Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 22.298
Filtrar
1.
Medicine (Baltimore) ; 99(5): e18977, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000429

RESUMEN

To address the remaining medical misconducts after the zero-makeup drug policy (ZMDP), e.g., over-examinations, China has given the priority to government supervision on medical institutions. This study evaluated the effect of government supervision on medical costs among inpatients with chronic obstructive pulmonary disease (COPD) in Sichuan province, the first province in China where the medical supervision was conducted.A linear interrupted time series (ITS) model was employed to analyze data about 72,113 inpatients from 32 hospitals. Monthly average medicine costs, diagnostic costs, and medical services costs, nursing costs from January 2015 to June 2018 were analyzed, respectively.The average hospitalization costs fell with a monthly trend of 42.90Yuan before the implementation of supervision (P < .001), and the declining trend remained with the more dramatic rate (-158.70Yuan, P < .001) after the government audit carried out. For western medicine costs, the monthly decreasing trend remained after the implementation of supervision (-66.44Yuan, P < .001); meanwhile, the monthly upward trend was changed into a downtrend trend for traditional Chinese medicine costs (-11.80Yuan, P = .009). Additionally, the increasing monthly trend in average diagnostics costs disappeared after government supervision, and was inversed to an insignificant decreasing trend at the rate of 26.18Yuan per month. Moreover, the previous upward trends were changed into downward trends for both medical service costs and nursing costs (P = .056, -44.71Yuan; P = .007, -11.17Yuan, respectively) after the supervision carried out.Our findings reveal that government supervision in Sichuan province was applicable to curb the growth of medical costs for inpatients with COPD, which may reflect its role in restraining physicians' compensating behaviors after the ZMDP. The government medical supervision holds promise to dismiss medical misconducts in Sichuan province, the experience of which may offer implications for other regions of China as well as other low- and middle-income countries.


Asunto(s)
Regulación Gubernamental , Hospitalización/economía , Pacientes Internos/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/economía , Garantía de la Calidad de Atención de Salud , Anciano , China , Femenino , Humanos , Masculino , Persona de Mediana Edad
4.
Medicine (Baltimore) ; 99(1): e18506, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895785

RESUMEN

BACKGROUND: Whether the occurrence of refeeding syndrome (RFS), a metabolic condition characterized by electrolyte shifts after initiation of nutritional therapy, has a negative impact on clinical outcomes remains ill-defined. We prospectively investigated a subgroup of patients included in a multicentre, nutritional trial (EFFORT) for the occurrence of RFS. METHODS: In this secondary analysis of a randomized-controlled trial investigating the effects of nutritional support in malnourished medical inpatients, we prospectively screened patients for RFS and classified them as "RFS confirmed" and "RFS not confirmed" based on predefined criteria (i.e. electrolyte shifts, clinical symptoms, clinical context, and patient history). We assessed associations of RFS and mortality within 180 days (primary endpoint) and other secondary endpoints using multivariable regression analysis. RESULTS: Among 967 included patients, RFS was confirmed in 141 (14.6%) patients. Compared to patients with no evidence for RFS, patients with confirmed RFS had significantly increased 180-days mortality rates (42/141 (29.8%) vs 181/826 (21.9%), adjusted odds ratio (OR) 1.53 (95% CI 1.02 to 2.29), P < .05). Patients with RFS also had an increased risk for ICU admission (6/141 (4.3%) vs 13/826 (1.6%), adjusted OR 2.71 (95% CI 1.01 to 7.27), P < .05) and longer mean length of hospital stays (10.5 ±â€Š6.9 vs 9.0 ±â€Š6.6 days, adjusted difference 1.57 days (95% CI 0.38-2.75), P = .01). CONCLUSION: A relevant proportion of medical inpatients with malnutrition develop features of RFS upon hospital admission, which is associated with long-term mortality and other adverse clinical outcomes. Further studies are needed to develop preventive strategies for RFS in this patient population.


Asunto(s)
Pacientes Internos/estadística & datos numéricos , Desnutrición/mortalidad , Apoyo Nutricional/efectos adversos , Síndrome de Realimentación/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Desnutrición/terapia , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Síndrome de Realimentación/etiología , Factores de Riesgo , Tasa de Supervivencia
5.
Medicine (Baltimore) ; 99(1): e18569, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895800

RESUMEN

An adverse drug reactions avoidability tool called the Liverpool ADR avoidability assessment tool (LAAT) was recently developed (for research purposes), and subsequently validated with mixed interrater reliability (IRR). We investigated the comparative IRR of this tool in an inpatient cohort to ascertain its practical application in this setting.The patient population was comprised of 44 ADR drug pairs drawn from an observational prospective cohort of patents with ADR attending a Weill Cornell Medicine-affiliated tertiary medical Centre in Doha Qatar (Hamad General Hospital). Using the LAAT, and modified Hallas tools, 4 independent raters (2 Clinical Pharmacologists, and 2 General Physicians) assessed and scored the 44 ADR-drug pairs. Agreement proportions between the rating pairs were evaluated as well individual/overall kappa statistics and intraclass correlation coefficients. We evaluated the weight of each of the 7 questions on the LAAT tool to ascertain its determinative role.Across 44 ADR-drug pairs, the overall median Fleiss kappa using the LAAT, and modified Hallas tools were 0.67 (interquartile range (IQR) 0.55, 0.76), 0.36 (IQR, 0.23-0.71) respectively. The overall percentage pairwise agreement with the LAAT and modified Hallas tools were 78.5%, and 62.2% respectively. Exact pairwise agreement occurred in 37 out of 44 (range 0.71-1), and 27 of 44 (0.53-0.77) ADR-drug pairs using the LAAT and modified Hallas tools respectively. Using the LAAT tool, the overall intraclass correlation coefficient was 0.68 (CI 0.55, 0.79), and 0.37 (CI 0.22, 0.53) with the modified Hallas tool.We report a higher proportion of "possible" and "definite" avoidability outcomes of adverse drug reactions compared with the modified Hallas, or that reported by developers of the LAAT tool. Although initially developed for research purposes, our report has suggested for the first time a potential applicability of this tool in clinical environment as well.


Asunto(s)
Rutas de Resultados Adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Adulto , Algoritmos , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Estudios Prospectivos , Qatar , Reproducibilidad de los Resultados
7.
Gesundheitswesen ; 82(1): e9-e16, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-30340235

RESUMEN

There is an increasing need for patient education in chronic low back pain with mental comorbidity. The present study was carried out in the setting of multidisciplinary inpatient rehabilitation and investigated the acceptance and feasibility of the Debora pain competence and depression prevention training comparing an intervention group with a control group. While patients of the intervention group took part in the pain competence and depression prevention training, patients of the control group only participated in pain competence training. METHOD: A total of 3 partial studies were used for formative evaluation. The triangulative design consisted of problem-centered interviews and focus groups with rehabilitation patients as well as focus groups with experts. The interviews were transcribed, anonymized, and content analysis was performed. RESULTS: The training was well accepted and feasible from the perspective of the patients and experts. The therapists had a significant influence on the participants' satisfaction. Suggestions for improvement focused on developing extensions of the pain and stress management aspects and on discussing individual problems. Compared to the intervention group and independent of depression, the control group assessed the training as being less satisfatory and showed poor group coherence. CONCLUSIONS: Results of the formal evaluation support the combined implementation of the Debora pain competence and depression prevention training program and suggest its long-term establishment in multidisciplinary inpatient rehabilitation.


Asunto(s)
Depresión , Dolor de la Región Lumbar , Educación del Paciente como Asunto , Depresión/complicaciones , Estudios de Factibilidad , Alemania , Humanos , Pacientes Internos , Dolor de la Región Lumbar/complicaciones
8.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 221-225, jan.-dez. 2020. tab
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1048046

RESUMEN

Objetivo: identificar os tipos de medicamentos mais utilizados por idosos hospitalizados e relacioná-los com o risco de desenvolvimento de lesão por pressão. Método: estudo descritivo e documental, realizado em um hospital de referência em traumas de Fortaleza, Ceará. A amostra constituiu-se por 48 prontuários e a coleta de dados ocorreu no período de agosto de 2015 a fevereiro de 2016. Resultados: ocorreu a análise dos 48 prontuários de pacientes idosos acamados que se encontravam internados na Unidade de Terapia Intensiva e enfermaria. A média de idade desses idosos foi de 75 anos com presença de 54,2% do sexo masculino e 45,8% do sexo feminino. Desse total, os fármacos que mais apareceram e tem relação com o desenvolvimento da lesão são: os anti-hipertensivos, analgésicos, diuréticos, drogas vasoativas e antibiótico. Conclusão: os tipos de medicamentos mais utilizados nos idosos deste estudo estavam diretamente relacionados às alterações no sistema circulatório do idoso


Objective: the study's main purpose has been to identify the types of medication most used by hospitalized-elderly people, while relating them to the risk of developing pressure injury. Method: it is a descriptive and documental study, which was performed in a trauma referral hospital from the Fortaleza city, Ceará State. The sample consisted of 48 medical records and the data collection took place from August 2015 to February 2016. Results: through the analysis of 48 medical records from elderly patients hospitalized in both Intensive Care Unit and ward, the following results were found: the average age of those elderly individuals was 75 years old, with 54.2% being males and 45.8% being females. Bearing in mind the total, the drugs that appeared the most and were also related to the development of pressure injury were as follows: antihypertensives, analgesics, diuretics, vasoactive drugs and antibiotics. Conclusion: the types of medication most used by the elderly patients addressed in this study were directly related to alterations in their circulatory system


Objetivo: identificar los tipos de medicamentos más utilizados por ancianos hospitalizados y relacionarlos con el riesgo de desarrollo de lesión por presión. Método: estudio descriptivo y documental, realizado en un hospital de referencia en traumas de Fortaleza, Ceará. La muestra se constituyó por 48 prontuarios y la recolección de datos ocurrió en el período de agosto de 2015 a febrero de 2016. Resultados: ocurrió el análisis de los 48 prontuarios de pacientes ancianos acamados que se encontraban internados en la Unidad de Terapia Intensiva y enfermería. El promedio de edad de estos ancianos fue de 75 años con presencia de 54,2% del sexo masculino y el 45,8% del sexo femenino. De ese total, los fármacos que más aparecieron y tienen relación con el desarrollo de la lesión son: los antihipertensivos, analgésicos, diuréticos, drogas vasoactivas y antibiótico. Conclusión: los tipos de medicamentos más utilizados en los ancianos de este estudio estaban directamente relacionados a las alteraciones en el sistema circulatorio del anciano


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Úlcera por Presión , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/complicaciones , Pacientes Internos , Salud del Anciano , Factores de Riesgo
9.
J Surg Res ; 245: 629-635, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31522036

RESUMEN

BACKGROUND: Emergency general surgery (EGS) accounts for more than 2 million U.S. hospital admissions annually. Low-income EGS patients have higher rates of postoperative adverse events (AEs) than high-income patients. This may be related to health care segregation (a disparity in access to high-quality centers). The emergent nature of EGS conditions and the limited number of EGS providers in rural areas may result in less health care segregation and thereby less variability in EGS outcomes in rural areas. The objective of this study was to assess the impact of income on AEs for both rural and urban EGS patients. MATERIALS AND METHODS: The National Inpatient Sample (2007-2014) was queried for patients receiving one of 10 common EGS procedures. Multivariate regression models stratified by income quartiles in urban and rural cohorts adjusting for sociodemographic, clinical, and other hospital-based factors were used to determine the rates of surgical AEs (mortality, complications, and failure to rescue [FTR]). RESULTS: 1,687,088 EGS patients were identified; 16.60% (n = 280,034) of them were rural. In the urban cohort, lower income quartiles were associated with higher odds of AEs (mortality OR, 1.21 [95% CI, 1.15-1.27], complications, 1.07 [1.06-1.09]; FTR, 1.17 [1.10-1.24] P < 0.001). In the rural context, income quartiles were not associated with the higher odds of AE (mortality OR, 1.14 [0.83-1.55], P = 0.42; complications, 1.06 [0.97-1,16], P = 1.17; FTR, 1.12 [0.79-1.59], P = 0.52). CONCLUSIONS: Lower income is associated with higher postoperative AEs in the urban setting but not in a rural environment. This socioeconomic disparity in EGS outcomes in urban settings may reflect health care segregation, a differential access to high-quality health care for low-income patients.


Asunto(s)
Tratamiento de Urgencia/efectos adversos , Disparidades en Atención de Salud/economía , Renta/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Operativos/efectos adversos , Adolescente , Adulto , Servicio de Urgencia en Hospital/estadística & datos numéricos , Tratamiento de Urgencia/estadística & datos numéricos , Fracaso de Rescate en Atención a la Salud/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitales Rurales/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Población Rural/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Estados Unidos/epidemiología , Población Urbana/estadística & datos numéricos , Adulto Joven
10.
Radiol Clin North Am ; 58(1): 1-17, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731894

RESUMEN

Bowel wall thickening in the hospitalized patient can be due to myriad etiologies. Familiarity with the optimal study protocols and a structured approach for evaluation are important. Understanding the pathology and knowing the imaging features of most common entities (ischemia, shock bowel, hemorrhage, infection, graft-versus-host disease, and fluid overload) enable radiologists to provide unique value to clinical management.


Asunto(s)
Diagnóstico por Imagen/métodos , Pacientes Internos , Intestinos/fisiopatología , Hospitalización , Humanos
11.
Radiol Clin North Am ; 58(1): 59-71, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731903

RESUMEN

Acute kidney injury (AKI) is characterized by a decline in the glomerular filtration rate. AKI affects up to 20% of hospitalized patients, and is even more common among intensive care unit admissions. Complications of AKI are related to uremia (encephalopathy, neuropathy, pericarditis), volume overload (pulmonary edema), and electrolyte disturbances (hyperkalemia). In addition to having increased associated morbidity and mortality, patients who develop AKI may never fully recover their baseline kidney function. Imaging can play a valuable role in the work-up of AKI. This article discusses the utility of imaging in characterizing AKI in adult patients in a hospital setting.


Asunto(s)
Lesión Renal Aguda/diagnóstico por imagen , Diagnóstico por Imagen/métodos , Pacientes Internos , Hospitalización , Humanos , Riñón/diagnóstico por imagen
12.
Radiol Clin North Am ; 58(1): 93-103, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731905

RESUMEN

This article describes an approach to analyzing the distribution of intravenous contrast on chest computed tomography and illustrates the various pathologies and pitfalls that may be encountered by the imager, especially in the hospitalized patient. Understanding normal and abnormal distribution of intravenous contrast can be used as a clue to detect alterations in physiology and flow.


Asunto(s)
Medios de Contraste , Cardiopatías/diagnóstico por imagen , Pacientes Internos , Embolia Pulmonar/diagnóstico por imagen , Intensificación de Imagen Radiográfica , Tomografía Computarizada por Rayos X/métodos , Corazón/diagnóstico por imagen , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Radiografía Torácica/métodos
13.
Orv Hetil ; 161(1): 11-16, 2020 Jan.
Artículo en Húngaro | MEDLINE | ID: mdl-31884812

RESUMEN

Introduction: There are no satisfying data about the difficulties of nutritional therapy during rehabilitation, but malnutrition and secondary sarcopenia increase the number of complications. Aim: The aim of this cross-sectional study was measuring of patients' malnutrition risk in the National Institute for Medical Rehabilitation of Hungary. Method: Malnutrition Universal Screening Tool was used in this study. Results: 44% of the patients had a risk of malnutrition (n = 331; average age: 59 years), 19% of the patients presented moderate risk and 25% had high risk of malnutrition. The sample consisted of 176 males and 155 females (53%/47%). The interquartile range of body mass index of patients was between 22-29.9 kg/m2 (s = 6.36). Comparison of units showed that the Brain Injury Rehabilitation Unit has the most malnutrition-risked patients (62.5%, 25 patients). Conclusions: Malnutrition screening tools are not sensitive enough in the case of special patient groups of rehabilitation, therefore a combined screening method is needed. Orv Hetil. 2020; 161(1): 11-16.


Asunto(s)
Pacientes Internos , Desnutrición/diagnóstico , Tamizaje Masivo/métodos , Sarcopenia , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Hungría , Masculino , Desnutrición/prevención & control , Persona de Mediana Edad , Evaluación Nutricional , Estado Nutricional
16.
Lancet ; 394(10214): 2069-2070, 2019 12 07.
Artículo en Inglés | MEDLINE | ID: mdl-31818404
19.
Orv Hetil ; 160(49): 1941-1947, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31786937

RESUMEN

Introduction and aim: To analyse and classify the ocular trauma cases at the in-patient ophthalmological department of the Markusovszky University Teaching Hospital between 2014 and 2018. Method: We analysed the eye injury cases between 01. 01. 2014 and 31. 12. 2018 in the in-patient clinic of our hospital. 98 eyes of 97 patients were included in this study. To classify the injuries, we used the Birmingham Eye Trauma Terminology (BETT) and the new expanded classification of Shukla et al. Results: From the 97 patients, 16 were female and 81 male. The average age was 43.3 ± 22.5 (min.: 3, max.: 92) years; 20 patients were younger than 18 years old. 46.4% of the cases were right eyes, 52.5% were left eyes, and 1% was bilateral. The average time from the injury until the treatment was 1.3 days. The average time spent in hospital because of the injury was 5.2 days. The average observation time was 9.7 months. 95.8% of the injuries were mechanical eye injuries. From this group, 74.2% localized only to the globe, 20.4% were adnexal injuries and 5.4% were destructive eye injuries. From the globe injuries, 15 were closed globe, 60 were open globe injuries, and in 21 cases there were intraocular foreign body present. In 93% of the cases it was possible to keep or improve the best corrected visual acuity during the treatment. Conclusion: With the new classification, we could classify all of the eye injury cases easily. Depending on the type of the eye injury, with appropriate treatment we can keep or improve the visual function of the eye. Orv Hetil. 2019; 160(49): 1941-1947.


Asunto(s)
Lesiones Oculares/clasificación , Pacientes Internos/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Lesiones Oculares/epidemiología , Lesiones Oculares/etiología , Femenino , Departamentos de Hospitales , Hospitales Universitarios , Humanos , Hungría/epidemiología , Masculino , Persona de Mediana Edad , Agudeza Visual
20.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 54(12): 829-834, 2019 Dec 09.
Artículo en Chino | MEDLINE | ID: mdl-31874483

RESUMEN

Objective: To analyze the clinical characteristics of oral candidiasis (OC) in in-patients with rheumatism, in order to provide theoretical basis for the prevention and treatment of OC in rheumatism patients. Methods: One thousand eight hundred and eight in-patients were recruited in the Department of Rheumatology, the Second Hospital of Shanxi Medical University from January 2017 to December 2017. The patients included 607 males and 1 201 females. Their average age was (49.5±15.5) years old with a ranging from 14 to 81 years. According to occurrence of OC or not, the patients were divided into OC group and non-OC group. The differences of general data, primary diseases, laboratory examinations, usage of glucocorticoid and immunosuppressant therapy were compared between the two groups, and the risk factors of OC occurrence were analyzed. Results: Two hundred and sixty-nine patients had OC and 1 539 patients had no OC. Age [(54.9±14.7) years], duration of illness [(9.4±4.4) years] and hospital stay [(15.3±5.7) d] in OC group were significantly longer than those in non-OC group. OC incidence in patients with connective tissue disease (CTD) [17.40% (193/1 109)] was higher than that in non-CTD patients [10.87% (75/699)] (P<0.001). OC most likely occurred in patients with such CTD as Sjögren syndrome (SS) and Behcet syndrome. OC incidence in non-CTD patients with osteoarthritis (OA) was highest. The salivary flow rate in OC group [(0.65±0.45) ml/min] was significantly lower than that in non-OC group [(0.78± 0.39) ml/min] (t=2.394, P=0.017). There was no statistical differences in other laboratory examinations between the two groups, including white blood cells (WBC), lymphocyte, platelet count, liver function, renal function, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, immunoglobulin G, immunoglobulin M, immunoglobulin A, C(3), C(4) and so on. OC incidence in patients using prednisone≥15 mg/d [17.16% (133/775)] was higher than that in patients using prednisone<15 mg/d [12.53% (94/750)] and patients not using prednisone [14.84% (42/283)] (P<0.05). The incidence of OC in patients with immunosuppressant therapy [16.11% (226/1 403)] was statistically higher than that in non-immunosuppressant patients [10.62% (43/405)] (P<0.01). Logistic regression analysis showed that the risk factors of OC occurrence included primary diseases (P<0.001), age (P<0.001), duration of illness (P=0.001) and duration of hospitalization (P=0.002). Conclusions: OC occurred commonly in rheumatism in-patients, especially in elder patients, patients with long duration of illness and hospital stay. OC incidence in CTD patients is significantly higher than that in non-CTD patients. Glucocorticoid and immunosuppressant therapy might significantly reduce the anti-fungal immunity of the patients.


Asunto(s)
Candidiasis Bucal/complicaciones , Enfermedades Reumáticas/complicaciones , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Síndrome de Behçet/complicaciones , Femenino , Humanos , Incidencia , Pacientes Internos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Factores de Riesgo , Síndrome de Sjögren/complicaciones , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA