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1.
Health Qual Life Outcomes ; 20(1): 3, 2022 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-35012568

RESUMEN

BACKGROUND: Fatigue is a frequent complaint amongst children and adolescents with obesity, and it interferes with adherence to dietary and exercise regimes that could reduce obesity. The present study evaluated the effect of an inpatient 3-week body weight reduction program on body weight and fatigue. METHOD: One hundred children and adolescents with obesity (64% female; aged 11-18 years) undertook an inpatient program of personalized diet, daily exercise, education, and counselling. RESULTS: The sample evidenced a mean reduction in body mass (females: ΔM = 4.3 (sd = 2.1) kg, p < .001), males: ΔM = 6.2 (sd = 2.6) kg, p < .001), BMI standard deviation score (females: ΔM = 0.17 (sd = 0.07), males: ΔM = 0.24 (sd = 0.08), p < .001) and fatigue (females: ΔM = 7.8 (sd = 9.7), males: ΔM = 5.0 (sd = 6.9), p < .001) as measured by the Pediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) and improvements on the Attention problems subscale of the Youth Self Report (total sample: ΔM = 0.89 (sd = 2.44), p < .001). Reliable change analyses revealed fatigue changes were achieved by up to 34% females and 17% males, but the majority did not achieve reliable change and changes in fatigue were not correlated with changes in body mass. CONCLUSIONS: The program achieved clinically significant improvements in some children and adolescents. Future studies should explore predictors of treatment responsiveness. Trial registration Observational study. Not registered.


Asunto(s)
Obesidad Pediátrica , Programas de Reducción de Peso , Adolescente , Niño , Fatiga , Femenino , Humanos , Pacientes Internos , Masculino , Calidad de Vida
2.
Mymensingh Med J ; 31(1): 258-262, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34999712

RESUMEN

The 2012 Junior Management of Really Sick Patients with Anorexia Nervosa (MaRSiPAN) guidelines recommends daily blood testing during the initial 5 days of children admitted for inpatient re-feeding. The aim of this study was to determine the clinical utility of this and whether blood tests could be minimised. Single centre retrospective study of children admitted for inpatient treatment of anorexia nervosa (January 2018 - August 2020) was done in a general paediatric ward. Weight, body mass index and re-feeding blood biochemistry were recorded. There were 37 patients, all females, aged between 11-17 years. Weight ranged from 21.4-61.75 Kg. Phosphate levels were 0.6-1.6 mmol/L; mean value 1.22 mmol/L. Over the 5 days of daily testing, mean and median values of all blood results remained within reference ranges. No biochemical indication of re-feeding syndrome was evident and resulted in no change of management. There is limited utility in daily blood testing for patients for the initial 5 days.


Asunto(s)
Anorexia Nerviosa , Adolescente , Anorexia Nerviosa/terapia , Índice de Masa Corporal , Niño , Femenino , Hospitalización , Humanos , Pacientes Internos , Estudios Retrospectivos
3.
J Psychiatr Pract ; 28(1): 62-66, 2022 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-34989347

RESUMEN

Clozapine is the antipsychotic of choice in treatment-resistant schizophrenia. Serum clozapine concentration testing is essential to monitor adherence, adjust dosing, and ensure treatment safety. However, patients who are acutely unwell are frequently reluctant to undergo blood testing requiring venipuncture. Also, conventional laboratory-based measurement of clozapine plasma levels can take days, thus contributing to the suboptimal use of clozapine when it is most needed. We pioneered clozapine whole-blood point of care (POC) testing in the acute inpatient setting in the treatment of a group of actively psychotic patients receiving clozapine during the outbreak of the COVID-19 pandemic. POC clozapine testing using automated homogenous immunoassay requires only finger prick blood sampling and is more acceptable to patients. As it produces results in minutes, clozapine POC testing serves to promptly ascertain adherence with treatment and inform therapeutic dosing. POC testing offered a more practical, less invasive, and quicker alternative to conventional methods of monitoring clozapine levels. Near immediate availability of clozapine levels expedited clinical decisions and helped ensure safe clozapine prescribing to our severely psychotic patients in a time of crisis. By facilitating patients' early safe discharge from the hospital, clozapine POC testing also reduced length of hospitalization.


Asunto(s)
Antipsicóticos , COVID-19 , Clozapina , Psiquiatría , Antipsicóticos/uso terapéutico , Clozapina/efectos adversos , Humanos , Pacientes Internos , Pandemias , Pruebas en el Punto de Atención , SARS-CoV-2
4.
Am J Occup Ther ; 76(1)2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34990510

RESUMEN

IMPORTANCE: Practitioners need to be familiar with, and involved in, managing quality-related adverse events in postacute care. OBJECTIVE: To determine interventions within the scope of occupational therapy that address preventable adverse events in adult postacute inpatient and home health settings. DATA SOURCES: Articles published from January 1995 through 2019 identified through searches of MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases. Study Selection and Data Collection: Articles were collected, evaluated, and analyzed by two independent reviewers. They were assessed and synthesized with a goal of informing clinical practice. FINDINGS: Twenty-four articles were included in the review. Of the 10 Centers for Medicare & Medicaid Services preventable adverse events, 6 were addressed: diabetes management (n = 2), dysphagia (n = 5), infection control (n = 1), pressure ulcers (n = 6), falls (n = 5), and discharge management (n = 5). There was strong strength of evidence that exercise programs should, when appropriate, be implemented in both inpatient and home health settings to decrease the risk of falls. There was moderate strength of evidence that practitioners could consider implementing a facility wide evidence-based pressure ulcer program; providing multidisciplinary rehabilitation and swallow strengthening exercises for dysphagia; implementing a multidisciplinary, multicomponent falls program; and using a manualized depression intervention in home health to decrease hospital readmission. CONCLUSIONS AND RELEVANCE: The review highlights the importance of preventable adverse events and of occupational therapy practitioners acknowledging and managing these events to enhance health outcomes and to control health care costs. What This Article Adds: Many interventions typically performed by occupational therapy practitioners address preventable adverse events. The review highlights the importance of practitioners being aware of this category of impairment or injury.


Asunto(s)
Terapia Ocupacional , Adulto , Anciano , Humanos , Pacientes Internos , Medicare , Readmisión del Paciente , Atención Subaguda , Estados Unidos
5.
Zhonghua Yan Ke Za Zhi ; 58(1): 28-34, 2022 Jan 11.
Artículo en Chino | MEDLINE | ID: mdl-34979790

RESUMEN

Objective: To analyze the composition of diagnosis in young inpatients with angle-closure glaucoma and to compare the clinical characteristics between primary angle-closure glaucoma (PACG) and secondary angle-closure glaucoma (SACG). Methods: This was a retrospective case series study. Angle-closure glaucoma patients aged 40 years or younger and hospitalized in Zhongshan Ophthalmic Center from January 2012 to December 2019 were included. The clinical diagnosis, gender, onset age, and results of general ophthalmic examination, A-scan ultrasonography measurements, ultrasound biomicroscopy, optical coherence tomography and visual field were recorded. The proportions and composition of PACG and SACG, as well as the misdiagnosis ratio, were analyzed. The onset age, visual acuity, visual field, and ocular parameters were compared between patients with PACG and SACG. Non-normally distributed data were represented by M (Q1, Q3). The difference between groups were compared by Mann-Whitney U test, Chi square test, and independent sample t test. Results: A total of 243 patients (243 eyes) were included in this study. The mean onset age was (28±9) years, and the male-to-female ratio was 1∶1.79. There were 93 patients (38.3%) in PACG group and 150 (61.7%) in SACG group. The age of PACG [34(28, 38)] was older than that of SACG [28(19, 34)], and the proportion of males in the SACG group (44.0%, 66/150) was significantly higher than that in the PACG group (22.6%, 21/93) (Z=-5.34, χ2=11.46; both P<0.01). Nanophthalmos (22.7%, 34 cases), autosomal recessive bestrophinopathy (ARB) (19.3%, 29 cases), uveitis (18.7%, 28 cases) and retinitis pigmentosa (14.0%, 21 cases) were the most common causes of SACG. The best corrected visual acuity (logarithm of the minimum angle of resolution) was 0.10 (0.00, 0.48) and 0.40 (0.06, 1.00), mean deviation of visual field was -8.07 (-27.49, -2.09) and -15.04 (-28.75, -5.97) dB, and subfoveal choroidal thickness was (452.3±130.7) and (396.3±120.9) µm in the PACG and SACG groups, respectively. The differences were statistically significant (Z=-4.86, -2.14; t=2.37; all P<0.05). There was no statistical difference in intraocular pressure, cup-to-disc ratio, extent of peripheral anterior synechia, central anterior chamber depth, lens thickness, mean retinal nerve fiber layer thickness between these two groups (all P>0.05). The misdiagnosis ratio was 10.7% (26/243) in all patients, while the misdiagnosis ratio of the SACG group (16.7%, 25/150) was higher than that of the PACG group (1.1%, 1/93) (χ²=14.61, P<0.001). Conclusions: PACG, nanophthalmos and ARB are the most common etiologies in young inpatients with angle-closure glaucoma. Compared to PACG, patients with SACG are younger, with worse visual acuity and more severe visual field defects, and easier to be misdiagnosed.


Asunto(s)
Glaucoma de Ángulo Cerrado , Adulto , Antagonistas de Receptores de Angiotensina , Inhibidores de la Enzima Convertidora de Angiotensina , Femenino , Glaucoma de Ángulo Cerrado/diagnóstico por imagen , Humanos , Pacientes Internos , Presión Intraocular , Masculino , Estudios Retrospectivos , Adulto Joven
6.
Pediatr Emerg Care ; 38(1): e393-e397, 2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34986593

RESUMEN

OBJECTIVES: Children presenting to the emergency department (ED) requiring psychiatric admission often undergo screening electrocardiograms (ECG) as part of the medical clearance process. The diagnostic yield of screening ECGs for this purpose has not been reported. The purpose of this study was to determine the clinical utility of screening ECGs in children and adolescents requiring acute inpatient psychiatric admission. METHODS: A single-center retrospective study of patients aged 5 to 18 years who did not have documented indications for ECG and underwent screening ECG before psychiatric inpatient admission over a 2-year period was conducted. Abnormal ECGs were identified via chart review and were reinterpreted by a pediatric cardiologist to determine potential significance to psychiatric care. Impact on treatment and disposition was examined. RESULTS: From January 2018 through December 2019, 252 eligible pediatric patients had a screening ECG in the ED before psychiatric admission. Twenty-one (8.3%) of these ECGs were interpreted as abnormal, and 6 (2.4%) were determined to be potentially relevant to psychiatric care in the setting of specific medication use. The abnormal ECG interpretations resulted in additional workup and/or cardiology consultation for 7 (2.7%) patients but had no impact on psychiatric admission. CONCLUSIONS: In the absence of concerning individual or family history or cardiac symptoms, routine screening ECGs as part of medical clearance for psychiatric admission are not warranted given the low yield of meaningful findings. The decision to obtain an ECG should be made with careful consideration of medical history and in the presence of specific indications.


Asunto(s)
Pacientes Internos , Evaluación Preoperatoria , Adolescente , Niño , Electrocardiografía , Servicio de Urgencia en Hospital , Hospitalización , Humanos , Estudios Retrospectivos
7.
PLoS One ; 17(1): e0261142, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35025917

RESUMEN

BACKGROUND: The Covid-19 pandemic in the United Kingdom has seen two waves; the first starting in March 2020 and the second in late October 2020. It is not known whether outcomes for those admitted with severe Covid were different in the first and second waves. METHODS: The study population comprised all patients admitted to a 1,500-bed London Hospital Trust between March 2020 and March 2021, who tested positive for Covid-19 by PCR within 3-days of admissions. Primary outcome was death within 28-days of admission. Socio-demographics (age, sex, ethnicity), hypertension, diabetes, obesity, baseline physiological observations, CRP, neutrophil, chest x-ray abnormality, remdesivir and dexamethasone were incorporated as co-variates. Proportional subhazards models compared mortality risk between wave 1 and wave 2. Cox-proportional hazard model with propensity score adjustment were used to compare mortality in patients prescribed remdesivir and dexamethasone. RESULTS: There were 3,949 COVID-19 admissions, 3,195 hospital discharges and 733 deaths. There were notable differences in age, ethnicity, comorbidities, and admission disease severity between wave 1 and wave 2. Twenty-eight-day mortality was higher during wave 1 (26.1% versus 13.1%). Mortality risk adjusted for co-variates was significantly lower in wave 2 compared to wave 1 [adjSHR 0.49 (0.37, 0.65) p<0.001]. Analysis of treatment impact did not show statistically different effects of remdesivir [HR 0.84 (95%CI 0.65, 1.08), p = 0.17] or dexamethasone [HR 0.97 (95%CI 0.70, 1.35) p = 0.87]. CONCLUSION: There has been substantial improvements in COVID-19 mortality in the second wave, even accounting for demographics, comorbidity, and disease severity. Neither dexamethasone nor remdesivir appeared to be key explanatory factors, although there may be unmeasured confounding present.


Asunto(s)
COVID-19/mortalidad , Mortalidad Hospitalaria/tendencias , Pacientes Internos/estadística & datos numéricos , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Anciano , Alanina/análogos & derivados , Alanina/uso terapéutico , COVID-19/tratamiento farmacológico , Estudios de Cohortes , Comorbilidad/tendencias , Dexametasona/uso terapéutico , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Londres , Masculino , Persona de Mediana Edad , Pandemias/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Modelos de Riesgos Proporcionales
8.
Int J Health Care Qual Assur ; ahead-of-print(ahead-of-print)2022 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-35048622

RESUMEN

PURPOSE: The purpose of this research is to examine the impact of perceived service quality (PSQ) on the behavioural intention (BI) of patients in Indian government hospitals. The underlying mechanism of trust and patient satisfaction (SAT) is examined as multiple mediating effect. DESIGN/METHODOLOGY/APPROACH: Data from 510 respondents were collected using structured questionnaires. Six government hospitals, namely, S.M.S. Hospital, J.L.N. Hospital, New Medical College Hospital, Maharana Bhupal Medical Hospital, Mathuradas Hospital and P.B.N. Hospital, were selected from the cities of Jaipur, Ajmer, Kota, Udaipur, Jodhpur and Bikaner, respectively. The data were collected from adult patients (>18 years old) who spent at least two nights in a government hospital between 1 October, 2020 and 30 December, 2020. PSQ formed as a reflective-formative model was analysed using the repeated indicator approach. Structural equation modelling (SEM) using SMART-PLS software was used to test the hypothesised model(s) derived deductively from literature. FINDINGS: The findings support the following conclusions: (1) the positive relationship between PSQ and BI is significant; (2) SAT mediates the PSQ and BI relationship; (3) trust mediates the PSQ and BI relationship; (4) the mediation effect of SAT is stronger than that of trust. PRACTICAL IMPLICATIONS: The results indicate that, in order to enhance the positive BI of patients towards government hospitals, it is necessary for the hospitals to work on strategies to enhance the service quality provided to patients. The outcome of this study will enable state government hospitals to get a better understanding of the different dimensions of service quality and will help in observing the factors that contribute to patients' satisfaction and trust in building long-term relationships by encouraging a positive BI. ORIGINALITY/VALUE: There is a dearth of research in India that evaluates the relationships between the constructs PSQ, trust, BI and SAT in the context of healthcare service. This empirical study is an attempt to fill this gap by focussing on the government hospitals in India.


Asunto(s)
Pacientes Internos , Intención , Adolescente , Adulto , Gobierno , Hospitales Públicos , Humanos , Satisfacción del Paciente , Calidad de la Atención de Salud , Encuestas y Cuestionarios
9.
J Wound Ostomy Continence Nurs ; 49(1): 34-50, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35040814

RESUMEN

PURPOSE: Hospital-acquired pressure injuries (HAPIs) have significant impacts on patient morbidity and mortality, with approximately 2.5 million patients treated for pressure-related injuries annually.1 This study aimed to describe the influence of a comprehensive wound care team on HAPIs over an 8-year period. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: All inpatients at an academic public hospital system with HAPIs during the study period from May 2012 to February 2020. METHODS: Data on wound stage, location, infection, medical device location if applicable, and risk factors were recorded from medical records. A 1-way analysis of variance was performed to assess for significance of mean number of cases, National Pressure Injury Advisory Panel (NPIAP) stage on initial presentation, and mean number of medical device-related wounds by year. RESULTS: A total of 957 cases were included. The median stage of pressure injury on assessment was 2, with the mean NPIAP stage declining from 2012 to 2020 (P = .003). Thirty-three percent of pressure injuries were attributed to medical devices, most commonly endotracheal tubing. The most common site of pressure injury was the sacrum (33.6%). CONCLUSION: Creation of a comprehensive wound care team within our academic public hospital system demonstrated a significant decline in device-related and pressure injury cases over the past 8 years. The wound care team focused on frequent assessment, education, and evidence-based treatment to lower these HAPI events.


Asunto(s)
Úlcera por Presión , Hospitales Públicos , Humanos , Pacientes Internos , Grupo de Atención al Paciente , Úlcera por Presión/epidemiología , Úlcera por Presión/prevención & control , Estudios Retrospectivos
10.
J Prof Nurs ; 38: 2-5, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35042586

RESUMEN

The American Association of Ambulatory Care Nurses (AAACN) promotes addressing the increasing need for registered nurses with specialized knowledge and skills to be effective in the ambulatory care environment (2014). A large University Medical Center was interested in offering a senior practicum clinical experience in the ambulatory care environment, that might result in future hiring of new graduate RNs for positions in 17 ambulatory care centers, to address vacancies and in support of the AAACNs goals (2014). The same University's School of Nursing needed to address the need for additional senior practicum clinical placements for 200+ pre-licensure nursing students, each semester. Targeting both the needs of the Medical Center and the School of Nursing, an academic-practice partnership resulted in the creation of a combined inpatient and outpatient, ambulatory care senior practicum clinical experience. This project resulted in a clearer understanding of the utility of ambulatory care environments as a site for nursing student clinical placements. Additionally, the project informed participating students about the roles of the nurse in the ambulatory setting, but did not result in an increased number of placements nor the hiring of newly-graduated RNs into the ambulatory care environment, to date. Lessons learned and potential solutions are shared.


Asunto(s)
Bachillerato en Enfermería , Estudiantes de Enfermería , Humanos , Pacientes Internos , Pacientes Ambulatorios , Selección de Personal
11.
Am J Occup Ther ; 76(1)2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-35037944

RESUMEN

IMPORTANCE: Depressive and anxiety symptoms across physical disability inpatient rehabilitation (IPR) patient groups are well documented and negatively affect functional recovery. The strategies within the occupational therapy scope of practice to address these symptoms in IPR are unclear. OBJECTIVE: To determine what interventions within the occupational therapy scope of practice have been used to address depressive and anxiety symptoms in IPR and to determine intervention efficacy. DATA SOURCES: Nine databases for all publication years were searched (PubMed, Scopus, Embase, Web of Science, PsycINFO, Cochrane Library, AgeLine, OTseeker, and CINAHL). Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for abstracting data and assessing quality. Included articles were peer reviewed, based in the United States, in English, controlled clinical trials or randomized controlled trials, in the IPR setting, and within the occupational therapy scope of practice. Two reviewers independently screened articles, with disagreements resolved by consensus. FINDINGS: Five of 8,082 articles met inclusion criteria. Diagnoses included stroke (n = 1), traumatic brain injury (n = 1), spinal cord injury (n = 1), and musculoskeletal conditions (n = 2). Results are discussed among four categories: study design and outcome variables, intervention type, intervention intensity, and intervention efficacy. CONCLUSIONS AND RELEVANCE: Limited, moderate-quality evidence exists within the occupational therapy scope of practice for addressing depressive and anxiety symptoms in the physical disability IPR setting. Interventions primarily included cognitive and behavioral strategies. Further research among diverse patient populations is needed to support occupational therapy practitioners in facilitating client participation and functioning. What This Article Adds: This systematic review provides an evaluation of the evidence within the occupational therapy scope of practice to address depressive and anxiety symptoms within the physical disability IPR setting. This research can support occupational therapy practitioners to comprehensively address physical and mental health for participation in IPR.


Asunto(s)
Terapia Ocupacional , Ansiedad , Humanos , Pacientes Internos , Recuperación de la Función
12.
Int J Med Inform ; 157: 104596, 2022 01.
Artículo en Inglés | MEDLINE | ID: mdl-34785487

RESUMEN

IMPORTANCE: Diabetes is common amongst hospitalised patients and contributes to increased length of stay and poorer outcomes. Digital transformation, particularly the implementation of electronic medical records (EMRs), is rapidly occurring across the healthcare sector and provides an opportunity to improve the safety and quality of inpatient diabetes care. Alongside this revolution has been a considerable and ongoing evolution of digital interventions to optimise care of inpatients with diabetes including optimisation of EMRs, digital clinical decision support systems (CDSS) and solutions utilising data visibility to allow targeted patient review. OBJECTIVE: To systematically appraise the recent literature to determine which digitally-enabled interventions including EMR, CDSS and data visibility solutions improve the safety and quality of non-critical care inpatient diabetes management. METHODS: Pubmed, Embase and Cochrane databases were searched for suitable articles. Selected articles underwent quality assessment and analysis with results grouped by intervention type. RESULTS: 1202 articles were identified with 42 meeting inclusion criteria. Four key interventions were identified; computerised physician order entry (n = 4), clinician decision support systems (n = 21), EMR driven active case finding (data visibility solutions) and targeted patient review (n = 10) and multicomponent system interventions (n = 7). Studies reported on glucometric outcomes, evidence-based medication ordering including medication errors, and patient and user outcomes. An improvement in glucometric measures particularly mean blood glucose and proportion of target range blood glucose levels and rates of evidence-based insulin prescribing were consistently demonstrated. CONCLUSION: Digitally-enabled interventions utilised to improve quality and safety of inpatient diabetes care were heterogenous in design. The majority of studies across all intervention types reported positive effects for evidence-based prescribing and glucometric outcomes. There was less evidence for digital interventions reducing diabetes medication administration errors or impacting patient outcomes (length of stay).


Asunto(s)
Sistemas de Apoyo a Decisiones Clínicas , Diabetes Mellitus , Sistemas de Entrada de Órdenes Médicas , Diabetes Mellitus/tratamiento farmacológico , Registros Electrónicos de Salud , Humanos , Pacientes Internos
13.
Int J Dermatol ; 61(1): 48-53, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34242397

RESUMEN

BACKGROUND: Dermatology consultation has been shown to have a significant beneficial impact on admitted hospital patients with concurrent or newly diagnosed skin conditions. This study aimed to determine the change in diagnosis and management after dermatology consultation in a tertiary Australian referral hospital. METHODS: A retrospective analysis of dermatology consultations for hospital inpatients from June 1, 2018, through November 11, 2019, was performed. Demographic and clinical data were extracted from electronic medical records, and a chi-squared test was used to analyze categorical variables. RESULTS: There were 306 consultations during the period of interest. The male to female ratio was 1:1 with a median age of 63. Consultations were most often requested by medical teams (69%), and the majority of patients seen in the emergency department were discharged home (86%). In 44% of cases, the requesting team did not provide a diagnosis; in the cases where it did provide a diagnosis, it was changed 57.9% of the time. The most commonly misdiagnosed conditions were dermatitis and skin infections. Dermatologists established or changed management in 82% of cases, and a total of 676 suggestions were made for management. CONCLUSION: The results of this review reinforce the value of dermatology input in the diagnosis and management of hospital in patients. Ensuring maintained presence of hospital-based dermatologists has the potential to improve diagnosis and management of cutaneous issues early on; by extension, this can minimize unnecessary investigations, improve the quality of healthcare, reduce hospital burden, and facilitate outpatient follow-up.


Asunto(s)
Dermatología , Enfermedades de la Piel , Australia , Femenino , Humanos , Pacientes Internos , Masculino , Derivación y Consulta , Estudios Retrospectivos , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/terapia , Centros de Atención Terciaria
15.
Support Care Cancer ; 30(1): 677-686, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34363109

RESUMEN

BACKGROUND: Frailty is emerging as an important determinant for health. Compared with Western countries, research in the field of frailty started at a later stage in China and mainly focused on older community dwellers. Little is known about frailty in Chinese cancer patients, nor the risk factors of frailty. This study aimed at investigating the prevalence of frailty and its risk factors in elderly inpatients with gastric and colorectal cancer. METHODS: This cross-sectional study was conducted at a tertiary hospital in China from Mar. 2020 to Nov. 2020. The study enrolled 265 eligible inpatients aged 60 and older with gastric and colorectal cancer who underwent surgery. Demographic and clinical characteristics, biochemical laboratory parameters, and anthropometric data were collected from all patients. The Groningen Frailty Indicator was applied to assess the frailty status of patients. A multivariate logistic regression model analysis was performed to identify the risk factors of frailty and to estimate their 95% confidence intervals. RESULTS: The prevalence of frailty in elderly inpatients with gastric and colorectal cancer was 43.8%. A multivariate logistic regression analysis showed that older age (OR = 1.065, 95% CI: 1.001-1.132, P = 0.045), low handgrip strength (OR = 4.346, 95% CI: 1.739-10.863, P = 0.002), no regular exercise habit (OR = 3.228, 95% CI: 1.230-8.469, P = 0.017), and low MNA-SF score (OR = 11.090, 95% CI: 5.119-24.024, P < 0.001) were risk factors of frailty. CONCLUSIONS: This study suggested a relatively high prevalence of frailty among elderly inpatients with gastric and colorectal cancer. Older age, low handgrip strength, no regular exercise habit, and low MNA-SF score were identified as risk factors of frailty.


Asunto(s)
Neoplasias Colorrectales , Fragilidad , Anciano , China/epidemiología , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/cirugía , Estudios Transversales , Anciano Frágil , Evaluación Geriátrica , Fuerza de la Mano , Humanos , Pacientes Internos , Persona de Mediana Edad , Prevalencia , Factores de Riesgo
16.
Am J Occup Ther ; 76(1)2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34964839

RESUMEN

IMPORTANCE: Readmissions are costly for Medicare and are associated with poor patient outcomes. OBJECTIVE: To determine whether two domains relevant to acute occupational therapy practice-self-care status and social factors-were associated with readmissions for Medicare patients in the Medicare Hospital Readmissions Reduction Program (HRRP). DESIGN: Cross-sectional, retrospective study. SETTING: Single academic medical center. PARTICIPANTS: Medicare inpatients with a diagnosis included in the HRRP (N = 17,618). Outcomes and Measures: Three logistic regression models were estimated to examine the associations among (1) self-care status and 30-day readmission, (2) social support and 30-day readmission, and (3) housing situation and 30-day readmission. Subgroup analyses were conducted for the individual HRRP diagnoses. RESULTS: No associations were found between acute self-care status, social support, or housing situation and 30-day readmission when all HRRP diagnoses were examined together. However, higher levels of independence with self-care were significantly associated with reduced odds of readmission for patients with pneumonia. CONCLUSIONS AND RELEVANCE: The findings for patients with pneumonia are consistent with those of other studies done in the acute care setting. Deficiencies in acute occupational therapy documentation may have affected the findings for the other HRRP diagnoses. What This Article Adds: This study is the first to examine the association between acute self-care status (as documented by acute care occupational therapy practitioners) and readmission.


Asunto(s)
Pacientes Internos , Readmisión del Paciente , Anciano , Estudios Transversales , Humanos , Medicare , Estudios Retrospectivos , Autocuidado , Factores Sociales , Estados Unidos
17.
Am J Cardiol ; 162: 111-115, 2022 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34903336

RESUMEN

Cardiac arrhythmias have been observed in patients hospitalized with coronavirus disease (COVID-19). Most analyses of rhythm disturbances to date include cases of sinus tachycardia, which may not accurately reflect true cardiac dysfunction. Furthermore, limited data exist regarding the development of conduction disturbances in patients hospitalized with COVID-19. Hence, we performed a retrospective review and compared characteristics and outcomes for patients with versus without incident arrhythmia, excluding sinus tachycardia, as well as between those with versus without incident conduction disturbances. There were 27 of 173 patients (16%) hospitalized with COVID-19 who developed a new arrhythmia. Incident arrhythmias were associated with an increased risk of intensive care unit admission (59% vs 31%, p = 0.0045), intubation (56% vs 20%, p <0.0001), and inpatient death (41% vs 10%, p = 0.0002) without an associated increase in risk of decompensated heart failure or other cardiac issues. New conduction disturbances were found in 13 patients (8%). Incident arrhythmias in patients hospitalized with COVID-19 are associated with an increased risk of mortality, likely reflective of underlying COVID-19 disease severity more than intrinsic cardiac dysfunction. Conduction disturbances occurred less commonly and were not associated with adverse patient outcomes.


Asunto(s)
Arritmias Cardíacas/etiología , COVID-19/complicaciones , Sistema de Conducción Cardíaco/fisiopatología , Hospitalización/estadística & datos numéricos , Pacientes Internos , SARS-CoV-2 , Anciano , Arritmias Cardíacas/epidemiología , Arritmias Cardíacas/terapia , COVID-19/epidemiología , COVID-19/terapia , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos/epidemiología
18.
J Clin Neurosci ; 95: 88-93, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34929657

RESUMEN

Optimal management of metastatic lung cancer to the spine (MLCS) incorporates a multidisciplinary approach. With improvements in lung cancer screening andnonsurgical treatment, the role for surgerymay be affected. The objective of this study is to assess trends in the surgical management of MLCS using the National Inpatient Sample (NIS) database. The NIS was queried for patients with MLCS who underwent surgery from 2005 to 2014. The frequencies of spinal decompression alone, spinal stabilization with or without (+/-) decompression, and vertebral augmentation were calculated. Statistical analysis was performed to analyze the effect of patient characteristics on outcomes. The most common procedure performed was vertebral augmentation (10719, 44.3%), followed by spinal stabilization +/- decompression (8634, 35.7%) and then decompression alone (4824, 20.0%). The total number of surgeries remained stable, while the rate of spinal stabilizations increased throughout the study period (p < 0.001). Invasive procedures such as stabilization and decompression were associated with greater costs, length of stay,complications and mortality. Increasingcomorbidity was associated with increased odds of complication, especially in patients undergoing more invasive procedures. In patients with lowpre-operative comorbidity, the type of procedure did not influence the odds of complication. Graded increases in length of stay, cost and mortality were seen with increasing complication rate.The rate of spinal stabilizations increased, which may be due to either increased early detection of disease facilitating use of outpatient vertebral augmentation procedures and/or the recognition that surgical decompression and stabilization are necessary for optimal outcome in the setting of MLCS with neurological deficit.


Asunto(s)
Neoplasias Pulmonares , Fusión Vertebral , Descompresión Quirúrgica , Detección Precoz del Cáncer , Humanos , Pacientes Internos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/cirugía , Complicaciones Posoperatorias , Estudios Retrospectivos
19.
Appetite ; 168: 105665, 2022 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34455024

RESUMEN

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is associated with binge eating (BE), food addiction (FA), and obesity/higher BMI in individuals without alcohol use disorder (AUD). ADHD is highly prevalent in patients with AUD, but it is unknown whether the presence of comorbid AUD might change the nature of the association between ADHD, BE, FA and BMI (food and alcohol may either compete for the same brain neurocircuitry or share vulnerability risk factors). Here, we filled this gap by testing the association between ADHD and FA/BE in adult patients hospitalized for AUD, with the strength of simultaneously assessing childhood and adult ADHD. We also investigated the association between ADHD and BMI, and the other factors associated with BMI (FA/BE, AUD severity). METHODS: We included 149 AUD inpatients between November 2018 and April 2019. We assessed both childhood and adulthood ADHD (Wender Utah Render Scale and Adult ADHD Self-Report Scale), FA (modified Yale Food Addiction Scale 2.0), BE (Binge Eating Scale), and BMI and AUD (clinical assessment). RESULTS: In multivariable analyses adjusted for age, adult ADHD was associated with higher BE scores (p = .048), but not significant BE (9% vs. 7%; p = .70). ADHD was also associated with FA diagnosis and the number or FA symptoms, with larger effect size for adult (ORs: 9.45[95%CI: 2.82-31.74] and 1.38[1.13-1.69], respectively) than childhood ADHD (ORs: 4.45[1.37-14.46] and 1.40[1.13-1.75], respectively). In multivariable analysis, BMI was associated with both significant BE (p < .001) and FA diagnosis (p = .014), but not adult ADHD nor AUD severity. CONCLUSION: In patients hospitalized for AUD, self-reported adult ADHD was associated with FA and BE, but not BMI. Our results set the groundwork for longitudinal research on the link between ADHD, FA, BE, and BMI in AUD inpatients.


Asunto(s)
Alcoholismo , Trastorno por Déficit de Atención con Hiperactividad , Trastorno por Atracón , Adicción a la Comida , Adulto , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Niño , Humanos , Pacientes Internos
20.
Am J Occup Ther ; 76(1)2022 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-34962515

RESUMEN

IMPORTANCE: After spinal cord injury (SCI), as many as 45% of people experience at least one hospital readmission within 1 yr. Identification of feasible low-cost interventions to reduce hospital readmissions after SCI is needed. OBJECTIVE: To explore whether a relationship exists between routine exercise and hospital readmission rates 1 yr after SCI. DESIGN: We conducted a secondary analysis of data from the SCIRehab Project, a prospective cohort study. SETTING: Five SCI inpatient rehabilitation facilities across the United States. PARTICIPANTS: Participants were people age 12 yr and older who had sustained an SCI, were admitted to a participating inpatient rehabilitation facility, completed the 12-mo postinjury interview, and reported exercising either monthly or not at all since discharge (N = 520). Outcomes and Measures: The SCIRehab Project conducted 12-mo post-inpatient rehabilitation discharge interviews. As part of the interviews, self-reported hospital readmissions and exercise frequencies since discharge (self-reported number of months, average days per week, and average minutes per day of exercise participation) were collected and analyzed. RESULTS: A χ2 analysis determined that a significant correlation (φ = -.091, p = .038) exists between monthly exercise and hospital readmissions 1 yr postinjury. Compared with those who did not exercise, participants who exercised monthly had 8.4% fewer hospital readmissions. CONCLUSIONS AND RELEVANCE: A relationship exists between exercise and hospital readmission, but follow-up research is needed to determine whether regular exercise reduces hospital readmissions among this population. What This Article Adds: After discharge, 44% of the participants did not exercise during the first year after injury. Identifying or implementing accessible community exercise programs is an area of opportunity for occupational therapy practitioners and future researchers to explore.


Asunto(s)
Readmisión del Paciente , Traumatismos de la Médula Espinal , Niño , Humanos , Pacientes Internos , Alta del Paciente , Estudios Prospectivos , Estados Unidos
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