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1.
Medicine (Baltimore) ; 99(9): e19379, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118784

RESUMEN

To examine the willingness to pay (WTP) for a quality-adjusted life year (QALY) gained among advanced non-small cell lung cancer (NSCLC) patients in Viet Nam and to analyze the factors affecting an individual's WTP.A cross-sectional, contingent valuation study was conducted among 400 NSCLC patients across 6 national hospitals in Viet Nam. Self-reported information was recorded from patients regarding their socio-demographic status, EQ-5D (EuroQol-5 dimensions) utility, EQ-5D vas, and WTP for 1 QALY gained. To explore the factors related to the WTP, Gamma Generalized Linear Model and multiple logistic regression tools were applied to analyze data.The overall mean and median of WTP/QALY among the NSCLC patients were USD $11,301 and USD $8002, respectively. Strong association was recorded between WTP/QALY amount and the patient's education, economic status, comorbidity status, and health utility.Government and policymakers should consider providing financial supports to disadvantaged groups to improve their access to life saving cancer treatment.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/economía , Carcinoma de Pulmón de Células no Pequeñas/psicología , Financiación de la Atención de la Salud , Pacientes Internos/psicología , Años de Vida Ajustados por Calidad de Vida , Adolescente , Adulto , Anciano , Carcinoma de Pulmón de Células no Pequeñas/terapia , Estudios Transversales , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Vietnam
2.
R I Med J (2013) ; 103(2): 24-27, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32122096

RESUMEN

C. difficile is a complication of antibiotic therapy. Certain antibiotics are associated with a higher rate of developing C. difficile. The charts of 54 patients with nosocomial C. difficile were reviewed and very few had received a high-risk antibiotic. Seven (13%) of 54 patients had not received any antibiotics in the hospital prior to the positive stool test for C. difficile. Moreover, 6 of the 7 had no documentation of receiving an antibiotic in the 56 days prior to admission suggesting that they might be colonized with C. difficile.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Clostridium/tratamiento farmacológico , Clostridium difficile/efectos de los fármacos , Infección Hospitalaria/tratamiento farmacológico , Prescripción Inadecuada/efectos adversos , Pacientes Internos , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/epidemiología , Clostridium difficile/aislamiento & purificación , Infección Hospitalaria/microbiología , Femenino , Hospitales , Humanos , Incidencia , Pacientes Internos/estadística & datos numéricos , Tiempo de Internación , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Rhode Island/epidemiología
3.
R I Med J (2013) ; 103(2): 28-30, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32122097

RESUMEN

The rate of nosocomial C. difficile in Rhode Island is among the highest in the country. Colonization with C. difficile is uncommon but can lead to falsely identifying a patient as having C. difficile infection. Additionally, unrecognized C. difficile colonization may act as a reservoir in the hospital. During a 19-day period, rectal swabs obtained for routine VRE surveillance were cultured for C. difficile. Overall, 51 (7.9%) of 649 patients had C. difficile by culture. The majority (n=36, 71%) of patients from whom a rectal swab grew C. difficile did not have a sample sent to the clinical laboratory. Hence, at least 5.5% of the 649 patients were colonized. One patient was classified as having hospital-acquired C. difficile since the clinical specimen was sent to the clinical laboratory on hospital day 4. This patient was culture positive on admission and hence misclassified as having hospital- acquired C. difficile.


Asunto(s)
Infecciones por Clostridium/epidemiología , Clostridium difficile/aislamiento & purificación , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Pacientes Internos/estadística & datos numéricos , Adulto , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Hospitales , Humanos , Tiempo de Internación , Recto/microbiología , Rhode Island
4.
West Afr J Med ; 37(1): 67-73, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030715

RESUMEN

OBJECTIVE: The purpose of this study was to examine trends in clinical characteristics and in-hospital mortality of HIV patients in a low resource setting in the period 2010 to 2016. METHODS: Data on socio-demographic and clinical characteristics of 313 hospitalized HIV positive patients at the University College Hospital, Ibadan, Nigeria were retrospectively extracted, described and examined for trends. Factors independently associated with mortality were identified using multiple logistic regression. RESULTS: The mean age was 39 years (SD = 9.8) and about two thirds were female. The proportion of females decreased significantly from 83.3% in 2010-2011 to 39.8% in 2016. There was a significant reduction in the diagnosis of disseminated tuberculosis and mortality from 19.4% and 42.9% in 2010-2011 to 4.8% and 27.9% in 2016 respectively. On multiple logistic regression, being male, having neurological features, meningitis, and shorter stay in hospital had significantly higher odds of mortality. CONCLUSION: There was a reduction in in-hospital mortality of HIV patients over the period from 2010 to 2016. Being male and presence of neurological features were associated with mortality. Larger prospective studies are needed to further investigate this observed reduction in mortality among hospitalised patients.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones por VIH/tratamiento farmacológico , Pacientes Internos/estadística & datos numéricos , Mortalidad/tendencias , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Adolescente , Adulto , Fármacos Anti-VIH/administración & dosificación , Femenino , Infecciones por VIH/mortalidad , Hospitales de Enseñanza , Hospitales Universitarios , Humanos , Tiempo de Internación , Masculino , Meningitis/complicaciones , Meningitis/mortalidad , Persona de Mediana Edad , Nigeria/epidemiología , Admisión del Paciente/estadística & datos numéricos , Admisión del Paciente/tendencias , Estudios Retrospectivos , Distribución por Sexo , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/mortalidad , Adulto Joven
5.
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
6.
Neuropsychiatr ; 34(1): 22-26, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-31970717

RESUMEN

BACKGROUND: Despite the demographic development and the increasing number of psychiatric diseases in older people, there are only few scientific investigations on the characteristics of patients in gerontopsychiatry and their mortality. In this retrospective case control study patient data were examined in order to establish which features of patients who died in a department of gerontopsychiatry show differences to those of patients who were discharged. METHOD: A total of 284 patient files from the department of gerontopsychiatry and geriatric psychotherapy of the State Hospital Graz II were evaluated. Between 1 January 2015 and 31 December 2017, a total of 51 women and 91 men died (= cases) in hospital. These patients were compared with 142 sex-matched patients (control group) who were discharged during the same period of time. The evaluation was carried out using logistic regression models. RESULTS: Patients who died on the geriatric psychiatry ward were clearly older and were in a clearly poorer physical state of health than the discharged patients. The deceased patients had a 2.7-fold higher chance of an ischemic cardiac disease as well as a 2.5-fold and 3.5-fold higher chance of being referred from a nursing home or hospital, respectively. They also had a threefold higher chance for a lower functional status, a fourfold increased chance of higher C­reactive protein (CRP) values and a diagnosis of delirium compared to discharged patients. CONCLUSION: The deceased patients had a substantially poorer state of health and tended to suffer more from delirium compared to the discharged patients. Structural health policy precautions must be undertaken so that unnecessary transfers to gerontopsychiatry departments do not become necessary.


Asunto(s)
Delirio/epidemiología , Delirio/psicología , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Austria/epidemiología , Femenino , Humanos , Masculino , Estudios Retrospectivos
7.
Lancet Psychiatry ; 7(2): 135-147, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31974072

RESUMEN

BACKGROUND: Psychiatric disorders are established risk factors for self-harm. However, variation in the risk of self-harm by specific psychiatric disorder and stratified by gender and age is rarely examined in population-representative samples. This study aimed to investigate the risk of self-harm following diagnosis of different psychiatric disorders in an Asian population, through a review of inpatient records retrieved from the Hong Kong Clinical Data Analysis and Reporting System (CDARS). METHODS: For this nested case-control study, the inpatient data of people admitted for any reason to Hong Kong public hospitals, between Jan 1, 2000, and Dec 31, 2010, were extracted from CDARS. Cases were people aged 10 years or older who had been admitted to inpatient care with a first-listed record of psychiatric disorder during the study period. The seven psychiatric disorders of interest were: depression, alcohol misuse or dependence, personality disorders, bipolar disorders, anxiety disorders, schizophrenia, and substance misuse or dependence. Two control patients were matched per case from a subsample of all individuals with the same gender, age, and admission time (ie, same calendar year and month), who did not have any record of the psychiatric disorders of interest. Any patients with a history of self-harm diagnosis before, or at the same time as, the first diagnosis of psychiatric disorder (cases) or admission (controls), were excluded. For each diagnostic category, a Cox proportional hazard regression model was fitted to estimate the adjusted hazard ratio (HR; plus 95% CIs) of associated self-harm, adjusting for gender, age, control-matched admission time, 20 districts of residence, physical comorbidities established as risk factors for self-harm (diabetes, asthma, migraine, epilepsy, HIV, and cancer), and presence of the six other psychiatric disorders. We repeated this analysis in subgroups stratified by gender (male and female) and by age (adolescent, 10-24 years; young adult, 25-44 years; middle-aged, 45-64 years; and older people, ≥65 years). FINDINGS: Between 2000 and 2010, we followed up a cohort of 86 353 people with a first-recorded diagnosis of a psychiatric disorder of interest, and 134 857 matched controls. The highest risk of self-harm was observed in patients with substance misuse or dependence (adjusted HR vs matched controls, 9·6 [95% CI 8·4-11·0]), followed by those with personality disorders (3·7 [2·8-4·9]) and alcohol misuse or dependence (3·2 [2·9-3·7]). When stratified by gender and age, the highest risk of self-harm behaviour was found in the substance misuse or dependence group for both genders (for female patients: adjusted HR vs matched controls, 7·7 [6·0-9·8]; and for male patients, 10·5 [8·9-12·4]), and for all age groups (adolescent: 9·6 [7·2-12·7]; young adults: 10·2 [8·4-12·3]; middle-aged: 11·2 [8·0-15·6], and older people: 3·2 [1·7-6·1]). INTERPRETATION: First-recorded diagnoses of psychiatric disorders were significantly associated with an elevated risk of subsequent self-harm. The associations varied considerably by diagnostic categories across gender and age subgroups. Our findings highlight the need to develop more efficient and targeted preventive measures in psychiatric care management, with specific attention to demographic characteristics linked to increased risk within the same diagnostic category. FUNDING: None.


Asunto(s)
Trastornos de Ansiedad/epidemiología , Trastorno Bipolar/epidemiología , Trastorno Depresivo/epidemiología , Trastornos de la Personalidad/epidemiología , Esquizofrenia/epidemiología , Conducta Autodestructiva/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Estudios de Casos y Controles , Niño , Femenino , Estudios de Seguimiento , Hong Kong/epidemiología , Hospitales Públicos/estadística & datos numéricos , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Sistemas de Registros Médicos Computarizados/estadística & datos numéricos , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Riesgo , Factores Sexuales , Adulto Joven
8.
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
9.
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
10.
Spine (Phila Pa 1976) ; 45(2): 124-133, 2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-31851144

RESUMEN

STUDY DESIGN: Serial cross-sectional study utilizing the National Inpatient Sample (NIS) 2005 to 2014. OBJECTIVE: The aim of this study was to examine the trends of opioid-use disorders among hospitalized patients with spinal conditions and treatment and to identify its contributing factors. SUMMARY OF BACKGROUND DATA: The opioid is widely used in chronic spinal conditions, and misuse of prescriptions is the main culprit of the opioid crisis. Cannabis, the most commonly utilized illicit drug, has recently been substituted for opioid despite increasing cannabis-use emergency room visits. There is limited information on opioid-use disorders, the association with cannabis, and other contributing factors. METHODS: We analyzed the 2005 to 2014 NIS data that identified opioid-use disorders among hospitalized patients with cervical and lumbar spinal conditions and treatment using the International Classification of Disease, Ninth Revision-Clinical Modification codes for opioid abuse, dependence, poisoning, and cervical and lumbar spinal diseases and procedures. The compound annual growth rate (CAGR) was used to quantify trends of opioid-use disorders among hospitalized patients. Multilevel and multivariable regression analyses were performed to determine their contributing factors. RESULTS: The number of hospitalizations with spinal conditions and treatment increased from 2005 to 2011, then decreased between 2011 and 2014 with an overall decrease in length of stay, resulting in the CAGR of -1.60% (P < .001). Almost 3% (2.93%, n = 557,423) of hospitalized patients with spinal conditions and treatment were diagnosed as opioid-use disorders and its CAGR was 6.47% (P < .0001). Opioid-use disorders were associated with cannabis-use disorders (odds ratio 1.714), substance use, mental health condition, younger age, white race, male sex, higher household income, and public insurance or uninsured. CONCLUSION: This study suggests that opioid-use disorders are increasing among hospitalized patients with spinal conditions and treatment and associated with several demographic, and socioeconomic factors, including cannabis-use disorders. LEVEL OF EVIDENCE: 3.


Asunto(s)
Hospitalización/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Abuso de Marihuana/epidemiología , Trastornos Relacionados con Opioides/epidemiología , Enfermedades de la Columna Vertebral/terapia , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Vértebras Cervicales , Estudios Transversales , Bases de Datos Factuales , Diagnóstico Dual (Psiquiatría) , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hospitalización/tendencias , Humanos , Renta , Seguro de Salud/estadística & datos numéricos , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Estados Unidos/epidemiología
11.
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
13.
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
14.
NeuroRehabilitation ; 45(4): 519-524, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31868690

RESUMEN

BACKGROUND: Contemporary goals of rehabilitation after traumatic brain injury (TBI) aim to improve cognitive and motor function by applying concepts of neuroplasticity. This can be challenging to carry out in TBI patients with motor, balance, and cognitive impairments. OBJECTIVE: To determine whether use of dynamic body-weight support (DBWS) would allow safe administration of intensive motor therapy during inpatient rehabilitation and whether its use would yield greater improvement in functional recovery than standard-of-care (SOC) therapy in adults with TBI. METHODS: Data in this retrospective cohort study was collected from patients with TBI who receive inpatient rehabilitation incorporating DBWS (n = 6) and who received inpatient rehabilitation without DBWS (SOC, n = 6). The primary outcome measure was the change in Functional Independence Measures (FIM) scores from admission to discharge. RESULTS: There was significant improvement in total FIM scores at discharge compared to admission for both the DBWS (p = 0.001) and SOC (p = 0.005) groups. Overall, the DBWS group had greater improvement in total FIM score and FIM subscales compared to the SOC group. CONCLUSIONS: Our results suggest DBWS has the potential to allow a greater intensity of therapy during inpatient rehabilitation and yield better outcomes compared to SOC in patients with TBI.


Asunto(s)
Lesiones Traumáticas del Encéfalo/rehabilitación , Vida Independiente/normas , Rehabilitación Neurológica/métodos , Aparatos Ortopédicos , Adulto , Femenino , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Movimiento , Rehabilitación Neurológica/instrumentación , Alta del Paciente/estadística & datos numéricos , Recuperación de la Función
15.
East Asian Arch Psychiatry ; 29(4): 118-123, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31871308

RESUMEN

OBJECTIVE: To determine the prevalence of adult attention deficit hyperactivity disorder (ADHD) and comorbid mental disorders in a Malaysian forensic mental hospital. METHODS: All adult patients admitted to the forensic wards who were able to understand Malay or English language and give written informed consent were included. Participants were assessed using the Conners Adult Attention-Deficit Diagnostic Interview for DSM-IV (for presence of adult ADHD and a history of childhood ADHD) and the Mini International Neuropsychiatric Interview (for psychiatric comorbidities). Sociodemographic and offence-related data were also collected. RESULTS: Of 199 patients admitted, 120 were included for analysis. The mean age of participants was 36.3 years. 94.2% were men. 81.7% were single, divorced, or separated. 25% had a history of childhood ADHD. The prevalence of adult ADHD was 15.8%. The persistence rate was 63%. Among the 19 participants with adult ADHD, the most common psychiatric comorbidities were substance dependence (68.4%), lifetime depression (63.2%), and generalised anxiety disorder (47.4%). Compared with participants without ADHD, participants with adult ADHD were less likely to be married (0% vs 21.8%, p = 0.022) and more likely to have alcohol abuse (15.8% vs 2%, p = 0.028), lifetime manic/hypomanic episodes (42.1% vs 7.9%, p = 0.001), and generalised anxiety disorder (47.4% vs 19.8%, p = 0.017), and were of younger age at first offence (21.8 years vs 26.9 years, p = 0.021). CONCLUSIONS: Adult ADHD is common in a Malaysian forensic mental hospital and is associated with unmarried status, alcohol abuse, lifetime manic/hypomanic episodes, generalised anxiety disorder, and younger age at first offence.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Psiquiatría Forense , Hospitales Psiquiátricos , Pacientes Internos/psicología , Pacientes Internos/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Malasia/epidemiología , Masculino , Prevalencia , Escalas de Valoración Psiquiátrica
16.
Inquiry ; 56: 46958019886958, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31701787

RESUMEN

In large proportions of rural areas in many developing countries, health care delivery system is less developed and is less likely to be equipped to conduct sophisticated treatment for coronary heart disease (CHD) patients locally. This study aims at describing the status quo of and exploring factors associated with hospitalization costs of CHD in township hospitals where only drug therapy was available for CHD conditions. We collected data of inpatients with CHD from discharge records from 10 township hospitals in rural Liaoning from December 2013 to December 2014. We used multilevel linear regression to analyze the factors associated with CHD hospitalization costs. A total of 4635 inpatients were included in the analysis. We found that the average hospitalization costs were 6249.97 RMB (US$1012.47) with the average of 8.89 days of hospitalization in township hospitals in Liaoning. Age, gender, length of stay, the number of times of admissions, by which route was hospitalized, and type of CHD were all the factors significantly associated with hospitalization costs of CHD in township hospitals. The factors associated with hospitalization costs of CHD in township hospitals in rural China showed some different features from the existing studies. When the government designs the related policy, the policy makers need to consider the specific feature of hospitalization costs of CHD in township hospitals in rural areas.


Asunto(s)
Enfermedad Coronaria/economía , Costos de Hospital , Pacientes Internos/estadística & datos numéricos , Servicios de Salud Rural , Adulto , Anciano , Anciano de 80 o más Años , China , Enfermedad Coronaria/terapia , Femenino , Hospitalización/economía , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad
17.
Medicine (Baltimore) ; 98(48): e18113, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31770235

RESUMEN

The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03-1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01-2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48-1.13, P = .15).Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.


Asunto(s)
Anciano Frágil/estadística & datos numéricos , Fragilidad/mortalidad , Desnutrición/mortalidad , Deficiencia de Vitamina D/mortalidad , Deficiencia de Vitamina D/terapia , Anciano , Anciano de 80 o más Años , Suplementos Dietéticos , Femenino , Fragilidad/sangre , Fragilidad/complicaciones , Humanos , Pacientes Internos/estadística & datos numéricos , Masculino , Desnutrición/sangre , Desnutrición/complicaciones , Prevalencia , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento , Vitamina D/análogos & derivados , Vitamina D/sangre , Vitamina D/uso terapéutico , Deficiencia de Vitamina D/complicaciones , Vitaminas/uso terapéutico
18.
Environ Health Prev Med ; 24(1): 63, 2019 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-31759388

RESUMEN

The identification of death is critical for epidemiological research. Despite recent developments in health insurance claims databases, the quality of death information in claims is not guaranteed because health insurance claims are collected primarily for reimbursement. We aimed to examine the usefulness and limitations of death information in claims data and to examine methods for improving the quality of death information for aged persons.We used health insurance claims data and enrollment data (as the gold standard) from September 2012 through August 2015 for nondependent persons aged 65-74 years enrolled in Japanese workplace health insurance. Overall, 3,710,538 insured persons were registered in the database during the study period. We analyzed 45,441 eligible persons. Inpatient and outpatient deaths were identified from the discharge/disease status in the claims, with sensitivities of 94.3% and 47.4%, specificities of 98.5% and 99.9%, and PPVs of 96.3% and 95.7%, respectively, using enrollment data as the gold standard. For outpatients, death defined as a combination of disease status and charge data for terminal care still indicated low sensitivity (54.7%).The validity of death information in inpatient claims was high, suggesting its potential usefulness for identifying death. However, given the low sensitivity for outpatient deaths, the use of death information obtained solely from records in outpatient claims is not recommended.


Asunto(s)
Muerte , Planes de Asistencia Médica para Empleados/estadística & datos numéricos , Formulario de Reclamación de Seguro/estadística & datos numéricos , Anciano , Estudios Transversales , Bases de Datos Factuales , Femenino , Planes de Asistencia Médica para Empleados/normas , Humanos , Pacientes Internos/estadística & datos numéricos , Japón , Masculino , Pacientes Ambulatorios/estadística & datos numéricos , Reproducibilidad de los Resultados
19.
Med Care ; 57(11): 869-874, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31634268

RESUMEN

INTRODUCTION: Surgery accounts for almost half of inpatient spending, much of which is concentrated in a subset of high-cost patients. To study the effects of surgeon and hospital characteristics on surgical expenditures, a way to adjust for patient characteristics is essential. DESIGN: Using 100% Medicare claims data, we identified patients aged 66-99 undergoing elective inpatient surgery (coronary artery bypass grafting, colectomy, and total hip/knee replacement) in 2014. We calculated price-standardized Medicare payments for the surgical episode from admission through 30 days after discharge (episode payments). On the basis of predictor variables from 2013, that is, Elixhauser comorbidities, hierarchical condition categories, Medicare's Chronic Conditions Warehouse (CCW), and total spending, we constructed models to predict the costs of surgical episodes in 2014. RESULTS: All sources of comorbidity data performed well in predicting the costliest cases (Spearman correlation 0.86-0.98). Models on the basis of hierarchical condition categories had slightly superior performance. The costliest quintile of patients as predicted by the model captured 35%-45% of the patients in each procedure's actual costliest quintile. For example, in hip replacement, 44% of the costliest quintile was predicted by the model's costliest quintile. CONCLUSIONS: A significant proportion of surgical spending can be predicted using patient factors on the basis of readily available claims data. By adjusting for patient factors, this will facilitate future research on unwarranted variation in episode payments driven by surgeons, hospitals, or other market forces.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Medicare/economía , Procedimientos Quirúrgicos Operativos/economía , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/economía , Colectomía/economía , Puente de Arteria Coronaria/economía , Episodio de Atención , Femenino , Humanos , Masculino , Estados Unidos
20.
Rinsho Shinkeigaku ; 59(11): 716-722, 2019 Nov 08.
Artículo en Japonés | MEDLINE | ID: mdl-31656262

RESUMEN

We analyzed the registration data of inpatients with facioscapulohumeral muscular dystrophy (FSHD) receiving care at 27 specialized institutions for muscular dystrophy in Japan from 1999 to 2013 using data from October 1 of each year. The number of inpatients of each year ranged from 63 to 72 (67.1 ± 3.3) throughout the study period. Those aged over 50 years gradually increased during the study period, while the oldest inpatient was 82.8 years old. Most could not walk. The rate of respirator dependency increased from 21.0% in 1999 to 71.0% in 2013, while the rate of patients receiving oral nutrition was 98.4% in 1999 and then reduced to 75.4% in 2013. There were 36 death cases reported in the database, including 15 patients with respiratory failure and 4 with heart failure. Our findings indicate that FSHD patients in a severe condition are impacted by respiratory and nutritional problems and their prognosis for survival is related to respiratory failure.


Asunto(s)
Hospitalización/estadística & datos numéricos , Hospitales Especializados/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Distrofia Muscular Facioescapulohumeral/mortalidad , Adulto , Factores de Edad , Anciano , Causas de Muerte , Femenino , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Distrofia Muscular Facioescapulohumeral/complicaciones , Distrofia Muscular Facioescapulohumeral/fisiopatología , Distrofia Muscular Facioescapulohumeral/terapia , Apoyo Nutricional , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/etiología , Índice de Severidad de la Enfermedad , Factores de Tiempo , Ventiladores Mecánicos/estadística & datos numéricos
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