acute care events (hospitalizations and emergency department visits) per participant at 6 months. The co-primary outcome was change in participants' health-related quality of life measured by the St George's Respiratory Questionnaire (SGRQ) at 6 months after discharge (score, 0 [best] to 100 [worst]; 4-point difference is clinically meaningful). Results: Among 240 patients who were randomized (mean [SD] age, 64.9 [9.8] years; 61.7% women), 203 (85%) completed the study. The mean (SD) baseline SGRQ score was 62.3 (18.8) in the intervention group and 63.6 (17.4) in the usual care group. The mean number of COPD-related acute care events per participant at 6 months was 1.40 (95% CI, 1.01-1.79) in the intervention group vs 0.72 (95% CI, 0.45-0.97) in the usual care group (difference, 0.68 [95% CI, 0.22-1.15]; P = .004). The mean change in participants' SGRQ total score at 6 months was 2.81 in the intervention group and -2.69 in the usual care group (adjusted difference, 5.18 [95% CI, -2.15 to 12.51]; P = .11). During the study period, there were 15 deaths (intervention: 8; usual care: 7) and 339 hospitalizations (intervention: 202; usual care: 137). Conclusions and Relevance: In a single-site randomized clinical trial of patients hospitalized due to COPD, a 3-month program that combined transition and long-term self-management support resulted in significantly greater COPD-related hospitalizations and emergency department visits, without improvement in quality of life. Further research is needed to determine reasons for this unanticipated finding. Trial Registration: ClinicalTrials.gov Identifier: NCT02036294.


Asunto(s)
Hospitalización/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Calidad de Vida , Automanejo , Cuidado de Transición , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos
20.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(10): 1056-1059, 2019 Oct 06.
Artículo en Chino | MEDLINE | ID: mdl-31607055

RESUMEN

We analyzed the influenza surveillance data of Children's Hospital of Suzhou University from 2016 to 2018 and estimated the hospitalization burden of children under 5 years old due to influenza infection in Suzhou. The results showed that the influenza virus positive rate of 1 451 severe acute respiratory infection (SARI) cases in Children's Hospital of Suzhou University was 13.6% (95%CI: 11.8%-15.3%; 197 cases), among which the influenza pandemic intensity in 2017-2018 was relatively high, and A/H1N1 was the main pandemic virus. It was estimated that the hospitalization rate of influenza-related SARI in children under 5 years old in Suzhou was 6.9‰ (95%CI: 6.6‰-7.2‰), among which the hospitalization rate of children aged<6 months was higher, up to 11.4‰ (95%CI: 9.9‰-12.8‰).


Asunto(s)
Gripe Humana/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Niño , Preescolar , China/epidemiología , Hospitalización , Humanos , Lactante , Subtipo H1N1 del Virus de la Influenza A
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA