Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.587
Filtrar
2.
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
3.
Emerg Med Clin North Am ; 38(1): 193-206, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31757250

RESUMEN

Many orthopedic injuries can have hidden risks that result in increased liability for the emergency medicine practitioner. It is imperative that emergency medicine practitioners consider the diagnoses of compartment syndrome, high-pressure injury, spinal epidural abscess, and tendon lacerations in the right patient. Consideration of the diagnosis and prompt referrals can help to minimize the complications these patients often develop.


Asunto(s)
Urgencias Médicas , Tratamiento de Urgencia/métodos , Responsabilidad Legal , Mala Praxis/legislación & jurisprudencia , Procedimientos Ortopédicos/legislación & jurisprudencia , Gestión de Riesgos/legislación & jurisprudencia , Heridas y Traumatismos/terapia , Humanos , Procedimientos Ortopédicos/métodos
4.
BMJ ; 367: l6395, 2019 12 04.
Artículo en Inglés | MEDLINE | ID: mdl-31801725

RESUMEN

OBJECTIVE: To investigate whether remote ischaemic preconditioning (RIPC) prevents myocardial injury in patients undergoing hip fracture surgery. DESIGN: Phase II, multicentre, randomised, observer blinded, clinical trial. SETTING: Three Danish university hospitals, 2015-17. PARTICIPANTS: 648 patients with cardiovascular risk factors undergoing hip fracture surgery. 286 patients were assigned to RIPC and 287 were assigned to standard practice (control group). INTERVENTION: The RIPC procedure was initiated before surgery with a tourniquet applied to the upper arm and consisted of four cycles of forearm ischaemia for five minutes followed by reperfusion for five minutes. MAIN OUTCOME MEASURES: The original primary outcome was myocardial injury within four days of surgery, defined as a peak plasma cardiac troponin I concentration of 45 ng/L or more caused by ischaemia. The revised primary outcome was myocardial injury within four days of surgery, defined as a peak plasma cardiac troponin I concentration of 45 ng/L or more or high sensitive troponin I greater than 24 ng/L (the primary outcome was changed owing to availability of testing). Secondary outcomes were peak plasma troponin I and total troponin I release during the first four days after surgery (cardiac and high sensitive troponin I), perioperative myocardial infarction, major adverse cardiovascular events, and all cause mortality within 30 days of surgery, length of postoperative stay, and length of stay in the intensive care unit. Several planned secondary outcomes will be reported elsewhere. RESULTS: 573 of the 648 randomised patients were included in the intention-to-treat analysis (mean age 79 (SD 10) years; 399 (70%) women). The primary outcome occurred in 25 of 168 (15%) patients in the RIPC group and 45 of 158 (28%) in the control group (odds ratio 0.44, 95% confidence interval 0.25 to 0.76; P=0.003). The revised primary outcome occurred in 57 of 286 patients (20%) in the RIPC group and 90 of 287 (31%) in the control group (0.55, 0.37 to 0.80; P=0.002). Myocardial infarction occurred in 10 patients (3%) in the RIPC group and 21 patients (7%) in the control group (0.46, 0.21 to 0.99; P=0.04). Statistical power was insufficient to draw firm conclusions on differences between groups for the other clinical secondary outcomes (major adverse cardiovascular events, 30 day all cause mortality, length of postoperative stay, and length of stay in the intensive care unit). CONCLUSIONS: RIPC reduced the risk of myocardial injury and infarction after emergency hip fracture surgery. It cannot be concluded that RIPC overall prevents major adverse cardiovascular events after surgery. The findings support larger scale clinical trials to assess longer term clinical outcomes and mortality. TRIAL REGISTRATION: ClinicalTrials.gov NCT02344797.


Asunto(s)
Fijación de Fractura/efectos adversos , Lesiones Cardíacas/prevención & control , Fracturas de Cadera/cirugía , Precondicionamiento Isquémico Miocárdico/métodos , Complicaciones Posoperatorias/prevención & control , Anciano , Anciano de 80 o más Años , Tratamiento de Urgencia , Femenino , Lesiones Cardíacas/etiología , Humanos , Análisis de Intención de Tratar , Masculino , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Complicaciones Posoperatorias/etiología , Método Simple Ciego , Factores de Tiempo , Resultado del Tratamiento
5.
Zhonghua Shao Shang Za Zhi ; 35(11): 811-813, 2019 Nov 20.
Artículo en Chino | MEDLINE | ID: mdl-31775470

RESUMEN

Objective: To explore the effect of tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall in emergency treatment of laryngeal edema in patients with burns. Methods: From November 2000 to August 2018, 22 patients with severe burn or extremely severe burn combined with acute laryngeal edema were rescued in the author's unit, including 18 males and 4 females, aged 17 to 68 years. All patients were complicated with mild inhalation injury or above and more than deep partial-thickness burn to head, face, and neck. From November 2000 to October 2012, simple emergency tracheotomy was performed for 12 cases. From May 2013 to August 2018, tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall was performed for 10 cases. Rescue effect and complication of the two kinds of tracheotomy were recorded. Data were processed with Fisher's exact probability test. Results: Among the 12 patients treated with simple emergency tracheotomy, 5 cases survived and 7 cases died of suffocation during tracheotomy. Among the 10 patients treated with tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall, 9 cases survived and 1 case died of cardiac arrest caused by arrhythmia. There was statistically significant difference in successful rescue effect between the two kinds of tracheotomy (P<0.05). Among the 14 patients who were successfully rescued, symptoms of insomnia and post-traumatic stress disorder occurred in 12 cases, which were relieved after symptomatic treatment for 14 to 45 d without permanent hypoxic brain damage. Conclusions: In case of loss of the condition of preventive tracheotomy, first aid of acute laryngeal edema of burn patient is very difficult. Tracheotomy combined with thyrocricocentesis and puncture of front tracheal wall is simple and rapid with high successful rate and amelioration of hypoxia, which is an ideal plan for laryngeal edema.


Asunto(s)
Obstrucción de las Vías Aéreas , Quemaduras/cirugía , Tratamiento de Urgencia , Edema Laríngeo/cirugía , Traqueotomía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Punciones , Adulto Joven
6.
Medicine (Baltimore) ; 98(47): e17950, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764795

RESUMEN

OBJECTIVE: To investigate the role of YKL-40 in ST segment elevation myocardial infarction (STEMI) and its relationship to C-reactive protein (CRP) and matrix metalloproteinase-9 (MMP-9). METHODS: This prospective study included 358 STEMI patients who were sent to the Emergency Department of our hospital from April 2014 to December 2017. Serum levels of YKL-40, CRP and MMP-9 were determined using commercially available Enzyme linked immunosorbent assay (ELISA) kits. Major adverse cardiovascular events (MACE) and overall survival time were analyzed. RESULTS: GRACE scores (P < .001) and the levels of YKL-40 (P < .001), MMP-9 (P < .001), and CRP (P < .001) were significantly higher in deceased patients compared to those that survived. The levels of CRP (P = .007) and MMP-9 (P = .022) were significantly higher in the high YKL-40 group. The GRACE scores were also significantly elevated (P = .011, 95% CI 2.1 (-9.7 to -1.3)). Cumulative MACE rates and cardiac death rates were significantly higher in the high YKL-40 group (P < .001, 95% CI 3.9 (1.9-8.2)). Overall survival times were significantly longer in patients with lower YKL-40 levels (P < .0001). CONCLUSION: Elevated YKL-40 levels positively correlate with CRP and MMP-9 levels and are associated with clinical outcomes including MACE and 6-month survival in STEMI patients.


Asunto(s)
Proteína C-Reactiva/análisis , Proteína 1 Similar a Quitinasa-3/sangre , Metaloproteinasa 9 de la Matriz/sangre , Infarto del Miocardio con Elevación del ST/sangre , Infarto del Miocardio con Elevación del ST/terapia , Enfermedad Aguda , Correlación de Datos , Tratamiento de Urgencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos
7.
Lakartidningen ; 1162019 Nov 19.
Artículo en Sueco | MEDLINE | ID: mdl-31742654

RESUMEN

Seventeen cases of infections in spinal structures were reported 2010-2017 to the Swedish Health and Social Care Inspectorate (IVO), a government agency responsible for supervising health care, for missed or delayed diagnosis. All patient records were scrutinized in order to find underlying causes and common factors. The delayed diagnoses were equally found among men and women and most frequent in in the age-group 65 to 79 years of age. The diagnostic delay most probably in many cases led to patient harm and avoidable sequelae, many with severe impairment for daily life. Several of the patients had a locus minoris resistentiae in the spine and in several cases the entry port of infections were cutaneous wounds, for example leg ulcers. The most important finding was that in the majority of cases the clinical investigation was inadequate and the clinical follow-up - while in hospital! - was inferior, without documentation of muscular weakness and sensory loss. In several cases a too passive management was found, when the losses eventually had become apparent, delaying surgical interventions.


Asunto(s)
Enfermedades de la Columna Vertebral , Anciano , Síndrome de Cauda Equina/complicaciones , Síndrome de Cauda Equina/diagnóstico , Síndrome de Cauda Equina/etiología , Síndrome de Cauda Equina/terapia , Diagnóstico Tardío , Errores Diagnósticos , Discitis/complicaciones , Discitis/diagnóstico , Discitis/etiología , Discitis/terapia , Tratamiento de Urgencia , Femenino , Humanos , Masculino , Osteomielitis/complicaciones , Osteomielitis/diagnóstico , Osteomielitis/etiología , Osteomielitis/terapia , Calidad de la Atención de Salud/normas , Enfermedades de la Columna Vertebral/complicaciones , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/etiología , Enfermedades de la Columna Vertebral/terapia , Estenosis Espinal/complicaciones , Estenosis Espinal/diagnóstico , Estenosis Espinal/etiología , Estenosis Espinal/terapia , Espondilitis/complicaciones , Espondilitis/diagnóstico , Espondilitis/etiología , Espondilitis/terapia , Vértebras Torácicas , Tiempo de Tratamiento
8.
Undersea Hyperb Med ; 46(5): 709-712, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31683371

RESUMEN

We describe the emergency management of a man who experienced acute vision loss diagnosed as direct traumatic optic neuropathy (TON) in his right eye (no light perception) after falling from a height. TON is caused by a high-impact mechanism of injury. Clinical findings include acute vision loss, which is typically immediate, afferent pupillary defect, decreased color vision, and visual field defects. Treatment is controversial because of the lack of strong evidence supporting intervention over observation. In this case report, our treatment strategy comprised immediate hyperbaric oxygen (HBO2) and daily high doses of a steroid. On the second day, minocycline was added to the treatment regimen for its neuroprotective effects. The patient was discharged after receiving six HBO2 treatments and six days of intravenous solumedrol transitioned to oral prednisone. After the third HBO2 treatment, his vision improved to 20/100; after the fourth treatment, it was 20/40 and plateaued. At the time of discharge, it was 20/40. At two-month follow-up, his corrected visual acuity was 20/60+2 in the affected eye. Immediate HBO2 for ischemic and mechanical injury to the optic nerve following trauma is a therapeutic option.


Asunto(s)
Ceguera/terapia , Glucocorticoides/administración & dosificación , Hemisuccinato de Metilprednisolona/administración & dosificación , Minociclina/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Traumatismos del Nervio Óptico/terapia , Accidentes por Caídas , Enfermedad Aguda , Adulto , Ceguera/etiología , Terapia Combinada/métodos , Tratamiento de Urgencia/métodos , Humanos , Masculino , Traumatismos del Nervio Óptico/complicaciones , Prednisona/administración & dosificación , Recuperación de la Función
10.
J Athl Train ; 54(10): 1074-1082, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31633408

RESUMEN

CONTEXT: Recent studies suggested that a large population of high school-aged athletes participate on club sport teams. Despite attempts to document emergency preparedness in high school athletics, the adherence to emergency and medical coverage standards among club sport teams is unknown. OBJECTIVE: To determine if differences in emergency preparedness and training existed between coaches of high school teams and coaches of high school-aged club teams. DESIGN: Cross-sectional survey. SETTING: Online questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 769 coaches (females = 266, 34.6%) completed an anonymous online questionnaire regarding their emergency preparedness and training. MAIN OUTCOME MEASURE(S): The questionnaire consisted of (1) demographics and team information, (2) emergency preparedness factors (automated external defibrillator [AED] availability, emergency action plan [EAP] awareness, medical coverage), and (3) emergency training requirements (cardiopulmonary resuscitation/AED, first aid). RESULTS: High school coaches were more likely than club sport coaches to be aware of the EAP for their practice venue (83.9% versus 54.4%, P < .001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% versus 68.9%, P = .54). High school coaches were more likely to be made aware of the EAP during competitions (47.5% versus 37.1%, P = .02), but the majority of coaches in both categories indicated that they were never made aware of EAPs. High school coaches were more likely than club coaches to (1) have an AED available at practice (87.9% versus 58.8%, P < .001), (2) report that athletic trainers were responsible for medical care at practices (31.2% versus 8.8%, P < .001) and competitions (57.9% versus 31.2%, P < .001), and (3) be required to have cardiopulmonary resuscitation, AED, or first-aid training (P < .001). CONCLUSIONS: High school coaches displayed much greater levels of emergency preparedness and training than coaches of high school-aged club teams. Significant attention and effort may be needed to address the lack of emergency preparedness and training observed in club coaches.


Asunto(s)
Traumatismos en Atletas/terapia , Reanimación Cardiopulmonar , Desfibriladores/provisión & distribución , Tratamiento de Urgencia , Tutoría , Deportes Juveniles/lesiones , Adulto , Reanimación Cardiopulmonar/instrumentación , Reanimación Cardiopulmonar/métodos , Estudios Transversales , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/normas , Femenino , Humanos , Masculino , Tutoría/métodos , Tutoría/organización & administración , Tutoría/normas , Competencia Profesional , Encuestas y Cuestionarios , Estados Unidos , Universidades
11.
Br Dent J ; 227(8): 705-710, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31654007

RESUMEN

Objective To explore how parents access emergency care for their children following avulsion of a permanent tooth.Method Semi-structured qualitative interviews were undertaken with parents of children who had suffered a tooth avulsion injury in the previous two years. The interviews were recorded and transcribed verbatim. Framework analysis was used to analyse the data and interpret the core concepts from the interviews. Results Nine parents participated in the study. None of the children received the appropriate emergency dental care within the timeframe identified by national and international guidelines. The core themes that emerged following the analysis were knowledge, access and emotion.Discussion & Conclusions The parents who were interviewed for this study had poor knowledge of what to do in the event of a tooth avulsion injury. This lack of knowledge directly impaired their ability to navigate emergency dental care for their child. They described their upset and distress following their child's injury, but also feelings of frustration and disappointment in relation to the emergency care their child received. There is a need to develop appropriate support and clinical pathways to enable parents to rapidly access appropriate and timely care for their child following a complex dental trauma.


Asunto(s)
Servicios Médicos de Urgencia , Padres , Niño , Servicio de Urgencia en Hospital , Tratamiento de Urgencia , Familia , Humanos , Masculino , Investigación Cualitativa
12.
Am Surg ; 85(10): 1142-1145, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657311

RESUMEN

The ACS Committee on Trauma specifies prehospital criteria that trigger trauma team activation (TTA). The study aims to define the relationship between TTA and time of day, mechanism of injury, and need for operative intervention. All trauma patients presenting to LAC+USC (January 2008-July 2018) after triggering TTA were screened. Patients were excluded if time of ED arrival was undocumented. Demographics, injury data, and outcomes were analyzed. After exclusions (<1%), 54,826 patients were enrolled. The median age was 35 [IQR 23-53]. The median Injury Severity Score was 4 [1-10]. The most common mechanisms of injury were falls (n = 14,166; 31%), auto versus pedestrian collisions (n = 11,921; 26%), and motor vehicle collisions (n = 11,024; 24%). Penetrating trauma comprised 16 per cent (n = 8,686). The busiest hour for TTAs was 19:00 to 20:00, although penetrating trauma was most common between 23:00 and 01:00. Emergent surgical intervention in absolute numbers was most frequent between 20:00 and 01:00. As a proportion of the number of TTAs per hour, emergent operative intervention was most frequent between 23:00 and 06:00. In conclusion, the volume of TTAs and the triggering mechanism of injury vary significantly by time of day. The need for operative intervention is highest overnight. This information can be used to help increase hospital preparedness and allocate resources accordingly.


Asunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Factores de Tiempo , Centros Traumatológicos/estadística & datos numéricos , Heridas no Penetrantes/etiología , Heridas Penetrantes/etiología , Escala Resumida de Traumatismos , Adulto , California/epidemiología , Tratamiento de Urgencia/estadística & datos numéricos , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Triaje , Heridas no Penetrantes/epidemiología , Heridas no Penetrantes/mortalidad , Heridas no Penetrantes/cirugía , Heridas Penetrantes/epidemiología , Heridas Penetrantes/mortalidad , Heridas Penetrantes/cirugía , Adulto Joven
13.
Am Surg ; 85(10): 1146-1149, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657312

RESUMEN

Cirrhosis is associated with adverse outcomes after emergency general surgery (EGS). The objective of this study was to determine the safety of laparoscopic cholecystectomy (LC) in EGS patients with cirrhosis. We performed a two-year retrospective cohort analysis of adult patients who underwent LC for symptomatic gallstones. The primary outcome was the incidence of intraoperative complications. Of 796 patients, 59 (7.4%) were cirrhotic, with a median model for end-stage liver disease (MELD) score of 15 (IQR, 7). On unadjusted analysis, patients with cirrhosis were older, more likely to be male (both P < 0.01), diabetic (P < 0.001), had a higher incidence of preadmission antithrombotic therapy use (P < 0.02), and experienced a longer time to surgery (3.2 vs 1.8 days, P < 0.001). Coarsened exact matching revealed no difference in intra- or postoperative complications between groups (P = 0.67). Operative duration was longer in patients with cirrhosis (162 vs 114 minutes, P = 0.001), who also had a nonsignificant increase in the rate of conversion to an open cholecystectomy (14% vs 4%, P = 0.07). The results of this study indicate that LC may be safely performed in EGS patients with cirrhosis.


Asunto(s)
Colecistectomía Laparoscópica/efectos adversos , Tratamiento de Urgencia/efectos adversos , Cálculos Biliares/cirugía , Complicaciones Intraoperatorias/epidemiología , Cirrosis Hepática/complicaciones , Enfermedad Aguda , Adulto , Factores de Edad , Conductos Biliares/lesiones , Conversión a Cirugía Abierta/estadística & datos numéricos , Tratamiento de Urgencia/métodos , Femenino , Fibrinolíticos/uso terapéutico , Cálculos Biliares/etiología , Hemorragia/epidemiología , Humanos , Incidencia , Intestinos/lesiones , Complicaciones Intraoperatorias/etiología , Cirrosis Hepática/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Seguridad , Factores Sexuales , Factores de Tiempo , Tiempo de Tratamiento/estadística & datos numéricos
14.
BMJ ; 367: l5462, 2019 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-31597637

RESUMEN

The studyPeden CJ, Stephens T, Martin G et al. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 2019;393:2213-21.This project was funded by the NIHR Health Services and Delivery Research Programme (project number 12/5005/10).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000789/national-quality-improvement-programmes-need-time-and-resources-to-have-impact.


Asunto(s)
Dolor Abdominal/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo , Tratamiento de Urgencia , Mejoramiento de la Calidad/organización & administración , Enfermedad Aguda , Análisis por Conglomerados , Vías Clínicas , Procedimientos Quirúrgicos del Sistema Digestivo/normas , Tratamiento de Urgencia/normas , Humanos , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad/normas
16.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 31(3): 323-325, 2019 Aug 27.
Artículo en Chino | MEDLINE | ID: mdl-31544418

RESUMEN

In China, the mountainous and hilly schistosomiasis-endemic areas are mainly distributed in 2 provinces of Sichuan and Yunnan. Although great success has been achieved in schistosomiasis control in mountainous and hilly areas, there is a risk of re-emerging schistosomiasis in local areas. Hereby, we described the emergency treatment of two schistosomiasis outbreaks that occurred in transmission-interrupted areas of Yunnan Province in 2011 and 2013, pointed out the risk of schistosomiasis rebounding in mountainous and hilly areas and proposed some suggestions.


Asunto(s)
Brotes de Enfermedades , Tratamiento de Urgencia , Esquistosomiasis , Animales , China/epidemiología , Humanos , Esquistosomiasis/tratamiento farmacológico , Esquistosomiasis/epidemiología , Esquistosomiasis/prevención & control , Esquistosomiasis/transmisión , Caracoles
17.
Rev Col Bras Cir ; 46(4): e2211, 2019 Sep 09.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31508734

RESUMEN

OBJECTIVE: to evaluate the applicability of the "Timing of Acute Care Surgery" (TACS) color classification system in a tertiary public hospital of a developing country. METHODS: we conducted a longitudinal, retrospective study in a single center, from March to August 2016 and the same period in 2017. We opted for the selection of four surgical specialties with high demand for emergencies, previously trained on the TACS system. For comparisons with the previous classifications, we considered emergencies as reds and oranges and urgencies, as yellow, with an ideal time interval for surgery of one hour and six hours, respectively. RESULTS: non-elective procedures accounted for 61% of the total number of surgeries. The red, orange and yellow classifications were predominant. There was a significant improvement in the time before surgery in the yellow color after the TACS system. Day and night periods influenced the results, with better ones during the night. CONCLUSION: this is the first study to use the TACS system in the daily routine of an operating room. The TACS system improved the time of attendance of surgeries classified as yellow.


Asunto(s)
Tratamiento de Urgencia/clasificación , Triaje/métodos , Brasil , Color , Urgencias Médicas , Tratamiento de Urgencia/estadística & datos numéricos , Humanos , Estudios Longitudinales , Sistemas de Información en Quirófanos , Quirófanos , Estudios Retrospectivos , Especialidades Quirúrgicas/clasificación , Especialidades Quirúrgicas/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/clasificación , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Centros de Atención Terciaria , Factores de Tiempo
19.
BMC Health Serv Res ; 19(1): 669, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533708

RESUMEN

BACKGROUND: Measuring patient satisfaction has become an important parameter of the continuous quality assessment and improvement in anaesthesia services. The aim of this study was to assess the level of patient satisfaction with perioperative anaesthesia care and to determine the factors that influence satisfaction. METHOD: This study is an cross sectional design, conducted on 470 patients who underwent different types of surgeries at two National Referral Hospitals in Asmara, Eritrea between January and March of 2018. Patients were interviewed 24 h after the operation using a Tigrigna translated Leiden Perioperative Care Patient Satisfaction questionnaire (LPPSq). Descriptive and inferential analysis were made using SPSS (version 22). Statistical significance level was set at P < 0.05. RESULTS: The overall satisfaction score was 68.8%. Less fear and concern was observed among patients with satisfaction scores of 87.5%. Staff-patient relationship satisfaction score was 75%. Patients were least satisfied with information provision (45%). Multivariable analysis revealed that satisfaction of patients who did surgery at Halibet hospital is significantly higher (p < 0.001) than those patients who did at Orotta hospital. Moreover, those patients who did elective surgery had higher level of satisfaction that those who did emergency surgery (p < 0.001). CONCLUSION: Moderate level of satisfaction was observed among the patients. Generally, the study emphasized that the information provision about anesthesia and surgery was low. Patients described better staff-patient relationship and low fear and concern related to anesthesia and surgery was observed.


Asunto(s)
Anestesia/normas , Satisfacción del Paciente/estadística & datos numéricos , Atención Perioperativa/normas , Adulto , Anestesia/psicología , Estudios Transversales , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Tratamiento de Urgencia/psicología , Tratamiento de Urgencia/normas , Eritrea , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Relaciones Profesional-Paciente , Derivación y Consulta/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
20.
Artículo en Inglés | MEDLINE | ID: mdl-31484307

RESUMEN

Volunteers active in psychosocial emergency care offer psychological first aid to survivors of accidents and trauma, their relatives, eye witnesses, bystanders, and other first responders. So far, there are no studies that investigate the secondary and primary traumatization of this group of first responders. We included N = 75 volunteers, who filled out questionnaires to assess their secondary (QST/FST) and primary traumatization (PDS), and levels of comorbid psychological stress (PHQ-9, GAD-7, SF-12). We investigated factors of resilience by measuring attachment behavior (ECR-RD, RQ-2), level of personality functioning (OPD-SFK), sense of coherence (SOC-29), social support (F-SozU), and mindfulness (MAAS). The volunteers' levels of secondary and primary traumatization were below cut-off scores. Their levels of comorbid psychological stress were comparable to representative norm samples. Additionally, the volunteers presented high levels of resilience. Gender (ß = 0.26; p < 0.05), case discussions (ß = -0.37; p < 0.05), and social support (ß = 0.45; p < 0.01) were revealed to be predictors of secondary traumatization, while mindfulness turned out to be a predictor of primary traumatization (ß = -0.34; p = 0.008). However, we cannot rule out that the low prevalence of traumatization and comorbid psychological stress in our study sample might not be explained by a positive response bias.


Asunto(s)
Desgaste por Empatía/psicología , Servicios Médicos de Urgencia , Resiliencia Psicológica , Estrés Psicológico , Adulto , Tratamiento de Urgencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Plena , Prevalencia , Apoyo Social , Encuestas y Cuestionarios , Voluntarios
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA