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1.
Rev. clín. esp. (Ed. impr.) ; 220(2): 79-85, mar. 2020. tab
Artículo en Español | IBECS | ID: ibc-186416

RESUMEN

Objetivo: Analizar si existen factores sociales que influyan en la estancia hospitalaria prolongada (EHP) de pacientes con agudización grave de EPOC (AEPOC), además de factores clínico-demográficos. Metodología: Estudio de cohortes prospectivo. Se incluyeron pacientes consecutivos que ingresaron por AEPOC en un servicio de Neumología. Se registraron variables demográficas, clínicas (tabaquismo, exacerbaciones e infecciones, disnea, impacto según cuestionario CAT, función pulmonar, comorbilidades, oxigenoterapia y ventilación no invasiva) y sociales (situación económica, disponibilidad y sobrecarga de cuidador, dependencia en actividades básicas e instrumentales, riesgo social y uso de servicios sociales), utilizando cuestionarios e índices como Barthel, Lawton-Brody, Zarit, Barber y Gijón. Se realizó un análisis univariante y multivariante mediante un modelo de regresión logística. Resultados: Se incluyeron 253 pacientes, y la edad media fue de 68,9+/-9,8años. El 77,1% fueron varones. En el modelo de regresión logística se incluyeron tabaquismo activo, valor del FEV1, puntuación en CAT >10, disnea 3-4 de la mMRC, presencia de gérmenes en cultivos de esputo, comorbilidad cardiovascular, anemia, oxigenoterapia domiciliaria, vivir solo, residencia en zona rural, sobrecarga del cuidador y la detección de riesgo/problema sociofamiliar. Las variables que se asociaron de forma independiente con la posibilidad de una EHP fueron la puntuación en cuestionario CAT >10 (OR=8,9; p=0,04) y la detección de riesgo/problema sociofamiliar (OR=2,6; p=0,04). Fumar activamente fue predictor de estancia más breve (OR=0,15; p=0,002). Conclusiones: Variables relacionadas con la esfera social juegan un papel relevante en la estancia hospitalaria, además del impacto de la enfermedad y la persistencia del tabaquismo en pacientes con AEPOC graves


Objective: To determine whether there are social factors that affect the prolonged hospital stay (PHS) of patients with severe chronic obstructive pulmonary disease exacerbation (COPDE), as well as clinical-demographic factors. Methodology: We conducted a prospective cohort study that consecutively included patients who were admitted to a Pneumology department for COPDE. We recorded demographic, clinical (tobacco use, exacerbations and infections, dyspnoea, impact according to CAT questionnaire, pulmonary function, comorbidities, oxygen therapy and noninvasive ventilation) and social (financial status, caregiver availability and overload, dependence for basic and instrumental activities, social risk and use of social services) variables, employing questionnaires and indices such as Barthel, Lawton-Brody, Zarit, Barber and Gijón. We performed a univariate and multivariate analysis using a logistic regression model. Results: The study included 253 patients, with a mean age of 68.9+/-9.8years; 77.1% of whom were men. The logistic regression model included active tobacco use, FEV1 value, CAT score >10, dyspnoea 3-4 on the MMRC, the presence of bacteria in sputum cultures, cardiovascular comorbidity, anaemia, home oxygen therapy, living alone, rural residence, caregiver overload and detecting social-family risks/problems. The variables independently associated with the possibility of PHS were a CAT score >10 (OR, 8.9; P=.04) and detecting a social-family risk/problem (OR, 2.6; P=.04). Active smoking was a predictor of shorter stays (OR, 0.15; P=.002). Conclusions: Variables related to the social sphere play a relevant role in hospital stays, as do the impact of the disease and the persistent use of tobacco by patients with severe COPD exacerbation


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Tiempo de Internación/estadística & datos numéricos , Brote de los Síntomas , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Pruebas de Función Respiratoria/estadística & datos numéricos , Determinantes Sociales de la Salud/estadística & datos numéricos , Predicción , Tabaquismo/epidemiología
2.
Isr Med Assoc J ; 22(3): 173-177, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32147983

RESUMEN

BACKGROUND: The use of a high flow nasal cannula (HFNC) was examined for different clinical indications in the critically ill. OBJECTIVES: To describe a single center experience with HFNC in post-extubation critical care patients by using clinical indices. METHODS: In this single center study, the authors retrospectively evaluated the outcome of patients who were connected to the HFNC after their extubation in the intensive care unit (ICU). At 48 hours after the extubation, the patients were divided into three groups: the group weaned from HFNC, the ongoing HFNC group, and the already intubated group. RESULTS: Of the 80 patients who were included, 42 patients were without HFNC support at 48 hours after extubation, 22 and 16 patients were with ongoing HFNC support and already intubated by this time frame, respectively. The mean ROX index (the ratio of SpO2 divided by fraction of inspired oxygen to respiratory rate) at 6 hours of the weaned group was 12.3 versus 9.3 in the ongoing HFNC group, and 8.5 in the reintubated group (P = 0.02). The groups were significantly different by the ICU length of stay, tracheostomy rate, and mortality. CONCLUSIONS: Among patients treated with HFNC post-extubation of those who had a higher ROX index were less likely to undergo reintubation.


Asunto(s)
Extubación Traqueal , Cuidados Críticos/métodos , Terapia por Inhalación de Oxígeno/métodos , Terapia por Inhalación de Oxígeno/estadística & datos numéricos , Insuficiencia Respiratoria/terapia , Adulto , Anciano , Anciano de 80 o más Años , Cánula , Enfermedad Crítica , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno/instrumentación , Estudios Retrospectivos , Tiempo , Adulto Joven
3.
Laeknabladid ; 106(3): 123-129, 2020.
Artículo en Islandés | MEDLINE | ID: mdl-32124735

RESUMEN

INTRODUCTION: To maximize the use of intensive care unit (ICU) re--sources, it is important to estimate the prevalence and risk factors for prolonged ICU unit stay after coronary artery bypass grafting (CABG) surgery. MATERIAL AND METHODS: This retrospective cohort study included all patients who underwent primary isolated CABG at Landspitali between 2001 and 2018. Patient information was collected from hospital charts and death registries. Patients who stayed in the ICU for the conventional one night postoperatively were compared with those who needed longer stays in the ICU. Survival rate was estimated with the Kaplan-Meier method. Predictors for prolonged ICU stay were calculated with logistic regression and the outcome used to create a calculator that estimates the probability of prolonged ICU stay. RESULTS: Out of 2177 patients, 20% required prolonged ICU stay. Patients with prolonged stay were more frequently female (23% vs 16%, p=0.001), had a higher rate of cardiovascular risk factors and higher EuroSCORE II (4.7 vs. 1.9, p<0.001). They also had a higher rate of impaired renal function before surgery (14% vs. 4%, p<0.001) and emergent surgery (18% vs. 2%, p<0.001). Furthermore, these patients had higher rates of both short-term and long-term complications, and lower long-term survival (85% vs 68% five-year survival rate, p<0.0001). Independent risk factors for prolonged ICU stay were advanced age, female gender, EuroSCORE II, history of heart diseases, impaired renal function and emergent surgery.  Conclusions: Every fifth patient had a prolonged ICU stay after CABG. Several risk factors predicted prolonged ICU stay after CABG, in particular patients' medical condition before surgery, EuroSCORE II and emergent surgery. A better understanding of the risk factors for prolonged ICU stay will hopefully aid in scheduling CABG surgeries at Landspitali.


Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria , Unidades de Cuidados Intensivos , Tiempo de Internación , Anciano , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Islandia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo
4.
Medicine (Baltimore) ; 99(10): e19363, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150080

RESUMEN

Hospital readmission rates are used as a metric to measure quality patient care. While several tools predict readmissions based on patient-specific characteristics, this study assesses if physician characteristics correlate with hospital readmission rates.In a 5-year retrospective electronic record review at a single institution, 31 internal medicine attending physicians' discharges were tracked for a total of 70 physician years, and 15,933 hospital discharges. Each physician's yearly 7-day, 8 to 30-day, and 30-day readmission rates were compared. Each rate was also correlated with years of post-graduate clinical experience, discharge volume, physician sex, and fiscal year.Individual physicians had significantly different 7-day, 8 to 30-day, and 30-day readmission rates from each other. The rates were not related to sex, years after post-graduate training, or fiscal year. However, physician patient volume correlated with 7-day readmission rates. Physicians who discharged ≤100 patients per year had a higher 7-day readmission rate than physicians who discharged >100 patients per year. This correlation with patient volume did not hold for the 8 to 30-day and 30-day readmission rates.Individual physicians differ in their patient readmission rates in 7-day, 8 to 30-day, and 30-day categories. A critical level of a physician's hospital activity, as reflected by the number of patient discharges per year (>100), results in lower 7-day readmission rates. Sex, post-graduate years of clinical experience, and fiscal year did not play a role. The lack of correlation between each physicians' 7-day and 8 to 30-day readmission rates suggests that different physician factors are involved in these 2 rates.


Asunto(s)
Readmisión del Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Adulto , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Alta del Paciente/normas , Alta del Paciente/estadística & datos numéricos , Pennsylvania , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Retrospectivos
5.
Dtsch Arztebl Int ; 116(7): 116-117, 2020 02 14.
Artículo en Inglés | MEDLINE | ID: mdl-32164826
6.
West J Emerg Med ; 21(2): 404-410, 2020 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-32191198

RESUMEN

INTRODUCTION: Shortening emergency department (ED) visit time can reduce ED crowding, morbidity and mortality, and improve patient satisfaction. Point-of-care testing (POCT) has the potential to decrease laboratory turnaround time, possibly leading to shorter time to decision-making and ED length of stay (LOS). We aimed to determine whether the implementation of POCT could reduce time to decision-making and ED LOS. METHODS: We conducted a randomized control trial at the Urgency Room of Siriraj Hospital in Bangkok, Thailand. Patients triaged as level 3 or 4 were randomized to either the POCT or central laboratory testing (CLT) group. Primary outcomes were time to decision-making and ED LOS, which we compared using Mann-Whitney-Wilcoxon test. RESULTS: We enrolled a total of 248 patients: 124 in the POCT and 124 in the CLT group. The median time from arrival to decision was significantly shorter in the POCT group (106.5 minutes (interquartile [IQR] 78.3-140) vs 204.5 minutes (IQR 165-244), p <0.001). The median ED LOS of the POCT group was also shorter (240 minutes (IQR 161.3-410) vs 395.5 minutes (IQR 278.5-641.3), p <0.001). CONCLUSION: Using a point-of-care testing system could decrease time to decision-making and ED LOS, which could in turn reduce ED crowding.


Asunto(s)
Toma de Decisiones , Servicio de Urgencia en Hospital , Satisfacción del Paciente , Pruebas en el Punto de Atención , Tiempo de Tratamiento , Aglomeración , Femenino , Hospitales , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto , Tailandia , Factores de Tiempo , Triaje
7.
Zhen Ci Yan Jiu ; 45(1): 51-6, 2020 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-32144909

RESUMEN

OBJECTIVE: To observe the effect of low-frequency electrical acupoint stimulation on gastrointestinal motility in patients undergoing radical gastrectomy, and its impact on regulation of inflammatory response, so as to evaluate its clinical value. METHODS: A total of 177 patients undergoing radical gastrectomy were randomly divided into conventional group (n=43), low-frequency electrical acupoint stimulation (LEAS) group (n=45), fast track surgery (FTS) group (n=46) and FTS+LEAS group (n=43). Patients of the conventional group received conventional treatment (pre-surgical mechanical bowel preparation, post-surgical fasting, and indwelling abdominal drainage tube, etc.). Patients in the LEAS group were treated by low-frequency electrical stimulation at bilateral Zusanli (ST36), Shangjuxu(ST37), Xiajuxu(ST39) and Sanyinjiao(SP6) for 30 min, once daily from 1 day after the operation to first postoperative flatus. FTS group was given fast track surgery treatment, such as preoperative education, preoperative nutritional support, early oral feeding, early removal of abdominal drainage tube, etc. The FTS+LEAS group was given low-frequency electrical acupoint stimulation on the basis of the FTS treatment. Levels of white blood cells (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) at 1, 3, and 6 d after the operation in the 4 groups were assayed. The first postoperative flatus and defecation time were recorded. RESULTS: After the treatment, the first postoperative flatus and defecation time in the LEAS, FTS and FTS+LEAS groups were significantly shorter than those of the conventional group (P<0.05), and the first flatus time of the FTS+LEAS group was even earlier than that of the FTS group (P<0.05). No significant differences were found among the 3 groups in the postoperative defecation time (P>0.05). The CRP levels in the 4 groups on 3 and 6 d after operation were higher than those on the 1st postoperative day, and the highest level was on 3 d after the operation. Compared with the conventional group, CRP level on 3 d and CRP and IL-6 levels on 3 and 6 d in the LEAS and FTS+LEAS groups were significantly lower (P<0.05). Compared with the LEAS group, the levels of N, CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS group were significantly increased (P<0.05). Compared with the FTS group, the level of CRP on 3 d and the levels of N, CRP, IL-6 on 6 d in the FTS+LEAS group were significantly decreased (P<0.05). CONCLUSION: FTS combined with LEAS is superior to simple FTS or LEAS treatment in shortening the first flatus and defecation time and promoting the recovery of gastrointestinal motility function in patients undergoing radical gastrectomy, which may be associated with its effect in alleviating postoperative inflammatory responses.


Asunto(s)
Puntos de Acupuntura , Neoplasias Gástricas , Estimulación Eléctrica , Gastrectomía , Motilidad Gastrointestinal , Humanos , Tiempo de Internación , Complicaciones Posoperatorias
8.
Zhonghua Yi Xue Za Zhi ; 100(6): 447-451, 2020 Feb 18.
Artículo en Chino | MEDLINE | ID: mdl-32146768

RESUMEN

Objective: To compare and analyze the curative effect of three surgical methods in the treatment of small intestine atresia, and to provide evidence for individualized surgical treatment of children with small intestine atresia. Methods: The clinical diagnosis and treatment of 168 children with small intestine Ⅱ, Ⅲ, Ⅳ type atresia in our hospital from January 2008 to September 2017 were retrospectively analyzed and they were divided into different types according to the operation. The three groups were end-to-end anastomosis group (EEA, n=58), end oblique anastomosis group (EOA, n=68), and proximal end-end anastomosis group (PEA, n=42). The EEA group and the EOA group were further divided into group a (EEA-a/EOA-a) with a proximal intestinal tube diameter greater than 4.0 times the distal end and a group b ((EEA-b/EOA-b) with a diameter less than or equal to 4.0 times the distal intestinal tube diameter. The gender, gestational age, birth weight, type of atresia, and postoperative defecation time, postoperative feeding time, postoperative hospital stay and postoperative follow-up complications were compared. Results: There was no significant difference in gender, gestational age and birth weight between the groups (P>0.05). The PEA group was better than EEA-a group and EOA-a group in postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications (P<0.05). The postoperative defecation time, postoperative feeding time, postoperative hospital stay and complications of the EOA-a group were better than those of the EEA-a group (P<0.05). There was no statistically significant difference in postoperative defecation time, postoperative feeding time, and complications between the EEA-b group and the EOA-b group (P>0.05), but the postoperative hospital stay in the EEA-b group was longer than that in the EOA-b group (P<0.05). Conclusion: PEA is recommended for children with a proximal intestinal canal diameter greater than 4.0 times greater than the distal end because of the rapid recovery and fewer complications; EOA is recommended for children with a proximal intestinal canal diameter of 4.0 or less because of its advantage of shorter hospital stay than EEA surgery. Congenital intestinal atresia has a better effect according to the specific conditions of the child.


Asunto(s)
Atresia Intestinal , Intestino Delgado/anomalías , Anastomosis Quirúrgica , Niño , Humanos , Tiempo de Internación , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento
9.
Am Surg ; 86(2): 104-109, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167051

RESUMEN

Deep vein thrombosis (DVT) is linked to reimbursements and publicly reported metrics. Some hospitals discourage venous duplex ultrasound (VDUS) screening in asymptomatic trauma patients because they often find higher rates of DVT. We aim to evaluate the association between lower extremity (LE) VDUS screening and pulmonary embolism (PE) in trauma patients. Trauma patients admitted to an urban Level-1 trauma center between 2010 and 2015 were retrospectively analyzed. We characterized the association of asymptomatic LE VDUSs with PE, upper extremity DVT, proximal LE DVT, and distal LE DVT by univariate and multivariable logistic regression controlling for confounders. Of the 3959 trauma patients included in our study-after adjusting for covariates related to patient demographics, injury, and procedures-there was a significantly lower likelihood of PE in screened patients (odds ratio (OR) = 0.02, P < 0.001) and a higher rate of distal LE DVT (OR 11.1, P = 0.004). Screening was not associated with higher rates of proximal LE DVT after adjustment for covariates (OR = 1.8, P = 0.193). PE was associated with patient transfer status, pelvis fracture, and spinal procedures in unscreened patients. After adjusting for covariates, we have shown that LE VDUS asymptomatic screening is associated with lower rates of PE in trauma patients and not associated with higher rates of proximal LE DVT. Our detailed institutional review of a large cohort of trauma patients over five years provides support for ongoing asymptomatic screening and better characterizes venous thromboembolism outcomes than similarly sized purely administrative data reviews. As a retrospective cohort study with a large sample size, no loss to follow-up, and a population with low heterogeneity, this study should be considered as level III evidence for care management.


Asunto(s)
Enfermedades Asintomáticas , Embolia Pulmonar/diagnóstico por imagen , Tromboembolia Venosa/diagnóstico por imagen , Trombosis de la Vena/diagnóstico por imagen , Heridas y Traumatismos/complicaciones , Femenino , Humanos , Tiempo de Internación , Modelos Logísticos , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Masculino , Oportunidad Relativa , Embolia Pulmonar/complicaciones , Embolia Pulmonar/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Ultrasonografía Doppler Dúplex/estadística & datos numéricos , Tromboembolia Venosa/complicaciones , Trombosis de la Vena/complicaciones
10.
Am Surg ; 86(2): 83-89, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32167053

RESUMEN

The ACS NSQIP Surgical Risk Calculator is designed to estimate the chance of an unfavorable outcome after surgery. Our goal was to evaluate the accuracy of the calculator in our emergency general surgery population. Surgical outcomes were compared to predicted risk. The risk was calculated with surgeon adjustment scores (SASs) of 1 (no adjustment), 2 (risk somewhat higher), and 3 (risk significantly higher than estimate). Two hundred and twenty-seven patients met the inclusion criteria. An SAS of 1 or 2 accurately predicted risk of mortality (5.7% and 8.5% predicted versus 7.9% actual), whereas a risk adjustment of 3 indicated significant overestimation of mortality rate (14.8% predicted). There was good overall prediction performance for most variables with no clear preference for SAS 1, 2, or 3. Poor correlation was seen with SSI, urinary tract infection, and length of stay variables. The ACS NSQIP Surgical Risk Calculator yields valid predictions in the emergency general surgery population, and the data support its use to inform conversations about outcome expectations.


Asunto(s)
Urgencias Médicas , Medición de Riesgo/métodos , Procedimientos Quirúrgicos Operativos/mortalidad , Exactitud de los Datos , Humanos , Tiempo de Internación , Modelos Logísticos , Persona de Mediana Edad , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/mortalidad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Infecciones Urinarias/mortalidad , Heridas y Traumatismos/clasificación , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/cirugía
11.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(3): 185-188, 2020 Mar 12.
Artículo en Chino | MEDLINE | ID: mdl-32164085

RESUMEN

At the end of December 2019, a novel coronavirus (COVID-19) caused an outbreak in Wuhan, and has quickly spread to all provinces in China and 26 other countries around the world, leading to a serious situation for epidemic prevention. So far, there is still no specific medicine. Previous studies have shown that chloroquine phosphate (chloroquine) had a wide range of antiviral effects, including anti-coronavirus. Here we found that treating the patients diagnosed as novel coronavirus pneumonia with chloroquine might improve the success rate of treatment, shorten hospital stay and improve patient outcome. In order to guide and regulate the use of chloroquine in patients with novel coronavirus pneumonia, the multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia developed this expert consensus after extensive discussion. It recommended chloroquine phosphate tablet, 500mg twice per day for 10 days for patients diagnosed as mild, moderate and severe cases of novel coronavirus pneumonia and without contraindications to chloroquine.


Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Cloroquina/análogos & derivados , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , China , Cloroquina/administración & dosificación , Consenso , Esquema de Medicación , Humanos , Tiempo de Internación , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/etiología , Guías de Práctica Clínica como Asunto
12.
J Assoc Physicians India ; 68(2): 39-42, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009361

RESUMEN

Background: Pulmonary complications are one of the most common causes of postoperative morbidity and mortality after coronary artery bypass graft (CABG) surgery. There is paucity of data of CABG in abnormal pulmonary function tests (PFT) in Indian population. Objectives: To study correlation of PFT with clinical outcome in patients undergoing CABG. Methods: Three hundred seventy patients aged 35 to 65 years who underwent CABG between May 2015 and November 2016 and ready to participate were included for this prospective observational study. Each patient was subjected to detailed clinical history, clinical examination and PFT. Primary outcome measures were post CABG ventilator stay, intensive care unit (ICU) stay, and hospital stay. Fisher's exact tests was used to compare qualitative data whereas Mann-Whitney U test was used to find the significant difference between quantitative variables. Results: Higher percentage of patients whose forced expiratory volume in one second (FEV1) was abnormal had longer ventilator stay, ICU stay and hospital stay as compared patients whose FEV1 was normal. Restrictive disease, obstructive disease, and mixed disease patients had longer ventilator stay, ICU stay and hospital stay as compared patients whose spirometry was normal. Conclusion: Abnormal PFT was independent strong predictor of prolonged ventilation, longer length of ICU and hospital stay.


Asunto(s)
Puente de Arteria Coronaria , Unidades de Cuidados Intensivos , Pruebas de Función Respiratoria , Adulto , Anciano , Humanos , Tiempo de Internación , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Espirometría
16.
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
17.
Crit Care ; 24(1): 49, 2020 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-32050985

RESUMEN

BACKGROUND: Severe blunt chest injury sometimes induces acute respiratory failure (ARF), requiring ventilator use. We aimed to evaluate the effect of performing rib fixation with the addition of video-assisted thoracoscopic surgery (VATS) on patients with ARF caused by blunt thoracic injury with ventilator dependence. METHODS: This observational study prospectively enrolled patients with multiple bicortical rib fractures with hemothorax caused by severe blunt chest trauma. All patients received positive pressure mechanical ventilation within 24 h after trauma because of ARF. Some patients who received rib fixation with VATS were enrolled as group 1, and the others who received only VATS were designated as group 2. The length of ventilator use was the primary clinical outcome. Rates of pneumonia and length of hospital stay constituted secondary outcomes. RESULTS: A total of 61 patients were included in this study. The basic demographic characteristics between the two groups exhibited no statistical differences. All patients received operations within 6 days after trauma. The length of ventilator use was shorter in group 1 (3.19 ± 3.37 days vs. 8.05 ± 8.23, P = 0.002). The rate of pneumonia was higher in group 2 (38.1% vs. 75.0%, P = 0.005). The length of hospital stay was much shorter in group 1 (17.76 ± 8.38 days vs. 24.13 ± 9.80, P = 0.011). CONCLUSION: Rib fixation combined with VATS could shorten the length of ventilator use and reduce the pneumonia rate in patients with severe chest blunt injury with ARF. Therefore, this operation could shorten the overall length of hospital stay.


Asunto(s)
Respiración Artificial , Traumatismos Torácicos , Cirugía Torácica Asistida por Video , Desconexión del Ventilador , Heridas no Penetrantes , Adulto , Anciano , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Síndrome de Dificultad Respiratoria del Adulto , Costillas/cirugía , Traumatismos Torácicos/cirugía , Heridas no Penetrantes/cirugía
18.
Crit Care ; 24(1): 62, 2020 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087760

RESUMEN

OBJECTIVE: In septic patients, multiple retrospective studies show an association between large volumes of fluids administered in the first 24 h and mortality, suggesting a benefit to fluid restrictive strategies. However, these studies do not directly estimate the causal effects of fluid-restrictive strategies, nor do their analyses properly adjust for time-varying confounding by indication. In this study, we used causal inference techniques to estimate mortality outcomes that would result from imposing a range of arbitrary limits ("caps") on fluid volume administration during the first 24 h of intensive care unit (ICU) care. DESIGN: Retrospective cohort study SETTING: ICUs at the Beth Israel Deaconess Medical Center, 2008-2012 PATIENTS: One thousand six hundred thirty-nine septic patients (defined by Sepsis-3 criteria) 18 years and older, admitted to the ICU from the emergency department (ED), who received less than 4 L fluids administered prior to ICU admission MEASUREMENTS AND MAIN RESULTS: Data were obtained from the Medical Information Mart for Intensive Care III (MIMIC-III). We employed a dynamic Marginal Structural Model fit by inverse probability of treatment weighting to obtain confounding adjusted estimates of mortality rates that would have been observed had fluid resuscitation volume caps between 4 L-12 L been imposed on the population. The 30-day mortality in our cohort was 17%. We estimated that caps between 6 and 10 L on 24 h fluid volume would have reduced 30-day mortality by - 0.6 to - 1.0%, with the greatest reduction at 8 L (- 1.0% mortality, 95% CI [- 1.6%, - 0.3%]). CONCLUSIONS: We found that 30-day mortality would have likely decreased relative to observed mortality under current practice if these patients had been subject to "caps" on the total volume of fluid administered between 6 and 10 L, with the greatest reduction in mortality rate at 8 L.


Asunto(s)
Fluidoterapia , Mortalidad Hospitalaria , Sepsis , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Servicio de Urgencia en Hospital , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Persona de Mediana Edad , Respiración Artificial , Estudios Retrospectivos , Sepsis/mortalidad , Sepsis/terapia , Factores de Tiempo
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